Lise Fonsmark - Academia.edu (original) (raw)
Papers by Lise Fonsmark
Nephrology Dialysis Transplantation, 2018
INTRODUCTION AND AIMS: Online hemodiafiltration (OL-HDF) with high convective volumes (CV) has be... more INTRODUCTION AND AIMS: Online hemodiafiltration (OL-HDF) with high convective volumes (CV) has been asociated with improved patient survival. Increasing blood flow (Qb) is probably the best option to achieve higher CV, but the rise in Qb entails a progressive reduction in filtration fraction (FF). The aim of this study was to compare different automatic control systems of substitution rate in postdilution OL-HDF using elevated Qb. METHODS: Three control systems were compared in the same 28 patients with usual Qb > 400 ml/min, according to their usual four-hour dialysis prescription and dialyzer: Ultracontrol-AK200 TM UltraS(Baxter), Ultracontrol-Artis TM (Baxter) and AutoSub Plus-5008CorDiax(FMC). We collected vascular access, monitor Qb, effective Qb, arterial and venous pressures, substitution and ultrafiltration rates and volumes hourly, clearances (K) by ionic dialysance, Kt/V, reduction rates of different molecular weight uremic toxins, viscosity parameters, heparin dose and dialyzer clotting status at the end of OL-HDF session. RESULTS: Table 1 represents the results obtained with the three systems (n 28). Ultracontrol-AK200UltraS had higher FF, substitution and CV, but only significant differences were obtained with FF. Ultracontrol-Artis required higher heparin dose than Ultracontrol-AK200U (p 0.024) with no differences in dialyzer clotting status. Selecting those patients with Qb>450ml/min (n18), Ultracontrol-AK200UltraS obtained higher CV (37.663.7 L) compared with Ultracontrol-Artis (33.964.6 L, p¼0.007) or AutoSub Plus (34.963.3 L, p¼0.018), owing to higher FF (32.962.6 %, 28.963.3 %, 29.662.5 % respectively, p<0.001). There were no differences in Qb, hemoglobin, proteins, albumin or gammaglobulins. Differences in hourly CV and FF were more obvious since second hour of treatment. With Qb>450ml/min, Ultracontrol-AK200UltraS reached better reduction of beta2-microglobulin(B2M) (87.664.2 vs 82.968.1 %, p¼0.035) and cystatin-C (84.663.7 vs 81.963.5 %, p¼0.027) compared with AutoSub Plus, and better reduction in creatinine (81.163.7 vs 74.965.1 %, p<0.001), B2M (87.664.2 vs 84.363.1%, p¼0.007), cystatin-C (84.663.7 vs 80.363.5 %, p<0.001) and prolactin (77.167.5 vs 58.7629 %, p¼0.007) compared with Ultracontrol-Artis. CONCLUSIONS: AK200UltraS Ultracontrol system for automatic substitution control optimizes convective transport in postdilution OL-HDF with the highest blood flows. Each substitution control system offers its benefits in different situations.
Journal of Pediatric Gastroenterology & Nutrition, 2021
Supplemental Digital Content is available in the text ABSTRACT Objectives: Paediatric acute liver... more Supplemental Digital Content is available in the text ABSTRACT Objectives: Paediatric acute liver failure (P-ALF) is a rare condition and is associated with a high mortality rate. Management of P-ALF aims to stabilise vital organ functions and to remove circulating toxins and provide vital plasma factors that are lacking. High-volume plasmapheresis (HVP) removes protein-bound substances and improves survival in adult ALF. It is unknown if this effect can be extrapolated to P-ALF. The aim of this study is to report the safety and feasibility of HVP in P-ALF. Methods: Children with P-ALF were offered HVP if bilirubin was higher than 200 μmol/L or if the aetiology was toxic hepatitis. HVP was performed with fresh frozen plasma corresponding to 10% of the body weight on a minimum of 3 consecutive days. Diagnostics, biochemical and clinical data during HVP as well as outcome data after 3 months were collected from 2012 to 2019 and retrospectively analysed. Results: Sixteen children were treated by HVP and completed at least one series of three treatment sessions with HVP. The only complication seen was an increase in pH > 7.55 in three children within the first 12 hours and was corrected with hydrochloric acid. No bleeding or septic episodes were noted during HVP. Eight children survived without liver transplantation, two survived after successful grafting and a total of six children died. The liver injury unit score between survivors with their own liver and the rest, the two groups was significantly different (P = 0.005). Conclusion: HVP with fresh frozen plasma is feasible and well tolerated in children with P-ALF. No serious adverse events and no procedure-related mortality were observed.
The American Journal of Tropical Medicine and Hygiene, 2001
We present a prospective case-control study of 27 serologically confirmed dengue hemorrhagic feve... more We present a prospective case-control study of 27 serologically confirmed dengue hemorrhagic fever (DHF) patients with severe central nervous system symptoms. Dengue associated encephalopathy accounted for 0.5% of 5,400 patients admitted with DHF. The mortality rate among children with encephalopathy was 22%, with the survivors experiencing a complete recovery. Liver enzymes and bilirubin were significantly elevated in the study group. In analysis of the cerebrospinal fluid (CSF), reverse transcriptase-polymerase chain reaction revealed dengue-3-specific RNA in one evaluated case. Dengue-specific immunoglobulin M was detected in CSF in 14 of 22 assessable patients, indicating a localized infection. Magnetic resonance imaging scans showed cerebral edema in the majority of patients, although encephalitis-like changes were less common. There was an equal distribution of primary and secondary infections. On the basis of previous reports and of the findings of our study, DHF probably encompasses an expanding clinical spectrum that infrequently involves encephalitis due to a direct neurotropic effect of dengue virus.
Danish medical journal, 2015
Sedation of critically ill patients undergoing mechanical ventilation should be minimized or comp... more Sedation of critically ill patients undergoing mechanical ventilation should be minimized or completely avoided. Only in selected situations is sedation indicated as first line therapy (increased intracranial pressure or therapeutic hypothermia). The critical care physicians primary objective should be to focus on the reversible causes of agitation, such as: pain, anxiety, delirium, dyspnea, withdrawal symptoms, sleep or gastrointestinal symptoms. If sedation is used a validated sedation scale is recommended. On a daily basis sedation should be interrupted and only restarted after a thorough search for reversible causes of discomfort and stress.
Acta anaesthesiologica Belgica, 2002
The ideal anaesthesia for direct laryngoscopy is profound and yet brief. The present study sought... more The ideal anaesthesia for direct laryngoscopy is profound and yet brief. The present study sought to determine whether a new anaesthetic technique based on infusion of the ultra short-acting opioid remifentanil was superior to our routine alfentanil multiple-dose technique in terms of haemodynamic stability, stress responses and recovery. A total of 58 patients were randomized to receive propofol and either remifentanil or alfentanil as part of a total intravenous anaesthesia. In the remifentanil group, systolic blood pressure during anaesthesia remained significantly lower than baseline values, while it increased significantly in the alfentanil group. None of the patients receiving remifentanil showed stress responses (hypertension, tachycardia, somatic or autonomic responses), compared to 22 patients (79%) in the alfentanil group (P < 0.0001). In the remifentanil group, hypotension or bradycardia requiring intervention arose in 5 (18%) and 3 patients (11%); neither response was...
Ugeskrift for laeger, Jan 17, 1997
The purpose of this study was to identify the patterns of use of sedative agents and withdrawal p... more The purpose of this study was to identify the patterns of use of sedative agents and withdrawal problems in the paediatric intensive care unit (PICU). A questionnaire survey was mailed to 46 Danish intensive care units. Only 24 of these treated paediatric patients needing mechanical ventilation. The agents most frequently employed were morphine and midazolam. There was general satisfaction with the used drugs. The majority of departments noted that there was no protocol for sedation in their PICU. The majority of departments (70.8%) did not consider drug withdrawal to be a problem, but those departments who treated most children considered drug withdrawal to be a problem.
Ugeskrift for laeger, Jan 21, 1993
We analyzed the outcome after prehospital cardiac arrest in a part of greater Copenhagen. Four di... more We analyzed the outcome after prehospital cardiac arrest in a part of greater Copenhagen. Four different emergency medical systems were acting: a system providing basic life support only (group 1), a system providing basic life support and early defibrillation (group 2), a system providing basic life support followed by advanced cardiac life support (group 3), and a system providing basic life support and early defibrillation followed by advanced cardiac life support (group 4). Over a 2-year period 624 cases of cardiac arrest were reported, 34 were discharged from hospital. The survival to discharge from hospital and the one-year survival were significantly better in group 4. Our data reconfirm that early advanced cardiac life support improves survival rates for prehospital cardiac arrest.
Ugeskrift for laeger, Jan 30, 1988
Ugeskrift for laeger, Jan 30, 1988
Ugeskrift for laeger, Jan 24, 1989
In order to test the efficacy of a semiautomatic defibrillator (Heartstart 2000) in connection wi... more In order to test the efficacy of a semiautomatic defibrillator (Heartstart 2000) in connection with cardiac arrest outside hospital, the apparatus was installed in two of the ambulances belonging to the Copenhagen Fire Service. The ambulance district involved was also equipped with an ambulance staffed by a doctor. A total of 48 patients with cardiac arrest were found and 16 of these had ventricular fibrillation. Six of the 16 patients have since been discharged from hospital (37.5%). The defibrillator had a high diagnostic certainty with a sensitivity of 96.5% and a specificity of 100%. No practical problems of note occurred in connection with employment of the defibrillator. The ambulance staffs underwent six hours of training and this appeared to be adequate. It is concluded that Heartstart 2000 functions well and effectively in connection with revival of patients with cardiac arrest outside hospital.
American journal of physiology. Heart and circulatory physiology, 2003
We assessed the hypothesis that the epinephrine surge present during sepsis accelerates aerobic g... more We assessed the hypothesis that the epinephrine surge present during sepsis accelerates aerobic glycolysis and lactate production by increasing activity of skeletal muscle Na(+)-K(+)-ATPase. Healthy volunteers received an intravenous bolus of endotoxin or placebo in a randomized order on two different days. Endotoxemia induced a response resembling sepsis. Endotoxemia increased plasma epinephrine to a maximum at t = 2 h of 0.7 +/- 0.1 vs. 0.3 +/- 0.1 nmol/l (P < 0.05, n = 6-7). Endotoxemia reduced plasma K(+) reaching a nadir at t = 5 h of 3.3 +/- 0.1 vs. 3.8 +/- 0.1 mmol/l (P < 0.01, n = 6-7), followed by an increase to placebo level at t = 7-8 h. During the declining plasma K(+), a relative accumulation of K(+) was seen reaching a maximum at t = 6 h of 8.7 +/- 3.8 mmol/leg (P < 0.05). Plasma lactate increased to a maximum at t = 1 h of 2.5 +/- 0.5 vs. 0.9 +/- 0.1 mmol/l (P < 0.05, n = 8) in association with increased release of lactate from the legs. These changes were...
Ugeskrift for laeger, 2008
Intensive Care Medicine, 2009
European Journal of Anaesthesiology, 2001
Background and objective The aim of this study was to determine possible age-associated differenc... more Background and objective The aim of this study was to determine possible age-associated differences in human blood pressure regulation during an immunological challenge in healthy subjects. Methods Eight healthy young volunteers (median age 24 yr) and nine healthy elderly volunteers (median age 66 yr) received an intravenous bolus injection of Eschericia coli endotoxin (2 ng kg ±1). Blood pressure, heart rate and core temperature were monitored during the ®rst 7 h. Plasma catecholamine concentrations were measured at hourly intervals. Results The elderly showed a signi®cantly more pronounced decrease in mean arterial pressure 4±7 h after endotoxin administration compared with the young controls (ANOVA; age´time; P < 0.0005). This mainly re¯ected a decrease in the systolic blood pressure in the elderly. The heart rate of both groups increased without difference between groups. Increased plasma epinephrine concentrations were found 2±3 h after endotoxin administration in both groups. Five hours after the endotoxin challenge, the epinephrine concentration had returned to control values in the elderly group only, in spite of decreased blood pressure. Conclusion In conclusion, healthy elderly subjects fail to maintain a constant mean arterial pressure in response to the immunological challenge of endotoxemia.
Critical Care Medicine, 1999
To record the number of children with withdrawal symptoms after the administration of sedatives f... more To record the number of children with withdrawal symptoms after the administration of sedatives for mechanical ventilation, and to discuss the possible connection with the administration of midazolam. Retrospective data collection from case records and charts. Medical and surgical intensive care unit (ICU) in a university hospital. Children 6 months to 14 yrs of age who required sedation for mechanical ventilation (n = 40). None. Kind and amount of sedatives and analgesics, duration of administration, and occurrence of withdrawal symptoms. The frequency of withdrawal symptoms was 35% (14/40) of the sedated children. A total dose of midazolam of &amp;gt;60 mg/kg was strongly significantly associated with occurrence of withdrawal. Statistical analysis to determine the occurrence of withdrawal associated with the administration of morphine was not possible. Signs and symptoms of a withdrawal reaction were observed in several children. The occurrence of withdrawal was statistically related to high doses of midazolam, but it was not possible to determine the influence of morphine. If large doses of midazolam and opioids have been administered, there may be justification for reducing the dose gradually instead of abruptly, or using longer-acting benzodiazepines or opioids on discontinuation of sedation.
Critical Care, 2001
P14 Facial continuous positive airway pressure therapy for cardiogenic pulmonary oedema: a study ... more P14 Facial continuous positive airway pressure therapy for cardiogenic pulmonary oedema: a study of its efficacy in an emergency department setting within the UK
Clinical Diagnostic Laboratory Immunology, 2001
The purpose of this study was to investigate whether an age-associated impaired acute-phase respo... more The purpose of this study was to investigate whether an age-associated impaired acute-phase response exists. Nine healthy elderly volunteers (median, 66 years; range, 61 to 69 years) and eight young controls (median, 24 years; range, 20 to 27 years) were given an intravenous bolus of endotoxin (2 ng/kg). The rectal temperature was monitored continuously, and blood samples for cytokine measurements were obtained before endotoxin administration as well as 0.5, 1, 1.5, 2, 3, 4, 8, 12, and 24 h after the injection. The elderly subjects showed a more prolonged fever response compared to the young controls. Levels of tumor necrosis factor alpha (TNF-α), soluble TNF receptors (sTNFR-I), interleukin-6 (IL-6), IL-8, IL-10, and IL-1 receptor antagonist (IL-1ra) in plasma increased markedly following endotoxin administration in both groups. The elderly group showed larger initial increases in TNF-α and sTNFR-I levels and prolonged increased levels of sTNFR-I. Monocyte concentrations decreased ...
Clinical and Vaccine Immunology, 2002
Seventeen volunteers received an intravenous bolus of endotoxin (2 ng/kg of body weight). Endotox... more Seventeen volunteers received an intravenous bolus of endotoxin (2 ng/kg of body weight). Endotoxin-induced lymphopenia was constituted mainly by cells with an immature phenotype (CD45RA + CD45RO − ) that were less likely to undergo apoptosis (CD28 + ), whereas cells with the highest rates of disappearance were characterized by an activated phenotype (CD45RA − CD45RO + ) as well as a phenotype linked to apoptosis (CD95 + CD28 − ). In conclusion, endotoxin-induced lymphopenia reflects the disappearance from the circulation of activated lymphocytes prone to undergo apoptosis.
Nephrology Dialysis Transplantation, 2018
INTRODUCTION AND AIMS: Online hemodiafiltration (OL-HDF) with high convective volumes (CV) has be... more INTRODUCTION AND AIMS: Online hemodiafiltration (OL-HDF) with high convective volumes (CV) has been asociated with improved patient survival. Increasing blood flow (Qb) is probably the best option to achieve higher CV, but the rise in Qb entails a progressive reduction in filtration fraction (FF). The aim of this study was to compare different automatic control systems of substitution rate in postdilution OL-HDF using elevated Qb. METHODS: Three control systems were compared in the same 28 patients with usual Qb > 400 ml/min, according to their usual four-hour dialysis prescription and dialyzer: Ultracontrol-AK200 TM UltraS(Baxter), Ultracontrol-Artis TM (Baxter) and AutoSub Plus-5008CorDiax(FMC). We collected vascular access, monitor Qb, effective Qb, arterial and venous pressures, substitution and ultrafiltration rates and volumes hourly, clearances (K) by ionic dialysance, Kt/V, reduction rates of different molecular weight uremic toxins, viscosity parameters, heparin dose and dialyzer clotting status at the end of OL-HDF session. RESULTS: Table 1 represents the results obtained with the three systems (n 28). Ultracontrol-AK200UltraS had higher FF, substitution and CV, but only significant differences were obtained with FF. Ultracontrol-Artis required higher heparin dose than Ultracontrol-AK200U (p 0.024) with no differences in dialyzer clotting status. Selecting those patients with Qb>450ml/min (n18), Ultracontrol-AK200UltraS obtained higher CV (37.663.7 L) compared with Ultracontrol-Artis (33.964.6 L, p¼0.007) or AutoSub Plus (34.963.3 L, p¼0.018), owing to higher FF (32.962.6 %, 28.963.3 %, 29.662.5 % respectively, p<0.001). There were no differences in Qb, hemoglobin, proteins, albumin or gammaglobulins. Differences in hourly CV and FF were more obvious since second hour of treatment. With Qb>450ml/min, Ultracontrol-AK200UltraS reached better reduction of beta2-microglobulin(B2M) (87.664.2 vs 82.968.1 %, p¼0.035) and cystatin-C (84.663.7 vs 81.963.5 %, p¼0.027) compared with AutoSub Plus, and better reduction in creatinine (81.163.7 vs 74.965.1 %, p<0.001), B2M (87.664.2 vs 84.363.1%, p¼0.007), cystatin-C (84.663.7 vs 80.363.5 %, p<0.001) and prolactin (77.167.5 vs 58.7629 %, p¼0.007) compared with Ultracontrol-Artis. CONCLUSIONS: AK200UltraS Ultracontrol system for automatic substitution control optimizes convective transport in postdilution OL-HDF with the highest blood flows. Each substitution control system offers its benefits in different situations.
Journal of Pediatric Gastroenterology & Nutrition, 2021
Supplemental Digital Content is available in the text ABSTRACT Objectives: Paediatric acute liver... more Supplemental Digital Content is available in the text ABSTRACT Objectives: Paediatric acute liver failure (P-ALF) is a rare condition and is associated with a high mortality rate. Management of P-ALF aims to stabilise vital organ functions and to remove circulating toxins and provide vital plasma factors that are lacking. High-volume plasmapheresis (HVP) removes protein-bound substances and improves survival in adult ALF. It is unknown if this effect can be extrapolated to P-ALF. The aim of this study is to report the safety and feasibility of HVP in P-ALF. Methods: Children with P-ALF were offered HVP if bilirubin was higher than 200 μmol/L or if the aetiology was toxic hepatitis. HVP was performed with fresh frozen plasma corresponding to 10% of the body weight on a minimum of 3 consecutive days. Diagnostics, biochemical and clinical data during HVP as well as outcome data after 3 months were collected from 2012 to 2019 and retrospectively analysed. Results: Sixteen children were treated by HVP and completed at least one series of three treatment sessions with HVP. The only complication seen was an increase in pH > 7.55 in three children within the first 12 hours and was corrected with hydrochloric acid. No bleeding or septic episodes were noted during HVP. Eight children survived without liver transplantation, two survived after successful grafting and a total of six children died. The liver injury unit score between survivors with their own liver and the rest, the two groups was significantly different (P = 0.005). Conclusion: HVP with fresh frozen plasma is feasible and well tolerated in children with P-ALF. No serious adverse events and no procedure-related mortality were observed.
The American Journal of Tropical Medicine and Hygiene, 2001
We present a prospective case-control study of 27 serologically confirmed dengue hemorrhagic feve... more We present a prospective case-control study of 27 serologically confirmed dengue hemorrhagic fever (DHF) patients with severe central nervous system symptoms. Dengue associated encephalopathy accounted for 0.5% of 5,400 patients admitted with DHF. The mortality rate among children with encephalopathy was 22%, with the survivors experiencing a complete recovery. Liver enzymes and bilirubin were significantly elevated in the study group. In analysis of the cerebrospinal fluid (CSF), reverse transcriptase-polymerase chain reaction revealed dengue-3-specific RNA in one evaluated case. Dengue-specific immunoglobulin M was detected in CSF in 14 of 22 assessable patients, indicating a localized infection. Magnetic resonance imaging scans showed cerebral edema in the majority of patients, although encephalitis-like changes were less common. There was an equal distribution of primary and secondary infections. On the basis of previous reports and of the findings of our study, DHF probably encompasses an expanding clinical spectrum that infrequently involves encephalitis due to a direct neurotropic effect of dengue virus.
Danish medical journal, 2015
Sedation of critically ill patients undergoing mechanical ventilation should be minimized or comp... more Sedation of critically ill patients undergoing mechanical ventilation should be minimized or completely avoided. Only in selected situations is sedation indicated as first line therapy (increased intracranial pressure or therapeutic hypothermia). The critical care physicians primary objective should be to focus on the reversible causes of agitation, such as: pain, anxiety, delirium, dyspnea, withdrawal symptoms, sleep or gastrointestinal symptoms. If sedation is used a validated sedation scale is recommended. On a daily basis sedation should be interrupted and only restarted after a thorough search for reversible causes of discomfort and stress.
Acta anaesthesiologica Belgica, 2002
The ideal anaesthesia for direct laryngoscopy is profound and yet brief. The present study sought... more The ideal anaesthesia for direct laryngoscopy is profound and yet brief. The present study sought to determine whether a new anaesthetic technique based on infusion of the ultra short-acting opioid remifentanil was superior to our routine alfentanil multiple-dose technique in terms of haemodynamic stability, stress responses and recovery. A total of 58 patients were randomized to receive propofol and either remifentanil or alfentanil as part of a total intravenous anaesthesia. In the remifentanil group, systolic blood pressure during anaesthesia remained significantly lower than baseline values, while it increased significantly in the alfentanil group. None of the patients receiving remifentanil showed stress responses (hypertension, tachycardia, somatic or autonomic responses), compared to 22 patients (79%) in the alfentanil group (P < 0.0001). In the remifentanil group, hypotension or bradycardia requiring intervention arose in 5 (18%) and 3 patients (11%); neither response was...
Ugeskrift for laeger, Jan 17, 1997
The purpose of this study was to identify the patterns of use of sedative agents and withdrawal p... more The purpose of this study was to identify the patterns of use of sedative agents and withdrawal problems in the paediatric intensive care unit (PICU). A questionnaire survey was mailed to 46 Danish intensive care units. Only 24 of these treated paediatric patients needing mechanical ventilation. The agents most frequently employed were morphine and midazolam. There was general satisfaction with the used drugs. The majority of departments noted that there was no protocol for sedation in their PICU. The majority of departments (70.8%) did not consider drug withdrawal to be a problem, but those departments who treated most children considered drug withdrawal to be a problem.
Ugeskrift for laeger, Jan 21, 1993
We analyzed the outcome after prehospital cardiac arrest in a part of greater Copenhagen. Four di... more We analyzed the outcome after prehospital cardiac arrest in a part of greater Copenhagen. Four different emergency medical systems were acting: a system providing basic life support only (group 1), a system providing basic life support and early defibrillation (group 2), a system providing basic life support followed by advanced cardiac life support (group 3), and a system providing basic life support and early defibrillation followed by advanced cardiac life support (group 4). Over a 2-year period 624 cases of cardiac arrest were reported, 34 were discharged from hospital. The survival to discharge from hospital and the one-year survival were significantly better in group 4. Our data reconfirm that early advanced cardiac life support improves survival rates for prehospital cardiac arrest.
Ugeskrift for laeger, Jan 30, 1988
Ugeskrift for laeger, Jan 30, 1988
Ugeskrift for laeger, Jan 24, 1989
In order to test the efficacy of a semiautomatic defibrillator (Heartstart 2000) in connection wi... more In order to test the efficacy of a semiautomatic defibrillator (Heartstart 2000) in connection with cardiac arrest outside hospital, the apparatus was installed in two of the ambulances belonging to the Copenhagen Fire Service. The ambulance district involved was also equipped with an ambulance staffed by a doctor. A total of 48 patients with cardiac arrest were found and 16 of these had ventricular fibrillation. Six of the 16 patients have since been discharged from hospital (37.5%). The defibrillator had a high diagnostic certainty with a sensitivity of 96.5% and a specificity of 100%. No practical problems of note occurred in connection with employment of the defibrillator. The ambulance staffs underwent six hours of training and this appeared to be adequate. It is concluded that Heartstart 2000 functions well and effectively in connection with revival of patients with cardiac arrest outside hospital.
American journal of physiology. Heart and circulatory physiology, 2003
We assessed the hypothesis that the epinephrine surge present during sepsis accelerates aerobic g... more We assessed the hypothesis that the epinephrine surge present during sepsis accelerates aerobic glycolysis and lactate production by increasing activity of skeletal muscle Na(+)-K(+)-ATPase. Healthy volunteers received an intravenous bolus of endotoxin or placebo in a randomized order on two different days. Endotoxemia induced a response resembling sepsis. Endotoxemia increased plasma epinephrine to a maximum at t = 2 h of 0.7 +/- 0.1 vs. 0.3 +/- 0.1 nmol/l (P < 0.05, n = 6-7). Endotoxemia reduced plasma K(+) reaching a nadir at t = 5 h of 3.3 +/- 0.1 vs. 3.8 +/- 0.1 mmol/l (P < 0.01, n = 6-7), followed by an increase to placebo level at t = 7-8 h. During the declining plasma K(+), a relative accumulation of K(+) was seen reaching a maximum at t = 6 h of 8.7 +/- 3.8 mmol/leg (P < 0.05). Plasma lactate increased to a maximum at t = 1 h of 2.5 +/- 0.5 vs. 0.9 +/- 0.1 mmol/l (P < 0.05, n = 8) in association with increased release of lactate from the legs. These changes were...
Ugeskrift for laeger, 2008
Intensive Care Medicine, 2009
European Journal of Anaesthesiology, 2001
Background and objective The aim of this study was to determine possible age-associated differenc... more Background and objective The aim of this study was to determine possible age-associated differences in human blood pressure regulation during an immunological challenge in healthy subjects. Methods Eight healthy young volunteers (median age 24 yr) and nine healthy elderly volunteers (median age 66 yr) received an intravenous bolus injection of Eschericia coli endotoxin (2 ng kg ±1). Blood pressure, heart rate and core temperature were monitored during the ®rst 7 h. Plasma catecholamine concentrations were measured at hourly intervals. Results The elderly showed a signi®cantly more pronounced decrease in mean arterial pressure 4±7 h after endotoxin administration compared with the young controls (ANOVA; age´time; P < 0.0005). This mainly re¯ected a decrease in the systolic blood pressure in the elderly. The heart rate of both groups increased without difference between groups. Increased plasma epinephrine concentrations were found 2±3 h after endotoxin administration in both groups. Five hours after the endotoxin challenge, the epinephrine concentration had returned to control values in the elderly group only, in spite of decreased blood pressure. Conclusion In conclusion, healthy elderly subjects fail to maintain a constant mean arterial pressure in response to the immunological challenge of endotoxemia.
Critical Care Medicine, 1999
To record the number of children with withdrawal symptoms after the administration of sedatives f... more To record the number of children with withdrawal symptoms after the administration of sedatives for mechanical ventilation, and to discuss the possible connection with the administration of midazolam. Retrospective data collection from case records and charts. Medical and surgical intensive care unit (ICU) in a university hospital. Children 6 months to 14 yrs of age who required sedation for mechanical ventilation (n = 40). None. Kind and amount of sedatives and analgesics, duration of administration, and occurrence of withdrawal symptoms. The frequency of withdrawal symptoms was 35% (14/40) of the sedated children. A total dose of midazolam of &amp;gt;60 mg/kg was strongly significantly associated with occurrence of withdrawal. Statistical analysis to determine the occurrence of withdrawal associated with the administration of morphine was not possible. Signs and symptoms of a withdrawal reaction were observed in several children. The occurrence of withdrawal was statistically related to high doses of midazolam, but it was not possible to determine the influence of morphine. If large doses of midazolam and opioids have been administered, there may be justification for reducing the dose gradually instead of abruptly, or using longer-acting benzodiazepines or opioids on discontinuation of sedation.
Critical Care, 2001
P14 Facial continuous positive airway pressure therapy for cardiogenic pulmonary oedema: a study ... more P14 Facial continuous positive airway pressure therapy for cardiogenic pulmonary oedema: a study of its efficacy in an emergency department setting within the UK
Clinical Diagnostic Laboratory Immunology, 2001
The purpose of this study was to investigate whether an age-associated impaired acute-phase respo... more The purpose of this study was to investigate whether an age-associated impaired acute-phase response exists. Nine healthy elderly volunteers (median, 66 years; range, 61 to 69 years) and eight young controls (median, 24 years; range, 20 to 27 years) were given an intravenous bolus of endotoxin (2 ng/kg). The rectal temperature was monitored continuously, and blood samples for cytokine measurements were obtained before endotoxin administration as well as 0.5, 1, 1.5, 2, 3, 4, 8, 12, and 24 h after the injection. The elderly subjects showed a more prolonged fever response compared to the young controls. Levels of tumor necrosis factor alpha (TNF-α), soluble TNF receptors (sTNFR-I), interleukin-6 (IL-6), IL-8, IL-10, and IL-1 receptor antagonist (IL-1ra) in plasma increased markedly following endotoxin administration in both groups. The elderly group showed larger initial increases in TNF-α and sTNFR-I levels and prolonged increased levels of sTNFR-I. Monocyte concentrations decreased ...
Clinical and Vaccine Immunology, 2002
Seventeen volunteers received an intravenous bolus of endotoxin (2 ng/kg of body weight). Endotox... more Seventeen volunteers received an intravenous bolus of endotoxin (2 ng/kg of body weight). Endotoxin-induced lymphopenia was constituted mainly by cells with an immature phenotype (CD45RA + CD45RO − ) that were less likely to undergo apoptosis (CD28 + ), whereas cells with the highest rates of disappearance were characterized by an activated phenotype (CD45RA − CD45RO + ) as well as a phenotype linked to apoptosis (CD95 + CD28 − ). In conclusion, endotoxin-induced lymphopenia reflects the disappearance from the circulation of activated lymphocytes prone to undergo apoptosis.