Minna Tallgren - Academia.edu (original) (raw)
Papers by Minna Tallgren
Circulation, 2014
Introduction: Optimal blood pressure target in resuscitated patients is unknown but current guide... more Introduction: Optimal blood pressure target in resuscitated patients is unknown but current guidelines recommend maintaining mean arterial pressure (MAP) between 60 to 90 mmHg. Our aim was to determine associations between time-weighted MAP levels and vasopressor load (VL) during the first 48 hours after OHCA and 1-year neurologic outcome in a prospective observational cohort of OHCA patients treated in the ICU. Methods: We included 503 patients with out-of-hospital-cardiac arrest (OHCA) treated in 21 ICUs from the FINNRESUSCI study between 2010 and 2011. Hemodynamic data and vasopressor doses were collected prospectively in two, five or 15 minute intervals depending on the ICU. Totally 1.2 million blood pressure values were analysed. We identified optimal thresholds for time-weighted (TW) MAP and outcome with receiver operating characteristic curve analysis (ROC). Using multivariate regression including co-morbidities, factors at resuscitation, sequential organ failure scores, TW M...
Stereotactic and Functional Neurosurgery, 2020
Background: To obtain magnetic resonance (MR) images of good quality for accurate target localiza... more Background: To obtain magnetic resonance (MR) images of good quality for accurate target localization in deep brain stimulation (DBS) surgery, sedation or anesthesia may be used, although their usefulness has not been proven. Objective: To assess whether sedation or general anesthesia (GA) improve the quality of MR imaging (MRI). Methods: The records of DBS procedures for Parkinson’s disease (PD), dystonia, and essential tremor in our tertiary neurosurgical unit between January 2011 and June 2016 were reviewed. Adult patients with preoperative MR images were included. Patient records concerning MRI, surgery, adverse events, and clinical outcome were retrospectively scrutinized and analyzed. MR image quality was assessed by two independent radiologists. Results: A total of 215 preoperative MR images for 177 DBS procedures were analyzed. The MRI sequences performed under GA were superior to those performed without anesthesia or under sedation (p < 0.01). Virtually all images captur...
Critical Care Medicine, 2004
Scandinavian journal of clinical and laboratory investigation, Jan 24, 2015
Activated protein C (APC), an endogenous anticoagulant, has antithrombotic, fibrinolytic and anti... more Activated protein C (APC), an endogenous anticoagulant, has antithrombotic, fibrinolytic and anti-inflammatory properties. We recently conducted a controlled study (APCAP, activated protein C in severe acute pancreatitis) of APC treatment of patients with severe acute pancreatitis (SAP). Here we studied the effect of APC on the pivotal coagulation parameters of the surviving patients in the APCAP study. The study consisted of 20 patients of whom 10 patients had received APC and 10 patients had received placebo. Coagulation parameters, physiological anticoagulants, thrombograms and circulating levels of IL-6 and CRP were determined on admission and at days 1, 3-4 and 6-7. During follow-up, the temporal levels of prothrombin time (PT) decreased and the temporal levels of thromboplastin time (TT) increased in placebo group (p < 0.001 for both), but not in APC group. The temporal levels of antithrombin (AT) increased less in APC group than in placebo group (p = 0.011). The shapes of ...
Transplantation Proceedings, 2001
Clinical Pharmacology & Therapeutics, 1997
The pharmacokinetics and ventilatory effects of oxycodone were studied in six volunteer patients ... more The pharmacokinetics and ventilatory effects of oxycodone were studied in six volunteer patients with end-stage liver cirrhosis before and after orthotopic liver transplantation. Plasma samples and urine were collected for 24 hours after intravenous administration of 0.05 mg/kg oxycodone hydrochloride. Concentrations of oxycodone and its metabolites, noroxycodone and oxymorphone, were measured in plasma and urine. THe median elimination half-life of oxycodone was 13.9 hours (range, 4.6 to 24.4 hours) in patients with cirrhosis before transplantation and 3.4 hours (range, 2.6 to 5.1 hours) after transplantation (p < 0.05). Correspondingly, oxycodone clearance increased from 0.26 L/min (range, 0.15 to 0.73 L/min) before transplantation to 1.13 L/min (range, 0.71 to 3.98 L/min) after transplantation (p < 0.05). Oxycodone depressed ventilation more strongly before transplantation than after transplantation (p < 0.05). Care should be exercised when oxycodone is used in patients with end-stage disease.
Duodecim; lääketieteellinen aikakauskirja, 2006
Patient Education and Counseling, 2013
Scandinavian Journal of Infectious Diseases, 1991
High prevalence of hepatitis C antibodies (anti-HCV) have been found in the Middle- and Southern ... more High prevalence of hepatitis C antibodies (anti-HCV) have been found in the Middle- and Southern European countries in connection with chronic liver diseases. In a study of Finnish chronic liver disease patients no anti-HCV antibodies were found in 22 autoimmune chronic active hepatitis, in 5 chronic persistent hepatitis and in 38 alcoholic liver disease patients. 2/30 primary biliary cirrhosis patients were anti-HCV positive. As a comparison 3/9 patients with acute community acquired non-A non-B hepatitis and 28/48 i.v. drug addicts had anti-HCV antibodies. The results indicate that HCV infections in Finnish chronic hepatitis patients are rare.
Intensive Care Medicine, 2005
To assess the value of the diagnosis of overt disseminated intravascular coagulation (DIC) accord... more To assess the value of the diagnosis of overt disseminated intravascular coagulation (DIC) according to the International Society on Thrombosis and Haemostasis (ISTH) criteria and that of the parameters included in the ISTH score for overt DIC in predicting day 28 mortality in intensive care patients. Also, to assess the value of the components of the score in the diagnosis of overt DIC. Retrospective clinical study in a university hospital intensive care unit. 494 consecutive patients admitted in the ICU between January 2002 and October 2003. Clinical and laboratory data, including hemostatic parameters, were collected from computerized databases and patient files. Altogether 19% (95/494) of the patients fulfilled the criteria for overt DIC. Their day 28 mortality rate was higher than that of patients without overt DIC (40% vs. 16%). The lowest platelet count (area under curve, AUC, 0.910), highest plasma D-dimer (AUC 0.846), lowest antithrombin (AUC 0.823), and Owren-type prothrombin time activity (AUC 0.797) discriminated well the patients with and without overt DIC, whereas plasma fibrinogen (AUC 0.690) had poor discriminative power. No patient with the diagnosis of overt DIC had decreased plasma fibrinogen. Day-1 SOFA and APACHE II score, the first CRP measurement, and the lowest antithrombin were independent predictors of day 28 mortality. The diagnosis of overt DIC was not an independent predictor of day 28 mortality. In ICU patients plasma antithrombin seems a promising candidate in the panel of indicators for overt DIC whereas the value of plasma fibrinogen is in doubt.
Intensive Care Medicine, 2005
Intensive Care Medicine, 2005
To assess long-term survival and health-related quality of life in patients with acute renal fail... more To assess long-term survival and health-related quality of life in patients with acute renal failure. Cross-sectional cohort study in the ten-bed medical-surgical intensive care unit and the three-bed acute dialysis unit in a tertiary care hospital. 703 patients receiving renal replacement therapy for acute renal failure during 1998-2002. The mortality rate was 41% at 28 days, 57% at 1 year, and 70% at 5 years. SOFA score, age, and continuous renal replacement therapy were independent predictors of 1-year mortality. The median follow-up time was 3.9 years for mortality and 2.4 years for health-related quality of life. Of the 229 survivors in 2003, 153 (67%) responded to the health-related quality of life questionnaire. Health-related quality of life was evaluated with the EuroQol (EQ-5D) instrument including a visual analogue scale (VAS) score to evaluate the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s perceived health. The EQ-5D score was significantly lower in the study population than in the age- and gender-matched Finnish population (0.68 vs. 0.86). Median VAS scores were 69.5 and 70.0, respectively. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; age and duration of follow-up had no significant effect on EQ-5D or VAS scores. Mortality and EQ-5D data were used to calculate quality-adjusted life years. Quality-adjusted survival was poor (15 quality-adjusted life years per 100 patients in the first year of follow-up). The long-term survival of patients with acute renal failure is poor. Although survivors have a low health-related quality of life, they are as satisfied with their health as the general population.
European Journal of Vascular and Endovascular Surgery, 2007
Critical Care Medicine, 2005
Critical Care Medicine, 1999
To evaluate hepatic and splanchnic oxygenation during liver transplantation. Prospective study. U... more To evaluate hepatic and splanchnic oxygenation during liver transplantation. Prospective study. University hospital. Ten adult patients undergoing liver transplantation. Standardized surgery and anesthesia without venovenous bypass. Hepatic oxygenation was assessed by analyzing oxygen tension, oxygen saturation, and lactate concentration in hepatic venous blood. Splanchnic oxygenation was assessed by analyzing oxygen tension, oxygen saturation, and lactate concentration in portal venous blood and by gastric tonometry. Before reperfusion, the grafts were flushed with 1000 mL of acetated Ringer&amp;#39;s solution and 400 mL of portal venous blood. The effluent blood from the graft was wasted and showed a mean pH of 6.86 and a lactate concentration of 9.4 mmol/L. Five minutes after portal reperfusion, most of the grafts produced lactate. Portal-hepatic venous P(CO2) difference ranged from 3 to 16 torr (0.4-2.1 kPa). By the time of restoration of the infrahepatic caval flow mean 24 mins later, eight of the grafts had stopped producing lactate. Mean hepatic venous oxygen tension was 47 torr (6.3 kPa), stabilizing to 41 torr (5.5 kPa) at the end of surgery. Acidosis resolved without pharmacologic interventions. Mean gastric mucosal pH was 7.29 during the anhepatic phase and 7.40 at the end of surgery. One of the patients developed hepatic arterial thrombosis intraoperatively. Her data were analyzed separately. Later, the other patients recovered with good liver function, whereas the patient with hepatic arterial thrombosis was successfully retransplanted. The liver grafts received well-oxygenated portal venous blood during reperfusion, despite the low values of gastric mucosal pH immediately before reperfusion. Hepatic oxygenation became adequate soon after reperfusion. In the patient with hepatic arterial thrombosis, the recovery of hepatic oxygenation was impaired and lactic acidosis persisted.
Critical Care Medicine, 2007
Critical Care Medicine, 2006
Clinical Nephrology, 2004
HLA-DR expression and plasma levels of pro- and anti-inflammatory cytokines (IL-6, IL-8 and IL-10... more HLA-DR expression and plasma levels of pro- and anti-inflammatory cytokines (IL-6, IL-8 and IL-10) and their predictive value concerning survival of critically ill systemic inflammatory response syndrome (SIRS) patients with and without acute renal failure (ARF) were evaluated. A total of 103 consecutive adult patients with SIRS from 2 university hospital intensive care units participated in the study. Laboratory data for all patients were prospectively collected on the day of admission and 2 days thereafter. Patients with acute renal failure (ARF) and non-ARF patients were compared by Mann-Whitney U-test. Independent predictors of mortality were tested using forward stepwise logistic multiple regression analysis. The discriminative power of different variables was tested using receiver operating characteristic (ROC) curve analysis. ARF developed in 36 patients (35%). ARF patients showed significantly lower HLA-DR expression and higher plasma levels of IL-6, IL-8 and IL-10 than non-ARF patients. In ARF, moderate discriminative power in predicting survival was observed for day 2 IL-6 and IL-10 plasma levels (AUCs 0.703 and 0.749, respectively). We found no clinically significant discriminative power in predicting survival of ARF patients for monocyte HLA-DR expression or cytokine plasma levels. Therefore, our results do not support the use of HLA-DR expression or cytokine plasma levels for that purpose.
Circulation, 2014
Introduction: Optimal blood pressure target in resuscitated patients is unknown but current guide... more Introduction: Optimal blood pressure target in resuscitated patients is unknown but current guidelines recommend maintaining mean arterial pressure (MAP) between 60 to 90 mmHg. Our aim was to determine associations between time-weighted MAP levels and vasopressor load (VL) during the first 48 hours after OHCA and 1-year neurologic outcome in a prospective observational cohort of OHCA patients treated in the ICU. Methods: We included 503 patients with out-of-hospital-cardiac arrest (OHCA) treated in 21 ICUs from the FINNRESUSCI study between 2010 and 2011. Hemodynamic data and vasopressor doses were collected prospectively in two, five or 15 minute intervals depending on the ICU. Totally 1.2 million blood pressure values were analysed. We identified optimal thresholds for time-weighted (TW) MAP and outcome with receiver operating characteristic curve analysis (ROC). Using multivariate regression including co-morbidities, factors at resuscitation, sequential organ failure scores, TW M...
Stereotactic and Functional Neurosurgery, 2020
Background: To obtain magnetic resonance (MR) images of good quality for accurate target localiza... more Background: To obtain magnetic resonance (MR) images of good quality for accurate target localization in deep brain stimulation (DBS) surgery, sedation or anesthesia may be used, although their usefulness has not been proven. Objective: To assess whether sedation or general anesthesia (GA) improve the quality of MR imaging (MRI). Methods: The records of DBS procedures for Parkinson’s disease (PD), dystonia, and essential tremor in our tertiary neurosurgical unit between January 2011 and June 2016 were reviewed. Adult patients with preoperative MR images were included. Patient records concerning MRI, surgery, adverse events, and clinical outcome were retrospectively scrutinized and analyzed. MR image quality was assessed by two independent radiologists. Results: A total of 215 preoperative MR images for 177 DBS procedures were analyzed. The MRI sequences performed under GA were superior to those performed without anesthesia or under sedation (p < 0.01). Virtually all images captur...
Critical Care Medicine, 2004
Scandinavian journal of clinical and laboratory investigation, Jan 24, 2015
Activated protein C (APC), an endogenous anticoagulant, has antithrombotic, fibrinolytic and anti... more Activated protein C (APC), an endogenous anticoagulant, has antithrombotic, fibrinolytic and anti-inflammatory properties. We recently conducted a controlled study (APCAP, activated protein C in severe acute pancreatitis) of APC treatment of patients with severe acute pancreatitis (SAP). Here we studied the effect of APC on the pivotal coagulation parameters of the surviving patients in the APCAP study. The study consisted of 20 patients of whom 10 patients had received APC and 10 patients had received placebo. Coagulation parameters, physiological anticoagulants, thrombograms and circulating levels of IL-6 and CRP were determined on admission and at days 1, 3-4 and 6-7. During follow-up, the temporal levels of prothrombin time (PT) decreased and the temporal levels of thromboplastin time (TT) increased in placebo group (p < 0.001 for both), but not in APC group. The temporal levels of antithrombin (AT) increased less in APC group than in placebo group (p = 0.011). The shapes of ...
Transplantation Proceedings, 2001
Clinical Pharmacology & Therapeutics, 1997
The pharmacokinetics and ventilatory effects of oxycodone were studied in six volunteer patients ... more The pharmacokinetics and ventilatory effects of oxycodone were studied in six volunteer patients with end-stage liver cirrhosis before and after orthotopic liver transplantation. Plasma samples and urine were collected for 24 hours after intravenous administration of 0.05 mg/kg oxycodone hydrochloride. Concentrations of oxycodone and its metabolites, noroxycodone and oxymorphone, were measured in plasma and urine. THe median elimination half-life of oxycodone was 13.9 hours (range, 4.6 to 24.4 hours) in patients with cirrhosis before transplantation and 3.4 hours (range, 2.6 to 5.1 hours) after transplantation (p < 0.05). Correspondingly, oxycodone clearance increased from 0.26 L/min (range, 0.15 to 0.73 L/min) before transplantation to 1.13 L/min (range, 0.71 to 3.98 L/min) after transplantation (p < 0.05). Oxycodone depressed ventilation more strongly before transplantation than after transplantation (p < 0.05). Care should be exercised when oxycodone is used in patients with end-stage disease.
Duodecim; lääketieteellinen aikakauskirja, 2006
Patient Education and Counseling, 2013
Scandinavian Journal of Infectious Diseases, 1991
High prevalence of hepatitis C antibodies (anti-HCV) have been found in the Middle- and Southern ... more High prevalence of hepatitis C antibodies (anti-HCV) have been found in the Middle- and Southern European countries in connection with chronic liver diseases. In a study of Finnish chronic liver disease patients no anti-HCV antibodies were found in 22 autoimmune chronic active hepatitis, in 5 chronic persistent hepatitis and in 38 alcoholic liver disease patients. 2/30 primary biliary cirrhosis patients were anti-HCV positive. As a comparison 3/9 patients with acute community acquired non-A non-B hepatitis and 28/48 i.v. drug addicts had anti-HCV antibodies. The results indicate that HCV infections in Finnish chronic hepatitis patients are rare.
Intensive Care Medicine, 2005
To assess the value of the diagnosis of overt disseminated intravascular coagulation (DIC) accord... more To assess the value of the diagnosis of overt disseminated intravascular coagulation (DIC) according to the International Society on Thrombosis and Haemostasis (ISTH) criteria and that of the parameters included in the ISTH score for overt DIC in predicting day 28 mortality in intensive care patients. Also, to assess the value of the components of the score in the diagnosis of overt DIC. Retrospective clinical study in a university hospital intensive care unit. 494 consecutive patients admitted in the ICU between January 2002 and October 2003. Clinical and laboratory data, including hemostatic parameters, were collected from computerized databases and patient files. Altogether 19% (95/494) of the patients fulfilled the criteria for overt DIC. Their day 28 mortality rate was higher than that of patients without overt DIC (40% vs. 16%). The lowest platelet count (area under curve, AUC, 0.910), highest plasma D-dimer (AUC 0.846), lowest antithrombin (AUC 0.823), and Owren-type prothrombin time activity (AUC 0.797) discriminated well the patients with and without overt DIC, whereas plasma fibrinogen (AUC 0.690) had poor discriminative power. No patient with the diagnosis of overt DIC had decreased plasma fibrinogen. Day-1 SOFA and APACHE II score, the first CRP measurement, and the lowest antithrombin were independent predictors of day 28 mortality. The diagnosis of overt DIC was not an independent predictor of day 28 mortality. In ICU patients plasma antithrombin seems a promising candidate in the panel of indicators for overt DIC whereas the value of plasma fibrinogen is in doubt.
Intensive Care Medicine, 2005
Intensive Care Medicine, 2005
To assess long-term survival and health-related quality of life in patients with acute renal fail... more To assess long-term survival and health-related quality of life in patients with acute renal failure. Cross-sectional cohort study in the ten-bed medical-surgical intensive care unit and the three-bed acute dialysis unit in a tertiary care hospital. 703 patients receiving renal replacement therapy for acute renal failure during 1998-2002. The mortality rate was 41% at 28 days, 57% at 1 year, and 70% at 5 years. SOFA score, age, and continuous renal replacement therapy were independent predictors of 1-year mortality. The median follow-up time was 3.9 years for mortality and 2.4 years for health-related quality of life. Of the 229 survivors in 2003, 153 (67%) responded to the health-related quality of life questionnaire. Health-related quality of life was evaluated with the EuroQol (EQ-5D) instrument including a visual analogue scale (VAS) score to evaluate the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s perceived health. The EQ-5D score was significantly lower in the study population than in the age- and gender-matched Finnish population (0.68 vs. 0.86). Median VAS scores were 69.5 and 70.0, respectively. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; age and duration of follow-up had no significant effect on EQ-5D or VAS scores. Mortality and EQ-5D data were used to calculate quality-adjusted life years. Quality-adjusted survival was poor (15 quality-adjusted life years per 100 patients in the first year of follow-up). The long-term survival of patients with acute renal failure is poor. Although survivors have a low health-related quality of life, they are as satisfied with their health as the general population.
European Journal of Vascular and Endovascular Surgery, 2007
Critical Care Medicine, 2005
Critical Care Medicine, 1999
To evaluate hepatic and splanchnic oxygenation during liver transplantation. Prospective study. U... more To evaluate hepatic and splanchnic oxygenation during liver transplantation. Prospective study. University hospital. Ten adult patients undergoing liver transplantation. Standardized surgery and anesthesia without venovenous bypass. Hepatic oxygenation was assessed by analyzing oxygen tension, oxygen saturation, and lactate concentration in hepatic venous blood. Splanchnic oxygenation was assessed by analyzing oxygen tension, oxygen saturation, and lactate concentration in portal venous blood and by gastric tonometry. Before reperfusion, the grafts were flushed with 1000 mL of acetated Ringer&amp;#39;s solution and 400 mL of portal venous blood. The effluent blood from the graft was wasted and showed a mean pH of 6.86 and a lactate concentration of 9.4 mmol/L. Five minutes after portal reperfusion, most of the grafts produced lactate. Portal-hepatic venous P(CO2) difference ranged from 3 to 16 torr (0.4-2.1 kPa). By the time of restoration of the infrahepatic caval flow mean 24 mins later, eight of the grafts had stopped producing lactate. Mean hepatic venous oxygen tension was 47 torr (6.3 kPa), stabilizing to 41 torr (5.5 kPa) at the end of surgery. Acidosis resolved without pharmacologic interventions. Mean gastric mucosal pH was 7.29 during the anhepatic phase and 7.40 at the end of surgery. One of the patients developed hepatic arterial thrombosis intraoperatively. Her data were analyzed separately. Later, the other patients recovered with good liver function, whereas the patient with hepatic arterial thrombosis was successfully retransplanted. The liver grafts received well-oxygenated portal venous blood during reperfusion, despite the low values of gastric mucosal pH immediately before reperfusion. Hepatic oxygenation became adequate soon after reperfusion. In the patient with hepatic arterial thrombosis, the recovery of hepatic oxygenation was impaired and lactic acidosis persisted.
Critical Care Medicine, 2007
Critical Care Medicine, 2006
Clinical Nephrology, 2004
HLA-DR expression and plasma levels of pro- and anti-inflammatory cytokines (IL-6, IL-8 and IL-10... more HLA-DR expression and plasma levels of pro- and anti-inflammatory cytokines (IL-6, IL-8 and IL-10) and their predictive value concerning survival of critically ill systemic inflammatory response syndrome (SIRS) patients with and without acute renal failure (ARF) were evaluated. A total of 103 consecutive adult patients with SIRS from 2 university hospital intensive care units participated in the study. Laboratory data for all patients were prospectively collected on the day of admission and 2 days thereafter. Patients with acute renal failure (ARF) and non-ARF patients were compared by Mann-Whitney U-test. Independent predictors of mortality were tested using forward stepwise logistic multiple regression analysis. The discriminative power of different variables was tested using receiver operating characteristic (ROC) curve analysis. ARF developed in 36 patients (35%). ARF patients showed significantly lower HLA-DR expression and higher plasma levels of IL-6, IL-8 and IL-10 than non-ARF patients. In ARF, moderate discriminative power in predicting survival was observed for day 2 IL-6 and IL-10 plasma levels (AUCs 0.703 and 0.749, respectively). We found no clinically significant discriminative power in predicting survival of ARF patients for monocyte HLA-DR expression or cytokine plasma levels. Therefore, our results do not support the use of HLA-DR expression or cytokine plasma levels for that purpose.