Biomedical subjects

Ilkka Parviainen

Publications and source records attributed to Ilkka Parviainen.

8 recordsLinked to original sources

PubMed2007

Incidence, treatment, and outcome of severe sepsis in ICU-treated adults in Finland: the Finnsepsis study.

OBJECTIVE: To determine the incidence and outcome of severe sepsis in the adult Finnish population and to evaluate how treatment guidelines in severe sepsis are applied in clinical practice. STUDY DESIGN: A prospective study in 24 closed multidisciplinary ICUs in 21 hospitals (4 university and 17 tertiary hospitals) in Finland. PATIENTS: All 4,500 consecutive ICU admission episodes were screened for severe sepsis during a 4-month period (1 November 2004 - 28 February 2005). The referral population was 3,743,225. RESULTS: The severe sepsis criteria were fulfilled in 470 patients, who had 472 septic episodes. The incidence of severe sepsis in the ICUs in Finland was 0.38/1000 in the adult population (95% confidence interval 0.34-0.41). The mean ICU length of stay was 8.2+/-8.1 days. ICU, hospital, and 1-year mortality rates were 15.5%, 28.3%, and 40.9%, respectively. Respiratory failure requiring ventilation support was the most common organ failure (86.2%); septic shock was present in 77% and acute renal failure in 20.6% of cases. Activated protein C was given to only 15 of the 55 patients with indication (27%) and low-dose corticosteroids to 150 of 366 (41%) patients with septic shock. CONCLUSIONS: This prospective study found the incidence of ICU-treated severe sepsis in Finland to be 0.38 per 1,000 of the population. The ICU and hospital mortalities were also lower than earlier reported in United States or Australia. Evidence-based sepsis therapies were not used as often as recommended.

Adult↗

PubMed2006

Propofol in the treatment of refractory status epilepticus.

OBJECTIVES: To study prospectively the effects of propofol anesthesia on seizure control, hemodynamics and course of intensive care in patients with refractory status epilepticus. DESIGN AND SETTING: Prospective observational study in the general intensive care unit in a tertiary university hospital. PATIENTS: Ten patients with refractory status epilepticus. INTERVENTIONS: Patients received propofol anesthesia aiming to burst suppression EEG pattern for 12 h. MEASUREMENTS AND RESULTS: Dose of propofol, quality of burst suppression EEG, hemodynamics and the course of intensive care were recorded. Clinical and electrophysiological seizures terminated quickly, but maintaining burst suppression EEG pattern required incremental doses of propofol. Despite high doses of propofol, recovery from anesthesia was fast. CONCLUSIONS: High doses of propofol are needed in the treatment of refractory status epilepticus. The maintenance of continuous-burst suppression is difficult, and vigilant titrating of dosage of propofol is necessary under continuous EEG monitoring.

Adult↗

PubMed2006

[Not Available].

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Journal Article↗

PubMed2005

Does fluid loading influence measurements of intestinal permeability?

INTRODUCTION: Urinary recovery of enterally administered probes is used as a clinical test of intestinal mucosal permeability. Recently, evidence has been provided that the recovery of some but not all sugar probes is dependent on the amount of diuresis and renal function. The aim of this study was to assess the effect of fluid loading on the urinary recovery of sugar probes in healthy volunteers. METHODS: In a cross-over study, 10 healthy volunteers ingested 100 ml of a solution containing 0.2 g of 3-O-methyl-D-glucose (3-OMG), 0.5 g of D-xylose, 1.0 g of L-rhamnose, and 5.0 g of lactulose on two different days. The volunteers were randomized to receive either 2 litres of Ringer acetate or no fluid during the following 3 hours. The sugar concentrations were measured in 5-hour urine samples period. RESULTS: Fluid loading increased urine production and urinary recovery of xylose. Fluid loading did not influence the urinary recovery of 3-OMG, L-rhamnose, or lactulose. Neither the lactulose/rhamnose ratio nor the 3-OMG/rhamnose ratio changed. CONCLUSION: Fluid loading increases mediated carbohydrate transport but not the lactulose/rhamnose ratio, after oral sugar administration in healthy volunteers. It remains to be determined whether sugar probes are handled differently in response to fluids in patients with organ dysfunctions.

Adult↗

PubMed2005

Refractory generalised convulsive status epilepticus : a guide to treatment.

The patient with status epilepticus has continuous or rapidly repeating seizures. Generalised convulsive status epilepticus (GCSE) is the most common form of the disorder and is a life-threatening condition that requires prompt medical management. Status epilepticus that does not respond to first-line benzodiazepines (lorazepam or diazepam) or to second-line antiepileptic drugs (phenytoin/fosphenytoin, phenobarbital or valproate) is usually considered refractory and requires more aggressive treatment. The optimal treatment of refractory GCSE has not been defined, but patients should be treated in an intensive care unit, as artificial ventilation and haemodynamic support are required. Invasive haemodynamic monitoring is often necessary and EEG monitoring is essential. The drug treatment of refractory GCSE involves general anaesthesia with continuous intravenous anaesthetics given in doses that abolish all clinical and electrographic epileptic activity, often requiring sedation to the point of burst suppression on the EEG. Barbiturate anaesthetics, pentobarbital in the US and thiopental sodium in Europe and Australia, are the most frequently used agents and are highly effective for refractory GCSE both in children and adults. Indeed, they remain the only way to stop seizure activity with certainty in severely refractory cases. Other options are midazolam for adults and children and propofol for adults only.Regardless of the drug selected, intravenous fluids and vasopressors are usually required to treat hypotension. Once seizures have been controlled for 12-24 hours, continuous intravenous therapy should be gradually tapered off if the drug being administered is midazolam or propofol. Gradual tapering is probably not necessary with pentobarbital or thiopental sodium. Continuous EEG monitoring is required during high-dose treatment and while therapy is gradually withdrawn. During withdrawal of anaesthetic therapy, intravenous phenytoin/fosphenytoin or valproate should be continued (these agents having been administered during earlier phases of GCSE) to ensure an adequate baseline of antiepileptic medication so as to prevent the recurrence of status epilepticus. If additional medication is needed, the most appropriate antiepileptic drugs are gabapentin for focal seizures and levetiracetam and topiramate for all seizure types, as these drugs can be started at high doses with a low risk of idiosyncratic reactions. Even with current best practice, mortality in patients who experience refractory GCSE is about 50% and only the minority return to their premorbid functional baseline. Therefore, new treatment options are urgently needed. The ideal new drug for refractory GCSE would be one that has the ability to stop seizures more effectively and safely than current drugs, and that has neuroprotective properties to prevent the brain damage and neurological morbidity caused by GCSE.

Age Factors↗

PubMed2003

Resolution and outcome of acute circulatory failure does not correlate with hemodynamics.

INTRODUCTION: Hemodynamic goals in the treatment of acute circulatory failure (ACF) are controversial. In critical care, organ failures can be assessed using Sequential Organ Failure Assessment and its refinement, total maximal Sequential Organ Failure Assessment (TMS). We studied the associations between resolution of ACF and hemodynamics in the early (< 24 hours) phase of intensive care unit care and their relation to TMS and mortality. PATIENTS AND METHODS: Eighty-three patients with ACF (defined as arterial lactate > 2 mmol/l and/or base deficit > 4) who had pulmonary artery catheters and stayed for longer than 24 hours in the intensive care unit were included. Hemodynamics, oxygen transport, vasoactive drugs and TMS scores were recorded. Normalisation of hyperlactatemia and metabolic acidosis in less than 24 hours after admission was defined as a positive response to hemodynamic resuscitation. RESULTS: Fifty-two patients responded to resuscitation. Nonresponders had higher mortality than responders (52% versus 33%, P = 0.044). Hospital mortality was highest (63%) among nonresponders who received vasoactive drugs. The TMS scores of nonresponders (median [interquartile range], 12 9-16) were higher than the scores of responders (10 7-12, P = 0.019). Late accumulation of TMS scores was associated with increasing mortality, and if the TMS score increase occurred > 5 days after admission then the mortality was 77%. Responders had higher mean arterial pressure at 24 hours, but it was no different between survivors and nonsurvivors. No other hemodynamic and oxygen transport variables were associated with the success of resuscitation or with mortality. CONCLUSIONS: Except for the mean arterial pressure at 24 hours, invasively derived hemodynamic and oxygen transport variables are not associated with the response to resuscitation or with mortality. Positive response to resuscitation in ACF is associated with less severe organ failures as judged by TMS scores. Late accumulation of the TMS score predicts poor outcome.

Acidosis, Lactic↗

PubMed2002

Safe long-distance interhospital ground transfer of critically ill patients with acute severe unstable respiratory and circulatory failure.

OBJECTIVE: To assess the safety of long-distance ground interhospital transport of critically ill patients with the most severe unstable respiratory failure after establishment of a dedicated transport system. DESIGN AND SETTING: Cohort study, retrospective chart review in 13 hospitals and intensive care units (ICU) in Finland, and a tertiary referral center and ICU of a university hospital. PATIENTS: 66 consecutive critically ill patients who were transferred to our ICU from 13 different ICUs in Finland because of severe, progressive respiratory failure, 52 (79%) with acute respiratory distress syndrome. MEASUREMENTS AND RESULTS: Major complications during transfer and patients' oxygenation. The median transfer distance was 161 km (range 120-460 km). Drugs for cardiovascular support were infused in 59 patients (89%) during transfer. Fourteen patients (21%) were transferred in prone position because of life-threatening hypoxemia. The ratio of arterial blood PaO(2) and the fraction of oxygen in the ventilator was 8.5+/-2.7 kPa (64+/-20 mmHg) before transfer and 9.7+/-3.6 kPa (73+/-27 mmHg) after transfer. There were no major complications during the transfer. ICU mortality was 30%. CONCLUSIONS: Long-distance interhospital ground transfer of even critically ill patients with severe unstable respiratory and circulatory failure is safe if a dedicated transport team and a specially equipped transport vehicle are used.

Adult↗

PubMed2002

Treatment of impaired perfusion in septic shock.

Severe sepsis and septic shock are relatively common problems in intensive care. The mortality in septic shock is still high, and the main causes of death are multiple organ failure and refractory hypotension. Impaired tissue perfusion due to hypovolemia, disturbed vasoregulation and myocardial dysfunction contribute to the multiple organ dysfunction. Treatment of hemodynamics in septic shock consists of appropriate fluid therapy guided by invasive monitoring combined with vasoactive drugs aiming to correct hypotension and inappropriately low cardiac output. The drug of choice for low vascular resistance is norepinephrine, while insufficient myocardial contractility is commonly treated with dobutamine. The use of norepinephrine seems to be associated with better prognosis as compared to results from the use of dopamine or epinephrine. In septic shock, vasopressin levels are low, and therefore, vasopressin has been advocated as a vasopressor. Its effectiveness and safety have not yet been documented, and so far it is regarded as an experimental treatment Recent data support the use of corticosteroid, at least in some of the patients with septic shock. Also, activated protein C, a drug with anti-inflammatory and antithrombotic properties, decreases mortality in patients with septic shock.

Adrenal Cortex Hormones↗