Browsing by Subject "Hypotension"

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  • Alanen, Hanna-Mari; Koponen, Hannu; Leinonen, Esa (2016)
    Enemmistö muistisairauspotilaista saa haittaavia käytösoireita jossakin sairauden vaiheessa. Käytösoireiden ensisijainen lääkehoito on muistisairauden asianmukainen lääkehoito. Psykoosilääkkeet saattavat lisätä aivoverenkierron häiriöiden määrää ja kuolleisuutta dementiapotilailla, joten niiden käyttö tulee rajata vain vaikeisiin psykoottisiin ja levottomuutena tai aggressiivisuutena ilmeneviin käytösoireisiin. Muistisairauksia sairastavilla on myös suurentunut riski saada psykoosilääkkeistä ekstrapyramidaalioireita, infektioita, väsymystä ja hypotensiota. Amerikan psykiatriyhdistyksen uunituore hoitosuositus linjaa ja tarkentaa psykoosilääkkeiden käytön ­periaatteita tällä potilasryhmällä.
  • Hästbacka, Johanna; Kirkegaard, Hans; Soreide, Eldar; Taccone, Fabio Silvio; Rasmussen, Bodil Steen; Storm, Christian; Kjaergaard, Jesper; Laitio, Timo; Duez, Christophe Henri Valdemar; Jeppesen, Anni N.; Grejs, Anders M.; Skrifvars, Markus B. (2021)
    Purpose: We explored whether severe or critical hypotension can be predicted, based on patient and resuscitation characteristics in out-of-hospital cardiac arrest (OHCA) patients. We also explored the association of hypotension with mortality and neurological outcome. Materials and methods: We conducted a post hoc analysis of the TTH48 study (NCT01689077), where 355 out-of-hospital cardiac arrest (OHCA) patients were randomized to targeted temperature management (TTM) treatment at 33 degrees C for either 24 or 48 h. We recorded hypotension, according to four severity categories, within four days from admission. We used multivariable logistic regression analysis to test association of admission data with severe or critical hypotension. Results: Diabetes mellitus (OR 3.715, 95% CI 1.180-11.692), longer ROSC delay (OR 1.064, 95% CI 1.022-1.108), admission MAP (OR 0.960, 95% CI 0.929-0.991) and non-shockable rhythm (OR 5.307, 95% CI 1.604-17.557) were associated with severe or critical hypotension. Severe or critical hypotension was associated with increased mortality and poor neurological outcome at 6 months. Conclusions: Diabetes, non-shockable rhythm, longer delay to ROSC and lower admission MAP were predictors of severe or critical hypotension. Severe or critical hypotension was associated with poor outcome. (C) 2020 Published by Elsevier Inc.
  • Humaloja, Jaana; Skrifvars, Markus B.; Raj, Rahul; Wilkman, Erika; Pekkarinen, Pirkka T.; Bendel, Stepani; Reinikainen, Matti; Litonius, Erik (2021)
    Background In neurocritically ill patients, one early mechanism behind secondary brain injury is low systemic blood pressure resulting in inadequate cerebral perfusion and consequent hypoxia. Intuitively, higher partial pressures of arterial oxygen (PaO2) could be protective in case of inadequate cerebral circulation related to hemodynamic instability. Study purpose We examined whether the association between PaO2 and mortality is different in patients with low compared to normal and high mean arterial pressure (MAP) in patients after various types of brain injury. Methods We screened the Finnish Intensive Care Consortium database for mechanically ventilated adult (>= 18) brain injury patients treated in several tertiary intensive care units (ICUs) between 2003 and 2013. Admission diagnoses included traumatic brain injury, cardiac arrest, subarachnoid and intracranial hemorrhage, and acute ischemic stroke. The primary exposures of interest were PaO2 (recorded in connection with the lowest measured PaO2/fraction of inspired oxygen ratio) and the lowest MAP, recorded during the first 24 h in the ICU. PaO2 was grouped as follows: hypoxemia (<8.2 kPa, the lowest 10th percentile), normoxemia (8.2-18.3 kPa), and hyperoxemia (> 18.3 kPa, the highest 10th percentile), and MAP was divided into equally sized tertiles (<60, 60-68, and > 68 mmHg). The primary outcome was 1-year mortality. We tested the association between hyperoxemia, MAP, and mortality with a multivariable logistic regression model, including the PaO2, MAP, and interaction of PaO2*MAP, adjusting for age, admission diagnosis, premorbid physical performance, vasoactive use, intracranial pressure monitoring use, and disease severity. The relationship between predicted 1-year mortality and PaO2 was visualized with locally weighted scatterplot smoothing curves (Loess) for different MAP levels. Results From a total of 8290 patients, 3912 (47%) were dead at 1 year. PaO2 was not an independent predictor of mortality: the odds ratio (OR) for hyperoxemia was 1.16 (95% CI 0.85-1.59) and for hypoxemia 1.24 (95% CI 0.96-1.61) compared to normoxemia. Higher MAP predicted lower mortality: OR for MAP 60-68 mmHg was 0.73 (95% CI 0.64-0.84) and for MAP > 68 mmHg 0.80 (95% CI 0.69-0.92) compared to MAP <60 mmHg. The interaction term PaO2*MAP was nonsignificant. In Loess visualization, the relationship between PaO2 and predicted mortality appeared similar in all MAP tertiles. Conclusions During the first 24 h of ICU treatment in mechanically ventilated brain injured patients, the association between PaO2 and mortality was not different in patients with low compared to normal MAP.
  • Wilkman, Erika; Kuitunen, Anne (2018)