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Purpose We aimed to evaluate post-resuscitation care, implementation of therapeutic hypothermia (TH) and outcomes of intensive care unit (ICU)-treated out-of-hospital cardiac arrest (OHCA) patients in Finland. Methods We included all adult OHCA patients admitted to 21 ICUs in Finland from March 1, 2010 to February 28, 2011 in this prospective observational study. Patients were followed (mortality and neurological outcome evaluated by Cerebral Performance Categories, CPC) within 1 year after cardiac arrest. Results This study included 548 patients treated after OHCA. Of those, 311 patients (56.8 %) had a shockable initial rhythm (incidence of 7.4/100,000/year) and 237 patients (43.2 %) had a non-shockable rhythm (incidence of 5.6/100,000/year). At ICU admission, 504 (92 %) patients were unconscious. TH was given to 241/281 (85.8 %) unconscious patients resuscitated from shockable rhythms, with unfavourable 1-year neurological outcome (CPC 3-4-5) in 42.0 % with TH versus 77.5 % without TH (p < 0.001). TH was given to 70/223 (31.4 %) unconscious patients resuscitated from non-shockable rhythms, with 1-year CPC of 3-4-5 in 80.6 % (54/70) with TH versus 84.0 % (126/153) without TH (p = 0.56). This lack of difference remained after adjustment for propensity to receive TH in patients with non-shockable rhythms. Conclusions One-year unfavourable neurological outcome of patients with shockable rhythms after TH was lower than in previous randomized controlled trials. However, our results do not support use of TH in patients with non-shockable rhythms., Author(s): Jukka Vaahersalo [sup.1] [sup.11], Pamela Hiltunen [sup.2], Marjaana Tiainen [sup.3], Tuomas Oksanen [sup.1], Kirsi-Maija Kaukonen [sup.1], Jouni Kurola [sup.2], Esko Ruokonen [sup.2], Jyrki Tenhunen [sup.4] [sup.5], Tero Ala-Kokko [sup.6], [...]

Purpose To assess the prognostic information of chromogranin A (CgA), a marker associated with adrenergic tone and myocardial function, in patients with severe sepsis. Methods CgA levels were measured at the time of study inclusion and 72 h later in 232 patients with severe sepsis recruited from 24 ICUs in Finland (FINNSEPSIS study). Results Sixty-five patients (28 %) died during the index hospitalization. CgA levels at inclusion and after 72 h correlated with several established indices of risk in sepsis. Patients who died during the hospitalization had higher baseline CgA levels than hospital survivors: 14.0 (Q1-3, 7.4-27.4) versus 9.1 (5.9-15.8) nmol/l, P = 0.002, and after 72 h: 16.2 (9.0-31.1) versus 9.8 (6.0-18.0) nmol/l, P = 0.001. Prior cardiovascular disease (P = 0.04) and cardiovascular SOFA levels on day 3 (P = 0.03) were associated with higher CgA levels after 72 h by linear regression. CgA levels on study inclusion and after 72 h were independently associated with hospital mortality by logistic regression: OR (logarithmically transformed CgA levels) 1.95 (95 % CI 1.01-3.77), P = 0.046 and OR 2.03 (95 % CI 1.18-3.49), P = 0.01, respectively. The prognostic accuracy was comparable for CgA measurements and SAPS II score, and the addition of CgA measurements to the SAPS II score improved risk stratification of the patients as assessed by the category-free net reclassification index. A CgA level >6.6 nmol/l on study inclusion was associated with septic shock during the hospitalization. Conclusion CgA levels measured during hospitalization for severe sepsis are associated with cardiovascular dysfunction and may provide additional prognostic information in patients with severe sepsis., Author(s): Helge Røsjø [sup.1] [sup.2], Ståle Nygård [sup.2] [sup.3], Kirsi-Maija Kaukonen [sup.4], Sari Karlsson [sup.5], Mats Stridsberg [sup.6], Esko Ruokonen [sup.7], Ville Pettilä [sup.4], Torbjørn Omland [sup.1] [sup.2] Author Affiliations: [...]

Purpose To assess the clinical utility of a recently developed highly sensitive cardiac troponin T (hs-cTnT) assay for providing prognostic information on patients with sepsis. Methods cTnT levels were measured by the novel hs-cTnT assay at two time points (inclusion and 72 h thereafter) in a subgroup of patients from the FINNSEPSIS study and associations with clinical outcomes were examined. Results for the hs-cTnT assay were compared to those of the established fourth-generation cTnT assay. Results cTnT measured by the fourth-generation and hs-cTnT assay was detectable in 124 (60%) and 207 (100%) patients, respectively, on inclusion in this study. hs-cTnT levels on inclusion correlated with several indices of risk in sepsis, including the simplified acute physiology score (SAPS) II and sequential organ failure assessment (SOFA) scores. The level of hs-cTnT on inclusion was higher in hospital non-survivors (n = 47) than survivors (n = 160) (median 0.054 [Q1-3, 0.022-0.227] versus 0.035 [0.015-0.111] [mu]g/L, P = 0.047), but hs-cTnT level was not an independent predictor of in-hospital mortality. hs-cTnT levels on inclusion were also higher in patients with septic shock during the hospitalization (0.044 [0.024-0.171] versus 0.033 [0.012-0.103] [mu]g/L, P = 0.03), while this was not the case for the fourth-generation cTnT assay or NT-proBNP levels. Conclusions Circulating hs-cTnT is present in patients with severe sepsis and septic shock, associates with disease severity and survival, but does not add to SAPS II score for prediction of mortality. hs-cTnT measurement could still have a role in sepsis as an early marker of shock., Author(s): Helge Røsjø [sup.1] [sup.2] [sup.3], Marjut Varpula [sup.4], Tor-Arne Hagve [sup.5], Sari Karlsson [sup.6], Esko Ruokonen [sup.7], Ville Pettilä [sup.4], Torbjørn Omland [sup.1] [sup.2] [sup.3] Author Affiliations: (1) grid.411279.8, [...]

Byline: Rita Linko (1), Marjatta Okkonen (1), Ville Pettila (2), Juha Perttila (3), Ilkka Parviainen (4), Esko Ruokonen (4), Jyrki Tenhunen (5), Tero Ala-Kokko (6), Tero Varpula (1) Keywords: Acute respiratory failure; Acute lung injury; Acute respiratory distress syndrome; Mechanical ventilation; Outcome Abstract: Objective To evaluate the incidence, treatment and mortality of acute respiratory failure (ARF) in Finnish intensive care units (ICUs). Study design Prospective multicentre cohort study. Methods All adult patients in 25 ICUs were screened for use of invasive or non-invasive ventilatory support during an 8-week period. Patients needing ventilatory support for more than 6 h were included and defined as ARF patients. Risk factors for ARF and details of prior chronic health status were assessed. Ventilatory and concomitant treatments were evaluated and recorded daily throughout the ICU stay. ICU and 90-day mortalities were assessed. Results A total of 958 (39%) from the 2,473 admitted patients were treated with ventilatory support for more than 6 h. Incidence of ARF, acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) was 149.5, 10.6 and 5.0/100,000 per year, respectively. Ventilatory support was started with non-invasive interfaces in 183 of 958 (19%) patients. Ventilatory modes allowing triggering of spontaneous breaths were preferred (81%). Median tidal volume/predicted body weight was 8.7 (7.6--9.9) ml/kg and plateau pressure 19 (16--23) cm[H.sub.2]O. The 90-day mortality of ARF was 31%. Conclusions While the incidence of ARF requiring ventilatory support is higher, the incidence of ALI and ARDS seems to be lower in Finland than previously reported in other countries. Tidal volumes are higher than recommended in the concept of lung protective strategy. However, restriction of peak airway pressure was used in the majority of ARF patients. Author Affiliation: (1) Intensive Care Units, Department of Anaesthesia and Intensive Care Medicine, Division of Surgery, Helsinki University Hospital, Helsinki, Finland (2) Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Center, Monash University, Melbourne, Australia (3) Department of Anesthesia and Intensive Care Medicine, Turku University Hospital, Turku, Finland (4) Division of Intensive Care, Kuopio University Hospital, Kuopio, Finland (5) Department of Intensive Care Medicine, Critical Care Medicine Research Group, Tampere University Hospital, Tampere, Finland (6) Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland Article History: Registration Date: 28/05/2009 Received Date: 14/01/2009 Accepted Date: 07/05/2009 Online Date: 13/06/2009 Article note: This article is discussed in the editorial available at: doi: 10.1007/s00134-009-1518-0. Electronic supplementary material The online version of this article (doi: 10.1007/s00134-009-1519-z) contains supplementary material, which is available to authorized users.

Byline: Esko Ruokonen (1), Ilkka Parviainen (1), Stephan M. Jakob (2), Silvia Nunes (3), Maija Kaukonen (4), Stephen T. Shepherd (5), Toni Sarapohja (5), J. Raymond Bratty (5), Jukka Takala (2) Keywords: Dexmedetomidine; Sedatives; Deep sedation; Conscious sedation; Intensive care; Critical care; Mechanical ventilation Abstract: Purpose To compare dexmedetomidine (DEX) with standard care (SC, either propofol or midazolam) for long-term sedation in terms of maintaining target sedation and length of intensive care unit (ICU) stay. Methods A pilot, phase III, double-blind multicenter study in randomized medical and surgical patients (n = 85) within the first 72 h of ICU stay with an expected ICU stay of aY=48 h and sedation need for aY=24 h after randomization. Patients were assigned to either DEX (a$?1.4 ug kg.sup.-1 h.sup.-1 n = 41) or SC (n = 44), with daily sedation stops. Results Non-inferiority of DEX versus SC was not confirmed. Target Richmond agitation--sedation score (RASS) was reached a median of 64% (DEX) and 63% (SC) of the sedation time (ns). The length of ICU stay was similar in DEX and SC. Patients with RASS target 0--3 (DEX 78%, SC 80%) were at target sedation 74% (DEX) and 64% (SC) of the time (ns), whereas those with RASS target -4 or less reached the target 42% (DEX) and 62% (SC) of the time (P = .006). Post hoc analyses suggested shorter duration of mechanical ventilation for DEX (P = 0.025). Conclusions This pilot study suggests that in long-term sedation, DEX is comparable to SC in maintaining sedation targets of RASS 0 to -3 but not suitable for deep sedation (RASS -4 or less). DEX had no effect on length of ICU stay. Its effects on other relevant clinical outcomes, such as duration of mechanical ventilation, should be tested further. Author Affiliation: (1) Department of Anesthesiology and Intensive Care Medicine, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland (2) Department of Intensive Care Medicine, Bern University Hospital and University of Bern, 3010, Bern, Switzerland (3) Department of Intensive Care, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland (4) Units of Intensive Care Medicine, Division of Anesthesiology and Intensive Care Medicine, Department of Surgery, Helsinki University Central Hospital, P.O. Box 340, 00029, HUS, Helsinki, Finland (5) Orion Pharma, P.O. Box 65, 02101, Espoo, Finland Article History: Registration Date: 03/09/2008 Received Date: 13/05/2008 Accepted Date: 14/08/2008 Online Date: 16/09/2008 Article note: Registered at ClinicalTrials.gov, number NCT00226785. A complete list of investigators and study centers appears in the Appendix. This study was sponsored by Orion Pharma, Helsinki, Finland, through research contracts negotiated directly with the participating hospitals. Electronic supplementary material The online version of this article (doi: 10.1007/s00134-008-1296-0) contains supplementary material, which is available to authorized users.

High doses of growth hormone may increase the risk of death in critically ill patients. In a study of over 500 intensive care patients, those who received growth hormone were twice as likely to die as those who did not. They also had longer hospital stays and were on a ventilator longer than patients who did not receive growth hormone.

Abstract Background By tradition colloid solutions have been used to obtain fast circulatory stabilisation in shock, but high molecular weight hydroxyethyl starch (HES) may cause acute kidney failure in patients with severe sepsis. Now lower molecular weight HES 130/0.4 is the preferred colloid in Scandinavian intensive care units (ICUs) and 1st choice fluid for patients with severe sepsis. However, HES 130/0.4 is largely unstudied in patients with severe sepsis. Methods/Design The 6S trial will randomise 800 patients with severe sepsis in 30 Scandinavian ICUs to masked fluid resuscitation using either 6% HES 130/0.4 in Ringer's acetate or Ringer's acetate alone. The composite endpoint of 90-day mortality or end-stage kidney failure is the primary outcome measure. The secondary outcome measures are severe bleeding or allergic reactions, organ failure, acute kidney failure, days alive without renal replacement therapy or ventilator support and 28-day and 1/2- and one-year mortality. The sample size will allow the detection of a 10% absolute difference between the two groups in the composite endpoint with a power of 80%. Discussion The 6S trial will provide important safety and efficacy data on the use of HES 130/0.4 in patients with severe sepsis. The effects on mortality, dialysis-dependency, time on ventilator, bleeding and markers of resuscitation, metabolism, kidney failure, and coagulation will be assessed. Trial Registration ClinicalTrials.gov: NCT00962156