Is there lack of ICU beds in Iceland?

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Energy expenditure and nutritional support in intensive care patients

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenSTUDY OBJECTIVES: Nutritional support of ICU patients is usually guided by estimations of their caloric needs. However, recent studies have shown that energy expenditure (EE) of critically ill patients is not as high as previously thought. The goal of this study was to measure EE in ICU patients, compare it with estimated EE and evaluate nutritional support. METHODS: Energy expenditure was measured with indirect calorimetry in a broad group of ICU patients requiring mechanical ventilation >48 hours. In comparison EE was estimated with the Harris-Benedict equation. Nutritional support during ICU stay was registered. RESULTS: Mean measured EE of 56 patients was 1820 +/- 419 kcal/day or 22 kcal/kg/day. The Harris- Benedict equation underestimated EE by 11%, but adding a stress factor resulted in 15% overestimation. Mean nutritional support was 1175 +/- 442 kcal/day or 67% of EE. The energy deficit was greatest during the first week of ICU stay. Mean protein administration was 0,44 g/kg/day. CONCLUSION: Measured EE of ICU patients was less than nutritional support recommended by international guidelines. These results are in accordance with recent studies. Nutritional support was only 67% of measured energy expenditure and protein content less than recommended. Further studies are needed as it has not be shown how this might influence outcome.Tilgangur: Við næringu gjörgæslusjúklinga er oftast stuðst við áætlaða orkuþörf. Rannsóknir benda þó til að orkunotkun sé minni en áður var talið. Markmið þessarar rannsóknar var að mæla raunverulega orkunotkun gjörgæslusjúklinga og bera saman við áætlaða orkunotkun og að kanna magn og samsetningu næringargjafar. Aðferðir: Orkunotkun var mæld með óbeinni efnaskiptamælingu (indirect calorimetry) hjá sjúklingum sem þurftu öndunarvélameðferð >48 klukkustundir. Til samanburðar var orkunotkun áætluð með Harris-Benedict-jöfnu. Skráðar voru upplýsingar um alla næringargjöf sem sjúklingur fékk. Niðurstöður: Meðalorkunotkun hjá 56 sjúklingum reyndist vera 1820 ± 419 kcal/dag. Harris-Bene-dict-jafnan vanmat orkunotkun um 11,3% en með viðbættum streitustuðli var um 15,3% ofmat að ræða. Meðalnæringargjöf var 1175 ± 442 kcal/dag eða um 67% af orkunotkun. Mestur munur var á orkunotkun og næringargjöf í fyrstu viku gjörgæslumeðferðar. Próteingjöf var að meðaltali 0,44 g/kg/dag. Ályktun: Orkunotkun gjörgæslusjúklinga var minni en sú orkugjöf sem mælt er með samkvæmt næringarleiðbeiningum sérgreinafélaga en í samræmi við niðurstöður annarra nýlegra rannsókna. Næringargjöf var einungis 67% af mældri orkunotkun og próteininnihald næringar undir ráðlögðu magni. Ekki hefur verið sýnt fram á að það hafi áhrif á horfur sjúklinga. Þörf er á frekari rannsóknum á þessu sviði

Injecting drug abuse: Survival after intensive care admission and forensic toxicology reports at death

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnInngangur: Notkun vímuefna í æð er alþjóðlegt vandamál sem hefur alvarlegar afleiðingar fyrir neytandann og samfélagið í heild. Markmið rannsóknarinnar var að skoða tvennt varðandi alvarlegustu afleiðingar neyslu vímuefna í æð: afdrif þeirra sem þurftu að leggjast inn á gjörgæslu og réttarefnafræðilegar skýrslur um andlát eftir neyslu vímuefna í æð. Efniviður og aðferðir: Kannaðar voru allar innlagnir á gjörgæsludeild Landspítala sem tengdust notkun vímuefna í æð á tímabilinu 2003-2007 og metin 5 ára lifun. Einnig var farið yfir réttarefnafræðilegar skýrslur vegna dauðsfalla einstaklinga með sögu um notkun vímuefna í æð á sama tímabili. Niðurstöður: Alls reyndust 57 einstaklingar hafa sögu um notkun vímuefna í æð við innlögn á gjörgæsludeild á tímabilinu, sem er um 1% af heildarfjölda innlagna. Innlagnir voru oftast vegna eitrunar (52%) eða lífshættulegrar sýkingar (39%). Miðgildi aldurs var 26 ár og 66% voru karlar. Eitranir voru algengastar, oftast vegna misnotkunar á lyfseðilsskyldum lyfjum. Dánartíðni á sjúkrahúsi var 16% og 5 ára dánartíðni 35%. Meðaltími frá útskrift að andláti var 916 ± 858 dagar. Alls fundust 38 krufningarskýrslur einstaklinga með sögu um notkun vímuefna í æð á tímabilinu, eða 4,1/105/ár fyrir aldurshópinn 15-59 ára. Algengasta dánarorsök var eitrun (53%) sem oftast var vegna misnotkunar á lyfseðilsskyldum lyfjum (90%) og oft voru mörg efni tekin samtímis. Ályktun: Lífslíkur einstaklinga sem nota vímuefni í æð og hafa þurft gjörgæsluinnlögn eru verulega skertar. Áhyggjuefni er hve algengt er að nota lyfseðilsskyld lyf við slíka neyslu. Umfang vandans virðist svipað og á öðrum Norðurlöndum.----------------------------------------------------------------------------------------------------------------------------------------Introduction: Injecting drug abuse is a worldwide problem with serious consequences for the individual and for society. The purpose of this study was to gather information on the most serious complications of injecting drug use from two perspectives, intensive care admissions and forensic toxicology reports. Material and methods: Firstly, intensive care admissions related to injecting drug abuse during a five year period were reviewed for demographics, complications and 5 year survival. Secondly, information from forensic toxicology reports regarding deaths amongst known injecting drug abusers were gathered for the same period. Results: A total of 57 patients with a history of active injecting drug use were admitted to intensive care or approximately 1% of admissions, most often for overdose (52%) or life threatening infections (39%). Median age was 26, males were 66%. The most common substances used were prescription drugs. Hospital mortality was 16% and five year survival 65%. Average time from hospital discharge to death was 916±858 days. During the study period 38 deaths of individuals with a history of injecting drugs were identified by forensic toxicology reports or 4.1/105 population/year (age 15-59). Cause of death was most often overdose (53%), usually from prescription opiates but multiple drug use was common. Discussion: The life expectancy of injecting drug abusers after intensive care admission is substantially decreased, with 35% death rate within five years. A widespread use of prescription drugs is of concern. Injecting drug abuse seems to be a similar health problem in magnitude in Iceland as in other Scandinavian countries

Clinical aspects and follow up of suicide attempts treated in a general intensive care unit at Landspitali University Hospital in Iceland 2000-2004

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)OBJECTIVE: To gather information on patients admitted to an intensive care unit (ICU) after a serious suicide attempt (SA). METHODS: Retrospective analysis and follow up of admittances to ICUs of Landspitali University Hospital after SA years 2000-2004. RESULTS: Admittances because of SA were 251 (4% of ICU admissions, 61% females, 39% males, mean age 36 yr +/- 14 ). Ten percent were admitted more than once and 61% had prior history of SA. Drug intoxication was the most prevalent type of SA (91%) and the most frequent complication was pneumonia. Following ICU stay 36% of the patients were admitted to psychiatric wards and 80% received psychiatric follow up. The main psychiatric diagnosis was addiction (43%). Majority of patients were divorced or single and the rate of unemployment was high. Mortality during ICU stay was 3%. During 3-7 year follow up 21 patients died (10 %), majority due to suicide. In a survival analysis only the number of tablets taken, APACHE II score and number of somatic diseases predicted risk of death. CONCLUSION: The patient group is young (36 yr), majority are women (61%), repeated attempts are frequent, social circumstances are poor and death rate after discharge from hospital is high (10%) even though the vast majority (80%) receives psychiatric follow up.This raises the question if the offered treatment is effective enough. Key words: Suicide attempt, suicide, drug poisoning, intensive care, mental health care.Tilgangur: Að kanna afdrif þeirra sem þarfnast innlagnar á gjörgæslu eftir alvarlega sjálfsvígstilraun. Aðferðir: Aftursæ rannsókn á innlögnum á gjörgæsludeildir Landspítala vegna alvarlegra sjálfsvígstilrauna árin 2000-2004. Niðurstöður: Innlagnir vegna alvarlegra sjálfsvígstilrauna voru 251 (4% allra innlagna, 61% konur, 39% karlar, meðalaldur 36 ár ± 14). Tíu prósent lögðust inn oftar en einu sinni og 61% höfðu áður gert alvarlega sjálfsvígstilraun. Inntaka lyfja var algengasta aðferðin (91%) og oftast voru notuð bensódíazepín. Meðferð í öndunarvél þurftu 27% sjúklinga og algengasti fylgikvillinn var lungnabólga. Í kjölfarið voru 36% sjúklinga lagðir inn á geðdeild en 80% fengu eftirfylgd innan geðheilbrigðiskerfisins. Algengasta geðgreining var fíkn (43%). Stór hluti sjúklinga voru fráskildir eða einhleypir og atvinnuþátttaka lítil. Þrjú prósent sjúklinga lést af völdum alvarlegra sjálfsvígstilrauna og á 3-7 ára eftirfylgdartímabili lést 21 sjúklingur (10%), flestir fyrir eigin hendi. Í aðhvarfsgreiningu höfðu einungis fjöldi inntekinna taflna, APACHE II gildi og fjöldi sjúkdómsgreininga forspárgildi varðandi horfur sjúklinga. Ályktun: Þetta er ungur sjúklingahópur, meirihluti konur, endurteknar alvarlegar sjálfsvígstilraunir eru algengar, félagslegar aðstæður erfiðar og dánartíðni há þrátt fyrir að hátt hlutfall fái eftirfylgd innan geðheilbrigðiskerfisins. Það vekur spurningar um hvort meðferðarúrræði sem í boði eru séu nægjanlega árangursrík

Visits to an emergency department due to head injuries

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnÁverkar á höfði eru algeng afleiðing slysa og ofbeldis. Þeir geta haft varanlegar afleiðingar í för með sér og eru ein af meginorsökum fyrir ótímabærum dauða. Markmið rannsóknarinnar var að gera heildarúttekt á komum á bráðadeild Landspítala vegna áverka á höfði í Reykjavík og athuga nýgengi, eðli og alvarleika en slík heildarúttekt hefur ekki verið gerð áður. Skoðaðar voru afturvirkt allar komur Reykvíkinga á Landspítala vegna áverka á höfði á árunum 2000-2005 og 2008-2009. Upplýsingum var safnað úr sjúkraskrárkerfum Landspítala. Áverkagreiningar voru flokkaðar í mjúkpartaáverka, augnáverka, höfuðbeinaáverka, innankúpu- og heilataugaáverka og fjöláverka. Valin var ein aðalgreining ef höfuðáverkagreiningar voru margar. Niðurstöður: Á 8 árum komu 35.031 Reykvíkingar á Landspítala vegna áverka á höfði. Karlar voru 67%. Meðalaldur var 26 ár (0-107). Flestar komur voru hjá börnum á aldrinum 0-4 ára (20,8%), 5-9 ára (11,5%) og ungu fólki 20-24 ára (9,4%). Árlegt nýgengi lækkaði úr 4,2% árið 2000 í 3,3% árið 2009. Nýgengi innlagna lækkaði úr 181/ár/100.000 íbúa árið 2000 í 110/ár/100.000 íbúa árið 2009. Slys orsökuðu 80,5% áverkanna en slagsmál og ofbeldi 12,7%. Flestir komu á bráðadeild vegna mjúkparta-áverka (65%), augnáverka (15%) og innankúpu- og heilataugaáverka (14%). Hlutfallslega flestir lögðust inn vegna innankúpublæðingar (90,1%). Innlagðir voru 8,7% þeirra er hlutu andlitsbeinabrot en 79,2% þeirra er hlutu höfuðkúpubrot. Ályktanir: Algengustu orsakir áverka á höfði eru slys og ofbeldi sem karlar verða oftar fyrir en konur. Algengasta komuástæðan er sár á höfði en algengasta innlagnarástæðan innankúpublæðing. Nýgengi koma og innlagna Reykvíkinga á Landspítala vegna áverka á höfði fór lækkandi síðasta áratuginn.Introduction: Head injury is a common consequence of accidents and violence. It can result in permanent disability and is one of the leading causes of premature death worldwide. Our aim was to review all visits to Landspitali University Hospital (LUH) from head injuries, to study the incidence, nature and severity of head injuries. Material and methods: A retrospective study on all visits of Reykjavik's inhabitants to LUH for head injuries in the years 2000-2005 and 2008-2009. Data were collected from patient records at LUH. One main diagnosis was used if head injury diagnoses were many. They were categorised into 5 groups; soft tissue injury, eye injury, injury to cranium, intracranial- and cranial nerve injury and multiple trauma. Results: During the study period 35.031 patients presented with head injuries to LUH. Males were 67%. Mean age was 26 years (0-107). The highest rate was among infants and children aged 0-4 years (20.8%), followed by 5-9 years (11,5%) and 20-24 years (9.4%). The annual incidence decreased between the study periods from 4.2% to 3.3%. The annual incidence for admitted head injury patients decreased from 181/year/100.000 inhabitants to 110/year/100.000 inhabitants. Most often injuries were caused by accidents (80,5%) and violence (12.7%). Soft tissue injury was the most common injury (65%), followed by eye injury (15%) and intracranial- and cranial nerve injury (14%). The injuries that most frequently led to hospital admission were intracranial bleeding (90.1%), followed by skull fracture (79.2%). Conclusion: Accidents and violence caused most head injuries and they are more common among men than women. Patients with intracranial haemorrhage were usually admitted. Incidence of hospital visits and admissions because of head injuries in Reykjavik has decreased over the last decade. Key words: Head injury, accident, violence, brain injury, intracranial bleeding

Ljósmyndir lækna frá COVID-19-sumrinu 2020

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Intensive care patients with influenza A (H1N1) infection in Iceland 2009

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)BACKGROUND: We describe the main characteristics of patients that required intensive care due to the influenza (H1N1) outbrake in 2009. METHODS: Retrospective and prospective analysis of medical records from patients admitted to ICU with positive RT-PCR for (H1N1). RESULTS: During a six week period in the fall of 2009, 16 patients were admitted to intensive care in Iceland with confirmed H1N1 infection. Mean age was 48 years (range 1-81). Most patients were considered quite healthy but the majority had risk factors such as smoking, obesity or hypertension. All but one had fever, cough, dyspnea and bilateral infiltrates on chest x-ray and developed any organ failures (mean SOFA score 7). 12 needed mechanical ventilation and two extra corporeal membrane oxygenation (ECMO). Mean APACHE II score was 20. No patient died in the ICU but one elderly patient with multiple underlying diseases died a few days after being discharged from the ICU. CONCLUSIONS: (1) The incidence of severe influenza A (H1N1) that leads to ICU admission appears to be high in Iceland. (2) Many patients developed acute respiratory distress syndrome in addition to other organ failures, and required additional measures for oxygenation such as prone position, nitric oxide inhalation and ECMO. (3) 28 day mortality was low. (4) This study will aid in future outbreak planning in Iceland. Key words: influenza A, pneumonia, multiple organ failure, death rate, intensive care, ventilator therapy, ECMO.Tilgangur: Að lýsa helstu einkennum og afdrifum þeirra sem lögðust inn á gjörgæsludeildir á Íslandi vegna inflúensusýkingar af A stofni (H1N1) haustið 2009. Aðferðir: Aflað var upplýsinga um sjúklinga sem lögðust inn á gjörgæsludeildir á Íslandi með staðfesta H1N1 2009 sýkingu. Niðurstöður: 16 sjúklingar lögðust inn á gjörgæsludeildir vegna inflúensu A (H1N1) sýkingar, meðalaldur 48 ár (1-81). Flestir töldust vera tiltölulega frískir fyrir, en 13 höfðu þó sögu um reykingar, offitu eða háþrýsting. 15 höfðu hita, hósta, öndunarþyngsli og dreifðar íferðir í báðum lungum á lungnamynd og margir fengu fjöllíffærabilun. Allir fengu veirulyf og 12 voru meðhöndlaðir í öndunarvél, þar af tveir einnig í hjarta- og lungnavél. Enginn sjúklingur lést á gjörgæsludeild, en einn fjölveikur aldraður sjúklingur lést síðar á legudeild. Ályktanir: (1) Tíðni alvarlegra sjúkdómseinkenna af völdum inflúensu A (H1N1) sem leiða til gjörgæslumeðferðar er há á Íslandi. (2) Þessir sjúklingar fá flestir, auk annarra líffæratruflana, mjög alvarlega öndunarbilun sem oft lætur ekki undan hefðbundinni öndunarvélameðferð. (3) Árangur meðferðar á íslenskum gjörgæsludeildum hefur verið góður. (4) Niðurstöður þessarar rannsóknar geta nýst yfirvöldum við mat á meðferðarmöguleikum og fyrirbyggjandi aðgerðum gegn þessum lífshættulega sjúkdómi

Prevalence of modifiable risk factors in primary elective arthroplasty and their association with infections

Funding Information: The study was approved by the Science Committee of the Capital area’s Primary Care and University of Iceland and by the Icelandic National Bioethics Committee (case number: VSN-18-098) and is registered at ClinicalTrials. gov (NCT05399186). This study was supported by grants from Landspitali Research Fund (A-2019-056, A-202-042, A-2021-036) and Research fund of Sigridur Larusdottir by University of Iceland. Data sharing is possible after reasonable request. The authors declare no conflict of interest. Completed disclosure forms for this article following the ICMJE template are available on the article page, doi: 10.2340/17453674.2023.8480 Publisher Copyright: © 2023 The Author(s).Background and purpose — The aim of this study was to identify the prevalence of modifiable risk factors of surgical site infections (SSI) in patients undergoing primary elective total joint arthroplasty (TJA) receiving conventional preoperative preparation, and to explore their association with infectious outcomes. Patients and methods — Information regarding modifiable risk factors (anemia, diabetes, obesity, nutritional status, smoking, physical activity) was prospectively gath-ered in patients undergoing primary TJA of hip or knee in 2018–2020 at a single institution with 6 weeks’ follow-up time. Results — 738 patients (median age 68 years [IQR 61–73], women 57%) underwent TJA (knee 64%, hip 36%). Anemia was detected in 8%, diabetes was present in 9%, an additional 2% had undiagnosed diabetes (HbA1c > 47 mmol/mol), and 8% dysglycemia (HbA1c 42–47 mmol/mol). Obesity (BMI ≥ 30) was observed in 52%. Serum albumin, total lymphocyte count, and vitamin D below normal limits was identified in 0.1%, 18%, and 16%, respectively. Current smokers were 7%. Surgical site complications occurred in 116 (16%), superficial SSI in 57 (8%), progressing to periprosthetic joint infection in 7 cases. Univariate analysis identified higher odds of superficial SSI for BMI ≥ 30 (OR 2.1, 95%CI 1.2–3.8) and HbA1c ≥ 42 mmol/mol (OR 2.2, CI 1.1–4.2), but no association was found with other factors. Conclusion — In a general population undergoing primary TJA an association was found between obesity (52%) and dysglycemia/diabetes (19%) and superficial SSI (8%), which progressed to PJI in 12% of cases, generating a 1% total rate of PJI. Modification of these risk factors might mitigate infectious adverse outcomes.Peer reviewe

Utilization and outcomes of tracheostomies in the intensive care unit in Iceland in 2007–2020 : A descriptive study

Funding Information: The work undertaken in this study was supported by a contribution from the Landspitali University Hospital Research Fund. Publisher Copyright: © 2022 Acta Anaesthesiologica Scandinavica Foundation.Background: Tracheostomies are commonly utilized in ICU patients due to prolonged mechanical ventilation, upper airway obstruction, or surgery in the face/neck region. However, practices regarding the timing of placement and utilization vary. This study provides a nationwide overview of tracheostomy utilization and outcomes in the ICU over a 14-year period. Methods: A retrospective study including all patients that received a tracheostomy during their ICU stay in Iceland between 2007 and 2020. Data were retrieved from hospital records on admission cause, comorbidities, indication for tracheostomy insertion, duration of mechanical ventilation before and after tracheostomy placement, extubation attempts, complications, length of ICU and hospital stay and survival. Descriptive statistics were provided, and survival analysis was performed using Cox regression. Results: A total of 336 patients (median age 64 years, 33% females) received a tracheostomy during the study period. The most common indication for tracheostomy insertion was respiratory failure, followed by neurological disorders. The median duration of mechanical ventilation prior to tracheostomy insertion was 9 days and at least one extubation had been attempted in 35% of the cases. Percutaneous tracheostomies were 32%. The overall rate of complications was 25% and the most common short-term complication was bleeding (5%). In-hospital mortality was 33%. The one- and five-year survival rate was 60% and 44%, respectively. Conclusions: We describe a whole-nation practice of tracheostomies. A notable finding is the relatively low rate of extubation attempts prior to tracheostomy insertion. Future work should focus on standardization of assessing the need for tracheostomy and the role of extubation attempts prior to tracheostomy placement.Peer reviewe

Ventilator-induced lung injury results in oxidative stress response and mitochondrial swelling in a mouse model

© 2022. The Author(s).BACKGROUND: Mechanical ventilation is a life-saving therapy for critically ill patients, providing rest to the respiratory muscles and facilitating gas exchange in the lungs. Ventilator-induced lung injury (VILI) is an unfortunate side effect of mechanical ventilation that may lead to serious consequences for the patient and increase mortality. The four main injury mechanisms associated with VILI are: baro/volutrauma caused by overstretching the lung tissues; atelectrauma, caused by repeated opening and closing of the alveoli resulting in shear stress; oxygen toxicity due to use of high ratio of oxygen in inspired air, causing formation of free radicals; and biotrauma, the resulting biological response to tissue injury, that leads to a cascade of events due to excessive inflammatory reactions and may cause multi-organ failure. An often-overlooked part of the inflammatory reaction is oxidative stress. In this research, a mouse model of VILI was set up with three tidal volume settings (10, 20 and 30 mL/kg) at atmospheric oxygen level. Airway pressures and heart rate were monitored and bronchoalveolar lavage fluid (BALF) and lung tissue samples were taken. RESULTS: We show a correlation between increased inflammation and barrier failure, and higher tidal volumes, evidenced by increased IL-6 expression, high concentration of proteins in BALF along with changes in expression of adhesion molecules. Furthermore, swelling of mitochondria in alveolar type II cells was seen indicating their dysfunction and senescence-like state. RNA sequencing data present clear increases in inflammation, mitochondrial biogenesis and oxidative stress as tidal volume is increased, supported by degradation of Keap1, a redox-regulated substrate adaptor protein. CONCLUSIONS: Oxidative stress seems to be a more prominent mechanism of VILI than previously considered, indicating that possible treatment methods against VILI might be identified by impeding oxidative pathways.Peer reviewe