INTRODUÇÃO: Endomiocardiofibrose (EMF) é uma cardiomiopatia restritiva (CMR), caracterizada por uma disfunção diastólica, mas com a função sistólica e a fração de ejeção preservadas ou, em fases avançadas da doença, pouco prejudicadas. O consumo máximo de oxigênio (VO2) é um marcador de mortalidade na insuficiência cardíaca sistólica (ICS). Apesar da mortalidade ser semelhante entre a CMR e ICS, ainda não é conhecido se o treinamento físico pode melhorar o VO2 pico em pacientes com EMF. O objetivo deste estudo foi verificar se 4 meses de treinamento combinado podem melhorar a capacidade funcional e qualidade de vida em pacientes com EMF. MÉTODOS: Vinte e um pacientes com EMF (classe funcional II e III, NYHA) foram divididos em 2 grupos: treinamento físico (EMF-TF, n = 9) e sedentários (EMF-Sed, n = 12). Foram avaliados: VO2 pico, pulso de O2, relação deltaFC/deltaVO2 e relação deltaVO2/deltaW, pelo teste cardiopulmonar (TECP); volume diastólico final (VDF), volume sistólico (VS) e volume diastólico do átrio esquerdo (AE), pela ecocardiografia (Simpson); e qualidade de vida, pelo questionário Minnesota Living With Heart Failure Questionnaire (MLWHFQ). Os resultados do TECP dos pacientes com EMF foram comparados com os resultados de indivíduos controle saudáveis sedentários (CSS). Foi considerado significativo P < 0,05. RESULTADOS: Idade não foi diferente entre EMF-Sed, EMF-TF e CSS (58±9 vs. 55±8 vs. 53±6 anos, P = 0,31; respectivamente). O grupo EMF-TF apresentou um aumento do VO2 pico pós-intervenção, comparado com o momento pré e comparado com o grupo EMF-Sed, mas esse valor foi menor, comparado ao CSS (17,4 ± 3,0 para 19,7 ± 4,4 vs. 15,3 ± 3,0 para 15,0±2.0 vs. 24,5 ± 4,6 ml/kg/min, P < 0,001; respectivamente). O pulso de O2 do grupo EMF-TF no momento pós-intervenção foi maior, comparado ao momento pré e ao grupo EMF-Sed, mas foi semelhante, quando comparado ao grupo CSS (9,3 ± 2,6 para 11,1 ± 2,8 vs. 8,6 ± 2,2 para 8,6 ± 1 vs. 11,2 ± 2,9 ml/batimentos; P < 0,05; respectivamente). A relação deltaFC/deltaVO2 diminuiu no momento pós-intervenção no grupo EMF-TF, comparado ao momento pré e ao grupo EMF-Sed, igualando-se ao grupo CSS (75 ± 36 para 57 ± 14 vs. 68 ± 18 para 73 ± 14 vs. 56±17 bpm/L; P < 0,05; respectivamente). O grupo EMF-TF reduziu significativamente a relação deltaVO2/deltaW, após o período de treinemento, comparado ao momento pré e ao grupo EMF-Sed, igualando-se ao grupo CSS (12,3 ± 2.8 para 10,2 ± 1.9 vs. 12,6±1.7 para 12,4 ± 1.7 vs. 10,0 ± 0,9 ml/min/Watts; P = 0,002; respectivamente). O treinamento físico também aumentou o VDF do grupo EMF-TF, quando comparado ao grupo EMF-Sed (102,1 ± 64,6 para 136,2 ± 75,8 vs. 114,4 ± 55,0 para 100,4 ± 49,9 ml; P < 0,001; respectivamente) e o VS (57,5±31,9 para 72,2 ± 27,4 vs. 60,1 ± 25,2 para 52,1 ± 18,1 ml; P = 0,01; respectivamente), e diminuiu o volume diastólico do AE [69,0 (33,3- 92,7) para 34,9 (41,1-60,9) vs. 44,6 (35,8-73,3) para 45,6 (27,0-61,7) ml; P < 0,001; respectivamente). A qualidade de vida dos pacientes EMF-TF, quando comparados com o grupo EMF-Sed também melhorou após o período de treinamento físico (45±17 para 27±15 vs. 47±20 para 45 ± 23 pontos; P < 0,05; respectivamente). CONCLUSÃO: Esses resultados esclarecem que os pacientes com EMF se beneficiaram com o treinamento físico combinado, enfatizando a importância dessa ferramenta não farmacológica no tratamento clínico habitual desses pacientes / BACKGROUND: Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy (RCM), characterized by a diastolic dysfunction, but with preserved systolic function and preserved ejection fraction, except in severe cases, in which these two present mild reduction. Maximal oxygen consumption (VO2) is a marker of mortality in systolic heart failure (SHF). Although mortality in RCM can be similar to SHF, it is still unknown if physical training can improve peak VO2 in patients with EMF. The aim of the present study was to evaluate if 4 months of combined physical training could improve functional capacity and quality of life in patients with EMF. METHODS: Twenty one EMF patients (functional class II and III, NYHA) were divided into 2 groups: physical training (EMF-PT, n = 9) and sedentary (EMF-Sed, n = 12). Peak VO2, O2 pulse, deltaFC/deltaVO2 relation and deltaVO2/deltaW relation were evaluated by cardiopulmonary exercise test (CPX); end diastolic volume (EDV), stroke volume (SV) and left atrium diastolic volume were evaluated by echocardiography (Simpson); and quality of life was evaluated by Minnesota Living With Heart Failure Questionnaire (MLWHFQ). CPX results from EMF patients were compared to a healthy sedentary (HS) control group. Significance was considered P < 0,05. RESULTS: Age was not different between EMF-PT, EMF-Sed and HS (58 ± 9 vs. 55±8 vs. 53 ± 6 years, P = 0,31; respectively). EMF-PT group presented an increase in peak VO2 after training compared to EMF-Sed group, but was lower compared to HS (17,4 ± 3,0 to 19,7 ± 4,4 vs. 15,3 ± 3,0 to 15,0 ± 2.0 vs. 24,5 ± 4,6 ml/kg/min, P < 0,001; respectively). O2 pulse in EMF-PT group increased after training compared to EMFSed group, and was similar compared to HS (9,3 ± 2,6 to 11,1±2,8 vs. 8,6±2,2 to 8,6 ± 1 vs. 11,2±2,9 ml/betas; P < 0,05; respectively). deltaFC/deltaVO2 relation decreased after training in EMF-PT group compared to EMF-Sed group, and was similar compared to HS (75 ± 36 to 57 ± 14 vs. 68 ± 18 to 73 ± 14 vs. 56 ± 17 bpm/L; P < 0,05; respectively). deltaVO2/deltaW relation decreased after training in EMF-PT group compared to EMF-Sed group, and was similar compared to HS (12,3 ± 2.8 to 10,2 ± 1.9 vs. 12,6 ± 1.7 to 12,4 ± 1.7 vs. 10,0 ± 0,9 ml/min/Watts; P = 0,002; respectively). Physical training also increased EDV in EMF-PT compared to EMFSed (102,1±64,6 to 136,2±75,8 vs. 114,4±55,0 to 100,4±49,9 ml; P < 0,001; respectively) and SV (57,5±31,9 to 72,2±27,4 vs. 60,1±25,2 to 52,1±18,1 ml; P = 0,01; respectively), and decreased left atrium diastolic volume [69,0 (33,3-92,7) to 34,9 (41,1-60,9) vs. 44,6 (35,8- 73,3) to 45,6 (27,0-61,7) ml; P < 0,001; respectively). Quality of life in EMF-PT group improved after training when compared to EMF-Sed group (45±17 to 27±15 vs. 47 ± 20 to 45 ± 23 points; P < 0,05; respectively). CONCLUSION: These results point out that patients with EMF benefit from combined physical training emphasizing the importance of this nonpharmacological tool in the clinical treatment of these patients

Globally, out-of-hospital cardiac arrest (OHCA) occurs ranging between 20 to 140 per 100 000 people, with only 2-11% surviving. Immediate bystanders, i.e. a person close to the victim, performing Cardiopulmonary Resuscitation (CPR) have a vital role to play in the chain of survival from OHCA. Today CPR training takes place in many different contexts as workplaces and schools, but there is still a lack of knowledge concerning CPR in society at large. The overarching aim for this thesis is to find new ways of delivering CPR in order to train more laypeople and save more lives. By initially exploring CPR training in both workplaces and compulsory schools in Sweden, my final design question for this thesis has been: How might we empower the teachers to enable them to carry out CPR training at school? Ethnographic fieldwork both exploring CPR training in workplaces and schools including interviews with mainly instructors, teachers, and laypeople as well as participatory observations in CPR training, have been carried out. In addition, the fieldwork included being a participant in a CPR training course myself. The results from my research process were clustered into insights and potential opportunity areas. Departing from these insights a decision was made to continue the thesis with CPR training in schools as reaching out to children and young people already at school can open the path for more long-term sustainable knowledge. Despite CPR training being core content from year 7 in compulsory schools in Sweden, it is not carried out in a majority of them. My research shows that lack of CPR material as well as an unclear syllabus in Physical Education and Health in how to involve CPR in your teaching, are some of the main obstacles for teachers and reasons for why CPR training is not being carried out in every school today. Potential future scenarios were explored through creative workshops and idea sessions with the users and main stakeholders. The explorations led to focusing on the teachers, as they have a vital role in being the bridge between the CPR knowledge and the pupils. My final proposal is CiPRA: a collaborative CPR education platform for teachers and schools, with the aim to increase the knowledge and the conditions for teachers to carry out CPR training, starting already from six years of age. The structure of the platform follows the years of the Swedish school system and the recommended steps fromThe Swedish Resuscitation Council for CPR training and first aid. The platform enables teachers to plan and prepare CPR training, both long a short term irrespective of previous experience. The platform is based on three main parts; knowledge contributions from teachers, teaching content both through pre-made lessons and an idea bank as well as a shared booking system for practical CPR material. Together these parts unify in an individual lesson planning for every teacher. In my final design proposal, it has been important to emphasise the main insights as well as making sure that every involved stakeholder is represented.

Varje år sker omkring sextusen hjärtstopp utanför sjukhus i Sverige. Endast tio procent beräknas överleva. Ambulanssjuksköterskan har riktlinjer för hur hon ska påbörja, genomföra och eventuellt avsluta en hjärtlungräddning prehospitalt. Frågan om att avbryta en hjärtlungräddning är studerad i begränsad omfattning. Beslutet fattas under ansträngda förhållanden med etiska konflikter involverade, vilket kan påverka ambulanssjuksköterskan psykiska välbefinnande och hennes förmåga att vidare utföra sitt arbete. Syftet med studien är att beskriva upplevelsen av att avbryta hjärtlungräddning hos sjuksköterskor inom ambulanssjukvården och hur upplevelsen eventuellt påverkas av olika faktorer (förbättringspotentialer) kopplade såväl till ambulansorganisationen, vårdaren och omständigheterna kring hjärtstoppet. En kvalitativ intervjustudie har gjorts för att besvara studiens syfte. Tolv intervjuer genomfördes med ambulanssjuksköterskor från tre ambulansstationer i Västsverige. En öppen fråga med hänvisning till studiens syfte besvarades av informanterna. Resultatet indikerar att ambulanssjuksköterskan, vid den vanligaste varianten av hjärtstopp, inte upplever avbrytandet som särskilt problematiskt. Vidare visar studien på att omgivande faktorer i samband med avbrytandet har en påverkan på ambulanssjuksköterskan. Det som informanterna beskrev som viktigt i sammanhanget var samtalet med kollegan samt tid för återhämtning och reflektion efter en emotionellt påfrestande situation. Ambulanssjuksköterskan värnar om sin yrkesroll och för att bevara denna behöver de vissa förutsättningar i sin omgivning. Det är viktigt att organisationen kring ambulanssjuksköterskan tillser att dessa behov tillgodoses för att de på ett tillfredställande sätt ska kunna utföra sitt arbete och samtidigt inte påverkas allt för mycket på ett personligt plan. Ett nytt spår i utbildningen av hjärtlungräddning där ambulanssjuksköterskan får ökad kunskap i att hantera människor i sorg och kris samt att organisatoriskt beakta behovet av tid för samtal och reflektion, främst tillsammans med närmast kollegan, kan vara av värde i framtiden. / Every year, about six thousand cardiac arrests occur outside hospitals in Sweden. Only ten percent are estimated to survive. The ambulance nurse has guidelines for how she should start, carry out and possibly terminate a cardiopulmonary resuscitation in the prehospital setting. The problems surrounding termination of a cardiopulmonary resuscitation has been scarcely studied. The decision is made under strained conditions with ethical conflicts involved, which can affect the ambulance nurse's mental well-being and her ability to further carry out her work. The purpose of the study is to describe the experiences of interrupting cardiopulmonary resuscitation among nurses in ambulance care and how these experiences may be influenced by different factors (some of which may be amenable for improvement) and linked to the ambulance organization, the healthcare provider and circumstances at the event. A qualitative interview study has been performed to address the purpose of the study. Twelve interviews were conducted with ambulance nurses from three ambulance stations in western Sweden. An open-ended question with reference to the purpose of the study was answered by the informants. The result indicates that the ambulance nurse, during the most common type of cardiac arrest, does not experience the interruption as particularly problematic. Furthermore, the study shows that surrounding factors in connection with the interruption have an impact on the ambulance nurse. What the informants described as important in the context was the conversation with the colleague and time for recovery and reflection after an emotionally stressful situation. The ambulance nurse safeguards her professional role and in order to maintain this, they need certain conditions in the environment. It is important that the organization around the ambulance nurse ensures that these requirements are met so that she or he can carry out the work in a satisfactory manner and at the same time not be affected too much on a personal level. A new track in the training of cardiopulmonary resuscitation where the ambulance nurse gains increased knowledge in dealing with people in grief and crisis and to organizationally consider the need for time for conversation and reflection, mainly together with the closest colleague, may be of value in the future.

OBJECTIVES: Standard blood flow rates for cardiopulmonary bypass have been assumed to be the same for awake cardiac surgery with thoracic epidural anesthesia as for general anesthesia. However, compared to general anesthesia, awake cardiac surgery with epidural anesthesia may be associated with higher oxygen consumption due to missing effect of general anesthetics. This may result in insufficient oxygen delivery and lactic acidosis when standard blood flow rates were used. The primary aim of our study was to investigate if standard blood flow rates are adequate in awake cardiac surgery. The secondary aim was to evaluate postoperative clinical outcomes of patients undergoing awake cardiac surgery. METHODS: Forty-seven patients undergoing elective on-pump cardiac surgery were assigned to receive either epidural (Group TEA, n=17), combined (Group TEA-GA, n=15) or general (Group GA, n=15) anesthesia. To monitor adequacy of standard blood flow rates, arterial lactate, acid base parameters, central venous and jugular bulb saturation were measured at six time points during in all groups. Blood flow rates were adjusted when needed. Subsequently, early and late postoperative outcome data including hospital and 3-year mortality was recorded and compared among the study groups RESULTS: No lactic acidosis has...

Syfte och frågeställningar: Syftet med studien är att undersöka hur undervisning i hjärt-lungräddning kommer till uttryck i ämnet idrott och hälsa. För att uppnå studiens syfte kommer följande frågeställningar att besvaras: Hur tolkar lärare i ämnet idrott och hälsa styrdokumenten vad gäller HLR i årskurs 7-9? Hur undervisar lärare i HLR i årskurs 7-9? Vilka förutsättningar har lärare i idrott och hälsa att bedriva undervisning i HLR i årskurs 7-9?  Metod: Studiens metod är en kvalitativ ansats, varpå datainsamling har genomförts med semistrukturerade intervjuer. De sju lärare som deltar i studien har valts ut genom två olika urval, målstyrt urval och bekvämlighetsurval. Intervjuerna genomfördes digitalt via Zoom, Meet och Teams. Empirin transkriberades digitalt samt genom manuell hantering, och analyserades med hjälp av en tematisk analys. Studiens teoretiska ramverk är läroplansteori och ramfaktorteori. Resultat: Lärarna anser att läroplanen genom centralt innehåll är undervisningens kodex. HLR är ett explicit begrepp i centralt innehåll men saknar definition vilket lämnar utrymme för lärarna att göra sina tolkningar av begreppet. HLR sätts i relation till simning och anses vara ett viktigt moment i undervisningen. Undervisningen i HLR kommer till uttryck i varierande omfattning. Momentet undervisas såväl teoretiskt som praktiskt, där video är en återkommande metod i undervisningen. Eleverna ges möjlighet att öva praktiskt med hjälp av övningsdockor. Praktisk träning av bröstkompressioner ingår i samtliga lärares undervisning av HLR, medan inblåsningar är ett teoretiskt moment. Lärarnas förutsättningar ser olika ut där ramfaktorer som exempelvis kunskap, utrustning och tid påverkar undervisningen i HLR.  Slutsats: Lärarna tolkar HLR i det centrala innehållet sett från eget perspektiv och förmåga. Det är lärarnas kunskaper i och om HLR samt deras förutsättningar som är avgörande för hur HLR kommer till uttryck i undervisningen. Lärarna tolkar och navigerar styrdokumenten med hjälp av erfarenhet och kunskap, vilket innebär att undervisningen i HLR kommer till uttryck på olika sätt. Lärarna utmanas av en mängd olika ramfaktorer vilka har mer eller mindre inverkan på undervisningen. / Aim and research questions: The aim of the study is to investigate how teaching in cardiopulmonary resuscitation is expressed when teaching physical education and health. In order to achieve the aim of the study, the following questions will be answered: How do teachers in physical education and health interpret the curriculum regarding CPR in grades 7-9? How do teachers teach CPR in grades 7-9? What prerequisites do physical education and health teachers have to teach CPR in grades 7-9?  Method: The study's method is a qualitative approach, after which data has been collected with semi-structured interviews. The seven teachers participating in the study have been selected through two different samplings, goal-directed sampling and convenience sampling. The interviews were conducted digitally via Zoom, Meet and Teams. Data was transcribed digitally as well as through manual handling, and analyzed using a thematic analysis. The study's theoretical framework is curriculum theory and frame factor theory. Results: The teachers believe that the curriculum, through central content, is the teaching code. CPR is an explicit expression of the concept in central content but lacks a definition, which leaves room for the teachers to make their own interpretations of the concept. CPR is put in relation to swimming and is considered an important part of teaching. Teaching in CPR is expressed to varying extents. CPR is taught both theoretically and practically, where video is a recurring method in the teaching. The students are given the opportunity to practice practically with the help of a practice dummy. Practical training of chest compressions is included in all teachers' teaching of CPR, while inhalations are a theoretical part. The teachers' conditions look different where frame factors such as knowledge, equipment and time affect the teaching of CPR. Conclusions: The teachers interpret CPR in the central content from their own perspective and ability. It is the teachers' knowledge of and about CPR as well as their prerequisites that are decisive for how CPR is expressed in teaching. The teacher’s interpret and navigate the curriculum with help of experience and knowledge, which means that the teaching of CPR is expressed in different ways. The teachers are challenged by a variety of frame factors which have more or less impact on the teaching. / <p>Uppsatsen tilldelades stipendiemedel ur Överste och Fru Adolf Johnssons fond 2023.</p>

Au Canada, on estime que 30 000 chirurgies cardiaques sont effectuées chaque année (1). L'insuffisance ventriculaire droite demeure une complication courante chez les patients subissant une chirurgie cardiaque. L'incidence de l’insuffisance ventriculaire droite périopératoire aiguë sévère peut aller de 0,1 % après une cardiotomie à 20 à 30 % après l'implantation d'un dispositif d'assistance ventriculaire gauche (2). La survenue d'une défaillance ventriculaire droite est encore plus fréquente en présence d'hypertension pulmonaire. Les conséquences de l'insuffisance ventriculaire droite en chirurgie cardiaque comprennent une détérioration périopératoire et des effets indésirables tels qu'un sevrage difficile de la circulation extracorporelle, une utilisation accrue d'agents vasoactifs intraveineux, et un risque accru de mortalité. Par conséquent, le diagnostic et le traitement de l’hypertension pulmonaire et de la dysfonction ventriculaire droite sont essentiels dans la période périopératoire pour éviter les complications. La surveillance simultanée et en continue des courbes de pression de l’artère pulmonaire et du ventricule droit à l'aide du cathétérisme de l'artère pulmonaire est un outil de surveillance important chez les patients en chirurgie cardiaque pour la détection précoce d'un dysfonctionnement du ventricule droit et pour évaluer la réponse au traitement. Les stratégies thérapeutiques dans ce contexte devraient se concentrer sur la réduction de la postcharge du ventricule droit et l'amélioration de la fonction du ventricule droit tout en évitant l'hypotension systémique. Les hypothèses de cette thèse sont les suivantes : 1) les vasodilatateurs inhalés sont supérieurs aux agents administrés par voie intraveineuse pour le traitement et la gestion de l’hypertension pulmonaire en chirurgie cardiaque, 2) la combinaison d'époprosténol inhalé et de la milrinone inhalée (iE&iM) est une stratégie efficace pour faciliter le sevrage de la circulation extracorporelle et pour réduire les besoins en inotropes intraveineux, 3) tous les patients n'ont pas une réponse vasodilatatrice positive à la combinaison de l’iE&iM, 4) la réponse à l’iE&iM est associée à des changements des courbes de pression du ventricule droit et de l’artère pulmonaire, et 5) le gradient de la chambre de chasse du ventricule droit et la vitesse d’augmentation de la pression intraventriculaire droite (dP/dt) ont le potentiel d'être des marqueurs pharmacodynamiques de la réponse au traitement. Le travail compris dans cette thèse consiste en 3 études. La première est une revue systématique et méta-analyse d'essais contrôlés randomisés démontrant que l'administration de vasodilatateurs inhalés pour le traitement de l’hypertension pulmonaire pendant la chirurgie cardiaque est associée à une amélioration de la performance du ventricule droit comparé aux agents administrés par voie intraveineuse. La deuxième étude est une analyse de cohorte rétrospective de 128 patients recevant l’iE&iM avant la circulation extracorporelle. Cette étude a démontré une réponse vasodilatatrice au traitement par l’iE&iM chez 77% des patients. Une réponse favorable était associée à un sevrage facile de la circulation extracorporelle plus fréquent et à une utilisation plus faible d'inotropes intraveineux. De plus, cette étude a également démontré qu'une hypertension pulmonaire plus sévère est prédictive d'une réponse vasodilatatrice pulmonaire positive, tandis qu'un European System for Cardiac Operative Risk Evaluation score (EuroSCORE) II élevé est un prédicteur de non-réponse au traitement. La dernière étude de cette thèse est une étude de cohorte prospective incluant 26 patients recevant iE&iM avec surveillance continue de la courbe de pression du ventricule droit démontrant l'innocuité et l'efficacité de cette approche thérapeutique dans l'amélioration de la fonction ventriculaire droite. / In Canada there is an estimated 30,000 cardiac surgeries that are performed each year (1). Right ventricular failure (RVF) remains a common complication in patients undergoing cardiac surgery. The incidence of severe acute perioperative RVF can range from 0.1% after cardiotomy to 20-30% after left ventricular assist device implantation (2). The occurrence of RVF is even more frequent in the presence of pulmonary hypertension (PH). Consequences of RVF in cardiac surgery include perioperative deterioration and adverse outcomes such as difficult separation from cardiopulmonary bypass (CPB), increased use of intravenous (IV) vasoactive agents and an increased risk of mortality. Therefore, the diagnosis and treatment of PH and right ventricular (RV) dysfunction is essential in the perioperative period to circumvent complications. Continuous and simultaneous monitoring of both pulmonary artery pressure (Ppa) and RV pressure (Prv) waveforms using pulmonary artery catheterization is an important monitoring tool in cardiac surgery patients for early detection of RV dysfunction and for evaluating response to treatment. Therapeutic strategies in this context should focus on reducing RV afterload and improving RV function while avoiding systemic hypotension. The hypotheses of this thesis are the following: 1) inhaled aerosolized vasodilators are superior to IV administered agents for the treatment and management of PH in cardiac surgery, 2) the combination of inhaled epoprostenol and inhaled milrinone (iE&iM) is an effective strategy to facilitate separation from CPB and reduce the requirements for IV inotropes, 3) not all patients have a positive vasodilator response to iE&iM, 4) response to iE&iM is associated with changes in RV and PA pressure waveforms, and 5) RV outflow tract (RVOT) gradient and RV maximal rate of pressure rise during early systole (dP/dt) have the potential to be pharmacodynamic markers of response to treatment. The work comprised in this thesis consist of 3 studies. The first is a systematic review and meta-analysis of randomized controlled trials showing that administration of inhaled vasodilators for the treatment of PH during cardiac surgery is associated with improved RV performance compared to IV administered agents. The second study is a retrospective cohort analysis of 128 patients receiving iE&iM before CPB. This study showed that 77% of patients have a vasodilator response to iE&iM treatment. A favorable vasodilator response was associated with more frequent easy separation from CPB and lower use of IV inotropes post-CPB. In addition, more severe PH at baseline is shown to be predictive of a positive pulmonary vasodilator response while high European System for Cardiac Operative Risk Evaluation score (EuroSCORE) II is a predictor of non-response to treatment. The last study of this thesis is a prospective cohort study including 26 patients receiving iE&iM with continuous monitoring of Prv waveform demonstrating the safety and efficacy of this treatment approach in improving RV function.

Varje år drabbas ungefär 10 000 personer i Sverige av plötsligt hjärtstopp där chansen att överleva ett utanför sjukhus endast är 10%. Vid ett plötsligt hjärtstopp har tidigt startad hjärt-lungräddning visat sig fördubbla chanserna till överlevnad, vilket gör det till en livsviktig behandling. Hjärt-lungräddning måste däremot utföras på ett korrekt sätt och därmed presenteras riktlinjer för hur behandlingen ska utföras. Riktlinjer uppdateras ständigt för att behandlingen ska bli så effektiv som möjligt vilket har visat sig kunna leda till mindre kunskap samt ett sämre utförande när träning inom hjärt-lungräddning inte utförs kontinuerligt samt på ett korrekt sätt. Tidigare studier har därmed visat på svårigheter vid utförandet av behandlingen, där exempelvis flertalet personer har svårt att nå rätt kompressionsdjup. Denna studie ämnar därför att möta detta problem genom att tillsammans med Vital Signs och deras produkt CPR-guide undersöka huruvida tekniska hjälpmedel som ger feedback i realtid kan förbättra utförandet av kompressioner vid hjärt-lungräddning. Därmed är syftet med studien att undersöka om användningen av Vital Signs CPR-guide i samband med genomförande av hjärt-lungräddning förbättrar personer utan medicinsk bakgrunds utförande av behandlingen. Vidare formuleras studiens frågeställning på detta sätt: Hur skiljer sig utförandet av hjärt-lungräddning av bystanders med teknologiskt stöd jämfört med utförandet utan teknologiskt stöd utifrån European Resuscitation Council senaste riktlinjer? Studiens tester utfördes på 25 personer som fick utföra kompressioner på en docka som registrerade varje kompressions djup och takt. Testpersonerna började med att utföra hjärt-lungräddning i 1 minut utan något tekniskt hjälpmedel för att sedan utföra kompressionerna i 1 minut till, men denna gång med CPR-guide som tekniskt hjälpmedel. Utförandena med- och utan tekniskt hjälpmedel analyserades och jämfördes sedan för att se eventuell förbättring. Resultatet av studien visade att utförandet förbättrades avsevärt vid användning av tekniskt hjälpmedel. Det sammanslagna medelvärdet för utförandena ökade från 46,08 % till 82,40%, vilket innebär en förbättring på nästan det dubbla. Även takten för kompressionerna förbättrades från 96,92 kompressioner per minut till 109,40 kompressioner per minut. Förändringen innebar att kompressionerna gick från att vara för långsamma enligt riktlinjerna till en takt som hamnar inom riktlinjerna. Samma förbättring registrerades även för djupet på kompressionerna där testerna utan CPR-guide registrerade ett medelvärde under riktlinjerna på 46,60 för att sedan, med CPR-guide, hamna inom riktlinjerna med ett medelvärde på 51,48. Studiens resultat bekräftar och förstärker tidigare forskning inom området, som har visat på förbättringar i hjärt-lungräddning när tekniska hjälpmedel används. Detta nya bidrag till kunskap kan ha en betydande inverkan på fortsatt forskning och ökad förståelse för vikten av teknologiskt stöd i akuta situationer. Resultaten pekar på möjligheter till kvalitetshöjning vid hjärt-lungräddning och påvisar det unika och viktiga perspektiv som denna studie har tillfört. / Every year, 10,000 people in Sweden suffer from a sudden cardiac arrest, where the chance of surviving outside the hospital is only 10%. In the event of a sudden cardiac arrest, early CPR has been shown to double the chances of survival, making it a vital treatment. Cardiopulmonary resuscitation, on the other hand, must be carried out in a correct way and thus guidelines are presented for how the treatment should be carried out. Guidelines that are constantly updated so that the treatment is as effective as possible, which has been shown to lead to less knowledge and poorer performance when training in cardiopulmonary resuscitation is not carried out continuously and in a correct manner. Previous studies have thus shown difficulties in performing the treatment, where, for example, the majority of people find it difficult to reach the right depth. This study therefore aims to address this problem by investigating, together with Vital Signs and their product CPR-guide, whether technical aids that provide real-time feedback can improve the performance of compressions in cardiopulmonary resuscitation. Thus, the purpose of the study is to investigate whether the use of the Vital Signs CPR-guide in connection with the implementation of cardiopulmonary resuscitation improves the performance of the treatment by people without a medical background. Furthermore, the study's question is formulated in this way: How does the performance of cardiopulmonary resuscitation by bystanders with technological support differ compared to the performance without technological support based on the European Resuscitation Council's latest guidelines? The study's tests were performed on 25 people who were asked to perform compressions on a dummy that recorded the depth and rate of each compression. The test subjects started by performing cardiopulmonary resuscitation for 1 minute without any technical aid and then performed the compressions for 1 more minute, but this time with the CPR-guide as a technical aid. The executions with and without a technical aid were analyzed and then compared to see any improvement. The results of the study showed that performance improved significantly when using technical aids. The combined average of the executions increased from 46.08% to 82.40%, an improvement of almost twofold. The rate of compressions also improved from 96.92 compressions per minute to 109.40 compressions per minute. An improvement that means the compressions went from being too slow according to the guidelines to a rate that falls within the guidelines. The same improvement was also recorded for the depth of compressions where the tests without the CPR-guide recorded a mean value below the guidelines of 46.60 and then, with the CPR-guide, fell within the guidelines with a mean value of 51.48. The study's results confirm and reinforce previous research in the field, which has shown improvements in cardiopulmonary resuscitation when technical aids are used. This new contribution to knowledge may have a significant impact on continued research and increased understanding of the importance of technological support in emergency situations. The results point to opportunities for quality improvement in cardiopulmonary resuscitation and demonstrate the unique and important perspective that this study has brought.

In patients after cardiac surgery, there is an increase in the level of molecules with both pro-inflammatory and anti-inflammatory effects. This increase is influenced by the patient's clinical condition, but also by the nature of the operation itself, which uses conventional extracorporeal circulation. This technique leads to damage to blood elements by direct contact with air and parts of the extracorporeal circulation, as well as to ischemia-reperfusion injury. The specifics of cardiac surgery then affect possible postoperative complications such as multiorgan failure or septic shock. The diploma thesis is divided into a theoretical and a practical part. The theoretical part describes the principle and influence of cardiopulmonary bypass on the human body and the complications that are associated with its use. Furthermore, IFN-γ is described herein as a potential marker of septic conditions that could reflect the clinical postoperative condition of patients. The practical part of the diploma thesis monitored the percentage change of selected cell populations and the production of IFN-γ in the peripheral blood of patients before and after cardiac surgery. Furthermore, the response of individual isolated populations of healthy volunteers to selected stimulators was investigated. The percentage of...

Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) is secreted by cardiac ventricular myocytes upon pressure and volume overload and is a prognostic marker to monitor the severity of precapillary pulmonary hypertension and the extent of right heart failure. Objectives: The impact of physical exercise on NT-proBNP levels in patients with left heart disease was demonstrated previously. No data regarding patients with isolated right heart failure and the influence of acute exercise on NT-proBNP serum levels exist. Methods: Twenty patients with precapillary pulmonary hypertension were examined. Hemodynamic parameters were measured during right heart catheterization. Serum NT-proBNP of patients was measured at rest, after a 6-min walking test, during ergospirometry and during recovery, all within 7 h. Significant differences in sequential NT-proBNP values, relative changes compared to values at rest and the correlation between NT-proBNP and obtained parameters were assessed. Results: At rest, the mean serum level of NT-proBNP was 1,278 ± 998 pg/ml. The mean level of NT-proBNP at maximal exercise was increased (1,592 ± 1,219 pg/ml), whereas serum levels decreased slightly during recovery (1,518 ± 1,170 pg/ml). The relative increase of serum NT-proBNP during exercise correlated with pulmonary vascular resistance (r = 0.45; p = 0.026) and cardiac output (r = –0.5; p = 0.015). Conclusions: In this study, we demonstrated acute changes in NT-proBNP levels due to physical exercise in a small group of patients with precapillary pulmonary hypertension. Our results also confirm the predominant usefulness of NT-proBNP as an intraindividual parameter of right heart load. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

No description available.