Malene Schou Nielsson

Mortality in elderly ICU patients: a cohort study.

The population is aging. We examined changes in the proportion of elderly (≥ 80 years) intensive care unit (ICU) patients during 2005–2011 and the association between age and mortality controlling for preexisting morbidity.

Validity of the coding for intensive care admission, mechanical ventilation, and acute dialysis in the Danish National Patient Registry: a short report.

Background Large health care databases provide a cost-effective data source for observational research in the intensive care unit (ICU) if the coding is valid. The aim of this study was to investigate the accuracy of the recorded coding of ICU admission, mechanical ventilation, and acute dialysis in the population-based Danish National Patient Registry (DNPR). Methods We conducted the study in the North Denmark Region, including seven ICUs. From the DNPR we selected a total of 150 patients with an ICU admission by the following criteria: (1) 50 patients randomly selected among all patients registered with an ICU admission code, (2) 50 patients with an ICU admission code and a concomitant code for mechanical ventilation, and (3) 50 patients with an ICU admission code and a concomitant code for acute dialysis. Using the medical records as gold standard we estimated the positive predictive value (PPV) for each of the three procedure codes. Results We located 147 (98%) of the 150 medical records. Of these 147 patients, 141 (95.9%; 95% confidence interval [CI]: 91.8–98.3) had a confirmed ICU admission according to their medical records. Among patients, who were selected only on the coding for ICU admission, the PPV for ICU admission was 87.2% (95% CI: 75.6–94.5). For the mechanical ventilation code, the PPV was 100% (95% CI: 95.1–100). Forty-nine of 50 patients with the coding for acute dialysis received this treatment, corresponding to a PPV of 98.0% (95% CI: 91.0–99.8). Conclusion We found a high PPV for the coding of ICU admission and even higher PPVs for mechanical ventilation, and acute dialysis in the DNPR. The DNPR is a valuable data source for observational studies of ICU patients.

Impact of Bispectral Index for monitoring propofol remifentanil anaesthesia. A randomised clinical trial

Previous research has shown that the use of the bispectral index (BIS) monitor to measure the depth of anaesthesia reduces the amount of anaesthetics administered and the recovery time from general anaesthesia. The effect of BIS on recovery from anaesthesia and consumption of anaesthetics in a paediatric population receiving total intravenous anaesthesia (TIVA) with propofol and remifentanil has not been studied.

Birth and Neonatal Outcomes Following Opioid Use in Pregnancy: A Danish Population-Based Study

Background Few population-based data exist on birth outcomes in women who received opioid maintenance treatment during pregnancy. We therefore examined adverse birth outcomes in women exposed to methadone or buprenorphine during pregnancy and the risk of neonatal abstinence syndrome (NAS) among neonates exposed to buprenorphine, methadone, and/or heroin in utero. Patients and Methods This study included all female Danish residents with a live birth or a stillbirth from 1997 to 211. We identified the study population, use of opioids and opioid substitution treatment, birth outcomes, and NAS through medical registers. Birth outcomes included preterm birth (born before 38th gestational week), low-birth weight (LBW) (<2,500 g, restricted to term births), small for gestational age (SGA) (weight <2 standard deviations from the sex- and gestational-week-specific mean), congenital malformations, and stillbirths. We used log-binomial regression to estimate the prevalence ratio (PR) for birth outcomes. Results Among 95,172 pregnancies in a total of 571,823 women, we identified 557 pregnancies exposed to buprenorphine, methadone, and/or heroin (167 to buprenorphine, 197 to methadone, 28 to self-reported heroin, and 165 to combinations). Compared with nonexposed pregnancies, prenatal opioid use was associated with greater prevalence of preterm birth (PR of 2.8 (95% confidence interval (CI), 2.3–3.4)), LBW among infants born at term (PR of 4.3 (95% CI, 3.0–6.1)), and being SGA (PR of 2.7 (95% CI, 1.9–4.3)). Restricting the analyses to women who smoked slightly lowered these estimates. The prevalence of congenital malformations was 8.3% in opioid-exposed women compared with 4.2% in nonexposed women (PR of 2.0 (95% CI, 1.5–2.6)). The risk of NAS ranged from 7% in neonates exposed to buprenorphine only to 55% in neonates exposed to methadone only or to opioid combinations. Conclusion The maternal use of buprenorphine and methadone during pregnancy was associated with increased prevalence of adverse birth outcomes, and this increase could only be explained to a smaller extent by increased prevalence of smoking. The risk of NAS was eight-fold higher in methadone-exposed neonates than that in buprenorphine-exposed neonates, but this difference may at least partly be explained by differences in underlying indications (analgesic versus opioid maintenance treatment) between the two groups.