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Savilampi, Johanna
Publications (10 of 13) Show all publications
Milton, A., Schandl, A., Soliman, I. W., Meijers, K., van den Boogaard, M., Larsson, I. M., . . . Sackey, P. V. (2018). Development of an ICU discharge instrument predicting psychological morbidity: a multinational study. Intensive Care Medicine, 44(12), 2038-2047
Open this publication in new window or tab >>Development of an ICU discharge instrument predicting psychological morbidity: a multinational study
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2018 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 44, no 12, p. 2038-2047Article in journal (Refereed) Published
Abstract [en]

Purpose: To develop an instrument for use at ICU discharge for prediction of psychological problems in ICU survivors.

Methods: Multinational, prospective cohort study in ten general ICUs in secondary and tertiary care hospitals in Sweden, Denmark and the Netherlands. Adult patients with an ICU stay12h were eligible for inclusion. Patients in need of neurointensive care, with documented cognitive impairment, unable to communicate in the local language, without a home address or with more than one limitation of therapy were excluded. Primary outcome was psychological morbidity 3months after ICU discharge, defined as Hospital Anxiety and Depression Scale (HADS) subscale score11 or Post-traumatic Stress Symptoms Checklist-14 (PTSS-14) part B score>45.

Results: A total of 572 patients were included and 78% of patients alive at follow-up responded to questionnaires. Twenty percent were classified as having psychological problems post-ICU. Of 18 potential risk factors, four were included in the final prediction model after multivariable logistic regression analysis: symptoms of depression [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.10-1.50], traumatic memories (OR 1.44, 95% CI 1.13-1.82), lack of social support (OR 3.28, 95% CI 1.47-7.32) and age (age-dependent OR, peak risk at age 49-65years). The area under the receiver operating characteristics curve (AUC) for the instrument was 0.76 (95% CI 0.70-0.81).

Conclusions: We developed an instrument to predict individual patients' risk for psychological problems 3months post-ICU, http://www.imm.ki.se/biostatistics/calculators/psychmorb/. The instrument can be used for triage of patients for psychological ICU follow-up.

Trial registration: The study was registered at clinicaltrials.gov, NCT02679157.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Intensive care, PICS, Follow-up, Depression, Post-traumatic stress, Anxiety
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-70858 (URN)10.1007/s00134-018-5467-3 (DOI)000452162900002 ()30467678 (PubMedID)2-s2.0-85057112977 (Scopus ID)
Note

Funding Agencies:

ALF Funding  

Olle Engqvist Byggmästare Foundation 

Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-07Bibliographically approved
Cock, C., Doeltgen, S. H., Omari, T. & Savilampi, J. (2018). Effects of remifentanil on esophageal and esophagogastric junction (EGJ) bolus transit in healthy volunteers using novel pressure-flow analysis. Neurogastroenterology and Motility, 30(2), Article ID e13191.
Open this publication in new window or tab >>Effects of remifentanil on esophageal and esophagogastric junction (EGJ) bolus transit in healthy volunteers using novel pressure-flow analysis
2018 (English)In: Neurogastroenterology and Motility, ISSN 1350-1925, E-ISSN 1365-2982, Vol. 30, no 2, article id e13191Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Remifentanil is associated with subjective dysphagia and an objective increase in aspiration risk. Studies of opioid effects have shown decreased lower esophageal sphincter relaxation. We assessed bolus transit through the esophagus and esophagogastric junction (EGJ) during remifentanil administration using objective pressure-flow analysis.

METHODS: Data from 11 healthy young participants (23±3 years, 7 M) were assessed for bolus flow through the esophagus and EGJ using high-resolution impedance manometry (Manoscan™, Sierra Scientific Instruments, Inc., LES Angeles, CA, USA) with 36 pressure and 18 impedance segments. Data were analyzed for esophageal pressure topography and pressure-flow analysis using custom Matlab analyses (Mathworks, Natick, USA). Paired t tests were performed with a P-value of < .05 regarded as significant.

KEY RESULTS: Duration of bolus flow through (remifentanil/R 3.0±0.3 vs baseline/B 5.0 ± 0.4 seconds; P < .001) and presence at the EGJ (R 5.1 ± 0.5 vs B 7.1 ± 0.5 seconds; P = .001) both decreased during remifentanil administration. Distal latency (R 5.2 ± 0.4 vs B 7.5 ± 0.2 seconds; P < .001) and distal esophageal distension-contraction latency (R 3.5 ± 0.1 vs B 4.7 ± 0.2 seconds; P < .001) were both reduced. Intrabolus pressures were increased in both the proximal (R 5.3 ± 0.9 vs B 2.6 ± 1.3 mm Hg; P = .01) and distal esophagus (R 8.6 ± 1.7 vs B 3.1 ± 0.8 mm Hg; P = .001). There was no evidence of increased esophageal bolus residue.

CONCLUSIONS AND INFERENCES: Remifentanil-induced effects were different for proximal and distal esophagus, with a reduced time for trans-sphincteric bolus flow at the EGJ, suggestive of central and peripheral μ-opioid agonism. There were no functional consequences in healthy subjects.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
Dysphagia, esophagus, motility, opioids
National Category
Medical Laboratory and Measurements Technologies Gastroenterology and Hepatology Neurology
Identifiers
urn:nbn:se:oru:diva-61712 (URN)10.1111/nmo.13191 (DOI)000427292000017 ()28833926 (PubMedID)2-s2.0-85040788155 (Scopus ID)
Note

Funding Agencies:

Australian National Health and Medical Research Council Senior Research Fellowship  APP1079715 

Research Fund of the Orebro County Council, Sweden 

Available from: 2017-11-13 Created: 2017-11-13 Last updated: 2018-08-16Bibliographically approved
Savilampi, J., Omari, T., Magnuson, A. & Ahlstrand, R. (2016). Effects of remifentanil on pharyngeal swallowing: A double blind randomised cross-over study in healthy volunteers. European Journal of Anaesthesiology, 33(9), 622-630
Open this publication in new window or tab >>Effects of remifentanil on pharyngeal swallowing: A double blind randomised cross-over study in healthy volunteers
2016 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 9, p. 622-630Article in journal (Refereed) Published
Abstract [en]

Background: Exposure to remifentanil increases the incidence of pulmonary aspiration in healthy volunteers. This effect may be explained by impairment of airway defence mechanisms and/or altered swallowing function. Pressure-flow analysis is a technique that allows objective assessment of swallowing based on pressure-impedance patterns recorded during bolus swallowing.

Objectives: The aim of this study was to use pressure-flow analysis to quantify the effect of remifentanil on healthy pharyngeal swallowing and to compare these effects with morphine.

Design: A double-blind, randomised, cross-over study.

Setting: A tertiary care teaching hospital.

Volunteers: Eleven young volunteers (mean age, 23 years) and seven older volunteers (mean age, 73 years).

Interventions: Volunteers were studied twice and received either a target-controlled remifentanil infusion (target concentrations: young, 3 ng ml; old, 2 ng ml) or a bolus injection of morphine (dose: young, 0.1 mg kg; old, 0.07 mg kg). Pharyngeal pressure and impedance were recorded with an indwelling catheter while swallowing 10 boluses of liquid during each measuring phase. Variables defining swallowing function were calculated and compared to determine drug effects.

Main outcome measures: Pharyngeal pressure-flow variables following remifentanil exposure.

Results: Changes produced by remifentanil in the measured variables were consistent with greater dysfunction of swallowing. Both the strength of the pharyngeal contractions and pharyngeal bolus propulsion were reduced, whereas flow resistance was increased. The swallow risk index, a global index of swallowing dysfunction, increased overall. At the experimental doses tested, morphine produced similar, but less extensive effects on swallowing.

Conclusion: Remifentanil induced dysfunction of the pharyngeal swallowing mechanism. This may contribute to an increased risk of aspiration.

Trial registration: NCT01924234

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-50384 (URN)10.1097/EJA.0000000000000461 (DOI)000380765800003 ()27191923 (PubMedID)2-s2.0-84980494750 (Scopus ID)
Note

Funding Agency:

Örebro County Council

Available from: 2016-05-30 Created: 2016-05-24 Last updated: 2018-09-18Bibliographically approved
Doeltgen, S. H., Omari, T. I. & Savilampi, J. (2016). Remifentanil alters sensory neuromodulation of swallowing in healthy volunteers: Quantification by a novel pressure-impedance analysis. American Journal of Physiology - Gastrointestinal and Liver Physiology, 310(11), G1176-G1182
Open this publication in new window or tab >>Remifentanil alters sensory neuromodulation of swallowing in healthy volunteers: Quantification by a novel pressure-impedance analysis
2016 (English)In: American Journal of Physiology - Gastrointestinal and Liver Physiology, ISSN 0193-1857, E-ISSN 1522-1547, Vol. 310, no 11, p. G1176-G1182Article in journal (Refereed) Published
Abstract [en]

Exposure to remifentanil contributes to an increased risk of pulmonary aspiration, likely through reduced pharyngeal contractile vigour and diminished bolus propulsion during swallowing. Here, we employed a novel high resolution pressure-flow analysis to quantify the biomechanical changes across the upper esophageal sphincter (UES). Eleven healthy young participants (mean age 23.3±3.1 years, 7 male) received remifentanil via intravenous target controlled infusion with an effect-site concentration of 3 ng/ml. Before and 30 min following commencement of remifentanil administration, participants performed ten 10 ml saline swallows while pharyngo-esophageal manometry and electrical impedance data were recorded using a 4.2 mm diameter catheter housing 36 circumferential pressure sensors. Remifentanil significantly shortened the time period of UES opening (p<0.001) and increased residual UES pressure (p=0.003). At the level of the hypopharynx, remifentanil significantly shortened the time latency from maximum bolus distension to peak contraction (p=0.004) and significantly increased intrabolus distension pressure (p=0.024). Novel mechanical states analysis revealed that the latencies between the different phases of the stereotypical UES relaxation sequence were shortened by remifentanil. Reduced duration of bolus flow during shortened UES opening in concert with increased hypopharyngeal distension pressures are mechanically consistent with increased flow resistance due to a more rapid bolus flow rate. These biomechanical changes are congruent with modification of the physiologic neuro-regulatory mechanism governing accommodation to bolus volume.

Place, publisher, year, edition, pages
Bethesda, USA: American Physiological Society, 2016
Keywords
Remifentanil, swallowing, high resolution manometry, upper esophageal, sphincter, μ−opioid receptor
National Category
Physiology Gastroenterology and Hepatology
Research subject
Physiology
Identifiers
urn:nbn:se:oru:diva-50320 (URN)10.1152/ajpgi.00138.2016 (DOI)000377433200030 ()27151943 (PubMedID)
Note

Funding Agencies:

Research Fund of the Örebro County Council, Sweden OLL-367441

National Health and Medical Research Council Senior Research Fellowship APP1079715

Available from: 2016-05-27 Created: 2016-05-16 Last updated: 2018-07-10Bibliographically approved
Cock, C., Doeltgen, S., Omari, T. I. & Savilampi, J. (2016). Remifentanil induced changes in esophageal and esophagogastric junction (EGJ) bolus transport in healthy volunteers. Neurogastroenterology and Motility, 28(S1), 68-68
Open this publication in new window or tab >>Remifentanil induced changes in esophageal and esophagogastric junction (EGJ) bolus transport in healthy volunteers
2016 (English)In: Neurogastroenterology and Motility, ISSN 1350-1925, E-ISSN 1365-2982, Vol. 28, no S1, p. 68-68Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
National Category
Gastroenterology and Hepatology Neurology
Identifiers
urn:nbn:se:oru:diva-52830 (URN)000383290900218 ()
Available from: 2016-10-11 Created: 2016-10-06 Last updated: 2017-11-29Bibliographically approved
Savilampi, J., Ahlstrand, R., Geijer, H. & Wattwil, M. (2015). Aspiration during monitored anesthesia care reply [Letter to the editor]. Anesthesiology, 122(2), 472-472
Open this publication in new window or tab >>Aspiration during monitored anesthesia care reply
2015 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 122, no 2, p. 472-472Article in journal, Letter (Refereed) Published
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-44433 (URN)10.1097/ALN.0000000000000536 (DOI)000351734900032 ()25603213 (PubMedID)
Available from: 2015-04-24 Created: 2015-04-24 Last updated: 2018-06-29Bibliographically approved
Savilampi, J., Magnusson, A. & Ahlstrand, R. (2015). Effects of remifentanil on esophageal motility: A double blind, randomized, cross-over study in healthy volunteers. Acta Anaesthesiologica Scandinavica, 59(9), 1126-1136
Open this publication in new window or tab >>Effects of remifentanil on esophageal motility: A double blind, randomized, cross-over study in healthy volunteers
2015 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 9, p. 1126-1136Article in journal (Refereed) Published
Abstract [en]

Background: Recent studies have shown that remifentanil increases the risk of aspiration and induces subjective swallowing difficulties. The mechanisms are not completely understood. Here, we investigated whether remifentanil impairs esophageal motility and hypothesized that this is one possible underlying mechanism. Naloxone was used to evaluate whether the effects of remifentanil are mediated through opioid receptors. We also examined subjective swallowing difficulties and the influence of metoclopramide on remifentanil-induced effects.

Methods: Fourteen healthy volunteers participated in a double-blind, randomized, cross-over trial at the University Hospital in orebro, Sweden. They were studied on two different occasions, during which they were randomly assigned to receive either naloxone given as a bolus of 6g/kg followed by an infusion of 0.1g/kg/min, or saline 5min before target-controlled infusions of remifentanil at three target-site concentrations: 1, 2, and 3 ng/ml. On both occasions, 0.2mg/kg metoclopramide was given before the final measurement. Five swallows were performed during each measuring condition, and the metrics defining esophageal motility were measured by high-resolution manometry. Outcomes were differences in the metrics at baseline vs. during remifentanil infusion, with naloxone vs. placebo, and with remifentanil before and after metoclopramide administration. Differences in swallowing difficulties were also recorded.

Results: Remifentanil decreased swallow-evoked esophagogastric junction relaxation and the latency time of esophageal peristalsis. There were no significant effects of naloxone or metoclopramide on remifentanil-induced effects, and we detected no differences in swallowing difficulties.

Conclusions: Remifentanil induces dysfunction of esophageal motility; this may contribute to the elevated risk of regurgitation and aspiration.

National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-44661 (URN)10.1111/aas.12534 (DOI)000360982900006 ()25923045 (PubMedID)2-s2.0-84941254659 (Scopus ID)
Note

Funding Agency:

Örebro County Council

Available from: 2015-05-20 Created: 2015-05-20 Last updated: 2018-06-30Bibliographically approved
Savilampi, J. (2015). Effects of remifentanil on esophageal sphincters and swallowing function. (Doctoral dissertation). Örebro: Örebro university
Open this publication in new window or tab >>Effects of remifentanil on esophageal sphincters and swallowing function
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Örebro: Örebro university, 2015. p. 57
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 119
Keywords
Pulmonary aspiration, postoperative lung complications, silent aspiration, defence against pulmonary aspiration, remifentanil, competence, of esophageal sphincters, esophageal peristalsis, pharyngeal swallowing, high resolution manometry
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-42216 (URN)978-91-7529-065-2 (ISBN)
Public defence
2015-04-17, Universitetssjukhuset, Wilandersalen, Södra Grev Rosengatan, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-01-26 Created: 2015-01-26 Last updated: 2017-10-17Bibliographically approved
Savilampi, J., Ahlstrand, R. & Magnuson, A. (2015). Effects of remifentanil on pharyngeal swallowing: a double blind, randomized, cross-over study in healthy volunteers. Paper presented at 33rd Congress of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine, Reykjavik, Iceland, June 10, 2015. Acta Anaesthesiologica Scandinavica, 59, 46-46
Open this publication in new window or tab >>Effects of remifentanil on pharyngeal swallowing: a double blind, randomized, cross-over study in healthy volunteers
2015 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, p. 46-46Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell, 2015
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-45306 (URN)000356009400128 ()
Conference
33rd Congress of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine, Reykjavik, Iceland, June 10, 2015
Available from: 2015-07-22 Created: 2015-07-20 Last updated: 2017-12-04Bibliographically approved
Savilampi, J., Ahlstrand, R., Magnuson, A., Geijer, H. & Wattwil, M. (2014). Aspiration Induced by Remifentanil: A Double-blind, Randomized, Crossover Study in Healthy Volunteers. Anesthesiology, 121(1), 52-58
Open this publication in new window or tab >>Aspiration Induced by Remifentanil: A Double-blind, Randomized, Crossover Study in Healthy Volunteers
Show others...
2014 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 121, no 1, p. 52-58Article in journal (Refereed) Published
Abstract [en]

Background: Remifentanil is widely used for monitored anesthesia care in spontaneously breathing patients. However, the authors' previous studies have shown that remifentanil induces subjective swallowing difficulties, which may increase the risk of aspiration.

Methods: Twenty-five healthy volunteers participated in a double-blind, randomized, crossover trial at the University Hospital in orebro, orebro, Sweden. The volunteers were studied on two different occasions during which they received either remifentanil with an effect-site target concentration of 3 ng/ml or saline over 1 h. A radionuclide tracer was infused simultaneously into the nasopharynx at a rate of 0.1 ml/min. Aspiration was determined by lung scans, and subjective swallowing difficulties and grip strength were evaluated. The primary outcome was the difference in occurrence of aspiration between remifentanil and placebo treatments. The secondary outcomes were differences in swallowing difficulty and grip strength and the association between aspiration and swallowing difficulty.

Results: During remifentanil and placebo infusion, 48 and 12% of the volunteers aspirated, respectively, difference: 36% (95% CI, 10 to 62%). A similar significant difference was found for swallowing difficulties but not for the association between aspiration and swallowing. No difference was found in grip strength between the two treatments.

Conclusions: Remifentanil infusion at concentrations used in monitored anesthesia care increases the incidence of aspiration. However, the subjective swallowing difficulty induced by remifentanil is not indicative of the aspiration risk.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2014
National Category
Anesthesiology and Intensive Care
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-35818 (URN)10.1097/ALN.0000000000000202 (DOI)000337758500010 ()24598216 (PubMedID)2-s2.0-84902874808 (Scopus ID)
Note

Funding Agency:

Research Fund of the Örebro County Council, Örebro, Sweden

Available from: 2014-08-27 Created: 2014-07-30 Last updated: 2018-06-09Bibliographically approved
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