Publications by authors named "B Nyholm"
Lower versus higher blood pressure targets during intensive care of comatose patients resuscitated from out-of-hospital cardiac arrest - A Bayesian analysis of the BOX trial.
Eur Heart J Acute Cardiovasc Care
December 2024
Background: The Blood Pressure and Oxygenation Targets After out-of-hospital cardiac arrest (BOX) trial found no statistically significant differences in mortality or neurological outcomes with mean arterial blood pressure targets of 63 versus 77 mmHg in patients receiving intensive care post-cardiac arrest. In this study, we aimed to evaluate the effect on 1-year mortality and assess heterogeneity in treatment effects (HTE) using Bayesian statistics.
Methods: We analyzed 1-year all-cause mortality, 1-year neurological outcomes, and plasma neuron-specific enolase (NSE) at 48 hours using Bayesian logistic and linear regressions primarily with weakly informative priors.
Article Synopsis
- Out-of-hospital cardiac arrest (OHCA) survivors are at high risk for brain injury, leading to potential withdrawal of life support; accurate neuroprognostication methods, like automated pupillometry, are crucial to avoid premature decisions.
- In a multi-center study involving 710 comatose OHCA patients, the research aimed to validate specific pupillometry thresholds—NPi ≤ 2 and qPLR < 4%—to predict unfavorable neurological outcomes without false positives.
- Results showed that the proposed pupillometry thresholds were effective in predicting poor outcomes at various time points and improved the sensitivity of neuron-specific enolase (NSE) testing, supporting a multimodal approach to neuropro
Background: To assess the effect of targeting higher or lower blood pressure during postresucitation intensive care among comatose patients with out-of-hospital cardiac arrest with a history of heart failure.
Methods: The BOX trial (Blood Pressure and Oxygenation Targets After Out-of-Hospital Cardiac Arrest) was a randomized, controlled, double-blinded, multicenter study comparing titration of vasopressors toward a mean arterial pressure (MAP) of 63 versus 77 mm Hg during postresuscitation intensive care. Patients with a history of heart failure were included in this substudy.
Background: Identifying covert consciousness in intensive care unit (ICU) patients with coma and other disorders of consciousness (DoC) is crucial for treatment decisions, but sensitive low-cost bedside markers are missing. We investigated whether automated pupillometry combined with passive and active cognitive paradigms can detect residual consciousness in ICU patients with DoC.
Methods: We prospectively enrolled clinically low-response or unresponsive patients with traumatic or nontraumatic DoC from ICUs of a tertiary referral center.
Article Synopsis
- - The BOX trial examined the effects of different blood pressure and oxygenation targets, as well as varying durations of fever prevention, on the health outcomes of comatose patients after cardiac arrest, ultimately finding no significant differences in long-term disability or mortality rates.
- - Conducted as a randomized controlled trial, 789 patients were assigned to either low or high blood pressure targets, restrictive or liberal oxygenation levels, and differing durations of fever control, with a one-year follow-up for mortality.
- - Results showed similar one-year mortality rates across all tested interventions, indicating that neither the low/high blood pressure nor the restrictive/liberal oxygenation strategies significantly impacted patient survival outcomes after one year.