Knut Arvid Kirkebøen

• Hisdal, Jonny; Landsverk, Svein A.; Hoff, Ingrid Elise Taraldsrud; Hagen, Ove Andreas; Kirkebøen, Knut Arvid & Høiseth, Lars Øivind (2019). Associations between changes in precerebral blood flow and cerebral oximetry in the lower body negative pressure model of hypovolemia in healthy volunteers. PLOS ONE. 14(6), s. 1–14. doi: 10.1371/journal.pone.0219154. Fulltekst i vitenarkiv Vis sammendrag

  Reductions in cerebral oxygen saturation (ScO2) measured by near infra-red spectroscopy have been found during compensated hypovolemia in the lower body negative pressure (LBNP)-model, which may reflect reduced cerebral blood flow. However, ScO2 may also be contaminated from extracranial (scalp) tissues, mainly supplied by the external carotid artery (ECA), and it is possible that a ScO2 reduction during hypovolemia is caused by reduced scalp, and not cerebral, blood flow. The aim of the present study was to explore the associations between blood flow in precerebral arteries and ScO2 during LBNP-induced hypovolemia. Twenty healthy volunteers were exposed to LBNP 20, 40, 60 and 80 mmHg. Blood flow in the internal carotid artery (ICA), ECA and vertebral artery (VA) was measured by Doppler ultrasound. Stroke volume for calculating cardiac output was measured by suprasternal Doppler. Associations of changes within subjects were examined using linear mixed-effects regression models. LBNP reduced cardiac output, ScO2 and ICA and ECA blood flow. Changes in flow in both ICA and ECA were associated with changes in ScO2 and cardiac output. Flow in the VA did not change during LBNP and changes in VA flow were not associated with changes in ScO2 or cardiac output. During experimental compensated hypovolemia in healthy, conscious subjects, a reduced ScO2 may thus reflect a reduction in both cerebral and extracranial blood flow.

• Hoff, Ingrid Elise Taraldsrud; Høiseth, Lars Øivind; Kirkebøen, Knut Arvid & Landsverk, Svein A. (2019). Volumetric and end-tidal capnography for the detection of cardiac output changes in mechanically ventilated patients early after open heart surgery. Critical Care Research and Practice. ISSN 2090-1305. 2019:6393649, s. 1–9. doi: 10.1155/2019/6393649. Fulltekst i vitenarkiv Vis sammendrag

  Background. Exhaled carbon dioxide (CO2) reflects cardiac output (CO) provided stable ventilation and metabolism. Detecting CO changes may help distinguish hypovolemia or cardiac dysfunction from other causes of haemodynamic instability. We investigated whether CO2 measured as end-tidal concentration (EtCO2) and eliminated volume per breath (VtCO2) reflect sudden changes in cardiac output (CO). Methods. We measured changes in CO, VtCO2, and EtCO2 during right ventricular pacing and passive leg raise in 33 ventilated patients after open heart surgery. CO was measured with oesophageal Doppler. Results. During right ventricular pacing, CO was reduced by 21% (CI 18–24; p < 0.001), VtCO2 by 11% (CI 7.9–13; p < 0.001), and EtCO2 by 4.9% (CI 3.6–6.1; p < 0.001). During passive leg raise, CO increased by 21% (CI 17–24; p < 0.001), VtCO2 by 10% (CI 7.8–12; p < 0.001), and EtCO2 by 4.2% (CI 3.2–5.1; p < 0.001). Changes in VtCO2 were significantly larger than changes in EtCO2 (ventricular pacing: 11% vs. 4.9% (p < 0.001); passive leg raise: 10% vs. 4.2% (p < 0.001)). Relative changes in CO correlated with changes in VtCO2 (p = 0.53; p = 0.002) and EtCO2 (p = 0.47; p = 0.006) only during reductions in CO. When dichotomising CO changes at 15%, only EtCO2 detected a CO change as judged by area under the receiver operating characteristic curve. Conclusion. VtCO2 and EtCO2 reflected reductions in cardiac output, although correlations were modest. The changes in VtCO2 were larger than the changes in EtCO2, but only EtCO2 detected CO reduction as judged by receiver operating characteristic curves. The predictive ability of EtCO2 in this setting was fair. This trial is registered with NCT02070861.

• Hoff, Ingrid Elise Taraldsrud; Hisdal, Jonny; Landsverk, Svein A.; Røislien, Jo; Kirkebøen, Knut Arvid & Høiseth, Lars Øivind (2019). Respiratory variations in pulse pressure and photoplethysmographic waveform amplitude during positive expiratory pressure and continuous positive airway pressure in a model of progressive hypovolemia. PLOS ONE. 14:e0223071(9), s. 1–15. doi: 10.1371/journal.pone.0223071. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Respiratory variations in pulse pressure (dPP) and photoplethysmographic waveform amplitude (dPOP) are used for evaluation of volume status in mechanically ventilated patients. Amplification of intrathoracic pressure changes may enable their use also during spontaneous breathing. We investigated the association between the degree of hypovolemia and dPP and dPOP at different levels of two commonly applied clinical interventions; positive expiratory pressure (PEP) and continuous positive airway pressure (CPAP). Methods 20 healthy volunteers were exposed to progressive hypovolemia by lower body negative pressure (LBNP). PEP of 0 (baseline), 5 and 10 cmH2O was applied by an expiratory resistor and CPAP of 0 (baseline), 5 and 10 cmH2O by a facemask. dPP was obtained non-invasively with the volume clamp method and dPOP from a pulse oximeter. Central venous pressure was measured in 10 subjects. Associations between changes were examined using linear mixed-effects regression models. Results dPP increased with progressive LBNP at all levels of PEP and CPAP. The LBNP-induced increase in dPP was amplified by PEP 10 cmH20. dPOP increased with progressive LBNP during PEP 5 and PEP 10, and during all levels of CPAP. There was no additional effect of the level of PEP or CPAP on dPOP. Progressive hypovolemia and increasing levels of PEP were reflected by increasing respiratory variations in CVP. Conclusion dPP and dPOP reflected progressive hypovolemia in spontaneously breathing healthy volunteers during PEP and CPAP. An increase in PEP from baseline to 10 cmH2O augmented the increase in dPP, but not in dPOP.

• Høiseth, Lars Øivind; Hoff, Ingrid E Taraldsrud; Hagen, Ove Andreas; Kirkebøen, Knut Arvid & Landsverk, Svein A. (2016). Respiratory variations in the photoplethysmographic waveform amplitude depend on type of pulse oximetry device. Journal of clinical monitoring and computing. ISSN 1387-1307. 30(3), s. 317–325. doi: 10.1007/s10877-015-9720-9. Fulltekst i vitenarkiv
• Hagen, Ove Andreas; Høiseth, Lars Øivind; Roslin, Andre; Landsverk, Svein A.; Woldbæk, Per R & Pripp, Are Hugo [Vis alle 8 forfattere av denne artikkelen] (2016). Impact of Norepinephrine on Regional Cerebral Oxygenation During Cardiopulmonary Bypass. Journal of Cardiothoracic and Vascular Anesthesia. ISSN 1053-0770. 30(2), s. 291–296. doi: 10.1053/j.jvca.2015.12.015. Fulltekst i vitenarkiv
• Lindholm, Espen; Aune, Erlend; Seljeflot, Ingebjørg; Otterstad, Jan Erik & Kirkebøen, Knut Arvid (2015). Biomarkers of inflammation in major vascular surgery: a prospective randomised trial. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 59(6), s. 773–787. doi: 10.1111/aas.12466. Fulltekst i vitenarkiv
• Høiseth, Lars Øivind; Hoff, Ingrid E Taraldsrud; Hagen, Ove Andreas; Landsverk, Svein A. & Kirkebøen, Knut Arvid (2015). Agreement between stroke volume measured by oesophageal Doppler and uncalibrated pulse contour analysis during fluid loads in severe aortic stenosis. Journal of clinical monitoring and computing. ISSN 1387-1307. 29(4), s. 435–441. doi: 10.1007/s10877-015-9666-y. Fulltekst i vitenarkiv
• Høiseth, Lars Øivind; Hisdal, Jonny; Hoff, Ingrid E Taraldsrud; Hagen, Ove Andreas; Landsverk, Svein A. & Kirkebøen, Knut Arvid (2015). Tissue Oxygen Saturation and Finger Perfusion Index in Central Hypovolemia: Influence of Pain. Critical Care Medicine. ISSN 0090-3493. 43(4). doi: 10.1097/CCM.0000000000000766. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: Tissue oxygen saturation and peripheral perfusion index are proposed as early indirect markers of hypovolemia in trauma patients. Hypovolemia is associated with increased sympathetic nervous activity. However, many other stimuli, such as pain, also increase sympathetic activity. Since pain is often present in trauma patients, its effect on the indirect measures of hypovolemia needs to be clarified. The aim of this study was, therefore, to explore the effects of hypovolemia and pain on tissue oxygen saturation (measurement sites: cerebral, deltoid, forearm, and thenar) and finger photoplethysmographic perfusion index. Design: Experimental study. Setting: University hospital clinical circulation and research laboratory. Subjects: Twenty healthy volunteers. Interventions: Central hypovolemia was induced with lower body negative pressure (–60 mm Hg) and pain by the cold pressor test (ice water exposure). Interventions were performed in a 2 × 2 fashion with the combination of lower body negative pressure or not (normovolemia), and ice water or not (sham). Each subject was thus exposed to four experimental sequences, each lasting for 8 minutes. Measurements and Main Results: Measurements were averaged over 30 seconds. For each person and sequence, the minimal value was analyzed. Tissue oxygenation in all measurement sites and finger perfusion index were reduced during hypovolemia/sham compared with normovolemia/sham. Tissue oxygen saturation (except cerebral) and perfusion index were reduced by pain during normovolemia. There was a larger reduction in tissue oxygenation (all measurement sites) and perfusion index during hypovolemia and pain than during normovolemia and pain. Conclusions: Pain (cold pressor test) reduces tissue oxygen saturation in all measurement sites (except cerebral) and perfusion index. In the presence of pain, tissue oxygen saturation and perfusion index are further reduced by hypovolemia (lower body negative pressure, –60 mm Hg). Thus, pain must be considered when evaluating tissue oxygen saturation and perfusion index as markers of hypovolemia in trauma patients.

• Hoff, Ingrid E Taraldsrud; Høiseth, Lars Øivind; Hisdal, Jonny; Røislien, Jo; Landsverk, Svein A. & Kirkebøen, Knut Arvid (2014). Respiratory variations in pulse pressure reflect central hypovolemia during noninvasive positive pressure ventilation. Critical Care Research and Practice. ISSN 2090-1305. 2014. doi: 10.1155/2014/712728. Fulltekst i vitenarkiv
• Lindholm, Espen; Aune, Erlend; Frøland, Gisle S.; Kirkebøen, Knut Arvid & Otterstad, Jan Erik (2014). Analysis of transthoracic echocardiographic data in major vascular surgery from a prospective randomised trial comparing sevoflurane and fentanyl with propofol and remifentanil anaesthesia. Anaesthesia. ISSN 0003-2409. 69(6), s. 558–572. doi: 10.1111/anae.12604. Fulltekst i vitenarkiv
• Høiseth, Lars Øivind; Hoff, Ingrid E Taraldsrud; Hagen, Ove Andreas; Landsverk, Svein A. & Kirkebøen, Knut Arvid (2014). Dynamic variables and fluid responsiveness in patients for aortic stenosis surgery. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 58(7), s. 826–834. doi: 10.1111/aas.12328. Fulltekst i vitenarkiv
• Lindholm, Espen; Aune, Erlend; Noren, Camilla; Seljeflot, Ingebjørg; Hayes, Thomas & Otterstad, Jan Erik [Vis alle 7 forfattere av denne artikkelen] (2013). The Anesthesia in abdominal Aortic Surgery. A prospective, randomized, controlled trial comparing Troponin T release with Fentanyl-Svoflutane and Propofol-remifentanil anesthesia in major vascular sugery. Anesthesiology. ISSN 0003-3022. 119(4), s. 802–812. doi: 10.1097/ALN.0b013e31829bd883. Fulltekst i vitenarkiv
• Kvandal, Per; Sheppard, Lawrence; Landsverk, Svein A.; Stefanovska, Aneta & Kirkebøen, Knut Arvid (2013). Impaired cerebrovascular reactivity after acute traumatic brain injury can be detected by wavelet phase coherence analysis of the intracranial and arterial blood pressure signals. Journal of clinical monitoring and computing. ISSN 1387-1307. 27(4), s. 375–383. doi: 10.1007/s10877-013-9484-z. Fulltekst i vitenarkiv
• Høiseth, Lars Øivind; Hoff, Ingrid E Taraldsrud; Myre, Kirsti; Landsverk, Svein A. & Kirkebøen, Knut Arvid (2012). Dynamic variables of fluid responsiveness during pneumoperitoneum and laparoscopic surgery. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 56(6), s. 777–786. doi: 10.1111/j.1399-6576.2011.02641.x. Fulltekst i vitenarkiv
• Antonsen, Lars Prag & Kirkebøen, Knut Arvid (2012). Evaluation of Fluid Responsiveness: Is Photoplethysmography a Noninvasive Alternative? Anesthesiology Research and Practice. ISSN 1687-6962. 2012. doi: 10.1155/2012/617380. Fulltekst i vitenarkiv Vis sammendrag

  Background. Goal-directed fluid therapy reduces morbidity and mortality in various clinical settings. Respiratory variations in photoplethysmography are proposed as a noninvasive alternative to predict fluid responsiveness during mechanical ventilation. This paper aims to critically evaluate current data on the ability of photoplethysmography to predict fluid responsiveness. Method. Primary searches were performed in PubMed, Medline, and Embase on November 10, 2011. Results. 14 papers evaluating photoplethysmography and fluid responsiveness were found. Nine studies calculated areas under the receiver operating characteristic curves for Δ POP (>0.85 in four, 0.75–0.85 in one, and <0.75 in four studies) and seven for PVI (values ranging from 0.54 to 0.98). Correlations between Δ POP/PVI and Δ PP/other dynamic variables vary substantially. Conclusion. Although photoplethysmography is a promising technique, predictive values and correlations with other hemodynamic variables indicating fluid responsiveness vary substantially. Presently, it is not documented that photoplethysmography is adequately valid and reliable to be included in clinical practice for evaluation of fluid responsiveness.

• MESIC, HARIS; Kirkebøen, Knut Arvid & Bains, Ravi (2012). The Importance of a Skin Bridge in Peripheral Tissue Perfusion in Perforator Flaps. Plastic and Reconstructive Surgery. ISSN 0032-1052. 129(3), s. 428E–434E. doi: 10.1097/PRS.0b013e31824423f8. Fulltekst i vitenarkiv
• Lindholm, Espen; Seljeflot, Ingebjørg; Aune, Erlend & Kirkebøen, Knut Arvid (2012). Proinflammatory cytokines and complement activation in salvaged blood from abdominal aortic aneurism surgery and total hip replacement surgery. Transfusion. ISSN 0041-1132. 52(8), s. 1761–1769. doi: 10.1111/j.1537-2995.2011.03528.x. Fulltekst i vitenarkiv
• Høiseth, Lars Øivind; Hoff, Ingrid E Taraldsrud; Skare, Øivind; Kirkebøen, Knut-Arvid & Landsverk, Svein A. (2011). Photoplethysmographic and pulse pressure variations during abdominal surgery. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 55(10), s. 1221–1230. doi: 10.1111/j.1399-6576.2011.02527.x. Fulltekst i vitenarkiv
• Kirkebøen, Knut-Arvid; LINDHOLM, ESPEN & Ræder, Johan (2010). Valg av anestesimetode og anestesimidler. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 130(4), s. 388–391. doi: 10.4045/tidsskr.08.0370. Fulltekst i vitenarkiv
• Veel, Terje; Bugge, Jan Frederik; Kirkebøen, Knut Arvid & Pleym, Hilde (2010). Anestesi ved åpen hjertekirurgi hos voksne. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 130(6), s. 618–622. Fulltekst i vitenarkiv
• Kirkebøen, Knut-Arvid; Lindholm, Espen & Ræder, Johan (2010). Valg av anestesimetode og anestesimidler. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 130(4), s. 388–391. doi: 10.4045/tidsskr.08.0370. Fulltekst i vitenarkiv
• JONASSEN, ALF ARNE; Petersen, AJ; Mohr, Stephan; Andersson, C; Skattum, Jorunn Pettersen & Kvernebo, Knut [Vis alle 9 forfattere av denne artikkelen] (2004). Sevoflurane-induced malignant hyperthermia during cardiopulmonary bypass and moderate hypothermia. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 48(8), s. 1062–1065. Fulltekst i vitenarkiv

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• Høiseth, Lars Øivind; Hisdal, Jonny; Landsverk, Svein A. & Kirkebøen, Knut Arvid (2015). The authors reply: Pain and tissue oxygenation. Critical Care Medicine. ISSN 0090-3493. 43(10), s. e463–e464. doi: 10.1097/CCM.0000000000001206. Fulltekst i vitenarkiv
• Lindholm, Espen; Aune, Erlend; Otterstad, Jan Erik & Kirkebøen, Knut Arvid (2014). In reply. Anesthesiology. ISSN 0003-3022. 120(5), s. 1292–1297. doi: 10.1097/ALN.0000000000000188. Fulltekst i vitenarkiv
• Kirkebøen, Knut Arvid (2014). Adenosine as a regulator of NFκB activation. Acta Physiologica. ISSN 1748-1708. 210(3), s. 465–467. doi: 10.1111/apha.12203. Fulltekst i vitenarkiv
• Mohr, Stefan; Jonassen, Alf; Pettersen, Arne & Kirkebøen, Knut-Arvid (2004). Changes in clinical picture of malignant hyperthermia, consequences for monitoring. Fulltekst i vitenarkiv

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