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The role of ATP-MgCl2 in ischemia-reperfusion and sepsis
Nalos, Marek ; Kasal, Eduard (advisor) ; Matějovič, Martin (referee) ; Šrámek, Vladimír (referee)
The previously reported multiple beneficial effects of ATP-MgCl2 were tested in two clinically relevant large animal models. We observed mainly cardiovascular effects of ATP-MgCl2 likely related to purinergic receptors stimulation. Adding ATP and its metabolite adenosine to ex vivo LPS stimulated whole human blood cultures and measuring cytokine secretion we have further tested whether modulation of inflammation might be responsible for some of the ATP-MgCl2 effects. The results are summarized as follows: 1. Infusing ATP-MgCl2 intravenously in a porcine I-R injury model of thoracic aortic cross clamping provides better cardiovascular stability compared to currently used standard agent sodium nitroprusside. Although ATP-MgCl2 led to reduced gut lactate release we could not demonstrate any beneficial effects on numerous markers of reperfusion injury. Moreover the combination of sodium nitroprusside with esmolol provided hemodynamic control superior to ATP-MgCl2. 2. In long term hyperdynamic porcine model of sepsis ATP-MgCl2 increased portal venous blood flow, reduced ileal mucosal-arterial pCO2 gap and preserved hepatic arterial buffer response as well as metabolic coupling between lactate release from the gut and its utilization by the liver. Despite the beneficial effects of ATP-MgCl2 on hepatosplanchnic...
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End-of-life decision making and quality of life in critically ill patiens
Pařízková, Renata ; Zavázalová, Helena (advisor) ; Kasal, Eduard (referee) ; Cvachovec, Karel (referee)
The development of intensive care during last several decades has brought the ability to increase patients survival and quality of life (QOL) however new tasks and concerns especially in ethics occured. Emerging imbalance among therapeutical options and economic resources together with false optimism of physicians and public regarding "borderless" possibilities of medicine started the discussion about allocation of resources to patients in whom real hope for improvement of medical status or quality of life could be anticipated. Intensive care can prolong dying often associated with distress and loss of dignity that is in contradiction to ethic principles and the main right of human. Withdrawing organ support techniques that is considered as a futile, inappropriate and without chance to improve clinical outcome is in accordance with ethic rules. In this situation, the principal goal of medicine, preserving life and health is no longer affordable therefore it is necessary to change our effort to ensure basic patient's physical, psychological, social and spiritual needs with accent to respect dignity. The aim of PhD theses was: - to define areas and key principles regarding end-of-life decision (EOLD) making in intensive care, - to identify factores affecting short and long-term outcome (surviving and quality...
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Acute kidney injury in sepsis: phatophysiological and therapeutical aspects
Chvojka, Jiří ; Matějovič, Martin (advisor) ; Kasal, Eduard (referee) ; Maňák, Jan (referee) ; Balík, Martin (referee)
Sepsis and septic shock remain major cause of mortality in non-coronary intenisve care units. Prognosis of septic patiens worsens further in case of concomitant acute kidney injury. Pathophysiological pathways leading to renal dysfunction in sepsis remain unclear despite of enormous experimental and clinical research. Similarly, the role of extracorporeal blood purification techniques as an adjunctive treatment in sepsis is highly controversial. The aim of our study was to dynamically assess renal haemodynamic, microvascular and metabolic responses in a porcine clinically relevant model of septic shock. The same experimental model was used in experiments elucidating potential benefit effects of two distinct haemopurification methods on different biological responses to infectious insult.
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Hemodynamics in the early stages of the critical illness and in the perioperative setting
Beneš, Jan ; Kasal, Eduard (advisor) ; Málek, Jiří (referee) ; Kroužecký, Aleš (referee) ; Adamus, Milan (referee)
Beneš J.: HEMODYNAMIKA V ČASNÉ FÁZI KRITICKÝCH STAVŮ A PERIOPERAČNÍ MEDICÍNĚ - Využití méně invazivních monitorovacích prostředků k cílené hemodynamické péči ABSTRACT Hemodynamic instability occurs very often in critically ill patients and during the perioperative period. Insufficiency in the preload, contractility and afterload contribute in major part to this phenomenon. Hemodynamic monitoring allows clinicians to recognize and to intervene early the underlying cause. Due to new technologies development in recent years it is possible to provide continuous monitoring of hemodynamic parameters with diminished invasivity. Hemodynamic optimization and goal directed therapy show treatment benefit in some groups of critically ill patients and mainly during the perioperative period. Aim of hemodynamic optimizations is to attain the best obtainable hemodynamic conditions with use of fluid loading and inotropic support. In many studies in recent years goal-directed therapy was associated with morbidity and mortality reduction. According to the results of our clinical research hemodynamic optimization using stroke volume variation and minimally invasive device based on the pressure wave analysis is feasible and show the same results as other works with more invasive devices. Key words Hemodynamic monitoring,...
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Vasopresin and its analogues in treatment of cardiac arrest
Truhlář, Anatolij ; Černý, Vladimír (advisor) ; Kasal, Eduard (referee) ; Ošťádal, Petr (referee)
Vasopressin and its analogues in treatment of cardiac arrest Introduction: Recent guidelines for cardiopulmonary resuscitation (CPR) recommend use of drugs as an integral part of treatment. Vasoactive drugs have been used in resuscitation to increase myocardial and cerebral perfusion during chest compressions. Resuscitation research is trying to find alternative vasopressors to adrenaline, for which the long-term survival benefit has not been proven. Successful use of terlipressin in cardiac arrest (CA) was documented in small studies in children and some rare case reports. Terlipressin has never been tested in CA of cardiac aetiology in any clinical or experimental study. Objectives: We aimed to evaluate the role of catecholamines and non-adrenergic vasopressors, vasopressin and terlipressin, during CPR based on review of selected trials. Introduction of a standardized experimental porcine model of ventricular fibrillation (VF) was done for research of therapeutic interventions during CPR. We aimed to evaluate the effects of terlipressin with adrenaline on perfusion of vital organs during prolonged CPR compared to placebo with adrenaline. We tested our hypothesis that terlipressin, if given simultaneously with the first dose of epinephrine during CPR for VF, increases CorPP (coronary perfusion pressure) or...
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Hemodynamics in the early stages of the critical illness and in the perioperative setting
Beneš, Jan ; Kasal, Eduard (advisor) ; Málek, Jiří (referee) ; Kroužecký, Aleš (referee) ; Adamus, Milan (referee)
Beneš J.: HEMODYNAMIKA V ČASNÉ FÁZI KRITICKÝCH STAVŮ A PERIOPERAČNÍ MEDICÍNĚ - Využití méně invazivních monitorovacích prostředků k cílené hemodynamické péči ABSTRACT Hemodynamic instability occurs very often in critically ill patients and during the perioperative period. Insufficiency in the preload, contractility and afterload contribute in major part to this phenomenon. Hemodynamic monitoring allows clinicians to recognize and to intervene early the underlying cause. Due to new technologies development in recent years it is possible to provide continuous monitoring of hemodynamic parameters with diminished invasivity. Hemodynamic optimization and goal directed therapy show treatment benefit in some groups of critically ill patients and mainly during the perioperative period. Aim of hemodynamic optimizations is to attain the best obtainable hemodynamic conditions with use of fluid loading and inotropic support. In many studies in recent years goal-directed therapy was associated with morbidity and mortality reduction. According to the results of our clinical research hemodynamic optimization using stroke volume variation and minimally invasive device based on the pressure wave analysis is feasible and show the same results as other works with more invasive devices. Key words Hemodynamic monitoring,...
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Acute kidney injury in sepsis: phatophysiological and therapeutical aspects
Chvojka, Jiří ; Matějovič, Martin (advisor) ; Kasal, Eduard (referee) ; Maňák, Jan (referee) ; Balík, Martin (referee)
Sepsis and septic shock remain major cause of mortality in non-coronary intenisve care units. Prognosis of septic patiens worsens further in case of concomitant acute kidney injury. Pathophysiological pathways leading to renal dysfunction in sepsis remain unclear despite of enormous experimental and clinical research. Similarly, the role of extracorporeal blood purification techniques as an adjunctive treatment in sepsis is highly controversial. The aim of our study was to dynamically assess renal haemodynamic, microvascular and metabolic responses in a porcine clinically relevant model of septic shock. The same experimental model was used in experiments elucidating potential benefit effects of two distinct haemopurification methods on different biological responses to infectious insult.
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The role of ATP-MgCl2 in ischemia-reperfusion and sepsis
Nalos, Marek ; Kasal, Eduard (advisor) ; Matějovič, Martin (referee) ; Šrámek, Vladimír (referee)
The previously reported multiple beneficial effects of ATP-MgCl2 were tested in two clinically relevant large animal models. We observed mainly cardiovascular effects of ATP-MgCl2 likely related to purinergic receptors stimulation. Adding ATP and its metabolite adenosine to ex vivo LPS stimulated whole human blood cultures and measuring cytokine secretion we have further tested whether modulation of inflammation might be responsible for some of the ATP-MgCl2 effects. The results are summarized as follows: 1. Infusing ATP-MgCl2 intravenously in a porcine I-R injury model of thoracic aortic cross clamping provides better cardiovascular stability compared to currently used standard agent sodium nitroprusside. Although ATP-MgCl2 led to reduced gut lactate release we could not demonstrate any beneficial effects on numerous markers of reperfusion injury. Moreover the combination of sodium nitroprusside with esmolol provided hemodynamic control superior to ATP-MgCl2. 2. In long term hyperdynamic porcine model of sepsis ATP-MgCl2 increased portal venous blood flow, reduced ileal mucosal-arterial pCO2 gap and preserved hepatic arterial buffer response as well as metabolic coupling between lactate release from the gut and its utilization by the liver. Despite the beneficial effects of ATP-MgCl2 on hepatosplanchnic...
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