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The Influence of the Prone Position on Systemic Hemodynamics in Spinal Surgery
Kukrálová, Lucie ; Dostálová, Vlasta (advisor) ; Málek, Jiří (referee) ; Kieslichová, Eva (referee)
1 Summary Hemodynamic monitoring is a fundamental part of perioperative care. This thesis deals with hemodynamic changes due to the prone position under physiological, awake state and under general anesthesia during spondylosurgical procedures and to assess the influence of the patient's body support. The next goal was to evaluate the effect of extended non-invasive hemodynamic monitoring on perioperative circulatory stability, used hemodynamic interventions, and the occurrence of postoperative complications. This work consists of two separate studies. In the study "Hemodynamic changes in prone position - a non-invasive physiological study" 12 healthy volunteers older than 18 years were included. Non-invasive hemodynamic measurement was initiated using ClearSight/EV 1000 system in supine position (S position). Cardiac index (CI), stroke volume index (SVI), stroke volume variation (SVV), systemic vascular resistance index (SVRI) and mean arterial pressure (MAP) were recorded. Following parameters were measured using ultrasound at predefined sites: expiratory area of v. cephalica (sVCe), v. saphena (sVSe), v. jugularis interna (sVJe), expiratory and inspiratory area (sVCIe a sVCIi), and maximum and minimum diameter (dVCImax a dVCImin) of v. cava inferior and index of colapsibility (VCI CI) were calculated....
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Severe community-acquired pneumonia: Patient characteristics and reliability of the scoring systems
Bartoš, Hynek ; Džupová, Olga (advisor) ; Kieslichová, Eva (referee) ; Rožnovský, Luděk (referee)
Introduction: Even in the 21st century, pneumonia represents a serious medical problem with high morbidity and mortality. The aim of the clinical study was to describe the group of patients with severe community-acquired pneumonia and to evaluate the predictive efficiency of the applied scoring systems. Methods: A prospective multicenter observational study was carried out in the period 1/9/2017 - 1/7/2021 in three Czech ICU. Patients with community-acquired pneumonia requiring ICU admission within 48 hours of hospital admission were included in the study. Anamnestic data, clinical manifestations, etiological agent, antibiotic treatment, applied intensive care methods and treatment outcomes were recorded. A total of ten scoring systems were applied to describe the clinical severity of pneumonia and their reliability was evaluated in terms of predicting mortality and the need for intensive care. Due to the current covid-19 pandemic, patients with coronavirus infection were also included in the study; for analysis, the patients were divided into two groups - covid and non-covid. Results: A total of 315 patients, 68.3% men and 31.7% women, with the age range of 18-88 years and an average age of 61.1 ± 14.1 years, were included in the study. Fifty-nine percent of patients had at least one serious comorbidity,...
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The influence of the treatment of experimental acute liver failure by FPSA/Prometheus on intracranial pressure
Pražák, Josef ; Cvachovec, Karel (advisor) ; Červinková, Zuzana (referee) ; Kieslichová, Eva (referee)
Background: Cerebral edema is a well-known and fatal complication of acute liver failure (ALF). The influence of the treatment by artificial liver devices on the cerebral damage caused by ALF is usually monitored by only measuring the intracranial pressure (ICP). The aim of this work was to determine the influence of Fractionated Plasma Separation and Adsorption (FPSA), nonbiological artificial liver device, on the intracranial pressure. The second goal of this work was to determine the potential role of cerebral microdialysis in monitoring of the efficiency of fractionated plasma separation and adsorption (FPSA) treatment of ALF. Methods: Two types of surgical resection model of ALF were used in two separate experiments in pigs. In the first study data from monitoring of the intracranial pressure of ALF group (animals with ALF only) and FPSA group (animals with ALF treated by FPSA) were compared. In the second study data from monitoring by cerebral microdialysis and ICP of the ALF group (animals with ALF only), FPSA group (animals with ALF treated by FPSA) and SHAM group (animals with only laparotomy) were compared using statistical analyses. Results: In both experiments, the ICP was significantly higher in the ALF group than in the FPSA group from the 9th hour of the experiment. In the second...
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Complications of sedation interruption in mechanically ventilated patients: a retrospective observational cohort study
Bandíková, Nikola ; Duška, František (advisor) ; Kieslichová, Eva (referee)
This thesis focuses on the strategy of daily sedation interruptions, as one of the approaches to minimizing complications of sedation in mechanically ventilated patients in intensive care units. The theoretical part summarizes the rationale and evolution of sedation over time as well as the evolution of the concept of daily sedation vacation. The practical part is a cross-over cohort study in which we processed record-level retrospective data from a clinical information system and compared the incidence of several a priori defined complications during the period of sedation interruption and a control period of the same duration in the same patient. We compared 269 sedation interruption periods (median duration of 14.9 hours [interquartile range 5.7-31.9]) and the same number of equally long control periods in 111 patients. The following complications occurred during sedation interruption vs. during control period: inadvertent extubation 0 vs 1, other tubes removal 1 vs 2, fall 0 vs 0, desaturation 33 vs. 23 (p=0,12), tachycardia 10 vs. 6 (p=0,3), hypertension 8 vs. 9 (p=0,8) and hypotension 13 vs. 22 (p=0,01). We also compared proportions of time spent in physiological functions deteriorations between studied periods with the following results: desaturation 0.20 % vs 0.16 % (p=0.11), tachycardia...
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The Impact of Analgosedation on Heart Function
Omran, Nedal ; Černý, Vladimír (advisor) ; Vaněk, Tomáš (referee) ; Kieslichová, Eva (referee)
Introduction Nowadays, sedation has become an essential part of clinical practice. Despite this fact, we still lack data describing the exact impact of sedation on cardiac function. Objective The aim of this work is to compare the changes in cardiac function induced after sedation with midazolam or dexmedetomidine by magnetic resonance imaging (MRI). A total of 30 volunteers were randomized into two groups: 15 patients in the midazolam (MID) group and 15 patients in the dexmedetomidine (DEX) group. Each participant underwent a one session MRI imaging of the heart during and after sedation administration. The following parameters were recorded: right ventricular (Pul-vol) and left ventricular (Ao-vol) stroke volume, maximal blood flow velocity through the aortic (Ao-flow) and through the pulmonary valve (Pul-flow) during systole, and maximal blood flow velocity through the mitral valve during early (E-diast) and late diastole (L-diast). The monitor recorded mean blood pressure (MAP), pulse (P), and blood oxygen saturation (SpO2) at 5minute intervals. Results As for the parameters of ventricular systolic function dexmedetomidine decreased significantly Ao-vol (p = 0.006), Pul-vol (p = 0.003), Ao-flow (p = 0.048) and Pul-flow (p = 0.007). Midazolam also significantly decreased Ao-vol (p = 0.001), Pul-vol (p =...
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Acute kidney injury in critically ill: experimental and clinical approaches
Valešová, Lenka ; Matějovič, Martin (advisor) ; Nalos, Marek (referee) ; Kieslichová, Eva (referee)
Acute kidney injury (AKI) complicates more than one third of intensive care unit admissions and is burdened by high morbidity and mortality of affected patients, with incidence steadily rising. Sepsis is the leading cause of AKI in critically ill. Despite growing insights into the pathogenesis of sepsis- induced AKI, we are so far not able to define successful AKI prevention and treatment. We aimed at assessing molecular mechanisms of sepsis- induced AKI using clinically relevant large animal model of sepsis and implementing new techniques of molecular biology- genomics and proteomics. Although acidosis is a common acid base disorder in critically ill, its role remains controversial. It is unknown whether acidosis is a marker of disease severity or is directly implicated in pathogenesis of acute organ dysfunction states. Its protective role is discussed with growing evidence of acidosis induced cellular energetics downregulation and reduced oxygen demand in stress conditions. We aimed to evaluate physiological effects of different types of acidosis on healthy organism on systemic and regional level, including a complex research of its effects on kidney to search for new AKI preventive and treatment modalities, which permissive acidosis could represent. Key words Acute kidney injury - sepsis -...
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Effect of selected drugs on mitochondrial metabolism in an in vitro model of human skeletal muscle
Krajčová, Adéla ; Anděl, Michal (advisor) ; Kieslichová, Eva (referee) ; Houštěk, Josef (referee)
Introduction: Increasing number of reports reflect that mitochondrial dysfunction can be induced by some of the commonly used drugs and can play a key role in the development of their adverse effects. One of these drugs is a phenol derivative propofol. Propofol is an intravenous, fast and short-acting hypnotic agent, routinely used either for induction and maintenance of anaesthesia during surgery, or for sedation in intensive care units. Propofol infusion syndrome (PRIS) is a rare, but serious adverse effect of the drug with a very high mortality. Typical features of the syndrome include metabolic acidosis, arrhythmias, ECG changes that are similar to those of Brugada syndrome, hypertriglyceridemia, fever, hepatomegaly, rhabdomyolysis, cardiac and/or renal failure. The risk of the syndrome increases with raising dose and duration of propofol administration (˃48 hours). The mechanism of the syndrome is still unknown: pilot studies performed on animal models are suggestive of its mitochondrial origin. In the first part of the study, we performed the analysis of 153 published case reports and all experimental studies related to PRIS. Another aim of the study was to test hypothesis of propofol- induced mitochondrial damage by in vitro exposure of human skeletal muscle-derived cells to a range of...
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The meaning of the dead donor rule in current transplantion ethics
Rusinová, Kateřina ; Šimek, Jiří (advisor) ; Kieslichová, Eva (referee) ; Hříbek, Tomáš (referee)
The thesis presents current understanding of the concept of death and criteria for diagno- sis of death in the context of organ donation. We will argue that 1) the dead donor rule should not be the necessary condition for retrieving organs for transplantation and 2) it should be permissible to retrieve organs from patients that are imminently dying (not dead yet), with respect to the principle of autonomy and non-maleficence. We will first present the impossibility and current inconsistencies in determining the exact "moment of death" and we will then demonstrate that current organ donors do not fulfill biological criteria for death and that the dead donor rule is not respected in clinical practice. We suggest that in the context of recent major technological advances in the field of critical care medicine the dead donor rule becomes irrelevant and does not contribute to the transplantation ethics. The legal concept of death and the biological phenomenon of death become more and more distant. We argue that declaring death is not necessary for ethically justified policy in transplantation. Both the societal trust and the protection of vulnerable individuals can be ensured by different ethical principles (i.e. the principle of autonomy and the principle of non- maleficence). The sound ethical...
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Role of therapeutic approach in the treatment outcome, hospital costs, one-year post-hospital medical costs and quality of life in the patients who survived acute methanol poisoning.
Rulíšek, Jan ; Zacharov, Sergej (advisor) ; Máca, Jan (referee) ; Kieslichová, Eva (referee)
(English) Background: Methanol poisoning is severe medical condition with a need of urgent intensive treatment. Mass poisoning outbreak took place in the Czech Republic in 2012-2013. Costs of hospital treatment of methanol poisoning present significant financial burden to healthcare systems. The effect of treatment modality choice on clinical outcome and healthcare costs is not known, as well as its impact on the quality of life of methanol poisoning survivors after hospital discharge. Aim: To compare different therapeutic methods, choice of antidote (fomepizole versus ethanol) and extracorporeal elimination method (intermittent vs. continuous dialysis) for optimizing clinical outcome, cost-effectiveness, hospital costs, post-discharge costs, and the quality of life in survivors. Methods: For prospective cohort study, all patients hospitalized with acute methanol poisoning were included (n=106); for hospital and one-year healthcare costs study, all survivors of acute methanol poisoning (n=83) were included. For longitudinal quality of life study all survivors with informed consent (n=54) and control group of chronic alcohol abusers, age- and gender-balanced, without history of methanol poisoning (n=23), were included. Results: Comparative data of clinical effectiveness of elimination techniques...
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ACUTE PAIN SERVICE AND ITS IMPLEMENTATION AT THE CLINIC KARIP IKEM
Dračka, Pavel ; Svobodová, Hana (advisor) ; Kieslichová, Eva (referee)
1 ABSTRAKT Akutní léčba bolesti se zlepšuje postupně v průběhu několika posledních let, ale odborné vzdělávání stále chybí. Neléčená akutní bolest může mít škodlivé účinky na pacienta, pokud jde o pohodlí a zotavení z traumatu nebo chirurgickém zákroku. Akutní bolest může snížit u pacienta cévní prokrvení, zvýšit spotřebu kyslíku, potlačit činnost imunitního systému, případně zvýšit riziko výskytu žilní trombózy. Ačkoli akutní pooperační bolest musí být léčena agresivně, pacienti jsou nejvíce zranitelní během tohoto období pro rozvoj nežádoucích účinků, a proto hodnocení skóre bolesti a výběr vhodné farmakoterapie jsou nezbytné procesy v terapeutickém plánování. Stav akutní bolesti vyžaduje pečlivé a důkladné úvodní posouzení a následné přehodnocení, kromě častých úprav dávkování analgetik, také sledování jimi vyvolaných vedlejších účinků. Neexistuje žádný režim nebo terapie akutní bolesti, který je vhodný pro všechny pacienty. Analgetika musí být upravena pro individuálního pacienta. ASA v roce 2004 doporučila nejlepší přístup k léčbě akutní bolesti používáním multimodálních technik. Agresivní léčbou akutní bolesti lze eliminovat potenciál pro rozvoj chronických bolestivých syndromů a může pomoci mobilizovat pacienta dříve. I když u některých pacientů léčení pro akutní bolesti je komplikované, v důsledku...
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