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The impact of neuoropretection on brain metabolism and cognitive function during carotid endarterectomy
Mraček, Jan ; Choc, Milan (advisor) ; Chytra, Ivan (referee) ; Náhlovský, Jiří (referee)
The impact of neuroprotection on brain metabolism and cognitive function during carotid endarterectomy Introduction: Neuroprotection is a strategy that works against the biochemical and molecular manifestations that lead to ischemic brain injury. The aim of neuroprotection is to protect the hypoperfused brain region through influence upon ischemic cascade and by reducing the progress of injurious reperfusion. The development of neuroprotection has been proceeding alongside a growing understanding of brain ischemia pathophysiology. In spite of the demonstrable effects of many agents in animal models, until now none of the tested neuroprotective agents have been shown to improve the outcome in a phase III clinical trial. Objectives: Primary objective of this study was to evaluate the impact of neuroprotection, administered before carotid endarterectomy, on brain metabolism and cognitive function. The potential influence of metabolic changes within the brain on clinical outcome was assessed. The secondary objective was to assess the satisfaction of patients with the type of anesthesia administered (general or local) and to consider the preference for general or local anesthesia during similar operations in the future. Methods: A total of 35 patients underwent carotid endarterectomy with prophylactic combine...
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Optimization of Hemodynamics of Trauma Patients in Intensive Care Using Transesophageal Doppler Monitoring
Pradl, Richard ; Chytra, Ivan (advisor) ; Málek, Jiří (referee) ; Šrámek, Vladimír (referee)
Esophageal Doppler was confirmed as a useful non-invasive tool for management of fluid replacement in elective surgery. The aim of this study was to assess the effect of early optimization of intravascular volume using esophageal Doppler on blood lactate levels and organ dysfunction development in comparison with standard hemodynamic management in multiple-trauma patients. This was a randomized controlled trial. Multiple-trauma patients with blood loss of more than 2,000 ml admitted to the intensive care unit (1CU) were randomly assigned to the protocol group with esophageal Doppler monitoring and to the control group. Fluid resuscitation in the Doppler group was guided for the first 12 hours of ICU stay according to the protocol based on data obtained by esophageal Doppler, whereas control patients were managed conventionally. Blood lactate levels and organ dysfunction during ICU stay were evaluated. Eighty patients were randomly assigned to Doppler and 82 patients to control treatment. The Doppler group received more intravenous colloid during the first 12 hours of ICU stay (1,667±426 ml versus 682±322 ml; p < 0,0001), and blood lactate levels in the Doppler group were lower after 12 and 24 hours of treatment than in the control group (2,92±0,54 mmol/1 versus 3,23±0,54 mmol/1 [p = 0,0003] and 1,99±0,44...
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Influence of anesthesia type on the incidence of postoperative cognitive dysfunction
Kletečka, Jakub ; Chytra, Ivan (advisor) ; Dostál, Pavel (referee) ; Málek, Jiří (referee)
Resume Cognitive decline is a common perioperative complication, affecting about one-quarter of patients at one week after surgery. It is a temporary disorder, which influences mainly executive functions, memory and spatial orientation. The decline is short-lived, with complete resolution in first months after surgery. Low education and higher age are the only known risk factors with hard evidence, although it can be diagnosed also in younger patients. Particularly in seniors, this disorder is associated with deterioration of the quality of life. No differences in incidence were found between general and regional anaesthesia, neither between certain anaesthetics. The only evidence-based prevention is a minimalization of the impact of surgery and anaesthesia on patients, e.g. with fast-track approach. Optimization of the depth of the anaesthesia using EEG and derived parameters is promising, but with little evidence yet. Research of the postoperative cognitive dysfunction (POCD) is significantly influenced with the heterogeneity of published studies, consensus on POCD definition and diagnostics is still missing. Another important limiting factor is a continuous change in methods and drugs in anaesthesia and perioperative care in last twenty years, and therefore comparing current results with older studies is...
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Liver and kidney dysfunction in critically ill patients. Support options and compensation functions
Kroužecký, Aleš ; Matějovič, Martin (advisor) ; Chytra, Ivan (referee) ; Viklický, Ondřej (referee) ; Dostál, Pavel (referee)
22 23 7. Summary The liver and kidney are an important organs involved in a number of biosynthetic, biotransformative, detoxifying, endocrine and immune processes and therefore it is understandable that its dysfunction is associated with adverse outcome of critically ill patients. Hepatic and renal dysfunctions in critical illness are relatively common and occur usually as a component of multiple organ dysfunction syndrome (MODS). Several mechanisms have been proposed to explain the development of MODS. Among these, 1) the hypoxic component resulted from an inadequate oxygen supply to tissues, and 2) cytotoxic effects of various mediators are believed the key elements in the pathophysiology of MODS. From these complex causes of injury are probably the most therapeutically attainable the hemodynamic disturbances and maintenance of adequate organ perfusion pressure using vasopressors is one of the cornerstones of treatment of critically ill patients. Blood flow through organs is autoregulated over a wide range of mean arterial pressure (MAP). There is an agreement that under physiological conditions minimum value of MAP necessary to ensure this autoregulation is about 60- 65 mm Hg. Therefore MAP > 65 mmHg has been recommended as a goal for the vasopressor therapy in sepsis. In critical condition, however,...
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The Importance of Measuring Intraabdominal Pressure in Cases of Severe Acute Pancreatitis
Kural, Tomáš ; Třeška, Vladislav (advisor) ; Chytra, Ivan (referee) ; Kala, Zdeněk (referee) ; Leffler, Jan (referee)
Treatment of severe acute pancreatitis is considered to be conservative. The only generally accepted indication for surgery in severe acute pancreatitis patients is an established infection of the necrotic tissue and persisting or progressing symptoms of multiorgan failure despite the maximal intensive treatment. For surgical treatment are also indicated patients with complications of severe acute pancreatitis (erosive hemorrhage, perforation of GIT etc.). In the proposed work, attention is drawn to those cases, where the general condition of the patient deteriorates combined with a progression of ACS and where a decompressive laparotomy can improve the prognosis of the disease. In our group of 214 patients with severe acute pancreatitis, who were treated over the last six years, 70 patients were indicated for surgery. Out of this count, in 17 cases the indication for decompressive laparotomy was a raise of intraabdominal pressure up to the values of ACS together with the symptoms of organ dysfunction, 6 patients died and 11 younger patients survived.
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Hemo elimination method in the treatment of sepsis and early multi-organ dysfunction
Sýkora, Roman ; Matějovič, Martin (advisor) ; Chytra, Ivan (referee) ; Maňák, Jan (referee) ; Šrámek, Vladimír (referee)
The most common cause of death in patients with sepsis/septic shock is deterioration of the function of multiple organs, termed multiple organ dysfunction syndrome. Although our understanding of mechanisms involved in the pathophysiology of sepsis-induced tissue damage has improved substantially, therapy of these syndromes still remains largely supportive. The hallmark of sepsis is an overwhelming systemic production of both pro- and anti-inflammatory mediators leading to generalized endothelial and epithelial damage, microcirculatory-mitochondrial distress, altered endocrine and coagulation homeostasis and cellular immune hyporesponsiveness. Therefore, the hypothesis that modulation of this excessive immunological and biological response to infection might improve patient outcome appears reasonable. Hemoelimination techniques represent biologically plausible way to provide non-specific removal of soluble pro- and anti-inflammatory mediators, although the concept of blood purification in sepsis remains a matter of considerable debate. The aim of this thesis was to elucidate effects of 1) high volume hemofiltration (HVHF) and 2) coupled plasma filtration adsorption (CPFA) in a long-term, hyperdynamic porcine septic shock model, which fulfils the criteria for human sepsis. We hypothesized that both HVHF and...
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Replacement and Support of Vital Organs in Sepsis Pathophysiology and New Aspects of Treatments
Martínková, Vendula ; Matějovič, Martin (advisor) ; Chytra, Ivan (referee) ; Charvát, Jiří (referee)
Infectious diseases are the worldwide leading cause of morbidity and mortality. Sepsis is the major cause of death in infectious diseases. It is one of the most serious and also one of the most difficult treatable conditions of contemporary medicine. Sepsis is the main cause of death in intensive care units. Causal therapy of sepsis does not yet exist. With a far better understanding of patho/physiological mechanism of sepsis, it is possible to model new preclinical experiments to verify the efficiency and security of new therapeutic procedures. Large animal experiments in progressive sepsis, with the use of domestic porcine, play a vital role. Long-standing experience with this model and similarity to human facilitate the realization of more complex experiments with potential for the relevant translation of results into the subsequent clinical studies on human subjects. The objective of this doctoral dissertation was to assess on the clinically relevant model: 1) the efficiency and security of extracorporeal membrane oxygenation in the event of vasoplegic septic shock; and 2) the benefit of two innovative therapeutic approaches to treatment of sepsis: a) the intravenous administration of mesenchymal stem cells; and b) the activation of the neuro-inflammatory reflex through the vagus nerve stimulation.
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Influence of anesthesia type on the incidence of postoperative cognitive dysfunction
Kletečka, Jakub ; Chytra, Ivan (advisor) ; Dostál, Pavel (referee) ; Málek, Jiří (referee)
Resume Cognitive decline is a common perioperative complication, affecting about one-quarter of patients at one week after surgery. It is a temporary disorder, which influences mainly executive functions, memory and spatial orientation. The decline is short-lived, with complete resolution in first months after surgery. Low education and higher age are the only known risk factors with hard evidence, although it can be diagnosed also in younger patients. Particularly in seniors, this disorder is associated with deterioration of the quality of life. No differences in incidence were found between general and regional anaesthesia, neither between certain anaesthetics. The only evidence-based prevention is a minimalization of the impact of surgery and anaesthesia on patients, e.g. with fast-track approach. Optimization of the depth of the anaesthesia using EEG and derived parameters is promising, but with little evidence yet. Research of the postoperative cognitive dysfunction (POCD) is significantly influenced with the heterogeneity of published studies, consensus on POCD definition and diagnostics is still missing. Another important limiting factor is a continuous change in methods and drugs in anaesthesia and perioperative care in last twenty years, and therefore comparing current results with older studies is...
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The impact of neuoropretection on brain metabolism and cognitive function during carotid endarterectomy
Mraček, Jan ; Choc, Milan (advisor) ; Chytra, Ivan (referee) ; Náhlovský, Jiří (referee)
The impact of neuroprotection on brain metabolism and cognitive function during carotid endarterectomy Introduction: Neuroprotection is a strategy that works against the biochemical and molecular manifestations that lead to ischemic brain injury. The aim of neuroprotection is to protect the hypoperfused brain region through influence upon ischemic cascade and by reducing the progress of injurious reperfusion. The development of neuroprotection has been proceeding alongside a growing understanding of brain ischemia pathophysiology. In spite of the demonstrable effects of many agents in animal models, until now none of the tested neuroprotective agents have been shown to improve the outcome in a phase III clinical trial. Objectives: Primary objective of this study was to evaluate the impact of neuroprotection, administered before carotid endarterectomy, on brain metabolism and cognitive function. The potential influence of metabolic changes within the brain on clinical outcome was assessed. The secondary objective was to assess the satisfaction of patients with the type of anesthesia administered (general or local) and to consider the preference for general or local anesthesia during similar operations in the future. Methods: A total of 35 patients underwent carotid endarterectomy with prophylactic combine...
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The Importance of Measuring Intraabdominal Pressure in Cases of Severe Acute Pancreatitis
Kural, Tomáš ; Třeška, Vladislav (advisor) ; Chytra, Ivan (referee) ; Kala, Zdeněk (referee) ; Leffler, Jan (referee)
Treatment of severe acute pancreatitis is considered to be conservative. The only generally accepted indication for surgery in severe acute pancreatitis patients is an established infection of the necrotic tissue and persisting or progressing symptoms of multiorgan failure despite the maximal intensive treatment. For surgical treatment are also indicated patients with complications of severe acute pancreatitis (erosive hemorrhage, perforation of GIT etc.). In the proposed work, attention is drawn to those cases, where the general condition of the patient deteriorates combined with a progression of ACS and where a decompressive laparotomy can improve the prognosis of the disease. In our group of 214 patients with severe acute pancreatitis, who were treated over the last six years, 70 patients were indicated for surgery. Out of this count, in 17 cases the indication for decompressive laparotomy was a raise of intraabdominal pressure up to the values of ACS together with the symptoms of organ dysfunction, 6 patients died and 11 younger patients survived.
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