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Effect of antibiotic administration in the early stages of ICU stay on the microbiome of the oral cavity and upper respiratory tract
Gusarova, Bogdana ; Duška, František (advisor) ; Cibulková, Ivana (referee)
Objectives: The primary goals of this study are to describe the dynamics of the oral microbiome and the microbiome of the upper respiratory tract in patients subjected to mechanical ventilation, and to provide a detailed description of quantitative and qualitative changes in the composition of the oral microbiome following the administration of antibiotic therapy. Methodology: The research was designed as a prospective observational case-control study. From March to June 2023, twenty patients were included in this study. They were hospitalized at the Anesthesiology and Resuscitation Clinic of Královské Vinohrady University Hospital and met the established criteria. Samples from the gingival area and the root of the tongue were collected from each patient before and after antibiotic administration. The samples were subsequently processed using the 16S ribosomal RNA gene sequencing method. Results: The primary finding of the research project was the dynamics of the microbiome. Our study revealed that intubation leads to a shift of the microbial community from the oral cavity to the root of the tongue within a matter of days, or for some patients, even within hours. Furthermore, the administration of antibiotic therapy had a significant negative impact on the growth of bacterial flora in the oral...
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Influence of early antibiotic treatment on lower airway microbial colonisation in patients receiving mechanical ventilation
Kroupová, Alžběta ; Duška, František (advisor) ; Kukol, Václav (referee)
AJ Introduction: Ventilator-associated pneumonia (VAP) is a significant source of morbidity and mortality among patients undergoing mechanical ventilation. Its development is preceded by colonization of the lower respiratory tract with pathogenic bacteria. The purpose of this study was to investigate how antibiotic therapy administered for non-pulmonary infections affects the colonization of the lower respiratory tract compared to patients not receiving antibiotics. The hypothesis is that antibiotic treatment reduces colonization of the lower respiratory tract but increases the occurrence of multidrug-resistant bacteria. Methods: This was a retrospective observational cohort study conducted on critically ill patients hospitalized at the Department of Anesthesiology and Resuscitation, Third Faculty of Medicine, Charles University, and University Hospital Kralovske Vinohrady. This study is part of an ongoing project aimed at improving the quality of care and preventing VAP in intensive care unit patients. Patients had to meet certain criteria: they had to be on mechanical ventilation for more than 48 hours, have no pre-existing pulmonary diseases upon hospital admission, and not be immunocompromised. The primary outcome was the difference in the proportion of patients with positive microbiological...
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Sources of error in interpretation of blood gas analysis: Current acid-base models of plasma
Krbec, Martin ; Duška, František (advisor) ; Jabor, Antonín (referee) ; Caironi, Pietro (referee)
Sources of error in interpretation of blood gas analysis: Current acid-base models of plasma Abstract of Doctoral thesis Martin Krbec Introduction. Evaluation of acid-base status is an essential tool used by clinicians to guide therapy in a wide range of conditions. Of all biological fluids, in which the acid-base equilibrium has been studied, isolated plasma is the best described one. For its evaluation, two main approaches have been developed: One is the traditional bicarbonate-centered school based the work of Henderson, Hasselbalch, van Slyke, and Siggaard-Andersen. The other is the quantitative physicochemical approach invented by Stewart and further developed by Staempfli and Constable or Figge and Fencl. Each of the mentioned models uses a set of constants for characterizing the behavior of non-carbonic buffers (proteins and phosphates) in plasma, the value of which is crucial for precise calculation of derived parameters. The values of the constants used by the Stewart model, i.e., the total weak nonvolatile acid concentration (Atot) and its dissociation constant (pKa), have only been experimentally determined once in a group of 8 healthy volunteers. Our aim was to experimentally determine the value of these constants in healthy volunteers and, for the first time ever, in two populations of...
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Mitochondrial function in skeletal muscle of critically ill
Urban, Tomáš ; Duška, František (advisor) ; Bořilová Linhartová, Petra (referee) ; Lipový, Břetislav (referee)
Aerobic phosphorylation in the mitochondria is an essential source of ATP for the functioning of higher organisms. It can be assumed that in critically ill patients, alterations in mitochondrial function are not only a para-phenomenon but also a cause of metabolic dysfunction and skeletal muscle function. In addition, critically ill patients are given drugs that facilitate care but may have unwanted side effects. Among these is the widely used diisopropylphenol, i.e. propofol. However, there is increasing evidence that propofol can induce propofol infusion syndrome, leading to mitochondrial dysfunction and failure, which can lead to the death of the patient. The research question in our project was whether there are differences in mitochondrial function compared to a control group in critically ill patients at different stages of the disease, and whether there is a difference between the group rehabilitating with the FES-CE device, i.e. functional electrical stimulation assisted ergometry, and the group with standard rehabilitation. Furthermore, we aimed to determine whether and how different parts of the respiratory chain are inhibited during propofol administration. In a subgroup of patients enrolled in a prospective randomized controlled trial, The Effect of Functional Electrical...
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Nutritional support in critically ill pattients
Riško, Peter ; Duška, František (advisor)
The thesis is about rearrangements of energy metabolism in critically ill and describes metabolism of components of parenteral nutrition. The work beginns with the description of stress starvation and underlying endocrine changes. The core of my diploma work is about metabolic processes, which proceed in organism with suplemented nutriens and their influence on pacient's outcomes.
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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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Family guide throughout intensive care unit - creating website
Lau, Veronika ; Duška, František (advisor) ; Zýková, Ivana (referee)
Key words: intensive care; relatives; information resources; web One of the most important ICU patient's family members' needs is to be sufficiently informed. However, the information transfer occurs in stressful circumstances and in an unfamiliar environment, which impairs the ability to remember and understand the information provided by the healthcare team. Information materials, which can be both printed and digital, are a useful tool to complement verbal communication with family members. While there is a plethora of such information materials available on foreign websites, there is no similar comprehensive set of information in the Czech language. The aim of this work was to create a Guide throughout Intensive Care Unit. The guide was inspired by available foreign web materials and adapted to the scope of care provided in the intensive care units of the Department of Anaesthesia and Intensive Care Medicine, Charles University, 3rd Faculty of Medicine and FNKV. The individual topics of the Guide were designed to be applicable to all patients admitted to intensive care unit and divided into sections to provide information to the patients' relatives in a logical sequence: Introduction to Intensive Care, Patient Admission, During the Stay, Leaving the Intensive Care Unit, and Visiting the...
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The influence of early intensified rehabilitation on the clinical outcome of critically ill patients
Waldauf, Petr ; Duška, František (advisor) ; Hagovská, Magdaléna (referee) ; Maňák, Jan (referee)
1 Executive Summary The overarching goal of this thesis was to assess the efficacy and safety of an innovative rehabilitation technique - functional electrical stimulation-assisted cycle ergometry - in critically ill patients. We firstly (Project A) investigated physiological changes induced by this technique in a group of 14 healthy volunteers and compared it, in a cross-over design, to normal volitional low intensity exercise. We have shown an increase in whole-body energy expenditure similar to 25 W exercise. Then (Project B) we have performed a meta-analysis of randomised-controlled studies available to date to compare in the population of critically ill patients the effect of neuromuscular electrical stimulation, passive cycling, and early goal-directed rehabilitation. We found that only goal directed rehabilitation has positive effects on patient-centred outcomes. There were no published studies using functional electrical stimulation-assisted cycle ergometry. Lastly (Project C) in a large, single centre randomised controlled trial we have tested an innovative functional electrical stimulation-assisted cycle ergometry-based early rehabilitation protocol compared to standard of care in critically ill patient. We have not found any significant differences in the physical function after six months of...
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The Intensive Care Unit-Acquired Weakness: the role of mitochondrial dysfunction in its pathogenesis
Jiroutková, Kateřina ; Duška, František (advisor) ; Houštěk, Josef (referee) ; Maňák, Jan (referee)
BACKGROUND: ICU-acquired weakness impairs functional outcome in survivors of critical illness. Therefore, deepening our understanding of its pathogenesis is an important goal as muscle-specific therapeutic targets are urgently needed. Systemic inflammation and sepsis are the main risk factors of ICUAW, and these syndromes are associated with mitochondrial dysfunction. The aim of our study was to collect reliable information on the mitochondrial function of human skeletal muscle in the protracted phase of critical illness. Additionally, we explored mitochondrial respiratory parameters following experimentally induced changes in the availability or composition of selected nutrients (fatty acids and glutamine). MATERIALS and METHODS: Vastus lateralis muscle biopsy samples from patients with ICU- acquired weakness and age-matched healthy controls were obtained. In human skeletal muscle tissue homogenates mitochondrial functional indices were assessed by high- resolution respirometry, individual functional capacities of respiratory complexes were measured by spectrophotometry and correlated with concentrations of electron transport chain key subunits measured by western blot. Additionally, using human myoblasts and myotubes we studied the influence of extracellular environment manipulations by...
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Effects of acute starvation and of type 2 diabetes mellitus upon insulin resistance and substrate utilization in obese subjects
Duška, František ; Anděl, Michal (advisor) ; Haluzík, Martin (referee) ; Mourek, Jindřich (referee) ; Stárka, Luboslav (referee)
Very-low calorie diet or even total short-term fasting is widely used in clinical practice in order to improve metabolic compensation of patients with type 2 diabetes mellitus. Although benefits of weight reduction are well proven in T2DM, much less is known about effects of acute starvation, during which the interruption of the afflux of energy substrates is not followed by a major change of body composition. We hypothesize the improvement of insulin effects on glucose metabolism in T2DM as these patients may lack the key metabolic responses which impair insulin sensitivity in lean, non-diabetic subjects. Moreover, we assume according to "thrifty genotype hypothesis" that protein wasting during starvation will be positively related to insulin effects on glucose disposal and negatively related to insulin antilipolytic and antiketogenic effects. In the light of this we designed an observational, prospective, in-hospital study, comparing the effects of 60 hours fast on various aspects of insulin resistance, endocrine regulation and metabolism in 10 patients with T2DM and 10 obese controls without diabetes (OB).
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