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Evaluation of fluid balance in critically ill patients.
Trněná, Michaela ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
The aim of this study was to evaluate the fluid balance of polytrauma patients hospitalized in the intensive care unit at the University Hospital in Hradec Kralove. Very little knowledge about this issue can be found; therefore we tried to clarify how the body responds to trauma and whether it is possible to influence the further course of the disease by controlling the amount of administered fluid. The study included 13 patients, 12 men and 1 woman with different length of hospitalization. The examination of the patients was carried out by the bioelectrical impedance analysis of the body composition which is able to determine the proportion of individual body components (water, muscle mass, fat). All the patients were examined twice, each after a different time period. Other data were collected from medical documentation related to fluid balance and laboratory results. After assessing the results we discovered differences in the measured values in the first and second test. While during the first examination no statistical correlation between the distribution of the fluids in the body and the intake and output was found, the second examination showed a statistically significant relationship between the fluid intake and subsequent body composition (fluid overload, total body water, extra and...
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Utilisation of nutritive substrates at polytraumatic patients.
Valentová, Gabriela ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
There are significant differences in the metabolism of nutritional substrates in polytrauma patients. The actual metabolic needs of the patient may not be achieved despite the guidelines and recommendations for energy supply in the parenteral and enteral form of nutrition are followed. Subsequently this may lead to the occurrence of complications. The aim of the study was to compare the energy intake of each nutrient substrate supplied with nutrition by finding the nutritional substrate utilisation value which is obtained from indirect calorimetry measurements in patients with multiple injuries at the surgical ICU 1 of the Hradec Králové Teaching Hospital. By comparing this data you can obtain the optimum value for the nutritional needs of the patients. In the study we used seven spontaneously breathing polytrauma patients, three women and four men, of an average age of 41±21 years. Utilisations of nutritive substrates of each patient were obtained by indirect calorimetry. Accurate information on the amount and composition of nutrition supplied over 24 hours was also obtained. The patients received an average of 3.80±1.40 g/kg/day of carbohydrates, 1.03±0.56 g/kg/day of lipids and 1.40 ± 0.44 g/kg /day of proteins. The total energy intake was on average 30.94±11.03 kcal/kg/day. In six of seven...
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Resting energy expenditure at polytraumatic patients.
Šimandl, Ondřej ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
The aim of this study was to determine and evaluate resting energy expenditure (REE) and the utilization of nutritional substrates in 14 polytrauma patients in the ICU. Was also assessed level of impact Overhydration (OH) on the accuracy of the determination. Diagnostic investigations using indirect calorimetry (IC) was performed in 9 men and 5 women (age 30 ± 15 years, BMI 27.5 ± 9.4 kg·m-2) with polytrauma (ISS 41 ± 16). For more accurate sizing of REE and extent of utilization of nutritional substrates were used equations derived from the equation of Weir, not Softwear calorimeter. Using IC volumes were determined only inspired an expired oxygen and carbon dioxide. To determine the rate of OH was used bioimpedance analysis methods using BCM. Almost 86% (8 men and 4 women) examined patients showed hypermetabolism. Average REE value was 2241.38 ± 854.27 kcal·day-1, which represented an average increase of prediction of 38.09 ± 49.09% due to the physiological condition. A statistically significant relationship was demonstrated between REE determined using the Weir equation according and the Harris-Bennedict equation without (P = 0,01) with deduction of OH (P = 0,007) only in men. In clinical practice, significant correlations were established between the REE-IC and BSA (P < 0,01), LTM (P < 0,05),...
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Evaluation of anthropometric parameters at polytraumatic patiens.
Broulíková, Zuzana ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
1 Abstract The evaluation of anthropometric paramters is one of an assessment of nutritional status of hospitalized patients. The correct designation of this condition is necessary to determine the patient's prognosis and further treatment to prevent or capture the first signs of developing malnutrition. This negatively affects the patient's condition and cause the development of other complications and prolonged treatment. In this study, anthropometric data collection were examined in polytraumatic patients. Examinations were conducted over a period of 8 months on Unit of the intensive care. The examination shall be subjected to a total of 20 patients with polytrauma different aged 15-64 years, 15 men and 5 women. The results were listed and evaluated examinations at 12 patients, the remaining patients could not be observed in the results of the work for missing data. Patients were examined twice during hospitalization, the basic length of the interval between inspections was 2 weeks. The results were statistically processed and evaluated the changes in some anthropometric parameters between the two measurement periods. Attention has been focused on prognostic indicators of nutritional status - the value of weight, BMI, left arm circumference, thickness of triceps skinfolds, FM (fat mass), FFM (fat- free...
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Resting energy expenditure by polytraumatic patients.
Tichá, Veronika ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
Critically ill patients are characterized by an increased catabolic response, a hypermetabolic state, higher nutritional requirements and a decreased capacity for utilization of parenteral substrate. Measurement of energetic expenditure in critically ill patients is necessery to determine the optimal nutritional support which is individual for everyone patient with the view of contribute to recovery, to prevent possible complications of overfeeding or underfeeding and reduce the hospitalization period. Energy expenditure was measured in two intervals by indirect calorimetry in 12 polytrauma patients (mean age 32 years ± 16 years) in the intensive care unit at FN HK. The hypermetabolic state of patients was evaluated from the ratio of REE/BEE (REE regarding basal energy expenditure calculated on the basis of the Harris-Benedict equation) and was also evaluated utilization of substrates. Resting energy expenditure during the first examination was on average 2195 kcal/d ± 665,8 kcal/d, at the second examination of 2031 kcal/d ± 590,9 kcal/d. Between measurements was no statistically significant difference. Mean REE/BEE was 122,3 % ± 27,44 %, 118,5 % ± 23,15 %, respectively. Respiratory quotient has an average around 0,81, which indicates a preferential utilization of proteins. The large loss of...
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Communication with hospitalized senior
Šimůnek, Viktor ; Havel, Eduard (advisor) ; Machalová, Iva (referee) ; Mareš, Jiří (referee)
This bachelor's work deals the communication with hospitalized elderlies. The theoretical part adverts to the phenomena which influence the communication process. It is concerned with problems in an old age in the context of hospitalization of seniors and proposes to optimal methods of communication. Two types of anonymous question-forms form the basis of this work. One is determined to the hospitalized elderlies and the other to the nursing staff. The research probes how the nursing staff manage to communicate with hospitalized elderlies and how are the seniors satisfied with such communication. The research proceeded in two smaller health care facilities.
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Relatives' visits at intensive care units relatives'and staff's view
Kovalová, Lenka ; Havel, Eduard (advisor) ; Pečenková, Jaroslava (referee) ; Cerman, Jaroslav (referee)
It is desired to know the meaning on relatives visits liberalization on intensive care unit in the view of visitors and the staff. Questionnaires about the visits possible problems were filled up by visitors (53 persons) and intensive care nurses (60 persons). The next results are formulated: The visits of relatives at intensive care unite are obvious and is the obligatory part of treatment process. It is not routine practise to know the patient's wish about the plan visit before the visit. Nobody of visitors was discouraged from visiting the patient on intensive care unit. It is necessary to construct the unites with the better possibility of privacy. The relatives prefer the long duration of visit. The relatives means, that a comatose patient can hear them and the visit helps the patient in healing process. The intensive care unit staff must allow relatives to presence during some therapeutic and diagnostic procedures.
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