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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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Multiplex Immunoassay in critically ill children
Šašek, Lumír ; Kobr, Jiří (advisor) ; Kroužecký, Aleš (referee) ; Kula, Roman (referee)
Multiplex immunoassay in critically ill children MUDr. Lumír Šašek Severe lung diseases leading to respiratory failure are the most common causes of critical conditions in childhood. From the perspective of the forecasting is in many cases difficult to identify the further development of the disease and thus allow the setting of adequate therapy. Pulmonary involvement leads to system response, and the response intensity should be at the level of the cytokines directly proportional to the degree of pulmonary disability. This work aims to follow in pediatric patients, the systemic inflammatory response dependence on the degree of lung injury using a multiplex immunoassay on the one hand and clinical, laboratory and imaging parameters on the other. It should identify, if possible, expression of early systemic cytokine markers that correlate with the degree of lung injury, which was determined by standardized scoring and monitoring parameters. This is a prospective, non-randomized observational study. The study group included 32 patients. The study included critically ill patients by PRISM III-12 and LIS with respiratory failure with the need for invasive mechanical ventilation. Patients were followed for up to 48 hours. Correlation between clinical (and laboratory) manifestations of lung disease and...
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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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Multiplex Immunoassay in critically ill children
Šašek, Lumír ; Kobr, Jiří (advisor) ; Kroužecký, Aleš (referee) ; Kula, Roman (referee)
Multiplex immunoassay in critically ill children MUDr. Lumír Šašek Severe lung diseases leading to respiratory failure are the most common causes of critical conditions in childhood. From the perspective of the forecasting is in many cases difficult to identify the further development of the disease and thus allow the setting of adequate therapy. Pulmonary involvement leads to system response, and the response intensity should be at the level of the cytokines directly proportional to the degree of pulmonary disability. This work aims to follow in pediatric patients, the systemic inflammatory response dependence on the degree of lung injury using a multiplex immunoassay on the one hand and clinical, laboratory and imaging parameters on the other. It should identify, if possible, expression of early systemic cytokine markers that correlate with the degree of lung injury, which was determined by standardized scoring and monitoring parameters. This is a prospective, non-randomized observational study. The study group included 32 patients. The study included critically ill patients by PRISM III-12 and LIS with respiratory failure with the need for invasive mechanical ventilation. Patients were followed for up to 48 hours. Correlation between clinical (and laboratory) manifestations of lung disease and...
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Methods of tissue perfusion and microcirculation assessment in experiment
Šitina, Michal ; Černý, Vladimír (advisor) ; Stříteský, Martin (referee) ; Kroužecký, Aleš (referee)
Methods of tissue perfusion and microcirculation assessment in experiment - set of experimental studies Michal Sitina Summary of doctoral thesis Doctoral study program Surgery Hradec Kralove 2013 Summary In the course of the doctoral study we have performed 4 experimental animal studies and one theoretical study using a mathematical model. Three of the studies were published in journals with an impact factor. All studies, using various research methods, deal with a microcirculation. We have assessed the method of the indicator dialysis as insatisfactory for an accurate measurement of the tissue perfusion. We have demonstrated no negative influence of a moderate hypothermia on the cerebral autoregulation of a pig. The mathematical model identified several factors, that can influence the THR test of the cerebral autoregulation. The influence of the inertia assessed the mathematical model as marginal. The methodical study of a visualisation of the surface brain microcirculation of rabbit using SDF imaging proved a high quality of visualisation. The measured parameters corresponded with the other literature values. An application of the SDF imaging of the brain surface mentioned above showed no changes of the brain microcirculation of rabbit at the early stage of the endotoxemia. Powered by TCPDF (www.tcpdf.org)
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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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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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