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Non-invasive lung ventilation in intensive care from the nurse's point of view
Čechová, Alena ; Juřena, Zdeněk (advisor) ; Máca, Jan (referee)
Noninvasive ventilation (NIV) is a method that can provide a respiratory support during the respiratory failure and reduce the need for invasive mechanical ventilation (IMV) with its risks and complications. However, the failure rate of NIV use remains high. Furthermore, intubation and invasive mechanical ventilation required after NIV failure shows to provide worse patients outcomes compared to their early intubation. While nurses are an integral part of management of these patients contributing to the NIV success, the thesis deals with the nurses' viewpoint of this problematics. In the research, there were involved general nurses and paramedics working in the field of intensive care, where the most of the patients indicated to this treatment are located in the Czech Republic. A qualitative research method performed by the semi-structured interviews has been used for this purpose. It focuses three main areas: 1) acquiring the knowledge and skills, 2) the most common problems and related troubleshooting and 3) the difficulty of caring for the patients with NIV compared to use of invasive ventilation. The research shows that most of the skills nurses need to care for these patients are gained by multiple clinical experience. On the contrary, the role of the school education is insignificant in this...
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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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Role of alarmins in perioperative medicine.
Máca, Jan ; Holub, Michal (advisor) ; Závada, Josef (referee) ; Veselý, Jaroslav (referee)
Introduction: Inflammatory response (IR) is a fundamental reaction to the cell and tissue injury. It is aimed at correcting the pathologic condition and maintaining the structural and functional integrity of the organism. The insult with too extensive or prolonged effect can lead to dysregulation of IR to the systemic level. Major abdominal surgery (MAS) can be considered as a potentially significant insult. Alarmins are endogenous, intracellular proteins that are passively or actively released upon the cell injury to extracellular space where they express their bioactive effect. Alarmins has therefore potential reflect the degree of surgical injury. Purpose: The main goal of the study was elucidating the role of selected alarmins in inflammatory response after MAS. The secondary aims were: 1) determining the relationship between alarmins and outcome prediction, 2) to determine relationship of alarmins and place of surgical intervention, 3) to determine correlation between alarmins and some of the surgery characteristics, e.g. length of surgery, blood loss, and intraoperative fluid load, 4) compare injury caused by laparoscopy and open surgery reflected by alarmins, and 5) to confirm previous results by determining the role of alarmins in surgical injury in subgroup of patients undergoing colorectal...
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