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Diagnostics, Prevention and Therapy of Candida Sepsis in Adults
Dvořák, Tomáš ; Pachl, Jan (advisor)
My diploma paper focuses on systemic candidiasis. The first part of the paper deals with current possibilities in prevention, diagnostics and therapy of Candida sepsis. In the second part I introduced three case studies of patients with Candida sepsis diagnosis. It describes the selected diagnostic and therapeutic process, which is confronted with the current state of knowledge in the management of candidiasis.
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Analgosedation in Critically
Tůma, Pavel ; Pachl, Jan (advisor) ; Provazníková, Hana (referee)
A stay in a department KAR can bring beside treatment and often saving of live in acute period a risk too. Just length of hospitalization has high effect for developement of infectious and psychiatrics disease and shortening of length of hospitalization can prevent this complication. Severe trauma of body, chirurgical or incidental, produces a reproductive phyziological response. A mechanism of initiation, regulation and a maintenance includes mostly neuroendocrinal axis. An optimal level for suppression of stress response is still unknown. An environment of JIP is a litle bit abnormal from an environment i common live. Mostly all incoming patients in ICU experience a pain due to performing of procedure, advance of disease or immobility without possibility for change position. A pain cause sympatic hyperaktivity, which increase hearth's frequency, stroke volume and consumption of oxygen by myokard.Assesment of sedation is difficult, because it is not in clinical praxis for disposition objektive method for assesment. Impossibility of adequate assesment of pain is not optimal for managing of pain. Need for sedation during using of mechanical ventilation is individual different. An inadequate deep sedation inhibits function of respiratory centre. Deep sedation without a positive affecting of mental function...
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Comparing Morbidity and Mortality in Trauma Patients in the Franco-German System and the Anglo-American System of Emergency Medicine
Scott, Cameron Stewart ; Pachl, Jan (advisor)
The study should aid in determining if there is a benefit in the Anglo-American System versus the Franco-German System of Emergency Medicine in terms of trauma outcomes. This is of significant value for many countries that are now implementing Emergency Medicine as its own specialty. It may also be especially useful for countries considering implementation of the Anglo-American system. Additionally, it will help to determine whether emergency physicians at the scene of a trauma are of significant benefit over paramedics alone. Finally, this may have special significance for developing countries as they improve their health care systems and consider what type of system or combination of systems they may like to implement for emergency services.
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Pathophysiology of Brain Injury after Subarachnoid Haemorrhage and its Management Options
Kolář, Martin ; Pachl, Jan (advisor) ; Gál, Roman (referee) ; Zazula, Roman (referee)
Aneurismal subarachnoid hemorrhage (SAK) is a cerebrovascular accident with high mortality. It carries both short and long term consequences. Mechanisms of neurologic damage after SAK include intracranial hypertension, early and delayed brain vasoconstriction, as well as inflammatory response are involved. Vasoconstriction is a crucial phenomenon in both early and delayed phases and nitric oxide (NO) plays the key role. Aim of the study was to test following hypotheses in animal model: 1. Subarachnoid hemorrhage causes decrease of brain perfusion by mechanism of intracranial hypertension and early vasoconstriction, 2. Both administration of vasodilator - NO donor, and elimination of intracranial hypertension can reverse the early hypoperfusion, 3. SAH leads to generation of free radicals, 4. Administration of antioxidant (melatonin) can attenuate the free radical damage. Methods: Adult male Wistar rats were used for the experiments. SAH was induced by injection of arterial blood into prechiasmatic cistern. Perfusion of brain cortex was measured by Laser Speckle Contrast Analysis (LASCA). In the first experiment, SAH was induced and sodium nitroprusside (SNP, 10 µg / 5 µl) was administered into the lateral ventricle in 2 phases according to the dynamics of perfusion changes: (1) all animals received...
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The impact of early anticoagulant therapy on the survival of the patients with cardiac arrest caused by acute myocardial infarction
Knor, Jiří ; Pachl, Jan (advisor) ; Březina, Aleš (referee) ; Herold, Ivan (referee)
Introduction. Formation of microthrombi after successful resuscitation for out-of-hospital cardiac arrest (OHCA) may lead to the microcirculatory dysfunction and have a negative influence on patient's outcome. We performed a randomized clinical study assessing effect of intra-arrest heparin administration in OHCA patients with suspected acute myocardial infarction (AIM) on their prognosis. Method. The OHCA patients were randomized during CPR for the intra-arrest intravenous heparin 10 000 units (Group H) or for treatment without heparin (Group C). The mortality rate, favourable neurological outcome in 3 months after OHCA and the occurrence of major bleeding were registered and evaluated with statistical methods (Fisher exact test, Student t test). Results. Out of 88 randomized patients, the AIM was subsequently confirmed in 63 of them (71.6 %). There were 30 patients in group H and 33 in group C. The return of spontaneous circulation (ROSC, Group H: 40.0 %, Group C: 45.4 %, p = 0.859) and good neurological status during 3 months period after OHCA (Group H: 6.7 %, Group C: 9.1 %, p = 0.909) did not differ between groups as well as neurological outcome between subgroups of the patients who achieved the ROSC (Group H: 16.7 %, Group C: 20.0 %, p = 0.990). No major bleeding was observed. Conclusions....
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Analgosedation in Critically
Tůma, Pavel ; Pachl, Jan (advisor) ; Provazníková, Hana (referee)
A stay in a department KAR can bring beside treatment and often saving of live in acute period a risk too. Just length of hospitalization has high effect for developement of infectious and psychiatrics disease and shortening of length of hospitalization can prevent this complication. Severe trauma of body, chirurgical or incidental, produces a reproductive phyziological response. A mechanism of initiation, regulation and a maintenance includes mostly neuroendocrinal axis. An optimal level for suppression of stress response is still unknown. An environment of JIP is a litle bit abnormal from an environment i common live. Mostly all incoming patients in ICU experience a pain due to performing of procedure, advance of disease or immobility without possibility for change position. A pain cause sympatic hyperaktivity, which increase hearth's frequency, stroke volume and consumption of oxygen by myokard.Assesment of sedation is difficult, because it is not in clinical praxis for disposition objektive method for assesment. Impossibility of adequate assesment of pain is not optimal for managing of pain. Need for sedation during using of mechanical ventilation is individual different. An inadequate deep sedation inhibits function of respiratory centre. Deep sedation without a positive affecting of mental function...
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Lung Biotrauma
Vobruba, Václav ; Martásek, Pavel (advisor) ; Straňák, Zbyněk (referee) ; Pachl, Jan (referee)
The aim of this study was to investigate longitudinal changes of the pulmonary inflammatory process as a result of mechanical stress due to mechanical ventilation (MV). The concentrations of IL-8, TNF-α, MIP-1β, nitrites/nitrates and inducible nitric oxide synthases (iNOS) were investigated indicate in bronchoalveolar lavage (BAL). 23 piglets were divided into three groups. Group I: animals breathing spontaneously; group II: MV (TV=7 ml/kg, PEEP= 5 cmH2O); group III: MV (TV=15 ml/kg ; PEEP= 0 cmH20). The focus of the study was the influence of CMV on the hemodynamics, pulmonary function, changes in certain chemokine and cytokine levels, and the inducible NOS and nitrite/nitrate production in BAL. A significant increase in heart rate was found in Group III during the 3rd hour of the experiment - both in relation the the initial levels and to the levels of the other groups (p = 0.01 and 0.008 respectively). During the same time period, a significant drop in blood pressure readings was detected in this group as well. A significant increase of the CVP levels was found in Group III starting already from the 1st hour of the experiment. CMV with high tidal volumes lead to a sinificant decrease in lung compliance in Group III already from the 1st hour of the experiment (p < 0.001). Concentrations of...
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The impact of early anticoagulant therapy on the survival of the patients with cardiac arrest caused by acute myocardial infarction
Knor, Jiří ; Pachl, Jan (advisor) ; Březina, Aleš (referee) ; Herold, Ivan (referee)
Introduction. Formation of microthrombi after successful resuscitation for out-of-hospital cardiac arrest (OHCA) may lead to the microcirculatory dysfunction and have a negative influence on patient's outcome. We performed a randomized clinical study assessing effect of intra-arrest heparin administration in OHCA patients with suspected acute myocardial infarction (AIM) on their prognosis. Method. The OHCA patients were randomized during CPR for the intra-arrest intravenous heparin 10 000 units (Group H) or for treatment without heparin (Group C). The mortality rate, favourable neurological outcome in 3 months after OHCA and the occurrence of major bleeding were registered and evaluated with statistical methods (Fisher exact test, Student t test). Results. Out of 88 randomized patients, the AIM was subsequently confirmed in 63 of them (71.6 %). There were 30 patients in group H and 33 in group C. The return of spontaneous circulation (ROSC, Group H: 40.0 %, Group C: 45.4 %, p = 0.859) and good neurological status during 3 months period after OHCA (Group H: 6.7 %, Group C: 9.1 %, p = 0.909) did not differ between groups as well as neurological outcome between subgroups of the patients who achieved the ROSC (Group H: 16.7 %, Group C: 20.0 %, p = 0.990). No major bleeding was observed. Conclusions....
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Comparing Morbidity and Mortality in Trauma Patients in the Franco-German System and the Anglo-American System of Emergency Medicine
Scott, Cameron Stewart ; Pachl, Jan (advisor)
The study should aid in determining if there is a benefit in the Anglo-American System versus the Franco-German System of Emergency Medicine in terms of trauma outcomes. This is of significant value for many countries that are now implementing Emergency Medicine as its own specialty. It may also be especially useful for countries considering implementation of the Anglo-American system. Additionally, it will help to determine whether emergency physicians at the scene of a trauma are of significant benefit over paramedics alone. Finally, this may have special significance for developing countries as they improve their health care systems and consider what type of system or combination of systems they may like to implement for emergency services.
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