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The influence of the treatment of experimental acute liver failure by FPSA/Prometheus on intracranial pressure
Pražák, Josef ; Cvachovec, Karel (advisor) ; Červinková, Zuzana (referee) ; Kieslichová, Eva (referee)
Background: Cerebral edema is a well-known and fatal complication of acute liver failure (ALF). The influence of the treatment by artificial liver devices on the cerebral damage caused by ALF is usually monitored by only measuring the intracranial pressure (ICP). The aim of this work was to determine the influence of Fractionated Plasma Separation and Adsorption (FPSA), nonbiological artificial liver device, on the intracranial pressure. The second goal of this work was to determine the potential role of cerebral microdialysis in monitoring of the efficiency of fractionated plasma separation and adsorption (FPSA) treatment of ALF. Methods: Two types of surgical resection model of ALF were used in two separate experiments in pigs. In the first study data from monitoring of the intracranial pressure of ALF group (animals with ALF only) and FPSA group (animals with ALF treated by FPSA) were compared. In the second study data from monitoring by cerebral microdialysis and ICP of the ALF group (animals with ALF only), FPSA group (animals with ALF treated by FPSA) and SHAM group (animals with only laparotomy) were compared using statistical analyses. Results: In both experiments, the ICP was significantly higher in the ALF group than in the FPSA group from the 9th hour of the experiment. In the second...
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End-of-life decision making and quality of life in critically ill patiens
Pařízková, Renata ; Zavázalová, Helena (advisor) ; Kasal, Eduard (referee) ; Cvachovec, Karel (referee)
The development of intensive care during last several decades has brought the ability to increase patients survival and quality of life (QOL) however new tasks and concerns especially in ethics occured. Emerging imbalance among therapeutical options and economic resources together with false optimism of physicians and public regarding "borderless" possibilities of medicine started the discussion about allocation of resources to patients in whom real hope for improvement of medical status or quality of life could be anticipated. Intensive care can prolong dying often associated with distress and loss of dignity that is in contradiction to ethic principles and the main right of human. Withdrawing organ support techniques that is considered as a futile, inappropriate and without chance to improve clinical outcome is in accordance with ethic rules. In this situation, the principal goal of medicine, preserving life and health is no longer affordable therefore it is necessary to change our effort to ensure basic patient's physical, psychological, social and spiritual needs with accent to respect dignity. The aim of PhD theses was: - to define areas and key principles regarding end-of-life decision (EOLD) making in intensive care, - to identify factores affecting short and long-term outcome (surviving and quality...
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The use of thromboelastography (TEG) in the evaluation of coagulation in patients on intensive care unit (ICU)
Durila, Miroslav ; Cvachovec, Karel (advisor) ; Stříteský, Martin (referee) ; Kovářová Kudrnová, Zuzana (referee)
Patients in the intensive care unit are in critical condition which is often accompanied by a coagulation disorder. Sepsis as a leading cause of death in critically ill patients may be associated with both hypercoagulable state with microtrombi formation in microcirculation and with increased production of endogenous heparinoids with inhibitory effects on blood clotting. Central venous catheter and arterial catheter are established in patients for hemodynamic monitoring and these are flushed with heparin to prevent their closure. Both inputs are used for blood sampling for laboratory tests such as blood count and coagulation parameters, including thromboelastography (TEG). In the first step of the work, arterio-venous differences in coagulation parameters were investigated in patients with sepsis. Higher concentration of D-dimers and lower antithrombin activity were found in venous blood. This finding can be explained by increased antithrombin consumption in hypercoagulable state and reactive hyperfibrinolysis. Inconsistency in the site of blood sampling may then lead to misinterpretation of the pathophysiological processes in the body. No significant differences were found in TEG parameters. In the second step of the work we examined how heparin commonly used for catheter flushing affects TEG-assessed...
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Nitric oxide - an indicator for severity of injury in polytrauma
Beitl, Evžen ; Hoch, Jiří (advisor) ; Cvachovec, Karel (referee) ; Zeman, Miroslav (referee)
- Part I (clinical study) Background: Patients with injuries to multiple organs or organ systems are in a serious risk of shock, multiorgan failure and death. Although there are scoring systems available to assess the extent of polytrauma and guide prognosis, their usefulness is limited by their considerably subjective nature. As the production of nitric oxide (NO) by many cell types is elevated by tissue injury, we hypothesized that serum concentration of NO (and its oxidation products, NOx) represents a suitable marker of polytrauma correlating with prognosis. We wanted to prove that nitric oxide can serve as an indicator for severity of injury in polytrauma. Methods: We measured serum NOx and standard biochemical parameters in 93 patients with various degrees of polytrauma, 15 patients with minor injuries and 20 healthy volunteers. Results: On admission, serum NOx was higher in patients with moderate polytrauma than in both controls and patients with minor injury, and it was even higher in patients with severe polytrauma. Surprisingly, NOx on admission was normal in the group of patients that required cardiopulmonary resuscitation or died within 48 hours after admission. In groups where it was elevated on admission, serum NOx dropped to normal values within 12 hours. Blood lactate levels on...
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Fibrinolysis in cardiac surgery and possibillity of its control
Špegár, Ján ; Vaněk, Tomáš (advisor) ; Cvachovec, Karel (referee) ; Stříteský, Martin (referee)
Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study SUMMARY The study was performed to examine a possible augmentation of systemic administration of tranexamic acid by the additional topical application during heart valve surgery in the post-aprotinin era. One-hundred patients were enrolled in the study and all the patients were given tranexamic acid intravenously. The participants were randomized into two groups (A, n = 49; B, n = 51), and before commencing the sternal suturing, the study solution (group A: 250 ml of normal saline + tranexamic acid 2.5 g, placebo group B: 250 ml of normal saline) was poured into the pericardial cavity. The cumulative blood loss (geometric means [95% confidence intervals]) 4 h after the surgery was 86.1 [56.1, 132.2] ml in group A, and 135.4 [94.3, 194.4] in group B, test for equality of geometric means P = 0.107, test for equality of variances P = 0.059. Eight hours after the surgery, the blood loss was 199.4 [153.4, 259.2] ml in group A, 261.7 [205.1, 334.0] ml in group B, P = 0.130 and P = 0.050, respectively. Twentyfour hours postoperatively the blood loss was 504.2 [436.0, 583.0] ml in group A, 569.7 [476.0, 681.7] ml in group B, P = 0.293 and P = 0.014, respectively. The proportion of patients...
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The fluid therapy during burn shock guided by hemodynamic parameters
Tokarik, Monika ; Vaněk, Tomáš (advisor) ; Cvachovec, Karel (referee) ; Kofránek, Jiří (referee)
ABSTRACT Keywords Burn shock; fluid therapy; arterial pulse contour analysis; dynamic preload parameters; hourly urine output. Introduction: Our hypothesis is based on the assumption that the volume therapy in the acute phase of burn shock corrected by a combination of dynamic preload parameters and hourly diuresis is reduced compared to fluid therapy which is corrected only by hourly diuresis. The dynamic preload parameters seem to be the most reliable predictors of response to fluid challenge. Materials and Methods: A group of 21 burned patients meeting preliminary criteria (age range 18 - 75 years with 2nd - 3rd - degree burns and TBSA ≥10 - 75 %) was randomized during 2009 - 2011 as follows. Hemodynamic monitoring through lithium dilution cardiac output was used in 10 randomized patients (LiDCO group) while those without LiDCO monitoring were defined as a control group. The modified Brooke formula as a starting resuscitative formula, ...
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Hemodynamic optimalization in hepatic recection
Zatloukal, Jan ; Pradl, Richard (advisor) ; Cvachovec, Karel (referee) ; Málek, Jiří (referee)
Lowering of central venous pressure in hepatic surgery is nowadays widely recommended and used procedure. Low central venous pressure anesthesia is associated with decreased blood loss and improved clinical outcome. There are several approaches how to reach low central venous pressure. Till now none of them is recommended as superior in terms of patient safety and clinical outcome. Concurrently there is still debate if to use the low central venous pressure anesthesia principle or if it could be replaced with a principle of anesthesia with high stroke volume variation (or another dynamic preload parameter) with the use of a more sophisticated hemodynamic monitoring method. Results of our study didn't show any significant difference between two approaches used for reduction of central venous pressure, but suggest that the principle of low central venous pressure anesthesia could be possibly replaced by the principle of high stroke volume variation anesthesia which presumes the use of advanced hemodynamic monitoring. KEYWORDS Hepatic resection, central venous pressure, Pringle maneuver, hemodynamics, hemodynamic monitoring, fluid therapy, anesthesia
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Alternation of Glycocalyx in Critical Illness and during Major Surgery and Approaches for Glycocalyx Protection
Astapenko, David ; Černý, Vladimír (advisor) ; Cvachovec, Karel (referee) ; Adamus, Milan (referee)
Background: Glycocalyx represents a protective cellular coat on a sugar basis. It serves as a communication medium with outside environment. Glykokalyx also covers the inner apical surface of endothelial cells where it is called the endothelial glycocalyx (EG). Research from last decade declare its pivotal role in physiology and pathophysiology of microcirculation. EG is prone to be damaged in critical conditions but there are more questions than what we actually know about this complex structure. Also, there are new methods being developed for more precise description of EG condition. The aim: The aim of this thesis is to evaluate the level of contemporary evidence about EG and to evaluate methods of its assessment. To describe the condition of EG in experimental model of cardiac arrest (CA) in pig and in experimental model of iatrogenic hypernatremia in rabbit. To describe the influence of different types of anesthesia on EG in patients in perioperative care. To describe the dynamic changes of EG in patients in critical care. To evaluate response of EG to fluid challenge of 500 ml of normal saline in healthy volunteers and the response of EG to administration of lipid emulsion in patients in critical care. To describe the condition of EG in patients with dyslipidemia, with long term home parenteral...
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Nitric oxide - an indicator for severity of injury in polytrauma
Beitl, Evžen ; Hoch, Jiří (advisor) ; Cvachovec, Karel (referee) ; Zeman, Miroslav (referee)
- Part I (clinical study) Background: Patients with injuries to multiple organs or organ systems are in a serious risk of shock, multiorgan failure and death. Although there are scoring systems available to assess the extent of polytrauma and guide prognosis, their usefulness is limited by their considerably subjective nature. As the production of nitric oxide (NO) by many cell types is elevated by tissue injury, we hypothesized that serum concentration of NO (and its oxidation products, NOx) represents a suitable marker of polytrauma correlating with prognosis. We wanted to prove that nitric oxide can serve as an indicator for severity of injury in polytrauma. Methods: We measured serum NOx and standard biochemical parameters in 93 patients with various degrees of polytrauma, 15 patients with minor injuries and 20 healthy volunteers. Results: On admission, serum NOx was higher in patients with moderate polytrauma than in both controls and patients with minor injury, and it was even higher in patients with severe polytrauma. Surprisingly, NOx on admission was normal in the group of patients that required cardiopulmonary resuscitation or died within 48 hours after admission. In groups where it was elevated on admission, serum NOx dropped to normal values within 12 hours. Blood lactate levels on...
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Hemodynamic optimalization in hepatic recection
Zatloukal, Jan ; Pradl, Richard (advisor) ; Cvachovec, Karel (referee) ; Málek, Jiří (referee)
Lowering of central venous pressure in hepatic surgery is nowadays widely recommended and used procedure. Low central venous pressure anesthesia is associated with decreased blood loss and improved clinical outcome. There are several approaches how to reach low central venous pressure. Till now none of them is recommended as superior in terms of patient safety and clinical outcome. Concurrently there is still debate if to use the low central venous pressure anesthesia principle or if it could be replaced with a principle of anesthesia with high stroke volume variation (or another dynamic preload parameter) with the use of a more sophisticated hemodynamic monitoring method. Results of our study didn't show any significant difference between two approaches used for reduction of central venous pressure, but suggest that the principle of low central venous pressure anesthesia could be possibly replaced by the principle of high stroke volume variation anesthesia which presumes the use of advanced hemodynamic monitoring. KEYWORDS Hepatic resection, central venous pressure, Pringle maneuver, hemodynamics, hemodynamic monitoring, fluid therapy, anesthesia
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