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Application of insulin in the regulation of blood glucose levels within the therapy in critically ill patients
Beil, Kamil ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
This thesis presents and compares the results of clinical trials found during intensive insulin therapy (IIT) in critically ill patients (CIP) hospitalized in intensive care units (ICU). The aim of this thesis was to search usage processing and the importance applications of insulin in the treatment of critically ill patients in intensive care units. It explains principles and issues of insulin use in this indication with presentation of IIT risks. Clinical studies were carried out in the ICU with a different focus (medical, surgical, cardiac surgery, mixed etc.). In most studies, patients were randomized into two groups - group IIT maintained glycemic range from 80 to 110 mg / dl, i.e. from 4,4 to 6,1 mmol / l; group of conventional insulin therapy should range glycemia from 180 to 200 mg / dl, i.e. from 10,0 to 11,1 mmol / l. In most studies, it has been shown to reduce complications and mortality in patients treated with IIT compared to patients treated with conventional insulin therapy. Less strict insulin therapy was able partially leave IIT advantage and reduce the risk of hypoglycemia. On the other hand, although IIT increased risk of hypoglycemia, did not increase mortality. Explaining the observed differences in mortality and morbidity among studies appear to be obviously differences in...
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Energy expenditure and utilization of nutritive substrates in septic patients during hospitalization in ICU
Hladová, Eliška ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
The aim of this work were examinations of septic patiens to determinate energy expenditure and the utilization of nutritional substrates and to compare results of examinations to standart recommendations of ESPEN for patient's nutrition. For investigations was used indirect calorimetry. Our group of septic patients consisted of three men and three women from 58 to 73 years old. The lenght of the hospital stay was different, so the group was heterogenous and each patient was in different phase of sepsis. Five of six patients were in hypermetabolism. The value of energy expenditure was from 87,3 % to 176,2 %. Average energy expenditure was 1790,3 ± 414,9 kcal/ kg/ day and average energy of nutrition was 2080,2 ± 754,7kcal/ kg/ day. As for nutritional substrates, average income of carbohydrates was 257,9 ± 109,9 g/ den. Average utilization of carbohydrates was 83,9 ± 62,1 g/ day. So the intake of carbohydrates were significantly higher, than the utilization. Average income of lipids was 63,6 ± 15,7 g/ day and average utilization was 102,1 ± 61,8 g/ day. There was also significant diference between lipid utilization and lipid intake. Average income of proteins was 127,4 ± 61,7 g/ day. Average utilization of proteins was 132,5 ± 53,6 g/ day. To conclusion, the results of examinations, measured by...
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The evaluation of DNA oxidative damage at polytraumatic patients.
Štrofová, Marcela ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
The aim of this study was to observe levels of oxidative DNA damage in patients with multiple injuries in correlation with the nutritional support that the patients have received during their hospital stay. Oxidative DNA damage was evaluated in two periods of time, first evaluation was performed during standard nutritional support according to the ESPEN guidelines. Second evaluation was performed after a change in nutrition according to individual parameters of metabolism and utilization of nutritional components based on indirect calorimetric measurements. This study included 6 patients with multiple injuries hospitalized in the Intensive Care Unit 1 at the Department of Surgery, University Hospital in Hradec Kralove. In this experiment DNA isolated from peripheral lymphocytes was used to evaluate oxidative DNA damage. This DNA was analyzed using the Comet Assay method. The enzymatic version of the Comet Assay was used to determine the oxidative damage of purines and pyrimidines, and the alkaline version was used for detection of single strand breaks. Mann-Whitney test was used for statistic evaluation the difference between both measuremetns, correlation analysis for relations between Comet Assay results and clinical parameters. Significant correlations between a total amount of nutrients given...
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Evaluation of nitrogen balance with respect to the administered parenteral and enteral nutrition and the composition of the body in critically ill patients
Vaňková, Martina ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
The aim of this thesis was to identify and assess the nitrogen balance due to the field of nutritional support, body composition, energy expenditure, utilization of nutritional substrates and their changes during the hospitalization. Nitrogen balance was determined in 12 men and one woman (age 44 ± 16,4 years) with multiple injuries (ISS 40 ± 11) in the ICU based on 2 measurements in the time interval of 1-7 days, as the difference between the received and the ecrected nitrogen. The energy expenditure and nutritional substrate utilization nutritional indirect calorimetry, body composition analysis and blood chemistry laboratory were examined at patients. Correlation analysis revealed dependence between nitrogen balance and other monitored parameters and also dependence on the length of their trauma. Total protein intake averaged 1,40 ± 0,69 g.kg-1 .d-1 . At this dose were recorded negative values of nitrogen balance in the first measurement of the 9-patients and in the second measurement of the whole group. In this work also the results of uptake of parenteral and enteral route were compared. In practice, significant correlations were found between total uptake and energy expenditure (p = 6,31.10-3 ; r = 0,6) in the first measurement, and on the other hand negative correlation during the second...
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The energy expenditure at critically ill patients
Švrčková, Alexandra ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
The aim of this study was to determine energy expenditure and to find relations between resting energy expenditure (REE) and selected parameters in 14 polytraumatic patients in the ICU of University Hospital in Hradec Kralove, which were easily measurable and usable for REE prediction. In this study 7 men (age 36 ± 18 years) and 7 women (age 58 ± 28 years) with polytrauma were examined. The assessment of REE was measured via indirect calorimetry (IC) method. The examination also included bioimpedance analysis (BIA). BIA was useful especially for obtaining values of overhydration (OH), lean tissue mass (LTM) and metabolically active body cell mass (BCM). Average REE-IC (measured by IC) was 2116 ± 516 kcal·day-1 in men and 1450 ± 407 kcal·day-1 in women (P = 0.018). Statistically significant difference between men's and women's population was also found in these relations: calculation of basal energy expenditure according to Harris-Bennedict equation without (P = 0.001) and with deduction of OH from body weight (P = 0.001), at "breathing energy expenditure" (REE related to respiratory rate) (P = 0.018) and at (REE related to heart rate) "heart rate energy expenditure" (P = 0.038). REE-IC related to kilogram of BCM with and without deduction of overhydration was shown as statistically significant...
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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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