|
|
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,...
|
|
|
Options of continual glycemia monitoring in critically ill patients and treatment of hyperglycemia with the use of insulin algorithms
Bláha, Jan ; Haluzík, Martin (advisor) ; Matějovič, Martin (referee) ; Vaněk, Tomáš (referee)
Glycaemia control is nowadays one of the most discussed topics in intensive care. The landmark Leuven study, which has brought hyperglycaemia in intensive care to the centre of interest, demonstrated that tight glycaemia control (TGC) targeted to maintain euglycaemia between 4.4 to 6.1 mmol/l reduced mortality and frequency of organ complications associated with critical illness. Although this study was published eight years ago, there is still no general agreement about approach to tight glycaemia control in critically ill patients. Doubts have been raised about both the universality of intensive glycaemia control, and especially its safety in terms of potential damage to patients by episodes of hypoglycaemia. Our studies did not focus on questions of importance or risk of TGC, but we concentrated on key point of hole TGC concept - on glycaemia control in critically ill patients itself. The aims of our studies were the research of subcutaneous adipose tissue as an alternative-site for continuous glucose measurements in ICU patients, and comparison and development of insulin algorithms for hyperglycaemia treatment and normoglycaemia management. We demonstrated good correlation between arterial and interstitial subcutaneous glucose concentrations in critically ill patients undergoing deep hypothermia. We...
|
|
|
The role of ATP-MgCl2 in ischemia-reperfusion and sepsis
Nalos, Marek ; Kasal, Eduard (advisor) ; Matějovič, Martin (referee) ; Šrámek, Vladimír (referee)
The previously reported multiple beneficial effects of ATP-MgCl2 were tested in two clinically relevant large animal models. We observed mainly cardiovascular effects of ATP-MgCl2 likely related to purinergic receptors stimulation. Adding ATP and its metabolite adenosine to ex vivo LPS stimulated whole human blood cultures and measuring cytokine secretion we have further tested whether modulation of inflammation might be responsible for some of the ATP-MgCl2 effects. The results are summarized as follows: 1. Infusing ATP-MgCl2 intravenously in a porcine I-R injury model of thoracic aortic cross clamping provides better cardiovascular stability compared to currently used standard agent sodium nitroprusside. Although ATP-MgCl2 led to reduced gut lactate release we could not demonstrate any beneficial effects on numerous markers of reperfusion injury. Moreover the combination of sodium nitroprusside with esmolol provided hemodynamic control superior to ATP-MgCl2. 2. In long term hyperdynamic porcine model of sepsis ATP-MgCl2 increased portal venous blood flow, reduced ileal mucosal-arterial pCO2 gap and preserved hepatic arterial buffer response as well as metabolic coupling between lactate release from the gut and its utilization by the liver. Despite the beneficial effects of ATP-MgCl2 on hepatosplanchnic...
|
|
|
Hemo elimination method in the treatment of sepsis and early multi-organ dysfunction
Sýkora, Roman ; Matějovič, Martin (advisor) ; Chytra, Ivan (referee) ; Maňák, Jan (referee) ; Šrámek, Vladimír (referee)
The most common cause of death in patients with sepsis/septic shock is deterioration of the function of multiple organs, termed multiple organ dysfunction syndrome. Although our understanding of mechanisms involved in the pathophysiology of sepsis-induced tissue damage has improved substantially, therapy of these syndromes still remains largely supportive. The hallmark of sepsis is an overwhelming systemic production of both pro- and anti-inflammatory mediators leading to generalized endothelial and epithelial damage, microcirculatory-mitochondrial distress, altered endocrine and coagulation homeostasis and cellular immune hyporesponsiveness. Therefore, the hypothesis that modulation of this excessive immunological and biological response to infection might improve patient outcome appears reasonable. Hemoelimination techniques represent biologically plausible way to provide non-specific removal of soluble pro- and anti-inflammatory mediators, although the concept of blood purification in sepsis remains a matter of considerable debate. The aim of this thesis was to elucidate effects of 1) high volume hemofiltration (HVHF) and 2) coupled plasma filtration adsorption (CPFA) in a long-term, hyperdynamic porcine septic shock model, which fulfils the criteria for human sepsis. We hypothesized that both HVHF and...
|
|
| |
|
|
iPhone OS Software Development
Matejovič, Martin ; Láník, Aleš (referee) ; Koutný, Jiří (advisor)
This thesis covers software development for Apple's mobile phonde iPhone. Official iPhone SDK is available from Apple developer's web site. The thesis includes iVoip application, developed using iPhone SDK. This application could be used as VoIP client using SIP protocol.
|
|
| |
|
| |
|
| |
|
| |
guest ::
