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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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Invasive provision critically ill pacient on anesthesiology and resuscitation ward
HROMADA, Přemysl
The subject and objective of this work was to observe and describe the possibilities of invasive monitoring in the anaesthesiology-resuscitation ward. Attention was focused on the research of knowledge of the types of invasive monitoring on the anesthesiology-resuscitation ward in the nursing and paramedic job positions. A comparison of knowledge of the types of invasive monitoring of these workers was realized in two selected hospitals - Jihlava Hospital, Contribution Organization and České Budějovice Hospital, a.s. To realize these objectives, it was necessary at first to study the types of invasive monitoring and theoretically to describe selected types of monitoring. After that was realized the practical qualitative research of knowledge in this area. This research was conducted by semi-structured interviews with randomly selected anesthesiology-resuscitation staff in the nursing and paramedic job positions of those hospitals. The knowledge gained from the interviews was subsequently composed in the form of tables, and on this basis the information received from both hospitals was compared with each other in the examined group of workers. The benefit of this work is the acquisition information on the knowledge of the staff of the anesthesiology and resuscitation ward in the area of invasive monitoring of critically ill patients. It has been found that the knowledge of the employees depends on what kind of invasive monitoring these staff encounter most often in the ward. Staff who work in a regional hospital have wider knowledge than the staff who work in district hospital, because workers in a regional hospital do more often and more types of invasive monitoring, than workers in district hospital.
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Invasive monitoring critically ill pacient on anesthesiology and resuscitation ward
HROMADA, Přemysl
This work describes the current state of providing intensive care for critically ill patients at ARO, then dedicates with the concept of critically ill patient, invasive monitoring, and also acquaints with the ARO department and the subject of its activities. From the point of view of invasive monitoring of a critically ill patient, the theoretical part of this work presents individual ways of monitoring the cardiovascular system. For each of these KVS monitoring methods, the subject and importance of this monitoring, its indication, contraindication, performance technique, as well as possible complications and, last but not least, nursing care that is essential in the care of a critically ill patient are described. The practical part of this work monitors and compares the knowledge of the ARO staff of České Budějovice and Jihlava Hospital regarding the various ways of invasive monitoring of KVS. The subject and objective of this work was to observe and describe the possibilities of invasive monitoring in the anaesthesiology-resuscitation ward. Attention was focused on the research of knowledge of the types of invasive monitoring on the anesthesiology-resuscitation ward in the nursing and paramedic job positions. A comparison of knowledge of the types of invasive monitoring of these workers was realized in two selected hospitals - Jihlava Hospital, Contribution Organization and České Budějovice Hospital, a.s. To realize these objectives, it was necessary at first to study the types of invasive monitoring and theoretically to describe selected types of monitoring. After that was realized the practical qualitative research of knowledge in this area. This research was conducted by semi-structured interviews with randomly selected anesthesiologyresuscitation staff in the nursing and paramedic job positions of those hospitals. The knowledge gained from the interviews was subsequently composed in the form of tables, and on this basis the information received from both hospitals was compared with each other in the examined group of workers. The benefit of this work is the acquisition information on the knowledge of the staff of the anesthesiology and resuscitation ward in the area of invasive monitoring of critically ill patients. It has been found that the knowledge of the employees depends on what kind of invasive monitoring these staff encounter most often in the ward. Staff who work in a regional hospital have wider knowledge than the staff who work in district hospital, because workers in a regional hospital do more often and more types of invasive monitoring, than workers in district hospital.
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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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Invasive monitoring in intensive care
CUPER, Tomáš
Invasive monitoring is a repetitive, durative observation of physiological functions of a patient and functioning of apparatuses which serve as support of these functions. It is thus an active, repetitive and continuous process when both the patient and the medical apparatuses are regarded. The human factor is thus essential and vital. The reason for application of the invasive monitoring during an intensive hospital care is above all the ability to support physiological functions of a patient, at the same time, it serves to timely detect divergences in physiological values; it very often effectively helps in further decision-making of medical interventions, and clarifies the effectiveness of patient´s treatment. The theoretical part of this bachelor thesis deals with the issue of invasive monitoring in intensive hospital care. The beginning of the thesis provides an explanation what actually the invasive monitoring means, and clarifies and characterises intensive medicine and monitoring in general. The individual types of invasive monitoring are divided according to areas of basic living functions in cardiovascular, respiratory, and central nervous system. With every type of invasive monitoring comes an explanation and clarification of it, further, generally indicated and contraindicated statuses are provided, along with instruments and the way monitoring is applied. The theoretical part is concluded by a chapter that deals with general nursing care. The practical part focuses on mapping of the most often used types of invasive monitoring given critically ill patients in Anaesthesiology and Resuscitation wards, and Urgent Admittance wards in hospitals of the area of South Bohemia, and the region of Carlsbad, and mapping of knowledge of staff of Anaesthesiology and Resuscitation and Urgent Admittance in the particular regions given invasive monitoring. The research was implemented by a quantitative method using a printed standardised questionnaire. The amount of data was collected in March 2014. The target group of the research was a team of general nurses and paramedics, who work in Anaesthesiology and Resuscitation wards and Urgent Admittance wards. The anonymous questionnaire was handed out 100 exemplars for hospitals in South Bohemia, and 100 exemplars for hospitals in the region of Carlsbad. In South Bohemia, there were picked the hospitals in České Budějovice, Jindřichův Hradec, Písek, Prachatice, and Tábor, there. In the region of Carlsbad, there were picked the hospitals in Cheb, Carlsbad, and Sokolov, there, to fill in the questionnaire. There took part 141 respondents in the research. The total amount of responses out of 200 exemplars (100%) of the questionnaire thus reached 70, 5%. The questionnaire contained the total of 28 questions, out of which the opening 4 were stratification-like, question nr. 5 was closed, question nr. 6 were half-open and the remaining 22 questions were dealing with knowledge of respondents in the issue of invasive monitoring in intensive care. The results were progressed by the statistic programme SPSS into well arranged tables, and the set hypotheses were statistically evaluated with help of X2 square test. The goal of this bachelor thesis was to map the most often used types of invasive monitoring with critically ill patients in Anaesthesiology and Resuscitation wards, and Urgent Admittance wards in hospitals of South Bohemia, and in region of Carlsbad. This goal was fulfilled. The next goal was to map knowledge of invasive monitoring given staff of Anaesthesiology and Resuscitation wards, and Urgent Admittance wards in hospitals of South Bohemia, and in region of Carlsbad. This goal was fulfilled too. Statistically evaluated questionnaire proved that the workers have the knowledge in the area of treatment, hemodynamic values, as well as techniques in taking care of critically ill patients in Intensive Care wards.
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