- MeSH
- lidé MeSH
- náhlé příhody MeSH
- péče o pacienty v kritickém stavu * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
The hypodynamic septic shock appears to be a promising indication to veno-arterial membrane oxygenation (VA-ECMO) support of a patient with insufficient cardiac output. With cardiac recovery most of those patients progress into a hyperdynamic septic shock with cardiac output, which may not match critically low systemic vascular resistance to maintain perfusion pressures. Such refractory distributive shock represents a challenging indication to VA-ECMO. We report a rare case of a 27-year old patient who developed severe refractory hypodynamic septic shock due to the bilateral staphylococcal pneumonia and had to be initially rescued by femoro-femoral VA-ECMO. Despite extensive measures, he remained in intractable hypotension and profound tissue hypoperfusion with imminent multiorgan failure. The commencement of a second jugulo-axillary VA ECMO secured a total blood flow of 14.3 L/min, which restored perfusion pressure and successfully bridged patient over the period of critical haemodynamic instability and ultimately may have facilitated recovery.
Extracorporeal life support has been increasingly utilized in different clinical settings to manage either critical respiratory or heart failure. Complex airway surgery with significant or even total perioperative airway obstruction represents an indication for this technique to prevent/overcome a critical period of severe hypoxaemia, hypoventilation, and/or apnea. This review summarizes the current published scientific evidence on the utility of extracorporeal respiratory support in airway obstruction associated with hypoxaemia, describes the available methods, their clinical indications, and possible limitations. Extracorporeal membrane oxygenation using veno-arterial or veno-venous mode is most commonly employed in such scenarios caused by endoluminal, external, or combined obstruction of the trachea and main bronchi.
Refrakterní distributivní šok představuje u kriticky nemocných stav s excesivní smrtností. Neadrenergní vasopresory, mezi které patří i methylenová modř, získávají stále na významu jako tzv. záchranná léčba u vazoparalytických stavů. V tomto přehledového článku shrnujeme dosavadní literární evidenci použití methylenové modři v indikaci refrakterního šoku u kriticky nemocných pacientů.
Refractory distributive shock is associated with excessive mortality in critically ill patients. Non-adrenergic vasopressors, including methylene blue, are often considered as an adjuvant therapy to the usual, catecholamine-based vasopressor treatment. In this narrative review we summarize the current scientific evidence on the use of methylene blue in the treatment of refractory distributive shock in different clinical situations.
- Klíčová slova
- distributivní šok, refrakterní šok, vaskulární hyporesponzivita,
- MeSH
- lidé MeSH
- methylenová modř * terapeutické užití MeSH
- šok * farmakoterapie MeSH
- vazoplegie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Před deseti lety byly v časopisech European Journal of Cardiothoracic Surgery a Journal of Anaesthesia publikovány výsledky prospektivní nerandomizované studie zabývající se perioperačním managementem a klinickými výsledky kardiochirurgických pacientů podstupující výkon při vědomí v epidurální anestezii. Tento přehledový článek přináší kritické zhodnocení výsledků práce a dalšího vývoje v této problematice nazíraný s odstupem jedné dekády.
Ten years ago, the results of prospective non-randomized study investigating perioperative management and clinical outcome of awake cardiac surgery patients undergoing procedure in sole epidural anaesthesia were published in European Journal of Cardiothoracic Surgery and Journal of Anaesthesia. This review article provides a critical assessment of the results of this work and further developments in this area, seen from a distance of one decade
- Klíčová slova
- hrudní epidurální anestezie,
- MeSH
- epidurální anestezie metody MeSH
- kardiochirurgické výkony * metody trendy MeSH
- lidé MeSH
- mimotělní oběh MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Hemodynamic effectiveness of methylene blue (MB) was tested in patients with refractory distributive shock. A retrospective analysis of 20 critically-ill patients who developed refractory shock was performed. Patients were divided into two study groups as responders with positive hemodynamic response to MB administration (defined as 10% decrease of norepinephrine dose) and non-responders. Hemodynamic, outcome data and baseline tissue hypoxia-related parameters including ratio of central venous-to-arterial carbon dioxide tension to arterio-venous oxygen content (P(v-a)CO2/C(a-v)O2) were compared between the groups. There were 9 (45%) responders and 11 (55%) non-responders to single bolus of MB administration. Dose of MB did not differ between responders and non-responders (1.3 ± 0.5 vs. 1.3 ± 0.4 mg/kg respectively, P = 0.979). MB responders had lower baseline P(v-a) CO2/C(a-v)O2 (1.79 ± 0.73 vs. 3.24 ± 1.18, P = 0.007), higher pH (7.26 ± 0.11 vs. 7.16 ± 0.10, P = 0.037) and lower lactate levels at 12 hours post MB administration (3.4 ± 2.7 vs. 9.9 ± 2.2 mmol/L, P = 0.002) compared to non-responders. Methylene blue represents a non-adrenergic vasopressor with only limited effectiveness in patients with refractory distributive shock. Profound tissue hypoxia with high degree of anaerobic metabolism was associated with the loss of hemodynamic responsiveness to its administration.
- MeSH
- analýza přežití MeSH
- hemodynamika účinky léků MeSH
- krevní tlak účinky léků MeSH
- kyslík krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- methylenová modř terapeutické užití MeSH
- noradrenalin terapeutické užití MeSH
- retrospektivní studie MeSH
- senioři MeSH
- šok farmakoterapie mortalita MeSH
- vazokonstriktory terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVES: Usefulness of immature granulocyte percentage (IG%) to discriminate between postoperative non-infective systemic inflammatory response syndrome (SIRS) and sepsis was tested in cardiac surgical patients. METHODS: A retrospective analysis of 124 patients who developed non-infective SIRS and sepsis after elective cardiac surgery was performed. Predictive ability of IG% to predict sepsis was compared to procalcitonin (PCT), white blood cell count, temperature and different biomarker combinations using receiver operating characteristic and logistic regression analysis. The optimal cut-off points, diagnosis sensitivity and specificity were calculated. RESULTS: There were 44 patients diagnosed with sepsis and 80 patients with non-infective SIRS. In receiver operating characteristic analysis, area under the curve was higher for IG% (0.71) and PCT (0.72) compared to white blood cell count (0.62) and temperature (0.58). The best cut-off value for IG% was 1.45% (sensitivity 70.5%, specificity 60%) and 1.43 µg/l for PCT (sensitivity 65.9%, specificity 75%). The combination of IG% and PCT provided the best sepsis prediction (area under the curve of 0.8, sensitivity 63.6% and specificity 88.8%). CONCLUSIONS: In cardiac surgical patients, IG% is a helpful marker with the moderate ability to discriminate between sepsis and non-infective SIRS, comparable to serum PCT. A combination of these parameters increased the test's overall predictive ability by improving its specificity.
- MeSH
- biologické markery krev MeSH
- granulocyty patologie MeSH
- kardiochirurgické výkony * MeSH
- lidé MeSH
- počet leukocytů MeSH
- prognóza MeSH
- prokalcitonin krev MeSH
- retrospektivní studie MeSH
- ROC křivka MeSH
- senioři MeSH
- sepse diagnóza etiologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: Cardiac surgery in octogenarians with severely deteriorated functional status is increasingly common, but outcome data are still limited. The aim of this study was to compare postoperative outcome, survival, and quality of life of low-, medium-, and high-risk octogenarians undergoing cardiac surgery. METHODS: In all, 285 Czech octogenarians who underwent any cardiac surgical procedure between January 2011 and December 2012 were included in the study. Five out of all twelve national adult cardiac surgical centers participated in the study, representing almost half of all octogenarians operated in our country in that period. Patients' perioperative data were analyzed retrospectively. Follow-up was performed by interviewing patients by telephone. RESULTS: There was higher 30-day mortality (20% vs. 6.4% vs. 5.2%, respectively, p <0.001), lower 2-year survival (60% vs. 84.0% vs. 85.4%, respectively, p <0.05), and lower Karnofsky score (44.4 vs. 70.1 vs. 70.6, respectively, p <0.001) in high-risk group compared with medium- and low-risk groups, respectively. Greater improvement in New York Heart Association (NYHA) status was noted in high- and medium-risk groups compared with low-risk group (51% vs. 45% vs. 24%, respectively, p <0.05). CONCLUSION: High perioperative mortality, poor 2-year survival, and low postoperative quality of life have been observed in high-risk octogenarians undergoing cardiac surgery.
- MeSH
- časové faktory MeSH
- hodnocení rizik MeSH
- Kaplanův-Meierův odhad MeSH
- kardiochirurgické výkony škodlivé účinky mortalita MeSH
- Karnofského skóre MeSH
- kvalita života MeSH
- lidé MeSH
- pooperační komplikace diagnóza etiologie mortalita terapie MeSH
- proporcionální rizikové modely MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- věkové faktory MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- srovnávací studie MeSH
- Geografické názvy
- Česká republika MeSH
A massive left ventricular thrombosis represents a rare however, catastrophic complication of a central veno-arterial extra-corporeal membrane oxygenation. We report a case of such complication in a patient with severe left ventricular dysfunction after cardiac surgery. Its management and preventive measures are described and discussed.
- MeSH
- dysfunkce levé srdeční komory etiologie patofyziologie MeSH
- fatální výsledek MeSH
- kardiochirurgické výkony škodlivé účinky MeSH
- kardiogenní šok etiologie patofyziologie MeSH
- koronární trombóza etiologie patofyziologie MeSH
- lidé MeSH
- mimotělní membránová oxygenace škodlivé účinky MeSH
- obstrukce výtoku ze srdeční komory etiologie patofyziologie MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Publikační typ
- abstrakt z konference MeSH
