Monitorace kvality spánku a deliria jsou naprosto zásadní pro poskytování moderní intenzivní péče. Představují však přístrojovou a personální výzvu. Nejen proto, že určité metody monitorace, např. polysomnografie, monitorovaný spánek samy ovlivňují. Ačkoliv existují nové alternativy, polysomnografie zůstává zlatým standardem v diagnostice a výzkumu poruch spánku pro nejlepší validitu získaných dat. Bez monitorace a screeningových metod nelze spolehlivě diagnostikovat delirium a poruchy spánku v intenzivní péči a bez jasně stanovené diagnózy nelze zkoumat dopady deliria a snížené kvality spánku. Tento článek shrnuje jednotlivé možnosti monitorace spánku i deliria, jejich výhody a limitace v prostředí intenzivní péče.
Monitoring sleep quality and delirium are essential in providing modern intensive care. They present both equipment and personnel challenges. Not only because certain monitoring methods, such as polysomnography, affect monitored sleep themselves. Although new alternatives exist, polysomnography remains the gold standard in diagnosing and researching sleep disorders for the validity of the data obtained. Without monitoring and screening methods, delirium and sleep disorders cannot be reliably diagnosed in intensive care. Without a clearly established diagnosis, the outcomes of delirium and reduced sleep quality cannot be investigated. This article summarizes various options for monitoring both sleep and delirium, their advantages and limitations in the critical care setting.
- MeSH
- delirium * diagnóza prevence a kontrola MeSH
- kvalita spánku MeSH
- lidé MeSH
- monitorování fyziologických funkcí klasifikace metody MeSH
- monitory vědomí MeSH
- péče o pacienty v kritickém stavu MeSH
- polysomnografie metody MeSH
- sběr dat metody MeSH
- spánek * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
Špatná kvalita spánku a rozvoj deliria jsou časté komplikace v intenzivní péči. Incidence obou komplikací je vysoká a pohledem medicíny založené na důkazech jsou v obou případech signifikantně prokázané závažné konsekvence. Stran deliria je k dispozici více dat, zatímco u zhoršené kvality spánku je i vzhledem k technickým limitacím monitorace a diagnostiky významný prostor k dalšímu výzkumu. Tento článek shrnuje data, která jsou k dispozici stran epidemiologie a rizikových faktorů snížené kvality spánku i deliria v prostředí intenzivní péče.
Poor quality of sleep and delirium are frequent complications of intensive care. The incidence of both complications is high, and evidence-based medicine has significantly demonstrated serious consequences in both cases. More data are available on delirium. While there is significant room for further research on sleep quality impairment, there are also technical limitations of monitoring and diagnosis. This article summarises known data on the epidemiology and risk factors of decreased quality of sleep and delirium in the intensive care setting.
Beta-lactam antibiotics remain one of the most preferred groups of antibiotics in critical care due to their excellent safety profiles and their activity against a wide spectrum of pathogens. The cornerstone of appropriate therapy with beta-lactams is to achieve an adequate plasmatic concentration of a given antibiotic, which is derived primarily from the minimum inhibitory concentration (MIC) of the specific pathogen. In a critically ill patient, the plasmatic levels of drugs could be affected by many significant changes in the patient's physiology, such as hypoalbuminemia, endothelial dysfunction with the leakage of intravascular fluid into interstitial space and acute kidney injury. Predicting antibiotic concentration from models based on non-critically ill populations may be misleading. Therapeutic drug monitoring (TDM) has been shown to be effective in achieving adequate concentrations of many drugs, including beta-lactam antibiotics. Reliable methods, such as high-performance liquid chromatography, provide the accurate testing of a wide range of beta-lactam antibiotics. Long turnaround times remain the main drawback limiting their widespread use, although progress has been made recently in the implementation of different novel methods of antibiotic testing. However, whether the TDM approach can effectively improve clinically relevant patient outcomes must be proved in future clinical trials.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) is a new disease in children and adolescents that occurs after often asymptomatic or mild COVID-19. It can be manifested by different clinical symptomatology and varying severity of disease based on multisystemic inflammation. The aim of this retrospective cohort trial was to describe the initial clinical presentation, diagnostics, therapy and clinical outcome of paediatric patients with a diagnosis of PIMS-TS admitted to one of the 3 PICUs. All paediatric patients who were admitted to the hospital with a diagnosis of paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) during the study period were enrolled in the study. A total of 180 patients were analysed. The most common symptoms upon admission were fever (81.6%, n = 147), rash (70.6%, n = 127), conjunctivitis (68.9%, n = 124) and abdominal pain (51.1%, n = 92). Acute respiratory failure occurred in 21.1% of patients (n = 38). Vasopressor support was used in 20.6% (n = 37) of cases. Overall, 96.7% of patients (n = 174) initially tested positive for SARS-CoV-2 IgG antibodies. Almost all patients received antibiotics during in-hospital stays. No patient died during the hospital stay or after 28 days of follow-up. Initial clinical presentation and organ system involvement of PIMS-TS including laboratory manifestations and treatment were identified in this trial. Early identification of PIMS-TS manifestation is essential for early treatment and proper management of patients.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Malignant Hyperthermia (MH) is a rare, hereditary, life-threatening disease triggered by volatile anesthetics and succinylcholine. Rarely, MH can occur after non-pharmacological triggers too. MH was detected more often in children and young adults, which makes this topic very important for every pediatric specialist, both anesthesiologists and intensivists. MH crisis is a life-threatening severe hypermetabolic whole-body reaction. Triggers of MH are used in pediatric intensive care unit (PICU) as well, volatile anesthetics in difficult sedation, status asthmaticus or epilepticus, and succinylcholine still sometimes in airway management. Recrudescence or delayed onset of MH crisis hours after anesthesia was previously described. MH can also be a cause of rhabdomyolysis and hyperpyrexia in the PICU. In addition, patients with neuromuscular diseases are often admitted to PICU and they might be at risk for MH. The most typical symptoms of MH are hypercapnia, tachycardia, hyperthermia, and muscle rigidity. Thinking of the MH as the possible cause of deterioration of a patient's clinical condition is the key to early diagnosis and treatment. The sooner the correct treatment is commenced, the better patient ́s outcome. This narrative review article aims to summarize current knowledge and guidelines about recognition, treatment, and further management of MH in PICU.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Currently, ultrasound-guided central venous catheter (CVC) insertion is recommended in pediatric patients. However, the clinical practice may vary. The primary aim of this study was the overall success rate and the first attempt success rate in ultrasound-guided CVC insertion versus anatomic-based CVC insertion in pediatric patients. The secondary aim was the incidence of associated complications and the procedural time. The physician could freely choose the cannulation method and venous approach. Data were collected for 10 months. Overall, 179 patients were assessed for eligibility and 107 patients were included. In almost half of the patients (48.6%), the percutaneous puncture was performed by real-time ultrasound navigation. In 51.4% of the patients, the puncture was performed by the landmark method. The overall success rate was 100% (n = 52) in the real-time ultrasound navigation group, 96.4% (n = 53) in the landmark insertion group, (p = 0.496). The first percutaneous puncture success rate was 57.7% (n = 30) in the real-time ultrasound navigation group and 45.5% (n = 25) in the landmark insertion group, (p = 0.460). The data show a higher overall success rate and the first success rate in the US-guided CVC insertion group, but the difference was not statistically significant.
- Publikační typ
- časopisecké články MeSH
