- Publikační typ
- abstrakt z konference MeSH
Patients with pulmonary hypertension and end-stage lung disease are fraught with high mortality while on a waiting list for lung transplant. With sometimes rapid deterioration they may require veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as an immediate life-saving technique, which is a time-limited solution. The technique of pulmonary artery to left atrium (PA-LA) shunt fitted with an oxygenator enables bridging the patient to transplant for a longer time period. This low-resistance paracorporeal pumpless lung assist device allows for de-adaptation of the right ventricle back to lower afterload before the lung transplantation is carried out. The PA-LA shunt with an oxygenator also conveys a risk of multiple complications with reported median of 10-26 days until transplant. We report a case of pulmonary capillary hemangiomatosis in a 35-year-old female who had to wait for donor lungs during the pandemic of SARS-CoV-2 for 143 days on PA-LA shunt with oxygenator following 51 days on VA-ECMO. The extremely long course associated with multiple complications including three cerebral embolisms, episodes of sepsis and ingrowth of the return cannula into the left ventricular wall gives insight into the limits of this bridging technique.
- MeSH
- arteria pulmonalis MeSH
- COVID-19 * MeSH
- dospělí MeSH
- lidé MeSH
- mimotělní membránová oxygenace * metody MeSH
- pandemie MeSH
- plíce MeSH
- plicní hypertenze * etiologie MeSH
- SARS-CoV-2 MeSH
- srdeční síně MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
OBJECTIVES: The aim of the study was to obtain data on demands on the intensive care capacities to treat COVID-19 patients, and to identify predictors for in-hospital mortality. METHODS: The prospective observational multicentre study carried out from 1 March till 30 June 2020 included adult patients with confirmed SARS-CoV-2 infection with respiratory failure requiring ventilatory support or high-flow nasal oxygen therapy (HFNO). RESULTS: Seventy-four patients, 46 males and 28 females, median age 67.5 (Q1-Q3: 56-75) years, were included. Sixty-four patients (86.5%) had comorbidity. Sixty-six patients (89.2%) were mechanically ventilated, four of them received extracorporeal membrane oxygenation therapy. Eight patients (10.8%) were treated with non-invasive ventilation and HFNO only. The median of intensive care unit (ICU) stay was 22.5 days. Eighteen patients (24.3%) needed continuous renal replacement therapy. Thirty patients (40.5%) died. Age and acute kidney injury were identified as independent predictors of in-hospital death, and chronic kidney disease showed trend towards statistical significance for poor outcome. CONCLUSIONS: Sufficient number of intensive care beds, organ support equipment and well-trained staff is a decisive factor in managing the COVID-19 epidemic. The study focused on the needs of intensive care in the COVID-19 patients. Advanced age and acute kidney injury were identified as independent predictors for in-hospital mortality. When compared to clinical course and ICU management of patients with severe community-acquired pneumonia caused by other pathogens, we observed prolonged need for ventilatory support, high rate of progression to acute respiratory distress syndrome and significant mortality in studied population.
- MeSH
- COVID-19 * MeSH
- dospělí MeSH
- lidé MeSH
- mortalita v nemocnicích MeSH
- péče o pacienty v kritickém stavu MeSH
- prospektivní studie MeSH
- SARS-CoV-2 MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
OBJECTIVES: The prevalence of infectious endocarditis (IE) in intravenous drug users (IDUs) is increasing, and the number of patients who need surgery is also rising. Relatively little is known about the short-term and long-term outcomes of these operations. METHODS: This study is a retrospective analysis of our institutional results, focussing on risk factors for perioperative death, major adverse events and long-term survival. A total of 50 of the 66 (75.75%) patients had postoperative follow-up, and the mean follow-up time was 53.9 ± 9.66 months. Patients were divided into 2 groups depending on whether they were having their first operation or were being reoperated for recurrent IE. RESULTS: From March 2006 to December 2015, a total of 158 patients underwent surgery for IE; 72 (45.6%) of them were identified as active IDUs. The operative mortality in IDUs was 8.33% (6 patients), with no significant difference between the 2 groups (P = 0.6569). Survival rates at 1 year, at 3 years and at the end of follow-up were 92%, 72% and 64%, respectively. There was significantly worse survival of patients with recurrent IE (log-rank test, P = 0.03). CONCLUSIONS: Although the short-term results of operation for IE in IDUs are good, long-term outcomes are not satisfactory. The survival of patients with recurrence of IE caused by return to intravenous drug use is significantly worse.
- MeSH
- dospělí MeSH
- endokarditida etiologie mortalita chirurgie MeSH
- intravenózní abúzus drog komplikace mortalita MeSH
- lidé MeSH
- míra přežití MeSH
- mladý dospělý MeSH
- recidiva MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví 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
1. vydání 131 stran : ilustrace ; 27 cm
Matematická statistika nachází široké uplatnění ve vědě, technice, ekonomii a v mnoha dalších oblastech lidské činnosti. Tato učebnice představuje testování hypotéz, základní statistické metody a naznačuje možnosti využití vhodných výpočetních nástrojů. Nakladatelská anotace
- Publikační typ
- abstrakt z konference MeSH
BACKGROUND: Lung transplantation is considered an established treatment for patients with end-stage chronic respiratory failure. Patients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at high risk of death. Extracorporeal membrane oxygenation (ECMO) has been proposed as an alternative bridging strategy to mechanical ventilation. The shear stress created by the mechanical pumps causes changes in the hematological system in almost all patients treated with ECMO. An antithrombotic strategy to mitigate ECMO bleeding and thrombotic complications is necessary. The use of thrombolytic therapy is recommended for patients with acute symptomatic embolism with associated hypotension or shock. In this setting, the hemodynamic benefits of thrombolytic treatment far outweigh its bleeding risk. CASE PRESENTATION: This case report describes a 32-year-old woman suffering from lymphangioleiomyomatosis, who underwent urgent double-lung transplantation. This patient was maintained on ECMO preoperatively, perioperatively, and postoperatively due to life-threatening hypoxemia caused by the progression of her pulmonary tissue damage. Multiple thrombi developed in the early postoperative period, in both right and left heart atria. Direct thrombolysis was successfully performed on the first postoperative day. CONCLUSION: According to the current published literature, direct thrombolysis of thrombi in both right and left atria in a patient supported on ECMO following urgent double-lung transplantation is an extremely rare treatment method. Even when taking into account all of the risks associated with thrombolysis and arteriovenous ECMO support, we found that this technique is very effective and, without a doubt, it saved the life of our patient.
- Publikační typ
- časopisecké články MeSH
Podání tekutin je zásadní postup u pacientů s hypovolemickým oběhovým selháním. Neadekvátní tekutinová resuscitace má vážné a v některých případech fatální následky. Odlišení pacientů volum dependentních a nedependentních je jedním z důležitých úkolů intenzivisty. Dříve používané parametry jako CVP a PAOP v tomto rozhodování selhávají. Echokardiografie nabízí možnost, hlavně díky dynamickým parametrům (variace průměru IVC a SVC, variace maximální transaortální rychlosti a VTI), rozlišit pacienty, kteří budou profitovat z podaných tekutin. Limitací je mandatorní ventilace konstantním dechovým objemem. PLRT může pomoci s diagnostikou u spontánně ventilujících pacientů nebo u pacientů s arytmií.
Fluid administration is a basic therapeutic approach in patients with hypovolaemic circulatory failure. Inappropriate fluid resuscitation has serious and in some cases fatal consequences. To distinguish between volume responsive or non-responsive patients is one of the intensivist's high priority tasks. Formerly used static parameters like CVP and PAOP are failing in this decision making. Echocardiography is offering an opportunity to monitor dynamic parameters (IVS and SVC diameter variation, maximal transaortic velocity and VTI) to identify the patients, which will profit from fluid administration. The necessity of mechanical ventilation is a limitation of this approach. PLRT can help with diagnosis in spontaneously breathing patients or in patients with arrhythmias.
BACKGROUD: Pulmonary alveolar proteinosis is a rare disorder that is characterized by a large accumulation of lipoproteinaceous material within the alveoli. This causes respiratory failure due to a restriction of gas exchange and changes in the ventilation/perfusion ratio. Clinical symptoms are variable and depend on the severity of damage of the lung parenchyma. Treatment method is whole-lung lavage, where the accumulated lipoproteinaceous material is removed using large quantities of saline. CASE PRESENTATION: This case report describes a 45 year old patient with advanced pulmonary alveolar proteinosis. Due to the presence of severe global respiratory insufficiency, this patient could not undergo the classic whole-lung lavage using a double-lumen tube and selective lung ventilation. The whole-lung lavage was performed with the support of veno-venous extracorporeal membrane oxygenation. A total of 27 l of warm saline was used. CONCLUSION: According to the current published literature, whole-lung lavage with extra-corporeal membrane oxygenation support is a very rare treatment method. Even when taking into account all of the risks associated with whole-lung lavage and v-v extracorporeal membrane oxygenation support, we found that this technique is very effective and, without a doubt, it saved the life of our patient.
- MeSH
- bronchoalveolární laváž metody MeSH
- dyspnoe etiologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mimotělní membránová oxygenace metody MeSH
- plicní alveolární proteinóza patofyziologie terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
