Background: Single-lung ventilation facilitates surgical exposure during minimally invasive cardiac surgery. However, a deeper knowledge of antibiotic distribution within a collapsed lung is necessary for effective antibiotic prophylaxis of pneumonia. Patients and Methods: The pharmacokinetics/pharmacodynamics (PK/PD) of cefuroxime were compared between the plasma and interstitial fluid (ISF) of collapsed and ventilated lungs in 10 anesthetized pigs, which were ventilated through a double-lumen endotracheal cannula. Cefuroxime (20 mg/kg) was administered in single 30-minute intravenous infusion. Samples of blood and lung microdialysate were collected until six hours post-dose. Ultrafiltration, in vivo retrodialysis, and high-performance liquid chromatography-tandem mass spectrometry were used to determine plasma and ISF concentrations of free drug. The concentrations were examined with non-compartmental analysis and compartmental modeling. Results: The concentration of free cefuroxime in ISF was lower in the non-ventilated lung than the ventilated one, evidenced by a lung penetration factor of 47% versus 63% (p < 0.05), the ratio between maximum concentrations (65%, p < 0.05), and the ratio between the areas under the concentration-time curve (78%, p = 0.12). The time needed to reach a minimum inhibitory concentration (MIC) was 30%-40% longer for a collapsed lung than for a ventilated one. In addition, a delay of 10-40 minutes was observed for lung ISF compared with plasma. The mean residence time values (ISF collapsed lung > ISF ventilated lung > plasma) could explain the absence of practically important differences in the time interval with the concentration of cefuroxime exceeding the MICs of sensitive strains (≤4 mg/L). Conclusion: The concentration of cefuroxime in the ISF of a collapsed porcine lung is lower than in a ventilated one; furthermore, its equilibration with plasma is delayed. Administration of the first cefuroxime dose earlier or at a higher rate may be warranted, as well as dose intensification of the perioperative prophylaxis of pneumonia caused by pathogens with higher MICs.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- atelektáza * farmakoterapie MeSH
- cefuroxim * MeSH
- mikrodialýza MeSH
- modely u zvířat MeSH
- prasata MeSH
- torakotomie MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Albumin je stále široce studovaným proteinem lidského těla. Historicky nejdéle je podáván jako objemová náhrada s využitím jeho onkotických vlastností. V oblasti tekutinové terapie je v posledních letech dále srovnáván s ostatními typy roztoků v různých klinických indikacích a je sledována zejména jeho bezpečnost. Předmětem zájmu výzkumu jsou jeho další biologické účinky, které jsou využívány ve specifických klinických situacích: jaterní selhání, prevence selhání ledvin, syndrom akutní respirační tísně dospělých, traumatické poškození mozku, ovariální hyperstimulační syndrom. Přehledový článek shrnuje současný stav odborného poznání a jeho využití jak u dospělých pacientů v intenzivní péči, tak v neonatologii. Diskutuje vybrané klinické syndromy a dosud známou fyziologii albuminu v lidském těle. Věnuje se též použití albuminu v postupech mimotělní podpory orgánových funkcí: mimotělní oběh v kardiochirurgii, dialýza a plazmaferéza.
Albumin is still a widely studied protein of the human body. Historically, it has been infused as a volume replacement using its oncotic properties. In the field of fluid therapy in recent years, it has been compared with other types of solutions in various clinical indications and its safety was monitored. Another subject of research is its other biological effects, which are used in specific clinical situations: liver failure, prevention of acute renal failure, adult acute respiratory distress syndrome, traumatic brain injury, ovarian hyperstimulation syndrome. The review article summarizes the current state of knowledge and its use in adult patients in intensive care as well as in neonatology. It also discusses selected clinical syndromes and the hitherto known physiology of albumin in the human body. It also deals with the use of albumin in extracorporeal support of organ functions: extracorporeal circulation in the cardiac surgery, dialysis and plasmapheresis.
BACKGROUND: To report single-institution experience with minimally invasive mitral valve operations through the right minithoracotomy over a 5-year period. METHODS: Patients who underwent minimally invasive mitral valve surgery (MIMVS) between January 2012 and December 2016 were included. Clinical follow-up data were collected in a prospective database and analyzed retrospectively. RESULTS: Data from 151 patients were assessed (mean age, 63.4 ± 9.7 years; 55% were females). Overall 30-day mortality was 0.7% (n = 1). Mean operating time, cardiopulmonary bypass, and aortic cross-clamp times were 254.9 ± 48.7, 140.5 ± 36.1, and 94.8 ± 27.0 minutes, respectively. Associated procedures were tricuspid valve annuloplasty (37.1%, n = 56) and closure of atrial septal defect (6.0%, n = 9). Cryoablation was performed in 43.7% of patients (n = 66). One patient (0.7%) required conversion to median sternotomy and six patients (4.0%) underwent re-explorations due to bleeding. Median postoperative hospital stay was 12 days. Overall survival at 5 years was 94.1% ± 2.0%. Freedom from reoperation was 94.6% ± 2.9% at 5 years. CONCLUSIONS: MIMVS is a feasible, safe, and reproducible approach with low mortality and morbidity. Mitral valve surgery through a small thoracotomy is a good alternative to conventional surgical access.
- MeSH
- anuloplastika mitrální chlopně * škodlivé účinky mortalita MeSH
- časové faktory MeSH
- chirurgická náhrada chlopně * škodlivé účinky mortalita MeSH
- databáze faktografické MeSH
- echokardiografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mitrální chlopeň diagnostické zobrazování patofyziologie chirurgie MeSH
- mitrální insuficience diagnostické zobrazování mortalita patofyziologie chirurgie MeSH
- pooperační komplikace etiologie chirurgie MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- studie proveditelnosti MeSH
- torakotomie škodlivé účinky metody mortalita 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
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Endothelial glycocalyx (EG) is a carbohydrate-rich vascular lining of the apical surface of endothelial cells. It has been proved to have an essential role in vascular homeostasis. Lipid emulsions as part of parenteral nutrition (PN) are widely used in patients in the setting of critical care and perioperative medicine. Due to their structure, lipids may potentially interact with EG. The aim of the study was to evaluate the effect of lipid emulsion on EG. OBJECTIVE: To assess the influence of lipid emulsion on EG integrity in ICU patients using a videomicroscopic and biochemical methods. METHODS: Patients in surgical ICU after major abdominal surgery or cardio surgery and in general ICU were assessed for eligibility for this pilot observational study in University Hospital. The study was performed during the first day of adding lipids as a part of their PN. The patients were given the SMOFlipid 20% for 6 hours in prescribed dose of approx. 1 g/kg of body weight. EG integrity was measured indirectly by automated sublingual videomicroscopy calculating a parameter PBR which describes the amount of lateral deviation of red blood cells from the central column and by levels of syndecan-1 and syndecan-4 in plasma as EG degradational products. Measurements were performed before lipid administration (T0) and 30 minutes after (T6) the infusion of lipid emulsion was completed. The statistical analysis was performed at the level of significance p < 0.05, data are expressed as mean ± standard deviation (SD) and for PBR as median and interquartile range (IQR). RESULTS: Fifteen patients were studied, from them 9 included in final analysis. PBR (expressed in μm) increased after the lipid infusion with no statistical significance (T0 = 2.10; 1.97-2.33 vs. 2.28; 2.11-2.45, p = 0.13). At T6 both syndecans showed statistically significant decrease in their particular levels. Syndecan-1 at T0 = 2580±1013 ng/l, resp. at T6 = 2365±1077 ng/l, p = 0.02; syndecan-4 at T0 = 134±29 ng/l, resp. at T6 = 123±43 ng/l, p = 0.04. CONCLUSION: In our study, we showed that six hours long SMOFlipid 20% infusion had no detrimental effect on the EG integrity as assessed by PBR value and by syndecan-1 and syndecan-4 plasmatic levels. Observed decrease of syndecans shortly after lipid infusion allows us to hypothesize even possibly protecting effect of lipids on EG.
- MeSH
- dospělí MeSH
- emulgátory terapeutické užití MeSH
- endoteliální buňky metabolismus MeSH
- glykokalyx metabolismus MeSH
- jednotky intenzivní péče MeSH
- lidé středního věku MeSH
- lidé MeSH
- lipidy terapeutické užití MeSH
- mladiství MeSH
- mladý dospělý MeSH
- pilotní projekty MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- videomikroskopie metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Background: Liver resection is a surgical procedure associated with a high risk of hepatic failure that can be fatal. One of the key mechanisms involves ischemia-reperfusion damage. Building on the well-known positive effects of hydrogen at mitigating this damage, the goal of this work was to demonstrate the antioxidant, anti-inflammatory, and anti-apoptotic effects of inhaled hydrogen in domestic pigs during major liver resection. Methods: The study used a total of 12 domestic pigs, 6 animals underwent resection with inhaled hydrogen during general anesthesia, and 6 animals underwent the same procedure using conventional, unsupplemented, general anesthesia. Intraoperative preparation of the left branch of the hepatic portal vein and the left hepatic artery was performed, and a tourniquet was applied. Warm ischemia was induced for 120 minutes and then followed by liver reperfusion for another 120 minutes. Samples from the ischemic and non-ischemic halves of the liver were then removed for histological and biochemical examinations. Results: An evaluation of histological changes was based on a numerical expression of damage based on the Suzuki score. Liver samples in the group with inhaled hydrogen showed a statistically significant reduction in histological changes compared to the control group. Biochemical test scores showed no statistically significant difference in hepatic transaminases, alkaline phosphatase (ALP), lactate dehydrogenase (LD), and lactate. However, a surprising result was a statistically significant difference in gamma-glutamyl-transferase (GMT). Marker levels of oxidative damage varied noticeably in plasma samples. Conclusions: In this experimental study, we showed that inhaled hydrogen during major liver resection unquestionably reduced the level of oxidative stress associated with ischemia-reperfusion damage. We confirmed this phenomenon both histologically and by direct measurement of oxidative stress in the organism.
- Publikační typ
- časopisecké články MeSH
Cíl: Embolizace lienální tepny se stává rutinní součástí konzervativní léčby pacientů s poraněním sleziny a spontánní rupturou sleziny. Cílem naší studie bylo zhodnocení souboru našich pacientů. Metodika: Naše studie retrospektivně zhodnotila výsledky embolizační léčby u pacientů s poraněním sleziny, kteří nebyli primárně indikováni k operační léčbě v letech 2016 a 2017. Výsledky: Do studie bylo zahrnuto deset nemocných. Tři z nich utrpěli polytrauma, šest mělo izolovanou laceraci sleziny v důsledku tupého abdominálního poranění a jedna nemocná měla spontánní rupturu sleziny při myeloproliferativním syndromu. Všichni pacienti byli vyšetřeni pomocí kontrastního CT břicha. Všichni měli provedenou angiografii, následná embolizace byla provedena u osmi pacientů. U žádného z osmi embolizovaných pacientů nedošlo k opakování krvácení a u sedmi z nich byla zachována slezina, u jedné pacientky byla provedena splenektomie 2. den pro vysoké riziko rozvoje subfrenického abscesu (imu-nosuprimovaná pacientka). Naopak jeden neembolizovaný pacient měl dvoudobou rupturu sleziny s nutností splenektomie. Všech deset pacientů bylo ve sledovaném období 3-24 měsíců bez komplikací. Závěry: Embolizace při neoperační léčbě krvácení ze sleziny zachovala slezinu u sedmi z osmi (87,5 %) embolizovaných pacientů. Embolizace lienální tepny je významnou součástí protokolu konzervativní léčby pacientů s poraněnou slezinou.
Purpose: Embolisation of the splenic artery has become routine part of conservative therapy of patients with injury of the spleen and spontaneous splenic rupture. The goal of our study was assessment of our series of patients. Methods: Our study is a retrospecitve analysis of results of embolisation therapy in patients with injured spleen who were not primarily indicated for surgical therapy in 2016 and 2017. Results: There were 10 patients included in the study. Three of them had polytrauma, six had isolated laceration of the spleen due to blunt abdominal trauma, and one woman suffered from spontaneous rupture of the spleen having underlying myeloproliferative syndrome. All patients had contrast enhanced CT scan of the abdominal cavity and angiography Embolisation was performed in eight patiens. There was no recurrent bleeding in all embolised patiens, and in 7 of them the spleen was preserved. One patient underwent splenectomy for high risk of sub-phrenic abscess development in immuno-compromised setting the other day. On contrary one nonembolised patient had delayed rupture of the spleen which neccessitated splenectomy. All ten patients fully recovered in follow up of 3-24 months. Conclusions: Embolisation in nonoperative management of splenic hemorrhage saved spleen in 7 out of 8 (87.5%) embolised patients. Embolisation of the splenic artery is a significant part of protocol of conservative therapy of patients with injury of the spleen.
- MeSH
- arteria lienalis diagnostické zobrazování chirurgie MeSH
- chemoembolizace metody přístrojové vybavení MeSH
- dítě MeSH
- dospělí MeSH
- periferní katetrizace metody přístrojové vybavení MeSH
- retrospektivní studie MeSH
- ruptura sleziny * diagnostické zobrazování etiologie chirurgie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
BACKGROUND: The optimal surgical approach to reconnecting bowel ends safely after resection is of great importance. OBJECTIVES: This project is focused on assessment of the perianastomotic microcirculation quality in the short postoperative period when using three different anastomosis techniques in experimental animal. METHODS: The experimental study involved 27 young female domestic pigs divided into three subgroups of 9 animals according to each surgical method of anastomosis construction in the sigmoid colon region: by manual suture, by stapler, or by gluing. Blood microcirculation in the anastomosis region was monitored using Laser Doppler Flowmetry (LDF). Anastomosis healing was evaluated by macroscopic and histological examination. RESULTS: Evaluation of the microcirculation in the anastomosis region showed the smallest decrease in perfusion values in animals reconstructed by suturing (Δ= -38.01%). A significantly more profound drop was observed postoperatively after stapling or gluing (Δ= -52.42% and Δ= -59.53%, respectively). All performed anastomoses healed without any signs of tissue and function pathology. CONCLUSIONS: Sewing, stapling, and gluing techniques for bowel anastomosis each have a different effect on regional microcirculation during 120 min. postoperatively. Nevertheless, the final results of anastomosis healing were found without of any pathology in all experimental animals managed by above mentioned anastomotic techniques.
- MeSH
- anastomóza chirurgická metody MeSH
- kolon patologie chirurgie MeSH
- laser doppler flowmetrie metody MeSH
- lidé MeSH
- mikrocirkulace fyziologie MeSH
- pooperační období MeSH
- prasata MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
OBJECTIVES: Postinfarction ventricular septal defect is a serious mechanical complication of acute myocardial infarction associated with high postoperative mortality. The aim of this study was to review our experience with surgical repair of postinfarction ventricular septal defect and to identify predictors of early and late outcomes. METHODS: Thirty-nine patients (19 men and 20 women, mean age 68.4 ± 9.9 years) with postinfarction ventricular septal defect who underwent surgical repair at our institution between 1996 and 2016 were retrospectively evaluated. Risk factors were assessed by univariate analysis, with those found significant included in multivariate analysis. RESULTS: The ventricular septal defect was anterior in 21 (54%) patients and posterior in 18 (46%) patients. Mean aortic cross-clamp time was 91.8 ± 26.8 min, and mean cardiopulmonary bypass time was 146.3 ± 49.7 min. Twelve (31%) patients underwent concomitant coronary artery bypass grafting. The 30-day mortality rate was 36% (n = 14). The 30-day survival rate was higher with than without concomitant coronary artery bypass grafting (83% vs 56%), but concomitant coronary artery bypass grafting did not influence late survival (P = 0.098). Univariate analysis identified age, emergency surgery, inotropic support, Killip class, preoperative aspartate aminotransferase concentration, renal replacement therapy and ventricular septal defect diagnosis to operation interval as predictors of 30-day mortality. However, multivariate analysis showed that age and renal replacement therapy were the only independent risk factors of 30-day mortality. CONCLUSIONS: Surgical repair of postinfarction ventricular septal defect has a high 30-day mortality rate. Higher age at presentation and postoperative renal replacement therapy are independent predictors of early mortality.
- MeSH
- defekty komorového septa etiologie chirurgie MeSH
- infarkt myokardu komplikace MeSH
- koronární bypass MeSH
- lidé středního věku MeSH
- lidé MeSH
- míra přežití MeSH
- multivariační analýza MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři 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
- Publikační typ
- abstrakt z konference MeSH
