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BACKGROUND: Dexamethasone 6 mg in patients with severe COVID-19 has been shown to decrease mortality and morbidity. The effects of higher doses of corticosteroid, that would further increase anti-inflammatory effects, are uncertain. The objective of our study was to assess the effect of 20 mg dexamethasone vs. 6 mg dexamethasone intravenously in patients with moderate-to-severe acute respiratory distress syndrome (ARDS) and COVID-19. METHODS: In a multicenter, open-label, randomized trial conducted in nine hospitals in the Czech Republic, we randomized adult patients with ARDS and COVID-19 requiring high-flow oxygen, noninvasive or invasive mechanical ventilation to receive either intravenous high-dose dexamethasone (20 mg/day on days 1-5, 10 mg/day on days 6-10) or standard-dose dexamethasone (6 mg/d, days 1-10). The primary outcome was 28-day ventilator-free days. The five secondary outcomes were 60-day mortality, C-reactive protein dynamics, 14-day WHO (World Health Organization) Clinical Progression Scale score, adverse events and 90-day Barthel index. The long-term outcomes were 180- and 360-day mortality and the Barthel index. The planned sample size was 300, with interim analysis after enrollment of 150 patients. RESULTS: The trial was stopped due to a lack of recruitment, and the follow-up was completed in February 2023. Among 234 randomized patients of 300 planned patients, the primary outcome was available for 224 patients (110 high-dose and 114 standard-dose dexamethasone; median [interquartile range (IQR)] age, 59.0 [48.5-66.0] years; 130 [58.0%] were receiving noninvasive or invasive mechanical ventilation at baseline). The mean number of 28-day ventilator-free days was 8.9 (± 11.5) days for high-dose dexamethasone and 8.0 (± 10.7) days for standard-dose dexamethasone, with an absolute difference of + 0.81 days (95% CI - 2.12-3.73 days). None of the prespecified secondary outcomes, including adverse events, differed between the groups. CONCLUSIONS: Despite not reaching its prespecified enrollment, there was no signal to either benefit or harm high-dose dexamethasone over standard-dose dexamethasone in patients with COVID-19 and moderate-to-severe ARDS. Trial registration Trial registration: ClinicalTrials.gov Identifier: NCT04663555. Registered 10 December 2020, https://clinicaltrials.gov/study/NCT04663555?term=NCT04663555&rank=1 and EudraCT: 2020-005887-70.

MeSH
COVID-19 * mortalita komplikace MeSH
dexamethason * aplikace a dávkování terapeutické užití MeSH
farmakoterapie COVID-19 * MeSH
lidé středního věku MeSH
lidé MeSH
SARS-CoV-2 MeSH
senioři MeSH
syndrom dechové tísně * farmakoterapie mortalita MeSH
umělé dýchání * MeSH
výsledek terapie MeSH
vztah mezi dávkou a účinkem léčiva MeSH
Check Tag
lidé středního věku MeSH
lidé MeSH
mužské pohlaví MeSH
senioři MeSH
ženské pohlaví MeSH
Publikační typ
časopisecké články MeSH
multicentrická studie MeSH
randomizované kontrolované studie MeSH
Geografické názvy
Česká republika MeSH

Článek

Hledání cest k přežití srdeční zástavy a extrakorporální oxygenoterapie - ECPR
[Searching for ways to survive cardiac arrest and extracorporeal oxygen therapy - ECPR]

Knor, Jiří, 1966-
Autor Autorita Klinika anesteziologie a resuscitace 3. LF UK a FNKV v Praze Zdravotnická záchranná služba Pardubického kraje Vysoká škola zdravotnická Praha

Časopis lékařů českých. 2024 ; 163 (6) : 227-229.

ISSN 0008-7335
Medvik
Zdroj

Moderní kardiopulmonální resuscitace a její uvedení do široké praxe má více než šedesátiletou historii. Přes všechny snahy o zlepšení původních postupů a zlepšení výsledků péče o pacienty se srdeční zástavou zůstávají základní doporučení a pravidla moderní neodkladné resuscitace prakticky stejná jako v době jejího vzniku. V posledních letech se z důvodu zvýšení počtu pacientů přežívajících srdeční zástavu využívá neodkladná resuscitace v kombinaci s metodou extrakorporální mimotělní oxygenace (ECPR). Tento postup ukazuje potenciál a možnosti současné medicíny, avšak zároveň přináší spoustu otazníků a nelze jej doporučit rutinně.

Modern cardiopulmonary resuscitation and its introduction into wide practice has more than sixty years of history. Despite all efforts to improve the original procedures and improve the results of care for patients with cardiac arrest, the basic recommendations and rules of modern emergency resuscitation remain practically the same as at the time of its inception. In recent years, in order to increase the number of patients surviving cardiac arrest, urgent resuscitation has been used in combination with the method of extracorporeal cardiopulmonary oxygenation (ECPR). This procedure shows the potential and possibilities of contemporary medicine, but at the same time it brings a lot of question marks and cannot be recommended routinely.

Článek

Understanding the Acid-Base Response to Respiratory Derangements: Finding, and Clinically Applying, the In Vivo Base Excess

Critical care explorations. 2024 ; 6 (12) : e1191. [pub] 20241216

Crit Care Explor
ISSN 2639-8028
Medvik
Zdroj

OBJECTIVES: To evaluate the base excess response during acute in vivo carbon dioxide changes. DESIGN: Secondary analysis of individual participant data from experimental studies. SETTING: Three experimental studies investigating the effect of acute in vivo respiratory derangements on acid-base variables. SUBJECTS: Eighty-nine (canine and human) carbon dioxide exposures. INTERVENTIONS: Arterial carbon dioxide titration through environmental chambers or mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: For each subject, base excess was calculated using bicarbonate and pH using a fixed buffer power of 16.2. Analyses were performed using linear regression with arterial dioxide (predictor), base excess (outcome), and studies (interaction term). All studies show different baselines and slopes for base excess across carbon dioxide titrations methods. Individual subjects show substantial, and potentially clinically relevant, variations in base excess response across the hypercapnic range. Using a mathematical simulation of 10,000 buffer power coefficients we determined that a coefficient of 12.1 (95% CI, 9.1-15.1) instead of 16.2 facilitates a more conceptually appropriate in vivo base excess equation for general clinical application. CONCLUSIONS: In vivo changes in carbon dioxide leads to changes in base excess that may be clinically relevant for individual patients. A buffer power coefficient of 16.2 may not be appropriate in vivo and needs external validation in a range of clinical settings.

MeSH
acidobazická rovnováha * fyziologie MeSH
dospělí MeSH
hyperkapnie patofyziologie metabolismus MeSH
koncentrace vodíkových iontů MeSH
lidé MeSH
oxid uhličitý * metabolismus MeSH
poruchy acidobazické rovnováhy patofyziologie metabolismus MeSH
psi MeSH
umělé dýchání MeSH
zvířata MeSH
Check Tag
dospělí MeSH
lidé MeSH
mužské pohlaví MeSH
psi MeSH
ženské pohlaví MeSH
zvířata MeSH
Publikační typ
časopisecké články MeSH

Článek

Effect of tissue viscoelasticity on delivered mechanical power in a physical respiratory system model: distinguishing between airway and tissue resistance

Biomedical physics & engineering express. 2024 ; 11 (1) : . [pub] 20241204

Biomed Phys Eng Express
ISSN 2057-1976
Medvik
Zdroj

Understanding the mechanics of the respiratory system is crucial for optimizing ventilator settings and ensuring patient safety. While simple models of the respiratory system typically consider only flow resistance and lung compliance, lung tissue resistance is usually neglected. This study investigated the effect of lung tissue viscoelasticity on delivered mechanical power in a physical model of the respiratory system and the possibility of distinguishing tissue resistance from airway resistance using proximal pressure measured at the airway opening. Three different configurations of a passive physical model of the respiratory system representing different mechanical properties (Tissue resistance model, Airway resistance model, and No-resistance model) were tested. The same volume-controlled ventilation and parameters were set for each configuration, with only the inspiratory flow rates being adjusted. Pressure and flow were measured with a Datex-Ohmeda S/5 vital signs monitor (Datex-Ohmeda, Madison, WI, USA). Tissue resistance was intentionally tuned so that peak pressures and delivered mechanical energy measured at airway opening were similar in Tissue and Airway Resistance models. However, measurements inside the artificial lung revealed significant differences, with Tissue resistance model yielding up to 20% higher values for delivered mechanical energy. The results indicate the need to revise current methods of calculating mechanical power delivery, which do not distinguish between tissue resistance and airway flow resistance, making it difficult to evaluate and interpret the significance of mechanical power delivery in terms of lung ventilation protectivity.

Kniha

Textbook of transplantation and mechanical support for end-stage heart and lung disease

2 svazky : barevné ilustrace ; 29 cm

MeSH
nemoci srdce * terapie MeSH
plicní hypertenze MeSH
rozšířená kardiopulmonální recuscitace MeSH
transplantace plic MeSH
transplantace srdce MeSH
Publikační typ
učebnice MeSH

Kniha

Farmakoterapie urgentních stavů

Jessenius Moderní farmakoterapie

4. doplněné a rozšířené vydání 282 stran : ilustrace ; 19 cm

Publikace se zaměřuje na farmakoterapii různých urgentních (náhlých) stavů a na léčiva, která se k tomu používají. Obsahuje i kazuistiky. Určeno odborné veřejnosti.

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