AIM: To assess the feasibility, safety and efficacy of using a high-flow nasal cannula (HFNC) for stabilising very preterm infants after birth. METHODS: A prospective observational study included preterm infants born at 28 + 0 to 31 + 6 weeks' gestation between February 2021 and December 2022 at the General University Hospital in Prague. Following delayed cord clamping, HFNC was administered at a flow rate of 8 L/min through the infants' nostrils. Criteria for switching to continuous positive airway pressure (CPAP) or positive pressure ventilation (PPV) included persistent bradycardia in the first few minutes or low saturation of oxygen (SpO2) after 5 min, respectively. RESULTS: Of the 65 infants enrolled in the study, 56 (86%) were successfully stabilised exclusively using HFNC while 7 (11%) required PPV. Additionally, 52 (80%) infants achieved SpO2 > 80% at 5 min, and 54 (83%) infants were successfully treated with HFNC within the first 3 h of life. CONCLUSION: The primary use of HFNC seems to be an appropriate alternative to CPAP for the stabilisation of very premature infants after birth and subsequent transfer to the NICU. A randomised trial comparing HFNC and CPAP in the delivery room will enable to answer the questions raised in this study.

• MeSH
• kanyla * MeSH
• lidé MeSH
• novorozenci extrémně nezralí * MeSH
• novorozenec nedonošený MeSH
• novorozenec MeSH
• oxygenoterapie * přístrojové vybavení   metody   MeSH
• prospektivní studie MeSH
• studie proveditelnosti MeSH
• trvalý přetlak v dýchacích cestách MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

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

The fetus develops normally in a hypoxic environment but exaggerated hypoxia late in pregnancy is a worrisome sign often observed in hypertensive disorders of pregnancy, placental insufficiency, or fetal growth restriction (FGR). Serial fetal biometry and the cerebroplacental ratio (CPR, calculated as the middle cerebral artery [MCA] / the umbilical artery [UmbA] pulsatility indices [PI]), are commonly used to indicate fetal "brain sparing" resulting from exaggerated fetal hypoxia. But unclear is the extent to which a low CPR indicates pathology or is a physiological response for maintaining cerebral blood flow. We studied 31 appropriate for gestational age (AGA) pregnancies at low (LA, 1670 m) or high (HA, 2879 m) altitude, given the chronic hypoxia imposed by HA residence, and 54 LA women with a clinical diagnosis of FGR. At week 34, the MCA PI was lower in the LA-FGR than the LA-AGA group but lower still in the HA-AGA compared to either LA groups due to a trend toward higher end-diastolic velocity (EDV). We concluded that the lower MCA PI was likely due to greater cerebral vasodilation in the HA AGA group and an indication of physiological versus pathological fetal hypoxia. Future reporting of serial MCA and UmbA values and their determinants along with the CPR could improve our ability to distinguish between physiological and pathological fetal brain sparing. Keywords: Birth weight, Cerebroplacental ratio, Fetal physiology, HDP, High altitude.

• MeSH
• arteria cerebri media * diagnostické zobrazování   patofyziologie   MeSH
• arteriae umbilicales diagnostické zobrazování   patofyziologie   MeSH
• dospělí MeSH
• hypoxie plodu * patofyziologie   MeSH
• hypoxie patofyziologie   MeSH
• lidé MeSH
• mozek patofyziologie   krevní zásobení   diagnostické zobrazování   MeSH
• mozkový krevní oběh fyziologie   MeSH
• nadmořská výška MeSH
• růstová retardace plodu * patofyziologie   MeSH
• těhotenství MeSH
• ultrasonografie prenatální metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Acanthopanax senticosus (Rupr. et Maxim.) is commonly used in Traditional Chinese Medicine. Syringin is a major ingredient of phenolic glycoside in Acanthopanax senticosus. OBJECTIVE: This study was performed to investigate whether Syringin could protect high glucose-induced bone marrow mesenchymal stem cells (BMSCs) injury, cell senescence, and osteoporosis by inhibiting JAK2/STAT3 signaling. METHODS: BMSCs isolated from both the tibia and femur of mice were induced for osteogenesis. The cell senescence was induced using the high glucose medium. The cells were treated with 10 and 100 μmol/l Syringin. Immunohistochemistry staining was performed to determine the β-galactosidase (SA-β-gal) levels in differentially treated BMSCs. MTT assay and flow cytometry analysis were also performed to assess cell viability and cell cycle. The level of ROS in cells with different treatment was measured by using flow cytometry with DCF-DA staining. Calcium deposition and mineralized matrices were detected with alizarin red and ALP staining, respectively. Osteogenesis related genes OCN, ALP, Runx2, and BMP-2 were detected by RT-PCR. Levels of senescence-related proteins including p53 and p21, as well as JAK2, p-JAK2, STAT3, and p-STAT3 were detected by Western blot analysis. RESULTS: Syringin treatment reversed the phenotypes of senescence caused by high glucose in BMSCs, including the arrest of G0/G1 cell cycle, enhanced SA-β-gal activity, and impaired cell growth. Syringin also decreased the elevated ROS production and the levels of p53, p21, and JAK2/STAT3 signaling activation. In addition, Syringin also enhanced the osteogenic potential determined by ARS and ALP staining, as well as increasing OCN, ALP, Runx2, and BMP-2 expressions. CONCLUSION: Syringin protects high glucose-induced BMSC injury, cell senescence, and osteoporosis by inhibiting JAK2/STAT3 signaling.

• MeSH
• fenylpropionáty farmakologie   MeSH
• glukosa * metabolismus   toxicita   MeSH
• glukosidy * farmakologie   MeSH
• Janus kinasa 2 * metabolismus   MeSH
• mezenchymální kmenové buňky * účinky léků   metabolismus   MeSH
• myši MeSH
• osteogeneze * účinky léků   MeSH
• osteoporóza * prevence a kontrola   metabolismus   chemicky indukované   patologie   farmakoterapie   MeSH
• reaktivní formy kyslíku metabolismus   MeSH
• signální transdukce * účinky léků   MeSH
• stárnutí buněk * účinky léků   MeSH
• transkripční faktor STAT3 * metabolismus   MeSH
• zvířata MeSH
• Check Tag
• mužské pohlaví MeSH
• myši MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

Téma bylo zpracováno formou diplomové práce, která se zabývá podpůrnými respiračními, ventilačními a neinvazivními technikami dechové podpory, které souvisejí s celosvětovou pandemií covidu-19, která v období 2020–2021 ovlivnila život mnoha lidí. Během pandemie se v nemocnicích rozšířila terapie vysokoprůtokovým nosním kyslíkem (HFNC –high-flow nasal cannul; high-flow) jakožto možná alternativa umělé plicní ventilace (UPV) u covid pozitivních pacientů. Práce se zabývá problematikou, zda HFNC může být alternativou UPV u covid pozitivních pacientů v intenzivní péči. Empirická část vyplývá z kvantitativních výzkumů. První výzkum byl zaměřen na sestry a jejich zkušenosti a znalosti s technikou HFNC, jejím principem a fungováním, a to prostřednictvím rozeslaných dotazníků. Druhý výzkum byl zpracován sběrem sekundárních dat za pomoci statistické analýzy. Ve druhém kvantitativním šetření bylo cílem znázornění ventilačních režimů u všech hospitalizovaných pacientů, kteří podstoupili terapii na UPV či HFNC, zjistit, zda je HFNC alternativou UPV u covid pozitivních pacientů a zda nedošlo k jejímu selhání během terapie.

The topic was explored through a master’s thesis that focuses on supportive respiratory, ventilatory, and non-invasive techniques of respiratory assistance related to the global covid-19 pandemic, which affected the lives of many people during the period of 2020–2021. During this pandemic, the use of high-flow nasal oxygen therapy (high-flow) proliferated in hospitals as a potential alternative to invasive mechanical ventilation for covid-positive patients. The thesis addresses the question of whether high-flow can serve as an alternative to invasive mechanical ventilation for covid-positive patients in intensive care. The empirical part is derived from quantitative research. The first study focused on nurses and their experiences and knowledge of the high-flow technique, its principles, and its functioning, through distributed questionnaires. The second study utilized secondary data collection and statistical analysis. In the second quantitative investigation, the goal was to depict ventilation strategies in all hospitalized patients who underwent therapy with either invasive mechanical ventilation or high-flow, to determine whether high-flow can serve as an alternative to invasive mechanical ventilation for covid-positive patients, and whether its failure occurred during the therapy.

BACKGROUND: Cerebral air embolism (CAE) is an uncommon medical emergency with a potentially fatal course. We have retrospectively analyzed a set of patients treated with CAE at our comprehensive stroke center and a hyperbaric medicine center. An overview of the pathophysiology, causes, diagnosis, and treatment of CAE is provided. RESULTS: We retrospectively identified 11 patients with cerebral venous and arterial air emboli that highlight the diversity in etiologies, manifestations, and disease courses encountered clinically. Acute-onset stroke syndrome and a progressive impairment of consciousness were the two most common presentations in four patients each (36%). Two patients (18%) suffered from an acute-onset coma, and one (9%) was asymptomatic. Four patients (36%) were treated with hyperbaric oxygen therapy (HBTO), high-flow oxygen therapy without HBOT was started in two patients (18%), two patients (18%) were in critical care at the time of diagnosis and three (27%) received no additional treatment. CAE was fatal in five cases (46%), caused severe disability in two (18%), mild disability in three (27%), and a single patient had no lasting deficit (9%). CONCLUSION: Cerebral air embolism is a dangerous condition that necessitates high clinical vigilance. Due to its diverse presentation, the diagnosis can be missed or delayed in critically ill patients and result in long-lasting or fatal neurological complications. Preventative measures and a proper diagnostic and treatment approach reduce CAE's incidence and impact.

• Publikační typ
• časopisecké články MeSH

PURPOSE OF REVIEW: This article offers an overview of recent randomized controlled trials (RCTs) testing the efficacy of veno-arterial extracorporeal membrane oxygenation (VA ECMO) and microaxial flow pump (mAFP) in treating cardiogenic shock, including findings from the DanGer shock trial. It summarizes the clinical implications and limitations of these studies and key decision-making considerations for cardiogenic shock device use. RECENT FINDINGS: Despite important limitations in all published RCTs, the routine use of VA ECMO for acute myocardial infarction related cardiogenic shock did not demonstrate benefit and should be reserved for selected patients with extreme forms of cardiogenic shock. Conversely, mAFP (Impella CP) appears promising for cardiogenic shock due to ST elevation myocardial infarction. A stepwise approach - initial mAFP use for cardiogenic shock with left ventricular failure, supplemented by VA ECMO if mAFP is inadequate or if severe right ventricular failure is present - may be preferable, but requires validation through RCTs. High complication rates in device arms underscore the need for careful patient selection, preventive strategies, education for centers and operators, and further research. SUMMARY: Recent trials offer insights into mechanical circulatory support in cardiogenic shock, but their real-world applicability is limited. Despite potential benefits, the use of VA ECMO and mAFP is associated with significant complication rates, emphasizing the need for personalized use.

• MeSH
• kardiogenní šok * terapie   MeSH
• lidé MeSH
• mimotělní membránová oxygenace * metody   MeSH
• podpůrné srdeční systémy * MeSH
• randomizované kontrolované studie jako téma * MeSH
• výběr pacientů MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

In humans and many animals, a trade-off between a sufficiently high concentration of erythrocytes (hematocrit) to bind oxygen and sufficiently low blood viscosity to allow rapid blood flow has been achieved during evolution. The optimal value lies between the extreme cases of pure blood plasma, which cannot practically transport any oxygen, and 100% hematocrit, which would imply very slow blood flow or none at all. As oxygen delivery to tissues is the main task of the cardiovascular system, it is reasonable to expect that maximum oxygen delivery has been achieved during evolution. Optimal hematocrit theory, based on this optimality principle, has been successful in predicting hematocrit values of about 0.3-0.5, which are indeed observed in the systemic circulation of humans and many animal species. Similarly, the theory can explain why a hematocrit higher than normal, ranging from 0.5 to 0.7, can promote better exertional performance. Here, we present a review of theoretical approaches to the calculation of the optimal hematocrit value under different conditions and discuss them in a broad physiological context. Several physiological and medical implications are outlined, for example, in view of blood doping, temperature adaptation, dehydration, and life at high altitudes.

• MeSH
• erytrocyty fyziologie   metabolismus   MeSH
• hematokrit metody   MeSH
• kyslík * krev   metabolismus   MeSH
• lidé MeSH
• modely kardiovaskulární MeSH
• viskozita krve fyziologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Efektivita práce levé komory vyžaduje udržení srdečního výdeje, který je nárokován systémovým oběhem, a to bez vysokých metabolických nároků nebo nároků na kyslík ze strany myokardu levé komory. V tomto článku je levá komora uvažována jako pumpa a výkonnost je založena na hodnocení měření jejích tlaků, objemů a průtoku. Analýza funkce komory z hlediska vztahů mezi tlakem a objemem umožňuje plně analyzovat globální a regionální dynamiku komory, kterou lze poměrně snadno a přesně získat pomocí vodivostního katétru. Maximální změna tlaku za jednotku času v levé komoře je považována za ukazatel kontraktility levé komory, za jistých situací může být alternativou arteriální dP/dt max jakožto méně invazivní metoda. Při hodnocení nových kardiostimulačních technik a srdeční resynchronizační terapie se jako nejpraktičtější metoda jeví invazivní systolický krevní tlak s průměrováním více tepů a doplněním o několikrát opakované střídání stimulací

Effective performance of the left ventricle requires the maintenance of a cardiac output as demanded by the systemic circulation without a high hemodynamic cost or pressure and without a high metabolic cost or oxygen demand by the left ventricular myocardium. In this article the left ventricle is considered as a pump and performance is based on evaluation of measurements of its pressure, volumes, and flow. Analysis of ventricular function in terms of pressure-volume relationships allows global and regional ventricular dynamics to be fully analyzed and relatively easily and precisely obtained with conductance catheter. The maximum rate of left ventricular pressure is classically considered as a marker of left ventricular contractility and in specific situation arterial dP/dtmax, as minimally invasive method, can be an alternative. When assessing new pacing techniques and cardiac resynchronization therapy, invasive systolic blood pressure appears to be the most practical measure with multi-beat averaging and the addition of multiple spaced repeated alternations.

• Klíčová slova
• dP/dtmax, Srdeční funkce,
• MeSH
• diagnostické techniky kardiovaskulární klasifikace   MeSH
• funkce levé komory srdeční * MeSH
• hemodynamika MeSH
• kontrakce myokardu fyziologie   MeSH
• krevní tlak MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

BACKGROUND: Maintaining the patient awake and not intubated during the venovenous extracorporeal membrane oxygenation (VV ECMO) reduces the risk of ventilation-induced lung injury in patients with ARDS. Currently, there is a lack of data on outcomes and complications associated with the awake ECMO approach. OBJECTIVES: To evaluate outcomes and the occurrence of complications of awake ECMO approach guided by local safety protocol comprising ultrasound-guided cannulation, argatroban-based anticoagulation, respiratory support, and routine sedation targeted to reduce respiratory effort and keeping nurse-to-patient ratio of 1:1. DESIGN: A single-center retrospective case series analysis. METHODS: Consecutive patients with COVID-19-related acute respiratory distress syndrome (ARDS) (CARDS) treated by full awake VV ECMO approach from April 2019 to December 2023 were eligible. RESULTS: Our center treated 10 patients (mean age 54.7 ± 11.6 years) with CARDS with an awake ECMO approach. The reasons for awake ECMO included the presence of barotrauma in six patients, a team consensus to prefer awake ECMO instead of mechanical ventilation in three patients, and the patient's refusal to be intubated in one case. Before ECMO, patients were severely hypoxemic, with a mean value of Horowitz index of 48.9 ± 9.1 mmHg and a mean respiratory rate of 28.8 ± 7.3 breaths per minute on high-flow nasal cannula or noninvasive ventilation support. The mean duration of awake VV ECMO was 558.0 ± 173.6 h. Seven patients (70%) were successfully disconnected from ECMO and fully recovered. Intubation from respiratory causes was needed in three patients (30%), all of whom died eventually. In total, three episodes of delirium, two episodes of significant bleeding, one pneumothorax requiring chest tube insertion, and one oxygenator acute exchange occurred throughout the 5580 h of awake ECMO. No complications related to cannula displacement or malposition occurred. CONCLUSION: The awake ECMO strategy guided by safety protocol appears to be a safe approach in conscious, severely hypoxemic, non-intubated patients with COVID-19-related ARDS.

• MeSH
• antikoagulancia aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• arginin analogy a deriváty   MeSH
• bdění * MeSH
• COVID-19 * komplikace   terapie   MeSH
• dospělí MeSH
• intervenční ultrasonografie MeSH
• kyseliny pipekolové MeSH
• lidé středního věku MeSH
• lidé MeSH
• mimotělní membránová oxygenace * škodlivé účinky   metody   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• sulfonamidy MeSH
• syndrom dechové tísně * terapie   etiologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH