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

Volné kyslíkové radikály a mechanismus lipoperoxidace podle současných prací mají zřejmě významnou úlohu při vzniku dysfunkce svalového aparátu u nemocných v průběhu sepse a septického šoku. Svalová dysfunkce může postihovat i dýchací svaly, a podílet se tak na rozvoji svalového selhání s nutností podpory ventilace. Cílem studie bylo zhodnocení stupně lipoperoxidace a antioxidativního aparátu u nemocných v průběhu odvykání od ventilátoru. Na souboru 37 nemocných s nutností umělé plicní ventilace byly prospektivně sledovány koncentrace malondialdehydu, glutathionu, aktivity glutathionperoxidázy a superoxiddismutázy, koncentrace betakarotenu a selenu. K hodnocení byly použity hodnoty v den přijetí, poslední den řízené ventilace, den zahájení odpojování od ventilátoru a za 24 hodin spontánní ventilace po odpojení od ventilátoru. Podle doby odvykání byli nemocní rozděleni (skupina S, odvykání Ł 3 dny, n = 15), (skupina L, odvykání > 3 dny, n = 22). Nemocní s dobou odvykání nad 3 dny měli signifikantně vyšší koncentrace malondialdehydu při přijetí, signifikantně nižší aktivitu glutathionperoxidázy po dosažení odpojení od ventilátoru, nesignifikantně nižší koncentrace betakarotenu a selenu. Prodloužená doba ventilační podpory a odvykání od ventilátoru delší než tři dny byly spojeny s vyšším stupněm lipoperoxidace při přijetí a s poklesem koncentrací vybraných ukazatelů antioxidativní ochrany. Dosažené výsledky podporují předpoklad úlohy lipoperoxidace jako jednoho z možných mechanismů podílejících se na rozvoji svalové dysfunkce u nemocných v průběhu odvykání od ventilátoru.

According to the current literature data, free oxygen radicals and mechanism of lipoperoxidation play an important role during development of muscular system dysfunction during sepsis and septic shock. Muscular dysfunction can affect respiratory muscles and contribute to muscular fatigue with subsequent need for ventilatory support. The aim of the study was to assess the degree of lipoperoxidation and capacity of antioxidatory apparatus in patients during weaning period. In 37 mechanically ventilated patients we prospectively monitored the concentrations of malonedialdehyd, glutathion, glutathionperoxidase activity and superoxiddismutase activity; betacaroten concentrations and selenium concentrations. The values were obtained on admission, last day of mechanical ventilation, at the start of weaning and after 24 hours of spontaneous breathing after disconnecting from ventilatory support. According to the length of weaning, patients were divided into two groups: group S, weaning period Ł 3 days, n = 15; group L, weaning period > 3 days, n = 22. Patients weaned for more than three days had significantly higher concentrations of malonedialdehyd on admission, significantly lower activity of glutathionperoxidase level when successfully weaned, non-significantly lower levels of beta-caroten and selenium. Prolonged ventilatory support and weaning period longer than three days were associated with higher degree of lipoperoxidation on admission and with a decrease of concentrations of selected markers of antioxidatory protective mechanisms. The results support an assumption that lipoperoxidation may play a role in the development of muscular system dysfunction in patients during the weaning period.

• MeSH
• dospělí MeSH
• glutathion metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• malondialdehyd krev   MeSH
• odpojení od ventilátoru škodlivé účinky   MeSH
• peroxidace lipidů MeSH
• scavengery volných radikálů krev   MeSH
• sepse terapie   MeSH
• svalová slabost etiologie   metabolismus   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH

INTRODUCTION: Airway management is a critical component of out-of-hospital cardiac arrest (OHCA) resuscitation. The primary aim of this study was to describe pre-hospital airway management in adult patients post-OHCA. Secondary aims were to investigate whether tracheal intubation (TI) versus use of supraglottic airway device (SGA) was associated with patients' outcomes, including ventilator-free days within 26 days of randomization, 6 months neurological outcome and mortality. METHODS: Secondary analysis of the Target Temperature Management-2 (TTM2) trial conducted in 13 countries, including adult patients with OHCA and return of spontaneous circulation, with data available on pre-hospital airway management. A multivariate logistic regression model with backward stepwise selection was employed to assess whether TI versus SGA was associated with outcomes. RESULTS: Of the 1900 TTM2 trial patients, 1702 patients (89.5%) were included, with a mean age of 64 years (Standard Deviation, SD = 13.53); 79.1% were males. Pre-hospital airway management was SGA in 484 (28.4%), and TI in 1218 (71.6%) patients. At hospital admission, 87.8% of patients with SGA and 98.5% with TI were mechanically ventilated (p < 0.001). In the multivariate analysis, TI in comparison with SGA was not independently associated with an increase in ventilator-free days within 26 days of randomization, improved neurological outcomes, or decreased mortality. The hazard ratio for mortality with TI vs. SGA was 1.06, 95%Confidence Interval (CI) 0.88-1.28, p = 0.54. CONCLUSIONS: In the multicentre randomized TTM2-trial including patients with OHCA, most patients received prehospital endotracheal intubation to manage their airway. The choice of pre-hospital airway device was not independently associated with patient clinical outcomes. TRIAL REGISTRATION NUMBER: NCT02908308.

• MeSH
• intratracheální intubace * metody   MeSH
• kardiopulmonální resuscitace * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• terapeutická hypotermie metody   MeSH
• urgentní zdravotnické služby * metody   MeSH
• zajištění dýchacích cest * metody   MeSH
• zástava srdce mimo nemocnici * terapie   mortalita   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

BACKGROUND: Since December 2019, SARS-CoV-2 virus has infected millions of people worldwide. In patients with COVID-19 pneumonia in need of oxygen therapy or mechanical ventilation, dexamethasone 6 mg per day is currently recommended. However, the dose of 6 mg of dexamethasone is currently being reappraised and may miss important therapeutic potential or may prevent potential deleterious effects of higher doses of corticosteroids. METHODS: REMED is a prospective, open-label, randomised controlled trial testing the superiority of dexamethasone 20 mg (dexamethasone 20 mg on days 1-5, followed by dexamethasone 10 mg on days 6-10) vs 6 mg administered once daily intravenously for 10 days in adult patients with moderate or severe ARDS due to confirmed COVID-19. Three hundred participants will be enrolled and followed up for 360 days after randomization. Patients will be randomised in a 1:1 ratio into one of the two treatment arms. The following stratification factors will be applied: age, Charlson Comorbidity Index, CRP levels and trial centre. The primary endpoint is the number of ventilator-free days (VFDs) at 28 days after randomisation. The secondary endpoints are mortality from any cause at 60 days after randomisation; dynamics of the inflammatory marker, change in WHO Clinical Progression Scale at day 14; and adverse events related to corticosteroids and independence at 90 days after randomisation assessed by the Barthel Index. The long-term outcomes of this study are to assess long-term consequences on mortality and quality of life at 180 and 360 days. The study will be conducted in the intensive care units (ICUs) of ten university hospitals in the Czech Republic. DISCUSSION: We aim to compare two different doses of dexamethasone in patients with moderate to severe ARDS undergoing mechanical ventilation regarding efficacy and safety. TRIAL REGISTRATION: EudraCT No. 2020-005887-70. ClinicalTrials.gov NCT04663555. Registered on December 11, 2020.

• MeSH
• COVID-19 * MeSH
• dexamethason škodlivé účinky   MeSH
• dospělí MeSH
• farmakoterapie COVID-19 MeSH
• kvalita života MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• prospektivní studie MeSH
• randomizované kontrolované studie jako téma MeSH
• SARS-CoV-2 MeSH
• syndrom dechové tísně * diagnóza   farmakoterapie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH

OBJECTIVES: The primary objective of this study is to test the hypothesis that administration of dexamethasone 20 mg is superior to a 6 mg dose in adult patients with moderate or severe ARDS due to confirmed COVID-19. The secondary objective is to investigate the efficacy and safety of dexamethasone 20 mg versus dexamethasone 6 mg. The exploratory objective of this study is to assess long-term consequences on mortality and quality of life at 180 and 360 days. TRIAL DESIGN: REMED is a prospective, phase II, open-label, randomised controlled trial testing superiority of dexamethasone 20 mg vs 6 mg. The trial aims to be pragmatic, i.e. designed to evaluate the effectiveness of the intervention in conditions that are close to real-life routine clinical practice. PARTICIPANTS: The study is multi-centre and will be conducted in the intensive care units (ICUs) of ten university hospitals in the Czech Republic. INCLUSION CRITERIA: Subjects will be eligible for the trial if they meet all of the following criteria: 1. Adult (≥18 years of age) at time of enrolment; 2. Present COVID-19 (infection confirmed by RT-PCR or antigen testing); 3. Intubation/mechanical ventilation or ongoing high-flow nasal cannula (HFNC) oxygen therapy; 4. Moderate or severe ARDS according to Berlin criteria: • Moderate - PaO2/FiO2 100-200 mmHg; • Severe - PaO2/FiO2 < 100 mmHg; 5. Admission to ICU in the last 24 hours. EXCLUSION CRITERIA: Subjects will not be eligible for the trial if they meet any of the following criteria: 1. Known allergy/hypersensitivity to dexamethasone or excipients of the investigational medicinal product (e.g. parabens, benzyl alcohol); 2. Fulfilled criteria for ARDS for ≥14 days at enrolment; 3. Pregnancy or breastfeeding; 4. Unwillingness to comply with contraception measurements from enrolment until at least 1 week after the last dose of dexamethasone (sexual abstinence is considered an adequate contraception method); 5. End-of-life decision or patient is expected to die within next 24 hours; 6. Decision not to intubate or ceilings of care in place; 7. Immunosuppression and/or immunosuppressive drugs in medical history: a) Systemic immunosuppressive drugs or chemotherapy in the past 30 days; b) Systemic corticosteroid use before hospitalization; c) Any dose of dexamethasone during the present hospital stay for COVID-19 for ≥5 days before enrolment; d) Systemic corticosteroids during present hospital stay for conditions other than COVID-19 (e.g. septic shock); 8. Current haematological or generalized solid malignancy; 9. Any contraindication for corticosteroid administration, e.g. • intractable hyperglycaemia; • active gastrointestinal bleeding; • adrenal gland disorders; • presence of superinfection diagnosed with locally established clinical and laboratory criteria without adequate antimicrobial treatment; 10. Cardiac arrest before ICU admission; 11. Participation in another interventional trial in the last 30 days. INTERVENTION AND COMPARATOR: Dexamethasone solution for injection/infusion is the investigational medicinal product as well as the comparator. The trial will assess two doses, 20 mg (investigational) vs 6 mg (comparator). Patients in the intervention group will receive dexamethasone 20 mg intravenously once daily on day 1-5, followed by dexamethasone 10 mg intravenously once daily on day 6-10. Patients in the control group will receive dexamethasone 6 mg day 1-10. All authorized medicinal products containing dexamethasone in the form of solution for i.v. injection/infusion can be used. MAIN OUTCOMES: Primary endpoint: Number of ventilator-free days (VFDs) at 28 days after randomisation, defined as being alive and free from mechanical ventilation. SECONDARY ENDPOINTS: a) Mortality from any cause at 60 days after randomisation; b) Dynamics of inflammatory marker (C-Reactive Protein, CRP) change from Day 1 to Day 14; c) WHO Clinical Progression Scale at Day 14; d) Adverse events related to corticosteroids (new infections, new thrombotic complications) until Day 28 or hospital discharge; e) Independence at 90 days after randomisation assessed by Barthel Index. The long-term outcomes of this study are to assess long-term consequences on mortality and quality of life at 180 and 360 days through telephone structured interviews using the Barthel Index. RANDOMISATION: Randomisation will be carried out within the electronic case report form (eCRF) by the stratified permuted block randomisation method. Allocation sequences will be prepared by a statistician independent of the study team. Allocation to the treatment arm of an individual patient will not be available to the investigators before completion of the whole randomisation process. The following stratification factors will be applied: • Age <65 and ≥ 65; • Charlson Comorbidity index (CCI) <3 and ≥3; • CRP <150 mg/L and ≥150 mg/L • Trial centre. Patients will be randomised in a 1 : 1 ratio into one of the two treatment arms. Randomisation through the eCRF will be available 24 hours every day. BLINDING (MASKING): This is an open-label trial in which the participants and the study staff will be aware of the allocated intervention. Blinded pre-planned statistical analysis will be performed. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): The sample size is calculated to detect the difference of 3 VFDs at 28 days (primary efficacy endpoint) between the two treatment arms with a two-sided type I error of 0.05 and power of 80%. Based on data from a multi-centre randomised controlled trial in COVID-19 ARDS patients in Brazil and a multi-centre observational study from French and Belgian ICUs regarding moderate to severe ARDS related to COVID-19, investigators assumed a standard deviation of VFD at 28 days as 9. Using these assumptions, a total of 142 patients per treatment arm would be needed. After adjustment for a drop-out rate, 150 per treatment arm (300 patients per study) will be enrolled. TRIAL STATUS: This is protocol version 1.1, 15.01.2021. The trial is due to start on 2 February 2021 and recruitment is expected to be completed by December 2021. TRIAL REGISTRATION: The study protocol was registered on EudraCT No.:2020-005887-70, and on December 11, 2020 on ClinicalTrials.gov (Title: Effect of Two Different Doses of Dexamethasone in Patients With ARDS and COVID-19 (REMED)) Identifier: NCT04663555 with a last update posted on February 1, 2021. FULL PROTOCOL: The full protocol (version 1.1) is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting dissemination of this material, the standard formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

• MeSH
• COVID-19 komplikace   terapie   MeSH
• délka pobytu MeSH
• dexamethason aplikace a dávkování   MeSH
• glukokortikoidy aplikace a dávkování   MeSH
• hodnocení ekvivalence jako téma MeSH
• klinické zkoušky, fáze II jako téma MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• progrese nemoci MeSH
• randomizované kontrolované studie jako téma MeSH
• SARS-CoV-2 MeSH
• syndrom dechové tísně etiologie   terapie   MeSH
• umělé dýchání * MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• protokol klinické studie MeSH

The objective of this current work was to determinate the effect of high temperatures on milk production of dairy cows in southern Slovakia in the year 2015. The hypotheses that milk production is influenced by the altitude and cooling were tested. Production data included 227,500 test-day records belonging to 34 Holstein breed herds situated in lowlands, 115 to 150 m above sea level (ASL) and kept in free-stall housing. Dairy farms were classified into groups based on cooling system. The first group of cows (19 herds) was cooled evaporative (foggers) and forced ventilation, and the second group (15 herds) was using cooled only forced ventilation (automatically controlled fans in housing and feeding areas). During the period from May to September, 36 summer and 22 tropical days were recorded, 37 days had a mean thermal humidity index value above 72.0, and on 34 days we recorded mean values above 78.0. The highest milk yields were recorded at the altitude 1 (115 m ASL) (9219.0 kg year-1; 10327.0 kg year-1) and the lowest at the altitude 2 (126 m ASL) (7598.7 kg year-1; 8470.21 kg year-1) (P < 0.001). Dairy cows cooled evaporative milked significantly more milk than cows cooled only with forced air flow (9650.4 kg vs. 8528.0 kg; P < 0.001). Fat and protein production differed also significantly (364.0 kg vs. 329.5 kg, P < 0.001; 312.2 kg vs. 279.7 kg, P < 0.001). It can be concluded that not only heat stress but also location farm above sea level can affect milk production. Evaporative cooling associated with increased air velocity is the appropriate protection against high temperatures.

• MeSH
• laktace MeSH
• mlékárenství MeSH
• mléko * MeSH
• nadmořská výška MeSH
• poruchy vyvolané tepelným stresem * MeSH
• skot MeSH
• zvířata MeSH
• Check Tag
• skot MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Novel coronavirus SARS-CoV-2 is known to be susceptible in vitro to exposure to hydroxychloroquine and its effect has been found to be potentiated by azithromycin. We hypothesise that early administration of hydroxychloroquine alone or in combination with azithromycin can prevent respiratory deterioration in patients admitted to intensive care due to rapidly progressive COVID-19 infection. METHODS: Design: Prospective, multi-centre, double-blind, randomised, controlled trial (RCT). PARTICIPANTS: Adult (> 18 years) within 24 h of admission to the intensive care unit with proven or suspected COVID-19 infection, whether or not mechanically ventilated. Exclusion criteria include duration symptoms of febrile disease for ≥ 1 week, treatment limitations in place or moribund patients, allergy or intolerance of any study treatment, and pregnancy. INTERVENTIONS: Patients will be randomised in 1:1:1 ratio to receive Hydroxychloroquine 800 mg orally in two doses followed by 400 mg daily in two doses and azithromycin 500 mg orally in one dose followed by 250 mg in one dose for a total of 5 days (HC-A group) or hydroxychloroquine + placebo (HC group) or placebo + placebo (C-group) in addition to the best standard of care, which may evolve during the trial period but will not differ between groups. Primary outcome is the composite percentage of patients alive and not on end-of-life pathway who are free of mechanical ventilation at day 14. SECONDARY OUTCOMES: The percentage of patients who were prevented from needing intubation until day 14, ICU length of stay, and mortality (in hospital) at day 28 and 90. DISCUSSION: Although both investigational drugs are often administered off label to patients with severe COVID-19, at present, there is no data from RCTs on their safety and efficacy. In vitro and observational trial suggests their potential to limit viral replication and the damage to lungs as the most common reason for ICU admission. Therefore, patients most likely to benefit from the treatment are those with severe but early disease. This trial is designed and powered to investigate whether the treatment in this cohort of patients leads to improved clinical patient-centred outcomes, such as mechanical ventilation-free survival. TRIAL REGISTRATION: Clinical trials.gov: NCT04339816 (Registered on 9 April 2020, amended on 22 June 2020); Eudra CT number: 2020-001456-18 (Registered on 29 March 2020).

• MeSH
• azithromycin aplikace a dávkování   MeSH
• Betacoronavirus * MeSH
• dvojitá slepá metoda MeSH
• hydroxychlorochin aplikace a dávkování   MeSH
• jednotky intenzivní péče MeSH
• kombinovaná farmakoterapie MeSH
• koronavirové infekce farmakoterapie   mortalita   MeSH
• lidé MeSH
• pandemie MeSH
• prospektivní studie MeSH
• randomizované kontrolované studie jako téma * MeSH
• virová pneumonie farmakoterapie   mortalita   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• protokol klinické studie MeSH

OBJECTIVE: Cardiac resynchronization therapy is a therapeutic option in patients with chronic heart failure. Epicardial lead implantation for biventricular pacing is usually the method of second choice after failed coronary sinus cannulation. The present study describes an initial experience with minimally invasive surgical lead implantation using thoracoscopy. METHODS: Since August 2008, a total of 17 patients (mean age 69.6 + 11.1 years) with congestive heart failure, NYHA functional class 3.1 +/- 0.4, and depressed ejection function (24.8% +/- 5.7%) were referred for surgery because of failed left ventricular lead implantation through the coronary sinus. Under single-lung ventilation and video-assisted thoracoscopy, epimyocardial steroid-eluting screw-in leads were implanted on the left ventricular free wall. RESULTS: There were no in-hospital deaths or major co-morbidities. The mean skin-to-skin operating time was 115.9 +/- 32.1 min, and the post-operative average length of stay was 8.4 +/- 2.5 days. Intraoperative acute threshold capture of the left ventricular lead was 0.88 +/- 0.54 V/0.5 ms, and the value of lead impedance was 434.7 +/- 110.8 Omega. Extension to a small thoracotomy was necessary in 1 patient to stop epicardial vein bleeding. CONCLUSION: Minimally invasive left ventricular lead implantation is a safe procedure with excellent acute threshold capture.

• MeSH
• hrudní chirurgie video-asistovaná MeSH
• implantované elektrody MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční resynchronizační terapie metody   MeSH
• srdeční selhání terapie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Úvod: Srdeční resynchronizační léčba pomocí biventrikulární stimulace se v posledních letech stala léčebnou metodou u některých nemocných s chronickým srdečním selháním. Chirurgická implantace levokomorové epimyokardiální elektrody na levou srdeční komoru se stala metodou volby tam, kde nelze dosáhnout optimální polohy elektrody cestou koronárního sinu. Cílem práce je seznámit čtenáře s výsledky miniinvazivní thorakoskopické implantace levokomorové srdeční elektrody. Metoda: V období od srpna 2008 do ledna 2010 bylo na Kardiochirurgické klinice Fakultní nemocnice Hradec Králové indikováno k implantaci thorakoskopickým přístupem 12 nemocných (průměrný věk 71,9 ± 8,9 let) s funkční třídou NYHA 2,9 ± 0,3 a systolickou dysfunkcí levé komory s ejekční frakcí 25,5 ± 5,0 %. V selektivní plicní intubaci byla videoasistovaným přístupem implantována šroubovací epimyokardiální elektroda na laterální povrch levé srdeční komory. Výsledky: V souboru operovaných nedošlo k žádnému úmrtí. Průměrná délka operace byla 124,2 ± 34,6 minut a průměrná délka pooperační hospitalizace byla 8,3 ± 2,4 dnů. Prahová hodnota pro stimulaci byla na konci operace v průměru 0,85 ± 0,58 V/0,5 ms. U jednoho nemocného jsme provedli konverzi na minithorakotomii pro krvácení. Závěr: Miniinvazivní thorakoskopická implantace levokomorové srdeční elektrody u nemocných indikovaných k resynchronizační léčbě představuje relativně bezpečnou metodu s velmi dobrou prahovou hodnotou pro stimulaci. Představuje metodu volby při selhání katetrizační metody.

Introduction: Cardiac resynchronization therapy is a therapeutic option in patients with congestive heart failure. Surgical epicardial lead placement for biventricular pacing is the method of choice after failed coronary sinus (CS) cannulation. We describe our initial experience with minimally invasive surgical lead implantation using video-assisted thoracoscopy. Methods: From August 2008 to January 2010, a total of 12 patients (mean age 71.9 ± 8.9 years) with congestive heart failure, NYHA functional class 2.9 ± 0.3 and depressed ejection function (25.5 ± 5.0%) were referred for surgery because of failed CS left ventricular lead implantation. Under single-lung ventilation and video-assisted thoracoscopy, epimyocardial steroid-eluting screw-in leads were implanted on the left ventricular free wall. Results: There were no in-hospital deaths. Mean skin-to-skin operating time was 124.2 ± 34.6 minutes and the postoperative average length of stay was 8.3 ± 2.4 days. Intraoperative threshold capture of the left ventricular lead was 0.85 ± 0.58 V/0.5 ms. Conversion to a small thoracotomy was necessary in one patient due to bleeding. Conclusion: Minimally invasive left ventricular lead implantation is a relatively safe procedure with excellent threshold capture.

• Klíčová slova
• Srdeční resynchronizační léčba, Implantace elektrody, Thorakoskopie,
• MeSH
• elektrická stimulace metody   přístrojové vybavení   MeSH
• elektrofyziologické techniky kardiologické metody   využití   MeSH
• implantované elektrody využití   MeSH
• koronární jednotky MeSH
• lidé MeSH
• medicína založená na důkazech trendy   MeSH
• peroperační péče metody   ošetřování   využití   MeSH
• pooperační péče metody   ošetřování   využití   MeSH
• statistika jako téma MeSH
• systolické srdeční selhání patofyziologie   terapie   MeSH
• torakoskopie metody   využití   MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• Check Tag
• lidé MeSH

OBJECTIVES: The purpose of this report is to analyze factors affecting morbidity and mortality following pneumonectomy for non-small cell lung cancer (NSCLC). METHODS: We reviewed our institutional experience with all consecutive patients undergoing pneumonectomy for NSCLC from 1998 to 2010. Patients were analyzed with regard to hospital mortality and morbidity and long-term outcome. RESULTS: There were 310 patients following pneumonectomy. Overall 30-day mortality rate was 5.5 %. Chronic obstructive pulmonary disease, induction therapy, smoking habits and obesity had no statistical influence on short-term outcome. Coronary artery disease and respiratory failure were identified as risk factors for increased 30-day mortality (p<0.01). Right pneumonectomy and presence of respiratory failure with mechanical ventilation increases the incidence of bronchopleural fistula (p<0.01). CONCLUSIONS: Patients with right pneumonectomies are at increased risk. Coronary artery disease and respiratory failure adversely affect morbidity and mortality after this procedure (Tab. 3, Ref. 19). Full Text in free PDF www.bmj.sk.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití MeSH
• nádory plic mortalita   chirurgie   MeSH
• nemalobuněčný karcinom plic mortalita   chirurgie   MeSH
• pneumektomie škodlivé účinky   mortalita   MeSH
• rizikové faktory MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH