Hyponatremie je stanovena jako koncentrace sodíku nižší než 135 mmol/l. Jedná se o celosvětově nejčastější poruchu elektrolytů. Nejčastějšími projevy hyponatremie jsou gastrointestinální a neurologické obtíže. Příležitostně může vést hyponatremie k poruchám srdečního rytmu. V námi prezentované kazuistice vedla těžká hyponatremie k sinusové bradykardii s alternujícím stupněm atrioventrikulární blokády a srdeční zástavě. Obnovení sinusového rytmu bylo dosaženo až po úpravě koncentrace sodíku. Těžká hyponatremie a protrahovaná zástava oběhu však u pacienta vedly k malignímu otoku mozku. Tento jedinečný případ zdůrazňuje kritickou roli sodíku v srdeční elektrofyziologii a ukazuje důležitost monitorace koncentrace sodíku u pacientů se zástavou oběhu.
Hyponatremia, characterized by sodium levels below 135 mmol/l, is the most prevalent electrolyte disorder worldwide. It presents with a wide range of clinical symptoms, particularly in the neurological and gastrointestinal domains, occasionally leading to cardiac arrhythmias. In our specific case, severe hyponatremia resulting from potomania resulted in sinus bradycardia with alternating atrioventricular block and subsequent cardiac arrest. Restoration of sinus rhythm was achieved following correction of the sodium levels. However severe hyponatremia and long-lasting CPR resulted in brain oedema, which ultimately led to brain death. Per national regulations, the patient was enrolled in an organ donor program, resulting in successful organ transplants. This unique case underscores the critical role of sodium levels in cardiac electrophysiology and highlights the necessity of monitoring electrolyte levels in patients experiencing cardiac arrest.
- MeSH
- edém mozku etiologie MeSH
- elektrokardiografie MeSH
- fosfopyruváthydratasa analýza MeSH
- hypertrofie pravé komory srdeční komplikace MeSH
- hyponatremie * komplikace MeSH
- kardiopulmonální resuscitace MeSH
- lidé středního věku MeSH
- lidé MeSH
- mozková smrt MeSH
- pití alkoholu škodlivé účinky MeSH
- pitva MeSH
- recidiva MeSH
- srdeční zástava * etiologie komplikace patologie terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Background: Awareness and understanding of organ donation after brain death can significantly influence an individuals' perceptions of the issue. Objectives: The aim of this study was to determine the current level of awareness and perception of the Slovenian public regarding organ donation after brain death. Methods: A cross-sectional study was conducted using a questionnaire to collect data from a sample of 784 individuals. Inferential statistics were conducted using IBM SPSS version 25. Results: The research sample of the studied Slovenian population demonstrated support for organ donation after brain death, despite a relatively low level of awareness of the topic. Significant demographic differences emerged in respondents' perceptions of organ donation. Female respondents, individuals with higher levels of educational attainment, and those working in health and social care exhibited more positive attitudes. In contrast, the age group of 50 years and above obtained the lowest scores. Statistically significant differences in awareness levels were only observed among different work sectors, with individuals working in health and social care showing higher levels of awareness. A positive yet weak correlation was found between the awareness and perceptions regarding the topic. Conclusion: Raising public awareness is essential for promoting organ donation. This can be achieved through the dissemination of information on the subject by experienced professionals.
A 41-year-old man was admitted to hospital due to sudden loss of consciousness. A regional brain perfusion SPECT/low-dose CT showed abnormal 99m Tc-HMPAO uptake in the right hemisphere frontotemporally without any other supratentorial or infratentorial radiotracer uptake. A neuropathological examination disclosed a middle cerebral artery aneurysm. Presumably, vessel wall fibrosis prevented collapse. Multiple transmural dissections of the fibrotic aneurysmal wall were the source of the subarachnoid hemorrhage. This interesting image shows that radiotracer accumulation in cerebral artery aneurysms can be a diagnostic pitfall in brain death scintigraphy assessment.
BACKGROUND: While 4 randomized controlled clinical trials confirmed the early benefits of hypothermic oxygenated machine perfusion (HOPE), high-level evidence regarding long-term clinical outcomes is lacking. The aim of this follow-up study from the HOPE-ECD-DBD trial was to compare long-term outcomes in patients who underwent liver transplantation using extended criteria donor allografts from donation after brain death (ECD-DBD), randomized to either HOPE or static cold storage (SCS). METHODS: Between September 2017 and September 2020, recipients of liver transplantation from 4 European centers receiving extended criteria donor-donation after brain death allografts were randomly assigned to HOPE or SCS (1:1). Follow-up data were available for all patients. Analyzed endpoints included the incidence of late-onset complications (occurring later than 6 months and graded according to the Clavien-Dindo Classification and the Comprehensive Complication Index) and long-term graft survival and patient survival. RESULTS: A total of 46 patients were randomized, 23 in both arms. The median follow-up was 48 months (95% CI: 41-55). After excluding early perioperative morbidity, a significant reduction in late-onset morbidity was observed in the HOPE group (median reduction of 23 Comprehensive Complication Index-points [p=0.003] and lower incidence of major complications [Clavien-Dindo ≥3, 43% vs. 85%, p=0.009]). Primary graft loss occurred in 13 patients (HOPE n=3 vs. SCS n=10), resulting in a significantly lower overall graft survival (p=0.029) and adverse 1-, 3-, and 5-year survival probabilities in the SCS group, which did not reach the level of significance (HOPE 0.913, 0.869, 0.869 vs. SCS 0.783, 0.606, 0.519, respectively). CONCLUSIONS: Our exploratory findings indicate that HOPE reduces late-onset morbidity and improves long-term graft survival providing clinical evidence to further support the broad implementation of HOPE in human liver transplantation.
Aim: This study explores nurses' experiences of caring for (potentially) brain-dead patients. Design: A qualitative interpretative phenomenological design was chosen to describe the phenomenon in all its complexity and dimensions. Methods: In 2016, twelve episodic interviews were conducted with intensive care nurses from six wards. The interviews related to their experiences of caring for (potentially) brain-dead patients and were analyzed according to Benner's Interpretative Phenomenology. Results: Three key phenomena were generated: 1) The brain is dead; the body is alive; 2) Coping within high performance medicine and 3) Power(-lessness). The participants' experience was that caring for a (potentially) brain-dead patient and explaining brain death to the patient's relatives is very demanding. In the intensive care unit, nurses are required to diligently provide exemplary methodical and routine care, most of the time without an outlet to relieve their own work-related burdens. In some situations, the interviewees felt powerless. Conclusion: The data collected have provided a deeper insight into the situation intensive care nurses face when caring for (potentially) brain-dead patients. Nevertheless, the authors recommend further research on all phenomena, and also the design of appropriate training and support for nurses.
Nedostatek vhodných orgánů představuje celosvětový problém pro transplantační medicínu. Dárci s prokázanou smrtí mozku (donor after brain death) reprezentují ve vyspělých zemích i České republice nejčastější skupinu dárců orgánů. Po smrti mozku často dochází k rozvoji orgánové dysfunkce, která může vést k poškození orgánů a ovlivnit jejich viabilitu pro úspěšnou transplantaci. Extrakorporální membránová oxygenace představuje účinnou možnost zajištění orgánové perfuze okysličenou krví při selhání obvyklých postupů. Článek popisuje klinický průběh 36letého dárce s prokázanou smrtí mozku, který byl napojen na venovenózní ECMO s cílem překlenutí průvodní těžké hypoxemie jako přemosťující techniku k multiorgánovému odběru. V článku je diskutována odborná, právní a etická problematika s vymezením možností a podmínek, za kterých lze tento postup využít.
The lack of suitable organs is a global problem for transplant medicine. Donors with brain death represent the most common group of organ donors in developed countries and the Czech Republic. After brain death, organ dysfunction often develops, which can lead to organ damage and affect its viability for successful transplantation. Extracorporeal membrane oxygenation is an effective option of circulatory and lung support in the event of failure of normal procedures. The case report describes the clinical course of a 36-year-old donor with proven brain death who was connected to venous ECMO to bridge severe hypoxemia as a bridging technique for organ donation. The article discusses professional, legal and ethical issues with the definition of possibilities and conditions under which this procedure can be used.
- MeSH
- dárci tkání * MeSH
- dospělí MeSH
- lidé MeSH
- mimotělní membránová oxygenace * MeSH
- mozková smrt MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Knowledge of living donor liver transplantation (LDLT) for autoimmune liver diseases (AILDs) is scarce. This study analyzed survival in LDLT recipients registered in the European Liver Transplant Registry with autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis (PSC) and the non-autoimmune disorder alcohol-related cirrhosis. In total, 29 902 individuals enrolled between 1998 and 2017 were analyzed, including 1003 with LDLT. Survival from >90 days after LDLT for AILDs in adults was 85.5%, 74.2%, and 58.0% after 5, 10, and 15 years. Adjusted for recipient age, sex, and liver transplantation era, adult PSC patients receiving LDLT showed increased mortality compared to donation after brain death (DBD) (hazard ratio [HR] = 1.95, 95% confidence interval [CI] = 1.36-2.80, p < .001). Pediatric PSC patients showed also increased mortality >90 days after LDLT compared to DBD (HR = 3.00, 95% CI 1.04-8.70, p = .043). Multivariate analysis identified several risk factors for death in adult PSC patients receiving LDLT including a male donor (HR = 2.49, p = .025). Adult PSC patients with LDLT versus DBD conferred increased mortality from disease recurrence (subdistribution hazard ratio [subHR] = 5.36, p = .001) and biliary complications (subHR = 4.40, p = .006) in multivariate analysis. While long-term outcome following LDLT for AILD is generally favorable, PSC patients with LDLT compared to DBD might be at increased risk of death.
- MeSH
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mozková smrt MeSH
- nemoci jater * etiologie MeSH
- přežívání štěpu MeSH
- registrace MeSH
- retrospektivní studie MeSH
- transplantace jater * škodlivé účinky MeSH
- výsledek terapie MeSH
- žijící dárci MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND Kidney donation after circulatory death (DCD) follows confirmation of death using cardiorespiratory criteria, while donation after brain death (DBD) uses neurological criteria. DBD and DCD donors are the main sources of grafts for transplantation. This retrospective cohort study from a single center in the Czech Republic aimed to compare 5-year post-transplantation outcomes after DCD and DBD transplantation without pre-mortem heparin administration. MATERIAL AND METHODS A total of 227 recipients with matched donors enrolled in the transplantation program at our institution between 2015 and 2019 were analyzed. Following the application of the inclusion criteria, 99 recipients and 94 matched donors were finally included in the study. RESULTS The duration of cold ischemia (median 961 vs 1100 min, P=0.028) and the perfusion with the preservation solution (median 11 vs 22 min, P<0.001) was statistically significantly shorter in DBD than in DCD grafts. The 1-year survival rates were 97.5% (95% CI 94.1-100.0%) and 90.0% (95% CI: 77.8-100.0%) for DBD and DCD recipients, respectively. The 3-year survival rates were 91.9 (95% CI: 86.0-98.4) and 90.0 (95% CI: 77.8-100.0) for the DBD and DCD groups, respectively. The overall difference in survival between the 2 groups of patients was not statistically significant (P=0.750) nor was disease-free survival (P=0.370). CONCLUSIONS This retrospective study from a single center showed similar 5-year results after kidney transplantation for DCD and DBD donors without pre-mortem heparin administration, including the time to graft failure and patient survival.
- MeSH
- heparin MeSH
- lidé MeSH
- mozková smrt * MeSH
- přežívání štěpu MeSH
- retrospektivní studie MeSH
- transplantace ledvin * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
V předkládaném přehledovém článku autoři článku představují legislativní úpravu týkající se rozdílu smrti mozku a nevratné zástavy oběhu (NHBD – non heart beating donor, DCD – donation after cardiac death), které jsou základním pilířem novely transplantačního zákona č. 44/2013 v České republice. Blíže popisují proces dárcovství DCD a kategorizaci dárců orgánů a tkání dle Maastrichtských kritérií. Zaměřují se na rozdílnost mezi diagnostikou smrti mozku a nevratnou zástavou oběhu. Problematiku znalostí personálu o možnostech odběru orgánů a tkání od dárců po nevratné zástavě oběhu a jeho základním legislativním rámci v České republice shrnují v závěru své práce.
In this review article, the authors present the legislative regulation regarding the difference between brain death and irreversible circulatory arrest (NHBD – non heart beating donor, DCD – donation after cardiac death), which are the main pillars of the amendment to the Transplantation Act No. 44/2013 in the Czech Republic. They describe in more detail the process of DCD donation and the categorization of organ and tissue donors according to the Maastricht criteria. They focus on the difference between the diagnosis of brain death and irreversible circulatory arrest. They summarize the issue of staff knowledge about the possibilities of organ and tissue procurement from donors after irreversible circulatory arrest and its basic legislative framework in the Czech Republic in the conclusion of their work.
- MeSH
- lidé MeSH
- mozková smrt * diagnóza MeSH
- náhlá srdeční smrt MeSH
- odběr tkání a orgánů * etika zákonodárství a právo MeSH
- transplantace etika zákonodárství a právo MeSH
- zákonodárství lékařské MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- lidé MeSH
- mozková smrt * diagnostické zobrazování diagnóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
