BACKGROUND: There is still a lack of evidence as to which method of biological sample collection is optimal for identifying bacterial pathogens causing hospital-acquired pneumonia (HAP). Much effort has been made to find an easy and valid approach to be used in clinical practice. METHODS: The primary endpoint of this prospective, observational study was to determine the predictive value of oropharyngeal swab (OS) and gastric aspiration (GA) as simple and non-invasive methods for diagnosing HAP. Their efficacy was compared to endotracheal aspiration (ETA) and protected specimen brushing (PSB), the standard methods approved for HAP diagnosis. RESULTS: Initially, 56 patients were enrolled. Significant amounts of bacterial pathogens were detected in 48 patients (79 isolates) in Round A and in 39 patients (45 isolates) in Round B (after 72 hours). The sensitivity rates were: ETA 98%, PSB 31%, OS 64% and GA 67% in Round A and ETA 87%, PSB 32%, OS 74% and GA 42% in Round B. Strains of 12 bacterial species were identified in the samples. The three most common etiological agents (both rounds together) were Klebsiella pneumoniae (23.7%), Burkholderia multivorans (21.1%) and Pseudomonas aeruginosa (15.8%). CONCLUSIONS: Blind ETA is an optimum method for obtaining biological samples for identification of etiological agents causing HAP in intubated patients. Microbial etiological agents were more frequently detected in ETA samples than in those collected by PSB. If ETA/PSB results are negative, samples may be collected by OS and/or GA as these techniques followed ETA in terms of the frequency of pathogen detection.
- Klíčová slova
- hospital-acquired pneumonia - bacterial pathogens - tracheal aspiration - protected specimen brushing.,
- MeSH
- Bacteria * izolace a purifikace MeSH
- bakteriální pneumonie * diagnóza mikrobiologie MeSH
- infekce spojené se zdravotní péčí * diagnóza mikrobiologie MeSH
- lidé MeSH
- mikrobiologické techniky * normy MeSH
- péče o pacienty v kritickém stavu MeSH
- prospektivní studie MeSH
- reprodukovatelnost výsledků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
INTRODUCTION: Severe sepsis is still associated with significant morbidity and mortality, which is however different, as well as its management, depending on the region. What is the situation in the Czech Republic and what is the character of patients with severe sepsis is currently not known. The aim of the project is to describe the processes of care, outcome and characteristics of patients with severe sepsis admitted to the intensive care department of the Czech Republic. METHODS: This is a multicentre and observational project with retrospective enrollment of patients who meet the criteria for severe sepsis before or within 24 hours after admission to selected intensive care units (ICU EPOSS). RESULTS: 394 patients were analyzed. Median age at admission was 66 (56- 76) years, males predominated (58.9%) and the median APACHE II score on admission was 25 (19- 32). Patients were predominantly medical (56.9%) and most were secondary admitted from other ICU (53.6%). Meeting the criteria of severe sepsis was most frequently within the period (± 4 hours) of admission the EPOSS ICU (77.6%). Median total fluid intake during the first 24 hours was 6,680 (4,840- 9,450) ml. Most patients required mechanical ventilation (58.4%). Compliance with the resuscitation bundle of severe sepsis in our group was very good and was associated with lower mortality of patients. Most frequently, the EPOSS ICU length of stay (LOS) was 7 (3- 15) days and median hospital LOS was 13 (8- 28) days. Hospital mortality in our cohort was 35.8%. CONCLUSION: Introducing the project, which in its first stage obtained valuable and internationally comparable data about patients with severe sepsis admitted to the involved ICU in the Czech Republic.
- MeSH
- délka pobytu statistika a číselné údaje MeSH
- dodržování směrnic MeSH
- dospělí MeSH
- infekce spojené se zdravotní péčí diagnóza mortalita terapie MeSH
- jednotky intenzivní péče * MeSH
- lidé středního věku MeSH
- lidé MeSH
- mortalita v nemocnicích MeSH
- pilotní projekty MeSH
- resuscitace MeSH
- retrospektivní studie MeSH
- senioři MeSH
- sepse diagnóza mortalita terapie MeSH
- umělé dýchání MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- Geografické názvy
- Česká republika MeSH
The aim of this pilot study was to compare the efficacy of pulsed radiofrequency to the greater occipital nerve versus a greater occipital nerve block with a mixture of local anaesthetic and steroid in the management of refractory cervicogenic headache. We enrolled 30 patients suffering from refractory cervicogenic headache. Patients were randomly allocated into two groups of fifteen. A greater occipital nerve block with steroid was utilised in group A, while a pulsed radiofrequency treatment was employed in group B. Success of both procedures was evaluated by comparing pre and post intervention Visual Analogue Scale of pain, Medication Quantification Scale - III. and Global Perceived Effect at three and 9 months after the procedures. At three months post therapy a significant decrease in Visual Analogue Scale (p<0.001) was identified (3.2 points in group A, 3.3 points in group B respectively). In group B pain remained reduced even after 9 months (p<0.001) when compared to pre treatment scores. The consumption of analgesic medication was reduced significantly in both groups at three months (p<0.001) and 9 months (p<0.01), respectively. No serious complication was noted. Greater occipital nerve block is a safe, efficient technique in the management of cervicogenic headaches. Despite the lack of high quality scientific evidence (level III or IV) in the literature, we have extensive experience with steroid application and pulsed radiofrequency to the greater occipital nerve and report the beneficial results in our study.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření bolesti MeSH
- mladý dospělý MeSH
- nervová blokáda * MeSH
- posttraumatická bolest hlavy terapie MeSH
- pulsní radiofrekvenční terapie * MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
BACKGROUND: Pulsed radiofrequency treatment (PRF) applied to the suprascapular nerve may provide pain relief for patients suffering from shoulder pain as described in three case series. AIMS: The effect of PRF to the suprascapular nerve was retrospectively analysed on 28 patients with shoulder pain lasting longer than 1 month, with a 6-month follow-up. Group A was treated with PRF and local anaesthetics only while group B was treated with PRF, local anaesthetic and steroid. Pain scores were evaluated before and after the procedure and at 1, 3 and 6 months. RESULTS: More than 50% of patients in both groups had significant pain relief after 3 months. No major, but only one minor complication occurred. CONCLUSIONS: Our results suggest that the analgesic effects of PRF last more than 3 months in the majority of patients. The addition of steroid to the PRF treatment appears to have no benefit.
- MeSH
- bolest ramene farmakoterapie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření bolesti MeSH
- nervová blokáda metody MeSH
- rameno inervace účinky záření MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
BACKGROUND: Following opioid and intravenous anaesthetic, tracheal intubation may be accomplished without any muscle relaxant. In this study, we evaluated the dose requirements for sufentanil with propofol without muscle relaxant administration to obtain clinically acceptable intubation conditions and cardiovascular responses. METHODS AND RESULTS: After midazolam (0.05 mg x kg(-1)), 90 patients were randomized into three equal groups, each receiving sufentanil 0.2 (SUF-0.2), 0.3 (SUF-0.3) or 0.4 (SUF-0.4) microg x kg(-1), respectively. Following induction of anaesthesia with propofol (2 mg x kg(-1)), the quality of tracheal intubation was assessed as excellent or good (clinically acceptable) and poor. Excellent intubation conditions were observed in 28%, 41% and 54% of patients in groups SUF-0.2, SUF-0.3 and SUF-0.4, respectively, while poor conditions were present in 31% (SUF-0.2; p = 0.041 vs. SUF-0.3, p = 0.006 vs SUF-0.4), 7% (SUF-0.3) and 3% (SUF-0.4). Patients with induction-related hypotension were older than those without (60 +/- 15 vs. 52 +/- 17 yr, p = 0.013). CONCLUSIONS: Sufentanil (0.3-0.4 microg x kg(-1)) in combination with propofol (2 mg.kg(-1)) provided clinically acceptable intubating conditions in 93-97% patients.
- MeSH
- anestetika intravenózní aplikace a dávkování MeSH
- celková anestezie * MeSH
- hemodynamika MeSH
- intratracheální intubace * MeSH
- lidé středního věku MeSH
- lidé MeSH
- nervosvalové blokátory aplikace a dávkování MeSH
- propofol aplikace a dávkování MeSH
- sufentanil aplikace a dávkování MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- Názvy látek
- anestetika intravenózní MeSH
- nervosvalové blokátory MeSH
- propofol MeSH
- sufentanil MeSH
BACKGROUND AND OBJECTIVE: There is increasing evidence of gender differences in the pharmacokinetics and pharmacodynamics of aminosteroid neuromuscular blocking agents. Compared to males, females are more susceptible, requiring approximately 30% less rocuronium to achieve the same degree of neuromuscular block. However, little information is available whether this difference is applicable to modern benzylisoquinolines (cisatracurium). METHODS: In all, 848 patients (423 males, 425 females) undergoing general surgery under total intravenous anaesthesia with muscle relaxation, tracheal intubation and mechanical ventilation were studied. Patients were randomized to receive a single bolus dose of cisatracurium (0.1 mg kg-1, 221 males and 199 females) or rocuronium (0.6 mg kg-1, 202 males and 226 females). The onset time for 95% depression of T1, clinical duration until 25% recovery and recovery index (T1 from 25% to 75%) were determined with an NMT electromyographic module of the Datex-Ohmeda S/5 Anaesthesia Monitor. The data for male and female groups were compared with appropriate statistical tests (unpaired t-test, Mann-Whitney rank sum test and Fisher's exact test). RESULTS: In both groups (cisatracurium and rocuronium), males were significantly taller (P < 0.001) and heavier (P < 0.001) than females, but the body mass index was comparable. For rocuronium, the onset time was shorter 91.7 +/- 14.3 s vs. 108.0 +/- 14.6 s (P < 0.001) and the clinical duration was increased in females 43.3 +/- 7.8 min vs. 31.3 +/- 5.5 min (P < 0.001). In the cisatracurium group, both onset times (248.9 +/- 60.7 s for males vs. 253.4 +/- 70.9 s for females) and clinical duration (42.6 +/- 6.9 min for males vs. 43.1 +/- 6.9 min for females) were similar. The recovery index was identical for males and females in both groups. CONCLUSIONS: Females were more sensitive than males to a single bolus dose of rocuronium. Under the study conditions described, the onset time was shorter and the clinical duration was increased in female patients. This suggests that the routine dose of rocuronium should be reduced in females compared to males. On the contrary, we could demonstrate no gender differences in the onset time or clinical duration of cisatracurium.
- MeSH
- androstanoly aplikace a dávkování MeSH
- atrakurium aplikace a dávkování analogy a deriváty MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- nervosvalová blokáda metody MeSH
- pohlavní dimorfismus * MeSH
- rokuronium MeSH
- rozvrh dávkování léků MeSH
- senioři MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
- Názvy látek
- androstanoly MeSH
- atrakurium MeSH
- cisatracurium MeSH Prohlížeč
- rokuronium MeSH
