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 authors present a case report of a patient with febrile pancytopenia, hepatosplenomegaly and weight loss as main symptoms of visceral leishmaniasis. Standard treatment regimen with amphothericin B led to relapse of the disease after several weeks. The definitive cure of the disease was achieved with cytostatic miltefosin (Impavido©), which is not registered in the Czech Republic. The aim of this article is to point out this imported protozoan infection and its basic clinical and laboratory features.
- MeSH
- dospělí MeSH
- hepatomegalie komplikace MeSH
- horečka komplikace MeSH
- leishmanióza viscerální komplikace diagnóza farmakoterapie MeSH
- lidé MeSH
- pancytopenie komplikace MeSH
- splenomegalie komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
Assessment of the cerebral microcirculation by on-line visualization has been impossible for a long time. Sidestream dark-field (SDF) imaging is a relatively new method allowing direct visualization of cerebral surface layer microcirculation using hand-held probe for direct contact with target tissue. The aim of this study was to elucidate the feasibility of studying the cerebral microcirculation in situ by SDF imaging and to assess the basic cerebral microcirculatory parameters in mechanically ventilated rabbits. Images were obtained using SDF imaging from the surface of the brain via craniotomy. Clear high contrast SDF images were successfully obtained. Total small-vessel density was 14.6+/-1.8 mm/mm(2), total all-vessel density was 17.9+/-1.7 mm/mm(2), DeBacker score was 12.0+/-1.6 mm(-1) and microvascular flow index was 3.0+/-0.0. This method seems to be applicable in animal studies with possibility to use SDF imaging also intraoperatively, providing unique opportunity to study cerebral microcirculation during various experimental and clinical settings.
This study evaluated inflammatory, coagulation and microvascular responses to a continuous 24-h work day in 13 healthy intensive care physicians. Inflammatory markers (interleukin [IL]-2, IL-6, IL-10, tumour necrosis factor-α, matrix metalloproteinase [MMP]-9 and adiponectin), adhesion molecules (vascular cellular adhesion molecule-1 and intercellular adhesion molecule-1 [ICAM-1]), coagulation parameters (thrombin-anti thrombin, von Willebrand factor and tissue factor) and sublingual micro circulation were assessed before and after a 24-h work shift. The 24-h work shift had no effect on inflammatory markers and ICAM-1. Direct visualization of micro-circulation did not reveal stress-related perfusion abnormalities. A 24-h work shift in the intensive care unit was associated with significantly increased plasma levels of tissue factor - a potentially important mechanism linking acute job strain, haemostasis and atherosclerosis. The long-term consequences warrant further evaluation.
- MeSH
- biologické jevy * MeSH
- biologické markery krev MeSH
- časové faktory MeSH
- cévní endotel patofyziologie MeSH
- dospělí MeSH
- fyziologický stres * MeSH
- hemodynamika MeSH
- hemostáza MeSH
- jednotky intenzivní péče * MeSH
- lidé MeSH
- mediátory zánětu metabolismus MeSH
- mikrocirkulace MeSH
- tkáňový faktor metabolismus MeSH
- zdraví * MeSH
- zdravotnický personál * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- biologické markery MeSH
- mediátory zánětu MeSH
- tkáňový faktor MeSH
Hypothermia was shown to attenuate ventilator-induced lung injury due to large tidal volumes. It is unclear if the protective effect of hypothermia is maintained under less injurious mechanical ventilation in animals without previous lung injury. Tracheostomized rats were randomly allocated to non-ventilated group (group C) or ventilated groups of normothermia (group N) and mild hypothermia (group H). After two hours of mechanical ventilation with inspiratory fraction of oxygen 1.0, respiratory rate 60 min(-1), tidal volume 10 ml x kg(-1), positive end-expiratory pressure (PEEP) 2 cm H2O or immediately after tracheostomy in non-ventilated animals inspiratory pressures were recorded, rats were sacrificed, pressure-volume (PV) curve of respiratory system constructed, bronchoalveolar lavage (BAL) fluid and aortic blood samples obtained. Group N animals exhibited a higher rise in peak inspiratory pressures in comparison to group H animals. Shift of the PV curve to right, higher total protein and interleukin-6 levels in BAL fluid were observed in normothermia animals in comparison with hypothermia animals and non-ventilated controls. Tumor necrosis factor-alpha was lower in the hypothermia group in comparison with normothermia and non-ventilated groups. Mild hypothermia attenuated changes in respiratory system mechanics and modified cytokine concentration in bronchoalveolar lavage fluid during low lung volume ventilation in animals without previous lung injury.
- MeSH
- bronchoalveolární lavážní tekutina imunologie MeSH
- cytokiny metabolismus MeSH
- dechový objem fyziologie MeSH
- hypotermie metabolismus patofyziologie MeSH
- krysa rodu Rattus MeSH
- mechanika dýchání * MeSH
- plíce metabolismus MeSH
- poškození plic metabolismus MeSH
- potkani Sprague-Dawley MeSH
- TNF-alfa metabolismus MeSH
- umělé dýchání MeSH
- zvířata MeSH
- Check Tag
- krysa rodu Rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- cytokiny MeSH
- TNF-alfa MeSH
The case of a patient with a penetrating cardiac injury successfully treated by thoracotomy is reported. In a suicidal attempt, he suffered a self-inflicted thoracic stub wound penetrating the left ventricle. During transport to the hospital, he developed circulatory instability. He was admitted to the emergency department with no signs of life and bilateral non-responding mydriasis. Immediately, urgent anterolateral thoracotomy at the left 5th rib was performed. The pericardium was opened, cardiac tamponade was evacuated and the stab wound in the right ventricle was sutured. The subsequent ventricular fibrillation was treated using defibrillation with an electric discharge of 200 J. After sinus rhythm had resumed, the patient was transferred to the operating theatre for the finishing of thoracic exploration. No more injury was found. Intermittent myoclonus had persisted since admission, and a CT scan showed diffuse cerebral oedema due to post-hypoxic brain damage. During the following hospitalisation, the patient underwent the SSEP examination (evoked potentials) and no signs of decortication were found. At four weeks after injury, the patient was transported to his regional hospital he was afebrile, with stable circulation, spontaneous ventricular function and the GCS of 8 to 9.
- MeSH
- bodné rány chirurgie MeSH
- dospělí MeSH
- lidé MeSH
- náhlé příhody MeSH
- pokus o sebevraždu MeSH
- poranění srdce chirurgie MeSH
- torakotomie * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- MeSH
- lidé MeSH
- multiorgánové selhání terapie MeSH
- paliativní péče * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Assessment of hepatic microcirculation by on-line visualization has been impossible for a long time. Sidestream dark-field (SDF) imaging is a relatively new method allowing direct visualization of both mucosal microcirculation and surface layers microcirculation of solid organs using hand-held probe for direct contact with target tissue. The aim of this study was to evaluate the feasibility of studying the rat hepatic microcirculation in situ by SDF imaging. The liver lobes were left in situ, and images were obtained using SDF imaging on the surface of the liver via upper midline laparotomy. Images were captured intermittently during 10-sec apnoea and recorded. The microvascular parameters were compared with previous validation studies. Clear high contrast SDF images were successfully obtained. Quantitative analysis revealed a mean FSD (functional sinusoidal density) of 402+/-15 cm/cm(2), a sinusoidal diameter of 10.2+/-0.5 microm and postsinusoidal venular diameter of 33.9+/-13 microm. SDF imaging is a suitable noninvasive method for accurate quantification of the basic microcirculatory parameters of the liver in situ without a need to exteriorize the liver lobes. This method seems to be applicable in animal studies with possibility to use SDF imaging also intraoperatively, providing unique opportunity to study liver microcirculation during various experimental and clinical settings.
- MeSH
- interpretace obrazu počítačem MeSH
- jaterní oběh * MeSH
- játra krevní zásobení MeSH
- krysa rodu Rattus MeSH
- mikrocirkulace * MeSH
- polarizační mikroskopie metody MeSH
- potkani Wistar MeSH
- reprodukovatelnost výsledků MeSH
- studie proveditelnosti MeSH
- umělé dýchání * MeSH
- zvířata MeSH
- Check Tag
- krysa rodu Rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- srovnávací studie MeSH
The pathophysiology of microcirculation is intensively investigated to understand disease development at the microscopic level. Orthogonal polarization spectral (OPS) imaging and its successor sidestream dark-field (SDF) imaging are relatively new noninvasive optical techniques allowing direct visualization of microcirculation in both clinical and experimental studies. The goal of this experimental study was to describe basic microcirculatory parameters of skeletal muscle and ileal serous surface microcirculation in the rat using SDF imaging and to standardize the technical aspects of the protocol. Interindividual variability in functional capillary density (FCD) and small vessels (<25 microm in diameter) proportion was determined in anesthetized rats on the surface of quadriceps femoris (m. rectus femoris and m. vastus medialis) and serous surface of ileum. Special custom made flexible arm was used to fix the SDF probe minimizing the pressure movement artifacts. Clear high contrast images were analyzed off-line. The mean FCD obtained from the surface of skeletal muscle and ileal serous surface was 219 (213-225 cm/cm(2)) and 290 (282-298 cm/cm(2)) respectively. There was no statistically significant difference between rats in mean values of FCD obtained from the muscle (P = 0.273) in contrast to ileal serous surface, where such difference was statistically significant (P = 0.036). No statistically significant differences in small vessels percentage was detected on either the muscle surface (P = 0.739) or on ileal serous surface (P = 0.659). Our study has shown that interindividual variability of basic microcirculatory parameters in rat skeletal muscle and ileum is acceptable when using SDF imaging technique according to a highly standardized protocol and with appropriate fixation device. SDF imaging represents promising technology for experimental and clinical studies.
- MeSH
- čtyřhlavý sval stehenní krevní zásobení MeSH
- ileum krevní zásobení MeSH
- krysa rodu Rattus MeSH
- mikrocirkulace MeSH
- polarizační mikroskopie * metody normy MeSH
- potkani Wistar MeSH
- reprodukovatelnost výsledků MeSH
- serózní membrána krevní zásobení MeSH
- zvířata MeSH
- Check Tag
- krysa rodu Rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Authors present the case of little patient with the dissection, pseudoaneurysm and finally a rupture of the interventricular septum after the blunt thracic injury. The patient was smitten as a pedestrian by a car and during the whole period of her stay in the hospital she was showing signs of circulatory instability. Due to the current intraabdominal injuries this circulatory decompensation was first assigned to hemoperitoneum, for which the girl was operated on about 3 hours after admission. Nevertheless, even after the abdminal cavity check, after the treatment of supreficial liver lacerations and intensive volume resuscitation the patient showed signs of insufficiency. Diagnosis was finally determined on the base of the transthoracic echocardiography (TTE), which proved the traumatic rupture of interventricular septum. The operation followed correcting the defect, which was performed with a good result according to the TTE postoperatively. Nevertheless, 27 hours after the admission the patient died due to the electromechanical dissociation. In the discussion the authors then evoke a number of papers concerning the same topic.
