• Klíčová slova
• Critical illness, Emergency department, Hospital wards, Intensive care, Inter-hospital, Pre-hospital, Survival,
• Publikační typ
• časopisecké články MeSH

PURPOSE: The echocardiography parameters may predict the maintenance of sinus rhythm after cardioversion of a supraventricular arrhythmia (SVA). MATERIALS AND METHODS: Patients in septic shock with onset of an SVA, normal to moderately reduced LV systolic function (EF_LV˃̳35%) and on a continuous noradrenaline of <1.0 μg/kg.min were included. Echocardiography was performed at the arrhythmia onset, 1 h and 4 h post cardioversion on an infusion of propafenone or amiodarone. RESULTS: Cardioversion was achieved in 96% of the 209 patients within a median time of 6(1.8-15.6)h, 134(64.1%) patients experienced at least one SVA recurrence after cardioversion. At 4 h the left atrial emptying fraction (LA_EF, cut-off 38.4%, AUC 0.69,p˂0.001), and transmitral A wave velocity-time-integral (Avti, cut-off 6.8 cm, AUC 0.65,p = 0.001) showed as limited predictors of a single arrhythmia recurrence. The LA_EF 44(36,49)%, (p = 0.005) and the Avti 8.65(7.13,9.50)cm, (p < 0.001) were associated with sustained sinus rhythm and decreased proportionally to increasing numbers of arrhythmia recurrences (p < 0.001 and p = 0.007, respectively). The enlarged left atrial end-systolic diameter at the arrhythmia onset (p = 0.04) and elevated systolic pulmonary artery pressure at 4 h (p = 0.007) were weak predictors of multiple(˃3) recurrences. CONCLUSION: The LA_EF and Avti are related to arrhythmia recurrences post-cardioversion suggesting potential guidance to the choice between rhythm and rate control strategies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03029169, registered on 24th of January 2017.

• Klíčová slova
• A wave velocity-time-integral, Atrial fibrillation, Left atrial emptying fraction, Left atrial end-systolic volume, Left-atrial end-systolic diameter, Trans-mitral a wave,
• MeSH
• amiodaron terapeutické užití   aplikace a dávkování   MeSH
• antiarytmika terapeutické užití   MeSH
• echokardiografie * MeSH
• elektrická defibrilace * MeSH
• lidé středního věku MeSH
• lidé MeSH
• propafenon terapeutické užití   aplikace a dávkování   MeSH
• prospektivní studie MeSH
• recidiva MeSH
• senioři MeSH
• septický šok * terapie   patofyziologie   komplikace   MeSH
• supraventrikulární tachykardie terapie   patofyziologie   diagnostické zobrazování   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze II MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• amiodaron MeSH
• antiarytmika MeSH
• propafenon MeSH

PURPOSE: The aim was to verify the impact of obesity on the long-term outcome of patients with severe SARS-CoV-2 ARDS. MATERIALS AND METHODS: The retrospective study included patients admitted to the high-volume ECMO centre between March 2020 and March 2022. The impact of body mass index (BMI), co-morbidities and therapeutic measures on the short and 90-day outcomes was analysed. RESULTS: 292 patients were included, of whom 119(40.8%) were treated with veno-venous ECMO cannulated mostly (73%) in a local hospital. 58.5% were obese (64.7% on ECMO), the ECMO was most frequent in BMI > 40(49%). The ICU mortality (36.8% for obese vs 33.9% for the non-obese, p = 0.58) was related to ECMO only for the non-obese (p = 0.04). The 90-day mortalities (48.5% obese vs 45.5% non-obese, p = 0.603) of the ECMO and non-ECMO patients were not significantly influenced by BMI (p = 0.47, p = 0.771, respectively). The obesity associated risk factors for adverse outcome were age <50 (RR 2.14) and history of chronic immunosuppressive therapy (RR 2.11, p = 0.009). The higher dosage of steroids (RR 0.57, p = 0.05) associated with a better outcome. CONCLUSIONS: The high incidence of obesity was not associated with worse short and long-term outcomes. ECMO in obese patients together with the use of steroids in the later stage of ARDS may improve survival.

• Klíčová slova
• Corticosteroids, Covid-19, Extracorporeal membrane oxygenation, Morbid obesity, Obesity, SARS-CoV-2 ARDS,
• MeSH
• COVID-19 * terapie   MeSH
• hormony kůry nadledvin terapeutické užití   MeSH
• lidé MeSH
• obezita komplikace   MeSH
• retrospektivní studie MeSH
• SARS-CoV-2 MeSH
• syndrom dechové tísně * terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• hormony kůry nadledvin MeSH

PURPOSE: To identify patient, disease and organizational factors associated with decisions to forgo life-sustaining therapies (DFLSTs) in critically ill immunocompromised patients admitted to the intensive care unit (ICU) for acute respiratory failure. MATERIAL AND METHODS: We performed a secondary analysis of the international EFRAIM prospective study, which enrolled 1611 immunocompromised patients with acute respiratory failure admitted to 68 ICUs in 16 countries between October 2015 and June 2016. Multivariate logistic analysis was performed to identify independent predictors of DFLSTs. RESULTS: The main causes of immunosuppression were hematological malignancies (50%) and solid tumor (38%). Patients had a median age of 63 yo (54-71). A pulmonologist was involved in the patient management in 38% of cases. DFLSTs had been implemented in 28% of the patients. The following variables were independently associated with DFLSTs: 1) patient-related: older age (OR 1.02 per one year increase, 95% confidence interval(CI) 1.01-1.03,P < 0.001), poor performance status (OR 2.79, 95% CI 1.98-3.93, P < 0.001); 2) disease-related: shock (OR 2.00, 95% CI 1.45-2.75, P < 0.001), liver failure (OR 1.59, 95% CI 1.14-2.21, P = 0.006), invasive mechanical ventilation (OR 1.79, 95% CI 1.31-2.46, P < 0.001); 3) organizational: having a pulmonologist involved in patient management (OR 1.85, 95% CI 1.36-2.52, P < 0.001), and the presence of a critical care outreach services (OR 1.63, 95% CI 1.11-2.38, P = 0.012). CONCLUSIONS: A DFLST is made in one in four immunocompromised patient admitted to the ICU for acute respiratory failure. Involving a pulmonologist in patient's management is associated with less non beneficial care.

• Klíčová slova
• Decisions to forgo life-sustaining therapies, Hematological malignancies, Pneumocystis, Systemic diseases, Transplantation,
• MeSH
• imunokompromitovaný pacient MeSH
• jednotky intenzivní péče MeSH
• lidé MeSH
• prospektivní studie MeSH
• respirační insuficience * terapie   MeSH
• smrt MeSH
• syndrom dechové tísně * terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: The characteristics and impact of bacteremia have not been widely investigated in immunocompromised patients with acute respiratory failure (ARF). METHODS: We performed a secondary analysis of a prospective cohort of immunocompromised patients with ARF (EFRAIM study). After exclusion of blood cultures positive for coagulase negative Staphylococci, we compared patients with (n = 236) and without (n = 1127) bacteremia. RESULTS: The incidence of bacteremia was 17%. Bacterial pneumonia and extra-pulmonary ARDS were the main causes of ARF in bacteremic patients. Bacteremia involved gram negative rods (48%), gram positive cocci (40%) or were polymicrobial (10%). Bacteremic patients had more hematological malignancy, higher SOFA scores and increased organ support within 7 days. Bacteremia was associated with higher crude ICU mortality (40% versus 32%, p = 0.02), but neither hospital (49% versus 44%, p = 0.17) nor 90-day mortality (60% versus 56%, p = 0.25) were different from non-bacteremic patients. After propensity score matching based on baseline characteristics, the difference in ICU mortality lost statistical significance (p = 0.06), including in a sensitivity analysis restricted to patients with pneumonia. CONCLUSIONS: We analyzed a large population of immunocompromised patients with ARF and an incidence of bacteremia of 17%. We could not demonstrate an impact of bacteremia on mortality after adjusting for baseline characteristics.

• Klíčová slova
• Acute respiratory failure, Bacteremia, Cancer, Critical care, Hematological malignancy, Immunocompromised,
• MeSH
• bakteriemie * epidemiologie   MeSH
• imunokompromitovaný pacient MeSH
• jednotky intenzivní péče MeSH
• kritický stav MeSH
• lidé MeSH
• prospektivní studie MeSH
• respirační insuficience * epidemiologie   MeSH
• syndrom dechové tísně * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

OBJECTIVE: Intensive Care Units (ICU) acquired Pneumonia (ICU-AP) is one of the most frequent nosocomial infections in critically ill patients. Our aim was to determine the effects of having an ICU-AP in immunosuppressed patients with acute hypoxemic respiratory failure. DESIGN: Post-hoc analysis of a multinational, prospective cohort study in 16 countries. SETTINGS: ICU. PATIENTS: Immunosuppressed patients with acute hypoxemic respiratory failure. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: The original cohort had 1611 and in this post-hoc analysis a total of 1512 patients with available data on hospital mortality and occurrence of ICU-AP were included. ICU-AP occurred in 158 patients (10.4%). Hospital mortality was higher in patients with ICU-AP (14.8% vs. 7.1% p < 0.001). After adjustment for confounders and centre effect, use of vasopressors (Odds Ratio (OR) 2.22; 95%CI 1.46-3.39) and invasive mechanical ventilation at day 1 (OR 2.12 vs. high flow oxygen; 95%CI 1.07-4.20) were associated with increased risk of ICU-AP while female gender (OR 0.63; 95%CI 0.43-94) and chronic kidney disease (OR 0.43; 95%CI 0.22-0.88) were associated with decreased risk of ICU-AP. After adjustment for confounders and centre effect, ICU-AP was independently associated with mortality (Hazard Ratio 1.48; 95%CI 14.-1.91; P = 0.003). CONCLUSIONS: The attributable mortality of ICU-AP has been repetitively questioned in immunosuppressed patients with acute respiratory failure. This manuscript found that ICU-AP represents an independent risk factor for hospital mortality.

• Klíčová slova
• Immunosuppression, Infection, Pneumonia, Sepsis, VA-LRTI,
• MeSH
• jednotky intenzivní péče MeSH
• kohortové studie MeSH
• lidé MeSH
• mortalita v nemocnicích MeSH
• pneumonie * epidemiologie   MeSH
• prospektivní studie MeSH
• respirační insuficience * epidemiologie   MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: In patients with pleural effusion (PLE) monitored by Electrical Impedance Tomography (EIT) an increase in end-expiratory lung impedance (EELI) is observed following evacuation of the PLE. We aimed at differentiating the effect of fluid removal from lung reaeration and describe the change in ventilation distribution. MATERIALS AND METHODS: Mechanically ventilated patients were monitored by EIT during PLE evacuation. End-expiratory lung volume (EELV) was measured concurrently. We included a calibration maneuver consisting of an increase in positive end-expiratory pressure (PEEP) by 5 cm H2O. The ratio ΔEELI/ΔEELV was used to compare changes of EELI and EELV in response to the calibration maneuver and PLE evacuation. At the same time we assessed distribution of ventilation using changes in tidal variation. RESULTS: PLE removal resulted in a 6-fold greater increase in ΔEELI/ΔEELV when compared to the calibration maneuver (r = 0.84, p < .05). We observed a relative increase in ventilation in the area of the effusion (mean 7.1%, p < .006) and an overall shift of ventilation to the dorsal fraction of the lungs (mean 8%, p < .0002). CONCLUSIONS: The increase in EELI in the EIT image after PLE removal was primarily due to the removal of the conductive effusion fluid.

• Klíčová slova
• Electrical impedance, Mechanical ventilation, Pleural effusion, Thoracocentesis, Tomography,
• MeSH
• dechový objem MeSH
• dospělí MeSH
• drenáž metody   MeSH
• elektrická impedance * MeSH
• jednotky intenzivní péče MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemocnice univerzitní MeSH
• pilotní projekty MeSH
• pleurální výpotek terapie   MeSH
• plíce fyziologie   MeSH
• počítačová rentgenová tomografie metody   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ventilace umělá s výdechovým přetlakem metody   MeSH
• vojenské nemocnice MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH

PURPOSE: Autonomic imbalance as measured by heart rate variability (HRV) has been associated with poor outcome after stroke. Observations on HRV changes in intracerebral hemorrhage (ICH) are scarce. Here, we aimed to investigate HRV in ICH as compared to a control group and to explore associations with stroke severity, hemorrhage volume and outcome after ICH. METHODS: We examined the autonomic modulation using frequency domain analysis of HRV during the acute phase of the ICH and in a healthy age- and hypertension-matched control group. Hematoma volume, intraventricular extension, initial stroke severity and baseline demographic, clinical parameters as well as mortality and functional outcome were included in the analysis. RESULTS: 47 patients with ICH and 47 age- and hypertension matched controls were analyzed. ICH patients showed significantly lower total high frequency band (HF) and low frequency band (LF) powers (p = 0.01, p < 0.001), higher normalized HF power (p = 0.03), and lower LF/HF ratio (p < 0.001) as compared to the controls. Autonomic parameters showed associations with stroke severity (p = 0.004) and intraventricular involvement (p = 0.01) and predicted poor outcome independently (p = 0.02). CONCLUSIONS: Autonomic changes seems to be present in acute ICH and are associated with poor outcome independently. This may have future monitoring and therapeutic implications.

• Klíčová slova
• Autonomic, Critical care, Heart rate variability, Intracerebral hemorrhage, Mortality, Outcome,
• MeSH
• autonomní nervový systém patofyziologie   MeSH
• cerebrální krvácení diagnóza   patofyziologie   MeSH
• cévní mozková příhoda patofyziologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• prognóza MeSH
• senioři MeSH
• srdeční frekvence fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• amiodaron * MeSH
• lidé MeSH
• metoprolol MeSH
• propafenon MeSH
• septický šok * MeSH
• srdeční arytmie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• komentáře MeSH
• práce podpořená grantem MeSH
• Názvy látek
• amiodaron * MeSH
• metoprolol MeSH
• propafenon MeSH

PURPOSE: Identification of clinical and laboratory predictors related to Infectious Complications (ICs) in patients after Out-of-Hospital Cardiac Arrest (OHCA). METHODS: Patients, aged >18, after an OHCA between 9/2013 and 11/2015, surviving >24h, were studied. RESULTS: Study group consisted of 42 patients (mean age 63.4years, 88.1% men). Forty percent of patients had IC; lower respiratory tract infections were most common (87.5% of cases). ICs were more common in patients receiving Targeted Temperature Management (50% vs. 10%; p=0.032). Antibiotics were used in 85.7% of patients. The mean time to therapy initiation was 9.6 (SD 7.1) hours after admission. The mean course of treatment was 9.0 (SD 6.2) days. Fifty-three percent of patients receiving early antibiotic treatment didn't have IC. Initial antibiotic therapy was changed more often in patients with IC (75% vs. 38.9%; p=0.045). C-Reactive Protein, Procalcitonin, Troponin and White Blood Cell count values were higher in patients with IC. CONCLUSION: Early initiated antibiotic treatment is overused in patients after OHCA. This practice is associated with necessitating antibiotic change in the majority of patients with IC. Assessment of clinical and laboratory parameters in the first days after OHCA increases the likelihood of appropriate ATB therapy.

• Klíčová slova
• Antibiotic therapy, Infection, Infectious Complications, Out-of-Hospital Cardiac Arrest, Prophylactic antibiotic treatment,
• MeSH
• antibakteriální látky terapeutické užití   MeSH
• antibiotická profylaxe statistika a číselné údaje   MeSH
• C-reaktivní protein metabolismus   MeSH
• čas zasáhnout při rozvinutí nemoci MeSH
• délka pobytu statistika a číselné údaje   MeSH
• infarkt myokardu s elevacemi ST úseků komplikace   terapie   MeSH
• infekce dýchací soustavy komplikace   prevence a kontrola   MeSH
• kalcitonin metabolismus   MeSH
• koronární jednotky statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• procedury zbytečné MeSH
• sepse komplikace   prevence a kontrola   MeSH
• terapeutická hypotermie metody   MeSH
• umělé dýchání statistika a číselné údaje   MeSH
• urgentní služby nemocnice statistika a číselné údaje   MeSH
• zástava srdce mimo nemocnici komplikace   terapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Názvy látek
• antibakteriální látky MeSH
• C-reaktivní protein MeSH
• kalcitonin MeSH