Anesteziologie & intenzivní medicína po pěti letechEditorial

Ivan Herold

Anest. intenziv. Med. 2008;19(1):3-4  

Some aspects of molecular biology in critically ill patients in the context of current laboratory medicineIntensive Care Medicine

M. Průcha, S. Peková, L. Sedláčková

Anest. intenziv. Med. 2008;19(1):5-8  

Biomarkers are recognized as objective indicators of normal biological processes, pathogenic processes or pharmacological responses to a therapeutic intervention.Sepsis is a multifactorial disease distinguished by the paucity of diagnostic tests (biomarkers) available. New biomarkers allow for a better understanding of the pathogenesis of diseases and better stratification of patients in connection with improved clinical decision making, diagnosis and treatment. New technologies - genomics and proteomics - enable multiplex detection and evaluation of biomarkers. The goal of the diagnostics at present is the implementation of new technologies and...

New trends in the clinical research of microcirculationIntensive Care Medicine

Z. Turek, V. Černý

Anest. intenziv. Med. 2008;19(1):9-11  

The structural and functional pathology of microcirculation is the crucial mechanism of the development of various types of diseases especially sepsis and other types of distributive shock. Intensive progression in microcirculatory research including pathophysiological relationships and a unique opportunity to visualize microcirculation at the bedside produced a lot of new results, but their comparability and exact interpretation are extremely difficult due to incomparable methods in the recent clinical studies. Several key points for image acquisition and analysis were identified: 3-5 sites per organ, elimination of pressure-induced artefacts, appropriate...

Vzdělávací akce IPVZNews from CSARIM

Anest. intenziv. Med. 2008;19(1):11  

Is haemocoagulation inhibitor therapy in sepsis appropriate?Intensive Care Medicine

J. Blatný, O. Zapletal

Anest. intenziv. Med. 2008;19(1):12-15  

This review focuses on the problems and questions regarding the treatment of septic patients using coagulation inhibitor concentrates from the haematologist's point of view. Currently available published data are reviewed and summarised and on its basis recommendations for the administration of commercially available coagulation inhibitor concentrates (mainly AT, PC, aPC and heparins) are formulated.

Advances in mechanical ventilation in childrenIntensive Care Medicine

M. Fedora

Anest. intenziv. Med. 2008;19(1):16-18  

Mechanical ventilation is a common intervention provided in paediatric intensive care units. The management of mechanical ventilation in paediatrics is guided by a limited number of paediatric trials along with the application of adult data. Mechanical ventilation with pressure limitation and low tidal volume has become customary in paediatric intensive care. High frequency oscillatory ventilation is considered a suitable method to 'open the lung' and certainly is a lung-protective approach. Further research of noninvasive ventilation, prone positioning, the surfactant and weaning support to assist the paediatric intensivists in the application of...

Vzdělávací akce IPVZNews from CSARIM

Anest. intenziv. Med. 2008;19(1):18  

Advances in the prevention, diagnostics and therapy of ventilator associated pneumoniaIntensive Care Medicine

P. Dostál

Anest. intenziv. Med. 2008;19(1):19-22  

Results of recently published trials and meta-analyses on ventilator-associated pneumonia (VAP) suggest that the use of multi-module programmes may lead to a substantial reduction of VAP of between 31 and 57%. The use of an endotracheal tube with a polyurethane cuff and subglottic secretion drainage helps to prevent early and late-onset VAP and seems to be a promising method for VAP prevention. Invasive quantitative cultures of the broncho-alveolar lavage fluid enable higher de-escalation therapy rates that seem safe in patients with effective treatment of VAP. The combined measurement of serum procalcitonin (PCT) and BAL soluble triggering receptor...

Advances in nephrology in critically ill patientsIntensive Care Medicine

I. Novák, A. Kroužecký, J. Raděj, J. Chvojka, R. Sýkora, T. Karvunidis, M. Matějovič

Anest. intenziv. Med. 2008;19(1):23-25  

Acute renal injury (ARI) is a growing clinical problem in critically ill patients and has significant clinical and economic consequences. Some recent studies point to a rising incidence of ARI in the intensive care units over the past several years. Actual evidence suggests there has been some improvement in outcome over time but the mortality associated with ARI remains unacceptably high at around 40%. The consensus-developed definitions of ARI (the RIFLE scale) will be useful for clinical practice in this regard. During the progression of ARI - most frequently caused by severe sepsis as part of multiple organ failure - we can assess two components:...

Blood purification and acute renal failure: the timing, method selection and dosing of renal replacement therapyIntensive Care Medicine

T. Kotulák

Anest. intenziv. Med. 2008;19(1):26-31  

Acute renal injury (ARI) is a frequent complication in critically ill patients. Despite the development of new renal replacement techniques (RRT), better nutritional support and haemodynamic monitoring over past decades the mortality of ARI remains high (60%). There are several issues in the management of RRT. The first question is the timing of the initiation of the intervention and its impact on the outcome of ARI and renal recovery. Results of trials on early versus late initiation of renal replacement therapy do not allow the drawing of definitive conclusions. Survival or recovery of renal function has been evaluated as an outcome in several trials...

Vzdělávací akce IPVZNews from CSARIM

Anest. intenziv. Med. 2008;19(1):31  

Neuromonitoring of brain injury patientsIntensive Care Medicine

R. Pařízková

Anest. intenziv. Med. 2008;19(1):32-36  

Monitoring traumatic brain injury represents an integral part of the intensive care of severely brain injured patients. Special methods for neuromonitoring allow the detection and treatment of early secondary ischaemic insults associated with worse outcome. This review article covers the current views of brain tissue oxygen monitoring used in clinical practice.

Polyneuropathy and myopathy of critically ill patients - what's new?Intensive Care Medicine

J. Maňák

Anest. intenziv. Med. 2008;19(1):37-39  

This review summarizes important experimental and clinical studies published in the field of neuromuscular abnormalities of the critically ill during the last two years. Experimental work is focused mostly on the loss of membrane excitability using different animal models. Clinical studies emphasize that neuromuscular abnormalities occur early in the course of critical illness representing probably a part of the multiple organ dysfunction syndrome. The possible role of intensive insulin therapy in the pathogenesis of critical illness polyneuropathy and myopathy is discussed. Tight glycaemic control seems to be the only preventive measure which could...

Current treatment of sepsis in childrenIntensive Care Medicine

V. Vobruba, O. Černá

Anest. intenziv. Med. 2008;19(1):40-46  

Sepsis requires prompt recognition and aggressive therapy: early goal-directed therapy decreases morbidity and mortality. Recommendations for the specific management of paediatric sepsis have historically been extrapolated from literature in adults and from expert consensus opinion. This review presents recent recommendations for the management of paediatric sepsis.

Vzpomínka na prim. MUDr. Miroslava KlíčePersonalia

Anest. intenziv. Med. 2008;19(1):46  

The management of severe acute pancreatitis - state of the artIntensive Care Medicine

F. Vyhnánek, I. Vyhnánková

Anest. intenziv. Med. 2008;19(1):47-53  

Necrotizing pancreatitis develops in about 25% of patients with acute pancreatitis (AP). The severity of AP is linked to the presence of systemic and organ dysfunctions and/or the necrotizing process. Risk factors determining independently the outcome of severe AP are early multi-organ failure, infection of necrotic tissue and extended necrosis. Up to one third of patients with necrotizing pancreatitis develop infection of the necrosis in the later course. Current methods of therapy in severe AP based on EBM treatment guidelines have resulted in decreased operative morbidity, mortality and length of hospital stay in patients with infected pancreatic...

The use of ultrasound in the critically ill patientIntensive Care Medicine

M. Balík

Anest. intenziv. Med. 2008;19(1):54-61  

The availability of an ultrasound device in the critical care setting significantly enhances the diagnostic options and makes the management of critically ill patients more effective. A growing number of papers confirm that qualified intensivists can provide accurate, safe and extensive diagnosis of the haemodynamic system with the aid of echocardiography. An examination of the lungs and pleural space and a quantification of the pleural fluid and eventual exclusion of an anterior pneumothorax should be an integral part of the transthoracic echocardiographic examination. Interrogation of the abdomen in sepsis of unknown origin, acute abdominal syndrome...

Advances in artificial nutrition in intensive care: organ - specific substratesIntensive Care Medicine

Z. Zadák, P. Vyroubal

Anest. intenziv. Med. 2008;19(1):62-65  

A combination of novel amino acid formulae of a higher generation and the recognition of the conditional essential character of amino acids introduce new options for the management of critical illness. The effectiveness of specific types of nutrition is further increased by a combination with new types of fat emulsions based on a combination of triacyl-glycerols and saturated fatty acids, MCT oils, monoen-triacylglycerols and an optimal combination of triacyl-glycerols containing omega-3 and omega-6 fatty acids.An indubitable contribution and a pioneer trend is the combination of higher generations of the amino acid formulae Neonutrin 10% and 15%...

Vzdělávací akce IPVZIntensive Care Medicine

Anest. intenziv. Med. 2008;19(1):65  

Withholding and withdrawing therapy in the intensive care unit - the French approachIntensive Care Medicine

K. Rusinová

Anest. intenziv. Med. 2008;19(1):66-68  

Problems related to intensive care ethics have become an important issue during the last few years, in particular end-of-life decisions in the ICU, withholding and withdrawing therapy, and communication with family members. The present article is based on a translation of two documents mapping the development of the discussion and solving these issues in France. It concerns the official attitude of a professional society to the withdrawing of life sustaining therapy in 2002 and the legislative standard defining the patients' rights at the end of life in 2005.In France, patients in an advanced or terminal stage of their disease are entitled to refuse...

Výborová schůze ČSARIMNews from CSARIM

Anest. intenziv. Med. 2008;19(1):69-70  

Zápis z jednání výboru 3/2007News from CSIM

Anest. intenziv. Med. 2008;19(1):71-72  

Nové knihyBook Reviews

Anest. intenziv. Med. 2008;19(1):72