Beta-blokátory v intenzivní a urgentní medicíně: update 2025 

prof. MUDr. Vladimír Černý, Ph.D., FCCM, FESAIC, doc. MUDr. Roman Škulec, Ph.D.

Anest. intenziv. Med. 2025;36(Suppl.A)

Zajímavosti z literaturyHighlights from the literature

Horáček M., Klučka J., Skříšovská T.

Anest. intenziv. Med. 2025;36(3):226-233

How strongly should clinicians adhere to guidelines?Editorial

Černý V.

Anest. intenziv. Med. 2025;36(3):155 | DOI: 10.36290/aim.2025.044

Diagnostika a léčba život ohrožujícího krvácení u dětských pacientů v intenzivní a perioperační péči 2024New guidelines

Zaoral T., Blatný J., Jonáš J., Lauková K., Nosáľ S., Raffaj D., Kratochvíl M., Slívová I., Černý V.

Anest. intenziv. Med. 2025;36(3):217-225 | DOI: 10.36290/aim.2025.035

Zásady účelné antibiotické terapie u hospitalizovaných pacientů - Souhrn diskuze a stanovisko mezioborového panelu k systémové implementaci antibiotického stewardshipuReports from professional societies

Adámková V., Černý V., Dlouhý P., Malina P., Matějovič M., Šrámek V., Žemličková H.

Anest. intenziv. Med. 2025;36(3):213-216 | DOI: 10.36290/aim.2025.031

Who is J. B. West?Short Communication

Málek J.

Anest. intenziv. Med. 2025;36(3):211-212 | DOI: 10.36290/aim.2025.038

Spinal anaesthesia and maternal hypotension: basic pathophysiology and an opinion of an interdisciplinary working group on its managementShort Communication

Bláha J., Heřman H., Kacerovský M., Koucký M., Lukšová M., Nosková P., Nguyenová Q. G., Pařízek A., Seidlová D., Straňák Z., Štourač P.

Anest. intenziv. Med. 2025;36(3):203-210 | DOI: 10.36290/aim.2025.042

Hypotension after spinal anaesthesia occurs in most parturients undergoing caesarean section. The text describes the mechanism of hypotension, summarises the current evidence for treating this complication, and presents the consensus opinion of an interdisciplinary panel on its management. The text has been endorsed by the Czech Society of Anaesthesiology, Resuscitation, and Intensive Care Medicine, the Czech Gynaecological and Obstetric Society, and the Czech Neonatological Society.

The physiology of acid-base balanceClinical physiology

Duška F.

Anest. intenziv. Med. 2025;36(3):198-202 | DOI: 10.36290/aim.2025.034

Acid-base balance is a key component of internal homeostasis, essential for enzyme function, cellular signaling, and ATP synthesis. The physiological mechanisms that maintain a stable pH in the extracellular fluid include acid production, buffering, and elimination. The body continuously generates both volatile acids (CO₂) and non-volatile acids (e.g., lactate, sulfate, phosphate). CO₂ is excreted by the lungs, while non-volatile acids are partly metabolized and partly excreted by the kidneys. Blood buffering systems-particularly the bicarbonate buffer, hemoglobin, and plasma proteins-help mitigate acute changes in pH. To assess acid-base...

Donation after circulatory death in a regional hospital in Czech Republic: a case reportCase Report

Kalina M., Jobánek J., Mareš J., Pokorná E.

Anest. intenziv. Med. 2025;36(3):194-197 | DOI: 10.36290/aim.2025.030

Transplantation is a well-established therapeutic option that saves lives and improves the quality of life of patients. A shortage in organs has led to an increased use of donation after circulatory death. Donation after circulatory death is nowadays used in some way in most countries in the developed world. We present two cases of a successfully conducted donation after circulatory death in a regional hospital with the aim to demonstrate the feasibility and share a successful practice.

Bicarbonate in year 2025 - indications, contraindications, pitfalls and future perspectivesReview Article

Müller J., Raděj J., Karvunidis T., Valešová L., Horák J., Kříž M., Huňková E., Pavlík R., Matějovič M.

Anest. intenziv. Med. 2025;36(3):188-193 | DOI: 10.36290/aim.2025.036

Hydrogencarbonate (bicarbonate) is a physiologically occurring weak anion that is essential for the regulation of acid-base balance. Sodium bicarbonate solutions of various concentrations are commonly used to correct severe metabolic acidosis and hyperkalemia, However, there is a lack of evidence to support the effectiveness of this intervention, Furthemore, the administration of hypertonic sodium-rich solution may be potentially harmful to certain patient groups. Conversely, the role for bicarbonate in a number of less traditional indications remains to be discovered.

Proposal for updating terminology in end­‑of­‑life care in intensive care units in the Czech RepublicReview Article

Maláska J., Doležal T., Kratochvíl M., Štourač P., Doležal A., Sláma O., Zielina M., Rusinová K., výzkumná skupina RIPE‑ICU

Anest. intenziv. Med. 2025;36(3):182-187 | DOI: 10.36290/aim.2025.033

End-of-life (EOL) care in intensive care units (ICUs) is a complex clinical, legal and ethical challenge where language and terminology play a critical role in supporting decision-making and interdisciplinary collaboration. This article presents a proposal for a document that responds to the need to update and unify the terminology used in EOL care in the Czech Republic. Its aim is not to redefine terms from scratch but to reflect current developments in international discourse and to align terminology with the Czech clinical, legal and ethical context. The document is the result of a consensus process using a modified Delphi method. It was developed...

Immunomodulation in managing sepsis­‑induced immunosuppression: current options and challengesReview Article

Tomášková V., Helán M.

Anest. intenziv. Med. 2025;36(3):175-181 | DOI: 10.36290/aim.2025.037

Despite progress in diagnosis and treatment, sepsis remains a significant challenge to the health care system globally. In recent decades, the level of knowledge in the field of sepsis has undergone a significant shift towards targeted therapy influencing the immune response in an attempt to dampen the early hyperinflammatory state but also to influence later immunoparalysis. Although this sepsis-induced immunosuppression has not been fully understood yet, it is evident that reduced functions of innate and adaptive immunity are associated with a worsened patient outcome. Based on this finding, several pharmacological approaches to immunostimulation...

The influence of anxiety and environmental factors on sleep quality in patients hospitalized in intensive care unitsOriginal Article

Locihová H., Šrámková K., Slonková J., Zoubková R., Maternová K., Šonka K., Jarošová D.

Anest. intenziv. Med. 2025;36(3):167-174 | DOI: 10.36290/aim.2025.032

Introduction: Sleep is a fundamental component of human health, and its quality can be affected by various psychological and environmental factors. Objective: This study aimed to determine the level of anxiety in patients hospitalized in the intensive care unit (ICU), analyze its relationship with sleep quality, and identify environmental factors that disrupt this quality. Methods: A multicenter cross-sectional study was conducted in ICUs of six selected hospitals in the Czech Republic. The ICU Sleep Questionnaire (SICQ) and the Beck Anxiety Inventory assessed subjective sleep quality and anxiety levels. Results: A total of 267 ICU patients were included....

The process of pain assessment in intensive care patients from the perspective of non­‑medical health professionals - a cross­‑sectional questionnaire studyOriginal Article

Mica P., Pokorná A., Pešáková E.

Anest. intenziv. Med. 2025;36(3):159-166 | DOI: 10.36290/aim.2025.027

Study goal: Pain in patients in the intensive care unit (ICU) represents a significant clinical problem requiring a systematic approach to treatment, as well as to monitoring and evaluation of the presence or intensity of pain. Patients are often immobilized, exposed to invasive procedures, and other stressors affecting pain intensity. Patients' ability to verbally express pain levels is often limited. Effective assessment of pain intensity, as well as other pain indicators, is crucial to ensure patient comfort and to prevent complications associated with untreated pain. Study type: cross-sectional questionnaire study. Type of workplace: Intensive...

Prof. George Silvay 1935–2025Obituary

Cvachovec K., Černý V.

Anest. intenziv. Med. 2025;36(2):151

Zajímavosti z literaturyHighlights from the literature

Horáček M., Klučka J.

Anest. intenziv. Med. 2025;36(2):142-150

Algorithm for the diagnosis of malignant hyperthermiaNew guidelines

Štěpánková D., Klincová M., Schröderová I., Zídková J., Gaillyová R., Fajkusová L., Štourač P.

Anest. intenziv. Med. 2025;36(2):120-138

Collaboration between ČSARIM and NIKEZ – a unique opportunity to impact clinical practice?Editorial

Černý V.

Anest. intenziv. Med. 2025;36(2):65 | DOI: 10.36290/aim.2025.029

Commentary on the standard operating procedure NIKEZ Algorithm for the diagnosis of malignant hyperthermia in the Czech Republic and its practical consequencesCorrespondence

Štěpánková D., Klincová M., Schröderová I., Zídková J., Gaillyová R., Fajkusová L., Vyškovský R., Štourač P.

Anest. intenziv. Med. 2025;36(2):139-141 | DOI: 10.36290/aim.2025.018

Preventive procedures for ventilator-associated pneumonia - current recommendationsNew guidelines

Zoubková R., Światkowská M., Glac T., Madziová S., Haltofová A., Rusková K., Nytra I., Pospíšilová J., Kučerová Z., Ševčík P.

Anest. intenziv. Med. 2025;36(2):110-119 | DOI: 10.36290/aim.2025.022

Ventilator-associated pneumonia is one of the most common nosocomial infections in intensive care units. Overall, it affects approximately one in 100 patients in intensive care and up to 1 in 10 patients with mechanical ventilation. Influenceable sources of infection include effective preventive measures implemented in clinical practice based on the education of nurses. These are usually simple measures such as using a semirecumbent position, taking care of oral hygiene, checking the pressure in the obturation ballon, or suctioning secretions in the subglottic space. The aim of the text is to provide current recommendations regarding preventive measures...

Stanovisko výboru ČSARIM Etapy anesteziologické a operační péče - terminologie a definiceReports from professional societies

Balík M., Beneš J., Bláha J., Černá Pařízková R., Černý V., Duška F., Dostál P., Gabrhelík T., Mach D., Michálek P., Stern M., Ševčík P., Štourač P., Truhlář A., Vymazal T.

Anest. intenziv. Med. 2025;36(2):108-109 | DOI: 10.36290/aim.2025.024

Stanovisko výboru ČSARIM Zachování dostupnosti sukcinylcholinu v klinické praxiReports from professional societies

Balík M., Beneš J., Bláha J., Černá Pařízková R., Černý V., Duška F., Dostál P., Gabrhelík T., Mach D., Michálek P., Stern M., Ševčík P., Štourač P., Truhlář A., Vymazal T.

Anest. intenziv. Med. 2025;36(2):107 | DOI: 10.36290/aim.2025.025

Stanovisko výboru ČSARIM Zachování dostupnosti desfluranu v klinické praxiReports from professional societies

Balík M., Beneš J., Bláha J., Černá Pařízková R., Černý V., Duška F., Dostál P., Gabrhelík T., Mach D., Michálek P., Stern M., Ševčík P., Štourač P., Truhlář A., Vymazal T.

Anest. intenziv. Med. 2025;36(2):106 | DOI: 10.36290/aim.2025.026

Long-term vascular access in anesthesiology and intensive care medicine and tunnelizationShort Communication

Brožek T., Dovjak P., Chovanec V., Kletečka J., Nosková P., Astapenko D.

Anest. intenziv. Med. 2025;36(2):102-105 | DOI: 10.36290/aim.2025.021

Long-term venous accesses are now an integral part of complex patient care. They have also found their way into the field of anesthesiology and intensive care. Mostly, long-term access is inserted in specialized outpatient clinics or vascular access centers, often under the supervision of anesthesiologists. This short review article discusses the types of long-term accesses, the possibilities of their use in our field, and tunneling, which moves the so-called exit site into a safe zone and thus, together with ultrasound navigation during insertion, allows the vascular access to be tailored exactly to the patient and to deviate from the old dogmatic...

Fatal intravascular haemolysis caused by Clostridium perfringens - case report and literature reviewCase Report

Harazim M.

Anest. intenziv. Med. 2025;36(2):97-101 | DOI: 10.36290/aim.2025.020

This case report documents a case of fulminant bacteraemia caused by Clostridium perfringens in a 76-year-old healthy man, which led to massive intravascular haemolysis, refractory septic shock and death within a few hours. Typical CT findings of gas in the liver and laboratory evidence of massive hemolysis led to suspicion of toxin-producing infection, which was confirmed post mortem by culture and PCR detection of alpha-toxin. The case report describes the extremely rapid course of the disease and highlights the need for urgent consideration of this diagnosis in septic states with hemolysis. We discuss the pathophysiology and diagnostic possibilities...

Anaphylactoid syndrome of pregnancy (amniotic fluid embolism)Case Report

Bundzáková K.

Anest. intenziv. Med. 2025;36(2):91-96 | DOI: 10.36290/aim.2025.013

Anaphylactoid syndrome of pregnancy is a rare but fatal obstetric complication that results in sudden cardiovascular collapse, altered consciousness, respiratory failure, and disseminated intravascular coagulation [1]. This case report describes a 25-year-old woman in labor who, on preoperative ultrasound, had intrauterine fetal death with placental abruption and who experienced sudden cardiac arrest during an emergency cesarean section. Despite immediate resuscitation and intensive care, the patient died. Autopsy confirmed the presence of fetal elements in the pulmonary vasculature, definitively establishing the diagnosis of anaphylactoid pregnancy...

Therapeutic drug monitoring - a path to more effective antibiotic therapyReview Article

Juhás V., Šudáková A., Harazim M.

Anest. intenziv. Med. 2025;36(2):84-90 | DOI: 10.36290/aim.2025.015

Therapeutic drug monitoring (TDM) is a key tool in optimizing antibiotic therapy in critically ill patients. The variability of pharmacokinetics and pharmacodynamics (PK/PD) in this population often requires an individualized approach that goes beyond standard dosing schedules. Early implementation of TDM, especially during the first 48 hours of treatment, is essential to achieve target therapeutic antibiotic concentrations. The correct administration strategy, using prolonged or continuous infusions of the administered antibiotics, plays a significant role in achieving optimal PK/PD parameters. At our institution, we have observed a high variability...

Malignant hyperthermia "up­‑to­‑date practically" - non­‑systematic review articleReview Article

Štěpánková D., Klincová M., Schröderová I., Bönischová T., Tomášková V., Havránková N., Štourač P.

Anest. intenziv. Med. 2025;36(2):74-83 | DOI: 10.36290/aim.2025.014

Malignant hyperthermia (MH) is a rare, hereditary, life-threatening pharmacogenetic disease induced by some commonly used anaesthetics. This review article aims to summarise, from a practical point of view, the news and current recommendations in the field of MH so that the anaesthesiologist-intensivist can easily use them in daily practice. The theoretical introduction is only brief, as it serves to gain an essential awareness of the issue of MH. As a matter of priority, we will look at the most common situations where a doctor may encounter MH. We will focus on the anaesthesiology clinic and the recognition of risk factors. In the operating room,...

Adverse events risk score assessment of anaesthesia nurse activities in the context of the Czech RepublicOriginal Article

Bejvančická P., Brabcová I.

Anest. intenziv. Med. 2025;36(2):68-73 | DOI: 10.36290/aim.2025.016

Objective: Anaesthesia care is burdened with a certain level of risk. The nurse is an essential part of the anaesthesia team. It is necessary to implement appropriate risk management strategies in the nursing. The aim of this study was to define the nurses' activities in anaesthesia care and evaluate risk score of adverse events for individual activities. Design: Delphi study. Descriptive study. Materials and methods: The 1st phase of the research included 2 Delphi rounds, the expert panel consisted of 20 anaesthesia nurses with overlap in management or education in anaesthesiology. The consensus level was set at 80% agreement of experts. A Likert...

Zajímavosti z literaturyHighlights from the literature

Horáček M., Málek J., Klučka J.

Anest. intenziv. Med. 2025;36(1):55-61 | DOI: 10.36290/aim.2025.010