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  

ČSARIM v roce 2025 – kde se nacházíme v polovině mandátu výboru?Editorial

Černý V.

Anest. intenziv. Med. 2025;36(1):4-5 | DOI: 10.36290/aim.2025.008  

Česká společnost intenzivní medicíny (ČSIM) jako partnerská organizace Evropské společnosti intenzivní medicíny (ESICM)Editorial

Balík M.

Anest. intenziv. Med. 2025;36(1):3 | DOI: 10.36290/aim.2025.005  

Premedication in children: what if it fails?Correspondence

Frelich M., Stašová B., Fišerová D., Astapenko D., Jor O.

Anest. intenziv. Med. 2025;36(1):52-54 | DOI: 10.36290/aim.2025.003  

Angiotensin II - mechanism of action, current evidence and position paper of the interdisciplinary working group on its use in intensive care settingsNew guidelines

Balík M., Beneš J., Černý V., Kula R., Matějovič M., Říha H., Tencer T.

Anest. intenziv. Med. 2025;36(1):46-51 | DOI: 10.36290/aim.2025.004  

The medicinal product Giapreza containing angiotensin II for intravenous administration has been registered in the Czech Republic since 2023. The article describes the mechanism of action of the drug, summarizes the current scientific evidence of its efficacy and safety, and presents the opinion of an interdisciplinary working group on the use of angiotensin II in intensive care units, especially in patients with refractory vasoplegic shock. The text has been endorsed by the Czech Society of Intensive Medicine, the Czech Society of Anesthesiology and Intensive Medicine, and the Czech Acute Cardiac Care Association.

Iliocostalis plane block (ICPB): technical reportShort Communication

Nalos D., Beňo L., Škvára D.

Anest. intenziv. Med. 2025;36(1):43-45 | DOI: 10.36290/aim.2025.002  

The article describes a variant of the erector spinae plane block (ESPB) on the chest. The application site is between the fascia of the iliocostalis muscle and the serratus posterior superior muscle. The distribution of the local anesthetic is medial to the distribution of the anesthetic in the case of erector spinae plane block (ESPB). The lateral direction is evidence of the spread of applied LA up to the mid-axillary line. The extent of analgesia is similar to that of ESPB. The application site is well identifiable and lies more superficially and far from the backbone structures than the ESPB application site. The block will look for indications...

Nursing Care of a Central Venous CatheterShort Communication

Kletečka J., Vlasáková A., Nosková P., Astapenko D.

Anest. intenziv. Med. 2025;36(1):39-42 | DOI: 10.36290/aim.2025.007  

Nursing care for central venous catheters has undergone significant advancements in recent years due to new materials that reduce infection risk, enhance patient comfort, and allow for less frequent dressing changes. A key innovation is the use of sutureless fixation systems, which eliminate skin trauma caused by sutures while maintaining sufficient catheter stability. Other advanced methods, including transparent dressings, chlorhexidine-releasing dressings, and cyanoacrylate glue for exit site closure, help reduce bacterial colonization and infection risk. This review article focuses on the various materials used and the correct procedures for initial...

Our experience with VV ECMO­‑assisted surgery: case report seriesCase Report

Chovanec Z., Pestal A., Berkova A., Cervenak V., Penka I., Cundrle I.

Anest. intenziv. Med. 2025;36(1):34-38 | DOI: 10.36290/aim.2025.001  

Veno­‑venous extracorporeal membrane oxygenation (VV ECMO) is a technique of extracorporeal support that facilitates blood gas exchange, enabling the complete replacement of lung function for a specified duration, such as during surgery. By using this method, we are able to provide surgical treatment to highly selected patients who would otherwise be unable to undergo thoracic surgery, including tracheal/carinal surgery and high­‑risk one­‑lung ventilation due to previous lung resection or severe lung impairment. This case series presents our experience with elective and acute ECMO­‑assisted thoracic surgery (excluding lung...

Fatal ecstasy (MDMA) intoxication with extreme hyperpyrexia, rhabdomyolysis, and disseminated intravascular coagulopathyCase Report

Mynář M., Samek J., Břízová P., Zátopková L., Hejna P., Turek Z.

Anest. intenziv. Med. 2025;36(1):29-33 | DOI: 10.36290/aim.2024.065  

Ecstasy (MDMA - 3,4-methylenedioxymethamphetamine) is a synthetic psychoactive amphetamine with stimulatory effects on the user's sympathetic nervous system. The prevalence of MDMA misuse has been widely increasing in young people below 20 years of age. For first-time users, MDMA is considered the most dangerous drug in terms of serious complications such as extreme hyperpyrexia, rhabdomyolysis, disseminated intravascular coagulopathy, and brain edema. The presented case study describes fatal MDMA intoxication in young men with rapid onset of extreme hyperpyrexia above 42 °C, massive rhabdomyolysis, DIC, and multiple organ failure leading to death....

Alveolar-arterial oxygen difference in intensive careReview Article

Kutěj M., Haiduk F., Sagan J., Máca J.

Anest. intenziv. Med. 2025;36(1):22-28 | DOI: 10.36290/aim.2025.006  

The alveolo-arterial oxygen difference (P_(A-a)O₂) describes the difference between alveolar and arterial oxygen tension. The primary purpose of P_(A-a)O₂ is to distinguish between extra- and intra-pulmonary causes of hypoxemia. P_(A-a)O₂ has come to the forefront again in the context of the SARS-CoV-2 (COVID-19) coronavirus pandemic, where relatively simple methods of patient triage and therapeutic approaches have been sought. In the intensive care setting, where it is almost always obvious whether the cause of hypoxemia is extrapulmonary or intrapulmonary, the importance of P_(A-a)O₂...