Risk­‑assesment before lung surgery - what's new? Narrative review articleReview Article

Bartoš Š., Predáč A., Čundrle I.

Anest. intenziv. Med. 2025;36(4):280-286 | DOI: 10.36290/aim.2025.041

Surgical treatment is the primary therapeutic option for patients with early-stage lung cancer. The most common causes of perioperative morbidity and mortality in these patients are postoperative pulmonary complications. Peak oxygen consumption (VO2) has long been considered the gold standard for predicting these complications. In recent years, several new parameters for risk assessment have been described in peer-reviewed journals, notably ventilatory efficiency (VE/VCO2 slope) and end-tidal CO2. Both parameters have demonstrated excellent predictive ability for postoperative pulmonary complications, even in patients in whom peak VO2 failed. This...

The specifics of psychiatric patients in the context of anaesthesiaReview Article

Apjarová T., Bönischová T., Kosinová M., Štourač P.

Anest. intenziv. Med. 2025;36(4):272-279 | DOI: 10.36290/aim.2025.045

The prevalence of psychiatric disorders is rising globally, with one in five individuals now affected. As a result, patients taking psychotropic medications are encountered frequently in clinical practice. This article explores the specific considerations in providing anaesthetic care to psychiatric patients, with a focus on pharmacological interactions between psychotropic and anaesthetic drugs, as well as on the risks associated with their combined use. Additionally, the article discusses strategies to minimize potential complications during the perioperative period.

Current methods of cardiac output monitoringReview Article

Klimovič A., Smékalová O., Kletečka J., Beneš J., Zatloukal J.

Anest. intenziv. Med. 2025;36(4):262-271 | DOI: 10.36290/aim.2025.048

Cardiac output monitoring and other parameters as part of extended hemodynamic monitoring represent an advanced tool for the early detection of circulatory disturbances that cannot be identified through standard vital sign monitoring. Such disturbances may lead to inadequate tissue oxygen delivery and subsequent clinical deterioration. Extended hemodynamic monitoring is indicated in patients who do not respond to initial therapy, and in the perioperative setting, it is recommended for high-risk patients undergoing high-risk surgical procedures. The choice of cardiac output monitoring modality may be challenging due to the wide range of available technologies,...

Hypertonic sodium lactate solution in the resuscitation of septic shock: a narrative review of pathophysiology, preclinical and clinical dataReview Article

Kříž M., Nalos M., Vintrych P., Müller J., Raděj J., Matějovič M.

Anest. intenziv. Med. 2025;36(4):253-261 | DOI: 10.36290/aim.2025.047

Aim: Excessive fluid accumulation during fluid resuscitation is associated with increased mortality and organ dysfunction. The promise of personalized fluid therapy lies in maximizing its benefits while minimizing the harmful effects of fluid resuscitation. This includes prediction of the hemodynamic response to infusion and careful consideration of its volume and composition in the context of the clinical situation. In light of recent paradigm shifts in lactate metabolism, we therefore discuss current evidence on the concept of low-volume intravenous resuscitation with hypertonic sodium lactate (HSL). Design: A narrative review of the current literature...

Comparison of ibuprofen and paracetamol combination with ketorolac and paracetamol in patients undergoing gynecologic surgery:  A review of pain level, coagulation profile, and interleukin-6 levelsOriginal Article

Maarif M. K., Musba A. M. T., Datu M. D., Gaus S., Wirawan N. S., Adil A.

Anest. intenziv. Med. 2025;36(4):247-252 | DOI: 10.36290/aim.2025.043

Background: Postoperative pain management in gynecological surgery remains a significant challenge, with many patients experiencing moderate to severe pain despite standard analgesic interventions. The risk of complications, such as bleeding and prolonged recovery, is heightened by the use of certain analgesics, emphasizing the need for optimal pain management strategies. This study compares the efficacy of two multimodal analgesic regimens-ibuprofen-paracetamol and ketorolac-paracetamol-on pain, coagulation, and interleukin-6 (IL-6) levels.  Methods: A double-blind randomized trial was conducted with 40 patients undergoing gynecological surgery....

Experiences of HCPs working at ICUs with a virtual reality in postgraduate training - multicentre surveyOriginal Article

Prokopová T., Diabelko D., Vafková T., Klabusayová E., Hudec J., Štourač P.

Anest. intenziv. Med. 2025;36(4):241-246 | DOI: 10.36290/aim.2025.039

Objective: The primary goal of this study was to explore the experience of health care professionals (HCPs) working at intensive care units (ICUs) with virtual reality (VR) involvement in postgraduate training. The second goal was to explore the expectations and common concerns associated with the VR-based courses. Design: Observational online cross-sectional survey. Setting: ICUs of various types across hospitals in the Czech Republic. Material and methods: An online questionnaire for HCPs working at ICUs. Methods of descriptive statistics were used for data interpretation. Results: A total...

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...