Anesteziologie a intenzivní medicína, 2001 (vol. 12), issue 2
Heparin-induced Thrombocytopenia (HIT): Pathophysiology, Diagnosis and Recommendations for Clinical Practise in Anaesthesiology and Critical Care MedicineArticles
S. Kleinschmidt, U. T. Seyfert
Anest. intenziv. Med. 2001;12(2):58-63
decades, heparins have been used successfully for prophylaxis and treatment of thromboembolic complications. although heparin-inducedthrombocytopenia (HIT Type II) is a well-known adverse effect of heparin therapy, thromboembolic complications during heparin therapy are rarelydiagnosed exactly to be related to HIT. An immunologic cause of HIT by generation of multimodal immune complexes against a neo antigen of heparinand platelet factor 4 is equivocally accepted as the decisive pathophysiological mechanism. The incidence of HIT seems to be related to the type ofheparin (unfractioned/low molecular weight) or other underlying risks such as peripheral...
Our Experience with Terminal Weaning from Ventilatory Support in Critical Care PatientsArticles
V. Černý, R. Pařízková, P. Dostál, R. Jahodářová, I. Herold, D. Nalos
Anest. intenziv. Med. 2001;12(2):64-68
Terminal weaning from ventilatory support represents on of the possible techniques of complex withdrawing of therapy in patients with irreversiblefailure of vital functions. In the period from January 1, 1999 to June 1, 2000 mechanical ventilation was withdrawn in 15 patients with terminal illnesses;all patients from the group died. In ten patients, withdrawing of ventilatory support was done by terminal disconnection from the ventilator, in fivepatients ventilatory support was gradually decreased without terminal extubation. Analgosedation was used in eight patients, no muscle relaxants wereused. The mean period of ventilatory support withdrawal until...
Weaning from Ventilatory Support in Critical Care PatientsArticles
R. Pařízková, V. Černý, P. Dostál, R. Jahodářová
Anest. intenziv. Med. 2001;12(2):69-72
Weaning from ventilatory support in critically ill patients in terminal stage of organ dysfunction represents one part of the process of withdrawingorgan support techniques. The principal aim of weaning of mechanical ventilatory support is not enhancing the process of dying, but withdrawing thatpart of therapy that in medically futile situations when stress, pain, dyscomfort and suffering associated with prolonged ventilatory support are notoutweighed by benefit with respect to the outcome in unfavourable prognosis in critically ill patient with irreversibly damaged integrity of organfunctions. The process of weaning from mechanical ventilation is...
Pathophysiology of Gut Failure in MODSArticles
I. Chytra, E. Kasal, R. Pradl, A. Židková, P. Altman
Anest. intenziv. Med. 2001;12(2):73-80
This review article discusses pathophysiology of gut failure and its relation to multi-organ failure (MOF). Triggering factors are reviewed withpathophysiologic mechanisms which take part on the increase of intestinal wall permeability, leading to translocation of bacteria or their toxins fromthe intestinal lumen. In conclusion, the authors state that in spite of deemed connection between bacterial translocation, increased intestinal wallpermeability and the development of MOSF, there is no clear definition or evidence of that relationship.
The Prognostic Scoring of Polytraumatized Patients and the Validity of ISS and TRISS for Prediction of SurvivalArticles
J. Bonaventura, M. Peštál, R. Hájek
Anest. intenziv. Med. 2001;12(2):81-86
Polytraumatized patients are endangered by development of the multiorgan dysfunction syndrome (MODS) immediately after the accident becauseof the traumatic shock and later especially by progression of the septic complications. Predisposition for septic complications is caused by neurohumoralmechanisms - reaction on polytrauma and potentiated by the invasive therapeutic approaches during the resuscitation care.Topic of the project was to document all the predisponable influences for individual organ and systemic dysfunctions, optimalization of the therapeuticapproaches for the prevention and therapy of the individual organ dysfunctions in the large...
The Courses of Organ Dysfunctions in the Complex MODS in Traumatized Patients and the PrognosisArticles
J. Bonaventura, M. Peštál, R. Hájek
Anest. intenziv. Med. 2001;12(2):87-97
1113 of traumatized patients treated on ICU in the Trauma hospita lin Brno were divided into the groups second the posttraumatic clinical course.Consecutively we have analysed a reasons for the development of the multiple organ dysfunction syndrome.Incidence of the traumatic shock was 34.77 % with mortality of 22.99 %. Incidence of the MODS was 12.03 %, with the mortality 58.23 %.The typical clinical find of the patients with the MODS was respiratory dysfunction (outcome in 60 %, mortality in 80 %). The difference betweenoutcome and mortality was found with the marked incidence of cardiovascular dysfunction (60 % contrary 10 %) and acute renal dysfunction...
Capnometry in Pre-hospital Emergency Care - a Luxury or Gold Standard?Articles
J. Šeblová
Anest. intenziv. Med. 2001;12(2):98-100
This review discusses a possible role for capnometry or capnography in a daily practice of pre-hospital emergency care. Advantages anddisadvantages of different technologies are outlined with their possibilities to affect the interpretation of results. The interpretation can be affectedalso by instability of vital functions in the early phase of care for the critically ill. Ther e are undisputable absolute indications for the use of capnometer:monitoring of mechanically ventilated patients, verification of proper endotracheal tube placement; other indications for capnometry can be seen inthe assessment of effectivity of cardiopulmonary resuscitation,...
Capnoemtry in Emergency MedicineArticles
Pokorný J. jr
Anest. intenziv. Med. 2001;12(2):101-103
The paper presents a review of capnometry in prehospital emergency care. Basic advantages and disadvantages of currently used "sidestream"and "mainstream" monitors are reviewed with respect to the specificities of an out-hospital setting. The most important diseases and situations affectingthe measurement are outlined. The author presents his opinion on current indication for capnometry monitoring in prehospital emergency care. Thereis stressed the need for concurrent capnometry monitoring with other types of monitoring along with careful and continuous clinical observation ofpatients' vital signs.