In this article, the author presents a set of annotated papers published in 2022 in the world literature that are significantly related to pre-hospital care.

In this article, the author presents a set of annotated papers published in 2022 in the world literature that are significantly related to emergency medicine. Publications from the pre-hospital setting are not included in the selection.

From the Evidence-based medicine (EBM) point-of-view, the year 2022 due to the slowly subsiding world SARS-CoV-2 pandemic, brought the whole complex of articles, publications, and guidelines once again. The aim of the article Year 2022 in pediatric anesthesia and intensive care is to highlight the important publications that should not be missed due to their impact on daily clinical practice.

By 2022, publishing has already returned to the standard. This means that the global SARS-CoV-2 pandemic for anaesthesio­logists is all but forgotten, and the safety of anesthesia is again the dominant issue. However, in addition to the traditional search for answers to whether we should prefer regional or general anesthesia and for which procedures and what is the best prevention of PONV, there is now another associated topic - postoperative delirium and postoperative cognitive dysfunction. Although both entities are crucial to the overall perioperative course, they still need more attention. This is even though, especially in elderly patients, they have already been shown to significantly affect perioperative morbidity and mortality. Moreover, to the surprise of many, recent data show that their incidence is not so much dependent on the type of anesthesia but on the quality of its administration. This text aims to briefly summarize some key publications in the field of anesthesiology and to highlight papers that should not escape attention.

The use of ECMO methods has experienced a significant boom in recent years, mainly due to the SARS-CoV-2 pandemic. Many workplaces that had little or no experience with ECMO currently possess the relevant technology and can use this method in real clinical practice. The prone position (PP) has changed from the original position of rescue intervention to the leading position among the methods that should be considered standard in patients with a severe form of acute respiratory failure. Thus, the combination of pronation and ECMO support has received considerable attention in recent years. This text, although a year in the 2022 review, briefly discusses available evidence-based medicine publications over the past few years devoted to this topic. The use of PP in clinical conditions other than mechanical ventilation (MV), e.g. in conscious patients on non-invasive ventilatory support, is described in the next section of this text. Another topic is the correct setting of MV while using PP and the effect of PP in pregnant patients with COVID-19. Inhalational anesthetics and their use for sedation of patients on UPV are currently among the frequently discussed topics within the optimization of intensive care. Conversely, ventilator-induced dysfunction of the main respiratory muscles, especially the diaphragm, has been a serious topic in critical care for a long time. Next, critically ill patients are at risk of hyperoxemia both as part of MV and ECMO support. The negative impact of this condition is the final topic of the article.

The intensive care medicine literature continued to resonate with the fading COVID-19 pandemic in 2022. Nevertheless, several interesting scientific publications have appeared in the field of critical care nephrology, the contents of which are worth mentioning. This summary article aims to guide the reader through the most fundamental aspects of nephrotoxicity, acute kidney injury, and extracorporeal purification methods.

In 2022, intensive medicine all around the world gradually began to return to standard tracks, although we could still observe the effects of the pandemic waves of the disease COVID-19. In the literature, we could note the publication of research studies of "violently terminated" pandemics and new works. This review article presents a selection of the most interesting published articles in general intensive care medicine and those focusing on cardiovascular issues.

The article highlights and discusses several current topics that have been published in the field of anaesthesiology in obstetrics in the Czech Republic and abroad last year. It summarizes the influence of the COVID-19 pandemic on anesthesiological praxis in obstetrics. It also presents new developments in systemic and neuraxial obstetric analgesia, Caesarean Section anesthesia, and emergencies in the peripartum period.

Cardiac anesthesia and postoperative care in cardiac surgery have their specifics, which differ from other specialties. The last two years marked by the COVID-19 pandemic were associated with a slowdown in elective cardiac surgery. Currently, the number of procedures is increasing again. New drugs are tested, new guidelines are published, innovative and hybrid procedures are performed, with the goal of reducing invasiveness for the patients. The aim of this review is to present readers with the important outputs of publications related to cardiac anesthesia, postoperative care in cardiac surgery, and the use of extracorporeal circulatory support over the past year.

This year's summary discusses important publications in the field of antibiotic therapy, fluid therapy, metabolic resuscitation, extracorporeal hemoadsorption methods, temperature control, and summarizes new advances in phenotyping critically ill septic patients.

This article presents a selection of interesting basic research, clinical studies, new recommendations, new definitions of pain, a new type of nociplastic pain, and a completely new type of post-covid headache. Only foreign and relevant sources are discussed.

This article aims to select recently published regional anesthesia articles, especially those with the highest impact on common clinical practice in our country. We present the most recent recommendations for anatomical structures to identify on ultrasound for the performance of intermediate and advanced blocks in ultrasound-guided regional anesthesia in addition to the results of big data trials and other interesting articles. We believe that the outcomes of this consensus can offer support for the standardization of education in ultrasound-guided regional anesthesia.

Despite the existence of many guidelines in the management of trauma, trauma is still the leading cause of death in young age groups, and mortality has not decreased in the Czech Republic over the past 10 years. The issues of circulatory stability, indications for the administration of whole blood, routine use of imaging methods, and prioritization of individual care steps are still not clearly defined. We decided to use a questionnaire study to map what the initial care of traumatized patients looks like across our country in 12 trauma centers and to define the circulatory stability of the patient, on which the sequence of individual diagnostic and therapeutic steps is built. Methodology: We created a questionnaire-based multicenter study and addressed the clinical workplaces of all trauma centers in the Czech Republic. The questions were focused on the procedure for treating traumatized patients. In May 2022, the questionnaire was sent to the leading physicians of all 12 trauma centers in the Czech Republic, according to the current Bulletin of the Ministry of Health. Additional questions were created based on the answers. The leading physicians of the trauma centers answered at their discretion regarding the current situation at their workplace. We processed the answers obtained using descriptive statistics. Results: In eight centers, the head of the trauma team is a traumatologist. Most often (in four centers), a trauma team comprises six people. Only five centers administer whole blood, although seven of the 12 centers believe it has an indication for administration in traumatized patients. Circulatory stability can be defined as a systolic pressure above 80-90 mmHg without vasopressors and a heart rate below 120/min; borderline stability as a condition where vasopressor support is needed to maintain the systolic blood pressure above 80-90 mmHg, and heart rate is 120-130/min and instability when even the use of vasopressors does not lead to maintain stable systolic pressure above 80-90 mmHg, and heart rate is above 130/min. Eight workplaces have CT scans as part of the emergency department, and routine X-rays of the chest, pelvis, and E-FAST (Extended Focused Assessment with Sonography in Trauma) are performed by only three sites. All 12 centers are inclined to use a CT scan at FAST positive circulatory stable patients, and four centers even in borderline stable patients to establish a definitive diagnosis. All centers can perform chest drainage in the emergency department; ten centers perform emergency thoracotomy, and four centers perform laparotomy. Only three centers use the REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) catheter in the emergency room. Conclusion: Despite certain variability in trauma care management across the Czech Republic, the concepts of circulating stability, boundary stability, and instability are common to all trauma centers. These concepts can be used in further professional discussions to optimize the management of this group of patients.

The article highlights and discusses several current topics that were published in the field of mainly acute pain therapy last year. It summarizes the current publications concerning systemic analgesia, methods of pain therapy and international guidelines concerning pain therapy.

Objective: Covid-19 is associated with a significantly increased risk of macrovascular and microvascular thrombotic complications, especially in critically ill patients with a severe form of the disease. Antithrombotic prophylaxis is an important part of treatment and was being applied using different drugs and dosing schemes during the pandemic. Data comparing various possibilities of antithrombotic therapy in these patients is lacking. The primary endpoint of this study was a retrospective assessment of ICU-free days, hospital-free days, and bleeding or thrombotic complications in critically ill patients with covid-19 pneumonia, who initially received higher doses of anticoagulation therapy either using subcutaneous (s. c.) application of low molecular weight heparin (LMWH) or continuous intravenous (i. v.) infusion of unfractionated heparin (UFH). The secondary endpoint was to compare 30-day mortality. Design: Retrospective cohort study. Setting: Intensive Care Unit (ICU) of a university hospital. Material and methods: A retrospective analysis of medical records of critically ill patients with covid-19 associated pneumonia and acute respiratory failure was performed. Patients were admitted to the ICU from 1. 3. 2020 to 31. 3. 2022 and received higher doses of anticoagulation using s. c. nadroparine or i. v. infusion of UFH at least from the second to eighth day of admission. Results: A total of 153 patients were included in the analysis. Median of ICU-free days at 30 days was 15 days for LMWH group and 12 days for UFH group (p = 0.1932). Median of hospital-free days at 60 days and 90 days was 5,5 days for LMWH group and 0 days pro UFH group (p = 0.5511), 26 days and 23 days (p = 0.6590) respectively. The difference in incidence of thromboembolic complications was not significant (1.96% in LMWH group and 7.84% in UFH group (p = 0.2732)). Minor bleeding complications were more frequent in LMWH group (11.76% vs. 0.98%, p = 0.0058). Logistic regression model found no significant effect of anticoagulation therapy on 30-day mortality. Conclusion: No statistically significant difference was found between both groups in the incidence of thromboembolic complications, the number of ICU-free days, the number of hospital-free days. Logistic regression model proved no effect of anticoagulation type on 30day mortality. In the LMWH group, a higher frequency of minor bleeding complications was observed, while the frequency of major bleeding complications did not increase.

Objective: The study aimed to evaluate the clinical outcome of patients hospitalized for COVID-19 in two university hospitals in 2021-2022, define risk factors, and evaluate the effect of specific treatment procedures. Design: A multicentric retrospective study. Setting: Intensive care units. Material and methods: The study included all adult patients hospitalized for COVID-19. The demographic data, comorbidities, degree of vaccination, ventilatory support, and pharmacotherapy were recorded. The study aimed to determine the impacts of selected risk factors, pharmacotherapy, and vaccination against SARS-CoV-2 on the clinical outcome. Results: A total of 3,835 patients were included in the study; the median age was 71 years. 523 (13.6 %) patients died during hospitalization and 930 (24.3 %) patients died until 90 days after admission. Of patients treated with mechanical ventilation or ECMO, 53.4 % died until 90 days. Males had a higher mortality rate than women; 64.3 % died in the group with ventilatory support older than 65 years. Most patients (76.2 %) were not vaccinated against SARS-CoV-2; these patients accounted for 87.4 % of the deceased. Obesity, arterial hypertension, diabetes mellitus, coronary heart disease, and atrial fibrillation were the main risk factors for death, the risk increased with several comorbidities. The analyses showed a significant protective effect of vaccination against the risk of death, especially in the group of elderly patients with multiple comorbidities. The inconclusive impact of vaccination was apparent in the group of younger patients. Chronic pharmacotherapy with heparin, warfarin, antithrombotic agents, and corticoids increased the risk of death. Treatment with remdesivir and casivirimab/imdevimab reduced the risk of death in contrast to therapy with convalescent plasma and corticoids. Conclusion: The study demonstrated a significant protective effect of vaccination against severe course and death in hospitalized patients with COVID-19. In patients who developed a severe course of disease requiring mechanical ventilation and/or ECMO, the protective effect of vaccination is inconclusive. The main risk factors for an unfavourable clinical outcome were older age, male sex, and comorbidities (overweight, diabetes mellitus, hypertension, coronary artery diseases).

Term postoperative cognitive disorder stands for deterioration of cognitive function after surgery in postoperative period. Evaluation and diagnostics of cognitive disorders in perioperative period were highlighted by the increasing number of geriatric patients undergoing a surgery with general anaesthesia, with the goal of fast recovery and preservation of the quality of life. Deterioration in cognitive function after surgery was originally called postoperative cognitive dysfunction. The definitions of postoperative cognitive dysfunction varied. In order to unite them, in 2018 there were published new recommendations during which the postoperative cognitive dysfunction was replaced by the term perioperative neurocognitive disorder. This was divided based on different time frames of onset to pre-existing neurocognitive disorder, postoperative delirium, delayed neurocognitive disorder and (postoperative) neurocognitive disorder. Main goals of this advanced narrative review were description of terminology, identification of risk factors, prevention, and therapy of perioperative neurocognitive disorder.

The article gives an overview of the use of curare from a poison of hunting arrows to its use in medicine as a muscle relaxant and a review of other substances that followed. People who have made a significant contribution to this history are listed. The development of muscle relaxant antidotes, the discovery of the nicotinic acetylcholine receptor, and the use and abuse of muscle relaxants outside of operating rooms are described.

Objective: The aim of this publication was to describe the occurrence of malignant hyperthermia (MH) in the Czech and Slovak populations, including genetic results and reasons for reporting to the MH diagnostic centre. Design: Retrospective observational cohort study. Setting: Academic Centre of Malignant Hyperthermia of Masaryk University. Material and methods: All probands referred to our MH diagnostic centre from 2002 to 2022 were enrolled. Each proband was a representative of one unrelated family. Probands were investigated according to diagnostic guidelines valid at the time of reporting by molecular genetic testing and muscle in vitro contraction test (IVCT). All probands with completed MH diagnostics were included in the final analysis. Results: By the end of 2022, there were a total of 303 reports related to the risk of MH. A total of 236 IVCT tests were performed, 129 negatives and 107 positives. There were 223 persons susceptible to MH (MHS) registered from 75 Czech and 8 Slovak families. A diagnostic pathogenic variant in the RYR1 gene was found only in 37 MHS families (45%). MH was excluded in 87 families (MHN). Conclusion: In 20 years of systematic work, a unique set of 83 MHS families has been collected in our Czech and Slovak populations. Despite the routine availability of state-of-the-art MH diagnostics, more than half of our MH families do not have a confirmed MH genetic background and can benefit from scientific progress and further research.

Supraglottic airway devices currently belong to routine clinical practice for securing the airways in elective procedures, but also for tracheal intubation or oxygenation in difficult intubation scenarios. Other indications are airway management in emergency and intensive care medicine or pre-hospital care. Increased safety requirements, extended indications, and use in acute situations have led to the development of novel supraglottic airway devices. Universal devices such as Ambu Aura Gain, LMA Protector, or i-gel Plus allow use in elective surgery and subsequent fiberscope-guided tracheal intubation. Other devices such as the LMA Guardian have been developed in order to increase seal pressures, while the Baska mask has a self-regulating cuff pressure that should theoretically reduce the incidence of postoperative complications. LMA Gastro was developed for endoscopic procedures on the oesophagus and stomach, iLTS, and TotalTrack VLM as special aids for difficult airway management.

Human gut microbiota consists of bacteria, archaea, fungi and viruses, and its composition, specific to each individual, is shaped by many factors. Pathological imbalance in the composition and/or diversity of microorganisms (dysbiosis), is associated with a wide range of diseases. The intestinal microbiome is the result of a complicated interplay between the host and the intestinal microflora. Critically ill patients have a reduced number of symbiotic bacteria ( particularly Firmicutes and Bacteroidetes) and, conversely, a relative increase in pathogenic intestinal bacteria (particularly Proteobacteria), and the rate of dysbiosis is directly proportional to the severity of their condition. On the other hand, the intestinal microbiota affects the permeability of the intestinal barrier, immune regulation, systemic inflammation, and, in turn, influences the clinical condition of critically ill patients. Altering the composition of intestinal bacteria by probiotics, prebiotics or antibiotics has long been used in intensive care. Ultimate intervention to affect the intestinal microbiota is fecal microbial transplantation (FMT) from healthy donors. In critically ill patients, FMT is described in case reports and case series as effective and safe method in the treatment of dysmicrobia in severe and fulminant C. difficile colitis, antibiotic-associated diarrhea, severe forms of inflammatory bowel disease or as a rescue therapy of sepsis. Despite the undisputable biological plausibility and positive effect observed in individual patients, FMT cannot be recommended as a routine procedure in this high-risk population, as high-quality prospective controlled clinical studies are completely absent. The article summarizes directions of future research and the method of implementation of FMT in critically ill patients.

The lack of suitable organs is a global problem for transplant medicine. Donors with brain death represent the most common group of organ donors in developed countries and the Czech Republic. After brain death, organ dysfunction often develops, which can lead to organ damage and affect its viability for successful transplantation. Extracorporeal membrane oxygenation is an effective option of circulatory and lung support in the event of failure of normal procedures. The case report describes the clinical course of a 36-year-old donor with proven brain death who was connected to venous ECMO to bridge severe hypoxemia as a bridging technique for organ donation. The article discusses professional, legal and ethical issues with the definition of possibilities and conditions under which this procedure can be used.

Objectives: To evaluate the effectiveness of ARS - a newly developed instrument designed for advance care planning for patients with advanced serious illness - in clinical settings, to examine potential differences in perceived effectiveness of ARS between experts and practitioners, and to determine areas in which ARS is perceived as most useful. Design: Survey; descriptive and correlational study. Setting: Departments of anaesthesiology, resuscitation, intensive medicine, neurology, infectious diseases, and internal medicine, at university and district hospitals. Material and methods: Ten experts with extensive experience in the field and 20 practitioners instructed to use ARS in their everyday practice rated the usefulness of ARS on several criteria. Data were analysed using descriptive statistics, principal component analysis, correlation analyses, and t-tests. Results: Both groups generally perceived ARS as undemanding and easy to understand. However, compared to practitioners, experts were much more unanimous in rating ARS highly in the composite criteria of Lower Cognitive Load and Communication Facilitation (Cohen's d = 1.70 and 1.14; p < 0.01). Years of clinical experience were negatively, albeit non-significantly, related to Lower Cognitive Load ratings in practitioners (Spearman's ρ = -0.37, p = 0.13). Ratings of this criterion were generally higher at hospital departments without any previously implemented procedures for advance care planning and decision-making (d = 1.86, p < 0.001). Conclusion: Both experts and practitioners generally rated ARS as easy to follow, undemanding, and potentially useful. Implementation of the instrument in practice might increase the quality of medical care for patients with advanced serious illness.

Processed EEG (pEEG) monitoring is currently used in four indications. The benefit has been demonstrated in the reduction of awakening and recovery times and in reducing the risk of accidental awareness during general anesthesia with the TIVA technique, while the indications for prevention of too deep anesthesia and personalization of anesthesia management are still questionable. Intuitively, it seems that personalized management of anesthesia using data not only from pEEG, but also from other basic monitors could improve results. The relevant studies are still ongoing. Spectrograms obtained by Fourier transformation of the raw EEG curve are suitable for personalizing anesthesia. In the spectrograms, there are significant variations between individual anesthetics, which are caused by different mechanisms of effects and various effects on neuronal circuits in the brain. Parameters such as median frequency and spectral edge frequency (SEF) are also useful. The spectrograms are shown on some monitors that are already commonly available in the Czech Republic such as SedLine Sedation Monitor, Conox or newer generation BIS devices. To titrate antinociception in anesthesia, not only pEEG, but other parameters from basic monitoring, such as respiratory system compliance, the difference between inhaled and exhaled oxygen concentration, Surgical Plethysmography Index from pulse oximetry can also be used. Aging-related EEG changes and the use of spectrograms at the beginning, during maintenance, and emergence from anesthesia will be presented in the third part of this collection of articles.

Study goal: Palliative care is an essential part of a complex approach to patients in the intensive care unit (ICU). This study aimed to describe palliative care practice in ICU in the Czech Republic. Study type: a cross-sectional, questionnaire study Material and methods: The inclusion criteria for study participation were nurses or physicians taking care of patients in the ICU for patients with Coronavirus Disease 2019 (COVID-19). The participants could participate by filling out the electronic survey with 40 questions. The questionnaire was evaluated by descriptive statistical analysis. Results: 313 questionnaires were analyzed. Participants reported up to 15 different terms for end-of-life care, the most often being palliative care (75.1%, n=235). The supportive care, especially sedatives, was most frequently adjusted according to the patient's needs. On the other hand, as a standard approach, the parenteral (35.8%, n=112) and enteral (17.3%, n=54) nutrition were most often withdrawn. Regarding organ support, renal replacement therapy (69.7%, n=218) and vasopressors (60.4%, n=189) were often withdrawn. The most rarely withdrawn organ support was artificial ventilation (24.6%, n=77), endotracheal intubation (11.5%,n=36), and tracheostomy cannula (2.9%, n=9). The majority of respondents would appreciate further education in palliative care. Conclusion: Palliative care is an essential theme not only in the COVID-19 pandemic. The palliative care terminology and practice used in the Czech Republic are heterogeneous. There is a space for further research and education in palliative care.

Currently, more and more emphasis is placed on the scientist not only to publish but mainly on being cited. In recent years, the world of academic research and publication has been invaded by low-quality and commercial journals that imitate serious peer-reviewed scientific journals. These journals often parasitize on the names of prestigious journals and state that they have a high impact factor. The work aims to present what the impact factor is and how it can be verified so that the publishing author does not send an article to an undesired journal.

After decades of use, the consumption of suxamethonium is decreasing. Anesthetists - and not only they - became accustomed to its use. They respect its contraindications, not unimportant side effects, and use it when perceived benefit prevails over possible risks. Available data show that suxamethonium is still used, although the scope of its indications has diminished. Its use is appropriate during crash induction to anesthesia or whenever the need to secure the airways quickly arises, in ENT and dental or maxillofacial surgery, during electroshock therapy, and in managing certain complications of anesthesia. Like with the use of all neuromuscular blocking agents the recovery from its effect should be objectively assessed. It is the key to the safety of its use. Objections that it is unfeasible in depolarizing blocks can not succeed. Appropriate methods are available and needed technical support is commercially available.