[Non-invasive ventilation support in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD)]. / Neinvazivní ventilacní podpora u pacientu s akutní exacerbací chronické obstrukcní plicní nemoci (CHOPN).

AIM: To verify that the use of noninvasive ventilatory support in acute exacerbation of chronic obstructive pulmonary disease leads to decreasing the number of deaths, shortening in-hospital stay and decreasing number of endotracheal intubations (ETI). SETTING: The study was conducted at a respiratory department's ICU in 2002-2004. METHODS: Patients hospitalized on ICU with acute exacerbation of COPD, respiratory acidosis and global respiratory failure were randomised into two groups. Patients in group A were treated by conservative medical therapy (oxygen, bronchodilator, corticosteroid), patients in group B received noninvasive ventilation with face mask. The parameters followed were: decrease in the number of deaths, shortening of ICU stay, reduction of ETI, faster improvement of breathing frequency, heart rate, pH, PaO2, PaCO2, lactate, dyspnoea symptom score and lung functions. RESULTS: Each group consisted of 30 randomised patients. There were 10 intubated patients in group A, as opposed to 3 in group B (N = 60; P = 0.034). Average length of ICU stay was 9.8 days in group A and 7.1 days in group B (N = 60; P = 0.756). Mortality rate was identical in both groups: 3 patients survived, 7 patients died. We found faster decrease of breathing frequency after one hour of noninvasive ventilation in group B (28.3 +/- 7.1 vs. 24.6 +/- 6.3, N = 59, p = 0.03). CONCLUSION: No difference was found in mortality rate. We observed decreasing of ETI rate with NIV. We found a tendency to shortening of ICU stay. There was faster improvement of breathing frequency after one hour of NIV.

Performances of three R-AN-D-N wastewater treatment plants in the Czech Republic.

The evolution of Czech standards requires higher efficiency of nutrient removal from municipal wastewaters. At the beginning of the last decade of 20th century, a new activated sludge configuration called R-AN-D-N process has been described, successfully tested and now largely used at several wastewater treatment plants (WWTP) in the Czech republic. The main feature of the R-AN-D-N process is the introduction of a regeneration zone in sludge recycle, which enables to increase sludge age in the system without any substantial increase in WWTP volume. Performances of three Czech large WWTP with R-AN-D-N configuration have been monitored and compared within a period of one and a half years. The results confirmed excellent nutrient removal efficiency for wastewaters with different proportion between sewage and industrial effluents. Two of three monitored WWTP received wastewaters from breweries (Budweiser and Pilsner Urquell). The settleability of activated sludge from all three WWTP was correct, with SVI values usually ranging from 50 to 150 ml/g. Monitoring of sludge composition indicated proliferation of several filamentous bacteria, particularly types 0581, 0092 and M. parvicella. No severe bulking events were observed. Finally, the operational costs expressed in CZK (Czech crown: 1 CZK = [see symbol in text]0.0322) per cubic metre of treated sewage or per capita amounts respectively from 2.24 to 6.52, and from 285 to 342.