RESUMEN
Intense exercise leads to increased production of free radicals, resulting in an inflammatory response in athletes. For this reason, it was decided to investigate whether a single intensive exercise until exhaustion applied after a 2-week rest period would result in a violation of the pro-oxidant-antioxidant balance. Twenty-seven trained female basketball players (age: 16.55 ± 0.96 years, body mass: 66.40 ± 13.68 kg, height: 173.45 ± 5.14 cm) were enrolled to the study following the application of inclusion and exclusion criteria. Study was conducted at the end of the competitive training phase. Participants underwent incremental treadmill exercise, with blood samples collected before the test, immediately post-exercise, and after a 3-h restitution period. Total antioxidant capacity (TAC) levels increased significantly after exercise and remained unchanged after 3 h. Concentration of interleukin-10 (IL-10) and creatine kinase (CK) significantly increased after exercise and then decreased. Concentration of interleukin-2 (IL-2) was significantly reduced immediately and 3 h after exercise, while interleukin-13 (IL-13), interleukin-1α (IL-1α), and tryptophan (TRP) decreased 3 h after exercise. No significant changes were observed in other biochemical parameters. Obtained results show an increased antioxidant capacity which reduced oxidative stress and inflammation in response to intense exercise indicating that rested athletes have a high adaptation and elevated tolerance to effort.
Asunto(s)
Antioxidantes , Baloncesto , Inflamación , Estrés Oxidativo , Humanos , Femenino , Inflamación/metabolismo , Adolescente , Antioxidantes/metabolismo , Interleucina-10/sangre , Interleucina-10/metabolismo , Atletas , Creatina Quinasa/sangre , Creatina Quinasa/metabolismo , Descanso/fisiología , Interleucina-1alfa/metabolismo , Interleucina-1alfa/sangre , Interleucina-2/sangre , Interleucina-2/metabolismo , Ejercicio Físico/fisiología , Interleucina-13/sangre , Interleucina-13/metabolismo , Triptófano/metabolismo , Triptófano/sangreRESUMEN
Working Group: Prof. Lukasz Krzych, MD, PhD - Chairman of the Working Group, Chairman of the Intensive Care Section of the Polish Society of Anaesthesiology and Intensive Therapy Assistant Prof. Alicja Bartkowska-Sniatkowska, MD, PhD - Deputy Chairwoman of the Paediatric Section of the Polish Society of Anaesthesiology and Intensive Therapy Prof. Piotr Knapik, MD, PhD - Chairman of the Scientific and Educational Section of the Polish Society of Anaesthesiology and Intensive Therapy Assistant Prof. Marzena Zielinska, MD, PhD - Chairwoman of the Paediatric Section of the Polish Society of Anaesthesiology and Intensive Therapy Assistant Prof. Dariusz Maciejewski, MD, PhD - Intensive Therapy Section of the Polish Society of Anaesthesiology and Intensive Therapy Maciej Cettler, MD - Paediatric Section of the Polish Society of Anaesthesiology and Intensive Therapy Prof. Radoslaw Owczuk, MD, PhD - President-Elect of the Polish Society of Anaesthesiology and Intensive Therapy Prof. Krzysztof Kusza, MD, PhD - Outgoing President of the Polish Society of Anaesthesiology and Intensive Therapy Expert Group (in alphabetical order): Representatives of the Board of the Society of Anaesthesiology and Intensive Therapy: Alicja Bartkowska-Sniatkowska, Piotr Knapik, Lukasz Krzych, Krzysztof Kusza, Romuald Lango, Agnieszka Misiewska-Kaczur, Mariusz Piechota Representatives of the sections and branches of the Polish Society of Anaesthesiology and Intensive Therapy: Pawel Andruszkiewicz, Maciej Cettler, Tomasz Czarnik, Miroslaw Czuczwar, Michal Domagala, Anna Dylczyk-Sommer, Krzysztof Kobylarz, Waldemar Machala, Dariusz Maciejewski, Irena Ozóg-Zabolska, Andrzej Piotrowski, Beata Rybojad, Katarzyna Sierlikakowska, Wojciech Szczek, Bulat Tuyakov, Marzena Zielinska, Maciej Zukowski Regional consultants in the field of anaesthesiology and intensive therapy: Stanislaw Lech Czaban, Wojciech Dabrowski, Tomasz Gaszynski, Beata Koscialkowska, Lukasz Krzych, Andrzej Malek, Dariusz Onichimowski, Wojciech Serednicki, Karina Stefanska-Wronka, Wieslaw Switala, Janusz Trzebicki.
Asunto(s)
Anestesiología , Niño , Cuidados Críticos , Hospitalización , Humanos , Unidades de Cuidados Intensivos , PoloniaRESUMEN
BACKGROUND: The accumulation of physiological stress and the presence of inflammation disturb iron management in athletes during intense training. However, little is known about the mechanisms regulating iron levels in athletes during training periods with low training loads. In the current study, we analyzed the effect of an acute exercise on early responses of iron and iron regulatory proteins at the end of such training periods. METHODS: The study was performed at the end of competitive phase of training. A total of 27 trained female basketball players were included in the study after application of the inclusion/exclusion criteria. The participants performed an incremental exercise on a treadmill. Blood samples were taken before the test, immediately after exercise, and after 3 h of restitution. Parameters, such as interleukin (IL) 6, hepcidin, ferritin, transferrin, hemopexin, and lactoferrin levels, total iron-biding capacity (TIBC), unsaturated iron-biding capacity (UIBC) were determined by using appropriate biochemical tests. RESULTS: The level of iron increased significantly after exercise, and then decreased within next 3 h restitution. Except for iron levels, only TIBC levels significantly increased after exercise and decreased to baseline level during rest period. No significant changes in the levels of hepcidin, IL-6, and other proteins related to the iron homeostasis were observed. CONCLUSIONS: The increases in iron level after acute exercise is short-term and transient and appear to have been insufficient to induce the acute systemic effects in rested athletes.
RESUMEN
Electrical impedance tomography (EIT) is a non-invasive, radiation-free method of diagnostics imaging, allowing for a bedside, real-time dynamic assessment of lung function. It stands as an alternative for other imagining methods, such as computed tomography (CT) or ultrasound. Even though the technique is rather novel, it has a wide variety of possible applications. In the era of modern mechanical ventilation, a dynamic assessment of patient's respiratory condition appears to fulfil the idea of personalized treatment. Additionally, an increasing frequency of respiratory failure among intensive care populations raises demand for improved monitoring tools. This review aims to raise awareness and presents possible implications for the use of EIT in the intensive care setting.
Asunto(s)
Impedancia Eléctrica , Monitoreo Fisiológico , Respiración Artificial/métodos , Tomografía/métodos , COVID-19/terapia , Humanos , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/terapia , SARS-CoV-2RESUMEN
Based on the data currently available in literature, the factors inducing acute lung injury resulting from the increasingly widespread use of e-cigarettes (vaping) (EVALI) were analysed. Although the number of traditional smokers in the population has been declining, vaping may be dangerous to health due to the substances contained in various e-cigarette liquids and cause acute respiratory failure during various forms of pneumonitis. In addition to tetrahydrocannabinol (THC), cannabidiol (CB) and other opioids, the major injuring factors include standard ingredients of e-liquid, such as propylene glycol, vegetable glycerine, colouring dyes, and flavouring agents. Vaping-associated lung injury impairs the alveolar-capillary barrier and distribution of respiratory volume manifesting the features of atelectasis, which is particularly pronounced in lipoid pneumonia. Due to critical gas exchange disorders, ICU treatment is required in an increasing number of patients. The management is essentially based on steroid and antibiotic therapy; whenever the ventilator is needed, the principles of lung-protective ventilation should be strictly followed. If mechanical ventilation fails, ECMO should be considered.
Asunto(s)
Lesión Pulmonar Aguda/etiología , Lesión Pulmonar Aguda/terapia , Anestesiología , Cuidados Críticos , Sistemas Electrónicos de Liberación de Nicotina , Vapeo , Humanos , Neumonía/etiología , Neumonía/terapiaAsunto(s)
Traqueostomía , Traqueotomía , Broncoscopía , Humanos , Ultrasonografía , Ultrasonografía IntervencionalRESUMEN
An intensive physical exercise program could lead to a decrease in immune system function. Effects of long-term supplementation of bovine colostrum on the response of immune function on physical exercise test in athletes were examined. Twenty-seven elite female basketball players (age 16-19) were randomly assigned to either an experimental group or a control group. Eventually, n = 11 athletes completed intervention in the experimental group (3.2 g bovine colostrum orally twice a day for 24 weeks), while n = 9 athletes in the control group were given a placebo. Before the supplementation, after 3 and 6 months, subjects performed the physical exercise stress test. Before, just after, and 3 h after physical exercise testing, blood was drawn and immune system indicators were examined. Plasma interleukin (IL)-1alpha, IL-2, IL-10, IL-13, tumor necrosis factor (TNF) alpha, creatine kinase (CK MM), immunoglobulin G (IgG), insulin-like growth factor 1 (IGF1), and WBC, lymphocyte (LYM), monocyte (MON), and granulocyte (GRA) were measured. A statistically significant change in IL-10 in response to the exercise program during the supplementation period in both groups was observed (p = 0.01). However, the results of the rest of the comparisons were statistically insignificant (p > 0.05). Contrary to our initial hypothesis, there were no significant effects of bovine supplementation on the dynamics of immune system function indicators.
Asunto(s)
Atletas , Baloncesto , Calostro , Creatina Quinasa , Citocinas , Suplementos Dietéticos , Inmunoglobulina G , Adolescente , Adulto , Animales , Bovinos , Creatina Quinasa/sangre , Creatina Quinasa/inmunología , Citocinas/sangre , Citocinas/inmunología , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Recuento de Leucocitos , Adulto JovenRESUMEN
Na podstawie przegladu aktualnego pismiennictwa przedstawiono zasady i praktyczne efekty zastosowania wysokoprzeplywowego leczenia tlenem (WLT) wsród chorych intensywnej terapii i poddanych zabiegom operacyjnym. Rezultaty stosowania WLT wybiegaja poza uzyskanie stabilnego i kontrolowanego stezenia tlenu w powietrzu oddechowym. Dodatkowe efekty zwiazane sa z uzyskiwaniem dodatnich cisnien w fazie wydechu, zjawiska wyplukiwania CO2 i czynnosciowego zmniejszania przestrzeni martwej, wzrostu koncowo - wydechowej objetosci pluc w wyniku ograniczania mikro-niedodmy i poprawy dystrybucji objetosci oddechowej. W wyniku optymalnego nawilzania i ogrzewania mieszaniny wdechowej dochodzi do zmniejszenia oporów wentylacji i pracy oddychania. Opisane efekty WLT sklaniaja do prób jej wykorzystywania nie tylko jako narzedzia tlenoterapii biernej, ale równiez jako urzadzenia alternatywnego dla wentylacji nieinwazyjnej lub wczesnej intubacji. Zakres zastosowan ocenionych w pismiennictwie dotyczy ostrej hypoksemicznej niewydolnosci oddechowej, wstepnej fazy ARDS, POChP, okresu okolooperacyjnego oraz zastosowan podczas procesów diagnostycznych (gastroskopia, bronchoskopia). Szczególna forma WLT jest poddawana aktualnie ocenie adaptacja metody dla chorych z tracheostomia, usprawniajaca glównie procesy nawilzania mieszaniny oddechowej. WLT wymaga dalszych ocen w duzych, randomizowanych badaniach, jednak dotychczasowe efekty stosowania sa zachecajace.
Asunto(s)
Anestesiología , Cuidados Críticos , Terapia por Inhalación de Oxígeno , Humanos , Insuficiencia Respiratoria/terapia , TraqueostomíaRESUMEN
BACKGROUND: The increasing population of very old intensive care patients (VIPs) is a major challenge currently faced by clinicians and policymakers. Reliable indicators of VIPs' prognosis and purposefulness of their admission to the intensive care unit (ICU) are urgently needed. METHODS: This is a report from the Polish sample of the VIP1 multicentre cohort study (NCT03134807). Patients ≥ 80 years of age admitted to the ICU were included in the study. Information on the type and reason for admission, demographics, utilisation of ICU procedures, ICU length of stay, organ dysfunction and the decision to apply end-of-life care was collected. The primary objective was to investigate the impact of frailty syndrome on ICU and 30-day survival of VIPs. Frailty was assessed with the Clinical Frailty Scale (≥ 5 points on a scale of 1-9). RESULTS: We enrolled 272 participants with a median age of 84 (81-87) years. Frailty was diagnosed in 170 (62.5%) patients. The ICU and 30-day survival rates were equal to 54.6% and 47.3% respectively. Three variables were found to significantly increase the odds of death in the ICU in a multiple logistic regression model: SOFA score (OR = 1.16; 95%CI 1.16-1.24), acute mode of admission (OR = 5.1; 95%CI 1.67-15.57) and frailty (OR = 2.25; 95%CI 1.26-4.01). CONCLUSION: Measuring frailty in critically ill older adults can facilitate making more informed clinical decisions and help avoid futile interventions.
Asunto(s)
Fragilidad , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Tiempo de Internación , Modelos Logísticos , MasculinoRESUMEN
Extracorporeal Membrane Oxygenation (ECMO) has become well established technique of the treatment of severe acute respiratory failure (Veno-Venous ECMO) or circulatory failure (Veno-Arterial ECMO) which enables effective blood oxygenation and carbon dioxide removal for several weeks. Veno-Venous ECMO (V-V ECMO ) is a lifesaving treatment of patients in whom severe ARDS makes artificial lung ventilation unlikely to provide satisfactory blood oxygenation for preventing further vital organs damage and progression to death. The protocol below regards exclusively veno-venous ECMO treatment as a support for blood gas conditioning by means of extracorporeal circuit in adult patients with severe ARDS. V-V ECMO does not provide treatment for acutely and severely diseased lungs, but it enables patient to survive the critical phase of severe ARDS until recovery of lung function. Besides avoiding patients death from hypoxemia, this technique can also prevent further progression of the lung damage due to artificial ventilation. Recent experience of ECMO treatment since the outbreak of AH1N1 influenza pandemic in 2009, along with technical progress and advancement in understanding pathophysiology of ventilator-induced lung injury, have contributed to significant improvement of the results of ECMO treatment. Putative factors related to increased survival include patients retrieval after connecting them to ECMO, and less intensive anticoagulation protocols. The aim of presenting this revised protocol was to improve the effects of ECMO treatment in patients with severe ARDS, to enhance ECMO accessibility for patients who might possibly benefit from this treatment, to reduce time until patient's connection to ECMO, and to avoid ECMO treatment in futile cases. The authors believe that this protocol, based on recent papers and their own experience, can provide help and advice both for the centers which develop V-V ECMO program, and for doctors who will refer their patients for the treatment in an ECMO center.
Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Respiración Artificial/métodos , Síndrome de Dificultad Respiratoria/terapia , Adulto , Anestesiología , Dióxido de Carbono/sangre , Cuidados Críticos/métodos , Humanos , Oxígeno/sangre , Guías de Práctica Clínica como Asunto , Lesión Pulmonar Inducida por Ventilación Mecánica/fisiopatologíaRESUMEN
Mechanical ventilation of disease-affected lungs, as well as being an inadequate mode of ventilation for initially healthy lungs, can cause significant changes in their structure and function. In order to differentiate these processes, two terms are used: ventilator-associated lung injury (VALI) and ventilator-induced lung injury (VILI). In both cases, lung injury primarily results from differences in transpulmonary pressure - a consequence of an imbalance between lung stress and strain. This paper focuses on changes in lung structure and function due to this imbalance. Moreover, in this context, barotrauma, volutrauma and atelectrauma are interpreted, and the importance of signal transduction as a process inducing local and systemic inflammatory responses (biotrauma), is determined. None of the assessed methods of reducing VALI and VILI has been found to be entirely satisfactory, yet studies evaluating oscillatory ventilation, liquid ventilation, early ECMO, super-protective ventilation or noisy ventilation and administration of certain drugs are under way. Low tidal volume ventilation and adequately adjusted PEEP appear to be the best preventive measures of mechanical ventilation in any setting, including the operating theatre. Furthermore, this paper highlights the advances in VILI/VALI prevention resulting from better understanding of pathophysiological phenomena.
Asunto(s)
Pulmón/fisiopatología , Respiración Artificial/efectos adversos , Lesión Pulmonar Inducida por Ventilación Mecánica/fisiopatología , Animales , Barotrauma/etiología , Barotrauma/prevención & control , Humanos , Respiración con Presión Positiva/métodos , Respiración Artificial/métodos , Transducción de Señal , Volumen de Ventilación Pulmonar/fisiología , Lesión Pulmonar Inducida por Ventilación Mecánica/prevención & controlRESUMEN
BACKGROUND: Mechanical ventilation is the primary method of supporting organ function in patients treated in intensive care units (ICUs). Lung damage from mechanical ventilation can be avoided by using the correct ventilation modes. This study was designed to assess the epidemiology and treatment strategies of patients receiving mechanical ventilation in ICUs in Poland. MATERIAL AND METHODS: This study was done using a point-prevalence methodology. Questionnaires requesting demographic data, indications for ventilation, variables involved in ventilation, airway access, methods of sedation, and mode of weaning were sent to 148 ICUs. RESULTS: Eighty-three ICUs took part in the study. The rate of ventilated patients was 73.6%. The indications for mechanical ventilation were: acute respiratory failure (40%), coma (40%), chronic obstructive pulmonary disease (COPD) exacerbation (14%), and neuromuscular diseases (5%). Patients were ventilated by orotracheal tube (58%), tracheostomy tube (41%), and mask/helmet (1%). The mean tidal volume was 8 ml/kg and positive end-expiratory pressure was commonly used. The mean oxygen concentration was 40%. Synchronized intermittent mandatory ventilation with pressure support was the most frequently used ventilatory mode. Benzodiazepine and opioids were used for sedation in 91% of centers. A systematic testing of the depth of sedation was performed at 48% surveyed ICUs. Ventilation monitoring with biomechanical methods was used at 53% of centers. CONCLUSIONS: Mechanical ventilation is commonly used in ICUs in Poland. Almost half of the ventilated patients had extrapulmonary indications. Patients were ventilated with low concentrations of oxygen, and positive end-expiratory pressure (PEEP) was commonly employed.
Asunto(s)
Unidades de Cuidados Intensivos/estadística & datos numéricos , Respiración Artificial/estadística & datos numéricos , Estudios Transversales , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Polonia/epidemiologíaAsunto(s)
Procedimientos Quirúrgicos Ambulatorios/métodos , Anestesia/métodos , Anestesiología/métodos , Atención Ambulatoria/métodos , Atención Ambulatoria/normas , Procedimientos Quirúrgicos Ambulatorios/normas , Anestesia/normas , Anestesiología/normas , Anestésicos/administración & dosificación , Humanos , Tiempo de InternaciónRESUMEN
Sedation and analgesia, which are universally used in intensive care units (ICUs), provide patients with comfort and safety. The current trends aim at light sedation; the objective is to ensure the minimal sedation level for improving patients' autonomy and enabling the professional staff to assess the patients' neurological status and cognitive functions. Reports in the literature have indicated that a sedative or an entire sedation procedure can affect cognitive processes, the duration of mechanical ventilation and treatment outcomes in critically ill patients. At present, special attention is given to post-sedation delirium. Although sedatives differ in their uptake points, which can influence the quality of sedation, their common characteristic is substantial impairment of cognitive functions, memory and respiration. Alpha 2-adrenergic receptor agonists, which comprise a novel group of agents, are used frequently for sedation. One of these medications is dexmedetomidine, which is designed to sedate adult ICU patients who exhibit a score ≥ -3 according to the Richmond Agitation-Sedation Scale. Recent studies comparing the use of dexmedetomidine and the other sedative agents that are most commonly administered in ICUs demonstrated that the former largely fulfils the expectations of intensivists.
Asunto(s)
Dexmedetomidina/uso terapéutico , Hipnóticos y Sedantes/uso terapéutico , Unidades de Cuidados Intensivos , Agonistas de Receptores Adrenérgicos alfa 2/efectos adversos , Agonistas de Receptores Adrenérgicos alfa 2/uso terapéutico , Enfermedad Crítica , Delirio/epidemiología , Dexmedetomidina/efectos adversos , Humanos , Hipnóticos y Sedantes/efectos adversos , Agitación Psicomotora/tratamiento farmacológico , Respiración Artificial/métodosRESUMEN
Sufentanil, a potent α-1 agonistic opioid, was synthesized in mid-1970s. It was introduced into clinical practice ten years later, gaining some popularity over the last twenty years. A piperidine derivative, sufentanil has been reported to be 6-10 times more potent than fentanyl, depending on the route of administration; it has been registered for intravenous, epidural and subarachnoid administration. Its reported off-label use has included intra-articular and intranasal administration; moreover, it has been applied as an adjunct in peripheral blocks. In the review, contemporary uses of sufentanil, together with detailed pharmacokinetics and pharmacodynamics are presented. The author concludes that the limited side effects of sufentanil, together with its attractive pharmacokinetic profile, should promote its wider use in clinical practice.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Anestésicos Intravenosos/uso terapéutico , Sufentanilo/uso terapéutico , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/farmacología , Anestésicos Intravenosos/efectos adversos , Anestésicos Intravenosos/farmacología , Cuidados Críticos/métodos , Fentanilo/administración & dosificación , Fentanilo/uso terapéutico , Humanos , Uso Fuera de lo Indicado , Sufentanilo/efectos adversos , Sufentanilo/farmacologíaAsunto(s)
Protocolos Clínicos/normas , Cuidados Críticos/normas , Enfermedad Crítica/terapia , Nutrición Enteral/normas , Unidades de Cuidados Intensivos/organización & administración , Apoyo Nutricional/normas , Adulto , Algoritmos , Cuidados Críticos/estadística & datos numéricos , Nutrición Enteral/estadística & datos numéricos , Medicina Basada en la Evidencia , Adhesión a Directriz , Humanos , Evaluación de Necesidades , Apoyo Nutricional/estadística & datos numéricos , PoloniaRESUMEN
This article presents in illustrations the classical technique of transdermal identification and anatomy of paravertebral space (PVS) comparing to other techniques. This have to be acknowledged by anaesthesiologists as well as by other specialists to perform thoracic paravertebral blockade (TPVB)--earlier elapsed but nowadays getting more popular--safely. In addition the article contains a short description of author's own modification of Eason's and Wyatt's technique.