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1.
Med Sci Monit ; 25: 5727-5737, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31371694

RESUMO

BACKGROUND Patients under 30 years of age constitute a unique population in the Intensive Care Unit (ICU). The aim of this study was to obtain information on young adults admitted to Polish ICUs and to identify independent predictors of favorable outcome in this population. MATERIAL AND METHODS Data from 20 651 adult patients from the Silesian Registry of Intensive Care Units conducted in the Silesian Region of Poland since October 2010 were analyzed. Patients aged 18-29 years were identified and their data were compared to the remaining population. Preadmission and admission variables that independently influence the favorable outcome (defined as survival of ICU stay and discharge in a condition other than vegetative state or minimally conscious state) were identified. RESULTS Among 20 609 analyzed adult patients, 850 (4.1%) were under the age of 30 years. Young adults had a lower mean APACHE II and SAPS III score at admission and were more frequently admitted to the ICU due to trauma, poisonings, acute neurological disorders, and obstetric complications. ICU mortality was over 2 times lower (20.1% vs. 45.3%, p<0.001). Independent variables affecting favorable outcome in this population were: admission to ICU from the operating theatre and multiple trauma as a primary cause of admission. CONCLUSIONS The greater chance of favorable outcome in adults under the age of 30 years admitted to the ICU is due to their unique characteristics. Favorable outcome in young adults is most likely among patients admitted to the ICU following multiple trauma or admitted from the operating theatre.

2.
J Crit Care ; 53: 87-90, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31202163

RESUMO

PURPOSE: We aimed to investigate sleep quality (SQ), daytime sleepiness (DS), and their relation with subject- and work-related factors among Polish anaesthesiologists. METHODS: The study group comprised 786 anaesthesiologists. The Sleep Quality Scale (SQS) was applied in order to assess SQ, while excessive DS was evaluated using the Epworth Sleepiness Scale (ESS). RESULTS: The median score on the SQS was 31 (IQR 27-35) points. The median score on the ESS was 17 (IQR 13-20) points, with mild-to-moderate excessive DS found in 260 (33.1%) and severe excessive DS among 478 (60.8%) of those surveyed. Worse SQ was found in females; smokers; those who suffered from any chronic diseases; those who were receiving medication interfering with sleeping habits; those who were unsatisfied with their sleep; those who had a greater number of night shifts; and those who had a lower number of non-working days. A detrimental sleepiness pattern was determined by one's advanced age, the presence of any chronic diseases and lower satisfaction with one's sleep quantity. CONCLUSION: Poor SQ and excessive DS are frequently occurring phenomena. Since sleep disturbances are also related to the nature of their profession, the problem could be reduced by introducing organisational changes at work.

3.
Anaesthesiol Intensive Ther ; 50(4): 291-296, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30378093

RESUMO

BACKGROUND: The measurement of blood pressure (BP) is routinely performed in perioperative care. The reliability of results is essential for the implementation of treatment ensuring haemodynamic stability. The aim of the present study was to assess the prevalence and basic determinants of inter-arm BP differences among patients with advanced peripheral atherosclerosis undergoing vascular surgical procedures of the lower limbs. METHODS: The prospective study was carried out in patients scheduled for elective lower limb vascular surgery. One-time non-invasive BP measurements were performed sequentially on the brachial arteries of both upper extremities before the induction of anaesthesia, maintaining the shortest possible interval between measurements. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded. RESULTS: The results of 173 patients (including 123 men aged 67 ± 8 years) were analysed. In 16 (9.3%) patients, an inter-arm difference in BP was already observed during the preoperative examination. SBP and DBP was higher in the right limb in 86 (49.7%) an 80 (46.3%) patients, respectively. Moreover, the medians of inter-arm differences in SBP, DBP and MAP were 9 (IQR 4-17), 5 (IQR 3-10) and 7 mm Hg (IQR 3-12), respectively. An evaluation of the determinants of BP differences related to the presence of additional diseases demonstrated that patients with arterial hypertension were characterised by higher SBP and MAP disproportions (P = 0.04 and P = 0.01). CONCLUSIONS: In the population of patients with disseminated atherosclerosis, the inter-arm differences in BP substantially exceed the measurement error limits and are likely to be associated with arterial hypertension. If in doubt about BP disproportions, intraoperative monitoring of BP should be recommended using an invasive method on the limb presenting higher non-invasively measured values.

4.
Anaesthesiol Intensive Ther ; 50(4): 277-282, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30317537

RESUMO

BACKGROUND: The red blood cell distribution width index (RDW) is one of several parameters routinely analysed in peripheral blood counts. The aim of the study was to assess the usefulness of RDW in the prediction of in-hospital mortality in patients undergoing high-risk gastroenterological surgery. METHODS: Prospective observation covered 229 patients who underwent surgery, for whom the risk of cardiovascular complications was high due to the type of procedure. The patient's individual risk was assessed using the criteria of the American Society of Anesthesiologists (ASA-PS). Peripheral blood for morphological examination was collected preoperatively. The following parameters of the red blood cell system were evaluated: red blood cell count (RBC), haemoglobin (Hgb), haematocrit (Hct), mean corpuscular volume (MCV), RDW expressed as a standard deviation (SD) and a coefficient of variation (CV). The occurrence of hospital death was the main endpoint. RESULTS: Patients who died had had statistically significantly lower RBC, Hgb and Hct values, as well as higher RDWSD and RDW-CV values. Both the preoperative RDW-SD and RDW-CV values predicted the outcome, respectively: AUC RDW-SD = 0.744 (95% CI: 0.683­0.799; P < 0.001), AUC RDW-CV = 0.762 (95% CI: 0.702­0.816; P < 0.001). In logistic regression, it was confirmed that RDW predicted mortality (OR RDW-SD = 1.21; P < 0.001, OR RDW-CV = 1.62; P = 0.01), even after adjustment for individual risk and other erythrocyte parameters. CONCLUSION: RDW is a valuable screening predictor of in-hospital mortality in patients undergoing high-risk gastroenterological surgery, regardless of the estimated individual risk and the value of other erythrocyte parameters. Evaluation of the RDW may be helpful in the identification of patients requiring correction of haematological disorders in the pre-operative period, as well as, in particular, surveillance in the perioperative period.

5.
Kardiochir Torakochirurgia Pol ; 15(2): 130-134, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30069195

RESUMO

Introduction: Health-related quality of life (QoL) is an acknowledged index of treatment effectiveness. There are several methods of its evaluation which are predisposed to different risk of bias. Aim: To investigate the agreement between objective and subjective tools of QoL assessment in patients who underwent endoscopic atraumatic coronary artery bypass (EACAB) grafting. Material and methods: This prospective observational study covered 705 consecutive patients who underwent EACAB between April 1998 and December 2010. Quality of life was assessed in a follow-up of 2132 ±1313 days among 482 subjects using the WHOQoL-BREF questionnaire as an objective tool and the Likert scale as a more subjective method. Results: There was good agreement between a 5-step Likert scale and a 5-step BREF Q1 ('overall quality of life') and Q2 ('general health') with a concordance correlation coefficient of CCC = 0.64 (95% CI: 0.58-0.69) and CCC = 0.49 (95% CI: 0.43-0.55), respectively. There was also a statistically significant correlation between answers reported using the Likert scale and all domains of BREF: physical health (R = 0.54, p < 0.001), psychological health (R = 0.56, p < 0.001), social relationships (R = 0.45, p < 0.001) and environment (R = 0.56, p < 0.001). Conclusions: The Likert scale is useful in QoL assessment in patients after minimally invasive coronary surgery. This simple and easy-to-use screening method may be used interchangeably with a more reliable but also more complex questionnaire tool.

6.
Anaesthesiol Intensive Ther ; 50(2): 170-172, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29953577

RESUMO

AHA is an extremely rare disorder, with annual incidence of 1.5 cases per million population. This clinical entity is caused by autoantibodies directed against coagulation factor VIII, what leads to decreased serum activity of thereof, and is characterized by spontaneous or induced by trauma, or invasive procedure bleeding. Approximately 50% of cases are idiopathic in origin, affecting both sexes, with median age at diagnosis of 74 years. We present a case report of a patient diagnosed with acquired haemophilia A (AHA) in the perioperative period.

7.
Curr Vasc Pharmacol ; 16(6): 561-568, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29034840

RESUMO

BACKGROUND: Volatile Anaesthetics (VA) are commonly used worldwide for induction and/or maintenance of general anaesthesia. They act in the central nervous system to reduce sensation and motor response during surgical and invasive diagnostic procedures. VAs also have some non-anaesthetic properties in the brain when administrated to patients at the extremes of age. Their biological impact on other organs should be taken into account during administration of anaesthesia. OBJECTIVE: In this review we summarize the recent knowledge on the non-anaesthetic effects of inhaled halogenic ethers on cells and tissues. RESULTS AND CONCLUSION: Exposure to VAs may promote lasting neuro-behavioural deficits in the brains of developing children and deterioration in cognitive performance in elderly individuals. Preconditioning with VAs can prevent or minimise tissue ischaemia in the heart and brain. VAs act as an antiinflammatory in response to tissue damage during surgery and may attenuate both local and systemic inflammatory response. Further research is needed to elucidate a link between laboratory findings and their possible effects in humans. Because many questions remain unanswered in this field, translational medicine should be more focused on safety in anaesthesia for the improvement public health.

8.
Cardiol J ; 25(2): 254-259, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28497841

RESUMO

BACKGROUND: Fluid resuscitation in massive bleeding may cause coagulation disorders by dilution of platelets and clotting factors or by the impact on their function. The aim of this study was to investigate the effects of balanced crystalloid and colloid solutions on platelets in vitro using complex assessment of coagulation. METHODS: The study group was comprised of 32 American Society of Anesthesiologists physical status class I male volunteers, aged 21-35 (29 ± 4) years, weighting 59-103 (81.2 ± 9.8) kg. Whole blood samples were diluted at a 4:1 ratio with the following fluids: balanced crystalloid (Plasmalyte®), 6% hydroxyethyl starch 130/0.4 (Volulyte®) and succinylated gelatin (Geloplasma®). Coagulation was as-sessed using standard morphology, rotational thromboelastometry and aggregometry. RESULTS: Dilution with all fluids caused statistically significant drop in the number of platelets (p < 0.01) but the effect did not differ between solutions (p > 0.05 for all). Other platelet parameters, such as platelet distribution width, mean platelet volume and platelet-large cell ratio were not affected by the solutions. Hemodilution had no effect on platelet function (p = 0.1). Decreased platelet component of clot strength was found for all three fluids (p < 0.05), although the effect for colloids was more pronounced. CONCLUSIONS: The effect of balanced crystalloids and colloids on platelet aggregation was insignificant, even after 20% volume substitution with the resuscitation fluids. (.

10.
Anaesthesiol Intensive Ther ; 49(4): 259-267, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29027654

RESUMO

BACKGROUND: Drug-drug interactions constitute a serious health hazard in everyday clinical practice in critically ill patients. Drug-drug interactions may be pharmacokinetic or pharmacodynamic in their nature. We aimed to investigate the quantity and quality of possible drug-drug interactions, and their possible side effects in intensive care unit patients in a 12-month period. METHODS: This retrospective study covered data on pharmacological treatment of 43 consecutive patients (11 females, 32 males) aged 62 ± 15 years, hospitalized between January 2015 and February 2016. Pharmacokinetic DDIs were identified and graded. Only severe and clinically important drug-drug interactions were subjected for further analysis. RESULTS: Median baseline SAPS III was 53 (IQR 38-67) points. Median intensive care unit stay was 12 (6-25) days. Subjects were treated with a median number of 22 (12-27) drugs. We identified 27 (16-41) possible drug-drug interactions per patient, including 3 (1-7) drug-drug interactions of a severe grade. The total number of severe and clinically important drug-drug interactions was 253 of which 227 were analyzed in detail. No possible side-effects of drug-drug interactions were identified. CONCLUSIONS: DDIs as well as their side-effects are challenging regarding their precise evaluation, especially due to the need for multidrug treatment in critically ill patients. Concentration-controlled therapy should be recommended, especially for treatment with vancomycin, digoxin and valproate. Pantoprazole should be a proton pump-inhibitor of choice. Drug dose modification is necessary in combined treatment with fluconazole and amiodarone or rifampicin. From a clinical point of view, the most important impact of drug-drug interactions is on antibiotic treatment effectiveness, especially with meropenem when valproate is also prescribed.


Assuntos
Interações de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Unidades de Terapia Intensiva , Idoso , Cuidados Críticos , Estado Terminal , Relação Dose-Resposta a Droga , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Preparações Farmacêuticas/administração & dosagem , Preparações Farmacêuticas/metabolismo , Farmacocinética , Estudos Retrospectivos
11.
Chron Respir Dis ; 14(3): 270-275, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28774204

RESUMO

At least 5% of all intensive care unit patients require prolonged respiratory support. Multiple factors have been suggested as possible predictors of successful respiratory weaning so far. We sought to verify whether the Acute Physiology and Chronic Health Evaluation II (APACHE II) can predict freedom from prolonged mechanical ventilation (PMV) in patients treated in a regional weaning centre. The study group comprised 130 consecutive patients (age; median (interquartile range): 71 (62-77) years), hospitalized between 1 January 2012, and 31 December 2013. APACHE II score was assessed based on the worst values taken during the first 24 hours after admission. Glasgow coma scale was excluded from calculations due to the likely influence of sedative agents. The outcome was defined as freedom from mechanical ventilation, with or without tracheostomy on discharge. Among survivors ( n = 115), 88.2% were successfully liberated from mechanical ventilation and 60.9% from tracheostomy. APACHE II failed to predict freedom from mechanical ventilation (area under the receiver-operating characteristic curve [AUROC] = 0.534; 95% confidence interval [CI]: 0.439-0.628; p = 0.65) and tracheostomy tube removal (AUROC = 0.527; 95% CI: 0.431-0.621; p = 0.63). Weaning outcome was unrelated to the aetiology of respiratory failure on admission ( p = 0.41). APACHE II cannot predict weaning outcome in patients requiring PMV.


Assuntos
APACHE , Insuficiência Respiratória/terapia , Desmame do Respirador , Idoso , Área Sob a Curva , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Humanos , Ventilação com Pressão Positiva Intermitente , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Insuficiência Respiratória/etiologia , Estudos Retrospectivos , Traqueostomia
13.
Anaesthesiol Intensive Ther ; 49(2): 106-109, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28643322

RESUMO

BACKGROUND: Severe accidental hypothermia is defined as a core temperature below 28 Celsius degrees. Within the last years, the issue of accidental hypothermia and accompanying cardiac arrest has been broadly discussed and European Resuscitation Council (ERC) Guidelines underline the importance of Extracorporeal Rewarming (ECR) in treatment of severely hypothermic victims. The study aimed to evaluate the actual costs of ECR with VA-ECMO and of further management in the Intensive Care Unit of patients admitted to the Severe Accidental Hypothermia Centre in Cracow, Poland. METHODS: We carried out the economic analysis of 31 hypothermic adults in stage III-IV (Swiss Staging) treated with VA ECMO. Twenty-nine individuals were further managed in the Intensive Care Unit. The actual treatment costs were evaluated based on current medication, equipment, and dressing pricing. The costs incurred by the John Paul II Hospital were then collated with the National Health Service (NHS) funding, assessed based on current financial contract. RESULTS: In most of the cases, the actual treatment cost was greater than the funding received by around 10000 PLN per patient. The positive financial balance was achieved in only 4 (14%) individuals; other 25 cases (86%) showed a financial loss. CONCLUSION: Performed analysis clearly shows that hospitals undertaking ECR may experience financial loss due to implementation of effective treatment recommended by international guidelines. Thanks to new NHS funding policy since January 2017 such loss can be avoided, what shall encourage hospitals to perform this expensive, yet effective method of treatment.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Parada Cardíaca/terapia , Hipotermia/terapia , Reaquecimento/métodos , Adulto , Oxigenação por Membrana Extracorpórea/economia , Custos de Cuidados de Saúde , Parada Cardíaca/economia , Parada Cardíaca/etiologia , Humanos , Hipotermia/economia , Unidades de Terapia Intensiva/economia , Polônia , Reaquecimento/economia , Índice de Gravidade de Doença , Resultado do Tratamento
14.
Acta Biochim Pol ; 64(3): 499-501, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28651024

RESUMO

Many studies have suggested a link between long-term PPI treatment and hypomagnesaemia, though none of them investigated the short-term exposure in high-risk patients. We sought to investigate this issue in 90 critically ill patients. We assessed serum Mg concentrations, necessity of Mg supplementation, PPI dose, duration of PPI therapy and route of administration. In multiple analysis we found that Mg supplementation (positive effect/p=0.03) and enteral route of PPI administration (negative effect/p=0.02) had significant impact on Mg concentration. Although the deleterious relationship between short-term PPI treatment and Mg concentration was found, further studies should be provided to confirm this interesting effect.


Assuntos
Deficiência de Magnésio/induzido quimicamente , Magnésio/sangue , Magnésio/uso terapêutico , Inibidores da Bomba de Prótons/efeitos adversos , Administração Intravenosa , Idoso , Estado Terminal , Nutrição Enteral , Feminino , Humanos , Unidades de Terapia Intensiva , Magnésio/administração & dosagem , Deficiência de Magnésio/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Inibidores da Bomba de Prótons/administração & dosagem , Inibidores da Bomba de Prótons/uso terapêutico
15.
Kardiol Pol ; 75(8): 779-785, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28553873

RESUMO

BACKGROUND: Popular intravenous fluids in clinical use may have an impact on electrolyte concentration and metabolic balance and should be considered as powerful pharmacological agents. There is a growing body of evidence that fluid therapy should be more individualised and preferably based on balanced solutions. AIM: We sought to investigate the impact of three commonly used balanced fluids on electrolytes and metabolic equilibrium in an in vitro setting. METHODS: Study group comprised 32 healthy male volunteers (without history of any acute/chronic disorder or known metabolic abnormality), aged 21-35 (29 ± 4) years, weight 59-103 (81.2 ± 9.8) kg, from whom blood samples were withdrawn. The whole blood was diluted in 4:1 ratio with the study solutions to make an end-concentration of 20 vol.% of each solution. The test solutions included balanced crystalloid (Plasmalyte®, Baxter, Poland [PL]), succinylated gelatin (Geloplasma®, Fresenius Kabi, Poland [GEL]) and 6% HES 130/0.4 (Volulyte®, Fresenius Kabi, Poland [HES]). RESULTS: All fluids caused comparable degree of haemodilution. PL and GEL decreased (104 mmol/L, interquartile range [IQR] 103-105; and 106 mmol/L, IQR 105-107.5, respectively), whereas HES increased the concentration of Cl- to 109 (IQR 108-110) mmol/L. PL and HES decreased (136, IQR 136-137 mmol/L; and 138 mmol/L, IQR 137-139, respectively), whereas GEL increased the Na+ level to 140.5 (IQR 140-141) mmol/L. PL and HES decreased osmolality (277.2 mOsm/kg, IQR 275.7-278.4; and 280.9 mOsm/kg, IQR 279.3-282.0, respectively). GEL increased it to 285.7 (IQR 283.7-286.8) mOsm/kg. All test solutions caused a similar statistically significant (p < 0.05) drop in base excess and bicarbonate concentration, and these fell outside the reference values. Due to its composition, GEL caused a significant increase in lactate concentration. HES and GEL caused a statistically significant drop in strong ion difference value. Due to high lactate level, the effect of GEL was most pronounced. CONCLUSIONS: Balanced intravenous solutions should be safe in terms of their impact on human plasma electrolyte and meta-bolic equilibrium when administered to replace up to 20% of blood volume. In metabolic acidosis, balanced succinylated gelatin should be used with caution. Therefore, arterial blood gas analysis should be performed in patients in whom significant amounts of fluid are administrated, preferably with assessment of Cl-, Na+, lactate concentrations as well as pH, osmolality, and strong ion difference.


Assuntos
Sangue/efeitos dos fármacos , Eletrólitos/sangue , Hidratação , Gelatina/farmacologia , Derivados de Hidroxietil Amido/farmacologia , Soluções Isotônicas/farmacologia , Succinatos/farmacologia , Adulto , Análise Química do Sangue , Soluções Cristaloides , Voluntários Saudáveis , Humanos , Concentração de Íons de Hidrogênio , Masculino , Adulto Jovem
20.
Kardiochir Torakochirurgia Pol ; 13(3): 217-223, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27785135

RESUMO

INTRODUCTION: The prognosis in out-of-hospital sudden cardiac arrest (OHCA) remains unfavorable and depends on a number of demographic and clinical variables, the reversibility of its causes and its mechanisms. AIM: To investigate the risk factors of prehospital death in patients with OHCA in Bielsko County. MATERIAL AND METHODS: The study analyzed all dispatch cards of the National Emergency Medical Services (EMS) teams in Bielsko-Biala for the year 2013 (n = 23 400). Only the cards related to sudden cardiac arrest in adults were ultimately included in the study (n = 272; 190 men, 82 women; median age: 71 years). RESULTS: Sixty-seven victims (45 men, 22 women) were pronounced dead upon the arrival of the EMS team, and cardiopulmonary resuscitation (CPR) was not undertaken. In the remaining group of 205 subjects, CPR was commenced but was ineffective in 141 patients (97 male, 44 female). Although univariate analysis indicated 6 predictors of prehospital death, including OHCA without the presence of witnesses (odds ratio (OR) = 4.2), OHCA occurring in a public place (OR = 3.1), no bystander CPR (OR = 9.7), no bystander cardiac massage (OR = 13.1), initial diagnosis of non-shockable cardiac rhythm (OR = 7.0), and the amount of drugs used for CPR (OR = 0.4), logistic regression confirmed that only the lack of bystander cardiac massage (OR = 6.5) and non-shockable rhythm (OR = 4.6) were independent determinants of prehospital death (area under ROC curve = 0.801). CONCLUSIONS: Non-shockable rhythm of cardiac arrest and lack of bystander cardiac massage are independent determinants of prehospital death in Bielsko-Biala inhabitants suffering from OHCA.

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