Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs, Jan 27, 2018
We report a case of a 20-year-old male patient suffering from motorcycle accident complicated by ... more We report a case of a 20-year-old male patient suffering from motorcycle accident complicated by rapid development of severe refractory hypoxemia and hypercapnia due to serious bilateral lung contusions and lacerations. Positive pressure mechanical ventilation induced pressure-dependent massive air leak from disrupted pulmonary tissue. Simultaneous implementation of veno-venous extracorporeal membrane oxygenation together with surfactant application allowed prolonged disconnection of patient from mechanical ventilation ("total lung rest" mode). Despite considerable areas of nonaerated tissue on computed tomography prior to the disconnection from mechanical ventilation, almost total functional recovery of lungs was eventually achieved.
Intensive care of severe trauma patients focuses on the treatment of haemorrhagic shock. Tissues ... more Intensive care of severe trauma patients focuses on the treatment of haemorrhagic shock. Tissues should be perfused sufficiently with blood and with sufficient oxygen content to ensure adequate tissue oxygen delivery. Tissue metabolism can be monitored by microdialysis, and the lactate/pyruvate ratio (LPR) may be used as a tissue ischemia marker. The aim of this study was to determine the adequate cardiac output and haemoglobin levels that avoid tissue ischemia. Adult patients with serious traumatic haemorrhagic shock were enrolled in this prospective observational study. The primary observed parameters included haemoglobin, cardiac output, central venous saturation, arterial lactate and the tissue lactate/pyruvate ratio. Forty-eight patients were analysed. The average age of the patients was 39.8 ± 16.7, and the average ISS was 43.4 ± 12.2. Hb < 70 g/l was associated with pathologic arterial lactate, ScvO2 and LPR. Tissue ischemia (i.e., LPR over 25) developed when CI ≤ 3.2 l/mi...
During the pandemy caused by novel influenza A virus (subgroup H1N1), a significant number of pat... more During the pandemy caused by novel influenza A virus (subgroup H1N1), a significant number of patients became critically ill from respiratory failure. In the most severe cases of primary pneumonia, patients develop refractory hypoxemic acute respiratory distress syndrome (ARDS) with typical computed tomographic findings of multi-lobar alveolar opacities and extremely reduced pulmonary airspace. To reduce the risk of injurious ventilation and promote survival, some authors recommend the use of extracorporeal membrane oxygenation (ECMO). Unfortunately, ECMO is expensive, associated with serious complications, and available at very few centers. Other therapeutic options are clearly needed. Here we report three patients with severe influenza pneumonia who recovered following treatment with porcine surfactant (Tab. 1, Fig. 3, Ref. 6). Full Text in free PDF www.bmj.sk.
Excessive forms of the response of organism to infection play an important role in the pathogenes... more Excessive forms of the response of organism to infection play an important role in the pathogenesis of severe sepsis. They may consist of either local pro-inflammatory response with a massive release of cytokines into the systemic circulation, or may be presented as an excessive systemic anti-inflammatory response. In the first case, the result is a systemic pro-inflammatory state, characterised by natural stages of the inflammatory response, in which dysfunction of macrocirculation is followed by microcirculation derangement and mitochondrial alteration at the end. These mechanisms are responsible for the development of remote organs failure. The result in the second case is a deactivation of local immunocompetent cells, which results in the risk of uncontrollable growth of microorganisms, especially in organs with an impaired antimicrobial barrier. This may explain the clinically observed recurrence of septic episodes, when a resolution of infection at one site is later replaced w...
Abdominal compartment syndrome (ACS) is defined as a sustained increase of intra-abdominal pressu... more Abdominal compartment syndrome (ACS) is defined as a sustained increase of intra-abdominal pressure (IAP) above 20 mmHg followed by the development of organ dysfunction. Treatment of ACS is still a question to be discussed and surgical decompression is usually preferred. According to recent data, massive crystalloid resuscitation of shock plays a key role in the development of secondary ACS in trauma patients. As mentioned previously, a high volume of infused crystalloids and a positive fluid balance were associated with ACS development in trauma patients as well as in septic patients. Moreover, we observed that a treatment strategy based on the achievement of a negative fluid balance resulted in a dramatic decrease in IAP and an improvement in haemodynamics and ventilation. This approach has been indicated as an interesting option for non-surgical treatment, with a caution that such intervention may exacerbate gut hypoperfusion. In this report we present two patients with secondary...
There is no doubt that artificial ventilation of lungs seems to be proven as life-saving manoeuvr... more There is no doubt that artificial ventilation of lungs seems to be proven as life-saving manoeuvre, whereas a growing amount of evidence is presented and published recently that artificial ventilation cause damage to patient by so far unexplained mechanism--by conversion of mechanical stress to biochemical signals inducing local and systemic inflammatory response, which is wide spreading and causing multiple organ dysfunction syndrome (MODS). Higher mortality of patients with acute lung injury on MODS rather than acute respiratory failure itself can be explained just by these findings. The article is brief summary of recent opinions of mechanism of ventilator induced lung and systemic injury. There is also evidence that the process of implementation of these finding into clinical practice is exceedingly slow.
Ceská gynekologie / Ceská lékarská spolecnost J. Ev. Purkyne, 2006
Overview of recent knowledge about risks and benefits of blood transfusion. Review article. Depar... more Overview of recent knowledge about risks and benefits of blood transfusion. Review article. Department of Anaesthesiology and Intensive Care, University Hospital, Ostrava. Summary of previously published data. Transfusion of blood and blood products remains controversial in clinical practice. Neither indication and timing nor benefit of this procedure is clearly determined. Previously often reported complications as blood-group incompatibility and infection are less frequent now, and new transfusion's side effects as TRIM (transfusion-related immunomodulation) and TRALI (transfusion-related lung injury) are reported with growing evidence. This risk (often underestimated in the past) is discussed in the article, and compared with blood transfusion benefits. Either restrictive or more open approach to blood transfusion are supported as well as criticised by different groups of clinicians and "good clinical practice" definition remains open for the future.
Klinická mikrobiologie a infekc̆ní lékar̆ství, 2006
Severe sepsis is at present serious medical and social problem. In contrast to many other disease... more Severe sepsis is at present serious medical and social problem. In contrast to many other diseases its incidence shows an upward tendency and so does mortality due to sepsis. From the point of view of pathogenesis the cause of this complaint is a disturbed response to infection. The basis of this disruption is either a huge local inflammation that goes hand in hand with the penetration of proinflammatory cytokines into systemic circulation or an excessive proinflammatory systemic response. In the first instance the consequence is a systemic proinflammatory response accompanied by a disruption of macrocirculation, later also of microcirculation and finally mitochondrial failure. These mechanisms are responsible for the gradual failure of distant organs. In the second instance the consequence is a deactivation of systemic and local immunocompetent cells accompanied by the risk of uncontrolled proliferation of microorganisms. Affected are organs with a disturbed antimicrobial barrier, ...
Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti, 2005
Perioperative optimalization of haemodynamics is associated with improved post-operative developm... more Perioperative optimalization of haemodynamics is associated with improved post-operative development, as presented in most published studies. This study has confirmed that intra-operative correction of cardiac output back to it's physiological level is associated with improved post-operative course in the group of patients undergoing major elective intraabdominal surgery. Statistically significant decreasing of post-operative complications (4.7% vs 17.7%), decreased length of stay (LOS) in the ICU by 33% and decreased LOS in the hospital by 24% was recorded. Interpretation of the study could be limited by using non-indexed cardiac output values and higher female presentation in the group of patients (although statistically not significant).
Klinická mikrobiologie a infekc̆ní lékar̆ství, 2008
Anticytokine therapy in sepsis belongs to a subgroup of therapeutic interventions referred to as ... more Anticytokine therapy in sepsis belongs to a subgroup of therapeutic interventions referred to as antiinflammatory or immunomodulatory strategies in the intensive care literature. Between the mid-1980s and the late 1990s, this approach was considered very promising. Against all expectations, it proved ineffective or even harmful in many cases. However, the recent literature is suggestive of a renewed interest in the topic. Therefore, we attempted at a retrospective search for causes of the failure.
Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs, Jan 27, 2018
We report a case of a 20-year-old male patient suffering from motorcycle accident complicated by ... more We report a case of a 20-year-old male patient suffering from motorcycle accident complicated by rapid development of severe refractory hypoxemia and hypercapnia due to serious bilateral lung contusions and lacerations. Positive pressure mechanical ventilation induced pressure-dependent massive air leak from disrupted pulmonary tissue. Simultaneous implementation of veno-venous extracorporeal membrane oxygenation together with surfactant application allowed prolonged disconnection of patient from mechanical ventilation ("total lung rest" mode). Despite considerable areas of nonaerated tissue on computed tomography prior to the disconnection from mechanical ventilation, almost total functional recovery of lungs was eventually achieved.
Intensive care of severe trauma patients focuses on the treatment of haemorrhagic shock. Tissues ... more Intensive care of severe trauma patients focuses on the treatment of haemorrhagic shock. Tissues should be perfused sufficiently with blood and with sufficient oxygen content to ensure adequate tissue oxygen delivery. Tissue metabolism can be monitored by microdialysis, and the lactate/pyruvate ratio (LPR) may be used as a tissue ischemia marker. The aim of this study was to determine the adequate cardiac output and haemoglobin levels that avoid tissue ischemia. Adult patients with serious traumatic haemorrhagic shock were enrolled in this prospective observational study. The primary observed parameters included haemoglobin, cardiac output, central venous saturation, arterial lactate and the tissue lactate/pyruvate ratio. Forty-eight patients were analysed. The average age of the patients was 39.8 ± 16.7, and the average ISS was 43.4 ± 12.2. Hb < 70 g/l was associated with pathologic arterial lactate, ScvO2 and LPR. Tissue ischemia (i.e., LPR over 25) developed when CI ≤ 3.2 l/mi...
During the pandemy caused by novel influenza A virus (subgroup H1N1), a significant number of pat... more During the pandemy caused by novel influenza A virus (subgroup H1N1), a significant number of patients became critically ill from respiratory failure. In the most severe cases of primary pneumonia, patients develop refractory hypoxemic acute respiratory distress syndrome (ARDS) with typical computed tomographic findings of multi-lobar alveolar opacities and extremely reduced pulmonary airspace. To reduce the risk of injurious ventilation and promote survival, some authors recommend the use of extracorporeal membrane oxygenation (ECMO). Unfortunately, ECMO is expensive, associated with serious complications, and available at very few centers. Other therapeutic options are clearly needed. Here we report three patients with severe influenza pneumonia who recovered following treatment with porcine surfactant (Tab. 1, Fig. 3, Ref. 6). Full Text in free PDF www.bmj.sk.
Excessive forms of the response of organism to infection play an important role in the pathogenes... more Excessive forms of the response of organism to infection play an important role in the pathogenesis of severe sepsis. They may consist of either local pro-inflammatory response with a massive release of cytokines into the systemic circulation, or may be presented as an excessive systemic anti-inflammatory response. In the first case, the result is a systemic pro-inflammatory state, characterised by natural stages of the inflammatory response, in which dysfunction of macrocirculation is followed by microcirculation derangement and mitochondrial alteration at the end. These mechanisms are responsible for the development of remote organs failure. The result in the second case is a deactivation of local immunocompetent cells, which results in the risk of uncontrollable growth of microorganisms, especially in organs with an impaired antimicrobial barrier. This may explain the clinically observed recurrence of septic episodes, when a resolution of infection at one site is later replaced w...
Abdominal compartment syndrome (ACS) is defined as a sustained increase of intra-abdominal pressu... more Abdominal compartment syndrome (ACS) is defined as a sustained increase of intra-abdominal pressure (IAP) above 20 mmHg followed by the development of organ dysfunction. Treatment of ACS is still a question to be discussed and surgical decompression is usually preferred. According to recent data, massive crystalloid resuscitation of shock plays a key role in the development of secondary ACS in trauma patients. As mentioned previously, a high volume of infused crystalloids and a positive fluid balance were associated with ACS development in trauma patients as well as in septic patients. Moreover, we observed that a treatment strategy based on the achievement of a negative fluid balance resulted in a dramatic decrease in IAP and an improvement in haemodynamics and ventilation. This approach has been indicated as an interesting option for non-surgical treatment, with a caution that such intervention may exacerbate gut hypoperfusion. In this report we present two patients with secondary...
There is no doubt that artificial ventilation of lungs seems to be proven as life-saving manoeuvr... more There is no doubt that artificial ventilation of lungs seems to be proven as life-saving manoeuvre, whereas a growing amount of evidence is presented and published recently that artificial ventilation cause damage to patient by so far unexplained mechanism--by conversion of mechanical stress to biochemical signals inducing local and systemic inflammatory response, which is wide spreading and causing multiple organ dysfunction syndrome (MODS). Higher mortality of patients with acute lung injury on MODS rather than acute respiratory failure itself can be explained just by these findings. The article is brief summary of recent opinions of mechanism of ventilator induced lung and systemic injury. There is also evidence that the process of implementation of these finding into clinical practice is exceedingly slow.
Ceská gynekologie / Ceská lékarská spolecnost J. Ev. Purkyne, 2006
Overview of recent knowledge about risks and benefits of blood transfusion. Review article. Depar... more Overview of recent knowledge about risks and benefits of blood transfusion. Review article. Department of Anaesthesiology and Intensive Care, University Hospital, Ostrava. Summary of previously published data. Transfusion of blood and blood products remains controversial in clinical practice. Neither indication and timing nor benefit of this procedure is clearly determined. Previously often reported complications as blood-group incompatibility and infection are less frequent now, and new transfusion's side effects as TRIM (transfusion-related immunomodulation) and TRALI (transfusion-related lung injury) are reported with growing evidence. This risk (often underestimated in the past) is discussed in the article, and compared with blood transfusion benefits. Either restrictive or more open approach to blood transfusion are supported as well as criticised by different groups of clinicians and "good clinical practice" definition remains open for the future.
Klinická mikrobiologie a infekc̆ní lékar̆ství, 2006
Severe sepsis is at present serious medical and social problem. In contrast to many other disease... more Severe sepsis is at present serious medical and social problem. In contrast to many other diseases its incidence shows an upward tendency and so does mortality due to sepsis. From the point of view of pathogenesis the cause of this complaint is a disturbed response to infection. The basis of this disruption is either a huge local inflammation that goes hand in hand with the penetration of proinflammatory cytokines into systemic circulation or an excessive proinflammatory systemic response. In the first instance the consequence is a systemic proinflammatory response accompanied by a disruption of macrocirculation, later also of microcirculation and finally mitochondrial failure. These mechanisms are responsible for the gradual failure of distant organs. In the second instance the consequence is a deactivation of systemic and local immunocompetent cells accompanied by the risk of uncontrolled proliferation of microorganisms. Affected are organs with a disturbed antimicrobial barrier, ...
Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti, 2005
Perioperative optimalization of haemodynamics is associated with improved post-operative developm... more Perioperative optimalization of haemodynamics is associated with improved post-operative development, as presented in most published studies. This study has confirmed that intra-operative correction of cardiac output back to it's physiological level is associated with improved post-operative course in the group of patients undergoing major elective intraabdominal surgery. Statistically significant decreasing of post-operative complications (4.7% vs 17.7%), decreased length of stay (LOS) in the ICU by 33% and decreased LOS in the hospital by 24% was recorded. Interpretation of the study could be limited by using non-indexed cardiac output values and higher female presentation in the group of patients (although statistically not significant).
Klinická mikrobiologie a infekc̆ní lékar̆ství, 2008
Anticytokine therapy in sepsis belongs to a subgroup of therapeutic interventions referred to as ... more Anticytokine therapy in sepsis belongs to a subgroup of therapeutic interventions referred to as antiinflammatory or immunomodulatory strategies in the intensive care literature. Between the mid-1980s and the late 1990s, this approach was considered very promising. Against all expectations, it proved ineffective or even harmful in many cases. However, the recent literature is suggestive of a renewed interest in the topic. Therefore, we attempted at a retrospective search for causes of the failure.
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