[Serious sepsis treatment in intensive care departments in the Czech Republic -  EPOSS Project pilot results]. / Lécba tezké sepse na pracovistích intenzivní péce v Ceské republice -  pilotní výsledky projektu EPOSS.

INTRODUCTION: Severe sepsis is still associated with significant morbidity and mortality, which is however different, as well as its management, depending on the region. What is the situation in the Czech Republic and what is the character of patients with severe sepsis is currently not known. The aim of the project is to describe the processes of care, outcome and characteristics of patients with severe sepsis admitted to the intensive care department of the Czech Republic. METHODS: This is a multicentre and observational project with retrospective enrollment of patients who meet the criteria for severe sepsis before or within 24 hours after admission to selected intensive care units (ICU EPOSS). RESULTS: 394 patients were analyzed. Median age at admission was 66 (56- 76) years, males predominated (58.9%) and the median APACHE II score on admission was 25 (19- 32). Patients were predominantly medical (56.9%) and most were secondary admitted from other ICU (53.6%). Meeting the criteria of severe sepsis was most frequently within the period (± 4 hours) of admission the EPOSS ICU (77.6%). Median total fluid intake during the first 24 hours was 6,680 (4,840- 9,450) ml. Most patients required mechanical ventilation (58.4%). Compliance with the resuscitation bundle of severe sepsis in our group was very good and was associated with lower mortality of patients. Most frequently, the EPOSS ICU length of stay (LOS) was 7 (3- 15) days and median hospital LOS was 13 (8- 28) days. Hospital mortality in our cohort was 35.8%. CONCLUSION: Introducing the project, which in its first stage obtained valuable and internationally comparable data about patients with severe sepsis admitted to the involved ICU in the Czech Republic.

Therapeutic hypothermia after out-of-hospital cardiac arrest with the target temperature 34-35 degrees C.

BACKGROUND: The objective of this study was to evaluate the impact of mild hypothermia (34-35 degrees C) on the final neurological outcome in patients after resuscitation from out-of-hospital cardiac arrest. METHODS: Forty three patients, admitted at University Hospital Brno after the out-of-hospital cardiac arrest, were included in the cohort study. The inclusion criteria were out-of-hospital cardiac arrest resulting from ventricular fibrillation or non-perfusing ventricular tachycardia as well as recovery of spontaneous circulation within 60 minutes after first symptoms. Blanketrol II (Cinncinnatti Sub Zero, USA) water mattresses were used for cooling the patients. The temperature was maintained at 34-35 degrees C for 24 hours. Favorable neurological outcome was defined as a Pittsburgh cerebral-performance category 1 (good recovery) or 2 (moderate disability) on five-category scale. RESULTS: The required temperature was reached in all patients; the cooling rate was 0.8 +/- 0.3 degrees C/hour. The time between the restoration of circulation and reaching the temperature of 35 degrees C was 119 +/- 32 minutes. The time induce the hypothermia (with the core body temperature below 35 degrees C) was 26 +/- 2 hours. Good outcome at hospital discharge was achieved in 21 out of 43 (49%) patients. Ten patients died in the hospital and two patients died after the discharge from the hospital, with the overall 6 months mortality being 28%. CONCLUSION: The study confirmed feasibility, safety and possible efficacy of the mild hypothermia (34-35 degrees C) patients after the cardiac arrest. To evaluate whether the target temperature 34-35 degrees C is as beneficial as 32-34 degrees C; a randomised controlled trial design should be used (Tab. 4, Fig. 2, Ref. 17). Full Text (Free, PDF) www.bmj.sk.

[Peroperative autotransfusion using a cell saver in ruptured aneurysms of the abdominal aorta]. / Vyuzití peroperacní autotransfuze cell saverem u ruptury aneuryzmatu brisní aorty.

The authors present five cases where a cell saver was used in rupture of an aneurysm of the abdominal aorta. During the peroperative collection they obtained 830 +/- 150 ml of autologous red cell concentrate. They assume that this blood is an invaluable source of volume replacement during urgent operations on the abdominal aorta.

[Impossibility of artificial ventilation in a prone position in a patient with deformity of the spine (case-history).]. / Znemoznení umelé plicní ventilace pronacní polohou u nemocné s deformitou pátere.

The authors present the case of a 15-year-old female patient (Jehova's Witness) who was operated at the age of two on account of a Wilms' tumour of the kidney and irradiated with subsequent postirra-diation scoliosis. In 1990-1993 she was six times subjected to anaesthesia for distraction with a Harrington rod and repeated redistractions. All anaesthesias were of the general type, with artificial pulmonary ventilation in the prone position and without complications. Anaesthesiological methods and procedures were used which made it possible to avoid administration of blood or blood derivatives. In March 1993 the patient was prepared with erythropoietin for the final treatment of the deformed spine. During general anaesthesia suddenly artificial pulmonary ventilation in a prone position became impossible due to complete collapse of the trachea closely behind the end of the armed tracheal tube. After postponing the procedure, bronchoscopic and CT examination in a supine position during spontaneous respiration confirmed stenosis of the distal portion of the trachea to one third of the lumen. The authors assume that the cause are altered anatomical relations of the mediastinum caused by distraction and repeated redistractions in a field affected by irradiation. Key words: deformity of the spine, stenosis of the trachea, Jehova's Witnesses.