Centrum pro vyzkum a vyvoj

Hradec Králové, Czech Republic

Centrum pro vyzkum a vyvoj

Hradec Králové, Czech Republic
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Objective: This study aimed to obtain recent epidemiological data on hospital-acquired pneumonia (HAP) in intensive care patients and to determine adequate empirical antimicrobial therapy. Setting: Department of Anaesthesiology, Resuscitation and Intensive Care Medicine. Patients and methods: The prospective, multicenter, observational study assessed the spectrum of detected bacterial pathogens and their resistance to antimicrobial agents. It was compared with a reference approach to initial antibiotic therapy in early- and late-onset HAP. Results: Total 317 patients were included in the study. The final patient sample comprised 201 subjects (159 males and 42 females) with a mean age of 59.9 years. Total 260 valid samples of lower respiratory tract secretions were obtained. Early- and late-onset HAP was detected in 26 (12.9%) and 175 (87.1%) patients, respectively. A total of 22 bacterial species were identified as etiological agents, with detection rates higher that 5% being noted in only 6 of them (Klebsiella pneumoniae 20.4%, Pseudomonas aeruginosa 20.0%, Escherichia coli 10.8%, Enterobacter spp. 8.1%, Staphylococcus aureus 6.2% and Burkholderia cepacia complex 5.8%). Gram-negative bacteria were most prevalent (86.1%). Patients with early-onset HAP had considerably higher prevalence of strains of Staphylococcus aureus (26.9%) and Haemophilus influenzae (15.4%). In late-onset HAP, most dominant were the strains of Pseudomonas aeruginosa (21.8%) and Klebsiella pneumoniae (21.4%). Most pathogens causing HAP (74.0%) were shown to have a unique restriction profile. Adequate initial empirical antibiotic therapy was noted in 59.7% of patients. Conclusion: The reference approach to initial empirical antibiotic therapy of early- and late-onset HAP was consistent with the spectrum of bacterial pathogens and their susceptibility to antimicrobial agents.

Zadak Z.,Centrum pro Vyzkum a Vyvoj | Hyspler R.,Centrum pro Vyzkum a Vyvoj | Ticha A.,Centrum pro Vyzkum a Vyvoj
Casopis Lekaru Ceskych | Year: 2015

The review article covers specific methods of artificial nutrition in current advances in intensive care. This area of care is somewhat specific, and indications for pharmaconutrients are different from classical artificial nutrition. The pharmaconutrients of amino acid and polyenoic fatty acid groups are described. The components of nutritional pharmacology, based on exceedingly high doses of pure nutritional substrates, are a useful and safe means of modifying selected mechanisms, such as fluidocoagulation, inflammatory reactions or vasomotorics.

Koblizek V.,Plicni Klinika | Pracharova S.,Plicni Klinika | Hronek M.,Centrum pro Vyzkum a Vyvoj | Kovarik M.,Centrum pro Vyzkum a Vyvoj
Studia Pneumologica et Phthiseologica | Year: 2013

Background: Psychological sequelae of chronic obstructive pulmonary disease (COPD) may influence the patients' functional status independently of disease severity. The presence of depression among several phenotypes of COPD is not clearly understood. Aim: The objective was to find out the actual rates of depression in both basic clinical phenotypes of COPD. Methods and material: Multicomponent assessment of 38 consecutive patients (6 females, 66.7 ± 7.6 years) with stable COPD (GOLD categories A 1, B21, CO, D 16) in an out-patient department of a university hospital (non-interventional cross-sectional Complexity of COPD Study). Results: Twenty-seven patients had bronchitic and 11 subjects suffered from non-bronchitic phenotypes of COPD (post-ipratropium and salbutamol FEV1 57.7 %). The bronchitic phenotype was associated with lower levels of depressive symptoms (Beck scale 5.1 ± 3.0, Zung scale 50.2 ±10.9) than the non-bronchitic subtype of COPD (Beck scale 8.3 ± 3.4, Zung scale 57.5 ± 7.4). However, the difference reached statistical significance only in Beck's questionnaire (p = 0.013; Mann-Whitney U-test). In all the other parameters (BMI, FFMI, education level, inhalation risk, 6-MWD, exercise desaturation, mMRC dyspnea, Celli's BODE, Puhan's BODE, ADO, CAT, all SGRQ domains, arterial blood gases, ECG heart rate), there were no differences between the two basic phenotypes. Conclusion: The non-bronchitic phenotype of COPD was associated with more depression complaints than the bronchitic one. This difference was not apparent in terms of quality of life, prognostic indices and numerous other variables describing the course of COPD.

Zadak Z.,Centrum pro vyzkum a vyvoj | Hyspler R.,Centrum pro vyzkum a vyvoj | Ticha A.,Centrum pro vyzkum a vyvoj
Anesteziologie a Intenzivni Medicina | Year: 2012

New role and rennaisance of branched chain aminoacids in intensive care The branched chain amino acids valine, leucine and isoleucine are essential nutrients with more than nutritional effects. They are important mediators and structural components in proteosynthesis and they regulate hormonal functions. Leucine is a precursor in cholesterol synthesis and as such plays an important role in muscle tissue growth and in sarcopenia suppression. Older and recent data are reviewed and support wider utilization of branched chain amino acids in intensive care.

Zadak Z.,Centrum Pro Vyzkum A Vyvoj | Ticha A.,Centrum Pro Vyzkum A Vyvoj | Hyspler R.,Centrum Pro Vyzkum A Vyvoj
Anesteziologie a Intenzivni Medicina | Year: 2016

The role of the bowel function in intensive care has for a long time been underestimated, but the metabolic or barrier function failure can have potentially fatal consequences. This review summarises the major causes and effects of functional and metabolic bowel damage with emphasis on critical care. The dominant factors are intestinal hypoperfusion consequent to systemic hypotension, restriction of blood flow in the mesenteric area due to partial obstruction of the mesenteric arteries, inflammation, toxicity of xenobiotics to enterocytes, infectious agents, lack of nutrients, ionizing radiation and mechanical bowel damage. The necessary tests for possible comorbidities, which further deteriorate bowel function, and specific intestinal laboratory examinations are described. These include saccharide absorption tests and determination of D-lactate or intestinal fatty acid binding protein. The basic options for nutritional improvement of the intestinal function are listed, namely minimal enteral nutrition, the current recommendations for prevention of intestinal damage in critical care and the cholinergic vagal stimulation concept using choline precursors. Adherence to such regimens facilitates restoration or maintenance of the gut function.

Hyspler R.,Centrum Pro Vyzkum A Vyvoj | Ticha A.,Centrum Pro Vyzkum A Vyvoj | Svobodova I.,Centrum Pro Vyzkum A Vyvoj | Zada Z.,Centrum Pro Vyzkum A Vyvoj
Klinicka Biochemie a Metabolismus | Year: 2015

Objective: The aim of the study was to develop and validate an easily available and robust enzymatic method for determination of D-lactate in blood plasma and urine. The developed method was used for the evaluation of plasmatic D-lactate levels in patients in perioperative care. Design: The article describes the methodology and presents the results of a prospective, observational study. Settings: Center for Research and Development, University Hospital Hradec Krové Material and Methods: Blood plasma was deproteinated by ultrafiltration; urine may be analysed directly. The principle of the method is the coupled reaction of D-lactate dehydrogenase reducing nicotinamide adenine dinucleotide and D-glutamate pyruvate transaminase. The end-point concentration of nicotinamide adenine dinucleotide is determined as absorbance at 340 nm. The patient cohort consisted of 117 patients operated for colorectal cancer. The blood samples were collected preoperatively, 2 hours after operation, and daily from the first to the fourth postoperative day. Data are presented as median (interquartile range). Results: The precision achieved in plasma was 1.5 - 4.9 %. A quantification limit of 10 μmol/L and detection limit of 5 μmol/l were found. The method is linear from 10 μmol/L to 1 mmol/L. Basal preoperative values of 33.4 (26.4; 39.7) μmol/L increased within two hours postoperatively to 90.2 (78; 101) μmol/L, and D-lactate concentration peaked on the first postoperative day. The concentration returned to basal values on the fourth day. Conclusion: The described method may be used widely in clinical chemistry laboratories due to its availability, robustness and simplicity, wherever D-lactate testing is required.

Zadak Z.,Centrum Pro Vyzkum A Vyvoj | Ticha A.,Centrum Pro Vyzkum A Vyvoj | Hronek M.,Centrum Pro Vyzkum A Vyvoj | Hyspler R.,Klinika Gerontologicka A Metabolicka
Vnitrni Lekarstvi | Year: 2011

Summary: Current model of metabolic and nutritional disorders management utilizes modern techniques that promote some of the nutritional techniques to pharmacoteherapy. This approach is demonstrated on an example of multiple organ failure and systemic inflammatory reaction managed with pharmacologically active nutritional substrates, such as arginine, glutamine, taurine, threonine and cysteine. Treatment of sarcopenia in older age is also discussed. Personalized nourishment as a component part of a wider term personalized medicine represents a new approach that requires recognition of individual differences in human genome and its expression. However, this approach also requires a change of attitude towards laboratory diagnostics and clinical practice, with patients and clinical prediction as the focal point. From this perspective, there is a need to replace current traditional laboratory tests with a new system that utilizes molecular biology and bioinformatics.

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