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1. Intravenous enoxaparin as alternative ECMO anticoagulation over a period of 94 days: a case report

Author: Miroslav Durila, Jan Berousek, Vlasta Vlasakova, and Tomas Vymazal
Subjects: Pulmonary and Respiratory Medicine, Surgery, General Medicine, Cardiology and Cardiovascular Medicine
Abstract: Background Unfractionated heparin is used worldwide as a standard anticoagulation therapy for extracorporeal membrane oxygenation (ECMO) machines. However, its use brings about significant bleeding and thrombotic complications for critically ill patients. This case report shows that low molecular weight heparin together with ECMO-produced primary haemostasis pathology can be used as an alternative way of ECMO anticoagulation. Case presentation This paper presents the case of a patient with respiratory failure who subsequently suffered from cardiac failure and spent 94 days on combined V-V and V-A ECMO devices (two ECMO devices running simultaneously on one patient) with intravenous enoxaparin used instead of unfractionated heparin anticoagulation. No life-threatening bleeding/thrombotic events happened during this period, nor did any technical problems with ECMO occur. Conclusions In this case report, continuous intravenous low molecular weight heparin anticoagulation was used as a safe alternative to ECMO anticoagulation.
Published: 2023
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2. Effect of targeted coagulopathy management and 5% albumin as volume replacement therapy during lung transplantation on allograft function: a secondary analysis of a randomized clinical trial

Author: Jaromir Vajter, Jiri Vachtenheim, Zuzana Prikrylova, Jan Berousek, Tomas Vymazal, Robert Lischke, Archer Kilbourne Martin, and Miroslav Durila
Subjects: Pulmonary and Respiratory Medicine
Abstract: Background Primary graft dysfunction (PGD) after lung transplantation (LuTx) contributes substantially to early postoperative morbidity. Both intraoperative transfusion of a large amount of blood products during the surgery and ischemia–reperfusion injury after allograft implantation play an important role in subsequent PGD development. Methods We have previously reported a randomized clinical trial of 67 patients where point of care (POC) targeted coagulopathy management and intraoperative administration of 5% albumin led to significant reduction of blood loss and blood product consumption during the lung transplantation surgery. A secondary analysis of the randomized clinical trial evaluating the effect of targeted coagulopathy management and intraoperative administration of 5% albumin on early lung allograft function after LuTx and 1-year survival was performed. Results Compared to the patients in the control (non-POC) group, those in study (POC) group showed significantly superior graft function, represented by the Horowitz index (at 72 h after transplantation 402.87 vs 308.03 with p p n = 9) and 3.2% (n = 1), respectively (p = 0.003). The difference in 1-year survival was not statistically significant (10 patients died in non-POC group vs. 4 patients died in POC group; p = 0.17). Conclusions Utilization of a POC targeted coagulopathy management combined with Albumin 5% as primary resuscitative fluid may improve early lung allograft function, provide better circulatory stability during the early post-operative period, and have potential to decrease the incidence of PGD without negative effect on 1-year survival. Trial registration This clinical trial was registered at ClinicalTrials.gov (NCT03598907).
Published: 2023
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3. Should minimally invasive approaches in rectal surgery be regarded as a key element of modern enhanced recovery perioperative care?

Author: P. Kocian, Tomas Vymazal, Adam Whitley, Jiří Hoch, Petr Přikryl, and Filip Pazdirek
Subjects: Laparoscopic surgery, medicine.medical_specialty, Surgical stress, Colorectal cancer, business.industry, medicine.medical_treatment, General Medicine, medicine.disease, Surgery, Enhanced recovery, Cohort, medicine, Robotic surgery, Rectal surgery, medicine.symptom, business, Postoperative nausea and vomiting
Abstract: INTRODUCTION The aim of study was to assess the impact of an enhanced recovery after surgery (ERAS) protocol and minimally invasive approaches on short-term outcomes in rectal surgery. PATIENTS AND METHODS A consecutive series of patients that underwent open or minimally invasive rectal resections in a single institution between January 2015 and April 2020 were included in the study. An ERAS program was introduced in April 2016. The study cohort was divided into three groups: open surgery without ERAS, open surgery with ERAS, and minimally invasive surgery with ERAS. Outcome measures compared were recovery parameters, surgical stress parameters, 30-day morbidity and mortality, oncological radicality and length of hospital stay. RESULTS A total of 202 patients were included: 43 in the open non-ERAS group, 92 in the open ERAS group and 67 in the minimally invasive ERAS group. All recovery parameters apart from postoperative nausea and vomiting were significantly improved in both ERAS groups. Surgical stress parameters, prolonged postoperative ileus, and hospital stay were significantly reduced in the minimally invasive ERAS group. The overall 30-day morbidity and mortality and oncological radicality did not significantly differ among the three groups. CONCLUSIONS Minimally invasive approaches and enhanced recovery care in rectal surgery improve short-term outcomes. Their combination leads to an improvement in recovery parameters and a reduction of prolonged postoperative ileus and hospital stay.
Published: 2021
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4. Rotational thromboelastometry reduces blood loss and blood product usage after lung transplantation

Author: Lukas Pollert, Jan Berousek, Miroslav Durila, Robert Lischke, Jiri Vachtenheim, Michal Garaj, Jaromir Vajter, and Tomas Vymazal
Subjects: Male, Pulmonary and Respiratory Medicine, medicine.medical_treatment, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Blood product, Coagulopathy, medicine, Humans, Lung transplantation, Blood Transfusion, Pandemics, Point of care, Hemostasis, Transplantation, SARS-CoV-2, business.industry, COVID-19, Perioperative, Blood Coagulation Disorders, Middle Aged, medicine.disease, Thrombelastography, Thromboelastometry, Anesthesia, Female, Surgery, Fresh frozen plasma, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Lung Transplantation
Abstract: BACKGROUND: The shortage of blood products has become a worldwide problem, especially during the COVID-19 Pandemic. Here, we investigated whether a point of care (POC) approach to perioperative bleeding and coagulopathy based on rotational thromboelastometry (ROTEM) results could decrease perioperative blood loss and the perioperative consumption of blood products during lung transplantation. METHODS: Patients undergoing bilateral lung transplantation were randomized into two groups: In the first group, designated the "non POC" group, the management of perioperative bleeding and coagulopathy was based on the clinical experience of the anesthesiologist; in the second group, designated the "POC" group, the management of perioperative bleeding, and coagulopathy was based on the ROTEM results. RESULTS: After performing an interim statistical analysis, the project was prematurely terminated as the results were significantly in favor of the POC approach. Data were analyzed for the period January 2018 until June 2020 when 67 patients were recruited into the study. There was significantly decreased perioperative blood loss in the POC group (nâ¯=â¯31 patients) with pâ¯=â¯0.013, decreased perioperative consumption of RBC with pâ¯=â¯0.009, and decreased perioperative consumption of fresh frozen plasma with p < 0.0001 (practically no fresh frozen plasma was used in the POC group) without deteriorating clot formation in secondary and primary hemostasis as compared to the non POC group (nâ¯=â¯36). CONCLUSION: POC management of perioperative bleeding and coagulopathy based on ROTEM results is a promising strategy to decrease perioperative blood loss and the consumption of blood products in lung transplantation.
Published: 2021
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5. COVID-19 severe pneumonia: Prospective multicentre study on demands on intensive care capacities

Author: Michal Moravec, Tomáš Hyánek, Olga Džupová, Jiří Beneš, Frantisek Mosna, Hynek Bartoš, Zdeňka Krupková, Jan Berousek, Tomáš Tencer, Tomas Vymazal, and Peter Brestovanský
Subjects: Adult, Male, medicine.medical_specialty, Critical Care, medicine.medical_treatment, Population, law.invention, law, Intensive care, Extracorporeal membrane oxygenation, Humans, Medicine, Hospital Mortality, Prospective Studies, Renal replacement therapy, education, Aged, education.field_of_study, SARS-CoV-2, business.industry, Public Health, Environmental and Occupational Health, Acute kidney injury, COVID-19, General Medicine, medicine.disease, Intensive care unit, Respiratory failure, Emergency medicine, Female, business, Kidney disease
Abstract: OBJECTIVES: The aim of the study was to obtain data on demands on the intensive care capacities to treat COVID-19 patients, and to identify predictors for in-hospital mortality. METHODS: The prospective observational multicentre study carried out from 1 March till 30 June 2020 included adult patients with confirmed SARS-CoV-2 infection with respiratory failure requiring ventilatory support or high-flow nasal oxygen therapy (HFNO). RESULTS: Seventy-four patients, 46 males and 28 females, median age 67.5 (Q1-Q3: 56-75) years, were included. Sixty-four patients (86.5%) had comorbidity. Sixty-six patients (89.2%) were mechanically ventilated, four of them received extracorporeal membrane oxygenation therapy. Eight patients (10.8%) were treated with non-invasive ventilation and HFNO only. The median of intensive care unit (ICU) stay was 22.5 days. Eighteen patients (24.3%) needed continuous renal replacement therapy. Thirty patients (40.5%) died. Age and acute kidney injury were identified as independent predictors of in-hospital death, and chronic kidney disease showed trend towards statistical significance for poor outcome. CONCLUSIONS: Sufficient number of intensive care beds, organ support equipment and well-trained staff is a decisive factor in managing the COVID-19 epidemic. The study focused on the needs of intensive care in the COVID-19 patients. Advanced age and acute kidney injury were identified as independent predictors for in-hospital mortality. When compared to clinical course and ICU management of patients with severe community-acquired pneumonia caused by other pathogens, we observed prolonged need for ventilatory support, high rate of progression to acute respiratory distress syndrome and significant mortality in studied population.
Published: 2021
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6. Prospective, randomized, controlled, double-blind, multi-center, multinational study on the safety and efficacy of 6% Hydroxyethyl starch (HES) sOlution versus an Electrolyte solutioN In patients undergoing eleCtive abdominal Surgery: study protocol for the PHOENICS study

Author: Wolfgang Buhre, Dianne de Korte-de Boer, Marcelo Gama de Abreu, Thomas Scheeren, Matthias Gruenewald, Andreas Hoeft, Donat R. Spahn, Alexander Zarbock, Sylvia Daamen, Martin Westphal, Ute Brauer, Tamara Dehnhardt, Sonja Schmier, Jean-Francois Baron, Stefan De Hert, Željka Gavranović, Bernard Cholley, Tomas Vymazal, Wojciech Szczeklik, Helmar Bornemann-Cimenti, Marina Blanca Soro Domingo, Ioana Grintescu, Radmilo Jankovic, Javier Belda, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), University of Zurich, Buhre, Wolfgang, MUMC+: Centrum voor Acute en Kritieke Zorg (3), RS: MHeNs - R3 - Neuroscience, Anesthesiologie, and MUMC+: MA Anesthesiologie (9)
Subjects: Male, Hydroxyethyl starch, 10216 Institute of Anesthesiology, Plasma Substitutes, Medicine (miscellaneous), 610 Medicine & health, GLOMERULAR-FILTRATION-RATE, Hydroxyethyl Starch Derivatives, Electrolytes, Double-Blind Method, Abdomen, Medicine and Health Sciences, 2736 Pharmacology (medical), Humans, Multicenter Studies as Topic, Pharmacology (medical), Volume therapy, Multi-center, Prospective Studies, Colloids, Non-inferiority trial, DIRECTED FLUID THERAPY, Randomized Controlled Trials as Topic, Aged, 80 and over, OUTCOMES, Double-blinded, RESUSCITATION, MORTALITY, Blood loss, 2701 Medicine (miscellaneous), HES, trial, Randomized controlled trial, Randomized controlled, Multinational, SURVIVAL, Female, Surgery, TRIAL, Safety, ACUTE-RENAL-FAILURE
Abstract: Background Hydroxyethyl starch (HES) solutions are used for volume therapy to treat hypovolemia due to acute blood loss and to maintain hemodynamic stability. This study was requested by the European Medicines Agency (EMA) to provide more evidence on the long-term safety and efficacy of HES solutions in the perioperative setting. Methods PHOENICS is a randomized, controlled, double-blind, multi-center, multinational phase IV (IIIb) study with two parallel groups to investigate non-inferiority regarding the safety of a 6% HES 130 solution (Volulyte 6%, Fresenius Kabi, Germany) compared with a crystalloid solution (Ionolyte, Fresenius Kabi, Germany) for infusion in patients with acute blood loss during elective abdominal surgery. A total of 2280 eligible patients (male and female patients willing to participate, with expected blood loss ≥ 500 ml, aged > 40 and ≤ 85 years, and ASA Physical status II–III) are randomly assigned to receive either HES or crystalloid solution for the treatment of hypovolemia due to surgery-induced acute blood loss in hospitals in up to 11 European countries. The dosing of investigational products (IP) is individualized to patients’ volume needs and guided by a volume algorithm. Patients are treated with IP for maximally 24 h or until the maximum daily dose of 30 ml/kg body weight is reached. The primary endpoint is the treatment group mean difference in the change from the pre-operative baseline value in cystatin-C-based estimated glomerular filtration rate (eGFR), to the eGFR value calculated from the highest cystatin-C level measured during post-operative days 1-3. Further safety and efficacy parameters include, e.g., combined mortality/major post-operative complications until day 90, renal function, coagulation, inflammation, hemodynamic variables, hospital length of stay, major post-operative complications, and 28-day, 90-day, and 1-year mortality. Discussion The study will provide important information on the long-term safety and efficacy of HES 130/0.4 when administered according to the approved European product information. The results will be relevant for volume therapy of surgical patients. Trial registration EudraCT 2016-002162-30. ClinicalTrials.govNCT03278548
Published: 2022
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7. THE ASSESSMENT OF STRUCTURAL CONCRETE WITH RECYCLED AGGREGATES IN TERMS OF SUSTAINABILITY

Author: Kristyna Hrabova, Jakub Niedoba, Tomas Vymazal, Jaromir Lanik, and Bretislav Teply
Published: 2021
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8. Effect of Dexamethasone In Patients With ARDS And COVID-19 (REMED Trial) – Study Protocol For A Prospective, Multi-Centre, Open-Label, Parallel-Group, Randomized Controlled Trial

Author: Tomas Vymazal, Mervyn Singer, Jana Vinklerová, Tomáš Gabrhelík, Martin Balik, Jan Zatloukal, Jana Kubátová, František Duška, Olga Klementova, Roman Gál, Milan Kratochvíl, Adam Svobodník, Jan Maláska, Jozef Klučka, Jan Stašek, Jan Hruda, Jan Máca, Regina Demlová, and Pavel Novotný
Subjects: Protocol (science), ARDS, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, medicine.disease, law.invention, Randomized controlled trial, law, Internal medicine, medicine, In patient, Multi centre, Open label, business, Dexamethasone, medicine.drug
Abstract: Background: Since December 2019, SARS-Co-2 virus has infected millions of people worldwide. In patients with COVID-19 pneumonia in need for oxygen therapy or mechanical ventilation, dexamethasone 6 mg per day is currently recommended. However, the dose of 6 mg of dexamethasone is currently being reappraised and may miss important therapeutic potential or may prevent a potential deleterious effects of a higher doses of corticosteroids. Methods: REMED is a prospective, open-label, randomised controlled trial testing superiority of dexamethasone 20 mg (dexamethasone 20 mg on day 1–5, followed by dexamethasone 10 mg on day 6–10) vs 6 mg administered once daily intravenously for 10 days in adult patients with moderate or severe ARDS due to confirmed COVID-19. 300 participants will be enrolled and followed up for 360 days after randomization. Patients will be randomised in a 1:1 ratio into one of the two treatment arms. Following stratification factors will be applied: age, Charlson Comorbidity index, CRP levels and trial centre. Primary endpoint is number of ventilator-free days (VFDs) at 28 days after randomisation. Secondary endpoints are mortality from any cause at 60 days after randomisation; Dynamics of inflammatory marker, change in WHO Clinical Progression Scale at Day 14; Adverse events related to corticosteroids and independence at 90 days after randomisation assessed by Barthel Index.The long-term outcomes of this study are to assess long-term consequences on mortality and quality of life at 180 and 360 days. The study will be conducted in the intensive care units (ICUs) of ten university hospitals in the Czech Republic. Discussion: We aim to compare two different dose of dexamethasone in patients with moderate to severe ARDS undergoing mechanical ventilation regarding efficacy and safetyTrial registration: EudraCT No.:2020-005887-70 and ClinicalTrials.gov Identifier: NCT04663555 on December 11, 2020 on ClinicalTrials.gov
Published: 2021
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9. Efficacy and safety of suvratoxumab for prevention of Staphylococcus aureus ventilator-associated pneumonia (SAATELLITE)

Author: Saad Nseir, Thierry Boulain, Georgios Baltopoulos, Julie Vignaud, Adel Maamar, Kathryn Shoemaker, Bertrand Souweine, Frédéric Dailler, Pierre-François Laterre, Pedro Moura, Jacques Creteur, Lucia Viña Soria, Terramika Bellamy, Andreas Meier-Hellmann, Alain Mercat, Matthias Gründling, Johann Motsch, Djillali Annane, Paula Ramirez, Christophe Guitton, Antonio Torres Marti, Marco Maggiorini, Tomas Suchy, Alain Lepape, Petr Svoboda, Michal Hanauer, Jan Pachl, Martin Balik, Jérôme Pugin, Jean-Christophe Navellou, Miguel Sánchez-García, Laurent Argaud, Arnaud Desachy, Vasilios Koulouras, Jean-Luc Pagani, Raúl De Pablo Sanchez, Pierre-François Dequin, Carole Schwebel, Ana Catalina Hernandez Padilla, Georgios Filntisis, Patrick Biston, Tomas Vymazal, Juan Carlos Valia, Vadryn Pierre, Frank E. J. Coenjaerts, Frank Wappler, Vladimir Sramek, Fabienne Tamion, Ildikó Krémer, Hasan S Jafri, Zsuzsa Marjanek, Didier Chochrad, Jose Lorente, Marc Simon, Herbert Spapen, Juan Carlos Montejo González, Omar Ali, Cédric Bretonnière, Maria Consuelo Pintado Delgado, Filip Dubovsky, Leen Timbermont, Apostolos Komnos, Christine Lammens, Pin Ren, Tobias Welte, Spyros Zakynthinos, Olivier Barraud, Tomas Hruby, Alain Dive, Herman Goossens, Alexey Ruzin, Marc J. M. Bonten, Ricard Ferrer Roca, Lorenz Reill, Yves Bouckaert, Epaminondas Zakynthinos, Zoltán Szentkereszty, Oliver A. Cornely, Josep Trenado, Antoine Gros, Marc Bourgeois, Ferhat Meziani, Katrin Schmidt, Bruno François, Philippe Eggimann, Ioanna Soultati, Jean-Marc Tadie, Frank Bloos, Agnes Sarkany, Francis Schneider, Susan Colbert, Maria Deja, Mark T. Esser, Gilles Francony, Caroline Rolfes, Martin Nováček, Ana Loza Vazquez, Yuling Wu, Jean-Yves Lefrant, Dolores Escudero, Jean Chastre, Frédéric Foret, René Robert, Vasileios Bekos, Vincent Huberlant, Ioannis Pnevmatikos, Vriendenkring VUB, Supporting clinical sciences, Intensive Care, Internal Medicine Specializations, COMBACTE Consortium, SAATELLITE Study Group, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, and UCL - (SLuc) Service de soins intensifs
Subjects: 0301 basic medicine, Male, Pilot Projects, Critical Care and Intensive Care Medicine, law.invention, 0302 clinical medicine, Randomized controlled trial, Belgium, law, Germany, Data monitoring committee, 030212 general & internal medicine, Lung, Czech Republic, education.field_of_study, Greece, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, Staphylococcal Infections, Middle Aged, 3. Good health, Infectious Diseases, Treatment Outcome, Broadly Neutralizing Antibodies/administration & dosage, young adult, Female, France, Switzerland, Antibodies, Monoclonal, Humanized/administration & dosage, Adult, medicine.medical_specialty, Staphylococcus aureus, Adolescent, 030106 microbiology, Population, Staphylococcus aureus/drug effects, Placebo, Antibodies, Monoclonal, Humanized, lung, Young Adult, 03 medical and health sciences, Double-Blind Method, Internal medicine, Pneumonia, Ventilator-Associated/prevention & control, medicine, Humans, Adverse effect, education, Aged, Hungary, Portugal, business.industry, medicine.disease, Interim analysis, Respiration, Artificial, Pneumonia, Staphylococcal Infections/prevention & control, Spain, Human medicine, business, Broadly Neutralizing Antibodies
Abstract: Summary Background Staphylococcus aureus remains a common cause of ventilator-associated pneumonia, with little change in incidence over the past 15 years. We aimed to evaluate the efficacy of suvratoxumab, a monoclonal antibody targeting the α toxin, in reducing the incidence of S aureus pneumonia in patients in the intensive care unit (ICU) who are on mechanical ventilation. Methods We did a multicentre, randomised, double-blind, placebo-controlled, parallel-group, phase 2 pilot trial at 31 hospitals in Belgium, the Czech Republic, France, Germany, Greece, Hungary, Portugal, Spain, and Switzerland. Eligible patients were in the ICU, aged ≥18 years, were intubated and on mechanical ventilation, were positive for S aureus colonisation of the lower respiratory tract, as assessed by quantitative PCR (qPCR) analysis of endotracheal aspirate, and had not been diagnosed with new-onset pneumonia. Patients were excluded if they had confirmed or suspected acute ongoing staphylococcal disease; had received antibiotics for S aureus infection for more than 48 h within 72 h of randomisation; had a Clinical Pulmonary Infection Score of 6 or higher; had an acute physiology and chronic health evaluation II score of 25 or higher with a Glasgow coma scale (GCS) score of more than 5, or an acute physiology and chronic health evaluation II score of at least 30 with a GCS score of 5 or less; had a Sequential Organ Failure Assessment score of 9 or higher; or had active pulmonary disease that would impair the ability to diagnose pneumonia. Colonised patients were randomly assigned (1:1:1), by use of an interactive voice or web response system, to receive either a single intravenous infusion of suvratoxumab 2000 mg, suvratoxumab 5000 mg, or placebo. Randomisation was done in blocks of size four, stratified by country and by whether patients had received systemic antibiotics for S aureus infection. Patients, investigators, and study staff involved in the treatment or clinical evaluation of patients were masked to patient assignment. The primary efficacy endpoint was the incidence of S aureus pneumonia at 30 days, as determined by a masked independent endpoint adjudication committee, in all patients who received their assigned treatment (modified intention-to-treat [ITT] population). Primary safety endpoints were the incidence of treatment-emergent adverse events at 30 days, 90 days, and 190 days after treatment, and the incidence of treatment-emergent serious adverse events, adverse events of special interest, and new-onset chronic disease at 190 days after treatment. All primary safety endpoints were assessed in the modified ITT population. This trial is registered with ClinicalTrials.gov ( NCT02296320 ) and the EudraCT database (2014-001097-34). Findings Between Oct 10, 2014, and April 1, 2018, 767 patients were screened, of whom 213 patients with confirmed S aureus colonisation of the lower respiratory tract were randomly assigned to the suvratoxumab 2000 mg group (n=15), the suvratoxumab 5000 mg group (n=96), or the placebo group (n=102). Two patients in the placebo group did not receive treatment after randomisation because their clinical conditions changed and they no longer met the eligibility criteria for dosing. As adjudicated by the data monitoring committee at an interim analysis, the suvratoxumab 2000 mg group was discontinued on the basis of predefined pharmacokinetic criteria. At 30 days after treatment, 17 (18%) of 96 patients in the suvratoxumab 5000 mg group and 26 (26%) of 100 patients in the placebo group had developed S aureus pneumonia (relative risk reduction 31·9% [90% CI −7·5 to 56·8], p=0·17). The incidence of treatment-emergent adverse events at 30 days were similar between the suvratoxumab 5000 mg group (87 [91%]) and the placebo group (90 [90%]). The incidence of treatment-emergent serious adverse events at 30 days were also similar between the suvratoxumab 5000 mg group (36 [38%]) and the placebo group (32 [32%]). No significant difference in the incidence of treatment-emergent adverse events between the two groups at 90 days (89 [93%] in the suvratoxumab 5000 mg group vs 92 [92%] in the placebo group) and at 190 days (93 [94%] vs 93 [93%]) was observed. 40 (40%) patients in the placebo group and 50 (52%) in the suvratoxumab 5000 mg group had a serious adverse event at 190 days. In the suvratoxumab 5000 mg group, one (1%) patient reported at least one treatment-emergent serious adverse event related to treatment, two (2%) patients reported an adverse event of special interest, and two (2%) reported a new-onset chronic disease. Interpretation In patients in the ICU receiving mechanical ventilation with qPCR-confirmed S aureus colonisation of the lower respiratory tract, the incidence of S aureus pneumonia at 30 days was not significantly lower following treatment with 5000 mg suvratoxumab than with placebo. Despite these negative results, monoclonal antibodies still represent one promising therapeutic option to reduce antibiotic consumption that require further exploration and studies. Funding AstraZeneca, with support from the Innovative Medicines Initiative Joint Undertaking.
Published: 2021

10. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Author: Labeau, Sonia O, Afonso, Elsa, Benbenishty, Julie, Blackwood, Bronagh, Boulanger, Carole, Brett, Stephen J, Calvino-Gunther, Silvia, Chaboyer, Wendy, Coyer, Fiona, Deschepper, Mieke, François, Guy, Honore, Patrick M, Jankovic, Radmilo, Khanna, Ashish K, Llaurado-Serra, Mireia, Lin, Frances, Rose, Louise, Rubulotta, Francesca, Saager, Leif, Williams, Ged, Blot, Stijn I, Dritan, Muzha, Antoni Margarit Ribas, Fernando, Lipovesty, Cecilia, Loudet, Fiona, Coyer, Philipp, Eller, Nafseen, Mostafa, Patrick, M Honoré, Vanesa Mercado Telleria, Jasmina, Smajic, Paula Cristina Nogueira, Khalid Mahmood Khan Nafees, Romuald, Hentchoya, Louise, Rose, Javiera, Soledad, Frances, Lin, Yenny, Cardenas, Amylkar Garay Reyes, Alan, Sustic, Meropi, Mpouzika, Tamas, Vymazal, Hanne Irene Jensen, Hernan, Aguirre-Bermeo, Liivi, Maddison, Maija, Valta, Silvia, Calvino-Gunther, Frank, Bloos, Faustina Excel Adipa, Vasilios, Koulouras, Judy, Enamorado, Zsuzsann, Ágoston, Hrönn, Birgisdóttir, Amit, Gupta, Mohan, Gurjar, Bram, Kilapong, Seyed Mohammadreza Hashemian, Ignacio, Martin-Loeches, Julie, Benbenishty, Andrea, Cortegiani, Kelly, Fletcher, Yoshiro, Hayashi, Wangari, Waweru-Siika, Khalid, Abidi, Sang-Min, Lee, Burhan, Hadri, Mihails, Dolgusevs, Fayez François Abillama, Tomas, Jovaisa, Cyril, Thix, Muhammed, Elhadi, Basri Mat Nor, Shanti, Ratnam, Mohd Zulfakar Mazlan, Sundaresan, Maiyalagan, Luis, Sánchez-Hurtado, Adrian, Belii, Mendsaikhan, Naranpurev, Prabha, Gautam, Dylan De Lange, Rachael, Parke, Rose Ekama Ilesanmi, Mirjana, Shosholcheva, Antonija, Petosic, Ranveig, Lind, Madiha Hashmi Ffarcsi, Javier, Bogarin, Aaron Mark Hernandez, Malgorzata, Mikaszewska-Sokolewicz, Bruno, Sousa, Dana, Tomescu, Dorel, Sandesc, Theogene, Twagirumugabe, Vitaly, Gusarov, Maie, Ebaid, Radmilo, Jankovic, Gari, Slobodianiuk, Andrea, Martonova, Rihard, Knafelj, Mervyn, Mer, Emilio, Maseda, Bernardo, Panka, Joerg, C Schefold, Eva, Joelsson-Alm, Konlawij, Trongtrakul, Lorna, Merritt-Charles, Lamia Ouanes Besbes, Yalım, Dikmen, Lesia, Zgrzheblovska, Mark, Fielding, Francesca, Rubulotta, Ashish, K Khanna, Leif, Saager, Ingrid von der Osten, Alban, Greca, Alma, Cani, Nordian, Xhindi, Genci, Hyska, Antonio Margarit Ribas, Susana, Pinto, Paulo, Alves, Romina, Esposito, Emanuel, Valgolio, John Thomas Sanchez Minope, Antonio, Abdala, Maria, Ayala, Silvina, Bravo, Ana, Bantar, Patricia, Delgado, Gustavo, Badariotti, Fernando, Lipovestky, Ana, Diaz, Pablo, Saul, Mariano, Setten, Alejandra, Aucapina, Ysica, Acosta, Victor, Gonzalez, Luis, Camputaro, Fernando, Baccaro, Robert, Villa, Marcela, Mastantuono, Emiliano, Dean, Oscar Fernández Rostello, Patricia, Brizuela, Julio Ricardo Bartoli, Matias, Guereschi, Cristian, Quiroga, Sofia, Putruele, Paula, Villegas, Veronica, Curilen, Ruben, Fernandez, Mariangeles Gabriela Nocheretti, Rosana Gabriela Escalante, Cecilia Inés Loudet, Silvia, Fernandez, Ana Laura Gonzalez, Gustavo Andres Alvarez, Federico, Iglesias, Silvia, Chaparro, Graciela, Zakalik, Gonzalo, Pagella, Matías, Baini, Pierina Arias Campos, Ignacio, Sabbag, Armando, Schmukler, Imelda Perdomo Fonseca, Gonzalo Martín Alvarez, Mario, Ramirez, Fernando, Tapia, Carlos Alejandro Bascary, Graciela Del Valle Gimenez, Fernando Pablo Bertoletti, Esteban, Milioto, Pablo Julio Maldonaldo Bonsignore, Maria Alejandra Fernandez, Julie, Smith, Tim, Chimunda, Lorraine, Thompson, Teena, Maguire, Wendy, Chaboyer, Stacey, Watts, Marion, Mitchell, Madeleine, Powell, India, Lye, Leanne, Parsons, Nerilee, Baker, Claire, Reynolds, Amy, Thompson, Kristy, Masters, Kellie, Sosnowski, Lynette, Morrison, Gavin, D Leslie, Ramanathan, Lakshmanan, Alexis, Tabah, Wendy, Brown, Sharon, McDowell-Skaines, Andrea, Mclucas, Chris, Smith, Mandy, Tallot, Sarah, Jones, Michelle, Barakat-Johnson, Thomas, Leong, Rand, Butcher, Kerrie, Martin, Philipp, Douschan, Dirk von Lewinski, René, Schmutz, Uta, Kolussi, Fatema, Salman, Zainab, Ateya, Koen De Decker, Niels Van Regenmortel, Anita, Jans, Patricia, Wijnands, Stefano, Coremans, Patrick, M Honore, David De Bels, Tanja, Depuydt, Caroline, Paillet, Luc-Marie, Jacquet, Walter, Swinnen, Francis, Hannes, Matthia, Mergeay, Stijn Van de Velde, Silvie, Allaert, Pieter, Hoste, Christophe, Borin, Sandrine, Balon, Vincent, Fraipont, Patrick, Biston, Nicolas De Schryver, Thierry, Dugernier, Ilse Van Cotthem, Angelica Olivetto de Almeida, Silvia Angelica Jorge, Delmiro, Becker, Raysa Cristina Schmidt, Evellyn, Oliveira, Aline, Ramalho, Eliane, Mazocoli, Audrey, Fioretti, Elaine, Barros, Leticia, Serpa, Suzana, Bianchini, Ticiane, Campanili, Taís, Pantaleao, Paulo Carlos Garcia, Ana Lucia Vitti Ronchini, Rayanne, Santos, Nurulhuda Binti, A Manap, Sean, Bagshaw, Dominic, Carney, Jon, Davidow, Ella, Rokosh, Andréa Maria Laizner, Samantha, Smith, Megan, Mcquirter, Betty Star Kampayana, René, Favre, Martin, Sills, Julie, Dallaire, Cathy, Becker, Sherissa, Microys, Bonnie, Bowes, Jennifer, Lajeunesse, Rishi, Ghosh, Jacqueline, Baptiste-Savoie, Rose, 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Michael, Isanan, Marta, Tubacka, Przemyslaw, Jasiewicz, Miroslaw, Czuczwar, Michal, Borys, Aleksandra, Gutysz-Wojnicka, Lidia, Glinka, Ryszard, Gawda, Jan, Bilawicz, Paula, Cabrita, João, Vieira, Margarida Ferreira Figueiredo, Cristiana Mota Pinheiro, Nelson, Antunes, Laura, Pedro, Fatima, Ferreira, Isabel, Parente, Maria, Varela, Fatima, Fernandes, Claudia, Martins, Abel, Viveiros, Raquel, Cavaco, Clara Santa Rita, Sofia, Dias, Ana Margarida Feranandes, Pedro, Silva, Catarina, Nunes, João, Cabral, Filpe, Pires, Hilaryano, Ferreira, Jacinta, Santos, Vitor Manuel Vaz Pinto, Bruno Miguel Bispo, Amelia, Ferreira, Elena, Molinos, Estevão, Lafuente, Ricardo, Gregorio, Humberto, Costa, Ângela, Lima, Susana, Ferreira, Vanda, Seromenho, Eulália, Luis, Idália, Valerio, Helena, Cesar, Ana, Tavares, Ahmed Subhy Alsheikhly, Saeed, Mahmood, Catalin Traian Guran, Alida, Moise, Daniela Carmen Filipescu, Mihail, Luchian, Mihai, Popescu, Monica Adriana Scutariu, Cristina, Petrisor, Natalia, Hagau, 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Slobodianiuk, Daria, Rabarova, Danca, Lančaričová, Janko, Vlaovic, Matjaž, Groznik, Milica, Lukic, Janja, Perme, Maja, Sostaric, Nejc, Umek, Tomislav, Mirkovic, Simon, Dolenc, Misa, Fister, Nika, Zorko, Andrej, Markota, Nomhle Princess Yeni, Phumele, Jali, Shelley, Schmollgruber, Muhommed Ridwaan Syed, Nivisha, Parag, Robert, Wise, Maria, Galiana, José Alejandro Navarro, Ana María De Pablo, Patricia, Albert, Pilar, Martinez, Yolanda, Mendiara, Barbara, Garcia, Ana Alabart Llinas, Marilyn, Riveiro, Elisabet, Gallart, Alba, Riera, Miquel, Sanz, Swagotika, Salo, Miguel Angel Gimenez Lajara, Montserrat Venturas Nieto, Rosa, Garcia, José Manuel Garcia Pena, Maria Carmen Gorgolas, Maria Aranzazu Isasi, Rafael, Sierra, Federico, Gordo, Isabel, Conejo, Vicent, Salvà-Costa, Carolina, Garzón-Tovar, Sara, Lospitao, Rafael, Gonzalez, Pedro, Gutierrez, Mercè, Girona, Jordi, Adamuz, Pablo Garcia Olivares, José Peral Gutierrez de Ceballos, Celia, Tirado, Irene De Wit, Ana Belén Curto Polo, Maria Del Mar Diaz Salcedo, Javier, Ripolles-Melchor, Eugenio, Martinez-Hurtado, Jorge Duerto Alvarez, María Luisa Bravo Arcas, Juan Ignacio Torres Gonzalez, Ana Belén Sánchez de la Ventana, Pablo Lopez-Arcas Calleja, Raquel Garcia Alvarez, Purificacion Sanchez Zamora, Alvaro Ortega Guerrero, Rosario, Cosano, Jonathan, Perez-Vacas, Margarita, Campos-Perez, Emma Moreno Barreiro, Losune Cano Sanchez, Monica Garcia Diaz, Raquel, Jimenez, Lorena Del Rio Cabajo, Daniel Sancho Muriel, Helena Fernandez Alonso, Ana Wensell Fernández, Isabel Santín Piñan, Guillermo Muñiz Albaiceta, Maria Cristina Iglesias Fernandez, Francisco Javier Saenz Abos, Pablo, Monedero, Ramon Molina Chueca, Lydia Gallego Aguirre, Silvia Call Manosa, Carmen Partera Luque, Neus, Calpe, Monica Recio Losilla, Meritxell Tapia Fores, Olga, Farre, Oscar, Fernandez, M Del Rosario Villar Redondo, Donaldo, S Arteta Arteta, Maria Angeles Hurtado Sanchez, Cristina Paños Espinosa, Laura Martinez Reyes, Laura Claramunt Domenech, Carmen Velasco Guillén, Josep Trenado Alvarez, Mercedes Del Cotillo, Jesus Emilio Barrueco-Francioni, Belen Burgos Conde, Maria Pilar Sogues Blanco, Maria Luisa Blasco, Ana Isabel Clement, Clara, Hurtado, Luz Coronado Sanz, David, Perez-Torres, Estefanía, Prol-Silva, Jorge, Pereira, Iván Areán González, Anastasio Espejo Cano, Cesar Rodriguez Nuñez, Inmaculada Lorenzo Fernadez, Alejandra Azahara Marguello Fernandez, Rosa Del Bosque Diez, Badiola, Hilario, Begoña, Zalba-Etayo, Ana, Pascual-Bielsa, Preveen, Banwarie, Dick, Nahar, Alisha van Axel, Naraindath, N Boedjawan, Erika Backlund Jansson, Ann-Sofie, Malvemyr, Lotta, Johansson, Ulla, Sandberg, Catarina, Tingsvik, Gunilla, Mattsson, Gun, Löf, Martin, Spångfors, Mona, Ringdal, Sebastian, Geijer, Lotti, Orvelius, Mia, Hylen, Caroline, Lagerhäll, Eva, Åkerman, Viveca Hamback Hellkvist, Ulrica, Mickelsson, Ewa, Wahlbom, Ing-Marie, Larsson, Ewa, Wallin, Filippo, Boroli, Solenne, Ory, Margaret Lynn Jong, Alexander, Dullenkopf, Martin, Lang, Yvan, Fleury, Marianne, Maus, Nawfel, Ben-Hamouda, Anne, Fishman, Mei Yu Hsu, Shu Chuan Chang, Konlawij, Trongtratul, Chaiwut, Sawawiboon, Sunthiti, Morakul, Bodin, Khwannimit, Keevan, Singh, Dale, Ventour, Dianne, Figaro-Barclay, Sasha, Sankar-Maharaj, Mhamed Sami Mebazaa, Salma, Kamoun, Souheil, Elatrous, Lamia, Besbes, Fekri, Abroug, Walid, Naija, Youssef Zied Elhechmi, Walid, Sellami, Zied, Hajjej, Takoua, Merhabene, Imen, Talik, Ozlem Ozkan Kuscu, Ozcengiz, Dilek, Avşar, Zerman, Hayriye Cankar Dal, Sema, Turan, Semih, Aydemir, Hakan, Yilmaz, Duygu Kayar Calili, Seval, İzdes, Melike, Cengiz, Ayça, Gümüş, Banu, Taşdemir, Ali, Kağnıcı, Mustafa, Ay, Serap Avcı Ay, Gulbahar, Caliskan, Turkay, Akbas, Abidin Oner Balbay, Serdar, Efe, Volkan, Inal, Gülseren, Elay, Pınar, Karabacak, Boğaç, Özserezli, Evren, Şentürk, Oktay, Demirkiran, Suha, Bozbay, Elif, Erdogan, Mustafa, Akker, Nebia, Peker, Asu, Ozgultekin, Sibel Ocak Serin, Can, Turan, Gulsah, Karaoren, Senay, Goksu, Sait, Karakurt, Huseyin, Arikan, Fethi, Gül, İsmail, Cinel, Iskender, Kara, Hasan Nabi Undar, Yesim Serife Bayraktar, Jale Bengi Çelik, Murat Emre Tokur, Demet Tok Aydin, İsmail, Yildiz, Beysim, Özcan, Başar, Erdivanli, Ahmet, Eroglu, Devrim, Akdağ, Nurdan, Ünlü, Adonis, Dungca, Ashwaq, Ali, Bindu, Thankamma, Paul Eric Reyes, Sini, John, Ajitha, Rajendran, Fatima Kasem El Ahmad, Kathleen Ann Smiley, Susanna, Hojden, Mia Thorning Miller, Vishnu Das Sasidharan Nair, Maria Gracia San Antonio, Khaled Al Qawasmeh, Sabah Abu Shawish, Hilary, Twiggs, Ines, Rosado, Volodymyr, Babych, Faye, Morren, Charlotte, Young, Nicola, Vaughan-Jones, Stephanie, Harris, Karen, Burns, Carmel, Georgiev, Rosina, Shayamano, Ian, Kerslake, Peter, Creber, Ana, Vochin, Catherine, O'Brien, Paul, Caddell, Samantha, Hagan, Mandy, Hughes, Tomasz, Torlinski, James, Sherwin, Santhana, Kannan, Amber, Markham, Richard, Lebon, Jason, Cupitt, Julius, Cranshaw, Nigel, White, Victoria, Marriott, Wendy, Milner, Casiano Barrera Groba, Joao, Azoia, Petra, 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A.S., Goller, S., Afonso, E., Larina, E., Labeau, Sonia O. 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[0000-0003-2145-0345], Apollo - University of Cambridge Repository, Critical Care, Labeau S.O., Afonso E., Benbenishty J., Blackwood B., Boulanger C., Brett S.J., Calvino-Gunther S., Chaboyer W., Coyer F., Deschepper M., Francois G., Honore P.M., Jankovic R., Khanna A.K., Llaurado-Serra M., Lin F., Rose L., Rubulotta F., Saager L., Williams G., Blot S.I., Muzha D., Ribas A.M., Lipovesty F., Loudet C., Eller P., Mostafa N., Telleria V.M., Smajic J., Nogueira P.C., Nafees K.M.K., Hentchoya R., Soledad J., Cardenas Y., Reyes A.G., Sustic A., Mpouzika M., Vymazal T., Jensen H.I., Aguirre-Bermeo H., Maddison L., Valta M., Bloos F., Adipa F.E., Koulouras V., Enamorado J., Agoston Z., Birgisdottir H., Gupta A., Gurjar M., Kilapong B., Hashemian S.M., Martin-Loeches I., Cortegiani A., Fletcher K., Hayashi Y., Waweru-Siika W., Abidi K., Lee S.-M., Hadri B., Dolgusevs M., Abillama F.F., Jovaisa T., Thix C., Elhadi M., Nor B.M., Ratnam S., Mazlan M.Z., Maiyalagan S., Sanchez-Hurtado L., Belii A., 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N.N., Jansson E.B., Malvemyr A.-S., Johansson L., Sandberg U., Tingsvik C., Mattsson G., Lof G., Spangfors M., Ringdal M., Geijer S., Orvelius L., Hylen M., Lagerhall C., Akerman E., Hellkvist V.H., Mickelsson U., Wahlbom E., Larsson I.-M., Wallin E., Boroli F., Ory S., Jong M.L., Dullenkopf A., Lang M., Fleury Y., Maus M., Ben-Hamouda N., Fishman A., Hsu M.Y., Chang S.C., Trongtratul K., Sawawiboon C., Morakul S., Khwannimit B., Singh K., Ventour D., Figaro-Barclay D., Sankar-Maharaj S., Mebazaa M.S., Kamoun S., Elatrous S., Besbes L., Abroug F., Naija W., Elhechmi Y.Z., Sellami W., Hajjej Z., Merhabene T., Talik I., Kuscu O.O., Dilek O., Zerman A., Dal H.C., Turan S., Aydemir S., Yilmaz H., Calili D.K., Izdes S., Cengiz M., Gumus A., Tasdemir B., Kagnici A., Ay M., Ay S.A., Caliskan G., Akbas T., Balbay A.O., Efe S., Inal V., Elay G., Karabacak P., Ozserezli B., Senturk E., Demirkiran O., Bozbay S., Erdogan E., Akker M., Peker N., Ozgultekin A., Serin S.O., Turan C., Karaoren G., Goksu S., Karakurt S., Arikan H., Gul F., Cinel I., Kara I., Undar H.N., Bayraktar Y.S., Celik J.B., Tokur M.E., Aydin D.T., Yildiz I., Ozcan B., Erdivanli B., Eroglu A., Akdag D., Unlu N., Dungca A., Ali A., Thankamma B., Reyes P.E., John S., Rajendran A., Ahmad F.K.E., Smiley K.A., Hojden S., Miller M.T., Das Sasidharan Nair V., Antonio M.G.S., Qawasmeh K.A., Shawish S.A., Twiggs H., Rosado I., Babych V., Morren F., Young C., Vaughan-Jones N., Harris S., Burns K., Georgiev C., Shayamano R., Kerslake I., Creber P., Vochin A., O'Brien C., Caddell P., Hagan S., Hughes M., Torlinski T., Sherwin J., Kannan S., Markham A., Lebon R., Cupitt J., Cranshaw J., White N., Marriott V., Milner W., Groba C.B., Azoia J., Polgarova P., George S., Kapoor R., Lynch C., Fox N., Cranmer K., Llewellym T., Matthews K., Maltby L., Ibao J., Boulton K., Jarman R., Baxter K., Raj A.S., Moghal A., White J., Barrowcliffe S., Pulletz M., Ganeshalingam V., Baruah R., Baker H., Woods J., Ei P.P., Ogbeide V., Hayden P., Hughes J., Balasubramanian M., Salberg A., Saha R., Holmquist D., Derbyshire C., Smith N., Stones E., Ademokun J., Legorburo M.S., North S., Brett C., Jaundoo H., Craig J., Whiteley S., Howcroft C., Wilby L., Delve P., Shaw D., Williams K., Welters I.D., McMullen J., Brett S., Flores L., Trueman-Dawkins T., Templeton M., Adams J., Prowle J., Byers H., McDonnell A., Rose B.O., Reece-Anthony R., Mendes L., Vizcaychipi M., Bull R., Lacaden G., Santiago E., Delgado C.C., Farnell-Ward S., Thorpe E., Somerville J., Williams A., Cummings D., Derrick H., Brumwell S., Randell C., McCann N., Aves E., Berry G., Szakmany T., Gunter U., Pulak P., Sarkar N., Wright K., Gomes V., Jones J., Palfrey R., Camsooksai J., Lewis A., Eneas A., Tridente A., Barr L., Thomas B., Parkin E., Horner D., Frey C., Bench S., Baumber R., Broadhurst P., Jackson M., Williams L., Clark M., Paddle J., Bean S., Buckley S., Palfreeman C., Liu S., Allison N., Attwood B., Parsons P., Houghton V., Turner S.J., Higgins D., Bielskute E., Horrigan N., Jacob R., Habgood K., Zaki A., Collins A., Lord J., Ramiro C., Kubisz-Pudelko A., Kotze M., Williams H., Iovenko I., Tsarev A., Briva A., Mendez G., Napolitano L., Teig M., Rodriguez G.E., Ben-Jacob T., Potestio C., Eng T., Mahanes D., Khanna A., Duggal A., Nananmori M., Lois M., Karamchandani K., Bealer C., Barefield C., Terry D., Fivecoat P., Idowu O., Cata J., Clesi T., Peterson J., Hatton K., Dhaliwal J., Mueller D., Tao J., Eltorai A.S., Pastores S.M., Remor N., Salazar J., Barkas D., Joffe A., Barnes C., Sona C., Schallom M., Short J., Lorenzo J., Von Der Osten I., Borkowska M., Demarre L., Pleitinckx V., Xing C., Debue A.-S., Goller S., Larina E., Labeau, S. O., Blackwood, B., Brett, S. J., Deschepper, M., Francois, G., Honore, P. M., Khanna, A. K., Williams, G., Blot, S. I., Ribas, A. M., Telleria, V. M., Nogueira, P. C., Nafees, K. M. K., Reyes, A. G., Jensen, H. I., Adipa, F. E., Agoston, Z., Hashemian, S. M., Lee, S. -M., Abillama, F. F., Nor, B. M., Mazlan, M. Z., Sanchez-Hurtado, L., De lange, D., Ilesanmi, R. E., Ffarcsi, M. H., Hernandez, A. M., Schefold, J. C., Besbes, L. O., Minope, J. T. S., Rostello, O. F., Bartoli, J. R., Nocheretti, M. G., Escalante, R. G., Loudet, C. I., Gonzalez, A. L., Alvarez, G. A., Campos, P. A., Fonseca, I. P., Alvarez, G. M., Bascary, C. A., del Valle Gimenez, G., Bertoletti, F. P., Bonsignore, P. J. M., Fernandez, M. A., Leslie, G. D., Mclucas, A., Jacquet, L. -M., de Almeida, A. O., Jorge, S. A., Schmidt, R. C., Garcia, P. C., Ronchini, A. L. V., Manap, N. B. A., Laizner, A. M., Mcquirter, M., Kampayana, B. S., Sepulveda, M. I., Zamorano, M. J. F., Zhao, R. H., Hu, L. P., Jiao, Q. F., Wang, H. Y., Xia, C. J., Insu, L., Zhu, J. Y., Zhu, J. F., Huang, R. F., Wang, L. L., Song, J. H., Liu, X. M., Li, Z. S., Li, L. C., Zeng, J. M., Hu, X. C., Wang, R. X., Tak, P. S., Ho, S. W., Jiang, Q. X., Huang, L. P., Liu, X. L., Jiang, J. H., Gong, Y. Y., Lei, D. H., Bi, A. P., Zhao, H. M., Cao, Z. Q., Wu, S. F., Tian, X. F., Feng, Z. X., Liu, X. Z., Jiang, Z. X., Wang, G. X., Hu, R. L., Li, X. Q., Yu, Z. J., Yang, Y. X., Gama, L. M. S., Hernandez, J. S., Ochoa, M. -E., Reyes, A. J. G., Filipovic-Grcic, I., Vukovic, A., Pecenkovic, S., Suput, A., Radivojevic, R. C., Culjak, H., Adam, V. N., Pedersen, K. R., Kjaergard, I. E., Kodal, A. M., Hansen, T. C. B., Pedersen, A. S. B., Thomsen, T. D., Frandsen, T. M., Bliksted, I. A., Tamayo, L. M., Tutillo, D. R. M., Hurtado, C. V., Garcia, M. F., Kutimets, M., Lofqvist, C., Sakki, J. -K., Valta, M. A., Plantefeve, G., Deserts, M. D., Gunther, S. C., Timsit, J. -F., Farkas, J. -C., Bosl, K., Schuppel, S., Stubner, A., Osei, I. P., Kusi-Appiah, A. -C., Yakubu, Y. H., Patsiou, E. -C., Stalika, K. M. M., Enamorado, J. E., Jonasdottir, R. J., Lestari, M. I., Finn, D. O. C. R., Mcpherson, S., Ghioldi, D. M., Bruno, A. V., Maggiore, S. M., Volta, C. A., Taibi, M. R., Tranello, F. P., Giusti, G. D., Martin, M. A., Correia, M. C., Kim, J. H., Kim, K. C., Bae, J. -M., Park, S. Y., Park, T. S., Lee, H. B., Kim, S. C., Chee, H. K., Huh, J. W., Sim, Y. S., Ahn, J. -J., Kang, B. J., Lee, W. -Y., Lee, S. J., Feghaly, M. E., Belkhair, W. A., Tababa, O. W. E., Alkhumsi, S. I. R., Alshrif, A. I., Aboufray, A. A., Triki, A. R., Zahra, H. B., Al-Alawi, M. M. S., Ghula, M. A. A., Bahrin, L. K. K., Deva, S. R., Rahim, A. H. A., Hassan, W. N. W., Ismail, W. N. W., Ali, M. N., Khoo, T. M., Samat, N. M., Tong, J. M. G., Adib, N. A. N., Nor, M. B. M., Sulaiman, S. R., Foong, K. W., Hua, N. P., Zermeno, J. M., Nava, C. L. L., Nandyelly, S. J. R., Sanchez-Hurtado, L. A., Nava, L. P. A., Herrera, J. G., de Anda, G. F. V., Namendys-Silva, S. A., Romero-Gonzalez, J. P., Sosa, M. A., de Molina Serrano, J. I. R., Iburrigarro, S. R., Padilla, N. R. C., Pineda, A. A. V., Villafuerte, M. V. E., Herrera, M. O. G., Subedi, N. B., Pathak, S. D., Vermeijden, J. W., Gerritsen, R. T., Fijen, J. -W., Adejumo, P. O., Sankey, B. J., Olsen, B. F., Jensen, K. D., Johansen, B. F., Finnstrom, I. J., Skorstad, E. M., Lunde, G. A., Akselsen, G. R., Monstad, K. R., Hogvall, L., Malmin, S. K., Andersen, M. H., Hargott, R. F., de Jesus Ortiz, A., Cabral, D. M. B., Rivas, J. C., Moreira, M. L., Ellazar, C. G., Cerezo, F. D., Palo, J. E., Aperocho, C. A. J., Figueiredo, M. F., Pinheiro, C. M., Rita, C. S., Feranandes, A. M., Pinto, V. M. V., Bispo, B. M., Lima, A., Alsheikhly, A. S., Guran, C. T., Filipescu, D. C., Scutariu, M. A., Ebaid, M. S., Velickovic, D., Rajkovic, M., Stanojevic, M., Turcan, A., Lancaricova, D., Yeni, N. P., Syed, M. R., Navarro, J. A., De Pablo, A. M., Llinas, A. A., Lajara, M. A. G., Nieto, M. V., Pena, J. M. G., Gorgolas, M. C., Isasi, M. A., Salva-Costa, V., Garzon-Tovar, C., Olivares, P. G., de Ceballos, J. P. G., Polo, A. B. C., del Mar Diaz Salcedo, M., Alvarez, J. D., Arcas, M. L. B., Gonzalez, J. I. T., de la Ventana, A. B. S., Calleja, P. L. -A., Alvarez, R. G., Zamora, P. S., Guerrero, A. O., Barreiro, E. M., Sanchez, L. C., Diaz, M. G., Muriel, D. S., Alonso, H. F., Fernandez, A. W., Pinan, I. S., Albaiceta, G. M., Fernandez, M. C. I., Abos, F. J. S., Chueca, R. M., Aguirre, L. G., Manosa, S. C., Luque, C. P., Losilla, M. R., Fores, M. T., del Rosario Villar Redondo, M., Arteta Arteta, D. S., Sanchez, M. A. H., Espinosa, C. P., Reyes, L. M., Domenech, L. C., Guillen, C. V., Alvarez, J. T., del Cotillo, M., Barrueco-Francioni, J. E., Conde, B. B., Blanco, M. P. S., Blasco, M. L., Clement, A. I., Sanz, L. C., Gonzalez, I. A., Cano, A. E., Nunez, C. R., Fernadez, I. L., Fernandez, A. A. M., Boedjawan, N. N., Jansson, E. B., Malvemyr, A. -S., Lof, G., Spangfors, M., Lagerhall, C., Akerman, E., Hellkvist, V. H., Larsson, I. -M., Jong, M. L., Hsu, M. Y., Chang, S. C., Mebazaa, M. S., Elhechmi, Y. Z., Kuscu, O. O., Dal, H. C., Calili, D. K., Izdes, S., Gumus, A., Tasdemir, B., Kagnici, A., Ay, S. A., Balbay, A. O., Ozserezli, B., Senturk, E., Serin, S. O., Gul, F., Cinel, I., Undar, H. N., Bayraktar, Y. S., Celik, J. B., Tokur, M. E., Aydin, D. T., Yildiz, I., Ozcan, B., Akdag, D., Unlu, N., Reyes, P. E., Ahmad, F. K. E., Smiley, K. A., Miller, M. T., Antonio, M. G. S., Qawasmeh, K. A., Shawish, S. A., Groba, C. B., Raj, A. S., Ei, P. P., Legorburo, M. S., Welters, I. D., Mcmullen, J., Mcdonnell, A., Rose, B. O., Delgado, C. C., Mccann, N., Turner, S. J., Rodriguez, G. E., Eltorai, A. S., Pastores, S. M., Demarre, L., and Debue, A. -S.
Subjects: Male, Original, medicine.medical_treatment, artificial, Critical Care and Intensive Care Medicine, Medical and Health Sciences, Pressure ulcer, law.invention, Decubitus epidemiology, ICU, Morbidity, Mortality, Outcome, Pressure injury, Risk factors, Adult, Aged, Hospital Mortality, Humans, Patient Discharge, Prevalence, Risk Factors, Intensive Care Units, Respiration, Artificial, 0302 clinical medicine, decubitus epidemiology, pressure injury, pressure ulcer, outcome, risk factors, morbidity, mortality, law, Medicine and Health Sciences, adults, Medicine, Simplified Acute Physiology Score, icu, ziekenhuissterfte, Immunodeficiency, intensive care, European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators, mannen, volwassenen, COST, Intensive care unit, STATE, ULCERS, Underweight, medicine.symptom, Life Sciences & Biomedicine, Human, medicine.medical_specialty, risicofactoren, Decubitus epidemiology, ICU, Pressure injury, Pressure ulcer, Outcome, Risk factors, Morbidity, Mortality, pressure injuries, Intensive Care Unit, prevalentie, NO, 1117 Public Health and Health Services, DecubICUs Study Team, 03 medical and health sciences, Critical Care Medicine, Anesthesiology, General & Internal Medicine, Health Sciences, ouderen, Mechanical ventilation, Science & Technology, business.industry, decubitus, Risk Factor, 030208 emergency & critical care medicine, 1103 Clinical Sciences, Odds ratio, medicine.disease, Emergency & Critical Care Medicine, Confidence interval, 030228 respiratory system, Emergency medicine, kunstmatige ademhaling, RISK-FACTORS, business, respiration
Abstract: Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347, Funder: Flemish Society for Critical Care Nurses, Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat.
Published: 2021
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11. Rotational thromboelastometry assessment of ballanced crystalloid, hydroxyethyl starch and gelatin effects on coagulation: a randomized trial

Author: Silvie Sevcikova, Tomas Vymazal, and Miroslav Durila
Subjects: Adult, Male, food.ingredient, Knee Joint, Hydroxyethyl starch, Plasma Substitutes, Gelatin, Fibrin, Hydroxyethyl Starch Derivatives, lcsh:RD78.3-87.3, 03 medical and health sciences, Colloid, Arthroscopy, 0302 clinical medicine, food, 030202 anesthesiology, Coagulopathy, Anesthesiology, Rotational thromboelastometry, medicine, Humans, Coagulation (water treatment), RD78.3-87.3, Colloids, Crystalloids, Blood Coagulation, Whole blood, biology, Chemistry, Crystalloid Solutions, General Medicine, Middle Aged, medicine.disease, Thrombelastography, Thromboelastometry, lcsh:Anesthesiology, Anesthesia, biology.protein, Female, Blood Coagulation Tests, medicine.drug
Abstract: Background and objectives: Modern crystalloid and colloid solutions are balanced solutions which are increasingly used in perioperative period. However, studies investigating their negative effect on whole blood coagulation are missing, and vivid debate is going on about which solution has the minimal coagulopathy effect. The aim of our study was to assess the effect of modern fluid solutions on whole blood coagulation using rotational thromboelastometry. Methods: Blood samples were obtained from 30 patients during knee arthroscopy before and after administration of 500 mL of crystalloid, Hydroxyethyl Starch and gelatin according to the randomization. Rotational thromboelastometry (Extem, Intem and Fibtem tests) was used to assess negative effect of fluid solutions on whole blood coagulation. Results: In Extem test, the initiation phase of fibrin clot formation represented by CT parameter was not influenced by any fluid solution (p > 0.05). The speed of clot formation represented by CFT and α angle was impaired by Hydroxyethyl Starch and gelatin but not by crystalloids (p 0.05). Conclusion: Extem test appears to be sensitive to coagulopathy effect of modern colloids and crystalloids. Hydroxyethyl starch has the most obvious negative effect on clot formation followed by gelatin and finally by crystalloids. Intem test seems to be insensitive to adverse effect of modern colloids and crystalloids. Resumo: Justificativa e objetivos: Os cristaloides e coloides modernos são soluções balanceadas e cada vez mais utilizadas no período perioperatório. No entanto, não há estudos que avaliem seu efeito negativo na coagulação do sangue total e o intenso debate sobre a solução que cause um efeito mínimo na coagulopatia permanece. O objetivo de nosso estudo foi avaliar o efeito das soluções líquidas modernas na coagulação do sangue total com o uso da tromboelastometria rotacional. Métodos: De acordo com a randomização, amostras de sangue foram colhidas de 30 pacientes durante a artroscopia de joelho, antes e após a administração de 500 mL de cristaloides, hidroxietilamido e gelatina. A tromboelastometria rotacional (testes Extem, Intem e Fibtem) foi utilizada para avaliar o efeito negativo das soluções líquidas na coagulação do sangue total. Resultados: No teste Extem, a fase de iniciação da formação de coágulos de fibrina representada pelo parâmetro CT não foi influenciada por nenhuma solução líquida (p > 0,05). A velocidade da formação de coágulos representada pelo CFT e pelo ângulo α foi prejudicada pelo hidroxietilamido e pela gelatina, mas não pelos cristaloides (p 0,05). Conclusão: O teste Extem parece ser sensível ao efeito de coagulopatia dos coloides e cristaloides modernos. O hidroxietilamido apresentou o efeito negativo mais óbvio na formação do coágulo, seguido pela gelatina e finalmente pelos cristaloides. O teste Intem parece ser insensível ao efeito adverso dos coloides e cristaloides modernos. Keywords: Arthroscopy, Coagulopathy, Crystalloids, Gelatin, Hydroxyethyl starch, Rotational thromboelastometry, Palavras-chave: Artroscopia, Coagulopatia, Cristaloides, Gelatina, Hidroxietilamido, Tromboelastometria rotacional
Published: 2019

12. Tromboelastometria rotacional na avaliação dos efeitos de cristaloides balanceados, hidroxietilamido e gelatina na coagulação: estudo randômico

Author: Miroslav Durila, Tomas Vymazal, and Silvie Sevcikova
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology
Abstract: Resumo Justificativa e objetivos Os cristaloides e coloides modernos sao solucoes balanceadas e cada vez mais utilizadas no periodo perioperatorio. No entanto, nao ha estudos que avaliem seu efeito negativo na coagulacao do sangue total e o intenso debate sobre a solucao que cause um efeito minimo na coagulopatia permanece. O objetivo de nosso estudo foi avaliar o efeito das solucoes liquidas modernas na coagulacao do sangue total com o uso da tromboelastometria rotacional. Metodos De acordo com a randomizacao, amostras de sangue foram colhidas de 30 pacientes durante a artroscopia de joelho, antes e apos a administracao de 500 mL de cristaloides, hidroxietilamido e gelatina. A tromboelastometria rotacional (testes Extem, Intem e Fibtem) foi utilizada para avaliar o efeito negativo das solucoes liquidas na coagulacao do sangue total. Resultados No teste Extem, a fase de iniciacao da formacao de coagulos de fibrina representada pelo parâmetro CT nao foi influenciada por qualquer solucao liquida (p > 0,05). A velocidade da formacao de coagulos representada pelo CFT e pelo ângulo α foi prejudicada pelo hidroxietilamido e pela gelatina, mas nao pelos cristaloides (p 0,05). Conclusao O teste Extem parece ser sensivel ao efeito de coagulopatia dos coloides e cristaloides modernos. O hidroxietilamido apresentou o efeito negativo mais obvio na formacao do coagulo, seguido pela gelatina e finalmente pelos cristaloides. O teste Intem parece ser insensivel ao efeito adverso dos coloides e cristaloides modernos.
Published: 2019
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13. Enhanced recovery after colorectal surgery: the clinical and economic benefit in elderly patients

Author: Tomas Vymazal, Daniel Hodyc, Adam Whitley, Petr Přikryl, P. Kocian, Markéta Bocková, Jiří Hoch, and Blanka Čermáková
Subjects: medicine.medical_specialty, business.industry, General surgery, Vascular surgery, University hospital, Readmission rate, Colorectal surgery, Cardiac surgery, 03 medical and health sciences, 0302 clinical medicine, Enhanced recovery, 030220 oncology & carcinogenesis, Perioperative care, Medicine, 030211 gastroenterology & hepatology, Surgery, business, Abdominal surgery
Abstract: We performed this study to investigate the feasibility and clinical and financial benefit of an enhanced recovery after surgery (ERAS) protocol in elderly patients undergoing colorectal resections. Patients over the age of 65 undergoing open colorectal resections at the department of surgery of the Motol University Hospital in Prague between January 2015 and August 2017 were included in the study. Patients who received ERAS perioperative care formed the ERAS group and patients who received standard perioperative care formed the control group. Adherence to the ERAS protocol, hospitalisation length, readmission rate, 30-day postoperative morbidity and mortality, and treatment costs were analysed. Seventy-four patients were included in the ERAS group and sixty-one in the control group. Patient and surgical characteristics were similar in the two groups. An adherence of 83.8% to the ERAS protocol was achieved. Recovery parameters were improved and hospital stay length was shortened, while readmission rate, morbidity and mortality. Although not statistically significant, treatment costs were reduced by an average of €1187 per patient. We showed that our enhanced recovery after colorectal surgery protocol in elderly patients is feasible, effective, safe and reduces treatment costs.
Published: 2019
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14. Optical Devices in Tracheal Intubation—State of the Art in 2020

Author: Frantisek Kolek, Olga Klementova, Jan Matek, Pavel Michalek, and Tomas Vymazal
Subjects: medicine.medical_specialty, Computer science, medicine.medical_treatment, Clinical Biochemistry, Laryngoscopy, Review, flexible fiberoptic intubation, optical intubation, law.invention, 03 medical and health sciences, 0302 clinical medicine, Laryngoscopes, 030202 anesthesiology, law, Intensive care, medicine, Fiberscope, Intubation, Medical physics, optical stylet, lcsh:R5-920, medicine.diagnostic_test, Tracheal intubation, fiberoptic tracheal tubes, 030208 emergency & critical care medicine, Supraglottic airway, 3. Good health, supraglottic airway, Airway management, hybrid device, lcsh:Medicine (General)
Abstract: The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.
Published: 2021

15. Complex Immunometabolic Profiling Reveals the Activation of Cellular Immunity and Biliary Lesions in Patients with Severe COVID-19

Author: Tomas Vymazal, Josef Zamecnik, Zuzana Parackova, Martin Tulach, Adam Klocperk, Marketa Bloomfield, Anna Sediva, Luis Fernando Casas Mendez, Irena Zentsova, Petra Vrabcova, Grigorij Meseznikov, Jan Balko, Jan Sipek, and Alzbeta Grandcourtova
Subjects: 0301 basic medicine, Cellular immunity, Pathology, medicine.medical_specialty, Fulminant, T cells, lcsh:Medicine, Inflammation, macromolecular substances, Article, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Immune system, Immunity, medicine, 030212 general & internal medicine, IL-6, business.industry, SARS-CoV-2, lcsh:R, Acute kidney injury, COVID-19, General Medicine, medicine.disease, Acquired immune system, hepatopathy, immunity, GGT, 030104 developmental biology, acute kidney injury, biliary lesion, medicine.symptom, liver disease, business
Abstract: This study aimed to assess the key laboratory features displayed by coronavirus disease 2019 (COVID-19) inpatients that are associated with mild, moderate, severe, and fatal courses of the disease, and through a longitudinal follow-up, to understand the dynamics of the COVID-19 pathophysiology. All severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients admitted to the University Hospital in Motol between March and June 2020 were included in this study. A severe course of COVID-19 was associated with an elevation of proinflammatory markers, an efflux of immature granulocytes into peripheral blood, the activation of CD8 T cells, which infiltrated the lungs, transient liver disease. In particular, the elevation of serum gamma-glutamyl transferase (GGT) and histological signs of cholestasis were highly specific for patients with a severe form of the disease. In contrast, patients with a fatal course of COVID-19 failed to upregulate markers of inflammation, showed discoordination of the immune response, and progressed toward acute kidney failure. COVID-19 is a disease with a multi-organ affinity that is characterized by the activation of innate and cellular adaptive immunity. Biliary lesions with an elevation of GGT and the organ infiltration of interleukin 6 (IL-6)-producing cells are the defining characteristics for patients with the fulminant disease.
Published: 2020

16. Complex Immuno-metabolic Profiling Reveals Activation of Cellular Immunity and Biliary Lesion in Patients with Severe COVID-19

Author: Jan Balko, Josef Zamecnik, Jan Sipek, Alzbeta Grandcourtova, Martin Tulach, Tomas Vymazal, Marketa Bloomfield, Anna Sediva, Adam Klocperk, Luis Fernando Casas Mendez, Grigorij Meseznikov, Petra Vrabcova, Zuzana Parackova, and Irena Zentsova
Subjects: Cellular immunity, Coronavirus disease 2019 (COVID-19), biology, business.industry, Acute kidney injury, medicine.disease, medicine_pharmacology_other, Lesion, Liver disease, Immunity, Immunology, medicine, biology.protein, In patient, medicine.symptom, Interleukin 6, business
Abstract: The aim of this study was to assess the key laboratory features displayed by coronavirus disease 2019 (COVID-19) inpatients which associated with mild, moderate, severe and fatal course of the disease and, through longitudinal follow-up, to understand the dynamics of COVID-19 pathophysiology. All SARS-CoV-2 positive patients admitted to the University Hospital in Motol between March and June 2020 were included in this study. Severe course of COVID-19 was associated with elevation of proinflammatory markers, efflux of immature granulocytes into peripheral blood, activation of CD8 T cells, which infiltrate lungs, and transient liver disease. In particular, the elevation of serum gamma-glutamyl transferase (GGT) and histological signs of cholestasis were highly specific for patients with severe disease. In contrast, patients with fatal course of COVID-19 failed to upregulate markers of inflammation, showed dyscoordination of immune response and progressed towards acute kidney failure. COVID-19 is a disease with multi-organ affinity characterized by activation of innate and cellular adaptive immunity. Biliary lesion with elevation of GGT and organ-infiltration of IL-6 producing cells are defining characteristic for patients with fulminant disease.
Published: 2020
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17. Case Report: Systemic Inflammatory Response and Fast Recovery in a Pediatric Patient With COVID-19

Author: Zuzana Parackova, Tomas Vymazal, Hana Malcova, Pavla Dolezalova, Adam Klocperk, Petr Pavlicek, Anna Sediva, and Jitka Dissou
Subjects: lcsh:Immunologic diseases. Allergy, 0301 basic medicine, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Immunology, Case Report, Inflammation, Systemic inflammation, 03 medical and health sciences, 0302 clinical medicine, Immunophenotyping, hemic and lymphatic diseases, medicine, Immunology and Allergy, innate immunity, Hemophagocytic lymphohistiocytosis, Innate immune system, SARS-CoV-2, business.industry, fungi, neutrophil, COVID-19, Immunosuppression, medicine.disease, pediatric, 030104 developmental biology, hemophagocytic lymphohistiocytosis, Macrophage activation syndrome, medicine.symptom, lcsh:RC581-607, business, PIMS-TS, macrophage activation syndrome, 030215 immunology
Abstract: We report a case of an 8-year-old girl who underwent a SARS-CoV-2 infection manifesting with atypical symptoms spearheaded by abdominal discomfort and systemic inflammation and partially mimicking hemophagocytic lymphohistiocytosis (HLH) or macrophage activation syndrome (MAS), which however did not fulfill the HLH/MAS diagnostic criteria. In this case of what has since been described as Pediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-COV-2 (PIMS-TS) we documented excellent clinical response to immunosuppression with systemic corticosteroids and intravenous immunoglobulins. We show a detailed longitudinal development of neutrophil immunophenotype which suggests activation and engagement of neutrophils during PIMS-TS with compensatory contraction of the response and contra-regulation of neutrophil phenotype during recovery.
Published: 2020
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18. Systemic inflammatory response and fast recovery in a pediatric patient with COVID-19

Author: Jitka Dissou, Tomas Vymazal, Pavla Doležalová, Anna Sediva, Zuzana Parackova, Petr Pavlicek, Adam Klocperk, and Hana Malcova
Subjects: Czech, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, Inflammatory response, Fast recovery, University hospital, language.human_language, Adolescent medicine, Pediatric patient, Family medicine, Anesthesiology, medicine, language, business
Abstract: Adam Klocperk1, M.D., Ph.D., Zuzana Parackova1, MSc., Jitka Dissou2, M.D., Hana Malcova3, M.D., Ph.D., Petr Pavlicek4, M.D., Tomas Vymazal4, M.D., As. Prof., Pavla Doležalova5, M.D., Prof., Anna Sediva1, M.D., Prof.1Department of Immunology, 2ndFaculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague, Czech Republic2Emergency Department for Children, University Hospital in Motol, Prague, Czech Republic3Department of Children and Adult Rheumatology, University Hospital in Motol , Prague, Czech Republic4Department of Anesthesiology and Intensive Care Medicine, 2nd Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague, Czech Republic5Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Adolescent Medicine, General University Hospital in Prague and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
Published: 2020
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19. Acquired primary hemostasis pathology detected by platelet function analyzer 200 seen during extracorporeal membrane oxygenation is sufficient to prevent circuit thrombosis: A pilot study

Author: Tomas Smetak, Jaromir Vajter, Michal Garaj, Tomas Vymazal, Jan Berousek, Miroslav Durila, and Pavel Hedvicak
Subjects: Pulmonary and Respiratory Medicine, Blood Platelets, Pathology, medicine.medical_specialty, medicine.medical_treatment, 0206 medical engineering, Pilot Projects, 02 engineering and technology, 030204 cardiovascular system & hematology, Primary hemostasis, 03 medical and health sciences, 0302 clinical medicine, Extracorporeal Membrane Oxygenation, medicine, Extracorporeal membrane oxygenation, Lung transplantation, Humans, Platelet, In patient, Prospective Studies, Respiratory system, Transplantation, Hemostasis, business.industry, Thrombosis, Heparin, Blood Coagulation Disorders, medicine.disease, 020601 biomedical engineering, surgical procedures, operative, Surgery, Cardiology and Cardiovascular Medicine, business, Biomarkers, medicine.drug, Lung Transplantation
Abstract: Extracorporeal membrane oxygenation (ECMO) use during lung transplantation surgery produces primary hemostasis pathology detected by a PFA 200. The PFA 200 results return to the preoperative values soon after ECMO explantation. This phenomenon of primary hemostasis pathology detected by the PFA 200 was successfully used to prevent circuit thrombosis in patients on prolonged ECMO with respiratory or cardiac failure without the use of unfractionated heparin.
Published: 2020

20. Video Laryngoscopic Intubation Using the King VisionTM Laryngoscope in a Simulated Cervical Spine Trauma: A Comparison Between Non-Channeled and Channeled Disposable Blades

Author: Tomas Brozek, Will Donaldson, Jiri Votruba, Jan Bláha, Tomas Henlin, Tomas Vymazal, and Pavel Michalek
Subjects: Larynx, medicine.medical_specialty, medicine.medical_treatment, channeled blade, Clinical Biochemistry, Cervical spine injury, non-channeled blade, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Medicine, Intubation, In patient, cervical spine injury, Neck trauma, videolaryngoscopy, King Vision™ laryngoscope, lcsh:R5-920, business.industry, Tracheal intubation, food and beverages, 030208 emergency & critical care medicine, Cervical spine, Surgery, medicine.anatomical_structure, king vision™ laryngoscope, Total success rate, business, lcsh:Medicine (General)
Abstract: Videolaryngoscopes may reduce cervical spine movement during tracheal intubation in patients with neck trauma. This manikin study aimed to compare the performance of disposable non-channeled and channeled blades of the King Vision™ videolaryngoscope in simulated cervical spine injury. Fifty-eight anesthesiologists in training intubated the TruMan manikin with the neck immobilized using each blade in a randomized order. The primary outcome was the time needed for tracheal intubation, secondary aims included total success rate, the time required for visualization of the larynx, number of attempts, view of the vocal cords, and subjective assessment of both methods. Intubation time with the channeled blade was shorter, with a median time of 13 s (IQR 9−19) vs. 23 s (14.5−37.5), p < 0.001, while times to visualization of the larynx were similar in both groups (p = 0.54). Success rates were similar in both groups, but intubation with the non-channeled blade required more attempts (1.52 vs. 1.05; p < 0.001). The participants scored the intubation features of the channeled blade significantly higher, while visualization features were scored similarly in both groups. Both blades of the King Vision™ videolaryngoscope are reliable intubation devices in a simulated cervical spine injury in a manikin model when inserted by non-experienced operators. The channeled blade allowed faster intubation of the trachea.
Published: 2020

21. Limited diagnostic possibilities for bloodstream infections with broad‐range methods: A promising PCR/electrospray ionization‐mass spectrometry platform is no longer available

Author: Dragos Florea, Pavel Drevinek, Claus Moser, Jan Berousek, Jan Tkadlec, Eliska Bebrova, Tomas Vymazal, Vendula Martinkova, and Jaroslava Adamkova
Subjects: Adult, Male, Microbiological Techniques, Spectrometry, Mass, Electrospray Ionization, bloodstream infections, Electrospray ionization, lcsh:QR1-502, Bacteremia, Mass spectrometry, Diagnostic tools, Polymerase Chain Reaction, Microbiology, lcsh:Microbiology, law.invention, molecular diagnostics, Young Adult, Broad spectrum, law, RNA, Ribosomal, 16S, Sepsis, medicine, Humans, broad‐range PCR, Blood culture, Time to positivity, Polymerase chain reaction, Aged, Aged, 80 and over, medicine.diagnostic_test, business.industry, Reproducibility of Results, Middle Aged, Molecular diagnostics, 16S PCR, PCR/ESI‐MS, Molecular Diagnostic Techniques, Commentary, Female, business
Abstract: Fast and accurate detection of causative agents of bloodstream infections remains a challenge of today's microbiology. We compared the performance of cutting‐edge technology based on polymerase chain reaction coupled with electrospray ionization‐mass spectrometry (PCR/ESI‐MS) with that of conventional broad‐range 16S rRNA PCR and blood culture to address the current diagnostic possibilities for bloodstream infections. Of 160 blood samples tested, PCR/ESI‐MS revealed clinically meaningful microbiological agents in 47 samples that were missed by conventional diagnostic approaches (29.4% of all analyzed samples). Notably, PCR/ESI‐MS shortened the time to positivity of the blood culture‐positive samples by an average of 34 hr. PCR/ESI‐MS technology substantially improved current diagnostic tools and represented an opportunity to make bloodstream infections diagnostics sensitive, accurate, and timely with a broad spectrum of microorganisms covered., By using the polymerase chain reaction coupled with electrospray ionization‐mass spectrometry (PCR/ESIMS) technology, we detected pathogenic agents in 29.4% (47 of 160) more samples than by using 16S rRNA PCR and/or blood culture. Thus, the PCR/ESI‐MS represented an opportunity to make the bloodstream infection diagnostics highly sensitive and accurate.
Published: 2020
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22. Evaluation of Thromboelastometry in Sepsis in Correlation With Bleeding During Invasive Procedures

Author: Tomas Vymazal, Jakub Jonas, Miroslav Durila, and Pavel Lukáš
Subjects: Adult, Male, medicine.medical_specialty, invasive procedure, medicine.medical_treatment, Blood Loss, Surgical, thromboelastometry, 030204 cardiovascular system & hematology, Sepsis, sepsis, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Laparotomy, medicine, Humans, International Normalized Ratio, Aged, Prothrombin time, Aged, 80 and over, medicine.diagnostic_test, EXTEM, business.industry, 030208 emergency & critical care medicine, Retrospective cohort study, Hematology, General Medicine, Dialysis catheter, Original Articles, Middle Aged, medicine.disease, prothrombin time, Surgery, Thrombelastography, Thromboelastometry, Anesthesia, Female, Fresh frozen plasma, business, Central venous catheter
Abstract: Prolongation of prothrombin time (PT) is often encountered in patients with sepsis. On the other hand, thromboelastometry as a global coagulation test might yield normal results. The aim of our study was to evaluate whether prolonged PT in the presence of normal thromboelastometry parameters is associated with severe bleeding in patients with sepsis undergoing invasive procedures. In patients with sepsis undergoing low-risk bleeding invasive procedures (central venous catheter placement, dialysis catheter insertion, drain insertion, and so on) or high-risk bleeding invasive procedures (surgical tracheostomy, surgical laparotomy, thoracotomy, and so on), coagulation was assessed by thromboelastometry using EXTEM test (test for evaluation of the extrinsic pathway of coagulation, contains activator of extrinsic pathway) and with PT. For period of years 2013 to 2016, we assessed occurrence of severe bleeding during those procedures and 24 hours later in patients with prolonged PT and normal thromboelastometry results. This retrospective study was performed at Department of Anaesthesiology and Intensive Care Medicine of Motol University Hospital in Prague. Data from 76 patients with sepsis were analyzed. Median value of international normalized ratio (INR) was 1.59 (min—1.3 and max—2.56), and median value of prothrombin ratio (PR) was 1.5 (min—1.23 and max—2.55) with normal thromboelastometry finding. Despite prolonged INR/PR, no severe bleeding was observed during invasive procedures. Our data show that sepsis may be accompanied by normal thromboelastometry results, despite prolonged values of PT, and invasive procedures were performed without severe bleeding. This approach to coagulation assessment in sepsis may reduce administration of fresh frozen plasma to the patients. The study was registered at Clinical Trials.gov with assigned number NCT02971111.
Published: 2017

23. Purpose of the study - The aim of our study was to evaluace the impact of Neodoplpasse infusion postoperatively on the clot forming process

Author: Jan Berousek and Tomas Vymazal
Subjects: Pharmacology, Pharmaceutical Science, Pharmacy
Abstract: Ucel studie: Cilem prace bylo prokazat, že Neodolpasse 250 ml neovlivňuje vznik a kvalitu krevniho koagula v casnem pooperacnim obdobi. Použite metody: Od řijna 2014 do cervna 2015 jsme prospektivně sledovali 207 pacientů, kteři byli přijati na nase odděleni z důvodu bezprostředni pooperacni pece. Pacienti podstoupili operace totalni endoprotezy kycelniho a kolenniho kloubu, skoliozy a resekcni výkony na tenkem a tlustem střevě z laparotomie. Pacientům byl po přijezdu na pooperacni odděleni podan Neodolpasse 250 ml intravenozně v průběhu 90 minut. Před podanim a 2 a 4 hodiny po dokapani byly pacientům měřeny viskoelasticke vlastnosti plne krve metodou rotacni tromboelastometrie. Výsledky: I přes heterogenitu ve věku, typu výkonu a jeho delce jsme nezaznamenali po podani 250 ml Neodolpasse statisticky významne odchylky od casu tvorby koagula, rychlosti jeho tvorby ani maximalni sily. Vsichni pacienti měli nekomplikovaný průběh hospitalizace na nasem odděleni. Zavěr: Podle nasich pozorovani Neodolpasse podaný v bezprostřednim pooperacnim obdobi nezpůsobuje poruchy vzniku ani tvorby krevniho koagula. Limitem nasi prace je relativně malý soubor pacientů.
Published: 2017
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24. Usefulness of perioperative rotational thrombelastometry during scoliosis surgery in children

Author: Dagmar Maresova, Michal Barna, Martin Malosek, Miroslav Durila, Jakub Jonas, Tomas Vymazal, and Jan Stulik
Subjects: medicine.medical_specialty, Blood transfusion, business.industry, medicine.medical_treatment, General Medicine, Perioperative, Scoliosis, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Anesthesia, Pediatric surgery, Coagulopathy, Deformity, Coagulation testing, Medicine, medicine.symptom, business, 030217 neurology & neurosurgery, Point of care
Abstract: OBJECTIVESurgical correction of scoliosis in pediatric patients is associated with significant blood loss. Rotational thrombelastometry (ROTEM) might help to decrease the use of blood transfusion products by enabling an early point of care (POC) diagnosis of coagulopathy, thus helping to provide targeted therapy. The aim of this case-control study was to find out whether POC use of ROTEM during scoliosis surgery in children helps to reduce the need for blood transfusion products.METHODSData were prospectively analyzed from all patients treated during 2016–2018 who received ROTEM-based therapy during scoliosis surgery. These patients were compared with a group of historical controls treated during 2014–2016 whose scoliosis treatment did not include ROTEM. Perioperative blood loss, consumption of blood transfusion products, and hospital LOS were compared between the groups.RESULTSA total of 37 patients were analyzed, 22 patients in the non-ROTEM group and 15 patients in the ROTEM group. In the ROTEM group compared with the non-ROTEM group, there was significantly lower perioperative blood loss and administration of packed red blood cell units, no administration of fresh-frozen plasma, and shorter overall hospital LOS (p < 0.05).CONCLUSIONSROTEM use during scoliosis surgery in children seems to help to decrease blood loss and the use of blood transfusion products and may also shorten the hospital LOS.Clinical trial registration no.: NCT03699813 (clinicaltrials.gov).
Published: 2019

25. Disharmonic Inflammatory Signatures in COVID-19: Augmented Neutrophils’ but Impaired Monocytes’ and Dendritic Cells’ Responsiveness

Author: Marketa Bloomfield, Anna Sediva, Grigorij Mesežnikov, Zuzana Parackova, Petra Vrabcova, Jitka Smetanova, Adam Klocperk, Tomas Vymazal, Luis Fernando Casas Mendez, and Irena Zentsova
Subjects: Adult, Male, PD-L1, Neutrophils, medicine.medical_treatment, Pneumonia, Viral, Biology, B7-H1 Antigen, Monocytes, Article, Immunophenotyping, Pathogenesis, Interferon, medicine, Humans, dendritic cells, lcsh:QH301-705.5, Pandemics, innate immunity, Cells, Cultured, Aged, Aged, 80 and over, degranulation, Innate immune system, SARS-CoV-2, Degranulation, COVID-19, General Medicine, Middle Aged, medicine.disease, Immunity, Innate, Neutrophilia, IFN alpha, Cytokine, lcsh:Biology (General), cytokine storm, Immunology, biology.protein, Cytokines, Female, medicine.symptom, Coronavirus Infections, Cytokine storm, medicine.drug
Abstract: COVID-19, caused by SARS-CoV-2 virus, emerged as a pandemic disease posing a severe threat to global health. To date, sporadic studies have demonstrated that innate immune mechanisms, specifically neutrophilia, NETosis, and neutrophil-associated cytokine responses, are involved in COVID-19 pathogenesis, however, our understanding of the exact nature of this aspect of host&ndash, pathogen interaction is limited. Here, we present a detailed dissection of the features and functional profiles of neutrophils, dendritic cells, and monocytes in COVID-19. We portray the crucial role of neutrophils as drivers of hyperinflammation associated with COVID-19 disease via the shift towards their immature forms, enhanced degranulation, cytokine production, and augmented interferon responses. We demonstrate the impaired functionality of COVID-19 dendritic cells and monocytes, particularly their low expression of maturation markers, increased PD-L1 levels, and their inability to upregulate phenotype upon stimulation. In summary, our work highlights important data that prompt further research, as therapeutic targeting of neutrophils and their associated products may hold the potential to reduce the severity of COVID-19.
Published: 2020
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26. Thromboelastometry as an Alternative Method for Coagulation Assessment in Pediatric Patients Undergoing Invasive Procedures: A Pilot Study

Author: Marianna Durilova, Tomas Vymazal, Jakub Jonas, Miroslav Durila, Michal Rygl, and Jiri Skrivan
Subjects: Male, Adolescent, medicine.medical_treatment, Pilot Projects, Postoperative Hemorrhage, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, medicine, Coagulation testing, Humans, Child, Retrospective Studies, Prothrombin time, medicine.diagnostic_test, business.industry, Infant, Blood Coagulation Disorders, Tonsillectomy, Thrombelastography, Thromboelastometry, Coagulation, 030220 oncology & carcinogenesis, Anesthesia, Child, Preschool, Pediatrics, Perinatology and Child Health, Surgery, Female, Fresh frozen plasma, business, Central venous catheter, Partial thromboplastin time
Abstract: Introduction Standard coagulation tests (activated partial thromboplastin time [aPTT] and prothrombin time [PT]) are used for the assessment of coagulation profile in critically ill pediatric patients undergoing invasive interventions such as insertion of central venous catheter, tonsillectomy, laparotomy, etc. However, these tests do not reflect the profile of whole blood coagulation. Rotational thromboelastometry (ROTEM) as a point of care (POC) viscoelastic test may serve as an alternative method. Due to its ability to assess coagulation profile of the whole blood, it might yield normal results despite prolonged aPTT/PT results. The aim of this study was to find out if there was any severe bleeding during or after invasive procedures if ROTEM test was normal despite prolonged values of aPTT/PT in pediatric patients. Materials and Methods We retrospectively analyzed data for the years 2015 to 2017 for pediatric patients with prolonged values of aPTT or PT and normal ROTEM tests—internal thromboelastometry (INTEM) (assessing internal pathway of coagulation) and external thromboelastometry (EXTEM) (assessing external pathway of coagulation)—and we looked for severe bleeding during or after invasive procedures. Results In 26 pediatric patients (children from 2 months to 17 years old), we found that INTEM and EXTEM tests showed normal coagulation despite prolonged values of aPTT ratio with a median of 1.47 (minimum 1.04 and maximum 2.05), international normalized ratio with a median of 1.4 (minimum 0.99 and maximum 2.10), and PT ratio with a median of 1.30 (minimum 0.89 and maximum 2.11). In these patients, no severe bleeding was observed during interventions or postoperatively. Conclusion Our data support using thromboelastometry method as an alternative coagulation test for the assessment of coagulation profile in pediatric patients undergoing surgical or other invasive procedures, especially using it as a POC test. All invasive procedures in our study were performed without severe bleeding despite prolonged values of PT/aPTT with normal ROTEM results. It seems that ROTEM assessment of coagulation may lead to decreased administration of fresh frozen plasma and shorten time of patient preparation for intervention.
Published: 2018

27. Laryngeal mask for airway management in open tracheal surgery-a retrospective analysis of 54 cases

Author: Jan Schutzner, Tomas Vymazal, Pavel Michalek, Paul Johnson, and Martina Krecmerova
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, medicine.medical_treatment, Tracheal intubation, respiratory system, 030204 cardiovascular system & hematology, Dehiscence, Anastomosis, Tracheal tube, medicine.disease, Tracheal Stenosis, Surgery, 03 medical and health sciences, 0302 clinical medicine, Pulmonary aspiration, Laryngeal mask airway, 030202 anesthesiology, medicine, Airway management, Original Article, business
Abstract: Background: Airway management in tracheal resections presents many challenges. The aim of this retrospective analysis is to report the efficacy and complications associated with the use of the laryngeal mask airway in this procedure. Methods: The charts of 54 consecutive patients operated for tracheal stenosis during the period 2009–2016 were reviewed. This cohort included only resections of the trachea. We evaluated total success rate of laryngeal mask insertion (%), insertion success rate on the first attempt, the quality of intraoperative ventilation through the laryngeal mask, the quality of fibre optic view through the device, incidence of bleeding during the first 24 h, signs of dehiscence of the anastomosis within 48 h and 30-day mortality. Results: The laryngeal mask airway provided a patent airway throughout the procedure in 52 (96.4%) patients. Insertion of the device failed in 1 (1.8%) patient due to abnormal upper airway anatomy. Another patient (1.8%) developed laryngeal mask malposition during intraoperative neck extension subsequently requiring tracheal intubation. Fibre optic view through the devices including insertion of the flexible bronchoscope was satisfactory in 52 (96.4%) patients. Serious complications, such as pulmonary aspiration, early postoperative bleeding or suture dehiscence were not observed in this cohort. Conclusions: Based on this analysis of 54 patients, we would consider the laryngeal mask airway a feasible alternative to the tracheal tube for airway management and ventilation during open tracheal surgery.
Published: 2018

28. The use of broad-range bacterial PCR in the diagnosis of infectious diseases: a prospective cohort study

Author: Pavel Drevinek, Vilém Rohn, F. Mosna, D. Jahoda, Tomas Vymazal, Jan Tkadlec, M. Peckova, D. Raszka, J. Berousek, M. Kvapil, and L. Sramkova
Subjects: 0301 basic medicine, Microbiology (medical), Adult, Male, medicine.medical_specialty, Adolescent, 030106 microbiology, Nucleotide sequencing, Polymerase Chain Reaction, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Internal medicine, RNA, Ribosomal, 16S, medicine, Humans, Blood culture, Clinical significance, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Child, Whole blood, Aged, Aged, 80 and over, Bacteriological Techniques, medicine.diagnostic_test, business.industry, Infant, General Medicine, Bacterial Infections, Sequence Analysis, DNA, Middle Aged, Confidence interval, Infectious Diseases, Molecular Diagnostic Techniques, Child, Preschool, Cohort, Female, business
Abstract: Objectives Broad-range PCR has the potential to detect virtually any bacterial species via amplification and nucleotide sequencing of a DNA region common to all bacteria. We aimed to evaluate its usefulness and clinical relevance when applied to a wide variety of primary sterile materials. Methods A prospective study including 1370 samples (75 heart valves, 151 joint tissue samples, 230 joint aspirates, 848 whole blood samples and 66 culture-negative cerebrospinal fluid samples) were studied by using a commercial PCR system for detecting 16S rDNA (Molzym). The PCR results were compared with culture and were considered to provide added diagnostic value only if the PCR approach revealed new pathogens that were missed by culture. Results The added value of PCR was evident in 173 of 555 PCR-positive samples (0.126; 0.109–0.144 (proportion from all tested samples; 95% confidence interval)), most frequently in examinations of heart valves (0.56; 0.448–0.672) and joint tissue samples (0.219; 0.153–0.284). In contrast, the lowest rate of PCR with added value was noted for blood samples, regardless of the patient cohort they had been drawn from (nononcologic patients from intensive care: 0.065; 0.043–0.087, haematooncologic children: 0.048; 0.027–0.070). Moreover, PCR missed up to 7.1% of blood culture findings (0.071; 0.048–0.095) regarded as clinically relevant, which was the second highest failure rate after joint tissue samples (0.099; 0.052–0.147). Conclusions Broad-range PCR substantially increases detection rate of pathogens, especially from heart valves and joint samples. However, a concurrent risk of false-negative PCR results justifies the need for parallel culture.
Published: 2018

29. Rotational Thromboelastometry Helps to Reduce Blood Product Consumption in Critically Ill Patients during Small Surgical Procedures at the Intensive Care Unit - a Retrospective Clinical Analysis and Literature Search

Author: Marta Astraverkhava, Miroslav Durila, and Tomas Vymazal
Subjects: Prothrombin time, medicine.medical_specialty, medicine.diagnostic_test, Clinical pathology, business.industry, 030208 emergency & critical care medicine, Hematology, 030204 cardiovascular system & hematology, Intensive care unit, law.invention, 03 medical and health sciences, Thromboelastometry, 0302 clinical medicine, law, Blood product, Intensive care, Emergency medicine, medicine, Immunology and Allergy, Fresh frozen plasma, business, Whole blood, Research Article
Abstract: Background: Patients at intensive care units (ICUs) are often transfused to correct increased coagulation parameters (prothrombin time and activated partial thromboplastine time) and/or low platelet count. Thromboelastometry using whole blood is considered to be superior to these tests. In clinical praxis, prolonged standard tests are seen but thromboelastometry values are normal. The objective was to compare the blood product consumptions before and after the introduction of thromboelastometry assays into the treatment protocol during small surgical procedures at our mixed ICU. Methods: We analyzed 1,879 patients treated at our ICU who underwent small interventions. We compared the fresh frozen plasma and platelet consumption before and after the introduction of rotational thromboelastometry into the routine use. The obtained data were compared to relevant research results from the PubMed database, the MeSH index in the Medline database, and Google Scholar using key words ‘tromboelastometry', ‘fresh frozen plasma' and ‘platelets'. Results: Annual fresh frozen plasma and platelet consumptions were significantly decreased following thromboelastometry introduction. The number of patients and procedures did not differ significantly during the periods analyzed. Conclusion: Routine thromboelastometry assays can enable significant reduction of blood product consumption in critically ill patients undergoing small surgery without any bleeding complications.
Published: 2018

30. Minimally invasive approach to calcified aortic valve replacement: Anaesthetic considerations

Author: Tomas Vymazal
Subjects: medicine.medical_specialty, Calcified aortic valve, Transcatheter aortic, business.industry, aortic valve stenosis, Gold standard (test), medicine.disease, Anaesthesia, lcsh:RD78.3-87.3, Special Article, Stenosis, Anesthesiology and Pain Medicine, Increased risk, Aortic valve replacement, lcsh:Anesthesiology, Internal medicine, Aortic valve stenosis, medicine, Cardiology, cardiovascular system, aortic valve replacement, calcified aortic valve, business, transcatheter aortic valve implantation
Abstract: For symptomatic patients with severe calcified aortic valve stenosis, open heart surgery for aortic valve replacement remains the gold standard. However, elderly patients with an increased risk profile can be treated by using transcatheter approaches (transcatheter aortic valve implantation [TAVI]). The major considerations related to use of general and local anaesthesia for TAVI are discussed in this review.
Published: 2015

31. Respiratory Strategies and Airway Management in Patients with Pulmonary Alveolar Proteinosis: A Review

Author: Tomas Vymazal and Martina Krecmerova
Subjects: medicine.medical_specialty, medicine.medical_treatment, lcsh:Medicine, Review Article, Pulmonary Alveolar Proteinosis, General Biochemistry, Genetics and Molecular Biology, Extracorporeal Membrane Oxygenation, Intubation, Intratracheal, Extracorporeal membrane oxygenation, medicine, Humans, Continuous positive airway pressure, Airway Management, Intensive care medicine, Evidence-Based Medicine, Lung, General Immunology and Microbiology, business.industry, Patient Selection, lcsh:R, General Medicine, respiratory system, medicine.disease, Combined Modality Therapy, Respiration, Artificial, Treatment Outcome, medicine.anatomical_structure, Respiratory failure, Breathing, Airway management, Airway, business, Pulmonary alveolar proteinosis
Abstract: Background. Pulmonary alveolar proteinosis is a rare disorder characterized by a large accumulation of lipoproteinaceous material within the alveoli. This causes respiratory failure due to a restriction of gas exchange and changes in the ventilation/perfusion ratio. Treatment methods include noninvasive pharmacological approaches and invasive procedures, such as whole-lung lavage under general anesthesia.Methods. Based on the literature search using free-term key words, we have analyzed published articles concerning the perioperative management of adult and pediatric patients with pulmonary alveolar proteinosis.Results and Discussion. In total, 184 publications were analyzed. Only a few manuscripts were related to anesthetic, respiratory, and airway management in patients suffering from pulmonary alveolar proteinosis. Airway should be strictly separated using a double-lumen tube. Respiratory strategies involve the use of manual clapping, continuous positive airway pressure, high-frequency jet ventilation of the affected lung, and employment of venovenous extracorporeal membrane oxygenation in the most serious of cases.Conclusion. The goal of this review is to summarize the current published information about an anesthetic management strategy with a focus on airway management, ventilation, and oxygenation techniques in PAP patients.
Published: 2015
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32. Effect of Balanced Crystalloid, Gelatin and Hydroxyethyl Starch on Coagulation Detected by Rotational Thromboelastometry In Vitro

Author: Miroslav Durila, Tomas Vymazal, and Silvie Sevcikova
Subjects: Adult, Male, food.ingredient, Sodium Acetate, Magnesium Chloride, Plasma Substitutes, Hydroxyethyl starch, Sodium Chloride, Fibrinogen, Gelatin, Gluconates, General Biochemistry, Genetics and Molecular Biology, Potassium Chloride, Hydroxyethyl Starch Derivatives, 03 medical and health sciences, 0302 clinical medicine, food, 030202 anesthesiology, medicine, Coagulation (water treatment), Humans, 030212 general & internal medicine, Chemistry, Balanced Crystalloid Solution, Healthy Volunteers, Thrombelastography, Thromboelastometry, Clotting time, Anesthesia, Female, medicine.drug
Abstract: Fluid resuscitation with crystalloid and colloid solutions is a common treatment in perioperative medicine. However, a variety of unbalanced or balanced solutions are used in clinical practice and there is still vivid debate going on regarding selection of optimal fluid with minimal negative effect on coagulation to minimize bleeding and blood transfusion requirements. The aim of the study was to investigate adverse effects of balanced crystalloids and colloids on coagulation measured by thromboelastometry in vitro.Blood samples were obtained from healthy volunteers undergoing knee arthroscopy. Adverse effects of balanced crystalloid, hydroxyethyl starch, and gelatin were evaluated by thromboelastometry after 20% dilution of blood with the solution in vitro. Parameters of EXTEM and FIBTEM test were evaluated.Clotting time of EXTEM was not significantly influenced by any of the investigated solutions (p0.05). However, significant impairment of clot formation time of EXTEM was detected in hydroxyethyl starch and gelatin groups in comparison with controls (p0.05), while crystalloid did not affect this parameter significantly (p0.05). Similar results were found in α angle although significant coagulopathy effect was found only in hydroxyethyl starch samples (p0.05). Maximum clot firmness of EXTEM and FIBTEM tests was significantly affected by both hydroxyethyl starch and gelatin (p0.05) but not by crystalloid.Balanced crystalloid solution does not seem to have a negative influence on the coagulation process as measured by thromboelastometry. On the other hand, balanced colloids may impair propagation phase of coagulation, strength of coagulum, and level of functional fibrinogen. Hydroxyethyl starch seems to have a stronger anticoagulant effect compared to gelatin.
Published: 2017

33. Hypotension after induction of general anesthesia: occurrence, risk factors, and therapy. A prospective multicentre observational study

Author: Ondrej Jor, Michaela Trlicova, Jan Máca, Pavel Ševčík, Vladimir Cerny, Vera Mikulova, Petr Reimer, Martina Litschmannová, Jirina Koutna, Tomas Vymazal, and Michaela Gemrotova
Subjects: Adult, Mean arterial pressure, medicine.medical_specialty, Sufentanil, Blood Pressure, 030204 cardiovascular system & hematology, Anesthesia, General, 03 medical and health sciences, 0302 clinical medicine, Bolus (medicine), 030202 anesthesiology, Risk Factors, Anesthesiology, Diabetes mellitus, medicine, Intubation, Intratracheal, Humans, Decompensation, Arterial Pressure, Prospective Studies, Propofol, Aged, business.industry, Blood Pressure Determination, Middle Aged, medicine.disease, Anesthesiology and Pain Medicine, Blood pressure, Cross-Sectional Studies, Anesthesia, Hypertension, Hypotension, business, Anesthetics, Intravenous, medicine.drug
Abstract: Hypotension after induction of general anesthesia (GAIH) is common in anesthesiology practice and can impact outcomes. In this prospective multicenter, cross-sectional, observational study, the hypotension was defined as a decrease in mean arterial pressure of > 30% compared to the first measurement in the operation theatre before general anesthesia (GA) induction. Blood pressure was measured immediately at the time of endotracheal intubation (TETI), at five (T5) and 10 (T10) minutes after. All subjects aged > 18 years undergoing elective non-cardiac surgery under GA were included. The goals were description of GAIH occurrence, the association of GAIH with selected comorbidities, chronic medications, and anesthetics with GAIH, and the type and efficacy of interventions used to correct hypotension. Data from 661 subjects, whose GA was induced with propofol and sufentanil, were analyzed. In 36.5% of subjects, GAIH was observed at ≥ 1 of the assessed time points. GAIH was present in 2.9% subjects at all time points. The probability of GAIH is raising with age, degree of hypertension at time of arrival to theatre and presence of diabetes. The type of volatile anesthetic was not associated with the occurrence of GAIH. The overall efficiency of interventions to correct hypotension was 94.4%. Bolus fluids were the most often used intervention and was 96.4% effective. GAIH rate depends on age, degree of blood pressure decompensation prior the surgery, and presence of diabetes mellitus type II.
Published: 2017

34. Point of Care Management of Perioperative Coagulopathy Reduces Blood Loss and Consumption of Blood Transfusion Products (Preliminary Results)

Author: Robert Lischke, Jaromir Vajter, Tomas Vymazal, Miroslav Durila, and Jan Berousek
Subjects: Pulmonary and Respiratory Medicine, Consumption (economics), Transplantation, medicine.medical_specialty, Blood transfusion, business.industry, medicine.medical_treatment, Perioperative, medicine.disease, Blood loss, Coagulopathy, medicine, Surgery, Cardiology and Cardiovascular Medicine, business, Intensive care medicine, Point of care
Published: 2019
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35. Point of Care Management of Perioperative Bleeding or Coagulopathy and Volume Replacement Strategy with Albumin 5% Seems to Reduce Primary Graft Disfunction after Lung Transplantation (Preliminary Results)

Author: Miroslav Durila, Jan Berousek, Robert Lischke, Jaromir Vajter, Tomas Vymazal, and Zuzana Prikrylova
Subjects: Pulmonary and Respiratory Medicine, Artificial ventilation, Transplantation, business.industry, medicine.medical_treatment, Primary Graft Dysfunction, Perioperative, medicine.disease, Thromboelastometry, Anesthesia, Coagulopathy, Intravascular volume status, Medicine, Lung transplantation, Surgery, Fresh frozen plasma, Cardiology and Cardiovascular Medicine, business
Abstract: Purpose Primary Graft Dysfunction (PGD) is the most common complication during the first 72 hours after lung transplant. Amount of perioperative blood loss and blood product administration may be some of the causes. Intravascular volume during surgery and in ICU is usually maintained by the administration of crystalline and colloids solutions and by administration of fresh frozen plasma (FFP) due to coagulopathy. In the field of the allogenic ischemic organ FFP essentially becomes another allogenic material and can cause undesired immunomodulation and contribute to the development of PGD. Nowadays point of care (POC) management of coagulopathy and bleeding is available using methods such as thromboelastometry (ROTEM), platelet function analyzer (PFA 200) and agregometer (Multiplate) which contribute to the optimalization of blood products and coagulation factors administration. The purpose of this study is to find out if POC management of perioperative bleeding and coagulopathy can reduce postoperative PGD development and length of artificial ventilation. Methods 18 patients undergoing bilateral lung transplantation were randomized into 2 groups. In the first group (9 subj) the management of perioperative bleeding or coagulopathy and volume replacement strategy were based on clinical experience of the anesthesiologist - standard approach. In the second group (9 subj) the management of perioperative bleeding and coagulopathy was based on the results of POC methods. Albumin 5% solution was preferably used for volume replacement therapy. Results In the POC management group PGD development, length of artificial ventilation and langht of stay was significantly reduced. Conclusion POC management of perioperative bleeding or coagulopathy and volume replacement strategy with Albumin 5% significantly reduce PGD development and decrease length of stay and artificial ventilation.
Published: 2019
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36. Stability of Non-Activated Rotational Thromboelastometry Assay in Time of Citrated Blood (Appropriate Time Interval for Analysis)

Author: Tomas Vymazal, Silvie Sevcikova, and Miroslav Durila
Subjects: Adult, Male, 0301 basic medicine, Severe bleeding, Time Factors, Coagulation time, Normal values, 030204 cardiovascular system & hematology, Sodium Citrate, General Biochemistry, Genetics and Molecular Biology, Specimen Handling, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Time windows, Coagulopathy, medicine, Humans, Citrates, Prospective Studies, Blood Coagulation, business.industry, Anticoagulants, medicine.disease, Healthy Volunteers, Thrombelastography, Thromboelastometry, 030104 developmental biology, Blood Preservation, Anesthesia, Female, Sample collection, business, Blood sampling
Abstract: BACKGROUND Activated methods of thromboelastometry such as EXTEM and INTEM are routinely used in management of severe bleeding. However, sometimes the patient is bleeding despite the normal values of EXTEM/ INTEM. Non-activated thromboelastometry (NATEM) is the most sensitive to coagulopathy and shows pathologic results in such cases. However, it is necessary to find an appropriate time interval between blood sampling and NATEM analysis as the results are strongly influenced by time. METHODS In 18 healthy volunteers we performed NATEM analyses of citrated blood samples at 0, 5, 10, 15, 20, 30, and 60 minutes after sampling. RESULTS All NATEM parameters showed a procoagulation trend with the time elapsing from blood sample collection with coagulation time (CT) being the most sensitive parameter. After 20 minutes this parameter became relatively stable as the difference among CT at 20th, 30th, and 60th minute was not statistically significant (p > 0.05). The least differences of CT values with maximum time window were found between 30 and 60 minutes. CONCLUSIONS Citrated blood sample becomes stable after 20 minutes of storage but the time window between 30 and 60 minutes seems to be more suitable for NATEM analysis in clinical practice.
Published: 2016
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37. 1505: PROCEDURES IN SEPSIS DONE WITHOUT BLEEDING WHEN NORMAL THROMBOELASTOMETRY DESPITE PROLONGED INR

Author: Tomas Vymazal and Miroslav Durila
Subjects: Sepsis, Thromboelastometry, business.industry, Anesthesia, medicine, Critical Care and Intensive Care Medicine, medicine.disease, business
Published: 2018
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38. Is Allogeneic Blood Transfusion a Risk Factor for Sternal Dehiscence Following Cardiac Surgery? A Prospective Observational Study

Author: Tomas Vymazal, Radim Durpekt, Michal Horáček, Karel Cvachovec, and Marie Hladíková
Subjects: Male, Sternum, medicine.medical_specialty, Blood transfusion, medicine.medical_treatment, Dehiscence, Pulmonary Disease, Chronic Obstructive, Risk Factors, Surgical Wound Dehiscence, medicine, Humans, Obesity, Prospective Studies, Cardiac Surgical Procedures, Aged, Aged, 80 and over, Wound dehiscence, business.industry, Transfusion Reaction, Surgical wound, General Medicine, Perioperative, Middle Aged, musculoskeletal system, medicine.disease, Surgery, Cardiac surgery, surgical procedures, operative, Median sternotomy, Female, Cardiology and Cardiovascular Medicine, Packed red blood cells, business
Abstract: Sternal dehiscence following cardiac surgery has a multifactorial etiology. Significant risk factors contributing to sternal dehiscence include chronic obstructive pulmonary disease (COPD), obesity, or re-exploration due to bleeding or pericardial tamponade. We have focused on the role of allogeneic blood transfusion as a factor leading to the poor healing of surgical wounds. A prospective observational study of 1553 elective and emergency cardiac surgery patients was performed between January 2003 and June 2007. All of the patients enrolled in this study underwent median sternotomy. We studied the relationship between sternal dehiscence following cardiac surgery and the total number of packed red blood cells transfused.The incidence of sternal dehiscence in the study group was 3.4%. Diabetic patients did not have a higher incidence of wound dehiscence. Although COPD,2) obesity,2) and re-exploration4) contributed to sternal dehiscence, the number of allogeneic blood transfusions during the perioperative period was an important independent risk factor for sternal dehiscence. Patients with sternal dehiscence received an average of 7.6 transfusion units (TU) of allogeneic blood versus 1.6 TU of allogeneic blood in the group without sternal dehiscence (P < 0.00005). The dehiscence affected patients without any other significant risk factor who received 6 or more TU, or patients with at least one significant risk factor who received 4 or more TU of allogeneic blood.According to our results, the total amount of allogeneic blood transfused is an important risk factor contributing to sternal dehiscence. Regardless of other risk preconditions, the transfusion of 6 or more TU could result in sternal dehiscence following cardiac surgery.
Published: 2009
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39. Extracorporeal membrane oxygenation to support repeated whole-lung lavage in a patient with pulmonary alveolar proteinosis in life threatening dyspnoe – a case report

Author: Vladimír Bicek, Alzbeta Grandcourtova, Martina Krecmerova, Tomas Vymazal, Frantisek Petrik, Marek Lekes, and Frantisek Mosna
Subjects: medicine.medical_specialty, medicine.medical_treatment, Case Report, Pulmonary Alveolar Proteinosis, Bronchoalveolar Lavage, Pulmonary alveolar proteinosis (PAP), General anesthesia (GA), Extracorporeal Membrane Oxygenation, Parenchyma, medicine, Extracorporeal membrane oxygenation, Humans, Respiratory system, medicine.diagnostic_test, business.industry, Oxygenation, Middle Aged, respiratory system, Extracorporeal membrane oxygenation (ECMO), medicine.disease, Surgery, Dyspnea, Treatment Outcome, Anesthesiology and Pain Medicine, Bronchoalveolar lavage, Respiratory failure, Anesthesia, Breathing, Female, business, Pulmonary alveolar proteinosis, Whole-lung lavage (WLL)
Abstract: Backgroud Pulmonary alveolar proteinosis is a rare disorder that is characterized by a large accumulation of lipoproteinaceous material within the alveoli. This causes respiratory failure due to a restriction of gas exchange and changes in the ventilation/perfusion ratio. Clinical symptoms are variable and depend on the severity of damage of the lung parenchyma. Treatment method is whole-lung lavage, where the accumulated lipoproteinaceous material is removed using large quantities of saline. Case presentation This case report describes a 45 year old patient with advanced pulmonary alveolar proteinosis. Due to the presence of severe global respiratory insufficiency, this patient could not undergo the classic whole-lung lavage using a double-lumen tube and selective lung ventilation. The whole-lung lavage was performed with the support of veno-venous extracorporeal membrane oxygenation. A total of 27 l of warm saline was used. Conclusion According to the current published literature, whole-lung lavage with extra-corporeal membrane oxygenation support is a very rare treatment method. Even when taking into account all of the risks associated with whole-lung lavage and v-v extracorporeal membrane oxygenation support, we found that this technique is very effective and, without a doubt, it saved the life of our patient.
Published: 2015
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40. Feasibility of full and rapid neuromuscular blockade recovery with sugammadex in myasthenia gravis patients undergoing surgery - a series of 117 cases

Author: Tomas Vymazal, Vladimír Bicek, Robert Lischke, and Martina Krecmerova
Subjects: medicine.medical_specialty, Therapeutics and Clinical Risk Management, Neuromuscular transmission, Postoperative residual curarization, Sugammadex, medicine, Pharmacology (medical), General Pharmacology, Toxicology and Pharmaceutics, Rocuronium, neuromuscular blockade recovery, Original Research, Neuromuscular Blockade, myasthenia gravis, Chemical Health and Safety, business.industry, General Medicine, medicine.disease, general anesthesia, Myasthenia gravis, Hypoventilation, Surgery, Muscle relaxation, Anesthesia, sugammadex, medicine.symptom, business, Safety Research, medicine.drug
Abstract: Tomas Vymazal,1 Martina Krecmerova,1 Vladimír Bicek,1 Robert Lischke2 1Department of Anaesthesiology and ICM, 2nd Faculty of Medicine, 23rd Surgical Department of 1st Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic Purpose: Myasthenia gravis (MG) is an autoimmune disease interfering with neuromuscular transmission. Patients are at risk of postoperative residual curarization (PORC) if nondepolarizing muscle relaxants are used. Clinically inapparent insufficient muscle strength may result in hypoventilation and postoperative bronchopneumonia. We describe a cohort of 117 cases in which sugammadex was used in MG patients undergoing surgery with muscle relaxation with rocuronium.Methods and patients: We anesthetized 117 patients with MG using rocuronium and sugammadex as neuromuscular blockade reversal agent. One hundred five patients underwent surgical thymectomy and 12 underwent cholecystectomy (five laparotomic and seven laparoscopic). We measured time from sugammadex administration to recovery and to extubation, using the TOF-Watch® (series of four consecutive electrical impulses [the train-of-four] >0.9). We tracked peripheral capillary oxygen saturation (SpO2) 10% above baseline, number of reintubations within the first 48 hours, and number of pneumonias within 120 hours, postoperatively. Results were processed as average, minimum, and maximum values.Results: The period needed to reach train-of-four of 0.9 following sugammadex administration was on average 117 seconds (minimum of 105 seconds/maximum of 127 seconds) and differed within deviation 10% above a baseline, no emergent reintubation within the first 48 hours, and no pneumonia diagnosed on clinical basis within 120 hours, postoperatively in all 117 patients.Conclusion: In this cohort of MG patients undergoing surgery using rocuronium and sugammadex, we did not observe any signs of postoperative residual curarization and respiratory depression. The neuromuscular blockade recovery was reliable, predictable, and rapid. Keywords: neuromuscular blockade recovery, myasthenia gravis, general anesthesia, sugammadex&nbsp
Published: 2015

41. Tracheostomy in intensive care unit patients can be performed without bleeding complications in case of normal thromboelastometry results (EXTEM CT) despite increased PT-INR: a prospective pilot study

Author: Jan Berousek, Tomas Vymazal, Pavel Lukáš, Miroslav Durila, Michal Zábrodský, and Marta Astraverkhava
Subjects: medicine.medical_specialty, Hemorrhage, Pilot Projects, law.invention, Sepsis, Plasma, Tracheostomy, law, Anesthesiology, medicine, Coagulopathy, Humans, International Normalized Ratio, Prospective Studies, Prospective cohort study, Prothrombin time, medicine.diagnostic_test, business.industry, Thromboelastometry, Bleeding, Reproducibility of Results, Blood Coagulation Disorders, medicine.disease, Intensive care unit, Thrombelastography, Surgery, Intensive Care Units, Anesthesiology and Pain Medicine, Prothrombin Time, Fresh frozen plasma, business, Research Article
Abstract: Background Coagulopathy is often accompanied by prolongation of prothrombin time (PT) in septic and nonseptic patients in intensive care unit (ICU). The conventional way to correct the coagulopathy is to administer fresh frozen plasma (FFP) before invasive procedures to minimise the risk of bleeding. However, prolonged PT can be present even in hypercoagulation status, resulting in unnecessary administration of FFP. In the present study, we have assessed the reliability of thromboelastometry in case of prolonged PT and the relationship to bleeding complications during surgical tracheostomy. Methods The study was conducted during the period between April 2013 and April 2014 in patients undergoing surgical tracheostomy. Coagulation status was assessed using PT, and the status was reassessed by thromboelastometry for prolonged PT. Tracheostomy was performed in patients with normal thromboelastometry results without administering FFP. Results Tracheostomy was performed in total 119 patients. Normal value of PT as measured by international normalized ratio (INR) ≤ 1.2 was found in 64 (54 %) patients, while prolonged INR > 1.2 was found in 55 (46 %) patients. Patients with INR ≥ 1.3 (with INR min- 1.3, max- 1.84, and median- 1.48) were further analysed by thromboelastometry. Despite prolonged INR, thromboelastometry results were in normal ranges in all cases except one. With normal thromboelastometry, tracheostomy was performed safely without any bleeding complication. Conclusions Surgical tracheostomy in septic and nonseptic patients can be performed without bleeding complications in case of normal thromboelastometry results (EXTEM CT) despite increased PT-INR. This method can help physicians to reduce unnecessary administration of FFP in patients.
Published: 2015
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42. Evaluation of fibrinogen concentrates and prothrombin complex concentrates on coagulation changes in a hypothermic in vitro model using thromboelastometry and thromboelastography

Author: Tomas Vymazal, Pavel Lukáš, Marta Astraverkhava, and Miroslav Durila
Subjects: Adult, Male, Rotation, Clinical Biochemistry, Fibrinogen, Models, Biological, Hypothermia, Induced, Coagulopathy, Medicine, Humans, Blood Coagulation, medicine.diagnostic_test, business.industry, General Medicine, Hypothermia, medicine.disease, Thrombosis, Prothrombin complex concentrate, Thromboelastography, Blood Coagulation Factors, Thrombelastography, Thromboelastometry, Coagulation, Anesthesia, Female, medicine.symptom, business, medicine.drug
Abstract: Background. Hypothermic coagulopathy is very challenging in bleeding trauma patients. Therefore, we decided to evaluate the efficacy of fibrinogen and prothrombin complex in 30°C hypothermia in vitro to investigate if higher levels of fibrinogen and prothrombin complex concentrate can compensate for the hypothermic effect on coagulation as measured by thromboelastometry/thromboelastography. Methods. Blood samples were obtained from 12 healthy volunteers (six men and six women) in our study. Measurements were performed at 37°C and 30°C simultaneously, then at 30°C with adding fibrinogen and prothrombin complex and in the last step samples with added coagulation factors were warmed back to 37°C. Results. We found that 30°C hypothermic coagulopathy can be detected both by thromboelastometry and thromboelastography. Hypothermic coagulopathy can be restored by fibrinogen to the point where the results do not significantly differ from 37°C values (p > 0.05). After warming the sample with fibrinogen to 37°C, the thrombodynamic potential index was not significantly different from baseline (p > 0.05), although there was a trend to prothrombotic status. The addition of prothrombin complex concentrate to 30°C hypothermic sample was not able to correct hypothermic coagulopathy in vitro. Conclusions. Coagulopathy caused by the 30°C hypothermia in vitro model can be corrected by fibrinogen concentrate compared to prothrombin complex concentrate. In spite of a tendency to prothrombotic status, this was not significant with the use of the recommended dose of fibrinogen even after warming the blood to 37°C. However, measurement performed at 37°C seems to be safer than at 30°C.
Published: 2015

43. Impact of retransfusion of blood processed in cell-saver on coagulation versus cardiopulmonary bypass: a prospective observational study using thromboelastography

Author: Tomas Vymazal, Michal Horáček, and Martin Filaun
Subjects: medicine.medical_specialty, medicine.medical_treatment, lcsh:Medicine, Postoperative Hemorrhage, General Biochemistry, Genetics and Molecular Biology, law.invention, coagulopathy, law, Fibrinolysis, medicine, Coagulopathy, Cardiopulmonary bypass, Humans, Blood Transfusion, Prospective Studies, Blood Coagulation, Cardiopulmonary Bypass, biology, medicine.diagnostic_test, business.industry, lcsh:R, thromboelastography, medicine.disease, bleeding, Protamine, Thromboelastography, Cardiac surgery, Thrombelastography, Coagulation, Anesthesia, Retreatment, biology.protein, Observational study, fibrinolysis, business, cell-saver, circulatory and respiratory physiology
Abstract: Aims: To compare an impact of retransfusion of blood processed in cell-saver (CS) with that of cardiopulmonary bypass (CPB) on blood coagulation in patients undergoing cardiac surgery. Methods: Prospective observational study using thromboelastography (TEG). Results: TEG samples from 170 patients were analyzed. Cardiopulmonary bypass was used in 100 patients while 70 patients were operated off-pump. In 20 off-pump patients collected blood was processed by cell-saver and returned. In all patients clot formation after heparin neutralization by protamine was unimpaired. However, there was a significant increase in fibrinolysis defined by the TEG parameter Lysis time 30 min after the maximum amplitude of the clot was reached (Ly30) in groups with CPB or CS but this increase still did not exceed the threshold for clinical fibrinolysis (Ly30 > 7.5%). In the group without CPB there was no significant impact on coagulation. Conclusion: Surgery that avoids CPB and/or CS is the gentlest method for inducing blood coagulation.
Published: 2012

44. Massive hemorrhage management – a best evidence topic report

Author: Tomas Vymazal
Subjects: medicine.medical_specialty, Chemical Health and Safety, business.industry, Psychological intervention, MEDLINE, General Medicine, medicine.disease, Fibrinogen, Surgery, Coagulation, Cryoprecipitate, Coagulopathy, medicine, Pharmacology (medical), Platelet, General Pharmacology, Toxicology and Pharmaceutics, Intensive care medicine, business, Safety Research, medicine.drug, Whole blood
Abstract: INTRODUCTION: Massive hemorrhage remains a major cause of potentially preventable deaths. Better control of bleeding could improve survival rates by 10%-20%. Transfusion intervention concepts have been formulated in order to minimize acute traumatic coagulopathy. These interventions still have not been standardized and vary among medical centers. MATERIALS AND METHODS: Based on a literature search using free term keywords and Medical Subject Heading (MeSH) index, we analyzed published articles addressing massive hemorrhage, component therapy, fresh whole blood, and fibrinogen from the year 2000 onward, in journals with impact factor >1.000, in Medline, PubMed, and Google Scholar. The evidence was grouped into topics including laboratory testing and transfusion interventions/viscoelastic assays vs standard laboratory tests, the effect of component therapy on patient outcome, the effect of warm fresh whole blood on patient outcome, and the effects of fibrinogen in severe bleeding. The obtained information was compared, evaluated, confronted, and was focused on to present an adequate and individual-based massive hemorrhage management approach. RESULTS: Viscoelastic whole-blood assays are superior to standard coagulation blood tests for the identification of coagulopathy and for guiding decisions on appropriate therapy in patients with severe bleeding. Replacement of plasma, red blood cells, platelets, and fibrinogen in a ratio of 1:1:1:1 has appeared to be the best substitution for lost whole blood. There is no evidence that cryoprecipitate improves the outcome of patients with severe hemorrhage. Current literature promotes the transfusion of warm fresh whole blood, which seems to be superior to the component therapy in certain clinical situations. Some authors recommend that fibrinogen and other coagulation factors be administered according to the viscoelastic attributes of the blood clot. CONCLUSION: This best-evidence topic report brings comprehensive information about massive hemorrhage management.
Published: 2015
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45. Lidocaine not so innocent: Cardiotoxicity after topical anaesthesia for bronchoscopy

Author: Tomas Vymazal and Michal Horáček
Subjects: medicine.medical_specialty, Topical anaesthesia, Cardiotoxicity, medicine.diagnostic_test, Lidocaine, business.industry, MEDLINE, Surgery, lcsh:RD78.3-87.3, Anesthesiology and Pain Medicine, Bronchoscopy, lcsh:Anesthesiology, Anesthesia, medicine, Letters to Editor, business, medicine.drug
Published: 2012
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46. Přímá transaortální implantace chlopně do aortální pozice u nemocného po chirurgické revaskularizaci myokardu

Author: Josef Veselka, Petr Hájek, Giuseppe Bruschi, Martin Malý, Tomas Vymazal, Marek Šetina, and Kateřina Linhartová
Subjects: Cardiology and Cardiovascular Medicine

47. Point of Care Management of Perioperative Coagulopathy Reduces Consumption of Fresh Frozen Plasma and Seems to Be Associated with Decreased Apache and Sofa Scores in Patients Undergoing Lung Transplantation (Preliminary Results)

Author: Tomas Vymazal, Miroslav Durila, Robert Lischke, Jaromir Vajter, and Jan Berousek
Subjects: Pulmonary and Respiratory Medicine, Transplantation, Blood transfusion, APACHE II, business.industry, medicine.medical_treatment, Perioperative, medicine.disease, Clinical trial, Anesthesia, medicine, Coagulopathy, Lung transplantation, Surgery, SOFA score, Fresh frozen plasma, Cardiology and Cardiovascular Medicine, business
Abstract: Purpose Lung transplantation is often accompanied with significant bleeding and coagulopathy. Perioperative management usually consists of administering of fresh frozen plasma (FFP) and red blood cells. However, usage of blood transfusion products, especially FFP, may be associated with higher morbidity of patient. Point of care (POC) monitoring of coagulopathy by thrombelastometry (ROTEM), platelet function analyzer (PFA 200) and agregometer (Multiplate) and subsequent aimed therapy may lead to decreased consumption of FFP. The purpose of this study is to investigate if POC based monitoring and treatment of coagulopathy may decrease consumption of FFP, APACHE II (Acute Physiology and Chronic Health Evaluation) and SOFA (Sequential Organ Failure Assessment) scores. Methods Patients undergoing bilateral lung transplantation were randomized into 2 groups. In the first group (non-POC group) management of bleeding and coagulopathy was based on anesthesiologist´s experience by administering FFP or other coagulation factors. In the second group (POC group) management of coagulopathy was based on results of POC methods such as ROTEM, PFA 200, Multiplate and 5% albumin solution was used to maintain normovolemia. Results Total number of analyzed patients is 46. In POC group no FFP unit was used at all. Admission APACHE II score as well as SOFA score 24 hours after admission was significantly decreased in POC group of patients (p Conclusion Perioperative usage of POC methods such as ROTEM, PFA 200 and Multiplate to diagnose and treat coagulopathy significantly reduces consumption of FFP and may decrease APACHE II and SOFA score in patients undergoing lung transplantation. The study is registered in clinical trial database with number: CTN03598907.

48. Management of hypotension after general anaesthesia induction - multicenter questionnaire study

Author: Tomas Vymazal, Pavel Ševčík, L. Zach, Olga Klementova, J. Firment, Vladimír Černý, Jan Máca, M. Pauliny, J. Čapková, K. Bezděk, Tomáš Pařízek, Martina Litschmannová, and Ondřej Jor
Subjects: Anesthesiology and Pain Medicine, Blood pressure, Descriptive statistics, business.industry, High variability, Medicine, Computer-assisted web interviewing, Critical Care and Intensive Care Medicine, business, Response Variability, Demography, Questionnaire study
Abstract: Objective: The aim of our study was to assess the management of hypotension after general anaesthesia induction (GAIH). Design: Multicenter questionnaire study. Setting: Eight different size anaesthesiology departments located in the Czech or Slovak Republics. Materials and methods: The respondents responded to three identification questions (workplace, length of practince) and ten GAIH management questions in our online questionnaire. Simple descriptive statistics describing the representation of the respondents' answers in absolute and relative terms were used. Normalized entropy (H) was used to assess the variability of responses. Results: A fully completed questionnaire was obtained from 172 respondents. The highest rate of variability was observed in question 1.: "As the baseline blood pressure value (BP), to which I compare other BP values, I consider..." H = 0.966. The lowest response variability rate was observed in question 4.: "As hypotension, I consider the Of BP..." H = 0.07). Conclusion: Our results indicate high variability of GAIH management among anaesthetists.

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48 results on '"Tomas Vymazal"'

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