21 research outputs found
Neuromuscular blockade in clinical practice in paediatric anaesthesia: retrospective cohort trial in a tertiary paediatric anaesthesia centre
Background. Neuromuscular blockade is
associated with improved airway conditions
for intubation and superior conditions
for surgical interventions (predominantly
important in laparoscopic surgery).
Residual neuromuscular blockade in the
postoperative period is, according to recently
published data, associated with a
negative impact on perioperative morbidity
and mortality.
Aim. Te aim of the study was to describe
daily practice in clinical paediatric anaesthesia
in a tertiary children’s hospital.
Methods. Data from anaesthesiology
records during the period 1.1.2016 to
31.12.2016 were retrospectively screened.
Primary outcomes included the rate of
surgery cases with neuromuscular blockade,
the incidence of cases with perioperative
neuromuscular blockade monitoring
and the incidence of neuromuscular
pharmacologic block reversal. Secondary
outcomes were myorelaxant usage according
to the age of patients and duration of
surgery.
Results. Overall 8046 paediatric patients
underwent general anaesthesia in the study
period. Muscle relaxants were administered
in 1650 cases (20.5%). Te most frequently
administered muscle relaxant was
mivacurium (48.2 %, n=795), followed by
cis-atracurium (36.4 %, n=601), suxamethonium
(10.3 %, n=170) and rocuronium
(7.0 %, n=115). Neuromuscular blockade
monitoring was used only in 2.5% (n=41)
of cases. Active neuromuscular blockade
reversal was administered in 5.8% (n=95)
of cases.
Conclusion. Neuromuscular blockade in
paediatric anaesthesia was less frequent
compared to adults. Te low rate of neuromuscular
blockade monitoring in combination
with the low rate of active block reversal
can be considered dangerous due to
the relatively high risk of potential residual
postoperative blockade, that can negatively
influence clinical outcome
Incidence of emergence delirium in the pediatric PACU: Prospective observational trial
Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by perception and psychomotor disorder and has a negative impact on morbidity in the form of maladaptive behavior, which can last weeks after anesthesia. Patients with developed ED present with psychomotor anxiety, agitation, and are at higher risk of unintentional extraction of an intravenous cannula, self-harm and nausea and vomiting. The described incidence of ED varies between 25-80%, with a higher prevalence among children younger than 6 years of age. We aimed to determine the incidence of ED in pediatric patients (>1 month) after general anesthesia in the post-anesthesia care unit (PACU), using Paediatric Anaesthesia Emergence Delirium (PAED) score, Watcha score and Richmond agitation and sedation scale (RASS). The incidence of ED was the highest in the PAED score with cutoff >= 10 points (89.0%, n = 1088). When using PAED score >12 points, ED incidence was 19.3% (n = 236). The lowest incidence was described by Watcha and RASS scores, 18.8% (n = 230) vs. 18.1% (n = 221), respectively. The threshold for PAED >= 10 points seems to give false-positive results, whereas the threshold >12 points is more accurate. RASS scale, although intended primarily for estimation of the depth of sedation, seems to have a good predictive value for ED.Web of Science910art. no. 159
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
BACKGROUND: Since December 2019, SARS-CoV-2 virus has infected millions of people worldwide. In patients with COVID-19 pneumonia in need of 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 potential deleterious effects of higher doses of corticosteroids. METHODS: REMED is a prospective, open-label, randomised controlled trial testing the superiority of dexamethasone 20 mg (dexamethasone 20 mg on days 1-5, followed by dexamethasone 10 mg on days 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. Three hundred 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. The following stratification factors will be applied: age, Charlson Comorbidity Index, CRP levels and trial centre. The primary endpoint is the number of ventilator-free days (VFDs) at 28 days after randomisation. The secondary endpoints are mortality from any cause at 60 days after randomisation; dynamics of the inflammatory marker, change in WHO Clinical Progression Scale at day 14; and adverse events related to corticosteroids and independence at 90 days after randomisation assessed by the 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 doses of dexamethasone in patients with moderate to severe ARDS undergoing mechanical ventilation regarding efficacy and safety. TRIAL REGISTRATION: EudraCT No. 2020-005887-70. ClinicalTrials.gov NCT04663555. Registered on December 11, 2020
Financial schemes and their applications in critical infrastructure
DOI nepřidělenThe paper deals with the issue of critical infrastructure, with emphasis on the economic
aspect. Funding is the important precondition of critical infrastructure operation. Currently
in the Slovak republic and the EU, fi nancial schemes are proposed whose primary function
is to implement the funding to improve safety in the SR and EU. The fi rst scheme (SR) is
based on the tasks set by law. The second scheme is based on the EU strategy - funding is
associated with improving the security of its member countries
Continuity of Entrepreneurial Activities and Enterprise Risk Management
An enterprise performs its activities within micro-, macro-and internal environment. The characters are subject of these environments and their consequences are many times in contradiction to defined enterprise objectives. The specific items are generally called risks. The risk is quantified as the multiplication of likelihood and the consequences of the specific event. There is optimal level of risk (generally) what is a compromise between the amount of risk and return/ invested capital. Intuitively this assumption is clear but the problem in practice is to answer/solve following questions: How to establish optimal level of risks? Is there only one level or is there a hierarchy of enterprise risks? How to evaluate/quantify risks and their consequences? Is there a set of relevant/irrelevant risks and under which criteria to define them? How to proceed to establish organizational structures responsible for/focused on risk management? Nowadays, an enterprise is facing to the following risks: globalization, loss of reputation, shortening of a product life cycle, new technologies, catastrophic events (natural catastrophes, catastrophes as the impact of man-made activities), different economic and non-economic risks active in interaction between an enterprise and its environment. Risks mentioned above are complex, while specific situation of an enterprise can be characterized by political, social, technological, technical and other features. All this says about “downsizing of entrepreneurial world” and “acceleration of the development”, those threats existence and operation of an enterprise
Pediatric Patient with Ischemic Stroke: Initial Approach and Early Management
Acute Ischemic Stroke (AIS) in children is an acute neurologic emergency associated with significant morbidity and mortality. Although the incidence of AIS in pediatric patients is considerably lower than in adults, the overall cumulative negative impact of the quality of life could be even higher in children. The age-related variable clinical presentation could result in a delay in diagnosis and could negatively influence the overall outcome. The early management should be based on early recognition, acute transfer to pediatric AIS centre, standardised approach (ABCDE), early neurologic examination together with neuroimaging (preferable Magnetic Resonance Imaging—MRI). The treatment is based on supportive therapy (normoxemia, normocapnia, normotension and normoglycemia) in combination with intravenous/intraarterial thrombolytic therapy and/or mechanical thrombectomy in selected cases. Pediatric stroke centres, together with the implementation of local stroke management protocols, could further improve the outcome of pediatric patients with AIS
Euro in the Slovak Republic
The implementation of Euro is linked with risks and opportunities. In the paper is described readiness of the country for the adoption of the common currency – Maastricht criteria
Ventilator-Associated Pneumonia Prevention in Pediatric Patients: Narrative Review
Ventilator-associated pneumonia (VAP), one of the most common healthcare-associated infections in intensive care settings, is associated with significant morbidity and mortality. VAP is diagnosed in >10% of patients on mechanical ventilation, incidence rising with number of ventilator days. In recent decades, the pathophysiology of VAP, VAP risk factors and treatment have been extensively studied. In critically ill pediatric patients, mechanical issues such as insufficient tightness of the ventilator circuit (mainly due to historically based preference of uncuffed tubes) and excessive humidity in the circuit are both significant risk factors of VAP development. Protocol-based approaches to critically ill patients on mechanical ventilation, closed suctioning, upper body position, enteral feeding and selective gastric acid suppression medication have a beneficial effect on VAP incidence. In recent decades, cuffed tubes applied to the whole spectrum of critically ill pediatric patients (except neonates 2O) management and the use of specialized tracheal tubes with subglottic suction ports combined with close infraglottic tracheal suctioning, have been implemented. The aim of this review was to summarize the current evidence-based knowledge about the pathophysiology, risk factors, diagnosis, treatment and prevention of VAP in clinically oriented settings