Biological indices applied to benthic macroinvertebrates at reference conditions of mountain streams in two ecoregions (Poland, the Slovak Republic)

The study was carried out from 2007 to 2010 in two ecoregions: the Carpathians and the Central Highlands. The objectives of our survey were to test the existing biological index metric based on benthic macroinvertebrates at reference conditions in the high- and mid-altitude mountain streams of two ecoregions according to the requirements of the EU WFD and to determine which environmental factors influence the distribution of benthic macroinvertebrates. Our results revealed statistically significant differences in the values of the physical and chemical parameters of water as well as the mean values of metrics between the types of streams at the sampling sites. RDA analysis showed that the temperature of the water, pH, conductivity, the stream gradient, values of the HQA index, and altitude were the parameters most associated with the distribution of benthic macroinvertebrate taxa and the values of the metrics. The values of biological indices should be considered according to the stream typology including altitude and geology. At the reference conditions, the suggested border values of biological indices are very harsh. The values of the biological indices of most sampling sites did not correspond to the requirements of the high status in rivers. The streams at altitudes above 1,200 m a.s.l. should be treated as another river type and new reference values should be established

Analysis of nutrition mixtures in ITU patients

Background. The aim of this study was to analyse the composition of parenteral nutrition (PN) mixtures used in the ITU. Methods. Restrospective analysis involved 2124 prescriptions for individual PN bags. They were administered over an 18-month period, to 160 ITU patients with the mean APACHE II score of 26 points (range: 5-61), calculated on admission. The mortality rate was 40%. Nutrition programs were prepared individually following the 2009 ESPEN guidelines. The prescription was modified according to the individual patient’s clinical condition. One hundred and sixty prescriptions were analysed on the first day of PN (T1), 139 – on the second day (T2) and 1825 on the third and subsequent days (T3). Results. The mean energy supplies were: 1381 kcal/day (range: 456-2612) on T1, 1467 kcal/day (range: 524-2860) on T2, and 1654 kcal/day (range: 390-2969) on T3. The mean supplies of amino acids, glucose and lipids were as follows: amino acids 68.3 g/day (range:20-120) on T1; 71.6 g/ day (range:27.5-125) on T2; 88.0 g/day (range:11-196) on T3; glucose 210.25 g/day (range: 120- 400) on T1; 218.34 g/day (range: 65-480) on T2; 278.5 g/day (range: 18-520) on T3; lipids 34.9 g/ day (range: 0-100) on T1; 38.7 g/day (range: 0-100) on T2; 52.66 g/day (range: 0-117) on T3. The percentages of non-protein energy from lipids were: 29.25 (0-73) on T1; 31.58 (range: 0-60) on T2; 33.5 (0-60) on T3. The following statistically significant differences were found: T2-T3- (p<0.05). Conclusions. The compositions of nutrition bags prepared for ITU patients were consistent with the ESPEN guidelines. The composition varied on different days of nutrition. The differences in the supply of nutrition components indirectly confirm the need for individual prescriptions for ITU patients

Difficulties in funding of VA-ECMO therapy for patients with severe accidental hypothermia

Background: Severe accidental hypothermia is defined as a core temperature below 28 Celsius degrees. Within the last years, the issue of accidental hypothermia and accompanying cardiac arrest has been broadly discussed and European Resuscitation Council (ERC) Guidelines underline the importance of Extracorporeal Rewarming (ECR) in treatment of severely hypothermic victims. The study aimed to evaluate the actual costs of ECR with VA-ECMO and of further management in the Intensive Care Unit of patients admitted to the Severe Accidental Hypothermia Centre in Cracow, Poland. Methods: We carried out the economic analysis of 31 hypothermic adults in stage III-IV (Swiss Staging) treated with VA ECMO. Twenty-nine individuals were further managed in the Intensive Care Unit. The actual treatment costs were evaluated based on current medication, equipment, and dressing pricing. The costs incurred by the John Paul II Hospital were then collated with the National Health Service (NHS) funding, assessed based on current financial contract. Results: In most of the cases, the actual treatment cost was greater than the funding received by around 10,000 PLN per patient. The positive financial balance was achieved in only 4 (14%) individuals; other 25 cases (86%) showed a financial loss. Conclusion: Performed analysis clearly shows that hospitals undertaking ECR may experience financial loss due to implementation of effective treatment recommended by international guidelines. Thanks to new NHS funding policy since January 2017 such loss can be avoided, what shall encourage hospitals to perform this expensive, yet effective method of treatment

The prevalence of infections and colonisation with Klebsiella pneumoniae strains isolated in ICU patients

Background: Klebsiella spp. are among the bacteria most commonly isolated from patients with infections in ICUs. The source of these infections may be the microflora of the patient or the hospital environment. Increasingly, Klebsiella strains are also being isolated from epidemic outbreaks. This situation is largely the result of widespread, irrational antibiotic use, the virulence of the bacterial strains and their ability to survive in the hospital environment. The purpose of this dissertation was to estimate the prevalence of Klebsiella pneumoniae strains isolated from patients hospitalised in a single ICU.Methods: Seventy-eight isolates of K. pneumoniae were studied. The identification and the susceptibility to selected antibiotics were tested by an automated system, VITEK2 Compact. For the analysed strains, the production of different beta-lactamases was noted.Results: Production of ESBL was detected in 64.1% of the K. pneumoniae strains isolated from infections and 74.4% from rectal swabs. Most of the strains were susceptible to imipenem (97.7%) and meropenem (96.1%). Sixty-nine (57.0%) of the analysed strains were identified as multidrug resistant.Conclusion: Most of the analysed Klebsiella pneumoniae strains produced ESBL-beta-lactamases. The frequency of colonisation and infection with multidrug resistant strains of K. pneumoniae in patients hospitalised in the ICU is very high.Background: Klebsiella spp. are among the bacteria most commonly isolated from patients with infections in ICUs. The source of these infections may be the microflora of the patient or the hospital environment. Increasingly, Klebsiella strains are also being isolated from epidemic outbreaks. This situation is largely the result of widespread, irrational antibiotic use, the virulence of the bacterial strains and their ability to survive in the hospital environment. The purpose of this dissertation was to estimate the prevalence of Klebsiella pneumoniae strains isolated from patients hospitalised in a single ICU.Methods: Seventy-eight isolates of K. pneumoniae were studied. The identification and the susceptibility to selected antibiotics were tested by an automated system, VITEK2 Compact. For the analysed strains, the production of different beta-lactamases was noted.Results: Production of ESBL was detected in 64.1% of the K. pneumoniae strains isolated from infections and 74.4% from rectal swabs. Most of the strains were susceptible to imipenem (97.7%) and meropenem (96.1%). Sixty-nine (57.0%) of the analysed strains were identified as multidrug resistant.Conclusion: Most of the analysed Klebsiella pneumoniae strains produced ESBL-beta-lactamases. The frequency of colonisation and infection with multidrug resistant strains of K. pneumoniae in patients hospitalised in the ICU is very high

Zaktualizowany protokół postępowania u chorych wymagających zastosowania pozaustrojowej oksygenacji krwi (ECMO) w leczeniu ostrej niewydolności oddechowej dorosłych. Zalecenia i wytyczne Zespołu ds. Terapii ECMO Żylno-Żylnym, powołanego przez konsultanta

Extracorporeal Membrane Oxygenation (ECMO) has become well established technique of the treatment of severe acute respiratory failure (Veno-Venous ECMO) or circulatory failure (Veno-Arterial ECMO) which enables effective blood oxygenation and carbon dioxide removal for several weeks. Veno-Venous ECMO (V-V ECMO ) is a lifesaving treatment of patients in whom severe ARDS makes artificial lung ventilation unlikely to provide satisfactory blood oxygenation for preventing further vital organs damage and progression to death. The protocol below regards exclusively veno-venous ECMO treatment as a support for blood gas conditioning by means of extracorporeal circuit in adult patients with severe ARDS. V-V ECMO does not provide treatment for acutely and severely diseased lungs, but it enables patient to survive the critical phase of severe ARDS until recovery of lung function. Besides avoiding patients death from hypoxemia, this technique can also prevent further progression of the lung damage due to artificial ventilation. Recent experience of ECMO treatment since the outbreak of AH1N1 influenza pandemic in 2009, along with technical progress and advancement in understanding pathophysiology of ventilator-induced lung injury, have contributed to significant improvement of the results of ECMO treatment. Putative factors related to increased survival include patients retrieval after connecting them to ECMO, and less intensive anticoagulation protocols. The aim of presenting this revised protocol was to improve the effects of ECMO treatment in patients with severe ARDS, to enhance ECMO accessibility for patients who might possibly benefit from this treatment, to reduce time until patient’s connection to ECMO, and to avoid ECMO treatment in futile cases. The authors believe that this protocol, based on recent papers and their own experience, can provide help and advice both for the centers which develop V-V ECMO program, and for doctors who will refer their patients for the treatment in an ECMO center.  Extracorporeal membrane oxygenation (ECMO), which enables effective blood oxygenation and carbon dioxide removal for several weeks, has become a well established technique for the treatment of severe acute respiratory failure (V-V ECMO, veno-venous ECMO) or circulatory failure (veno-arterial ECMO). Veno-venous ECMO is a life-saving treatment in patients in whom severe acute respiratory distress syndrome (ARDS) makes mechanical ventilation unlikely to provide satisfactory blood oxygenation for preventing further vital organ damage and progression to death. The protocol below refers only to V-V ECMO therapy as a measure to support blood gas exchange by means of an extracorporeal circuit in adult patients with severe ARDS. Veno-venous ECMO does not provide treatment for acutely and severely diseased lungs but it enables the patient to survive the critical phase of severe ARDS until recovery of lung function. In addition to preventing death from hypoxemia, this technique can also prevent further progression of lung damage due to mechanical ventilation. Recent experience in ECMO therapy since the outbreak of an influenza A(H1N1) pandemic in 2009, along with technical progress and better understanding of the pathophysiology of ventilatorinduced lung injury, have contributed to a significant improvement in ECMO treatment outcomes. Postulated factors related to an increased survival include wider use of ECMO during patient transfer and less intensive anticoagulation protocols. The aim of presenting this revised protocol was to improve ECMO treatment outcomes in patients with 93 Romuald Lango i wsp., Protokół ECMO severe ARDS, to enhance ECMO accessibility for patients who might possibly benefit from this treatment, to reduce the time until institution of ECMO therapy, and to avoid ECMO therapy in futile cases. The authors believe that this protocol, based on recent papers and their own experience, can provide help and advice both for the centers which develop V-V ECMO program, and for doctors who will refer their patients for treatment in an ECMO center.  

Tolerancja żywienia dojelitowego wśród pacjentów w-starszym wieku na oddziale intensywnej terapii

Introduction. The health problems of old age are a generalized decline of organ efficiency, neuromuscular conduction and metabolic processes. Content of water in the body decrease while the occurrence of malnutrition increase. The percentage of people admitted to hospital wards including intensive care also increases. The aim of this study was to evaluate the tolerance of the industrial diets in patients over 60 years old treated in the Intensive Care Unit.Material and methods. A retrospective analysis of medical and nursing documentation of 134 patients over 60 years old hospitalized in the years 2009–2010, who was fed at least for 5 days by industrial enteral diets administered by nasogastric tube continuous infusion of 20 h/day. Feeding tolerance was assessed in the 1st, 3rd and 5th day of feeding. Analysed: diet infusion rate, signs of intolerance from the gastrointestinal tract (residual and the number of defecations).Results. Enteral Nutrition was implemented average on the 4th day of stay. Previously, 84 patients were fed parenterally. On the first day the average speed of infusion was 33 ml/h, on the third day-55 ml/h, and on thefifth day-66 ml/h (p &lt; 0.05). Residuals occurred on the first day in 37 patients, on the third day in 26, and on the fifth day in 18 patients. In d1 diarrhea occurred in 2 patients, on the 3rd day-in 7 patients, on the fifth day-in 4 patients. Enteral nutrition was abandoned in 9 patients (total) because of: intense residuals of gastric content, gastrointestinal bleeding, vomiting, surgical treatment of the underlying disease. The level of CRP in patients with residuals was significantly higher in the d1 and d3 as compared to patients without residual.Conclusions. Feeding with enteral industry diets implemented gradually in the ICU is well tolerated by patients over 60 years old. Symptoms from gastrointestinal tract require modifications of planned enteral nutrition therapy, while the lack of tolerance and the need to stop nutritional treatment are usually associated with deterioration of general condition and progress of the underlying disease.Wstęp. Problemy zdrowotne osób w wieku podeszłym to uogólniony spadek: wydolności narządowej, przewodnictwa nerwowo-mięśniowego, procesów metabolicznych. Zmniejsza się zawartość wody w organizmie oraz zwiększa się występowanie niedożywienia. Wzrasta także liczba osób przyjmowanych na oddziały szpitalne, między innymi oddziały intensywnej terapii (OIT). Celem pracy była ocena tolerancji diet przemysłowych u pacjentów powyżej 60. roku życia leczonych na OIT.Materiał i metody. Metodą badań była retrospektywna analiza dokumentacji lekarsko-pielęgniarskiej 134 pacjentów powyżej 60. roku życia, u których co najmniej przez 5 dni stosowano żywienie dojelitowe dietami przemysłowymi podawanymi przez zgłębnik nosowo-żołądkowy wlewem ciągłym 20 h/dobę. Tolerancję żywienia oceniano w 1., 3. oraz 5. dobie żywienia. Analizowano: prędkość wlewu diety, objawy nietolerancji ze strony przewodu pokarmowego (zaleganie oraz liczbę wypróżnień).Wyniki. Żywienie enteralne wdrażane było średnio w 4. dobie pobytu; 84 pacjentów żywionych było wcześniej parenteralnie. Średnia prędkość wlewu w pierwszej dobie wynosiła 33 ml/godzinę, w 3. — 55 ml/godzinę, a w 5. — 66 ml/godzinę; (p &lt; 0,05). Zaleganie w żołądku wystąpiło w 1. dobie u 37 chorych, w dobie 3. u 26 chorych,a w dobie 5. u 18. W dobie 1. biegunka wystąpiła u 2 pacjentów, w 3. — u 7 pacjentów, w 5. — u 4. Od żywienia dojelitowego odstąpiono łącznie u 9 pacjentów z powodu: intensywnych zalegań treści żołądkowej, krwawienia z przewodu pokarmowego, wymiotów, operacyjnego leczenia choroby podstawowej. Poziom białka C-reaktywnego (CRP) u pacjentów z zaleganiami był istotnie statystycznie wyższy w d1 i d3 w porównaniu z pacjentami bez zalegań.Wnioski. Żywienie dojelitowe dietami przemysłowymi wdrażane stopniowo na OIT jest dobrze tolerowane przez pacjentów powyżej 60. roku życia. Występujące objawy ze strony przewodu pokarmowego wymagają modyfikacji zaplanowanej terapii żywieniowej dojelitowej, natomiast brak tolerancji i konieczność przerwania leczenia żywieniowego związane są najczęściej z pogorszeniem stanu ogólnego i postępem choroby podstawowej