Modern Paediatric Emergency Department: Potential Improvements in Light of New Evidence.

The increasing attendance of paediatric emergency departments has become a serious health issue. To reduce an elevated burden of medical errors, inevitably caused by a high level of stress exerted on emergency physicians, we propose potential areas for improvement in regular paediatric emergency departments. In an effort to guarantee the demanded quality of care to all incoming patients, the workflow in paediatric emergency departments should be sufficiently optimised.

Sildenafil affects the human Kir2.1 and Kir2.2 channels at clinically relevant concentrations: Inhibition potentiated by low Ba.

Sildenafil (Viagra), the first approved and widely used oral drug for the treatment of erectile dysfunction, was occasionally associated with life-threatening ventricular arrhythmias in patients. Since inward rectifier potassium current ( ) may considerably contribute to this arrhythmogenesis, we investigated the effect of sildenafil on the human Kir2.1 and Kir2.

Fourth branchial cleft anomaly in a 7-month-old infant: A case report and literature review.

Fourth branchial cleft anomalies are rare head and neck congenital lesions seen in children. They present as a neck inflammatory mass and arise essentially on the left side of the neck. We report the case of a 7-month-old female with a mass of the neck associated with respiratory distress.

Aminophylline at clinically relevant concentrations affects inward rectifier potassium current in a dual way.

Bronchodilator aminophylline may induce atrial or less often ventricular arrhythmias. The mechanism of this proarrhythmic side effect has not been fully explained. Modifications of inward rectifier potassium (Kir) currents including I are known to play an important role in arrhythmogenesis; however, no data on the aminophylline effect on these currents have been published.

[Antibiotics therapy in critically ill patients: the other side of the coin].

The aim of this mini-review is to draw attention to the risk aspects associated with antibiotic treatment in critically ill patients. These include antibiotic underdosing in the early phase of sepsis if treatment is governed by pharmacopoeia and unnecessarily long exposure to antibiotics if treatment is guided by traditional recommendations for the length of antibiotic administration. The need for discussing the loading dose of antibiotics and routine monitoring of serum antibiotic concentrations during treatment is stated.

Nicotine replacement therapy in surgical patients.

Background And Aims: The effect in smokers of nicotine withdrawal following surgery may contribute to the development of postoperative delirium. Nicotine is known to increase myocardial oxygen demand, coronary vasoconstriction, and may cause platelet activation leading to thrombosis. All of this can negatively impact postoperative recovery.

[Nutritional support in the early stage of critical illness - focused on energy and protein intake].

The aim of this article is to emphasize the importance of taking into account the mechanism of host's response to insult when choosing a nutritional strategy in the early phase of a critical illness. At the same time, the article discusses the risks associated with early aggressive nutritional intervention for both energy and protein intake. Today, it seems that the most optimal choice of nutritional support during the first week of stay in the ICU is a gradual increase in both energy and protein intake.

[Hypoxemia/hypoxia and new concepts of oxygen therapy in intensive care].

Oxygen is biologically vital element sustaining life. The tissue oxygen delivery is therefore precisely regulated. The degree of tissue oxygenation is estimated by measurement of oxygen blood level.

Distribution of data in cellular electrophysiology: Is it always normal?

The distribution of data presented in many electrophysiological studies is presumed to be normal without any convincing evidence. To test this presumption, the cell membrane capacitance and magnitude of inward rectifier potassium currents were recorded by the whole-cell patch clamp technique in rat atrial myocytes. Statistical analysis of the data showed that these variables were not distributed normally.

Current density as routine parameter for description of ionic membrane current: is it always the best option?

The current density (J) is a parameter routinely used to characterize individual ionic membrane currents. Its evaluation is based on the presumption that the magnitude of whole-cell ionic membrane current (I) is directly proportional to the cell membrane capacitance (C), i.e.

[Presepsin in the diagnostics of sepsis].

Sepsis remains one of the most common causes of death worldwide. It is caused by a complex of inadequate host responses to infection. It is also often difficult to distinguish sepsis from a non-infectious cause of systemic inflammatory response syndrome.

Multi-parametric functional hemodynamic optimization improves postsurgical outcome after intermediate risk open gastrointestinal surgery: a randomized controlled trial.

Background: Perioperative goal directed therapy (pGDT) using flow monitoring has been associated with improved outcomes. However, its protocols are often based on stroke volume only: as a target for fluid loading, inotropic support and vasopressors (via mathematical coupling of systemic vascular resistance). In this trial, we have tested the multi-parametric pGDT protocol based on esophageal Doppler variables (corrected flow time, peak velocity) in intermediate-to-high risk patients undergoing gastrointestinal surgery.

Exogenous surfactant as a bridge to prolonged "total lung rest" in severely injured patient during extracorporeal membrane oxygenation.

We report a case of a 20-year-old male patient suffering from motorcycle accident complicated by rapid development of severe refractory hypoxemia and hypercapnia due to serious bilateral lung contusions and lacerations. Positive pressure mechanical ventilation induced pressure-dependent massive air leak from disrupted pulmonary tissue. Simultaneous implementation of veno-venous extracorporeal membrane oxygenation together with surfactant application allowed prolonged disconnection of patient from mechanical ventilation ("total lung rest" mode).

Role of heart-rate variability in preoperative assessment of physiological reserves in patients undergoing major abdominal surgery.

Background: Major abdominal surgery (MAS) is associated with increased morbidity and mortality. The main objective of our study was to evaluate the predictive value of heart-rate variability (HRV) concerning development of postoperative complications in patients undergoing MAS. The secondary objectives were to identify the relationship of HRV and use of vasoactive drugs during anesthesia, intensive care unit length of stay (ICU-LOS), and hospital length of stay (H-LOS).

Incidence and risk factors for delirium development in ICU patients - a prospective observational study.

Background And Aims: Delirium is an acute brain dysfunction and a frequent complication in critically ill patients. When present it significantly worsens the prognosis of patients. The aim of this study was to evaluate the incidence of delirium and risk factors for delirium in a mixed group of trauma, medical and surgical ICU patients.

Nicotine at clinically relevant concentrations affects atrial inward rectifier potassium current sensitive to acetylcholine.

Nicotine abuse is associated with variety of diseases including arrhythmias, most often atrial fibrillation (AF). Altered inward rectifier potassium currents including acetylcholine-sensitive current I are known to be related to AF pathogenesis. Since relevant data are missing, we aimed to investigate I changes at clinically relevant concentrations of nicotine.

Addictive drugs, arrhythmias, and cardiac inward rectifiers.

In many addictive drugs including alcohol and nicotine, proarrhythmic effects were reported. This review provides an overview of the current knowledge in this field (with a focus on the inward rectifier potassium currents) to promote the lacking data and appeal for their completion, thus, to improve understanding of the proarrhythmic potential of addictive drugs.

Patient survival, predictive factors and disease course of severe sepsis in Czech intensive care units: A multicentre, retrospective, observational study.

Background: Severe sepsis/septic shock is associated with high mortality. In Central Europe, there is a dearth of information on the prevalence and treatment of severe sepsis. The EPOSS (Data-based Evaluation and Prediction of Outcome in Severe Sepsis) project launched in 2011 was aimed at collecting data on patients with severe sepsis/septic shock.

[Metabolism monitoring with microdialysis in the intensive care].

Therapy of haemorrhagic shock presents a huge challenge nowadays. Changes in circulation and metabolism are preceded with changes in cells, vessels and extracellular fluid. The main disorder takes place in microcirculation.

[Anticytokine therapy in sepsis and why it fails].

Anticytokine therapy in sepsis belongs to a subgroup of therapeutic interventions referred to as antiinflammatory or immunomodulatory strategies in the intensive care literature. Between the mid-1980s and the late 1990s, this approach was considered very promising. Against all expectations, it proved ineffective or even harmful in many cases.

[Pathogenesis of severe sepsis--from macrocirculation to mitochondria].

Severe sepsis is at present serious medical and social problem. In contrast to many other diseases its incidence shows an upward tendency and so does mortality due to sepsis. From the point of view of pathogenesis the cause of this complaint is a disturbed response to infection.