Background Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old critically ill patients are particularly at risk. This study aimed to investigate the impact of... more
Background Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old critically ill patients are particularly at risk. This study aimed to investigate the impact of diabetes mellitus on 90-day mortality in a high-risk cohort of critically ill patients over 70 years of age. Methods This multicentre international prospective cohort study was performed in 151 ICUs across 26 countries. We included patients ≥ 70 years of age with a confirmed SARS-CoV-2 infection admitted to the intensive care unit from 19th March 2020 through 15th July 2021. Patients were categorized into two groups according to the presence of diabetes mellitus. Primary outcome was 90-day mortality. Kaplan–Meier overall survival curves until day 90 were analysed and compared using the log-rank test. Mixed-effect Weibull regression models were computed to investigate the influence of diabetes mellitus on 90-day mortality. Results This study included 3420 p...
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Shift healthcare workers are a group particularly exposed to an increased risk of poor eating habits and are affected by many diseases. The aim of the study was to evaluate the dietary patterns (DPs), including the Polish-adapted... more
Shift healthcare workers are a group particularly exposed to an increased risk of poor eating habits and are affected by many diseases. The aim of the study was to evaluate the dietary patterns (DPs), including the Polish-adapted Mediterranean Diet (Polish-aMED®) score, and dietary fat intake in association with the shift work of healthcare workers. This cross-sectional study involved 445 healthcare workers from the West Pomeranian in Poland. Dietary data were collected using an FFQ-6®. A posteriori DPs were derived with a Principal Component Analysis (PCA). The Polish-aMED® score and the individual’s percentage of energy from dietary fat (Pfat) were calculated. Healthcare shift work compared to the daily work was associated with approximately 2-times higher odds of adherence to the ‘Meat/fats/alcohol/fish’ DP in the upper tertile (OR: 2.38; 95% Cl: 1.27–4.47; p < 0.01) and higher Pfat >35% of total energy intake (OR: 1.73; 95% Cl: 1.06–2.83; p < 0.05). Healthcare shift wor...
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Patients with “post-COVID” syndrome manifest with a variety of signs and symptoms that continue/develop after acute COVID-19. Among the most common are gastrointestinal (GI) and mental symptoms. The reason for symptom occurrence lies in... more
Patients with “post-COVID” syndrome manifest with a variety of signs and symptoms that continue/develop after acute COVID-19. Among the most common are gastrointestinal (GI) and mental symptoms. The reason for symptom occurrence lies in the SARS-CoV-2 capability of binding to exact receptors, among other angiotensin converting enzyme 2 (ACE2) receptors in gastrointestinal lining and neuropilin-1 (NRP-1) in the nervous system, which leads to loss of gastrointestinal and blood-brain barriers integrity and function. The data are mounting that SARS-CoV-2 can trigger systemic inflammation and lead to disruption of gut-brain axis (GBA) and the development of disorders of gut brain interaction (DGBIs). Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are the most common DGBIs syndromes. On the other hand, emotional disorders have also been demonstrated as DGBIs. Currently, there are no official recommendations or recommended procedures for the use of probiotics in patients with...
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Invitation to participate in a multi-center study for validation of cerebral computed tomography angiography and computed tomography perfusion in the determination of cerebral circulatory arrest during brain death/death by neurological criteria diagnosis procedure in paediatric population below 1...more
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Purpose Critically ill old intensive care unit (ICU) patients suffering from Sars-CoV-2 disease (COVID-19) are at increased risk for adverse outcomes. This post hoc analysis investigates the association of the Activities of Daily Living... more
Purpose Critically ill old intensive care unit (ICU) patients suffering from Sars-CoV-2 disease (COVID-19) are at increased risk for adverse outcomes. This post hoc analysis investigates the association of the Activities of Daily Living (ADL) with the outcome in this vulnerable patient group. Methods The COVIP study is a prospective international observational study that recruited ICU patients ≥ 70 years admitted with COVID-19 (NCT04321265). Several parameters including ADL (ADL; 0 = disability, 6 = no disability), Clinical Frailty Scale (CFS), SOFA score, intensive care treatment, ICU- and 3-month survival were recorded. A mixed-effects Weibull proportional hazard regression analyses for 3-month mortality adjusted for multiple confounders. Results This pre-specified analysis included 2359 patients with a documented ADL and CFS. Most patients evidenced independence in their daily living before hospital admission (80% with ADL = 6). Patients with no frailty and no disability showed t...
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Purpose Lactate is an established prognosticator in critical care. However, there still is insufficient evidence about its role in predicting outcome in COVID-19. This is of particular concern in older patients who have been mostly... more
Purpose Lactate is an established prognosticator in critical care. However, there still is insufficient evidence about its role in predicting outcome in COVID-19. This is of particular concern in older patients who have been mostly affected during the initial surge in 2020. Methods This prospective international observation study (The COVIP study) recruited patients aged 70 years or older (ClinicalTrials.gov ID: NCT04321265) admitted to an intensive care unit (ICU) with COVID-19 disease from March 2020 to February 2021. In addition to serial lactate values (arterial blood gas analysis), we recorded several parameters, including SOFA score, ICU procedures, limitation of care, ICU- and 3-month mortality. A lactate concentration ≥ 2.0 mmol/L on the day of ICU admission (baseline) was defined as abnormal. The primary outcome was ICU-mortality. The secondary outcomes 30-day and 3-month mortality. Results In total, data from 2860 patients were analyzed. In most patients (68%), serum lacta...
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An organ transplantation is the most effective method of treatment when the organ is becoming insuficient. In the process of the transplant arrangements it’s important to prepare donor for multiorgan donation. Many pathophysiological... more
An organ transplantation is the most effective method of treatment when the organ is becoming insuficient. In the process of the transplant arrangements it’s important to prepare donor for multiorgan donation. Many pathophysiological processes after the brain death making it imposible. In some cases those disorders are caused by cytokines and in the others higher risk of nosocomial infection during the treatment in ICU. In this article were presented the most common problems of multiorgan donation, which make donation impossible or less effective.
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Alzheimer’s disease, a neurodegenerative disease, is one of the most common causes of dementia if elderly people worldwide. Alzheimer’s disease leads to the alienation of individuals and their exclusion from social and professional life.... more
Alzheimer’s disease, a neurodegenerative disease, is one of the most common causes of dementia if elderly people worldwide. Alzheimer’s disease leads to the alienation of individuals and their exclusion from social and professional life. It is characterized mainly by the degradation of memory and disorientation, which occurs as a result of the loss of neuronal structure and function in different brain areas. In recent years, more and more attention has been paid to use in the treatment of natural bioactive compounds that will be effective in neurodegenerative diseases, including Alzheimer’s disease. G. biloba L. and its most frequently used standardized extract (EGb 761), have been used for many years in supportive therapy and in the prevention of cognitive disorders. The paper presents an overview of reports on the pathogenesis of Alzheimer’s disease, as well as a summary of the properties of G. biloba extract and its effects on the possible pathogenesis of the disease. By explorin...
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Background Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present... more
Background Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80–89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower ...
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Background: Brain death/death by neurologic criteria (BD/DNC) guidelines are routinely analyzed, compared and updated in the majority of countries and are later implemented as national criteria. At the same time, extensive works have been... more
Background: Brain death/death by neurologic criteria (BD/DNC) guidelines are routinely analyzed, compared and updated in the majority of countries and are later implemented as national criteria. At the same time, extensive works have been conducted in order to unify clinical procedures and to validate and implement new technologies into a panel of ancillary tests. Recently evaluated computed tomography angiography and computed tomography perfusion (CTA/CTP) seem to be superior to traditionally used digital subtraction angiography (DSA), transcranial Doppler (TCD) and cerebral perfusion scintigraphy for diagnosis of cerebral circulatory arrest (CCA). In this narrative review, we would like to demonstrate scientific evidence supporting the implementation of CTA/CTP in Polish guidelines for BD/DNC diagnosis. Research and implementation process: In the first of our base studies concerning the potential usefulness of CTA/CTP for the confirmation of CCA during BD/DNC diagnosis procedures,...
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Invitation to participate in a multi-center study for validation of cerebral computed tomography angiography and computed tomography perfusion in the determination of cerebral circulatory arrest during brain death/death by neurological criteria diagnosis procedure in paediatric population below 1...more
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Hyperosmotic therapy is commonly used to treat intracranial hypertension in traumatic brain injury patients. Unfortunately, hyperosmolality also affects other organs. An increase in plasma osmolality may impair kidney, cardiac, and immune... more
Hyperosmotic therapy is commonly used to treat intracranial hypertension in traumatic brain injury patients. Unfortunately, hyperosmolality also affects other organs. An increase in plasma osmolality may impair kidney, cardiac, and immune function, and increase blood–brain barrier permeability. These effects are related not only to the type of hyperosmotic agents, but also to the level of hyperosmolality. The commonly recommended osmolality of 320 mOsm/kg H2O seems to be the maximum level, although an increase in plasma osmolality above 310 mOsm/kg H2O may already induce cardiac and immune system disorders. The present review focuses on the adverse effects of hyperosmolality on the function of various organs.
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Background: During routine diagnosis of brain death, changes in pupil diameter in response to the stimulation of peripheral nerves are sometimes observed. For example, pupillary dilation after diagnosed brain death is described in the... more
Background: During routine diagnosis of brain death, changes in pupil diameter in response to the stimulation of peripheral nerves are sometimes observed. For example, pupillary dilation after diagnosed brain death is described in the literature as the ciliospinal reflex. However, pupil constriction creates diagnostic doubts. Objective: The pupillometric analysis of pupil response to stimulation of the cervicothoracic spinal cord in patients with diagnosed brain death. Methods: Instrumental tests to confirm the arrest of cerebral circulation were performed in 30 adult subjects (mean age 53.5 years, range 26–75 years) with diagnosed brain death. In addition, a pupillometer was used to measure the change in pupil diameter in response to neck flexion. Intervention: Flexion of the neck and measuring the response in change of the pupil with the use of the pupillometer. Results: The change in the pupil was observed in the examined group of patients. Difference in pupil size ≥ 0.2 mm was o...
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Research Interests: Emergency Medicine, Anesthesiology, Frailty, Prediction, Medicine, and 14 moreComorbidity, Critical Care, Activities of Daily Living, Elderly, Outcome, INTENSIVE CARE, Journal Article, Pain Medicine, Clinical Sciences, Cognitive impairment, Public health systems and services research, Intensive Care Medicine, Cognitive Functioning, and Medicine and Health Sciences
BACKGROUND This study was designed to determine diagnostic accuracy of computed tomographic perfusion (CTP) compared to computed tomographic angiography (CTA) for the diagnosis of brain death (BD). MATERIAL AND METHODS Whole-brain CTP was... more
BACKGROUND This study was designed to determine diagnostic accuracy of computed tomographic perfusion (CTP) compared to computed tomographic angiography (CTA) for the diagnosis of brain death (BD). MATERIAL AND METHODS Whole-brain CTP was performed in patients diagnosed with BD and in patients with devastating brain injury with preserved brainstem reflexes. CTA was derived from CTP datasets. Cerebral blood flow (CBF) and volume (CBV) were calculated in all brain regions. CTP findings were interpreted as confirming diagnosis of BD (positive) when CBF and CBV in all ROIs were below 10 mL/100 g/min and 1.0 mL/100 g, respectively. CTA findings were interpreted using a 4-point system. RESULTS Fifty brain-dead patients and 5 controls were included. In brain-dead patients, CTP results revealed CBF 0.00-9.98 mL/100 g/min and CBV 0.00-0.99 mL/100 g, and were thus interpreted as positive in all patients. CTA results suggested 7 negative cases, providing 86% sensitivity. In the non-brain-dead ...
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Extracorporeal Membrane Oxygenation (ECMO) is a well-established method of support in patients with severe respiratory and/or circulatory failure. Unfortunately, this invasive method of treatment is associated with a high risk of... more
Extracorporeal Membrane Oxygenation (ECMO) is a well-established method of support in patients with severe respiratory and/or circulatory failure. Unfortunately, this invasive method of treatment is associated with a high risk of neurological complications including brain death. Proper diagnosis of brain death is crucial for the termination of futile medical care. Currently, the legal system in Poland does not provide an accepted protocol for apnea tests for patients on ECMO support. Veno-arterial ECMO is particularly problematic in this regard because it provides both gas exchange and circulatory support. CO₂ elimination by ECMO prevents hypercapnia, which is required to perform an apnea test. Several authors have described a safe apnea test procedure in patients on ECMO. Maximal reduction of the sweep gas flow to the oxygenator should maintain an acceptable haemoglobin oxygenation level and reduce elimination of carbon dioxide. Hypercapnia achieved via this method should allow an ...
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Labour is thought to be one of the most intense and painful experiences in a woman's life. Numerous studies using a Visual Analogue Scale invariably demonstrate that 20% of women in labour describe the pain as "unbearable"... more
Labour is thought to be one of the most intense and painful experiences in a woman's life. Numerous studies using a Visual Analogue Scale invariably demonstrate that 20% of women in labour describe the pain as "unbearable" and 60% describe the pain as "very intense". Since the mid-1980s, continuous epidural analgesia during labour has been considered the gold standard of labour anaesthesia and is currently the most frequently used. There are situations in which this type of analgesia could not be used. An alternative pain management is administration of parenteral opioids, the most frequently used of which is pethidine. Its use is associated with adverse effects and unsatisfactory analgesia. Since the second half of the 20th century, a new generation of opioids, such as fentanyl or remifentanil, has been used. Despite their much better pharmacokinetic and pharmacodynamic parameters, obstetricians, midwives and neonatologists are most aware of pethidine, proba...
Research Interests: Medicine, Poland, Pregnancy, Humans, Female, and 8 moreAnesthesia, Labor Pain, Fentanyl, Pain Measurement, Meperidine, Piperidines, Pethidine, and Remifentanil
To assess the impact of various forms of intrapartum analgesia on birth condition of the newborn. The study included 109 newborns, among them 23 from mothers who received intravenous patient-controlled analgesia (PCA) using remifentanil... more
To assess the impact of various forms of intrapartum analgesia on birth condition of the newborn. The study included 109 newborns, among them 23 from mothers who received intravenous patient-controlled analgesia (PCA) using remifentanil (0.2 microg/kg per dose), 31 infants from mothers treated with PCA epidural anesthesia with fentanyl and 0.125% bupivacaine, 34 newborns from mothers treated with pethidine analgesia given on an ad hoc basis at a dose of 50 mg by intramuscular injection, and 21 newborns from mothers who did not use any form of anesthesia. The birth condition was evaluated in all infants by Apgar score and umbilical artery blood gases. In the blood from the umbilical vein the concentration of cortisol and interleukin-6 were evaluated. The use of epidural analgesia with bupivacaine as well as pethidine given intramuscularly did not impair the status of newborn evaluated on the basis of Apgar score, however, it adversely modifies the pH and umbilical artery blood pCO2. ...
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Although epidural anaesthesia has become a standard method for labour analgesia all over the world, it is far from being ideal because of side effects and contraindications. Many alternative techniques have therefore been proposed,... more
Although epidural anaesthesia has become a standard method for labour analgesia all over the world, it is far from being ideal because of side effects and contraindications. Many alternative techniques have therefore been proposed, including the continuous infusion of remifentanil. Encouraged by positive reports, we compared the efficacy of patient-controlled remifentanil infusion (PCA) with patient-controlled continuous epidural analgesia (PCEA). Fifty-two ASA I and II parturients were arbitrarily allocated, without randomisation, to two groups to receive PCEA with 0.125% bupivacaine and 0.2 microg kg(-1) fentanyl (basic infusion 1 mL h(-1), bolus 4 mL, lock-out time 15 min) or remifentanil PCA (0.2 microg kg(-1) bolus doses, without basic infusion, lock-out time 2 min). The intensity of pain was assessed using the VAS scale every 15 min in the PCEA group and every 10 min in the PCA group. During the first two hours of labour, the VAS score was significantly lower in the PCEA group...
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Research Interests: Electrophysiology, Medicine, Poland, Brain Death, Humans, and 15 moreSpinal Cord, Cell Death, Infant, Brain injury, Cadaver, Great Britain, Adult, Code of Practice, Ministry of Health, Brain stem, Child preschool, Frequently Asked Questions, guidelines as topic, Patient selection, and Medical and Health Sciences
Research Interests: Medicine, Poland, Brain Death, Humans, Neuroradiology, and 15 moreFemale, Male, Perfusion, Angiography, Aged, Middle Aged, Gold Standard, Adult, Computed Tomographic Angiography, Middle Cerebral Artery, Cerebral Angiography, Digital Subtraction Angiography Market, Medical and Health Sciences, Computed tomography angiography, and Digital subtraction angiography
Research Interests: Radiology, Medicine, Brain Death, Prospective studies, Humans, and 15 moreNeuroradiology, Female, Male, Glasgow Coma Scale, Clinical Sciences, Angiography, Aged, Middle Aged, Observer Variation, Adult, Reproducibility of Results, Kappa, Neurosciences, Middle Cerebral Artery, and Cerebral Angiography
Research Interests: Psychology, Clinical Psychology, Cognitive Science, Psychiatry, Psychosis, and 15 moreCausality, Medicine, Humans, Health related Quality of Life, Coping, Female, Male, Psychosocial, Health Status, Clinical Sciences, Geriatric Psychiatry, Geriatric, Middle Aged, Chi Square Distribution, and Psychotic Disorders
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... LETTER TO THE EDITOR. Pregnancy complicated by Werner syndrome. Joanna Sołek-Pastuszka 1 ,; Edyta Zagrodnik-Ułan 2 ,; Tomasz Płonka 3 ,; Marcin Wylot 2 ,; Jowita Biernawska 1 ,; Romuald Bohatyrewicz 1 ,; Władysław Kos 2 ,; Maciej... more
... LETTER TO THE EDITOR. Pregnancy complicated by Werner syndrome. Joanna Sołek-Pastuszka 1 ,; Edyta Zagrodnik-Ułan 2 ,; Tomasz Płonka 3 ,; Marcin Wylot 2 ,; Jowita Biernawska 1 ,; Romuald Bohatyrewicz 1 ,; Władysław Kos 2 ,; Maciej Żukowski 1 ,; Zbigniew Celewicz 3. ...
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Background: The main nutritional consequences of COVID-19 include reduced food intake, hypercatabolism, and rapid muscle wasting. Some studies showed that malnutrition is a significant problem among patients hospitalized due to COVID-19... more
Background: The main nutritional consequences of COVID-19 include reduced food intake, hypercatabolism, and rapid muscle wasting. Some studies showed that malnutrition is a significant problem among patients hospitalized due to COVID-19 infection, and the outcome of patients with SARS-CoV-2 is strongly associated with their nutritional status. The purpose of this study was to collect useful information about the possible elements of nutritional and probiotic therapy in patients infected with the SARS-CoV-2 virus. Methods: A narrative review of the literature, including studies published up to 13 September 2021. Results: Probiotics may support patients by inhibiting the ACE2 receptor, i.e., the passage of the virus into the cell, and may also be effective in suppressing the immune response caused by the proinflammatory cytokine cascade. In patients’ diet, it is crucial to ensure an adequate intake of micronutrients, such as omega-3 fatty acids (at 2–4 g/d), selenium (300–450 μg/d) an...
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Labour is thought to be one of the most intense and painful experiences in a woman's life. Numerous studies using a Visual Analogue Scale invariably demonstrate that 20% of women in labour describe the pain as "unbearable"... more
Labour is thought to be one of the most intense and painful experiences in a woman's life. Numerous studies using a Visual Analogue Scale invariably demonstrate that 20% of women in labour describe the pain as "unbearable" and 60% describe the pain as "very intense". Since the mid-1980s, continuous epidural analgesia during labour has been considered the gold standard of labour anaesthesia and is currently the most frequently used. There are situations in which this type of analgesia could not be used. An alternative pain management is administration of parenteral opioids, the most frequently used of which is pethidine. Its use is associated with adverse effects and unsatisfactory analgesia. Since the second half of the 20 th century, a new generation of opioids, such as fentanyl or remifentanil, has been used. Despite their much better pharmacokinetic and pharmacodynamic parameters, obstetricians, midwives and neonatologists are most aware of pethidine, prob...
Introduction. Abdominal aorta aneurysm is a recognized cause of death for the European population. The identification of intra-operative risk factors for perioperative death is of crucial importance for the society. Material and methods.... more
Introduction. Abdominal aorta aneurysm is a recognized cause of death for the European population. The identification of intra-operative risk factors for perioperative death is of crucial importance for the society. Material and methods. A prospective observational study was conducted in the Vascular Surgery Department of the Pomeranian Medical University in Szczecin, Poland. The study group consisted of 95 patients, diagnosed with abdominal aorta aneurysm in the sub-renal region scheduled for an operative procedure of straight vascular graft implantation. Patient qualification was fulfilled according to TASC criteria. The influence of preoperative factors, hemodynamic and metabolic parameters on the risk of death in the study population was analyzed. Postoperatively, observation was continued for 28 days. Results. In this study group an increase of lactate, potassium levels or pH decrease during the first minute post cross-clamp release were significant risk factors for perioperati...
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Deterioration of the pulmonary function after the apnea test (AT) conducted with the classic oxygen insufflation AT (I-AT) is often observed during the brain death (BD) diagnosis procedure. In the present study, two AT methods were... more
Deterioration of the pulmonary function after the apnea test (AT) conducted with the classic oxygen insufflation AT (I-AT) is often observed during the brain death (BD) diagnosis procedure. In the present study, two AT methods were compared before a method is recommended for the currently revised Polish BD criteria. Classic I-AT and continuous positive airway pressure AT (CPAP-AT) were performed in 60 intensive care unit patients. I-AT was performed at the end of two series of clinical tests, and approximately 1-1.5 h later, after BD was confirmed, a different method, CPAP-AT with 100% FiO and CPAP value of 10 cm HO provided by a ventilator in CPAP mode was performed. The patients in I-AT and CPAP-AT groups were further divided into two subgroups: non-hypoxemic (NH) with good lung function before AT (PaO/FiO index ≥ 200 mmHg) and hypoxemic (H) with poor lung function (PaO/FiO index < 200 mmHg). PaO and PaCO were recorded prior to I-AT and CPAP-AT at time-point one (T1), 5 min aft...
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Polish brain death (BD) criteria established in 2007 are currently under review and therefore all reports about any problems noticed during diagnostic attempts are being carefully analyzed. According to information from intensive care... more
Polish brain death (BD) criteria established in 2007 are currently under review and therefore all reports about any problems noticed during diagnostic attempts are being carefully analyzed. According to information from intensive care units, patients with poor baseline lung function often do not tolerate ventilator disconnection during the apnea test (AT) despite previous preoxygenation and catheter O2 insufflation. Abortion of AT because of decrease of saturation as measured by pulse oximetry is quite common. To solve this problem, implementation of continuous positive airway pressure (CPAP) with 100% O2 was proposed as an option for newly developed guidelines. Before implementation of CPAP for AT we verified it by means of a multicenter trial in a group of 51 patients with various lung function. In one case, in a patient with baseline PaO2 of 83 mm Hg during ventilation with 100% oxygen, we used the CPAP option for AT and successfully completed BD diagnosis. In conclusion, ventilator-delivered CPAP for AT may be a valuable alternative to the classic oxygen insufflation method for the BD diagnosis procedure in patients with severe lung injury and poor baseline oxygenation.
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Introduction According to Polish brain death (BD) criteria instituted in 2007, confirmatory tests should be used in specific situations such as intoxication, infratentorial processes, extensive facial damage, in children up to one year of... more
Introduction According to Polish brain death (BD) criteria instituted in 2007, confirmatory tests should be used in specific situations such as intoxication, infratentorial processes, extensive facial damage, in children up to one year of age and any case when clinical examination seems to be inadequate. These tests are often unavailable due to insufficient access to proper equipment and qualified specialists. Therefore, finding a confirmatory test, which would be widely available, simple to perform and easy to interpret became of fundamental importance. Computed tomographic angiography (CTA) seemed to be the test of choice for this purpose because new generation of CT scanners became widely available. The method is simple and relatively cheap. Despite of this fact, CTA was not included in Polish BD criteria in 2007 because of limited expertise and lack of generally accepted criteria. In this situation, after approval of Bioethical Committee we organized Polish national multicentre trial for evaluation of CTA in the diagnosis of BD. Methods In 7 cooperating centres, we examined 119 patients, which fulfilled standard clinical BD criteria. In all cases two-phase CTA was performed with assessment of intracranial vessels at 60 sec. after contrast administration. Cerebral circulatory arrest in CTA was defined as the absence of opacification of M4 segments of the middle cerebral artery (M4-MCA) and deep cerebral veins, the same as in criteria of French Society of Neuroradiology [1]. Results In 107 patients, CTA revealed the absence of opacification of M4-MCA segments and deep cerebral veins. This met the French diagnostic criteria of cerebral circulatory arrest. This gave the sensitivity of 90% (95% CI 83-94%) for CTA in the diagnosis of BD. Additionally we identified potential points of pitfalls, which will be mentioned in currently elaborated Polish instruction. Conclusions 1. CTA is a valuable confirmatory test for BD diagnosis. 2. Polish instruction will be compatible with French protocol published in 2011. Reference: 1. Societe Francaise de Neuroradiologie, Societe Francaise de Radiologie, Agence de la Biomedecine. [Recommendations on diagnostic criteria of brain death by the technique of CT angiography]. J Neuroradiol. 2011;38(1):36–39.
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BACKGROUND The application of computed tomographic angiography (CTA) for the diagnosis of brain death (BD) is limited because of the low sensitivity of the commonly used two-phase method consisting of assessing arterial and venous... more
BACKGROUND The application of computed tomographic angiography (CTA) for the diagnosis of brain death (BD) is limited because of the low sensitivity of the commonly used two-phase method consisting of assessing arterial and venous opacification at the 60th second after contrast injection. The hypothesis was that a reduction in the scanning delay might increase the sensitivity of the test. Therefore, an original technique using CTA was introduced and compared with catheter angiography as a reference. MATERIAL AND METHODS In a prospective multicenter trial, 84 clinically brain-dead patients were examined using CTA and catheter angiography. The sensitivities of original CTA technique, involving an arterial assessment at the 25th second and a venous assessment at the 40th second, and the standard CTA, involving an arterial and venous assessment at the 60th second, were compared to catheter angiography. RESULTS Catheter angiography results were consistent with the clinical diagnosis of B...
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Chronic algodystrophy is difficult to treat, because the disease in this stage is usually resistant to many therapies. It particularly concerns conditions with predominant severe, intractable pain and disability of the involved extremity.... more
Chronic algodystrophy is difficult to treat, because the disease in this stage is usually resistant to many therapies. It particularly concerns conditions with predominant severe, intractable pain and disability of the involved extremity. In these, the severest cases, searching for effective pain control therapy is extremely important. Intravenous ketamine infusions constitute a promising therapy, which appeared recently. Ketamine possesses properties of blocking central sensitization and development of neuropathic pain through its effect on NMDA receptor, a critical factor in this process. The article presents problem of chronic, refractory algodystrophy, mechanism of ketamine action in pain control, literature review on treatment outcomes and authors' own experience in this field. Ketamine seems to be a useful option for pain control in patients with refractory algodystrophy.
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ABSTRACT Remifentanil is increasingly used as a component of cardiac anaesthesia. Following cardiac surgery remifentanil is often substituted for alternative opioids on the intensive care unit. We were interested to evaluate postoperative... more
ABSTRACT Remifentanil is increasingly used as a component of cardiac anaesthesia. Following cardiac surgery remifentanil is often substituted for alternative opioids on the intensive care unit. We were interested to evaluate postoperative continuation of remifentanil in the form of remifentanil patient control analgesia (RPCA) for those patients who received intraoperative remifentanil. The objectives of this study were to assess the safety, efficacy and feasibility of the RPCA. Ten patients who received an intravenous infusion of remifentanil perioperatively for coronary artery bypass graft surgery (CABG) had their remifentanil infusion converted to RPCA following extubation on the intensive care unit. Remifentanil patient control analgesia delivered an initial background infusion consistent with the infusion rate at extubation and with a bolus facility of 50 microg administered over 5 min followed by a 5-min lockout. Data collection included sedation and pain scores, respiratory rate, arterial blood gases, number of successful/unsuccessful attempts and the background infusion rate for each subject over a period of 12 h following extubation. The data from nine male and one female patient were analyzed by using SPSS11 for Windows. During the study period the patients achieved adequate pain control and made more RPCA attempts at lower background infusion rates. No episodes of apnoea, SpO(2) less than 95% or a rise in PaCO(2) greater than 6.5 kPa were observed. Remifentanil patient control analgesia with a background infusion was effective and safe for postoperative pain relief in this group of spontaneously breathing ICU patients following cardiac surgery.