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1.
Dynamics of capillary lactate levels in patients with out-of-hospital cardiac arrest
Vitka Vujanović, Vesna Borovnik Lesjak, Dušan Mekiš, Matej Strnad, 2023, izvirni znanstveni članek

Opis: Background and Objectives: An effective strategy for cardiopulmonary resuscitation should be based on tissue perfusion. Our primary aim was to determine the association between capillary lactate values and initial rhythm as well as the probability of the return of spontaneous circulation in out-of-hospital cardiac arrest patients. Materials and Methods: This prospective observational cohort study included all patients with non-traumatic out-of-hospital cardiac arrest, older than 18 years, resuscitated by a prehospital emergency medical team between April 2020 and June 2021. Capillary lactate samples were collected at the time of arrival and every 10 min after the first measurement until the time of the return of spontaneous circulation (ROSC) or, if ROSC was not achieved, at the time of declaring death on the scene. Results: In total, 83 patients were enrolled in the study. ROSC was achieved in 28 patients (33.7%), 21 were admitted to hospital (26.3%), and 6 (7.23%) of them were discharged from hospital. At discharge, all patients had Cerebral Performance Category Scale 1 or 2. Initial capillary lactate values were significantly higher in patients with a non-shockable rhythm compared to the group with a shockable rhythm (9.19 ± 4.6 versus 6.43 ± 3.81; p = 0.037). A significant difference also persisted in a second value taken 10 min after the initial value (10.03 ± 5,19 versus 5.18 ± 3.47; p = 0.019). Capillary lactate values were higher in the ROSC group and non-ROSC group at the time of restored circulation (11.10 ± 6.59 and 6.77 ± 4.23, respectively; p = 0.047). Conclusions: Capillary lactate values are significantly higher in patients with a non-shockable first rhythm in out-of-hospital cardiac arrest (OHCA). There is also a significantly different rise in capillary lactate levels in patients with ROSC.
Ključne besede: cardiopulmonary resuscitation, out-of-hospital cardiac arrest, lactate, return of spontaneous circulation
Objavljeno v DKUM: 16.04.2024; Ogledov: 107; Prenosov: 5
.pdf Celotno besedilo (1,17 MB)
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2.
Vpliv intubacije na izid preživetja pri obolelih za COVID-19
Jože Rečnik, 2023, diplomsko delo

Opis: Uvod: V preteklosti in tudi sodobnem svetu so bili in so prisotni različni virusi. V različnih zgodovinskih obdobjih so se virusi spreminjali in izumirali. Pri ljudeh pa vedno povzročajo različne vrste težav, ki lahko povzročijo smrt bolnika. Pri tem se v zdravstveni negi postavlja vprašanje, kako najbolje poskrbeti za bolnika, pri katerem samostojnost dihanja ni več mogoča in je zaradi tega nujna intubacija. Metode: Z metodo analize smo primerjali, analizirali in sintetizirali članke različnih avtorjev, ki so pregledno in znanstveno poročali o različnih vplivih intubacije pri tistih bolnikih, ki so oboleli za covidom-19. Literaturo smo iskali v podatkovnih bazah PubMed, CINAHL, Cochrane library in Science direct. Rezultati: V končno analizo smo vključili šest raziskav. Pregledne in primerjane raziskave so pokazale, da trenutno ne moremo zagotovo trditi, ali intubacija zviša oziroma zniža možnost preživetja. Na izide preživetja vplivajo tudi fiziološke lastnosti bolnikov. Razprava in zaključek: Ugotovili smo, da je večje število kritično bolnih, ki so oboleli za covidom-19, potrebovalo endotrahealno intubacijo. Iz rezultatov pregledane literature smo ugotovili, da ne moremo podati enotnega odgovora na vprašanje, kako zgodnja oziroma pozna intubacija glede na čas sprejema v urgentni center vpliva na končni izid zdravljenja bolnika, ki je okužen s covidom-19.
Ključne besede: intubacija, covid-19, preživetje, zdravstvena nega
Objavljeno v DKUM: 16.08.2023; Ogledov: 503; Prenosov: 156
.pdf Celotno besedilo (738,99 KB)

3.
Predictors of mortality and prehospital monitoring limitations in blunt trauma patients
Matej Strnad, Vesna Borovnik Lesjak, Vitka Vujanović, Tine Pelcl, Miljenko Križmarić, 2015, izvirni znanstveni članek

Opis: This study aimed at determining predictors of in-hospital mortality and prehospital monitoring limitations in severely injured intubated blunt trauma patients. We retrospectively reviewed patients' charts. Prehospital vital signs, Injury Severity Score (ISS), initial Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), arterial blood gases, and lactate were compared in two study groups: survivors (n=40) and nonsurvivors (n=30). There were no significant differences in prehospital vital signs between compared groups. Nonsurvivors were older (P=0.006), with lower initial GCS (P<0.001) and higher ISS (P<0.001), along with higher lactate (P<0.001) and larger base deficit (BD; P=0.006 ), whereas RTS (P=0.001) was lower in nonsurvivors. For predicting mortality, area under the curve (AUC) was calculated: for lactate 0.82 (P<0.001), for ISS 0.82 (P<0.001), and for BD 0.69 (P=0.006). Lactate level of 3.4mmol/L or more was 82% sensitive and 75% specific for predicting in-hospital death. In a multivariate logistic regression model, ISS (P=0.037), GCS (P=0.033), and age (P=0.002) were found to be independent predictors of in-hospital mortality. The AUC for regression model was 0.93 (P<0.001). Increased levels of lactate and BD on admission indicate more severe occult hypoperfusion in nonsurvivors whereas vital signs did not differ between the groups.
Ključne besede: vital signs, nonsurvivors, survivors
Objavljeno v DKUM: 14.06.2017; Ogledov: 1067; Prenosov: 387
.pdf Celotno besedilo (1,30 MB)
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4.
Prehospital hyperoxemia does not influence the functional neurological outcome in polytraumatized patients with traumatic head injury
Vitka Vujanović, Tine Pelcl, Mateja Špindler, Zalika Klemenc-Ketiš, Matej Strnad, 2013, objavljeni povzetek znanstvenega prispevka na konferenci

Opis: Introduction: The association between hyperoxemia and neurological outcome in trauma patients is not clear. We examined the association between prehospital hyperoxemia and neurological outcome in polytraumatized patients. Methods: This was a retrospective study of polytraumatized patients with traumatic head injury who were endotracheal intubated and ventilated with supplemental oxygen (100%) in the prehospital emergency setting. Arterial partial oxygen pressure (PaO2) was measured after the arrival to the hospital trauma center. We included the patients with initial PaO2 above 160 mmHg (hyperoxemia group). The severity of the trauma was determined upon the admission to the hospital by injury severity scale (ISS) and the outcome was assessed at the discharge from the hospital using Glasgow coma scale (GCS), Glasgow outcome scale (GOS) and Cerebral performance categories scale (CPC). Mann-Whitney's test was used for data analysis. Results: Sixty patients were involved in the study. Forty-eight (80%) of them were men and 86.7% sustained blunt trauma. Hyperoxemia was present in 41.6% of patients. Initial average ISS was 38, in patients with normoxemia 32.5 and in patients with hyperoxemia 35.4. Discharge GCS, GOS and CPC in hyperoxemia group compared to normoxemia group were 9.86 vs. 9.33 (p=0.503), 2.52 vs. 2.24 (p=0.613) and 3.10 vs. 3.19 (p=0.936) with the duration of hospitalization of 26.64 days vs. 27.72 days (p=0.984). Conclusions: Prehospital hyperoxemia did not influence the functional neurological outcome. One of the reasons for this finding could be short arrival time to the trauma center where repeated analysis of arterial blood gases were performed. Therefore, correction of fraction of inspired oxygen according to the arterial blood gases analysis shorten the time of hyperoxemia thus reduced neuronal brain damage. References: Beynon et al. Brain tissue oxygen monitoring and hyperoxic treatment in patients with traumatic brain injury. J Neurotrauma 2012;29:2109-23. Brenner et al. Association between early hyperoxia and worse outcomes after traumatic brain injury. Arch Surg. 2012; 16:1-5. Davis et al. Both hypoxemia and extreme hyperoxemia may be detrimental in patients with severe traumatic brain injury. J Neurotrauma 2009;26:2217-23.
Ključne besede: poškodba glave, nujna medicina
Objavljeno v DKUM: 10.07.2015; Ogledov: 1590; Prenosov: 99
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