The aim of this study was to evaluate the fluid balance of polytrauma patients hospitalized in the intensive care unit at the University Hospital in Hradec Kralove. Very little knowledge about this issue can be found; therefore we tried to clarify how the body responds to trauma and whether it is possible to influence the further course of the disease by controlling the amount of administered fluid. The study included 13 patients, 12 men and 1 woman with different length of hospitalization. The examination of the patients was carried out by the bioelectrical impedance analysis of the body composition which is able to determine the proportion of individual body components (water, muscle mass, fat). All the patients were examined twice, each after a different time period. Other data were collected from medical documentation related to fluid balance and laboratory results. After assessing the results we discovered differences in the measured values in the first and second test. While during the first examination no statistical correlation between the distribution of the fluids in the body and the intake and output was found, the second examination showed a statistically significant relationship between the fluid intake and subsequent body composition (fluid overload, total body water, extra and...

This thesis deals with the control of blood glucose levels of critically ill patients in intensive care, focusing on hyperglycemia of the critically ill and possible therapy within the competences of nursing and medical staff. The theoretical part of the thesis deals with the issue of hyperglycemia of critically ill patients from the medical and nursing perspective as well as the issues concerning instrumentation. The first chapter describes briefly the history of insulin, relating to its discovery and introduction into practice. The following chapter describes the concepts of critically ill, intensive medicine, intensive care as well as specific nursing care. Short information about etiology, diagnosis, treatment and complications of diabetes mellitus is described in the third chapter. The following are the chapters, which are more specifically devoted to the issue of hyperglycemia of the critically ill, including chapters on glucose homeostasis of the critically ill, the evolution of blood glucose levels, instrument technique, insulin protocols, insulin therapy, details of insulin therapy in intensive care and on the principles of correct blood collection for the determination of blood glucose levels in the conditions of intensive care. The empirical part of this work contains research on the...

The Egyptian vulture (Neophron percnopterus) is the smallest and the most threatened european vulture species. Recently, wild populations have been declining dramatically and monitoring is too difficult especially because part of the european population migrates. That is the reason why this species was declared endangered in the IUCN Red list of threatened species (IUCN, 2014). Prague zoo has great results in breeding of these birds of prey. In season of 2013, two juveniles were bred (1 male, 1 female) from 7 of all the Europe. Another juvenile was bred in Zlín-Lešná zoo. In the year 2013, Czech republic therefore bred almost a half of these vultures in european breedings (EAZA). In 2014 the results of breedings are also succesfull, more then half (13 juveniles in total, 3 from Prague, 4 from Zlín-Lešná) was risen in these breedings. Prague zoo has been keeping the egyptian vulture studbook for more than 10 years and is also in charge of the European endangered species programme for this vulture. For coordination improvement and to increase the succes of european breeding it is important to summarize the data and use them to provide better breeding conditions in other zoos. One of the program objectives is also the reintroduction of the animals back to its natural environment. This master´s degree provides summarization of etology research from seasons 2013 and 2014, short research of etology in Zlín-Lešná zoo, summarization of another european breedings and also assesment of all the breedings factors including those preceeding the nesting like incubation of the eggs, and birds hatching.

Butterfly family Lycaenidae is cosmopolitan. Some species of the family are common in the Czech Republic, but some are at the risk of extinction, which is caused either by lack of habitat or host plant deficiency. Among the most endangered species in the Czech Republic are the damon blue (Polyommatus damon (Denis a Schiffermüller, 1775)) and the turquoise blue (Polyommatus dorylas (Denis a Schiffermüller, 1775)). This thesis aims to review the biology of both species, causes of threat and possibilities of their practical conservation, and to describe genetic variability of Czech populations of two critically endangered Lycenids, the damon blue and the turquoise blue, and to compare them with European populations for potential import of alien individuals to Czech populations. Genetic assignment is important for possible reintroduction or revitalization of Czech populations from foreign sources. I detected in this thesis that the damon blue has more genetic variability than the turquoise blue and this pattern is not only geographical. I assume that Czech populations of both species experienced bottleneck and are under genetic drift. Furthermore, the Central European individuals genetically differ from Southern European and Baltic samples, and the number of haplotypes is high in Central Europe. The current distribution is not caused by colonization after the last glacial period. According to the results, it is appropriate to protect all current populations separately, rather than supplement them from other sources, because they can be genetically different. Finally, I discuss the management planned for the two species in the Czech Republic and connect it to my results.

Glycaemic control in critically ill patients has been a topic of considerable attention for the past 20 years. In literature and at scientific meetings, there have been ongoing debates regarding the efficacy of glycaemic control in these patients with frequently entirely opposite opinions. These range from a strict invasive approach with target glycaemia 4-6 mmol/l to a liberal approach tolerating even values higher than 12 mmol/l. In the preview of this PhD thesis we have analysed so far published literature and describe the reasons for this inconsistency. According to the results of recent studies, the most significant efficacy of tight glycaemic control has been observed in cardiac surgical patients. If we consider the concept of tight glycaemic control as efficient strategy, there are three important questions remaining unanswered as follow. Does the specific algorithm-protocol play a key part in the concept of tight glycaemic control alongside the knowledge and skills of nursing staff in safe and efficient blood glucose control? What is the ideal timing of starting the strategy of tight glycaemic control (TGC) in cardiac surgical patient? And is there any benefit in outcome respect to mortality or morbidity? Do we have any more safe and efficient option or add-on to standard perioperative...

Author: Bc. Marie Hejnová Title: Effect of Functional Electrical Stimulation-Assisted Ergometry on Muscle Cross-Sectional Diameter, Nitrogen and Fluid Balance in Critically Ill Objectives: The aim of this thesis was to investigate the effect of functional electrical stimulation-assisted cycling ergometry (FES-CE) on cross-sectional diameter of the quadriceps femoris (QF) muscle of both lower extremities in critically ill patients. Another objective was to evaluate if the measured values are responding to the changes in muscle tissue or are caused by an oedema. Methods: The intervention group received daily intensified physical therapy and FES-CE. We measured cross-sectional diameter of the QF muscle repeatedly by a diagnostic ultrasound. We recorded daily nitrogen balance to objectivize catabolism of muscle and fluid balance to objectivize amount of cumulative fluid. Results: The total of 115 patients were evaluated. Average decrease of cross-sectional diameter of QF muscle in the intervention group was 0.020 ± 0.070 cm/day, in the control group it was 0.017 ± 0.084 cm/day (p = 0.87). We registered an opposite result from the eighth day onwards, the intervention group had average decrease 0.025 ± 0.047 cm/day and the control group 0.040 ± 0.076 cm/day (p = 0.38). The nitrogen intake was...

Beneš J.: HEMODYNAMIKA V ČASNÉ FÁZI KRITICKÝCH STAVŮ A PERIOPERAČNÍ MEDICÍNĚ - Využití méně invazivních monitorovacích prostředků k cílené hemodynamické péči ABSTRACT Hemodynamic instability occurs very often in critically ill patients and during the perioperative period. Insufficiency in the preload, contractility and afterload contribute in major part to this phenomenon. Hemodynamic monitoring allows clinicians to recognize and to intervene early the underlying cause. Due to new technologies development in recent years it is possible to provide continuous monitoring of hemodynamic parameters with diminished invasivity. Hemodynamic optimization and goal directed therapy show treatment benefit in some groups of critically ill patients and mainly during the perioperative period. Aim of hemodynamic optimizations is to attain the best obtainable hemodynamic conditions with use of fluid loading and inotropic support. In many studies in recent years goal-directed therapy was associated with morbidity and mortality reduction. According to the results of our clinical research hemodynamic optimization using stroke volume variation and minimally invasive device based on the pressure wave analysis is feasible and show the same results as other works with more invasive devices. Key words Hemodynamic monitoring,...

Multiorgan dysfunction syndrom is the major driving pathophysiological mechanism of morbidity and mortality in critically ill patients. Gastrointestinal dysfunction usually develops as a result critical illness and it is believed to play a key role in the development and progression of multiple organ dysfunction. Moreover, any primary disorder of the gastrointestinal tract, if severe enough, can lead to a critical state and secondary multiorgan dyfunction. Despite intensive experimental and clinical research, reliable tools for monitoring and evaluation of the severity of gastrointestinal dysfunction remain unknown. In the same line, therapy of this complex pathology remains largely supportive. The aim of this thesis was first to explain the severity of the most common and most serious nosocomial infection of the digestive tract, second to elucidate the safety and effectiveness of the endoscopic dual enteral probe insertion in ventilated critically ill patients, and, third to evaluate new diagnostic tools of the gastrointestinal dysfunction. Finally, we present an ongoing project aimed at investigating esophageal dysfunction in mechanically ventilated critically ill patients.

Nowadays the parental presence in the pediatric intensive care units (PICU) is quite common. Building a fellowship between parents and health care staff and high quality parents' integration into the care is a very demanding process. First of all, the success of this process largely depends upon the nurse. It is the very nurse who leads, educates, supports and also professionally integrates parents into their child's care. In addition, critically ill child's care in cooperation with parents is complicated by a high parental stress level, child's serious condition and high professional and technical requirements posed to the nurse. The graduation thesis concentrates on the parents' integration into the care of a critically ill child from the nurse's point of view. The goal of this thesis was to describe the general conditions of parents' integration into the critically ill child's care and to map the actual state of the cooperation within the nurse ? parent ? critically ill child relation from the nurse's point of view. Other goals included the analysis of nurse's feeling of readiness for work with parents of critically ill children, and elaboration of a booklet concerning the initial introduction of an intensive care and resuscitation unit for infants and older children for better parents' awareness. In the research part of the thesis a qualitative research was used. The data collection technique was a semi-standardized interview. A research sample was represented by seven nurses working in the sphere of the critically ill children care in four selected hospitals in the Czech Republic. The study took place in the period starting May 2011 till July 2011. The research results revealed that the parental integration conditions are not quite optimal. First of all, in this sphere the nurses pointed to a limited accommodation capacity for parents, lack of supporting services and unsatisfactory site layout of the intensive care units. The nurses expressed their readiness to the closer cooperation with critically ill children's parents in the basic nursing sphere, mostly, thereafter, in the sphere of hygiene care. The parental cooperation in the special-care sphere was accepted rather negatively by the respondents. As the research results show, most of the nurses consider the work with parents psychologically very demanding and during their school education they had never been prepared for it by anybody. Findings flowing from the research results gave birth to the information booklet that is a basic informational and educational material for parents of children admitted to the intensive and resuscitation care unit for older children and infants in Hradec Králové University Teaching Hospital. It also represents a detailed instruction for a similar material for other facilities of this type and, last but not least, it facilitates the whole process of initial parents' education for nurses. This graduation thesis can also assist in the education of children's nurses, help students and nurses working with critically ill children's parents understand the "Family-centered care" principles and their practical introduction.

Multiorgan dysfunction syndrom is the major driving pathophysiological mechanism of morbidity and mortality in critically ill patients. Gastrointestinal dysfunction usually develops as a result critical illness and it is believed to play a key role in the development and progression of multiple organ dysfunction. Moreover, any primary disorder of the gastrointestinal tract, if severe enough, can lead to a critical state and secondary multiorgan dyfunction. Despite intensive experimental and clinical research, reliable tools for monitoring and evaluation of the severity of gastrointestinal dysfunction remain unknown. In the same line, therapy of this complex pathology remains largely supportive. The aim of this thesis was first to explain the severity of the most common and most serious nosocomial infection of the digestive tract, second to elucidate the safety and effectiveness of the endoscopic dual enteral probe insertion in ventilated critically ill patients, and, third to evaluate new diagnostic tools of the gastrointestinal dysfunction. Finally, we present an ongoing project aimed at investigating esophageal dysfunction in mechanically ventilated critically ill patients.