Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery Abstract Currently, the most commonly used technical solution for pumping blood during extracorporeal circulation during cardiac surgery, as well as for some types of ECMO (extracorporeal membrane oxygenation) are either a roller pump or centrifugal pump. Due to its advantages the centrifugal pump is mainly used for prolonged extracorporeal circulation in cardiac surgery and as a heart and / or lung support system. In current literature there is a lack of compelling scientific evidence that would clearly support its use in a routine cardiac surgery. The aim of our study was to compare both types of currently used blood pumps in longer cardiac procedures with deep hypothermic circulation arrest. In a randomized clinical study we had selected a group of patients that underwent a pulmonary endarterectomy (PEA) in order to demonstrate the positive effects of the centrifugal pump on the postoperative inflammatory reactions. There were no statistically significant differences between these two pumps when other clinical and laboratory parameters were observed. Based on the hypothesis that significant temperature changes during cardiac procedure with a deep hypothermia can affect sealing pressure of the endotracheal tube cuff, we performed a...

Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery Abstract Currently, the most commonly used technical solution for pumping blood during extracorporeal circulation during cardiac surgery, as well as for some types of ECMO (extracorporeal membrane oxygenation) are either a roller pump or centrifugal pump. Due to its advantages the centrifugal pump is mainly used for prolonged extracorporeal circulation in cardiac surgery and as a heart and / or lung support system. In current literature there is a lack of compelling scientific evidence that would clearly support its use in a routine cardiac surgery. The aim of our study was to compare both types of currently used blood pumps in longer cardiac procedures with deep hypothermic circulation arrest. In a randomized clinical study we had selected a group of patients that underwent a pulmonary endarterectomy (PEA) in order to demonstrate the positive effects of the centrifugal pump on the postoperative inflammatory reactions. There were no statistically significant differences between these two pumps when other clinical and laboratory parameters were observed. Based on the hypothesis that significant temperature changes during cardiac procedure with a deep hypothermia can affect sealing pressure of the endotracheal tube cuff, we performed a...

Title: Application of blood flow restriction by a sport training of climbers - an innovative training method for sportsmen? Author: Tomáš Javorský BSc. Department: Department of Physiology Supervisor: doc. Jiří Baláš, Ph.D. Abstract: The most common injuries of performance climbers include tendon injuries of finger flexors. This kind of injury can leave a sportsman unable to follow his training programme for several months, which can have a crucial impact on his peak season. The thesis comprised a comparison of a high-intensity training performed at 70% of muscle strength maximum, with a blood flow restriction training performed at a 30% muscle load, and also the physiological and functional aspects of the training. Objectives: The presumption is, that the combination of a low muscle load with an ischemy will achieve the same results as a high-intensity training. We also presume, that the alterations in muscle oxygenation remain the same despite different amounts of performed muscle work. Methods: 13 participants finished the experiment performed in the form of a crossover study. During the experiment the muscle oxidative capacity and the extent of the muscle deoxygenation were measured by spectroscopy. The maximum force, critical force, impulse and the impulse above the critical force point were measured...

Introduction: Left-ventricular (LV) distension and consequent pulmonary congestion are complications frequently discussed in patients with severe LV dysfunction treated with veno- arterial extracorporeal membrane oxygenation (VA ECMO). The goal of this study was to describe the influence of high VA ECMO flows to LV distension, lung hemodynamics, and lung fluid accumulation. Methods of LV decompression were studied to prevent lung edema. Methods: In all experiments porcine models under general anesthesia were used. The effects of high extracorporeal blood flow (EBF) on LV heart work were assessed in a chronic heart failure model. The effects of LV afterload on lung fluid accumulation were evaluated by electrical impedance tomography (EIT) on acute heart failure models. Phase and frequency filtration and mathematical analysis were applied to the raw EIT data. Subsequently, mini- invasive techniques of LV decompression were evaluated for LV work. Results: The stepwise increases of VA ECMO flow improved both hemodynamic and oxygenation parameters. Nevertheless, it also caused distension and increased work of LV. The rise in EBF led to increased pulmonary capillary wedge pressure and lung fluid accumulation assessed by EIT in heart failure. The methods for LV decompression (Impella pump, atrial...

Aim: To examine local muscle oxygen kinetics when performing wrist extensions till failure in an occluded versus non-occluded state, to compare the perceived ratings of pain and local muscle exertion, and analysing presence of gender differences. Methods: Twenty-one healthy individuals (mean age 25,6±3.2, 10 females) performed wrist extensions at 30% of peak isometric strength till failure. The order in which the states was performed was randomized. The oxygen kinetics in the m. extensor digitorum was analysed using Near-infrared spectroscopy continuously. Ratings of perceived pain and local muscle exertion were collected before exercise, when reaching failure and post exercise recovery. Result: No difference was identified in tissue oxygen saturation (TOI) at the exercise plateau (-24.0±18.3% vs -23.5±13.9%, p=0.609). TOI at rest was lower for the occluded state (64.2±4.5% vs 57.2±5.9%, p<0.001). During the second minute of recovery, there was a greater increase in TOI for the occluded state (0.01±0.01%/sec vs 0.04±0.03/sec, p<0.001). A higher rating of perceived pain was found for the occluded state during baseline (0.0±0.0 vs 0.7±0.9, p=0.005) and first minute of recovery post exercise (2.3±2.0 vs 3.3±2.1, p=0.011). No clinically relevant gender differences were found. Conclusion: Venous occlusion during low-intensity dynamic wrist extensions affects the local oxygen kinetics in the muscle before and after exercise. The oxygenation kinetics does not differ when exercise plateau is reached when both regimes are performed till failure. This suggests that performing low-load dynamic wrist extensions in a no-relaxation manner, may have the same effects no matter whether occlusion is used or not. / Syfte: Att undersöka den lokala syreomsättningen i muskeln när handledsextensioner utförs till failure i ockluderat tillstånd jämfört med icke-ockluderat tillstånd, samt att jämföra den skattade upplevda smärtan och lokala muskelansträngningen, och eventuella skillnader mellan könen. Metod: Tjugoen friska individer (medelålder 25.6±3.2, 10 kvinnor) utförde handledsextentioner på 30 % av maximal isometrisk styrka till failure. Ordningen av ocklusion och icke-ocklusion var randomiserad. Nära-infraröd spektroskopi användes för att undersöka syreomsättningen lokalt i m. extensor digitorum. Skattning av upplevd smärta och lokal muskelansträngning samlades in före träning, vid failure och vid återhämtning efter träning. Resultat: Ingen skillnad identifierades i vävnadssyremättnad (TOI) vid uppnådd träningsplatå (-24.0±18.3% vs -23.5±13.9%, p=0.609). TOI i vila var lägre för det ockluderade tillståndet (64.2±4.5% vs 57.2±5.9%, p <0.001). Under den andra återhämtningsminuten var det en större ökning av TOI för det ockluderade tillståndet (0.01±0.01%/sek vs 0.04±0.03/sek, p <0.001). En högre skattning av upplevd smärta sågs för det ockluderade tillståndet under den första vilominuten (0.0±0.0 vs 0.7±0.9, p=0.005) och första minuten av återhämtning (2.3±2.0 vs 3.3±2.1, p=0.011). Inga kliniskt relevanta skillnader mellan könen hittades. Slutsats: Ocklusion under lågintensiva dynamiska handledsextensioner påverkar den lokala syreomsättningen i muskeln före och efter träning. Den muskulära syreomsättningen skiljer sig däremot inte när träningsplatå uppnås när båda regimerna utförs till failure. Detta tyder på att utförande av dynamiska handledsextensioner på låg belastning utan att muskeln tillåts att slappna av, kan ge samma effekter oberoende av om ocklusion appliceras eller inte.

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Simple Summary Good oxygenation of both bowel ends is an important prerequisite to promote anastomotic healing after colorectal resections. Bowel oxygenation is usually assessed clinically. Hyperspectral imaging is a contactless and contrast-free tool that allows quantifying tissue oxygen intraoperatively. In this study, the results of 105 colorectal resections with hyperspectral imaging are reported. Abstract Background: A perfusion deficit is a well-defined and intraoperatively influenceable cause of anastomotic leak (AL). Current intraoperative perfusion assessment methods do not provide objective and quantitative results. In this study, the ability of hyperspectral imaging (HSI) to quantify tissue oxygenation intraoperatively was assessed. Methods: 115 patients undergoing colorectal resections were included in the final analysis. Before anastomotic formation, the bowel was extracted and the resection line was outlined and imaged using a compact HSI camera, in order to provide instantaneously quantitative perfusion assessment. Results: In 105 patients, a clear demarcation line was visible with HSI one minute after marginal artery transection, reaching a plateau after 3 min. In 58 (55.2%) patients, the clinically determined transection line matched with HSI. In 23 (21.9%) patients, the clinically established resection margin was entirely within the less perfused area. In 24 patients (22.8%), the HSI transection line had an irregular course and crossed the clinically established resection line. In four cases, HSI disclosed a clinically undetected lesion of the marginal artery. Conclusions: Intraoperative HSI is safe, well reproducible, and does not disrupt the surgical workflow. It also quantifies bowel surface perfusion. HSI might become an intraoperative guidance tool, potentially preventing postoperative complications.

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