6th Day of young intensivists
In the first lecture block, dr. Klincová (Brno) commenced with a case presentation on malignant neuroleptic syndrome in a 16-year-old boy, emphasizing the diagnostic challenges and association with antipsychotic withdrawal. Dr. Klimovič (Plzeň) followed with a case of spontaneous retroperitoneal bleeding in a 25-year-old man on immunosuppressive therapy, delving into the complexities of diagnosis and treatment, including the identification of severe FXIII deficiency. Dr. Papaj (Olomouc) contributed a motorcyclist case, underscoring the successful rehabilitation after significant injuries. Dr. Tlapáková (Hradec Králové) concluded the block with a case involving systemic rigidity and again malignant neuroleptic syndrome.
Moving to the second block, dr. Puškáš (Brno) discussed the applications of fosfomycin and challenges associated with carbapenems. Dr. Lečbychová (Ostrava) delved into fluoroquinolones, addressing their spectrum, side effects, and the rising concern of resistance. Dr. Šušol (Ostrava) provided insights into antimicrobial therapy, emphasizing the significance of identifying high-risk patients and accurate fungal infection diagnosis.
Transitioning to the English block, dr. Svoboda (Prague) introduced topics such as space medicine, dr. Szigetváry (Budapest) talked about intraoperative PEEP titration. Dr. Karim (Budapest) discussed the critical role of investigating the microbiome in critically ill patients, citing a compelling case involving febrile symptoms and the impact of high FiO2 on respiratory microbiota. Dr. Papp (Budapest) explored PCT-assisted antibiotic therapy, highlighting its potential in reducing the duration of treatment, albeit with a minor increase in recurrence.
In the final block, dr. Pařízek (Bratislava) offered insights into dyspnea, emphasizing the use of point-of-care ultrasound (POCUS) for differential diagnosis. Dr. Petraniová (Banská Bystrica) delved into worsening hypotension, stressing the need for considering multifactorial origins, especially when patients are unresponsive to vasopressor treatment. Dr. Nagypál (Banská Bystrica) focused on atrial fibrillation in ICU patients, discussing triggers and the potential risk of bradycardia. Dr. Bílská (Ústí nad Labem) explored deteriorating oliguria, providing a detailed overview of potential causes, including mechanical obstruction, shock, medication effects, and physiological oliguria, with a spotlight on the most common cause—septic shock.
Tuesday
Rubín
Reports from congresses and travels.
The 21st edition of Pediatric Intensive Care News commenced with the insightful opening by dr. Zaoral and dr. Kula (both Ostrava), delving into the historical context of pediatric mortality. Dr. Zaoral, before initiating the first lecture, engaged the audience in a survey on their expectations, setting an interactive tone. His presentation covered the history of child mortality, reflecting on the almost 50% reduction post-World War II. He prompted contemplation on the persistently high child mortality in developing nations and advocated for strategic actions to address it.
Subsequently, a segment focused on congress reports and travels unfolded. Dr. Dominik (Brno) shared experiences from the previous ESPNIC in Athens, highlighting speakers like dr. Maitland's focus on fluid therapy in Africa and dr. Inwald's insights on inotropic fluids. The emphasis was on the importance of individualization for optimal outcomes. Dr. Raffaj (Nottingham), who attended the Critical Care Nephrology congress in London, stressed the collaboration between pediatricians and non-pediatric specialists. He underscored the significance of CRRT and the crucial training of nurses operating dialysis machines.
Sepsis in Children - Unusual Case Studies
Dr. Heinige (Prague) initiated a block on unusual case studies with a presentation on iGAS in critically ill children in the Czech Republic, analyzing cases from September 2022 to December 2023. Dr. Kozáková (Praha) discussed updates on streptococcal infections, noting a substantial rise in 2023, cautioning about potential underreporting. Dr. Nosál (Martin) presented a challenging case involving ARDS in a 3-month-old, revealing a rare genetic condition known as incontinentia pigmenti. The subsequent section featured dr. Mikušová's (Banská Bystrica) presentation on an unexpected cause of multiorgan failure – influenza virus. She detailed a case of a 3-year-old with febrile respiratory infection, complicated by pseudomonadal pneumonia and sepsis. Dr. Mikušová emphasized the importance of vaccination as the most effective tool against severe influenza outcomes. Dr. Petrík (Banská Bystrica) delved into extracorporeal membrane oxygenation (ECMO) in septic patients, elaborating on its indications and cannulation principles for different age groups. Dr. Klabusayová (Brno) shared a compelling case of toxic shock syndrome in a 14-year-old, highlighting the complex decision-making process for severe respiratory and circulatory disorders. The section concluded with dr. Leden's (Praha) presentation on ECMO in septic shock therapy, providing a comprehensive overview and summarizing results from his institution.
Individual Therapy for Pediatric Sepsis
Transitioning to the next segment on individual sepsis therapy, dr. Zaoral (Ostrava) delved into the role of genetics in personalized medicine. He highlighted how interindividual variability influences disease progression and treatment responses. Dr. Drábková (Brno) followed with a presentation on antibiotic use in pediatric sepsis. She emphasized the urgency of broad-spectrum antibiotics, administered within specific timeframes, and the subsequent shift to narrower-spectrum antibiotics to prevent resistance. Dr. Kořístková (Ostrava) discussed the monitoring of antibiotic levels in children, emphasizing the importance of minimizing invasive procedures. She specifically focused on commonly monitored antibiotics like amikacin and gentamicin. Dr. Průcha (Prague) revisited foundational concepts and reminisced about professor Vilček's contributions, particularly the patenting of a monoclonal antibody against TNF-alpha. He highlighted the relevance of -omics technologies in identifying infectious agents. Dr. Fedora (Brno) concluded the sepsis therapy section with a presentation on individualized approaches using genomic studies. He traced the evolution of genomic studies in pediatrics, citing Hector Wong's pioneering work categorizing nearly 7000 genes.
Strokes in Children Do Indeed Exist
Shifting gears to the Childhood Stroke segment, dr. Kopecká (H. Králové) opened with a compelling case of successful thrombolysis and subsequent angiography in an 11-year-old. Dr. Heinige (Prague) proposed a pediatric stroke protocol, emphasizing the crucial role of identifying patients through FAST and considering the time window for intervention. Dr. Dominik (Brno) shared surprising cases of hemorrhagic strokes in children, debunking the misconception that ischemic strokes dominate in this age group. His cases included a 3-year-old with sudden loss of consciousness, later diagnosed with extensive intracranial bleeding and a positive anti-SARS-CoV-2 test. Dr. Štěpánová (Ostrava) presented two cases of childhood strokes, emphasizing their frequent occurrence in the perinatal period. Both cases involved neurological anomalies and complications necessitating intervention. The final presentation in this section was delivered by dr. Procházka (Ostrava), who focused on the experience of treating childhood strokes. He underscored the statistical insights derived from interventions at the Institute of Radiodiagnostics, highlighting the considerable time lag between symptom onset and reperfusion procedures.
Antracit
Antibiotic stewardship
Dr. Kolář (Olomouc) opened the lecture block on antibiotics, discussing the timing of initiation and termination of antibiotic therapy in the intensive care setting. He emphasized accurate result interpretation and thorough diagnostics to distinguish infection from colonization. Dr. Doubravská (Olomouc) continued, addressing the timely administration of antibiotics and the challenge of determining who benefits from antibiotic treatment. For non-septic patients, delaying antibiotic therapy until all necessary tests are conducted may be considered. Dr. Htoutou Sedláková (Olomouc) then led a panel discussion on Antibiotic Prophylaxis vs. Therapy, highlighting the importance of adherence to guidelines. Lastly, dr. Lengerová (Brno) discussed molecular diagnostics in clinical fields, emphasizing its routine use, particularly PCR, in diagnosing viral infections and its potential application for yeasts, molds, and challenging-to-culture bacteria. The benefits include a high negative predictive value and suitable automation, but drawbacks include high specificity due to natural genetic variability among microorganisms.
Sapphire
Vascular Events in Children Do Indeed Exist
In the Clinical Pharmacy in Intensive Care block, dr. Gregorová (Prague) introduced the first speaker, dr. Linhartová (Prague). Dr. Linhartová discussed the use of levetiracetam in renal insufficiency, emphasizing altered kinetics in renal dysfunction. Routine renal function assessment involves estimating glomerular filtration. In a case study, elevated levels prompted suspicion of renal dysfunction. Temporarily discontinuing levetiracetam, adjusting renal function, and reintroducing a lower dose were successful. Dr. Linhartová's second presentation focused on vancomycin in glomerular hyperfiltration. Similar to levetiracetam, vancomycin is minimally metabolized and primarily eliminated through renal pathways. The presentation explored augmented renal clearance and changes in vancomycin kinetics during renal dysfunction. Dr. Gregorová (Prague) addressed drug clearance during Renal Replacement Therapy (RRT), emphasizing dosage adjustments and monitoring pharmacokinetic changes. Dr. Brezinová concluded with colistin dosing in Continuous Veno-Venous Hemodialysis (CVVHD), stressing the importance of loading doses and Therapeutic Drug Monitoring (TDM).
Intensive care in infectology - a tsunami of streptococcal infections?
In the Infectiology Intensive Care block, dr. Sagan (Ostrava) and dr. Bartoš (Prague) introduced dr. Krůtová (Prague), who explored the intriguing rise in the incidence of S. pyogenes post-COVID. Dr. Štefan (Prague) shifted the focus to invasive streptococcal infection, and dr. Máca (Ostrava) presented a compelling case of streptococcal infection in critical care, accentuating the gravity of severe outcomes. Dr. Cimrman (Ústí nad Labem) took the spotlight to discuss toxic shock syndrome as a varicella complication. He presented a challenging case involving a young man with progressive eye swelling and redness, complicating varicella. Despite standard treatments, the patient faced refractory hypotension, respiratory failure, and ultimately required amputation due to progressing gangrene. Concluding the day's presentations, dr. Mikolášek (Brno) provided insights into streptococcal septic shock, defining it as a complex, dynamic interplay between the host and microorganism. His case study depicted a 13-year-old girl with streptococcal pneumonia as a complication of viral infection.
Clinical nutrition in the ICU
Dr. Novák (Prague) initiated the Clinical Nutrition in Intensive Care block, focusing on intestinal failure and the role of enteral nutrition. Dr. Kohout (Prague) discussed gut microbiota modulation, emphasizing its crucial impact on various organ systems. Dr. Káňová (Ostrava) highlighted the significance of muscle mass in survival and addressed Post Intensive Care Syndrome. Dr. Těšínský (Prague) concluded, comparing nutritional recommendations for critically ill patients and cautioning against early full nutrition in certain cases, emphasizing prolonged nutritional support post-ICU as crucial.
Financing and management of intensive care
The day concluded with a block on Financing and Management of Intensive Care led by dr. Folwarczny and dr. Ševčík (Ostrava). The speakers discussed insurance finances, highlighting the need for systemic changes in financing and legislation to optimize the entire healthcare system.
Wednesday
Sapphire
Wednesday's main program of Colours of Sepsis was initiated by dr. Kula (Ostrava) with his lecture "Colours of Sepsis - the show must go on." He reflected on the festival's beginnings in 2004, acknowledging significant progress in intensive medicine. Dr. Kula highlighted the persistent challenge of inadequate causal sepsis treatment and discussed fluid management strategies and the importance of identifying patient phenotypes for optimal therapy.
Hot Topics in intensive care
Dr. Matějovič (Plzeň) opened the block "Hot topics in intensive care" with a focus on challenges faced by morbidly obese patients in critical care. He emphasized the impact of obesity on ventilation, perioperative management, and thromboembolic risk. The obesity paradox was discussed, noting that people with higher or normal BMI had comparable survival rates, while those with lower BMI fared worse. Dr. Giamarellos-Bourboulis (Athens, Greece) presented on immunotherapy's role in hospitalized infection patients, advocating for targeted therapy based on biomarkers and phenotyping to reduce sepsis risk. Dr. Hahn (Sweden) addressed hypovolemia solutions. Dr. Regenmortel (Antwerp, Belgium) recommended hypotonic fluids based on his study, challenging excessive sodium administration during intensive care.
Diverse Layers of Surgery
The surgical lecture block began with dr. Kočí (Hradec Králové) discussing fibrinogen's use in trauma, highlighting the need for careful consideration and availability. Dr. Ryska (Lancaster, UK) explored prehabilitation's role in reducing postoperative complications, suggesting screening tests, especially anaerobic threshold, for predicting outcomes. Dr. Skoblej (Havířov) addressed fluid overload, excessive sedation, irrational antibiotic use, stress ulcer prophylaxis, and the importance of nutrition and rehabilitation in surgical intensive care. Dr. Urbánek (Brno) discussed gastrointestinal paralysis and pharmacological interventions, focusing on ileus treatment. Dr. Adámková (Prague) concluded the surgical block, emphasizing the challenges in antibiotic use and the impact on the patient's microbiome.
Significance of Glycocalyx in Clinical Medicine
Dr. Černý (Prague) introduced the block "Significance of Glycocalyx in Clinical Medicine." Dr. Hahn (Sweden) highlighted fluid volume kinetics' impact on glycocalyx damage. Dr. Navrátil (Hradec Králové) discussed glycocalyx's role in transplantation, emphasizing its importance for organ microcirculation. Dr. Hahn concluded with "Maldistribution of Fluid by Volume Kinetics," addressing the negative effects of albumin deficiency on glycocalyx.
Grand Opening of Colours of Sepsis and a Lecture by a Special Guest
The second day concluded with a presentation by Ing. Dana Drábová, Ph.D., dr. h. c. mult., President of the State Office for Nuclear Safety (Prague), discussing nuclear technologies in various fields, highlighting their similarities with medical applications and their potential benefits and risks.
Gold
Pediatric Intensive Care - Nursing Section
In the morning, the reporting team supported the first half of the sister section, featuring presentations on diverse medical cases. Ms. Nečasová (Brno) discussed toxic shock syndrome in a pediatric patient, covering both medical and nursing management, emphasizing the challenge of managing delirium and the necessity of limb amputation during hospitalization. Subsequently, Mr. Jatagandzidis (Dresden) spoke about ECLS (ECMO), detailing a case involving a 14-year-old with Ebstein's anomaly, stressing the importance of a comprehensive CT scan after ECMO connection. Dr. Laurinc (Bratislava) addressed pediatric post-cardiothoracic surgery pain, debunking myths, emphasizing unique challenges in children's pain treatment, and presenting non-pharmacological therapies. Lastly, Ms. Manová and Ms. Šolcová (Ostrava) discussed stroke in an 8-year-old, covering treatment procedures and rehabilitation success with physiotherapy and speech intervention.
Rubín
Varia
In the early morning, the pediatric intensive care community convened for insightful lectures on various medical subjects. Dr. Kulhánek (Prague) delved into independent lung ventilation, emphasizing its applicability in asymmetrical lung issues. He shared a case involving a 6-month-old girl with progressive respiratory failure, ultimately intubated with two ETC No. 3 tubes and dual ventilators. Dr. Pokorná (Hradec Králové) presented a preterm infant's case with late sepsis and multifocal osteomyelitis, highlighting the use of fosfomycin in antibiotic therapy, particularly beneficial for life-threatening infections. The focus shifted to nutritional aspects in pediatric intensive care with dr. Klabusayová (Brno) emphasizing nutritional screening and early initiation of enteral nutrition, discussing challenges and highlighting the use of indirect calorimetry for assessing nutritional needs. Dr. Hrdličková (Prague) shared insights into palliative care on the pediatric ICU, emphasizing the importance of understanding prognosis and incorporating care limitations into the treatment plan. Dr. Gřegořová (Ostrava) discussed post-mortem genetic analysis, underscoring the significance of these findings not excluding hereditary conditions due to epigenetics.
Intoxication and Substance Abuse in Children
Dr. Mravčík (Brno) provided an overview of the current drug situation in the Czech Republic, addressing new psychoactive substances and their impact. Dr. Ducháčová (Ostrava) explored intoxication before, during, and after COVID-19, shedding light on risk periods for substance use in children. Dr. Kotíková (Prague) presented data on self-harm and suicidal attempts in children based on inquiries to the Toxicological Information Center, offering valuable insights for medical professionals. Dr. Uhlíř (Ostrava) highlighted the nuances of adolescent self-harm, emphasizing impulsivity and its connection to commonly accessible medications. He explored potential interventions such as psychotherapy, coping technique groups, and pharmacotherapy. Dr. Koudelková (Brno) provided a comprehensive overview of psychoactive medication intoxication, featuring a detailed case study of carbamazepine poisoning and discussing its properties and potential toxidromes.
Perioperative Medicine in Children
Dr. Pavlíček (Prague) initiated the afternoon session, introducing dr. Divák (Ostrava), who delved into the variances in preoperative preparations between healthy and comorbid pediatric patients. The first objective emphasized the importance of establishing contact between the child and the physician during preoperative examinations. Following this, dr. Teplá (Prague) tackled postoperative complications, highlighting issues like laryngospasm, hypothermia, hyperthermia, PONV (postoperative nausea and vomiting), hypotension, and emergent delirium. She identified patient groups with a high risk of postoperative complications, including premature infants, neonates, those with genetically conditioned syndromes, and those with respiratory infections. Dr. Teplá also noted the varying response of red-haired patients to anesthetics. Dr. Čutora (Banská Bystrica) addressed pediatric patients with difficult intravenous access (DIVA), pointing out factors contributing to challenging venous entry. He emphasized the importance of using the DIVA score to evaluate the difficulty of venous access. Dr. Ťoukálková (Brno) discussed regional anesthesia in the perioperative period for children. She outlined the key principles for pre-transfer examination to the operating room, explained the administration of nerve blockades, and detailed anesthetic record documentation. Dr. Lauková (Bratislava) presented on viscoelastic tests, focusing on rotational thromboelastometry (ROTEM). She highlighted ROTEM's high negative predictive value (95-97%) and its assessment parameters for clotting time, clot firmness, and fibrinolytic processes. The final presentation by dr. Kenderessy (Banská Bystrica) centered on the "fragile child," discussing frailty syndrome, the ASA scale, and underscoring the significance of individualized medicine, surpassing standardized scales.
Thursday
Sapphire
Nature Respect
Thursday's lecture day in the Sapphire Hall commenced with the Nature Respect block. Dr. Maňák (Hradec Králové) initiated it with a talk on chyme reinfusion. He presented a case of a patient with acute biliary pancreatitis, where chyme reinfusion led to an immediate reduction in stool frequency, potential cessation of parenteral nutrition, decreased need for infusion fluids, and overall improvement. A retrospective study indicated that most patients, two days post-chyme reinfusion, no longer required parenteral nutrition. Dr. Řehořová (Prague) continued with a presentation on the microbiome in critically ill patients. She highlighted the impact of gut microbiota on immune cascades and its predefinition intrauterinely. Factors like antibiotics, opioids, or proton pump inhibitors influence ICU patients, and she discussed protective agents like DaV-132 and ribaxamase. Fecal transplants, mentioned by dr. Řehořová, are subject to donor selection, as only about 20% meet the criteria. Dr. Duška (Prague) discussed skeletal muscle in ICU patients, emphasizing the increasing post-ICU mortality and the rise in survivors with permanent disability. He highlighted that early full nutrition might not be ideal, proposing potential benefits from intermittent nutrition, ketone supplements, and ketogenic diets.
Cardiopulmonary Resuscitation and Urgent Medicine
Dr. Líčeník (Peterborough, UK) opened the CPR block with the concept of a hybrid mobile stroke unit (MSU), emphasizing its time-critical role in stroke management. Dr. Gretz (Hradec Králové) discussed the challenges of sepsis in pre-hospital emergency care, highlighting the need for screening using NEWS2 and debunking myths about pulmonary embolism (PE). Dr. Varhaník (Hradec Králové) addressed PE myths, emphasizing diagnostic tools such as Well's and Geneva scores, D-dimers, and the YEARS algorithm. Dr. Škulec (Bratislava) focused on pre-hospital diagnosis of acute aortic syndrome, stressing the importance of clinical suspicion and reliable imaging methods. The definitive examination for aortic dissection confirmation is a CT angiogram. The year 2023 insights, presented by dr. Trenkler (Krompachy), covered resuscitation without adrenaline, new defibrillation strategies (DSED and VCD), and the discussion around ECPR, where studies found no survival differences between ECPR and conventional CPR.
ČSIM
Dr. Čundrle (Brno) delved into risks associated with rapid correction of hyponatremia, emphasizing the need for a careful approach. Dr. Chvojka (Plzeň) addressed the challenges in sepsis definition and early diagnosis, stressing altered mental status as a crucial symptom. Dr. Černý (Prague) discussed sepsis in obstetrics, highlighting the impact of physiological changes in pregnancy on its manifestations. Limited evidence and pregnancy exclusion from studies make sepsis diagnosis challenging. He emphasized three key clinical questions related to sepsis: infection presence, signs of organ dysfunction, and hypotension. Dr. Balík (Prague) focused on arrhythmias in septic shock, particularly supraventricular arrhythmias, cautioning against amiodarone's toxic properties. He presented a study comparing amiodarone and propafenone, showing better outcomes with propafenone, especially in patients with lower LAVI. Dr. Duška (Prague) concluded with the LandiSep Trial on Landiolol in septic shock, presenting an unpublished study.
Urgent Admission - Not All Resuscitations Are the Same!
Dr. Leden (Prague) opened the last program block on emergency admission with a focus on ECPR in children, emphasizing the importance of quality CPR for successful outcomes. Dr. Knor (Prague) discussed the prognosis of immediate resuscitation in seniors, highlighting the challenges of resuscitating polymorbid seniors and suggesting age-specific considerations for CPR indications. Dr. Otáhalová (Ostrava) presented a case of traumatic cardiac arrest in a patient with an ICD, raising questions about CPR with ICD involvement. Dr. Šipula (Ostrava) discussed ICD indications, types, and functionality principles. Dr. Grenar (Hradec Králové) introduced limited ultrasound examination with a focus on identifying reversible causes of cardiac arrest. Dr. Popela (Olomouc) addressed injuries after CPR, detailing manual and mechanical compression options and the potential tissue damage associated with compressions. Dr. Šeblová (Prague) concluded the day with a presentation on ethical aspects of pediatric emergency care, touching upon autonomy and decision-making capacity in children, as well as the increasing relevance of pediatric palliative care.
Platinum
Cardiology
The morning started with dr. Folwarczny from Ostrava introducing dr. Marek (Přerov), who discussed imaging methods in cardiology, focusing on echocardiography, magnetic resonance, and PET/CT. Dr. Gregořová (Ostrava) highlighted the use of genetic testing in cardiology, emphasizing indications and red flags for hereditary conditions. Dr. Pastucha (Ostrava) addressed legislative aspects of preventing sudden death in sports. Dr. Klásková (Olomouc) discussed PIMS syndrome in young athletes related to COVID-19, emphasizing cardiac issues.
Work of Young Intensivists
Thursday's lecture day continued with a block led by dr. Káňová (Ostrava), introducing young intensivists. Dr. Renza (Prague) discussed the transposition of simulation studies into clinical practice, showing improved competence among paramedics in administering sufentanil after simulation training. Dr. Irecký (Zlín) focused on Methoxyflurane, its history, biochemical properties, and clinical usage. Dr. Kutěj (Ostrava) explored the significance of Alveolo-arterial Difference (AaD) in assessing gas exchange disorders in CARDS. Dr. Prokopová (Brno) covered palliative care in the ICU, discussing the PEOpLE-C19 study on moral distress during the Covid-19 pandemic among healthcare workers. Dr. Nagypal (Banská Bystrica) presented the ECMO program in Slovakia, and dr. Smoleňák (Banská Bystrica) discussed the vision and potential eCPR programs.
Silver
Simulations in Medicine
Thursday morning was led by dr. Štourač (Brno) with a block on Simulation in Medicine, focusing on the specifics of education in various stages of professional growth. Dr. Prokopová (Brno) discussed Pregraduate Education, emphasizing the homogeneity of pregraduate students and the importance of pre-learning, practical training, and debriefing. Dr. Kosinová (Brno) continued with Postgraduate Education, presenting changes in simulation medicine education post-COVID-19 and highlighting the offers at the Simulation Center in Brno (SIMU). Mgr. Dvořáček (Brno) addressed non-medical professions in simulations, emphasizing defining educational goals before addressing modalities, financial, lecturing, and spatial considerations. Foreign guest dr. Lausch (Hungary) spoke about Single Hero Rescuers, defining their role and the need for simulation education to acquire competencies. Dr. Vafek (Brno) concluded with preparing instructors for simulation education, emphasizing the changing education system and the attributes of a good instructor. The workshop on preparing simulation education for different target groups was led by dr. Štourač, with discussions on AED usage, healthcare worker education, and student participation. The participants explored the bradycardia algorithm and evaluated students' performance, concluding the workshop with a debriefing.
Friday
Sapphire
Clinical Biochemistry in Intensive Care
Dr. Franeková (Prague) opened the Friday session on Clinical Biochemistry and Intensive Care. Dr. Jabor (Prague) discussed Sodium cation: from basics to present, emphasizing WHO's salt intake recommendations and revealing the Czech population's excessive consumption. He presented studies on sodium intake's impact on overall mortality, particularly significant for those over 60. Dr. Káňová (Ostrava) addressed Biochemical markers of muscle impairment in PICS (Post Intensive Care Syndrome), studying the physical and mental effects, highlighting the decline in postprandial protein synthesis after 50, leading to senile sarcopenia. She presented a study correlating muscle mass with patient survival on the ICU, emphasizing key biochemical markers of sarcopenia and muscle loss. Dr. Jabor (Prague) discussed Biochemical markers of acute kidney failure, covering NGAL, creatinine, KIM-1, and IL-18, introducing the NeprhoCheck device measuring TIMP-2 and IGFBP-7 for crucial insights in acute kidney failure. Dr. Hagerf (Prague) focused on continuous glucose monitoring in early post-transplantation, summarizing glucose concentration measurement device possibilities and presenting a study on continuous glucose monitoring in intensive care at IKEM. The session concluded with dr. Protuš (Prague) discussing research on continuous glucose monitoring sensors, revealing comparable accuracy post-surgery and in outpatient care.
Rubín
Friday morning in the Ruby Hall was dedicated to life-saving procedures. In collaboration with AKUTNĚ.cz, a series of lectures and a practical workshops were prepared. Dr. Štourač (Brno) and dr. Otáhal (Prague) welcomed participants, with dr. Otáhal emphasizing the importance of continuous education and skill repetition. He presented a compelling case of a patient with a submandibular abscess, requiring intubation using FOB. Challenges arose during autoextubation and unsuccessful reintubation, leading to BACT due to progressing desaturation. Dr. Křikava (Brno) discussed difficult airway management, introducing predictors and the LEMON mnemonic. He highlighted recommended practices, including the latest ASA guidelines (2022), and transitioned to videolaryngoscopy, emphasizing preparedness. Dr. Brožek (Prague) delved into fiberoptic intubation, explaining terms like difficult to ventilate and difficult to intubate. Dr. Michálek (Prague) focused on supraglottic airway management, detailing historical development and comparing modern devices. Dr. Klabusayová (Brno) addressed pediatric airway management, emphasizing the unique challenges due to anatomical differences and presented research on tracheal tubes. She highlighted the low incidence of difficult airways in children but stressed the higher complication rate associated with airway management. Dr. Otáhal returned to discuss infraglottic airway management, covering cricothyrotomy and BACT. He emphasized the importance of declaring a problem, informing the team, and requesting assistance. Dr. Kubalová (Zlín) concluded the block with intraosseous access, explaining its advantages and the insertion procedure. The practical skill training on models supervised by each speaker followed the theoretical introduction.
Gold
Neurointensive Care
The last day concluded in the Gold hall with a block on neurointensive care. Dr. Volný and dr. Hon (Ostrava) welcomed guests, and dr. Volný began his lecture on current recommendations for reperfusion therapy in iCMP. He covered basic imaging methods, emphasizing the role of CT, and discussed the use of artificial intelligence in diagnosing CMP. The shift in recommendations now favors administering thrombolysis before mechanical thrombectomy for eligible patients. Dr. Volný also presented on endovascular treatment for posterior circulation occlusion, emphasizing the importance of CT and CTA for patients with basilar artery occlusion. Dr. Hon discussed analgosedation during endovascular interventions, emphasizing maintaining hemodynamic stability. Dr. Bučková (Ostrava) addressed respiratory insufficiency in myasthenia gravis, highlighting diagnostic approaches and management strategies, including oxygen therapy, ventilatory support, plasma exchange, and IVIG. Dr. Blahutová (Ostrava) discussed therapeutic plasma exchange/immunoadsorption in critically ill neurological patients, covering methods, indications, and pros and cons.
