239 research outputs found
Pevnost Evropa? Zhodnocení nápadů pro budoucnost EU
No full textBibliographic note Putensen, J., 2019. Fortress Europe? Evaluation of Ideas for the Future of the EU. Master's thesis. Charles University, Prague. Abstract This thesis explores the use of the symbolic term Fortress Europe by political parties and move- ments in Austria, Germany, and Italy who are in favor of establishing a Fortress Europe and their ideas for what a Fortress Europe should look like. While the use of the term by left-wing critics of European immigration policies has been well covered in the literature, no author has yet analyzed the use of the term by political parties and movements that have started to demand a Fortress Europe since 2015. Based on an analysis of the appearance of the term Fortress Eu- rope in European media coverage conducted via the Factiva database, three countries with a relatively high use of the term in their media were selected for in-depth case studies. In partic- ular, the ideas of the following three extreme right groups were analyzed and compared: the Identitarian Movement Austria (IBÖ), the National Democratic Party of Germany (NPD), and Fortezza Europa (literal translation from Italian: Fortress Europe). It was found that their vi- sions of a Fortress Europe are very similar and aim to prevent any type of foreign immigration on a large scale in order to preserve...Katedra politologieDepartment of Political ScienceFakulta sociálních vědFaculty of Social Science
Fortress Europe? Evaluation of Ideas for the Future of the EU
No full textBibliographic note Putensen, J., 2019. Fortress Europe? Evaluation of Ideas for the Future of the EU. Master's thesis. Charles University, Prague. Abstract This thesis explores the use of the symbolic term Fortress Europe by political parties and move- ments in Austria, Germany, and Italy who are in favor of establishing a Fortress Europe and their ideas for what a Fortress Europe should look like. While the use of the term by left-wing critics of European immigration policies has been well covered in the literature, no author has yet analyzed the use of the term by political parties and movements that have started to demand a Fortress Europe since 2015. Based on an analysis of the appearance of the term Fortress Eu- rope in European media coverage conducted via the Factiva database, three countries with a relatively high use of the term in their media were selected for in-depth case studies. In partic- ular, the ideas of the following three extreme right groups were analyzed and compared: the Identitarian Movement Austria (IBÖ), the National Democratic Party of Germany (NPD), and Fortezza Europa (literal translation from Italian: Fortress Europe). It was found that their vi- sions of a Fortress Europe are very similar and aim to prevent any type of foreign immigration on a large scale in order to preserve..
Video vs. direct laryngoscopy for adult surgical and intensive care unit patients requiring tracheal intubation: a systematic review and meta-analysis of randomized controlled trials
No full textOBJECTIVE: This systematic review and meta-analysis aimed to determine whether a specific videolaryngoscopy technique is superior to standard direct laryngoscopy using a Macintosh blade to reduce the risk of difficult intubation in surgical and intensive care unit patients. MATERIALS AND METHODS: We identified all randomized controlled trials comparing videolaryngoscopes (VLSs) to direct laryngoscopy in the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE (from inception to April 2020). The primary outcome was difficult intubation in adult surgical and intensive care unit patients. Secondary outcomes were successful intubation at the first attempt, airway trauma, sore throat, hoarseness, hypoxia, and mortality. RESULTS: We included 97 randomized controlled trials to evaluate 12775 patients. A high risk of bias was found in at least 50% of the included studies for each outcome. VLSs reduced the risk of difficult intubation compared to direct Macintosh laryngoscopy (RR 0.48, 95% CI from 0.35 to 0.65). VLSs increased the rate of successful intubation at the first attempt when compared to direct Macintosh laryngoscopy (RR 1.03, 95% CI from 1.00 to 1.07). Lower risks of airway trauma were found with VLSs (RR 0.69, 95% CI from 0.55 to 0.86). A decreased risk of hoarseness was associated with the use of VLSs (RR 0.67, 95% CI from 0.54 to 0.83). In addition, VLSs did not significantly reduce the risk of hypoxia compared with direct laryngoscopy (RR 0.83, 95% CI from 0.60 to 1.16). CONCLUSIONS: In this systematic review and meta-analysis, we found that the use of VLSs reduced the risk of difficult intubation and slightly increased the ratio of successful intubation at the first attempt among adult patients
Informed consent for tracheostomy procedures in Intensive Care Unit: An Italian national survey
No full textBackground. Critically ill patients in Intensive Care Unit (ICU), due to their temporary or permanent incompetence, are often not capable to provide informed consent (IC), although required, for not emergency invasive procedures, like elective tracheostomy. By Italian law, a person with partially/temporarily physical/mental impairment needs a legal tutorship appointed by the court (Support Administrator, SA). We performed a national survey in Italy to investigate IC practice for elective tracheostomy procedure in critically ill conscious and unconscious patients in ICU. Methods. Questions about IC were included in a survey concerning the clinical practice of tracheostomy in ICU. The survey was approved by the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI, no 434 - 28 March 2012) and sent by e-mail to all members included in its mailing list. The duration of the survey was three months from April to June 2012. All required information was referred to the year 2011. Results. The mailed questionnaire correctly fulfilled was sent back by 131/427 (30%) national ICUs. Our data showed 1) in conscious patients, IC was obtained by 82.4% of ICUs; 2) in unconscious patients, IC was obtained in only 61.8% with different procedures not following the current Italian law, 3) for surgical tracheostomy performed in operating room, IC was obtained in conscious and unconscious patients in only 69.8% and 47.2% of ICUs, respectively, 4) risk/benefit informative document was provided in 61.1% ICUs, but available only in 47.2% of ICUs performing tracheostomy in operating room. Conclusion. In Italian ICUs, participating to this study, the procedures related to IC for conscious and unconscious critically ill patients requiring surgical or percutaneous tracheostomy are not in line with current legal rules and procedures
Meta-analysis: ventilation strategies and outcomes of the acute respiratory distress syndrome and acute lung injury.
No full textPercutaneous and surgical tracheostomy in critically ill adult patients: a meta-analysis
No full textIntroductionThe aim of this study was to conduct a meta-analysis to determine whether percutaneous tracheostomy (PT) techniques are advantageous over surgical tracheostomy (ST), and if one PT technique is superior to the others.MethodsComputerized databases (1966 to 2013) were searched for randomized controlled trials (RCTs) reporting complications as predefined endpoints and comparing PT and ST and among the different PT techniques in mechanically ventilated adult critically ill patients. Odds ratios (OR) and mean differences (MD) with 95% confidence interval (CI), and I2 values were estimated.ResultsFourteen RCTs tested PT techniques versus ST in 973 patients. PT techniques were performed faster (MD, ¿13.06 minutes (95% CI, ¿19.37 to ¿6.76 (P <0.0001)); I2¿=¿97% (P <0.00001)) and reduced odds for stoma inflammation (OR, 0.38 (95% CI, 0.19 to 0.76 (P¿=¿0.006)); I2¿=¿2% (P¿=¿0.36)), and infection (OR, 0.22 (95% CI, 0.11 to 0.41 (P <0.00001)); I2¿=¿0% (P¿=¿0.54)), but increased odds for procedural technical difficulties (OR, 4.58 (95% CI, 2.21 to 9.47 (P <0.0001)); I2¿=¿0% (P¿=¿0.63)). PT techniques reduced odds for postprocedural major bleeding (OR, 0.39 (95% CI, 0.15 to 0.97 (P¿=¿0.04)); I2¿=¿0% (P¿=¿0.69)), but not when a single RCT using translaryngeal tracheostomy was excluded (OR, 0.58 (95% CI, 0.21 to 1.63 (P¿=¿0.30)); I2¿=¿0% (P¿=¿0.89)). Eight RCTs compared different PT techniques in 700 patients. Multiple (MDT) and single step (SSDT) dilatator techniques are associated with the lowest odds for difficult dilatation or cannula insertion (OR, 0.30 (95% CI, 0.12 to 0.80 (P¿=¿0.02)); I2¿=¿56% (P¿=¿0.03)) and major intraprocedural bleeding (OR, 0.29 (95% CI, 0.10 to 0.85 (P¿=¿0.02)); I2¿=¿0% (P¿=¿0.72)), compared to the guide wire dilatation forceps technique.ConclusionIn critically ill adult patients, PT techniques can be performed faster and reduce stoma inflammation and infection but are associated with increased technical difficulties when compared to ST. Among PT techniques, MDT and SSDT were associated with the lowest intraprocedural risks and seem to be preferabl
Meta-analysis: ventilation strategies and outcomes of the acute respiratory distress syndrome and acute lung injury.
No full textBACKGROUND:
Trials have provided conflicting results regarding the effect of different ventilatory strategies on the outcomes of patients with the acute respiratory distress syndrome (ARDS) and acute lung injury.
PURPOSE:
To determine whether ventilation with low tidal volume (Vt) and limited airway pressure or higher positive end-expiratory pressure (PEEP) improves outcomes for patients with ARDS or acute lung injury.
DATA SOURCES:
Multiple computerized databases (through March 2009), reference lists of identified articles, and queries of principal investigators. No language restrictions were applied.
STUDY SELECTION:
Randomized, controlled trials (RCTs) reporting mortality and comparing lower versus higher Vt ventilation, lower versus higher PEEP, or a combination of both in adults with ARDS or acute lung injury.
DATA EXTRACTION:
Using a standard protocol, 2 reviewer teams assessed trial eligibility and abstracted data on quality of study design and conduct, population characteristics, intervention, co-interventions, and confounding variables.
DATA SYNTHESIS:
4 RCTs tested lower versus higher Vt ventilation at similar PEEP in 1149 patients, 3 RCTs compared lower versus higher PEEP at low Vt ventilation in 2299 patients, and 2 RCTs compared a combination of higher Vt and lower PEEP ventilation versus lower Vt and higher PEEP ventilation in 148 patients. Lower Vt ventilation reduced hospital mortality (odds ratio, 0.75 [95% CI, 0.58 to 0.96]; P = 0.02) compared with higher Vt ventilation at similar PEEP. Higher PEEP did not reduce hospital mortality (odds ratio, 0.86 [CI, 0.72 to 1.02]; P = 0.08) compared with lower PEEP using low Vt ventilation. Higher PEEP reduced the need for rescue therapy to prevent life-threatening hypoxemia (odds ratio, 0.51 [CI, 0.36 to 0.71]; P < 0.001) and death (odds ratio, 0.51 [CI, 0.36 to 0.71]; P < 0.001) in patients receiving rescue therapies.
LIMITATIONS:
Pooling according to similar ventilatory strategies resulted in few RCTs analyzed in each group. The benefit of low Vt is derived from only 1 study.
CONCLUSION:
Available evidence from a limited number of RCTs shows better outcomes with routine use of low Vt but not high PEEP ventilation in unselected patients with ARDS or acute lung injury. High PEEP may help to prevent life-threatening hypoxemia in selected patients
Superimposed high-frequency jet ventilation combined with continuous positive airway pressure/assisted spontaneous breathing improves oxygenation in patients with H1N1-associated ARDS
No full textBackground: Numerous cases of swine-origin 2009 H1N1 influenza A virus (H1N1)-associated acute respiratory distress syndrome (ARDS) bridged by extracorporeal membrane oxygenation (ECMO) therapy have been reported; however, complication rates are high. We present our experience with H1N1-associated ARDS and successful bridging of lung function using superimposed high-frequency jet ventilation (SHFJV) in combination with continuous positive airway pressure/assisted spontaneous breathing (CPAP/ASB).
Methods: We admitted five patients with H1N1 infection and ARDS to our intensive care unit. Although all patients required pure oxygen and controlled ventilation, oxygenation was insufficient. We applied SHFJV/CPAP/ASB to improve oxygenation.
Results: Initial PaO2/FiO2 ratio prior SHFJV was 58-79 mmHg. In all patients, successful oxygenation was achieved by SHFJV (PaO2/FiO2 ratio 105-306 mmHg within 24 h). Spontaneous breathing was set during first hours after admission. SHFJV could be stopped after 39, 40, 72, 100, or 240 h. Concomitant pulmonary herpes simplex virus (HSV) infection was observed in all patients. Two patients were successfully discharged. The other three patients relapsed and died within 7 weeks mainly due to combined HSV infection and in two cases reoccurring H1N1 infection.
Conclusions: SHFJV represents an alternative to bridge lung function successfully and improve oxygenation in the critically ill
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