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In this experimental and translational study, it was investigated: a) the effects of acute systemic anesthetic propofol administration on hematological and standard biochemical parameters, cardiovascular biomarkers, and oxidative stress parameters in hemolysate, coronary effluent and cardiac tissue homogenate, and compared with the effects of acute ketamine or etomidate administration, b) acute administration of propofol to cardiodynamic characteristics and coronary flow, and compared with the effects of acute administration of ketamine or etomidate, on the isolated heart, and c) participation of gasotransmitters (NO, H2S and CO), using specific inhibitors of synthesis or production, as well in the presence of verapamil (calcium channel blocker), all in the effects of acute administration of propofol on cardiodynamic characteristics, coronary flow, oxidative stress parameters in hemolysate, in cardiac tissue homogenate and in coronary effluent in rats. Material and methods: Male Wistar albino rats (Ratus Norvegicus), 6-8 weeks old and weighing about 200-250 g, were used in the experiments. Experimental animals (total n = 84) were divided into 6 groups (each group consisted of two subgroups with 7 animals in each subgroup: bolus injection of the anesthetic propofol (1% 10 mg/ml) at a dose of 100 mg / kg b.w. intraperitoneally) (ip.), bolus injection of anesthetic ketamine at a dose of 40 mg/kg b.w. (ip.), bolus injection of anesthetic etomidate at a dose of 20 mg/kg b.w. (ip.), inhibitor of the enzyme NO synthase (inhibitor of NO synthesis) Nomega-nitro-L-arginine monomethyl ester (L-NAME) at a dose of 60 mg/kg b.w. (ip.) plus bolus injection of propofol (1% 10 mg/ml) at a dose of 100 mg/kg b.w. (ip.), cystathionine gamma lyase (inhibitor of H2S synthesis) DL-propargylglycine (DL-PAG) at a dose of 50 mg/kg bw (ip.) plus bolus injection of propofol (1% 10 mg/ml) at a dose of 100 mg/kg b.w. (ip.), inhibitor of the enzyme heme oxygenase subtype 1 (CO synthesis inhibitor

Uvod: Primena modernih aparata za anesteziju sa naprednim monitoringom i nove generacije inhalacionih anestetika omogućili su uvođenje novije tehnike inhalacione anestezije - anestezije niskog protoka. Anestezija niskog protoka se definiše kao inhalaciona anesteziološka tehnika koja se izvodi putem kružnog sistema sa protokom svežeg gasa koji je značajno niži od minutnog volumena. Zbog specifičnosti ove tehnike anestezije, monitoring je esencijalan za sigurno izvođenje anestezije niskog protoka. Anestezija niskog protoka ima značajne prednosti u odnosu na anesteziju visokog protoka. Pre svega, to su pozitivni efekti na plućnu funkciju, kao i ekonomske i ekološke prednosti. Mogući nedostaci ove tehnike nastaju kao posledica neadekvatnog izvođenja anestezije niskim protokom, a uključuju: hipoksiju, preveliku ili nedovoljnu koncentraciju inhalacionog anestetika što dovodi do neadekvatne dubine anestezije, hiperkapniju i moguću akumulaciju endogenih, potencijalno toksičnih gasova. Održavanje hemodinamske stabilnosti tokom anestezije je od velike važnosti, iz razloga što povećava sigurnost tokom anestezije i smanjuje učestalost postoperativnih komplikacija. Ne manje značajni su i vreme i kvalitet oporavka bolesnika nakon anestezije, koji mogu uticati na dužinu boravka u bolnici, kao i na učestalost postoperativnih komplikacija. Materijal i metode: Studija je bila prospektivna, randomizovana, obuhvatila je ukupno 100 bolesnika oba pola, starosti od 18 do 70 godina, koji su se podvrgli laparoskopskoj operaciji žučne kese. Bolesnici su svrstani u dve grupe, grupa N (n=50 bolesnika) gde je bila primenjena anestezija niskim protokom (1 l/min), i grupa V (n=50 bolesnika) gde je bila primenjena anestezija visokim protokom (4 l/min). Analizirani su i upoređivani opšti (demografski) parametri, hemodinamski parametri, respiratorni i parametri vezani za oporavak bolesnika nakon anestezije. Cilj: Uporediti broj bolesnika kod kojih je evidentirana hemodinamska nestabilnost tokom anes, Introduction: The use of modern anesthesia devices with complex monitoring and new generations of inhalation anesthetics have enabled the introduction of a more advanced technique of inhalation anesthesia – low flow anesthesia. Low flow anesthesia is an inhalation anesthesia technique performed through fresh gas flow circuit system significantly lower than the minute volume. Due to the specifics of this anesthesia technique, monitoring is essential for the safe performance of low flow anesthesia. Low flow anesthesia has significant advantages over high flow anesthesia. First of all, due to its positive effects on pulmonary function, as well as economic and ecological benefits. Possible disadvntages of this technique occur due to inadequate low flow anesthesia conduct, which includes the following: hypoxia, excessive or insufficient concentration of inhaled anesthetic leading to inadequate depth of anesthesia, hypercapnia and possible accumulation of endogenous, potentially toxic gases. Hemodynamic stability maintenance during anesthesia is of great importance, because it increases safety during anesthesia and reduces the incidence of postoperative complications. Time and quality of patient's recovery after anesthesia are of no less importance, which can also affect the length of hospital stay, as well as the frequency of postoperative complications. Material and methods: The study was prospective, comprising randomly allocated patients. It included a total of 100 patients of both sexes, aged 18 to 70 yearsd old, who underwent laparoscopic cholecystectomy. Patients were allocated in two groups, group N (n=50 patients) where low flow anesthesia (1 L/min) was administered, and group V (n=50 patients) where high flow anesthesia (4 L/min) was administered. General (demografic) parameters, hemodynamic, respiratory and the ones related to patient recovery, after anesthesia had been administered, were analyzed and compared. Objective: To compare the number of patients with

Sepsa je klinički sindrom karakterisan prisustvom infekcije i neadekvatnog sistemskog inflamatornog odgovora organizma i može se komplikovati razvojem septičnog šoka i multiorganske disfunkcije. Sepsa predstavlja jedan od najvećih zdravstveniih problema današnjice širom sveta sa visokim mortalitetom. Takođe, ona je glavni preventabilni uzrok smrti unutar bolnica. Poznavanje i jasno definisanje prediktivnih faktora mortaliteta kod pacijenata u sepsi pomaže u bržoj identifikaciji kritično obolelih pacijenata i pravovremenom ordiniranju adekvatne terapije, te doprinosi razvoju novih strategija primarne i sekundarne prevencije. Kreiranje modela za predikciju mortaliteta pruža mogućnost kvantifikacije težine stanja pacijenata, što ih čini neizostavnim u naučno-istraživačkom radu, pogotovo u oblastima poboljšanja kvaliteta i personalizovane medicine. Opšti cilj ovog istraživanja je bio da se utvrde nezavisni prediktori mortaliteta u sepsi, kao i da se formira prediktivni model smrtnog ishoda. Specifični ciljevi su bili da se utvrdi korelacija koncetracije laktata, vrste prijema i komorbiditeta sa mortalitetom u sepsi. Ispitivanje je sprovedeno kao opservaciono, neinterventno, delom retrospektivno, delom prospektivno. Obuhvaćena je konsekutivna serija pacijenata sa sepsom primljenih u Jedinicu intenzivnog lečenja Instituta za plućne bolesti Vojvodine u Sremskoj Kamenici od 01.01.2017. do 31.07.2019. godine. Metodama logističke regresivne analize su procenjeni faktori rizika za 28-dnevni mortalitet. Nakon identifikacije nezavisnih prediktora konstruisan je i validiran prediktivni model. Studijom je ukupno obuhvaćeno 307 pacijenata sa sepsom od kojih je 52,4% preminulo unutar 28 dana od prijema. Nije postojala statistički značajna razlika (p>0,05) u mortalitetu od sepse u odnosu na vrstu prijema pacijenata u jedinicu intenzivne nege. Vrednost laktata pri prijemu i vrednost Čarlson skora je bila u pozitivnoj korelaciji sa mortalitetom. Konačni model predikcije mortaliteta sad, Sepsis is a clinical syndrome characterized by both the presence of the infection and inadequate systemic inflammatory organism response that can be additionally complicated by the development of septic shock and multiorgan dysfunction. Recently sepsis is defined as one of the biggest health problems in the world with high mortality and a major preventable cause of death within hospitals. Knowledge and clear definition of predictive mortality factors for patients with sepsis contribute to faster identification of critically ill patients and timely administration of adequate therapy, as well as to the development of new strategies for primary and secondary prevention. Creating a model for predicting mortality provides the possibility of quantifying the severity of the patients' condition that can be indispensable in scientific research, especially in the areas of quality improvement and personalized medicine. The overall aim of this thesis was to determine independent predictors of mortality in sepsis, as well as to form a predictive model of mortality. Whereas specific objectives of the thesis were to determine the correlation of lactate concentration, type of admission and comorbidity with mortality for sepsis. The investigation was conducted as observational, noninterventional, partly retrospectively, partly prospectively. The research included consecutive series of patients with sepsis admitted to the Intensive Care Unit of the Institute for Pulmonary Diseases of Vojvodina in Sremska Kamenica from 01.01.2017 to 31.07.2019. Risk factors for 28-day mortality were estimated by logistic regression analysis methods. After the estimation of independent predictors, a predictive model was constructed and validated. The study involved a total of 307 patients with sepsis, of whom 52.4% died within 28 days of admission. There was no statistically significant difference (p>0.05) in mortality from sepsis in relation with the admission type of patients to the intensive care un

Akutni respiratorni distres sindrom (ARDS) se karakteriše hipoksemičnom respiratornom insuficijencijom koja se javlja unutar sedam dana od izlaganja predisponirajućem faktoru sa obostranim infiltratima na rendgenskom snimku pluća ili kompjuterizovanoj tomografiji, a koji se ne mogu objasniti postojanjem efuzija, atelektaza ili čvorića. ARDS ima veliki uticaj na globalno zdravlje širom sveta i on je glavni uzrok respiratorne insuficijencije sa visokom stopom morbiditeta i mortaliteta kod kritično obolelih pacijenata. Invazivna protektivna mehanička ventilacija pluća je glavni terapijski oslonac ARDS-a. ARDS može biti prouzrokovan različitim etiološkim faktorima, ali samo adekvatan tretman istih je važan u poboljšanju ishoda lečenja. Cilj: Identifikacija, dijagnostički i prognostički značaj angiopoietina 2 i solubilnog receptora za krajnje glikozilirane produkte (sRAGE) u adultnom respiratornom distres sindromu, a u odnosu na težinu kliničke slike ARDS-a i krajnji ishod lečenja. Metodologija: Ispitivanje je sprovedeno kao prospektivna studija koja je obuhvatala 69 ispitanika sa ARDS-om i 27 ispitanika bez dijagnoze ARDS-a je činilo kontrolnu grupu. Ispitanici su bili hospitalizovani na Odeljenju intenzivnog lečenja II Klinike za anesteziju, intenzivnu terapiju i terapiju bola Kliničkog centra Vojvodine, Odeljenju intenzivne nege Instituta za plućne bolesti Sremska Kamenica, kao i na Klinici za infektivne bolesti Kliničkog centra Vojvodine u periodu od 2017. do 2019. godine. Klinički uzorak činile su osobe kod kojih je postavljena dijagnoza akutnog respiratornog distres sindroma u skladu sa kriterijumima Berlinske definicije iz 2012. godine. Iz medicinske dokumentacije, za svakog ispitanika uključenog u istraživanje su uzeti u razmatranje i analizu sledeći parametri u toku prvih 24 časa od momenta prijema na prethodno navedena odeljenja: demografske i opšte karakteristike ispitanika od značaja za istraživanje, numerički pokazatelji procene težine bolesti ispitanika (AP, The acute respiratory distresssyndrome (ARDS) is characterized by hypoxemic respiratory failure occuring less than seven days from a predisposing clinical insult, with bilateral opacities on chest radiograph or computed tomography not fully explained by effusion, atelectasis or nodules. ARDS have a high impact on global health across the world and it is a major cause of acute respiratory failure with high morbidity and mortality in critically ill patients. Invasive mechanical ventilation with lung protective strategies is the mainstay of ARDS treatment. ARDS can be caused by various aetiologies and adequate treatment of the responsible cause is crucial to improve the outcome. The objective of the research: Identification of the diagnostic and prognostic significance of angiopoietin 2 and the solube forms of the receptor for advanced glycation end-products (sRAGE) in adult respiratory distress syndrome in relation to the severity of the clinical picture of ARDS and the ultimate outcome of treatment. Methodology: The study was conducted as a prospective study that included 69 patients with ARDS and 27 patients with no ARDS were control group. The subjects were hospitalized at the Intensive Care Unit II of the Clinic for Anesthesia, Intensive Care and Pain Therapy of the Clinical Center of Vojvodina, the Intensive Care Unit of the Institute for Pulmonary Diseases of Sremska Kamenica, as well as at the Clinic for Infectious Diseases of he Clinical Center of Vojvodina from 2017 to 2019. years. The clinical sample consisted of individuals diagnosed with acute respiratory distress syndrome in accordance with the 2012. Berlin definition criteria. From the medical records, the following parameters were considered and analyzed for each respondent within the first 24 hours of admission to the aforementioned departments: demographic and deneral characteristics of respondents of importance for the study, numerical indicators of assessment of severity of respondents'diseases (APA

Lactate levels are widely used as an indicator of outcome in critically ill patients. We investigated the prognostic value of postoperative lactate levels for postoperative complications (POCs), mortality and length of hospital stay after elective major abdominal surgery. A total of 195 patients were prospectively evaluated. Lactate levels were assessed on admission to the intensive care unit (ICU) [L-0], at 4 hours (L-4), 12 hours (L-12), and 24 hours (L-24) after the operation. Demographic and perioperative clinical data were collected. Patients were monitored for complications until discharge or death. Receiver operating characteristic (ROC) curves were used to determine the predictive value of lactate levels for postoperative outcomes. The best cut-off lactate values were calculated to differentiate between patients with and without complications, and outcomes in patients with lactate levels above and below the cut-off thresholds were compared. Univariate and multivariate analyses were used to identify variables associated with POCs and mortality. Seventy-six patients developed 184 complications (18 deaths), while 119 had no complications. Serum lactate levels were higher in patients with complications at all time points compared to those without complications (p lt 0.001). L-12 had the highest predictive value for complications (AUROC(12) = 0.787; 95% CI: 0.719-0.854; p lt 0.001) and mortality (AUROC(12) = 0.872; 95% CI: 0.794-0.950;p lt 0.00l). The best L-12 cut-off value for complications and mortality was 1.35 mmol/l and 1.85 mmol/l, respectively. Multivariate analysis revealed that L-1(2) >= 1.35 mml/l was an independent predictor of postoperative morbidity (OR 2.58; 95% CI 1.27-5.24,p = 0.001) . L-24 was predictive of POCs after major abdominal surgery. L-12 had the best power to discriminate between patients with and without POCs and was associated with a longer hospital stay.

UVOD: Anestezija je povezana sa promenama ventilacije, koje počinju sa prvim datim lekom, a mogu da traju i danima posle hirurške intervencije. Hipoksemija je najočiglednija posledica ove promene. U anesteziološkoj praksi i perioperativnom tretmanu bolesnika kiseonička terapija zauzima značajno mesto. Još uvek ne postoje jasne, na dokazima zasnovane, smernice za upotrebu kiseoničke terapije u postoperativnom periodu. Razlog verovatno leži u činjenici da veliki broj faktora može da utiče na ishod lečenja hirurškog bolesnika i zato je teško ispitati njihove pojedinačne uticaje. Kiseonička terapija tretira ili prevenira nastanak hipoksije obezbeđujući inspiratornu koncentraciju kiseonika veću od iste u vazduhu. Kod najvećeg broja pacijenata u postoperativnom periodu ne postoji potreba za strogom kontrolom inspiratorne koncentracije kiseonika, a administracija kiseoničke terapije sprovodi se primenom uređaja niskog protoka i varijabilne performanse, kao što su nazalna kanila i kiseonička maska za lice. Brojna istraživanja poslednjih decenija pokušala su da daju odgovor na pitanja da li postoji stvarna razlika u primeni ova dva uređaja, posebno u svetlu razvoja hipoksemije u postoperativnom periodu. Prednosti primene nazalne kanile su bolje prihvatanje od strane bolesnika u poređenju sa maskom, obično zbog manje izraženog osećaja klaustrofobije pri upotrebi nazalne kanile. Nazalna kanila, ne zahteva uklanjanje prilikom nege usne duplje ili per os unosa što obezbeđuje kontinuitet u isporuci kiseonika. Nedostaci nazalne kanile vezani su za otežanu primenu kod bolesnika sa nazogastričnom sondom ili otežanim disanjem na nos. Pri protocima većim od 4 litre u mnuti može izazvati nelagodnost na nosnoj sluznici bolesnika. Literaturni podaci, ukazuju da se primenom kiseoničke maske ipak postižu veće inspiratorne koncentracije kiseonika, te da se epizode desaturacije i hipoksemije znatno ređe javljaju. Međutim, postoje i istraživanja koja ukazuju na mogućnost ponovnog udisanja vaz, INTRODUCTION: Anesthesiology is associated with vicissitudes in ventilation, which start with application of first medicine and last for days following surgical intervention. Hypoxemia is a most common side effect of vicissitudes in ventilation. Oxygen therapy is important in anesthesiology and post-operative treatment of a patient. There are no clear evidence-based guidelines for application of oxygen therapy in post-operative period. Numerous factors influence patient’s treatment outcome and it is difficult to examine each factor’s independent impact. Oxygen therapy treats or prevents occurrence of hypoxemia by providing inspiratory concentration of oxygen greater than the amount found in air. Most patients in post-operative period don’t require vigilant control of inspiratory concentration of oxygen, and administration of oxygen therapy is implemented with a low flow device with variable performances such as nasal cannula and oxygen face mask. Various research attempts where made in the last decades to discover an evident difference between these two devices, especially in cases where hypoxemia occurred in post-operative period. One advantage to using nasal cannula over oxygen face mask is that its better perceived by a patient as it reduces feeling of claustrophobia. Nasal cannula doesn’t need to be removed during oral cavity care or “per os” intake which ensures continuous oxygen delivery. The drawback to using nasal cannula is that its challenging to insert it in a patient with nasogastric tube or difficult nasal breathing. Also, patient can experience nasal discomfort if the oxygen flow is bigger than four litters per minute. Literature data shows that application of oxygen trough the face mask achieves greater inspiratory concentrations of oxygen, and reduces the occurrence of desaturation and hypoxemia. Still, there is research which points out to the possibility of breathing in from dead space in the mask, in lower flows, which can partially affect pressur

Postoperative complications are the major cause of postoperative morbidity and mortality and remain to be a serious burden for a healthcare system. The early identification of patients at risk may play a pivotal role in rational decisions regarding perioperative management. The aim of this study was to explore the characteristics of complications in high-risk patients after major abdominal surgery. We also assessed and compared the accuracy of the Clavien-Dindo classification (CDC) and the Comprehensive Complication Index (CCI) for evaluation of postoperative morbidity and the predictive performance of the POSSUM scoring system for complications and mortality. Finally, we wanted to explore the significance of early indicators of altered peripheral perfusion after major abdominal surgery for the occurrence of severe complications. A prospective, observational, cohort study included 206 high-risk surgical patients undergoing major abdominal surgery at the Clinic for Digestive Surgery, Clinical Center of Serbia, from November 2016 to October 2017. We found that the complication rate in our cohort was 60.7% and that the occurrence of complications was associated with the longer ICU stay (p<0.001), postoperative length of stay (p<0.001) and lower functional activity at hospital discharge (p<0.001). The CCI was shown to be of superior accuracy in high-risk patients with multiple complications compared to the CDC as it demonstrated a higher correlation to the resource utilization indicators (p<0.001). The POSSUM scoring system showed the sub-optimal performance for prediction of morbidity and mortality in this cohort of patients (AUCmorbidity= 0.708, O:E ratio=1.07; AUCmortality= 0.744, O:E ratio=0.38). We found that the alterations of peripheral perfusion early after the operation were more pronounced in patients who developed more severe complications. Capillary refill time, central-to-peripheral temperature gradient, and venoarterial pCO2 difference to arteriovenous O2, Postoperativne komplikacije su vodeći uzrok postoperativnog morbiditeta i mortaliteta i predstavljaju značajno opterećenje za zdravstveni sistem u celini. Rana identifikacija bolesnika sa povećanim rizikom može imati ključnu ulogu u donošenju racionalnih odluka u vezi sa perioperativnim lečenjem. Cilj ove studije bio je da ispita karakteristike komplikacija kod visokorizičnih bolesnika nakon velike abdominalne hirurgije. Takođe smo procenili i uporedili preciznost Clavien-Dindo klasifikacije (CDC) i Comprehensive Complication Index-a (CCI) za evaluaciju postoperativnog morbiditeta i ispitali prediktivne karakteristike POSSUM skora za komplikacije i mortalitet. Konačno, analizirali smo značaj ranih pokazatelja periferne perfuzije za pojavu teških komplikacija nakon velike abdominalne hirurgije. Prospektivna, opservaciona, kohortna studija pratila je 206 visokorizičnih bolesnika podvrgnutih velikoj abdominalnoj operaciji na Klinici za digestivnu hirurgiju Kliničkog centra Srbije, od novembra 2016 do oktobra 2017.godine. Pokazali smo da je učestalost komplikacija u našoj kohorti bila 60.7% i da je pojava komplikacija bila udružena sa dužim boravkom u jedinici intenzivnog lečenja (JIL) (p< 0.001), dužom postoperativnom hospitalizacijom (p<0.001) i nižim funkcionalnim kapacitetom na otpustu iz bolnice (p<0.001). Takođe je prikazano da je CCI prikladnija skala za visokorizične bolesnike sa udruženim komplikacijama u poređenju sa CDC jer je ispoljila jaču korelaciju sa parametrima hospitalizacije (p<0.001). POSSUM skor je pokazao suboptimalne karakteristike u predviđanju rizika za morbiditet i mortalitet u ovoj kohorti bolesnika (AUCmorbiditet = 0.708, O:E odnos = 1.07; AUCmortalitet = 0.744, O:E odnos =0.38). Poremećaj periferne perfizije rano nakon operacije bio je izraženiji kod onih bolesnika kod kojih su se razvile teže komplikacije. Kao nezavisni prediktori teških komplikacija su se izdvojili vreme kapilarnog punjenja, centralno-periferni gradijent temperature i odno

Trauma predstavlja vodeći uzrok smrti u grupi pacijenata do 40 godina. Sepsa je jedna od najčešćih i najznačajnijih infektivnih komplikacija u toku lečenja teško povređenih pacijenata. Definiše se kao životno-ugrožavajuće stanje sa insuficijencijom organa uzrokovano neadekvatnim odgovorom domaćina na infekciju. Imuno-inflamatorni odgovor u traumi i sepsi umnogome je determinisan genetskom predispozicijom za modulisanje i alteraciju proinflamatornih i antiinflamatornih procesa. Polimorfizmi pojedinačnih nukleotida (PPN) su najčešći tip genskih polimorfizama i predstavljaju normalnu varijaciju u naslednoj osnovi. Polimorfizmi gena za proinflamatorni citokin TNFA, TNF-β, kao i receptore slične Toll-u 2 i 4 (TLR2 i TLR4) i njihova povezanost sa sepsom nisu bili predmet dosadašnjih istraživanja u populaciji traumatizovanih pacijenata u našoj zemlji. Cilj studije bila je procena epidemioloških karakteristika infekcija krvi i sepse kod pacijenata sa traumom lečenih u jedinicama intenzivnog lečenja (JIL). Procenjeni su incidencija, ishodi lečenja, uzročnici infekcija krvi (IK) i sepse i njihova antimikrobna rezistencija, izvori infekcije kod sepse i uticaj IK na ishod i preživljavanje kod sepse, kao i faktori rizika za nastanak IK i sepse. Drugi cilj studije bila je procena genetičkih faktora rizika za nastanak sepse, odnosno distibucija PPN gena TNFA, LTA, TLR2 i TLR4 kod pacijenata sa sepsom, pacijenta bez sepse i zdravih pripadnika kontrolne grupe, kao i asocijacija ovih PPN sa nastankom sepse. Pored toga procenjen je doprinos kliničkih i genetskih faktora rizika u predikciji sepse nakon traume. Sprovedena je prospektivna kohortna studija u koju je uključeno 406 odraslih pacijenata sa srednje teškom i teškom traumom hopitalizovanih duže od 48h u JIL Urgentnog centra Kliničkog centra Srbije u periodu od 01.11.2014. do 30.04.2016. godine. Na prijemu su procenjeni brojni klinički paramteri i uzeta je krv za molekularno-genetičku analizu. Primarni ishodi su bili IK i sepsa

Lactate levels are widely used as an indicator of outcome in critically ill patients. We investigated the prognostic value of postoperative lactate levels for postoperative complications (POCs), mortality and length of hospital stay after elective major abdominal surgery. A total of 195 patients were prospectively evaluated. Lactate levels were assessed on admission to the intensive care unit (ICU) [L-0], at 4 hours (L-4), 12 hours (L-12), and 24 hours (L-24) after the operation. Demographic and perioperative clinical data were collected. Patients were monitored for complications until discharge or death. Receiver operating characteristic (ROC) curves were used to determine the predictive value of lactate levels for postoperative outcomes. The best cut-off lactate values were calculated to differentiate between patients with and without complications, and outcomes in patients with lactate levels above and below the cut-off thresholds were compared. Univariate and multivariate analyses were used to identify variables associated with POCs and mortality. Seventy-six patients developed 184 complications (18 deaths), while 119 had no complications. Serum lactate levels were higher in patients with complications at all time points compared to those without complications (p lt 0.001). L-12 had the highest predictive value for complications (AUROC(12) = 0.787; 95% CI: 0.719-0.854; p lt 0.001) and mortality (AUROC(12) = 0.872; 95% CI: 0.794-0.950;p lt 0.00l). The best L-12 cut-off value for complications and mortality was 1.35 mmol/l and 1.85 mmol/l, respectively. Multivariate analysis revealed that L-1(2) >= 1.35 mml/l was an independent predictor of postoperative morbidity (OR 2.58; 95% CI 1.27-5.24,p = 0.001) . L-24 was predictive of POCs after major abdominal surgery. L-12 had the best power to discriminate between patients with and without POCs and was associated with a longer hospital stay.

Uvod: Traumatsko moždano oštećenje (TMO) predstavlja globalni zdravstveni problem koji pogađa oko 10 miliona ljudi godišnje širom sveta. Teška traumatska moždana oštećenja (TTMO) čine 10% svih TMO i imaju visoku stopu mortaliteta i neizvestan oporavak. Ranije prepoznavanje sistemskih faktora koji utiču na ishod lečenja može da ima značajan uticaj na pravovremeno započinjanje terapijskih mera i smanjivanje morbiditeta i mortaliteta. Cilj istraživanja: Identifikovati sistemske faktore koji imaju značajan uticaj na ishod lečenja povređenih sa TTMO u Jedinici intenzivnog lečenja (JIL) tokom prvog dana hospitalizacije. Metodologija: Ispitivanje je sprovedeno kao retrospektivno-prospektivna studija koja je obuhvatila 115 povređenih ispitanika sa TTMO koji su hospitalizovani u JIL Urgentnog centra Kliničkog centra Vojvodine (UC KCV) u periodu od 1.01.2014.-1.10.2017. Iz medicinske dokumentacije, za svakog ispitanika uključenog u istraživanje su uzeti u razmatranje i analizu sledeći parametri u toku prvih 24 časa od momenta prijema u JIL: demografske i opšte karakteristike ispitanika od značaja za istraživanje i sistemski prediktivni faktori (sistolni i srednji arterijski pritisak- SAP/MAP, glikemija-ŠUK, telesna temperatura-TT, pH, parcijalni pritisak kiseonika-PaO2 i parcijalni pritisak ugljem dioksida- PaCO2) registrovani u pet vremenskih tačaka (0h, 6h, 12h,18h, 24h). Svi gore navedeni podaci su posmatrani i analizirani kao prediktorski faktori tj. nezavisne varijable u odnosu na zavisnu varijablu „ishod lečenja“ definisanu kao Glazgovska skala ishoda (Glasgow outcome scale-GOS) nakon otpusta povređenih iz JIL na Kliniku za neurohirurgiju KCV i GOS nakon otpusta iz Klinike za neurohirurgiju KCV i „tok lečenja“ definisan kroz dužinu boravka povređenih u JIL UC KCV, dužinu boravka na Klinici za neurohirurgiju KCV, odnosno ukupno trajanje hospitalizacije u KCV, kao i otpust kući ili u odgovarajući rehabilitacioni centar. Statistička analiza je izvršena pomoću statističkog, Introduction: Traumatic brain injury (TBI) is a global health problem that affects about 10 million people worldwide annually. Severe traumatic brain injury (STBI) account for 10% of all TBI and has high morbidity and unreliable recovery. Early recognition of systemic factors that affect the treatment outcome can have a significant impact on the timely initiation of therapeutic measures and the reduction of morbidity and mortality. The objective of the research: to identify systemic factors that have a significant impact on the treatment outcome of the STBI patients in the Intensive Care Unit (ICU) during the first day of hospitalization. Methodology: The study was conducted as a retrospective-prospective study that included 115 injured patients with STBI who were hospitalized in the ICU, Emergency Center (EC) of the Clinical Center of Vojvodina (CCV) in the period from 01.01.2014 to 1.10.2017. From the medical documentation, for each participant involved in the research, the following parameters within the first 24 hours after the admission were considered and analyzed: demographic and general characteristics of the participants of importance for research and systemic predictive factors (systolic and mean arterial pressure-SAP / MAP, glycemia, body temperature -TT, pH, partial pressure of oxygen-PaO2 and partial pressure of carbon dioxide-PaCO2) registered at five time points (0h, 6h, 12h,18h, 24h). All of the above data were observed and analyzed as predictors, ie, independent variables in relation to the dependent variable "treatment outcome" defined as the Glasgow Outcome Scale (GOS) after the transfer from the ICU to the Clinic of neurosurgery of the CCV and GOS after discharge from a Clinic of neurosurgery and "treatment course" defined by length of stay in ICU, or the total duration of hospitalization in CCV, as well as the release to the home or the appropriate rehabilitation center. Statistical analysis was performed using the IBM SPSS 23 statistical packag

Cilj rada je da se odredi učestalost i faktori rizika za pojavu intraoperativnih poremećaja srčanog ritma i variranja krvnog pritiska. Metodologija: Ova kohortna, retrospektivna studija, uključila je 2304 pacijenta podvrgnuta maksilofacijalnoj ili hirurgiji uva, grla ili nosa. Ispitivani su sledeći faktori rizika: pol, životno doba, ASA status, otežana intubacija, vrsta hirurgije, trajanje anestezije, intraoperativna transfuzija, indukovana hipotenzijai sledeći komorbiditeti: hipertenzija, kardiomiopatija, poremećaji srčanog ritma, ishemijska bolest srca, prethodni cerebrovaskularni insult, hronična bubrežna insuficijencija, hiperlipoproteinemija i dijebetes melitus. Registrovani su sledeći intraoperativni poremećaji: hipertenzija, hipertenzivna kriza i poremećaji srčanog ritma (tahikardija, bradikardija, novonastala intraoperativna atrijalna fibrilacija, supraventrikularne i ventrikularne ekstrasistole). Za statističku obradu korišćen je Mann Whitney U test, Pirson-ov2test (tablicekontingencije), logistička regresiona analiza i ROC krive. Rezultati: Većina bolesnika je bila muškog pola pola (63.2%), starija od 50 godina i ASA1 klase (48%). Najviše bolesnika bilo je podvrgnuto hirurgiji grla (38.2%). Intraoperativno variranje krvnog pritiska i/ ili intraoperativne poremećaje srčanog ritma imalo je 29.4% pacijenata. Najveća učestalost intraoperativnih minor srčanih komplikacija bila je u maksilofacijalnoj hirurgiji (35.4%), odmah zatim u hirurgiji uva (35.1%),a najređe u hirurgiji nosa (21.3%). Od svih minor srčanih komplikacija najčešća je bila bradikardija (20.5%), zatim hipertenzija (5.3%), tahikardija (4.7%), ventrikularne ekstrasistole (0.5%), supraventrikularne ekstrasistole (0.3%), dok novonastala intraoperativn aritmija absoluta nije registrovana ni kod jednog pacijenta. Logističkom regresijom kao faktori rizika izdvojili su se: prethodna srčana aritmija, trajanje anestezije, indukovana hipotenzija i hirurgija uva. Zaključak: Intraoperativno variranje krvnog, The aim of our study was to determine the incidence and the risk factors for intraoperative cardiac rhythm disturbances and blood pressure variation in maxillofacial, ear, nose and throat surgery. Methods: This cohort retrospective study included 2304 patients who underwent either maxillofacial, ear, nose or throat surgery. These risk factors were studied:gender,age, ASA status, difficult airway management, type of surgery, duration of anaesthesia, intraoperative transfusion,induced hypotension and comorbidity such as: hypertension,cardiomyopathy,cardiac arrhythmias, ischemic heart disease, history of cerebrovascular insult,chronic kidney disease,hyperlipoproteinemiaana diabetes mellitus. These intraoperative minor cardiac complications were registered: hypertension, hypertension crisis, tachycardia, bradycardia, new onset of atrial fibrillation, supraventricular and ventricular extrasystoles. For statistical data analysis we used: Mann Whitney U test, Pirson’s2test, logistic regression and ROC curves. Results: The majority of patients were male (63.2%), older than 50 years and ASA status 1. The most of patients underwent throat surgery (38.2%). Intraoperative blood pressure variation and/or cardiac rhythm disturbances were present in 29.4% of patients. The highest incidence of intraoperative minor cardiac complications were in maxillofacial surgery (35.4%), then in ear surgery (35.1%), and the lowest incidence were in nose surgery (21.3%). Among all minor cardiac complications, the most frequent was bradycardia (20.5%), then hypertension (5.3%), tachycardia (4.7%), ventricular extrasystoles(0.5%),supraventricular extrasystoles(0.3%) and no new onset atrial fibrillation was registered. Logistic regression analysis idenified these risk factors: previous cardiac arrhythmia, anaesthesia suration, induced hypotension and ear surgery. Conclusion: Intraoperative blood pressure variation and cardiac rhythm disturbances, particularly bradycardia, are common in maxillofacia

Za procenu stanja mikrocirkulacije i perfuzije tkiva i organa standardno se koriste saturacija mešane venske krvi kiseonikom (Sv̄ O2) i nivo serumskog laktata. Laktat je odloženi pokazatelj tkivne hipoperfuzije jer podleže složenom metabolizmu, dok se poluživot saturacije venske krvi kiseonikom meri u sekundama te je ona rani pokazatelj hipoperfuzije organa. Ispitivali smo korelaciju između vrednosti saturacija kiseonikom krvi iz centralne vene (ScvO2) i plućne arterije (Sv̄ O2) tokom operativnog i ranog post operativnog perioda. Odnos između ova dva parametra testirali smo upoređivanjem vrednosti srčanog indeksa (CI) izračunatih na dva načina, kod elektivno operisanih bolesnika zbog aneurizme abdominalne aorte (AAA). Koncept korišćenja ScvO2 umesto Sv̄O2, za izračunjavanje CI ostaje kontroverzan s obzirom da još uvek nema pouzdanih podataka koji bi ukazivali da jedna saturacija može biti adekvatna zamena drugoj. ScvO2 parametar koji se dobija uzimanjem uzoraka krvi iz centralnog venskog katetera (CVC), a Sv̄ O2 uzimanjem uzoraka krvi iz plućnog katetera (PAC). Upotreba ScvO2 umesto Sv̄ O2 za procenu tkivne hipoperfuzije je aktuelna metoda s obzirom da je CVC znatno jeftiniji i tehnički lakši za korišćenje od PAC-a što umanje rizik od nastanka komplikacija. CILJ: Svrha studije je testiranje korelacije između ScvO2 i Sv̄ O2 u različitim vremenima merenja kod pacijenata podvrgnutih elektivnim operacijama AAA. Dodatno smo želeli da ispitamo da li izračunati CI korišćenjem ScvO2 pomoću Fick-ove jednačini (CI-F) može biti adekvatna zamena CI dobijenom merenjem putem PAC-a. Takođe, ispitivali smo uticaj ScvO2 i nivoa laktata u serumu, merenih u sukcesivnim vremenskim intervalima, na ishod lečenja. METOD: Prospektivnom observacionom studijom obuhvatili smo 125 konsekutivnih bolesnika podvrgnutih elektivnim operacijama na abdominalnoj aorti usled anaeurizmatske bolesti.Vrednosti ScvO2 i Sv̄ O2 kao i CI su dobijene uzimanjem uzoraka krvi i merenjem u tri različita vremena. N, For evaluation of global tissue hypoperfusion routinely is used mixed venous oxygen saturation Sv̄ O2 and lactate level. Lactate is a delayed parameter of tissue hypoperfusion because of complex lactate kinetics, while half-life of oxygen saturation is measured in seconds, so that it is an early indicator of organ hypoperfusion. We evaluated the relationship between central venous oxygen saturation ScvO2 and Sv̄ O2 in elective surgery of the abdominal aortic aneurysm (AAA). The adequacy of their interchangeability was tested by comparing cardiac indices (CI) calculated by two methods in patients that underwent abdominal aortic surgery. The concept of utilizing ScvO2 instead Sv̄ O2 is again active, because that the ScvO2 is parameter obtained by taking blood samples from CVC. That catheter is cheaper, the majority of doctors are skillful by its placement, and its placement is followed up with a lower risk. OBJECTIVE: Principle objective of our study was to test the correlation between ScvO2 and Sv̄ O2 in different time frames, in patients undergoing elective AAA surgery. Additionally, we wanted to determine if the use of ScvO2 for calculating CI, by modified Fick equation (CI-F), could be feasible and accurate surrogate for the values obtained by PAC. We also examined the influence of ScvO2 and lactate level, measured in successive time intervals, on the outcome of treatment. METHODS: Prospective observational study included 125 consecutive patients that underwent elective AAA surgery. The ScvO2 and Sv̄ O2 data, as well as CI and CI-F values, were obtained and compared from samples taken in three different time frames: immediately after induction of general anesthesia (T0), immediately after admission in the intensive care unit (ICU)(T1), and 8h after admission in the ICU (T2). Fick equation, used for CI estimation from ScvO2 (CI-F), for the purpose of this study, was simplified according to Walley. At the same time , we measured the level of serum lactate. RESULTS

Background/Aims: Liver resection is the gold standard in managing patients with metastatic or primary liver cancer. The aim of our study was to compare the traditional clamp-crushing technique to the radiofrequency-assisted liver resection technique in terms of postoperative liver function. Methodology: Liver function was evaluated preoperatively and on postoperative days 3 and 7. Liver synthetic function parameters (serum albumin level, prothrombin time and international normalized ratio), markers of hepatic injury and necrosis (serum alanine aminotransferase, aspartate aminotransferase and total bilirubin level) and microsomal activity (quantitative lidocaine test) were compared. Results: Forty three patients completed the study (14 had clamp-crushing and 29 had radiofrequency assisted liver resection). The groups did not differ in demographic characteristics, pre-operative liver function, operative time and perioperative transfusion rate. In postoperative period, there were similar changes in monitored parameters in both groups except albumin levels, that were higher in radiofrequency-assisted liver resection group (p=0.047). Conclusions: Both, traditional clamp-crushing technique and radiofrequency assisted liver resection technique, result in similar postoperative changes of most monitored liver function parameters.

Background/Aims: Liver resection is the gold standard in managing patients with metastatic or primary liver cancer. The aim of our study was to compare the traditional clamp-crushing technique to the radiofrequency-assisted liver resection technique in terms of postoperative liver function. Methodology: Liver function was evaluated preoperatively and on postoperative days 3 and 7. Liver synthetic function parameters (serum albumin level, prothrombin time and international normalized ratio), markers of hepatic injury and necrosis (serum alanine aminotransferase, aspartate aminotransferase and total bilirubin level) and microsomal activity (quantitative lidocaine test) were compared. Results: Forty three patients completed the study (14 had clamp-crushing and 29 had radiofrequency assisted liver resection). The groups did not differ in demographic characteristics, pre-operative liver function, operative time and perioperative transfusion rate. In postoperative period, there were similar changes in monitored parameters in both groups except albumin levels, that were higher in radiofrequency-assisted liver resection group (p=0.047). Conclusions: Both, traditional clamp-crushing technique and radiofrequency assisted liver resection technique, result in similar postoperative changes of most monitored liver function parameters.

Uvod: Učestalost akutne renalne insuficijencije, odnosno akutnog bubrežnog oštećenja u jedinicama intenzivnog lečenja se kreće od 36 do 66 %. Akutno bubrežno oštećenje povišava smrtnost, trajanje hospitalizacije i ukupne troškove lečenja. Ranije prepoznavanje prediktivnih faktora za nastanak akutnog bubrežnog oštećenja može da ima značajan uticaj na pravovremeno započinjanje terapijskih mera i smanjivanje mortaliteta kod kritično obolelih. Cilj istraživanja: Utvrditi incidencu akutnog bubrežnog oštećenja na Odeljenju reanimacije Urgentnog centra Kliničkog centra Vojvodine tokom 2011.godine, učestalost sepse kao etiološkog faktora i značajne prediktivne faktore za nastanak akutnog bubrežnog oštećenja koji se javljaju u toku prvih 24 časa lečenja na odeljenju intenzivnog lečenja. Metodologija: Retrospektivno-prospektivna opservaciona studija uključila je uzorak od 251 ispitanika koji su se lečili na dva odeljenja intenzivnog lečenja u Kliničkom centru Vojvodine tokom 2010, 2011, i prvih 6 meseci 2012.godine. Iz medicinske dokumentacije (istorije bolesti, dnevne terapijske liste i liste vitalnih i laboratorijskih parametara) za svakog ispitanika je verifikovano prisutvo ili odsustvo potencijalnog prediktivnog faktora. Zatim je zabeležena pojava akutnog bubrežnog oštećenja prema RIFLE kriterijumima. Statistička analiza je izvršena pomoću statističkog paketa IBM SPSS 20 Statistics. Podaci su predstavljeni tabelarno i grafički, a statistička značajnost određivana je na nivou p< 0,05. Prikupljeni podaci su obrađeni standardnim statističkim testovima. Za izvođenje modela predviđanja primenjena je multivarijatna logistička regresija. Određene su granične tačke na osnovu ROC analize za dobijene značajne prediktore iz multivarijacione logističke regresije i izračunati su pridruženi bodovi koji bi činili skoring sistem za utvrđivanje rizika od nastanka akutnog bubrežnog oštećenja. Rezultati: Incidenca akutnog bubrežnog oštećenja na Odeljenju reanimacije Urgentnog centra Kliničk, Introduction: The incidence of acute renal insufficiency (acute kidney injury) in intensive care unit is between 36 and 66 %. Acute kidney injury is responsible for higher mortality, longer hospitalization and higher costs. Earlier recognition of acute kidney injury predictive factors could have important impact on right timing of therapeutic measures and lower mortality in critically ill patients. Aims: investigate the incidence of acute kidney injury during 2011. in patients who are hospitalized at Department of reanimation of Emergency centre, Clinical centre of Vojvodina, incidence of acute kidney injury caused by sepsis in the same period and detect acute kidney injury occurrence predicitive factors Methodology: This retrospective-prospective observational study investigated 251 critically ill patients-study subjects who were treated at two intensive care departments in Clinical centre of Vojvodina during 2010, 2011 and first six months of 2012. Potential predictive factors were identified out of medical records (patient history, daily therapeutic lists, vital parameters and laboratory values lists); the occurrence of acute kidney injury was noted according to RIFLE criteria. IBM SPSS version 20 was used for statistical analysis, standard statystical test were applied. The results were presented in tables and graphs, statystical significance was set at p value of less than 0,05. Multivariate logistic regression model was used for potential predictive factors. Statystically important factors were identified and their best sensitivity and specificity cut-off values were found using ROC curve analysis.; These cut-off values were used for creating a scoring system that determines the risk for acute kidney injury occurrence. Results: The incidence of acute kidney injury at Department of reanimation, Clinical centre of Vojvodina in patients who were hospitalized at least 48 hours was 32 % during 2011. The cut off value of provoked hourly urine output during first hou

Introduction. State of severe oxidative stress is encountered in sepsis. Paraoxonase 1 (PON1) protects against oxidative stress but also undergoes inactivation upon that condition. We investigated PON1 activity in surgical patients with sepsis in relation to oxidative stress status, inflammation, disease severity, and survival. Methods. Prospective observational study. Sixty-nine surgical patients with sepsis were compared to 69 age/sex matched healthy controls. PON1 paraoxonase and diazoxonase activities, selected biochemical, hematological and oxidative stress parameters were measured on admission to ICU and 24, 48, 72, and 96 hours later. Disease severity scores were calculated daily. Results. Septic patients had significantly lower PON1 activities compared to control group at all time points. PON1 activities had good capacity to differentiate septic patients from healthy controls. Low PON1 activities were associated with higher disease severity scores and higher risk of death. Correlation between PON1 activity and markers of inflammation failed to reach significance. Decrease in PON1 activity was correlated with an increase in reducing components in plasma. Conclusion. Our study demonstrated lower PON1 activity in surgical patients with sepsis compared to healthy controls. PON1 activity also reflected severity of the disease. Low PON1 activity was associated with higher mortality of surgical patients with sepsis.