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Additional file 4. Correlations between retinal and conjunctival microcirculatory parameters at baseline and after 24 h.

Introduction: Marathon race transiently elevates the probability of sudden death. Also during long-distance run may occur various gastrointestinal symptoms with range from mild nausea to hemorrhagic stool. However microcirculatory nature of this disturbances is not clear. Microcirculation of sublingual mucosa is part of interest, because it is easy and noninvasively accessible, changes have relation with mortality and it is part of the upper digestive tract. Here, we evaluate changes in sublingual microcirculation induced by a marathon race. Methods: Thirteen healthy male controls and 13 male marathon runners volunteered for the study. We performed sublingual microcirculation, using a Cytocam-IDF device (Braedius Medical, Huizen, The Netherlands), and systemic hemodynamic measurements four times on the marathon runners: 24 hours prior to their participation in the Kaunas Marathon (distance: 41.2 km), directly after finishing the marathon, 24 hours after the marathon and one week after the marathon. Results: The marathon runners exhibited a higher functional capillary density (FCD) and total vascular density of small vessels at the first visit compared with the controls. Overall, we did not find any changes in sublingual microcirculation in the marathon runners at any of the visits. However, in a subgroup of marathon runners with a decreased FCD after finishing the marathon race compared to increased FCD had shorter running time (190.37 ± 30.2 vs. 221.80 ± 23.4 min, p = 0.045), ingested less fluids (907 ± 615 vs. 1950 ± 488 ml, p = 0.007) during the race and lost much more weight (−2.4 ± 1.3 vs. -1.0 ± 0.8 kg, p = 0.041). Conclusions: Recreational marathon running is not associated with an alteration of sublingual microcirculation. However, faster running and dehydration may be crucial for further impairing microcirculation.

Objective. To determine the influence of electrocardiographically documented cardiac rhythm during sudden cardiac arrest on successful resuscitation among out-of-hospital deaths in Kaunas city. Material and methods. An observational prospective study was conducted between 1 January, 2005, and 30 December, 2005, in Kaunas city with a population of 360 627 inhabitants. In this period, all cases of cardiac arrest were analyzed according to the guidelines of the Utstein consensus conference. Cardiac arrest (both of cardiac and noncardiac etiology) was confirmed in 72 patients during one year. Effective cardiopulmonary resuscitation was performed in 18 patients. Results. The total number of deaths from all causes in Kaunas during 1-year study period was 6691. Sixty-two patients due to sudden death of cardiac etiology were resuscitated by emergency medical services personnel. Return of spontaneous circulation was achieved in 11 patients. Ventricular fibrillation was observed in 33 (53.2%) patients. Asystole was present in 11 (17.7%) and other rhythms in 18 (29.1%) cases. Patients with ventricular fibrillation as an initial rhythm were more likely to be successfully resuscitated than patients with asystole. Conclusions. Ventricular fibrillation was the most common electrocardiographically documented cardiac rhythm registered during cardiac arrest in out-of-hospital settings. Ventricular fibrillation as a mechanism of cardiac arrest was associated with major cases of successful resuscitation.

Objective. To show differences in the changes of electrocardiographic and echocardiographic data after early and late mechanical recanalization of infarct related artery with and without stent implantation and to assess the value of QRS score in the follow-up period. Material and methods. A total of 248 consecutive patients were divided into these groups: early angioplasty (£24 hours) without stents (n=114) or with stents (n=6) and later (>24 hours) angioplasty without stents (n=114) or with stents (n=14). The changes in QRS score and echocardiographic left ventricular ejection fraction during the hospital and 3-month follow-up periods were compared between the groups. Results. QRS score did not increase in a hospital in early or late angioplasty with stents groups, while in the groups without stents especially of early angioplasty increased (2.6±2.5 vs. 3.6±2.4, P=0.001). Left ventricular ejection fraction increased after 3 months only in early angioplasty groups especially with stents (30.0±3.5 vs. 38.4±5.2, P=0.008), but there were no significant differences between the QRS score at discharge and after 3 months (5.4±4.3 vs. 5.0±1.9). Conclusions. Myocardial injury did not increase in a hospital in the cases of early or late angioplasty with stents, while in the cases without stents increased. Left ventricular ejection fraction increased after 3 months only in the cases of early angioplasty especially with the stent implantation, but the QRS score showed no differences, so the QRS score may be not predictive of improvement in ejection fraction at follow-up.

Praėjus penkeriems metams nuo paskutinių tarptautinių gaivinimo rekomendacijų išleidimo, 2005 metų pabaigoje Amerikos širdies asociacija bei Europos gaivinimo taryba išleido rekomendacijas gydytojams praktikams. Šiame straipsnyje pateikiamos klinikinės mirties nustatymo, pradinio gaivinimo sekos, užspringimo pagalbos naujovės pagal naujausias rekomendacijas, kurios aktualios kiekvienam medikui. Five years after the last issue of the guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, in 2005 American Heart Association and European Resuscitation Council published new guidelines. In this review, basic life support (BLS) technique, indications for use of an automated external defibrillator (AED), recognition of sudden cardiac arrest, and management of choking (foreign-body airway obstruction) are presented according to the “Resuscitation Guidelines 2005.”.

Sunkaus sepsio ir sepsinio šoko gydymo skubumas ir tinkamumas per pirmąsias valandas, vystantis audinių hipoperfuzijai ir dauginės organų disfunkcijos sindromui, reikšmingas baigčiai. Ankstyva tikslinė terapija, antimikrobinio gydymo ypatybės, skubaus infekcijos židinio nustatymo ir optimalios kontrolės metodų parinkimas, infuzinės terapijos sudėties, tempo ir tolerancijos optimizavimas, vazopresoriai ir inotropinis gydymas, vazopresino skyrimo reikšmė ir indikacijos, kortikosteroidų nauda ir gydymo taktika, rekombinantinio žmogaus aktyvuoto proteino C vartojimo vertė bei glikemijos kontrolės svarba – tai nauji sunkaus sepsio ir sepsinio šoko gydymo aspektai. The mortality rate of infection-induced organ dysfunction or hypoperfusion abnormalities due to severe sepsis and septic shock remains unacceptably high. The adequacy and speed of treatment administered in the first hours after syndrome develops influence outcome. Initial resuscitation, appropriate antimicrobial treatment, selection of optimal control methods, properties of fluid therapy, use of vasopressors and inotropic therapy, proper corticosteroid administration, value of the use of recombinant human activated protein C, and glucose control are the most important points newly evaluated for severe and septic shock management.

This article reviews the phys iology of cardiopulmonary resuscitation (CPR), monitoring and new devices for generating blood flow during CPR. Two controversial mechanisms of blood flow during chest compressions are described: the thoracic pump mechanism and cardiac pump mechanism. Also, new physiological aspects of blood flow, physiology of ventilation and gas transport during CPR are overviewed. A variety of alternative techniques and devices are now explored in order to improve perfusion pressures and/or blood flow during CPR, including active compression decompression CPR, inspiratory impedance threshold valve, phased chest and abdominal compression-decompression CPR and others. Initial methods of cardiopulmonary resuscitation monitoring are direct observations of pulse and respiration. Electrocardiogram remains the most essential tool for diagnosis and monitoring of cardiac arrest. Monitoring of diastolic blood pressure, myocardial perfusion pressure and end-tidal CO2 are also useful. Other types of monitoring during cardiac arrests can provide information about effectiveness of CPR.

Straipsnyje apžvelgiama gaivinimo fiziologija, stebėjimas bei naujos priemonės, kurios užtikrina kraujotaką gaivinimo metu. Aprašant kraujotakos fiziologiją krūtinės ląstos paspaudimų metu, akcentuojami du pagrindiniai mechanizmai – „širdies pompos“ ir „krūtinės ląstos pompos“. Nagrinėjant dujų pernašos, dirbtinės plaučių ventiliacijos fiziologiją gaivinimo metu, pabrėžiami atskirų parametrų pokyčiai bei kokybiško gaivinimo modelis. Siekiant padidinti vainikinių arterijų perfuzinį spaudimą ar (ir) kraujotaką, atliekamos studijos su alternatyviomis kraujotaką užtikrinančiomis priemonėmis bei metodais, pavyzdžiui, įterpiami pilvo paspaudimai, aktyvi kompresija-dekompresija, aktyvi krūtinės kompresija-dekompresija kartu su aktyvia įterpiama pilvo kompresija-dekompresija, dažnesni paspaudimai. Pagrindiniai gaivinimo stebėjimo metodai yra pulso čiuopimas ir tiesioginis kvėpavimo įvertinimas. Nustatant ir stebint staigios mirties mechanizmą, svarbūs elektrokardiogramos rodmenys. Taip pat naudojamas CO2 iškvėpimo pabaigoje bei invazinis arterinio kraujospūdžio stebėjimas. Kiti stebėjimo metodai turi papildomą reikšmę sprendžiant apie gaivinimo efektyvumą. This article reviews the physiology of cardiopulmonary resuscitation (CPR), monitoring and new devices for generating blood flow during CPR. Two controversial mechanisms of blood flow during chest compressions are described: the thoracic pump mechanism and cardiac pump mechanism. Also, new physiological aspects of blood flow, physiology of ventilation and gas transport during CPR are overviewed. A variety of alternative techniques and devices are now explored in order to improve perfusion pressures and/or blood flow during CPR, including active compression decompression CPR, inspiratory impedance threshold valve, phased chest and abdominal compression-decompression CPR and others. Initial methods of cardiopulmonary resuscitation monitoring are direct observations of pulse and respiration. Electrocardiogram remains the most essential tool for diagnosis and monitoring of cardiac arrest. Monitoring of diastolic blood pressure, myocardial perfusion pressure and end-tidal CO2 are also useful. Other types of monitoring during cardiac arrests can provide information about effectiveness of CPR.

Treatment method of hemophilia with continuous infusion of clotting factor concentrates is not widespread. We report our experience with the use of continuous infusion of factor VIII in patient with mixed trauma, crush syndrome and acute renal failure. Patient was successfully treated with fasciotomy of left upper arm and forearm, 6 procedures of hemodialysis, 34.500 units of clotting factor VIII concentrate, and 13 red blood cells units. Our experience confirms the safety, efficiency, and economy of the method of the constant infusion of clotting factor concentrates for hemophilia patient requiring replacement therapy, surgical intervention, and hemodialysis.

Treatment in the intensive care units has aggressive character. A lot of invasive diagnostic and treatment procedures are used in order to keep vital functions of the patients. Some complications are associated with treatment methods. Hospital acquired infections are the main cause of mortality. Since artificial lung ventilation is the most common invasive treatment method, ventilator-associated pneumonia is the most common hospital acquired infection. The development of hospital acquired infections is dependent on two independent pathophysiological factors: decreased patient immunity and colonization of patient cavities by bacteria. Ventilator-associated pneumonia causes almost half of intensive care units infections. The most etiologic organisms responsible for ventilator-associated pneumonia in Europe and North America are Pseudomonas species and Methicillin resistant Staphylococcus aureus. Diagnosis of ventilator-associated pneumonia is based on clinical and laboratory criteria (fever, leukocytosis, purulent endotracheal secretions) and pulmonary infiltrates on chest radiograms. Pathogen can be distinguished using invasive or noninvasive techniques. Antimicrobial resistance aggravates treatment of ventilator-associated pneumonia. Antibiotic treatment should be chosen on the ground of clinical data, hospital epidemiologic situation and most common pathogens. Prevention of ventilator-associated pneumonia is based on improving basic hygiene and nursing quality. Ventilator-associated pneumonia morbidity could be reduced by identification of risk factors and risk prevention.

Our thesis aims to estimate the frequency of delirium in the ICU, analyze the relationship between the duration of delirium and long-term cognitive impairment, and determine the impact of delirium on quality of life.

The management of SAP has been shifted from a past that involved aggressive approaches such as early surgical interventions, liberal antibiotics usage and aggressive fluid resuscitation to now follow a more restricted and conservative methodology. The importance in the ICU setting is to always work for supporting vital organ systems, particularly the cardiovascular and pulmonary systems. Nutritional support, management of infections and pain are also critical areas that increase patient survival.

To review the line of management of Acute liver failure from organ specific management to liver transplantation. To analyze the methods of organ specific management for patients suffering from ALF in the ICU. To analyze the use of liver transplantation in the management of ALF.

[...]. The aim and objectives of the study The aim of the study is to evaluate prevalence and characteristics of conjunctival microcirculation and glycocalyx alterations in Neurological critically ill patiens. The objectives of the study: 1. To compare microcirculatory parameters measured in ocular conjunctiva and sublingual mucosa in groups of brain dead and healthy controls. 2. To evaluate microcirculatory characteristics in ocular conjunctiva and sublingual mucosa in groups of mixed Neurological and Cardiosurgical critically ill patients and healthy controls. 3. To evaluate capiliary glycocalix perfused boundary region thickness in ocular conjunctiva and sublingual mucosa in groups of mixed Neurological and Cardiosurgical critically ill patients and healthy controls. 4. To measure glycocalyx shedding marker Syndecan-1 groups of mixed Neurological and Cardiological critically ill patients and healthy controls and to evaluate severity of endothelial damage between groups. 5. To study the association of microcirculatory alterations and glycocalyx injury parameters in groups of mixed Neurological and Cardiosurgical critically ill patients. [...].

Introduction – dysnatremias (hyponatremias, hypernatremias) – are common problem in patients admitted to the intensive care unit (ICU). The prevalence of dysnatremias is between 25 and 45%. This condition is related with poor outcomes, increased mortality in critically ill patients. Rate of lethality reaches 17%. The avoidance of dysnatremias may improve prognosis. Aim – to review the impact of dysnatremias for ICU treated patients morbidity and lethality. Objectives – to analyse the prevalence, comorbidities, methods of treatment, length of stay in ICU, to asses the impact of hyponatremias, hypernatremias, normonatremias on patients lethality rate. Methods – retrospective study of randomly selected 100 patients data, who were treated in intensive care unit between year 2016 – 2017. Criterias of inclusion were: admitted to intensive care unit more than 24h, evaluation of sodium concentration at admission day. Patients were reviewed for demographic features, the cause of admission, the hospital unit until admission to intensive care unit, comorbidities, SOFA, the laboratory sodium concentration on admission day, the methods of treatment (vazopressors, steroids, blood transfusions, mechanical ventilation, renal replacement therapy, central venous catheterization), the length of stay in ICU, the outcome (survivors, non - survivors). Results – the study analysed data of 84 patients who complied with inclusion criterias- 51,2% were diagnosed hyponatremia, 9,5% - hypernatremia, 39,3% - normonatremia. Chronic renal failure was the most common condition for hyponatremia. The methods of treatment had impact on Na concentration changes: renal replacement therapy 3,8 time increased the risk for hyponatremia, usage of steroids for ICU patients treatment – 3,8 and central venous catheterization 1,7 time increased the risk for hypernatremia. Length of stay in ICU in hyponatremic patients were 2,84, hypernatremic – 4,00, normonatremia – 5,61 days. Lethality rate in patients with hyponatremia were 46,5%, hypernatremia - 75%, normonatremia – 54,5%. Conclusions – dysnatremias on ICU admission were diagnosed more than half of patients. Chronic renal failure was associated with hyponatremia. There are connection between renal replacement therapy and hyponatremia, use of steroids for ICU patients treatment and central venous catheterization and hypernatremia in critical care patients. Concentration of Na in blood serum did not affect lenght of ICU stay. Dysnatremia and normonatremia on admission day did not impact the rate of lethality.

AIM Assessment of the latest evidence regarding the use of targeted temperature management in out-ofhospital cardiac arrest patients and its associated protocol, and its potential use in traumatic brain injury, hepatic encephalopathy and stroke which are associated with cerebral edema. OBJECTIVES 1. To evaluate mortality and 6 months neurological outcome in out-of-hospital cardiac arrest (OHCA) patients upon receiving targeted temperature management (TTM). 2. To evaluate the optimal time of initiation, target temperature to reach and duration of TTM procedure in OHCA patients. 3. To evaluate the efficacy of TTM in reducing intracranial pressure (ICP) and its complication in traumatic brain injury, hepatic encephalopathy and stroke. RESULTS Early trials showed clear benefit of moderate hypothermia (33°C) in terms of survival and 6-months neurological outcome but they were subject to bias. Later studies compared (33°C) and strict fever control (36°C) showed no benefits whatsoever of one temperature over the other. Trials and studies directed at identifying the optimal initiation time and duration of therapy found no supporting evidence. For traumatic brain injury, TTM did not have efficacy when mortality and morbidity data were looked at. However, subgroup analyses showed significantly better outcomes among patients with surgically removed hematomas under TTM management. TTM was successful in reducing high ICP in patients with hepatic encephalopathy having refractory ICP awaiting orthotopic liver transplantation. Trials concerning the benefits of TTM in Acute ischemic stroke found no significant difference in mortality and 90-day outcome but higher rates of pneumonia were reported. CONCLUSION There is low-quality evidence that targeted temperature management is effective in improving mortality and 6-months outcome in out-of-hospital cardiac arrest patients with shockable rhythm (VF/ VT), with no supporting duration or target temperature. No direct evidence supports targeted temperature management in traumatic brain injury in terms of mortality and morbidity, however it may be useful in surgically removed hematomas. There is a low level of evidence that targeted temperature management is effective in patients with hepatic encephalopathy having refractory ICP awaiting orthotopic liver transplantation. There is no evidence that targeted temperature management is effective in improving mortality and 3 months outcome in patients with acute ischemic stroke.

Aim: To assess the difference in knowledge, attitude and practice of basic life support among trained and untrained participants. Objectives: 1. To study the level of knowledge and practice of BLS among trained and untrained medical students. 2. To assess the attitude towards BLS among participants 3. To evaluate differences in knowledge, practice and attitude between trained and untrained participants. 4. To assess effect of previous training in BLS on participants 5. To provide the university with the results and conclusion of the research work.

The aim of this paper was to identify the major causes, risk factors, diagnostic procedures and treatment of pulmonary embolism in the setting of ICU. It was oriented swell toward highlighting how treatment implications influence the mortality rates of pulmonary embolism patients in the ICU. The objectives were to evaluate the effectiveness of treatment variations implemented in the setting of the ICU for PE patients. In addition, to shed light on the advantages of thrombolysis and anti-aggregant therapy. And finally, to identify the outcomes and mortality rates that emerge after applying both assisted and non-assisted mechanical ventilation therapy in for PE patients residing in the intensive care unit. Results revealed that In terms of mortality, thrombolytic therapy is a gold standard and has shown efficacy in reduction of RVD in patients that are both hemodynamically stable and those after an acute PE. There is a higher impact on mortality reduction, minimised risk of pulmonary embolism recurrence and reduction in time till hospital discharge when thrombolytic therapy is combined with anticoagulants. Thrombolytic therapy showed to minimise the risk of hemodynamic decompensation but elevate the possibility of a stroke and/or haemorrhage in patients that were hemodynamically unstable in the ICU setting. On the other hand, the mortality rates of those on mechanical ventilation in the ICU setting range between 60-80% respectively. Conclusion: The evidence after a decade of accumulation reveals a low rates of improvement and high rates of mortality with Mechanical ventilation. In terms of mortality, thrombolytic therapy is a gold standard that has been widely adopted in the treatment and prophylaxis after a PE has taken place. It remains to be controversial in respect to having sudden bleeding and strokes. The best outcomes of thrombolytic therapy are seen when it is combined with anticoagulants.

Aim and objectives. The aim of this study was to determine the impact of endotracheal tube (ET) cuff pressure control, nosocomial infection risk factors and surgery type on development of ventilator-associated pneumonia (VAP). Secondary objective was to determine the prevalence of VAP and it‘s main pathogens in Lithuanian University of Health Sciences hospital Kaunas Clinics, Cardiothoracic and vascular surgery intensive care unit (ICU). Methods. This was a prospective randomized controlled study. The study included patients, who went into the ICU after a heart, chest or major vascular surgery intubated and stayed there longer than 48 hours. The patients were randomly divided into 2 groups: control group and exposure group. In the control group, ET cuff pressure was observed, but not adjusted. In the exposure group ET cuff pressure was adjusted and maintained within the normal range (20-30 cm H_2O). Nosocomial infection risk factors was observed in both groups. Statistical analysis was performed using SPSS 22.0 data package.

Author: Lithuanian university of health sciences VI year 14 group student A. Bajelis, Intensive care unit. Title: Prognostic systems accuracy determination in predicting patient’s outcomes, retrospectively evaluating patients, treated in the intensive care unit, who suffered from acute pancreatitis. Aim: To evaluate and compare patient's outcomes determined by prognostic systems – APACHE II, SAPS II and SAPS III, their application possibilities, retrospectively assessing acute pancreatitis patients which were treated in intensive care unit. Goals: 1. Retrospectively evaluate acute pancreatitis patients who were treated in intensive care unit, forecast outcomes, using APACHE II, SAPS II and SAPS III prognostic systems. 2. Compare APACHE II, SAPS II and SAPS III systems calibration and discrimination in predicting acute pancreatitis patients treated in intensive care unit, outcomes. Methodology and results: Retrospective patient’s analysis were made. The object of research – patients diagnosed with acute pancreatitis, treated in LSMUL KK intensive care unit from 01 January 2012 until the year of 2016 May 31. Each patients risk of death was estimated using APACHE II, SAPS II and SAPS III prognostic systems. To compare the prognostic systems, Pearson correlation was evaluated between each of the predictive score calculated for each patient and the patient’s actual outcome. Using binary logistic regression, the Hosmer-Lemeshow test assessed prognostic systems calibration – APACHE II and SAPS III calibration was good - χ2 6,8 and 12,8 (p>0,05) respectively, SAPS II calibration was poor - χ2 - 20,718, p18 points), 0,7708 (>41 point), 0,6563 (>77 points) respectively. Comparing the prognostic systems in pairs, statistically significant differences were not found (p values> 0.05), so systems were compared by AUC – which was highest SAPS II system’s. Calculation of SMR showed, all three systems over-predicted patients mortality. Conclusions: No statistical significance between prognostic systems was observed, thus all three systems – APACHE II, SAPS II and SAPS III – are suitable for predicting the outcome of treatment in patients with acute pancreatitis. These systems are sensitive and specific, but SAPS II prognostic results should be a subject of consideration, because of system’s poor calibration.

Agnė Kaunienė. Master’s thesis “Early Complications in the Intensive Care Unit (ICU) after Renal Transplantation Analysis”. Scientific supervisor Prof. V. Pilvinis, MD, PhD; Lithuanian University of Health Sciences, Faculty of Medicine, Department of Intensive care – Kaunas. Condition of a patient and their graft during the first days after the renal transplantation mainly depends on a patient’s condition before surgery and their risk factors as well as donor’s age, their harmful habits, comorbid conditions and causes of death. [1] Therefore, this work aims to determine the frequency of early complications related to the time duration of HD from the moment when the kidney failure has been determined to the renal transplantation, and assess the most common disorders of homeostasis and other complications. The objectives: 1) to assess the interface of HD duration from the final diagnosis of kidney failure to renal transplantation and ICU early complications; 2) to assess the rate of the occurance of the most common early onset-complications, i.e. of cardiovascular and surgerical complications and infections; 3) to assess the urgent need of HD due to homeostasis disorders; 4) to assess the occurance of early onset-complications for the recipients who smoked and for the recipients who received a kidney transplant of a donor who used to smoke. Methodology: 1) analysis of the data of LSMUL KK patients who underwent a cadaver renal transplantation under 2014 and 2015; 2) assessment of the interface of HD duration from the final diagnosis of kidney failure to renal transplantation and ICU early complications; 3) performance of the statistical analysis. Results. In total 66 recipients were studied (34 men and 32 women) who in LSMUL KK underwent a cadaver renal transplantation under 2014 and 2015. The age of patients varies from 20 to 68 years. In conformity with the renal replacement therapy type – 64 (96.97 %) patients had treatment with haemodialysis, 2 (3.03 %) patients underwent peritoneal dialysis. According to the sequence of the transplant, it was the first kidney transplantation for 63 (95.5 %) patients and the second for 3 (4.5 %) patients. The patients who had renal transplantation, on average were undergoing 2.42 ± 2.13 years of HD. Early complications were not more frequent (p = 0.066) among the recipients who smoked and the recipients who received a kidney from a donor who used to smoke. The common frequency of the early onset-complications after a kidney transplantation is 38 (57.6%). Early complications after kidney transplantation occured as follows: homeostasis – for 31 (46.5%) patient, surgical complications – for 8 (12.0%) patients, cardiovascular complications – for 8 (13.6%) patients, acute rejection – for 3 (4.5%) patients, infection – for 15 (22.5%) patients. 26 (39.3%) patients had waited for the kidney transplantatio for 1 year, 40 (60.6%) patients had waited longer than a year. The early complications after kidney transplantation occured for 13 (50%) patients who had waited for the transplantation for a period of one year and for 25 (62.5%) patients who had waited longer than one year. Early complications were more frequent among those patients whose waiting time was longer than a year (p = 0.049). The study revealed that the relationship between the HD duration from the final diagnosis of kidney failure to renal transplantation and ICU early complications is r=0,588 (p=0,037). According to the data of the creatinine tests, the recovery of the renal function was independent from the HD duration to renal transplantation (p = 0.072). Emergency HDs were performed for 18 (27.2 %) patients of whom 9 (13.6 %) patients had homeostasis disorders and 9 (13.6 %) patients had hypervolemia. Conclusions. The longer the duration of HDs performed until the renal transplantation, the more early complications occur. Homeostasis disorder is the most common early complication after renal transplantation. An influence of smoking for the early complications after renal transplantation has not been proven.

Author: Sengin Lézan Zindrou Title: Blood transfusion practice among medical physicians working at Kauno Klinkos Hospital. Aim: To review the clinical practice of blood transfusion in different clinical settings, to evaluate the threshold of blood transfusion as well as the units of blood used. Objectives:1. To assess blood transfusion threshold among physicians according clinical practice (different medical specialties). 2. To determine and compare the threshold for blood transfusion between younger physicians with less clinical practice and older physicians with more clinical practice in the intensive care department. 3.To evaluate current practice according present guidelines.4. To determine if experience has any influence when it comes to blood transfusion. Methodology: A scenario-based survey was conducted among 84 clinical physicians at the Lithuanian University of Health Sciences Kauno Klinikos. Distributing hypothetical scenarios and collecting data for hemoglobin trigger for each scenario estimated clinical practice of blood transfusion. Study participants: Clinical physicians at the LUHS Kauno Klinikos. Results: A total of 84 medical physicians, 33 (39%) of which were surgeons, 26 (31%) were intensivists and 25 (30%) of the physicians had different therapeutic specialties. The majority of the physicians in the first scenario, 38 (45,2%) chose a threshold of 80 g/L of hemoglobin. In the second scenario the majority 44 (52,4%) choose a threshold of 80 g/L, in the third scenario majority of the physicians 37 (44%) choose to transfuse at a threshold of 70 g/L and in the fourth and last scenario the majority which was 29 (34,5%) of the physicians choose to not plan a transfusion. There was no significant difference found between the groups of specialties (p>0,05) Conclusions: Years of experience does not have an influence on the threshold chosen by clinical physicians working at Kauno Klinikos hospital, neither does the specialty of the physician. In general, the tactic was restrictive with some lack of knowledge in patients suffering with cardiovascular diseases receiving a transfusion.

The transfer of patients from the intensive care unit (ICU) to the general medical ward is high risk for adverse events and health care provider dissatisfaction. We aimed to identify the most frequent medical adverse events that physicians face after a recent transfer of patients from the ICU to the general medical ward. Another goal was to find what information is important to communicate during an ICU transfer.

Author: Ali Munir Mohammed. Title: Study of nutrition practice in the intensive care unit at Lithuanian University of Health Sciences Kauno Klinikos (LUHSKK): The “NutritionDay” survey 2016. Aim: To present an overview of the current practice of nutrition support in the intensive care unit (ICU) at the Hospital of Lithuanian University of Health Sciences Kauno Klinikos (LUHSKK). Objectives: 1.To assess the practice of nutritional support in the intensive care unit (ICU) at the Hospital of Lithuanian University of Health Sciences Kauno Klinikos (LUHSKK) using the “NutritionDay” survey. 2. To assess the nutritional condition of the patients hospitalized in the ICU at the LUHSKK. 3. To assess whether nutritional targets were met for the patients hospitalized in the ICU department at the LUHSKK. 4. To compare the results with previous data and reference data from “NutritionDay”. Methodology: A survey was conducted among patients hospitalized in the ICU at the LUHSKK. A set of questionnaire is used to evaluate the characteristics of the intensive care unit, the status of the patients, reason of hospitalization, nutritional condition, and the type of nutritional support. Study participants: Patients hospitalized in the intensive care unit at the LUHSKK. Results: A total of 23 patients were included, 56.5% were male. The main reason of ICU admission included pulmonary disease (56.6%), sepsis (43.5%), and abdominal disorders (39.1%). Over 40% of the patients were not fed the first day. Oral feeding was possible in 2 (8.7%) patients, whereas 21 (91.3%) patients were provided with artificial nutritional support, out of which 7 (30.4%) given enteral nutrition, 4 (17.4) parenteral nutrition, and 10 (43.5%) with both enteral and parenteral nutrition. The mean planned and given calories was 1361.7 ± 202.1 kcal/day and 1361.7 ± 202.1 kcal/day respectively using enteral nutrition, and 643.0 ± 480.1 kcal/day and 375.0 ± 485.6 respectively for parenteral nutrition. The median day of initiation of nutritional support was 3 days [range 0 – 11]. Conclusion: Current practice of nutritional support is falling below the recommendations and the prescription of nutrition appears to be generalized among the patients. There are unfavorable routines such as delays of initiation, affecting the optimal implementation of nutrition support. This shows that there is inadequate adherence to the European guidelines on nutritional support.