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Biomedical subjects

Andrius Macas

Publications and source records attributed to Andrius Macas.

9 recordsLinked to original sources
PubMed2006

The treatment of multiple injuries: prehospital emergency aid.

OBJECTIVE: To evaluate initial (prehospital) assessment and management of high-energy blunt polytrauma patients. MATERIAL AND METHODS: Prehospital assessment and management of high-energy blunt polytrauma patients was analyzed. The extent of initial assessment and management was compared with Advanced Trauma Life Support recommendations. RESULTS: Altogether, 101 (63.05%) of 159 polytrauma patients (mean Injury Severity Score was 28.04) were admitted to Kaunas University of Medicine Hospital by the Emergency Aid Service after motor vehicle traffic accidents. In comparison with Advanced Trauma Life Support recommendations initial assessment (ABCDE) reached 14% and management reached 10.6%. CONCLUSIONS: Initial assessment of high-energy blunt polytrauma patients reached 14% and management reached 10.6% of that recommended by Advanced Trauma Life Support.

Accidents, Traffic↗
PubMed2006

[Acute heart failure].

There are still many discussions among physicians how heart failure should be defined. Despite many suggested traditional classifications, majority of definitions circulating in clinical practice and their appropriate usage remain unclear. A new approach of acute heart failure classification suggested by European Society of Cardiology is presented in the article. Diagnostic strategy of acute heart failure as well as recommendations for prehospital and inpatient treatment of its forms (pulmonary edema and cardiogenic shock) are presented in the article. Application of new medications, recently introduced to the clinical practice for treatment of acute heart failure, is discussed.

Acute Disease↗
PubMed2006

Impedance cardiography for aortic balloon counterpulsation impact assessment on patients hemodynamics during acute myocardial infarction.

BACKGROUND AND OBJECTIVE: The evaluation of hemodynamics in patients with acute myocardial infarction is crucial. Intra-aortic balloon pumping or counterpulsation in patients with cardiogenic shock is supposed to be monitored exceptionally by invasive methods for assessment of hemodynamics. However, noninvasive methods might have place in monitoring these patients. The objective of the study was to evaluate the possibility of applying noninvasive methods for evaluation of hemodynamics during acute myocardial infarction complicated by cardiogenic shock and managed by intra-aortic balloon pumping. PATIENTS AND METHODS: A total of 16 patients were investigated according to the study protocol. Anterior acute myocardial infarction was diagnosed in 11 (68.75%) patients, inferior--in 4 (25%), circular--in 1 (6.25%). Primary percutaneous transluminal coronary angioplasty was successfully performed in 7 (43.75%) patients, unsuccessfully--in 1 (6.25%) patient, who died within the first 18 hours. Half of patients (50%) underwent cardiac surgery within the first two weeks. Mortality rate was 68.75% (11 patients). A prospective controlled study was carried out to compare two different methods--intermittent thermodilution (ITD) and impedance cardiography (ICG)--for simultaneous cardiac output measurements in patients with acute myocardial infarction complicated by cardiogenic shock and managed by intraaortic balloon counterpulsation. Statistical analysis was performed with Bland-Altman and linear regression. RESULTS: Correlation coefficient was calculated comparing cardiac output values derived from ICG and ITD; it ranged from 0.24 to 0.98 in separate patients. It was observed a weak correlation of ICG and ITD measurements before initiation of intra-aortic balloon pumping--0.24-0.27 in separate cases. The correlation improved during intra-aortic balloon pumping--0.58-0.98 and at the termination of intra-aortic balloon pumping--0.67-0.97. The observed correlation was more pronounced in patients not receiving high doses of inotropes and ranged 0.58-0.98 while for patients receiving high doses of inotropes correlation was less pronounced 0.29-0.5. CONCLUSIONS: Significant correlation of cardiac output values was observed between the impedance cardiography and intermittent thermodilution techniques during intra-aortic balloon counterpulsation. Noninvasive evaluation of hemodynamic indices by continuous monitoring of impedance cardiography during acute myocardial infarction, complicated by cardiogenic shock and managed by intra-aortic balloon counterpulsation is a reliable method for further application.

Acute Disease↗
PubMed2006

[Hospital-acquired urinary tract infections].

Urinary tract infections are responsible for 40-60% of all hospital-acquired infections. Increased age of patients and comorbid diseases render hospitalized patients more susceptible to infection. Almost 80% of hospital-acquired urinary tract infections are associated with urinary catheters, and only 5-10% of urinary infections are caused by invasive manipulations in the urogenital tract. Pathogens of hospital-acquired urinary tract infections are frequently multi-resistant, and antibiotic therapy can only be successful when the complicating factors are eliminated or urodynamic function is restored. For treatment of complicated hospital-acquired urinary tract infections, the antibiotics must exhibit adequate pharmacodynamic and pharmacokinetic properties: high renal clearance of unmetabolized form with good antimicrobial activity in both acidic and alkaline urine. For selection of empirical treatment of hospital-acquired urinary tract infections, it is necessary to evaluate localization of infection, its severity, possible isolates, and the most frequent pathogens in the department where patient is treated. The best choice for the starting the antimicrobial therapy is the cheapest narrow-spectrum effective antibiotic in the treatment of urinary tract infection until microbiological evaluation of pathogens will be received. Adequate management of urinary tract infections lowers the rate of complications, requirements for antibacterial treatment, selection of multi-resistant isolates and is cost effective.

Adult↗
PubMed2003

Golden hour - early postinjury period.

Quality and adequacy of specialized first aid for patients affected by high energy trauma is extremely important factor in order to reduce postraumatic disability and mortality of polytrauma patients. Treatment strategies for high energy trauma management are in early stages of development. Adequate aid can be rendered only in a few centers of Lithuania. Pre-hospital and very early hospital stages of patients with high energy trauma, which significance is proven, are unsatisfactory and inadequate. A retrospective study was performed in order to analyze efficacy and adequacy of pre-hospital (Kaunas Emergency Station, KES) and very early hospital (Kaunas University of Medicine Hospital Emergency Room, ER) management stages for 53 patients affected by high energy trauma and admitted to Kaunas University of Medicine Hospital during the period of 2001-2002. Averaged injury severity score, according to ISS, was 21.3, mortality rate was 34%. It was established long duration of pre-hospital and early hospital stage of management (accordingly 34+/-6.5 and 50+/-17.2 minutes), extremely rare monitoring of vital signs in pre-hospital stage (breathing was evaluated for 1.9% of patients, heart rate for 26.4% of patients). Fluid therapy as a part of complex treatment was applied for 7.5% of patients in pre-hospital stage and 3.8% in very early hospital stage.

Accidents, Traffic↗
PubMed2002

[Multiple trauma: evaluation of patient's condition and local injuries by trauma classification systems].

Evaluation of polytrauma patient's status by using scoring system is very important for selection of patient's placement and management, prophylaxis and diagnosis of early complications. In the article trauma classification systems are presented and discussed. Clinical evidences of Kaunas Medical University Hospital are presented as well. There are suggestive recommendations on evaluation of polytrauma patient's status and proper separation of severely injured.

Adolescent↗
PubMed2002

[Use of adenosine and high-energy phosphates in cardiac anesthesiology].

Usage of adenosine and high-energy phosphates in cardiac anesthesiology is widely discussed. Implementation of above substances can be achieved via three possible ways: during the preparation of patients for cardiac surgery, during surgery and after the surgery during intensive postoperative care. Optimum methods for cardiac protection, which could guarantee safe, lasting heart function preservation after the surgery are investigated till now. Advantages and disadvantages of adenosine application during preoperative and postoperative periods as well as in cardiac surgery are presented. Possibilities to use phosphocreatine for cardioprotection will be discussed as well.

Adenosine↗
PubMed2002

[Application of methods for hemodynamic monitoring in critical cardiac pathology (an experimental model for assessment of hemodynamics)].

Hemodynamic assessment of critically compromised patients with cardiac pathology is one of the goals of recent diagnostics and treatment strategies. Different methods for assessment of hemodynamics are applied in clinical practice. However, applied methods (invasive and noninvasive) have specific advantages and disadvantages. These are discussed in the article. First experience of experimental model for assessment of hemodynamics in laboratory conditions is analyzed in the article. In the year 2002 it was explored a possibility to use standard procedure to evaluate hemodynamics for laboratory animals in Kaunas University of Medicine. It were selected 6 laboratory animals of different weight and sex. 7 measurements of hemodynamics were performed. Standard methodics was successfully applied in the experimental model. Results, method limitations and recommendations for further studies are presented in the article.

Animals↗