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Martin Balik

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Head of intensive care of the General University Hospital in Prague. Assistant Professor in Anaesthesia and Intensive Care at the 1stMedical Faculty of Charles University in Prague. Member of ESICM and European Society of Cardiology (ESC), Board of EDEC (European Diploma in Echocardiography, ESICM) since 2015, past member of EDIC subcommittee ESICM (2012-2015). EDEC and EDIC examiner. Extracorporeal Life Support Organisation (ELSO), member of Scientific Board of the Euro-ELSO since 2017. Scientific secretary of Czech Society of Intensive Care, Chair of Society since 2021. Member of steering board of Czech Society of Anaesthesiology and Intensive Care, Head of the Ultrasound Section. Graduated in 1994 and completed his national qualification in anaesthesia and intensive care in 2001. Pregraduate and postgraduate elective attachments in the UK (Bradford 1993, Leeds 1994), completed internships in Austria (Salzburg 2000, Graz 2001). EDIC in 2002, Czech intensive care exam 2008. Intensivist and echocardiographist in Westmead and Nepean Hospitals in Australia in 2004-2005. European Accreditation in Transthoracic Echocardiography (ESC) in 2006, reaccredited in 2013 and 2019. Ph.D. in Biochemical Sciences (Charles University) completed in 2006. Publishing and lecturing particularly in the field of cardiology, nephrology, ultrasound and ECMO in the critically ill.

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Imperial College London

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Papers by Martin Balik

Prognostic Impact of Serial Imaging in Severe Acute Respiratory Distress Syndrome on the Extracorporeal Membrane Oxygenation

Journal of Clinical Medicine

Background: The impact of serial imaging on the outcome of ICU patients has not been studied spec... more Background: The impact of serial imaging on the outcome of ICU patients has not been studied specifically in patients with high illness severity. Methods: The authors sought a relationship between the numbers of antero-posterior supine chest X-rays (CXR), computed tomography (CT) examinations, and outcome in a cohort of 292 patients with severe COVID-19 ARDS collected over 24 months in a high-volume ECMO center with established ultrasound and echocardiographic diagnostics. Of the patients, 172 (59%) were obese or morbidly obese, and 119 (41%) were treated with ECMO. Results: The median number of CXRs was eight per 14 days of the length of stay in the ICU. The CXR rate was not related to ICU survival (p = 0.37). Patients required CT scanning in 26.5% of cases, with no relationship to the outcome except for the better ICU survival of the ECMO patients without a need for a CT scan (p = 0.01). The odds ratio for survival associated with ordering a CT scan in an ECMO patient was 0.48, p ...

Vazopresin a jeho role v anesteziologii a intenzivní medicíně

Anesteziologie a intenzivní medicína, Aug 1, 2015

Vazopresin má svoji nezastupitelnou roli v řízení tonu cév a jeho nedostatečná hladina se významn... more Vazopresin má svoji nezastupitelnou roli v řízení tonu cév a jeho nedostatečná hladina se významně podílí na rozvoji refrakterních šokových stavů spojených se sepsí, hemoragií a mimotělním oběhem. Jeho funkce při kontrole udržování arteriálního tlaku se zvýrazňuje ve chvílích, kdy jsou ostatní systémy blokované, nefunkční či k udržení tlaku nestačí-například při septickém šoku nebo u refrakterní vazoparalýzy. Nízké dávky vazopresinu mohou ve zmíněných situacích synergickým účinkem s noradrenalinem přispět k normalizaci cévního tonu a obnovení perfuze vitálně důležitých orgánů. Mezi indikace patří septický šok s potřebou vysoké terapeutické dávky noradrenalinu, a to zvláště u pacientů s dysfunkcí myokardu a plicní hypertenzí na umělé plicní ventilaci. Vazopresin se uplatní u závažné vazoparalýzy nejen v souvislosti se sepsí, ale i v kardioanestezii a u intoxikací kardiofarmaky. Význam má u dárců orgánů, portální hypertenze a během kardiopulmonální resuscitace. V České republice je na rozdíl od řady zemí EU, Kanady, Austrálie a Nového Zélandu dostupný pouze na zvláštní dovoz, což jej činí pro konkrétního pacienta, nacházejícího se v danou chvíli v kritickém stavu, téměř nepoužitelným. K dispozici je u nás volně pouze jeho syntetický analog terlipressin, který je však, pro svou odlišnou farmakodynamiku a farmakokinetiku, horší řiditelnost a vyšší počet vedlejších efektů v těchto situacích méně vhodný. Proto je dosažitelnost krátkodobě působícího vazopresinu na našem trhu velmi žádoucí. KLÍČOVÁ SLOVA vazopresin-septický šok-hypotenze-vazoparalýza-portální hypertenze-dárci orgánů-kardiopulmonální resuscitace

Extracorporeal Membrane Oxygenation for Septic Shock

Critical Care Medicine, 2019

Objectives: Septic shock carries a high mortality risk. Studies have indicated that patients with... more Objectives: Septic shock carries a high mortality risk. Studies have indicated that patients with septic shock may benefit from extracorporeal membrane oxygenation. In most studies, patients exhibited shock due to myocardial dysfunction rather than distributive/vasoplegic shock. One proposed theory is that venoarterial extracorporeal membrane oxygenation alleviates a failing myocardial function. Design: Retrospective observational study. Setting: Single-center, high-volume extracorporeal membrane oxygenation unit. Patients: All patients treated for septic shock between 2012 and 2017 with an age greater than 18 years old, fulfilling septic shock criteria according to “Sepsis-3” at acceptance for extracorporeal membrane oxygenation, presence of cardiocirculatory failure requiring a support equivalent to a Vasoactive Inotropic Score greater than 50 to reach a mean arterial pressure greater than 65 mm Hg despite adequate fluid resuscitation, were included. Interventions: None. Measureme...

Pulmonary consolidation alters the ultrasound estimate of pleural fluid volume when considering chest drainage in patients on ECMO

Critical Care

Imaging of COVID-19 in critical care with a focus on chest ultrasound

Anesteziologie a intenzivní medicína

Imaging methods available at the bedside have become an indispensable part of the diagnostic proc... more Imaging methods available at the bedside have become an indispensable part of the diagnostic process of COVID-19 in the intensive care setting. Chest ultrasound has been established as an exquisite bedside imaging tool to assess and diagnose a myriad of lung pathologies, assess the pleural space and diaphragm, and ultimately gauge therapeutic interventions. Furthermore, vital information can be attained on the haemodynamic status of a patient when chest ultrasound is combined with echocardiography and Doppler vascular assessment. Bedside chest x-ray has its technical limitations, is not sensitive in early stages of the disease, and exposes patients to radiation. Computed tomography has great spatial resolution and all the structures in the chest can be assessed, but on the other hand, it requires patient transport and exposes them to radiation and the potential side effects of contrast administration. Recently, chest ultrasound has proved to be extremely useful during the COVID-19 pandemic in assessing COVID-19 pneumonia and its complications with a resultant reduction in potential infectious cross-contamination of staff and patients due to transport to and from the radiology department. In this review, the authors compare the three most frequent modalities of chest imaging in the diagnosis of COVID-19 in critical care, with a focus on the benefits of chest ultrasound.

Interpleural location of chest drain on ultrasound excludes pneumothorax and associates with a low degree of chest drain foreshortening on the antero-posterior chest X-ray

The Ultrasound Journal

Background The role of chest drain (CD) location by bedside imaging methods in the diagnosis of p... more Background The role of chest drain (CD) location by bedside imaging methods in the diagnosis of pneumothorax has not been explored in a prospective study yet. Methods Covid-19 ARDS patients with pneumothorax were prospectively monitored with chest ultrasound (CUS) and antero-posterior X-ray (CR) performed after drainage in the safe triangle. CD foreshortening was estimated as a decrease of chest drain index (CDI = length of CD in chest taken from CR/depth of insertion on CD scale + 5 cm). The angle of inclination of the CD was measured between the horizontal line and the CD at the point where it enters pleural space on CR. Results Of the total 106 pneumothorax cases 80 patients had full lung expansion on CUS, the CD was located by CUS in 69 (86%), the CDI was 0.99 (0.88–1.06). 26 cases had a residual pneumothorax after drainage (24.5%), the CD was located by CUS in 31%, the CDI was 0.76 (0.6–0.93),p < 0.01. The risk ratio for a pneumothorax in a patient with not visible CD betwee...

The Effects of a Novel Calcium-Free Lactate Buffered Dialysis and Substitution Fluid for Regional Citrate Anticoagulation - Prospective Feasibility Study

by Martin Balik, Michal Otahal, Jan Rulisek, and Helena Brodska

Blood Purification, 2014

fluid performed well within ordinary CRRT dosage and Qb up to 150 ml/min. Lactate levels mildly i... more

Pharmacokinetics of imipenem in critically ill patients during empirical treatment of nosocomial pneumonia: A comparison of 0.5-h and 3-h infusions

by Michal Lipš and Martin Balik

International Journal of Antimicrobial Agents, 2014

Please cite this article in press as: Lipš M, et al. Pharmacokinetics of imipenem in critically i... more Please cite this article in press as: Lipš M, et al. Pharmacokinetics of imipenem in critically ill patients during empirical treatment of nosocomial pneumonia: A comparison of 0.5-h and 3-h infusions. Int J Antimicrob Agents (2014), http://dx.

Envenoming by the viperid snake Proatheris superciliaris: A case report

Toxicon, 2008

Snake bites caused by viperid snakes of Atheris genus are extremely rare, envenoming of a bite of... more Snake bites caused by viperid snakes of Atheris genus are extremely rare, envenoming of a bite of related viper Proatheris superciliaris was described only once in the literature. The present case study depicts the envenoming of a 57 years old Czech man, a private herpetologist, who was bitten to his finger. He developed painful local reaction, nausea, hematuria, hypertension, chest and lumbar pain. Coagulopathy and thrombocytopenia subsequently developed as well as acute renal failure, hepatic and lung lesion. Intensive care therapy was purely symptomatic and supportive as no antisera exists. Treatment included haemodialysis, substitution of fresh frozen plasma and platelets. Patient completely recovered during 1 month.

Concomitant use of beta-1 adrenoreceptor blocker and norepinephrine in patients with septic shock. Reply to a letter to the authors

by Martin Balik, Michal Otahal, Jan Rulisek, and Hana Bartakova

Wiener klinische Wochenschrift, 2014

Your article is protected by copyright and all rights are held exclusively by Springer-Verlag Wie... more Your article is protected by copyright and all rights are held exclusively by Springer-Verlag Wien. This e-offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to selfarchive your work, please use the accepted author's version for posting to your own website or your institution's repository. You may further deposit the accepted author's version on a funder's repository at a funder's request, provided it is not made publicly available until 12 months after publication.

Cystatin C as a Marker of Residual Renal Function during Continuous Hemodiafiltration

Kidney and Blood Pressure Research, 2005

Background: The level of residual renal function (RRF) has an important impact on follow-up in cr... more Background: The level of residual renal function (RRF) has an important impact on follow-up in critically ill patients with renal failure. There is currently no clear marker of RRF. Methods: Cystatin C (cysC) concentrations were measured before and during the first 48 h of CVVHDF in 33 mechanically ventilated patients suffering from renal failure. Samples were drawn both from the ports proximal and distal to the filter. Each of the two control groups consisted of 10 patients. Results: The levels of cysC were significantly higher in the group where diuresis (Vu) remained low or decreased after 48 h of treatment (n = 21, Vu median 380 (80-935) ml/24 h, cysC range 4.44-3.42 mg/l) than in the group where Vu increased to the level of 1.5 ml W kg -1 W h -1 or higher after 48 h of treatment (n = 12, Vu 4,570 (4,000-5,130) ml/24 h, cysC 3.17-2.46 mg/l, p ! 0.01). Creatinine clearance taken before treatment was not different between the groups. Significant correlation between cysC levels and Vu was found (r = -0.44, p ! 0.0001). CysC levels were significantly higher in non-survivors than in survivors (3.54 B 1.38 vs. 3.07 B 1.24, p ! 0.03). Conclusion: The levels of cysC are inversely related to Vu. High levels of cysC are associated with low residual diuresis, longer duration of CVVHDF and higher intensive care unit mortality in patients treated with CVVHDF.

Hyperinvasive approach to out-of hospital cardiac arrest using mechanical chest compression device, prehospital intraarrest cooling, extracorporeal life support and early invasive assessment compared to standard of care. A randomized parallel groups comparative study proposal. “Prague OHCA study”

Journal of Translational Medicine, 2012

$Research paper thumbnail of Bioenergetic gain of citrate anticoagulated continuous hemodiafiltration—a comparison between 2 citrate modalities and unfractionated heparin$

Bioenergetic gain of citrate anticoagulated continuous hemodiafiltration—a comparison between 2 citrate modalities and unfractionated heparin

by Martin Balik, Michal Otahal, Ferdinand Polak, Heleen Straaten, and Kateřina Rusinová

Journal of Critical Care, 2013

Purpose: To determine bioenergetic gain of 2 different citrate anticoagulated continuous hemodiaf... more Purpose: To determine bioenergetic gain of 2 different citrate anticoagulated continuous hemodiafiltration (CVVHDF) modalities and a heparin modality. Materials and Methods: We compared the bio-energetic gain of citrate, glucose and lactate between 29 patients receiving 2.2% acid-citrate-dextrose with calcium-containing lactate-buffered solutions (ACD/ Ca plus /lactate), 34 on 4% trisodium citrate with calcium-free low-bicarbonate buffered fluids (TSC/ Ca min /bicarbonate), and 18 on heparin with lactate buffering (Hep/lactate). Results: While delivered CVVHDF dose was about 2000 mL/h, total bioenergetic gain was 262kJ/h (IQR 230-284) with ACD/Ca plus /lactate, 20 kJ/h (8-25) with TSC/Ca min /bicarbonate (P b .01) and 60 kJ/h (52-76) with Hep/lactate. Median patient delivery of citrate was 31.2 mmol/h (25-34.7) in ACD/ Ca plus /lactate versus 14.8 mmol/h (12.4-19.1) in TSC/Ca min /bicarbonate groups (P b .01). Median delivery of glucose was 36.8 mmol/h (29.9-43) in ACD/Ca plus /lactate, and of lactate 52.5 mmol/h (49.2-59.1) in ACD/Ca plus /lactate and 56.1 mmol/h (49.6-64.2) in Hep/lactate groups. The higher energy delivery with ACD/Ca plus /lactate was partially due to the higher blood flow used in this modality and the calcium-containing dialysate. ☆ ClinicalTrials.gov Identifier: NCT01361581. Journal of Critical Care (2012) xx, xxx-xxx

Fluid Therapy LiDCO Controlled Trial—Optimization of Volume Resuscitation of Extensively Burned Patients through Noninvasive Continuous Real-Time Hemodynamic Monitoring LiDCO

Journal of Burn Care & Research, 2013

This pilot trial aims at gaining support for the optimization of acute burn resuscitation through... more This pilot trial aims at gaining support for the optimization of acute burn resuscitation through noninvasive continuous real-time hemodynamic monitoring using arterial pulse contour analysis. A group of 21 burned patients meeting preliminary criteria (age range 18-75 years with second- third- degree burns and TBSA ≥10-75%) was randomized during 2010. A hemodynamic monitoring through lithium dilution cardiac output was used in 10 randomized patients (LiDCO group), whereas those without LiDCO monitoring were defined as the control group. The modified Brooke/Parkland formula as a starting resuscitative formula, balanced crystalloids as the initial solutions, urine output of 0.5 ml/kg/hr as a crucial value of adequate intravascular filling were used in both groups. Additionally, the volume and vasopressor/inotropic support were based on dynamic preload parameters in the LiDCO group in the case of circulatory instability and oligouria. Statistical analysis was done using t-tests. Within the first 24 hours postburn, a significantly lower consumption of crystalloids was registered in LiDCO group (P = .04). The fluid balance under LiDCO control in combination with hourly diuresis contributed to reducing the cumulative fluid balance approximately by 10% compared with fluid management based on standard monitoring parameters. The amount of applied solutions in the LiDCO group got closer to Brooke formula whereas the urine output was at the same level in both groups (0.8 ml/kg/hr). The new finding in this study is that when a fluid resuscitation is based on the arterial waveform analysis, the initial fluid volume provided was significantly lower than that delivered on the basis of physician-directed fluid resuscitation (by urine output and mean arterial pressure).

CRT-127 Hyperinvasive Approach To Out-of Hospital Cardiac Arrest Using Mechanical Chest Compression Device, Prehospital Intraarrest Cooling, Extracorporeal Life Support And Early Invasive Assessment Compared To Standard Of Care. A Randomized Parallel Groups Comparative Study. “Prague Ohca Study"....

by Martin Balik, Ondrej Franek, Jiri Danda, and Vratislav Mrazek

JACC: Cardiovascular Interventions, 2013

Effect of the degree of tricuspid regurgitation on cardiac output measurements by thermodilution

Intensive Care Medicine, 2002

Objective: To determine the relationship between the degree of tricuspid regurgitation (TR) and a... more Objective: To determine the relationship between the degree of tricuspid regurgitation (TR) and accuracy of cardiac output measurement by thermodilution in mechanically ventilated patients. Design and setting: Prospective observational study in a 20-bed general intensive care unit in the university hospital. Patients: We examined 27 patients (not undergoing cardiac surgery): 8 with no or 1st degree TR, 9 with 2nd degree, and 10 with 3rd degree TR. Interventions: All patients were measured twice using simultaneously transesophageal echocardiography and pulmonary artery catheter for cardiac output. Measurements and results: Continuous Doppler measurements were taken in the left ventricular outflow tract at the level of the aortic valve. Cardiac output was calculated by multiplying the velocity-time integral by aortic valve area and heart rate. Simultaneous pulmonary artery catheter measurements were taken averaging the results of the three 10-cc boluses of iced saline. The difference between the methods was 0.5±1.1 l/min (mean ±2 SD) in patients with no or 1st degree TR (r=0.96), 0.8±2.0 l/min in those with 2nd degree TR (r=0.92), and 1.9±2.3 l/min in those with 3rd degree TR (r=0.69). Conclusions: A high degree of TR is associated with underestimation of cardiac output measured by thermodilution. A (1999) Effects of injectate volume on thermodilution measurements of cardiac output in patients with low ventricular ejection fraction. Am J Crit Care 8:86-92 3. Tournadre JP, Chassard D, Muchada R (1997) Overestimation of low cardiac output measured by thermodilution. Br J Anaesth 79:514-516

Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients

by Michal Otahal, Martin Balik, P. Plásil, J. Pazout, and M. Fric

Intensive Care Medicine, 2006

appears to be a safe procedure.

Prognostic values of B-type natriuretic peptide in severe sepsis and septic shock*

Critical Care Medicine, 2007

Objective: To investigate the changes in B-type natriuretic peptide concentrations in patients wi... more

Systemic citrate load during continuous renal replacement therapy is not negligible and can be predicted using indirect methods

by Michal Otahal and Martin Balik

Critical Care, 2011

Homeostatic indications for the administration of diuretics

Critical Care, 1999

Crit Care 1999, 3 3 ( (s su up pp pl l 1 1) ):P1 I In nt tr ro od du uc ct ti io on n: : Critical... more Crit Care 1999, 3 3 ( (s su up pp pl l 1 1) ):P1 I In nt tr ro od du uc ct ti io on n: : Critically ill patients requiring intensive care are at risk of iatrogenic ocular damage. Studies have reported an incidence of eye problems of up to 40% in critically ill ventilated patients. We conducted this study to assess the incidence of ocular complications in our intensive care unit where all patients are cared for according to an eye care standard.

Prognostic Impact of Serial Imaging in Severe Acute Respiratory Distress Syndrome on the Extracorporeal Membrane Oxygenation

Journal of Clinical Medicine

Background: The impact of serial imaging on the outcome of ICU patients has not been studied spec... more Background: The impact of serial imaging on the outcome of ICU patients has not been studied specifically in patients with high illness severity. Methods: The authors sought a relationship between the numbers of antero-posterior supine chest X-rays (CXR), computed tomography (CT) examinations, and outcome in a cohort of 292 patients with severe COVID-19 ARDS collected over 24 months in a high-volume ECMO center with established ultrasound and echocardiographic diagnostics. Of the patients, 172 (59%) were obese or morbidly obese, and 119 (41%) were treated with ECMO. Results: The median number of CXRs was eight per 14 days of the length of stay in the ICU. The CXR rate was not related to ICU survival (p = 0.37). Patients required CT scanning in 26.5% of cases, with no relationship to the outcome except for the better ICU survival of the ECMO patients without a need for a CT scan (p = 0.01). The odds ratio for survival associated with ordering a CT scan in an ECMO patient was 0.48, p ...

Vazopresin a jeho role v anesteziologii a intenzivní medicíně

Anesteziologie a intenzivní medicína, Aug 1, 2015

Vazopresin má svoji nezastupitelnou roli v řízení tonu cév a jeho nedostatečná hladina se významn... more Vazopresin má svoji nezastupitelnou roli v řízení tonu cév a jeho nedostatečná hladina se významně podílí na rozvoji refrakterních šokových stavů spojených se sepsí, hemoragií a mimotělním oběhem. Jeho funkce při kontrole udržování arteriálního tlaku se zvýrazňuje ve chvílích, kdy jsou ostatní systémy blokované, nefunkční či k udržení tlaku nestačí-například při septickém šoku nebo u refrakterní vazoparalýzy. Nízké dávky vazopresinu mohou ve zmíněných situacích synergickým účinkem s noradrenalinem přispět k normalizaci cévního tonu a obnovení perfuze vitálně důležitých orgánů. Mezi indikace patří septický šok s potřebou vysoké terapeutické dávky noradrenalinu, a to zvláště u pacientů s dysfunkcí myokardu a plicní hypertenzí na umělé plicní ventilaci. Vazopresin se uplatní u závažné vazoparalýzy nejen v souvislosti se sepsí, ale i v kardioanestezii a u intoxikací kardiofarmaky. Význam má u dárců orgánů, portální hypertenze a během kardiopulmonální resuscitace. V České republice je na rozdíl od řady zemí EU, Kanady, Austrálie a Nového Zélandu dostupný pouze na zvláštní dovoz, což jej činí pro konkrétního pacienta, nacházejícího se v danou chvíli v kritickém stavu, téměř nepoužitelným. K dispozici je u nás volně pouze jeho syntetický analog terlipressin, který je však, pro svou odlišnou farmakodynamiku a farmakokinetiku, horší řiditelnost a vyšší počet vedlejších efektů v těchto situacích méně vhodný. Proto je dosažitelnost krátkodobě působícího vazopresinu na našem trhu velmi žádoucí. KLÍČOVÁ SLOVA vazopresin-septický šok-hypotenze-vazoparalýza-portální hypertenze-dárci orgánů-kardiopulmonální resuscitace

Extracorporeal Membrane Oxygenation for Septic Shock

Critical Care Medicine, 2019

Objectives: Septic shock carries a high mortality risk. Studies have indicated that patients with... more Objectives: Septic shock carries a high mortality risk. Studies have indicated that patients with septic shock may benefit from extracorporeal membrane oxygenation. In most studies, patients exhibited shock due to myocardial dysfunction rather than distributive/vasoplegic shock. One proposed theory is that venoarterial extracorporeal membrane oxygenation alleviates a failing myocardial function. Design: Retrospective observational study. Setting: Single-center, high-volume extracorporeal membrane oxygenation unit. Patients: All patients treated for septic shock between 2012 and 2017 with an age greater than 18 years old, fulfilling septic shock criteria according to “Sepsis-3” at acceptance for extracorporeal membrane oxygenation, presence of cardiocirculatory failure requiring a support equivalent to a Vasoactive Inotropic Score greater than 50 to reach a mean arterial pressure greater than 65 mm Hg despite adequate fluid resuscitation, were included. Interventions: None. Measureme...

Pulmonary consolidation alters the ultrasound estimate of pleural fluid volume when considering chest drainage in patients on ECMO

Critical Care

Imaging of COVID-19 in critical care with a focus on chest ultrasound

Anesteziologie a intenzivní medicína

Imaging methods available at the bedside have become an indispensable part of the diagnostic proc... more Imaging methods available at the bedside have become an indispensable part of the diagnostic process of COVID-19 in the intensive care setting. Chest ultrasound has been established as an exquisite bedside imaging tool to assess and diagnose a myriad of lung pathologies, assess the pleural space and diaphragm, and ultimately gauge therapeutic interventions. Furthermore, vital information can be attained on the haemodynamic status of a patient when chest ultrasound is combined with echocardiography and Doppler vascular assessment. Bedside chest x-ray has its technical limitations, is not sensitive in early stages of the disease, and exposes patients to radiation. Computed tomography has great spatial resolution and all the structures in the chest can be assessed, but on the other hand, it requires patient transport and exposes them to radiation and the potential side effects of contrast administration. Recently, chest ultrasound has proved to be extremely useful during the COVID-19 pandemic in assessing COVID-19 pneumonia and its complications with a resultant reduction in potential infectious cross-contamination of staff and patients due to transport to and from the radiology department. In this review, the authors compare the three most frequent modalities of chest imaging in the diagnosis of COVID-19 in critical care, with a focus on the benefits of chest ultrasound.

Interpleural location of chest drain on ultrasound excludes pneumothorax and associates with a low degree of chest drain foreshortening on the antero-posterior chest X-ray

The Ultrasound Journal

Background The role of chest drain (CD) location by bedside imaging methods in the diagnosis of p... more Background The role of chest drain (CD) location by bedside imaging methods in the diagnosis of pneumothorax has not been explored in a prospective study yet. Methods Covid-19 ARDS patients with pneumothorax were prospectively monitored with chest ultrasound (CUS) and antero-posterior X-ray (CR) performed after drainage in the safe triangle. CD foreshortening was estimated as a decrease of chest drain index (CDI = length of CD in chest taken from CR/depth of insertion on CD scale + 5 cm). The angle of inclination of the CD was measured between the horizontal line and the CD at the point where it enters pleural space on CR. Results Of the total 106 pneumothorax cases 80 patients had full lung expansion on CUS, the CD was located by CUS in 69 (86%), the CDI was 0.99 (0.88–1.06). 26 cases had a residual pneumothorax after drainage (24.5%), the CD was located by CUS in 31%, the CDI was 0.76 (0.6–0.93),p < 0.01. The risk ratio for a pneumothorax in a patient with not visible CD betwee...

The Effects of a Novel Calcium-Free Lactate Buffered Dialysis and Substitution Fluid for Regional Citrate Anticoagulation - Prospective Feasibility Study

by Martin Balik, Michal Otahal, Jan Rulisek, and Helena Brodska

Blood Purification, 2014

fluid performed well within ordinary CRRT dosage and Qb up to 150 ml/min. Lactate levels mildly i... more

Pharmacokinetics of imipenem in critically ill patients during empirical treatment of nosocomial pneumonia: A comparison of 0.5-h and 3-h infusions

by Michal Lipš and Martin Balik

International Journal of Antimicrobial Agents, 2014

Please cite this article in press as: Lipš M, et al. Pharmacokinetics of imipenem in critically i... more Please cite this article in press as: Lipš M, et al. Pharmacokinetics of imipenem in critically ill patients during empirical treatment of nosocomial pneumonia: A comparison of 0.5-h and 3-h infusions. Int J Antimicrob Agents (2014), http://dx.

Envenoming by the viperid snake Proatheris superciliaris: A case report

Toxicon, 2008

Snake bites caused by viperid snakes of Atheris genus are extremely rare, envenoming of a bite of... more Snake bites caused by viperid snakes of Atheris genus are extremely rare, envenoming of a bite of related viper Proatheris superciliaris was described only once in the literature. The present case study depicts the envenoming of a 57 years old Czech man, a private herpetologist, who was bitten to his finger. He developed painful local reaction, nausea, hematuria, hypertension, chest and lumbar pain. Coagulopathy and thrombocytopenia subsequently developed as well as acute renal failure, hepatic and lung lesion. Intensive care therapy was purely symptomatic and supportive as no antisera exists. Treatment included haemodialysis, substitution of fresh frozen plasma and platelets. Patient completely recovered during 1 month.

Concomitant use of beta-1 adrenoreceptor blocker and norepinephrine in patients with septic shock. Reply to a letter to the authors

by Martin Balik, Michal Otahal, Jan Rulisek, and Hana Bartakova

Wiener klinische Wochenschrift, 2014

Your article is protected by copyright and all rights are held exclusively by Springer-Verlag Wie... more Your article is protected by copyright and all rights are held exclusively by Springer-Verlag Wien. This e-offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to selfarchive your work, please use the accepted author's version for posting to your own website or your institution's repository. You may further deposit the accepted author's version on a funder's repository at a funder's request, provided it is not made publicly available until 12 months after publication.

Cystatin C as a Marker of Residual Renal Function during Continuous Hemodiafiltration

Kidney and Blood Pressure Research, 2005

Background: The level of residual renal function (RRF) has an important impact on follow-up in cr... more Background: The level of residual renal function (RRF) has an important impact on follow-up in critically ill patients with renal failure. There is currently no clear marker of RRF. Methods: Cystatin C (cysC) concentrations were measured before and during the first 48 h of CVVHDF in 33 mechanically ventilated patients suffering from renal failure. Samples were drawn both from the ports proximal and distal to the filter. Each of the two control groups consisted of 10 patients. Results: The levels of cysC were significantly higher in the group where diuresis (Vu) remained low or decreased after 48 h of treatment (n = 21, Vu median 380 (80-935) ml/24 h, cysC range 4.44-3.42 mg/l) than in the group where Vu increased to the level of 1.5 ml W kg -1 W h -1 or higher after 48 h of treatment (n = 12, Vu 4,570 (4,000-5,130) ml/24 h, cysC 3.17-2.46 mg/l, p ! 0.01). Creatinine clearance taken before treatment was not different between the groups. Significant correlation between cysC levels and Vu was found (r = -0.44, p ! 0.0001). CysC levels were significantly higher in non-survivors than in survivors (3.54 B 1.38 vs. 3.07 B 1.24, p ! 0.03). Conclusion: The levels of cysC are inversely related to Vu. High levels of cysC are associated with low residual diuresis, longer duration of CVVHDF and higher intensive care unit mortality in patients treated with CVVHDF.

Hyperinvasive approach to out-of hospital cardiac arrest using mechanical chest compression device, prehospital intraarrest cooling, extracorporeal life support and early invasive assessment compared to standard of care. A randomized parallel groups comparative study proposal. “Prague OHCA study”

Journal of Translational Medicine, 2012

$Research paper thumbnail of Bioenergetic gain of citrate anticoagulated continuous hemodiafiltration—a comparison between 2 citrate modalities and unfractionated heparin$

Bioenergetic gain of citrate anticoagulated continuous hemodiafiltration—a comparison between 2 citrate modalities and unfractionated heparin

by Martin Balik, Michal Otahal, Ferdinand Polak, Heleen Straaten, and Kateřina Rusinová

Journal of Critical Care, 2013

Purpose: To determine bioenergetic gain of 2 different citrate anticoagulated continuous hemodiaf... more Purpose: To determine bioenergetic gain of 2 different citrate anticoagulated continuous hemodiafiltration (CVVHDF) modalities and a heparin modality. Materials and Methods: We compared the bio-energetic gain of citrate, glucose and lactate between 29 patients receiving 2.2% acid-citrate-dextrose with calcium-containing lactate-buffered solutions (ACD/ Ca plus /lactate), 34 on 4% trisodium citrate with calcium-free low-bicarbonate buffered fluids (TSC/ Ca min /bicarbonate), and 18 on heparin with lactate buffering (Hep/lactate). Results: While delivered CVVHDF dose was about 2000 mL/h, total bioenergetic gain was 262kJ/h (IQR 230-284) with ACD/Ca plus /lactate, 20 kJ/h (8-25) with TSC/Ca min /bicarbonate (P b .01) and 60 kJ/h (52-76) with Hep/lactate. Median patient delivery of citrate was 31.2 mmol/h (25-34.7) in ACD/ Ca plus /lactate versus 14.8 mmol/h (12.4-19.1) in TSC/Ca min /bicarbonate groups (P b .01). Median delivery of glucose was 36.8 mmol/h (29.9-43) in ACD/Ca plus /lactate, and of lactate 52.5 mmol/h (49.2-59.1) in ACD/Ca plus /lactate and 56.1 mmol/h (49.6-64.2) in Hep/lactate groups. The higher energy delivery with ACD/Ca plus /lactate was partially due to the higher blood flow used in this modality and the calcium-containing dialysate. ☆ ClinicalTrials.gov Identifier: NCT01361581. Journal of Critical Care (2012) xx, xxx-xxx

Fluid Therapy LiDCO Controlled Trial—Optimization of Volume Resuscitation of Extensively Burned Patients through Noninvasive Continuous Real-Time Hemodynamic Monitoring LiDCO

Journal of Burn Care & Research, 2013

This pilot trial aims at gaining support for the optimization of acute burn resuscitation through... more This pilot trial aims at gaining support for the optimization of acute burn resuscitation through noninvasive continuous real-time hemodynamic monitoring using arterial pulse contour analysis. A group of 21 burned patients meeting preliminary criteria (age range 18-75 years with second- third- degree burns and TBSA ≥10-75%) was randomized during 2010. A hemodynamic monitoring through lithium dilution cardiac output was used in 10 randomized patients (LiDCO group), whereas those without LiDCO monitoring were defined as the control group. The modified Brooke/Parkland formula as a starting resuscitative formula, balanced crystalloids as the initial solutions, urine output of 0.5 ml/kg/hr as a crucial value of adequate intravascular filling were used in both groups. Additionally, the volume and vasopressor/inotropic support were based on dynamic preload parameters in the LiDCO group in the case of circulatory instability and oligouria. Statistical analysis was done using t-tests. Within the first 24 hours postburn, a significantly lower consumption of crystalloids was registered in LiDCO group (P = .04). The fluid balance under LiDCO control in combination with hourly diuresis contributed to reducing the cumulative fluid balance approximately by 10% compared with fluid management based on standard monitoring parameters. The amount of applied solutions in the LiDCO group got closer to Brooke formula whereas the urine output was at the same level in both groups (0.8 ml/kg/hr). The new finding in this study is that when a fluid resuscitation is based on the arterial waveform analysis, the initial fluid volume provided was significantly lower than that delivered on the basis of physician-directed fluid resuscitation (by urine output and mean arterial pressure).

CRT-127 Hyperinvasive Approach To Out-of Hospital Cardiac Arrest Using Mechanical Chest Compression Device, Prehospital Intraarrest Cooling, Extracorporeal Life Support And Early Invasive Assessment Compared To Standard Of Care. A Randomized Parallel Groups Comparative Study. “Prague Ohca Study"....

by Martin Balik, Ondrej Franek, Jiri Danda, and Vratislav Mrazek

JACC: Cardiovascular Interventions, 2013

Effect of the degree of tricuspid regurgitation on cardiac output measurements by thermodilution

Intensive Care Medicine, 2002

Objective: To determine the relationship between the degree of tricuspid regurgitation (TR) and a... more Objective: To determine the relationship between the degree of tricuspid regurgitation (TR) and accuracy of cardiac output measurement by thermodilution in mechanically ventilated patients. Design and setting: Prospective observational study in a 20-bed general intensive care unit in the university hospital. Patients: We examined 27 patients (not undergoing cardiac surgery): 8 with no or 1st degree TR, 9 with 2nd degree, and 10 with 3rd degree TR. Interventions: All patients were measured twice using simultaneously transesophageal echocardiography and pulmonary artery catheter for cardiac output. Measurements and results: Continuous Doppler measurements were taken in the left ventricular outflow tract at the level of the aortic valve. Cardiac output was calculated by multiplying the velocity-time integral by aortic valve area and heart rate. Simultaneous pulmonary artery catheter measurements were taken averaging the results of the three 10-cc boluses of iced saline. The difference between the methods was 0.5±1.1 l/min (mean ±2 SD) in patients with no or 1st degree TR (r=0.96), 0.8±2.0 l/min in those with 2nd degree TR (r=0.92), and 1.9±2.3 l/min in those with 3rd degree TR (r=0.69). Conclusions: A high degree of TR is associated with underestimation of cardiac output measured by thermodilution. A (1999) Effects of injectate volume on thermodilution measurements of cardiac output in patients with low ventricular ejection fraction. Am J Crit Care 8:86-92 3. Tournadre JP, Chassard D, Muchada R (1997) Overestimation of low cardiac output measured by thermodilution. Br J Anaesth 79:514-516

Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients

by Michal Otahal, Martin Balik, P. Plásil, J. Pazout, and M. Fric

Intensive Care Medicine, 2006

appears to be a safe procedure.

Prognostic values of B-type natriuretic peptide in severe sepsis and septic shock*

Critical Care Medicine, 2007

Objective: To investigate the changes in B-type natriuretic peptide concentrations in patients wi... more

Systemic citrate load during continuous renal replacement therapy is not negligible and can be predicted using indirect methods

by Michal Otahal and Martin Balik

Critical Care, 2011

Homeostatic indications for the administration of diuretics

Critical Care, 1999

Crit Care 1999, 3 3 ( (s su up pp pl l 1 1) ):P1 I In nt tr ro od du uc ct ti io on n: : Critical... more Crit Care 1999, 3 3 ( (s su up pp pl l 1 1) ):P1 I In nt tr ro od du uc ct ti io on n: : Critically ill patients requiring intensive care are at risk of iatrogenic ocular damage. Studies have reported an incidence of eye problems of up to 40% in critically ill ventilated patients. We conducted this study to assess the incidence of ocular complications in our intensive care unit where all patients are cared for according to an eye care standard.