The aim of the study was to compare the effect of sevoflurane and propofol anesthesia on myocardi... more The aim of the study was to compare the effect of sevoflurane and propofol anesthesia on myocardial contractility during laparotomic cholecystectomy using transesophageal echo-Doppler. In the study, 40 patients were randomized into two groups, depending on whether they received sevoflurane or propofol anesthesia. Heart rate, cardiac index, stroke volume, left ventricular ejection time and acceleration were measured 10 minutes after induction of anesthesia, 1 minute and 25 minutes after incision. The results were analyzed using paired t-test and ANOVA. Significantly lower values were found for all parameters after the initial measurement (p < 0.05). In the sevoflurane group, stroke volume decreased from 66 +/- 6.2 ml/beat to 65 +/- 6.4 ml/beat and to 63 +/- 5.6 ml/beat 1 minute and 25 minutes after incision respectively. In the propofol group changes were from 64 ml/beat to 58 +/- 10.5 ml/beat to 58 +/- 8.6 ml/beat. Stroke volume was significantly higher in the sevoflurane than in...
Sažetak: Cilj rada bio je utvrditi odnos disperzije QT intervala i pojave ranih ventrikulskih ari... more Sažetak: Cilj rada bio je utvrditi odnos disperzije QT intervala i pojave ranih ventrikulskih aritmija u bolesnika s akutnim infarktom miokarda. Disperzija QT intervala praćena je dinamički tijekom hospitalizacije te izražavana kao razlika između najduljeg i najkraćeg ...
Severe COVID-19 pneumonia in which mechanical ventilation is unable to achieve adequate gas excha... more Severe COVID-19 pneumonia in which mechanical ventilation is unable to achieve adequate gas exchange can be treated with veno-venous ECMO, eliminating the need for aggressive mechanical ventilation which might promote ventilator-induced lung injury and increase mortality. In this retrospective observational study, 18 critically ill COVID-19 patients who were treated using V-V ECMO during an 11-month period in a tertiary COVID-19 hospital were analyzed. Biomarkers of inflammation and clinical features were compared between survivors and non-survivors. Survival rates were compared between patients receiving ECMO and propensity matched mechanically ventilated controls. There were 7 survivors and 11 non-survivors. The survivors were significantly younger, with a higher proportion of females, higher serum procalcitonin at ICU admission, and before initiation of ECMO they had significantly lower Murray scores, PaCO2, WBC counts, serum ferritin levels, and higher glomerular filtration rate...
After the implantation of the left ventricular assisted device (LVAD), patients are admitted in i... more After the implantation of the left ventricular assisted device (LVAD), patients are admitted in intensive care unit (ICU). During the period of first several days, the goal of the postoperative care is to stabilize the patients’ hemodynamics. Monitoring the continuous cardiac output, filling volumes and outflow resistance is necessary for the proper functioning of the pump. The use of pulmonary artery catheter and the transesophageal echocardiography are primary procedures. During the operation of the left ventricular support, the measuring of proper ventricular function and the early recognition of its dysfunction is important for a positive outcome. Further potential complications in connection with these patients are an increased risk of hemorrhage and thromboembolism. The infection of drivelines and devices in the early postoperative period occurs in up to 40 % of these patients. In case of a cardiac arrest, a special procedure has to be performed in patients in whom LVAD was im...
ImportanceMeropenem is a widely prescribed β-lactam antibiotic. Meropenem exhibits maximum pharma... more ImportanceMeropenem is a widely prescribed β-lactam antibiotic. Meropenem exhibits maximum pharmacodynamic efficacy when given by continuous infusion to deliver constant drug levels above the minimal inhibitory concentration. Compared with intermittent administration, continuous administration of meropenem may improve clinical outcomes.ObjectiveTo determine whether continuous administration of meropenem reduces a composite of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria compared with intermittent administration in critically ill patients with sepsis.Design, Setting, and ParticipantsA double-blind, randomized clinical trial enrolling critically ill patients with sepsis or septic shock who had been prescribed meropenem by their treating clinicians at 31 intensive care units of 26 hospitals in 4 countries (Croatia, Italy, Kazakhstan, and Russia). Patients were enrolled between June 5, 2018, and August 9, 2022, and the final 90-day follow-up was completed in November 2022.InterventionsPatients were randomized to receive an equal dose of the antibiotic meropenem by either continuous administration (n = 303) or intermittent administration (n = 304).Main Outcomes and MeasuresThe primary outcome was a composite of all-cause mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28. There were 4 secondary outcomes, including days alive and free from antibiotics at day 28, days alive and free from the intensive care unit at day 28, and all-cause mortality at day 90. Seizures, allergic reactions, and mortality were recorded as adverse events.ResultsAll 607 patients (mean age, 64 [SD, 15] years; 203 were women [33%]) were included in the measurement of the 28-day primary outcome and completed the 90-day mortality follow-up. The majority (369 patients, 61%) had septic shock. The median time from hospital admission to randomization was 9 days (IQR, 3-17 days) and the median duration of meropenem therapy was 11 days (IQR, 6-17 days). Only 1 crossover event was recorded. The primary outcome occurred in 142 patients (47%) in the continuous administration group and in 149 patients (49%) in the intermittent administration group (relative risk, 0.96 [95% CI, 0.81-1.13], P = .60). Of the 4 secondary outcomes, none was statistically significant. No adverse events of seizures or allergic reactions related to the study drug were reported. At 90 days, mortality was 42% both in the continuous administration group (127 of 303 patients) and in the intermittent administration group (127 of 304 patients).Conclusions and RelevanceIn critically ill patients with sepsis, compared with intermittent administration, the continuous administration of meropenem did not improve the composite outcome of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28.Trial RegistrationClinicalTrials.gov Identifier: NCT03452839
The aim of the study was to compare the effect of sevoflurane and propofol anesthesia on myocardi... more The aim of the study was to compare the effect of sevoflurane and propofol anesthesia on myocardial contractility during laparotomic cholecystectomy using transesophageal echo-Doppler. In the study, 40 patients were randomized into two groups, depending on whether they received sevoflurane or propofol anesthesia. Heart rate, cardiac index, stroke volume, left ventricular ejection time and acceleration were measured 10 minutes after induction of anesthesia, 1 minute and 25 minutes after incision. The results were analyzed using paired t-test and ANOVA. Significantly lower values were found for all parameters after the initial measurement (p < 0.05). In the sevoflurane group, stroke volume decreased from 66 +/- 6.2 ml/beat to 65 +/- 6.4 ml/beat and to 63 +/- 5.6 ml/beat 1 minute and 25 minutes after incision respectively. In the propofol group changes were from 64 ml/beat to 58 +/- 10.5 ml/beat to 58 +/- 8.6 ml/beat. Stroke volume was significantly higher in the sevoflurane than in...
Sažetak: Cilj rada bio je utvrditi odnos disperzije QT intervala i pojave ranih ventrikulskih ari... more Sažetak: Cilj rada bio je utvrditi odnos disperzije QT intervala i pojave ranih ventrikulskih aritmija u bolesnika s akutnim infarktom miokarda. Disperzija QT intervala praćena je dinamički tijekom hospitalizacije te izražavana kao razlika između najduljeg i najkraćeg ...
Severe COVID-19 pneumonia in which mechanical ventilation is unable to achieve adequate gas excha... more Severe COVID-19 pneumonia in which mechanical ventilation is unable to achieve adequate gas exchange can be treated with veno-venous ECMO, eliminating the need for aggressive mechanical ventilation which might promote ventilator-induced lung injury and increase mortality. In this retrospective observational study, 18 critically ill COVID-19 patients who were treated using V-V ECMO during an 11-month period in a tertiary COVID-19 hospital were analyzed. Biomarkers of inflammation and clinical features were compared between survivors and non-survivors. Survival rates were compared between patients receiving ECMO and propensity matched mechanically ventilated controls. There were 7 survivors and 11 non-survivors. The survivors were significantly younger, with a higher proportion of females, higher serum procalcitonin at ICU admission, and before initiation of ECMO they had significantly lower Murray scores, PaCO2, WBC counts, serum ferritin levels, and higher glomerular filtration rate...
After the implantation of the left ventricular assisted device (LVAD), patients are admitted in i... more After the implantation of the left ventricular assisted device (LVAD), patients are admitted in intensive care unit (ICU). During the period of first several days, the goal of the postoperative care is to stabilize the patients’ hemodynamics. Monitoring the continuous cardiac output, filling volumes and outflow resistance is necessary for the proper functioning of the pump. The use of pulmonary artery catheter and the transesophageal echocardiography are primary procedures. During the operation of the left ventricular support, the measuring of proper ventricular function and the early recognition of its dysfunction is important for a positive outcome. Further potential complications in connection with these patients are an increased risk of hemorrhage and thromboembolism. The infection of drivelines and devices in the early postoperative period occurs in up to 40 % of these patients. In case of a cardiac arrest, a special procedure has to be performed in patients in whom LVAD was im...
ImportanceMeropenem is a widely prescribed β-lactam antibiotic. Meropenem exhibits maximum pharma... more ImportanceMeropenem is a widely prescribed β-lactam antibiotic. Meropenem exhibits maximum pharmacodynamic efficacy when given by continuous infusion to deliver constant drug levels above the minimal inhibitory concentration. Compared with intermittent administration, continuous administration of meropenem may improve clinical outcomes.ObjectiveTo determine whether continuous administration of meropenem reduces a composite of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria compared with intermittent administration in critically ill patients with sepsis.Design, Setting, and ParticipantsA double-blind, randomized clinical trial enrolling critically ill patients with sepsis or septic shock who had been prescribed meropenem by their treating clinicians at 31 intensive care units of 26 hospitals in 4 countries (Croatia, Italy, Kazakhstan, and Russia). Patients were enrolled between June 5, 2018, and August 9, 2022, and the final 90-day follow-up was completed in November 2022.InterventionsPatients were randomized to receive an equal dose of the antibiotic meropenem by either continuous administration (n = 303) or intermittent administration (n = 304).Main Outcomes and MeasuresThe primary outcome was a composite of all-cause mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28. There were 4 secondary outcomes, including days alive and free from antibiotics at day 28, days alive and free from the intensive care unit at day 28, and all-cause mortality at day 90. Seizures, allergic reactions, and mortality were recorded as adverse events.ResultsAll 607 patients (mean age, 64 [SD, 15] years; 203 were women [33%]) were included in the measurement of the 28-day primary outcome and completed the 90-day mortality follow-up. The majority (369 patients, 61%) had septic shock. The median time from hospital admission to randomization was 9 days (IQR, 3-17 days) and the median duration of meropenem therapy was 11 days (IQR, 6-17 days). Only 1 crossover event was recorded. The primary outcome occurred in 142 patients (47%) in the continuous administration group and in 149 patients (49%) in the intermittent administration group (relative risk, 0.96 [95% CI, 0.81-1.13], P = .60). Of the 4 secondary outcomes, none was statistically significant. No adverse events of seizures or allergic reactions related to the study drug were reported. At 90 days, mortality was 42% both in the continuous administration group (127 of 303 patients) and in the intermittent administration group (127 of 304 patients).Conclusions and RelevanceIn critically ill patients with sepsis, compared with intermittent administration, the continuous administration of meropenem did not improve the composite outcome of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28.Trial RegistrationClinicalTrials.gov Identifier: NCT03452839
Uploads
Papers by Nikola Bradić