Until the outbreak of WW II, anaesthesiology, as a separate specialty, did not exist in Poland. After the fall of Poland, a large section of the Polish Armed Forces was evacuated to France and after that, to the UK, where Polish military physicians had a unique opportunity to obtain training in modern anaesthesia. The first regular courses were established at the University of Edinburgh. After WW II, doctor Stanisław Pokrzywnicki, a pioneer of Polish anaesthesiology, who was trained by Sir Robert Macintosh, and doctor Bolesław Rutkowski, an anaesthesiologist in London, returned to Poland and started regular services. This led to the registering of anaesthesiology as a separate specialty in 1951. In the article, the wartime and post-war stories of the first Polish anaesthesiologists are presented.

Lipid solutions used in parenteral nutrition (PN) are generally well tolerated. Recent studies reporting their effects on the immune system indicate that various compositions can modulate the immune response, thus affecting the response to pathogens and autoaggressive diseases. In this review, we discuss the compositions of various commercially available lipid solutions and their effects on the immune response to various pathologies. We conclude that: 1. Soybean oil-based emulsions are immunosuppressive and should be used with caution in inflammatory conditions, and are contraindicated in sepsis. 2. Mixtures of medium chain triglycerides and soybean oil are better tolerated. 3. Olive oil-based mixtures are neutral and are especially recommended for burned patients, premature infants and for long term PN. 4. Fish oil-based emulsions are beneficial in inflammatory conditions and in patients after major abdominal surgery.

Coagulopathies of various origins have been mentioned among the leading causes of morbidity in hospitals all over the world. Time-consuming coagulation assays delay the diagnosis and response to a dynamic pathology. The need to analyse whole blood for the accurate identification of coagulopathies has led to a revival of interest in thromboelastography (TEG). This simple test can be performed at the bedside using non-anticoagulated blood, and enables complex assessment of extrinsic and intrinsic pathways of coagulation and fibrinolysis. TEG can be also used to predict postoperative bleeding and/or organ dysfunction. TEG has been widely used in research, but poor understanding of the technique has limited its clinical use. Controversies regarding the relationship between traditional tests and TEG have made the bedside use of TEG less popular than it should be. In the review, the authors discuss details of the process and practical aspects of its use in clinical settings.

Blunt chest trauma is frequently associated with cardiac contusion and structural damage, most cases only being recognized after death. We report a case of multiple organ trauma, where cardiac failure, caused by tricuspid valve rupture, was markedly delayed.A 21 yr old man was admitted to hospital after a car accident. He was suffering from cerebral contusion and oedema, pulmonary contusion, and a left pneumothorax. He also had multiple fractures of the facial bones, orbit, L4 vertebra and left tibia. He was tracheotomised, and a subdural sensor was inserted for continuous monitoring of intracranial pressure. He was sedated and ventilated for two weeks. On the 12th day, his jaw was reconstructed, and immediately after surgery, mild signs of cardiac failure were observed, which were attributed to cardiac contusion. Two weeks after admission, the patient was weaned from the ventilator, and three days later, his facial bones were reconstructed. Four days later, the signs of cardiac failure reappeared. Transoesophageal echocardiography revealed rupture of a head of papillary muscle, with 4th degree tricuspid insufficiency and enlargement of the right ventricle. The ruptured muscle was reconstructed under extracorporeal circulation, and the patient made a satisfactory recovery.Acute tricuspid valve insufficiency, albeit rare, may occur in patients with blunt chest trauma. Sedation and lack of physical activity may delay the definite diagnosis, especially when only transthoracic echocardiography is used. Cardiac arrhythmias, diastolic murmur, or signs of congestive cardiac failure in a chest trauma patient may all suggest some structural damage; therefore, transoesophageal echocardiography should be performed as early as possible in such situations.

Pain on admission, especially after trauma, is the most common complaint (over 80%) of patients in the emergency department. During a four-week period, an anonymous, voluntary survey on the quality of pain management was conducted among adult patients reporting to the emergency department.Five hundred questionnaires were distributed during admission, and 260 were returned. Patients were asked about localisation and severity of pain (NRS - Numerical Rating Scale), the quality and speed of assistance in the emergency department, and the effectiveness of analgesia.Ninety percent of patients reported pain of varying intensity. The median pain scores on admission were 5.2, 7.3 during management, and 3.8 on discharge. Over 90% of patients were questioned about pain, but only 20% received some medication. Nevertheless, 80% of those surveyed were satisfied, and there was no correlation between the severity of pain and administration of analgesics. Fifty percent of patients received analgesics for home use, and 66% were instructed about further treatment.Despite the frequency and intensity of pain, analgesics were rarely offered in the emergency department. A surprisingly high level of satisfaction was reported, despite suboptimal pain management. This indicates either that non-pharmacologic methods of pain treatment play an important role, or that the severity of pain is overestimated by patients.

Among many factors that may affect mortality among ITU patients, the time of admission has been reported to play some, but ill-defined role. In the retrospective study, we analysed the time of admission, severity of the underlying disease, clinical status on admission and mortality among adult patients treated in a single ITU over a six-year period.We compared the mortality of patients who were admitted during daytime (7 a.m. to 6:59 p.m.) and at night (7 p.m. to 6:59 a.m.). We also compared those admitted on weekdays (Monday 7 p.m. to Friday 6:59 a.m.) to those admitted during weekends (Friday 7 p.m. to Monday 7 a.m.). The patients condition was assessed using the APACHE II scale. Brain dead organ donors and readmissions were excluded from the analysis.The retrospective study involved the data of 1789 patients. Mortality was higher in patients who were admitted during the night and during weekends, when compared to daytime and weekdays, respectively. Mortality was also higher in patients admitted directly from the operating theatre after emergency surgery, but only during nights and weekends. The following independent factors in ITU mortality have been identified: length of ITU stay (OR 1.015; % CI 1.005-1.024), admission from a hospital ward (OR 1.39; 95% CI 1.04-1.86) and APACHE II score (OR 1.177; 95% CI 1.156-1.198).Time of admission has not been identified as a single independent factor of ITU mortality, but admissions at night and during weekends were associated with higher mortality, probably because of emergency conditions.

Systemic connective tissue diseases are relatively rare disorders of unknown origin, possibly related to autoimmunity. In the retrospective study, we analysed the records of nine patients suffering from connective tissue disorders who were treated during a two-year period in an intensive therapy unit.Hospital medical records, observational charts and all other available medical documents were analysed.The clinical courses of 9 patients were studied. They included 4 with scleroderma, 3 with systemic lupus erythematosus, and 2 with inflammatory myopathy. They were admitted to the ITU because of sepsis and/or pneumonia, pulmonary haemorrhage, or cardiovascular failure. Three patients (2 with systemic sclerosis, 1 with systemic lupus erythematosus) died.A multidisciplinary approach to treatment is a key factor in the successful management of patients with rare diseases, such as connective tissue pathologies. Frequent infections with respiratory and/or circulatory complications are the most common causes of severe morbidity in these patients.

It has been suggested that red blood cell transfusions may affect the outcome and frequency of infection in patients treated in ITU settings. We have therefore retrospectively analysed the records of one hundred and sixty-three patients treated in a large tertiary intensive care unit, in order to find any relationship between red blod cell transfusions and the frequency of nosocomial infections.The patients were allocated to two groups: T - those who were transfused and N - those who were not. Among the transfused patients, two further subgroups were selected: those who were transfused within 48 h before any signs of infection were observed (n), and those in whom the transfusion was more than 48 h before infection was noted (t).There was a statistically significant difference between groups T and N (50.9% vs 38.1% infected patients), but not between subgroups t and n.Nosocomial infections were more frequently observed in patients who required red blood cell transfusion. Red blood cell transfusion cannot be regarded a sole factor affecting nosocomial infection rates.