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Brosseau C, Danger R, Durand M, Durand E, Foureau A, Lacoste P, Tissot A, Roux A, Reynaud-Gaubert M, Kessler R, Mussot S, Dromer C, Brugière O, Mornex JF, Guillemain R, Claustre J, Magnan A, Brouard S, Velly J, Rozé H, Blanchard E, Antoine M, Cappello M, Ruiz M, Sokolow Y, Vanden Eynden F, Van Nooten G, Barvais L, Berré J, Brimioulle S, De Backer D, Créteur J, Engelman E, Huybrechts I, Ickx B, Preiser T, Tuna T, Van Obberghe L, Vancutsem N, Vincent J, De Vuyst P, Etienne I, Féry F, Jacobs F, Knoop C, Vachiéry J, Van den Borne P, Wellemans I, Amand G, Collignon L, Giroux M, Angelescu D, Chavanon O, Hacini R, Martin C, Pirvu A, Porcu P, Albaladejo P, Allègre C, Bataillard A, Bedague D, Briot E, Casez‐Brasseur M, Colas D, Dessertaine G, Francony G, Hebrard A, Marino M, Protar D, Rehm D, Robin S, Rossi‐Blancher M, Augier C, Bedouch P, Boignard A, Bouvaist H, Briault A, Camara B, Chanoine S, Dubuc M, Quétant S, Maurizi J, Pavèse P, Pison C, Saint‐Raymond C, Wion N, Chérion C, Grima R, Jegaden O, Maury J, Tronc F, Flamens C, Paulus S, Philit F, Senechal A, Glérant J, Turquier S, Gamondes D, Chalabresse L, Thivolet‐Bejui F, Barnel C, Dubois C, Tiberghien A, Pimpec‐Barthes F, Bel A, Mordant P, Achouh P, Boussaud V, Méléard D, Bricourt M, Cholley B, Pezella V, Brioude G, D'Journo X, Doddoli C, Thomas P, Trousse D, Dizier S, Leone M, Papazian L, Bregeon F, Coltey B, Dufeu N, Dutau H, Garcia S, Gaubert J, Gomez C, Laroumagne S, Mouton G, Nieves A, Picard C, Rolain J, Sampol E, Secq V, Perigaud C, Roussel J, Senage T, Mugniot A, Danner I, Haloun A, Abbes S, Bry C, Blanc F, Lepoivre T, Botturi‐Cavaillès K, Loy J, Bernard M, Godard E, Royer P, Henrio K, Dartevelle P, Fabre D, Fadel E, Mercier O, Stephan F, Viard P, Cerrina J, Dorfmuller P, Feuillet S, Ghigna M, Hervén P, Le Roy Ladurie F, Le Pavec J, Thomas de Montpreville V, Lamrani L, Castier Y, Mordant P, Cerceau P, Augustin P, Jean‐Baptiste S, Boudinet S, Montravers P, Dauriat G, Jébrak G, Mal H, Marceau A, Métivier A, Thabut G, Lhuillier E, Dupin C, Bunel V, Falcoz P, Massard G, Santelmo N, Ajob G, Collange O, Helms O, Hentz J, Roche A, Bakouboula B, Degot T, Dory A, Hirschi S, Ohlmann‐Caillard S, Kessler L, Schuller A, Bennedif K, Vargas S, Bonnette P, Chapelier A, Puyo P, Sage E, Bresson J, Caille V, Cerf C, Devaquet J, Dumans‐Nizard V, Felten M, Fischler M, Si Larbi A, Leguen M, Ley L, Liu N, Trebbia G, De Miranda S, Douvry B, Gonin F, Grenet D, Hamid A, Neveu H, Parquin F, Picard C, Stern M, Bouillioud F, Cahen P, Colombat M, Dautricourt C, Delahousse M, D'Urso B, Gravisse J, Guth A, Hillaire S, Honderlick P, Lequintrec M, Longchampt E, Mellot F, Scherrer A, Temagoult L, Tricot L, Vasse M, Veyrie C, Zemoura L, Dahan M, Murris M, Benahoua H, Berjaud J, Le Borgne Krams A, Crognier L, Brouchet L, Mathe O, Didier A, Krueger T, Ris H, Gonzalez M, Aubert J, Nicod L, Marsland B, Berutto T, Rochat T, Soccal P, Jolliet P, Koutsokera A, Marcucci C, Manuel O, Bernasconi E, Chollet M, Gronchi F, Courbon C, Hillinger S, Inci I, Kestenholz P, Weder W, Schuepbach R, Zalunardo M, Benden C, Buergi U, Huber L, Isenring B, Schuurmans M, Gaspert A, Holzmann D, Müller N, Schmid C, Vrugt B, Rechsteiner T, Fritz A, Maier D, Deplanche K, Koubi D, Ernst F, Paprotka T, Schmitt M, Wahl B, Boissel J, Olivera‐Botello G, Trocmé C, Toussaint B, Bourgoin‐Voillard S, Séve M, Benmerad M, Siroux V, Slama R, Auffray C, Charron D, Lefaudeux D, Pellet J. Blood CD9 + B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation. Am J Transplant 2019; 19:3162-3175. [PMID: 31305014 DOI: 10.1111/ajt.15532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/12/2019] [Accepted: 07/07/2019] [Indexed: 01/25/2023]
Abstract
Bronchiolitis obliterans syndrome is the main limitation for long-term survival after lung transplantation. Some specific B cell populations are associated with long-term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow-up. CD24hi CD38hi transitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24hi CD38hi transitional B cells specifically secrete IL-10 and express CD9. Thus, patients with a total CD9+ B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL-10-secreting CD24hi CD38hi transitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9-expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long-term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome-free survival.
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Affiliation(s)
- Carole Brosseau
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Richard Danger
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Maxim Durand
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Faculté de Médecine, Université de Nantes, Nantes, France
| | - Eugénie Durand
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Aurore Foureau
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Philippe Lacoste
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Adrien Tissot
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France.,Faculté de Médecine, Université de Nantes, Nantes, France
| | - Antoine Roux
- Hôpital Foch, Suresnes, France.,Université Versailles Saint-Quentin-en-Yvelines, UPRES EA220, Versailles, France
| | | | | | - Sacha Mussot
- Centre Chirurgical Marie Lannelongue, Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardiopulmonaire, Le Plessis Robinson, France
| | | | - Olivier Brugière
- Hôpital Bichat, Service de Pneumologie et Transplantation Pulmonaire, Paris, France
| | | | | | - Johanna Claustre
- Clinique Universitaire Pneumologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm U1055, Grenoble, France
| | - Antoine Magnan
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Sophie Brouard
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Centre d'Investigation Clinique (CIC) Biothérapie, CHU Nantes, Nantes, France
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2
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Janssen F, Richet I, Caekelberghs E, Attyia R, Gauthier M, Gergely T, Mayer M, Sosnowski M, Lucidi V, Berré J, Preiser JC. [Religious and cultural aspects of organ transplantation]. Rev Med Brux 2017; 38:490-493. [PMID: 29318805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The number of transplantations is mainly limited by the shortage of organs, thereby leading to potentially lethal delays for patients registered on waiting lists. Among the causes of refusals of organ donation, religious reasons are often advocated. In order to make the point, we organized a debate between representatives of secularism ( " laïcité ") and of the most represented religions in Belgium, i.e. catholic, Islamic and Judaic. Even though the representation of death was variable, organ donation is authorized and even encouraged by the fundamental texts. Refusals of organ donation result more often from personal interpretations by local preachers. Therefore, the gathering of political and religious authorities in order to promote organ donation is desirable instead of sowing doubt for pseudo-religious reasons.
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Affiliation(s)
| | - I Richet
- Service de Néonatalogie, H.I.S. (Site Etterbeek-Ixelles)
| | | | - R Attyia
- Service de langue arabe, études islamiques et histoire de l'art musulman, ULg
| | | | | | - M Mayer
- Aumônerie catholique, Hôpital Erasme
| | | | - V Lucidi
- Service de Chirurgie digestive, Hôpital Erasme
| | - J Berré
- Service des Soins intensifs, Hôpital Erasme
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3
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Vincent JL, Berré J, Creteur J. Withholding and withdrawing life prolonging treatment in the intensive care unit: a current European perspective. Chron Respir Dis 2016; 1:115-20. [PMID: 16279270 DOI: 10.1191/1479972304cd021rs] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background:Many deaths are now preceded by an end of life decision, particularly in the intensive care unit (ICU), but such practices vary considerably between countries, ICUs and individuals, depending on many factors including cultural and religious background, family and peer pressure and local practice. Aims:In this review, we will discuss the application of the four key ethical principles-beneficence, nonmaleficence, autonomy and distributive justice - to withdrawing/withholding decisions. Methods: Drawing data from several national and international studies, we then summarize the current situation across Europe regarding such practices before making some suggestions as to how we could facilitate the often difficult decision making process by improved communication between staff, patient and relatives.
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Affiliation(s)
- J L Vincent
- Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium.
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4
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De Ryckere M, Maetens Y, Berré J, Vincent JL, Preiser JC. P143 Impact de l’utilisation d’un arbre décisionnel d’initiation et d’adaptation de la nutrition entérale en réanimation. NUTR CLIN METAB 2011. [DOI: 10.1016/s0985-0562(11)70210-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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5
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De Weer AS, Da Ros M, Berré J, Mélot C, Goldman S, Peigneux P. Environmental influences on activity patterns in altered states of consciousness. Eur J Neurol 2011; 18:1432-4. [DOI: 10.1111/j.1468-1331.2011.03477.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Beydon L, Audibert G, Berré J, Boulard G, Gabrillargues J, Bruder N, Hans P, Puybasset L, Ravussin P, de Kersaint-Gilly A, Ter Minassian A, Dufour H, Lejeune JP, Proust F, Bonafé A. [Pain management in severe subarachnoid haemorrhage]. ACTA ACUST UNITED AC 2005; 24:782-6. [PMID: 15922538 DOI: 10.1016/j.annfar.2005.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L Beydon
- Département d'anesthésie-réanimation chirurgicale, CHU, 4, rue Larrey, 49933 Angers cedex 01, France.
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7
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Berré J, Hans P, Puybasset L, Beydon L, Audibert G, Bruder N, Ravussin P, Boulard G, Ter Minassian A, Dufour H, de Kersaint-Gilly A, Gabrillargues J, Lejeune JP, Proust F, Bonafé A. [Epilepsy in patients suffering from severe subarachnoid haemorrhage]. ACTA ACUST UNITED AC 2005; 24:739-41. [PMID: 15885965 DOI: 10.1016/j.annfar.2005.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J Berré
- Service des soins intensifs, hôpital universitaire Erasme, ULB, route de Lennick 808, 1070 Bruxelles, Belgique.
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8
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Hans P, Audibert G, Berré J, Bruder N, Ravussin P, Ter Minassian A, Puybasset L, Beydon L, Boulard G, Bonafé A, de Kersaint-Gilly A, Gabrillargues J, Lejeune JP, Proust F, Dufour H. [Cardiovascular and pulmonary consequences of severe subarachnoid haemorrhage]. Ann Fr Anesth Reanim 2005; 24:734-8. [PMID: 15885973 DOI: 10.1016/j.annfar.2005.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- P Hans
- Service universitaire d'anesthésie-réanimation, CHR de la Citadelle, boulevard du XII(e)-de-Ligue, 4000 Liège, Belgique.
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9
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Dufour H, Bonafé A, Bruder N, Boulard G, Ravussin P, Lejeune JP, Gabrillargues J, Beydon L, Audibert G, Berré J, Hans P, Puybasset L, Ter Minassian A, Proust F, de Kersaint-Gilly A. Diagnostic en hôpital général et prise en charge immédiate des hémorragies méningées graves. ACTA ACUST UNITED AC 2005; 24:715-20. [PMID: 15967627 DOI: 10.1016/j.annfar.2005.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H Dufour
- Service de neurochirurgie, CHU de la Timone, rue Saint-Pierre, 13385 Marseille cedex 05, France.
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10
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Proust F, Dufour H, Lejeune JP, Bonafé A, de Kersaint-Gilly A, Puybasset L, Berré J, Bruder N, Ravussin P, Hans P, Audibert G, Boulard G, Ter Minassian A, Beydon L, Gabrillargues J. [Severe subarachnoid haemorrhage: treatment of rebleeding and of an intracerebral haematoma]. Ann Fr Anesth Reanim 2005; 24:756-60. [PMID: 15885969 DOI: 10.1016/j.annfar.2005.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- F Proust
- Service de neurochirurgie, hôpital Charles-Nicolle, rue de Germont, 76031 Rouen cedex, France.
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11
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Bruder N, Ravussin P, Hans P, Berré J, Puybasset L, Audibert G, Boulard G, Beydon L, Ter Minassian A, Dufour H, Bonafé A, Gabrillargues J, Lejeune JP, Proust F, de Kersaint-Gilly A. Anesthésie pour le traitement des hémorragies méningées graves par rupture d'anévrisme. ACTA ACUST UNITED AC 2005; 24:775-81. [PMID: 15922545 DOI: 10.1016/j.annfar.2005.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- N Bruder
- Département d'anesthésie-réanimation, CHU de la Timone-Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
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12
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Puybasset L, Beydon L, Dufour H, Proust F, Audibert G, Bonafé A, Berré J, Boulard G, Gabrillargues J, Bruder N, de Kersaint-Gilly A, Hans P, Ravussin P, Lejeune JP, Ter Minassian A. [Severe subarachnoid haemorrhage: patient follow-up (biology, local metabolic measurements)]. Ann Fr Anesth Reanim 2005; 24:787-90. [PMID: 15925477 DOI: 10.1016/j.annfar.2005.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- L Puybasset
- Unité de neuroanesthésie-réanimation, groupe hospitalier Pitié-Salpétrière, 47-83, boulevard de l'Hôpital, 75651 paris cedex 13, France.
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13
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Boulard G, Ravussin P, Proust F, Bonafé A, Audibert G, De Kersaint-Gilly A, Hans P, Berré J, Bruder N, Puybasset L, Ter Minassian A, Dufour H, Lejeune JP, Gabrillargues J, Beydon L. [Organisation of care for patients suffering from subarachnoid haemorrhage]. Ann Fr Anesth Reanim 2005; 24:721-2. [PMID: 15876514 DOI: 10.1016/j.annfar.2005.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- G Boulard
- Département d'anesthésie-réanimation, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.
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14
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Ter Minassian A, Proust F, Berré J, Hans P, Bonafé A, Puybasset L, Audibert G, de Kersaint-Gilly A, Beydon L, Bruder N, Boulard G, Ravussin P, Dufour H, Lejeune JP, Gabrillargues J. [Severity criteria for subarachnoid haemorrhage: intracranial hypertension, hydrocephalus]. Ann Fr Anesth Reanim 2005; 24:723-8. [PMID: 15922542 DOI: 10.1016/j.annfar.2005.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- A Ter Minassian
- Département d'anesthésie-réanimation chirurgicale I, CHU, 4, rue Larrey, 49033 Angers cedex 1, France.
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15
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Audibert G, Puybasset L, Bruder N, Hans P, Berré J, Beydon L, Ravussin P, Boulard G, Ter Minassian A, de Kersaint-Gilly A, Dufour H, Gabrillargues J, Bonafé A, Proust F, Lejeune JP. Hémorragie sous-arachnoïdienne grave : natrémie et rein. ACTA ACUST UNITED AC 2005; 24:742-5. [PMID: 15885975 DOI: 10.1016/j.annfar.2005.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- G Audibert
- Service d'anesthésie-réanimation chirurgicale, hôpital central, CO n 34, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France.
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16
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Proust F, Ter Minassian A, Hans P, Puybasset L, Berré J, Bonafé A, Dufour H, Audibert G, De Kersaint-Gilly A, Boulard G, Beydon L, Ravussin P, Lejeune JP, Gabrillargues J, Bruder N. [Treatment of intracranial hypertension in patients suffering from severe subarachnoid haemorrhage]. Ann Fr Anesth Reanim 2005; 24:729-33. [PMID: 15967626 DOI: 10.1016/j.annfar.2005.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- F Proust
- Service de neurochirurgie, CHU de Rouen, hôpital Charles-Nicolle, avenue de Germont, 76031 Rouen cedex, France.
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Proust F, Bonafé A, Lejeune JP, de Kersaint-Gilly A, Gabrillargues J, Dufour H, Puybasset L, Bruder N, Hans P, Beydon L, Audibert G, Boulard G, Ter Minassian A, Berré J, Ravussin P. L'anévrisme : occlure le sac pour prévenir le resaignement. ACTA ACUST UNITED AC 2005; 24:746-55. [PMID: 15922551 DOI: 10.1016/j.annfar.2005.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- F Proust
- Service de neurochirurgie, hôpital Charles-Nicolle, rue de Germont, 76031 Rouen cedex, France.
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Berré J, Gabrillargues J, Audibert G, Hans P, Bonafé A, Boulard G, Lejeune JP, Bruder N, De Kersaint-Gilly A, Ravussin P, Ter Minassian A, Dufour H, Beydon L, Proust F, Puybasset L. Hémorragies méningées graves : prévention, diagnostic et traitement du vasospasme. ACTA ACUST UNITED AC 2005; 24:761-74. [PMID: 15885968 DOI: 10.1016/j.annfar.2005.03.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- J Berré
- Service des soins intensifs, hôpital universitaire Erasme, ULB, route de Lennick 808, 1070 Bruxelles, Belgique.
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Bastin R, Barvais L, Mélot C, Vincent JL, Berré J. Preliminary results of prolonged target controlled infusion of sufentanil adjusted to an effort pain score after cardiac surgery. Acta Anaesthesiol Belg 2005; 56:31-6. [PMID: 15822418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Repeated boluses of i.v. morphine are often used for analgesia after cardiac surgery, but this procedure frequently provides inadequate pain relief. Target controlled infusion (TCI) of opioid drugs has been proposed as an alternative. The objective of this study was to evaluate the effects of prolonged sufentanil TCI adjusted to an effort pain score on the postoperative course after cardiac surgery. Twenty-six patients scheduled for cardiac surgery were anaesthetised using TCI of propofol and sufentanil, followed by early extubation. In the postoperative period, patients were randomly allocated to receive either boluses of i.v. morphine (Bolus group), adapted to a pain score at rest, or sufentanil TCI with a low target concentration (0.08-0.1 ng/ml), adapted to a pain score during deep inspiration (TCI group). Postoperative pain was assessed using a Verbal Numerical Score (VNS) before and during three stimuli: extubation, lateral positioning and physiotherapy. In 15 patients, inspiratory capacity was evaluated by incentive spirometry (IS) on postoperative day 1. Three patients in each group were withdrawn because of delayed extubation. Clinical characteristics, mean time to extubation and PaCO2 were similar in both groups. Analgesia was adequate at rest in both groups as indicated by low pain scores. Pain intensity increased significantly during the three stimuli (p < 0.01). VNS were lower in the TCI than in the Bolus group (3.8 +/- 0.5 versus 4.8 +/- 0.5, p = 0.03). Nine of 10 patients in the TCI group but only 4 of 10 patients in the bolus group gave a VNS below 5 during the stimuli. IS performance was better preserved in the TCI than in the Bolus group (53 +/- 5% versus 35 +/- 5% of preoperative values, p < 0.05). These observations indicate that after cardiac surgery, postoperative pain management with prolonged TCI of sufentanil adapted to a pain score during deep inspiration can achieve better analgesia during routine bedside procedures and higher pulmonary volumes than on-demand boluses of morphine.
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Affiliation(s)
- R Bastin
- Department Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium
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20
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Faymonville ME, Pantke KH, Berré J, Sadzot B, Ferring M, de Tiège X, Mavroudakis N, van Bogaert P, Lambermont B, Damas P, Franck G, Lamy M, Luxen A, Moonen G, Goldman S, Maquet P, Laureys S. Zerebrale Funktionen bei hirngeschädigten Patienten. Anaesthesist 2004; 53:1195-202. [PMID: 15597160 DOI: 10.1007/s00101-004-0747-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Comatose, vegetative, minimally conscious or locked-in patients represent a problem in terms of diagnosis, prognosis, treatment and everyday management at the intensive care unit. The evaluation of possible cognitive functions in these patients is difficult because voluntary movements may be very small, inconsistent and easily exhausted. Functional neuroimaging cannot replace the clinical assessment of patients with altered states of consciousness. Nevertheless, it can describe objectively how deviant from normal the cerebral activity is and its regional distribution at rest and under various conditions of stimulation. The quantification of brain activity differentiates patients who sometimes only differ by a brief and incomplete blink of an eye. In the present paper, we will first try to define consciousness as it can be assessed at the patient's bedside. We then review the major clinical entities of altered states of consciousness encountered in the intensive care unit. Finally, we discuss the functional neuroanatomy of these conditions as assessed by positron emission tomography (PET) scanning.
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Affiliation(s)
- M-E Faymonville
- Department of Anesthesiology and Intensive Care Medicine, CHU Sart Tilman, University of Liège, Belgium
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21
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De Tiége X, Bier JC, Massat I, Laureys S, Lotstra F, Berré J, Mendlewicz J, Goldman S. Regional cerebral glucose metabolism in akinetic catatonia and after remission. J Neurol Neurosurg Psychiatry 2003; 74:1003-4. [PMID: 12810808 PMCID: PMC1738544 DOI: 10.1136/jnnp.74.7.1003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Vincent JL, Appoloni O, Berré J, Brimioulle S, Creteur J, De Backer D, Leeman M, Mélot C. [The intensive care department]. Rev Med Brux 2003; 23 Suppl 2:163-6. [PMID: 12584937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Intensive Care Departments are designed for the care of the critically ill, and are equipped with all the material necessary for monitoring and treatment, as well as specially trained medical, nursing, and paramedical staff. With a team of more than 170 highly qualified staff, the Department of Intensive Care at Erasme Hospital, has acquired a national and international reputation in the fields of clinical and experimental research and education, as well as for its standards of clinical practice. Clinical and experimental studies have been high in quantity and quality, and have covered all the key areas in the field of intensive care medicine: severe sepsis, multiple organ failure, transport and metabolism of oxygen, systemic and regional hemodynamic alterations (pulmonary, cerebral, hepato-splanchnic,...), metabolic disorders,... not forgetting issues associated with the complexities of medical ethics. The quality of care, clinical, scientific and personal, offered by the Department of Intensive Care at Erasme Hospital has earned it the high level reputation for which it is renowned in Belgium, and indeed worldwide.
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Abstract
Disseminated aspergillosis is an uncommon but frequently fatal disease in critically ill populations. With studies suggesting that the incidence of this disease is increasing, and with relatively few epidemiological data available in this population, we evaluated cases of disseminated aspergillosis identified at autopsy over a one-year period on a 31-bed mixed medico-surgical intensive care unit (ICU) of an academic university hospital. In 1999, there were 489 deaths out of 2984 ICU admissions, and 222 autopsies were performed. Post-mortem examination demonstrated disseminated aspergillosis involving non-contiguous organs in 6 (2.7%) autopsies and, of these, five patients (2.3% of total) had had chronic obstructive pulmonary disease (COPD) and had been treated with corticosteroids and mechanical ventilation for pulmonary infection. One patient also had granulocytopenia. In each patient, sputum and bronchoalveolar lavage (BAL) cultures had been positive for Aspergillus fumigatus after ICU admission but this was considered as colonization and the patients were given fluconazole for suspected candidal infection. In conclusion, COPD patients treated with corticosteroids and presenting with pulmonary infection should be considered at risk for disseminated aspergillosis. The rapidly fatal outcome after ICU admission suggests that colonization with Aspergillus can occur before ICU admission.
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Affiliation(s)
- G Dimopoulos
- Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium
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Mélot C, Moraine JJ, Berré J. Monitoring in neuroanaesthesia: update of clinical usefulness. Eur J Anaesthesiol 2002; 19:381. [PMID: 12095021 DOI: 10.1017/s0265021502210625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Preiser JC, Van Gossum A, Berré J, Vincent JL, Carpentier Y. Enteral feeding with a solution enriched with antioxidant vitamins A, C, and E enhances the resistance to oxidative stress. Crit Care Med 2000; 28:3828-32. [PMID: 11153621 DOI: 10.1097/00003246-200012000-00013] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess whether dietary supplementation with the antioxidant vitamins A, C, and E enhances parameters of oxidative stress and influences the course of critically ill patients. DESIGN Prospective, randomized, double-blinded, placebo-controlled study. SETTING Department of medicosurgical intensive care of an academic hospital. PATIENTS Fifty-one patients expected to require at least 7 days of enteral feeding. Thirty-seven of these patients (age, 57 +/- 7 yrs; Simplified Acute Physiology Score II, 33 +/- 6 points) completed the study. INTERVENTIONS Twenty patients were randomized to receive the formula supplemented with vitamins A (67 microg/dL), C (13.3 mg/ dL), and E (4.94 mg/dL), and 17 patients received an isocaloric and isonitrogenous control solution. MEASUREMENTS AND MAIN RESULTS Plasma levels of antioxidant vitamins, lipid peroxidation (estimated by the malonyldialdehyde assay), and low-density lipoprotein (LDL), and erythrocyte resistance to experimental oxidative stress were determined on samples drawn two consecutive days before the initiation of feeding and at the end of the 7-day period. Clinical outcome measures included documented infection and intensive care unit and 28-day survival. Administration of the supplemented solution increased significantly the concentration of plasma beta-carotene (from 0.2 +/- 0.0 microg/mL to 0.6 +/- 0.1 microg/mL; p < 0.01) and plasma and LDL-bound alpha-tocopherol (from 6.0 +/- 0.4 microg/mL and 2.9 +/- 0.9 microg/mL to 9.7 +/- 0.5 microg/mL and 4.3 +/- 1.2 microg/mL, respectively; p < 0.05), and improved LDL resistance to oxidative stress by 21 +/- 4% (p < 0.05). No such change was observed in the control group. There was no significant difference in clinical outcome between the two groups. CONCLUSIONS Supplemental antioxidant vitamins added to enteral feeding solutions are well absorbed. Dietary supplementation with vitamins A, C, and E is associated with an improvement in antioxidant defenses, as assessed by ex vivo tests.
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Affiliation(s)
- J C Preiser
- Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
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Moraine JJ, Berré J, Mélot C. Is cerebral perfusion pressure a major determinant of cerebral blood flow during head elevation in comatose patients with severe intracranial lesions? J Neurosurg 2000; 92:606-14. [PMID: 10761649 DOI: 10.3171/jns.2000.92.4.0606] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECT Head elevation as a treatment for lower intracranial pressure (ICP) in patients with intracranial hypertension has been challenged in recent years. Therefore, the authors studied the effect of head position on cerebral hemodynamics in patients with severe head injury. METHODS The effect of 0 degrees, 15 degrees, 30 degrees, and 45 degrees head elevation on ICP, cerebral blood flow (CBF), systemic arterial (PsaMonro) and jugular bulb (Pj) pressures calibrated to the level of the foramen of Monro, cerebral perfusion pressure (CPP), and the arteriovenous pressure gradient (PsaMonro - Pj) was studied in 37 patients who were comatose due to severe intracranial lesions. The CBF decreased gradually with head elevation from 0 to 45 degrees, from 46.3+/-4.8 to 28.7+/-2.3 ml x min(-1) x 100 g(-1) (mean +/- standard error, p<0.01), and the PsaMonro - Pj from 80+/-3 to 73+/-3 mm Hg (p< 0.01). The CPP remained stable between 0 degrees and 30 degrees of head elevation, at 62+/-3 mm Hg, and decreased from 62+/-3 to 57+/-4 mm Hg between 30 degrees and 45 degrees (p<0.05). A simulation showed that the 38% decrease in CBF between 0 degrees and 45 degrees resulted from PsaMonro - Pj changes for 19% of the decrease, from a diversion of the venous drainage from the internal jugular veins to vertebral venous plexus for 15%, and from CPP changes for 4%. CONCLUSIONS During head elevation the arteriovenous pressure gradient is the major determinant of CBF. The influence of CPP on CBF decreases from 0 to 45 degrees of head elevation.
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Affiliation(s)
- J J Moraine
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
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Detriche O, Berré J, Massaut J, Vincent JL. The Brussels sedation scale: use of a simple clinical sedation scale can avoid excessive sedation in patients undergoing mechanical ventilation in the intensive care unit. Br J Anaesth 1999; 83:698-701. [PMID: 10690129 DOI: 10.1093/bja/83.5.698] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sedation is an important component of patient comfort in the intensive care unit (ICU), especially in those undergoing mechanical ventilation. Sedation that is too light or too deep can have important consequences, and therefore assessment of the degree of sedation should be an important part of patient management. Although there are many methods available to assess the degree of sedation, none is ideal. Therefore, we developed a new sedation scale and analysed its clinical impact in the management of patients undergoing mechanical ventilation. The study comprised two consecutive phases. In the first phase, the medical team did not use a sedation scale. In the second phase, the medical staff used the new sedation scale, comprising five levels, depending on the perceived degree of sedation: levels 1 and 2 = oversedation; levels 3 and 4 = correct sedation; and level 5 = undersedation. There were no significant differences in mean or highest levels between patients in the two phases (mean 2.89 (SD 0.11) vs 2.67 (0.13), P = 0.22; highest 3.16 (0.11) vs 3.10 (0.14), P = 0.78). However, the lowest level was significantly greater in patients in the second phase than in those in the first phase (2.61 (0.11) vs 2.16 (0.13); P = 0.011), indicating that the number of patients with excessive sedation was significantly reduced with the introduction of this scale. Thus the use of this scale can have a real clinical impact for patients undergoing mechanical ventilation, principally by avoiding excessive sedation.
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Affiliation(s)
- O Detriche
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
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Abstract
The use of induced hypertension in head injury patients is controversial. We present the case of a 19-year-old man admitted with severe head trauma after a road accident and describe the beneficial effects that increasing arterial blood pressure had on the cerebral perfusion pressure, cerebral blood flow and jugular bulb oxygen saturation in this patient.
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Affiliation(s)
- M Ferring
- Department of Anaesthesiology, Erasme University Hospital, Free University of Brussels, Route de Lennik 808, B-1070 Brussels, Belgium
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Berré J, Vachiéry JL, Moraine JJ, Naeije R. Cerebral blood flow velocity responses to hypoxia in subjects who are susceptible to high-altitude pulmonary oedema. Eur J Appl Physiol Occup Physiol 1999; 80:260-3. [PMID: 10483794 DOI: 10.1007/s004210050591] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Cerebral blood flow increases on exposure to high altitude, and perhaps more so in subjects who develop acute mountain sickness. We determined cerebral blood flow by transcranial Doppler ultrasound of the middle cerebral artery at sea level, in normoxia (fraction of inspired O2, F(I)O2 0.21), and during 15-min periods of either hypoxic (F(I)O2 0.125) or hyperoxic (F(I)O2 1.0) breathing, in 7 subjects with previous high-altitude pulmonary oedema, 6 climbers who had previously tolerated altitudes between 6000 m and 8150 m, and in 20 unselected controls. Hypoxia increased mean middle cerebral artery flow velocity from 69 (3) to 83 (4) cm x s(-1) (P<0.001) in the controls, from 63 (3) to 75 (3) cm x s(-1) (P<0.001) in the high-altitude pulmonary-oedema-susceptible subjects, and from 58 (4) to 70 (4) cm x s(-1) (P<0.001) in the successful high-altitude climbers. Hyperoxia decreased mean middle cerebral flow velocity to 60 (3) cm x s(-1) (P<0.001), 53 (3) cm x s(-1) (P<0.01), and 49 (3) cm x s(-1) (P<0.01) in the controls, high-altitude pulmonary-oedema-susceptible, and high-altitude climbers, respectively. We conclude that a transcranial Doppler-based estimate of cerebral blood flow is affected by hypoxic and hyperoxic breathing, and that it is not predictive of tolerance to high altitude.
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Affiliation(s)
- J Berré
- Department of Intensive care, Erasme University Hospital, Brussels, Belgium
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Preiser JC, Berré J, Carpentier Y, Jolliet P, Pichard C, Van Gossum A, Vincent JL. Management of nutrition in European intensive care units: results of a questionnaire. Working Group on Metabolism and Nutrition of the European Society of Intensive Care Medicine. Intensive Care Med 1999; 25:95-101. [PMID: 10051085 DOI: 10.1007/s001340050793] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To describe the practical aspects of nutritional management in intensive care units (ICUs). DESIGN A 49-item questionnaire was sent to the physician members of the European Society for Intensive Care Medicine. The issues addressed included: medical environment, assessment of nutritional status and current practice for enteral and parenteral nutrition. SETTING 1608 questionnaires were sent in 35 European countries. ANALYSIS The answers were pooled and stratified by country. RESULTS 271 questionnaires were answered (response rate 17%). Assessment of nutritional status was generally based on clinical (99%) and biochemical (82%) parameters rather than on functional (24%), anthropometric (23%), immunological (18%) or questionnaire-based (11%) data. Two thirds of 2774 patients hospitalised in the corresponding ICUs at the time the questionnaire was answered were receiving nutritional support; 58% of those were fed by the enteral route, 23% by the parenteral route and 19% by combined enteral and parenteral. The preferred modality was enteral nutrition, instituted before the 48th h after admission, at a rate based on estimated caloric requirements. Specific and modified solutions were rarely used. Parenteral nutrition was less commonly used than enteral, although the practices differed between countries. It was mainly administered as hospital-made all-in-one solutions, at a rate based on calculated caloric requirements. CONCLUSIONS European intensivists are concerned by the nutritional management of their patients. The use of nutritional support is common, essentially as early enteral feeding.
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Vincent JL, Berré J. Beta-blocking agents can increase PaO2. Crit Care Med 1998; 26:1613. [PMID: 9751602 DOI: 10.1097/00003246-199809000-00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
In current clinical practice, it is important to be able to evaluate the evidence supporting each of our actions. Physicians can no longer rely on tradition or habit; however, with the increasing number of journals available, it is impossible for the practicing clinician to keep abreast of all the relevant literature. One valuable method of gathering and summarizing the latest information and opinions is the use of round tables and consensus conferences. Published reports of round table and consensus conference findings can be invaluable in guiding the clinician.
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Affiliation(s)
- J L Vincent
- Department of Intensive Care Medicine, Erasme University Hospital, Free University of Brussels, Belgium
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Abstract
It is well established that cerebral blood flow (CBF) is sensitive to variations in arterial PCO2 (PaCO2) and can be influenced by changes in jugular venous return due to elevated intrathoracic pressure. Therefore, we compared cerebral CO2 vasoreactivity when PaCO2 was altered either by changing inspired PCO2 or tidal volume. In addition, we sought to determine if noninvasive transcranial Doppler ultrasonography can be used instead of invasive CBF measurement to determine cerebral CO2 vasoreactivity. In 36 mechanically ventilated patients in coma due to acute brain lesion, we evaluated CBF by continuous jugular thermodilution, middle cerebral artery flow velocity (Vm) by transcranial Doppler ultrasonography, intracranial pressure (ICP; in only 23 of them) by intraventricular catheter, systemic and pulmonary hemodynamic variables, and arterial and jugular bulb blood gases. Measurements were taken at four levels of PaCO2 (25, 30, 35, and 40 mmHg) by modifying in a random order either tidal volume or inspired PCO2. Cerebral, pulmonary, and systemic hemodynamic changes were similar in magnitude during both methods of altering PaCO2. From the highest to the lowest PaCO2, CBF decreased from 61+/-7 to 36+/-4 ml/min/100 g (p < 0.001, mean +/- SE), Vm from 89+/-7 to 65+/-5 cm/s (p < 0.001), and ICP from 29+/-2 to 12+/-2 mmHg (p < 0.001), but cerebral perfusion pressure remained constant, ranging from 65+/-3 to 67+/-4 mmHg (p = NS). Arteriojugular oxygen content difference increased from 3.2+/-0.2 to 5.7+/-0.4 ml/dl (p < 0.001). Eleven of the 20 patients with a preserved CBF response to CO2 survived to 6 months, whereas only two of the 16 patients with an altered response were alive at 6 months (p < 0.05). When compared with CBF by jugular thermodilution, the rates of sensitivity and specificity of transcranial Doppler ultrasonography to detect impaired cerebral CO2 vasoreactivity were 69% and 65%, respectively. In conclusion, the reduction of PaCO2 from 40 to 25 mmHg by modifying either tidal volume or inspired PCO2 resulted in similar effects on cerebral, pulmonary, and systemic circulations. Cerebral CO2 vasoreactivity is of prognostic value in brain-injured patients when determined using CBF but may be misleading when evaluated using velocities measured by transcranial Doppler ultrasonography.
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Affiliation(s)
- J Berré
- Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium
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Berré J, De Backer D, Moraine JJ, Mélot C, Kahn RJ, Vincent JL. Dobutamine increases cerebral blood flow velocity and jugular bulb hemoglobin saturation in septic patients. Crit Care Med 1997; 25:392-8. [PMID: 9118652 DOI: 10.1097/00003246-199703000-00004] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the effects of dobutamine on cerebral hemodynamics in septic patients with stable hemodynamic status. DESIGN Open-label, prospective study. SETTING Multidisciplinary department of intensive care in a university hospital. PATIENTS Fourteen mechanically ventilated septic patients with altered mental status and stable hemodynamic status. INTERVENTIONS Dobutamine infusion, in incremental doses of 2 micrograms/kg/min every 10 mins, for < or = 10 micrograms/kg/min. MEASUREMENTS AND MAIN RESULTS Mean flow velocity in the right middle cerebral artery, as measured by transcranial Doppler, increased from 68 +/- 6 (SEM) cm/sec at baseline to 80 +/- 7 cm/sec (p < .001) with 10 micrograms/kg/min of dobutamine. Cerebral arterial-venous oxygen content difference and cerebral oxygen extraction ratio concurrently decreased from 4.1 +/- 0.2 to 3.4 +/- 0.3 mL/dL (p < .05) and from 46 +/- 3% to 36 +/- 4% (p < .05), respectively. Dobutamine also increased cardiac index from 3.8 +/- 0.3 to 6.3 +/- 0.5 L/min/m2 (p < .001) and systemic oxygen delivery (DO2) from 497 +/- 35 to 817 +/- 55 mL/min/m2. Mean arterial pressure increased slightly from 77 +/- 3 mm Hg to a maximum value of 86 +/- 4 mm Hg (p < .05). Relative changes in mean flow velocity were better correlated with cardiac index (r2 = .52, p < .001) than with arterial pressure (r2 = .20; p < .001). Cerebral DO2 (estimated by the product of mean flow velocity and arterial oxygen content) increased by 12% with dobutamine, whereas estimated cerebral oxygen consumption (VO2) did not. CONCLUSION These measurements of middle cerebral artery flow velocity and jugular bulb oximetry suggest that dobutamine increases cerebral blood flow but not cerebral VO2 in stable septic patients.
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Affiliation(s)
- J Berré
- Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium
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Abstract
The Kety-Schmidt technique can be regarded as the reference method for the measurement of cerebral blood flow (CBF). However, the method is somewhat cumbersome for routine use in the intensive care unit (ICU) at the beside. The continuous thermodilution technique developed many years ago for the measurement of coronary sinus blood flow can be applied for the measurement of jugular blood flow (JBF). However, the measurement of JBF by thermodilution has never been validated using the Kety-Schmidt reference method. We first validate the continuous thermodilution in vitro by comparison with a volumetric flow. The thermodilution method is accurate for flows between 50 and 900 ml min-1 with a mean difference volumetric-thermodilution flow of -1 +/- 18 ml min-1 (mean +/- SD), and precise with a coefficient of variability ranging between 1.21% and 2.50%. In vivo accuracy was assessed by comparing in 15 comatose patients CBF measured using the Kety-Schmidt (CBFKS) method and estimated from JBF measured by thermodilution (CBFTH) at four levels of arterial PaCO2 (25, 30, 35, and 40 mm Hg). The mean difference CBFKS-CBFTH is -0.9 +/- 3.6 ml min-1 100 g-1. In vivo precision of the method was good, with a coefficient of variability of 4.1% in mean. We conclude that jugular continuous thermodilution technique is a reliable method for estimating CBF at the bedside. This technique allows repeated measurements jugular bulb blood sampling for brain metabolic studies.
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Affiliation(s)
- C Mélot
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
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Vachiéry JL, McDonagh T, Moraine JJ, Berré J, Naeije R, Dargie H, Peacock AJ. Doppler assessment of hypoxic pulmonary vasoconstriction and susceptibility to high altitude pulmonary oedema. Thorax 1995; 50:22-7. [PMID: 7886643 PMCID: PMC473700 DOI: 10.1136/thx.50.1.22] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Subjects with previous high altitude pulmonary oedema may have stronger than normal hypoxic pulmonary vasoconstriction. Susceptibility to high altitude pulmonary oedema may be detectable by echo Doppler assessment of the pulmonary vascular reactivity to breathing a hypoxic gas mixture at sea level. METHODS The study included 20 healthy controls, seven subjects with a previous episode of high altitude pulmonary oedema, and nine who had successfully climbed to altitudes of 6000-8842 m during the 40th anniversary British expedition to Mount Everest. Echo Doppler measurements of pulmonary blood flow acceleration time (AT) and ejection time (ET), and of the peak velocity of the tricuspid regurgitation jet (TR), were obtained under normobaric conditions of normoxia (fraction of inspired oxygen, FIO2, 0.21), of hyperoxia (FIO2 1.0), and of hypoxia (FIO2 0.125). RESULTS Hypoxia decreased AT/ET by mean (SE) 0.06 (0.01) in the control subjects, by 0.11 (0.01) in those susceptible to high altitude pulmonary oedema, and by 0.02 (0.02) in the successful high altitude climbers. Hypoxia increased TR in the three groups by 0.22 (0.06) (n = 14), 0.56 (0.13) (n = 5), and 0.18 (0.1) (n = 7) m/s, respectively. However, AT/ET and/or TR measurements outside the normal range, defined as mean +/- 2 SD of measurements obtained in the controls under hypoxia, were observed in only two of the subjects susceptible to high altitude pulmonary oedema and in five of the successful high altitude climbers. CONCLUSIONS Pulmonary vascular reactivity to hypoxia is enhanced in subjects with previous high altitude pulmonary oedema and decreased in successful high altitude climbers. However, echo Doppler estimates of hypoxic pulmonary vaso-constriction at sea level cannot reliably identify subjects susceptible to high altitude pulmonary oedema or successful high altitude climbers from a normal control population.
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Affiliation(s)
- J L Vachiéry
- Department of Cardiology, Erasme University Hospital, B-1070 Brussels, Belgium
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Abstract
PURPOSE Both dobutamine and prostacyclin (PGI2) have been used to increase oxygen delivery in septic patients, but their effects on cerebral blood flow have not been well studied. METHODS In 10 septic patients with altered mental status, stable hemodynamic status, and normal lactatemia, we investigated the effects of successive infusions of dobutamine at 5 micrograms/kg/min and PGI2 at 5 ng/kg/min on mean blood flow velocity in a middle cerebral artery, using transcranial Doppler flowmetry. RESULTS Mean flow velocity increased with dobutamine (from 52 +/- 4 to 62 +/- 6 cm/s, P < .005) but not with PGI2 (from 55 +/- 5 to 57 +/- 5 cm/s, P = not significant). Each substance significantly increased cardiac index. Dobutamine increased arterial pressure from 85 +/- 6 to 91 +/- 5 mm Hg (P < .05), but PGI2 decreased it from 87 +/- 6 to 77 +/- 5 mm Hg (P < .005). With each agent, mean flow velocity was correlated with cardiac index (r = .51, P < .001) but not with arterial pressure. PGI2 reduced PaO2 from 103 +/- 10 to 82 +/- 6 mm Hg (P < .005). Cerebral oxygen delivery (estimated by the product of mean flow velocity and arterial oxygen content) increased by 19% with dobutamine but remained unchanged with PGI2. CONCLUSIONS Dobutamine and PGI2 at the administered doses exert different effects on arterial pressure and middle cerebral artery flow velocity in septic patients. According to these data, dobutamine increases cerebral oxygen delivery more than PGI2.
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Affiliation(s)
- J Berré
- Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium
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De Backer D, Berré J, Zhang H, Kahn RJ, Vincent JL. Relationship between oxygen uptake and oxygen delivery in septic patients: effects of prostacyclin versus dobutamine. Crit Care Med 1993; 21:1658-64. [PMID: 8222681 DOI: 10.1097/00003246-199311000-00014] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To compare the effects of prostacyclin (PGI2) and dobutamine on the relationship between oxygen delivery (DO2) and oxygen uptake (VO2) in stable septic patients. DESIGN Prospective study using a crossover design with alternate order of medications. PATIENTS Seventeen patients with documented sepsis and a stable hemodynamic status with normal blood lactate concentrations. Eleven patients were mechanically ventilated. Eight patients eventually died. INTERVENTIONS DO2 and VO2 were calculated before and after a 20-min infusion of 5 ng/kg/min of PGI2 followed or preceded by 5 micrograms/kg/min of dobutamine. MEASUREMENTS AND MAIN RESULTS Both medications increased cardiac output significantly. At the dose used, PGI2 infusion reduced mean arterial pressure from 90.8 +/- 16.8 to 81.5 +/- 17.3 mm Hg (p < .01) and PaO2 from 97 +/- 25 torr to 82 +/- 22 torr (from 12.9 +/- 3.3 to 10.9 +/- 2.9 kPa) (p < .01) and increased venous admixture from 17.5 +/- 0.6% to 23.8 +/- 8.2% (p < .01). Dobutamine had no significant influence on these variables. PGI2 increased DO2 by 19% (from 470 +/- 105 to 557 +/- 117 mL/min/m2, p < .01) while dobutamine increased DO2 by 27% (from 463 +/- 103 to 589 +/- 156 mL/min/m2, p < .01). PGI2 increased VO2 by 5% (from 148 +/- 38 to 155 +/- 36 mL/min/m2) while dobutamine increased VO2 by 10% (from 146 +/- 36 to 161 +/- 41 mL/min/m2, p < .01). Accordingly, there was an identical decrease in oxygen extraction with PGI2 (from 32.4 +/- 8.2% to 28.6 +/- 7.1%, p < .01) and dobutamine (from 32.4 +/- 8.3% to 28.5 +/- 7.8%, p < .01). The responses to these medications were similar in survivors and nonsurvivors. CONCLUSIONS PGI2 and dobutamine at the doses used have similar effects on oxygen extraction in critically ill, septic patients, but dobutamine increases DO2 more consistently and is better tolerated than prostacyclin.
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Affiliation(s)
- D De Backer
- Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium
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Moraine JJ, Lamotte M, Berré J, Niset G, Leduc A, Naeije R. Relationship of middle cerebral artery blood flow velocity to intensity during dynamic exercise in normal subjects. Eur J Appl Physiol Occup Physiol 1993; 67:35-8. [PMID: 8375362 DOI: 10.1007/bf00377701] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cerebral blood flow has been reported to increase during dynamic exercise, but whether this occurs in proportion to the intensity remains unsettled. We measured middle cerebral artery blood flow velocity (vm) by transcranial Doppler ultrasound in 14 healthy young adults, at rest and during dynamic exercise performed on a cycle ergometer at a intensity progressively increasing, by 50 W every 4 min until exhaustion. Arterial blood pressure, heart rate, end-tidal, partial pressure of carbon dioxide (PETCO2), oxygen uptake (VO2) and carbon dioxide output were determined at exercise intensity. Mean vM increased from 53 (SEM 2) cm.s-1 at rest to a maximum of 75 (SEM 4) cm.s-1 at 57% of the maximal attained VO2 (VO2max), and thereafter progressively decreased to 59 (SEM 4) cm.s-1 at VO2max. The respiratory exchange ratio (R) was 0.97 (SEM 0.01) at 57% of VO2max and 1.10 (SEM 0.01) at VO2max. The PETCO2 increased from 5.9 (SEM 0.2) kPa at rest to 7.4 (SEM 0.2) kPa at 57% of VO2max, and thereafter decreased to 5.9 (SEM 0.2) kPa at VO2max. Mean arterial pressure increased from 98 (SEM 1) mmHg (13.1 kPa) at rest to 116 (SEM 1) mmHg (15.5 kPa) at 90% of VO2max, and decreased slightly to 108 (SEM 1) mmHg (14.4 kPa) at VO2max. In all the subjects, the maximal value of vm was recorded at the highest attained exercise intensity below the anaerobic threshold (defined by R greater than 1). We concluded that cerebral blood flow as evaluated by middle cerebral artery flow velocity increased during dynamic exercise as a function of exercise intensity below the anaerobic threshold.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J J Moraine
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
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Dominguez-Roldan JM, Murillo-Cabezas F, Munoz-Sanchez A, Maestre A, Porras F, Santamaria-Mifsut JL, Facco E, Munari M, Baratto F, Behr AU, Bruno R, Giron GP, Sonnet ML, Perrot D, Floret D, Guillaume C, Bui-Xuan B, Vedrinne JM, Motin J, Dall’Acqua G, Cesaro S, Giacomini M, Allaouchiche B, Moulaire V, Bouffard Y, Latronico N, Fenzi F, Guarneri B, Tomelleri G, Tonin P, Rizzuto N, Candiani A, Lacguaniti LG, Irone M, Zamperetti N, Gulino A, Pellegrin C, Dan M, Sandroni C, Bareili A, Piazza O, Della Corte F, Kovacs A, Cucurachi M, Sab JM, Sirodot M, Straboni JP, Dorez D, Dubols JM, Gaussorgues P, Robert D, Delafosse B, Kopp N, Faure JL, Neidecker J, Parma A, Marzorati S, Rampini PM, Egidi M, Calappi E, Massci R, Montolivo M, Gemma M, Regi B, Fiacchino F, Montero JG, Leyba CO, Osuna JM, Jimenez JJ, Noval RL, Hernandez PC, Gervaix A, Beghetti M, Berner M, Schneider A, Rilliet B, Berré J, De Backer D, Moraine JJ, Vincent JL, Kahn RJ, Latour J, Reig A, Ribera D, Alemañ MC, Basco JL, López M, Pastor M, Carrasco F, Zaplana J, Ruiz MR, Sánchez M, Boillot A, Capellier G, Balvay P, Cordier A, Tissot M, Barale F, Bricchi M, Franceschetti S. Neurology. Intensive Care Med 1992. [DOI: 10.1007/bf03216367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE To assess the hemodynamic effects of the addition of small bolus doses of the phosphodiesterase inhibitor enoximone to adrenergic therapy in patients with severe heart failure. DESIGN Open label, prospective study. SETTING Multidisciplinary department of intensive care in a university academic hospital. PATIENTS Twelve surgical patients after cardiac surgery and ten medical patients with ischemic or dilated cardiomyopathy who had signs of altered tissue perfusion associated with a low cardiac index (less than 2.25 L/min/m2), despite adrenergic therapy. INTERVENTIONS Small iv bolus doses of 0.25 mg/kg of enoximone. MEASUREMENTS AND MAIN RESULTS This treatment resulted in significant increases in cardiac index and left ventricular stroke work index without significant changes in heart rate or mean arterial pressure. Furthermore, the effects of half this dose (i.e., 0.125 mg/kg), studied in 11 patients, demonstrated a significant drug-induced increase in mean (+/- SD) cardiac index (from 1.58 +/- 0.29 to 1.84 +/- 0.27 L/min/m2, p less than .01) without change in mean arterial pressure (from 74.5 +/- 12.1 to 76.5 +/- 12.6 mm Hg, nonsignificant). CONCLUSIONS Direct iv injections of enoximone can significantly increase the cardiac index in critically ill patients treated by adrenergic agents for severe heart failure. The administration of small doses of enoximone is effective and has minimal effect on arterial pressure.
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Affiliation(s)
- J L Vincent
- Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium
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Abstract
The addition of enoximone, a phosphodiesterase inhibitor, to adrenergic agents has been found useful in increasing cardiac output in severe heart failure. In one study of 13 patients in cardiogenic shock already receiving adrenergic support, enoximone was administered as a bolus of 0.5 mg/kg over 20 minutes. Pulmonary artery occlusion pressure decreased significantly from 21.7 +/- 5.8 mm Hg to 19.8 +/- 6.0 mm Hg (P less than 0.01) and cardiac index increased markedly. A second study investigated the effects of the addition of small boluses of enoximone to adrenergic agents in low flow states associated with heart failure (n = 8) or postoperative states after cardiac surgery (n = 10). Each of the 18 patients was treated with dobutamine; 12 patients were also treated with dopamine and 4 with noradrenaline. Enoximone was administered as small but increasing intravenous boluses. No significant change in mean arterial pressure was observed, but on 0.5 mg/kg of enoximone pulmonary artery occlusion pressure decreased significantly from 24.6 +/- 8.7 mm Hg to 19.4 +/- 9.9 mm Hg (heart failure) and from 18.2 +/- 3.3 mm Hg to 15.3 +/- 3.8 mm Hg (cardiac surgery) after the initial dose of 0.125 mg/kg. Cardiac index increased markedly after enoximone, 0.25 mg/kg. These changes were significant after the initial dose of 0.125 mg/kg. Thus, the addition of even small doses of enoximone to adrenergic agents can markedly increase cardiac index without significant effect on arterial pressure in medical or surgical cardiac patients.
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Affiliation(s)
- J L Vincent
- Department of Intensive Care, Erasmus University Hospital, Free University of Brussels, Belgium
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Abstract
Low cardiac output in acute heart failure can result in a functional impairment of organs, when tissue hypoxia occurs and cardiogenic shock develops. To restore cardiac output, various forms of therapy can be considered. Fluid replacement is sometimes beneficial in acute situations where oedema can reduce effective plasma volume. Vasodilators are often contra-indicated in shock, when arterial pressure is usually low. Inotropic therapy consists primarily of the administration of adrenergic agents. Dopamine and noradrenaline can be indicated in severe hypotension, to maintain coronary perfusion. Dobutamine is the catecholamine of choice to increase myocardial contractility. However, decreased responsiveness of the myocardial receptors to adrenergic stimulation rapidly becomes an important limitation. Phosphodiesterase inhibitors represent an interesting option to increase contractility, also by increasing cyclic AMP levels in the myocardium. In this respect, the combination of phosphodiesterase inhibitors with adrenergic agents is attractive. The additional vasodilatory properties of these agents can contribute to the increase in cardiac output with limited risk of further reduction in arterial pressure. In 13 patients with cardiogenic shock persisting despite the use of adrenergic agents, the addition of enoximone, 0.5 mg/kg, resulted in significant increases in cardiac index and stroke volume index and a significant decrease in pulmonary artery balloon occlusion pressure without consistent change in mean arterial pressure. In 8 patients, a second infusion of 0.5 g/kg amplified these effects. All but one of these patients survived the episode of cardiogenic shock, and 5 patients were discharged alive. In some cases, even lower doses of enoximone resulted in dramatic increases in cardiac output and oxygen transport in patients already treated with dobutamine with limited success.
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Affiliation(s)
- J L Vincent
- Department of Intensive Care, Erasmus University Hospital, Free University of Brussels, Belgium
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Berré J, Thys JP, Husson M, Gangji D, Klastersky J. Penetration of ciprofloxacin in bronchial secretions after intravenous administration. J Antimicrob Chemother 1988; 22:499-504. [PMID: 3204076 DOI: 10.1093/jac/22.4.499] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Ciprofloxacin concentrations in serum and in bronchial secretions were studied after single and multiple intravenous administrations for two days in ten patients. The dose given was either 0.75 or 1.5 mg/kg. With the lower dose, the peak concentrations in the bronchial secretions were (mean +/- S.D.) 0.40 +/- 0.29 mg/l after the first injection and 0.35 +/- 0.25 mg/l after the fourth injection. With the higher dose, the corresponding mean peak bronchial concentrations were 0.84 +/- 0.58 and 1.16 +/- 0.86 mg/l respectively. The half-lives of the drug in bronchial secretions ranged from 2.13 to 3.72 h. The penetration of ciprofloxacin into bronchial secretions was excellent as demonstrated by the high ratios of the areas under the concentration curves obtained in the serum and in bronchial secretions which ranged from 0.79 to 1.11.
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Affiliation(s)
- J Berré
- Service des Soins Intensifs, Hôpital Universitaire Erasme, Brussels, Belgium
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Abstract
Thirteen patients in severe cardiogenic shock, persisting despite the use of adrenergic agents, were treated with enoximone, a recently available phosphodiesterase inhibitor. Cardiogenic shock was characterized by low cardiac output (less than 2.5 liter.min-1.m-2), elevated pulmonary artery balloon-occluded pressure (greater than or equal to 15 mm Hg), decreased urine output (less than 20 ml.hour-1) and increased blood lactate (greater than or equal to 2.0 mEq.liter-1). Ten patients were mechanically ventilated. A short-term intravenous infusion of 0.5 mg.kg-1 in 20 minutes of enoximone resulted in significant increases in cardiac index (from 1.8 +/- 0.3 to 2.9 +/- 0.3 liter.min-1.m-2, p less than 0.001) and stroke index (from 17.8 +/- 3.3 to 21.9 +/- 5.1 ml.m-2, p less than 0.001) and significant decrease in pulmonary artery balloon-occluded pressure (from 21.7 +/- 5.8 to 19.8 +/- 6.0 mm Hg, p less than 0.01) without a consistent change in mean arterial pressure (from 79 +/- 8 to 76 +/- 9 mm Hg, difference not significant). Enoximone administration decreased arterial oxygen tension (from 108 +/- 42 to 94 +/- 36 mm Hg, p less than 0.01) and increased venous admixture (from 12.8 +/- 6.5 to 16.0 +/- 8.0%, p less than 0.01). In 8 patients, a second infusion of 0.5 mg.kg-1 immediately thereafter amplified these changes. All patients but one survived the episode of cardiogenic shock and 5 patients left the hospital alive. These results indicate that the addition of enoximone to adrenergic agents in the treatment of cardiogenic shock can markedly increase cardiac output and stroke volume without substantial effects on arterial pressure.
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Affiliation(s)
- J L Vincent
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
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Berré J, Ros AM, Vincent JL, Dufaye P, Brimioulle S, Kahn RJ. Technical and psychological complications of high-frequency jet ventilation. Intensive Care Med 1987; 13:96-9. [PMID: 3471801 DOI: 10.1007/bf00254792] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The type and the incidence of complications during treatment with high-frequency jet ventilation were evaluated in 10 critically ill patients with acute respiratory failure. HFJV was used for 2 to 34 days for management of bronchopleural fistulae, tracheal rupture, laryngeal trauma or voluminous lung abscesses. The most significant technical problems observed were disconnection or kinking of the jet catheter, hypothermia and CO2 retention. Insufficient humidification could induce severe complications such as viscous bronchial secretions, desiccation of the tracheobronchial mucosa or total obturation of the endotracheal tube. Psychological tolerance of high-frequency jet ventilation was generally satisfactory but the ventilator noise was sometimes hardly tolerated. Patients could develop a psychological dependence to high-frequency jet ventilation, leading to weaning problems. Solutions are suggested to decrease the incidence and severity of the technical and psychological complications.
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Abstract
Many critically ill patients suffer pain which can produce by itself undesirable effects. Consequently, pain must be carefully prevented, or at least, treated early and effectively. Basal analgesia can be provided by repeated intramuscular administration of narcotics, or rather by continuous intravenous infusion of morphine or meperidine or by a regional anesthetic procedure such as an epidural block. Computer-assisted intravenous "on demand" analgesia with Fentanyl can also be used. When pain coverage is required during transient events such as active physiotherapy or dressing changes, additional intravenous of a narcotic (1-2 mg morphine e.g.) or inhalation of nitrous oxide with oxygen are usually effective.
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Abstract
The time course of lactacidemia was studied prospectively in 17 patients during fluid resuscitation for an episode of noncardiogenic shock, in 5 patients after grand mal seizures, and in 5 patients after successful CPR for cardiac arrest. The 9 patients in whom shock was reversed with fluid administration demonstrated a regular decrease in lactate concentrations, which exceeded 5% of the initial value during the first 60 min of treatment. In the other patients who expired despite similar therapy, lactacidemia was not significantly affected. During circulatory shock, repeated lactate determinations represent a more reliable prognostic index than an initial value taken alone. Changes in lactate concentration can provide an early and objective evaluation of the patient's response to therapy.
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Vincent JL, Vanherweghem JL, Degaute JP, Berré J, Dufaye P, Kahn RJ. Acetate-induced myocardial depression during hemodialysis for acute renal failure. Kidney Int 1982; 22:653-7. [PMID: 7162037 DOI: 10.1038/ki.1982.225] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We studied the cardiovascular effects of hemodialysis in five critically ill patients with ultrafiltration using, alternately, bicarbonate and acetate in the dialysate. After 3 hr of dialysis with acetate, significant decreases in both arterial pressure and stroke volume resulted in lowered left ventricular stroke work (P less than 0.025). This effect persisted 30 min after the end of the dialysis (P less than 0.025). Differences in the patients' cardiac preload were ruled out by similar pulmonary artery balloon-occluded pressures during both types of dialysis. These observations suggest that dialysis with acetate can result in myocardial depression. The use of bicarbonate dialysate is thus advisable for acute hemodialysis in critically ill patients.
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