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Lesny M, Conrad M, Latarche C, Sylvestre A, Gaujard E, Dubois V, Quignard C, Citro V, Thomas JC, Bridey C, Weber AM, Simon C, Klein S, Gibot S, Bollaert PE. Adverse events during nursing care procedure in intensive care unit: The PREVENIR study. Intensive Crit Care Nurs 2020; 60:102881. [PMID: 32499089 DOI: 10.1016/j.iccn.2020.102881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/06/2019] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Intensive care unit patients undergo several nursing care procedures (NCP) every day. These procedures involve a risk for adverse events (AE). Yet, their prevalence, intensity, and predisposing risk factors remain poorly established. The main objective of the study was to measure the incidence and severity of NCP related AE. DESIGN This prospective observational multicentre study was conducted in 9 ICUs. All NCP were recorded for four consecutive weeks. For each NCP, the following were collected: patients' baseline characteristics, type of NCP, characteristics of the NCP, AE and therapeutic responses. RESULTS 5849 NCP occurred in 340 patients. Among the 340 patients included, 292 (85.9%) were affected by at least one AE, and 141 (41.5%) by an SAE during a NCP. Thirty % of NCP were associated with at least one AE: hemodynamic AE in 17.1%, respiratory AE in 13.6%, agitation and pain (3.7% and 3.3%). Eight invasive devices were accidentally removed. Severe Adverse Events (SAE) occurred in 5.5% of NCP. The main risk factor associated with SAE was pain/agitation at the beginning of the NCP. CONCLUSION AE are frequent during NCP in ICU. We identified several risk factors, some of them preventable, that could be considered for the development of recommendations for the nursing care of critically ill patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02881645.
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Affiliation(s)
- M Lesny
- Réanimation médicale, Hôpital central, CHU Nancy, France
| | - M Conrad
- Réanimation médicale, Hôpital central, CHU Nancy, France.
| | - C Latarche
- Qualité Gestion des risques, CHU Nancy, France
| | | | - E Gaujard
- Réanimation médicale, Hôpital central, CHU Nancy, France
| | - V Dubois
- Réanimation neurochirurgicale, Hôpital central, CHU Nancy, France
| | - C Quignard
- Réanimation chirurgicale, Hôpital central, CHU Nancy, France
| | - V Citro
- Réanimation, CHR Metz, France
| | - J C Thomas
- Réanimation chirurgicale Cardiovasculaire, Hôpitaux de Brabois, CHU Nancy, France
| | - C Bridey
- Réanimation médicale, Hôpitaux de Brabois, CHU Nancy, France
| | - A M Weber
- Réanimation médicale, CHU Strasbourg, France
| | - C Simon
- Réanimation chirurgicale, Hôpitaux de Brabois, CHU Nancy, France
| | - S Klein
- CIC-EC INSERM, CHU Nancy, France
| | - S Gibot
- Réanimation médicale, Hôpital central, CHU Nancy, France
| | - P E Bollaert
- Réanimation médicale, Hôpital central, CHU Nancy, France
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2
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Corriger J, Beaudouin E, Rothmann R, Penven E, Haumonte Q, Thomas H, Picaud J, Nguyen-Grosjean VM, Corriger-Ippolito J, Braun F, De Talancé M, Auburtin B, Atain-Kouadio P, Borsa-Dorion A, Baugnon D, De Carvalho M, Jaussaud R, Nguyen-Thi PL, Bollaert PE, Demoly P, Tanno LK. Epidemiological Data on Anaphylaxis in French Emergency Departments. J Investig Allergol Clin Immunol 2018; 29:357-364. [PMID: 30411700 DOI: 10.18176/jiaci.0348] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although anaphylaxis has been considered a priority public health issue in the world allergy community, epidemiological data on morbidity and mortality remain suboptimal. We performed the first multicenter epidemiological study in French emergency departments (EDs). The study covered 7 EDs over a period of 1 year. The objectives were to identify areas that are amenable to change and to support ongoing national and international efforts for better diagnosis, management, and prevention of anaphylaxis. METHODS Ours was a descriptive study based on data routinely reported to French institutional administrative databases from 7 French public health institutions in the Lorraine region between January and December 2015. Data were collected based on the anaphylaxisrelated codes of the International Classification of Diseases (ICD)-10, and cases were clinically validated as anaphylaxis. RESULTS Of the 202 079 admissions to the EDs, 4817 had anaphylaxis-related codes; of these, 323 were clinically validated as anaphylaxis. Although 45.8% were severe, adrenaline was prescribed in only 32.4% of cases. Of the 323 cases, 57.9% were subsequently referred for an allergy work-up or evaluation (after or during hospitalization), and 17.3% were prescribed autoinjectable epinephrine. CONCLUSION Our results highlight an urgent need for improved public health initiatives with respect to recognition and treatment of anaphylaxis. We flag key problems that should be managed in the coming years through implementation of national and international actions.
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Affiliation(s)
- J Corriger
- Allergy Department, Hospital Emile Durkheim, Epinal, France.,Internal Medicine and Clinical Immunology Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - E Beaudouin
- Allergy Department, Hospital Emile Durkheim, Epinal, France
| | - R Rothmann
- Emergency Department, Hospital Mercy-Metz, Ars-Laquenexy, France
| | - E Penven
- Occupational Diseases Department, University Hospital, Vandoeuvre-lès-Nancy, France.,Division of Allergy, Dermatology Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - Q Haumonte
- Allergy Department, Hospital Emile Durkheim, Epinal, France
| | - H Thomas
- Allergy Department, Hospital Emile Durkheim, Epinal, France
| | - J Picaud
- Allergy Department, Hospital Emile Durkheim, Epinal, France
| | | | - J Corriger-Ippolito
- Division of Allergy, Dermatology Department, University Hospital, Vandoeuvre-lès-Nancy, France.,Emergency Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - F Braun
- Emergency Department, Hospital Mercy-Metz, Ars-Laquenexy, France
| | - M De Talancé
- Emergency Department, Hospital Emile Durkheim, Epinal, France
| | - B Auburtin
- Pediatric Emergency Department, Hospital Emile Durkheim, Epinal, France
| | - P Atain-Kouadio
- Emergency Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - A Borsa-Dorion
- Pediatric Emergency Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - D Baugnon
- Emergency Department, Hospital of Verdun-Saint-Mihiel, Verdun, France
| | - M De Carvalho
- Biology and Immunology Laboratory, University Hospital, Vandoeuvre-lès-Nancy, France
| | - R Jaussaud
- Internal Medicine and Clinical Immunology Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - P L Nguyen-Thi
- Clinical Research Platform, ESPRI-BioBase Unit, University Hospital, Vandoeuvre-lès-Nancy, France
| | - P E Bollaert
- Medical Intensive Care Unit, University Hospital, Nancy, France
| | - P Demoly
- Division of Allergy, Department of Pulmonology, University of Montpellier, France and Sorbonne University, INSERM, IPLESP, EPAR team, Paris, France
| | - L K Tanno
- Division of Allergy, Department of Pulmonology, University of Montpellier, France and Sorbonne University, INSERM, IPLESP, EPAR team, Paris, France
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3
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Boufenzer A, Sennoun N, Bouazza Y, Derive M, Bollaert PE, Gibot S. Role of TREM-1 in endothelial dysfunction during experimental sepsis. Crit Care 2012. [PMCID: PMC3504850 DOI: 10.1186/cc11736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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4
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Gibot S, Boufenzer A, Bouazza Y, Groubatch F, Alauzet C, Barraud D, Bollaert PE, Leroy P, Tran N, Derive M. Effects of a TREM-like transcript-1 derived peptide during septic shock in pigs. Crit Care 2012. [PMCID: PMC3504849 DOI: 10.1186/cc11735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Rothmann C, Ruschel N, Streiff R, Pitti R, Bollaert PE. Embolie graisseuse pulmonaire après liposuccion. ACTA ACUST UNITED AC 2006; 25:189-92. [PMID: 16269230 DOI: 10.1016/j.annfar.2005.07.084] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2004] [Accepted: 07/26/2005] [Indexed: 11/25/2022]
Abstract
A 24-year-old woman undergoes buttock's liposuction as an outpatient procedure. As she went back home, progressive dyspnea, respiratory distress and collapse developed. At hospital admission, she was dyspneic with thoracic oppression, tachycardia and anguish. Chest X-ray and thoracic CT scan suggested a pulmonary localisation of fat emboli. Symptomatic treatment allowed complete recovery. This report discusses diagnosis of fat emboli after liposuction as well as epidemiology and physiopathology.
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Affiliation(s)
- C Rothmann
- Service d'Accueil des Urgences, CHR de Metz-Thionville, Hôpital Bon-Secours, 1, place P.-de-Vigneulles, 57038 Metz cedex, France.
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Ducrocq X, Bracard S, Taillandier L, Anxionnat R, Lacour JC, Guillemin F, Debouverie M, Bollaert PE. Comparison of intravenous and intra-arterial urokinase thrombolysis for acute ischaemic stroke. J Neuroradiol 2005; 32:26-32. [PMID: 15798610 DOI: 10.1016/s0150-9861(05)83018-4] [Citation(s) in RCA: 30] [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: 10/22/2022]
Abstract
Intravenous fibrinolysis (IVF) with rt-PA (alteplase) provides significant benefits in acute ischaemic stroke when it is given within the first three hours following stroke onset. Intra-arterial fibrinolysis (IAF) with pro-urokinase in PROACT II study provides quite the same benefit in the first 6 hours. IVF and IAF have never been compared. To compare the efficacy and safety of IVF and IAF with urokinase given within the first 6 hours of acute ischaemic stroke. Patients fulfilling the selection criteria were randomly assigned to receive urokinase 900,000 units via intravenous or intra-arterial routes. This randomised monocentre study was done between December 1995 and August 1997. The primary outcome was defined as the number of patients with a modified Rankin score of 2 or less. Secondary outcomes included mortality, frequency of symptomatic intracranial haemorrhage (SIH), neurological and functional scores. Fourteen patients were given IVF and 13 IAF. The study was terminated by the National Health Authorities when 27 patients had been included because of the mortality rate. Seven patients (26%) died, 4 in the IV group (oedematous infarct in 3 and recurrence in 1), 3 in the IA group (SIH in 2, and oedematous infarct in 1). Patients given IVF were treated significantly earlier (4:16 h vs 5:24 h; p=.007). Although IA patients showed greater and earlier improvement there was no significant difference in primary and secondary outcomes. Because of premature termination, the trial was too small to provide any reliable and conclusive results. Intra-arterial fibrinolysis began significantly later than IV fibrinolysis but it gave non-significantly better results in this prematurely terminated study.
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Affiliation(s)
- X Ducrocq
- Service de Neurologie, Centre Hospitalier Universitaire, Hôpital Central, avenue de Lattre de Tassigny, CO 34, 54035 Nancy Cedex.
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Abstract
BACKGROUND Sepsis may be complicated by impaired corticosteroid production. Giving corticosteroids could potentially benefit patients. OBJECTIVES To examine the effects of corticosteroids on death at one month in patients with severe sepsis and septic shock. SEARCH STRATEGY We searched the Cochrane Infectious Diseases Group's trial register (August 2003), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2003), MEDLINE (August 2003), EMBASE (August 2003), LILACS (August 2003), reference lists of articles, and also contacted trial authors. SELECTION CRITERIA Randomized and quasi-randomized controlled trials of corticosteroids versus placebo or supportive treatment in severe sepsis and septic shock. DATA COLLECTION AND ANALYSIS Two pairs of reviewers agreed the eligibility of trials. One reviewer extracted data, which was checked by the other reviewers and the primary author of the paper whenever possible. We obtained some missing data from the trial authors. We assessed trial methodological quality. MAIN RESULTS We identified 15 trials (n =2023). Corticosteroids did not change 28-day all-cause mortality (15 trials, n = 2022, relative risk (RR) 0.92, 95% confidence interval (CI) 0.75 to 1.14; random effects model) and hospital mortality (13 trials, n = 1418, RR 0.89, 95% CI 0.71 to 1.11; random effects model); however, there was statistically significant heterogeneity, with some evidence that this was related to the dosing strategy. Corticosteroids reduced intensive care unit mortality (4 trials, n = 425, RR 0.83, 95% CI 0.70 to 0.97), increased the proportion of shock reversal by day 7 (6 trials, n = 728, RR 1.22, 95% CI 1.06 to 1.40) and by day 28 (4 trials, n = 425, RR 1.26, 95% CI 1.04 to 1.52), without increasing the rate of gastroduodenal bleeding (10 trials, n = 1321, RR 1.16, 95% CI 0.82 to 1.65), superinfection (12 trials, n = 1705, RR 0.93, 95% CI 0.73 to 1.18), and of hyperglycaemia (6 trials, n = 608, RR 1.22, 0.84 to 1.78). REVIEWER'S CONCLUSIONS Overall, corticosteroids did not change 28-day mortality and hospital mortality in severe sepsis and septic shock. Long course of low dose corticosteroids reduced 28-day all-cause mortality, and intensive care unit and hospital mortality.
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Affiliation(s)
- D Annane
- Critical Care Department, Hôpital Raymond Poincaré, Assistance Publique - Hôpitaux de Paris, 104. Boulevard Raymond Poincaré, Garches, Ile de France, France
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Feillet F, Steinmann G, Vianey-Saban C, de Chillou C, Sadoul N, Lefebvre E, Vidailhet M, Bollaert PE. Adult presentation of MCAD deficiency revealed by coma and severe arrythmias. Intensive Care Med 2003; 29:1594-7. [PMID: 12897989 DOI: 10.1007/s00134-003-1871-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2003] [Accepted: 05/23/2003] [Indexed: 10/26/2022]
Abstract
We report the case of a 33-year-old man who presented with headaches and vomiting. Soon after admission he became drowsy and agitated, developed ventricular tachycardia and his neurological state worsened (Glasgow coma score 6). Blood analysis showed respiratory alkalosis, hyperlactacidemia (8 mmol/l), hyperammonemia (390 micro mol/l) and hypoglycaemia (2.4 mmol/l). Subsequently, he developed supraventricular tachycardia, ventricular tachycardia and ultimately ventricular fibrillation resulting in cardiac arrest, which was successfully treated. A CT scan of the head revealed cerebral oedema. Whilst in the intensive care unit, he developed renal failure and rhabdomyolysis. The metabolic abnormalities seen at the time of admission normalised within 48 h with IV glucose infusion. Biological investigations, including urinary organic acids and plasma acylcarnitines, showed results compatible with MCAD deficiency. Mutation analysis revealed the patient was homozygous for the classical mutation A985G. This is one of only a few reports of severe cardiac arrhythmia in an adult due to MCAD deficiency. This condition is probably under-diagnosed in adult patients with acute neurological and/or cardiac presentations.
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Affiliation(s)
- F Feillet
- Service de Réanimation Médicale Pédiatrique, Hôpital d'Enfants, CHU Brabois, Allée du Morvan, Vandoeuvre les Nancy, 54500 Nancy, France.
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9
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Bollaert PE. [Role of plasminogen activators in the treatment of deep venous thrombosis]. Ann Cardiol Angeiol (Paris) 2002; 51:169-71. [PMID: 12471649 DOI: 10.1016/s0003-3928(02)00091-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In deep vein thrombosis, thrombolytic agents can improve vein patency more rapidly than conventional anticoagulant therapy. The clinical benefit of thrombolytic use would be a reduction in the incidence and severity of the postthrombotic syndrome and limb salvage in "phlegmatia caerulea". A literature review suggests that streptokinase and rt-PA do better than heparin regarding vein patency. A clinical benefit on postthrombotic syndrome can only be suggested by available evidence. The risk of major bleeding is increased by thrombolytic agents as compared with heparin. Mortality for cerebral bleeding is about 0.5%. Currently, thrombolytic therapy is only recommended for limb salvage in phlegmatia caerulea.
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Affiliation(s)
- P E Bollaert
- Service de réanimation médicale, hôpital Central, 54035 Nancy, France.
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10
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Bollaert PE. [New techniques in artificial ventilation]. Bull Acad Natl Med 2001; 184:1643-50; discussion 1651. [PMID: 11471385] [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: 02/20/2023]
Abstract
In recent years, considerable improvement has been achieved in the field of mechanical ventilation. A lot of experimental and clinical research has been done to reduce the adverse effects of mechanical ventilation. It is currently of importance that high volumes and pressures have been demonstrated as sources of alveolar-capillary membrane injury in lungs. In the acute respiratory distress syndrome, mechanical ventilator settings have evolved from the goal of strict correction of gas exchange towards a lung-protective strategy where priority is given to tidal volumes limitation and alveolar recruitment. Pressure-assisted ventilatory modes, such as pressure support have been introduced, resulting in better patient-ventilator synchronisation, good tolerance and easier weaning process. Pressure support is also a largely used mode in noninvasive ventilation which has been proved to improve outcome in chronic obstructive pulmonary diseases.
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Affiliation(s)
- P E Bollaert
- Service de Réanimation Médicale, CHU-Hôpital Central-54035 Nancy
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Levy B, Sadoune LO, Gelot AM, Bollaert PE, Nabet P, Larcan A. Evolution of lactate/pyruvate and arterial ketone body ratios in the early course of catecholamine-treated septic shock. Crit Care Med 2000; 28:114-9. [PMID: 10667509 DOI: 10.1097/00003246-200001000-00019] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.6] [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: 11/26/2022]
Abstract
OBJECTIVES To measure arterial lactate/pyruvate (L/P) and arterial ketone body ratios as reflection of cytoplasmic and mitochondrial redox state at different stages of catecholamine-treated septic shock and compare them with normal and pathologic values obtained in patients in shock who have decreased oxygen transport (cardiogenic shock), and to assess the relationship between the time course of lactate, L/P ratio, and mortality in septic shock. DESIGN Prospective, observational human study. SETTING A university intensive care unit. PATIENTS Sixty consecutive adult patients who developed septic shock and lactic acidosis requiring the administration of vasopressors. Twenty patients in the intensive care unit without shock, sepsis, and hypoxia and with normal lactate values and 10 patients with cardiogenic shock were also studied. MEASUREMENTS Hemodynamic measurements, arterial and mixed venous blood gases, arterial lactate and pyruvate concentrations, and arterial ketone body ratio were measured within 4 hrs after the introduction of catecholamine and 24 hrs later. MAIN RESULTS Fifteen patients (25%) died within the first 24 hrs of septic shock, and these early fatalities had a higher blood lactate (12.2+/-3 versus 4.6+/-1.3 mmol/L; p<.01) concentration and a higher L/P ratio (37+/-4 versus 20+/-1; p<.01) than those who died later. No difference was found for arterial ketone body ratio (0.41+/-0.1 versus 0.50+/-0.06). Forty-five patients survived >24 hrs including 25 survivors and 20 nonsurvivors. Although there was no difference between survivors and nonsurvivors in initial lactate concentration (4.1+/-0.4 and 4.6+/-0.3, respectively), L/P ratio (19+/-1 and 20+/-1, respectively), and arterial ketone body ratio (0.5+/-0.06 and 0.52+/-0.07, respectively), blood lactate and L/P ratio significantly decreased during the first 24 hrs in the survivors (2.8+/-0.4 and 14+/-1, respectively; p<.05). and were stable in the nonsurvivors (4+/-0.3 and 22+/-1, respectively) Although returning to normal values after 24 hrs in survivors and nonsurvivors, arterial ketone body ratio was higher in survivors (1.72+/-0.17 versus 1.09+/-0.15; p<.05). Lactate and L/P ratio were closely correlated (r2 = .8, p<.0001). In the cardiogenic shock group, lactate concentration was 4+/-1 mmol/L, L/P ratio was 40+/-6, and arterial ketone body ratio was 0.2+/-0.05. The mortality rate was 60%. CONCLUSIONS The main result of the present study is that hemodynamically unstable patients with sepsis needing catecholamine therapy had a lactic acidosis with an elevated L/P ratio and a decreased arterial ketone body ratio, suggesting a decrease in cytoplasmic and mitochondrial redox state. The duration of lactic acidosis is associated with the development of multiple organ failure and death.
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Affiliation(s)
- B Levy
- Polyvalent Intensive Care Unit, Central Hospital, Nancy Cedex, France
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Levy B, Nace L, Bollaert PE, Dousset B, Mallie JP, Larcan A. Comparison of systemic and regional effects of dobutamine and dopexamine in norepinephrine-treated septic shock. Intensive Care Med 1999; 25:942-8. [PMID: 10501749 DOI: 10.1007/s001340050986] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [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: 10/28/2022]
Abstract
OBJECTIVES To compare the effects of dobutamine and dopexamine on systemic hemodynamics, lactate metabolism, renal function and the intramucosal-arterial PCO(2) gap in norepinephrine-treated septic shock. DESIGN A prospective, interventional, randomized clinical trial. SETTING Adult medical/surgical intensive care unit in a university hospital. PATIENTS After volume resuscitation, 24 patients were treated with norepinephrine alone titrated to obtain a mean arterial pressure of 75 mmHg and a cardiac index greater than 3. 5 l/min(-1). m(-2). INTERVENTIONS Patients were randomized to receive an infusion of dobutamine (n = 12) (5 microg/kg per min) or dopexamine (n = 12) (1 microg/kg per min). MEASUREMENTS AND MAIN RESULTS Baseline measurements included: hemodynamic parameters, renal parameters (diuresis, creatinine clearance and urinary sodium excretion), gastric mucosal-arterial PCO(2) gap, arterial and mixed venous gases and arterial lactate and pyruvate levels. These measurements were repeated after 1 (H(1)), 4 (H(4)) and 24 (H(24)) h. No difference was found between dobutamine and dopexamine among H(0) and H(1), H(4) and H(24) values for hemodynamics. Dobutamine and dopexamine at low doses had no significant effect on mean arterial pressure, heart rate, cardiac index, oxygen delivery, oxygen consumption and pulmonary artery occlusion pressure. No patients developed arrhythmia or electrocardiographic signs of myocardial ischemia. After 4 and 24 h lactate concentration decreased in the dobutamine group from 2.4 +/- 1 mmol/l to 1.7 +/- 0. 7 mmol/l and 1.5 +/- 0.4 mmol/l, respectively, while it increased in the dopexamine group from 2.3 +/- 1 mmol/l to 2.7 +/- 1 mmol/l after 4 h and returned to baseline values after 24 h (2.2 +/- 0.6). After 24 h the lactate/pyruvate ratio decreased in the dobutamine group from 15 +/- 5 to 12 +/- 3 (p < 0.05) while it was unchanged in the dopexamine group (from 16 +/- 6 to 17 +/- 4). Arterial pH increased in the dobutamine group from 7.35 +/- 0.05 to 7.38 +/- 0.07 (p < 0. 05) while it was unchanged in the dopexamine group (from 7.34 +/- 0. 01 to 7.35 +/- 0.10). The PCO(2) gap decreased after 1 and 4 h in both the dobutamine and dopexamine groups (p < 0.05 with respect to baseline). When looking at individual responses, however, patients from both groups exhibited an increased gastric PCO(2) gap. No difference was found between dobutamine and dopexamine for renal parameters. CONCLUSIONS In norepinephrine-treated septic shock, low doses of neither dobutamine nor dopexamine caused significant effects on systemic hemodynamics and renal function and both dobutamine and dopexamine inconsistently improved the PCO(2) gap. The present results support the need for individual measurement of the effects of catecholamine on the PCO(2) gap.
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Affiliation(s)
- B Levy
- Polyvalent Intensive Care Unit, Central Hospital, 29 Avenue du Marechal de Lattre de Tassigny, CO 34, F-54 035 Nancy Cedex, France.
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Bollaert PE, Frisoni A. Epidemiology, mechanisms and clinical features of rhabdomyolysis. Minerva Anestesiol 1999; 65:245-9. [PMID: 10389399] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- P E Bollaert
- Service de Réanimation Médicale, Hôpital Central, Nancy
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Levy B, Valtier M, de Chillou C, Bollaert PE, Cane D, Mallie JP. Beneficial effects of L-canavanine, a selective inhibitor of inducible nitric oxide synthase, on lactate metabolism and muscle high energy phosphates during endotoxic shock in rats. Shock 1999; 11:98-103. [PMID: 10030795 DOI: 10.1097/00024382-199902000-00005] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [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: 11/26/2022]
Abstract
Overproduction of NO by an inducible NO synthase (iNOS) plays a role in the pathophysiology of septic shock. In such situations, NOS inhibition might be of therapeutic value, although detrimental side effects possibly related to inhibition of constitutive NOS have been reported. The use of L-canavanine, a selective inhibitor of iNOS, might be more suitable. The aim of the study was to compare in a rodent endotoxic shock the effects of saline (2 mL/h), N(G)-methyl-L-arginine(L-NMMA) (10 mg/kg/h) and L-canavanine (100 mg/kg/h) on muscle intracellular pH (pHi) and intracellular bioenergetic patterns (ATP, phosphocreatine/inorganic phosphate ratio) using in vivo 31P magnetic resonance spectroscopy (31P MRS). Three groups of anesthetized, mechanically ventilated and paralyzed rats received an intravenous infusion of 15 mg/kg of endotoxin. A fourth time-matched control group (n = 8) received 2 mL/h of saline. Mean arterial pressure, femoral blood flow, arterial blood gases, lactate, nitrate level, and 31P nuclear magnetic resonance (31P MRS) measurements were acquired at onset (T = 0), 90 min (T = 90), and 180 min (T180) after the endotoxin challenge. Femoral oxygen delivery was calculated as the product of femoral blood flow (mL/min) and arterial oxygen content. Endotoxin induced a marked decrease in arterial pressure and femoral oxygen delivery and an increase in lactate level. Intracellular pH and phosphocreatine/inorganic phosphate ratio decreased. ATP level did not change. Both L-NMMA and L-canavanine reversed the endotoxin-induced decrease in arterial pressure. L-NMMA attenuated the decrease in femoral oxygen delivery and the increase in lactate level while these were corrected by L-canavanine. Considering 31P MRS derived bioenergetic indices, the endotoxin-induced decrease in pHi and Pcr/Pi was attenuated by L-NMMA and corrected by L-canavanine. In conclusion, in a rodent model of endotoxinic shock, the continuous infusion of L-canavanine, a selective iNOS inhibitor, improved the systemic hemodynamic parameters and the intracellular bio-energetic patterns estimated by in vivo 31P MRS. To the contrary, the continuous infusion of both constitutive and inducible NOS inhibitor L-NMMA was not followed by the same achievement.
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Affiliation(s)
- B Levy
- Service de Réanimation Médicale, Hôpital Central, Nancy, France.
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Feillet F, Levy B, Bosser G, Derelle J, Bollaert PE, Monin P. Severe hypoxaemia induced by an intrapulmonary arterio-venous fistula: indication for nitric oxide. Eur J Pediatr 1998; 157:1036. [PMID: 9877051 DOI: 10.1007/s004310050997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 10/28/2022]
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17
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Levy B, Perrigault PF, Gawalkiewicz P, Sebire F, Escriva M, Colson P, Wahl D, Frederic M, Bollaert PE, Larcan A. Gastric versus duodenal feeding and gastric tonometric measurements. Crit Care Med 1998; 26:1991-4. [PMID: 9875909 DOI: 10.1097/00003246-199812000-00026] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [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: 01/15/2023]
Abstract
OBJECTIVE To compare the influence of gastric and postpyloric enteral feeding on the gastric tonometric PCO2 gap (tonometric PCO2 - PaCO2). DESIGN A prospective, clinical trial. SETTING Two intensive care units in a university hospital. PATIENTS Twenty patients undergoing mechanical ventilation and enteral feeding without catecholamines, sepsis, or sign of hypoxia. INTERVENTIONS Patients were randomized to receive feeding through the tonometer (gastric group), or through a postpyloric tube (postpyloric group). MEASUREMENTS AND MAIN RESULTS The patients received tube feeding at a rate of 50 mL/hr during 4 hrs. Baseline measurements included: mean arterial pressure, heart rate, tonometric parameters, arterial gases, and arterial lactate concentration. Except for lactate concentration, these measurements were repeated after 1 and 4 hrs of enteral feeding and 2 hrs after stopping enteral feeding. During the study, arterial pH and PaCO2 did not change. During enteral feeding, the PCO2 gap increased in the gastric group from a mean of 7+/-5 to 17+/-14 (SD) torr (0.9 0.7 to 2.3+/-1.9 kPa) (p< .O01) and did not change in the postpyloric group (5+/-5 to 3+/-1 torr [0.7+/-0.7 to 0.4+/-0.1 kPa]). Two hours after stopping enteral feeding, the PCO2 gap was still increased in the gastric group (15+/-9 vs. 7+/-5 torr [2.0+/-1.2 vs. 0.9+/-0.7 kPa]) (p < .01). CONCLUSION The results indicate that gastric enteral feeding increased the PCO2 gap. However, postpyloric enteral feeding does not interact with gastric tonometric measurements and should be used when using gastric tonometry in enterally fed patients.
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Affiliation(s)
- B Levy
- Polyvalent Intensive Care Unit, Central Hospital, Nancy, France.
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18
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Clément L, Frimat L, Champigneulles J, Touchard G, Bollaert PE, Kessler M. Infarctus pulmonaire révélant une glomérulonéphrite avec dépôts organisés microtubulaires d'immunoglobuline monoclonale IgG λ. Rev Med Interne 1998. [DOI: 10.1016/s0248-8663(98)80318-4] [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: 11/29/2022]
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Abstract
OBJECTIVES Preliminary studies have suggested that low doses of corticosteroids might rapidly improve hemodynamics in late septic shock treated with catecholamines. We examined the effect of hydrocortisone on shock reversal, hemodynamics, and survival in this particular setting. DESIGN Prospective, randomized, double-blind, placebo-controlled study. SETTING Two intensive care units of a University hospital. PATIENTS Forty-one patients with septic shock requiring catecholamine for >48 hrs. INTERVENTIONS Patients were randomly assigned either hydrocortisone (100 mg i.v. three times daily for 5 days) or matching placebo. MEASUREMENTS AND MAIN RESULTS Reversal of shock was defined by a stable systolic arterial pressure (>90 mm Hg) for > or =24 hrs without catecholamine or fluid infusion. Of the 22 hydrocortisone-treated patients and 19 placebo-treated patients, 15 (68%) and 4 (21%) achieved 7-day shock reversal, respectively, a difference of 47% (95% confidence interval 17% to 77%; p = .007). Serial invasive hemodynamic measurements for 5 days did not show significant differences between both groups. At 28-day follow-up, reversal of shock was higher in the hydrocortisone group (p = .005). Crude 28-day mortality was 7 (32%) of 22 treated patients and 12 (63%) of 19 placebo patients, a difference of 31% (95% confidence interval 1% to 61%; p = .091). Shock reversal within 7 days after the onset of corticosteroid therapy was a very strong predictor of survival. There were no significant differences in outcome in responders and nonresponders to a short corticotropin test. The respective rates of gastrointestinal bleeding and secondary infections did not differ between both groups. CONCLUSIONS Administration of modest doses of hydrocortisone in the setting of pressor-dependent septic shock for a mean of >96 hrs resulted in a significant improvement in hemodynamics and a beneficial effect on survival. These beneficial effects do not appear related to adrenocortical insufficiency.
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Affiliation(s)
- P E Bollaert
- Medical Intensive Care Unit, Hôpital Central, Centre Hospitalier Universitaire, Nancy, France
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Quilici N, Audibert G, Conroy MC, Bollaert PE, Guillemin F, Welfringer P, Garric J, Weber M, Laxenaire MC. Differential quantitative blood cultures in the diagnosis of catheter-related sepsis in intensive care units. Clin Infect Dis 1997; 25:1066-70. [PMID: 9402359 DOI: 10.1086/516090] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.2] [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: 02/05/2023] Open
Abstract
The aim of this prospective study was to compare differential blood cultures and quantitative catheter tip cultures for the diagnosis of catheter-related sepsis. Over a period of 2 years, 283 central venous catheters were inserted in 190 adult patients. Catheters were removed when they were no longer needed or when infection was suspected. Immediately before removal of the central venous catheters, blood cultures were performed, with blood drawn simultaneously from the catheter and the peripheral vein. After removal, quantitative catheter culture was performed according to the Brun-Buisson modified Cleri technique. Fifty-five quantitative catheter cultures were positive. They were classified as contaminated (n = 18), colonized (n = 23), or infected (n = 14). Differential blood cultures correctly identified 13 infections. With a catheter/peripheral cfu ratio of 8, differential blood cultures had a sensitivity of 92.8% and a specificity of 98.8%. When the catheters were removed because of suspected infection, differential blood cultures had a sensitivity of 92.8% and a specificity of 100%. Differential blood culture, a technique that does not necessitate catheter removal, seems effective in the diagnosis of catheter-related sepsis in patients in the intensive care unit.
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Affiliation(s)
- N Quilici
- Department of Anesthesia and Surgical Intensive Care, Hôpital Central and University of Nancy, France
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Levy B, Bollaert PE, Lucchelli JP, Sadoune LO, Nace L, Larcan A. Dobutamine improves the adequacy of gastric mucosal perfusion in epinephrine-treated septic shock. Crit Care Med 1997; 25:1649-54. [PMID: 9377878 DOI: 10.1097/00003246-199710000-00013] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.8] [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: 02/05/2023]
Abstract
OBJECTIVE To assess the effects of dobutamine at a rate of 5 micrograms/kg/min on hemodynamics and gastric intramucosal acidosis in patients with hyperdynamic septic shock treated with epinephrine. DESIGN A prospective, interventional, clinical trial. SETTING An adult, 16-bed medical/surgical intensive care unit of a university hospital. PATIENTS Twenty septic shock patients with a mean arterial pressure of > 75 mm Hg and a cardiac index of > 3.5 L/min/m2. INTERVENTIONS After baseline measurements (H0), each patient received dobutamine at a rate of 5 micrograms/kg/min. Baseline measurements included: hemodynamic parameters, tonometric parameters, arterial and mixed venous gases, and arterial lactate concentrations. These measurements were repeated after 1 (H1), 2 (H2), and 3 (H3) hrs. After H2 measurements, dobutamine was stopped. The patients were separated into two groups according to their PCO2 gap (tonometer PCO2-PaCO2). The increased PCO2 gap group was defined by a PCO2 gap > 8 torr (> 1.1 kPa) (n = 13), and the normal PCO2 gap group by a PCO2 gap < or = 8 torr (< or = 1.1 kPa)(n = 7). MEASUREMENTS AND MAIN RESULTS Dobutamine at 5 micrograms/kg/min had no significant effects on mean arterial pressure, heart rate, cardiac index, systemic vascular resistance, oxygen delivery, and oxygen consumption in epinephrine-treated septic shock. No patients developed arrhythmia or electrocardiographic signs of myocardial ischemia. During dobutamine infusion, arterial lactate concentration decreased from 5.1 +/- 0.4 in the increased PCO2 gap group and 4.2 +/- 0.4 in the normal PCO2 gap group to 3.9 +/- 0.3 and 3.5 +/- 0.3 mmol/L, respectively (p < .01). The PCO2 gap decreased and gastric intramucosal pH increased in the increased PCO2 gap group from 12 +/- 0.8 (1.6 +/- 0.1 kPa) to 3.5 +/- 0.8 torr (0.5 +/- 0.1 kPa) (p < .01) and from 7.11 +/- 0.03 to 7.18 +/- 0.02 (p < .01), respectively, and did not change in the normal PCO2 gap group. After stopping dobutamine infusion, the PCO2 gap and intramucosal pH returned to baseline values in the increased PCO2 gap group. CONCLUSION The addition of 5 micrograms/kg/min of dobutamine added to epinephrine in hyperdynamic septic shock selectively improved the adequacy of gastric mucosal perfusion without modification in systemic hemodynamics.
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Affiliation(s)
- B Levy
- Medical Intensive Care Unit, Central Hospital, Nancy, France
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Levy B, Bollaert PE, Charpentier C, Nace L, Audibert G, Bauer P, Nabet P, Larcan A. Comparison of norepinephrine and dobutamine to epinephrine for hemodynamics, lactate metabolism, and gastric tonometric variables in septic shock: a prospective, randomized study. Intensive Care Med 1997; 23:282-7. [PMID: 9083230 DOI: 10.1007/s001340050329] [Citation(s) in RCA: 248] [Impact Index Per Article: 9.2] [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
OBJECTIVES To compare the effects of norepinephrine and dobutamine to epinephrine on hemodynamics, lactate metabolism, and gastric tonometric variables in hyperdynamic dopamine-resistant septic shock. DESIGN A prospective, intervention, randomized clinical trial. SETTING Adult medical/surgical intensive care unit in a university hospital. PATIENTS 30 patients with a cardiac index (CI) > 3.51 x min(-1) x m(-2) and a mean arterial pressure (MAP) < or = 60 mmHg after volume loading and dopamine 20 microg/kg per min and either oliguria or hyperlactatemia. INTERVENTIONS Patients were randomized to receive an infusion of either norepinephrine-dobutamine or epinephrine titrated to obtain an MAP greater than 80 mmHg with a stable or increased CI. MEASUREMENTS AND MAIN RESULTS Baseline measurements included: hemodynamic and tonometric parameters, arterial and mixed venous gases, and lactate and pyruvate blood levels. These measurements were repeated after 1, 6, 12, and 24 h. All the patients fulfilled the therapeutic goals. No statistical difference was found between epinephrine and norepinephrine-dobutamine for systemic hemodynamic measurements. Considering metabolic and tonometric measurements and compared to baseline values, after 6 h, epinephrine infusion was associated with an increase in lactate levels (from 3.1 +/- 1.5 to 5.9 +/- 1.0 mmol/l;p < 0.01), while lactate levels decreased in the norepinephrine-dobutamine group (from 3.1 +/- 1.5 to 2.7 +/- 1.0 mmol/l). The lactate/pyruvate ratio increased in the epinephrine group (from 15.5 +/- 5.4 to 21 +/- 5.8; p < 0.01) and did not change in the norepinephrine-dobutamine group (13.8 +/- 5 to 14 +/- 5.0). Gastric mucosal pH (pHi) decreased (from 7.29 +/- 0.11 to 7.16 +/- 0.07; p < 0.01) and the partial pressure of carbon dioxide (PCO2) gap (tonometer PCO2-arterial PCO2) increased (from 10 +/- 2.7 to 14 +/- 2.7 mmHg; p < 0.01) in the epinephrine group. In the norepinephrine-dobutamine group pHi (from 7.30 +/- 0.11 to 7.35 +/- 0.07) and the PCO2 gap (from 10 +/- 3.0 to 4 +/- 2.0 mmHg) were normalized within 6 h (p < 0.01). The decrease in pHi and the increase in the lactate/pyruvate ratio in the epinephrine group was transient, since it returned to normal within 24 h. CONCLUSIONS Considering the global hemodynamic effects, epinephrine is as effective as norepinephrine-dobutamine. Nevertheless, gastric mucosal acidosis and global metabolic changes observed in epinephrine-treated patients are consistent with a markedly inadequate, although transient, splanchnic oxygen utilization. The metabolic and splanchnic effects of the combination of norepinephrine and dobutamine in hyperdynamic dopamine-resistant septic shock appeared to be more predictable and more appropriate to the current goals of septic shock therapy than those of epinephrine alone.
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Affiliation(s)
- B Levy
- Réanimation Médicale Polyvalente, Hôpital Central, Nancy, France
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Bollaert PE, Lelarge P, Larcan A. Transient post-renal obstruction and renal protection against nephrotoxic damage. Intensive Care Med 1996; 22:1132-3. [PMID: 8923085 DOI: 10.1007/bf01699243] [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: 02/03/2023]
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Blum A, Mousseaux E, Deneuville M, Chabot F, Bollaert PE, Claudon M, Danchin N, Regent D. [New imaging techniques in pulmonary embolism]. Arch Mal Coeur Vaiss 1995; 88:1735-43. [PMID: 8815834] [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: 02/02/2023]
Abstract
Acute pulmonary embolism is a medical emergency and diagnostic certitude must be obtained as early as possible. In clinically serious situations, spiral CT is a reliable diagnostic tool. It provides direct signs of embolism with visualisation of thrombi in the pulmonary arteries as far as the segmental branches and its diagnostic value does not change in cases of pulmonary parenchymal involvement. In emergencies, spiral CT should replace pulmonary angiography, which is more costly and associated with greater morbidity and mortality. Other methods, in particular MRI, which is totally innocuous, could play an important role in the diagnostic strategy of acute pulmonary embolism in the near future.
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Affiliation(s)
- A Blum
- Service de radiologie adultes, CHU Brabois, Vandoeuvre-lès-Nancy
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25
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Levy B, Bollaert PE, Nace L, Larcan A. Intracranial hypertension and adult respiratory distress syndrome: usefulness of tracheal gas insufflation. J Trauma 1995; 39:799-801. [PMID: 7473982 DOI: 10.1097/00005373-199510000-00039] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The management of increased intracranial pressure (ICP) in patients with an associated acute lung injury is difficult. High levels of PaCO2 as tolerated for permissive hypercapnia are deleterious for cerebral circulation. In such circumstances, tracheal gas insufflation (TGI), which was recently proposed to reduce PaCO2, may be of benefit. We report the cases of two patients with severe adult respiratory distress syndrome and head trauma complicated with elevated ICP. The introduction of TGI decreased PaCO2 by 17 and 26%, decreased ICP, and increased calculated cerebral perfusion pressure. We conclude that TGI could be added to a pressure-targeted strategy of ventilatory management when severe adult respiratory distress syndrome was associated to an intracranial hypertension.
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Affiliation(s)
- B Levy
- Polyvalent Intensive Care Unit, Central Hospital, Nancy, France
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Bollaert PE, Levy B, Nace L, Laterre PF, Larcan A. Hemodynamic and metabolic effects of rapid correction of hypophosphatemia in patients with septic shock. Chest 1995; 107:1698-701. [PMID: 7781370 DOI: 10.1378/chest.107.6.1698] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.8] [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: 01/27/2023] Open
Abstract
STUDY OBJECTIVE To examine the hemodynamic and metabolic short-term effects of hypophosphatemia correction in patients with septic shock receiving catecholamine therapy. DESIGN Prospective, single cohort study. SETTING ICU, university hospital. PATIENTS Ten patients with septic shock and hypophosphatemia below 2 mg/dL. INTERVENTIONS Infusion of glucose-1-phosphate solution (20 mmol of elemental phosphorus) for 60 min. MEASUREMENTS AND RESULTS Hemodynamic, oxygen-derived, acid-base, and electrolyte parameters before and immediately after phosphate infusion. Left ventricular stroke work index increased significantly (22%) from a mean low value of 24 +/- 10 g/m2 without changes in filling pressures. Systolic arterial pressure improved by 12%. Arterial pH improved slightly but significantly. Ionized calcium level slightly decreased within the normal range values. Other parameters remained unchanged. CONCLUSIONS Severe hypophosphatemia may be considered as a superimposed cause of myocardial depression, inadequate peripheral vasodilatation, and acidosis in septic shock. A rapid correction of hypophosphatemia is well tolerated and may have both myocardial and vascular beneficial effects. The magnitude of the response, however, is variable and unpredictable on the basis of serum phosphorus levels.
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Affiliation(s)
- P E Bollaert
- Service de Réanimation Médicale, Hopital Central, Centre Hospitalier Universitaire, Nancy, France
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Levy B, Bollaert PE, Bauer P, Nace L, Audibert G, Larcan A. Therapeutic optimization including inhaled nitric oxide in adult respiratory distress syndrome in a polyvalent intensive care unit. J Trauma 1995; 38:370-4. [PMID: 7897719 DOI: 10.1097/00005373-199503000-00013] [Citation(s) in RCA: 26] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To investigate the effects of inhaled nitric oxide (NO) in adult respiratory distress syndrome (ARDS) associated with a therapeutic optimization strategy on oxygen parameters, barotrauma, and evolution in a medical and surgical intensive care unit. DESIGN Prospective study. MATERIALS AND METHODS Twenty consecutive patients with ARDS were studied (Murray score 3.6 +/- 0.2). Eleven were surgical patients and nine were medical patients. All fulfilled the extracorporeal membrane oxygenation entry criteria. The APACHE II score predicted mortality was 39%. All were ventilated with FiO2 1 with positive end-expiratory pressure (PEEP) of 11 +/- 1 cm H2O. Therapeutic optimization included permissive hypercapnia, tracheal gas insufflation, prone position, continuous hemofiltration, treatment of infection, and pleural drainage. We used NO continuously inhaled at a concentration ranging from 5 to 10 ppm. MEASUREMENTS AND MAIN RESULTS After 1 hour, inhaled NO improved PaO2 in all patients except one (78 +/- 11 to 130 +/- 25 mm Hg) (p < 0.05), allowing a reduction of FiO2 and PEEP. After 24 hours, mean pulmonary arterial pressure decreased from 31 +/- 3 to 25 +/- 2 mm Hg (p < 0.05). Systemic hemodynamics were unaffected. Oxygen delivery increased from 531 +/- 135 to 603 +/- 125 mL/minute/m-2 (p < 0.05). Barotraumatic lesions were present in only one patient. Reversal of ARDS was obtained in 16 patients, of whom 14 (70%) were discharged. CONCLUSIONS This study was shorter to demonstrate an improvement in the survival rate. Nevertheless, these preliminary results are encouraging. Because of its safety, effectiveness, and easy use, inhaled NO should be used as a part of a therapeutic optimization protocol before considering more invasive and expensive procedures, such as extracorporeal respiratory support or intravascular oxygenation.
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Affiliation(s)
- B Levy
- Polyvalent Intensive Care Unit, Hôpital Central, Nancy, France
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Bollaert PE, Robin-Lherbier B, Mallie JP, Nace L, Escanye JM, Larcan A. Effects of sodium bicarbonate on striated muscle metabolism and intracellular pH during endotoxic shock. Shock 1994; 1:196-200. [PMID: 7735951 DOI: 10.1097/00024382-199403000-00007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [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: 01/26/2023]
Abstract
The effects of HCO3Na load on acid-base balance and muscle intracellular bioenergetics have been investigated using 31P-magnetic resonance spectroscopy in an experimental model of endotoxinic shock. Anesthetized, mechanically ventilated, and paralyzed rats (n = 16) were given an intravenous bolus of Escherichia coli lipopolysaccharide (15 mg/kg). When shock was established they were randomly assigned to receive either HCO3Na intravenously (2 mmol/kg in 2 min) or an equimolar saline injection. Lipopolysaccharide induced a significant decrease in the levels of mean arterial pressure (58 +/- 6 vs. 120 +/- 8 mmHg), arterial pH (7.20 +/- .03 vs. 7.35 +/- .01), intracellular pH (6.86 +/- .04 vs. 7.08 +/- .01), a marked hyperlactatemia (7 +/- 3 vs. 1.2 +/- .2 mmol/L) and a drop in the phosphocreatine-inorganic phosphate ratio. In the bicarbonate-loaded rats, mean arterial pressure further decreased whereas it remained unchanged in the saline group. Bicarbonate increased arterial pH and PaCO2 transiently. In the saline group, arterial pH decreased and PaCO2 remained stable. In both groups, intracellular pH and high energy phosphates had a similar evolution. In this model of septic shock, partial correction of arterial pH using HCO3Na did not reduce the metabolic cellular injury in skeletal muscle. Based on these results, HCO3Na may be of limited therapeutic value in severe septic metabolic acidosis.
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Affiliation(s)
- P E Bollaert
- Department of Medical Intensive Care, University of Nancy, France
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Bellou A, Bollaert PE, Bauer P, Larcan A, de Korwin JD. La crise rénale de sclérodermie. À propos de 3 observations. Rev Med Interne 1994. [DOI: 10.1016/s0248-8663(05)82657-8] [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: 11/16/2022]
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Abstract
OBJECTIVE to determine the outcome of stroke patients undergoing mechanical ventilation. DESIGN retrospective chart review and follow-up telephone interview. SETTING medical ICU in a multidisciplinary university hospital. PATIENTS AND PARTICIPANTS 199 stroke patients from 1984-1989 where the final diagnosis was stroke. INTERVENTIONS all patients were admitted for the need of mechanical ventilation. MEASUREMENTS AND RESULTS demographic information, previous relevant diseases, stroke type, general clinical and neurological data, biochemical variables, severity of illness were recorded for the first 24 h following ICU admission. A 1-year follow-up was performed, including mortality and functional status of survivors. Of 170 eventually analyzable patients, 123 (72.4%) died during their ICU stay and 156 (91.8%) during the first year. Three variables were independently associated with one-year mortality: Glasgow score < 10 (p < 0.03), bradycardia (p < 0.001), absence of brainstem reflexes (p < 0.0004). CONCLUSION overall prognosis of stroke needing mechanical ventilation is poor, strongly linked to symptoms of neurological impairment.
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Affiliation(s)
- P Burtin
- Service de Réanimation Médicale, Hôpital Central, Centré Hospitalier Universitaire de Nancy, France
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32
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Bollaert PE, Robin-Lherbier B, Mallie JP, Guilland JC, Straczek J, Larcan A. Effect of chronic potassium depletion on muscle bioenergetics in rats. J Lab Clin Med 1993; 121:668-74. [PMID: 8478594] [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: 01/31/2023]
Abstract
To test the hypothesis of muscle bioenergetic impairment in potassium depletion, chronic potassium-depleted rats and pair-fed control rats were studied with phosphorus 31 nuclear magnetic resonance measurements of leg muscle intracellular pH, phosphocreatine, inorganic phosphate, and adenosine triphosphate at rest and during maximal nontetanic stimulation, 48 hours after a swimming test. The potassium-depleted rats exhibited a significant hypokalemia, a metabolic extracellular alkalosis, and an intracellular acidosis. Their physical endurance was markedly reduced, and they displayed higher plasma creatine kinase levels than the control group. However, the phosphocreatine/inorganic phosphate ratio, which is a measure of the energy reserve of the cell, was similar in both groups at rest and during electrical stimulation and subsequent recovery. Resting muscle glycogen and relative intracellular acidification during stimulation did not differ in the two groups, arguing against an impairment of anaerobic metabolism in potassium depletion. These results indicate that the energy availability of muscle cell is unchanged during potassium deficiency.
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Affiliation(s)
- P E Bollaert
- Service de Réanimation Médicale, Université de Nancy I, France
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Bellou A, de Korwin JD, Bollaert PE, Laugros A, Bauer P, Larcan A. Myocardiopathie fatale au cours d'un lupus érythémateux disseminé révélé par une maladie thrombo-embolique et un infarctus hépatique. Discussion physiopathologique. Rev Med Interne 1993. [DOI: 10.1016/s0248-8663(05)80222-x] [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: 10/25/2022]
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Tormo C, Calvo R, Ferrandis S, Parra V, Maravall JL, Lacuevo V, Dreyfuss D, Mier L, Leviel F, Lanore JJ, Djedaïni K, Costa F, Paillard M, Del Rio F, Cardenal C, De Castro J, Blesa A, Martín-Benitez J, Hermo B, Suarez R, Martín SF, Le Cacheux P, de Ligny BH, Cardineau E, Ryckelvnck JP, Marggraf G, Schumann V, Doetsch N, Wagner K, Philipp T, Reidemeister JC, Aykaç B, Öz H, Sun S, Bozkurt P, Cotonel B, Mercatello A, HadjAïssa A, Chery C, Pozet N, Clermont N, Bégou C, Tissot E, Fisher LP, Moskovtchenko JF, Laurent V, Coronel B, Bret M, Colon S, Colpart JJ, Woittiez AJJ, Drenth IM, Jamali M, Bollaert PE, Cao T, Bauer P, Kessler M, Lambert H, Larcan A, Rogiere PE, Leeman M, Kahn RJ, Vincent JL, Nagler J, Neels H, Singer M, Screaton G, McNally T, Mackie I, Machin S, Cohen S, Haller M, Schönfelder R, Briegel J, Jauch KW, Zwiebel F, Forst H, Sicignano A, Vesconi S, Bellato V, De Pietri P, Minuto A, Foroni C, Comité C, Caprioli R, Gemignani R, Stefani M, Russo V, Mazzei A, Rusehi R, Pardelli M, Matamis D, Tsagourias M, Melekos T, Bitzani M, Rodini I, Rigos D, Inglis TJJ, Kuteifan K, Martin-Barbaz F, Man NK, Descamps JM, Bosch FH, van Genderen W, van Leusen R, de Boer JP, Creasey AA, Chang A, Roem D, Eerenberg AJM, Brouwer MC, Hack CE, Taylor FB. Kidney. Intensive Care Med 1992. [DOI: 10.1007/bf03216356] [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: 11/29/2022]
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35
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Abstract
After obstetrical surgery, a young woman developed an acute renal failure of one kidney, the other having been protected by a fortuitous ureteral ligation. The possible effects of a temporary kidney exclusion on itself and on the other kidney are discussed.
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Affiliation(s)
- P Lelarge
- Service de Reanimation Medicale, Hopital Central, University of Nancy I, France
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36
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Bauer P, Weber M, Mur JM, Protois JC, Bollaert PE, Condi A, Larcan A, Lambert H. Transient non-cardiogenic pulmonary edema following massive ingestion of ethylene glycol butyl ether. Intensive Care Med 1992; 18:250-1. [PMID: 1430593 DOI: 10.1007/bf01709843] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [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: 12/27/2022]
Abstract
A case of acute poisoning with ethylene glycol butyl ether (EGBE) is reported in a chronic alcohol abuser. On admission the 53-year-old patient was comatose with metabolic acidosis, shock, and noncardiogenic pulmonary edema confirmed by haemodynamic study. Following supportive treatment and haemodialysis the outcome was favorable. The relationship between respiratory failure and EGBE is examined.
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Affiliation(s)
- P Bauer
- Service de Réanimation Médicale et Centre Anti-Poisons, Hôpital Central, Nancy, France
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37
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Weber M, Renaud D, Bauer P, Bollaert PE, Boileau S, Grodidier G, Larcan A, Lambert H. [Current status of poisoning by ingestion of caustics: apropos of a series of 49 cases]. J Toxicol Clin Exp 1992; 12:27-33. [PMID: 1460588] [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: 12/27/2022]
Abstract
The authors report the history of 49 patients, admitted to an intensive care unit after a caustic or corrosive ingestion. This series follows a similar one, related in 1979. An update is made for early evaluation and management, based on patients classification in three groups: severe cases, moderate cases, mild cases. Clinical and biological data, treatment and outcome for the three groups are related. The frequency and gravity of these poisonings appear to be the same as in the first series, with poor prognosis for extreme emergencies and high risk of oesophageal or gastric stricture for important forms. In this population, 20% of extreme emergencies have favorable outcome with early major surgical procedure.
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Affiliation(s)
- M Weber
- Centre Anti-Poisons de Nancy, Hôpital Central, France
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Nace L, Bauer P, Lelarge P, Bollaert PE, Larcan A, Lambert H. Multiple European wasp stings and acute renal failure. Nephron Clin Pract 1992; 61:477. [PMID: 1501749 DOI: 10.1159/000186974] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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39
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Bollaert PE, Gimenez M, Robin-Lherbier B, Escanye JM, Mallie JP, Robert J, Larcan A. Respective effects of malnutrition and phosphate depletion on endurance swimming and muscle metabolism in rats. Acta Physiol Scand 1992; 144:1-7. [PMID: 1595346 DOI: 10.1111/j.1748-1716.1992.tb09260.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To examine the respective roles of malnutrition and phosphate depletion on muscle exercise capacity and bioenergetics, phosphate-depleted, either underfed or partly refed rats; phosphate-supplemented, either underfed or partly refed rats; and well-nourished control animals were studied, using swim time to exhaustion and 31P NMR spectroscopy measurements of muscle phosphocreatine, inorganic phosphate, adenosine triphosphate and intracellular pH. Only partly refed rats displayed hypophosphataemia. Swim time to exhaustion was lower in non-refed rats than in controls. Among the four groups, both refeeding and phosphate depletion positively affected swim time to exhaustion (both with P less than 0.02), and swim time to exhaustion was negatively correlated with phosphataemia (P less than 0.05). At rest, the ratio of muscle phosphocreatine/inorganic phosphate was lower in the phosphate-supplemented rats than in controls, whereas muscle phosphocreatine/adenosine triphosphate and intracellular pH were comparable. After non-tetanic stimulation, the muscle phosphocreatine recovery was slower in the four groups than in controls and closely correlated with exhaustion (P less than 0.01). These findings suggest that malnutrition alters the capacity of muscular work, mainly because of a reduced cell oxidative energy availability. These patterns are improved by partial refeeding and clearly influenced by the level of phosphorus intake, whether depletion is capable of improving metabolic alterations or uncontrolled supplementation is deleterious in malnourished animals.
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Affiliation(s)
- P E Bollaert
- Service de Réanimation, University of Nancy I, France
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Levy B, Bollaert PE, Laprevote-Heully MC, Bauer P, Lambert H, Larcan A. [Acute vena cava thrombosis after insertion of Greenfield filter. A forgotten classic complication]. Presse Med 1991; 20:1739. [PMID: 1836591] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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41
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Abstract
The nonfatal case of a 20 year-old woman who ingested 6 grams of chloroquine in a suicide attempt is reported. After initial ventricular fibrillation, she rapidly developed a pulmonary edema with cardiogenic shock. She was successfully treated with diazepam, epinephrine, dobutamine and mechanical ventilation. Plasma chloroquine levels showed an initial peak of 36 micrograms/mL. The patient was discharged fully recovered after 19 days. The interaction between chloroquine and diazepam is discussed, as is the need for careful management of epinephrine therapy.
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Affiliation(s)
- P Bauer
- Department of Intensive Care Unit, University Hospital, Hôpital Central, Nancy, France
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Bauer P, Audibert G, Bollaert PE, Briquel ME, Lambert H, Larcan A. [Acquired deficiency of coagulation factor VIII in post partum with transplacental passage]. Presse Med 1990; 19:1547. [PMID: 2146668] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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43
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Bollaert PE, Bauer P, Audibert G, Lambert H, Larcan A. Effects of epinephrine on hemodynamics and oxygen metabolism in dopamine-resistant septic shock. Chest 1990; 98:949-53. [PMID: 2209154 DOI: 10.1378/chest.98.4.949] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.1] [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: 12/30/2022] Open
Abstract
The hemodynamic effects of epinephrine were prospectively studied in 13 patients with septic shock who remained hypotensive after both fluid loading and dopamine. Hemodynamic measurements were performed before and one hour after the start of epinephrine infusion. Systolic, diastolic, and mean arterial pressure increased in all patients (p less than 0.01). Cardiac index and systemic vascular resistance increased by 34 and 32 percent, respectively (p less than 0.05), but heart rate and pulmonary vascular resistance remained unchanged. There was a concomitant increase in oxygen delivery (p less than 0.01) and oxygen consumption (p less than 0.05), the magnitude of the latter being related to baseline lactacidemia (p less than 0.01). In view of the generally recognized physiologic goals of septic shock management, we conclude that epinephrine could be an appropriate alternative where fluid loading and dopamine have failed.
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Affiliation(s)
- P E Bollaert
- Service de Reanimation Médicale, Centre Hospitalier Regional et Universitaire, Nancy, France
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Larcan A, Bollaert PE, Bauer P, Weber M. [Clinical examination of the comatose patient]. Rev Prat 1989; 39:2399-409. [PMID: 2602862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The clinical examination of a comatose patient may be divided into neurological ang general. The neurological examination aims at determining all that is proper to the state of coma, its complication, whatever they origin (mostly cerebral oedema and herniation) and its focal signs. As for the coma itself, one may distinguish between disorders of consciousness or perceptivity and disorders of wakefulness. Specific reactivity and reactivity to pain. This must be combined with a study of muscle tone (reactions in flexion and extension, reflexes). Reflexes of the brain stem, nowadays better known, provide for a better assessment of severity and a better evaluation of tiered suffering. Vegetative symptoms, including respiration, cardiovascular system, temperature, trophicity, sphincteral function, must be studies in all comas. The classification of comas into stages of severety and the relevant scores (Glasgow, Liège) must be known with their advantages and limitations. The general clinical evaluation, including past history and associated signs, may suggest an aetiological diagnosis and point to the necessary paraclinical explorations.
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Weber M, Martin A, Bollaert PE, Bauer P, Leroy F, Meley M, Lambert H. [Poisoning by immersion in a cleaning tank]. J Toxicol Clin Exp 1989; 9:355-8. [PMID: 2632793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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47
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Weber M, Bauer P, Bollaert PE, Laprevote-Heully MC, Lambert H, Larcan A. [Apropos of pheochromocytoma and pulmonary edema]. Presse Med 1989; 18:1299-300. [PMID: 2528140] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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48
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Gille JP, Bauer P, Bollaert PE, Tousseul B, Kachani-Mansour R, Munsch L. CO2 removal with hemodialysis and control of plasma oncotic pressure. ASAIO Trans 1989; 35:654-7. [PMID: 2480802 DOI: 10.1097/00002480-198907000-00158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
CO2 removal by hemodialysis, associated with systemic alkalinization, is the simplest method of metabolic CO2 elimination. In this experimental work, the authors investigated the efficacy of this protocol in modifying an alkaline perfusate by addition of dextran 40. The results, unlike those of preceding experimental series without dextran, disclosed no significant change in weight, hemodynamic variables, electrolyte concentrations or osmotic or oncotic pressures after 12 hours. Sixty-five percent of metabolic CO2 was eliminated with a bypassed blood flow rate of only 8% of cardiac output.
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Affiliation(s)
- J P Gille
- Inserm, Vandoeuvre les Nancy, France
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49
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Bollaert PE, Robin-Lherbier B, Escanye JM, Bauer P, Lambert H, Robert J, Larcan A. Phosphorus nuclear magnetic resonance evidence of abnormal skeletal muscle metabolism in chronic alcoholics. Neurology 1989; 39:821-4. [PMID: 2725876 DOI: 10.1212/wnl.39.6.821] [Citation(s) in RCA: 11] [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: 01/02/2023] Open
Abstract
Pathophysiologic events leading to rhabdomyolysis in alcoholics are not clearly understood. We examined 18 alcoholic patients (10 with and 8 without a recent history of rhabdomyolysis) and 15 healthy non-alcoholic volunteers by phosphorus nuclear magnetic resonance spectroscopy of thenar eminence muscle. At rest, phosphocreatine, ATP, and pH levels were similar in patients and control subjects. During aerobic exercise, phosphocreatine utilization was greater, pH fell more slowly, and maximum acidosis was less in alcoholics with previous rhabdomyolysis than in control subjects. During ischemic exercise, both patient groups exhibited a significantly slower and smaller decrease in pH than did control subjects. These findings are consistent with impaired muscular glycolysis or glycogenolysis in both alcoholic groups. This metabolic myopathy may contribute to the onset of acute rhabdomyolsis.
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Affiliation(s)
- P E Bollaert
- Service de Réanimation, Hôpital Central, C.H.R.U. de Nancy, France
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50
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Bauer P, Bollaert PE, Sadoul N, Lambert H, Larcan A. [Use of Ringer lactate in cibenzoline poisoning]. Presse Med 1989; 18:588. [PMID: 2523067] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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