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Hardy M, Michaux I, Bulpa P, Schonau B, Nicolay B, de Maistre E, Godon A, Lecompte T, Mullier F. Serial fibrin monomer and D-dimer plasma levels measurements can capture thrombotic complications in critically ill COVID-19 patients: A prospective observational study. Thromb Res 2023; 221:69-72. [PMID: 36476478 PMCID: PMC9712142 DOI: 10.1016/j.thromres.2022.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Affiliation(s)
- M. Hardy
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Science (NARILIS), Hematology Laboratory, Namur, Belgium,CHU UCL Namur, Anesthesiology Department, Namur, Belgium,Corresponding author at: Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Science (NARILIS), Hematology Laboratory, Namur, Belgium
| | - I. Michaux
- Université catholique de Louvain, CHU UCL Namur, Intensive Care Medicine Department, Namur, Belgium
| | - P. Bulpa
- Université catholique de Louvain, CHU UCL Namur, Intensive Care Medicine Department, Namur, Belgium
| | - B. Schonau
- CHU UCL Namur, Vascular Medicine Department, Namur, Belgium
| | - B. Nicolay
- CHU UCL Namur, Anesthesiology Department, Namur, Belgium
| | - E. de Maistre
- Service d'Hématologie Biologique, Unité d'hémostase, CHU Dijon, Dijon, France
| | - A. Godon
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, Grenoble, France
| | - T. Lecompte
- University of Namur, Pharmacy Department, Namur, Belgium,Université de Lorraine, Nancy, France
| | - F. Mullier
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Science (NARILIS), Hematology Laboratory, Namur, Belgium
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Dincq AS, Thiltgès L, Michaux I, Gourdin M, Kalscheuer G, Melly L, Gillet M, Bareille M, Lessire S, Hardy M. Towards optimized red blood cells ordering prior to cardiac surgery: a single center retrospective study. Acta Anaest Belg 2022. [DOI: 10.56126/73.4.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background: Cardiac surgery is associated with a high rate of intraoperative transfusion, requiring pre- ordering or ordering of packed red blood cell (PRBC) before surgery. Our institutional strategy is based on a systematic type and screen (T/S) ordering of 3 PRBCs at the blood bank then stored in a dedicated refrigerator in the operating room for each patient scheduled for cardiac surgery. However, these PRBC units are not always transfused and are therefore at risk of destruction if temperature fluctuations are detected during transport and storage processes. In addition, these orders represent a burden for the blood bank. Therefore, it is relevant to move towards a more tailored PRBC order before cardiac surgery and challenge the systematic ordering protocol.
Methods: The Transfusion Understanding Scoring Tool (TRUST) and the Transfusion Risk and Clinical Knowledge (TRACK) Score are designed to stratify blood transfusion needs in cardiac surgery. We retrospectively performed both scores for each patient scheduled for cardiac surgery. Then, we compared their performance to predict PRBC transfusion and determined the optimal threshold to optimize the preoperative PRBC order reflecting the needs of our population managed with our local standards.
Results: Receiver operating characteristic (ROC) curves for prediction of PRBC transfusion using the two scores were computed for the whole cohort (n=1249). Both scores performed well (areas under ROC curves: 0.81 and 0.82 (95% CI) using the TRACK Score and the TRUST, respectively). A TRUST < 3 identified a subgroup of patients (53.6%) at low risk of transfusion. The availability of 1 T/S PRBC in the OR would cover the needs of the majority (92.5%) of this group.
Conclusions: In our institution, the use of the TRUST preoperatively could offer a more tailored T/S PRBC order for the intraoperative period, especially in the low-risk transfusion group.
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Schröder E, Jamart J, Eucher P, Guédès A, Louagie Y, Mbende C, Michaux I, Macq A, Guillaume L, Richard M, Dahin G, Cuvelier N, Lusuka R, Buche M. Temporal changes of short and long-term outcome after aortic valve replacement. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.173] [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: 11/28/2022]
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Michaux I, Bulpa P, Dincq AS, Dumonceaux M, Rondelet B, Seldrum S, Patrick E. One-year survival impact of early right ventricular diastolic dysfunction after lung transplantation. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.047] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Michaux I, Bulpa P, Dincq AS, Dumonceaux M, Rondelet B, Seldrum S, Evrard P. Right ventricular systolic dysfunction early after lung transplantation: prevalence and impact on 1-year survival. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.048] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Noël A, Vastrade C, Dupont S, de Barsy M, Huang TD, Van Maerken T, Leroux-Roels I, Delaere B, Melly L, Rondelet B, Dransart C, Dincq AS, Michaux I, Bogaerts P, Glupczynski Y. Nosocomial outbreak of extended-spectrum β-lactamase-producing Enterobacter cloacae among cardiothoracic surgical patients: causes and consequences. J Hosp Infect 2019; 102:54-60. [PMID: 30630000 DOI: 10.1016/j.jhin.2019.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 10/14/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Enterobacteriaceae are recognized as leading pathogens of healthcare-associated infections. AIM To report the investigation of a nosocomial outbreak of extended-spectrum β-lactamase-producing Enterobacter cloacae affecting cardiothoracic surgery patients in a Belgian academic hospital. METHODS Cases were defined based on epidemiological and microbiological investigations, including molecular typing using repetitive element-based polymerase chain reaction and multi-locus sequence typing. Case-control studies followed by field evaluations allowed the identification of a possible reservoir, and the retrospective assessment of human and financial consequences. FINDINGS Over a three-month period, 42 patients were infected or colonized by CTX-M-15-producing E. cloacae strains that belonged to the same clonal lineage. Acquisition mainly occurred in the intensive care unit (N = 23) and in the cardiothoracic surgery ward (N = 16). All but one patient had, prior to acquisition, undergone a cardiothoracic surgical procedure, monitored by the same transoesophageal echocardiography (TOE) probe in the operating room. Despite negative microbiological culture results, the exclusion of the suspected probe resulted in rapid termination of the outbreak. Overall, the outbreak was associated with a high mortality rate among infected patients (40%) as well as significant costs (€266,550). CONCLUSION The outbreak was indirectly shown to be associated with the contamination of a manually disinfected TOE probe used per-operatively during cardiothoracic surgery procedures, because withdrawal of the putative device led to rapid termination of the outbreak.
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Affiliation(s)
- A Noël
- Infection Control Unit, CHU UCL Namur, Yvoir, Belgium.
| | - C Vastrade
- Infection Control Unit, CHU UCL Namur, Yvoir, Belgium
| | - S Dupont
- Infection Control Unit, CHU UCL Namur, Yvoir, Belgium
| | - M de Barsy
- National Reference Centre for Monitoring Antimicrobial Resistance in Gram-Negative Bacteria, CHU UCL Namur, Yvoir, Belgium
| | - T D Huang
- National Reference Centre for Monitoring Antimicrobial Resistance in Gram-Negative Bacteria, CHU UCL Namur, Yvoir, Belgium
| | - T Van Maerken
- Infection Control Unit, Ghent University Hospital, Ghent, Belgium
| | - I Leroux-Roels
- Infection Control Unit, Ghent University Hospital, Ghent, Belgium
| | - B Delaere
- Infectious Diseases Unit, Internal Medicine Department, CHU UCL Namur, Yvoir, Belgium
| | - L Melly
- Cardiovascular, Thoracic Surgery and Lung Transplantation Department, CHU UCL Namur, Yvoir, Belgium
| | - B Rondelet
- Cardiovascular, Thoracic Surgery and Lung Transplantation Department, CHU UCL Namur, Yvoir, Belgium
| | - C Dransart
- Anesthesiology Department, CHU UCL Namur, Yvoir, Belgium
| | - A S Dincq
- Anesthesiology Department, CHU UCL Namur, Yvoir, Belgium
| | - I Michaux
- Intensive Care Unit Department, CHU UCL Namur, Yvoir, Belgium
| | - P Bogaerts
- National Reference Centre for Monitoring Antimicrobial Resistance in Gram-Negative Bacteria, CHU UCL Namur, Yvoir, Belgium
| | - Y Glupczynski
- Infection Control Unit, CHU UCL Namur, Yvoir, Belgium; National Reference Centre for Monitoring Antimicrobial Resistance in Gram-Negative Bacteria, CHU UCL Namur, Yvoir, Belgium
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Betomvuko P, Michaux I, Gabriel L, Bihin B, Gourdin M, De Saint Hubert M. P-429: Gait speed as predictor of outcomes of elective cardiac surgery in older patients. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30526-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Magnette C, De Saint Hubert M, Swine C, Bouhon S, Jamart J, Dive A, Michaux I. Functional status and medium-term prognosis of very elderly patients after an ICU stay: a prospective observational study. Minerva Anestesiol 2015; 81:743-751. [PMID: 25634479] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Because the proportion of elderly patients admitted to the intensive care unit (ICU) is increasing, the objective of this study was to test the hypothesis that very elderly patients with better preadmission functional status would have better medium-term survival and functional status after an ICU stay. METHODS In this observational study, 96 patients (68% surgical and 32% medical) aged ≥80 years and admitted to the ICU between May 2008 and June 2009 were recruited. Functional status was assessed using a modified Katz Scale and the Lawton Scale. Primary outcomes were: one-year mortality and its independent predictive factors, one-year functional status and perceived quality of life. RESULTS Multivariate analysis showed that type of admission (surgical vs. medical), existence of cancer, Sequential Organ Failure Assessment (SOFA) Score at ICU admission and occurrence of septic complications during the ICU stay were independent predictive factors for one-year mortality, but preadmission functional status was not. At one year, despite functional decline in 50% of survivors, 68% perceived their health status to be equivalent to or better than before and 82.6% would agree to a further ICU stay. CONCLUSION One-year mortality of very elderly patients after an ICU stay is not related to preadmission functional status but to the type of admission, existence of cancer, SOFA Score at ICU admission and occurrence of septic complications during the ICU stay. Despite functional decline in half of these patients, one year after admission 82.6% would agree to another ICU stay.
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Affiliation(s)
- C Magnette
- Department of Intensive Care Medicine, CHU Dinant Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium -
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de Saint-Hubert M, Jamart J, Gabriel L, Gourdin M, Mitchell J, Michaux I. Assessment of frailty in older patients before cardiac surgery. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gizzi M, Delaere B, Weynand B, Clement J, Maes P, Vergote V, Laenen L, Hjelle B, Verroken A, Dive A, Michaux I, Evrard P, Creytens D, Bulpa P. Another case of "European hantavirus pulmonary syndrome" with severe lung, prior to kidney, involvement, and diagnosed by viral inclusions in lung macrophages. Eur J Clin Microbiol Infect Dis 2013; 32:1341-5. [PMID: 23670277 PMCID: PMC7102061 DOI: 10.1007/s10096-013-1885-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/17/2013] [Indexed: 12/24/2022]
Abstract
Puumala virus (PUUV) is considered a classic Old World etiologic agent of nephropathia epidemica (NE), or hemorrhagic fever with renal syndrome (HFRS). HFRS is considered to be distinct from hantavirus (cardio-)pulmonary syndrome (HPS or HCPS), described in the New World. Here, we report a severe case, which fulfilled most, if not all, Centers for Disease Control and Prevention (CDC) criteria for HPS, needing non-invasive ventilation and subsequent acute hemodialysis. However, the etiological agent was PUUV, as proved by serological testing, real-time polymerase chain reaction (PCR), and sequencing. Viral antigen was detected by specific anti-PUUV immunostaining, showing, for the first time, greenish intracytoplasmic inclusions in bronchoalveolar lavage (BAL) macrophages. This case definitely confirms that HPS can be encountered during PUUV infections. Interestingly, special findings could render the diagnosis easier, such as greenish homogeneous cytoplasmic inclusions, surrounded by a fine clear halo in BAL macrophages. Therefore, although the diagnosis remains difficult before the onset of renal involvement, the occurrence of severe respiratory failure mimicking community-acquired pneumonia must alert the clinician for possible HPS, especially in endemic areas.
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Affiliation(s)
- M. Gizzi
- Intensive Care Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, 5530 Yvoir, Belgium
| | - B. Delaere
- Infectious Diseases Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - B. Weynand
- Pathology Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - J. Clement
- National Reference Centre for Hantaviruses, University Hospitals Leuven, Gasthuisberg, University of Leuven, Leuven, KU Belgium
- Zoonotic Infectious Diseases unit, Clinical Virology, Rega Institute for Medical Research, Leuven, KU Belgium
| | - P. Maes
- National Reference Centre for Hantaviruses, University Hospitals Leuven, Gasthuisberg, University of Leuven, Leuven, KU Belgium
- Zoonotic Infectious Diseases unit, Clinical Virology, Rega Institute for Medical Research, Leuven, KU Belgium
| | - V. Vergote
- National Reference Centre for Hantaviruses, University Hospitals Leuven, Gasthuisberg, University of Leuven, Leuven, KU Belgium
- Zoonotic Infectious Diseases unit, Clinical Virology, Rega Institute for Medical Research, Leuven, KU Belgium
| | - L. Laenen
- National Reference Centre for Hantaviruses, University Hospitals Leuven, Gasthuisberg, University of Leuven, Leuven, KU Belgium
- Zoonotic Infectious Diseases unit, Clinical Virology, Rega Institute for Medical Research, Leuven, KU Belgium
| | - B. Hjelle
- Departments of Pathology, Biology, Molecular Genetics and Microbiology, Center for Infectious Diseases and Immunity, University of New Mexico, Albuquerque, NM USA
| | - A. Verroken
- Microbiology Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - A. Dive
- Intensive Care Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, 5530 Yvoir, Belgium
| | - I. Michaux
- Intensive Care Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, 5530 Yvoir, Belgium
| | - P. Evrard
- Intensive Care Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, 5530 Yvoir, Belgium
| | - D. Creytens
- Pathology Department, University Hospital Ghent, Ghent, Belgium
| | - P. Bulpa
- Intensive Care Unit, Centre Hospitalier Universitaire de Mont-Godinne, Université Catholique de Louvain, 5530 Yvoir, Belgium
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Bulpa P, Evrard P, Bouhon S, Schryvers F, Jamart J, Michaux I, Dive A, Vander Borght T, Krug B. Polyurethane does not protect better than polyvinyl cuffed tracheal tubes from microaspirations. Minerva Anestesiol 2013; 79:498-503. [PMID: 23511349] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Mechanically ventilated patients are prone to develop ventilator associated pneumonia due to microaspirations of subglottic secretions around the endotracheal tube cuff (usually constructed of polyvinyl material). A novel polyurethane cuff has been designed to minimize these leakages. The aim of the study was to compare the tracheal sealing capacities between the two tubes. METHODS Twenty-nine consecutive patients from whom tracheal intubation was necessary as part of their care were randomized to receive either a polyvinyl HI-LO Evac® or a polyurethane SEALGUARD Evac® endotracheal tube. Patients requiring emergency intubation, with unstable hemodynamics or history of tracheal/laryngeal disease were excluded. For the entire study, cuff pressure was set at 30 cmH2O, and ventilator parameters were adjusted for a plateau pressure ≤30 cmH2O; Patients were fasting, placed in a strict 45° position during 12 hours and sedated if needed. After injection of 74 MBq 99mTc-DTPA diluted in 5 mL 0.9% NaCl just above the cuff, tracheal radioactivity was assessed sequentially (hourly from T0 to T6, then T8 and T12 hours) using a scintillation camera. RESULTS Sixteen polyurethane and 13 polyvinyl tubes were compared. Leakages were observed in 11/29 patients (38%) (5/16 polyurethane and 6/13 polyvinyl tubes [P=NS]). Leakages occurred more often in female (7/8) than in male patients (4/21) (P<0.001). Microaspirations were decreased with larger tubes (size 9 vs. ≤8.5: 24% vs. 75%; P=0.01), whatever the cuff membrane. CONCLUSION These preliminary results suggest that both tubes are poorly effective in preventing microaspirations.
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Affiliation(s)
- P Bulpa
- Intensive Care Unit, CHU Mont-Godinne, Université Catholique de Louvain, 5530 Yvoir, Belgium.
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Ausselet N, Bourgeois M, Gérard V, Verroken A, Tuerlinckx D, Marchand E, Huang TD, Michaux I, Glupczynski Y, Delaere B. Clinical, virological and epidemiological assessment of 2009 influenza A (H1N1) pandemic in a Belgian university hospital. Acta Clin Belg 2012; 67:286-91. [PMID: 23019805 DOI: 10.2143/acb.67.4.2062674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recommendations were applied before and during the Belgian pandemic (2009) H1N1 influenza wave at a university hospital (420 beds), for optimizing isolation processes and therapeutic management of possible and confirmed infected cases. METHODS All patients presenting to the Emergency Department (ED) between August 1st and December 31st 2009 were screened for ILI symptoms, and were isolated for clinical assessment in case of positive screening. Patients categorized as possible influenza cases and who required hospitalization were isolated in dedicated wards. Specific diagnostic algorithms were implemented. Medical charts were retrospectively reviewed and matched with results of the microbiology laboratory. Patient's characteristics were analyzed, the contribution of laboratory diagnosis on therapy and lengh of stay (LOS) in isolation was also assessed. RESULTS 310 patients out of 6068 had a positive screening for ILI, of these, 265 were retained as possible influenza cases and 139 required hospitalization. Twenty-eight children (8 requiring hospitalization) and 20 hospitalized adult patients had confirmed influenza infection. Five adult patients were admitted to the intensive care unit (ICU), 3 requiring extracorporeal membrane oxygenation (ECMO). There was no death related to the new influenza strain. The majority of confirmed patients were diagnosed during the Belgian epidemic wave, with a sensitivity of antigen detection of 50% in children and 35% in adults comparatively to real-time PCR (RT-PCR). CONCLUSIONS The impact of (2009) H1N1 pandemic influenza remained limited, except for ICU patients requiring ECMO. Implementation of screening, isolation, and virological diagnosis processes led to significant improvement of patient management.
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Affiliation(s)
- N Ausselet
- Division of Infectious Diseases, Department of Internal Medicine, CHU Mont-Godinne - Catholic University of Louvain, Yvoir, Belgium
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Sinapi I, Bulpa P, Gonzalez M, Buche M, Delaunois L, Michaux I, Dive A, Evrard P. 185 Renal Failure and Hemolysis 10 Days after Lung Transplantation. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.859] [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: 11/27/2022] Open
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Bulpa P, Bouhon S, Schryvers F, Jamart J, Evrard P, Michaux I, Dive A, Borght T, Krug B. Microaspirations during mechanical ventilation: polyurethane versus polyvinyl cuffed endotracheal tubes. Crit Care 2010. [PMCID: PMC2934331 DOI: 10.1186/cc8460] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wang J, Seeberger MD, Skarvan K, Michaux I, Bernet F, Arsenic R, Buser P, Filipovic M. Intra-operative myocardial ischaemia cannot be detected by analysis of transmitral inflow patterns in patients undergoing off-pump coronary surgery. Eur J Anaesthesiol 2007; 25:1-7. [PMID: 17594738 DOI: 10.1017/s0265021507000737] [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: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Transmitral inflow patterns have been used for detection of myocardial ischaemia. However, its diagnostic value has not been tested in anaesthetized and mechanically ventilated patients undergoing coronary artery bypass graft surgery. METHODS Transmitral inflow patterns were studied by transoesophageal Doppler echocardiography in 43 patients undergoing coronary artery bypass graft surgery without cardiopulmonary bypass after opening of the sternum (baseline) and during grafting of the left anterior descending artery. Peak early (E) and peak late (A) transmitral velocities and their ratio (E/A) were recorded. Myocardial ischaemia was defined by standard criteria using two-dimensional echocardiography and seven-lead electrocardiogram. RESULTS Thirty-one patients (64 +/- 8 yr, 9 women) fulfilled the predefined inclusion criteria for analysis. During distal revascularization, 16 patients showed myocardial ischaemia and 15 did not. The use of vasoactive drugs, haemodynamic findings and transmitral inflow patterns were similar in both groups at baseline and during grafting. In the ischaemic group, E was 67.1 +/- 13.9 cm s-1 at baseline and 69.5 +/- 23.2 cm s-1 during grafting, and the E/A ratios were 1.3 +/- 0.3 and 1.4 +/- 0.9, respectively. In the non-ischaemic group, E was 64.0 +/- 17.1 cm s-1 at baseline and 60.9 +/- 14.8 cm s-1 during grafting, and the E/A ratios were 1.4 +/- 0.7 and 1.2 +/- 0.3, respectively. CONCLUSIONS Analysis of Doppler findings of transmitral inflow patterns did not allow for detection of myocardial ischaemia during surgical revascularization of the myocardium.
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Affiliation(s)
- J Wang
- University Hospital Basel, Department of Anaesthesia, Basel, Switzerland
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Filipovic M, Michaux I, Wang J, Hunziker P, Skarvan K, Seeberger M. Effects of sevoflurane and propofol on left ventricular diastolic function in patients with pre-existing diastolic dysfunction. Br J Anaesth 2007; 98:12-8. [PMID: 17060331 DOI: 10.1093/bja/ael277] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [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: 12/22/2022] Open
Abstract
BACKGROUND The effects of anaesthetics on left ventricular (LV) diastolic function in patients with pre-existing diastolic dysfunction are not well known. We hypothesized that propofol but not sevoflurane will worsen the pre-existing LV diastolic dysfunction. METHODS Of 24 randomized patients, 23 fulfilled the predefined echocardiographic criterion for diastolic dysfunction. They received general anaesthesia with sevoflurane 1 MAC (n=12) or propofol 4 mug ml(-1) (n=11). Echocardiographic examinations were performed at baseline and in anaesthetized patients under spontaneous breathing and under positive pressure ventilation. Analysis focused on peak early diastolic velocity of the mitral annulus (E(a)). RESULTS During spontaneous breathing, E(a) was higher in the sevoflurane than in the propofol group [mean (95% CI) 7.0 (5.9-8.1) vs 5.5 (4.7-6.3) cm s(-1); P<0.05], reflecting an increase of E(a) from baseline only in the sevoflurane group (P<0.01). Haemodynamic findings were similar in both groups, but the end-tidal carbon dioxide content was more elevated in the propofol group (P<0.01). During positive pressure ventilation, E(a) was similarly low in the sevoflurane and propofol groups [5.3 (4.2-6.3) and 4.4 (3.6-5.2) cm s(-1), respectively]. CONCLUSIONS During spontaneous breathing, early diastolic function improved in the sevoflurane but not in the propofol group. However, during positive pressure ventilation and balanced anaesthesia, there was no evidence of different effects caused by the two anaesthetics.
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Affiliation(s)
- M Filipovic
- Department of Anaesthesia, University of Basel Hospital CH-4031 Basel, Switzerland.
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Filipovic M, Wang J, Michaux I, Hunziker P, Skarvan K, Seeberger MD. Effects of halothane, sevoflurane and propofol on left ventricular diastolic function in humans during spontaneous and mechanical ventilation. Br J Anaesth 2004; 94:186-92. [PMID: 15556965 DOI: 10.1093/bja/aei028] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [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: 11/14/2022] Open
Abstract
BACKGROUND There is limited knowledge of the effects of anaesthetics on left ventricular (LV) diastolic function in humans. Our aim was to evaluate these effects in humans free from cardiovascular disease. METHODS Sixty patients (aged 18-47 yr) who had no history or signs of cardiovascular disease were randomized to receive general anaesthesia with halothane, sevoflurane or propofol. Echocardiography was performed at baseline and during spontaneous respiration at 1 minimum alveolar concentration (MAC) of the inhalational agents or propofol 4 microg ml(-1) (step 1), and repeated during positive-pressure ventilation with 1 and 1.5 MAC of the inhalational agents or with propofol 4 and 6 microg ml(-1) (steps 2a and 2b). Analysis of echocardiographic measurements focused on heart rate corrected isovolumic relaxation time (IVRT(c)) and early diastolic peak velocity of the lateral mitral annulus (E(a)). RESULTS IVRT(c) decreased from baseline to step 1 in the halothane group (82 [95% CI, 76-88] ms and 74 [95% CI, 68-80] ms respectively; P=0.02), remained stable in the sevoflurane group (78 [95% CI, 72-83] ms and 73 [95% CI, 67-81] ms; n.s.) and increased in the propofol group (80 [95% CI, 74-86] ms and 92 [95% CI, 84-102] ms; P=0.02). E(a) decreased in the propofol group only (18.8 [95% CI, 16.5-19.9] cm s(-1) and 16.0 [95% CI, 14.9-17.9] cm s(-1); P=0.003). From step 2a to step 2b, IVRT(c) increased further in the propofol group (109 [95% CI, 99-121] ms and 119 [95% CI, 99-135] ms; P=0.04) but remained stable in the other two groups. E(a) did not change from step 2a to step 2b. CONCLUSIONS Halothane and sevoflurane did not impair LV relaxation, whereas propofol caused a mild impairment. However, the impairment by propofol was of a magnitude that is unlikely to cause clinical diastolic dysfunction.
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Affiliation(s)
- M Filipovic
- Department of Anaesthesia and Medical Intensive Care Unit, University of Basel/Kantonsspital, CH-4031 Basel, Switzerland.
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Michaux I, Haufroid V, Dive A, Buchet JP, Bulpa P, Mahieu P, Installé E. Repetitive endoscopy and continuous alkaline gastric irrigation in a case of arsenic poisoning. J Toxicol Clin Toxicol 2001; 38:471-6. [PMID: 10981956 DOI: 10.1081/clt-100102005] [Citation(s) in RCA: 10] [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: 11/03/2022]
Abstract
BACKGROUND The poor prognosis of patients with persistent gastrointestinal radio-opacities after oral arsenic poisoning supports efficient gastrointestinal decontamination as critical for survival. In a case of massive arsenic ingestion, we performed repetitive gastric endoscopy and a continuous alkaline irrigation of the stomach over several days. CASE REPORT A 41-year-old woman was admitted 4 hours after intentional ingestion of trivalent arsenic powder 5 g. The admission abdominal X-ray confirmed the presence of multiple gastric opacities. Initial treatment was gastric lavage with normal saline, dimercaprol chelation, and supportive therapy. Since gastric opacities persisted on the abdominal X-ray at 34 hours despite repeated gastric lavage, a gastroscopy was performed showing nonremovable agglomerates. In an attempt to achieve further gastric decontamination, we performed a continuous gastric alkaline irrigation. After 3 days of alkaline irrigation, the abdomen was normal on X-ray but the gastroscopy still showed arsenic concretions. Alkaline irrigation was continued for another 3 days until total disappearance of arsenic agglomerates at the gastroscopy. Admission urinary arsenic was 3663 microg/L. A total of 46.2 mg of inorganic arsenic, or less than 1% the ingested dose, was extracted from the stomach by this technique. The patient was discharged from the intensive care unit 20 days after admission without sequelae.
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Affiliation(s)
- I Michaux
- Department of Intensive Care Medicine, Mont-Godinne, Yvoir, Belgium
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Abstract
Superwarfarins have progressively replaced warfarin as rodenticides as they are more potent and have a longer anticoagulant activity. Human exposure may be complicated by spontaneous haemorrhage in various sites. We report the case of a 51-year-old woman who was admitted with spontaneous haemoperitoneum and intramural haematoma along the small intestine. After the evidence of a deficit of vitamin K1-dependent clotting factors (II, VII, IX, X), the patient admitted that she was chronically ingesting difenacoum. She was successfully treated with fresh frozen plasma and vitamin K1. Follow-up was not accepted.
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Affiliation(s)
- L Soubiron
- Department of Intensive Care, Cliniques Universitaires St-Luc, Brussels, Belgium
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Hernandez JM, Mecucci C, Criel A, Meeus P, Michaux I, Van Hoof A, Verhoef G, Louwagie A, Scheiff JM, Michaux JL. Cytogenetic analysis of B cell chronic lymphoid leukemias classified according to morphologic and immunophenotypic (FAB) criteria. Leukemia 1995; 9:2140-6. [PMID: 8609731] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
609 patients with B cell chronic lymphoproliferative disorder were studied with the primary aim of analyzing the cytogenetic profile of B cell chronic lymphocytic leukemias and, if possible, define correlations with FAB classification of these diseases. Morphological and immunological studies were performed according to criteria proposed by the FAB group. A panel of monoclonal antibodies, including at least sIg, CD19, CD5, and FMC7 was used. Interpretations of morphology and cytogenetics were made independently. When applying strict FAB criteria 65% of the cases could be classified. Most of them (44%) were chronic lymphocytic leukemia (CLL). The cases not satisfying strict FAB criteria could be divided into two groups: one closely related to CLL, and here defined as atypical CLL (aCLL) (21%) and another group consisting of patients with leukemic manifestations of B cell non-Hodgkin's lymphoma (LL) (14%). Analyzable metaphases were obtained in 89% of patients. Clonal abnormalities were present in 35% of patients. The most frequent chromosomal changes were abnormalities of chromosome 11q (60 cases), trisomy 12 (46 cases) and structural rearrangements of chromosome 14q (44 cases). Statistical associations with FAB subtypes were found: aCLL and trisomy 12 (P < 0.00001); mantle zone lymphoma (MZL) and t(11;14) (P < 0.00001) and del(6)(q) (P < 0.0001); CLL/mixed cell type and del(6)(q) (P < 0.002); follicular lymphoma and t(14;18) (P < 0.00001); splenic lymphoma with villous lymphocytes and del(7)(q) (P < 0.0004); leukemic lymphoma (LL) with rearrangements in chromosome 9q (P < 0.0001) and trisomy of 3 (P < 0.001). Chronic lymphocytic leukemia was not statistically associated with any specific chromosomal abnormality. However, this subtype showed a high incidence of del(11)(q) and rearrangements of 13q. This study confirms the value of cytogenetic investigation in the diagnosis of these disorders and may provide some new elements for future refinement of the FAB classification in mature B cell lymphocytic disorders.
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Affiliation(s)
- J M Hernandez
- Center for Human Genetics, Katholieke Universiteit Leuven, Belgium
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