1
|
Preparation and medical follow-up for a single-handed transatlantic rowing race. Int Marit Health 2017; 68:7-11. [PMID: 28357830 DOI: 10.5603/imh.2017.0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A single-handed transatlantic rowing race was organised between Senegal and French Guyana (2600 nautical miles). During the race, rowers adjust their lifestyle to maintain an optimal level of performance. Nutrition, circadian rhythm disturbance, psychological state, pain and other medical problems impact on physical abilities and increase the occurrence of accidents. We surveyed the prevalence of medical complications during this race and the preparation that we could suggest for this kind of activity. MATERIALS AND METHODS This is a descriptive, retrospective case series study. Follow-up consisted of sending out a questionnaire and performing individual interviews. RESULTS A total of 23 participants including 1 woman and 22 men; mean age of 46.5 years (range: 35-59) entered the race. The race lasted for 39 to 52 days with participants rowing between 10 and 12 h/day. Nine participants dropped out. Energy intake was 4500 to 6000 kcal/day and fluid intake was 4 to 5.5 L/day. Mean weight loss was 13.3 kg. The resting period was 6 ± 1 h/24 h divided into 1.5 to 2 h periods essentially during darkness. A total of 92% of the racers required medical care for dermatological problems; other conditions requiring medical care were: tendinitis in 10 cases, diarrhoea in 4, moderate to severe seasickness in 4, hallucinations in 3, panic attacks in 2, burns in 2, and disembarkation syndrome ("land sickness") lasting from 45 min to 6 h in 13. CONCLUSIONS Physiological and psychological impact of this type of event is still unclear. The most common medical problems are dermatological, rheumatological complications and minor trauma. Medical and psychological preparation should be offered to candidates for these competitions.
Collapse
|
2
|
Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv 2016; 9:646-56. [DOI: 10.1016/j.jcin.2015.12.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/30/2015] [Accepted: 12/15/2015] [Indexed: 01/20/2023]
|
3
|
Epidemiology of unintentional drowning in a metropolis of the French Mediterranean coast: a retrospective analysis (2000-2011). Int J Inj Contr Saf Promot 2015; 23:317-22. [PMID: 26082429 DOI: 10.1080/17457300.2015.1047862] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Drowning affects more than 500,000 people worldwide and is responsible for at least 350,000 deaths each year. In France, 1235 drowning resulting in 496 deaths were recorded in the summer 2012. This retrospective study has investigated the epidemiology of drowning in the city of Marseille (South of France) between 2000 and 2011. We identified 449 cases of unintentional drowning. The highest incidence was found among males with a median age of 36 years. The incidence was 5.3 victims per 10,000 inhabitants with a mortality rate of 1.2 per 10,000. These accidents occurred mainly at sea (89%) and during the summer season. A majority of drowning victims (69%) were admitted in a hospital. This is the only study in France to analyse data on drowning throughout the year and over a long period. Drowning is a serious condition burdened by 22% of victims who die.
Collapse
|
4
|
Adherence to protocol and determinants in ST-elevation myocardial infarction. Int J Cardiol 2013; 166:548-9. [PMID: 23157808 DOI: 10.1016/j.ijcard.2012.09.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
|
5
|
Early psychological care of the French victims of the Costa Concordia shipwreck. Int Marit Health 2013; 64:2-6. [PMID: 23788158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 06/02/2023] Open
Abstract
Most of the French passengers who survived the shipwreck of the cruise ship Costa Concordia were repatriatedfrom Italy to Marseille, one of the stopovers of the cruise. The shipwreck happened during the nightof 13th-14th January 2012 and entailed the forced evacuation of 4195 passengers and crewmembers.Thirty-two persons died and 2 others are still reported missing. The massive and unexpected inflow of402 French citizens in the port of Marseille required the quick setting up of welcome facilities, not only tosolve logistical problems, but also to address psychological and sometimes even medical problems. ThePrehospital Psychological Emergency Service (CUMP) and the Prehospital Emergency Medical Service(SAMU) of Marseille examined 196 persons in total, and were able to avoid a great number of emergencyadmissions deemed necessary because of difficult psychological situations (death, missing or lost persons,acute stress). The objective of this report is to rapidly present the emergency committee as a whole andto describe in more detail the work that the CUMP accomplished during the 36 hours necessary to takecharge of the majority of the French passengers of the Costa Concordia.
Collapse
|
6
|
Abstract
Despite the considerable number of studies reported to date, the causative agents of pneumonia are not completely identified. We comprehensively applied modern and traditional laboratory diagnostic techniques to identify microbiota in patients who were admitted to or developed pneumonia in intensive care units (ICUs). During a three-year period, we tested the bronchoalveolar lavage (BAL) of patients with ventilator-associated pneumonia, community-acquired pneumonia, non-ventilator ICU pneumonia and aspiration pneumonia, and compared the results with those from patients without pneumonia (controls). Samples were tested by amplification of 16S rDNA, 18S rDNA genes followed by cloning and sequencing and by PCR to target specific pathogens. We also included culture, amoeba co-culture, detection of antibodies to selected agents and urinary antigen tests. Based on molecular testing, we identified a wide repertoire of 160 bacterial species of which 73 have not been previously reported in pneumonia. Moreover, we found 37 putative new bacterial phylotypes with a 16S rDNA gene divergence ≥ 98% from known phylotypes. We also identified 24 fungal species of which 6 have not been previously reported in pneumonia and 7 viruses. Patients can present up to 16 different microorganisms in a single BAL (mean ± SD; 3.77 ± 2.93). Some pathogens considered to be typical for ICU pneumonia such as Pseudomonas aeruginosa and Streptococcus species can be detected as commonly in controls as in pneumonia patients which strikingly highlights the existence of a core pulmonary microbiota. Differences in the microbiota of different forms of pneumonia were documented.
Collapse
|
7
|
Abstract
BACKGROUND The short-term effects of smoke inhalation have been little studied in European wildland firefighters, especially in an intra-individual design. Our purpose is to study the spirometric changes from the early stage during a wildland fire season and to compare smokers and non-smokers. METHODS A population of 108 firefighters from a Civil Security Unit, based in Corsica, was tested immediately after having been exposed to the smoke of coniferous trees. RESULTS Out of 108 people, 59 were smokers and 49 were non-smokers without any acute or chronic pulmonary disease. Compared to baseline values, a decrease of spirometric parameters was observed immediately after the end of exposure and an even greater decrease was seen after 24 hr (FEV1 -0.53 L; FVC -0.59 L; PEF -53 L min(-1), P < 0.05 for each). None of the participants complained of respiratory symptoms. Three months after the end of the season, a final test was given which revealed a persistent decrease in spirometric parameters in comparison with baseline values (FEV1 -0.28 L; FVC -0.34 L; PEF -45 L min(-1), P < 0.05 for each). Comparison of smoking and non-smoking groups did not show any noteworthy difference for each parameter or the importance of their decline. CONCLUSIONS The findings show that firefighters are likely to develop respiratory impairments after wood smoke exposure. We did not observe any statistical differences between smokers and non-smokers.
Collapse
|
8
|
|
9
|
Comparison of lung injury after normal or small volume optimized resuscitation in a model of hemorrhagic shock. Intensive Care Med 2007; 33:1645-54. [PMID: 17541551 DOI: 10.1007/s00134-007-0692-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 04/26/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare lung injury induced by a hemorrhagic shock resuscitated with normal saline or with small volumes of a hypertonic/hyperoncotic solution. DESIGN AND SETTING Randomized, controlled, laboratory study in an animal research laboratory. SUBJECTS Nineteen pigs (43 +/- 4 kg). INTERVENTIONS After anesthesia and mechanical ventilation animals were bled to induce a 2-h deep shock and resuscitated for 2 h using normal saline (NS, 2 ml/kg per minute, n = 7) or the association of 7.2% NaCl with 6% hydroxyethylstarch 200/0.5 (HSHES, 4 ml/kg in 10 min followed by 0.2 ml/kg per minute, n = 7) to reach cardiac index and mixed venous oxygen saturation goals. Lungs were removed 6[Symbol: see text]h after the initiation of hemorrhage. Five animals were used as controls without hemorrhage. MEASUREMENTS AND RESULTS Resuscitation goals were achieved using 90 +/- 17 ml/kg NS or 6.8 +/- 1.9 ml/kg HSHES. Lung injury was noted in both hemorrhage groups but was not influenced by the type of resuscitation. Extravascular lung water was measured at 9.6 +/- 1.8 ml/kg in the NS group, 9.2 +/- 1.6 ml/kg in the HSHES, group and 6.4 +/- 1 m/kg in the control group. The degree of histological alveolar membrane focal thickening and interstitial neutrophil infiltration were significantly more pronounced in the hemorrhage groups with no difference between the two types of fluid loading. Finally, pulmonary levels of IL-8 were higher after hemorrhage regardless of the type of resuscitation. CONCLUSIONS When included in an optimized and goal directed resuscitation, the use of normal saline or a small volume of hypertonic/hyperoncotic solution does not result in a different early hemorrhage-induced lung injury.
Collapse
|
10
|
Protective ventilation influences systemic inflammation after esophagectomy: a randomized controlled study. Anesthesiology 2006; 105:911-9. [PMID: 17065884 DOI: 10.1097/00000542-200611000-00011] [Citation(s) in RCA: 243] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Esophagectomy induces a systemic inflammatory response whose extent has been recognized as a predictive factor of postoperative respiratory morbidity. The aim of this study was to determine the effectiveness of a protective ventilatory strategy to reduce systemic inflammation in patients undergoing esophagectomy. METHODS The authors prospectively investigated 52 patients undergoing planned esophagectomy for cancer. Patients were randomly assigned to a conventional ventilation strategy (n = 26; tidal volume of 9 ml/kg during two-lung and one-lung ventilation; no positive end-expiratory pressure) or a protective ventilation strategy (n = 26; tidal volume of 9 ml/kg during two-lung ventilation, reduced to 5 ml/kg during one-lung ventilation; positive end-expiratory pressure 5 cm H2O throughout the operative time). RESULTS Plasmatic levels of interleukin (IL)-1beta, IL-6, IL-8, and tumor necrosis factor alpha were measured perioperatively and postoperatively. Pulmonary function and postoperative evolution were also evaluated. Patients who received protective strategy had lower blood levels of IL-1beta, IL-6, and IL-8 at the end of one-lung ventilation (0.24 [0.15-0.40] vs. 0.56 [0.38-0.89] pg/ml, P < 0.001; 91 [61-117] vs. 189 [127-294] pg/ml, P < 0.001; and 30 [22-45] vs. 49 [29-69] pg/ml, P < 0.05, respectively) and 18 h postoperatively (0.18 [0.13-0.30] vs. 0.43 [0.34-0.54] pg/ml, P < 0.001; 54 [36-89] vs. 116 [78-208] pg/ml, P < 0.001; 16 [11-24] vs. 35 [28-53] pg/ml, P < 0.001, respectively). Protective strategy resulted in higher oxygen partial pressure to inspired oxygen fraction ratio during one-lung ventilation and 1 h postoperatively and in a reduction of postoperative mechanical ventilation duration (115 +/- 38 vs. 171 +/- 57 min, P < 0.001). CONCLUSION A protective ventilatory strategy decreases the proinflammatory systemic response after esophagectomy, improves lung function, and results in earlier extubation.
Collapse
|
11
|
Abstract
Ameba-associated microorganisms should be suspected when conventional microbiologic test results are negative. To elucidate the role of ameba-associated microorganisms (AAMs) as etiologic agents of pneumonia, we screened for Legionella spp., Parachlamydia acanthamoeba, Afipia sp., Bosea spp., Bradyrhizobium spp., Mesorhizobium amorphae, Rasbo bacterium, Azorhizobium caulinodans, Acanthamoeba polyphaga mimivirus, and conventional microorganisms in 210 pneumonia patients in intensive-care units by using culture, polymerase chain reaction, and serologic testing. These resulted in 59 diagnoses in 40 patients. AAMs and non-AAMs were implicated in 10.5% of the patients. The infectious agents were identified in 15 patients: Acanthamoeba polyphaga mimivirus, 8; Legionella pneumophila, 3; L. anisa, 1; Parachlamydia sp., 1; Bosea massiliensis, L. worsleiensis, L. quinlivanii, and L. rubrilucens, 1; and M. amorphae and R. bacterium, 1. A. polyphaga mimivirus was the fourth most common etiologic agent, with a higher seroprevalence than noted in healthy controls. This finding suggested its clinical relevance. Therefore, AAM might cause nosocomial pneumonia and should be suspected when conventional microbiologic results are negative.
Collapse
|
12
|
Inhaled Nitric Oxide Does Not Prevent Pulmonary Edema After Lung Transplantation Measured By Lung Water Content. Chest 2006; 129:1024-30. [PMID: 16608953 DOI: 10.1378/chest.129.4.1024] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE In order to assess the effects of inhaled nitric oxide (iNO) in preventing early-onset lung edema from occurring after lung transplantation, we measured extravascular lung water (EVLW) in a group of lung transplant recipients who were at high risk for developing ischemia-reperfusion-induced lung injury. DESIGN Prospective, randomized study. SETTINGS Surgical ICU in a teaching hospital. PATIENTS Thirty double-lung transplant recipients. INTERVENTIONS Patients were randomized to receive or not receive 20 ppm iNO at the time of reperfusion (ie, before any occurrence of lung edema). In the NO group, iNO was then administered for a 12-h period. A double-dilution technique was used for the serial assessment of EVLW, intrathoracic blood volume, and cardiac index. Standard hemodynamic and pulmonary parameters were also recorded during the first 3 postoperative days. MEASUREMENTS AND RESULTS Patients who received iNO did not have a different lung water content compared to control subjects (p = 0.61 [by analysis of variance (ANOVA)]). Blood oxygenation (ie, Pao(2)/fraction of inspired oxygen [Fio(2)] ratio) did not differ between the two groups (p = 0.61 [by ANOVA]). In both groups, EVLW and Pao(2)/Fio(2) ratio dropped significantly over time, regardless of the use of iNO (p < 0.01 [by ANOVA]). CONCLUSIONS In the population studied, prophylactic iNO that was administered at 20 ppm had no effect on pulmonary edema formation and resolution following lung transplantation.
Collapse
|
13
|
Abstract
STUDY OBJECTIVES Anastomotic leakage after esophagectomy is associated with high postoperative morbidity and mortality. The most important predisposing factors for anastomotic leaks are ischemia of the gastric conduit and low blood oxygen content. The aim of this study was to evaluate the influence of thoracic epidural analgesia (TEA) on the incidence of anastomotic leakage after esophagectomy. DESIGN Retrospective study. SETTING A thoracic surgery and anesthesia department in a teaching hospital. PATIENTS Two hundred seven patients who underwent one-stage esophagectomy between 1998 and 2003. INTERVENTIONS The effects of perioperative factors and postoperative complications on the incidence of anastomotic leakage were analyzed. Leakage was defined as an anastomotic disruption detected by an ionic x-ray contrast study and confirmed by upper endoscopy in the postoperative period. Analyzed factors included effective TEA placed before the surgical procedure. MEASUREMENTS AND RESULTS Anastomotic leakage occurred in 23 patients (11%). This complication was associated with a significant increase in length of stay in the ICU and in the hospital (mean, 19 +/- 16 days vs 9 +/- 7 days [+/- SD], p = 0.008; and 43 +/- 27 days vs 23 +/- 11 days, respectively; p < 0.001). Mortality in patients presenting anastomotic leakage was 26%, compared with 5.4% in the remainder (p = 0.002). Factors independently associated with the incidence of leakage included estimated blood loss per milliliter during the surgical procedure (odds ratio [OR], 1.004; 95% confidence interval [CI], 1.001 to 1.007), the cervical location for anastomosis (OR, 5.4; 95% CI, 1.3 to 22.9), and the development of an ARDS in the postoperative period (OR, 4.1; 95% CI, 2.6 to 176.5). Ninety-three patients benefited from an effective TEA for 4.4 +/- 0.8 days. The use of TEA was independently associated with a decrease in the incidence of anastomotic leakage (OR, 0.13; 95% CI, 0.02 to 0.71). CONCLUSIONS The results of this retrospective study suggest that TEA is associated with a decrease in occurrence of anastomotic leakage.
Collapse
|
14
|
Accuracy and limits of transpulmonary dilution methods in estimating extravascular lung water after pneumonectomy. Chest 2005; 128:927-33. [PMID: 16100188 DOI: 10.1378/chest.128.2.927] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The measurement of extravascular lung water index by double indicator (EVLWIdi) or the measurement of extravascular lung water index by transpulmonary thermodilution (EVLWItt) could be useful after pneumonectomy. Since pulmonary blood flow and volume are altered after pneumonectomy, the validity of these methods is uncertain. This study has compared measurements of EVLWIdi and EVLWItt with measurement of extravascular lung water index by gravimetry (EVLWIg) in a porcine model of pulmonary edema induced after right pneumonectomy. DESIGN Randomized laboratory study. SETTING Animal research laboratory. SUBJECTS Twenty-seven female pigs; mean weight, 35 +/- 5 kg (+/- SD). INTERVENTIONS The pigs were anesthetized, placed on mechanical ventilation, and allocated to a two-lung group (n = 10) or a right pneumonectomy group (n = 17). EVLWIdi and EVLWItt were measured at baseline, 60 min after pneumonectomy, and 60 min after IV injection of oleic acid (OA). MEASUREMENTS AND RESULTS There was a good correlation between EVLWIg and EVLWIdi values (r = 0.96, p < 0.0001 in the two-lung group; and r = 0.81, p = 0.02 in the pneumonectomy group). EVLWIdi underestimated EVLWIg in the two-lung group (- 3 mL/kg; 95% confidence interval [CI], - 7 to + 2 mL/kg) and in the pneumonectomy group (- 0.9 mL/kg; 95% CI, - 3.3 to + 1.5 mL/kg). After pneumonectomy, EVLWItt decreased in mean by 27% and increased in mean by 70% after OA acid. There was a good correlation between EVLWIg and EVLWItt values (r = 0.96, p < 0.0001 in the two-lung group; and r = 0.90, p < 0.0001 after pneumonectomy). EVLWItt slightly overestimated gravimetric value in the two-lung group (+ 1.5 mL/kg; 95% CI, - 1.5 to + 4.2 mL/kg) and largely overestimated gravimetric value after pneumonectomy (+ 5 mL/kg; 95% CI, + 3.4 to + 6.8 mL/kg). CONCLUSION Double-indicator and transpulmonary thermodilution methods could be useful in monitoring extravascular lung water index (EVLWI) after pneumonectomy, but transpulmonary thermodilution largely overestimates EVLWI.
Collapse
|
15
|
Abstract
Background
Satisfaction is considered a valuable measure of outcome of healthcare processes. Only a few anesthesia-related validated questionnaires are reported. Because their scope is restricted to specific clinical contexts, their use remains limited. The objective of the current study was to develop and validate a self-reported questionnaire, Evaluation du Vecu de l'Anesthesie Generale (EVAN-G), assessing the satisfaction of the perioperative period surrounding general anesthesia.
Methods
Development of the EVAN-G questionnaire comprised a phase of item generation and a phase of psychometric validation. The patient sample was generated to be proportionally matched to the population of patients undergoing general anesthesia in France. The structure of the questionnaire was identified studying interitem, item-dimension, and interdimension correlations and factor analyses. Data were concurrently gathered to assess external validity. The discriminant validity was determined by comparison of scores across well known patient groups. Reliability was assessed by computation of Cronbach alpha coefficients and by test-retest.
Results
Eight hundred seventy-four patients were recruited in eight anesthesia departments. The EVAN-G includes 26 items; six specific scores and one global index score are available. Correlations between EVAN-G scores and other concurrent measures supported convergent validity. The EVAN-G correlated poorly with age, American Society of Anesthesiologists physical status, total anesthesia time, and number of previous anesthesias. Significantly higher satisfaction was reported by patients older than 65 yr, belonging to the laryngeal mask group. Reliability and reproducibility were shown.
Conclusion
The EVAN-G adds important information oriented toward patients' perceptions. The authors' approach provides a novel, valid, and reliable tool that may be used in anesthesia practice.
Collapse
|
16
|
NH2 terminal pro–brain natriuretic peptide plasma level as an early marker of prognosis and cardiac dysfunction in septic shock patients*. Crit Care Med 2005; 33:1001-7. [PMID: 15891328 DOI: 10.1097/01.ccm.0000162561.82012.e9] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate N-terminal pro-brain natriuretic peptide (NT-proBNP) level as a prognostic factor and a marker of myocardial dysfunction in patients with septic shock. DESIGN Prospective observational study. SETTING Intensive care unit. SUBJECTS A total of 39 patients diagnosed with septic shock and requiring mechanical ventilation. MEASUREMENTS AND MAIN RESULTS Demographic, hemodynamic, respiratory, and biological data (notably NT-proBNP, lactate, and cardiac troponin I) were collected at inclusion and every 12 hrs. The independent factors for death were higher Sequential Organ Failure Assessment score in the 24-hr period after inclusion (odds ratio, 4.7; 95% confidence interval, 1.15-19.3) and the highest NT-proBNP level in the 24-hr period after inclusion (odds ratio, 1.12 per 1000 pg/mL increase; 95% confidence interval, 1.05-1.26). An NT-proBNP of >13,600 pg/mL predicted intensive care unit mortality with an accuracy of 77%. Area under the receiver operating characteristic curve was 0.8 (p = .002; 95% confidence interval, 0.66-0.93). NT-proBNP levels were over the accepted normal range in all patients. Values were highest between 24 and 36 hrs after onset of septic shock and were significantly higher in nonsurvivors at each time between inclusion and day 7. The lowest left ventricular stroke work index of the first 24-hr period after inclusion was the only factor that independently influenced higher NT-proBNP levels at the same time (odds ratio, 0.91; 95% confidence interval, 0.84-0.98). CONCLUSION NT-proBNP seems to be an early factor of prognosis and myocardial dysfunction in patients with septic shock.
Collapse
|
17
|
Abstract
Mimivirus, the largest virus known to date, is an amebal pathogen like Legionella spp. When mimivirus was used as an antigen in a migration inhibition factor assay, seroconversion was found in patients with both community- and hospital-acquired pneumonia. Mimivirus DNA was found in respiratory samples of patients with hospital-acquired pneumonia.
Collapse
|
18
|
Traitement endovasculaire des ruptures isthmiques de l'aorte chez le polytraumatisé : utilisation de stents de deuxième génération. ACTA ACUST UNITED AC 2005; 24:355-60. [PMID: 15826785 DOI: 10.1016/j.annfar.2005.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Accepted: 01/24/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Prospective analysis of endovascular management of traumatic isthmic rupture with second generation stent grafts. STUDY DESIGN Prospective analysis and follow-up. PATIENTS Ten consecutive multiple injured patients presenting an acute isthmic traumatic rupture who underwent an endovascular repair with second generation stent grafts. METHODS AND RESULTS The aortic injury was diagnosed by spiral computed tomography scan. The appropriate time to repair was decided according to multidisciplinary decision after analysis of associated injuries status and mediastinal lesions evolution. Endovascular repair was successfully completed in all patients under general anaesthesia without requirement of haemodynamic manipulations. Despite a prolonged length of stay related to associated injuries, all patients were discharged from hospital without migration of devices or complication related to the endovascular procedure. After a 20 months follow-up (range 6 - 38 months), all patients were alive with a satisfactory CT scan analysis. CONCLUSION The immediate availability of the second generation of stents-grafts allowed the endovascular treatment of isthmic rupture without haemodynamic manipulations or massive heparinization. The analysis of this selected series reinforces the interest of this non-invasive technique for anaesthetists especially in polytraumatized patients.
Collapse
|
19
|
Influence of support on intra-abdominal pressure, hepatic kinetics of indocyanine green and extravascular lung water during prone positioning in patients with ARDS: a randomized crossover study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2005; 9:R251-7. [PMID: 15987398 PMCID: PMC1175887 DOI: 10.1186/cc3513] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Revised: 02/21/2005] [Accepted: 03/07/2005] [Indexed: 12/15/2022]
Abstract
Introduction Prone positioning (PP) on an air-cushioned mattress is associated with a limited increase in intra-abdominal pressure (IAP) and an absence of organ dysfunction. The respective influence of posture by itself and the type of mattress on these limited modifications during the PP procedure remains unclear. The aim of this study was to evaluate whether the type of support modifies IAP, extravascular lung water (EVLW) and the plasma disappearance rate of indocyanine green (PDRICG) during PP. Methods A prospective, randomized, crossover study of 20 patients with acute respiratory distress syndrome (ARDS) was conducted in a medical intensive care unit in a teaching hospital. Measurements were made at baseline and repeated after 1 and 6 hours of two randomized periods of 6 hours of PP with one of two support types: conventional foam mattress or air-cushioned mattress. Results After logarithmic transformation of the data, an analysis of variance (ANOVA) showed that IAP and PDRICG were significantly influenced by the type of support during PP with an increase in IAP (P < 0.05 by ANOVA) and a decrease in PDRICG on the foam mattress (P < 0.05 by ANOVA). Conversely, the measurements of EVLW did not show significant modification between the two supports whatever the posture. The ratio of the arterial oxygen tension to the fraction of inspired oxygen significantly increased in PP (P < 0.0001 by ANOVA) without any influence of the support. Conclusion In comparison with a conventional foam mattress, the use of an air-cushioned mattress limited the increase in IAP and prevented the decrease in PDRICG related to PP in patients with ARDS. Conversely, the type of support did not influence EVLW or oxygenation.
Collapse
|
20
|
Usefulness of ultrasonography in predicting pleural effusions > 500 mL in patients receiving mechanical ventilation. Chest 2005; 127:224-32. [PMID: 15653988 DOI: 10.1378/chest.127.1.224] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVE To assess the accuracy of chest ultrasonography in predicting pleural effusions > 500 mL in patients receiving mechanical ventilation. DESIGN Prospective study. SETTING Surgical and medical ICU in a teaching hospital. PATIENTS Forty-four patients receiving mechanical ventilation with indications of chest drainage of a nonloculated pleural effusion. INTERVENTIONS Diagnosis of pleural effusion was based on clinical examination and chest radiography. Chest drainage was indicated when considered as potentially useful for the patient (hypoxemia and/or weaning failure). Sonograms were performed before drainage at the bedside, in the supine position, and measurements were performed at the end of expiration. Effusions were classified as > 500 mL or < or = 500 mL according to the drained volume. MEASUREMENTS AND RESULTS The drained volume ranged from 100 to 1,800 mL (mean, 730 +/- 440 mL [+/- SD]). The distance between the lung and posterior chest wall at the lung base (PLDbase) and the distance between the lung and posterior chest wall at the fifth intercostal space (PLD5) were significantly correlated with the drained volume (PLDbase, r = 0.68, p < 0.001; PLD5, r = 0.56, p < 0.001). A PLDbase > 5 cm predicted a drained volume > 500 mL with a sensitivity of 83%, specificity of 90%, positive predictive value of 91%, and negative predictive value of 82%. Interobserver and intraobserver percentages of error were, respectively, 7 +/- 6% and 9 +/- 6% for PLDbase, and 6 +/- 5% and 8 +/- 5% for PLD5. The PaO2/fraction of inspired oxygen ratio significantly increased after chest drainage in patients with collected volumes > 500 mL (p < 0.01). CONCLUSIONS Bedside pleural ultrasonography accurately predicted a nonloculated pleural effusion > 500 mL in patients receiving mechanical ventilation using simple and reproducible measurements.
Collapse
|
21
|
|
22
|
Accuracy of the double indicator method for measurement of extravascular lung water depends on the type of acute lung injury*. Crit Care Med 2004; 32:811-7. [PMID: 15090967 DOI: 10.1097/01.ccm.0000114831.59185.02] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The double indicator method is sensitive to alterations in the distribution of pulmonary blood flow. This distribution is influenced by the type of lung injury. The aim of this study was to compare measurements of lung water by the double indicator method with measurements obtained by gravimetry in a direct lung injury model induced by tracheal instillation of hydrochloric acid and in an indirect lung injury model induced by the intravenous injection of oleic acid. DESIGN Prospective, randomized laboratory study. SETTING Animal research laboratory. SUBJECTS Forty-two female pigs (28+/-3 kg). INTERVENTIONS Pigs were anesthetized and ventilated and were allocated into three groups: control (n = 6), hydrochloric acid (4 mL/kg intratracheally, n = 24), or oleic acid (0.1 mL/kg intravenously, n = 12). MEASUREMENTS AND MAIN RESULTS Hydrochloric acid instillation or oleic acid injection resulted in a similar hypoxemia and induced a two- to three-fold increase in extravascular lung water (EVLW) by gravimetry (EVLWG) at 3 hrs compared with controls. In the oleic acid group, there was a significant correlation between EVLWG and EVLW by double indicator method (EVLWDI; r =.88, p <.0001). The bias for EVLWDI - EVLWG measurements was -5.2 mL/kg (95% confidence interval, -5.7 to -4.7 mL/kg) with 95% limits of agreement of -7 to -3.4 mL/kg. In the hydrochloric acid group, there was no significant correlation between EVLWDI and EVLWG values, and the double indicator method failed to detect pulmonary edema in 65% of the animals (EVLWDI <8 mL/kg). The bias was -7.9 mL/kg (95% confidence interval, -9.3 to -6.5 mL/kg) with 95% limits of agreement of -14.4 to -1.4 mL/kg. CONCLUSIONS The double indicator method is useful for evaluation of pulmonary edema in indirect lung injury, as induced by oleic acid, but produces misleading values in direct lung injury, as produced by hydrochloric instillation.
Collapse
|
23
|
Long-term outcome in intensive care unit survivors after mechanical ventilation for intracerebral hemorrhage. Crit Care Med 2003; 31:2651-6. [PMID: 14605538 DOI: 10.1097/01.ccm.0000094222.57803.b4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate long-term survival and functional outcome in intensive care unit survivors after mechanical ventilation for intracerebral hemorrhage. DESIGN Retrospective chart review and prospective follow-up study. SETTING Outpatient follow-up. PATIENTS Between 1997 and 2000, 120 patients were mechanically ventilated for an intracerebral hemorrhage at our intensive care unit. Sixty-two patients were discharged from hospital (in-hospital mortality = 48%). Sixty patients were evaluated for survival and functional outcome (two were lost to follow-up). Time between discharge and follow-up was > or =1 yr and was a mean of 27 +/- 14 months (range, 12-56). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients' physicians were first asked about survival, and patients or proxies were interviewed by phone. Barthel Index and modified Rankin Scale scores were collected, and demographic information and general data were reviewed. The estimated life-table survival curve after discharge was 64.6% at 1 yr and 57% at 3 yrs. In the 24 patients who died, the mean time between discharge and death was 5 +/- 6 months. Probability of death after discharge significantly increased if age at admission was >65 yrs (p <.01; odds ratio, 3.5; 95% confidence interval, 1.4-9.1) and if Glasgow Coma Scale score at discharge was <15 (p <.01; odds ratio, 3.9; 95% confidence interval, 1.6-9.5). In the 36 long-term survivors, Barthel Index was 67.5 +/- 15 (median +/- median absolute dispersion) and modified Rankin Scale score was 2.6 +/- 0.5. Fifteen patients (42%) had a slight or no disability (Barthel Index > or =90 and modified Rankin Scale score < or =2), whereas 21 patients (58%) had moderate or severe disability (Barthel Index < or =85 and modified Rankin Scale score >2). CONCLUSIONS Probability of survival at 3 yrs after mechanical ventilation for an intracerebral hemorrhage was >50%. Age was an important determinant of long-term survival. Forty-two percent of long-term survivors were independent for activities of daily living. Only a few long-term survivors had a very high degree of disability.
Collapse
|
24
|
Abstract
STUDY OBJECTIVES Lipid emulsions have been suspected of inducing certain modifications in gas exchange and pulmonary hemodynamics. The aim of this prospective study was to evaluate the hemodynamic and pulmonary effects of two lipid emulsions. DESIGN Prospective, randomized, double-blind, crossover study. SETTING Medical and surgical ICU in a French university hospital. PATIENTS Eighteen patients presenting ARDS. INTERVENTIONS Each patient received a 6-h infusion of a 20% fat emulsion containing 100% long-chain triglycerides (LCTs) and a 6-h infusion of 50% LCTs/50% medium-chain triglycerides (MCTs) 20% lipid emulsion at the rate of 1.0 mL/kg/h. An 18-h period with no lipids separated the two periods. An additional 18-h period after the end of the second lipid emulsion administration was observed prior to the final measurements. MEASUREMENTS AND RESULTS The MCT/LCT emulsion increased the PaO(2)/fraction of inspired oxygen (FIO(2)) ratio (p = 0.005) compared with LCT emulsion alone. The mean (+/- SD) PaO(2)/FIO(2) ratio increased from 165 +/- 55 to 191 +/- 64 mm Hg after 1 h of LCT/MCT administration (p < 0.03), and to 175 +/- 46 mm Hg after 6 h. Moreover, there was an increase in oxygen delivery after 6 h of LCT/MCT administration (p < 0.001 vs baseline). While a time-related increase in mean pulmonary artery pressure (p = 0.012) during lipid administration was found, no effect of the kind of lipid emulsion was observed. The time-related increase in cardiac index (p = 0.002) was more marked when the patients received the LCT/MCT emulsion (p = 0.002). Pulmonary vascular resistances were not affected by the kind of lipid emulsion. CONCLUSIONS The present work showed that while the LCT emulsion induced no deleterious effects on oxygenation in ARDS patients, the LCT/MCT emulsion improved the PaO(2)/FIO(2) ratio and had a further beneficial effect on oxygen delivery.
Collapse
|
25
|
Acute toxicity of local anesthetic ropivacaine and mepivacaine during a combined lumbar plexus and sciatic block for hip surgery. ACTA ANAESTHESIOLOGICA BELGICA 2003; 53:221-3. [PMID: 12461832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Hip fracture is a common pathology in elderly patients. Intercurrent diseases, mainly cardiac and respiratory, often result in significant morbidity and mortality. Anesthesia for hip fracture can be provided by general or regional techniques. The combination of a lumbar plexus and posterior sciatic nerve block represents an alternative to neuraxial technique of anaesthesia such as spinal anesthesia (4, 6). We report a case of acute toxicity resulting in the injection of local anesthetics Ropivacaine and Mepivacaine in elderly patient. An elderly woman was scheduled for surgical repair of a fractured femur neck by dynamic hip screw synthesis. Anesthesia was realized by peripheral nerve bi-block (lumbar plexus and posterior sciatic block) (7). The patient experienced seizures and dysrhythmias twenty minutes after block completion and injection of the anesthetic solution [Ropivacaine 0.75%, administered for lumbar plexus block performed via the posterior approach (WINNIE) and Mepivacaine 1.5%, administered for posterior sciatic nerve block (LABAT)]. Cardiopulmonary resuscitation was successful. All signs of toxicity disappeared after injection of midazolam and atropine, intubation and 100% oxygen ventilation. We decided to proceed with surgery. The postoperative course was uncomplicated and made a full recovery.
Collapse
|
26
|
Can the tomographic aspect characteristics of patients presenting with acute respiratory distress syndrome predict improvement in oxygenation-related response to the prone position? Anesthesiology 2002; 97:599-607. [PMID: 12218526 DOI: 10.1097/00000542-200209000-00013] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In some patients with acute respiratory distress syndrome, the prone position is able to improve oxygenation, whereas in others it is not. It could be hypothesized that the more opacities that are present in dependent regions of the lung when the patient is in the supine position, the better the improvement in oxygenation is observed when the patients are turned prone. Therefore, we conducted a prospective study to identify computed tomographic scan aspects that could accurately predict who will respond to the prone position. METHODS We included 46 patients with acute respiratory distress syndrome (31 responders and 15 nonresponders). Computed tomographic scan was performed in the 6-h period preceding prone position. Blood gas analyses were performed before and at the end of the first 6-h period of prone position. RESULTS Arterial oxygen partial pressure/fraction of inspired oxygen increased from 117 +/- 42 (mean +/- SD) in the supine position to 200 +/- 76 mmHg in the prone position (P < 0.001). There were 31 responders and 15 nonresponders. There was a vertebral predominance of the opacities (P < 0.0001). However, there was no difference between responders and nonresponders. When only the amount of consolidated lung located under the heart was evaluated, there was more consolidated tissue under the heart relative to total lung area in nonresponders than in responders (P = 0.01). CONCLUSIONS There are no distinctive morphologic features in the pattern of lung disease measured by computed tomographic scanning performed with the patient in the supine position that can predict response to the prone position.
Collapse
|
27
|
Conventional mechanical ventilation of healthy lungs induced pro-inflammatory cytokine gene transcription. Respir Physiol Neurobiol 2002; 132:191-203. [PMID: 12161332 DOI: 10.1016/s1569-9048(02)00069-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We investigated the potential inflammatory reaction induced by mechanical ventilation (MV) using 10 ml/kg tidal volume and no positive end-expiratory pressure (PEEP) in control (C, n = 8), spontaneously breathing (SB, n = 12) and mechanically ventilated (MV, n = 12) rabbits with normal lungs. After 6 h (MV and SB groups) or immediately (C group), lungs were removed for measurement of wet-to-dry (W/D) weight ratio and for bronchoalveolar lavage (BAL). Pulmonary mechanics were also studied. MV animals developed a modest but significant (P < 0.01) impairment of arterial blood oxygenation and had higher W/D lung weight ratio than C ones. In MV group, BAL macrophage count was greater (P < 0.05) than in SB one. MV induced an upregulation of MCP-1, TNF-alpha, and IL-1beta gene transcription (mRNAs), without significant elevation of the corresponding protein cytokines in the BAL supernatant, except for MCP-1 (P < 0.05). These data suggest that MV, even using moderate tidal volume, elicits a pro-inflammatory stimulus to the lungs.
Collapse
|
28
|
Patients in the intensive care unit are exposed to amoeba-associated pathogens. Infect Control Hosp Epidemiol 2002; 23:462-5. [PMID: 12186213 DOI: 10.1086/502086] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To study the role of amoeba-associated alpha Proteobacteria as infecting agents in intensive care units (ICUs). DESIGN Amoeba-associated alpha Proteobacteria were isolated from water samples taken from ICU taps and general hospital reservoir tanks using an amoebal co-culture procedure. Isolates were identified by 16S rDNA gene sequence comparison, and one isolate of each species was used as an antigen in a microimmunofluorescence assay to test the sera of the patients in the ICUs and compare them with those of control subjects. SETTING The four university hospitals in Marseilles, France. PATIENTS The sera of 85 patients in the ICUs with nosocomial pneumonia were tested. RESULTS We isolated 64 bacterial strains that were identified as Afipia species or close relatives within the Rhizobiaceae subgroup of alpha Proteobacteria. These bacteria were assigned to 8 different species. Eleven patients were found to have an elevated antibody titer to either Afipia genospecies 1, or 3 still unnamed bacteria. No specific antibodies were detected in 100 control subjects (P < .01). CONCLUSION These preliminary results support the hypothesis that ICU patients are exposed to amoeba-associated alpha Proteobacteria.
Collapse
|
29
|
High or low doses of almitrine bismesylate in ARDS patients responding to inhaled NO and receiving norepinephrine? Intensive Care Med 2001; 27:1737-43. [PMID: 11810116 DOI: 10.1007/s00134-001-1128-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2000] [Accepted: 09/03/2001] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the effects on oxygenation and pulmonary haemodynamics of almitrine bismesylate (AB) 5 microg/kg per minute and 16 microg/kg per minute in ARDS patients responding to and receiving inhaled NO (iNO) and presenting septic shock requiring norepinephrine, while no difference was observed in a previous trial including iNO responders and nonresponders. DESIGN Prospective, cohort study. SETTING Adult medico-surgical intensive care unit of a university hospital. PATIENTS Fifteen patients with ARDS receiving and responding to iNO (10 ppm) and presenting septic shock requiring norepinephrine (mean 0.5+/-0.45 microg/kg per minute, range 0.08- 2.08). INTERVENTIONS The protocol consisted of two consecutive phases in a fixed order: continuous intravenous infusion of AB 5 microg/kg per minute for 30 min, and continuous intravenous infusion of AB 16 microg/kg per minute for 30 min. MEASUREMENTS AND MAIN RESULTS AB 5 microg/kg per minute significantly increased PaO2/FiO2 ( P<0.05) compared with iNO alone [160 (range 77-450) mmHg vs 122 (range 70-225) mmHg]. AB 16 microg/kg per minute produced a greater increase of PaO2/FiO2 ( P<0.05) when compared with 5 microg/kg per minute [227 (range 84-501) mmHg]. AB did not improve shunt at any dose regimen. AB produced an increase in mean pulmonary arterial pressure (MPAP) from 22+/-5 to 25+/-4 mmHg ( P<0.03). MPAP did not significantly increase between the two doses. Pulmonary vascular resistances and other haemodynamic and respiratory parameters were not affected by almitrine bismesylate. CONCLUSIONS These results suggest that it is possible to obtain a further improvement in oxygenation by increasing AB infusion rate in ARDS patients iNO responders receiving norepinephrine. Due to the potential deleterious effects of AB, this strategy should be used in the most severely hypoxaemic patients.
Collapse
|
30
|
Is a short trial of prone positioning sufficient to predict the improvement in oxygenation in patients with acute respiratory distress syndrome? Intensive Care Med 2001; 27:1044-9. [PMID: 11497137 DOI: 10.1007/s001340000799] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine whether a 1-h trial of prone positioning is sufficient to identify responders. DESIGN Prospective clinical cohort study in a medico-surgical ICU in a teaching hospital. PATIENTS 49 patients with acute respiratory distress syndrome. INTERVENTIONS A 6-h period of prone positioning. MEASUREMENTS AND RESULTS Baseline measurements (blood gas analysis and respiratory parameters) were evaluated in supine position just prior to turning the patients prone. Measurements were then repeated 1 h after the beginning of prone positioning (PP1h) and at the end of the 6-h period of prone positioning (PP6h). The last measurements were performed 1 h after repositioning the patients supine. Prone position induced an increase in the PaO2/FIO2 ratio (p < 0.001). A response (increase in PaO2/FIO2 ratio of at least 20 % at PP1h and/or at PP6h) was observed in 37 of 49 patients (76%). Twenty-seven of these patients (73%) were responders at PP1h while 10 (27%) were responders only at PP6h- In all, two-thirds of the patients were considered persistent responders. However, whereas the PaO2/FIO2 ratio decreased significantly 1 h after repositioning the fast responders supine, the PaO2/ FIO2 ratio remained unchanged after repositioning slow responders. CONCLUSIONS A short-term trial of prone positioning does not appear a sufficient method to identify patients who would benefit from the postural treatment.
Collapse
|
31
|
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) has been implicitly accused of increasing mortality. However, it is not certain that pneumonia is responsible for death or whether fatal outcome is caused by other risk factors for death that exist before the onset of pneumonia. The aim of this study was to evaluate the attributable mortality caused by VAP by performing a matched-paired, case-control study between patients who died and patients who were discharged from the intensive care unit after more than 48 h of mechanical ventilation. METHODS During the study period, 135 consecutive deaths were included in the case group. Case-control matching criteria were as follows: (1) diagnosis on admission that corresponded to 1 of 11 predefined diagnostic groups; (2) age difference within 10 yr; (3) sex; (4) admission within 1 yr; (5) APACHE II score within 7 points; (6) ventilation of control patients for at least as long as the cases. Precise clinical, radiologic, and microbiologic definitions were used to identify VAP. RESULTS Analysis was performed on 108 pairs that were matched with 91% of success. There were 39 patients (36.1%) who developed VAP in each group. Multivariate analysis showed that renal failure, bone marrow failure, and treatment with corticosteroids but not VAP were independent risk factors for death. There was no difference observed between cases and controls concerning the clinical and microbiologic diagnostic criteria for pneumonia. CONCLUSION Ventilator-associated pneumonia does not appear to be an independent risk factor for death.
Collapse
|
32
|
Abstract
The aim of this study was to assess the accuracy of protected telescoping catheter performed using: 1) protected distal aspiration, or 2) protected mini-bronchoalveolar lavage for the diagnosis of ventilator-associated bacterial pneumonia. Twenty-seven patients who died after receiving mechanical ventilation for at least 72 h were included in a comparative prospective post-mortem study. The two microbiological sampling procedures were performed immediately after death. Surgical pneumonectomies and biopsies were performed within 30 min of death at the bedside for histological examination. The results of the two techniques were compared with histological post-mortem lung examination or biopsies. Histological examination of the parenchyma showed signs of pneumonia in 14 cases. Lung tissue culture was positive in nine of these 14 cases. When ventilator-associated bacterial pneumonia was defined by the association of histological signs and positive lung tissue culture the sensitivity was 78% for both sampling techniques, specificity was 86% for mini-bronchoalveolar lavage and 100% for protected distal aspiration (at a threshold of 1 x 10(3) cfu x mL(-1)). Both techniques protected the distal aspiration and mini-bronchoalveolar lavage, and provided good specificity with an acceptable sensitivity for the diagnosis of ventilator-associated bacterial pneumonia.
Collapse
|
33
|
Abstract
In vitro, halogenated agents reduce the pulmonary vasoconstrictor response to alveolar hypoxia in isolated perfused lungs. However, studies in intact animals have been less convincing. The aim of the present study was to assess the effect of sevoflurane on hypoxic pulmonary vasoconstriction (HPV) in anaesthetized piglets using the pressure/cardiac index relationship (P/Q). Ten large white piglets were anaesthetized and mechanically ventilated, alternately in hyperoxia (FIO2 = 0.4) and hypoxia (FIO2 = 0.12). Multipoint plots of pulmonary arterial pressure (PAP) or differences between PAP and left atrial pressure (LAP) against Q were generated by gradual inflation of a balloon introduced into the inferior vena cava. P/Q relationships were established in hyperoxia and hypoxia at baseline, and then with sevoflurane. In hypoxia, pressure gradients (PAP-LAP) increased at every level of Q, thus demonstrating active pulmonary vasoconstriction. Sevoflurane at 1 MAC did not affect these P/Q relationships in hyperoxia or hypoxia as compared with baseline. Sevoflurane at a clinically relevant concentration (1 MAC) has no significant effect on HPV in anaesthetized piglets.
Collapse
|
34
|
Inhaled NO and almitrine bismesylate in patients with acute respiratory distress syndrome: effect of noradrenalin. Eur Respir J 1999; 14:1283-9. [PMID: 10624756 DOI: 10.1183/09031936.99.14612839] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The combination of inhaled nitric oxide with almitrine bismesylate has been proposed for the management of acute respiratory distress syndrome in order to divert pulmonary blood flow away from poorly ventilated toward well-ventilated areas. The aims of this prospective and comparative study were to: 1) confirm the beneficial effects on oxygenation of this association; 2) evaluate the haemodynamic effects of this association; and 3) evaluate the influence of noradrenaline (a nonspecific vasoconstrictor) on the modification of gas exchange related to inhaled NO and/or almitrine bismesylate. Forty-one sedated paralysed and ventilated patients were investigated. Haemodynamic and blood gas measurements were performed in a fixed order: baseline; inhalation of NO for 30 min.; intravenous infusion of almitrine bismesylate; and concomitant administration of inhaled NO and almitrine bismesylate. Inhaled NO and almitrine bismesylate increased arterial oxygen tension (Pa,O2)/inspiratory oxygen fraction (FI,O2) (p<0.001). The association of inhaled NO with almitrine bismesylate resulted in a dramatic improvement in Pa,O2/FI,O2 (p<0.0001 versus almitrine bismesylate, p<0.05 versus inhaled NO). In patients receiving noradrenalin (n = 19), almitrine bismesylate had no effect on oxygenation. The present study confirmed that the combination of inhaled NO with almitrine bismesylate improved oxygenation, and demonstrated that almitrine bismesylate has no effect on oxygenation in patients receiving noradrenalin.
Collapse
|
35
|
[A scale of perioperative satisfaction for anesthesia. II--Preliminary results]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1999; 18:858-65. [PMID: 10575501 DOI: 10.1016/s0750-7658(00)88193-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To assess the patient's experience of anaesthesia in the early postoperative period, with a self-completed questionnaire (Evan). STUDY DESIGN Descriptive and evaluative study. PATIENTS The study included 742 adults undergoing an elective surgical or non surgical procedure under anaesthesia. METHODS An Evan questionnaire with 25 questions was completed 24 hours after anaesthesia by the patient. The questionnaire explored six areas, each one being marked out from 0 to 100, as the visual analogue scale. The marks were compared with consideration of age, gender, ASA physical class, type of anaesthesia, anaesthesia duration and type of surgery. RESULTS The mean global mark was 76 +/- 9 (min-max: 34-99). Marks were lower in the youngest patients, in females, in ASA 1 patients, in longest surgical procedures, especially with regard to areas belonging to "apprehension", "pain-discomfort" and "physical needs". The lowest mark was given for the "information" provided during the pre-anaesthetic evaluation. Differences in marks occurred also between surgical specialities. CONCLUSION The Evan questionnaire is a valuable tool for assessing the patient's opinion on the perioperative period. Further studies are required to extend its use to other fields, as ambulatory surgery.
Collapse
|
36
|
[A scale of perioperative satisfaction for anesthesia. I--Construction and validation]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1999; 18:848-57. [PMID: 10575500 DOI: 10.1016/s0750-7658(00)88192-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To develop and to validate a scale assessing perioperative patient's satisfaction with anaesthesia (Evan). STUDY DESIGN Descriptive and evaluative study. PATIENTS The study included 742 adults undergoing a surgical or a diagnostic procedure under general anaesthesia. Emergency, ambulatory and obstetrical cases were excluded. METHODS A multidisciplinary working party produced 85 questions focusing on various pertinent areas describing satisfaction. After a validation, 25 out of them were selected for the questionnaire. The latter was completed within the 24 hours following anaesthesia by 742 inpatients. RESULTS Item analysis showed a homogeneous distribution of the answers to each item. Main component analysis allowed to explain 53% of total variance. Six dimensions were isolated by the exploratory analysis: anxiety, embarrassment, fear, pain-discomfort, information and physical needs. Scoring method followed a simple additive model: for each dimension, the scale scored 0-100. The global score represented the sum of the six dimensions also scored 0-100. Acceptability of Evan questionnaire was satisfactory, with a spontaneous non response rate of less than 1% and a completion duration at 11 +/- 8 min. CONCLUSION A self-completed questionnaire on patient's satisfaction with anaesthetic period was validated, allowing a global and multidimensional assessment of patient's satisfaction.
Collapse
|
37
|
Abstract
It has been suggested that the increase in PO(2) observed with nitric oxide (NO) should be enhanced by the addition of a vasoconstrictor agent. The vasoconstrictor used in combination with NO should mimic or enhance hypoxic vasoconstriction. The aim of this study was to evaluate the respiratory and hemodynamic effects of norepinephrine (a nonspecific vasoconstrictor), almitrine bismesylate (a specific pulmonary vasoconstrictor), and inhaled NO, alone or together. During a 6-mo period, 16 patients presenting with ARDS were prospectively investigated. On inclusion, no patient was receiving cardiovasoactive drugs. The protocol consisted of seven consecutive phases: baseline, norepinephrine (in order to obtain a 3 mm Hg rise in mean pulmonary arterial pressure [Ppa]), almitrine bismesylate (16 micrograms/kg/min), inhaled NO (20 ppm delivered during inspiration), norepinephrine + inhaled NO, almitrine bismesylate + inhaled NO, almitrine bismesylate + norepinephrine + inhaled NO. General factorial analysis of variance showed that inhaled NO and almitrine bismesylate increased oxygenation (p < 0.0001). Norepinephrine had no effect on oxygenation. A synergistic effect between inhaled NO and almitrine bismesylate was found (p < 0.05), whereas norepinephrine did not affect the response to inhaled NO. Nitric oxide produced a significant decrease in Ppa and pulmonary vascular resistances (PVRI) (p < 0.0001). Both almitrine bismesylate and norepinephrine induced an increase in Ppa (p < 0.0001). Norepinephrine increased PVRI (p < 0.002), whereas almitrine bismesylate had no effect on PVRI. The present results support the hypothesis that a selective pulmonary vasoconstrictor enhances the increase in oxygenation induced by inhaled NO, whereas norepinephrine attenuates this effect.
Collapse
|
38
|
Does norepinephrine modify the effects of inhaled nitric oxide in septic patients with acute respiratory distress syndrome? Anesthesiology 1998; 89:1089-98. [PMID: 9821996 DOI: 10.1097/00000542-199811000-00008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Hypoxia-related pulmonary vasoconstriction enhanced by norepinephrine could be deleterious in patients with the acute respiratory distress syndrome (ARDS) and sepsis. A prospective study compared the effects of nitric oxide on cardiorespiratory parameters, including the evaluation of right ventricular function in patients with ARDS and sepsis who were receiving or not receiving norepinephrine. METHODS During a 15-month period, 27 patients with ARDS and sepsis were prospectively investigated (group 1: 15 patients not receiving norepinephrine; group 2: 12 patients receiving norepinephrine). Right ventricular ejection fraction was measured by thermodilution. After baseline measurements, nitric oxide was administered at increasing inspiratory concentrations. RESULTS The ratio of oxygen tension in arterial blood to the fractional concentration of oxygen in inspired gas increased in the two groups. After logarithmic transformation of the data, an analysis of variance was performed that did not show any difference between the two groups. A dose-dependent decrease in mean pulmonary arterial pressure was observed in the two groups. This decrease and the increase in right ventricular ejection fraction induced by inhaled nitric oxide were more marked when patients received norepinephrine (P < 0.0001). CONCLUSION Norepinephrine did not influence the beneficial effects of inhaled nitric oxide administered to patients with ARDS and sepsis on oxygenation.
Collapse
|
39
|
[Incidence of myocardial lesions after vascular surgery: diagnosis by troponin Ic]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1998; 16:950-4. [PMID: 9750643 DOI: 10.1016/s0750-7658(97)82143-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the incidence of myocardial damages diagnosed following vascular surgery using the cardiac troponin I measurement technique and conventional methods. STUDY DESIGN Prospective epidemiological study. PATIENTS Fifty-four patients who underwent surgery for either aneurysmal disease in 28 cases or occlusive aortic disease in 26 cases. METHODS Plasma concentration of cardiac troponin I (significant at a concentration > 1.5 ng.mL-1) was measured by immunoenzymofluorimetry on the second and fifth postoperative days. Conventional monitoring methods included daily electrocardiogram (ECG), enzymatic assay of total-PCK, and measurement of plasma levels of the MB isoenzyme of phosphokinase creatine (MB-PCK) (significant at > 1 ng.mL-1 and RI > 1.5). RESULTS The cardiac troponin I measurement technique allowed the diagnosis of minor myocardial damages during the postoperative period in five patients, whereas with the conventional methods (clinical signs. ECG, and MB-PCK) only three myocardial lesions were diagnosed. CONCLUSION The cardiac troponin I measurement technique allows diagnosis of minor myocardial damages following vascular surgery. Conventional methods underestimate the incidence of these damages.
Collapse
|
40
|
Abstract
BACKGROUND It has been suggested that fibrosis present during the fibroproliferative phase of acute respiratory distress syndrome (ARDS) can be treated by corticosteroids. However, neither clinical nor microbiologic criteria permit differentiation of this fibroproliferative phase from a nosocomial pneumonia. The aim of this observational case series was to evaluate the safety and utility of open-lung biopsy (OLB) performed in patients receiving ventilatory support who had persistent ARDS despite negative bacterial cultures. METHODS During a 4-yr period, 37 OLBs were performed in 36 of 197 patients receiving ventilatory support who had ARDS. The severity of ARDS was assessed by a lung injury score of 3.1 +/- 0.4 (mean +/- SD) and a median ratio of the partial pressure of oxygen (PaO2) to the fraction of inspired oxygen (FiO2) of 118 mmHg. Histologic examination; bacterial, fungal, and acid-fast staining; and cultures of the tissue sample were performed. RESULTS Fibrosis was present in only 41% of the lung specimens obtained by OLB. Only six patients received corticosteroids (17%). In 9 of the 15 patients with fibrosis, cytomegalovirus pneumonia precluded the use of corticosteroids. Histologic cytomegalovirus pneumonia was diagnosed in 18 cases. Histologic bacterial or mycobacterial pneumonia was diagnosed in five cases. No significant change in arterial blood gases was noted as linked to the biopsy procedure except an increase of the PaO2/FiO2 ratio. One pneumothorax was diagnosed on a chest roentgenogram 12 h after OLB. Only one patient required blood transfusion during the 48-h period after OLB (for an hemothorax). Five patients had moderate air leaks from operative chest tubes for 2-10 days. CONCLUSIONS Open lung biopsy appeared to be a useful and acceptably safe diagnostic technique in patients with ARDS. It permitted the diagnosis of unexpected cytomegalovirus pneumonia.
Collapse
|
41
|
Respective and combined effects of prone position and inhaled nitric oxide in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 1998; 157:580-5. [PMID: 9476876 DOI: 10.1164/ajrccm.157.2.9705046] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Inhaled nitric oxide (NO) and prone position (PP) are two of the new therapeutics proposed in the setting of acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate the hemodynamic and respiratory effects of NO and prone position in patients with ARDS. Fourteen patients, sedated, paralyzed, and ventilated using volume-control mode, were prospectively investigated. All patients had a radial artery catheter, a pulmonary artery catheter, and a 3-F fiberoptic thermistor catheter advanced via the femoral artery into the descending aorta. The protocol consisted of seven phases: baseline measurements in supine position, SP (T0); SP + NO (T1); baseline 2 in SP (T2); PP without NO (T3); NO + PP (T4); SP + NO (T5); and PP + NO (T6). Inhaled NO (T1) induced an increase in PO2/FI(O2) (from 128 +/- 44 to 180 +/- 75 mm Hg, p < 0.004). Prone position (T3) resulted in an increase in PO2/FI(O2) (193 +/- 83 mm Hg, p < 0.003 versus T0). The association of NO with PP (T4) resulted in a significant improvement in PO2/FI(O2) (261 +/- 98 mm Hg) when compared with T0, T1, and T3. Analysis of variance showed a significant and additive effect of NO and PP on both PO2/FI(O2) (p < 0.000) and shunt fraction (QS/QT) (p < 0.01). Since the association of NO with PP presents additive effects on oxygenation, this association can be proposed for the treatment of ARDS.
Collapse
|
42
|
[Effects of intravenous immunoglobulins in thrombopenia related to septic shock]. Presse Med 1997; 26:945-50. [PMID: 9238177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Intravenous immunoglobulins have been shown to be effective in the treatment of immunologically mediated thrombocytopenia. Several articles have been published on the positive effect of immunoglobulins in sepsis-related death. We retrospectively studied the effects of intravenous immunoglobulins used during septic shock thrombocytopenia over a 5-year period in a polyvalent intensive care unit. PATIENTS AND METHODS Inclusion criteria were development of acute thrombocytopenia under 75 G/l during septic shock, excluding all cases of disseminated intravascular coagulation. Thirty-five patients were included in the study; 18 were given polyvalent intravenous immunoglobulins (group IgIV) and 17 were not (controls). The two groups were comparable for SAPS and APACHE II gravity scores at admission and at day 0 (first day of septic shock with platelet count under 75 G/l), age, sex, platelet count at admission, OSF score, type of referral unit, McCabe score, and the presence of 4 parameters which might affect platelet count hemofiltration, ARDS, surgery, Swan-Ganz catheter. RESULTS Platelet counts increased on day 8 in the treatment group (63.5 G/l, range 25-453 versus 105.7 G/l, range 38-355; p = 0.0505). The number of days with thrombocytopenia was the same in both groups. Overall mortality was high (60%) but there was a difference between the two groups in favor of the treated group (74.7% versus 44.4%; p = 0.053). The number of red cell units (214 vs. 164) and plasma units (175 vs. 54) transfused was higher in the control group. Platelet transfusion was equivalent in the two groups. DISCUSSION Although we were unable to demonstrate a significant difference in the effects of immunoglobulins on platelet level and mortality, the trend during this evaluation was comparable with that reported in the literature. For transfusion, and although the results were not significant, a notion of reduced risk was evident. Prospective trials are needed to confirm these observations.
Collapse
|
43
|
Abstract
We used the technique of random amplification of polymorphic DNA (RAPD) to type 130 isolates of Stenotrophomonas (Xanthomonas) maltophilia, using four arbitrary short primers. Of the 130 isolates, 51 were from the hospital environment, 48 from clinical specimens and 31 were geographically diverse environmental isolates. DNA amplification with the four sets of primers generated 112 RAPD patterns that differed by two or more bands in one of the four primers. Sixteen pairs of isolates were of the same RAPD pattern and some of these pairs represented clinical strains obtained from patients hospitalized at the same time in the same ward. In three patients, two to three strains of S. maltophilia which gave different RAPD fingerprints were isolated on the same day from different specimens. RAPD fingerprinting demonstrated great genomic diversity within the species S. maltophilia and provided an effective method for the study of the epidemiology of both clinical and environmental strains.
Collapse
|
44
|
[Comparison of extrapleural and intrapleural analgesia with bupivacaine after thoracotomy]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1995; 14:249-55. [PMID: 7486293 DOI: 10.1016/s0750-7658(95)80002-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare the analgesic and the ventilatory effects as well as blood concentrations of bupivacaine, administered either in the extrapleural or interpleural space after posterolateral thoracotomy. STUDY DESIGN Randomized clinical trial. PATIENTS Twenty ASA class I and II patients, scheduled for elective thoracic surgery were randomly allocated either in the IP group (catheter inserted into the interpleural space) or the EP group (catheter inserted in extrapleural position, paravertebrally above the posterior parietal pleura). METHODS In the catheter, inserted at the Th4 level at the end of the surgical procedure, 20 mL of 0.5% bupivacaine were injected after full recovery from anaesthesia, with the thoracic drains clamped for 30 min. The injection was repeated every six hours. Pain was evaluated after a deep inspiration with a visual analog scale (VAS), before and 1.3 and 6 hours after the injection. Analgesia was considered as effective if the VAS score at the end of the first hour was less than 30 mm. Otherwise 0.1 mg.kg-1 of morphine was administered subcutaneously. The forced vital capacity (FVC) and the forced expiratory volume one second (FEV1) were measured preoperatively and on 1st (D1) and 2nd postoperative Day (D2). Blood samples for measurements of plasma bupivacaine concentrations were obtained at 5, 10, 20, 30, 60, 90, 120, 150, 180 and 250 min respectively after the first injection. RESULTS Bupivacaine provided a more rapid, deep and prolonged analgesia by extrapleural than by interpleural route. Analgesia was effective in 9 patients in EP group vs 4 patients in IP group (P < 0.05). Morphine requirements were 4 +/- 8 mg in EP group vs 17 +/- 10 mg in the IP group (P < 0.05). The FVC and FEV1 values were similarly decreased on D1, but recovery was better in EP group on D2 (P < 0.05). Bupivacaine peak concentrations in plasma were lower in EP group (0.86 +/- 0.42 microgram.mL-1) than in IP group (1.63 +/- 1.44 micrograms.mL-1), however the difference was not significant. CONCLUSIONS Extrapleural administration of bupivacaine provides better analgesia as the anaesthetic agent comes in closer contact with intercostal nerves and with lower risk of loss of agent through the pleural drainage. Therefore its use is recommended preferentially over the interpleural route for analgesia after posterolateral thoracotomy.
Collapse
|
45
|
[Tracheobronchial healing after lung and heart-lung transplantations. Apropos of 64 anastomoses]. Ann Cardiol Angeiol (Paris) 1994; 43:380-3. [PMID: 7993031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The authors report an analysis concerning the healing of tracheo-bronchial anastomoses after lung- and heart-lung transplantation. The present study includes 64 anastomoses selected from a total of 80 cases. Sixteen had to be excluded because of early post-operative death; none of these deaths was related to an air-way complication. Bronchial healing was assessed by bronchoscopic follow-up; the appearance of the suture-line was classified according to Couraud's grades. The initial reference was the examination at 2 weeks, which was compared to subsequent follow-up. At the initial assessment, 42 anastomoses were grade 1, 4 were grade II, and 18 were grade III. The subsequent anatomic result was satisfactory for 52 sutures (81%). The complications were malacia in 2 cases, stenoses treated with a stenting device in 4 cases, dehiscence in 6 cases. The duration of ischemia and postoperative mechanical respiratory support, as well as the proximal or distal site of the anastomosis appeared to be of significant prognostic value.
Collapse
|
46
|
[Bronchial cancer associated with atheromatous arteriopathy. Prognostic and therapeutic consequences in pulmonary excision]. Presse Med 1992; 21:1507-12. [PMID: 1465372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Between January 1980 and January 1985, 462 consecutive patients underwent lung resection for bronchogenic carcinoma. Eighty of these patients (17.3 percent) had atherosclerosis involving mainly the coronary arteries (40 percent). The mortality rate was significantly higher in patients with atherosclerosis (10 percent) than in those without it (4.7 percent), but the long-term survival was not affected with the presence of atherosclerosis. The lung carcinoma-atherosclerosis association raises two problems: what investigations should be carried out in this group of patients at risk, and what treatment should be given priority when vascular lesions are present and likely to become complicated by pulmonary surgery? However, the presence of atherosclerosis should not lead to a re-evaluation of the need for lung resection.
Collapse
|
47
|
Abstract
Gastric contents regurgitation into the oesophagus during induction of anaesthesia may easily fail to be recognized. The incidence of this complication was investigated in 59 consecutive patients. They were scheduled for elective thoracic surgery. Anaesthesia was induced with thiopentone (6 mg.kg-1), fentanyl (3 micrograms.kg-1), and either atracurium (0.4 mg.kg-1), vecuronium (0.1 mg.kg-1) or suxamethonium (1.5 mg.kg-1). Oesophageal pH was monitored with an oesophageal pH probe, connected to a portable computer. The pH probe had a virtually instantaneous response time and was positioned in the lower oesophagus. Acid reflux was defined as a decrease in pH to less than 4.0. During the course of induction, three patients (5%) presented an episode of acid reflux. No patient presented any clinical or radiological signs of pulmonary aspiration. This study suggests that monitoring oesophageal pH is a simple method of detecting gastric reflux during the period of induction.
Collapse
|
48
|
Monitoring of central venous oxygen saturation versus mixed venous oxygen saturation in critically ill patients. Intensive Care Med 1992; 18:101-4. [PMID: 1613187 DOI: 10.1007/bf01705041] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Continuous monitoring of mixed venous (SvO2) and central venous (ScO2) oxygen saturation was compared in 7 critically-ill patients (Apache II score: 19 +/- 2.1) to determine whether or not information derived from ScO2 were reliable in clinical practice. Patients were catheterized with both a pulmonary artery (PA) and a central venous (CV) catheter, each of them mounted with fiberoptic sensors (Opticath PA Catheter P7110 and Opticath CV Catheter U440, Abbott). A total of 580 comparative measurements were obtained during periods without and with therapeutic interventions (drug-titration, bronchial suction, use of PEEP, changes in FiO2 ...). The systematic error between the 2 measurement techniques was 0.6% and 0.3% in periods with and without therapeutic interventions, respectively. The variability between the 2 techniques was 10% for both periods. Differences between the values were greater than or equal to 5% in 49% of values during periods of stability and in 50% of values during periods with therapeutic interventions. There were poor correlations between the values during periods without (r = 0.48) and with therapeutic interventions (r = 0.62). Better, but still less than ideal, correlations were obtained with changes in SvO2 and ScO2 during periods without (r = 0.70) and with therapeutic interventions (r = 0.77). Although there is a need to develop a simple technique to monitor mixed venous oxygen saturation, the present study indicates that ScO2 monitoring was not reliable in the study patients.
Collapse
|
49
|
|
50
|
Anesthesia and critical care in surgical management of acute aortic dissections. JOURNAL OF CARDIOTHORACIC ANESTHESIA 1989; 3:51. [PMID: 2520989 DOI: 10.1016/0888-6296(89)90794-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|