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Biomedical subjects

A Cuvelier

Publications and source records attributed to A Cuvelier.

At least 19 recordsLinked to original sources
PubMed2006

[Lesional pulmonary oedema following laparoscopy for haemorrhage: aetiological assessment and possible gas embolism].

A 44-year-old woman had to undergo repeat laparoscopy, four hours after laparoscopic sigmoidectomy, because of persistent bleeding from the drain. The bleeding caused perioperative shock and necessitated transfusional support. The following day she developed dyspnea, revealing pulmonary oedema. As her respiratory status continued to deteriorate and the bleeding persisted, she was transferred to the intensive care unit on day 2, after corrective laparotomy. The echocardiogram ruled out cardiogenic pulmonary oedema. No inhalation had occurred during the three anaesthetic procedures, and onset several hours after transfusion argued against lesional pulmonary oedema secondary to packed red cell transfusion. Given the context of repeat surgery by laparoscopy because of active bleeding, a diagnosis of lesional pulmonary oedema complicating CO(2) embolism was made. She received symptomatic treatment and her respiratory status gradually improved. Four months later her clinical status was normal. The different causes of postoperative pulmonary oedema and the pathophysiologic mechanisms of pulmonary lesions induced by gas embolism are discussed.

Adult↗
PubMed2005

[Domiciliary ventilation in patients with COPD].

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) has become one of the main indications for domiciliary ventilation, which is usually non-invasive (NIV). This review focuses on the pathophysiology processes and clinical trial data that underlie current guidelines from international societies. STATE OF THE ART: To date most published studies about domiciliary ventilation in COPD have been short-term and their message is complicated by the presence of significant methodological problems. The two controlled studies of > or =12 months-duration both found that survival was not improved by long-term NIV. Domiciliary ventilation may be considered when long-term oxygen therapy is unsuccessful and when failed with a progressive deterioration in clinical respiratory status with recurrent episodes of acute hypercapnic respiratory failure. A diurnal PaCO(2) > or =55 mmHg (7.3 kPa) is a necessary but not sufficient condition to consider domiciliary ventilation. CONCLUSION: Domiciliary ventilation should only be initiated in selected patients on the basis of clinical symptoms and exacerbation frequency. Until further characterization of patients who are likely to respond, the response to treatment should be assessed regularly.

Clinical Trials as Topic↗
PubMed2005

Dependency on mask ventilation after acute respiratory failure in the intermediate care unit.

The predictive factors for long-term dependency (LTD) on noninvasive ventilation (NIV) immediately after acute hypercapnic respiratory failure (AHRF) have not been identified. The present authors studied 42 patients with chronic obstructive pulmonary disease (COPD) and 58 non-COPD patients successfully treated by NIV for an AHRF episode. Parameters at stable state, at admission for AHRF and during a 1-yr follow-up were compared in patients with or without LTD-NIV at discharge. The incidence of LTD-NIV was 39% in non-COPD patients and 19% in COPD patients. Based on multivariate analysis with stepwise logistic regression, lower baseline pH values and noninfectious causes of AHRF were independently associated with LTD-NIV. Mutually adjusted odds ratios were found to be 1.316 (95% confidence interval (CI) = 1.127-1.536) for a 0.01 decrease of baseline pH value and 5.1 (95% CI = 1.8-14.0) for a noninfectious cause of AHRF. Outcome after 1 yr was poor in COPD patients. Long-term dependency on noninvasive ventilation is not an uncommon situation after resolution of an acute hypercapnic respiratory failure episode, especially in patients with non-chronic obstructive pulmonary disease causes of respiratory failure. The present study raises the need for prospective validation of a weaning protocol in patients managed by noninvasive ventilation for an acute hypercapnic respiratory failure episode.

Acute Disease↗
PubMed2004

FEV1 reversibility does not adequately predict effect of formoterol via Aerolizer in chronic obstructive pulmonary disease.

Evaluation of patients with chronic obstructive pulmonary disease (COPD) often includes the use of post-bronchodilator reversibility testing to guide treatment decisions. Recommendations for reversibility testing differ and there is no universally accepted method or outcome criterion. A survey of recent clinical trials with beta2-agonists in COPD illustrates the diversity of methods used to assess reversibility and highlights the difficulty of comparing data from such trials. Two recent studies demonstrated the benefits of treatment with the long-acting beta2-agonist bronchodilator formoterol (Foradil Aerolizer) in patients with COPD. When patients were classified according to their degree of reversibility as partially or poorly reversible, improvements were observed in both groups irrespective of the definition applied. These results suggest that bronchodilator reversibility testing should not be used as a rigid basis for treatment decisions with beta2-agonists in COPD patients. There is a pressing need for the role of reversibility testing to be clearly defined.

Administration, Inhalation↗
PubMed2004

[Non-invasive ventilation of elderly patients in the intensive care unit].

INTRODUCTION: An increasing number of elderly patients, with acute respiratory failure (ARF) due to e.g. COPD exacerbation or cardiac failure, are being referred to intensive care units for mechanical ventilation. STATE OF ART: NIV can be an effective ventilatory technique in ARF due to a variety of aetiologies. NIV has been shown to decrease endotracheal intubation rates, complication rates and median hospital length of stay. When managing acute-on-chronic respiratory failure, NIV is a first-line ventilatory technique, in the absence of criteria for immediate endotracheal intubation. The efficacy of NIV depends on the expertise of the medical and nursing staff (including physiotherapists) and should always be performed in an appropriate setting. There are very few data about NIV in the elderly but studies, which included patients over 75 years, did not identify different outcomes for this age group. PERSPECTIVES: Future clinical studies on NIV should allow us to better understand which patients will benefit the most from the technique. Certain specific settings in elderly populations, such as in palliative care or when an "non intubation order" has been given by the patient, his family or the medical/nursing staff, are under evaluation. CONCLUSIONS: NIV is effective and well tolerated and it has become a key ventilatory technique in the management of ARF, particularly for elderly patients.

Acute Disease↗
PubMed2003

[Instrumental treatment of chronic obstructive bronchopneumonia. The place of non-invasive ventilation].

OF DEBATABLE INTEREST: Although the place of non-invasive ventilation (NIV) is indisputable in the management of acute respiratory failure during chronic obstructive pulmonary disease (COPD), where it significantly reduces the rate of intubation and complications and the number of days spent in intensive care, its interest is debated in the long term management of chronic obstructive respiratory failure (CORF). EFFICACY TO BE DEMONSTRATED: Although several short term studies confirm the efficacy of NIV on some physiological parameters and on the quality of sleep and quality of life in some patients, long term prospective studies are still too few and do not confirm these data on small series of patients and limited time. FOR CERTAIN CATEGORIES OF PATIENTS: It is legitimous to consider that sub-groups of patients respond to NIV, notably in cases of instable CORF non-controlled by medical treatments or by well-conducted kinesitherapy and oxygentherapy.

Bronchopneumonia↗
PubMed2003

[Non-invasive ventilation of elderly patients in the intensive care unit].

INTRODUCTION: An increasing number of elderly patients, with acute respiratory failure (ARF) due to e.g. COPD exacerbation or cardiac failure, are being referred to intensive care units for mechanical ventilation. STATE OF ART: NIV can be an effective ventilatory technique in ARF due to a variety of aetiologies. NIV has been shown to decrease endotracheal intubation rates, complication rates and median hospital length of stay. When managing acute-on-chronic respiratory failure, NIV is a first-line ventilatory technique, in the absence of criteria for immediate endotracheal intubation. The efficacy of NIV depends on the expertise of the medical and nursing staff (including physiotherapists) and should always be performed in an appropriate setting. There are very few data about NIV in the elderly but studies, which included patients over 75 years, did not identify different outcomes for this age group. PERSPECTIVES: Future clinical studies on NIV should allow us to better understand which patients will benefit the most from the technique. Certain specific settings in elderly populations, such as in palliative care or when an "non intubation order" has been given by the patient, his family or the medical/nursing staff, are under evaluation. CONCLUSIONS: NIV is effective and well tolerated and it has become a key ventilatory technique in the management of ARF, particularly for elderly patients.

Acute Disease↗
PubMed2002

Nutritional depletion in patients on long-term oxygen therapy and/or home mechanical ventilation.

The purpose of this study was to estimate the prevalence of malnutrition in outpatients on long-term oxygen therapy or home mechanical ventilation, to determine the relationships between malnutrition and impairment/disability and smoking and also to identify relevant tools for routine nutritional assessment. In 744 patients (M:F 1.68, aged 65+/-15 yrs) with chronic obstructive pulmonary disease (COPD, 40%), restrictive disorders (27%), mixed respiratory failure (15%), neuromuscular diseases (13%) and bronchiectasis (5%), body mass index (BMI), fat-free mass (FFM), serum albumin, transthyretin, 6-min walking test, forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and blood gases were recorded. FFM was the most sensitive parameter for detecting malnutrition, being abnormal in 53.6% of patients, while BMI was <20 in 23.2%, serum albumin <35 g x L(-1) in 20.7%, and serum transthyretin <200 mg x L(-1) in 20%. FFM depletion predominated in neuromuscular, bronchiectasis and restrictive disorders. BMI and FFM were correlated with FEV1, FVC and 6-min walking test. In multivariate analysis a BMI<20 was related to FEV1 and smoking habits, and a low FFM to smoking, FEV1 and female sex. Malnutrition is highly prevalent in home-assisted respiratory patients and is related to causal disease, forced expiratory volume in one second, smoking and disability. Fat-free mass appeared to be the most sensitive and relevant nutritional parameter according to impairment and disability.

Aged↗
PubMed2002

[Mediastinal teratoma with recurrent encysted pleural effusion].

A 25 year old man with no previous history was admitted for a recurrent right sided encysted pleural effusion. Thoracocentesis revealed an exudative lipase-rich-fluid. Because of the persistence of abundant pleural fluid after several thoracocentesis a diagnostic mediastinotomy was performed. This revealed a necrotic cystic mediastinal tumor composed of well differentiated pancreatic tissue, nervous tissue, digestive and respiratory glands, and a dermoid mass with hair and sebacious glands. This led to a diagnosis of benign, mature mediastinal teratoma. We suggest that the chronic pleural effusion was maintained by a fistula from the tumour into the pleural cavity and the secretion of proteolytic enzymes by the well-differentiated pancreatic tissue.

Adult↗
PubMed2002

[Bilateral pleural thickening pseudo-tumour due to tuberculosis].

The authors report the case of a 20 year old Senegalese woman in whom pulmonary and bone tuberculosis presented as bilateral, lobulated pleural thickening without effusion, associated with a vertebral abscess at D 9-10. The diagnosis was obtained by histological examination of a CT guided pleural biopsy. After 12 months treatment there was complete resolution of the pleural disease. Tuberculous pleural disease is rarely bilateral and such presentation as a pseudo-tumour is very rare in Europe. Anatomically the pleural disease would seem to have been secondary to the vertebral disease as the result of direct spread.

Abscess↗
PubMed2002

[COPD].

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Humans↗