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Biomedical subjects

A Dougnac

Publications and source records attributed to A Dougnac.

At least 19 recordsLinked to original sources
PubMed2001

[Study of cytokines kinetics in severe sepsis and its relationship with mortality and score of organic dysfunction].

BACKGROUND: The Infectious Systemic Inflammatory Response syndrome and multiple organic dysfunction have common physiopathological mechanisms. Multiple organic dysfunction can be assessed using severity scores. AIM: To relate cytokine kinetics with a multiple organic dysfunction score during sepsis. MATERIAL AND METHODS: Tumor necrosis factor alpha (TNF alpha) and interleukin 6 (IL6) kinetics were studied in 25 patients with severe sepsis with less than 48 h of evolution and interleukin 1 beta (IL beta) kinetics was studied in 13 patients. Measurements were made at 0, 12, 24 and 48 hours after admission to the study, using an ELISA technique. These parameters were correlated with the Marshall multiple organic dysfunction score and survival. RESULTS: Mean age of study subjects was 70 years, the APACHE II score was 16.9 +/- 6 and the Marshall score was 6.8 +/- 3.6. Sepsis was of pulmonary origin in 56% of patients and intra abdominal in 32%. Mortality was 36%. TNF alpha increased during the study period (24.1 pg/ml initially and 37.8 pg/ml at 24 hours, with a slight posterior reduction, p < 0.02). These levels had no association with mortality or organic dysfunction. IL6 remained elevated during the first hours and had a tendency to decrease thereafter. Decreased patients had higher values than survivors (306 pg/ml and 55.4 pg/ml respectively, p = 0.011). Its values were tightly correlated with Marshall score, with the number of failing organs, with the presence of shock and with probability of dying during hospitalization. IL1 beta remained low and was not associated with clinical parameters. CONCLUSIONS: There is a tight correlation between the elevation of IL6 and the severity of the Systemic Inflammatory Response and mortality in these patients with sepsis.

APACHE↗
PubMed1999

[Systemic inflammatory response syndrome: is it comparable with severe sepsis?].

BACKGROUND: In 1992, a consensus conference defined the terms systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock. Since then, numerous reports have validated the prognostic usefulness of these operative definitions. AIM: To evaluate if sepsis severity criteria, as defined by the Consensus Conference, can be applied to noninfectious SIRS. PATIENTS AND METHODS: Five hundred eighteen patients admitted to 5 intensive care units (ICU) from 4 hospitals were prospectively evaluated during a 3 months period. Patients that met at least one severity criteria were included. SIRS etiology, organ dysfunction and evolution were recorded in each patient. RESULTS: One hundred two patients were included: 79 with sepsis (group I) and 23 with noninfectious SIRS (group II). ICU and hospital mortality were comparable (43 and 48% in sepsis compared to 43 and 51% in non infectious SIRS). The most common sources of sepsis were pneumonia and peritonitis. Group II patients had a wide variety of diseases. ICU stay, APACHE score and number of organs with dysfunction were not different among groups. Only the incidence of renal dysfunction was higher in the septic group. CONCLUSIONS: The Consensus sepsis severity criteria can be applied to noninfectious SIRS, defining a population subset with similar high mortality and organ dysfunction incidence, although with greatly heterogeneous etiologies.

APACHE↗
PubMed1998

Use of methylene blue in patients with refractory septic shock: impact on hemodynamics and gas exchange.

PURPOSE: The purpose of this study was to assess the acute effects of methylene blue, an inhibitor of nitric oxide synthesis, on hemodynamics and gas exchange in patients with refractory septic shock in a prospective clinical trial at medical and surgical intensive care units in a tertiary university hospital. PATIENTS AND METHODS: Prospective, sequential study of 10 consecutive patients admitted with severe septic shock of diverse causes and unable to achieve an adequate arterial pressure despite the use of at least two vasoactive drugs. Six of them also developed acute lung injury. All received 1 mg/kg intravenous bolus of methylene blue. Hemodynamic and respiratory parameters were measured at baseline and at 30, 60, 120, and 180 minutes after the bolus injection. RESULTS: Systolic, diastolic, mean arterial blood pressure, and systemic vascular resistance increased significantly in all patients, whereas no significant changes were observed in cardiac output, oxygen consumption, or oxygen extraction ratio. Gas exchange remained unaffected in patients with acute lung injury. CONCLUSIONS: Methylene blue had an acute vasopressor effect in patients with refractory septic shock, and it was not deleterious on respiratory function.

Adult↗
PubMed1997

[Malignant neuroleptic syndrome, medical-psychiatric approach].

We report the case of a 42 years old male, with a bipolar disorder and receiving lithium therapy, valproic acid and clonazepam. Due to an exacerbation of his underlying disease, he was admitted to a psychiatric clinic and received 50 mg of intramuscular chlorpromazine in two occasions. Afterwards, the patient had an alteration of consciousness, fever reaching 39 degrees C and generalized muscular rigidity. Laboratory work-up showed a normal brain CT scan, a diffuse slowness in the EEG and a creatinphosphokinase that reached values of 3.040 U/l. He was transferred to an intensive care unit and treated with sodium dantrolene and bromocriptine, obtaining a good clinical response.

Adult↗
PubMed1997

[Clinical epidemiologic study of patients admitted to the intensive care unit, according to age].

BACKGROUND: Lately, we have observed an increase in the admission to intensive care units of patients over 65 years old, probably due to the increase in life expectancy that is occurring in Chile. AIM: To compare the frequency of admissions to intensive care units in patients over 65 years old, their diagnoses, their severity and hospital course, with those of younger patients. PATIENTS AND METHODS: The charts of all patients admitted to an intensive care unit of a University Hospital, during one year, were reviewed. The diagnosis that caused the admission was considered the main disease. Severity at the moment of admission was assessed using the Apache score. RESULTS: A total of 777 patients were admitted during the study period. Twenty had to be excluded due to lack of reliable data. Four hundred thirty two (57%) were over 65 years old. Cardiovascular diseases were the main cause of admission in young and old patients. Mortality was 14.8% of patients over 65 years old and 18.7% in younger patients. Main causes of death were cardiac arrest, cardiogenic shock, sepsis and cerebrovascular disease. No differences in causes of death were observed between young and old patients. CONCLUSIONS: Patients older than 65 years old admitted to intensive care units are very similar to their younger counterparts in their prognosis and causes of admission.

Adolescent↗
PubMed1997

[Study of the survival of elderly patients in intensive care units. Should they be admitted to these units?].

BACKGROUND: An important increase in health care costs has occurred lately, determined in part by the expenses of intensive care units. An important proportion of beds in these units are occupied by elders, with high costs and dubious results. AIM: To study the survival of elderly patients in intensive care units to shed light on the question if these patients should be admitted to these facilities. MATERIAL AND METHODS: We retrospectively analyzed the mortality of 443 patients older than 65 years old, admitted to an intensive care unit between 1993 and 1994. The mortality was compared with that of 334 younger patients admitted in the same period. Severity of disease was determined using admission APACHE II score. RESULTS: Older patients had a higher admission APACHE score than younger subjects (18.4 +/- 8.4 and 14.5 +/- 8.7 respectively, p < 0.01). Mortality during the intensive care unit stay was similar in older and younger patients (18.5 and 14.4%, respectively). Hospital mortality was also similar (22.4 and 25.9%, respectively). Older patients had a higher frequency of chronic diseases and degree of functional impairment. Mortality rates for different diseases were also similar in older and younger patients. CONCLUSIONS: Older age was not associated with a higher mortality during intensive care unit stay. Prognosis is determined by the admission severity score and the number of concomitant chronic diseases.

APACHE↗
PubMed1996

[Prolonged inhalation of nitric oxide in adult respiratory distress syndrome in a case].

Inhalation therapy with nitric oxide has been suggested as beneficial in the adult respiratory distress syndrome, however there are few reports of its prolonged use. We report a patient with a chronic lymphocytic leukemia that developed an adult respiratory distress syndrome with severe hypoxemia, refractory to conventional therapeutic measures, during the course of a septic shock. The patient received nitric oxide (19 ppm) improving arterial oxygen saturation and allowing the reduction of FiO2 to 40%. The patient died five days later due to a multiple organ failure.

Aged↗
PubMed1996

[Inhibition of the nitric oxide pathway in refractory septic shock].

AIM: To assess the acute effects of methylene blue infusion, an inhibitor of nitric oxide synthesis, on hemodynamic parameters in patients with refractory septic shock. PATIENTS AND METHODS: Fourteen patients admitted to intensive care units with septic shock of diverse etiologies and unable to maintain median arterial pressures over 60 mm Hg with the use of at least 2 vasoactive drugs, were studied. All received a 1 mg/kg bolus of methylene blue Hemodynamic parameters were measured before and 30, 60, 120 and 180 min after the bolus. RESULTS: Systolic and diastolic blood pressure and systemic vascular resistance increased in all patients. There were no significant changes in cardiac output, oxygen consumption or extraction. CONCLUSIONS: Methylene blue has an acute pressor effect in patients with septic shock.

Adult↗
PubMed1996

[Patients with acute adult respiratory distress syndrome: effects of inhaled nitric oxide on gas exchange and hemodynamics].

BACKGROUND: Adult respiratory distress syndrome is highly prevalent in intensive care units and has a high mortality. Lately, nitric oxide has been used as adjuvant therapy. AIM: To study the effects of nitric oxide inhalation in patients with adult respiratory distress syndrome. PATIENTS AND METHODS: Twelve patients with adult respiratory distress syndrome, were subjected to nitric oxide inhalation at a concentration of 10 parts per million, during 30 minutes. RESULTS: At the end of the nitric oxide inhalation period, there was an improvement of PaO2/FIO2 ratio from 89 +/- 32 to 111 +/- 43 mm Hg and a 16% reduction of lung shunting (Qs/Qt). CONCLUSIONS: Nitric oxide inhalation at a concentration of 10 parts per million improved arterial oxygenation and reduced pulmonary shunting in patients with adult respiratory distress syndrome.

Administration, Inhalation↗
PubMed1995

[Vital prognosis in severe acute hepatic failure. Value of the quantitative indexes of evaluation].

The aim of this study was to assess the predictive value for mortality of admission and daily APACHE II score, mortality due to multiple organ failure and the Organ Failure Score in patients with acute hepatic failure. We retrospectively studied 15 such patients admitted to an intensive care unit. Thirteen patients died (87%) and their admission APACHE II score was 22 +/- 7.5 compared to 21 +/- 8.5 in survivors. Daily APACHE II score, mortality due to multiple organ failure and multiple organ failure score had a 100% sensitivity to predict mortality and a 69.2, 76.9 and 76.9% specificity respectively. The predictive accuracies of multiple organ failure and multiple organ failure score were 80% and significantly better than the accuracy of admission APACHE II score (53%). We conclude that these prognostic scores can be useful in the assessment of patients with acute hepatic failure.

APACHE↗
PubMed1994

Significance of pathologic oxygen supply dependency in critically ill patients: comparison between measured and calculated methods.

OBJECTIVE: oxygen supply dependency at normal or high oxygen delivery rate has been increasingly proposed as a hallmark and a risk factor in critical illnesses. We hypothesized that as far as an adequate oxygen delivery is provided, oxygen consumption, when determined by indirect calorimetry, is not dependent on oxygen delivery in critically ill patients whereas calculated oxygen consumption is associated with artefactual correlation of oxygen consumption and delivery. DESIGN: oxygen delivery, oxygen consumption and their relationship were analyzed prospectively. Metabolic data gained from both measured and calculated methods were obtained simultaneously before and after volume loading. SETTING: the study was completed in the intensive care unit as part of the management protocol of the patients. PATIENTS: 32 consecutive patients entered the study and were divided into 3 groups according to a clinical condition known to favour oxygen supply dependency: sepsis syndrome, adult respiratory distress syndrome and acute primary liver failure. INTERVENTION: the rise in oxygen delivery was obtained by colloid infusion (oxygen flux test) performed in hemodynamically and metabolically stable patients. All were mechanically ventilated. No change in therapy was allowed during the test. MEASUREMENTS AND RESULTS: oxygen consumption was simultaneously evaluated by calculation (Fick Principle) and direct measurement using indirect calorimetry. Oxygen delivery was derived from the cardiac output (thermodilution) and arterial content of oxygen. Oxygen supply dependency was considered while observing an increase in oxygen delivery greater than 45 ml/min.m2. Irrespective of patient's clinical diagnosis and outcome, measured oxygen uptake remained unaltered by volume infusion whereas both oxygen delivery and calculated oxygen consumption increased significantly. Arterial lactate level > 2 mmol/l and measured oxygen extraction ratio > 25% failed to identify oxygen supply dependency when measured data were considered. CONCLUSION: analysis of oxygen uptake, when measured by indirect calorimetry, failed to substantiate oxygen supply dependency in the vast majority of the critically ill patients irrespective of diagnosis and outcome. Mathematical coupling of shared variables accounted for the correlation between oxygen delivery and calculated oxygen consumption.

Adult↗
PubMed1994

Evaluation of oxygen uptake and delivery in critically ill patients: a statistical reappraisal.

OBJECTIVE: The evaluation of oxygen consumption (VO2) and oxygen delivery (DO2) has gained increasing importance in the monitoring of critically ill patients. They can be obtained from either direct measurements or by indirect calculations based on the Fick principle. However the choice between these two approaches remains controversial. The aim of the study was to investigate whether these 2 methods provide similar results, and if not, to define the best one in terms of reproducibility. DESIGN: Oxygen delivery and oxygen consumption were prospectively analyzed in 171 consecutive critically ill patients. Metabolic data were obtained simultaneously. SETTING: The study was completed in the intensive care unit as part of the management of the patients studied. PATIENTS: A first "group" of 279 evaluations was carried out in 73 consecutive critically ill patients. The results were subsequently validated by 423 observations performed in the 98 following patients. INTERVENTIONS: Before and during each evaluation, the patients were kept in stable hemodynamic and metabolic conditions. All were mechanically ventilated. MEASUREMENTS AND RESULTS: VO2 was evaluated by calculation (Fick principle) and direct measurement using indirect calorimetry. Cardiac output was both measured by the thermodilution technique and calculated (Fick principle) and the data were used for the evaluation of the directly measured and indirectly calculated DO2. For both VO2 and DO2 the agreement between direct and indirect evaluations was not satisfactory. Differences as great as 55 ml/min.m2 and 267 ml/min.m2 between simultaneously measured and calculated VO2 and DO2 respectively may be expected. Finally, the indirect calculated methods were less reproducible than the measured ones. These observations resulted mainly from the cumulative effects of the random errors in the metabolic data entering into the calculation of VO2 and DO2. CONCLUSIONS: Our data suggested that the indirect calculation (Fick equation) and the direct measurement (indirect calorimetry, thermodilution) of both VO2 and DO2 did not provide similar results. Direct measurements are more reproducible methods and must be preferred.

Adolescent↗
PubMed1994

[Multiple organ failure syndrome in fulminant hepatic failure].

BACKGROUND: in fulminant hepatic failure, different organs systems become involved and a multiple systems organic failure may ensure. AIM: to perform a retrospective analysis of patients with fulminant hepatic failure admitted to UC Hospital Intensive Care Unit. PATIENTS AND METHODS: the charts of fourteen patients (8 male) were analyzed. Multiple systems organic failure was defined as the presence of 2 or more organic dysfunctions. The evolution and mortality of these patients was analyzed. RESULTS: patient's ages ranged from 30 to 74 years. The etiology of hepatic failure was B hepatitis in 4, non A non B hepatitis in 5, acute fatty liver of pregnancy in 3 and use of halothane and HIN in 2. ICU stay ranged from 1 to 44 days and 2 patients survived (one with drug induced liver failure and one with acute fatty live of pregnancy). Mean prothrombin time was 19 +/- 9.5%, total bilirrubin was 24 +/- 8.9 mg/dl and 12 patients reached grade IV encephalopathy. Mean admission APACHE II score was 21.5 +/- 6. Twelve patients developed multiple systems organic failure, that appeared 1.5 days after or was already present at ICU admission; it lasted a mean of 2.5 days and all these 12 patients died. Neurologic involvement occurred in 13 patients, renal in 10, cardiovascular in 9, respiratory in 5 and hematological involvement in 1. CONCLUSIONS: multiple systems organic failure is frequent in fulminant hepatic failure and is associated with a high mortality.

Adult↗
PubMed1993

[Mortality in an intensive care unit: predictive value of APACHE II severity score versus maximum APACHE].

Patients admitted to intensive care units (ICU) experience constant changes in their general condition. Therefore, the determination of Apache score within the first 24 hours of admission may not be a reliable index of severity. The aim of this study was to measure daily Apache scores in ICU patients, and to determine if the maximum score (Maximum Apache) attained during hospitalization had a better prognostic value than that of admission. We measured daily Apache scores to 314 patients admitted to Hospital Clínico UC ICU. Mean admission score was 17.5 +/- 9.3 (range: 1-47) and mean maximum score was 18.6 +/- 9.7 (range: 1-47), p < 0.001. Mortality during ICU stay was 17.2%, and 8.6% during hospitalization after ICU discharge. Only 78.3% of patients attained their maximum apache score during the first 24 hours of admission, whereas 21.7% attained it during the rest of ICU hospitalization. Excluding subjects with less than one day of ICU stay, 33% of patients attained maximum Apache score after 24 hours of ICU admission. Statistical analysis showed that maximum Apache score was a better predictor of mortality than that of admission.

Adolescent↗
PubMed1992

[Clinical evaluation, evolution and intensive care treatment of severe acute pancreatitis].

Severe acute pancreatitis is morphologically characterized by an intense and necrotizing inflammatory process responsible for early remote organ dysfunctions and late regional complications. Retroperitoneal necrosis has to be identified early by several biological markers and abdominal CT study. A better understanding of the pathophysiological mechanisms underlying the natural history of severe acute pancreatitis, progress in intensive care support and the emergence of new conservative or surgical strategies aimed at removing the necrotic areas and their toxic by-products have led to a dramatic reduction in early and overall mortality for the patient with this disease.

Acute Disease↗
PubMed1991

Syncope: etiology, prognosis, and relationship to age.

Syncope is a common and particularly troublesome problem in the elderly population. In a series of 146 patients admitted for syncope to an acute care hospital in Chile during a 4-year period, 2/3 (68%) were aged 65 years and older. A specific etiology could be established in 62%, and 3/4 of these were cardiovascular in origin. Diagnosis was established entirely on history, physical examination, resting ECG, and 24-hour cardiac monitoring in most cases but in some, more sophisticated measures (i.e., echocardiography, electrophysiologic studies, blood tests, EEG) were needed, and mostly to confirm clinically suspected problems. In-hospital mortality was 2.1% and mortality at the end of the approximately 2-year follow-up period was 18.1%. Mortality was higher for persons over age 65 than for younger persons (23.9% vs 2.3%), and for persons with cardiovascular syncope than for persons with other kinds of syncope (28.3% vs 8.9%). This study confirms the particular lethality of syncope in the elderly population and outlines a relatively simple strategy with which most syncope patients can be diagnosed without resorting to expensive procedures.

Adult↗
PubMed1991

[Sublingual captopril versus nifedipine in the treatment of hypertensive crisis].

The currently accepted drug of choice for treatment of hypertensive crisis is sublingual nifedipine. We compared the effects of sublingual captopril (25 mg) to those of nifedipine (10 mg) in 54 patients with this complication who came to the emergency room. Five min after administration of captopril, blood pressure decreased from 197.5 +/- 32.7/118.3 +/- 8.2 to 156 +/- 27.2/95.8 +/- 12.9 mmHg and heart rate decreased from 87.9 +/- 15.1 to 74.7 +/- 10.9 (p < 0.05). Blood pressure in the nifedipine group decreased from 198 +/- 27.3/120 +/- 9.8 to 147.7 +/- 17.8/86 +/- 17.9 (p < 0.05), while no change was observed in heart rate. Delayed measurements showed lower diastolic pressures at 60 and 75 min and lower systolic pressure at 120 min in the nifedipine group (p < 0.054). Few and not significantly different side effects were observed with both drugs. Thus, sublingual captopril is useful for treatment of hypertensive crisis.

Administration, Sublingual↗