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Biomedical subjects

Antoine Cuvelier

Publications and source records attributed to Antoine Cuvelier.

14 recordsLinked to original sources
PubMed2005

Limitations of transcutaneous carbon dioxide measurements for assessing long-term mechanical ventilation.

STUDY OBJECTIVES: Transcutaneous CO(2) pressure (Ptcco(2)) and transcutaneous O(2) pressure (Ptco(2)) measurements are routinely used in pediatric ICUs in order to avoid serial arterial punctures. The aim of this study was to determine the value of Ptcco(2) assessment during the evaluation of home ventilation in 12 adult patients with COPD or restrictive respiratory failure in the stable state (mean [+/- SD] basal Paco(2), 48.8 +/- 8.3 mm Hg) who were treated by mask or tracheotomy-mediated ventilation. METHODS: After radial catheter insertion, patients were instructed to breathe spontaneously for 40 min and then to receive ventilation for 40 min according to their individual home ventilation modalities. An in vivo calibration was performed in the initial stage of the study in order to optimize the arterial Pco(2) and Ptcco(2) values. Every 5 min, transcutaneous measurements were performed and simultaneously compared with arterial values. MEASUREMENTS AND RESULTS: Ptcco(2) and Ptco(2) were correlated with arterial values (p < 0.0001) except for Paco(2) values of > 56 mm Hg and Pao(2) values of > 115 mm Hg. During ventilation, Paco(2) decreased >or= 4 mm Hg in seven patients. Ptcco(2) variations recorded during consecutive 5-min periods while the patient received mechanical ventilation were well correlated with the arterial variations (p = 0.0033), with a delay of < 5 min. CONCLUSION: Ptcco(2) values and variations accurately reflected Paco(2) values and variations during mechanical ventilation. However, the accuracy of these data seems to be restricted to patients with Paco(2) values of < 56 mm Hg.

Aged↗
PubMed2004

[Means and organisation of the management of severe forms of COPD].

Chronic obstructive pulmonary disease is becoming the 3rd aetiology of death by disease. In its advanced presentation, it generates a chronic respiratory failure with hypoxia and frequent hypercapnia. Its complex management implies at that stage a medical treatment, physiotherapy and pulmonary rehabilitation, associated with long-term oxygentherapy. In the most severe stages, may be discussed long-term home mechanical ventilation with non invasive connection in order to avoid tracheotomy and to prevent acute respiratory episodes leading these patients in intensive care units and yet responsible for 15 000 deaths per year in our country.

Humans↗
PubMed2004

C-reactive protein and body mass index predict outcome in end-stage respiratory failure.

STUDY OBJECTIVE: To determine the predictive factors of morbidity and mortality in patients with end-stage respiratory disease. DESIGN: Prospective, multicenter cohort study. SETTING: Thirteen outpatient chest clinics within the Association Nationale de Traitement à Domicile de l'Insuffisance Respiratoire. PARTICIPANTS: Stable adult patients with chronic respiratory failure receiving long-term oxygen therapy and/or home mechanical ventilation (n = 446; 182 women and 264 men; aged 68.5 +/- 12.1 years [+/- SD]); Respiratory diseases were COPD in 42.8%, restrictive disorders in 36.3%, mixed respiratory failure in 13.5%, and bronchiectasis in 7.4%. Recruitment was performed during the yearly examination. Patients with neuromuscular diseases and sleeping apnea were excluded. MEASUREMENTS AND RESULTS: Hospitalization days and survival were recorded during a follow-up of 14.3 +/- 5.6 months. Body mass index (BMI), serum albumin, and transthyretin levels were considered for their predictive value of outcome, together with demographic data, underlying respiratory disease, respiratory function, hemoglobin, C-reactive protein, smoking habits, oral corticosteroid use, and antibiotic treatment courses. Overall, 1.8 +/- 1.7 hospitalizations (cumulative stay, 17.6 +/- 27.1 days) were observed in 254 of 446 patients (57%). Independent predictors of hospitalization were oral corticosteroids, FEV(1), and plasma C-reactive protein. One-year and 2-year cumulative survivals were 93% and 69%, respectively. Plasma C-reactive protein, BMI, Pao(2) on room air, and oral corticosteroids independently predicted survival in multivariate analysis. CONCLUSION: Besides established prognosis factors such as FEV(1) and Pao(2), nutritional depletion as assessed by BMI and overall systemic inflammation as estimated by C-reactive protein appear as major determinants of hospitalization and death risks whatever the end-stage respiratory disease. BMI and C-reactive protein should be included in the monitoring of chronic respiratory failure. Oral corticosteroids as maintenance treatment in patients with end-stage respiratory disease are an independent risk factor of death, and should be avoided in most cases.

Administration, Oral↗
PubMed2003

[Diagnosis of community acquired pneumonia in adults].

In contrast with acute bronchitis, which is benign and very frequent, community acute pneumonia has to be considered as a serious illness with a mortality rate that can reach 10-15% in inpatients. In adult, pneumonia is usually due to bacteria and antibiotherapy is always required. Clinical diagnosis is based on presumption signs: fever, tachycardia, tachypnea, thoracic pain, localised rales and a global severity impression. A chest X-ray is required. The pathogens involved are usually Streptococcus pneumoniae or atypical organisms. In inpatients (severe pneumonia or presence of risk factors), other pathogens such as gram negative bacilli or anaerobes are possible. The accurate diagnosis is based on invasive methods, which are not justified in outpatients but indicated in severe pneumonia.

Adult↗
PubMed2002

Evaluation of candidates for long-term ventilation.

This article considers the evaluation of patients prior to institution of long-term ventilation (LTV). LTV has evolved from a concept of necessity ventilation to a more satisfactory approach of preventive LTV, enabled by the impressive development of noninvasive mechanical ventilation (NIV). Due to its convenience and efficacy, and its safety compared with invasive ventilation, NIV has rapidly gained popularity among patients with chronic respiratory failure (CRF) requiring intermittent ventilatory assistance. Evaluation of candidates for LTV involves clinical and laboratory evaluations and sleep monitoring. It includes consideration of the etiology of CRF, be it restrictive lung disease, chronic obstructive pulmonary disease, obesity or other cause, and considers the feasibility of LTV as well as its desirability.

Chronic Disease↗
PubMed2002

Refillable oxygen cylinders may be an alternative for ambulatory oxygen therapy in COPD.

STUDY OBJECTIVES: To compare, in clinical conditions, the efficacy of refilled oxygen cylinders (O2-HFs) in improving oxygenation and exercise capacity of patients with COPD during a 6-min walking test. DESIGN: Prospective randomized study with a cross-over design. SETTING: A university teaching hospital. PATIENTS: Ten patients with COPD, in a stable state and previously treated with long-term domiciliary oxygen therapy. Baseline characteristics were as follows: age, 65 +/- 7 years; PaO2 on room air, 55.4 +/- 6.3 mm Hg; PaCO2 on room air, 46.2 +/- 7.4 mm Hg; FEV1/vital capacity, 47 +/- 7%; and FEV1, 30 +/- 7% of predicted value (mean +/- SD). DESIGN: All patients performed three successive 6-min walking tests, the first test in room air and the other tests in a randomized order with either a conventional oxygen cylinder (O2-C) or an O2-HF. MEASUREMENTS AND RESULTS: The fraction of inspired oxygen (FIO2) delivered by O2-HFs was significantly lower than the FIO2 delivered by O2-Cs (94.2 +/- 2.6% vs 98.8 +/- 4.9%, p = 0.02). Mean O2-HF and O2-C weights before the walking tests were similar (3,510 +/- 251 g and 3,770 +/- 142 g, respectively; p = 0.09). Mean transcutaneous oxygen saturation was similarly improved with both oxygen delivery systems. Mean distances with O2-C (373.5 +/- 81 m) and O2-HF (375 +/- 97 m) were not different but significantly improved, as compared with room air (334.5 +/- 90 m; p = 0.03 and 0.02, respectively). Dyspnea sensations were similar for the three tests. CONCLUSION: O2-HFs are as efficient as O2-Cs for performing short-term exercises. Because of a lower cost, pressurizing units may be worthwhile for improving ambulatory oxygen therapy and pulmonary rehabilitation programs.

Aged↗
PubMed2002

Dry powder ipratropium bromide is as safe and effective as metered-dose inhaler formulation: a cumulative dose-response study in chronic obstructive pulmonary disease patients.

A multi-center, open, randomized, 2-way crossover study was conducted with chronic obstructive pulmonary disease (COPD) patients to compare the safety and efficacy of cumulative doses of ipratropium bromide administered from a pressurized metered-dose inhaler (MDI) or from a breath-activated dry powder inhaler (DPI). Enrolled in the study were 39 patients with moderate to severe COPD and who showed a > or= 15% increase in baseline forced expiratory volume in the first second (FEV(1)) after 80 microg of ipratropium bromide. Thirty-six patients were evaluable for efficacy analysis, and 38 patients were included in the safety analysis group. A significant improvement in pulmonary function was observed following inhalation of cumulative doses of ipratropium bromide (from 20 to 320 microg), but no statistically significant difference was found between the 2 formulations. The dose-response curves were similar. There was no statistical difference in area-under-the-curve during the 180 min period after the last dose for any of the pulmonary function variables. Overall, effects on pulse rate, blood pressure, and QT interval on electrocardiogram were no different between the devices. Six mild adverse events occurred in 4 patients: ventricular ectopic beats on electrocardiogram at 270 min with MDI, bad taste with both MDI and DPI, slight transient increase in blood pressure in the same patient during each study day with both MDI and DPI. Two moderate adverse events occurred in 2 patients: transient ventricular ectopic beats on electrocardiograms with DPI at 270 min, moderate bronchospasm with MDI at 200 min. Patients expressed a preference for DPI, which was found to have a better acceptability and appeared to be easier to use than MDI. The new lactose powder formulation of ipratropium bromide inhaled via the breath-activated DPI is a safe and effective alternative to the chlorofluorocarbon-propelled MDI.

Adult↗