[Caspofungin: indication in Candida albicans-induced severe sepsis?].
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Antifungal Agents↗
Biomedical subjects
B Rouvin
Publications and source records attributed to B Rouvin.
[Severe malaria in intensive care units in 2003].
Malaria requiring intensive care is characterized by failure of one or more organ systems and/or development of several metabolic disorders secondary to the presence of Plasmodium faliciparum in the blood. Severe imported malaria in non-immunized adults causes multiple organ failure with variable degrees of altered mental status. Acute pulmonary edema is frequent, jaundice associated with mild disturbance of liver function is consistent, arterial hypertension due to hypovolemia is usual, and acute renal insufficiency is uncommon. Coagulation disorders are generally low-grade, acidosis is an unfavorable prognostic factor, severe hypoglycemia can occur after the beginning of quinine treatment, and anemia is an consistent but discrete symptom. In endemic areas emphasis should be placed on the complications of severe malaria in pregnant women due to the high incidence of hypoglycemia and pulmonary edema. Severe malaria can develop early in children in endemic zones. Presenting signs include cerebral malaria in older children and severe anemia in young children. Quinine is the reference treatment with a bolus of 17 mg/kg followed by a daily maintenance dose of 24 mg/kg. Use of artemether should be restricted to quinine-resistant forms. Total blood exchange transfusion is not recommended. Supportive symptomatic treatment, e.g. mechanically assisted ventilation and kidney dialysis, is required. In endemic zones over 90% of deaths involve children without access to intensive care facilities. Mortality rates associated with management of severe imported malaria in intensive care range from 10 to 30%.
Adult↗
Biphasic-flow induced ventilation allows simultaneous ventilation in several animals, using a single multiple output ventilator--a preliminary report.
Biphasic-flow induced ventilation (BiFIV) is a variable time-cycled tracheal gas insufflation mode, using a specific multiluminal endotracheal tube. Some recent studies have reported efficiency of this new ventilatory mode in experimental in vitro and in vivo settings. We hypothesized that this ventilatory mode could be able to deliver simultaneous efficient ventilation for several animals, using a single ventilator prototype. The study was performed in three groups of three domestic pigs with a normal lung compliance. Each pig was initially anaesthetized, intubated with the specific endotracheal tube, and ventilated with a conventional ventilatory device. The animals were then simultaneously ventilated under BiFIV, using a single ventilator prototype, for each group of three animals. Physiological parameters and arterial blood gases were recorded at each study phase. All animals but one survived the experiment. We did not observe any significant differences in arterial gas exchange, under both ventilatory modes. Oxygenation was as efficient for each three animals ventilated under BiFIV, using a single ventilator device, as under conventional ventilation, using three separate ventilators (PaO2 = 112+/-17 mmHg under conventional ventilation versus 115+/-16 mmHg under BiFIV). In conclusion, variable time-cycled tracheal gas insufflation may allow an efficient multiple ventilation on several animals, using a single multiple output ventilatory device, in a normal lung animal model. If validated on subsequent pathological models, it could thus be interesting in laboratory and/or mass casualty situations.
Animals↗
Hemodynamic aspects and oxygenation variables in severe malaria of adults in Africa.
OBJECTIVES: Study of the hemodynamic profile and oxygenation variables in severe malaria to determine whether they are identical to those observed in severe bacterial infections. DESIGN AND SETTING: Prospective study in an intensive care unit of a West African hospital. PATIENTS AND PARTICIPANTS: Two groups of adult patients hospitalized for severe malaria according to WHO criteria, a control group (n = 13) with systemic vascular resistance of 800 dyne s(-1) cm(-5) or higher and a hyperkinetic group (n = 16) with a level lower than 800 dyne s(-1) cm(-5). Twenty-nine patients participated in this study (19 semi-immune, 10 nonimmune). INTERVENTIONS: Before hemodynamic study a loading dose of quinine formiate was administered: 20 mg/ kg intravenously for 4 h. Artificial ventilation was used in the case of persistent hypoxemia. MEASUREMENTS AND RESULTS: The hemodynamic study with Swan-Ganz catheter was performed after filling with 1,000 ml lactated Ringer's solution. From a clinical and a biological standpoint there was no difference between the two groups except for creatine phosphokinase, which was significantly higher in the hyperkinetic group: 2404 +/- 3654 vs. 1,898 +/- 1,828 IU/l. Hemodynamic and oxygenation variables showed a significant difference in cardiac index (6.1 +/- 1.2 vs. 3.9 +/- 1.21 min(-1) m(-2)), systemic vascular resistance (536 +/- 143 vs. 1098 +/- 170 dyne s(-1) cm(-5)), oxygen delivery (645 +/- 163 vs. 482 +/- 186 ml min(-1) m(-2)), and oxygen extraction (23 +/- 9 % vs. 34 +/- 14 %). Oxygen extraction was negatively correlated with oxygen delivery in the control group but not in the hyperkinetic group. Eight of 10 nonimmune patients (80 %) were in the hyperkinetic group versus 8 of 19 semi-immune patients (42 %; p < 0.05). Nine patients in the hyperkinetic group (69 %) and seven of the control group (46 %) died (NS). CONCLUSIONS: In contrast to severe bacterial infections, severe malaria does not always induce hyperkinetic-type hemodynamic changes. Such changes are observed mostly in nonimmune subjects.
Adult↗
Efficacy of continuous insufflation of oxygen combined with active cardiac compression-decompression during out-of-hospital cardiorespiratory arrest.
BACKGROUND: During experimental cardiac arrest, continuous insufflation of air or oxygen (CIO) through microcannulas inserted into the inner wall of a modified intubation tube and generating a permanent positive intrathoracic pressure, combined with external cardiac massage, has previously been shown to be as effective as intermittent positive pressure ventilation (IPPV). METHODS: After basic cardiorespiratory resuscitation, the adult patients who experienced nontraumatic, out-of-hospital cardiac arrest with asystole, were randomized to two groups: an IPPV group tracheally intubated with a standard tube and ventilated with standard IPPV and a CIO group for whom a modified tube was inserted, and in which CIO at a flow rate of 15 l/min replaced IPPV (the tube was left open to atmosphere). Both groups underwent active cardiac compression-decompression with a device. Resuscitation was continued for a maximum of 30 min. Blood gas analysis was performed as soon as stable spontaneous cardiac activity was restored, and a second blood gas analysis was performed at admission to the hospital. RESULTS: The two groups of patients (47 in the IPPV and 48 in the CIO group) were comparable. The percentages of patients who underwent successful resuscitation (stable cardiac activity; 21.3 in the IPPV group and 27.1% in the CIO group) and the time necessary for successful resuscitation (11.8 +/- 1.8 and 12.8 +/- 1.9 min) were also comparable. The blood gas analysis performed after resuscitation (8 patients in the IPPV and 10 in the CIO group) did not show significant differences. The arterial blood gases performed after admission to the hospital and ventilation using a transport ventilator (seven patients in the IPPV group and six in the CIO group) showed that the partial pressure of arterial carbon dioxide (PaCO2) was significantly lower in the CIO group (35.7 +/- 2.1 compared with 72.7 +/- 7.4 mmHg), whereas the pH and the partial pressure of arterial oxygen (PaO2) were significantly higher (all P < 0.05). CONCLUSIONS: Continuous insufflation of air or oxygen alone through a multichannel open tube was as effective as IPPV during out-of-hospital cardiac arrest. A significantly greater elimination of carbon dioxide and a better level of oxygenation in the group previously treated with CIO probably reflected better lung mechanics.
Adolescent↗
[Value of prolonged epidural analgesia in thoracic surgery].
The use of high thoracic epidurals for post-thoracotomy pain relief in 156 patients is reviewed. Analgesia was maintained with a continuous infusion of a local anaesthetic, bupivacaïne 0.5% 40 ml, mixed with a narcotic, fentanyl 10 ml (perfusion rate between 3 and 7 ml/h). There was successful analgesia in 92%, with efficient ventilation, effective cough, no respiratory distress and only 8 cases of fibroaspiration. Only two significant respiratory complications occurred, due to incorrect management of the peridural route: the analgesic mixture was too concentrated and was injected by bolus instead of by continuous infusion. Other complications occurred, 8 cases of nausea or pruritus, 4 hallucinations, 10 cases of urinary retention lasting more than 24 h, 14 superior limb palsies and 22 Horner's oculopapillary syndrome. All of these complications were minor, easy to manage, and resolved after stopping peridural infusion. In conclusion, peridural analgesia is highly effective and improves the atmosphere in post-thoracotomy wards.
Analgesia, Epidural↗
[Severe hypophosphoremia in a toxic shock syndrome].
A case of toxic shock syndrome occurring during a menstrual period, and associated with severe hypophosphataemia, is reported. The patient was a 21-year old woman using tampons. On the fourth day, she developed encephalopathy with decreased consciousness and hyperventilation. Severe hypophosphataemia was noted. A phage-group-1 Staphylococcus aureus, producing TSST-1 and enterotoxin A, was isolated from vaginal, pharyngeal and skin sites. Pathogenesis and role of hypophosphataemia in toxic shock syndrome are emphasized.
Adult↗
Prevalence of hepatitis A antibodies in French recruits in 1985.
The epidemiological study of hepatitis A antibodies prevalence in 1000 french recruits shows a 20% fall in people of 18-20 years old between 1979 and 1985, and identifies variables such as residence in coasting area, stay overseas, study level, as the most important social and geographical risk factors. These results are in agreement with the evolution observed in different other european countries.
Adolescent↗
[Metabolic alkalosis. Association of sodium gamma-hydroxybutyrate and hydrocortisone hemisuccinate].
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Alkalosis↗
[Peridural anesthesia in thoraco-abdominal surgery. Propofol-methohexital comparison for complementary anesthesia].
Two groups of 20 patients scheduled for major abdominal surgery or thoracic surgery received analgesia by thoracic peridural route: 850 and 837 micrograms.kg-1 of bupivacaine, plus 4.30 and 4.20 micrograms.kg-1 of fentanyl. Anaesthesia was induced and maintained with either infusion of propofol 0.2% or infusion of methohexital 0.1% and patients were intubated and ventilated. The quality of induction was good in the two groups (3.48 mg.kg-1 in 4 min with propofol and 2.76 mg.kg-1 in 5 min with methohexital). But only 4 of propofol group needed vecuronium for intubation; they were 19 in the other group. Maintenance was extremely smooth with propofol (0.088 mg.kg-1.min-1) in 18 cases. In contrast, poor anaesthetic control was obtained with 14 methohexital patients and had to be abandoned. Hemodynamic data show fc, Pa and Ppa decreased with propofol but increased with methohexital in response to laryngoscopy and intubation. In this study, the onset of 5 sinusal bradycardias was noted with propofol. Two of them were severe 39 and 38 b.min-1 with major decrease of LVSWI to 32.45 and 24.47 g.mm-2. The role of hypovolemia (Bainbridge reflex) or vagomimetic effect of propofol is discussed. Nevertheless, this study shows that propofol given by infusion can better achieve adequate anaesthesia than methohexital.
Abdomen↗