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C Girault

Publications and source records attributed to C Girault.

At least 19 recordsLinked to original sources
PubMed2006

Changes in severity and organ failure scores as prognostic factors in onco-hematological malignancy patients admitted to the ICU.

OBJECTIVE: To determine whether severity and organ failure scores over the first 3 days in an ICU predict in-hospital mortality in onco-hematological malignancy patients. DESIGN AND SETTING: Retrospective study in a 22-bed medical ICU. PATIENTS: 92 consecutive patients with onco-hematological malignancies including 20 hematopoietic stem cell transplantation (HSCT) patients (11 with allogenic HSCT). MEASUREMENTS: Simplified Acute Physiology Score (SAPS) II, Organ Dysfunction and/or Infection (ODIN) score, Logistic Organ Dysfunction System (LODS), and Sequential Organ Failure Assessment (SOFA) score were recorded on admission. The change in each score (Delta score) during the first 3 days in the ICU was calculated as follows: severity or organ failure score on day 3 minus severity or organ failure score on day 1, divided by severity or organ failure score on day 1. RESULTS: In-hospital mortality was 58%. Using multivariate analysis in-hospital mortality was predicted by all scores on day 1 and all Delta scores. Areas under the receiver operating characteristics curves were similar for SAPS II (0.78), ODIN (0.78), LODS (0.83), and SOFA (0.78) scores at day 1. They were also similar for DeltaSAPS II, DeltaODIN, DeltaLODS, and DeltaSOFA. Similar results were observed when excluding patients with allogenic HSCT. CONCLUSION: Severity and three organ failure scores on day 1 and Delta scores perform similarly in predicting in-hospital mortality in ICU onco-hematological malignancy patients but do not predict individual outcome. Decision to admit such patients to the ICU or to forgo life-sustaining therapies should not be based on these scores.

Female↗
PubMed2006

[Quality of care assessment and nosocomial pneumonia in the intensive care unit].

INTRODUCTION: Nosocomial pneumonia (NP) is a major cause of infection in the intensive care unit and is responsible for a significant increase in morbidity, mortality and healthcare costs. Ventilator-associated pneumonia is the most frequent and severe form of NP. STATE OF ART: Assessment of the quality of care and healthcare practices relating to the prevention and treatment of nosocomial pneumonia represents a potentially vast area but has been little studied in the literature. Difficulties include the lack of either a "gold standard" for diagnosis, or standardization of techniques for microbiological sampling and, therefore, the lack of reliable indicators of performance in the management of NP. Currently, published data mainly involve diagnostic strategies, preventive measures and antibiotic therapy. PERSPECTIVES AND CONCLUSIONS: In line with the latest published recommendations, clinicians should continue their efforts in this field to improve the management and reduce the impact of NP in the intensive care unit.

Cross Infection↗
PubMed2005

[Bickerstaff's brainstem encephalitis].

INTRODUCTION: Bickerstaff's brainstem encephalitis represents a differential diagnostic that must be discuss with meningoencephalitis with ophtalmoplegia, ataxia and confusion. EXEGESE: A 26 year-old woman presented a Bickerstaff syndrome. A severe disturbance of consciousness had lead to admission in intensive care unit with mechanical ventilation. Electrophysiological tests and the brain magnetic resonance were normal. We have not observed systemic anti-G1Qb antibody in our patient. Nevertheless, 66% of patients with Bickerstaff syndrome have anti-GQ1b antibody during the acute phase period. We observed a beneficial effect of IV Ig treatment although no significant improvement was observed with corticosteroids. CONCLUSION: Controlled clinical trials are needed to established the efficacy of IV Ig or plasmapheresis as a specific therapy for this pathology.

Adrenal Cortex Hormones↗
PubMed2005

Serum erythropoietin levels in septic shock.

Erythropoietin is a glycoprotein hormone mainly released by the kidney, which stimulates red blood cell production. However, in sepsis, the mechanisms responsible for the final increase in circulating erythropoietin remain unclear Seventeen critically ill patients with Simplified Acute Physiologic Score average 66 (range 43 to 103) were included in this study. Ten patients survived and seven died within 28 days. Blood samples obtained at different times were assayed for erythropoietin, cytokine levels and lactate measurements. PCO2 gap was assessed to detect the presence of gastric mucosal acidosis. Erythropoietin decreased in the patients who survived while it remained high or increased in non-survivors (37+/-6.5 vs 147+/-6. 7 UI/l respectively, P<0.05). Erythropoietin plasma levels were correlated with IL-6 levels (r=0.84, P<0.05) and TNFalpha levels (r=0.84, P<0.05). We observed a significant positive relationship between erythropoietin plasma levels and lactate concentrations (r= 0.89, P< 0. 05) and with PCO2 gap (r=0.9, P < 0.05). No correlation was found between erythropoietin concentration and the other parameters. High serum erythropoietin levels in non-survivors were observed with septic shock despite an increase in the levels of proinflammatory cytokines. We found a relationship between erythropoietin concentration and biological markers of tissue hypoperfusion i.e. lactate levels or PCO2 gap. This relationship could suggest tissue hypoperfusion as the stimulating factor for erythropoietin production in septic shock.

Adult↗
PubMed2003

Double relapse of incomplete form of thrombotic thrombocytopenic purpura.

BACKGROUND: Although several etiologies can be identified in thrombotic thrompocytopenic purpura (TTP), idiopathic cases are still frequent. Incomplete forms are rare and the diagnosis should be suspected in case of thrombocytopenia and microangiopathic haemolytic anaemia. Relapses are frequent in the complete classic form but rarely reported in incomplete forms. According to the literature, mortality and morbidity are significantly improved with plasma exchange (PE). Nevertheless, the management and treatment of relapses remain problematic. CASE REPORT: A 35-year-old woman presented with a double relapse of an incomplete TTP form in the second (24 months) and the fourth year (40 months) after the initial episode. The patient underwent plasma infusion, PE, and was then started on corticosteroids. She also received antiplatelet agents. The main biological indicators were platelet count, haematocrit, lactate dehydrogenase level and schistocytes. Following this treatment, the patient's condition rapidly improved. CONCLUSION: In this incomplete form of TTP, two relapses occurred, with the same presentation. Standard therapy was effective in this case.

Adult↗
PubMed2003

Adverse effect of polyvalent immunoglobulin in the treatment of Guillain-Barre syndrome.

BACKGROUND: Acute polyradiculoneuropathy or Guillain-Barre syndrome is a neurological disease which may present with severe forms which have a poor prognosis. The patient's management requires multidisciplinary specialised care. Morbidity has been reported to be significantly improved with initial therapy using high-dose intravenous immunoglobulin (IVIG). However, this therapy represent an immunological risk which has remained overlooked by clinicians in the majority of cases and is not clearly stated by the pharmaceutical companies. Therefore, the use of IVIG in the intensive care unit can cause some problems. CASE REPORT: A 32-year-old woman presented with clinical signs of Guillain-Barre syndrome. The patient received high-dose intravenous immunoglobulin (TEGELINE). Nine days after beginning therapy, she presented with severe immunological hemolytic anaemia; the IVIG was suspected as the cause. The blood cell count returned to normal approximately two months after the onset of the hemolytic syndrome. CONCLUSION: Despite the effectiveness of IVIG therapy in the management of various diseases, intensive care clinicians should be aware of possible major adverse effects which make a careful assessment of the patient necessary before treatment. It may also be important to consider the patient's ABO blood group before initiating IVIG treatment, particularly in patients bearing A and/or B blood group antigens.

ABO Blood-Group System↗
PubMed2003

[VENISE: Non-invasive ventilation during mechanical ventilation weaning in chronic respiratory failure patients. A prospective randomised controlled and multicenter trial].

INTRODUCTION: The clinical efficacy of non-invasive ventilation (NIV) has now been demonstrated in the management of acute-on-chronic respiratory failure (ACRF) in various etiologies. Endotracheal mechanical ventilation (ETMV) can lead to numerous complications and weaning difficulties increasing the risk of prolonged ETMV, morbidity and mortality as well as excess cost of intensive care. Therefore, it could be useful to consider NIV for delivering effective ventilatory support to reduce the length of ETMV in ACRF patients who are still not capable of maintaining spontaneous breathing. From the interesting but discordant results of two recent randomised controlled trials, a working group from the Société de Réanimation de Langue Française (SRLF) decided to perform a new prospective randomised controlled multicenter trial. The aim of the study will be to assess the usefulness of NIV as an extubation and weaning technique in ventilated ACRF patients. METHODS: The methodology used will compare three parallel weaning strategies in ACRF patients considered difficult to wean: invasive conventional weaning (group A), extubation relayed by nasal oxygentherapy (group B), and extubation relayed by NIV (group C). Based on the main end-point defined as the weaning success rate, 208 patients from 17 investigator centers are planned to be included. Results of the study will also allow to assess the respective impact of the three weaning strategies on the length of ETMV and weaning, the mechanical ventilation-related morbidity, the patients lengths of stay and mortality. EXPECTED RESULTS: Results of the VENISE trial should permit to improve the management of the difficult to wean ACRF patients and thus contribute to more precisely define the place of NIV in the weaning and prevention of re-intubation strategies in these patients.

Chronic Disease↗
PubMed2001

[Acute respiratory failure in patients with chronic respiratory insufficiency].

In the absence of severe clinical signs requiring endotracheal intubation, non-invasive mechanical ventilation is the first-line treatment in patients with chronic respiratory insufficiency. For a patient with non-invasive support, the probability to avoid intubation is 2 or 3 times higher than for a patient initially treated by oxygen therapy alone. Oxygen therapy will remain the recommended approach for staff unfamiliar with non-invasive support. In chronic obstructive pulmonary disease (COPD) ventilated patients, keeping the intrinsic positive end-expiratory pressure to a minimum level decreases the risk of barotrauma. During exacerbation, in these patients, the 3 most often prescribed medications are inhaled bonchodilators, corticosteroids, and antibiotics. In addition to long term home oxygen therapy, the preventive measures include education of patients, pulmonary rehabilitation programs, and eventually routine use of ventilatory support in a home ventilatory setting.

Acute Disease↗
PubMed2001

Two cases of foodborne botulism type E and review of epidemiology in France.

In 1999, two new cases of type E botulism were observed in French hospitals. Since this type of botulism is uncommon in France, the cases prompted a national epidemiological study. Sixteen cases of type E botulism, including the two cases reported here, occurred between 1952 and 1999. The clinical and treatment characteristics of all cases were evaluated, and the results suggest that, despite its rarity, type E botulism should be considered by clinicians in France. Changes in the eating habits of people in France, as in the rest of Europe, with the increased consumption of vacuum-packed fish from endemic areas and decreased consumption of local foodstuffs, could explain the occurrence of the most recent cases.

Adult↗
PubMed2001

A shock associated with adult-onset Still's disease.

Only two cases of adult-onset Still's disease associated with shock have been previously described. We report a case of shock in a man with adult-onset Still's disease and discuss the relationship between the two processes by assessing tumor necrosis factor-alpha, procalcitonin and interleukin-6 concentrations.

Calcitonin↗
PubMed2000

Difficulties in the management of an incomplete form of refractory thrombotic thrombocytopenic purpura, the usefulness of vincristine.

BACKGROUND: Although several etiologies can be identified in thrombotic thrombocytopenic purpura (TTP), idiopathic cases are still frequent. Incomplete forms are more rare. Currently, the diagnosis may be made in cases of thrombocytopenia and microangiopathic hemolytic anemia. According to the literature, mortality and morbidity are significantly improved with plasma exchange. However, treatment in refractory forms remains problematic. CASE REPORT: A 33-year old woman presented with an incomplete form of TTP, refractory to a combination of therapeutics. The patient underwent plasma infusion, plasma exchange, and then was started on corticosteroids. She also received intravenous immunoglobulins and antiplatelet agents in close proximity to vincristine (Oncovin) infusion. The main biological indicators used were the platelet count, hematocrit, LDH, and the presence of schistocytes. Following vincristine treatment, the patient's condition rapidly improved. CONCLUSION: Vincristine administered after the failure of standard therapeutics was effective in this refractory form of TTP.

Adrenal Cortex Hormones↗
PubMed1999

Toxicological analysis in agitated patients.

OBJECTIVE: To assess the toxicological etiologies in agitated patients and to evaluate their initial clinical diagnosis in the light of toxicological results analysis. DESIGN: Prospective clinical study. SETTING: Emergency Department (ED) in a 2,650-bed University Hospital. PATIENTS: Fifty-eight consecutively enrolled patients admitted to the ED in agitated states over a 6-month period. MEASUREMENTS AND RESULTS: All patients underwent laboratory tests including blood glucose, ethanol and serum drug screening. Toxicology tests were conducted by fluorescence polarization immunoassay and confirmed by high performance liquid chromatography/diode array detector and gas chromatography-mass spectrometry. The physician's initial diagnosis was evaluated in the light of toxicological analysis results. Serum toxicological analysis revealed that 50/58 patients were under the influence of alcohol and/or a drug. Benzodiazepines (22/58), selective serotonin reuptake inhibitors (5/58) and opiates (4/58) were the most frequently observed. The initial clinical diagnosis was alcohol intoxication in 39 patients, although 1 patient was not under the influence of alcohol and 16 also had benzodiazepine in their sera. Moreover, the diagnosis of serotonin syndrome was overlooked in two patients. CONCLUSION: Most agitated patients were under the influence of alcohol and/or a drug. Benzodiazepine alone or in association with alcohol was surprisingly frequent. A serotonin syndrome may explain the agitation state.

Adolescent↗
PubMed1999

Fomepizole (4-methylpyrazole) in fatal methanol poisoning with early CT scan cerebral lesions.

BACKGROUND: Methanol poisoning, potentially fatal, is generally treated with the combination of ethanol as antidote, and hemodialysis. Fomepizole, a competitive inhibitor of alcohol dehydrogenase, has more recently been used, and is capable of blocking the toxic metabolism of methanol. To our knowledge, its use has never been reported as an antidote in severe methanol poisoning requiring hemodialysis. CASE REPORT: We report a case of fatal methanol poisoning (1.9 g/L on admission) suspected due to the combined presence of coma and severe metabolic acidosis with normokalaemia. CONCLUSION: The fomepizole treatment protocol (10 mg/kg by i.v. infusion over 1 hour before dialysis, repeated 12 hours later in combination with 1.5 mg/kg/h during dialysis) was simple to use and appeared effective in eliminating methanol in combination with hemodialysis. The case is also unusual in terms of severity and the early onset of cerebral lesions demonstrated by computed tomography (CT) scan.

Acidosis↗
PubMed1999

Effects of pressure ramp slope values on the work of breathing during pressure support ventilation in restrictive patients.

OBJECTIVE: To investigate, in restrictive patients, the influence of pressure ramp slope values on the efficacy of pressure support ventilation. DESIGN: Prospective study. SETTING: A university hospital medical intensive care unit. PATIENTS: Twelve intubated restrictive patients. INTERVENTIONS: Patients were randomly assigned to four sequences in which the values of the slope of the pressure ramp increase were modulated so that the plateau pressure was reached within a predetermined time: 0.1, 0.50, 1, or 1.50 secs. The more rapidly the pressure plateau was achieved, the higher was the initial flow rate. For convenience, these four different ventilatory settings were termed T 0.1, T 0.5, T 1, and T 1.5. MEASUREMENTS AND MAIN RESULTS: We measured the following parameters 10 mins after application of each pressure ramp slope: inspiratory work of breathing, breathing pattern, and intrinsic PEEP (PEEPi). Work of breathing was evaluated using Campbell's diagram, and expressed as a percentage of the values observed under spontaneous ventilation. A marked interindividual variation of the values for work of breathing was observed under spontaneous ventilation; the mean value for work of breathing was 1.97 +/- 0.82 joule/L, with a range of 1.22 to 4.10 joule/L. Comparison between the means for each sequence and each variable measured was performed by two-way analysis of variance with internal comparisons between sequences by Duncan's test. Between the first (T 0.1) and the last (T 1.5) sequence, the reduction of values of the pressure ramp slope induced a progressive increase in the values for work of breathing, regardless of the mode of expression (in joule, joule/L, or joule/min). The values for work of breathing (joule/ L), expressed as a percentage of the values observed under spontaneous ventilation, increased from 44.2 +/- 14.4% to 78.3 +/- 17.8% (p < .001). In contrast, the reduction of the pressure ramp slope values and initial flow rate did not induce any significant change in tidal volume, respiratory frequency, and PEEPi. CONCLUSION: Among the four tested slope values, the steepest was that which induced the lowest possible work of breathing in restrictive patients ventilated by pressure support ventilation. In this type of patient, we therefore suggest that the programmed pressure value should be reached by using a steep pressure ramp slope.

Acute Disease↗
PubMed1999

Noninvasive ventilation as a systematic extubation and weaning technique in acute-on-chronic respiratory failure: a prospective, randomized controlled study.

Prolonged duration of endotracheal mechanical ventilation (ETMV) is associated with an increased morbidity and mortality in intensive care unit (ICU) patients. The aim of this study was to assess the usefulness of noninvasive ventilation (NIV) as a systematic extubation and weaning technique to reduce the duration of ETMV in acute-on-chronic respiratory failure (ACRF). Among 53 consecutively intubated patients admitted for ACRF, we conducted a prospective, randomized controlled trial of weaning in 33 patients who failed a 2-h T-piece weaning trial (2 h-WT) although they met simple criteria for weaning. Conventional invasive pressure support ventilation (IPSV) was used as the control weaning technique in 16 patients (IPSV group), and NIV was applied immediately after extubation in 17 patients (NIV group). The two weaning groups were similar for type of chronic respiratory failure (CRF), pulmonary function data, age, Simplified Acute Physiology Score (SAPS II), and severity of ACRF on admission. The characteristics of the two groups were also similar at randomization. In the IPSV group, 12 of 16 patients (75%) were successfully weaned and extubated, versus 13 of 17 (76.5%) in the NIV group (p = NS). NIV like IPSV significantly and similarly improved gas exchange in relation to that achieved during 2 h-WT (p < 0.05). The duration of ETMV was significantly shorter in the NIV (4.56 +/- 1.85 d) than in the IPSV group (7.69 +/- 3.79 d) (p = 0. 004). NIV also reduced the mean period of daily ventilatory support, but increased the total duration of ventilatory support related to weaning (3.46 +/- 1.42 d, versus 11.54 +/- 5.24 d with NIV; p = 0. 0001). Most patients in the IPSV group developed complications related to ETMV and/or the weaning process, but the difference was not significant (nine of 16 versus six of 17). The durations of ICU and hospital stays and the 3-mo survival were similar in the two groups. In conclusion, NIV permits earlier removal of the endotracheal tube than with conventional IPSV, and reduces the duration of daily ventilatory support without increasing the risk of weaning failures. NIV should be considered as a new and useful systematic approach to weaning in patients with ACRF who are difficult to wean.

Acute Disease↗
PubMed1998

Suppression of heparinization of central venous catheters between cycles of chemotherapy. Results of a phase I study.

A phase I study to evaluate heparinization of tunnelled subclavian catheters (TSC) was conducted in 42 patients who each had a TSC for chemotherapy. They were enrolled in the study from August 1994 to December 1995. The inclusion criteria were: age 18-70, no general anticoagulant treatment, TSC used only for chemotherapy, informed consent. Heparinization was performed at the end of each cycle and then at increasing intervals: 11, 13, 15, 17, 19, and 21 days. A 21-day interval was intended to mimic the suppression of heparinization between cycles. Heparinization was performed with a 250 IU/ml heparin solution. Anti-Xa activity was studied before each heparinization. For each interval, at least 5 patients were followed up for two cycles. If no blockages were present progression to the next step was authorized. If one blockage was observed 5 additional patients were required to have their TSCs heparinized after the same interval. Two blockages (block) after the same interval meant that the previous interval was recorded as the longest tolerable. There were no blocks with the 11-day interval (6 patients), 1 block after 13 days (10 patients), 1 block after 15 days (10 patients), and no blocks after 17 days (5 patients), 19 days (6 patients), or 21 days (5 patients). The median anti-Xa activity (curative rate 0.2-0.6) was, respectively 11 days 6.74; 13 days 5.47; 15 days 4.71; 17 days 3.61; 19 days 3.67; 21 days 5.10 (NS). Heparinization between two cycles of chemotherapy is unnecessary. A high level of heparin activity persisted constantly inside the catheter lumen through the 3-week observation period.

Adenocarcinoma↗