PubMed Health⌕ Search

Biomedical subjects

C T Cloutier

Publications and source records attributed to C T Cloutier.

At least 19 recordsLinked to original sources
PubMed1993

Diagnostic laparoscopy as an adjunct to selective conservative management of solid organ injuries after blunt abdominal trauma.

To investigate the efficacy of diagnostic laparoscopy (DL) as an adjunct in patient selection for conservative management of solid organ injuries (SOI) following blunt abdominal trauma, 15 patients with injuries documented by computed tomographic (CT) scanning were prospectively evaluated. Diagnostic laparoscopy was performed in an attempt to characterize SOI, to evaluate the abdomen for associated occult injuries, and to select patients for conservative management or laparotomy. The 15 patients had CT evidence of 17 SOIs (nine spleen, eight liver), and DL allowed adequate visualization of 15 of the 17 injuries. Occult hollow viscus injury was discovered in 2 of 15 patients (one colon, one small bowel) and required laparotomy. In the remaining 13 patients, DL revealed ongoing hemorrhage in four patients and poor visualization in one patient that prompted laparotomy (four splenorrhaphy, one hepatorrhaphy). Conservative management was employed in the treatment of eight patients with findings of minor injury or adequate hemostasis on DL. The average transfusion requirement in this group was 1.8 U. No patient failed conservative management. There were no complications attributable to DL. These data demonstrate that DL may become an effective adjunct in patient selection for conservative management of SOI following blunt abdominal trauma.

Abdominal Injuries↗
PubMed1992

Early postlaparotomy percutaneous endoscopic gastrostomy.

Percutaneous endoscopic gastrostomy (PEG) is a relatively new procedure, the indications for which are evolving. We have recently attempted PEG placement in 19 patients during the early postlaparotomy period (less than 14 days) for initiating enteral feedings or providing decompression of the gastrointestinal tract. All patients had unexpected postoperative complications, including neurologic catastrophe, recurrent obstruction of the small intestine, acute respiratory failure, enterocutaneous fistula or poor oral intake. Of 19 attempts, PEG placement was successful in 18 patients (94.7 per cent). There were no major complications; two minor complications (exit site infection) were associated with catheter placement. All PEG placed for enteral feedings were successfully used for nutritional support, and gastrointestinal decompression was accomplished in seven of eight patients requiring PEG. The results of this study demonstrate that PEG is technically feasible, safe and effective in the early postlaparotomy period in high-risk patients with complicated postoperative courses and the need for long term enteral access.

Adult↗
PubMed1991

Incidence and timing of hypothermia in trauma patients undergoing operations.

Hypothermia is a major problem in patients who have sustained trauma. We reviewed the cases of 100 consecutive trauma patients transferred directly to the operating room (OR) from the Emergency Department (ED) in a Level I trauma center; 26 cases could not be evaluated. Forty-two patients (57%) became hypothermic at some time between injury and leaving the OR. Fifty-five patients (74%) had a temperature (T) recorded on arrival to the ED; but only 7 (12%) were hypothermic (34.7 degrees +/- 1.5 degrees C). In contrast, 34 patients (46%) arrived in the OR hypothermic (34.8 degrees +/- 0.9 degrees C) and 26 (76%) of these left the OR hypothermic (34.8 degrees +/- 0.9 degrees C). Eight additional patients (20%) arriving in the OR with a T greater than 35.9 degrees C left the OR hypothermic (35.1 degrees +/- 0.4 degrees C). The mean T loss in the ED was significantly greater than that lost in the OR (-0.8 degrees +/- 0.7 degrees C vs. 0.0 degrees +/- 0.6 degrees C; p less than 0.0001, ANOVA). Ninety-two percent of the patients lost temperature in the ED, while 43% of the patients gained temperature in the OR. Hypothermia was associated with lower Trauma Scores, and those patients who were severely hypothermic received more intravenous fluids. However, the impact of fluid infusion was not independent from Trauma Score and did not fully explain the magnitude of the heat loss. These data suggest that hypothermia in trauma patients has a multifactoral etiology related to the magnitude of injury and that the major T loss occurs in the ED rather than in the OR.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Ibuprofen plus prostaglandin E1 in a septic porcine model of adult respiratory distress syndrome.

Prostaglandin manipulation has been shown to improve pulmonary dysfunction in animal models of acute respiratory distress syndrome. Using our previously reported porcine model of Pseudomonas-induced respiratory failure, we examined the therapeutic effects of a vasodilating prostaglandin, PGE1, and a reversible cyclooxygenase inhibitor, ibuprofen. Forty-two animals were randomized to seven groups: I--ibuprofen; II--PGE1; III--ibuprofen + PGE1; IV--Pseudomonas + ibuprofen; V--Pseudomonas + PGE1; VI--Pseudomonas + ibuprofen + PGE1; VII--Pseudomonas. Ibuprofen significantly improved pulmonary vasoconstriction, pulmonary hypertension, and hypoxemia, as well as increased survival slightly. PGE1 had no effect on pulmonary dysfunction, but prevented the rise in systemic vascular resistance that occurred in untreated, infected animals and animals treated with ibuprofen alone. Combination therapy improved stroke volume index, a measure of nonpulmonary organ function.

Alprostadil↗
PubMed1988

Effect of positive end-expiratory pressure on extravascular lung water in porcine acute respiratory failure.

Recent studies of acute respiratory failure suggest that PEEP causes increased pulmonary interstitial fluid collection and therefore increased extravascular lung water (EVLW). We examined the effect of increasing levels of PEEP on EVLW in 20 to 25-kg pigs with acute respiratory failure induced by continuous infusion of live Pseudomonas aeruginosa (2 X 10(8) organisms/20 kg.min). Animals were intubated, paralyzed, and ventilated at 15 ml/kg tidal volume and an FIO2 of 0.4. Pigs in group 1 were given 4 ml/kg.h of iv fluid (lactated Ringer's solution) with no PEEP administered. Animals in groups 2 through 5 were given 0, 4, 17, and 44 ml/kg.h of lactated Ringer's solution, respectively, and PEEP was added at 5-cm H2O increments per half-hour, starting one hour after beginning P. aeruginosa infusion. EVLW in PEEP animals was less than or equal to that in controls despite variation in the administration of lactated Ringer's solution. This suggests that PEEP may slow EVLW accumulation over time and provide a protective effect that allows increased amounts of crystalloid fluids to be administered.

Animals↗
PubMed1987

Does compliance reflect oxygen delivery in porcine septic respiratory failure treated with positive end-expiratory pressure?

Oxygen delivery (DO2) in patients with acute respiratory failure has been correlated with total lung and chest wall compliance (CT), the optimal positive end-expiratory pressure (PEEP) level reportedly corresponds to maximal DO2. To test the validity of the relationship, we studied the correlation between CT and DO2 in 12 septic pigs with acute respiratory failure induced by continuous infusion of live Pseudomonas aeruginosa bacteria. Cardiac output, pulmonary and systemic arterial BP, blood gases, extravascular lung water, tidal volume, and airway pressure were measured serially in six control animals and six animals receiving increasing amounts of PEEP. There was no significant correlation between DO2 and CT in either group; however, animals receiving PEEP had less extravascular lung water.

Acute Disease↗
PubMed1987

Complement depletion in a porcine model of septic acute respiratory disease.

In a porcine model of severe septic acute respiratory failure produced by continuous infusion of live Pseudomonas aeruginosa, the role of the complement system was studied by pretreating animals with cobra venom factor (CVF) to deplete C3. Three groups of spontaneously breathing animals were monitored with Swan-Ganz and arterial thermodilution catheters. Group I was pretreated with 80 U/kg of CVF iv 16-18 hours before testing. Group II received Ps. aeruginosa iv (2 X 10(8)/20 kg/minute). Group III was pretreated with CVF and later given the Pseudomonas infusion. The CH50 as a measure of complement activity was less than 7% of normal level in Groups I and III. No changes in respiratory variables occurred in Group I. In Group II, the mean pulmonary artery pressure doubled, intrapulmonary shunt fraction (Qs/Qt) increased, PaO2 decreased, and extravascular lung water doubled in 4 hours. In Group III, the pulmonary hypertension, hypoxemia, increase in Qs/Qt, and increase in EVLW were all significantly less than in Group II. Neutropenia occurred with the Pseudomonas infusion in Groups II and III.

Animals↗
PubMed1986

Post-traumatic pancreatic sequestrum: recognition and treatment.

Midline pancreatic injury from blunt trauma can be very subtle. Although nonoperative management usually results in early complications, chronic symptoms may develop 2 months to 2 years after injury. Four patients with pancreatic sequestrum demonstrated the need for ERCP in patients with epigastric pain developing late after injury, emphasizing the importance of early operation and complete exploration of pancreatic injuries.

Abdominal Injuries↗
PubMed1986

A critical comparison of the hematologic, cardiovascular, and pulmonary response to steroids and nonsteroidal anti-inflammatory drugs in a model of sepsis and adult respiratory distress syndrome.

Improved survival of patients receiving high-dose steroid therapy in sepsis and adult respiratory distress syndrome (ARDS) has been reported, but such therapy and its benefits remain controversial. Recently research has been directed toward manipulation of the arachidonic acid cascade. Improved survival and hemodynamics with administration of nonsteroidal anti-inflammatory drugs (NSAID) have been reported in animal models of sepsis and ARDS. The purpose of this study was to compare the effects of steroids (methylprednisolone) and NSAID (ibuprofen) in a porcine model of septic ARDS induced by a continuous infusion of live Pseudomonas aeruginosa. Cardiopulmonary parameters were monitored in animals intubated, paralyzed, and ventilated at a 250 ml tidal volume and 0.5 Fio2. Pigs were randomly assigned to one of five groups: groups I and II received respective doses of 12.5 mg/kg ibuprofen and 30 mg/kg methylprednisolone at 20 and 210 minutes after baseline; group III had P. aeruginosa only; groups IV and V received respective doses of ibuprofen and methylprednisolone at 20 and 210 minutes of sepsis. Significant pulmonary edema, increased intrapulmonary shunting, hypoxemia, hemoconcentration, and systemic hypotension occurred with P. aeruginosa infusion. In septic animals treated with ibuprofen normal systemic arterial pressure was maintained, hemoconcentration was decreased, and oxygenation was improved with a significant decrease in shunting and pulmonary edema. Administration of methylprednisolone improved hemoconcentration and cardiac index, but no significant effect on pulmonary edema, intrapulmonary shunting, or oxygenation was observed. The results of this study demonstrated a significant beneficial effect of ibuprofen and we would encourage controlled clinical trials of this drug in the management of sepsis and ARDS. On the other hand, methylprednisolone was found to be relatively ineffective in treatment of circulatory collapse and ARDS associated with sepsis.

Animals↗
PubMed1984

Effects of ibuprofen on a porcine model of acute respiratory failure.

Blockade of the arachidonic acid cascade has been shown to improve survival and hemodynamic alterations in animal models of sepsis and acute respiratory failure (ARF). The effects of intravenous ibuprofen, a cyclooxygenase inhibitor, were observed in 20-30 kg pigs with ARF induced by a continuous LD100 infusion of live Pseudomonas aeruginosa (2 X 10(8)/20 kg/min). Cardiopulmonary parameters were monitored in animals intubated, paralyzed, and ventilated at a 250-ml tidal volume and 0.5 FiO2. Pigs were randomly assigned to three groups: Group I received 2 bolus infusions of ibuprofen (12.5 mg/kg) at 20 and 210 min after baseline; Group II had Ps. aeruginosa (2 X 10(8) CFU/20 kg/min) only; Group III received Ps. aeruginosa and 12.5 mg/kg of ibuprofen at 20 and 210 min of ARF. Ibuprofen alone caused no significant changes in cardiorespiratory parameters. With Ps. aeruginosa infusion, significant pulmonary hypertension, hypoxemia, increased intrapulmonary shunt fraction, and systemic hypotension occurred. In the septic animals treated with ibuprofen, oxygenation was improved by a significant decrease in shunt, pulmonary edema, and pulmonary hypertension.

Acute Disease↗
PubMed1984

Effect of bilateral adrenalectomy on blood sugar level and plasma refill in a rat hemorrhagic shock model.

Recent studies suggest that the hyperglycemic response to hemorrhage and shock may play a role in promoting plasma refill via its hyperosmolar effect. This relationship was tested in a bilaterally adrenalectomized rat model. After a left carotid arterial cannulation, seven adrenalectomized rats and seven control rats with intact adrenal glands were bled periodically for periods of 15 min followed by 15 min of rest. The initial hemorrhage depleted 7.5% of the total blood volume (TBV) and subsequent hemorrhages 5% each. The study period extended up to 120 min to replicate a hemorrhage of 22.5% of TBV. Micromethod hematocrits (Hct) and blood sugar (BS) were monitored every 15 min and results were analyzed by use of a BMD-P statistical package on an AMDAHL 470 computer. A significant (p less than 0.05) increase in BS during shock was seen in the control rats, while the adrenalectomized animals did not demonstrate a significant hyperglycemic response. There was no significant difference in the plasma refill observed between the two groups. At 60 min, the Hct fell 3.6 +/- 1.7 and 4.6 +/- 0.6 percentage points for control and adrenalectomized animals, respectively, while at 120 min, a respective Hct drop of 7.5 +/- 1.6 and 5.4 +/- 1.1 percentage points was noted. This study indicates that the absence of the hyperglycemic response in the adrenalectomized rats had no effect on plasma refill when compared to the response of control rats with intact adrenals.

Adrenalectomy↗
PubMed1984

Crystalloid versus colloid resuscitation in experimental hemorrhagic pancreatitis.

In a canine model of acute hemorrhagic pancreatitis, crystalloid resuscitation with a balanced salt solution adequately restored plasma volume, supported tissue perfusion and prevented excessive hemodilution without detrimental effects on pulmonary pressures or oxygenation. No advantages in using colloid resuscitation were apparent in our study.

Acute Disease↗
PubMed1983

Comparison of live bacteria infusions in a porcine model of acute respiratory failure.

Acute respiratory failure (ARF) related to sepsis continues to have a high mortality and uncertain pathogenesis. With a reproducible live Pseudomonas aeruginosa infusion pig model, the gas exchange, hemodynamics, and pulmonary clearance of this organism were compared with live Staphylococcus aureus and Escherichia coli. Lightly anesthetized, male, mixed-breed pigs, 15-30 kg, were intubated, allowed to breathe spontaneously, and had femoral artery, central venous, and Swan-Ganz catheterization through cutdowns. After baseline data were collected, approximately 1 X 10(9) organisms/20 kg/min were infused into a central vein for 4 hr with frequent monitoring of the variables. Immediate autopsies were done for related quantitative tissue culture studies. S. aureus pigs maintained a high rate of lung bacterial clearance with pulmonary hypertension, a nonsignificant decrease in PaO2, and relatively normal lungs at autopsy. Ps. aeruginosa and E. coli animals developed systemic hypotension, pulmonary hypertension, increased pulmonary vascular resistance, hypoxemia, and decreased pulmonary clearance. Their lungs had gross congestion and edema. These studies confirm the suitability of E. coli and Ps. aeruginosa infusion into pigs as a model of sepsis-induced ARF in man. The findings also indicate that neither pulmonary hypertension nor bacterial clearance by the lungs is sufficient to cause ARF.

Acute Disease↗
PubMed1983

Prostacyclin in experimental septic acute respiratory failure.

Manipulation of prostaglandins (PG) in animal models of sepsis and acute respiratory failure (ARF) is promising. Prostacyclin (PGI2), a short-acting vasodilator, was evaluated in a porcine model of ARF produced by continuous infusion of live Pseudomonas aeruginosa (Ps.). Cardiopulmonary parameters were monitored in three groups of spontaneously breathing animals that received 0.1 micrograms PGI2/kg/min begun 20 min after baseline (Group I); 2 X 10(8) Ps./20 kg/min (Group II); identical Ps. infusion and then PGI2 begun at 20 min (Group III). The decrease in mean arterial blood pressure and cardiac index with Ps. infusion was improved by PGI2 treatment. In Groups II and III, mean pulmonary artery pressure (PAP) doubled (P less than 0.005) and pulmonary vascular resistance (PVR) tripled (P less than 0.01) by 15 min. Both PAP and PVR were decreased significantly with PGI2 treatment. In both Ps. groups, significant hypoxemia occurred. PGI2 improves cardiac output and acts as a pulmonary vasodilator, but does not improve oxygenation in this porcine model of severe ARF.

Acute Disease↗
PubMed1983

Indomethacin improvement of septic acute respiratory failure in a porcine model.

The effects of indomethacin, a prostaglandin synthesis blocker, were tested in a porcine model of septic acute respiratory failure (ARF) produced by continuous infusion of live Ps. aeruginosa. Control groups received either indomethacin boluses (2 mg/kg) intravenously at 20 and 210 minutes or Ps. aeruginosa infusion (2 X 10(8) CFU/20 kg/min). The treatment group received both continuous Ps. aeruginosa infusion and indomethacin. Indomethacin alone transiently but significantly decreased cardiac indices, heart rate, and PaCO2. With Ps. aeruginosa infusion, significant pulmonary hypertension, hypoxemia, increased intrapulmonary shunt fraction, and systemic hypotension occurred. In this porcine model of septic ARF, indomethacin doubled the survival period and improved cardiopulmonary parameters.

Acute Disease↗
PubMed1983

Experimental pancreatitis does not produce pulmonary hypertension.

The onset of experimental hemorrhagic pancreatitis in dogs was rapidly followed by a deterioration of CO, blood pressure, LVSW and RVSW, along with significant elevations of Hct, SVR and PVR. These alterations could all be reversed by the administration of Ringer's lactate. These findings support the concept that the major physiopathologic characteristic of severe acute pancreatitis is a loss of effective plasma and extracellular fluid volumes and that the replacement of fluid losses corrects the hemodynamic alterations. In neither of the experimental groups did pulmonary hypertension develop. We found no evidence in this model of hemorrhagic pancreatitis for a circulating pulmonary vasoactive substance.

Acute Disease↗