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Biomedical subjects

Claude Martin

Publications and source records attributed to Claude Martin.

At least 37 records · Page 2Linked to original sources
PubMed2004

Risk factors for late-onset ventilator-associated pneumonia in trauma patients receiving selective digestive decontamination.

OBJECTIVE: To determine the independent risk factors for late-onset ventilator-associated pneumonia (VAP) in trauma patients receiving selective digestive decontamination (SDD). DESIGN: A 4-year, prospective cohort study of trauma patients meeting the following criteria: injury severity score >15, and duration of mechanical ventilation >5 days. Predictors of late-onset VAP occurrence were assessed by logistic regression analysis. POPULATION: All patients received SDD consisting of polymixin E, gentamicin, and amphotericin B applied in nostrils, mouth, and gut with a 3-day course of parenteral cefazolin. VAP was suspected on clinical and radiological signs, and confirmed by the presence of at least one microorganism at a concentration of at least 10(4) CFU/ml on the broncho-alveolar lavage. MEASUREMENT: Independent risk factors for late-onset VAP. RESULTS: A late-onset VAP was diagnosed in 90 (56%) out of 159 patients. Predicting factors for late-onset VAP were: use of non-depolarizing muscle relaxant agents for intubation [3.4 (CI 1.08-10.73)], duration of intubation [1.06 (CI 1.01-1.17)], length of intensive care unit (ICU) stay [1.05 (CI 1.02-1.09)], and prior tracheal colonization [1.03 (CI 1.02-1.21)]. Exposure to prior antimicrobial treatment, except SDD, conferred protection [0.3 (0.12-0.74)]. CONCLUSION: This study confirms the role of duration of intubation, length of ICU stay, and prior tracheal colonization in the development of late-onset VAP. The results also highlight the importance of the initial management on the development of late-onset VAP. The type of neuromuscular blocking agents to intubate trauma patients should be evaluated in future studies.

Adult↗
PubMed2004

Clinical review: Vasopressin and terlipressin in septic shock patients.

Vasopressin (antidiuretic hormone) is emerging as a potentially major advance in the treatment of septic shock. Terlipressin (tricyl-lysine-vasopressin) is the synthetic, long-acting analogue of vasopressin, and has comparable pharmacodynamic but different pharmacokinetic properties. Vasopressin mediates vasoconstriction via V1 receptor activation on vascular smooth muscle. Septic shock first causes a transient early increase in blood vasopressin concentrations; these concentrations subsequently decrease to very low levels as compared with those observed with other causes of hypotension. Infusions of 0.01-0.04 U/min vasopressin in septic shock patients increase plasma vasopressin concentrations. This increase is associated with reduced need for other vasopressors. Vasopressin has been shown to result in greater blood flow diversion from nonvital to vital organ beds compared with adrenaline (epinephrine). Of concern is a constant decrease in cardiac output and oxygen delivery, the consequences of which in terms of development of multiple organ failure are not yet known. Terlipressin (one or two boluses of 1 mg) has similar effects, but this drug has been used in far fewer patients. Large randomized clinical trials should be conducted to establish the utility of these drugs as therapeutic agents in patients with septic shock.

Adult↗
PubMed2004

Survey of the use of catecholamines by French physicians.

OBJECTIVE: The objective of the study was to perform a descriptive approach of the current use of catecholamines by French physicians. DESIGN: A questionnaire of 12 questions with 4 items established by a group of French intensivists. POPULATION: French physicians from 433 departments working in the following practicing areas: intensive care unit (ICU), emergency department, and pre-hospital setting. MEASUREMENTS: Responding physicians were asked about the catecholamine that they would select in various clinical settings. RESULTS: The response rate was 82%. Of the responding physicians, 277 (78%) worked in an ICU, 28 (8%) in an emergency department, and 21 (6%) in a pre-hospital setting. Dobutamine was chosen for patients with cardiogenic shock by 90% of the respondents. Norepinephrine was the first choice agent as vasopressor in patients with septic shock in 52% of the cases. Dopamine was selected in a clinical setting requiring an optimization of regional blood flow, as in the concept of high-risk surgical patients. Dopexamine was used as a second or third choice agent to improve regional blood flow and cardiac output. The indications of epinephrine for anaphylactic shock and cardio-circulatory arrest were obvious for more than 90% of responding physicians. CONCLUSION: A lack of standardization appears in the use of catecholamines by French physicians, particularly for improvement of regional circulation and management of high-risk surgical patients. Guidelines that define the place of each catecholamine in these settings are required to improve the quality of prescription.

Catecholamines↗
PubMed2004

Catheter-associated urinary tract infections in intensive care units.

The purpose of this review is to analyze literature concerning the diagnosis, prevention, and management of catheter-associated urinary tract infection (CAUTI) occurring in patients hospitalized in the intensive care unit (ICU). Analysis was performed from personal and "Pubmed" data, crossing the following keywords: "urinary tract infection", "catheter', and "intensive care unit". Few clinical trials including ICU patients were found despite the abundance of expert opinions. There is no consensus on the use of urinary reagent tests for diagnosis. The prevention of CAUTI in ICU patients does not require expensive devices. Neither complex closed drainage systems nor silver-coated urinary catheters have demonstrated efficacy in comparative randomized clinical trials. Bladder irrigation should not be used, except when an obstruction of the catheter is highly likely. The administration of prophylactic antimicrobial therapy, although effective in reducing the incidence of urinary bacteria, cannot be recommended in ICU patients. The management of CAUTI in ICU patients has not been evaluated in clinical trials. The level of evidence provided in this field is weak, and underlines the need for randomized studies to improve management of patients.

Cross Infection↗
PubMed2004

Cell adhesion molecules as a marker reflecting the reduction of endothelial activation induced by glucocorticoids.

In vitro, steroids down-regulate the expression of cell adhesion molecules (CAMs) in endothelial cells stimulated by lipopolysaccharide. Low-dose hydrocortisone is a new treatment of patients with septic shock, a state that is characterized by an endothelial injury. The aim of the present study was to investigate whether the plasma levels of soluble CAMs, reflecting in vivo endothelial activation, could be modulated in patients with septic shock treated by hydrocortisone. This was a prospective and observational study conducted in the intensive care unit at a university hospital. The subjects included 40 patients with septic shock (American College of Chest Physicians Consensus Conference/Society of Critical Care Medicine definition); 45 healthy blood donors served as controls. The patients receiving the standard care ("reference group") during the first 6 months were compared with the patients receiving the hydrocortisone therapy ("hydrocortisone group") for the next 6 months. Measurements of sCAMs were performed on days 1 and 3 of the disease. On day 1, sE-selectin, sP-selectin, sVCAM-1, and sICAM-1 were significantly elevated in patients with septic shock compared with healthy donors. sE-selectin levels significantly decreased between days 1 and 3 in the "hydrocortisone group," whereas there was no significant change in the "reference group". Surprisingly, sICAM-1 levels significantly increased between days 1 and 3 only in patients treated by hydrocortisone. No significant changes were observed for sP-selectin and sVCAM-1 levels in the two groups. In patients with septic shock, glucocorticoids differently affected the pattern of evolution of sCAMs, with sE-selectin being decreased and sICAM-1 being increased. Expression of sP-selectin and sVCAM-1 was not affected.

Adult↗
PubMed2004

Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update.

OBJECTIVE: To provide the American College of Critical Care Medicine with updated guidelines for hemodynamic support of adult patients with sepsis. DATA SOURCE: Publications relevant to hemodynamic support of septic patients were obtained from the medical literature, supplemented by the expertise and experience of members of an international task force convened from the membership of the Society of Critical Care Medicine. STUDY SELECTION: Both human studies and relevant animal studies were considered. DATA SYNTHESIS: The experts articles reviewed the literature and classified the strength of evidence of human studies according to study design and scientific value. Recommendations were drafted and graded levels based on an evidence-based rating system described in the text. The recommendations were debated, and the task force chairman modified the document until <10% of the experts disagreed with the recommendations. CONCLUSIONS: An organized approach to the hemodynamic support of sepsis was formulated. The fundamental principle is that clinicians using hemodynamic therapies should define specific goals and end points, titrate therapies to those end points, and evaluate the results of their interventions on an ongoing basis by monitoring a combination of variables of global and regional perfusion. Using this approach, specific recommendations for fluid resuscitation, vasopressor therapy, and inotropic therapy of septic in adult patients were promulgated.

Adult↗
PubMed2004

Terlipressin in catecholamine-resistant septic shock patients.

To determine the effects on hemodynamics, laboratory parameters, and renal function of terlipressin used in septic-shock patients with hypotension not responsive to high-dose norepinephrine (>2.0 microg x kg(-1) x min(-1)) and dopamine (25 microg x kg(-1) x min(-1)), a prospective, open-label study was carried out in 17 patients. Patients received one or two boluses of 1 mg of terlipressin. In all patients terlipressin induced a significant increase in mean arterial pressure (MAP), systemic vascular resistance, pulmonary vascular resistance, and left and right ventricular stroke work. The increase in MAP was accompanied by a significant decrease in heart rate and cardiac index, but stroke volume remained unchanged. Oxygen delivery and consumption were significantly decreased. Blood lactate concentrations significantly decreased over the study period. Bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were significantly increased. Thrombocytes were significantly decreased. No change in prothrombin time was observed. Renal function, assessed by urine flow and creatinine clearance, was significantly improved. Pulmonary function assessed by Pao2/Fio2 ratio was not affected. A significant reduction in norepinephrine and dopamine infusion rates was observed in all patients. Eight patients died during their ICU stay from late multiple organ failure. Within the limitations of the present study (open-label design, small group of patients), it can be concluded that in septic shock patients with hypotension nonresponsive to fluid resuscitation and high-dose vasopressors, terlipressin can be effective to restore MAP. Cardiac index should be closely monitored because it was significantly decreased by terlipressin. Renal function was significantly improved. Mesenteric circulation was not evaluated, but hepatic function was altered during the study period. Further studies are required to determine whether terlipressin is safe in terms of outcome in septic shock patients.

Alanine Transaminase↗
PubMed2004

Clinical and therapeutic features of nonpostoperative nosocomial intra-abdominal infections.

OBJECTIVE: To compare the clinical, microbiological, and therapeutic features of nonpostoperative nosocomial intra-abdominal infections (non-PostopNAI) with community-acquired intra-abdominal infections (CAI). SUMMARY BACKGROUND DATA: Prospective (June 2000 through January 2001) consecutive case series analysis of patients operated for secondary nonpostoperative intra-abdominal infections collected in 176 study centers (surgical wards and intensive care units). PATIENTS AND METHODS: Clinical, microbiological, and therapeutic characteristics of CAI and non-PostopNAI infections were collected. Management of antibiotic therapy was decided by the attending physician. The efficacy of treatment was evaluated over a 30-day period after the index episode. RESULTS: Evaluatable observations (n = 1008) were collected (761 CAI and 247 non-PostopNAI), including 285 intensive care unit patients. When compared with CAI patients, non-PostopNAI patients presented an increased interval between admission to the surgical ward and operation (1.3 +/- 1.5 vs. 0.5 +/- 0.7 days in CAI patients; P < 0.001), increased proportions of underlying diseases, a more severe clinical condition as assessed by increased proportions of hospitalization in the intensive care unit (48% vs. 22% in CAI patients, P < 0.001) and a higher SAPS II score (34 +/- 15 vs. 24 +/- 14, P < 0.001). In non-PostopNAI patients, increased proportions of therapeutic failure (15% vs. 7% in CAI patients, P < 0.01) and of fatalities (12% vs. 4% in CAI patients, P < 0.001) were observed. CONCLUSIONS: Delayed diagnosis and increased severity are the main characteristics of non-PostopNAI infections. Microbiological features are quite similar in CAI and non-PostopNAI infections, suggesting that antibiotic therapy recommended for CAI infections could be applied to non-PostopNAI patients. Characteristics of non-PostopNAI patients should lead to identify them as a specific entity in clinical trials.

Abdomen↗
PubMed2004

The effects of remifentanil on endotracheal suctioning-induced increases in intracranial pressure in head-injured patients.

In patients with severe traumatic brain injury, bronchotracheal toilet may be accompanied by deleterious variations in intracranial pressure (ICP). To avoid these effects, IV opioids have been proposed. Twenty mechanically-ventilated patients received 3 ascending IV doses of remifentanil: dose 1 (1 microg/kg bolus, 0.25 microg/kg/min infusion); dose 2 (2 microg/kg bolus, 0.5 microg/kg/min infusion); and dose 3: (4 microg/kg bolus, 1 microg/kg/min infusion). Endotracheal suction was performed 20 min after the beginning of infusion to assess coughing. Heart rate, ICP, mean arterial blood pressure (MAP), cerebral perfusion pressure (CPP), middle cerebral artery mean flow velocity (V(MCA)), and bispectral index were monitored throughout the 30-min study period. Twelve, 15, and 19 patients receiving dose 1, 2, and 3, respectively, required vasopressors to maintain CPP >60 mm Hg. Suctioning resulted in coughing in 16, 15, and 5 patients receiving dose 1, 2, and 3, respectively. An increase in ICP, without change in V(MCA), corresponded to the reduction in MAP consistent with the preservation of autoregulation. Remifentanil used as a continuous infusion in head-injured patients is not an effective drug to block responses to suctioning.

Adult↗
PubMed2004

Renal effects of norepinephrine in septic and nonseptic patients.

OBJECTIVE: To assess the effects of a norepinephrine-induced vasoconstriction on renal function in septic and nonseptic patients. DESIGN: Open-label prospective study. SETTING: Medical-surgical ICU in an urban teaching hospital. PATIENTS: Fourteen patients with septic shock and 12 uninfected patients with head trauma (Glasgow coma score, < 8). INTERVENTIONS: Patients received norepinephrine infusion to increase systemic vascular resistance index (SVRI), and to raise mean arterial BP (MAP) to > 70 mm Hg in the septic group and cerebral perfusion pressure (CPP) to > 70 mm Hg in the head trauma group. MEASUREMENTS AND MAIN RESULTS: MAP and SVRI increased in both groups (p < 0.001), and CPP significantly increased in the head trauma group (p < 0.001). The cardiac index was not modified in either group. Norepinephrine infusion reestablished urine flow in 12 of the 14 septic patients (p < 0.001), with a decrease in serum creatinine levels (p < 0.001) and an increase in creatinine clearance rate (p < 0.001) after 24 h. Urine parameters were not affected in the head trauma group. CONCLUSION: Within the limitation of the present study, norepinephrine administration induces a marked vasoconstriction in septic and nonseptic patients. Norepinephrine has positive effects on renal function in septic patients but has no significant effect on the same urinary parameters when administered to uninfected patients with normal renal function.

Blood Pressure↗
PubMed2003

Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit.

OBJECTIVE: To determine the risk factors for catheter-associated urinary tract infection in a polyvalent intensive care unit (ICU). DESIGN: Prospective cohort study. SETTING: Sixteen-bed polyvalent ICU in a French university hospital. INTERVENTIONS: Prospective patient surveillance of patients included in two successive studies of two urine drainage systems. MAIN OUTCOME MEASURES: Bacteriuria occurrence in 553 ICU patients requiring a bladder catheter for longer than 48 h. The following variables were analyzed as possible risk factors: age, sex, severity score at admission, diagnosis on admission, duration of bladder catheterization, length of ICU stay, prior exposure to antibiotics, and system of urine drainage. RESULTS: The frequency of catheter-associated bacteriuria was 9.6%. From the multivariate analysis, five independent risk factors were determined: female sex, length of ICU stay, use of an antimicrobial therapy, severity score at admission, and duration of catheterization. CONCLUSION: In our study, the drainage system did not influence the occurrence of bacteriuria. To decrease the rate of catheter-associated bacteriuria in polyvalent ICU patients, removal of the bladder catheter must be performed as soon as possible.

Adult↗
PubMed2003

Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit.

OBJECTIVE: To determine the risk factors for catheter-associated urinary tract infection in a polyvalent intensive care unit (ICU). DESIGN AND SETTING: Prospective cohort study in a 16-bed polyvalent ICU in a French university hospital. INTERVENTIONS: Prospective patient surveillance of patients included in two successive studies of two urine drainage systems. MEASUREMENTS AND RESULTS: Bacteriuria occurrence in 553 ICU patients requiring a bladder catheter for longer than 48 h. The following variables were analyzed as possible risk factors: age, sex, severity score at admission, diagnosis on admission, duration of bladder catheterization, length of ICU stay, prior exposure to antibiotics, and system of urine drainage. The frequency of catheter-associated bacteriuria was 9.6%. From the multivariate analysis, five independent risk factors were determined: sex female, length of ICU stay, use of an antimicrobial therapy, severity score at admission, and duration of catheterization. CONCLUSIONS: In our study the drainage system did not influence the occurrence of bacteriuria. To decrease the rate of catheter-associated bacteriuria in polyvalent ICU patients removal of the bladder catheter must be performed as soon as possible.

APACHE↗
PubMed2003

Comparison of effectiveness of two urinary drainage systems in intensive care unit: a prospective, randomized clinical trial.

OBJECTIVE: In a previous non-randomized study, we demonstrated that no difference occurred in the rate of acquisition of bacteriuria between a complex closed drainage system (CCDS) and a two-chamber drainage system (TCDS) in patients in an intensive care unit (ICU). To confirm this result, we performed a randomized, prospective, and powerful study assessing the effectiveness of the CCDS and the TCDS in ICU patients. DESIGN: Randomized, prospective, and controlled study. SETTING: Medico-surgical intensive care unit (16 beds) in a teaching hospital. PATIENTS AND INTERVENTIONS: Three hundred and eleven patients requiring an indwelling urinary catheter for longer than 48 h were assigned individuals to the TCDS group or CCDS group to compare the rate of acquisition of bacteriuria. MEASUREMENTS AND RESULTS: Patients did not receive prophylactic antibiotics during placement management or catheter withdrawal. Urine samples were obtained weekly for the duration of catheterization and within 24 h after catheter removal, and each time symptoms of urinary infection were suspected. There was no statistical difference in the rate of bacteriuria between the two groups. Bacteriuria occurred in 8% and 8.5% of patients for TCDS and CCDS, respectively. Rates of urinary tract infection were 12.1 and 12.8 episodes per 1,000 days of catheter. CONCLUSION: This randomized study, that compares the effectiveness of a TCDS and a CCDS in ICU patients, confirms the results of our previous study. No differences were noted between the two systems (a =0.05). The higher cost of CCDS is not justified for ICU patients.

Adult↗
PubMed2003

Comparison of effectiveness of two urinary drainage systems in intensive care unit: a prospective, randomized clinical trial.

OBJECTIVE: In a previous nonrandomized study we observed no difference in the rate of acquisition of bacteriuria between a complex closed drainage system (CCDS) and a two-chamber drainage system (TCDS) in ICU patients. To confirm this result we performed a statistically powerful study assessing the effectiveness of the CCDS and the TCDS in ICU patients. DESIGN AND SETTING: Randomized, prospective, and controlled study in the medicosurgical intensive care unit (16 beds) in a teaching hospital. PATIENTS AND INTERVENTIONS: We assigned 311 patients requiring indwelling urinary catheter for longer than 48 h to TCDS or CCDS to compare the rate of acquisition of bacteriuria. MEASUREMENTS AND RESULTS: Patients did not receive prophylactic antibiotics during placement management or catheter withdrawal. Urine samples were obtained weekly for the duration of catheterization and within 24 h after catheter removal, and each time symptoms of urinary infection were suspected. There was no statistical difference in the rate of bacteriuria between the two groups: 8% with TCDS and 8.5% with CCDS. Rates of urinary tract infection were 12.1 episodes with TCDS and 12.8 episodes with CCDS per 1000 days of catheter. CONCLUSIONS: This randomized study on the effectiveness of TCDS and CCDS in ICU patients confirms the findings of our previous study. No differences were noted between the two systems. The higher cost of CCDS is not justified for ICU patients.

Adult↗
PubMed2003

Outcome of postoperative pneumonia in the Eole study.

OBJECTIVES: Prognosis factors of ventilator-associated pneumonia (VAP) have been largely investigated, while the data concerning postoperative pneumonia (POP) are scarce. The aim of this multicenter, prospective study was to evaluate the predictive factors of mortality due to POP and the impact of initial antibiotic therapy on outcome. METHODS: Two hundred centers were included. Diagnosis of POP was assessed on clinical and laboratory criteria, chest X-ray changes and microbiological criteria, when possible. Outcomes of the patients were noted. An independent committee made a retrospective assessment of appropriateness of antimicrobial therapy. RESULTS: The overall mortality among the 556 cases of POP was 23% (126 patients). Five parameters were independently associated with mortality: American Society of Anesthesiology (ASA) grade 3 or more ( p<0.001), age 64 years or more ( p<0.01), time to onset of pneumonia more than 3 days ( p<0.01), mottling ( p<0.05) and hypotension ( p<0.05). Among the 322 microbiologically confirmed cases of pneumonia, 92 received inappropriate antibiotic (AB) therapy (29%). No difference in mortality was observed between the patients receiving inappropriate and appropriate AB therapy (22.8 vs 16.9%). In this subgroup, three parameters remained independently associated with mortality: ASA grade 3 or higher ( p<0.001), time to onset of pneumonia more than 3 days ( p<0.05) and hypotension ( p<0.05). Inappropriate initial AB did not modify the model ( p=0.22). CONCLUSIONS: Five independent predictive factors for mortality of POP were identified. Despite a trend toward decreased mortality with appropriate initial antimicrobial therapy, no difference was observed between the groups. Polymicrobial pneumonia or non-fermenting Gram-negative bacilli appeared to be a risk factor for inappropriate AB.

Adult↗
PubMed2003

Population pharmacokinetics of moxifloxacin in plasma and bronchial secretions in patients with severe bronchopneumonia.

OBJECTIVE: Our objective was to construct a population pharmacokinetic model for moxifloxacin disposition in plasma and bronchial secretions in patients with severe bronchopneumonia who were mechanically ventilated. METHODS: Seventeen patients receiving 400 mg moxifloxacin intravenously daily were enrolled in this multicenter, prospective, open-label study. Blood and bronchial samples were collected on days 1 and 4. The population pharmacokinetic modeling was performed with NONMEM. RESULTS: Moxifloxacin rapidly appeared in bronchial secretions and reached maximum concentrations within 1 to 2 hours. The concentrations achieved in plasma and bronchial secretions showed parallel profiles versus time on days 1 and 4. The pharmacokinetics was best described by a 2-compartment model with a link to bronchial secretions. The population pharmacokinetic parameters were as follows (given as estimate with percent interindividual variability in parentheses except where otherwise indicated): clearance, 14.3 L/h (25%); central distribution volume, 62.9 L (14%); intercompartmental clearance, 27.2 L/h (36%); peripheral distribution volume; 71 L (32%); fraction of moxifloxacin clearance to bronchial secretions, 0.11 (range, 0.06-0.16); and elimination rate constant for bronchial secretions, 1.7 h(-1) (40%). The plasma terminal half-life was 6.7 hours. The bronchial-to-plasma exposure ratio was 1.0 (range, 0.6-2.0). With a conservative 90% minimum inhibitory concentration (MIC(90)) of 0.25 mg/L, the maximum concentration/MIC(90) ratios were higher than 10 and the area under the curve/MIC(90) ratios were roughly 100 for plasma and bronchial secretions. CONCLUSIONS: This study showed the fast diffusion of moxifloxacin into the lungs in ventilated patients with severe respiratory infection. The bronchial secretions reached bactericidal levels for common germs found in respiratory tract infections.

Adult↗
PubMed2003

Micronized fenofibrate normalizes the enhanced lipidemic response to a fat load in patients with type 2 diabetes and optimal glucose control.

This study evaluated the postprandial (PP) response to an oral fat load in 28 male patients with type 2 diabetes (mean HbA1c of 5.1%), all receiving metformin and performing physical exercise, compared with healthy subjects. The effects of micronized fenofibrate (200 mg once daily) on triglycerides (TG) and retinyl palmitate (RP) responses, lipoprotein mass concentrations, post-heparin lipase activities and coagulation factors were investigated after a 16-week double-blind, placebo-controlled period. Higher and delayed TG response after the oral fat load (P<0.001) corresponding to increases in both intestinally and endogenous TG-rich lipoproteins and lower lipoprotein lipase (LPL) activity 30 and 60 min post-heparin injection (P<0.05) were observed in the patients as compared with controls. Fasting PAI-1 activity, 6 h PP Factor VII and PAI-1 activities were higher in patients (P=0.036, P=0.032 and P=0.017, respectively). After fenofibrate treatment, TG and RP responses and peak LPL activity were no more significantly different from controls at baseline. Compared with placebo, fasting TG-rich lipoproteins and HDL(3) mass concentrations were significantly lower and higher, respectively; PP chylomicrons and very low density lipoprotein (VLDL) mass concentrations were lower; fasting and PP fibrinogen levels were significantly reduced after fenofibrate treatment. Diabetes control was unchanged throughout the study. Fenofibrate normalized the abnormal PP response and improved the fasting lipoprotein abnormalities in patients with type 2 diabetes and optimal glucose control.

Adult↗