Biomedical subjects

D Thebert

Publications and source records attributed to D Thebert.

3 recordsLinked to original sources

PubMed2001

[Computer-assisted coronary surgery].

Routine totally endoscopic, beating heart, coronary surgery should be made possible by the use of computer enhanced surgical techniques. It includes a totally endoscopic mammary artery harvesting, a correct exposure and an adequate stabilization of the coronary artery at the anastomotic site, a perfect anastomosis of the mammary artery on the left anterior descending coronary artery using a microsurgical suture technique. This complex surgical protocol will be reached by a step by step approach. The first 20 patients who accepted to be operated with tele-manipulated instruments make the substance of this first report. In 19 cases, the dissection of the internal mammary artery could be performed with an optimal result: the lack of bleeding during the dissection emphasizes the excellent visualization of the operative field and the precision of the dissection. The satisfactory blood flow in the mammary artery at the time of the coronary anastomosis suggests the lack of spasm and confirms the atraumatic dissection. The distal anastomosis of the coronary bypass has been performed through a mid line sternotomy to avoid an excessive prolongation of the operative time. The anatomic conditions and the quality of the vessel wall allowed to perform the coronary anastomosis with the tele-manipulated instruments in nine cases only: in six patients, the mammary artery has been implanted on the descending artery, in three, a venous autograft on the diagonal branch. Our initial clinical experience with this new technique suggests that a very precise and fine surgery can be performed with an acceptable prolongation of the operative time. More experience and further developments in the instrumentation are nevertheless required to allow completion of the entire procedure totally closed chest, on a beating heart.

Aged↗

PubMed1998

Clinical evaluation of the Abbott Qvue-OptiQ continuous cardiac output system in critically ill medical patients.

PURPOSE: The aim of this study was to evaluate the reliability of a new continuous cardiac output (CCO) monitoring device (Qvue/OptiQ system; Abbott Critical Care Systems, Mountain View, CA) based on the pulsed warm thermodilution technique in critically ill medical patients. METHODS: Nineteen patients with cardiogenic or septic shock were included in the study. Pairs of CCO and intermittent bolus cardiac output (ICO) were noted at least every 6 hours for determination of bias, precision, and limits of agreement. Simultaneously, blood samples were collected, and arterial-venous oxygen content difference (C[a-v]O2) was determined. A multiple stepwise logistic regression was used to identify situations associated with a CCO-ICO difference exceeded 20%. A multiple linear regression was performed to analyze the respective accuracy of CCO and ICO to predict the variations of C[a-v]O2. RESULTS: A total of 203 pairs of cardiac output measurements was obtained. The bias was 0.12 L/min (1.2% of pairs mean) and the precision 1.0 L/min (13%). The 95% limits of agreement were between -1.7 L/min (-25%) and 1.9 L/min (+26%). Low blood temperatures and heart rates above 120 beats/min were significantly associated with a ICO-CCO difference higher than 20%. In a multiple linear regression, CCO was significantly correlated with C[a-v]O2, an independent reflection of the patient's cardiac output; by contrast, ICO did not. CONCLUSION: These results suggest that ICO and CCO measurement by the Qvue/OptiQ system are interchangeable, except for temperature or heart rate extreme values.

Cardiac Output↗

PubMed1998

Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis.

To identify the potential impact of novel therapeutic approaches, we studied the early predictive factors of survival at the onset of acute respiratory distress syndrome (ARDS) in a 24-bed medical ICU of an academic tertiary care hospital. Over a 48-mo period, a total of 3,511 adult patients were admitted and 259 mechanically ventilated patients met ARDS criteria, as defined by American-European consensus conference, i.e., bilateral pulmonary infiltrates and PaO2/FIO2 lower than 200 without left atrial hypertension. These patients were randomly included in a developmental sample (177 patients) and a validation sample (82 patients). Demographic variables, hemodynamic and respiratory parameters, underlying diseases, as well as several severity scores (SAPS, SAPS-II, OSF) and Lung Injury Score (LIS) were collected. These variables were compared between survivors and nonsurvivors and entered into a stepwise logistic regression model to evaluate their independent prognostic roles. The overall mortality rate was 65%. SAPS-II, the severity of the underlying medical conditions, the oxygenation index (mean airway pressure x FIO2 x 100/PaO2), the length of mechanical ventilation prior to ARDS, the mechanism of lung injury, cirrhosis, and occurrence of right ventricular dysfunction were independently associated with an elevated risk of death. Model calibration was very good in the developmental and validation samples (p = 0.84 and p = 0.72, respectively), as was model discrimination (area under the ROC curves of 0.95 and 0.92, respectively). Thus, the prognosis of ARDS seems to be related to the triggering risk factor, the severity of the respiratory illness, and the occurrence of a right ventricle dysfunction, after adjustment for a general severity score.

Academic Medical Centers↗