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Biomedical subjects

F Brivet

Publications and source records attributed to F Brivet.

At least 19 recordsLinked to original sources
PubMed2003

Emergence of nosocomial Pseudomonas aeruginosa colonization/infection in pregnant women with preterm premature rupture of membranes and in their neonates.

The epidemiology, risk factors, maternal and neonatal outcomes of nosocomial Pseudomonas aeruginosa acquisition in preterm premature rupture of membranes were analysed. Of 63 women receiving antibiotic prophylaxis with co-amoxiclav, 11 acquired P. aeruginosa vaginal carriage with a median delay of 15 days (6-42) i.e. an incidence of 8.94 per 1000 days of expectant management. Five neonates born to 11 positive mothers were colonized or infected, three of whom died of fulminant sepsis. The duration of antibiotic treatment and multiple pregnancy were identified as independent risk factors. The epidemiological investigation revealed a vertical transmission between mothers and neonates, and suggested selective pressure of antibiotic treatment.

Adult↗
PubMed1999

[Organ procurement from cardiac arrest donors: outcome of kidney grafts and recommendations].

OBJECTIVES: To compare literature data with results obtained with organs procured from donors who died from cardiac arrest and to make proposals for this mode of organ procurement in France. METHODS: Over the last 10 years, 10 organ donors (2%) among a series of 486 donors in a state of brain death, had died of cardiac arrest. The arrest were perfused with double-balloon catheters. The outcome of the subsequent kidney grafts was compared with data in the literature. RESULTS: Fifteen of the 18 kidneys from cardiac arrest donors were functioning 1 month after implantation compared with 17 of the 20 kidneys from braindeath donors with beating hearts. The rate of acute tubular necrosis was 55% in the cardiac arrest kidneys and 40% in the beating-heart kidneys. Serum creatinine at 1 yeart was 145 +/- 69 mumol/l 17 +/- 29 mumol/l respectively. DISCUSSION: These results and those reported in the literature demonstrate that kidney procurement from cardiac arrest donors is feasible. If intensive care and surgery units are well organized, this type of organ procurement could provide a larger number of organs for transplantation. Emergency teams must be available for preparing and transferring the organs.

Cadaver↗
PubMed1997

Quality of life 6 months after intensive care: results of a prospective multicenter study using a generic health status scale and a satisfaction scale.

OBJECTIVE: To assess the quality of life of intensive care survivors 6 months after discharge. DESIGN: Multicenter prospective study. SETTING: Medical-surgical intensive care units (ICUs) of four French university hospitals. PATIENTS: Among the 589 patients admitted to the four ICUs between 1 January and 31 March 1989, 329 were investigated. MEASUREMENTS AND RESULTS: A generic scale assessing health-related quality of life, the Nottingham Health Profile (NHP), a satisfaction scale, the Perceived Quality of Life scale (PQOL) and a questionnaire on professional status were sent by mail 6 months after discharge. Data concerning age, severity of acute illness (assessed by the Simplified Acute Physiology Score) and main diagnosis were recorded. A total of 223 questionnaires (67.8 %) were analysable. The professional status remained unchanged in 79.7% of the patients, despite a significant (p < 0.01) increase (15.3 vs 22.1%) in sick leave. Quality of life, assessed with NHP, was fair (50th percentile = 0.73 on a 0 to 1 scale), whereas satisfaction measured by PQOL was lower (50th percentile = 0.61). Both scales correlated well (z = 9.853; p = 0.0001) but with a large dispersion. The NHP scale showed a severe reduction in energy, sleep and emotional reactions, whereas social isolation, pain and physical handicap were infrequent. Family support was rated with the PQOL score as very good, whereas dissatisfaction concerning recreational and professional activities was expressed. Subsequent sick leave was associated with a poor quality of life (p < 0.05). Quality of life was mainly a function of the diagnosis, not of age and severity of illness: patients admitted for suicide attempt or chronic obstructive pulmonary disease fared poorly. CONCLUSIONS: Quality of life measured with a health-related quality of life scale and a satisfaction scale 6 months after an ICU stay depended on the admission diagnosis. Different dimensions of quality of life were variably affected.

Adolescent↗
PubMed1996

[What are the advances in the treatment of acute kidney failure?].

Mortality due to acute renal failure has remained high over the last three decades despite a better understanding of the pathophysiologic mechanics involved and advances in the management of critically ill patients. This paradoxical situation raises many questions concerning the criteria used to assess treatment and disease severity as well as the effectiveness of certain recently proned "advances". In the 1980s, much progress was made in preventing and/or limiting the extent of acute renal failure. The use of very early and vigorous fluid administration associated with alkaline diuresis prevents traumatic rhabdomyolysis; saline hydration before and after radiocontrast administration protects against the acute decrease in renal function in high-risk patients; maintenance of an adequate intravascular volume and of blood pressure helps prevent acute renal failure. After the onset of acute failure, low-dose dopamine can increase urine output, whereas dobutamine improves creatinine clearance but there is no evidence that increasing urine output lowers morbidity or mortality. New techniques have been proposed for acute renal replacement therapy, but except for use of bicarbonate dialysis and biocompatible membranes, none have been shown to be superior. It has been claimed, on the basis of uncontrolled or retrospective studies, that continuous hemofiltration or hemodiafiltration could have a beneficial effect on survival and/or the course of infectious complications. However, convincing evidence of this beneficial effect is lacking since these techniques are incompatible with clinically pertinent removal of proinflammatory cytokines. The type of renal support may have no effect on outcome. Can further progress be expected in the future? Antagonists of NO receptors and growth factors have a protective effect on renal function in animal models, results which may be of clinical relevance. Their clinical potential should be evaluated in prospective randomized trials involving patients where severity of illness is assessed at inclusion using a multiparametric model combining a severity score and relevant prognostic factors.

Acute Kidney Injury↗
PubMed1996

[Management of HELLP syndrome before 32 weeks of amenorrhea. 22 cases].

OBJECTIVES: Assess expression and management of HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) occurring before 32 weeks gestation. METHODS: Among 50 patients presenting HELLP syndrome from 1990 to 1994, 22 (44%) who developed the syndrome before 32 weeks gestation were evaluated retrospectively. RESULTS: Most of the patients were primiparous and HELLP syndrome recurred in 2 during a second gestation before 32 weeks gestation. Only three cases began during the post partum period. All patients had severe pre-eclampsia before discovery of the HELLP syndrome. Episodes of eclampsia also occurred in 6. The most frequent clinical manifestation was epigastric pain. Ten patients had acute severe renal failure. The 3 post partum patients had severe complications (eclampsia, renal failure, subcapsular hepatic hematoma). Obstetrical intervention was required in all cases. Cesarean section was performed within 48 hours of diagnosis. Pregnancy had to be terminated in 3 cases between 24 and 29 weeks gestation. There was one fetal death in utero and one during the neonatal period. Seventeen live infants were delivered. In the group of 11 infants born after 30 weeks gestation, only 1 had hyalin membrane disease which developed in all those born before 30 weeks, including 2 with broncho-pulmonary dysplasia. CONCLUSION: Based on the physiological mechanisms involved in HELLP syndrome, criteria for obstetrical extraction and the possibilities for conservative management in very premature pregnancies, we propose a management protocol for HELLP syndrome developing before 32 weeks gestation. Corticosteroid therapy may be given for 48 hours in cases without maternal or fetal complications in order to accelerate fetal maturation before extraction.

Abortion, Therapeutic↗
PubMed1996

Prognostic factors in acute renal failure due to sepsis. Results of a prospective multicentre study. The French Study Group on Acute Renal Failure.

BACKGROUND: Sepsis is a major cause of acute renal failure in hospital patients, but its incidence and the associated prognostic factors have rarely been assessed prospectively by multivariate analysis. METHODS: We conducted a prospective 6-month study in 20 multidisciplinary intensive care units to assess the prognosis of patients hospitalized with acute renal failure due to sepsis. Sepsis syndrome and septic shock were defined according to the criteria of the Society of Critical Care Medicine Consensus Conference. Severity scoring indexes (SAPS, APACHE II, and organ system failure (OSF)) were measured on ICU admission and on inclusion. The end-point was hospital mortality. RESULTS: Acute renal failure had a septic origin in 157 patients (Group 1), comprising 68 with septic shock and 89 with sepsis syndrome, and did not result from infection in 188 patients (Group 2). Patients with septic acute renal failure were older (mean age: 62.2 versus 57.9 years, P<0.02) and had on inclusion a higher SAPS (19.3 versus 16.1, P<0.001), APACHE II (29.6 versus 24.3, P<0.001), and OSF (2.07 versus 1.52, P<0.001) than patients with non-septic acute renal failure. They had a higher need for mechanical ventilation (69.1% versus 47.3%, P<0.001), and acute renal failure was more often delayed during the ICU stay than was present on admission (47.7% versus 32.4% respectively, P<0.005). Hospital mortality was higher in patients with septic acute renal failure (74.5%) than in those whose renal failure did not result from sepsis (45.2%, P<0.001). Mortality was influenced by the presence of a septic shock (79.4%) or of a sepsis syndrome on inclusion (70.8%). Using a stepwise logistic regression model, sepsis was an independent predictor of hospital mortality (OR, 2.51; 95% CI, 1.44-4.39) as well as a delayed occurrence of acute renal failure, oliguria, an altered previous health status hospitalization prior to ICU, need for mechanical ventilation, age and severity scoring indexes on inclusion. In total patients, mortality was higher in dialyzed than in non-dialyzed patients (P<0.001), and in those treated by continuous compared to intermittent techniques (P<0.01). Patients dialyzed with biocompatible membranes had a lower mortality than those treated with cellulose membranes (P<0.005). CONCLUSIONS: Patients with acute renal failure due to sepsis have a worse prognosis than those with non-septic acute renal failure. Sepsis and the above-defined predictive factors are to be considered in studies on prognosis of ARF patients. Our results suggest that the use of biocompatible membranes may reduce significantly mortality in these patients.

Acute Kidney Injury↗
PubMed1995

Evaluation of severity scoring systems in ICUs--translation, conversion and definition ambiguities as a source of inter-observer variability in Apache II, SAPS and OSF.

OBJECTIVE: To explore translation, conversion and definition ambiguities, when using severity scoring systems in patients admitted to intensive care units (ICUs). DESIGN: A prospective study of the prognosis of acute renal failure in ICUs. SETTING: The study was conducted in 20 French ICUs. PATIENTS: 360 patients presenting with severe acute renal failure were studied during their ICU stay. MEASUREMENTS AND RESULTS: The inter-observer variability of Apache II (acute physiology and chronic health evaluation), SAPS (simplified acute physiology score), and OSF (organ-system failure) was considered. For Apache II, we explored the uncertainty of measurements arising from conversion into SI units, the rounding procedures used for the non-inclusive intervals defined for quantitative parameters such as age, mean arterial pressure (MAP) or serum creatinine, the absence of definition of acute renal failure (ARF) and its consequence on doubling serum creatinine values, and the absence of guidelines in the case of spontaneous ventilation when arterial blood gases (ABG) and forced inspiratory oxygen (FIO2) were not measured. The resulting variability was evaluated, calculating the lowest and the highest value of the scoring system for each patient. The mean difference by patient was greater than 1.5 (p < 0.0001). Other examples were presented and discussed for SAPS and OSF. CONCLUSIONS: Translation, conversion and definition ambiguities are a source of inter-observer variability and increase the risk of classification and/or selection biases. This gives rise to particular concern in the design and analysis of multicenter trials of meta-analysis, and improvement of these scoring systems should be envisaged in the future.

APACHE↗