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Biomedical subjects

F Colardyn

Publications and source records attributed to F Colardyn.

At least 19 recordsLinked to original sources
PubMed2005

Temporal scanner thermometry: a new method of core temperature estimation in ICU patients.

BACKGROUND AND AIMS: Temperature measurement is a routine task of patient care, with considerable clinical impact, especially in the ICU. This study was conducted to evaluate the accuracy and variability of the Temporal Artery Thermometer (TAT) in ICU-patients. Therefore, a convenience sample of 57 adult patients, with indwelling pulmonary artery catheters (PAC) in a 40-bed intensive care unit in a university teaching hospital was used. METHODS: The study design was a prospective, descriptive comparative analysis. Body temperature was thereby measured simultaneously with the TAT and the Axillary Thermometer (AT), and was compared with the temperature recording of the PAC. The use of vasoactive medication was recorded. RESULTS AND CONCLUSIONS: Mean temperature of all measurements was: PAC: 37.1 degrees C (SD: 0.87), TAT 37.0 degrees C (SD: 0.68) and axillary thermometer: 36.6 degrees C (SD: 0.94). The measurements of the TAT and the PAC were not significantly different (man differnce: 0.14 degrees C; SD: 0.51; p = 0.33); whereas the measurements of the PAC and the AT differed significantly (mean difference: 0.46 degerees C; SD: 0.39; p < 0.001). Mean diference in PAC versus TAT analyses, between patients with vasopressor therapy (0.12 degrees C; SD: 0.55), and without vasopressor therapy (0.19 degrees C; SD: 0.48) was not statistically significant (p = 0.47). CONCLUSION: We can conclude that the temporal scanner has a relatively good reliability with an acceptable accuracy and variability in patients with normothermia. The results are comparable to those of the AT, but they do not seem to be sufficient to prove any substantial benefit compared to rectal, oral or bladder thermometry.

Adult↗
PubMed2004

Invasive aspergillosis in critically ill patients: attributable mortality and excesses in length of ICU stay and ventilator dependence.

Invasive aspergillosis is a rare disease in intensive care unit (ICU) patients and carries a poor prognosis. The aim of the present study was to determine the attributable mortality due to invasive aspergillosis in critically ill patients. In a retrospective, matched cohort study (July 1997-December 1999), 37 ICU patients with invasive aspergillosis were identified together with 74 control patients. Matching of control (1:2) patients was based on the acute physiology and chronic health evaluation (APACHE) II classification: an equal APACHE II score (+/-1 point) and diagnostic category. This matching procedure results in an equal expected in-hospital mortality for cases and controls. Additionally, control patients were required to have an ICU stay equivalent to or longer than the case before the first culture positive for Aspergillus spp. Patients with invasive aspergillosis were more likely to experience acute renal failure (43.2% versus 20.5%; P = 0.020). They also had a longer ICU stay (median: 13 days versus seven days; P < 0.001) as well as a more extended period of mechanical ventilator dependency (median: 13 days versus four days; P < 0.001). Hospital mortalities for cases and controls were 75.7% versus 56.8%, respectively (P=0.051). The attributable mortality was 18.9% (95% CI: 1.1-36.7). A multivariate survival analysis showed invasive aspergillosis [hazard ratio (HR): 1.9, 95% CI: 1.2-3.0; P = 0.004] and acute respiratory failure (HR: 6.5, 95%: 1.4-29.3; P < 0.016) to be independently associated with in-hospital mortality. In conclusion, it was found that invasive aspergillosis in ICU patients carries a significant attributable mortality of 18.9%. In a multivariate analysis, adjusting for other co-morbidity factors, invasive aspergillosis was recognized as an independent predictor of mortality.

Aspergillosis↗
PubMed2004

Bloodstream infections after surgery for severe acute pancreatitis.

OBJECTIVE: To analyze the incidence and outcome of bloodstream infections (BSIs) in patients operated on for severe acute pancreatitis to identify the source and associated risk factors. METHODS: We retrospectively (1995-2001) analyzed 45 patients treated surgically for severe acute pancreatitis. We recorded demographic characteristics, data on surgical and medical treatment and disease severity, the occurrence of BSIs, microbiological data concerning the BSIs and other infectious processes, the incidence of organ failure, and data on surgical and infectious complications. RESULTS: Fifteen episodes of BSI were found in 7 of 45 patients (15%), with 18 organisms involved. In all but 1 episode, the source of the BSI was pancreatic necrosis. Most of the organisms were gram positive (11); the others were gram negative (6) or fungi (1). Mortality was statistically not different in patients with a BSI (57% vs. 35%). Multivariate analysis demonstrated that only the length of intensive care unit (ICU) stay was associated with the occurrence of BSIs (OR, 1.05; 95% CI, 1.02-1.09; P < 0.01). CONCLUSION: A BSI is not a rare finding after surgery for severe acute pancreatitis, especially in patients with a prolonged ICU stay. The source is the infected necrosis in most of BSI episodes.

Acute Disease↗
PubMed2003

Fungal infections in patients with severe acute pancreatitis and the use of prophylactic therapy.

Data from an 8-year period for 46 patients with severe acute pancreatitis and infected pancreatic necrosis were analyzed to determine the incidence of fungal infection, to identify risk factors for the development of fungal infection, and to assess the use of early fluconazole treatment. Intraabdominal fungal infection was found in 17 (37%) of 46 patients. Candida albicans was isolated most frequently (15 patients); Candida tropicalis and Candida krusei were found in 1 patient each. Characteristics of patients with fungal infection were not different from patients without fungal infection. The difference in mortality was not statistically significant between patients with fungal infection and patients without fungal infection. Early antifungal therapy (prophylactic or preemptive antifungal therapy) was administered to 18 patients, and only 3 of them developed fungal infection. In this cohort of critically ill patients, no risk factors for fungal infection could be demonstrated, and mortality among patients who received early antifungal therapy was not different. Early treatment with fluconazole seems to prevent fungal infection in these high-risk patients.

Acute Disease↗
PubMed2003

Reappraisal of attributable mortality in critically ill patients with nosocomial bacteraemia involving Pseudomonas aeruginosa.

In a retrospective study, population characteristics and outcome were investigated in intensive care unit (ICU) patients with hospital-acquired Pseudomonas aeruginosa bacteraemia admitted over a seven-year period (January 1992 through December 1998). A matched cohort study was performed in which all ICU patients with P. aeruginosa bacteraemia were defined as cases (N=53). Matching (1:2 ratio) of the controls (N=106) was based on the APACHE II classification: an equal APACHE II score (+/-1 point) and an equal diagnostic category. Patients with P. aeruginosa bacteraemia had a higher incidence of acute respiratory failure, haemodynamic instability, a longer ICU stay and length of ventilator dependence (P<0.05). In-hospital mortalities for cases and controls were 62.3 vs. 47.2% respectively (P=0.073). Thus, the attributable mortality was 15.1% (95% confidence intervals: -1.0-31.2). In a multivariate survival analysis the APACHE II score was the only variable independently associated with mortality. In conclusion, P. aeruginosa bacteraemia is associated with a clinically relevant attributable mortality (15%). However, we could not find statistical evidence of P. aeruginosa being an independent predictor of mortality.

APACHE↗
PubMed2003

Adrenal insufficiency in severe acute pancreatitis.

Relative adrenal insufficiency is common in patients with severe sepsis and septic shock. We describe three patients with severe acute pancreatitis who developed signs suggestive of adrenal insufficiency during the early phase of the disease. Clinical features and possible causes of adrenal insufficiency are discussed.

Acute Disease↗
PubMed2002

Evaluation of human albumin use in a university hospital in Belgium.

UNLABELLED: In 1996-1997, a drug use evaluation (DUE) of human albumin was conducted in the Ghent University Hospital (Belgium) to determine the pattern and appropriateness of the albumin use. The DUE was followed by permanent review of the albumin consumption. This paper describes how the DUE was carried out and how the albumin use in our hospital changed over time. METHOD: The study was based on criteria for indications and end of treatment, accepted by consensus of the physicians prescribing albumin. Albumin treatment episodes were classified as appropriate or inappropriate according to these criteria. RESULTS: For 115 treatment episodes in 90 patients, the researchers found 21 (18.3%) deviations from the developed criteria. After analysis, half out of them were considered as minor. Most deviations involved starting treatment too early (n = 17). Follow-up results indicated that the overall consumption of albumin dropped by 50.1% from 1994 to 1999, while the consumption of colloid solutions during the same period remained stable. CONCLUSION: A good compliance with internally developed criteria for indications and end of treatment with human albumin was observed. Discussion with the clinicians involved led to the development of stricter criteria and a continuous decrease in albumin consumption.

Belgium↗
PubMed2001

Outcome in critically ill patients with candidal fungaemia: Candida albicans vs. Candida glabrata.

In a retrospective study (1 January 1992-12 December 1998), we investigated population characteristics and outcome in critically ill patients with fungaemia involving C. albicans (n=41) and C. glabrata (n=15). Patients with C. glabrata fungaemia were significantly older compared with patients in the C. albicans group (P=0.024). There were no other differences in population characteristics or severity of illness. Logistic regression analysis showed age (P=0.021), the presence of a polymicrobial blood stream infection (P=0.039), and renal failure (P=0.044) to be independent predictors of mortality. There was no significant difference in in-hospital mortality between the C. glabrata and C. albicans groups (60.0% vs. 41.5%; P=0.24). Since age was an independent predictor of mortality, the trend towards a higher mortality in patients with C. glabrata can be explained by this population being significantly older. In conclusion, we found no difference in mortality between patients with fungaemia involving C. albicans and C. glabrata.

Adolescent↗
PubMed2001

Course of neuropsychological recovery from moderate-to-severe head injury: a 2-year follow-up.

Neuropsychological outcome and recovery of a group of 91 patients with moderate-to-severe head injuries were prospectively investigated over a 2 year period, with evaluations at acute hospital discharge at 6 months and 2 years post-injury. A group of 39 trauma patients with injuries to parts of the body other than the head were used as controls. The head injured group performed significantly worse than the control group at baseline, 6 months and 2 years post-injury. Significant improvement was found during the first 6 months, but also between 6 months and 2 years post-injury. Trauma controls also performed significantly better at 6 months post-injury compared to baseline. Differential practice effects between groups cause difficulties in determining recovery. Within the head injured group, three distinct recovery groups were identified varying as a function of coma-length and coma-duration. The first group is comparable with the trauma controls. The other two groups demonstrate significant neuropsychological impairments at baseline, with one group showing a marked improvement over the 2 year period, and the other group showing only small improvement over this time period.

Adult↗
PubMed2000

Early predictors of mortality and morbidity after severe closed head injury.

Mortality and morbidity of 158 patients with severe head injury were studied in relation to age, and early (24-h) clinical and computed tomography data. For comparison of outcome data in survivors, a group of 32 patients with traumatic injuries to parts of the body other than the head was used as controls. Within the head-injured group, the mortality rate was 51%. Logistic regression analyses combined 13 out of 16 predictors into a model with an accuracy of 93%, a sensitivity of 90%, and a specificity of 95%. These include age, Glasgow Coma Scale (GCS) score, pupillary reactivity, blood pressure, intracranial pressure, blood glucose, platelet count, body temperature, cerebral lactate, and subdural, intracranial, subarachnoid, and ventricular hemorrhage. At 6 months postinjury, head-injury survivors and trauma controls were evaluated with the Glasgow Outcome Scale (GOS), a neuropsychological test battery and the Sickness Impact Profile (SIP). Head-injury survivors had a higher proportion of disabilities and neuropsychological dysfunctions than trauma controls. They also report more quality of life-related functional limitations on the SIP scales for mobility, intellectual behavior, communication, home management, eating, and work. Linear regression analysis resulted in age being the only important predictor of outcome on the GOS, the GCS score being the best predictor of neuropsychological functioning, and pupillary reactivity being the most predictive for self-reported quality of life as measured by SIP. Those factors important for predicting mortality (clinical variables such as ICP or blood glucose level, and CT observations) failed to show any significant relationship with morbidity.

Adult↗
PubMed2000

Indigenous malaria in a suburb of Ghent, Belgium.

We report here details of a patient with Plasmodium falciparum malaria which was acquired in the vicinity of Ghent (Evergem) in July 1997. Indigenous malaria disappeared from Belgium in 1938. Due to an increase in international travel, the influx of migrant labor and the changing environmental conditions, there has been an upsurge of imported malaria. Airport- and port-malaria is acquired through the bite of a tropical anophelline mosquito by people whose geographical history excludes exposure to this vector in its natural habitat. As far as we know, only two cases of port-malaria have been reported: in Marseille. We describe here another possible case of port-malaria due to infection with P. falciparum in a 42-year-old woman with an underlying non-Hodgkin lymphoma.

Adult↗
PubMed1999

Functional, life-threatening disorders and splenectomy following liver transplantation.

UNLABELLED: Splenectomy (SPL) in cirrhotic patients undergoing liver transplantation (LTx) may resolve specific problems related to the procedure itself, in case of functional and life-threatening clinical situations often occurring as a result of liver cirrhosis and portal hypertension. METHOD: A single-center experience of ten splenectomies in a series of 180 consecutive adult liver transplant patients over a period of 6 yr is reported. The mean patient age was 46.8 +/- 9.5 yr (range 25 57 yr). Indications for SPL were post-operative massive ascitic fluid loss (n = 3), severe thrombocytopenia (n = 3), acute intra-abdominal hemorrhage (n = 2), infarction of the spleen (n = 1), and multiple splenic artery aneurysms (n = 1). RESULTS: Extreme ascites production due to functional graft congestion disappeared post-SPL, with an improvement of the hepatic and renal functions. SPL was also effective in cases of thrombocytopenia persistence post-LTx, leading to an increase in the platelet count after about 1 wk. Bleeding episodes related to left-sided portal hypertension or trauma were also resolved. The rejection rate during hospitalization was 0%, and no other episodes were recorded in the course of the long-term follow-up. However, sepsis with a fatal outcome occurred in 4 patients, i.e. between 2 and 3 wk post-SPL in three cases and 1 yr after the procedure as a result of pneumococcal infection in the last case. Fatal traumatic cranial injury occurred 3 yr post-LTx in another case. Five patients (50%) are still alive and asymptomatic after a median follow-up period of 36 months. CONCLUSION: The lowering of the portal flow appears to resolve unexplained post-operative ascitic fluid loss as a result of functional graft congestion following LTx. However, because of the enhanced risk of SPL-related sepsis, a partial splenic embolization (PSE) or a spleno-renal shunt could be used as an alternative procedure because it allows us to preserve the immunological function of the spleen. SPL is indicated in case of post-transplant bleeding due to left-sided portal hypertension and trauma, spleen infarction, and to enable prevention of hemorrhage in liver transplant patients with multiple splenic artery aneurysms. Severe and persistent thrombocytopenia could be treated with PSE. Because the occurrence of fatal sepsis post-SPL is a major complication in LTx, functional disorders, such as ascites and thrombocytopenia, should be treated with a more conservative approach.

Acute Disease↗