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F Colardyn

Publications and source records attributed to F Colardyn.

120 records · Page 7Linked to original sources
PubMedDate not supplied

The effect of tube thoracostomy on oxygenation in ICU patients.

Previous research found that in noncritically ill patients, thoracocentesis has an unpredictable effect on oxygenation, possibly due to re-expansion pulmonary edema and systemic hypotension. The authors performed a retrospective analysis to study the effect of tube thoracostomy on oxygenation in ICU patients, and the complications associated with it. The authors reviewed the charts of 58 ICU patients in whom 74 procedures were performed. Demographic data, APACHE II score, and indication for thoracocentesis were retrieved from the patient's file. The P(a)O(2)/FiO(2) ratio was calculated before, 12, 24, and 48 hours after tube thoracostomy. P(a)O(2)/FiO(2) ratios at the mentioned time intervals were compared using 1-way analysis of variances (ANOVA) with repeated measures. Logistic regression analysis was used to identify factors associated with a good response to treatment. Age of the patients was 53 +/- 19.0 years (range, 17-88), APACHE II score was 21 +/- 8.3 (range, 6-38), and median length of stay was 13.5 days (interquartile range, 7-25). The volume drained during the first 24 hours was 1077 +/- 667 ml. P(a)O(2)/FiO(2) ratio was 185 +/- 79.3 before chest drainage, 197 +/- 79.1 at 12 hours, 217 +/- 88.9 at 24 hours, and 233 +/- 99.8 at 48 hours. In only 54% of the procedures, a response to therapy was present. Multivariate analysis identified a P(a)O(2)/FiO(2) below 180 to be independently associated with improvement in oxygenation. At 24 and 48 hours, the P(a)O(2)/FiO(2) ratio was significantly higher than before drainage (P <.001). There were 13 complications in 11 procedures (14.9%). The authors' results suggest that tube thoracostomy can be used as an adjunct in the treatment of selected patients with hypoxemic respiratory failure in the ICU. A low P(a)O(2)/FiO(2) seems to be a good predictor of response to therapy. However, the complication rate is considerable, especially in patients with a prolonged ICU stay.

APACHE↗
PubMedDate not supplied

Infectious complications of acute pancreatitis.

Disease severity in patients with acute pancreatitis varies from mild disease with minimal morbidity, to severe disease in which a whole spectrum of local and systemic complications may occur. Infectious complications frequently arise, and especially infection of pancreatic necrosis is an important risk factor for mortality. Several strategies have been devised to reduce this risk, and the use of prophylactic therapy, e.g. selective digestive decontamination, can be considered in patients with documented necrosis fo the pancreas. Pancreatic abscesses and infected pseudocysts arise later in the course of disease, and should be considered as separate entities, due to differences in therapy and outcome of these patients. When infection occurs, source control using either surgical or percutaneous drainage techniques, is essential to avoid systemic complications.

Abscess↗
PubMedDate not supplied

Invasive aspergillosis in critically ill patients: analysis of risk factors for acquisition and mortality.

OBJECTIVE: To investigate outcome in patients who develop invasive aspergillosis in the ICU, and to evaluate whether specific risk factors for the acquisition of invasive aspergillosis are associated with mortality. DESIGN: Retrospective cohort study (07/1997-12/1999) with screening of 8988 admissions. SETTING: 54-bed ICU of the 1060-bed Ghent University Hospital. PATIENTS: 38 ICU patients with invasive aspergillosis. Invasive aspergillosis was defined as proven by positive histology and tissue culture and as probable by a combination of clinical suspicion as well as microbiological and radiological data. Seventeen patients had risk factors (neutropenia, haematological malignancy, immunosuppressive therapy). In the other 21 apparently immunocompetent patients, invasive aspergillosis was a complication following ARDS, COPD, pneumonia, acute liver failure, burns, severe bacterial infection and malnutrition. MEASUREMENTS: Population characteristics and outcome were compared for patients with and without risk factors for the acquisition of invasive aspergillosis. RESULTS: Patients with risk factors had higher APACHE II scores. No difference was found between patients with and without risk factors in in-hospital mortality (82% vs. 71%; p=0.431). In patients with specific risk factors, the observed mortality was not different from the mortality as expected on basis of the APACHE II (p=0.940). In patients without risk factors the observed mortality exceeded the expected mortality (p<0.001). CONCLUSION: The incidence of invasive aspergillosis in this series is 4/1000 admissions. No difference in mortality was found between patients with and without risk factors for the acquisition of invasive aspergillosis. Yet, the prognosis of the patients without risk factors seems to alter more seriously by the development of this infection.

APACHE↗
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Appropriate and timely empirical antimicrobial treatment of icu infections--a role for carbapenems.

Treatment of serious nosocomial infections in the intensive care unit requires swift, effective, well-tolerated and appropriate therapy from the outset. The consequences of inappropriate treatment, i.e. the use of antibiotics that are ineffective against the causative pathogen(s) or delayed therapy, are numerous and impact negatively upon both the patient and the ever-dwindling healthcare resources in many hospitals. Although antibiotics have revolutionised the treatment of infections, their inappropriate and untimely use within the intensive care setting has led to the emergence and spread of antibiotic-resistant bacteria worldwide. Consequently, to ensure successful patient outcomes (reduce morbidity and mortality), it is important that any antibiotic treatment employed is right first time. Treatment of serious infections in the intensive care unit requires an empirical stratagem providing broad-spectrum coverage to a wide range of suspected or difficult-to-treat pathogens such as Pseudomonas aeruginosa. However, to prevent the errors of the past, this needs to be tailored as soon as the pathogen has been identified and resistance patterns are known. The carbapenems are potent parenteral antibiotics, with an ultra-broad spectrum of activity that encompasses multi-drug resistant and difficult-to-treat Gram-negative bacteria. Clinical trial data supports the clinical effectiveness of these agents in patients with difficult to treat pathogens.

Bacterial Infections↗
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Ventilator-associated pneumonia in a tertiary care ICU: analysis of risk factors for acquisition and mortality.

OBJECTIVE: To investigate the incidence, risk factors and mortality of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients. DESIGN: Prospective, observational, population-based study. SETTING: The medical (14-bed) and surgical ICU (26-bed) of the Ghent University Hospital. METHODS: All 1295 patients admitted to the ICU during 4 three-month periods between 1996 and 1998 were included. A set of demographic and clinical variables were collected at the day of admission and during the ICU course. RESULTS: The incidence of VAP among ICU patients ventilated at least 48 hours was 23.1%. The mean time to the development of VAP was 9.6 days with a median of 6 days. In the population of patients ventilated for at least 48 hours, a comparison was made between patients with (n = 89) and without VAP (n = 296). Patients with VAP had a significant longer ICU stay, with a longer ventilation dependency. Logistic regression analysis identified admission diagnosis other than trauma (OR: 0.51, 95% CI: 0.29-0.89; p = 0.02) and the length of ICU stay (OR: 1.05, 95% CI: 1.03-1.07; p < 0.001) to be independently associated with the acquisiton of VAP. In comparison with the total study population, patients with VAP had a higher ICU mortality (20.2% vs. 12.0%; p = 0.04), but not in the cohort group of patients at risk for VAP (ventilated > 48 hours)(20.2% vs. 31.3%; p = 0.03). The factors independently associated with death were higher SAPS II scores (OR 1.02, 95% CI: 1.003-1.032; p = 0.02), an admission diagnosis other than trauma (OR 0.36, 95% CI: 0.17-0.75; p = 0.006) and length of ICU stay (OR 0.97, 95% CI: 0.946-0.995; p = 0.02). This model did not recognize VAP as an independent predictor of death (OR 0.79, 95% CI: 0.41-1.53; p = 0.492). CONCLUSIONS: The incidence of VAP in our ICU is 23.1%. Length of ICU stay and an admission diagnosis other than trauma are major risk factors for the development of this nosocomial infection. VAP is associated with a high fatality rate. However, after adjustment for disease severity and length of ICU stay, VAP was not identified as an independent predictor of death.

Adult↗
PubMedDate not supplied

Peripheral vascular effects of calcium entry blockers in normal volunteers.

The peripheral vascular effects of calcium entry blockers have been scarcely investigated. Therefore we examined the effects of different doses of tiapamil and nifedipine in two groups of volunteers. The measurements were done by plethysmography. At a lower dose there is a significant increase in venous capacity. At a higher dosage there is an increase of the arterial flow, eliciting a reflex sympathetic stimulation with heart rate increase and venoconstriction. Therefore calcium entry blockers can be considered as arterial and venodilators.

Adult↗
PubMedDate not supplied

[Activities of mobile emergency units in Ghent].

We present here the analysis of the activities of the mobile intensive care unit of the university hospital of Ghent in 1984. The call for medical intervention from the unit originated in most cases from the 900 centre. Trauma and cardiac arrest were the most frequent reasons for intervention. The majority of the interventions of the mobile unit were needed for patients at home. These data illustrate the need for orienting the medical emergency care systems towards patients at home.

Ambulances↗
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Value of venous occlusion plethysmography to study venoactive medication in men.

Venous occlusion plethysmography is a useful tool to investigate the effect of a vaso-active medication on the venous circulation in man. However, room temperature can be very critical when small changes have to be detected. Therefore several authors induce a preconstriction of the veins for example with norepinephrine. When the conditions of the experiment are carefully controlled and a very sensitive plethysmograph is used, a significant effect on forearm veins can be shown even after small doses of nitrates and a high room temperature; matching with placebo is critically needed. It is likely that by lowering room temperature the response would be exaggerated. Taking these restrictions in mind, venous occlusion plethysmography can be a very valuable, non-invasive tool to study the effect of vaso-active treatment on the veins in men.

Heart Failure↗
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Fatal complications of neuroleptic drugs. A clinico-pathological study of three cases.

We report three cases of fatal hyperthermia in the course of neuroleptic drug treatment. One patient developed his symptoms within hours after a single drug dose whereas the two others had a prolonged symptomatology which lasted for several days after the administration of different neuroleptic drugs. Biochemical events included diffuse intravascular coagulation, muscle cell necrosis and acute renal failure. Rhabdomyolysis was proved pathologically in two patients but brain lesions were atypical in all three cases. We conclude that the biochemical and pathological abnormalities seen in these patients are those which have been described by some authors in the malignant hyperthermia syndrome after anaesthesia. The symptomatology however can be insidious and the syndrome can develop after withdrawal of the drugs.

Adult↗
PubMedDate not supplied

The effect of cimetidine versus ranitidine on the gastric emptying rate of intensive care unit patients sustained on artificial respiration.

OBJECTIVE: To answer the question if their is a difference between cimetidine versus ranitidine on the gastric emptying rate. DESIGN: Prospective, blinded, randomised controlled study. SETTING: A mixed intensive care unit at the University Hospital. PATIENTS: Twenty-four patients sustained on artificial respiration. INTERVENTIONS: Blinded and randomised either cimetidine 200 mg or ranitidine 50 mg were administered IV, after administration of 500 ml of enteral nutrition. MAIN OUTCOME MEASURES: The gastric emptying rate (gastric filling index) was measured over 120 minutes by an ultrasonographic method. In both groups t/2 was very long, there was no statistical difference between the two groups concerning the mean gastric filling index values at successive measurements (time 0 to 120 minutes). Neither was there a difference between the young and the elderly, female and male patients. CONCLUSION: Following administration of either ranitidine or cimetidine in bolus, no difference in the gastric emptying of gastric liquid feeding could be observed in critically ill intubated, ventilated patients.

Adult↗