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G Bernardin

Publications and source records attributed to G Bernardin.

At least 37 records · Page 2Linked to original sources
PubMed1996

Blood pressure and arterial lactate level are early indicators of short-term survival in human septic shock.

OBJECTIVE: To identify early prognostic markers of septic shock among catheterization-derived hemodynamic and metabolic data. DESIGN: Prospective cohort study. SETTING: A medical intensive care unit in a university hospital. PATIENTS: Thirty-two consecutive patients with septic shock, separated into two groups according to short-term (10-day) evolution: 18 acute survivors and 14 fatalities. MEASUREMENTS: Usual hemodynamic and metabolic variables were measured at the onset of shock, i.e., when the catheter was inserted (T0), and 24 h later (T24). The values collected for each group at T0 and T24 and their 24-h changes were compared. RESULTS: On admission, no difference was found between acute survivors and eventual fatalities. After 24 h, fatalities presented with significantly lower mean arterial pressure (p <0.01), left ventricular stroke work index (p <0.05) and higher lactate levels (p <0.01) than acute survivors. Moreover, the 24-h changes of lactate and blood pressure were also of prognostic value (p <0.05). Oxygen delivery and oxygen consumption did not differ statistically between the two groups. At T24, a mean arterial pressure of less than 85 mmHg and a lactate level equal to or greater than 3.5 mmol/l were independently associated with poor survival (37.5% and 30.7%, respectively). Day 10 survival was only 12.5% when both criteria were present at T24. CONCLUSIONS: Changes in mean arterial pressure and arterial blood lactate within the first 24 h of treatment are strong prognostic indicators of short-term survival in patients with septic shock. After 24 h of treatment, maintenance of a mean blood pressure equal to or greater than 85 mmHg correlates with survival at day 10. Data suggest that early reductions in both cardiac function and vascular tone play a determining role in the hypotension observed in fatalities. Persistence of hyperlactatemia in hypotensive patients bodes particularly ill. Blood pressure and lactate level are simple bedside parameters that can enable the clinician to identify patients with a high risk of mortality.

Adult↗
PubMed1996

Nocardia pseudobrasiliensis sp. nov., a new species of Nocardia which groups bacterial strains previously identified as Nocardia brasiliensis and associated with invasive diseases.

We studied five strains of a new Nocardia taxon recently identified among Nocardia brasiliensis strains associated with invasive diseases (R. J. Wallace, Jr., B. A. Brown, Z. Blacklock, R. Ulrich, K. Jost, J. M. Brown, M. M. McNeil, G. Onyi, V. A. Steingrube, and J. Gibson, J. Clin. Microbiol. 33:1528-1533, 1995) to determine their taxonomic status. Several characteristics of these organisms, including the presence of chemotype IV cell walls, nocardomycolic acids, a predominant menaquinone similar to that of Nocardia asteroides ATCC 19247T (T = type strain), and G+C contents ranging from 67 to 68 mol%, are characteristics of the genus Nocardia. Phylogenies based on small-subunit ribosomal DNA sequences clearly confirmed that all five strains belong to the genus Nocardia and occur on a single branch that is clearly distinct from N. brasiliensis. This branch forms a clade with Nocardia vaccinii, Nocardia nova, Nocardia otitidiscaviarum, and Nocardia seriolae. The five new strains exhibited high levels of DNA relatedness with each other, as determined by DNA-DNA hybridization experiments (S1 nuclease procedure), but not with N. brasiliensis strains or with strains of the four phylogenetically related Nocardia species mentioned above. The five new strains differ from N. brasiliensis in the following characteristics: mycolic acid pattern, decomposition of adenine, nitrate reduction, and antimicrobial agent susceptibilities. Therefore, we propose that these strains belong to a new species, Nocardia pseudobrasiliensis. The type strain is strain ATCC 51512, which was isolated from a leg abscess on a patient suffering from ulcerative colitis.

DNA, Bacterial↗
PubMed1995

[Prognosis of acute tuberculous respiratory distress syndrome. 4 cases].

OBJECTIVES: We examined the characteristics of 4 cases of adult respiratory distress syndrome in patients with tuberculosis in an attempt to improve prognosis. METHODS: Four new cases of adult respiratory distress syndrome were described together with a review of the cases reported in the literature. Inclusion criteria were the presence of the syndrome as defined according to the American-European consensus conference and the criteria described by Murray et al. and identification of the mycobacteria causing tuberculosis. RESULTS: A total of 52 cases were included in the study. The sex ratio was 0.71 and mean age 46 +/- 15 years. Eight patients had a past history of pulmonary tuberculosis. Alcoholism was the primary immunodepression factor observed (35%) followed by human immunodeficiency virus infection (13%). For 74% of the patients, the disease course lasted 7 days. The initial chest X-ray was suggestive of tuberculosis in 11. Intradermoreaction to tuberculin was positive in 2 out of 17 patients. Direct examination of non-invasive respiratory samples was positive in 44% for mycobacteria. Disseminated tuberculosis was seen in 64%. Anti-tuberculosis antibiotherapy was started on the first day of intensive care in 68% of the patients; rapid treatment was associated with better prognosis: 1.5 +/- 1.2 days versus 3 +/- 2.7 in fatal cases (p = 0.02). Adjuvant corticosteroid therapy was used in 46% of the cases and was apparently associated with unfavourable outcome: 74% mortality versus 58% without corticosteroids. Ventilatory assistance was required in 88% and associated with poor prognosis (13% survival versus 100% without assistance) (p < 10(-3)). Outcome was fatal in 36 cases (70%) with a mean delay of 9.7 +/- 10.8 days. CONCLUSION: The conditions required for improving the prognosis of adult respiratory distress syndrome in tuberculosis patients included suspecting tuberculosis in all cases of acute respiratory failure of unknown origin, particularly in the immunodepressed patient, and to avoid missing this diagnosis in case of a non-suggestive chest X-ray and a negative though exhaustive microbiology search. Adjuvant corticotherapy is uneffective and may be dangerous.

Acute Disease↗
PubMed1994

Swan-Ganz catheter-related pulmonary valve infective endocarditis: a case report.

We report the case of a 29-year-old man with decompensated alcoholic cardiomyopathy who developed a Staphylococcal pulmonic valve infective endocarditis during hemodynamic monitoring, as a consequence of catheter-related bacteremia. As experimentally demonstrated, the damaging role of the pulmonary artery catheter on the endocardial surface plays a major role in the pathogenesis of related right-sided infective endocarditis. Occurrence of bacteremia in a catheterized patient should be considered as a high risk situation, and righ-heart infective endocarditis must be suspected whenever patient presents fever or bacteremia without obvious site of infection. Doppler echocardiography is the reference diagnosis procedure.

Adult↗
PubMed1989

[Two-dimensional echocardiography during the acute phase of myocardial infarction. Diagnostic and prognostic value].

A bidimensional cardiac sonogram was performed in 152 consecutive patients with in 24 hours after hospitalization in the intensive care unit for acute myocardial infarction, in order to evaluate the contribution of this technique to the diagnosis, determination of early complication and the prognosis. For this study, the left ventricle was divided in 10.segments. For each segment, systolic mobility as well as thickness were evaluated. It was possible to obtain a proper recording in 134 patients. Abnormal left ventricular kinetics (at least 1 segment) is present in all anterior transmural infarctions with, in 90 p. cent of the cases, a concordance between electrical and sonographic localization and in 89 p. cent of inferior between electrical and sonographic localization and in 89 p. cent of inferior only present in 65 p. cent. Abnormal kinetics is only present in 65 p. cent of non transmural infarctions. In 15 patients with clinical infarction without any electrical sign, the cardiac sonogram permitted to make the diagnosis and establish the localization of the infarction. In 46 p. cent of the cases, a left ventricular asynergy was observed at a distance of the necrosed area. In these patients, the mortality and cardiogenic shock rates during hospitalization were higher than for patients who did not present these abnormal findings (p less than 0.01). In conclusion, bidimensional cardiac sonography is a very specific diagnostic tool, permitting an early prognosis and able to detect early complication, especially of pericardial and mechanical nature.

Adult↗