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Biomedical subjects

J C Chevrolet

Publications and source records attributed to J C Chevrolet.

At least 55 records · Page 3Linked to original sources
PubMed1996

Unusual cause of lethal pulmonary aspergillosis in patients with chronic obstructive pulmonary disease.

Two patients admitted to two different medical wards of our institution following respiratory decompensation of chronic obstructive pulmonary disease (COPD) were subsequently transferred to the same room of the medical intensive care unit (ICU) and intubated. Both patients developed invasive pulmonary aspergillosis and died soon after. Because COPD itself is rarely associated with lethal pulmonary aspergillosis, both cases were reviewed, and a retrospective investigation was conducted. Both patients had repeated sputum cultures while on the medical ward before their admission to the ICU; none of the sample grew Aspergillus spp. A. fumigatus was found in tracheal aspirates of both patients from the first day of their intubation while in the ICU. The pulmonary condition of both patients worsened, and invasive aspergillosis was diagnosed by bronchoalveolar lavage. Despite therapy with amphotericin B, the patients died 16 and 22 d after intubation, respectively. Both deaths were attributed to pulmonary aspergillosis; autopsy confirmed a massive pneumonia of the five lobes due to A. fumigatus in one patient. Investigation revealed that an air filter had been replaced 30 h before the first patient was admitted to the room. Experimental air filter replacement performed 12 d after the second patient died revealed the presence of A. fumigatus on the surface of the filters as well as a 10-fold increase in room air fungal counts during the procedure. This study shows that exposure to high concentrations of airborne Aspergillus spp. related to air filter change was associated with fatal invasive aspergillosis in two mechanically ventilated patients. Such infection can be prevented by the establishment and application of guidelines for air filter replacement.

Aged↗
PubMed1996

Complement depletion during haemofiltration with polyacrilonitrile membranes.

BACKGROUND: Polyacrylonitrile (PAN, AN69) dialysis membranes have been shown to improve the outcome of critically ill patients. Factor D is an essential enzyme of the alternative pathway of complement and is increased during renal failure. On the other hand the contact of blood with biomaterials activates the complement cascade through the alternative pathway. PAN filters adsorb factor D which looses its enzymatic activity whilst bound to the membrane [1]; the complement alternative pathway function of serum exposed to PAN filters is greatly diminished and restored after addition of purified factor D [1]. The aim of our study was to measure the time course of factor D adsorption and its blood concentration during CVVH in critically ill patients with acute renal failure. METHODS: We studied seven critically ill patients with ARF before, during and after continuous veno-venous haemofiltration (CVVH) with AN69. RESULTS: There was a rapid decrease of factor D levels to 62(+/-6%) of the pre-CVVH value during the first 2 h, which continued to 51(+/-7.3%) after 12 h; at 24 h there was a slight rise to 62 +/- 12%. Sequential use of Polyacrylonitrile (AN69) filters lowered factor D levels below the normal plasma concentration in three patients, thus producing a state of factor D depletion. CONCLUSION: The significant reduction of factor D levels during CVVH with PAN filters suggests that frequent changes of PAN filters may reduce alternative pathway function by lowering factor D levels. CVVH (as opposed to intermittent dialysis) with PAN membranes may further improve the outcome of critically ill patients.

Acrylic Resins↗
PubMed1995

Pulmonary scintigraphy at the bedside in intensive care patients with suspected pulmonary embolism.

OBJECTIVE: Performance of pulmonary scintigraphy (PS) for suspected pulmonary embolism (PE) in ICU patients normally involves the added risk of transporting unstable patients to the nuclear medicine unit (NMU) and poses technical difficulties in ventilating intubated patients. This retrospective study addresses the feasibility of performing PS as the bedside. MATERIAL AND METHODS: During a 2-year period, all ICU patients with suspected PE underwent PS at the bedside, performed with a mobile gamma-camera. 99mTc-labelled albumin macroaggregates were used for the perfusion studies. Gasified 99mTc or 81mKr gas was administered by an adapting technique in intubated patients. RESULTS: 45 patients were studied, 29 (64%) of whom were intubated and 21 (47%) of whom were in shock. PE was confirmed or excluded by PS in 49% of patients. Angiography was performed in 4 patients (8%). In the rest, a combination of low clinical and low or very low PS probabilities rendered PE highly unlikely. There was no evidence of PE in the subsequent follow-up. CONCLUSIONS: In ICU patients with suspected PE, PS can be performed at the bedside with a mobile gamma-camera. The risk of transporting unstable patients can thus be avoided.

Adult↗
PubMed1995

The repeated measurement of vital capacity is a poor predictor of the need for mechanical ventilation in myasthenia gravis.

OBJECTIVE: Testing the hypothesis that, in myasthenia gravis (MG), repeated measurements of vital capacity (VC) and various parameters derived from this measurement [median or lowest value of measured VCs during hospitalization, VC values < 20 ml/kg body weight (BW) or < 13 ml/kg BW, or an index assessing the variability of VC values during the whole ICU stay] could predict the need for intubation and mechanical ventilation (MV), as has been shown in other neuromuscular diseases with respiratory failure. DESIGN: Retrospective study with medical chart revision of all the patients with MG and respiratory failure admitted to our intensive care unit between 1985 and 1993. SETTING: Medical intensive care unit (15 beds) of a university hospital. PATIENTS AND METHODS: Five patients suffering from ten episodes of acute respiratory failure due to their decompensated MG. Repeated measurements of arterial blood gases and VC by trained respiratory therapists, at least every 4 h. RESULTS: There was no difference in any of these parameters between patients eventually requiring MV (four episodes) and those in whom mechanical ventilation was not necessary (six episodes). CONCLUSIONS: VC repeated measurements is a poor predictor of the need for further MV in MG patients. This can probably be ascribed to the erratic nature of MG, a disease whose course is largely influenced by many parameters (infection, treatment modifications, initiation of corticosteroid therapy, stress, psychological factors, etc.). Early admissions to the ICU of MG patients with respiratory dysfunction is thus recommended.

Adolescent↗
PubMed1995

Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the influence of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. DESIGN: Data were collected prospectively over a 1-yr period (study year) and compared with previously collected prospective data recorded in our chronic obstructive pulmonary disease database during a 5-yr period. SETTING: The medical intensive care unit (ICU) of a university hospital. PATIENTS: Eighty-seven patients with chronic obstructive pulmonary disease. Fifteen patients had chronic obstructive pulmonary disease that required mechanical ventilation for acute exacerbation of their disease (study year), and 72 were patients with chronic obstructive pulmonary disease from the previously collected data. INTERVENTIONS: The ICU course (duration of mechanical ventilation, mortality) was recorded, as well as several respiratory parameters (pulmonary function tests and arterial blood gases in stable conditions, and nutritional status), and they were compared with an "index of nursing." MEASUREMENTS AND MAIN RESULTS: We developed an "index of nursing", comparing the effective workforce of the nurses (number and qualifications) with the ideal workforce required by the number of patients and the severity of their diseases. A value of 1.0 represented a perfect match between the needed and the effectively present nurses, whereas a lesser value signified a diminished available workforce. This index was compared with the complications and duration of weaning from mechanical ventilation. During the first 5 yrs, the duration of mechanical ventilation increased progressively from 7.3 +/- 8.0 to 38.2 +/- 25.8 days (p = .006). A significant inverse correlation between the duration of mechanical ventilation and the nursing index (p = .025) was found. In the sixth comparative year, the number of nurses increased (nursing index = 1.05) and the duration of mechanical ventilation decreased to 9.9 +/- 13 days (p < .001, yr 5 vs. yr 6). CONCLUSIONS: The quality of nursing appears to be a measurable and critical factor in the weaning from mechanical ventilation of patients with chronic obstructive pulmonary disease. Below a threshold in the available workforce of ICU nurses, the weaning duration of patients with chronic obstructive pulmonary disease increases dramatically. Therefore, very close attention should be given to the education and number of ICU nurses.

Aged↗
PubMed1995

Pulmonary vascular reactivity in severe pulmonary hypertension associated with mixed connective tissue disease.

Pulmonary vascular reactivity tests were performed in a young woman with mixed connective tissue disease and severe pulmonary hypertension. Vasoreactivity was documented in response to intravenous prostacyclin (PGI2), oral nifedipine, and inhaled nitric oxide, with quantitative differences. Nitric oxide produced a moderate lowering of pulmonary arterial pressure and resistance without any deleterious systemic effect. The use of nitric oxide in testing for pulmonary vasoreactivity merits further evaluation.

Adult↗
PubMed1995

[Cytokine inhibitors in intensive care].

OBJECTIVE: To examine three typical disease states seen in intensive care, sepsis, Fulminant purpura and acute respiratory distress syndrome (ARDS) to assess the implication of cytokines in their pathogenesis and particularly in the clinical applications of possible cytokine inhibitors. SOURCE OF DATA: The data bank of MedLine and the Index Medicus 1985-1993 and the first part of 1994. These sources have enabled us to consult publications in French and English and to include information on both animals and humans. The publications issued from Intensive Care Congresses have also been scrutinised; the Société de Réanimation de Langue Française, The American Thoracic Society and the 13th and 14th International Symposium on Intensive Care and Emergency Medicine, Brussels. SELECTION OF DATA: This review emphasizes certain areas of work including recognised work which has been published on the immunotherapy of sepsis in man, on those papers which have been published as a preliminary communication in the from of a summary and on certain papers relating to animal work which are regularly cited in Intensive Care literature. DISCUSSION: The relationship between cytokines and the three selected disease states have been briefly described. The greater part of those papers which have either been published or are in the process of being published present pharmacotherapeutic data in phase 2 or phase 3 in relationship to anticytokines and sepsis. As for the treatment of Fulminant purpura and ARDS, using anticytokine antibodies in 1994 we are still in the stage of hypothesis and speculation. CONCLUSIONS: Future clinical strategies designed to combat. Future clinical strategies designed to fight against the most critical diseases in intensive care medicine require some use of any kind of immunotherapy. In animal studies, convincing data are available showing that immunotherapy improves the prognosis of sepsis, whereas in humans, to date, the results appear to be deceiving. Future research in this direction is mandatory, in sepsis and in other disease states, like ARDS, because no other hope for treating these patients seems to appear in a near future.

Adult↗
PubMed1994

[Nitrous oxide (NO) in the treatment of adult respiratory distress syndrome].

Inhaled nitric oxide (NO) may be beneficial in patients with adult respiratory distress syndrome (ARDS), by lowering the venous admixture in the lungs and thereby improving the hypoxemia, and by its vasodilator effect which improves pulmonary hypertension. We studied 6 patients with severe ARDS (PaO2/FiO2 9.6 +/- 1.7 kPa and mean pulmonary artery pressure [PAPm] 37 +/- 4 mm Hg) during short term inhalation of NO (30 minutes) at a concentration of 32 ppm. In all patients, we observed the same response, i.e. a significant increase in PaO2 (28 +/- 8% at the same FiO2, p = 0.014) and a decrease in PAPm (15 +/- 5%; p = 0.038) with rapid reversal when NO inhalation was halted. Toxic metabolites of NO, such as NO2, NO3, etc. remained < 1 ppm when measured in different sections of the respiratory circuit. We conclude, in agreement with the study of Rossaint et al. [16], that (1.) inhaled NO may be beneficial in ARDS by improving pulmonary hypertension and gas exchange; (2.) short term NO inhalation is probably safe; (3.) however, the safety of long term administration of NO and a beneficial effect on survival in ARDS patients remain to be shown.

Administration, Inhalation↗
PubMed1994

Anticoagulation in patients treated by continuous venovenous hemofiltration: a retrospective study.

The most adequate anticoagulation regimen during extracorporeal renal replacement therapy can be difficult to define. Two hundred fifty-five critically ill patients with a mean age (+/- SD) of 58.2 +/- 16.3 years were treated by continuous venovenous hemofiltration (CVVH) between 1986 and 1992 in our intensive care units. Blood was circulated through hemofilters, either polyacrylonitrile (AN 69; Hospal, Lyon, France) or polyamide (FH 66; Gambro, Lund, Sweden), using a roller pump and an air safety system. The patients were classified into three subgroups according to the amount of heparin needed to achieve an adequate anticoagulation (ie, prevention of extracorporeal circuit clotting without inducing a patient's bleeding tendency): group 1, 37 patients who received no heparin (14.5%); group 2, 189 patients who received 100 to 700 IU/hr of heparin (74.1%); and group 3: 29 patients who received more than 700 IU/hr of heparin (11.4%). We analyzed the filter survival, the routine coagulation parameters, and the evolution of the patients for each group. Median duration of treatment was 144 hours (range, 4 to 1,152 hours). There were no differences in requirement of heparin among the two types of membrane: AN 69 (mean +/- SD), 393 +/- 106 IU/hr v FH 66, 374 +/- 35.3 IU/hr (range, 0 to 2,000 IU/hr). There were no relationships between the amount of heparin the patients received and the mean survival of the filters (group 1, 22.1 +/- 14.8 hr; group 2, 24.7 +/- 13.2 hr; group 3, 23 +/- 9.6 hr).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Prolonged treatment with almitrine for refractory hypoxemia in adult respiratory distress syndrome.

A 49-year-old man presented with an atypical pneumonia entailing an adult respiratory distress syndrome (ARDS). The refractory hypoxemia caused a myocardial infarction, leading us to try pharmacologic treatments. Almitrine bismesilate (AB) infusion allowed improvement of arterial oxygenation during 115 h without adverse effect. This case is, to our knowledge, the first reported prolonged treatment using AB for hypoxemia due to ARDS.

Almitrine↗
PubMed1994

Neuromuscular disorder in intensive care unit patients treated with pancuronium bromide. Occurrence in a cluster group of seven patients and two sporadic cases, with electrophysiologic and histologic examination.

During six consecutive months, seven patients admitted to our ICU (15 beds, general ICU, approximately 300 intubated patients per year) for acute respiratory failure requiring intubation and mechanical ventilation presented with a peculiar neuromuscular disorder. After the occurrence of this cluster group of patients, we detected two more similar but isolated cases in the following 18 months, ie, altogether 9 patients in 2 years of observation, or 1.55 percent of all intubated patients in our ICU. Sedation was achieved using midazolam, curarization was effected with the neuromuscular non-depolarizing agent pancuronium bromide (PB), and corticosteroids were administered to eight patients. Shortly after discontinuation of sedation and curarization, we observed a persistent tetraparetic syndrome and/or peroneal palsy with a concomitant increase of serum creatine kinase (CK). None of the patients was septic or had the multisystem organ failure. A strong association between CK increase and PB administration was found, whereas no patient suffered severe liver or kidney failure. The duration of the neurologic deficit ranged from 4 to 52 weeks, with only partial recovery for some patients; the duration of dysfunction was apparently related to the total dose of corticosteroids received. Two patients had difficulty being weaned from the respirator and required tracheostomy. Electrophysiologic studies showed signs of axonal neuropathy and myopathic changes, ie, motor units of brief duration, small amplitude, overly abundant for the voluntary effort being exerted. Muscle biopsies showed significant myopathic alterations, with foci of muscle necrosis in most patients and minimal lymphocytic inflammation in one patient. The neurologic complication described differs from the polyneuropathy in critically ill patients. Furthermore, PB or corticosteroids or both appear to be the causal agents. The duration of the neuromuscular dysfunction may be related to concomitant steroid therapy. The CK enzyme seems to be a marker of the disorder. This disorder is associated with myopathic alterations and axonal degeneration in some patients. Pancuronium bromide should be used with caution, particularly when associated with steroids therapy, and it may cause difficulty in weaning patients from the respirator.

Adult↗
PubMed1994

[Non occlusive mesenteric ischemia: a late complication of cardiogenic shock].

The case of a diabetic 62-year-old man with a past history of myocardial infarction, developing a cardial arrest followed by successful cardiopulmonary resuscitation, is reported. In the late clinical course, the patient displayed abdominal signs related to mesenteric ischaemia. The pathophysiology of non-occlusive mesenteric ischaemia is discussed. Risk factors such as diabetes, cardiovascular disease, hemodialysis, the use of digoxine or alpha-adrenergic drugs are listed. Non-occlusive mesenteric ischaemia is not an infrequent complication of cardiac failure in high risk patients.

Diabetic Ketoacidosis↗
PubMed1993

[Are infant resistant to carbon monoxide poisoning?].

A 20 year old woman and her 13 weeks old infant were found in the same place close together in a house fire. As soon as possible, on-the-spot treatment was initiated simultaneously for both victims, i.e. oxygen (100% FIO2), using endotracheal intubation and mechanical ventilation for the mother, with hyperbaric oxygen when in the hospital, and by facial mask for the baby. On admission (35 minutes after discovery in the fire), the mother remained comatose, whereas the baby showed only moderate neurologic abnormalities. The initial laboratory assessment showed a pH of 7.12 for the mother and 7.06 for the baby.

Adult↗
PubMed1993

[ARDS and mechanical ventilation--"primum nil nocere"].

Present evidence demonstrates that mechanical ventilation in patients with adult respiratory distress syndrome (ARDS) contributes to the ongoing pulmonary damage, a condition known as "ventilator lung". Data from various animal studies indicate that volume, rather than pressure, is probably the main culprit. Accordingly, clinicians should use tidal volumes smaller than those usually recommended. This approach leads to hypercapnia (i.e. so-called "permissive hypercapnia"), which seems to have very few adverse effects and might even be beneficial. Moreover, there is an added risk of atelectasis, which can be prevented by the application of positive end-expiratory pressure (PEEP). The present study reviews the pathophysiological mechanisms by which mechanical ventilation is injurious to the lung, and attempts to outline an approach aimed at minimizing such damage.

Humans↗
PubMed1993

[Delay in management and treatment of patients with suspected acute myocardial infarction: role of the public, of extra- and intra-hospital structures and transportation methods].

The potential impact of thrombolytic agents on mortality and morbidity from coronary artery disease is weakened by in- and out-of-hospital delays occurring in the management of acute myocardial infarction. The goals of this study were to review the situation 5 years after the publication of the GISSI study. From October 1, 1991 to March 31, 1992, all the events occurring between symptom onset and in-hospital treatment were analyzed for 620 consecutive patients with suspected myocardial infarction seen in the emergency ward of the University Hospital, Geneva. Among them, 189 (30.5%) had myocardial infarction and 144 (23%) unstable angina. Mean and median delay between symptom onset and hospital arrival for the 620 patients were 10 h 02 min and 2 h 55 min respectively; 117 (19%) patients came straight to the hospital alone, with the risk of arrhythmic complications en route to the emergency ward but with shorter time delays (mean delay: 6 h 13 min; median delay: 2 h 30 min) than the 503 (81%) patients who called out-of-hospital services (mean delay: 10 h 55 min; median delay: 3 h; p < 0.04). The latter patients accounted for 47% of mean out-of-hospital delay and the out-of-hospital services for 53%. Minimization or ignorance of symptoms, waiting for relief from medication and attempts to reach relatives were responsible for long patients' decision times.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗