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Biomedical subjects

J C Chevrolet

Publications and source records attributed to J C Chevrolet.

At least 73 records · Page 4Linked to original sources
PubMed1993

[Assisted ventilation at home].

In patients with chronic respiratory failure, in particular in those with accompanying wall-dependent restrictive syndrome (i.e. kyphoscoliosis, certain myopathies...) shortness of breath and sequelae of cor pulmonale usually limit quality of life distinctly. In particular repeated hospitalizations necessitated by remittent occurrence of severe respiratory decompensation, usually in the course of infections, reduce life quality and life expectancy. Thus, selected patients may benefit remarkably from a device for assisted ventilation at home as a technical measure with good results. The number of hospitalizations is markedly reduced, shortness of breath can even disappear completely, so that patients can regain social activity. The usually non-invasive technique (ventilation with nose-mask) is applied at night, so that disturbance is low for the patient and his surroundings. It is however necessary, that his financial burden and technical maintenance and servicing of materials is granted by an organisation, who is also able to provide safety for the patient and his family on a long term.

Home Care Services↗
PubMed1993

Group A beta-haemolytic streptococcus septicaemia: the toxic strep syndrome. Report of our cases developing septic shock and multiple organ failure.

During the last two decades, severe group A beta-haemolytic streptococcal infections have been defined as the "toxic strep syndrome", and have been reported not only in immunocompromised or elderly people, but also occasionally in previously healthy patients. We describe 4 patients presenting with the toxic strep syndrome, requiring surgery and intensive care, and briefly review the related literature. Fatigue, localized pain and other nonspecific symptoms were associated with the onset of the disease, followed by septic shock with multiple organ failure. Early diagnosis and surgical intervention, if necessary, are mandatory. Subsequently, appropriate supportive treatment of vital organ dysfunction and penicillin as the antibiotic of choice represent the cornerstones of the management of this syndrome.

Adult↗
PubMed1993

Alterations in inspiratory and leg muscle force and recovery pattern after a marathon.

We measured lung mechanics and metabolic parameters, first in a series of 15 marathon (M) and 12 half-marathon (H) runners, before and 2.5 h after the race, in order to assess the running effect on respiratory muscles. Maximal static inspiratory (Pi) and expiratory (Pe) pressures, maximal voluntary ventilation (MVV), blood lactate (LAC), arterialized blood gases (ABG), plasma glucose (GLU), and, with a visual analog scale, subjective tiredness were assessed. Pi decreased in M and H without change in Pe, MVV, or lung mechanics; it was still abnormal 2.5 h after the race and did not correlate with LAC, ABG, training parameters, running times, or subjective tiredness. A second study of six other M compared Pi, Pe, adductor pollicis longus (Ppol), and triceps surae (Ptri) forces, aiming to: 1) assess the reproducibility of the prolonged Pi decrease without Pe change, 2) prove that such a decrease corresponded to a real reduction in inspiratory muscle force and was not due to a poor collaboration of the subjects, 3) correlate Pi decrease with the force loss of a potentially tired leg muscle: the triceps surae. We observed a significant and similar decrease in Pi and Ptri, but no change in Ppol and Pe. Moreover, the high correlation between Pi and Ptri diminutions suggested a similar recovery pattern for inspiratory and leg muscles. In conclusion, the prolonged decrease in Pi after such races is compatible with inspiratory muscle fatigue, which, as well as its recovery, is similar to leg muscle tiredness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Measurement of pulmonary artery occlusion (wedge) pressure using the Swan-Ganz catheter: various pitfalls].

The Swan Ganz pulmonary artery catheter is widely used in the intensive care unit. It allows the determination of important hemodynamic parameters. Among these, pulmonary artery occlusion pressure ("wedge" pressure) is often considered to reflect accurately left ventricular preload and pulmonary capillary hydrostatic pressure. However, many interferences may render data interpretation difficult, especially in patients undergoing mechanical ventilation. This article reviews some of these pitfalls.

Capillaries↗
PubMed1992

Bronchoscopy in the intensive care unit.

The development of the flexible, fiberoptic bronchoscope has made bronchoscopic examinations possible in ICU patients undergoing mechanical ventilation. Over the years, the number of such procedures has greatly increased, with both diagnostic and therapeutic objectives, such as performing difficult intubation, management of atelectasis and hemoptysis, diagnosis of nosocomial pneumonia in ventilated patients, and early detection of airway lesions in selected situations, such as high-frequency ventilation. The complication rate can be kept low if the endoscopist has a precise knowledge of the many pathophysiological and technical facets particular to bronchoscopy under these difficult conditions. This article reviews some of these aspects, in the light of our personal experience.

Bronchoalveolar Lavage Fluid↗
PubMed1992

Severe acute myocardial infarction during a staphylococcal septicemia with meningoencephalitis. A possible contraindication to thrombolytic treatment.

We report the first case of lethal intracranial haemorrhage complicating a treatment by rt-PA in a patient presenting with a simultaneous staphylococcal septicemia with meningoencephalitis and an acute myocardial infarction with cardiogenic shock. The presence of microvascular lesions in the central nervous system seems to be important risk factor for intracranial haemorrhage and we recommend extreme caution in the use of thrombolytic treatment in septicemic patients with acute myocardial infarction, particularly when neurological symptoms are present.

Cerebral Hemorrhage↗
PubMed1992

Serum TNF in patients with severe malaria treated by exchange transfusion.

The authors report on three cases of severe P. falciparum malaria successfully treated by iv quinine and exchange transfusion. Serum concentrations of Tumor Necrosis Factor (TNF) were determined before and during treatment. After an initial decrease, serum levels of TNF remained markedly elevated during the first 48 hours despite exchange transfusion. Though exchange transfusion accelerates the elimination of parasites from the blood, it seems to have no immediate effects on reducing serum levels of cytokines such as TNF.

Adult↗
PubMed1991

[Indications for intubation and mechanical ventilation in aspecific chronic obstructive bronchopneumopathy].

COPD (chronic obstructive pulmonary disease) is characterized by recurrent exacerbations of respiratory failure, and mechanical ventilation appears often to be the only therapeutic tool available to avoid an imminent fatal outcome. However, when these patients are candidates for mechanical ventilation they are in the terminal phase of a very severe and chronic debilitating illness, and it is important to select patients with reasonable survival expectancy and an acceptable quality of life before initiating mechanical ventilation. We strongly advocate a non-dogmatic attitude based on the scientific data at present available in the literature.

Humans↗
PubMed1991

[Mechanical ventilation and weaning of patients with obstructive bronchopneumopathy].

Mechanical ventilation of chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure poses certain problems specific to the pathophysiology of this condition. These difficulties arise during the mechanical ventilation phase as well as during weaning. A thorough knowledge of the mechanisms involved and of the means of minimizing complications allows the vast majority of these patients to be weaned successfully. This article reviews some of these problems and possible solutions.

Alkalosis, Respiratory↗
PubMed1991

[The role of thrombolysis in the treatment of pulmonary embolism: indications and results].

The indications, contraindications, results and complications of thrombolytic treatment in pulmonary embolism are reviewed. The natural history of this condition and recent developments in the field of thrombolysis are particularly emphasized. If hemodynamic breakdown is present, thrombolysis is clearly indicated. On the other hand, the place of thrombolytic treatment in the presence of non-massive pulmonary embolism remains to be established. In practice the authors' policy includes intravenous administration of a rather high dose of rt-PA (alteplase) (50 mg) over a short period of time (2 hours), possibly followed by a second 5-hours infusion of 10 mg/h. However, other treatment schemes are also well established.

Contraindications↗
PubMed1991

[ The intestine-liver-lung axis in septic syndrome].

Abacteremic sepsis is frequent in intensive care units, and is closely associated with the development of adult respiratory distress syndrome (ARDS) and multiple systems organ failure (MSOF). It carries a high mortality. The gut is thought to be the "motor" of such septic states and the first step of a "gut-liver-lung axis". Shock of any type or sepsis can by themselves lead to increased permeability of the intestinal mucosal barrier. This, in turn, may promote bacterial translocation, i.e. the passage of bacteria or bacterial products such as endotoxin from the lumen of the gut into the portal bloodstream. When such products reach the liver, activation of Küpffer cells occurs, resulting in the secretion of pro-inflammatory and hypotensive mediators. The latter are mainly the tumor necrosis factor-alpha and interleukins-1 and -6. These substances trigger many biologic cascades, and may explain the development of abacteremic septic states and MSOF. The mediators cause binding of polymorphonuclear neutrophils to pulmonary endothelial cells, and their degranulation. In addition, they activate local and systemic coagulation mechanisms. This explains the morphological changes observed in early sepsis-induced ARDS, i.e. pulmonary edema, vascular thrombosis and hemorrhages. Studies are currently in progress in an attempt to limit bacterial and endotoxin translocation and the action of the mediators.

Bacterial Physiological Phenomena↗
PubMed1991

[Barbiturate coma in the treatment of refractory status epilepticus in adults. Usefulness of continuous electroencephalography in intensive care].

Status epilepticus represents one of the most frequent neurological reasons for admission to the intensive care ward. If it resists well-managed treatment, more aggressive measures must be taken. We report 3 such situations in which patients were treated by barbiturate coma under continuous electroencephalographic monitoring. On the basis of this experience we attempt to elaborate guidelines for the use of this technique.

Adult↗
PubMed1991

[Home mechanical ventilation in Switzerland in 1990. Future developments].

Home mechanical ventilation (HMV) was initiated in polio centers in the mid-50s (iron lung). Ten years ago, chronic respiratory insufficiency patients began to be treated with positive pressure ventilation via tracheostomy tube. Survival of kyphoscoliotic and myopathic patients was impressive in uncontrolled studies. Today it appears that similar results may be obtained with a new non-invasive technique, nasal mechanical ventilation. The present situation of HMV in Switzerland (number of patients and their location) and the results of this treatment are described. In addition, we report on a short series of 24 Swiss patients collected in 4 centers. We show that HMV is possible in Switzerland and that the results in survival and quality of life are excellent, provided that the indications for this technique are consistent with the recommendations in the literature.

Adolescent↗
PubMed1991

Repeated vital capacity measurements as predictive parameters for mechanical ventilation need and weaning success in the Guillain-Barré syndrome.

In Guillain-Barré syndrome (GBS), respiratory failure is a life-threatening complication, and its occurrence may be difficult to predict. We studied prospectively 10 patients with GBS by serial measurements of pulmonary function and arterial blood gases from the the time they were admitted to hospital. Five patients developed respiratory failure and had to be intubated, whereas the other five developed no ventilatory impairment. VC measurements were very useful in predicting respiratory failure several days before intubation. In patients who were eventually intubated, VC decreased during the 48 h preceding the occurrence of respiratory failure and intubation, which was required when VC was 15.2 +/- 3.7 ml/kg body weight (BW). In nonintubated patients, VC was stable and greater than 40 ml/kg BW. In addition, VC measurements allowed us to determine the beginning of the weaning procedure (no weaning trial could be performed successfully when VC was less than 7 ml/kg BW), to rationally follow its course, and to choose the time for extubation, i.e., when VC was greater than 15 ml/kg BW.

Carbon Dioxide↗
PubMed1991

Nasal positive pressure ventilation in patients with acute respiratory failure. Difficult and time-consuming procedure for nurses.

Intubation and mechanical ventilation are well-established techniques in the management of patients with acute respiratory failure; however, there are situations in which these procedures cannot be used safely for various reasons. A recently described noninvasive technique, nasal positive-pressure ventilation (NPPV), has been developed for home ventilation of certain patients with chronic ventilatory insufficiency. We hypothesized that NPPV could be used in selected patients in whom intubation and mechanical ventilation were clearly indicated, but not immediately possible, or even contraindicated. Six patients were treated with NPPV during an episode of acute respiratory failure and enrolled in a prospective study. We found that NPPV was successful in avoiding intubation, but only in the three patients suffering from a restrictive pulmonary disorder, whereas the procedure was unsuccessful in patients with obstructive disorders. Moreover, in every patient, acute NPPV was very time-consuming for the nursing staff: in patients with restrictive disorders, a nurse had to monitor a patient submitted to NPPV during 41 +/- 9 percent of the duration of ventilation and during 91 +/- 9 percent of the NPPV time in patients with obstructive disorders. We conclude that acute NPPV may be attempted in selected patients with acute respiratory failure, predominantly patients with restrictive respiratory disorders, but that this procedure is very time-consuming for nurses.

Acute Disease↗
PubMed1991

Very severe self-poisoning lithium carbonate intoxication causing a myocardial infarction.

A case of severe lithium carbonate self-poisoning is described, presenting with a very high serum lithium level (14.6 mmol/L) on admission. Lengthy and repeated hemodialyses were required to lower lithemia to nontoxic ranges. As is usually reported, our patient had prolonged neurologic manifestations (coma, hyperreflexia, fluctuating focal signs) and developed hypotension, cardiovascular collapse, nephrogenic diabetes insipidus, and diarrhea. Other less common features were the occurrence of acute myocardial infarction without coronary artery lesions and thrombocytopenia. The possible pathogenic mechanisms are discussed. Hemodialysis and supportive intensive care treatment are commented upon. The final outcome was favorable, and the patient recovered completely.

Bipolar Disorder↗