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Biomedical subjects

J C Richard

Publications and source records attributed to J C Richard.

At least 19 recordsLinked to original sources
PubMed1998

Unplanned extubation: risk factors of development and predictive criteria for reintubation.

OBJECTIVES: To define patients at risk for unplanned extubation; to assess the influence of nursing workload on the incidence of unplanned extubation; and to determine predictive criteria for patients requiring reintubation. DESIGN: A prospective, case-control study, with 10 and 15 mos of data collection. SETTING: University medical intensive care department. PATIENTS: In the first study, which lasted 10 mos, unplanned extubation occurred in 40 (14%) of 281 ventilated and intubated patients; 36 cases were sufficiently documented to be compared with 74 intubated and ventilated controls. In the second study, which lasted 15 mos, the reintubated patients (n=23) of a series of 62 unplanned extubation patients were compared with those who were not reintubated (n=39). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The following parameters were recorded: gender, age, main reason for admission, Simplified Acute Physiology Score II, route of intubation (oral or nasotracheal), tube diameter, ventilatory mode, FiO2, frequency and tidal volume delivered by the ventilator immediately before unplanned extubation, arterial blood gases performed 24 hrs before unplanned extubation, the presence of any sedation with, in this case, the last Ramsay score, the presence of hand restraints, the presence of weaning of ventilation, the accidental or deliberate nature of unplanned extubation, the Glasgow Coma Score at the time of unplanned extubation, the duration of ventilation before unplanned extubation, total duration of ventilation and stay in the intensive care unit, and the patient's survival or death. The nursing workload was evaluated using a score derived from the Projet de Recherche en Nursing and adapted to intensive care. Unplanned extubation patients were more frequently intubated orally than controls (33.3% vs. 14.9%, respectively; p< .05). In the population of sedated patients, unplanned extubation patients were more frequently agitated than controls (60% vs. 19%, respectively; p < .05). The nursing workload did not differ between days with and days without unplanned extubation. Twenty-three (37%) of the 62 cases of documented unplanned extubation were reintubated. Predictive factors of reintubation are, in decreasing order of importance: Glasgow Coma Score of <11, accidental nature of unplanned extubation, and a PaO2/FiO2 ratio <200 torr (<26.7 kPa). CONCLUSIONS: Patients at risk for unplanned extubation are characterized by oral intubation and insufficient sedation. In the department studied, and with the specific score used, we did not observe a relationship between the nursing workload and the incidence of unplanned extubation. A Glasgow Coma Score of <11, the accidental nature of unplanned extubation, and a PaO2/FiO2 ratio <200 torr (<26.7 kPa) are factors associated with a risk of reintubation.

Accidents↗
PubMed1998

Expiratory valves used for home devices: experimental and clinical comparison.

A bench study followed by a clinical trial were performed to evaluate the mechanical characteristics of five (commercially available) expiratory valves used for home ventilators, as well as the potential clinical impact of differences between these valves. In the in vitro study, expiratory valve resistance was evaluated under unvarying conditions, whereas dynamic behaviour was evaluated by calculating the imposed expiratory work of breathing during a simulated breath generated by a lung model. Differences in resistance and imposed expiratory work of up to twofold and 150%, respectively, were found across valves. We then conducted a randomized crossover clinical study to compare the effects of the least resistive (Bennett) and most resistive expiratory valves (Peters) in 10 intubated patients receiving pressure support ventilation. There were no significant differences regarding blood gases or respiratory parameters except for the oesophageal pressure-time product (PTPoes), which was significantly increased by the Peters valve (236+/-113 cmH2O x s x min(-1) versus 194+/-90 cmH2O x s x min(-1)). An analysis of individual responses found that the Peters valve induced substantial increases in intrinsic positive end-expiratory pressure (PEEP), PTPoes, and expiratory activity in those patients with the greatest ventilatory demand. In conclusion, differences between home expiratory valve resistances may have a clinically relevant impact on the respiratory effort of patients with a high ventilatory demand.

Adult↗
PubMed1997

Physiological effects and optimisation of nasal assist-control ventilation for patients with chronic obstructive pulmonary disease in respiratory failure.

BACKGROUND: A study was undertaken to investigate the effects of non-invasive assist-control ventilation (ACV) by nasal mask on respiratory physiological parameters and comfort in acute on chronic respiratory failure (ACRF). METHODS: Fifteen patients with chronic obstructive pulmonary disease (COPD) were prospectively and randomly assigned to two non-invasive ventilation (NIV) sequences in spontaneous breathing (SB) and ACV mode. ACV settings were always optimised and therefore subsequently adjusted according to patient's tolerance and air leaks. RESULTS: ACV significantly decreased all the total inspiratory work of breathing (WOBinsp) parameters, pressure time product, and oesophageal pressure variation in comparison with SB mode. The ACV mode also resulted in a significant reduction in surface diaphragmatic electromyographic activity to 36% of the control values and significantly improved the breathing pattern. SB did not change the arterial blood gas tensions from baseline values whereas ACV significantly improved both the PaO2 from a mean (SD) of 8.45 (2.95) kPa to 13.31 (2.15) kPa, PaCO2 from 9.52 (1.61) kPa to 7.39 (1.39) kPa, and the pH from 7.32 (0.03) to 7.40 (0.07). The respiratory comfort was significantly lower with ACV than with SB. CONCLUSIONS: This study shows that the clinical benefit of non-invasive ACV in the management of ACRF in patients with COPD results in a reduced inspiratory muscle activity providing an improvement in breathing pattern and gas exchange. Despite respiratory discomfort, the muscle rest provided appears sufficient when ACV settings are optimised.

Acute Disease↗
PubMed1997

Comparative physiologic effects of noninvasive assist-control and pressure support ventilation in acute hypercapnic respiratory failure.

STUDY OBJECTIVE: To compare the effects of noninvasive assist-control ventilation (ACV) and pressure support ventilation (PSV) by nasal mask on respiratory physiologic parameters and comfort in acute hypercapnic respiratory failure (AHRF). DESIGN: A prospective randomized study. SETTING: A medical ICU. PATIENTS AND INTERVENTIONS: Fifteen patients with COPD and AHRF were consecutively and randomly assigned to two noninvasive ventilation (NIV) sequences with ACV and PSV mode, spontaneous breathing (SB) via nasal mask being used as control. ACV and PSV settings were always subsequently adjusted according to patient's tolerance and air leaks. Fraction of inspired oxygen did not change between the sequences. MEASUREMENTS AND RESULTS: ACV and PSV mode strongly decreased the inspiratory effort in comparison with SB. The total inspiratory work of breathing (WOBinsp) expressed as WOBinsp/tidal volume (VT) and WOBinsp/respiratory rate (RR), the pressure time product (PTP), and esophageal pressure variations (deltaPes) were the most discriminant parameters (p<0.001). ACV most reduced WOBinsp/VT (p<0.05), deltaPes (p<0.05), and PTP (0.01) compared with PSV mode. The surface diaphragmatic electromyogram activity was also decreased >32% as compared with control values (p<0.01), with no difference between the two modes. Simultaneously, NIV significantly improved breathing pattern (p<0.01) with no difference between ACV and PSV for VT, RR, minute ventilation, and total cycle duration. As compared to SB, respiratory acidosis was similarly improved by both modes. The respiratory comfort assessed by visual analog scale was less with ACV (57.23+/-30.12 mm) than with SB (75.15+/-18.25 mm) (p<0.05) and PSV mode (81.62+/-25.2 mm) (p<0.01) in our patients. CONCLUSIONS: During NIV for AHRF using settings adapted to patient's clinical tolerance and mask air leaks, both ACV and PSV mode provide respiratory muscle rest and similarly improve breathing pattern and gas exchange. However, these physiologic effects are achieved with a lower inspiratory workload but at the expense of a higher respiratory discomfort with ACV than with PSV mode.

Acute Disease↗
PubMed1997

Syndrome of inappropriate secretion of antidiuretic hormone in two elderly women with elevated serum fluoxetine.

OBJECTIVE: Fluoxetine is widely prescribed for depressed patients. Hyponatremia secondary to inappropriate secretion of antidiuretic hormone has been reported in a few cases associated with routine use of fluoxetine, especially in elderly patients. The mechanism has been postulated to be linked to the inappropriate secretion of antidiuretic hormone. Serum concentrations of antidiuretic hormone and fluoxetine have not been reported in previously published reports. CASE REPORT: We report two new cases of severe and reversible hyponatremia associated with routine use of fluoxetine therapy in two elderly women. Fluoxetine-induced inappropriate secretion of antidiuretic hormone was confirmed by elevated serum concentrations of antidiuretic hormone and fluoxetine.

Aged↗
PubMed1994

Weaning criteria from mechanical ventilation.

Although the majority of mechanically-ventilated patients can be rapidly transferred to spontaneous breathing, a substantial minority of them develop difficulties during weaning attempts, prolonging the length of hospital stay and increasing the risk of complications. Inversely, excessively early weaning and extubation increase the morbidity of ventilated patients. It is, therefore, essential to be able to determine the ideal time of weaning for each patient, more particularly for those likely to develop difficulties. Various clinical and laboratory criteria of weaning, or, more precisely, predictive factors of weaning, may therefore help the intensive care physician to precisely evaluate the suitability of disconnecting a patient from a ventilator. Many of the classical criteria used are frequently inaccurate in predicting the outcome of weaning, and new criteria have been described and designed to be more objective and discriminant in predicting the suitability of weaning. The authors make a critical review and analyse the limitations of these different criteria.

Acute Disease↗
PubMed1982

Acute septic arthritis of the fingers. A clinical study of 87 cases.

The authors analyse a clinical series of 87 operated cases of acute septic arthritis of the fingers. Arthritis followed either a direct neglected punctiform inoculation or an adjacent infection (subcutaneous felon), or a serious open wound having received emergency surgery. During surgery a careful assessment was made of the extent of the infection, indicating the condition of the cartilage and that of the articular and periarticular soft tissues. Treatment was either conservative (surgical drainage, synovectomy and closure) or non-conservative (arthrodesis, articular resection or even amputation). The short term results were evaluated on recovery from infection and the long term results (after six months) on the joint function. There is a correlation between the causative factor, the pathology and the prognosis: direct punctiform inoculations operated upon at an early stage and simple joint wounds did not have a regional infection; in all other cases there was one. Conservative treatment was limited to those patients with no regional infection. In these cases, a localized abnormal aspect of the cartilage did not prove to be irreversible. Thus the prognosis was good only in cases of direct punctiform inoculations operated upon at an early stage. In the other cases, either the conservative treatment failed, or a non-conservative treatment was decided upon immediately. Severe joint infection leads to residual lack of motion, and the destruction of the articular surfaces may induce the surgeon to perform an arthrodesis. In the early stages of arthritis, surgical attempts have been made at controlling the infection and preserving articular motion (1, 2). The few works published on that matter deal with larger limb joints. In this paper we present a series of 87 cases of acute septic arthritis of the fingers.

Acute Disease↗
PubMed1982

[70 patients operated on for sciatica without herniated disk].

Seventy patients suffering from sciatica were operated in whom no disc herniation was found. In 42 instances, compression of bony origin was found. These cases were either due to general narrowing of the spinal canal with signs in the distribution of several roots with neurological intermittent claudication, or to narrowing of the lateral recess or intervertebral foramen with involvement of only one root. Decompressive surgery was always beneficial for pain. In 20 instances a disc was found to be only bulging; disc excision was performed in 17 of these patients. In 8 instances, no abnormality was found. Some patients were nevertheless cured by disc excision, a single laminectomy being useful. The incidence of additional psychological problems is discussed. It is concluded that the clinical signs should guide the surgeon rather than the radiological findings in decisions for surgical treatment. Patients who have been correctly treated by conservative means for an adequate time should be systematically operated on if they have not shown sufficient clinical improvement.

Adult↗
PubMed1981

[Fixation of fractures of the fifth metacarpal (author's transl)].

The authors describe the treatment which they recommend for fractures of the fifth metacarpal. After a brief description of fractures of the proximal end of the diaphysis and of the head of the bone, they study in detail fractures of the neck of the fifth metacarpal. They found that conservative treatment is not very successful but that internal fixation tends to have iatrogenic complications. They recommend a transverse pinning of the bone after reduction by manual traction. Two or three pins are driven from the fifth to the fourth metacarpal through the head and the shaft. This treatment allows early mobilisation.

Bone Nails↗
PubMed1977

Amiodarone-like haemodynamic and non-competitive antiadrenergic properties of a benzoyl-indolizine.

1. 2-Ethyl-3-(4-gamma-di-n-butylaminopropoxy-benzoyl)-indolizine hydrochloride (L 9394) induced in the ananesthetized dog a marked and long-lasting decrease in heart rate together with a transient reduction in blood pressure. 2. L 9394 decreased Robinson's index, an effect which suggests that the substance reduces the oxygen requirements of the heart. 3. L 9394 markedly increased coronary arterial blood flow. 4. L 9394 is endowed with non-competitive antiadrenergic properties. 5. L 9394 did not impair cardiac function since cardiac output and stroke volume increased appreciably during the initial phase of action and did not fall below the control values at any time thereafter. 6. The overall haemodynamic properties of L 9394, which were similar to those of amiodarone, are considered to be potentially valuable for the long-term treatment of angina pectoris.

Adrenergic beta-Antagonists↗