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Biomedical subjects

J Kienlen

Publications and source records attributed to J Kienlen.

At least 19 recordsLinked to original sources
PubMed1999

[Management of multiple trauma in the emergency room].

The management of multiple trauma patient in the emergency room is paradoxical because the treatment must be performed as soon as possible, but the precise diagnosis using imaging is time consuming. Multiple trauma might be classified into 3 classes. Patient in class 1 is severely injured with serious neurological, respiratory and/or hemodynamic distress. Imaging procedures only consist on chest x-ray, abdominal ultrasonography and echocardiography if needed, while saving treatments are immediately required such as tracheal intubation and mechanical ventilation in case of severe brain trauma or acute respiratory failure, chest tubing in case of massive pleural effusion, surgery for hemostasis. Class 2 is represented by a patient who is seriously injured but quite stabilized by intensive care such as massive vascular loading. The aim of clinical examination is to choose specific imaging to detect and to treat potential lethal injuries such as abdominal US, chest x-ray (4 views), angiography for embolisation, brain CT scan. Class 3 patient is stabilized because of medical management on the field by MICU (SAMU/SMUR). The best management is to first perform total body CT scan to obtain quick and precise diagnosis of injury and to organize specific imaging procedure or specific surgery. In conclusion, the best management of multiple trauma implies trained medical and paramedical staff including emergency physicians and anesthesiologists in the hospital but also in the fields, efficient medical dispatching to transport the patient in the hospital able to immediately manage the patient, surgeons of several specialties, radiologist. Indeed, the aim is not to transport as quick as possible the patient in the nearest center, but to have a logical strategy in order to have the quickest discharge with the least sequellae as possible.

Angiography↗
PubMed1992

Comparison of hydrophobic heat and moisture exchangers with heated humidifier during prolonged mechanical ventilation.

Inspired gases must be warmed and humidified during mechanical ventilation. In a prospective randomized study we compared the performance of a heated humidifier (HH) (Draegger Aquaport) and a heat and moisture exchanger (HME) (Pall Filter BB 2215). A total of 116 patients requiring mechanical ventilation (Servo 900 C Siemens) were enrolled into the study and were randomly assigned to 2 groups. Patients in group I were ventilated with a traditional breathing circuit with HH and patients in group II using a simplified circuit with HME. Pre-existing and hospital acquired atelectasis and pneumonia, occurrence of endotracheal tube (ET) occlusion and ventilatory parameters (respiratory rate, tidal volume) were studied. No statistical difference was found between groups for each parameter except the greater frequency of ET occlusions in the II group (0/61 vs 9/55) (p = 0.0008). Pall Filter (PF), a hydrophobic filter, humidifies the dry gases from the condensed water which is put down on the HME surfaces during cooling of saturated expired gases. This purely physical property is linked to the magnitude of the thermic gradient between the expired gases and the ambiant temperature. Performance impairment of PF in our study might be due to high ambiant temperature in the intensive care unit (usually around 28 degrees C) which reduces thermic gradient and water exchanges. We conclude that efficiency of PF may be weak in some conditions of ambiant temperature.

Adult↗
PubMed1991

[Spontaneous rupture of the liver during triplet pregnancy following in vitro fertilization].

The authors present an observation of a spontaneous rupture of the liver happening during the 8th month of gestation of a triple pregnancy obtained by in-vitro fertilization. The diagnosis was done with some delay but evolution was successful for the mother and all her children. It is elective ligation of the right branch of the hepatic artery which produced the hemostasis.

Adult↗
PubMed1990

[Pharmacokinetics and changes in the physical properties of blood and urine after administration of dextran 60000].

A study was carried out to assess the changes induced by an infusion of dextran, molecular weight 60,000 daltons, in blood and urine. Plasma and urine dextran and serum protein concentrations, haematocrit, blood and urine viscosities, and blood oncotic pressure were measured in 10 consecutive male patients. Fifteen min after administration of 20 ml dextran 1000 (Promit), they were each given 500 ml (30 g) dextran 60 (Hemodex) over 30 min for plasma volume expansion. The measurements were carried out at the end of the infusion, and then at regular intervals over a 48 h period. The highest dextran blood concentrations were found at the end of the infusion, decreasing thereafter with a distribution half-life of 1.83 +/- 0.64 h, and an elimination half-life of 25.5 +/- 7.6 h. Haematocrit values decreased by 12%, and serum protein concentrations by 9.5%, after the end of the infusion. These changes remained significant for 9 h; they were probably due to the dilution effect of 500 ml of dextran. Colloid osmotic pressure was not significantly altered (20.7 +/- 4.7 mmHg vs. 23.1 +/- 5.1 mmHg 48 h after the end of the infusion). The colloid osmotic pressure due to dextran 60 compensated for the fall in protein concentration. A decrease in blood viscosity was found at different shear rates, despite dextran 60 being highly viscous. This could also be explained by a dilution effect. The highest degree of urinary excretion occurred 30 min after the end of the infusion, and lasted for 3 h. Forty-five percent of the total dextran dose had been excreted by the 48th hour.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[The course of blood concentrations of propofol administered at a constant rate, combined with fentanyl].

The blood concentration of propofol was studied in 14 ASA 1 informed patients, who were to undergo orthopaedic or plastic surgery lasting at least 90 min. Anaesthesia was induced with a 2 mg.kg-1 bolus of propofol together with 0.86 microgram.kg-1 fentanyl. This was followed by a constant rate infusion of propofol and fentanyl, 5 mg.kg-1.h-1 and 3 micrograms.kg-1.h-1 respectively. The mean duration of propofol infusion was 153 +/- 63 min, with extremes of 90 and 315 min. Propofol concentration was measured using gas phase chromatography on total arterial blood; the lower limit of detection was 0.05 mg.l-1. During the infusion, blood concentrations were found between 2 and 4 mg.l-1. It was 2.25 mg.l-1 at the fifth min; this was 80% of the concentration found at the 120th min. There was in fact no statistically significant difference between the values found at the 90th, 120th and 150th min. On stopping the infusion, the concentrations fell rapidly during the first 5 min, and then more slowly. By the 30th min, it had reached a value 4.5 times less than that at the end of the infusion. However, individual variations were found, which could explain delayed recovery. The calculated pharmacokinetic parameters were: elimination half-life = 41.7 +/- 20 min, clearance = 2.14 +/- 0.55 l.min-1 and equilibrium distribution volume = 43.4 +/- 15.2 l. These results are discussed. It is therefore possible to give propofol continuously at a constant rate without having any accumulative effect.

Adolescent↗
PubMed1987

[Midazolam used for premedication reinforces sleep induced by flunitrazepam].

This single blind study aimed to discover possible effects of intramuscular premedication with midazolam on the sleep induced by intravenous flunitrazepam. 24 male patients, aged 17 to 71 years, who were to undergo surgery to the distal parts of an upper limb under regional anaesthesia, were randomly assigned to two equal groups: in the midazolam group, an intramuscular premedication of 0.12 mg.kg-1 midazolam with 0.5 mg atropine was given, whereas in the control group atropine only was used. In all patients, 1 mg flunitrazepam was given intravenously 45 min after the premedication, before carrying out regional anaesthesia. No other drug was given. In the midazolam group, the time of loss of spontaneous conversation was reduced (p less than 0.05), as well as the time of eye closure (p less than 0.001), and the time for recovery of the capacity to count backwards was increased (p less than 0.001). So, premedication with 0.12 mg.kg-1 midazolam intravenously 45 min before giving 1 mg flunitrazepam reinforced the sleep induced by the latter.

Adult↗
PubMed1985

[Effect of exclusive enteral feeding with Enteronutril on serum lipids].

Ten patients aged between 18 and 73 years admitted to our intensive care unit were placed on exclusive artificial nutrition with Enteronutril receiving on average 2.855 +/- 496 kcal/day (715 +/- 125 g). This solution is poor in lipids (1.5%) and contains no linoleic acid (C18:2). Its effects on serum lipids were analysed after 5, 10 and 15 days of treatment. Total cholesterol (TC) and phospholipids (PL) showed no significant change. However, triglycerides (TG) rose on d15 and pre-beta-lipoproteins were significantly higher on d5. The latter rose further from d10 to d15. The C18:2 fraction of total lipids (TL) fell precipitously on d5 (-50%). Although C18:2 remained stable from d5 to d10, a new, slower decrease occurred from d10 to d15. This decrease was accompanied by a specific rise in oleic (C18:1) and palmitoleic (C16:1) acids. Palmitic (C16:0) and stearic (C18:0) acids were unaffected. Arachidonic acid (C20:4) remained within normal limits up to d15. Eicosatrienoic acid which was measurable on d0 presented no significant rise during the course of the study. The changes in C18:2 were inversely proportional to those of C18:1 or C16:1. This translated a lack of C18:2 relative to delta 9 desaturase (freed of the inhibition usually exerted by C18:2). These results showed that the body could maintain a sufficient level of linoleic acid to synthesize arachidonic acid by drawing on its C18:2 reserves from fatty tissue. Nevertheless, these reserves were progressively exhausted beyond d10, thereby causing a shortage of arachidonic acid.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

[Pharmacokinetics of intravenous non-steroidal anesthetics].

Even though the anesthetic agents thiopental, ketamine, propanidid and etomidate all belong to very different chemical families they are all characterized by a very large degree of liposolubility. This explains their rapid penetration into the brain. The pharmacokinetic model of thiopental is a three compartment model. There is strong protein binding and only the free fraction is active. The very short action of the product after a single injection is due to the rapid redistribution of the agent into the muscle mass because its hepatic metabolization is very slow. However, when given over prolonged time the adipose compartment plays an important role in the mixture of the product, explaining the prolonged sleep produced. The central depressant actions of thiopental and consequently its action on CMRO2 depend on the initial dose and the route of administration. A single and massive injection produces a small and temporary reduction in the CMRO2 even though the plasmic concentration is high. In contrast prolonged intravenous infusion produces more severe and longer lasting depression of the CMRO2. The pharmacokinetic model of ketamine is tri-compartmental. There is weak protein binding. After IV injection ketamine rapidly enters the brain and the maximum concentration is reached one minute later. After that the cerebral concentration rapidly falls as does the plasma level. Signs of waking are seen at a concentration of 130 micrograms per gram of tissue. An increase in the dose of ketamine does not much influence the duration of analgesia but increase the waking time. This suggests that its indication in ambulatory anesthesia should be looked at with care. It is metabolized by the liver with the formation of several metabolites of which some are active. The kinetics of propanidid can be explained on the basis of a monocompartmental model. The speed of the fall in plasma level of the product is related to the speed of injection. High plasma concentrations mobilize a larger quantity of plasma pseudo-cholinesterases, increasing thus the speed of degradation. The product is rapidly hydrolized (plasma and liver cholinesterases). The duration of action is longer when used at low doses or when it is administered at a constant dose. Propanidid does not have any accumulative effect. The kinetics of etomidate follow a tri-compartmental model. It is very rapidly and largely distributed in the organism, the peak cerebral concentration being reached in less than one minute. There is strong protein binding. Repeated administration of the drug produces an increase in anesthetic sleep but also a delay in recovery. Etomidate is hydrolized by hepatic esterases.

Anesthesia, Intravenous↗
PubMed1981

[Study of delayed skin hypersensitivity using the multitest in an intensive care unit].

A multiple puncture procedure was employed to determine delayed skin hypersensitivity in 76 patients admitted to an Intensive Care Unit. This new method enables the responses to 7 antigens to be measured after a single application. Patient reactivity was assessed on admission (D0) and during hospitalisation (D7 and D14). Results were analysed as a function of modifications in antigenic response during hospitalisation, and its incidence on subsequent infection and mortality. Mortality in anergic patients was 85.71 p. cent, infection being the cause in 90 p. cent of these cases. A very association was found between anergy and mortality (p less than 0.001). These results suggest that cell immunity skin tests in patients admitted for intensive care treatment can be of some value for assessing prognosis. Tests must be repeated during hospitalisation, however, as immunity defences progress, in fact--in one direction or another--up to the 14th day or even beyond, an a single test on the day of admission is insufficient for prognostic purposes.

Adolescent↗