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Biomedical subjects

J M Boles

Publications and source records attributed to J M Boles.

At least 19 recordsLinked to original sources
PubMed1998

[Spontaneous positive end-expiratory pressure ventilation in elderly patients with cardiogenic pulmonary edema. Assessment in an emergency admissions unit].

OBJECTIVES: Intubation and ventilatory assistance are often required in patients presenting severe hypoxemic respiratory distress, but may be contraindicated in elderly subjects due to an underlying condition. The aim of this study was to assess the feasibility, acceptability and contribution of early assistance with spontaneous positive end-expiratory pressure ventilation for elderly subjects admitted to an emergency unit for acute respiratory distress due to cardiogenic pulmonary edema. PATIENTS AND METHODS: In our emergency admission unit, all patients with life-threatening hypoxemic respiratory distress are initially assisted with noninvasive spontaneous positive end-expiratory pressure ventilation using a standardized commercial device. We retrospectively analyzed the the files of all patients aged over 70 years who were treated with this standard protocol for cardiogenic pulmonary edema from April 1996 through September 1997. RESULTS: During the study period, 36 patients aged over 70 years required ventilatory assistance according to the standard protocol. Intubation was not reasonable in most of the patients (n = 30). After 1 hour of ventilation, none of the patients developed clinical signs of life-threatening distress. Blood gases demonstrated improved oxygenation (AEPO2 = +184.9 +/- 105.4 mmHg; p < 0.000001). Thirty-two patients were considered to be cured (88.9%) and were discharged; the cardiovascular condition was fatal in 4 patients (11.1%). CONCLUSION: The rapid improvement in clinical signs and blood gases as well as the final outcome suggests that early assistance with spontaneous positive end-expiratory pressure ventilation is warranted at admission for elderly patients with respiratory distress due to cardiogenic pulmonary edema. Compared with a control group of hospitalized patients cared for during the preceding year and who were not treated with the standard protocol, we also demonstrated a clear improvement in mortality (11% versus 20%).

Admitting Department, Hospital↗
PubMed1998

[A sociomedical geriatric assessment in the emergency units: an alternative to the hospitalization of aged patients?].

BACKGROUND: Elderly patients admitted to the emergency unit are usually hospitalized in medical units. Could a gerontologic evaluation in the emergency room lead to another solution than hospitalization? METHODS: Since January 1993, a sociomedical geriatric reception has been operating in the emergency unit of the university hospital in Brest, France, every day from 10 AM. to 6 PM. Patients older than 75 years, dependent or at risk of dependence are examined by a geriatrician. The medical situation is evaluated. The nutrition status, the cognitive functions, the thymic functions, the gait, and the functional abilities are systematically studied. In the same time the social evaluation is realised by a social worker. RESULTS: From January 1993 to December 1996, 1,514 patients have been cared for by the social medical team. Once the assessment of each patient was made only 49% of them actually had to be hospitalized in a medical department. The outcome of 100 patients discharged between January 1994 and June 1994 was evaluated one year after their discharge at home, 11 patients were rehospitalized. The reason for rehospitalization were different from the reasons for the first hospitalization. CONCLUSION: A gerontologic assessment in the emergency room permits to avoid hospitalization in 50% of the cases. One year after discharge at home only 11% of the patients were rehospitalized.

Aged↗
PubMed1998

Non-invasive continuous positive airway pressure in acute hypoxaemic respiratory failure--experience of an emergency department.

Non-invasive continuous positive airway pressure (CPAP) seems to decrease the need for intubation in patients with severe cardiogenic pulmonary oedema (CPO) in the intensive care unit. The goals of our study were to delineate indications for CPAP in the emergency department, and to confirm its usefulness in such a setting. We retrospectively assess the evolution of all patients ventilated under CPAP for an acute hypoxaemic respiratory failure over a 1-year period (n = 64 patients). Hypercarbia and respiratory acidosis were present in most patients with CPO (PaCO2 = 54.4+/-22.3 mmHg; pH = 7.27+/-0.13), according to respiratory exhaustion, although initial PaCO2 was low in the pneumonia group. There was a significant improvement of arterial blood gases after 1 hour of ventilation in the CPO group (PaO2 = 254.1+/-121.0 mmHg; PaCO2 = 44.0+/-12.6 mmHg; pH = 7.34+/-0.08; p < 0.0001 for both parameters). In the pneumonia group, oxygenation was also improved but with the persistence of a significant shunt (PaO2 = 157.6+/-84.4 mmHg). Fifty-four patients (84%) were considered as successfully ventilated under CPAP, with no need for intubation and a favourable evolution, mainly in the CPO group. No side effects were reported. In conclusion, CPAP is a useful and easy-to-use ventilatory device in the emergency department. It is now one of our first line treatments during prehospital and emergency care of patients with CPO.

Acute Disease↗
PubMed1998

[Spontaneous ventilation in positive expiratory pressure in cardiogenic pulmonary edema. Prospective study].

New equipment facilitating the use of spontaneous ventilation with positive expiratory pressure (PEP) has become available in France since January 1996. This technique was applied in 38 patients with severe cardiogenic pulmonary oedema and persistent respiratory distress despite high flow classical oxygen therapy and standard treatment. After 1 hour of ventilation with a flow of 220 l/min of 100% oxygen with an average PEP of 7.7 cm H20, a significant improvement of clinical (heart and respiratory rate) and biological parameters (arterial gases) was observed. There were no side effects. Four patients died during the hospital period and only 1 was intubated. Spontaneous ventilation with PEP is a simple technique for coronary care units and, compared with conventional oxygen therapy, it rapidly improves arterial oxygenation, reduces respiratory work and improves conditions of cardiac load. Acute severe cardiogenic pulmonary oedema seems to be an indication of choice, especially in the elderly, where it may help avoid an often controversial intubation.

Aged↗
PubMed1997

[Knowledge and beliefs of 4th-year medical students concerning professional practices in general medicine. Results of a survey conducted at the School of Medicine of Brest].

As part of preparations for the first seminar in general practice, organized for medical students in their forth year at the Brest faculty of medicine, students were asked to fill in a questionnaire concerning their beliefs and knowledge concerning general-practice medicine. Fifty-two students, or 89.6% of the class, completed the questionnaires. The results showed that despite the lack of formal contacts with this type of practice during their studies, the students had a good idea of what general-practice medicine is and of the role of the general practitioner in our health-care system. However, this study has illustrated the difficulties students experience in defining their future professional direction, since they receive no information during their training on the different options in medical practice.

Adult↗
PubMed1997

[Use of helium-oxygen gas mixtures in acute obstructive respiratory insufficiencies].

Therapeutic use of helium has been described since 1930. Its main action is to reduce bronchial resistances and consequently overall respiratory work. Helium is substituted for nitrogen. The effects of inhaling a helium-oxygen mixture result exclusively from the physicochemical properties of helium: very low density, high kinetic viscosity. With the advent of selective bronchodilators, use of helium was rapidly abandoned until recently with new interest for the treatment of severe acute asthma. We review the literature on the physical properties of helium-oxygen mixtures and propose an analysis of their therapeutic use in severe acute asthma as well as other indications such as acute episodes of obstructive bronchopneumonia and obstruction of the upper airways. Due to the non-invasive nature of this technique, its easy use with spontaneous ventilation and the large body of theoretical data emphasizing its adaptation for therapeutic use, helium-oxygen gas mixtures offer an important therapeutic option for treating severe diseases with poor prognosis. A multicentric national study is under way to validate its use early by emergency ambulatory units for the treatment of severe acute asthma.

Acute Disease↗
PubMed1990

[Upper respiratory tract infections in patients with tracheal intubation].

Nosocomial sinusitis (NS) is observed in 10 to 30 per cent of patients under mechanical ventilation (MV) and in up to 40 per cent in those with nasotracheal intubation. This complication occurs in the first two weeks of MV in 3 out of 4 cases. Apart from a pyrexia, the clinical signs are inconsistent. Radiography at the bedside using a cradle to immobilize the head, shows either opacification of the sinus or a fluid-air level. Cerebral CT scanning is justified when intracranial extension of the infection is suspected. NS is the source of many complications: parasinusitis, intracranial infection, septicemia, and, above all, nosocomial pneumonia. The treatment requires withdrawal of nasal tubes, cleaning the nostrils, nasal decongestants and drainage after transmeatal puncture. The latter procedure enables samples of pus to be taken for bacteriological investigation. The potential gravity of NS justifies a systematic work-up in all patients on MV and strict surveillance of the efficacy of the chosen treatment.

Cross Infection↗
PubMed1989

Folic acid deficiency in intensive care patients: comparison between two regimens of supplementation.

Serum folic acid (SFA) and red blood cell folic acid (RbcFA) levels were determined in 40 patients on the day of admission to our intensive care unit (ICU, D0). 65% of the patients had low SFA (< 3,4 ng/ml) and 27.5% had low RbcFA (< 275 ng/ml)L. Twenty-four hours later (Day 1:D1), both SFA and RbcFA had decreased significantly (respectively 0.49 ng/ml and 21 ng/ml, p < 0.01) in the 40 patients; the magnitude of RbcFA decrease was greater in patients with sepsis than in those without sepsis (p < 0.02). SFA and RbcFA levels were significantly lower in patients with sepsis on D0 and D1. Forty-two other patients with documented hypofolatemia were then randomly allocated to two regimens of FA supplementation. Patients on regimen A had an intravenous injection of 0.5 mg folinic acid daily for ten days whereas patients on regimen B received a single 5 mg intravenous injection of FA on day 1. Both regimens increased significantly SFA and RbcFA levels. But regimen A should be recommended because 1) RbcFA levels were significantly higher than with regimen B (p < 0.05) and 2) the mean increase was higher, particularly in patients with initial sepsis (p < 0.01).

Journal Article↗