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Biomedical subjects

J M Raurich

Publications and source records attributed to J M Raurich.

At least 19 recordsLinked to original sources
PubMed2004

In-hospital and 2-year survival of patients treated with mechanical ventilation for acute exacerbation of COPD.

OBJECTIVE: To analyze in-hospital and 2-year survival of patients who require mechanical ventilation with intubation after acute respiratory failure due to exacerbation of chronic obstructive pulmonary disease (COPD). The secondary objective was to identify the prognostic factors for in-hospital mortality and mortality at 2 years. PATIENTS AND METHODS: We retrospectively studied 101 patients with suspected COPD admitted to the intensive care unit between July 1993 and December 1998. Variables potentially related to mortality were analyzed with a univariate model and by logistic regression. RESULTS: In-hospital survival was 74.3% and 2-year survival was 55.4%. Survival at 2 years was 81% for patients discharged from hospital. The variables associated with in-hospital mortality were age greater than 65 years, electrocardiographic diagnosis of chronic cor pulmonale, and development of multiorgan dysfunction syndrome. No factors predictive of mortality at 2 years were identified. CONCLUSIONS: The in-hospital survival rate for patients with an acute exacerbation of COPD who require mechanical ventilation is good and the 2-year survival rate is acceptable. Age, electrocardiographic signs of cor pulmonale, and development of multiorgan dysfunction syndrome were associated with greater risk of in-hospital mortality.

Acute Disease↗
PubMed2004

A new neovalve type in short bowel syndrome surgery.

The objective of this study was to compare the clinical and analytical repercussion of a new type of intestinal valve -which can be used in both massive resections and right hemicolectomies requiring the elimination of the ileocecal valve- on two historical series of patients: one group with ileocolic resections and end-to-end anastomoses (EE), and one group with Ricotta valves. We compared 23 patients with ileocolic resection and end-to-end anastomosis, 15 with Ricotta's valve, and 20 patients with a new valve made with a small intestinal invagination. There were no statistically significant differences in baseline characteristics among patients. Patients with the new valve showed less relevant weight loss and fewer stools at 3 months and one year when compared to patients with Ricotta's valve, and particularly those with ileocolic resection. Moreover, with the new valve technique there was neither colonization of the ileal mucosa nor bacterial overgrowth. In conclusion, in massive intestinal resections and right hemicolectomies, including the ileocecal valve, the new valve technique would be of choice.

Adult↗
PubMed1997

Effects of N-acetylcysteine on tissue oxygenation in patients with multiple organ failure and evidence of tissue hypoxia.

Covert tissue hypoxia, particularly of the splanchnic region, appears important in the pathogenesis of multiple organ failure (MOF). This investigation evaluates the effects of N-acetylcysteine (NAC) upon several measures of tissue oxygenation in 10 patients with severe MOF and evidence of splanchnic hypoxia (as suggested by a pathologically low value (< 7.32) of the pH of the gastric mucosa (pHi)). Patients were studied following a prospective, randomized, placebo-controlled, cross-over design. Measurements included pulmonary and systemic haemodynamics, cardiac output by thermodilution, arterial and mixed venous blood gas values, blood lactate concentration, whole-body oxygen uptake by analysis of the expired gases, and pHi by tonometry. A complete set of measurements was obtained before and 45 min after the infusion of NAC (150 mg.kg-1 in 250 mL of saline) and, also, before and 45 min after the infusion of an equivalent volume of saline. NAC increased the cardiac index and vasodilated the systemic circulation (p < 0.01). However, O2 delivery to the tissues did not increase because the arterial oxygen content fell after NAC (p < 0.01). Mean O2 extraction or lactate concentration did not change after NAC, and pHi fell slightly (from 7.11 +/- 0.21 to 7.07 +/- 0.21; p < 0.05). The infusion of saline did not modify any variable significantly. The O2 extraction fraction increased exponentially in those patients with reduced O2 transport to the tissues. These results argue against a beneficial effect of N-acetylcysteine upon tissue oxygenation in patients with severe multiple organ failure and evidence of splanchnic hypoxia. Furthermore, they suggest that the mechanisms controlling the extraction of oxygen by the peripheral tissues in these patients were not impaired.

Acetylcysteine↗
PubMed1995

[Energy expenditure of patients with Crohn's disease. Course study during hospitalization].

Weight loss and protein energy malnutrition are frequent in Crohn's disease. The increase of resting energy expenditure has been pointed out as the cause of these findings. In this study we report eleven patients with Crohn's disease, six women and five men hospitalized with active Crohn's disease. In three patients the disease involved the small bowel, in five the large bowel and three shared large and small bowel involvement. At the beginning of the hospitalization the activity disease index of Van Hees was 196 +/- 52, range: 132-265. The resting energy expenditure was eleven percent higher than that, of a healthy population (p: n.s). During hospitalization the energy expenditure decreased weekly with statistically significant difference. No relation has been observed between the activity index of Van Hees, and any of the energy parameters studied. Patients with body weight lower 90% of ideal weight, had an increased resting energy expenditure when that was expressed in kcal/kg of weight (p = 0.003). Fever was the sole parameter analyzed with statistically significant relation with consumption of oxygen: with the index of oxygen consumption (p = 0.03) and with the percentage of resting energy expenditure (p = 0.006). In summary, the REE in active Crohn's disease is higher than that of healthy population, although without statistically significance. The REE tends to normalization coinciding with the decreasing of inflammatory activity. Increased energy expenditure has been detected in weight loss patients.

Adolescent↗
PubMed1993

Diagnosis of nosocomial pneumonia in mechanically ventilated patients by the blind protected telescoping catheter.

OBJECTIVES: To demonstrate that blind insertion of the protected telescoping catheter (PTC-NB) through the orotracheal tube can provide reliable pulmonary samples for the diagnosis of nosocomial pneumonia (NP) in ventilated patients. DESIGN: We performed a random comparison between the protected telescoping catheter introduced through a bronchofiberscope (PTC-B) and the PTC-NB to diagnose NP. SETTING: A general intensive care unit of a University Hospital. PATIENTS: 40 consecutive patients on mechanical ventilation and with suspicion of NP. The diagnosis of NP was suspected by clinical and chest X-ray findings. MEASUREMENTS AND RESULTS: NP was confirmed microbiologically in 26 (65%) patients and maintained in 8 patients by clinical and radiological criteria. PTC-NB confirmed the microbiological diagnosis of PN in 21 (80%) patients. The use of antibiotics prior taking respiratory samples reduced the sensitivity of PTC-NB and PTC-B from 100-74% and from 94-70% (p = 0.001). Both techniques agreed in 24 of 33 (73%) patients but such agreement was better when PN was on the right lung. Two patients developed a self-limiting hemoptysis after the PTC-B procedure. CONCLUSIONS: PTC-NB is as sensitive as specific as PTC-B for diagnosing PN in mechanically ventilated patients, being a much easier technique to use.

Adolescent↗
PubMed1991

The accuracy of the Biox 3700 pulse oximeter in patients receiving vasoactive therapy.

The accuracy of pulse oximetry for the prediction of oxygen saturation of arterial blood in patients with shock has been hardly studied. This study was undertaken to determine if O2 arterial saturation estimated by the Biox 3700 pulse oximeter (SpO2) with an ear probe could reliably substitute for the measurements of O2 saturation (HbO2) with an IL-282 Co-Oximeter in samples of arterial blood obtained from 24 caucasian patients. All patients were mechanically ventilated and needed vasoactive drugs (dopamine and/or dobutamine). Of 24 patients 13 had shock: cardiogenic (n = 6) and septic (n = 7). The mean difference between HbO2 and SpO2 was 2.49% +/- 4.24, with a 95% confidence interval of 0.7% to 4.3% (p = 0.009). There were clinically important differences between both methods since in 9 of 24 patients (37%) SpO2 values were at least 4% lower or greater than HbO2. This disagreement was also apparent in patients with (6/13, 46%) or without shock (3/11, 27%). To conclude, pulse oximetry is not always a sufficiently reliable method to predict HbO2 in patients with or without shock treated with vasoactive drugs.

Blood Pressure↗
PubMed1991

Ascites increases the resting energy expenditure in liver cirrhosis.

The purpose of this study was to investigate the effect of ascites on the energy metabolism of patients with liver cirrhosis. The resting energy expenditure was determined in 10 patients with liver cirrhosis and ascites of moderate or large volume. The resting energy expenditure measurement was performed using indirect calorimetry and the resting energy expenditure predictive value was calculated with the Harris-Benedict equation, both before and after removal of ascitic fluid by paracentesis. Metabolic stress factors were absent in all cases. After an interval of 11.2 +/- 7.7 days between measurements, a weight loss of 16.6 +/- 10.3 kg was observed with paracentesis. The resting energy expenditure measured by indirect calorimetry showed a statistically significant decrease from 1682 +/- 291 to 1523 +/- 240 kcal/day (P less than 0.005) after removal of ascites. The repeatability of our indirect calorimetry method only allowed for the analysis of the results in 4 of 10 patients in whom ascites removal produced a consistent decrease in resting energy expenditure. There were no statistically significant differences between the measurements obtained by indirect calorimetry and those provided by the Harris-Benedict equation, but the latter had a moderate reliability in predicting the real resting energy expenditure of every patient. Our results suggest that, far from being an inert volume, ascites may be associated, at least in some patients, with an increased resting energy expenditure and therefore accelerate the appearance of protein energy malnutrition with corresponding complications.

Adult↗
PubMed1989

Validation of a new closed circuit indirect calorimetry method compared with the open Douglas bag method.

New equipment designed for the routine measurement of oxygen uptake (VO2) using a closed circuit method has been validated by comparing it with a standard Douglas bag method. The equipment (The Caloric Measurement Unit, CMU) has been tested in 10 critically ill patients during mechanical ventilation (MV) and in 10 spontaneously breathing healthy subjects. Determinations of VO2 and of the resting energy expenditure (REE) were measured in duplicate with the standard method and once with the CMU. Six additional patients receiving MV were studied with the CMU to evaluate the reproducibility and the effect of FIO2 = 1 vs FIO2 = 0.43 on VO2 measurements. Considering the whole group of 10 patients and 10 subjects, the mean difference of VO2 between both methods was -2 +/- 21 ml/min (95% confidence interval, -11.8 to 7.8 ml/min, p = 0.6) standard deviation. Both methods had a similar reproducibility and the mean difference of VO2 measured at the two different FIO2 with the CMU was -3.2 +/- 11 ml/min (95% confidence interval, -14.7 to 8.4 ml/min, p = 0.5). No statistically significant difference was found between derived REE values obtained from either method. These data show a good correlation between the two methods suggesting that CMU may be used in place of the standard method with the same accuracy in measurement of VO2 even at FIO2 = 1.

Adult↗
PubMed1984

Wedge pulmonary angiography to determine the accuracy of pulmonary wedge pressure.

Wedge pulmonary angiography was done in 11 patients with acute respiratory failure, to assess the accuracy of pulmonary arterial wedge pressure (WP) as an estimation of left ventricular end-diastolic pressure (LVEDP). The pulmonary artery (PA) catheter tip was placed into a dependent position in the lungs. Although the pulmonary vein was not visualized in 7 of 11 patients, in no case was there a significant difference between WP and LVEDP. When WP is no greater than 15 mm Hg, wedge pulmonary angiography does not reflect the accuracy of WP; however, left ventricular filling pressure can be accurately estimated by WP in most of these patients.

Acute Disease↗
PubMed1983

Measurement of functional residual capacity during mechanical ventilation. Comparison of a computerized open nitrogen washout method with a closed helium dilution method.

The functional residual capacity of patients treated with mechanical ventilation was measured with two methods: the closed helium dilution method and the open nitrogen washout method with a computerized system. Measurements of FRC were made with and without PEEP. The results obtained did not show significant differences between the methods. Additionally we checked the accuracy of the open nitrogen washout method to measure FRC of patients and healthy subjects breathing high concentrations of oxygen which was the same as breathing air. Both methods were equally reliable and safe when measuring the FRC of patients on mechanical ventilation but the nitrogen method was easier and quicker.

Computers↗
PubMed1982

Normal values of functional residual capacity in the sitting and supine positions.

The measurement of functional residual capacity (FRC) has assumed new importance in the diagnosis of acute respiratory failure. However few reference values exist for FRC in supine positions for both sexes. We measured the FRC in 100 healthy subjects with the helium dilution closed circuit method in the sitting and supine positions. There were 50 women aged 20 to 63 years and 50 men aged 22 to 65 years. Fifty five subjects were smokers (25 women and 30 men) but no significant differences were found between FRC of smokers and nonsmokers. The FRC always decreased when the subject changed from the sitting to supine position. In this study, the correlation coefficients between FRC and height were statistically significant for both sexes, the influence of age and weight on FRC being negligible. Our results provide useful reference values for FRC in the supine position.

Adult↗
PubMed1982

A simple method for measuring the effect of PEEP on functional residual capacity during mechanical ventilation.

An indirect method for measuring the increment of functional residual capacity (FRC) produced by positive end-expiratory pressure (PEEP) during controlled mechanical ventilation was evaluated in 13 patients with acute respiratory failure. The actual FRC with and without PEEP was measured with a computerized nitrogen washout method. The results obtained did not show significant differences between the measured and the calculated increment of FRC. This indirect method accurately measures how much alveolar recruitment (estimated as increment of FRC) is produced by PEEP.

Female↗
PubMed1981

The effect of lateral positions on gas exchange in patients with unilateral lung disease during mechanical ventilation.

Positional changes have long been known to have a gravitational effect on the distribution of pulmonary blood flow. The effect of body position, supine, right and left lateral decubitus, on gas exchange were evaluated in 10 patients with predominantly unilateral lung disease. All patients were treated with mechanical ventilation and PEEP. Arterial blood gases, measured after 15 min in each of the three positions, showed that lying on the side of the "normal" lung resulted in a higher arterial pO2 (mean: 144 mmHg) than lying on that of the "damaged" lung (mean: 86 mmHg). The delta AapO2 values were 334 to 391 mmHg. Both differences were statistically significant (p less than 0.005). No significant changes mean arterial carbon dioxide tensions were noted.

Adolescent↗
PubMedDate not supplied

Incidence of gastroesophageal reflux and aspiration in mechanically ventilated patients using small-bore nasogastric tubes.

BACKGROUND: Use of a large-bore nasogastric tube (NGT) and patient position are considered key factors in promoting gastroesophageal reflux (GER) and pulmonary aspiration in critically ill patients. The objective of this study was to determine the incidence of GER and pulmonary aspiration of gastric contents in mechanically ventilated (MV) patients using small-bore NGTs. METHODS: We studied 30 patients on mechanical ventilation for acute respiratory failure who tolerated enteral nutrition through a small-bore NGT. Patients were randomly assigned to a group with (n = 16) or without (n = 14) a small-bore NGT and were maintained in a semirecumbent position during the study. GER and aspiration of gastric contents were assessed by a radioisotopic technique. Scans were done 24 hours after technetium-99m administration (n = 30). In 9 patients a dynamic scintigraphy was performed immediately after colloid administration, and samples of blood and tracheal and oropharyngeal secretions were obtained basally, 30 minutes, and 24 hours after technetium administration and analyzed for radioactivity using a gamma counter. RESULTS: Both groups were similar in age, underlying diagnosis, number of days of mechanical ventilation at the day of study, and mortality. There were no GER reaching the oropharynx and aspiration of gastric contents in both groups. CONCLUSIONS: GER and aspiration of gastric contents were not detected in MV patients using small-bore NGTs and may be a simple measure to prevent ventilator-associated pneumonia.

Female↗
PubMedDate not supplied

Gastroesophageal reflux in intubated patients receiving enteral nutrition: effect of supine and semirecumbent positions.

The incidence of gastroesophageal reflux (GER) in critically ill patients as well as the effect of a nasogastric tube (NGT) and body position as risk factors for GER were determined. Seventy patients with orotracheal intubation receiving enteral nutrition through a NGT for more than 48 hours were prospectively studied with two randomly assigned body positions: supine or semirecumbent. Detection of GER was achieved by scintigraphy after labeling gastric contents with 500 microCi of technetium-99m sulfur colloid administered through the NGT. In 50 patients scintigraphy was performed after subjects had remained in the randomized position for 2 hours with the NGT pinched. Twenty additional patients were studied after the NGT had been removed. In 50 patients with NGT, GER was present in 74% (37 of 50) and was higher in the supine position (81%, 21 of 26) than in the semirecumbent position (67%, 16 of 24), but this difference was not statistically significant (p = .26). In 20 patients without NGT, the incidence of GER was 35% (7 of 20) and it was also higher in the supine (50%, 6 of 12) than in the semirecumbent position (12%, 1 of 8, p = .16). There was a statistically significant difference between GER in patients with and without NGT (74% vs 35%, p = .0002). These data show that there is a high incidence of GER in patients with orotracheal intubation and NGT. The presence of a NGT is a risk factor for GER. Semirecumbency does not prevent GER, but there is less incidence than in the supine position.

Adolescent↗