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Biomedical subjects

Jean-François Muir

Publications and source records attributed to Jean-François Muir.

14 recordsLinked to original sources
PubMed2005

Limitations of transcutaneous carbon dioxide measurements for assessing long-term mechanical ventilation.

STUDY OBJECTIVES: Transcutaneous CO(2) pressure (Ptcco(2)) and transcutaneous O(2) pressure (Ptco(2)) measurements are routinely used in pediatric ICUs in order to avoid serial arterial punctures. The aim of this study was to determine the value of Ptcco(2) assessment during the evaluation of home ventilation in 12 adult patients with COPD or restrictive respiratory failure in the stable state (mean [+/- SD] basal Paco(2), 48.8 +/- 8.3 mm Hg) who were treated by mask or tracheotomy-mediated ventilation. METHODS: After radial catheter insertion, patients were instructed to breathe spontaneously for 40 min and then to receive ventilation for 40 min according to their individual home ventilation modalities. An in vivo calibration was performed in the initial stage of the study in order to optimize the arterial Pco(2) and Ptcco(2) values. Every 5 min, transcutaneous measurements were performed and simultaneously compared with arterial values. MEASUREMENTS AND RESULTS: Ptcco(2) and Ptco(2) were correlated with arterial values (p < 0.0001) except for Paco(2) values of > 56 mm Hg and Pao(2) values of > 115 mm Hg. During ventilation, Paco(2) decreased >or= 4 mm Hg in seven patients. Ptcco(2) variations recorded during consecutive 5-min periods while the patient received mechanical ventilation were well correlated with the arterial variations (p = 0.0033), with a delay of < 5 min. CONCLUSION: Ptcco(2) values and variations accurately reflected Paco(2) values and variations during mechanical ventilation. However, the accuracy of these data seems to be restricted to patients with Paco(2) values of < 56 mm Hg.

Aged↗
PubMed2004

[Means and organisation of the management of severe forms of COPD].

Chronic obstructive pulmonary disease is becoming the 3rd aetiology of death by disease. In its advanced presentation, it generates a chronic respiratory failure with hypoxia and frequent hypercapnia. Its complex management implies at that stage a medical treatment, physiotherapy and pulmonary rehabilitation, associated with long-term oxygentherapy. In the most severe stages, may be discussed long-term home mechanical ventilation with non invasive connection in order to avoid tracheotomy and to prevent acute respiratory episodes leading these patients in intensive care units and yet responsible for 15 000 deaths per year in our country.

Humans↗
PubMed2004

Pleural effusion revealing giant cell arteritis.

Pulmonary involvement is considered to be rare in giant cell arteritis (GCA), usually occurring in the course of the disease. We describe the case of a patient who developed left pleural effusion revealing GCA. Thoracic CT scan demonstrated an abundant left pleural effusion and a thickening of the aortic wall. The patient's condition improved rapidly, with regression of pulmonary clinical features and complete clearance of pleural effusion, after institution of steroid therapy. Our case report reinforces the possibility of unusual presentation of GCA; such a diagnosis should, therefore, be considered in elderly patients presenting with pulmonary manifestations, even in the absence of typical clinical features of temporal arteritis (e.g. headache, jaw claudication, blurred vision, scalp tenderness) or polymyalgia rheumatica.

Journal Article↗
PubMed2004

Development of a primary-care tool to assess treatment success in COPD: consensus report from a closed meeting of respiratory and primary-care specialists.

A 1-day meeting, attended by invited respiratory and primary-care specialists all of whom had an international profile and a specific interest in Chronic Obstructive Pulmonary Disease (COPD), considered specific research recommendations from the Global Initiative in Obstructive Lung Disease (GOLD) workshop report. Attendees discussed developing a tool to complement spirometry and help primary-care physicians assess treatment success in patients with chronic obstructive pulmonary disease. Discussion focused on the requirement of such a tool, and the limitations of existing tools. Proposals followed for a simple, cost-effective checklist for primary-care. This paper is a consensus report of the discussions from the meeting. Decisions reached on the proposed questionnaire were unanimous.

Journal Article↗
PubMed2003

[Diagnosis of community acquired pneumonia in adults].

In contrast with acute bronchitis, which is benign and very frequent, community acute pneumonia has to be considered as a serious illness with a mortality rate that can reach 10-15% in inpatients. In adult, pneumonia is usually due to bacteria and antibiotherapy is always required. Clinical diagnosis is based on presumption signs: fever, tachycardia, tachypnea, thoracic pain, localised rales and a global severity impression. A chest X-ray is required. The pathogens involved are usually Streptococcus pneumoniae or atypical organisms. In inpatients (severe pneumonia or presence of risk factors), other pathogens such as gram negative bacilli or anaerobes are possible. The accurate diagnosis is based on invasive methods, which are not justified in outpatients but indicated in severe pneumonia.

Adult↗
PubMed2002

Evaluation of candidates for long-term ventilation.

This article considers the evaluation of patients prior to institution of long-term ventilation (LTV). LTV has evolved from a concept of necessity ventilation to a more satisfactory approach of preventive LTV, enabled by the impressive development of noninvasive mechanical ventilation (NIV). Due to its convenience and efficacy, and its safety compared with invasive ventilation, NIV has rapidly gained popularity among patients with chronic respiratory failure (CRF) requiring intermittent ventilatory assistance. Evaluation of candidates for LTV involves clinical and laboratory evaluations and sleep monitoring. It includes consideration of the etiology of CRF, be it restrictive lung disease, chronic obstructive pulmonary disease, obesity or other cause, and considers the feasibility of LTV as well as its desirability.

Chronic Disease↗
PubMed2002

Dry powder ipratropium bromide is as safe and effective as metered-dose inhaler formulation: a cumulative dose-response study in chronic obstructive pulmonary disease patients.

A multi-center, open, randomized, 2-way crossover study was conducted with chronic obstructive pulmonary disease (COPD) patients to compare the safety and efficacy of cumulative doses of ipratropium bromide administered from a pressurized metered-dose inhaler (MDI) or from a breath-activated dry powder inhaler (DPI). Enrolled in the study were 39 patients with moderate to severe COPD and who showed a > or= 15% increase in baseline forced expiratory volume in the first second (FEV(1)) after 80 microg of ipratropium bromide. Thirty-six patients were evaluable for efficacy analysis, and 38 patients were included in the safety analysis group. A significant improvement in pulmonary function was observed following inhalation of cumulative doses of ipratropium bromide (from 20 to 320 microg), but no statistically significant difference was found between the 2 formulations. The dose-response curves were similar. There was no statistical difference in area-under-the-curve during the 180 min period after the last dose for any of the pulmonary function variables. Overall, effects on pulse rate, blood pressure, and QT interval on electrocardiogram were no different between the devices. Six mild adverse events occurred in 4 patients: ventricular ectopic beats on electrocardiogram at 270 min with MDI, bad taste with both MDI and DPI, slight transient increase in blood pressure in the same patient during each study day with both MDI and DPI. Two moderate adverse events occurred in 2 patients: transient ventricular ectopic beats on electrocardiograms with DPI at 270 min, moderate bronchospasm with MDI at 200 min. Patients expressed a preference for DPI, which was found to have a better acceptability and appeared to be easier to use than MDI. The new lactose powder formulation of ipratropium bromide inhaled via the breath-activated DPI is a safe and effective alternative to the chlorofluorocarbon-propelled MDI.

Adult↗