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Biomedical subjects

M Belghith

Publications and source records attributed to M Belghith.

At least 37 records · Page 2Linked to original sources
PubMed1995

Is tracheal gas insufflation an alternative to extrapulmonary gas exchangers in severe ARDS?

Tracheal gas insufflation (TGI) of pure oxygen combined with mechanical ventilation decreases dead space and increases CO2 clearance. In the present study, TGI was used in six patients with ARDS who met extracorporeal membrane oxygenation criteria and who were severely hypoxemic and hypercapnic despite optimal pressure-controlled ventilation. This open clinical study aimed to investigate the effects of 4 L/min continuous flow of oxygen given via an intratracheal catheter. PaCO2 decreased from 108 +/- 32 to 84 +/- 26 mm Hg (p < 0.05), and no significant change in PaO2 (68 +/- 18 vs 96 +/- 43, p = 0.06). There was no change in airway pressures and hemodynamic variables. A slight increase in end-expiratory and end-inspiratory volumes with TGI possibly occurred, as seen on tracings from respiratory inductive plethysmography (Respitrace). We conclude that TGI improves tolerance of limited pressure ventilation by removing CO2, but it may induce changes in lung volumes that are not detected by ventilator measurements.

Adult↗
PubMed1995

Subjective psychological status of severely ill patients discharged from mechanical ventilation.

OBJECTIVE: To evaluate psychological status in consecutive survivors of ICU who needed mechanical ventilation (MV). DESIGN: Prospective study. SETTING: Twenty-four bed intensive care unit. PATIENTS: Fifty-four mechanically ventilated patients were considered for the study; 43 patients were included, but 11 refused or were unable to fill in the form. INTERVENTIONS: A 32-question form was filled out by the patients 48-96 hours after weaning from mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: The mean characteristics of the patients were: age 51.6 years, simplified acute physiologic score (SAPS) 14, organ system failure (OSF) 1.57, OMEGA score 277, length of stay 29 days, length of mechanical ventilation 14 days. Thirty-three required sedation, 30 analgesia, 20 paralysis. The results were as follows: Pain: 13 suffered intolerable pain with a mean intensity of pain during care of 3.5/10. Comfort: 25 felt an inability to communicate, 18 were bothered by noise and 15 by light, while nine feared to be abandoned by staff. Sleep disorders: 28 remember dreaming with a personal judgement about these dreams (0 = pleasant, 10 = nightmare) of 7.6/10; 17 noticed increasing sleep disorders during their stay. Anxiety: 22 felt diffuse anxiety disorder and 16 described intense fear of dying at least once. Mood: 38 felt physical depression and 18 intellectual depression. Delirium or confusion: 33 had delirium or a confused state at the time of weaning and nine suffered hallucinations. Nine correctly appreciated their length of stay and 18 knew the date when they were interviewed. CONCLUSIONS: These results showed that psychological status is poor in ventilated ICU patients, which should be considered in their care.

Adult↗
PubMed1994

Permissive hypercapnia and intravascular oxygenator in the treatment of patients with ARDS.

This open clinical study was aimed at testing the hypothesis that an intravascular oxygenator (IVOX) may help to perform permissive hypoventilation in 10 patients with severe ARDS. After initial evaluation, we tried to reduce ventilator settings before and after IVOX implantation. Before IVOX, poor clinical tolerance and worsening oxygenation did not allow for a significant decrease in ventilator settings. With IVOX, peak inspiratory pressure (PIP) was reduced from 47 to 39 cm H2O (p = 0.005) and minute ventilation from 13 +/- 3.5 to 11 +/- 3 L/min. CO2 removal by IVOX allowed a significant decrease in PaCO2 from 66 +/- 15 to 59 +/- 13 mm Hg. Improvement of oxygenation with IVOX was not significant. Furthermore, interruption of oxygen flow through IVOX did not change oxygenation variables. Tolerance of the IVOX device was good, but insertion of the device was followed by a significant decrease in both cardiac index and pulmonary wedge pressure. In conclusion, IVOX improves tolerance of hypoventilation by limiting hypercapnia in ARDS patients. These preliminary results must be confirmed by a randomized controlled study.

Adult↗
PubMed1994

Extracorporeal carbon dioxide removal technique improves oxygenation without causing overinflation.

Extracorporeal CO2 removal combined with low frequency positive pressure ventilation (ECCO2R-LFPPV) improves gas exchange and decreases peak pressures, respiratory rates, and tidal volumes in animals and in humans. Recent evidence suggests that pulmonary barotrauma results from lung overinflation rather than from high pressures. This study was to test the hypothesis whether ECCO2R-LFPPV could improve gas exchange without causing lung overinflation, despite the use of higher levels of PEEP, when compared with conventional mechanical ventilation. Eleven patients with severe adult respiratory distress syndrome (ARDS) who failed to respond to different modes of mechanical ventilation were treated with ECCO2R-LFPPV. Risk of pulmonary barotrauma was evaluated by static pressure-volume (P-V) curves and dynamic changes in volumes monitored by respiratory inductive plethysmography (Respitrace). ECCO2R-LFPPV PaO2/FIO2 increased from 79 +/- 21 to 207 +/- 108 (p = 0.003). Risk of barotrauma, as shown by the shape of the P-V curve, was present in all patients receiving mechanical ventilation even though most of them were treated with permissive hypoventilation. By contrast, no evidence of persistent lung overinflation could be detected by either static P-V curves or dynamic measurements in nine of 11 patients who were treated by ECCO2R-LFPPV. The two remaining patients had severe airway obstruction because of bleeding, and they remained ventilated with persistent risk of barotrauma. We conclude that ECCO2R-LFPPV improves gas exchange without causing lung overinflation in a majority of patients with ARDS.

Adolescent↗
PubMed1993

[C-reactive protein in bacterial meningitis in adults].

In order to assess the benefits of serial assays of C-reactive protein in the course of bacterial meningitis in adults, daily blood samples were taken for CRP measurement during 10 days in 21 consecutive patients (mean age: 24 +/- 8 years) hospitalized for bacterial meningitis principally due to Neisseria meningitidis (n = 15). The highest CRP level (178 +/- 38 mg/l) was present on admission, followed by a regular decrease occurring in uncomplicated meningitis until normal level was achieved on day 9. The CRP kinetics was not influenced by the type of causative micro-organism. This study shows that CRP kinetics in adults is similar to that reported in children. The benefit of CRP assays in optimizing the duration of antibiotic treatment of meningitis needs to be more carefully assessed.

Adolescent↗
PubMed1993

Extracorporeal carbon dioxide removal and low-frequency positive-pressure ventilation. Improvement in arterial oxygenation with reduction of risk of pulmonary barotrauma in patients with adult respiratory distress syndrome.

Mortality of the adult respiratory distress syndrome (ARDS) remains high and could be increased by pulmonary barotrauma induced by positive-pressure mechanical ventilation. Extracorporeal CO2 removal combined with low-frequency positive-pressure ventilation (ECCO2R-LFPPV) has been proposed to reduce lung injury while supporting respiratory failure. Use of this technique in 23 patients resulted in the following: a dramatic and highly significant increase of PaO2 obtained rapidly with ECCO2R-LFPPV, allowing subsequent reduction in inspired oxygen fraction; a reduction of the risk of barotrauma evidenced by a significant decrease in pressures and insufflated volumes; a survival rate of 50 percent. Bleeding was the only complication related to the technique and was the cause of death in four patients. This method allowed improvement in gas exchange along with reduction of the risk of barotrauma caused by the ventilator.

Adolescent↗
PubMed1993

[Neonatal testicular ischemic necrosis without torsion, associated with antithrombin III deficit].

There have been few reports of neonatal ischemic necrosis of the testis without torsion of the spermatic cord, which may be caused either by compression in utero or by transient torsion of the spermatic cord resolving spontaneously before surgery. The patient reported herein developed an inflammatory swelling of the right scrotum and an ecchymotic plaque over the left thigh at four days of age. Ischemic necrosis of the right testis without torsion was found upon surgery. When the patient was ten days of age, he developed an inflammatory swelling in the left scrotum; ischemic necrosis of the left testis without torsion was again found upon surgery. Thrombosis of the spermatic vessels was suspected. Postoperatively, ecchymotic and necrotic skin lesions developed, followed by pulmonary embolism and cerebral thrombosis. Outcome was fatal. Hematologic tests in the neonate and his parents established the diagnosis of inherited antithrombin III deficiency. Ischemic necrosis of the testes was thus probably due to hypercoagulability. No similar cases have been reported to date.

Antithrombin III Deficiency↗
PubMed1993

[Abdominal cystic lymphangioma in children].

Cystic lymphangioma is a rare tumour (6% of benign tumours in children), frequently situated in the cervical or axillary region and exceptionally intraabdominal. It arises due to a congenital defect in the connection of the primary lymphatic channels with the central collecting system. It presents clinically either in the form of a pseudo-appendix or pseudo-ascites syndrome or in the form of an abdominal tumour with or without compression of adjacent structures. It can now be easily diagnosed by ultrasonography. Treatment is well defined and consists of surgical resection of the isolated lymphangioma or associated with the adjacent intestine, depending on the site of the tumour. It has a good prognosis.

Abdominal Neoplasms↗
PubMed1992

Effects of aprotinin on hemorrhagic complications in ARDS patients during prolonged extracorporeal CO2 removal.

The effects of aprotinin, a broad-based proteinase inhibitor, in the management of hemorrhagic complications during prolonged venovenous extracorporeal CO2 removal in patients with adult respiratory distress syndrome are not evaluated. In two patients, aprotinin infusion was added to heparin to treat bleeding, occurring after few days of bypass and responsible for respiratory and hemodynamic deterioration. After aprotinin infusion (loading dose of 2 x 10(6) kIU followed by a continuous infusion of 5 x 10(5) kIU/h) combined with heparin, bleeding vanished until the end of bypass.

Adult↗
PubMed1991

Cardiac dysfunction and pulmonary edema following scorpion envenomation.

Cardiac dysfunction with pulmonary edema following scorpion envenomation (SE) has been documented only in a few isolated case reports. We conducted a systematic hemodynamic study in five consecutive patients (mean age, 21.6 +/- 8 years) presenting with pulmonary edema occurring a few hours (9.6 +/- 5.2 hours) after SE. All patients had increased pulmonary capillary wedge pressure (mean, 25 +/- 1.8 mm Hg) while the systemic vascular resistance was elevated only in one. The stroke volume index was markedly depressed (21.7 +/- 3.6 ml/sq m) whereas cardiac index was normal or slightly decreased (2.5 +/- 0.4 L/min/sq m). Cerebral infarct and sudden cardiac arrest were the cause of death in two patients. In the three survivors, all the hemodynamic disturbances and respiratory abnormalities disappeared within a few days. We conclude that cardiac dysfunction was found in all five patients and this was reversible in the three surviving the acute episode.

Adult↗
PubMed1990

[Neonatal hydrocolpos with distal vaginal atresia. Apropos of 2 cases].

Two cases of neonatal hydrocolpos due to distal vaginal atresia is reported where hydro-vaginal distension produced respiratory distress and bowel obstruction radiologic and ultrasonic studies established the diagnostic of hydrocolpos surgery combining abdomino-perineal approaches was successfully done. In this occasion the authors emphasize the characteristics of this abnormality with review of literature and insist on the major interest of prenatal diagnostic in taking early infants.

Female↗
PubMed1990

[Sleep apnea syndromes and Arnold-Chiari malformation].

The Arnold-Chiari malformation (MAC), ectopic medulla of the cerebral hemispheres, may be the basis of respiratory problems provoked by compression of the respiratory centre. It is associated with numerous respiratory problems in children; there are however few publications related to the association of MAC and ventilatory problems in adults. It was recently suggested and subsequently shown that the syndrome of sleep apnoea (SAS) could occur in relation to MAC. We report a new observation documenting the association of MAC and SAS. The surgical cure of MAC enabling a remission of SAS suggests the existence in this case of a causal relation between the two pathologies. A search for such a malformation by imagery of the occipito-medullary crest should be a part of the work up in SAS when the cause remains undetermined.

Adult↗
PubMed1990

[Pulmonary embolism and paradoxical embolism in a patient with chronic respiratory insufficiency treated with mechanical ventilation].

The authors report a case of paradoxical embolism associated with pulmonary embolism in a male patient under mechanical ventilation for chronic respiratory failure. They review the present diagnostic criteria of paradoxical embolism and insist on the determinant contribution of contrast echocardiography to the diagnosis. They also discuss the factors which make this type of patient liable to reopening of the foramen ovale and to paradoxical embolism. The clinical and gasometric characteristics of pulmonary embolism occurring in patients under mechanical ventilation are detailed.

Blood Gas Analysis↗