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Biomedical subjects

M Monchi

Publications and source records attributed to M Monchi.

25 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↗
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↗
PubMedDate not supplied

Comparison of net protein utilization of milk protein mild enzymatic hydrolysates and free amino acid mixtures with a close pattern in the rat.

The nutritive value of two nitrogen-containing mixtures, one formed from small peptides (milk protein mild enzymatic hydrolysates) and the other consisting of a mixture of free amino acids having the same pattern except for glutamine, was measured in rats with and without experimental liver and exogenous pancreas dysfunction. For this purpose, 30 animals (group N) were fitted with an indwelling duodenal catheter; 36 animals (group L) also underwent ligation and resection of the biliopancreatic duct. After a 3-day recovery period, the animals in each group, divided into three equivalent batches, were given, for 10 days, a protein-free diet ad libitum and a twice-daily duodenal infusion (5 mL) of either saline, the small peptides, or the free amino acid mixture. The nitrogen-containing mixtures provided 0.32 g of nitrogen per day. A blood sample (left side of the heart) was collected 1 hour before (five to six animals per batch) and after (five to six animals per batch) the last infusion for determination of glucose, insulin, and amino acids. After the animals were killed, their carcasses were freeze-dried, ground, and analyzed for nitrogen content. Under these conditions, the net protein utilization (the gain in body nitrogen in the animals infused with one of the two nitrogen-containing solutions in comparison with the animals infused with saline only divided by the nitrogen ingested) was calculated.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗