[Unusual presentation of a common disease].
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Aged, 80 and over↗
Biomedical subjects
M Shahla
Publications and source records attributed to M Shahla.
Oxygen supply dependency can characterize septic shock.
OBJECTIVE: To demonstrate that oxygen consumption (VO2) can be dependent on oxygen delivery (DO2) during hemodynamic instability and independent of DO2 following stabilization. DESIGN: We retrospectively reviewed hemodynamic and blood gas data collected from ten patients in whom DO2 was acutely altered during an episode of septic shock (phase A) and after recovery from this episode (phase B). SETTING: General intensive care unit of a university hospital. PATIENTS: 10 critically ill adult patients (aged 55 +/- 19 years). INTERVENTIONS: DO2 was altered by fluid challenge, administration of vasoactive agents, or application of positive end-expiratory pressure. RESULTS: In phase A, changes in VO2 (121 +/- 32 vs 165 +/- 36 ml/min.m2; p < 0.001) paralleled changes in DO2 (415 +/- 153 vs 607 +/- 217 ml/min.m2; p < 0.001), but oxygen extraction (O2ER) remained stable (31.9 +/- 11.2 vs. 30.2 +/- 8.9%; NS). In phase B, changes in DO2 (412 +/- 118 vs 526 +/- 152 ml/min.m2; p < 0.001) were associated with opposite changes in O2ER (36.1 +/- 4.2 vs 28.9 +/- 4.9%; p < 0.001), and VO2 was unchanged (147 +/- 35 vs 149 +/- 33 ml/min.m2; NS). The mean VO2/DO2 slope was greater in phase A than in phase B (0.26 +/- 0.09 vs. 0.08 +/- 0.08; p < 0.004). Blood lactate levels were higher in phase A than in phase B (3.3 +/- 1.8 vs 1.6 +/- 0.6 mEq/l; p < 0.05). CONCLUSIONS: Oxygen supply independency and dependency can be found at different times in the same critically ill patient. Our findings are consistent with the concept that VO2/DO2 dependency is a marker of septic shock. Interventions to increase DO2 are probably justified when this phenomenon is present.
Adult↗
International participation in major intensive care journals. "The smaller the better".
OBJECTIVE: This study seeks to assess the scientific contributions in the field of intensive care medicine from each of the major countries (per million inhabitants) and discusses the possible factors which may contribute to any differences. DATA SOURCE: Review of scientific journals. STUDY SELECTION: We examined the total number of published papers (between 1989 and 1993) in five major respiratory and intensive care journals: Intensive Care Medicine, Critical Care Medicine, Chest, The American Review of Respiratory Disease, and Circulatory Shock. DATA SYNTHESIS: Amongst the American journals, USA and Canada were the predominant contributors followed by the other countries in the following order: Switzerland, Sweden, Belgium, the Netherlands, Finland, Austria, Denmark, UK, France, Spain, Italy, Norway, Japan and Germany. CONCLUSIONS: The present study reveals that the smaller European nations have a greater participation than the larger European nations in the major intensive care journals. This phenomenon could be due to different submission practices in these countries compared with the larger European countries, where a considerable number of papers are submitted to local renowned journals. There was no absolute correlation between a nation's gross national product and the total number of publications.
Critical Care↗
Corticosteroids increase blood interleukin-10 levels during cardiopulmonary bypass in men.
BACKGROUND: Interleukin (IL)-10 is a potent antiinflammatory cytokine inhibiting the release of tumor necrosis factor--alpha (TNF-alpha) and IL-8 by activated macrophages and polymorphonuclear leukocytes. Cardiopulmonary bypass (CPB) represents a unique situation where an inflammatory reaction is predictably induced. The present study examined the influence of CPB on the release of TNF-alpha, IL-1 beta, IL-8, and IL-10 and also defined the effects of pretreatment with corticosteroids on the release of these cytokines. METHODS: The study included 22 patients undergoing coronary artery bypass graft operations, including eight control patients and seven patients who received dexamethasone, and seven patients who received methylprednisolone 4 hours before the operation. Cytokines were measured with the enzyme-linked immunosorbent assay technique before treatment, before anesthesia induction, immediately before heparin administration, before aorta declamping, 10 minutes and 90 minutes after aorta declamping, and 4 hours after the end of CPB. RESULTS: In the control patients the TNF-alpha levels and especially the IL-8 levels increased during CPB and reached their maximal levels 4 hours after CPB. IL-10 levels rose moderately and transiently, reaching peak values 90 minutes after aorta declamping. Notably, administration of corticosteroids prevented IL-8 release but increased IL-10 levels, which were tenfold higher than in the control group 90 minutes after aorta declamping (dexamethasone, 271 +/- 128 pg/ml; methylprednisolone, 312 +/- 213 pg/ml; control, 17 +/- 12 pg/ml, p < 0.05). IL-1 beta was not detected in any group of patients. CONCLUSIONS: The present data indicate that IL-10 is released together with proinflammatory cytokines during and after CPB and that pretreatment with corticosteroids markedly enhances this release. The release of IL-10 may play an important role in the antiinflammatory effects of corticosteroids.
Aged↗
Administration of an antibody to E-selectin in patients with septic shock.
OBJECTIVES: To determine the safety and pharmacokinetics of a murine monoclonal antibody to E-selectin in patients with newly developed septic shock. DESIGN: Open-label, prospective, phase II pilot study with escalating doses of the antibody. SETTING: Intensive care unit of a 900-bed university hospital. PATIENTS: Nine patients who survived the first 24 hrs of septic shock. INTERVENTIONS: In addition to standard therapy, an intravenous bolus of a murine monoclonal antibody to E-selectin, CY1787, was given at doses of 0.1 mg/kg (n = 3), 0.33 mg/kg (n = 3), and 1.0 mg/kg (n = 3). MEASUREMENTS AND MAIN RESULTS: CY1787 was well tolerated in all patients. Signs of shock resolved in all patients, and organ failure entirely reversed in eight patients. All patients survived the 28-day follow-up. Administration of CY1787 was associated with an early and brisk increase in PaO2/FIO2 ratio (p < .001), from 146 +/- 38 mm Hg (19.5 +/- 5.1 kPa) to 205 +/- 45 mm Hg (27.3 +/- 6.0 kPa) after 2 hrs, and 250 +/- 58 mm Hg (33.3 +/- 7.7 kPa) after 12 hrs. A dose-related effect of CY1787 was suggested by an earlier weaning from catecholamine therapy and a faster resolution of organ failure in the high-dose group. Development of antimouse antibodies was documented in eight patients. CONCLUSIONS: This pilot study indicates that this antibody to E-selectin appears to be safe and may represent a promising form of therapy in septic shock.
Adult↗
European participation in major intensive care journals.
To evaluate the recent evolution of the European contribution to the international literature in intensive care medicine, we reviewed the source of all original articles and case reports published from 1989 to 1993 in 5 major journals: Critical Care Medicine, Intensive Care Medicine, Chest, The American Review of Respiratory Disease and Circulatory Shock. There was an overall decline in the US contributions and a corresponding increase in the European participations to Chest and the American Review of Respiratory Disease, but not to Critical Care Medicine or Circulatory Shock. The European participation to Intensive Care Medicine remained largely predominant. The evaluation of the contributions of major European countries to these 5 journals revealed a progressive increase in the French, Italian and Spanish contributions, whilst the German contribution remained stable and the UK contributions decreased. The UK contribution, which was the first in 1989, became second in 1993, after France.
Authorship↗