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M Thicoïpé

Publications and source records attributed to M Thicoïpé.

13 recordsLinked to original sources
PubMed2004

[Protocol for advanced prehospital emergency care of severe head injury].

OBJECTIVES: To analyze the frequency of systemic factors leading to secondary brain insults in victims of serious head trauma in a prehospital setting and to evaluate a protocol for the advanced prehospital emergency care by mobile intensive care unit (i.e., the French Samu-Smur system). STUDY DESIGN: Prospective study, over a period of 24 months. PATIENTS AND METHODS: This prospective study involved 60 victims of severe head injuries (with the exception of polytrauma patients). Tracheal intubation was performed on each patient under direct laryngoscopy and after induction of anaesthesia (fentanyl-etomidate-rocuronium). Controlled ventilation and vascular loading (objectives: SpO(2) >or= 97%, PETCO(2) between 30 and 35 mmHg, SAP >or= 90 mmHg) were administered. RESULTS: Hypoxaemia was found to be the most frequent cause of secondary insults (57% of patients with SpO(2) < 97%). In the case involving an accident that occurred 17 km from the hospital (with extremes of 6-65 km), the speed of medical intervention was note-worthy: tracheal intubation was performed 50 min after the accident, and the patient was admitted into a trauma centre 101 min after impact (median). However, faster intervention could be obtained if the transmission of the alert was improved. The conditions under which the tracheal intubation was performed were found to be satisfactory (difficult intubation 1.6%) without deteriorating the haemodynamic status. This is probably related to the use of muscle relaxants and the choice of etomidate as the first line hypnotic in the prehospital emergency care.

Adolescent↗
PubMed2000

Mitochondrial energy metabolism in brain-dead organ donors.

OBJECTIVES: Change from aerobic to anaerobic metabolism has been described in brain-dead organ donors (BDOD) managed for organ procurement. Such modifications could lead to a depletion in intracellular adenine nucleotides and in part explain primary graft dysfunction. The purpose of this study was to investigate the mitochondrial energy metabolism in BDOD using permeabilized muscle fibers. METHODS: With institutional approval, the study was performed prospectively in 15 consecutive BDOD. In each patient, muscle biopsy and blood samples for the determination of plasma lactate and pyruvate were obtained just before organ removal. Mitochondrial respiratory parameters of skeletal muscle were determined in saponin-skinned muscle fibers. Mitochondrial oxygen consumption rates were measured polarographically using different substrates and inhibitors of the respiratory chain complexes. Results were compared to those obtained from muscle biopsies performed in 10 healthy patients during orthopedic surgery. RESULTS: Fifteen donors, 13 men and 2 women, aged 35 +/- 11 yrs, were studied. All patients had a high lactate-to-pyruvate ratio (10). Mitochondrial respiration rates were significantly decreased during adenosine triphosphate (ATP) synthesis. CONCLUSIONS: Major changes in energy metabolism occurred during brain death with a decrease in ATP synthesis capacity. High-risk donors should be recognized for a better graft evaluation.

Adenosine Triphosphate↗
PubMed1998

[Medical treatment of spinal cord injury in the acute stage].

OBJECTIVES: To evaluate the effect on neurologic outcome and the safety of nimodipine (N), methylprednisolone (M), or both (MN) versus no medical treatment (P) in spinal cord injury at the acute phase. STUDY DESIGN: Prospective, randomized clinical trial. PATIENTS: One hundred and six patients with a spinal trauma, including 48 with paraplegia and 58 with tetraplegia. METHOD: After eligibility, patients were randomly allocated in one of the following groups: M = methylprednisolone 30 mg.kg-1 over 1 hour, followed by 5.4 mg.kg-1.h-1 for 23 hours, N = nimodipine 0.015 mg.kg-1.h-1 over 2 hours followed by 0.03 mg.kg-1.h-1 for 7 days, MN or P. Neurologic assessment (ASIA score) was performed by a senior neurologist before treatment and at the 1-year follow-up. Early spinal decompression and stabilization was performed as soon as possible after injury. RESULTS: One hundred patients were reassessed at the 1-year follow-up. Neurologic improvement was seen in each group (P < 0.0001), however no neurologic benefit from treatment was observed. Infectious complications occurred more often in patients treated with M. Early surgery (49 patients), within the first 8 hours did not influence the neurologic outcome. The only predictor of the latter was the extent of the spinal injury (complete or incomplete lesion). CONCLUSION: Currently, no evidence of the benefit of medical treatment in this indication is existing. Because of the lack of clinical studies proving efficacy of pharmacological treatment in this specific pathology, a systematic use of medications cannot be recommended.

Acute Disease↗
PubMed1996

[Subarachnoid hemorrhage caused by aneurysm rupture. Initial management of patients].

Subarachnoid haemorrhage is a severe illness with a high mortality and morbidity. Its diagnosis is considered in the case of a brutal, violent and unusual headache. It is confirmed rapidly with the conventional techniques such as CT-scan and lumbar puncture. The main complications (ischaemia, rebleeding, hydrocephalus) occur during the first two weeks and are a usual event in case of a lack of diagnosis or specialised medical, surgical and radiological management. Among the complications, rebleeding badly affects prognosis, and only early surgery or interventional radiology may improve the outcome. Delayed ischaemia may be prevented by medical management with correction of hypovolaemia and administration of calcium antagonists, before and after surgery, particularly between the 4th and the 10th day. When signs of ischaemia occur, aggressive treatment should be administered in order to improve cerebral perfusion pressure and cerebral blood flow. The treatment is aimed to prevent the complications of subarachnoid haemorrhage and to establish optimal conditions for surgical and radiological procedures.

Aneurysm, Ruptured↗
PubMed1996

Hemodynamic effects of spinal anesthesia in the elderly: single dose versus titration through a catheter.

Sixty elderly patients (> 70 yr old) undergoing surgery for hip fracture were prospectively studied in order to compare hemodynamic tolerance of titrated doses of hyperbaric bupivacaine using continuous spinal anesthesia (CSA) versus single-dose spinal anesthesia (SDSA). Patients were randomized into two groups (CSA group: n = 30; SDSA group: n = 30). The SDSA patients received 10-15 mg of 0.5% hyperbaric bupivacaine (based on age and height), and the CSA patients received a starting dose of 5 mg of 0.5% hyperbaric bupivacaine, followed after 15 min by optional reinjection of 2.5 mg every 5 min until a T10 level sensory block was reached. Onset of anesthesia, noninvasive hemodynamic variables and the need for ephedrine were studied for 4 h after induction of anesthesia. Spinal anesthesia was successful in all patients. Decreases in mean arterial pressure were significantly less frequent and less pronounced in the CSA group (19.9% +/- 1.6% of the baseline value) than in the SDSA group (40.2% +/- 1.9%, P < 0.0001). The mean dose of ephedrine was significantly less in the CSA group (1.8 +/- 0.7 mg, administered to only 37% of patients) than in the SDSA group (19.4 +/- 3.3 mg administered to all patients, P < 0.0001). No late complications related to the spinal anesthesia technique were observed in either group. We concluded that CSA, using small titrated doses of 0.5% hyperbaric bupivacaine, is safe, efficient, and provides better hemodynamic stability than SDSA in elderly patients.

Aged↗
PubMed1995

[Traumatic diaphragmatic rupture with delayed unusual disclosure].

The authors report the case of a delayed presentation of a traumatic diaphragmatic rupture in a 22-year-old patient admitted to hospital for a minor surgical procedure under general anaesthesia. Nine months before, he had a road traffic accident with a minor thoracic trauma. Three days after surgery, the patient was readmitted for a tension hydrothorax due to the herniation and the perforation of the stomach into the left pleural cavity. Such a delayed presentation of a traumatic diaphragmatic rupture remains uncommon. The peroperative ventilatory factors involved in the development of the hernia are discussed.

Accidents, Traffic↗
PubMed1995

[Bilateral bronchial rupture: problems of respiratory management].

The authors report the case of bilateral bronchial rupture in a 39-year-old multiple trauma patient. During the thoracotomy for right main bronchus repair, a partial left bronchial rupture was recognized because of severe hypoxaemia after left selective intubation.

Adult↗
PubMed1994

[Autotransfusion, with blood drained from a hemothorax, using the ConstaVac device].

The technique of autotransfusion with blood drained from a haemothorax has been described nearly 80 years ago. The shed blood is easy to collect and is incoagulable. This technique as two indications: lifesaving autotransfusion in the prehospital phase and blood saving and/or transfusional safety at hospital arrival. This prospective study assessed its value as well as the advantages and disadvantages of the ConstaVac system in 30 patients suffering from haemothorax. This apparatus consists of a 800 mL collecting reservoir on a support equipped with an electric aspirator and a battery. The collected blood is transferred into a reinfusion bag while remaining in a closed circuit. The retransfused volume was 685 +/- 430 mL, representing 80% of the collected volume. The retransfusion took place in less than four hours. The patients with an isolated haemothorax did not receive any homologous blood. Only one technical problem occurred, related to the excessive volume of the haemothorax. The shed blood has decreased content of platelets, fibrinogen, and is incoagulable. Moreover, it is hemolyzed. Its hematocrit is lower than the patient's one. On the other hand, the concentration of 2,3 DPG remains normal. These modifications have no detrimental consequences on the patients as long as the autotransfused volume does not exceed two litres. Infectious problems are rare. Handling requires strict asepsis. The ConstaVac system is marketed for postoperative autotransfusion. It is compact, self-contained and very easy to use. It is the only system able of ensuring blood drainage and retransfusion simultaneously, without requiring any opening of the circuit.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Traumatic rupture of the aortic isthmus in a patient with severe head injury].

A 32-year-old man sustained a severe head injury in a road traffic accident. On admission, he was in deep coma (6 on the Glasgow coma scale). The aortic knuckle was difficult to identify on a plain chest film. Twenty hours after admission, the aortic knuckle had completely disappeared and the mediastinal shadow had become enlarged. The diagnosis of a ruptured aortic isthmus was confirmed by angiography. Surgical repair of this lesion may be carried out either with simple aortic cross-clamping, or by using cardiopulmonary bypass (CPB). Either technique may worsen other injuries, especially head injury, by initiating severe arterial hypertension or coagulation disturbances. In this patient, the technique chosen was aortic cross-clamping with permanent monitoring of the intracranial and cerebral perfusion pressures. Anaesthesia was obtained with 5 mg.kg-1 of thiopentone, 30 mg.kg-1 x h-1 of sodium gamma hydroxybutyrate and 8 micrograms.kg-1 x h-1 of fentanyl. Surgery lasted for 90 min, with 33 min of aortic clamping. The increase in arterial blood pressure was controlled with 0.25 mg.kg-1 x h-1 of thiopentone and nicardipine which was stopped 8 min before unclamping. The postoperative course was uneventful. Sedation was stopped after 8 days, and the patient regained consciousness two days later. These remained a paraplegia with no sensory deficit, which had totally receded 15 months later. Carrying out this emergency surgery without CPB means that the intracranial pressure must imperatively be monitored during surgery. Any intracranial hypertension should delay the surgery.

Adult↗
PubMed1991

[Plasma catecholamines in brain death].

The purpose of this study was to find out whether a severe fall in plasma catecholamines levels can be observed in brain dead patients, that might contribute to haemodynamic disturbances in these patients. Plasma catecholamines (epinephrine and norepinephrine) were measured by HPLC combined with electrochemical detection in 18 consecutive brain dead patients referred to the multiorgan donors unit at the Bordeaux University Hospital. Two samples were obtained: the first one at the time of donor referral (11.2 +/- 9 h after the clinical onset of brain death), and the second one just before organ procurement (19.8 +/- 1 h after the clinical onset of brain death). The results showed that plasma catecholamines levels were similar in both samples, with mean values within the normal range. There was no correlation between the plasma levels of each of the catecholamines and the mean arterial pressures at the time of sampling. Very high plasma catecholamines levels have been found by other authors after brain injuries. After the onset of brain death, they return to basal rest values and do not continue to fall as is the case in animal experiments. The haemodynamic disturbances observed in brain dead patients therefore cannot be due only to sympathoadrenal failure.

Adult↗