PubMed Health⌕ Search

Biomedical subjects

P F Perrigault

Publications and source records attributed to P F Perrigault.

At least 19 recordsLinked to original sources
PubMed2005

[Catheter-related infections: how to reduce the risk?].

Subcutaneous tunnelling of short-term catheters and the choice of site of catheter insertion are the two factors which influence the risk of catheter-related infection. Catheters inserted into a femoral vein have been associated with a higher risk of infection than those inserted into a subclavian vein. However, a meta-analysis comparing the internal jugular and subclavian sites did not report any difference. Regarding tunnelling, two randomized studies showed a benefit in terms of infection rates for the jugular and femoral sites when the blood sampling was not performed via the catheters. For the subclavian site tunnelling does not seem to bring any advantage compared to conventional insertion.

Anesthesia↗
PubMed2003

[Phoning study about postoperative practice and application of non-invasive ventilation].

OBJECTIVES: Incidence and management of positive pressure non-invasive ventilation (NIV) in intensive care unit (ICU) in the postoperative period. STUDY DESIGN: Phoning study performed on September 2001 in 60 ICU of south of France (public: 47, private: 13, medical: 11, surgical: 20, medical-surgical: 29), which were randomized from a national list. RESULTS: NIV was used currently on 55% and casually on 35% of the units. Ten percent of ICU, which never use NIV, were surgical on 83% with a lower number of bed (7 +/- 3 vs. 12 +/- 5). The most often humidification device used was a Heat and Moisture Exchanger (HME) (52%), a Heated Humidifier (HH) (26%), either (4%) and none device (19%). ICU that never used a humidification device used a home ventilator in 30%. Ventilators used were more often heavy ICU ventilators (80%) with a facial mask (89%). NIV was performed exclusively by physicians in 15% of cases and in collaboration after the first application in 71% of cases. Sixty-nine % of intensivists used NIV as a first choice for the treatment of acute postoperative respiratory failure and 54% of intensivists for the treatment of postoperative atelectasis. CONCLUSION: Use of NIV increases in ICU, particularly in surgical units. Practices are different between ICU. An HME is the most frequently humidification device used.

Data Collection↗
PubMed2000

[Cerebral arterial air embolism associated with pneumothorax in a patient with pressure support ventilation].

A 20-year-old woman was admitted to the ICU following a road traffic accident. She had a periorbital haematoma with a normal cerebral state on CT-scan, intrahepatic and intrasplenic haematomas and several fractures of the limb that were fixed on day 3. Twenty-four hours later, she developed a cough with symptoms of decerebration The head CT-scan showed diffuse pneumocephalus suitable with cerebral air embolism and the chest X ray a right tension pneumothorax. A chest tube was inserted. Despite the lack of hyperbaric oxygen therapy the patient recovered fully. The pneumocephalus disappeared totally after 48 hours. Seven days later, CT-scan of the head with coronal slides showed an orbital floor fracture associated with an intra-orbital aerocele.

Accidents, Traffic↗
PubMed1999

Staphylococcus aureus nasal carriage in 104 cirrhotic and control patients. A prospective study.

BACKGROUND/AIMS: Bacterial infections, specially Staphylococcus aureus (S. aureus) septicemia, remain a leading cause of death following liver transplantation. It has been demonstrated that nasal carriage of S. aureus is associated with invasive infections in patients undergoing hemodialysis and could be decreased by use of antibiotic nasal ointment. However, in cirrhotic patients, the frequency of nasal carriage is unknown. The aims of this study were to determine the prevalence of S. aureus nasal carriage in cirrhotic patients and to assess nosocomial contamination. METHODS: One hundred and four patients were included in a prospective study, 52 cirrhotic and 52 control (hospitalized patients without cirrhosis or disease which might increase the rate of nasal carriage of S. aureus). On admission and after a few days of hospitalization, nasal specimens from each anterior naris were obtained for culture. S. aureus was identified by the gram strain, positive catalase and coagulase reactions; antibiotic susceptibility was determined using a disk-diffusion test. RESULTS: Both groups were similar with regard to age and sex. The prevalence of nasal colonization on hospital admission was 56% in cirrhotic patients and 13% in control patients (p = 0.001). After an average of 4 days, 42% of cirrhotics and 8% of control patients were colonized (p = 0.001), without any nosocomial contamination. Three strains out of 29 were oxacillin-resistant in cirrhotic patients, and none in controls (p>0.05). There was no statistical difference in carriage rate according to sex, age, cause of cirrhosis and Child-Pugh score. Previous hospitalization (OR, 6.3; 95% CI, 2.3 to 19.9; p = 0.0006) and cirrhosis (OR, 4.4; 95% CI, 1.5 to 13.4; p = 0.0048) were independent predictors of colonization. CONCLUSION: Cirrhotic patients had a higher S. aureus nasal carriage rate than control subjects. Previous hospitalization and cirrhosis diagnosis were correlated to nasal colonization. Further studies are necessary to determine if nasal decontamination could reduce S. aureus infections after liver transplantation.

Adolescent↗
PubMed1999

Alcoholic cirrhosis is a good indication for liver transplantation, even for cases of recidivism.

BACKGROUND/AIMS: Alcoholic cirrhosis remains a controversial indication for liver transplantation, mainly because of ethical considerations related to the shortage of donor livers. The aim of this study was to review experience to date, focusing on survival rates and complications, and the effect of alcohol relapse on outcome and alterations in marital and socioprofessional status. METHODS: The results for 53 patients transplanted for alcoholic cirrhosis between 1989 and 1994 were compared with those for 48 patients transplanted for non-alcoholic liver disease. The following variables were analysed: survival, rejection, infection, cancer, retransplantation, employment and marital status, alcoholic recurrence. The same variables were compared between alcohol relapsers and non-relapsers. RESULTS: Recovery of employment was the only significantly different variable between alcoholic (30%) and non-alcoholic patients (60%). Two factors influenced survival in the absence of alcohol recidivism: age and abstinence before transplantation. For all other variables, there were no differences between alcoholic and non-alcoholic patients, and, within the alcoholic group, between relapsers and non-relapsers. The recidivism rate was 32%. CONCLUSION: The data indicate that liver transplantation is justified for alcoholic cirrhosis, even in cases of recidivism, which did no affect survival and compliance with the immunosuppressive regimen. These good results should help in educating the general population about alcoholic disease.

Adult↗
PubMed1999

Changes in occlusion pressure (P0.1) and breathing pattern during pressure support ventilation.

BACKGROUND: The purpose of this study was to investigate changes in breathing pattern, neuromuscular drive (P0.1), and activity of the sternocleidomastoid muscles (SCM) during a gradual reduction in pressure support ventilation (PSV) in patients being weaned off controlled mechanical ventilation. METHODS: Eight non-COPD patients recovering from acute respiratory failure were included in this prospective interventional study. All patients were unable to tolerate discontinuation from mechanical ventilation. Each patient was evaluated during a period of spontaneous breathing and during PSV. Four successive levels of PSV were assessed in the following order: 20 cm H2O (PS20), 15 cm H2O (PS15), 10 cm H2O (PS10), and 5 cm H2O (PS5). RESULTS: When pressure support was reduced from PS20 to PS10 the respiratory rate (f) and the rapid shallow breathing index (f/VT) significantly increased and tidal volume (VT) significantly decreased. These parameters did not vary when pressure support was reduced from PS10 to PS5. Conversely, P0.1 varied negligibly between PS20 and PS15 but increased significantly at low PSV levels. P0.1 values were always greater than 2.9 cm H2O (4.1 (1.1) cm H2O) when SCM activity was present. When contraction of the SCM muscles reappeared the P0.1 was the only parameter that changed significantly. CONCLUSIONS: In postoperative septic patients the value of P0.1 seems to be more useful than breathing pattern parameters for setting the optimal level of pressure assistance during PSV.

Acute Disease↗
PubMed1998

Prevalence of monoclonal immunoglobulins after liver transplantation: relationship with posttransplant lymphoproliferative disorders.

BACKGROUND: A high incidence of serum monoclonal immunoglobulins (mIgs) has been described after solid organ transplantation. For transplant recipients, the prevalence of posttransplant lymphoproliferative disorders (PTLDs) has been reported to be between 2% and 6%. The relationship between the finding of serum mIg in transplant recipients and the subsequent development of PTLDs is not clearly documented. METHODS: We retrospectively analyzed all cases of mIg and PTLD that occurred in 86 liver transplant recipients who survived more than 3 months. Patients were characterized by protein electrophoresis, immunofixation electrophoresis, pre- and post-liver transplantation Epstein-Barr virus (EBV) serology, EBV presence in lymphoproliferative tissues by in situ hybridization, type of infection episodes, rejection episodes, and immunosuppressive treatment. RESULTS: Thirty-eight patients (44%) had abnormal immunofixation electrophoresis with an electrophoretic Ig peak. Twelve patients had a polyclonal Ig peak, and 26 patients had mIgs (30%). These 26 patients were divided into two groups: 13 patients had a transient mIg peak with a mean delay for normalization of electrophoresis of 2 months, and 13 patients had a permanent mIg peak. No correlation could be demonstrated between the appearance of abnormal banding and indications for transplantation, age of patients, and acute rejection rate. There was a strong correlation between occurrence of viral infections and presence of permanent mIg. Three patients with permanent mIg (23%) developed PTLD and died. CONCLUSIONS: We concluded that the prevalence of mIg after liver transplantation was 30%. Viral infections increase the risk of developing mIg. Persistence of mIg beyond 7 months may be regarded as prelymphomas necessitating a careful follow-up in these patients.

Adolescent↗
PubMed1998

Tension-time index of inspiratory muscles in COPD patients: role of airway obstruction.

Inspiratory muscle function has been shown to be related to general muscle weakness, weight loss, blood gas tensions, airway obstruction and hyperinflation. The aim of this study was to define (1) the factor that is the main determinant of the tension-time index of the inspiratory muscles (TTmus), and which this increases the risk of inspiratory muscle fatigue; and (2) whether a breathing strategy is adopted to avoid inspiratory muscle fatigue. Twenty-seven normal volunteers and 35 stable COPD outpatients (FEV1% predicted, range: 21-89%; and FRC/TLC, range: 49-77%) were studied. The TTmus was determined as follows: TTmus = PI/PImax.TI/Ttot, where Pi is the mean inspiratory pressure calculated from the mouth occlusion pressure (P0.1), PImax is the maximal inspiratory pressure, TI is the inspiratory time, and Ttot is the total time of the breathing cycle. COPD patients showed significantly lower PImax and higher P0.1, PI, PI/PImax, and TTmus than normal subjects. No patient had a TTmus value higher than the inspiratory muscle fatigue threshold of 0.33. The FEV1 was significantly correlated with TTmus and all its components in the patients. The FRC/TLC was also correlated with all components except PI. Body weight was only correlated with PImax. In a forward and backward stepwise regression analysis, FEV1 appeared to be the only significant factor explaining the variance of log (PI/PImax) and log (TTmus), whereas FRC/TLC was the principal determinant of PImax. In COPD patients, a non-linear relationship was found between TI and P0.1. A negative linear relationship was found between TI/Ttot and PI/PImax. In conclusion, although hyperinflation predominantly affected inspiratory muscle strength in a group of stable COPD patients with a wide range of severity, airway obstruction was the principal factor determining the magnitude of TTmus. In addition, in order to remain below the inspiratory muscle fatigue threshold, as the severity of airway obstruction increased, patients adopted a breathing strategy characterized by decreased TI/Ttot as inspiratory pressure demand increased.

Adaptation, Physiological↗
PubMed1998

Changes in breathing pattern and respiratory muscle performance parameters during difficult weaning.

OBJECTIVE: This study examined, using noninvasive means, the changes in breathing pattern and inspiratory muscle pressure-time indices during difficult progressive withdrawal of pressure-support ventilation. DESIGN: A prospective analysis of the temporal evolution of several respiratory variables in difficult-to-wean patients. SETTING: A university hospital intensive care unit. PATIENTS: A heterogeneous group of 17 patients receiving prolonged mechanical ventilation. INTERVENTIONS: Daily measurements of breathing pattern and respiratory muscle performance parameters in difficult-to-wean patients. MEASUREMENTS AND MAIN RESULTS: We examined breathing pattern variables, rapid shallow breathing (respiratory rate/tidal volume), tracheal occlusion pressure, maximal inspiratory pressure (P(I)max), and the tension-time index of the inspiratory muscles (TTmus = P(I)/P(I)max x Ti/Ttot) (where Ti/Ttot is inspiratory fraction of the cycle). All measurements were repeated at 24-hr intervals throughout the difficult weaning period. The patients were extubated on satisfying ten of 12 classical weaning criteria. Eleven patients were successfully weaned from mechanical ventilation while six patients were not. Weaning failure was associated with the following: a) longer periods of mechanical ventilation before weaning; b) high values of tracheal occlusion pressure, respiratory rate, minute ventilation, and effective impedance maintained throughout the difficult weaning period; and c) persistent high PaCO2 and intrinsic positive end-expiratory pressure values. As the weaning failure patients' inspiratory muscles confronted an increasing inspiratory load, values of the tension-time index of the inspiratory muscles entered or remained in the fatigue zone. In contrast, weaning success patients normalized their breathing pattern and decreased their tracheal occlusion pressure, effective impedance, and tension-time index values. CONCLUSIONS: Breathing pattern alterations and respiratory muscle performance impairments lead to ventilator dependency after prolonged mechanical ventilation. The measurement of variables such as the noninvasive tracheal occlusion pressure, inspiratory power of breathing, and tension-time index of the inspiratory muscles facilitate the management of difficult-to-wean patients.

Aged↗
PubMed1998

Gastric versus duodenal feeding and gastric tonometric measurements.

OBJECTIVE: To compare the influence of gastric and postpyloric enteral feeding on the gastric tonometric PCO2 gap (tonometric PCO2 - PaCO2). DESIGN: A prospective, clinical trial. SETTING: Two intensive care units in a university hospital. PATIENTS: Twenty patients undergoing mechanical ventilation and enteral feeding without catecholamines, sepsis, or sign of hypoxia. INTERVENTIONS: Patients were randomized to receive feeding through the tonometer (gastric group), or through a postpyloric tube (postpyloric group). MEASUREMENTS AND MAIN RESULTS: The patients received tube feeding at a rate of 50 mL/hr during 4 hrs. Baseline measurements included: mean arterial pressure, heart rate, tonometric parameters, arterial gases, and arterial lactate concentration. Except for lactate concentration, these measurements were repeated after 1 and 4 hrs of enteral feeding and 2 hrs after stopping enteral feeding. During the study, arterial pH and PaCO2 did not change. During enteral feeding, the PCO2 gap increased in the gastric group from a mean of 7+/-5 to 17+/-14 (SD) torr (0.9 0.7 to 2.3+/-1.9 kPa) (p< .O01) and did not change in the postpyloric group (5+/-5 to 3+/-1 torr [0.7+/-0.7 to 0.4+/-0.1 kPa]). Two hours after stopping enteral feeding, the PCO2 gap was still increased in the gastric group (15+/-9 vs. 7+/-5 torr [2.0+/-1.2 vs. 0.9+/-0.7 kPa]) (p < .01). CONCLUSION: The results indicate that gastric enteral feeding increased the PCO2 gap. However, postpyloric enteral feeding does not interact with gastric tonometric measurements and should be used when using gastric tonometry in enterally fed patients.

Aged↗
PubMed1998

Activated sub-populations of lymphocytes and natural killer cells in normal liver and liver grafts before transplantation.

AIMS/BACKGROUND: The anatomic structure of the liver suggests that it is a place of intense trafficking between intra-hepatic and peripheral blood compartment leukocytes. Furthermore, the liver contains a large number of passenger leukocytes that may play a role in the appearance of donor-type microchimerism after transplantation. In this study, we aimed to define the principal lymphocyte sub-populations contained in donor peripheral blood and liver grafts and in normal liver removed during minimally invasive surgery. METHODS: Liver biopsies were taken at the time of vascular clampage during liver extraction from donors in a brain dead state (GI: n=14). Normal liver biopsies were removed during minimaly invasive surgery (GII: n= 10). RESULTS: We observed evidence of the presence of lymphocytic activation associated with the two major CD8+ lymphocyte and natural killer (NK) cell populations in the two groups, with a significant increase in TCRgammadelta-bearing lymphocyte receptors between normal liver and the liver graft. CONCLUSIONS: The presence of activated leukocytes in the graft could have a fundamental role in induction of peripheral tolerance. This activation could be the result of a basic immunological response linked to the interaction of T cells and NK cells, and of secondary activation due to stress and the conditions necessary for organ removal from donors in a brain dead state.

Adult↗
PubMed1997

Hepatitis C virus genotypes and quantitation of serum hepatitis C virus RNA in liver transplant recipients: relationship with severity of histological recurrence and implications in the pathogenesis of HCV infection.

The reasons for the wide variation of incidence and severity of recurrent hepatitis C after liver transplantation are not clear. We have studied liver transplant recipients to assess the impact of hepatitis C virus (HCV) genotype and HCV RNA quantification on HCV recurrence after transplantation. Twenty-two patients received transplants for HCV cirrhosis and were followed up with virological and histological assessments. Mean follow-up was 39 months. HCV genotype was determined with line probe assay (Inno-Lipa). HCV RNA quantity was determined in serum samples by use of polymerase chain reaction nested assay. HCV genotype 1 was detected in 13 patients and other genotypes in 9. Histological recurrence rates were 69% in patients with genotype 1 and 66% in patients with other genotypes. All cases of severe histological injury (chronic active hepatitis or cirrhosis) were observed in patients with genotype 1. HCV RNA quantity was significantly higher in patients with genotype 1 (mean, 2.023 x 10(3) copies/mL) than in patients with other genotypes (mean, 27,403 copies/mL). In conclusion, the severity of histological recurrence after liver transplantation for HCV disease was higher in patients infected by HCV genotype 1 than in those infected with other genotypes. The levels of viral replication were higher in patients with HCV genotype 1 than in those with other genotypes.

Adult↗
PubMed1996

Fulminant hepatitis after carbimazole and propranolol administration.

We report the case of a patient who developed jaundice, encephalopathy, a marked increase in serum aminotransferase activity and a decrease in prothrombin and proaccelerin levels, after 6 weeks' treatment with carbimazole and propranolol for hyperthyroidism. The patient ultimately underwent orthotopic liver transplantation. This case strongly suggests that carbimazole may occasionally induce fulminant hepatitis and that careful monitoring of liver enzymes may be useful during the treatment of hyperthyroidism with this drug.

Adrenergic beta-Antagonists↗
PubMed1995

Failure of ursodeoxycholic acid to prevent acute cellular rejection after liver transplantation.

BACKGROUND/AIMS: Acute rejection is still a major problem after liver transplantation. Ursodeoxycholic acid has beneficial effects in cholestasis by reducing the expression of major histocompatibility complex antigens. METHODS: We have performed a double-blind randomised study comparing ursodeoxycholic acid with placebo for the prevention of acute cellular rejection after liver transplantation. Twenty-six patients received ursodeoxycholic acid 600 mg per day and 24 patients received placebo for 2 months. RESULTS: Neither rejection incidence nor rejection severity was significantly different in the two groups (p > 0.90). CONCLUSIONS: We conclude that adjuvant ursodeoxycholic acid administration does not prevent rejection after liver transplantation.

Acute Disease↗
PubMed1995

Occlusion pressure and its ratio to maximum inspiratory pressure are useful predictors for successful extubation following T-piece weaning trial.

STUDY OBJECTIVE: In most weaning studies, failure group patients are reventilated prior to extubation, thus compromising the evaluation of the applied weaning indices' predictive values. This study determines the usefulness of both standard and recent indices in predicting successful extubation following prolonged mechanical ventilation. DESIGN AND METHODS: Following a successful 20-min T-piece trial, ten traditional weaning criteria, as well as airway occlusion pressure (PO.1), maximal inspiratory pressure (MIP), PO.1/MIP ratio, and shallow breathing (F/VT) were determined in unselected patients undergoing prolonged mechanical ventilation. Having satisfied 8 of 10 classic weaning criteria, 67 patients were extubated after an additional 40 min of successful spontaneous T-piece breathing, and included in the study. After extubation, the tracheal tube resistive pressure (RP) values were measured. RESULTS: Twelve (18%) patients failed extubation. The failure group's average age was significantly greater (69.43 vs 48.43 years). The PO.1, PO.1/MIP, and F/VT values of the success (3.62 +/- 1.35 cm H2O, 0.05 +/- 0.04, and 50 +/- 23 b.min-1.L-1) and failure (7.38 +/- 2.67 cm H2O, 0.14 +/- 0.04, and 69 +/- 25 b.min-1.L-1) groups were significantly different (p < 0.005). The diagnostic accuracies of these indices were, respectively, 88%, 98%, and 73%. The spirometric, gas exchange, and tracheal tube RP values of the two groups showed no significant differences. CONCLUSION: PO.1 and PO.1/MIP ratio provide the best means of predicting extubation success, and they are not influenced by tracheal tube resistance.

Acute Disease↗