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P Ferdinande

Publications and source records attributed to P Ferdinande.

At least 19 recordsLinked to original sources
PubMed2005

Liver transplantation using livers from septuagenarian and octogenarian donors: an underused strategy to reduce mortality on the waiting list.

Shortage of liver grafts is the only limiting factor for application of liver transplantation and causes an increasing mortality on the waiting list. Very old donors (>70 to 80 years old) are rarely referred to transplant centers because of the assumption that these livers will not work properly. Alternatively, transplant teams may be reluctant to use these very old livers due to the risk of poor posttransplant outcome. We reviewed our experience with seven liver transplantations using very old donor livers. We found that the results in terms of graft function and patient survival are adequate. Interestingly, the majority of these donors originated from a single referring donor unit (of more than 20 units who belong to our donor network) that systematically refers all brain-dead donors to the transplant center, independent of the age of the potential donor. This implies that many of these donors are left undetected in other units. In conclusion, very old donors should be referred to transplant centers since results of transplantation with these grafts are favorable.

Age Factors↗
PubMed2004

Phrenic nerve dysfunction after heart-lung and lung transplantation.

BACKGROUND: Phrenic nerve dysfunction (PND) is a well-known complication after cardiac surgery, but reports on its incidence and consequences after heart-lung and lung transplantation are scarce. METHODS: The incidence and consequences (ventilator days and intensive-care unit length of stay [ICU LOS]) of PND were studied by retrospective chart review of 27 heart-lung (HLTx) and 111 lung (LTx) transplantations performed from July 1991 to June 2001 at the Leuven University Hospital, Leuven, Belgium. On clinical suspicion of diaphragmatic dysfunction, nerve conduction studies were performed, which were completed with a needle electromyogram (EMG) of the diaphragm when the conduction study was non-conclusive. RESULTS: The incidence of PND in 21 evaluable HLTx recipients was 42.8% (9 of 21 patients), resulting in significantly more ventilator days for PND patients (37.6 +/- 36.3 days vs 5.3 +/- 3 days; p < 0.05) and a prolonged ICU LOS (46.8 +/- 33 vs 9.8 +/- 4.9 days; p < 0.05). In the 97 evaluable LTx patients, 9.3% (9 of 97 patients) developed PND. This resulted in more ventilator days for the PND group (30.6 +/- 14.8 days vs non-PND 7.9 +/- 14.8 days. p < 0.05) and a longer ICU LOS (PND 37.8 +/- 18.7 days vs non-PND 12.1 +/- 17.8 p < 0.05). Needle EMG of the diaphragm revealed denervation in 1 HLTx and 5 LTx patients. In LTx patients sustaining PND more tracheostomies were performed (44.4% vs 4.5% for non-PND patients p < 0.005). Eight of 9 LTx patients with PND had sequential single-lung transplantation. CONCLUSIONS: PND represents an important clinical problem after HLTx and LTx and has a considerable influence on both number of ventilator days and ICU resource utilization.

Adult↗
PubMed2001

Intensive insulin therapy in critically ill patients.

BACKGROUND: Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes. Whether the normalization of blood glucose levels with insulin therapy improves the prognosis for such patients is not known. METHODS: We performed a prospective, randomized, controlled study involving adults admitted to our surgical intensive care unit who were receiving mechanical ventilation. On admission, patients were randomly assigned to receive intensive insulin therapy (maintenance of blood glucose at a level between 80 and 110 mg per deciliter [4.4 and 6.1 mmol per liter]) or conventional treatment (infusion of insulin only if the blood glucose level exceeded 215 mg per deciliter [11.9 mmol per liter] and maintenance of glucose at a level between 180 and 200 mg per deciliter [10.0 and 11.1 mmol per liter]). RESULTS: At 12 months, with a total of 1548 patients enrolled, intensive insulin therapy reduced mortality during intensive care from 8.0 percent with conventional treatment to 4.6 percent (P<0.04, with adjustment for sequential analyses). The benefit of intensive insulin therapy was attributable to its effect on mortality among patients who remained in the intensive care unit for more than five days (20.2 percent with conventional treatment, as compared with 10.6 percent with intensive insulin therapy, P=0.005). The greatest reduction in mortality involved deaths due to multiple-organ failure with a proven septic focus. Intensive insulin therapy also reduced overall in-hospital mortality by 34 percent, bloodstream infections by 46 percent, acute renal failure requiring dialysis or hemofiltration by 41 percent, the median number of red-cell transfusions by 50 percent, and critical-illness polyneuropathy by 44 percent, and patients receiving intensive therapy were less likely to require prolonged mechanical ventilation and intensive care. CONCLUSIONS: Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit.

APACHE↗
PubMed2001

Needs of relatives of critical care patients: perceptions of relatives, physicians and nurses.

OBJECTIVES: This study investigated differences between the perceptions of relatives, physicians and nurses concerning the needs of relatives of critical care patients. DESIGN AND PARTICIPANTS: Perceived needs were assessed in 200 relatives, 38 physicians, and 143 nurses using a 45-item questionnaire. SETTING: Data were gathered at the intensive care unit of the University Hospital Gasthuisberg. RESULTS AND CONCLUSIONS: The overall rankings of the needs by the three groups are very similar. Information emerges as most important factor, with considerably less importance attached to comfort and support. There were significant differences between the groups on all categories and on 24 individual needs. Regarding the need categories, both nurses and physicians underestimate the relatives' need for information and proximity to the patient. Physicians also underestimate the relatives' need for assurance. On the individual need items, relatives' needs are generally underestimated by the staff, but in some cases overestimations are found.

Adult↗
PubMed2001

What works in severe head injury?

Traumatic brain injury has an important socioeconomic impact in industrialized countries. However, well-conducted clinical trials are rare. Case-control studies have shown that prevention works. Pathophysiological understanding is becoming more complete as data on chemokines, local brain tissue oxygen tension and hypothermia accumulate. Multimodality monitoring will certainly assume greater importance in the future. Research with targeted therapeutic strategies indicates that secondary ischaemic insults can be prevented. Specific subgroups of patients with traumatic brain injury who will benefit from the use of hypothermia and barbiturates have been identified. Enteral feeding is the preferred nutritional strategy, and the follow-up period should be extended beyond the traditional 1 year.

Journal Article↗
PubMed1997

Randomized, controlled trial of selective digestive decontamination in 600 mechanically ventilated patients in a multidisciplinary intensive care unit.

OBJECTIVE: To evaluate the efficacy of two regimens of selective decontamination of the digestive tract in mechanically ventilated patients. DESIGN: Prospective, randomized, concurrent trial. SETTING: Multidisciplinary intensive care unit (ICU) in a 1,800-bed university hospital. PATIENTS: Consecutive patients (n = 660) who were likely to require mechanical ventilation for at least 48 hrs were randomized to one of three groups: conventional antibiotic regimen (control group A); oral and enteral ofloxacin-amphotericin B (group B); and oral and enteral polymyxin E-tobramycin-amphotericin B (group C). Both treatment groups received systemic antibiotics for 4 days (ofloxacin in group B and cefotaxime in group C). INTERVENTIONS: Patients were randomized to receive standard treatment (control group A, n = 220), selective decontamination regimen B (group B, n = 220), and selective decontamination regimen C (group C, n = 220). After early deaths and exclusions from the study, 185 controls (group A) and 193 (group B)/200 (group C) selective decontamination regimen patients were available for analysis. MEASUREMENTS AND MAIN RESULTS: Measurements included colonization and primary/secondary infection rate, ICU mortality rate, emergence of antibiotic resistance, length of ICU stay, and antimicrobial agent costs. The study duration was 19 months. The patient groups were fully comparable for age, diagnostic category, and severity of illness. One third of patients in each group suffered a nosocomial infection at the time of admission. There was a significant difference between treatment group B and control group A in the number of infected patients (odds ratio of 0.42, 95% confidence interval of 0.27 to 0.64), secondary lower respiratory tract infection (odds ratio of 0.47, 95% confidence interval of 0.26 to 0.82), and urinary tract infection (odds ratio of 0.47, 95% confidence interval of 0.27 to 0.81). Significantly more Gram-positive bacteremias occurred in treatment group C vs. group A (odds ratio of 1.22, 95% confidence interval 0.72 to 2.08). Infection at the time of admission proved to be the most significant risk factor for subsequent infection in control and both treatment groups. ICU mortality rate was almost identical (group A 16.8%, group B 17.6%, and group C 15.5%) and was not significantly related to primary or secondary infection. Increased antimicrobial resistance was recorded in both treatment groups: tobramycin-resistant enterobacteriaceae (group C 48% vs. group A 14%, p < .01), ofloxacin-resistant enterobacteriaceae (group B 50% vs. group A 11%, p < .02), ofloxacin-resistant nonfermenters (group B 81% vs. group A 52%, p < .02), and methicillin-resistant Staphylococcus aureus (group C 83% vs. group A 55%, p < .05). Antimicrobial agent costs were comparable in control and group C patients; one third less was spent for group B patients. CONCLUSIONS: In cases of high colonization and infection rates at the time of ICU admission, the preventive benefit of selective decontamination is highly debatable. Emergence of multiple antibiotic-resistant microorganisms creates a clinical problem and a definite change in the ecology of environmental, colonizing, and infecting bacteria. The selection of multiple antibiotic-resistant Gram-positive cocci is particularly hazardous. No beneficial effect on survival is observed. Moreover, selective decontamination adds substantially to the cost of ICU care.

Adult↗
PubMed1996

Thyrotropin-releasing hormone in critical illness: from a dopamine-dependent test to a strategy for increasing low serum triiodothyronine, prolactin, and growth hormone concentrations.

OBJECTIVE: The aim of this study was to examine the effect of dopamine infusion on the thyrotropin (TSH), thyroid hormone, prolactin, and growth hormone responses to thyrotropin-releasing hormone (TRH) in critically ill patients. DESIGN: Prospective, randomized, controlled, open-labeled clinical study. SETTING: The intensive care unit, University Hospital Gasthuisberg, Leuven, over a 1-month period. PATIENTS AND INTERVENTIONS: In 15 critically ill patients receiving dopamine treatment (5 micrograms/kg/min) for a mean of 43.3 +/- 1.2 (SEM) hrs after trauma or cardiac surgery, we studied the TSH, thyroid hormone, prolactin, and growth hormone responses to the administration of two consecutive intravenous TRH boluses of 200 micrograms, with a 6-hr interval. The dopamine infusion was continued in the control group and discontinued in the study group. Serum concentrations of TSH, prolactin, and growth hormone were measured before and 20, 40, 60, and 120 mins after TRH administration. Serum concentrations of thyroxine (T4), triiodothyronine (T3), reverse T3, and thyroid hormone binding globulin were determined before and 120 mins after each TRH injection. MEASUREMENTS AND MAIN RESULTS: There was a > 100-fold interindividual variation in the baseline TSH concentration and in the TSH peak value after TRH administration. Two consecutive doses of TRH evoked a mean 16% increase in serum T4 concentration (p = .003) and a mean 47% increase in T3 (p = .001), whereas serum reverse T3 and thyroid hormone binding globulin values remain unaltered. Each of the TRH boluses increased serum growth hormone concentrations in the continued dopamine and discontinued dopamine groups, by a median of 60% (p = .001) and 68% (p = .001), respectively. Three hours after dopamine withdrawal, there was a three-fold increase of the peak TSH response (p = .001), a higher T3 response (p = .01), and a ten-fold increase of the peak prolactin value (p = .001) in response to TRH administration. CONCLUSIONS: The TSH response to TRH administration in critical illness presents a striking interindividual variation and dopamine dependent. Repeated TRH administration results in a repetitive increase of TSH, prolactin, growth hormone, T4, and T3, without increasing reverse T3. These observations point toward a potential for TRH as a strategy for reversing the euthyroid sick syndrome, growth hormone deficiency, and immune dysfunction associated with critical illness.

Adolescent↗
PubMed1995

Isolated right ventricular unloading for postcardiotomy right ventricular failure in a child.

Severe right ventricular (RV) failure after total correction of double outlet RV (DORV) with pulmonary atresia was completely reversed with extracorporeal mechanical RV unloading in a 2.5-year-old child. The patient could be weaned after 168 h of RV assist device (RVAD) support using a centrifugal Bio-Medicus pump and was discharged from the hospital without adverse effects. This experience of isolated RV unloading in a child encourages further application of RVAD in pediatric patients.

Cardiopulmonary Bypass↗
PubMed1995

Dehydroepiandrosterone sulphate in critical illness: effect of dopamine.

OBJECTIVE: As part of a study on the effect of dopamine therapy on pituitary dependent hormone secretion in critical illness, we documented the impact of this inotropic and vasoactive catecholamine on the serum concentrations of dehydroepiandrosterone sulphate (DHEAS). Concomitantly, serum levels of PRL and cortisol were determined. PATIENTS AND DESIGN: In a prospective, randomized, controlled, open-labelled clinical study, 20 critically ill, adult polytrauma patients receiving dopamine treatment (5 micrograms/kg/mi i.v. for a median 109 hours (range (21-296 hours)), were studied to evaluate the effect of dopamine withdrawal on serum concentrations of DHEAS, PRL and cortisol. The median age of the studied patients was 37 years (range 18-83 years). MEASUREMENTS: Serum DHEAS and cortisol concentrations were measured by RIA and PRL by IRMA. The assessed serum samples were obtained at 0300 h on each of two consecutive study nights. RESULTS: Withdrawal of dopamine infusion was found to elicit a median 25% increase of serum DHEAS concentrations within 24 hours whereas no significant change in DHEAS levels was observed when dopamine infusion was continued throughout both study nights (P = 0.01 continued vs interrupted dopamine). Prolactin levels were undetectable as long as dopamine was infused, and increased to a median of 317 IU/l after 24 hours of dopamine withdrawal (P = 0.0007). Elevated serum cortisol levels remained comparable with continued and interrupted dopamine infusion. CONCLUSIONS: Dopamine infusion appears to suppress serum DHEAS concentrations in critically ill patients without affecting their elevated serum cortisol levels, suggesting a differential regulation of DHEAS and cortisol metabolism in critical illness. The lowering effect of dopamine on DHEAS levels could be linked to the concomitant suppression of circulating PRL. The simultaneous suppression of circulating PRL and DHEAS by dopamine infusion may be an iatrogenic factor maintaining or aggravating the anergic state of prolonged severe illness.

Adolescent↗
PubMed1995

Prevention of postintubation laryngotracheal stenosis.

Laryngotracheal complications after translaryngeal intubation and specifically tracheotomy are a common problem. Surgical correction of PITS is not always successful. Pathogenetic mechanisms of PITS are direct pressure necrosis by overinflated endotracheal tube and cuff material, duration of intubation, macro- and microtrauma during intubation, the specific technique of endotracheal intubation, severity of respiratory failure, infection and poor tissue perfusion due to hemodynamic instability. Following preventive guidelines are proposed: the use of high volume low pressure cuffs, cuff pressure monitoring, ventilatory support with lower airway pressures, prevention of macrotrauma during intubation and microtrauma during maintenance, adapted policy of choice between translaryngeal and tracheotomy techniques, anti-infectious strategy and swift hemodynamic stabilization.

Hemodynamics↗
PubMed1991

Mitochondrial function in myocardial stunning.

Mitochondrial respiration parameters were studied in mitochondria isolated from normal, ischemic and post-ischemic rabbit hearts. Mitochondrial function was related to tissue content of high energy phosphates (HEP) and cardiac function in the isolated working rabbit heart preparation. It was found that after 10 and 20 mins of global normothermic ischemia followed by 20 mins of Langendorff reperfusion, mitochondrial function and HEP content of the myocardium were not significantly diminished. Myocardial creatine phosphate even showed a significant overshoot as compared to the pre-ischemic condition. When these hearts were allowed to perform work, recovery of cardiac function was incomplete while mitochondrial function and HEP content remained in the normal range. Prolonged ischemia (30 mins) resulted in a significant depression of mitochondrial function and myocardial ATP content during and after ischemia. Recovery of contractile function was severely depressed. These results show that impaired cardiac function after a mild ischemic insult (myocardial stunning) can be associated with near normal mitochondrial function and HEP contents.

Adenosine Triphosphate↗
PubMed1989

Extracorporeal treatment of acute renal failure in the intensive care unit: a critical view.

Acute renal failure in critically ill patients is seldom an isolated problem but is more usually associated with multiple organ failure. When choosing an extracorporeal kidney replacement therapy, these other failing organs must be taken into account. Therefore the choice of an artificial kidney in patients requiring intensive care depends on both the efficacy of the technique and its possible adverse effects on cerebral, pulmonary and cardiovascular function. The most important pathogenic factors in the development of dysequilibrium syndromes, arterial hypoxemia and hypotension are treatment timing, diffusive solute transfer, bio-incompatible membranes and some specific dialysate components (buffer, electrolyte concentrations). It is important to understand the mechanisms by which these factors exert their adverse effects. Application of these pathophysiological mechanisms to the cardiopulmonary and neurologic status of the individual patient permits the prediction of their clinical outcome. This approach will lead to individualised treatment selection, thereby avoiding deleterious side-effects without loss of efficacy.

Acute Kidney Injury↗
PubMed1987

The use of midazolam and diazepam for sedation following aorto-coronary bypass surgery.

The new water-soluble benzodiazepine midazolam was compared in a randomized study to diazepam for postoperative sedation in fifty patients following aortocoronary bypass surgery with a sufentanil-anesthesia. Midazolam and diazepam were administered intravenously in repeated doses in conjunction with an opioid infusion (piritramide) from the end of surgery during a twelve-hour study period, patients being artificially ventilated. Midazolam scored better than diazepam for quality of sedation and cardiovascular stability during the period of mechanical ventilation and for respiration during the weaning period and after extubation, although no difference was found in weaning time from artificial ventilation and time of extubation. Hemodynamic tolerance for both drugs was good. The administration of a loading dose of midazolam 5 mg caused a slight, transient decrease in mean arterial pressure. Midazolam appeared to be a more effective sedative agent than diazepam for short-term administration during mechanical ventilation. No evidence of cumulation and prolonged recovery was seen.

Adult↗