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1.
J Clin Monit Comput ; 36(5): 1271-1278, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-34550528

RESUMO

Validity and reproducibility of clinical capillary refill time (CRT) measurement depend on many factors in daily routine practice. We conducted a prospective validation study of an automatized handheld prototype device providing standardized CRT assessment (DiCART™) in 20 healthy volunteers. Three different methods of CRT measurement were compared before and during dynamic circulatory changes induced by venous and arterial occlusion tests at both upper and lower limb levels: CRTCLIN corresponding to basic clinical assessment and considered as the reference method; CRTVIDEO corresponding to off-line videos reviewed by investigators recorded by DiCART™; and CRTDiCART corresponding to on-line videos analysed by a built-in proprietary mathematical algorithm included in DiCART™. Five subjects were excluded because of a DiCART™ dysfunction. ROCAUC to detect arterial occlusion test changes at the upper limb level were 1.00 (95%CI 1.00; 1.00), 0.96 (95%CI 0.88; 1.00), and 0.92 (95%CI 0.79; 1.00) for CRTCLIN, CRTVIDEO, and CRTDiCART, respectively. Precision of CRTCLIN and CRTVIDEO were significantly better than CRTDiCART (0.18 and 0.20 vs. 0.28; P < 0.05). Percentages of error were 76% and 87% for CRTVIDEO and CRTDiCART, respectively. DiCART™ had an excellent discrimination to detect major changes in CRT induced by arterial ischemia. However, the perfectible precision, the poor agreement with clinical assessment and numerous device dysfunctions give leads to the development of a further version of the prototype before promoting its use in clinical practice.Trial registration clinicaltrial.gov. Identifier: NCT04538612.


Assuntos
Capilares , Hemodinâmica , Voluntários Saudáveis , Humanos , Estudos Prospectivos , Reprodutibilidade dos Testes
2.
J Antimicrob Chemother ; 73(2): 297-305, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29155990

RESUMO

Objectives: Antifungal resistance is a significant and emerging threat. Stewardship programmes (SPs) have been proposed as an opportunity to optimize antifungal use. While examples of antifungal SP implementation have been recently described, there is yet to be an overview of interventions and their impacts on performance measures. Methods: We systematically reviewed published articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses check-list 2009. MEDLINE was searched using the term 'antifungal stewardship' on 15 February 2017. Eligible studies were those that described an antifungal SP and included an intervention and an evaluation of performance measures. Results: A total of 97 studies were identified and 14 were included. Only five studies reported an antifungal stewardship team composed of all the recommended members. The main intervention was the formulation of recommendations to change treatment (12 of 14). The main performance measure collected was antifungal consumption (10 of 14), followed by antifungal expenditure (7 of 14), adherence to therapeutic advice (4 of 14) and impact on mortality (4 of 14). Antifungal consumption was reduced by 11.8% to 71% and antifungal expenditure by as much as 50%. Adherence to therapeutic advice ranged from 40% to 88%, whereas antifungal SPs had no impact on mortality. Conclusions: All antifungal SPs had an impact, in particular on antifungal consumption and antifungal expenditure. Active intervention including a review of prescriptions seems to have more impact than implementation of treatment guidelines only. According to available published studies, antifungal consumption appears to be the most achievable performance measure to evaluate the impact of an antifungal SP.


Assuntos
Antifúngicos/uso terapêutico , Gestão de Antimicrobianos/métodos , Uso de Medicamentos/normas , Micoses/tratamento farmacológico , Farmacorresistência Fúngica , Humanos
3.
Br J Anaesth ; 121(6): 1323-1331, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30442260

RESUMO

BACKGROUND: Fluid administration to increase stroke volume index (SVi) is a cornerstone of haemodynamic resuscitation. We assessed the accuracy of SVi variation during a calibrated abdominal compression manoeuvre (ΔSVi-CAC) to predict fluid responsiveness in children. METHODS: Patients younger than 8 yr with acute circulatory failure, regardless of their ventilation status, were selected. SVi, calculated as the average of five velocity-time integrals multiplied by the left ventricular outflow tract surface area, was recorded at four different steps: baseline, after an abdominal compression with a calibrated pressure of 25 mm Hg, after return to baseline, and then after a volume expansion (VE) of 10 ml kg-1 lactated Ringer solution over 10 min. Patients were classified as responders if SVi variation after volume expansion (ΔSVi-VE) increased by at least 15%. RESULTS: The 39 children included had a median [inter-quartile range (IQR)] age of 9 [5-31] months. Twenty patients were fluid responders and 19 were non-responders. ΔSVi-CAC correlated with ΔSVi-VE (r=0.829; P<0.001). The area under the receiver operating characteristic curve (ROCAUC) was 0.94 [95% confidence interval (CI), 0.85-0.99]. The best threshold for ΔSVi-CAC was 11% with a specificity of 95% [95% CI, 84-100] and a sensitivity of 75% [95% CI, 55-95]. ROCAUC of respiratory variation of IVC diameter (ΔIVC) was 0.53 [95% CI, 0.32-0.72]. CONCLUSION: ΔSVi-CAC during abdominal compression was a reliable method to predict fluid responsiveness in children with acute circulatory failure regardless of their ventilation status. CLINICAL TRIALS REGISTRATION: CPP Lyon sud est II: n° ANSM 2015-A00388-41 Clinicaltrial.gov: NCT02505646.


Assuntos
Hidratação , Abdome , Calibragem , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pressão
4.
Br J Anaesth ; 119(6): 1110-1117, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29028910

RESUMO

Background: Blood lactate is a strong predictor of mortality, and repeated blood lactate assays are recommended during surgery in high-risk patients. We hypothesized that the use of intravascular microdialysis incorporated in a central venous catheter would be interchangeable with the reference blood gas technique to monitor changes in blood lactate. Methods: Microdialysis and central venous blood lactate measurements were recorded simultaneously in high-risk cardiac surgical patients. The correlation between absolute values was determined by linear regression, and the Bland-Altman test for repeated measurements was used to compare bias, precision, and limits of agreement. Changes in lactate measurements were evaluated with a four-quadrant plot and trend interchangeability method (TIM). Results: In the 23 patients analysed, the central venous catheter was used as part of standard care, with no complications. The correlation coefficient for absolute values ( n =104) was 0.96 ( P <0.0001). The bias, precision, and limits of agreement were -0.19, 0.51, and -1.20 to 0.82 mmol litre -1 , respectively. The concordance rate for changes in blood lactate measurements ( n =80) was 94% with the four-quadrant plot. In contrast, the TIM showed that 23 (29) changes in lactate measurements were not interpretable, and among the remaining 57 (71) interpretable changes, 18 (32) were interchangeable, 8 (14) were in the grey zone, and 31 (54) were not interchangeable. Conclusions: Microdialysis with a central venous catheter appears to provide reliable absolute blood lactate values. Although changes in blood lactate measurements showed an excellent concordance rate, changes between the two methods were poorly interchangeable with the TIM. Clinical trial registration: NCT02296593.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cateteres Venosos Centrais , Ácido Láctico/sangue , Microdiálise/instrumentação , Microdiálise/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Gasometria/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Risco
5.
Acta Anaesthesiol Scand ; 57(6): 704-12, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23521161

RESUMO

BACKGROUND: The Nexfin device uses non-invasive photoplethysmography to monitor cardiac output and respiratory variations in pulse pressure and stroke volume. The aim of this study was to compare rapid changes in cardiac index after fluid challenge between Nexfin and bolus transpulmonary thermodilution and the ability to predict fluid responsiveness of dynamic indices given by Nexfin. METHODS: Simultaneous comparative cardiac index were collected from transpulmonary thermodilution and Nexfin before and after fluid challenge in 45 patients following conventional cardiac surgery. Correlations, Bland-Altman analyses and percentage errors were calculated. Pulse pressure variations and stroke volume variations before fluid challenge were collected to assess their discrimination in predicting fluid responsiveness. RESULTS: Eight (18%) patients were excluded. A weak positive relationship was found between rapid changes in cardiac index after fluid challenge given by both technologies (n = 37, r = 0.39, P = 0.019). Bias, precision and limits of agreements were 0.20 l/min/m(2) (95% confidence interval (CI) 0.02-0.40), 0.57 l/min/m(2) and ± 1.12 l/min/m(2) before fluid challenge, and 0.01 l/min/m(2) (95% CI -0.24 to 0.26), 0.74 l/min/m(2) and ± 1.45 l/min/m(2) after fluid challenge. Percentage errors between Nexfin and transpulmonary thermodilution were 55% and 58% before and after fluid challenge, respectively. Pulse pressure variations and stroke volume variations given by Nexfin were not discriminant to predict fluid responsiveness: areas under receiver operating characteristics curves 0.57 (95% CI 0.40-0.73) and 0.50 (0.33-0.67), respectively. CONCLUSIONS: The Nexfin cannot be used to measure rapid changes in cardiac index following fluid challenge and to predict fluid responsiveness after cardiac surgery.


Assuntos
Pressão Sanguínea , Débito Cardíaco , Cuidados Críticos/métodos , Hidratação , Fotopletismografia/instrumentação , Cuidados Pós-Operatórios/métodos , Termodiluição/métodos , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Superfície Corporal , Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Determinação de Ponto Final , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/instrumentação , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade , Volume Sistólico , Resultado do Tratamento
6.
Br J Anaesth ; 109(4): 514-21, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22750726

RESUMO

BACKGROUND: This observational study was designed to evaluate the reliability and precision of a new digital photoplethysmographic device (Nexfin, BMEYE B.V., Amsterdam, The Netherlands) for continuous and non-invasive assessment of arterial pressure and cardiac output. METHODS: Fifty consecutive adult subjects were prospectively enrolled at admission to the intensive care unit after conventional cardiac surgery and investigated hourly from T0 to T4. Simultaneous comparative systolic, diastolic, and mean arterial pressures and cardiac index (CI) data points were collected from an invasive radial artery catheter, transpulmonary thermodilution catheter, and the Nexfin device. Correlations were determined by linear regression. The Bland-Altman analysis was used to compare bias, precision, and limits of agreement. RESULTS: Six (12%) subjects were excluded from the analysis because of the inability to obtain a reliable photoplethysmographic signal. No complications were observed. A significant relationship was found between absolute values of photoplethysmographic and radial systolic (r(2)=0.56, P<0.001), diastolic (r(2)=0.61, P<0.001), and mean (r(2)=0.77, P<0.001) arterial pressures. A significant relationship was also found between transpulmonary thermodilution and Nexfin CI absolute values (r(2)=0.33, P<0.001). Bias, precision, and limits of agreement between the mean photoplethysmographic and radial arterial pressures were 4.6 (95% confidence interval: 3.7-5.5), 6.5, and -17.3 to 8.1 mm Hg, respectively. The percentage error between transpulmonary thermodilution and the Nexfin for CI measurement was 50%. CONCLUSIONS: The Nexfin device is safe, convenient, and reliable in measuring continuous non-invasive arterial pressure but not interchangeable with transpulmonary thermodilution to monitor CI.


Assuntos
Pressão Arterial/fisiologia , Débito Cardíaco/fisiologia , Procedimentos Cirúrgicos Cardíacos , Fotopletismografia/instrumentação , Fotopletismografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral , Ponte Cardiopulmonar , Feminino , Dedos/irrigação sanguínea , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Fotopletismografia/efeitos adversos , Período Pós-Operatório , Padrões de Referência , Fluxo Sanguíneo Regional/fisiologia , Reprodutibilidade dos Testes , Termodiluição , Adulto Jovem
7.
Eur J Anaesthesiol ; 25(6): 490-7, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18339209

RESUMO

BACKGROUND AND OBJECTIVE: A single cardiac troponin I (cTnI) 24-h measurement is an independent predictor of short- and long-term adverse outcome after coronary surgery. We compared a single cTnI 24-h measurement and kinetic analysis of cTnI release in predicting in-hospital outcome in unselected cardiac surgery patients. METHODS: Consecutive patients (n = 184) undergoing cardiac surgery with cardiopulmonary bypass were included and divided into two groups according to the time course of postoperative peak serum cTnI (6 or 24 h after surgery). Serial measurements of cTnI were performed the day before surgery, at the end of surgery and 6, 24 and 120 h after surgery in all patients. The total amount of cTnI released (integrated area under the curve), postoperative major adverse cardiac events (ventricular arrhythmias, myocardial infarction and congestive heart failure) and in-hospital death were recorded. Data are expressed as median (95% CI). RESULTS: In all, 152 (83%) patients had an early peak cTnI (6 h after surgery) and 32 (17%) patients had a late peak cTnI (24 h after surgery). The integrated area under the curve differed between both groups: 159 (142-178) vs. 321 (255-590), respectively, P < 0.001. Major adverse cardiac events and/or death (22 vs. 9%, P = 0.04) was greater in patients with a late peak cTnI. The integrated area under the curve and the peak value of cTnI were no more accurate than a single 24-h measurement in predicting the occurrence of major adverse cardiac events and/or death. CONCLUSIONS: Kinetic analysis of cTnI release was no more accurate than a single 24-h measurement in predicting in-hospital poor outcome.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Troponina I/sangue , Idoso , Área Sob a Curva , Arritmias Cardíacas/mortalidade , Biomarcadores/sangue , Procedimentos Cirúrgicos Eletivos , Feminino , Insuficiência Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Infarto do Miocárdio/mortalidade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
8.
J Clin Anesth ; 32: 236-41, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27290981

RESUMO

STUDY OBJECTIVE: Clinical reasoning by anesthesiology residents in emergency situations where optimal management is uncertain could be improved by setting up a tutored practice exchange group. This study attempted to evaluate the impact of a practice exchange group (PEG), tutored by a senior anesthesiologist, on anesthesiology residents in emergency situations. Changes in clinical reasoning were measured by script concordance tests (SCT). DESIGN: We conducted a controlled, non-randomized study. SETTING AND PARTICIPANTS: Participants are residents in anesthesiology in Rouen, Caen and Amiens University Hospitals. INTERVENTIONS: Two resident groups were made up without randomization. The first group was the control group and consisted of residents from Amiens University Hospital and Caen University Hospital. The second study group (PEG group) consisted of residents from Rouen University Hospital, who followed weekly PEG sessions. Two groups had the same learning objectives except the PEG. MEASUREMENTS: In both the control group and the study group, each resident's clinical reasoning was assessed in the same formal manner by SCT. The primary outcome measurement of this study was to compare SCT results in the study group with PEG training (PEG group) with those without (control group). MAIN RESULTS: Performance in the SCT, expressed as degree of concordance with the expert panel (95% CI), was better in the PEG group (64% [62.1%-66%]) than in control group (60% [57.5%-62.8%])) (P= .004). CONCLUSION: Our study strongly suggests that an expert-directed, peer-conducted educational training program may improve the clinical reasoning of anesthesiology residents as measured by SCT.


Assuntos
Anestesiologia/educação , Competência Clínica , Internato e Residência/métodos , Estudantes de Medicina , Tomada de Decisões , Emergências , França , Humanos
9.
Chest ; 114(2): 556-62, 1998 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9726745

RESUMO

STUDY OBJECTIVES: Positive end-expiratory pressure (PEEP) has been proposed to improve cardiac output in patients with left ventricular (LV) dysfunction. This study was designed to compare quantitative global and regional LV performance in response to PEEP in patients with normal and poor LV function. DESIGN: A prospective clinical trial. SETTING: Adult medical ICU in a university hospital. PATIENTS: Twelve critically ill patients requiring respiratory support and divided into two groups according to baseline transesophageal echocardiographic (TEE) measurements: normal LV dimensions and fractional area of contraction (FAC=61+/-5%) (n=7) and dilated cardiomyopathy with reduced FAC (21+/-1%) (n=5). MEASUREMENTS AND RESULTS: All patients were studied when two successive levels of PEEP (best PEEP as the highest value of respiratory compliance and high PEEP as best PEEP+10 cm H2O) were applied. Global systolic LV performance and quantitative regional wall motion analysis performed by the centerline method were assessed on the TEE transgastric short-axis view. End-systolic wall stress (ESWS) was used as a reliable indication of LV afterload. PEEP reduced LV dimensions asymmetrically in both groups of patients and septolateral diameter significantly decreased without affecting global LV systolic performance. Additionally, high PEEP produced a significant impairment in septal kinetics as evidenced by the centerline method. High PEEP also decreased ESWS for all patients (-27% in normal group and -23% in cardiac group, p<0.05) without significant improvement in global systolic LV performance (FAC: +2% in normal group and +0% in cardiac group; not significant). CONCLUSIONS: PEEP cannot be recommended routinely to improve LV performance in patients with severe dilated cardiomyopathy.


Assuntos
Cardiomiopatia Dilatada/complicações , Ecocardiografia Transesofagiana , Respiração com Pressão Positiva , Disfunção Ventricular Esquerda/terapia , Função Ventricular Esquerda/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Débito Cardíaco , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica , Estudos Prospectivos , Testes de Função Respiratória , Resultado do Tratamento , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia
10.
Intensive Care Med ; 25(9): 936-41, 1999 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10501748

RESUMO

OBJECTIVE: Evaluation of the impact of low-volume, pressure-limited ventilation on the recovery rate of acute respiratory distress syndrome (ARDS). DESIGN: Prospective observational clinical study with historical control. SETTING: University hospital intensive care unit (ICU). PATIENTS: We studied two groups of, respectively, 33 and 37 ARDS patients separated by 15 years ("historical", June 1978-April 1981, and "recent", October 1993-June 1996). METHOD: ARDS was defined as the presence of bilateral chest infiltrates and a PaO(2)/FIO(2) ratio of less than 200 mmHg under controlled ventilation regardless of PEEP level. Any cardiac participation was excluded by right heart catheterization in the "historical" group and by echo-Doppler examination in the "recent" group. The origin of ARDS was principally pulmonary (ARDS(p)) in both groups (26/33 and 29/37, respectively), and secondarily extrapulmonary (ARDS(exp)) (7/33 and 8/37, respectively). In the "historical" group, normocapnia was the major goal for respiratory support and was achieved in all patients regardless of airway pressure levels. In contrast, end-inspiratory plateau pressure in the "recent" group was limited to 30 cmH(2)O under respiratory support, regardless of PaCO(2) level. The "historical" and "recent" ARDS groups were compared with regard to therapeutic procedure and outcome. RESULTS: Normalization of PaCO(2) (36 +/- 6 mmHg) in the "historical" group required high airway pressure (end-inspiratory plateau pressure at 39 +/- 4 cmH(2)O) and high tidal volume (13 ml/kg). Respiratory support used in the "recent" group was less aggressive, with lower airway pressure (end-inspiratory plateau pressure 25 +/- 4 cmH(2)O) and tidal volume (9 ml/kg) resulting in "permissive" hypercapnia (51 +/- 10 mmHg). Mortality rates significantly decreased from 64 % in the "historical" group to 32 % in the "recent" group (p < 0.01). This decrease concerned only ARDS(p), which was markedly predominant in both groups. CONCLUSION: Mortality due to ARDS of pulmonary origin has declined in our unit over the last 15 years. Low-volume, pressure-limited (protective) ventilation seems the most likely reason for improved survival, despite hypercapnia.


Assuntos
Síndrome do Desconforto Respiratório/diagnóstico , Adulto , Hemodinâmica , Humanos , Pessoa de Meia-Idade , Mortalidade/tendências , Prognóstico , Estudos Prospectivos , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório/mortalidade , Síndrome do Desconforto Respiratório/fisiopatologia , Síndrome do Desconforto Respiratório/terapia , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Fatores de Tempo
11.
Presse Med ; 28(4): 187-94, 1999 Jan 30.
Artigo em Francês | MEDLINE | ID: mdl-10071634

RESUMO

A FREQUENT AND SEVERE EVENT: The incidence and the pathogenic mechanisms of cardiac complications in general surgery patients are now well described. Acute myocardial necrosis, the most frequent complication, is observed in 3 to 5% of patients at risk. Most are silent subendocardial lesions, but may have a short-term or mid-term life-threatening effect in these surgery patients. EARLY POSTOPERATIVE PERIOD: In most patients, cardiac events occur within 48 hours of surgery. Diagnosis is confirmed by elevated troponin I. The immediate postoperative period is characterized by increased left ventricular load and metabolic disturbances, increased release of catecholinergic mediators and hypercoagulability, factors related to the effect of anesthesia on circulation and surgical stimuli. These modifications compromise the energy balance in the myocardium and favor the development of left ventricular failure. ECG RECORDINGS: Continuous recordings in the postoperative period have shown that although the number of episodes of myocardial ischemia is not affected during surgery, their number doubles during the postoperative period, a factor predicting postoperative infarction. OPTIMAL CARE: Cardiovascular and anti-aggregate therapy should be adapted in patients with an underlying heart or coronary condition. Postoperative circulatory load and hyperaggregability should be controlled. This involves preventing hypothermia, intensive analgesia and, in some cases, cardiovascular therapy using beta blockers or alpha 2 agonists.


Assuntos
Infarto do Miocárdio/reabilitação , Assistência Perioperatória , Complicações Pós-Operatórias/reabilitação , Terapia Combinada , Eletrocardiografia Ambulatorial , Humanos , Infarto do Miocárdio/etiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco
12.
Ann Fr Anesth Reanim ; 22(7): 631-4, 2003 Jul.
Artigo em Francês | MEDLINE | ID: mdl-12946495

RESUMO

We report two patients in vasodilatory septic shock refractory to catecholamines in which a continuous infusion of terlipressin was associated with a dramatic increase in systemic arterial blood pressure and short-term survival. Low doses of terlipressin were sufficient in both cases (0.01-0.0 mg h(-1)) to restore blood pressure by increase of systemic vascular resistances. The haemodynamic response was immediate, long-acting, dose-dependent and reversible in a few hours when the drug administration was stopped. A further increase in terlipressin dose regimen markedly decreased cardiac performance. Terlipressin simultaneously induced vasoconstriction within the cutaneous vascular territory, leading to local skin necrosis. The splanchnic vascular territory seemed to be constricted in the same way. Further studies are needed to better understand and precise the role of terlipressin in the treatment of vasodilatory septic shock refractory to catecholamines.


Assuntos
Catecolaminas/uso terapêutico , Lipressina/análogos & derivados , Lipressina/uso terapêutico , Choque Séptico/tratamento farmacológico , Vasoconstritores/uso terapêutico , Agonistas Adrenérgicos beta/uso terapêutico , Idoso , Dobutamina/uso terapêutico , Resistência a Medicamentos , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Infusões Intravenosas , Lipressina/administração & dosagem , Masculino , Norepinefrina/uso terapêutico , Choque Séptico/fisiopatologia , Terlipressina , Vasoconstritores/administração & dosagem , Vasodilatação/fisiologia
13.
Ann Fr Anesth Reanim ; 23(9): 862-72, 2004 Sep.
Artigo em Francês | MEDLINE | ID: mdl-15471633

RESUMO

OBJECTIVES: Ageing of the surgical population and the evolution in anaesthetic techniques have led the Club d'anesthésie-réanimation et techniques en chirurgie cardiaque (ARTECC) to conduct a survey among French cardiac surgery centers. The aim was to profile patient population undergoing cardiac surgery and perioperative techniques employed. STUDY: National prospective study including all adult patients undergoing cardiac surgery on January 23rd, 24th and 25th, 2001. Data were collected during the first 48 postoperative hours. MATERIAL AND METHODS: Seven referent centers drafted a record form. Sixty-one centers sent back 425 patient forms, 399 were analyzed. The following were statistically studied: type of surgery, patient characteristics, preoperative treatment, monitoring, anaesthesia, cardio-pulmonary bypass (CPB) characteristics, duration of mechanical ventilation, length of stay in intensive care unit, postoperative complications. RESULTS: Patient mean age was 64.3 +/- 13.3 years. Patients over 80-year-old represented 2.5% of the population. Beating heart coronary aortic bypass grafts (13% surgery) and preoperative transoesophagal echography were not frequent. Propofol and sufentanil were the main anaesthetic agents used. There was a marked trend for fast-track procedures. CONCLUSIONS: The ARTECC study pointed out some reserve in practices and that the impact of new techniques seems limited. Regular use of studies of that kind will provide an effective tool to compare national practices.


Assuntos
Anestesia/tendências , Procedimentos Cirúrgicos Cardíacos/tendências , Cuidados Críticos/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos , Agendamento de Consultas , Ponte Cardiopulmonar/estatística & dados numéricos , Coleta de Dados , Feminino , França/epidemiologia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Pacientes , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/epidemiologia , Cuidados Pré-Operatórios/tendências , Estudos Prospectivos , Respiração Artificial
14.
Rev Pneumol Clin ; 53(4): 210-2, 1997.
Artigo em Francês | MEDLINE | ID: mdl-9616822

RESUMO

Treatment of amiodarone-induced pulmonary toxicity generally consists in simply discontinuing the drug with subsequent improvement in clinical condition and radiologic abnormalities. Corticosteroid therapy, when used, may accelerate recovery. Early diagnosis is however necessary and mandates the immediate cessation of the drug otherwise diffuse interstitial and alveolar damage can develop and lead to acute respiratory distress syndrome with a high rate mortality. To our knowledge, the use of inhaled nitric oxide to improve arterial oxygenation in amiodarone-induced ARDS has not yet been described. Here we report the case of a patient in whom 2 ppm inhaled nitric oxide in association with mechanical ventilation dramatically improved a life-threatening hypoxemia. We therefore submit that inhaled nitric oxide could be of benefit in patients with amiodarone-induced ARDS.


Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Óxido Nítrico/administração & dosagem , Síndrome do Desconforto Respiratório/induzido quimicamente , Administração por Inalação , Idoso , Humanos , Masculino
15.
Cah Anesthesiol ; 43(3): 313-8, 1995.
Artigo em Francês | MEDLINE | ID: mdl-7583900

RESUMO

The effect of 10 ml of intra-articular buprenorphine (0.30 mg) or normal saline on postoperative pain after shoulder surgery was studied in a randomized, prospective, double-blind study in 30 ASA I-II patients receiving general anaesthesia. The pain scores (Five Point Scale ranging from "no pain" to "unbearable pain" and Visual Analog Pain Scale) 1, 2, 3, 4, 6 and 24 hours after surgery, time to first analgesic use and total 6-hours and 24-hours analgesic requirements were recorded. VAPS was significantly lower in the buprenorphine group compared with placebo-treated patients one hour after surgery (p < 0.05). The time to first analgesic use was longer and total 6-h opioid requirements were lower in the buprenorphine group when compared with the control group (p < 0.05). No significant differences were detected in total 24-h analgesic requirements between the two groups. These results indicate that intra-articular injection of buprenorphine after shoulder surgery provides short analgesia. This effect may be mediated by systemic absorption.


Assuntos
Buprenorfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Articulação do Ombro , Adolescente , Adulto , Idoso , Analgésicos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Buprenorfina/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Injeções Intra-Articulares , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Cloreto de Sódio/administração & dosagem
16.
Cah Anesthesiol ; 40(5): 343-7, 1992.
Artigo em Francês | MEDLINE | ID: mdl-1422932

RESUMO

Transurethral prostatic resection using a 1.5% glycine solution causes a well known clinical and metabolic syndrome called TURP-syndrome. Recent development of percutaneous renal surgery is responsible of several similar accidents. In a prospective study of 150 patients (mean age: 35 +/- 10) subjected to a percutaneous nephrolithotomy, the natremia and the amino acid content of the plasma were measured preoperatively and immediately postoperatively by chromatography. The study shows that there is a post-nephrolithotomy syndrome in two per cent. This syndrome contains a hemodilution with hyponatremia and reabsorption of irrigation fluid. Glycolemia, serinemia and threoninemia increase significantly. These modifications have a good correlation between them except for the natremia. Variability of results in this study and in the literature is explained by difficulty and duration of surgery, volume of glycol used, increasing intrarenal pressures and sudden opening of vessels peroperatively. The gravity of post-nephrolithotomy syndrome requires to change the irrigate solute and use normal saline solution when it is possible.


Assuntos
Glicina/sangue , Nefrostomia Percutânea , Irrigação Terapêutica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemodiluição , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Serina/sangue , Sódio/sangue , Síndrome , Treonina/sangue
17.
Ann Fr Anesth Reanim ; 33(1): e9-14, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24373673

RESUMO

OBJECTIVES: The aim of the study was to compare NIRS parameters in combination with a vascular occlusion test (VOT) at a proximal (leg) and a distal (foot) site in male and female. STUDY DESIGN: A prospective experimental study in healthy subjects. PATIENTS AND METHODS: Twenty volunteers (10 male, 10 female, 28 ± 4 years) were investigated during 4 experimental steps: baseline, ischemia, reperfusion, and baseline. For each volunteer, 3 NIRS optodes were placed on right and left calves and the left arch of the foot. Blood pressure, heart rate and peripheral pulse oxymetry were monitored. RESULTS: Significant differences were observed at baseline between regional oxygen saturation (rSO2) values according to the site of measurement (proximal rSO2 81 ± 9% vs distal rSO2 60 ± 5%, P<0.001) but not according to gender. Both decreases in proximal and distal rSO2 during ischemia and increases over baseline values during reperfusion depended on group membership (male or female). NIRS parameters during the VOT were significantly higher in male when compared with female at the proximal site: desaturation rate 5.6% (IQR: 5.5) vs 2.5% (IQR: 0.8), P=0.001; resaturation rate 40.7% (IQR: 6.6) vs 21.7% (IQR: 5.4), P=0.003; and ΔrSO2 10.0% (IQR: 7.0) vs 5.5% (IQR: 6.0), P=0.041. CONCLUSIONS: Values of rSO2 at the lower limb varied according to the anatomical site of measurement. A VOT induced major changes in rSO2 that differed between male and female. These results should be taken into account in further clinical studies.


Assuntos
Oclusão de Enxerto Vascular/diagnóstico , Extremidade Inferior/irrigação sanguínea , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Adulto , Pressão Sanguínea/fisiologia , Feminino , Pé/irrigação sanguínea , Voluntários Saudáveis , Frequência Cardíaca/fisiologia , Humanos , Perna (Membro)/irrigação sanguínea , Masculino , Oximetria , Oxigênio/sangue , Estudos Prospectivos , Fluxo Sanguíneo Regional , Caracteres Sexuais
18.
Ann Fr Anesth Reanim ; 32(6): 397-401, 2013 Jun.
Artigo em Francês | MEDLINE | ID: mdl-23684432

RESUMO

STUDY DESIGN: Opinion survey. OBJECTIVES: To know the level of satisfaction and the expectations of the residents in anesthesiology in the Northwest of France. MATERIALS AND METHODS: A standardized questionnaire assessing the theoretical and practical training was mailed to the 4th- and 5th-year anesthesiology residents (DESAR 4 and 5) in the Northwest of France over a 6-month period. Four items were studied: the profile of responders, the approval of theoretical and practical teaching, and the improvement propositions. RESULTS: The response rate was 61%. A change in speciality has never been looked for by 95% of residents. The training was considered as good or very good in 90% of cases. The elements of theoretical teaching are variably considered according to their merits. Practical training gave entire satisfaction whatever its type and place. Additional specific training in regional anesthesia, difficult intubation and echocardiography is required. Most DESAR would be interested in obtaining a post-internship job or a stage in private hospitals. DISCUSSION: Teaching generally meets the expectations of students. These regional data are similar with the results of French national surveys. They highlight the good quality of training but suggest it could be further improved. CONCLUSION: The homogeneity of teaching, based on the objectives proposed by the French College of Anesthesiologists, and the dynamism of the French Society of Anesthesiology and Critical Care Medicine ensures the quality of training for future specialists.


Assuntos
Anestesiologia/educação , Atitude do Pessoal de Saúde , Comportamento do Consumidor/estatística & dados numéricos , Internato e Residência , Médicos/psicologia , Adulto , Escolha da Profissão , Currículo , Coleta de Dados , França , Humanos
19.
Ann Fr Anesth Reanim ; 32(12): 833-7, 2013 Dec.
Artigo em Francês | MEDLINE | ID: mdl-24184168

RESUMO

OBJECTIVE: Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in intensive care unit (ICU). The aim of the study was to evaluate the follow-up of the guidelines for VAP prevention. STUDY DESIGN: Retrospective, observational and multicenter study. PATIENTS AND METHODS: During one year, all patients with mechanical ventilation over 48 hours were included in the CCLIN-Ouest Network. The demographic characteristics of the patients, the use of specific protocol for VAP prevention and the density of incidence of VAP were recorded. The use of a protocol for preventing VAP (absence, incomplete, complete and care bundle (i.e. complete prevention of VAP with weaning mechanical protocol and sedation protocol)) was collected. RESULTS: 26 ICU with 5742 patients were included. Ten ICU (38%; 2595 patients) had no protocol for VAP prevention, eight ICU (31%; 1821 patients) had an incomplete protocol, five ICU (19%; 561 patients) had a complete protocol and three ICU (12%; 765 patients) had a care bundle. The density of incidence of VAP was 14.8‰ (Interquartile range [IQR]: 10.2-0.1) for no protocol group, 15.6‰ [IQR: 12.6-6.2] for incomplete protocol group, 11.0‰ [IQR: 9.1-14.0] for complete protocol group and 12.9‰ [5-7,7-9,9-12] for care bundle group (P=0.742). CONCLUSIONS: The compliance to prevention of VAP was poor. Proposals for improving practice are discussed.


Assuntos
Cuidados Críticos/métodos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Idoso , Protocolos Clínicos , Sedação Consciente , Feminino , Seguimentos , França/epidemiologia , Fidelidade a Diretrizes , Pesquisas sobre Atenção à Saúde , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Desmame do Respirador
20.
Ann Fr Anesth Reanim ; 31(1): e1-5, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22154443

RESUMO

BACKGROUND: Septic shock remains a major cause of death in intensive care units (ICU) and an inappropriate antibiotic regimen worsens the prognosis. The aim of the study was to assess the impact of an information campaign on modalities of prescription of aminoglycosides in septic shock. STUDY DESIGN: A prospective observational study. METHODS: Consecutive septic shock patients admitted to the surgical ICU over a 2-year period were included. An information campaign allowed to differentiate between a pre- (P1) and a post- (P2) interventional period. The campaign clarified the rules and requirements for pharmacological monitoring of aminoglycosides. The main objective was to increase the rate of prescription of peak serum aminoglycoside following the first intravenous injection. RESULTS: One hundred and forty-eight patients (P1=76 and P2=72) were finally included into the study. Similar clinical characteristics were observed during both periods. The rate of prescription of peak serum aminoglycoside following the first injection was performed in 49% (P1) versus 65% (P2), P=0.09. The length of stay in ICU was 16 days [extremes: 1-74] (P1) versus 17 days [extremes: 1-133] (P2) (P=0.84). Inhospital mortality was 28% (P1) versus 26% (P2), P=0.86. CONCLUSIONS: An information campaign describing the modalities of prescription of aminoglycosides in septic shock failed to improve medical practices and patient outcomes. A mobile team of antibiotics could be useful in daily practice.


Assuntos
Aminoglicosídeos/uso terapêutico , Antibacterianos/uso terapêutico , Disseminação de Informação , Choque Séptico/tratamento farmacológico , Idoso , Aminoglicosídeos/administração & dosagem , Antibacterianos/administração & dosagem , Estudos de Coortes , Cuidados Críticos/métodos , Monitoramento de Medicamentos , Prescrições de Medicamentos/estatística & dados numéricos , Determinação de Ponto Final , Feminino , Mortalidade Hospitalar , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva/organização & administração , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Administração dos Cuidados ao Paciente , Estudos Prospectivos , Melhoria de Qualidade , Tamanho da Amostra , Choque Séptico/complicações , Resultado do Tratamento
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