Medicolegal Implications of Nosocomial Infections: A Case Report of Aspergillus Contamination during Cardiac Surgery.

Nosocomial infections have become a major issue of public health and lead to an increasing number of suits for damages. We present a rare case of Aspergillus contamination during cardiac surgery, describe the medicolegal investigation, and present the new system for compensation of bodily injury after nosocomial infection in France, based on the law of March 4, 2002 on patient rights and quality in the health system. This case demonstrates the limits of compensation for nosocomial infections on the grounds of national solidarity. The expert report requested by the regional commission for conciliation and compensation is of fundamental importance in enabling the commission to decide between fault and inherent risk of treatment.

Rate of carbon dioxide production and energy expenditure in fed and food-deprived adult dogs determined by indirect calorimetry and isotopic methods.

OBJECTIVE: To evaluate energy expenditure (EE) in dogs by estimating rate of CO2 production (rCO2). ANIMALS: 15 Beagles. PROCEDURE: Food was withheld for 24 hours, and all dogs received an IV infusion of 13C sodium bicarbonate for 8 hours. Breath samples were collected before infusion and at 30-minute intervals from 4 to 8 hours, and 13C enrichment in breath CO2 was measured, using gas chromatography-isotopic ratio mass spectrometry. Food was withheld from 6 dogs, and rCO2 and O2 consumption were measured, using a conventional indirect calorimeter. The CO2 production and O2 consumption were measured by use of indirect calorimetry in 6 other fed dogs that were injected with 2H2O and H2(18)O. Blood samples were collected before tracer injection, 4 hours later, and on days 4, 7, and 11. Deuterium and 18O enrichments in plasma water were determined. RESULTS: Mean rCO2 measured by indirect calorimetry was 516 +/- 34 and 410 +/- 16 micromol/kg(0.75)/min in 6 fed and 6 food-deprived dogs, respectively. The rCO2 calculated from 13C-bicarbonate dilution was 482 +/- 30 micromol/kg(0.75)/min. Mean rCO2 determined by use of the double-labeled water method was 1,036 +/- 46 mmol/kg(0.75)/d. Mean energy expenditure calculated from rCO2 determined by infusion of 13C bicarbonate, indirect calorimetry in fed and food-deprived dogs, and infusion of double-labeled water was 386 +/- 39, 379 +/- 25, 338 +/- 14, and 552 +/- 25 kJ/kg(0.75)/d, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Energy expenditure calculated by indirect calorimetry in unfed dogs can be considered representative of basal metabolic rate.