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1

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Relationships between Polymorphonuclear Neutrophils and Cytokines in Patients with Adult Respiratory Distress Syndrome (1994)

CHOLLET-MARTIN, S. ; MONTRAVERS, P. ; GIBERT, C. ; [et al.]

Oxford, UK : Blackwell Publishing Ltd

Annals of the New York Academy of Sciences 725 (1994), S. 0

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ISSN: 1749-6632

Source: Blackwell Publishing Journal Backfiles 1879-2005

Topics: Natural Sciences in General

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1111/j.1749-6632.1994.tb39818.x

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2

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Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients (1999)

Roupie, E. ; Lepage, E. ; Wysocki, M. ; [et al.]

Springer

Intensive care medicine 25 (1999), S. 920-929

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ISSN: 1432-1238

Keywords: Key words Acute lung injury ; Acute respiratory distress syndrome ; Mechanical ventilation

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract Objective: To evaluate the prevalence and outcome of the acute respiratory distress syndrome (ARDS) among patients requiring mechanical ventilation. Design: A prospective, multi-institutional, initial cohort study including 28-day follow-up. Settings: Thirty-six French intensive care units (ICUs) from a working group of the French Intensive Care Society (SRLF). Patients: All the patients entering the ICUs during a 14-day period were screened prospectively. Hypoxemic patients, defined as having a PaO2/FIO2 ratio (P/F) of 300 mmHg or less and receiving mechanical ventilation, were classified into three groups, according to the Consensus Conference on ARDS: group 1 refers to ARDS (P/F: 200 mmHg or less and bilateral infiltrates on the chest X-ray); group 2 to acute lung injury (ALI) without having criteria for ARDS (200 〈 P/F ≤ 300 mmHg and bilateral infiltrates) and group 3 to patients with P/F of 300 mmHg or less but having exclusion criteria from the previous groups. Results: Nine hundred seventy-six patients entered the ICUs during the study period, 43 % of them being mechanically ventilated and 213 (22 %) meeting the criteria for one of the three groups. Among all the ICU admissions, ARDS, ALI and group 3 patients amounted, respectively, to 6.9 % (67), 1.8 % (17) and 13.3 % (129) of the patients, and represented 31.5 %, 8.1 % and 60.2 % of the hypoxemic, ventilated patients. The overall mortality rate was 41 % and was significantly higher in ARDS patients than in the others (60 % vs 31 % p 〈 0.01). In group 3, 42 patients had P/F less than 200 mmHg associated with unilateral lung injury; mortality was significantly lower (40.5 %) than in the ARDS group. In the whole group of hypoxemic, ventilated patients, septic shock and severity indices but not oxygenation indices were significantly associated with mortality, while the association with immunosuppression revealed only a trend (p = 0.06). Conclusions: In this survey we found that very few patients fulfilled the ALI non-ARDS criteria and that the mortality of the group with ARDS was high.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/s001340050983

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3

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Improvement of internal jugular vein cannulation using an ultrasound-guided technique (1997)

Slama, M. ; Novara, A. ; Safavian, A. ; [et al.]

Springer

Intensive care medicine 23 (1997), S. 916-919

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ISSN: 1432-1238

Keywords: Key words Ultrasound ; Venous access ; Catheterization ; Critical illness ; Internal jugular vein

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract Objective: To determine whether ultrasound guidance can help operators to improve the results of jugular vein access in the ICU. Design: Prospective, randomized study. Setting: General Intensive Care Unit of a University Hospital. Patients: Seven-nine patients were assigned to internal jugular vein cannulation using anatomical landmarks alone (control group, n = 42) or with ultrasound guidance (ultrasound group, n = 37). Intervention: All cannulations were performed by junior house staff under the direct supervision of a senior physician. In the ultrasound group, an ultrasonography (7.5 MHz) was used and the transducer was covered by a sterile sheath. The placement and direction of the cannulating needle were determined on the ultrasound image. Measurements and results: Internal jugular vein cannulation was successful in 37/37 (100 %) patients in the ultrasound group and in 32/42 patients (76 %) in the control group (p 〈 0.01). Average access time was longer in the control group (235 ± 408 s vs 95 ± 174 s, p = 0.06) and carotid artery puncture occurred in five patients in each group (p = 0.83). Jugular cannulation was successful at the first attempt in 26 % in the control group and 43 % in the ultrasound group (p = 0.11). Thirty-two patients (86 %) in the ultrasound group and 23 patients (55 %) in the control group (p 〈 0.05) were cannulated within 3 min. The cannula could therefore not be inserted within 3 min in 19 patients (45 %) in the control group. Failure was explained by thrombosis (n = 1), small caliber of the internal jugular vein (〈 5 mm, n = 3), abnormal vascular relations (n = 3). Among the ten primary failures of cannulation, an internal jugular vein catheter was able to be inserted in four cases by an experienced physician on the side initially selected and with ultrasound guidance in two cases. The catheter was inserted into the contralateral internal jugular vein under ultrasound guidance in the remaining four cases. Conclusion: Ultrasound guidance improved the success rate of jugular vein cannulation in ICU patients. Our results suggest that ultrasound guidance should be used when the internal jugular vein has not been successfully cannulated within 3 min by the external landmark-guided technique.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/s001340050432

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4

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Characterization of intensive care unit patients using a model based on the presence or absence of organ dysfunctions and/or infection: The ODIN model (1993)

Fagon, J. Y. ; Chastre, J. ; Novara, A. ; [et al.]

Springer

Intensive care medicine 19 (1993), S. 137-144

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ISSN: 1432-1238

Keywords: Organ dysfunctions ; Infection ; Severity of disease ; Prognosis

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract Objective To evaluate the sensitivity, specificity and overall accuracy of a model based on the presence or absence of organ dysfunctions and/or infection (ODIN) to predict the outcome for intensive care unit patients. Design Prospective study. Setting General intensive care unit in a university teaching hospital. Patients 1070 consecutive, unselected patients. Interventions There were no interventions. Measurements and main results We recorded within the first 24h of admission the presence or absence of dysfunction in 6 organ systems: respiratory, cardiovascular, renal, hematologic, hepatic and neurologic, and/or infection (ODIN) in all patients admitted to our ICU, thus establishing a profile of organ dysfunctions in each patient. Using univariate analysis, a strong correlation was found between the number of ODIN and the death rate (2.6, 9.7, 16.7, 32.3, 64.9, 75.9, 94.4 and 100% for 0, 1, 2, 3, 4, 5, 6 and 7 ODIN, respectively; (p〈0.001). In addition, the highest mortality rates were associated with hepatic (60.8%), hematologic (58.1%) and renal (54.8%) dysfunctions, and the lowest with respiratory dysfunction (36.5%) and infection (38.3%). For taking into account both the number and the type of organ dysfunction, a logistic regression model was then used to calculate individual probabilities of death that depended upon the statistical weight assigned to each ODIN (in the following order of descending severity: cardiovascular, renal, respiratory, neurologic, hematologic, hepatic dysfunctions and infection). The ability of this severity-of-disease classification system to stratify a wide variety of patients prognostically (sensitivity 51.4%, specificity 93.4%, overall accuracy 82.1%) was not different from that of currently used scoring systems. Conclusions These findings suggest that determination of the number and the type of organ dysfunctions and infection offers a clear and reliable method for characterizing ICU patients. Before a widespread use, this model requires to be validated in other institutions.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/BF01720528

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5

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Procedures for the diagnosis of pneumonia in ICU patients (1992)

Chastre, J. ; Fagon, J. -Y. ; Lamer, Ch.

Springer

Intensive care medicine 18 (1992), S. S10

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ISSN: 1432-1238

Keywords: Diagnosis ; Protected specimen brush technique (PSB) ; Bronchoalveolar lavage (BAL)

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract The optimal technique for diagnosing nosocomial bacterial pneumonia in critically ill patients cared for in the intensive care unit remains unclear, especially in the subgroup of patients requiring mechanical ventilation. An important advance has been the development of the protected specimen brush technique. Secretions obtained using this technique and evaluated by quantitative cultures are useful in distinguishing patients with and without pneumonia. However, this procedure has important limitations in that results are not available immediately, and in that a few false negative of false positive results may occur. Bronchoalveolar lavage has been suggested to be of value in establishing the diagnosis of pneumonia, because the cells and liquid recovered can be examined microscopically immediately after the procedure and are also suitable for quantitative culture. Microscopic identification of bacteria within cells recovered by lavage may provide a sensitive and specific means for the early and rapid diagnosis of pneumonia in this setting. The lavage technique can also be conveniently incorporated into a protocol along with quantitative culture of samples obtained using the protected specimen brush. This combination will probably improve the overall accuracy of diagnosis while allowing the administration of prompt empiric antimicrobial therapy in most patients with pneumonia.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/BF01752971

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6

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Diagnostic and therapeutic implications of transesophageal echocardiography in medical ICU patients with unexplained shock, hypoxemia, or suspected endocarditis (1996)

Slama, M. A. ; Novara, A. ; Putte, P. ; [et al.]

Springer

Intensive care medicine 22 (1996), S. 916-922

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ISSN: 1432-1238

Keywords: Transesophageal echocardiography ; Shock ; Endocarditis ; Hypoxemia ; Intensive care unit ; Critical care ; Echocardiography ; Transthoracic echocardiography ; Hemodynamics ; Ventricular function ; Therapy

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract Objective To evaluate the diagnostic and therapeutic implications of transesophageal echocardiography (TEE) in intensive care patients. Design Comparative study. Setting A 10-bed general intensive care unit. Patients Between 1 January 1992 and 31 May 1993, 61 patients prospectively identified with shock (n=14), severe, unexplained hypoxemia (Partial pressure of oxygen in arterial blood/fractional inspired oxygen 〈200) (n=31), or suspected endocarditis (n=16) underwent a TEE examination to supplement transthoracic echocardiography (TTE) examination. Interventions The results of each TEE examination were compared with the clinical findings and TTE data. TEE examinations were classified as follows: 0, TEE results were similar to TTE results; 00, TEE examination resulted in exclusion of suspected abnormalities; 1, TEE revealed a new but minor diagnosis compared to the TTE diagnosis; 2, TEE revealed a new major diagnosis not requiring a change of treatment; 3, TEE results revealed a new major diagnosis requiring an immediate change of treatment. Results Intraobserver reliability of the TEE classification was confirmed by a 100% concordance and interobserver reliability was evaluated as an 84% concordance. Results of the TEE classification were: class 0,n=21 (34%); class 00,n=13 (21%); class 1,n=7 (12%); class 2,n=8 (13%); class 3,n=12 (20%). Therapeutic implications of TEE in class 3 patients were cardiac surgery in 5 patients (2 cases of acute mitral regurgitation, 2 valvular abscesses, and 1 hematoma compressing the left atrium), discontinuation of positive end-expiratory pressure in 1 ventilated patient with an atrial septal defect, weaning off mechanical ventilation in 1 patient with an atrial septal defect, prescription of antimicrobial therapy in 3 patients with endocarditis, and prescription of anticoagulant therapy in 2 patients with left atrial thrombus. No difficulty inserting the transducer was observed in any of the 61 patients studied. The only noteworthy complication was a case of spontaneously resolving atrial fibrillation. Conclusion TEE is safe and well tolerated and is useful in the management of patients in the intensive care unit with shock, unexplained and severe hypoxemia, or suspected endocarditis when TTE is inconclusive.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/BF02044116

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7

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Diagnostic and therapeutic implications of transesophageal echocardiography in medical ICU patients with unexplained shock, hypoxemia, or suspected endocarditis (1996)

Slama, M. A. ; Novara, A. ; Putte, P. Van De ; [et al.]

Springer

Intensive care medicine 22 (1996), S. 916-922

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ISSN: 1432-1238

Keywords: Key words Transesophageal echocardiography ; Shock ; Endocarditis ; Hypoxemia ; Intensive care unit ; Critical care ; Echocardiography ; Transthoracic echocardiography ; Hemodynamics ; Ventricular function ; Therapy

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract Objective: to evaluate the diagnostic and therapeutic implications of transesophageal echocardiography (TEE) in intensive care patients. Design: Comparative study. Setting: A 10-bed general intensive care unit. Patients: Between 1 January 1992 and 31 May 1993, 61 patients prospectively identified with shock (n=14), severe, unexplained hypoxemia (Partial pressure of oxygen in arterial blood/fractional inspired oxygen〈200) (n=31), or suspected endocarditis (n=16) underwent a TEE examination to supplement transthoracic echocardiography (TTE) examination. Interventions: The results of each TEE examination were compared with the clinical findings and TTE data. TEE examinations were classified as follows: 0, TEE results were similar to TTE results; 00, TEE examination resulted in exclusion of suspected abnormalities; 1, TEE revealed a new but minor diagnosis compared to the TTE diagnosis; 2, TEE revealed a new major diagnosis not requiring a change of treatment; 3, TEE results revealed a new major diagnosis requiring an immediate change of treatment. Results: Intraobserver reliability of the TEE classification was confirmed by a 100% concordance and interobserver reliability was evaluated as an 84% concordance. Results of the TEE classification were: class 0, n=21 (34%); class 00, n=13 (21%); class 1, n=7 (12%); class 2, n=8 (13%); class 3, n=12 (20%). Therapeutic implications of TEE in class 3 patients were cardiac surgery in 5 patients (2 cases of acute mitral regurgitation, 2 valvular abscesses, and 1 hematoma compressing the left atrium), discontinuation of positive end-expiratory pressure in 1 ventilated patient with an atrial septal defect, weaning off mechanical ventilation in 1 patient with an atrial septal defect, prescription of antimicrobial therapy in 3 patients with endocarditis, and prescription of anticoagulant therapy in 2 patients with left atrial thrombus. No difficulty inserting the transducer was observed in any of the 61 patients studied. The only noteworthy complication was a case of spontaneously resolving atrial fibrillation. Conclusion: TEE is safe and well tolerated and is useful in the management of patients in the intensive care unit with shock, unexplained and severe hypoxemia, or suspected endocarditis when TTE is inconclusive.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/s001340050187

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8

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Diagnosis of nosocomial pneumonia in intensive care unit patients (1989)

Chastre, J. ; Fagon, J. -Y. ; Domart, Y. ; [et al.]

Springer

European journal of clinical microbiology & infectious diseases 8 (1989), S. 35-39

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ISSN: 1435-4373

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract The optimal technique for diagnosing nosocomial bacterial pneumonia in critically ill patients cared for in the intensive care unit remains unclear, especially in the subgroup of patients requiring mechanical ventilation. An important advance has been the development of the protected specimen brush technique. We and others have demonstrated that secretions obtained using this technique and evaluated by quantitative cultures are useful in distinguishing patients with and without pneumonia. However, this procedure has important limitations in that results are not available immediately and in that a few false negative or false positive results may be observed. Recently, the use of bronchoalveolar lavage has been suggested to be of value in establishing the diagnosis of pneumonia, since the cells and liquid recovered can be examined microscopically immediately after the procedure and are also suitable for quantitative culture. We believe that microscopic identification of bacteria within cells recovered by lavage may provide a sensitive and specific means for early and rapid diagnosis of pneumonia in this setting and that the lavage technique can be conveniently incorporated into a protocol along with the quantitative culture of samples obtained using the protected specimen brush. This combination will probably improve the overall accuracy of diagnosis while allowing the administration of prompt empiric antimicrobial therapy in the majority of patients with pneumonia.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/BF01964118

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