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  • 1
    Electronic Resource
    Electronic Resource
    Intensive care use in a developing country: a comparison between a Tunisian and a French unit (1998)
    Springer
    Intensive care medicine 24 (1998), S. 1144-1151 
    Details
    ISSN: 1432-1238
    Keywords: Key words Simplified Acute Physiology Score ; Omega system ; Severity of illness index ; Workload ; Outcome assessment ; Intensive care unit comparison ; Cost-effectiveness analysis ; Evaluation studies ; Organization ; Quality of care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To compare the variations in intensive care (ICU) outcome in relation to variations in resources utilization and costs between a developed and a developing country with different medical and economical conditions. Design and setting: Prospective comparison between a 26-bed French ICU and an 8-bed Tunisian ICU, both in university hospitals. Patients: Four hundred thirty and 534 consecutive admissions, respectively, in the French and Tunisian ICUs. Measurements: We prospectively recorded demographic, physiologic, and treatment information for all patients, and collected data on the two ICU structures and facilities. Costs and ICU outcome were compared in the overall population, in three groups of severity indexes and among selected diagnostic groups. Results: Tunisian patients were significantly younger, were in better health previously and were less severely ill at ICU admission (p 〈 0.01). French patients had a lower overall mortality rate (17.2 vs 22.5 %; p 〈 0.01) and received more treatment (p 〈 0.01). In the low severity range, the outcome and costs were similar in the two countries. In the highest severity range, Tunisian and French patients had similar mortality rates, while the former received less therapy throughout their ICU stays (p 〈 0.05). Conversely, in the mid-range of severity, mortality was higher among Tunisian patients, and a difference in management was identified in COPD patients. Conclusion: Although the Tunisian ICU might appear more cost-effective than the French one in the highest severity group of patients, most of this difference appeared in relation to shorter lengths of ICU stay, and a poorer efficiency and cost-effectiveness was suggested in the mid-range severity group. Differences in economical constraints may partly explain differences in ICU performances. These results indicate where resource allocation could be directed to improve the efficiency of ICU care.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050737
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  • 2
    Electronic Resource
    Electronic Resource
    Patients' preferences concerning medical information and surrogacy: results of a prospective study in a French emergency department (2000)
    Springer
    Intensive care medicine 26 (2000), S. 52-56 
    Details
    ISSN: 1432-1238
    Keywords: Key words Ethics ; Surrogacy ; Medical information ; Emergencies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To study the wishes of a sample of French patients about medical information and surrogacy, at a time when the French Ministry of Health is supporting increased patient autonomy.¶Design: A cohort of competent patients with non-critical illnesses or injuries completed an intention-to-act questionnaire on the amount of medical information they would want to receive should they be hospitalized or in a life-threatening situation. The percentage of patients who would want to have a surrogate if they were in a coma was determined, as well as the identity of the preferred surrogate. The subgroup of patients who were married or living with a partner was evaluated separately to determine how often the spouse/partner was the preferred surrogate. Associations were looked for between patients' wishes and age, sex, educational level, occupation, hierarchical order in the family, and level of confidence in medicine.¶Setting: The emergency room of a teaching hospital in the Paris area (France).¶Results: Of the 1089 patients included in the study, 5.5 % reported that they would not want any information, 25.3 % that they would want to participate actively in all decisions about their care, and 87.3 % that they would want to be fully informed if they were in a life-threatening situation. Slightly less than one-third of the patients (29.6 %) believed they would not want a surrogate if they developed a coma. Among the patients living with a spouse/partner, 40.6 % (229/561) indicated they would want their spouse/partner to be their surrogate. A significant correlation was observed between wanting more information and wanting a surrogate. Younger patients with a higher educational level were significantly more likely to predict a desire for information and for a surrogate than the other patients.¶Conclusion: Our patients expressed a strong desire to receive extensive information should they become seriously ill, and two-thirds of them reported they would want a surrogate. However, only 40.6 % of the patients living with a spouse/partner would want their spouse/partner to be their surrogate. These data suggest that the time has probably come to propose a nation-wide public hearing on medical information and surrogacy in France.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050011
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  • 3
    Electronic Resource
    Electronic Resource
    Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients (1999)
    Springer
    Intensive care medicine 25 (1999), S. 920-929 
    Details
    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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  • 4
    Electronic Resource
    Electronic Resource
    Incidence of ARDS (2000)
    Springer
    Intensive care medicine 26 (2000), S. 816-817 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051254
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  • 5
    Electronic Resource
    Electronic Resource
    Authors' reply (2000)
    Springer
    Intensive care medicine 26 (2000), S. 1020-1020 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051311
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  • 6
    Electronic Resource
    Electronic Resource
    Clinical evaluation of a continuous intra-arterial blood gas system in critically ill patients (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1162-1168 
    Details
    ISSN: 1432-1238
    Keywords: Blood gas monitor ; Critical care ; Equipment ; Acute respiratory distress syndrome ; Hypotension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate the clinical performance of a new, continuous intra-arterial blood gas monitoring system (CIABG) in abnormal ranges of blood gases, and during episodes of low blood pressure, in critically ill patients. Design Prospective study. Settings Medical ICU, University Hospital. Methods The CIABG system, based on fluorescent dyes, consists of a fiber-optic sensor introduced through an arterial catheter. Twenty-one sensors were evaluated in 15 acutely ill patients. A high failure rate (6/21) was found, due to the brittleness of the fibers. The bias, between CIABG and standard method, and precision were determined for each fiber and for the overall values. Analysis focused on the data collected in patients with arterial oxygen tension (PaO2) values below 75 mmHg, pH lower than 7.35 and arterial carbon dioxide partial pressure (PaCO2) values exceeding 50 mmHg and during episodes of low blood pressure. The accuracy of the CIABG to follow sequential changes in blood gases was studied among the abnormal values. Results Measurements with CIABG among the abnormal values showed biases of +2 mmHg, +0.1 mmHg and +0.005 for PaO2, PaCO2 and pH, respectively, and precisions of 9.0 mmHg, 3.5 mmHg and 0.027, respectively. Bias and precision were not influenced by hemodynamic instability. A substantial difference in the performance of individual CIABG was observed for PaO2 analysis, with 30% of the fibers having a much poorer performance than the others. The sensors were kept in place for 5±2 days and the drift rate per day was 0.005 for pH, 0.6 mmHg for PaCO2 and −1.2 mmHg for PaO2. Conclusion In situations of severe hypoxemia, hypercapnia and acidosis, the agreement between CIABG and arterial blood sampling (ABS) is better for PaCO2 and pH than for PaO2, and is not influenced by episodes of low blood pressure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709330
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  • 7
    Electronic Resource
    Electronic Resource
    Clinical evaluation of a continuous intra-arterial blood gas system in critically ill patients (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1162-1168 
    Details
    ISSN: 1432-1238
    Keywords: Key words Blood gas monitor ; Critical care ; Equipment ; Acute respiratory distress syndrome ; Hypotension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate the clinical performance of a new, continuous intra-arterial blood gas monitoring system (CIABG) in abnormal ranges of blood gases, and during episodes of low blood pressure, in critically ill patients. Design: Prospective study. Settings: Medical ICU, University Hospital. Methods: The CIABG system, based on fluorescent dyes, consists of a fiber-optic sensor introduced through an arterial catheter. Twenty-one sensors were evaluated in 15 acutely ill patients. A high failure rate (6/21) was found, due to the brittleness of the fibers. The bias, between CIABG and standard method, and precision were determined for each fiber and for the overall values. Analysis focused on the data collected in patients with arterial oxygen tension (PaO2) values below 75 mmHg, pH lower than 7.35 and arterial carbon dioxide partial pressure (PaCO2) values exceeding 50 mmHg and during episodes of low blood pressure. The accuracy of the CIABG to follow sequential changes in blood gases was studied among the abnormal values. Results: Measurements with CIABG among the abnormal values showed biases of +2 mmHg, +0.1 mmHg and +0.005 for PaO2, PaCO2 and pH, respectively, and precisions of 9.0 mmHg, 3.5 mmHg and 0.027, respectively. Bias and precision were not influenced by hemodynamic instability. A substantial difference in the performance of individual CIABG was observed for PaO2 analysis, with 30% of the fibers having a much poorer performance than the others. The sensors were kept in place for 5±2 days and the drift rate per day was 0.005 for pH, 0.6 mmHg for PaCO2 and –1.2 mmHg for PaO2. Conclusion: In situations of severe hypoxemia, hypercapnia and acidosis, the agreement between CIABG and arterial blood sampling (ABS) is better for PaCO2 and pH than for PaO2, and is not influenced by episodes of low blood pressure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709330
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  • 8
    Electronic Resource
    Electronic Resource
    Effects of ventilation in ventral decubitus position on respiratory mechanics in adult respiratory distress syndrome (1997)
    Springer
    Intensive care medicine 23 (1997), S. 1219-1224 
    Details
    ISSN: 1432-1238
    Keywords: Key words Acute respiratory failure ; Gas exchange ; Mechanics ; Body position ; Compliance of respiratory system ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To assess the potential benefits of a period of ventilation in ventral decubitus (VD) on oxygenation and respiratory mechanics in the adult respiratory distress syndrome (ARDS). Design: In a stable condition during baseline ventilation in dorsal decubitus (DD), after 15 min of ventilation in VD and after 10 min of restored DD, the following parameters were studied: arterial blood gas tension, haemodynamics and static respiratory compliance (Crs), evaluated with the rapid airway occlusion technique. Setting: The study was completed in the intensive care units of university hospitals as part of the management of the patients studied. Patients: Twelve patients (7 males, 5 females, mean age 51.8 ± 16.6 years) suffering from ARDS of different aetiologies. Interventions: Before and during each evaluation, the patients were kept under stable haemodynamic and metabolic conditions. The ventilatory setting was kept constant. All the patients were sedated, paralysed and mechanically ventilated. Results: A statistically significant increase in the ratio between the arterial partial pressure of oxygen and fractional inspired oxygen (p 〈 0.01) was observed between the baseline conditions (mean 123.9 ± 22.6) and VD (mean 153.0 ± 16.9), while no statistical significance was noted between baseline conditions and after 10 min of restored DD (mean 141.1 ± 19.7). A significant increase in Crs (p 〈 0.001) was observed between baseline conditions (mean 42 ± 10.1) and VD (mean 48.8 ± 9.6) and between baseline conditions and restored DD (mean 44.7 ± 10.6). Two patients were considered non-responders. All the patients were haemodynamically stable. No side effects were noted. Conclusions: We observed an increase in oxygenation and Crs when the patients were turned from the supine to the prone position with the upper thorax and pelvis supported.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050489
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  • 9
    Electronic Resource
    Electronic Resource
    Intrapleural administration of streptokinase in complicated purulent pleural effusion: a CT-guided strategy (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1351-1353 
    Details
    ISSN: 1432-1238
    Keywords: Key words Empyema ; Pleural ; Computed tomography scan ; Fibrinolytics ; Streptokinase
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To determine the usefulness and the results of a strategy using intrapleural streptokinase (SK) instillation guided by repeated computed tomography (CT) scan examinations in pleural empyemas unresponsive to chest tube drainage. Design: A retrospective chart review. Setting: The medical Intensive Care Unit and Department of Radiology, in a university hospital. Patients: Sixteen patients with empyema who had a persistent pleural effusion despite drainage, among 37 patients with infectious pleural effusion. Interventions: In the 16 patients, CT examination was performed before and at least once after SK. Intrapleural SK was instilled, either through the chest tube or via a needle puncture, according to the CT scan results. Results: The first CT scan confirmed a persistent effusion in all, showing a multiloculated effusion in 13 patients, and an ectopic loculus in one. The first SK instillation resulted in a dramatic increase of fluid drained per day (from 68±28 ml to 567±262 ml; p〈0.001), leading to complete resolution in 11 patients, while the others required a second CT scan-guided procedure. In one, the chest tube was misplaced, while in two, transparietal injection was needed. Finally, a complete resolution was observed in 14 (87.5%) of the patients. Two patients had a poor initial response to SK and were eventually scheduled for video-thoracoscopy. A single episode of chills and fever was observed among 32 SK instillations. Conclusion: CT-guided SK instillation in pleural empyema appears to be safe, and allowed complete resolution in 87.5% of our patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709550
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  • 10
    Electronic Resource
    Electronic Resource
    Additive effect on gas exchange of inhaled nitric oxide and intravenous almitrine bismesylate in the adult respiratory distress syndrome (1994)
    Springer
    Intensive care medicine 20 (1994), S. 254-259 
    Details
    ISSN: 1432-1238
    Keywords: Inhaled nitric oxide ; Almitrine bismesylate ; Adult respiratory distress syndrome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To assess the additive effect of inhaled nitric oxide (NO) and intravenous almitrine bismesylate (ALM) on gas exchange. Design Prospective self-controlled study. Setting 3 medico-surgical intensive care units. Patients 17 patients with severe hypoxemia (PaO2/FIO2 ratio: 88±30mmHg, venous admixture: 47±7%) and elevated mean pulmonary artery pressure (MPAP: 30±5mmHg) due to adult respiratory distress syndrome (ARDS). Interventions 5 conditions were studied: 1) baseline, 2) 5 to 10ppm of NO during 30min, 3) discontinuation of NO during 30min, 4) ALM infusion (0.5mg/kg) during 30min, 5) ALM infusion (0.5mg/kg) during 30min in combination with 5 to 10ppm of NO. Measurement and results The PaO2/FIO2 ratio rose from 88±30 to 98±37mmHg (NS) with NO alone, and from 92±25 to 130±56mmHg (p〈0.01) with NO+ALM (p〈0.05 vs NO alone). Seven patients were considered as “NO-responders” (rise in PaO2/FIO2 ratio of 10mmHg or more with NO); in this subgroup the PaO2/FIO2 ratio rose from 87±30 to 128±39mmHg (p〈0.05) with NO alone, and from 93±20 to 169±51mmHg (p〈0.01) with NO+ALM (p〈0.05 versus NO alone). MPAP decreased from 30±5 to 26±5mmHg (p〈0.01) with NO alone, increased slightly from 28±5 to 31±5mmHg (NS) with ALM alone and decreased to 27±5mmHg (p〈0.05) with NO+ALM. Conclusions NO+ALM had additive effects on gas exchange while decreasing MPAP in patients with ARDS. The effects of NO alone were small and non significant, except in a subgroup of 7 patients in whom the combination of both therapies had the more pronounced results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01708960
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