Norepinephrine kinetics and dynamics in septic shock and trauma patients.

Background: There is considerable variability in the inter-patient response to norepinephrine. Pharmacokinetic studies of dopamine infusion in volunteers and in patients have also shown large variability. The purpose of this study was to define the pharmacokinetics of norepinephrine in septic shock and trauma patients.

Recombinant activated factor VIIa and hemostasis in critical care: a focus on trauma.

In this article we describe the current use of recombinant activated factor VII (rFVIIa; NovoSeven) in trauma patients. Emphasis is placed on current uses as defined by key studies, efficacy data, and safety data. Most published studies in trauma patients are retrospective case studies and reports, although an international, double-blind, randomized, controlled, phase II study has been conducted that reported on the efficacy of rFVIIa in reducing the amount of blood products transfused in blunt trauma patients.

Endothelial oxidative stress induced by serum from patients with severe trauma hemorrhage.

Objective: Shock induces oxidative stress by ischemia-reperfusion phenomenon. Endothelial cells are involved in the inflammatory response and oxidative stress responsible for microcirculation impairment and organ failure. We examined the potential of serum from patients to induce in vitro reactive oxygen species production by cultured human umbilical vein endothelial cells (HUVECs).

[Pneumatic anti-shock garment use leading to non-visualization of pelvic arterial bleeding on angiography].

Initial reports of pneumatic anti-shock garment (PASG) in severely hypotensive patients appeared promising. Nevertheless, large-scale studies in prehospital settings have shown no overall reduction in mortality rates among hypotensive patients with application of the PASG. However, in a subsample of patients with blood pressure < or =50 mmHg, PASG seems to be useful to reduce bleeding and improve survival.

[Lung separation after reintubation with airway exchange catheter in multiple trauma patient with massive haemoptysis].

A 24-year-old man fell from the third floor. He developed an unilateral pulmonary parenchymal injury and a significant haemoptysis following blunt thoracic trauma. Because of its abundance, it was not possible to obtain adequat oxygenation.

Reoxygenation after hypoxia and glucose depletion causes reactive oxygen species production by mitochondria in HUVEC.

In hemorrhagic shock, local hypoxia is present and followed by reoxygenation during the therapeutic process. In endothelium, reactive oxygen species (ROS) have been identified as a cause of inflammatory reactions and tissular lesions in ischemic territory during reoxygenation. This study was designed to identify the enzymatic mechanisms of ROS formation during reoxygenation after hypoxia.

Decrease in left ventricular ejection time on digital arterial waveform during simulated hypovolemia in normal humans.

Background: Left ventricular ejection time (LVET) measured in central arteries is modified during hypovolemia. We compared modifications of the pulse wave in a central artery (carotid) and in a peripheral artery (digital) during central hypovolemia induced by lower body negative pressure (LBNP) in conscious volunteers.

Methods: Hypovolemia was simulated with progressive LBNP (baseline, -10, -20, and -30 mm Hg) in nine young healthy volunteers.

[Prospective study of harvest-to-transplant time: proposed organization].

Introduction: The cold ischaemia time of a kidney before transplantation has a negative impact on the risk of acute tubular necrosis and graft survival. This cold ischaemia time can be reduced by a different organization of harvesting, organ distribution and transplantation.

Material And Methods: Seventy nine organ donor case files from the same hospital were reviewed from reception of the donor until transplantation.

Propofol and remifentanil for intubation without muscle relaxant: the effect of the order of injection.

Background: Common practice in intubation without muscle relaxant is to inject the opioid drug prior to the hypnotic drug. Because remifentanil reaches adequate cerebral concentration more rapidly than does propofol, we tested the hypothesis that injection of remifentanil after propofol might lead to better intubating conditions.

Methods: Thirty ASA I-II patients scheduled for elective surgery and with no anticipated difficult intubation were enrolled in the study.

Long-term results of renal transplantation using kidneys harvested from non-heartbeating donors: a 15-year experience.

Purpose: To expand the pool of suitable organ donors we developed an organ procurement program of non-heartbeating donors during the last 15 years. We compare graft survival in patients receiving renal transplants procured from non-heartbeating with recipients of kidneys from heartbeating donors.

Materials And Methods: From 1986 to 1999, 60 renal transplantations were performed with kidneys harvested from non-heartbeating donors (Mastrich category IV).

[What are the arguments in favour of local allocation of kidneys harvested for transplantation?].

Unlabelled: The rules of organ allocation allow one of the two kidneys harvested to be transplanted locally while the other is exchanged. This rule of local priority does not exist in all countries. The purpose of this article is to determine whether this rule provides a benefit for the patient.

Dobutamine and gastric-to-arterial carbon dioxide gap in severe sepsis without shock.

Objectives: To evaluate the effect of an early dobutamine infusion on gastrointestinal perfusion in patients with severe sepsis.

Design: Prospective, randomized, controlled, multicenter clinical study.

Setting: Six medical and/or surgical intensive care units (ICU) of teaching hospitals.

Microcirculation in intestinal villi: a comparison between hemorrhagic and endotoxin shock.

Using intravital microscopy, we studied the effects of hemorrhagic and endotoxin (ETX) shock on the velocity of erythrocytes (red blood cells [RBC]) and the density of perfused villi in mouse small intestine. The mice were divided into four groups: control, normotensive sepsis (a low ETX group, 1.5 mg/kg intravenously), hypotensive sepsis (a high ETX group, 10 mg/kg intravenously), and a hemorrhagic group.

Effects of tidal volume reduction in acute respiratory distress syndrome on gastric mucosal perfusion.

Objective: This study was conducted with the aim of testing the effects of a reduction in tidal volume (V(T)) on gastric mucosal perfusion using laser-Doppler flowmetry in patients with acute respiratory distress syndrome (ARDS).

Design: It was designed as a prospective study.

Patients: Seventeen patients with ARDS were enrolled in the study.

Rapid reactive oxygen species production by mitochondria in endothelial cells exposed to tumor necrosis factor-alpha is mediated by ceramide.

Tumor necrosis factor (TNF)-alpha increases mitochondrial reactive oxygen species (ROS) production in tumor cells and hepatocytes. However, whether TNF-alpha stimulates mitochondrial ROS production in endothelial cells (EC) has not yet been reported. We studied the effect of TNF-alpha on mitochondrial ROS generation in EC and the signaling pathways involved.

[Coagulation abnormalities after total hip prosthesis (THP), a rare cause: antibiotic prophylaxis].

A 87-year-old patient developed coagulation abnormality following hip surgery related to the prophylactic use of cefamandole. Cefamandole as others cephalosporins with a methyl-tetrazol-thiol lateral chain interferes with the vitamin K regeneration cycle as do oral anticoagulants. Therefore, the use of others antibiotics or systematic vitamin K1 supplementation or single dose of cefamandole is recommended for patients with renal failure or with malnutrition.

[Impact of an information booklet on patient satisfaction in anesthesia].

Objective: The aim of this study was to evaluate the satisfaction of adult surgical patients before and after an information booklet concerning anaesthetic techniques and complications, and postoperative management has been proposed during preanaesthetic visits.

Study Design: Survey.

Method: Three surveys have been performed using an anonymous questionnaire of 25 items with graduated answers (very good, good, bad, very bad, no opinion) concerning patient satisfaction on structure, physician behavior, information and well being.

Effects of epinephrine, norepinephrine, or the combination of norepinephrine and dobutamine on gastric mucosa in septic shock.

Objectives: To compare in the same patient with septic shock, respective effects of epinephrine, norepinephrine, and the combination of norepinephrine and dobutamine (5 microg/kg/min) on systemic hemodynamic parameters and gastric mucosal perfusion using gastric tonometry and laser-Doppler flowmetry techniques.

Design: Prospective, controlled, randomized, crossover study.

Setting: University hospital intensive care unit.

Intracellular signaling by reactive oxygen species during hypoxia in cardiomyocytes.

Cardiomyocytes suppress contraction and O2 consumption during hypoxia. Cytochrome oxidase undergoes a decrease in Vmax during hypoxia, which could alter mitochondrial redox and increase generation of reactive oxygen species (ROS). We therefore tested whether ROS generated by mitochondria act as second messengers in the signaling pathway linking the detection of O2 with the functional response.

Cardiac output during liver transplantation.

Purpose: Measurement of cardiac output is an essential part of anaesthetic practice in patients undergoing major operative procedures. A thermodilution technique, using a pulmonary artery catheter is currently accepted as the gold standard in clinical practice. However its use is associated with several limitations.

Gastric mucosal oxygen delivery decreases during cardiopulmonary bypass despite constant systemic oxygen delivery.

Unlabelled: Previous studies report a decrease in gastric mucosal oxygen delivery during cardiopulmonary bypass (CPB). However, in these studies, CPB was associated with a reduction in systemic oxygen delivery (DO2). Conceivably, this decrease in DO2 could have contributed to the observed decrease in gastric mucosal oxygen delivery.