Early veno-venous haemodiafiltration for sepsis-related multiple organ failure.

Introduction: We conducted a prospective observational study from January 1995 to December 2004 to evaluate the impact on recovery of a major advance in renal replacement therapy, namely continuous veno-venous haemodiafiltration (CVVHDF), in patients with refractory septic shock.

Method: CVVHDF was implemented after 6-12 hours of maximal haemodynamic support, and base excess monitoring was used to evaluate the improvement achieved. Of the 60 patients studied, 40 had improved metabolic acidosis after 12 hours of CVVHDF, with a progressive improvement in all failing organs; the final mortality rate in this subgroup was 30%.

Pulmonary artery interventions: an overview.

Interventional radiologists should be familiar with minimally invasive procedures used to treat various abnormalities of the pulmonary arteries. These well-established techniques, which obviate open surgery, are safe and effective when performed by an experienced interventionalist. Catheter-based thrombolysis with intrapulmonary arterial infusion of thrombolytic drugs, percutaneous thrombectomy, or embolus fragmentation can be performed in patients with life-threatening pulmonary embolism.

Recurrent pulmonary embolism with non-mobile thrombus in a patient with leiomyosarcoma of the left renal vein.

We describe the case of a man who suffered recurrent pulmonary embolisms despite well-conducted oral anticoagulant therapy. Echocardiography and helical computed tomography revealed a non-mobile right atrial mass related to a leiomyosarcoma of the left renal vein. The prognosis of such a disease is bad and the patient died at 1-year follow-up.

Incidence, causes and prognosis of hypotension related to meprobamate poisoning.

Objective: Meprobamate self-poisoning has been reported as potentially inducing hypotension. We examined the incidence and causes of hypotension induced by this poisoning and its prognosis.

Design And Setting: Retrospective observational study conducted in a medical ICU between June 1997 and October 2003.

Monitoring of right-sided heart function.

Purpose Of Review: Because the right side of the heart supplies blood to the pulmonary circulation, its integrity is required for both adequate respiratory and circulatory function. By reducing pulmonary perfusion, right-sided heart failure may compromise arterial oxygenation and left ventricular filling, and monitoring of right-sided heart function at the bedside in critically ill patients is fundamental. Two recent clinical commentaries have focused on the invaluable help provided by echocardiography for this purpose.

Diagnosis of right ventricular dysfunction in acute pulmonary embolism using helical computed tomography.

Forty-six consecutive patients with pulmonary embolism (PE) who underwent pulmonary angiography, helical computed tomography (CT), and echocardiography in the investigators' emergency department were studied. It was determined that the CT right ventricular (RV)/left ventricular (LV) end-diastolic area ratio was correlated with PE obstruction and echocardiography. A CT RV/LV area ratio >1 had a sensitivity of 88% and a specificity of 88% in diagnosing significant PE.

Prone position improves mechanics and alveolar ventilation in acute respiratory distress syndrome.

Objective: We tested the hypothesis that ventilation in the prone position might improve homogenization of tidal ventilation by reducing time-constant inequalities, and thus improving alveolar ventilation. We have recently reported in ARDS patients that these inequalities are responsible for the presence of a "slow compartment," excluded from tidal ventilation at supportive respiratory rate.

Design: In 11 ARDS patients treated by ventilation in the prone position because of a major oxygenation impairment (PaO(2)/FIO(2) View Article and Find Full Text PDF

Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients.

Objective: In mechanically ventilated patients inspiratory increase in pleural pressure during lung inflation may produce complete or partial collapse of the superior vena cava. Occurrence of this collapse suggests that at this time external pressure exerted by the thoracic cavity on the superior vena cava is greater than the venous pressure required to maintain the vessel fully open. We tested the hypothesis that measurement of superior vena caval collapsibility would reveal the need for volume expansion in a given septic patient.

[Negative D-dimers and peripheral pulmonary embolism].

The measurement of D-dimers is a recent addition to the diagnostic strategy of pulmonary embolism and has been shown to be a valuable tool with excellent sensitivity. However, there have been rare reports of patients with pulmonary embolism but negative D-dimer tests. The object of this study was to study patients with pulmonary embolism but negative D-dimers and to compare them with a population of patients with pulmonary embolism and raised D-dimers.

Use of transthoracic echocardiography combined with venous ultrasonography in patients with pulmonary embolism.

Background: The diagnosis of pulmonary embolism (PE) remains difficult. Ultrasounds allow for the exploration of the venous system to great extent and for the detection of indirect signs of PE. The aim of this study was to determine the incidence of acute cor pulmonale (ACP) and deep venous thrombosis (DVT) found by ultrasonographic techniques in a population of patients with PE.

Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients.

Objective: To evaluate the extent to which respiratory changes in inferior vena cava (IVC) diameter can be used to predict fluid responsiveness.

Design: Prospective clinical study.

Setting: Hospital intensive care unit.

[Treatment of severe sepsis and septic shock].

The 3 poles of treatment. These are the hemodynamic management, early antibiotherapy and more specific treatments, based on improved physiopathological knowledge. From a hemodynamic point of view The first stage must always be to detect and correct the hypovolemia.

[Diagnosis of sepsis, severe sepsis and septic shock].

Consensual and precise definitions. Sepsis is composed of a suspected or documented infection associated with at least 2 SIRS criteria (systemic inflammatory response syndrome). Severe sepsis is sepsis with arterial hypotension and failure of one or several organs following the reduction in tIssue perfusion.

The issue of dynamic hyperinflation in acute respiratory distress syndrome patients.

Dynamic hyperinflation is produced by a diffuse expiratory flow limitation impairing exhalation under mechanical ventilation. It constitutes a serious clinical problem in patients exhibiting bronchial asthma or chronic obstructive pulmonary disease, when mechanical ventilation is required. But this phenomenon may also complicate respiratory support in acute respiratory distress syndrome (ARDS) patients.

Early patterns of static pressure-volume loops in ARDS and their relations with PEEP-induced recruitment.

Objective: Evaluation of low-flow pressure-volume loop at the bedside in ARDS, as an aid to assess recruitment produced by PEEP.

Materials And Methods: Low-flow pressure-volume loop at the bedside were obtained on the first day of respiratory support in 54 successive pulmonary ARDS patients (49 of whom had pneumonia) treated between April 1999 and June 2002. From the loop obtained at ZEEP, we determined manually the lower inflexion point (LIP).

Cyclic changes in arterial pulse during respiratory support revisited by Doppler echocardiography.

It has long been known that there are cyclic changes in arterial pressure during mechanical ventilation. They are caused by cyclic changes in both the right and left ventricular stroke output, occurring in opposite phases. As a result, arterial pulse pressure is increased during inspiration and decreased during expiration.

Inhibition of matrix metalloproteinases by lung TIMP-1 gene transfer limits monocrotaline-induced pulmonary vascular remodeling in rats.

Extracellular matrix dysregulation is key to the development of pulmonary hypertension (PH), suggesting a pivotal role for the proteases that control matrix remodeling. Both hypoxia- and monocrotaline-induced PH are associated with increased protease activity in the distal and proximal pulmonary arteries. However, the role of proteases is not completely understood.