[Pulmonary fibrosis during treatment involving amiodarone].
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Biomedical subjects
Publications and source records attributed to B Palmier.
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Fifteen patients with adult respiratory distress syndrome (ARDS) were studied: 11 in the early stage of ARDS (group 1); 4 in the late stage (group 2). The inspiratory and expiratory static pressure-volume (P-V) curves of the respiratory system were compared to the pulmonary shunt (Qsp/Qt) when PEEP was increased; cardiac output was kept constant. In group 1 patients, we found that a concavity on the P-V curves was associated with an abrupt decrease in Qsp/Qt when PEEP was increased; the concavity on the expiratory curve was correlated with the change in Qsp/Qt but not the concavity on the inspiratory curve. In group 2 patients, the P-V curves were found rectilinear and Qsp/Qt was not abruptly decreased when PEEP was increased. Expiratory P-V curve can be used to determine: first, whether a patient should be ventilated with PEEP; second, the PEEP level which can be set on the respirator. In group 1 patients, when PEEP was set to a value corresponding to the inflexion point, i.e., the point of departure from the exponential shape (mean value 14.6 +/- 2.8 cm H2O), Qsp/Qt compared to zero PEEP was abruptly decreased to 87.6 +/- 6%; further increase in PEEP had little advantage.
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Among the 94 tricyclic antidepressant intoxications received in 3 years in the intensive care unit of Edouard Herriot Hospital, 16 with cardio-vascular manifestations are studied. The criteria of selection is the presence on the electrocardiogram (ECG) of a ventricular trouble in conduction excitability or automaticity. Eight times, the ingested dose exceeds 20 mg/kg. 10 times several toxics are taken explaining the severity of coma and the rarity of convulsions. 2 collapses, 1 shock, 1 cardiac arrest occur. The most frequent ECG abnormalities are: T modifications, (90 p. 100), prolongation of QT interval (60 p. 100), right bundle branch block (50 p. 100) or left one (25 p. 100). Only one death occurs; (1 p. 100 of this series). Ventricular dysrythmia or myocardial failure represent the main criteria in the evaluation of severity of the tricyclic antidepressant intoxication. For the treatment, a complete digestive evacuation is needed, Hemodialysis, plasmapheresis, or hemoperfusion cannot be actually recommended. The treatment of cardiac troubles involves essentially sodium. and eventually intra-cardiac pace maker.