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Biomedical subjects

B Regnier

Publications and source records attributed to B Regnier.

At least 91 records · Page 5Linked to original sources
PubMed1980

The role of iatrogenic disease in admissions to intensive care.

We prospectively studied all patients admitted to a multidisciplinary intensive care unit to determine how many of their diseases were iatrogenic and, of these, what number were potentially avoidable. Of 325 patients admitted in the course of one year, 41 (12.6%) were hospitalized because of iatrogenic disease. Many of these patients had concomitant serious illnesses. Nevertheless, 19 patients (46.3%) were admitted with iatrogenic disease resulting from therapeutic or technical errors that were potentially avoidable. Iatrogenic disease was fatal in eight cases, life-threatening in 13, moderate in 20.

Adolescent↗
PubMed1980

[Acute haemorrhagic pancreatitis. Criteria of letality (author's transl)].

A retrospective study of severity symptoms in a series of 102 patients operated upon for acute haemorrhagic pancreatitis showed that the risk of death was much significantly higher when shock (p less than 0,00001) and renal failure (p less than 0,0001) were present. The association, during the post-operative period, of shock and renal failure with one of the following symptoms: digestive haemorrhage, psychic disorders, pulmonary oedema, post-operative peritonitis and evisceration invariably proved fatal. It is suggested that controlled therapeutic trials should be carried out in patients presenting with these complications.

Acute Disease↗
PubMed1980

[Artificial enteral nutrition. Overview of the technics and their applications].

In intensive care it is usual to give from between 3000 and 4500 calories. It seems that an intake of 1 gram of nitrogen for 150 to 200 calories from a non-protein source allows the optimal utilization of nitrogen. The advances made in the manufacture of nutritional mixtures and the techniques of administration often allow high calorie/protein intakes by the oral route alone. Small calibre silicone tubes which are perfectly tolerated are now available. They avoid naso-pharyngeal, oesophageal and pulmonary complications, and there is no reflux. Continuous oral feeding usually given by a pump improves gastric tolerance, reduces the digestive secretions, and slows down the intestinal transit. Digestion and absorption are improved. This technique, as well as the new tubes, allows comatose patients to be fed without any risk. The use of refrigerated nutripompes avoids bacterial proliferation in the nutritional liquid, which can affect digestion. Furthermore these pumps reduce the work of the nurse. Various nutritional mixtures allow a high calorie intake despite the abnormal digestion in the patient. Complications of oral feeding are rare. Reactions of intolerance and the respiratory risks have been considerably reduced. Metabolic disorders can be easily avoided. Diarrhoea is the result either of bacterial proliferation or an error in administration. These complications are definitely less frequent and less serious than those of feeding by the intravenous route, and the precautions to be taken are much simpler. The method is also cheaper.

Avitaminosis↗
PubMed1979

[Acute renal failure due to non traumatic rhabdomyolysis. 11 cases (author's transl)].

Previous nuclear disease was found twice: Mc Ardle disease, dermatomyositis. Causative factors were: strenous exercise, hyperthermia, intoxication, influenza. Myalgias and/or myoedema was recorded in ten cases, associated with an hypovolemia of variable severity in eight. Oligo-anuria was observed in eight cases. The acute renal failure (ARF) was characterized by an increase in the serum creatinin more important than the rise in the blood urea and, in some cases, severe metabolic disturbances: hyperkaliema (6 cases), hypocalcemia (5 cases), hyperphosphatemia (5 cases) and hyperuricemia (5 cases). Diagnosis was made by the increase in sera of the muscles enzymes, specially the CPK and the search for myoglobinuria, positive during the first seven days. A complete recovery of renal function was observed in the nine survivors with a transient and moderate hypercalcemia in three. Three patients had persistant neuro-muscular deficiencies. Non traumatic rhabdomyolysis is not a rare cause of ARF and should be considered when the etiology of ARF is uncertain.

Acute Kidney Injury↗
PubMed1979

Comparative haemodynamic effects of dopamine and dobutamine in septic shock.

Septic shock associated with depressed myocardial function generally requires the use of catecholamine. Currently dopamine is often selected. Dobutamine is a newly developed catecholamine which has been shown to be of value in severe cardiomyopathic disease. The aim of this work was to determine the most appropriate drug by comparing haemodynamic responses to dopamine and dobutamine in 19 studies carried out in 11 patients with septic shock and heart failure. Cardiac index increased siliarly with dopamine and dobutamine (33%), as did stroke volume (respectively 26.4 and 25%). Arterial pressure increased by 17% with dopamine whereas it did not significantly change with dobutamine due to reduction in vascular resistance of 19%. Dobutamine decreased filling pressure, either right (14%) of left (28%) whilst they slightly but unsignificantly increased with dopamine. Pulmonary shunting increased more with dopamine (47%) than with dobutamine (16%), but PaO2 remained constant with both. Since septic shock is characterized by lowered arterial pressure and vasodilatation it is concluded that effects of dopamine on capacitance and resistance vessels make this drug more suitable. In addition it selectively increases renal blood flow. Nevertheless dobutamine could be appropriate, in case of very high filling pressures, severe peripheral vasoconstriction, marked pulmonary shunting and in some cases where dopamine becomes ineffective.

Catecholamines↗
PubMed1979

Hyperkinetic shock in viral and pneumococcal pneumonias.

Ten patients, suffering from severe viral or bacterial pneumonia had circulatory shock, characterised haemodynamically by normal or high cardiac output (CI = 4.1 +/- 1.2 1/min/m2) and low systemic resistance (SVR = 14 +/- 3.7 mm Hg/1/min/m2). Existence of such a hyperkinetic state greatly complicates the management of patients. Plasma volume expansion, performed in five cases of initial hypovolaemia, and Dopamine infusion (five patients) increased markedly the intra-pulmonary shunting. High level PEEP ventilation was not tolerated, despite the improvement of blood gases it produced. Extra-corporeal membrane lung oxygenation (three cases), whilst giving an initial decrease of shunting and restoring SVR, produced no long term surviors. All ten patients died from intractable shock and severe hypoxaemia. Spontaneous ventilation with positive expiratory pressure (CPAP) is believed to be an attractive alternative, due to its absence of deleterious haemodynamic effects.

Adult↗
PubMed1978

Hemodynamic effects of dopamine in septic shock with and without acute renal failure.

Hemodynamic response to dopamine hydrochloride in septic shock with myocardial dysfunction was studied in ten patients with normal renal function (group 1) and in ten patients with acute renal failure (group 2). The control hemodynamic data were similar in the two groups. Dopamine in groups 1 and 2 induced significant (P less than .01) and similar increases in cardiac index and mean aortic pressure. Group 1 had a smaller increase in heart rate (+ 16%), than group 2 (+ 24%), but this difference was not significant. Stroke volume index had a significant increase in group 1 (+ 18%), whereas it did not increase significantly in group 2 (+ 4%); this difference of changes in stroke volume index between the two groups was significant (P less than .01). This phenomenon suggests an increased chronotropic effect and/or a reduced inotropic effect of dopamine in patients with septic shock and acute renal failure.

Acute Kidney Injury↗
PubMed1978

Haemodynamic study of patients with severe sepsis during haemodialysis.

A study was performed in order to observe haemodynamic changes induced by haemodialysis in 14 patients with acute renal failure and severe sepsis. Left ventricular function, as assessed by changes in pulmonary wedge pressure and left ventricular stroke work index through plasma volume expansion, did not change during haemodialysis. Ultrafiltration-induced decreases in cardiac index provoked in 8 patients, with nearly normal initial systemic arteriolar resistance, had adequate and constant increase in their resistance (p less than 0.001), whereas 6 patients with low initial systemic arteriolar resistance did not increase their resistance and had a frequent (9/13 measurements) and significant (p less than 0.001) fall in mean aortic pressure. This abnormality of vascular tone is probably due to severe sepsis and explains why hypotension is a frequent occurrence during haemodialysis in such patients.

Acute Kidney Injury↗
PubMed1978

Hypovolaemic shock with oedema due to increased capillary permeability.

A case of severe hypovolaemic shock related to idiopathic oedema was observed in a 37 year old woman. Large plasma volume expansion (nearly 12 1 over 9 hours) did not change the clinical status. Haemodynamic studies showed low cardiac index (1.1 1/min/m2), decreased left ventricular stroke work index (6.7 gm/m2), and high systemic arterial resistance (52 mmHg/1/min/m2). Dopamine infusion improved the haemodynamic condition which returned to normal 30 hours after the beginning of shock. After recovery, capillary permeability measured by a modification of Landis' method was markedly increased. A study of albumin metabolism showed a normal intravascular pool and a rapid exchange compartment with a twofold increase in slow exchange compartment. Hormonal levels and complement fractions were within normal limits. Serum protein immuno-electrophoresis showed an abnormal IgG. These results clearly demonstrate that hypovolaemia is related to increased capillary permeability and leakage of albumin out of the vascular space. When large infusions fail, inotropic agents, especially Dopamine, should be used in such cases.

Adult↗
PubMed1978

Pulmonary gas exchange during venoarterial bypass with a membrane lung for acute respiratory failure.

In patients with fulminating pulmonary edema not responsive to conventional therapy, venoarterial membrane lung bypass can provide assistance if decreased systemic blood pressure prevents use of high-level positive end-expiratory pressure ventilation. In 10 patients with acute respiratory failure, partial venoarterial bypass provided a rapid and marked improvement of systemic oxygenation. Measurement of pulmonary blood flow (PBF) and intrapulmonary shunting (QS/QP) during bypass via prolonged left heart catheterization showed that left ventricular PaO2 was increased through a rapid and profound reduction of QS/QP. During the first days of bypass, derecruitment of pulmonary vessels is probably the mechanism of improved pulmonary oxygenation. When low pulmonary arterial pressures (PAP) are sustained, resorption of pulmonary edema is favored. Despite the beneficial effects of bypass, death occurred in every case due to diffuse interstitial fibrosis and/or parenchymal damage. The absence of healing, due to prolonged circulatory exclusion, may be detrimental despite immediate improvement. Because of this possibility, venovenous or mixed perfusion should be more extensively explored.

Acute Disease↗