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Biomedical subjects

D Journois

Publications and source records attributed to D Journois.

At least 19 recordsLinked to original sources
PubMed2005

[European normative recommendations for medical gas pipeline systems].

Several recent decisions have been made in order to increase the security of medical gases delivery in French hospitals. These different changes affect: 1) the hospital itself with the creation of working groups in charge of both monitoring and maintenance of gases networks; 2) the pharmaceutical regulation with promotion of several gases to the status of drugs or need of CE marking for the whole gas network. European rules onset required to give up French former norms (NF) to the profit of "NF EN" rules. Nevertheless, the new norm NF EN 737-3 which concerns medical gases distribution systems does not affect principal clauses of the previous NF S 90-155. It introduces new elements allowing to deploy two types of medical gases networks: the double pressure level used in France and the single pressure level used in the rest of Europe. This new norm, which attempts to harmonize alarm control systems in both types of networks, suffers from important limitations describing the double pressure level systems. Lastly, the final checking proposed by this new norm is very different from the previous one, and is likely to be problematic for the final users within the hospital.

Anesthesiology↗
PubMed2004

[Abdominal aorta lesion during surgical treatment of a foraminal disk hernia].

We report a case of an abdominal aorta lesion on a 54-year-old woman, who underwent surgery for the treatment of a foraminal disk hernia. At the end of the hernia repair, a sudden hypovolaemic collapse occurred. A computed tomography revealed an abdominal aorta disruption and a retroperitoneal haematoma. An endovascular treatment was preferred to a surgical reintervention and an endoluminal stent-graft was inserted; the postoperative course was uneventful. This case report describes an example of vascular complications of disk hernia surgery which are rare but potentially serious. It emphasizes the increasing development of endovascular procedures and their utility in the treatment of acute contained aortic disruption.

Aorta, Abdominal↗
PubMed2001

High-volume haemofiltration in human septic shock.

OBJECTIVE: To evaluate whether high volume haemofiltration improves haemodynamics and affects serum cytokine and complement concentrations in human septic shock. DESIGN AND SETTING: Randomized cross-over clinical trial in a tertiary intensive care unit. PATIENTS: Eleven patients with septic shock and multi-organ failure. INTERVENTIONS: Patients were assigned to either 8 h of high-volume haemofiltration (HVHF; 6 l/h) or 8 h of standard continuous veno-venous haemofiltration (CVVH; 1 l/h) in random order. MEASUREMENTS AND MAIN RESULTS: We measured changes in haemodynamic variables, dose of norepinephrine required to maintain a mean arterial pressure greater than 70 mmHg and plasma concentrations of complement anaphylatoxins and several cytokines. An 8-h period of HVHF was associated with a greater reduction in norepinephrine requirements than a similar period of CVVH (median reduction: 10.5 vs. 1.0 microg/min; p = 0.01; median percentage reduction: 68 vs. 7%; p = 0.02). Both therapies were associated with a temporary reduction (p < 0.01) in the plasma concentration of C3a, C5a, and interleukin 10 within 2 h of initiation. HVHF was associated with a greater reduction in the area under the curve for C3a and C5a (p < 0.01). The concentration of the measured soluble mediators in the ultrafiltrate was negligible. CONCLUSIONS: HVHF decreases vasopressor requirements in human septic shock and affects anaphylatoxin levels differently than standard CVVH.

APACHE↗
PubMed2000

[Comparison of two measurement methods: the Bland and Altman assessment].

Bland-Altman analysis for comparison of two methods of clinical measurement is frequently used in scientific publications. This article is more appropriate than the conventional linear regression analysis. This paper gives an overview of the principles for the use of Bland-Altman analysis as well as the specific terminology attached to it. The Bland-Altman comparison analysis is mainly a tool for clinical interpretation. The bias and the agreement limits provide the variation of the values of the technique compared to the other. The difference between the two methods of measurement is plotted against the average obtained with each of the two techniques. Bland-Altman analysis can also be used to check the repeatability of a measurement technique within the same subject and to determine a repeatability coefficient. With an adaptation of the calculation of the agreement limits, the average of multiple measurements for each subject with two measurement techniques can be used for the Bland-Altman analysis.

Regression Analysis↗
PubMed1999

Hemofiltration during cardiopulmonary bypass.

Several factors combine to facilitate the evolution towards heart and multi-organ failure following cardiac surgery. Some of these factors are related to pure cardiac aspects like the existence of a preoperative heart disease, the use of aortic cross clamping or performance of cardiotomy. Cardiopulmonary bypass (CPB) also plays an important role in the occurrence of postoperative organ dysfunctions by two principal means: firstly by inducing a profound hemodilution, which impairs oxygen transport through tissues. This phenomenon is pointed out in the postoperative period by the existence of increased transpulmonary O2 gradients, extravascular lung water volume and subsequent impairments of O2 transport. Secondly CPB is deleterious by triggering an important inflammatory reaction. This reaction is largely related to the ratio of the circuit area to the patient's body surface area and is therefore maximal in children. It has been widely demonstrated that the very early paths of this reaction imply several humoral factors including kinins, coagulation factor-XII and complement fragments. The activation of these factors is self-amplified and triggers both expression and release of numerous mediators by endothelial cells and leukocytes. Finally, these mediators are responsible for the well described "post-bypass syndrome" which is, from a clinical viewpoint, very close to hyperkinetic septic shocks. Several methods have been proposed to reduce the deleterious effects of both cardiac surgery and CPB. The older one is hypothermia that considerably reduces the triggering of the inflammatory mediators network. Heparin-coated circuits may also reduce this reaction to some extent. Hemofiltration has been introduced in the 90's in CPB management. Because of its very high tolerance in patients with compromised circulatory status this technique was already used in the postoperative period to treat patients with acute renal failure. Initially hemofiltration was intended to correct the accumulation of extravascular water during or immediately following the surgical procedure. Nevertheless several of its "side-effects" appeared to be useful like reduction of postoperative blood loss and immediate hemodynamics improvement. Several studies attempted to point out the mechanism of action of hemofiltration and although removal of inflammatory mediator occurs, there is currently no proofs that this removal is the actual mechanism by which this technique acts. At the early beginning of the use of its utilization hemofiltration during cardiac surgery aimed either to concentrate blood at the end of the procedure or to rapidly restore a normal fluid and electrolytes balance. Today some new implementations of this technique are proposed either to reduce the triggering of the inflammatory reaction to CPB or to reduce the immediate postoperative drug support.

Cardiopulmonary Bypass↗
PubMed1998

Incidence and predictors of major hemorrhagic complications from thrombolytic therapy in patients with massive pulmonary embolism.

PURPOSE: The risk factors for bleeding in patients receiving recombinant tissue-type plasminogen activator for massive pulmonary embolism are not known. PATIENTS AND METHODS: The hospital records of 132 consecutive patients who received recombinant tissue-type plasminogen activator for massive pulmonary embolism were retrospectively reviewed. Bleeding was estimated by using the bleeding severity index, a method previously validated in patients receiving anticoagulants. Multivariate stepwise logistic regression was used to identify independent risk factors for bleeding. Four other definitions of bleeding in large pulmonary embolism thrombolytic trials were also used, and the agreement among these criteria was assessed. RESULTS: According to the bleeding severity index, 33 patients (25%) had one or more major bleeding complications. Hemorrhage at the venous puncture site for angiography was the most frequent complication (15 patients, 11%). Major bleeding at the catheterization site was more common at the femoral site (14 of 63 patients = 22%) than at the brachial site (1 of 63 patients = 2%; P = 0.0004). The use of the five different bleeding definitions resulted in a variation in the major bleeding rate from 3% to 43%. The kappa coefficient varied from 0.07 to 0.84, indicating poor agreement between most of the classifications. CONCLUSION: The use of the femoral vein for pulmonary angiography was the only variable significantly associated with major bleeding. Most of the differences observed in the pulmonary embolism thrombolytic trials are likely related to the differences in the definition of bleeding rather than to the thrombolytic regimen.

Aged↗
PubMed1998

Hemofiltration during cardiopulmonary bypass.

Several factors combine to facilitate the evolution towards heart and multi-organ failure following cardiac surgery. Some of these factors are related to pure cardiac aspects, for example, the existence of a preoperative heart disease, the use of aortic cross clamping or performance of cardiotomy. Cardiopulmonary bypass (CPB) also plays an important role in the occurrence of postoperative organ dysfunctions by two principal means. It induces a profound hemodilution, which impairs oxygen transport through tissues. This phenomenon becomes obvious in the postoperative period by the existence of increased transpulmonary O2 gradients, extravascular lung water volume and subsequent impairments of O2 transport. (2) Cardiopulmonary bypass is deleterious by triggering an important inflammatory reaction. This reaction is largely related to the ratio of the circuit area to the patient's body surface area and is therefore maximal in children. It has been widely demonstrated that the very early paths of this reaction imply several humoral factors including kinins, coagulation factor XII and complement fragments. The activation of these factors is self-amplified and triggers both expression and release of numerous mediators by endothelial cells and leukocytes. Finally, these mediators are responsible for the well described "post-bypass syndrome," which is, from a clinical viewpoint, very close to hyperkinetic septic shock. Several methods have been proposed to reduce the deleterious effects of both cardiac surgery and CPB. The older one is hypothermia that considerably reduces the triggering of the inflammatory mediator network. Heparin-coated circuits may also reduce this reaction to some extent. Hemofiltration has been introduced in the 1990s in CPB management. Because of its very high tolerance in patients with compromised circulatory status this technique was already used in the postoperative period to treat patients with acute renal failure. Initially hemofiltration was intended to correct the accumulation of extravascular water during or immediately following the surgical procedure. Nevertheless, several of its side-effects appeared to be useful, such as the reduction of postoperative blood loss and immediate improvement in hemodynamics. Several studies attempted to point out the mechanism of action of hemofiltration and although removal of inflammatory mediator occurs, there is currently no proof that this removal is the actual mechanism by which this technique acts.

Adult↗
PubMed1998

[Hemofiltration during severe sepsis or multiorgan failure syndrome].

Continuous renal replacement therapy (CRRT) has been used in intensive care units particularly in patients with sepsis or multiorgan failure. In comparison to intermittent haemodialysis, hemofiltration techniques offers an improved hemodynamic tolerance, related to the absence of osmotic pressure gradient. Indeed, hemofiltration is based on the physical principle of convection to remove substances from the plasma. The removal of substances that are released during sepsis, acute respiratory distress syndrome or multiorgan failure may be of particular interest. Several human studies have demonstrated that hemofiltration removes various inflammatory mediators, but the clinical significance of this removal remains questionable. If this removal occurs predominantly by convection, interest in hemofiltration will focus on high volume hemofiltration in order to obtain maximal ultrafiltrate flows. Patients with sepsis or multiorgan failure require close monitoring of most vital functions. The use of a CRRT technique emphasizes the importance of this monitoring and adds new monitoring issues relative to fluid balance, anticoagulation, hypothermia or drug removal.

Cytokines↗
PubMed1997

Elastic energy as an index of right ventricular filling.

BACKGROUND: Right ventricle (RV) preload assessment remains controversial because the complexity of RV geometry is an obstacle to wall stress modeling. We developed a method to evaluate end-diastolic RV elastic energy (EL), a variable that integrates all the stretching effects of venous return and that can be easily estimated at the bedside from the area under the diastolic RV pressure-volume curve. The purpose of this study was to compare the clinical utility of EL and of the two conventional variables used to assess RV filling, ie, right atrial pressure (Pra) and RV end-diastolic volume (EDV). METHOD: We studied 26 postoperative patients who required a rapid fluid challenge. Energetics were evaluated by constructing the RV pressure-volume loop at the bedside using right heart catheterization with RV ejection fraction (EF) derivation. Correlations between RV filling and RV performance (ejection and mechanical efficiency) were studied. RV filling indexes were Pra, EDV, and EL. Indexes of RV ejection were stroke volume (SV), RV stroke work (RVSW), mechanical energy expenditure during ejection (EM), and total energy expenditure of contraction (ET). Indexes of RV mechanical efficiency were EF and the EM/ET ratio. RESULTS: Three important results were obtained. First, among RV ejection indexes, those that correlated best with RV filling indexes were EM and ET. Second, we found significant linear relationships between improved RV filling, as assessed by changes in EDV and EL, and improved RV ejection, as assessed by changes in SV, RVSW, EM, or ET. Third, changes in EDV and EL also predicted improved mechanical efficiency, as assessed by changes in EF and EM/ET. In, all situations, changes in EL yielded the strongest correlations. CONCLUSIONS: Derivation of EL is simple and appears to be the best clinical means of assessing Starling's law of the heart for the RV.

Adult↗
PubMed1996

Ten-year experience with surgical treatment of partial atrioventricular septal defect: risk factors in the early postoperative period.

Partial atrioventricular septal defects are electively repaired with good results. However, recent reports suggest that such repair is potentially a high-risk surgical procedure. Our aim was to determine the risk factors of adverse outcome early after surgical treatment of atrioventricular septal defects in our hospital. A retrospective study was done in 100 consecutive patients from 2 months to 50.6 years old (median 3.6 years) who underwent surgical correction between January 1984 and December 1993. An intermediate form of the lesion was noted in 31% of cases. Congestive heart failure occurred in 50% of cases. Preoperative left atrioventricular valve incompetence (moderate to severe) was present in 63% of patients. Severe abnormalities of left subvalvular apparatus were noted in 28% of patients. The cleft of the left atrioventricular valve was closed in 76% of cases. The study was done to determine risk factors associated with hospital mortality (13%), postoperative residual left atrioventricular valve incompetence (23%), and early reoperation (14%) within the first 30 postoperative days. Univariate analysis showed that age at the date of operation and cleft closure were not related to an early adverse outcome. A stepwise logistic regression with variables selected by univariate analysis identified infections and severe abnormalities of left subvalvular apparatus as predictive factors of early death (odds ratio, 28.07 and 6.18, respectively), preoperative left atrioventricular valve regurgitation as a predictive factor of residual postoperative left atrioventricular valve regurgitation (odds ratio, 5.34), and severe abnormalities of left subvalvular apparatus as a predictive factor of early reoperation (odds ratio, 5.27). These results emphasize the importance of the severity of the morphologic features of the left subvalvular apparatus, the occurrence of early postoperative infections, and the presence of residual left atrioventricular valve regurgitation as risk factors in the early period after surgical correction of partial atrioventricular septal defects.

Adolescent↗
PubMed1996

High-volume, zero-balanced hemofiltration to reduce delayed inflammatory response to cardiopulmonary bypass in children.

BACKGROUND: In previous studies, researchers suggested a beneficial role of hemofiltration performed during cardiopulmonary bypass in children. This study was performed to assess both clinical effects and inflammatory mediator removal by high-volume, zero-fluid balance ultrafiltration during rewarming (Z-BUF). METHODS: Twenty children undergoing cardiac surgery were assigned randomly to Z-BUF or a control group. Plasma C3a, interleukin (IL)-1, IL-6, IL-8, IL-10, tumor necrosis factor, myeloperoxidase, and leukocyte count were measured before (T1) and after (T2) hemofiltration and 24 h later (T3). The intensive care unit staff was blinded to the patient's group. Postoperative alveolar-arterial oxygen gradient, time to extubation, body temperature, and postoperative blood loss were monitored. RESULTS: Ultrafiltration rate was 4,972 (3,183-6,218) mL/m2 (median [minimum-maximum]) in the Z-BUF group, where significant reductions were observed in postoperative blood loss, time to extubation (10.8[9-18] vs. 28.2 [15-58] h) and postoperative alveolar-arterial oxygen gradient (320 [180-418] vs. 551 [485-611] mmHg at T3). In the Z-BUF group, significant removal of tumor necrosis factor, IL-10, myeloperoxidase, and C3a were observed at T2. Interleukin 1, IL-6, IL-8, and myeloperoxidase were decreased at T3, suggesting earlier removal of factor(s) that may trigger their release. CONCLUSIONS: These results suggest that hemofiltration exerts some beneficial clinical effects that are not due to water removal. The role of the early removal of factors triggering the inflammatory response, rather than a direct removal of cytokines, deserves further investigation.

Anesthetics↗