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Biomedical subjects

F Gouin

Publications and source records attributed to F Gouin.

At least 127 records · Page 7Linked to original sources
PubMed1991

[Comparison of thrombogenic risk between teflon and polyethylene in prolonged catheterization of the radial artery].

This prospective study was designed to compare the rates of radial artery thrombosis after long-term cannulation with two different types of catheters with similar size. It included 101 patients, randomly assigned to group A (n = 51, 61 +/- 17 years, 80% males), and group B (n = 50, 55.8 +/- 18 years, 54% males). Patients in group A were cannulated with a polyethylene catheter (Leader Cath. 115-09), and those in group B with a Teflon catheter (Plastimed Seldicath). The diagnosis of arterial occlusion was made by way of a bedside angiography performed before catheter removal. An X-ray was taken after injection of 10 to 15 ml Hexabrix through the catheter. The two groups were similar with regard to anthropometric parameters (except for the sex ratio), cannulation technique, used drugs, duration of cannulation, pathological events during the stay in intensive care. The rate of complete arterial thrombosis in the two groups was similar (10%). There were no differences in the rates of partial thrombosis (51 vs. 36%, n.s.) and of absence of thrombosis (39 vs. 54%, n.s.). The rate of arterial thrombosis did not vary with the duration of cannulation, nor with age, sex, systemic heparinization, vascular collapse, cannulation technique. However, 4 polyethylene catheters were infected on removal (coagulase negative Staphylococcus, Pseudomonas aeruginosa) versus only one Teflon catheter (Staphylococcus epidermidis). In conclusion, the biocompatibility of Teflon and polyethylene catheters was found to be similar.

Adult↗
PubMed1991

Pharmacokinetics and tissue penetration of a single 1,000-milligram, intravenous dose of metronidazole for antibiotic prophylaxis of colorectal surgery.

The levels of metronidazole in serum and tissue penetration of metronidazole were studied after prophylactic administration in 11 patients undergoing elective colorectal surgery. A single dose of 1,000 mg given intravenously was administered before surgery. Adequate drug levels in serum (greater than or equal to MIC for 90% of strains tested [MIC90] for Bacteroides fragilis) were found in all patients throughout the procedure. Mean peak (15-min) and last-determined (24-h) metronidazole levels in serum were 28.8 +/- 8 and 4.2 +/- 1.7 mg/liter, respectively. The beta-phase elimination half-life was 9.5 +/- 2.3 h, and the clearance and apparent volume of distribution were 57 +/- 13 ml/min and 0.7 +/- 0.1 liter/kg, respectively. In the colonic wall at surgical anastomosis, tissue metronidazole levels greater than or equal to MIC90 for B. fragilis were found in 91% of patients. In the abdominal wall fat and epiploic fat, tissue metronidazole levels greater than or equal to MIC90 for B. fragilis were found in 40 to 60% of patients at surgical incision and closure. No anaerobic infection occurred during the study.

Aged↗
PubMed1991

Ofloxacin pharmacokinetics in mechanically ventilated patients.

The pharmacokinetics of ofloxacin were studied in 12 intensive care patients, 6 of whom were under controlled mechanical ventilation. All patients had a creatinine clearance of greater than 80 ml/min per 1.73 m2. They were given 3 mg of ofloxacin per kg of body weight intravenously at a constant flow rate in 30 min twice a day for 7 days. Pharmacokinetic studies were performed on days 1 and 7. Between days 1 and 7, significant increases in the alpha (distribution) and beta (elimination) phase half-lives, the area under the serum concentration-time curve, and peak and trough levels in serum were observed, together with a marked decrease (greater than 50%) in total body clearance. Possible contributing factors for alteration of ofloxacin pharmacokinetics in ventilated patients were patient age, liver dysfunction, drug interaction, and drug accumulation in a deep compartment. This study shows that in intensive care patients the pharmacokinetics of ofloxacin differ from those reported for healthy volunteers.

Critical Care↗
PubMed1991

[Diffusion of ciprofloxacin into bronchial secretions in mechanically ventilated patients].

The aim of the study was to evaluate, in clinical conditions, the penetration of ciprofloxacin into bronchial secretions. Eight patients were included in the study. They presented with nosocomial pneumonia and were under controlled mechanical ventilation. Ciprofloxacin was given at a dose of 3 mg/kg over 30 min. Serial bronchial and blood samples were obtained over a 12 hour period on day 2 and 4. Ciprofloxacin was measured by HPLC. Serum peak levels were 2.95 +/- 1 mg/l on day 2, and 2.43 +/- 0.7 mg/l on day 4. Bronchial peak and through levels were 0.95 +/- 0.51 mg/l and 0.21 +/- 0.12 mg/l, respectively, on day 2, and 0.76 +/- 0.17 mg/l and 0.18 +/- 0.14 mg/l, respectively, on day 4. The ratio of bronchial/serum peak was 0.32 +/- 0.11 and 0.33 +/- 0.06 on day 2 and 4, respectively. The ratio of AUC 0-12 h in the bronchial secretions/AUC 0-12 h in the serum samples was 0.66 +/- 0.04 and 0.55 +/- 0.27 on day 2 and 4, respectively.

Aged↗
PubMed1990

[An imipenem-cilastatin combination in the treatment of infection at general intensive care units].

The purpose of this multicentre open trial carried out in 286 patients (mean age: 58 +/- 17 years) was to evaluate the effectiveness of imipenem-cilastatin in the treatment of severe infections observed in intensive care units. In more than 90 per cent of the cases an underlying pathology was present before the infection, and 41 per cent of the patients had previously been operated upon. Respiratory tract infections and septicaemias accounted for 75 per cent of the cases. The infection had been present for 7.1 +/- 8.2 days before treatment was instituted, and in 66 per cent of the cases it was nosocomial. The frequency of prolonged artificial ventilation (198 cases) demonstrated the severity of these infections. Seventy-three per cent of the initial 622 isolates were Gram-negative bacilli; the responsible organisms were Pseudomonas aeruginosa in 106 cases and Acinetobacter in 76 cases. Imipenem-cilastatin was administered alone in 173 cases and combined with other antibiotics in 113 cases. The mean dosage and duration of treatment were 29.2 +/- 9.9 mg.kg-1 and 13.4 +/- 7 days respectively. Clinical cure or improvement was achieved in 244 out of 284 assessable patients (65.2 per cent). Among the 40 therapeutic failures, 16 were due to a resistant organism isolated during treatment (P. aeruginosa 10, P. maltophilia 6). These good or very good clinical results show that imipenem is effective in the treatment of severe infections observed in intensive care units.

Adult↗
PubMed1990

[Risk of thrombosis in prolonged catheterization of the radial artery: comparison of 2 types of catheters].

The thrombosis rate after long-term cannulation of the radial artery was assessed prospectively in 48 intensive care patients randomly assigned to groupe A (polyethylene Leader-Cath 115-09 catheter; n = 50, aged 55 +/- 20 years, 74% male patients) or groupe B (Teflon Viggo Floswitch 4441 catheter; n = 48, aged 58.6 +/- 16 years, 73% male patients). Bedside angiography was carried out with 10 to 15 ml Hexabrix before removal of the catheter. The two groups were similar with regard to anthropometric parameters, used drugs, pathological events during the stay in ICU, arterial cannulation technique and its duration. There was no case of clinically significant ischaemia. The rate of X-ray total arterial thrombosis was 20% in group A, and 2% in group B (p less than 0.01). There was no difference in the rate of partial thrombosis (54% vs. 41.7% respectively, NS) and of lack of thrombosis (26% vs. 56.3% respectively, NS). The overall rate of thrombosis was greater in group A than in group B, but not significantly (74% vs. 43.7% respectively). The duration of arterial cannulation did not influence the rate of thrombosis. However it was higher in males of Group A than in those of Group B (p less than 0.01), when heparin was not given (p less than 0.05); when vaso-active drugs were used (p less than 0.05); and when the time required for cannula insertion was greater than 5 min (p less than 0.01). It is concluded that Teflon catheters are more biocompatible than polyethylene catheters.

Adult↗
PubMed1990

Lower oesophageal reflux during priming with vecuronium.

We have studied the effects of vecuronium given in divided doses (priming principle) on the frequency of acid reflux into the oesophagus. Two groups of 16 patients were studied. After induction with thiopentone 6 mg kg-1 and fentanyl 3 micrograms kg-1, patients in one group were given vecuronium 0.01 mg kg-1 as a priming dose, followed by an intubation dose of 0.1 mg kg-1 4 min later. Patients in the other group were given no priming dose. Lower oesophageal pH was monitored continuously and acid reflux was defined as a decrease in pH to less than 4.0. One patient in each group had acid reflux during the time course of the induction. This study suggests that vecuronium 0.01 mg kg-1 given as a priming dose does not increase the risk of acid reflux into the oesophagus.

Anesthesia, Intravenous↗
PubMed1990

Pharmacokinetics of long-term propofol infusion used for sedation in ICU patients.

The pharmacokinetics of propofol were determined in nine patients (seven men, two women, (mean +/- SD) 55.8 +/- 21.2 yr, 65.2 +/- 8 kg) requiring prolonged mechanical ventilation of their lungs. After an initial dose of 1-3 mg/kg, propofol was administered iv at 3 mg/kg/h for 72 h. Arterial blood samples were collected at selected times during and up to 72 h after infusion. Propofol whole blood concentrations were determined by high-performance liquid chromatography with fluorescence detection. Individual pharmacokinetic parameters were estimated by noncompartmental analysis. Derived pharmacokinetic parameters showed a long terminal phase (T1/2 = 1878 +/- 672 min), a large volume of distribution at steady state (Vdss = 1666 +/- 756 l), and a high total body clearance (Cl = 1.57 +/- 0.56 l/min). While the propofol terminal elimination half-life is longer than that previously reported, emergence from sedation after prolonged administration will be governed by both redistribution mechanisms arising from the large distribution volumes and elimination from the body.

Adult↗
PubMed1990

Renal effects of norepinephrine used to treat septic shock patients.

Twenty-four patients with septic shock (cardiac index [CI] greater than or equal to 4 L.min-1.m-2, systemic vascular resistance index [SVRI] less than or equal to 350 dyne.sec.cm-5.m-2, systolic BP less than or equal to 90 mm Hg, oliguria less than 30 ml/h) were treated with norepinephrine (NE) infused either alone or in combination with dopamine and/or dobutamine. In all patients, NE resulted in either an increase in BP, no change, or an increase in CI and restored SVRI to the normal range. In 20 patients, normalization of systemic hemodynamics was followed by re-establishment of urine flow, decrease in serum creatinine, and increase in creatinine clearance. None of these 20 patients received low dose dopamine or furosemide. Four patients remained oliguric. Two of these four patients died and two developed acute renal failure. These findings suggest that NE infusion does not worsen renal ischemia related to hemodynamic disturbances in septic shock patients, and may have beneficial effects on renal function.

Adult↗
PubMed1990

Assessment of creatinine clearance in intensive care patients.

Assessment of creatinine clearance (CC) in ICU patients was compared using three methods. The reference method (CC 24 h) used measurements of serum creatinine and urinary creatinine after collection of urine over a 24-h period. The other two methods were predictive methods: the Kampmann nomogram and the formula developed by Gault and Cockcroft. The two predictive methods correlated well with one another. Correlation between the predictive and the reference methods was poor or absent. A discriminant analysis revealed that measurement of urinary creatinine was a major factor in CC estimation. In conclusion, the reference method of CC assessment is preferred to obtain a reliable estimation of glomerular filtration rate in ICU patients.

Adolescent↗
PubMed1990

Septic shock: a goal-directed therapy using volume loading, dobutamine and/or norepinephrine.

In patients with septic shock and acute respiratory failure, norepinephrine (NE) alone or in combination with dobutamine was used. The aim of therapy was to obtain or maintain Cl greater than or equal to 4.5 l.min-1.m-2, SVR greater than or equal to 700-800 dyn.s.cm-5 and oxygen delivery (Do2) greater than or equal to 550 ml.min-1.m-2. Twenty-three patients (58 +/- 3 years) were studied. Initially patients were given intravenous fluid resuscitation to obtain optimal cardiac filling pressures. Eleven patients were considered to be in hyperdynamic septic shock (cardiac index (CI) greater than 4.5 l.min-1.m-2, SVR less than or equal to 600 dyn.s.cm-5 and oliguria) and were given NE as a single agent (0.9 +/- 0.2 micrograms kg-1.min-1). The other 12 patients had Cl less than 3.5 l.min-1.m-2 and were given a combination of dobutamine (12 +/- 0.09 micrograms.kg-1.min-1) and NE (1.1 +/- 0.2 micrograms.kg-1.min-1). The latter drug was added since systemic vascular resistance (SVR) was less than 600 and oliguria persisted while on dobutamine. In all patients, during NE infusion SVR was greater than 700 dyn.s.cm-5, Cl greater than or equal to 4.5 l.min-1.m-2 and Do2 greater than 550 ml.min-1.m-2. Urine flow was significantly increased during NE infusion, and only four patients remained oliguric. Anion gap and oxygen consumption were not modified. A complete resolution of septic shock was seen in 16 out of 23 patients (70%). Hospital mortality was 56%.

Adult↗
PubMed1990

Pharmacokinetics and tissue penetration of a single dose of ornidazole (1,000 milligrams intravenously) for antibiotic prophylaxis in colorectal surgery.

Levels in serum and tissue penetration of ornidazole were studied after a single intravenous injection of 1,000 mg given to 14 patients for prophylaxis of surgical infection. They were scheduled for elective colorectal surgery. Adequate levels in blood (greater than or equal to MIC for 90% of Bacteroides fragilis strains tested) were found in all patients throughout the procedure and up to hour 24. Mean-maximal (15 min) and last-determined (24 h) ornidazole levels in serum were 24 +/- 5.2 and 6.3 +/- 1.4 mg/liter, respectively. beta-Phase elimination half-life was 14.1 +/- 2.7 h, and clearance and apparent volume of distribution were 47 +/- 12 ml/min and 0.9 +/- 0.13 liters/kg, respectively. In all patient, adequate levels in tissue were found in the abdominal wall and the epiploic fat at time of incision and in the colonic wall at time of anastomosis. At time of closure, all but one patient had adequate levels in tissue in the abdominal wall and the epiploic fat. No anaerobic nor aerobic infection occurred in the study patients.

Aged↗
PubMed1990

Heat and moisture exchangers and vaporizing humidifiers in the intensive care unit.

A prospective, randomized, controlled study was undertaken to compare the Pall Ultipor breathing circuit filter (PUBCF), a heat-and-moisture exchanger, and heated hot water systems (HHWSs) in ICU patients submitted to controlled mechanical ventilation. Humidification of inspired gas and bacterial contamination of breathing circuits were evaluated. During the study, there were six episodes of tracheostomy tube (TT) occlusion in six patients included in the PUBCF group. No patient out of 42 included in the HHWS group experienced this complication (p less than 0.01). There were 4 percent of days with thick and tenacious bronchial secretions in the PUBCF group and no case in the HHWS group (p less than 0.02). In the PUBCF group, 23 percent of days with hypothermia were noted as opposed to 12 percent in the HHWS group (p less than 0.01). Fewer breathing circuits were found to be contaminated in the PUBCF group (11 percent) than in the HHWS group (54 percent, p less than 0.01). In patients with an organism growing in bronchial specimens, the same organism was found to contaminate the breathing circuit in 10 percent of cases in the PUBCF group and 77 percent of cases in the HHWS (p less than 0.01). We conclude that, in the conditions of this study, the PUBCF did not provide sufficient humidification of inspired gas in ICU patients. Protection against contamination of breathing circuits was effective, but 10 percent of patients remained at risk for this complication.

Adult↗