Search PubMed⌕ Search

Biomedical subjects

F Gouin

Publications and source records attributed to F Gouin.

At least 163 records · Page 9Linked to original sources
PubMed1987

Vecuronium or suxamethonium for rapid sequence intubation: which is better?

The effects of suxamethonium, and of vecuronium given after three subparalyzing (priming) doses, on the time of onset of neuromuscular blockade and on the resultant intubating conditions were compared. This study involved five groups of 10 patients (ASA class I or II) who were premedicated with flunitrazepam 0.015 mg kg-1 i.m. Anaesthesia was induced with thiopentone 6 mg kg-1 and fentanyl 0.003 mg kg-1. In groups 2, 3 and 4 the patients were given a priming dose of vecuronium 0.01, 0.015 and 0.02 mg kg-1, respectively. Three minutes later the intubating dose of vecuronium was given: 0.1 mg kg-1 (group 1), 0.09 mg kg-1 (group 2), 0.085 mg kg-1 (group 3), 0.08 mg kg-1 (group 4). When the electromyographic response was 95% of control, the trachea was intubated. In groups 2, 3 and 4, the onset time was significantly decreased compared with group 1. Increasing the priming dose from 0.01 mg kg-1 did not offer any advantage. The duration of blockade (time from the intubating dose to 15% recovery) was not significantly increased with any priming dose. In group 5, the trachea was intubated after suxamethonium 1.5 mg kg-1. Mean onset time, which was significantly shorter than in the other groups, was half that of the groups that received a priming dose. Intubation conditions were better in group 5 than in the other groups (P less than 0.01).

Adult↗
PubMed1987

Abnormalities of some phagocyte membrane receptors during nosocomial infections.

The frequent and severe nosocomial infections in ICU patients suggest that these patients are immunodeficient. We studied the phagocytic activity of granulocytes and monocytes isolated from the blood of 32 ICU patients with nosocomial pneumonia (19 male, 13 female; age 41 +/- 4 yr). Cells were tested in standard medium and in the presence of patients' serum. Blood granulocytes and monocytes were purified and separately exposed to opsonized zymosan (to test C3 receptor function), immunoglobulin-coated erythrocytes (to test Fc receptor function), and glutaraldehyde-treated erythrocytes (to test nonspecific binding structures). Phagocytosis and superoxide anion production were measured. Granulocytes of patients exhibited a substantial decrease of zymosan ingestion (p less than .05), whereas phagocytosis of other particles was normal. Monocytes from the patients displayed an unselective overall decrease of phagocytic ability for the three particle types (p less than .05). Patients' sera were at least as efficient as a pool of normal sera in opsonizing zymosan. Further, no phagocytic inhibitor was found in the tested patients. In conclusion, we point out a deficiency of membrane receptors of neutrophils and monocytes in ICU patients with nosocomial infection.

Adult↗
PubMed1987

Right ventricular function during positive end-expiratory pressure. Thermodilution evaluation and clinical application.

Right ventricular (RV) function was studied in 13 patients under controlled mechanical ventilation with positive end-expiratory pressure (PEEP) for adult respiratory distress syndrome. The assessment of RV function was made by the thermodilution technique. Calculations of RV ejection fraction (RVEF) and RV end-diastolic volume (RVEDV) were performed. In 11 patients, increasing PEEP was accompanied by a progressive decrease in blood pressure (BP), stroke volume (SV), RVEDV, and no change in RVEF. Increasing PEEP further was accompanied by a further decrease in RV preload. The remaining two patients exhibited a decrease in BP, SV, RVEF and an increase in RVEDV. One of these two patients exhibited a large decrease in cardiac output (CO). Thus, measurement of RVEDV (best parameter of ventricular preload) and RVEF are easily performed at the patient's bedside using a special thermodilution technique. This allows selection of the best treatment of PEEP-induced decrease in CO.

Adult↗
PubMed1986

[Assessment of ventricular function by thermodilution in controlled ventilation with positive end expiratory pressure].

Controlled mechanical ventilation with PEEP can induce important haemodynamic modifications. The aim of this study was to focus on right ventricular function, often altered with that kind of respiratory support. Bed-side assessment of right ventricular function was made possible through thermodilution technique. Eleven patients receiving PEEP from 0 to 15 cmH2O were studied. Right ventricular end-diastolic volume (RVEDV), cardiac output (CO) and right ventricular ejection fraction (RVEF) were obtained for each patient. Increasing PEEP produced the same disturbances in nine patients, i.e. decreased RVEF. Blood volume expansion brought back to normal the haemodynamic values. Two patients had a decrease in CO and RVEF associated with an increase in RVEDV. In one of these two patients, dobutamine corrected the RV dysfunction. Using thermodilution technique, abnormalities of RV preload can be accurately assessed. From these data, the most appropriate treatment can then be chosen.

Adult↗
PubMed1986

[Pulmonary artery catheterization by the percutaneous approach to the axillary vein].

The choice of venous access can be difficult in patients under intensive care. The axillary vein appeared interesting to evaluate. This prospective study involved 63 punctures carried out in 59 patients during a 16 month period (14 females and 45 males; mean age: 54 +/- 4 yr). 34 patients were tracheostomized and under controlled respiration; some had coagulation abnormalities (8 cases). The other 29 patients were undergoing a preoperative haemodynamic study. Puncture of the axillary vein was carried out with the needle inserted at an angle of 30 degrees to the skin surface and directed parallel to the artery medial to its course. The Seldinger technique was used (catheter and guide wire). Overall success rate was 87.5%. In 73%, less than three attempts were required. After the catheter was set in place in the axillary vein, the mean time required to reach the pulmonary artery was 7 +/- 15 min (range: 20 s-45 min). Less than 1 min was needed in 60%. Extrasystoles were observed in 3.6%. The incidence of arterial puncture was 11% without any late complications. In every case, pulmonary artery and capillary wedge pressure curves were obtained, as well as cardiac output measurements. Mean duration of catheterization was 2 +/- 1.1 days in the preoperative haemodynamic group and 4 +/- 1.7 days in the other. No infectious complication was related to the catheterization. One thrombosis of the axillary and subclavian veins was noted (1.8%). The axillary vein appeared therefore to be useful for pulmonary artery catheterization. It is an alternative choice in patients under controlled ventilation and with coagulation problems.

Adult↗
PubMed1986

The axillary vein: an alternative approach for percutaneous pulmonary artery catheterization.

The axillary vein route was investigated prospectively for percutaneous pulmonary artery catheterization in 79 patients who underwent 83 attempts. Forty nine of these patients were tracheostomized and under mechanical ventilation and eight had hemostasis disorders. Successful catheterization was achieved 74 times in the 79 patients. Pulmonary artery was reached within 6 +/- 2.1 min after the catheter was set in place in the axillary vein. Less than 1 min was needed in 53 cases. Puncture of the axillary artery was noted in 11 patients without complication. No other significant complication was noted following the punctures. Mean duration of catheterizations was 3.6 +/- 2 days. No septicemia was related to the catheterization procedure. One thrombosis of the axillary vein was noted. Catheterization of the pulmonary artery via the axillary vein is safe, simple and reliable and can represent an alternative method should the use of other routes be unsuccessful.

Adolescent↗
PubMed1986

[Clinical and pharmacokinetic study of ceftriaxone in severe infections in adults in intensive care].

Twenty patients with severe nosocomial bacterial infections hospitalized in an intensive care unit were treated by ceftriaxone alone, in a single daily IV injection of 2 g. Clinical and bacteriological results show that ceftriaxone has good activity against enterobacteria. The four patients (20%) who failed to respond had superinfection by Pseudomonas aeruginosa, a finding that suggests that ceftriaxone should be used in combination with another antibiotic for the treatment of nosocomial infections. Pharmacokinetic results in our patients show that with the dosage used peak and trough serum levels are greater than the MICs of susceptible pathogens.

Adult↗
PubMed1985

[Anomalies of the membrane receptors of blood phagocytic cells in nosocomial pulmonary infections].

Patients in intensive care units have frequent and severe opportunistic bacterial pneumoniae, even if they were previously free from respiratory disease. A search was made in these patients for possible immune deficiencies. Granulocyte and monocyte phagocytic activities were studied separately in 17 patients with bacterial bronchopneumonia (male: 13, female: 4; age: 41 +/- 5 yr). The ability of three types of particles (opsonized zymosan, immunoglobulin coated and glutaraldehyde-treated sheep red cells) to trigger ingestion was measured. Cells were tested either in normal AB serum or in the presence of patient's serum. A substantial 40% decrease of the fraction of granulocytes ingesting zymosan was found in our experimental conditions (p less than 0.001). Activity with the other particles was not significantly altered. Patients' sera were at least as efficient as a pool of normal sera in opsonizing zymosan. Furthermore, no phagocytic inhibitor was found in the patients tested. Underlying mechanisms for these abnormalities remain unknown, but a better understanding of the aetiology of the altered bactericidal function of phagocytic cells is required before suggesting immunomodulating treatments.

Adult↗
PubMed1985

[Drug-induced agranulocytosis. Discussion of the responsibility of metronidazole].

A case of severe agranulocytosis is reported in a 43 year old white male with Guillain-Barré syndrome. This patient was treated for an acute aspiration pneumonia and received several antibiotic regimens. An acute agranulocytosis occurred during the stay in the intensive care unit and was followed by a severe septic shock. Bone marrow aplasia was confirmed by needle aspiration. Metronidazole was withdrawn and agranulocytosis improved within three days. None of the other drugs given to the patient were withdrawn. Another bone marrow examination performed several days later revealed a markedly improved granulopoiesis. The patient died with multiple organ failure. The role of metronidazole is discussed in this case as this drug seemed highly responsible for the observed agranulocytosis.

Adult↗
PubMed1985

[Postoperative herpetic encephalitis. Value of Klapper's diagnostic method].

A case of a 51 year old female with herpes encephalitis is reported. She underwent surgery for chronic pancreatitis with pseudocyst formation. On the third postoperative day, she developed a severe vesicular nasolabial eruption associated with a deep stupor. Anti-Herpes simplex viral (HSV) antibodies were found in both blood and cerebrospinal fluid. Klapper's anti-HSV antibody ratio was calculated and agreed with the hypothesis of herpes encephalitis. The patient was given nucleoside analogues. She rapidly improved and was discharged from the intensive care unit without any sequelae. The frequency of HSV infection in intensive care patients and the use of Klapper's index for the diagnosis of herpes encephalitis in these patients are then discussed.

Antibodies, Viral↗
PubMed1985

Central venous and pulmonary artery catheterizations via the axillary vein.

We report the results of over 300 central venous and pulmonary artery catheterizations via the axillary vein. We found that the success rate with this method compares well with those of other catheterization routes, whilst the risk of mechanical injury, even for artificially ventilated patients, was virtually eliminated.

Axillary Vein↗