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Biomedical subjects

F Jardin

Publications and source records attributed to F Jardin.

At least 109 records · Page 6Linked to original sources
PubMed1979

Effect of dopamine on intrapulmonary shunt fraction and oxygen transport in severe sepsis with circulatory and respiratory failure.

The hemodynamic response to a dopamine HCl infusion (10 microgram/kg per min) was measured in 25 adult patients with severe sepsis: there were 6 patients with circulatory hyperdynamic states, 9 patients with myocardial failure, and 10 with hypovolemia. Each patient also had acute respiratory failure. Changes of intrapulmonary shunt fraction (Qs/Qt), arterial and mixed venous oxygen tension (PaO2 and PvO2), oxygen transport, and oxygen consumption (VO2) were evaluated before and after dopamine infusion. Dopamine infusion produced clinical improvement and increased cardiac output. The hemodynamic response seemed to differ slightly according to the pattern of circulatory failure: chronotropic effect appeared to be predominant in hyperdynamic states, whereas inotropic effect appeared to be predominant in myocardial failure or hypovolemia. Moreover, in hypovolemic patients we noted a rise in pulmonary capillary wedge pressure suggesting an additional increase in venous return. During this treatment, we also noted a worsening of the Qs/Qt despite the increase in pulmonary blood flow; this worsening did not prevent significant improvements in VO2, but the improvement in PVO2 was offset by increased Qs/Qt and PaO2 remained unchanged.

Adult↗
PubMed1979

Hemodynamic factors influencing arterial hypoxemia in massive pulmonary embolism with circulatory failure.

Arterial hypoxemia is a common finding in acute pulmonary embolism, and its severity is generally assumed to be proportional to the extent of pulmonary artery obstruction. We studied blood gases (during room air breathing and 100% oxygen breathing) and hemodynamic data is seven patients with massive pulmonary embolism and circulatory failure. All measurements were made before and 30 minutes after medical therapy of shock. We observed that a low cardiac output state can result in a misleading improvement in arterial oxygenation during massive pulmonary embolism, and that an improved circulatory status resulting from medical therapy (including inotropic drug infusion with or without blood volume expansion) can paradoxically increase arterial hypoxemia. We conclude that severity of arterial hypoxemia may not reflect the severity of pulmonary artery obstruction in acute pulmonary embolism if shock is present.

Adult↗
PubMed1979

Venous admixture in human septic shock: comparative effects of blood volume expansion, dopamine infusion and isoproterenol infusion on mismatching of ventilation and pulmonary blood flow in peritonitis.

A hemodynamic study with blood gas analysis was performed so we could observe changes induced by blood volume expansion, dopamine infusion and isoproterenol infusion in 20 adult patients suffering from peritonitis complicated with septic shock and acute respiratory failure. Blood volume expansion increased cardiac index (from 2.6 +/- 1.21/min/m2 to 3.4 +/- 1.31/min/m2; p less than 0.001), but also enhanced venous admixture (QS/QT) from 27 +/- 14% to 36 +/- 13%; p less than 0.01). Dopamine infusion increased cardiac index (from 2.6 +/- 0.9 1/min/m2 to 3.4 +/- 1 l/min/m2; p less than 0.001), but also enhanced venous admixture (from 25 +/- 11% to 31 +/- 12%, p less than 0.001). Isoproterenol infusion increased cardiac index (from 2.6 +/- 0.9 l/min/m2 to 3.6 +/- 1.1 l/min/m2; p less than 0.001), but also enhanced venous admixture (from 27 +/- 12% to 33 +/- 11%; p less than 0.001). This worsening in mismatching of ventilation and blood flow is correlated with the enhancement in pulmonary blood flow obtained by these three therapeutic procedures.

Adult↗
PubMed1979

[Circulatory and respiratory effects of aspiration and reinfusion of ascites in cirrhosis. Apropos of 14 ascitic attacks treated by this method].

Aspiration and replacement of ascites in 14 patients with cirrhosis was carried out using a Rhodiascit (Rhône-Poulenc) apparatus. Hemodynamic studies were used to evaluate the effects of this therapy on circulatory and respiratory parameters. Results showed that the hemodynamic tolerance of the treatment, which produces a slow increase in blood volume, was excellent as there was an increase in the cardiac index without raising the pressure under which replacement was made. Futhermore, no adverse effects on blood respiratory functions were noted in these patients who had blood hypoxia before treatment, but the removal of ascitic fluid produced no improvement in arterial gasometric parameters which is contrary to what one would expect.

Adult↗
PubMed1978

Immediate and middle-term cardiorespiratory effects of positive end-expiratory pressure in thirteen cases of non-haemodynamic pulmonary oedema.

Thirteen patients with severe acute respiratory failure were ventilated with positive end-expiratory pressure (PEEP) for 9 days. Haemodynamic measurements were performed after 15 min during 100% oxygen breathing, first with intermittent-positive pressure ventilation, secondly with positive end-expiratory pressure. The latter improved the Pa, O2 from 89 to 150 torr, decreased the QS/QT from 43% to 32% and decreased the Pa, CO2 from 37 to 34 torr; this improvement in gas exchange was accompanied by a decrease in cardiac index from 4.4 to 3.7 1 min-1m-2 without changing the systemic arterial pressure. Despite this beneficial effect on arterial blood oxygenation, it did not improve the survival rate of patients with severe acute respiratory failure.

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↗
PubMed1978

Massive pulmonary embolism with circulatory failure: survival following sixty hours' support with a membrane lung.

A 62-year-old man had circulatory failure from massive pulmonary embolism following a road accident. Despite intensive therapy including urokinase infusion, inotropic drugs, and mechanical ventilation, the patient's circulatory status deteriorated. When it became impossible to maintain the mean systemic arterial pressure above 50 mm. Hg and the cardiac index above 1 L. per minute per square meter, circulatory support by partial cardiopulmonary bypass with a membrane lung was begun. Acute circulatory failure and acute pulmonary hypertension were promptly reduced by this procedure, and patient's status necessitated only intravenous heparin infusion and mechanical ventilation. After 60 hours of bypass the patient was weaned from the membrane lung, and 1 month later he was discharged from the hospital.

Extracorporeal Circulation↗
PubMed1977

[Hemodynamic profile in acute respiratory distress syndromes in the adult (author's transl)].

Hemodynamic, investigations carried out on 25 patients suffering from acute respiratory distress in the adult established a specific hemodynamic profile for that syndrome, including precapillary pulmonary artery hypertension and systemic arterial hypotension. The level of pulmonary vascular resistance (abnormally high) and systemic arterial resistance (abnormally low) were referred to the cardiac index (which may be increased in some patients due to infusions of Dopamine, or reduced in others due to an veno-arterial bypass). The observed hemodynamic disorders are not related to hypoxemia since this is corrected by permanent positive pressure breathing, or by extracorporeal oxygenation.

Acute Disease↗