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F Wattel

Publications and source records attributed to F Wattel.

At least 37 records · Page 2Linked to original sources
PubMed1994

Carbon dioxide rebreathing method of cardiac output measurement during acute respiratory failure in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To compare measurement of cardiac output by the CO2 rebreathing method vs. the thermodilution cardiac output technique in the setting of acute respiratory failure in patients with chronic obstructive pulmonary disease. DESIGN: Prospective, comparative study of two methods in a consecutive sample. SETTING: Intensive care unit. PATIENTS: Twenty-five patients with chronic obstructive pulmonary disease with acute respiratory failure were studied. The patients were being mechanically ventilated and monitored with systemic and pulmonary artery catheters. MEASUREMENTS AND MAIN RESULTS: Cardiac output was determined, using both the thermodilution technique and an indirect CO2 Fick method. Veno-arterial CO2 content difference was calculated from an estimated mixed venous PCO2 obtained by an equilibrium CO2 rebreathing method and measured PaCO2. PCO2 was converted to content using the equation of the CO2 dissociation curve described by McHardy. A wide range of cardiac output was studied. There was a significant correlation between thermodilution and CO2 rebreathing methods (r2 = .92, p < .001). The mean difference between thermodilution and CO2 rebreathing methods was -0.06 L/min/m2, standard deviation for the bias was 0.028 L/min/m2, and 95% confidence interval for the bias was -0.120 to -0.001 L/min/m2. CONCLUSION: Our results suggest that the CO2 rebreathing method may be a reliable non-invasive technique to determine cardiac output in mechanically ventilated patients with chronic obstructive pulmonary disease.

Acute Disease↗
PubMed1994

Non-invasive measurement of cardiac output in patients with acute lung injury using the carbon dioxide rebreathing method.

STUDY OBJECTIVE: To compare measurement of cardiac output by the CO2 rebreathing method with the thermodilution cardiac output technique in mechanically ventilated patients with acute lung injury. DESIGN: Prospective study comparing two methods of cardiac output measurement in 22 consecutive patients with acute lung injury. SETTING: Intensive care unit of a university hospital. PATIENTS: Twenty-two mechanically ventilated patients with acute lung injury monitored with systemic and pulmonary artery catheters. MEASUREMENTS AND RESULTS: Cardiac output was determined using both the thermodilution technique and an indirect CO2 Fick method. Veno-arterial CO2 content difference was calculated from an estimated mixed venous CO2 tension obtained by an equilibrium CO2 rebreathing method and measured arterial CO2 tension. Carbon dioxide pressure was converted to content using the equation of the CO2 dissociation curve described by McHardy. A wide range of cardiac index was studied from 2.7-5.7 l/min/m2. There was a significant correlation between thermodilution and CO2 rebreathing methods (r2 = 0.82, p < 0.01). The mean difference between the CO2 rebreathing method and thermodilution was 0.05 l/min/m2, with a standard deviation for the bias of 0.38 l/min/m2. CONCLUSION: Our results suggest that the CO2 rebreathing method may be a reliable non-invasive technique to determine cardiac output in mechanically ventilated patients with acute lung injury.

Carbon Dioxide↗
PubMed1993

Pedicle musculocutaneous flap transplantation: prediction of final outcome by transcutaneous oxygen measurements in hyperbaric oxygen.

In pedicle musculocutaneous flaps, a local circulatory insufficiency with a total or subtotal ischemia may occur and jeopardize the result of the reconstructive surgery. Transcutaneous oxygen pressure (PtcO2) monitoring has been shown to reflect tissue perfusion and has been advocated to predict the final outcome of ischemic flaps. Unfortunately, under normal atmospheric conditions, this test is not sufficiently discriminative. We evaluate the effect of hyperbaric oxygen conditions on the efficiency of this test. Fifteen patients with pedicle musculocutaneous flap were evaluated by clinical examination and transcutaneous oxygen tension measurements. The final outcome was healing in 7 and failure in 8. In order to determine the predictive value of transcutaneous oxygen tension, measurements were done immediately after the surgical procedure. In ambient air, neither the absolute value of transcutaneous oxygen tension (2.6 +/- 3.6 versus 11.7 +/- 12.6 torr; N.S.) nor the difference or the ratio between the transcutaneous oxygen tension of the flap and the subclavicular reference shows any significant difference according to the outcome (failure or success). The same is true in normobaric oxygen. In hyperbaric oxygen, however, there is a significant difference in transcutaneous oxygen tension between the two groups (12 +/- 12 versus 378 +/- 385 torr; p < 0.01). A transcutaneous oxygen tension higher than 50 torr in hyperbaric oxygen (2.5 atm abs) is the best cutoff value to discriminate success from failure.

Adult↗
PubMed1992

Massive arsenic poisoning--effect of hemodialysis and dimercaprol on arsenic kinetics.

In massive arsenic poisoning, the use of hemodialysis and dimercaprol (BAL) therapy is still controversial. Hemodialysis is thought of value only for supportive care. BAL therapy has been criticized because of its delayed action, its own toxicity and its possible influence on arsenic clearance during hemodialysis. We studied arsenic kinetics during an acute suicidal intoxication (10 g of sodium arsenate). Treatment included gastric lavage, oral charcoal and supportive measures. Hemodialysis was performed immediately and repeated the next day. BAL therapy was prescribed only on the second day. Cardiovascular collapse, anuria and hepatic disturbance recovered in a few days and the patient could be discharged on the 15th day. Instantaneous serum arsenic hemodialysis clearance was 85 +/- 75 ml/min without previous BAL injection and 87.5 +/- 75 ml/min with a previous 250 mg BAL injection (difference not significant) indicating that BAL did not impede arsenic dialysis. The calculated total hemodialysis clearance of arsenic was higher than mean serum hemodialysis clearance indicating that erythrocyte bound arsenic is also eliminated during dialysis. We propose to consider early hemodialysis as an elimination measure in massive arsenic poisoning and to choose BAL as a chelator when dialysis is required.

Adult↗
PubMed1992

[Role of hyperbaric oxygenation in the treatment of acute anaerobic infections].

Hyperbaric oxygenation (HBO), as an adjuvant treatment in necrotizing soft tissues infections and in gas gangrene is reviewed, including its specific effects, experimental studies and clinical reports. With a global therapeutic management, considered as an emergency state, including surgery, antibiotic regimens and HBO, we can obtained 50% mortality and morbidity decrease with a more conservative surgery. Finally, favorable outcome is associated with early therapeutics and localization of the initial necrotizing infection.

Acute Disease↗
PubMed1991

[Pseudosurgical acute abdomen syndrome in primary pulmonary hypertension].

The case is reported of a 49-year-old chronic alcoholic woman, who presented with severe pulmonary arterial hypertension (PAH) mimicking as an acute abdomen. She was admitted with right-sided hypochondrial abdominal pain and hepatomegaly, with a moderate jaundice. On admission to intensive care unit, she had an arterial blood pressure of 110/70 mmHg, a heart rate of 100 b.min-1, and a respiratory rate of 36 c.min-1. An electrocardiogram showed sinus rhythm and right-sided heart failure. Whilst breathing 6 l.min-1 oxygen, her arterial blood gases were: PaO2 47 mmHg PaCO2 29 mmHg. Severe PAH was confirmed by measuring her mean pulmonary arterial pressure, which was 46 mmHg, whilst her pulmonary wedge pressure was 7 mmHg. Hepatic function was also altered: total bilirubin 41 mumol.l-1, alkaline phosphatase 145 UI.l-1 and gamma glutamyl transferase 1 340 UI.l-1. She developed arterial hypotension, which did not respond to increasing doses of isoproterenol. She died on the third day. Necropsy confirmed the diagnosis of primary PAH, with acute "cardiac liver".

Abdomen, Acute↗
PubMed1991

Effects of bicarbonate therapy on hemodynamics and tissue oxygenation in patients with lactic acidosis: a prospective, controlled clinical study.

OBJECTIVE: To determine whether correction of acidemia using bicarbonate improves hemodynamic variables and tissue oxygenation in patients with lactic acidosis. DESIGN: Prospective, randomized, blinded, cross over study. Each patient sequentially received sodium bicarbonate and sodium chloride. The order of the infusions was randomized. PATIENTS: Ten patients with metabolic acidosis, increased arterial plasma lactate concentrations (greater than 2.45 mmol/L), and no severe renal failure (creatinine less than 250 mumol/L [less than 2.3 mg/dL]). METHOD: Sodium bicarbonate (1 mmol/kg body weight) or equal volume of sodium chloride was injected iv at the beginning of two successive 1-hr study periods. Period order was randomized. Arterial and venous blood gas measurements, plasma electrolytes (sodium, potassium, chloride), osmolality and lactate, 2,3-diphosphoglycerate (DPG), and oxygen hemoglobin affinity, hemodynamic variables, oxygen delivery, and oxygen consumption measurements were obtained before and repeatedly during the 1-hr period after the injection of bicarbonate or sodium chloride. MEASUREMENTS AND MAIN RESULTS: Sodium bicarbonate administration increased arterial and venous pH, serum bicarbonate, and the partial pressure of CO2 in arterial and venous blood. Hemodynamic responses to sodium bicarbonate and sodium chloride were similar. Tissue oxygenation (as estimated by oxygen delivery, oxygen consumption, oxygen extraction ratio, and transcutaneous oxygen pressure) was not modified. No changes in serum sodium concentration, osmolality, arterial and venous lactate, red cell 2,3-DPG levels, or hemoglobin affinity for oxygen were observed. CONCLUSION: Administration of sodium bicarbonate did not improve hemodynamic variables in patients with lactic acidosis, but did not worsen tissue oxygenation.

Acidosis, Lactic↗
PubMed1991

[TNF and sepsis].

Recent experiments have demonstrated that TNF plays an important role in the pathogenesis of septic shock. To confirm the involvement of TNF in human septic shock, serum TNF levels were measured in 10 adult patients admitted to the intensive care unit for sepsis with or without shock. Septic shock was corroborated by hemodynamic data (right catheterization, measurement of cardiac output by thermodilution). For TNF measurement, venous blood samples were withdrawn, as soon as possible after the onset of sepsis, into a pyrogen--free tube. Serum TNF levels were determined using a radioimmunoenzymatic assay (IRE Medgenix). During septic shock (n = 7), TNF levels were significantly higher (m = 354 +/- 131 pg/ml) than during sepsis without shock (n = 8; m = 145 +/- 35 pg/ml) (p less than 0.0005). TNF levels were also significantly higher in non-survivors (m = 392 +/- 111 pg/ml) than in survivors (m = 167 +/- 81 pg/ml) (p less than 0.0005). The value of 250 pg/ml seems to be critical: no patient without shock had TNF levels above 250 and all the patients who died early during the first 24 h) had TNF levels above 250. The TNF level is negatively correlated with the platelet count (r = -0.70; p less than 0.05). These data favor a pathophysiological for TNF in human sepsis and septic shock.

Adolescent↗
PubMed1990

Post-traumatic limb ischemia: prediction of final outcome by transcutaneous oxygen measurements in hyperbaric oxygen.

In limb injuries (amputation, laceration injuries, or compartment syndrome), a circulatory insufficiency with a total or subtotal ischemia may occur and jeopardize the result of reconstructive surgery. Transcutaneous oxygen monitoring has been shown to reflect tissue perfusion and has been advocated to predict the final outcome of major vascular trauma of the limb. Unfortunately, in normal atmospheric conditions, this test is not sufficiently discriminative; we evaluate the effect of hyperbaric oxygen on the efficiency of this test. 23 patients with major vascular trauma of the limbs were evaluated by clinical examination and transcutaneous oxygen pressure (PTCO2) measurements. Sixteen had arterial repair and seven had clinical evidence of peripheral ischemia without an arterial lesion. In normal air, the transcutaneous oxygen values in the traumatized limb, of these 23 patients, were significantly lower than in the nontraumatized limb. But neither the absolute PTCO2 value nor the ratio between the traumatized limb's PTCO2 and that of the nontraumatized one can predict the final outcome (amputation). In hyperbaric oxygen (2.5 ATA), this ratio is significantly higher in the group where the surgery will succeed than in the group where final amputation will be needed (81.2 +/- 26.0 vs. 15.2 +/- 13.1; p less than 0.01). The overall sensitivity and specificity of prediction of the limb's final outcome when the bilateral PTCO2 ratio in 2.5 ATA pure oxygen is less than 0.40, are 100% and 94%, respectively. But what is perhaps more interesting is that, when considering a ratio value of less than 0.20, amputation can be predicted with a 100% true predictive value.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

Hyperbaric oxygen therapy in chronic vascular wound management.

Many nonhealing tissues are hypoxic, with oxygen tensions frequently ranging from 5 to 15 mmHg. In such an environment, the normal wound healing sequence is disrupted or halted and phagocytic killing activity depressed. So the adjunctive use of hyperbaric oxygen (HBO), based on physiologic data and clinical observations, can provide the substrate necessary to initiate and sustain the healing process. During a twelve-month period, 20 patients with a nonhealing wound were referred to the hyperbaric center: chronic arterial insufficiency ulcers in 9 cases, diabetic wounds (foot lesions) in 11 cases. Adjunctive HBO therapy, initiated twice a day, consisted of pure oxygen, 2.5 ATA, 90 min. The average length of sessions was 46 (15-108). Complete healing was observed in 15 of 20 cases. The wound management can be helped with the transcutaneous oxygen measurements under hyperbaric oxygen. The distal TCPO2 at 2.5 ATA pure oxygen is a reliable test to predict final outcome (healing or no change), when these values were not different in normal air and in normobaric oxygen: (table; see text) In hyperbaric oxygen therapy, when the distal TCPO2 value was inferior to 100 mmHg, all patients showed either no improvement or aggravation, and when the value was higher than 100 mmHg, wound healing was achieved with all patients.

Blood Gas Monitoring, Transcutaneous↗
PubMed1990

[Hyperbaric oxygen therapy in the treatment of wounds, in plastic and reconstructive surgery].

After recalling the mechanism of action of hyperbaric oxygen (HBO) on healing processes, the authors review the principal indications for this technique in plastic and reconstructive surgery, such as crush injuries and acute post-traumatic ischemia of the limbs, skin flaps and skin grafts, when there is a risk of their not taking, and burns. They stress the importance of strict, stratified therapeutic protocols with control of the hyperoxygenation induced by HBO. In the authors' experience, transcutaneous measurements of the partial pressure of oxygen under the hyperbaric atmosphere is a very useful method with a predictive value to determine the indications for treatment with HBO and to monitor its effects.

Blood Gas Monitoring, Transcutaneous↗
PubMed1989

[Nosocomial bronchopneumopathies].

Nosocomial bronchopulmonary infections are common and severe complications, particularly in intensive care units. The high incidence of pneumonia is related to multiple factors such as underlying disease, acute respiratory failure, nutritional disorders, depressed mental status and the frequent need tracheal intubation. The most frequent cause of respiratory tract infection is aspiration of oropharyngeal secretions. In hospitalized patients, there is usually an oropharyngeal colonization with Gram-negative bacteria. Prevention of nosocomial bronchopulmonary infections requires close attention to the patient's environment, proper techniques, handwashing and decontamination of respiratory equipment.

Bronchial Diseases↗