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H Gastinne

Publications and source records attributed to H Gastinne.

16 recordsLinked to original sources
PubMed1992

A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. The French Study Group on Selective Decontamination of the Digestive Tract.

BACKGROUND: Selective decontamination of the digestive tract with topical nonabsorbable antibiotics has been reported to prevent nosocomial infections in patients receiving mechanical ventilation, and the procedure is used widely in Europe. However, it is unclear whether selective decontamination improves survival. METHODS: We conducted a randomized, double-blind multicenter study in which 445 patients receiving mechanical ventilation in 15 intensive care units were given either prophylactic nonabsorbable antibiotics (n = 220) or a placebo (n = 225). Topical antibiotics (tobramycin, colistin sulfate, and amphotericin B) or a placebo was administered through a nasogastric tube and applied to the oropharynx throughout the period of ventilation. The main end points were the mortality rate in the intensive care unit and within 60 days of randomization. RESULTS: A total of 142 patients died in the intensive care unit; 75 (34 percent) in the treatment group and 67 (30 percent) in the placebo group (P = 0.37). Mortality within 60 days of randomization was similar in the two groups (P = 0.40), even after adjustment for factors that were either unbalanced or individually predictive of survival in the two groups (P = 0.70). Pneumonia developed in 59 patients (13 percent) in the intensive care unit within 30 days of enrollment in the study (33 in the placebo group and 26 in the treatment group, P = 0.42). Pneumonia acquired in the intensive care unit and due to gram-negative bacilli was less frequent (P = 0.01) in the treatment group than in the placebo group. The total charges for antibiotics were 2.2 times higher in the treatment group. CONCLUSIONS: Selective decontamination of the digestive tract does not improve survival among patients receiving mechanical ventilation in the intensive care unit, although it substantially increases the cost of their care.

Administration, Topical↗
PubMed1992

[Perceptions of consequences of chronic respiratory insufficiency in subjects over 65 years with home respiratory assistance. Apropos of 85 patients].

Chronic respiratory diseases (C.R.D.) induce changes in daily activities and mood for the patients who require respiratory assistance (oxygen delivery or ventilation). The aim of this study was to compare physical and social consequences of this disease. A self administered questionnaire was sent to one hundred patients, over sixty five years of age, who were affiliated with the "Association Limousine d'Aide aux Insuffisants Respiratories" (A.L.A.I.R.). The mean age was 72.4 +/- 0.66 (65-92), the mean PaO2 was 54 mm Hg +/- 0.2 (39-76). C.R.D. was stable during the study and treatments did not change. The questionnaire was composed of four scales and twenty-eight subjects; each item was weighed for importance. Subjects included: symptoms, mood, sleep, relationships with their wife or family, home activities. Eighty-five questionnaires were analysed. Reproductibility was good (92%) and non-responses to some questions was less than 10%. Coherence between the scales and the twenty-eight items was poor. Regression linear analysis found that only dyspnea was correlated with PaO2 (p < 0.007). For patients, the most important items were: abnormalities of home activities (37%), dyspnea (38%), relationships with their wife (39%) or family (45%), dependence (52%) and perception of A.L.A.I.R. (77%). Quality of life is an important concept for these patients with C.R.D. versus clinical symptoms. Perception of respiratory assistance is very good.

Activities of Daily Living↗
PubMed1991

Antibiotic levels in bronchial tree and in serum during selective digestive decontamination.

Selective digestive decontamination has been found to prevent pulmonary infections in mechanically ventilated patients. The aims of this study were: 1) to determine whether detectable levels of antibiotics could be found in bronchial tree secretions of patients receiving SDD, and 2) to evaluate antibiotic serum levels. In 15 patients receiving mechanical ventilation and SDD for 10 days or more, tobramycin and amphotericin B levels were determined every 3 days in the following specimens: tracheal aspirates, distal bronchial secretions and blood samples. 82% of tracheal aspirates contained detectable (greater than 0.18 mg/l), tobramycin concentrations; the levels varied widely between patients and large day-to-day variations were observed. Every patient had at least 1 tracheal aspirate with tobramycin level higher than 0.5 mg/l during his course. 40% of distal specimens contained detectable tobramycin levels (10 patients). Serum determinations showed detectable concentration of tobramycin in 50% of the specimens (9 patients). Two patients with renal failure had serum tobramycin levels higher than 2 mg/l. In 13 tracheal aspirates cultures were positive and 15 species were isolated; 13 had a MIC higher than the corresponding tobramycin level in tracheal secretions. We conclude that substantial levels of antibiotics can be found frequently in respiratory tract specimens of patients receiving SDD. Therefore, the usual microbiological criteria used to assess respiratory tract infection may be unreliable in this setting and other criteria may be required. Follow-up of antibiotic serum levels is required, especially in patients with renal failure.

Acute Kidney Injury↗
PubMed1988

Unilateral diaphragmatic dysfunction in blunt chest trauma.

This study was undertaken to evaluate unilateral diaphragmatic dysfunction within ten days after blunt chest trauma. Thirty patients with unilateral chest injury, or predominantly one-sided injuries, were investigated in the supine position, under analgesia. Right and left hemidiaphragm displacement (DD) was measured, using digital subtraction radiography, during quiet and forced breathing. The diaphragmatic contribution to breathing was determined by rib cage and abdominal circumference measurement changes. In both breathing modes, DD of the injured side was lower than DD of the uninjured side (p less than 0.01, p less than 0.001). Six patients had complete diaphragmatic motionlessness. The inspired air volume due to diaphragmatic motion (Vab) was reduced when compared to normal subjects and Vab/VT ratio was always found to be less than 0.65. The degree of diaphragmatic dysfunction appeared related to injury location and is most severe in injuries of the lower chest which implies direct diaphragm muscle injury, although other mechanisms may be implicated. Diaphragmatic dysfunction can contribute to respiratory failure in these patients, and should be considered.

Diaphragm↗
PubMed1984

A simple radio-isotopic method for the detection of bronchial inhalation during intensive care.

The high incidence of pneumopathy in intensive care units might be due to the pulmonary aspiration of gastric juice following gastro-oesophageal reflux. The paper describes a radio-isotopic method using material easy to install at the patient's bedside. This technique demonstrated aspiration of gastric juice in the lungs of 8 of 25 intensive care patients investigated. Such a method might be useful later to demonstrate that silent bronchial aspirations of gastric juice are responsible for pulmonary complications.

Humans↗
PubMed1982

[Oesophagitis during mechanical ventilation].

Twenty-one patients whose condition required mechanical ventilation with nasogastric intubation were investigated for oesophagitis before the 3rd day and on the 15th day of treatment, including endoscopy and biopsy. Lesions of oesophagitis were detected in 14 cases during the initial examination and in 19 cases on the second endoscopy. The course of the lesions varied from one patient to another and appeared to be unrelated to the course of the primary disease. Oesophagitis in these patients is probably due to frequent episodes of gastro-oesophageal reflux encouraged by cough, impaired consciousness and the presence of a tube. Reflux may also be the cause of inapparent and recurrent lung aspiration.

Adult↗
PubMed1981

[Evaluation of a method for the measurement of static total compliance (Siemens Elema LMC 940 calculator)].

The aim of the present study was to validate the method for the measurement of total compliance proposed by Siemens Elema. The pressure and flow signals of the Servo 900 respirator are treated by an LMC-940 calculator. 1 - A study with a pulmonary model was used to evaluate the applicability of the measuring techniques used by the calculator. Tele-inspiratory alveolar pressure is accurately assessed for successive measurements of inspiratory resistance if the interruption of inspiratory flow is at least 0.3 seconds. Tele-expiratory alveolar pressure is accurately interpreted even if flow at the end of expiration is not nil, as long as airway resistance remains constant. The error in measurement of tidal volume depends in part upon the compression relaxation effect of gases in the circuit. The device used to compensate for this effect is effective up to a tele-inspiratory pressure of 1.96 kPa (20 cm H2O). Beyond this pressure, tidal volume is overestimated. The error is small, if the time after which the flow is integrated is 130 ms. For shorter periods, the correction is less satisfactory. 2 - A study in eight patients was used to assess the validity of 38 measurements of Ctot on the respirator in comparison with contemporary measurements made under static conditions using a syringe. A highly significant linear correlation was seen between values of Ctot obtained by the two methods: Ctot syringe = 0.94 X Ctot calculator = 0.55 ml.cmH2O-1. (n = 38; r = 0.95; p less than 0.001). The mean error of the calculator for a given reference value was 0.099 l.kPa-1 (9.65 ml.cmH2O-1). There was a closer relation for variations in Ctot recorded by the two methods. Variations were always in the same sense, and their correlation was highly significant (n = 19; r = 0.98; p less than 0.001). Such a method for the surveillance of compliance is extremely easy. The accuracy of absolute values for Ctot is limited but it is a reliable method for following variations in compliance and hence the effects of treatment.

Evaluation Studies as Topic↗
PubMed1981

[Compared results of flail chests treatments : standard internal pneumatic stabilization, new technics of assisted ventilation, osteosynthesis (author's transl)].

The analysis of 170 cases of flail chests, divide into three groups according to the type of treatment, proves the efficiency of the new technics of assisted ventilation and of the osteosynthesis by Judet clasps. The most significant advantages of those two complementary methods are a lowered mortality rate and a reduced frequency of refractory hypoxy and infectious complications.

Adult↗
PubMed1978

Hypovolaemic shock with oedema due to increased capillary permeability.

A case of severe hypovolaemic shock related to idiopathic oedema was observed in a 37 year old woman. Large plasma volume expansion (nearly 12 1 over 9 hours) did not change the clinical status. Haemodynamic studies showed low cardiac index (1.1 1/min/m2), decreased left ventricular stroke work index (6.7 gm/m2), and high systemic arterial resistance (52 mmHg/1/min/m2). Dopamine infusion improved the haemodynamic condition which returned to normal 30 hours after the beginning of shock. After recovery, capillary permeability measured by a modification of Landis' method was markedly increased. A study of albumin metabolism showed a normal intravascular pool and a rapid exchange compartment with a twofold increase in slow exchange compartment. Hormonal levels and complement fractions were within normal limits. Serum protein immuno-electrophoresis showed an abnormal IgG. These results clearly demonstrate that hypovolaemia is related to increased capillary permeability and leakage of albumin out of the vascular space. When large infusions fail, inotropic agents, especially Dopamine, should be used in such cases.

Adult↗