Search PubMed⌕ Search

Biomedical subjects

J P Fosse

Publications and source records attributed to J P Fosse.

9 recordsLinked to original sources
PubMed1992

Effects of doxapram on hypercapnic response during weaning from mechanical ventilation in COPD patients.

Failure of weaning from mechanical ventilation in COPD patients is often related to diaphragmatic fatigue. Whether there is a central respiratory drive fatigue and a reserve of excitability is still debated. The purpose of this study was to analyze the following in 13 COPD patients weaned from mechanical ventilation: (1) ventilatory (VE/PETCO2) and neuromuscular (P0.1/PETCO2) response to hypercapnia; (2) the maximum reserve capacity measured through changes in the VE/PETCO2 and P0.1/PETCO2 slopes after doxapram (DXP) infusion, which, given during the test, allows measurement of the maximum response capacity to overstimulation; and (3) analyze the influence of these changes on the outcome of weaning. The results show a variable P0.1/PETCO2 response and a low VE/PETCO2. DXP infusion does not change the slopes of these relations but increases the end-expiratory volume (delta FRCd); (p less than 0.02). Since there was no change in the VE/PETCO2, P0.1/PETCO2, and delta FRC values with or without DXP, there was no excitability reserve in patients who were successfully weaned. When weaning failed, DXP did not change VE/PETCO2 and P0.1/PETCO2 slope, but delta FRCd was greater the delta FRC (p less than 0.001). The excitability reserve in these patients leads to an increase in end-expiratory volume, probably worsening the diaphragm dysfunction.

Aged↗
PubMed1989

Steady-state breathing pattern responses to small inspiratory resistive loads in COPD patients. Application to weaning from mechanical ventilation.

We investigated the effect of small inspiratory resistive loads on the breathing patterns of patients with COPD admitted to the ICU for acute respiratory failure. Patients were in stable clinical condition three days after weaning from the acute-phase ventilation. Healthy nonsmokers served as controls. Breathing patterns were recorded for 20-min periods during unloaded breathing (R0), then with small inspiratory resistive loads (R1 = 2.5 cmH2O L/s and R2 = 5.2 cmH2O L/s) applied in random order. Respiratory parameters were memorized in real time and blood gases measured continuously with a transcutaneous PO2/PCO2 monitor and compared periodically with arterial blood gases. Minute volume (VE) and respiratory rate decreased with no modification in blood gas values. In the COPD patients, R1 was too small to be perceived; when R2 was applied, no increase in TI was observed, and VT and VT/TI decreased. The VE could not be maintained despite a shortening of expiratory time. The COPD patients did not have significant increase of occlusion pressure (P0.1). Mean blood gas values did not change during the testing, but the coefficient of variation of tcPCO2 increased. During the critical period following weaning from artificial ventilation, COPD patients did not respond in the same manner as normal subjects to inspiratory resistive loads, but did not have modified gas exchange during the 20-min period.

Aged↗
PubMed1989

[Severe cardiac decompensation: value in the early hours of a combination of amrinone and dobutamine].

Ten patients with severe chronic heart failure (class III and IV of the NYHA classification) received treatment for severe heart failure with dobutamine (10, then 15 micrograms.kg-1.min-1), then with dobutamine combined with amrinone (7.5, then 10 micrograms.kg-1.min of each). Used alone, dobutamine improves cardiac performance (cardiac index from 1.8 +/- 0.24 l.min-1.m-2 to 2.65 +/- 0.44 l.min-1.m-2). These results are further improved when amrinone is associated with dobutamine. Blood pressure increases with dobutamine and no decrease is recorded when amrinone is introduced, despite a gradual decrease in systemic arterial resistances. Pulmonary artery wedge pressure shows a significant decrease only when the strongest dose of the combined drugs is used. However, this positive effect is counterbalanced by an increase in pulse frequency. Side effects, be it on the blood count (platelets count reduced from 255,600 +/- 3974 mm-3 to 207,400 +/- 3380 mm-3 with no clinic sign) or cardiovascular activity (one case of premature ventricular contraction; one case of transient junctional rhythm), do not require the suspension of treatment. Thus, the dobutamine-amrinone combination treatment seems a promising one.

Aged↗
PubMed1989

[Uncommon collapse].

Explore the source record for details and available documents.

Adrenal Gland Neoplasms↗
PubMed1989

[Hyperoxia test during attempts to withdraw artificial ventilation].

A 30 minute test of hyperoxia (10 l.min-1) was conducted in patients (n = 21) with chronic obstructive lung disease during the weaning trials from mechanical ventilation. Two groups were formed according to whether the occlusion pressure at 100 ms (PO.1), index of central stimulation, decreased or not during the test. The first group lowered PO.1 and increased PaCO2 by decreasing VE (minute-ventilation), VA (alveolar ventilation) and increasing the VD/VT ratio; the others had a lower PO.1 and did not modify it after administration of 02 despite a lowered PaO2 initially identical to that in the first group. They held PaCO2 constant by increasing VE and by maintaining VA in relationship with an improvement in diaphragm contractility and/or a better response to hypercapnia stimulus. All the patients is this group were successfully weaned eight days after the study period.

Aged↗