Biomedical subjects

Lila Bouadma

Publications and source records attributed to Lila Bouadma.

4 recordsLinked to original sources

PubMed2004

Characteristics and outcomes of HIV-infected patients in the ICU: impact of the highly active antiretroviral treatment era.

OBJECTIVE: To examine whether the introduction of highly active antiretroviral therapy (HAART) has changed the rate of admission, the clinical spectrum, and the mortality of HIV-infected ICU patients. DESIGN: Observational study. SETTING: Infectious diseases ICU in a teaching hospital, Paris, France. PATIENTS: All HIV-infected patients admitted during a pre-HAART era (1995-1996; n=189) and a HAART era (1998-2000; n=236). INTERVENTIONS: None. MEASUREMENTS AND RESULTS: At the HAART era, 79% of patients had derived no or little benefit from the availability of HAART at ICU admission: 44% had no history of antiretroviral (ARV) medications and 35% had failed to respond to ARV. As compared with the pre-HAART era, the rate of hospitalized HIV-infected patients requiring the ICU stay increased (HAART, 5.9% vs pre-HAART, 4.4%; p=0.004). The admission was more likely to occur through the emergency room (45 vs 29%, p=0.0004), and the patients to be foreigners (38.1 vs 28.6%; p=0.04). After adjustment for significant prognostic covariates (AIDS-related tumors at admission, CD4 count <50/mm(3), poor functional status (Knaus score C or D), SAPSII, and need for mechanical ventilation), ICU survival was unchanged (adjusted OR=0.613, 95% CI=0.312-1.206), but 3-month survival was significantly improved (adjusted OR=0.57; 95% CI=0.32-0.99; p=0.045). CONCLUSION: The number of HIV-infected patients admitted to the ICU remained high in the HAART era. Underutilization of HAART and limited access to health care are possible explanations. The ICU mortality has remained unchanged, but 3-month mortality has decreased.

Adult↗

PubMed2004

Infectious and inflammatory dissemination are affected by ventilation strategy in rats with unilateral pneumonia.

OBJECTIVE: To evaluate the effect of V(T) reduction and alveolar recruitment on systemic and contralateral dissemination of bacteria and inflammation during right-side pneumonia. DESIGN: Interventional animal study. SETTING. University hospital research laboratory. SUBJECTS: A total of 54 male Wistar rats. INTERVENTIONS: One day after right lung instillation of 1.4x10(7) Pseudomonas aeruginosa, rats were left unventilated or ventilated for 2 h at low V(T) (6 ml/kg) with different strategies of alveolar recruitment: no PEEP, 8 cm H(2)O PEEP, 8 cm H(2)O PEEP in a left lateral position, 3 cm H(2)O PEEP with partial liquid ventilation, or high V(T) (set such as end-inspiratory pressure was 30 cm H(2)O) without PEEP (ZEEP). After ventilation the lungs, spleen and liver were cultivated for bacterial counts. Global bacterial dissemination was scored considering the percentage of positive spleen, liver and left lung cultures. TNF-alpha was assayed in plasma before and after mechanical ventilation. MEASUREMENTS AND RESULTS: All rats had right-side pneumonia with similar bacterial counts. All mechanical ventilation strategies, with the exception of low V(T)-PEEP 8, promoted contralateral lung dissemination. Overall bacterial dissemination was less in non-ventilated controls (22%) and low V(T)-PEEP 8 (22%) than in high V(T)-ZEEP (67%), low V(T)-PEEP 8 in left lateral position (59%) and low V(T)-ZEEP (56%) ( p<0.05). Partial liquid ventilation prevented systemic bacterial translocation, but at the expense of contralateral bacterial seeding. Plasma TNF-alpha concentration increased significantly after mechanical ventilation with no PEEP at both high and low V(T). CONCLUSIONS: Our results suggest that PEEP might reduce the risk of ventilation-induced bacterial and inflammatory mediator dissemination during pneumonia.

Animals↗

PubMed2004

Ventilation strategy affects cytokine release after mesenteric ischemia-reperfusion in rats.

OBJECTIVE: To evaluate the impact of different ventilation modalities on lung and plasma concentrations of cytokines in a model of secondary lung inflammation, mesenteric ischemia-reperfusion, in rats. DESIGN: Prospective, randomized, controlled animal study. SETTING: Research laboratory of a university. SUBJECTS: Sixty-four male adult Wistar rats weighing 320-380 g. INTERVENTIONS: Eight groups were studied. Two groups underwent no surgical procedure: They were either not ventilated or ventilated with an injurious modality consisting of 30 mL/kg tidal volume (Vt) without positive-end expiratory pressure (PEEP). Animals of the other groups underwent laparotomy with or without 2-hr mesenteric ischemia followed by 4 hrs of reperfusion during which the rats were mechanically ventilated. Ventilation modalities were conventional (tidal volume 10 mL/kg, PEEP 3 cm H2O), protective (6 mL/kg, 6 cm H(2)O), or injurious (tidal volume 30 mL/kg and no PEEP). Rats were killed by exsanguination, and their lungs were excised and homogenized in buffer. Supernatants of lung homogenates and plasmas were stored at -80 degrees C for subsequent measurements. MEASUREMENTS AND MAIN RESULTS: Tumor necrosis factor-alpha, interleukin-1 beta, interleukin-6, macrophage inhibitory protein 2, and interleukin-10 were determined in lung supernatants and plasmas with a rat-specific enzyme-linked immunosorbent assay. Lung and plasma cytokine concentrations were not significantly different between rats ventilated with the injurious modality only and nonventilated rats. Lung and plasma cytokine concentrations were higher in rats that had undergone mesenteric ischemia-reperfusion than in rats with laparotomy only, whatever ventilation modality. Lung and plasma cytokine concentrations were higher in these rats after the injurious ventilation modality than after the other modalities. CONCLUSION: This study shows that an injurious ventilation does not produce significant in vivo release of cytokines in intact animals but promotes the release of pro- and anti-inflammatory cytokines in an inflammatory context.

Animals↗

PubMed2003

Managing SARS.

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Burkholderia pseudomallei↗