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Biomedical subjects

M Rapin

Publications and source records attributed to M Rapin.

At least 73 records · Page 4Linked to original sources
PubMed1978

Hemodynamic effects of dopamine in septic shock with and without acute renal failure.

Hemodynamic response to dopamine hydrochloride in septic shock with myocardial dysfunction was studied in ten patients with normal renal function (group 1) and in ten patients with acute renal failure (group 2). The control hemodynamic data were similar in the two groups. Dopamine in groups 1 and 2 induced significant (P less than .01) and similar increases in cardiac index and mean aortic pressure. Group 1 had a smaller increase in heart rate (+ 16%), than group 2 (+ 24%), but this difference was not significant. Stroke volume index had a significant increase in group 1 (+ 18%), whereas it did not increase significantly in group 2 (+ 4%); this difference of changes in stroke volume index between the two groups was significant (P less than .01). This phenomenon suggests an increased chronotropic effect and/or a reduced inotropic effect of dopamine in patients with septic shock and acute renal failure.

Acute Kidney Injury↗
PubMed1978

Haemodynamic study of patients with severe sepsis during haemodialysis.

A study was performed in order to observe haemodynamic changes induced by haemodialysis in 14 patients with acute renal failure and severe sepsis. Left ventricular function, as assessed by changes in pulmonary wedge pressure and left ventricular stroke work index through plasma volume expansion, did not change during haemodialysis. Ultrafiltration-induced decreases in cardiac index provoked in 8 patients, with nearly normal initial systemic arteriolar resistance, had adequate and constant increase in their resistance (p less than 0.001), whereas 6 patients with low initial systemic arteriolar resistance did not increase their resistance and had a frequent (9/13 measurements) and significant (p less than 0.001) fall in mean aortic pressure. This abnormality of vascular tone is probably due to severe sepsis and explains why hypotension is a frequent occurrence during haemodialysis in such patients.

Acute Kidney Injury↗
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↗
PubMed1978

[Comparative study of the effects of dobutamine and dopamine in septic shock].

This work aims at the evaluation of the effects of dobutamine in the effects of dobutamine in the treatment of septic shock and to compare them to the effects of dopamine used in the same conditions. Eleven patients presenting with both a state of septic shock and confirmed cardiac insufficiency were submitted to the protocol. The dosage was determined by the clinical results : 6.22 microgram/kg/min for dopamine and 4.2 to 25 microgram/kg/min for dobutamine. The results show that although the effect on cardiac output is comparable with the two drugs, some differences in their effects delineates their respective distinct indications. Indeed, although dobutamine seems less arythmic, lovers more the ventricular filling pressure and increases less the intra-pulmonary shunt, dopamine causes less reduction in the systemic resistance which in the case of septic shock seems more logical. Nevertheless dobutamine is perhaps easier to handle.

Blood Pressure↗
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↗
PubMed1977

Haemodynamic effects of dopamine in septic shock.

The Haemodynamic response to dopamine infusion has been assessed in 30 patients in septic shock with myocardial dysfunction. Dopamine infusion resulted in a haemodynamic improvement as indicated by significant increases in cardiac output of 38.4% (p less than .001), stroke volume 18.7% (p less than .001), and mean arterial pressure of 33% (p less than .001). Despite the inotropic effect, left ventricular filling pressure did not change in 20 cases and increased in 10 cases. Mean peripheral resistance remained unchanged with a scatter of individual responses depending upon factors such as dopamine dose and initial vascular resistance. Dopamine increased intrapulmonary shunting by 48% (p less than .001), insignificantly decreased PaO2, increased mixed venous oxygen saturation by 16% (p less than .02) and decreased pulmonary vascular resistance by 15% (p less than .02). Both isoprenaline and dopamine improve stroke volume by an inotropic action, with an increase in venous return in the case of the latter and a reduction in afterload in the former. It is concluded that the usefulness of dopamine in septic shock may be limited in patients with previous myocardial disease because of the risk of increasing preload and in hypoxaemic patients because of the risk of increasing intrapulmonary shunting.

Blood Pressure↗
PubMed1976

[The changes of survival of patients hospitalized in a resuscitation service].

In order to define criteria of prognosis for patients hospitalized in intensive care units, 2105 cases of patients treated for an acute life threatening illness for 4 years were reviewed. According to severity of initial illness, 3 groups were defined: Ist one initial illness, presumably reversible (55,3%), IInd, several initial illnesses presumably reversible (27,7%), IIIrd, one or several initial illnesses, with at least one of them presumably irreversible (17%). Total mortality was 31,3%, significantly lower in women than in men. According to groups, mortality was 8,7% in the Ist, 42,7% in the IInd (p less than 0,0001), 88,8% in the IIIrd (p less than 0,0001). In any group prognosis was influenced by the type of initial disease (respiratory, circulatory, renal or metabolic, septic, neurologic and hepato-digestive failure). In groups I and II mortality was greater when high risk factors exist, and is more and more bad with age, but always minus that 50%. In the group III mortality was the same with or without high risk factors, was not influenced by age, and was always near 90%. For 4 years, mortality significantly lowered in the group II, from 57% to 29%. We conclude that treatment in an intensive care unit of life threatening visceral acute failure has a poor result when this later is related to an chronic or non presumably reversible disorder. In other cases high risk factor, particularly old age, is not a contre indication to treatment in an intensive care unit.

Adolescent↗