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X Viviand

Publications and source records attributed to X Viviand.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Survey of 39 South East Group hospital centers on the practice of antibiotic prophylaxis in surgery].

A survey was carried out in 39 hospitals regarding the prescribing of perioperative antibiotics. The day of the survey, hospital pharmacists collected information on prescription patterns of antibiotics and, for 3 days, the duration of their administration. A total of 1,131 cases were surveyed, originating from digestive surgery (20%), orthopaedics (31%), gynaecology (15%), ophthalmic surgery (15%), and others (19%). Duration of surgery was 72 +/- 68 min. For all types of surgeries, antibiotics not recommended by the French consensus conference were prescribed. Third generation cephalosporins were used in 17% of patients in gynaecological surgery. In 20% of cases, antibiotics were administered at an inappropriate time: 9.5% after the beginning of surgery, 8% at the time of pre-medication, and 2.5% the day before surgery. Administration exceeded 48 hours in 10% of the cases. In conclusion, special attention should be paid to limit the prescription of third generation cephalosporins, to inject antibiotic at the induction of anaesthesia and to reduce the duration of their administration.

Antibiotic Prophylaxis↗
PubMed1998

Effects of trimebutine on sphincter of Oddi motility in patients with post-cholecystectomy pain.

BACKGROUND: Trimebutine is an opiate modulator of the gastrointestinal motility that interacts with enkephalinergic receptors. AIM: To evaluate the effects of trimebutine (50 mg intravenous injection) on the motility of the sphincter of Oddi (SO) as assessed by endoscopic manometry. METHODS: Endoscopic manometry was performed on 15 cholecystectomized patients who presented with symptoms suggestive of SO dysfunction. Prior to the endoscopic manometry, endoscopic ultrasonography was performed in order to rule out the possible presence of a bile duct stone. RESULTS: Injecting trimebutine resulted in a significant increase in the SO antegrade phasic contraction rate (P = 0.02). Trimebutine decreased the basal pressure of the SO (32.5 vs. 27.5 mmHg), but the difference is not statistically significant (P = 0.11). The effects of trimebutine differed depending on the basal SO motility anomalies involved, but the period of latency was similar (mean 89 s: range 30-240 s). The basal anomalies were an increased basal SO pressure of > 40 mmHg in three patients, a tachyoddia (frequency of phasic contractions (PC) > 10/min) in six patients, prolonged PC (> 10 s) in two patients and an absence of phasic contraction in one patient. The basal pressure of the SO decreased in the three patients presenting with SO hyperpressure, but returned to a normal value in one case. The frequency of the PC decreased to normal in three out of the six patients with tachyoddia. The duration of the PC returned to normal in the two patients with prolonged PC whereas their frequencies increased. Prolonged PC developed in the patient without any detectable phasic contraction. CONCLUSIONS: Trimebutine modulates SO motility in various ways depending on the basal SO motility anomaly observed after cholecystectomy. This regulatory effect suggests the existence of encephalinergic control of SO motility.

Adult↗
PubMed1998

Preservation of humidity and heat of respiratory gases in spontaneously breathing, tracheostomized patients.

BACKGROUND: Ventilation with endotracheal intubation bypasses the upper airway and the normal heat and moisture exchanging process of inspired gases. A continuous loss of moisture and heat occurs and predisposes patients to serious airway damage. We therefore prospectively studied one heated humidifier system, one cold humidifier system and one heat and moisture exchanger in spontaneously breathing, tracheostomized intensive care unit patients to determine the ability to preserve patients' heat and water. METHODS: Following a randomized order, 10 patients were spontaneously ventilated for 24-h periods with the Nam 35 humidifier (Europe Medical, France, a cold water humidifier), the heat and moisture exchange Trach-Vent (Gibeck, Sweden), and the Aerodyne humidifier (Kendall USA). In each patient, during the inspiration phase, the following measurements were performed: mean values of temperature and relative humidity of inspired gases. The absolute humidity was calculated. Values were obtained in each patients after 40 min and 24 h. RESULTS: The Trach-Vent filter and the Aerodyne humidifier had better humidification and thermic capacities than the Nam 35 humidifier (P < 0.001). With the Nam 35 humidifier, no patient had temperature of inspired gas > 29 degrees C. Concerning absolute humidity of inspired gases, the Nam 35 humidifier achieved a lower performance than the other two tested systems (P < 0.001). CONCLUSION: In spontaneously breathing, tracheostomized intensive care unit patients, the Trach-Vent heat and moisture exchanger and the Aerodyne heated system achieved satisfactorily preservation of heat and humidity of inspired gases.

Body Temperature↗
PubMed1998

Comparing two heat and moisture exchangers, one hydrophobic and one hygroscopic, on humidifying efficacy and the rate of nosocomial pneumonia.

OBJECTIVE: Many heat and moisture exchangers with filter (HMEF) have been developed. In-house data from companies provide some information about their performances; unfortunately, to our knowledge, no comparative evaluation in clinical conditions has been undertaken of these newer products. The aim of this study was to compare the efficiency of two HMEFs, one hydrophobic and one hygroscopic, on humidifying capacity and the rate of bronchial colonization and ventilator-associated pneumonia in ICU patients. DESIGN: Prospective, randomized study. SETTING: ICU of a university hospital. PATIENTS: All patients who required mechanical ventilation for > or = 24 h during the study period. INTERVENTIONS: On admission to the ICU, patients were randomly assigned to one of two groups. In one group, the patients were ventilated with a hygroscopic device (Humid-Vent Filter Light HMEF; Gibeck; Upplands Vaesby, Sweden). The condensation surface was made of paper (Microwell) impregnated with CaCl2. The filter membrane was made of polypropylene. In the other group, the patients were ventilated with a hydrophobic device (Pall BB100 HMEF). The condensation surface was made of a hydrophobic resin with a hydrophylic layer. The filter membrane was made of ceramic fibers. In both groups, HMEFs were changed daily. MEASUREMENTS AND RESULTS: Both groups of patients were similar for the tested characteristics, including parameters of mechanical ventilation. Sixty-six patients were ventilated for 11.7+/-11 days with the Humid-Vent Filter Light HMEF and 70 patients for 12.2+/-12 days with the Pall BB 100. Patients ventilated with the Humid-Vent Filter Light underwent 6.0+/-3.0 tracheal aspirations and 1.7+/-2.0 instillations per day, and those with the Pall BB 100, 6.0+/-3.0 and 1.6+/-2.0 per day, respectively (not significant [NS]). Abundance of tracheal secretions, presence of blood, and viscosity, evaluated by semiquantitative scales, were similar in both groups. No difference in the rate of atelectasis was observed between the two groups (7.5% and 7.1%, NS). One episode of tracheal tube occlusion was observed with the Humid-Vent Filter Light HMEF, and one with the other HMEF (NS). One patient in each group (NS) was switched to an active heated humidifier because of very tenacious bronchial secretions despite repeated instillations. Tracheal colonization was observed at a rate of 67% with the Humid-Vent Filter Light and 58% with the Pall BB 100 (NS). A small, but NS difference was observed in the rate of ventilator-associated pneumonia: Humid-Vent Filter Light, 32% (27.1 per 1000 ventilator days); and Pall BB 100, 37% (30.4 per 1000 ventilator days). Bacteria responsible for tracheal colonization and pneumonia were similar in both groups. Three patients in each group died from their nosocomial pneumonia. CONCLUSION: Despite differences in their components, the two HMEFs tested achieved similar performances in terms of humidification and heating of inspired gases. Only one episode of endotracheal tube occlusion was detected and very few patients (one in each group) had to be switched to an active heated humidifier. No difference was observed either in the rate of tracheal colonization or of ventilator-associated pneumonia. These data show that the hygroscopic HME (Humid-Vent Filter Light) and the hydrophobic HME (Pall BB 100) are suited for use in ICU patients.

Adult↗
PubMed1997

[Target-controlled intravenous anesthesia].

Target-controlled infusion (TCI) is a new delivery system for i.v. anaesthetic agents with which the anaesthetist targets a plasma drug concentration to achieve a predetermined effect. With this system, the tedious task of calculating the amount of administered drug required to achieve the target concentration is left in charge of a microprocessor which commands the infusion device. TCI has long been used only by a few research teams, but this year a much wider field opens to this delivery system through marketing of Diprifusor, a TCI system specifically designed for administration of propofol in everyday practice. This article describes the rationale for administering i.v. agents through TCI delivery systems, the pharmacokinetic basis of TCI, the regulations and a broad overview of clinical applications, both recent and yet to come.

Anesthesia, Intravenous↗
PubMed1997

Study of some phagocyte membrane receptors in patients receiving intravenous polyvalent immunoglobulins as adjunct treatment for nosocomial pneumonia.

PURPOSE: Phagocytosis is a major mechanism of defense against bacterial infections. The ingestion of bacteria by phagocytes involves a variety of cell membrane recognition structures and, among them, immunoglobulin receptors. The aim of this study was to test the phagocytic activity of granulocytes and monocytes of intensive care unit (ICU) patients, and to evaluate the effects of intravenous polyvalent immunoglobulins (IVIG) used as adjunct treatment of nosocomial pneumonia on some phagocyte membrane receptors of these patients. MATERIALS AND METHODS: The phagocytic activity of granulocytes and monocytes of 41 mechanically ventilated patients with nosocomial bacterial pneumonia was studied during the acute phase of infection. These ICU patients were compared with 21 hospitalized, noninfected volunteer patients hospitalized in a medical ward. Peripheral blood granulocytes and monocytes were studied. Of the 41 ICU patients, after randomization, 21 received IVIG at a dose of 1 g/kg for 3 days. The 41 ICU patients were compared with the 21 non-ICU, noninfected hospitalized controls. The 21 ICU patients who received 3 days of IVIG were also compared with the 20 ICU patients not receiving IVIG. Cells were tested in standard immunoglobulin-free medium (fetal calf serum) and in the presence of patients' serum. Blood granulocytes and monocytes were purified and separately exposed to three types of particles: antibody-coated erythrocytes (to test immunoglobulin receptors), opsonized zymosan (to test C3 receptors), and glutaraldehyde-treated erythrocytes (to test lectinlike or other nonspecific binding sites). Phagocytosis and superoxide anion production (oxidative burst) were measured. RESULTS: Granulocytes of ICU patients compared with those of non-ICU, noninfected patients exhibited a substantial decrease of zymosan ingestion (P < .05), whereas phagocytosis of other particles was normal. Monocytes from the ICU patients, compared with those of the non-ICU, noninfected patients, displayed an unselective overall decrease of phagocytic ability for the three particle types (P < .05). The phagocytosis activity of the three membrane receptor species of blood monocytes and granulocytes of ICU patients was not significantly modified by the IVIG infusion. For both monocytes and granulocytes, no significant improvement was observed in the fraction of cells that ingested at least one foreign particle and the mean number of particles per cell having phagocytized at least one foreign particle. Granulocyte and monocyte functions were also tested by the production of reduced ferricytochrome and no significant improvement in the oxidative burst was observed after infusion of IVIG. CONCLUSION: Infected ICU patients display a deficiency of phagocytosis membrane receptors of blood granulocytes and monocytes. The addition of IVIG to standard therapy does not improve the phagocytic activity of ICU patients with nosocomial pneumonia.

Adult↗
PubMed1997

Lower extremity deep vein thrombosis: a prospective, randomized, controlled trial in comatose or sedated patients undergoing femoral vein catheterization.

OBJECTIVES: To determine the rate of lower extremity deep vein thrombosis after the use of femoral catheters in intensive care unit (ICU) comatose or sedated adults. Results were then compared with results of patients undergoing superior vena cava catheterization. DESIGN: Prospective, randomized, controlled, unblinded study. SETTING: A mixed medical/surgical ICU in a university hospital. PATIENTS: Sixty-one comatose or sedated patients admitted to the ICU who underwent central venous catheterization. INTERVENTIONS: Patients were monitored for signs of thrombotic complications. On catheter removal, a lower-extremity bilateral phlebographic examination was performed in each patient. MEASUREMENTS AND MAIN RESULTS: After randomization, 31 patients underwent femoral vein catheterization and 30 patients underwent superior vena cava catheterization, either by axillary (21 patients) or internal jugular vein (10 patients) cannulation. Single lumen polyurethane catheters were inserted for a mean duration of 7.1 +/- 4.6 (SD) days in the femoral vein group and 9.9 +/- 5.5 days in the superior vena cava group (p = NS). No patient had clinical signs of leg venous thrombosis or pulmonary embolism during the study period. In each patient, lower extremity bilateral phlebography was performed at the time of catheter removal. Leg phlebographies were normal in 18 (60%) patients in the femoral vein group and 26 (84%) patients in the superior vena cava group. Fibrin sleeves which developed around the femoral catheters were seen in seven (23.3%) patients in the femoral vein group and in no patients in the superior vena cava cannulation group. Three patients had femoral vein thrombosis, two (6.6%) patients in the femoral vein group (two nonobstructive thromboses, adherent to the common femoral vein wall) and one (3.0%) patient in the superior vena cava group (nonobstructive thrombosis which developed in the superficial femoral vein) (p = NS). Lower deep extremities thrombosis developed in five (16.7%) patients in the femoral vein group and in five (16%) patients in the superior vena cava group (p = NS). CONCLUSIONS: Femoral vein catheterization with a polyurethane catheter is associated with a lower rate of extremity deep vein thrombosis which is similar to the rate observed after superior vena cannulation in comatose or sedated patients. Femoral vein thrombosis was observed at a rate of 6.6% after femoral vein cannulation and a rate of 3% after superior vena cava cannulation. Given the acceptable rate of this clinically important complication, femoral vein cannulation offers an attractive alternative to insertion via the vena cava in the critically ill.

APACHE↗
PubMed1997

A prospective evaluation of the use of femoral venous catheters in critically ill adults.

OBJECTIVE: To determine the rate of complications following the use of femoral catheters in adults. DESIGN: Prospective survey of major and minor complications. SETTING: A mixed medical/surgical intensive care unit (ICU) in a university hospital. PATIENTS: Eighty consecutive patients admitted to the ICU who underwent right femoral venous catheterization over a 13-month period. INTERVENTIONS: Patients were carefully monitored for mechanical, infectious, and thrombotic complications. On catheter removal, a lower extremity bilateral phlebographic examination was performed in each patient. MEASUREMENTS AND MAIN RESULTS: There were 80 polyurethrane catheters inserted for a mean duration of 8.8 +/- 4.4 (SD) days. Catheters were inserted by interns or residents (75%) or by critical care fellows (25%). Minor complications consisted of arterial puncture (15%), local hematoma (4.4%), local bleeding (3%), and local inflammation (5%). After insertion, 17% of catheter tips were in the right atrium, 13% in the abdominal vena cava, 63% in the thoracic inferior vena cava (correct position), and 8% in aberrant abdominal intravascular positions. After repositioning, 80% of catheter tips were in the thoracic inferior vena cava. One patient developed a catheter-related bacteremia. Catheter-related sepsis were seen in three (3.7%) patients and catheter colonization in 11 (13.7%) patients. No patient had clinical signs of deep vein thrombosis or pulmonary embolism. Bilateral phlebography was performed in 70 patients at the time of catheter removal and was normal in 45 (64%) patients. Fibrin sleeves were seen in 11 (15.7%) patients. Lower extremity deep vein thrombosis developed in 24 (34%) patients. Six (8.5%) patients had femoral vein thrombosis (common femoral vein in two patients, and superficial femoral vein in four patients). Eighteen (25.7%) patients developed popliteal vein or posterior tibial vein thrombosis that was either bilateral (n = 16) or homolateral (n = 2) to the femoral catheter. CONCLUSIONS: Based on the data from this study, we conclude that femoral vein catheterization with a polyurethane catheter is associated with an 8.5% frequency rate of femoral vein thrombosis. Thrombosis in the popliteal vein or posterior tibial vein is higher (25.7%), but is homolateral to the catheter with only a 2.8% frequency rate. Infectious complications are low and similar to those of other central venous routes. Given the acceptable rate of clinically important complications, femoral venous catheterization offers an attractive alternate site of insertion to the jugular and subclavian veins for central venous access in the critically ill.

Adult↗
PubMed1996

Local antibiotic prophylaxis in surgery.

The perioperative use of antibiotics is an established and accepted technique for the prevention of postoperative infection. Intravenous administration often is preferred, and intramuscular administration is possible, although it has certain drawbacks. This article examines a variety of other routes of administration for delivering antibiotics locally to the surgical site. These techniques merit further study in prospectively randomized trials.

Antibiotic Prophylaxis↗
PubMed1996

Penetration of ceftriaxone (1 or 2 grams intravenously) into mediastinal and cardiac tissues in humans.

Penetration of ceftriaxone into heart tissues (valves, myocardium, auricles, and pericardium) and mediastinal tissues (fat and sternal bone) was evaluated after two regimens of ceftriaxone administration. Ten patients (group 1) were given 1,000 mg of ceftriaxone intravenously 30 min before anesthesia. Ten other patients (group 2) received the same dose and then a second 1,000-mg dose at the time of initiation of cardiopulmonary bypass. Similar and very satisfactory penetrations of ceftriaxone into tissue were observed for both groups. During opening and closure of the thorax, mean ceftriaxone concentration was in excess of the MIC at which 90% of the potential pathogens were inhibited (> or = 4 micrograms/g) in the thoracic fat, the sternal bone, and the pericardium. No significant differences between the two administration regimens in penetration of ceftriaxone into tissue were observed. During cardiopulmonary bypass, the ceftriaxone concentration was > or = 4 micrograms/g in the myocardium, the endocardium, and the auricle. The regimen of ceftriaxone administration did not significantly influence penetration of the drug into heart tissues. However, for some patients in the two groups and mainly in the sternal bone at the time of thorax closure (6 patients in group 1 and 5 patients in group 2), ceftriaxone levels in tissues were less than the MICs (4 micrograms/g) for some potential pathogens (methicillin-susceptible Staphylococcus aureus and methicillin-susceptible Staphylococcus epidermidis). During the different steps of the surgical procedures, all (10 of 10) patients in each group had tissue ceftriaxone levels greater than the MICs for gram-negative aerobic bacilli (0.1 microgram/g), except for Pseudomonas spp.

Bone and Bones↗
PubMed1996

Concentrations of ceftriaxone (1,000 milligrams intravenously) in abdominal tissues during open prostatectomy.

Ceftriaxone concentrations in abdominal tissues were evaluated at different stages of open prostatectomy. Ceftriaxone was administered as antibiotic prophylaxis, and 15 consecutive patients were given a single dose of ceftriaxone (1,000 mg intravenously in 1 min) 30 min before surgery. Ceftriaxone concentrations in tissue were determined at three stages of the surgical procedure; upon the opening of the abdominal cavity, during the prostatectomy, and upon the closure of the abdominal cavity. Samples of the following tissues or sample were assayed: epiploic and abdominal-wall fat; Retzius' space, bladder, and prostate tissue; and urine. During the different stages of the surgical procedure, for all patients, and in the different tested tissues, ceftriaxone concentrations greater than or equal to the cutoff point (4 micrograms/g of tissue) were measured. The highest concentrations were obtained in the bladder (43 +/- 18 micrograms/g) and in the prostate (35 +/- 18 micrograms/g). In fatty tissues, concentrations were between 13 +/- 5 and 22 +/- 8 micrograms/g. All patients (15 of 15) had ceftriaxone levels in tissue greater than the MICs for the potential pathogens (Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis). In conclusion, during open prostatectomy and after the use of a single dose of ceftriaxone (1,000 mg), high antibiotic levels were obtained throughout the surgical procedure in the tissues potentially involved in postoperative infection.

Abdominal Muscles↗
PubMed1996

Selective decontamination of the digestive tract in multiple trauma patients. A prospective double-blind, randomized, placebo-controlled study.

STUDY OBJECTIVE: The aims of the study were to evaluate the technique of selective digestion decontamination (SDD) in preventing the development of nosocomial infections in a selected population and to assess the effects on colonization of the oropharynx, nares, and bronchi. A financial assessment was also performed. DESIGN: Prospective, double-blind, randomized placebo-controlled trial using amphotericin B, colistin sulfate (polymixin E), and gentamicin applied to the nares, the oropharynx, and enterally; no parenteral antibiotics were given during the study period. The SDD was applied every 6 h during the study period. SETTING: Multidisciplinary ICU in a university hospital. PATIENTS: A total of 148 trauma patients admitted emergently and intubated within less than 24 h were enrolled. Seventy-two patients who received placebo and 76 treated patients were analyzed on an "intention-to-treat" basis. INTERVENTIONS: Microbiologic surveillance samples of oropharyngeal and bronchial secretions, urine, and any other potentially infected sites were taken at the time of ICU admission and twice weekly thereafter until discharge from the unit. MEASUREMENTS AND RESULTS: With the use of SDD, colonization was significantly reduced in the oropharynx and nares (<0.05) but not in bronchi. However, episodes of bronchopneumonia were significantly reduced (19 in the active group vs 37 in the placebo group; p,0.01). Staphylococcus aureus remained the main potential pathogen causing bronchial colonization and subsequent bronchopneumonia. There was no reduction in the incidence of other infections. Days in the ICU, duration of mechanical ventilation, and mortality rate were unchanged. After the use of SDD, Gram-positive colonization tended to increase and this was mainly due to methicillin-resistant coagulase-negative staphylococci. The total cost of antibiotic therapy ($62,117 [US] in the placebo group and $36,008 in the SDD group) was decreased by 42% with the use of SDD. Clinically important complications of SDD were not encountered. CONCLUSIONS: The use of SDD in this population of trauma patients reduced the incidence of bronchopneumonia and the total charge for antibiotics. Stay in the ICU, mechanical ventilation, and mortality rate were unchanged. Methicillin-resistant coagulase-negative staphylococci were selected by SDD in some patients and the clinical relevance of this colonization needs further evaluation.

Amphotericin B↗
PubMed1995

Comparison of concentrations of two doses of clavulanic acid (200 and 400 milligrams) administered with amoxicillin (2,000 milligrams) in tissues of patients undergoing colorectal surgery.

The concentrations of clavulanic acid and amoxicillin were determined in sera and different abdominal tissues of 17 patients who underwent elective colorectal surgery. Patients were randomly allocated to two groups. At the time of induction of anesthesia, patients in group 1 were given 200 mg of clavulanic acid with 2,000 mg of amoxicillin and patients in group 2 received 400 mg of clavulanic acid with 2,000 mg of amoxicillin. In both groups, the initial dose was administered again after 2 h. Blood samples were collected to determine peak and trough antibiotic levels. Serial blood samples were also collected at predetermined periods (opening and closure of the abdominal cavity and surgical anastomosis). Abdominal wall fat, epiploic fat, and colonic wall tissue samples were collected simultaneously. Antibiotic concentrations were determined by high-performance liquid chromatography. Increasing the dose of clavulanic acid to 400 mg resulted in significantly higher peak and trough levels in serum (P < 0.03). Following the injection of 400 mg, mean concentrations of clavulanic acid in the fatty tissues were significantly increased at the time of opening (P < 0.02). The concentrations of clavulanic acid and amoxicillin in fatty tissues were 17 to 52% and 12 to 23% of the levels in sera, respectively. In the colonic wall, the concentrations of clavulanic acid and amoxicillin were 52 to 63% and 49 and 27% of the levels in sera, respectively. In sera, clavulanic acid given at a dose of 200 or 400 mg reached or exceeded the concentrations found to be effective in vitro to reduce the MICs of amoxicillin from the resistant to the susceptible category for 90% of the potential pathogens. In most of the tissues investigated, increased the dose of clavulanic acid to 400 mg resulted in a significantly higher number of samples with concentrations found to be effective in vitro (72 versus 11%; P < 0.05). In conclusion, increasing the dose of clavulanic acid to 400 mg resulted in higher levels in sera and improved penetration into the abdominal tissues in patients undergoing colorectal surgery.

Adipose Tissue↗
PubMed1995

Comparing two heat and moisture exchangers with one vaporizing humidifier in patients with minute ventilation greater than 10 L/min.

STUDY OBJECTIVE: To evaluate in patients submitted to minute ventilation > 10 L/min the ability to preserve patients' heat and humidity of two heat and moisture exchangers (HMEs) and one vaporizing humidifier (VH). DESIGN: Prospective, randomized, comparative, non-blinded study. SETTING: Intensive care unit of a university hospital. PATIENTS: Nine tracheally intubated, mechanically ventilated patients, sedated and submitted to mechanical ventilation with minute ventilation > 10 L/min. INTERVENTIONS: Using the psychrometric method, relative humidity (RH) and absolute humidity (AH) of inspired gas were obtained as well as temperature of inspired gas and tracheal temperatures (maximal and minimal). Following a randomized order, each patient was ventilated for two 24-h periods with a vaporizing humidifier (Bennett Cascade 2, Bennett; France) and one of two HMEs: Pall Ultipor filter BB50 (Pall Biomedical; France) or DAR Hygroster filter (Peters; France). Both were first tested for a 45-min period and then the HME that achieved the best performance in terms of temperature and water preservation was tested for 24 h. MEASUREMENTS AND RESULTS: During the 45-min test period, the Pall Ultipor HME achieved a lower performance than the other two systems for any of the studied parameters (p < 0.05 to p < 0.0001). The DAR Hygroster HME achieved lower temperature of inspired gas (29.9 vs 32.0 degrees C, p < 0.005) and lower absolute humidity (29.3 vs 33.2 mg H2O/L, p < 0.005) than the Bennett Cascade 2. After 24 h of use, lower values of temperature of inspired gas (28.5 vs 32.0 degrees C, p < 0.002) and of AH (28.0 vs 33.6 mg H2O/L, p < 0.001) were obtained with the DAR Hygroster HME than with the Bennett Cascade 2. No differences were found between the two systems for the other tested parameters. At that time, no patients had RH lower than 97% and absolute humidity lower than 23 mg H2O/L with the use of the DAR Hygroster HME. CONCLUSIONS: In patients with minute ventilation > 10 L/min, the DAR Hygroster HME showed a thermic and humidification capability similar to the reference system, the Bennett Cascade 2 VH. In these patients, the Pall Ultipor HME had a significantly lower capability.

Adolescent↗
PubMed1995

[Penetration of ceftriaxone (1 or 2 gr intravenous) into mediastinal and cardiac tissues in man].

Ceftriaxone penetration into heart tissues (valves, myocardium, auricles and pericardium) and mediastinal tissues (fat and sternal bone) was evaluated after two regimens of ceftriaxone administration. Ten patients were given 1,000 g intravenously of ceftriaxone 30 min. before anesthesia. Ten other patients received the same dose and then a second 1,000 mg dose at the time of initiation of cardiopulmonary bypass. Similar and very satisfactory ceftriaxone tissue penetrations were observed in both groups. However, for some patients in the two groups and mainly in the sternal bone at the time of thorax closure, ceftriaxone levels in tissues were less than the MICs for some potential pathogens (Methicillin susceptible Staphylococcus aureus and Staphylococcus epidermidis). During the different steps of the surgical procedures all patients in both groups had tissue levels greater than the MICs for Gram negative aerobic bacilli, except for Pseudomonas spp.

Adult↗
PubMed1994

[Modes of administration of Diprivan].

Administration of propofol using standard syringe pumps has become routine in anaesthesia. The marketing of syringe pumps adapter for anaesthesia (high flow rate enabling a bolus injection and a slower rate for maintenance), allows an easier setting up of total intravenous anaesthesia. Computer-aided infusion of propofol will undoubtedly expand in the near future, as a result of the forthcoming marketing of computer-controlled infusion pumps and of improvement in the recognition of accurate individual pharmacokinetic parameters. This computer-aided infusion will be based on a blood concentration criterion, and no longer on a dosage regimen given to the patient. A closed loop regulatory system remains in the domain of research.

Drug Delivery Systems↗
PubMed1994

Penetration of vancomycin into mediastinal and cardiac tissues in humans.

Vancomycin penetration into heart tissues (valves, myocardium, auricles, and pericardium) and mediastinal tissues (fat and sternal bone) was evaluated after two regimens of vancomycin administration. Ten patients were given 15 mg of vancomycin per kg of body weight before anesthesia. Ten other patients received the same dose and then a second 7.5-mg/kg dose at the time of initiation of cardiopulmonary bypass. Similar and satisfactory vancomycin tissue penetrations were observed in both groups. However, for some patients in the two groups, vancomycin levels in tissue were less than the MICs for potential pathogens (Staphylococcus aureus and Staphylococcus epidermidis).

Adipose Tissue↗