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991.
Stéphane Legriel Julia Hilly-Ginoux Matthieu Resche-Rigon Sybille Merceron Jeanne Pinoteau Matthieu Henry-Lagarrigue Fabrice Bruneel Alexandre Nguyen Pierre Guezennec Gilles Troché Olivier Richard Fernando Pico Jean-Pierre Bédos 《Resuscitation》2013
Background
The independent prognostic significance of postanoxic status epilepticus (PSE) has not been evaluated prospectively since the introduction of therapeutic hypothermia. We studied 1-year functional outcomes and their determinants in comatose survivors of cardiac arrest (CA), with special attention to PSE.Methods
106 comatose CA survivors admitted to the intensive care unit in 2005–2010 were included in a prospective observational study. The main outcome measure was a Cerebral Performance Category scale (CPC) of 1 or 2 (favorable outcome) 1 year after CA.Results
CA occurred out-of-hospital in 89 (84%) patients and was witnessed from onset in 94 (89%). Median times were 6 min (IQR, 0–11) from CA to first-responder arrival and 23 min (14–40) from collapse to return of spontaneous circulation. PSE was diagnosed in 33 (31%) patients at a median of 39 h (4–49) after CA. PSE was refractory in 24 (22%) cases and malignant in 19 (20%). After 1 year, 31 (29.3%) patients had favorable outcomes including 2 (6.44%) with PSE. Factors independently associated with poor outcome (CPC ≥ 3) were PSE (odds ratio [OR], 14.28; 95% confidence interval [95% CI], 2.77–50.0; P = 0.001), time to restoration of spontaneous circulation (OR, 1.04/min; 95% CI, 1–1.07; P = 0.035), and LOD score on day 1 (OR, 1.28/point; 95% CI, 1.08–1.54; P = 0.003).Conclusion
PSE strongly and independently predicts a poor outcome in comatose CA survivors receiving therapeutic hypothermia, but some patients with PSE survive with good functional outcomes. PSE alone is not sufficient to predict failure to awaken after CA in the era of therapeutic hypothermia. 相似文献992.
Matthieu Marchetti Antoine Benedetti Olivier Mimoz Jean-Yves Lardeur Jérémy Guenezan Nicolas Marjanovic 《The American journal of emergency medicine》2017,35(3):444-447
Objectives
Acute heart failure (AHF) is a leading cause of admission in emergency departments (ED). It is associated with significant in-hospital mortality, suggesting that there is room for improvement of care. Our aims were to investigate clinical patterns, biological characteristics and determinants of 30-day mortality.Methods
We conducted a single site, retrospective review of adult patients (≥ 18 years) admitted to ED for AHF over a 12-month period. Data collected included demographics, clinical, biological and outcomes data. Epidemiologic data were collected at baseline, and patients were followed up during a 30-day period.Results
There were a total of 322 patients. Mean age was 83.9 ± 9.1 years, and 47% of the patients were men. Among them, 59 patients (18.3%) died within 30 days of admission to the ED. The following three characteristics were associated with increased mortality: age > 85 years (OR = 1.5[95%CI:0.8–2.7], p = 0.01), creatinine clearance < 30 mL/min (OR = 2.6[95%CI:1.4–5], p < 0.001) and Nt-proBNP > 5000 pg/mL (OR = 2.2[95%CI:1.2–4], p < 0.001). The best Nt-proBNP cut-off value to predict first-day mortality was 9000 pg/mL (area under the curve (AUC) [95%CI] of 0.790 [0.634–0.935], p < 0.001). For 7-day mortality, it was 7900 pg/mL (0.698 [0.578–0.819], p < 0.001) and for 30-day mortality, 5000 pg/mL (0.667 [0.576–0.758], p < 0.001).Conclusions
Nt-proBNP level on admission, age and creatinine clearance, are predictive of 30-day mortality in adult patients admitted to ED for AHF. 相似文献993.
Ria Blaauwbroek Martijn J. Bouma Wemke Tuinier Klaas H. Groenier Matthieu H. G. de Greef Betty Meyboom- de Jong Willem A. Kamps Aleida Postma 《Supportive care in cancer》2009,17(8):1041-1048
Objective The aim of this study was to evaluate the results of home-based exercise counselling with feedback from a pedometer on fatigue
in adult survivors of childhood cancer.
Patients Adult survivors of childhood cancer were recruited from the long-term follow-up clinic of the University Medical Centre Groningen,
The Netherlands. A score of 70 mm on a visual analogue scale (scale, 0–100 mm) for fatigue was used as an inclusion criterion.
Controls were recruited by the survivors among their healthy siblings or peers.
Methods During 10 weeks, the counselor encouraged the survivors to change their lifestyle and enhance daily physical activity such
as walking, cycling, housekeeping and gardening. As a feedback to their physical activity, the daily number of steps of each
survivor was measured by a pedometer and registered using an online step diary at the start of the programme and after 4 and
10 weeks. Fatigue was the primary outcome measure, assessed with the Checklist Individual Strength (CIS) at start (T0), 10 weeks
(T10) and 36 weeks (T36). Thirty-three healthy age-matched control persons were asked to complete the CIS.
Results Out of 486 cancer survivors, 453 were interested and were asked to complete the VAS to measure fatigue; 67 out of 254 respondents
met the inclusion criteria, 21 refused, 46 were enrolled and eight dropped out during the study. The mean scores on the CIS
in the survivors at T0 was 81.42 (SD ± 20.14) and at T10 62.62 (SD ± 20.68), which was a significant improvement (p < 0.0005). At T36, the end of the study, the mean CIS score was 63.67 (SD ± 23.12); this was a significant improvement compared
with the mean CIS at the start (p < 0.0005). There was no significant difference in the mean CIS scores of the controls during the follow-up period.
Conclusion The stimulation of daily physical activity using exercise counselling and a pedometer over 10 weeks leads to a significant
decrease in fatigue in adult survivors of childhood cancer, and this improvement lasts for at least 36 weeks. 相似文献
994.
Eddy Fan Luciano Gattinoni Alain Combes Matthieu Schmidt Giles Peek Dan Brodie Thomas Muller Andrea Morelli V. Marco Ranieri Antonio Pesenti Laurent Brochard Carol Hodgson Cecile Van Kiersbilck Antoine Roch Michael Quintel Laurent Papazian 《Intensive care medicine》2016,42(5):712-724
Despite expensive life-sustaining interventions delivered in the ICU, mortality and morbidity in patients with acute respiratory failure (ARF) remain unacceptably high. Extracorporeal membrane oxygenation (ECMO) has emerged as a promising intervention that may provide more efficacious supportive care to these patients. Improvements in technology have made ECMO safer and easier to use, allowing for the potential of more widespread application in patients with ARF. A greater appreciation of the complications associated with the placement of an artificial airway and mechanical ventilation has led clinicians and researchers to seek viable alternatives to providing supportive care in these patients. Thus, this review will summarize the current knowledge regarding the use of venovenous (VV)-ECMO for ARF and describe some of the recent controversies in the field, such as mechanical ventilation, anticoagulation and transfusion therapy, and ethical concerns in patients supported with VV-ECMO. 相似文献
995.
Matthieu Schmidt Elie Zogheib Hadrien Rozé Xavier Repesse Guillaume Lebreton Charles-Edouard Luyt Jean-Louis Trouillet Nicolas Bréchot Ania Nieszkowska Hervé Dupont Alexandre Ouattara Pascal Leprince Jean Chastre Alain Combes 《Intensive care medicine》2013,39(10):1704-1713
Purpose
This study was designed to identify factors associated with death by 6 months post-intensive care unit (ICU) discharge and to develop a practical mortality risk score for extracorporeal membrane oxygenation (ECMO)-treated acute respiratory distress syndrome (ARDS) patients. We also assessed long-term survivors’ health-related quality of life (HRQL), respiratory symptoms, and anxiety, depression and post-traumatic stress disorder (PTSD) frequencies.Methods
Data from 140 ECMO-treated ARDS patients admitted to three French ICUs (2008–2012) were analyzed. ICU survivors contacted >6 months post-ICU discharge were assessed for HRQL, psychological and PTSD status.Results
Main ARDS etiologies were bacterial (45 %), influenza A[H1N1] (26 %) and post-operative (17 %) pneumonias. Six months post-ICU discharge, 84 (60 %) patients were still alive. Based on multivariable logistic regression analysis, the PRESERVE (PRedicting dEath for SEvere ARDS on VV-ECMO) score (0–14 points) was constructed with eight pre-ECMO parameters, i.e. age, body mass index, immunocompromised status, prone positioning, days of mechanical ventilation, sepsis-related organ failure assessment, plateau pressure andpositive end-expiratory pressure. Six-month post-ECMO initiation cumulative probabilities of survival were 97, 79, 54 and 16 % for PRESERVE classes 0–2, 3–4, 5–6 and ≥7 (p < 0.001), respectively. HRQL evaluation in 80 % of the 6-month survivors revealed satisfactory mental health but persistent physical and emotional-related difficulties, with anxiety, depression or PTSD symptoms reported, by 34, 25 or 16 %, respectively.Conclusions
The PRESERVE score might help ICU physicians select appropriate candidates for ECMO among severe ARDS patients. Future studies should also focus on physical and psychosocial rehabilitation that could lead to improved HRQL in this population. 相似文献996.
Eveillard M Pradelle MT Lefrancq B Guilloteau V Rabjeau A Kempf M Vidalenc O Grosbois M Zilli-Dewaele M Raymond F Joly-Guillou ML Brunel P 《American journal of infection control》2011,39(4):339-341
We monitored hand hygiene and gloving practices by direct observation in 8 health care settings for elderly persons in western France. Compliance with hand hygiene was better than that reported by previous studies, was better for single contacts and before or after a series of successive contacts than inside series, and was closely related to gloving practices. Practices differed among the settings. 相似文献
997.
Charniot JC Vignat N Albertini JP Bogdanova V Zerhouni K Monsuez JJ Legrand A Artigou JY Bonnefont-Rousselot D 《Rejuvenation research》2008,11(2):393-398
Oxidative stress (OS) is a keystone in the pathology of the ischemia reperfusion sequence (acute coronary syndromes, cardiac surgery, transplantation). In heart failure, the implication of OS is less understood. This study was intended to evaluate OS in acute heart failure. Criteria for inclusion were consecutive patients hospitalized in our cardiology department for a first pulmonary edema that revealed a dilated cardiomyopathy (DCM). Exclusion criteria included known cardiomyopathy, smoker, acute coronary syndrome, and treatment with angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARAII). OS was evaluated in blood samples: thiobarbituric acid-reactive substances (TBARS), total antioxidant status (TAS), plasma alpha-tocopherol, vitamin A, and beta-carotene. Standard biochemical parameters including CRP, fibrinogen, lipid, and creatinine were assayed. Ten patients (80% men, mean age 55.3 +/- 7.9 years) were included and followed during a 6 month period. The etiologies of DCM were alcohol (n = 3), anti-cancer drugs (n = 2), valvulopathies (n = 2), or idiopathic (n = 3). In acute heart failure, TBARS were elevated (1.69 micromol/L; normal value 0.6-4.2 micromol/L) and TAS status was decreased (0.96 mmol/L; normal value 1.3-1.9 pmol/L). OS was more important when patients had atrial or ventricular arrhythmia. Nevertheless, liposoluble antioxidant parameters (beta-carotene, vitamin A, alpha-tocopherol) had a usual value. At the term of the follow-up, patients returned to a stable condition, OS markers revealed normal values, and every Holter ECG showed no supraventricular or ventricular arrhythmias. In acute heart failure, oxygen-free radicals are increased. We thus hypothetized that a modification in OS could be responsible for arrhythmias and complications of acute heart failure. 相似文献
998.
999.
Olivier Van Hove Vasileios Andrianopoulos Ali Dabach Olivier Debeir Alain Van Muylem Dimitri Leduc Alexandre Legrand Rudy Ercek Véronique Feipel Bruno Bonnechère 《The clinical respiratory journal》2023,17(3):176-186
Introduction
Over the last 5 years, the analysis of respiratory patterns presents a growing usage in clinical and research purposes, but there is still currently a lack of easy-to-use and affordable devices to perform such kind of evaluation.Objectives
The aim of this study is to validate a new specifically developed method, based on Kinect sensor, to assess respiratory patterns against spirometry under various conditions.Methods
One hundred and one participants took parts in one of the three validations studies. Twenty-five chronic respiratory disease patients (14 with chronic obstructive pulmonary disease (COPD) [65 ± 10 years old, FEV1 = 37 (15% predicted value), VC = 62 (20% predicted value)], and 11 with lung fibrosis (LF) [64 ± 14 years old, FEV1 = 55 (19% predicted value), VC = 62 (20% predicted value)]) and 76 healthy controls (HC) were recruited. The correlations between the signal of the Kinect (depth and respiratory rate) and the spirometer (tidal volume and respiratory rate) were computed in part 1. We then included 66 HC to test the ability of the system to detect modifications of respiratory patterns induced by various conditions known to modify respiratory pattern (cognitive load, inspiratory load and combination) in parts 2 and 3.Results
There is a strong correlation between the depth recorded by the Kinect and the tidal volume recorded by the spirometer: r = 0.973 for COPD patients, r = 0.989 for LF patients and r = 0.984 for HC. The Kinect is able to detect changes in breathing patterns induced by different respiratory disturbance conditions, gender and oral task.Conclusions
Measurements performed with the Kinect sensors are highly correlated with the spirometer in HC and patients with COPD and LF. Kinect is also able to assess respiratory patterns under various loads and disturbances. This method is affordable, easy to use, fully automated and could be used in the current clinical context. Respiratory patterns are important to assess in daily clinics. However, there is currently no affordable and easy-to-use tool to evaluate these parameters in clinics. We validated a new system to assess respiratory patterns using the Kinect sensor in patients with chronic respiratory diseases. 相似文献1000.
We examined the immediate and long-term outcome after stenting of the left main coronary artery (LMCA) in 41 consecutive patients who had been considered unsuitable for coronary artery bypass graft surgery (CABG). The procedure was elective in thirty-two patients (78%) with a protected LMCA in 24 patients and non-protected LMCA in 8 patients; the procedure was acute in the setting of myocardial infarction or complication of a diagnostic angiography in 9 patients (22%). The mean follow-up duration was 19 +/- 13 months. There were 5 in-hospital and 3 late deaths; repeat angioplasty was performed in 5 cases, but only one for LMCA restenosis. Results varied considerably depending on the clinical presentation. For acute patients, technical success was achieved in 89%, survival at hospital discharge was 44% and there was no cardiac event at the late follow-up. For elective patients, technical success was achieved in 100%, survival at hospital discharge was 96% and 90% at follow-up. The results of our study suggest that when patients have surgical risks, elective LMCA stenting either protected or unprotected may be undertaken with a high procedural success rate and a favourable clinical late follow-up. 相似文献