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ABSTRACT: We report the case of a 37-year-old woman who survived from severe hypothermia (rectal temperature: 22 degrees C) and prolonged cardiac arrest with asystole after benzodiazepine and tricyclic antidepressant poisoning. Basic-cardiopulmonary resuscitation and mechanical ventilation was started by a French Mobile Intensive-Care unit. Spontaneous circulation was restored at 25 degrees C under epinephrin after three hours of chest compression from home to the intensive-care unit and rewarming with extracorporeal circulation. The patient was discharged at day 13 without any neurological deficit. The discussion focuses on the benefit of extracorporeal-membrane oxygenation (ECMO) as extracorporeal circulation device through femoral access, the differential diagnosis between death and recoverable cardiac arrest and neuroprotection.
Annales francaises d'anesthesie et de reanimation 07/2008; 27(6):510-3. · 0.77 Impact Factor
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ABSTRACT: Meningoencephalitis is the most common central nervous system complication caused by Mycoplasma pneumoniae. Its frequency is probably underestimated.
The study's aim was to determine the retrospectively incidence of M. pneumoniae meningoencephalitis among other cases of encephalitis diagnosed in infectiology, neurology and ICU at the Clermont-Ferrand University hospital in 2004 and 2005.
A case of meningoencephalitis was defined by encephalopathy (altered level of consciousness and/or change in personality), with one or more of the following symptoms: fever, seizure, focal neurological findings, meningitis, electroencephalography or neuroimaging findings consistent with encephalitis. Tumor and hematoma diagnosed by scan were excluded. M. pneumoniae was considered as a possible cause when patients had positive serological test (IgM Elisa) and/or positive PCR results for the CSF.
Four (8.3%) patients among 48 cases of encephalitis could have been caused by M. pneumoniae. All except one convulsed initially. Pneumopathy was found in two patients. All received a specific treatment later. Antibiotics seemed to influence evolution in only two patients. These 4 cases appeared during an epidemic between November 2004 and August 2005: 48 hospitalized adults had positive serological test for M. pneumoniae in 2005 and 15 in 2004, whereas the number of tests was the same in 2004 and in 2005.
M. pneumoniae should be investigated as a cause of meningoencephalitis if initial tests are negative, if patients have respiratory symptoms and in case of epidemic. Presumptive treatment of meningoencephalitis should include an antibiotic active against M. pneumoniae.
Médecine et Maladies Infectieuses 12/2007; 37(11):738-45. · 0.72 Impact Factor
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ABSTRACT: A bronchial secretion draining effect is frequently suggested as a mechanism for oxygenation improvement during prone positioning (PP) in patients with acute respiratory distress syndrome (ARDS). Nevertheless, it has never really been evaluated. The aim of this study was to search for an interrelationship between the volume of the bronchial secretion and the improvement of the PaO2/FIO2 ratio during prone positioning, with NO inhalation or not.
Open prospective clinical study.
The study included 15 consecutive patients with severe ARDS (PaO2/FIO2 < 200 after alveolar recruitment, Murray score > 2.5).
They were returned to the prone position for 4 hours (h0-h4) combined with an inhalation of 5 ppm NO during 1 hour (h2-h3). Tracheal suction were performed hourly between h-2 and h6 and weighed on a precision scale from h-1 to h6. Haemodynamic, blood gas and respiratory compliance were recorded at h0, h2, h3, h4 and h6.
No significant haemodynamic changes were observed in the various phases. Compared with the baseline condition at h0, PP and PP + NO respectively improved PaO2/FIO2 by 102 +/- 62% at h2 (P < 0.005) and 156 +/- 79% at h3 (P < 0.005/h0 and < 0.01/h2). 14/15 patients responded to PP and 15/15 to PP + NO (gain in PaO2/FIO2 > 10%). Concerning secretions, we collected 3.0 +/- 7.5 g, 4.4 +/- 6.1 g, 1.7 +/- 1.4 g and 1.7 +/- 1.6 between h-2 and h0, h0 and h2, h2 and h4, h4 and h6. Individual assessments showed no relationship between the PaO2/FIO2 evolution at any time and the quantity of secretions obtained during the first 2 hours in the prone position. Six patients presented secretions of less than 1 g between h0 and h2, and for whom the improvement in oxygenation was higher than average (115 +/- 53% at h2).
In patients with little or moderate secretions, the improvement observed in oxygenation, with or without NO, does not depend on their volume.
Annales Françaises d Anesthésie et de Réanimation 04/2000; 19(3):156-63. · 0.84 Impact Factor
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ABSTRACT: A 69-year-old women was admitted to the hospital with meningitis due to Streptococcus pneumoniae. The strain was susceptible to penicillin but intermediate to cefotaxime. In Europe the decrease of susceptibility generally
pertains more to penicillin than to cefotaxime. Such a strain is perhaps a forewarning of the existence of high-level cephalosporin-resistant
strains. Despite the possible detection of the resistance by oxacillin disk, it underlines the need to determine the MICs
of different beta-lactams without delay and to choose the most efficient treatment.
Infection 01/2000; 28(1):58-59. · 2.66 Impact Factor
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ABSTRACT: To determine the efficacy and side effects of prone positioning (PP) and nitric oxide (NO) inhalation, alone, associated, or combined with i.v. almitrine for the treatment of hypoxaemia in severe acute respiratory distress syndrome (ARDS).
Over a period of 20 months, 27 consecutive critically ill patients with severe ARDS (Murray score > 2.5, PaO2/FiO2 < 170 after alveolar recruitment) were prospectively and randomly included. They inhaled NO for two hours at concentrations of 5 and 10 ppm for one hour each (H0-H2). One hour later, they were returned to the prone position for four hours (H3-H7). During the last two hours in this position (H5-H7), they were assigned to further inhalation of 10 ppm NO (Group B, n = 9) or to no further inhalation (Group A, n = 9). In group C (n = 9), the procedure for group B was combined with perfusion of 16 mg.kg-1.min-1 almitrine throughout the study.
Compared with control values, two hours NO inhalation improves PaO2/FiO2 and shunt effect by +28% and -9%, PP by +88% and -27%, PP + almitrine by +132% and -28%, NO + almitrine by +153 and -28%, PP + NO by +94% and -29%, NO + PP + almitrine by +327 and -48%. NO inhalation reduces pulmonary vascular resistance. Other haemodynamic parameters remain unchanged, whatever the treatment. NO inhalation improves PaO2/FiO2 by over 20% in 50% of the patients and PP is effective in 78% of the cases.
Prone Position improves PaO2/FiO2 significantly more than NO alone but less than PP + almitrine or NO + almitrine. The best results are obtained with the association of NO + Prone position + Almitrine.
Canadian Journal of Anaesthesia 06/1998; 45(5 Pt 1):402-9. · 2.35 Impact Factor
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ABSTRACT: Enterobacter aerogenes strains resistant to imipenem were isolated in 10 patients, 7 of whom had received imipenem-cilastatin. The strains were differentiated by biotype, antibiotype, and plasmid content. All of the strains overproduced a chromosomal cephalosporinase and lost a major outer membrane protein with a size of about 40 kDa. In 5 of the 10 patients, E. aerogenes strains resistant to extended-spectrum cephalosporin were isolated during the same stay. In three patients, the similarity between the imipenem-susceptible and -resistant strains suggests the occurrence of mutation and reversion in vivo. The combination imipenem-cilastatin has been critically important for use with multiresistant strains of Enterobacter spp., but its use increases the risk of selection of imipenem-resistant strains.
Journal of Clinical Microbiology 02/1993; 31(1):123-7. · 4.15 Impact Factor
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La Presse Médicale 12/1992; 21(37):1775. · 0.67 Impact Factor
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ABSTRACT: In July 1984 Klebsiella pneumoniae producing beta-lactamase CTX-1(TEM-3) (K. pneumoniae-CTX-1) spread from an Intensive Care Unit (ICU) throughout the hospitals of Clermont-Ferrand, France, and were isolated in four other hospitals of the region. A retrospective case control study was conducted in the ICU to characterize the risk factors for nosocomial infection with this organism. The cases were the 74 patients who had had K. pneumoniae-CTX-1 isolated from one or more clinical samples between July 1984 and December 1987. They were compared with 74 controls for host risk factors, underlying disease, procedures and antibiotic treatment. The monthly incidence of infection/colonization varied from 0% to 14.6%. The mortality rate attributable to this organism was 0.26% during the study period. The duration of stay of cases was longer than that of controls. More cases than controls had ventilatory assistance. However, the predominant risk factor was emergency abdominal surgery. Before K. pneumoniae-CTX-1 was isolated, cases received quinolones and trimethoprim sulphamethoxazole more often than controls. However, only 15% of cases had received third generation cephalosporins while at the onset of K. pneumoniae-CTX-1 infection colonization, 32 patients were no longer being given antibiotics. The use of antibiotic prophylaxis by, for example, selective digestive tract decontamination should be considered in patients at high risk of infection.
Journal of Hospital Infection 06/1991; 18(1):5-13. · 3.39 Impact Factor
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ABSTRACT: A fifteen-year-old girl, with a clean medical history, was admitted to the intensive care unit 90 minutes after ingestion of 2.5 g potassium cyanide. She had typical signs of severe cyanide poisoning including deep coma, circulatory failure, and major metabolic acidosis. Gastric lavage and antidotal treatment with 4 g hydroxocobalamin and 8 g sodium hyposulfite was administered without delay together with supportive treatment consisting of mechanical ventilation with FIO2, blood alkalinisation and administration of beta-stimulants. These measures led to a rapid clinical improvement. The ventilatory support was discontinued after 24 hours and the patient left the intensive care unit on the fourth day with only slightly impaired mental status. She survived despite a very high blood cyanide concentration (494 mumol.l-1 on admission) probably because of the rapid symptomatic and antidotal treatment.
Annales Françaises d Anesthésie et de Réanimation 02/1990; 9(4):383-5. · 0.84 Impact Factor
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ABSTRACT: From Summer 1983 to Summer 1986, 34 cases of septicemia due to Pseudomonas cepacia could be detected in several intensive care units in the university hospital in Clermont-Ferrand (France). Intravascular catheters can be involved in the inoculation of this bacterial agent: a previous respiratory tract infection or a drained abscess can be the portal of entry of the bacteremia. Three patients died from the septicemia and the overall prognosis of the intensive care patients looks significatively worsened. The removing of the catheters and drains, the opening of an infected collection were useful but not sufficient to overcome. The choice of a good antibiotic was not easy; only ceftazidime, minocycline and cotrimoxazole have a fair activity in vitro. We only assessed the good results of ceftazidime. Pseudomonas cepacia is also resistant for many antiseptics. The large use of disinfecting procedures in intensive care units promotes the diffusion of this bacteria.
Pathologie Biologie 06/1987; 35(5):616-9. · 1.53 Impact Factor
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La Presse Médicale 12/1986; 15(39):1973. · 0.67 Impact Factor
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The American Journal of Cardiology 10/1986; 58(7):666. · 3.37 Impact Factor
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ABSTRACT: The index studied (simplified acute physiology score, or SAPS) is calculated from 14 measurable clinical and laboratory data obtained during the first 24 hours from admission. It was tested in a prospective study involving 280 consecutive patients treated in a 16-bed intensive care unit. Good correlations were found between SAPS and mortality rate and between SAPS and the two most widely used scoring systems: the Knaus index or APS (acute physiology score) and the Cullen index or TISS (therapeutic intervention scoring system), both evaluating therapeutic effectiveness. SAPS data being easy to collect, the simplified index could be used in many intensive care units or even applied to old case-records. Its main value lies in comparisons between two groups of patients with the same death probability and in evaluations of activities in intensive care units.
La Presse Médicale 04/1985; 14(12):677-80. · 0.67 Impact Factor
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Annales Françaises d Anesthésie et de Réanimation 02/1985; 4(6):533-4. · 0.84 Impact Factor
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ABSTRACT: A 69-year-old woman was admitted to the hospital with meningitis due to Streptococcus pneumoniae. The strain was susceptible to penicillin but intermediate to cefotaxime. In Europe the decrease of susceptibility generally pertains more to penicillin than to cefotaxime. Such a strain is perhaps a forewarning of the existence of high-level cephalosporin-resistant strains. Despite the possible detection of the resistance by oxacillin disk, it underlines the need to determine the MICs of different beta-lactams without delay and to choose the most efficient treatment.
Infection 28(1):58-9. · 2.66 Impact Factor
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La Presse Médicale 22(1):34. · 0.67 Impact Factor
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Cahiers d'anesthésiologie 35(2):99-102.
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ABSTRACT: In July 1984 Klebsiella pneumoniae producing beta-lactamase CTX-1 (TEM-3) (K. pneumoniae-CTX-1) spread from an Intensive Care Unit (ICU) throughout the hospitals of Clermont-Ferrand, France, and were isolated in four other hospitals of the region. A retrospective case control study was conducted in the ICU to characterize the risk factors for nosocomial infection with this organism. The cases were the 74 patients who had had K. pneumoniae-CTX-1 isolated from one or more clinical samples between July 1984 and December 1987. They were compared with 74 controls for host risk factors, underlying disease, procedures and antibiotic treatment. The monthly incidence of infection/colonization varied from 0% to 14·6%. The mortality rate attributable to this organism was 0·26% during the study period. The duration of stay of cases was longer than that of controls. More cases than controls had ventilatory assistance. However, the predominant risk factor was emergency abdominal surgery. Before K. pneumoniae-CTX-1 was isolated, cases received quinolones and trimethoprim sulphamethoxazole more often than controls. However, only 15% of cases had received third generation cephalosporins while at the onset of K. pneumoniae-CTX-1 infection/colonization, 32 patients were no longer being given antibiotics. The use of antibiotic prophylaxis by, for example, selective digestive tract decontamination should be considered in patients at high risk of infection.
Journal of Hospital Infection.
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ABSTRACT: R\'esum\'e Nous rapportons l'observation d'une femme de 37 ans, prise en charge \`a son domicile en asystolie et hypothermie \`a 22 °C dans les suites d'une intoxication m\'edicamenteuse volontaire par benzodiaz\'epines et antid\'epresseurs tricycliques. Apr\`es intubation trach\'eale et transfert en milieu hospitalier par le Samu, la r\'eanimation a comport\'e un r\'echauffement par circulation extracorporelle \`a l'origine d'une reprise d'activit\'e cardiaque sous adr\'enaline, apr\`es plus de trois heures de compressions thoraciques. Les suites ont \'et\'e marqu\'ees par une excellente r\'ecup\'eration neurologique, autorisant la sortie de r\'eanimation apr\`es deux semaines. La discussion aborde l'int\'er\^et de l'oxyg\'enation extracorporelle dans cette situation, la neuroprotection et les \'el\'ements favorables incitant \`a une r\'eanimation prolong\'ee. We report the case of a 37-year-old woman who survived from severe hypothermia (rectal temperature: 22 °C) and prolonged cardiac arrest wi
Annales Françaises d'Anesthésie et de Réanimation. In Press, Corrected Proof.
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ABSTRACT: A case of nosocomial meningitis due to a Klebsiella pneumoniae producing a CAZ-5 extended-spectrum beta-lactamase and an Enterobacter aerogenes producing a derepressed cephalosporinase is reported. The intrathecal catheter incriminated was removed and a treatment with ceftazidime (4 g/24 h) and amikacin (1.5 g/24 h) was started. After 24 h ceftazidime was replaced by imipenem (2 then 4 g/24 h). This treatment failed to obtain cerebrospinal fluid sterilization; therefore the imipenem dosage was increased to 8 g/24 h and two intrathecal infusions of amikacin (50 mg) were carried out. Thereafter the patient recovered.
Infection 19(3):181-3. · 2.66 Impact Factor
