C C Arvieux

Centre Hospitalier Universitaire de Brest, Brest, Brittany, France

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Publications (74)138.08 Total impact

  • G. Gueret · L. Hélaine · C. Arvieux
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    ABSTRACT: Sigue existiendo una gran variabilidad entre centros sanitarios en cuanto a la práctica de transfusiones sanguíneas, a pesar de que han mejorado los conocimientos al respecto y se han publicado numerosas recomendaciones. El control perioperatorio de la transfusión debe preverse en la consulta de anestesia y adaptarse a cada paciente. Durante la operación, la decisión de transfundir sangre se rige por la determinación de la concentración de hemoglobina. Si bien el control de la hemorragia debe constituir la prioridad, la decisión de realizar una transfusión sanguínea debe tener en cuenta la tolerabilidad clínica, la progresión y el riesgo de recidiva de la hemorragia, los medios de monitorización del paciente, así como los plazos necesarios para la obtención de productos sanguíneos. Hay que tener siempre presente que las muertes secundarias a la ausencia o retraso de la transfusión son más numerosas que las secundarias a la propia transfusión. Del mismo modo, no debe olvidarse que una anemia bien tolerada bajo anestesia general puede descompensarse bruscamente al despertar. Es difícil proponer un único umbral de transfusión, ya que éste depende de muchos factores, en particular de los antecedentes del paciente y de su tolerabilidad a la anemia. Por ejemplo en Francia, las recomendaciones de la Haute Autorité de Santé siguen siendo vigentes. La tolerabilidad a la anemia puede mejorarse controlando el consumo de oxígeno y aumentando su concentración en el aire inspirado. Las complicaciones agudas más frecuentes de las transfusiones son los errores de administración, el síndrome de dificultad respiratoria aguda postransfusional (transfusion related acute lung injury) y la sobrecarga volémica. El riesgo de transmisión de enfermedades víricas se ha vuelto extremadamente bajo. El papel de la transfusión en la mortalidad y la morbilidad postoperatorias sigue siendo controvertido, ya que no se ha demostrado formalmente mediante ensayos aleatorizados.
    12/2011; 37(4):1–12. DOI:10.1016/S1280-4703(11)71134-3
  • Archives de Pédiatrie 07/2011; 18(7):809-810. DOI:10.1016/j.arcped.2011.04.016 · 0.41 Impact Factor
  • G. Gueret · L. Hélaine · C. Arvieux
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    ABSTRACT: Malgrado il miglioramento delle conoscenze e la pubblicazione di numerose raccomandazioni, la pratica della trasfusione sanguigna resta ancora estremamente variabile da un centro all’altro. La gestione perioperatoria della trasfusione deve essere prevista al momento della visita anestesiologica e deve essere adattata al paziente. Intraoperatoriamente, la decisione della trasfusione sanguigna è guidata dalla misurazione del tasso di emoglobina. Benché il controllo del sanguinamento debba restare la priorità, la decisione di realizzare una trasfusione sanguigna deve tenere conto della tolleranza clinica, dell’evolutività e del rischio di recidiva del sanguinamento, dei mezzi di monitoraggio del paziente, così come dei tempi necessari per ottenere dei prodotti ematici. Si deve sempre ricordare che i decessi secondari all’assenza o al ritardo di una trasfusione sono più numerosi di quelli secondari alla trasfusione. Allo stesso tempo, non si deve dimenticare che un’anemia ben tollerata sotto anestesia generale può scompensarsi improvvisamente al risveglio. È difficile proporre una soglia trasfusionale unica, in quanto essa dipende da numerosi fattori, in particolare dai precedenti del paziente e dalla tollerabilità dell’anemia. Le raccomandazioni dell’Alta Autorità di Sanità restano di attualità. La tollerabilità dell’anemia può essere migliorata controllando il consumo di ossigeno e aumentando la concentrazione dell’ossigeno nell’aria inspirata. Le complicanze acute più frequenti della trasfusione sono gli errori burocratici, la sindrome di distress respiratorio acuto post-trasfusionale (transfusion related acute lung injury) e il sovraccarico volemico. Il rischio di trasmissione di malattie virali è divenuto estremamente basso. Il ruolo della trasfusione sulla mortalità e sulla morbilità postoperatorie resta discusso, in quanto non è stato formalmente dimostrato da studi randomizzati.
    01/2011; 16(4):1–11. DOI:10.1016/S1283-0771(11)70679-X
  • A Henckes · J Arvieux · G Cochard · P Jézéquel · C C Arvieux
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    ABSTRACT: We report the case of a healthy 21-year-old woman who performed iterative breath-hold dives in relatively cold water, not exceeding depths of 5 meters but with "empty lungs." At the end of a dive, after experiencing an intense involuntary diaphragmatic contraction underwater, she presented hemoptysis followed by chest pain and cough. Chest radiography and computed tomography were performed 24 hours later, confirming the diagnosis of pneumomediastinum. The clinical course was benign: However, chest pain and effort dyspnea lasted for a few weeks. The pathophysiology of this accident may be explained by a combination of mechanisms involved in several clinical entities, namely pulmonary edema of immersion, pulmonary barotrauma and spontaneous pneumomediastinum.
    Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc 01/2011; 38(3):213-6. · 0.72 Impact Factor
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    ABSTRACT: Objective To compare the PaCO2 with the ETCO2 obtained with the Smart Capnoline™ in the postoperative setting of cardiac surgery during ventilation and after extubation
    Annales Françaises d Anesthésie et de Réanimation 01/2011; 30(1):13-16. DOI:10.1016/j.annfar.2010.11.008 · 0.84 Impact Factor
  • G. Gueret · L. Touffet · C.-C. Arvieux · J.-L. Bourgain
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    ABSTRACT: Objective To test a high-frequency jet ventilator, the Monsoon™ (Acutronic laboratory) on a lung model with regard to delivered tidal volume and tracheal pressure measured through the injector.
    Annales Françaises d Anesthésie et de Réanimation 11/2010; 29(11):821-825. DOI:10.1016/j.annfar.2010.08.006 · 0.84 Impact Factor
  • M. Coat · J.-P. Pennec · M. Guillouet · C.-C. Arvieux · G. Gueret
    Annales Françaises d Anesthésie et de Réanimation 09/2010; 29(9):661-661. DOI:10.1016/j.annfar.2010.06.004 · 0.84 Impact Factor
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    ABSTRACT: Many devices are available to assess cardiac output (CO) in critically ill patients and in the operating room. Classical CO monitoring via a pulmonary artery catheter involves continuous cardiac output (CCO) measurement. The second generation of Flotrac/Vigileo monitors propose an analysis of peripheral arterial pulse waves to calculate CO (APCO) without calibration. The aim of our study was to compare the CO between the Swan Ganz catheter and the VigileoT. In this observational study, nine patients undergoing coronary artery bypass grafting were prospectively included. APCO, mean (CCO) and instantaneous CO (ICO) were measured. Perioperative and postoperative assessments were performed up to 24 hours post-surgery. Measurements were recorded every minute, resulting in the collection of 6492 data pairs. Comparison of APCO and ICO showed a limited bias of -0.1 l/min but an important percentage error of 48%. Corresponding values were -0.1 l/min and 46% for the APCO versus CCO comparison, and 0 and 17% for ICO versus CCO comparison. Large inter-individual variability does exist. During cardiac surgery and after leaving the operating room, Vigileo is not clinically equivalent to continuous thermodilution by pulmonary artery catheter Nevertheless, the connection between CCO and ICO relates the difference between APCO and CCO more to the different algorithms used. Further efforts should be concentrated on assessing the ability of this device to track changes in cardiac output.
    Anaesthesia and intensive care 03/2010; 38(2):295-301. · 1.47 Impact Factor
  • L. Hélaine · C.-C. Arvieux · G. Gueret
    Annales Françaises d Anesthésie et de Réanimation 01/2010; 29(1):64-65. DOI:10.1016/j.annfar.2009.12.001 · 0.84 Impact Factor
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    ABSTRACT: L’insuffisance rénale est de survenue fréquente en réanimation périopératoire où les causes se trouvent rassemblées pour produire une atteinte rénale multifactorielle. Les techniques d’épuration extrarénale se sont progressivement améliorées tant en ce qui concerne leur efficacité que leur facilité d’utilisation; il n’en demeure pas moins que l’insuffisance rénale reste une affection grave qui comporte un risque vital propre. Par ailleurs, les suites opératoires en urologie se sont trouvées simplifiées par l’avènement de techniques chirurgicales moins invasives, limitant les complications hémorragiques notamment. Le TURP syndrome voit également sa fréquence diminuer par l’utilisation d’une irrigation avec du sérum physiologique, et non de l’eau glycocollée, rendue possible par l’emploi de la résection par laser.
    Réanimation et urgences, 12/2009: pages 129-142;
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    ABSTRACT: Les techniques d’épuration extrarénales se sont progressivement améliorées tant en ce qui concerne leur efficacité que leur facilité d’utilisation. Le personnel infirmier joue un rôle central dans la mise en œuvre et la gestion de ces techniques. Il n’en demeure pas moins que l’insuffisance rénale reste une affection grave qui comporte un risque vital propre.
    12/2009: pages 435-443;
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    ABSTRACT: L’indication de pose d’un cathéter veineux profond implique l’emploi d’un équipement adapté, une technique appropriée de pose et des conditions d’asepsie chirurgicale. Tout aussi importants que la technique d’insertion, les soins apportés à l’accès veineux après sa pose conditionnent la durée de vie du cathéter permettant ainsi d’épargner le capital veineux du patient et surtout de prévenir toute complication septique pouvant mettre en danger la vie du patient.
    Réanimation et urgences, 12/2009: pages 385-394;
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    ABSTRACT: Acute renal dysfunction (ARD) is common after cardiac surgery with cardiopulmonary bypass (CPB). CPB results in a sudden systemic inflammatory response. Systemic and local pro-inflammatory cytokines synthesis has been linked with sub-clinical renal injury, especially tubular lesions. Therefore, we sought to assess the systemic synthesis pro-inflammatory cytokines and its association with perioperative ARD after cardiac surgery with CPB. Sixty-two patients undergoing cardiac surgery with CPB were prospectively included. Four groups of patients were defined according to blood creatinine increase: no ARD (less than 25% increase), faint ARD (25-50% increase), moderate ARD (50-100% increase), severe ARD (more than 100% increase). Within the 48 post-operative hours was ARD observed as no dysfunction (41.9%), faint (32.2%), moderate (16.1%), severe (9.6%). One patient had to undergo a dialysis. Pre-operative characteristics were homogenous between the four groups excepted the left ventricle ejection fraction. ARD was associated with a low urinary output with high sodium excretion fraction. Significant increase of IL-6 level occurred when patients underwent a severe ARD despite no significant differences for the CRP and TNF-alpha concentrations. Severe acute renal dysfunction after cardiac surgery with CPB is associated with a significant increased IL-6 systemic production.
    Cytokine 02/2009; 45(2):92-8. DOI:10.1016/j.cyto.2008.11.001 · 2.87 Impact Factor
  • L. Hélaine · A. Cadic · E. Magro · A. Simon · G. Kiss · G. Gueret · C.-C. Arvieux
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    ABSTRACT: We report the case of a 36-year-old man who underwent neurosurgery for a T9 spine fracture consecutive to a fall. The patient had complete postoperative blindness which did not totally recover during the hospital stay. Decreased visual acuity and postoperative vision loss are not uncommon in spine surgery. Such postoperative complications in spine surgery are severe. To avoid them, it is mandatory to identify the contributing factors and set up a preventive strategy.
    Annales Françaises d Anesthésie et de Réanimation 02/2009; 28(2):165-167. DOI:10.1016/j.annfar.2008.12.003 · 0.84 Impact Factor
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    ABSTRACT: Cataract surgery can be performed with peribulbar anesthesia. The classical technique consists of two injections of local anesthetics. The purpose of our study was to assess peribulbar anesthesia with a single injection and a limited volume of local anesthetics. After local ethics committee agreement and oral consent, patients scheduled for cataract surgery using peribulbar anesthesia were prospectively included. The lower temporal puncture was performed with a peribulbar needle with propofol sedation. The mixture of local anesthetics was administered with tactile control of orbital pressure. The puncture was followed by a 10-min compression of the ocular globe. Akinesia, analgesia, complications, and surgical conditions were noted. A total of 101 successive patients were included. We administered 1.2 mg/kg of propofol. The volume of local anesthetics administered was 5.0 +/- 0.9 ml. Ninety patients had akinesia at 10 min and 6.7% moderate chemosis. No puncture complication occurred. At the end of surgery, the pain noted by the patients was 0.4 +/- 2.1 out of 100 (range, 0-10). Surgical conditions were good for all patients. Peribulbar anesthesia performed with a single injection and a limited volume of local anesthetics allows cataract surgery in good conditions for the surgeon with very good analgesia for the patient.
    Journal francais d'ophtalmologie 11/2008; 31(8):781-5. · 0.36 Impact Factor
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    ABSTRACT: Intoxications with sodium channel-blocking agents are an important cause of morbidity and mortality due to refractory cardiotoxicity. While treatments are mainly supportive, successful use of intravenous fat emulsions has been reported in several cases. Ion channels including sodium and calcium channels play a major role in generating and conducting action potentials that initiate myocardial contraction. Sodium channel blockade therefore explains arrhythmias and myocardial depression in overdoses. In animal studies, Intralipid® was shown to be beneficial on hemodynamic recovery and survival after cardiovascular collapse caused by local anaesthetics as well as other membrane stabilising agents (clomipramine and propanolol). Although the exact mechanism of lipid rescue is still unknown, several hypotheses have been suggested: “lipid sink” removing the lipophilic drug from tissues into a lipid phase, metabolic benefit on myocardial ATP synthesis or direct effect of free fatty acids on ion channels, especially calcium channels. In clinical practice, based on human cases and experimental reports since no randomised study is available, lipid emulsions should be considered as a complement of conventional cardiovascular support, given its reported safety.
    Réanimation 10/2008; 17(7). DOI:10.1016/j.reaurg.2008.07.009
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    ABSTRACT: Introduction La chirurgie de la cataracte peut se réaliser sous anesthésie péribulbaire. La technique classique comprend deux injections d’anesthésiques locaux. Le but de notre étude est d’évaluer l’anesthésie péribulbaire avec une seule injection et un volume limité d’anesthésiques locaux. Matériel et méthode Après accord du comité d’éthique local et consentement oral, des patients devant bénéficier d’une chirurgie de la cataracte sous anesthésie péribulbaire ont été prospectivement inclus. La ponction temporale inférieure a été réalisée avec une aiguille à anesthésie péribulbaire sous sédation par propofol. Le mélange d’anesthésiques locaux a été administré sous contrôle tactile de la pression sus-orbitaire. La ponction était suivie d’une compression du globe oculaire de 10 minutes. L’akinésie, l’analgésie, les complications et les conditions opératoires ont été notées. Résultats Cent un patients consécutifs ont été inclus. 1,2 mg/kg de propofol ont été administrés. Le volume d’anesthésiques locaux administrés était de 5,0 ± 0,9 ml. Une akinésie complète a été obtenue à 10 minutes chez 90 % des patients et un chémosis chez 6,7 %. Aucune complication liée à la ponction n’est survenue. En fin d’intervention, la douleur notée par les patients était de 0,4 ± 2,1 sur 100 (0 à 10). Les conditions opératoires notées par le chirurgien étaient excellentes pour tous les patients. Discussion Une anesthésie péribulbaire réalisée avec une seule injection et un volume d’anesthésiques locaux limité permet la réalisation de la chirurgie de la cataracte dans de bonnes conditions pour le chirurgien avec une très bonne analgésie pour le patient.
    Journal Français d Ophtalmologie 10/2008; 31(8):781-785. DOI:10.1016/S0181-5512(08)74397-3 · 0.36 Impact Factor
  • A. Henckes · F. Lion · G. Cochard · J. Arvieux · C.-C. Arvieux
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    ABSTRACT: Objectives Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk factors, conditions of occurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolution of this accident.
    Annales Françaises d Anesthésie et de Réanimation 09/2008; 27(9):694-699. DOI:10.1016/j.annfar.2008.05.011 · 0.84 Impact Factor
  • G Kiss · G Gueret · O Corre · R Deredec · C C Arvieux
    European Journal of Anaesthesiology 02/2008; 25(1):83-4; author reply 84-5. DOI:10.1017/S0265021507002621 · 3.01 Impact Factor
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    ABSTRACT: The aim of this study was to compare cardiac output measurements of the non-invasive cardiac output and the pulmonary artery catheter during repeat surgery for hip replacement. In this prospective observational study, patients undergoing repeat hip surgery who needed a pulmonary artery catheter were included. A standard protocol was followed for induction, endotracheal intubation and maintenance of anaesthesia (sufentanil, etomidate, sevoflurane, cisatracurium). After endotracheal intubation, the non-invasive cardiac output was connected and a pulmonary artery catheter was inserted. Data were collected every 3 min until patients were extubated. Ten patients were included and 2455 points of comparison recorded. Cardiac output from the pulmonary artery catheter varied from 1.7 to 8.9 L min(-1) (mean 4.1 L min(-1)) and the non-invasive cardiac output (using averaging mode) from 1.7 to 8.0 L min(-1) (mean 3.7 L min(-1)). There was a significant correlation between them (P < 0.01; bias 0.3 L min(-1); limits of agreement +1.9 and -2.5 L min(-1)), although these differed between patients. The perioperative bias was small and the non-invasive cardiac output slightly underestimated cardiac output intraoperatively compared to the pulmonary artery catheter. The bias was smaller when mean cardiac output was below 3 L min(-1). Core temperature between 34.4 degrees C and 37.6 degrees C had no influence on the differences.
    European Journal of Anaesthesiology 12/2007; 24(12):1028-33. DOI:10.1017/S026502150700110X · 3.01 Impact Factor

Publication Stats

237 Citations
138.08 Total Impact Points

Institutions

  • 2006–2011
    • Centre Hospitalier Universitaire de Brest
      • Service d'Ophtalmologie
      Brest, Brittany, France
  • 2004
    • Hospital Centre University of Fort de France
      Fort Royal, Martinique, Martinique
  • 1995–1999
    • CHU de Lyon - Hôpital Cardio-vasculaire et Pneumologique Louis Pradel
      Lyons, Rhône-Alpes, France
    • University Joseph Fourier - Grenoble 1
      Grenoble, Rhône-Alpes, France
  • 1991
    • McGill University
      Montréal, Quebec, Canada
    • Emory University
      Atlanta, Georgia, United States