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ABSTRACT: Objective. To undertake a retrospective assessment of a knowledge translation of how a low tidal volume setting has affected the overall outcome of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) patients in Québec ICUs. Material and methods. This was a study of case files from five Québec ICUs, separated into two groups: those from before and after November 2000 (i.e. 6 months after the publication of the first ARDS Network trial). The primary outcome was changes in tidal volume. Secondary outcomes comprised mortality, number of days without organ dysfunction/failure, positive end-expiratory pressure (PEEP) level, respiratory rate and partial pressure of CO2 (PaCO2). Results. Of 105 patients, 55 were studied before and 50 after the landmark trial. Compared to the situation before November 2000: (i) tidal volume (normalized to predicted ideal body weight) fell; (ii) PEEP, respiratory rate and PaCO2 rose; and (iii) in-hospital mortality decreased and days without organ failure increased after November 2000. Conclusions. The knowledge translation of ventilation settings for ALI/ARDS patients has moved closer to standard practice in Québec ICUs following the publication of the ARDS Network trial. This may have affected mortality and morbidity.
07/2009; 4(1):15-21.
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ABSTRACT: Neutrophil elastase in the cystic fibrosis airways inhibits opsonophagocytosis and induces the expression of interleukin-8, a neutrophil chemoattractant. Prolastin is a therapeutic preparation of alpha-1 proteinase inhibitor (alpha1,-PI), a neutrophil elastase inhibitor. The objective of this study was to determine the effects of Prolastin aerosol therapy on airway inflammation in cystic fibrosis.
The primary endpoint of this study was sputum taurine, an amino-acid present in high concentrations in neutrophils. Sputum taurine correlates with respiratory exacerbations of cystic fibrosis. Seventeen patients with cystic fibrosis were each assigned to three sequential 10-day periods including first, aerosol therapy of 5 ml saline solution bid; second, aerosol therapy of 250 mg Prolastin bid; third, no aerosol therapy. On days 8, 9 and 10 of each period, early morning sputum was collected for the quantification of alpha1-PI, neutrophil elastase activity, IL-8 and taurine.
During Prolastin therapy, a 3-fold increase in sputum alpha1-PI was observed (P = 0.002). Baseline values of sputum alpha1-PI correlated with the values obtained after Prolastin aerosol (R = 0.77, P < 0.01). Sputum neutrophil elastase activity remained unchanged but taurine decreased after Prolastin therapy (during therapy P = 0.052, after therapy P = 0.026). Prolastin aerosol therapy had no adverse effect on pulmonary function.
Aerosol therapy with Prolastin in patients with cystic fibrosis leads to a progressive decrease in sputum taurine. This suggests that even in the absence of sustained elastase inhibition, Prolastin aerosol therapy may have a beneficial effect on airway inflammation in patients with cystic fibrosis.
Clinical and investigative medicine. Médecine clinique et experimentale 09/2006; 29(4):201-7. · 1.15 Impact Factor
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Olivier Lesur,
Stephan Langevin, Yves Berthiaume,
Martin Légaré,
Yoanna Skrobik,
Jean-François Bellemare,
Bruno Lévy,
Yvan Fortier,
Francois Lauzier,
Gina Bravo,
Marc Nickmilder,
Eric Rousseau,
Alfred Bernard
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ABSTRACT: Injury to the alveolocapillary barrier characterizes ALI/ARDS; therefore determining levels of lung epithelium-specific small proteins in serum may help predict clinical outcomes. We examined whether serum Clara cell protein (CC-16) concentration is correlated with the outcome, mechanical ventilation duration, and incidence of nonpulmonary organ failure.
Prospective multicenter observational study conducted by the Quebec Critical Care Network.
Seventy-eight adult ARDS patients requiring mechanical ventilation were enrolled and 28-day mortality was the primary outcome. Ventilatory parameters were computed and blood was sampled daily. Clinical information collected included cause of death, duration of mechanical ventilation, number of ventilator-free days, and organ failures.
Median serum levels of CC-16 were significantly higher in nonsurvivors than survivors on days 0-2 (19.93 microg/l, IQR 11.8-44.32, vs. 8.9, 5.66-26.38) and sustained up to day 14. CC-16 levels were correlated positively with the number of failing organs (rho 0.3623) and requirement for prolonged mechanical ventilation. Predictors of patient mortality included age, arterial carbon dioxide partial pressure, CC-16, and APACHE II score (odds ratios 1.35, 1.52, 1.37, 1.159, respectively).
Higher initial CC-16 serum level is associated with increased risk of death, fewer ventilator-free days, and increased frequency of nonpulmonary multiple organ failure. CC-16 is a valuable biomarker of ARDS that may help predict outcome among ARDS patients with high-risk mortality.
Intensive Care Medicine 09/2006; 32(8):1167-74. · 5.40 Impact Factor
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ABSTRACT: Clearance of mucus from airways is the cornerstone of therapy for lung disease in patients with cystic fibrosis (CF). This paper describes the operation of the Frequencer, a novel respiratory physiotherapy device comprised of an electro-acoustical transducer. We hypothesized that the Frequencer would be a safe and effective therapy to help clear secretions from the airways of subjects with CF.
To verify this hypothesis, 22 individuals with CF were recruited to this study comparing sputum production during conventional chest physiotherapy (CCPT) and Frequencer therapy using a crossover design. The sputum weight was the main outcome measure.
Sputum weight was found to be a reproducible measure of the efficacy of chest physiotherapy in individual patients. The Frequencer induced airway clearance in patients with CF that was equivalent to that of CCPT. Furthermore, treatment of a 4% mucin preparation ex vivo with the Frequencer significantly reduced the viscosity of the mucin solution as determined in a capillary rheometer.
These results indicate the Frequencer is safe and as effective as CCPT in inducing airway clearance in patients with CF.
Clinical and investigative medicine. Médecine clinique et experimentale 07/2006; 29(3):159-65. · 1.15 Impact Factor
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Pediatric Pulmonology 05/2004; 37(4):379-81; author reply 381-2; discussion 382. · 2.53 Impact Factor
