Pulmonary haemodynamics and blood gas tensions were investigated in eight healthy volunteers, bre... more Pulmonary haemodynamics and blood gas tensions were investigated in eight healthy volunteers, breathing room air and at the 15th min of an acute inspiratory hypoxia (fraction of inspired oxygen, (FIO2), 0.125) before and after administration of ibuprofen, a cyclooxygenase inhibitor, and of dazoxiben, a thromboxane A2 (TxA2) synthetase inhibitor; both drugs either with or without an infusion of prostaglandin E1. Hypoxia decreased arterial oxygen tension (PaO2) to below 50 mmHg in every subject and increased pulmonary vascular resistance by an average of 100-150% from baseline values. Acute and chronic dazoxiben or ibuprofen administration markedly reduced serum thromboxane B2 (TxB2), the stable metabolite of TxA2, but had no effect on pulmonary haemodynamics and blood gas tensions in both normoxic and hypoxic conditions. Prostaglandin E1 given in addition to ibuprofen or to dazoxiben did not inhibit hypoxia-induced increases in pulmonary vascular resistance. The stability of this hypoxic pressor response on repetition of an acute hypoxic exposure was established in six additional healthy subjects. Although obtained on a small number of subjects, these results do not suggest that products of the cyclooxygenase pathway of arachidonic acid metabolism play an important role in modulating normoxic or hypoxic pulmonary vascular tone in man.
Yora Mostmans: acquisition of data and analysis and interpretation of data, drafting of the artic... more Yora Mostmans: acquisition of data and analysis and interpretation of data, drafting of the article, final approval of the version to be published. Martine Grosber: acquisition of data or analysis and interpretation of data, drafting of the article, final approval of the version to be published. Martijn Blykers: acquisition of data or analysis and interpretation of data, critical revising of the article for important intellectual content and final approval of the version to be published. Pierre Mols: substantial contributions to conception and design of the study, acquisition of data, critical revising of the article for important intellectual content and final approval of the version to be published. Nicole Naeije: substantial contributions to conception and design of the study, acquisition of data, drafting of the article, final approval of the version to be published. Jan Gutermuth: acquisition of data or analysis and interpretation of data, critical revising of the article for important intellectual content and final approval of the version to be published.
Background: Optimal out of hospital cardiac arrest (OHCA) airway management strategies remain unc... more Background: Optimal out of hospital cardiac arrest (OHCA) airway management strategies remain unclear. We compared chest compression fraction (CCF) between patients receiving endotracheal intubation (ETI) versus bag mask ventilation (BMV). Methods: We studied adult OHCA enrolled from our center in the CAAM trial. Primary exposures were ETI or BMV. Primary outcome was whole intervention CCF, adjusted for Utstein confounders. Secondary outcomes were per cycle CCF, no flow time associated (NFT) with ventilation, rhythms checks and mechanical chest compression device placement. Results: Of 2040 OHCA enrolled in the CAAM trial we analyzed 112 cases recruited by our center. Unadjusted CCF was 0.89 for ETI and 0.88 for BMV (p=0.19). Compared with BMV, ETI achieved lower NFT associated with ventilations (32 vs 127 seconds; p<0.001). ETI cases experienced higher NFT associated with rhythm checks (69.5 vs 42.5 seconds p=0.02) and with mechanical chest compression placement (29 vs 20 seconds; p=0.04). CCF was higher during the first cycle in BMV than in ETI patients (0.81 vs 0.74; p=0.02). After correction for confounders we observed no difference in global intervention CCF between the ETI and BMV (∆CCF [ETI-BMV] 0.301; [95%CI:-1.9-2.51]; p=0.79). Conclusion:In our substudy whole intervention CCF among OHCA was not modified by ETI compared to BMV. In the ETI group we observed lower NFT associated with ventilations and higher NFT associated with mechanical chest compression devices placement. CCF was lower in the ETI group during the first cycle. pauses associated with ventilation, ETI was associated with an increase in pauses associated with rhythm checks and mechanical chest compression device placement.
Twelve patients exhibiting difficuities during discontinuation of artificial ventilation permitte... more Twelve patients exhibiting difficuities during discontinuation of artificial ventilation permitted us to investigate inspiratory muscle fatigue. In six patients showing electromyographic evidence of inspiratory muscle fatigue, a sequence of events leading to respiratory acidemia emerged-namely electromyographic evidence of fatigue, accompanied or followed by an increased respiratory rate, in tu'n followed by ahema&~ between abdominal and rib tags breathing (respiratory a&mans), psmdoxic inward abdominal motion during inspiratton (abdominal paradox),
The American review of respiratory disease, Nov 1, 1987
Hemodynamics, blood gases, lung mechanics, and the distributions of ventilation-perfusion ratios ... more Hemodynamics, blood gases, lung mechanics, and the distributions of ventilation-perfusion ratios (VA/Q) were studied before and after iv diltiazem, 0.5 mg/kg over 30 min, in 6 patients with pulmonary hypertension secondary to the adult respiratory distress syndrome (ARDS) ventilated with 7 to 20 cm H2O positive end-expiratory pressure (PEEP). Diltiazem decreased systemic and pulmonary arterial pressures without changes in cardiac output and in filling pressures of the heart, and with a slowing of heart rate. Pulmonary vascular resistances decreased from 401 +/- 59 to 329 +/- 58 dyne.s.cm-5.m2 (mean +/- SEM), p less than 0.01. Arterial Po2 decreased from 87 +/- 10 to 80 +/- 11 mm Hg (p less than 0.02) without changes in arterial PCO2, mixed venous PO2, and O2 consumption. Lung compliance and airway resistances did not change. Diltiazem increased true shunt from 23 +/- 5 to 30 +/- 7% of total blood flow (p less than 0.02) without other modification in the pattern of VA/Q distribution as measured by the multiple inert gas elimination technique. These results suggest that pulmonary vascular tone contributes to the maintenance of VA/Q matching in patients with ARDS.
To compare the performances of molecular and non-molecular tests to diagnose respiratory viral in... more To compare the performances of molecular and non-molecular tests to diagnose respiratory viral infections and to evaluate the pros and contras of each technique. Methods: Two hundred ninety-nine respiratory samples were prospectively explored using multiplex molecular techniques (FilmArray Respiratory Panel, Clart Pneumovir), immunological techniques (direct fluorescent assay, lateral flow chromatography) and cell cultures. Findings: Molecular techniques permitted the recovery of up to 50% more respiratory pathogens in comparison to non-molecular methods. FilmArray detected at least 30% more pathogens than Clart Pneumovir which could be explained by the differences in their technical designs. The turnaround time under 2 hours for the FilmArray permitted delivery of results when patients were still in the emergency room.
A 65 year old patient presents himself to the Emergency Room with general physical alteration, di... more A 65 year old patient presents himself to the Emergency Room with general physical alteration, diarrhea, and abdominal pain. After a thorough medical exam and workup, two hypotheses are retained; secondary dyslipidemia due to a non insulin dependent diabetes, and angiocholitis. The presentation of this case report is to stress the following two messages: 1) major hypertriglyceridemia, to the point of rendering the blood lactescent, can be secondary and transitional; 2) hypertriglyceridemia of this importance can render the evaluation of blood samples difficult.
Objectif : Analyser la faisabilite et les effets hemodynamiques de la perfusion d'un volume l... more Objectif : Analyser la faisabilite et les effets hemodynamiques de la perfusion d'un volume limite de NaCI a 7,2 %/hydroxyethyl amidon 6 % 200/0,5 (HS-HES) au cours de la reanimation prehospitaliere et du transport aux urgences de traumatises. Modalites: Etude prospective randomisee. Materiels et methode : Les traumatises ont ete pris en charge suivant les recommandations de l'American Trauma Life Support, avec un score de Hannovre egal ou superieur a 10, ont recu un bolus de 250 ml de HS-HES (groupe traite) ou 250 ml de HES seul (groupe controle). Resultats: Chez 35 patients (19/16) la perfusion initiale de 250 ml de HES ou de HS-HES et la poursuite de la perfusion ont augmente la pression arterielle et diminue la frequence cardiaque. La perfusion supplementaire de colloides (745 ± 134 ml versus 359 ± 93 ml p < 0,05) et de cristalloides (268 ± 81 ml vers 86 ± 43 ml p < 0,005) etait plus importante dans le groupe controle que dans le groupe HS-HES. Le temps consacre a la perfusion et au transport jusqu'aux urgences etait de 29 ± 3 min dans le groupe controle et 21 ± 4 min dans le groupe HS-HES (p < 0,05). Conclusions: Cette etude conduite chez le patient traumatise demontre que l'administration de 250 ml d'HS-HES est possible. Elle permet la normalisation des parametres hemodynamiques avec un plus petit volume de colloides et de cristalloides et ceci en une periode de temps plus breve.
The aim of the study was to evaluate the consequences of the administration of paracetamol on the... more The aim of the study was to evaluate the consequences of the administration of paracetamol on the mean arterial pressure (MAP) of patients hospitalized in an intensive care unit, as well as the influence of the route of administration (oral vs. IV). This is an observational, prospective, and single center study that has been carried out in the medical and surgical intensive care unit (ICU) of the Centre Hospitalier de Jolimont, Haine Saint-Paul (Belgium). A cohort of 107 consecutive patients was collated over a period of three months. A group of 75 patients (group 1) received an unique dose of 1g of paracetamol intravenously and was compared to a group of 32 patients (group 2) who received the same dose orally (effervescent tablets). MAP was recorded either non-invasively (cuff), or with invasive means (arterial line), before (T0) and 15, 30, 45, 60, 90, and 120 min after administration of the drug. In both groups, the administration of paracetamol resulted in a drop of MAP of 10 to 20% in 30 patients (28% of the cohort), 20% to 40% in 23 patients (21%) and over 40% in 4 patients (3.7%). Six patients (5%) had to be treated by fluid replacement or vasopressors during the observation period. No significant difference in regard to the magnitude of the fall of MAP was noted between the two groups. The kinetics of the fall in blood pressure was essentially identical in both groups with a decrease of 5-6% occurring already at 30 min. Beyond 30 min, the MAP stabilized in group 1 with the blood pressure nadir observed at 30 min, whereas it tended to further decrease in group 2 with a delayed blood pressure nadir (-10% vs. T0) in the ninetieth minute. We believe that this observation is important as it draws the attention on the need for a strict hemodynamic monitoring in the many patients hospitalized in ICU and receiving paracetamol and on the anticipation it implies about the vigilance of the medical staff to quickly address these hemodynamic changes.
1981;80;570-574 Chest R Naeije, R Hallemans, P Mols and C Melot cirrhosis. Hypoxic pulmonary vaso... more 1981;80;570-574 Chest R Naeije, R Hallemans, P Mols and C Melot cirrhosis. Hypoxic pulmonary vasoconstriction in liver http://chestjournal.chestpubs.org/content/80/5/570 can be found online on the World Wide Web at: The online version of this article, along with updated information and services ) ISSN:0012-3692 http://chestjournal.chestpubs.org/site/misc/reprints.xhtml ( without the prior written permission of the copyright holder. reserved. No part of this article or PDF may be reproduced or distributed Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights of been published monthly since 1935. Copyright1981by the American College is the official journal of the American College of Chest Physicians. It has Chest
Background Randomized trials have shown that trans-nasal evaporative cooling initiated during CPR... more Background Randomized trials have shown that trans-nasal evaporative cooling initiated during CPR (i.e. intra-arrest) effectively lower core body temperature in out-of-hospital cardiac arrest patients. However, these trials may have been underpowered to detect significant differences in neurologic outcome, especially in patients with initial shockable rhythm. Methods We conducted a post hoc pooled analysis of individual data from two randomized trials including 851 patients who eventually received the allocated intervention and with available outcome (“as-treated” analysis). Primary outcome was survival with favourable neurological outcome at hospital discharge (Cerebral Performance Category [CPC] of 1–2) according to the initial rhythm (shockable vs. non-shockable). Secondary outcomes included complete neurological recovery (CPC 1) at hospital discharge. Results Among the 325 patients with initial shockable rhythms, favourable neurological outcome was observed in 54/158 (34.2%) pat...
Pulmonary haemodynamics and blood gas tensions were investigated in eight healthy volunteers, bre... more Pulmonary haemodynamics and blood gas tensions were investigated in eight healthy volunteers, breathing room air and at the 15th min of an acute inspiratory hypoxia (fraction of inspired oxygen, (FIO2), 0.125) before and after administration of ibuprofen, a cyclooxygenase inhibitor, and of dazoxiben, a thromboxane A2 (TxA2) synthetase inhibitor; both drugs either with or without an infusion of prostaglandin E1. Hypoxia decreased arterial oxygen tension (PaO2) to below 50 mmHg in every subject and increased pulmonary vascular resistance by an average of 100-150% from baseline values. Acute and chronic dazoxiben or ibuprofen administration markedly reduced serum thromboxane B2 (TxB2), the stable metabolite of TxA2, but had no effect on pulmonary haemodynamics and blood gas tensions in both normoxic and hypoxic conditions. Prostaglandin E1 given in addition to ibuprofen or to dazoxiben did not inhibit hypoxia-induced increases in pulmonary vascular resistance. The stability of this hypoxic pressor response on repetition of an acute hypoxic exposure was established in six additional healthy subjects. Although obtained on a small number of subjects, these results do not suggest that products of the cyclooxygenase pathway of arachidonic acid metabolism play an important role in modulating normoxic or hypoxic pulmonary vascular tone in man.
Yora Mostmans: acquisition of data and analysis and interpretation of data, drafting of the artic... more Yora Mostmans: acquisition of data and analysis and interpretation of data, drafting of the article, final approval of the version to be published. Martine Grosber: acquisition of data or analysis and interpretation of data, drafting of the article, final approval of the version to be published. Martijn Blykers: acquisition of data or analysis and interpretation of data, critical revising of the article for important intellectual content and final approval of the version to be published. Pierre Mols: substantial contributions to conception and design of the study, acquisition of data, critical revising of the article for important intellectual content and final approval of the version to be published. Nicole Naeije: substantial contributions to conception and design of the study, acquisition of data, drafting of the article, final approval of the version to be published. Jan Gutermuth: acquisition of data or analysis and interpretation of data, critical revising of the article for important intellectual content and final approval of the version to be published.
Background: Optimal out of hospital cardiac arrest (OHCA) airway management strategies remain unc... more Background: Optimal out of hospital cardiac arrest (OHCA) airway management strategies remain unclear. We compared chest compression fraction (CCF) between patients receiving endotracheal intubation (ETI) versus bag mask ventilation (BMV). Methods: We studied adult OHCA enrolled from our center in the CAAM trial. Primary exposures were ETI or BMV. Primary outcome was whole intervention CCF, adjusted for Utstein confounders. Secondary outcomes were per cycle CCF, no flow time associated (NFT) with ventilation, rhythms checks and mechanical chest compression device placement. Results: Of 2040 OHCA enrolled in the CAAM trial we analyzed 112 cases recruited by our center. Unadjusted CCF was 0.89 for ETI and 0.88 for BMV (p=0.19). Compared with BMV, ETI achieved lower NFT associated with ventilations (32 vs 127 seconds; p<0.001). ETI cases experienced higher NFT associated with rhythm checks (69.5 vs 42.5 seconds p=0.02) and with mechanical chest compression placement (29 vs 20 seconds; p=0.04). CCF was higher during the first cycle in BMV than in ETI patients (0.81 vs 0.74; p=0.02). After correction for confounders we observed no difference in global intervention CCF between the ETI and BMV (∆CCF [ETI-BMV] 0.301; [95%CI:-1.9-2.51]; p=0.79). Conclusion:In our substudy whole intervention CCF among OHCA was not modified by ETI compared to BMV. In the ETI group we observed lower NFT associated with ventilations and higher NFT associated with mechanical chest compression devices placement. CCF was lower in the ETI group during the first cycle. pauses associated with ventilation, ETI was associated with an increase in pauses associated with rhythm checks and mechanical chest compression device placement.
Twelve patients exhibiting difficuities during discontinuation of artificial ventilation permitte... more Twelve patients exhibiting difficuities during discontinuation of artificial ventilation permitted us to investigate inspiratory muscle fatigue. In six patients showing electromyographic evidence of inspiratory muscle fatigue, a sequence of events leading to respiratory acidemia emerged-namely electromyographic evidence of fatigue, accompanied or followed by an increased respiratory rate, in tu'n followed by ahema&~ between abdominal and rib tags breathing (respiratory a&mans), psmdoxic inward abdominal motion during inspiratton (abdominal paradox),
The American review of respiratory disease, Nov 1, 1987
Hemodynamics, blood gases, lung mechanics, and the distributions of ventilation-perfusion ratios ... more Hemodynamics, blood gases, lung mechanics, and the distributions of ventilation-perfusion ratios (VA/Q) were studied before and after iv diltiazem, 0.5 mg/kg over 30 min, in 6 patients with pulmonary hypertension secondary to the adult respiratory distress syndrome (ARDS) ventilated with 7 to 20 cm H2O positive end-expiratory pressure (PEEP). Diltiazem decreased systemic and pulmonary arterial pressures without changes in cardiac output and in filling pressures of the heart, and with a slowing of heart rate. Pulmonary vascular resistances decreased from 401 +/- 59 to 329 +/- 58 dyne.s.cm-5.m2 (mean +/- SEM), p less than 0.01. Arterial Po2 decreased from 87 +/- 10 to 80 +/- 11 mm Hg (p less than 0.02) without changes in arterial PCO2, mixed venous PO2, and O2 consumption. Lung compliance and airway resistances did not change. Diltiazem increased true shunt from 23 +/- 5 to 30 +/- 7% of total blood flow (p less than 0.02) without other modification in the pattern of VA/Q distribution as measured by the multiple inert gas elimination technique. These results suggest that pulmonary vascular tone contributes to the maintenance of VA/Q matching in patients with ARDS.
To compare the performances of molecular and non-molecular tests to diagnose respiratory viral in... more To compare the performances of molecular and non-molecular tests to diagnose respiratory viral infections and to evaluate the pros and contras of each technique. Methods: Two hundred ninety-nine respiratory samples were prospectively explored using multiplex molecular techniques (FilmArray Respiratory Panel, Clart Pneumovir), immunological techniques (direct fluorescent assay, lateral flow chromatography) and cell cultures. Findings: Molecular techniques permitted the recovery of up to 50% more respiratory pathogens in comparison to non-molecular methods. FilmArray detected at least 30% more pathogens than Clart Pneumovir which could be explained by the differences in their technical designs. The turnaround time under 2 hours for the FilmArray permitted delivery of results when patients were still in the emergency room.
A 65 year old patient presents himself to the Emergency Room with general physical alteration, di... more A 65 year old patient presents himself to the Emergency Room with general physical alteration, diarrhea, and abdominal pain. After a thorough medical exam and workup, two hypotheses are retained; secondary dyslipidemia due to a non insulin dependent diabetes, and angiocholitis. The presentation of this case report is to stress the following two messages: 1) major hypertriglyceridemia, to the point of rendering the blood lactescent, can be secondary and transitional; 2) hypertriglyceridemia of this importance can render the evaluation of blood samples difficult.
Objectif : Analyser la faisabilite et les effets hemodynamiques de la perfusion d'un volume l... more Objectif : Analyser la faisabilite et les effets hemodynamiques de la perfusion d'un volume limite de NaCI a 7,2 %/hydroxyethyl amidon 6 % 200/0,5 (HS-HES) au cours de la reanimation prehospitaliere et du transport aux urgences de traumatises. Modalites: Etude prospective randomisee. Materiels et methode : Les traumatises ont ete pris en charge suivant les recommandations de l'American Trauma Life Support, avec un score de Hannovre egal ou superieur a 10, ont recu un bolus de 250 ml de HS-HES (groupe traite) ou 250 ml de HES seul (groupe controle). Resultats: Chez 35 patients (19/16) la perfusion initiale de 250 ml de HES ou de HS-HES et la poursuite de la perfusion ont augmente la pression arterielle et diminue la frequence cardiaque. La perfusion supplementaire de colloides (745 ± 134 ml versus 359 ± 93 ml p < 0,05) et de cristalloides (268 ± 81 ml vers 86 ± 43 ml p < 0,005) etait plus importante dans le groupe controle que dans le groupe HS-HES. Le temps consacre a la perfusion et au transport jusqu'aux urgences etait de 29 ± 3 min dans le groupe controle et 21 ± 4 min dans le groupe HS-HES (p < 0,05). Conclusions: Cette etude conduite chez le patient traumatise demontre que l'administration de 250 ml d'HS-HES est possible. Elle permet la normalisation des parametres hemodynamiques avec un plus petit volume de colloides et de cristalloides et ceci en une periode de temps plus breve.
The aim of the study was to evaluate the consequences of the administration of paracetamol on the... more The aim of the study was to evaluate the consequences of the administration of paracetamol on the mean arterial pressure (MAP) of patients hospitalized in an intensive care unit, as well as the influence of the route of administration (oral vs. IV). This is an observational, prospective, and single center study that has been carried out in the medical and surgical intensive care unit (ICU) of the Centre Hospitalier de Jolimont, Haine Saint-Paul (Belgium). A cohort of 107 consecutive patients was collated over a period of three months. A group of 75 patients (group 1) received an unique dose of 1g of paracetamol intravenously and was compared to a group of 32 patients (group 2) who received the same dose orally (effervescent tablets). MAP was recorded either non-invasively (cuff), or with invasive means (arterial line), before (T0) and 15, 30, 45, 60, 90, and 120 min after administration of the drug. In both groups, the administration of paracetamol resulted in a drop of MAP of 10 to 20% in 30 patients (28% of the cohort), 20% to 40% in 23 patients (21%) and over 40% in 4 patients (3.7%). Six patients (5%) had to be treated by fluid replacement or vasopressors during the observation period. No significant difference in regard to the magnitude of the fall of MAP was noted between the two groups. The kinetics of the fall in blood pressure was essentially identical in both groups with a decrease of 5-6% occurring already at 30 min. Beyond 30 min, the MAP stabilized in group 1 with the blood pressure nadir observed at 30 min, whereas it tended to further decrease in group 2 with a delayed blood pressure nadir (-10% vs. T0) in the ninetieth minute. We believe that this observation is important as it draws the attention on the need for a strict hemodynamic monitoring in the many patients hospitalized in ICU and receiving paracetamol and on the anticipation it implies about the vigilance of the medical staff to quickly address these hemodynamic changes.
1981;80;570-574 Chest R Naeije, R Hallemans, P Mols and C Melot cirrhosis. Hypoxic pulmonary vaso... more 1981;80;570-574 Chest R Naeije, R Hallemans, P Mols and C Melot cirrhosis. Hypoxic pulmonary vasoconstriction in liver http://chestjournal.chestpubs.org/content/80/5/570 can be found online on the World Wide Web at: The online version of this article, along with updated information and services ) ISSN:0012-3692 http://chestjournal.chestpubs.org/site/misc/reprints.xhtml ( without the prior written permission of the copyright holder. reserved. No part of this article or PDF may be reproduced or distributed Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights of been published monthly since 1935. Copyright1981by the American College is the official journal of the American College of Chest Physicians. It has Chest
Background Randomized trials have shown that trans-nasal evaporative cooling initiated during CPR... more Background Randomized trials have shown that trans-nasal evaporative cooling initiated during CPR (i.e. intra-arrest) effectively lower core body temperature in out-of-hospital cardiac arrest patients. However, these trials may have been underpowered to detect significant differences in neurologic outcome, especially in patients with initial shockable rhythm. Methods We conducted a post hoc pooled analysis of individual data from two randomized trials including 851 patients who eventually received the allocated intervention and with available outcome (“as-treated” analysis). Primary outcome was survival with favourable neurological outcome at hospital discharge (Cerebral Performance Category [CPC] of 1–2) according to the initial rhythm (shockable vs. non-shockable). Secondary outcomes included complete neurological recovery (CPC 1) at hospital discharge. Results Among the 325 patients with initial shockable rhythms, favourable neurological outcome was observed in 54/158 (34.2%) pat...
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