2,833 publications from this institution
Direct iv injections of enoximone can significantly increase the cardiac index in critically ill patients treated by adrenergic agents for severe heart failure. The administration of small doses of enoximone is effective and has minimal effect on arterial pressure.
Because oxygen free radicals have been implicated in the endothelial cell damage and in the myocardial depression occurring during severe sepsis, we investigated whether N-acetyl-L-cysteine (NAC) could influence the oxygen extraction capabilities during an acute reduction in blood flow induced by cardiac tamponade after endotoxin challenge. Sixteen anesthetized, saline-infused, and ventilated dogs received Escherichia coli endotoxin (2 mg/kg) 30 min before tamponade was induced by repeated bolus injections of warm saline into the pericardial space. Thirty minutes before endotoxin administration, nine dogs received NAC (150 mg/kg, followed by a 20 mg.kg-1.h-1 infusion); the other seven dogs served as a control group. The NAC group maintained higher cardiac index, oxygen delivery (DO2), and left ventricular stroke work index, but lower systemic and pulmonary vascular resistance, than the control group. The oxygen uptake (VO2) levels at critical DO2 (DO2crit) were identical in the two groups. However, DO2crit was significantly lower in the NAC than in the control group (8.1 +/- 1.7 vs. 10.8 +/- 1.8 ml.kg-1.min-1, P < 0.01). Critical oxygen extraction ratio and the slope of the VO2-to-DO2-dependent line were higher in the NAC than in the control group (72 +/- 14 vs. 53 +/- 15% and 0.80 vs. 0.56, respectively; both P < 0.05). The peak lactate and the maximal tumor necrosis factor (TNF) levels were lower in the NAC than in the control group (5.2 +/- 0.4 vs. 7.6 +/- 0.4 mM, and 0.14 +/- 0.03 vs. 1.21 +/- 0.58 ng/ml, respectively; both P < 0.01). NAC significantly increased glutathione peroxidase activity.(ABSTRACT TRUNCATED AT 250 WORDS)
La question du rapport des jeunes enseignants en formation initiale avec les « nouvelles technologies » demeure une question vive tant il est vrai que les usages de ce qu'il est convenu d'appeler les « TICE » en milieu scolaire restent rares. De nombreuses questions se posent encore au sujet de l'utilisation des TICE par les enseignants. Est-il vrai par exemple, comme on le dit souvent, que les jeunes sont plus ouverts que leurs aînés aux nouvelles technologies ? Les IUFM sont-ils des centres d'innovation ou de diffusion de ce point de vue ? Parviennent-ils à banaliser les usages ? Deux ans après le « Plan d'urgence » quels en étaient les résultats ? Peut on percevoir des évolutions sensibles sur une si courte période ? Et enfin, les stagiaires de mathématiques ont-ils une attitude particulière vis à vis des TICE ? C'est pour tenter d'apporter quelques éléments de réponses à ces questions que deux enquêtes ont été menées auprès d'étudiants de seconde année de l'IUFM de Reims en 2000 et 2001. Cette communication détaille les résultats de ces enquêtes et fournit quelques pistes de réflexion sur la formation aux TICE à l'IUFM.
To the Editor: In the article by Schou et al. [1] regarding the effects of acute normovolemic hemodilution on the tolerance of anesthetized pigs to uncompensated blood loss, in their discussion, they state, "we could not confirm the findings of Van der Linden and coworkers that hemodilution increases the tolerance to hemorrhage." We cannot accept the interpretation the authors have placed on our data. Indeed, contrary to their interpretation, we specifically stated in our article [2] "the present data do not imply that the reduced hemoglobin is beneficial at the onset of acute hemorrhage." In our study [2], we tested the hypothesis that hemodilution is associated with an increase in tissue oxygen extraction capabilities, and for this purpose, we used a model of progressive hemorrhage, which has also been used by other groups to evaluate the effects of different conditions on tissue oxygen extraction capabilities in anesthetized animals [3,4]. It was not the purpose of our study to assess the tolerance of hemodiluted animals to hemorrhage, as in the study by Schou et al. [1]. We believe that it is, in fact, a logical assumption that hemodilution will decrease the tolerance to blood loss as the oxygen reserves decrease, and that animals will not tolerate acute blood loss under conditions of extreme hemodilution. Furthermore, at least some of the animals studied by Schou et al. [1] had already developed tissue dysoxia before the hemorrhagic sequence was started, because of the high degree of hemodilution. This is illustrated by the significant increase in serum lactate reported by the authors after the hemodilution procedure and before hemorrhage. In the same animal species, the pig, Trouwborst et al. [5] and Rasanen [6] showed that the critical level of hemodilution below which tissue oxygen delivery did not match oxygen demand, with resultant tissue hypoxia, was reached at a hemoglobin level of 4.0 g/dL, with an oxygen extraction ratio of 56%-57%. Before the hemorrhagic sequence, animals in the study by Schou et al. [1] had a hemoglobin level of 3.3 +/- 0.3 g/dL and an oxygen extraction ratio of 65% +/- 6%. In this situation, the ability of tissue to extract more oxygen to compensate for a further decrease in oxygen delivery due to the decreased blood volume could certainly be expected to be very limited. Philippe Van der Linden, MD, PhD Department of Cardiac Anesthesia; CHU Charleroi; Charleroi, Belgium Jean-Louis Vincent, MD, PhD Department of Intensive Care; CUB Erasme; Brussels, Belgium
Many reasons have been put forward over the years to explain the many negative results from trials of immunomodulatory therapies. Future studies need to be designed to specifically target patients who can benefit from the intervention being studied rather than at the sepsis population in general. The timing of administration of potential therapies also needs to be taken more into consideration.
Vincent, J L; de Bel, Ernst; Mallick, Abhiram; Malledant, Yannick; Sakr, Yasser; Reinhart, Konrad; Hoste, Eric On behalf of SOAP investigators Author Information
Department of Intensive Care Erasme University Hospital Free University of Brussels Brussels, Belgium *See also p. 1334.
Severe sepsis is a common disease process in the critically ill and is associated with substantial morbidity and mortality. Continuing research has provided considerable insight into the pathophysiology of sepsis over recent years, enabling various aspects of the sepsis response to be targeted. Discoveries related to the link between coagulation and inflammation have been particularly exciting, leading to the development of recombinant activated protein C. This review will discuss current definitions of sepsis, describe new approaches to classification and diagnosis of patients with sepsis, present recommendations for management, and briefly highlight areas of ongoing and future research.
