Comparison of bedside measurement of cardiac output with the thermodilution method and the Fick method in mechanically ventilated patients

INTRODUCTION: Bedside cardiac output determination is a common preoccupation in the critically ill. All available methods have drawbacks. We wished to re-examine the agreement between cardiac output determined using the thermodilution method (QTTHERM) and cardiac output determined using the metabolic (Fick) method (QTFICK) in patients with extremely severe states, all the more so in the context of changing practices in the management of patients. Indeed, the interchangeability of the methods is a clinically relevant question; for instance, in view of the debate about the risk–benefit balance of right heart catheterization. PATIENTS AND METHODS: Eighteen mechanically ventilated passive patients with a right heart catheter in place were studied (six women, 12 men; age, 39–84 years; simplified acute physiology scoreII, 39–111). QTTHERM was obtained using a standard procedure. QTFICK was measured from oxygen consumption, carbon dioxide production, and arterial and mixed venous oxygen contents. Forty-nine steady-state pairs of measurements were performed. The data were normalized for repeated measurements, and were tested for correlation and agreement. RESULTS: The QTFICK value was 5.2 ± 2.0 l/min whereas that of QTTHERM was 5.8 ± 1.9 l/min (R = 0.840, P < 0.0001; mean difference, -0.7 l/min; lower limit of agreement, -2.8 l/min; upper limit of agreement, 1.5 l/min). The agreement was excellent between the two techniques at QTTHERM values <5 l/min but became too loose for clinical interchangeability above this value. Tricuspid regurgitation did not influence the results. DISCUSSION AND CONCLUSIONS: No gold standard is established to measure cardiac output in critically ill patients. The thermodilution method has known limitations that can lead to inaccuracies. The metabolic method also has potential pitfalls in this context, particularly if there is increased oxygen consumption within the lungs. The concordance between the two methods for low cardiac output values suggests that they can both be relied upon for clinical decision making in this context. Conversely, a high cardiac output value is more difficult to rely on in absolute terms

Inspiratory resistances facilitate the diaphragm response to transcranial stimulation in humans

BACKGROUND: Breathing in humans is dually controlled for metabolic (brainstem commands) and behavioral purposes (suprapontine commands) with reciprocal modulation through spinal integration. Whereas the ventilatory response to chemical stimuli arises from the brainstem, the compensation of mechanical loads in awake humans is thought to involve suprapontine mechanisms. The aim of this study was to test this hypothesis by examining the effects of inspiratory resistive loading on the response of the diaphragm to transcranial magnetic stimulation. RESULTS: Six healthy volunteers breathed room air without load (R0) and then against inspiratory resistances (5 and 20 cmH(2)O/L/s, R5 and R20). Ventilatory variables were recorded. Transcranial magnetic stimulation (TMS) was performed during early inspiration (I) or late expiration (E), giving rise to motor evoked potentials (MEPs) in the diaphragm (Di) and abductor pollicis brevis (APB). Breathing frequency significantly decreased during R20 without any other change. Resistive breathing had no effect on the amplitude of Di MEPs, but shortened their latency (R20: -0.903 ms, p = 0.03) when TMS was superimposed on inspiration. There was no change in APB MEPs. CONCLUSION: Inspiratory resistive breathing facilitates the diaphragm response to TMS while it does not increase the automatic drive to breathe. We interpret these findings as a neurophysiological substratum of the suprapontine nature of inspiratory load compensation in awake humans

Invasive pulmonary aspergillosis in patients with decompensated cirrhosis: case series

BACKGROUND: Opportunistic invasive fungal infections are increasingly frequent in intensive care patients. Their clinical spectrum goes beyond the patients with malignancies, and for example invasive pulmonary aspergillosis has recently been described in critically ill patients without such condition. Liver failure has been suspected to be a risk factor for aspergillosis. CASE PRESENTATION: We describe three cases of adult respiratory distress syndrome with sepsis, shock and multiple organ failure in patients with severe liver failure among whom two had positive Aspergillus antigenemia and one had a positive Aspergillus serology. In all cases bronchoalveolar lavage fluid was positive for Aspergillus fumigatus. Outcome was fatal in all cases despite treatment with voriconazole and agressive symptomatic treatment. CONCLUSION: Invasive aspergillosis should be among rapidly raised hypothesis in cirrhotic patients developing acute respiratory symptoms and alveolar opacities

MODULATION DU CONTROLE CORTICAL DE LA CONTRACTION DIAPHRAGMATIQUE CHEZ L'HOMME

PARIS12-CRETEIL BU Multidisc. (940282102) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Exposure homogeneity of pharmaceutical materials in reverberation chamber

The growing interest of using RFID technology in the pharmaceutical domain leads to questions about the EMF exposure of drugs. In this sense, different types of exposure systems have been studied and in particular the exposure in reverberation chamber. In order to expose multiple drug samples simultaneously, this study evaluate the difference in exposure homogeneity between one or multiple samples exposition. Simulations give condition on both the size and the distance between the samples to reach homogeneity.info:eu-repo/semantics/publishe

Is nitrogen functionality responsible for contrasted responses of riverine dissolved organic matter in pyrolysis?

Fractions of dissolved organic matter (DOM) from the Loire and the Gartempe rivers were obtained using Amberlite XAD resin fractionation procedure. According to the eluting system used and to the polarity of their components, the fractions were termed hydrophobic (HPO) and transphilic (TPI) for the Loire (elution with acetonitrile/water mixture) and hydrophobic acid (HPOA) and transphilic acid (TPIA) for the Gartempe (elution with NaOH). In addition, for the Loire, colloids (COL) were pre-isolated through a dialysis step. The composition of the three fractions from the Loire was investigated with solid state cross polarisation/magic angle spinning (CP/MAS) 13C NMR and Curie point pyrolysis at 650°C with and without tetramethylammonium hydroxide (TMAH). Separation and identification of the released compounds were performed using gas-chromatography/mass spectrometry (GC/MS) and focussed on nitrogen-containing pyrolysis products (N-products). Quantitative differences were observed between the N-product distribution of the HPO and TPI fractions, whilst the few N-products from the COL fraction exhibited different structures corresponding to peptidoglycan contribution. Comparison with previous results obtained for two DOM fractions (HPOA and TPIA) from the Gartempe river (France) revealed that pyrolysis detection of nitrogen containing molecules is not only related to the nitrogen content of the fractions, even in the case of similar hydrophobicity, but also likely to the functionality of nitrogen in the macromolecule sources. To correlate the molecular level information about N-containing moieties with the functionality of nitrogen in the macromolecular sources, the five fractions of DOM were investigated through X-ray photoelectron spectroscopy (XPS) and solid state cross polarisation/magic angle spinning (CP/MAS) 15N NMR. C1s XPS and 15N NMR analyses revealed an important contribution from amide nitrogen in all the DOM fractions, with a large increase from the hydrophobic fractions to the transphilic and colloids ones. Moreover, 15N NMR revealed an additional pyrrole nitrogen contribution in the HPO fraction of the Loire and in the TPI and TPIA fractions of both rivers. For the two rivers, the d 15N values were maximal for the fraction containing the highest proportion of amide N, and decreased in parallel with increasing pyrrole N contribution. Only the hydrophobic acid fraction of the Gartempe, which did not contain any pyrrole N was characterised by a lack of N-containing pyrolysis products, suggesting that their detection could be dependent on the presence of pyrrole N in the macromolecule sources

Early degradation of plant alkanes in soils: a litterbag experiment using C-13-labelled leaves

International audienceWe monitored the carbon isotope composition of bulk leaves and specific long-chain alkanes during a four-year litterbag experiment using C-13-labelled leaves and unlabelled reference leaves of the European beech tree (Fagus sylvatica L.). Whereas the isotope composition of alkanes from C-13-enriched leaves exhibited a marked decrease in C-13-content, the isotope composition of unlabelled reference leaves remained nearly constant. We interpreted this difference as evidence for a microbial contribution to the long-chain alkane pool of the decomposing leaves and related it to the progressive invasion of leaves by soil organisms which was revealed upon microscopic examination. These results suggest that long-chain alkanes may not provide an unaltered record of organic carbon isotope composition in soils and sediments

Expiratory flow limitation as a determinant of orthopnea in acute left heart failure.

8nonenoneA. DUGUET; C. TANTUCCI; O. LOSINGUEZ; R. ISNARD; D. THOMAS; M. ZELTER; J.P. DERENNE; T. SIMILOWSKIA., Duguet; Tantucci, Claudio; O., Losinguez; R., Isnard; D., Thomas; M., Zelter; J. P., Derenne; T., Similowsk