Bernard Lambermont - Academia.edu (original) (raw)
Papers by Bernard Lambermont
To assess baroreflex intervention during increase in left ventricular afterload, we compared the ... more To assess baroreflex intervention during increase in left ventricular afterload, we compared the effects of aortic banding on the intact cardiovascular system and under hexamethonium infusion. Six open-chest pigs, instrumented for measurement of aortic pressure and flow, left ventricular pressure and volume, were studied under pentobarbital-sufentanil anesthesia. Vascular arterial properties were estimated with a four-element windkessel model. Left ventricular contractility was assessed by the slope of end-systolic pressure-volume relationship. The effects of aortic banding on mechanical aortic properties were unaffected by autonomic nervous system inhibition. However, increase in peripheral arterial vascular resistance and in heart rate were prevented by hexamethonium. Aortic banding increased left ventricular contractility and stroke work. Left ventricular-arterial coupling remained unchanged, but mechanical efficiency was impaired. These ventricular changes were independent of baroreflex integrity. Our results demonstrate that an augmentation in afterload has a composite effect on left ventricular function. Left ventricular performance is increased, as demonstrated by increase in contractility and stroke work, but mechanical efficiency is decreased. These changes are observed independently of baroreflex integrity. Such mechanisms of autoregulation, independent of the autonomic nervous system, are of paramount importance in heart transplant patients.
Acta gastro-enterologica Belgica
ABSTRACT
Archives des maladies du coeur et des vaisseaux
The authors report the case of a 50 year old man admitted to hospital with a right hemiplegia and... more The authors report the case of a 50 year old man admitted to hospital with a right hemiplegia and aphasia of sudden onset in whom embolic fragments were found in the left mid and anterior cerebral artery territories at left carotid angiography : transoesophageal echocardiography demonstrated a protrusive plaque of atherosclerosis in the ascending aorta and a pediculated thrombosis in the descending aorta. Biological investigations revealed a protein S level of 3% (normal : 70-140%). This case illustrates the acute development of a thromboembolic phenomenon originating from the aortic arch in a patient with a coagulation defect.
Annales Françaises d Anesthésie et de Réanimation
Our study was to assess the validity of SAPS II (New Simplified Acute Physiology Score) to predic... more Our study was to assess the validity of SAPS II (New Simplified Acute Physiology Score) to predict the probability of in hospital mortality, in a cohort of patient admitted to a medical intensive care unit. Prospective study. Out of 467 the 525 patients admitted were included. SAPS score and in hospital mortality prediction were calculated for each of them. In this group, SAPS II offered a satisfactory discrimination power with an area under the curve of 0.843. However, calibration showed a lack of fit (chi 2 = 28.5, P < 0.001), with an overall under prediction of mortality (observed versus expected ratio of 1.12). This SAPS II lower predicting accuracy in a specific population and for individual outcome prediction may reduce its interest in clinical decision-making.
Revue médicale de Liège
We report the case of a patient with liver cirrhosis who was admitted to the emergency room for r... more We report the case of a patient with liver cirrhosis who was admitted to the emergency room for rapid occurrence of dyspnea and severe hypoxemia at rest. Lung CT-scan and echocardiography did not disclose any right-to-left shunt and right-sided heart catheterization evidenced major precapillary pulmonary hypertension. The present feature supports the hypothesis that the pulmonary complications of cirrhosis, the hepatopulmonary syndrome and the portopulmonary hypertension, which are usually considered as mutually exclusive, may coexist. In such circumstances, the right failing heart is the major determinant to the immediate prognosis.
![Research paper thumbnail of [Extracorporeal blood purification in the intensive care units]](https://attachments.academia-assets.com/40055779/thumbnails/1.jpg)
](Néphrologie & Thérapeutique
La mortalité reste élevée chez les patients de soins intensifs chez qui un traitement de suppléan... more La mortalité reste élevée chez les patients de soins intensifs chez qui un traitement de suppléance rénale est nécessaire. Dans cet article, nous faisons le point sur les données récentes de la littérature qui améliorent la prise en charge de tels patients. Nous discutons successivement du choix du mode d'épuration (intermittente ou continue), de la membrane, de la dose à prescrire, du type d'anticoagulation et du moment où débuter la suppléance.
Revue médicale de Liège
Severe exacerbations of asthma can be life-threatening if not aggressively treated. Despite the p... more Severe exacerbations of asthma can be life-threatening if not aggressively treated. Despite the publication of therapeutic guidelines developed by experts in this field and people education programs, early recognition and characterization of patients at risk for fatal asthma remain scarce. We report the case of a young lady suffering from acute exacerbation of asthma responsible for intensive care admission with long term mechanical ventilation due to the lack in initial appropriate care.
Proceedings of 18th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 1997
... Paul Gerard, Thierry Pochet, Bernard Lambermont, Olivier Detry, Philippe Potty, Vincent D... more ... Paul Gerard, Thierry Pochet, Bernard Lambermont, Olivier Detry, Philippe Potty, Vincent D' Orio, Jean-Olivier Defraigne, Anny Fossion and Raymond Limet Hemodynamics Research ... Effect on characteristic impedance depends on the respective positions of mot, oo , o1 and oIC. ...
International angiology: a journal of the International Union of Angiology
Myocardial revascularisation being frequently performed during acute myocardial ischemia, in a ho... more Myocardial revascularisation being frequently performed during acute myocardial ischemia, in a hostile hemodynamic environment, we evaluated left ventriculo-arterial (VA) coupling, left ventricular (LV) mechanical efficiency, and the mechanical properties of the systemic vasculature during acute myocardial ischemia. In 6 pigs, vascular properties [characteristic impedance (R(1)), peripheral resistance (R(2)), compliance (C), inductance (L), arterial elastance (E(a))] were estimated with a windkessel model. LV function was assessed by the slope (E(es)) of end-systolic pressure-volume relationship (ESPVR), and stroke work (SW) - end-diastolic volume (EDV) relation. Pressure-volume area (PVA) was referred to as myocardial oxygen consumption. VA coupling was defined as E(es)/E(a), and mechanical efficiency as SW/PVA. After baseline recordings, the left anterior descending coronary artery was ligated and hemodynamic measures obtained every 30 minutes for 3 hours. Data are expressed as mean (SEM). Coronary occlusion induced an ESPVR rightward shift, and decreased E(es) from 3.67 (0.33) to 1.92 (0.20) mmHg/ml and the slope of the SW - EDV relationship from 72.3 (3.4) to 40.4 (4.5) mmHg (p<0.001), while E(a) increased from 3.33 (0.56) to 4.65 (0.29) mmHg/ml (p<0.005). This was responsible for a dramatic alteration of VA coupling from 1.22 (0.11) to 0.44 (0.07), (p<0.001). While R2 increased from 1.72 (0.30) to 2.38 (0.16) mmHg x s x ml(-1) (p<0.05) and C decreased from 0.78 (0.16) to 0.46 (0.08) ml/mmHg (p<0.05), R(1) and L were unchanged. Coronary occlusion decreased SW from 4056 (223) to 2580 (122) mmHg.ml (p<0.001), while PVA and SW/PVA decreased from 5575 (514) to 4813 (317) mmHg x ml (NS), and from 0.76 (0.04) to 0.57 (0.03) (p<0.001), respectively. Acute myocardial ischemia severely altered left ventriculo-arterial coupling and LV mechanical efficiency. Impaired left VA coupling was due to a combination of augmented arterial elastance, secondary to early vasoconstriction later associated with decreased arterial compliance, and decreased LV contractility.
The International journal of artificial organs
Objective: To confirm in vivo the hypothesis that hemofiltration with a large pore membrane can a... more Objective: To confirm in vivo the hypothesis that hemofiltration with a large pore membrane can achieve significant cytokine clearance. Method: We used a well-known animal model of endotoxinic shock (0.5 mg/kg of lipopolysaccharide from Escherichia Coli over a period of 30 mins). Six pigs were hemofiltrated for 3 hours with a large pore membrane (78 Å pore, 80 kDa cut off) (Sureflux FH 70, Nipro, Osaka, Japan). The ultrafiltration rate was 45 ml/kg/min. Samples were taken from arterial, venous line and in the ultrafiltrate at T120 and T240. We measured concentrations of interleukin 6, interleukin 10 and albumin. Results: At T120 and T240, the IL-6 clearances were 22 ± 7 and 15 ± 3 ml/min, respectively. The IL-6 sieving coefficients were 0.97 and 0.7 at T120 and T240, respectively. At T120 and T240, the IL-10 clearances were 14 ± 4 and 10 ± 7 ml/min, respectively The sieving coefficients were 0.63 and 0.45 at T120 and T240, respectively. The concentrations of IL-6 and IL-10 were the same at T0 and T240. At T60 and T240, the plasmatic albumin concentrations were 24 ± 4 g/L and 23 ± 4 g/L, respectively (p = 0.13). Conclusions: In this animal model of endotoxinic shock, we confirm the high cytokine clearance observed when hemofiltration is applied to a large pore membrane. The loss of albumin seems negligible. The impact of such clearances on hemodynamic stability and survival remains to be proved.
Brain
H 2 15 O-PET was used to investigate changes in regional cerebral blood flow in response to audit... more H 2 15 O-PET was used to investigate changes in regional cerebral blood flow in response to auditory stimulation in patients in the vegetative state. Five patients in a vegetative state of hypoxic origin were compared with 18 age-matched controls. In addition, the cerebral metabolism of these patients and 53 age-matched controls was studied using [ 18 F]fluorodeoxyglucose. In control subjects, auditory click stimuli activated bilateral auditory cortices [Brodmann areas (BA) 41 and 42] and the contralateral auditory association cortices (BA 22). In the patients, although resting metabolism was decreased to 61% of normal values, bilateral auditory areas 41 and 42 showed activation as seen in the controls, but the temporoparietal junction cortex (BA 22) failed to be activated. Moreover, the auditory Keywords: vegetative state; consciousness; functional neuroimaging; statistical parametric mapping; positron emission tomography Abbreviations: BA ϭ Brodmann area; rCBF ϭ regional cerebral blood flow; rCMRGlu ϭ regional cerebral metabolic rate for glucose; SPM ϭ statistical parametric mapping; STG ϭ superior temporal gyrus; STS ϭ superior temporal sulcus; TTG ϭ transverse temporal gyrus
European Journal of Heart Failure Supplements
Introduction: Congestive heart failure (CHF) is characterized by increased inflammatory and apopt... more Introduction: Congestive heart failure (CHF) is characterized by increased inflammatory and apoptotic processes, while the improvement of the underlying hemodynamics has beneficial effects on both inflammation and apoptosis. We investigated the effects of levosimendan and dobutamine on serum levels of interleukin-6 (IL-6), tumor necrosis factor-a (TNF-a), and apoptotic markers soluble Fas (sFas) and soluble Fas ligand (sFasL) in patients with decompensated CHF. Methods: Forty patients (32 males and 8 females, aged 714-2.1 years, NYHA III-IV, LVEF<30%) with decompensated CHF were randomly allocated into three groups and received a 24-hour intravenous infusion of dobutamine (n=13), levosimendan (n=13) or placebo (n=14). Left ventricular dimensions, ejection fraction and end-systolic wall stress were estimated by echocardiography, while levels of IL-6, TNF-a, sFas and sFasL were determined with ELISA at baseline and immediately after the treatment. All values are expressed as means4-SEM. Results: End-systolic wall stress was significantly decreased in the levosimendan-treated group (from 7824-66 to 6614-72 gr/cm 2, p<0.05) while remained unchanged in dobutamine and placebo groups (from 7374-49 and 7224-49 to 7524-54 and 739-4-50 gr/cm 2 respectively, p=NS for both). Serum levels of IL-6, sFas and sFasL were significantly decreased in the levosimendan-treated group (from 12.74-1.6, 6.94-0.98 and 69.3:1:5.3 to 10.98 pg/ml, 5.9-4-0.99 ng/ml and 60.5:t:5.16 pg/mi respectively, p<0.05 for all) but remained unchanged in dobutamine-treated (from 12.4-1.5, 6.94-0.86 and 66.04-5.3 to 13.2 pg/ml, 7.374-0.97 ng/ml and 66.64-6.51 pg/ml respectively, p=NS for all) and placebo groups (from 10.54-1.1, 6.44-0.58 and 67.24-5.1 to 10.71 pg/ml, 5.734-0.66 ng/ml and 68.04-5.01 pg/ml respectively, p=NS for all). Serum levels of TNF-a remained unchanged in levosimendan and dobutamine-treated groups (from 11.94-1.5 and 12.94-1.7 to 11.4-t-1.91 and 12.54-1.71 pg/ml respectively, p=NS for both) while it was slightly increased in the placebo-treated group (from 12.24-1.8 to 13.14-1.91 pg/ml, p<0.05). Conclusions: Levosimendan seems to be superior than dobutamine in patients with decompensated CHF, since it decreases cardiac wall stress, it depresses the expression of pro-inflammatory cytokines, having also anti-apoptotic properties. Therefore, the beneficial effects of levosimendan on the clinical status of advanced CHF patients, may be a result of its anti-inflammatory and anti-apoptotic properties.
Medical engineering & physics, 2015
Re: Chung et al. Letter to the Editor in response to: Early detection of abnormal left ventricula... more Re: Chung et al. Letter to the Editor in response to: Early detection of abnormal left ventricular relaxation in acute myocardial ischemia with a quadratic model. Med Eng Phys. 2014 Sep;36(9):1101--5. Morimont et al. Dear Dr Black, We are grateful for the comments to our recent manuscript [1] provided by Chung, Shmuylovich and Kovács and we very much appreciate their effort in further elucidating left ventricular (LV) relaxation [2].
Patients with acute respiratory failure are given mechanical ventilation (MV) for treatment and b... more Patients with acute respiratory failure are given mechanical ventilation (MV) for treatment and breathing support. During MV, positive end-expiratory pressure (PEEP) is applied to recruit collapsed alveoli and maximized oxygenation. However, there are no well established methods for quantifying alveoli recruitment with PEEP increase. 7 anesthetised pigs weighting 22.94.1kg underwent a protocolised recruitment manoeuvre with PEEP increase
To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) r... more To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient-ventilator asynchrony in intensive care patients undergoing noninvasive ventilation with an oronasal face mask. In this prospective interventional study we compared patient-ventilator synchrony between PS (with ventilator settings determined by the clinician) and NAVA (with the level set so as to obtain the same maximal airway pressure as in PS). Two 20-min recordings of airway pressure, flow and electrical activity of the diaphragm during PS and NAVA were acquired in a randomized order. Trigger delay (T(d)), the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s neural inspiratory time (T(in)), ventilator pressurization duration (T(iv)), inspiratory time in excess (T(iex)), number of asynchrony events per minute and asynchrony index (AI) were determined. The study included 13 patients, six with COPD, and two with mixed pulmonary disease. T(d) was reduced with NAVA: median 35 ms (IQR 31-53 ms) versus 181 ms (122-208 ms); p = 0.0002. NAVA reduced both premature and delayed cyclings in the majority of patients, but not the median T(iex) value. The total number of asynchrony events tended to be reduced with NAVA: 1.0 events/min (0.5-3.1 events/min) versus 4.4 events/min (0.9-12.1 events/min); p = 0.08. AI was lower with NAVA: 4.9 % (2.5-10.5 %) versus 15.8 % (5.5-49.6 %); p = 0.03. During NAVA, there were no ineffective efforts, or late or premature cyclings. PaO(2) and PaCO(2) were not different between ventilatory modes. Compared to PS, NAVA improved patient ventilator synchrony during noninvasive ventilation by reducing T(d) and AI. Moreover, with NAVA, ineffective efforts, and late and premature cyclings were absent.
To assess baroreflex intervention during increase in left ventricular afterload, we compared the ... more To assess baroreflex intervention during increase in left ventricular afterload, we compared the effects of aortic banding on the intact cardiovascular system and under hexamethonium infusion. Six open-chest pigs, instrumented for measurement of aortic pressure and flow, left ventricular pressure and volume, were studied under pentobarbital-sufentanil anesthesia. Vascular arterial properties were estimated with a four-element windkessel model. Left ventricular contractility was assessed by the slope of end-systolic pressure-volume relationship. The effects of aortic banding on mechanical aortic properties were unaffected by autonomic nervous system inhibition. However, increase in peripheral arterial vascular resistance and in heart rate were prevented by hexamethonium. Aortic banding increased left ventricular contractility and stroke work. Left ventricular-arterial coupling remained unchanged, but mechanical efficiency was impaired. These ventricular changes were independent of baroreflex integrity. Our results demonstrate that an augmentation in afterload has a composite effect on left ventricular function. Left ventricular performance is increased, as demonstrated by increase in contractility and stroke work, but mechanical efficiency is decreased. These changes are observed independently of baroreflex integrity. Such mechanisms of autoregulation, independent of the autonomic nervous system, are of paramount importance in heart transplant patients.
Acta gastro-enterologica Belgica
ABSTRACT
Archives des maladies du coeur et des vaisseaux
The authors report the case of a 50 year old man admitted to hospital with a right hemiplegia and... more The authors report the case of a 50 year old man admitted to hospital with a right hemiplegia and aphasia of sudden onset in whom embolic fragments were found in the left mid and anterior cerebral artery territories at left carotid angiography : transoesophageal echocardiography demonstrated a protrusive plaque of atherosclerosis in the ascending aorta and a pediculated thrombosis in the descending aorta. Biological investigations revealed a protein S level of 3% (normal : 70-140%). This case illustrates the acute development of a thromboembolic phenomenon originating from the aortic arch in a patient with a coagulation defect.
Annales Françaises d Anesthésie et de Réanimation
Our study was to assess the validity of SAPS II (New Simplified Acute Physiology Score) to predic... more Our study was to assess the validity of SAPS II (New Simplified Acute Physiology Score) to predict the probability of in hospital mortality, in a cohort of patient admitted to a medical intensive care unit. Prospective study. Out of 467 the 525 patients admitted were included. SAPS score and in hospital mortality prediction were calculated for each of them. In this group, SAPS II offered a satisfactory discrimination power with an area under the curve of 0.843. However, calibration showed a lack of fit (chi 2 = 28.5, P < 0.001), with an overall under prediction of mortality (observed versus expected ratio of 1.12). This SAPS II lower predicting accuracy in a specific population and for individual outcome prediction may reduce its interest in clinical decision-making.
Revue médicale de Liège
We report the case of a patient with liver cirrhosis who was admitted to the emergency room for r... more We report the case of a patient with liver cirrhosis who was admitted to the emergency room for rapid occurrence of dyspnea and severe hypoxemia at rest. Lung CT-scan and echocardiography did not disclose any right-to-left shunt and right-sided heart catheterization evidenced major precapillary pulmonary hypertension. The present feature supports the hypothesis that the pulmonary complications of cirrhosis, the hepatopulmonary syndrome and the portopulmonary hypertension, which are usually considered as mutually exclusive, may coexist. In such circumstances, the right failing heart is the major determinant to the immediate prognosis.
Néphrologie & Thérapeutique
La mortalité reste élevée chez les patients de soins intensifs chez qui un traitement de suppléan... more La mortalité reste élevée chez les patients de soins intensifs chez qui un traitement de suppléance rénale est nécessaire. Dans cet article, nous faisons le point sur les données récentes de la littérature qui améliorent la prise en charge de tels patients. Nous discutons successivement du choix du mode d'épuration (intermittente ou continue), de la membrane, de la dose à prescrire, du type d'anticoagulation et du moment où débuter la suppléance.
Revue médicale de Liège
Severe exacerbations of asthma can be life-threatening if not aggressively treated. Despite the p... more Severe exacerbations of asthma can be life-threatening if not aggressively treated. Despite the publication of therapeutic guidelines developed by experts in this field and people education programs, early recognition and characterization of patients at risk for fatal asthma remain scarce. We report the case of a young lady suffering from acute exacerbation of asthma responsible for intensive care admission with long term mechanical ventilation due to the lack in initial appropriate care.
Proceedings of 18th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 1997
... Paul Gerard, Thierry Pochet, Bernard Lambermont, Olivier Detry, Philippe Potty, Vincent D... more ... Paul Gerard, Thierry Pochet, Bernard Lambermont, Olivier Detry, Philippe Potty, Vincent D' Orio, Jean-Olivier Defraigne, Anny Fossion and Raymond Limet Hemodynamics Research ... Effect on characteristic impedance depends on the respective positions of mot, oo , o1 and oIC. ...
International angiology: a journal of the International Union of Angiology
Myocardial revascularisation being frequently performed during acute myocardial ischemia, in a ho... more Myocardial revascularisation being frequently performed during acute myocardial ischemia, in a hostile hemodynamic environment, we evaluated left ventriculo-arterial (VA) coupling, left ventricular (LV) mechanical efficiency, and the mechanical properties of the systemic vasculature during acute myocardial ischemia. In 6 pigs, vascular properties [characteristic impedance (R(1)), peripheral resistance (R(2)), compliance (C), inductance (L), arterial elastance (E(a))] were estimated with a windkessel model. LV function was assessed by the slope (E(es)) of end-systolic pressure-volume relationship (ESPVR), and stroke work (SW) - end-diastolic volume (EDV) relation. Pressure-volume area (PVA) was referred to as myocardial oxygen consumption. VA coupling was defined as E(es)/E(a), and mechanical efficiency as SW/PVA. After baseline recordings, the left anterior descending coronary artery was ligated and hemodynamic measures obtained every 30 minutes for 3 hours. Data are expressed as mean (SEM). Coronary occlusion induced an ESPVR rightward shift, and decreased E(es) from 3.67 (0.33) to 1.92 (0.20) mmHg/ml and the slope of the SW - EDV relationship from 72.3 (3.4) to 40.4 (4.5) mmHg (p<0.001), while E(a) increased from 3.33 (0.56) to 4.65 (0.29) mmHg/ml (p<0.005). This was responsible for a dramatic alteration of VA coupling from 1.22 (0.11) to 0.44 (0.07), (p<0.001). While R2 increased from 1.72 (0.30) to 2.38 (0.16) mmHg x s x ml(-1) (p<0.05) and C decreased from 0.78 (0.16) to 0.46 (0.08) ml/mmHg (p<0.05), R(1) and L were unchanged. Coronary occlusion decreased SW from 4056 (223) to 2580 (122) mmHg.ml (p<0.001), while PVA and SW/PVA decreased from 5575 (514) to 4813 (317) mmHg x ml (NS), and from 0.76 (0.04) to 0.57 (0.03) (p<0.001), respectively. Acute myocardial ischemia severely altered left ventriculo-arterial coupling and LV mechanical efficiency. Impaired left VA coupling was due to a combination of augmented arterial elastance, secondary to early vasoconstriction later associated with decreased arterial compliance, and decreased LV contractility.
The International journal of artificial organs
Objective: To confirm in vivo the hypothesis that hemofiltration with a large pore membrane can a... more Objective: To confirm in vivo the hypothesis that hemofiltration with a large pore membrane can achieve significant cytokine clearance. Method: We used a well-known animal model of endotoxinic shock (0.5 mg/kg of lipopolysaccharide from Escherichia Coli over a period of 30 mins). Six pigs were hemofiltrated for 3 hours with a large pore membrane (78 Å pore, 80 kDa cut off) (Sureflux FH 70, Nipro, Osaka, Japan). The ultrafiltration rate was 45 ml/kg/min. Samples were taken from arterial, venous line and in the ultrafiltrate at T120 and T240. We measured concentrations of interleukin 6, interleukin 10 and albumin. Results: At T120 and T240, the IL-6 clearances were 22 ± 7 and 15 ± 3 ml/min, respectively. The IL-6 sieving coefficients were 0.97 and 0.7 at T120 and T240, respectively. At T120 and T240, the IL-10 clearances were 14 ± 4 and 10 ± 7 ml/min, respectively The sieving coefficients were 0.63 and 0.45 at T120 and T240, respectively. The concentrations of IL-6 and IL-10 were the same at T0 and T240. At T60 and T240, the plasmatic albumin concentrations were 24 ± 4 g/L and 23 ± 4 g/L, respectively (p = 0.13). Conclusions: In this animal model of endotoxinic shock, we confirm the high cytokine clearance observed when hemofiltration is applied to a large pore membrane. The loss of albumin seems negligible. The impact of such clearances on hemodynamic stability and survival remains to be proved.
Brain
H 2 15 O-PET was used to investigate changes in regional cerebral blood flow in response to audit... more H 2 15 O-PET was used to investigate changes in regional cerebral blood flow in response to auditory stimulation in patients in the vegetative state. Five patients in a vegetative state of hypoxic origin were compared with 18 age-matched controls. In addition, the cerebral metabolism of these patients and 53 age-matched controls was studied using [ 18 F]fluorodeoxyglucose. In control subjects, auditory click stimuli activated bilateral auditory cortices [Brodmann areas (BA) 41 and 42] and the contralateral auditory association cortices (BA 22). In the patients, although resting metabolism was decreased to 61% of normal values, bilateral auditory areas 41 and 42 showed activation as seen in the controls, but the temporoparietal junction cortex (BA 22) failed to be activated. Moreover, the auditory Keywords: vegetative state; consciousness; functional neuroimaging; statistical parametric mapping; positron emission tomography Abbreviations: BA ϭ Brodmann area; rCBF ϭ regional cerebral blood flow; rCMRGlu ϭ regional cerebral metabolic rate for glucose; SPM ϭ statistical parametric mapping; STG ϭ superior temporal gyrus; STS ϭ superior temporal sulcus; TTG ϭ transverse temporal gyrus
European Journal of Heart Failure Supplements
Introduction: Congestive heart failure (CHF) is characterized by increased inflammatory and apopt... more Introduction: Congestive heart failure (CHF) is characterized by increased inflammatory and apoptotic processes, while the improvement of the underlying hemodynamics has beneficial effects on both inflammation and apoptosis. We investigated the effects of levosimendan and dobutamine on serum levels of interleukin-6 (IL-6), tumor necrosis factor-a (TNF-a), and apoptotic markers soluble Fas (sFas) and soluble Fas ligand (sFasL) in patients with decompensated CHF. Methods: Forty patients (32 males and 8 females, aged 714-2.1 years, NYHA III-IV, LVEF<30%) with decompensated CHF were randomly allocated into three groups and received a 24-hour intravenous infusion of dobutamine (n=13), levosimendan (n=13) or placebo (n=14). Left ventricular dimensions, ejection fraction and end-systolic wall stress were estimated by echocardiography, while levels of IL-6, TNF-a, sFas and sFasL were determined with ELISA at baseline and immediately after the treatment. All values are expressed as means4-SEM. Results: End-systolic wall stress was significantly decreased in the levosimendan-treated group (from 7824-66 to 6614-72 gr/cm 2, p<0.05) while remained unchanged in dobutamine and placebo groups (from 7374-49 and 7224-49 to 7524-54 and 739-4-50 gr/cm 2 respectively, p=NS for both). Serum levels of IL-6, sFas and sFasL were significantly decreased in the levosimendan-treated group (from 12.74-1.6, 6.94-0.98 and 69.3:1:5.3 to 10.98 pg/ml, 5.9-4-0.99 ng/ml and 60.5:t:5.16 pg/mi respectively, p<0.05 for all) but remained unchanged in dobutamine-treated (from 12.4-1.5, 6.94-0.86 and 66.04-5.3 to 13.2 pg/ml, 7.374-0.97 ng/ml and 66.64-6.51 pg/ml respectively, p=NS for all) and placebo groups (from 10.54-1.1, 6.44-0.58 and 67.24-5.1 to 10.71 pg/ml, 5.734-0.66 ng/ml and 68.04-5.01 pg/ml respectively, p=NS for all). Serum levels of TNF-a remained unchanged in levosimendan and dobutamine-treated groups (from 11.94-1.5 and 12.94-1.7 to 11.4-t-1.91 and 12.54-1.71 pg/ml respectively, p=NS for both) while it was slightly increased in the placebo-treated group (from 12.24-1.8 to 13.14-1.91 pg/ml, p<0.05). Conclusions: Levosimendan seems to be superior than dobutamine in patients with decompensated CHF, since it decreases cardiac wall stress, it depresses the expression of pro-inflammatory cytokines, having also anti-apoptotic properties. Therefore, the beneficial effects of levosimendan on the clinical status of advanced CHF patients, may be a result of its anti-inflammatory and anti-apoptotic properties.
Medical engineering & physics, 2015
Re: Chung et al. Letter to the Editor in response to: Early detection of abnormal left ventricula... more Re: Chung et al. Letter to the Editor in response to: Early detection of abnormal left ventricular relaxation in acute myocardial ischemia with a quadratic model. Med Eng Phys. 2014 Sep;36(9):1101--5. Morimont et al. Dear Dr Black, We are grateful for the comments to our recent manuscript [1] provided by Chung, Shmuylovich and Kovács and we very much appreciate their effort in further elucidating left ventricular (LV) relaxation [2].
Patients with acute respiratory failure are given mechanical ventilation (MV) for treatment and b... more Patients with acute respiratory failure are given mechanical ventilation (MV) for treatment and breathing support. During MV, positive end-expiratory pressure (PEEP) is applied to recruit collapsed alveoli and maximized oxygenation. However, there are no well established methods for quantifying alveoli recruitment with PEEP increase. 7 anesthetised pigs weighting 22.94.1kg underwent a protocolised recruitment manoeuvre with PEEP increase
To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) r... more To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient-ventilator asynchrony in intensive care patients undergoing noninvasive ventilation with an oronasal face mask. In this prospective interventional study we compared patient-ventilator synchrony between PS (with ventilator settings determined by the clinician) and NAVA (with the level set so as to obtain the same maximal airway pressure as in PS). Two 20-min recordings of airway pressure, flow and electrical activity of the diaphragm during PS and NAVA were acquired in a randomized order. Trigger delay (T(d)), the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s neural inspiratory time (T(in)), ventilator pressurization duration (T(iv)), inspiratory time in excess (T(iex)), number of asynchrony events per minute and asynchrony index (AI) were determined. The study included 13 patients, six with COPD, and two with mixed pulmonary disease. T(d) was reduced with NAVA: median 35 ms (IQR 31-53 ms) versus 181 ms (122-208 ms); p = 0.0002. NAVA reduced both premature and delayed cyclings in the majority of patients, but not the median T(iex) value. The total number of asynchrony events tended to be reduced with NAVA: 1.0 events/min (0.5-3.1 events/min) versus 4.4 events/min (0.9-12.1 events/min); p = 0.08. AI was lower with NAVA: 4.9 % (2.5-10.5 %) versus 15.8 % (5.5-49.6 %); p = 0.03. During NAVA, there were no ineffective efforts, or late or premature cyclings. PaO(2) and PaCO(2) were not different between ventilatory modes. Compared to PS, NAVA improved patient ventilator synchrony during noninvasive ventilation by reducing T(d) and AI. Moreover, with NAVA, ineffective efforts, and late and premature cyclings were absent.