Leo Bossaert - Academia.edu (original) (raw)

Papers by Leo Bossaert

Resuscitation, Aug 1, 1991

Acta Clinica Belgica, 1997

Acta Clinica Belgica, 1987

SummaryThe use of the organic solvents ethanol and propylene glycol in injectable nitroglycerin i... more SummaryThe use of the organic solvents ethanol and propylene glycol in injectable nitroglycerin is potentially hazardous, because of the possibility of cardiodcpression, arrhythmias and/or coronary vasospasm; neurotoxicity and depression of the central nervous system; hyperosmolality, lactic acidosis and hemolysis, especially in patients with diminished renal function; interaction with disulfiram and compounds with a disulfiram-like action; interaction with oral antidiabetics and with heparin. Nitroglycerin itself can cause methemoglobinemia.Obviously, the use of NTG solutions containing no ethanol nor PG could solve most of the cited problems, except methemoglobinemia. However, when used in low doses (up to 150200 /xg/min) in patients with normal liver and kidney function, NTG remains a very effective and safe drug, usually free of any side-cffects. ISDN which is a watery solution without organic solvents, could be used as a safe alternative.

American Heart Journal, Aug 1, 1973

... Artery Disease and Intensive Cardiac Care, Hôpital Européen Georges Pompidou, Paris, France C... more ... Artery Disease and Intensive Cardiac Care, Hôpital Européen Georges Pompidou, Paris, France Charles D. Deakin, Consultant in Cardiac Anaesthesia and Critical Care, Southampton University Hospital NHS Trust, Southampton, UK Joel Dunning, Registrar in ... Schwindt, Univ. ...

Springer eBooks, 1991

Neurotraumatized patients are often hypertensive. Their elevated blood pressure generally results... more Neurotraumatized patients are often hypertensive. Their elevated blood pressure generally results from increased activity of the autonomic nervous system — i.e. a hyperadrenergic state — and is most often accompanied by an increased heart rate and elevated cardiac output. Other clinical patterns such as the Cushing’s response of bradycardia and hypertension also occur.

Springer eBooks, 2004

Automated external defibrillators (AEDs) were introduced into clinical use in the early 1980s [1,... more Automated external defibrillators (AEDs) were introduced into clinical use in the early 1980s [1,2], but acceptance was slow and it is only recently that their potential for community resuscitation has become widely appreciated. In Europe-as elsewhere-we remain a long way from the optimal use of an important technology. Sufficient experience has been gained, however, to show both the value of AEDs and their limitations, and to indicate where priorities for deployment might lie as their availability increases. The evidence confirming that we should encourage their widespread use is compelling. Whilst there may be a potential role for in-hospital use, the greatest contribution that AEDs can make towards improving survival from cardiac arrest lies outside hospital-for use in public places by persons who are not healthcare professionals.

Revista española de cardiología, Jun 1, 2011

Steinkopff eBooks, 2002

Das European Resuscitation Council (ERC) veroffentlichte 1998 zuletzt Leitlinien fur erweiterte l... more Das European Resuscitation Council (ERC) veroffentlichte 1998 zuletzt Leitlinien fur erweiterte lebensrettende Masnahmen (ALS; [1]). Diese basierten auf der Empfehlung des International Liaison Committee on Resuscitation (ILCOR) [2]. Auf Einladung der American Heart Association trafen sich 1999 und 2000 Vertreter des ILCOR bei einer Reihe von Gelegenheiten in Dallas, um einen wissenschaftlichen Konsens als Grundlage fur kunftige Leitlinien zu finden. Bei den Beratungen spielten Vertreter des ERC eine wichtige Rolle. Als Ergebnis wurden die „Internationalen Leitlinien 2000 fur kardiopulmonale Reanimation und kardiovaskulare Notfallversorgung — ein wissenschaftlicher Konsens“ [3] veroffentlicht. Der Konsens wurde so weit wie moglich evidenzbasiert belegt. Die ERC ALS Working Group hat unter Berucksichtigung dieser Veroffentlichung Anderungen in den Leitlinien empfohlen, die fur die Praxis in Europa geeignet erscheinen. Im folgenden Beitrag finden sich diese Anderungen und eine Zusammenfassung des Ablaufes der ALS-Masnahmen.

Drugs, Jun 1, 1991

SummaryThe synthesis of adenosine triphosphate (ATP) depends on the coordinated interaction of ox... more SummaryThe synthesis of adenosine triphosphate (ATP) depends on the coordinated interaction of oxygen delivery and glucose breakdown in the Krebs cycle. Cellular oxygen depots are non-existent, therefore the peripheral cells are totally dependent on the circulation for sufficient oxygen delivery. Shock is the clinical manifestation of cellular oxygen craving. The commonly measured variables — blood pressure, heart rate, urinary output, cardiac output and systemic vascular resistance — are not sensitive or accurate enough to warn of impending death in acutely ill patients nor are they appropriate for monitoring therapy. Calculated oxygen transport and oxygen consumption parameters provide the best available measures of functional adequacy of both circulation and metabolism.In order to optimise oxygen delivery (DO2), 4 interacting factors must be taken into account: cardiac output, blood haemoglobin content, haemoglobin oxygen saturation and avidity of oxygen binding to haemoglobin. For viscosity reasons, the optimal haemoglobin concentration is in the vicinity of 90 to 100 g/L, but for optimising the oxygen transport 100 to 115 g/L or a haematocrit of 30 to 35% seems better. The p50 (the pO2 at which haemoglobin is 50% saturated) describes the oxygen-haemoglobin dissociation curve; normally its value is ± 27mm Hg. It can be influenced by attaining normal body temperature, pH, pCO2 and serum phosphorous levels. In order to obtain an arterial blood saturation (SaO2) of more than 90% with acceptable haemodynamics, the ventilation mode and inspired oxygen fraction (FiO2) must be adapted; care must be taken not to stress the labile circulation with haemodynamic compromising ventilation techniques [e.g. high positive end expiratory pressure (PEEP) levels, inverse-ratio ventilation, etc.].The factor most amenable to manipulation is the cardiac output, with its 4 determinants — preload, afterload, contractility and heart rate. In daily clinical practice, heart rate should be between 80 and 120 beats/min; small variations are acceptable. Important deviations must be treated by chemically [isoprenaline (isoproterenol)] or electrically (pacing techniques) accelerating the heart, or with the different antiarrhythmic drugs. A wide variety of agents is available to decrease the preload: diuretics [especially furosemide (frusemide)], venodilators like nitroglycerin (glyceryl trinitrate), isosorbide dinitrate (sorbide nitrate) and sodium nitroprusside, ACE inhibitors, phlebotomy, and haemofiltration techniques (peritoneal or haemodialysis, continuous arteriovenous haemofiltration). To increase the preload, volume loading using a rigid protocol (‘rule of 7 and 3’), preferably with colloids, or vasopressor agents [norepinephrine (noradrenaline), epinephrine (adrenaline), dopamine] are useful. Arterial vasopressors are needed to improve perfusion pressure of ‘critical’ (coronary and cerebral) arteries. Afterload can be decreased by arterial vasodilators. Predominantly arterial dilators are hydralazine and clonidine, while sodium nitroprusside, nitroglycerin and isosorbide dinitrate have combined arterial and venous dilating actions. Norepinephrine, epinephrine and dopamine combine inotropic with vasoconstricting properties; dobutamine, dopexamine and the phosphodiesterase inhibitors amrinone, milrinone and enoximone are combined positive inotropic and afterload reducing drugs. The phosphodiesterase inhibitors possess lusitropic (i.e. promoting myocardial relaxation) effects. Myocardial oxygen consumption is certainly increased by norepinephrine, epinephrine, isoprenaline and dopamine, while dobutamine only has minimal effects and the phosphodiesterase inhibitors lower it.To treat a critically ill patient according to the abovementioned strategy, the intensive care physician must rely on invasive haemodynamic measurements. Several derived parameters, all critically dependent on a correct determination of the cardiac output, give insight into pathophysiological process; they are also necessary to guide sometimes complex pharmacological manipulations in order to maximise oxygen delivery and consumption.

European Heart Journal, Feb 1, 2002