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  • 1
    Online-Ressource
    Online-Ressource
    SAGE Publications ; 2001
    In:  Journal of Endotoxin Research Vol. 7, No. 4 ( 2001-08), p. 305-309
    In: Journal of Endotoxin Research, SAGE Publications, Vol. 7, No. 4 ( 2001-08), p. 305-309
    Kurzfassung: Septic shock is one of the leading causes of death in intensive care units world-wide. Scientists have made great improvements in understanding mechanisms of inflammation, and the sequence of activation of the various pro- and anti-inflammatory markers is now well known. In contrast, physicians have failed to improve survival from septic shock despite the development of specific targets at various points in the cytokine cascade considered to have a key role in host survival in sepsis. Corticosteroids were among the first anti-inflammatory drugs to be tested in large randomized controlled trials. These trials showed that patients with septic shock did not benefit from a short course of large doses of steroids. More recent findings highlighting the role of the integrity of the hypothalamic—pituitary—adrenal axis to respond appropriately to a septic insult, have led to a re-appraisal of the use of steroids in septic shock. Several randomized controlled trials have evaluated the efficacy of a replacement therapy with hydrocortisone in severe sepsis. These trials strongly suggest that this replacement therapy reduces the morbidity of septic shock and may favorably affect survival from septic shock.
    Materialart: Online-Ressource
    ISSN: 0968-0519
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2001
    ZDB Id: 2381250-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    In: Chronic Respiratory Disease, SAGE Publications, Vol. 18 ( 2021-01), p. 147997312110369-
    Kurzfassung: Purpose: Non-invasive ventilation (NIV) is the reference standard for managing chronic hypoventilation in patients with Duchenne muscular dystrophy (DMD). In these patients, upper airway obstruction under NIV may compromise efficacy and adherence. We aim to describe a novel pattern of expiratory obstructive events occurring during nocturnal barometric NIV. Methods: We retrospectively included all patients with DMD who underwent full-night polygraphy during NIV as part of their usual follow-up between May 2018 and July 2019. Results: We provide a step-by-step description of this previously undescribed pattern of obstruction. Expiratory obstructions lead to end-inspiratory breath-holding and impossibility to take another inspiratory breath with a barometric mode until expiration occurs. These events were observed in 4 (36%) of 11 DMD patients under barometric NIV. Conclusion: Expiratory obstructions may be common in DMD patients receiving NIV and should be sought out routinely. This previously undescribed variant of obstructive event must be identified.
    Materialart: Online-Ressource
    ISSN: 1479-9731 , 1479-9731
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2021
    ZDB Id: 2222367-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
    In: Chronic Respiratory Disease, SAGE Publications, Vol. 16 ( 2019-01-01), p. 147997231879026-
    Kurzfassung: Ineffective efforts (IEs) are among the most common types of patient–ventilator asynchrony. The objective of this study is to validate IE detection during expiration using pressure and flow signals, with respiratory effort detection by esophageal pressure (Pes) measurement as the reference, in patients with neuromuscular diseases (NMDs). We included 10 patients diagnosed with chronic respiratory failure related to NMD. Twenty-eight 5-minute recordings of daytime ventilation were studied for IE detection. Standard formulas were used to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of IE detection using pressure and flow signals compared to Pes measurement. Mean sensitivity and specificity of flow and pressure signal-based IE detection versus Pes measurement were 97.5% ± 5.3% and 91.4% ± 13.7%, respectively. NPV was 98.1% ± 8.2% and PPV was 67.6% ± 33.8%. Spearman’s rank correlation coefficient indicated a moderately significant correlation between frequencies of IEs and controlled cycles ( ρ = 0.50 and p = 0.01). Among respiratory cycles, 311 (11.2%) were false-positive IEs overall. Separating false-positive IEs according to their mechanisms, we observed premature cycling in 1.2% of cycles, delayed ventilator triggering in 0.1%, cardiac contraction in 9.2%, and upper airway instability during expiration in 0.3%. Using flow and pressure signals to detect IEs is a simple and rapid method that produces adequate data to support clinical decisions.
    Materialart: Online-Ressource
    ISSN: 1479-9731 , 1479-9731
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2019
    ZDB Id: 2222367-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
    In: Journal of Intensive Care Medicine, SAGE Publications
    Kurzfassung: There is a growing interest in the quality of work life (QWL) of healthcare professionals and staff well-being. We decided to measure the perceived QWL of ICU physicians and the factors that could influence their perception. Methods: We performed a survey coordinated and executed by the French Trade Union of Intensive Care Physicians (SMR). QWL was assessed using the French version of the Work-Related Quality of Life (WRQoL) scale, perceived stress using the French version of 10 item-Perceived Stress Scale (PSS-10) and group functioning using the French version of the Reflexivity Scale, the Social Support at Work Questionnaire (QSSP-P). Results: 308 French-speaking ICU physicians participated. 40% perceived low WRQoL, mainly due to low general well-being, low satisfaction with working conditions and low possibility of managing the articulation between their private and professional lives. Decreased QWL was associated with being a woman (p = .002), having children (p = .022) and enduring many monthly shifts (p = .022). Conclusions: This work highlights the fact that ICU physicians feel a significant imbalance between the demands of their profession and the resources at their disposal. Communication and exchanges within a team and quality of social support appear to be positive elements to maintain and/or develop within our structures.
    Materialart: Online-Ressource
    ISSN: 0885-0666 , 1525-1489
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2023
    ZDB Id: 2001472-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
    Online-Ressource
    Online-Ressource
    SAGE Publications ; 2016
    In:  Clinical EEG and Neuroscience Vol. 47, No. 1 ( 2016-01), p. 75-82
    In: Clinical EEG and Neuroscience, SAGE Publications, Vol. 47, No. 1 ( 2016-01), p. 75-82
    Kurzfassung: We prospectively studied early bedside standard EEG characteristics in 61 acute postanoxic coma patients. Five simple EEG features, namely, isoelectric, discontinuous, nonreactive to intense auditory and nociceptive stimuli, dominant delta frequency, and occurrence of paroxysms were classified yes or no. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) of each of these variables for predicting an unfavorable outcome, defined as death, persistent vegetative state, minimally conscious state, or severe neurological disability, as assessed 1 year after coma onset were computed as well as Synek’s score. The outcome was unfavorable in 56 (91.8%) patients. Sensitivity, specificity, PPV, NPV, and AUC of nonreactive EEG for predicting an unfavorable outcome were 84%, 80%, 98%, 31%, and 0.82, respectively; and were all very close to the ones of Synek score 〉 3, which were 82%, 80%, 98%, 29%, and 0.81, respectively. Specificities for predicting an unfavorable outcome were 100% for isoelectric, discontinuous, or dominant delta activity EEG. These 3 last features were constantly associated to unfavorable outcome. Absent EEG reactivity strongly predicted an unfavorable outcome in postanoxic coma, and performed as accurate as a Synek score 〉 3. Analyzing characteristics of some simple EEG features may easily help nonneurophysiologist physicians to investigate prognostic issue of postanoxic coma patient. In this study ( a) discontinuous, isoelectric, or delta-dominant EEG were constantly associated with unfavorable outcome and ( b) nonreactive EEG performed prognostic as accurate as a Synek score 〉 3.
    Materialart: Online-Ressource
    ISSN: 1550-0594 , 2169-5202
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2016
    ZDB Id: 2647038-X
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
    Online-Ressource
    Online-Ressource
    SAGE Publications ; 2006
    In:  Journal of Endotoxin Research Vol. 12, No. 3 ( 2006-06), p. 151-170
    In: Journal of Endotoxin Research, SAGE Publications, Vol. 12, No. 3 ( 2006-06), p. 151-170
    Kurzfassung: Sepsis and systemic inflammatory response syndrome (SIRS) are associated with an exacerbated production of both pro- and anti-inflammatory mediators that are mainly produced within tissues. Although a systemic process, the pathophysiological events differ from organ to organ, and from organ to peripheral blood, leading to the concept of compartmentalization. The nature of the insult ( e.g. burn, hemorrhage, trauma, peritonitis), the cellular composition of each compartment ( e.g . nature of phagocytes, nature of endothelial cells), and its micro-environment ( e.g. local presence of granulocyte-macrophage colony stimulating factor [GM-CSF] in the lungs, low levels of arginine in the liver, release of endotoxin from the gut), and leukocyte recruitment, have a great influence on local inflammation and on tissue injury. High levels of pro-inflammatory mediators ( e.g. interleukin-1 [IL-1] , tumor necrosis factor [TNF], gamma interferon [IFN-γ] , high mobility group protein-1 [HMGB1], macrophage migration inhibitory factor [MIF] ) produced locally and released into the blood stream initiate remote organ injury as a consequence of an organ cross-talk. The inflammatory response within the tissues is greatly influenced by the local delivery of neuromediators by the cholinergic and sympathetic neurons. Acetylcholine and epinephrine contribute with IL-10 and other mediators to the anti-inflammatory compensatory response initiated to dampen the inflammatory process. Unfortunately, this regulatory response leads to an altered immune status of leukocytes that can increase the susceptibility to further infection. Again, the nature of the insult, the nature of the leukocytes, the presence of circulating microbial components, and the nature of the triggering agent employed to trigger cells, greatly influence the immune status of the leukocytes that may differ from one compartment to another. While anti-inflammatory mediators predominate within the blood stream to avoid igniting new inflammatory foci, their presence within tissues may not always be sufficient to prevent the initiation of a deleterious inflammatory response in the different compartments.
    Materialart: Online-Ressource
    ISSN: 0968-0519
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2006
    ZDB Id: 2381250-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
    Online-Ressource
    Online-Ressource
    SAGE Publications ; 2006
    In:  Journal of Endotoxin Research Vol. 12, No. 3 ( 2006-06-01), p. 151-170
    In: Journal of Endotoxin Research, SAGE Publications, Vol. 12, No. 3 ( 2006-06-01), p. 151-170
    Materialart: Online-Ressource
    ISSN: 0968-0519 , 1743-2839
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2006
    ZDB Id: 2381250-3
    ZDB Id: 2041941-7
    Standort Signatur Einschränkungen Verfügbarkeit
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