Papers by Jacques Devriendt
PLOS ONE, Sep 10, 2021
Background In this prospective observational study, we evaluated the effects of fluid bolus (FB) ... more Background In this prospective observational study, we evaluated the effects of fluid bolus (FB) on venous-to-arterial carbon dioxide tension (P va CO 2) in 42 adult critically ill patients with preinfusion P va CO 2 > 6 mmHg. Results FB caused a decrease in P va CO 2 , from 8.7 [7.6−10.9] mmHg to 6.9 [5.8−8.6] mmHg (p < 0.01). P va CO 2 decreased independently of pre-infusion cardiac index and P va CO 2 changes during FB were not correlated with changes in central venous oxygen saturation (S cv O 2) whatever pre-infusion CI. Pre-infusion levels of P va CO 2 were inversely correlated with decreases in P va CO 2 during FB and a pre-infusion P va CO 2 value < 7.7 mmHg could exclude a decrease in P va CO 2 during FB (AUC: 0.79, 95%CI 0.64-0.93; Sensitivity, 91%; Specificity, 55%; p < 0.01). Conclusions Fluid bolus decreased abnormal P va CO 2 levels independently of pre-infusion CI. Low baseline P va CO 2 values suggest that a positive response to FB is unlikely.
American Journal of Case Reports, Jul 5, 2023
BMC Anesthesiology, Jun 11, 2014
Background: Transcranial Doppler can detect cerebral perfusion alteration in septic patients. We ... more Background: Transcranial Doppler can detect cerebral perfusion alteration in septic patients. We correlate static Transcranial Doppler findings with clinical signs of sepsis-associated encephalopathy. Methods: Forty septic patients were examined with Transcranial Doppler on the first and third day of sepsis diagnosis. The pulsatility index (PI) and cerebral blood flow index (CBFi) were calculated by blood velocity in the middle cerebral artery (cm/sec). Patients underwent a daily cognitive assessment with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) test. Results: Twenty-one patients (55%) were found to present confusion. The majority of the patients presented a PI > 1.1 (76%). PI on the first day (but not the third day) could predict a positive CAM-ICU test in septic patients (PI cutoff: 1.3, AUC: 0.905, p < 0.01, sensitivity: 95%, specificity: 88%, AUC: 0.618, p = 0.24). Multivariable analysis showed that PI on the first day is related to a positive CAM-ICU test independent of age and APACHE II score (OR: 5.6, 95% CI: 1.1-29, p = 0.03). A decrease of the PI on the third day was observed in the group that presented initially high PI (>1.3) (2.2 ± 0.71 vs. 1.81 ± 0.64; p = 0.02). On the other hand, an increase in PI was observed in the other patients (1.01 ± 0.15 vs. 1.58 ± 0.57; p < 0.01). On only the first day, the mean blood velocity in the middle cerebral artery and CBFi were found to be lower in those patients with a high initial PI (36 ± 21 vs. 62 ± 28 cm/sec; p < 0.01, 328 ± 101 vs. 581 ± 108; p < 0.01, respectively). Conclusions: Cerebral perfusion disturbance observed with Transcranial Doppler could explain clinical symptoms of sepsis-associated encephalopathy.
Annals of Intensive Care, Feb 11, 2020
European Journal of Anaesthesiology, May 1, 2008
Presse Medicale, 1989
SCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe
BMC Anesthesiology, Jan 31, 2023
Background High ratio of the carbon dioxide veno-arterial difference to the oxygen arterial-venou... more Background High ratio of the carbon dioxide veno-arterial difference to the oxygen arterial-venous difference (P va CO 2 /C av O 2) is associated with fluid bolus (FB) induced increase in oxygen consumption (VO 2). This study investigated whether P va CO 2 /C av O 2 was associated with decreases in blood-lactate levels FB in critically ill patients with hyperlactatemia. Methods This prospective observational study examined adult patients in the intensive care unit (ICU) with lactate levels > 1.5 mmol/L who received FBs. Blood-lactate levels were measured before and after FB under unchanged metabolic, respiratory, and hemodynamic conditions. The primary outcome was blood-lactate levels after FB. Significant decreases in blood-lactate levels were considered as blood-lactate levels < 1.5 mmol/L or a decrease of more than 10% compared to baseline. Results The study enrolled 40 critically ill patients, and their median concentration of blood lactate was 2.6 [IQR:1.9 − 3.8] mmol/L. There were 27 (68%) patients with P va CO 2 /C av O 2 ≥ 1.4 mmHg/ml, and 10 of them had an increase in oxygen consumption (dVO 2) ≥ 15% after FB, while 13 (32%) patients had P va CO 2 /C av O 2 < 1.4 mmHg/ml before FB, and none of them had dVO 2 ≥ 15% after FB. FB increased the cardiac index in patients with high and low preinfusion P va CO 2 /C av O 2 (13.4% [IQR: 8.3 − 20.2] vs. 8.8% [IQR: 2.9 − 17.4], p = 0.34). Baseline P va CO 2 /C av O 2 was not found to be associated with a decrease in blood lactate after FB (OR: 0.88 [95% CI: 0.39 − 1.98], p = 0.76). A positive correlation was observed between changes in blood lactate and baseline P va CO 2 /C av O 2 (r = 0.35, p = 0.02). Conclusions In critically ill patients with hyperlactatemia, P va CO 2 /C av O 2 before FB cannot be used to predict decreases in blood-lactate levels after FB. Increased P va CO 2 /C av O 2 is associated with less decrease in blood-lactate levels.
PubMed, 1989
This article reports a case of leaflet embolization of a mitral Edwards-Duromedics prosthesis. Th... more This article reports a case of leaflet embolization of a mitral Edwards-Duromedics prosthesis. The patient had abrupt onset of acute pulmonary edema and was initially treated medically for 3 days. Fluoroscopy showed only one freely moving leaflet and the other was (incorrectly) assumed to be blocked in the closed position. The patient received IV thrombolysis for another 3 days and was finally operated. He died 8 days later from sepsis and the leaflet was recovered at autopsy in the abdominal aorta. Leaflet escape of a mitral Edwards-Duromedics prosthesis is a rare, potentially curable mode of valve failure. Correct interpretation of clinical signs and symptoms and of fluoroscopy should allow early diagnosis and surgical therapy.
PubMed, 1996
We report on a 45-year old woman with daytime sleepiness, polycythemia, hypoxemia and hypercapnia... more We report on a 45-year old woman with daytime sleepiness, polycythemia, hypoxemia and hypercapnia, admitted to hospital on three occasions in a 10 month period for acute respiratory failure. Polysomnography demonstrated apneas of central type, testing of the respiratory drive suggested central alveolar hypoventilation and magnetic resonance imaging showed an Arnold-Chiari malformation with syringomyelia. The originality of this case is the absence of any neurologic sign, respiratory failure being the sole manifestation of the Arnold-Chiari malformation.
Intensive Care Medicine, Feb 10, 2005
TTP treated with Rituximab after initial PE. A 59-year-old man was hospitalised for aphasia, pare... more TTP treated with Rituximab after initial PE. A 59-year-old man was hospitalised for aphasia, paresis of the inferior right facial nerve, and fever (38 °C). His blood analysis revealed low platelets (15,000/mm3), haemolytic microangiopathic anaemia (hemoglobin=10.2 g/dl, schistocytes 8%, LDH 1,300 UI/l, haptoglobin 0.05 g/l), and renal failure (creatinine=123.9 mmol/l, urea=18.5 mmol/l). PE with 60 ml/kg fresh frozen plasma daily and methylprednisolon (1 mg·kg·day) was started. Although neurological symptoms and thrombopenia resolved after four PE, two PE/week were needed in order to achieve a platelet count of >100,000/mm3. Methylprednisolon was tapered off after 2 weeks. ADAMTS13 activity (AA) was undetectable and inhibitor activity (IA) was 16 BU/ml before the first PE. During PE AA was <5% and IA was oscillating between 2 BU/ml and 8 BU/ml. After Rituximab was administered at 375 mg·m2·week during 4 weeks, the platelet count stabilized at >150,000/mm3, PE was discontinued, AA was 7.5%, and IA became undetectable. The patient has been in remission for 9 months. In conclusion, although only anecdotal reports are available, Rituximab is very promising in the treatment of TTP with deficiency of AA and IA. Prospective studies, however, are difficult to perform due to the rareness of TTP.
Journal of Translational Internal Medicine, Mar 1, 2019
et al. Diagnosing acute respiratory distress syndrome with the Berlin definition: Which technical... more et al. Diagnosing acute respiratory distress syndrome with the Berlin definition: Which technical investigations should be the best to confirm it?
PubMed, May 1, 2009
Dopamine and norepinephrine are widely used as first line agents to correct hypotension in patien... more Dopamine and norepinephrine are widely used as first line agents to correct hypotension in patients with acute circulatory failure. There has been considerable debate in recent years as to whether one is better than the other. Both drugs can increase blood pressure in shock states, although norepinephrine is more powerful. Dopamine can increase cardiac output more than norepinephrine, and in addition to the increase in global blood flow, has the potential advantage of increasing renal and hepatosplanchnic blood flow. However, dopamine has potentially detrimental effects on the release of pituitary hormones and especially prolactin, although the clinical relevance of these effects is unclear. Observational studies have provided conflicting results regarding the effects of these two drugs on outcomes, and results from a recently completed randomized controlled trial are eagerly waited.
Acta Cardiologica, 1998
info:eu-repo/semantics/publishe
Nephrology Dialysis Transplantation, 2005
Journal of Critical Care, Feb 1, 2017
We assessed the security and efficiency of intravenously injected agitated saline in conjunction ... more We assessed the security and efficiency of intravenously injected agitated saline in conjunction with transthoracic echocardiography to identify recirculation in patients supported with a veno-venous extracorporeal membrane oxygenation (VV ECMO) device. Materials and Methods: We injected agitated saline four consecutive times separated by an interval of 5 minutes in two patients supported by VV ECMO. In both patients, the drainage cannula was placed in the left femoral vein, and the return cannula was placed in the right internal jugular vein. Echocardiography was performed during the injection and until the bubbles disappeared. The security of the method was assessed by evaluating the mechanical function of the ECMO and the efficiency of the oxygenator. The value of this method was assessed by visualizing the increase of inferior vena cava's echogenicity as well as by measuring the time required for this change to occur after the injection of agitated saline at different ECMO output levels. Results: We did not observe any change in ECMO, oxygenation function, or in the hemodynamic status of patients after the four injections of agitated saline. The echogenicity of the inferior vena cava increased more rapidly as the ECMO's output increased. The recirculation phenomenon was noted even with low levels of ECMO output (<2 L/min). Conclusions: Transthoracic echocardiography in conjunction with agitated saline administration may be a safe and easily applicable method to evaluate a recirculation phenomenon in patients supported with VV ECMO.
Emerging Infectious Diseases, Apr 1, 2005
International Journal of Infectious Diseases, Mar 1, 2010
Intensive Care Medicine, Aug 1, 1995
Sir: The morbidity associated with the accidental aspiration of foreign bodies is well documented... more Sir: The morbidity associated with the accidental aspiration of foreign bodies is well documented [1-3]. It is classically seen in children, with 70% of cases occurring in those less than 3 years of age [41. A 43-year-old asthmatic presented at our accident and emergency department with a 10-day history of increasingly severe wheezing and dry coughing. He recalled having used his salbutamol inhaler 10 days previously, immediately after which he experienced a transient choking sensation. On that occasion, the patient had taken his inhaler, the mouthpiece of
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Papers by Jacques Devriendt