Papers by françois lemaire
Annales de l'anesthésiologie française
Réanimation Urgences, 1997
Esprit, 2007
Au-dela des campagnes mediatiques sur l’euthanasie, mourir a l’hopital est une realite banale. Po... more Au-dela des campagnes mediatiques sur l’euthanasie, mourir a l’hopital est une realite banale. Pourquoi est-ce ainsi que l’on meurt ? Quelle incidence cela a-t-il sur les relations avec le personnel hospitalier ? Que peut faire la loi pour encadrer la prise en charge des personnes dans les derniers jours de leur vie ?
Bulletin de physio-pathologie respiratoire
The American review of respiratory disease, 1987
Vasodilator therapy for pulmonary hypertension ideally should cause a proportionately greater red... more Vasodilator therapy for pulmonary hypertension ideally should cause a proportionately greater reduction of resistance in the pulmonary vascular bed than in the systemic circulation. This should limit the occurrence of systemic hypotension, which can complicate the use of most vasodilator drugs. Urapidil is a new vasodilator that acts by postsynaptic alpha 1-blockade while inhibiting the aortic pressure baroreceptor reflex and reducing central sympathetic tone. We investigated and compared the short-term effects of Urapidil and hydralazine in 10 patients suffering varying degrees of pulmonary hypertension. Each patient received either 0.35 mg/kg hydralazine or 0.75 mg/kg Urapidil intravenously on 2 sequential days in a randomized order. The main effect of Urapidil was to decrease the mean pulmonary artery pressure in all 10 patients from 44 +/- 4 to 37 +/- 3.5 mm Hg (p less than 0.001). After Urapidil infusion, the mean decrease of resistance in the pulmonary vascular bed (32%) excee...
La Nouvelle presse médicale, Jan 11, 1975
Hemodynamic data were collected in 42 patients with pulmonary edema (P.E.) due to altered permeab... more Hemodynamic data were collected in 42 patients with pulmonary edema (P.E.) due to altered permeability of various causes. Pulmonary artery wedge pressure (PWP) was normal, whatever the time of the study and the severity of the P.E. Pulmonary artery hypertension was present in the cases with severe hypoxemia, but disappeared with hypoxemia correction. In some cases, a hyperkinetic or a hypovolemic syndrome was found, being induced by the cause of P.E. Although within normal limits, PWP was significantly higher at the first hours of P.E. than after the 6th hour. Perfusion of colloid solutes worsened P.E., although increasing PWP by only a few mmHg. Dehydration using diuretics markedly improved the venous admixture, although PWP was previously normal. These data document the production of P.E. in many causes-such as severe sepsis, drowning, fat embolism, barbiturate overdose-by impaired alveolo-capillary permeability, PWP and blood protein content remaining within normal limits. They a...
La Nouvelle presse médicale, Jan 3, 1979
La Revue du praticien, Jan 21, 1978
Anesthésie, analgésie, réanimation
Annales de l'anesthésiologie française, 1975
Pulmonary edema due to disorders in alveolo-capillary permeability (or lesional) are differentiat... more Pulmonary edema due to disorders in alveolo-capillary permeability (or lesional) are differentiated from hemodynamic pulmonary edema by the fact that they arise in spite of normal pulmonary capillary pressure (PCP). A hemodynamic study was carried out in 42 cases of lesional P.E. The PCP was normal whatever the date of the examination and the gravity of the P.E. Pulmonary arterial hypertension was only found in the presence of frank hypoxemia and disappeared with the correction of the latter. If there was no hemodynamic profile due to P.E. itself, its etiology sometimes induced a hyperkinetic or hypovolemic syndrome. Finally it was apparent that PCP was significantly higher- although normal- at the initial stage than after 6 hours of P.E.; that an elevation in PCP of only a few mm Hg by the perfusion of colloids aggravated the P.E., that despite the normal value for the PCP dehydration evidently improved hematosis. Thus this study confirms that numerous cases of P.E. can occur while...
Presse médicale (Paris, France : 1983), 2011
Presse médicale (Paris, France : 1983), Jan 12, 2005
Revue française des maladies respiratoires, 1980
Annales françaises d'anesthèsie et de rèanimation, 1982
Information provided by computation of shunt and alveolar arterial oxygen differences have been c... more Information provided by computation of shunt and alveolar arterial oxygen differences have been compared in 58 episodes of acute respiratory failure. In order to demonstrate the role of hemodynamic factors on pulmonary gas exchange, we compared blood gas measurements made in 29 patients with a high cardiac output and a reduced arteriovenous oxygen difference [C(a--v-)O2 less than 3.5 ml], with 33 measurements corresponding to a low cardiac output and a widened C(a--v-)O2 (greater than 6.5 ml). When the data was pooled together, the same P(A--a)O2 corresponded to many different shunt values, depending on the level of mixed venous oxygenation (PV-O2). QS/Qtot and P(A--a)O2 were quasi linearly correlated only when they corresponded to patients with the same C(a--v-)O2. For the same value of shunt, the PaO2 was always raised when the PV-O2 was raised. As far as pulmonary gas exchange is concerned, shunt calculation in acute respiratory failure is preferable to P(A--a)O2, especially when...
Annales de l'anesthésiologie française, 1981
La semaine des hôpitaux : organe fondé par l'Association d'enseignement médical des hôpitaux de Paris, Jan 8, 1974
Archives des maladies du coeur et des vaisseaux, 1990
Mechanical ventilation is a valuable therapeutic option in left ventricular failure because of it... more Mechanical ventilation is a valuable therapeutic option in left ventricular failure because of its effect on ventricular load. However, weaning cardiac patients form mechanical ventilation may result in severe pulmonary oedema, especially if it is not properly prepared. Some of the factors which contribute to pulmonary oedema are: 1) increased venous return due to the inversion ot the regime of inthrathoracic pressures and the release of catecholamines commonly observed during weaning, 2) reduction of left ventricular compliance due to myocardial ischemia, compression of the cardiac chambers by the lungs, ventricular interdependence in some cases and left ventricular dilatation in others, 3) increased left ventricular afterload due to negative intrathoracic pressures and increased systolic blood pressure. Of all the causes of unsuccessful weaning, left ventricular dysfunction should be carefully considered because its treatment alone may enable the patients to be taken off the venti...
The American review of respiratory disease, 1991
The work of breathing is a major determinant of the success of weaning from mechanical ventilatio... more The work of breathing is a major determinant of the success of weaning from mechanical ventilation. The aim of this study was to assess whether an inhaled bronchodilator could reduce the mechanical load on the respiratory muscles and diminish the work. For this purpose, 15 intubated patients in the process of weaning from mechanical ventilation inhaled the beta 2-agonist bronchodilator albuterol via a spacer device filled with 1 mg of the drug and connected to the endotracheal tube. During spontaneous breathing, the mean work of breathing diminished significantly after albuterol, from 9.35 +/- 1.05 to 8.33 +/- 1.13 J/min (p less than 0.01), and seven patients exhibited a decrease superior or equal to 15%. This decrease resulted from a marked reduction in lung and airway resistance, from 12.0 +/- 1.7 to 9.8 +/- 1.4 cm H2O.L-1.s (p less than 0.05). No significant changes were observed in the breathing pattern, intrinsic PEEP or arterial blood gas measurements after albuterol, and peri...
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Papers by françois lemaire