Showing papers by "Benoit Vallet published in 2003"
TL;DR: This first randomized controlled multicenter trial on the use of xenon as an inhalational anesthetic confirms that xenon in oxygen provides effective and safe anesthesia, with the advantage of a more rapid recovery when compared with anesthesia using isoflurane–nitrous oxide.
Abstract: Background All general anesthetics used are known to have a negative inotropic side effect. Since xenon does not have a negative inotropic effect, it could be an interesting future general anesthetic. The aim of this clinical multicenter trial was to test the hypothesis of whether recovery after xenon anesthesia is faster compared with an accepted, standardized anesthetic regimen and that it is as effective and safe. Method A total of 224 patients in six centers were included in the protocol. They were randomly assigned to receive either xenon (60 +/- 5%) in oxygen or isoflurane (end-tidal concentration, 0.5%) combined with nitrous oxide (60 +/- 5%). Sufentanil (10 mcirog) was intravenously injected if indicated by defined criteria. Hemodynamic, respiratory, and recovery parameters, the amount of sufentanil, and side effects were assessed. Results The recovery parameters demonstrated a statistically significant faster recovery from xenon anesthesia when compared with isoflurane-nitrous oxide. The additional amount of sufentanil did not differ between both anesthesia regimens. Hemodynamics and respiratory parameters remained stable throughout administration of both anesthesia regimens, with advantages for the xenon group. Side effects occurred to the same extent with xenon in oxygen and isoflurane-nitrous oxide. Conclusion This first randomized controlled multicenter trial on the use of xenon as an inhalational anesthetic confirms, in a large group of patients, that xenon in oxygen provides effective and safe anesthesia, with the advantage of a more rapid recovery when compared with anesthesia using isoflurane-nitrous oxide.
218 citations
TL;DR: Direct and indirect evidence for endothelial cell alteration in humans during septic shock is emerging and the present review details recently published literature on this rapidly evolving topic.
Abstract: During the past decade a unifying hypothesis has been developed to explain the vascular changes that occur in septic shock on the basis of the effect of inflammatory mediators on the vascular endothelium. The vascular endothelium plays a central role in the control of microvascular flow, and it has been proposed that widespread vascular endothelial activation, dysfunction and eventually injury occurs in septic shock, ultimately resulting in multiorgan failure. This has been characterized in various models of experimental septic shock. Now, direct and indirect evidence for endothelial cell alteration in humans during septic shock is emerging. The present review details recently published literature on this rapidly evolving topic.
121 citations
TL;DR: The Pco2 gap is a marker of mortality in ventilated patients in the intensive care unit and a threshold value of 20 mm Hg for P co2 gap and 2.5 mmol/L for lactate is found, which was associated with a sensitivity and specificity of 0.70 and 0.72, respectively.
Abstract: Context: Contrary to tonometer gastric intramucosal pH, there is currently no validated threshold prognostic value for PCO2 gap (tonometer gastric mucosal PCO2 minus arterial PCO2) in the critically ill patient. Objective: To demonstrate a relationship between PCO2 gap and mortality in mechanically ventilated patients. Design and Setting: Inception cohort study from a 9-month prospective survey of 95 consecutively ventilated critically ill patients in a teaching hospital. Patients: All the ventilated patients of the intensive care unit were included at their admission. Measurements and Main Results: Gastric PCO2 using regional capnometry with air-automated tonometry, arterial gas, lactate, and organ system failure score were measured at admission and after 6, 12, 24, 48, 72, 96, and 120 hrs. For the entire population, the 28-day mortality was 44%. In multivariate analysis, independent predictors of death were organ system failure score (odds ratio, 2.12; 95% confidence interval, 1.02‐3.14), 24-hr PCO2 gap (odds ratio, 1.57; 95% confidence interval, 1.10 ‐2.24), and 24-hr lactate (odds ratio, 1.48; 95% confidence interval, 1.06 ‐2.05). We found a threshold value of 20 mm Hg for PCO2 gap and 2.5 mmol/L for lactate, which was associated with a sensitivity of 0.70 and 0.72, respectively, and a specificity of 0.72 and 0.73, respectively. Conclusion: The PCO2 gap is a marker of mortality in ventilated patients in the intensive care unit. (Crit Care Med 2003; 31:474 ‐480)
111 citations