Automated EEG entropy measurements in coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state
Gosseries, Olivia ; Schnakers, Caroline ; LEDOUX, Didier et al
in Functional Neurology (2011)
Monitoring the level of consciousness in brain injured patients with disorders of consciousness is crucial as it provides diagnostic and prognostic information. Behavioral assessment remains the gold ... [more ▼]
Monitoring the level of consciousness in brain injured patients with disorders of consciousness is crucial as it provides diagnostic and prognostic information. Behavioral assessment remains the gold standard for assessing consciousness but previous studies have shown a high rate of misdiagnosis. This study aimed to investigate the usefulness of electroencephalography (EEG) entropy measurements in differentiating unconscious (coma or vegetative) from minimally conscious patients. Left fronto-temporal EEG recordings (10-minute resting state epochs) were prospectively obtained in 56 patients and 16 age-matched healthy volunteers. Patients were assessed in the acute (≤1 month post-injury;n=29) or chronic (>1 month post-injury; n=27) stage. The etiology was traumatic in 23 patients. Automated online EEG entropy calculations (providing an arbitrary value ranging from 0 to 91) were compared with behavioral assessments (Coma Recovery Scale-Revised) and outcome. EEG entropy correlated with Coma Recovery Scale total scores (r=0.49). Mean EEG entropy values were higher in minimally conscious (73±19; mean and standard deviation) than in vegetative/unresponsive wakefulness syndrome patients (45±28). Receiver operating characteristic analysis revealed an entropy cut-off value of 52 differentiating acute unconscious from minimally conscious patients (sensitivity 89% and specificity 90%). In chronic patients, entropy measurements offered no reliable diagnostic information. EEG entropy measurements did not allow prediction of outcome. User-independent time-frequency balanced spectral EEG entropy measurements seem to constitute an interesting diagnostic – albeit not prognostic – tool for assessing neural network complexity in disorders of consciousness in the acute setting. Future studies are needed before using this tool in routine clinical practice, and these should seek to improve automated EEG quantification paradigms in order to reduce the remaining false negative and false positive findings. [less ▲]Detailed reference viewed: 215 (10 ULg)
Clinical sedation and bispectral index in burn children receiving gamma-hydroxybutyrate.
ROUSSEAU, Anne-Françoise ; ; et al
in European Journal of Anaesthesiology. Supplement (2011), 28(Suppl 48), 150Detailed reference viewed: 16 (5 ULg)
End of life care in the operating room for non-heart-beating donors: organization at the University Hospital of Liege.
JORIS, Jean ; KABA, Abdourahmane ; LAUWICK, Séverine et al
in Transplantation Proceedings (2011), 43(9), 3441-4
Non-heart-beating (NHB) organ donation has become an alternative source to increase organ supply for transplantation. A NHB donation program was implemented in our institution in 2002. As in many ... [more ▼]
Non-heart-beating (NHB) organ donation has become an alternative source to increase organ supply for transplantation. A NHB donation program was implemented in our institution in 2002. As in many institutions the end of life care of the NHB donor (NHBD) is terminated in the operating room (OR) to reduce warm ischemia time. Herein we have described the organization of end of life care for these patients in our institution, including the problems addressed, the solution proposed, and the remaining issues. Emphasis is given to our protocol elaborated with the different contributors of the chain of the NHB donation program. This protocol specifies the information mandatory in the medical records, the end of life care procedure, the determination of death, and the issue of organ preservation measures before NHBD death. The persisting malaise associated with NHB donation reported by OR nurses is finally documented using an anonymous questionnaire. [less ▲]Detailed reference viewed: 71 (21 ULg)
Quantitative evaluation of fluid resuscitation in burn children : a retrospective study.
ROUSSEAU, Anne-Françoise ; LEDOUX, Didier ; et al
in Burns : Journal of the International Society for Burn Injuries (2011), 37(suppl 1), 12Detailed reference viewed: 37 (10 ULg)
Contribution of donors after cardiac death to the deceased donor pool: 2002 to 2009 university of liege experience.
; Meurisse, Nicolas ; Delbouille, Michèle et al
in Transplantation Proceedings (2010), 42(10), 4369-72
OBJECTIVE: In this study, we have evaluated the organ procurement and transplantation activity from donors after cardiac death (DCD) at our institution over an 8-year period. Our aim was to determine ... [more ▼]
OBJECTIVE: In this study, we have evaluated the organ procurement and transplantation activity from donors after cardiac death (DCD) at our institution over an 8-year period. Our aim was to determine whether this program influenced transplantation programs, or donation after brain death (DBD) activity. METHODS: We prospectively collected our procurement and transplantation statistics in a database for retrospective review. RESULTS: We observed an increasing trend in potential and actual DCD number. The mean conversion rate turning potential into effective donors was 58.1%. DCD accounted for 16.6% of the deceased donor (DD) pool over 8 years. The mean age for effective DCD donors was 53.9 years (range, 3-79). Among the effective donors, 63.3% (n = 31) came from the transplant center and 36.7% (n = 18) were referred from collaborative hospitals. All donors were Maastricht III category. The number of kidney and liver transplants using DCD sources tended to increase. DCD kidney transplants represented 10.8% of the DD kidney pool and DCD liver transplants made up 13.9% of the DD liver pool over 8 years. The DBD program activity increased in the same time period. In 2009, 17 DCD and 33 DBD procurements were performed in a region with a little >1 million inhabitants. CONCLUSION: The establishment of a DCD program in our institution enlarged the donor pool and did not compromise the development of the DBD program. In our experience, DCD are a valuable source for abdominal organ transplantation. [less ▲]Detailed reference viewed: 35 (15 ULg)
Interest of routine dosage of meropenem in difficult to treat infections
Frippiat, Frédéric ; ; Denooz, Raphael et al
Poster (2010, October 23)Detailed reference viewed: 38 (8 ULg)
Intérêt de la cystatine C plasmatique pour la détection d'une insuffisance rénale chez le patient hospitalisé aux soins intensifs : résultats préliminaires
Delanaye, Pierre ; Cavalier, Etienne ; et al
in Néphrologie & Thérapeutique (2010, September), 6(5), 349-350Detailed reference viewed: 31 (4 ULg)
Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury.
; ; et al
in Critical Care: the Official Journal of the Critical Care Forum (2010), 14(6), 221
INTRODUCTION: Outcome studies in patients with acute kidney injury (AKI) have focused on differences between modalities of renal replacement therapy (RRT). The outcome of conservative treatment, however ... [more ▼]
INTRODUCTION: Outcome studies in patients with acute kidney injury (AKI) have focused on differences between modalities of renal replacement therapy (RRT). The outcome of conservative treatment, however, has never been compared with RRT. METHODS: Nine Belgian intensive care units (ICUs) included all adult patients consecutively admitted with serum creatinine >2 mg/dl. Included treatment options were conservative treatment and intermittent or continuous RRT. Disease severity was determined using the Stuivenberg Hospital Acute Renal Failure (SHARF) score. Outcome parameters studied were mortality, hospital length of stay and renal recovery at hospital discharge. RESULTS: Out of 1,303 included patients, 650 required RRT (58% intermittent, 42% continuous RRT). Overall results showed a higher mortality (43% versus 58%) as well as a longer ICU and hospital stay in RRT patients compared to conservative treatment. Using the SHARF score for adjustment of disease severity, an increased risk of death for RRT compared to conservative treatment of RR = 1.75 (95% CI: 1.4 to 2.3) was found. Additional correction for other severity parameters (Acute Physiology And Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA)), age, type of AKI and clinical conditions confirmed the higher mortality in the RRT group. CONCLUSIONS: The SHARF study showed that the higher mortality expected in AKI patients receiving RRT versus conservative treatment can not only be explained by a higher disease severity in the RRT group, even after multiple corrections. A more critical approach to the need for RRT in AKI patients seems to be warranted. [less ▲]Detailed reference viewed: 19 (7 ULg)
The long way of biomarkers: from bench to bedside.
; Damas, Pierre ; PREISER, Jean-Charles
in Intensive Care Medicine (2010), 36(4), 565-6Detailed reference viewed: 8 (2 ULg)
Extracorporeal membrane oxygenation (ECMO) in ICU patients suffering from cardiogenic shock, refactory hypoxemia or cardiac arrest
MASSION, Paul ; LEDOUX, Didier ; PIRET, Sonia et al
in Revue Médicale de Liège (2010)Detailed reference viewed: 40 (6 ULg)
L’ECMO (ExtraCorporeal Membrane Oxygenation) aux soins intensifs : intérêt chez le patient en choc cardiogénique réfractaire, en hypoxémie réfractaire ou en arrêt cardiaque.
Massion, Paul ; Ledoux, Didier ; et al
in Revue Médicale de Liège (2010), 65
ExtraCorporeal Membrane Oxygenation (ECMO) is a cardiopulmonary assistance device able to support patients in cardiac arrest, refractory cardiogenic shock or refractory hypoxemia otherwise sentenced to ... [more ▼]
ExtraCorporeal Membrane Oxygenation (ECMO) is a cardiopulmonary assistance device able to support patients in cardiac arrest, refractory cardiogenic shock or refractory hypoxemia otherwise sentenced to death. Recent technical progresses, early indication decision, bedside multidisciplinary implant, specific complications screening and echocardiographic weaning testing are crucial points to allow success of this exceptional technique. [less ▲]Detailed reference viewed: 136 (21 ULg)
Hyperacute graft rejection during heart transplantation for giant cell myocarditis: A case report.
; Delbecque, Katty ; Defraigne, Jean-Olivier et al
in Pathology - Research & Practice (2010), 15(206), 411-4
We report the case of a patient with giant cell myocarditis who was bridged to transplantation with mechanical circulatory support and developed a fatal perioperative hyperacute rejection. The patient had ... [more ▼]
We report the case of a patient with giant cell myocarditis who was bridged to transplantation with mechanical circulatory support and developed a fatal perioperative hyperacute rejection. The patient had received abundant transfusions that had raised her anti-HLA antibody titers. The cross-match test was positive. No pre-transplantation immunosuppressive therapy had been administered given concomitant infection. The severity and acuteness of the rejection in this case likely reflect the combined effect of preformed anti-HLA antibodies in the context of an active organ-specific immune process at the time of transplantation. This case raises the questions of the need for intensive immunosuppressive therapy before transplantation in giant cell myocarditis and of the management of patients with positive cross-match in the context of a giant cell myocarditis. [less ▲]Detailed reference viewed: 19 (3 ULg)
Les prélèvements à coeur arrêté: une source d'organes trop souvent oubliée?
Detry, Olivier ; De Roover, Arnaud ; Damas, Pierre et al
in Hospitals.be (2010), 8(1), 7-12
La transplantation est aujourd’hui victime de son succès. Les procédures de prélèvement à coeur arrêté se doivent de respecter les règles d’éthique et les dispositions légales en la matière. La pénurie ... [more ▼]
La transplantation est aujourd’hui victime de son succès. Les procédures de prélèvement à coeur arrêté se doivent de respecter les règles d’éthique et les dispositions légales en la matière. La pénurie relative d’organes sera partiellement comblée lorsqu’elles seront appliquées dans une majorité d'hôpitaux du pays. [less ▲]Detailed reference viewed: 29 (12 ULg)
Liver transplantation from controlled donation after cardiac death (DCD) donors: a single center experience
Detry, Olivier ; ; Seydel, Benoît et al
in Liver Transplantation (2009, July), 15(7), 180-181Detailed reference viewed: 50 (14 ULg)
Liver transplant donation after cardiac death : experience at the University of Liège
Detry, Olivier ; Seydel, Benoît ; Delbouille, Marie-Hélène et al
in Transplantation Proceedings (2009), 41(2), 582-4
Aim: Donation after cardiac death (DCD) has been proposed to partly overcome the organ donor shortage. In liver transplantation, the additional warm ischemia linked to DCD procurement may promote higher ... [more ▼]
Aim: Donation after cardiac death (DCD) has been proposed to partly overcome the organ donor shortage. In liver transplantation, the additional warm ischemia linked to DCD procurement may promote higher rate of primary non-function and ischemic type biliary lesions. In this study we reviewed the results of DCD liver transplantation at the University of Liège. Patients and Methods: From 2003 to 2007, 13 controlled DCD liver transplantations were consecutively performed. The records of all donors and recipients were retrospectively reviewed, particularly evaluating the outcome and the occurrence of biliary complications. Mean follow-up was 25 months. Results: Mean donor age was 51 years and their mean intensive care stay was 5.4 days. Mean time between ventilation arrest and cardiac arrest was 9.3 min. Mean time between cardiac arrest and arterial flush was 7.7 min. No touch period was 2 to 5 min. Mean graft cold ischemia was 295 min and mean suture warm ischemia was 38 min. Postoperatively there was no primary non-function. Mean peak transaminase was 2,546 UI/ml. Patient and graft survival was 100% at one year. Two patients (15%) developed graft main bile duct stenosis and underwent endoscopic management. No patient developed symptomatic intrahepatic bile duct strictures or needed retransplantation in the follow-up. Conclusions: The experience of the transplantation department of the University of Liege confirms that controlled DCD donors may be a valuable source of transplantable liver grafts, in case of short procurement warm ischemia and short transplant cold ischemia. [less ▲]Detailed reference viewed: 134 (22 ULg)
Results of liver transplantation from controlled donation after cardiac death (DCD) donors: a single center experience
Detry, Olivier ; Seydel, Benoît ; et al
in Acta Gastro-Enterologica Belgica (2009, January), 72(1), 25Detailed reference viewed: 60 (17 ULg)
Intermittent versus continuous renal replacement therapy for acute kidney injury patients admitted to the intensive care unit: results of a randomized clinical trial.
; ; et al
in Nephrology Dialysis Transplantation (2009), 24(2), 512-8
BACKGROUND: There is uncertainty on the effect of different dialysis modalities for the treatment of patients with acute kidney injury (AKI), admitted to the intensive care unit (ICU). This controlled ... [more ▼]
BACKGROUND: There is uncertainty on the effect of different dialysis modalities for the treatment of patients with acute kidney injury (AKI), admitted to the intensive care unit (ICU). This controlled clinical trial performed in the framework of the multicentre SHARF 4 study (Stuivenberg Hospital Acute Renal Failure) aimed to investigate the outcome in patients with AKI, stratified according to severity of disease and randomized to different treatment options. METHODS: This was a multicentre prospective randomized controlled trial with stratification according to severity of disease expressed by the SHARF score. ICU patients were eligible for inclusion when serum creatinine was >2 mg/dL, and RRT was initiated. The selected patients were randomized to intermittent (IRRT) or continuous renal replacement therapy (CRRT). RESULTS: A total of 316 AKI patients were randomly assigned to IRRT (n = 144) or CRRT (n = 172). The mean age was 66 (range 18-96); 59% were male. Intention-to-treat analysis revealed a mortality of 62.5% in IRRT compared to 58.1% in CRRT (P = 0.430). No difference between IRRT and CRRT could be observed in the duration of ICU stay or hospital stay. In survivors, renal recovery at hospital discharge was comparable between both groups. Multivariate analysis, including the SHARF score, APACHE II and SOFA scores for correction of disease severity, showed no difference in mortality between both treatment modalities. This result was confirmed in pre-specified subgroup analysis (elderly, patients with sepsis, heart failure, ventilation) and after exclusion of possible confounders (early mortality, delayed ICU admission). CONCLUSIONS: Modality of RRT, either CRRT or IRRT, had no impact on the outcome in ICU patients with AKI. Both modalities need to be considered as complementary in the treatment of AKI (Clinical Trial: SHARF 4, NCT00322933, http://ClinicalTrials.gov). [less ▲]Detailed reference viewed: 6 (1 ULg)
Mesure du débit de filtration glomérulaire aux soins intensifs basée sur l’iohexol : clairance plasmatique ou urinaire ?
Delanaye, Pierre ; Cavalier, Etienne ; Lambermont, Bernard et al
in Réanimation (2009), 18(1), 112Detailed reference viewed: 110 (15 ULg)
Le sepsis, réponse adaptée ou non à l’infection?
in Réanimation (2009), 18(4), 277-281
Sepsis, severe sepsis and septic shock were thought to be provoked by an overwhelming inflammation in response to an infectious process. This was documented in several animal studies. However, in human ... [more ▼]
Sepsis, severe sepsis and septic shock were thought to be provoked by an overwhelming inflammation in response to an infectious process. This was documented in several animal studies. However, in human sepsis, excess of inflammation is hard to be observed. Compartimentalization of the host response rather favors a systemic anti-inflammatory climate. Clinical situations are complex: on one hand, virulence factors of microorganisms can directly harm the host tissues, divert the defence mechanisms or distract the control mechanisms of the host, preventing the normal interaction of endogenous mediators. On the other hand, septic shock mostly occurs in patients experiencing previous organic or functional vital failures before the development of infection. The vulnerability of the patient appears therefore to be a key point in the severity of the disease. Enhancing the host defence mechanisms rather than inhibiting the inflammatory reaction may become a preferential option. [less ▲]Detailed reference viewed: 6 (1 ULg)
5 ans d’expérience monocentrique de transplantation hépatique avec des donneurs à cœur arrêté de catégorie 3 de Maastricht
Detry, Olivier ; Seydel, Benoît ; et al
in Journal de Chirurgie (2008, December), 145Detailed reference viewed: 115 (17 ULg)