References of "Damas, Pierre"
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See detailSAPS 3 admission score: an external validation in a general intensive care population
Ledoux, Didier ULg; Canivet, Jean-Luc ULg; Preiser, Jean-Charles ULg et al

in Intensive Care Medicine (2008)

OBJECTIVES: To validate the SAPS 3 admission score in an independent general intensive care case mix and to compare its performances with the APACHE II and the SAPS II scores. DESIGN: Cohort observational ... [more ▼]

OBJECTIVES: To validate the SAPS 3 admission score in an independent general intensive care case mix and to compare its performances with the APACHE II and the SAPS II scores. DESIGN: Cohort observational study. SETTING: A 26-bed general ICU from a Tertiary University Hospital. PATIENTS AND PARTICIPANTS: Eight hundred and fifty-one consecutive patients admitted to the ICU over an 8-month period. Of these patients, 49 were readmissions, leaving 802 patients for further analysis. INTERVENTION: None. MEASUREMENTS AND RESULTS: APACHE II, SAPS II and SAPS 3 variables were prospectively collected; scores and their derived probability of death were calculated according to their original manuscript description. The discriminative power was assessed using the area under the ROC curve (AUROC) and calibration was verified with the Hosmer-Lemeshow goodness-of-fit test. The AUROC of the APACHE II model (AUROC = 0.823) was significantly lower than those of the SAPS II (AUROC = 0.850) and SAPS 3 models (AUROC = 0.854) (P = 0.038). The calibration of the APACHE II model (P = 0.037) and of the SAPS 3 global model (P = 0.035) appeared unsatisfactory. On the contrary, both SAPS II model and SAPS 3 model customised for Central and Western Europe had a good calibration. However, in our study case mix, SAPS II model tended to overestimate the probability of death. CONCLUSION: In this study, the SAPS 3 admission score and its prediction model customised for Central and Western Europe was more discriminative and better calibrated than APACHE II, but it was not significantly better than the SAPS II. [less ▲]

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See detailCyclic appearance of left ventricular outflow tract dynamic obstruction during mechanical ventilation: evidence for a preload dependent phenomenon.
Canivet, Jean-Luc ULg; Lancellotti, Patrizio ULg; Radermecker, Marc ULg et al

in Journal of Intensive Care Medicine (2008), 23(4), 281-4

The cyclic appearance of dynamic left ventricular outflow tract obstruction during mechanical ventilation, according to the phasic changes in preload, is described in this article. Hemodialysis-induced ... [more ▼]

The cyclic appearance of dynamic left ventricular outflow tract obstruction during mechanical ventilation, according to the phasic changes in preload, is described in this article. Hemodialysis-induced fluid removal resulted in preload dependence as evidenced by the pulse pressure variation in a 56-year-old critically ill patient. The clinical picture was suggestive of myocardial failure. Transthoracic echocardiography disclosed dynamic left ventricular outflow tract obstruction associated with systolic anterior motion of the mitral valve. Progressive fluid restitution resulted in a parallel decrease in both the degree of dynamic obstruction and pulse pressure variation. During fluid loading, dynamic obstruction disappeared at first during the inspiratory phase of intermittent positive pressure ventilation corresponding to the phasic increase in left ventricular preload. Further fluid loading resulted in the disappearance of dynamic obstruction during both inspiratory and expiratory phase of intermittent positive pressure ventilation. This is the first reported case clearly relating left ventricular outflow tract dynamic obstruction to preload dependence during mechanical ventilation in a critically ill patient without predisposing anatomical factor. [less ▲]

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See detailIntensive care unit acquired infection and organ failure
Damas, Pierre ULg; Ledoux, Didier ULg; Nys, Monique ULg et al

in Intensive Care Medicine (2008), 34

OBJECTIVE: To assess the temporal relationship between ICU-acquired infection (IAI) and the prevalence and severity of organ dysfunction or failure (OD/F). DESIGN AND SETTING: Observational, single center ... [more ▼]

OBJECTIVE: To assess the temporal relationship between ICU-acquired infection (IAI) and the prevalence and severity of organ dysfunction or failure (OD/F). DESIGN AND SETTING: Observational, single center study in a mixed intensive care unit of a university hospital. PATIENTS: We analyzed 1,191 patients hospitalized for more than 2 days during a 2-year observation period: 845 did not acquire IAI, 306 of whom had infection on admission (IOA); 346 did acquire IAI, 125 of whom had IOA. MEASUREMENTS AND RESULTS: The SOFA score was calculated daily, both SOFAmax, the sum of the worst OD/F during the ICU stay, and SOFApreinf, the sum of the worst OD/F existing before the occurrence of the first IAI. The SAPS II and SOFA score of the first 24 h were significantly higher in patients with than in those without IAI. SOFApreinf of IAI patients was also higher than the SOFAmax of patients without IAI both in patients with (12.1+/-4.6 vs. 8.9+/-4.7) and those without IOA (9.2+/-4.0 vs. 6.7+/-3.5). SOFApreinf represented 85.7% of the value of SOFAmax in patients with IAI. SOFApreinf increased significantly with the occurrence of sepsis, severe sepsis, or septic shock during ICU stay. Severe sepsis and septic shock during ICU stay as well as SOFApreinf were part of the factors associated with hospital mortality. CONCLUSIONS: IAI is significantly associated with hospital mortality; however, its contribution to OD/F is minor. Moreover, severity of IAI seems to be related to previous health status. [less ▲]

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See detailRenal failure and ICU-acquired infection
WIESEN, Patricia ULg; LAYIOS, Nathalie ULg; NYS, Monique ULg et al

in Intensive Care Medicine (2008), 34(Suppl 1), 2650864

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See detailVoluntary brain processing in disorders of consciousness
Schnakers, Caroline ULg; Perrin, F.; Schabus, M. et al

in Neurology (2008), 71(20), 1614-1620

Background: Disentangling the vegetative state from the minimally conscious state is often difficult when relying only on behavioral observation. In this study, we explored a new active evoked related ... [more ▼]

Background: Disentangling the vegetative state from the minimally conscious state is often difficult when relying only on behavioral observation. In this study, we explored a new active evoked related potentials paradigm as an alternative method for the detection of voluntary brain activity. Methods: The participants were 22 right-handed patients (10 traumatic) diagnosed as being in a vegetative state (VS) (n 8) or in a minimally conscious state (MCS) (n 14). They were presented sequences of names containing the patient’s own name or other names, in both passive and active conditions. In the active condition, the patients were instructed to count her or his own name or to count another target name. Results: Like controls, MCS patients presented a larger P3 to the patient’s own name, in the passive and in the active conditions. Moreover, the P3 to target stimuli was higher in the active than in the passive condition, suggesting voluntary compliance to task instructions like controls. These responses were even observed in patients with low behavioral responses (e.g., visual fixationand pursuit). In contrast, no P3 differences between passive and active conditions were observed for VS patients. Conclusions: The present results suggest that active evoked-related potentials paradigms may permit detection of voluntary brain function in patients with severe brain damage who present with a disorder of consciousness, even when the patient may present with very limited to questionablyany signs of awareness. [less ▲]

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See detailChurg Strauss Syndrome masquerading septic shock.
Delleuze, Pierre-Philippe; CANIVET, Jean-Luc ULg; PREISER, Jean-Charles ULg et al

in Acta Clinica Belgica (2008), 63(4), 269-72

Systemic inflammatory response syndrome (SIRS) can be related to acute inflammatory conditions that can be sometimes missed and inappropriately managed as severe infections. We report a case of Churg ... [more ▼]

Systemic inflammatory response syndrome (SIRS) can be related to acute inflammatory conditions that can be sometimes missed and inappropriately managed as severe infections. We report a case of Churg Strauss Syndrome (CSS), presenting as septic shock with acute onset of fever and multiple organ failure including pulmonary involvement with severe hypoxemia, hypotension requiring vasoactive support and acute renal failure. Antibiotics were discontinued and intravenous steroids allowed a rapid clinical improvement in close relationship with the fall in circulating eosinophils count. [less ▲]

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See detailAre blood transfusions associated with greater mortality rates? Results of the Sepsis Occurrence in Acutely Ill Patients study.
Vincent, Jean-Louis; Sakr, Yasser; Sprung, Charles et al

in Anesthesiology (2008), 108(1), 31-9

BACKGROUND: Studies have suggested worse outcomes in transfused patients and improved outcomes in patients managed with restricted blood transfusion strategies. The authors investigated the relation of ... [more ▼]

BACKGROUND: Studies have suggested worse outcomes in transfused patients and improved outcomes in patients managed with restricted blood transfusion strategies. The authors investigated the relation of blood transfusion to mortality in European intensive care units (ICUs). METHODS: The Sepsis Occurrence in Acutely Ill Patients study was a multicenter, observational study that included all adult patients admitted to 198 European ICUs between May 1 and May 15, 2002 and followed them until death, until hospital discharge, or for 60 days. Patients were classified depending on whether they had received a blood transfusion at any time during their ICU stay. RESULTS: Of 3,147 patients, 1,040 (33.0%) received a blood transfusion. These patients were older (mean age, 62 vs. 60 yr; P = 0.035) and were more likely to have liver cirrhosis or hematologic cancer, to be a surgical admission, and to have sepsis. They had a longer duration of ICU stay (5.9 vs. 2.5 days; P < 0.001) and a higher ICU mortality rate (23.0 vs. 16.3%; P < 0.001) but were also more severely ill on admission (Simplified Acute Physiology Score II, 40.2 vs. 34.7; P < 0.001; Sequential Organ Failure Assessment score, 6.5 vs. 4.5; P < 0.001). There was a direct relation between the number of blood transfusions and the mortality rate, but in multivariate analysis, blood transfusion was not significantly associated with a worse mortality rate. Moreover, in 821 pairs matched according to a propensity score, there was a higher 30-day survival rate in the transfusion group than in the other patients (P = 0.004). CONCLUSION: This observational study does not support the view that blood transfusions are associated with increased mortality rates in acutely ill patients. [less ▲]

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See detailComment prédire l'évolution du coma post-anoxique?
Kirsch, Murielle ULg; Boveroux, Pierre ULg; Massion, Paul ULg et al

in Revue Médicale de Liège (2008), 63(5-6), 263-268

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See detailA french validation study of the Coma Recovery Scaled-Revised (CRS-R)
Schnakers, Caroline ULg; Majerus, Steve ULg; Giacino, Joseph et al

in Brain Injury (2008), 22(10), 786-792

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See detailLes échelles d’évaluation des états de conscience altérée
Ledoux, Didier ULg; Piret, Sonia ULg; Boveroux, Pierre ULg et al

in Réanimation (2008), 17

L’évaluation de l’état de conscience revêt une importance clinique considé- rable. En effet, déterminer avec précision la sévérité de l’altération de conscience permet non seulement d’établir un pronostic ... [more ▼]

L’évaluation de l’état de conscience revêt une importance clinique considé- rable. En effet, déterminer avec précision la sévérité de l’altération de conscience permet non seulement d’établir un pronostic vital et fonctionnel mais aussi de suivre plus efficacement l’évolution clinique des patients avec lésion cérébrale et d’optimaliser l’utilisation des ressources disponibles. Dans cet article, nous passons en revue les principales échelles d’évaluation des états de conscience altérée. Nous nous intéressons particu- lièrement à instrument récemment publié, l’échelle «Full Outline of UnResponsiveness» (FOUR). En effet, cette dernière constitue une avancée considérable dans l’évaluation cli- nique des patients présentant un état de conscience altérée. Parmi les apports de cette échelle, on notera sa contribution au diagnostic d’un locked-in syndrome, d’un état de conscience minimale ou encore d’un état de mort cérébrale. Nous pensons qu’en rai- son de son apport à l’examen clinique durant la phase initiale d’un état de conscience altérée, l’échelle FOUR devrait être préférée à la désormais classique échelle de Glasgow. [less ▲]

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See detailBloodless liver transplantation: Experience with Jehovah's witnesses
Detry, Olivier ULg; De Roover, Arnaud ULg; Coimbra Marques, Carla ULg et al

in Transplant International (2007, September), 20(Supplement 2), 291812

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See detailCystatin C blood level as a risk factor for death after heart surgery
Ledoux, Didier ULg; Monchi, M.; Chapelle, Jean-Paul ULg et al

in European Heart Journal (2007), 28(15), 1848-53

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See detailPancreatic cellular injury after cardiac surgery with cardiopulmonary bypass: Frequency, time course and risk factors
Nys, Monique ULg; Venneman, Ingrid ULg; Deby-Dupont, G. et al

in Shock (Augusta, Ga.) (2007), 27(5), 474-481

Although often clinically silent, pancreatic cellular injury (PCI) is relatively frequent after cardiac surgery with cardiopulmonary bypass; and its etiology and time course are largely unknown. We ... [more ▼]

Although often clinically silent, pancreatic cellular injury (PCI) is relatively frequent after cardiac surgery with cardiopulmonary bypass; and its etiology and time course are largely unknown. We defined PCI as the simultaneous presence of abnormal values of pancreatic isoamylase and immunoreactive trypsin (IRT). The frequency and time evolution of PCI were assessed in this condition using assays for specific exocrine pancreatic enzymes. Correlations with inflammatory markers were searched for preoperative risk factors. One hundred ninety-three patients submitted to cardiac surgery were enrolled prospectively. Blood IRT, amylase, pancreatic isoamylase, lipase, and markers of inflammation (alpha1-protease inhibitor, alpha2-macroglobulin, myeloperoxidase) were measured preoperatively and postoperatively until day 8. The postoperative increase in plasma levels of pancreatic enzymes and urinary IRT was biphasic in all patients: early after surgery and later (from day 4 to 8 after surgery). One hundred thirty-three patients (69%) experienced PCI, with mean IRT, isoamylase, and alpha1-protease inhibitor values higher for each sample than that in patients without PCI. By multiple regression analysis, we found preoperative values of plasma IRT >or=40 ng/mL, amylase >or=42 IU/mL, and pancreatic isoamylase >or=20 IU/L associated with a higher incidence of postsurgery PCI (P < 0.005). In the PCI patients, a significant correlation was found between the 4 pancreatic enzymes and urinary IRT, total calcium, myeloperoxidase, alpha1-protease inhibitor, and alpha2-macroglobulin. These data support a high prevalence of postoperative PCI after cardiac surgery with cardiopulmonary bypass, typically biphasic and clinically silent, especially when pancreatic enzymes were elevated preoperatively. [less ▲]

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See detailCascade high volume hemofiltration : Preliminary data in septic shock patients
WIESEN, Patricia ULg; MONCHI, Mehran; DUBOIS, Bernard ULg et al

in Blood Purification (2007), 25

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See detailActualites therapeutiques en medecine intensive.
CANIVET, Jean-Luc ULg; Monchi, Mehran; PREISER, Jean-Charles ULg et al

in Revue Médicale de Liège (2007), 62(5-6), 277-80

Over the last ten years, much progress has been achieved in intensive care medicine. Large randomized studies, most often their multicentric, were performed and their results were translated into rules to ... [more ▼]

Over the last ten years, much progress has been achieved in intensive care medicine. Large randomized studies, most often their multicentric, were performed and their results were translated into rules to be followed for the most appropriate treatment of life-threatening organ failures. The place of non-invasive ventilation in the management of hypercapnic or hypoxic respiratory insufficiencies was thus defined, and the methods for less traumatic mechanical ventilation were specified. The techniques of renal replacement therapy were compared and the optimal doses of dialysis or hemofiltration were established. The metabolic support of the patients was also altered following landmark studies, such as the management of blood glucose, which deeply influenced the approach to critically ill patients. [less ▲]

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See detailCadaveric liver transplantation for non-acetaminophen fulminant hepatic failure: A 20-year experience
Detry, Olivier ULg; De Roover, Arnaud ULg; Coimbra Marques, Carla ULg et al

in World Journal of Gastroenterology (2007), 13(9), 1427-1430

AIM: To investigate the long-term results of liver transplantation (LT) for non-acetaminophen fulminant hepatic failure (FHF). METHODS: Over a 20-year period, 29 FHF patients underwent cadaveric whole LT ... [more ▼]

AIM: To investigate the long-term results of liver transplantation (LT) for non-acetaminophen fulminant hepatic failure (FHF). METHODS: Over a 20-year period, 29 FHF patients underwent cadaveric whole LT. Most frequent causes of FHF were hepatitis B virus and drug-related (not acetaminophen) liver failure. All surviving patients were regularly controlled at the out-patient clinic and none was lost to follow-up. Mean follow-up was 101 mo. RESULTS: One month, one-, five- and ten-year patient survival was 79%, 72%, 68% and 68%, respectively. One month, one-, five- and ten-year graft survival was 69%, 65%, 51% and 38%, respectively. Six patients needed early (< 2 mo) retransplantation, four for primary non-function, one for early acute refractory rejection because of ABO blood group incompatibility, and one for a malignant tumor found in the donor. Two patients with hepatitis B FHF developed cerebral lesions peri-transplantion: One developed irreversible and extensive brain damage leading to death, and one suffered from deep deficits leading to continuous medical care in a specialized institution. CONCLUSION: Long-term outcome of patients transplanted for non-acetaminophen FHF may be excellent. As the quality of life of these patients is also particularly good, LT for FHF is clearly justified, despite lower graft survival compared with LT for other liver diseases. (C) 2007 The WJG Press. All rights reserved. [less ▲]

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See detailL'anticoagulation de l'hémofiltration continue: Citrate versus Héparine
Damas, Pierre ULg; Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2007), 62

L'insuffisance rénale aiguë aux Soins Intensifs affecte un patient sur cinq et souvent nécessite le recours à une épuration extra-rénale. L'hémofiltration continue est choisie pour certains patients ... [more ▼]

L'insuffisance rénale aiguë aux Soins Intensifs affecte un patient sur cinq et souvent nécessite le recours à une épuration extra-rénale. L'hémofiltration continue est choisie pour certains patients (instabilité hémodynamique, neurologique, mais nécessite, comme d'ailleurs l'hémodialyse, une anticoagulation. Le citrate, utilisé dans le travail publié, est sorti vainqueur de sa comparaison avec l'héparine non fractionnée. Son utilisation nécessite cependant une surveillance attentive. [less ▲]

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