References of "LAMBERMONT, Bernard"
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See detailDéterminant physiologique du NGAL sanguin et discordance entre NGAL sanguin et urinaire.
DELANAYE, Pierre ULiege; Claisse, G; Mehdi, M et al

Poster (2013)

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See detailDéterminant physiologique du NGAL sanguin et discordance entre NGAL sanguin et urinaire.
DELANAYE, Pierre ULiege; Claisse, G; Mehdi, M et al

Poster (2013)

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See detailProcalcitonin for antibiotic treatment in intensive care unit patients.
LAYIOS, Nathalie ULiege; LAMBERMONT, Bernard ULiege

in Current infectious disease reports (2013), 15(5), 394-9

Procalcitonin (PCT), a 116-aminoacids prohormone, has been substantially studied over the last 2 decades in the field of sepsis. Disappointingly low sensitivity values led to the abandonment of the ... [more ▼]

Procalcitonin (PCT), a 116-aminoacids prohormone, has been substantially studied over the last 2 decades in the field of sepsis. Disappointingly low sensitivity values led to the abandonment of the concept of it as a diagnostic tool and then to its being considered more as a prognostic marker with a good correlation with severe infection. Later on, growing concerns about multidrug-resistant bacteria in the ICU environment and about the cost and side effects of antibiotics suggested that PCT might prove to be a valuable asset in stewardship programs. Numerous but hardly comparable randomized controlled trials assessing either initiation or deescalation in ICU patients have been published. Stewardship encompassing PCT should focus on the latter, because of the high negative predictive value of this biomarker. However, there still would be safety concerns if a systematic implementation of PCT were to be considered in daily stewardship programs in the ICU, especially in extra-thoracic sepsis. [less ▲]

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See detailIs extended or continuous infusion of Carbapenems the obvious solution to improve clinical outcomes and reduce mortality?
FRIPPIAT, Frédéric ULiege; VERCHEVAL, Christelle ULiege; LAMBERMONT, Bernard ULiege et al

in Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America (2013), 57(2), 324-325

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See detailNAVA enhances tidal volume and diaphragmatic electro-myographic activity matching: a Range90 analysis of supply and demand
Moorhead, K. T.; Piquilloud, L.; LAMBERMONT, Bernard ULiege et al

in Journal of Clinical Monitoring and Computing (2013), 27(1)

Neurally adjusted ventilatory assist (NAVA) is a ventilation assist mode that delivers pressure in proportionality to electrical activity of the diaphragm (Eadi). Compared to pressure support ventilation ... [more ▼]

Neurally adjusted ventilatory assist (NAVA) is a ventilation assist mode that delivers pressure in proportionality to electrical activity of the diaphragm (Eadi). Compared to pressure support ventilation (PS), it improves patient-ventilator synchrony and should allow a better expression of patient's intrinsic respiratory variability. We hypothesize that NAVA provides better matching in ventilator tidal volume (Vt) to patients inspiratory demand. 22 patients with acute respiratory failure, ventilated with PS were included in the study. A comparative study was carried out between PS and NAVA, with NAVA gain ensuring the same peak airway pressure as PS. Robust coefficients of variation (CVR) for Eadi and Vt were compared for each mode. The integral of Eadi (sh{phonetic}Eadi) was used to represent patient's inspiratory demand. To evaluate tidal volume and patient's demand matching, Range90 = 5-95 % range of the Vt/sh{phonetic}Eadi ratio was calculated, to normalize and compare differences in demand within and between patients and modes. In this study, peak Eadi and sh{phonetic}Eadi are correlated with median correlation of coefficients, R > 0.95. Median sh{phonetic}Eadi, Vt, neural inspiratory time (Ti_ <br /> Neural), inspiratory time (Ti) and peak inspiratory pressure (PIP) were similar in PS and NAVA. However, it was found that individual patients have higher or smaller sh{phonetic}Eadi, Vt, Ti_ <br /> Neural, Ti and PIP. CVR analysis showed greater Vt variability for NAVA (p < 0.005). Range90 was lower for NAVA than PS for 21 of 22 patients. NAVA provided better matching of Vt to sh{phonetic}Eadi for 21 of 22 patients, and provided greater variability Vt. These results were achieved regardless of differences in ventilatory demand (Eadi) between patients and modes. © 2012 Springer Science+Business Media New York. [less ▲]

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See detailAssessment of ventricular contractility and ventricular-arterial coupling with a model-based sensor.
Desaive, Thomas ULiege; LAMBERMONT, Bernard ULiege; JANSSEN, Nathalie ULiege et al

in Computer Methods & Programs in Biomedicine (2013), 109(2),

Estimation of ventricular contractility and ventricular arterial coupling is clinically important in diagnosing and treating cardiac dysfunction in the critically ill. However, experimental assessment of ... [more ▼]

Estimation of ventricular contractility and ventricular arterial coupling is clinically important in diagnosing and treating cardiac dysfunction in the critically ill. However, experimental assessment of indexes of ventricular contractility, such as the end-systolic pressure-volume relationship, requires a highly invasive maneuver and measurements that are not typical in an intensive care unit (ICU). This research describes the use of a previously validated cardiovascular system model and parameter identification process to evaluate the right ventricular arterial coupling in septic shock. Model-based ventricular arterial coupling is defined by the ratio of the end systolic right ventricular elastance (E(esrvf)) over the pulmonary artery elastance (E(pa)) or the mean pulmonary inflow resistance (R(pulin)). Results are compared to the clinical gold-standard assessment (conductance catheter method). Six anesthetized healthy pigs weighing 20-30kg received a 0.5mgkg(-1) endotoxin infusion over a period of 30min from T0 to T30, to induce septic shock and veno-venous hemofiltration was used from T60 onward. The results show good agreement with the gold-standard experimental assessment. In particular, the model-based right ventricular elastance (E(esrvf)) correlates well with the clinical gold standard (R(2)=0.69) and the model-based non-invasive coupling (E(esrvf)/R(pulin)) follow the same trends and dynamics (R(2)=0.37). The overall results show the potential to develop a model-based sensor to monitor ventricular-arterial coupling in clinical real-time. [less ▲]

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See detailValidation of subject-specific cardiovascular system models from porcine measurements.
Revie, J. A.; Stevenson, D. J.; Chase, J. G. et al

in Computer Methods & Programs in Biomedicine (2013), 109(2),

A previously validated mathematical model of the cardiovascular system (CVS) is made subject-specific using an iterative, proportional gain-based identification method. Prior works utilised a complete set ... [more ▼]

A previously validated mathematical model of the cardiovascular system (CVS) is made subject-specific using an iterative, proportional gain-based identification method. Prior works utilised a complete set of experimentally measured data that is not clinically typical or applicable. In this paper, parameters are identified using proportional gain-based control and a minimal, clinically available set of measurements. The new method makes use of several intermediary steps through identification of smaller compartmental models of CVS to reduce the number of parameters identified simultaneously and increase the convergence stability of the method. This new, clinically relevant, minimal measurement approach is validated using a porcine model of acute pulmonary embolism (APE). Trials were performed on five pigs, each inserted with three autologous blood clots of decreasing size over a period of four to five hours. All experiments were reviewed and approved by the Ethics Committee of the Medical Faculty at the University of Liege, Belgium. Continuous aortic and pulmonary artery pressures (P(ao), P(pa)) were measured along with left and right ventricle pressure and volume waveforms. Subject-specific CVS models were identified from global end diastolic volume (GEDV), stroke volume (SV), P(ao), and P(pa) measurements, with the mean volumes and maximum pressures of the left and right ventricles used to verify the accuracy of the fitted models. The inputs (GEDV, SV, P(ao), P(pa)) used in the identification process were matched by the CVS model to errors <0.5%. Prediction of the mean ventricular volumes and maximum ventricular pressures not used to fit the model compared experimental measurements to median absolute errors of 4.3% and 4.4%, which are equivalent to the measurement errors of currently used monitoring devices in the ICU ( approximately 5-10%). These results validate the potential for implementing this approach in the intensive care unit. [less ▲]

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See detailVisualisation of Time-Variant Respiratory System Elastance in ARDS Models.
Van Drunen, E. J.; Chiew, Y. S.; Zhao, Z. et al

in Biomedizinische Technik. Biomedical engineering (2013), 58(suppl 1)

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See detailReduction in VAP incidence by subglottic secretion drainage and antibiotic consumption in ICU patients
VAN CAUWENBERGE, Isabelle ULiege; ANCION, Arnaud ULiege; LAMBERMONT, Bernard ULiege et al

in Intensive Care Medicine (2013), 39(Suppl 2), 465-4660898

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See detailEffects of Large-Pore Hemofiltration in a Swine Model of Fulminant Hepatic Failure.
DETRY, Olivier ULiege; JANSSEN, Nathalie ULiege; CHERAMY-BIEN, Jean-Paul ULiege et al

in Artificial Organs (2012), 36(11), 981-987

Among the different potential mechanisms that could lead to brain edema and intracranial hypertension in fulminant hepatic failure (FHF), the inflammatory hypothesis implies that systemic inflammation ... [more ▼]

Among the different potential mechanisms that could lead to brain edema and intracranial hypertension in fulminant hepatic failure (FHF), the inflammatory hypothesis implies that systemic inflammation might be in part responsible for an increase in cerebral blood flow (CBF) and brain water content. In this study, the authors used a validated ischemic FHF swine model to evaluate the effects of 80 kDa large-pore membrane hemofiltration (LPHF) on intracranial pressure (ICP) and CBF, in relation with the clearance of proinflammatory cytokines and blood liver tests, as primary end points. Fifteen pigs were randomized into one of three groups: SHAM, FHF, and FHF + LPHF. All experiments lasted 6 h. In the FHF groups, liver failure was induced by liver ischemia. After 2 h, the FHF + LPHF group underwent 4 h of a zero-balance continuous veno-venous hemofiltration using a 0.7-m(2) , large-pore (78 A) membrane with a cutoff of 80 kDa. ICP, CBF, mean arterial pressure, central venous pressure, and heart rate were continuously monitored and recorded. Arterial aspartate aminotransferase, total bilirubin, creatinine, international normalized ratio, glucose, lactate and serum cytokines interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha were measured at T0, T120, and T360. Over the 6 h following liver ischemia, the FHF group developed a significant increase in ICP. This ICP rise was not observed in the SHAM group and was attenuated in the FHF + LDHF group. However, the ICP levels were not different at T360 in the FHF + LDHF group compared to the FHF group. No significant effect of LPHF on liver tests or levels of proinflammatory cytokines could be demonstrated. In this model, 80 kDa LPHF was not efficient to control FHF intracranial hypertension and to decrease serum cytokine levels. [less ▲]

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See detailNeurally adjusted ventilatory assist (NAVA) improves patient-ventilator interaction during non-invasive ventilation delivered by face mask
Piquilloud, L; Tassaux, D; Bialais, E et al

in Intensive Care Medicine (2012)

PURPOSE: To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient-ventilator asynchrony in intensive care patients undergoing noninvasive ventilation ... [more ▼]

PURPOSE: To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient-ventilator asynchrony in intensive care patients undergoing noninvasive ventilation with an oronasal face mask. METHODS: In this prospective interventional study we compared patient-ventilator synchrony between PS (with ventilator settings determined by the clinician) and NAVA (with the level set so as to obtain the same maximal airway pressure as in PS). Two 20-min recordings of airway pressure, flow and electrical activity of the diaphragm during PS and NAVA were acquired in a randomized order. Trigger delay (T(d)), the patient's neural inspiratory time (T(in)), ventilator pressurization duration (T(iv)), inspiratory time in excess (T(iex)), number of asynchrony events per minute and asynchrony index (AI) were determined. RESULTS: The study included 13 patients, six with COPD, and two with mixed pulmonary disease. T(d) was reduced with NAVA: median 35 ms (IQR 31-53 ms) versus 181 ms (122-208 ms); p = 0.0002. NAVA reduced both premature and delayed cyclings in the majority of patients, but not the median T(iex) value. The total number of asynchrony events tended to be reduced with NAVA: 1.0 events/min (0.5-3.1 events/min) versus 4.4 events/min (0.9-12.1 events/min); p = 0.08. AI was lower with NAVA: 4.9 % (2.5-10.5 %) versus 15.8 % (5.5-49.6 %); p = 0.03. During NAVA, there were no ineffective efforts, or late or premature cyclings. PaO(2) and PaCO(2) were not different between ventilatory modes. CONCLUSION: Compared to PS, NAVA improved patient ventilator synchrony during noninvasive ventilation by reducing T(d) and AI. Moreover, with NAVA, ineffective efforts, and late and premature cyclings were absent. [less ▲]

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See detailstructural model of the mitral valve included in a cardiovascular closed loop model. Static and dynamic validation
Paeme, Sabine ULiege; Pironet, Antoine ULiege; Chase, J. Geoffrey et al

Conference (2012, August 31)

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See detailStructural model of the mitral valve included in a cardiovascular closed loop model. Static and dynamic validation
Paeme, Sabine ULiege; Pironet, Antoine ULiege; Chase, J. Geoffrey et al

in proceedings of 8th IFAC Symposium on Biological and Medical Systems, Budapest 29-31 août 2012 (2012, August 31)

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See detailBeat-to-beat estimation of the continuous left and right cardiac elastance from metrics commonly available in clinical settings.
Stevenson, David; Revie, James; Chase, J. Geoffrey et al

in BioMedical Engineering OnLine (2012), 11(1), 73

ABSTRACT: INTRODUCTION: : Functional time-varying cardiac elastances (FTVE) contain a rich amount of information about the specific cardiac state of a patient. However, a FTVE waveform is very invasive to ... [more ▼]

ABSTRACT: INTRODUCTION: : Functional time-varying cardiac elastances (FTVE) contain a rich amount of information about the specific cardiac state of a patient. However, a FTVE waveform is very invasive to directly measure, and is thus currently not used in clinical practice. This paper presents a method for the estimation of a patient specific FTVE, using only metrics that are currently available in a clinical setting. METHOD: : Correlations are defined between invasively measured FTVE waveforms and the aortic and pulmonary artery pressures from 2 cohorts of porcine subjects, 1 induced with pulmonary embolism, the other with septic shock. These correlations are then used to estimate the FTVE waveform based on the individual aortic and pulmonary artery pressure waveforms, using the "other" dysfunction's correlations as a cross validation. RESULTS: : The cross validation resulted in 1.26% and 2.51% median errors for the left and right FTVE respectively on pulmonary embolism, while the septic shock cohort had 2.54% and 2.90% median errors. CONCLUSIONS: : The presented method accurately and reliably estimated a patient specific FTVE, with no added risk to the patient. The cross validation shows that the method is not dependent on dysfunction and thus has the potential for generalisation beyond pulmonary embolism and septic shock. [less ▲]

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See detailAlgorithmic Processing of Pressure Waveforms to FacilitateEstimation of Cardiac Elastance
Stevenson, D.; Revie, J.; Chase, J. G. et al

in BioMedical Engineering OnLine (2012), 11

Introduction: Cardiac elastances are highly invasive to measure directly, but are clinically useful due tothe amount of information embedded in them. Information about the cardiac elastance, which can be ... [more ▼]

Introduction: Cardiac elastances are highly invasive to measure directly, but are clinically useful due tothe amount of information embedded in them. Information about the cardiac elastance, which can be used toestimate it, can be found in the downstream pressure waveforms of aortic pressure (Pao) and the pulmonaryartery (Ppa). However these pressure waveforms are typically noisy and biased, and require processing in orderto locate the specific information required for the cardiac elastance estimation. This paper presents the methodto algorithmically process the pressure waveforms. Methods: A shear transform is developed in order to helplocate information in the pressure waveforms. This transform turns difficult to locate corners into easy to locatemaximum or minimum points as well as providing error correction. Results: The method located all points 87out of 88 waveforms for Ppa to within the sampling frequency. For Pao, out of 616 total points, 605 were foundwithin 1%, 5 within 5%, 4 within 10% and 2 within 20%. Conclusions: The presented method provides arobust, accurate and dysfunction independent way to locate points on the aortic and pulmonary artery pressurewaveforms, allowing the non-invasive estimation of the left and right cardiac elastance. [less ▲]

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See detailComputer-based monitoring of global cardiovascular dynamics during acute pulmonary embolism and septic shock in swine
Revie, JA; Stevenson, D; Chase, JG et al

in Critical Care (2012), 16 (Suppl 1)

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