References of "LEDOUX, Didier"
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See detailCerebral subarachnoid blood migration consecutive to a lumbar haematoma after spinal anaesthesia
Goujon-Dubois, Julie; Hans, Grégory ULg; Senard, Marc ULg et al

in Acta Anaesthesiologica Belgica (2008), 59(3), 223

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See detailMesurer la douleur chez le patient non communicant.
Chatelle, Camille ULg; Vanhaudenhuyse, Audrey ULg; Mergam, Anne-Nora ULg et al

in Revue Médicale de Liège (2008), 63(5-6), 429-37

Pain is a subjective experience. Its assessment is based on the subject's direct verbal report. This method of assessment is, however, impossible in patients who cannot communicate their feelings. In this ... [more ▼]

Pain is a subjective experience. Its assessment is based on the subject's direct verbal report. This method of assessment is, however, impossible in patients who cannot communicate their feelings. In this context, indirect measurements such as behavioral observations or physiological measurements are needed. To facilitate the assessment of pain in non-communicative patients, numerous standardized behavioral scales have been developed. The aim of this review is to discuss the main validated pain scales employed in end-stage dementia, newborn and preverbal children, and severely brain damaged patients with a disorder of consciousness such as coma, the vegetative state or the minimally conscious state. [less ▲]

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See detailQuelle vie apres le Locked-In syndrome?
Bruno, Marie-Aurélie ULg; Pellas, F.; Bernheim, J. L. et al

in Revue Médicale de Liège (2008), 63(5-6), 445-51

The Locked-In Syndrome (LIS) is classically caused by an anterior pontine vascular lesion and characterized by quadriplegia and anarthria with preserved consciousness and intellectual functioning. We here ... [more ▼]

The Locked-In Syndrome (LIS) is classically caused by an anterior pontine vascular lesion and characterized by quadriplegia and anarthria with preserved consciousness and intellectual functioning. We here review the definition, etiologies, diagnosis and prognosis of LIS patients and briefly discuss the few studies on their quality of life and the challenging end-of-life decisions that can be encountered. Some clinicians may consider that LIS is worse than being in a vegetative or in a minimally conscious state. However, preliminary data from chronic LIS survivors show a surprisingly preserved self-scored quality of life and requests of treatment withdrawal or euthanasia, though not absent, are infrequent. [less ▲]

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See detailCerebral subarachnoid blood migration consecutive to a lumbar haematoma after spinal anaesthesia
Hans, Grégory ULg; Senard, Marc ULg; Ledoux, Didier ULg et al

in Acta Anaesthesiologica Scandinavica (2008), 52

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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 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 detailEvaluation comportementale et par neuroimagerie fonctionnelle des patients en état végétatif
Vanhaudenhuyse, Audrey ULg; Schnakers, Caroline ULg; Boly, Mélanie ULg et al

in Revue Médicale de Liège (2007), 62 Spec No

Currently, there remains a high rate of misdiagnosis of the vegetative state. This should incite clinicians to use the most sensitive "coma scales" to detect signs of consciousness in these patients. The ... [more ▼]

Currently, there remains a high rate of misdiagnosis of the vegetative state. This should incite clinicians to use the most sensitive "coma scales" to detect signs of consciousness in these patients. The gold standard remains the Glasgow Coma Scale (GCS, Teasdale and Jennet, 1974), with the Glasgow Liege Scale (GLS, Born, 1988) adding standardized assessment of brainstem reflexes. New sensible behavioral assessment tools for use in the acute neurocritical care setting include the Full Outline of UnResponsiveness (FOUR, Wijdicks et al., 2005). The Coma Recovery Scale-Revised (CRS-R, Giacino and Kalmar, 2004) specifically tests the diagnostic criteria differentiating vegetative from minimally conscious patients. Detecting signs of consciousness also depends on the employed methodology. We showed that for the assesment of the presence of visual pursuit, using a moving mirror is better suited than using a moving object or person. The clinical diagnosis can be confirmed by cerebral positron emission tomography studies objectively quantifying residual metabolic activity in vegetative and minimally conscious patients. Ongoing studies evaluate the prognostic value of functional magnetic resonance imaging studies in these challenging patient populations. [less ▲]

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See detailPost-operative analgesia for minor hand surgery: comparison between two dosages of paracetamol
Legrand, Alexandre; Kirsch, Murielle ULg; Dresse, Caroline ULg et al

in Acta Anaesthesiologica Belgica (2007), 58(3), 221

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See detailSelection of resistance during sequential use of preferential antibiotic classes
Damas, Pierre ULg; Canivet, Jean-Luc ULg; Ledoux, Didier ULg et al

in Intensive Care Medicine (2006), 32

OBJECTIVE: To determine the effect of antibiotic class pressure on the susceptibility of bacteria during sequential periods of antibiotic homogeneity. DESIGN AND SETTING: Prospective study in a mixed ICU ... [more ▼]

OBJECTIVE: To determine the effect of antibiotic class pressure on the susceptibility of bacteria during sequential periods of antibiotic homogeneity. DESIGN AND SETTING: Prospective study in a mixed ICU with three separated subunits of eight, eight, and ten beds. PATIENTS AND PARTICIPANTS: The study examined the 1,721 patients with a length of stay longer than 2 days. INTERVENTIONS: Three different antibiotic regimens were used sequentially over 2 years as first-choice empirical treatment: cephalosporins, fluoroquinolone, or a penicillin-beta-lactamase inhibitor combination. Each regimen was applied for 8 months in each subunits of the ICU, using "latin square" design. RESULTS: We treated 731 infections in 546 patients (32% of patients staying more than 48 h). There were 25.5 ICU-acquired infections per 1,000 patient-days. Infecting pathogens and colonizing bacteria were found in 2,739 samples from 1,666 patients (96.8%). No significant change in global antibiotic susceptibility was observed over time. However, a decrease in the susceptibility of several species was observed for antibiotics used as the first-line therapy in the unit. Selection pressure of antibiotics and occurrence of resistance during treatment was documented within an 8-month rotation period. CONCLUSIONS: Antibiotic use for periods of several months induces bacterial resistance in common pathogens [less ▲]

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See detailCombination therapy versus monotherapy: a randomised pilot study on the evolution of inflammatory parameters after ventilator associated pneumonia
Damas, Pierre ULg; Garweg, Christophe ULg; Monchi, Mehran et al

in Critical Care (2006), 10(2), 52

Introduction Combination antibiotic therapy for ventilator associated pneumonia (VAP) is often used to broaden the spectrum of activity of empirical treatment. The relevance of such synergy is commonly ... [more ▼]

Introduction Combination antibiotic therapy for ventilator associated pneumonia (VAP) is often used to broaden the spectrum of activity of empirical treatment. The relevance of such synergy is commonly supposed but poorly supported. The aim of the present study was to compare the clinical outcome and the course of biological variables in patients treated for a VAP, using a monotherapy with a beta-lactam versus a combination therapy. Methods Patients with VAP were prospectively randomised to receive either cefepime alone or cefepime in association with amikacin or levofloxacin. Clinical and inflammatory parameters were measured on the day of inclusion and thereafter. Results Seventy-four mechanically ventilated patients meeting clinical criteria for VAP were enrolled in the study. VAP was microbiologically confirmed in 59 patients (84%). Patients were randomised to receive cefepime (C group, 20 patients), cefepime with amikacin (C-A group, 19 patients) or cefepime with levofloxacin (C-L group, 20 patients). No significant difference was observed regarding the time course of temperature, leukocytosis or C-reactive protein level. There were no differences between length of stay in the intensive care unit after infection, nor in ventilator free days within 28 days after infection. No difference in mortality was observed. Conclusion Antibiotic combination using a fourth generation cephalosporin with either an aminoside or a fluoroquinolone is not associated with a clinical or biological benefit when compared to cephalosporin monotherapy against common susceptible pathogens causing VAP. [less ▲]

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See detailQuantifying consciousness
Laureys, Steven ULg; Piret, Sonia ULg; Ledoux, Didier ULg

in Lancet Neurology (2005), 4(12), 789-790

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See detailImpact of operator expertise on collection of the APACHE II score and on the derived risk of death and standardized mortality ratio
Ledoux, Didier ULg

in Anaesthesia & Intensive Care (2005), 33(5), 585-590

We assessed the impact of operator expertise on collection of the APACHE II score, the derived risk of death and standardized mortality ratio in 465 consecutive patients admitted to a multi-disciplinary ... [more ▼]

We assessed the impact of operator expertise on collection of the APACHE II score, the derived risk of death and standardized mortality ratio in 465 consecutive patients admitted to a multi-disciplinary tertiary hospital ICU. Research coordinators and junior clinical staff independently collected the APACHE II variables; experts (senior clinical staff) rescored 20% of the records. Agreement was moderate between junior clinical staff and research coordinators or senior clinical staff for most variables of the acute physiology score (weighted kappa<0.6); agreement between research coordinators and senior clinical staff data collectors was good (weighted kappa >0.75). The APACHE II score and its derived risk of death (ROD) were significantly lower using the junior clinical staff dataset compared to research coordinators and senior clinical staff (APACHE II score: 13.4+/-9.2 vs 16.8+/-8.5 vs 17.1+/-7 7, P<0.001; ROD: 14.7%+/-22.4% vs 21.6%+/-22.6% vs 20.8%+/-22.4%, P<0.01 respectively). The discriminative capacity was not altered by the lack of agreement (area under Receiver Operator Characteristic curve >0.8) but calibration of ROD from the junior clinical staff dataset was poor (Goodness-of-fit: P= 0.001). The standardized mortality ratio (SMR) was higher with the junior clinical staff dataset (SMR: 1.22, 95% CI: 0.96-1.52 vs 0.87, 95% CI: 0.70-1.06 vs 0.76, 95% CI: 0.40-1.3 calculated from junior clinical staff research coordinators and senior clinical staff datasets respectively). We conclude that the expertise of data collectors significantly influences the APACHE II score, the derived risk of death and the standardized mortality ratio. Given the importance of such scores, ICUs should be provided with sufficient resources to train and employ dedicated data collectors. [less ▲]

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See detailEffect of hydroxyethylstarch on renal function in cardiac surgery: A large scale retrospective study
Wiesen, Patricia ULg; Canivet, Jean-Luc ULg; Ledoux, Didier ULg et al

in Acta Anaesthesiologica Belgica (2005), 56(3), 257-263

BACKGROUND: Recent reports indicated negative effects of hydroxyethylstarch (HES) on renal function. The goal of this large scale retrospective study was to detect whether there was an association between ... [more ▼]

BACKGROUND: Recent reports indicated negative effects of hydroxyethylstarch (HES) on renal function. The goal of this large scale retrospective study was to detect whether there was an association between postoperative deterioration of renal function and the use of HES 200 kD, 0.5 DS in the cardiac surgery setting. METHODS: Retrospective analysis of daily collected data in 3124 patients who underwent coronary artery bypass and/or valvular surgery. Three groups were compared according to differences in fluid therapy: --GEL: gelatin was used as priming fluid of extracorporeal circulation (ECC) and for postoperative filling (n = 1276). --MIX: HES was used as priming fluid of ECC an gelatin was used for postoperative filling (n = 1008). --HES: HES was used as priming fluid of ECC and for postoperative filling (n = 840). MAIN RESULTS: There were no significant differences in postoperative serum creatinine concentrations between the 3 groups: GEL: 12,2 +/- 0,5 mg/l; MIX: 12,3 +/- 0.5 mg/l; HES: 12,3 +/- 0.6 mg/l. The need for postoperative extrarenal epuration was not significantly different between the 3 periods: GEL: 2,9%; MIX: 3,1%; HES: 3,8%. CONCLUSION: The use of HES 200 kD, 0.5 DS in cardiac surgery does not seem to be associated with a clinically significant deterioration of postoperative renal function. [less ▲]

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See detailThe use of protocols for nutritional support is definitely needed in the intensive care unit
Preiser, Jean-Charles ULg; Ledoux, Didier ULg

in Critical Care Medicine (2004), 32(11), 2354-2355

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See detailCitrate vs. heparin for anticoagulation in continuous venovenous hemofiltration: a prospective randomized study
Monchi, Mehran; Berghmans, Denis; Ledoux, Didier ULg et al

in Intensive Care Medicine (2004), 30(2), 260-265

Abstract Objective: To compare the efficacy and safety of adjusted-dose unfractionated heparin with that of regional citrate anticoagulation in intensive care patients treated by continuous venovenous ... [more ▼]

Abstract Objective: To compare the efficacy and safety of adjusted-dose unfractionated heparin with that of regional citrate anticoagulation in intensive care patients treated by continuous venovenous hemofiltration (CVVH). Design and setting: Prospective, randomized, clinical trial in a 32-bed medical and surgical ICU in a university teaching hospital. Patients: ICU patients with acute renal failure requiring continuous renal replacement therapy, without cirrhosis, severe coagulopathy, or known sensitivity to heparin. Interventions: Before the first CVVH run patients were randomized to receive anticoagulation with heparin or trisodium citrate. Patients eligible for another CVVH run received the other study medication in a crossover fashion until the fourth circuit. Measurements and results: Fortynine circuits (hemofilters) were analyzed: 23 with heparin and 26 with citrate. The median lifetime of hemofilters was 70 h (interquartile range 44–140) with citrate anticoagulation and 40 h (17–48) with heparin (p=0.0007). One major bleeding occurred during heparin anticoagulation and one metabolic alkalosis (pH=7.60) was noted with citrate after a protocol violation. Transfusion rates (units of red cells per day of CVVH) were, respectively, 0.2 (0.0–0.4) with citrate and 1.0 (0.0–2.0) with heparin (p=0.0008). Conclusions: Regional citrate anticoagulation seems superior to heparin for the filter lifetime and transfusion requirements in ICU patients treated by continuous renal replacement therapy. [less ▲]

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See detailBronchoalveolar lavage fluids of ventilated patients with acute lung injury activate NF-kappa B in alveolar epithelial cell line: role of reactive oxygen/nitrogen species and cytokines
Nys, Monique ULg; Deby-Dupont, Ginette; Habraken, Yvette ULg et al

in Nitric Oxide (2003), 9(1), 33-43

In human alveolar epithelial cell line, we investigated the binding activity of NF-kappaB induced by the bronchoalveolar lavage fluids (BALs) from ventilated patients with acute lung injury (ALI), in ... [more ▼]

In human alveolar epithelial cell line, we investigated the binding activity of NF-kappaB induced by the bronchoalveolar lavage fluids (BALs) from ventilated patients with acute lung injury (ALI), in correlation with the concentrations of inflammatory cytokines, RNOS, and the severity of the ALI. In BALs obtained in 67 patients (16 bronchopneumonia, 14 infected ARDS, 20 ARDS, and 17 ALI patients without bronchopneumonia and no ARDS), we measured endotoxin, IL-1beta, IL-8, and nitrated proteins (NTP), the activity of mycloperoxidase, and the capacity to activate the NF-kappaB in alveolar A549 cells by electrophoretic mobility shift and supershift assays. The neutrophil counts and mean IL-1beta, IL-8, myeloperoxidase, and NTP values were increased in bronchopneumonia and infected ARDS groups compared to ARDS and ALI without bronchopneumonia and no ARDS groups (P < 0.001). The number of neutrophils was correlated to those of IL-1beta, IL-8, myeloperoxidase, NTP, and endotoxin in all groups (P < 0.0001). NF-kappaB activity was induced in alveolar like cells by BALs in all groups, was higher in bronchopneumonia and infected ARDS groups (P < 0.02), and was correlated to IL-1beta (P = 0.0002), IL-8 (P = 0.02), NTP (P = 0.014), myeloperoxidase (P = 0.016), and neutrophil counts (P = 0.003). BALs of bronchopneumonia and infected ARDS patients had increased inflammatory mediators (compared to ARDS and ALI without bronchopneumonia and no ARDS patients) that correlated to neutrophil counts and to the NF-kappaB-binding activity. These mediators and NF-kappaB activation may induce an amplification of inflammatory phenomena. By in vitro studies, we confirmed that NO-derived species (10(-6) to 10(-5) M peroxynitrite and 10(-5) M nitrites) and myeloperoxidase (at concentration equivalent to that found in BALs) can participate in the NF-kappaB activation. (C) 2003 Elsevier Inc. All rights reserved. [less ▲]

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