References of "PREISER, Jean-Charles"
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See detailClinical Experience with Tight Glucose Control by Intensive Insulin Therapy
Preiser, Jean-Charles ULg; Devos, P.

in Critical Care Medicine (2007), 35(9 Suppl), 503-7

OBJECTIVE: To describe the current status and the clinical data related to the effects of tight glucose control by intensive insulin therapy in critically ill patients. DESIGN: Review article. SETTING ... [more ▼]

OBJECTIVE: To describe the current status and the clinical data related to the effects of tight glucose control by intensive insulin therapy in critically ill patients. DESIGN: Review article. SETTING: University hospital. PATIENTS: Medical and surgical critically ill patients in whom a correlation between blood glucose and outcome variables were searched. INTERVENTIONS: Tight glucose control by intensive insulin therapy. MEASUREMENTS AND MAIN RESULTS: In contrast to the decreases in mortality and to low severity of adverse effects reported when insulin rate was titrated to keep blood glucose between 80 and 110 mg/dL, the benefits were not confirmed in multicenter prospective studies. Retrospective data found an association between a mean blood glucose level of <140-150 mg/dL and improved outcome. Currently unanswered issues include the optimal target for blood glucose, the effects of high blood glucose variability, the risks and hazards of hypoglycemia, and the potential influence of the underlying disorder on the effects of tight glucose control. CONCLUSIONS: Recommendations regarding the practical aspects of tight glucose control by intensive insulin therapy cannot be presently issued. An intermediate target level for blood glucose of 140-180 mg/dL seems to be associated with the lowest risk-to-benefit ratio. [less ▲]

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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 detailSteps for the implementation and validationof tight glucose control
Preiser, Jean-Charles ULg; Devos, P.

in Intensive Care Medicine (2007), 33(4), 570-571

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See detailCurrent controversies around tight glucose control in critically ill patients
Devos, P.; Preiser, Jean-Charles ULg

in Current Opinion in Clinical Nutrition & Metabolic Care (2007), 10(2), 206-209

Purpose of review This review updates our knowledge on the benefits and risks of tight glucose control by intensive insulin therapy critically ill patients, as well as discussing unanswered questions ... [more ▼]

Purpose of review This review updates our knowledge on the benefits and risks of tight glucose control by intensive insulin therapy critically ill patients, as well as discussing unanswered questions related to the subject. Recent findings At the cellular level, the toxic effects of elevated and highly variable glucose concentration are related to an increase in oxidative stress and to several toxic intracellular derivates generated as by-products of the glycolytic pathway. Clinically, several recent studies have suggested that the optimal target for blood glucose may be higher than the 'normal' values of 4.4-6.1 mmol/l for various categories of patients. Also, the variability in glucose level, appears to be an important determinant of glucose toxicity. Conflicting data on the hazards of,hypoglycaemia are emerging. Summary Practical recommendations for the implementation of tight glucose control using intensive insulin therapy cannot be disseminated until questions relating to optimal blood glucose level and the corresponding categories of patients have been resolved. The issues of glucose, variability and the most efficient method of preventing hypoglycaemia will probably represent important parameters for comparing the safety and quality of protocols used for tight glucose control. [less ▲]

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See detailGestion de la glycémie aux soins intensifs
Preiser, Jean-Charles ULg; Devos, P.

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

The aim of this article is to describe the current status and understanding and the clinical data related to the effects of Tight Glucose Control by Intensive Insulin therapy, TGCIIT, in critically ill ... [more ▼]

The aim of this article is to describe the current status and understanding and the clinical data related to the effects of Tight Glucose Control by Intensive Insulin therapy, TGCIIT, in critically ill patients. Recent prospectively collected data, from one centre, demonstrated decreases of mortality and of various other outcomes in critically ill patients treated with TGCIIT. These results are currently awaiting confirmation, although available data from prospective multi-centre studies do not seem to support the external validity of the beneficial effects of TGCIIT titrated to restore blood glucose between 80 and 110 mg/dl. Also, recent data raised new closely related and relevant issues including the variability of blood glucose, the risks of hypoglycaemia, and the delineation of the categories of patients in whom TGCIIT could bring an actual benefit. [less ▲]

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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 detailBiomarkers of oxidative stress in critically ill patients: what should be measured, when and how?
Lemineur, T.; Deby-Dupont, G.; Preiser, Jean-Charles ULg

in Current Opinion in Clinical Nutrition & Metabolic Care (2006), 9(6), 704-710

Purpose of review This review is dedicated to updating the knowledge on oxidative stress in critically ill patients with an intense inflammatory reaction, and to link it with recent findings supporting ... [more ▼]

Purpose of review This review is dedicated to updating the knowledge on oxidative stress in critically ill patients with an intense inflammatory reaction, and to link it with recent findings supporting the possible involvement of oxidative injuries in systems and organs that frequently fail in the critically ill. Recent findings Some direct or indirect biomarkers of oxidative stress have been validated in critically ill patients, and further support the major role of oxidative stress in these conditions. Summary The assessment of oxidative stress, defined as the association between an increased production of oxygen-derived species and an exhaustion of the stores of antioxidants, requires a multimodal approach. Oxidative damage itself can be much better estimated by quantifying the oxidative byproducts of the lipids and proteins associated with an evaluation of the remaining stores of the corresponding functional antioxidants, or the activity of antioxidant enzymes, than by global tests of the total oxidative damage or the total antioxidant stores. Recent clinical data confirm an important role of increased oxidative stress in the acute dysfunctions of the respiratory, renal and cerebral systems. [less ▲]

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See detailMethylene blue: An old-timer or a compound ready for revival?
Donati, A.; Preiser, Jean-Charles ULg

in Critical Care Medicine (2006), 34(11), 2862-2863

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See detailThe ideal arena for intensive and continuous questioning
Preiser, Jean-Charles ULg

in Current Opinion in Critical Care (2006), 12(4), 289-289

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See detailDiarrhoea in the critically ill
Wiesen, Patricia ULg; Van Gossum, A.; Preiser, Jean-Charles ULg

in Current Opinion in Critical Care (2006), 12(2), 149-154

Purpose of review The purpose of this review is to update the knowledge on diarrhoea, a common problem in critically ill patients. Epidemiological data will be discussed, with special emphasis on ... [more ▼]

Purpose of review The purpose of this review is to update the knowledge on diarrhoea, a common problem in critically ill patients. Epidemiological data will be discussed, with special emphasis on diarrhoea in tube-fed patients and during antibiotic therapy. The possible preventive and therapeutic measures will be presented. Recent findings The need for concise definitions of diarrhoea was recently re-emphasized. The use of pump-driven continuous instead of intermittent enteral feeding is less often associated with diarrhoea. The discontinuation of enteral feeding during diarrhoea is not justified. Clostridium difficile-associated diarrhoea is frequent during antibiotic therapy with quinolones and cephalosporins. Formulas enriched with water-soluble fibres are probably effective to prevent diarrhoea, and promising data on the modulation of gut microflora with probiotics and prebiotics were recently released. Summary Diarrhoea is common in critically ill patients, especially when sepsis and hypoalbuminaemia are present, and during enteral feeding and antibiotic therapy. The management of diarrhoea includes generous hydration, compensation for the loss of electrolytes, antidiarrheal oral medications, the continuation of enteral feeding, and metronidazole or glycopeptides in the case of moderate to severe C. difficile colitis. The place of enteral formulas enriched with water-soluble fibres, probiotics and prebiotics is not yet fully defined. [less ▲]

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See detailGlucose, insulin and myocardial ischaemia
Devos, P.; Chiolero, R.; Van den Berghe, G. et al

in Current Opinion in Clinical Nutrition & Metabolic Care (2006), 9(2), 131-139

Purpose of review The importance of glucose metabolism and insulin therapy during myocardial ischaemia is increasingly being investigated. Insulin is used to achieve a tight glucose control or as part of ... [more ▼]

Purpose of review The importance of glucose metabolism and insulin therapy during myocardial ischaemia is increasingly being investigated. Insulin is used to achieve a tight glucose control or as part of glucose-insulin-potassium therapy. We have reviewed (1) the physiological and physiopathological consequences of hyperglycaemia focusing on potential machanisms of myocardial ischaemia, (2) the effects of insulin on vascular tone, on the release of free fatty acids, on inflammatory pathways, on the switch of energy source and on apoptosis, and (3) clinical data reporting the effects of intensive insulin therapy and glucose-insulin-potassium solutions during myocardial ischaemia and ischaemic heart failure. Recent findings In addition to its known toxic cellular effects, hyperglycaemia increases the activity of inducible nitric oxide synthase and promotes inflammation. Conversely insulin exerts anti-inflammatory and anti-apoptotic effects. Glucose-insulin-potassium solutions could improve survival after acute myocardial infarction or after surgery, according to recent meta-analyses, but confirmation of these data is eagerly awaited. Summary Hyperglycaemia is toxic, while insulin is beneficial during acute myocardial ischaemia. Some recent evidence confirms a substantial benefit of insulin administered either alone to achieve a tight glucose control or as a component of glucose-insulin-potassium therapy. Further research is needed to confirm that tendency and to define the threshold of tight glucose control. [less ▲]

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See detailIs it time for implementation of tight glycaemia control by intensive insulin therapy in every ICU?
Devos, P.; Preiser, Jean-Charles ULg

in Critical Care (2006), 10(2), 130

The second study on tight glycaemia control by intensive insulin therapy (IIT) confirmed in medical intensive care unit patients the decrease in hospital mortality reported by the same team in the first ... [more ▼]

The second study on tight glycaemia control by intensive insulin therapy (IIT) confirmed in medical intensive care unit patients the decrease in hospital mortality reported by the same team in the first IIT trial in surgical patients. However, methodological concerns, the high rate of hypoglycaemia in spite of the infusion of large doses of parenteral glucose and the frequent use of steroids presently preclude considering these results as recommendations in other intensive care units, but rather argue for the need for large-scale assessment of the IIT approach by multi-centre studies to confirm the efficacy and safety of this therapeutic modality. [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 detailPseudomembranous colitis with Clostridium difficile during treatment by moxifloxacine (quinolone)
Le Goff, Caroline ULg; Wiesen, Patricia ULg; Collette, Julien ULg et al

Poster (2005, October 27)

C. difficile is the most frequently pathogenic agent isolated in colitis associated with antibiotics and pseudomembranous colitis (PMC). C. difficile takes advantage of the disturbance of the intestinal ... [more ▼]

C. difficile is the most frequently pathogenic agent isolated in colitis associated with antibiotics and pseudomembranous colitis (PMC). C. difficile takes advantage of the disturbance of the intestinal flora to settle. We report a case of PMC appeared during treatment with moxifloxacine in a pulmonary infection in an emphysematous patient. The diarrhea is generally benign, but can be severe, with toxic megacolon or even the extreme case of colic perforation. The diagnosis is based on the research of toxins of C. difficile (A and/or B) in the intestinal stools or liquids (collected at the time of the endoscopic examination) to which is associated the anaerobic culture on selective agar. The reference method is the measurement of the cytotoxic effect of the B-toxin on a cell culture. Metronidazole or vancomycine constitutes the treatment. The prevention of relapses is very important, hygiene measures and probiotic agents must be associated to the antibiotic treatment. [less ▲]

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See detailHeme oxygenase: A new piece in the glutamine puzzle
Preiser, Jean-Charles ULg; Coeffier, M.

in Critical Care Medicine (2005), 33(2), 457-458

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See detailNitric oxide-related products and myeloperoxidase in bronchoalveolar lavage fluids from patients with ALI activate NF-kappa B in alveolar cells and monocytes.
Nys, Monique ULg; Preiser, Jean-Charles ULg; Deby, Ginette ULg et al

in Vascular Pharmacology (2005), 43(6), 425-33

An increased production of NO* and peroxynitrite in lungs has been suspected during acute lung injury (ALI) in humans, and recent studies provided evidence for an alveolar production of nitrated compounds ... [more ▼]

An increased production of NO* and peroxynitrite in lungs has been suspected during acute lung injury (ALI) in humans, and recent studies provided evidence for an alveolar production of nitrated compounds. We observed increased concentrations of nitrites/nitrates, nitrated proteins and markers of neutrophil degranulation (myeloperoxidase, elastase and lactoferrine) in the fluids recovered from bronchoalveolar lavage fluids (BALF) of patients with ALI and correlated these changes to the number of neutrophils and the severity of the ALI. We also observed that BALFs stimulated the DNA-binding activity of the nuclear transcription factor kappa B (NF-kappaB) as detected by electrophoretic mobility shift assay in human alveolar cells (A549) and monocytes (THP1). The level of activation of the NF-kappaB-binding activity was correlated to the concentration of nitrated proteins and myeloperoxidase. Furthermore, in vitro studies confirmed that NO*-derived species (peroxynitrite and nitrites) and the neutrophil enzyme myeloperoxidase by themselves increased the activation of NF-kappaB, thereby arguing for an in vivo pathogenetic role of NO*-related products and neutrophil enzymes to human ALI. [less ▲]

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See detailTight blood glucose control: a recommendation applicable to any critically ill patient?
Devos, P.; Preiser, Jean-Charles ULg

in Critical Care (2004), 8(6), 427-429

The issue of tight glucose control with intensive insulin therapy in critically ill patients remains controversial. Although compelling evidence supports this strategy in postoperative patients who have ... [more ▼]

The issue of tight glucose control with intensive insulin therapy in critically ill patients remains controversial. Although compelling evidence supports this strategy in postoperative patients who have undergone cardiac surgery, the use of tight glucose control has been challenged in other situations, including in medical critically ill patients and in those who have undergone non-cardiac surgery. Similarly, the mechanisms that underlie the effects of high-dose insulin are not fully elucidated. These arguments emphasize the need to study the effects of tight glucose control in a large heterogeneous cohort of intensive care unit patients. [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 detailA comparison among portal lactate, intramucosal sigmoid pH, and Delta CO2 (Paco(2) regional Pco(2)) as indices of complications in patients undergoing abdominal aortic aneurysm surgery
Donati, A.; Cornacchini, O.; Loggi, S. et al

in Anesthesia and Analgesia (2004), 99(4), 1024-1031

Our aim in this observational, prospective, noncontrolled study was to detect, in 29 patients who underwent abdominal aortic aneurysm (AAA) surgery, correlations between the incidence of postoperative ... [more ▼]

Our aim in this observational, prospective, noncontrolled study was to detect, in 29 patients who underwent abdominal aortic aneurysm (AAA) surgery, correlations between the incidence of postoperative organ failure and intraoperative changes in arterial and portal blood lactate; changes in intramucosal sigmoid pH (pHi); differences between sigmoid P-CO2 and arterial P-CO2 (DeltaCO(2)); and hemoglobin (Hb). Hb, arterial blood lactate concentrations, pHi, and DeltaCO(2) (air tonometry) were recorded at the start of anesthesia (T0), before aorta clamping (T1), 30 minutes after clamping (T2), and at the end of surgery (T3). Portal venous lactate concentrations were recorded at T1 and T2. Patients were stratified into two groups: group A patients had no postoperative organ failure, and group B patients had one or more organ failures. As compared with group A (n = 16), group B patients (n = 13) had a lower pHi value at T2 and T3 and a higher DeltaCO(2) at T3. A pHi value of <7.15 was a predictor of organ failure, with a sensitivity of 92.3%, a specificity of 68.8%, and positive and negative predictive values of 70.6% and 91.7%, respectively, whereas a DeltaCO(2) value of >28 mm Hg predicted later organ failure with a sensitivity of 92.3%, a specificity of 62.5%, and positive and negative predictive values of 66.6% and 90.9%, respectively. Portal venous lactate concentrations were larger in group B at T2 (P<0.001), and an increase greater than or equal to5 g/dL predicted later postoperative organ failure with a sensitivity of 92.3%, a specificity of 100%, and positive and negative predictive values of 100% and 94.1%, respectively. The comparison of the receiving operator characteristic curves to test the discrimination of each variable and the logistic regression analysis revealed that the increase in portal lactate was the best predictor for the development of postoperative organ failure. Hb concentration was significantly smaller in group B at T0 (13.8 +/- 1.0 g/dL versus 12.2 +/- 2.2 g/dL) and T2 (10.9 +/- 1.2 g/dL versus 9.1 +/- 1.9 g/dL). In conclusion, both pHi and DeltaCO(2) are reasonably sensitive prognostic indices of organ failures after AAA surgery, but they are less specific and accurate than portal venous lactate. [less ▲]

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See detailIs parenteral nutrition guilty?
Varga, P.; Griffiths, R.; Chiolero, R. et al

in Intensive Care Medicine (2003), 29(11), 1861-1864

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