References of "Preiser, Jean-Charles"
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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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See detailGut Mucosal and Plasma Concentrations of Glutamine: A Comparison between Two Enriched Enteral Feeding Solutions in Critically Ill Patients
Preiser, Jean-Charles ULg; Peres-Bota, D.; Eisendrath, P. et al

in Nutrition Journal (2003), 2

BACKGROUND: Addition of glutamine to enteral nutrition formulas is consistently associated with a significant decrease in septic morbidity in critically ill patients, possibly related to the attenuation ... [more ▼]

BACKGROUND: Addition of glutamine to enteral nutrition formulas is consistently associated with a significant decrease in septic morbidity in critically ill patients, possibly related to the attenuation of gut dysfunction. This pilot study was undertaken to compare the effects of enteral administration of two glutamine-enriched formulas containing either additional free glutamine or glutamine-rich proteins, with a standard solution on plasma and mucosal concentrations of glutamine in patients admitted in the Department of Intensive Care. METHODS: Following randomization, glutamine concentration was determined in endoscopically sampled duodenal biopsies and plasma, before and after a 7-day period of continuous administration of the designated solution. RESULTS: The mucosal concentration of glutamine increased in the duodenal biopsies sampled from patients randomized to the solution containing the glutamine-rich proteins (from 3.6 +/- 2.2 to 6.7 +/- 5.2 micro-mol/g protein), but not from the others. There were no differences between the 3 groups in the plasma concentrations of glutamine, which remained stable over time. CONCLUSION: The source of supplemental glutamine can influence gut mucosal glutamine concentrations, suggesting differences in its availability or utilization. [less ▲]

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See detailGlutamine, a life-saving nutrient, but why?
Preiser, Jean-Charles ULg; Wernerman, J.

in Critical Care Medicine (2003), 31(10), 2555-2556

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See detailAntioxidant Therapy in Intensive Care
Lovat, R.; Preiser, Jean-Charles ULg

in Current Opinion in Critical Care (2003), 9(4), 266-70

PURPOSE OF REVIEW: This review intends to summarize the recent findings regarding the presence of increased oxidative stress in critically ill patients and its potential pathophysiologic role, as well as ... [more ▼]

PURPOSE OF REVIEW: This review intends to summarize the recent findings regarding the presence of increased oxidative stress in critically ill patients and its potential pathophysiologic role, as well as the results of recent clinical trials of antioxidant therapies. RECENT FINDINGS: Several lines of evidence confirm the increase in oxidative stress during critical illness. The oxidative damage to cells and tissues eventually contributes to organ failure. Prophylactic administration of antioxidant vitamins or glutamine, incorporated in the nutritional support or given as separate medications, efficiently attenuates the oxidative stress and in some studies improves the outcome of critically ill patients. Few data on the effects of N-acetylcysteine or trace elements have been published during the last two years. SUMMARY: Patients at risk of organ failure could benefit from the early adjunction of antioxidant treatment, including vitamins and glutamine. [less ▲]

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