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See detailEfficacy of the RemoweLL cardiotomy reservoir for fat and leucocyte removal from shed mediastinal blood: a randomized controlled trial.
LAGNY, Marc-Gilbert ULg; GOTHOT, André ULg; HANS, Grégory ULg et al

in Perfusion (2016)

Efficacy of the RemoweLL cardiotomy reservoir for Fat and Leucocyte removal from shed mediastinal blood: a randomized controlled trial. ABSTRACT (176 words) Introduction Re-transfusion of lipid particles ... [more ▼]

Efficacy of the RemoweLL cardiotomy reservoir for Fat and Leucocyte removal from shed mediastinal blood: a randomized controlled trial. ABSTRACT (176 words) Introduction Re-transfusion of lipid particles and activated leucocytes with shed mediastinal blood (SMB) can aggravate cardiopulmonary bypass-associated inflammation and increase the embolic load. This study evaluated the fat and leucocyte removal capacity of the RemoweLL cardiotomy reservoir. Methods Forty-five patients undergoing elective on-pump cardiac surgery were randomly allocated to filtration of SMB using the RemoweLL or the Admiral cardiotomy reservoir. The primary outcome was the drop in leucocytes and lipid particles obtained with the two filters. The effect of the filters on other blood cells and inflammatory mediators such as myeloperoxidase (MPO) was also assessed. Results The RemoweLL cardiotomy filter removed 16.5 % of the leucocytes (P < 0.001) while no significant removal of leucocytes was observed with the Admiral (P = 0.48). The percentage reductions in lipid particles were similar in the two groups (26% vs 23 %, P = 0.2). Both filters similarly affected the level of MPO (P = 0.71). Discussion The RemoweLL filter more effectively removed leucocytes from SMB than the Admiral. It offered no advantage in term of lipid particle clearance. [less ▲]

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See detailThe place of viscoelastic testing in clinical practice.
Hans, Grégory ULg; Besser, Martin W.

in British Journal of Haematology (2016), 173(1), 37-48

Hellmut Hartert was the first person to exploit the viscoelastic properties of clotting blood to measure blood coagulation in 1948. Since then, the technology has improved, allowing these analyses to be ... [more ▼]

Hellmut Hartert was the first person to exploit the viscoelastic properties of clotting blood to measure blood coagulation in 1948. Since then, the technology has improved, allowing these analyses to be performed as point-of-care tests with immediately-available results. The addition of several activators and inhibitors to the original assay creates a panel of tests able to quantify the different aspects of blood clotting that can rival conventional laboratory assays. However, although much progress has been made, the standardization and validation of these tests still need improvement. Viscoelastic analyses of blood coagulation are mainly used to guide haemostatic therapy in bleeding patients and have proven superior to standard clotting tests in some circumstances. There is potential to extend their use to other areas, such as drug monitoring, and diagnosis and management of congenital bleeding disorders. The forthcoming cartridge-based assays are expected to improve the reliability and usability of viscoelastic assays of blood coagulation but high quality clinical trials remain urgently needed to determine their exact place, benefit and cost effectiveness. [less ▲]

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See detailTransversus abdominis plane block or intravenous lignocaine in open prostate surgery: a randomized controlled trial.
Maquoi, I.; Joris, J. L.; Dresse, C. et al

in Acta Anaesthesiologica Scandinavica (2016), 60(10), 1453-1460

BACKGROUND AND OBJECTIVES: Transversus abdominis plane block (TAP) and intravenous lignocaine are two analgesic techniques frequently used after abdominal surgery. We hypothesized that these two ... [more ▼]

BACKGROUND AND OBJECTIVES: Transversus abdominis plane block (TAP) and intravenous lignocaine are two analgesic techniques frequently used after abdominal surgery. We hypothesized that these two techniques improve post-operative analgesia after open prostate surgery and sought to compare their efficacy on immediate post-operative outcome after open prostate surgery. METHODS: After ethics committee approval, 101 patients were enrolled in this prospective study and randomly allocated to receive bilateral ultrasound-guided TAP (n = 34), intravenous lignocaine (n = 33) or placebo (n = 34). In addition, intravenous paracetamol was given every 6 h. The primary endpoint was the cumulative opioid consumption during the first 48 post-operative hours (median[IQR]). Secondary endpoints included pain scores at rest and upon coughing, need for rescue tramadol, incidence of post-operative nausea and vomiting (PONV), recovery of bowel function and incidence of bladder catheter-related discomfort. RESULTS: Cumulative piritramide consumption after 48 h was 28 [23] mg in the control group, 21 [29] mg in the TAP group and 21 [31] mg in the lignocaine group (P = 0.065). There was no significant difference in post-operative pain scores between groups. The proportions of patients requiring rescue tramadol, experiencing PONV or bladder catheter-related discomfort were similar in each group. Recovery of bowel function was also similar in the three groups. CONCLUSIONS: Our study suggests that TAP block and intravenous lignocaine do not improve the post-operative analgesia provided by systematic administration of paracetamol after open prostatectomy. [less ▲]

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See detailPrediction of the post-dilution hematocrit during cardiopulmonary bypass. Are new formulas needed?
ERPICUM, Marie ULg; Dardenne, Nadia ULg; HANS, Grégory ULg et al

in Perfusion (2016)

Objectives: Predicting the post-dilution hematocrit is an important tool to avoid preventable anemia or unnecessary transfusion. Simplified empirical formulas currently used for such a prediction may lead ... [more ▼]

Objectives: Predicting the post-dilution hematocrit is an important tool to avoid preventable anemia or unnecessary transfusion. Simplified empirical formulas currently used for such a prediction may lead to large errors. We aimed to improve the accuracy of these formulas by a better estimation of the dilution volume and the patient circulatory blood volume. Methods: We compared the estimation accuracy of two formulas, using fixed (formula A) versus estimated (formula D) dilution volume and patient circulatory blood volume for 100 cardiac interventions. The difference between predicted and measured HctT1 was considered as “good” if less than 0.5%, “moderate” between 0.5 and 2% and “poor” if higher than 2%. The influence of the body mass index (BMI) on patient blood volume estimation was explored by categorized groups’ comparison. Results: The mean difference between predicted and measured HctT1 differed significantly between formulas A and D. Formula A didn’t differ from HctT1 (p=0.19, IC95% [-0.89-0.18]), but a significant and higher underestimation was observed in the BMI⩽25 group compared to the other BMI groups (p<0.001). Formula D overestimated HctT1 (p<0.001, IC95% [1.01-1.93]) without a difference between the BMI groups. No difference was observed in their overall proportions of good (11 vs 10%), moderate (44 vs 46%) and poor predictions (47 vs 44%) (p=0.117). Conclusions: Formulas used for post-dilution hematocrit prediction lead to major estimation errors and a risk of inadequate transfusion practices. Estimations performed by experienced clinicians could not minimize these biases in all clinical cases as significant errors remain, with potential clinical impact. No estimation formula should be used as a hard tool for transfusing patients, but rather as a guide to predicting the probability of transfusion requirement. [less ▲]

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See detailTransfusion needs during liver transplantation at the chu of liege (belgium): characteristics and preoperative predictive factors
PAGE, Isaline ULg; HANS, Grégory ULg; DETRY, Olivier ULg et al

in Transplant International (2015, November), 28(S4), 461272

Introduction: Liver transplantation (LT) can result in significant bleeding requiring transfusion of allogenic blood products, which potentially leads to postoperative morbidity and mortality (1). This ... [more ▼]

Introduction: Liver transplantation (LT) can result in significant bleeding requiring transfusion of allogenic blood products, which potentially leads to postoperative morbidity and mortality (1). This study aimed to determine transfusion needs during LT in our institution and its preoperative predictive factors. Material and Methods: Two hundred LT performed at the CHU Liege between 2006 and 2012 were respectively reviewed (age = 55 ` 11 yo, BMI = 25.5 ` 4.4 kg/m2, F/M = 45/155, MELD score = 19 ` 10). Transfu- sion needs of the different blood products during POD 0, and POD 0–7 were recorded. Parameters associated with the transfusion of more than 2 units of RBC (p ≤ 0.1) were identified using the Kruskal Wallis and chi square tests (table 1). These parameters were then placed into a backward stepwise logistic regression model for the transfusion of more than two units of RBC at POD 0. A p value threshold ≥0.1 was used for leaving the model. Results: Transfusion needs were: RBC = 2[0–4], FFP = 4[2–7], PLT = 1[0– 1] during POD 0; and RBC = 3[0–6], FFP = 6[3–10], PLT = 1[0–2] during POD 0–7. Preoperative factors independently associated with the transfusion of more than two units of RBC were preop Hb (0.6 [0.46–0.79], p < 0.001) and MELD score (1.13 [1.06–1.20], p < 0.001). Discussion: These results suggest that preop Hb and MELD score are associated with blood requirements during LT. [less ▲]

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See detailHydroxyethyl Starch 130/0.4 and the Risk of Acute Kidney Injury After Cardiopulmonary Bypass: A Single-Center Retrospective Study.
LAGNY, Marc-Gilbert ULg; ROEDIGER, Laurence ULg; KOCH, Jean-Noël ULg et al

in Journal of Cardiothoracic and Vascular Anesthesia (2015)

Hydroxyethyl Starches (HES) have been shown to increase the risk of acute kidney injury (AKI) in intensive care unit patients suffering sepsis. Whether this risk also applies to patients undergoing ... [more ▼]

Hydroxyethyl Starches (HES) have been shown to increase the risk of acute kidney injury (AKI) in intensive care unit patients suffering sepsis. Whether this risk also applies to patients undergoing elective surgery remains unclear. We investigated whether HES is associated with acute kidney injury after on-pump cardiac surgery. Materials and Methods: Balanced HES 130/0.4 (Volulyte®, Fresenius Kabi AG, Bad Homburg, Germany) was used as a pump prime and for intraoperative fluid therapy until July 2013 and has been entirely replaced by a balanced crystalloid solution (Plasmalyte®, Baxter, Lessines, Belgium) from August 2013. Data from 697 adult patients undergoing cardiac surgery between April 2013 and June 2014 were reviewed. HES patients were propensity-matched on previously published risk factors for AKI after cardiac surgery to patients treated with crystalloids. Postoperative AKI was defined as the primary outcome and assessed using the Acute Kidney Injury Network classification. A conditional logistic regression was used to investigate the association between the use of HES and postoperative AKI. Secondary outcomes included renal function at postoperative day 7, 30-day mortality, lengths of ICU and hospital stays and the incidence of postoperative respiratory complications. Results and Discussion: One hundred and thirty HES patients were successfully matched with 130 crystalloids patients. HES was significantly associated with postoperative AKI (odds ratio=2.4; 95 % CI= 1.2-4.8; P=0.02). No significant association was found between HES and any of the secondary outcomes. Conclusion: This study suggests that using balanced HES 130/0.4 as a pump prime and for intraoperative fluid therapy in adult patients undergoing on-pump cardiac surgery is associated with a higher incidence of AKI during the early postoperative period. [less ▲]

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See detailImpact of 6 % hydroxyethyl starch (HES) 130/0.4 on the correlation between standard laboratory tests and thromboelastography (TEG(R)) after cardiopulmonary bypass.
HANS, Grégory ULg; Hartstein, Gary ULg; Roediger, Laurence et al

in Thrombosis research (2015), 135(5), 984-9

BACKGROUND: Hydroxyethyl starches (HES) affect the results of thromboelastography (TEG(R)). We sought to determine whether using HES rather than crystalloids for cardiopulmonary bypass (CPB) prime and ... [more ▼]

BACKGROUND: Hydroxyethyl starches (HES) affect the results of thromboelastography (TEG(R)). We sought to determine whether using HES rather than crystalloids for cardiopulmonary bypass (CPB) prime and intraoperative fluid therapy changes the TEG cutoff values best identifying patients with a low platelet count or a low fibrinogen level after CPB. METHODS: Data from 96 patients who had on-pump cardiac surgery, a TEG(R) (kaolin-heparinase) and standard investigations of blood clotting performed after separation from CPB and protamine administration were retrospectively reviewed. Patients were assigned to the HES or crystalloid group according to whether balanced 6% HES 130/0.4 or balanced crystalloids were used for intraoperative fluid therapy and pump prime. Mutlivariable linear regression models with computation of the standardized regression coefficients were used to identify independent associations between the four main TEG parameters (R time, alpha angle, K time and MA) and the type of fluid used, the INR, the aPTT, the fibrinogen level and the platelet count. Receiver-operating-characteristic curves were used to assess the effect of HES on the ability of TEG parameters to identify patients with a platelet count<80.000mul(-1) or a fibrinogen level<1.5 gr l(-1) and on the cutoff values best identifying these patients. RESULTS: The type of fluid used significantly affected the MA (P<0.001), the K time (P<0.001) and the alpha angle (P<0.001) regardless of the results of the standard clotting tests. According to standardized ss regression coefficients the platelet count and the type of fluid used were stronger predictors of the MA, the alpha angle and the K time than the fibrinogen level. MA better predicted platelets<80.000mul(-1) than K time and alpha angle (P=0.023). The best cutoff value of MA identifying patients with platelets<80.000mul(-1) was 62mm in the crystalloid group and 53mm in the HES group. MA, K time and alpha angle were poor predictors of the postoperative fibrinogen level. CONCLUSION: HES significantly changes the cutoff value of TEG(R) MA best identifying patients<80.000mul(-1) after on-pump cardiac surgery. [less ▲]

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See detailThe effect of intraoperative 6% balanced hydroxyethyl starch (130/0.4) during cardiac surgery on transfusion requirements.
HANS, Grégory ULg; Ledoux, Didiier; Roediger, Laurence et al

in Journal of cardiothoracic and vascular anesthesia (2015), 29(2), 328-32

OBJECTIVES: To compare transfusion requirements in adult cardiac surgery patients when balanced hydroxyethyl starches (HES) (130/0.4) or balanced crystalloids is used for pump prime and intraoperative ... [more ▼]

OBJECTIVES: To compare transfusion requirements in adult cardiac surgery patients when balanced hydroxyethyl starches (HES) (130/0.4) or balanced crystalloids is used for pump prime and intraoperative fluid therapy. DESIGN: Data were obtained retrospectively from medical records and perfusion charts. Matching based on propensity scores was used to adjust for potential confounders. SETTING: A university hospital. PARTICIPANTS: Adult patients undergoing cardiac surgery with the use of cardiopulmonary bypass. INTERVENTIONS: Allocation to one of the study groups according to whether balanced HES or balanced crystalloids was used for pump prime and intraoperative fluid therapy. MEASUREMENTS AND MAIN RESULTS: 240 propensity-matched patients were retained for final analyses. Forty-eight patients (40%) of the colloid group and 28 patients (23.3%) of the crystalloid group received blood products, with an odd ratio (95% CI) of 2.1(1.2-3.8 (P=0.009). After bypass HES patients had lower hemoglobin levels (8.4 [1.3] gr/dL vs 9.6 [2] gr/dL; P<0.001) and a higher cumulative chest drain output after 3 hours (180 [210] mL vs 140 [100] mL, P<0.001]. Heparinase thromboelastogram (TEG(R)) showed longer K times (2.5[1.1] vs 1.6[0.8], P<0.001) and lower maximal amplitudes (55.1[12.5] vs 63.4[9.8], P=0.008). CONCLUSIONS: HES patients required more transfusions, owing to greater hemodilution, HES-induced clotting disturbances, and bleeding. [less ▲]

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See detailLa Narcolepsie-Cataplexie aujourd'hui
DEPIERREUX, Frédérique ULg; FANIELLE, Julien ULg; Martin-Lecomte, Marianne ULg et al

in Revue Médicale de Liège (2014), 69(2), 72-81

Diagnostic criteria and pathophysiology of narcolepsy- <br />cataplexy have evolved considerably over the last 10 years. <br />The main cause, already mentioned in a previous paper, in the <br />Revue ... [more ▼]

Diagnostic criteria and pathophysiology of narcolepsy- <br />cataplexy have evolved considerably over the last 10 years. <br />The main cause, already mentioned in a previous paper, in the <br />Revue Médicale de Liège, in 2002, is based, in human beings, <br />on a destruction of specific cells located in the lateral and <br />posterior part of the hypothalamus (the perifornical nuclei, <br />containing some 70,000 neurons), producing peptides which <br />stimulate the central nervous system; they are called hypocretins <br />or orexins. The role of autoimmunity in their disappearance <br />becomes more evident. The treatment is simplified but <br />remains symptomatic. It is mainly based on Sodium Oxybate <br />or Gamma-Hydroxybutyrate, syrup, prescribed for the night. <br />The authors report on their own experience in this regard and <br />on future therapeutics more targeted towards the cause of the <br />disease. [less ▲]

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See detailRecruitment of lung volume during surgery neither affects the postoperative spirometry nor the risk of hypoxaemia after laparoscopic gastric bypass in morbidly obese patients: a randomized controlled study.
DEFRESNE, Aline ULg; HANS, Grégory ULg; GOFFIN, Pierre ULg et al

in British journal of anaesthesia (2014), 113(3), 501-7

BACKGROUND: Intraoperative recruitment manoeuvres (RMs) combined with PEEP reverse the decrease in functional residual capacity (FRC) associated with anaesthesia and improve intraoperative oxygenation ... [more ▼]

BACKGROUND: Intraoperative recruitment manoeuvres (RMs) combined with PEEP reverse the decrease in functional residual capacity (FRC) associated with anaesthesia and improve intraoperative oxygenation. Whether these benefits persist after operation remains unknown. We tested the hypothesis that intraoperative RMs associated with PEEP improve postoperative spirometry including FRC and reduce the incidence of postoperative hypoxaemia in morbidly obese (MO) patients undergoing laparoscopic gastric bypass. METHODS: After IRB approval and informed consent, 50 MO patients undergoing laparoscopic gastric bypass under volume-controlled ventilation (tidal volume 6 ml kg(-1) of IBW) were randomly ventilated with either 10 cm H(2)O PEEP or with 10 cm H(2)O PEEP and one RM carried out after induction of pneumoperitoneum, and another after exsufflation. Anaesthesia and analgesia were standardized. Spirometry was assessed before operation and 24 h after surgery. Postoperative oxygenation and the apnoea-hypopnoea index (AHI) were recorded during the first postoperative night. RESULTS: Age, BMI, and STOP BANG score were similar in both groups. FRC decrease after surgery was minimal [0.15 (0.14) litre in control and 0.38 (0.19) litre in the RM group] and similar between the groups (P=0.35). FVC, FEV1, mean [Formula: see text], percentage of time spent with [Formula: see text] below 90%, and AHI did not differ significantly between the groups. CONCLUSIONS: This study demonstrates that when added to a protective mechanical ventilation combining low tidal volume and high PEEP, two RMs do not improve postoperative lung function including FRC, arterial oxygenation, and the incidence of obstructive apnoea in MO patients after laparoscopic upper abdominal surgery. CLINICAL TRIAL REGISTRATION: EudraCT 2011-000999-33. [less ▲]

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See detailSTOP BANG but not BMI predicts postoperative obstructive apnoea and hypoxaemia after laparoscopic upper-abdominal surgery: 5AP2-5
Pirenne, S.; HANS, Grégory ULg; Joris, J. et al

in European Journal of Anaesthesiology (2013), 30

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See detailPreoperative Anaemia
HANS, Grégory ULg; Jones, Nicola

in Continuous Education in Anaesthesia, Critical Care & Pain (2013), 13(3), 71-74

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See detailMechanical Ventilation During Anaesthesia: Pathophysiology and Clinical Implications
Dresse, Caroline; JORIS, Jean ULg; HANS, Grégory ULg

in Trends in Anaesthesia and Critical Care (2012), 2(2), 71-75

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