References of "Larbuisson, Robert"
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See detailSelf-Medication Practice among Amateur Runners: Prevalence and Associated Factors
Locquet, Médéa ULg; Beaudart, Charlotte ULg; LARBUISSON, Robert ULg et al

in Journal of Sports Science & Medicine (2016), 15(2), 387-8

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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 detailRecommandations pour la prevention et la prise en charge des hemorragies massives.
TONGLET, Martin ULg; LARBUISSON, Robert ULg; GERARD, Christiane ULg et al

Report (2015)

Belgian recommendations for prevention and guidance in case of severe bleeding.

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See detailDu processus aux soins intégrés : expérience de gestion de projet bottom-up
ERPICUM, Marie ULg; BASSLEER, Bernard ULg; Defraigne, Jean-Olivier ULg et al

Conference (2014, July 08)

Implementation of blood conservation strategies is a current issue in a public health view, especially in cardiac surgery. A service project has been initiated in the cardiovascular department of the CHU ... [more ▼]

Implementation of blood conservation strategies is a current issue in a public health view, especially in cardiac surgery. A service project has been initiated in the cardiovascular department of the CHU of Liege aiming to develop a blood conservation program. This project has evolved into the creation of a clinical pathway of the cardiac surgery patient and then into an institutional model for the development of other clinical pathways. This evolution leads to meet with the missions and strategic objectives of the Institution and some national projects. The process of this approach weaves a horizontal and vertical grid. The multidisciplinary membership, supported by medical and nursing leadership and the institutional support, will determine the sustainability of this project. [less ▲]

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See detailEpargne sanguine : aspects préopératoires
LARBUISSON, Robert ULg

Scientific conference (2013, May 24)

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See detailEpargne sanguine en chirurgie cardiaque : Etude rétrospective des pratiques
ERPICUM, Marie ULg; DEFRAIGNE, Jean ULg; LARBUISSON, Robert ULg

Report (2013)

Cette étude rétrospective s’inscrit dans le cadre des recherches de la thèse de doctorat sur l’épargne sanguine à travers l’itinéraire clinique du patient opéré cardiaque. Son objectif est de dresser un ... [more ▼]

Cette étude rétrospective s’inscrit dans le cadre des recherches de la thèse de doctorat sur l’épargne sanguine à travers l’itinéraire clinique du patient opéré cardiaque. Son objectif est de dresser un état des lieux de la prise en charge des patients opérés cardiaques au CHU de Liège, des pratiques d’épargne sanguine qui y sont employées et de leur impact sur le recours à la transfusion, les durées de séjour et la mortalité. Cet audit devrait permettre de 1) mettre en évidence les éléments pouvant être améliorés dans l’organisation actuelle de la prise en charge de ces patients afin de concourir aux objectifs d’épargne sanguine 2) servir de base à l’élaboration d’un itinéraire clinique du patient opéré cardiaque. [less ▲]

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See detailUtilisation du système CardioPAT® en postopératoire de chirurgie cardiaque
ERPICUM, Marie ULg; FLECHE, Jérôme; SENARD, Marc ULg et al

Report (2013)

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See detailMultimodality blood conservation strategy in cardiac surgery with cardiopulmonary bypass: the CHU of Liege experience
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Poster (2012, November 20)

This study presents the transfusion rates of cardiac surgery patients and describes the in-house strategy of blood conservation applied in a single centre

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See detailPostoperative bleeding and autotransfusion
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Poster (2012, November 20)

Bleeding in the postoperative period of cardiac surgery is not rare. Mediastinal bleedings could potentially be saved with a cell salvage device. This practice may contribute to decreased allogeneic ... [more ▼]

Bleeding in the postoperative period of cardiac surgery is not rare. Mediastinal bleedings could potentially be saved with a cell salvage device. This practice may contribute to decreased allogeneic transfusion. This study explores the effectiveness of a chest drainage system combined with a cell salvage option during the postoperative period of cardiac surgery in patients at high risk of bleeding [less ▲]

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See detailL'épargne sanguine: un enjeu actuel
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

in Revue Médicale de Liège (2012), 67(11), 593-596

In view of the demographic evolution, the progress of quality requirements and the shortage of donors, a deficiency of blood components is to be feared in the coming years.. This implies the development ... [more ▼]

In view of the demographic evolution, the progress of quality requirements and the shortage of donors, a deficiency of blood components is to be feared in the coming years.. This implies the development of a blood conservation strategy, the revision of transfusion practices and the implementation of preventive measures to limit transfusion requirements. Each department caring for patients at high transfusion risk should assess and rationalize its transfusion practices in a structured multidisciplinary way [less ▲]

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See detailMultimodality blood conservation strategy in cardiac surgery with cardiopulmonary bypass : the CHU of Liège experience
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Poster (2012, September 29)

Introduction: The aim of this study is to analyze the transfusion rates of cardiac surgery patients in a single centre following an in-house strategy of blood conservation. Methods: The data of all adult ... [more ▼]

Introduction: The aim of this study is to analyze the transfusion rates of cardiac surgery patients in a single centre following an in-house strategy of blood conservation. Methods: The data of all adult patients undergoing normothermic cardiac surgery with cardiopulmonary bypass (CPB) over a 1 year period were retrospectively collected (n=491). Management protocols were described. The transfusion rates of allogeneic blood components were recorded: red blood cells (RBC), fresh frozen plasma (FFP) and platelets (PT), as well as the number of units transfused. The timing of transfusion was categorized: during CPB (peroperative period), within the first 48 postoperative hours after wean out CPB (early postoperative period) and during the hospitalisation from surgery until discharge (hospitalisation). The hematocrit values were recorded during CPB, 10 minutes after wean out CPB, after the first 48 postoperative hours and at discharge from hospital. Results: Two hundred and forty-eight patients (50%) received an allogeneic blood component transfusion during hospitalisation. One hundred and twenty-one patients (25%) received RBC during the operative period; the median of units transfused was 2(1-2).The lowest hematocrit value during CPB was 21(19-24) % in median. A cell salvage device was used in each case: the median volume of washed red blood cells transfused was 678(512-891) mL. The median hematocrit value after CPB was 23(21-25) %. One hundred and sixty-five patients (34%) were transfused in the early postoperative period: 27% received RBC, 18% received FFP and 18% received PT. The median of units transfused was 2(1-3) for RBC, 4(2-6) for FFP and 1(1-2) for PT. The median hematocrit value after 48 hours was 32(29-34) % and 32(30-35) % at discharge. Conclusion: The transfusion rates observed in this series are relatively high compared with the literature. Improvements will be made in our practice and protocols management in order to decrease the need of transfusion. This detailed audit of the transfusion practices in our cardiac surgery centre would be helpful to value the effectiveness of further improvements. [less ▲]

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See detailPostoperative bleeding and autotransfusion
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Poster (2012, September 29)

Introduction: Bleeding in the postoperative period of cardiac surgery is not infrequent. Mediastinal bleeding is usually collected in a chest drainage system and discarded. Nevertheless, this blood could ... [more ▼]

Introduction: Bleeding in the postoperative period of cardiac surgery is not infrequent. Mediastinal bleeding is usually collected in a chest drainage system and discarded. Nevertheless, this blood could potentially be managed with a cell salvage device during the first six postoperative hours. This practice is generally performed only in case of a surgical re-exploration for massive bleeding and may contribute to decreased allogeneic transfusion. But in case of postoperative coagulopathy requiring medical treatment, re-exploration is usually postponed and consequently, collected blood is discarded. Therefore, chest drainage systems combined with a cell salvage option could optimize the management of blood losses and transfusions in the postoperative period, regardless of any surgical re-exploration. The aim of this study is to assess the effectiveness of such a system during the postoperative period of cardiac surgery, in patient at high risk of bleeding. Method : During a 6 months period, the CardioPAT® (Haemonetics) device was used in all cardiac surgery patients at high risk of postoperative bleeding. The following data were prospectively collected: hemoglobin level, bleeding volume, volume of autologous washed red blood cell transfused by the CardioPAT® (WRBC), volume of allogeneic red blood cell (RBC), fresh frozen plasma (FFP) or platelets (PT) transfused and surgical re-exploration. Results : The CardioPAT® was used in 16 patients during the target period. Mean postoperative bleeding volume was 338±337mL after 1 hour and 820±727mL after 6 hours. The cell salvage option was used in 9 (56%) cases and mean WRBC transfused volume was 153±212mL. One patient required surgical re-exploration. All patients transfused by WRBC received previously an allogeneic transfusion (RBC, FFP and/or PT). The hemoglobin level of blood collected in the CardioPAT® device impacted on the delay and the blood volume required for WRBC availability; lower was the hemoglobin level, larger was the volume of blood required to obtain a concentrate of WRBC. Consequently, patients with a very low hemoglobin level were anyway transfused with RBC. Conclusion : The CardioPAT® device can reduce allogeneic blood transfusion after cardiac surgery in patients at high risk of bleeding. It gives time to treat coagulopathy, leading to a decrease of surgical re-exploration. However, a device with a larger reservoir and with a flexible processing speed would be more accurate in case of major haemorrhage. Systematic utilisation of this device at the time of FFP and/or PT transfusion is a safe but expensive strategy. It seems more accurate to use this device in a permissive bleeding strategy, waiting for the spontaneous coagulation recovery of the patient, in the first postoperative hours. [less ▲]

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See detailAbout the diagnosis of acute transfusion-related reaction during cardiopulmonary bypass
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Conference (2012, September 29)

Many advances have been realized in the field of blood safety during the last decade: donors’ selection, leukoreduction of packed red blood cells and platelet concentrates, genomic screening of blood ... [more ▼]

Many advances have been realized in the field of blood safety during the last decade: donors’ selection, leukoreduction of packed red blood cells and platelet concentrates, genomic screening of blood-borne diseases, viral and bacterial inactivation process,... However, transfusion of blood components remains unsafe. Therefore, detecting and reporting transfusion-related complications are still essential means for both the patients’ management and the public health approach, since these measures help to adjust preventive measures to be applied in a haemovigilance purpose. Most acute transfusion-related complications occur within minutes or hours after transfusion and require urgent medical care; delayed transfusion reactions may also develop days, even months later, implying a longer follow-up. Transfusion of red blood cells is not infrequent during cardiac surgery with cardiopulmonary bypass. Symptoms of acute transfusion-related reactions include hypotension, diffuse bleeding, hemoglobinuria and oliguria. These symptoms are identical to those that can be observed during a complicated cardiopulmonary bypass. Consequently, identification of acute transfusion-related reactions in this particular situation is quite difficult and probably leads to an under-reporting of their occurrence. In this paper, we explore how to track acute transfusion-related reactions during cardiopulmonary bypass. Any suspicion of such reactions must leads to investigations, in order to confirm the diagnosis. Their detection would allow to better focus their specific treatment and further their notification in a global blood safety policy. [less ▲]

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See detailCardiac paraganglioma : diagnostic work up and review of the literature.
Sooknunden, Marvyn ULg; HAMOIR, Etienne ULg; de Leval, Laurence ULg et al

in Acta Chirurgica Belgica (2012), 112

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See detailValve aortique percutanée
ERPICUM, Marie ULg; DEFRAIGNE, Jean ULg; LANCELLOTTI, Patrizio ULg et al

in Urgences & Accueil (2010), 11(40), 6-8

Transcatheter aortic valve implantation (TAVI) is increasingly performed and represents a relatively safe alternative treatment for high risk patients denied to surgical aortic valve replacement. TAVI is ... [more ▼]

Transcatheter aortic valve implantation (TAVI) is increasingly performed and represents a relatively safe alternative treatment for high risk patients denied to surgical aortic valve replacement. TAVI is performed at the University Hospital of Liege since July 2008 with the Medtronic CoreValve Revalving® system by femoral or subclavian access. This paper exposed the technique of TAVI and the nursing care required after this procedure. [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 detailDescription and Evaluation of a Simplified Technique for Replacement of the Ascending Aorta and Proximal Arch in Degenerative Aneurysmal Disease
Radermecker, M. A.; Nasser, A.; Fontaine, R et al

in Acta Chirurgica Belgica (2007), 107(6), 733-8

The distal extension of ascending aorta pathology often requires prosthetic grafting into the proximal arch. In order to perform optimal distal anastomosis, an open technique under a short period of ... [more ▼]

The distal extension of ascending aorta pathology often requires prosthetic grafting into the proximal arch. In order to perform optimal distal anastomosis, an open technique under a short period of circulatory arrest (CA) was adopted. For this purpose we evaluated prospectively a simplified technique for surgery and perfusion. The aneurysmal aorta was directly cannulated to cool down the patient to 26 degrees C. Under CA and retrograde cerebral perfusion, the diseased aorta and aortic cannulation site were resected. After completion of the distal anastomosis, antegrade rewarming was performed via recannulation of the AAo graft (side branch graft) whilst surgery was proceeded on the root and/or aortic valve. This technique clearly addresses the safety of cannulation into the aneurismal aorta. The issues of cerebral and visceral protection during CA and antegrade reperfusion and rewarming have been analysed prospectively in eight patients operated on over a period of 6 months. Our preliminary results indicate that this technique of arterial cannulation and CA at 26 degrees C for the management of degenerative AAo disease involving the proximal arch appears safe both in terms of cerebral and systemic (visceral, muscular) protection. By this way, the complications related to deep hypothermia and prolonged cardiopulmonary bypass are avoided. This assumption may be only valid for a CA period less than 30 min. This preliminary study is limited by its small size and heterogeneity of the pathologies. However, the simplicity, surgical ease, rapidity and efficacy conveyed by this technique warrant further consideration and evaluation. [less ▲]

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