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Search Results: 1 - 10 of 192184 matches for " Erwan D'aranda "
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Dialysis disequilibrium syndrome in neurointensive care unit: the benefit of intracranial pressure monitoring
Pierre Esnault, Guillaume Lacroix, Pierre-Julien Cungi, Erwan D'Aranda, Jean Cotte, Philippe Goutorbe
Critical Care , 2012, DOI: 10.1186/cc11877
Abstract: A 51-year-old man was admitted for severe traumatic brain injury. At admission, an extradural hematoma was evacuated. After surgery, ICP monitoring guided the treatment. At day 4, toxic acute renal failure appeared. Fearing the occurrence of a DDS, we used continuous veno-venous hemofiltration (CVVH), which allowed a gradual reduction in urea without an intracranial hypertension (ICH) episode. Later, after a resumption of diuresis, we stopped CVVH. At day 11, urea increased to 35.6 mmol/L and creatininemia to 452 μmol/L. Serum sodium was 145 mmol/L. Because the trauma had occurred several days before, we decided to perform HD. One hour after the start of HD, an ICH appeared (ICP = 37 mm Hg). Urea was 22.3 mmol/L and serum sodium was 144 mmol/L (unchanged). DDS was diagnosed. After HD was stopped, osmotherapy was administered, and neurosedation was increased, ICP returned to normal (Figure 1). Afterward, we successfully used CVVH without a new episode of ICH. At day 19, the patient was discharged and later made a full recovery.DDS was first described in 1962 [2]. Symptoms due to cerebral edema vary from headache, nausea, and convulsion to coma. In our case, we detect DDS by ICP monitoring. Risk factors are first HD, severe uremia, age, pre-existing neurological disorders, and metabolic acidosis. A rapid clearing of small-sized molecules (such as urea) generated the symptoms. The main theory is the 'reverse urea effect', in which the shift of urea between brain intracellular space and plasma is not immediate but causes a brain intracellular space to interstitial osmotic gradient and leads to cerebral edema [3].This case is didactic because, as we monitored the ICP, we saw the consequences of DDS on the brain. Treatments consist of a slow gentle start of HD, increasing dialysate sodium levels, and administration of osmotically active substances. We think that CVVH should be used to treat patients with risk factors, especially in the neurointensive care unit [4]. This t
Is non-invasive ventilation the best ventilatory support for 'do not intubate' patients?
Guillaume Lacroix, Julien Legodec, Erwan D'Aranda, Pierre Esnault, Pierre-Emmanuel Romanat, Philippe Goutorbe
Critical Care , 2012, DOI: 10.1186/cc11435
Abstract: We do not, however, entirely accept the views of Schortgen and colleagues. Use of the non-invasive ventilation mask for palliative care patients with acute respiratory distress prevents the patient from eating and talking, and the patient's experience can be that of being smothered. When the major indication is hypoxemia, a treatment option is the administration of high-flow oxygen using up to 60 l/minute heated and humidified oxygen through a nasal cannula [3]. The mouth is thus freed and the patient is able to eat and talk with his family. The cost to efficiency ratio is favourable because the Optiflow? oxygenation system (Fischer and Paykel?, Auckland, New Zealand) costs €4,000 versus €15,600 for the V60? ventilation system (Philips?, Amsterdam, New Netherlands). Non-invasive ventilation appears preferable in chronic obstructive pulmonary disease patients with hypercapnia.We tested high-flow oxygen administration in 10 'do not intubate' patients receiving palliative cancer care in whom a high oxygen concentration mask failed to relieve dyspnoea (abstract accepted for the Société Fran?aise d'Anesthésie Réanimation National Congress, September 2012). The mean respiratory rate fell from 29 to 22 breaths/minute (P <0.01) and the ability to communicate (visual analogue scale) increased from 2 to 7 (P <0.01).To conclude, high-flow oxygen is an easy and cheap way to relieve dyspnoea in 'do not intubate' patients.The authors declare that they have no competing interests.
Recruitment maneuver after apnea test or continuous positive airway pressure apnea test?
Guillaume Lacroix, Erwan d'Aranda, Jean Cotte, Pierre Esnault, Pierre-Emmanuel Romanat, Philippe Goutorbe
Critical Care , 2012, DOI: 10.1186/cc11453
Abstract: Armelle Nicolas-Robin and Marie PariesWe thank Dr Lacroix and colleagues for their interest in our study and we appreciate the opportunity to respond. We wish to remind that the aim of our study [1] was not to compare the PaO2/FiO2 ratio after apnea tests performed by disconnecting or not the patient from the ventilator. It was to show that hypoxemia after disconnection from the ventilator may be prevented by a single RM applied just after reconnection. Dr Lacroix theorizes that a RM is not useful if the apnea test is performed without disconnection in the CPAP mode. This hypothesis has not been validated, even by Mascia and colleagues [2], who showed that a global lung protective strategy (including no disconnection plus RMs) improved the PaO2/FiO2 ratio, compared with the conventional strategy (including disconnection with no RM). To our knowledge, the only prevention by the non-disconnection in the CPAP mode has not been evaluated. Our study demonstrated the interest of RM in the case of an apnea test performed by disconnecting the patient from the ventilator. This result is all the more useful because an apnea test performed without disconnection in the CPAP mode is not possible with all ventilators, especially those that do not allow inhibition of the apnea ventilation security mode in case of prolonged apnea.CPAP: continuous positive airway pressure; FiO2: fractional inspired oxygen; PaO2: arterial oxygen tension; RM: recruitment maneuver.The authors declare that they have no competing interests.
Evaluation of early mini-bronchoalveolar lavage in the diagnosis of health care-associated pneumonia: a prospective study
Guillaume Lacroix, Bertrand Prunet, Julien Bordes, Nathalie Cabon-Asencio, Yves Asencio, Tiphaine Gaillard, Sandrine Pons, Erwan D'aranda, Delphine Kerebel, Eric Meaudre, Philippe Goutorbe
Critical Care , 2013, DOI: 10.1186/cc12501
Abstract: We prospectively included all patients presenting with HCAP in the emergency department. Blood cultures and fiberoptic bronchoscope-guided distal protected small volume bronchoalveolar lavage (FODP mini-BAL) were performed in each patient. Empiric antibiotic therapy was adapted microbiological findings were available. The primary objective was to assess that FODP mini-BAL is more efficient than blood cultures to identify pathogens with the ratio of identification between both techniques as principal criteria.We included 54 patients with HCAP. Pathogens were identified in 46.3% of cases using mini-BAL, and in 11.1% of cases using blood cultures (p < 0.01). When patient did not receive antibiotic therapy before the procedure, pathogens were identified in 72.6% of cases using mini-BAL, and in 9.5% of cases using blood cultures (p<0.01). We noted multidrug-resistant pathogens in 16% of cases. All bronchoscopic procedures could be performed in patients without complications.FODP mini-BAL was more efficient than blood cultures for identifying pathogens in patients presenting with HCAP. When bacteriological identification was obtained, antibiotic therapy was adapted in 100% of cases.
Consideraciones filogenéticas y biogeográficas preliminares del género Sorghastrum (Poaceae: Andropogoneae).
Patricia Dávila Aranda
Acta botánica mexicana , 1991,
Abstract:
Landau damping in Sobolev spaces for the Vlasov-HMF model
Erwan Faou,Frédéric Rousset
Mathematics , 2014,
Abstract: We consider the Vlasov-HMF (Hamiltonian Mean-Field) model. We consider solutions starting in a small Sobolev neighborhood of a spatially homogeneous state satisfying a linearized stability criterion (Penrose criterion). We prove that these solutions exhibit a scattering behavior to a modified state, which implies a nonlinear Landau damping effect with polynomial rate of damping.
Curves in Hilbert modular varieties
Erwan Rousseau,Frédéric Touzet
Mathematics , 2015,
Abstract: We study curves in Hilbert modular varieties from the point of view of the Green-Griffiths-Lang conjecture claiming that entire curves in complex projective varieties of general type should be contained in a proper subvariety. In the first part, using holomorphic foliations theory, we establish the Second Main Theorem in this context as well as a function field analogue of Vojta's conjecture. In the second part, with a metric approach, we establish the strong Green-Griffiths-Lang conjecture for Hilbert modular varieties up to finitely many possible exceptions.
Rainfall Maximum Intensities for Urban Hydrological Design in Mexican Republic
Campos–Aranda D.F.
Ingeniería, investigación y tecnología , 2010,
Abstract: Firstly, through the urban hydrosystem concept and through urbanization, the difficulties and approach of the urban flood estimation are established, based in the Intensity–Duration–Frequency curves (IDF). Next, in 10 recording gages located in very different geographic zones, a procedure is contrasted for IDF estimation curves, which utilized the Chen formula and the available information in the Mexican Republic for isohyet intensities and annual daily maximum rainfall. Late, having verified their capacity and approximation to reproduce the IDF curves, the utilized procedure was applied in 45 important locations of the country, showing the results. Lastly, the conclusions are formulated, which point out the approximation and simplicity of the proposal procedure.
Limits on a Light Leptophobic Gauge Boson
Alfredo Aranda,Christopher D. Carone
Physics , 1998, DOI: 10.1016/S0370-2693(98)01309-4
Abstract: We consider the phenomenology of a naturally leptophobic $Z$-prime boson in the 1 to 10 GeV mass range. The $Z$-prime's couplings to leptons arise only via a radiatively-generated kinetic mixing with the $Z$ and photon, and hence are suppressed. We map out the allowed regions of the mass-coupling plane and show that such a $Z$-prime that couples to quarks with electromagnetic strength is not excluded by the current data. We then discuss possible signatures at bottom and charm factories.
Bosonic Topcolor
Alfredo Aranda,Christopher D. Carone
Physics , 2000, DOI: 10.1142/S0217751X01008436
Abstract: A topcolor model is presented that contains both composite and fundamental scalar fields. Strong dynamics accounts for most of the top quark mass and part of the electroweak symmetry breaking scale. The fundamental scalar is weakly coupled and transmits its share of electroweak symmetry breaking to the light fermions. The model is allowed by the current experimental bounds, and can give a potentially large contribution to $D^0-\bar{D^0}$ mixing.
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