La Tunisie médicale
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La Tunisie médicale · Nov 2005
Multicenter Study[Sedative practice in intensive care units results of a Maghrebian survey].
sedation is central to the management of intensive care patients. The aim of this study was to establish the current sedation practice in Maghrebian intensive care units (ICUs). The use of sedation policies with or without a written protocol, the use of scoring systems, the influence of costs on drug choice, the most common drugs for sedation and the use of neuromuscular blocking agents. ⋯ sedation may seem secondary in the initial management of intensive care patients, only 63% of our respondents had a sedation policy and 20% a written protocol though its use is thought to improve outcome and reduce costs. Economic aspect was important for the choice of the drug to use (64%), this may explain the preferential use of Midazolam 98% in association with an analgesic (Fentanyl: 85%) while Propofol is used only in 14% though pharmacoeconomic studies may be in fact in favor of the latter. Neuromuscular blocking agents are less frequently used (16%) mainly because of the risk of complications.
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La Tunisie médicale · Oct 2005
Case Reports[Successful use of levosimendan in a patient with cardiogenic shock complicating acute myocardial infarction].
Levosimendan is a new inodilator that improves cardiac contractility by sensitizing troponin C to calcium. This drug has proved to be effective in treating advanced congestive heart failure but has not been evaluated in cardiogenic shock. We present the case of a 54-year-old male patient treated successfully with levosimendan for cardiogenic shock following acute myocardial infarction. ⋯ Levosimendan induced a steady decline of increased pulmonary capillary wedge pressure, followed by an increase in cardiac index and mixed venous oxygen saturation. Left ventricular ejection fraction improved from 25% to 47%. Infusion of levosimendan can be used in cardiogenic shock without side effects and to improve hemodynamics and left ventricular function.
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La Tunisie médicale · Sep 2005
Review Case Reports[Reexpansion pulmonary edema a vacuo: a case report and literature review].
Reexpansion pulmonary edema is a rare and potentially lethal complication with a 15 to 20% mortality. We report one case of pulmonary edema after evacuation of spontaneous right pneumothorax The pathophysiology of reexpansion pulmonary edema remains obscure; mechanical and inflammatory processes (production of Inerleukin 8--and Leukotrienne B4) seem incriminated. Duration and seventy of lung collapse and the rate of reexpansion appear to be the main causes justifying preventive measures. Curative treatment is based on oxygenation and lower aspiration pressure.