Gilles Beaucaire

Ventilation-induced lung injury is associated with an increase in gut permeability.

Mechanical ventilation is associated with several harmful effects mainly related to high tidal volumes (Vt). Ventilator-induced lung injury can be responsible for an increased production of inflammatory mediators. We evaluated remote consequences on the gut of lung triggered inflammatory response, neutralizing anti-tumor necrosis factor (TNF) antibody was administered to assess the role of TNF in lung and gut permeability changes. Rats were anesthetized and ventilated for 2 h. A control group (Con: Vt = 10 mL/kg) was compared with a high Vt group (HV: Vt = 30 mL/kg). One &mgr;Ci of I125-labeled human serum albumin was injected to measure extravascular albumin space. Gut permeability was evaluated by plasma-to-lumen ratio leakage of I125 human serum albumin. Extravascular albumin space increased in the HV group from 446 ± 50 &mgr;L to 2783 ± 887 &mgr;L. Gut index of permeability increased from 5.1 ± 1.2 to 14.2 ± 4.9. Anti-TNF antibody prevented both lung and gut increase in permeability. High tidal volume ventilation resulted in an increase in lung edema and gut permeability, antagonism of TNF with neutralizing antibodies abrogated the increase in gut permeability as well as lung edema.

Community-Acquired Pneumonia in the Intensive Care Unit: Epidemiological and Prognosis Data in Older People

OBJECTIVES: To compare epidemiological data, etiology, and prognosis of severe community‐acquired pneumonia (CAP) in the intensive care unit (ICU) according to age (< or ≥ 65 years) and to determine prognostic factors of CAP in older people.

Pulmonary Stress Injury Within Physiological Ranges of Airway and Vascular Pressures

PURPOSE The aim of this study was to assess the respective role of a small elevation in pulmonary capillary pressure, airway pressure, or both on alveolar capillary barrier permeability in an isolated perfused rat lung model. MATERIALS AND METHODS Four groups were studied with low or high airway pressure (LA: 10 mL/kg (tidal volume); HA: 20 mL/kg), low or high pulmonary artery pressure (LP: 9 mm Hg; HP: 12 mm Hg): LALP, HALP, LAHP, and HAHP. The lungs were ventilated and perfused ex vivo for 30 minutes. Quantification of fluorescein isothiocyanate-labeled (FITC) dextran in bronchoalveolar lavage (BAL) fluid and radiolabeled tracers assessed alveolar capillary barrier permeability. RESULTS BALF FITC-dextran was similar in the three groups with either one or two low-pressure parameters (LALP, LAHP, HALP), but high amounts were found in the HAHP group (375.2 x 10(-6) mg/mL v, respectively, 21.4, 26.2, and 30 x 10(-6) mg/mL, P = .0001). These results were consistent with the albumin space and extravascular lung water: higher values only in the HAHP group statistically different from the other groups (P < .002). Interalveolar pore examined with scanning electron microscopy showed an increase in diameters between LALP and HAHP (P < .0001). CONCLUSIONS We can conclude that elevation of either the pulmonary artery pressure from 8 to 11 mm Hg or the alveolar pressure from 10 to 15 mm Hg alone does not change the permeability of the alveolar capillary membrane; however, there is an additive effect of these pressures.

Bacteremia Caused by Aeromonas hydrophila Complex in the Caribbean Islands of Martinique and Guadeloupe

Aeromonas species are Gram-negative bacilli of the water environment whose survival appears facilitated by warm climates. There have been no reports on Aeromonas species in the [corrected] Caribbean to date. Our aim was to describe clinical and bacteriological features in patients presenting with such bacteremia in Martinique and Guadeloupe. During a 14-year period, we retrospectively identified 37 patients. The mean age was 55 years and in 89% of cases underlying disease such as digestive diseases, cutaneous wounds, and malignancy were identified. One case was related to severe strongyloidiasis and one with snake bite. Polymicrobial bacteremia was identified in 38%, essentially with Enterobacteriaceae. All Aeromonas isolates were resistant to amoxicillin but extended-spectrum beta-lactam and fluoroquinolone were active against more than 95%. During hospitalization 10 patients died (27%). Older age, occurrence of multiorgan failure, and impaired renal function were associated with in-hospital mortality.

A-05 Caractéristiques des bactériémies à Aeromonas hydrophila aux Antilles

Introduction et objectifs Les Aeromonas sont des bacilles a Gram negatif, dont le reservoir naturel est l’environnement hydrique et dont la multiplication est fonction des conditions de temperature. L’homme se contamine par voie digestive ou transcutanee a l’occasion d’une plaie souillee et les principales manifestations cliniques sont des gastro-enterites, des infections cutanees et/ou des tissus mous et des bacteriemies communautaires. Materiels et methodes Nous avons etudie retrospectivement les dossiers des patients ayant presente une bacteriemie a Aeromonas hyrophila pris en charge dans les CHU de Martinique et de Guadeloupe entre 1996 et 2008. Resultats Au cours de cette periode, 27 patients ont ete identifies, 18 (67 %) etaient des hommes, l’âge moyen etait de 57 ans [19-87] et 23 (85 %) d’entre eux etaient porteurs d’au moins une des pathologies sous-jacente suivantes : 9 (33 %) presentaient une hepatopathie chronique, 8 (30 %) une immunodepression (4 hemopathies, 3 cancers digestifs et 1 infection par le VIH), 7 (30 %) une plaie recente et/ou un accident de la voie publique. Chez 9 patients (33 %) une deuxieme espece bacterienne etait identifiee et il s’agissait dans 6 cas d’une enterobacterie. L’antibiotherapie prescrite etait une betalactamine dans 96 % des cas, associee a un aminoside chez 44 % des patients. Chez deux patients l’apparition d’une souche resistante a l’antibiotique prescrit (un patient sous cefotaxime, l’autre sous ceftazidime) a ete observee. La mortalite hospitaliere etait de 33 % et le deces survenait en mediane 9 jours [1-38 j] apres la date de positivite de l’hemoculture. Conclusion Les bacteriemies a Aeromonas hydrophila surviennent le plus souvent dans un contexte d’hepatopathie, d’immunodepression ou de plaie traumatique. L’evolution est fatale dans un tiers des cas.