Weaning Strategy from Veno-Arterial Extracorporeal Membrane Oxygenation (ECMO)

Background: Significant advances in extracorporeal technology have led to the more widespread use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) for cardiac failure. However, procedures for weaning from VA ECMO are not standardized. High death rate after successful weaning shows that many questions remain unresolved in this field

Chemical Analysis of the Essential Oils of Three Cistus Species Growing in North-West of Algeria

The study reports for the first time the chemical composition and the antibacterial activity of the essential oil hydrodistilled from three Cistaceae growing in Algeria: Cistus ladaniferus L., C. albidus L. and C. monspeliensis L. The oils were analyzed by GC-FID and GC-MS analyses. The major components of C. ladaniferus were 5-epi-7-epi-α-eudesmol (13.6%) and borneol (12.5%) whereas for C. albidus the main constituents were epi-α-bisabolol (11.4%) and β-bourbonene (8.7%). Epi- 13-manoyl oxide (28.6%), kaur-16-ene (8.1%) and nonanal (5.4%) were the principal ones for C. monspeliensis. In vitro, antimicrobial activity of the oils was investigated against nine microorganisms by disk diffusion and agar dilution assays. The Gram-positive bacteria resulted sensitive to the three oils, especially Bacillus subtilis ATCC 6633 and Staphylococcus aureus ATCC 25923. The volatiles of C. monspeliensis showed the best activity compared with other oils, comparable to or better than Gentamicin, a conventional antibiotic used as positive control in this study. The minimum inhibitory concentration (MIC) value of the oil was 0.25µg/L

0130: Mortality related to cardiogenic shock in critically ill patients in France, 1997-2012

IntroductionMost of data reporting epidemiology of cardiogenic shock (CS) concern patients with acute myocardial infarction admitted in intensive care unit of cardiology. However, CS patients managed in critical care unit (CCU) have often multiorgan failure and seem to have different characteristics and outcome. To our best knowledge no study reported characteristics and clinical outcomes of CS patients admitted in CCU.AimTo report key features, Mortality and Trends in mortality in a large cohort of patients with CS admitting in 33 French CCUs from 1997 to 2012.Methods and resultsWe queried the 1997–2012 database of Parisian area ICUs-the CubRea (Intensive Care Database User Group) database to identify all hospital stays with a principal or an associated diagnosis of CS (National classification of disease R 570). Among 303 314 hospital stays, 17 494 (5.8%) were CS. The patients were managed in 60% of cases in universitary centers. Mean age was 64.3±17.0. Men accounted for 11047 (63.1%). Mean SAPS II was 62.0±24.3. Among CS, only 535 (3.06%) were AMI whereas 2685 (15.3%) were cardiac arrest and 858 (4.9%) were drug intoxications. Mechanical ventilation was required in 12967 (74.1%) of cases, inotropes in 14640 (83.7%) of cases and renal support in 3886 (22.2%) of cases. Mean duration of hospital was 19.1 days±24.7. Intrahospital Mortality was high (46.2%). Predictors of intrahospital death are reported in Table. Over the 15-year period, mortality decreased (49.8% in 1997-2000 and 42.7% in 2009-2012, p<0.001) whereas the patients were more critically ill (SAPS II 58.8±25.4 in 1997-2000 vs 64.2 8±23.6 in 2009-2012, p<0.001).Conclusionit is the first study reporting the prevalence, determinants and prognostic factors of CS patients managed in reanimation. The mortality of these very critically ill patients remains high. However over the 15-year period, even if these patients are more and more critically ill, early mortality decreased.Abstratct 0130 – TableVariablesOR95% CIDrug intoxication.307.236.401Age (<60 yo).436.383.496Mechanical circulatory support.681.3781.228Sepsis.715.637.8022009-2012.998.8851.125SAPS II1.0361.0331.038Acidosis1.4531.2641.670Mechanical ventilation1.7181.4831.990Acute respiratory distress syndrome1.7941.5582.0661997-20001.8141.4522.267Hemodialysis1.8201.6092.060Inotropic use1.9821.1133.530Disseminated intravascular coagulation2.1191.5912.822Cardiac arrest4.3333.8404.88

Beta-blocker management in patients admitted for acute heart failure and reduced ejection fraction: a review and expert consensus opinion

The role of the beta-adrenergic signaling pathway in heart failure (HF) is pivotal. Early blockade of this pathway with beta-blocker (BB) therapy is recommended as the first-line medication for patients with HF and reduced ejection fraction (HFrEF). Conversely, in patients with severe acute HF (AHF), including those with resolved cardiogenic shock (CS), BB initiation can be hazardous. There are very few data on the management of BB in these situations. The present expert consensus aims to review all published data on the use of BB in patients with severe decompensated AHF, with or without hemodynamic compromise, and proposes an expert-recommended practical algorithm for the prescription and monitoring of BB therapy in critical settings

Analysis of the role of longitudinal ventricular functions in severe cardiac and circulatory failures

Les analyses des fonctions ventriculaires gauche (VG) et droite (VD) et des pressions de remplissage sont des éléments importants dans le contexte des défaillances cardio-circulatoires graves car elles ont des conséquences diagnostiques et pronostiques avec un impact sur les prises de décisions thérapeutiques. Toutefois, l'évaluation de la fonction myocardique en cas de choc reste difficile pour des raisons physiopathologiques et technologiques. Les paramètres de fonction ventriculaire longitudinale (FVL) pourraient avoir un intérêt dans ce domaine car ils permettent une évaluation directe d'une composante majeure de la mécanique ventriculaire. Ces paramètres ont été évalués chez les défaillances chroniques stables et ont montré leurs intérêts diagnostiques et pronostiques. Ils restent très peu étudiés dans les contextes aigues et graves.Despite advances in management and therapies, cardiogenic shock remains a clinical challenge with high mortality rates.The analysis of left and right ventricular functions and filling pressures are important in this context because they had diagnostic and prognostic consequences with impact in therapeutic decisions. Nevertheless, the assessment of myocardial function remains difficult for physiopathologic and technical reasons. The parameters of longitudinal ventricular function (LgVF) could have an interest in this context because they permit a direct assessment of a major component of ventricular mechanics whereas ejection fraction remains a global evaluation. These indices were assessed in chronic and stable heart failure patients and were found to have prognostic and diagnostic interests. Though, they were not evaluated in the context of acute and severe cardio-circulatory failures

Élaboration et expérimentation d'un modèle de frottement de glissement entre un solide et un support : diagramme de frottement de glissement

Partant de certains travaux de recherche qui ont mis en avant des difficultés conceptuelles chez les étudiants à propos du frottement de glissement, et tenant compte des modèles déjà existants, nous avons conçu un nouveau modèle : le diagramme de frottement de glissement (DFG) qui lie ce phénomène à la vitesse relative de glissement ou de glissement potentiel pour le cas d’adhérence, et qui tient compte de la rugosité surfacique. Pour impliquer des élèves de terminale scientifique (17-18 ans), dans la construction de ce modèle nous avons mis en oeuvre une séquence d’enseignement. L’évaluation du modèle a été faite en situation de résolution de problèmes. Cette évaluation est basée sur une analyse comparative des conceptions avant et après les activités de modélisation. Les résultats de l’expérimentation du modèle permettent de conclure à une nette amélioration des conceptions des élèves à propos des frottements.Aissaoui Abdelkrim, Benjelloun Nadia. Élaboration et expérimentation d'un modèle de frottement de glissement entre un solide et un support : diagramme de frottement de glissement . In: Didaskalia, n°33, 2008. pp. 141-165

Cardiac injury in COVID-19

International audienceAbstract OBJECTIVES Postoperative mediastinitis, a feared complication after cardiac surgery, is associated with high mortality, especially of critically ill patients. Candida species infections are rare and severe, with poorly known outcomes. We conducted a case–control study to describe the characteristics, management and outcomes of patients with postoperative Candida mediastinitis. METHODS This French, monocentre, retrospective study included all patients with postoperative Candida mediastinitis (January 2003–February 2020) requiring intensive care unit admission. Candida mediastinitis patients (henceforth cases) were matched 1:1 with postoperative bacterial mediastinitis (henceforth control), based on 3 factors during mediastinitis management: age &gt;40 years, cardiac transplantation and invasive circulatory device used. The primary end point was the probability of survival within 1 year after intensive care unit (ICU) admission. RESULTS Forty cases were matched to 40 controls. The global male/female ratio was 2.1, with mean age at admission 47.9 ± 13.8 years. Candida species were: 67.5% albicans, 17.5% glabrata, 15% parapsilosis, 5.0% tropicalis, 2.5% krusei and 2.5% lusitaniae. The median duration of mechanical ventilation was 23, 68.8% of patients received renal replacement therapy and 62.5% extracorporeal membrane oxygenation support. The probability of survival within the first year after ICU admission was 40 ± 5.5% and was significantly lower for cases than for controls (43 ± 8% vs 80 ± 6.3%, respectively; Log-rank test: P &lt; 0.0001). The multivariable Cox proportional hazards model retained only renal replacement therapy [hazard ratio (HR) 3.7, 95% confidence interval (CI) 1.1–13.1; P = 0.04] and Candida mediastinitis (HR 2.4, 95% CI 1.1–5.6; P = 0.04) as independently associated with 1-year mortality. CONCLUSIONS Candida mediastinitis is a serious event after cardiac surgery and independently associated with 1-year mortality. Further studies are needed to determine whether deaths are directly attributable to Candida mediastinitis

Clinical outcomes according to symptom presentation in patients with acute myocardial infarction: Results from the FAST-MI 2010 registry

International audienceBackground: Atypical clinical presentation in acute myocardial infarction (AMI) patients is not uncommon; most studies suggest that it is associated with unfavorable prognosis.Hypothesis: Long‐term clinical impact differs according to predominant symptom presentation (typical chest pain, atypical chest pain, syncope, cardiac arrest, or dyspnea) in AMI patients.Methods: FAST‐MI 2010, a nationwide French registry, included 4169 patients with AMI in 213 centers at the end of 2010 (76% of active centers). Demographics, medical history, hospital management, and outcomes were compared according to predominant symptom presentation.Results: Typical chest pain with no other symptom was reported in 3020 patients (68% in STEMI patients, 76% in NSTEMI patients). Atypical chest pain, dyspnea, syncope, and cardiac arrest were reported in 11%, 11%, 5%, and 1%, respectively. Patients with atypical clinical presentation had a higher cardiovascular risk profile and received fewer medications and a less invasive strategy. Using Cox multivariate analysis, atypical chest pain was not associated with higher death rate at 3 years (HR: 0.96, 95% CI: 0.69‐1.33, P = 0.78), whereas cardiac arrest (HR: 2.44, 95% CI: 1.00‐5.97, P = 0.05), syncope (HR: 1.70, 95% CI: 1.18‐2.46, P = 0.005), and dyspnea (HR: 1.66, 95% CI: 1.31‐2.10, P < 0.001) were associated with higher long‐term mortality compared with patients with typical isolated chest pain. Similar trends were observed in STEMI and NSTEMI populations.Conclusions: Atypical clinical presentation is observed in about 20% of AMI patients. Cardiac arrest, dyspnea, and syncope represent independent predictors of long‐term mortality in STEMI and NSTEMI populations