Le DeltaPP peut-il prédire la réponse au remplissage vasculaire chez les sujets en état de mort encéphalique ?

Nous avons mené une étude prospective bi-centrique approuvée par un comité d'éthique pour évaluer la valeur prédictive du DeltaPP afin de prédire la réponse au remplissage vasculaire chez les sujets et état de mort encéphalique (EME). Nous avons inclus 25 patients en EME nécessitant un remplissage vasculaire (RV). La mesure du deltaPP et du débit cardiaque (DC) était réalisé avant RV et on mesurait à nouveau le DC par échocardiographie trans-thoracique 30 minutes après le RV. Une réponse positive au RV était définie par une augmentation du DC = 15%. Dans notre étude, un seuil de 13% de deltaPP, comme utilisé en routine, ne permet pas de prédire la réponse au RV des sujets en EME, mais un seuil à 20% le permet avec une sensibilité de 100% et une spécificité de 40%. L'échec de cet indice chez ces patients est multifactoriel, et lié à la grande complexité de la physiopathologie de ces sujets.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia

International audienceBackground: Whether preventive inhaled antibiotics may reduce the incidence of ventilator-associated pneumonia is unclear.Methods: In this investigator-initiated, multicenter, double-blind, randomized, controlled, superiority trial, we assigned critically ill adults who had been undergoing invasive mechanical ventilation for at least 72 hours to receive inhaled amikacin at a dose of 20 mg per kilogram of ideal body weight once daily or to receive placebo for 3 days. The primary outcome was a first episode of ventilator-associated pneumonia during 28 days of follow-up. Safety was assessed.Results: A total of 850 patients underwent randomization, and 847 were included in the analyses (417 assigned to the amikacin group and 430 to the placebo group). All three daily nebulizations were received by 337 patients (81%) in the amikacin group and 355 patients (83%) in the placebo group. At 28 days, ventilator-associated pneumonia had developed in 62 patients (15%) in the amikacin group and in 95 patients (22%) in the placebo group (difference in restricted mean survival time to ventilator-associated pneumonia, 1.5 days; 95% confidence interval [CI], 0.6 to 2.5; P = 0.004). An infection-related ventilator-associated complication occurred in 74 patients (18%) in the amikacin group and in 111 patients (26%) in the placebo group (hazard ratio, 0.66; 95% CI, 0.50 to 0.89). Trial-related serious adverse effects were seen in 7 patients (1.7%) in the amikacin group and in 4 patients (0.9%) in the placebo group.Conclusions: Among patients who had undergone mechanical ventilation for at least 3 days, a subsequent 3-day course of inhaled amikacin reduced the burden of ventilator-associated pneumonia during 28 days of follow-up. (Funded by the French Ministry of Health; AMIKINHAL ClinicalTrials.gov number, NCT03149640; EUDRA Clinical Trials number, 2016-001054-17.)