Effets de la noradrenaline sur l'hemodynamique systémique et les indicateurs de précharge statiques et dynamiques chez les cérébro-lésès

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Évaluation échographique de la veine cave inférieure par voie latérale droite

RENNES1-BU Santé (352382103) / SudocSudocFranceF

Impact d'une "check-list" de prise en charge des 24 premières heures du choc septique

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Mesure de la variation respiratoire de pression pulsée (variabilité interindividuelle et choix de la méthode de mesure)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Effets hémodynamiques du rémifentanil chez l'enfant avec et sans atropine

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Determination of capillary hemoglobin levels using the HemoCue system in intensive care patients.

International audiencePURPOSE: The study aimed to compare hemoglobin (Hb) values determined using the portable HemoCue system (HemoCue Hb 201+; HemoCue AB, Ängelholm, Sweden) with laboratory Hb level determination. MATERIALS AND METHODS: Adult patients hospitalized in our surgical intensive care unit who required an Hb level determination were included. To determine Hb level, one drop of arterial (A) or venous (V) blood was analyzed using HemoCue (HemoCue([A/V])), and also with an automated analyzer in the laboratory (Hb reference method, or Hb Lab([A/V])). Capillary blood (Cap) sample obtained simultaneously by fingerstick was analyzed using HemoCue (HemoCue([Cap])). Factors that could interfere with the accuracy of fingerstick measurements were also studied. Paired Hb level measurements were compared by Bland and Altman analysis (Hb Lab([A/V]) vs HemoCue([A/V]) and HemoCue([Cap])). RESULTS: One hundred fifty blood samples were obtained from 79 patients. The mean absolute differences between Hb Lab [A] and HemoCue [A], Hb Lab [V] and HemoCue [V] and Hb Lab [A/V] and HemoCue [Cap] were 0.1 g/dl (95% confidence interval, -1.9 to + 2.2 g/dl), 0.1 g/dl (95%CI, -2.5 to +2.6 g/dl) and 1.1 g/dl (95%CI, -3.6 to + 5.8 g/dl, respectively. Edema was the sole independent risk factor for discordance between HemoCue([Cap]) and Hb Lab([A/V]) (odds ratio, 6.65; 95% CI, 1.99-22.21; P < .001]. CONCLUSIONS: Hemoglobin level determination using HemoCue should not be used in critically patients, especially when capillary blood samples are used and/or in presence of edema

Effect of remifentanil with and without atropine on heart rate variability and RR interval in children.

Remifentanil can cause bradycardia either by parasympathetic activation or by other negative chronotropic effects. The high frequency (HF) component of heart rate variability (HRV) is a marker of parasympathetic activity. This study aimed to evaluate the effect of remifentanil on RR interval and on HRV in children. Forty children ASA I or II were studied after approval by the human studies committee and informed parental consent was obtained. After stabilisation at sevoflurane 1 MAC, they were randomly divided into two groups: one received a 20 microg.kg(-1) atropine injection (AT + REMI) and the other ringer lactate solution (REMI). Three minutes later, a 1 microg.kg(-1) bolus of remifentanil was administered over 1 min, followed by a continual infusion at 0.25 microg.kg(-1).min(-1) for 10 min increased to 0.5 microg.kg(-1).min(-1) for a further 10 min. A time varying, autoregressive analysis of RR sequences was used to estimate classical spectral parameters: low (0.04-0.15 Hz; LF) and high (0.15-0.45 Hz; HF) frequency, whereas the root mean square of successive differences of RR intervals (rmssd) was derived directly from the temporal sequence. Statistical analyses were conducted by means of the multiple correspondence analysis and with non parametrical tests. Remifentanil induced an RR interval lengthening, i.e. bradycardia, in both groups compared to pretreatment values and was associated with an increase of HF and rmssd only for the REMI group. The parasympathetic inhibition by atropine did not totally prevent remifentanil's negative chronotropic effect. A direct negative chronotropic effect of remifentanil is proposed

Haemodynamic effects of remifentanil in children with and without intravenous atropine. An echocardiographic study.

International audienceBACKGROUND: Remifentanil is known to cause bradycardia and hypotension. We aimed to characterize the haemodynamic profile of remifentanil during sevoflurane anaesthesia in children with or without atropine. METHODS: Forty children who required elective surgery received inhalational induction of anaesthesia using 8% sevoflurane. They were allocated randomly to receive either atropine, 20 microg kg(-1) (atropine group) or Ringer's lactate (control group) after 10 min of steady-state 1 MAC sevoflurane anaesthesia (baseline). Three minutes later (T0), all children received remifentanil 1 microg kg(-1) injected over a 60 s period, followed by an infusion of 0.25 microg kg(-1) min(-1) for 10 min then 0.5 microg kg(-1) min(-1) for 10 min. Haemodynamic variables and echocardiographic data were determined at baseline, T0, T5, T10, T15 and T20 min. RESULTS: Remifentanil caused a significant decrease in heart rate compared with the T0 value, which was greater at T20 than T10 in the two groups: however, the values at T10 and T20 were not significantly different from baseline in the atropine group. In comparison with T0, there was a significant fall in blood pressure in the two groups. Remifentanil caused a significant decrease in the cardiac index with or without atropine. Remifentanil did not cause variation in stroke volume (SV). In both groups, a significant increase in systemic vascular resistance occurred after administration of remifentanil. Contractility decreased significantly in the two groups, but this decrease remained moderate (between -2 and +2 sd). CONCLUSION: Remifentanil produced a fall in blood pressure and cardiac index, mainly as a result of a fall in heart rate. Although atropine was able to reduce the fall in heart rate, it did not completely prevent the reduction in cardiac index

Maintenance nifedipine therapy for preterm symptomatic placenta previa: A randomized, multicenter, double-blind, placebo-controlled trial

<div><p>Objective</p><p>To assess the impact of maintenance nifedipine therapy on pregnancy duration in women with preterm placenta previa bleeding.</p><p>Methods</p><p>PPADAL was a randomized, double-blind, placebo-controlled trial conducted between 05/2008 and 05/2012 in five French hospitals. The trial included 109 women, aged ≥ 18 years, with at least one episode of placenta previa bleeding, intact membranes and no other pregnancy complication, at gestational age 24 to 34 weeks and after 48 hours of complete acute tocolysis. Women were randomly allocated to receive either 20 mg of slow-release nifedipine three times daily (n = 54) or placebo (n = 55) until 36 + 6 weeks of gestation. The primary outcome for the trial was length of pregnancy measured in days after enrolment. Main secondary outcomes were rates of recurrent bleeding, cesarean delivery due to hemorrhage, blood transfusion, maternal side effects, gestational age at delivery and adverse perinatal outcomes (perinatal death, chronic lung disease, neonatal sepsis, intraventricular hemorrhage > grade 2, perventricular leukomalacia > grade 1, or necrotizing enterocolitis). Analysis was by intention to treat.</p><p>Results</p><p>Mean (SD) prolongation of pregnancy was not different between the nifedipine (n = 54) and the placebo (n = 55) group; 42.5 days ± 23.8 versus 44.2 days ± 24.5, p = 0.70. Cesarean due to hemorrhage performed before 37 weeks occurred more frequently in the nifedipine group in comparison with the placebo group (RR, 1.66; 95% confidence interval, 1.05–2.72). Adverse perinatal outcomes were comparable between groups; 3.8% for nifedipine versus 5.5% for placebo (relative risk, 0.52; 95% confidence interval 0.10–2.61). No maternal mortality or perinatal death occurred.</p><p>Conclusion</p><p>Maintenance oral nifedipine neither prolongs duration of pregnancy nor improves maternal or perinatal outcomes.</p><p>Trial registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT00620724" target="_blank">NCT00620724</a></p></div