Chemical and Biological Aspects of Nutritional Immunity - Perspectives for New Anti-infectives Targeting Iron Uptake Systems : Perspectives for New Anti-infectives Targeting Iron Uptake Systems

Upon bacterial infection, one of the defense mechanisms of the host is the withdrawal of essential metal ions, in particular iron, which leads to "nutritional immunity". However, bacteria have evolved strategies to overcome iron starvation, for example, by stealing iron from the host or other bacteria through specific iron chelators with high binding affinity. Fortunately, these complex interactions between the host and pathogen that lead to metal homeostasis provide several opportunities for interception and, thus, allow the development of novel antibacterial compounds. This Review focuses on iron, discusses recent highlights, and gives some future perspectives which are relevant in the fight against antibiotic resistance

Regional anesthesia and analgesia after surgery in ICU

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Real-time continuous monitoring of injection pressure during peripheral nerve blocks in fresh cadavers

International audienceBackground: The incidence of unintentional intraneural injection while performing peripheral nerve block has been estimated to be 15% under real-time ultrasound guidance. Injection pressure increase may detect an intraneural injection. Real-time injection pressure changes throughout an entire nerve block procedure in relationship with needle tip location have never been reported.Methods: A new method was developed to precisely monitor the injection pressure curve during nerve blocks, based on a miniaturised Fabbri-Perrot pressure sensor. We tested in three fresh cadavers the ability of continuous pressure monitoring to discriminate between different tissues, as the injection pressure curve ascending slope, shape and plateau pressure value depend on tissue compliance. Injections of saline were performed by an electronic syringe pump with three different constant flow rates. Pressure was measured simultaneously at the tip and in the tubing of the needle.Results: At 10 mL/min injection flow, median peak injection pressure in the intraneural group at the needle tip was 315 mmHg, while at the perineural location it was 100 mmHg (p < 0.05). Median injection pressure was 95 mmHg in the intramuscular locations group, and 819 mmHg when a muscular fascia was indented (p < 0.05). A significant difference was noted for pressure measurements between the proximal port of the needle and the tip, 625 and 417 respectively.Conclusions: Based on significant differences in injection pressure values and curve shapes, the system was able to discriminate between four needle tip locations. This may help with needle tracking while performing a peripheral nerve block

Injection pressure monitoring during peripheral nerve blocks: from bench to operating theatre

International audienceBackground: Nerve damage can occur after ultrasound-guided peripheral nerve block (PNB). Injection pressure monitoring could improve the safety of PNB. The aim was to analyse parameters affecting pressure measurements during PNB.Methods: The flow characteristics of needles connected to a pressure-sensing device were evaluated. Needles were placed under ultrasound guidance extra or epineurally in nerves/plexus of fresh cadavers. Using three flow rates, 4 mL of saline was injected and plateau pressure was measured. Finally, orthopaedic surgery patients receiving PNB were enrolled for an observational real-time pressure monitoring study. During PNB, periods with pressure > 50 mmHg were noted (high pressure ≥ 750 mmHg). A blinded investigator recorded injection pressure curves and peak pressure.Results: The needle diameter influenced the injection pressure (β = 66.8; P 750 mmHg during 13.80% of the procedural time.Conclusions: Needle diameter, needle tip location, type of nerve/plexus, flow rates, and the anaesthetist can have a significant effect on injection pressure values and monitoring

The use of post-anaesthesia care units as a supply of ICU beds while maintaining scheduled surgery: a cross-sectional web-based feasibility survey in France

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Ventilation du patient avec obésité

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First-attempt success is associated with fewer complications related to intubation in the intensive care unit

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What is the most appropriate spontaneous breathing trial before extubation in ICU ventilated patients?

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Which spontaneous breathing trial to predict effort to breathe after extubation according to five critical illnesses: the cross-over GLOBAL WEAN study protocol

Introduction Readiness to be freed from ventilatory support can be evaluated by spontaneous breathing trial (SBT) assessing the patient’s ability to sustain respiratory effort after extubation. Current SBT practices are heterogenous and there are few physiological studies on the topic. The objective of this study is to assess which SBT best reproduces inspiratory effort to breathe after extubation depending on the patient’s illness.Methods and analysis This will be a multicentre randomised cross-over physiological study, in a large population, in the era of modern intensive care units using last generation modern ventilators. Each included patient will perform three 15-minute SBTs in a random order: pressure support ventilation (PSV) level of 7 cmH2O with positive end expiratory pressure (PEEP) level of 0 cmH2O, PSV 0 cmH2O with PEEP 0 cmH2O and T-piece trial. A rest period of baseline state ventilation will be observed between the SBTs (10 min) and before extubation (30 min). Primary outcome will be the inspiratory muscle effort, reflected by pressure time product per minute (PTPmin). This will be calculated from oesophageal pressure measurements at baseline state, before and after each SBT and 20 min after extubation. Secondary outcomes will be PTPmin at 24 hours and 48 hours after extubation, changes in physiological variables and respiratory parameters at each step, postextubation respiratory management and the rate of successful extubation. One hundred patients with at least 24 hours of invasive mechanical ventilation will be analysed, divided into five categories of critical illness: abdominal surgery, brain injury, chest trauma, chronic obstructive pulmonary disease and miscellaneous (pneumonia, sepsis, heart disease).Ethics and dissemination The study project was approved by the appropriate ethics committee (2019-A01063-54, Comité de Protection des Personnes TOURS - Région Centre - Ouest 1, France). Informed consent is required, for all patients or surrogate in case of inability to give consent.Trial registration number NCT04222569