Étude de l'impact respiratoire d'une hypoalbuminémie par la thermodilution transpulmonaire au cours du choc septique

Cette étude a évalué l'impact de l'albuminémie et de la pression oncotique (Ponc) sur la fonction respiratoire, par la mesure en thermodilution transpulmonaire (système PiCCO®) de l'eau pulmonaire extravasculaire (EPEV), au cours du choc septique. Il s'agissait d'une étude prospective, sur une série consécutive de 19 patients en choc septique ou en sepsis sévère. Le maintien de la pression artérielle était assuré par une expansion volémique (Hydroxyethylamidons) et l'utilisation d'amines vasoactives. L'albumine était administrée selon les critères de la conférence de consensus (albuminémie < 20 g/L et Ponc < 12 mmHg). La mesure de l'EPEV, de l'albuminémie et de la Ponc était réalisée quotidiennement pendant 5 jours. Il n'a pas été retrouvé de corrélation entre l'albuminémie et la Ponc d'une part et l'EPEV ou le rapport PaO2/FiO2 d'autre part. L'albuminémie et la Ponc n'ont pas influencé les paramètres respiratoires lors de cette étude, toutefois le maintien de la Ponc au delà de 12 mmHg reste à préconiser.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Intérêt de l'association d'une perfusion de sulfate de magnésium à une PCA morphine pour analgésie après oesophagectomie par thoraco-laparotomie

Cette étude prospective, en double aveugle contre placebo a été réalisée afin d'évaluer l'intérêt de l'association d'une perfusion de sulfate de magnésium au couple morphine PCA - paracétamol pour l'analgésie, après oesophagectomie par thoraco-laparotomie. Vingt-six patients ont été randomisés en deux groupes: un groupe de 14 recevant un placebo et un groupe de 12 recevant du sulfate de magnésium en postopératoire... Aucune complication n'a été rapportée quant à l'utilisation du sulfate de magnésium. La consommation de morphine totale, bien que réduite de 12% dans le groupe sulfate de magnésium, n'était pas significativement différente de celle consommée dans le groupe contrôle. Cette étude ne permet pas de retenir le sulfate de magnésium, à la dose utilisée, en association à la morphine et au paracétamol pour l'analgésie postopératoire de ce type de chirurgie.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Speckle-tracking analysis is a new available tool in order to assess left ventricular function in cardiology. Its noveltyrelies on the technological ability to track natural acoustic markers (known as speckle) within the myocardium duringthe cardiac cycle. This technology allows the evaluation of myocardium strain during systole and diastole. To date,global longitudinal strain (GLS) has been extensively studied in cardiology. It is now well established that GLS is moresensitive than left ventricular ejection fraction with 2D echocardiography in detecting systolic function impairment.It is also superior to left ventricular ejection fraction in the prediction of major cardio-vascular events. In the intensivecare unit (ICU) setting, data are scarce. In experimental model and human studies in septic shock, speckle-trackinganalysis suggests that GSL is impaired along with preserved left ventricular ejection fraction. Recent data also suggestthat GLS impairment could predict in-ICU mortality in septic shock. In severe subarachnoid haemorrhage patients,speckle-tracking analysis could be more sensitive in detecting stress cardiomyopathy. However, there are many gapsto fill in the critically ill patient. For instance, the influence of mechanical ventilation on GLS is not fully elucidated,and there are, to date, too few data to exactly assess potential GLS alterations on the patient’s outcome. Nonetheless,this new tool provides objective and sensitive data with acceptable intra and inter-observer variability and may beof primary interest in the evaluation of left-ventricular systolic function in the ICU.  Speckle-tracking analysis is a new available tool in order to assess left ventricular function in cardiology. Its novelty relies on the technological ability to track natural acoustic markers (known as speckle) within the myocardium during the cardiac cycle. This technology allows the evaluation of myocardium strain during systole and diastole. To date, global longitudinal strain (GLS) has been extensively studied in cardiology. It is now well established that GLS is more sensitive than left ventricular ejection fraction with 2D echocardiography in detecting systolic function impairment. It is also superior to left ventricular ejection fraction in the prediction of major cardio-vascular events. In the intensive care unit (ICU) setting, data are scarce. In experimental model and human studies in septic shock, speckle-tracking analysis suggests that GSL is impaired along with preserved left ventricular ejection fraction. Recent data also suggest that GLS impairment could predict in-ICU mortality in septic shock. In severe subarachnoid haemorrhage patients, speckle-tracking analysis could be more sensitive in detecting stress cardiomyopathy. However, there are many gaps to fill in the critically ill patient. For instance, the influence of mechanical ventilation on GLS is not fully elucidated, and there are, to date, too few data to exactly assess potential GLS alterations on the patient’s outcome. Nonetheless, this new tool provides objective and sensitive data with acceptable intra and inter-observer variability and may be of primary interest in the evaluation of left-ventricular systolic function in the ICU.

Unmasking Pandemic Echoes: An In-Depth Review of Long COVID's Unabated Cardiovascular Consequences beyond 2020.

At the beginning of 2020, coronavirus disease 2019 (COVID-19) emerged as a new pandemic, leading to a worldwide health crisis and overwhelming healthcare systems due to high numbers of hospital admissions, insufficient resources, and a lack of standardized therapeutic protocols. Multiple genetic variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been detected since its first public declaration in 2020, some of them being considered variants of concern (VOCs) corresponding to several pandemic waves. Nevertheless, a growing number of COVID-19 patients are continuously discharged from hospitals, remaining symptomatic even months after their first episode of COVID-19 infection. Long COVID-19 or 'post-acute COVID-19 syndrome' emerged as the new pandemic, being characterized by a high variability of clinical manifestations ranging from cardiorespiratory and neurological symptoms such as chest pain, exertional dyspnoea or cognitive disturbance to psychological disturbances, e.g., depression, anxiety or sleep disturbance with a crucial impact on patients' quality of life. Moreover, Long COVID is viewed as a new cardiovascular risk factor capable of modifying the trajectory of current and future cardiovascular diseases, altering the patients' prognosis. Therefore, in this review we address the current definitions of Long COVID and its pathophysiology, with a focus on cardiovascular manifestations. Furthermore, we aim to review the mechanisms of acute and chronic cardiac injury and the variety of cardiovascular sequelae observed in recovered COVID-19 patients, in addition to the potential role of Long COVID clinics in the medical management of this new condition. We will further address the role of future research for a better understanding of the actual impact of Long COVID and future therapeutic directions

Implementation of an Evidence-based Extubation Readiness Bundle in 499 Brain-injured Patients. A Before–After Evaluation of a Quality Improvement Project

International audienc

National security to guarantee the business entrepreneurship as a form of participation in the productive development of the country under the post-conflict

La presente investigación está orientada a evidenciar que en la actualidad el emprendimiento representa un elemento fundamental para el desarrollo del país toda vez que coadyuvan a renovar el tejido productivo de la sociedad y ofrecer nuevas oportunidades de desarrollo socio-económico que potencien el desarrollo de empresas que propendan por alcanzar niveles de productividad acorde a las necesidades apremiantes del país. En este ensayo, se evidenciará el primera medida, una reflexión y análisis del concepto del Emprendimiento desde lo conceptual y epistemológico que permitirá ir avanzando a la definición del emprendimiento empresarial, teniendo en cuenta que el modelo económico y la situación colombiana, presenta la potestad de dinamizar la economía a las empresas y personas; que con los procesos de integración económicas obliga para lo local y también con una visión global. El modelo económico actual, es catalogado como neoliberal, impregnado de máximas como: competitividad, productividad, rentabilidad; significando para algunas empresas y personas: absorción de mercados, alianzas, fusiones; y, para muchos, fracaso, fragmentación, exclusión y pobreza, entre otros flagelos. Lo cierto es que las tendencias son la integración y globalización de las economías y los mercados. Ante esa realidad, se describe la situación del caso colombiano, como sigue: el mercado, marca la diferencia entre países desarrollados, y los llamados “subdesarrollados” o en palabras de (Drucker’s, 2006) “mal administrados”, por muchas razones, sobresaliendo sus condicionamientos históricos, acentuado por procesos de violencia, migración, asilo interno o desplazamiento ante la colonización que según las épocas, se ha disfrazado con diferentes palabras y actores.The present investigation is orientated to demonstrate that at present the entrepreneurship represents a fundamental element for the development of the country although they contribute to renewing the productive fabric of the company and offering new opportunities of socio-economic development that promote the development of companies that they tend for reaching levels of identical productivity to the urgent needs of the country. In this test, there will be demonstrated the first measure, a reflection and analysis of the concept of the entrepreneurship from the conceptual thing and epistemology that will allow to be advancing to the definition of the managerial entrepreneurship, bearing in mind that the economic model and the Colombian situation, presents the legal authority to stir the economy into action to the companies and persons; that with the processes of integration economic forces for the local thing and also with a global vision. The economic current model, is catalogued as neoliberal impregnated with maxims as: competitiveness, productivity, profitability; meaning for some companies and persons: absorption of markets, alliances, mergers; and, for many, I fail, fragmentation, exclusion and poverty, between other scourges. The certain thing is that the trends are the integration and globalization of the economies and the markets. Before this reality, there is described the situation of the Colombian case, as it continues: the market, it marks the difference between developed countries, and the so called "underdeveloped ones" or in words " badly administered" (Drucker’s, 2006), for many reasons, standing out his historical conditionings, accentuated by processes of violence, migration, internal asylum or displacement before the settling that according to the epochs, has disguised itself with different words and actors

Association between continuous hyperosmolar therapy and survival in patients with traumatic brain injury – a multicentre prospective cohort study and systematic review

International audienceBackground : Intracranial hypertension (ICH) is a major cause of death after traumatic brain injury (TBI). Continuoushyperosmolar therapy (CHT) has been proposed for the treatment of ICH, but its effectiveness is controversial. Wecompared the mortality and outcomes in patients with TBI with ICH treated or not with CHT.Methods:We included patients with TBI (Glasgow Coma Scale≤12 and trauma-associated lesion on braincomputed tomography (CT) scan) from the databases of the prospective multicentre trials Corti-TC, BI-VILI andATLANREA. CHT consisted of an intravenous infusion of NaCl 20% for 24 hours or more. The primary outcome wasthe risk of survival at day 90, adjusted for predefined covariates and baseline differences, allowing us to reduce thebias resulting from confounding factors in observational studies. A systematic review was conducted includingstudies published from 1966 to December 2016. Results : Among the 1086 included patients, 545 (51.7%) developed ICH (143 treated and 402 not treated withCHT). In patients with ICH, the relative risk of survival at day 90 with CHT was 1.43 (95% CI, 0.99–2.06,p= 0.05). Theadjusted hazard ratio for survival was 1.74 (95% CI, 1.36–2.23,p< 0.001) in propensity-score-adjusted analysis. At day90, favourable outcomes (Glasgow Outcome Scale 4–5) occurred in 45.2% of treated patients with ICH and in 35.8%of patients with ICH not treated with CHT (p= 0.06). A review of the literature including 1304 patients from eightstudies suggests that CHT is associated with a reduction of in-ICU mortality (intervention, 112/474 deaths (23.6%) vs.control, 244/781 deaths (31.2%); OR 1.42 (95% CI, 1.04–1.95),p= 0.03,I2= 15%). Conclusions : CHT for the treatment of posttraumatic ICH was associated with improved adjusted 90-day survival.This result was strengthened by a review of the literature