Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS)

Echocardiography is increasingly used in the management of the critically ill patient as a non-invasive diagnostic and monitoring tool. Whilst in few countries specialized national training schemes for intensive care unit (ICU) echocardiography have been developed, specific guidelines for ICU physicians wishing to incorporate echocardiography into their clinical practice are lacking. Further, existing echocardiography accreditation does not reflect the requirements of the ICU practitioner. The WINFOCUS (World Interactive Network Focused On Critical UltraSound) ECHO-ICU Group drew up a document aimed at providing guidance to individual physicians, trainers and the relevant societies of the requirements for the development of skills in echocardiography in the ICU setting. The document is based on recommendations published by the Royal College of Radiologists, British Society of Echocardiography, European Association of Echocardiography and American Society of Echocardiography, together with international input from established practitioners of ICU echocardiography. The recommendations contained in this document are concerned with theoretical basis of ultrasonography, the practical aspects of building an ICU-based echocardiography service as well as the key components of standard adult TTE and TEE studies to be performed on the ICU. Specific issues regarding echocardiography in different ICU clinical scenarios are then described

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Le régime méditerranéen en phase avec les Objectifs de développement durable en région Provence-Alpes-Côte d’Azur ?

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Le régime méditerranéen en phase avec les Objectifs de développement durable en région Provence-Alpes-Côte d’Azur ?

National audienc

Quels sont les défis majeurs de l’alimentation et de l’agriculture de l’échelle mondiale à régionale ?

National audienceIl existe mille manières de produire de la nourriture et de s’alimenter mais le système « agriculture-alimentation » n’est aujourd’hui ni satisfaisant, ni durable, aussi bien à l’échelle globale que territoriale

Quels sont les défis majeurs de l’alimentation et de l’agriculture de l’échelle mondiale à régionale ?

National audienceIl existe mille manières de produire de la nourriture et de s’alimenter mais le système « agriculture-alimentation » n’est aujourd’hui ni satisfaisant, ni durable, aussi bien à l’échelle globale que territoriale

70.1: LED-Illuminated Pico Projector Architectures

Abstract Optical architecture choices optimize pico-projection engines for battery-powered embedded applications and wall-plug-powered stand-alone applications. Embedded engines offer power efficiencies above 6 lm/W, while stand-alone systems offer luminous outputs up to 110 lm

The shortest way to reach nutritional goals is to adopt Mediterraneanfood choices: evidence from computer-generated personalized diets

International audienceConclusion: Whether recommendations on total fats, MUFAs, or total carbohydrates are included or not in the definition of overall nutrient adequacy, foods typical of the Mediterranean diet are needed to reach overall nutrient adequacy. Am J Clin Nutr 2011;94:1127-37

The shortest way to reach nutritional goals is to adopt Mediterranean food choices

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