Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2-15.1], 13 J/min [IQR 10-17], and 14 J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22). Conclusions: Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation

Les conseils médicaux aux voyageurs agés

Face au nombre croissant de voyageurs âgés, il est important, pour les acteurs de santé, de bien les conseiller afin de limiter la survenue d accidents au cours de séjours à l étranger. La préparation du voyage passe d abord par une visite médicale avant de s attarder sur la vaccination (vaccins classiques et ceux liés au voyage) et sur la prévention antipaludique. Sur place, les recommandations portent principalement sur les risques liés au transport et à la déshydratation. Dans le cas du transport, la prévention se fait essentiellement sur le risque d accidents thromboemboliques favorisé par une station assise prolongée. Le risque de déshydratation est, quant à lui, potentialisé par de nombreux facteurs fréquemment rencontrés au cours d un voyage et chez les sujets âgés : chaleur, troubles gastro-intestinaux, incontinence urinaire, médicaments. Le dernier point de ces conseils s articule autour de l environnement du lieu de destination : décalage horaire, climat, altitude.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Une vue des États-Unis

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À table ! Alimentation et sciences sociales

Dossier de 6 articles.À l’honneur dans les blogs et magazines culinaires, les livres de régime, émissions et concours télévisés, l’alimentation n’en tient pas moins une place insoupçonnée, souvent souterraine ou clandestine, dans des œuvres fondatrices des sciences sociales. Ce dossier revient sur l’actualité éditoriale et scientifique de travaux regroupés aux États-Unis sous l’étiquette de food studies. [...] Ce dossier vise à présenter des manières de voir et de faire des sciences sociales de l’alimentation, en faisant jouer des problèmes, des terrains et des expériences de recherche variés. Un parti pris rassemble les contributions de ce dossier : contre une tendance à envisager l’alimentation sous ses formes les plus spectaculaires ou les plus nobles, celles d’une activité de loisir ou d’un patrimoine, il s’agit de la saisir par le bas, en s’intéressant à l’expérience des gens ordinaires, mais aussi des militants, des « critiques » et des « experts » confrontés à cet objet, dans ses multiples dimensions — diététiques, esthétiques et politiques. ..

Acute kidney injury is associated with a decrease in cortical renal perfusion during septic shock

Abstract Background Renal perfusion status remains poorly studied at the bedside during septic shock. We sought to measure cortical renal perfusion in patients with septic shock during their first 3 days of care using renal contrast enhanced ultrasound (CEUS). Methods We prospectively included 20 ICU patients with septic shock and 10 control patients (CL) without septic shock admitted to a surgical ICU. Cortical renal perfusion was evaluated with CEUS during continuous infusion of Sonovue (Milan, Italy) within the first 24 h (day 0), between 24 and 48 h (day 1) and after 72 h (day 3) of care. Each measurement consisted of three destruction replenishment sequences that were recorded for delayed analysis with dedicated software (Vuebox). Renal perfusion was quantified by measuring the mean transit time (mTT) and the perfusion index (PI), which is the ratio of renal blood volume (rBV) to mTT. Results Cortical renal perfusion was decreased in septic shock as attested by a lower PI and a higher mTT in patients with septic shock than in patients of the CL group (p = 0.005 and p = 0.03). PI values had wider range in patients with septic shock (median (min-max) of 74 arbitrary units (a.u.) (3–736)) than in patients of the CL group 228 a.u. (67–440)). Renal perfusion improved over the first 3 days with a PI at day 3 higher than the PI at day 0 (74 (22–120) versus 160 (88–245) p = 0.02). mTT was significantly higher in patients with severe acute kidney injury (AKI) (n = 13) compared with patients with no AKI (n = 7) over time (p = 0.005). The PI was not different between patients with septic shock with severe AKI and those with no AKI (p = 0.29). Conclusions Although hemodynamic macrovascular parameters were restored, the cortical renal perfusion can be decreased, normal or even increased during septic shock. We observed an average decrease in cortical renal perfusion during septic shock compared to patients without septic shock. The decrease in cortical renal perfusion was associated with severe AKI occurrence. The use of renal CEUS to guide renal perfusion resuscitation needs further investigation

Actes des 1eres journées GAMAE.: L'évaluation des jeux en agriculture, alimentation, environnement et territoires.

National audienceThis document includes the scientific papers and their supports of the 1st GAMAE symposium which took place on 9 and 10 June 2022 in Clermont-Ferrand (France). The theme of the symposium was the assessment of serious games on agricultural, environmental and food issues.Ce document regroupe les communications scientifiques et leurs supports du 1er colloque GAMAE qui s'est déroulé les 9 et 10 juin 2022 à Clermont-Ferrand (France). Le thème du colloque était l'évaluation des serious games sur les questions agricoles, environnementales et alimentaires

Thermal properties of 1.5µm InAs/InP quantum dot lasers

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Recombination processes in 1.55µm InAs/InP quantum dot lasers

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Lasers devices based on nanostructures grown on InP substrate for 1.55 μm emission

Third French Research Organizations - Tohoku University Joint Workshop on Frontier Material