Variation in general supportive and preventive intensive care management of traumatic brain injury: a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study

Abstract Background General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. Methods We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We analyzed 23 questions focused on: 1) circulatory and respiratory management; 2) fever control; 3) use of corticosteroids; 4) nutrition and glucose management; and 5) seizure prophylaxis and treatment. Results The survey was completed predominantly by intensivists (n = 33, 50%) and neurosurgeons (n = 23, 35%) from 66 centers (97% response rate). The most common cerebral perfusion pressure (CPP) target was > 60 mmHg (n = 39, 60%) and/or an individualized target (n = 25, 38%). To support CPP, crystalloid fluid loading (n = 60, 91%) was generally preferred over albumin (n = 15, 23%), and vasopressors (n = 63, 96%) over inotropes (n = 29, 44%). The most commonly reported target of partial pressure of carbon dioxide in arterial blood (PaCO2) was 36–40 mmHg (4.8–5.3 kPa) in case of controlled intracranial pressure (ICP) < 20 mmHg (n = 45, 69%) and PaCO2 target of 30–35 mmHg (4–4.7 kPa) in case of raised ICP (n = 40, 62%). Almost all respondents indicated to generally treat fever (n = 65, 98%) with paracetamol (n = 61, 92%) and/or external cooling (n = 49, 74%). Conventional glucose management (n = 43, 66%) was preferred over tight glycemic control (n = 18, 28%). More than half of the respondents indicated to aim for full caloric replacement within 7 days (n = 43, 66%) using enteral nutrition (n = 60, 92%). Indications for and duration of seizure prophylaxis varied, and levetiracetam was mostly reported as the agent of choice for both seizure prophylaxis (n = 32, 49%) and treatment (n = 40, 61%). Conclusions Practice preferences vary substantially regarding general supportive and preventive measures in TBI patients at ICUs of European neurotrauma centers. These results provide an opportunity for future comparative effectiveness research, since a more evidence-based uniformity in good practices in general ICU management could have a major impact on TBI outcome

Surgical fixation in flail chest: a local first encouraging experience.

peer reviewedWe report the case of a young woman who suffered from a severe traffic accident with major thoracic trauma consisting of hemopneumothorax and flail chest. At day 5 of mechanical ventilation, a surgical reduction and fixation of the fractured ribs were performed; the patient was liberated from mechanical ventilation the next day and discharged from the intensive care unit two days later. The success of this local first case incites us to further a similar approach in such challenging trauma cases

Thermal ageing evaluation of composite plates through electromechanical impedance

International audienceElectromechanical impedance monitoring is investigated to quantify changes in physical and mechanical properties during the ageing of composite plates. In this context, an experimental measurement protocol is proposed, on the basis of a broadband 1 MHz center frequency piezoelectric transducer. After a preliminary characterization of the parameters of the transducer itself, the acoustical impedance of the front medium is deduced. More particularly, the acoustical properties such as longitudinal wave velocity and attenuation are identified in the studied composite carbon/epoxy plates. From the electrical measurement results in the MHz frequency range, the acoustical impedance of the plate is plotted in the complex plane, showing characteristic signatures corresponding to the actually monitored composite plate. The ageing is quantified, showing the effectiveness of this non-destructive evaluation method. First, the acoustical parameters of a plate made of a carbon/epoxy composite are modeled in order to study their sensitivity. During the ageing, those acoustical properties are known to evolve significantly, i.e. a decrease of the wave velocity and an increase of the attenuation, which can both be related to the increase of the porosity level in the plate. Secondly, these acoustical properties are evaluated on a set of samples which were submitted to a range of ageing duration from 500 to 5000 h performed at a thermostated temperature of 180°C. The feasibility of the evaluation of the ageing is demonstrated, and the precision of this measurement is discussed both in terms of temperature dependency and reproducibility

Détermination de l'atténuation ultrasonore d'une huile silicone et estimation de la viscosité

National audienceDans le cadre d'une étude portant sur le suivi de polymérisation de matériau composite, une étude est réalisée sur des huiles de viscosité calibrée. La viscosité des fluides est liée aux phénomènes dissipatifs décrits en mécanique des fluides. Elle est mesurable notamment par une sollicitation périodique en cisaillement (fréquence de l'ordre du Hz). Ces phénomènes dissipatifs peuvent se mesurer au moyen d'ondes ultrasonores (fréquence de l'ordre du MHz). Pour cela, un dispositif expérimental approprié aux futures conditions de mesure est proposé. Le fluide étudié est placé entre 4 cm de verre et une plaque épaisse d'aluminium. L'épaisseur du fluide est de l'ordre de 6 mm. Les incertitudes liées aux conditions expérimentales sont quantifiées et leur incidence sur la précision de la mesure est discutée. Les résultats des deux mesures, mécanique et ultrasonore, sont confrontés et une corrélation est établie entre les résultats de trois huiles de viscosité calibrée. Ces données sont alors utilisées afin de déterminer la viscosité d'un fluide par la méthode ultrasonore

Monitoring of an ascending air bubble in a viscous fluid/fiber matrix medium using a phased array transducer

International audienceDetecting porosities of different scales, both micro and macro, is a current problem in the development of composite materials. This is especially true for composite materials manufactured using Resin Transfer Molding (RTM). When injecting resin in the fibrous preform porosities appear, originating essentially because of air trapped in the fiber matrix. Consequently, the interaction between air bubbles and fibers has been the subject of several numerical investigations. In this study, we propose an original experimental method to monitor the interaction of air bubbles with a fibrous matrix. A 10 MHz center frequency ultrasonic phased array transducer is used to monitor air bubbles in the millimeter range. The ultrasonic imaging method is first tested only with bubbles ascending in a channel containing silicone oil. Then it is tested again in a sample of fiber matrix immersed in the same channel. The results prove the effectiveness of the measurement process. These results then can be used to find a correlation between the appearance of porosities and the processes that generate them in order to consider how to improve RTM. They can also be used to understand the interaction phenomena between bubbles and folds in order to improve RTM process

Ultrasonic imaging of bubble motion in a fiber preform

International audienceDuring the Resin Transfer Molding (RTM) process, bubbles can appear and move between fiber strands and fiber folds. In this study, a monitoring method for the size and velocity of air bubbles using an ultrasonic phased array transducer is proposed. This method is tested in a flow of known viscous silicone oil along a sample of fiber preform. By ultrasonic imaging the fiber preform immersed in a viscous flow, a position-time map (xfl, t) is obtained for each acquisition date tacq. These data could be converted to (xfl, z, tacq) data. The bubble motion is extracted from the raw data by separation of the static component from the dynamic part of the signal. As a result, a modified C-scan is obtained and both the instantaneous position and velocity of a bubble could be extracted in the (x, z) plane. Through these measures, the evolution of the bubbles is related to the processes that generate them in order to consider improvements to the RTM technique

Prevalence of Toxoplasma gondii Antibodies in Stray Dogs in Taipei

International audienc