Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine.

OBJECTIVE: Circulatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock. METHODS: The European Society of Intensive Care Medicine invited 12 experts to form a Task Force to update a previous consensus (Antonelli et al.: Intensive Care Med 33:575-590, 2007). The same five questions addressed in the earlier consensus were used as the outline for the literature search and review, with the aim of the Task Force to produce statements based on the available literature and evidence. These questions were: (1) What are the epidemiologic and pathophysiologic features of shock in the intensive care unit ? (2) Should we monitor preload and fluid responsiveness in shock ? (3) How and when should we monitor stroke volume or cardiac output in shock ? (4) What markers of the regional and microcirculation can be monitored, and how can cellular function be assessed in shock ? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock ? Four types of statements were used: definition, recommendation, best practice and statement of fact. RESULTS: Forty-four statements were made. The main new statements include: (1) statements on individualizing blood pressure targets; (2) statements on the assessment and prediction of fluid responsiveness; (3) statements on the use of echocardiography and hemodynamic monitoring. CONCLUSIONS: This consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock

Perioperative echocardiography-guided hemodynamic therapy in high-risk patients:a practical expert approach of hemodynamically focused echocardiography

The number of high-risk patients undergoing surgery is growing. To maintain adequate hemodynamic functioning as well as oxygen delivery to the vital organs (DO2) amongst this patient population, a rapid assessment of cardiac functioning is essential for the anesthesiologist. Pinpointing any underlying cardiovascular pathophysiology can be decisive to guide interventions in the intraoperative setting. Various techniques are available to monitor the hemodynamic status of the patient, however due to intrinsic limitations, many of these methods may not be able to directly identify the underlying cause of cardiovascular impairment. Hemodynamic focused echocardiography, as a rapid diagnostic method, offers an excellent opportunity to examine signs of filling impairment, cardiac preload, myocardial contractility and the function of the heart valves. We thus propose a 6-step-echocardiographic approach to assess high-risk patients in order to improve and maintain perioperative DO2. The summary of all echocardiographic based findings allows a differentiated assessment of the patient's cardiovascular function and can thus help guide a (patho)physiological-orientated and individualized hemodynamic therapy

Pourquoi voir un docteur? C'est un dentiste qu'il vous faut! Santé buccale et médecine de premier recours: quels enjeux [Why try a docter when you need a dentist? Oral health and primary care medicine: what are the issues?].

Oral conditions have some of the highest prevalence and incidences rates of all health problems in industrialized countries. They are associated with pain, functional limitations, interferences with usual activities and life-threatening complications. Most people experiencing oral symptoms visit a dentist. But how many and why are patients with oral conditions presenting to general practitioners? Despite early separated training curriculum, there is an overlap with regard to clinicians in medicine and dentistry, who are called to treat patients seeking care for non dental problems of the maxillofacial region. This paper aims to get a fix on oral conditions in which primary care doctors have unmistakably to play a role in. However, studies have shown that physicians lack knowledge to promote oral health in their patients what lead universities to develop recently an oral health curriculum for medical students

Pourquoi voir un docteur? C'est un dentiste qu'il vous faut! Santé buccale et médecine de premier recours: quels enjeux [Why try a docter when you need a dentist? Oral health and primary care medicine: what are the issues?].

Oral conditions have some of the highest prevalence and incidences rates of all health problems in industrialized countries. They are associated with pain, functional limitations, interferences with usual activities and life-threatening complications. Most people experiencing oral symptoms visit a dentist. But how many and why are patients with oral conditions presenting to general practitioners? Despite early separated training curriculum, there is an overlap with regard to clinicians in medicine and dentistry, who are called to treat patients seeking care for non dental problems of the maxillofacial region. This paper aims to get a fix on oral conditions in which primary care doctors have unmistakably to play a role in. However, studies have shown that physicians lack knowledge to promote oral health in their patients what lead universities to develop recently an oral health curriculum for medical students

Osteoradionecrosis: an update.

Osteoradionecrosis (ORN) of the mandible is the most serious and severe side effect of combined treatment of head and neck tumors. A new theory for the pathogenesis of ORN has been proposed relating it to a fibro-atrophic mechanism including free radical formation, endothelial dysfunction, inflammation, microvascular thrombosis leading to bone and tissue necrosis. Risk factors mainly include radiation related risk factors, surgery and, tobacco and alcohol abuse. Removing of diseased teeth after and even probably after radiotherapy is generally considered the main risk factor in ORN. Conversely, steroid use before or after radiation may have a protective effect related to the inhibition of the initial inflammatory phase of ORN. Prevention of ORN is still based on the preventive extractions of decayed or periodontally compromised teeth before radiotherapy. Based on the current understanding of ORN pathophysiology, new preventive and therapeutic protocols have been suggested for mild to moderate stages. Free tissue surgical transfers is the treatment of choice of severe, extensive and long established ORN

Carie du biberon: un caillou dans la chaussure de la santé. [The impact of childhood caries]

The early childhood caries affect primary dentition before the eruption of the permanent teeth. It is set to extended use of a bottle containing fermentable carbohydrates. The early childhood caries is not only a dental disease: it is a social, cultural and behavioral condition that reflects the practices and beliefs around the child. Swiss data indicate that in aged 2 children, one of for could be affected by this devastating oral disease, mainly in vulnerable populations. The primary care physician has an important role in the screening of preschool children, in determining the risk level of the child for early childhood caries. Physicians can advise families, especially pregnant women, about preventive measures and behavior, leading to a dramatic drop of early childhood caries prevalence