51 research outputs found
Respiratory pulse pressure variation fails to predict fluid responsiveness in acute respiratory distress syndrome
International audienceIntroduction: Fluid responsiveness prediction is of utmost interest during acute respiratory distress syndrome (ARDS), but the performance of respiratory pulse pressure variation (Î RESP PP) has scarcely been reported. In patients with ARDS, the pathophysiology of Î RESP PP may differ from that of healthy lungs because of low tidal volume (Vt), high respiratory rate, decreased lung and sometimes chest wall compliance, which increase alveolar and/or pleural pressure. We aimed to assess Î RESP PP in a large ARDS population. Methods: Our study population of nonarrhythmic ARDS patients without inspiratory effort were considered responders if their cardiac output increased by >10% after 500-ml volume expansion. Results: Among the 65 included patients (26 responders), the area under the receiver-operating curve (AUC) for Î RESP PP was 0.75 (95% confidence interval (CI 95): 0.62 to 0.85), and a best cutoff of 5% yielded positive and negative likelihood ratios of 4.8 (CI 95 : 3.6 to 6.2) and 0.32 (CI 95 : 0.1 to 0.8), respectively. Adjusting Î RESP PP for Vt, airway driving pressure or respiratory variations in pulmonary artery occlusion pressure (ÎPAOP), a surrogate for pleural pressure variations, in 33 Swan-Ganz catheter carriers did not markedly improve its predictive performance. In patients with ÎPAOP above its median value (4 mmHg), AUC for Î RESP PP was 1 (CI 95 : 0.73 to 1) as compared with 0.79 (CI 95 : 0.52 to 0.94) otherwise (P = 0.07). A 300-ml volume expansion induced a â„2 mmHg increase of central venous pressure, suggesting a change in cardiac preload, in 40 patients, but none of the 28 of 40 nonresponders responded to an additional 200-ml volume expansion. Conclusions: During protective mechanical ventilation for early ARDS, partly because of insufficient changes in pleural pressure, Î RESP PP performance was poor. Careful fluid challenges may be a safe alternative
Echographie versus IRM pour la mesure de la lumiÚre laryngée cricoïdienne (étude chez le volontaire sain)
TOURS-BU MĂ©decine (372612103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Mesure non invasive de la pression artérielle chez le patient de réanimation (performance selon le site de mesure)
Introduction: En rĂ©animation, la pression artĂ©rielle (PA) est rĂ©guliĂšrement mesurĂ©e de façon non invasive, y compris chez le patient souffrant d'insuffisance circulatoire aigue (ICA), dans l'attente de la pose d'un cathĂ©ter artĂ©riel. Le brassard est parfois placĂ© sur la cheville ou la cuisse en raison de l'impossibilitĂ© de le positionner autour du bras, mais aucune Ă©tude n'a Ă©valuĂ© cette pratique. Nous avons donc Ă©tudiĂ© la fiabilitĂ© de la mesure non invasive de la PA en ces diffĂ©rents sites. MatĂ©riel et mĂ©thodes: Dans cette Ă©tude prospective, des patients hospitalisĂ©s en rĂ©animation ont Ă©tĂ© inclus s'ils Ă©taient porteurs d'un cathĂ©ter artĂ©riel et ne souffraient pas d'artĂ©riopathie oblitĂ©rante Ă©voluĂ©e. En cas de douleur marquĂ©e provoquĂ©e par le gonflage du brassard, le patient Ă©tait exclu. Pour chaque site (bras, cheville et cuisse [uniquement si score de Ramsay>4]), une sĂ©rie de 3 paires de mesures invasives et non invasives de la PA a Ă©tĂ© rĂ©alisĂ©e. Les patients souffrant d'ICA ont fait l'objet d'une 2e sĂ©rie de mesures aprĂšs intervention hĂ©modynamique (remplissage vasculaire et/ou modification de dose de catĂ©cholamines). RĂ©sultats: Sur les 159 patients inclus, 9 ont Ă©tĂ© exclus (artĂ©riopathie, douleur), 79 Ă©taient en ICA (dont 57 ayant bĂ©nĂ©ficiĂ© d'une intervention hĂ©modynamique). La mesure non invasive a Ă©chouĂ© aux 3 sites chez un mĂȘme patient, et Ă la cuisse chez un autre. Quel que soit le site de mesure, la concordance entre mesures invasives et non invasives Ă©tait meilleure pour la P AM que pour la PAS ou la PAD oĂč elle Ă©tait mĂ©diocre. La mesure non invasive de la PAM Ă©tait fiable au bras (biais moyen de 3,4+-5 mmHg), validant les critĂšres recommandĂ©s, contrairement Ă la cheville et la cuisse (biais moyen de 3,1+-7,7 et 5,7+-6,8 mmHg, respectivement). En revanche, chez le patient souffrant d'ICA, la mesure Ă la cheville et Ă la cuisse permettait une bonne dĂ©tection 1) d'une PAM 10% (ASC de 0,99 [0,92-1], 0,90 [0,80-0,97] et 0,96 [0,87-0,99], respectivement). Conclusion: Dans notre population de patients de rĂ©animation, seule la valeur de la PAM mesurĂ©e au bras est fiable, y compris en cas d'insuffisance circulatoire aigue. En cas d'impossibilitĂ© de positionner le brassard au niveau du bras, la cheville et la cuisse peuvent ĂȘtre des alternatives fiables, afin de dĂ©tecter les patients souffrant d'hypotension artĂ©rielle et pour identifier les rĂ©pondeurs Ă une intervention hĂ©modynamique, dans l'attente de la pose d'un cathĂ©ter artĂ©riel.MONTPELLIER-BU MĂ©decine UPM (341722108) / SudocMONTPELLIER-BU MĂ©decine (341722104) / SudocSudocFranceF
ĂpidĂ©miologie de la nĂ©phropathie induite par les produits de contraste iodĂ©s chez le patient de rĂ©animation (Ă©tude prospective)
MONTPELLIER-BU MĂ©decine UPM (341722108) / SudocMONTPELLIER-BU MĂ©decine (341722104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Dynamic Indices Derived from HeartâLung Interactions: Incende Quod Adorasti
International audienc
Lack of impact of iodinated contrast media on kidney cell-cycle arrest biomarkers in critically ill patients
Abstract Background Iodinated contrast media may contribute to acute kidney injury. However, several recent works suggest that this toxicity is minimal in the clinical setting. Recently, urinary G1 cell-cycle arrest proteins tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin like growth factor binding protein 7 (IGFBP-7) were identified as highly sensitive and specific biomarkers for early detection of kidney aggression. The impact of contrast administration on those biomarkers has not been specifically evaluated but could provide clues about the toxicity of contrast media. This study aimed at measuring changes in TIMP-2 and IGFBP-7 urinary concentrations before and after a contrast-enhanced computed tomography in critically ill patients. Methods 77 patients were included in a prospective observational cohort study. Urinary [TIMP -2]·[IGFBP-7] was measured before, 6 and 24 h after contrast infusion. Urine output and serum creatinine were followed 3 days. Results Median [TIMP-2]·[IGFBP-7] was 0.06 [interquartile range 0.04;0.26], 0.07 [0.03;0.34] and 0.10 [0.04;0.37] (ng/mL)2/1000 respectively before, 6 and 24 h after contrast infusion. Individual changes from baseline wereâââ0.01 [ââ0.11;0.11] and 0.00 [ââ0.10;0.09] (ng/ml)2/1000 at 6 and 24 h. These changes were not higher among the patients increasing their Kidney Disease Improving Global Outcome (KDIGO) classification within 3 days after contrast infusion (n =â14 [18%] based on creatinine criterion only, n =â42 [55%] based on creatinine and urine output). Conclusions Changes in [TIMP-2]·[IGFBP-7] urinary concentration after contrast-enhanced computed tomography were insignificant, suggesting minimal kidney aggression by modern iodinated contrast media
Evolution of Neurological Recovery during the First Year after Subarachnoid Haemorrhage in a French University Centre
International audienceINTRODUCTION: The evolution of neurological recovery during the first year after aneurysmal Subarachnoid Haemorrhage (SAH) is poorly described. PATIENTS: Patients with SAH in one university hospital from March the 1st 2010, to December 31st 2012, with a one-year follow-up. METHOD: Evaluation was performed via phone call at 3, 6 and 12\,months. Primary endpoint was poor neurological recovery (modified Rankin Scale 3-4-5-6), one year after SAH. Secondary endpoints were the incidence of lack of self-perceived previous health status recovery and incidence of cognitive disorders, one year after SAH. Risk factors of poor neurological recovery were retrieved with multivariable logistic regression. RESULTS: Two hundred and eleven patients were included and 208 had a complete follow-up. One hundred and twenty (57.7%) patients were female, 112 (53.8%) had a WFNS grade I-II-III. Seventy (33.6%) patients displayed one-year poor neurological outcome and risk factors of poor outcome were age, baseline Glasgow Coma Score\,â€q\,8, external ventricular drainage, intra-cranial hypertension and angiographic vasospasm. We observed an improvement in good outcome at 3\,months [112 (53.8%) patients], 6 months [127 (61.1%) patients] and one-year [138 (66.3%) patients]. Fifty-nine (35.3%) patients recovered previous health status, 96 (57.5%) had persistent behaviour disorders, and 71 (42.5%) suffered from memory losses at one year. DISCUSSION: Neurological recovery seems to improve over time. The same key complications should be targeted worldwide in SAH patients. CONCLUSION: Neurological complications in the following of SAH should be actively treated in order to improve outcome. The early neuro-ICU phase remains a key determinant of long-term recovery
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