ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Metformin toxicity.

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Les intoxications chez l’enfant

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Should blood glucose be tightly controlled in the intensive care unit?

Stress hyperglycemia occurs frequently during critical illness due to the increased resistance to insulin. The three domains of dysglycemia, that is, stress hyperglycemia, hypoglycemia, and high glycemic variability, are associated with a poor outcome. The risk-to-benefit ratio of intensive insulin therapy aiming at a blood glucose target ranging from 80 to 110 mg/dL has not been found beneficial in most interventional studies. Glycemic control titrated to reach liberal glycemic ranges of blood glucose and personalized targets are currently investigated in clinical trials.SCOPUS: ch.binfo:eu-repo/semantics/publishe

Year in review 2013: Critical care - metabolism

Novel insights into the metabolic alterations of critical illness, including new findings on association between blood glucose at admission and poor outcome, were published in Critical Care in 2013. The role of diabetic status in the relation of the three domains of glycemic control (hyperglycemia, hypoglycemia, and glycemic variability) was clarified: the association between mean glucose, high glucose variability, and ICU mortality was stronger in the non-diabetic than in diabetic patients. Improvements in the understanding of pathophysiological mechanisms of stress hyperglycemia were presented. Novel developments for the management of glucose control included automated closed-loop algorithms based on subcutaneous glucose measurements and microdialysis techniques. In the field of obesity, some new hypotheses that could explain the 'obesity paradox' were released, and a role of adipose tissue in the response to stress was suggested by the time course of adipocyte fatty-acid binding protein concentrations. In the field of nutrition, beneficial immunological effects have been associated with early enteral nutrition. Early enteral nutrition was significantly associated with potential beneficial effects on the phenotype of lymphocytes. Uncertainties regarding the potential benefits of small intestine feeding compared with gastric feeding were further investigated. No significant differences were observed between the nasogastric and nasojejunal feeding groups in the incidence of mortality, tracheal aspiration, or exacerbation of pain. The major risk factors to develop diarrhea in the ICU were described. Finally, the understanding of disorders associated with trauma and potential benefits of blood acidification was improved by new experimental findings.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Histoire d'une toux chronique.

A 64 years old woman was admitted for persistent dry cough. The cough was lasting for one month and was associated with throat clearing, asthenia and low fever mainly at night. A thorough anamnesis also revealed the existence of mild occipital headache. Empirical antibiotic therapy (clarithromycine) had previously been administered without any clinical improvement. Physical examination was normal. However, the blood tests showed an inflammatory syndrome. The diagnostic approach was focused on the lungs, sinuses and digestive tract and did not show any acute disease. The bronchoscopy demonstrated an edematous bronchial mucosa without endoluminal lesion. The results of bacteriological tests performed were negative. Given the age of the patient and the persistence of an inflammatory syndrome of unknown origin, the diagnosis of giant cell arteritis should be excluded, despite an unusual clinical presentation. This hypothesis was supported by a diagnostic biopsy of the right temporal artery, which histological analysis showed characteristic pattern.Case ReportsEnglish AbstractJournal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Place de l'imagerie médicale dans la lombosciatalgie

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Le concept du « Baby stomach » appliqué à la nutrition du patient agressé

Following the findings of deleterious effects of excessive nutritional support during the acute phase of critical illness, the concept of “baby stomach” was introduced to characterize the restricted ability to use macro-nutrients and to inhibit the endogenous glucose production. The clinical practice guidelines evolved in parallel. “Permissive underfeeding”, e.g. caloric and nitrogen intakes lower than energy expenditure and protein losses during the acute phase are now recommended by the scientific societies. Progressive caloric intakes reaching a maximum of 70 % of energy expenditure during the first 3–7 days after injury are proposed. The underlying pathophysiological mechanisms of the deleterious effects of excessive nutritional intakes are partially elucidated and include overfeeding, the inhibition of autophagy and refeeding hypophosphatemia. The data from the available clinical studies trigger a number of basic and clinical research, whose answers are definitely needed to further improve the nutritional management of the critically ill patients.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Update on glucose in critical care

The aim of this review is to summarize recent developments on the mechanisms involved in stress hyperglycemia associated with critical illness. Different aspects of the consequences of stress hyperglycemia as well as the therapeutic approaches tested so far are discussed: the physiological regulations of blood glucose, the mechanisms underlying stress hyperglycemia, the clinical associations, and the results of the prospective trials and meta-analyses to be taken into consideration when interpreting the available data. Current recommendations, challenges, and technological hopes for the future are be discussed.SCOPUS: re.jinfo:eu-repo/semantics/publishe

A Step Toward Personalized Glycemic Control

SCOPUS: no.jinfo:eu-repo/semantics/publishe