Marqueurs pronostiques neurologiques des arrêts cardiaques extrahospitaliers (étude rétrospectives gardoise de 2010 à 2013)

ntroduction L'évaluation du pronostic neurologique des .arrêts cardiaques (AC) demeure complexe; engageant le médecin dans des démarches éthiques et thérapeutiques délicates. Le but de cette étude est de déteminer précocement, quels sont les marqueurs anamnestiques, cliniques et paracliniques associés au mauvais pronostic neurologique chez les patients en vie à J3.Méthodes De janvier 2010 à mars 2013,130 arrêts cardiaques extrahospitaliers consécutifs, hospitalisés en réanimation au CHU de Nîmes étaient inclus rétrospectivement. Les paramètres cliniques, para cliniques (biologie et imagerie) et thérapeutiques étaient analysés afin de détenniner s'ils étaient corrélés au mauvais pronostique neurologique à 6 mois. (Catégories de performance cérébrales 3,4 et 5 de Glasgow-Pittsburgh) Résultats Une évolution neurologique favorable (CPC 1 et 2) était présente chez 27 patients, et 103 présentaient un pronostic neurologique péjoratif(CPC 3 ou 5), dont 98 décès au total. A J3, 80 patients étaient en vie. Le rythme initial, la durée de No et low flow, la sédation, la présence de convulsion ou d'un seul électroencéphalogranune pathologique, ainsi que l'absence de réactivité pupillaire et le Glasgow moteur à J+3 étaient significativement corrélés au mauvais pronostic H en était de même avec les paramètres biologiques à l'admission: lactates artériels, excès de base capnie, créatininémie, temps de prothrombine et NSE à 48h et 72h. La valeur seuil de la NSE était de 28,8[micro]g/L (Sp 100%, Se 84,6 %) avec une aire sous la courbe ROC de la NSE à 0.92 [0.85-1].Conclusion : La prédiction du devenir neurologique des patients victimes d'arrêts cardiaques peut être facilitée à l'aide des données cliniques et paracliniques habituelsAims Evaluation of neurological prognosis of cardiac arrest is complex, involving the physichin in difficult ethical and therapeutic approaches. The purpose of this study is to deterrnine wich clinical , biologic and imaging markers are associated with poor neurological outcome in patients alive on the third day. Methods Between 2010 and 2013,130 consecutive out-of-hospital cardiac arrest (OH CA) supported by the intensive care of the University Hospital of Nîmes were retrospectively included .Prehospital and hospital data were collected and analyzed to bring out any association with poor neurological outcome .(assessed using the Cerebral Perfonnance Categories of the Glasgow-Pittsburgh Outcome Categorie.) Results Twenty-seven patients had a good outcome (CPC I-2), and 103 evolved to poor outcome at six months (CPC 3- 5); with 98 deaths.The third day, 80 patients were alive initial rhythm, estimated no-flow and low-flow intervals,sedation, convulsion ,single pathological EEG, absent pupillary light response,and motor response to pain after 3 days were independently associated with poor outcomes .The same differences were found with biological parameters at admission blood lactate, base excess , creatinine levels, partial pressure of arterial carbon dioxide, prothrombin time and serum NSE performed at 48h and 72h.The ROC curve NSE levels determined a cllt-off value for NSE of 28,8 [micro]g/L to predict a poor neurological outcome (Sp 100%,Se 84,6%),withe an area under the curve of 0.92 [0.85-1] : Conclusion Predicting survival with good neurological recovery may be facilitated by using usual clinical,imaging and laboratory dataMONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Erratum: Concordance and limits between transcutaneous and arterial carbon dioxide pressure in emergency department patients with acute respiratory failure: a single-center, prospective, and observational study

International audienceAfter publication of this article (Scand J Trauma Resusc Emerg Med 23:40, 2015), it came to light that an earlier version had been published in error. This erratum contains the correct version of the article, which incorporates revisions made in response to reviewer comments. Additionally, one of the authors was inadvertently omitted from the author list. This author, Justin Yan, has been included in the corrected author list above.BACKGROUND: Transcutaneous CO2 (PtCO2) is a continuous and non-invasive measure recommended by scientific societies in the management of respiratory distress. The objective of this study was to evaluate the correlation between PtCO2 and arterial partial pressure of CO2 (PaCO2) by arterial blood gas analysis in emergency patients with dyspnoea, and to determine the factors that interfere with this correlation.METHODS: From January to June 2014, all adult patients admitted to the RR with dyspnoea during business hours were included in the study if arterial blood gas measurements were indicated. A sensor measuring the PtCO2 was attached to the ear lobe of the patient before the gas analysis. Anamnesis, clinical and laboratory parameters were identified.RESULTS: Ninety patients with dyspnoea were included (104 pairs of measurements). The median (IQR) age was 79 years (69 - 85). The correlation between PtCO2 and PaCO2 was R(2) =.83 (p<.001) but became lower for values of PaCO2 above 60 mm Hg. The mean bias (± SD) between the two methods of measurement (Bland-Altman analysis) was -1.4 mm Hg (± 7.7) with limits of agreement from -16.4 to 13.7 mm Hg. In univariate analysis, PaO2 interfered with this correlation. After multivariate analysis, temperature (OR = 3.01; 95 % CIs [1.16, 7.80]) and PaO2 (OR = 1.22; 95 % CIs [1.02, 1.47]) significantly interfered with this correlation.CONCLUSIONS: There is a significant correlation between PaCO2 and PtCO2 values for patients admitted to the emergency department for acute respiratory failure. One limiting factor to routine use of PtCO2 measurements in the emergency department is the presence of hyperthermia

SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax

Introduction: Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management.Methods: Literature review, analysis of literature according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients, and organizers to reach a consensus. Only expert opinions with strong agreement were selected.Results: A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and ≥2 cm at the hilum level on frontal chest x-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described.Conclusion: These guidelines are a step towards PSP treatment and follow-up strategy optimization in France

SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax

Abstract Introduction Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management. Methods Literature review, analysis of the literature according to the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients and organizers to reach a consensus. Only expert opinions with strong agreement were selected. Results A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and ≥ 2 cm at the hilum level on frontal chest X-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described. Conclusion These guidelines are a step towards PSP treatment and follow-up strategy optimization in France