Spontaneous breathing trial and post-extubation work of breathing in morbidly obese critically ill patients

Figure S5. difference in the work of breathing expressed in J/l between each test and the post-extubation period. Dashed line represents the absence of difference between the test and the post-extubation period. (JPG 44 kb

Neuronal Functions of ESCRTs

The endosomal sorting complexes required for transport (ESCRTs) regulate protein trafficking from endosomes to lysosomes. Recent studies have shown that ESCRTs are involved in various cellular processes, including membrane scission, microRNA function, viral budding, and the autophagy pathway in many tissues, including the nervous system. Indeed, dysfunctional ESCRTs are associated with neurodegeneration. However, it remains largely elusive how ESCRTs act in post-mitotic neurons, a highly specialized cell type that requires dynamic changes in neuronal structures and signaling for proper function. This review focuses on our current understandings of the functions of ESCRTs in neuronal morphology, synaptic plasticity, and neurodegenerative diseases

Artificial intelligence for diagnosis and Gleason grading of prostate cancer: The PANDA challenge

Through a community-driven competition, the PANDA challenge provides a curated diverse dataset and a catalog of models for prostate cancer pathology, and represents a blueprint for evaluating AI algorithms in digital pathology. Artificial intelligence (AI) has shown promise for diagnosing prostate cancer in biopsies. However, results have been limited to individual studies, lacking validation in multinational settings. Competitions have been shown to be accelerators for medical imaging innovations, but their impact is hindered by lack of reproducibility and independent validation. With this in mind, we organized the PANDA challenge-the largest histopathology competition to date, joined by 1,290 developers-to catalyze development of reproducible AI algorithms for Gleason grading using 10,616 digitized prostate biopsies. We validated that a diverse set of submitted algorithms reached pathologist-level performance on independent cross-continental cohorts, fully blinded to the algorithm developers. On United States and European external validation sets, the algorithms achieved agreements of 0.862 (quadratically weighted kappa, 95% confidence interval (CI), 0.840-0.884) and 0.868 (95% CI, 0.835-0.900) with expert uropathologists. Successful generalization across different patient populations, laboratories and reference standards, achieved by a variety of algorithmic approaches, warrants evaluating AI-based Gleason grading in prospective clinical trials.KWF Kankerbestrijding ; Netherlands Organization for Scientific Research (NWO) ; Swedish Research Council European Commission ; Swedish Cancer Society ; Swedish eScience Research Center ; Ake Wiberg Foundation ; Prostatacancerforbundet ; Academy of Finland ; Cancer Foundation Finland ; Google Incorporated ; MICCAI board challenge working group ; Verily Life Sciences ; EIT Health ; Karolinska Institutet ; MICCAI 2020 satellite event team ; ERAPerMe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Détermination de l'épreuve de ventilation spontanée représentative du travail respiratoire post-extubation lors du sevrage de la ventilation mécanique du patient obèse en réanimation

Justificatif de l'étude : Les épreuves de Ventilation Spontanée classiquement recommandées (Aide Inspiratoire (AI) 5-8 cmH20 ou piéce en T) n'ont jamais été évaluées dans le sevrage de la ventilation mécanique du patient obèse. L'objectif de ce travail était de déterminer parmi 5 différentes EVS, celle qui permettais de reproduire le plus précisément l'effort inspiratoire du patient obèse en post extubation. Matériel et Méthode : Etude prospective mono-centrique randomisée en cross-over. L'ensemble des patients obèses (définis par un indice de masse corporel >=35 Kg/m2) ayant requis plus d'une journée de ventilation mécanique ont été inclus. Chaque patient a bénéficié de 5 EVS de 15 minutes dans un ordre aléatoire (AI 7 cmH20+PEEP 7 cmH20 ; AI 0 cmH20+ PEEP 7 cmH20 ; AI 0 cmH20 + PEEP 7 cmH20 ; AI 0 cmH20+PEEP a cmH20 et pièce en T) avant d'être extubé. Les pressions oesophagiennes et gastriques étaient enregistrées en continu et les variables de l'effort respiratoire (swings, pressure time product (PTP) et work of breathing (WOB)) calculées. Résultats: Onze patients obèses morbides (IMC 44 kg/m2 +- 8) ont été inclus et extubé avec succés. La pièce en T et l'EVS en AI 0 cmH20 + PEEP 0 cmH20 permettaient de reproduire fiablement l'effort inspiratoire post extubation, avec un work of breathing (WOB) de 1.53 J/L +- 0.56, 1.50 J/L +- 0.64 et 1.56 J/L +- 0.68 respectivement, sans différence significative. Les autres EVS minimisaient significativement le WOB post extubation (p35 kg/m2 and mechanically ventilated for more than 24 hours were considered eligible to randomly challenge five different conditions of SBT belore extubation : PSV 7 cmH20 + PEEP 7 cm H20 ; PSV 0 cmH20 + PEEP 7 cmH20 ; PSV 7 cmH20 + PEEP 0 cmH20 ; PSV 0 cmH20 + PEEP 0 cmH20 and T piece. A 10 minutes period of rest was respected belween each SBT and belore extubation. All variables measurements were realized alter 15 minutes 01 each SBT: respiratory parameters, end expiratory lung volume (EELV), arterial blood gases, esophageal and gastric pressures. Inspiratory muscle effort was calculated as the esophageal and trans-diaphragmatic pressure time product and the work 01 breathing. Measurements and Main Resu/ts: eleven obese patients with mean BMI 44 kg/m' (+- 8) were successlully extubated alter succeeding the 5 SBT conditions. Post extubation inspiratory effort, calculated by work 01 breathing (WOB) in joules per liter was 1.53 J/L +- 0.56. This was statistically identical lor the Iwo SBT conditions without pressure support: T piece and PSV 0 cmH20+PEEP 0 cmH20, with respective WOB 01 1.50 J/L +- 0.64 and 1.56 J/L +- 0.68. This result was consistent whatever the chosen index (WOB per minute or esophageal and diaphragmatic pressure-time products). The 3 other SBT conditions with pressure support (PSV 7 cmH20 + PEEP 7 cm H20 ; PSV 0 cmH20 + PEEP 7 cmH20 ; PSV 7 cmH20 + PEEP 0 cmH20) statistically under-estimated post extubation respiratory effort respectively WOB 0.73 J/L +- 0.36, 1.17 J/L +- 0.45 and 1.12 J/L +- 0.55, P < 0.001). Conclusions: Our data suggest that in a selected population of morbidly critically ill obese patients, only a Tpiece and PSV 0 cmH20 + PEEP 0 cmH20 SBT are able to reproduce accurately respiratory effort alter extubation. Caregivers should be aware 01 these differences in SBT as they may play an important role in weaning decision-making lor morbidly obese patients.MONTPELLIER-BU Médecine UPM (341722108) / SudocSudocFranceF

La contention physique est-elle prohibée en réanimation ?

International audienc

Kazachstania slooffiae: An unexpected journey to a human pleural sample

International audienceWe report a case of a 50-year-old shepherd hospitalized in intensive care unit for hiatal hernia complicated by an occlusive syndrome. In post-surgery, an acute respiratory distress occurs due to mediastinitis with large pleural effusion. At the laboratory, direct examination of the pleural sample revealed the presence of pseudohyphae. Kazachstania slooffiae was identified by Mass Spectrometry and confirmed by DNA sequencing. This uncommon yeast has never been previously described in human infections. Although its pathogenicity is not well known, K. slooffiae should be considered in the case of critically ill patients