Personalized mechanical ventilation guided by ultrasound in patients with acute respiratory distress syndrome (PEGASUS): study protocol for an international randomized clinical trial

background acute respiratory distress syndrome (ARDS) is a frequent cause of hypoxemic respiratory failure with a mortality rate of approximately 30%. Identifying ARDS subphenotypes based on "focal" or "non-focal" lung morphology has the potential to better target mechanical ventilation strategies of individual patients. however, classifying morphology through chest radiography or computed tomography is either inaccurate or impractical. Lung ultrasound (LUS) is a non-invasive bedside tool that can accurately distinguish "focal" from "non-focal" lung morphology. We hypothesize that LUS-guided personalized mechanical ventilation in ARDS patients leads to a reduction in 90-day mortality compared to conventional mechanical ventilation. methods the personalized mechanical ventilation guided by ultrasound in patients with acute respiratory distress syndrome (PEGASUS) study is an investigator-initiated, international, randomized clinical trial (RCT) that plans to enroll 538 invasively ventilated adult intensive care unit (ICU) patients with moderate to severe ARDS. eligible patients will receive a LUS exam to classify lung morphology as "focal" or "non-focal". thereafter, patients will be randomized within 12 h after ARDS diagnosis to receive standard care or personalized ventilation where the ventilation strategy is adjusted to the morphology subphenotype, i.e., higher positive end-expiratory pressure (PEEP) and recruitment maneuvers for "non-focal" ARDS and lower PEEP and prone positioning for "focal" ARDS. the primary endpoint is all-cause mortality at day 90. secondary outcomes are mortality at day 28, ventilator-free days at day 28, ICU length of stay, ICU mortality, hospital length of stay, hospital mortality, and number of complications (ventilator-associated pneumonia, pneumothorax, and need for rescue therapy). after a pilot phase of 80 patients, the correct interpretation of LUS images and correct application of the intervention within the safe limits of mechanical ventilation will be evaluated. discussion PEGASUS is the first RCT that compares LUS-guided personalized mechanical ventilation with conventional ventilation in invasively ventilated patients with moderate and severe ARDS. If this study demonstrates that personalized ventilation guided by LUS can improve the outcomes of ARDS patients, it has the potential to shift the existing one-size-fits-all ventilation strategy towards a more individualized approach. trial registration the PEGASUS trial was registered before the inclusion of the first patient, https://clinicaltrials.gov/ (ID: NCT05492344)

Complicated pneumothorax and congenital lung cystic malformation

Congenital cystic adenomatoid malformation, also named congenital pulmonary airway malformation (CPAM), is a congenital lung abnormality which is uncommon in adults. The usual radiological appearance of CPAM is a cystic space-occupying lesion. We present one case of CPAM with unusual clinical and radiological findings, a complicated spontaneous pneumothorax with intracystic haemorrhage with successful conservative initial treatment, despite acute haemodynamic instability.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Right ventricule-specific therapies in ARDS: other vasodilating agents to be considered

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Une cause peu connue de vomissements incoercibles

Cannabis is a widely spread drug which chronic abuse may cause diverse adverse effects on the body, in the short and long term. Among these effects, we can cite digestive disorders, mainly characterized by the onset of cyclical vomiting illness. Vomiting symptoms can be temporarily relieved by hot water showers. As a matter of fact, many patients adopt a compulsive bathing behavior characterized by the irrepressible need of having showers or baths at a high temperature. We describe the case of two patients (22 and 23 years-old) who consume cannabis on a regular basis. They were admitted several times to hospital emergency rooms for complaints about uncontrollable vomiting with recurring abdominal pain. Multiple investigations and hospitalizations did not determine a precise diagnosis explaining the symptomatology. The final diagnosis is the vomiting syndrome caused by the consumption of cannabis.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Oesophageal lesions as first manifestation of necrotising sarcoid granulomatosis

Necrotising sarcoid granulomatosis is a rare disease associating sarcoid-like granulomas, vasculitis and necrosis in the lungs and seldom in extrapulmonary locations. We report the case of a 23-year-old woman with an initial symptom consisting of epigastric pain. Oesophagoscopy demonstrated oesophagitis. Evolution was marked by fever, dyspnoea and pulmonary lesions. The first presumptive diagnosis was Wegener disease but biopsies (of the lungs and the oesophagus) demonstrated the diagnosis of necrotising sarcoid granulomatosis. Evolution was favourable under corticoid therapy. Necrotising sarcoid granulomatosis may present as an extrapulmonary disease and is an important differential diagnosis of other disease such as Wegener disease.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Anticoagulation Prophylaxis in Extracorporeal Adsorption Techniques.

In this chapter, anticoagulation treatments for adsorption techniques in continuous renal replacement therapy (CKRT) will be reviewed. Anticoagulation used with adsorption techniques is quite different than anticoagulation in classical CKRT with nonadsorptive therapies. Regional citrate anticoagulation (RCA) and unfractionated heparin (UFH) are the most common anticoagulation modalities for both nonselective adsorptive membranes - such as surface-treated acrylonitrile 69 membranes (AN69ST) and polymethylmethacrylate membranes - and selective adsorptive membranes such as AN69-oXiris. For these techniques, the efficacy of RCA seems to be superior to UFH. Regardless of the lack of large comparative studies in comparison to ones conducted for adsorptive filter techniques in CKRT, RCA and UFH will also be discussed for nonselective adsorptive sorbents like CytoSorb and Jafron HA. For selective adsorptive sorbents, such as polymyxin-B hemoperfusion, UFH and RCA seems to be the appropriate techniques; however, randomized controlled trials confirming this are yet to be conducted. Lastly, anticoagulation prophylaxis for more specific techniques like coupled plasma filtration adsorption and double plasma molecular adsorption system will be discussed

Syndromes hémorragiques sous antidépresseurs inhibiteurs sélectifs de la recapture de la sérotonine (ISRS). A propos de deux cas et revue de la littérature

Selective serotonin re-uptake inhibitors are widely prescribed on a daily basis due to their recognized efficiency and their few side effects as opposed to tricyclic antidepressants. The iatrogenic effect mainly causes benign hemorrhagic episodes however some cases could get serious. The Belgian centre of pharmaco- therapeutical information warns prescribing physicians regarding the use of SSRIs. The existing risk of cutaneo-mucosal bleeding or other forms of hemorrhage due to SSRIs has been identified in the early 90s based on reported cases. Since then, cohort epidemiology studies or case studies have shown a correlation between the SSRIs intake and bleeding, linked to inhibition of the serotonin re-uptake (5HT). We report 2 clinical cases of patients who presented hemorrhages. One has been taking sertraline and the other fluoxetine. Through this literature review, we aim at discussing the impact of the different physiopathologic mechanisms.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Lack of relationship between fasting plasma citrulline and glucose absorption: Do not underestimate the role of the failing kidney!

SCOPUS: le.jinfo:eu-repo/semantics/publishe

The challenge of removal of sepsis markers by continuous hemofiltration

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Mechanism of arrhythmias during the infusion of Ringer's acetate and Ringer's lactate solutions during cardiac surgery: New insights

SCOPUS: le.jinfo:eu-repo/semantics/publishe