High-flow nasal cannula oxygen therapy alone or with non-invasive ventilation during the weaning period after extubation in ICU: the prospective randomised controlled HIGH-WEAN protocol

INTRODUCTION: Recent practice guidelines suggest applying non-invasive ventilation (NIV) to prevent postextubation respiratory failure in patients at high risk of extubation failure in intensive care unit (ICU). However, such prophylactic NIV has been only a conditional recommendation given the low certainty of evidence. Likewise, high-flow nasal cannula (HFNC) oxygen therapy has been shown to reduce reintubation rates as compared with standard oxygen and to be as efficient as NIV in patients at high risk. Whereas HFNC may be considered as an optimal therapy during the postextubation period, HFNC associated with NIV could be an additional means of preventing postextubation respiratory failure. We are hypothesising that treatment associating NIV with HFNC between NIV sessions may be more effective than HFNC alone and may reduce the reintubation rate in patients at high risk. METHODS AND ANALYSIS: This study is an investigator-initiated, multicentre randomised controlled trial comparing HFNC alone or with NIV sessions during the postextubation period in patients at high risk of extubation failure in the ICU. Six hundred patients will be randomised with a 1:1 ratio in two groups according to the strategy of oxygenation after extubation. The primary outcome is the reintubation rate within the 7 days following planned extubation. Secondary outcomes include the number of patients who meet the criteria for moderate/severe respiratory failure, ICU length of stay and mortality up to day 90. ETHICS AND DISSEMINATION: The study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03121482

Arch Pediatr

BACKGROUND: Neisseria meningitidis is a virulent bacteria provoking outbreaks of invasive meningococcal disease (IMD) that authorities may try to control with population-based vaccinations. Such campaigns are most often thoroughly followed. We assess the response of poor adherence during a population-based vaccination after a meningococcal B:14:P1.7,16 outbreak. METHODS: Between July, 2012, and April, 2013, six cases including one fatality of invasive meningococcal disease related to N. meningitidis B:14:P1.7,16/ST32 were reported in two neighboring counties. A vaccination campaign with MenBVac((R)) targeting 6911 inhabitants was implemented. People entering the vaccination schedule from January 2014 received 4CMenB. RESULTS: The number of immunized patients proved to be low, with 1721 (24.1%) receiving at least one dose out of 5069 doses administered. However, the incidence of IMD in the zone dramatically fell, with only one purpura fulminans case in June 2014 with a good outcome. The campaign was stopped after 1 year and a 2-year monitoring period was implemented until June, 2016, with no new cases. CONCLUSIONS: This outbreak probably self-terminated in a context of a low incidence of serogroup B IMD during 2014 in France. Poor adherence illustrates the growing vaccine hesitancy in France. Similar campaigns will have to be thoroughly planned and implemented in terms of timing, modalities of injections, and mass communication

Evidence of the influence of respiration on the heart rate variability after human heart transplantation: Role of observation model

Studying heart transplanted patients records provide interesting data since modulation of the heart rate is not due to neural activity [3]. Studying these patients reveals the so called mechanical modulation (MM) that is increased as the exercise intensity is higher. In a recent paper we have introduced the PFM model that relates the observed amplitude of the MM to the ventilation and the mean heart rate, with a set of non transplanted subjects. In this paper we use a time-frequency representation added to a t-test to show whether the HRV signal, or tachogram, contains or not power in the respiration frequency band. This approach is well adapted to the purely dynamic condition corresponding to increasing exercise. Observation models such as PFM and IPFM can be accounted in the analysis since there is no evidence of a linear interaction between observed values from the heart rate variability signal and physiological input such as the ventilation. The aforementioned models are compared regards our proposed t-test. 1

Apport de l'hybridation somatique pour l'exploitation des ressources génétiques des agrumes

National audienc

Apport de l'hybridation somatique pour l'exploitation des ressources génétiques des agrumes

National audienc

Study on the P-wave feature time course as early predictors of paroxysmal atrial fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice, increasing the risk of stroke and all-cause mortality. Its mechanisms are poorly understood, thus leading to different theories and controversial interpretation of its behavior. In this respect, it is unknown why AF is self-terminating in certain individuals, which is called paroxysmal AF (PAF), and not in others. Within the context of biomedical signal analysis, predicting the onset of PAF with a reasonable advance has been a clinical challenge in recent years. By predicting arrhythmia onset, the loss of normal sinus rhythm could be addressed by means of preventive treatments, thus minimizing risks for the patients and improving their quality of life. Traditionally, the study of PAF onset has been undertaken through a variety of features characterizing P-wave spatial diversity from the standard 12-lead electrocardiogram (ECG) or from signal-averaged ECGs. However, the variability of features from the P-wave time course before PAF onset has not been exploited yet. This work introduces a new alternative to assess time diversity of the P-wave features from single-lead ECG recordings. Furthermore, the method is able to assess the risk of arrhythmia 1 h before its onset, which is a relevant advance in order to provide clinically useful PAF risk predictors. Results were in agreement with the electrophysiological changes taking place in the atria. Hence, P-wave features presented an increasing variability as PAF onset approximates, thus suggesting intermittently disturbed conduction in the atrial tissue. In addition, high PAF risk prediction accuracy, greater than 90%, has been reached in the two considered scenarios, i.e. discrimination between healthy individuals and PAF patients and between patients far from PAF and close to PAF onset. Nonetheless, more long-term studies have to be analyzed and validated in future works.This work was supported by the projects TEC2010-20633 from the Spanish Ministry of Science and Innovation and PPII11-0194-8121 and PII1C09-0036-3237 from Junta de Comunidades de Castilla La Mancha.Martinez, A.; Alcaraz, R.; Rieta, JJ. (2012). Study on the P-wave feature time course as early predictors of paroxysmal atrial fibrillation. Physiological Measurement. 33(12):1959-1974. https://doi.org/10.1088/0967-3334/33/12/1959S195919743312Alcaraz, R., & Rieta, J. J. (2009). Time and frequency recurrence analysis of persistent atrial fibrillation after electrical cardioversion. Physiological Measurement, 30(5), 479-489. doi:10.1088/0967-3334/30/5/005AYTEMIR, K., OZER, N., ATALAR, E., SADE, E., AKSOYEK, S., OVUNC, K., … KES, S. (2000). P Wave Dispersion on 12-Lead Electrocardiography in Patients with Paroxysmal Atrial Fibrillation. 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