Complications pulmonaires postopératoires : comment anticiper et prévenir le risque ?

Although less studied than cardiac complications, postoperative pulmonary complications are frequent and serious after major surgery. A close team working between primary care physician, surgeon, anesthesiologist, lung and heart physicians is essential to prevent and reduce postoperative pulmonary complications. Preoperative evaluation focused on clinical data and choice of surgical and anaesthetic adapted techniques are the key elements for a better control of these risks. Postoperative lung expansion techniques can minimize rate and severity of respiratory complications

Point de vue des médecins par apport aux coûts de la santé

Le but de cet article est de s’intéresser aux moyens possibles permettant d’arriver à une diminution de ces coûts, et ce, notamment, à partir de changements liés aux interventions médicales. Une des solutions préconisées à ce sujet serait la nécessité d’adopter un consensus, avec comme prémisse la feuille de route du «Système de santé durable» émise par l’Académie Suisse des Sciences Médicales

Utilisation de la ventilation non invasive au long cours lors de BPCO.

Non-invasive ventilation (NIV) is recognized as first line therapy in acute hypercapnic respiratory failure and chronic alveolar hypoventilation caused by several diseases (restrictive thoracic disorders, neuromuscular disease and obesity-hypoventilation syndrome). In Switzerland and other European countries, long-term NIV has also been applied in hypercapnic patients with chronic obstructive pulmonary disease (COPD). However, only recently has conclusive evidence showing benefits of long-term NIV become available. Long-term NIV in COPD has now shown its efficacy in many studies. However, despite these findings, indications, ventilatory settings and monitoring remain poorly known and topic of debate

Somnolence résiduelle lors d’apnées du sommeil traitées par pression positive continue

Obstructive sleep apnea (OSA) is a common condition most often characterized by daytime sleepiness. cPAP therapy is very effective in reversing symptoms. However, some patients still complain of excessive daytime sleepiness despite treatment, It is essential to document sufficient use of CPAP and to rule out the presence of residual respiratory events. Search for other underlying causes of sleepiness are then to be investigated by a detailed history together with a sleep night recording. The purpose of this article is to guide the clinician in providing comprehensive medical care for those patients

Tuberculose osseuse : quand faut-il y penser ?

The most common presentation of bone tuberculosis (TB) is called spondylodiscitis, or "Pott's disease", which is a difficult diagnosis due to its low prevalence in Switzerland. It should be considered in patients with persistent back pain, who are at high risk, such as migrant population and immunocompromised patients. Diagnosis is based on imaging and the detection of M. tuberculosis in biopsy of affected vertebra orparaspinal abscess, or even if active tuberculosis is proven in any other site. It's essential to initiate appropriate treatment as quickly as possible in order to avoid neurological complications and spinal deformity and to identify cases that will require a surgical therapy

Prise en charge de l’hémoptysie massive

Less than 5% of all cases of haemoptysis are considered to be massive, representing a life-threatening condition that warrants urgent investigations and treatment. Efforts should be concentrated on determining the origin of the haemoptysis and the presence of an underlying respiratory pathology, in order to ensure supportive measures and a rapid control of the bleeding. Bronchial artery embolization is considered to be the treatment of choice and thoracic surgery should only be considered in cases of localized lesions with a high risk of re-bleeding, pulmonary artery hemorrhage and failure or contraindications to embolization

Cancer-associated retinopathy preceding the diagnosis of a pulmonary carcinoid tumour

Cancer-associated retinopathy (CAR) belongs to the paraneoplastic retinopathy syndromes and manifests itself by rapidly progressive vision loss, scotoma and photopsia. We herein reported the case of a 77-year-old woman without a cancer history who presents typical CAR symptoms. A complete workup followed by lung biopsy enabled the detection of a pulmonary carcinoid tumour. Treatment of oral cortisone was then initiated with dramatic improvements in the symptoms

Long-Term Noninvasive Ventilation in the Geneva Lake Area: Indications, Prevalence, and Modalities

Noninvasive ventilation (NIV) is standard of care for chronic hypercapnic respiratory failure, but indications, devices, and ventilatory modes are in constant evolution

Long-Term Non-invasive Ventilation: Do Patients Aged Over 75 Years Differ From Younger Adults?

Background: Noninvasive ventilation (NIV) is accepted as standard of care for chronic hypercapnic respiratory failure (CHRF) and is being increasingly implemented in older subjects. However, little is known regarding the use of NIV on a long-term basis in the very old. The outcomes of this study were: 1/to report the proportion of patients ≥ 75 years old (elderly) among a large group of long-term NIV users and its trend since 2000; 2/to compare this population to a younger population (<75 years old) under long-term NIV in terms of diagnoses, comorbidities, anthropometric data, technical aspects, adherence to and efficiency of NIV. Methods: In a cross-sectional analysis of a multicenter cohort study on patients with CHRF under NIV, diagnoses, comorbidities, technical aspects, adherence to and efficiency of NIV were compared between patients ≥ 75 and <75 years old (chi-square or Welch Student tests). Results: Of a total of 489 patients under NIV, 151 patients (31%) were ≥ 75 years of age. Comorbidities such as systemic hypertension (86 vs. 60%, p < 0.001), chronic heart failure (30 vs. 18%, p = 0.005), and pulmonary hypertension (25 vs. 14%, p = 0.005) were more frequent in older subjects. In the older group, there was a trend for a higher prevalence of chronic obstructive pulmonary disease (COPD) (46 vs. 36%, p = 0.151) and a lower prevalence of neuromuscular diseases (NMD) (19 vs. 11%, p = 0.151), although not significant. Adherence to and efficacy of NIV were similar in both groups (daily use of ventilator: 437 vs. 419 min, p = 0.76; PaCO2: 5.8 vs. 5.9 kPa, p = 0.968). Unintentional leaks were slightly higher in the older group (1.8 vs. 0.6 L/min, p = 0.018). Conclusions: In this cross-sectional study, one third of the population under NIV was ≥ 75 years old. Markers of efficacy of NIV, and adherence to treatment were similar when compared to younger subjects, confirming the feasibility of long-term NIV in the very old. Health-related quality of life was not assessed in this study and further research is needed to address this issue