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The survival rate after cardiac arrest (CA) remains low. The utilization of extracorporeal life support is proposed to improve management. However, this resource-intensive tool is associated with complications and must be used in selected patients. We performed a meta-analysis to determine predictive factors of survival. Among the 81 studies included, involving 9256 patients, survival was 26.2% at discharge and 20.4% with a good neurologic outcome. Meta-regressions identified an association between survival at discharge and lower lactate values, intrahospital CA, and lower cardio pulmonary resuscitation (CPR) duration. After adjustment for age, intrahospital CA, and mean CPR duration, an initial shockable rhythm was the only remaining factor associated with survival to discharge (β = 0.02, 95% CI: 0.007–0.02; p= 0.0004).

Study objective: In order to assess the effects of inhaled nitric oxide (iNO) in preventing early-onset lung edema from occurring after lung transplantation, we measured extravascular lung water (EVLW) in [...]

Study objectives: Anastomotic leakage after esophagectomy is associated with high postoperative morbidity and mortality. The most important predisposing factors for anastomotic leaks are ischemia of the gastric conduit and low [...]

Study objectives: The measurement of extravascular lung water index by double indicator (EVLWIDI) or the measurement of extravaseular lung water index by transpulmonary thermodilution (EVLWITT) could be useful after pneumonectomy. [...]

Study objective: To assess the accuracy of chest ultrasonography in predicting pleural effusions > 500 mL in patients receiving mechanical ventilation. Design: Prospective study. Setting: Surgical and medical ICU in [...]

Drowning is still a major cause of accidental death worldwide. In 1997, Szpilman proposed a classification of drowning that has become the reference. As considerable efforts have been made to improve prevention and care, it seemed appropriate to reassess the prognosis and clinical presentation of drowning patients more than 20 years after this first publication. The aim of this study is to provide a reappraisal of patients who need advanced health care and a precise description of their respective neurologic, respiratory, and hemodynamic profiles.

Aim:In an Emergency Department (ED), the etiological identification of infected subjects is essential. 13 infection-related biomarkers were assessed using a new flow cytometry procedure. Materials & methods:If subjects presented with febrile symptoms at the ED, 13 biomarkers’ levels, including CD64 on neutrophils (nCD64) and CD169 on monocytes (mCD169), were tested and compared with clinical records. Results:Among 50 subjects, 78% had bacterial infections and 8% had viral infections. nCD64 showed 82% sensitivity and 91% specificity for identifying subjects with bacterial infections. mCD169, HLA-ABC ratio and HLA-DR on monocytes had high values in subjects with viral infections. Conclusion:Biomarkers showed promising performances to improve the ED's infectious stratification.

Les fracture de côtes sont fréquentes, isolées ou associées à des lésions viscérales dans le cadre d’un polytraumatisme. Un patient ayant des fractures de côtes même isolées doit faire l’objet d’une surveillance à la recherche de signes cliniques susceptibles d’évoluer vers une détresse respiratoire. L’échographie pulmonaire permet de faire le bilan des lésions secondaires au traumatisme et d’en assurer le suivi au lit du patient. Un volet thoracique peut entraîner une défaillance respiratoire et peut faire l’objet d’une fixation chirurgicale. Une fracture de côtes est toujours douloureuse et relève donc d’une stratégie analgésique adaptée incluant la réalisation précoce de blocs analgésiques comme le bloc paravertébral.

En France, la prise en charge des urgences vitales intra-hospitalières (UVIH) est peu connue malgré des recommandations d’experts de 2004. Cette étude visait à décrire l’organisation de leur prise en charge dans les hôpitaux universitaires (HU).

Introduction This study investigated invasive mechanical ventilation modalities used in severe blunt chest trauma patients with pulmonary contusion. Occurrence, risk factors, and outcomes of early onset acute respiratory distress syndrome were also evaluated.Methods We performed a retrospective multicenter observational study including 115 adult patients hospitalized in six level 1 trauma intensive care units between April and September of 2014. Independent predictors of early onset acute respiratory distress syndrome were determined by multiple logistic regression analysis based on clinical characteristics and initial management.Results Protective ventilation principles were highly implemented, even prophylactically before acute respiratory distress syndrome occurrence. Early onset acute respiratory distress syndrome appeared to be associated with lung contusion of >20% of total lung volume and early onset pneumonia.Conclusions Predictors of early onset acute respiratory distress syndrome could help with identifying high-risk populations, potentially improving case management through specific protocol development for these patients.

Les fracture de côtes sont fréquentes, isolées ou associées à des lésions viscérales dans le cadre d’un polytraumatisme. Un patient ayant des fractures de côtes même isolées doit faire l’objet d’une surveillance à la recherche de signes cliniques susceptibles d’évoluer vers une détresse respiratoire. L’échographie pulmonaire permet de faire le bilan des lésions secondaires au traumatisme et d’en assurer le suivi au lit du patient. Un volet thoracique peut entraîner une défaillance respiratoire et peut faire l’objet d’une fixation chirurgicale. Une fracture de côtes est toujours douloureuse et relève donc d’une stratégie analgésique adaptée incluant la réalisation précoce de blocs analgésiques comme le bloc paravertébral.

Nous rapportons le cas d’un patient de 20ans aux antécédents psychiatriques, admis dans le service de réanimation pour une intoxication grave à la caféine compliquée d’un arrêt cardiaque sur une fibrillation ventriculaire récidivante. La correction des anomalies biologiques ainsi que la prescription de bêtabloquants ont permis de contrôler la récidive des troubles du rythme. L’évolution a été marquée par une insuffisance rénale secondaire à une rhabdomyolyse. Les intoxications graves à la caféine sont rares, mais l’évidente facilité d’acquisition de comprimés peut entraîner une augmentation de leur fréquence.

Therapeutic hypothermia (TH) is part of the treatment strategy for comatose survivors of cardiac arrest (CA). The aim of our study was to evaluate the efficiency and the safety of a noninvasive and affordable cooling procedure applied to all types of CA in an ICU.

Background:This study compared three different fluid resuscitation strategies in terms of respiratory tolerance and hemodynamic efficacy in a pig model of blunt chest trauma with lung contusion and controlled hemorrhagic shock. We hypothesized that the choice of fluid resuscitation strategy (type and amount of fluids) may impact differently contused lungs in terms of extravascular lung water (EVLW) 20 h after trauma. Methods:Anesthetized female pigs (n = 5group) received five bolt shots to the right thoracic cage and allowed to hemorrhage for 30 min, with 25 to 30 mLkg of blood loss. Pigs were randomly assigned to resuscitation groups that maintained a minimum mean arterial blood pressure of 70 mmHg with one of three methods: normal saline (NS), unrestricted normal saline; NOREPI, low-volume normal saline with norepinephrine; or HS-HES, hypertonic saline with hydroxyethyl starch. Control pigs were anesthetized, but received no injury or treatment. After 20 h, animals were killed to measure EVLW by gravimetry. Results:Fluid loading was significantly different in each group. All three treatment groups had higher EVLW than controls. Moderate, bilateral pulmonary edema was observed in the NS and HS-HES groups. The three treatment groups showed similar reductions in oxygenation. Static pulmonary compliance was diminished in the NS and HS-HES groups, but compliance was similar in NOREPI and control groups. The NOREPI group had pathological lactate levels. Conclusions:This study demonstrated the impact of fluid resuscitation on contused lungs. Twenty hours after the trauma, all three resuscitation approaches showed modest clinical consequences, with moderate lung edema and reduced compliance in response to the infused volume.

AbstractIntroductionAmbulance drivers often travel under stressful conditions at high speed while using vehicles with poor high-speed maneuverability. The occupant safety of ambulance vehicles has not yet been addressed by the automotive safety paradigm; particularly for the rear patient compartment. This study had two objectives: (1) to assess by survey the French Emergency Medical Services (EMS) to determine the layout of the vehicle most often used and the EMS personnel's behavior during transport; and (2) to conduct a crash test to analyze the injuries which may affect EMS personnel and patients in the rear patient compartment.MethodFirstly, a survey was distributed to the 50 largest metropolitan French EMS programs. Secondly, a crash test was performed with a Mobile Intensive Care Unit (MICU) in conditions closest to reality.ResultsForty-nine of the 50 biggest metropolitan French EMS programs responded to the survey. This represents 108 French MICUs. During the last three years, 12 of 49 EMS programs (24%) identified at least one accident with an MICU, and six of these 12 (50%) suffered at least one death in those accidents. A crash test using a typical French EMS MICU showed that after impact of a collision, the ambulance was moved more than five meters with major consequences for all passengers. A study-approved human cadaver placed in the position of a potential patient was partially thrown from the stretcher with a head impact. The accelerometric reaction of the anthropomorphic manikin head was measured at 48G.ConclusionThe crash test demonstrated a lack of safety for EMS personnel and patients in the rear compartment. It would be preferable if each piece of medical equipment were provided with a quick release system resistant to three-dimensional 10G forces. The kinetic changes undergone by the “patient” substitute on the stretcher would probably have an effect of causing injury pathology. This study highlights the need for more research and development in this area.FournierM, ChenaitiaH, MassonC, MicheletP, BehrM, AuffrayJP. Crew and patient safety in ambulances: results of a personnel survey and experimental side impact crash test. Prehosp Disaster Med. 2013;28(4):1-6.

The Emergency Medical Services (EMS) play a primordial role in the early management of adults with acute ischaemic stroke (AIS). The aim of this study was to evaluate the role and effectiveness of the EMS in the stroke chain of survival in Marseille.

Anaesthesia, postoperative pain and surgery (more so if the site of the surgery approaches the diaphragm) will induce respiratory modifications: hypoxaemia, pulmonary volume decrease and atelectasis associated to a restrictive syndrome and a diaphragm dysfunction. These modifications of the respiratory function occur early after surgery and may induce acute respiratory failure (ARF). Maintenance of adequate oxygenation in the postoperative period is of major importance, especially when pulmonary complications such as ARF occur. Non-invasive ventilation (NIV) refers to techniques allowing respiratory support without the need of endotracheal intubation. Two types of NIV are commonly used: non-invasive continuous positive airway pressure (CPAP) and non-invasive positive pressure ventilation (NPPV) which delivers two levels of positive pressure (pressure support ventilation+positive end-expiratory pressure). NIV may be an important tool to prevent (prophylactic treatment) or to treat ARF avoiding intubation (curative treatment). The aims of NIV are: (1) to partially compensate for the affected respiratory function by reducing the work of breathing, (2) to improve alveolar recruitment with better gas exchange (oxygenation and ventilation) and (3) to reduce left ventricular after load increasing cardiac output and improving haemodynamics. Evidence suggests that NIV, as a prophylactic or curative treatment, has been proven to be an effective strategy to reduce intubation rates, nosocomial infections, intensive care unit and hospital lengths of stay, morbidity and mortality in postoperative patients. However, before initiating NIV, any surgical complication must be treated.

The development of an early-onset pneumonia (EOP), occurring within the first 72 hours after admission, represents a critical event in severe thoracic trauma population. The aim of this study was to determine risk factors associated with the occurrence of this complication in this specific population.

Une grande partie du traitement médical adjuvant de l’accident de désaturation (ADD) repose sur l’administration d’aspirine, le plus précocement possible. Nous avons cherché sur quelles données s’appuyaient ces pratiques thérapeutiques et voulu connaître les habitudes des centres hyperbares français à ce sujet.

Prone positioning (PP) on an air-cushioned mattress is associated with a limited increase in intra-abdominal pressure (IAP) and an absence of organ dysfunction. The respective influence of posture by itself and the type of mattress on these limited modifications during the PP procedure remains unclear. The aim of this study was to evaluate whether the type of support modifies IAP, extravascular lung water (EVLW) and the plasma disappearance rate of indocyanine green (PDRICG) during PP. A prospective, randomized, crossover study of 20 patients with acute respiratory distress syndrome (ARDS) was conducted in a medical intensive care unit in a teaching hospital. Measurements were made at baseline and repeated after 1 and 6 hours of two randomized periods of 6 hours of PP with one of two support types: conventional foam mattress or air-cushioned mattress. After logarithmic transformation of the data, an analysis of variance (ANOVA) showed that IAP and PDRICGwere significantly influenced by the type of support during PP with an increase in IAP (P< 0.05 by ANOVA) and a decrease in PDRICGon the foam mattress (P< 0.05 by ANOVA). Conversely, the measurements of EVLW did not show significant modification between the two supports whatever the posture. The ratio of the arterial oxygen tension to the fraction of inspired oxygen significantly increased in PP (P< 0.0001 by ANOVA) without any influence of the support. In comparison with a conventional foam mattress, the use of an air-cushioned mattress limited the increase in IAP and prevented the decrease in PDRICGrelated to PP in patients with ARDS. Conversely, the type of support did not influence EVLW or oxygenation.

Serious pulmonary and cardiac failure may be treated with extracorporeal membrane oxygenation (ECMO) when the conventional treatment fails. Improvements in extracorporeal circulation devices have allowed us to set up two specialized mobile units: a mobile cardiac assistance unit (MCAU) and a mobile respiratory assistance unit (MRAU). Their role is to provide ECMO at patient's bedside, and then to ensure inter-hospital transport (IHT). The aim of this study was to evaluate our experiences with the transportation of patients on ECMO.

We report the case of a 36-year-old woman suffering from liver injury caused by the malfunction of a whipped cream siphon. When this patient handled the whipped cream siphon, the screwed metallic upper part of the siphon was suddenly dissociated from its base and came violently striking her right hypochondrium. At first, the severity of injury was underestimated. Subsequently, due to the persistence of pain experienced by the patient, an abdominal CT scan was performed. It highlighted a severe liver injury with rupture of a branch of the hepatic artery. The evolution was favorable after completion of an embolization and a secondary capsular rupture.

The present study assessed the opinion of general practitioners (GPs) concerning their relationships with intensivists.