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Abstract: In this case study, we report the longitudinal and multimodal follow‐up of a catastrophic initial presentation of cerebral fat embolism syndrome. We show that despite the initial severity, the cognitive outcome was ultimately very good but with a highly nonlinear time‐course and prolonged loss of consciousness (more than 2 months). Repeated clinical assessments and brain‐imaging techniques (electroencephalography, event‐related potential, 18‐Fluoro‐Deoxy‐Glucose‐PET and magnetic resonance imaging) allowed us to monitor and anticipate this dynamic, providing relevant information to guide decision making in front of withdrawal of life‐sustaining therapy discussions. This case illustrates the value of multimodal functional imaging in devastating brain injuries. [ABSTRACT FROM AUTHOR]

Abstract: Hepatic encephalopathy (HE) influences short‐term and long‐term prognoses. Recently, glycerol phenylbutyrate (PB), that lowers ammonia by providing an alternate pathway to urea for waste nitrogen excretion, has shown that it was effective in preventing the occurrence of HE in RCT. The aim was to assess the benefits of sodium PB in cirrhotic patients admitted to ICU for overt HE, in terms of ammonia levels decrease, neurological improvement, and survival. Cirrhotic patients who presented with overt HE, ammonia levels >100 μmol/L, and did not display any contra‐indication were included. Sodium PB was administered at 200 mg/kg/day. Control group included historical controls treated by standard therapy, matched for age, sex, MELD score, and severity of HE. Eighteen patients were included and treated with sodium PB (age: 59 [45–68], male gender: 15 [83%], Child–Pugh B: 8 [44%], Child–Pugh C: 10 [56%], and MELD score: 16 [13–23]). Ammonia levels significantly decreased in the PB as compared to the control group from inclusion to 12 h and from inclusion to 48 h (P = 0.0201 and P = 0.0230, respectively). The proportion of patients displaying neurological improvement was only higher in the PB‐treated group as compared to controls at ICU discharge (15 [83%] vs. 9 [50%], P = 0.0339). ICU discharge survival was significantly higher in patients treated with PB (17 [94%] vs. 9 [50%], P = 0.0017). In cirrhotic patients with overt HE, sodium PB could be effective in reducing ammonia levels and might be effective in improving neurological status and ICU discharge survival. More extensive data, especially a RCT, are mandatory. [ABSTRACT FROM AUTHOR]

Purpose: Prevention of multidrug resistant (MDR) bacterial contamination remains a major challenge in ICUs. Many hospital outbreaks involving MDR transmitted through environmental contamination have been reported. Bedside high-density EEG allow for dynamic cognitive evaluation in brain-injured patients and is used more and more frequently in clinical practice to evaluate brain function and predict outcome in severely neurologically impaired patients. Unfortunately, the material used for this procedure is not entirely disposable.Method: We performed a systematic analysis of MDR bacterial contamination in patients contaminated in our ICU using specific bacteriological methods.Results: We report a proven case of cross-contamination of an extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae strain, and a possible case of cross-contamination of a carbapenem-resistant Acinetobacter baumannii strain.Conclusion: Cross-contamination of MDR bacteria is possible through high-density EEG material. However, appropriate procedures can decrease this risk. [ABSTRACT FROM AUTHOR]

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The article discusses the measurement of positive end-expiratory pressure (PEEP)-induced alveolar-recruitment in inferring from regional changes in patients with acute respiratory distress syndrome (ARDS). It explores the use of pressure-volume (PV) curve method which requires long time before it can be used at the bedside of patients. The article also explores the use of PV recruitment module with eXtend ventilator and a study on the impact of gas exchange on the method.

Introduction Le drainage d’un épanchement pleural liquidien est habituellement pratiqué en réanimation lorsqu’un épanchement est jugé suffisamment abondant pour perturber la mécanique ventilatoire et générer des anomalies gazométriques [1] . Le but de l’étude était d’évaluer l’effet du drainage d’un épanchement pleural abondant sur la taille de la condensation sous-jacente et la ré-aération pulmonaire, à l’aide de l’échographie pulmonaire. Matériel et méthodes Il s’agit d’une étude prospective et observationnelle. Après l’accord du Comité de protection des personnes, les patients de réanimation ayant un épanchement pleural supérieur à 500 mL estimé par l’échographie pulmonaire ont été inclus [2] . Pour chaque patient, une échographie pulmonaire et un gaz du sang ont été réalisés avant (H0), 2 heures (H2) et 24 heures (H24) après le drainage de l’épanchement pleural. Douze régions pulmonaires ont été examinés sur poumons droit et gauche : antéro-supérieure, antéro-inférieure, latéro-supérieure, latéro-inférieure, postéro-supérieure et postéro-inférieure. L’aération pulmonaire a été notée pour chaque région : normalement aéré = 0, syndrome interstitiel pulmonaire = 1, syndrome alvéolo-interstitiel diffus = 2, condensation pulmonaire = 3. La somme de ces points détermine un score échographique pulmonaire (score de LUS). La surface transversale de la base (sus-diaphragmatique) et la hauteur de la condensation sous-jacente à l’épanchement ont été mesurées. Les résultats étaient exprimés en moyenne ± écart type ou en médiane (25–75 % interquartiles) selon la distribution des data. Les paramètres échographiques et gazométriques entre H0, H2 et H24 ont été comparés et analysés par le test Anova ou de Friedman suivi d’un test post hoc. Résultats Vingt-huit patients ont été étudiés. Le volume d’épanchement drainé était de 690 mL (505–957 mL) à H2 et de 890 mL (690–1515 mL) à H24. Le score de LUS, la surface de la condensation pulmonaire basale et la hauteur de la condensation diminuaient significativement après le drainage de l’épanchement ( Tableau 1 ). La ré-aération pulmonaire était observée majoritairement dans les régions latéro-inférieure et postéro-supérieure du poumon. La diminution de la surface de condensation à H24 était significativement corrélée au volume d’épanchement drainé ( r = 0,5, p = 0,008). Le rapport PaO 2 /FiO 2 restait inchangé à H2 et augmentait significativement à H24 chez les patients hypoxémiques à H0, définis comme PaO 2 /FiO 2 < 300 (H0 : 191 ± 78 ; H2 : 199 ± 68 ; H24 : 256 ± 92, p < 0,01). Discussion Le drainage d’un épanchement pleural abondant permet une ré-aération significative de la condensation pulmonaire sous-jacente. Chez les patients hypoxémiques, la ré-aération pulmonaire induit une amélioration significative de l’oxygénation artérielle. [ABSTRACT FROM AUTHOR]