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Background: Active fluid removal has been suggested to improve prognosis following the resolution of acute circulatory failure. To standardize the deresuscitation strategy, we have implemented a routine care protocol to guide fluid removal during continuous renal replacement therapy (CRRT). We designed a before-after pilot study to evaluate the impact of this deresuscitation strategy on the cumulative fluid balance.Methods: Consecutive ICU patients suffering from fluid overload and undergoing CRRT for acute kidney injury underwent a perfusion-based deresuscitation protocol combining a restrictive intake, continuous net ultrafiltration (UFnet) of 2 mL/kg/h, and both clinical and laboratory monitoring of perfusion (early dry group, N=42) and were compared to an historical group managed according to usual practices (control group, N=45). The primary outcome was the cumulative fluid balance at day 5 or at discharge. Secondary outcomes addressed the protocol safety. Adjustments were done with inverse probability of treatment weighting propensity score analysis.Results: Adjusted cumulative fluid balance was significantly lower in the early dry group (median [IQR]: -7784 [-11833 to -2933] mL) compared to the control group (-3492 [-9935 to -1736] mL, p=0.04). The difference was mainly driven by a greater daily UFnet (31 [22-46] mL/kg/day vs. 24 [15-32] mL/kg/day, p=0.01). There was no significant difference between both groups regarding maximal arterial lactate level and maximal norepinephrine dose requirement. Conclusion: Our perfusion-based deresuscitation protocol achieved a greater negative cumulative fluid balance compared to standard practices and was hemodynamically well tolerated. Those data suggest the feasibility of an interventional randomized clinical trial using a similar protocol.

Active fluid removal has been suggested to improve prognosis following the resolution of acute circulatory failure. We have implemented a routine care protocol to guide fluid removal during continuous renal replacement therapy (CRRT). We designed a before-after pilot study to evaluate the impact of this deresuscitation strategy on the fluid balance.Consecutive ICU patients suffering from fluid overload and undergoing CRRT for acute kidney injury underwent a perfusion-based deresuscitation protocol combining a restrictive intake, net ultrafiltration (UFnet) of 2 mL/kg/h, and monitoring of perfusion (early dry group, N = 42) and were compared to a historical group managed according to usual practices (control group, N = 45). The primary outcome was the cumulative fluid balance at day 5 or at discharge.Adjusted cumulative fluid balance was significantly lower in the early dry group (median [IQR]: -7784 [-11,833 to -2933] mL) compared to the control group (-3492 [-9935 to -1736] mL; p = 0.04). The difference was mainly driven by a greater daily UFnet (31 [22-46] mL/kg/day vs. 24 [15-32] mL/kg/day; p = 0.01). There was no significant difference between both groups regarding hemodynamic tolerance.Our perfusion-based deresuscitation protocol achieved a greater negative cumulative fluid balance compared to standard practices and was hemodynamically well tolerated.

International audience; No abstract available

Si la psychanalyse s’autorise a soutenir l’ecart necessaire a une circulation psychique dans la pratique du transfert, n’est-ce pas a partir de l’intervalle dont elle se fonde elle-meme ? Entre voix, silence et ecriture, l’intervalle de la parole analytique fait echo au manque du sujet. Mise en tension et co-creation d’un espace ethique et poetique, espace de desir, d’existence et de liberte a la place du vide siderant.

A woman aged 31 years with no medical history was admitted to the intensive care unit for acute epiglottitis. For 4 days, she had been complaining of fever, intractable vomiting and increasing cervical pain treated with anti-inflammatory drugs. The admission CT scan confirmed the diagnosis of acute epiglottitis associated with a parapharyngeal abscess (figure 1A). An intramural oesophageal dissection (IOD) was incidentally diagnosed (figure 1B), extending from the upper oesophageal sphincter to the lesser gastric curvature without any sign of mediastinitis (figure 1C …