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Byline: Aurelie Lefebvre (1), Christine Lorut (1), Marco Alifano (2), Herve Dermine (3), Nicolas Roche (1), Remy Gauzit (3), Jean-Francois Regnard (2), Gerard Huchon (1), Antoine Rabbat (1,4) Keywords: Noninvasive ventilation; Acute respiratory failure; Postoperative thoracic surgery; Lung resection; COPD; Outcomes Abstract: Background A single prospective randomized study found that, in selected patients with acute respiratory failure (ARF) following lung resection, noninvasive ventilation (NIV) decreases the need for endotracheal mechanical ventilation and improves clinical outcome. Method We prospectively evaluated early NIV use for ARF after lung resection during a 4-year period in the setting of a medical and a surgical ICU of a university hospital. We documented demographics, initial clinical characteristics and clinical outcomes. NIV failure was defined as the need for tracheal intubation. Results Among 690 patients at risk of severe complications following lung resection, 113 (16.3%) experienced ARF, which was initially supported by NIV in 89 (78.7%), including 59 with hypoxemic ARF (66.3%) and 30 with hypercapnic ARF (33.7%). The overall success rate of NIV was 85.3% (76/89). In-ICU mortality was 6.7% (6/89). The mortality rate following NIV failure was 46.1%. Predictive factors of NIV failure in univariate analysis were age (P = 0.046), previous cardiac comorbidities (P = 0.0075), postoperative pneumonia (P = 0.0016), admission in the surgical ICU (P = 0.034), no initial response to NIV (P < 0.0001) and occurrence of noninfectious complications (P = 0.037). Only two independent factors were significantly associated with NIV failure in multivariate analysis: cardiac comorbidities (odds ratio, 11.5 95% confidence interval, 1.9--68.3 P = 0.007) and no initial response to NIV (odds ratio, 117.6 95% confidence interval, 10.6--1305.8 P = 0.0001). Conclusion This prospective survey confirms the feasibility and efficacy of NIV in ARF following lung resection. Author Affiliation: (1) Department of Respiratory and Intensive Care Medicine, Hotel-Dieu Hospital, AP-HP, Universite Paris 5, Rene Descartes, Paris, France (2) Department of Thoracic Surgery, Hotel-Dieu Hospital, AP-HP, Universite Paris 5, Rene Descartes, Paris, France (3) Department of Anesthesiology and Surgical Intensive Care, Hotel-Dieu Hospital, AP-HP, Universite Paris 5, Rene Descartes, Paris, France (4) Pneumologie et Reanimation, Hotel-Dieu, 1, place du parvis de Notre-Dame, 75181, Paris Cedex 04, France Article History: Registration Date: 01/10/2008 Received Date: 08/04/2008 Accepted Date: 26/09/2008 Online Date: 14/10/2008 Article note: This work was presented during the September 2008 ESICM congress in Lisbon international meeting and published as an abstract. Electronic supplementary material The online version of this article (doi: 10.1007/s00134-008-1317-z) contains supplementary material, which is available to authorized users.

Byline: Aurelie Lefebvre (1), Suzanne Kural-Menasche (1), Michael Darmon (1), Guillaume Thiery (1), Jean-Paul Feugeas (1), Benoit Schlemmer (1), Elie Azoulay (1) Keywords: N-terminal pro B-type natriuretic peptide; Acute respiratory failure; Cancer patients; Congestive heart failure; Bronchoscopy; BAL Abstract: Objective To assess the accuracy of plasma N-terminal-pro-B-type natriuretic peptide concentrations (NT-proBNP) as a diagnostic tool to recognize acute respiratory failure (ARF) of cardiac origin. Methods Prospective observational study in 100 medical intensive care unit (ICU) patients. NT-proBNP was measured at ICU admission, and diagnosis of cardiac dysfunction was performed using echocardiography. Results Sixteen patients had cardiac ARF, 58 patients had noncardiac ARF, and 26 patients were non-ARF controls. Median (IQR) NT-proBNP was 1,951 (617--9,320)a-pg/ml and was significantly influenced by the level of renal dysfunction. Patients with noncardiac ARF had higher NT-proBNP [1,912 (704--1,922)a-pg/ml] than non-ARF patients [1,022 (383--2,613)a-pg/ml], but lower concentrations than cardiac ARF patients [4,536 (1,568--35,171)a-pg/ml]. The area under the curve (AUC) was 0.663a-+-a-0.078 (95% confidence interval 0.510--0.815) and was not significantly influenced by the level of renal dysfunction. In addition, using a stepwise logistic regression model, NT-proBNP failed to predict independently the presence of cardiac dysfunction. However, with specificity and negative predictive value of 100%, a NT-proBNP cutoff value of 500a-pg/ml seemed useful to rule out cardiac dysfunction. Indeed, none of the 16 patients with cardiac ARF had a NT-proBNP value below 500a-pg/ml, whereas it was the case in 8 (30.8%) non-ARF controls and in 12 (20.7%) noncardiac ARF patients. Conclusions In cancer patients with ARF, plasma NT-proBNP concentration is not a relevant tool to recognize cardiac dysfunction, but is specific enough to rule out the diagnosis in patients with plasma NT-proBNP concentrations below 500a-pg/ml. Author Affiliation: (1) Service de Reanimation Medicale, Hopital Saint-Louis, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France Article History: Registration Date: 03/01/2008 Received Date: 13/07/2007 Accepted Date: 04/12/2007 Online Date: 24/01/2008 Article note: This study was supported by grants from the Assistance Publique Hopitaux de Paris (AOM 04139), the French Society for Critical Care Medicine, and the Sepsis Academy of Ile de France (SAIF). This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-008-1001-3.

Abstract Objective: To study the prognosis and complications of cocaine body-packing (concealment of cocaine in the body for transportation between countries). Design: We retrospectively reviewed the files of all cocaine [...]