[Chikungunya outbreak on Reunion Island in 2005/2006: role of hospital physicians in raising alert]. / L'epidémie de chikungunya de la Réunion 2005-2006; place du médecin hospitalier dans l'alerte et la gestion de l'epidémie.

The epidemic of chikungunya (CHIK) that swept through Reunion Island from late 2005 to mid 2006 affected 38.2% of the population, i.e., 300000 people. Although this outbreak took place in a French overseas department with high public health standards, failure to anticipate a large-scale epidemic associated with unprecedented severity and unexpectedly high mortality led to a major public health crisis. The purpose of this report is to provide a complete account of the experience of hospital intensive care physicians in addressing problems ranging from discovery of severe forms to management of a major health crisis. This report underlines the role of the head hospital physician and the necessity of mutual trust and collaboration with supervisory authorities.

[Severe head injuries: effects of pre-hospital mechanical ventilation on capnia]. / Traumatismes crâniens graves: effets de la ventilation mécanique préhospitalière sur la capnie.

OBJECTIVE: To assess the effect on PaCO2 of mechanical ventilation during prehospital management of severely head-injured patients. STUDY DESIGN: Retrospective observational study. PATIENTS: Severely head-injured patients with Glasgow coma score < or = 8. All patients were sedated, with the trachea intubated and the lungs mechanically ventilated. METHODS: According to the capnia measured at the admission in the neurosurgical intensive therapy unit they were allocated into one of the following three groups: hypocapnia group (PaCO2 < 30 mmHg), recommended capnia group (PaCO2 = 30-38 mmHg) and hypercapnia group (PaCO2 > 38 mmHg). RESULTS: Out of the 42 patients with similarly severe head injuries, 19% were included in the recommended capnia group (PaCO2: 34 +/- 2 mmHg), 38% in the hypocapnia group (PaCO2: 23 +/- 3 mmHg) and 43% in the hypercapnia group (PaCO2: 47 +/- 7 mmHg). In all except three, PaO2 was above 95 mmHg. The settings of ventilatory parameters on the ventilators were similar. CONCLUSION: In 81% of patients, mechanical ventilation was inadequate as far as PaCO2 levels are concerned. Major hypocapnia and hypercapnia carry a potential risk for cerebral ischaemic. Therefore it is recommended to monitor PETCO2 during prehospital transport in medical ambulances and to determine arterial blood gases at arrival of severely head-injured patients in the admission unit for emergencies.