Asunto(s)
Betacoronavirus/inmunología , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/epidemiología , Personal de Salud/estadística & datos numéricos , Hospitales Filantrópicos/estadística & datos numéricos , Pandemias , Neumonía Viral/epidemiología , Adulto , Anticuerpos Antivirales/sangre , COVID-19 , Prueba de COVID-19 , Infecciones por Coronavirus/diagnóstico , Femenino , Fundaciones , Francia/epidemiología , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , SARS-CoV-2 , Estudios SeroepidemiológicosAsunto(s)
Adenosina Monofosfato/análogos & derivados , Aneurisma Intracraneal/cirugía , Trombosis Intracraneal/prevención & control , Inhibidores de Agregación Plaquetaria/uso terapéutico , Stents , Adenosina Monofosfato/uso terapéutico , Aspirina/uso terapéutico , Encéfalo/cirugía , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Optic neuritis could lead to severe visual impairment despite corticosteroids. Our aim was to evaluate the rate of visual improvement in patients treated with plasma exchange (PLEX) for severe steroid unresponsive optic neuritis and to identify predictive factors of outcome. Thirty-four patients (41 optic nerves damaged) with remaining visual acuity of 0.1 or less despite steroid pulse therapy were treated with PLEX from September 2010 to May 2015. Demographic and clinical neuro-ophthalmic findings, and spectral domain-optical coherence tomography data before PLEX treatment were analyzed. The mean symptom duration before PLEX was 34.6 days (median 28 days; range 6-92 days). After PLEX, the median final visual acuity was 0.8 and in 56 % of cases, final acuity was 0.5 or better. Past history of ipsilateral optic neuritis was associated significantly with poor outcome defined as final acuity less than 0.5. No significant difference in the visual outcome after PLEX was found between multiple sclerosis and neuromyelitis optica. In conclusion, this observational study showed that PLEX as second-line therapy led to a functionally important visual recovery in more than half patients with severe optic neuritis.
Asunto(s)
Neuritis Óptica/terapia , Intercambio Plasmático , Adolescente , Adulto , Resistencia a Medicamentos , Femenino , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Neuritis Óptica/diagnóstico , Neuritis Óptica/fisiopatología , Pronóstico , Estudios Retrospectivos , Esteroides/uso terapéutico , Resultado del Tratamiento , Agudeza Visual , Adulto JovenRESUMEN
INTRODUCTION: The Nexfin device estimates arterial pressure by the volume clamp method through a finger pneumatic cuff. It also allows to estimate cardiac index (CInoninv) by pulse contour analysis of the non-invasive arterial pressure curve. We evaluated the ability of the device to track changes in cardiac index induced by a fluid challenge. METHODS: We included 45 patients for whom a volume expansion (500 mL of saline infused over 30 min) was planned. The volume expansion-induced changes in cardiac index measured by transpulmonary thermodilution (CIinv, PiCCO device) and in CInoninv were recorded. RESULTS: In seven patients, the Nexfin could not record the arterial curve due to finger hypoperfusion. Considering both the values obtained before and after volume expansion (n = 76 pairs of measurements), the bias (lower and upper limits of agreement) between CIinv and CInoninv was 0.2 (-1.8 to 2.2) L/min/m2. The mean change in CInoninv was 10 ± 11%. The percentage error of CInoninv was 57%. The correlation between the changes in CIinv and CInoninv observed during volume expansion was significant (P = 0.0002) with an r2 = 0.31. CONCLUSIONS: The estimation of CI by the Nexfin device in critically ill patients is not reliable, neither for estimating absolute values of CI nor for tracking its changes during volume expansion.
Asunto(s)
Monitores de Presión Sanguínea , Gasto Cardíaco , Fluidoterapia , Fotopletismografía/instrumentación , Anciano , Enfermedad Crítica , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , TermodiluciónRESUMEN
PURPOSE: To evaluate efficacy and adverse events related to inhaled sevoflurane for long-term sedation compared with standard intravenous (i.v.) sedation with propofol or midazolam. METHODS: Randomized controlled trial. Sixty intensive care unit (ICU) patients expected to require more than 24 h sedation were randomly assigned to one of three groups: group S, inhaled sevoflurane; group P, i.v. propofol; group M, i.v. midazolam. All patients also received i.v. remifentanil for goal-directed sedation (Ramsay scale and pain score) until extubation or for a maximum of 96 h. Primary end points were wake-up times and extubation delay from termination of sedative administration. Proportion of time within Ramsay score 3-4, i.v. morphine consumption at 24 h post extubation, hallucination episodes after end of sedation, adverse events, inorganic fluoride plasma levels, and ambient sevoflurane concentrations were recorded. RESULTS: Forty-seven patients were analyzed. Wake-up time and extubation delay were significantly (P<0.01) shorter in group S (18.6 ± 11.8 and 33.6 ± 13.1 min) than in group P (91.3 ± 35.2 and 326.11 ± 360.2 min) or M (260.2 ± 150.2 and 599.6 ± 586.6 min). Proportion of time within desired interval of sedation score was comparable between groups. Morphine consumption during the 24 h following extubation was lower in group S than in groups P and M. Four hallucination episodes were reported in group P, five in group M, and none in group S (P=0.04). No hepatic or renal adverse events were reported. Mean plasma fluoride value was 82 µmol l(-1) (range 12-220 µmol l(-1)), and mean ambient sevoflurane concentration was 0.3 ± 0.1 ppm. CONCLUSIONS: Long-term inhaled sevoflurane sedation seems to be a safe and effective alternative to i.v. propofol or midazolam. It decreases wake-up and extubation times, and post extubation morphine consumption, and increases awakening quality.
Asunto(s)
Anestésicos por Inhalación/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Hipnóticos y Sedantes/administración & dosificación , Éteres Metílicos/administración & dosificación , Midazolam/administración & dosificación , Propofol/administración & dosificación , Adulto , Anestésicos por Inhalación/efectos adversos , Anestésicos por Inhalación/uso terapéutico , Anestésicos Intravenosos/efectos adversos , Anestésicos Intravenosos/uso terapéutico , Femenino , Humanos , Hipnóticos y Sedantes/efectos adversos , Hipnóticos y Sedantes/uso terapéutico , Unidades de Cuidados Intensivos , Masculino , Éteres Metílicos/efectos adversos , Éteres Metílicos/uso terapéutico , Midazolam/efectos adversos , Midazolam/uso terapéutico , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Propofol/efectos adversos , Propofol/uso terapéutico , Respiración Artificial , Sevoflurano , Desconexión del VentiladorRESUMEN
BACKGROUND: Congenital cleft palate (CP) is a common and painful surgical procedure in infants. CP repair is associated with the risk of postoperative airway obstruction, which may be increased with administration of opioids, often needed for analgesia. No described regional anesthesia technique can provide adequate pain control following CP repair in infants. The primary aim of this prospective and descriptive study was to observe the effectiveness of bilateral maxillary nerve blocks (BMB) using a suprazygomatic approach on pain relief and consumption of rescue analgesics following CP repair in infants. Analgesic consumption was compared to retrospective data. Complications related to this new technique in infants were also reviewed. METHODS: The landmarks and measurements recently defined in a three-dimensional study using computed tomography in infants were used. After general anesthesia, a BMB was performed bilaterally with 0.15 ml x kg(-1) 0.2% ropivacaine in infants scheduled for CP repair. Postoperative analgesia, administration of rescue analgesics, adverse effects, and time to feed were recorded in the 48-h period following surgery and compared to retrospective data. RESULTS: Thirty-three children, mean age 5 +/- 1.8 months and weight 8.3 +/- 1.2 kg, were studied. Eighteen patients out of 33 (55%) did not require additional opioids intra-operatively, vs two out of 20 (10%) without block. None needed morphine postoperatively, and intravenous nalbuphine was required in only six children (18%), vs 16 (80%) without block. Median time to feed was 8 h (range 2-24 h), vs 13 h (4-25) without block. No technical failure or complication related to the BMB was reported. CONCLUSION: BMB using a suprazygomatic approach seems to improve pain relief, to decrease peri-operative consumption of opioids, and to favor early feeding resumption after CP repair in infants.