[Acute mitral insufficiency revealed by unilateral Flash Pulmonary Edema]. / L'image du mois. Insuffisance mitrale aiguë révélée par un œdème aigu du poumon unilatéral.

Flash pulmonary edema (2 % of FPE cases) is observed in 25 % of cases of acute mitral insufficiency. This clinical disorder is often mistaken for infectious pneumonitis and treated as such, with as consequence an increased mortality of these patients. The diagnosis of acute mitral insufficiency is therefore essential for the optimal management of these patients. The etiologies of mitral insufficiency can be of primary or secondary origin. Cardiac ultrasound (trans-thoracic and trans-esophageal) represent the key to the diagnosis of acute mitral insufficiency and to ensure an adapted management. It consists initially in stabilizing the patient's condition (which may be critical) via pharmacological treatments and/or mechanical support. Once stabilized, the patient can benefit from a definitive treatment of the mitral insufficiency either via valve repair (plasty) or its complete replacement.

Un oedème aigu du poumon unilatéral (2 % des cas) est retrouvé dans 25 % des cas d'insuffisance mitrale aiguë. Celui-ci est souvent confondu à tort avec une pneumopathie infectieuse et traité comme telle avec, pour conséquence, une augmentation de la mortalité. Le diagnostic d'une insuffisance mitrale aiguë est donc primordial pour une prise en charge optimale du patient. Les étiologies de celle-ci peuvent être d'origine primaire ou secondaire. L'échographie cardiaque (trans-thoracique et trans-oesophagienne) sera la clef du diagnostic d'insuffisance mitrale aiguë pour assurer une prise en charge adaptée. Celle-ci consiste, dans un premier temps, à stabiliser l'état du patient (qui peut être critique) via des traitements médicamenteux ou/et un support mécanique. Ceci permettra d'amener le patient dans des conditions optimales afin qu'il puisse bénéficier d'un traitement définitif de l'insuffisance mitrale, que ce soit via une plastie ou un remplacement complet de la valve.

Early administration of Vitamin C in patients with sepsis or septic shock in emergency departments: A multicenter, double blinded, randomized controlled trial: The C-EASIE trial protocol.

BACKGROUND: Sepsis is a potentially life-threatening condition characterized by a deregulated body's response to infection causing injury to its own tissues and organs. Sepsis is the primary cause of death from infection. If not recognized and treated timely, it can evolve within minutes/hours to septic shock. Sepsis is associated with an acute deficiency of Vitamin C. Despite the proof-of-concept of the benefit of administering Vitamin C in patients with sepsis or septic shock, Vitamin C administration is not yet current practice. OBJECTIVE: To investigate the potential benefit of early administration of high doses of Vitamin C in addition to standard of care in patients with sepsis or septic shock. METHODS: This phase 3b multi-center trial is conducted in 8 hospitals throughout Belgium. In total 300 patients will be randomly assigned to one of two groups in a 1:1 allocation ratio. The intervention group will receive 1.5 g Vitamin C 4 times a day during 4 days, started within 6 hours after admission. The primary outcome is the average post-baseline patient SOFA score. CONCLUSION: This trial will determine whether the early administration of Vitamin C in patients with sepsis or septic shock can lead to a more rapid solution of shock and less deterioration from sepsis to septic shock, hereby reducing morbidity and mortality as well as the length of hospital stay in this patient population. TRIAL REGISTRATION: The C-EASIE trial has been registered on the ClinicalTrials.gov website on 10 February 2021 with registration number NCT04747795. TRIAL SPONSOR: UZ Leuven (sponsor's reference S63213).