[Lung ultrasound: clinical applications and perspectives in intensive care unit]. / Échographie pleuropulmonaire: applications cliniques et perspectives en réanimation.

OBJECTIVE: To describe the use of lung ultrasound in clinical practice and the new opportunities offered by this technology in intensive care unit (ICU) patients. METHOD: Review of signs identified by lung ultrasound and systematic analysis of data published within the last 5 years on its use in ICU. The literature has been extracted from the database Pubmed™. Specific keywords were used to select relevant publications. Clinical studies published in French and English languages were assessed. RESULTS: Lung ultrasound serves to diagnose, quantify, drain and monitor pleural effusions. In patients with acute respiratory failure, lung ultrasound participates to the diagnosis, the implementation of treatments and their follow-up. It helps to manage patients with pneumonia and acute lung injury. Finally, the investigation of the interstitial edema brings information about hemodynamics that can serve to manage our patients. CONCLUSION: Lung ultrasound is an easy, non-invasive, and non-irradiant technology. It brings lot of useful information at the patient's bedside.

HLA-DR and B7-2 (CD86) monocyte expressions after major cancer surgery: profile in sepsis.

AIM: HLA-DR monocyte expression may be affected by major surgery. A potential mechanism for monocyte activation is the engagement of costimulatory receptors (B7-2 or CD-86). The aim of the present study was to determine the possible role of monocyte HLA-DR and B7-2 molecules in the occurrence of postoperative sepsis after major cancer surgery. METHODS: This was an observational study in 25 consecutive patients undergoing major elective surgery. Flow cytometry measures were used to determine the expression of HLA-DR and its costimulatory receptors before (day 0) and after surgery (day 1 and day 2). RESULTS: After surgery, the rate of monocytes expressing HLA-DR decreased significantly in all the patients. As compared with day 0, the rate of monocytes expressing B7-2 decreased in all the patients (P<0.03). In the septic group, it remained significantly decreased postoperatively. In the non-septic group, it reached baseline levels at day 2. CONCLUSION: Results suggest a key role for costimulatory molecules in modulating inflammatory response in the context of subsequent postoperative sepsis after major cancer surgery. These molecules may be involved, in association with HLA-DR, in postoperative monocyte dysfunction.

[Venous oximetry: physiology and therapeutic implications]. / Oxymétrie veineuse : physiologie et implications thérapeutiques.

OBJECTIVES: The aims of this review are to point out the determinants of oxygen saturation of the haemoglobin of mixed venous blood (SvO(2)), to specify the correlations existing between SvO(2) and central venous saturation in superior vena cava (ScvO(2)), to determine and finally to locate the current place of venous oximetry in clinical practice. DATA SOURCES: A PubMed database research in English and French languages published until December 2006. The keywords were mixed venous blood oxygen saturation; oxygen consumption; oxygen delivery; oxygen extraction; tissue hypoxia; central venous oxygen saturation. DATA EXTRACTION: Data in selected articles were reviewed, clinical and basic science research relevant information was extracted. DATA SYNTHESIS: The SvO(2) reflects the peripheral extraction of oxygen (O(2)), O(2) delivery and consumption. Its value is related to four determinants: the O(2) consumption (VO(2)), cardiac flow (CF), haemoglobin level (Hb) and O(2) saturation of the haemoglobin of arterial blood (SaO(2)). ScvO(2) is more easily measurable than SvO(2). Under physiological conditions its value is 2 to 3% lower than that of SvO(2). In the critically ill patient, its value is 5% higher than that SvO(2). In most patients, changes in ScvO(2) values parallel those in SvO(2). The clinical interest of the monitoring of venous oximetry was underlined in cases of severe sepsis and septic shock, and during the perioperative period of major surgery. CONCLUSION: The management of patients in critical states with therapeutic goals integrating the monitoring of venous oximetry may reduce the morbidity and mortality of patients undergoing major surgery or hospitalised in the intensive care unit.