[The first wave of COVID-19 in Intensive care]. / La première vague de la COVID-19 aux Soins intensifs, mars-mai 2020.

In December 2019, in Wuhan, a new human infectious pathology was born, COVID-19, consisting above all in pneumoniae, induced by the coronavirus named SARS-CoV-2 because of the respiratory distress it caused (SARS for severe acute respiratory syndrome, and CoV for Coronavirus). A real health and planetary crisis has appeared, much more substantial than that linked to SARS-CoV-1 in 2002-2004 and to MERS-CoV (Middle East Respiratory Syndrome Coronavirus) in 2012. In addition to respiratory damage that can be dramatic, this pathology is complicated by the frequency of cardiovascular, renal and coagulation diseases. Health care systems have had to adapt urgently, in the absence of hindsight from the pathology, and without effective therapeutic weapons. Through this review of the literature, we detail our local practices for the overall management of patients hospitalized in Intensive care.

En décembre 2019, à Wuhan, une nouvelle pathologie infectieuse humaine est née, le COVID-19, consistant avant tout en une pneumonie, induite par le coronavirus nommé SARS-CoV-2 en lien avec l'intensité de la détresse respiratoire qu'il entraîne (SARS pour syndrome respiratoire aigu sévère, et CoV pour coronavirus). Une véritable crise sanitaire et planétaire est apparue, bien plus conséquente que celle liée au SARS-CoV-1 en 2002-2004 et au MERS-CoV (Middle East Respiratory Syndrome Coronavirus) en 2012. Outre une atteinte respiratoire pouvant être dramatique, cette pathologie est complexifiée par la fréquence des atteintes cardiovasculaires, rénales et de la coagulation. Les systèmes de soins de santé ont dû s'adapter urgemment, en l'absence de recul face à la pathologie, et sans armes thérapeutiques efficaces. Au travers de cette revue de la littérature, nous détaillons nos pratiques locales pour la prise en charge globale des patients hospitalisés aux Soins intensifs.

[Acute respiratory distress syndrome]. / Le syndrome de détresse respiratoire aiguë.

Since its first description in 1967, a lot of progress has been made in understanding the pathophysiology, diagnosis and management of acute respiratory distress syndrome (ARDS). This nosological entity is based on the appearance of a diffuse alveolar damage associating pulmonary epithelial barrier disruption with an alveolar filling, both responsible of profound hypoxemia and important morbi-mortality. Nowadays, ARDS remains a frequent syndrome, associated with various etiologies. Diagnosis is based on the occurrence of acute hypoxic respiratory failure not explained by cardiac insufficiency or volume overload, within 7 days after a recognized risk factor, and in the presence of bilateral pulmonary opacities not fully explained by effusions, atelectasis or nodules on the chest radiography. Survivors present an increased risk of developing cognitive decline, depression, post-traumatic stress, and typical ICU related side-effects such as polyneuropathy and sarcopenia. In this context and not withstanding significant recent progress in the field of mechanical ventilation and extra-corporeal respiratory assistance, early diagnosis remains essential to identify patients with ARDS in order to offer them the most appropriate therapy.

Depuis sa première description en 1967, des progrès majeurs ont été réalisés dans la compréhension de la physiopathologie, le diagnostic et la prise en charge du syndrome de détresse respiratoire aiguë (SDRA). Cette entité nosologique repose sur l'apparition d'un dommage alvéolaire diffus associant une rupture de la barrière épithéliale pulmonaire avec un comblement alvéolaire à l'origine d'une hypoxémie profonde. De nos jours, le SDRA reste un syndrome fréquent, grevé d'une mortalité élevée, et prenant source dans de multiples situations pathologiques. Le diagnostic du SDRA repose sur l'apparition d'une insuffisance respiratoire aiguë hypoxique non expliquée par une insuffisance cardiaque ou une surcharge volémique, dans un délai de 7 jours suivant l'apparition d'un facteur de risque reconnu, en présence d'opacités pulmonaires bilatérales non complètement expliquées par des épanchements, des atélectasies ou des nodules. Les survivants sont à haut risque de développer un déclin cognitif, une dépression, ou un stress post-traumatique en plus des effets secondaires classiques d'une longue hospitalisation en unité de soins intensifs que sont la polyneuropathie ou la sarcopénie. Dans ce contexte, et en dépit de progrès importants dans le domaine de la ventilation mécanique et de l'assistance respiratoire par circulation extra-corporelle, il reste primordial d'identifier précocement les patients souffrant de SDRA afin de leur proposer la thérapeutique la plus appropriée dès les premiers signes cliniques.

Degradation of a series of fluorinated acrylates and methacrylates initiated by OH radicals at different temperatures.

Rate coefficients for the gas-phase reactions of OH radicals with a series of fluorinated acrylates and methacrylates: 2,2,2-trifluoroethylmethacrylate (k 1), 1,1,1,3,3,3-hexafluoroisopropylacrylate (k 2), 1,1,1,3,3,3-hexafluoroisopropylmethacrylate (k 3), and 2,2,2-trifluoroethylacrylate (k 4) have been measured for the first time as a function of temperature in the range 290-308 K. The kinetic data obtained were used to derive the following Arrhenius expressions (in units of cm3 per molecule per s): k 1 = (2.13 ± 0.68) × 10-18 exp[(4745 ± 206)/T], k 2 = (8.72 ± 0.68) × 10-15 exp[(2166 ± 205)/T], k 3 = (6.30 ± 0.51) × 10-17 exp[(3721 ± 153)/T] and k 4 = (3.93 ± 0.43) × 10-16 exp[(3140 ± 129)/T]. The experiments were performed at normal atmospheric pressure in synthetic air using a 1080 L photoreactor and coupled with FTIR analysis to monitor the decay of the substances of interest and the reference compounds. The obtained negative temperature dependencies are in agreement with a mechanism implying an initial addition of the OH radical to the double bond. Atmospheric implications are discussed with reference to the rate coefficients obtained as a function of the temperature.

Effect of hydroxyethylstarch on renal function in cardiac surgery: a large scale retrospective study.

BACKGROUND: Recent reports indicated negative effects of hydroxyethylstarch (HES) on renal function. The goal of this large scale retrospective study was to detect whether there was an association between postoperative deterioration of renal function and the use of HES 200 kD, 0.5 DS in the cardiac surgery setting. METHODS: Retrospective analysis of daily collected data in 3124 patients who underwent coronary artery bypass and/or valvular surgery. Three groups were compared according to differences in fluid therapy: --GEL: gelatin was used as priming fluid of extracorporeal circulation (ECC) and for postoperative filling (n = 1276). --MIX: HES was used as priming fluid of ECC an gelatin was used for postoperative filling (n = 1008). --HES: HES was used as priming fluid of ECC and for postoperative filling (n = 840). MAIN RESULTS: There were no significant differences in postoperative serum creatinine concentrations between the 3 groups: GEL: 12,2 +/- 0,5 mg/l; MIX: 12,3 +/- 0.5 mg/l; HES: 12,3 +/- 0.6 mg/l. The need for postoperative extrarenal epuration was not significantly different between the 3 periods: GEL: 2,9%; MIX: 3,1%; HES: 3,8%. CONCLUSION: The use of HES 200 kD, 0.5 DS in cardiac surgery does not seem to be associated with a clinically significant deterioration of postoperative renal function.

["Fulminant" endocarditis due to Staphyloccocus aureus]. / Le cas clinique du mois. Endocardite "fulminante" a Staphylocoque doré.

We report two cases of "fulminant" endocarditis due to Staphyloccoccus aureus. In both cases, the echocardiographic and bacteriologic diagnosis was esthablished in a clinical picture of severe sepsis and thrombocytopenia evolving after a fever of less than 3 days duration.

Physician attitudes toward research study participation: a focus group.

The Wisconsin Research Network (WReN) and the UW Health Education And Research Trial (HEART) sponsored a focus group to explore the attitudes of primary care physicians toward research in their practices. Physicians, representing a variety of practice groups, emphasized that research is a low priority in their organizations. All had participated in some form of research, are philosophically committed to research as important to primary care, but are hesitant to commit themselves to participation in further research. They emphasized that academic researchers need to understand the constraints of primary care practice, propose research ideas that are practical and interesting to care providers, provide relevant feedback to participating practices, and do the majority of the research work themselves so impositions on the practice are minimal. The traditional barriers to practice-based research, such as the cost of physician and staff time and diversion from other tasks, continue to be of concern when physicians consider participation in research projects.

The cost of primary care research.

A significant portion of research project costs is incurred before the receipt of grant funds. This poses a problem for the initiation of primary care research, especially in community practice settings. Potential investigators need financial support for staff time, training, pilot work, and grant proposal writing if primary care researchers are to compete successfully for grant funds. To find this support, we need to understand and eventually quantify the actual costs of research with attention to those that are incurred before the receipt of grant funds. We outline 10 phases of the research process and provide a model for understanding where costs are incurred and by whom. Costs include those associated with maintaining practice interest in research, supporting practice participation, and disseminating research findings. They may be incurred by either an academic center or a research network, by the practices and physicians themselves, or by an extramural funding source. The needed investment for initiating primary care research can be itemized and, with further research, quantified. This will enhance the arguments for capital investments in the primary care research enterprise.

Atmospheric photooxidation of fluoroacetates as a source of fluorocarboxylic acids.

A 1080 L environmental chamber with in situ FTIR spectroscopy detection was used to study the product distribution and the mechanism of the Cl-initiated photooxidation of a series of fluoroacetates. The gas-phase reactions of Cl atoms with ethyl trifluoroacetate (CF(3)C(O)OCH(2)CH(3)), methyl trifluoroacetate (CF(3)C(O)OCH(3)), and methyl difluoroacetate (CF(2)HC(O)OCH(3)) were investigated at 296 +/- 2 K and atmospheric pressure (approximately 760 Torr) of synthetic air. The fate of the fluoroalkoxy radicals formed in the reaction with Cl atoms mainly occurs through (i) an H-atom abstraction by reaction with O(2,) to produce the corresponding fluoroanhydride and (ii) an alpha-ester rearrangement via a five-membered ring intermediate to give the corresponding fluoroacetic acid. The yields of fluoroacids (CF(2)XC(O)OH, with X = H, F) obtained were as follows: 78 +/- 5, 23 +/- 2, and 30 +/- 5% for CF(3)C(O)OCH(2)CH(3), CF(3)C(O)OCH(3), and CF(2)HC(O)OCH(3,), respectively. Yields of

A new instrument to measure gaseous nitrous acid (HONO) in the atmosphere.

A new in situ instrument (LOPAP: long path absorption photometer) to measure gaseous nitrous acid (HONO) using wet chemical sampling and photometric detection has been developed. This instrument is aimed to overcome the known problems with current HONO measurement techniques and was designed to be a cheap, sensitive, compact, and continuouslyworking HONO monitorfor ambient air measurements in the troposphere or for measurements of higher concentrations e.g. in smog chambers, in exhaust gases, and in indoor environments. Laboratory investigations were carried outto characterize the instrument components with respect to collection efficiency, optimum dye formation, optimum detection, and interfering species. Detection limits ranging from approximately 3 to 50 pptV have been obtained with response times from 4 to 1.5 min, respectively, using different instrument parameters. The accuracy of the measurements is in the range between +/-(10-15)%. The validation of the instrument was performed in the laboratory for HONO concentrations of 3 and 30 ppbV using ion chromatography and with a DOAS (differential optical absorption spectrometer) instrument in a large outdoor smog chamber in the range from 0.1 to 20 ppbV. The deviations were well within the errors of the measurements; however, when comparing the data with the DOAS instrument systematically higher values were found with the LOPAP instrument.

Nonintrusive optical measurements of aircraft engine exhaust emissions and comparison with standard intrusive techniques.

Nonintrusive systems for the measurement on test rigs of aeroengine exhaust emissions required for engine certification (CO, NO(x), total unburned hydrocarbon, and smoke), together with CO(2) and temperature have been developed. These results have been compared with current certified intrusive measurements on an engine test. A spectroscopic database and data-analysis software has been developed to enable Fourier-transform Infrared measurement of concentrations of molecular species. CO(2), CO, and NO data showed agreement with intrusive techniques of approximately ?30%. A narrow-band spectroscopic device was used to measure CO(2) (with deviations of less than ?10% from the intrusive measurement), whereas laser-induced incandescence was used to measure particles. Future improvements to allow for the commercial use of the nonintrusive systems have been identified and the methods are applicable to any measurement of combustion emissions.