Prognostic significance of central venous-to-arterial carbon dioxide difference during the first 24 hours of septic shock in patients with and without impaired cardiac function.

OBJECTIVE: To investigate the prognostic significance of central venous-to-arterial carbon dioxide difference (cv-art CO 2 gap) during septic shock in patients with and without impaired cardiac function. METHODS: We performed a prospective cohort study in 10 French intensive care units. Patients suffering from septic shock were assigned to the impaired cardiac function group ('cardiac group', n =123) if they had atrial fibrillation (AF) and/or left ventricular ejection fraction (LVEF) <50% at study entry and to the non-cardiac group ( n =240) otherwise. RESULTS: Central venous and arterial blood gases were sampled every 6 h during the first 24 h to calculate cv-art CO 2 gap. Patients in the cardiac group had a higher cv-art CO 2 gap [at study entry and 6 and 12 h (all P <0.02)] than the non-cardiac group. Patients in the cardiac group with a cv-art CO 2 gap >0.9 kPa at 12 h had a higher risk of day 28 mortality (hazard ratio=3.18; P =0.0049). Among the 59 patients in the cardiac group with mean arterial pressure (MAP) ≥65 mm Hg, central venous pressure (CVP) ≥8 mm Hg and central venous oxygen saturation (ScvO 2 ) ≥70% at 12 h, those with a high cv-art CO 2 gap (>0.9 kPa; n =19) had a higher day 28 mortality (37% vs. 13%; P =0.042). In the non-cardiac group, a high cv-art CO 2 gap was not linked to a higher risk of day 28 death, whatever the threshold value of the cv-art CO 2 gap. CONCLUSION: Patients with septic shock and with AF and/or low LVEF were more prone to a persistent high cv-art CO 2 gap, even when initial resuscitation succeeded in normalizing MAP, CVP, and ScvO 2 . In these patients, a persistent high cv-art CO 2 gap at 12 h was significantly associated with higher day 28 mortality.

[Fulminant myocarditis: clinical value of extracorporeal life support]. / Myocardites fulminantes : intérêt de l'assistance circulatoire temporaire.

Fulminant myocarditis is a rare cause of cardiogenic shock which usually occurs in young adults without known cardiac disease. Initial course may be complicated by a cardiogenic shock refractory to optimal medical treatment. Temporary circulatory assistance using an extracorporeal life support is of great clinical value in this setting, since myocardial systolic function usually fully recovers after a short time delay.

[Pain management with nerve root block under ct and neurostimulator guidance]. / Traitement de la douleur par infiltrations nerveuses sous contrôle tomodensitométrique et neurostimulateur.

PURPOSE: To evaluate the efficacy of nerve roots block under CT and neurostimulator guidance for the management of pain. MATERIAL: and method. Nerve root blocks were performed in 27 patients (pudendal nerve, intercostal nerve, ilio-hypogastric nerve, thoracic and lumbar sympatholysis). These were performed with corticosteroids (Altim((R))) (20 patients) or phenol (7 patients). RESULTS: Seventeen patients (63%) had pain reduction during at least 15 days. The pain relief was longer with phenol. Complications appeared in the 3 lumbar sympatholysis (inguinal pain) and one of the thoracic sympatholysis (Claude Bernard Horner syndrome). CONCLUSION: The nerve root blocks seem to have some efficacy and a further evaluation is necessary to assess their impact on the ability of patients to return to work and their need for pain medication. When performing these procedures, one must be careful to avoid potential complications and verify that the procedure is needed.

[Efficacy of C1-C2 block with posterior parasagittal approach in the treatment of Arnold neuralgia in 24 patients]. / Efficacité de l'infiltration de C1-C2 par voie parasagittale postérieure dans le traitement de la névralgie d'Arnold de 24 patients.

UNLABELLED: The purpose of the study is to evaluate the efficacy of C1-C2 block from a posterior parasagittal approach to treat Arnold neuralgia. MATERIALS AND METHODS: 24 patients have been interviewed after 33 blocks were performed. The mean delay was 22 months. The posterior approach had always been performed using fluoroscopy. 27 blocks were performed with Hydrocortancyl((R)), 6 with Altim((R)). RESULTS: 71% of patients were symptomatically improved after one month, 62% after 3 months and more than 50% after one year. Using a visual analogue scale, pain was reduced of 5.8, i.e. 70% of patients were improved. An important reduction of pain killer requirements was noted for improved patients, patients with pain recurrence asked for a new infiltration. No significant side effect was noted. CONCLUSION: Our method seems to be an efficient alternative to blocks performed on the origin of the nerve and to surgical treatment.