Multifaceted bench comparative evaluation of latest intensive care unit ventilators.

BACKGROUND: Independent bench studies using specific ventilation scenarios allow testing of the performance of ventilators in conditions similar to clinical settings. The aims of this study were to determine the accuracy of the latest generation ventilators to deliver chosen parameters in various typical conditions and to provide clinicians with a comprehensive report on their performance. METHODS: Thirteen modern intensive care unit ventilators were evaluated on the ASL5000 test lung with and without leakage for: (i) accuracy to deliver exact tidal volume (VT) and PEEP in assist-control ventilation (ACV); (ii) performance of trigger and pressurization in pressure support ventilation (PSV); and (iii) quality of non-invasive ventilation algorithms. RESULTS: In ACV, only six ventilators delivered an accurate VT and nine an accurate PEEP. Eleven devices failed to compensate VT and four the PEEP in leakage conditions. Inspiratory delays differed significantly among ventilators in invasive PSV (range 75-149 ms, P=0.03) and non-invasive PSV (range 78-165 ms, P<0.001). The percentage of the ideal curve (concomitantly evaluating the pressurization speed and the levels of pressure reached) also differed significantly (range 57-86% for invasive PSV, P=0.04; and 60-90% for non-invasive PSV, P<0.001). Non-invasive ventilation algorithms efficiently prevented the decrease in pressurization capacities and PEEP levels induced by leaks in, respectively, 10 and 12 out of the 13 ventilators. CONCLUSIONS: We observed real heterogeneity of performance amongst the latest generation of intensive care unit ventilators. Although non-invasive ventilation algorithms appear to maintain adequate pressurization efficiently in the case of leakage, basic functions, such as delivered VT in ACV and pressurization in PSV, are often less reliable than the values displayed by the device suggest.

[Rational approach of antibioprophylaxis: systematic review in ENT cancer surgery]. / Conduite rationnelle de l'antibioprophylaxie : revue systématique en chirurgie carcinologique ORL.

In head and neck cancer surgery antibiotic prophylaxis is effective in reducing the incidence of surgical site infections (SSI). However, controversies between antibiotic prophylaxis and curative antibiotic therapy exist, particularly when complex and decaying surgeries are performed in risky underlying conditions, with a risk of persisting salivary effusion in the postoperative period, or in the case of reconstruction with myo-cutaneous flaps. We have performed a systematic review of the literature according to PRISMA recommendations to answer the following questions: indications for antibiotic prophylaxis and curative antibiotic therapy, optimal duration, and choice of antibiotics for prophylaxis in head and neck cancer surgery. Literature analysis allows to conclude that patients undergoing Altemeier classes 2 and 3 surgical procedures should receive perioperative antibiotic prophylaxis restricted to the first 24 postoperative hours. No benefit has been shown with its extension beyond these 24 hours. The most adapted combinations of antibiotics in this setting are "amoxicillin+clavulanic acid" and "clindamycin+gentamicin". However, the level of evidence regarding the most decaying surgeries with high risk of SSI is low, making it necessary to perform new high-powered randomized trials in these patients. Eventually, it should be noted that antibiotic prophylaxis should be an integral part of SSI preventive measures, including application of hygiene measures, and postoperative monitoring of SSI clinical signs.

Alveolar fibroblasts in acute lung injury: biological behaviour and clinical relevance.

Although fibroblasts are key cells in the lung repair/fibrosis process, their characteristics are poorly studied in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The aims of our study were to: 1) determine the biological behaviour of alveolar fibroblasts during ALI; and 2) to evaluate the clinical relevance of positive alveolar fibroblast culture from patients with ALI/ARDS. Cells were cultured from bronchoalveolar lavage (BAL) obtained from 68 critically ill, ventilated patients: ALI n = 17; ARDS n = 31; and ventilated controls n = 20. Patients were followed for 28 days and clinical data was recorded. We studied proliferation, migration and collagen-1 synthesis capacities of fibroblasts. Cells expressing fibroblast markers were cultured from BAL obtained in six (35%) ALI patients and six (19%) ARDS patients, but never from ventilated controls. Alveolar fibroblasts exhibited a persistent activated phenotype with enhanced migratory and collagen-1 production capacities, with hyporesponsiveness to prostaglandin E(2) compared to normal lung fibroblasts (p< or =0.04). Positive fibroblast culture was associated with both an increased collagen-1 concentration and monocyte/macrophage percentage in BAL fluid (p< or =0.01), and with a reduced duration of mechanical ventilation (p<0.001). We conclude that activated alveolar fibroblasts can be cultured either in ALI or ARDS and that their presence might reflect the initiation of the organising phase of ALI.

Modulation of bleomycin-induced lung fibrosis by serotonin receptor antagonists in mice.

Serotonin (5-hydroxytryptamine; 5-HT) is known to increase proliferation and collagen synthesis by fibroblasts. Two receptor subtypes, 5-HT2A and 5-HT2B, have been shown to play the most important roles in the lung. In the present study, the role of serotonin in lung fibrosis was investigated using the bleomycin mouse model. Serotonin concentrations in lung homogenates increased significantly over the time course of bleomycin-induced fibrosis, with a maximum at day seven. The expression of serotonin receptors 5-HT2A and 5-HT2B increased in the lung after bleomycin treatment, as assessed by PCR, specific binding and immunohistochemistry. Blockage of 5-HT2A receptors by ketanserin and 5-HT2B receptors by SB215505 reduced bleomycin-induced lung fibrosis, as demonstrated by reduced lung collagen content and reduced procollagen 1 and procollagen 3 mRNA expression. Serotonin antagonists promoted an antifibrotic environment by decreasing the lung mRNA levels of transforming growth factor-beta1, connective growth factor and plasminogen activator inhibitor-1 mRNA, but had minimal effects on lung inflammation as assessed by bronchoalveolar lavage cytology analysis. Interestingly, the 5-HT2B receptor was strongly expressed by fibroblasts in the fibroblastic foci in human idiopathic pulmonary fibrosis samples. In conclusion, the present study showed involvement of serotonin in the pathophysiology of bleomycin-induced lung fibrosis in mice and identified it as a potential therapeutic target in lung fibrotic disorders.

[Assessment of the penetration of culture media in uterine cavity as an effect of cervical lavage before embryo transfer: prospective and observational study of samples obtained in hysterectomy]. / Evaluación de la penetración del medio de cultivo a la cavidad uterina como efecto del lavado cervical previo a la transferencia embrionaria: estudio prospectivo y observacional en piezas obtenidas por histerectomía.

Cervical lavage used to remove and cleaning some of the scale elements as well as cervical mucous during embryo transfer has been a regular practice in many reproductive centers worldwide. However, the microenvironment influence using these techniques will or not be detrimental in the embryo development. Under this issue, a prospective study was doing in 16 patients (underwent hysterectomy). A cervical lavage was performed previous to the procedure similar to the embryo's transfer step, subsequently cervical invasion was checking. The age was 36.4 +/- 8.6 years, preoperatory diagnosis was abnormal uterine bleeding (n = 4), myomata (n = 4), adenomiosis (n = 4), endometrial polyp (n = 3) and chronic pelvic pain (n = 1). Uterine weight was 127.5 +/- 55.4 g with a surgical time of 48.8 +/- 12.5 minutes. Medium in the uterine cavity was founded in only one case. We believe that cervical lavage is a secure technique in embryo transfer.

Prospective survey of colonization and infection caused by SHV-4 producing Klebsiella pneumoniae in a neurosurgical intensive care unit.

The occurrence of extended-spectrum beta-lactamase producing enterobacteria (ESBLE) has been prospectively surveyed in a neurosurgical intensive care unit (ICU). Of the 47 patients examined, 8 were identified as faecal carriers, and 2 of them developed a subsequent urinary tract infection. ESBLE were also detected in the immediate environment of five colonized and/or infected patients. All isolates were Klebsiella pneumoniae of a particular biotype which exhibited a similar antibiotype and produced an SHV-4 type beta-lactamase. However, plasmid profiling and ribotyping revealed that strains isolated from seven patients of hall A were a single epidemic clone, whereas strains isolated from the eighth patient of hall B were different. Comparison between the characteristics of patients who carried an ESBLE during the surveillance period, and control patients who did not, showed that a recent surgery, and the length of ICU stay were significantly associated with the acquisition of ESBLE.

[Microbial etiology of mild and moderate pelvic inflammatory disease]. / Etiología microbiana de la enfermedad inflamatoria pélvica leve y moderada (EIP).

Pelvic inflammatory disease (PID) is one of the most severe complications of sexually transmitted disease (STD). It can be due to the ascending of normal endogenous microorganisms of the female genital tract or the infection by microorganisms related to STD as Chlamydia trachomatis and Neisseria gonorrhoeae. PID leads to serious gynecoobstetric consequences as infertility and ectopic pregnancy. Clinicians face the problem of knowing the ethiology of PID in order to treat appropriatly patients with this clinical diagnosis. So that, this work pretends to establish what kind of microorganisms are implicated in PID. A proper isolation and identification of microorganisms achieved by culture of lower genital tract samples from endocervix, endometrium and peritoneal fluid, leading to a betther, specific and proper treatment of this disease.

[Calcified thrombus of the inferior vena cava. Apropos of a case]. / Thrombus calcifié de la veine cave inférieure. A propos d'un cas.

A case of calcified thrombus in the inferior vena cava discovered in child during the screening of a scoliosis is presented. Standard X-rays demonstrate the calcification and allow the diagnosis of calcified thrombus. Ultrasound, if necessary, can be performed. Pathogenesis remains at the present time unknown but congenital or hemodynamic factor are probable. Children are asymptomatic and no specific treatment is advised.

Computed arthrography: its role in the screening of joint diseases in pediatric radiology.

The purpose of this study was to analyse the accuracy of combined arthrography and computed tomography in pediatric radiology. 23 patients were selected and the joints studied (n = 25) were: elbow (1), shoulder (2), knee (8) and hip (14). The contribution of computed arthrography varies according to the joint and the disease concerned. Osteochondritis dissecans of the knee appears to be the best indication.

[Value of magnetic resonance imaging in the follow-up of children operated for portal hypertension]. / Intérêt de l'examen par résonance magnétique dans la surveillance de l'hypertension portale opérée chez l'enfant.

The authors report their experience concerning nuclear magnetic resonance imaging (NMR) in 7 children. They emphasize its importance in the post-operative study of portal hypertension. All those children got surgically created porto-systemic shunts. NMR imaging is easy, safe and trustable. It is able to visualise the shunt itself and to demonstrate the patency of this shunt. So, it is interesting when the usual controls have failed, particularly abdominal ultrasonography.