[Procalcitonin as a prognosis and diagnosis aid in post-operative cardiac surgery]. / Interet et limites de la procalcitonine en postoperatoire de chirurgie cardiaque.

Procalcitonin (PCT), has been identified as a reliable marker of bacterial infection in critically ill patients. After cardiac surgery, infectious and non infectious inflammatory processes can cause a significant increase in PCT production. At present, literature data seem to confirm that repeated measurements of PCT are a better marker than other parameters, both as prognosis and diagnosis aid. Normal PCT levels are less than 0.1 ng/ml. PCT levels < 2ng/ml can be observed after extracorporeal circulation in case of systemic inflammatory response, in the absente of any post operative complication. However, bacterial infection with organ dysfunction should be suspected when PCT levels are higher 5 ng/ml.

[Tracheotomy or prolonged tracheal intubation for long-term ventilation]. / Trachéotomie ou intubation tracheale prolongee en ventilation mécanique prolongee.

130 critically ill patients undergoing long term mechanical ventilation were divided into two groups, tracheotomy versus translaryngeal intubation. There were no difference in demographic characteristics between the two groups. The incidence of chronic obstructive pulmonary disease (COPD) was also higher in T. The tracheotomy was achieved at mean within 14 days after the beginning of mechanical ventilation. The incidence of pneumonia is the same in the two groups (41% for T versus 39% for I). The length of mechanical ventilation is longer in T (25 +/- 12 d versus 12 +/- 4 d). The COPD represent a risk factor for prolonged mechanical ventilation in T (18 days in COPD patients with tracheotomy versus 9 days in non COPD patients). The length of stay in intensive care unit is higher in T (29 +/- 13 d versus 15 +/- 4 d). The 28th day mortality is similar between the two groups. The tracheotomy didn't allow a shorter duration of mechanical ventilation. That's can be explain by the fact that we performed the tracheotomy in a high risk population for pulmonary complications (COPD) and often after a first failure of weaning form mechanical ventilation.