62 research outputs found
Studies on the differential feeding of grasshoppers on strains of Zea mays (L.)
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Évaluation de l’incidence de transfusion de concentrés de globule rouges avant et après la mise en place d’un programme péri-opératoire de gestion personnalisée du capital sanguin chez les patients adultes ayant une chirurgie cardiaque au CHU Nord de La Réunion. Une étude observationnelle rétrospective avant-après
No full textBackground : Anaemia and transfusion are common in cardiac surgery patients and are associated with significant morbidity and mortality. Multiple perioperative interventions have been described to reduce blood transfusion but rarely associated altogether. The aim of this study was to compare the incidence of red blood cell (RBC) transfusion in adult patients undergoing cardiac surgery before and after the implementation of a perioperative patient blood management (PBM) program.Method : This single centre retrospective observational study included consecutive adult patients scheduled for cardiac surgery in a French university teaching hospital. The first 6 months period (pre-PBM period) represented baseline practice. The second 6 months period (post-PBM period) represented the implementation of a PBM program, including preoperative, intraoperative, and postoperative interventions aimed at identifying and correcting anaemia, minimizing blood loss during surgery, and optimizing coagulation.Results : A total of 434 patients were included in the study between January 2021 to July 2022. The incidence of perioperative RBC transfusion (intraoperatively and during the first two postoperative days) was significantly reduced from 43% (90/213) in the pre-PBM period to 27% (60/221) in the post-PBM period (OR 0.51 (95%CI 0.34-0.76) p<0.001). This reduction in RBC transfusion was associated with a reduction in the median number of RBC units transfused (p=0.03) and persistent at day 30 after surgery (p<0.029).Conclusion : A perioperative PBM program in adults’ patients undergoing cardiac surgery was associated with a significant reduction in perioperative RBC transfusion, persistent at day 30.Introduction : L’anémie et la transfusion sont fréquentes chez les patients de chirurgie cardiaque et sont associées à une morbidité et une mortalité significative. De multiples interventions péri-opératoires ont été décrites pour réduire la transfusion sanguine mais ont rarement été associées ensemble. Le but de cette étude est de comparer l’incidence de la transfusion de concentré de globule rouge chez les patients adultes ayant une chirurgie cardiaque avant et après l’implémentation d’une gestion personnalisée du capital sanguin péri-opératoire (PBM).Méthode : Cette étude monocentrique, observationnelle et rétrospective, inclut consécutivement les patients adultes ayant une chirurgie cardiaque programmée dans un centre hospitalier universitaire français. La première période de 6 mois (période pré-PBM) représente la pratique de base. La seconde période de 6 mois (période post-PBM) représente l’implémentation d’un programme PBM, incluant des interventions préopératoires, intra-opératoires et post-opératoires visant à identifier et corriger l’anémie, minimiser les pertes sanguines durant la chirurgie et optimiser la coagulation.Résultats : Un total de 434 patients a été inclus dans l’étude entre Janvier 2021 et Juillet 2022. L’incidence de transfusion de CGR péri-opératoire (per-opératoire et durant les deux jours post-opératoires) réduit significativement de 43% (90/213) dans la période pré-PBM à 27% (60/221) dans la période post-PBM (OR 0.51 (IC95 0.34-0.76) p<0.001). Cette réduction de l’incidence de transfusion en CGR est associée avec une réduction du nombre moyen de CGR transfusé (p<0.03) et cela persiste 30 jours après la chirurgie (p<0.029).Conclusion : L’implémentation d’un programme PBM péri-opératoire chez les patients adultes ayant une chirurgie cardiaque est associé à une réduction significative de la transfusion de CGR, et cela persiste 30 jours après la chirurgie
Intraoperative management of brain-dead organ donors by anesthesiologists during an organ procurement procedure: results from a French survey
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Intraoperative management of brain-dead organ donors by anesthesiologists during an organ procurement procedure: results from a French survey
No full textBackgroundThis study aimed at describing usual anesthetic practices for brain-dead donors (BDD) during an organ procurement (OP) procedure and to assess the knowledge and self-confidence of French anesthesiologists with this practice.MethodsAn electronic and anonymous survey with closed-questions about anesthetic management of BDD was distributed to French anesthesiologists via the mailing list of the French Society of Anesthesiology and Intensive Care Medicine.ResultsFour hundred fifty-eight responses were analyzed. Respondents were mainly attending physicians with more than 10 years of clinical experience. 78% of them declared being cognizant of guidelines regarding management of BDD. Advanced hemodynamic monitoring and endocrine substitution were rarely considered by respondents (31 and 35% of respondents, respectively). 98% of the respondents used crystalloids for fluid resuscitation. During the procedure, use of neuromuscular blockers, opioids and sedative agents were considered by respectively 84, 61 and 27% of the respondents. A very high level of agreement (10 [8-10], on a ten-points Likert-style scale) was reported concerning the expected impact of intraoperative anesthetic management on the primary function of grafts.ConclusionsDeclared anesthetic practice appeared in accordance with guidelines concerning organ donor management in the ICU. Further studies are needed to evaluate the specific impact of intraoperative management during this procedure and thus the need for specific anesthetic guidelines
Noninvasive continuous monitoring versus intermittent oscillometric measurements for the detection of hypotension during digestive endoscopy.
No full textBackgroundHemodynamic monitoring during digestive endoscopy is usually minimal and involves intermittent brachial pressure measurements. New continuous noninvasive devices to acquire instantaneous arterial blood pressure may be more sensitive to detect procedural hypotension.PurposeTo compare the ability of noninvasive continuous monitoring with that of intermittent oscillometric measurements to detect hypotension during digestive endoscopy.MethodsIn this observational prospective study, patients scheduled for gastrointestinal endoscopy and colonoscopy under sedation were monitored using intermittent pressure measurements and a noninvasive continuous technique (ClearSight™, Edwards). Stroke volume was estimated from the arterial pressure waveform. Mean arterial pressure and stroke volume values were recorded at T1 (prior to anesthetic induction), T2 (after anesthetic induction), T3 (gastric insufflation), T4 (end of gastroscopy), T5 (colonic insufflation). Hypotension was defined as mean arterial pressure ResultsTwenty patients (53±17 years) were included. Six patients (30%) had a hypotension detected using intermittent pressure measurements versus twelve patients (60%) using noninvasive continuous monitoring (p = 0.06). Mean arterial pressure decreased during the procedure with respect to T1 (p ConclusionNoninvasive continuous monitoring was more sensitive than intermittent measurements to detect hypotension. Estimation of stroke volume revealed profound reductions in systemic flow. Noninvasive continuous monitoring in high-risk patients undergoing digestive endoscopy under sedation could help in detecting hypoperfusion earlier than the usual intermittent blood pressure measurements
Effectiveness of a high-fidelity simulation-based training program in managing cardiac arrhythmias in children: a randomised pilot study
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The effects of intraoperative lung protective ventilation with positive end-expiratory pressure on blood loss during hepatic resection surgery
No full textInternational audienceDuring high-risk abdominal surgery the use of a multi-faceted lung protective ventilation strategy composed of low tidal volumes, positive end-expiratory pressure (PEEP) and recruitment manoeuvres, has been shown to improve clinical outcomes. It has been speculated, however, that mechanical ventilation using PEEP might increase intraoperative bleeding during liver resection
Relationship between three commonly used non‐invasive fibrosis biomarkers and improvement in fibrosis stage in patients with non‐alcoholic steatohepatitis
No full textBackground & aimsNon-invasive biomarkers are needed for monitoring changes in liver histology in patients with non-alcoholic steatohepatitis (NASH). Obeticholic acid (OCA) was shown to improve fibrosis in patients with NASH in the FLINT trial; a post hoc analysis of these data was performed to determine the relationship between 3 non-invasive fibrosis markers and liver fibrosis improvement.MethodsIn the Phase 2b FLINT trial, patients were randomised (1:1) to receive 25 mg OCA or placebo once daily for 72 weeks. Aspartate aminotransferase:platelet ratio index (APRI), fibrosis-4 (FIB-4) index and non-alcoholic fatty liver disease fibrosis score (NFS) were evaluated in serum at baseline and weeks 24, 48, 72 and 96. Liver biopsies were obtained at baseline and 72 weeks.ResultsIn patients with fibrosis improvement at week 24, scores were reduced by a median of 34% for APRI, 10% for FIB-4 and 4% for NFS. Reductions in APRI (P = 0.015) and FIB-4 (P = 0.036), but not NFS (P = 0.201) at week 24, significantly correlated with ≥1-stage improvement in histologic fibrosis at week 72. Reductions in APRI at week 72 were significantly correlated with fibrosis improvement at week 72 (P = 0.012). Patients receiving OCA had significant reductions in all markers compared with patients receiving placebo at week 72 [APRI and FIB-4 (P < 0.0001); NFS (P < 0.05)].ConclusionsReadily available non-invasive markers may predict improvement in liver fibrosis in patients with NASH. Upon external confirmation and further refinement in larger populations, these markers may serve as surrogate endpoints in NASH clinical trials
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