Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Feb 2010
Review[Microcirculatory alterations in critically ill patients: pathophysiology, monitoring and treatments].
Microcirculation represents a complex system devoted to provide optimal tissue substrates and oxygen. Therefore, pathophysiological and technological knowledge developments tailored for capillary circulation analysis should generate major advances for critically ill patients' management. In the future, microcirculatory monitoring in several critical care situations will allow recognition of macro-microcirculatory decoupling, and, hopefully, it will promote the use of treatments aimed at preserving tissue oxygenation and substrate delivery.
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Ann Fr Anesth Reanim · Feb 2010
Review[ARDS and influenza A (H1N1): patients' characteristics and management in intensive care unit. A literature review].
Novel influenza A (H1N1) at the origin of the 2009 pandemic flu developed mainly in subjects of less than 65 years contrary to the seasonal influenza, which usually developed in elderly patients of more than 65 years. Elderly subjects are partly protected by old meetings with close stocks. Influenza A(H1N1) can arise in serious forms within 60 to 80% of cases a fulminant acute respiratory distress syndrome (ARDS) "malignant and fulminant influenza" in subjects without any comorbidity, which makes the gravity and the fear of this influenza. ⋯ Obesity, pregnancy and respiratory diseases (asthma, COPD) seem to be associated to the development of a severe viral pneumonia due to influenza A (H1N1) often with ARDS. Older age, high APACHE II and SOFA scores and a delay of initiation of the antiviral treatment by oseltamivir are associated to higher morbidity and mortality. Other analyses of the results obtained from the first published papers included more patients and future studies would permitted to better define the role of therapeutics such as steroids and ECMO.
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Ann Fr Anesth Reanim · Feb 2010
Multicenter Study[Practice assessment of central venous lines care in surgical ICU of French university hospitals].
Recommendations on insertion and maintenance of central venous catheters (CVC) in intensive care unit (ICU) patients were updated in 2002. The aim of this study was to estimate their knowledge and/or application by physicians in French university hospital ICUs. ⋯ The high number of answers allows setting of a precise state of CVCs insertion practices in adult surgical ICUs. Recommendations for central venous catheter insertion and maintenance are not still known and\or applied.
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Ann Fr Anesth Reanim · Feb 2010
Randomized Controlled Trial[Impact of intrathecal morphine on the tolerance of early feeding after cesarean section].
Early feeding is well tolerated in patients undergoing caesarean section under general or regional anaesthesia. Intrathecal morphine is effective for postoperative analgesia but can induce nausea and vomiting which may hamper feeding. This study assessed prospectively the effects of intrathecal morphine on early feeding in patients undergoing caesarean section. ⋯ A small dose of intrathecal morphine provided adequate and prolonged pain relief after caesarean section but increased the incidence of nausea and vomiting despite anti-emetic prophylaxis. Oral food intake was not hampered by intrathecal morphine.