Revue des maladies respiratoires
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In France, shisha (narghile) smoking is increasingly popular among adolescents and young adults and is generally thought to be less harmful and addictive than cigarettes. This systematic review of data on carbon monoxide (CO) poisoning in active or passive shisha tobacco smokers selected 17 studies. Sixteen case reports, including 39 patients (mean age: 22.3 years; males: 51.3%), described acute carbon monoxide poisoning in active shisha smokers. ⋯ The outcome was favourable in all patients. Shisha use must be suspected in cases of CO poisoning, especially in adolescents and young adults. Practitioners must help shisha users to stop their consumption.
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The obese patient is at an increased risk of perioperative complications. Most importantly, these include difficult access to the airways (intubation, difficult or impossible ventilation), and post-extubation respiratory distress secondary to the development of atelectasis or obstruction of the airways, sometimes associated with the use of morphine derivatives. The association of obstructive sleep apnea syndrome (OSA) with obesity is very common, and induces a high risk of peri- and postoperative complications. ⋯ Appropriate prophylaxis against venous thromboembolic disease and early mobilization are recommended, as thromboembolic disease is increased in the obese patient. The use of non-invasive ventilation to prevent the occurrence of acute post-operative respiratory failure and for its treatment is particularly effective in obese patients. In case of admission to ICU, an individualized ventilatory management based on pathophysiology and careful monitoring should be initiated.
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We are at a "post-trust" period, characterised by vaccine hesitancy which is being widely diffused by the media and social networks. The consequences of this include: measles, whooping cough epidemics, vaccine coverage decreasing for the youngest, and remaining at low levels in adults. Mandatory vaccination has been extended for children less than two years in France, with the objective to increase vaccination rates during this period. ⋯ Anti-vaccine ideas were born with vaccines; they are abundantly spread through the Internet and social networks and can give a false impression of their basis in reality. It is time for positive action not merely a defensive approach.
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In 2015, the International Society for Heart and Lung Transplantation (ISHLT) published a consensus document for the selection of lung transplant candidates. In the absence of recent French recommendations, this guideline is useful in order to send lung transplant candidates to the transplantation centers and to list them for lung transplantation at the right time. ⋯ These new recommendations, close to French practices, help clinicians to find the right time for referral of patients to transplantation centers. This is crucial for the prognosis of lung transplantation.
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Dyspnea results from an imbalance between ventilatory demand (linked to CO2 production, PaCO2 set-point and wasted ventilation-physiological dead space) and ventilatory capacity (linked to passive-compliance, resistance-and active-respiratory muscles-components of the respiratory system). Spirometry and static lung volumes investigate ventilatory capacity only. Ventilatory demand (increased for instance in all pulmonary vascular diseases due to increased physiological dead space) is not evaluated by these routine measurements. ⋯ Dyspnea has multiple domains and is inherently complex and weakly explained by resting investigations: explained variance is below 50%. The diagnostic strategy investigating dyspnea has to distinguish complaints related or not to exercise because dyspnea can occur independently from any effort. Cardiopulmonary exercise testing (V'O2, V'CO2, V'E and operating lung volumes measurements) allows the assessment of underlying pathophysiological mechanisms leading to functional impairment and can contribute to unmask potential underlying mechanisms of unexplained dyspnea although its "etiological diagnostic value" for dyspnea remains a challenging issue.