B Acad Nat Med Paris
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To evaluate the performance of intensive care unit (ICU) the severity scores are measured on the first day; organ system dysfunctions are measured several times during the stay. The severity scores are developed from large data bases of thousands of patients. They include the patient age, previous health status, severity and sometimes the main diagnosis. ⋯ By comparing the observed and expected mortality rates the Standard Mortality Ratio (SMR) may be measured. The data collection must be rigorous, the studied population must be similar to the population of the large data bases. Other elements of performance may be evaluated, such as the cost-efficiency or the quality of life or surviving patients.
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In recent years, considerable improvement has been achieved in the field of mechanical ventilation. A lot of experimental and clinical research has been done to reduce the adverse effects of mechanical ventilation. ⋯ Pressure-assisted ventilatory modes, such as pressure support have been introduced, resulting in better patient-ventilator synchronisation, good tolerance and easier weaning process. Pressure support is also a largely used mode in noninvasive ventilation which has been proved to improve outcome in chronic obstructive pulmonary diseases.
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B Acad Nat Med Paris · Jan 2000
Biography Historical Article[One hundred years ago --Jules Fontan and the wounded heart].
On the event of the centennial of the first wound of the left ventricule cured by suture, the author recalls the conditions under which Jules Fontan, surgeon of the Navy, obtained this memorable success. He recalls the first observation and analysed the obstacles which this surgeon had to overcome to finally open the era of surgical treatment of heart wounds caused by knife fights. A comparative study of diagnostic and therapeutic approaches implemented one hundred years later highlights the advances made in the area of heart wound surgery and also in planned heart surgery for which the 20th century will remain of all achievements.