[High flow, humidified-reheated oxygen therapy: a new oxygenation technique for adults]. / L'oxygénothérapie humidifiée-réchauffée à haut débit : une nouvelle technique d'oxygénation chez l'adulte.

Currently conventional oxygen therapy is the first choice symptomatic treatment in the management of acute respiratory failure (ARF). However, conventional oxygen therapy has important limitations which have lead to the development of heated and humidified high-flow nasal oxygen therapy (HFNO). HFNO is an innovative technique that can deliver, through special nasal cannulae, up to 100% of the inspired fraction (FiO2) with heated and humidified oxygen at a maximum flow of 70L/min. The characteristics of this technique (overcoming the patient's spontaneous inspiratory flow, heated humidification,) and its physiological effects (no dilution of FiO2, positive end-expiratory pressure, pharyngeal dead-space washout, decrease in airway resistance), allow efficient optimization of oxygenation with better tolerance for patients. Current data, mainly observational, show that HFNO could be used particularly for the management of hypoxemic ARF, notably in the more severe forms. Indications for using HFNO, alone or in association with noninvasive ventilation, are potentially very broad and may involve different types of ARF (post-operative, post-extubation, palliative care) and even the practice of invasive technical procedures (bronchial fibroscopy). However, though current studies are very encouraging and promise a clinical benefit on patient outcomes, randomized trials are still needed to demonstrate that HFNO avoids the need for endotracheal intubation in the management of ARF.

Does uncontrolled cardiac death for organ donation raise ethical questions? An opinion survey.

BACKGROUND: Organ donation after uncontrolled cardiac death raises complex ethical issues. We conducted a survey in a large hospital staff population, including caregivers and administrators, to determine their ethical viewpoints regarding organ donation after uncontrolled cardiac death. METHODS: Multicenter observational survey using a questionnaire, including information on the practical modalities of the procedure. Respondents were asked to answer 15 detailed ethical questions corresponding to different ethical issues raised in the literature. Ethical concerns was defined when respondents expressed ethical concerns in their answers to at least three of nine specifically selected ethical questions. RESULTS: One thousand one hundred ninety-six questionnaires were received, and 1057 could be analysed. According to our definition, 573 respondents out of 1057 (54%) had ethical concerns with regard to donation after cardiac death and 484 (46 %) had no ethical concerns. Physicians (55%) and particularly junior intensivists (65%) tended to have more ethical issues than nurses (52%) and hospital managers (37%). Junior intensivists had more ethical issues than senior intensivists (59%), emergency room physicians (46%) and transplant specialists (43%). CONCLUSION: Only 46% of hospital-based caregivers and managers appear to accept easily the legitimacy of organ donation after cardiac death. A significant number of respondents especially intensivists, expressed concerns over the dilemma between the interests of the individual and those of society. These results underline the need to better inform both healthcare professionals and the general population to help to the development of such procedure.

[Admission of women to an intensive care unit during pregnancy or the postpartum period: circumstances and prognosis. A retrospective series of 96 cases]. / Admissions en réanimation des femmes en cours de grossesse ou en post-partum: circonstances et pronostic. Une série rétrospective de 96 cas.

PURPOSE: Very few studies had been published about admission of obstetric patients in French intensive care units (ICU). PATIENTS AND METHODS: Files of women who had been admitted during pregnancy or the postpartum period to ICU of an academic hospital between January 1st 1997 and 31st December 2006 were analyzed. Diagnosis at admission, severity, main treatments and outcome were studied during two successive periods of 5 years. RESULTS: There were 96 admissions (0.95% of all admissions to ICU). They included 34 complications due to arterial hypertension (35%), among them 10 cases of pre-eclampsia, eight of eclampsia, seven of Hemolysis-Liver Enzymes-Low Platelet (HELLP) syndrome and two of retroplacental hematoma ; 26 postpartum haemorrhages (27%); and 36 miscellaneous diagnosis including two sepsis, four acute pulmonary oedema, four cardiomyopathy, three pulmonary embolism, and three acute liver steatosis. Mean Simplified Acute Physiologic Score (SAPS II) was 18.5±11.2 and mean Sequential Organ Failure Assessment (SOFA) 2.1±2.3. The main treatments were mechanical ventilation (50% of all cases) and transfusion (32%). The average ICU stay was 5.7±5.4 days. Two maternal deaths were observed (aortic dissection and peripartum cardiomyopathy). The number of patients admitted for postpartum haemorrhage increased from five to 21 over the two successive periods of the study. CONCLUSION: The number of women admitted to ICU during pregnancy or the postpartum period is low. Admissions for hemorrhage have increased. Regular monitoring of maternal morbidity and mortality gives relevant clues for assessing the quality of obstetrical care.

[An erysipelas revealing infection by Dermatobia hominis]. / Un érysipèle révélant une infection àDermatobia hominis.

Myiases are parasitic infections by larvae of flies. The development of intercontinental travels increases the incidence of tropical myiasis in travellers. We report the case of a patient, having recently stayed in Peru, presenting with an inflammatory plate of the right shoulder, covered with small papules with a hole inside. The initial aspect seemed like an erysipelas. Considering the resistance to the antibiotic treatment, the diagnosis of myiase was suspected. The local application of petroleum jelly allowed the exit of nine larvae of Dermatobia hominis and a fast good outcome. In human beings, the number of larvae usually infecting the same individual varies from one to four. This observation is original because of the number of implied larvae, which explains the intensity and the extent of the local inflammatory signs, which first looked like erysipelas. This diagnosis must be suspected in cases of erysipelas resistant to antibiotics in patients back from an endemic area.