Safe short circuit in cataract surgery: Incidence and risk factors for intraoperative medical action.

Cataract surgery has become the most frequent surgical procedure performed every year in Western countries. Perioperative patient circuit has to be adapted to the important medical needs and progress. Hence, a secure short circuit (SSC) for surgeries of the anterior segment of the eye under topical anaesthesia was created. Patients included in the circuit are selected first by surgeons and answer a medical questionnaire, they do not have any preoperative evaluation by anaesthesiologist, are monitored during surgery by the surgical team and in case of problem an intraoperative medical action (IMA) can be performed. We conducted a retrospective observational incidence study of the occurrence of the IMA, followed by a case control study. The primary outcome was to identify risk factors of IMA among the patients' medical history. Out of 2744 screened patients, 1592 patients were included during the period of November 2015 to November 2017. The rate of IMA was 5%, 81% of them presenting with intraoperative high blood pressure (HBP). In the case control study part, stepwise regression analysis revealed that a history of HBP and insulin-dependent diabetes (IDD) was significantly correlated with IMA (respectively, adjusted odds ratio 1.7, P=0.005 and 2.6, P=0.002). The low incidence of IMA showed that the SSC is a safe tool thanks to a selection and an optimised and secure pathway. A history of HBP and IDD was significantly associated with the occurrence of IMA. Therefore, an optimisation of the perioperative period would be beneficial in these cases.

Functional and metabolic activity of polymorphonuclear leukocytes from patients with adult respiratory distress syndrome: results of a randomized double-blind placebo-controlled study on the activity of prostaglandin E1.

Indirect and experimental evidence suggests that polymorphonuclear leukocytes, responding to an activating signal presumably related to the complement cascade activation, are involved in the pathogenesis of the adult respiratory distress syndrome (ARDS). The pathologic changes seem to be result of the polymorphonuclear leukocyte margination within the pulmonary capillary vessels and their activation with subsequent release of vasoactive peptides (thromboxane A2, prostaglandin E2) and toxic intracellular compounds. This study confirms that adherence, chemotaxis, and chemiluminescence are increased in polymorphonuclear leukocytes from patients with ARDS. Enhanced chemotactic and chemiluminescence capacities are likely specific to ARDS, whereas increased polymorphonuclear leukocyte adherence seems to be nonspecific. If increased polymorphonuclear leukocyte activation is important in the pathogenesis of ARDS, the inhibition of this phenomenon could play a therapeutic role. This double-blind prospective study was undertaken to assess if polymorphonuclear leukocyte activity is inhibited in vivo by the iv administration of prostaglandin E1 (PGE1) in patients with ARDS. A continuous infusion of PGE1 at a dose of 30 ng.kg-1.min-1 for 7 days did not modify the functional activity of polymorphonuclear leukocytes in patients with ARDS. Because hemodynamic instability was seen during infusion of this dose of PGE1, an increased dose was not tested. At the dose of PGE1 tested, no significant effect upon the function activity of polymorphonuclear leukocytes in patients with ARDS could be demonstrated.

A prospective study of protected bronchoalveolar lavage in the diagnosis of nosocomial pneumonia.

The value of a new technique of protected bronchoalveolar lavage not requiring bronchoscopy was prospectively evaluated for the diagnosis of nosocomial pneumonia in two groups of critically ill patients. The control group was comprised of 29 patients free of any pulmonary disease whose lungs were ventilated for a mean time of 14 +/- 9 days (mean +/- SD). The pneumonia group was comprised of 30 patients with histologically proven nosocomial pneumonia whose lungs were ventilated for a mean time of 11 +/- 8 days. All patients of the pneumonia group died, and postmortem lung biopsies were taken for bacteriologic and pathologic examination. Twice a week in the control group or within the day preceding death in the pneumonia group, distal bronchial samples were obtained by a technique of protected bronchoalveolar lavage performed at the bedside. Fifty-one distal bronchial samples were bacteriologically analyzed in the control group and 30 in the pneumonia group. The sensitivity of a positive protected bronchoalveolar lavage for diagnosing nosocomial pneumonia was 80%, whereas the specificity was 66%. In 73% of the patients of the pneumonia group, the microorganisms isolated in the protected bronchoalveolar lavage and in the lung culture were partially (16%) or completely in agreement (57%). Among the 43 microorganisms isolated in the lung cultures, 74% were recovered by the protected bronchoalveolar lavage technique. This study shows that the protected bronchoalveolar lavage is an accurate technique for the diagnosis of nosocomial pneumonia. Because the technique is simple, noninvasive, easily repeatable at the bedside, and enables gram staining, it represents an attractive alternative to the fiberoptic bronchoscopy technique using a plugged double-sheathed brush.