Procalcitonin and sepsis in the Emergency Department: an update.

OBJECTIVE: Due to significant mortality and morbidity which may be reduced by prompts treatment, there is great interest in determining an ideal biomarker for the diagnosis of sepsis upon presentation to the Emergency Department. The most specific test is a positive blood culture, but its sensitivity is very low, and the results are usually available 2 days after sampling. For this reason, research is conducted into serum biomarkers with greater sensitivity for which results can be available within hours of presentation. High initial procalcitonin levels are a sensitive marker of bacterial infection, and the degree of procalcitonin elevation may determine which patients are at greater risk for adverse outcomes (mortality or ICU admission). The purpose of this narrative review is to evaluate the utility of procalcitonin as a diagnostic marker of sepsis in the emergency department and the use of procalcitonin-guided management algorithms. MATERIALS AND METHODS: A PubMed search was conducted in June 2020 for procalcitonin, resulting in the retrieval of 371 articles which were screened for relevance. 48 articles were included in the review. CONCLUSIONS: Procalcitonin elevation may be used as an indication for initiation of antibiotic treatment, and antibiotics may be discontinued once procalcitonin normalizes. This approach leads to reduced antibiotic consumption, but it is not yet clear whether it ensures better outcomes for patients. Procalcitonin in centers where it is available could be a useful diagnostic and prognostic biomarker for patients presenting to the Emergency Department with symptoms suggestive of sepsis. Further research is however required to determine whether the use of procalcitonin measurements in management algorithms leads to improved patient outcomes.

Variation of Cognitive Function During a Short Stay at Hypobaric Hypoxia Chamber (Altitude: 3842 M).

OBJECTIVE: To observe the effects of a fast-acute ascent to high altitude on brain cognitive function and transcranial doppler parameters in order to understand the physiological countermeasures of hypoxia. METHODS: 17 high-altitude-naïve male subjects (mean age was 26.3 ± 8.1 years) participated in the study. We measured Critical Flicker Fusion Frequency (CFFF), blood oxygen saturation, Psychology Experiment Building (PEBL) including three tests (Modified Math Processing Task, Perceptual Vigilance Task, and Time Estimation Task), as well as Cerebral Blood Flow index (CBFi), mean cerebral artery Systolic and diastolic velocities, Cerebral Pulsatility index (CPi), and heart Rate. All were measured at sea level, at least 1 h after arrival at the hypobaric hypoxia equivalent of 3842 m and 1 h after return to sea level. RESULTS: Under acute exposure to hypobaric hypoxic conditions, significant decrease in CFFF [42.1 ± 1 vs. 43.5 ± 1.7 Hz at sea level (asl), p < 0.01], CBFi (611 ± 51 vs. 665 ± 71 asl, p < 0.01) and blood oxygen saturation (83 ± 4% vs. 98 ± 1% asl, p < 0.001) as compared to pre-ascent values were observed. Physiological countermeasures to hypoxia could be involved as there was no significant change in neuropsychometric tests, Systolic and Diastolic velocities and CPi. A significant increase in Heart Rate (81 ± 15 bpm vs. 66 ± 15 bpm asl, p < 0.001) was observed. All parameters returned to their basal values 1 h after regaining sea level. CONCLUSION: Hypoxia results in a decrease in CFFF, CBFi and oxygen saturation and in an increase in heart rate. As it decreased, Cerebral Blood Flow index does not seem to be the physiological measurement of choice to hypoxia explaining the maintenance of cognitive performance after acute exposure to hypobaric hypoxia and requires further investigation. Cerebral oxygen delivery and extraction could be one of the underlying mechanisms.

[Demographic evolution of patients with a surgical aortic valvular replacement in the era of percutaneous replacement]. / Evolution démographique des patients bénéficiant d'un remplacement valvulaire aortique chirurgical à l'ère du remplacement percutané.

INTRODUCTION: Percutaneous aortic valve replacement has been performed in daily practice for less than 10 years. This technique was until recently reserved for patients with very high surgical risk. There is little data in the literature documenting the impact of this percutaneous technique on the patient population continuing to benefit from a surgical replacement of the aortic valve. We studied the characteristics of these patients immediately before and after the introduction of the percutaneous technique in the CHU Brugmann. MATERIALS AND METHODS: Two separate cohorts of patients were retrospectively studied: one before the percutaneous era between 2005 and 2010 and the other after introduction of the percutaneous technique in our daily practice between 2010 and 2015. Demographic, intraoperative, mortality and postoperative morbidity indices were compared. RESULTS: The number of surgical replacements of the aortic valve was 194 before and 132 after introduction of the percutaneous technique. The demographic, operative characteristics and postoperative morbidity and mortality of the patients remained the same between the two cohorts. Only the incidence of pulmonary arterial hypertension (12.1 vs 25 %, p = 0.015) and recent myocardial infarction (0 vs 3 %, p = 0.003) were higher in the second cohort. CONCLUSION: Replacement of the aortic valve percutaneously did not significantly change the demographic characteristics and postoperative morbidity and mortality of patients candidate for surgical replacement of the aortic valve. Nevertheless, after its introduction, the number of surgical replacements dropped considerably in our center.

INTRODUCTION: Le remplacement valvulaire aortique percutané est réalisé en pratique quotidienne depuis moins de dix ans. Cette technique était jusqu'il y a peu réservée aux patients à très haut risque chirurgical. Il existe peu de données dans la littérature documentant l'impact de cette technique percutanée sur la population de patients continuant à bénéficier d'un remplacement chirurgical de la valve aortique. Nous avons étudié les caractéristiques de ces patients immédiatement avant et après l'introduction de la technique percutanée au CHU Brugmann. Matériel et méthodes : Deux cohortes distinctes de patients ont été étudiées rétrospectivement : l'une avant l'ère percutanée entre 2005 et 2010 et l'autre après introduction dans notre pratique quotidienne de la technique percutanée entre 2010 et 2015. Les données démographiques, peropératoires, la mortalité et des indices de morbidité postopératoire ont été comparés. Résultats : Le nombre de remplacements chirurgicaux de la valve aortique était de 194 avant et 132 après introduction de la technique percutanée. Les caractéristiques démographiques, opératoires et la morbi-mortalité postopératoire des patients sont restées identiques entre les deux cohortes. Seules les incidences d'hypertension artérielle pulmonaire (12,1 vs 25 %, p = 0,015) et d'infarctus myocardiques récents (0 vs 3 %, p = 0,003) étaient supérieures dans la seconde cohorte. CONCLUSION: Le remplacement de la valve aortique par voie percutanée n'a pas considérablement modifié les caractéristiques démographiques et la morbimortalité postopératoire des patients candidats à un remplacement chirurgical de la valve aortique. Le nombre total de remplacement chirurgical de la valve aortique a considérablement chuté.