[Intraoperative ventilatory strategy in cardiac surgery: towards a multimodal approach]. / Stratégie ventilatoire peropératoire en chirurgie cardiaque: vers une approche multimodale.

Cardiac surgery with or without cardiopulmonary bypass (CPB) remains associated to respiratory morbidity. The underlying mechanisms are multiple. Perioperative application of specific ventilatory strategies allows to limit the lung disturbances. The limitation of the inspired fraction, assisted ventilation controlled with low tidal volume, maintenance of ventilation during CPB and finally, a maneuver of vital capacity are the main components of respiratory management. Thus, to be fully effective, these strategies should be integrated into a multimodal approach starting from the induction and followed until ICU.

[Stomach rupture associated with noninvasive ventilation]. / Rupture gastrique au décours d'une séance de ventilation non invasive.

Noninvasive positive-pressure ventilation (NIPPV) is a safe method to treat acute respiratory failure and is known to decrease the need for intubation and the length of ICU-stay. Few severe complications have been reported even when the indications are respected. Some rare cases of gastric distension were recently described. We report the case of a gastric perforation associated with NIPPV. The treatment was closure with a primary interrupted two-layer suture. Recovery was complete and the patient was transferred to the ward on Day 11.