Matériau utilisé dans capnographie Un des obstacles à l&#39;utilisation de CO 2 expiré surveillance réside dans la disparité du matériel utilisé par les médecins d&#39;urgence. Pour clarifier cette situation, il est important de distinguer si le patient est sous ventilation artificielle ou à respirer spontanément. Comme pour le reste, les différentes techniques utilisées pour l&#39;analyse non plus avoir une implication sur les résultats cliniques et l&#39;efficacité. Cette déclaration se trouve dans le cas de la distinction traditionnelle entre soutirage et la capnographie dominante. Ces deux mesures techniques de CO 2 en utilisant des ondes infrarouges, le système utilise une pompe de soutirage d&#39;aspiration pour le transport de CO 2 de la bouche vers le détecteur situé dans le moniteur, tandis que le système traditionnel des mesures de CO 2 directement dans une petite chambre située à l&#39;embouchure de la patient et connecté au moniteur par un câble. Traditionnellement, le système latérale est utilisé pour les patients respirant spontanément que le système est plus léger, et le système conventionnel, un volumineux peu, est directement reliée à la sonde endotrachéale chez les patients intubés. Les progrès technologiques dans les dernières années ont fondamentalement réduit les différences entre grand public et les systèmes soutirage. Une nouvelle technologie est orienté vers le système de Microstream, qui est une sorte de «système de soutirage amélioré» dans lequel le CO2 se déplace le long d&#39;un mince tube avant d&#39;atteindre la chambre où le détecteur est situé, permettant une période de transition plus petite entre la bouche et la chambre de détection et de ainsi une courbe de capnographie qui est presque synchronisée avec le passage de l&#39;air à la bouche. Alors, laissez-nous jeter un oeil à ce qui distingue le choix du matériau, comme expliqué dans la deuxième moitié de la séquence vidéo: <ul><li> Si le médecin souhaite surveiller un patient en ventilation spontanée, afin de détecter les apnées precocely (pendant la sédation procédurale, ou après une intoxication médical), alors que la forme de la courbe est essentiel, la valeur réelle de ETCO 2 étant de moindre importance. Dans ce cas, il médecin peut choisir entre une sonde nasale ou capnomask combinant l&#39;administration d&#39;oxygène et de CO 2 d&#39;aspiration, ou d&#39;un tube mince de CO 2 d&#39;aspiration qui peut être placé sous un masque classique. </li><li> Si le médecin désire analyser précisément ETCO 2 en vue d&#39;adapter les paramètres à un respirateur, de vérifier le bon positionnement d&#39;une sonde endotrachéale, ou pour évaluer le pronostic pendant un arrêt cardiaque, il doit utiliser le matériel que peut être adapté pour une utilisation avec un tube endotrachéal (toujours placé derrière le filtre de sorte que les sécrétions du patient ne pas bloquer le tube). </li></ul> La courbe de capnographie Une courbe de capnographie classique pendant trois expirations est donnée dans la figure 1. La courbe retrouve l&#39;axe des x (valeur 0) à chaque inspiration, car il n&#39;y a pratiquement pas de CO 2 dans l&#39;air inspiré. <img src="/files/ftp_upload/2508/2508fig1.jpg" alt="Figure 1" /> Figure 1: alternance d&#39;inspiration-expiration Différences entre la PaCO 2 et ETCO 2 Il serait eutopique de croire que la surveillance non invasive de CO expiré 2 peut remplacer en toutes circonstances la nécessité pour les gaz du sang artériel (ABG) des mesures, considérées comme le gold standard pour la mesure de la PaCO 2. Tout dépend des indications pour la mesure du CO expiré 2 et cardio-respiratoires de l&#39;état du patient. Si l&#39;indication est la surveillance de l&#39;activité respiratoire pour éviter l&#39;hypoventilation et l&#39;apnée pendant la sédation, une simple analyse de la courbe est suffisante, quelle que soit la valeur de ETCO 2. D&#39;autre part, si l&#39;indication est de surveiller la ventilation adéquate du patient un traumatisme crânien sans antécédents de troubles cardio-respiratoire, on peut s&#39;attendre à l&#39;ETCO 2 de la valeur à être proche de la PaO 2 de valeur, bien que la nécessité d&#39;une précision PaCO 2 de valeur impose au moins un échantillon ABG, qui nous permet aussi de confirmer qu&#39;en effet, ETCO 2 est proche de la PaCO 2 dans le cas présent. Enfin, si nous sommes confrontés avec le cas d&#39;un patient qu&#39;il est intubé et ventilé en raison d&#39;une détresse respiratoire, ETCO 2 valeurs sera évidemment pas être une bonne approximation de la PaCO 2. La raison est simple; dès qu&#39;il y est une perturbation de ventilation-perfusion des ratios, indépendamment de ce que le présent trouble cardio-pulmonaire est un obstacle à l&#39;élimination correcte des émissions de CO 2 par les poumons est créé. En conséquence, le CO 2 s&#39;accumule dans le sang, et naso-buccal élimination est réduite, la création d&#39;une PaCO 2 - 2 ETCO dégradé. Dans cette circonstance, il est crucial de connaître la valeur de la PaCO 2 avanttoute interprétation de l&#39;ETCO valeur 2. La première partie de la séquence vidéo décrit la procédure à suivre pour l&#39;interprétation de la différence entre PaCO 2 et ETCO 2. Nous voyons que la mesure de ETCO 2 est obtenu immédiatement et de manière non-invasive, mais à ce stade ne peut pas permettre l&#39;adaptation des paramètres du respirateur. Cela implique d&#39;avoir à mesurer les deux PaCO qui peuvent ensuite être comparés avec les ETCO 2. La valeur de la PaCO 2 reste la valeur de référence pour l&#39;appréciation de la ventilation du patient. <ul><li> Si PaCO 2 mesurée est supérieure à la valeur souhaitée, par exemple au lieu de 60 mmHg 40mmHg, cela signifie que le patient est hypoventilated. Les paramètres du respirateur peuvent ensuite être adaptés; soit la fréquence respiratoire ou le volume courant peut être augmenté afin d&#39;augmenter la ventilation et donc diminution de la PaCO 2. L&#39;objectif consiste à réduire le ETCO 2 par 20 mmHg, indépendamment de la première ETCO valeur 2. Par exemple, il peut être possible que la valeur est ETCO 2 50mmHg lorsque les 2 Paco est mesurée à 60 mmHg, en raison d&#39;une PaCO 2-ETCO 2 gradient créé par la présence d&#39;une maladie cardio-respiratoire. Lorsque l&#39;adaptation des paramètres de l&#39;appareil respiratoire permet à l&#39;ETCO 2 à partir de chute de 50mmHg à 30mmHg, nous pouvons sans risque supposer que le patient est correctement ventilée avec une PaCO 2 de valeur ayant chuté de 60 mmHg à 40 mmHg. </li><li> Inversement, si les deux Paco est inférieure à la valeur cible, le patient est par conséquent le taux de l&#39;hyperventilation et respiratoire ou le volume courant doit être réduit pour atteindre la valeur cible. Si la PaCO 2 est de 20 mmHg inférieure à la valeur cible, il faut augmenter la ETCO 2 par 20 mmHg par la modification des paramètres du respirateur. </li></ul> Les artefacts et les pièges dans capnographie. Si la technologie pour mesure du CO 2 est devenu fiable en termes de précision, la reproductibilité du temps de réponse et la qualité de la courbe, il présente encore, comme pour tout paramètre surveillé, certaines limites: <ul><li> La première limitation est due au manque de connaissances correctes concernant la physiopathologie de CO 2 par le médecin, qui est alors peu enclins à utiliser la technique. Nous espérons que cette explication et les séquences vidéo qui l&#39;accompagne va aider à résoudre cette limitation. </li><li> Dans le cas de la respiration spontanée, l&#39;adjonction d&#39;oxygénothérapie à travers le masque va diluer la expirée de CO 2, qui sera significativement modifier le capnogramme et le ETCO 2 vont baisser. La séquence vidéo illustre ce phénomène. </li><li> Si l&#39;on veut suivre d&#39;hypoventilation ou d&#39;un événement d&#39;apnée, pendant la sédation procédurale, nous nous attendons ETCO 2, en corrélation avec la PaCO 2, à augmenter en parallèle à une hypoventilation du patient. Paradoxalement, un événement dans une hypoventilation respiration du patient est spontanément traduit par une baisse de ETCO 2, car le patient est alors seulement à respirer avec un très petit volume de marée, ce qui correspond essentiellement au volume mort de l&#39;espace trachéo-Bronchal, et comme nous le savez, cet espace ne participe pas à l&#39;échange gazeux et contient donc que très peu de CO 2. </li><li> Pendant la ventilation mécanique, l&#39;écueil est que l&#39;on oublie que ETCO 2 ne reflètent pas nécessairement la PaCO 2 (voir chapitre précédent). </li></ul>

<ol>
	<li>Gravenstein, J. S., Jaffe, M. B., Paulus, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Capnography, Clinical aspects. , (2004).</li><li>Kupnik, D., Skok, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capnometry+in+the+prehospital+setting:+are+we+using+its+potential.">Capnometry in the prehospital setting: are we using its potential.</a> Emerg Med J. 24, 614-617 (2007).</li><li>Delorio, N. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Continuous+end-tidal+carbon+dioxide+monitoring+for+confirmation+of+endotracheal+tube+placement+is+neither+widely+available+nor+consistently+applied+by+emergency+physicians.">Continuous end-tidal carbon dioxide monitoring for confirmation of endotracheal tube placement is neither widely available nor consistently applied by emergency physicians.</a> Emerg Med J. 22, 490-493 (2005).</li><li>Burton, J. H., Harrah, J. D., Germann, C. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+end-tidal+carbon+dioxide+monitoring+detect+respiratory+events+prior+to+current+sedation+monitoring+practices?.">Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?.</a> Acad Emerg Med. 13, 500-504 (2006).</li><li>Fletcher, R., Jonson, B., Cumming, G., Brew, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+concept+of+deadspace+with+special+reference+to+the+single+breath+test+for+carbon+dioxide.">The concept of deadspace with special reference to the single breath test for carbon dioxide.</a> Br J Anaesth. 53, 77-78 (1981).</li></ol>

Importance de CO 2 pour l&#39;organisme Avant d&#39;explorer CO 2 expiré surveillance, il est essentiel de mettre en perspective le rôle général joué par le CO2 dans le corps humain. Produite à un taux d&#39;environ 200 ml par minute, le CO 2 n&#39;est pas seulement un gaspillage sous-produit du métabolisme cellulaire. Si notre chémorécepteurs médullaires ont le rôle de maintien de la pression artérielle partielle de CO2 (PaCO 2) à 40 mm...

expired co2 measurement in intubated or spontaneously breathing patients from the emergency department

Le dioxyde de carbone (CO 2) avec de l&#39;oxygène (O 2) part le rôle d&#39;être le gaz le plus important du corps humain. La mesure du CO 2 expiré à la bouche a sollicité un intérêt croissant chez les médecins cliniques dans le service d&#39;urgence pour diverses indications: (1) la surveillance et le suivi du patient intubé; (2) la vérification de la position correcte d&#39;une sonde endotrachéale; (3 contrôle) d&#39;un patient en arrêt cardiaque; (4) la réalisation de normocapnie intubé des patients un traumatisme crânien; ventilation de surveillance (5) pendant la sédation procédurale. La vidéo permet aux médecins de se familiariser avec l&#39;utilisation de la capnographie et le texte propose une revue de la théorie et les directeurs concernés. En particulier, l&#39;importance des émissions de CO 2 pour l&#39;organisme, la pertinence de la mesure expirée de CO 2, les différences entre les artères et a expiré le CO 2, le matériau utilisé dans la capnographie avec leurs artefacts et des pièges, seront examinées. Depuis la réticence principale dans l&#39;utilisation de mesure du CO 2 expiré est due à un manque de connaissances correctes concernant la physiopathologie de CO 2 par le médecin, nous espérons que cette explication et les séquences vidéo qui l&#39;accompagne va aider à résoudre cette limitation.

Watch this Scientific Journal Video about Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department at JoVE.com

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

Cette vidéo explique comment effectuer CO<sub&gt; 2</sub&gt; Mesure chez les patients intubés ainsi que respirant spontanément. Les principales indications cliniques se réfèrent à des situations d&#39;urgence: (1) de vérifier le positionnement adéquat d&#39;un tube endotrachéal, (2) la réalisation de normocapnie chez les patients traumatisés, ventilation surveillance (3) dans le cas de sédation procédurale.

CO expiré 2 Mesure de patients intubés ou respirant spontanément à partir du service des urgences

Carbon dioxide (CO2) along with oxygen (O2) share the role of being the most important gases in the human body. The measuring of expired CO2 at the mouth ...

expired-co2-measurement-intubated-or-spontaneously-breathing-patients

Research

JoVE Journal

Medicine

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

16.1K vues.  Universit Catholique de Louvain Cliniques Universitaires Saint-Luc. Cette vidéo explique comment effectuer CO 2 Mesure chez les patients intubés ainsi que respirant spontanément. Les principales indications cliniques se réfèrent à des situations d'urgence: (1) de vérifier le positionnement adéquat d'un tube endotrachéal, (2) la réalisation de normocapnie chez les patients traumatisés, ventilation surveillance (3) dans le cas de sédation procédurale.

Vidéo: Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

Scleral Cross-linking Using Riboflavin and Ultraviolet-A Radiation for Prevention of Axial Myopia in a Rabbit Model

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal abnormalities. In addition, pathological myopia is a common irreversible cause of visual impairment and blindness1-3. Our study demonstrates the effect of scleral crosslinking using riboflavin and ultraviolet-A radiation on the development of axial myopia in a rabbit model. The axial length of the eyeball was measured by A-scan ultrasound in New Zealand white rabbits aged 13 days (male and female). The eye then underwent 360&#176; conjunctival peritomy with scleral crosslinking, followed by tarsorrhaphy. Axial elongation was induced in 13 day-old New Zealand rabbits by suturing their right eye eyelids (tarsorrhaphy). The eyes were divided into quadrants, and every quadrant had two scleral irradiation zones, each with an area of 0.2 cm&#178; and a radius of 4 mm. Crosslinking was performed by dropping 0.1% dextran-free riboflavin-5-phosphate onto the irradiation zones 20 sec before ultraviolet-A irradiation and every 20 sec during the 200 sec irradiation time. UVA radiation (370 nm) was applied perpendicular to the sclera at 57 mW/cm&#178; (total UVA light dose, 57 J/cm&#178;). Tarsorrhaphies were removed on day 55, followed by repeated axial length measurements. This study demonstrates that scleral crosslinking with riboflavin and ultraviolet-A radiation effectively prevents occlusion-induced axial elongation in a rabbit model.

We demonstrate the effect of scleral crosslinking with riboflavin and UVA on an axial elongation rabbit eye. Axial elongation was induced in 13 day-old New Zealand rabbits (male and female) by suturing their right eye eyelids (tarsorrhaphy).

Scléral Cross-linking Utilisation de la riboflavine et Ultraviolet-A rayonnement pour la prévention des Axial Myopie dans un modèle de lapin

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal ...

Recherche

Médecine

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or intraosseous routes, but in many patients, particularly in the emergency or critical care settings, these routes are often unavailable or time-consuming to access. A novel device is now available that offers an easy route for administration of medications or fluids via rectal mucosal absorption (also referred to as proctoclysis in the case of fluid administration and subsequent absorption). Although originally intended for the palliative care market, the utility of this device in the emergency setting has recently been described. Specifically, reports of patients being treated for dehydration, alcohol withdrawal, vomiting, fever, myocardial infarction, hyperthyroidism, and cardiac arrest have shown success with administration of a wide variety of medications or fluids (including water, aspirin, lorazepam, ondansetron, acetaminophen, methimazole, and buspirone). Device placement is straightforward, and based on the observation of expected effects from the medication administrations, absorption is rapid. The rapidity of absorption kinetics are further demonstrated in a recent report of the measurement of phenobarbital pharmacokinetics. We describe here the placement and use of this device, and demonstrate methods of pharmacokinetic measurements of medications administered by this method.

This study presents a novel device that offers an easy route to quickly provide medications and fluids in patients with limited or difficult IV access. This small-diameter device is placed in the distal third of the rectum, allowing for ongoing medication and fluids administration.

Une nouvelle approche pour l&#39;administration des médicaments et des fluides dans les scénarios et les situations d&#39;urgence

The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or ...

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can be&#160;achieved by either&#160;thrombolysis with recombinant tissue-plasminogen activator (rt-PA), the standard therapy for stroke patients who present within the first hours of symptom onset without contraindications, or by an endovascular approach, if a proximal brain vessel occlusion is detected. As the efficacy of both therapies declines over time, every minute saved along the way will improve the patient&#39;s outcome.
This critical situation requires thorough work and precise communication with the patient, the family and colleagues from different professions to acquire all relevant information and reach the right decision while carefully monitoring the patient. This is a high fidelity situation. In nonmedical high-fidelity environments such as aviation, Crew Resource Management (CRM) is used to enhance safety and team efficiency.
This guide shows how a Stroke Team algorithm, which is transferable to other hospital settings, was established and how regular simulation-based trainings were performed. It requires determination and endurance to maintain these time-consuming simulation trainings on a regular basis over the course of time. However, the resulting improvement of team spirit and excellent door-to-needle times will benefit both the patients and the work environment in any hospital.
A dedicated Stroke Team of 7 persons who are notified 24/7 by a collective call via speed dial and run a binding algorithm that takes approximately 20 min, was established. To train everybody involved in this algorithm, a simulation-based team training for all new Stroke Team members was conceived and conducted at monthly intervals. This led to a relevant and sustained reduction of the mean door-to-needle time to 25 min, and enhanced the feeling of stroke readiness especially in junior doctors and nurses.

Every min counts in acute stroke care. This guide shows how to establish a Stroke Team algorithm and enhance its performance with regular simulation training. The principles of Crew Resource Management (CRM) facilitate a straight workflow, reduce door-to-needle times and increase staff satisfaction.

Configuration d&#39;un AVC équipe Algorithme et la conduite de formation fondée sur la simulation au service d&#39;urgence - Guide pratique

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of a robotic system. In traditional robotic training for surgeons, a brief web based overview of performing an emergency undocking is provided during initial introductory training to the robotics system. During such a process, there is no training in delineation of interdisciplinary roles for operating room (OR) personnel. The training presented here uses formative simulation and debriefing followed by a lecture. For the simulation, a modified gynecologic simulator is draped in a steep trendelenburg position consistent with most gynecologic laparoscopic surgery. The training torso is modified using tubing hooked to pressure bags of red food colored IV fluid used to simulate a catastrophic vessel injury on demand. Positioned throughout the operating room setting is an interprofessional team consisting of embedded standardized persons (ESPs) to fulfill the roles of a circulating nurse, scrub nurse, anesthesiologist, and bedside assist surgeon. Robotic surgeons are presented a case scenario necessitating emergency undocking, and given control of the robotic instruments. The scenario is terminated following either successful completion of an emergency undock, or at five minutes due to the emergent nature of the case. A debriefing session with hands on training of the steps to emergency undocking, necessary equipment, troubleshooting techniques, and operating room personnel roles follows the simulation. The learners are presented with a short lecture reemphasizing the material presented in the debriefing for their own self-study. This training results in improved time accessing the patient, improved knowledge, confidence, and completion of critical actions, and can be replicated in most institutions. All robotic surgeons should be able to demonstrate competence in this crucial intervention. A limitation of the curriculum is ability to access the in-situ environment for training purposes.

This training platform is designed to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of the robotic system. Training includes the utilization of the technology and equipment to perform an emergency undocking, as well as delineation of roles for such a scenario.

Appareillage d’urgence en chirurgie robotique : un programme de Simulation

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

Setup and Execution Of the Blindfolded Code Training Exercise

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to improve resident physician communication and leadership strategies in high-acuity situations. The blindfolded code training exercise removes visual stimuli from the team leader, forcing the team leader to effectively utilize closed-loop communication. The simple act of blindfolding the team leader creates a learning environment where the leader must utilize a conceptual framework and critical thinking strategies to organize the team and manage the resuscitation. An advantage to this teaching technique is that it does not require any special simulation equipment, making it a low-cost approach. The blindfolded code training exercise can be applied to the management of any critically ill patient where the primary objective is to focus on developing communication skills in acute resuscitations. The purpose of the description of the blindfolded code training exercise is to provide guidance on how to perform this innovative teaching technique to force effective closed-loop communication.

The blindfolded code training exercise, which blindfolds the team leader in a code resuscitation simulation, is an advanced teaching technique to improve closed-loop communication, organizational skills, and critical thinking.&#160;

Installation et exécution de l’exercice d’entraînement de Code les yeux bandés

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to ...

CO2-Lasertonsillotomy Under Local Anesthesia in Adults

Tonsil-related complaints are very common among the adult population. Tonsillectomy under general anesthesia is currently the most performed surgical treatment in adults for such complaints. Unfortunately, tonsillectomy is an invasive treatment associated with a high complication rate and a long recovery time. Complications and a long recovery time are mostly related to removing the vascular and densely innervated capsule of the tonsils. Recently, CO2-lasertonsillotomy under local anesthesia has been demonstrated to be a viable alternative treatment for tonsil-related disease with a significantly shorter and less painful recovery period. The milder side-effect profile of CO2-lasertonsillotomy is likely related to leaving the tonsil capsule intact. The aim of the current report is to present a concise protocol detailing the execution of CO2-lasertonsillotomy under local anesthesia. This intervention has been performed successfully in our hospital in more than 1,000 patients and has been found to be safe and to be associated with a steep learning curve.

CO2-Lasertonsillotomy Under Local Anesthesia in Adults

CO2-lasertonsillotomy under local anesthesia is an interesting alternative treatment method for tonsillectomy under general anesthesia for tonsil-related complaints in adults. This report presents a step-by-step protocol detailing the execution of CO2-lasertonsillotomy under local anesthesia.

CO2-Lasertonsillotomy sous anesthésie locale chez les adultes

Tonsil-related complaints are very common among the adult population. Tonsillectomy under general anesthesia is currently the most performed surgical ...

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most frequent type of cardiac ablation procedure performed. Although generally safe, collateral injury to surrounding structures, particularly the esophagus, remains a concern. Cooling or warming the esophagus to counteract the heat from RF ablation, or the cold from cryoablation, is a method that is used to reduce thermal esophageal injury, and there are increasing data to support this approach. This protocol describes the use of a commercially available esophageal temperature management device to cool or warm the esophagus to reduce esophageal injury during left atrial ablation. The temperature management device is powered by standard water-blanket heat exchangers, and is shaped like a standard orogastric tube placed for gastric suctioning and decompression. Water circulates through the device in a closed-loop circuit, transferring heat across the silicone walls of the device, through the esophageal wall. Placement of the device is analogous to the placement of a typical orogastric tube, and temperature is adjusted via the external heat-exchanger console.

The goal of this protocol is to describe the use of esophageal temperature modulation to counteract esophageal thermal injury from left atrial ablation for the treatment of atrial fibrillation.

Refroidissement ou réchauffement de l’œsophage pour réduire les blessures œsophagienne pendant l’ablation auriculaire gauche dans le traitement de la fibrillation auriculaire

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most ...

Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis

Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in clinical settings including cardiovascular and brain surgery, neonatal monitoring and prehospital medicine. The NIRS monitoring devices are real-time and noninvasive, and have mainly been used for evaluating cerebral oxygenation in critically ill patients during an operation or intensive care. Thus far, the use of NIRS monitoring in patients with chronic kidney disease (CKD) including hemodialysis (HD) has been limited; therefore, we investigated rSO2 values in some organs during HD. We monitored rSO2 values using a NIRS device transmitting near-infrared light at 2 wavelengths of attachment. The HD patients were placed in a supine position, with rSO2 measurement sensors attached to the foreheads, the right hypochondrium and the lower legs to evaluate rSO2 in the brain, liver and lower leg muscles, respectively. NIRS monitoring could be a new approach to clarify changes in organ oxygenation during HD or factors affecting tissue oxygenation in CKD patients. This article describes a protocol to measure tissue oxygenation represented by rSO2 as applied in HD patients.

We present a protocol to measure regional oxygen saturation (rSO2) in hemodialysis (HD) patients by using a near-infrared spectroscopy monitor. The rSO2 value is an index of tissue oxygenation. This noninvasive and real-time monitoring could be useful for confirming changes in organ oxygenation during HD.

Mesure de l’oxygénation des tissus par spectroscopie proche infrarouge chez des patients sous hémodialyse

Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in ...

A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects

Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if administered at high concentration. Inhaled NO gas is routinely used to increase systemic oxygenation in different disease conditions. The administration of high concentrations of NO also exerts a virucidal effect in vitro. Owing to its favorable pharmacodynamic and safety profiles, the familiarity in its use by critical care providers, and the potential for a direct virucidal effect, NO is clinically used in patients with coronavirus disease-2019 (COVID-19). Nevertheless, no device is currently available to easily administer inhaled NO at concentrations higher than 80 parts per million (ppm) at various inspired oxygen fractions, without the need for dedicated, heavy, and costly equipment. The development of a reliable, safe, inexpensive, lightweight, and ventilator-free solution is crucial, particularly for the early treatment of non-intubated patients outside of the intensive care unit (ICU) and in a limited-resource scenario. To overcome such a barrier, a simple system for the non-invasive NO gas administration up to 250 ppm was developed using standard consumables and a scavenging chamber. The method has been proven safe and reliable in delivering a specified NO concentration while limiting nitrogen dioxide levels. This paper aims to provide clinicians and researchers with the necessary information on how to assemble or adapt such a system for research purposes or clinical use in COVID-19 or other diseases in which NO administration might be beneficial.

This simple and highly adaptable system device for the inhalation of high-concentration nitric oxide (NO) gas does not require mechanical ventilators, positive pressure, or high gas flows. Standard medical consumables and a snug-fitting mask are used to safely deliver NO gas to spontaneously breathing subjects.

Un nouveau système de masque d’inhalation pour délivrer des concentrations élevées de gaz d’oxyde nitrique chez les sujets respirant spontanément

Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if ...

Prédiction du pronostic de l’insuffisance cardiaque aiguë à l’aide de l’angle de phase et des Z-Scores BIVA

Clinical Application of Phase Angle and BIVA Z-Score Analyses in Patients Admitted to an Emergency Department with Acute Heart Failure

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, such as increased body fluid congestion or systemic congestion. This condition is one of the most common reasons for hospital admission and has been associated with poor outcomes. The phase angle indirectly measures intracellular status, cellular integrity, vitality, and the distribution of spaces between intracellular and extracellular body water. This parameter has been found to be a predictor of health status and an indicator of survival and other clinical outcomes. In addition, phase angle values of &lt;4.8&#176; upon admission were associated with higher mortality in patients with acute heart failure. However, low phase angle values may be due to alterations-such as the shifting of fluids from an intracellular body water (ICW) compartment to an ECW (extracellular body water) compartment and a concurrent decrease in body-cell mass (which can reflect malnutrition)-that are present in heart failure. Thus, a low phase angle may be due to overhydration and/or malnutrition. BIVA provides additional information about the body-cell mass and congestion status with a graphical vector (R-Xc graph). In addition, a BIVA Z-score analysis (the number of standard deviations from the mean value of the reference group) that has the same pattern as that of the ellipses for the percentiles on the original R-Xc graph can be used to detect changes in soft-tissue mass or tissue hydration and can help researchers compare changes in different study populations. This protocol explains how to obtain and interpret phase angle values and BIVA Z-score analyses, their clinical applicability, and their usefulness as a predictive marker for the prognosis of a 90-day event in patients admitted to an emergency department with acute heart failure.

Pleins feux sur l’auteur : Dévoilement des indicateurs pronostiques de l’insuffisance cardiaque - Le rôle de l’analyse de l’angle de phase et de l’impédance bioélectrique 

In this protocol, we explain how to obtain and interpret phase angle values and bioelectrical impedance vectorial analysis (BIVA) Z-score obtained by bioelectrical impedance in patients with acute heart failure admitted to the Emergency Department and their clinical applicability as a predictive marker for the prognosis of a 90-day event.

Application clinique des analyses de l’angle de phase et du score Z BIVA chez les patients admis aux urgences pour insuffisance cardiaque aiguë

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, ...