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Saint-Antoine-de-Breuilh, France

Jaber S.,Montpellier University | Coisel Y.,Montpellier University | Chanques G.,Montpellier University | Futier E.,Estaing University Hospital Center | And 7 more authors.
Anaesthesia | Year: 2012

We conducted an observational prospective multicenter study to describe the practices of mechanical ventilation, to determine the incidence of use of large intra-operative tidal volumes (⥠10 ml.kg -1 of ideal body weight) and to identify patient factors associated with this practice. Of the 2960 patients studied in 97 anaesthesia units from 49 hospitals, volume controlled mode was the most commonly used (85%). The mean (SD) tidal volume was 533 (82) ml; 7.7 (1.3) ml.kg -1 (actual weight) and 8.8 (1.4) ml.kg -1 (ideal body weight)). The lungs of 381 (18%) patients were ventilated with a tidal volume > 10 ml.kg -1 ideal body weight. Being female (OR 5.58 (95% CI 4.20-7.43)) and by logistic regression, underweight (OR 0.06 (95% CI 0.01-0.45)), overweight (OR 1.98 (95% CI 1.49-2.65)), obese (OR 5.02 (95% CI 3.51-7.16)), severely obese (OR 10.12 (95% CI 5.79-17.68)) and morbidly obese (OR 14.49 (95% CI 6.99-30.03)) were the significant (p≤0.005) independent factors for the use of large tidal volumes during anaesthesia. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

Funck-Brentano T.,Pitie Salpetriere Teaching Hospital | Gandjbakhch F.,Pitie Salpetriere Teaching Hospital | Etchepare F.,Pitie Salpetriere Teaching Hospital | Jousse-Joulin S.,Brest Teaching Hospital | And 9 more authors.
Arthritis Care and Research | Year: 2013

Objective: To assess the ability of ultrasonography (US) to predict radiographic damage in early arthritis. Methods: ESPOIR is a multicentric cohort of early arthritis (i.e., ≥2 swollen joints between 6 weeks and 6 months). US synovitis in B mode, power Doppler (PD) mode, and erosions were searched on the second through the fifth metacarpophalangeal and fifth metatarsophalangeal joints according to Outcome Measures in Rheumatology definitions. Structural radiographic progression was assessed using the modified Sharp/van der Heijde erosion score (SHS) at baseline and 1 and 2 years. Predictive factors of erosive arthritis at 2 years and rapid radiographic progression (RRP) at 1 year (defined by change of SHS ≥5) were searched. Results: A total of 127 patients were included, with a mean ± SD Disease Activity Score in 28 joints of 5.1 ± 1.3; 37.6% were anti-citrullinated protein antibody positive and 27.6% had typical rheumatoid arthritis (RA) erosions on radiographs. At 2 years, 42 patients (39.2%) had typical RA erosions. US erosions predicted radiographic evidence of erosive arthritis (odds ratio [OR] 1.44, 95% confidence interval [95% CI] 1.04-1.98). PD synovitis score was predictive of RRP at 1 year (OR 1.22, 95% CI 1.04-1.42). US erosions and PD synovitis scores were associated with change of SHS on linear regression. Of the 1,184 analyzed joints, 105 (8.9%) had radiographic erosion at 1 year. At the joint level, baseline US erosions were predictive of the presence of radiographic erosions at 1 year (P < 0.001). The same trend was observed in the joints without radiographic erosions at baseline (P = 0.052). Conclusion: US is useful to evaluate the potential severity of early arthritis: US erosions and PD-positive synovitis have prognostic value to predict future radiographic damage. Copyright © 2013 by the American College of Rheumatology.

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