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Clermont-Ferrand, France

Severgnini P.,University of Insubria | Selmo G.,University of Insubria | Lanza C.,University of Insubria | Chiesa A.,University of Insubria | And 11 more authors.

BACKGROUND:: The impact of intraoperative ventilation on postoperative pulmonary complications is not defined. The authors aimed at determining the effectiveness of protective mechanical ventilation during open abdominal surgery on a modified Clinical Pulmonary Infection Score as primary outcome and postoperative pulmonary function. METHODS:: Prospective randomized, open-label, clinical trial performed in 56 patients scheduled to undergo elective open abdominal surgery lasting more than 2 h. Patients were assigned by envelopes to mechanical ventilation with tidal volume of 9 ml/kg ideal body weight and zero-positive end-expiratory pressure (standard ventilation strategy) or tidal volumes of 7 ml/kg ideal body weight, 10 cm H2O positive end-expiratory pressure, and recruitment maneuvers (protective ventilation strategy). Modified Clinical Pulmonary Infection Score, gas exchange, and pulmonary functional tests were measured preoperatively, as well as at days 1, 3, and 5 after surgery. RESULTS:: Patients ventilated protectively showed better pulmonary functional tests up to day 5, fewer alterations on chest x-ray up to day 3 and higher arterial oxygenation in air at days 1, 3, and 5 (mmHg; mean ± SD): 77.1 ± 13.0 versus 64.9 ± 11.3 (P = 0.0006), 80.5 ± 10.1 versus 69.7 ± 9.3 (P = 0.0002), and 82.1 ± 10.7 versus 78.5 ± 21.7 (P = 0.44) respectively. The modified Clinical Pulmonary Infection Score was lower in the protective ventilation strategy at days 1 and 3. The percentage of patients in hospital at day 28 after surgery was not different between groups (7 vs. 15% respectively, P = 0.42). CONCLUSION:: A protective ventilation strategy during abdominal surgery lasting more than 2 h improved respiratory function and reduced the modified Clinical Pulmonary Infection Score without affecting length of hospital stay. Copyright © 2013, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Source

Edouard P.,Jean Monnet University | Rannou F.,University of Paris Descartes | Coudeyre E.,University Hospital of Clermont Ferrand
Physical Therapy in Sport

Introduction: Intra-articular injections of hyaluronic acid (HA) could have potential interest in therapy of acute knee trauma injuries, but few results are available in humans. Objective: We reviewed the literature for animal studies of intra-articular HA injections after knee trauma injury to determine the interest of human clinical research into and/or use of such injections for knee trauma. Methods: Systematic literature search on MEDLINE for studies involving animal models of osteoarthritis created by acute knee trauma injury, with HA injections beginning during the 2 weeks after injury. Results: The search revealed 14 studies with a high methodological quality: 7 related to meniscus injury, 3 ACL injury, 1 combined ACL-meniscus injury and 3 cartilage injury. The animal models were rabbits in 10 studies. Four studies demonstrated positive effects and 3 moderate effects of intra-articular HA injection for meniscus injury; 1 positive effects and 2 no effect for ACL injury; 1 positive effects for combined ACL-meniscus injury; and 2 moderate effects and 1 no effect for cartilage injury. Conclusions: With a high strength of recommendation, intra-articular HA injections in animal models with meniscus injury improved the healing process and/or had a protective role in articular cartilage, a slightly protective role in ACL injury animal models and low or no effect on healing in articular cartilage injury animal models. © 2013 Elsevier Ltd. Source

Hordonneau C.,Estaing University Hospital Center | Buisson A.,Estaing University Hospital Center | Buisson A.,University of Auvergne | Scanzi J.,Estaing University Hospital Center | And 10 more authors.
American Journal of Gastroenterology

OBJECTIVES:Magnetic resonance imaging (MRI) allows accurate assessment of Crohn's disease (CD), but requires gadolinium injection. Diffusion-weighted (DW)-MRI yields comparable performances in small bowel CD. We compared the accuracy of DW-MR enterocolonography (MREC) and the magnetic resonance index of activity (MaRIA), and performed an external validation of the Clermont score in assessing inflammation in CD.METHODS:This was an observational prospective study of a single-center cohort. A total of 130 CD patients underwent consecutively MREC with gadolinium injection and DWI sequences between July 2011 and December 2012.RESULTS:Of the 848 evaluated segments (small bowel=352, colon/rectum=496), 175 (20.6%) were active (small bowel=111, colon/rectum=64) defined as MaRIA ≥7. Using a receiver operating characteristic (ROC) curve, we determined an apparent coefficient of diffusion (ADC) threshold of 1.9 × 10 -3 mm 2 /s that yielded a sensitivity and a specificity in discriminating active from nonactive CD of 96.9% and 98.1%, respectively, for the colon/rectum, and 85.9% and 81.6%, respectively, for the ileum. ADC was better correlated to MaRIA ≥7 than related contrast enhancement obtained with injected sequences (P<0.001). The Clermont score (=1.646 × bowel thickness-1.321 × ADC+5.613 × edema+8.306 × ulceration+5.039) was highly correlated with the MaRIA (rho=0.99) in ileal CD but not in colonic CD (rho <0.80). Interobserver agreement was high with regard to ADC measurement (correlation >0.9, P<0.001, and concordance >0.9, P<0001).CONCLUSIONS:DW-MREC is a reliable tool to assess inflammation in colonic (ADC) and ileal (Clermont score) CD and its use in daily practice would avoid gadolinium injection. © 2014 by the American College of Gastroenterology. Source

Vallet B.,University Hospital of Lille | Futier E.,University Hospital of Clermont Ferrand
Current Opinion in Critical Care

Purpose of review: Tissue hypoxia is a key trigger for organ dysfunction. The maintenance of adequate tissue oxygenation is therefore of particular importance during major surgery. In this review, we discuss the physiological basis and the rationale underlying the recent concepts of perioperative oxygen therapy. Recent findings: Adequate tissue oxygenation is vital for optimal tissue healing in the surgical context. Nevertheless, the definitive proof for a beneficial effect of perioperative oxygen therapy with an increase in inspired oxygen has not been established. In contrast, optimization of oxygen delivery (DO2), using either or both fluid loading and inotropic supports, to prevent tissue hypoxia in relation to an increased oxygen consumption (VO2) could improve outcome. In this context, the use of central venous oxygen saturation (ScvO2), which reflects important changes in the DO2/VO2 relationship and of central venous-to-arterial carbon dioxide difference, to address adequacy of oxygen utilization, has shown promising results. Summary: Adequacy of oxygen delivery to tissue oxygen metabolic demand is essential during the perioperative period. The benefit of perioperative oxygen therapy is rather optimizing the DO2 than increasing inspired oxygen. Improving DO2 has been demonstrated in the perioperative period to reduce both morbidity and mortality. Adaptation of DO2 to O2 consumption using specific goals seems promising. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Futier E.,Estaing University Hospital Center | Constantin J.-M.,Estaing University Hospital Center | Pelosi P.,University of Insubria | Chanques G.,Montpellier University | And 3 more authors.

Background: Pulmonary function is impaired during pneumoperitoneum mainly as a result of atelectasis formation. We studied the effects of 10 cm H 2O of positive end-expiratory pressure (PEEP) and PEEP followed by a recruitment maneuver (PEEP+RM) on end-expiratory lung volume (EELV), oxygenation and respiratory mechanics in patients undergoing laparoscopic surgery. Methods: Sixty consecutive adult patients (30 obese, 30 healthy weight) in reverse Trendelenburg position were prospectively studied. EELV, static elastance of the respiratory system, dead space, and gas exchange were measured before and after pneumoperitoneum insufflation with zero end-expiratory pressure, with PEEP alone, and with PEEP+RM. Results are presented as mean ± SD. Results: Pneumoperitoneum reduced EELV (healthy weight, 1195 ± 405 vs. 1724 ± 774 ml; obese, 751 ± 258 vs. 886 ± 284 ml) and worsened static elastance and dead space in both groups (in all P < 0.01 vs. zero-end expiratory pressure before pneumoperitoneum) whereas oxygenation was unaffected. PEEP increased EELV (healthy weight, 570 ml, P < 0.01; obese, 364 ml, P < 0.01) with no effect on oxygenation. Compared with PEEP alone, EELV and static elastance were further improved after RM in both groups (P < 0.05), as was oxygenation (P < 0.01). In all patients, RM-induced change in EELV was 16% (P = 0.04). These improvements were maintained 30 min after RM. RM-induced changes in EELV correlated with change in oxygenation (r = 0.42, P < 0.01). Conclusion: RM combined with 10 cm H2O of PEEP improved EELV, respiratory mechanics, and oxygenation during pneumoperitoneum whereas PEEP alone did not. © 2010, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Source

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