0000000000131628
AUTHOR
Loic Bartamian
Contrôle périopératoire de la pression artérielle
Resume L’hypotension arterielle perioperatoire est frequente. Elle est associee a la survenue de deces, de lesions renales, myocardiques et cerebralesBien qu'il n’existe pas de definition consensuellel’effet de l’hypotension arterielle est connu comme etant la resultante d’un effet seuil et temps (plus de 10 min en dessous de 80 mmHg de pression arterielle moyenne (PAM)). Il convient d’individualiser les objectifs en fonction du terrain du patient et du risque operatoire. Chez le sujet sain, une PAM de 60–65 mmHg semblerait suffisante, alors que chez le sujet avec un risque operatoire plus eleve, une PAM superieure a 75–80 mmHg et/ou des variations inferieures a 10–20 % de la valeur de base…
Vasopressor-Sparing Strategies in Patients with Shock: A Scoping-Review and an Evidence-Based Strategy Proposition
Despite the abundant literature on vasopressor therapy, few studies have focused on vasopressor-sparing strategies in patients with shock. We performed a scoping-review of the published studies evaluating vasopressor-sparing strategies by analyzing the results from randomized controlled trials conducted in patients with shock, with a focus on vasopressor doses and/or duration reduction. We analyzed 143 studies, mainly performed in septic shock. Our analysis demonstrated that several pharmacological and non-pharmacological strategies are associated with a decrease in the duration of vasopressor therapy. These strategies are as follows: implementing a weaning strategy, vasopressin use, system…
Fasting does not guarantee empty stomach in the intensive care unit: A prospective ultrasonographic evaluation (The NUTRIGUS study).
BACKGROUND In the intensive care unit (ICU), a fasting period is usually respected to avoid gastric aspiration during airway management procedures. Since there are no recognised guidelines, intensive care physicians balance the aspiration risk with the negative consequences of underfeeding. Our objective was to determine the impact of fasting on gastric emptying in critically ill patients by using gastric ultrasound. MATERIAL AND METHODS Among the 112 patients that met the inclusion criteria, 100 patients were analysed. Gastric ultrasonography was performed immediately before extubation. Patients with either 1/ an absence of visualised gastric content (qualitative evaluation) or 2/ a gastri…