Comment on Dinesen et al. Diphoterine for Chemical Burns of the Skin: A Systematic Review. 2023, , 55-68.

We read with interest the recent publication of Dinesen et al. [..

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Polyamphoteric washing solutions (PWS) have been used for several years, mainly in industries, for cases of chemical ocular or cutaneous splashes by acid or alkali. We collected 37 cases reporting the use of PWS for ocular and cutaneous chemical splashes from several centres. Among the 37 cases, 55.

Etiologies, clinical features and outcome of cardiac arrest in HIV-infected patients.

Background: Compared to many other cardiovascular diseases, there is a paucity of data on the characteristics of successfully resuscitated cardiac arrest (CA) patients with human immunodeficiency virus (HIV) infection. We investigated causes, clinical features and outcome of these patients, and assessed the specific burden of HIV on outcome.

Methods: Retrospective analysis of HIV-infected patients admitted to 20 French ICUs for successfully resuscitated CA (2000-2012).

Ten good reasons why everybody can and should perform cardiac ultrasound in the ICU.

Critical care ultrasonography (CCUS) has been defined as an ultrasound evaluation of the heart, abdomen, pleura and lungs at the bedside by the intensivist, 24/7. Within CCUS, critical care echocardiography (CCE) is used to assess cardiac function and more generally haemodynamics. Experts in haemodynamics have published a 'consensus of 16' regarding an update on haemodynamic monitoring.

Myocardial dysfunction during H1N1 influenza infection.

Purpose: The purpose of the study is to evaluate the incidence and hemodynamic consequences of right ventricular (RV) and left ventricular (LV) dysfunction in critically ill patients with H1N1 infection.

Patients And Methods: This is a retrospective analysis of all patients admitted to the intensive care unit of an academic hospital between October 2009 and March 2011 with severe H1N1 infection. Hemodynamic measurements and respiratory conditions were noted daily during the intensive care unit stay.

Doppler echocardiography in shocked patients.

Purpose Of Review: To reiterate the necessity of integrating echocardiography in the management of shocked patients and to propose a step-by-step functional evaluation of hemodynamics proven to optimize hemodynamic monitoring and to adapt the treatment.

Recent Findings: Echocardiography has become the cornerstone to hemodynamic monitoring. By providing real-time images, echocardiography has the advantage over 'blind' technologies of an excellent diagnostic performance and of quick provision of information about the pathophysiology of circulatory failure.

Assessment of left ventricular function by pulse wave analysis in critically ill patients.

Purpose: Left ventricular (LV) performance is often quantified by echocardiography in critically ill patients. Pulse wave analysis (PWA) systems can also monitor cardiac function but in a continuous fashion. We compared echocardiographic and PWA-derived indices of LV function.

Respiratory variation in inferior vena cava diameter: surrogate of central venous pressure or parameter of fluid responsiveness? Let the physiology reply.

In the previous issue of Critical Care, Muller and colleagues investigated whether respiratory variation in inferior vena cava diameter (ΔIVC) could be a useful predictor of fluid responsiveness in spontaneously breathing patients. The study concludes that accuracy was not very good and therefore that this parameter should be used with caution in these patients. There is still confusion about the meaning of IVC respiratory variations, whether the patient is spontaneously breathing or mechanically ventilated.

Organ failure in the ICU: cardiac alterations.

Cardiac alterations may be defined as changes that lead to abnormal cardiac function. They include decrease in preload, increase in afterload, and depressed cardiac contractility. Cardiac dysfunction differs from cardiac failure: cardiac performance is altered, but this does not necessarily mean that the cardiovascular system is failing.

PaCO2 and alveolar dead space are more relevant than PaO2/FiO2 ratio in monitoring the respiratory response to prone position in ARDS patients: a physiological study.

Introduction: Our aims in this study were to report changes in the ratio of alveolar dead space to tidal volume (VDalv/VT) in the prone position (PP) and to test whether changes in partial pressure of arterial CO2 (PaCO2) may be more relevant than changes in the ratio of partial pressure of arterial O2 to fraction of inspired O2 (PaO2/FiO2) in defining the respiratory response to PP. We also aimed to validate a recently proposed method of estimation of the physiological dead space (VDphysiol/VT) without measurement of expired CO2.

Methods: Thirteen patients with a PaO2/FiO2 ratio < 100 mmHg were included in the study.

Cardiac tamponade.

Purpose Of Review: To re-emphasize the epidemiology, pathophysiology, diagnosis, and treatment of cardiac tamponade.

Recent Findings: Cardiac tamponade is a cause of obstructive shock. Incidence of cardiac tamponade is poorly documented.

[The value of mobile intensive care unit (MICU): does it remain to be proven?].

Recent international guidelines about emergency situations (ILCOR / ERC) pointed to the need of the whole "chain of survival". ALS, Advanced Life Support (the last and "medical" part of the chain ) is important and influences survival rate. If no doubt exists about "what" and "when" to do in such situations, there is no consensus in industrialized countries about "who" should be in charge of such out-of-hospital acute diagnosis and treatment: emergency physicians, emergency nurses, emergency medical technicians (EMT), other "new" professionals ? .

[Direct transfer of obstetrical data by magnetic means in a randomized multicenter trial of the subjective count of fetal movements by the mother-to-be].

Ten Belgian maternity hospitals have collaborated in an international clinical multicenter trial: Multicenter Fetal Movement Trial. Nine maternity hospitals were already managing a computerized data bank before their participation in the trial. In seven of these centers the local team was able to write a program for direct transmission of data, using standard sequential ASCII files.

Biochemical investigations after burning injury: complement system, protease-antiprotease balance and acute-phase reactants.

Seventeen burned patients were investigated--Group I (n=10) with a mean burned area expressed as unit burn standard (UBS) of 69 +/- 24 and Group II (n = 7) with a mean UBS of 23 +/- 8. Blood samples were collected immediately after admission, 6-12 h after injury, during the morning and evening of day 1, and then daily for 2 weeks. This prospective study demonstrated complement activation in vivo in all burned patients, measured by C3d/C3 ratio index which was not related to the extent of the burned surface.

Thromboxane and prostacyclin release in adult respiratory distress syndrome.

Plasma thromboxane B2 (TXB2) and 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) were measured in 84 patients at risk of developing adult respiratory distress syndrome (ARDS) (44 patients following multiple trauma, 29 patients following abdominal surgery and 11 patients with acute pancreatitis). Forty-nine of these 84 patients developed an ARDS. High (greater than 140 pg/ml plasma) TXB2 values were found in 52/84 patients.

Prostaglandin E2, prostacyclin, and thromboxane changes during nonpulsatile cardiopulmonary bypass in humans.

To study the effect of lung bypass on the production of prostaglandin E2, prostacyclin, and thromboxane A2, we measured simultaneously arterial and venous plasma concentrations of prostaglandin E2, 6-keto-prostaglandin F1 alpha (stable metabolite of prostacyclin), and thromboxane B2 (stable metabolite of thromboxane A2) before, during, and after cardiopulmonary bypass. Seventeen patients (age range 46 to 69 years) undergoing aorta-coronary bypass grafts were investigated. The prostaglandin E2 production rose sharply immediately after the onset of bypass (baseline: 9.

[Results of hip arthroplasty using Gérard's coupled, non-cemented cups. Analysis of 92 cases reviewed].

The authors have reviewed 92 cases of uncemented surface hip replacements with a minimum follow-up of 3 years. They were operated on using the Gérard technique which must be very precise to avoid devascularisation of the femoral head. 17 failures had to be operated on again.

Biochemical pathways of acute lung injury.

Complement fragments (C3, C3d, C5a), thromboxane B2 (TxB2), 6-keto-PGF1 alpha and immunoreactive trypsin (IRT) were measured in 98 patients at risk of developing the adult respiratory distress syndrome (ARDS): 53 multiple trauma, 28 abdominal surgery and 17 acute pancreatitis. Sixty-five of these patients developed ARDS: 30 multiple trauma, 19 abdominal surgery and 16 acute pancreatitis patients. Forty of the 65 ARDS patients and 9 out of the 33 non-ARDS patients died.

Changes in cerebrospinal fluid enzyme activity after severe head injury. Diagnostic and prognostic values.

We studied CSF CK and LDH isoenzyme activities in 27 patients with severe head injury and in 10 patients with chronic hydrocephalus not related to trauma. CSF enzymes showed an increased activity immediately after trauma, contrasting with the low values measured in the patients with hydrocephalus. In severe head injury, we found a correlation between enzyme release and brain dysfunction assessed according to two methods: the Glasgow coma scale (GCS), and the Liège coma scale (LCS) which uses elements of the GCS and the study of 5 brain stem reflexes.