Management of mechanical ventilation in acute severe asthma: practical aspects.

Background: Acute severe asthma induces marked alterations in respiratory mechanics, characterized by a critical limitation of expiratory flow and a heterogeneous and reversible increase in airway resistance, resulting in premature airway closure, lung, and chest wall dynamic hyperinflation and high intrinsic PEEP.

Discussion: These abnormalities increase the work of breathing and can lead to respiratory muscle fatigue and life-threatening respiratory failure, in which case mechanical ventilation is life-saving. When instituting mechanical ventilation in this setting, a major concern is the risk of worsening lung hyperinflation (thereby provoking barotrauma) and inducing or aggravating hemodynamic instability.

Electromyographic responses of paraspinal muscles to postural disturbance with special reference to scoliotic children.

Background: Electromyographic (EMG) responses of erector spinae to a postural perturbation have been described and interpreted as an unloading reflex. Moreover, these responses have been found clearly and constantly abnormal in subjects presenting a progressive idiopathic scoliosis when compared with responses observed in subjects presenting a nonprogressive scoliosis or in normal subjects.

Objective: To investigate responses to obtain more precise information on their components, on their origin, and on their variations in scoliotic children.

A computer program for interpreting pulmonary artery catheterization data: results of the European HEMODYN Resident Study.

We previously validated an expert computer program (Hemodyn) designed to assist in interpreting pulmonary artery catheterization data. The present multicentric study assessed the influence of Hemodyn on the therapeutic strategies of residents. Each resident made several diagnostic choices and suggested appropriate treatments based on pulmonary artery catheterization (PAC) data.

Pulmonary artery catheter: does the problem lie in the users?

The aims of this study were to look for the variability in the treatment of circulatory shock and to assess the extent to which this variability was reduced by pulmonary artery catheterization (PAC). At three international conferences in 1997-1998 (European Society of Critical Care Medicine, French Language Society for Critical Care [Société de Réanimation de Langue Française], and Society of Critical Care Medicine), a real-life clinical case was discussed in meetings among physicians and a panel of experts, with assistance from an expert computer program. A total of 417 physicians took part in the discussions.