Prone position in obese patients with acute respiratory distress syndrome after cardio-thoracic surgery.

Objectives: Prone positioning (PP) has benefits in patients with acute respiratory distress syndrome. The objective of this study was to compare the effects and complications of PP in obese versus non-obese patients with moderate-to-severe acute respiratory distress syndrome after cardiothoracic surgery.

Methods: We retrospectively analysed a database established in 2014-2021 in an intensive care unit.

Probabilistic Prediction of Gastrointestinal Ischemia after Cardiothoracic Surgery.

Background:  Gastrointestinal ischemia (GIisch) is challenging to diagnose in patients after cardiothoracic surgery. Computed tomography angiography (CTA) carries substantial false-negative and false-positive rates. The aim of the study was to evaluate if a combination of readily available variables improves the diagnosis of GIisch after cardiothoracic surgery.

Doppler echocardiography for surveillance of acute cardiac allograft rejection: a 28-year single-center experience.

Background: Endomyocardial biopsies (EMB) are recommended for the detection of acute cardiac rejection (ACR) despite limited sensitivity. We report the long-term post-transplant results of Doppler echocardiography as a noninvasive alternative of routine EMB.

Methods: Two cohorts of heart transplantation (HT) recipients were chronologically defined as follows: the Dual Monitoring Cohort (DMC) from January 1990 to December 1997 included patients who underwent routine EMB and Doppler echocardiography within 24 hours for ACR surveillance; and the "Echo-First Cohort" (EFC), including patients transplanted from January 1998 to December 2018 with Doppler echocardiography as first-line approach for ACR surveillance.

Circuit change during extracorporeal membrane oxygenation: single-center retrospective study of 48 changes.

Background: Bleeding and thrombosis induce major morbidity and mortality in patients under extracorporeal membrane oxygenator (ECMO). Circuit changes can be performed for oxygenation membrane thrombosis but are not recommended for bleeding under ECMO. The objective of this study was to evaluate the course of clinical, laboratory, and transfusion parameters before and after ECMO circuit changes warranted by bleeding or thrombosis.

[The perioperative role of high-flow cannula oxygen (HFNO)].

High-flow nasal cannula oxygen (HFNO) is commonly used during the perioperative period. Its numerous physiological benefits, satisfactory tolerance and ease of use have led to its widespread application in intensive care and post-anesthesia care units. HFNO is also used in the operating theater in multiple indications: as oxygen supplementation (associated with pressurization) prior to orotracheal intubation; in digestive and bronchial endoscopies, especially in patients at risk of hypoxemia; and in intraoperative surgery requiring spontaneous ventilation (ENT, thoracic surgery…).

Including Organ Dysfunctions in a Predictive Score for Nosocomial Pneumonia After Cardiothoracic Surgery.

Background: Clinical diagnosis of ICU-acquired pneumonia after cardiothoracic surgery is challenging. Johanson criteria (chest radiograph infiltrate, purulent tracheal secretions, fever, and leukocytosis) fail in half the cases. A high Clinical Pulmonary Infection Score (CPIS) and ≥ 2-point increase in Sequential Organ Failure Assessment (SOFA) score (SOFA↑ ≥ 2) may improve diagnosis.

Oxygenation versus driving pressure for determining the best positive end-expiratory pressure in acute respiratory distress syndrome.

Objective: The aim of this prospective longitudinal study was to compare driving pressure and absolute PaO/FiO ratio in determining the best positive end-expiratory pressure (PEEP) level.

Patients And Methods: In 122 patients with acute respiratory distress syndrome, PEEP was increased until plateau pressure reached 30 cmHO at constant tidal volume, then decreased at 15-min intervals, to 15, 10, and 5 cmHO. The best PEEP by PaO/FiO ratio (PEEP) was defined as the highest PaO/FiO ratio obtained, and the best PEEP by driving pressure (PEEP) as the lowest driving pressure.

Pulmonary thromboendarterectomy: The Marie Lannelongue Hospital experience.

Background: Targeted medical therapy and balloon pulmonary angioplasty (BPA) entered the field of chronic thromboembolic pulmonary hypertension (CTEPH) treatment in the early 2010's. Multimodal therapy is emerging as the new gold standard for CTEPH management. Whether this change of paradigm impacted early outcomes of pulmonary endarterectomy (PEA) remains unknown.

Extubation Failure Prediction by Echography of the Diaphragm After Cardiothoracic Surgery: The EXPEDIA Study.

Background: Successful extubation is difficult to predict. Ultrasound measurement of the diaphragm thickening fraction (DTF) might help predict weaning failure after cardiothoracic surgery.

Methods: We assessed the predictive performance of diaphragm ultrasound in a derivation cohort of 50 prospectively included cardiothoracic surgery subjects ready for a weaning trial and in a validation cohort of 39 subjects ventilated for ≥ 48 h.

Effect of Recruitment Maneuvers and PEEP on Respiratory Failure After Cardiothoracic Surgery in Obese Subjects: A Randomized Controlled Trial.

Background: Obesity may increase the risk of respiratory failure after cardiothoracic surgery. A recruitment maneuver followed by PEEP might decrease the risk of respiratory failure in obese subjects. We hypothesized that the routine use after heart surgery of a recruitment maneuver followed by high or low PEEP level would decrease the frequency of respiratory failure in obese subjects.

Neuromuscular Blockade Monitoring in Acute Respiratory Distress Syndrome: Randomized Controlled Trial of Clinical Assessment Alone or With Peripheral Nerve Stimulation.

Background: Whether train-of-four (TOF) monitoring is more effective than clinical monitoring to guide neuromuscular blockade (NMB) in patients with acute respiratory distress syndrome (ARDS) is unclear. We compared clinical monitoring alone or with TOF monitoring to guide atracurium dosage adjustment with respect to drug dose and respiratory parameters.

Methods: From 2015 to 2016, we conducted a randomized controlled trial comparing clinical assessments every 2 hours with or without corrugator supercilii TOF monitoring every 4 hours in patients who developed ARDS (Pao2/Fio2 <150 mm Hg) in a cardiothoracic intensive care unit.

Performances of stabilization/solidification process of acid mine drainage passive treatment residues: Assessment of the environmental and mechanical behaviors.

Residues from passive treatment of acid mine drainage (AMD) have variable chemical stability and could regenerate contaminated drainage. Stabilization/solidification (S/S) can prevent contaminant leaching. Residues were collected from a tri-step AMD field passive treatment system, operated for 6 years at the reclaimed Lorraine mine site, Quebec, Canada.

Geochemical behavior and stabilization of spent sulfate-reducing biofilter mixtures for treatment of acid mine drainage.

Sulfate-reducing biofilters operated in semi-passive or passive modes constitute an approach of choice for treatment of acidic mining effluents. The aim of the present study involved examining the behavior of biofilters after use based on two modes of management, namely in unsaturated and saturated media. Two acidophilic biofilters were investigated following their mixing with different alkaline industrial residues (i.

Environmental behavior of metal-rich residues from the passive treatment of acid mine drainage.

In closed or abandoned mine sites, passive systems are often used for acid mine drainage (AMD) treatment. They generate metal-rich residues with variable chemical stability, which is rarely reported. The objective of the present study was to evaluate the potential mobility of contaminants (metals and sulfates) from AMD post-treatment residues to better anticipate their fate and enable their proper management.

Treatment efficiency of iron-rich acid mine drainage in a tri-unit pilot system.

Treatment efficiency of iron-rich acid mine drainage (AMD; pH 3, and 2 and 4 g/L Fe) was tested in a laboratory tri-unit pilot-scale reactor (2.65 m) for 1 year. The first unit consisted of a passive biochemical reactor (PBR1), filled with reactive mixture (50% of manure, sawdust, maple chips, compost, urea, sediment, and sand; 50% of calcite), with the aim to neutralize acidity and to partially remove metals.

Ultrasound Assessment of Respiratory Workload With High-Flow Nasal Oxygen Versus Other Noninvasive Methods After Chest Surgery.

Objective: To compare the respiratory workload using the diaphragm thickening fraction (DTf) determined by sonography during high-flow nasal oxygen (HFNO), standard oxygen therapy (SOT), and noninvasive bilevel positive airway pressure support (BIPAP) in patients with acute respiratory failure (ARF) after cardiothoracic surgery.

Design: Prospective controlled clinical trial.

Setting: A French 23-bed cardiothoracic surgical intensive care unit.

Genetic analyses led to the discovery of a super-active mutant of the RNA polymerase I.

Most transcriptional activity of exponentially growing cells is carried out by the RNA Polymerase I (Pol I), which produces a ribosomal RNA (rRNA) precursor. In budding yeast, Pol I is a multimeric enzyme with 14 subunits. Among them, Rpa49 forms with Rpa34 a Pol I-specific heterodimer (homologous to PAF53/CAST heterodimer in human Pol I), which might be responsible for the specific functions of the Pol I.