Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Mar 2007
Review[Cardiopulmonary interactions in patients under positive pressure ventilation].
Heart-lung interactions during positive-pressure ventilation are characterized by an extreme sensibility to the patient's intravascular volume status. Indeed, a fall in cardiac output due to decreased ventricular preload can be observed when initiating positive-pressure ventilation. This phenomenon is due to the close anatomic-functional association between heart and lungs, and to the fact that pulmonary volume and intrathoracic pressure variations cyclically modify heart-lung interactions. The present review address the questions of the physiological and physiopathological effects of positive-pressure ventilation on the right and left venous returns, and on pulmonary and systemic vascular resistances.
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Ann Fr Anesth Reanim · Mar 2007
Review[The abnormal activated partial thromboplastin time biphasic waveform: a red flag in the sepsis? Technique and interest as marker of the sepsis].
The biphasic waveform (BPW) is an abnormality of the optical transmission waveform obtained during measurement of the activated partial thromboplastin time on a specific photometric haemostasis autoanalyzer. This abnormality is related to calcium-dependent formation of complexes between C reactive protein and very low density lipoprotein. Biphasic waveform had a high sensitivity and negative predictive value for the identification of patients with severe sepsis and septic shock. ⋯ Further trials should be necessary using BPW for diagnostic and management procedures. Compared with other laboratory markers such as C reactive protein or procalcitonin, activated partial thromboplastin time waveform analysis is a tool that is rapid, inexpensive, effective and available 24 hours a day. When the analyzer is locally available, waveform analysis of this routine coagulation test provides information for the diagnosis of severe sepsis and the prognosis of septic patients.