Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Mar 2014
Review[Nuclear magnetic resonance based metabolic phenotyping for patient evaluations in operating rooms and intensive care units.]
Metabolic phenotyping consists in the identification of subtle and coordinated metabolic variations associated with various pathophysiological stimuli. Different analytical methods, such as nuclear magnetic resonance, allow the simultaneous quantification of a large number of metabolites. Statistical analyses of these spectra thus lead to the discrimination between samples and the identification of a metabolic phenotype corresponding to the effect under study. ⋯ Metabolic phenotyping could be useful in anaesthesiology and intensive care medicine for the evaluation, monitoring or diagnosis of life-threatening situations, to optimise patient managements. This review introduces the physical and statistical fundamentals of NMR-based metabolic phenotyping, describes the work already achieved by this approach in anaesthesiology and intensive care medicine. Finally, potential areas of interest are discussed for the perioperative and intensive management of patients, from newborns to adults.
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Ann Fr Anesth Reanim · Feb 2014
ReviewConsequences of brain damage in the public debate regarding the end of life. The mediatic prism: A reflection of reality?
For the last 20 years or so, conflicts on life-support have become the object of widespread media coverage. By focusing public opinion on the alleged physicians' unreasonable obstinacy, these publicized cases impact social debates on life-support. By these, they justify claims for the legalization of assisted suicide, specifically the practice of termination of life by lethal injection. ⋯ As it turns out, the publicized filter does not reflect the true reality of cases involving unreasonable care. Specific procedures could aid in notifying the existence of such situations. The role of health care professionals (excluding physicians) appears to play an essential part in preventing these situations from happening.
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When a severe traumatic brain-injured patient arrives to hospital, fear of failure and definite opinions about the outcome modify early care and provoke self-fulfilling prophecies. It is obvious that working on prognosis is not only useful to inform relatives but also permits to maintain a high level of care, key for a better outcome. Mortality is high (40-50%) if deaths in the first days are not excluded. ⋯ Studies with complex statistical methodology give a good estimated probability of bad outcome but must be confirmed by more validation studies. Progress will come from a better understanding of physiopathology. Focuses on processing chain, rapid multi-monitoring, biomarkers, and investigations in MRI and TDI will help to establish opportunities for treatments and to determine limits.
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Ann Fr Anesth Reanim · Feb 2014
ReviewNeurological consequences of cardiac arrest: Where do we stand?
With increasing public education in basic life support and with the widespread use of automated defibrillators, post-cardiac arrest comatose patients represent a growing part of ICU admissions. However the prognosis remains very poor and only a very low proportion of these resuscitated patients will recover and will leave the hospital without major neurological impairments. Neurological dysfunction predominantly includes disorders of consciousness, and may also include other manifestations such as seizures, myoclonus status epilepticus and other forms of movement disorders including post-anoxic myoclonus. ⋯ Currently, early use of mild therapeutic hypothermia is the only treatment that demonstrated its ability to decrease neurological consequences and to improve the prognosis. Prognostication outcome is still mainly based on a rigorous clinical evaluation coupled with neuro-physiological investigations, but brain functional imaging could become a valuable tool in the near future. Clinical research focusing on survivors should be strongly encouraged in order to assess the mid- and long-terms outcome of survivors and to evaluate the impact of new treatments or strategies.