B Acad Nat Med Paris
-
To evaluate the performance of intensive care unit (ICU) the severity scores are measured on the first day; organ system dysfunctions are measured several times during the stay. The severity scores are developed from large data bases of thousands of patients. They include the patient age, previous health status, severity and sometimes the main diagnosis. ⋯ By comparing the observed and expected mortality rates the Standard Mortality Ratio (SMR) may be measured. The data collection must be rigorous, the studied population must be similar to the population of the large data bases. Other elements of performance may be evaluated, such as the cost-efficiency or the quality of life or surviving patients.
-
In recent years, considerable improvement has been achieved in the field of mechanical ventilation. A lot of experimental and clinical research has been done to reduce the adverse effects of mechanical ventilation. ⋯ Pressure-assisted ventilatory modes, such as pressure support have been introduced, resulting in better patient-ventilator synchronisation, good tolerance and easier weaning process. Pressure support is also a largely used mode in noninvasive ventilation which has been proved to improve outcome in chronic obstructive pulmonary diseases.
-
Septic shock is one of the leading cause of death in modern countries. Scientists have made huge improvement in the understanding of mechanisms of inflammation, and the sequence of activation of the various pro and anti-inflammatory markers is now well known. By contrary, physicians have failed to improve survival from septic shock, in spite of the development of specific targets of the various points of the cytokine cascade sought to have a key role in host survival to sepsis. ⋯ More recent findings highlighting the role of the integrity of the hypothalamic-pituitary -adrenal axis to appropriately respond to a septic insult, have led to a reappraisal of the use of steroids in septic shock. Several high quality randomised controlled trials have evaluated the efficacy and safety of a prolonged treatment with low dose hydrocortisone in severe sepsis. These trials strongly suggested that this strategy of corticotherapy reduced the morbidity of septic shock and may favourably affect survival from septic shock.
-
At its very early phase, septic shock is characterized by severe hypovolemia related to abundant fluid losses, increased venous compliance and maldistribution of extracellular fluid (interstitial edema, splanchnic pooling). It results in a drop in venous return and cardiac output. ⋯ Clinical examination and hemodynamic monitoring (Swan-Ganz catheter) appear to provide the most useful criteria to assess the limits of liquid administration. Better understanding in the mechanisms of circulatory dysfunction due to the inflammation cascades might soon lead to a new approach in fluid therapy.
-
B Acad Nat Med Paris · Jan 1999
Review[Current data on major novel antiamalaria drugs: Artemisinin (qinghaosu) derivatives].
Artemisinin or Qinghaosu (QHS) and its derivatives (mainly artemether and artesunate) are novel and the most rapidly acting antimalarial drugs, effective in adults and children against all the Plasmodium of humans, including multi-drug resistant Plasmodium falciparum. Resistance to these drugs has not been identified so far. QHS derivatives are very well tolerated and there is no evidence of serious clinical toxicity in man. ⋯ This route eliminates several disadvantages or risks associated with injections. The best indication for rectal administration will be probably a rescue treatment of severe malaria in rural and poorly equipped dispensaries before transfer to hospital for treatment using conventional modalities. All QHS derivatives should not be used for chemophophylaxis.