Intérêt de l’échographie pour l’étude du cartilage

Several imaging methods are available for the study of joint cartilage. Ultrasonography is generally used only to study the peripheral tissues. Exceptionally, ultrasonography is particularly well adapted for studying the trochanter cartilage of the knee joint that can be mobilized and exposed to the force of quadriceps contraction. We conducted a prospective study of 11 patients in order to compare the imaging performance of computed tomography versus ultrasonography for the evaluation of subchondral bone. Although it only studies the surface of the bone, ultrasonography was found to be very sensitive for analyzing subchondral irregularities, computed tomography remaining the gold standard for assessment of bone surface irregularities.     

Stratégie de la prise en charge de l’arrêt cardiaque

Almost 50,000 people are victims of cardiac arrest every year. Their average outcome is below 4%. The success of CardioPulmonary Resuscitation (CPR) includes immediate diagnosis of cardiac arrest, early defibrillation and chain of survival. External cardiac massage only slightly increases cardiac output. The latter can be improved by different techniques such as active compression-decompression or the impedance threshold valve if performed by well-trained teams. The principal drugs for resuscitation are epinephrine and amiodarone. Monitoring means such as capnography and invasive arterial pressure allow evaluating the efficiency of CPR. The assessment and the treatment of specific etiologies are also keys of success both during CPR and after return of spontaneous circulation.     

Place de l’acupuncteur et du thérapeute manuel dans la prise en charge pluridisciplinaire des douloureux chroniques

Résumé  La douleur est l’expression d’une lésion et/ou d’une souffrance. Il importe de prendre en charge à la fois le corps et l’esprit de chaque patient, notamment son système sensitivo-moteur, neurovégétatif, en tenant compte de ses comportements et coggnitions, et de l’environnement professionnel et familial. Les thérapies alternatives: acupuncture (médecine traditionnelle chinoise MTC), thérapies manuelles—ostéopathie (MMO), stimulations électriques transcutanée (TENS), développées au CHU de Nantes, permettent une approche et une réponse complémentaires à la prise en charge de la douleur. Elles s’inscrivent, à c?té des thérapies médicales classiques, dans une pratique d’équipe avec les mêmes objectifs. Nous rapportons par ailleurs les résultats d’une enquête de satisfaction effectuée auprès de 114 patients pris en charge au Centre de la Douleur du CHU de Nantes.      

Intérêt de la phase postprandiale pour la santé de l’Homme

Humans now spend more than three quarters of their life in postprandial state. Although the link between cardio-metabolic diseases and fasting metabolism have been extensively studied, it is equally important to examine the role of biological parameters in the postprandial phase in relation to lipotoxicity and glucotoxicity.The study of the postprandial phase modulation is of crucial to highlight the metabolic phenomena underlying lipemic and glycemic responses and to better characterize their long-term metabolic consequences.     

Intérêt de l’échographie thoracique et musculaire en kinésithérapie de réanimation

Ultrasonography has been used for many years by physiotherapists in the English-speaking countries. But its application to intensive care unit physiotherapy is a new trend and is gaining wide acceptance. Thoracic ultrasound allows the physiotherapist to assess the patient with more accuracy, allowing optimization of the treatment choice and monitoring. Muscular ultrasound allows the physiotherapist to make an assessment of intensive care unit-acquired weakness in the patient and follow up on recovery. Qualitative and quantitative muscle evolution may be a useful indicator of the patient’s severity status and of treatment efficacy. The use of ultrasonography by the physiotherapists is beneficial and should be supported and developed.     

Intérêts et limites de la posturographie pour l’évaluation des troubles de l’équilibre

Posturography, i.e. the assessment of balance based on modifications to the pressure centre collected by a force platform, has seen many developments over the last forty years. Recently, improvements have been proposed in the area of experimental conditions (single-leg balancing, limits of stability, dynamic posturography) and also to signal analysis (non-linear analysis). Even if posturography is the most suitable means for assessing the upright position, its place in the evaluation of balance problems remains under discussion. There are many reasons why its use has not been widely accepted. Indeed, aside from the initial purchase cost and the collecting and interpretation of results, many authors have called into question the reproducibility of the tests, their sensitivity, their specificity and their interest with regard to other clinical or instrumental examinations for certain diseases. These are the elements that will be tackled here, with the understanding that developments are constantly being put forward in this area, that will see a regular increase in the number of publications on this subject.     

Intérêt de l’évaluation quantitative des sources d’inconforts en réanimation

Potential sources of discomfort or stressors associated with an intensive care unit (ICU) stay can be classified as intrinsic or patient-related factors, environmental factors (such as noise and excess of light), and organizational factors. Two approaches facilitate the assessment of ICU-related stressors: first an objective approach by measuring physical or physiological parameters that characterize either ICU-related stressors or their impact on the critically ill patient, and second, a subjective approach using questionnaires (patient-related outcomes). Pain is frequently reported by ICU patients as the main stressful condition, in relation to many therapeutic or diagnostic procedures. Thirst and sleep deprivation are also perceived very negatively by ICU patients in studies based on questionnaires investigating patient-related outcomes. ICU stays without control of stressors may induce agitation and confusion (ICU psychosis) and increase the risk of developing a post-traumatic stress disorder. Promoting the IPREA (Inconforts des Patients de REAnimation, discomfort in critically ill patients) questionnaire and its implementation in routine clinical practice could be the starting point for the development of quality assurance programs based on the Deming Approach—PDCA “Plan Do Check Act.”     

Intérêt des huiles essentielles GAE® dans la prise en charge des affections virales des voies respiratoires en officine

During the winter, respiratory tract infections are very common. Those seasonal epidemics are often minor and have mainly a viral origin. However, symptoms are annoying and have an impact on the patient’s quality of life. The purpose is to examine the impact of treatment by essential oils GAE® on the quality of life and the respiratory comfort of patients with non-complicated respiratory infection symptoms. The observational study has been leaded in wintertime, in 89 pharmacies, using questionnaires for patients and pharmacists. Two hundred and five patients, men or women older than 18 years, with at least one symptom of respiratory tract inflammation and to whom pharmacists have given GAE®, participated in test. Results: the quality of life and the respiratory comfort are significantly improved after six days of GAE® intake (P < 0.0001). Respiratory infection major symptoms disappear faster with GAE® (4.9 days on average) than spontaneously (seven to ten days). In conclusion, this study shows the interest of viral respiratory infection care with GAE®, improving faster patient’s quality of life and respiratory comfort.     

Intérêt et limites des tests cliniques et des échelles ordinales pour l’évaluation de l’équilibre

The clinical examination of a patient presenting with a balance disorder should, in part, address and answer the following three questions: What is or are the causes? How severe is it? What changes have there been? The interview plays an essential role in the evaluation of the physical, psychological and social implications of the disorder. The examination is methodically carried out, noting the patient??s balance issues using a numerical system, which allows progress to be monitored, as objectively as possible, based on the treatment and rehabilitation received. Numerous tests, scores and scales have been designed, which are either generic or specific to certain diseases. They are very useful, especially when it comes to comparing patients, but they do not always use particularly reliable instrumentation and their predictive value is generally very poor. Moreover, they do not reproduce normal conditions, and therefore only partially reflect reality.     

Utilisation de l’échocardiographie Doppler dans la prise en charge des lésions cardiovasculaires traumatiques

Over the last decade, the initial assessment of patients presenting with a severe thoracic trauma changed dramatically. Angiography, historically considered the reference imaging modality for the diagnosis of traumatic aortic injuries (TAI), has been supplanted by non invasive techniques. Multiplane transesophageal echocardiography (TEE) or contrast-enhanced helical computed tomography of the chest are first-line imaging techniques currently used in most trauma centers for the screening of patients with suspected TAI. With the respect of a learning curve, TEE is an accurate imaging modality for the diagnosis of TAI and blunt cardiac trauma. In addition to its diagnostic capability, TEE provides valuable information which help guiding the therapeutic management of injured patients. The acute management of patients presenting with a precordial wound is mainly based on the early diagnosis of hemopericardium which should prompt surgical repair of an underlying cardiac injury. Accordingly, transthoracic echocardiography is the pivotal test performed upon admission, whereas TEE is usually performed peroperatively to precisely identify associated cardiac injuries. In summary, echocardiography Doppler is a pivotal imaging modality for the assessment of patients at high risk of sustaining blunt or penetrating cardiovascular trauma. This implies a consistent availability of full-featured echocardiographic systems and trained operators in trauma centers.     

Intérêts et limites des mesures de verticalité subjective pour l’évaluation des troubles de l’équilibre

The sense of verticality is considered one of the fundamental spatial parameters that the human being uses to establish mental images of the position of their body and the different parts of their body in space. It therefore plays a specific role in controlling posture. The perception of verticality results from the integration of visual, vestibular and somatosensory information. Different methods of verticality perception can be measured; the visual, haptic and postural vertical, each with different neurological integration circuits and thus the results can be separated into the different pathologies. Understanding the mechanisms which explain the changes in verticality perception, as well as their impact on balance, have been the focus of many studies over the last few years. In certain diseases, such as after a cerebral vascular accident (stroke), measurement of the perception of verticality is now part of the assessment of the balance issues seen in current clinical practice.     

Intérêt des fibres en nutrition entérale en réanimation : de la théorie à la pratique

Even though enteral nutrition has gained an indisputable position in the intensive care unit (ICU), the use of fiber-enriched formulas remains controversial. Healthpromoting features of dietary fibers (DF) outside the ICU reach a good level of evidence: alongside functional properties, DF have metabolic effects, mediated by short-chain fatty acids from colonic fermentation; some DF, named prebiotics, are a specific substrate of beneficial bacteria in the intestinal microbiota. However, the number and variety of compounds amongst DF make comparisons difficult, with consequently conflicting results of ICU clinical trials. The most promising results come from soluble fibers that help improve glycemic control. Although DF may help improve digestive health, prevention studies on diarrhea (except from partially hydrolysed guar gum) or constipation are not convincing. Reduced intestinal barrier permeability, leading to fewer bacterial translocation episodes, is a feature of synbiotic (prebiotics and probiotics together) use. A consensus on the use of DF in enteral nutrition formulas in the ICU is therefore difficult to reach. Only larger studies using the same DF (including prebiotics) may result in new recommendations for clinical practice.     

Intérêts potentiels de la citrulline en réanimation

Due to its highly specific metabolism, citrulline (CIT) is now recognized as a biomarker of functional intestinal mass. In the stressed and septic critically ill patient, plasma CIT is often very low at ～10 μmol/L (normal range: 38±8 μmol/L). These abnormal values are difficult to interpret as patients may present increased CIT recycling into arginine and/or arginine depletion. Additionally, multiple organ failure may further make this issue complex. Experimental studies in rodent models of sepsis have raised promising results, particularly regarding gut microcirculation, which now need to be confirmed by ongoing randomized clinical trials.