Huiles essentielles et composés organiques volatils,rôles et intérêts

The essential oils from aromatic plants are extracted from the plant world and used for thousands of years for their therapeutic properties, particularly anti infectious, often in the form of non-medicinal products. They play a significant role in plant defense and forest against natural aggression, including the fight against drought.Their compounds, due to their physico-chemical characteristics are called volatile organic compounds (VOCs). This term is sometimes also used to describe other compounds, volatile at room temperature and carbon-based, but due to human activity and considered as pollutants, such as petrochemical derivatives in particular.Terpenes, active substances found in essential oils and used for their therapeutic properties are issued at rates that can influence the chemical composition of the atmosphere. It is therefore necessary, as with any treatment, to take into account the tolerance of these natural substances, well studied in more than 1800 items. More than 2000 publications since 1995 have been devoted to pharmacology terpenes: it is mentioned in this study, these anti-inflammatory, decongestant, antiseptic, antiviral, antifungal, anti-parasitic, mucolytics, bile ducts, healing. Biological effects of essential oils are validated by many reliable and serious studies, as also are well documented data of toxicity and tolerance.Their use in confined spaces and domestic, particularly in low doses, would be of great interest especially for their antimicrobial effects, namely virucidal, bactericidal and fungicidal.In the current state of scientific knowledge, the benefit/risk ratio would be more in favor of their use with a good command of the recommendations of doses emitted into the environment.     

Le consultant pour les limitations et les arrêts de traitement en réanimation

In 2005, the French law about patients?? rights at end of life ratified that the decisions of withdrawing/withholding life-sustaining treatments must be undertaken by the physicians in charge of the patient, after obtaining the advice of an outboard consulting colleague. The purpose of this text is to put forward the perspective of the ethical committee of the French Society of Intensive Care Medicine regarding the role of this consulting physician and to propose guidelines to help choosing him (her).     

Monitorage de la saturation de pouls : intérêts et limites

Pulse oximetry is a standard monitoring device in intensive care and post-anesthesia care units, currently used to guide therapeutic interventions. Nevertheless, the accuracy of pulse oximetry in critical care patients has been poorly studied, and no beneficial effect on morbidity or mortality has been demonstrated. The cost-effectiveness of oximeters has also not been demonstrated. Conversely, several studies showed that the agreement between pulse oximetry and the arterial oxygen saturation, although within the limits ensured by the manufacturers, may not be clinically sufficient, especially in the most unstable patients. Thus, the clinicians should be aware of the advantages and limits of the pulse oximetry, to use it carefully and to avoid unrecognised hypoxemia associated with low SpO₂ targets.     

L’isolement en réanimation : intérêts,limites, perspectives

Contact isolation of patients carrying or infected with multidrug-resistant bacteria in the intensive care unit is a routine policy, usually promoted by the scientific societies. Its purpose is to limit and control the spread of multidrugresistant bacteria. These measures are expensive and sometimes difficult to apply in the endemic situation of France. They should certainly not be abandoned but considered in regards to the local epidemiology and the level of compliance with standard precautions in each unit. There are numerous ethical problems, other psychological consequences, and adverse effects due to contact isolation and cohorting, which should be known and considered for the balance of collective risk versus individual benefit.     

Enjeux et intérêts de l’épreuve d’effort cardiorespiratoire en transplantation hépatique

Cardiopulmonary exercise testing (CPET), used for a long time in cardiology and pulmonology, can provide interesting data for liver transplanted patients. Due to its dynamic and systemic nature, CPET allows to integrate the analysis of cardiovascular, respiratory, and muscle changes to exercise as well as to assess patient’s functional status. CPET also offers the opportunity to objectively set up a therapeutic or training program. To date, several studies have shown that the cirrhotic patient’s aerobic capacity is impaired, with a major risk for post-transplantation survival. The American College of Cardiology did not establish specific recommendations for the pre-operative cardiovascular assessment of liver transplant candidates. Therefore, even if CPET can provide useful data both during pre-transplant assessment and transplanted patients’ monitoring, most transplantation centres do not regularly use this method. The purpose of this review is to discuss important practical issues such as safety, feasibility, and usefulness of CPET in order to answer practitioner’s concerns regarding the opportunities and modalities for the evaluation of the capacity to exercise in liver transplantation.     

Biais attentionnel chez le patient douloureux chronique. Nature, évaluation et intérêts clinique et thérapeutique

The hypervigilance, the focus, the avoidance are a part of the vocabulary used by the clinician who takes care of the chronic pain. These notions are well known in cognitive psychology and correspond to the functioning and to the dysfunction to the selective attention. The objective of this article is to be interested in these attentional processes implied in the chronic pain by attempting to specify their nature (what attentional component?), the experimental paradigms allowing to estimate them (method, result and interpretation) and finally, by discussing their main implications (clinical and therapeutic).     

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.     

Infirmiers ressource douleur et pratiques avancées : mythe ou réalité ?

The organization of care offered is currently under review in view of the combined effects of the increased demand for care, the changing needs and expectations of the population, medical scarcity and growing economic pressure. The emergence of diseases linked to ageing, the development of chronic illnesses and the current public health issues call for the development of new support involving the redefinition of the outlines of the health professions. Pain, particularly when it is chronic, has become a national priority since the end of the 1990s. Health establishments must make every effort in order to manage pain. Pain Resource Nurses have developed new skills in the assessment and treatment of pain and/or in a cross-functional mission. Can these new skills be considered as advanced practices? Can the recognition of advanced nursing practice in the field of pain lead to the development of a new job, with a new professional identity?     

Les huiles végétales, intérêt diététique et gastronomique

Vegetable oils display different nutritional and organoleptic qualities depending on the way they are processed (virgin or refined oils) and on their fatty acid profile. Their diversified consumption, that is the way they should be used and preserved, allows both fatty acid balance and gourmet pleasure expectations to be met.     

Le point sur l’évolution de la jurisprudence

Acta Endoscopica - Bien que l’obligation de moyen qui s’impose aux médecins depuis l’arrêt Mercier du 20 mai 1936 ne soit pas fondamentalement remise en cause, il...