OBJECTIVES: To examine the effects of prone positioning on venous return and its determinants such as mean systemic pressure and venous return resistance in patients with acute respiratory distress syndrome. DESIGN: Prospective monocentric study. SETTINGS: A 25-bed medical ICU. PATIENTS: About 22 patients with mild-to-severe acute respiratory distress syndrome in whom prone positioning was decided. INTERVENTIONS: We obtained cardiac index, mean systemic pressure, and venous return resistance (the latter two estimated through the heart-lung interactions method) before and during prone positioning. Preload responsiveness was assessed at baseline using an end-expiratory occlusion test. MEASUREMENTS AND MAIN RESULTS: Prone positioning significantly increased mean systemic pressure (from 24 mm Hg [19–34 mm Hg] to 35 mm Hg [32–46 mm Hg]). This was partly due to the trunk lowering performed before prone positioning. In seven patients, prone positioning increased cardiac index greater than or equal to 15%. All were preload responsive. In these patients, prone positioning increased mean systemic pressure by 82% (76–95%), central venous pressure by 33% (21–59%), (mean systemic pressure – central venous pressure) gradient by 144% (83–215)%, while it increased venous return resistance by 71% (60–154%). In 15 patients, prone positioning did not increase cardiac index greater than or equal to 15%. In these patients, prone positioning increased mean systemic pressure by 28% (18–56%) ( p < 0.05 vs. patients with significant increase in cardiac index), central venous pressure by 21% (7–54%), (mean systemic pressure – central venous pressure) gradient by 28% (23–86%), and venous return resistance by 37% (17–77%). Eleven of these 15 patients were preload unresponsive. CONCLUSIONS: Prone positioning increased mean systemic pressure in all patients. The resulting change in cardiac index depended on the extent of increase in (mean systemic pressure – central venous pressure) gradient, of preload responsiveness, and of the increase in venous return resistance. Cardiac index increased only in preload-responsive patients if the increase in venous return resistance was lower than the increase in the (mean systemic pressure –central venous pressure) gradient.
Long-term health-related quality of life (HR-QOL) of patients surviving the acute phase of purpura fulminans (PF) has not been evaluated.This was a French multicenter exposed-unexposed cohort study enrolling patients admitted in 55 intensive care units (ICUs) for PF from 2010 to 2016. Adult patients surviving the acute phase of PF (exposed group) were matched 1:1 for age, sex, and Simplified Acute Physiology Score II with septic shock survivors (unexposed group). HR-QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36) questionnaire, the Hospital Anxiety and Depression (HAD) scale, the Impact of Event Scale-Revised (IES-R), and the activity of daily living (ADL) and instrumental ADL (IADL) scales. The primary outcome measure was the physical component summary (PCS) of the SF-36 questionnaire.Thirty-seven survivors of PF and 37 of septic shock were phone-interviewed at 55 (interquartile range [IQR], 35-83) months and 44 (IQR, 35-72) months, respectively, of ICU discharge (P = .23). The PCS of the SF-36 was not significantly different between exposed and unexposed patients (median, 47 [IQR, 36-53] vs 54 [IQR, 36-57]; P = .18). There was also no significant difference between groups regarding the mental component summary of the SF-36, and the HAD, IES-R, ADL and IADL scales. Among the 37 exposed patients, those who required limb amputation (n = 12/37 [32%]) exhibited lower PCS (34 [IQR, 24-38] vs 52 [IQR, 42-56]; P = .001) and IADL scores (7 [IQR, 4-8] vs 8 [IQR, 7-8]; P = .021) compared with nonamputated patients.Long-term HR-QOL does not differ between patients surviving PF and those surviving septic shock unrelated to PF. Amputated patients have an impaired physical HR-QOL but a preserved mental health.NCT03216577.
Le 25 novembre dernier, s’est tenu dans l’hémicycle du Conseil Economique, Social et Environnemental (CESE) un colloque portant sur l’ingénierie numérique organisé conjointement par l’Académie des Technologies, le Conseil Economique, Social et Environnemental (CESE) et le Conseil Général de l’Industrie, de l’Energie et des Technologies (CGIET). Le sous-titre Entre ruptures technologiques et progrès économique et sociétal donné à cet événement attirait d’emblée l’attention des participants sur l’ambition de cette journée de réflexion et sur l’ampleur des enjeux soulevés par ce qui aurait pu être perçu comme une discipline d’ingénieur parmi d’autres.
This work presents refined, updated subregional and regional non-indigenous species (NIS) inventories for the Mediterranean Sea, validated by national and taxonomic experts, with species records observed until December 2020. These datasets will be used as the baselines for the implementation of the Integrated Monitoring and Assessment Programme for the Mediterranean (IMAP) and the Mediterranean Quality Status Report 2023. In total, 1006 non-indigenous species have been found in Mediterranean marine and brackish waters. The highest numbers of NIS were observed in Israel, Türkiye, Lebanon and Italy. Approximately 45 species were categorized as data deficient, either due to lack of consensus on their alien status or the validity of their identification. Polychaeta, Foraminifera and macroalgae were the groups with the highest numbers of controversial species. There was a general increase in the yearly rate of new NIS introductions after the late 1990s, which appears to be slowing down in the last decade, but this may be confounded by reporting lags and differential research efforts. Between 1970 and 2020 there has been a steep increase in the proportion of shared species present throughout all four Mediterranean subregions, which are predominantly transported via shipping and recreational boating. While Lessepsian species are gradually spreading westwards and northwards, there is still a considerable invasion debt accumulating in the eastern and central Mediterranean.
Dans un contexte de gestion des systemes cotiers, l'approche developpee dans cette etude -associer un suivi des parametres environnementaux avec celui des peuplements pelagiques et benthiques- permet d'apprehender le fonctionnement global de l'ecosysteme. La veille ecologique menee depuis plus de 20 ans en rade de Brest a fait apparaitre un nouveau risque ecologique (et economique): la proliferation d'un filtreur benthique exotique, competiteur potentiel de la coquille Saint-Jacques, la crepidule Crepidula fornicata (L.). Ses mecanismes de proliferation etaient encore inconnus en rade, notamment concernant l'acceleration recente (15-20 ans) du processus. L'approche multidisciplinaire de ce travail permet d'etudier les mecanismes d'adaptation et de regulation naturelle de la crepidule en rade de Brest face aux fluctuations naturelles de l'environnement (hydroclimat) et aux perturbations anthropiques (eutrophisation...) et d'identifier ses impacts sur le fonctionnement de l'ecosysteme. Les causes de la proliferation actuelle de la crepidule en rade et ses impacts sur la structuration et le fonctionnement de l'ecosysteme ont ete precises : les filtreurs exercent un retro-controle de la production primaire (filtration, biodepositions). L'analyse des conditions favorables a la proliferation de la crepidule a montre la place importante prise par cette espece dans l'ecosysteme et a permis de mieux apprehender les processus d'evolution de son aire de repartition et de son stock. La description realisee des peuplements benthiques soumis a cette invasion constitue un etat de reference de la megafaune de la rade en 2000. Les impacts de la crepidule sur l'ecosysteme (colonne d'eau, sediment, biocenoses) ont ete precises. Des evolutions futures sont envisagees et des recommandations sont faites pour en limiter l'extension et perenniser la pecherie de coquilles Saint-Jacques en rade de Brest. Des perspectives sont proposees dans le cadre de la gestion integree de cet ecosysteme.
