Éditeur(s) : HAL CCSD
Résumé : International audience
BACKGROUND: The effects of pressure-controlled (PC) ventilation on the ventilatory and haemodynamic parameters during laparoscopy procedures had not been carefully assessed. This prospective cross-over study was undertaken to compare how volume-controlled (VC) and PC modes could affect pulmonary mechanics, gas exchange, and cardiac function in patients undergoing laparoscopy. METHODS: Twenty-one patients undergoing laparoscopic urological procedures had their lungs ventilated at the beginning with VC ventilation. PC ventilation was instituted at the end of the VC sequence. Ventilator settings were adjusted to keep tidal volume, respiratory rate, and Fi(o(2)) constant in every mode. A complete set of ventilatory, haemodynamic, and gas exchange parameters was obtained under VC after 40 min of pneumoperitoneum and 20 min after switching for PC. Transoesophageal echocardiography was performed in order to evaluate systolic and diastolic function of the heart. RESULTS: When VC was switched to PC, peak airway pressure decreased [mean (sd) 32 (6) vs 27 (6) cm H(2)O; P < 0.0001], peak inspiratory flow increased [17 (3) vs 48 (8) litre min(-1); P < 0.0001), and dynamic compliance improved [+15 (8)%]. No difference was noted for static airway pressure, static compliance, and arterial oxygenation. No significant change could be demonstrated in the systolic [left ventricular end-systolic wall stress 66 (16) vs 63 (14) x 10(3) dyn cm(-2) m(-2)] or diastolic function [early diastolic velocity 10.3 (2.5) vs 10.5 (2.7) cm s(-1)]. CONCLUSIONS: In this study, no short-term beneficial effect of PC ventilation could be demonstrated over conventional VC ventilation in patients with pneumoperitoneum.
BJA

hal-00689758
https://hal.archives-ouvertes.fr/hal-00689758
DOI : 10.1093/bja/aem166
PUBMED : 17626027

Éditeur(s) : HAL CCSD
Résumé : International audience
To determine whether exercise modality affects arterial hypoxemia (EIAH) during training-intensity exercise, 13 triathletes performed 20 min of cycling (C) followed by 20 min of running (R): C-R, and two weeks later, 20 min of R followed by 20 min of C:R-C. Each trial was performed at an intensity slightly above the ventilatory threshold and close to the daily training intensity (75 % of VO2max). Ventilatory data were collected continuously using an automated breath-by-breath system. Partial pressure of oxygen in arterial blood (PaO2) was measured after each C and R segment and arterial oxyhemoglobin saturation (SpO2) was monitored continuously via pulse oximetry. The metabolic rate was similar across modalities and trials, i.e., C-R (53.8 +/- 3.8 vs. 51.1 +/- 5.3 ml.min(-1).kg(-1)) and R-C (52.2 +/- 4.5 vs. 53.2 +/- 4.6 ml.min(-1).kg (-1)). EIAH showed significantly greater severity for R compared to C irrespective of the order (p < 0.05 for both trials). R values of PaO2 (and SpO2) for C-R and R-C were 88.7 +/- 6.0 mm Hg (93.0 +/- 0.6 % SpO2) and 86.6 +/- 7.3 mm Hg (93.5 +/- 0.6 % SpO2) and C values were 93.7 +/- 8.4 mm Hg (95.4 +/- 0.4 % SpO2) and 91.4 +/- 5.4 mm Hg (94.8 +/- 0.3 % SpO2). R ventilatory data described a significantly different breathing pattern than C, with higher respiratory rate (35.9 b.min(-1) vs. 51.1 b.min(-1) for C-R, p < 0.01; and 50.0 b.min(-1) vs. 41.5 b.min(-1) for R-C, p < 0.01) and lower tidal volume (2636 ml vs. 2282 ml for C-R, p < 0.02 and 2272 ml vs. 2472 ml for R-C, p < 0.05). We concluded that EIAH was greater during running than cycling for a similar metabolic rate corresponding to training intensity and that EIAH could thus be considered dependent on exercise modality.
Internation Journal of Sports Medicine

hal-00720806
https://hal.univ-antilles.fr/hal-00720806
https://hal.univ-antilles.fr/hal-00720806/document
https://hal.univ-antilles.fr/hal-00720806/file/sm290.pdf

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : International audience
Alveolar proteinosis (AP) is a rare disease characterized by alveolar accumulation of surfactant components, which impairs gas exchange. AP is classified into three groups: auto-immune AP defined by the presence of plasma autoantibodies anti-GM-CSF, the most frequent form (90 % of all AP); secondary AP, mainly occurring as a consequence of haematological diseases, or following on from toxic inhalation or infections, and genetic AP, which affects almost exclusively children. AP diagnosis is suspected where chest CT-scan demonstrates interstitial lung disease with a crazy paving aspect; and confirmed by bronchoalveolar lavage, which has a milky appearance and contains periodic acid Schiff positive proteinaceous alveolar deposits. The use of surgical lung biopsy to confirm AP is less frequent nowadays. In this context, positive antibodies against GM-CSF indicates an auto-immune etiology of the AP. Concerning management, whole lung lavage is the gold standard therapy. In refractory AP, new treatments are available such as subcutaneous or inhaled GM-CSF supplementation, or rituximab infusions. The clinical course is unpredictable. Spontaneous improvement or even cure can occur, and the 5-year actuarial survival is 95 %. The most frequent complications are infectious etiology.
La protéinose alvéolaire pulmonaire (PAP) est une maladie rare caractérisée par l’accumulation alvéolaire de composants du surfactant qui gêne les échanges gazeux. Les PAP sont séparées en trois groupes : les PAP auto-immunes caractérisées par la présence d’anticorps sériques anti-GM-CSF qui sont les plus fréquentes ; les PAP secondaires à une maladie sous-jacente, le plus souvent hématologique, mais aussi à l’inhalation de toxiques et à des infections ; enfin, les PAP d’origine génétique. Le diagnostic de PAP est évoqué sur le scanner thoracique avec une pneumopathie infiltrante diffuse ayant un aspect classique de crazy paving, puis confirmé par l’aspect laiteux du lavage bronchoalvéolaire, et la présence de matériel lipoprotéinacé PAS positif. La confirmation du diagnostic de PAP par biopsie pulmonaire chirurgicale est désormais rarement nécessaire. La positivité des anticorps sériques anti-GM-CSF signe le caractère auto-immun de la maladie. Le traitement de référence des PAP auto-immunes est le « grand lavage pulmonaire thérapeutique ». En cas de maladie réfractaire, d’autres traitements sont disponibles, tels que le GM-CSF en injection sous-cutanée ou en aérosol et le rituximab. L’évolution de la maladie est imprévisible. Une évolution spontanément favorable ou même une guérison spontanée peuvent survenir et la survie actuarielle à 5 ans est de 95 %. Les principales complications sont infectieuses.
ISSN: 0761-8425

hal-01085907
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01085907
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01085907/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01085907/file/Prot%C3%A9inose%20alv%C3%A9olaire%20pulmonaire_accepted.pdf
DOI : 10.1016/j.rmr.2014.08.009