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Objective: To describe the use of lung ultrasound in clinical practice and the new opportunities offered by this technology in intensive care unit (ICU) patients., Method: Review of signs identified by lung ultrasound and systematic analysis of data published within the last 5 years on its use in ICU. The literature has been extracted from the database Pubmed™. Specific keywords were used to select relevant publications. Clinical studies published in French and English languages were assessed., Results: Lung ultrasound serves to diagnose, quantify, drain and monitor pleural effusions. In patients with acute respiratory failure, lung ultrasound participates to the diagnosis, the implementation of treatments and their follow-up. It helps to manage patients with pneumonia and acute lung injury. Finally, the investigation of the interstitial edema brings information about hemodynamics that can serve to manage our patients., Conclusion: Lung ultrasound is an easy, non-invasive, and non-irradiant technology. It brings lot of useful information at the patient's bedside., (Copyright © 2012 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

Objective: This review discusses variability among patients in anesthesia, due to genetic polymorphisms., Data Sources: Articles in French and English languages were retrieved from PubMed database. The initial request was "anesth* and (genotyp* or polymorphism* or genetic*)"., Study Selection: Original articles, general reviews and one case report. Letters were excluded., Data Extraction: Rare genetic diseases were excluded from the scope of this review. We stressed on frequent genetic polymorphisms that may have a daily impact in anesthesiology., Data Synthesis: Most results were related to pain studies. We selected various examples to describe how genetic polymorphisms impacts the pharmacology of a given drug, and what are the clinical consequences., Conclusion: There is a growing field of pharmacogenetic related evidences in anesthesiology. The results from various animal and human studies underline the genetic origin of variability among individuals. How anaesthesists have to integrate these parameters for their daily practice is still unclear, but pharmacogenetic will obviously be a leading field of anesthesia research in the future.

Objectives: The aims of this review are to point out the determinants of oxygen saturation of the haemoglobin of mixed venous blood (SvO(2)), to specify the correlations existing between SvO(2) and central venous saturation in superior vena cava (ScvO(2)), to determine and finally to locate the current place of venous oximetry in clinical practice., Data Sources: A PubMed database research in English and French languages published until December 2006. The keywords were mixed venous blood oxygen saturation; oxygen consumption; oxygen delivery; oxygen extraction; tissue hypoxia; central venous oxygen saturation., Data Extraction: Data in selected articles were reviewed, clinical and basic science research relevant information was extracted., Data Synthesis: The SvO(2) reflects the peripheral extraction of oxygen (O(2)), O(2) delivery and consumption. Its value is related to four determinants: the O(2) consumption (VO(2)), cardiac flow (CF), haemoglobin level (Hb) and O(2) saturation of the haemoglobin of arterial blood (SaO(2)). ScvO(2) is more easily measurable than SvO(2). Under physiological conditions its value is 2 to 3% lower than that of SvO(2). In the critically ill patient, its value is 5% higher than that SvO(2). In most patients, changes in ScvO(2) values parallel those in SvO(2). The clinical interest of the monitoring of venous oximetry was underlined in cases of severe sepsis and septic shock, and during the perioperative period of major surgery., Conclusion: The management of patients in critical states with therapeutic goals integrating the monitoring of venous oximetry may reduce the morbidity and mortality of patients undergoing major surgery or hospitalised in the intensive care unit.

One of the goals of the medical management of head injured patients is to get a cerebral perfusion pressure between 60 and 70 mmHg. To reach such a goal, catecholamines are used after fluid challenge. Systemic effects of catecholamines depend on their affinity for the receptors alpha and beta. The topical application of norepinephrine (alpha predominant) induced a vasoconstriction on large cerebral arteries only. Cerebral blood flow increased in the pericontusionnal area, suggesting a loss of autoregulation. The topical application of dopamine at low concentration relaxed large cerebral arteries. Dopamine increased cerebral blood flow in the pericontusional area but data suggest a possible raise in the volume of contusion. Four human comparative studies have been published. The first study, which was not randomized, showed an intracranial pressure increase associated with dopamine. Two randomized clinical trials, published by the same group, demonstrated a better predictability with norepinephrine. The fourth study did not find any difference regarding cerebral haemodynamics. In conclusion, the quality of data on the effects of catecholamines on cerebral haemodynamics of head injured patients do not make it possible to conclude about their use.

Objectives: To study the efficacy of selective digestive decontamination (SDD) for the prevention of nosocomial infections, particularly pneumonia, as well as its impact on the emergence of multiresistant bacteria., Data Sources: Data collected from the Pubmed: original articles, review articles and editorial published on SDD. The keywords were: selective digestive decontamination, pneumonia, intensive care unit, infection., Data Selection: Ten randomized clinical trials performed since 1995 in mechanically ventilated adult patients hospitalized in intensive care unit., Results: The rationale for the use of SDD consists on the parenteral administration of a short course of antibiotic associated with the topical use of non-absorbable antibiotics directed against Gram negative bacteria. Five randomized studies described a reduction in the incidence of pneumonia associated with SDD. Only one study has showed a decrease in mortality rate. The other five studies, which present some methodological limitations, concluded the lack of efficacy of SDD. Regarding the emergence of multiresistant bacteria, the literature underlines the role of environment. The use of SDD seems to trigger the resistance in endemic areas, while these are softened in the units with a good control of their ecology., Conclusion: The data from the literature provide arguments to use SDD in targeted patient populations like multiple traumas in intensive care units, which have a low rate of multiresistant bacteria.