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Infrasound detections of Mediterranean cyclones known as medicanes (for « Mediterranean hurricanes ») are demonstrated in low- and high- frequency ranges, respectively. We summarize the main findings of a recently published study [1]. We use data from the infrasound station IS48 of the International Monitoring System, in Tunisia, to investigate the infrasound signatures of these meso-cyclones, using a multi-channel correlation algorithm. We discuss cases of detections and non-detections, based on the state of the middle atmosphere and of the wind noise measured at the station. Detections and likely sources are discussed in light of other datasets, comprising satellite observations of deep convection [2] and cloud-to-ground lightning detections from a ground-based network. Detections of infrasound emitted by the cyclone-related swell are modelled using a microbarom source model [3] and are in agreement with observations, comforting the identification of the lower frequency sources. This multi-technology and modelling approach allows to discuss the various sources at plat that may contribute to the monitoring of such extreme meteorological events.[1] Listowski, C.; Forestier, E.; Dafis, S.; Farges, T.; De Carlo, M.; Grimaldi, F.; Le Pichon, A.; Vergoz, J.; Heinrich, P.; Claud, C. Remote Monitoring of Mediterranean Hurricanes Using Infrasound. Remote Sens. 2022, 14, 6162. https://doi.org/10.3390/rs14236162[2] Dafis, S.; Claud, C.; Kotroni, V.; Lagouvardos, K.; Rysman, J. Insights into the convective evolution of Mediterranean tropical-like cyclones. Q. J. R. Meteorol. Soc. 2020, 146, 4147–4169.[3] De Carlo, M.; Accensi, M.; Ardhuin, F.; Le Pichon, A. ARROW (AtmospheRic InfRasound by Ocean Waves): A new real-time product for global ambient noise monitoring. In Proceedings of the EGU General Assembly 2022, Vienna, Austria, 23–27 May 2022

International audience; Background: Ventilator-associated pneumonia (VAP) is the most frequent health care-associated infection in severely ill patients, and aspiration of contaminated oropharyngeal content around the cuff of the tracheal tube is the main route of contamination.Research question: Is continuous regulation of tracheal cuff pressure using a pneumatic device superior to manual assessment three times daily using a portable manometer (routine care) in preventing VAP in patients with severe trauma?Study design and methods: In this open-label, randomized controlled superiority trial conducted in 13 French ICUs, adults (age ≥ 18 years) with severe trauma (Injury Severity Score > 15) and requiring invasive mechanical ventilation for ≥ 48 h were enrolled. Patients were randomly assigned (1:1) via a secure Web-based random number generator in permuted blocks of variable sizes to one of two groups according to the method of tracheal cuff pressure control. The primary outcome was the proportion of patients developing VAP within 28 days following the tracheal intubation, as determined by two assessors masked to group assignment, in the modified intention-to-treat population. This study is closed to new participants.Results: A total of 434 patients were recruited between July 31, 2015, and February 15, 2018, of whom 216 were assigned to the intervention group and 218 to the control group. Seventy-three patients (33.8%) developed at least one episode of VAP within 28 days following the tracheal intubation in the intervention group compared with 64 patients (29.4%) in the control group (adjusted subdistribution hazard ratio, 0.96; 95% CI, 0.76-1.20; P = .71). No serious adverse events related to the use of the pneumatic device were noted.Interpretation: Continuous regulation of cuff pressure of the tracheal tube using a pneumatic device was not superior to routine care in preventing VAP in patients with severe trauma.Clinical trial registration: ClinicalTrials.gov; No.: NCT02534974; URL: www.clinicaltrials.gov.

Introduction La pose sous controle echographique des catheters veineux centraux fait maintenant partie des recommandations. Elle permet de diminuer les echecs, d’obtenir un acces veineux plus rapide et de reduire les complications. L’echographie peut permettre egalement la verification de la bonne position et de l’absence de complications. L’objectif de l’etude SUBGEUS etait de comparer une technique tout echographique (pose et controle) versus le standard (reperage cutane et radiographique), pour evaluer le temps de pose de catheters sous-claviers et leur verification. Materiel et methodes Etude monocentrique, randomisee, controlee et approuvee par le comite d’ethique de Clermont-ferrand ayant inclus 300 patients necessitant la pose d’un catheter central sous-clavier, randomises dans deux groupes : « tout » echographie ECHO ou standard STD. Le critere de jugement principal etait le temps entre le debut de la procedure jusqu’a la verification du catheter. Les criteres de jugement secondaires etaient : le temps des differentes etapes de la procedure, la survenue de complications (pneumothorax, hematome, ponction arterielle), les malpositions, le taux d’echec (> 2 ponctions), le nombre de ponctions. Differents temps etaient evalues : T0 = desinfection, T1 = ponction, T2 = retour de sang, T3 = pansement colle, T4 = verification faite, T5 = correction faite si besoin. Resultats Cent cinquante catheters ont ete mis en place dans chaque groupe. L’âge, le BMI, le ratio homme/femme, le SOFA, l’IGS II, le cote de pose n’etaient pas differents. L’echographie a permis de reperer 10 cas de thromboses. Le temps total median de la procedure T0–T4 etait plus court dans le groupe ECHO (1064 [840–1350] vs 1345 [1065–1730] s, p = 0,0001). Les temps (en secondes) etaient pour ECHO/STD : T0-T1 (310 [213–400] vs 205 [138–255], p = 0,0001), T1–T2 (100 [55–222] vs 67 [25–145], p = 0,0005), T2–T3 (310 [245–394] vs 278 [194–373], p = 0,01), T3–T4 (292 [190–397] vs 672 [510–987], p = 0,001). Le taux d’echec n’etait pas significativement different entre les deux groupes (ECHO = 16 % vs STD = 19 % ; p = 0,54). Il n’existait pas de difference significative entre le nombre de ponctions (ECHO 1,6 ± 1,5 vs STD 1,8 ± 1,6, p = 0,28), et les malpositions (ECHO = 20 vs STD = 22, p = 0,74). Ont ete constates : 0 pneumothorax, 8 ponctions arterielles (5 ECHO, 3 STD, p = 0,72), 13 hematomes (8 ECHO, 5 STD, p = 0,57). Pour 11 cas, la radiographie pulmonaire permettait d’objectiver une malposition non detectee par l’echographie. Discussion Les premieres analyses de cette RCT montrent une diminution du temps total de procedure (pose + controle) avec un temps de ponction plus long mais un temps de controle plus rapide pour la mise en place de catheters veineux sous-claviers. Le taux d’echec et le nombre de malpositions ne sont pas differents. Neanmoins, la recherche de malpositions par l’echographie peut etre rendue difficile par une mauvaise echogenicite en regard de l’oreillette droite, la difficulte d’identifier un flux turgescent lors de l’epreuve de contraste et des malpositions au niveau des confluents veineux. L’echographie a permis de detecter une thrombose dans 7 % des cas.

Background Central venous catheters play an important role in patient care. Real-time ultrasound-guided subclavian central venous (SCV) cannulation may reduce the incidence of complications and the time between skin penetration and the aspiration of venous blood into the syringe. Ultrasonic diagnosis of catheter misplacement and pneumothorax related to central venous catheterization is rapid and accurate. It is unclear, however, whether ultrasound real-time guidance and examination can reduce procedure times and complication rates when compared with landmark guidance and radiographic examination for SCV catheterization. Methods/Design The Subclavian Central Venous Catheters Guidance and Examination by UltraSound (SUBGEUS) study is an investigator-initiated single center, randomized, controlled two-arm trial. Three hundred patients undergoing SCV catheter placement will be randomized to ultrasound real-time guidance and examination or landmark guidance and radiographic examination. The primary outcome is the time between the beginning of the procedure and control of the catheter. Secondary outcomes include the times required for the six components of the total procedure, the occurrence of complications (pneumothorax, hemothorax, or misplacement), failure of the technique and occurrence of central venous catheter infections. Discussion The SUBGEUS trial is the first randomized controlled study to investigate whether ultrasound real-time guidance and examination for SCV catheter placement reduces all procedure times and the rate of complications. Trial registration ClinicalTrials.gov Identifier: NCT01888094

Background: patients scheduled for colorectal surgery have a perioperative morbidity higher of 30 %. Reducing opioids is the main part of postoperative rehabilitation. Opioid free anesthesia (OFA) tends to expand using adrenergic α2 agonist such as cloninide. Haemodynamic tolerance brakes wide utilisation. Materials and methods: ACCRA is a retrospective observational study looking at patients who undergone scheduled colorectal laparoscopic surgery between april 2019 and april 2020. Main criterion was the analyse of haemodynamic tolerance, of patients which benefit clonidine based OFA protocol. Others criterions was post operative haemodynamic tolerance, sympathic bloc quality along anesthesia, anesthetics and analgesics drugs doses, lenghts of stay, post operative complications before the 7th day and analyse of patients who had conversion to laparotomy. Results: 114 patients had a scheduled colo-rectal surgery durind the study period. 42 had the unit OFA protocol ; 48 % had a significative haemodynamic event. Among 13 patients who hadn’t the unit OFA protocol, 38 % had a significative haemodynamic event. Conclusion: clonidine based OFA bring significative haemodynamic events ; a randomised trial comparing clonidine based OFA with multimodal opioid sparing anesthesia is needed to detect a haemodynamic over-risk and precise rehabilitation benefits.; Introduction : les patients opérés de chirurgie colo-rectale programmée ont une morbidité péri-opératoire supérieure à 30%. L’épargne des morphiniques est au coeur de la réhabilitation post opératoire. L’anesthésie sans morphinique (OFA) tend à se développer avec les agonistes α2 adrénergiques comme la clonidine. La tolérance hémodynamique de ces molécules freine leur utilisation. Matériels et méthodes : ACCRA est une étude rétrospective observationnelle s’intéressant aux patients opérés de chirurgie colorectale programmée par coelioscopie entre avril 2019 et avril 2020. L’objectif principal était d’analyser la tolérance hémodynamique des patients ayant bénéficiés d’un protocole d’OFA basé sur la clonidine. Les objectifs secondaires étaient la tolérance hémodynamique post opératoire, la qualité du bloc sympathique per anesthésique, les doses de drogues anesthésiques et antalgiques utilisées, les durées de séjour patient, les complications avant le 7e jour post opératoire et l’analyse des conversions en laparotomie. Résultats : 114 patients ont été opérés de chirurgie colorectale programmée sur la période d’étude ; 42 ont bénéficiés du protocole OFA du service. 48% des patients ont eu au moins un événement hémodynamique significatif. Parmi les 13 patients n’ayant pas bénéficié du protocole OFA, la proportion est de 38%. Conclusion : L’OFA à base de clonidine est à risque d’évènements hémodynamiques ; une étude randomisée comparant cette technique, à une anesthésie avec épargne morphinique multimodale, serait nécessaire pour détecter un éventuel sur-risque hémodynamique et pour préciser les bénéfices en terme de réhabilitation.