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Continuous monitoring of cerebral oxygenation is one of the diagnostic tools used in patients with brain injury. Direct and invasive measurement of cerebral oxygenation with a partial brain oxygen pressure (PbtOThis retrospective study was performed in a neurocritical care unit. Study participants underwent hourly PbtOFifty-one patients with subarachnoid hemorrhage were included. A total of 3362 simultaneous NIRS and PbtOPbtO

Supplemental Digital Content is available in the text., Long-term blood pressure variability (BPV), an increasingly recognized vascular risk factor, is challenging to analyze. The objective was to assess the impact of BPV modeling on its estimated effect on the risk of stroke. We used data from a secondary stroke prevention trial, PROGRESS (Perindopril Protection Against Stroke Study), which included 6105 subjects. The median number of blood pressure (BP) measurements was 12 per patient and 727 patients experienced a first stroke recurrence over a mean follow-up of 4.3 years. Hazard ratios (HRs) of BPV were estimated from 6 proportional hazards models using different BPV modeling for comparison purposes. The 3 commonly used methods first derived SD of BP measures observed over a given period of follow-up and then used it as a fixed covariate in a Cox model. The 3 more advanced modeling accounted for changes in BP or BPV over time in a single-stage analysis. While the 3 commonly used methods produced contradictory results (for a 5 mmHg increase in BPV, HR=0.75 [95% CI, 0.68–0.82], HR=0.99 [0.91–1.08], HR=1.19 [1.10–1.30]), the 3 more advanced modeling resulted in a similar moderate positive association (HR=1.08 [95% CI, 0.99–1.17]), whether adjusted for BP at randomization or mean BP over the follow-up. The method used to assess BPV strongly affects its estimated effect on the risk of stroke, and should be chosen with caution. Further methodological developments are needed to account for the dynamics of both BP and BPV over time, to clarify the specific role of BPV.

Background Dynamic arterial elastance (Eadyn), defined as the ratio between pulse pressure variations and stroke volume variations, has been proposed to assess functional arterial load. We evaluated the evolution of Eadyn during volume expansion and the effects of neosynephrine infusion in hypotensive and preload-responsive patients. Methods In this prospective bicentre study, we included 56 mechanically ventilated patients in the operating room. Each patient had volume expansion and neosynephrine infusion. Stroke volume and stroke volume variations were obtained using esophageal Doppler, and pulse pressure variations were measured through the arterial line. Pressure response to volume expansion was defined as an increase in mean arterial pressure (MAP) ≥ 10%. Results Twenty-one patients were pressure responders to volume expansion. Volume expansion induced a decrease in Eadyn (from 0.69 [0.58–0.85] to 0.59 [0.42–0.77]) related to a decrease in pulse pressure variations more pronounced than the decrease in stroke volume variations. Baseline and changes in Eadyn after volume expansion were related to age, history of arterial hypertension, net arterial compliance and effective arterial elastance. Eadyn value before volume expansion > 0.65 predicted a MAP increase ≥ 10% with a sensitivity of 76% (95% CI 53–92%) and a specificity of 60% (95% CI 42–76%). Neosynephrine infusion induced a decrease in Eadyn (from 0.67 [0.48–0.80] to 0.54 [0.37–0.68]) related to a decrease in pulse pressure variations more pronounced than the decrease in stroke volume variations. Baseline and changes in Eadyn after neosynephrine infusion were only related to heart rate. Conclusion Eadyn is a potential sensitive marker of arterial tone changes following vasopressor infusion.

Background Many maneuvers assessing fluid responsiveness (minifluid challenge, lung recruitment maneuver, end-expiratory occlusion test, passive leg raising) are considered as positive when small variations in cardiac index, stroke volume index, stroke volume variation or pulse pressure variation occur. Pulse contour analysis allows continuous and real-time cardiac index, stroke volume, stroke volume variation and pulse pressure variation estimations. To use these maneuvers with pulse contour analysis, the knowledge of the minimal change that needs to be measured by a device to recognize a real change (least significant change) has to be studied. The aim of this study was to evaluate the least significant change of cardiac index, stroke volume index, stroke volume variation and pulse pressure variation obtained using pulse contour analysis (ProAQT®, Pulsion Medical System, Germany). Methods In this observational study, we included 50 mechanically ventilated patients undergoing neurosurgery in the operating room. Cardiac index, stroke volume index, pulse pressure variation and stroke volume variation obtained using ProAQT® (Pulsion Medical System, Germany) were recorded every 12 s during 15-min steady-state periods. Least significant changes were calculated every minute. Results Least significant changes statistically differed over time for cardiac index, stroke volume index, pulse pressure variation and stroke volume variation (p Conclusion To conclude, the present study suggests that pulse contour analysis is able to detect rapid and small changes in cardiac index and stroke volume index, but the interpretation of rapid and small changes of pulse pressure variation and stroke volume variation must be done with caution.

Background We determined whether an audit on the adherence to guidelines for hospital-acquired pneumonia (HAP) can improve the outcomes of patients in intensive care units (ICUs). Methods This study was conducted at 35 ICUs in 30 hospitals. We included consecutive, adult patients hospitalized in ICUs for 3 days or more. After a 3-month baseline period followed by the dissemination of recommendations, an audit on the compliance to recommendations (audit period) was followed by a 3-month cluster-randomized trial. We randomly assigned ICUs to either receive audit and feedback (intervention group) or participate in a national registry (control group). The primary outcome was the duration of ICU stay. Results Among 1856 patients enrolled, 602, 669, and 585 were recruited in the baseline, audit, and intervention periods, respectively. The composite measures of compliance were 47% (interquartile range [IQR], 38–56%) in the intervention group and 42% (IQR, 25–53%) in the control group (P = .001). As compared to the baseline period, the ICU lengths of stay were reduced by 3.2 days in the intervention period (P = .07) and by 2.8 days in the control period (P = .02). The durations of ICU stay were 7 days (IQR, 5–14 days) in the control group and 9 days (IQR, 5–20 days) in the intervention group (P = .10). After adjustment for unbalanced baseline characteristics, the hazard ratio for being discharged alive from the ICU in the control group was 1.17 (95% confidence interval, .69–2.01; P = .10). Conclusions The publication of French guidelines for HAP was associated with a reduction of the ICU length of stay. However, the realization of an audit to improve their application did not further improve outcomes. Clinical Trials Registration NCT03348579.

International audience; Introduction: The US National Sleep Foundation recommends more than 7 hours of sleep per night for adults. Anaesthesiologists and intensivists (AI) are at high risk of short sleep time. The aim of this present survey was to assess the sleep duration of French AI and to identify independent factors related to a sleep time less than the recommended 7 hours.Methods: This prospective observational study was conducted between April and June 2018 and included 6,210 French AI with night-work obligations. The primary outcome variable was sleep duration strictly inferior to 7 hours per night. The covariables included in the multivariable model were selected after the univariate analysis, with those with a p < 0.05 included in the final model.Results: Of the 6,210 AI, 3,699 responded to the survey, and 2,483 were included in the analysis. Of the 2,483 responders, 1,533 (61.7%) reported sleep duration strictly less than 7 hours per night. After the multivariate analysis, the following risk factors were independently associated with sleep duration strictly under 7 hours: age (OR: 1.28 ; IC [1.19 - 1.37]), more than 5 on-call shifts per month, (OR: 1.41 ; IC [1.30 - 1.50]), active smoking (OR: 1.37 ; IC [1.07 - 1.75]), and screen consultation at bedtime (OR: 1.85 ; IC [1.31 - 2.62]).Conclusion: This study gives a recent overview of sleep time and quality of French AI. It could be a useful tool for monitoring sleep disorders among the practitioners and their impact on quality of life.

End-expiratory occlusion test (EEOT) has been proposed to predict fluid responsiveness in mechanically ventilated intensive care unit patients. The utility of this test during low-tidal-volume ventilation remains uncertain. This study aimed to determine whether hemodynamic variations induced by EEOT could predict the effect of volume expansion in patients with protective ventilation in the operating room.Forty-one patients undergoing neurosurgery were included. Stroke volume and pulse pressure variations were continuously recorded using pulse contour analysis before and immediately after a 30-second EEOT and after volume expansion (250 mL saline 0.9% given over 10 minutes). Patients with an increase in stroke volume ≥ 10% after volume expansion were defined as responders.Twenty patients were responders to fluid administration. EEOT induced a significant increase in stroke volume, which was correlated with the stroke volume changes induced by volume expansion (r = 0.55, P.0001). A 5% increase in stroke volume during EEOT discriminated responders to volume expansion with a sensitivity of 100% (95% confidence interval [CI], 83%-100%), a specificity of 81% (95% CI, 58%-95%), a positive predictive value of 84% (95% CI, 64%-96%), and a negative predictive value of 100% (95% CI, 80%-100%). The gray zone ranged from 4% to 8%, including 17% of patients. The best pulse pressure variation threshold was 9%, with a sensitivity of 60% (95% CI, 36%-81%) and specificity of 86% (95% CI, 64%-97%). The area under the receiver operating characteristics curve generated for changes in stroke volume induced by EEOT (0.91, 95% CI, 0.81-1.00) was significantly higher than the one obtained for pulse pressure variations (0.75, 95% CI, 0.60-0.90); P.05.Changes in stroke volume index induced by EEOT can predict fluid responsiveness in patients with protective ventilation in the operating room. This test may have potential applications.

Background From a physiological viewpoint, changes in end-tidal carbon dioxide (EtCO2) could be a simple, noninvasive, and inexpensive way to monitor changes in cardiac index. This study aimed to assess the utility of changes in EtCO2 as a marker of fluid responsiveness after volume expansion in the operating room. Methods A prospective observational study was conducted in a tertiary university teaching hospital, from August 2018 to February 2019. A total of 109 non-consecutive, mechanically ventilated adults undergoing neurosurgery in the supine position with cardiac output monitors were included. Patients with major respiratory disease, arrhythmia, or heart failure were excluded. Volume expansion with 250 ml of saline 0.9% was performed over 10 min to maximise cardiac output during surgery, according to current guidelines. A positive fluid challenge was defined as an increase in stroke volume index of more than 10% from baseline. Changes in stroke volume index (monitored using pulse contour analysis) and EtCO2 were recorded before and after infusion. Results A total of 242 fluid challenges in 114 patients were performed, of which 26.9% were positive. Changes in EtCO2 > 1.1% induced by infusions had utility for identifying fluid responsiveness, with a sensitivity of 62.9% (95% confidence interval [CI], 62.5–63.3%) and a specificity of 77.8% (95% CI, 77.6–78.1%). The area under the receiver operating characteristic curve for changes in EtCO2 after volume expansion was 0.683 (95% CI, 0.680–0.686). Conclusions Changes in EtCO2 induced by rapid infusion of 250 ml saline 0.9% lacked accuracy for identifying fluid responsiveness in mechanically ventilated patients in the operating room. Clinical trial registration NCT03635307.

International audience; Changes in stroke volume (deltaSV) induced by a lung recruitment manoeuvre (LRM) have been shown to accurately predict fluid responsiveness during protective mechanical ventilation. Cardiac output monitors are used in a limited number of surgical patients. In contrast, all patients are monitored with a pulse oximeter, that may enable the continuous monitoring of a peripheral perfusion index (PI). We postulated that changes in PI (deltaPI) may reflect deltaSV during brief modifications of cardiac preload. We studied 47 patients undergoing neurosurgery and ventilated with a tidal volume of 6-8 ml/kg. All patients were monitored with a pulse contour system enabling the continuous monitoring of SV and with a pulse oximeter enabling the continuous monitoring of PI. LRMs were performed by increasing airway pressure up to 30 cmH20 for 30 s. Fluid loads (250 ml of saline 0.9% in 10 min) were performed only in patients who experienced a deltaSV > 30% during LRMs (potential fluid responders). LRMs induced a 26% decrease in SV (p 30% with a sensitivity of 83% and a specificity of 78% (AUC = 0.84, 95%CI 0.71-0.93). 24 patients experienced a deltaSV > 30% and subsequently received fluid. Fluid loads induced a 16% increase in SV and a 17% increase in PI, but fluid-induced deltaPI and deltaSV were weakly correlated (r2 = 0.19). In neurosurgical patients, we conclude that deltaPI may be used as a surrogate for deltaSV during LRMs but not during fluid loading.

Background The aim of the present study was to explore the relationship between creatinine clearance (ClCr), cardiac index (CI) and renal vascular index (RVI) in order to assess the potential mechanisms driving ARC in critically ill trauma patient. The secondary objective was to assess the performance of RVI for prediction of ARC. Methods Every trauma patient who underwent cardiac and renal ultrasound measurements during their initial ICU management was retrospectively reviewed over a 3-month period. ARC was defined by a 24-hr measured ClCr ≥ 130 mL/min/1.73m2. A mixed effect model was constructed to explore covariates associated with ClCr over time. The performance of RVI for prediction of ARC was assessed by receiver operating characteristic (ROC) curve and compared to the ARCTIC (ARC in trauma intensive care) predictive scoring model. Results Thirty patients, contributing for 121 coupled physiologic data, were retrospectively analysed. There was a significant correlation between ClCr values and RVI (r = −0.495; P = 0.005) but not between ClCr and CI values (r = 0.023; P = 0.967) at day 1. Using a mixed effect model, only age remained associated with ClCr variations over time. The area under the ROC curve of RVI for predicting ARC was 0.742 (95% CI: 0.649–0.834; P Conclusion Ultrasonic evaluation of CI and RVI did not allow approaching the haemodynamic mechanisms responsible for ARC in patients. RVI was inaccurate and not better than clinical score for predicting ARC.

Background Mini-fluid challenge of 100 ml colloids is thought to predict the effects of larger amounts of fluid (500 ml) in intensive care units. This study sought to determine whether a low quantity of crystalloid (50 and 100 ml) could predict the effects of 250 ml crystalloid in mechanically ventilated patients in the operating room. Methods A total of 44 mechanically ventilated patients undergoing neurosurgery were included. Volume expansion (250 ml saline 0.9%) was given to maximize cardiac output during surgery. Stroke volume index (monitored using pulse contour analysis) and pulse pressure variations were recorded before and after 50 ml infusion (given for 1 min), after another 50 ml infusion (given for 1 min), and finally after 150 ml infusion (total = 250 ml). Changes in stroke volume index induced by 50, 100, and 250 ml were recorded. Positive fluid challenges were defined as an increase in stroke volume index of 10% or more from baseline after 250 ml. Results A total of 88 fluid challenges were performed (32% of positive fluid challenges). Changes in stroke volume index induced by 100 ml greater than 6% (gray zone between 4 and 7%, including 19% of patients) predicted fluid responsiveness with a sensitivity of 93% (95% CI, 77 to 99%) and a specificity of 85% (95% CI, 73 to 93%). The area under the receiver operating curve of changes in stroke volume index induced by 100 ml was 0.95 (95% CI, 0.90 to 0.99) and was higher than those of changes in stroke volume index induced by 50 ml (0.83 [95% CI, 0.75 to 0.92]; P = 0.01) and pulse pressure variations (0.65 [95% CI, 0.53 to 0.78]; P < 0.005). Conclusions Changes in stroke volume index induced by rapid infusion of 100 ml crystalloid predicted the effects of 250 ml crystalloid in patients ventilated mechanically in the operating room.

Objective: continuous monitoring of cerebral oxygenation is part of the therapeutic tools for brain damaged patients. Direct and invasive measurement of cerebral oxygenation using a probe (PbtO2) is promising but invasive. A non-invasive evaluation of regional transcranial oxygen saturation using near-infrared spectroscopy (NIRS) may be possible. The aim of this study was to assess the interchangeability between PbtO2 and NIRS over time in brain damaged patients. Methods: this is a retrospective study conducted in the neuro-intensive care unit of Bordeaux University Hospital. Fifty-eight severely brain-injured patients were equipped with a PbtO2 probe and a homolaterally NIRS sensor for simultaneous hourly measurements of PbtO2 and NIRS values for 72 consecutive hours. Measurements and Main Results: a total of 3988 simultaneous measurements of NIRS and PbtO2 was obtained. Point-wise correlation ranged from -0.25 and 0.25. Global correlation over time was 0.013 (p= 0.457). The bivariate linear-mixed model confirmed no significant correlation between the Pbt02 and NIRS follow-up. The concordance rate between rSO2 and PbtO2 was 41.8%. NIRS was not able to detect PbtO2 values less than 20 mmHg (Area Under Receiver Operating curve = 0.537 ([0.534 - 0.539]; p= 0.664) and percentage changes in NIRS was not able to detect a decrease in PbtO2 10% (Area Under Receiver Operating curve = 0.615 [0.614 - 0.616], p < 0.001). Conclusion: PbtO2 and NIRS measurements were not correlated. There is no evidence that NIRS could constitute a substitute for monitoring of PbtO2 at bedside in neurocritical care unit patients.; Introduction : chez les patients cérébrolésés, le monitorage multimodal, dont le monitorage de l’oxygénation cérébrale à travers la mesure de la pression tissulaire en oxygène (PtiO2) est maintenant admis comme améliorant le pronostic. Néanmoins, le caractère invasif de la PtiO2 nous a incité à étudier sa corrélation avec un dispositif non invasif : la saturation cérébrale en oxygène (rSO2) mesurée par NIRS, et ainsi déterminer si elles pouvaient être interchangeables. Matériel & méthodes : il s’agissait d’une étude observationnelle rétrospective menée dans l’unité de neuroréanimation du centre hospitalier universitaire de Bordeaux. Les sujets ont bénéficié de la mesure horaire simultanée de la PtiO2 et de la rSO2 pendant 72 heures. Résultats : un total de 3988 mesures simultanées de NIRS et de PtiO2 a été obtenu. La corrélation ponctuelle était comprise entre -0,25 et 0,25. La corrélation globale dans le temps était de 0,013 (p= 0,457). Le modèle bivarié linéaire-mixte a confirmé l'absence de corrélation significative entre la PtiO2 et la rSO2. Le taux de concordance entre la rSO2 et la PtiO2 était de 41,8 %. La NIRS n'était pas capable de détecter des valeurs de PtiO2 inférieures à 20 mmHg (Area Under Receiver Operating curve = 0,537 ([0,534 - 0,539] ; p= 0,664) et les variations en pourcentage de rSO2 ne détectaient pas une diminution de 10 % de la PtiO2 (Area Under Receiver Operating curve = 0,615 [0,614 - 0,616], p < 0,001). Conclusion : la PtiO2 et la rSO2 ne sont pas corrélées au cours du temps, probablement parce qu’elles ne mesurent pas le même processus biologique. Il n’y a aucune preuve que la NIRS pourrait constituer un substitut à la surveillance de PtiO2 au chevet des patients en neuro-réanimation.

Background: many maneuvers assessing fluid responsiveness (minifluid challenge, lung recruitment maneuver, endexpiratory occlusion test, passive leg raising) are considered as positive when small variations in cardiac index, stroke volume index, stroke volume variation or pulse pressure variation occur. Pulse contour analysis allows continuous and real-time cardiac index, stroke volume, stroke volume variation and pulse pressure variation estimations. To use these maneuvers with pulse contour analysis, the knowledge of the minimal change that needs to be measured by a device to recognize a real change (least significant change) has to be studied. The aim of this study was to evaluate the least significant change of cardiac index, stroke volume index, stroke volume variation and pulse pressure variation obtained using pulse contour analysis (ProAQT ®, Pulsion Medical System, Germany). Methods: in this observational study, we included 50 mechanically ventilated patients undergoing neurosurgery in the operating room. Cardiac index, stroke volume index, pulse pressure variation and stroke volume variation obtained using ProAQT ® (Pulsion Medical System, Germany) were recorded every 12 s during 15-min steady-state periods. Least significant changes were calculated every minute. Results: least significant changes statistically differed over time for cardiac index, stroke volume index, pulse pressure variation and stroke volume variation (p < 0.001). Least significant changes ranged from 1.3 to 0.7% for cardiac index, from 1.3 to 0.8% for stroke volume index, from 10 to 4.9% for pulse pressure variation and from 10.8 to 4.3% for stroke volume variation. Conclusion: to conclude, the present study suggests that pulse contour analysis is able to detect rapid and small changes in cardiac index and stroke volume index, but the interpretation of rapid and small changes of pulse pressure variation and stroke volume variation must be done with caution.; Introduction : plusieurs procédures utilisées pour déterminer la précharge-dépendance (« Minifluid » challenge, manœuvre de recrutement alvéolaire, pause télé-expiratoire, lever de jambes passif) sont considérées positives quand de petites variations dans l’index cardiaque (IC), le volume d’éjection systolique indexé (VEI), ou la variation respiratoire du volume d’éjection systolique (VVE) ou de la pression pulsée (VPP) sont notées. L’analyse du contour de l’onde de pouls permet une estimation en continu et en temps-réel de ces paramètres. Pour utiliser ces procédures avec l’analyse du contour de l’onde de pouls, la connaissance du changement minimal devant être mesuré par un appareil pour reconnaître un changement réel d’un paramètre (plus petit changement significatif ou least significant change, LSC) doit être étudiée. Le but de cette étude est d’évaluer le LSC de l’IC, du VEI, de la VVE et de la VPP en utilisant l’analyse du contour de l’onde de pouls (ProAQT ®, Pulsion Medical System, Germany). Méthodes : dans cette étude observationnelle, nous avons inclus 50 patients sous ventilation mécanique au bloc opératoire subissant une intervention de neurochirurgie. L’IC, le VEI, la VVE et la VPP obtenus en utilisant le ProAQT ® (Pulsion Medical System, Germany) ont été enregistrés toutes les 12 s pendant des périodes de stabilité hémodynamique de 15 min. Les LSC ont été calculés chaque minute. Résultats : les LSC différent de manière statistiquement significative chaque minute pour l’IC, le VEI, la VVE et la VPP (p < 0.001). Les LSC varient de 1,3 à 0,7% pour l’IC, de 1,3 à 0,8% pour le VEI, de 10 à 4,9% pour la VPP et de 10,8 à 4,3% pour la VVE. Conclusion : cette étude suggère que l’analyse du contour de l’onde de pouls est capable de détecter des variations rapides et de faible intensité pour l’IC et le VEI, mais l’interprétation des petits changements rapides des VVE et VPP doivent être prudentes.

Background: from a physiological viewpoint, changes in end-tidal carbon dioxide (EtCO2) could be a simple, noninvasive, and inexpensive way to monitor changes in cardiac index. This study aimed to assess the utility of changes in EtCO2 as a marker of fluid responsiveness after volume expansion in the operating room. Methods: a prospective observational study was conducted in a tertiary university teaching hospital, from August 2018 to February 2019. A total of 109 non-consecutive, mechanically ventilated adults undergoing neurosurgery in the supine position and equipped with cardiac output monitors were included. Patients with major respiratory disease, arrhythmia, or heart failure were excluded. Volume expansion with 250 ml of saline 0.9% was performed for 10 min to maximise cardiac output during surgery, according to current guidelines. A positive fluid challenge was defined as an increase in stroke volume index of more than 10% from baseline. Changes in stroke volume index (monitored using pulse contour analysis) and EtCO2 were recorded before and after infusion. Results: a total of 242 fluid challenges were performed (26.9% positive challenges). Changes in EtCO2 greater than 1.1% induced by infusions had utility for identifying fluid responsiveness, with a sensitivity of 62.9% (95% confidence interval, 62.5-63.3%) and a specificity of 77.8% (95% CI, 77.6-78.1%). The area under the receiver operating curve for changes in EtCO2 after volume expansion was 0.683 (95% CI, 0.680-0.686). Conclusions: changes in EtCO2 induced by rapid infusion of 250 ml saline 0.9% lacked accuracy for identifying fluid responsiveness in mechanically ventilated patients in the operating room., Contexte : physiologiquement, les variations de la fraction expirée en CO2 (EtCO2) après un remplissage vasculaire pourraient permettre, de manière simple, non invasive et peu coûteuse, de monitorer les variations de l'index cardiaque (IC). Cette étude évaluait l'utilité des variations de l'EtCO2 en tant que marqueur de la réponse au remplissage vasculaire à la suite d'une expansion volémique au bloc opératoire. Méthodes : une étude observationnelle prospective, menée au CHU de Bordeaux d'août 2018 à février 2019 a inclus des patients ventilés mécaniquement, opérés d’une neurochirurgie en décubitus dorsal et équipés d’un monitorage du débit cardiaque. Les patients souffrant de maladies respiratoires graves, d'arythmie ou d'insuffisance cardiaque ont été exclus. Une expansion volémique de 250mL de sérum salé à 0,9% a été effectuée sur 10 minutes, afin de maximiser le débit cardiaque pendant l'opération, conformément aux recommandations actuelles. Une épreuve positive de remplissage a été définie comme une augmentation du volume d’éjection systolique (VES) de plus de 10% par rapport au niveau de référence. Les variations de VES (monitorées par analyse du contour de l’onde de pouls) et de l'EtCO2 ont été enregistrées avant et après la perfusion. Résultats : un total de 242 épreuves de remplissage vasculaire ont été réalisées chez 109 patients non consécutifs (26,9% d'épreuves positives). Les variations de l'EtCO2 supérieures à 1,1% induites par ces perfusions ont permis d'identifier la réponse au remplissage vasculaire, avec une sensibilité de 62,9% (IC 95% : 62.5-63.3%) et une spécificité de 77,8% (IC 95% : 77.6-78.1%). L'aire sous la courbe ROC des variations de l'EtCO2 après expansion volémique était de 0,683 (IC 95% : 0,680-0,686). Conclusions : Les variations de l'EtCO2 induites par la perfusion rapide de 250mL de sérum salé à 0,9% manquaient de précision pour identifier la réponse au remplissage vasculaire chez les patients sous ventilation mécanique au bloc opératoire. Contexte : physiologiquement, les variations de la fraction expirée en CO2 (EtCO2) après un remplissage vasculaire pourraient permettre, de manière simple, non invasive et peu coûteuse, de monitorer les variations de l'index cardiaque (IC). Cette étude évaluait l'utilité des variations de l'EtCO2 en tant que marqueur de la réponse au remplissage vasculaire à la suite d'une expansion volémique au bloc opératoire.

Background: tracheostomy in the intensive care unit is not consensual. Specifically, in the neuro intensive care unit, protecting upper airways is challenging every day, in regards to altered conscience state and deglutition troubles. Tracheostomy could improve ventilatory mechanics in these patients. Factors associated to mechanical ventilation duration are not well defined. Our hypothesis was that tracheostomy could reduce mechanical ventilation duration. Methods: it was a retrospective study at neuro intensive care unit of the university hospital of Bordeaux. Between may 2016 and April 2018, 316 patients receiving mechanical ventilation for at least 72 hours in our neuro intensive care unit were retrospectively included, among them 50 were tracheostomized. Data collection included demographic variables, gravity scores, mechanical ventilation duration, length of stay in the intensive care unit. Multivariable analysis has been realized to study mechanical ventilation duration associated factors. Results: median mechanical ventilation duration in tracheostomized patients was 24,9 days [16,2-30,0] whereas intubated patients have been ventilated 9,5 days [6,0 - 10,9]. On the day they arrived, tracheostomized patients experienced more organ failure in regards to intubated patients (median SOFA score 8,0 [6,0 - 9,0] and 6,0 [5,0 - 8,0], p value = 0,038). Multivariable analysis made the tracheostomy an independent factor augmenting mechanical ventilation duration. We found only one mild complication linked to percutaneous tracheostomy procedure. Conclusion: percutaneous tracheostomy in the neuro intensive care unit make mechanical ventilation duration last longer. Weaning from mechanical ventilation protocol in those patients should be assessed., Contexte : l’indication de la trachéotomie en réanimation n’est pas consensuelle. Dans le cadre de la neuroréanimation, la protection des voies aériennes supérieures est une question de tous les jours, du fait de l’altération de l’état de vigilance et des troubles de la déglutition. La trachéotomie pourrait améliorer la mécanique ventilatoire de ces patients. Les facteurs associés à la durée de ventilation mécanique dans notre population ne sont pas connus. Notre hypothèse était que la trachéotomie permettrait de diminuer la durée de ventilation mécanique invasive. Matériels et Méthodes : il s’agissait d’une étude rétrospective réalisée dans la neuroréanimation au CHU de Bordeaux. Entre mai 2016 et avril 2018, nous avons inclus rétrospectivement 316 patients majeurs ventilés au moins 72 heures, dont 50 patients trachéotomisés. Nous avons recueilli les données démographiques, les scores de gravité, la durée de ventilation mécanique invasive, la durée de séjour pour tous les patients. Une analyse multivariable a été réalisée pour rechercher les facteurs liés à la durée de ventilation mécanique invasive. Résultats : la durée médiane de ventilation mécanique invasive des patients trachéotomisés était de 24,9 jours [16,2-30,0] tandis que celle des patients intubés au long cours était de 9,5 jours [6,0 - 10,9]. Les patients trachéotomisés présentaient plus de défaillances d’organes à l’entrée (score SOFA médian 8,0 [6,0 - 9,0] contre 6,0 [5,0 - 8,0], p valeur = 0,038). L’analyse multivariable ajustée sur les facteurs confondants montrait que la trachéotomie allongeait de manière indépendante la durée de ventilation mécanique. Nous n’avons retrouvé qu’une seule complication non grave parmi les patients trachéotomisés par voie percutanée. Conclusion : la trachéotomie percutanée en neuroréanimation allonge la durée de ventilation mécanique. La mise en place de protocole de sevrage ventilatoire devra être évaluée pour réduire la durée de ventilation des patients trachéotomisés.