Explore the vast range of titles available.

Assessment of fluid responsiveness relies on dynamic echocardiographic parameters that have not yet been compared in large cohorts. To determine the diagnostic accuracy of dynamic parameters used to predict fluid responsiveness in ventilated patients with a circulatory failure of any cause. In this multicenter prospective study, respiratory variations of superior vena cava diameter (∆SVC) measured using transesophageal echocardiography, of inferior vena cava diameter (∆IVC) measured using transthoracic echocardiography, of the maximal Doppler velocity in left ventricular outflow tract (∆VmaxAo) measured using either approach, and pulse pressure variations (∆PP) were recorded with the patient in the semirecumbent position. In each patient, a passive leg raise was performed and an increase of aortic velocity time integral greater than or equal to 10% defined fluid responsiveness. Among 540 patients (379 men; age, 65 ± 13 yr; Simplified Acute Physiological Score II, 59 ± 18; Sequential Organ Failure Assessment, 10 ± 3), 229 exhibited fluid responsiveness (42%). ∆PP, ∆VmaxAo, ∆SVC, and ∆IVC could be measured in 78.5%, 78.0%, 99.6%, and 78.1% of cases, respectively. ∆SVC greater than or equal to 21%, ∆VmaxAo greater than or equal to 10%, and ∆IVC greater than or equal to 8% had a sensitivity of 61% (95% confidence interval, 57-66%), 79% (75-83%), and 55% (50-59%), respectively, and a specificity of 84% (81-87%), 64% (59-69%), and 70% (66-75%), respectively. The area under the receiver operating characteristic curve of ∆SVC was significantly greater than that of ∆IVC (P = 0.02) and ∆PP (P = 0.01). ∆VmaxAo had the best sensitivity and ∆SVC the best specificity in predicting fluid responsiveness. ∆SVC had a greater diagnostic accuracy than ∆IVC and ∆PP, but its measurement requires transesophageal echocardiography.

Purpose Since 1997, we have routinely used prone positioning (PP) in patients who have a PaO 2 /FiO 2 below 100 mmHg after 24–48 h of mechanical ventilation and who are ventilated using a low stretch ventilation strategy. We report here the characteristics and prognosis of this subgroup of patients with severe lung injury to illustrate the feasibility, role, and impact of routine PP in acute respiratory distress syndrome (ARDS). Results A total of 218 patients were admitted because of ARDS between 1997 and 2009. Of these patients, 57 (26%) were positioned prone because of a PaO 2 /FiO 2 below 100 mmHg after 24–48 h of mechanical ventilation. Age was 51 ± 16 years, PaO 2 /FiO 2 74 ± 19, and PaCO 2 54 ± 10 mmHg. The lung injury score was 3.13 ± 0.15. Tidal volume was 7 ± 2 mL/kg, PEEP 5.6 ± 1.2 cmH 2 O, and plateau pressure 27 ± 3 cmH 2 O. Prone sessions lasted 18 h/day and 3.4 ± 1.1 sessions were required to obtain an FiO 2 below 60%. The 60-day mortality was 19% and death occurred after 12 ± 5 days. The ratio between observed and predicted mortality was 0.43. In patients with a PaO 2 /FiO 2 below 60 mmHg, the 60-day mortality was 28%. Logistic regression analysis showed that among the 218 patients, PP appeared to be protective with an odds ratio of 0.35 [0.16–0.79]. Conclusion We demonstrate the clinical feasibility of routine PP in patients with a PaO 2 /FiO 2 below 100 mmHg after 24–48 h and suggest that, when combined with a low stretch ventilation strategy, it is protective with a high survival rate.

Although donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) are frequently found in recipients after lung transplantation (LT), the characteristics of DSA which influence antibody-mediated rejection (AMR) in LT are not fully defined. We retrospectively analyzed 206 consecutive LT patients of our center (2010-2013). DSAs were detected by using luminex single antigen beads assay and mean fluorescence intensity was assessed. Within the study population, 105 patients had positive DSA. Patients with and without AMR (AMR ,  = 22, and AMR ,  = 83, respectively) were compared. AMR patients had significantly greater frequencies of anti-HLA DQ DSA (DQ DSA) than AMR patients (95 vs 58%, respectively,  < 0.0001). Compared to AMR patients, AMR patients had higher DQ DSA sum MFI [7,332 (2,067-10,213) vs 681 (0-1,887),  < 0.0001]. DQ DSA when associated with AMR, had more frequent graft loss and chronic lung allograft dysfunction (CLAD). These data suggest (i) that DSA characteristics clearly differ between AMR and AMR patients and (ii) the deleterious impact of DQ DSA on clinical outcome.