Joseph Moënne-Loccoz

Specific Metabolome Profile of Exhaled Breath Condensate in Patients with Shock and Respiratory Failure: A Pilot Study

Background: Shock includes different pathophysiological mechanisms not fully understood and remains a challenge to manage. Exhaled breath condensate (EBC) may contain relevant biomarkers that could help us make an early diagnosis or better understand the metabolic perturbations resulting from this pathological situation. Objective: we aimed to establish the metabolomics signature of EBC from patients in shock with acute respiratory failure in a pilot study. Material and methods: We explored the metabolic signature of EBC in 12 patients with shock compared to 14 controls using LC-HRMS. We used a non-targeted approach, and we performed a multivariate analysis based on Orthogonal Partial Least Square-Discriminant Analysis (OPLS-DA) to differentiate between the two groups of patients. Results: We optimized the procedure of EBC collection and LC-HRMS detected more than 1000 ions in this fluid. The optimization of multivariate models led to an excellent model of differentiation for both groups (Q2 > 0.4) after inclusion of only 6 ions. Discussion and conclusion: We validated the procedure of EBC collection and we showed that the metabolome profile of EBC may be relevant in characterizing patients with shock. We performed well in distinguishing these patients from controls, and the identification of relevant compounds may be promising for ICC patients.

Anxiety during inhalation induction in paediatrics: Sitting versus supine position, a randomised trial

STUDY OBJECTIVEnWe evaluated if the sitting or supine positions affect anxiety levels induced by the application of a facemask in children.nnnDESIGNnProspective, randomised study.nnnSETTINGnPaediatric hospital, operating room.nnnPATIENTSnTwo to twelve years old children, 1-3 ASA status, undergoing inhalation anaesthesia for elective surgery.nnnINTERVENTIONnChildren were randomly assigned to a sitting or supine position. After monitoring equipment was established, inhalation was inducted by the application of the mask.nnnMEASUREMENTSnChild anxiety was then assessed with the modified Yale Preoperative Anxiety Scale (mYPAS) before the application of the facemask and following mask application.nnnMAIN RESULTSnOverall, 99 children in the sitting group and 103 in the supine group were analysed. The mYPAS score was not different in both groups before the application of facemask (40 [28-51] versus 40 [28-53]; P=0.99). It increased (P=0.005) to a similar extent in both groups following mask application without difference between groups (48 [38-60] versus 48 [35-63]; P=0.95). Side effects were not different between both groups.nnnCONCLUSIONnIn children undergoing inhalation induction, sitting or supine positions did not modify anxiety induced by the application of a facemask, nor adverse effects; therefore, children should be allowed to choose their preferred position.

Chirurgie de scoliose idiopathique du grand enfant : quelle technique d’épargne transfusionnelle préopératoire choisir ?

Introduction Du fait d’une amelioration des techniques de conservation des produits sanguins labiles et des nouvelles techniques de detection virale, les transfusions de sang autologue et homologue exposent dorenavant les patients aux meme risques graves, que sont les erreurs d’administration. En chirurgie de scoliose idiopathique, deux techniques d’epargne sanguine preoperatoire sont utiliseesxa0: la transfusion autologue programmee (TAP) ou l’administration preoperatoire d’erythropoietine humaine recombinante (EPOrh). Le but de notre etude etait de comparer ces deux techniques. Materiel et methodes Etude retrospective monocentrique, inclusion de tous les patients operes dans notre institution pendant deux ans. En 2011, la technique d’epargne sanguine utilisee etait la TAP (nxa0=xa036xa0patients), et en 2012 l’EPOrh (nxa0=xa028xa0patients). L’analyse statistique a ete realisee a l’aide de tests de Mann–Whitney, Chi2, Kruskal–Wallis, et les tests de Dunn, p a ete fixe a 5xa0%. Resultats Soixante-quatre patients ont ete inclusxa0: 36 en 2011 (TAP), et 28 en 2012 (EPOrh). Au cours de la periode d’etude, l’equipe chirurgicale n’a pas change, et tous les patients ont ete traites en peroperatoire par acide tranexamique et systeme de recuperation et lavage du sang autologue. Entre 2011 et 2012, nous avons pu noter une diminution, a la fois, du taux de transfusion globale (transfusion autologue et homologue) de 86 a 25xa0% (pxa0 Discussion Nos resultats montrent que dans la chirurgie de scoliose idiopathique, l’administration preoperatoire d’EPOrh diminue, par rapport a un protocole de TAP, l’exposition a la transfusion sanguine globale. Cette difference s’explique par la faible applicabilite de la technique de TAP qui est moindre que celle de l’EPOrh. En effet, il s’agit d’une technique plus lourde a mettre en place, ayant de nombreuses contre-indications, necessitant des prelevements sanguins iteratifs et pouvant exposer le patient a une anemie preoperatoire. En termes de recours a la transfusion heterologue, et lorsqu’elle peut etre realisee, la TAP possede une efficacite certaine mais au prix d’une exposition plus frequente a la transfusion autologue. A l’heure ou la surete des produits sanguins labiles semble optimale, il ne semble pas legitime d’exposer les patients a un risque d’erreur transfusionnel plus important avec la TAP. Il semble donc raisonnable de proposer systematiquement l’administration d’EPOrh en preoperatoire de cette chirurgie.