The benefit-risk ratio of prophylactic non-invasive ventilation (NIV) and high-flow nasal oxygen therapy (HFNC-O
) during the early stage of blunt chest trauma remains controversial because of ...limited data. The main objective of this study was to compare the rate of endotracheal intubation between two NIV strategies in high-risk blunt chest trauma patients.
The OptiTHO trial was a randomized, open-label, multicenter trial over a two-year period. Every adult patients admitted in intensive care unit within 48 h after a high-risk blunt chest trauma (Thoracic Trauma Severity Score ≥ 8), an estimated PaO
/FiO
ratio < 300 and no evidence of acute respiratory failure were eligible for study enrollment (Clinical Trial Registration: NCT03943914). The primary objective was to compare the rate of endotracheal intubation for delayed respiratory failure between two NIV strategies: i) a prompt association of HFNC-O
and "early" NIV in every patient for at least 48 h with vs. ii) the standard of care associating COT and "late" NIV, indicated in patients with respiratory deterioration and/or PaO
/FiO
ratio ≤ 200 mmHg. Secondary outcomes were the occurrence of chest trauma-related complications (pulmonary infection, delayed hemothorax or moderate-to-severe ARDS).
Study enrollment was stopped for futility after a 2-year study period and randomization of 141 patients. Overall, 11 patients (7.8%) required endotracheal intubation for delayed respiratory failure. The rate of endotracheal intubation was not significantly lower in patients treated with the experimental strategy (7% 5/71) when compared to the control group (8.6% 6/70), with an adjusted OR = 0.72 (95%IC: 0.20-2.43), p = 0.60. The occurrence of pulmonary infection, delayed hemothorax or delayed ARDS was not significantly lower in patients treated by the experimental strategy (adjusted OR = 1.99 95%IC: 0.73-5.89, p = 0.18, 0.85 95%IC: 0.33-2.20, p = 0.74 and 2.14 95%IC: 0.36-20.77, p = 0.41, respectively).
A prompt association of HFNC-O
with preventive NIV did not reduce the rate of endotracheal intubation or secondary respiratory complications when compared to COT and late NIV in high-risk blunt chest trauma patients with non-severe hypoxemia and no sign of acute respiratory failure.
NCT03943914, Registered 7 May 2019.
As the largest class action suit in Canadian history, the Indian Residential Schools Settlement Agreement (2007-2015) had a great impact on the lives of Aboriginal survivors across Canada. In a rare ...account exploring survivor perspectives, Anne-Marie Reynaud considers the settlement's reconciliatory aspiration in conjunction with the local reality for the Mitchikanibikok Inik First Nations in Quebec. Drawing from anthropological fieldwork, this carefully crafted book weaves survivor experiences of the financial compensations and the Truth and Reconciliation Commission together with current theorizing on emotions, memory, trauma and transitional justice.
Abstract∞
The Canadian Truth and Reconciliation Commission (TRC) acquired over 1,200 material submissions through the gifts it received at its events. Though other TRCs mention objects in their ...records, the gift-giving practice that became central to TRC events in Canada was unprecedented, and so is its large collection of TRC-gifted objects today. The Canadian TRC is thus unique and faces the challenges of categorizing, preserving, displaying and honouring these material artefacts. What has been the post-TRC life of these objects and art pieces? What is their role in creating a collective memory of residential schools and how might they promote reconciliation? This article shows that the post-TRC life of the objects opens up new museological spaces and practices through the ways the objects are curated (or not) for remembering and learning about residential schools according to Indigenous protocols and ways of thinking and feeling.
Chez le sujet addict, la mise en place des enveloppes psychocorporelles est altérée. L’importance des interactions précoces et l’influence des défaillances de l’environnement sont essentielles dans ...cette problématique. Nous verrons dans cet article comment une prise en charge en psychomotricité peut permettre aux patients addicts de réinvestir leur corps et de restaurer les enveloppes psychocorporelles fragilisées afin de les conduire vers un mieux-être et un mieux vivre en soi.
Purpose
The Doppler-based resistive index (RI) and semi-quantitative evaluation of renal perfusion using color Doppler (SQP) have shown promising results for predicting persistent acute kidney injury ...(AKI) in preliminary studies. This study aimed at evaluating the performance of RI and SQP to predict short-term renal prognosis in critically ill patients.
Methods
Prospective multicenter cohort study including unselected critically ill patients. Renal Doppler was performed at admission to the intensive care unit. The diagnostic performance of RI and SQP to predict persistent AKI at day 3 was evaluated.
Results
Overall, 371 patients were included, of whom 351 could be assessed for short-term renal recovery. Two thirds of the included patients had AKI (
n
= 233; 66.3%), of whom 136 had persistent AKI (58.4%). Doppler-based RI was higher and SQP lower in AKI patients and according to AKI recovery. Overall performance in predicting persistent AKI was however poor with area under ROC curve of respectively 0.58 (95% CI 0.52–0.64) and 0.59 (95% CI 0.54–0.65) for RI and SQP. Optimal cutoff was respectively 0.71 and 2 for RI and SQP. At optimal cutoff, sensitivity and specificity were 50% (95% CI 41–58%) and 68% (62–74%) for RI and 39% (32–45%) and 75% (66–82%) for SQP.
Conclusion
Although statistically associated with AKI occurrence, RI and SQP perform poorly in predicting persistent AKI at day 3. Further studies are needed to adequately describe factors influencing Doppler-based assessment of renal perfusion and to delineate whether these indicators may be useful at the bedside.
Clinicaltrial.gov
NCT02355314.
This article approaches the Canadian TRC and its aspiration for reconciliation from an emotions perspective, thereby acknowledging the significant role emotions play in constituting identities and ...political communities, as well as understanding emotions as central to how conflicts are generated, viewed and solved (Hutchison and Bleiker 2008). I explore Michael Ure's claim that TRCs are host to a fundamental tension between the competing imperatives of justice (and its prime emotion of anger) and reconciliation (2008:286). The aim is to understand how survivors deal with this emotionally tense process and make sense of the TRC in this context. Cet article aborde la Commission de vérité et réconciliation (CVR) du Canada et son aspiration à la réconciliation à partir d'une perspective axée sur les émotions, reconnaissant par là le rôle clé que jouent les émotions dans la constitution des identités et des communautés politiques, et considérant ainsi leur position centrale dans le cadre de la création, la perception et la résolution des conflits (Hutchison et Bleiker 2008). J'explore la prémisse de Michael Ure selon laquelle les CVR sont le siège d'une tension fondamentale entre les impératifs concurrentiels de justice (et son expression principale de colère) et de réconciliation (2008:286). Je cherche à comprendre le sens donné à la CVR par les survivants, ainsi que leurs façons de gérer ce processus si tendu émotionnellement.
This study aimed at evaluating the performance of Doppler-based resistive index (RI) and semi-quantitative evaluation of renal perfusion using color-Doppler (SQP) to predict de novo AKI in the ...subgroup of critically ill patients without AKI at admission.
This study is an ancillary analysis of a prospective multicenter cohort study. Consecutive ICU patients requiring mechanical ventilation were included. Renal Doppler was performed at ICU admission. The diagnostic performance of RI and SQP to predict de novo AKI at day 3 was evaluated.
Among the 371 patients of the prospective cohort, 118 without AKI at study inclusion were included. Thirty-four patients (29%) developed an AKI. Neither RI (0.64 UI 0.57–0.70 vs 0.67 0.62–0.70 in no AKI and de novo AKI group respectively, p = 0.177) nor SQP (2 2, 3 vs 2 1–3 in no AKI and de novo AKI group respectively, p = 0.061) were associated with AKI occurrence. Overall performance in predicting de novo AKI was null to poor with area under ROC curve of respectively 0.60 (95% CI 0.49–0.65) and 0.58 (95% CI 0.47–0.60) for RI and SQP. Similar results were obtained after adjustment for confounders.
These results confirm the poor performance of Doppler-based indices in predicting renal prognosis of ICU patients.
•Renal Doppler is known to poorly predict renal recovery in unselected ICU patients.•This study focused on ICU patients with no overt renal dysfunction at admission.•In these patients, renal Doppler failed to predict de novo AKI.•Renal Doppler seems to be a useless tool to predict renal prognosis in ICU.
Background The benefit–risk ratio of prophylactic non-invasive ventilation (NIV) and high-flow nasal oxygen therapy (HFNC-O 2 ) during the early stage of blunt chest trauma remains controversial ...because of limited data. The main objective of this study was to compare the rate of endotracheal intubation between two NIV strategies in high-risk blunt chest trauma patients. Methods The OptiTHO trial was a randomized, open-label, multicenter trial over a two-year period. Every adult patients admitted in intensive care unit within 48 h after a high-risk blunt chest trauma (Thoracic Trauma Severity Score ≥ 8), an estimated PaO 2 /FiO 2 ratio < 300 and no evidence of acute respiratory failure were eligible for study enrollment (Clinical Trial Registration: NCT03943914). The primary objective was to compare the rate of endotracheal intubation for delayed respiratory failure between two NIV strategies: i) a prompt association of HFNC-O 2 and “early” NIV in every patient for at least 48 h with vs. ii) the standard of care associating COT and “late” NIV, indicated in patients with respiratory deterioration and/or PaO 2 /FiO 2 ratio ≤ 200 mmHg. Secondary outcomes were the occurrence of chest trauma-related complications (pulmonary infection, delayed hemothorax or moderate-to-severe ARDS). Results Study enrollment was stopped for futility after a 2-year study period and randomization of 141 patients. Overall, 11 patients (7.8%) required endotracheal intubation for delayed respiratory failure. The rate of endotracheal intubation was not significantly lower in patients treated with the experimental strategy (7% 5/71) when compared to the control group (8.6% 6/70), with an adjusted OR = 0.72 (95%IC: 0.20–2.43), p = 0.60 . The occurrence of pulmonary infection, delayed hemothorax or delayed ARDS was not significantly lower in patients treated by the experimental strategy (adjusted OR = 1.99 95%IC: 0.73–5.89, p = 0.18, 0.85 95%IC: 0.33–2.20, p = 0.74 and 2.14 95%IC: 0.36–20.77, p = 0.41 , respectively). Conclusion A prompt association of HFNC-O 2 with preventive NIV did not reduce the rate of endotracheal intubation or secondary respiratory complications when compared to COT and late NIV in high-risk blunt chest trauma patients with non-severe hypoxemia and no sign of acute respiratory failure. Clinical Trial Registration : NCT03943914, Registered 7 May 2019.
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