To provide French guidelines about "Airway management during paediatric anaesthesia".
A consensus committee of 17 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société ...Française d’Anesthésie-Réanimation, SFAR) and the Association of French speaking paediatric anaesthesiologists and intensivists (Association Des Anesthésistes Réanimateurs Pédiatriques d’Expression Francophone, ADARPEF) was convened. The entire process was conducted independently of any industry funding. The authors followed the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to assess the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations were not graded.
The panel focused on 7 questions: 1) Supraglottic Airway devices 2) Cuffed endotracheal tubes 3) Videolaryngoscopes 4) Neuromuscular blocking agents 5) Rapid sequence induction 6) Airway device removal 7) Airway management in the child with recent or ongoing upper respiratory tract infection. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the redaction of the recommendations were then conducted according to the GRADE® methodology.
The SFAR Guideline panel provides 17 statements on “airway management during paediatric anaesthesia”. After two rounds of discussion and various amendments, a strong agreement was reached for 100% of the recommendations. Of these recommendations, 6 have a high level of evidence (Grade 1 ± ), 6 have a low level of evidence (Grade 2 ± ) and 5 are experts’ opinions. No recommendation could be provided for 3 questions.
Substantial agreement exists among experts regarding many strong recommendations for paediatric airway management.
RTS,S/AS02A is a pre-erythrocytic stage malaria vaccine that provides partial protection against infection in malaria-naive adult volunteers and hyperimmune adults. A previous report showed that this ...vaccine reduced risk of clinical malaria, delayed time to new infection, and reduced episodes of severe malaria over 6 months in African children. An important remaining issue is the durability of protection against clinical disease in these children.
We did a randomised, controlled, phase IIb trial of RTS,S/AS02A given at 0, 1, and 2 months in 2022 Mozambican children aged 1–4 years. We previously determined vaccine efficacy (VE) against clinical malaria in a double-blind phase that included study months 2·5–8·5 (VE
2·5–8·5). We now report VE in a single-blind phase up to month 21 (VE
8·5–21). The primary endpoint was time to first or only clinical episode of
Plasmodium falciparum malaria (axillary temperature ⩾37·5°C and
P falciparum asexual parasitaemia >2500 per μL) detected through a passive case detection system. We also determined VE for other case definitions and for episodes of severe malaria. This study is registered with the
ClinicalTrials.gov identifier NCT00197041.
During the single-blind phase, VE
(8·5–21) was 28·9% (95% CI 8·4–44·8; p=0·008). At month 21, prevalence of
P falciparum infection was 29% lower in the RTS,S/AS02A group than in the control (p=0·017). Considering the entire study period, VE
(2·5–21) was 35·3% (95% CI 21·6–46·6; p<0·0001) and VE
(2·5–21) for severe malaria was 48·6% (95% CI 12·3–71·0; p=0·02).
These results show that RTS,S/AS02A confers partial protection in African children aged 1–4 years living in rural endemic areas against a range of clinical disease caused by
P falciparum for at least 18 months, and confirm the potential of malaria vaccines to become credible control tools for public-health use.
To evaluate the clinical utility of a new device for continuous noninvasive cardiac output monitoring (NICOM) based on chest bio-reactance compared with cardiac output measured semi-continuously by ...thermodilution using a pulmonary artery catheter (PAC-CCO).
Prospective, single-center study.
Intensive care unit.
Consecutive adult patients immediately after cardiac surgery.
Cardiac output measurements obtained from NICOM and thermodilution were simultaneously recorded minute by minute and compared in 110 patients. We evaluated the accuracy, precision, responsiveness, and reliability of NICOM for detecting cardiac output changes. Tolerance for each of these parameters was specified prospectively.
A total of 65,888 pairs of cardiac output measurements were collected. Mean reference values for cardiac output ranged from 2.79 to 9.27 l/min. During periods of stable PAC-CCO (slope<+/-10%, 2SD/mean<20%), the correlation between NICOM and thermodilution was R=0.82; bias was +0.16+/-0.52 l/min (+4.0+/-11.3%), and relative error was 9.1%+/-7.8%. In 85% of patients the relative error was <20%. During periods of increasing output, slopes were similar with the two methods in 96% of patients and intra-class correlation was positive in 96%. Corresponding values during periods of decreasing output were 90% and 84%, respectively. Precision was always better with NICOM than with thermodilution. During hemodynamic challenges, changes were 3.1+/-3.8 min faster with NICOM (p<0.01) and amplitude of changes did not differ significantly. Finally, sensitivity of the NICOM for detecting significant directional changes was 93% and specificity was 93%.
Cardiac output measured by NICOM had most often acceptable accuracy, precision, and responsiveness in a wide range of circulatory situations.
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•Evaluation toolbox for daylighting and electric lighting retrofit projects.•It considers energy use, retrofit costs, photometry and user comfort.•The toolbox was tested in 19 ...buildings and works well in practice.•The procedure needs further simplification for non-expert use.
In the field of lighting and daylighting, standard monitoring procedures to assess the overall performance of retrofit projects are scarce. Nevertheless, access to monitored data is crucial in assessing whether daylighting or electric lighting systems deliver the expected performance in terms of cost-effectiveness, energy efficiency and lighting quality. In order to bridge this gap, a lighting retrofit evaluation toolbox was developed as a part of the International Energy Agency-Solar Heating and Cooling Programme (IEA-SHC) Task 50: “Advanced Lighting Solutions for Retrofitting Buildings”. The evaluation toolbox focuses on non-residential buildings and covers four key aspects: energy efficiency, costs, quality of the lighting environment and user satisfaction. This article presents the main features of this evaluation toolbox, along with some lessons learned from its application in selected case studies.
Background. In 1977, we proposed the use of gelatin-resorcinol-formol (GRF) biological glue during surgery for acute type A aortic dissection.
Methods. From January 1977 to March 1998, 204 patients ...(146 men and 58 women) aged from 15 to 79 years (mean 54 ± 11) underwent emergency operation for type A aortic dissection in our institution. One hundred sixty-five patients (84%) were operated on within 48 h after the onset of symptoms. Twenty-eight patients (13.7%) had Marfan’s syndrome. In 43 patients (23%), the aortic valve was replaced either independently (6, 3%) or by means of a composite graft (37, 18.1%). Because of the location of the intimal tear, aortic replacement included the transverse arch in 60 patients (29.4%).
Results. Hospital mortality was 21% (39 patients): 25% in patients with arch replacement and 19.4% in patients without arch replacement (ns). One hundred sixty-one patients were discharged and followed from 2 months to 21 years postoperatively (mean 85 ± 66 months). During this interval, 25 patients (15.5%) required reoperation for a total of 33 reoperations. Seven patients (28%) died at reoperation. Upon univariate analysis, presence of Marfan’s syndrome (
p < 0.05) and absence of arch replacement (
p < 0.02) were risk factors for reoperation. Emergency operation (
p < 0.01) and thoracoabdominal replacement (
p < 0.04) were risk factors for death at reoperation. The actuarial freedom from reoperation (Kaplan-Meier, confidence interval 95%) is 96.1% (90.9%–98.2%) at 1 year, 87.6% (79.8%–92.7%) at 5 years, 80.9% (70.8%–88.1%) at 10 years, and 66.4% (51.1%–78.9%) at 15 years. A total of 39 patients (24.3%) died during follow-up. The presence of Marfan’s syndrome (
p < 0.01), reoperation (
p < 0.02), stroke (
p < 0.05), and cardiac failure (
p < 0.05) were risk factors for late mortality. The actuarial late survival including hospital mortality is 71.5% (64.3%–77.8%) at 1 year, 66% (58.3%–73%) at 5 years, 56.4% (47.7%–64.7%) at 10 years, and 46.3% (36.4%–56.5%) at 15 years.
Conclusions. The GRF glue has proven extremely useful during emergency initial surgery for acute type A dissection, making the procedure much easier and safer. As a result of this operative improvement, the use of the GRF glue seems to have had a beneficial influence on late results, but these also depend upon the patient’s basic condition.
This paper provides an overview of Subtask B: Tools and methods for solar design, of IEA SHC Task 41: Solar energy and architecture, 2009-2012. The focus of this Subtask was on identifying obstacles ...that architects are facing when implementing passive and active solar strategies in their design, especially during the early design phase (EDP) of building projects. The results of this Subtask also aim to provide strategies and resources for practitioners regarding the use of different digital tools and design methods for solar design.
Summary Background The RTS,S/AS01E candidate malaria vaccine is being developed for immunisation of infants in Africa through the expanded programme on immunisation (EPI). 8 month follow-up data have ...been reported for safety and immunogenicity of RTS,S/AS01E when integrated into the EPI. We report extended follow-up to 19 months, including efficacy results. Methods We did a randomised, open-label, phase 2 trial of safety and efficacy of the RTS,S/AS01E candidate malaria vaccine given with EPI vaccines between April 30, 2007, and Oct 7, 2009, in Ghana, Tanzania, and Gabon. Eligible children were 6–10 weeks of age at first vaccination, without serious acute or chronic illness. All children received the EPI diphtheria, tetanus, pertussis (inactivated whole-cell), and hepatitis-B vaccines, Haemophilus influenzae type b vaccine, and oral polio vaccine at study months 0, 1, and 2, and measles vaccine and yellow fever vaccines at study month 7. Participants were randomly assigned (1:1:1) to receive three doses of RTS,S/AS01E at 6, 10, and 14 weeks (0, 1, 2 month schedule) or at 6 weeks, 10 weeks, and 9 months (0, 2, 7 month schedule) or placebo. Randomisation was according to a predefined block list with a computer-generated randomisation code. Detection of serious adverse events and malaria was by passive case detection. Antibodies against Plasmodium falciparum circumsporozoite protein and HBsAg were monitored for 19 months. This study is registered with ClinicalTrials.gov , number NCT00436007. Findings 511 children were enrolled. Serious adverse events occurred in 57 participants in the RTS,S/AS01E 0, 1, 2 month group (34%, 95% CI 27–41), 47 in the 0, 1, 7 month group (28%, 21–35), and 49 (29%, 22–36) in the control group; none were judged to be related to study vaccination. At month 19, anticircumsporozoite immune responses were significantly higher in the RTS,S/AS01E groups than in the control group. Vaccine efficacy for the 0, 1, 2 month schedule (2 weeks after dose three to month 19, site-adjusted according-to-protocol analysis) was 53% (95% CI 26–70; p=0·0012) against first malaria episodes and 59% (36–74; p=0·0001) against all malaria episodes. For the entire study period, (total vaccinated cohort) vaccine efficacy against all malaria episodes was higher with the 0, 1, 2 month schedule (57%, 95% CI 33–73; p=0·0002) than with the 0, 1, 7 month schedule (32% CI 16–45; p=0·0003). 1 year after dose three, vaccine efficacy against first malaria episodes was similar for both schedules (0, 1, 2 month group, 61·6% 95% CI 35·6–77·1, p<0·001; 0, 1, 7 month group, 63·8% 40·4–78·0, p<0·001, according-to-protocol cohort). Interpretation Vaccine efficacy was consistent with the target put forward by the WHO-sponsored malaria vaccine technology roadmap for a first-generation malaria vaccine. The 0, 1, 2 month vaccine schedule has been selected for phase 3 candidate vaccine assessment. Funding Program for Appropriate Technology in Health Malaria Vaccine Initiative; GlaxoSmithKline Biologicals.
Architects can play a key role in future solar-integrated architecture as they are involved in the building process from the beginning. Solar-integrated architecture takes both passive and active use ...of solar energy into account. The aim of this research was to gain insight into the actual design processes of solar-integrated buildings. Therefore, semi-structured interviews were conducted with Swedish architects who designed such buildings. Results showed that teamwork was experienced as crucial and building performance simulation tools were hardly used by the architects themselves. Results from these interviews serve as input for the development of new architectural guidelines for designing solar-integrated architecture as part of IEA-SHC Task 41: Solar Energy & Architecture.
An efficient lighting control systems (LCS) should take advantage of the natural light available, but this presents some technical challenges as well as user related issues. So far, the assessment of ...lighting energy consumption of LCS has been based on technical features rather than the occupants’ acceptance.
This article presents the results of a monitoring study providing some recommendations based on the human and technical aspects of LCS in small scale applications.
Four identical peripheral office rooms located in Lund, Sweden, were equipped with four different LCS: manual switch at the door, presence detector, daylight dimming with absence detector and LED task lamp. Each occupant performed ordinary office tasks for two weeks in each room in April-May 2013. A subjective evaluation concerning the general lighting experience and the appreciation of the LCS was carried out.
The results indicate that the manual switch was greatly appreciated and it accomplished good energy performances (75% savings compared to the presence detector). The daylight-linked LCS achieved only slightly higher savings (79%), due to relatively high parasitic losses, but did not guarantee an optimal light environment. The desk lamp achieved 97% savings, but the lighting conditions were considered unacceptable by the office workers. In general, the participants in this study perceived all automatic controls as stressful.
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