The relationship between lung ultrasound (LUS) and chest computed tomography (CT) scans in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is not clearly defined. The primary objective of our study was to assess the performance of LUS in determining severity of SARS-CoV-2 pneumonia compared with chest CT scan. Secondary objectives were to test the association between LUS score and location of the patient, use of mechanical ventilation, and the pulse oximetry (SpO 2)/fractional inspired oxygen (FiO 2) ratio. Methods: A multicentre observational study was performed between 15 March and 20 April 2020. Patients in the Emergency Department (ED) or Intensive Care Unit (ICU) with acute dyspnoea who were PCR positive for SARS-CoV-2, and who had LUS and chest CT performed within a 24-h period, were included. Results: One hundred patients were included. LUS score was significantly associated with pneumonia severity assessed by chest CT and clinical features. The AUC of the ROC curve of the relationship of LUS versus chest CT for the assessment of severe SARS-CoV-2 pneumonia was 0.78 (CI 95% 0.68-0.87; p < 0.0001). A high LUS score was associated with the use of mechanical ventilation, and with a SpO 2 /FiO 2 ratio below 357. Conclusion: In known SARS-CoV-2 pneumonia patients, the LUS score was predictive of pneumonia severity as assessed by a chest CT scan and clinical features. Within the limitations inherent to our study design, LUS can be used to assess SARS-CoV-2 pneumonia severity.

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The occurrence of SR during BIS-controlled propofol and remifentanil anaesthesia is mainly observed in elderly male patients or in patients with a history of CAD. The mechanisms underlying SR and the potential consequences for the patient's postoperative outcome remain unsolved.

Background Quality of life (QoL) is a multifactorial concept that assesses physical and mental health. We prospectively studied the quality of life of patients undergoing coronary artery bypass graft (CABG) surgery using the Short-Form 36-item questionnaire (SF-36) up to 10 years after surgery. Methods Between January 2000 and December 2002, all patients undergoing elective isolated CABG in the cardiac & thoracic surgery department of a large university hospital in Eastern France underwent initial QoL evaluation with the SF-36. The same questionnaire was mailed to every patient annually (± 2 weeks around the date of surgery) up to 10 years after their operation. We recorded socio-demographic and clinical variables at inclusion. Predictors of impaired QoL at 10 years were identified by logistic regression. Results A total of 272 patients (213 men, 59 women) were enrolled; mean age at inclusion was 65 ± 10 years. At 10 years post-surgery, 81 patients had died (29.7%). The physical component summary (PCS) score was significantly higher at 5 years after surgery than at baseline ( p < 0.01), and significantly lower at 10 years than at 5 years (p < 0.01), although there remained a significant difference between 10-year PCS and baseline score ( p = 0.004). The mental component summary (MCS) score was significantly higher at 5 years than at the time of surgery ( p < 0.001), and remained significantly higher compared to baseline at 10 years after surgery ( p = 0.010). By multivariate analysis, diabetes and dypsnea were both associated with worse PCS at 10 years, while lower age was associated with better 10-year PCS. Only diabetes was associated with impaired MCS at 10 years. Conclusions Cardiac surgery appears to durably and positively affect both physical and mental components of quality of life. Electronic supplementary material The online version of this article (10.1186/s12955-019-1160-7) contains supplementary material, which is available to authorized users.

Clinical research remains a vital contributor to medical knowledge, and is an established and integral part of the practice of medicine worldwide. Respect for patient autonomy and ethical principles dictate that informed consent must be obtained from subjects before they can be enrolled into clinical research, yet these conditions may be difficult to apply in real practice in the intensive care unit (ICU).A number of factors serve to complexify the consent process in critically ill patients, notably decisional incapacity of the patient due to illness or sedation. Obtaining consent for research from a designated proxy or family member, commonly termed a "surrogate decision maker" (SDM) may be difficult, since SDMs dealing with the emotional, psychological and logistic impact of a sudden hospitalisation of their lovedone are not always receptive to the idea of research or emotionally equipped to reflect rationally on the opportunities being proposed to them. In addition, time constraints and workload pressures on the attending physician may render consent opportunities unfeasible, and the resulting loss of eligible patients could represent a bias in clinical trials, or limit the generalizability of their results. Alternative procedures such as deferred or waived consent have been used in the past and may be suitable alternatives in certain conditions, provided appropriate approval from institutional review boards (IRBs) can be obtained, in accordance with existing legislation. Some of the main questions inherent to the conduct of clinical research in critically ill patients are discussed in this review.

Hypophosphatemia in critically ill adults and children -A systematic review.

I.V. access was obtained and ECG, pulse oximetry, and continuous invasive arterial pressure monitoring were established. The patient was placed in the right lateral position and commenced on NIV. The insertion of the intrathecal catheter was technically difficult, and the epidural space was located with a 16 G Tuohy and the use of the image intensifier and contrast. A dural tap was achieved at 7 cm and an intrathecal catheter inserted to 11 cm. After incremental titration with 5 ml of levobupivacaine 0.25%, a block to T12 provided conditions suitable for surgery, which was completed without incident.After operation, NIV was continued. An infusion of bupivacaine 0.1% was commenced intrathecally at 1-1.5 ml h 21 , providing excellent analgesia and was continued for the following 4 days. The infusion was titrated to block height of T10-11 which provided good analgesia with no respiratory problems or motor block. The catheter was removed on day 5, following which the patient's analgesia requirement were met with paracetamol and nefopam. The patient was discharged home on day 11.The heterogeneity of ventilator-dependent patients and small number of studies of perioperative care makes the prediction of risk difficult. Patients now focus on psychosocial factors, rather than survival, leading to the concept of prolonged survival and acceptable exposure to risk. In this patient cohort, preoperative assessment and risk stratification is complex. Symptoms such as dyspnoea and orthopnoea are often late findings and physical evaluation is essential to detect accessory muscle recruitment, supine abdominal paradox, and encumbrance of upper or lower airways. 1 A substantial loss of respiratory muscle strength is typically accompanied by little or no change in spirometry or arterial blood gases. 2 Lung function tests can reveal a characteristically low vital capacity, reduced total lung capacity, and preserved residual volume. Transfer factor is normal when adjusted for lung volume.Evaluation of respiratory muscle strength is extremely useful, and has been shown to be sensitive and prognostic. 3 Peak expiratory flow during cough gives an overall evaluation of cough efficiency, values below 160-270 litre min 21 suggesting poor airway clearance. Evaluation of respiratory muscle strength is achieved by measuring maximal inspiratory pressure (PImax) and sniff nasal inspiratory pressure. A maximal expiratory pressure (PEmax) below 45 cm H 2 O may indicate compromised cough efficiency.There are few reports of the use of Bipap in the operating theatre. 4 -7 Our case highlights that using intraoperative NIV can be useful, and avoid the need for general anaesthesia and invasive ventilation.

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