Abstract Objective To report the immediate use of High-Frequency Oscillatory ventilation in an adult acute respiratory distress syndrome. Design Case report. Setting Intensive care unit at the Military Teaching Hospital of Toulon. Patient A 64-yr-old Caucasian male who developed acute respiratory distress syndrome in the course of severe falciparum malaria. Intervention Initial use of HFO to minimise ventilator-induced lung injury. Measurement and Main Results Rapid improvement of PaO2/fraction of inspired oxygen from 172 mmHg (NIV) to 310 mmHg with HFO. No ventilator-induced injury on CT scan after 5 days of invasive ventilation. Conclusion In contrast with previous studies, we successfully used lung protective ventilation with HFO immediately. Further studies, with immediate, rather than rescue use of HFO ventilation, are needed.
Intravenous morphine (IVM) is the most common strong analgesic used in trauma, but is associated with a clear time limitation related to the need to obtain an access route. The intranasal (IN) route provides easy administration with a fast peak action time due to high vascularization and the absence of first-pass metabolism. We aimed to determine whether IN sufentanil (INS) for patients presenting to an emergency department with acute severe traumatic pain results in a reduction in pain intensity non-inferior to IVM. In a prospective, randomized, multicenter non-inferiority trial conducted in the emergency departments of 6 hospitals across France, patients were randomized 1:1 to INS titration (0.3 μg/kg and additional doses of 0.15 μg/kg at 10 minutes and 20 minutes if numerical pain rating scale [NRS] > 3) and intravenous placebo, or to IVM (0.1 mg/kg and additional doses of 0.05 mg/kg at 10 minutes and 20 minutes if NRS > 3) and IN placebo. Patients, clinical staff, and research staff were blinded to the treatment allocation. The primary endpoint was the total decrease on NRS at 30 minutes after first administration. The prespecified non-inferiority margin was -1.3 on the NRS. The primary outcome was analyzed per protocol. Adverse events were prospectively recorded during 4 hours. Among the 194 patients enrolled in the emergency department cohort between November 4, 2013, and April 10, 2016, 157 were randomized, and the protocol was correctly administered in 136 (69 IVM group, 67 INS group, per protocol population, 76% men, median age 40 [IQR 29 to 54] years). The mean difference between NRS at first administration and NRS at 30 minutes was -4.1 (97.5% CI -4.6 to -3.6) in the IVM group and -5.2 (97.5% CI -5.7 to -4.6) in the INS group. Non-inferiority was demonstrated (p < 0.001 with 1-sided mean-equivalence t test), as the lower 97.5% confidence interval of 0.29 (97.5% CI 0.29 to 1.93) was above the prespecified margin of -1.3. INS was superior to IVM (intention to treat analysis: p = 0.034), but ...
This 26th dossier d'Agropolis is devoted to research and partnerships in agroecology. The French Commission for International Agricultural Research (CRAI) and Agropolis International, on behalf of CIRAD, INRAE and IRD and in partnership with CGIAR, has produced this new issue in the 'Les dossiers d'Agropolis international' series devoted to agroecology. This publication has been produced within the framework of the Action Plan signed by CGIAR and the French government on February 4th 2021 to strengthen French collaboration with CGIAR, where agroecology is highlighted as one of the three key priorities (alongside climate change, nutrition and food systems).