Bibliographie de Médecine d'Urgence

Mois de novembre 2023

Annals of Intensive Care

High-flow nasal cannula oxygen versus conventional oxygen therapy for acute respiratory failure due to COVID-19: a systematic review and meta-analysis.
Le Pape S, Savart S, Arrivé F, Frat JP, Ragot S, Coudroy R, Thille AW. | Ann Intensive Care. 2023 Nov 23;13(1):114
DOI:  | Télécharger l'article au format  
Keywords: Acute hypoxemic respiratory failure; COVID19; Conventional oxygen therapy; High-flow nasal cannula therapy; Intubation; Mortality.


Introduction : The effectiveness of high-flow nasal cannula oxygen therapy (HFNC) in patients with acute respiratory failure due to COVID-19 remains uncertain. We aimed at assessing whether HFNC is associated with reduced risk of intubation or mortality in patients with acute respiratory failure due to COVID-19 compared with conventional oxygen therapy (COT).

Méthode : In this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, and CENTRAL databases for randomized controlled trials (RCTs) and observational studies comparing HFNC vs. COT in patients with acute respiratory failure due to COVID-19, published in English from inception to December 2022. Pediatric studies, studies that compared HFNC with a noninvasive respiratory support other than COT and those in which intubation or mortality were not reported were excluded. Two authors independently screened and selected articles for inclusion, extracted data, and assessed the risk of bias. Fixed-effects or random-effects meta-analysis were performed according to statistical heterogeneity. Primary outcomes were risk of intubation and mortality across RCTs. Effect estimates were calculated as risk ratios and 95% confidence interval (RR; 95% CI). Observational studies were used for sensitivity analyses.

Résultats : Twenty studies were analyzed, accounting for 8383 patients, including 6 RCTs (2509 patients) and 14 observational studies (5874 patients). By pooling the 6 RCTs, HFNC compared with COT significantly reduced the risk of intubation (RR 0.89, 95% CI 0.80 to 0.98; p = 0.02) and reduced length of stay in hospital. HFNC did not significantly reduce the risk of mortality (RR 0.93, 95% CI 0.77 to 1.11; p = 0.40).

Conclusion : In patients with acute respiratory failure due to COVID-19, HFNC reduced the need for intubation and shortened length of stay in hospital without significant decreased risk of mortality.

Conclusion (proposition de traduction) : Chez les patients souffrant d'insuffisance respiratoire aiguë due à la COVID-19, la HFNC a réduit le besoin d'intubation et la durée du séjour à l'hôpital sans diminution significative du risque de mortalité.

Influence of different noninvasive oxygenation support devices on tidal volume.
Haudebourg AF, Maraffi T, Tuffet S, Le Corvoisier P, Mekontso Dessap A, Carteaux G. | Ann Intensive Care. 2023 Nov 25;13(1):116
DOI:  | Télécharger l'article au format  
Keywords: Continuous positive airway pressure; High-flow oxygen through nasal cannula; Noninvasive ventilation; Oxygen therapy; Patient self-inflicted lung injury; Respiratory failure; Tidal volume.


Introduction : Multiple devices are available for noninvasive oxygenation support, including non-rebreather oxygen mask (O2-mask), high-flow oxygen through nasal cannula (HFNC), continuous positive airway pressure (CPAP), mask noninvasive ventilation (Mask-NIV) and helmet NIV (Helmet-NIV). As tidal volume is a key determinant of efficacy and safety during ventilatory support, we assessed whether it was influenced by the type of noninvasive oxygenation device.

Méthode : A bench study using a manikin with a realistic face connected to a lung simulator was performed. Six conditions were assessed: no device, O2-mask, HFNC, CPAP, Mask-NIV and Helmet-NIV. Three respiratory mechanics were simulated (normal, obstructive, restrictive), at three simulated efforts (low, moderate, respiratory distress). Flow was recorded at the lung simulator inlet and mouth pressure into the manikin mouth. The same devices were evaluated on healthy volunteers with tidal volume assessed by electrical impedance tomography (EIT).

Résultats : Tidal volume was significantly influenced by oxygenation devices in bench model. As compared to O2-mask, HFNC and CPAP delivered significantly lower tidal volumes (440 ± 352 mL, 414 ± 333 mL and 377 ± 297 mL, respectively), while Mask-NIV or Helmet-NIV were associated with significantly higher tidal volumes (690 ± 321 mL and 652 ± 366 mL, respectively). Tidal volume was strongly correlated with the specific effect of each device on mouth pressure during inspiration: HFNC and CPAP were characterized by a negative PTPmouth (- 0.3 [- 0.8 to - 0.2] and - 0.7 [- 2.2 to - 0.5] cmH2O.sec/cycle, respectively), while Helmet-NIV and Mask-NIV were associated with a positive PTPmouth (4.5 [4.1-4.6] and 6.1 [5.9-7.1] cmH2O.sec/cycle, respectively). Tidal volume was also significantly influenced by oxygenation devices in healthy volunteers, with similar tidal volumes between O2-mask and CPAP (644 [571-764] and 648 [586-770] mL) but higher with HFNC, Mask-NIV and Helmet-NIV (819 [609-918], 1110 [661-1305] and 1086 [833-1243] mL).

Conclusion : Tidal volume is significantly influenced by noninvasive oxygenation support devices, with a strong correlation with the pressure variation generated into the mouth during inspiration. NIV was associated with the highest tidal volumes and CPAP with the lowest ones. Clinical studies are needed to clarify the clinical implications of these effects.

Conclusion (proposition de traduction) : Le volume courant est significativement influencé par les dispositifs d'oxygénation non invasifs, avec une forte corrélation avec la variation de pression générée dans la bouche pendant l'inspiration. La VNI est associée aux volumes courants les plus élevés et la CPAP aux plus faibles. Des études cliniques sont nécessaires pour clarifier les implications cliniques de ces effets.

Commentaire : Variables physiologiques des volontaires sains en fonction de chaque dispositif

European Heart Journal - Digital Health

International evaluation of an artificial intelligence-powered ecg model detecting acute coronary occlusion myocardial infarction.
Robert Herman, H Pendell Meyers, Stephen W Smith, Dario T Bertolone, Attilio Leone, Konstantinos Bermpeis, Michele M Viscusi, Marta Belmonte, Anthony Demolder, Vladimir Boza, Boris Vavrik, Viera Kresnakova, Andrej Iring, Michal Martonak, Jakub Bahyl, Timea Kisova, Dan Schelfaut, Marc Vanderheyden, Leor Perl, Emre K Aslanger, Robert Hatala, Wojtek Wojakowski, Jozef Bartunek, Emanuele Barbato.. | Eur Heart J Digit Health. 2023;, ztad074
DOI:  | Télécharger l'article au format  
Keywords: Electrocardiogram, artificial intelligence, acute coronary syndrome, myocardial infarction, Occlusion Myocardial Infarction, NSTEMI


Introduction : Majority of acute coronary syndromes (ACS) present without typical ST-elevation. One third of Non-ST-elevation myocardial infarction (NSTEMI) patients have an acutely occluded culprit coronary artery (occlusion myocardial infarction [OMI]), leading to poor outcomes due to delayed identification and invasive management. We sought to develop a versatile artificial intelligence (AI)-model detecting acute OMI on single standard 12-lead electrocardiograms (ECGs) and compare its performance to existing state-of-the-art diagnostic criteria.

Méthode : An AI model was developed using 18,616 ECGs from 10,543 patients with suspected ACS from an international database with clinically validated outcomes. The model was evaluated in an international cohort and compared with STEMI criteria and ECG experts in detecting OMI. Primary outcome of OMI was an acutely occluded or flow-limiting culprit artery requiring emergent revascularization.

Résultats : In the overall test set of 3,254 ECGs from 2,222 patients (age 62 ± 14 years, 67% males, 21.6% OMI), the AI model achieved an area under the curve (AUC) of 0.938 (95% CI: 0.924-0.951) in identifying the primary OMI outcome, with superior performance (accuracy 90.9% [95% CI: 89.7-92.0], sensitivity 80.6% [95% CI: 76.8-84.0], specificity 93.7 [95% CI: 92.6-94.8]) compared to STEMI criteria (accuracy 83.6% [95% CI: 82.1-85.1], sensitivity 32.5% [95% CI: 28.4-36.6], specificity 97.7% [95% CI: 97.0-98.3]) and similar performance compared to ECG experts (accuracy 90.8% [95% CI: 89.5-91.9], sensitivity 73.0% [95% CI: 68.7-77.0], specificity 95.7% [95% CI: 94.7-96.6]).

Conclusion : The present novel ECG AI model demonstrates superior accuracy to detect acute OMI when compared to the STEMI criteria. This suggests its potential to improve ACS triage ensuring appropriate and timely referral for immediate revascularization.

Conclusion (proposition de traduction) : Le nouveau système d'analyse de l'ECG démontre une précision supérieure dans la détection de l'infarctus du myocarde aigu par occlusion par rapport aux critères d'infarctus du myocarde avec sus-décalage du segment ST. Cela suggère son potentiel pour améliorer le triage des syndromes coronariens aigus en assurant une orientation appropriée et rapide vers une revascularisation immédiate.


2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.
Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, Fernanda de Almeida M, De Caen AR, Deakin . | Resuscitation. 2023 Nov 7:109992
DOI:  | Télécharger l'article au format  
Keywords: AHA Scientific Statements; Advanced life support; Cardiac arrest; First aid; Infant; Newborn; Pediatrics.


Editorial : The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training.

Conclusion : Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

Conclusion (proposition de traduction) : Les membres de six groupes de travail de l'International Liaison Committee on Resuscitation ont évalué, discuté et débattu de la qualité des preuves, en utilisant les critères d'évaluation, d'élaboration et d'évaluation de la gradation des recommandations, et leurs déclarations comprennent des recommandations de traitement consensuelles. Les sections Justification et Points forts du cadre des données probantes à la décision donnent un aperçu des délibérations des groupes de travail. En outre, les groupes de travail dressent la liste des lacunes de connaissances prioritaires pour la poursuite de la recherche. D'autres sujets sont abordés dans le cadre d'examens de la portée et de mises à jour des données probantes.

Mois de novembre 2023