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Bernat M, Boyer A, Roche M, Richard C, Bouvet L, Remacle A, Antonini F, Poirier M, Pastene B, Hammad E, Fond G, Bruder N, Leone M, Zieleskiewicz L. Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients. Anaesthesia 2024; 79:309-317. [PMID: 38205529 DOI: 10.1111/anae.16221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
Global warming is a major public health concern. Volatile anaesthetics are greenhouse gases that increase the carbon footprint of healthcare. Modelling studies indicate that total intravenous anaesthesia is less carbon intensive than volatile anaesthesia, with equivalent quality of care. In this observational study, we aimed to apply the findings of previous modelling studies to compare the carbon footprint per general anaesthetic of an exclusive TIVA strategy vs. a mixed TIVA-volatile strategy. This comparative retrospective study was conducted over 2 years in two French hospitals, one using total intravenous anaesthesia only and one using a mixed strategy including both intravenous and inhalation anaesthetic techniques. Based on pharmacy procurement records, the quantity of anaesthetic sedative drugs was converted to carbon dioxide equivalents. The primary outcome was the difference in carbon footprint of hypnotic drugs per intervention between the two strategies. From 1 January 2021 to 31 December 2022, 25,137 patients received general anaesthesia in the hospital using the total intravenous anaesthesia strategy and 22,020 in the hospital using the mixed strategy. The carbon dioxide equivalent footprint of hypnotic drugs per intervention in the hospital using the total intravenous anaesthesia strategy was 20 times lower than in the hospital using the mixed strategy (emissions of 2.42 kg vs. 48.85 kg carbon dioxide equivalent per intervention, respectively). The total intravenous anaesthesia strategy significantly reduces the carbon footprint of hypnotic drugs in general anaesthesia in adult patients compared with a mixed strategy. Further research is warranted to assess the risk-benefit ratio of the widespread adoption of total intravenous anaesthesia.
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Affiliation(s)
- M Bernat
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - A Boyer
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Roche
- Pharmacy Department, Service Central des Opérations Pharmaceutiques, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - C Richard
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - L Bouvet
- Department of Anesthesia and Critical Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - A Remacle
- Departement of Medical Information, Hôpital Nord, Marseille, France
| | - F Antonini
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Poirier
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - B Pastene
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - E Hammad
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - G Fond
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - N Bruder
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Leone
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - L Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
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Padilla C, Ortner C, Dennis A, Zieleskiewicz L. The need for maternal critical care education, point-of-care ultrasound and critical care echocardiography in obstetric anesthesiologists training. Int J Obstet Anesth 2023; 55:103880. [PMID: 37105833 DOI: 10.1016/j.ijoa.2023.103880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
Globally, the increase in medically complex obstetric patients is challenging the educational approach and clinical management of critically ill obstetric patients. This increase in medical complexity calls into question the educational paradigm in which future physicians are trained. Obstetric anesthesiologists, physician experts in the perio-perative planning and management of complex obstetric patients, represent an essential workforce in the strategies to address maternal mortality. Unfortunately, the development of peri-operative medicine and maternal critical care curricula has only received minor attention in most countries. Proposed guidelines and models highlight the existing need for tiered maternity care services in which critical care infrastructure plays a central role in the delivery of high-risk peripartum care. Therefore, the development of maternal critical care models designed to prepare obstetric anesthesiologists for the clinical challenges of a medically complex patient are warranted. Key critical care topics such as advanced ultrasonography, with the inclusion of quantitative echocardiographic assessments into obstetric anesthesiology educational curricula, will serve to better prepare physicians for the realities of an increasingly complex pregnant patient population, and further reinforce the critical care infrastructure detailed in the Levels of Maternal Care consensus. Despite an increasingly complex obstetric patient population, heterogeneity of maternal critical care practices exists across the globe, warranting standardization and further development of proposed curricula.
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Affiliation(s)
- C Padilla
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - C Ortner
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA, USA
| | - A Dennis
- Departments of Critical Care, Obstetrics and Gynecology, and Pharmacology, University of Melbourne, Australia
| | - L Zieleskiewicz
- Département d'Anesthésie-Réanimation, Médecine Péri-opératoire, Hôpital Nord, AP-HM Marseille, France
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Duclos G, Granier S, Hili A, Blanc J, Einav S, Leone. M, Zieleskiewicz L. Performance of non-invasive stroke volume variation during passive leg raise as a predictor of hypotension following induction of spinal anesthesia for elective cesarean delivery: a single cohort study. Int J Obstet Anesth 2021; 50:103251. [DOI: 10.1016/j.ijoa.2021.103251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 12/03/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
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Bouvet L, Zieleskiewicz L, Loubradou E, Alain A, Morel J, Argaud L, Chassard D, Leone M, Allaouchiche B. Reliability of gastric suctioning compared with ultrasound assessment of residual gastric volume: a prospective multicentre cohort study. Anaesthesia 2019; 75:323-330. [DOI: 10.1111/anae.14915] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 12/28/2022]
Affiliation(s)
- L. Bouvet
- Department of Anaesthesia and Intensive Care Hospices Civils de Lyon Hôpital Femme Mère Enfant Lyon France
- Department of Anaesthesia and Intensive Care APCSe VetAgro Sup UPSP 2016.A101 Marcy‐l'Etoile France
| | - L. Zieleskiewicz
- Department of Anaesthesia and Intensive Care Hôpital Nord Assistance Publique –Hôpitaux de Marseille Marseille France
| | - E. Loubradou
- Department of Anaesthesia and Intensive Care Hospices Civils de Lyon Hôpital Femme Mère Enfant Lyon France
| | - A. Alain
- Department of Anaesthesia and Intensive Care Hôpital Nord Assistance Publique –Hôpitaux de Marseille Marseille France
| | - J. Morel
- Department of Anaesthesia and Intensive Care Centre Hospitalier Universitaire de Saint‐Étienne Saint‐Étienne France
| | - L. Argaud
- Department of Anaesthesia and Intensive Care Civils de Lyon Groupement Hospitalier Centre Lyon France
| | - D. Chassard
- Department of Anaesthesia and Intensive Care Hospices Civils de Lyon Hôpital Femme Mère Enfant Lyon France
- Department of Anaesthesia and Intensive Care APCSe VetAgro Sup UPSP 2016.A101 Marcy‐l'Etoile France
| | - M. Leone
- Department of Anaesthesia and Intensive Care Hôpital Nord Assistance Publique –Hôpitaux de Marseille Marseille France
| | - B. Allaouchiche
- Department of Anaesthesia and Intensive Care APCSe VetAgro Sup UPSP 2016.A101 Marcy‐l'Etoile France
- Department of Anaesthesia and Intensive Care Hospices Civils de Lyon Groupement Hospitalier Sud Pierre‐Bénite Cedex France
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Dransart‐Rayé O, Roldi E, Zieleskiewicz L, Guinot PG, Mojoli F, Mongodi S, Bouhemad B. Lung ultrasound for early diagnosis of postoperative need for ventilatory support: a prospective observational study. Anaesthesia 2019; 75:202-209. [DOI: 10.1111/anae.14859] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2019] [Indexed: 01/06/2023]
Affiliation(s)
- O. Dransart‐Rayé
- Department of Anaesthesiology and Intensive Care C.H.U. Dijon France
| | - E. Roldi
- Department of Anaesthesia and Intensive Care Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo Foundation University of Pavia Italy
| | - L. Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Aix‐Marseille University Marseille France
- C2VN Inra Inserm Faculty of medicine Aix‐ Marseille University Marseille France
| | - P. G. Guinot
- Department of Anaesthesiology and Intensive Care C.H.U. Dijon France
- Lipness Team INSERM Research Center LNC‐UMR1231 and LabEx LipSTIC Université Bourgogne Franche‐Comté Dijon France
| | - F. Mojoli
- Department of Anaesthesia and Intensive Care Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo Foundation University of Pavia Italy
| | - S. Mongodi
- Department of Anaesthesia and Intensive Care Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo Foundation University of Pavia Italy
| | - B. Bouhemad
- Department of Anaesthesiology and Intensive Care C.H.U. Dijon France
- Lipness Team INSERM Research Center LNC‐UMR1231 and LabEx LipSTIC Université Bourgogne Franche‐Comté Dijon France
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Bobot M, Zieleskiewicz L, Burtey S, Jourde-Chiche N, Dussol B, Sallée M, Berland Y, Brunet P, Robert T. Performances diagnostiques de l’échographie pulmonaire et d’un score clinique pour l’évaluation de l’état d’hydratation chez le patient hémodialysé chronique. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Zieleskiewicz L, Bouvet L, Einav S, Duclos G, Leone M. Diagnostic point‐of‐care ultrasound: applications in obstetric anaesthetic management. Anaesthesia 2018; 73:1265-1279. [DOI: 10.1111/anae.14354] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 12/13/2022]
Affiliation(s)
- L. Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Aix Marseille university C2VN France
| | - L. Bouvet
- Department of Anaesthesia and Intensive Care Medicine Hospices Civils de Lyon Hôpital Femme Mère Enfant Bron France
| | - S. Einav
- General Intensive Care Shaare Zedek Medical Centre Hebrew University Faculty of Medicine Jerusalem Israel
| | - G. Duclos
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Marseille France
| | - M. Leone
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Marseille France
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Affiliation(s)
- L Bouvet
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | - F-P Desgranges
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | - D Chassard
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | - L Zieleskiewicz
- Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
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Duclos G, Hili A, Resseguier N, Kelway C, Haddam M, Bourgoin A, Carcopino X, Zieleskiewicz L, Leone M. Clearsight™ use for haemodynamic monitoring during the third trimester of pregnancy - a validation study. Int J Obstet Anesth 2018; 36:85-95. [PMID: 30392653 DOI: 10.1016/j.ijoa.2018.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 04/21/2018] [Accepted: 04/29/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND We assessed the validity of Clearsight™ as a non-invasive cardiac output and stroke volume monitoring device, comparing it with transthoracic echocardiography measurements during the third trimester of pregnancy. METHODS Measurements obtained from Clearsight™ were compared with those from echocardiography as the gold standard. The precision and accuracy of the Clearsight™ was measured using the Bland and Altman method. Clinical agreement with echocardiography was assessed using the agreement tolerability index. RESULTS Measurements were recorded from 44 pregnant women with a median [IQR range] gestational age of 33 [30-37] weeks. We found that Clearsight™ measurements presented a systematic overestimation of cardiac output, with mean bias [CI 95%] of 2.7 [2.3-3.0] L/min, with limits of agreement of -0.1 to 5.4 L/min. It overestimated stroke volume, with a bias of 29.5 [25.0-33.4] mL and a limit of agreement of -1.6 to 60.1 mL. In addition, the analysis of cardiac output showed a percentage of error of 41% and intra-class correlation [CI 95%] of 0.37 [0.17 to 0.53, P <0.001]. For stroke volume, the percentage of error was 40% and intra-class correlation 0.16 [-0.1 to 0.34; P=0.27]. We found that agreement tolerability index scores were unacceptable. We evaluated the ability of the device to track changes in cardiac output by inducing a left lateral decubitus position, but the analysis was inconclusive. CONCLUSION The agreement between Clearsight™ and the echocardiography measurements of cardiac output and stroke volume were not within an acceptable range in the third trimester of pregnancy.
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Affiliation(s)
- G Duclos
- Aix Marseille University, Department of Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Marseille, University Hospital of Marseille, Marseille, France.
| | - A Hili
- Aix Marseille University, Department of Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Marseille, University Hospital of Marseille, Marseille, France
| | - N Resseguier
- Aix Marseille University, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, University Hospital of Marseille, Marseille, France
| | - C Kelway
- Service de réanimation polyvalente, Hôpital sainte Musse, Toulon, France
| | - M Haddam
- Aix Marseille University, Department of Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Marseille, University Hospital of Marseille, Marseille, France
| | - A Bourgoin
- Aix Marseille University, Department of Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Marseille, University Hospital of Marseille, Marseille, France
| | - X Carcopino
- Department of Obstetrics and Gynecology, Gynépôle, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - L Zieleskiewicz
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
| | - M Leone
- Clinical Investigation Center 1409, Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France
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Nafati C, Gardette M, Leone M, Reydellet L, Blasco V, Lannelongue A, Sayagh F, Wiramus S, Antonini F, Albanèse J, Zieleskiewicz L. Use of speckle-tracking strain in preload-dependent patients, need for cautious interpretation! Ann Intensive Care 2018; 8:29. [PMID: 29468335 PMCID: PMC5821613 DOI: 10.1186/s13613-018-0376-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/16/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In critical patients, left ventricular ejection fraction and fractional shortening are used to reflect left ventricular systolic function. An emerging technique, two-dimensional-strain echocardiography, allows assessment of the left ventricle systolic longitudinal deformation (global longitudinal strain) and the speed at which this deformation occurs (systolic strain rate). This technique is of increasing use in critical patients in intensive care units and in the peri-operative period where preload constantly varies. Our objective, in this prospective single-center observational study, was to evaluate the effect of fluid resuscitation on two-dimensional-strain echocardiography measurements in preload-dependent critically ill patients. We included 49 patients with preload dependence attested by an increase of at least 10% in the left ventricular outflow track velocity-time integral measured by echocardiography during a passive leg raising maneuver. Echocardiography was performed before fluid resuscitation (echocardiography 1) and after preload independency achievement (echocardiography 2). RESULTS Two-dimensional-strain echocardiography was feasible in 40 (82%) among the 49 patients. With preload dependence correction, the absolute value of global longitudinal strain and systolic strain rate was significantly increased from, respectively, - 13.3 ± 3.5 to - 18.4% ± 4.5 (p < 0.01) and - 1.11 s-1 ± 0.29 to - 1.55 s-1 ± 0.55 (p < 0.001). The fluid resuscitation affects GLS and SSR in preload-dependent patients, with a shift, for GLS, from pathological to normal values. CONCLUSION In critically ill patients, the assessment of the systolic function by two-dimensional-strain echocardiography needs prior evaluation of preload dependency, in order to adequately interpret this variable. Future studies should assess the ability of global longitudinal strain to guide fluid management in the critically ill patients.
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Affiliation(s)
- C Nafati
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France. .,Service d'anesthésie et de réanimation, CHU de la Timone, 264 rue Saint Pierre, 13005, Marseille, France.
| | - M Gardette
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - M Leone
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, North Hospital, Marseille, France.,Centre d'Investigation Clinique, Aix-Marseille University, AP-HM, 14901, Marseille, France
| | - L Reydellet
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - V Blasco
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - A Lannelongue
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - F Sayagh
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - S Wiramus
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - F Antonini
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, North Hospital, Marseille, France
| | - J Albanèse
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - L Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, North Hospital, Marseille, France
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Dreyfus M, Weber P, Zieleskiewicz L. [Maternal deaths due to hypertensive disorders. Results from the French confidential enquiry into maternal deaths, 2010-2012]. ACTA ACUST UNITED AC 2017; 45:S38-S42. [PMID: 29117926 DOI: 10.1016/j.gofs.2017.10.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Indexed: 11/20/2022]
Abstract
Between 2010 and 2012, the rate of maternal death caused by hypertensive disorders (0,5/100,000 living birth) was reduced by 50% compared to the 2007-2009 period. Hypertensive disorders were responsible from 5% of maternal deaths and from 10% of direct maternal mortality. Eleven deaths happened during the postpartum period but 9 hypertensive complications began before delivery. Seventy percent of these deaths seem to be avoidable. The main causes of suboptimal management were: unappropriated or insufficient obstetrical and anesthetic treatments, undiagnosed HELLP syndrome and subcapsular liver hematoma, delayed treatment. The analysis of these maternal deaths gave the opportunity to stress some major lessons to optimize medical management in case of hypertensive diseases during pregnancy: abdominal symptoms during third trimester of pregnancy lead to search hypertensive disorders; HELLP syndrome with severe anemia indicate to carry out abdominal ultrasound.
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Affiliation(s)
- M Dreyfus
- UFR médecine, gynécologie-obstétrique et médecine de la reproduction, CHU de Caen, université de Caen, avenue de la Côte-de-Nacre, 14003 Caen, France.
| | - P Weber
- Gynécologie-obstétrique, centre hospitalier, 87, avenue d'Altkirch, 68051 Mulhouse, France
| | - L Zieleskiewicz
- Département d'anesthésie réanimation, réanimation polyvalente et fédération de traumatologie, CHU hôpital Nord, chemin des Bourrelu, 13915 Marseille, France
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Zieleskiewicz L, Noel A, Duclos G, Haddam M, Delmas A, Bechis C, Loundou A, Blanc J, Mignon A, Bouvet L, Einav S, Bourgoin A, Leone M. Can point-of-care ultrasound predict spinal hypotension during caesarean section? A prospective observational study. Anaesthesia 2017; 73:15-22. [PMID: 28986931 DOI: 10.1111/anae.14063] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2017] [Indexed: 12/18/2022]
Abstract
Spinal anaesthesia for elective caesarean section is associated with maternal hypotension, secondary to alteration of sympathetic tone and hypovolemia, in up to 70% of cases. Measurement of the subaortic variation in the velocity time integral (VTI) after passive leg raising allows prediction of fluid responsiveness. Our objective, in this prospective single-centre observational study, was to assess the ability of change in VTI after 45° passive leg raising to predict hypotension after spinal anaesthesia. Ultrasound measurements were performed just before elective caesarean section. Anaesthesia, intravenous coloading and prophylactic vasopressor treatment were standardised according to current guidelines. We studied 40 women. Hypotension occurred in 17 (45%) women. The area (95%CI) under the receiver operating characteristics (ROC) curve for the prediction of spinal hypotension was 0.8 (0.6-0.9; p = 0.0001). Seventeen women had a change in VTI with leg elevation ≤ 8%, which was predictive for not developing hypotension, and 11 had a change ≥ 21%, predictive for hypotension. The grey zone between 8% and 21%, with inconclusive values, included 12 women. We suggest that cardiac ultrasound provides characterisation of the risk of hypotension following spinal anaesthesia at elective caesarean section, and therefore may allow individualised strategies for prevention and management.
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Affiliation(s)
- L Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, Marseille, France
| | - A Noel
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, Marseille, France
| | - G Duclos
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, Marseille, France
| | - M Haddam
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, Marseille, France
| | - A Delmas
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, Marseille, France
| | - C Bechis
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, Marseille, France
| | - A Loundou
- Epidemiology and Methodology Department, Aix Marseille University, Marseille, France
| | - J Blanc
- Department of Obstetrics and Gynecology, Aix Marseille University, Marseille, France
| | - A Mignon
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, Marseille, France
| | - L Bouvet
- Department of Anaesthesia and Intensive Care Medicine, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - S Einav
- General Intensive Care, Shaare Zedek Medical Centre and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - A Bourgoin
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, Marseille, France
| | - M Leone
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, Marseille, France.,Centre d'Investigation Clinique 1409, AP-HM, Aix Marseille University, Marseille, France
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Zieleskiewicz L, Leone M. Re: Lung and cardiac ultrasound for hemodynamic monitoring of patients with severe pre-eclampsia. J. Ambrozic, G. Brzan Simenc, K. Prokselj, N. Tulz, M. Cvijic and M. Lucovnik. Ultrasound Obstet Gynecol 2017; 49: 104-109. Ultrasound Obstet Gynecol 2017; 49:22. [PMID: 28058788 DOI: 10.1002/uog.17354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- L Zieleskiewicz
- Department of Anesthesiology and Critical Care Medicine, North Hospital, Aix Marseille University, Marseille, France
| | - M Leone
- Department of Anesthesiology and Critical Care Medicine, North Hospital, Aix Marseille University, Marseille, France
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Zieleskiewicz L, Boghossian M, Delmas A, Jay L, Bourgoin A, Carcopino X, Poirier M, Cogniat B, Stewart A, Chassard D, Leone M, Bouvet L. Ultrasonographic measurement of antral area for estimating gastric fluid volume in parturients. Br J Anaesth 2016; 117:198-205. [DOI: 10.1093/bja/aew171] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/14/2022] Open
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Blasco V, Colavolpe J, Antonini F, Zieleskiewicz L, Nafati C, Albanèse J, Leone M. Long-term outcome in kidney recipients from donors treated with hydroxyethylstarch 130/0.4 and hydroxyethylstarch 200/0.6. Br J Anaesth 2015; 115:798. [DOI: 10.1093/bja/aev335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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16
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Zieleskiewicz L, Cornesse A, Hammad E, Haddam M, Brun C, Vigne C, Meyssignac B, Remacle A, Chaumoitre K, Antonini F, Martin C, Leone M. Implementation of lung ultrasound in polyvalent intensive care unit: Impact on irradiation and medical cost. Anaesth Crit Care Pain Med 2015; 34:41-4. [PMID: 25829314 DOI: 10.1016/j.accpm.2015.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the effect of implementing a daily lung ultrasound round on the number of chest radiographs and chest computed tomography (CT) scans in a polyvalent intensive care unit (ICU). STUDY DESIGN Retrospective study comparing two consecutive periods. PATIENTS All patients hospitalized for longer than 48 hours in a polyvalent ICU. METHODS Implementation of a daily lung ultrasound round after a short educational program. The number of chest radiographs and chest CT scans and the patient outcome were measured before (group PRE) and after (group POST) the implementation of a daily lung ultrasound round. RESULTS No demographic difference was found between the two groups, with the exception of a higher severity score in the group POST. For each ICU stay, the number of chest radiographs was 10.3 ± 12.4 in the group PRE and 7.7 ± 10.3 in the group POST, respectively (P<0.005) The number of chest CT scans was not reduced in the group POST, as compared with the group PRE (0.5 ± 0.7 CT scan/patient/ICU stay versus 0.4 ± 0.6 CT scan/patient/ICU stay, P=0.01). The ICU mortality was similar in both groups (21% versus 22%, P=0.75) CONCLUSION: The implementation of a daily lung ultrasound round was associated with a reduction in radiation exposure and medical cost without altering patient outcome.
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Affiliation(s)
- L Zieleskiewicz
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - A Cornesse
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - E Hammad
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - M Haddam
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - C Brun
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - C Vigne
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - B Meyssignac
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - A Remacle
- Department of medical informatics, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - K Chaumoitre
- Department of radiology, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - F Antonini
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - C Martin
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - M Leone
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
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Leone M, Zieleskiewicz L. Meeting the hidden face of the heart. Minerva Anestesiol 2014; 80:975-977. [PMID: 24472753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- M Leone
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix Marseille Université, Marseille, France -
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Duclos G, Dumont JC, Ranque S, Zieleskiewicz L, Bruder N. [Meningitis to Candida albicans at the adult, use of the new diagnosis methods]. ACTA ACUST UNITED AC 2014; 33:533-5. [PMID: 25127852 DOI: 10.1016/j.annfar.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/09/2014] [Indexed: 11/15/2022]
Abstract
Candida albicans or non-albicans are a frequent source of infection but seldom displayed in cerebrospinal fluid although responsible of an important number of nosocomial meningitis. Diagnosis is difficult which often delays treatment, which in turn hinders prognostic. This clinical case shows a patient afflicted with a deadly C. albicans meningitis and allows us to focus on new diagnostic tools and advice against this infection.
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Affiliation(s)
- G Duclos
- Département d'anesthésie-réanimation, hôpital Nord, chemin des Bourrelly, 13015 Marseille, France.
| | - J-C Dumont
- Département d'anesthésie-réanimation, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - S Ranque
- Laboratoire de mycologie médicale, hôpital de la Timone, université Aix-Marseille - Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - L Zieleskiewicz
- Département d'anesthésie-réanimation, hôpital Nord, chemin des Bourrelly, 13015 Marseille, France
| | - N Bruder
- Département d'anesthésie-réanimation, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
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Zieleskiewicz L, Boustiere V, Bourgoin A, Hammad E, Leone M, Bretelle F. Nicardipine-associated pulmonary edema in a parturient: use of chest ultrasound. Int J Obstet Anesth 2014; 23:291-2. [DOI: 10.1016/j.ijoa.2014.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/23/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
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Blasco V, Antonini F, Zieleskiewicz L, Hammad E, Albanèse J, Martin C, Leone M. Comparative study of three methods of estimation of creatinine clearance in critically ill patients. ACTA ACUST UNITED AC 2014; 33:e85-8. [PMID: 24835538 DOI: 10.1016/j.annfar.2014.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 04/08/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND At the bedside, the reference method for creatinine clearance determination is based on the measurement of creatinine concentrations in urine and serum (mCrCl). Several models are available to calculate the creatinine clearance from the serum creatinine concentration. This observational survey aimed at testing the hypothesis that the proposed equations are unreliable to determine accurate creatinine clearance in patients admitted to intensive care unit (ICU). METHOD Creatinine clearance was determined by the use of mCrCl. Then, we compared three equations: Cockcroft-Gault (CG), Simplified Modification of Diet in Renal Disease (MDRDs), and Chronic Kidney Disease Epidemiology (CKD-EPI) in 156 consecutive patients within the first 24hours after ICU admission. We tested the hypothesis that the three equations were equivalent. The agreement between the three equations was evaluated by linear regression and Bland and Altman analysis. RESULTS Bland and Altman analysis showed similar agreement between the three equations. The biases and precisions were -4.8±51, -1.3±50, and 8.2±44 for CG, MDRDs, and CKD-EPI equations, respectively (P>0.05). The precisions were similar for the three equations (P>0.05). The percentages of outliers at ±30% were 44%, 45%, and 49% for CG, MDRDs, and CKD-EPI, respectively (P>0.05). CONCLUSION Regarding the high percentage of outliers, the use of these equations cannot be recommended in ICU patients.
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Affiliation(s)
- V Blasco
- Service d'anesthésie et de réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, chemin des Bourrely, 13015 Marseille, France
| | - F Antonini
- Service d'anesthésie et de réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, chemin des Bourrely, 13015 Marseille, France
| | - L Zieleskiewicz
- Service d'anesthésie et de réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, chemin des Bourrely, 13015 Marseille, France
| | - E Hammad
- Service d'anesthésie et de réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, chemin des Bourrely, 13015 Marseille, France
| | - J Albanèse
- Service d'anesthésie et de réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, chemin des Bourrely, 13015 Marseille, France
| | - C Martin
- Service d'anesthésie et de réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, chemin des Bourrely, 13015 Marseille, France
| | - M Leone
- Service d'anesthésie et de réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, chemin des Bourrely, 13015 Marseille, France.
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Mahjoub Y, Lejeune V, Muller L, Perbet S, Zieleskiewicz L, Bart F, Veber B, Paugam-Burtz C, Jaber S, Ayham A, Zogheib E, Lasocki S, Vieillard-Baron A, Quintard H, Joannes-Boyau O, Plantefève G, Montravers P, Duperret S, Lakhdari M, Ammenouche N, Lorne E, Slama M, Dupont H. Evaluation of pulse pressure variation validity criteria in critically ill patients: a prospective observational multicentre point-prevalence study †. Br J Anaesth 2014; 112:681-685. [DOI: 10.1093/bja/aet442] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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Zieleskiewicz L, Lagier D, Contargyris C, Bourgoin A, Gavage L, Martin C, Leone M. Lung ultrasound-guided management of acute breathlessness during pregnancy. Anaesthesia 2012; 68:97-101. [PMID: 23088788 DOI: 10.1111/anae.12037] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Lung ultrasonography is a standard tool in the intensive care unit and in emergency medicine, but has not been described in the particular setting of the labour ward. During pregnancy, acute respiratory failure and pulmonary oedema are not uncommon life-threatening events. We present two case reports outlining the potential of lung ultrasonography in parturients. In case 1, lung ultrasonography allowed early diagnosis and treatment of acute dyspnoea in a parturient admitted for suspected asthma exacerbation. Lung ultrasonography revealed a 'B-pattern' of vertical lines radiating into the lung tissue, indicating severe pulmonary oedema complicating previously undiagnosed pre-eclampsia. In case 2, a pre-eclamptic patient was managed with combined transthoracic echocardiography and lung ultrasonography. The accuracy of lung ultrasonography in detecting interstitial oedema at a pre-clinical stage allowed adequate fluid resuscitation in this patient who had a high risk of alveolar pulmonary oedema. We believe that these cases strongly support the prospective validation of lung ultrasound for management of lung disorders in pregnant women.
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Affiliation(s)
- L Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, Marseille, France.
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Contargyris C, Zieleskiewicz L, Meyssignac B, Leone M, Martin C. [Late rupture of a mycotic aneurysm occurring after an appropriate antibiotic therapy of Streptococcus mitis mitral endocarditis]. ACTA ACUST UNITED AC 2012; 31:827-8. [PMID: 23021619 DOI: 10.1016/j.annfar.2012.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 08/15/2012] [Indexed: 11/28/2022]
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Zieleskiewicz L, Arbelot C, Hammad E, Brun C, Textoris J, Martin C, Leone M. [Lung ultrasound: clinical applications and perspectives in intensive care unit]. ACTA ACUST UNITED AC 2012; 31:793-801. [PMID: 22922015 DOI: 10.1016/j.annfar.2012.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 07/09/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the use of lung ultrasound in clinical practice and the new opportunities offered by this technology in intensive care unit (ICU) patients. METHOD Review of signs identified by lung ultrasound and systematic analysis of data published within the last 5 years on its use in ICU. The literature has been extracted from the database Pubmed™. Specific keywords were used to select relevant publications. Clinical studies published in French and English languages were assessed. RESULTS Lung ultrasound serves to diagnose, quantify, drain and monitor pleural effusions. In patients with acute respiratory failure, lung ultrasound participates to the diagnosis, the implementation of treatments and their follow-up. It helps to manage patients with pneumonia and acute lung injury. Finally, the investigation of the interstitial edema brings information about hemodynamics that can serve to manage our patients. CONCLUSION Lung ultrasound is an easy, non-invasive, and non-irradiant technology. It brings lot of useful information at the patient's bedside.
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Affiliation(s)
- L Zieleskiewicz
- Service d'anesthésie et de réanimation, Aix-Marseille université, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille cedex 20, France.
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Bellefleur JP, Milhaud Y, Beconcini G, Zieleskiewicz L, Ortega D, Martin C, Leone M. Réduction des coûts grâce à l’utilisation des seringues préremplies d’éphédrine. ACTA ACUST UNITED AC 2009; 28:211-4. [DOI: 10.1016/j.annfar.2008.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 12/02/2008] [Indexed: 12/01/2022]
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Zieleskiewicz L, Bellefleur JP, Antonini F, Ortega D, Leone M, Martin C. Gestion des voies aériennes supérieures en fin d’accouchement : enquête de pratique. ACTA ACUST UNITED AC 2009; 28:119-23. [DOI: 10.1016/j.annfar.2008.10.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 10/30/2008] [Indexed: 12/15/2022]
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