Stress index for positive end-expiratory pressure titration in prone position: a piglet study.
Identifieur interne : 000169 ( Main/Exploration ); précédent : 000168; suivant : 000170Stress index for positive end-expiratory pressure titration in prone position: a piglet study.
Auteurs : C. Pan [République populaire de Chine] ; R. Tang [République populaire de Chine] ; J. Xie [République populaire de Chine] ; J. Xu [République populaire de Chine] ; S. Liu [République populaire de Chine] ; T. Yu [République populaire de Chine] ; Y. Huang [République populaire de Chine] ; F. Guo [République populaire de Chine] ; Y. Yang [République populaire de Chine] ; H. Qiu [République populaire de Chine]Source :
- Acta anaesthesiologica Scandinavica [ 1399-6576 ] ; 2015.
Descripteurs français
- KwdFr :
- Animaux (MeSH), Décubitus ventral (MeSH), Modèles animaux de maladie humaine (MeSH), Mécanique respiratoire (physiologie), Poumon (physiopathologie), Suidae (MeSH), Syndrome de détresse respiratoire de l'adulte (physiopathologie), Ventilation à pression positive (MeSH), Volume courant (physiologie).
- MESH :
- physiologie : Mécanique respiratoire, Volume courant.
- physiopathologie : Poumon, Syndrome de détresse respiratoire de l'adulte.
- Animaux, Décubitus ventral, Modèles animaux de maladie humaine, Suidae, Ventilation à pression positive.
English descriptors
- KwdEn :
- MESH :
- physiology : Respiratory Mechanics, Tidal Volume.
- physiopathology : Lung, Respiratory Distress Syndrome, Adult.
- Animals, Disease Models, Animal, Positive-Pressure Respiration, Prone Position, Swine.
Abstract
BACKGROUND
Prone position ventilation is an important treatment for acute respiratory distress syndrome (ARDS), but chest wall elastance increases in prone position ventilation, and stress index may not reflect the changes in lung mechanics. We therefore investigated the effects of stress index guided PEEP titration on pulmonary mechanics and hemodynamics in the prone position in a piglet acute lung injury model.
METHODS
Ten piglets with severe lavage-induced lung injury were mechanically ventilated in a decremental PEEP trial after full lung recruitment in the prone position. Stress-index PEEP was the level at which the airway pressure stress index was 1, and open-lung PEEP was the level at which it was required to keep the lung open according to computed tomography (CT) scans. Respiratory mechanics, blood gases, hemodynamics, and whole-lung CT were recorded at the two PEEP levels.
RESULTS
Respiratory system elastance and lung elastance were improved in the prone position but the ratio of chest wall elastance and respiratory system elastance was higher in the prone position. There was no significant difference between open-lung and stress-index guided PEEPs in the prone position (P = 0.46). There was no significant difference between collapsed lung volume (P = 0.07) and hyperinflation lung volume (P = 0.76) in the two groups. Similarly, there was no significant difference between open-lung and stress-index guided PEEPs in terms of oxygenation index (P = 0.95) and PaCO2 (P = 0.42).
CONCLUSIONS
Stress index can be used to titrate PEEP in the prone position in a surfactant-depleted lung injury model.
DOI: 10.1111/aas.12590
PubMed: 26198816
Affiliations:
Links toward previous steps (curation, corpus...)
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Pan</name><affiliation wicri:level="1"><nlm:affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu</wicri:regionArea><wicri:noRegion>Jiangsu</wicri:noRegion></affiliation></author><author><name sortKey="Tang, R" sort="Tang, R" uniqKey="Tang R" first="R" last="Tang">R. Tang</name><affiliation wicri:level="1"><nlm:affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu</wicri:regionArea><wicri:noRegion>Jiangsu</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui</wicri:regionArea><wicri:noRegion>Anhui</wicri:noRegion></affiliation></author><author><name sortKey="Xie, J" sort="Xie, J" uniqKey="Xie J" first="J" last="Xie">J. Xie</name><affiliation wicri:level="1"><nlm:affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu</wicri:regionArea><wicri:noRegion>Jiangsu</wicri:noRegion></affiliation></author><author><name sortKey="Xu, J" sort="Xu, J" uniqKey="Xu J" first="J" last="Xu">J. Xu</name><affiliation wicri:level="1"><nlm:affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu</wicri:regionArea><wicri:noRegion>Jiangsu</wicri:noRegion></affiliation></author><author><name sortKey="Liu, S" sort="Liu, S" uniqKey="Liu S" first="S" last="Liu">S. Liu</name><affiliation wicri:level="1"><nlm:affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu</wicri:regionArea><wicri:noRegion>Jiangsu</wicri:noRegion></affiliation></author><author><name sortKey="Yu, T" sort="Yu, T" uniqKey="Yu T" first="T" last="Yu">T. Yu</name><affiliation wicri:level="1"><nlm:affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu</wicri:regionArea><wicri:noRegion>Jiangsu</wicri:noRegion></affiliation></author><author><name sortKey="Huang, Y" sort="Huang, Y" uniqKey="Huang Y" first="Y" last="Huang">Y. Huang</name><affiliation wicri:level="1"><nlm:affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu</wicri:regionArea><wicri:noRegion>Jiangsu</wicri:noRegion></affiliation></author><author><name sortKey="Guo, F" sort="Guo, F" uniqKey="Guo F" first="F" last="Guo">F. Guo</name><affiliation wicri:level="1"><nlm:affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu</wicri:regionArea><wicri:noRegion>Jiangsu</wicri:noRegion></affiliation></author><author><name sortKey="Yang, Y" sort="Yang, Y" uniqKey="Yang Y" first="Y" last="Yang">Y. Yang</name><affiliation wicri:level="1"><nlm:affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu</wicri:regionArea><wicri:noRegion>Jiangsu</wicri:noRegion></affiliation></author><author><name sortKey="Qiu, H" sort="Qiu, H" uniqKey="Qiu H" first="H" last="Qiu">H. Qiu</name><affiliation wicri:level="1"><nlm:affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu</wicri:regionArea><wicri:noRegion>Jiangsu</wicri:noRegion></affiliation></author></analytic><series><title level="j">Acta anaesthesiologica Scandinavica</title><idno type="eISSN">1399-6576</idno><imprint><date when="2015" type="published">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Animals (MeSH)</term><term>Disease Models, Animal (MeSH)</term><term>Lung (physiopathology)</term><term>Positive-Pressure Respiration (MeSH)</term><term>Prone Position (MeSH)</term><term>Respiratory Distress Syndrome, Adult (physiopathology)</term><term>Respiratory Mechanics (physiology)</term><term>Swine (MeSH)</term><term>Tidal Volume (physiology)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Animaux (MeSH)</term><term>Décubitus ventral (MeSH)</term><term>Modèles animaux de maladie humaine (MeSH)</term><term>Mécanique respiratoire (physiologie)</term><term>Poumon (physiopathologie)</term><term>Suidae (MeSH)</term><term>Syndrome de détresse respiratoire de l'adulte (physiopathologie)</term><term>Ventilation à pression positive (MeSH)</term><term>Volume courant (physiologie)</term></keywords><keywords scheme="MESH" qualifier="physiologie" xml:lang="fr"><term>Mécanique respiratoire</term><term>Volume courant</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Respiratory Mechanics</term><term>Tidal Volume</term></keywords><keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Poumon</term><term>Syndrome de détresse respiratoire de l'adulte</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Lung</term><term>Respiratory Distress Syndrome, Adult</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Animals</term><term>Disease Models, Animal</term><term>Positive-Pressure Respiration</term><term>Prone Position</term><term>Swine</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Animaux</term><term>Décubitus ventral</term><term>Modèles animaux de maladie humaine</term><term>Suidae</term><term>Ventilation à pression positive</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Prone position ventilation is an important treatment for acute respiratory distress syndrome (ARDS), but chest wall elastance increases in prone position ventilation, and stress index may not reflect the changes in lung mechanics. We therefore investigated the effects of stress index guided PEEP titration on pulmonary mechanics and hemodynamics in the prone position in a piglet acute lung injury model.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Ten piglets with severe lavage-induced lung injury were mechanically ventilated in a decremental PEEP trial after full lung recruitment in the prone position. Stress-index PEEP was the level at which the airway pressure stress index was 1, and open-lung PEEP was the level at which it was required to keep the lung open according to computed tomography (CT) scans. Respiratory mechanics, blood gases, hemodynamics, and whole-lung CT were recorded at the two PEEP levels.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Respiratory system elastance and lung elastance were improved in the prone position but the ratio of chest wall elastance and respiratory system elastance was higher in the prone position. There was no significant difference between open-lung and stress-index guided PEEPs in the prone position (P = 0.46). There was no significant difference between collapsed lung volume (P = 0.07) and hyperinflation lung volume (P = 0.76) in the two groups. Similarly, there was no significant difference between open-lung and stress-index guided PEEPs in terms of oxygenation index (P = 0.95) and PaCO2 (P = 0.42).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Stress index can be used to titrate PEEP in the prone position in a surfactant-depleted lung injury model.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">26198816</PMID><DateCompleted><Year>2016</Year><Month>11</Month><Day>09</Day></DateCompleted><DateRevised><Year>2016</Year><Month>12</Month><Day>30</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1399-6576</ISSN><JournalIssue CitedMedium="Internet"><Volume>59</Volume><Issue>9</Issue><PubDate><Year>2015</Year><Month>Oct</Month></PubDate></JournalIssue><Title>Acta anaesthesiologica Scandinavica</Title></Journal><ArticleTitle>Stress index for positive end-expiratory pressure titration in prone position: a piglet study.</ArticleTitle><Pagination><MedlinePgn>1170-8</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1111/aas.12590</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Prone position ventilation is an important treatment for acute respiratory distress syndrome (ARDS), but chest wall elastance increases in prone position ventilation, and stress index may not reflect the changes in lung mechanics. We therefore investigated the effects of stress index guided PEEP titration on pulmonary mechanics and hemodynamics in the prone position in a piglet acute lung injury model.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Ten piglets with severe lavage-induced lung injury were mechanically ventilated in a decremental PEEP trial after full lung recruitment in the prone position. Stress-index PEEP was the level at which the airway pressure stress index was 1, and open-lung PEEP was the level at which it was required to keep the lung open according to computed tomography (CT) scans. Respiratory mechanics, blood gases, hemodynamics, and whole-lung CT were recorded at the two PEEP levels.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Respiratory system elastance and lung elastance were improved in the prone position but the ratio of chest wall elastance and respiratory system elastance was higher in the prone position. There was no significant difference between open-lung and stress-index guided PEEPs in the prone position (P = 0.46). There was no significant difference between collapsed lung volume (P = 0.07) and hyperinflation lung volume (P = 0.76) in the two groups. Similarly, there was no significant difference between open-lung and stress-index guided PEEPs in terms of oxygenation index (P = 0.95) and PaCO2 (P = 0.42).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Stress index can be used to titrate PEEP in the prone position in a surfactant-depleted lung injury model.</AbstractText><CopyrightInformation>© 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Pan</LastName><ForeName>C</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tang</LastName><ForeName>R</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Xie</LastName><ForeName>J</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Xu</LastName><ForeName>J</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Liu</LastName><ForeName>S</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yu</LastName><ForeName>T</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Huang</LastName><ForeName>Y</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Guo</LastName><ForeName>F</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yang</LastName><ForeName>Y</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Qiu</LastName><ForeName>H</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2015</Year><Month>07</Month><Day>22</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Acta Anaesthesiol Scand</MedlineTA><NlmUniqueID>0370270</NlmUniqueID><ISSNLinking>0001-5172</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000818" MajorTopicYN="N">Animals</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004195" MajorTopicYN="N">Disease Models, Animal</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008168" MajorTopicYN="N">Lung</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011175" MajorTopicYN="Y">Positive-Pressure Respiration</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016684" MajorTopicYN="N">Prone Position</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012128" MajorTopicYN="N">Respiratory Distress Syndrome, Adult</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015656" MajorTopicYN="N">Respiratory Mechanics</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="Y">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D013552" MajorTopicYN="N">Swine</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013990" MajorTopicYN="N">Tidal Volume</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="revised"><Year>2015</Year><Month>05</Month><Day>14</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2015</Year><Month>06</Month><Day>08</Day></PubMedPubDate><PubMedPubDate PubStatus="received"><Year>2015</Year><Month>03</Month><Day>14</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2015</Year><Month>7</Month><Day>23</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2015</Year><Month>7</Month><Day>23</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2016</Year><Month>11</Month><Day>10</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">26198816</ArticleId><ArticleId IdType="doi">10.1111/aas.12590</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>République populaire de Chine</li></country></list><tree><country name="République populaire de Chine"><noRegion><name sortKey="Pan, C" sort="Pan, C" uniqKey="Pan C" first="C" last="Pan">C. Pan</name></noRegion><name sortKey="Guo, F" sort="Guo, F" uniqKey="Guo F" first="F" last="Guo">F. Guo</name><name sortKey="Huang, Y" sort="Huang, Y" uniqKey="Huang Y" first="Y" last="Huang">Y. Huang</name><name sortKey="Liu, S" sort="Liu, S" uniqKey="Liu S" first="S" last="Liu">S. Liu</name><name sortKey="Qiu, H" sort="Qiu, H" uniqKey="Qiu H" first="H" last="Qiu">H. Qiu</name><name sortKey="Tang, R" sort="Tang, R" uniqKey="Tang R" first="R" last="Tang">R. Tang</name><name sortKey="Tang, R" sort="Tang, R" uniqKey="Tang R" first="R" last="Tang">R. Tang</name><name sortKey="Xie, J" sort="Xie, J" uniqKey="Xie J" first="J" last="Xie">J. Xie</name><name sortKey="Xu, J" sort="Xu, J" uniqKey="Xu J" first="J" last="Xu">J. Xu</name><name sortKey="Yang, Y" sort="Yang, Y" uniqKey="Yang Y" first="Y" last="Yang">Y. Yang</name><name sortKey="Yu, T" sort="Yu, T" uniqKey="Yu T" first="T" last="Yu">T. Yu</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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