Search

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Critical Care Nursing is the property of Canadian Association of Critical Care Nurses and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The goal of this study was to assess plasma procalcitonin (PCT) concentrations during infectious events of burns in the ICU. We conducted a prospective, observational study in a 20-bed Burn Intensive Care Unit in Tunisia. A total of 120 septic patients admitted to the Burn ICU were included in our study. Sepsis was assumed according to the French Burn Association criteria for the presence of infection. Serum PCT was measured over the entire septic episode every 48 hours until resolution of infection, based on clinical signs and decrease of PCT of about 80% compared to its initial value. Patients were assigned to two groups depending on clinical course and outcome: Group A = patients with favourable evolution; Group B = patients with unfavourable evolution. Monitoring of kinetics of PCT allowed us to judge the effectiveness of the initial antibiotic therapy, with a threshold of 43.5% decrease at day 3 of treatment, with a better sensitivity and specificity of 79.6% and 87.7% respectively. In addition, PCT monitoring allowed a reduction in the duration of antibiotic therapy of 5±2.8 days versus 8 to 10 days before the use of PCT. [ABSTRACT FROM AUTHOR]

Peptic ulcer disease is a known complication in patients receiving non-steroidal anti-inflammatory drugs, in intensive care units or on anticoagulation. Screening and treatment for Helicobacter pylori should be offered to patients starting NSAID therapy. Proton pump inhibitors should be given to patients at high risk of developing a bleeding ulcer and dying from this complication. [ABSTRACT FROM AUTHOR]

Introduction: in sub-Saharan Africa, the impact of intensive care unit (ICU) hospitalization of COVID patients is not at all known in terms of quality of life because it is very poorly documented. The aim of this study was to describe the quality of life at three months of patients who had been in the ICU. Methods: we conducted a monocentric prospective cohort study over a 6-month period. Results: hundred and three (103) patients participated in the survey out of 123 patients discharged from the ICU during our study period, with a participation rate of 85%. The average length of stay in the ICU was 12 days with extremes of 2 and 36 days. The mean duration of oxygen therapy was 12±10 days. The assessment of quality of life with the SF-36 at 3 months after discharge from the intensive care unit showed impairment in eight domains, the most important of which were the emotional domain with a mean score of 57.6±44.6, the social functioning domain with a score of 60.77±24.07 and the vitality domain, which was 66.2±21.6. The global evaluation of the two main dimensions of the SF-36 showed a deficiency in the psychological dimension with a mean score of 64 with extremes of 12 and 90. This evaluation also showed an impairment of the physical dimension with a mean score of 70 with extremes of 20 and 97. Conclusion: our study showed a significant decrease in the quality of life of COVID-19 patients discharged from the intensive care unit. [ABSTRACT FROM AUTHOR]

Occlusion of femoro-popliteal bypass: treatment by percutaneous mechanical rotational thrombectomy using Rotarex® Illustrated with two case reports, we have reviewed the contemporary clinical data regarding the safety, the efficacy, and the outcomes of percutaneous mechanical rotational thrombectomy (PMT) therapy using Rotarex® catheter in acute and subacute femoro-popliteal bypass thrombosis. This approach has various advantages: minimally invasive, easy to use, short procedural time, reduced thrombus burden, low complication rate, no vessel wall damage, successful in restoring vessel patency, unmask underlying lesions, short hospital stay, and no intensive care unit stay. PMT with the Rotarex® system appears to be an effective alternative in the treatment of acute and subacute femoro-popliteal bypass occlusions compared to established therapies, such as vascular surgery and local lysis. [ABSTRACT FROM AUTHOR]

Group B Streptococcus late-onset disease, occurring from 7 through 89 days of life, remains an important cause of sepsis and meningitis in infants. The pathogenesis and mode of transmission associated with group B Streptococcus late-onset disease remain unclear. Neonate's digestive tract mucosa colonization may be acquired perinatally or postpartum, from maternal or non-maternal sources. Although maternal sources appear predominant, group B Streptococcus late-onset disease is not influenced by intrapartum antibiotic prophylaxis. Among non-maternal sources of transmission, horizontal nosocomial transmission is possible and may be underestimated in the neonate intensive care unit setting, accounting for about 10% of cases. The origin of transmission may be another patient, a caregiver or the intensive care unit environment. Awaiting for better understanding of transmissions routes and efficient strategies of prevention, clinicians facing such a case in a hospitalized neonate should maintain a high index of suspicion for a nosocomial origin and a potential cluster, ensure routine submission of isolate to a reference laboratory and reinforce infection control precautions. [ABSTRACT FROM AUTHOR]

Copyright of Sang Thrombose Vaisseaux is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Acute Coronary Syndrome (ACS) are one of the main causes of mortality in France. Patients presenting with ACS are typically hospitalized in a specialized cardiology ward. The main objective of this study was to describe, characterize and evaluate the outcome of patients hospitalized for ACS in a generalist intensive care unit (rather than a cardiac care unit)., Methods: This was a retrospective study. Our population consisted of ACS patients admitted to an intensive care unit in a hospital center (Centre Hospitalier de Troyes) between 2012 and 2021. All patients admitted for ACS to the intensive care unit and who underwent coronary angiography were included., Results: In 10 years, 104 patients, or 3.8% of ACS patients who underwent coronary angiography were admitted to intensive care. The majority were admitted after recovered cardiac arrest (72%) and were in cardiogenic shock (68%), accounting for a high in-hospital mortality (45.2%). In-hospital mortality was 45.2%. In multivariate analysis, the GRACE score was associated with in-hospital mortality (OR for each additional point = 1.024, 95% confidence interval 1.006-1.045, p = 0.01). Among the survivors, 88% had good neurological function when leaving the hospital., Discussion: Mortality of ACS patients in intensive care was close to 50%. However, the neurological prognosis of the surviving patients was good. This population is rarely mentioned in the literature, and deserves to be evaluated by multicenter, prospective registries, with a view to improving management and prognosis., Competing Interests: Déclaration de liens d'intérêts Les auteurs déclarent n'avoir aucun lien d'intérêt en relation avec cet article., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Painful procedures in intensive care are numerous. The aim of the study was to assess the management of pain associated with care in an intensive care unit (ICU). This was a descriptive and prospective study running from January to April 2019. All patients over 18 years admitted to the ICU of the Yaoundé Central Hospital who receive a painful care were included. The patient's consent or that of his family member was obtained. The variables evaluated were the care provided, the intensity of the pain, the management of the pain and the effectiveness. Pain intensity was assessed with the visual analogue scale (VAS) in conscious patients and with the Critical-care Pain Observation Tool (CPOT) in unconscious patients. Data were analyzed using SPSS 17.0 software. The sample was 102 patients. The mean age was 36.7 ± 15.6 years. The sex ratio was 0.64. The most frequent care was the dressing (18.6%). The preventive treatment was non-drug (88.8%) and drug (11.2%). No curative treatment has been given to the patients. The most painful treatments for conscious patients were dressings (12.7%). In unconscious patients, the most painful treatments were intubation (3.9%) and tracheal aspiration (2.9%). Management was not effective (n=64, 62.7%). The management of care related pain was not effective and adequate. The establishment of protocols would be an area for improvement [ABSTRACT FROM AUTHOR]

The 5-fluorouracil (5-FU)-induced hyperammonemic encephalopathy is a rare and poorly known serious 5-FU adverse drug reaction (ADR), that can be explained by two mechanisms: an inhibition of Krebs cycle and/or an impairment of urea cycle. Given the growing number of cancers treated with 5-FU and the paucity of data regarding this ADR, we performed a retrospective national analysis to better characterize 5-FU-induced hyperammonemic encephalopathy based on the French pharmacovigilance database. From 1986 to 2018, 30 patients were identified. 5-FU-induced hyperammonemic encephalopathy started in a median of 2 (interquartile: 1-4) days after 5-FU infusion onset. Most common neurological disorders were consciousness impairment (76%), seizures (53%) and confusion (40%). Hyperammonemia tended to be higher in patients with the lowest Glasgow score and admitted in intensive care unit (ICU) compared to non-ICU patients (250 [133-522] vs. 139 (68-220) mmol/L respectively, p=NS). Dihydropyrimidine deshydrogenase (DPD) deficiency was found in 27% of tested patients (n=3/11). Encephalopathy-induced mortality was 17%, 57% of patients were admitted in ICU and 70% had a complete neurological recovery within 5 (2-10) days. In patients with complete neurological recovery, a 5-FU rechallenge was considered in 14 (67%) patients and a relapse was observed in 57% of them. Nevertheless, no 5-FU-induced hyperammonemic encephalopathy relapse was observed as long as 5-FU rechallenge was performed with decreased 5-FU dosage. We report the largest cohort of 5-FU-induced hyperammonemic encephalopathy cases so far. This ADR should be suspected and ammonemia measured in all patients experiencing neurological disorders after 5-FU administration. In patients with complete neurological recovery, a 5-FU rechallenge could be cautiously considered. [ABSTRACT FROM AUTHOR]

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: Avec la pandémie de SARS-CoV-2, dans notre établissement, les lits de salle de surveillance post-interventionnelle du bloc opératoire ont été transformés en lits de réanimation non-COVID. Le service de pharmacie a accompagné les équipes au cours des trois périodes, avec la mise en place d'un circuit du médicament adapté : création d'une armoire de dotation, fréquence d'approvisionnement, dispensation nominative et présence pharmaceutique. Objectifs : évaluer l'organisation pharmaceutique mise en place, la satisfaction des équipes infirmiers et recueillir des axes d'amélioration. Méthode : un questionnaire a été remis aux infirmiers ayant travaillé dans cette unité. Résultats : au total, 155 patients, soit une analyse de 111 prescriptions, ont été pris en charge sur 126 jours d'ouverture de cette unité. L'ensemble des infirmiers ayant participé aux trois périodes ainsi que le cadre de santé ont complété le questionnaire, soit 21 réponses. L'étape ressentie comme la plus difficile est la prescription (48 %) liée au support papier utilisé. La présence pharmaceutique a été appréciée à 90 %, notamment pour des demandes d'approvisionnement d'un médicament (95 %), ou d'information sur un médicament (58 %). Il est souhaité (90 %) que cette présence soit renouvelée en cas de réouverture de l'unité. Une amélioration de la satisfaction est constatée à chaque période. Conclusion : en cas de nouvelle vague, il a été décidé de poursuivre le détachement d'un pharmacien pour sécuriser le fonctionnement de ce type d'unité, notamment par l'analyse quotidienne des prescriptions avec les médecins et par l'interaction avec les infirmiers pour le bon usage du médicament. During the SARS CoV-2 pandemia and at three separate time period, our institution chose to turn the post interventional surveillance room of the operating room into a non-COVID intensive care unit. The chosen workflow included that the pharmacy team provided support to the medical team and was instrumental to implement an adapted drug circuit, including the creation of a supply cabinet, a specific frequency of its supply, a nominative dispensation and the presence of a pharmacist. Objectives : The study aims to evaluate the proposed pharmaceutical organization workflow, the satisfaction of the nursing team and to collect their expert feedback for improvement. Method : A satisfaction survey questionnaire was set up and given to the nurses who worked in this temporary unit. Results : A total of 155 patients, i.e. an analysis of 111 prescriptions, were treated during the 126 days during which the unit was running. All the nurses who participated to the three time periods and the health care manager completed the questionnaire, i.e. 21 responses. The step that was felt to be the most difficult was prescribing (48%) due to the paper medium used. The presence of a pharmacist in the medical unit was appreciated by 90% of the survey respondents, particularly for requests on the supply of a drug (95%), or on drug information (58%). 90% of the respondents were hoping that this experience would be renewed if the unit opens again. An increase of the satisfaction due to the pharmaceutical presence is reported in each successive period. Conclusion : In case of an eventual new epidemic wave, it was decided to continue to assign a pharmacist to the non-COVID intensive care unit, in order to protect the unit performance. The survey revealed that two key factor are instrumental to this success, a daily analysis of prescriptions with the physicians and the on-site interaction with the nurses for the promotion of the right use of medications. [ABSTRACT FROM AUTHOR]

Background: Intubated and mechanically ventilated patients in the intensive care unit (ICU) may experience pain during routine oral procedures such as oral suctioning and tooth brushing. Despite the importance of pain prevention and management, little is known about patients’ experiences of procedural oral pain. Aims: The aim of this study was to explore patients’ recollections and recommendations for pain and discomfort during routine oral procedures. Methods: A qualitative descriptive design was used. Adult patients were recruited from a mixed medical–surgical–trauma ICU in an academic hospital in Toronto, Canada. Participants were interviewed using object elicitation methods within 7 days of discharge from the ICU. Data were analyzed using directed content analysis methods. Results: We recruited 33 participants who were primarily male (23, 70%), with an average age of 54 (SD = 18) years, admitted with a medical (13, 39%), trauma (11, 33%), or surgical (9, 27%) diagnosis and dentate (27, 82%). Most participants described oral procedures as painful, discomforting, and emotionally distressing. Identified sources of pain included dry, inflamed oral tissues and procedural technique. Procedural pain behaviors were perceived to be frequently misinterpreted by clinicians as agitation, with consequences including physical restraint and unrelieved suffering. Participants advocated for greater frequency of oral care to prevent oral health deterioration, anticipatory procedural guidance, and structured pain assessment to mitigate the dehumanizing experience of unmanaged pain. Conclusions: Patients described routine oral care procedures as painful and recalled suboptimal management of such pain. Procedural oral pain is an important target for practice improvement.

Résumé: L'activité du département de pharmacie clinique de Gustave Roussy n'a cessé d'augmenter ces dernières années sans que les changements organisationnels nécessaires pour y répondre n'aient pu être entrepris. Le poste de préparateur d'étages a été petit à petit déconsidéré et se voyait confier des tâches sans valeur ajoutée, avec une formation imparfaite et insuffisante. Face à une équipe démotivée, nous avons entrepris de repenser ce poste et le rôle des préparateurs d'étages qui font la liaison directe avec les services de soins. Pour mener ce projet nous avons utilisé une méthode de réingénierie de processus métiers intégrant les étapes support de conduite de changement de la méthode EPEHo. Celle-ci nous a permis d'impliquer les acteurs dès le début du projet. Immersion avec les préparateurs et les services de soins, management de proximité, cartographie du circuit, ateliers d'intelligence collective, démarches de résolution de problème, management visuel sont les différents outils auxquels nous avons eu recours. Au final, 3 champs ont été repensés dans le cadre de ce projet. Nous avons développé l'accueil des nouveaux préparateurs d'étages en communicant par différents biais auprès des services et de la pharmacie avant une arrivée. La formation a également été structurée en co-construisant un plan de formation et une grille d'habilitation. Enfin, l'intégration dans les équipes de soin s'est accrue dans les services d'hématologie et de réanimation par la mise en place de flashs 10' animés par la pharmacie. Cette approche « bottom-up » collaborative a permis de démarrer avec succès la transformation d'un poste confronté à une activité qui s'est dégradée au fil des mois et pour laquelle les acteurs étaient démotivés. The activity of the clinical pharmacy department has been increasing steadily over the last few years without the necessary organizational changes being undertaken. The position of clinical pharmacist technicians was gradually discredited and was given tasks without added value, with imperfect and insufficient training. Faced with a demotivated team, we undertook to rethink this position and the role of the clinical pharmacist technicians who are the direct liaison with the care services. To carry out this project, we used a business process reengineering method integrating the support steps of the EPEHo method. This method allowed us to involve the actors from the beginning of the project. Immersion with the clinical pharmacist technicians and the care services, local management, circuit mapping, collective intelligence workshops, problem-solving approaches, visual management are the different tools we used. In the end, 3 fields were rethought in the framework of this project. We developed the reception of new clinical pharmacist technicians by communicating with the departments and the pharmacy by different means before their arrival. Training was also structured by co-constructing a training plan and an accreditation grid. Finally, integration into the care teams has been increased in the hematology and intensive care units by setting up daily stand up meetings led by the pharmacy. This collaborative "bottom-up" approach enabled the successful start of the transformation of a clinical pharmacist technician faced with an activity that had deteriorated over the months and for which the stakeholders were demotivated. [ABSTRACT FROM AUTHOR]

In its severe form, corona virus disease-19 (COVID- 19) is characterized by various immunological abnormalities, dominated by massive pro- inflammatory cytokine and chemokine release, such as IL-6, TNF-α, IL-1b, IFN-y and monocyte chemoattractant protein-1 (MCP-1), associated with T CD3, T CD4 and T CD8 lymphopenia. These two abnormalities are significantly associated with COVID-19 acute severe respiratory syndrome. Conversely, these markers decrease during the favorable course of the disease. Coupled with other biological parameters such as leukopenia, increased level of CRP (C Reactive Protein), ferritin and D-dimers, high levels of IL-6 with CD4 and CD8 T cell lymphopenia may be considered as criteria of disease severity, justifying a rapid admission to the intensive care unit, and are also useful for patient monitoring. [ABSTRACT FROM AUTHOR]

Résumé: De nombreuses études réalisées chez des patients hospitalisés en réanimation et considérés comme immunocompétents ont révélé de profondes altérations immunitaires favorisant les réactivations virales. Les réactivations de certains Herpesviridae (HSV et CMV) ont notamment été associées à une augmentation de la morbi-mortalité des patients de réanimation. Le diagnostic précoce de ces réactivations est donc de plus en plus recommandé dans la prise en charge du patient hospitalisé en réanimation, même si les indications de mise en route d'un traitement antiviral sont encore en évaluation. Plus récemment, l'exploration du virome humain, et notamment la part des Torque teno virus (TTV), a été proposée pour estimer le niveau d'immunocompétence dans des populations de patients immunodéprimés à risque d'infections virales opportunistes. Chez les patients transplantés d'organe, la proportion représentée par les TTV augmente avec le degré d'immunodépression et est associée à un risque augmenté d'infections secondaires. Ce marqueur reste à évaluer dans d'autres contextes de dysfonction immunitaire, notamment chez les patients intubés ventilés de réanimation. Plus largement, le développement des approches de métagénomique permettra d'étudier les modifications du virome humain en lien avec le contexte immunitaire, et pourrait être un outil innovant, surtout dans le contexte de l'introduction de molécules immunorégulatrices pour la prise en charge des complications de réanimation. Studies performed in patients considered as immunocompetent and hospitalized in intensive care unit (ICU) have revealed profound immune alterations leading to an increased risk of viral reactivations. In particular, Herpesviridae reactivations (HSV and CMV) have been associated with an increased morbidity and mortality in ICU patients. Early diagnosis of these reactivations is now recommended in ICU patients, but the indications of an antiviral therapy remain to be better defined. Advances in molecular biology now allow us to study the human virome in different biological compartments. Among the more frequent viruses detected in the virome, Torque Teno Virus (TTV) has been shown to be associated to the immunocompetence level of immunocompromised patients at risk of opportunistic viral infections. In organ transplant patients, the TTV proportion in blood increases with the degree of immunosuppression and the risk of secondary infections. It remains to be evaluated in other immune dysfunction settings, such as ICU patients. Human virome modulation, as measured by metagenomics, is a promising tool to investigate immune status in various clinical settings. It could be an innovative marker for personalized care, including the evaluation of immunomodulatory molecules use for the prevention and treatment of infectious complications in ICU patients. [ABSTRACT FROM AUTHOR]

Nosocomial bacteremia (NB) is one of the most severe infections in burns in intensive care units. Their prognosis is worsened with the emergence and spread of multidrug resistant bacteria (MDR). Our retrospective study aimed to investigate clinical and bacteriological characteristics of NB occurring in patients hospitalized in the Trauma and Burn Center's Burn Unit (TBC-BU) in Tunisia, during a 3-year period (2016-2018). We found 261 NB in 216 patients, for a prevalence of 25.7% and an incidence density of 13.4‰ days of in-patient stay. The vast majority (88.9%) of NB occurred during the first 2 weeks of hospitalization. The catheterrelated bacteremia rate was 11.1%. P. æruginosa (20.2%) and A. baumannii (16.8%) were the 2 species most frequently isolated when S. aureus represented only 7.5% of isolates. Resistance rates were high, with 71% of P. æruginosa resistant to ceftazidime, 64% of S. aureus being MRSA, 69,5% of resistance to 3rd generation cephalosporins among Enterobacteriaceae, and colimycin remaining the only regularly active antibiotic (98%) on A. baumannii. The MDR rate was 44%, represented mainly by A. baumannii, ESBL-E and P. æruginosa. The mortality rate due to NB was 25%, with a significantly higher rate of MDR in fatal NB compared to that in NB with favorable outcome (p = 0,000019). [ABSTRACT FROM AUTHOR]

Objectives: In a context of heparin shortage, we studied the wasted quantities in three intensive care units (ICU) of a university hospital where two electric syringe pump (ESP) heparin protocols coexist (20,000UI/48mL used in the cardiology ICU and 25,000UI/50mL use in the medical and surgical ICUs)., Method: We performed a prospective observational study of patients treated with heparin ESP. We collected the information recorded in the prescription software connected to the ESP (dosage, start time, infusion rate, interruption times, date and time of end of treatment). We observed the ESPs, noted the time of start written on the label and the quantity remaining, and questioned nurses about the constraints that lead for changing the ESPs., Results: Between 23/03/23 and 19/05/23, 164 vials of 25,000UI/5mL were used. The wasted quantity was equivalent 42 vials: 18 vials (43%) of treatment stopped, nurses practices such as changing the ESP in advance 6 vials (14%), application of the rule "discard the ESP 24hours after preparation" 9 vials (21.5%) and 9 vials (21.5%) corresponding to the 45mL discarded for the 45 ESP prepared in the cardiology ICU., Conclusion: More than a quarter of the heparin purchased is wasted. The results should lead to policy decisions concerning the medications supply chain, i.e. abandoning the 20,000UI/48mL protocol, supply of ready to use heparin syringes by industry or by the pharmacy. It is essential that these data be fed back to nurses' teams, in order to gather their suggestions before considering any changes of their practices., (Copyright © 2024 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: bronchial dilations (BDs) seem to have a major role in the natural history of chronic obstructive pulmonary disease (COPD). The purpose of our study was to evaluate the impact of BDs on the severity and progression of COPD as well as on patients' prognosis. Methods: we conducted a retrospective, single-center, analytical study over the period 1995- 2017. The study was based on data from the medical records of patients with COPD who had undergone chest CT scan during the follow-up period. We compared two groups (G) of patients: G1: COPD with BDs; G2: COPD without BDs. Results: our study included 466 patients with COPD. Among them 101 (21.6%) had BDs associated with COPD. G1 patients had lower maximum expiratory volume in the first second (FEV1) (G1: 1.21 L, G2: 1.37 L, p = 0.015), lower forced vital capacity (FVC) (p = 0.014), a lower PaO2 at steady state (p = 0.049), a higher rate of acute exacerbations (AE) per year (G1: 3.31, G2: 2.44, p = 0.001) and a higher rate of hospitalizations in the Intensive Care Unit per year (p = 0.02). G1 patients with AE receiving treatment in hospital had lower PaO2 3) on admission (G1: 60 mmHg, G2: 63.7 mmHg, p = 0.02 G2: 63.7 mmHg, p = 0.023), more elevated carbon dioxide (CO2) levels (p = 0.001) and were characterized by a higher use of non-invasive ventilation (NIV) (p = 0.044) and invasive mechanical ventilation (p = 0.011). G2 patients had better overall survival (p = 0.002). Conclusion: bronchial dilatations are an indicator of poor prognosis in patients with chronic obstructive pulmonary disease, expecially because of the higher rate and severity of exacerbations, airway obstructions and mortality. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Medical Laboratory Science is the property of Canadian Society for Medical Laboratory Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Rigorous monitoring of vital functions in intensive care requires optimal visibility of patients and their environment. Conversely, respect for privacy is an ethical imperative to respect. Liquid crystal electrical film is a device that can be applied to windows and can take opaque or transparent form on demand. Its use could satisfy the visibility of patients and respect for their privacy., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Résumé: Avec les restrictions d'utilisation des immunoglobulines polyvalentes, le comité scientifique spécialisé temporaire propose comme alternative de recourir aux échanges plasmatiques (EP) dans la prise en charge du syndrome de Guillain-Barré (SGB). En effet, les EP à raison de 4 séances et les immunoglobulines (Ig) (0,4 g/kg/j) pendant 5 jours ont été démontrés comme équivalents en termes d'efficacité. Objectif : L'objectif de cette étude est d'évaluer le coût d'un traitement par échange plasmatique par rapport à des Ig dans un service de réanimation pour un patient de 80 kg atteint de SGB aigu (SGBA). Matériel et méthode : Les coûts directs (médicaments et dispositifs médicaux) ont été recensés avec l'équipe de réanimation. Les coûts d'hospitalisation (personnel, structure, amortissement) ont été fournis par la direction financière. Résultats : Les coûts directs sont respectivement de 5 131 euros pour l'administration des immunoglobulines (1 026 €/j) et de 2 614 euros pour les EP (653 €/séance). Les coûts totaux sont respectivement de 17 700 € et 15 200 € après intégration des coûts d'hospitalisation en réanimation. Conclusion : Bien que les EP apparaissent comme une alternative économique à la pénurie d'Ig, cette technique demande une maîtrise de l'équipement avec un temps de formation non-négligeable du fait de l'aspect technique et des complications potentielles. With the restrictions on the use of polyvalent immunoglobulins (Ig), the French temporary specialized scientific committee proposed plasma exchanges (PE) as an alternative of Ig in the treatment of Guillain-Barré syndrome (GBS). Indeed, 4 sessions of PE and immunoglobulins (Ig) (0.4 g/kg/day) for 5 days have been shown to be equivalent in terms of efficacy. Objective : To evaluate the costs of PE versus Ig treatment in an intensive care unit for a 80 kg-patient with acute GBS. Materiel and method : Direct costs (drugs and medical devices) were identified with the intensive care team. The costs of hospitalization (staff, structure, depreciation) were provided by the financial department. Results : The direct costs were respectively 5,131 euros for the Ig treatment (1,026 €/day) and 2,614 euros for EP (653 €/session). Global total costs were respectively 17,700 € and 15,200 € for intensive care unit hospitalization. Conclusion : EP are an economic alternative to the shortage of Ig, but this technique requires a mastery of the equipment with a non-negligible training time because of the technical aspect and potential complications. [ABSTRACT FROM AUTHOR]

Copyright of Vascular Access is the property of Canadian Vascular Access Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Asthmatic exacerbations (AEs) are a frequent reason for emergency department visits. Management should be guided by the severity of the attack but should also focus on patient education and prevention of future exacerbations. This article summarizes current recommendations for the management of both simple and life-threatening AE. When the clinical evolution is favorable, and the patient no longer presents any criteria of severity or risk factors for decompensation, a return home can be considered, with appropriate treatment and the organization of outpatient follow-up. However, if the patient's prognosis is likely to be engaged, transfer to an intensive care unit should not be delayed, to ensure optimal care., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Introduction: burnout is a particular cause of concern in Anesthesia and Intensive Care Units. In addition to its socio-economic impact, it alters the quality of care and patients prognosis. This study aims to assess its prevalence among the staff members of the Tunisian Anesthesia and Intensive Care Units. Methods: we conducted a multicenter cross-sectional study in the Anesthesia and Intensive Care Units of seven Tunisian University Hospitals. The study included the medical and paramedical staff who gave consent. The measuring instrument used was the Maslach burnout Inventory. Results: the study included 283 staff members (72.19%). The average age of subjects was 40.2 ± 9.38 years, with a female predominance. Maslach scale revealed that 94.71% of the participants had burnout. The mean emotional exhaustion score, depersonalization score and professional achievement score were 28.65 ± 11.92; 8.62 ± 6.65 and 34.58 ± 8.07 respectively. High to moderate burn-out level were found in 13.3% and 26.2% of cases respectively. Burn-out effects were dominated by additive behaviors (52.65%) and suicidal ideations (4.59%). Conclusion: burnout is becoming more and more a tangible reality for the staff members of the Anesthesia and Intensive Care Units, engendering serious social and personal consequences. [ABSTRACT FROM AUTHOR]

Introduction: In sub-Saharan countries, resuscitators and gynecologists are faced with uncommon situations related to clandestine abortions. Their complications are one of the reasons for hospitalization in intensive care units. The objective of this study was to describe the picture and profile of these patients. Material and Methods: It's a retrospective and descriptive study which was carried out on 38 patients admitted at Panzi intensive care unit with a diagnosis of clandestine abortion. Results: The prevalence of clandestine abortions was 0,38 % of patients admit in intensive care. It was young women of average age 23.3 ±8,7years. The duration of the consultation after induced abortion was 5,8 days (extremes between 3 days and 27)± 14,6 days). The cause of admission to intensive care was a disorder of consciousness for 55,2% of cases but also haemodynamic repercussions 31,6% hypotension and 47,4% of anuric patients. Amines were used in 16,6%, a need for blood transfusion for 63,1%. Laparotomy was required for 26,3% of cases. Peritonitis was the most common complication in 55,2%. The mortality rate was 23,7%. The average hospital stay was 9,3 days. Conclusion: The septic status, the neurological and hemodynamic repercussions of patients with an illegal abortion, requires admission in the intensive care. The mortality is still high in these cases. [ABSTRACT FROM AUTHOR]

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sleep in Intensive Care: A CRUCIAL BUT LITTLE-KNOWN ISSUE. Polysomnography is the best tool to study sleep in intensive care unit (ICU), but this recording is complex to perform in such environment. Sleep alterations in ICU patients are specific and include electroencephalographic abnormalities during sleep and wake, rendering sleep scoring more complicated. Severe deficit in deep sleep, rapid eye movement sleep and an important sleep fragmentation are reported by most studies. Sleep cycles are disorganized with many sleep episodes during daytime. Sleep disruptions result from light levels, noisy environment, and 24-hours nurses care. Assisted ventilation, sedation, loss of circadian rhythms also contribute to these disruptions. Biological and neurobehavioral consequences of sleep alterations lengthen weaning from mechanical ventilation and have some deleterious impacts on morbidity and mortality. Procedures to promote sleep have been attempted, with limited results to date. However, recent innovation might help to monitor sleep and help patients to achieve some restorative sleep., Competing Interests: L’auteur déclare avoir une participation financière dans le capital de l’entreprise Somno Engineering, avoir participé à des interventions ponctuelles pour Somno Engineering (essai clinique et travaux scientifiques, activité de conseil, conférences) et avoir été pris en charge, à l’occasion de déplacement pour congrès, par SOS Oxygène et ISIS Atlantique.

In the units for difficult patients (UMD) and the intensive psychiatric care units (Usip), patients whose mental pathologies have or could generate violent acts which can go as far as committing homicide are taken care of. If, during the psychiatric care of these patients, isolation and restraint measures can be put in place as a last resort, in general it is the symptomatological and behavioral appeasement of these persons that is sought in an alternative way., (Copyright © 2023. Publié par Elsevier Masson SAS.)

The units for difficult patients (UMD) and the intensive psychiatric care units (Usip) are psychiatric services that are not successively sectorized, created to meet the needs of intensive care in a closed environment and sometimes of a forensic nature. These two systems are used to care for patients whose clinical condition often makes it too complex to maintain them in sector psychiatric units, and many of their operating rules differ. This is not the case for seclusion and restraint measures and the application of the law governing these measures., (Copyright © 2023. Publié par Elsevier Masson SAS.)

High-voltage electrical burns are rare, but the functional prognosis is often disastrous. Electrical currents are responsible for a wide range of injuries and their clinical assessment is difficult. For a case of severe electrical burn, and based on the literature, the authors performed an early MRI to elaborate their surgical strategy and avoid multiple surgeries by determining the level of amputation. Analysis of the different MRI signals and the per-operative study of the tissues led the team to take an early surgical approach and we were able to determine the level of limb amputation. Early analysis of lesions by MRI imaging allows us to consider a more aggressive surgical approach and thus reduce the number of interventions and the duration of stay in the intensive care unit. [ABSTRACT FROM AUTHOR]