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The main objective was to assess the performance of the neutrophil-lymphocyte ratio (NLR) for early prediction of delayed neurological impairment and cerebral contusion worsening in patients with mild-to-moderate traumatic brain injury (TBI).Over a 3-year period, every adult patient triaged to our level 1 trauma center with brain contusion and Glasgow Coma Scale (GCS) of 10 or greater were retrospectively included. The main study outcome was the occurrence of delayed clinical deterioration, defined as a GCS10 and/or a secondary need for mechanical ventilation, within 5 days after TBI. The performance of NLR for prediction of delayed clinical deterioration was assessed by receiver operating characteristic (ROC) curve.Overall, 115 patients were included and 16 (14%) presented a delayed clinical deterioration. Overall, the NLR at ED admission was higher in patients who developed a delayed clinical deterioration (18 [12-29] vs 8 [5-13], p = 0.0003). The area under the ROC curves for NLR at ED admission in predicting delayed clinical deterioration was 0.79 [0.65-0.93] and NLR15 was found to be independently associated with the occurrence of delayed clinical deterioration (adjusted OR = 10.1 [95%CI: 2.3-45.6]).The NLR at ED admission was independently associated with the occurrence of delayed clinical deterioration, although limited by a poor discriminative value by itself. Further studies are needed to test the predictive value of composite scoring systems including NLR for prevention of under-triage of patients with mild-to-moderate TBI.

Resume Depuis une dizaine d’annees, la recherche clinique en Anesthesie-Reanimation voit une augmentation du nombre de protocoles developpes et de publications, tant au niveau medical que paramedical. Des reseaux tres structures existent a l’etranger et imposent une concurrence importante dans la course a l’innovation, ainsi qu’au deroulement et a la valorisation des protocoles de recherche. La complexification recente de la methodologie de la recherche clinique rend la professionnalisation et la structuration de la recherche clinique au sein de notre societe savante necessaires. Le Comite Reseau Recherche de la Societe francaise d’anesthesie et de reanimation (SFAR) a pour but de fournir un label qualite a la recherche clinique medicale et paramedicale, grâce a un accompagnement des projets de recherche tout au long du processus : expertise et interaction avec les investigateurs, recrutement des centres, suivi du deroulement des etudes, aide a la redaction des articles. Les objectifs sont d’aider les investigateurs a optimiser les chances de financements de projets, d’assurer la faisabilite des travaux et de valoriser scientifiquement les resultats. Pour la SFAR, cette valorisation des travaux de recherche nationaux participe au rayonnement international de notre specialite.

Introduction The use of direct oral anticoagulants (DOAC) is increasing. Specific concentrations are available and have been proven to be reliable and reproducible in optimising patient care. This retrospective, monocentric study aimed to describe the indications and consequences of monitoring DOAC plasma levels on patient care. Materials and methods We collected data of patients hospitalised at the Bordeaux University Hospital between January 2017 and December 2018. These included demographics, indications, type, dose of DOAC, standard coagulation tests, creatinine clearance and DOAC plasma concentration using specifically calibrated rivaroxaban and apixaban anti-Xa and dabigatran anti-IIa assays. The date of last DOAC intake, the time between intake and plasma level measurement were also collected and analysed. Results A total of 2197 DOAC assays in 1488 patients were obtained in various clinical situations: urgent or elective procedures, context of acute renal failure, suspicion or occurrence of ischemic strokes, intra-cranial and other bleeding sites. Interpretation of these assays led physicians to maintain, postpone or cancel invasive and high haemorrhagic risk procedures in 757, 261 and 56 cases respectively. The remaining 1123 assays were associated with no significant modification of patient care. DOAC plasma concentration was ≤30 ng ml-1 (sensitivity 85.4%, specificity 73.6%, positive predictive value 71.1%, negative predictive value 86.7%, AUC 0.81) after a last intake of at least 2 days. Conclusions Our study is, to date, the largest report of real-life measurement of specific DOAC plasma level at a single institution. Patient care was not modified in more than half of the assays.

Resume Le traumatisme thoracique est un motif frequent d’admission aux urgences et en reanimation. La gravite specifique est cependant difficile a estimer, celle-ci dependant du terrain de survenue, de la tolerance clinique et des lesions associees. Chez les patients sans defaillance vitale a l’admission, le pronostic est en etroite relation avec la survenue de complications respiratoires secondaires. La prise en charge chez ces patients s’appuie donc sur une strategie multimodale visant a limiter la survenue de ces complications : une optimisation de l’analgesie integrant l’analgesie locoregionale afin d’ameliorer la mecanique respiratoire et faciliter la kinesitherapie respiratoire ; une prise en charge ventilatoire non invasive en l’absence de contre-indication, realisee sous surveillance etroite par une equipe entrainee, afin d’ameliorer l’hematose et lutter contre les atelectasies ; un drainage reflechi des epanchements pleuraux avec l’interet des catheters de petit calibre dans le cadre de pneumothorax isoles ; une osteosynthese chirurgicale a discuter au cas par cas en cas de deplacement significatif afin de stabiliser les foyers de fractures et diminuer les consequences de consolidation vicieuse. Cette prise en charge multidisciplinaire doit etre debutee le plus precocement possible, le sous-triage etant associe a une augmentation significative de la charge de soins et des durees de sejour. En medecine d’urgence, toute la difficulte sera ainsi de rechercher des criteres pronostiques permettant la prise en charge et l’orientation les plus appropriees de ces patients ne presentant pas de signes de gravite a l’admission. Seule une reflexion collegiale et pluridisciplinaire au sein d’un meme hopital entre urgentistes, pneumologues, chirurgiens et reanimateurs permettra la mise en place de filieres de soins specifiques et adaptees a chaque patient.

In blunt chest trauma patients, the activation of inflammatory response is thought to be one of the pathophysiological pathways leading to delayed acute respiratory distress syndrome(ARDS). The main objective of the study was to assess the performance of the neutrophil-lymphocyte ratio(NLR) for prediction of delayed ARDS. The secondary objective was to compare NLR in patients with traumarelated focal and non-focal ARDS.Over a 2-year period, every adult patient triaged to our level 1 trauma center with multiple rib fractures and PaO 2 /FiO 2 ratio 200 at admission were retrospectively included. The NLR was recorded at admission in the Emergency Department(ED). The main study outcome was the occurrence of moderate to severe ARDS within 5 days after admission according to Berlin criteria. Two phenotypes (focal and non-focal ARDS) were determined based on the closest chest CT regarding the ARDS onset.216 patients were included and 42(19%) underwent moderate to severe ARDS within 5 days after ED admission (focal, N = 26 [12%] and non-focal, N = 16 [7%]). The NLR at ED admission was not statistically different between patients who developed or not a delayed ARDS (14 ± 13 vs. 11 ± 8,p = 0.095), although patients with non-focal ARDS presented higher NLR ratio than focal ARDS (21 ± 18 p 0.0001). The AUC for NLR at ED in predicting delayed ARDS was 0.53.In blunt chest trauma patients, the NLR at ED admission was unable to predict delayed ARDS over the five first days post-injury. Although not clinically relevant, the NLR was higher in patients with non focal ARDS.

Objectives The world is currently facing an unprecedented healthcare crisis caused by the COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic. Methods The group has endeavoured to produce a minimum number of recommendations to highlight the strengths to be retained in the 7 predefined areas: (1) protection of staff and patients; (2) benefit/risk and patient information; (3) preoperative assessment and decision on intervention; (4) modalities of the preanaesthesia consultation; (5) specificity of anaesthesia and analgesia; (6) dedicated circuits and (7) containment exit type of interventions. Results The SFAR Guideline panel provides 51 statements on anaesthesia management in the context of COVID-19 pandemic. After one round of discussion and various amendments, a strong agreement was reached for 100% of the recommendations and algorithms. Conclusion We present suggestions for how the risk of transmission by and to anaesthetists can be minimised and how personal protective equipment policies relate to COVID-19 pandemic context.

To compare the rate of therapeutic failure in critically ill patients treated by third-generation cephalosporins (3GCs) or piperacillin-tazobactam (PTZ) for wild-type AmpC-producing Enterobacterales pulmonary infections.Over a 4-year period, all adult patients treated for a wild-type AmpC-producing Enterobacterales pulmonary infection were retrospectively included. Two groups of patients were compared according to the definitive antibiotic therapy (3GCs or PTZ) considered after48 h of empirical antibiotic therapy. The main outcome was the rate of therapeutic failure (impaired clinical response under treatment and/or a relapse of pulmonary infection). The secondary outcome was a secondary acquisition of 3GCs resistance.Over the study period, 244 patients were included; 56 (23%) experienced therapeutic failure. In the non-adjusted cohort, the rate of therapeutic failure and emergence of resistance were significantly higher in the 3GCs group (32 vs. 18%, p = .011 and 13 vs. 5%, p = .035, respectively). In the propensity score-matched population, the use of 3GCs was associated with higher rates of therapeutic failure (HR = 1.61 [1.27-2.07]). The secondary de-escalation to 3GCs after 48 h of PTZ as a first-line antibiotic therapy was not associated with increased rate of emergence of resistance.Our study confirms that 3GCs should be avoided as first-line antibiotic therapy in wild-type AmpC-producing Enterobacterales pulmonary infections.

Postoperative complications within 30 days represent the third leading cause of death in the world. Multiple solutions have been proposed to tackle the clinical and economic burden of postoperative complications. They include the optimal fluid and hemodynamic management of patients undergoing major surgery. Technological innovations and a better understanding of cardiovascular physiology underlie the evolution of perioperative hemodynamic management, ranging from the mere normalization of heart rate, blood pressure, and central venous pressure to oxygen delivery maximization with a pulmonary artery catheter and individualized fluid management with esophageal Doppler or pulse contour methods. The concept of personalized hemodynamic management recently emerged and may soon become a reality, because of new technologies enabling noninvasive measurement of cardiac output, not only during and after but also before surgery. The monitoring of microcirculation and tissue perfusion may help to fine tune this approach. Importantly, mortality within 30 days after surgery is 1000 times higher than intraoperative mortality. Therefore, continuous ward monitoring with wireless and wearable sensors may be the next major opportunity to improve patient safety.

Introduction Airway management and tracheal intubation are routinely performed in paediatric anaesthesia and yet are associated with preventable adverse events. The McGrath® MAC is a video laryngoscope with a curved blade similar to the Macintosh blade, which has not been previously described in first intention paediatric tracheal intubation. We aimed to compare direct laryngoscopy to the McGrath® MAC video laryngoscope among novice laryngoscopists. Methods Six paediatric anaesthesia residents with novice skills in paediatric laryngoscopy were randomly assigned to perform tracheal intubation using either direct Macintosh laryngoscopy (DL) or the McGrath® MAC video laryngoscope (MM) as the first attempted device in children weighing between 10 and 20 kg without difficult intubation. Results Our study enrolled 132 children between August 2013 and April 2015. The time to intubation was shorter in the DL group (n = 67) compared to the MM group (n = 65) with 42 s (35–50) versus 48 s (43–58) P = 0.002. The time to best view was similar between the two groups (10 s [7–16] versus 10 s [8–15]; P = 0.50). The tube passage time was shorter with DL (29 s [25–35] versus 35 s [30–45]; P = 0.0002) and either Cormak & Lehane grade or Percentage Of Glottis Opening (POGO) scores were similar between groups. Minor reversible respiratory adverse events were similar between groups: 12 in the DL group (17.9%) versus 12 in the MM group (18.5%). Discussion McGrath® MAC video laryngoscopy, when performed by a novice laryngoscopist on easy-to-intubate children, is associated with longer intubation times.

Resume Les cytopathies mitochondriales sont des maladies rares pour lesquelles les enfants atteints sont soumis a des anesthesies repetees, dans le cadre d’une prise en charge de leur pathologie ou de l’urgence. Les agents de l’anesthesie presentent de nombreuses interactions avec le metabolisme mitochondrial, notamment les anesthesiques locaux, les agents halogenes et le propofol. De ce fait, il parait essentiel de parfaitement connaitre les malades suspects des la consultation d’anesthesie afin d’optimiser les protocoles d’anesthesie et de prevenir les complications perioperatoire. Les decompensations metaboliques a type d’acidose lactique, cardiorespiratoires et neurologiques sont a surveiller.

Introduction et but de l’etude Chez le patient de reanimation sous epuration extra-renale (EER), il existe des pertes importantes de micronutriments (MN : elements traces et vitamines) dans les effluents et il est recommande d’effectuer une compensation de ces pertes. Neanmoins les doses a utiliser ne sont pas precises. Une supplementation a ete mise en place et associe un ensemble de MN administre en continu, a la seringue electrique protegee de la lumiere. L’objectif de cette etude est d’evaluer l’efficacite de ce protocole de supplementation standardise sur les concentrations plasmatiques de MN apres avoir debuter une EER. Materiel et methodes Depuis novembre 2016, tout patient pris en charge dans le service de reanimation chirurgicale du CHU Pellegrin ayant une indication d’EER beneficie d’une supplementation standardisee en MN. Quinze patients ont beneficie d’au moins deux dosages seriques en des MN realises a J0 (avant initiation de l’EER) et entre J3 et J5 sous EER. Ces dosages concernent des elements traces (Zn, Se, Cu), les vitamines B, la vitamine C et D ainsi que le magnesium. Les concentrations seriques etaient comparees par test de Wilcoxon apparie. Les carences (concentration serique inferieure a la limite specifiee par le laboratoire) etaient comparees par test du χ2. Les valeurs sont exprimees en pourcentage de patient ayant une concentration plasmatique de MN superieure (exces %) ou inferieure (deficit %) a la normale entre les deux periodes. Resultats et analyse statistique Il existe une augmentation des concentrations significative du Zn entre J0 : 6,6 μmol/L [5,6–8,7] et 10,4 μmol/L [9–12,4] a J3–J5 et du Se : 0,6 μmol/L [0,4–0,6] a J0 pour 0,9 μmol/L [0,7–1,1]. La magnesemie est plus basse lors de la deuxieme periode : Mg : 0,8 mmol/L [0,7–0,9] et 0,6 mmol/L [0,5–0,6] a J3–J5 Tableau 1 . En ce qui concerne les vitamines B1,B6, B9 et B12, aucune concentration plasmatique inferieure a la normale n’est mis en evidence a J0 ni a J3-J5 en dehors de la vitamine B9 (14 %). Enfin des concentrations plasmatiques basses sont observees pour la vit C (50 % des patients) et la vitamine D (93 %) a J0 et elle persistent a J3-J5 respectivement 57 % et 100 %. Conclusion Lors d’une hemofiltration, on observe une diminution des concentrations plasmatiques des MN en dehors de vitamines B1, B6 et B12. Il existe une concentration basse et persitante pour le Zn, Se, Cu, Vit C et vit D. La mise en place d’une supplementation s’accompagne d’une augmentation de la concentration du Zn et du Se mais pas des autres MN. La magnesemie chute apres la mise en route de l’EER.

The purpose of this pilot study was to evaluate the correlation between diaphragmatic excursion measured by a right sub-costal ultrasound approach and forced vital capacity in patients with amyotrophic lateral sclerosis (ALS) or myotonic dystrophy (MD). All patients referred for pulmonary function testing underwent ultrasonic measurement of diaphragmatic excursion during quiet breathing, voluntary sniffing (Esniff) and forced breathing (EDEmax). Forty-five patients were included, mainly for amyotrophic lateral sclerosis or myotonic dystrophy. There was a significant correlation between EDEmax values and forced vital capacity (FVC) values (r = 0.68 [0.46–0.90], p < 0.0001) and between EDEmax values and percentage of predicted FVC values (r = 0.75 [0.55–0.95], p < 0.0001). At a threshold of EDEmax < 5.5 cm, the sensitivity and specificity of ultrasonic diaphragmatic excursion in predicting FVC ≤ 50% of theoretical values were 100% [66%–100%] and 69% [52%–84%] respectively, without any significant difference between males and females. There was no statistical correlation between maximal inspiratory pressure and Esniff.

Resume Le syndrome de Lyell est une pathologie cutaneo-muqueuse rare pouvant mettre en jeu le pronostic vital et fonctionnel des patients. Son diagnostic et son traitement precoces sont d’une importance capitale du fait de son fort taux de mortalite. Nous rapportons le cas d’une patiente de 42 ans, sans antecedent, ayant developpe un tableau de necrolyse epidermique toxique (NET). Le tableau clinique etait inhabituel par l’etendue des lesions (decollement cutane de plus de 95 % de la surface corporelle) et par la chute dentaire due a une atteinte parodontale majeure. La cause toxique n’a pas pu etre identifiee, la patiente beneficiait d’un traitement par paracetamol dont l’imputabilite n’a pas ete etablie.

Since several decades, anesthesia care and intensive care, as well, are engaged in the way of excellence in clinical care and research. This requirement is also applied for the selection of professor and academic workers. The goals of this article are twice: first to diffuse this knowledge at the medical community and second to describe in details the long process leading to the final appointment.

Haemorrhagic shock remains a leading cause of death in trauma patients. The concept of haematologic damage control is gradually taking place in the management of traumatic haemorrhagic shock. It is based primarily on the early implementation of a quality blood transfusion involving erythrocytes, plasmas and platelets transfusion. Red blood cell transfusion is mainly supported by the oxygen carrier properties of erythrocytes. However, it appears that erythrocytes ability to modulate the bioavailability of nitric oxide (NO) plays a major role in capillary opening and perfusion. Erythrocytes are also actively involved in the processes of hemostasis and coagulation. In this context, it seems difficult to define a threshold of hemoglobin concentration to determine the implementation of a blood transfusion in traumatic haemorrhagic shock.

Acute myocardial infarction, following coronary artery dissection, is a rare, but potentially fatal, syndrome after blunt chest trauma. The treatment is more complicated when intracerebral lesions are present, because of the need of anticoagulation. We report the case of a 37-year-old male patient, suffering from a polytraumatism with intracranial petechial haemorrhages who have a left coronary artery dissection with acute myocardial infarction.

Orthotopic liver transplantation can be associated with haemorrhage, particularly in patients with severe liver dysfunction. We assessed the value of rotation thromboelastometry (ROTEM) to monitor coagulation in the operating theatre, its correlation with routine laboratory findings, and its ability to guide platelet (Plt) and fibrinogen (Fg) transfusion.Twenty-three patients were included in this prospective observational study. Laboratory tests and ROTEM tests (EXTEM, INTEM, FIBTEM, and APTEM) were performed six times during the procedure. Correlations between laboratory findings and ROTEM parameters were sought. Thresholds for ROTEM parameters were determined with receiver-operating characteristic (ROC) curve analysis according to Plt count and Fg levels.Clot amplitude at 10 min (A10) of EXTEM was well correlated with Plt count and Fg levels (R(2)=0.46 and 0.52, respectively, P0.0001). FIBTEM A10 was correlated with Fg (R(2)=0.55, P0.0001). ROC analysis showed that EXTEM A10 with a threshold of 29 mm predicted thrombocytopenia with a sensitivity of 79% and a specificity of 60%, and a threshold of 26 mm predicted hypofibrinogenaemia with a sensitivity of 83% and a specificity of 75%.ROTEM is useful for the global assessment of coagulation in the operating theatre. EXTEM was the most informative for assessing the whole coagulation process and A10 showed value in guiding Plt and Fg transfusion.

Exertional heat stroke (EHS) is a life-threatening condition caused by an extreme elevation in core body temperature. Acute liver failure has been reported during EHS justifying liver transplantation in some cases. The Molecular Adsorbent Recirculating System (MARS) could be indicated in such situations. We report a case of a 58-year old patient who suffered acute liver failure occurring after EHS. The patient was referred for liver transplantation and benefited of MARS therapy. After three sessions of MARS, liver function improved progressively and the transplantation was not necessary. The patient completely recovered.

Resume Nous rapportons un nouveau cas d’embolie gazeuse avec l’utilisation de peroxyde d’hydrogene injecte sous pression dans une cavite pelvienne semi-close. L’accident a ete observe au decours de la realisation d’un pansement de cellulite necrosante pelvienne, apres injection sous pression de 250 ml d’eau oxygenee. Survenaient alors brutalement une chute de la PETCO 2 et de la SpO 2 , puis des troubles du rythme cardiaque. Le tableau clinique s’amendait en quelques minutes et la patiente a beneficie alors d’un traitement par oxygenotherapie hyperbare. L’evaluation neurologique, realisee a distance du fait de l’etat de choc septique, ne retrouvait aucune sequelle. La production d’oxygene gazeux sous l’effet des catalases tissulaires et la diffusion vasculaire de ces bulles permet d’expliquer ce tableau clinique d’embolie gazeuse. L’injection dans des cavites closes ou semi-closes de grands volumes de peroxyde d’hydrogene et/ou son injection sous pression doivent etre proscrites.

Resume Nous rapportons le cas d’un hematome sous-dural intracrânien chez une femme de 36 ans, survenu dans les suites d’une rachianesthesie realisee pour un eveinage saphene interne bilateral. La rachianesthesie a ete effectuee sans incident. Des cephalees intenses, sans signe neurologique associe, sont apparues au deuxieme jour postoperatoire, apres le retour a domicile. Une imagerie par resonance magnetique, pratiquee en raison d’un antecedent de thrombophlebite cerebrale, a mis en evidence une lame d’hematome sous-dural parieto-occipital droit, sans indication neurochirurgicale. La patiente a beneficie d’un blood-patch permettant l’amendement rapide de la symptomatologie. L’evolution a ete favorable sans sequelle.

Introduction L’optimisation hemodynamique dans les chirurgies a risque comme la transplantation hepatique orthotopique est un enjeu majeur pour reduire la morbi-mortalite perioperatoire. Le catheter arteriel pulmonaire (CAP) reste pour un grand nombre d’equipes la methode de reference pour le monitorage hemodynamique. Recemment, un dispositif original d’analyse du contour de l’onde de pouls sans calibration externe a ete propose (Pulsioflex ® , Pulsion Medical System, Munich, Allemagne). Ce travail a pour objectif de comparer l’estimation de l’index cardiaque par le Pulsioflex ® et par le CAP au cours des transplantations hepatiques. Materiel et methodes Il s’agit d’une etude prospective et observationnelle. Apres accord du Comite de protection des personnes, trente patients consecutifs beneficiant d’une transplantation hepatique ont ete inclus. L’index cardiaque etait mesure par CAP (IC-CAP) et par le moniteur Pulsioflex ® (IC-Pulsio) a 9 temps definis lors de la chirurgie. L’analyse statistique a fait appel a l’analyse de Bland-Altman, au calcul de la concordance et l’analyse type polar plot . Resultats 270 paires de donnees ont ete analysees. IC-Pulsio etait statistiquement different de IC-CAP (3,4 ± 0,9 L/min/m 2 contre 4,2 ± 1,6 L/min/m 2 ; p 2 et des limites d’agrement de–2,2 a 3,8 L/min/m 2 . Le pourcentage d’erreur etait de 79 %. Le biais moyen sur les variations d’IC etait de 0,1 L/min/m 2 et les limites de concordance de–1,8 a 2,0 L/min/m 2 . Le taux de concordance etait de 59 %. L’analyse en polar plot a montre un biais angulaire de 27° et des limites de concordance radiales de 50°. Le biais moyen entre les IC etait inversement proportionnel aux resistances vasculaires systemiques indexees ( r = –0,67, p r = –0,52, p Fig. 1 ). Discussion Le moniteur Pulsioflex ® ne permet pas d’estimer l’index cardiaque avec fiabilite chez les patients beneficiant d’une transplantation hepatique. Sa precision est affectee par les resistances vasculaires systemiques.

Introduction En anesthesie-reanimation, l’evaluation de la fonction respiratoire des patients atteints de pathologie neuromusculaire preexistante ou acquise repose sur des mesures repetees de capacite vitale forcee (CVF) et de pression inspiratoire maximale (PI max ). Dans ce contexte, l’objectif principal de cette etude etait de determiner la correlation entre l’excursion diaphragmatique mesuree par echographie, les volumes et les pressions respiratoires afin de predire une alteration de la capacite vitale chez les patients atteints de pathologie neuromusculaire. Materiel et methodes Apres accord du comite local d’ethique, tout patient atteint de pathologie neuromusculaire adresse au laboratoire d’explorations fonctionnelles respiratoires pour mesure de la capacite vitale forcee etait eligible au cours d’une periode de trois mois. Apres consentement oral des patients, une echographie diaphragmatique sous-costale droite etait realisee par un operateur en aveugle des explorations fonctionnelles. Les mesures d’excursion diaphragmatique etaient realisees au repos ( E quiet ), en respiration forcee ( E max ) puis au cours d’un sniffing test ( E sniff ) [1] . La relation entre l’excursion diaphragmatique, les volumes et les pressions respiratoires etait realisee par regression lineaire puis realisation d’une courbe ROC. Resultats Au cours de la periode d’etude, 48 patients ont ete inclus (faisabilite 96 %). Dans cette population, il existait une correlation moderee mais significative entre E max et CVF ( R 2 = 0,403, p p E max Fig. 1 ). En revanche, il n’existait pas de correlation statistique entre PI max et E sniff . ( p = 0,52). Discussion Cette etude preliminaire confirme qu’une diminution de l’excursion diaphragmatique en expiration forcee pourrait temoigner d’une alteration de la capacite vitale chez les patients atteints de pathologie neuromusculaire. Dans cette population, l’echographie pourrait constituer un nouveau marqueur predictif de sevrage difficile ou de defaillance respiratoire postoperatoire. Ces hypotheses meritent d’etre verifiees par des etudes pronostiques de plus large effectif en anesthesie-reanimation.

Introduction De nombreux appareils electriques et electroniques sont utilises au bloc operatoire (BO) dans le diagnostique, traitement et surveillance des patients. En situation de marche, ces appareils emettent des ondes electromagnetiques (EM) de tres basses frequences (TBF : 50/60 Hz) d’intensite variable. Selon certaines etudes, l’exposition aux ondes EM-TBF (> 2 mG : milliGauss) serait nocive pour la sante [1] mais d’autres n’ont trouve aucun lien de cause a effet [2] . Ainsi, l’organisation mondiale de la sante incite a promouvoir la recherche dans ce domaine afin de clarifier la situation [3] . A notre connaissance, il n’y pas d’etudes recentes sur l’exposition aux champs EM dans les BO [4] , [5] . Les buts de cette etude ont ete de detecter les sources, de determiner l’intensite journaliere de cette pollution et d’estimer la distance minimale de securite. Materiel et methodes Apres avis du CCP, cette etude observationnelle a ete conduite dans 10 BO. La mesure des champs electriques (CE) et champs magnetiques (CM) a ete realisee avec l’analyseur ME 3030B M/E (Gigahertz solutions, Allemagne) en 3 etapes : detection des sources de pollution EM : appareils a emission de CM > 2mG selon la norme Suedoise [4] ; determination de l’intensite journaliere en mesurant les CE et CM dans chaque BO, hors activite de 6–7 h (appareils eteints) et en activite de 8–10 h ; 12–14 h et 16–18 h pendant 3 jours ; estimation de la distance minimale de securite (DMS) definie comme la distance entre la source et le point ou le CM ≤ 2 mG. Les donnees ont ete analysees par modele mixte pour mesures repetees avec un p Resultats Les mesures de base (appareils eteints) : CE = 11 ± 4 V/m et CM : 1,5 ± 0,7 mG. Parmi les 100 appareils testes dans les 10 BO, 20 % etaient detectes comme polluants dont les principaux, par categories de fonction : systemes de rechauffage (Bair Hugger®, WarmTouch®, intensite moyenne de CE 25 ± 7 V/m et CM 17 ± 8 mG ; distance minimale de securite 30 ± 5 cm) ; microscopes (Leica®, Zeiss®, Pentero®, intensite moyenne de CE 29 ± 7 V/m et CM 16 ± 9 mG avec une distance minimale de securite de 120 ± 25 cm) ; pousse seringues electriques (Fresinus Kabi®) CE 22 ± 8 V/m et CM 13 ± 6 mG, distance minimale de securite 22 ± 5 cm. Il n’y avait pas de variabilite journaliere significative. Discussion Cette etude montre qu’environ 20 % d’appareils utilises au BO emettent des champs magnetiques > 2 mG. L’eloignement de ces appareils a une distance de securite (specifique a chaque appareil) des patients et des soignants pourrait eviter l’exposition de ces derniers aux CM. Nous n’avons evalue qu’une faible partie des appareils utilises dans notre institution. Les differences architecturales des BO et de materiels medicaux existes d’une institution a l’autre. Ainsi nous suggerons une evaluation specifique a chaque BO afin de prendre des mesures preventives adequates.

Lemierre syndrome is a rare clinical entity, characterized by thrombosis of the internal jugular vein that develops after an oropharyngeal infection. We report the case of a 22-year-old woman hospitalized initially for cellulitis of the face. In view of the aggravation of the clinical state (septic shock and multiple organ failure), a computed tomography of the neck was performed and revealed a thrombosis of the right internal and external jugular veins. The patient was treated with antibiotics, heparin, and by a surgical excision for the vascular lesions associated with ligation of jugular veins. The patient completely recovered from her infection.