55 research outputs found
Evaluation d'un protocole d'antibiothérapie probabiliste des péritonites communautaires et nosocomiales non postopératoires au CHU d'Amiens
No full textINTRODUCTION : Malgré les progrès médicaux, les péritonites gardent un pronostic sévère avec une mortalité évaluée entre 4 et 30%. La prescription d une antibiothérapie probabiliste appropriée et adaptée aux prélèvements infectieux est un élément fondamental de la prise en charge. Une évaluation des pratiques professionnelles en 2004-2005 au CHU d Amiens révélait un faible taux de suivi des recommandations responsable d une augmentation de morbidité. MATERIELS ET METHODES : Après rédaction et diffusion d un protocole d antibiothérapie probabiliste dans les péritonites aigües communautaires (PAC) et nosocomiales non postopératoires (PAN), nous avons mené une étude rétrospective entre 2009 et 2011 afin d évaluer son observance et son impact sur les malades. Une analyse univariée a comparé les malades selon la conformité ou non de leur antibiothérapie au protocole. Des facteurs indépendants de non respect du protocole étaient ensuite recherchés en analyse multivariée. RESULTATS : Parmi les 310 patients inclus, 223 (71,9%) présentaient une PAC et 87 (28,1%) une PAN. L âge moyen était de 60+-22 ans, avec un score IGS II à 24+-16. La prescription antibiotique était conforme au protocole dans 52,3% des cas et adaptée aux germes dans 80%. La mortalité était supérieure en cas de non observance (14,9 vs. 5,6%, p=0,011). Par ailleurs, on observait plus de reprise chirurgicale (17,6% vs. 9,3, p=0,047), de défaillance circulatoire (27% vs. 11,7, p=0,001), de complications infectieuses (38% vs. 19,8, p<0,001), de durée de ventilation mécanique (4+-12j vs. 2+-6, p<0,001), de séjour hospitalier (19+-23j vs. 11+-12, p=0,002) et en réanimation (6+-14j vs. 2+-5, p<0,001). Le suivi des recommandations dans les PAC était significativement amélioré après mise en place du protocole (62,8 vs. 31,7%, p<0,001). Les facteurs prédisposant à une prescription non conforme étaient l âge du médecin anesthésiste (plus de 36 ans) (OR 2,1 ; IC95% [1,3-3,5]) et la présence de facteurs de risque de BMR (OR 6 ; IC95% [2,7-13,2])CONCLUSION : Le non respect d un protocole d antibiothérapie dans les PAC et les PAN est associé à une augmentation de la morbidité et de la mortalité. L information doit être ciblée sur les médecins anesthésistes de plus de 36 ans et lors de facteurs de risque de BMR.AMIENS-BU Santé (800212102) / SudocSudocFranceF
Burnout syndrome in critical care team members: A monocentric cross sectional survey
No full textInternational audienceIntroduction: There has been a growing interest in evaluating the occurrence of burnout syndrome (BOS) among intensive care units (ICU) team over recent years. The aims of this study were to determine the prevalence of BOS among staff working in the Amiens University Hospital and to assess associated factors. Patients and methods: Prospective observational study based on self-administered questionnaires filled in by physicians and non-physicians working in 3 ICUs. Demographic data, well-being assessment, work relationships, level of BOS and depressive symptoms were investigated. Logistic regression analysis was performed to identify variables independently associated with BOS. Results: One hundred and sixty-one questionnaires were analysed. Participation rate was 90%. Thirtyt-wo respondents were physicians and 129 were non-physicians. The prevalence of BOS was 51% and was not significantly different between physicians and non-physicians (56% versus 50%; P = 0.501). Respondents who reported BOS less frequently had regular leisure activities (54 [66%] versus 70 [87%], P = 0.001). In the BOS group, well-being was significantly lower (4.8 +/- 2.5/10 versus 6 +/- 2/10, P = 0.001), a desire to leave the job was more frequently expressed (50 [61%] versus 32 [40%], P = 0.009) and depressive symptoms were significantly more frequent (41 [50%] versus 21 [27%], P = 0.002). Factors independently associated with BOS were regular leisure activities (OR 0.24 [0.1-0.59]; P = 0.002), the presence of depressive symptoms (OR 2.71 [1.26-5.84]; P = 0.011) and a well-being visual analogue scale >= 5 (OR 0.40 [0.18-0.89]; P = 0.024). Conclusions: BOS affects all ICU workers and is determined by multiple factors. Leisure activities and measures designed to improve well-being should be promoted. (C) 2016 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved
Hyperoxia during cardiopulmonary bypass does not increase respiratory or neurological complications: a post hoc analysis of the CARDIOX study
No full textInternational audienc
French ICUs fight back: An example of regional ICU organisation to tackle the SARS-CoV-2 outbreak
No full textInternational audienc
An urgent open surgical approach for left ventricle venting during peripheral veno-arterial extracorporeal membrane oxygenation for refractory cardiac arrest: case report
No full textInternational audienceThe objective of the study is to describe an emergency procedure for left ventricle venting during veno-arterial extracorporeal life support for refractory cardiac arrest. Veno-arterial extracorporeal membrane oxygenation is widely used in refractory cardiac arrest but is characterized by an increase in left ventricle afterload, which may impair cardiac contractility improvement. Different left ventricle venting techniques are available. We report the use of a surgical approach with sternotomy for left ventricle venting in a 21-year-old patient who was placed under veno-arterial extracorporeal membrane oxygenation for refractory cardiac arrest with severe pulmonary edema, respiratory failure, and left ventricle stasis. A 21-year-old woman was admitted for laparoscopic sleeve gastrectomy. In the recovery room, she developed a refractory circulatory shock. Transthoracic echocardiography revealed a dilated cardiomyopathy with severe left ventricle systolic dysfunction (left ventricle ejection fraction at 20%). Coronary angiogram was normal. On day 2, she underwent laparotomy for sepsis and she presented cardiac arrest secondary to ventricular tachycardia. We proceeded to peripheral veno-arterial extracorporeal membrane oxygenation as the cardiac arrest was refractory. A miniaturized veno-arterial extracorporeal membrane oxygenation system was implanted into the right femoral vessels onsite .The low flow duration was 40 minutes. Veno-arterial extracorporeal membrane oxygenation blood flow was set to 3 L min(-1), resulting in a closed aortic valve and a massive pulmonary edema. Transesophageal echocardiography showed left ventricular ejection fraction at 5% without aortic valve opening. We first implanted an intra-aortic balloon pump without clinical improvement. Transesophageal echocardiography revealed massive thrombus formation into the aortic root. We decided to perform an open surgical approach for left ventricle unload using a transmitral cannula (22 Fr) via the right superior pulmonary vein connected to the inflow tube of the veno-arterial extracorporeal membrane oxygenation with Y connection. Transesophageal echocardiography showed a full opening of aortic valve and elimination of valve aortic thrombus. Chest radiography showed a significant decrease of pulmonary congestion. We were able to withdraw extracorporeal life support organization on day 10 and discharged on day 54. Clinical explorations reveal a fulminant rocuronium-related hypersensitivity myocarditis. This salvage surgical technique using a modified central veno-arterial extracorporeal membrane oxygenation cannulation technique has efficiently decreased blood stasis and permitted rapid recovery
Effect of the oXiris membrane on microcirculation after cardiac surgery under cardiopulmonary bypass: study protocol for a randomised controlled trial (OXICARD Study)
No full textIntroduction Cytokine storm and endotoxin release during cardiac surgery with cardiopulmonary bypass (CPB) have been related to vasoplegic shock and organ dysfunction. We hypothesised that early (during CPB) cytokine adsorption with oXiris membrane for patients at high risk of inflammatory syndrome following cardiac surgery may improve microcirculation, endothelial function and outcomes.Methods and analysis The Oxicard trial is a prospective, monocentric trial, randomising 70 patients scheduled for cardiac surgery. The inclusion criterion is patients aged more than 18 years old undergoing elective cardiac surgery under CPB with an expected CPB time >90 min (double valve replacement or valve replacement plus coronary arterial bypass graft). Patients will be allocated to the intervention group (n=35) or the control group (n=35). In the intervention group, oXiris membrane will be used on the Prismaflex device (Baxter) at blood pump flow of 450 mL/min during cardiac surgery under CPB. In the control group, cardiac surgery under CPB will be conducted as usual without oXiris membrane. An intention-to-treat analysis will be performed. The primary endpoint will be the microcirculatory flow index measured by sublingual microcirculation device at day 1 following cardiac surgery. The secondary endpoints will be other microcirculation variables at CPB end, 6 hours after CPB, at day 1 and at day 2. We also aim to evaluate the occurrence of major cardiovascular and cerebral events (eg, myocardial infarction, stroke, ischaemic mesenteric, resuscitated cardiac arrest, acute kidney injury) within the first 30 days. Cumulative catecholamine use, intensive care unit length of stay, endothelium glycocalyx shedding parameters (syndecan-1, heparan-sulfate and hyaluronic acid), inflammatory cytokines (tumour necrosis factor (TNF) alpha, interleukin 1 (IL1) beta, IL 10, IL 6, lipopolysaccharide, endothelin) and endothelial permeability biomarkers (angiopoietin 1, angiopoietin 2, Tie2 soluble receptor and Vascular Endothelial Growth Factor (VEGF) will also be evaluated.Ethics and dissemination Ethical approval has been obtained from the Institutional Review Board of the University Hospital of Amiens (registration number ID RDB: 2019-A02437-50 in February 2020). Results of the study will be disseminated via peer-reviewed publications and presentations at national and international conferences.Trial registration number NCT04201119
Norepinephrine Exposure and Acute Kidney Injury after Cardiac Surgery under Cardiopulmonary Bypass: A Post-Hoc Cardiox Trial Analysis.
No full textInternational audienc
Almitrine for COVID-19 critically ill patients - a vascular therapy for a pulmonary vascular disease: Three case reports
No full textInternational audienceBACKGROUND Several reports with clinical, histological and imaging data have observed the involvement of lung vascular function to explain the severe hypoxemia in coronavirus disease 2019 (COVID-19) patients. It has been hypothesized that an increased pulmonary blood flow associated with an impairment of hypoxic pulmonary vasoconstriction is responsible for an intrapulmonary shunt. COVID-19 may lead to refractory hypoxemia (PaO2/FiO(2) ratio below 100 mmHg) despite mechanical ventilation and prone positioning. We hypothesized that the use of a pulmonary vasoconstrictor may help decrease the shunt and thus enhance oxygenation. CASE SUMMARY We report our experience with three patients with refractory hypoxemia treated with almitrine to enhance oxygenation. Low dose almitrine (Vectarion(R); Servier, Suresnes, France) was started at an infusion rate of 4 mu g x kg/min on a central line. The PaO2/FiO(2) ratio and total respiratory system compliance during almitrine infusion were measured. For the three patients, the PaO2/FiO(2) ratio time-course showed a dramatic increase whereas total respiratory system compliance was unchanged. The three patients were discharged from the intensive care unit. The intensive care unit length of stay for patient 1, patient 2 and patient 3 was 30 d, 32 d and 31 d, respectively. Weaning from mechanical ventilation was performed 13 d, 18 d and 15 d after almitrine infusion for patient 1, 2 and 3, respectively. We found no deleterious effects on the right ventricular function, which was similar to previous studies on almitrine safety. CONCLUSION Almitrine may be effective and safe to enhance oxygenation in coronavirus disease 2019 patients. Further controlled studies are required
Hypoxemia and prone position in mechanically ventilated Covid-19 patients: a prospective cohort study
No full textInternational audienc
Central venous-to-arterial CO2 difference is a poor tool to predict adverse outcomes after cardiac surgery: a retrospective study
No full textInternational audiencePurpose The venous-to-arterial carbon dioxide partial pressure difference (CO2 gap) has been reported to be a sensitive indicator of cardiac output adequacy. We aimed to assess whether the CO2 gap can predict postoperative adverse outcomes after cardiac surgery. Methods A retrospective study was conducted of 5,151 patients from our departmental database who underwent cardiac surgery from 1 January 2008 to 31 December 2018. Lactate level (mmol center dot L-1), central venous oxygen saturation (ScVO2) (%), and the venous-to-arterial carbon dioxide difference (CO2 gap) were measured at intensive care unit (ICU) admission and on days 1 and 2 after cardiac surgery. The following postoperative adverse outcomes were collected: ICU mortality, hemopericardium or tamponade, resuscitated cardiac arrest, acute kidney injury, major bleeding, acute hepatic failure, mesenteric ischemia, and pneumonia. The primary outcome was the presence of at least one postoperative adverse outcome. Logistic regression was used to assess the association between ScVO2, lactate, and the CO2 gap with adverse outcomes. Their diagnostic performance was compared using a receiver operating characteristic (ROC) curve. Results There were 1,933 patients (38%) with an adverse outcome. Cardiopulmonary bypass (CPB) parameters were similar between groups. The CO2 gap was slightly higher for the ``adverse outcomes'' group than for the ``no adverse outcomes'' group. Arterial lactate at admission, day 1, and day 2 was also slightly higher in patients with adverse outcomes. Central venous oxygen saturation was not significantly different between patients with and without adverse outcomes. The area under the ROC curve to predict outcomes after CPB for the CO2 gap at admission, day 1, and day 2 were 0.52, 0.55, and 0.53, respectively. Conclusion After cardiac surgery with CPB, the CO2 gap at ICU admission, day 1, and day 2 was associated with postoperative adverse outcomes but showed poor diagnostic performance
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