The pediatric intensive care unit in France: What happens afterwards?

Although pediatric post-intensive care syndrome is frequent and impacts the child's quality of life in various aspects, there are currently no guidelines regarding post-pediatric intensive care unit (PICU) follow-up. The aim of this study was to describe post-PICU follow-up in France. Among the 37 French PICUs, only 67 % had a consultation service, mostly performed by pediatric intensivists (95 %). Post-intensive care evaluation was the main objective for 46 % of these centers, whereas others focused on specific patient populations. Post-intensive care follow-up is highly heterogeneous and developing such consultation services appears to be a main challenge for PICU teams.

Decannulation in congenital central hypoventilation syndrome.

RATIONALE: Patients with congenital central hypoventilation syndrome (CCHS) require long-term ventilation to ensure gas exchange and to prevent deleterious consequences for neurocognitive development. Two ventilation modes may be used for these patients depending on their tolerance, one invasive by tracheostomy and the other noninvasive (NIV). For patients who have undergone a tracheostomy, transition to NIV is possible when they meet predefined criteria. Identifying the conditions favorable for weaning from a tracheostomy is critical for the success of the process. OBJECTIVE: The aim of the study was to share our experience of decannulation in a reference center; we hereby describe the modality of ventilation and its effect on nocturnal gas exchange before and after tracheostomy removal. METHODS: Retrospective observational study at Robert Debré Hospital over the past 10 years. The modalities of decannulation and transcutaneous carbon dioxide recordings or polysomnographies before and after decannulation were collected. RESULTS: Sixteen patients underwent decannulation following a specific procedure for transition from invasive to NIV. All decannulations were successful. The median age at decannulation was 12.6 [9.4; 14.1] years. Nocturnal gas exchange was not significantly different before and after decannulation, while expiratory positive airway pressure and inspiratory time increased significantly. An oronasal interface was chosen in two out of three patients. The median duration of hospital stay for decannulation was 4.0 [3.8; 6.0] days. CONCLUSION: Our study underlines that decannulation and transition to NIV are achievable in CCHS children using a well-defined procedure. Patient preparation is crucial to the success of the process.

[COVID-19 epidemic, a challenge successfully overcome by intensive care nurses]. / L'épidémie de Covid-19, une mise à l'épreuve réussie pour les infirmiers de réanimation.

The COVD-19 wave of spring 2020 had a major impact on French intensive care departments. The intense activity, the support of reinforcements in the acquisition of the necessary skills and their capacity to adapt made intensive care nurses key players in this crisis. Grouped together within the French National Federation of Intensive Care Nurses, they are campaigning to have the specificity of their practice to be recognised and for the creation of certified training in order to meet public healthcare needs not currently fulfilled.

["Teleconsultation facilitates access and the care pathway of children with multiple disabilities."] / « La téléconsultation facilite l'accès et le parcours de soins de l'enfant polyhandicapé ¼.

Teleconsultations facilitating access to care, offer undeniable added value to the digital care pathway of children with multiple disabilities. This innovation transforms and enhances practices and collaboration methods between healthcare, medico-social and private practice professionals. An interview with Monique Bredillot, general care coordinator for CESAP, the committee for studies, education and care for people with multiple disabilities.

[Support for families through a Disability Resource Unit]. / L'accompagnement des familles par une Cellule Ressource Handicap.

The Disability Resource Unit of the mother and infant welfare protection centre aims to facilitate the care of children with a disability in day care centres or at school. Thanks to the creation of a doctor-children's nurse partnership, the unit provides families with personalised support. Listening, availability and empathy are essential in order to meet as best as possible the specific needs of the child and the parents' expectations. Interview with Véronique Labidoire, child care worker and technical advisor in the Disability Resource Unit of the Gironde's mother and infant welfare protection centre.

[Therapeutic education of children who are victims or at risk of a stroke]. / L'éducation thérapeutique des enfants victimes ou à risque d'accident vasculaire cérébral.

Therapeutic patient education is one of the health improvement projects. It provides personalised support for a child who has suffered or is at risk of suffering a stroke, and their family. This approach requires the sharing and transfer of knowhow, behaviour and attitude on the part of specially trained health professionals.

[The mobile emergency and intensive care service, a place of transition for families]. / Le service mobile d'urgence et de réanimation, un lieu de transition pour les familles.

When the mobile emergency and intensive care service (Smur) intervenes with a child, the parents are in a completely unknown and anxiety-generating situation. The care team helps families to find their place, depending on the medical context and health status of the child. The intervention of the Smur therefore represents a place of transition for the parents.

[Caring for disabled teenagers in intensive care, a specific form of care]. / L'accueil de l'adolescent handicapé en réanimation, un soin a part entière.

Duchenne muscular dystrophy is a genetic degenerative disease, resulting in severe motor disability and associated with a fatal prognosis. Children suffering from the disease face numerous treatments and repeated hospitalisations. The care of young patients during these hospital stays represents a key moment for establishing a relationship of trust with them and their family. A survey of two paediatric intensive care units identified the establishment of this bond as being an integral part of care.