Fluid Intake in Critically Ill Patients: The "Save Useless Fluids For Intensive Resuscitation" Multicenter Prospective Cohort Study.

OBJECTIVES: Patients at risk of adverse effects related to positive fluid balance could benefit from fluid intake optimization. Less attention is paid to nonresuscitation fluids. We aim to evaluate the heterogeneity of fluid intake at the initial phase of resuscitation. DESIGN: Prospective multicenter cohort study. SETTING: Thirty ICUs across France and one in Spain. PATIENTS: Patients requiring vasopressors and/or invasive mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All fluids administered by vascular or enteral lines were recorded over 24 hours following admission and were classified in four main groups according to their predefined indication: fluids having a well-documented homeostasis goal (resuscitation fluids, rehydration, blood products, and nutrition), drug carriers, maintenance fluids, and fluids for technical needs. Models of regression were constructed to determine fluid intake predicted by patient characteristics. Centers were classified according to tertiles of fluid intake. The cohort included 296 patients. The median total volume of fluids was 3546 mL (interquartile range, 2441-4955 mL), with fluids indisputably required for body fluid homeostasis representing 36% of this total. Saline, glucose-containing high chloride crystalloids, and balanced crystalloids represented 43%, 27%, and 16% of total volume, respectively. Whatever the class of fluids, center of inclusion was the strongest factor associated with volumes. Compared with the first tertile, the difference between the volume predicted by patient characteristics and the volume given was +1.2 ± 2.0 L in tertile 2 and +3.0 ± 2.8 L in tertile 3. CONCLUSIONS: Fluids indisputably required for body fluid homeostasis represent the minority of fluid intake during the 24 hours after ICU admission. Center effect is the strongest factor associated with the volume of fluids. Heterogeneity in practices suggests that optimal strategies for volume and goals of common fluids administration need to be developed.

Feasibility of a repositioning schedule on pressure ulcer prevention in a French Intensive Care Unit: A pre and post-intervention pilot study.

AIMS: As a prerequisite of a multicentre study, we conducted a pilot study to assess the feasibility of a daily repositioning schedule in critically ill patients. The schedule was adapted to the patient's clinical condition, and the estimated risk for developing a pressure ulcer using the Braden scale. DESIGN: A single-center pre and post-intervention pilot study in a French Intensive Care Unit of a university teaching hospital. This study followed TREND guidelines. METHODS: During the first period (March to May 2018), pressure ulcer prevention was performed according to usual care. During the second period (June to August 2018), the repositioning schedule was adapted to the estimated risk for developing a pressure ulcer according to the Braden scale. Eligible patients had no pressure ulcer at baseline, were intubated within 24 hours of admission and expected to receive mechanical ventilation for at least 24 hours. The primary outcome was the rate of pressure ulcer development at 28 days of hospitalization or at discharge or death, as compared with usual care. Secondary outcomes included the feasibility and safety of the schedule, as assessed by caregivers' adherence and workload, and the rate of adverse events. RESULTS: In the pre-intervention period 20 participants were included, and 14 patients were included in the post-intervention period. There was no decrease in the pressure ulcers incidence with the intervention (25% vs. 28.6%; P = 1). The number of daily repositioning performed increased from 3.3 [IQR 3.0; 3.9] during the pre-intervention period to 4.3 [IQR 3.8; 5.2] during the post-intervention period (P < 0.05), where it differed from the number scheduled by 0.6 [IQR 0.1; 1.4] per day, indicating satisfactory adherence of caregivers to the protocol. Adverse events rate did not differ between the two periods (55.9% vs. 57.1%; P = 0.90). CONCLUSION: A personalised daily repositioning schedule in critically ill patients is feasible and safe. The efficacy of such a strategy, together with its economic impact, need to be assessed in a multicentre randomized trial.

Personal resources used by nurses enrolled in an advanced practice curriculum during the COVID-19 pandemic in France: Sequential mixed research / Ressources personnelles utilisées par les infirmiers inscrits dans un cursus en pratique avancée lors de la pandémie de coronavirus en France : une recherche mixte séquentielle

Introduction: At the beginning of 2020, a public health emergency was declared in France following the emergence of the SARS-CoV-2 pandemic. Context: Nurses involved in an advanced practice mobilized their specific skills during this health crisis by drawing on the available resources. Objectives: To analyze personal resources used by those nurses in the process of skill mobilization during the pandemic. Method: Sequential mixed research, first quantitative and then qualitative, concerning nurses or students enrolled in an advanced practice curriculum. Results: Our analysis highlighted two groups of activity for those nurses: frontline workers against COVID-19 or coordination. Coordination seemed to present more opportunities to use the specific skills of advance practice nursing. Discussion: Adjustment strategies for stress (coping and hardiness) boost nurses' commitment to their professional practice. Disciplinary knowledge contributes to the enrichment of the knowledge necessary for the mobilization of skills. Conclusion: Future research should explore resources and the mobilization of skills in the implementation of advance practice nursing.

Introduction: Début 2020, l'état d'urgence sanitaire est déclaré en France suite à l'émergence d'une pandémie au SARS-CoV-2. Contexte: Les infirmiers inscrits dans un parcours de pratique avancée ont mobilisé leurs compétences pendant cette crise en s'appuyant sur les ressources disponibles. Objectifs: Analyser les ressources personnelles utilisées par ces infirmiers dans le processus de mobilisation des compétences, lors de la crise sanitaire. Méthode: Recherche mixte séquentielle quantitative puis qualitative auprès des infirmiers français inscrits dans un cursus de pratique avancée. Résultats: Il émerge deux groupes d'activité pour ces infirmiers : en première ligne en service Covid, et la coordination. Il semble y avoir plus d'opportunités d'utiliser les compétences spécifiques à la pratique avancée en coordination. Discussion: Les stratégies d'ajustement au stress (coping et hardiesse) favorisent l'engagement des infirmiers dans leur pratique professionnelle. Les savoirs disciplinaires participent à l'enrichissement des connaissances nécessaires à la mobilisation des compétences. Conclusion: De futures recherches devraient explorer les ressources et la mobilisation des compétences dans l'implantation des infirmiers en pratique avancée.

Imaging Local Electric Field Distribution by Plasmonic Impedance Microscopy.

We report on imaging of local electric field on an electrode surface with plasmonic electrochemical impedance microscopy (P-EIM). The local electric field is created by putting an electrode inside a micropipet positioned over the electrode and applying a voltage between the two electrodes. We show that the distribution of the surface charge as well as the local electric field at the electrode surface can be imaged with P-EIM. The spatial distribution and the dependence of the local charge density and electric field on the distance between the micropipet and the surface are measured, and the results are compared with the finite element calculations. The work also demonstrates the possibility of integrating plasmonic imaging with scanning ion conductance microscopy (SICM) and other scanning probe microscopies.

Scanning Electrochemical Microscopy Study of Permeability of a Thiolated Aryl Multilayer and Imaging of Single Nanocubes Anchored to It.

Electroreduction of diazonium salts is a widely used technique for grafting organic films on various surfaces. In this paper, scanning electrochemical microscopy (SECM) was used for high-resolution characterization of a thiolated aryl multilayer film obtained by electrografting of thiophenol diazonium on highly ordered pyrolytic graphite (HOPG). The blocking properties of the film were evaluated, and the origins of incomplete surface passivation were elucidated by comparing current-distance curves and surface reactivity maps obtained with nanometer- and micrometer-sized tips. In this way, one can distinguish between different pathways of charge transport in the film, e.g., pinhole defects versus rate-limiting charge transfer through the film. Pd nanocubes were anchored to the film by thiol groups and imaged by SECM. The applicability of SECM to in situ visualization of the geometry of non-spherical nanoparticles has been demonstrated.

Surface Patterning Using Diazonium Ink Filled Nanopipette.

Molecular grafting of diazonium is a widely employed surface modification technique. Local electrografting of this species is a promising approach to surface doping and related properties tailoring. The instability of diazonium cation complicates this process, so that this species was generated in situ in many reported studies. In this Article, we report the egress transfer of aryl diazonium cation across the liquid/liquid interface supported at the nanopipette tip that can be used for controlled delivery this species to the external aqueous phase for local substrate patterning. An aryl diazonium salt was prepared with weakly coordinating and lipophilic tetrakis(pentafluorophenyl)borate anion stable as a solid and soluble in low polarity media. The chemically stable solution of this salt in 1,2-dichloroethane can be used as "diazonium ink". The ink-filled nanopipette was employed as a tip in the scanning electrochemical microscope (SECM) for surface patterning with the spatial resolution controlled by the pipette orifice radius and a few nanometers film thickness. The submicrometer-size grafted spots produced on the HOPG surface were located and imaged with the atomic force microscope (AFM).

Cleaning nanoelectrodes with air plasma.

Unlike macroscopic and micrometer-sized solid electrodes whose surface can be reproducibly cleaned by mechanical polishing, cleaning the nanoelectrode surface is challenging because of its small size and extreme fragility. Even very gentle polishing typically changes the nanoelectrode size and geometry, thus, complicating the replication of nanoelectrochemical experiments. In this letter, we show the possibility of cleaning nanoelectrode surfaces nondestructively by using an air plasma cleaner. The effects of plasma cleaning have been investigated by atomic force microscopy (AFM) imaging, voltammetry, and scanning electrochemical microscopy (SECM). A related issue, the removal of an insoluble organic film from the nanoelectrode by plasma cleaning, is also discussed.

TEMPO mixed SAMs: electrocatalytic efficiency versus surface coverage.

Electrocatalytic behavior of TEMPO derivative SAMs on gold has been studied in the presence of benzyl alcohol. The results demonstrate that interfacial activity of the SAMs can be enhanced by diluting the TEMPO moiety with an alkyl passive matrix. The absolute catalytic activity exhibits a maximum for an intermediate value of the surface coverage of catalytic centers. The most significant feature is the monotonic increase of the turnover (relative activity) until a limit value reached for low TEMPO surface concentrations. The electrocatalytic performances seem to be governed by a combination of two factors: the physical accessibility (by alcohol molecules in solution) and the regeneration (via the comproportionation of oxoammonium and hydroxylamine before electrochemical reoxidation) of the catalytic centers.

Electrochemical transduction on self-assembled monolayers: are covalent links essential?

Electrochemical transduction without covalent links between redox and complexant units in a complexing self-assembled monolayer has been established. The results demonstrate that transduction depends on the crown ether/ferrocene ratio and appears to be tunable.

Intermolecular interactions in self-assembled monolayers of tetrathiafulvalene derivatives.

The elaboration of mixed self-assembled monolayers (SAMs) of tetrathiafulvalene derivatives allows the modulation of intermolecular interactions and provides evidence of segregated distribution of redox centers.

[The advanced practice nurse in post-COViD-19 respiratory follow up]. / L'IPA dans le suivi respiratoire post-Covid-19.

The setting up of an advanced practice nursing activity to monitor patients with severe or very severe pneumonia associated with Severe Acute Respiratory Syndrome Coronavirus 2, is a reponse to the population's new health care needs and a massive influx of patients. The skills of the advanced practice nurse are mobilised in this context in order to carry out prevention missions and screening for potential sequelae which could lead to chronic respiratory failure.

Insights into carbon nanotube-assisted electro-oxidation of polycyclic aromatic hydrocarbons for mediated bioelectrocatalysis.

A series of polycyclic aromatics, naphthalene, phenanthrene, perylene, pyrene, 1-pyrenebutyric acid N-hydroxysuccinimide ester (pyrene NHS) and coronene, were immobilized via π stacking on carbon nanotube (CNT) electrodes and electro-oxidized in aqueous solutions. The obtained quinones were characterized and evaluated for the mediated electron transfer with FAD dependent glucose dehydrogenase during catalytic glucose oxidation.

Pain and dyspnea control during awake fiberoptic bronchoscopy in critically ill patients: safety and efficacy of remifentanil target-controlled infusion.

PURPOSE: Flexible fiberoptic bronchoscopy is frequently used in intensive care unit, but is a source of discomfort, dyspnea and anxiety for patients. Our objective was to assess the feasibility and tolerance of a sedation using remifentanil target-controlled infusion, to perform fiberoptic bronchoscopy in awake ICU patients. MATERIALS, PATIENTS AND METHODS: This monocentric, prospective observational study was conducted in awake patients requiring fiberoptic bronchoscopy. In accordance with usual practices in our center, remifentanil target-controlled infusion was used under close monitoring and adapted to the patient's reactions. The primary objective was the rate of successful procedures without additional analgesia or anesthesia. The secondary objectives were clinical tolerance and the comfort of patients (graded from "very uncomfortable" to "very comfortable") and operators (numeric scale from 0 to 10) during the procedure. RESULTS: From May 2014 to December 2015, 72 patients were included. Most of them (69%) were hypoxemic and admitted for acute respiratory failure. No additional medication was needed in 96% of the patients. No severe side-effects occurred. Seventy-eight percent of patients described the procedure as "comfortable or very comfortable". Physicians rated their comfort with a median [IQR] score of 9 [8-10]. CONCLUSION: Remifentanil target-controlled infusion administered to perform awake fiberoptic bronchoscopy in critically ill patients is feasible without requirement of additional analgesics or sedative drugs. Clinical tolerance as well as patients' and operators' comfort were good to excellent. This technique could benefit patients' experience.