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BACKGROUND: Immediate hypersensitivity reactions during anaesthesia are rare but potentially life-threatening. The epidemiology changes with time and evolving professional practice, and hence needs to be monitored. Our objective was to follow this epidemiology. METHODS: This was a retrospective, observational study in French hospital clinics, conducted by GERAP members (Groupe d'Étude des Réactions Anaphylactoïdes Périopératoires). Consecutive patients seen in allergo-anaesthesia outpatient clinics, who had experienced a hypersensitivity reaction during anaesthesia between 1 January 2011 and 31 December 2012, were included. Demographic data, allergy history, drugs received before the reaction, symptoms of the reaction, results of blood samples (histamine, tryptase, IgE-specific assays), and results of the allergy assessment were recorded. RESULTS: The most common causes of allergic reactions were (Neuromuscular Blocking Agents) NMBAs (N = 302; 60.6%), antibiotics (N = 91, 18.2%, Cephalosporin N = 49, 10%) and dyes (N = 27; 5.4%). Latex as an allergic agent was involved in 26 cases (5.2%), hypnotics in 11 cases (2.2%) and opioids in seven cases (1.4%). Of the NMBAs, Rocuronium had the highest proportion of reactions (13.8 reactions/100,000 vials sold) followed by Suxamethonium (13.3/100,000 vials sold). Cisatracurium had the lowest proportion of reactions (0.4/100,000 vials sold). Patients were sensitized to two or more NMBAs in 48.9% of cases and without testing, cross-sensitivity cannot be predicted. CONCLUSIONS: When compared with the previous GERAP studies, NMBAs are still the most frequently triggering allergens, with marked differences between individual NMBAs, but they are now followed by antibiotics (of which greater than 50% were cephalosporins) and dyes. Anaesthetists must be aware of the differences between drugs and of the pattern of emerging allergens. For the future of safe anaesthesia, allergy assessment is essential.
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Anestesia/efeitos adversos , Hipersensibilidade a Drogas/epidemiologia , Antibacterianos/efeitos adversos , Feminino , França/epidemiologia , Histamina/sangue , Humanos , Imunoglobulina E/sangue , Masculino , Bloqueadores Neuromusculares/efeitos adversos , Estudos Retrospectivos , Fatores de Tempo , Triptases/sangueRESUMO
OBJECTIVE/BACKGROUND: Gut ischemia reperfusion (IR) is thought to trigger systemic inflammation, multiple organ failure, and death. The aim of this study was to investigate inflammatory responses in blood and in two target organs after gut IR. METHODS: This was a controlled animal study. Adult male Wistar rats were randomized into two groups of eight rats: control group and gut IR group (60 minutes of superior mesenteric artery occlusion followed by 60 minutes of reperfusion). Lactate and four cytokines (tumor necrosis factor-a, interleukin [IL]-1b, IL-6, and IL-10) were measured in mesenteric and systemic blood. The relative gene expression of these cytokines was determined by real time polymerase chain reaction in the gut, liver, and lung. RESULTS: Gut IR significantly increased lactate levels in mesenteric (0.9 ± 0.4 vs. 3.7 ± 1.8 mmol/L; p < .001) and in systemic blood (1.3 ± 0.2 vs. 4.0 ± 0.3 mmol/L; p < .001). Gut IR also increased the levels of four cytokines in mesenteric and systemic blood. IL-6 and IL-10 were the main circulating cytokines; there were no significant differences between mesenteric and systemic cytokine levels. IL-10 was upregulated mainly in the lung,suggesting that this organ could play a major role during gut reperfusion. CONCLUSION: The predominance of IL-10 over other cytokines in plasma and the dissimilar organ responses,especially of the lung, might be a basis for the design of therapies, for example lung protective ventilation strategies, to limit the deleterious effects of the inflammatory cascade. A multi-organ protective approach might involve gut directed therapies, protective ventilation, hemodynamic optimization, and hydric balance.
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Compartimentos de Líquidos Corporais/metabolismo , Citocinas/sangue , Gastroenterite/complicações , Gastroenterite/metabolismo , Oclusão Vascular Mesentérica , Mesentério/irrigação sanguínea , Traumatismo por Reperfusão/metabolismo , Animais , Citocinas/genética , Expressão Gênica , Mucosa Intestinal/metabolismo , Isquemia , Fígado/metabolismo , Pulmão/metabolismo , Masculino , Artéria Mesentérica Superior , Distribuição Aleatória , Ratos , Ratos Wistar , Reperfusão , Traumatismo por Reperfusão/complicações , Fator de Necrose Tumoral alfa/metabolismo , Regulação para CimaRESUMO
OBJECTIVES: Mesenteric ischaemia/reperfusion (IR) may lead to liver mitochondrial dysfunction and multiple organ failure. We determined whether gut IR induces early impairment of liver mitochondrial oxidative activity and whether methylene blue (MB) might afford protection. DESIGN: Controlled animal study. MATERIALS AND METHODS: Rats were randomised into three groups: controls (n = 18), gut IR group (mesenteric ischaemia (60 min)/reperfusion (60 min)) (n = 18) and gut IR + MB group (15 mg kg(-1) MB intra-peritoneally) (n = 16). Study parameters were: serum liver function markers, blood lactate, standard histology and DNA fragmentation (apoptosis) on intestinal and liver tissue, maximal oxidative capacity of liver mitochondria (state 3) and activity of complexes II, III and IV of the respiratory chain measured using a Clark oxygen electrode. RESULTS: Gut IR increased lactate deshydrogenase (+982%), aspartate and alanine aminotransferases (+43% and +74%, respectively) and lactate levels (+271%). It induced segmental loss of intestinal villi and cryptic apoptosis. It reduced liver state 3 respiration by 30% from 50.1 ± 3 to 35.2 ± 3.5 µM O(2) min(-1) g(-1) (P < 0.01) and the activity of complexes II, III and IV of the mitochondrial respiratory chain. Early impairment of liver mitochondrial respiration was related to blood lactate levels (r(2) = 0.45). MB restored liver mitochondrial function. CONCLUSIONS: MB protected against gut IR-induced liver mitochondria dysfunction.
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Mesentério/irrigação sanguínea , Mesentério/efeitos dos fármacos , Azul de Metileno/farmacologia , Mitocôndrias Hepáticas/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Substâncias Protetoras/farmacologia , Traumatismo por Reperfusão/tratamento farmacológico , Alanina Transaminase/sangue , Animais , Apoptose/efeitos dos fármacos , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Citoproteção , Fragmentação do DNA/efeitos dos fármacos , Modelos Animais de Doenças , Complexo II de Transporte de Elétrons/metabolismo , Complexo III da Cadeia de Transporte de Elétrons/metabolismo , Complexo IV da Cadeia de Transporte de Elétrons/metabolismo , L-Lactato Desidrogenase/sangue , Ácido Láctico/sangue , Masculino , Mesentério/patologia , Mitocôndrias Hepáticas/metabolismo , Mitocôndrias Hepáticas/patologia , Ratos , Ratos Wistar , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologia , Fatores de TempoRESUMO
INTRODUCTION: Systemic capillary lactate, an end product of cellular anaerobic metabolism, has not established credibility in monitoring limb reperfusion. We assessed, in mice, whether local capillary lactate, arising from the reperfused limb, might be a relevant biomarker of reperfusion. REPORT: Systemic and local capillary lactate were sampled in the non-ischaemic and in the ischaemic limb. Only local lactate concentrations significantly increased after 2 h of ischaemia and decreased after reperfusion. DISCUSSION: Local, but not systemic, capillary lactate appeared as a potential reperfusion biomarker in this experimental acute limb ischaemia model.
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Capilares/metabolismo , Membro Posterior/irrigação sanguínea , Isquemia/sangue , Isquemia/terapia , Ácido Láctico/sangue , Músculo Esquelético/metabolismo , Animais , Biomarcadores/sangue , Camundongos , ReperfusãoRESUMO
OBJECTIVE: To evaluate the feasability and the potential usefulness of functional MRI (fMRI) for the evaluation of brain functions after severe brain injury, when compared to a multimodal approach (evoked potentials [EP] and Positron Emission Tomography [PET] examinations). MATERIAL AND METHODS: Seven patients (mean age: 49 years [23-73], three males, four females) presenting with coma after acute severe brain injuries underwent fMRI (auditive, visual, somesthesic), (18)F-FDG PET and EP (auditive, visual, somesthesic) within a 3-day period of time in a mean of 120 days after initial brain injury. fMRI activations in somesthesic, visual and auditive cortical areas were compared to EP (28 possible comparisons) and to the metabolic activity on PET examination in the same anatomical areas (21 possible comparisons). RESULTS: In case of availability, results were concordant between fMRI and PET in 10 comparisons but not in one, and between fMRI and EP in 11 comparisons but not in four. CONCLUSIONS: In many patients, there is a good concordance between fMRI and brain functions suggested by EP and metabolic activity demonstrated with PET. In few others, fMRI can be integrated in the early evaluation of brain functions to further augment our capacity for a proper evaluation of brain functions in critically ill patients.
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Dano Encefálico Crônico/diagnóstico , Hemorragia Cerebral/diagnóstico , Coma Pós-Traumatismo da Cabeça/diagnóstico , Eletroencefalografia , Potenciais Evocados/fisiologia , Hipóxia Encefálica/diagnóstico , Aumento da Imagem , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Tomografia por Emissão de Pósitrons , Adulto , Idoso , Dano Encefálico Crônico/fisiopatologia , Córtex Cerebral/patologia , Córtex Cerebral/fisiopatologia , Hemorragia Cerebral/fisiopatologia , Coma Pós-Traumatismo da Cabeça/fisiopatologia , Metabolismo Energético/fisiologia , Estudos de Viabilidade , Feminino , Fluordesoxiglucose F18 , Humanos , Hipóxia Encefálica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Consumo de Oxigênio/fisiologia , Estado Vegetativo Persistente/diagnóstico , Estado Vegetativo Persistente/fisiopatologia , Prognóstico , Sensibilidade e Especificidade , Adulto JovemRESUMO
We describe a case of platypnea-orthodeoxia syndrome (POS) due to atrial septal defect (ASD) occurring in the early postoperative course of a right pneumonectomy. Deformation of the atrial septum after right pneumonectomy deviates the blood from the inferior vena cava to ASD during the sitting position creating, a massive right-to-left shunt. Diagnosis can initially be missed by making contrast bubble test through the superior vena cava. The atrial septal defect was then closed using the surgical technique, allowing an instantaneous improvement of hematosis.
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INTRODUCTION: In thoracic surgery, extracorporeal life support (ECLS) technologies are used in cases of severe and refractory respiratory failure or as intraoperative cardiorespiratory support. The objectives of this review are to describe the rationale of ECLS techniques, to review the pulmonary diseases potentially treated by ECLS, and finally to demonstrate the efficacy of ECLS, using recently published data from the literature, in order to practice evidence based medicine. STATE OF THE ART: ECLS technologies should only be undertaken in expert centers. ECLS allows a protective ventilatory strategy in severe ARDS. In the field of lung transplantation, ECLS may be used successfully as a bridge to transplantation, as intraoperative cardiorespiratory support or as a bridge to recovery in cases of severe primary graft dysfunction. In general thoracic surgery, ECLS technology seems to be safe and efficient as intraoperative respiratory support for tracheobronchial surgery or for severe respiratory insufficiency, without significant increase in perioperative risk. PERSPECTIVE: The indications for ECLS are going to increase. Future improvements both in scientific knowledge and bioengineering will improve the prognosis of patients treated with ECLS for respiratory failure. Multicenter randomized controlled trials will refine the indications for ECLS and improve the global care strategies for these patients. CONCLUSION: ECLS is an efficient therapeutic strategy that will improve the prognosis of patients suffering from, or exposed to, the risks of severe respiratory failure.
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Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Procedimentos Cirúrgicos Torácicos/métodos , Oxigenação por Membrana Extracorpórea/métodos , Humanos , Transplante de Pulmão/métodos , Síndrome do Desconforto Respiratório/terapia , Insuficiência Respiratória/terapia , Resultado do TratamentoRESUMO
OBJECTIVE: D-lactate is the dextrogyre form of the lactate usually measured in intensive care. Its bacterial origin should make it a marker of translocation during gut ischemia. The aim was to test D-lactate as a postoperative marker of colic hypoperfusion measured during aortic surgery. STUDY DESIGN: Prospective observational cohort study. PATIENTS AND MEASUREMENTS: Patients operated for abdominal aortic aneurysm. Two groups were stratified on inferior mesenteric arterial residual pressure (IMArP) measured during the surgery: Colic hypoperfusion during surgery (CHs) group: patients with an IMArP < 40 mmHg. CONTROL GROUP: patients with an IMArP > or = 40 mmHg. Baseline data such as age, duration of aortic clamping and severity score (IGS II) were collected. The D-lactate was measured in postoperative at admission time in ICU and then daily. D-lactate(max) defined the maximum value of D-lactate for one patient. MAIN RESULTS: Twenty-nine patients were included, 23 in the control group and 6 in the CHs group. Groups were comparable at baseline. D-lactate(max) was significantly higher in the CHs group (median: 0.13 mmol/l; min-max: 0.03-0.9 mmol/l) than in the control group (0.03; 0-0.26 mmol/l, p=0.007). CONCLUSION: D-lactate could be postoperative marker of colic hypoperfusion measured during surgery for abdominal aortic aneurysm.
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Aneurisma da Aorta Abdominal/sangue , Aneurisma da Aorta Abdominal/cirurgia , Ácido Láctico/sangue , Período Pós-Operatório , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Pressão Sanguínea , Cuidados Críticos , Monitoramento Ambiental/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Reprodutibilidade dos TestesRESUMO
INTRODUCTION: Capnocytophaga canimorsus is a Gram negative bacillus present in oral flora and in saliva of dogs and cats. It can be responsible for septicaemia and meningitides in some patients after dog or cat bite two patient with a septic shock due to C. canimorsus, who presented with an extensive pupura are reported. CASE REPORT: A 50 year-old man with a past history of splenectomy was referred to an emergency department for a shock with vomiting, abdominal pain and generalized ecchymotic purpura culture samples isolated C. canimorsus in peritoneal fluid. Purpura occurred secondary to a disseminated intravascular coagulation. Despite intensive care and major antibiotherapy, the patient rapidly died. Four days previously, the patient administered pills in his dog mouth. The second patient was a 39 year old alcoholic man who was hospitalised for vomiting and septic shock witch occurred 24 hours after a dog bite. He presented with a livido and a diffuse purpura associated with necrotic lesions. Cultures of blood samples isolated C. canimorsus. CONCLUSION: These severe infections due to C. canimorsus should be avoided by the routine use of early antibiotherapy with amoxicilline and clavulanic acid in patients with dog or cat bite, particularly if patient with associated debilitating disorders.
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Capnocytophaga , Infecções por Bactérias Gram-Negativas/complicações , Púrpura/microbiologia , Choque Séptico/microbiologia , Adulto , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
This review addresses the pathophysiology of hemorrhagic shock, a condition produced by rapid and significant loss of intravascular volume, which may lead to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage, and death. The initial neuroendocrine response is mainly a sympathetic activation. Haemorrhagic shock is associated altered microcirculatory permeability and visceral injury. It is also responsible for a complex inflammatory response associated with hemostasis alteration.
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Choque Hemorrágico/fisiopatologia , Adaptação Fisiológica , Animais , Volume Sanguíneo , Células Quimiorreceptoras/fisiologia , Coagulação Intravascular Disseminada/etiologia , Coagulação Intravascular Disseminada/fisiopatologia , Hemodinâmica , Humanos , Hipotensão/etiologia , Hipotensão/fisiopatologia , Hipóxia/etiologia , Inflamação/etiologia , Inflamação/fisiopatologia , Microcirculação , Modelos Animais , Oxigênio/sangue , Pressorreceptores/fisiologia , Sistema Nervoso Simpático/fisiopatologia , Vasoconstrição/fisiologiaRESUMO
BACKGROUND: Delayed graft function (DGF) is an early postoperative complication of kidney transplantation (KT) predisposing to acute rejection and lower graft survival. Intraoperative arterial hypotension and hypovolemia are associated with DGF. Central venous pressure (CVP) is used to estimate volemia but its reliability has been criticized. Pleth variability index (PVI) is a hemodynamic parameter predicting fluid responsiveness. The aim of this study was to examine the relationship between intraoperative PVI and CVP values and the occurrence of DGF. METHODS: This was a prospective, noninterventional, observational, single-center study. All consecutive patients with KT from deceased donors were included. Recipients received standard, CVP, and PVI monitoring. Intraoperative hemodynamic parameters were recorded from recipients at 5 time points during KT. RESULTS: Forty patients were enrolled. There was a poor correlation between PVI and CVP values (r2 = 0.003; P = .44). Immediate graft function and DGF patients had similar hemodynamic values during KT, with the exception of PVI values, which were significantly higher in the DGF group. In particular, a PVI >9% before unclamping of the renal artery was the only predictive parameter of DGF in our multivariate analysis (P = .02). CONCLUSIONS: This study suggests that PVI values >9% during KT are associated with the occurrence of DGF.
Assuntos
Função Retardada do Enxerto/etiologia , Transplante de Rim/efeitos adversos , Monitorização Intraoperatória/estatística & dados numéricos , Adulto , Pressão Venosa Central/fisiologia , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Monitorização Fisiológica/métodos , Monitorização Fisiológica/estatística & dados numéricos , Pletismografia/métodos , Pletismografia/estatística & dados numéricos , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de RiscoRESUMO
The mortality of overwhelming postsplenectomy infections (OPSI) is significant (50 to 80 percent). Capnocytophaga canimorsus belongs to the normal oral flora of dogs and cats. It is seldom responsible for human infections, but its prognosis is bad (about 30 percent of overall mortality), especially in asplenic patients. We report a case of a splenectomized patient who suffered from communal septic shock due to C. canimorsus septicaemia. The course of events was rapidly fatal. Diagnosis and mode of contamination were determined only a few weeks after the patient's death. This late microbiological diagnosis is due to a slow growth of C. canimorsus in vitro.
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Capnocytophaga , Infecções por Bactérias Gram-Negativas/etiologia , Complicações Pós-Operatórias/etiologia , Choque Séptico/etiologia , Esplenectomia/efeitos adversos , Adulto , Animais , Cães , Evolução Fatal , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/fisiopatologia , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/fisiopatologia , Choque Séptico/microbiologia , Choque Séptico/fisiopatologiaRESUMO
INTRODUCTION: Mechanical ventilation can initiate ventilator-associated lung injury and postoperative pulmonary complications. The aim of this study was to evaluate (1) how mechanical ventilation was comprehended by anaesthetists (physician and nurses) and (2) the need for educational programs. METHODS: A computing questionnary was sent by electronic-mail to the entire anaesthetist from Alsace region in France (297 physicians), and to a pool of 99 nurse anaesthetists. Mechanical ventilation during anaesthesia was considered as optimized when low tidal volume (6-8mL) of ideal body weight was associated with positive end expiratory pressure, FiO2 less than 50%, I/E adjustment and recruitment maneuvers. RESULTS: The participation rate was 50.5% (172 professionals). Only 2.3% of professionals used the five parameters for optimized ventilation. Majority of professionals considered that mechanical ventilation adjustment influenced the patients' postoperative outcome. Majority of the professionals asked for a specific educational program in the field of mechanical ventilation. DISCUSSION: Only 2.3% of professionals optimized mechanical ventilation during anaesthesia. Guidelines and specific educational programs in the field of mechanical ventilation are widely expected.
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Assistência Perioperatória/estatística & dados numéricos , Respiração Artificial/efeitos adversos , Anestesia/métodos , Correio Eletrônico , França , Pesquisas sobre Atenção à Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Cuidados Intraoperatórios/métodos , Enfermeiros Anestesistas , Enfermeiras e Enfermeiros , Médicos , Respiração com Pressão Positiva , Respiração Artificial/métodosRESUMO
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.
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Anestesiologia/educação , Cuidados Críticos , Faculdades de Medicina/organização & administração , Docentes , França , Recursos HumanosAssuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Determinação da Pressão Arterial/instrumentação , Débito Cardíaco , Monitorização Intraoperatória/instrumentação , Feocromocitoma/cirurgia , Adulto , Determinação da Pressão Arterial/métodos , Cateterismo de Swan-Ganz/instrumentação , Cateterismo de Swan-Ganz/métodos , Falha de Equipamento , Feminino , Humanos , Monitorização Intraoperatória/métodosRESUMO
Anaphylactic shock is a rare, but potentially lethal complication, combining life-threatening circulatory failure and massive fluid shifts. Treatment guidelines rely on adrenaline and volume expansion by intravenous fluids, but there is no solid evidence for the choice of one specific type of fluid over another. Our purpose was to compare the time to achieve target mean arterial pressure upon resuscitation using adrenaline alone versus adrenaline with different resuscitation fluids in an animal model and to compare the tissue oxygen pressures (PtiO2) with the various strategies. Twenty-five ovalbumin-sensitised Brown Norway rats were allocated to five groups after anaphylactic shock induction: vehicle (CON), adrenaline alone (AD), or adrenaline with isotonic saline (AD+IS), hydroxyethyl starch (AD+HES) or hypertonic saline (AD+HS). Time to reach a target mean arterial pressure value of 75 mmHg, cardiac output, skeletal muscle PtiO2, lactate/pyruvate ratio and cumulative doses of adrenaline were recorded. Non-treated rats died within 15 minutes. The target mean arterial pressure value was reached faster with AD+HES (median: 10 minutes, range: 7.5 to 12.5 minutes) and AD+IS (median: 17.5 minutes, range: 5 to 25 minutes) versus adrenaline alone (median: 25 minutes, range: 20-30 minutes). There were also reduced adrenaline requirements in these groups. The skeletal muscle PtiO2 was restored only in the AD+HES group. Although direct extrapolation to humans should be made with caution, our results support the combined use of adrenaline and volume expansion for resuscitation from anaphylactic shock. When used with adrenaline the most effective fluid was hydroxyethyl starch, whereas hypertonic saline was the least effective.
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Anafilaxia/terapia , Pressão Arterial/efeitos dos fármacos , Epinefrina/uso terapêutico , Substitutos do Plasma/uso terapêutico , Ressuscitação/métodos , Agonistas alfa-Adrenérgicos/uso terapêutico , Animais , Débito Cardíaco/efeitos dos fármacos , Coloides/uso terapêutico , Modelos Animais de Doenças , Quimioterapia Combinada/métodos , Hidratação/métodos , Derivados de Hidroxietil Amido/uso terapêutico , Soluções Isotônicas , Microdiálise/métodos , Ratos , Solução Salina Hipertônica/uso terapêutico , Fatores de TempoRESUMO
OBJECTIVES: To clarify the procedures related to mechanical ventilation in the intensive care unit setting: allocation of ventilators, team education, maintenance and reference documents. STUDY DESIGN: Declarative survey. METHODS: Between September and December 2010, we assessed the assignment and types of ventilators (ICU ventilators, temporary repair ventilators, non-invasive ventilators [NIV], and transportation ventilators), medical and nurse education, maintenance of the ventilators, presence of reference documents. Results are expressed in median/range and proportions. RESULTS: Among the 62 participating ICUs, a median of 15 ventilators/ICU (range 1-50) was reported with more than one trademark in 47 (76%) units. Specific ventilators were used for NIV in 22 (35%) units, temporary repair in 49 (79%) and transportation in all the units. Nurse education courses were given by ICU physicians in 54 (87%) units or by a company in 29 (47%) units. Medical education courses were made by ICU senior physicians in 55 (89%) units or by a company in 21 (34%) units. These courses were organized occasionally in 24 (39%) ICU and bi-annually in 16 (26%) units. Maintenance procedures were made by the ICU staff in 39 (63%) units, dedicated staff (17 [27%]) or bioengineering technicians (14 [23%] ICU). Reference documents were written for maintenance procedures in 48 (77%) units, ventilator setup in 22 (35%) units and ventilator dysfunction in 20 (32%) ICU. CONCLUSIONS: This first survey shows disparate distribution of ventilators and practices among French ICU. Education and understanding of the proper use of ventilators are key issues for security improvement.
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Unidades de Terapia Intensiva/organização & administração , Respiração Artificial/métodos , Documentação , Educação Médica , Educação Médica Continuada , Falha de Equipamento/estatística & dados numéricos , França , Pesquisas sobre Atenção à Saúde , Humanos , Serviço Hospitalar de Engenharia e Manutenção/economia , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/estatística & dados numéricos , Enfermeiras e Enfermeiros , Equipe de Assistência ao Paciente/economia , Médicos , Ventiladores Mecânicos/estatística & dados numéricosRESUMO
This is the case report of a 16-year-old male who suffered major facial trauma in a road traffic accident (unhelmeted scooter rider against signpost). During prehospital care, he was stable and awake. He was admitted to the emergency room of our university hospital and rapidly transferred, in a sitting position and breathing spontaneously, to the operating room for emergent surgical tracheostomy under local anaesthesia and sedation. This procedure turned out to be difficult (sitting position, patient uncooperative) and ventilatory compromise led us to intubate the patient without difficulties: indeed, supraphysiological mouth aperture (due to multifocal mandible fractures) and presence of supraglottic bubbling under spontaneous ventilation facilitated intubation in spite of major oropharyngeal bleeding. This allowed rapid restoration of adequate ventilation and tracheostomy was performed under standard conditions without further problems. This case report confirms the superiority of orotracheal intubation under light sedation over emergent tracheostomy in this type of situation, as stated under the SFAR guidelines.
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Manuseio das Vias Aéreas/métodos , Traumatismos Faciais/cirurgia , Acidentes de Trânsito , Adolescente , Sedação Consciente , Serviços Médicos de Emergência , Hemorragia/complicações , Humanos , Intubação Intratraqueal , Masculino , Respiração Artificial , TraqueostomiaRESUMO
We report the case of a severe postpartum hemorrhage (PPH) that was successfully treated with two administrations of recombinant activated factor VII (rFVIIa). Two major thromboembolic events (TEE) occurred shortly afterwards: the first was an acute lower limb ischemia at H3, the second was a cardiac arrest complicating a massive pulmonary embolism on day 5. Fortunately, both events had a favorable outcome. This case report allows us to discuss the role of rFVIIa during severe PPH and its potential responsibility in these two major TEE.