Psychological impact of the COVID-19 pandemic and burnout severity in French residents: A national study

Background and objectives: We measured the impact of the COVID-19 pandemic on the mental health and burnout of French residents.MethodsResidents completed a questionnaire assessing their personal life, work, social relationships, mental health, burden and psychological impact of the pandemic. The Maslach Burnout Inventory (MBI) allowed to identify 5 classes of burnout of increasing severity: burnout free, intermediate, 1, 2 or 3 dimensions severely impacted. Variables significantly linked with burnout, defined as having a high impact on at least one of the 3 dimensions of the MBI, were entered into a logistic regression.ResultsThere were 1050 responses. Mean age was 27 ± 2 years. Since the start of the pandemic, only one resident in four said they were in their normal state of mind, more than half felt tired and one third anxious and/or stressed and/or depressed. The total burnout rate was 55%. There was a strong link between the severity of the burnout syndrome and the impact of the pandemic. 7 factors were independently linked to burnout: number of monthly calls (p < 0.001), psychiatric history (p < 0.001), interpersonal conflicts (p = 0.002), desire to quit the specialty (p = 0.002), fatigue (p = 0.004), job satisfaction (p = 0.004), and depression (p = 0.05).ConclusionCaring for Covid positive patients was not the most important cause of burnout, but there was a strong relationship between burnout severity and psychological impact of the pandemic.(AU)

A retrospective study of ketamine administration and the development of acute or post-traumatic stress disorder in 274 war-wounded soldiers.

The objective of this study was to explore whether ketamine prevents or exacerbates acute or post-traumatic stress disorders in military trauma patients. We conducted a retrospective study of a database from the French Military Health Service, including all soldiers surviving a war injury in Afghanistan (2010-2012). The diagnosis of post-traumatic stress disorder was made by a psychiatrist and patients were analysed according to the presence or absence of this condition. Analysis included the following covariables: age; sex; acute stress disorder; blast injury; associated fatality; brain injury; traumatic amputation; Glasgow coma scale; injury severity score; administered drugs; number of surgical procedures; physical, neurosensory or aesthetic sequelae; and the development chronic pain. Covariables related to post-traumatic and acute stress disorders with a p ≤ 0.10 were included in a multivariable logistic regression model. The data from 450 soldiers were identified; 399 survived, of which 274 were analysed. Among these, 98 (36%) suffered from post-traumatic stress disorder and 89 (32%) had received ketamine. Fifty-four patients (55%) in the post-traumatic stress disorder group received ketamine vs. 35 (20%) in the no PTSD group (p < 0.001). The 89 injured soldiers who received ketamine had a median (IQR [range]) injury severity score of 5 (3-13 [1-26]) vs. 3 (2-4 [1-6] in the 185 patients who did not (p < 0.001). At multivariable analysis, only acute stress disorder and total number of surgical procedures were independently associated with the development of post-traumatic stress disorder. In this retrospective study, ketamine administration was not a risk factor for the development of post-traumatic stress disorder in the military trauma setting.

Efficacy and safety of oral ketamine for the relief of intractable chronic pain: A retrospective 5-year study of 51 patients.

BACKGROUND: This work summarizes the efficiency, failures and adverse effects of oral administration of ketamine at home for intractable pain. METHODS: This 5-year retrospective study involved testing ketamine by intravenous in-hospital administration, then a conversion to an oral route, or oral treatment directly administered at home. The daily intravenous dose was increased by steps of 0.5 mg/kg to attain an effective daily dose of 1.5-3.0 mg/kg. Pain was evaluated on a numeric scale from 0 to 10, and evidence of adverse effects was collected every day. The effective daily dose was delivered orally (three to four intakes). If effective, ketamine was continued for 3 months. Short infusions or direct oral treatment began with a 0.5-mg/kg dose, then the daily ketamine dose was increased in 15- to 20-mg increments. RESULTS: Among 55 cases (51 patients, neuropathic pain 60%), the mean effective oral dose was 2 mg/kg. Ketamine was effective in 24 patients (44%, mean pain reduction 67 ± 17%), partially effective in 20% (mean pain reduction 30 ± 11%), with a mean opioid sparing of 63 ± 32%, and failure in 22%. Half of the patients experienced adverse effects, but only eight had to stop treatment. For patients with opioid therapy, failure of ketamine was less frequent (7% vs. 36%; p < 0.02), with fewer adverse effects (33% vs. 68%; p < 0.01). CONCLUSIONS: Pain was reduced or abolished in two-thirds of patients under ketamine therapy; ketamine was effective for patients taking opioids and resulted in few adverse effects.

[Which antivenom for Cerastes envenoming?]. / Quel antivenin pour les envenimations par les vipères du genre Cerastes ?

During Echis viper envenoming, the administration of a single FAV-Afrique(®) antivenin vial generally corrects hemostasis disorders in less than twelve hours. The correction of hemostasis after 36 hours by 4 vials of FAV-Afrique(®) is thus not in favor of the usefulness of this antivenin for Cerastes envenoming . Mortality due to viper envenoming in Africa is high, but more than 90 % of poisoned patients survive despite the absence of appropriate antivenom. The severity of poisoning depends on several factors: age and condition of the patient, location of the bite, composition and amount of injected venom, management delay, and therefore, survival is not necessarily synonymous of effectiveness of antivenom treatment. Cerastes venoms contain many enzymes that disrupt various stages of hemostasis. It remains to prove that FAV-Afrique(®), a polyvalent antivenom adapted to venom of the main species responsible for envenoming in sub-Saharan Africa, (Bitis, Echis, Naja and Dendroaspis), is able to neutralize these specific proteins. The most logical approach of Cerastes envenoming is the administration of an antivenin adapted to species found in North Africa: Favirept(®) (Sanofi Pasteur) is a polyvalent antivenom adapted to the venoms of C. cerastes, Bitis arietans, Echis leucogaster, Macrovipera deserti, Naja haje and Naja nigricollis.

[Burnout-associated factors in anesthesia and intensive care medicine. 2009 survey of the French Society of anesthesiology and intensive care]. / Facteurs associés au burnout en anesthésie-réanimation. Enquête 2009 de la Société française d'anesthésie et de réanimation.

OBJECTIVE: To assess factors related to burnout in anesthesia and intensive care. DESIGN: National prospective observational study. MATERIALS AND METHODS: Questionnaire posted on the French Society of anesthesia website from 3rd June 2009 to 27th August 2009: Maslach Burnout Inventory (MBI), Fast Alcohol Consumption Evaluation (FACE) and The Harvard National Depression Screening Day Scale (HANDS) scales and questions to assess health, work and personal life. RESULTS: One thousand six hundred and three questionnaires returned: 1091 anesthetists (67.6%), 241 intensivists (14.9%), 204 nurses (12.6%), emergency physicians (2.8%), supervisor nurses (0.9%). Seven hundred and sixty three in a university hospital (47.3%), 259 in a regional hospital (16.1%), 405 in a private structure (25.1%), 71 in a non-lucrative private structure (4.4%), 75 in a military hospital (4.6%). Rest of safety: 69.2% of institutions. Depression: 38.7%. Drug or chemicals addicted: 10.6%. Alcohol addicts: 10.6%. Among them, 62.3% of individuals were in burnout. Burnout was linked to fragmented sleep (P<0.00001), interpersonal conflicts (P<0.00001), perception of rest of safety (P<0.02), mental history (P<0.00001), suicidal ideations (P<0.00001), depression (P=0.00001), alcohol (P<0.002), drug consumption (P<0.00002), and accidents after a nightshift (P<0.05). Subjects in burnout intended more frequently to leave the profession (P<0.00001). Leaving in couple had a protective effect (P<0.005). The logistic regression model retained seven covariates independently associated with burnout: quality of work, of personal life, of fatigue, depression, conflicts with colleagues and patients, regretting the choice of specialty. CONCLUSION: This study of the largest cohort of anesthesia personnel performed in France detects a high proportion of burnout. It highlights links with tensors that may constitute possibilities of prevention of the burnout syndrome.

[Pulmonary embolism in the context of severe envenomation by a Moroccan viper]. / Embolie pulmonaire dans les suites d'une envenimation grave par une vipère marocaine.

Heparin, which was widely used thirty years ago for the treatment of viper envenomations, is now contra-indicated during the acute phase, which is at risk for hemorrhage and death. We report a case of pulmonary embolism, a rare situation in the context of viper envenomation. By means of this case report, we want to discuss the pathophysiological links between envenomation and thromboembolic disease, and on the other hand, the potential heparin usefulness, not during the acute, hemorrhagic phase, but as a prophylactic treatment when hemorrhagic risk has been replaced by an inflammatory syndrome, with increased fibrinogen and platelets which are then prothrombotic factors.

[Adder bites in France]. / Envenimations par les vipères en France.

Snake bites are a major public health problem in the tropics but they have a low incidence in Europe and are responsible for few deaths each year. The incidence is higher in children than in adults but no difference in severity seems to be observed between children and adults. In France, snake envenomations are due mainly to Vipera aspis and Vipera berus. The clinical presentation is usually limited to a local syndrome with pain and local inflammatory edema, but systemic signs occur in 17% of cases. Clinical grading published by the Institut Pasteur in Paris helps to assess the severity of envenomation and to decide the use of antivenom. Every bitten patient must be transferred in a hospital for medical assessment. Specific treatment is based on antivenom immunotherapy. However, other medical and surgical treatments have limited value.

[Ischaemic stroke secondary to viper envenomation in Morocco in the absence of adequate antivenom]. / Accident vasculaire cérébral ischémique à la suite d'une envenimation vipérine grave au Maroc, traitée par un antivenin inadapté

An ischaemic stroke is a rare complication of viper envenomation that is due to multifactorial pathophysiological mechanisms. The authors describe the case of a 55-year-old patient bitten by the viper Cerastes cerastes. The patient was admitted to the intensive care unit with multiple organ failure, disseminated intravascular coagulopathy, rhabdomyolysis, anuria and elevated troponin level. The persistent disturbance of consciousness has motivated a brain scan which has revealed a bifocal ischemic stroke. The complex venom of the species C. cerastes may induce hypotension, tissue necrosis, acute renal failure, bleeding disorders or DIC. With the cessation of a non-indicated heparintherapy and haemodialysis, the patient recovered in a few weeks despite the initial infusion of an unsuitable antivenom due to the late identification of the reptile. The preventive treatment of the complications of this envenomation is based on the infusion of the polyvalent antivenom Favirept(®).

[The damage control resuscitation concept]. / Le concept de damage control resuscitation.

OBJECTIVE: Damage control is a strategy of care for bleeding trauma patients, involving minimal rescue surgery associated to perioperative resuscitation. The purpose of this review is to draw up a statement on current knowledge available on damage control. DATA SOURCES: References were obtained from recent review articles, personal files, and Medline database research of English and French publications. All categories of articles on this topic have been selected. DATA SYNTHESIS: Historical damage control surgery, that consist of abbreviated laparotomy with second-look after resuscitation, is now included in a wider concept called "damage control resuscitation", addressing the lethal triad (coagulopathy, hypothermia and acidosis) at an early phase. Care is focused on coagulopathy prevention. Early resuscitation, or damage control ground zero, has been improved: aggressive management of hypothermia, bleeding control techniques, permissive hypotension concept and early use of vasopressors. Transfusion practices also have evolved: early platelets and coagulation factors administration, use of hemostatic agents like recombinant FVIIa, whole blood transfusion, denote the damage control hematology. Progress in surgical practices and development of arteriographic techniques lead to wider indications of damage control strategy.

[Acute respiratory distress syndrome caused by tropical eosinophilic lung disease: a case in Gabon]. / Syndrome de détresse respiratoire aiguë révélateur d'un poumon éosinophile tropical : une observation au Gabon.

The purpose of this report is to describe the case of a 28-year-old woman in whom acute respiratory distress syndrome (ARDS) following cholecystectomy led to the discovery of eosinophilic lung disease. Outcome was favorable after oxygenotherapy and medical treatment using ivermectin and corticosteroids. The case shows that hypereosinophilic syndrome can be the underlying cause of ARDS.

[Is there any place for hypertonic saline for fluid resuscitation in septic shock]. / Il y a-t-il une place pour le sérum salé hypertonique dans les états septiques graves?

Fluid loading is the first step, necessary to care for severe sepsis. Two main classes of solutions are currently available: crystalloids and colloids. The concept of small volume resuscitation with hypertonic saline has emerged these last years in the care of traumatic haemorrhagic shock. The main benefits are the restoration of intravascular volume, improvement of cardiac output and improvement of regional circulations. Many experiments highlight modulation of immune and inflammatory cascades. We report the mechanisms of action of hypertonic saline based on experimental human and animal studies, which advocate its use in septic shock.