Adverse events during nursing care procedure in intensive care unit: The PREVENIR study.

OBJECTIVES: Intensive care unit patients undergo several nursing care procedures (NCP) every day. These procedures involve a risk for adverse events (AE). Yet, their prevalence, intensity, and predisposing risk factors remain poorly established. The main objective of the study was to measure the incidence and severity of NCP related AE. DESIGN: This prospective observational multicentre study was conducted in 9 ICUs. All NCP were recorded for four consecutive weeks. For each NCP, the following were collected: patients' baseline characteristics, type of NCP, characteristics of the NCP, AE and therapeutic responses. RESULTS: 5849 NCP occurred in 340 patients. Among the 340 patients included, 292 (85.9%) were affected by at least one AE, and 141 (41.5%) by an SAE during a NCP. Thirty % of NCP were associated with at least one AE: hemodynamic AE in 17.1%, respiratory AE in 13.6%, agitation and pain (3.7% and 3.3%). Eight invasive devices were accidentally removed. Severe Adverse Events (SAE) occurred in 5.5% of NCP. The main risk factor associated with SAE was pain/agitation at the beginning of the NCP. CONCLUSION: AE are frequent during NCP in ICU. We identified several risk factors, some of them preventable, that could be considered for the development of recommendations for the nursing care of critically ill patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT02881645.

Chronic calf pain in athletes due to sural nerve entrapment. A report of 18 cases.

We retrospectively analyzed the charts of 13 athletes (18 limbs) who had sural nerve entrapment localized in the passage of the nerve through the superficial sural aponeurosis. There were 11 men and 2 women (average age, 43 years; range, 31 to 59). All patients reported chronic calf pain that was exacerbated during physical exertion. Delay to diagnosis averaged 9 months (range, 5 to 24). Tenderness in the calf was identified along the course of the sural nerve in all cases. In 10 patients (15 limbs) electrodiagnostic testing before surgery was positive. After failure of nonoperative treatment, surgery was conducted under local anesthesia. Neurolysis was performed by incising the superficial sural aponeurosis and the fibrous band in it through which the nerve passes. The results of the operation were evaluated in terms of residual symptoms, ability to return to the former sport, and degree of patient satisfaction. A final follow-up examination was performed an average of 14 months (range, 6 to 30) after the operation. The final result was excellent in 9 limbs (2 bilateral), good in 8 limbs (2 bilateral), and fair in 1 case. The differential diagnosis of sural nerve entrapment in athletes is discussed. Increase in sural muscle mass or development of local fibrous scar tissue compromised the sural nerve in its course through the unyielding and inextensible superficial sural aponeurosis.

Critical illness polyneuropathy. A 2-year follow-up study in 19 severe cases.

Critical illness polyneuropathy (CIP) is a reported cause of varying degrees of neuromuscular weakness in patients with multiple organ failure. Little is known concerning predictive factors of neurological recovery. The critical care conditions, neurological explorations and 2-year clinical follow-up of 19 patients who suffered from severe forms (quadriplegia or quadriparesis) of CIP were analyzed. Characteristics of patients who recovered clinically were compared with those of patients who did not. Two patients died within 2 months, 11 recovered completely, 4 remained quadriplegic and 2 remained quadriparetic. All patients suffered from sepsis, multiple organ dysfunction syndrome and a catabolic state before the onset of CIP. Outcome appears difficult to predict with clinical or electrophysiological data. Three parameters were significantly correlated with poor recovery: longer length of stay in the critical care unit, longer duration of sepsis and greater body weight loss. A relationship seems to exist between the severity of CIP and that of sepsis and its associated hypercatabolism. The favorable outcome usually attributed to CIP must be reconsidered. The authors recommend aggressive measures against sepsis to limit CIP and its sequelae.

Botulinum A toxin treatment for detrusor-sphincter dyssynergia in spinal cord disease.

We studied the efficacy of endoscopic injection of Botulinum A toxin (150 I.U. Dysport) in the treatment of detrusor-sphincter dyssynergia in 17 patients with spinal cord disease. One month after the injection, the postvoiding residual urine volume (-176 ml, P < 0.001), the bladder pressure on voiding (-19 cm water, P < 0.01), and the urethral pressure (-24 cm water, P < 0.001) were significantly decreased. The modality of voiding was improved in 10 patients (i.e. micturition by suprapubic tapping was easier to induce, discontinuation of indwelling catheter use, or decrease in frequency of intermittent catheterizations). The tolerance of the treatment was excellent. The therapeutic effect lasted 2 to 3 months on the average. The low doses used in this study probably explain in part why the treatment sometimes failed. Botulinum A toxin could become an alternative treatment for detrusorsphincter dyssynergia in certain patients, notably in those who are refractory to sphincterotomy or in patients, such as those who are tetraplegic, and who are incapable of performing intermittent self-catheterization.

A randomised, double blind, placebo controlled trial of botulinum toxin in the treatment of spastic foot in hemiparetic patients.

OBJECTIVE: To confirm the apparent effectiveness of botulinum toxin (BTX) in hemiparetic patients with ankle plantar flexors and foot invertor spasticity. METHODS: Twenty three hemiparetic patients with spasticity of the ankle plantar flexors and foot invertors were included in a randomised double blind, placebo controlled study with BTX. Patients were examined on days 0, 30, 90, and 120 and received one injection of BTX and one of placebo in a random order at day 0 and day 90. RESULTS: Patients reported a clear subjective improvement in foot spasticity after BTX (P = 0.0014) but not after placebo. Significant changes were noted in Ashworth scale values for ankle extensors (P < 0.0001) and invertors (P = 0.0002), and for active ankle dorsiflexion (P = 0.0001). Gait velocity was slightly but not significantly (P = 0.0731) improved after BTX injections. The severity of spasticity did not modify treatment efficacy, but BTX was less effective in patients with longer duration of spasticity (P = 0.0081). CONCLUSION: The efficacy of BTX injections in the treatment of spastic foot suggests that BTX may be particularly useful during the first year after a stroke.

Mean term follow-up of a series of post-traumatic syringomyelia patients after syringo-peritoneal shunting.

We report the follow-up of a series of post-traumatic syringomyelia patients treated by syringo-peritoneal shunting (SPS). The neurological status was determined following the international ASIA/IMSOP standards for neurological classification of spinal cord injury; this was completed by a modified Silberstein classification that identifies the ascending neurological symptoms as well as the increasing myelopathic symptoms in patients with post-traumatic syringomyelia. Magnetic resonance imaging (MRI) was systematically performed to assess the presence of a postoperative residual syrinx or of meningeal fibrosis. Eight patients were studied (five men, three women) with an age ranging from 17 to 54 years (mean of 30.7 years) at the time of the spinal cord injury. Three had a complete or nearly complete paraplegia, five were incomplete. The post-traumatic syringomyelia was diagnosed from 2 to 8 years after the spinal cord injury and was treated by syringo-peritoneal shunting. Early complications occurred in three patients: (1) displacement of the catheter, (2) obstruction of the catheter, and (3) haematomyelia, which disappeared after a new surgical procedure was performed. The postoperative follow-up ranged from 3 to 9 years (mean of 4.5 years). The neurological level decreased in every case and the ascending neurological symptoms decreased or were stabilised in seven patients. The postoperative ASIA/IMSOP scores and the increasing myelopathic symptoms improved in four patients but worsened in the four others, incomplete. The MRI showed an important decrease of the syrinxes in every patient associated with a serious meningeal fibrosis in five cases. Syringo-peritoneal shunting seems to be efficient in the treatment of the syrinx but may have a poor effect regarding the prevention of meningeal fibrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Permanent bruxism as a manifestation of the oculo-facial syndrome related to systemic Whipple's disease.

We report here a new case of oculomasticatory syndrome related to systemic Whipple's disease. The patient presented typical ophthalmoparesis associated with ocular myorhythmia consisting of 1 Hz convergent oscillations of both eyes. The masticatory involvement was remarkable and consisted of a permanent bruxism leading to severe tooth abrasions. Possible pathophysiology of such a disorder is discussed.