Duwat A, Turbelin A, Petiot S
… +4 more, Hubert V, Deransy R, Mahjoub Y, Dupont H
Ann Fr Anesth Reanim
· 2014 May · PMID 24810379
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OBJECTIVES: Assessing the theoretical knowledge, practical experience of French intensivists, and their compliance with French Anesthesiology and Critical Care Society's difficult airway algorithms of the expert's SFAR c...OBJECTIVES: Assessing the theoretical knowledge, practical experience of French intensivists, and their compliance with French Anesthesiology and Critical Care Society's difficult airway algorithms of the expert's SFAR conference of 2006. STUDY DESIGN: Prospective and descriptive national survey. MATERIAL AND METHODS: An anonymous questionnaire with 40 questions was emailed to physicians working in intensive care units in France. RESULTS: Five hundred and eight intensivists answered the survey. Ninety-seven percent of physicians reported having a portable storage unit for difficult intubation. As for practical experience, 421 physicians (83 %) have set up less than 10 laryngeal mask airway, 257 (51 %) have performed less than 10 intubations under fibroscopy and 269 (53 %) have never performed a cricothyroidotomy on mannequin, and 331 (65 %) on a patient. In case of emergency intubation, 29 % of them do not use a rapid sequence induction. Three hundred physicians (59 %) use capnography as monitoring of the endotracheal position. Two hundred and nine (42 %) consider they have not been trained to difficult intubation and 443 (87 %) would like to participate in high fidelity simulations mannequin. CONCLUSIONS: National airway management algorithm was insufficiently followed. Alternative techniques do not seem to be mastered by all physicians. French intensivists expect more training on difficult intubation, including high fidelity simulation.
Pignard J, Bourdeaux D, Kauffmann S
… +2 more, Constantin JM, Sautou V
Ann Fr Anesth Reanim
· 2014 May · PMID 24784917
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OBJECTIVES: To assess the stability of cisatracurium besilate solution stored at 5°C and 25°C. MATERIALS AND METHODS: Cisatracurium solutions at 2, 5 and 0.1mg/mL in 0.9 % sodium chloride or 5 % glucose were exposed to 5...OBJECTIVES: To assess the stability of cisatracurium besilate solution stored at 5°C and 25°C. MATERIALS AND METHODS: Cisatracurium solutions at 2, 5 and 0.1mg/mL in 0.9 % sodium chloride or 5 % glucose were exposed to 5°C and 25°C under 60 % relative humidity for seven days. The physicochemical stability was assessed at 24, 48hours and seven days with dosage of the active substance, detection of degradation products and a possible racemization, measuring pH, osmolality and turbidity, assessment of coloration, visible particles and invisible particles count. RESULTS: Cisatracurium besilate present good stability for 24hours at 5°C and 25°C for concentrations between 0.1 and 5mg/mL. Beyond 24hours, the solutions at 2 and 5mg/mL remained stable for seven days at 5°C. At 25°C, potentially toxic degradation products appear in solutions of 0.1mg/mL between 24 and 48hours. No racemization was detected, the drug remains in its active form cis. CONCLUSION: Cisatracurium solutions at 2 and 5mg/mL may be stored at 5°C or 25°C for seven days. It's advisable to keep the solutions in a dilution of 0.1mg/mL in 0.9 % sodium chloride or 5 % glucose in the refrigerator. No diluted solution should be stored at room temperature beyond 24hours.
Ziadi A, Hachimi A, Soraa N
… +4 more, Tassi N, Nejmi H, Elkhayari M, Samkaoui MA
Ann Fr Anesth Reanim
· 2014 May · PMID 24784916
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Anthrax meningoencephalitis is very rare especially following skin location. We report a case of meningoencephalitis secondary to skin lesion. The diagnosis is based on clinical presentation and confirmed by microbiologi...Anthrax meningoencephalitis is very rare especially following skin location. We report a case of meningoencephalitis secondary to skin lesion. The diagnosis is based on clinical presentation and confirmed by microbiological tests. Its evolution remains fatal despite aggressive resuscitation.
The early use of continuous positive airway pressure ventilation has been shown to be effective and is recommended for patients with obstructive sleep apnea. The complications of continuous positive airway pressure venti...The early use of continuous positive airway pressure ventilation has been shown to be effective and is recommended for patients with obstructive sleep apnea. The complications of continuous positive airway pressure ventilation are not well described. We report two cases of pneumocephalus following the use of continuous positive airway pressure ventilation after transsphenoidal surgery. One patient had an obstructive sleep apnea and the other suffered acute respiratory failure. In both cases, pneumocephalus caused major morbidity and required specific treatment and prolonged considerably hospital stay. Based on these observations we believe new precautions in the use of noninvasive continuous positive airway pressure ventilation should be recommended.
We describe the case of four patients who had undergone breast surgery. The post-operative analgesia consisted in levobupivacaine administered through a catheter placed between the pectoralis minor and the pectoralis maj...We describe the case of four patients who had undergone breast surgery. The post-operative analgesia consisted in levobupivacaine administered through a catheter placed between the pectoralis minor and the pectoralis major using ultrasound guided technique. The quality of the analgesia was excellent quality. No side-effects were encountered.
A 78-year-old man was admitted in the intensive care unit for epilepsy seizure (tonic-clonic seizure). Since three months, his wife reports motor dysfunction (weakness) and since two weeks, rapidly progressive changes in...A 78-year-old man was admitted in the intensive care unit for epilepsy seizure (tonic-clonic seizure). Since three months, his wife reports motor dysfunction (weakness) and since two weeks, rapidly progressive changes in cognition (apraxia, akinetic mutism). The diagnosis of probable sporadic Creutzfeldt-Jakob on the basis of clinical, EEG and MRI lesions was made. Refining diagnostic criteria is probably needed, including the usefulness of repeated MRI with FLAIR and diffusion-weighted imaging.
Ann Fr Anesth Reanim
· 2014 May · PMID 24703190
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OBJECTIVE: Update on simulation-based education and its evolution in North America. DATA SOURCES: Main articles including those published within the last five years and indexed in Medline, and unpublished data from the R...OBJECTIVE: Update on simulation-based education and its evolution in North America. DATA SOURCES: Main articles including those published within the last five years and indexed in Medline, and unpublished data from the Royal College of Physicians and Surgeons of Canada have been analyzed. DATA SYNTHESIS: After a review of historical development of simulation in North America, this article draw the place of simulation in healthcare, for medical education, research and assessment. Funding and accreditation of simulation centres are also discussed. CONCLUSION: Simulation is fully integrated in healthcare in North America and represents one of the main elements for healthcare professional education. Simulation is also a symbol of excellence for health and teaching institutions. The evolution of simulation in North America is likely to inform the future of simulation in France.
We report a patient in whom a tracheal bronchus was discovered intraoperatively during an endoscopy control. This observation led us to a focus on what to do in such cases.We report a patient in whom a tracheal bronchus was discovered intraoperatively during an endoscopy control. This observation led us to a focus on what to do in such cases.
OBJECTIVE: Describe systemic antifungal therapy in non-neutropenic adult patients in intensive care unit (ICU). PATIENTS AND METHOD: A prospective, observational study was conducted during the first half of 2010 in the 7...OBJECTIVE: Describe systemic antifungal therapy in non-neutropenic adult patients in intensive care unit (ICU). PATIENTS AND METHOD: A prospective, observational study was conducted during the first half of 2010 in the 7 ICU in a hospital with medical consultant on antimicrobial therapy. All non-neutropenic consecutive adult patients receiving systemic antifungal therapy for documented or suspected invasive fungal infection (IFI) apart from aspergillosis were included. RESULTS: Out of 1502 patients admitted in ICU, 104 (7 %) underwent systemic antifungal therapy, including 30 (29 %) for a documented IFI and 74 (71 %) for a suspected IFI. Candida albicans was identified in 23 (77 %) of the IFI and 45/52 (86 %) of the broncho-pulmonary and/or urinary colonizations in suspected IFI. Echinocandin was significantly more prescribed in patients with a documented infection (19/30 patients) and fluconazole in patients with a suspected infection (48/74 patients). The first line therapy was primarily stopped after recovery (11/30 patients) or de-escalation (9/30 patients) in documented infections, and for lack of indication (34/74 patients) or due to recovery (21/74 patients) in suspected infections after on average of 7 days of treatment. CONCLUSION: For ICU non-neutropenic adult patients in our center, antifungal therapy is prescribed two times out of three for suspected, unproved infections, in most cases with fluconazole. Documented infections were more often treated by echinocandin with secondary de-escalation. An interventional prospective study to assess the role of antifungal pre-emptive or empirical therapy is necessary.
The use of cocaine causes numerous cardiovascular and pulmonary side effects. In this context, the occurrence of a pneumomediastinum represents a specific complication, often misunderstood by primary care physicians. We...The use of cocaine causes numerous cardiovascular and pulmonary side effects. In this context, the occurrence of a pneumomediastinum represents a specific complication, often misunderstood by primary care physicians. We describe here on case of patient who suffered from subcutaneous emphysema and pneumomediastinum after smoking "crack". We emphasize the importance of always keeping in mind the possibility of illicit substance use in such cases, especially among young and healthy patients. A short observation period with outpatient follow-up is appropriate in the majority of patients. Invasive procedures have a low yield and should be based on a high degree of clinical suspicion for esophageal rupture or bronchial tree laceration.
OBJECTIVES: Tracheostomy is a frequent procedure in ICU but patient follow-up and management after ICU has been poorly documented. We conducted a practice survey in French general ICUs and in neurointensive care units co...OBJECTIVES: Tracheostomy is a frequent procedure in ICU but patient follow-up and management after ICU has been poorly documented. We conducted a practice survey in French general ICUs and in neurointensive care units concerning tracheostomized ICU patients and their management after ICU. STUDY DESIGN: National observational descriptive transversal study as survey of opinion and practices. MATERIALS AND METHODS: An email, with a link to an automated online questionnaire, was sent to two medical doctors of each French ICU. Demographic data and reported practices concerning indications, technique and post-ICU management were collected. RESULTS: We received 148 intensivists responses from different ICUs, of which 15% from neurointensivists. There was no difference between general intensivists and neurointensivists concerning the reported use of tracheostomy (10±13% vs 20±22%, P=0.05) and concerning the usual timing of the procedure (predominantly between the 10th and the 21th day) (P=0.62). Indications were weaning failure from the ventilator and neurological ventilatory dysfunction. Percutaneous tracheostomy was mainly performed irrespective of the type of unit. Only 48% of doctors declared usually be able to wean patient from the cannula before ICU discharge. Usual difficulties for post-ICU transfer due only to the presence of the cannula were found by 80% of respondants. Eighty-nine per cent of respondents felt that management of tracheostomized patients after the ICU could be improved. CONCLUSION: Tracheostomy is a frequent procedure, mostly percutaneous. Indications and timing for tracheostomy correspond to the recommendations. Reported difficulties in post-ICU management are important and present nationwide.