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Abstract: Medical devices are known to carry risks from design to scrap. Accident reports in ICU show that medical device account for only 20 % of accidents. Formation of users and providing a postmarketing incident reporting are thus essential in health institutions. Clinical and engineering departments should cooperate to produce and secure procedures which should be applied during the lifetime of each clinical device. Several points should be especially fulfilled: close cooperation between clinical departments and biomedical engineering departments with available technicians, computer-based inventory of all devices, evaluation of specifications required before purchasing a new device, education of users on utilisation and maintenance, technical follow-up of devices and keeping maintenance and repair logs, ability to provide users with replacement devices, provision of check-lists before use, forging criteria to decide when device should be discarded. These principles are simple and should be considered as mandatory in order to improve medical device related security. [Copyright &y& Elsevier]

Abstract: Anesthesia is a situation during which patients are exposed to a large number of drugs in a very short period of time. Almost all of such products may be incriminated as the cause of a hypersensitivity reaction. We conducted a retrospective analysis that included 171 patients who had had an allergy workup in the General Allergy Unit at the Angers CHU following a reaction which occurred during the course of a general or locoregional anesthesia between January 2000 and January 2007. The results of this analysis led us to raise some questions related to the interpretation in a number of these cases, i.e., the results suggesting polysensitization on the one hand, whereas, on the other hand, the tests were negative when done during the course of severe grade III reactions. These two points, which have not been considered up to the present in multicentric studies on the prevalence and the risk of peri-anesthesic allergic reactions, are the subject of the present article. [Copyright &y& Elsevier]

Abstract: Objective: To study the concordance of cardiac index (CI), mixed venous oxygen saturation (SvO2) and the arterial-mixed venous O2 content difference, i.e.: C(a–v)O2, postoperatively to cardiac surgery. We hypothesized that significant discrepancies would be measurable between C(a–v)O2 and SvO2, and CI, because the latter two indices encompass less metabolic components than the former. Design: Analysis of variables collected as part of routine care. Patients: Eighty anesthetized patients receiving mechanical ventilation after heart surgery. Measurements and results: Using linear regression of SvO2 versus C(a–v)O2 (Reg 1) and CI versus C(a–v)O2 (Reg 2), respectively we found that CI=2.2Lmin−1 m−2 and SvO2 =70% were equivalent to C(a–v)O2 =5ml/100ml. The error reflected by the vertical scatter of points around the regression line, once normalized was 3.24 times greater in Reg 2 than in Reg 1. Conclusions: The correspondence of CI, SvO2 and C(a–v)O2 values observed in a population of patients studied immediately after scheduled heart surgery match those reported in critically ill patients. SvO2 and furthermore CI induced a sizeable scatter of points around regression line. Accordingly, they appear as a lesser estimate of the flow/metabolism balance that may at best be inferred from C(a–v)O2. [Copyright &y& Elsevier]

Abstract: Objective: To study severe head injured patients (SHIP) during prehospital emergency care (Samu) and the first day in the French Pays-de-la-Loire area, in 2005. Study design: Prospective and multicenter. Patients and methods: All patients managed by Samu with GCS≤8 on the field, starting from a GCS≤10. Results: We report on 125 patients (88% of all SHIP managed in 2005), including 114 with a GCS less or equal to eight on which analysis was performed: age: 37±20 years, men: 4/1, road accident: 73%, fall: 20%, (polytrauma: 53%, artificial ventilation: 92%). Delays: field medical care 54±28min, transportation: 32±29min, total time to hospital: 1h55±48min. Direct admission in a center with neurosurgery on site: 68%; 47% of patients admitted in general hospitals were transferred to a tertiary hospital (71% to neurosurgery). Mortality before 24th hour (23%) was associated (p <0.05) with shorter transfer time, older patient, persistent shock, fluid loading greater than 1500ml, continuous infusion of vasopressors, focal neurological deficit. Problems were reported by Samu teams (21% of cases): medical care (32%), emergency ambulance availability (20%), alerting process (16%), on field care before Samu (12%). Of note, mannitol was never used, despite a mydriasis. Conclusion: We observed a delayed referral of patients to a tertiary hospital, a limited use of CT image transmission and the absence of mannitol administration but also organisational problems reported in 21% of cases problems are main target for quality improvement. [Copyright &y& Elsevier]

Abstract: Study design: The aim of this study was to assess how French anaesthesiologists perform continuing medical education (CME). Methods. – A 73 items survey was mailed to 1,000 anaesthesiologists (11% of anaesthesiologists population) of geographic, gender and institution representative of national anaesthesiologist demography. A second mail was sent to non-responders, 6 weeks later. Results. – The answer rate was 40.8% and the sample of responders appeared to match the French anaesthesiologist population. Seventy-two percent of surveyed anaesthesiologists were affiliated to the French society of anaesthesia-intensive care and 24% to other medical societies. Attendance to French congresses was 81% and miscellaneous congresses were equally appreciated in terms of quality. Only 17% of surveyed anaesthesiologists attended international congresses. Multi-thematic congresses were preferred by 67%. The annual time devoted to congresses was 6 days (median) with additional 4 days (median) reserved for practical courses. French medical journals and international journals had a reading rate of 89 and 37%, respectively. For 61% of responders CME was funded by institutional grants. Internet CME use was found in 73% of anaesthesiologists. Time and money were the two most frequent reasons invoked for CME restriction. Conclusion. – CME is a broadly shared activity, which still remains focussed on national resources. [Copyright &y& Elsevier]

Abstract: Neuro-imaging is essential for the initial evaluation and subsequent control in the acute stage of severe head injury. In these indications tomodensitometry (TDM) has a pivotal role. Despite the well recognized contribution of magnetic resonance imaging (MRI) to the investigation of most of acute neurological pathologies, MRI is not still a routine procedure for the initial investigation of patients with acute head injury. The superiority of morphological and functional MRI on TDM in this indication is discussed. [Copyright &y& Elsevier]

Objective. – We surveyed the residents in their first (R1) and fourth (R4, last) years of residency in anaesthesia and intensive care in France.Methods. – The questionnaires mailed to each resident were designed to obtain personal data, motivation for specializing in anaesthesia and their opinion of their training.Results. – The response rates were 48% for the R1 residents and 77% for the R4 residents. There were 40% females in this population and the R1 residents were 25 ± 1 year old, 29 ± 2 year-old for the R4 residents. Almost half (46%) of the R1 responders were married as were 74% of the R4 residents. They spent an average of € 726 each year on books, computers and other educational items. Most (71%) had opted for anaesthesia after considering other medical specialties, but only 12% had considered surgery. Half (51%) were on a training program that was far away from their home. They thought highly of their training, with the clinical training being rated above the non-clinical component. About half of them had obtained specialized certificates (mainly additional certification in intensive care and antibiotic therapy) during their residency. Two thirds of those in R4 expected to work in a public hospital and about one third expected to work in intensive care. Money was an important factor in their choice of profession. A majority planned to remain in the area where they had graduated in anaesthesia after their residency. Finally, 96% declared that they would choose anaesthesia again if they had to do so.Conclusion. – French residents in anaesthesia are satisfied of their initial choice for anaesthesia and don''t regret it at the end of their residency training. [Copyright &y& Elsevier]

Objective. – Medical reports in ICU are usually tape recorded and then typed by transcriptionist. Digital voice recognition (DVR) has considerably improved and may be a time saving method. The purpose of this study was to test IBM® Viavoice® (Pro Edition, Release 8, French version) for the generation of medical reports in a surgical intensive care unit.Methods. – A senior resident (Int) in anaesthesia, a senior academic (AS) anaesthesiologist and a confirmed medical secretary (Sec) all working in the same surgical ICU participated to the study. First, Int and AS trained Viavoice® according to the software requirements. Then 60 medical records (text files) served to automatically train the software. For the study, we prospectively used 20 consecutive medical records, which had been dictated on tape by either Int or AS. The transcription time by Sec, the number of typing errors and time needed for corrections were recorded. Int and AS with Viavoice® processed the same records. Turnaround time and errors were assessed for comparison to Sec work.Results. – Accuracy was 97, 92 and 95% for Sec, Int and AS, respectively. Transcription by Viavoice® was always significantly faster whatever the speaker than conventional transcription by a secretary. However, Int required significantly longer time to correct recorded text than did Sec and AS. The total turnaround time was significantly faster for AS than Sec (p < 0.01) but Int did not differ from Sec. The performance of Viavoice® did not rise with the number of records.Conclusion. – Viavoice® is as efficient as a confirmed transcriptionist. [Copyright &y& Elsevier]

Objective – To evaluate the impact of a French guideline on the clinical management of severe head injury (SHI) published in 1999.Study design – Nationwide survey.Methods – 182 medical centres answered the inquiry.Results – 111 centres declared to manage such patients suffering from SHI. 68% of doctors from these clinical departments did report to have read these guidelines. Fifty percent of them found in these guidelines useful data for their clinical practice. Forty four percent of centres could not monitor ICP lacking neurosurgical facility in their hospital. Conversely, all hospitals with neurosurgery available did monitor ICP. Seventy six percent of centres reported difficulties to find a facility, which would take these patients in charge when discharged from ICU. We analysed the main items included in the guidelines and report their impact. Seventy four percent of responders found that clinical management of SHI patients had improved during the last years.Conclusion – The French guidelines had a significant impact and seem to have provided a useful aid to clinical management of SHI patients. ICP monitoring and the shortage in post-ICU facilities are remaining issues. [Copyright &y& Elsevier]

Objectives: To evaluate what could be the benefit in terms of alarm suppression, of a new syringe pumps system, which allows automatic relay without alarms.Patients and methods: We have prospectively recorded the nature and the mode of relay of all syringe pumps for administration of drugs to patients in two ICU. The perfusion regimen was studied in 61 patients over the complete duration of their stay in two ICU. Alarms were also recorded in one ICU room, over 13 days consecutive. The records were processed off-line with an automatic detection-recognition system in order to assess the origin of each alarm. Accordingly, the amount of alarm corresponding to monitor, ventilator and syringe pumps was computed.Results: We found that syringe pumps, which would provide automatic relays without alarm, would suppress 17% of alarms in ICU and automatize 65% of the relay procedures, which are usually performed often in emergency, on response to the end of perfusion alarm.Conclusion: New syringe pumps allow both reduction of alarms in ICU and a better management of nurse workload. Indeed syringe relay can be planned in advance. [Copyright &y& Elsevier]