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Fat-soluble vitamins, including vitamins A, D, E and K, are molecules with no energy value that are essential for the body to function and for life. Their intake is almost exclusively exogenous, i.e. dietary. As a result, deficiencies in fat-soluble vitamins are rarer in industrialised countries than in countries with limited resources. However, even in the latter, certain groups of individuals are affected, such as newborns or growing children, pregnant or breast-feeding women and elderly or isolated subjects. Vitamin A, D, E and K deficiencies are also relatively common in people with digestive tract disorders, in patients suffering from chronic pathologies or in intensive care patients. Deficiencies or excesses of fat-soluble vitamins are responsible for a variety of more or less specific clinical symptoms. Treatment of deficiencies requires vitamin supplementation, a well-balanced diet and treatment of the cause. [ABSTRACT FROM AUTHOR]

Introduction: in sub-Saharan Africa, the impact of intensive care unit (ICU) hospitalization of COVID patients is not at all known in terms of quality of life because it is very poorly documented. The aim of this study was to describe the quality of life at three months of patients who had been in the ICU. Methods: we conducted a monocentric prospective cohort study over a 6-month period. Results: hundred and three (103) patients participated in the survey out of 123 patients discharged from the ICU during our study period, with a participation rate of 85%. The average length of stay in the ICU was 12 days with extremes of 2 and 36 days. The mean duration of oxygen therapy was 12±10 days. The assessment of quality of life with the SF-36 at 3 months after discharge from the intensive care unit showed impairment in eight domains, the most important of which were the emotional domain with a mean score of 57.6±44.6, the social functioning domain with a score of 60.77±24.07 and the vitality domain, which was 66.2±21.6. The global evaluation of the two main dimensions of the SF-36 showed a deficiency in the psychological dimension with a mean score of 64 with extremes of 12 and 90. This evaluation also showed an impairment of the physical dimension with a mean score of 70 with extremes of 20 and 97. Conclusion: our study showed a significant decrease in the quality of life of COVID-19 patients discharged from the intensive care unit. [ABSTRACT FROM AUTHOR]

Résumé: Avec la pandémie de SARS-CoV-2, dans notre établissement, les lits de salle de surveillance post-interventionnelle du bloc opératoire ont été transformés en lits de réanimation non-COVID. Le service de pharmacie a accompagné les équipes au cours des trois périodes, avec la mise en place d'un circuit du médicament adapté : création d'une armoire de dotation, fréquence d'approvisionnement, dispensation nominative et présence pharmaceutique. Objectifs : évaluer l'organisation pharmaceutique mise en place, la satisfaction des équipes infirmiers et recueillir des axes d'amélioration. Méthode : un questionnaire a été remis aux infirmiers ayant travaillé dans cette unité. Résultats : au total, 155 patients, soit une analyse de 111 prescriptions, ont été pris en charge sur 126 jours d'ouverture de cette unité. L'ensemble des infirmiers ayant participé aux trois périodes ainsi que le cadre de santé ont complété le questionnaire, soit 21 réponses. L'étape ressentie comme la plus difficile est la prescription (48 %) liée au support papier utilisé. La présence pharmaceutique a été appréciée à 90 %, notamment pour des demandes d'approvisionnement d'un médicament (95 %), ou d'information sur un médicament (58 %). Il est souhaité (90 %) que cette présence soit renouvelée en cas de réouverture de l'unité. Une amélioration de la satisfaction est constatée à chaque période. Conclusion : en cas de nouvelle vague, il a été décidé de poursuivre le détachement d'un pharmacien pour sécuriser le fonctionnement de ce type d'unité, notamment par l'analyse quotidienne des prescriptions avec les médecins et par l'interaction avec les infirmiers pour le bon usage du médicament. During the SARS CoV-2 pandemia and at three separate time period, our institution chose to turn the post interventional surveillance room of the operating room into a non-COVID intensive care unit. The chosen workflow included that the pharmacy team provided support to the medical team and was instrumental to implement an adapted drug circuit, including the creation of a supply cabinet, a specific frequency of its supply, a nominative dispensation and the presence of a pharmacist. Objectives : The study aims to evaluate the proposed pharmaceutical organization workflow, the satisfaction of the nursing team and to collect their expert feedback for improvement. Method : A satisfaction survey questionnaire was set up and given to the nurses who worked in this temporary unit. Results : A total of 155 patients, i.e. an analysis of 111 prescriptions, were treated during the 126 days during which the unit was running. All the nurses who participated to the three time periods and the health care manager completed the questionnaire, i.e. 21 responses. The step that was felt to be the most difficult was prescribing (48%) due to the paper medium used. The presence of a pharmacist in the medical unit was appreciated by 90% of the survey respondents, particularly for requests on the supply of a drug (95%), or on drug information (58%). 90% of the respondents were hoping that this experience would be renewed if the unit opens again. An increase of the satisfaction due to the pharmaceutical presence is reported in each successive period. Conclusion : In case of an eventual new epidemic wave, it was decided to continue to assign a pharmacist to the non-COVID intensive care unit, in order to protect the unit performance. The survey revealed that two key factor are instrumental to this success, a daily analysis of prescriptions with the physicians and the on-site interaction with the nurses for the promotion of the right use of medications. [ABSTRACT FROM AUTHOR]

Background: Delirium prevention in the ICU should focus on a non-pharmacological approach. However, these recommendations are not always applied by care providers., Objective: To select knowledge translation strategies to facilitate the implementation of non-pharmacological best practices to prevent delirium in the ICU., Method: A consensus study was conducted. Barriers and facilitators to the implementation of nonpharmacological methods, and knowledge translation strategies, were identified in two nominal groups. A context assessment was also carried out. Nine professionals and one patient-partner participated., Results: The barriers and facilitators on which consensus was reached were most frequently related to environmental context and resources, intention, and knowledge. The areas of organizational context with the highest levels of agreement were interpersonal relations, culture and leadership. Consequently, knowledge translation strategies were selected to facilitate practices, as well as to modify the environment and improve knowledge., Conclusion: A structured method was used during this study to guide the selection of knowledge translation strategies. The application of these strategies could potentially improve clinical practice in intensive care.

Copyright of Canadian Journal of Critical Care Nursing is the property of Canadian Association of Critical Care Nurses and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Gastrointestinal bleeding is a life-threatening condition, with a mortality depending on the cause and severity. The objective of this study was to retrospectively evaluate the epidemiological, clinical and evolutionary aspects of a series of patients diagnosed with gastrointestinal bleeding, admitted to the Intensive Care Unit of the Clinical Emergency Hospital of Bucharest, Romania. Material and methods. A retrospective, descriptive study was carried out, of patients diagnosed with upper and lower gastrointestinal bleeding, admitted to the Intensive Care Unit of the Clinical Emergency Hospital of Bucharest, Romania, between January 1st, 2013 – December 30th, 2018. The clinical variables were collected in a database designed exclusively for the study. Results. We observed that most of the cases were bleedings situated above the Treitz’s angle; the most frequent causes were peptic ulcer disease, followed by variceal hemorrhage and erosive gastroduodenitis. The three most frequent causes of upper gastrointestinal bleeding in our series were peptic ulcer disease, variceal hemorrhage and erosive gastroduodenitis. The global mortality due to gastrointestinal bleeding was 9.8%, with all cases occurring in the group of patients with upper gastrointestinal bleeding. Conclusions. It should be noted that in the group of patients who died, all had hemorrhagic shock at the time of admission, a fact that occurred only in 23% of the cases who survived. This highlights the prognostic value of the hemorrhagic shock on admission.

INTRODUCTION: The objective was to identify the predictive factors contributing to COVID-related deaths in Intensive Care Unit. METHODS: this was a 4-month (12th March to 12th July 2020) cross sectional study carried out in the intensive care unit of the COVID treatment center of Donka National Hospital, the only hospital with a COVID intensive care unit in Guinea. RESULTS: during our period of study 140 patients were hospitalized in the COVID intensive care unit and 35 patients died (25%). In univariate analysis, the occurrence of death was associated with: confusional syndrome (p=0.001), time to admission (p=0.001), use of an inotropic or vasopressor (p=0.001), Brescia score less than 2 (p=0.004), non-invasive ventilation (p=0.011), stroke (p=0.014), Acute Respiratory Distress Syndrome (ARDS) (p=0.015), male (p=0.021), provenance (p=0.021), acute renal failure (p=0.022), pulmonary embolism (p=0.022), invasive ventilation (p=0.022), and age less than 60 years (p=0. 047). In multivariate analysis, the factors predictive of mortality were: Acute Respiratory Distress Syndrome (ARDS) (OR= 6.33, 95% CI [1.66-29]; p = 0.007), a Brescia score 2 (OR =5.8, 95% CI [1.7-19.2]; p = 0.004) and admission delay (OR =5.6, 95% CI [1.8-17.5]; p = 0.003). CONCLUSION: our study shows that the acute respiratory distress syndrome, then the Brescia score less or equal to 2, and finally the time to admission to intensive care were all associated with an increased risk of death for patients. These results are different from those reported in Asia, Europe and North America.

The COVID-19 pandemic had caused significant morbidity and mortality, with over a million deaths recorded to date. Mortality recorded among severe-critically ill patients admitted to intensive care units (ICU) has been significantly high, especially in most COVID-19 epicenters. Reports on the unique clinical characteristics and outcomes from the ICU admissions are on-going with isolated studies in Africa. This study was a retrospective single-centre study involving all polymerase chain reaction (PCR) confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients admitted to the medical intensive care unit (MICU) of the department of medicine and therapeutics, Korle-Bu Teaching Hospital, over the period of 13thApril - 28th June 2020. Twenty-two (22) patients in total fulfilled the inclusion criteria and are included in this report. Patients' socio-demographic characteristics, clinical and laboratory parameters outcomes as well as treatment modalities employed were extracted from their respective medical records and analyzed using STATA version 14. Dyspnoea, fever and cough were most common associated symptoms. The mean duration of admission at the ICU was 4.1 ± 3.0 days with five deaths (22.7%). About 91% (20/22) had at least one comorbidity with hypertension as the most prevalent. The median oxygen saturation/fraction of inspired oxygen (SpO2FiO2) level was significantly higher in persons with only COVID-19 pneumonia compared to those with complicated respiratory failure (p=0.001). Six (27.3%) out of the 22 patients had non-invasive ventilation, with only 1/22 (4.5%) receiving mechanical ventilation. Although non-significant, the mean duration of ICU stay was relatively shorter in patients who received therapeutic doses of anticoagulation (p=0.32). Duration of treatment with methylprednisolone was significantly associated with patient outcomes (p=0.04) and serum ferritin levels had a tendency to negatively affect outcome (p=0.06). Clearly there are still no specific targeted medications for COVID-19 treatment, except for empirically symptoms-guided treatments and management of mild to critically ill patients. Early use of systemic corticosteroids for severe to critically ill patients in the ICU using S/F ratio and CRP levels may improve outcomes.

Rigorous monitoring of vital functions in intensive care requires optimal visibility of patients and their environment. Conversely, respect for privacy is an ethical imperative to respect. Liquid crystal electrical film is a device that can be applied to windows and can take opaque or transparent form on demand. Its use could satisfy the visibility of patients and respect for their privacy., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Effective communication remains key in delivery of comprehensive care to patient especially in the intensive care unit (ICU) setting. However, many providers, for various reasons, struggle with the art of effective communication adversely affecting relationship with patients and their families. Little is known or has been published about effective communication in ICUs within sub-Saharan Africa.

Résumé: La réactivation du virus herpes simplex 1 (HSV-1) est fréquente chez les patients de réanimation (entre 20 % et 50 % en fonction de la population étudiée) : elle commence au niveau oropharyngé après 3 à 5 jours d'hospitalisation, puis progresse de façon descendante pour atteindre le parenchyme pulmonaire entre 7 et 10 jours. Dans un petit nombre de cas, une véritable bronchopneumonie herpétique (définie par des signes cliniques, la présence du virus dans les voies aériennes et, soit la présence d'un effet cytopathique sur les cellules recueillies lors du lavage bronchoalvéolaire, soit une charge virale HSV-1 supérieure à 105 copies/million de cellules) peut survenir, après en médiane 14 jours de ventilation mécanique. La réactivation du HSV-1 est associée à une surmortalité, mais on ne sait pas à l'heure actuelle si elle est le témoin de la gravité de la maladie ou si elle a une morbi-mortalité propre. L'absence d'efficacité d'un traitement prophylactique ou préemptif a été démontrée par deux études randomisées, mais des études observationnelles suggèrent qu'un traitement curatif pourrait être bénéfique. À l'heure actuelle, on ne peut donc recommander l'aciclovir que chez les malades qui présentent une bronchopneumonie herpétique prouvée ou une charge virale supérieure à 105 copies/million de cellules dans le lavage bronchoalvéolaire. Herpes simplex virus 1 (HSV-1) reactivation is frequent in intensive care unit patients (20% to 50%, depending on case-mix): it begins in the throat after 3 to 5 days of hospital stay, then progress towards the respiratory tract to reach the lung after 7 to 10 days. In few cases, a HSV-1 bronchopneumonitis (defined by clinical symptom, HSV-1 in the lower respiratory tract and either specific cytopathic effect on cells collected during bronchoalveolar lavage or a HSV-1 load above 105 copies/million cells), can occur. HSV-1 reactivation is associated with mortality, but whether it is only a bystander or it has its own morbidity/mortality is unknown. Two randomized trials have shown lack of efficacy of acyclovir prophylactic or preemptive treatment, but observational studies suggest that acyclovir may be beneficial as a curative treatment. To date, we can only recommend acyclovir in patients with HSV-1 bronchopneumonitis or with HSV-1 load above 105 copies/million cells in the bronchoalveolar lavage. [ABSTRACT FROM AUTHOR]

INTRODUCTION: To describe all patients admitted to Tunisian intensive care unit with a diagnosis of influenza A/H1N1 virus infection after the 2009 influenza pandemic and to analyse their characteristics, predictors of complications and outcome. METHODS: all patients with influenza > 18-years-old hospitalized to the ICU department of Tunisian University hospital of Sousse, between December 1, 2009 and March 31, 2016, with a positive influenza A/H1N1/09 reverse transcriptase polymerase chain reaction (RT-PCR) from a nasopharyngeal specimen were included, were included. RESULTS: 40 cases were admitted to intensive care units. During the reporting period, 22 deaths in intensive care units (55%) were reported, the median age was 53 years (IQR 37-61), 24 (61%) were male, The median scores SAPS II and SOFA were respectively 29 (IQR 23-36) and 6 (IQR 3-10), 27% had chronic obstructive pulmonary disease (COPD), 33.3% diabetic and no patients were vaccinated against influenza A. The cause of admission was in 72.5% of the cases was hypoxemic pneumonae. By using a logistic regression, we found after adjustment to age, that acute respiratory distress syndrome (ARDS) (OR = 27; 95%CI: 3.62-203.78) was the only factor significantly associated with severe outcomes of the cases. CONCLUSION: patients in the first post pandemic season were significantly older and more frequently had underlying medical conditions. Multivariate analysis showed that older male patients with chronic lung disease were at increased risk for a severe clinical outcome.

INTRODUCTION: Intensive care unit (ICU) beds are a scarce resource, and admissions may require prioritization when demand exceeds supply. However, there are few data regarding both outcomes of admitted patients to intensive care unit (ICU) in comparison with outcomes of not admitted patients. The aim of this study was to assess reasons and factors associated to refusal of admission to ICU as well as the impact on mortality at 28 days and patients' outcomes. METHODS: single-center, cross-sectional descriptive study conducted in 8-bed Medical ICU at a Tunisian University hospital. All consecutive adult patients referred for admission to ICU during 6 months were included. We collected demographic data, ICU admission/refusal reasons, co-morbidity and diagnosis at time of admission, mortality probability model (MPMII0) score, day and time of admission, request for admission and mortality at 28 days. RESULTS: 327 patients were evaluated for ICU admission and 260 were refused to ICU (79.5%). Patients refused because of unavailability of beds represented 50% and patients considered "too sick to benefit" represented 22%. Multivariate analysis showed that the presence of acute respiratory failure and request by direct contact in the unit were independently associated to admission to ICU (OR: 0.15; 95% CI: 0.07-0.31 and OR: 0.16; 95% CI: 0.08-0.31, respectively). Higher mortality rates were shown in patients "too sick to benefit" (80.7%) and unavailable beds (26.56%). CONCLUSION: refusal of ICU admission was correlated with the severity of acute illness, lack of ICU beds and reasons for admission request. ICU clinicians should evaluate their triage decisions and, if possible, routinely solicit patient preferences during medical emergencies, taking steps to ensure that ICU admission decisions are in line with the goals of the patient. Ultimately, these efforts will help ensure that scarce ICU resources are used most effectively and efficiently.

Résumé Les tachycardies supra-ventriculaires et leur traitement ont été peu étudiées chez les patients critiques. But de l’étude Évaluer l’efficacité et l’innocuité de la cardioversion pour tachycardie supra-ventriculaire en réanimation. Patients et méthode Inclusion prospective de tous les patients qui ont présenté des tachyarythmies supra-ventriculaire incluant la fibrillation auriculaire, prolongée ≥ 30 secondes dans une réanimation médico-chirurgicales, à l’exception du postopératoire de chirurgie cardiaque. Les médicaments anti-arythmiques et/ou les chocs électriques ont été administrés de façon libérale. Résultats Au cours de la période d’étude de 15 mois, 108/846 (12,8 %) patients ont présenté des tachycardies supra-ventriculaires. Les médicaments anti-arythmiques ont été administrés chez 78 patients (72 %) ; pour la plupart de l’amiodarone (92 %), et/ou du magnésium (23 %), ce qui a entraîné un taux de conversion en rythme sinusal global de 68 %. Le choc électrique externe a été utilisé chez 26 patients (24 %), (médicaments anti-arythmiques reçus préalablement chez 24 patients) avec un taux succès immédiat de 80,8 %. Conclusion Le choc électrique externe a été associé à une conversion soutenue en rythme sinusal à 80,8 %, chez des patients de réanimation avec tachycardie supra-ventriculaire, alors que la plupart d’entre eux avait déjà reçu des médicaments anti-arythmiques. Supra-ventricular tachyarrhythmia and its treatment have been poorly investigated in ICU patients. Aims To evaluate efficacy and safety of cardioversion for supra-ventricular tachyarrhythmia in the intensive care unit (ICU). Patients and methods Prospective inclusion of all patients who presented supra-ventricular tachyarrhythmias lasting ≥ 30 seconds in a single medico-surgical ICU, except cardiac surgery. Anti-arrhythmic drugs and/or direct-current cardioversion were administered on a liberal basis. Results During the 15-month study period, 108/846 patients (12.8%) experienced supra-ventricular tachyarrhythmias. Anti-arrhythmic drugs were administered in 78 patients (72%); mostly amiodarone (92%), and/or magnesium (23%), resulting in an overall conversion rate of 68%. Direct-current cardioversion was used in 26 patients (24%), (24 patients received drug enhancement by anti-arrhythmic drugs) with an immediate 80.8%-success rate. Conclusion Direct-current cardioversion was associated with sustained conversion to sinus rhythm in 80.8% of ICU patients with supra-ventricular tachyarrhythmias, although most of them had already received drug enhancement. [ABSTRACT FROM AUTHOR]

Adverse drug events are a public health problem. On average, they are involved in 6.5% of hospital admissions, 9% of hospital stays and 15% of intensive care unit (ICU) admissions. Human and economic consequences are considerable for the society. It is necessary to study them in order to find solutions to limit their occurrences. The main objective of our study was to analyse adverse drug events responsible for hospitalization in ICU. Methods: In 20 months, this monocentric prospective study has included all patients admitted in ICU for involuntary adverse drug events. Each case was collected during clinical staffs to analyse the causes, the risk factors, the preventable proportion and the consequences. Results: Between June 2014 and January 2016, 154 patients were included, that is to say 10% of intensive care unit admissions. One third was already beforehand hospitalized. Patients were mostly old, polypathological and polymedicated. The main drugs involved were metformin, aspirin, vitamin K antagonists and antihypertensive drugs. In 55% of cases, it was potentially preventable. The median length of stay was four days in intensive care unit followed by nine days in another medical care unit for an average hospitalization cost per patient of 12,315 €. Forty-three patients (27.9%) died during their stay. Conclusion: Hospitalization for adverse drug events is frequent despite the fact that is often preventable. Identifying risk factors and sharing information between health care systems will allow to develop prevention strategies and to improve the patient care. [ABSTRACT FROM AUTHOR]

Résumé Si de nombreux facteurs de risque d’erreur ont été identifiés en réanimation, très peu d’études se sont intéressées au vécu du risque d’erreur chez les professionnels. Pourtant, l’approche psychologique du risque montre l’importance de la dimension subjective pour comprendre la manière dont le sujet appréhende le risque. Sur les 40 professionnels de réanimation, 75 % des professionnels vivent le risque d’erreur comme omniprésent. L’étude met en évidence l’existence d’un vécu différencié du risque d’erreur en fonction du niveau d’expérience, de l’encadrement et de coopération. Ces dimensions participent à la création d’une culture collective permettant de vivre le risque comme contrôlé. En revanche, pour les professionnels qui intègrent les services de réanimation, le risque est appréhendé de manière individuelle et est source d’anxiété. Cette étude se centre sur l’identification des situations à risque d’erreur, la manière dont les professionnels les vivent et s’en défendent. Cette approche subjective du risque nous permet de dégager des pistes de réflexion sur les enjeux du vécu du risque en termes de prévention et d’accompagnement des professionnels. Intensive care units are considered as services with a high risk of error. More and more studies have measured the incidence and impact of errors in intensive care units, but few of them are centered on the impact of the risk of error for professionals. This study focuses on the perception of the risk of error, how it is experienced, and the way in which professionals cope with it. Forty professionals (20 physicians, 20 nurses) participated in clinical interviews. We transcribed recordings and analysed the data using a phenomenological approach. The risk of error is omnipresent in intensive care units. For nurses with less than one years experience, the risk of error is associated with important manifestations of anxiety. On the contrary, for doctors and nurses who have worked for more than one year in ICU, their experience and the relationship of cooperation built with colleagues gives them a feeling of control over risky situations. Our results show that it is important to take into account the risk of error in order to better target the support and training for the ICU professionals. [ABSTRACT FROM AUTHOR]

Résumé Avec le vieillissement de la population, le taux d’admission des patients âgés admis en réanimation augmente de manière importante. L’objectif de cette mise au point est de faire un état des lieux de la littérature sur la réanimation du sujet âgé concernant les données démographiques, les critères d’admission, la mortalité, le pronostic fonctionnel et les aspects éthiques. Nous aborderons également plus spécifiquement les données sur l’arrêt cardiorespiratoire, l’état de choc, la détresse respiratoire aiguë et la confusion. La mortalité du patient de plus de 80 ans en réanimation peut atteindre jusqu’à 70 % à 1 an, mais est dépendante de nombreux facteurs, tels que les comorbidités ou la fragilité. Surtout, plus de la moitié des patients âgés recouvrent leur autonomie antérieure à long terme, et leur qualité de vie est identique à celle de la population du même âge. L’essentiel du pronostic vital et fonctionnel se jouant dans les 3 premiers mois qui suivent le passage en réanimation, nous aborderons les stratégies d’amélioration de la prise en charge via la création de filières dédiées de réanimation-gériatrie. The global population is aging and intensive care unit admission rate of elderly patients is dramatically increasing. The objective of this review is to provide an overview of the literature about the management of elderly patients in intensive care unit and more specifically about epidemiology, admission criteria, mortality, functional prognosis and ethical aspects. We also discuss the data on cardiorespiratory arrest, shock, acute respiratory failure and delirium. The mortality rate of patients over 80 years old in intensive care unit can reach up to 70% at 1 year, but is dependent on many factors, such as comorbidities or frailty. Above all, more than half of elderly patients recover their long-term autonomy. Their quality of life is comparable to that of the same age population. Considering that the first 3 months after an intensive care unit stay are the most decisive in terms of vital and functional prognosis, we will discuss strategies to improve care through the creation of dedicated intensive care-geriatrics networks. [ABSTRACT FROM AUTHOR]

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé L’augmentation de la prévalence de l’obésité conduit à l’augmentation du nombre de patients obèses admis dans les services de réanimation. Le « paradoxe de l’obésité » définit l’effet protecteur du surpoids et de l’obésité (jusqu’à 40 d’indice de masse corporelle) sur la mortalité en réanimation. Néanmoins, la mortalité réellement liée à l’obésité est probablement sous-estimée du fait de l’utilisation de scores pronostiques non adaptés. Lors de l’agression chez l’obèse, le tissu adipeux stocke les lipides, au lieu de les mobiliser comme source énergétique. Cela aggrave la réponse catabolique musculaire protéique secondaire à l’agression. La réponse métabolique à l’agression chez l’obèse pourrait impliquer des modifications qualitatives du tissu adipeux. L’hyperglycémie est une situation fréquente associée au mauvais pronostic d’où la nécessité du contrôle glycémique. La surnutrition est à bannir car dangereuse. L’assistance nutritionnelle a pour objectif principal de limiter le processus de dénutrition post-agression. Aucune méthode n’est validée pour l’évaluation de l’état nutritionnel et des besoins protéino-énergétiques chez l’obèse agressé. La stratégie de la nutrition artificielle chez l’obèse reste débattue, notamment le bien fondé d’une nutrition hypo-énergétique–hyperprotéique. La pauvreté de la littérature rend urgente la recherche chez le patient obèse agressé. The pandemic increase in obesity prevalence leads to a large increase in the number of obese patients admitted in the intensive care unit. The “obesity paradox” defines the protective effect of overweight and obesity (until 40 of body mass index) on intensive care unit mortality. In critically ill patients, obesity-related mortality is likely to be underestimated because of the use of non-suitable prognostic scores. During critical illness, the adipose tissue of obese patients stores lipids instead of utilizing them as energy source. It leads to the worsening of the muscle protein catabolism. The metabolic response to critical illness in obese patients may involve qualitative changes of the adipose tissue. Hyperglycemia is frequent and associated with patients’ poor prognosis making mandatory the glycemic control. Overnutrition must be avoided as it is deleterious. The main objective of nutritional support is to limit the malnutrition secondary to critical illness. In the critically ill obese patients, no method is validated for assessing nutritional status and protein–energy needs. The strategy of nutrition support is still largely debated, including the use of hypocaloric–hyperproteic feeding. The scarcity of scientific data makes urgent the biomedical research on the topic of the critically ill obese patients. [ABSTRACT FROM AUTHOR]

La fièvre boutonneuse méditerranéenne est une maladie infectieuse du groupe des rickettsioses due à une bactérie intracellulaire: Rickettsia Conorii. Les formes pauci symptomatiques et bénignes sont prédominantes. Les formes graves sont rares et de plus en plus rapportées dans la littérature récente avec une atteinte multi systémique sévère pouvant menacer le pronostic vital. Nous rapportons dans ce travail un cas très rare d'un patient de 52 ans admis en réanimation pour convulsions, état de choc septique et insuffisance rénale aiguë. Devant la découverte au deuxième jour de la prise en charge de lésions de type a chancre d'inoculation a et boutonneuses, le diagnostic de rickettsiose grave avec une atteinte multi viscérale sévère a été évoqué puis confirmé par une sérologie. Une antibiothérapie par doxycycline a été alors introduite. Le patient va développer cependant une nécrose tubulaire aiguë nécessitant des séances d'épuration extra-rénale. Il va développer rapidement une défaillance multi viscérale mortelle. La rickettsiose, par la vascularite microcirculatoire qu'elle engendre, peut donner des tableaux aussi sévères. Les mécanismes impliqués et les facteurs pronostiques éventuels sont discutés dans ce travail à travers une revue de la littérature.

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The intensive care unit (ICU) represents a special environment for patients. We analyzed patients in the ICU/ high care unit (HCU) with respect to dermatology counselling and skin problems.Setting: Academic Teaching Hospital over a 10 month period.Methods: The total number of patients of the ICU was 1,208 with a mean stay of 4.1 days. In the HCU the mean stay was 16 days. Diagnosis leading to admission were analyzed. All files of dermatological counselling were evaluated in detail.Results: Fifty-five patients with dermatologic problems were identified: 19 women and 26 males. The age ranged from 22 to 90 years of life (mean ± standard deviation: 67.2 ± 17.4 years). The total number of consultations were 85. The range of repeated dermatological consultation ranged from two to ten. The major reasons were skin and soft tissue infections, adverse drug reactions, chronic wounds including pressure sores and skin irritation or dermatitis. Pre-existing skin conditions may complicate the treatment and care during ICU/HCU stay.Conclusion: A tight collaboration between of the medical staff of ICU/HCU and dermatology department will ensure a rapid diagnosis and treatment of various skin conditions in the ICU, without increasing the costs significantly. Interdisciplinary education of nursing staff contributes to improved skin care in the ICU/HCU and helps to prevent acute skin failure.

During the last years, Intensive Care Unit (ICU) has recorded a massive progress in knowledge and operating possibilities, especially thanks to the techno-scientific innovations concerning biomedical technologies. The reflections expressed in this paper are the result of an interdisciplinary qualitative survey, which involved, through the creation of focus groups, about 50 health operators, doctors and nurses, working in six Italian intensive care units. The partakers have been asked to express their personal point of view concerning end-of-life decisions. The original aspect of this narrative is a critique to the image of medical technology as being able to take successfully part in any situation and doctors’ narratives aimed at rediscovering the importance of social relations.

The identification of the cause of acute encephalitis is difficult in spite of many developed diagnosis strategies. The cause is unknown in nearly 30 to 40 % of cases. Tuberculosis is endemic in Tunisia. Tuberculous encephalitis is rare in immunocompetent adults. We report in this work a rare case report of tuberculous encephalitis in an immunocompetent woman. She was 38 years old and had no medical history. She had a clinical presentation of mental confusion and fever that appeared from ten days. She was agitated with neck stiffness. Her initial Glasgow coma scale was thirteen. The CT scan of the head showed a brain temporal abscess (A). The cerebral spinal fluid examination showed elevated proteinorrachia of 172 mg/dl, normal glycorrachia and lymphocytic pleocytosis (76% of 340 WBC/mm3). The Magnetic resonance imaging (MRI) of the head performed in the second day revealed images of hydrocephalus (B). It showed also two images of brain vermian (C) and temporal abscesses (D). The diagnosis of tuberculous encephalitis was made by computing clinical, laboratory and imaging findings. She was admitted in the intensive care unit and treatment by cefotaxim and acyclovir was initiated. Antituberculous drugs were added at the second day of management after MRI. In the sixth day of management, the patient became comatose and required intubation and mechanical ventilation. She died three days later from neurologic complications.

Mediterranean spotted fever is an infectious disease belonging to the rickettsial group due to an intracellular bacterium: Rickettsia Conorii. Paucisymptomatic and benign forms are predominant. Severe forms are rare and increasingly reported in the recent literature with potentially lifethreatening severe multi-systemic involvement. We here report a very rare case of a 52-year old patient admitted to an Intensive Care Unit with convulsions, septic shock and acute renal failure. On the second day, given the discovery of « inoculation chancre »-like lesions which needed to be treated, the diagnosis of severe rickettsial disease with severe multivisceral involvement was suspected and then confirmed by serology. Antibiotic treatment with doxycycline was then administered. However the patient developed acute tubular necrosis requiring extrarenal purification sessions. The patient rapidly developed fatal multivisceral failure. Rickettsiosis is associated with microcirculatory vasculitis thus leading to severe clinical manifestations. The mechanisms involved and the possible prognostic factors have been discussed in this study through a review of the literature [ABSTRACT FROM AUTHOR]

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This research aimed to analyze the epidemio- clinical characteristic and the prognosis of patients with eclampsia admitted to the intensive care unit at the University Hospital of Point G. Materials and methods: The clinical records of all patients admitted to intensive care for eclampsia from September 2009 to February 2011 were retrospectively collected. We analyzed the following parameters: age, parity, gravidity, the admission deadline, the beginning of eclampsia compared to the term of pregnancy, the number of seizure, mode of delivery, score of Glasgow, blood pressure, proteinuria, complications and evolution. Results : Amoung 702 admissions, 158 patients, with a mean age of 20 ± 4 were hospitalized for eclampsia (22.5%). We recorded 106 cases of first pregnancies (67.1%) and 104 primiparous (65.8%). The admission period after the first seizure was over 6 hours for 90 patients (57%). The first seizure had occurred in ante-partum period for 69 patients, in per-partum period for 4 patients and in postpartum period for 85 patients. Ninety-three patients (59%) had consciousness disorders at admission, 12 patients received oxygen treatment. Vaginal delivery was the mode of delivery for 93patients and cesarean section for 65patients. Eclampsia was associated with renal failure in 25 patients, HELLP syndrome for 15 patients, the stroke for 5 patients, acute pulmonary edema for 3 patients, the coagulation disorders for one patient; and the sepsis for 6 patients. Maternal and perinatal lethality was 9.5% and 10.8% respectively. Conclusion : Eclampsia is a frequent medical and obstetric emergency in intensive care unit of the University Hospital of Point G and affects young patients during their first pregnancy and delivery. Maternal and perinatal lethality remains high, due to the delay in the cases management and the associated factors of gravity. Strong actions are needed to raise awareness for early medical visit and to prepare medical teams for better cases management. [ABSTRACT FROM AUTHOR]

Résumé Cet article s’emploie à différencier des pratiques de soin qui confrontent le soignant à la mort dans le contexte de la gériatrie et celui de la réanimation à partir d’un matériel clinique recueilli dans le cadre de séances d’analyse des pratiques auprès de soignants en gériatrie, d’une part, et d’entretiens réalisés avec des soignants de réanimation participant à une recherche universitaire, d’autre part. Au-delà des mécanismes défensifs individuels mis en place par les soignants pour gérer au mieux la problématique de la mort, c’est bien l’équipe, dans ses modalités de cohésion, dans son fonctionnement, dans ses stratégies collectives, qui peut soit étayer, soit fragiliser le soignant. Ainsi, nous montrerons en quoi ces contextes de travail différenciés orientent la façon de penser et d’agir des soignants dans leur gestion de la mort. Objectives This article aims at differentiating the case practices through which medical teams are confronted with death in a geriatric context and in an intensive care context. We study the subjective experience of health care professionals in intensive care unit and geriatric unit in front of patients with risk of death. Materials and methods Discourse from a test produced during some analysis sessions with a geriatric care team about their care practices and clinical interviews with a medical team working in an intensive care unit and carrying out university research. They had to develop their personal feeling about the organization of their work and their management of the relationship with the old patients or hospitalized patients. All interviews were entirely recorded and rewritten. Then, we proceeded to the coding of the interviews and we realized a thematic analysis with the consensus of three searchers. Results Beyond individual defensive mechanisms installed by them in order to manage the issue of death at the very best, it is the team, through their cohesion, through their working practices, through their collective strategies, who can play an important supporting role for its members in an intensive care unit or on the contrary generate suffering in geriatrics. Thus, we will show the way these differentiated contexts adjust the medical team's way of thinking and acting when they want to manage death and its conditions. [ABSTRACT FROM AUTHOR]

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCTION: The aim of the study is to compare efficacy of IvIg versus PE in treatment of mechanically ventilation adults with GBS in intensive care unit. METHODS: It is a prospective, non randomized study, realized in a medical ICU from 2006 to 2010. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 4 PE during 10-14 days). We collected demographic characteristics, clinical and therapeutic aspects and outcome. Statistical analysis used: The quantitative variables are expressed on mean , standard derivation and compared by Student test. The statistic analysis has been based on SPSS for windows. P = 0.05 is considered as significant. RESULTS: Forty-one patients (21 in group 1 and 20 in group 2) were enrolled. The mean age was 37.4 , 9.2 years, with a masculine predominance (75.4%). Electromyogram in all patients found acute inflammatory demyelinating polyradiculoneuropathy in 80.5 % of patients. The mean length of hospitalization was 45.3 9.2 days. The length of hospitalization of the IvIg group is less long than PE group (p = 0.03). The weaning of the MV was more precocious in IvIg group than PE group (p = 0.01). Also, the beginning of motility recuperation was precocious at IvIg group than PE group (p = 0.04). CONCLUSION: Our work reveals a meaningful difference for the MV weaning and precocious recovery in IvIg group compared to PE group.

Copyright of Bulletin de la Société de Pathologie Exotique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)