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Massanet P, Jung B, Molinari N, Villiet M, Moulaire V, Roch-Torreilles I, Jaber S, Reynes J, Corne P. [Antifungal treatment for suspected or proved candidiasis in the critically ill]. ACTA ACUST UNITED AC 2014; 33:232-9. [PMID: 24684836 DOI: 10.1016/j.annfar.2014.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 02/11/2014] [Indexed: 11/28/2022]
Abstract
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.
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Chanques G, Riboulet F, Molinari N, Carr J, Jung B, Prades A, Galia F, Futier E, Constantin JM, Jaber S. Fraction of mask pressure transmitted to the trachea using the Boussignac's CPAP facemask. Minerva Anestesiol 2014; 80:397. [PMID: 24280825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Coisel Y, Jourdan A, Conseil M, Pouzeratte Y, Verzilli D, Jung B, Chanques G, Jaber S. [Esophageal cancer surgery: evolution of pain management, hemodynamics and ventilation practices during 16 years]. ACTA ACUST UNITED AC 2014; 33:16-20. [PMID: 24439493 DOI: 10.1016/j.annfar.2013.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 12/05/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To describe the evolution of perioperative anesthesia practices in for esophageal cancer surgery. PATIENTS AND METHODS We conducted an observational retrospective study in a single center evaluating main perioperative practices during 16 years (1994-2009). Statistical analysis was done on 4 chronologic quartiles of same sample size. RESULTS Two hundred and seven consecutive patients were included during the 4 periods 1994-1997 (n=52), 1997-1999 (n=52), 1999-2003 (n=52) and 2004-2009 (n=51). The main significant evolutions between the first and the fourth period were observed: (i) in ventilation: lower tidal volume (9.6[8.6-10.6] vs 7.6[7.0-8.3] mL/kg of ideal body weight (IBW), p<0.01), increased use of Positive End Expiratory Pressure (0 vs 83%, p<0.001) and increased use of post-operative non-invasive ventilation (0 vs 51%, p<0.001); (ii) in hemodynamic management: lower fluid replacement (20.6 [16.0-24.6] vs 12.6 [9.7-16.2] mL/h/kg of IBW, p<0.001); (iii) in analgesia: increased use of epidural thoracic anesthesia (31 vs 57%, p<0.001). Peroperative bleeding, type of fluid replacement, length of mechanical ventilation, length of stay in intensive care unit, ventilatory free days and mortality at day 28 didn't change. CONCLUSIONS During these previous years, anesthesia practices in ventilation, hemodynamics and analgesia for esophageal cancer surgery have changed.
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Chanques G, Riboulet F, Molinari N, Carr J, Jung B, Prades A, Galia F, Futier E, Constantin JM, Jaber S. Comparison of three high flow oxygen therapy delivery devices: a clinical physiological cross-over study. Minerva Anestesiol 2013; 79:1344-1355. [PMID: 23857440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM High-flow-oxygen-therapy is provided by various techniques and patient interfaces, resulting in various inspired-fraction of oxygen (FiO2) and airway-pressure levels. However, tracheal measurements have never been performed. METHODS Three oxygen-delivery-devices were evaluated: 1) standard-high-flow-oxygen-facemask with reservoir-bag, 2) Optiflow(TM)-high-flow-nasal-cannulae and 3) Boussignac(TM)-oxygen-therapy-system. Main judgment criteria were airway-pressure and FiO2 measured in the trachea. The three devices were randomly evaluated in cross-over in 10 Intensive-Care-Unit patients using three oxygen flow-rates (15, 30 and 45 L/min) and two airway-tightness conditions (open and closed mouth). Airway-pressures and FiO2 were measured by a tracheal-catheter inserted through the hole of a tracheotomy tube. Comfort was evaluated by self-reporting. Data are presented as median [25-75th]. RESULTS 1) Regarding oxygen-delivery devices, BoussignacTM provided the highest mean tracheal pressure (13.9 [10.4-14.5] cmH20) compared to Optiflow(TM) (2 [1-2.3] cmH2O, P<0.001). BoussignacTM provided both positive inspiratory and expiratory airway-pressures, whereas Optiflow(TM) provided only positive expiratory airway-pressure. Reservoir-bag-facemask provided airway pressure close to zero. For FiO2, highest value was obtained for both Optiflow(TM) and facemask (90%) compared to Boussignac(TM) (80%), P<0.01. 2) Regarding oxygen-flow, airway-pressure and FiO2 systematically increased with oxygen-flow with the three devices except airway-pressure for the facemask. 3) Regarding the open-mouth position, mean airway-pressure decreased with Optiflow(TM) only (2 [1.2-3.3] vs. 0.6 [0.3-1] cmH2O, P<0.001). Opening the mouth had little impact on FiO2. 4) finally, discomfort-intensities were low for both Optiflow(TM) and reservoir-bag-facemask compared to Boussignac(TM), P<0.01. CONCLUSION On one hand, Boussignac(TM) is the only device that generates a relevant positive-airway-pressure during both inspiration-and-expiration, independently of mouth-position. Optiflow(TM) provides a low positive-airway-pressure (<4 cmH2O), highly dependent of mouth-closing. The reservoir-bag-facemask provides no positive-airway-pressure. On the other hand, FiO2 are slightly but significantly higher for Optiflow(TM) and reservoir-bag-facemask than for Boussignac(TM). Discomfort was lesser for Optiflow(TM) and reservoir-bag-facemask.
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Coisel Y, Galia F, Conseil M, Jung B, Chanques G, Jaber S. [Risk of barotrauma when using non-reinhalation Waters valves: a comparative study on bench test]. ACTA ACUST UNITED AC 2013; 32:749-55. [PMID: 24138768 DOI: 10.1016/j.annfar.2013.07.814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Manual ventilation is delivered in the operating room or the intensive care unit to intubated or non-intubated patients, using non-rebreathing systems such as the Waters valve. New generation Waters valves are progressively replacing the historic Waters valve. The aim of this study was to evaluate maximal pressure delivered by these 2 valves. TYPE OF STUDY Bench test. MATERIAL AND METHOD Thirty-two different conditions were tested, according to 2 oxygen flow rates (10 and 20L/min), without (static condition) or with manual insufflations (dynamic condition) and 4 valve expiratory opening pressures. The primary endpoint was maximal pressure measured at the exit of the valve, connected to a model lung and a bench test. RESULTS Measured pressures were different for most evaluated conditions. Increasing oxygen flow from 10 to 20L/min increased maximal pressure for both valves. Increasing valve expiratory opening pressure induced a significant increase in maximal pressure for the new generation valve (from 4 to 61cmH2O in static conditions and from 18 to 68cmH2O in dynamic conditions). For the historic valve, maximal pressure increased significantly but remained below 15cmH2O in both static and dynamic conditions. CONCLUSION Use of new generation Waters valves should be different from historic Waters valves. Indeed, barotrauma could be caused by badly adapted valve expiratory opening pressure settings.
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Sens N, Payan A, Sztark F, Piriou V, Bouaziz H, Bruder N, Jaber S, Jouffroy L, Lebuffe G, Mantz J, Piriou V, Roche S, Sztark F, Tauzin-Fin F. Évaluation du Risque CARDiaque de l’Opéré (RICARDO) : enquête nationale auprès des anesthésistes-réanimateurs concernant la prise en charge périopératoire du patient à risque cardiaque. ACTA ACUST UNITED AC 2013; 32:676-83. [DOI: 10.1016/j.annfar.2013.07.807] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 07/04/2013] [Indexed: 11/27/2022]
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Jaber S, Altaani H. Multiple giant coronary aneurysms in adult patient managed by exclusion with bypass, case report. J Cardiothorac Surg 2013. [PMCID: PMC3844570 DOI: 10.1186/1749-8090-8-s1-o183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Chanques G, Jaber S. [Unexpected progress of an old intensive care therapy, oxygen: towards more comfort and less mechanical ventilation…]. Rev Mal Respir 2013; 30:605-8. [PMID: 24182647 DOI: 10.1016/j.rmr.2013.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 07/16/2013] [Indexed: 01/17/2023]
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Chanques G, Jaber S. [I'm ready to add a simple test for my anesthesia consultation to screen patients at risk to develop cognitive dysfunction]. ACTA ACUST UNITED AC 2013; 32:546-7. [PMID: 23972630 DOI: 10.1016/j.annfar.2013.07.797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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De Jong A, Molinari N, Sebbane M, Prades A, Jaber S. Feasibility and effectiveness of prone position in morbidly obese ARDS patients: a case-control clinical study. Crit Care 2013. [PMCID: PMC3642540 DOI: 10.1186/cc12054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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De Jong A, Molinari N, Terzi N, Mongardon N, Jung B, Jaber S. Early identification of patients at risk of difficult intubation in the ICU: development and validation of the MACOCHA score in a multicenter cohort study. Crit Care 2013. [PMCID: PMC3642422 DOI: 10.1186/cc12095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Jaffuel D, Galia F, Gil F, Wautier F, Jaber S. Évaluation sur banc du volume courant produit par des ventilateurs de domicile en mode Trilevel et mode Bilevel. Neurophysiol Clin 2013. [DOI: 10.1016/j.neucli.2013.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Fang M, Simeonova I, Bardot B, Lejour V, Jaber S, Bouarich-Bourimi R, Morin A, Toledo F. Mdm4 loss in mice expressing a p53 hypomorph alters tumor spectrum without improving survival. Oncogene 2013; 33:1336-9. [DOI: 10.1038/onc.2013.62] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 01/02/2013] [Accepted: 01/07/2013] [Indexed: 12/19/2022]
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Jaffuel D, Galia F, Gil F, Wautier F, Jaber S. Évaluation sur banc du volume courant produit par des ventilateurs de domicile en mode Trilevel et mode Bilevel. Rev Mal Respir 2013. [DOI: 10.1016/j.rmr.2012.10.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chanques G, Conseil M, Coisel Y, Carr J, Jung B, Jaber S. Sédation-analgésie en réanimation : arrêt quotidien par les médecins ou gestion continue par les infirmières. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-012-0511-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Langeron O, Jaber S, Benhamou D, Plaud B. [Sfar research awards 2012]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2012; 31:671-672. [PMID: 22902609 DOI: 10.1016/j.annfar.2012.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Constantin JM, Jaber S. [Preoxygenation in obese patient with non-invasive pressure support ventilation: keep the pressure!]. ACTA ACUST UNITED AC 2012; 31:673-4. [PMID: 22867911 DOI: 10.1016/j.annfar.2012.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jaber S, Coisel Y, Chanques G, Futier E, Constantin JM, Michelet P, Beaussier M, Lefrant JY, Allaouchiche B, Capdevila X, Marret E. A multicentre observational study of intra-operative ventilatory management during general anaesthesia: tidal volumes and relation to body weight. Anaesthesia 2012; 67:999-1008. [DOI: 10.1111/j.1365-2044.2012.07218.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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69
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Boutin C, Vachiéry-Lahaye F, Alonso S, Louart G, Bouju A, Lazarovici S, Perrigault PF, Capdevila X, Jaber S, Colson P, Jonquet O, Ripart J, Lefrant JY, Muller L. Pratiques anesthésiques pour prélèvement d’organes chez le sujet en mort encéphalique et pronostic du greffon rénal. ACTA ACUST UNITED AC 2012; 31:427-36. [DOI: 10.1016/j.annfar.2011.11.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 11/10/2011] [Indexed: 11/28/2022]
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Jaber S, Al-Khayat M, Rihy Z, Refuel J. Laparoscopic-assisted management of severe necrotizing pancreatitis with obstructive jaundice: a case report. Asian J Endosc Surg 2011; 4:82-5. [PMID: 22776227 DOI: 10.1111/j.1758-5910.2011.00080.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a severely infected necrotizing pancreatitis managed with hand-assisted laparoscopic necrosectomy along with a review of the relevant literature. Minimally invasive necrosectomy has been shown to be efficient and advantageous in managing necrotizing pancreatitis. Multiple techniques have been advocated over the last decade. Laparoscopic pancreatic debridement is a feasible option for some patients with necrotizing pancreatitis. We selected hand-assisted laparoscopic pancreatic necrosectomy, which has gained some favor over open necrosectomy because of the morbidity and mortality associated with laparotomy. We report on an Indian male patient who presented with acute abdomen and severe jaundice. A CT scan of the abdomen showed severe necrotizing pancreatitis. After conservative management failed, a hand-assisted laparoscopic pancreatic necrosectomy was performed. The patient recovered and was discharged 4 weeks after surgery.
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Jung B, Carr J, Chanques G, Cisse M, Perrigault PF, Savey A, Lefrant JY, Lepape A, Jaber S. [Severe and acute pancreatitis admitted in intensive care: a prospective epidemiological multiple centre study using CClin network database]. ACTA ACUST UNITED AC 2011; 30:105-12. [PMID: 21316909 DOI: 10.1016/j.annfar.2011.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Accepted: 01/04/2011] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To describe the demographic characteristics, incidence of extra-abdominal hospital-acquired infections and outcome of patients admitted to intensive care unit (ICU) with severe acute pancreatitis. STUDY DESIGN A retrospective, observational multiple center (65 centers) analysis of prospectively acquired data. PATIENTS AND METHODS During 2 years, all consecutive admitted patients to ICU for severe acute pancreatitis in the centers participating in the nosocomial infections surveillance network CClin Sud-Est were included. Patients whose ICU stay was less than 48 hours were not included. Demographic characteristics, extra-abdominal hospital-acquired infections and clinical course were described. RESULTS During the study period, 510 patients were included which represented 2 % of patients with a length of stay longer than 48 hours in the 65 participating ICUs. The global attack rate of extra-abdominal hospital-acquired infections (pneumonia, bacteremia, urinary tract or central venous catheter infection) was 23 % in overall patients and it was 33 % in the 294 mechanically ventilated patients. ICU mortality was 20 % in overall patients and it was 34 % in mechanically ventilated patients. CONCLUSION Severe acute pancreatitis represents 2 % of ICU stay longer than 48 hours. Its clinical course is frequently complicated by hospital-acquired infections and is associated with an high ICU mortality rate. This epidemiological observational study may be used for calculating sample size for future multicenter interventional therapeutic studies.
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Serveaux-Delous MS, Lakhal K, Capdevila X, Lefrant JY, Jaber S. Prescription and clinical impact of chest radiographs in 104 French ICUs: the RadioDay Study. Crit Care 2011. [PMCID: PMC3061767 DOI: 10.1186/cc9557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Jaber S, Jung B. Postoperative non-invasive ventilation outside the ICU: do not go too far! Minerva Anestesiol 2011; 77:9-10. [PMID: 21273964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Chanques G, Sebbane M, Constantin JM, Ramillon N, Jung B, Cissé M, Lefrant JY, Jaber S. Analgesic efficacy and haemodynamic effects of nefopam in critically ill patients. Br J Anaesth 2010; 106:336-43. [PMID: 21205626 DOI: 10.1093/bja/aeq375] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pain management is challenging in intensive care unit (ICU) patients. The analgesic efficacy, tolerance, and haemodynamic effects of nefopam have never been described in critically ill patients. METHODS In consecutive medical-surgical ICU patients who received 20 mg of nefopam i.v. over 30 min, we measured pain, Richmond Agitation Sedation Scale (RASS), respiratory parameters, and adverse drug events at T0 (baseline), T30 (end-of-infusion), T60, and T90 min. Haemodynamic variables were assessed every 15 min from T0 to T60 and T90. Pain was evaluated by the behavioural pain scale (BPS, 3-12) or by the self-reported visual numeric rating scale (NRS, 0-10) according to communication capacity. RESULTS Data were analysed for 59 patients. As early as T30, median NRS and BPS decreased significantly from T0 to a minimum level at T60 for NRS [5 (4-7) vs 1 (1-3), P<0.001] and T90 for BPS [5 (5-6) vs 3 (3-4), P<0.001]. No significant changes were detected for RASS, ventilatory frequency, or oxygen saturation. Increased heart rate and decreased mean arterial pressure, defined as a change ≥15% from baseline, were found in 29% and 27% of patients, respectively. For the 18 patients monitored, cardiac output increased by 19 (7-29)% and systemic vascular resistance decreased by 20 (8-28)%, both maximally at T30. Heat sensation, nausea/vomiting, sweating, and mouth dryness were found, respectively, in 6%, 9%, 22%, and 38% of patients. CONCLUSIONS A single slow infusion of nefopam is effective in critically ill patients who have moderate pain. The risk of tachycardia and increased cardiac output and also hypotension and decreased systemic vascular resistance should be known to evaluate the benefit/risk ratio of its prescription.
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Paugam-Burtz C, Chatelon J, Follin A, Rossel N, Chanques G, Jaber S. [Perioperative anaesthetic practices in liver transplantation in France: Evolution between 2004 and 2008]. ACTA ACUST UNITED AC 2010; 29:419-24. [PMID: 20677378 DOI: 10.1016/j.annfar.2010.02.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine the evolution of French perioperative anaesthetic practices in liver transplantation between 2004 and 2008. STUDY DESIGN Phone survey. METHODS In 2004 and 2008, a similar questionnaire has been administered by phone to a senior anaesthesiologist from each French centre performing adult liver transplantation (n = 21). Results were compared using Fisher test and p < 0.05 was considered significant. RESULTS Between 2004 and 2008, there was a trend towards an increase of centres performing transplantation for more than 40% of Child C patients (p = 0.1). Simultaneously, work force dedicated to liver transplantation cases has been reduced since in 2008, one anaesthesiologist was in charge in 90% of the centres (p = 0.06 vs 2004). Perioperative practices remained largely heterogeneous between centres with regard to hemodynamic monitoring, fluid and blood products management, antifibrinolytics use or postoperative analgesia. CONCLUSIONS This French survey has shown a reduction of work force dedicated to a liver transplantation from 2004 to 2008 simultaneously with a trend towards a greater severity of liver recipients. Practices heterogeneity reflect at least in part, unresolved questions about the best perioperative management for liver transplantation and the need for guidelines. Working for standardization of our practices and multicentric trials could allow gaining a better understanding of what should be the good practices in perioperative management of liver transplantation.
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