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Le Conte P, Terzi N, Mortamet G, Abroug F, Carteaux G, Charasse C, Chauvin A, Combes X, Dauger S, Demoule A, Desmettre T, Ehrmann S, Gaillard-Le Roux B, Hamel V, Jung B, Kepka S, L’Her E, Martinez M, Milési C, Morawiec É, Oberlin M, Plaisance P, Pouyau R, Raherison C, Ray P, Schmidt M, Thille AW, Truchot J, Valdenaire G, Vaux J, Viglino D, Voiriot G, Vrignaud B, Jean S, Mariotte E, Claret PG. Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d'Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies. Ann Intensive Care 2019; 9:115. [PMID: 31602529 PMCID: PMC6787133 DOI: 10.1186/s13613-019-0584-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/21/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma exacerbation (SAE) in adult and pediatric patients. RESULTS The guidelines were related to 5 areas: diagnosis, pharmacological treatment, oxygen therapy and ventilation, patients triage, specific considerations regarding pregnant women. The literature analysis and formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research was conducted based on publications indexed in PubMed™ and Cochrane™ databases. Of the 21 formalized guidelines, 4 had a high level of evidence (GRADE 1+/-) and 7 a low level of evidence (GRADE 2+/-). The GRADE method was inapplicable to 10 guidelines, which resulted in expert opinions. A strong agreement was reached for all guidelines. CONCLUSION The conjunct work of 36 experts from 3 scientific societies resulted in 21 formalized recommendations to help improving the emergency and intensive care management of adult and pediatric patients with SAE.
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Affiliation(s)
- Philippe Le Conte
- Service d’Accueil des Urgences, CHU de Nantes, 5 allée de l’île gloriette, 44093 Nantes Cedex 1, France
- PHU3, Faculté de Médecine 1, rue Gaston Veil, 44035 Nantes, France
| | - Nicolas Terzi
- Service de Médecine Intensive Réanimation, CHU de Grenoble Alpes, 38000 Grenoble, France
- INSERM, U1042, University of Grenoble-Alpes, HP2, 38000 Grenoble, France
| | - Guillaume Mortamet
- Service de Réanimation Pédiatrique, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Fekri Abroug
- Service de réanimation, CHU de Monastir, Monastir, Tunisia
| | | | - Céline Charasse
- Pediatric Emergency Department, CHU Pellegrin Enfants, Bordeaux, France
| | - Anthony Chauvin
- Service des Urgences, Hôpital Lariboisière, APHP, Paris, France
| | - Xavier Combes
- Service des Urgences, CHU de la Réunion, Saint-Denis, France
| | - Stéphane Dauger
- Pediatric Intensive Care Unit, Robert Debré Hospital, APHP, Paris, France
| | - Alexandre Demoule
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP, INSERM, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne Université, Paris, France
| | | | - Stephan Ehrmann
- Médecine Intensive Réanimation, INSERM CIC 1415, réseau CRICS-TriggerSEP, CHRU de Tours and Centre d’Etude des Pathologies Respiratoires, INSERM U1100, faculté de médecine, Université de Tours, Tours, France
| | | | - Valérie Hamel
- Service des Urgences, CHU de Toulouse, Toulouse, France
| | - Boris Jung
- Service de MIR, CHU de Montpelliers, Montpellier, France
| | - Sabrina Kepka
- Service des Urgences, CHU de Strasbourg, Strasbourg, France
| | - Erwan L’Her
- Service de MIR, CHRU de Brest, Brest, France
| | - Mikaël Martinez
- Pôle Urgences, centre hospitalier du Forez, 42605 Montbrison, France
- Réseau d’urgence Ligérien Ardèche Nord (REULIAN), centre hospitalier Le Corbusier, 42700 Firminy, France
| | - Christophe Milési
- Département de Pédiatrie Néonatale et Réanimations, CHU de Montpellier, Montpellier, France
| | - Élise Morawiec
- Service de Pneumologie et Réanimation, GH Pitié-Salpêtrière, APHP, Paris, France
| | - Mathieu Oberlin
- Service des Urgences, centre hospitalier de Cahors, Cahors, France
| | | | - Robin Pouyau
- Pediatric Intensive Care Unit, Women‐Mothers and Children’s University Hospital, Lyon, France
| | | | - Patrick Ray
- Service des Urgences, CHU de Dijon, faculté de médecine de Dijon, Dijon, France
| | - Mathieu Schmidt
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Pitié–Salpêtrière Hospital, Medical Intensive Care Unit, Sorbonne Universités, 75651 Paris Cedex 13, France
| | - Arnaud W. Thille
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | | | | | - Julien Vaux
- SAMU 94, CHU Henri Mondor, AP-HP, Créteil, France
| | - Damien Viglino
- INSERM, U1042, University of Grenoble-Alpes, HP2, 38000 Grenoble, France
- Service des Urgences Adultes, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Guillaume Voiriot
- Service de réanimation polyvalente, Hôpital Tenon, APHP, Paris, France
| | - Bénédicte Vrignaud
- Pediatric Emergency Department, Women and Children’, s University Hospital, Nantes, France
| | - Sandrine Jean
- Service de Réanimation Pédiatrique, APHP Hôpital Trousseau, 75012 Paris, France
| | - Eric Mariotte
- Service de Médecine Intensive Réanimation, APHP Hôpital Saint Louis, 75010 Paris, France
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Ono Y, Tanigawa K, Shinohara K, Yano T, Sorimachi K, Inokuchi R, Shimada J. Human and equipment resources for difficult airway management, airway education programs, and capnometry use in Japanese emergency departments: a nationwide cross-sectional study. Int J Emerg Med 2017; 10:28. [PMID: 28905252 PMCID: PMC5597568 DOI: 10.1186/s12245-017-0155-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 09/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although human and equipment resources, proper training, and the verification of endotracheal intubation are vital elements of difficult airway management (DAM), their availability in Japanese emergency departments (EDs) has not been determined. How ED type and patient volume affect DAM preparation is also unclear. We conducted the present survey to address this knowledge gaps. METHODS This nationwide cross-sectional study was conducted from April to September 2016. All EDs received a mailed questionnaire regarding their DAM resources, airway training methods, and capnometry use for tube placement. Outcome measures were the availability of: (1) 24-h in-house back-up; (2) key DAM resources, including a supraglottic airway device (SGA), a dedicated DAM cart, surgical airway devices, and neuromuscular blocking agents; (3) anesthesiology rotation as part of an airway training program; and (4) the routine use of capnometry to verify tube placement. EDs were classified as academic, tertiary, high-volume (upper quartile of annual ambulance visits), and urban. RESULTS Of the 530 EDs, 324 (61.1%) returned completed questionnaires. The availability of in-house back-up coverage, surgical airway devices, and neuromuscular blocking agents was 69.4, 95.7, and 68.5%, respectively. SGAs and dedicated DAM carts were present in 51.5 and 49.7% of the EDs. The rates of routine capnometry use (47.8%) and the availability of an anesthesiology rotation (38.6%) were low. The availability of 24-h back-up coverage was significantly higher in academic EDs and tertiary EDs in both the crude and adjusted analysis. Similarly, neuromuscular blocking agents were more likely to be present in academic EDs, high-volume EDs, and tertiary EDs; and the rate of routine use of capnometry was significantly higher in tertiary EDs in both the crude and adjusted analysis. CONCLUSIONS In Japanese EDs, the rates of both the availability of SGAs and DAM carts and the use of routine capnometry to confirm tube placement were approximately 50%. These data demonstrate the lack of standard operating procedures for rescue ventilation and post-intubation care. Academic, tertiary, and high-volume EDs were likely to be well prepared for DAM.
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Affiliation(s)
- Yuko Ono
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, Fukushima, 960-1295, Japan. .,Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan.
| | - Koichi Tanigawa
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, Fukushima, 960-1295, Japan.,Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, Japan
| | - Kazuaki Shinohara
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Tetsuhiro Yano
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, Fukushima, 960-1295, Japan
| | - Kotaro Sorimachi
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, Fukushima, 960-1295, Japan
| | - Ryota Inokuchi
- Department of General and Emergency Medicine, JR Tokyo General Hospital, Tokyo, Japan
| | - Jiro Shimada
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, Fukushima, 960-1295, Japan
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Ono Y, Sugiyama T, Chida Y, Sato T, Kikuchi H, Suzuki D, Ikeda M, Tanigawa K, Shinohara K. Association between off-hour presentation and endotracheal-intubation-related adverse events in trauma patients with a predicted difficult airway: A historical cohort study at a community emergency department in Japan. Scand J Trauma Resusc Emerg Med 2016; 24:106. [PMID: 27576447 PMCID: PMC5006537 DOI: 10.1186/s13049-016-0296-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/22/2016] [Indexed: 11/30/2022] Open
Abstract
Background A reduction in medical staff such as occurs in hospitals during nights and weekends (off hours) is associated with a worse outcome in patients with several unanticipated critical conditions. Although difficult airway management (DAM) requires the simultaneous assistance of several appropriately trained medical caregivers, data are scarce regarding the association between off-hour presentation and endotracheal intubation (ETI)-related adverse events, especially in the trauma population. The aim of this study was to determine whether off-hour presentation was associated with ETI complications in injured patients with a predicted difficult airway. Methods This historical cohort study was conducted at a Japanese community emergency department (ED). All patients with inhalation burn, comminuted facial trauma (Abbreviated Injury Scale Score Face ≥3), and penetrating neck injury who underwent ETI from January 2007 to January 2016 in our ED were included. Primary exposure was off-hour presentation, defined as the period from 6:01 PM to 8:00 AM weekdays plus the entire weekend. The primary outcome measure was the occurrence of an ETI-related adverse event, including hypoxemia, unrecognized esophageal intubation, regurgitation, cardiac arrest, ETI failure rescued by emergency surgical airway, cuff leak, and mainstem bronchus intubation. Results Of the 123 patients, 75 (61.0 %) were intubated during off hours. Crude analysis showed that off-hour presentation was significantly associated with an increased risk of ETI-related adverse events [odds ratio (OR), 2.5; 95 % confidence interval (CI), 1.1–5.6; p = 0.033]. The increased risk remained significant after adjusting for potential confounders, including operator being an anesthesiologist, use of a paralytic agent, and injury severity score (OR, 3.0; 95 % CI, 1.1–8.4; p = 0.034). Conclusions In this study, off-hour presentation was independently associated with ETI-related adverse events in trauma patients with a predicted difficult airway. These data imply the need for more attentive hospital care during nights and weekends. Electronic supplementary material The online version of this article (doi:10.1186/s13049-016-0296-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuko Ono
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan. .,Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Takuya Sugiyama
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Yasuyuki Chida
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Tetsuya Sato
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Hiroaki Kikuchi
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Daiji Suzuki
- Department of Head and Neck Surgery, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Masakazu Ikeda
- Department of Otolaryngology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Koichi Tanigawa
- Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Fukushima Global Medical Science Center, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kazuaki Shinohara
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
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Ono Y, Shinohara K, Goto A, Yano T, Sato L, Miyazaki H, Shimada J, Tase C. Are prehospital airway management resources compatible with difficult airway algorithms? A nationwide cross-sectional study of helicopter emergency medical services in Japan. J Anesth 2015; 30:205-14. [PMID: 26715428 PMCID: PMC4819484 DOI: 10.1007/s00540-015-2124-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/13/2015] [Indexed: 11/29/2022]
Abstract
Purpose
Immediate access to the equipment required for difficult airway management (DAM) is vital. However, in Japan, data are scarce regarding the availability of DAM resources in prehospital settings. The purpose of this study was to determine whether Japanese helicopter emergency medical services (HEMS) are adequately equipped to comply with the DAM algorithms of Japanese and American professional anesthesiology societies. Methods This nationwide cross-sectional study was conducted in May 2015. Base hospitals of HEMS were mailed a questionnaire about their airway management equipment and back-up personnel. Outcome measures were (1) call for help, (2) supraglottic airway device (SGA) insertion, (3) verification of tube placement using capnometry, and (4) the establishment of surgical airways, all of which have been endorsed in various airway management guidelines. The criteria defining feasibility were the availability of (1) more than one physician, (2) SGA, (3) capnometry, and (4) a surgical airway device in the prehospital setting. Results Of the 45 HEMS base hospitals questioned, 42 (93.3 %) returned completed questionnaires. A surgical airway was practicable by all HEMS. However, in the prehospital setting, back-up assistance was available in 14.3 %, SGA in 16.7 %, and capnometry in 66.7 %. No HEMS was capable of all four steps. Conclusion In Japan, compliance with standard airway management algorithms in prehospital settings remains difficult because of the limited availability of alternative ventilation equipment and back-up personnel. Prehospital health care providers need to consider the risks and benefits of performing endotracheal intubation in environments not conducive to the success of this procedure. Electronic supplementary material The online version of this article (doi:10.1007/s00540-015-2124-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuko Ono
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan. .,Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan.
| | - Kazuaki Shinohara
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Aya Goto
- Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tetsuhiro Yano
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Lubna Sato
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hiroyuki Miyazaki
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Jiro Shimada
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Choichiro Tase
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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