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Lakhal K, Dauvergne JE, Messet-Charriere H, Nay MA, Kamel T, Muller G, Robert-Edan V, Rozec B, Ehrmann S, Jacquier S, Boulain T. Risk factors for poor performance in finger cuff non-invasive monitoring of arterial pressure: A prospective multicenter study. Anaesth Crit Care Pain Med 2024; 43:101333. [PMID: 38048986 DOI: 10.1016/j.accpm.2023.101333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Compared to the invasive technique, non-invasive monitoring of arterial pressure favors easier and faster implementation while potentially sacrificing some reliability. This may be particularly true for the Clearsight™ system (Edwards Lifesciences), which enables continuous monitoring. We evaluated the risk factors for its poor performance. METHODS Patients with an arterial catheter and stable mean arterial pressure (MAP) over a 5-min period were included. Six pairs of invasive and Clearsight measurements of MAP were collected and the bias between the two techniques was calculated. Poor performance of the Clearsight™ system was defined as either a failure to measure and display MAP or displaying an erroneous MAP (individual bias > 5 mmHg). Fingertip perfusion was assessed using the plethysmographic perfusion index (PI) and the capillary refill time (CRT). RESULTS Among 152 ICU patients (MAP of 81 ± 14 mmHg, norepinephrine in 78 [51%]), 78 (51%) experienced a poor performance of the Clearsight™ system: failure to display MAP in 19 (13%) patients, and erroneous value displayed in 59 (44%). In multivariate analysis, PI ≤ 0.85% (adjusted odds ratio [aOR] = 2.94 [95% confidence interval (95%CI):1.34;6.45]), CRT > 4 s (aOR = 5.28 [95%CI 1.39;20.05]), and the presence of hand edema (aOR = 2.06 [95%CI 1.01;4.21]) were associated with a higher likelihood of poor performance. Cardiac arrhythmia (aOR = 1.39 [95%CI 0.64;3.02]) and other tested variables were not associated with poor performance. CONCLUSIONS Half of the included patients exhibited poor Clearsight™ system performance. Our results caution against using finger cuff arterial pressure monitoring in patients with low PI (≤0.85%), protracted CRT (>4 s), or hand edema. REGISTRATION ClinicalTrials.gov, NCT04269382, Dr. G. Muller, February 13, 2020. https://classic. CLINICALTRIALS gov/ct2/show/NCT04269382.
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Affiliation(s)
- Karim Lakhal
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France.
| | - Jérôme E Dauvergne
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France
| | | | - Mai-Anh Nay
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
| | - Toufik Kamel
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
| | - Grégoire Muller
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France; CRICS-TriggerSep F-CRIN research network, Tours, France; Université de Tours, EA4245, Transplantation, Immunologie, Inflammation, Tours, France
| | - Vincent Robert-Edan
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France
| | - Bertrand Rozec
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France; Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes F-44093, France
| | - Stephan Ehrmann
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France; CRICS-TriggerSep F-CRIN research network, Tours, France; INSERM, Centre d'étude des pathologies respiratoires, U1100 Tours, France; Université de Tours, Tours, France
| | - Sophie Jacquier
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France
| | - Thierry Boulain
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
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Zinzoni V, Planche L, Le Potier S, Robin L, Le Parco C, Terrat P, Leroyer MH, Atger R, Dauvergne JE, Muller L, Fontaine L, Morand C, Dennemont P, Paillard O, Vastral S, Dardaine B, Le Guillou S, Maquigneau N, Martin S, Lachérade JC. Impact of two endotracheal tube fixation on the incidence of peri-oral lesions: Elastic adhesive strips versus cord in a protective sheath. Study protocol for a cluster cross-over randomized trial. PLoS One 2024; 19:e0297349. [PMID: 38330026 PMCID: PMC10852271 DOI: 10.1371/journal.pone.0297349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Endotracheal tube fixation in ventilated patients must be appropriate to ensure security during mechanical ventilation and prevent skin lesions. The incidence of endotracheal tube-caused pressure ulcers ranges from 7% to 45%. Various endotracheal tube fixations are used in intensive care units (ICUs) worldwide. By pressure exercised on the skin, these systems could lead to mucosal and skin peri-oral lesions. The main objective of this study is to evaluate the impact of the two fixation systems most commonly used in French ICUs (adhesive elastic band versus fixation cord with PolyVinyl Chloride (PVC) sheath) on the incidence of these peri-oral skin lesions. METHODS This studyis a multicenter, open-label, controlled, superiority, cluster cross-over randomized trial. 768 patients will be recruited in the 16 ICUs involved. The inclusion of patients will be carried out over two 12-month periods. Each site begins with one of the evaluated fixation systems: elastic adhesive tape or cord associated with a protective sheath. After a 4-month break, each site switches to the other fixation system. The primary outcome is the development of at least one peri-oral lesion during the first ten days of maintaining an orally inserted endotracheal tube. The presence of lesions is assessed by a blinded adjudication committee using photographs taken daily. DISCUSSION This study is the first multicenter, randomized trial designed to evaluate the impact of elastic adhesive tape versus fixation cord with PVC sheath on the incidence of peri-oral lesions. The results will provide data which could change and standardize care practices. TRIAL REGISTRATION https://www.clinicaltrials.gov. Reference number: NCT04819425.
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Affiliation(s)
- Vanessa Zinzoni
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Lucie Planche
- Unité de Recherche Clinique, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Sophie Le Potier
- Service de Réanimation Polyvalente, Centre Hospitalier Bretagne Sud, Lorient, France
| | - Laurence Robin
- Service de Réanimation Polyvalente, Centre Hospitalier d’Angoulême, Angoulême, France
| | - Cécile Le Parco
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Philippe Terrat
- Service de Réanimation, Centre Hospitalier de La Rochelle, La Rochelle, France
| | - Marie-Hélène Leroyer
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier du Mans, Le Mans, France
| | - Romain Atger
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jérôme E. Dauvergne
- Service d’anesthésie-réanimation, INSERM, CIC 1413, Hôpital Laënnec, Nantes Université, CHU Nantes, Nantes, France
- Institut du Thorax, CNRS, INSERM, Nantes Université, CHU Nantes, Nantes, France
| | - Lucie Muller
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d’Orléans, Orléans, France
| | - Laetitia Fontaine
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier Intercommunal de Poissy/Saint Germain-en-Laye, Poissy, France
| | - Célina Morand
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Pascaline Dennemont
- Service de Réanimation Polyvalente, Centre Hospitalier Universitaire de la Réunion, Saint-Pierre, La Réunion, France
| | - Ophélie Paillard
- Service de Neuro-réanimation, Centre Hospitalier Universitaire de la Réunion, Saint-Pierre, La Réunion, France
| | - Servane Vastral
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint-Nazaire, Saint-Nazaire, France
| | - Baptiste Dardaine
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Sylvie Le Guillou
- Service Anesthésie-Réanimation Chirurgicale, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Natacha Maquigneau
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Stéphanie Martin
- Unité de Recherche Clinique, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Jean-Claude Lachérade
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
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Kamel T, Sauvage B, Lakhal K, Ottavy G, Janssen-Langenstein R, Jacquier M, Larrat C, Jacq G, Dauvergne JE, Maugars D, Labruyere M, Simeon V, Cugnart C, Girault C, Boulain T. The accuracy of intensive care nurses' interpretation of chest radiographs to recognise misplacement of endotracheal and nasogastric tubes after a single training session and comparison with residents' interpretation. Aust Crit Care 2023; 36:948-954. [PMID: 36872100 DOI: 10.1016/j.aucc.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/23/2022] [Accepted: 01/10/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Misplacements of endotracheal and nasogastric tubes are frequent encounters in critically ill patients. OBJECTIVES The purpose of this study was to assess the effectiveness of a single standardised training session on the ability of intensive care registered nurses (RNs) to recognise the misplacement of endotracheal and nasogastric tubes on bedside chest radiographs of patients in intensive care units (ICUs). METHODS In eight French ICUs, RNs received a 110-min standardised teaching on the position of endotracheal and nasogastric tubes on chest radiographs. Their knowledge was evaluated within the subsequent weeks. For 20 chest radiographs, each with an endotracheal and nasogastric tube, RNs had to indicate whether each tube was in the proper or incorrect position. Training success was defined as >90% for the lower bound of the 95% confidence interval (95% CI) of the mean correct response rate (CRR). Residents of the participating ICUs underwent the same evaluation (without prior specific training). RESULTS In total, 181 RNs were trained and evaluated and 110 residents were evaluated. The global mean CRR for RNs was 84.6% (95% CI: 83.3-85.9), significantly higher than for residents (81.4% [95% CI: 79.7-83.2]) (P < 0.0001). The mean CRR for RNs and residents was 95.9% (93.9-98.0) and 97.0% (94.7-99.3) for misplaced nasogastric tubes (P = 0.54), 86.8% (85.2-88.5) and 82.6% (79.4-85.7) (P = 0.07) for nasogastric tubes in the correct position, 86.6% (83.8-89.3) and 62.7% (57.9-67.5) for misplaced endotracheal tubes (P < 0.0001), and 79.1% (76.6-81.6) and 84.7% (82.1-87.2) for endotracheal tubes in the correct position (P = 0.01), respectively. CONCLUSIONS The ability of trained RNs to detect tube misplacement did not reach the predetermined arbitrary level, indicating training success. Their mean CRR was higher than that for residents and was considered satisfactory for detecting misplaced nasogastric tubes. This finding is encouraging but insufficient to ensure patient safety. Transferring responsibility for reading radiographs to detect the misplacement of endotracheal tubes to intensive care RNs will need a more advanced or more in-depth teaching method.
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Affiliation(s)
- Toufik Kamel
- Service de Médicine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14 Avenue de l'hôpital, 45100 Orléans, France; ED 393, Université de Paris, France.
| | - Brice Sauvage
- Service de Médicine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14 Avenue de l'hôpital, 45100 Orléans, France.
| | - Karim Lakhal
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes F-44093, France.
| | - Grégoire Ottavy
- Service de Médicine Intensive-Réanimation, CHU de Nantes, France.
| | | | - Marine Jacquier
- Service de Médecine Intensive et Réanimation CHU de Dijon, France.
| | - Charlotte Larrat
- Service de Médecine Intensive et Réanimation CHRU de Tours, France.
| | - Gwenaëlle Jacq
- Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Versailles, France.
| | - Jérôme E Dauvergne
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes F-44093, France.
| | - Diane Maugars
- Service de Médicine Intensive-Réanimation, CHU de Nantes, France.
| | - Marie Labruyere
- Service de Médecine Intensive et Réanimation CHU de Dijon, France.
| | - Véronique Simeon
- Service de Médecine Intensive et Réanimation CHRU de Tours, France.
| | - Cécile Cugnart
- Rouen University Hospital, Medical Intensive Care Unit, F-76000 Rouen, France.
| | - Christophe Girault
- Normandie Univ, UNIROUEN, EA 3830, Rouen University Hospital, Medical Intensive Care Unit, F-76000 Rouen, France.
| | - Thierry Boulain
- Service de Médicine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14 Avenue de l'hôpital, 45100 Orléans, France.
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Lakhal K, Dauvergne JE, Kamel T, Messet-Charriere H, Jacquier S, Robert-Edan V, Nay MA, Rozec B, Ehrmann S, Muller G, Boulain T. Noninvasive Monitoring of Arterial Pressure: Finger or Lower Leg As Alternatives to the Upper Arm: A Prospective Study in Three ICUs. Crit Care Med 2023; 51:1350-1362. [PMID: 37232853 DOI: 10.1097/ccm.0000000000005945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES When the upper arm is inaccessible for measurements of arterial pressure (AP), the best alternative site is unknown. We performed a between-site comparison of the agreement between invasive and noninvasive readings of AP taken at the lower leg, the finger, and the upper arm. The risk associated with measurement errors and the trending ability were also assessed. DESIGN Prospective observational study. SETTING Three ICUs. PATIENTS Patients having an arterial catheter and an arm circumference less than 42 cm. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Three triplicates of AP measurements were collected via an arterial catheter (reference AP), a finger cuff system (ClearSight; Edward Lifesciences, Irvine, CA), and an oscillometric cuff (at the lower leg then the upper arm). Trending ability was assessed through an additional set of measurements after a cardiovascular intervention. The default bed backrest angle was respected. Failure to measure and display AP occurred in 19 patients (13%) at the finger, never at other sites. In 130 patients analyzed, the agreement between noninvasive and invasive readings was worse at the lower leg than that observed at the upper arm or the finger (for mean AP, bias ± sd of 6.0 ± 15.8 vs 3.6 ± 7.1 and 0.1 ± 7.4 mm Hg, respectively; p < 0.05), yielding a higher frequency of error-associated clinical risk (no risk for 64% vs 84% and 86% of measurements, respectively, p < 0.0001). According to the International Organization for Standardization (ISO) 81060-2:2018 standard, mean AP measurements were reliable at the upper arm and the finger, not the lower leg. In 33 patients reassessed after a cardiovascular intervention, both the concordance rate for change in mean AP and the ability to detect a therapy-induced significant change were good and similar at the three sites. CONCLUSIONS As compared with lower leg measurements of AP, finger measurements were, when possible, a preferable alternative to upper arm ones.
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Affiliation(s)
- Karim Lakhal
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Jérôme E Dauvergne
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Toufik Kamel
- Service de médecine intensive-réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | | | - Sophie Jacquier
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France
| | - Vincent Robert-Edan
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Mai-Anh Nay
- Service de médecine intensive-réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
- Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes, France
| | - Stephan Ehrmann
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France
- CRICS-TriggerSep F-CRIN research network, Tours, France
- INSERM, Centre d'étude des pathologies respiratoires, Tours, France
- Université de Tours, Tours, France
| | - Grégoire Muller
- Service de médecine intensive-réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
- CRICS-TriggerSep F-CRIN research network, Tours, France
- Université de Tours, EA4245, Transplantation, Immunologie, Inflammation, Tours, France
| | - Thierry Boulain
- Service de médecine intensive-réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
- CRICS-TriggerSep F-CRIN research network, Tours, France
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5
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Dauvergne JE, Ferey K, Croizard V, Chauvin M, Mainguy N, Mathelier N, Jehanno A, Maugars N, Badre G, Maze F, Chartier M, Vastral S, Epain G, Baudiniere L, Ronceray M, Lebidan M, Flattres D, Ambrosi X. Prevalence, risk factors of the use of physical restraint and impact of a decision support tool: A before-and-after study. Nurs Crit Care 2023. [PMID: 37400076 DOI: 10.1111/nicc.12945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Physical restraint is frequently used in intensive care units to prevent patients' life-threatening removal of indwelling devices. In France, their use is poorly studied. Therefore, to evaluate the need for physical restraint, we have designed and implemented a decision support tool. AIMS Besides describing the prevalence of physical restraint use, this study aimed to assess whether the implementation of a nursing decision support tool had an impact on restraint use and to identify the factors associated with this use. STUDY DESIGN A large observational, multicentre study with a repeated one-day point prevalence design was conducted. All adult patients hospitalized in intensive care units were eligible for this study. Two study periods were planned: before (control period) and after (intervention period) the deployment of the decision support tool and staff training. A multilevel model was performed to consider the centre effect. RESULTS During the control period, 786 patients were included, and 510 were in the intervention period. The prevalence of physical restraint was 28% (95% CI: 25.1%-31.4%) and 25% (95% CI: 21.5%-29.1%) respectively (χ2 = 1.35; p = .24). Restraint was applied by the nurse and/or nurse assistant in 96% of cases in both periods, mainly to wrists (89% vs. 83%, p = .14). The patient-to-nurse ratio was significantly lower in the intervention period (1:3.0 ± 1 vs. 1:2.7 ± 0.7, p < .001). In multivariable analysis, mechanical ventilation was associated with physical restraint (aOR [95% CI] = 6.0 [3.5-10.2]). CONCLUSION The prevalence of physical restraint use in France was lower than expected. In our study, the decision support tool did not substantially impact physical restraint use. Hence, the decision support tool would deserve to be assessed in a randomized controlled trial. RELEVANCE TO CLINICAL PRACTICE The decision to physically restrain a patient could be protocolised and managed by critical care nurses. A regular evaluation of the level of sedation could allow the most deeply sedated patients to be exempted from physical restraint.
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Affiliation(s)
- Jérôme E Dauvergne
- Service d'anesthésie-réanimation, hôpital Laënnec, Centre hospitalier universitaire de Nantes, Nantes, Cedex, France
| | - Kim Ferey
- Service de réanimation polyvalente, Centre hospitalier de Blois, Blois, Cedex, France
| | - Véronique Croizard
- Service de réanimation chirurgicale, hôpital Trousseau, Centre hospitalier universitaire de Tours, Tours, Cedex, France
| | - Morgan Chauvin
- Service de réanimation chirurgicale, Centre hospitalier universitaire de Rennes, Rennes, Cedex, France
| | - Nolwenn Mainguy
- Service de réanimation polyvalente, Centre hospitalier bretagne-atlantique, Vannes, Cedex, France
| | - Noeline Mathelier
- Service d'anesthésie-réanimation chirurgicale et brûlés, Hôtel Dieu, Centre hospitalier universitaire de Nantes, Nantes, Cedex, France
| | - Anaëlle Jehanno
- Service de réanimation, Centre hospitalier bretagne sud, Lorient, Cedex, France
| | - Nadège Maugars
- Service de soins intensifs de pneumologie, hôpital Laënnec, Centre hospitalier universitaire de Nantes, Nantes, Cedex, France
| | - Gaëtan Badre
- Service de réanimation polyvalente, Centre hospitalier de Chartres, Chartres, France
| | - Françoise Maze
- Service de réanimation chirurgicale, Centre hospitalier universitaire de Brest, Brest, France
| | - Marie Chartier
- Service de réanimation chirurgicale, Centre hospitalier universitaire d'Angers, Angers, France
| | - Servane Vastral
- Service de réanimation polyvalente, Centre hospitalier de Saint Nazaire, Saint-Nazaire, France
| | - Graziella Epain
- Service de réanimation chirurgicale, Centre hospitalier universitaire de Poitiers, Poitiers, France
| | - Lucie Baudiniere
- Service de réanimation neurochirurgicale, Centre hospitalier universitaire de Poitiers, Poitiers, France
| | - Mathilde Ronceray
- Service de réanimation neurochirurgicale, hôpital Bretonneau, Centre hospitalier universitaire de Tours, Tours, Cedex, France
| | - Mathias Lebidan
- Service de réanimation chirurgie thoracique et cardio vasculaire, Centre hospitalier universitaire de Rennes, Rennes, Cedex, France
| | - Delphine Flattres
- Service d'anesthésie-réanimation chirurgicale et brûlés, Hôtel Dieu, Centre hospitalier universitaire de Nantes, Nantes, Cedex, France
| | - Xavier Ambrosi
- Service d'anesthésie-réanimation, hôpital Laënnec, Centre hospitalier universitaire de Nantes, Nantes, Cedex, France
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Baneton S, Dauvergne JE, Gouillet C, Cartron E, Volteau C, Nicolet J, Corne F, Rozec B. Effect of Active Physiotherapy With Positive Airway Pressure on Pulmonary Atelectasis After Cardiac Surgery: A Randomized Controlled Study. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00353-1. [PMID: 37331837 DOI: 10.1053/j.jvca.2023.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES The authors investigated the effect of active work with positive airway pressure (PAP) in addition to chest physiotherapy (CP) on pulmonary atelectasis (PA) in patients undergoing cardiac surgery with cardiopulmonary bypass. DESIGN A randomized controlled study. SETTING At a single-center tertiary hospital. PARTICIPANTS Eighty adult patients undergoing cardiac surgery (coronary artery bypass grafting, valve surgery, or both), and presenting with PA after tracheal extubation on postoperative days 1 or 2, were randomized from November 2014 to September 2016. INTERVENTION Three days of CP, twice daily, associated with active work with PAP effect (intervention group) versus CP alone (control group). Pulmonary atelectasis was assessed by using the radiologic atelectasis score (RAS) measured from daily chest x-rays. All radiographs were reviewed blindly. MEASUREMENTS AND MAIN RESULTS Among included patients, 79 (99%) completed the trial. The primary outcome was mean RAS on day 2 after inclusion. It was significantly lower in the intervention group (mean difference and 95% CI: -1.1 [-1.6 to -0.6], p < 0.001). The secondary outcomes were the sniff nasal inspiratory pressure measured before and after CP and clinical variables. Sniff nasal inspiratory pressure was significantly higher in the intervention group on day 2 (7.7 [3.0-12.5] cmH2O, p = 0.002). The respiratory rate was lower in the intervention group (-3.2 [95% CI -4.8 to -1.6] breaths/min, p < 0.001) on day 2. No differences were found between the 2 groups for percutaneous oxygen saturation/oxygen requirement ratio, heart rate, pain, and dyspnea scores. CONCLUSIONS Active work with the PAP effect, combined with CP, significantly decreased the RAS of patients undergoing cardiac surgery after 2 days of CP, with no differences observed in clinically relevant parameters.
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Affiliation(s)
- Serge Baneton
- Service de kinésithérapie, hôpital Laënnec, CHU Nantes, Nantes, France
| | - Jérôme E Dauvergne
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France; Nantes Université, CHU Nantes, Service d'Anesthésie Réanimation, hôpital Laënnec, INSERM CIC 0004 Immunologie et Infectiologie, Nantes, France
| | - Charlene Gouillet
- Service de kinésithérapie, hôpital Laënnec, CHU Nantes, Nantes, France
| | - Emmanuelle Cartron
- ECEVE UMR-S 1123, Faculté de santé, Université Paris Cité, Paris, France
| | - Christelle Volteau
- Nantes Université, CHU Nantes, Direction de la Recherche et de l'innovation, Plateforme de méthodologie et biostatistique, Nantes, France
| | - Johanna Nicolet
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Frederic Corne
- Service de soins intensifs de pneumologie, hôpital Laënnec, CHU Nantes, Nantes, France
| | - Bertrand Rozec
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France; Nantes Université, CHU Nantes, Service d'Anesthésie Réanimation, hôpital Laënnec, INSERM CIC 0004 Immunologie et Infectiologie, Nantes, France.
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Lakhal K, Dauvergne JE, Rozec B. Regulation of Tracheal Cuff Pressure: Get Connected, Stay Connected. Chest 2021; 160:e245. [PMID: 34366054 DOI: 10.1016/j.chest.2021.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Karim Lakhal
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Jérôme E Dauvergne
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France.
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France; Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes, France
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Dauvergne JE, Geffray AL, Asehnoune K, Rozec B, Lakhal K. Automatic regulation of the endotracheal tube cuff pressure with a portable elastomeric device. A randomised controlled study. Anaesth Crit Care Pain Med 2020; 39:435-441. [PMID: 32376293 DOI: 10.1016/j.accpm.2020.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/26/2020] [Accepted: 04/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intermittent manual correction of the endotracheal tube cuff pressure (Pcuff) may delay the detection of underinflation (source of contaminated oropharyngeal content microaspiration) or overinflation (exposing to airway damage). Devices for automated continuous correction of Pcuff are appealing but some are inconvenient, expensive or even harmful. This prospective randomised controlled study tested whether the tracoe Smart Cuff Manager™ reduced the rate of patients undergoing≥1 episode of underinflation (Pcuff<20 cmH2O), as compared with routine manual Pcuff correction. The rate of patients with≥1 overinflation episode (Pcuff>30 cmH2O) and the incidence of under/overinflation were also compared. METHODS Patients with acute brain injury and likely to receive invasive mechanical ventilation for>48h were randomly allocated to receive, during 48h, automated Pcuff correction (combined with manual correction) or manual correction alone. Pcuff was measured with a dedicated manual manometer, at least every 8h. RESULTS Sixty patients were included and randomised (32 patients with manual and 28 with automated Pcuff correction) for 506 measurements of Pcuff (269 and 237, respectively). Automated correction of Pcuff was associated with a lower rate of patients with≥1 episode of underinflation (63% and 18%, respectively, P<0.001), a lower incidence of underinflation episodes (15% vs. 2%; P<0.001), a lower rate of manual corrections (77% vs. 58%; P<0.001). For overinflation, there were no significant between-groups differences (2% vs. 2%). The incidence of early respiratory infections was similar in both groups (29% vs. 25%, P=0.78). CONCLUSIONS The adjunction of continuous Pcuff control with the Tracoe Smart Cuff Manager™ to routine manual intermittent correction reduced the incidence of Pcuff underinflation episodes without provoking overinflation. TRIAL REGISTRATION ClinicalTrials NCT03330379. Registered 6 November 2017, https://clinicaltrials.gov/ct2/show/NCT03330379.
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Affiliation(s)
- Jérôme E Dauvergne
- Service d'anesthésie-réanimation, hôpital Laënnec, centre hospitalier universitaire de Nantes, boulevard Jacques-Monod, Saint-Herblain, 44093 Nantes cedex 1, France.
| | - Anne-Laure Geffray
- Service d'anesthésie-réanimation, Hôtel-Dieu, centre hospitalier universitaire, 44093, Nantes, France
| | - Karim Asehnoune
- Service d'anesthésie-réanimation, Hôtel-Dieu, centre hospitalier universitaire, 44093, Nantes, France
| | - Bertrand Rozec
- Service d'anesthésie-réanimation, hôpital Laënnec, centre hospitalier universitaire de Nantes, boulevard Jacques-Monod, Saint-Herblain, 44093 Nantes cedex 1, France
| | - Karim Lakhal
- Service d'anesthésie-réanimation, hôpital Laënnec, centre hospitalier universitaire de Nantes, boulevard Jacques-Monod, Saint-Herblain, 44093 Nantes cedex 1, France.
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