1
|
Abraham P, Dubois N, Rimmelé T, Lilot M, Balança B. Enhancing perioperative care through decontextualized simulation: A game-changer for non-technical skills training. J Clin Anesth 2024; 94:111428. [PMID: 38422954 DOI: 10.1016/j.jclinane.2024.111428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Paul Abraham
- Department of Anesthesiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon. Claude Bernard University Lyon 1-Hospices Civils de Lyon, Lyon, France.
| | - Nadège Dubois
- Medical Simulation Center, Public Health Department, Liège University, Liège, Belgium
| | - Thomas Rimmelé
- Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon. Claude Bernard University Lyon 1-Hospices Civils de Lyon, Lyon, France; EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
| | - Marc Lilot
- Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon. Claude Bernard University Lyon 1-Hospices Civils de Lyon, Lyon, France; Unit of Pediatric and Congenital Cardio-thoracic Anesthesia and Intensive Care, Medical-Surgical Department of Congenital Cardiology of the Fœtus, Child and Adult. Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard University Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Baptiste Balança
- Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon. Claude Bernard University Lyon 1-Hospices Civils de Lyon, Lyon, France; Neurologic Intensive care and Anesthesiology, Hospices Civils de Lyon, Pierre Wertheimer Hospital and Claude Bernard University Lyon 1 - Neuroscience Research Center, Lyon, France
| |
Collapse
|
2
|
Le Saux O, Canada B, Debarnot U, Haouhache NEH, Lehot JJ, Binay M, Cortet M, Rimmelé T, Duclos A, Rode G, Lilot M, Schlatter S. Association of Personality Traits With the Efficacy of Stress Management Interventions for Medical Students Taking Objective Structured Clinical Examinations. Acad Med 2024:00001888-990000000-00815. [PMID: 38534105 DOI: 10.1097/acm.0000000000005714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
PURPOSE Personality traits are associated with psychophysiological stress, but few studies focus on medical students. This study aimed to better understand the association of personality traits with the efficacy of stress management interventions for medical students. METHOD A randomized controlled trial was conducted with fourth-year students who took the objective structured clinical examination at Bernard University Lyon 1 in December 2021. Students were randomized in cardiac biofeedback, mindfulness, and control groups. Each intervention was implemented for 6 minutes before the examination. Physiological stress levels were collected during the intervention. Psychological stress levels were rated by students at baseline and after the intervention. Personality traits were assessed via the Big-Five Inventory. Interactions between personality traits and the efficacy of the interventions were analyzed using multivariable linear regression models. RESULTS Four hundred eighty-one students participated. Higher baseline psychological stress levels were associated with higher neuroticism and agreeableness (β = 10.27, 95% confidence interval (CI) [7.40, 13.13], P < .001 and β = 3.42, 95% CI [0.98, 5.85], P = .006, respectively) and lower openness (β = -4.95, 95% CI [-7.40, -2.49], P < .001). As compared to the control intervention, both stress management interventions led to lower levels of psychological (P < .001 for both) and physiological stress levels (biofeedback: P < .001 and mindfulness: P = .009). Biofeedback efficacy varied by extraversion score for psychological (β = -5.66, 95% CI [-10.83, -0.50], P = .03) and physiological stress reduction (β = -0.002, 95% CI [-0.003, -0.00004], P = .045). Mindfulness efficacy varied by agreeableness score for psychological stress reduction (β = -7.87, 95% CI [-13.05, -2.68], P = .003). CONCLUSIONS Students with a high score in extraversion may benefit more from biofeedback interventions, while students with high scores in agreeableness may benefit more from mindfulness interventions.
Collapse
|
3
|
Schmidt L, Zabelberg S, Schlatter S, Adams I, Douplat M, Perchet C, Lilot M, Rey AE, Mazza S. The impact of shift work on pain recognition, a robust ability among intensive care nurses. Eur J Pain 2023; 27:1203-1215. [PMID: 37434490 DOI: 10.1002/ejp.2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Pain empathy is essential for high-quality of care. The cognitive ability to identify and understand the pain in others remains underexplored in the context of hospital shift work. This study aimed to observe the early subliminal ability to detect pain in other faces and to investigate pain intensity evaluations during day and night shifts. METHODS Twenty-one nurses (31 ± 7 years, 20 women) from cardio-paediatric intensive care participated in this study. Eighteen nurses completed all testing in the morning and evening hours, before and after the 12-hour day and night shift. In the first test, the nurses had to decide if facial stimuli presented subliminally showed pain or not. During the second test, they consciously determined the intensity of the painful faces on a numerical scale. Sleep, sleepiness and empathy were also measured. RESULTS Recognition accuracy and pain sensitivity remained stable over time, only sensitivity increased following the work shift (F(1,15) = 7.10, p = 0.018). Intensity ratings remained stable. Sleepiness at the end of the night shift was negatively correlated with accuracy (ρ = -0.51, p = 0.018) and positively correlated with prior night shifts (ρ = -0.50, p = 0.022). CONCLUSION The judgement of facial pain expressions seems robust across shift types, only individual factors such as sleepiness interfere with pain recognition. Pain sensitivity may be enhanced during working hours. SIGNIFICANCE STATEMENT Some professions need to know how to assess pain 24/7 and a lack of sleep can disrupt the cognitive processes necessary for this assessment. Night shifts provoke a bias in pain management, and sleep deprivation, a decrease in pain evaluation. By conducting a repeated measure study in the field that applied a different paradigm (subliminal recognition of facial cues) we add evidence to the understanding of pain recognition and the impact of sleep deprivation on the early processing of pain in others.
Collapse
Affiliation(s)
- Laura Schmidt
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
| | | | - Sophie Schlatter
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
- Université Claude Bernard Lyon 1, Centre Lyonnais d'enseignement par la simulation en Santé, CLESS, SimuLyon, Lyon, France
| | - Inga Adams
- Universität zu Köln, Psychologie, Cologne, Germany
| | - Marion Douplat
- Hospices Civils de Lyon, Département des Urgences, Hôpital Lyon Sud, Lyon, France
| | - Caroline Perchet
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
| | - Marc Lilot
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
- Université Claude Bernard Lyon 1, Centre Lyonnais d'enseignement par la simulation en Santé, CLESS, SimuLyon, Lyon, France
- Hospices Civils de Lyon, Département d'Anesthésie-Réanimation, Hôpital Louis Pradel, Groupement Hospitalier Est, Lyon, France
| | - Amandine Eve Rey
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
| | - Stéphanie Mazza
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
| |
Collapse
|
4
|
Koca A, Schlatter S, Delas Q, Denoyel L, Lehot JJ, Lilot M, Rimmelé T. Influence of the embedded participant on learners' performance during high-fidelity simulation sessions in healthcare. BMC Med Educ 2023; 23:751. [PMID: 37821900 PMCID: PMC10568852 DOI: 10.1186/s12909-023-04724-0] [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] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The embedded participant (EP) plays a key role during a full scale/high-fidelity simulation (HFS) session. He/she is expected to guide the learner towards the achievement of the educational objectives of the scenario. However, his/her influence on learners' performance stands undetermined and this effect remains briefly addressed in the literature. This study primarily aims to assess whether the EP could have an influence on the performance of the learner during a HFS scenario. The secondary aim was to establish an inventory of the EP practices in France. METHODS This retrospective study was conducted in Lyon Claude Bernard University Health Simulation Centre (France). Anaesthesia and critical care residents in postgraduate years 1 to 5 who were scheduled for their HFS sessions during the 2016 to 2021 academic years were included. Two investigators independently evaluated the resident performance regarding both technical and non-technical skills from video recordings. In addition, a nationwide survey was sent out by email through the networks of the Francophone Healthcare Simulation Society (SoFraSimS, Société Francophone de Simulation en Santé) to collect information on EP practices in French-speaking Simulation centres. RESULTS From a total of 344 HFS videos analysed, a cohort of 19 experienced EPs was identified. The EPs had an influence on the technical and non-technical performances of the learners. The 147 responses to the survey showed that predefined rules of EP good practice existed in only 36% of the simulation centres and 65% of respondents believed that specific EP training would be justified. CONCLUSION The EP can exert an influence on the performance of the learners during HFS. For acting as an EP, a great variability of practices and a lack of training are reported by professionals working in simulation centres. These results suggest that more attention must be paid to EP training and attitudes during simulation, especially if summative simulations are extensively developed.
Collapse
Affiliation(s)
- Ayça Koca
- Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Turkey.
| | - Sophie Schlatter
- Claude Bernard Lyon 1 University, Hospices Civils de Lyon, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Quentin Delas
- Claude Bernard Lyon 1 University, Hospices Civils de Lyon, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon, Lyon, France
- Department of Anaesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Lucas Denoyel
- Claude Bernard Lyon 1 University, Hospices Civils de Lyon, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon, Lyon, France
| | - Jean-Jacques Lehot
- Claude Bernard Lyon 1 University, Hospices Civils de Lyon, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
- Department of Anaesthesiology and Critical Care Medicine, Louis Pradel Hospital, Hospices Civils de Lyon, Groupement Hospitalier Est, Lyon, France
| | - Marc Lilot
- Claude Bernard Lyon 1 University, Hospices Civils de Lyon, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
- Department of Anaesthesiology and Critical Care Medicine, Louis Pradel Hospital, Hospices Civils de Lyon, Groupement Hospitalier Est, Lyon, France
| | - Thomas Rimmelé
- Claude Bernard Lyon 1 University, Hospices Civils de Lyon, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon, Lyon, France
- Department of Anaesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
- Pathophysiology of Injury-Induced Immunosuppression (Pi3, Claude Bernard Lyon 1 University-Biomerieux-Hospices Civils de Lyon, Lyon, 7426, EA, France
| |
Collapse
|
5
|
Buléon C, Minehart RD, Rudolph JW, Blanié A, Lilot M, Picard J, Plaud B, Pottecher J, Benhamou D. Strategy to Develop a Common Simulation Training Program: Illustration with Anesthesia and Intensive Care Residency in France. Teach Learn Med 2023; 35:537-549. [PMID: 36251797 DOI: 10.1080/10401334.2022.2127730] [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] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
Phenomenon: The urgency of having fair and trustworthy competency-based assessment in medical training is growing. Simulation is increasingly recognized as a potent method for building and assessing applied competencies. The growing use of simulation and its application in summative assessment calls for comprehensive and rigorously designed programs. Defining the current baseline of what is available and feasible is a crucial first step. This paper uses anesthesia and intensive care (AIC) in France as a case study in how to document this baseline. Approach: An IRB-approved, online anonymous closed survey was submitted to AIC residency program directors and AIC simulation program directors in France from January to February 2021. The researcher-developed survey consisted of 65 questions across five sections: centers' characteristics, curricular characteristics, courses' characteristics, instructors' characteristics, and simulation perceptions and perspectives. Findings: The participation rate was 31/31 (100%) with 29 centers affiliated with a university hospital. All centers had AIC simulation activities. Resident training was structured in 94% of centers. Simulation uses were training (100%), research and development (61%), procedural or organizational testing (42%), and summative assessment (13%). Interprofessional full-scale simulation training existed in 90% of centers. Procedural training on simulators prior to clinical patients' care was performed "always" in 16%, "most often" in 45%, "sometimes" in 29% and "rarely" or "not" in 10% of centers. Simulated patients were used in 61% of centers. Main themes were identified for procedural skills, full-scale and simulated patient simulation training. Simulation activity was perceived as increasing in 68% of centers. Centers expressed a desire to participate in developing and using a national common AIC simulation program. Insights: Based on our findings in AIC, we demonstrated a baseline description of nationwide simulation activities. We now have a clearer perspective on a decentralized approach in which individual institutions or regional consortia conduct simulation for a discipline in a relatively homogeneous way, suggesting the feasibility for national guidelines. This approach provides useful clues for AIC and other disciplines to develop a comprehensive and meaningful program matching existing expectations and closing the identified gaps.
Collapse
Affiliation(s)
- Clément Buléon
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Caen Normandy University Hospital, Caen, France
- Medical School, University of Caen Normandy, Caen, France
- Center for Medical Simulation, Boston, MA, USA
| | - Rebecca D Minehart
- Center for Medical Simulation, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jenny W Rudolph
- Center for Medical Simulation, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Antonia Blanié
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Kremlin Bicêtre University Hospital, APHP, Paris, France
| | - Marc Lilot
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Edouard Herriot University Hospital, HCL, Lyon, France
| | - Julien Picard
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Grenoble University Hospital, Grenoble, France
| | - Benoît Plaud
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Saint-Louis University Hospital, APHP, Paris, France
| | - Julien Pottecher
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Dan Benhamou
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Kremlin Bicêtre University Hospital, APHP, Paris, France
| |
Collapse
|
6
|
Schwindenhammer V, Rimmelé T, Duclos A, Haesebaert J, Lilot M, Abraham P. A new standardized tool for quantification of closed-loop communication in trauma care: CAST Grid reliability study. Injury 2023; 54:110851. [PMID: 37336655 DOI: 10.1016/j.injury.2023.110851] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/11/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
BACKROUND The CAST Grid has been developed to evaluate the use of closed-loop communication (CLC) in the trauma bay. METHODS The CAST Grid and two validated non-technical team performance assessment tools (the TEAM and T-NOTECHS grids) were completed by 2 independent reviewers based on trauma care simulation videos from a French Level 1 trauma center. Intra- and inter-rater agreements were evaluated for CLC parameters and non-technical performance, and correlations between these parameters were analyzed. RESULTS The study analyzed 11 videos. The intra- and inter-rater agreement for the number of CLC per minute (CLC/min) was moderate and good, respectively, based on Lin's concordance correlation coefficient [95%CI] (0.57 [-0.40;0.94] and 0.77 [0.33;0.94]). However, the agreement was poor for the percentage of CLC (0.37 [-0.58;0.89] and -0.36 [-0.71;0.14], respectively). The study found that a lower number of CLC/min was correlated with an increased duration of the simulation (r = -0.75 [-0.93; -0.25]). CONCLUSION The CAST Grid showed a relatively good inter-rater agreement to quantify the number of CLC/min which was inversely correlated with the duration of care. This tool opens up the possibility of quantifying CLC and allows for new analyses of team functioning and interactions.
Collapse
Affiliation(s)
- Victor Schwindenhammer
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire Grenoble - Alpes, La Tronche, France; Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Lyon, France.
| | - Thomas Rimmelé
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Lyon, France; EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France; Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Antoine Duclos
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Lyon 1, CEDEX 08, F-69373 Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Lyon 1, CEDEX 08, F-69373 Lyon, France; Pôle Santé Publique, Service d'épidémiologie et de recherche clinique, F-69003, Hospices Civils de Lyon, Lyon, France
| | - Marc Lilot
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Lyon, France; Research on Healthcare Performance RESHAPE, INSERM U1290, Université Lyon 1, CEDEX 08, F-69373 Lyon, France; Hospices Civils de Lyon, Department of paediatric cardio-thoracic anesthesia and intensive care, Louis Pradel Hospital, Lyon, France
| | - Paul Abraham
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Lyon, France; Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Suisse
| |
Collapse
|
7
|
Lilot M, Jacquet-Lagreze M, Dadure C. Hemodynamic optimization in pediatrics: it’s time to grow up. Anaesth Crit Care Pain Med 2023; 42:101222. [PMID: 37004740 DOI: 10.1016/j.accpm.2023.101222] [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: 03/18/2023] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Marc Lilot
- Hospices Civils de Lyon, Department of Anaesthesia and Intensive Paediatric Cardio-thoracic Care, Hôpital Louis Pradel, Lyon, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, Research on Healthcare Performance, INSERM U1290, Centre Lyonnais d'Enseignement par Simulation en Santé, SIMULYON, France
| | - Matthias Jacquet-Lagreze
- Service d'anesthésie-réanimation, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, CarMeN Laboratoire, Inserm UMR 1060, Lyon, France
| | - Christophe Dadure
- Service d'Anesthésie Réanimation Femme-Mère-Enfant, CHU Lapeyronie, Université de Montpellier, Institut de Génomique Fonctionnelle, UMR 5203 CNRS - U 1191 INSERM, Montpellier, France.
| |
Collapse
|
8
|
Paraschiv AP, Balança B, Lilot M, Aigle L, Lehot JJ, Cejka JC. Use of a Digital Cognitive Aid Improves Memorization of Military Caregivers After High-Fidelity Simulations of Combat Casualty Care. Mil Med 2023; 188:e295-e300. [PMID: 33928372 DOI: 10.1093/milmed/usab175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/29/2021] [Accepted: 04/19/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION High-fidelity simulation is widely used in the ongoing education of caregivers. However, the complex high-stakes simulated crisis environment affects memorization. This study investigated whether participants would remember more key training messages 3 months after a simulated complex emergency situation if they had used a digital cognitive aid (CA) during the simulations. MATERIALS AND METHODS This randomized controlled trial was performed during a combat casualty training course for military physicians and nurses. Each pair of care providers completed two scenarios randomized to be undertaken either with or without a digital CA. At the end of each debriefing, instructors gave five scenario-specific key messages aloud. Three months later, learners were asked to recall the messages from their two scenarios and were scored for each scenario. The primary endpoint was the number of key messages recalled. The secondary endpoints were the influence on the results of the profession and the scenario block and age of the leader. RESULTS Thirty-six pairs of participants were included. Due to operational constraints, only 34 completed the study. The use of the digital CA was associated with a positive effect on memorization at 3 months (F = 82.2, P < .001), unrelated to the leader's profession, age, or the scenario block. The median of the memorization scores was 2/5 [1-3] with the digital CA and 1/5 [1-1] without it, which represents a difference of one memorized element (95% CI, 1-2; η2 = 0.39). CONCLUSIONS The digital CA allowed learners to remember twice as many key elements 3 months after simulated training of medical care for military combat casualties. A dedicated digital CA might be an asset for better care in a combat environment and for learning and memorizing critical care procedures following complex emergency situations.
Collapse
Affiliation(s)
- Andrei-Petru Paraschiv
- 154th Medical Unit, 1st Foreign Regiment, Aubagne, BP 21355-13784, France.,Health Services and Performance Research Lab (EA7425 HESPER), Claude-Bernard Lyon 1 University, Rhône, Villeurbanne 69100, France
| | - Baptiste Balança
- Research on Healthcare Performance RESHAPE, INSERM U1290, Claude-Bernard Lyon1 University, Lyon, France.,Department of Anesthesia and Intensive Care Medicine, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Rhône, Bron 69500, France.,Lyon Neuroscience Research Center, Bron 69500, France
| | - Marc Lilot
- Health Services and Performance Research Lab (EA7425 HESPER), Claude-Bernard Lyon 1 University, Rhône, Villeurbanne 69100, France.,Research on Healthcare Performance RESHAPE, INSERM U1290, Claude-Bernard Lyon1 University, Lyon, France.,Department of Anesthesia and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, Rhône 69003, France
| | - Luc Aigle
- 154th Medical Unit, 1st Foreign Regiment, Aubagne, BP 21355-13784, France.,Val-de-Grâce School Paris cedex 75230, France
| | - Jean-Jacques Lehot
- Health Services and Performance Research Lab (EA7425 HESPER), Claude-Bernard Lyon 1 University, Rhône, Villeurbanne 69100, France.,Research on Healthcare Performance RESHAPE, INSERM U1290, Claude-Bernard Lyon1 University, Lyon, France.,Department of Anesthesia and Intensive Care Medicine, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Rhône, Bron 69500, France
| | - Jean-Christophe Cejka
- Research on Healthcare Performance RESHAPE, INSERM U1290, Claude-Bernard Lyon1 University, Lyon, France.,Department of Anesthesia and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, Rhône 69003, France
| |
Collapse
|
9
|
Cortet M, Lilot M, Rode G. OSCEs for ranking medical students. Med Teach 2022; 44:1424-1425. [PMID: 35293834 DOI: 10.1080/0142159x.2022.2033712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Marion Cortet
- Service de Gynécologie-Obstétrique, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- LabTAU, INSERM U 1132, Université Lyon 1, Lyon, France
- Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
| | - Marc Lilot
- Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
- Univ. Lyon, UCBL-Lyon 1, Research on Healthcare Performance (RESHAPE) INSERM U1290 and medical simulation centre (CLESS), SAMSEI, Lyon, France
- Hospices Civils de Lyon, Departments of Anaesthesia and Intensive Care, Lyon, France
| | - Gilles Rode
- Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
- Service de Médecine et Réadaptation, Hôpital Henri Gabrielle, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
10
|
Favre-Félix J, Dziadzko M, Bauer C, Duclos A, Lehot JJ, Rimmelé T, Lilot M. High-Fidelity Simulation to Assess Task Load Index and Performance: A Prospective Observational Study. Turk J Anaesthesiol Reanim 2022; 50:282-287. [PMID: 35979975 PMCID: PMC9524413 DOI: 10.5152/tjar.2022.21234] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jérémy Favre-Félix
- Lyonnais Center for Education by Simulation in Health, Claude Bernard Lyon 1 University, SAMSEI, Lyon, France
- Department of Anaesthesiology and Reanimation, Hospices Civils de Lyon, Croix Rousse Hospital, Lyon, France
| | - Mikhail Dziadzko
- Department of Anaesthesiology and Reanimation, Hospices Civils de Lyon, Croix Rousse Hospital, Lyon, France
| | - Christian Bauer
- Lyonnais Center for Education by Simulation in Health, Claude Bernard Lyon 1 University, SAMSEI, Lyon, France
- Department of Anaesthesiology and Reanimation, Hospices Civils de Lyon, Croix Rousse Hospital, Lyon, France
| | - Antoine Duclos
- Department of Health Data, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, France
- Research on Healthcare Performance (RESHAPE), Claude Bernard Lyon 1 University, Lyon, France
| | - Jean-Jacques Lehot
- Lyonnais Center for Education by Simulation in Health, Claude Bernard Lyon 1 University, SAMSEI, Lyon, France
- Research on Healthcare Performance (RESHAPE), Claude Bernard Lyon 1 University, Lyon, France
- Department of Anaesthesiology and Reanimation, Hospices Civils de Lyon, Pierre Wertheimer Hospital, Lyon, France
| | - Thomas Rimmelé
- Lyonnais Center for Education by Simulation in Health, Claude Bernard Lyon 1 University, SAMSEI, Lyon, France
- Department of Anaesthesia and Reanimation, Hospices Civils de Lyon, Edouard Herriot Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Marc Lilot
- Lyonnais Center for Education by Simulation in Health, Claude Bernard Lyon 1 University, SAMSEI, Lyon, France
- Research on Healthcare Performance (RESHAPE), Claude Bernard Lyon 1 University, Lyon, France
- Department of Anaesthesia, Hospices Civils de Lyon, Woman Mother Child Hospital, Lyon, France
- Corresponding author: Marc Lilot, e-mail:
| |
Collapse
|
11
|
Calmettes M, Denoyel L, Duclos A, Lejus-Bourdeau C, Blanié A, Forestier C, Ciceron F, Mattatia L, Buleon C, Damm C, Mahoudeau G, Lehot JJ, Rimmelé T, Lilot M. Change in Sleep Quality of Residents the Night Before High-Fidelity Simulation: Results From a Prospective 1-Year National Survey. Turk J Anaesthesiol Reanim 2022; 50:295-302. [PMID: 35979977 PMCID: PMC9524411 DOI: 10.5152/tjar.2022.21235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: The stress level of participants in high-fidelity simulation stems from various factors but may result in anticipatory anxiety causing sleep disturbances during the night prior to simulation. The objective of this survey was to determine the change in sleep quality of residents during the night prior to the simulation. Methods: The survey was proposed for 1 year to all residents at the beginning of the simulation, in 10 simulation centres. The questionnaire combined demographics and the Leeds Sleep Evaluation Questionnaire using visual analogue scales divided into 4 sleep qualitative domains. The primary outcome was the prevalence of sleep disturbance (>10 mm on 1 domain). Secondary outcomes were the prevalence of severe sleep disturbance (>25 mm), as well as qualitatively and quantitatively reported explanatory sleep parameters. Results: Among respondents, 66% [95% CI: 63 to 69] of residents had more than 10 mm and 27% [95% CI: 24 to 30] had more than 25 mm of sleep disturbance. Residents with a sleep disturbance of more than 10 mm had fewer hours of sleep (6.4 [standard deviation = 1.8] vs 7.3 [standard deviation = 1.3], difference: −0.9 [95% CI: −1.1 to −0.7]; P < .0001), with a higher number of night-time awakenings (1.3 [standard deviation = 1.5] vs 0.7 [standard deviation = 0.9], difference: 0.6 [95% CI: 0.4 to 0.8]; P < .0001). Conclusion: Among residents participating in the simulation, a high prevalence of change in sleep quality during the night before the simulation was noted. Strategies to help residents achieve better sleep prior to simulation should be explored.
Collapse
Affiliation(s)
- Marion Calmettes
- Department of Anaesthesiology and Reanimation, Hospices Civils de Lyon, Lyon, France
| | - Lucas Denoyel
- Lyonnais Center for Education by Simulation in Health, Claude Bernard Lyon 1 University, SAMSEI, Lyon, France
| | - Antoine Duclos
- Department of Health Data, Hospices Civils de Lyon, Lyon, France
- Research on Healthcare Performance (RESHAPE), Claude Bernard Lyon 1 University, Lyon, France
| | - Corinne Lejus-Bourdeau
- Department of Anaesthesia and Surgical Resuscitation, Hôtel Dieu, Nantes University Hospital, Nantes, France
| | - Antonia Blanié
- Department of Anaesthesiology and Surgical Resuscitation, CHU Bicêtre LabForSIMS Faculty of Medicine, Paris-Sud, Le Kremlin Bicêtre, France
| | - Caroline Forestier
- CEnSIM Savoie Emergency Care - Savoie Simulation Education Center, Savoie Metropole Hospital Center, France
| | | | - Laurent Mattatia
- Department of Anaesthesia, Reanimation and Pain Emergency, SIMHU-Nîmes Medical Simulation Center, Carémeau Hospital Group, Nîmes University Hospital, France
| | - Clément Buleon
- Normandy Health Simulation Center (NorSimS), Caen University Hospital, France
| | - Cédric Damm
- Emergency Care Teaching Center, CESU, University Hospital Center of Rouen, France
| | - Gilles Mahoudeau
- UNISIMES European Health Simulation Unit, Strasbourg University Faculty of Medicine, France
| | - Jean-Jacques Lehot
- Department of Anaesthesiology and Reanimation, Hospices Civils de Lyon, Lyon, France
- Lyonnais Center for Education by Simulation in Health, Claude Bernard Lyon 1 University, SAMSEI, Lyon, France
- Research on Healthcare Performance (RESHAPE), Claude Bernard Lyon 1 University, Lyon, France
| | - Thomas Rimmelé
- Department of Anaesthesiology and Reanimation, Hospices Civils de Lyon, Lyon, France
- Lyonnais Center for Education by Simulation in Health, Claude Bernard Lyon 1 University, SAMSEI, Lyon, France
- University of Claude Bernard Lyon 1-Bio mericux-Hospices Civils de Lyon, Lyon, France
| | - Marc Lilot
- Department of Anaesthesiology and Reanimation, Hospices Civils de Lyon, Lyon, France
- Lyonnais Center for Education by Simulation in Health, Claude Bernard Lyon 1 University, SAMSEI, Lyon, France
- Research on Healthcare Performance (RESHAPE), Claude Bernard Lyon 1 University, Lyon, France
- Corresponding author: Marc Lilot, e-mail:
| |
Collapse
|
12
|
Torfs A, Chardonnal L, Meunier S, Désage S, Henaine R, Lilot M. Perioperative hemostatic management of a newborn with hereditary hemophilia A and emergent surgery for dextro-transposition of the great arteries. J Cardiothorac Vasc Anesth 2022; 36:3855-3858. [DOI: 10.1053/j.jvca.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 11/11/2022]
|
13
|
Paraschiv AP, Cejka JC, Lilot M, Aigle L, Lehot JJ, Balança B. Impact of a Digital Cognitive Aid on the Performance of Military Healthcare Teams During Critical Care Management in a Warfront Injury Situation: A Simulation Randomized Controlled Study. Simul Healthc 2022; 17:163-169. [PMID: 34934026 DOI: 10.1097/sih.0000000000000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Initial healthcare delivery after warfront injury is unpredictably challenging for military forces. As preparatory training, healthcare providers use simulation to improve their performance in stressful critical situations. This study investigated whether a digital CA held by the team leader improved performance in simulated combat casualty care. METHODS This randomized controlled trial was performed during a combat casualty training course for military physicians and nurses in France. Each pair of care providers completed 2 scenarios randomized to be undertaken either with or without a digital CA. The primary end point was the technical performance evaluated from a video recording by 2 independent raters using a pre-established score grid (up to 100%) according to military protocols. The secondary end point was the nontechnical performance (TEAM scale, maximum: 54 points). RESULTS Thirty-six pairs of participants were included. Use of the digital CA improved both technical (74% vs 53%, P < 0.001) and nontechnical (42 vs 32, P < 0.001) performance. CONCLUSIONS The digital CA improved technical and nontechnical performance during training of medical care for military combat casualties. Use of a dedicated digital CA might improve care in a combat environment. STUDY TYPE This study is a randomized controlled trial.
Collapse
Affiliation(s)
- Andrei-Petru Paraschiv
- From the 154th Medical Unit (A.-P.P., L.A.), 1st Foreign Regiment, Quartier Vienot, Aubagne Cedex; Department of Anesthesia and Intensive Care Medicine (J.-C.C., M.L.), Hospices Civils de Lyon (J.-C.C., M.L., J.-J.L., B.B.), Edouard Herriot Hospital, Lyon; Lyon Health Simulation Center, Claude-Bernard Lyon1 University, Villeurbanne; Val-de-Grâce School (L.A.), Paris Cedex; Department of Anesthesia and Intensive Care Medicine (J.-J.L., B.B.), Pierre Wertheimer Hospital, Bron; Research on Healthcare Performance RESHAPE (A.-P.P., J.-C.C., M.L., J.-J.L.), INSERM U1290, Claude-Bernard Lyon1 University, Lyon; and Lyon Neuroscience Research Center (B.B.), Bron, France
| | | | | | | | | | | |
Collapse
|
14
|
Jacquet-Lagrèze M, Acker A, Hentzen J, Didier C, De Lamer S, Chardonnal L, Bouhamri N, Portran P, Schweizer R, Lilot M, Fellahi JL. Preload Dependence Fails to Predict Hemodynamic Instability During a Fluid Removal Challenge in Children. Pediatr Crit Care Med 2022; 23:296-305. [PMID: 35190504 DOI: 10.1097/pcc.0000000000002906] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Fluid overload increases morbidity and mortality in PICU patients. Active fluid removal improves the prognosis but may worsen organ dysfunction. Preload dependence in adults does predict hemodynamic instability induced by a fluid removal challenge (FRC). We sought to investigate the diagnostic accuracy of dynamic and static markers of preload in predicting hemodynamic instability and reduction of stroke volume during an FRC in children. We followed the Standards for Reporting of Diagnostic Accuracy statement to design conduct and report this study. DESIGN Prospective noninterventional cohort study. SETTINGS From June 2017 to April 2019 in a pediatric cardiac ICU in a tertiary hospital. PATIENTS Patients 8 years old or younger, with symptoms of fluid overload after cardiac surgery, were studied. INTERVENTIONS We confirmed preload dependence by echocardiography before and during a calibrated abdominal compression test. We then performed a challenge to remove 10-mL/kg fluid in less than 120 minutes with an infusion of diuretics. Hemodynamic instability was defined as a decrease of 10% of mean arterial pressure. MEASUREMENT AND MAIN RESULTS We compared patients showing hemodynamic instability with patients remaining stable, and we built receiver operative characteristic (ROC) curves. Among 58 patients studied, 10 showed hemodynamic instability. The area under the ROC curve was 0.55 for the preload dependence test (95% CI, 0.34-0.75). Using a threshold of 10% increase in stroke volume index (SVi) during calibrated abdominal compression, the specificity was 0.30 (95% CI, 0.00-0.60) and the sensitivity was 0.77 (95% CI, 0.65-0.88). Mean arterial pressure variation and SVi variation were not correlated during fluid removal; r = 0.19; 95% CI -0.07 to 0.43; p = 0.139. CONCLUSIONS Preload dependence is not accurate to predict hemodynamic instability during an FRC. Our data do not support a reduction in intravascular volume being mainly responsible for the reduction in arterial pressure during an FRC in children.
Collapse
Affiliation(s)
- Matthias Jacquet-Lagrèze
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
- Laboratoire de recherche en Cardiovasculaire, Métabolisme, diabétologie et Nutrition (CarMeN), Inserm U1060, Lyon, France
- Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, Lyon, France
| | - Amélie Acker
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Julie Hentzen
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Capucine Didier
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Sabine De Lamer
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Laurent Chardonnal
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Noureddine Bouhamri
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Philippe Portran
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Rémi Schweizer
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Marc Lilot
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
- Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, Lyon, France
| | - Jean-Luc Fellahi
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
- Laboratoire de recherche en Cardiovasculaire, Métabolisme, diabétologie et Nutrition (CarMeN), Inserm U1060, Lyon, France
- Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, Lyon, France
| |
Collapse
|
15
|
Michel N, Bui-Xuan B, Bapteste L, Rimmele T, Lilot M, Chollet F, Favre H, Duclos A, Michel P. Implementation of an in situ simulation-based training adapted from Morbidity and Mortality conference cases: effect on the occurrence of adverse events-study protocol of a cluster randomised controlled trial. Trials 2022; 23:106. [PMID: 35109900 PMCID: PMC8812171 DOI: 10.1186/s13063-022-06040-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Morbidity and Mortality conference provides the necessary improvement measures for patient safety. However, they are an underused resource mainly because the conclusions to be drawn from the discussion and their implications for practice are not always well integrated by inpatient care teams. We therefore propose in this study two interventions to optimise their effectiveness: a passive feedback with wide dissemination by e-mail and/or on paper of the results of the Morbidity and Mortality conference to inpatient care teams and an active feedback with in situ inter-professional simulation-training programme in which scenarios will be based on cases studied in Morbidity and Mortality conference. In the present study, we hypothesise that the greatest reduction the occurrence of adverse event will be in the active feedback arm. METHODS A cluster randomised controlled study will be performed at four study sites. The unit of randomisation is wards within the study sites. Fifteen wards will be randomly assigned to passive feedback, active feedback, or a standard MMC (control arm). Passive feedback and active feedback arms will be compared to standard arm in terms of occurrence of adverse events. The trigger tool methodology used to identify adverse events is a retrospective review of inpatient records using "triggers": an adverse event is defined as a patient's stay with at least one positive trigger. DISCUSSION The in situ simulation training based on cases processed in Morbidity and Mortality conference is built according to the main topics identified for the successful implementation of healthcare simulation in patient safety programmes: technical skills, nontechnical skills, assessment, effectiveness, and system probing. The in situ simulation-training programme conducted as part of the study has the potential to improve patient safety during hospitalisation. We therefore expect the greatest reduction in the occurrence of adverse events in patients hospitalised in the active feedback arm. This expected result would have a direct impact on patient safety and would place in situ simulation at the highest level of the Kirkpatrick model. TRIAL REGISTRATION Clinicaltrials.gov NCT02771613. Registered on May 12, 2016. All items from the WHO Trial Registration Data Set can be found within the protocol.
Collapse
Affiliation(s)
- Nicolas Michel
- Departments of Anesthesia and Intensive Care, Hospices Civils of Lyon, Lyon, France.
| | - Bernard Bui-Xuan
- Departments of Anesthesia and Intensive Care, Hospices Civils of Lyon, Lyon, France
| | - Lionel Bapteste
- Departments of Anesthesia and Intensive Care, Hospices Civils of Lyon, Lyon, France
| | - Thomas Rimmele
- Departments of Anesthesia and Intensive Care, Hospices Civils of Lyon, Lyon, France.,Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation center), SAMSEI, Lyon, France.,EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Pi3), Claude Bernard Lyon 1 University-Biomérieux-Hospices Civils of Lyon, Lyon, France
| | - Marc Lilot
- Departments of Anesthesia and Intensive Care, Hospices Civils of Lyon, Lyon, France.,Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation center), SAMSEI, Lyon, France.,Department of Quality, patient safety and patient partnership, Hospices civils de Lyon, France, Université Claude Bernard Lyon 1, Health Services and Performance Research Lab (EA 7425 HESPER), Villeurbanne, France
| | | | - Hélène Favre
- Department of Quality, patient safety and patient partnership, Hospices civils de Lyon, France, Université Claude Bernard Lyon 1, Health Services and Performance Research Lab (EA 7425 HESPER), Villeurbanne, France
| | - Antoine Duclos
- Department of Quality, patient safety and patient partnership, Hospices civils de Lyon, France, Université Claude Bernard Lyon 1, Health Services and Performance Research Lab (EA 7425 HESPER), Villeurbanne, France.,Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Philippe Michel
- Department of Quality, patient safety and patient partnership, Hospices civils de Lyon, France, Université Claude Bernard Lyon 1, Health Services and Performance Research Lab (EA 7425 HESPER), Villeurbanne, France.,Quality Safety and Customer Relationship Department, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Hesper EA 7425, F -, 69003, Lyon, France
| |
Collapse
|
16
|
Büyük S, Bermede O, Erkoç S, Alkış N, Lilot M, Meço B. Use of simulation to teach in the operating room: don't Let the COVID-19 pandemic to interrupt education an observational clinical trial. Braz J Anesthesiol 2021; 72:185-188. [PMID: 34921904 PMCID: PMC8674114 DOI: 10.1016/j.bjane.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 11/18/2021] [Accepted: 11/27/2021] [Indexed: 12/05/2022] Open
Abstract
Background Simulation-based education has become the most important part of resident training in anesthesiology, especially during the pandemic. It allows learning the skills and the management of different situations without putting residents in risk of contamination, considering COVID-19 is highly contagious. The hypothesis was that simulation is still associated with improvement of knowledge acquisitions despite the context of the COVID-19 pandemic. Methods Residents of anesthesiology and intensive care subjected to an anaphylaxis simulation scenario. Their knowledge levels were assessed by true/false questions before and one month after the simulation session. The STAI test was used to measure anxiety levels before and after the scenario. Data were analyzed statistically using Wilcoxon and McNemar tests. Results Junior residents (< 2 years) received significantly higher scores in post-training theoretical tests compared to their pre-training scores (79.2 ± 9.6, 84.5 ± 8.2, p = 0.002, n = 21). There was no difference between pre- and post-test scores of seniors (80.2 ± 9, 81.8 ± 10.4, p = 0.3). Pre- and post-anxiety inventory scores were nearly the same and both were in the moderate group (39.8 ± 10.1, 39.3 ± 12.1, p = 0.8). Conclusion Simulation-based education improved the knowledge levels of the residents without raising anxiety levels. Thus, simulation-based training showed its value as an important tool of education during the pandemic, which needs to be further popularized for training at all institutions. Enlightening medical educators about this accomplished teaching method may lead to improved quality of medical education in developing countries and reshape how tomorrow's doctors are trained during pandemics.
Collapse
Affiliation(s)
- Sevcan Büyük
- University of Ankara School of Medicine, Department of Anaesthesiology and ICU, Ankara, Turkey.
| | - Onat Bermede
- University of Ankara School of Medicine, Department of Anaesthesiology and ICU, Ankara, Turkey
| | - Süheyla Erkoç
- University of Ankara School of Medicine, Department of Anaesthesiology and ICU, Ankara, Turkey
| | - Neslihan Alkış
- University of Ankara School of Medicine, Department of Anaesthesiology and ICU, Ankara, Turkey
| | - Marc Lilot
- University of Claude Bernard, Hospital Femmes Meres Enfants, Department of Paediatric Anaesthesiology, Lyon, France
| | - Başak Meço
- University of Ankara School of Medicine, Department of Anaesthesiology and ICU, Ankara, Turkey
| |
Collapse
|
17
|
Desgranges FP, Zorio V, Jacquet-Lagreze M, Lilot M. Plethysmographic variability index to predict fluid responsiveness in the general surgical paediatric population. Anaesth Crit Care Pain Med 2021; 40:100955. [PMID: 34626865 DOI: 10.1016/j.accpm.2021.100955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Violette Zorio
- Department of Anaesthesiology, Hospices Civils de Lyon, Lyon, France
| | | | - Marc Lilot
- Department of Anaesthesiology, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
18
|
Schlatter S, Guillot A, Schmidt L, Mura M, Trama R, Di Rienzo F, Lilot M, Debarnot U. Combining proactive transcranial stimulation and cardiac biofeedback to substantially manage harmful stress effects. Brain Stimul 2021; 14:1384-1392. [PMID: 34438047 DOI: 10.1016/j.brs.2021.08.019] [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: 06/01/2021] [Revised: 08/18/2021] [Accepted: 08/21/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies have identified the dorsolateral prefrontal cortex (dlPFC) as a core region in cognitive emotional regulation. Transcranial direct current stimulations of the dlPFC (tDCS) and heart-rate variability biofeedback (BFB) are known to regulate emotional processes. However, the effect of these interventions applied either alone or concomitantly during an anticipatory stress remains unexplored. OBJECTIVE The study investigated the effect of anodal tDCS and BFB, alone or combined, on psychophysiological stress responses and cognitive functioning. METHODS Following a stress anticipation induction, 80 participants were randomized into four groups and subjected to a 15-min intervention: neutral video viewing (ctrl), left dlPFC anodal tDCS (tdcs), heart-rate variability biofeedback (bfb), or a combined treatment (bfb + tdcs). Participants were then immediately confronted with the stressor, which was followed by an assessment of executive functions. Psychophysiological stress responses were assessed throughout the experiment (heart rate, heart-rate variability, salivary cortisol). RESULTS The tdcs did not modulate stress responses. Compared with both ctrl and tdcs interventions, bfb reduced physiological stress and improved executive functions after the stressor. The main finding revealed that bfb + tdcs was the most effective intervention, yielding greater reduction in psychological and physiological stress responses than bfb. CONCLUSIONS Combining preventive tDCS with BFB is a relevant interventional approach to reduce psychophysiological stress responses, hence offering a new and non-invasive treatment of stress-related disorders. Biofeedback may be particularly useful for preparing for an important stressful event when performance is decisive.
Collapse
Affiliation(s)
- Sophie Schlatter
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France; Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation centre), SAMSEI, Lyon, France.
| | - Aymeric Guillot
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France.
| | - Laura Schmidt
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation centre), SAMSEI, Lyon, France.
| | - Mathilde Mura
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France.
| | - Robin Trama
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France.
| | - Franck Di Rienzo
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France.
| | - Marc Lilot
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hospices Civils de Lyon, Departments of Anaesthesia and Intensive Care, University Claude Bernard Lyon 1, Lyon, France; Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation centre), SAMSEI, Lyon, France.
| | - Ursula Debarnot
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, 69 622, Villeurbanne, France; Institut Universitaire de France, France.
| |
Collapse
|
19
|
Mengin AC, Kayser C, Tuzin N, Perruisseau-Carrier J, Charpiot A, Berna F, Lilot M, Vidailhet P. Mindfulness Improves Otolaryngology Residents' Performance in a Simulated Bad-News Consultation: A Pilot Study. J Surg Educ 2021; 78:1357-1365. [PMID: 33221252 DOI: 10.1016/j.jsurg.2020.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/04/2020] [Accepted: 11/11/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Delivering bad news is a stressful moment for both patient and clinician. As poor bad-news consultation quality may lead to misunderstandings, lack of treatment adherence, acute or even post-traumatic stress in patients, training interventions to improve communication skills and stress-management are necessary. Mindfulness is a recognised stress-management strategy that has shown its efficacy in reducing stress in both health professionals and students. We then supposed that a short mindfulness meditation session performed just before a simulated breaking bad-news consultation to patients with laryngeal cancer may help ear, nose and throat (ENT) residents to master their stress and improve their management of this consultation. This study aims at showing how a short mindfulness meditation performed before a simulated bad-news consultation may improve performance in its realisation by ENT residents. MATERIALS AND METHODS We enrolled 53 ENT residents, randomised in 2 groups. The first group completed a 5-minute mindfulness session while the other group listened to a control track. Thereafter, every resident completed an 8-minute simulated bad-news consultation with a standardised patient. Two blinded expert assessors evaluated their performance on a 25-point grid (BNC-OSAS). Residents self-assessed their stress before and after the intervention and simulated patients rated their perception of physician's empathy. RESULTS The performance was significantly better in the mindfulness group than in the control group (m = 19.8, sd = 3.2 and m = 17.4, sd = 3.7 respectively, F(1,45)=5.27, p = 0.026, d = 0.67), especially in the communication and knowledge subdomains. There was no significant difference in perceived stress between the 2 groups. Empathy perceived by simulated patients was positively correlated to residents' performance. CONCLUSION A short mindfulness meditation is effective for improving ENT residents' performance in a simulated bad-news consultation. These results encourage further assessments of this method with objective measures of physiological stress. More research is required concerning the feasibility and efficacy of mindfulness before daily clinical activities such as stressing bad-news consultation.
Collapse
Affiliation(s)
- Amaury C Mengin
- Hôpitaux Universitaires de Strasbourg, Pôle de Psychiatrie, Strasbourg, France; Université de Strasbourg, Faculté de Médecine, UNISIMES (UNIté de SIMulation Européenne en Santé), Strasbourg, France; Inserm U1114 - Neuropsychologie cognitive et Physiopathologie de la Schizophrénie, Strasbourg, France; FMTS, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.
| | - Claire Kayser
- Hôpitaux Universitaires de Strasbourg, Pôle de Psychiatrie, Strasbourg, France; Université de Strasbourg, Faculté de Médecine, Strasbourg, France
| | - Nicolas Tuzin
- Hôpitaux Universitaires de Strasbourg, Département de Santé Publique, GMRC, Strasbourg, France; Université de Strasbourg, Laboratoire de Biostatistique et Informatique Médicale, iCUBE UMR 7357, Illkirch, France
| | - Joffrey Perruisseau-Carrier
- Université de Strasbourg, Faculté de Médecine, Strasbourg, France; Hôpitaux Universitaires de Strasbourg, Service d'Otorhinolaryngologie et Chirurgie Cervico-faciale, Strasbourg, France
| | - Anne Charpiot
- FMTS, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France; Université de Strasbourg, Faculté de Médecine, Strasbourg, France; Hôpitaux Universitaires de Strasbourg, Service d'Otorhinolaryngologie et Chirurgie Cervico-faciale, Strasbourg, France
| | - Fabrice Berna
- Hôpitaux Universitaires de Strasbourg, Pôle de Psychiatrie, Strasbourg, France; Inserm U1114 - Neuropsychologie cognitive et Physiopathologie de la Schizophrénie, Strasbourg, France; FMTS, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France; Université de Strasbourg, Faculté de Médecine, Strasbourg, France
| | - Marc Lilot
- Département d'anesthésie, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France; Centre Lyonnais d'Enseignement par Simulation en Santé, SAMSEI, Lyon, France; Health Services and Performance Research Lab (EA 7425 HESPER), Lyon, France
| | - Pierre Vidailhet
- Hôpitaux Universitaires de Strasbourg, Pôle de Psychiatrie, Strasbourg, France; Université de Strasbourg, Faculté de Médecine, UNISIMES (UNIté de SIMulation Européenne en Santé), Strasbourg, France; Inserm U1114 - Neuropsychologie cognitive et Physiopathologie de la Schizophrénie, Strasbourg, France; FMTS, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France; Université de Strasbourg, Faculté de Médecine, Strasbourg, France
| |
Collapse
|
20
|
Koca A, Abraham P, Cejka JC, Lilot M, Rimmelé T. Cognitive aids: What are we talking about? J Clin Anesth 2021; 74:110433. [PMID: 34182260 DOI: 10.1016/j.jclinane.2021.110433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/16/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Ayca Koca
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Stratégies d'Apprentissage des Métiers de Santé en Environnement Immersif (SAMSEI), Lyon, France; University of Ankara, Department of Emergency Medicine, Ankara, Turkey.
| | - Paul Abraham
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Stratégies d'Apprentissage des Métiers de Santé en Environnement Immersif (SAMSEI), Lyon, France; Hospices Civils de Lyon, Department of Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Jean-Christophe Cejka
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Stratégies d'Apprentissage des Métiers de Santé en Environnement Immersif (SAMSEI), Lyon, France; Hospices Civils de Lyon, Department of Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Marc Lilot
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Stratégies d'Apprentissage des Métiers de Santé en Environnement Immersif (SAMSEI), Lyon, France; Hospices Civils de Lyon, Department of Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Lyon, France; Hospital, Critical Care Medicine, Louis Pradel Hospital, Lyon, France
| | - Thomas Rimmelé
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Stratégies d'Apprentissage des Métiers de Santé en Environnement Immersif (SAMSEI), Lyon, France; Hospices Civils de Lyon, Department of Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Lyon, France; Université Claude Bernard Lyon 1, Pathophysiology of Injury-Induced Immunosuppression (Pi3, EA 7426), Lyon, France
| |
Collapse
|
21
|
Schlatter S, Schmidt L, Lilot M, Guillot A, Debarnot U. Implementing biofeedback as a proactive coping strategy: Psychological and physiological effects on anticipatory stress. Behav Res Ther 2021; 140:103834. [PMID: 33743384 DOI: 10.1016/j.brat.2021.103834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/19/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 01/10/2023]
Abstract
Anticipating a stressful situation involves psychophysiological reactions before the occurrence of the overt stress event. The current challenge in the stress domain is to characterize anticipatory stress reactions and how to effectively modulate them. The present study aimed to characterize the anticipation period and evaluate the benefits of a heart-rate variability biofeedback (BFB) intervention designed to manage anticipatory stress. Healthy participants were exposed to an anticipation stress period (15 min) during which they either practised BFB (stress + bfb, n = 15) or watched a neutral video (stress + video, n = 14). Anticipatory stress was effectively induced by the Trier Social Anticipatory Stress (TSAS) protocol, specifically designed for this study. Control participants, without anticipation stress, practised BFB for an equivalent time (ctrl + bfb, n = 15). Subsequently, all participants performed a set of cognitive tasks assessing executive functions. Heart-rate variability (cardiac coherence, standard deviation of the R-R intervals, root mean square of successive difference measure) and the evolution of the perceived psychological state were measured during the anticipation period. Self-reported judgements of how the intervention influenced stress and performance were further assessed. The main result showed that BFB is a relevant proactive stress-coping method. Compared with the stress + video group, participants who practised BFB attained higher cardiac coherence scores. Post-intervention self-reported measures revealed that BFB contributed to reduce psychological stress and increase perceived levels of performance. Together, these findings provide practical guidelines for examining the stress anticipation period by means of the TSAS protocol.
Collapse
Affiliation(s)
- Sophie Schlatter
- Univ. Lyon, UCBL-Lyon 1, Laboratoire Interuniversitaire de Biologie de La Motricité, EA 7424, F-69622, Villeurbanne, France.
| | - Laura Schmidt
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Marc Lilot
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hôpital Louis Pradel, Hospices Civils de Lyon, Departments of Anaesthesia and Intensive Care, Lyon, France; Centre Lyonnais d'Enseignement par Simulation en Santé (CLESS, medical simulation centre), University Claude Bernard Lyon 1, 69003, Lyon, France
| | - Aymeric Guillot
- Univ. Lyon, UCBL-Lyon 1, Laboratoire Interuniversitaire de Biologie de La Motricité, EA 7424, F-69622, Villeurbanne, France
| | - Ursula Debarnot
- Univ. Lyon, UCBL-Lyon 1, Laboratoire Interuniversitaire de Biologie de La Motricité, EA 7424, F-69622, Villeurbanne, France; Institut Universitaire de France, France.
| |
Collapse
|
22
|
Claverie D, Trousselard M, Sigwalt F, Petit G, Evain JN, Bui M, Guinet-Lebreton A, Chassard D, Duclos A, Lehot JJ, Rimmelé T, Canini F, Lilot M. Impact of stress management strategies and experience on electrodermal activity during high-fidelity simulation of critical situations. Br J Anaesth 2020; 125:e410-e412. [PMID: 32838978 DOI: 10.1016/j.bja.2020.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Damien Claverie
- Institut de Recherche Biomédicale des Armées (IRBA), Brétigny-sur-Orge, France.
| | - Marion Trousselard
- Institut de Recherche Biomédicale des Armées (IRBA), Brétigny-sur-Orge, France; Ecole du Val-de-Grâce, Paris, France
| | - Florent Sigwalt
- Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Lyon, France
| | - Guillaume Petit
- Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Lyon, France
| | - Jean-Noel Evain
- Départment d'Anesthésie et de Soins Intensifs, Hôpital Universitaire de Grenoble Alpes, Grenoble, France
| | - Monique Bui
- Hôpital d'Instruction des Armées Desgenettes, Service de Santé des Armées, Lyon, France
| | | | - Dominique Chassard
- Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par Simulation en Santé, SAMSEI, Lyon, France
| | - Antoine Duclos
- Health Data Department, Hospices Civils de Lyon, Lyon, France; Health Services and Performance Research Laboratory (EA 7425 HESPER), Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Jacques Lehot
- Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par Simulation en Santé, SAMSEI, Lyon, France; Health Services and Performance Research Laboratory (EA 7425 HESPER), Université Claude Bernard Lyon 1, Lyon, France
| | - Thomas Rimmelé
- Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par Simulation en Santé, SAMSEI, Lyon, France; EA 7426 Université Claude Bernard Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
| | - Frédéric Canini
- Institut de Recherche Biomédicale des Armées (IRBA), Brétigny-sur-Orge, France; Ecole du Val-de-Grâce, Paris, France
| | - Marc Lilot
- Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par Simulation en Santé, SAMSEI, Lyon, France; Health Services and Performance Research Laboratory (EA 7425 HESPER), Université Claude Bernard Lyon 1, Lyon, France
| |
Collapse
|
23
|
Zorio V, Lebreton T, Desgranges FP, Bochaton T, Desebbe O, Chassard D, Jacquet-Lagrèze M, Lilot M. Does a two-minute mini-fluid challenge predict fluid responsiveness in pediatric patients under general anesthesia? Paediatr Anaesth 2020; 30:161-167. [PMID: 31858641 DOI: 10.1111/pan.13793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/06/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Very little evidence for predictive markers of fluid responsiveness has been reported in children as compared to adults. The impact of hypovolemia or hypervolemia on morbidity has driven interest in the fluid challenge titration strategy. AIM The objective of this study was to explore the ability of a 3 mL kg-1 mini-fluid challenge over 2 minutes to predict fluid responsiveness in children under controlled ventilation. METHODS Children scheduled for surgery under general anesthesia were included and received a fluid challenge of 15 mL kg-1 of crystalloid prior to incision administered over 10 minutes in two steps: 3 mL kg-1 over 2 minutes then 12 mL kg-1 over 8 minutes. Fluid responsiveness was defined as a change of ≥10% in cardiac output estimated by left ventricular outflow tract velocity time integral (VTI) as measured by transthoracic ultrasound before and after the fluid challenge of 15 mL kg-1 . RESULTS Of the 55 patients included in the analysis, 43 were fluid responders. The increase in the VTI after the mini-fluid challenge (ΔVTIminiFC ) predicted fluid responsiveness with an area under the receiver operating characteristic curve of 0.77; 95% CI (0.63-0.87), P = .004. Considering the least significant change which was 7.9%; 95% CI (6-10), the threshold was 8% with a sensitivity of 53%; 95% CI (38-68); and a specificity of 77%; 95% CI (54-100). CONCLUSION ΔVTIminiFC weakly predicted the effects of a fluid challenge of 15 mL kg-1 of crystalloid in anesthetized children under controlled mechanical ventilation.
Collapse
Affiliation(s)
- Violette Zorio
- Department of Anesthesia and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thibault Lebreton
- Department of Anesthesia and Intensive Care, The Hospital Femme-Mère-Enfant (Woman-Mother-Child), Hospices Civils de Lyon, Bron, France
| | - François-Pierrick Desgranges
- Department of Anesthesia and Intensive Care, The Hospital Femme-Mère-Enfant (Woman-Mother-Child), Hospices Civils de Lyon, Bron, France
| | - Thomas Bochaton
- Cardiac Intensive Care Unit, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Olivier Desebbe
- Department of Anesthesia and Intensive Care, Ramsay Generale de Sante, Sauvegarde Clinic, Lyon, France
| | - Dominique Chassard
- Department of Anesthesia and Intensive Care, The Hospital Femme-Mère-Enfant (Woman-Mother-Child), Hospices Civils de Lyon, Bron, France
| | - Matthias Jacquet-Lagrèze
- Department of Anesthesia and Intensive Care, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Marc Lilot
- Department of Anesthesia and Intensive Care, The Hospital Femme-Mère-Enfant (Woman-Mother-Child), Hospices Civils de Lyon, Bron, France.,Health Services and Performance Research laboratory (EA 7425 HESPER), Claude Bernard Lyon 1 University, Lyon, France
| |
Collapse
|
24
|
Lilot M, Evain JN, Duclos A, Lehot JJ, Rimmelé T. Active participation in high fidelity simulation might be associated with higher stress level and better learning outcomes at three months than external observation. Anaesth Crit Care Pain Med 2019; 38:523-525. [DOI: 10.1016/j.accpm.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/22/2018] [Accepted: 01/03/2019] [Indexed: 11/16/2022]
|
25
|
Vassal O, Del Carmine P, Desgranges FP, Bouvet L, Lilot M, Gadot N, Timour-Chah Q, Chassard D. Assessment of Neurological Toxicity of Hydroxyethyl Starch 130/0.4 Injected in the Intrathecal Space in Rats. Pain Med 2019; 19:2016-2020. [PMID: 29420792 DOI: 10.1093/pm/pny005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective Epidural blood patch is the procedure of choice to relieve postdural puncture headache. Hydroxyethyl-starch (HES) has been proposed as a patch in some circumstances such as in the case of hematological disease due to the theoretical risk of neoplastic seeding to the central nervous system. Acute neurological HES toxicity has been excluded by a previous animal study, but the long-term neurological toxicity has not been evaluated. Methods Rats were randomly assigned to one of three groups: no intrathecal injection, 20 μL of intrathecal saline, or a 20-μL intrathecal HES (6% hydroxyethyl starch 130/0.4) administered via a cervical puncture. Clinical daily rat activity was measured before and after dural puncture by actinometry. The rats were killed at day 28, and the spinal cord was surgically removed and stained with hematoxylin-phloxine-saffron for gross and microscopic examination. Results Eleven rats underwent dural puncture without injection, 11 were injected with normal saline, and 12 received intrathecal HES. No clinical or actimetric changes (total distance traveled, number of direction changes, and number of rearings) were observed up to one month after injection. Nonspecific histopathological changes were equally observed in all groups. Conclusions The results of the current study indicate that intrathecal injection of HES in rats does not induce any clinical or histopathological evidence of long-term neuronal toxicity. Further safety studies in animals are warranted before HES might be considered a safe alternative to the classic epidural blood patch.
Collapse
Affiliation(s)
- O Vassal
- Department of Anesthesia, Hôpital Femme Mere Enfants (Hospices Civils de Lyon), Lyon, France
| | - P Del Carmine
- Aniphy, Claude Bernard Lyon University, University of Lyon, Lyon, France
| | - F-P Desgranges
- Department of Anesthesia, Hôpital Femme Mere Enfants (Hospices Civils de Lyon), Lyon, France
| | - L Bouvet
- Department of Anesthesia, Hôpital Femme Mere Enfants (Hospices Civils de Lyon), Lyon, France
| | - M Lilot
- Department of Anesthesia, Hôpital Femme Mere Enfants (Hospices Civils de Lyon), Lyon, France
| | - N Gadot
- Anipath, Laennec University, University of Lyon, Lyon, France
| | - Q Timour-Chah
- Aniphy, Claude Bernard Lyon University, University of Lyon, Lyon, France
| | - D Chassard
- Department of Anesthesia, Hôpital Femme Mere Enfants (Hospices Civils de Lyon), Lyon, France
| |
Collapse
|
26
|
Jacquet-Lagrèze M, Bouhamri N, Portran P, Schweizer R, Baudin F, Lilot M, Fornier W, Fellahi JL. Capillary refill time variation induced by passive leg raising predicts capillary refill time response to volume expansion. Crit Care 2019; 23:281. [PMID: 31420052 PMCID: PMC6697974 DOI: 10.1186/s13054-019-2560-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/31/2019] [Indexed: 12/29/2022]
Abstract
Background A peripheral perfusion-targeted resuscitation during early septic shock has shown encouraging results. Capillary refill time, which has a prognostic value, was used. Adding accuracy and predictability on capillary refill time (CRT) measurement, if feasible, would benefit to peripheral perfusion-targeted resuscitation. We assessed whether a reduction of capillary refill time during passive leg raising (ΔCRT-PLR) predicted volume-induced peripheral perfusion improvement defined as a significant decrease of capillary refill time following volume expansion. Methods Thirty-four patients with acute circulatory failure were selected. Haemodynamic variables, metabolic variables (PCO2gap), and four capillary refill time measurements were recorded before and during a passive leg raising test and after a 500-mL volume expansion over 20 min. Receiver operating characteristic curves were built, and areas under the curves were calculated (ROCAUC). Confidence intervals (CI) were performed using a bootstrap analysis. We recorded mortality at day 90. Results The least significant change in the capillary refill time was 25% [95% CI, 18–30]. We defined CRT responders as patients showing a reduction of at least 25% of capillary refill time after volume expansion. A decrease of 27% in ΔCRT-PLR predicted peripheral perfusion improvement with a sensitivity of 87% [95% CI, 73–100] and a specificity of 100% [95% CI, 74–100]. The ROCAUC of ΔCRT-PLR was 0.94 [95% CI, 0.87–1.0]. The ROCAUC of baseline capillary refill time was 0.73 [95% CI, 0.54–0.90] and of baseline PCO2gap was 0.79 [0.61–0.93]. Capillary refill time was significantly longer in non-survivors than in survivors at day 90. Conclusion ΔCRT-PLR predicted peripheral perfusion response following volume expansion. This simple low-cost and non-invasive diagnostic method could be used in peripheral perfusion-targeted resuscitation protocols. Trial registration CPP Lyon Sud-Est II ANSM: 2014-A01034-43 Clinicaltrial.gov, NCT02248025, registered 13th of September 2014 Electronic supplementary material The online version of this article (10.1186/s13054-019-2560-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Matthias Jacquet-Lagrèze
- Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France. .,Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008, Lyon, France.
| | - Nourredine Bouhamri
- Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
| | - Philippe Portran
- Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008, Lyon, France
| | - Rémi Schweizer
- Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008, Lyon, France
| | - Florent Baudin
- Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008, Lyon, France.,Département de Réanimation Pédiatrique, Centre Hospitalier Femme mère enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
| | - Marc Lilot
- Département d'Anesthésie Pédiatrique, Centre Hospitalier Femme Mère Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Centre Lyonnais d'Enseignement par Simulation en Santé, SAMSEI, Université Claude Bernard Lyon 1, Lyon, France.,Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude Bernard Lyon 1, Lyon, France.,EPICIME-CIC 1407 de Lyon, Inserm, Hospices Civils de Lyon, F-69677, Bron, France
| | - William Fornier
- Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008, Lyon, France
| | - Jean-Luc Fellahi
- Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008, Lyon, France
| |
Collapse
|
27
|
Lilot M, Evain JN, Vincent A, Gaillard G, Chassard D, Mattatia L, Ripart J, Denoyel L, Bauer C, Robinson P, Duclos A, Lehot JJ, Rimmelé T. [Simulation of difficult airway management for residents: prospective comparative study]. Rev Bras Anestesiol 2019; 69:358-368. [PMID: 31371173 DOI: 10.1016/j.bjan.2019.02.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/08/2019] [Accepted: 02/15/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Procedural simulation training for difficult airway management offers acquisition opportunities. The hypothesis was that 3 hours of procedural simulation training for difficult airway management improves: acquisition, behavior, and patient outcomes as reported 6 months later. METHODS This prospective comparative study took place in two medical universities. Second-year residents of anesthesiology and intensive care from one region participated in 3h procedural simulation (intervention group). No intervention was scheduled for their peers from the other region (control). Prior to simulation and 6 months later, residents filled-out the same self-assessment form collecting experience with different devices. The control group filled-out the same forms simultaneously. The primary endpoint was the frequency of use of each difficult airway management device within groups at 6 months. Secondary endpoints included modifications of knowledge, skills, and patient outcomes with each device at 6 months. Intervention cost assessment was provided. RESULTS 44 residents were included in the intervention group and 16 in the control group. No significant difference was observed for the primary endpoint. In the intervention group, improvement of knowledge and skills was observed at 6 months for each device, and improvement of patient outcomes was observed with the use of malleable intubation stylet and Eschmann introducer. No such improvement was observed in the control group. Estimated intervention cost was 406€ per resident. CONCLUSIONS A 3h procedural simulation training for difficult airway management did not improve the frequency of use of devices at 6 months by residents. However, other positive effects suggest exploring the best ratio of time/acquisition efficiency with difficult airway management simulation. CLINICALTRIALS. GOV IDENTIFIER NCT02470195.
Collapse
Affiliation(s)
- Marc Lilot
- Hospices Civils de Lyon, Département d'Anesthésie-Réanimation, Lyon, França; Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, Lyon, França; Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par Simulation en Santé, SAMSEI, Lyon, França.
| | - Jean-Noel Evain
- Groupe Hospitalo-Universitaire Carémeau, Division Anesthésie Réanimation Urgences Douleur, Simulation Médicale Hospitalo-Universitaire (SIMHU), Nîmes, França
| | - Alban Vincent
- Hospices Civils de Lyon, Département d'Anesthésie-Réanimation, Lyon, França
| | - Guillain Gaillard
- Hospices Civils de Lyon, Département d'Anesthésie-Réanimation, Lyon, França
| | - Dominique Chassard
- Hospices Civils de Lyon, Département d'Anesthésie-Réanimation, Lyon, França; Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par Simulation en Santé, SAMSEI, Lyon, França
| | - Laurent Mattatia
- Groupe Hospitalo-Universitaire Carémeau, Division Anesthésie Réanimation Urgences Douleur, Simulation Médicale Hospitalo-Universitaire (SIMHU), Nîmes, França
| | - Jacques Ripart
- Groupe Hospitalo-Universitaire Carémeau, Division Anesthésie Réanimation Urgences Douleur, Simulation Médicale Hospitalo-Universitaire (SIMHU), Nîmes, França
| | - Lucas Denoyel
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par Simulation en Santé, SAMSEI, Lyon, França
| | - Christian Bauer
- Hospices Civils de Lyon, Département d'Anesthésie-Réanimation, Lyon, França; Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par Simulation en Santé, SAMSEI, Lyon, França
| | - Philip Robinson
- Hospices Civils de Lyon, Direction de la Recherche Clinique et de l'Innovation, Lyon, França
| | - Antoine Duclos
- Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, Lyon, França; Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, França
| | - Jean-Jacques Lehot
- Hospices Civils de Lyon, Département d'Anesthésie-Réanimation, Lyon, França; Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, Lyon, França; Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par Simulation en Santé, SAMSEI, Lyon, França
| | - Thomas Rimmelé
- Hospices Civils de Lyon, Département d'Anesthésie-Réanimation, Lyon, França; Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par Simulation en Santé, SAMSEI, Lyon, França; Université Claude Bernard Lyon 1, Pathophysiology of Injury Induced Immunosuppression, Lyon, França
| |
Collapse
|
28
|
Lilot M, Evain JN, Vincent A, Gaillard G, Chassard D, Mattatia L, Ripart J, Denoyel L, Bauer C, Robinson P, Duclos A, Lehot JJ, Rimmelé T. Simulation of difficult airway management for residents: prospective comparative study. Brazilian Journal of Anesthesiology (English Edition) 2019. [PMID: 31371173 PMCID: PMC9391856 DOI: 10.1016/j.bjane.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and objectives Procedural simulation training for difficult airway management offers acquisition opportunities. The hypothesis was that 3 hours of procedural simulation training for difficult airway management improves: acquisition, behavior, and patient outcomes as reported 6 months later. Methods This prospective comparative study took place in two medical universities. Second-year residents of anesthesiology and intensive care from one region participated in 3 h procedural simulation (intervention group). No intervention was scheduled for their peers from the other region (control). Prior to simulation and 6 months later, residents filled-out the same self-assessment form collecting experience with different devices. The control group filled-out the same forms simultaneously. The primary endpoint was the frequency of use of each difficult airway management device within groups at 6 months. Secondary endpoints included modifications of knowledge, skills, and patient outcomes with each device at 6 months. Intervention cost assessment was provided. Results 44 residents were included in the intervention group and 16 in the control group. No significant difference was observed for the primary endpoint. In the intervention group, improvement of knowledge and skills was observed at 6 months for each device, and improvement of patient outcomes was observed with the use of malleable intubation stylet and Eschmann introducer. No such improvement was observed in the control group. Estimated intervention cost was 406€ per resident. Conclusions A 3 h procedural simulation training for difficult airway management did not improve the frequency of use of devices at 6 months by residents. However, other positive effects suggest exploring the best ratio of time/acquisition efficiency with difficult airway management simulation. ClinicalTrials.gov Identifier NCT02470195.
Collapse
|
29
|
Evain JN, Perrot A, Vincent A, Cejka JC, Bauer C, Duclos A, Rimmelé T, Lehot JJ, Lilot M. Team planning discussion and clinical performance: a prospective, randomised, controlled simulation trial. Anaesthesia 2019; 74:488-496. [PMID: 30768684 DOI: 10.1111/anae.14602] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 12/12/2022]
Abstract
Planning held before emergency management of a critical situation might be an invaluable asset for optimising team preparation. The purpose of this study was to investigate whether a brief planning discussion improved team performance in a simulated critical care situation. Forty-four pairs of trainees in anaesthesia and intensive care were randomly allocated to either an intervention or control group before participating in a standardised simulated scenario. Twelve different scenarios were utilised. Groups were stratified by postgraduate year and simulated scenario, and a facilitator was embedded in the scenario. In the intervention group, the pairs had an oral briefing followed by a 4-min planning discussion before starting the simulation. The primary end-point was clinical performance, as rated by two independent blinded assessors on a score of 0-100 using video records and pre-established scenario-specific checklists. Crisis resource management and stress response (cognitive appraisal ratio) were also assessed. Two pairs were excluded for technical reasons. Clinical performance scores were higher in the intervention group; mean (SD) 51 (9) points vs. 46 (9) in the control group, p = 0.039. The planning discussion was also associated with higher crisis resource management scores and lower cognitive appraisal ratios, reflecting a positive response. A 4-min planning discussion before a simulated critical care situation improved clinical team performance and cognitive appraisal ratios. Team planning should be integrated into medical education and clinical practice.
Collapse
Affiliation(s)
- J-N Evain
- Department of Anaesthesia and Intensive Care, Grenoble Alpes University Hospital, Grenoble, France
| | - A Perrot
- Department of Anaesthesia and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - A Vincent
- Department of Anaesthesia and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - J-C Cejka
- Department of Anaesthesia and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - C Bauer
- Department of Anaesthesia and Intensive Care, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - A Duclos
- Health Services and Performance Research laboratory (EA 7425), Claude Bernard Lyon 1 University, Lyon, France
| | - T Rimmelé
- Department of Anaesthesia and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - J-J Lehot
- Centre Lyonnais d'Enseignement par la Simulation en Santé, Claude Bernard Lyon 1 University, Lyon, France
| | - M Lilot
- Health Services and Performance Research laboratory (EA 7425), Claude Bernard Lyon 1 University, Lyon, France
| |
Collapse
|
30
|
Darbois N, Evain JN, Guillaud A, Lilot M, Pinsault N. [Open heart surgery under acupuncture ? Decrypting a program broadcast on France 2]. Sante Publique 2018; 30:455-464. [PMID: 30540134 DOI: 10.3917/spub.185.0455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To analyze a clip from the program ? Acupuncture, osteopathy, hypnosis: do complementary medicines have superpowers ? about acupuncture as an anesthetic for surgical procedures in China. To propose a rational explanation for the phenomena observed. To describe the processes leading a public service broadcasting channel to offer this type of content at prime time and the potential consequences in terms of public health. METHOD Analysis using critical thinking attitudes and skills, along with a bibliographical search of Medline, Google Scholar and Cochrane Library databases. RESULTS The information delivered in the television clip is ambiguous. It does not allow the viewer to form an informed opinion on the relevance of acupuncture as an anesthetic for surgical procedures. It is reasonable to assume that the clip shows surgery performed with undisclosed epidural anesthesia coupled with mild intravenous anesthesia, sometimes performed in other countries. What needs to be highlighted here is the overestimation of acupuncture added to the protocol. The media tend to exaggerate the risks and expected effects of the treatments they report on, which can lead patients to turn to unproven therapies. CONCLUSION Broadcasting such a clip at prime time underlines the urgent need for the public and all health professionals to be trained in sorting and critically analyzing health information.
Collapse
|
31
|
Jacquet-Lagrèze M, Tiberghien N, Evain JN, Hanna N, Courtil-Teyssedre S, Lilot M, Baudin F, Chardonnal L, Bompard D, Koffel C, Portefaix A, Javouhey E, Fellahi JL. Diagnostic accuracy of a calibrated abdominal compression to predict fluid responsiveness in children. Br J Anaesth 2018; 121:1323-1331. [PMID: 30442260 DOI: 10.1016/j.bja.2018.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/03/2017] [Revised: 05/24/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Fluid administration to increase stroke volume index (SVi) is a cornerstone of haemodynamic resuscitation. We assessed the accuracy of SVi variation during a calibrated abdominal compression manoeuvre (ΔSVi-CAC) to predict fluid responsiveness in children. METHODS Patients younger than 8 yr with acute circulatory failure, regardless of their ventilation status, were selected. SVi, calculated as the average of five velocity-time integrals multiplied by the left ventricular outflow tract surface area, was recorded at four different steps: baseline, after an abdominal compression with a calibrated pressure of 25 mm Hg, after return to baseline, and then after a volume expansion (VE) of 10 ml kg-1 lactated Ringer solution over 10 min. Patients were classified as responders if SVi variation after volume expansion (ΔSVi-VE) increased by at least 15%. RESULTS The 39 children included had a median [inter-quartile range (IQR)] age of 9 [5-31] months. Twenty patients were fluid responders and 19 were non-responders. ΔSVi-CAC correlated with ΔSVi-VE (r=0.829; P<0.001). The area under the receiver operating characteristic curve (ROCAUC) was 0.94 [95% confidence interval (CI), 0.85-0.99]. The best threshold for ΔSVi-CAC was 11% with a specificity of 95% [95% CI, 84-100] and a sensitivity of 75% [95% CI, 55-95]. ROCAUC of respiratory variation of IVC diameter (ΔIVC) was 0.53 [95% CI, 0.32-0.72]. CONCLUSION ΔSVi-CAC during abdominal compression was a reliable method to predict fluid responsiveness in children with acute circulatory failure regardless of their ventilation status. CLINICAL TRIALS REGISTRATION CPP Lyon sud est II: n° ANSM 2015-A00388-41 Clinicaltrial.gov: NCT02505646.
Collapse
Affiliation(s)
- M Jacquet-Lagrèze
- Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Bron, France; Université Claude-Bernard Lyon 1, Campus Lyon Santé Est, Lyon, France.
| | - N Tiberghien
- Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Bron, France
| | - J-N Evain
- Département de Réanimation Pédiatrique, Centre Hospitalier Femme Mère Enfant, Bron, France
| | - N Hanna
- Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Bron, France
| | - S Courtil-Teyssedre
- Département de Réanimation Pédiatrique, Centre Hospitalier Femme Mère Enfant, Bron, France
| | - M Lilot
- Département d'Anesthésie Pédiatrique, Centre Hospitalier Femme Mère Enfant, Bron, France; Université Claude-Bernard Lyon 1, Campus Lyon Santé Est, Lyon, France; Centre Lyonnais d'Enseignement par Simulation en Santé, SAMSEI, Lyon, France; Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, Lyon, France
| | - F Baudin
- Département de Réanimation Pédiatrique, Centre Hospitalier Femme Mère Enfant, Bron, France; Université Claude-Bernard Lyon 1, Campus Lyon Santé Est, Lyon, France
| | - L Chardonnal
- Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Bron, France
| | - D Bompard
- Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Bron, France
| | - C Koffel
- Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Bron, France
| | - A Portefaix
- EPICIME-CIC 1407 de Lyon, Inserm, Hospices Civils de Lyon, Bron, France
| | - E Javouhey
- Département de Réanimation Pédiatrique, Centre Hospitalier Femme Mère Enfant, Bron, France; Université Claude-Bernard Lyon 1, Campus Lyon Santé Est, Lyon, France
| | - J-L Fellahi
- Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Bron, France; Université Claude-Bernard Lyon 1, Campus Lyon Santé Est, Lyon, France
| |
Collapse
|
32
|
Lilot M, Evain JN, Bauer C, Cejka JC, Faure A, Balança B, Vassal O, Payet C, Bui Xuan B, Duclos A, Lehot JJ, Rimmelé T. Relaxation before Debriefing during High-fidelity Simulation Improves Memory Retention of Residents at Three Months. Anesthesiology 2018; 128:638-649. [DOI: 10.1097/aln.0000000000002045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background
High-fidelity simulation is known to improve participant learning and behavioral performance. Simulation scenarios generate stress that affects memory retention and may impact future performance. The authors hypothesized that more participants would recall three or more critical key messages at three months when a relaxation break was performed before debriefing of critical event scenarios.
Methods
Each resident actively participated in one scenario and observed another. Residents were randomized in two parallel-arms. The intervention was a 5-min standardized relaxation break immediately before debriefing; controls had no break before debriefing. Five scenario-specific messages were read aloud by instructors during debriefings. Residents were asked by telephone three months later to recall the five messages from their two scenarios, and were scored for each scenario by blinded investigators. The primary endpoint was the number of residents participating actively who recalled three or more messages. Secondary endpoints included: number of residents observing who recalled three or more messages, anxiety level, and debriefing quality.
Results
In total, 149 residents were randomized and included. There were 52 of 73 (71%) residents participating actively who recalled three or more messages at three months in the intervention group versus 35 of 76 (46%) among controls (difference: 25% [95% CI, 10 to 40%], P = 0.004). No significant difference was found between groups for observers, anxiety or debriefing quality.
Conclusions
There was an additional 25% of active participants who recalled the critical messages at three months when a relaxation break was performed before debriefing of scenarios. Benefits of relaxation to enhance learning should be considered for medical education.
Collapse
Affiliation(s)
- Marc Lilot
- From Université Claude Bernard Lyon 1, Centre Lyonnais d’Enseignement par Simulation en Santé, SAMSEI, Lyon, France; the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département d’anesthésie, Bron, France (M.L., J.-N. E.); Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, HESPER EA 7425, Lyon, France (M.L., A.D., C.P., J.-J.L); Hospices Civils de Lyon, Hôpital
| | - Jean-Noel Evain
- From Université Claude Bernard Lyon 1, Centre Lyonnais d’Enseignement par Simulation en Santé, SAMSEI, Lyon, France; the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département d’anesthésie, Bron, France (M.L., J.-N. E.); Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, HESPER EA 7425, Lyon, France (M.L., A.D., C.P., J.-J.L); Hospices Civils de Lyon, Hôpital
| | - Christian Bauer
- From Université Claude Bernard Lyon 1, Centre Lyonnais d’Enseignement par Simulation en Santé, SAMSEI, Lyon, France; the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département d’anesthésie, Bron, France (M.L., J.-N. E.); Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, HESPER EA 7425, Lyon, France (M.L., A.D., C.P., J.-J.L); Hospices Civils de Lyon, Hôpital
| | - Jean-Christophe Cejka
- From Université Claude Bernard Lyon 1, Centre Lyonnais d’Enseignement par Simulation en Santé, SAMSEI, Lyon, France; the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département d’anesthésie, Bron, France (M.L., J.-N. E.); Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, HESPER EA 7425, Lyon, France (M.L., A.D., C.P., J.-J.L); Hospices Civils de Lyon, Hôpital
| | - Alexandre Faure
- From Université Claude Bernard Lyon 1, Centre Lyonnais d’Enseignement par Simulation en Santé, SAMSEI, Lyon, France; the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département d’anesthésie, Bron, France (M.L., J.-N. E.); Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, HESPER EA 7425, Lyon, France (M.L., A.D., C.P., J.-J.L); Hospices Civils de Lyon, Hôpital
| | - Baptiste Balança
- From Université Claude Bernard Lyon 1, Centre Lyonnais d’Enseignement par Simulation en Santé, SAMSEI, Lyon, France; the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département d’anesthésie, Bron, France (M.L., J.-N. E.); Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, HESPER EA 7425, Lyon, France (M.L., A.D., C.P., J.-J.L); Hospices Civils de Lyon, Hôpital
| | - Olivia Vassal
- From Université Claude Bernard Lyon 1, Centre Lyonnais d’Enseignement par Simulation en Santé, SAMSEI, Lyon, France; the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département d’anesthésie, Bron, France (M.L., J.-N. E.); Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, HESPER EA 7425, Lyon, France (M.L., A.D., C.P., J.-J.L); Hospices Civils de Lyon, Hôpital
| | - Cécile Payet
- From Université Claude Bernard Lyon 1, Centre Lyonnais d’Enseignement par Simulation en Santé, SAMSEI, Lyon, France; the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département d’anesthésie, Bron, France (M.L., J.-N. E.); Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, HESPER EA 7425, Lyon, France (M.L., A.D., C.P., J.-J.L); Hospices Civils de Lyon, Hôpital
| | - Bernard Bui Xuan
- From Université Claude Bernard Lyon 1, Centre Lyonnais d’Enseignement par Simulation en Santé, SAMSEI, Lyon, France; the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département d’anesthésie, Bron, France (M.L., J.-N. E.); Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, HESPER EA 7425, Lyon, France (M.L., A.D., C.P., J.-J.L); Hospices Civils de Lyon, Hôpital
| | - Antoine Duclos
- From Université Claude Bernard Lyon 1, Centre Lyonnais d’Enseignement par Simulation en Santé, SAMSEI, Lyon, France; the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département d’anesthésie, Bron, France (M.L., J.-N. E.); Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, HESPER EA 7425, Lyon, France (M.L., A.D., C.P., J.-J.L); Hospices Civils de Lyon, Hôpital
| | - Jean-Jacques Lehot
- From Université Claude Bernard Lyon 1, Centre Lyonnais d’Enseignement par Simulation en Santé, SAMSEI, Lyon, France; the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département d’anesthésie, Bron, France (M.L., J.-N. E.); Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, HESPER EA 7425, Lyon, France (M.L., A.D., C.P., J.-J.L); Hospices Civils de Lyon, Hôpital
| | - Thomas Rimmelé
- From Université Claude Bernard Lyon 1, Centre Lyonnais d’Enseignement par Simulation en Santé, SAMSEI, Lyon, France; the Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Département d’anesthésie, Bron, France (M.L., J.-N. E.); Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, HESPER EA 7425, Lyon, France (M.L., A.D., C.P., J.-J.L); Hospices Civils de Lyon, Hôpital
| |
Collapse
|
33
|
Abraham P, Verdonk F, Buleon C, Tesniere A, Lilot M. Implementation of a novel synchronous multi-site all day high-fidelity simulation. Adv Simul (Lond) 2018; 3:2. [PMID: 29450028 PMCID: PMC5810051 DOI: 10.1186/s41077-018-0063-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 01/31/2018] [Indexed: 11/16/2022] Open
Abstract
Integration of simulation in educational curricula for anesthesia and intensive care residents is a hot topic. There is a great interest for simulation centers to share their experiences through multi-site synchronous simulation sessions. The present study results from an experience conducted at three sites in France (Paris, Lyon, and Caen), which involved 16 instructors and 25 residents facing the same scenario across 1 day. Synchronous simulations were performed at each site with local and shared debriefing via teleconference. This innovative approach to simulation was found to be feasible, although certain difficulties were encountered with connectivity.
Collapse
Affiliation(s)
- Paul Abraham
- Youth Committee of the French Society in Anesthesia and Intensive Care Medicine (SFAR), Paris, France.,2Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SAMSEI, Claude Bernard University Lyon 1, Health Services and Performance Research Lab (HESPER EA 7425), Department of Anesthesiology and Critical Care medicine, Hospices Civils de Lyon, Lyon, France
| | - Franck Verdonk
- Youth Committee of the French Society in Anesthesia and Intensive Care Medicine (SFAR), Paris, France.,3Department of Anesthesiology, Critical Care, SMUR, and Burn Unit, GH Saint-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique, Hôpitaux de Paris, Paris, France
| | - Clement Buleon
- 4Medical Simulation Center Normandie Simulation en Santé (NorSimS), Université Normandie-Caen, Caen University Hospital, Caen, France
| | - Antoine Tesniere
- 5Surgical Intensive Care Unit, Cochin Hospital, iLumens Simulation Department, Sorbonne Paris Cité University, Paris, France
| | - Marc Lilot
- 2Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SAMSEI, Claude Bernard University Lyon 1, Health Services and Performance Research Lab (HESPER EA 7425), Department of Anesthesiology and Critical Care medicine, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
34
|
Lilot M, Bellon A, Gueugnon M, Laplace MC, Baffeleuf B, Hacquard P, Barthomeuf F, Parent C, Tran T, Soubirou JL, Robinson P, Bouvet L, Vassal O, Lehot JJ, Piriou V. Comparison of cardiac output optimization with an automated closed-loop goal-directed fluid therapy versus non standardized manual fluid administration during elective abdominal surgery: first prospective randomized controlled trial. J Clin Monit Comput 2018; 32:993-1003. [DOI: 10.1007/s10877-018-0106-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 01/20/2018] [Indexed: 02/04/2023]
|
35
|
Lelaidier R, Balança B, Boet S, Faure A, Lilot M, Lecomte F, Lehot JJ, Rimmelé T, Cejka JC. Use of a hand-held digital cognitive aid in simulated crises: the MAX randomized controlled trial. Br J Anaesth 2017; 119:1015-1021. [DOI: 10.1093/bja/aex256] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 11/12/2022] Open
|
36
|
Bougouin W, Marijon E, Planquette B, Karam N, Dumas F, Celermajer D, Jost D, Lamhaut L, Beganton F, Cariou A, Meyer G, Jouven X, Bureau C, Charpentier J, Salem OBH, Guillemet L, Arnaout M, Ferre A, Geri G, Mongardon N, Pène F, Chiche JD, Mira JP, Labro G, Belon F, Luu VP, Chenet J, Besch G, Puyraveau M, Piton G, Capellier G, Martin M, Lascarrou JB, Le Thuaut A, Lacherade JC, Martin-Lefèvre L, Fiancette M, Vinatier I, Lebert C, Bachoumas K, Yehia A, Henry-Laguarrigue M, Colin G, Reignier J, Privat E, Escutnaire J, Dumont C, Baert V, Vilhelm C, Hubert H, Robert-Edan V, Lakhal K, Quartin A, Hobbs B, Cely C, Bell C, Pham T, Schein R, Geng Y, Ng C, Ehrmann S, Gandonnière CS, Boisramé-Helms J, Le Tilly O, De Bretagne IB, Mercier E, Mankikian J, Bretagnol A, Meziani F, Halimi JM, Le Guellec CB, Gaudry S, Hajage D, Tubach F, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Mayaux J, Nseir S, Ricard JD, Dreyfuss D, Robert R, Garzotto F, Kipnis E, Tetta C, Ronco C, Schnell D, Aurelie B, Reynaud M, Clec’h C, Benyamina M, Vincent F, Mariat C, Bornstain C, Gloulou O, Boussarsar M, Zelmat SA, Batouche DD, Chaffi B, Mazour F, Benatta N, Fathallah I, Aloui R, Zoubli A, Rouleau S, Kouraichi N, Fathallah I, Kouraichi N, Salem S, Vicaut E, Megarbane B, Ambroise D, Loriot AM, Bourgogne E, Megarbane B, Leroy C, Ghadhoune H, Jihene G, Trabelsi I, Allouche H, Brahmi H, Samet M, Ghord HE, Lebeau R, Laplanche JL, Benturquia N, Cohen Y, Megarbane B, Blel Y, M’rad A, Essafi F, Benabderrahim A, Jouffroy R, Resiere D, Sanchez B, Inamo J, Megarbane B, Morel J, Batouche DD, Zerhouni A, Tabeliouna K, Negadi A, Mentouri Z, Le Gall F, Hanouz JL, Normand H, Khoury A, Sall FS, Legrand M, De Luca A, Pugin A, Pazart L, Vidal C, Leroux F, Khoury A, L’Her E, Marjanovic N, Khoury A, Desmettre T, Terreaux J, Lambert C, Ragey SP, Baboi L, Bazin JE, Koffel C, Dhonneur G, Bouzit Z, Bradai L, Ayed IB, Aissa F, Darmon M, Haouache H, Marechal Y, Biston P, Piagnerelli M, Bortolotti P, Colling D, Colas V, Voisin B, Dewavrin F, Onimus T, Cantier M, Girardie P, Saulnier F, Urbina T, Nguyen Y, Druoton AL, Soudant M, Barraud D, Conrad M, Cravoisy-Popovic A, Nace L, Morisot A, Bollaert PE, Martin R, Bitker L, Richard JC, Brossier D, Goyer I, Marquis C, Lampin M, Duhamel A, Béhal H, Guérot E, Dhaoui T, Godeffroy V, Devouge E, Evrard D, Delepoulle F, Racoussot S, Grandbastien B, Lampin M, Heilbronner C, Roy E, Canet E, Masson A, Hadchouel-Duvergé A, Rigourd V, Delacroix E, Wroblewski I, Pin I, Ego A, Payen V, Debillon T, Millet A, De Montmollin E, Denot J, Berthelot V, Thueux E, Reymond M, De Larrard A, Amblard A, Leger PL, Aoul NT, Lemiale V, Oziel J, Voiriot G, Brule N, Moreau AS, Marhbène T, Sellami S, Jamoussi A, Ayed S, Mhiri E, Slim L, Khelil JB, Besbes M, Neuville M, Chawki S, Hamdi A, Ciroldi M, Cottereau A, Obadia E, Zerbib Y, Andrejak C, Ricome S, Dupont H, Baudin F, Timsit JF, Dureau P, Tanguy A, Arbelot C, Ben HK, Charfeddine A, Granger B, Laporte L, Hermetet C, Regaieg K, Khemakhem R, Sonneville R, Chelly H, Cheikh CM, Mountij H, Rghioui K, Haddad W, Cherkab R, Barrou H, Naima A, bennani OM, Regaieg K, Fayssoil A, Douib A, Samet A, Cungi PJ, Nguyen C, Cotte J, D’aranda E, Meaudre E, Avaro JP, Slaoui MT, Mokline A, Stojkovic T, Rahmani I, Laajili A, Amri H, Gharsallah L, Gasri B, Tlaili S, Hammouda R, Messadi AA, Behin A, Ogna A, Lofaso F, Laforet P, Wahbi K, Prigent H, Duboc D, Orlikowski D, Eymard B, Annane D, Le Guennec L, Cholet C, Bréchot N, Hekimian G, Besset S, Lebreton G, Nieszkowska A, Trouillet JL, Leprince P, Combes A, Luyt CE, Griton M, Sesay M, De Panthou NS, Bienvenu T, Biais M, Nouette-Gaulain K, Fossat G, Baudin F, Coulanges C, Bobet S, Dupont A, Courtes L, Benzekri D, Kamel T, Muller G, Bercault N, Barbier F, Runge I, Skarzynski M, Mathonnet A, Boulain T, Jouan Y, Teixera N, Hassen-Khodja C, Guillon A, Gaborit C, Grammatico-Guillon L, Rebière C, Azoulay E, Misset B, Ruckly S, Garrouste-Orgeas M, Kentish-Barnes N, Duranteau J, Thuong M, Joseph L, Renault A, Lesieur O, Larbi AGS, Viquesnel G, Zuber B, Marque S, Kandelman S, Pichon N, Floccard B, Galon M, Chevret S, Kentish-Barnes N, Seegers V, Legriel S, Jaber S, Lefrant JY, Reuter D, Guisset O, Cracco C, Seguin A, Durand-Gasselin J, Thirion M, Cohen-Solal Z, Foulgoc H, Rogier J, Delobbe E, Schortgen F, Asfar P, Julie BH, Grimaldi D, Fabien G, Anguel N, Sigismond L, Matthieu HL, Gonzalez F, François L, Guitton C, Schenck M, Jean-Marc D, Radermacher P, Kentish-Barnes N, Makunza JN, Nathalie MK, Pierre A, Adolphe KM, Mahieu R, Reydel T, Jamet A, Chudeau N, Huntzinger J, Grange S, Courte A, Lemarie J, Gibot S, Champey J, Dellamonica J, Du Cheyron D, Contou D, Tadié JM, Cour M, Beduneau G, Marchalot A, Guérin L, Jochmans S, Terzi N, Preau S, Brun-Buisson C, Dessap AM, Vedrenne-Cloquet M, Breinig S, Jung C, Brussieux M, Marcoux MO, Durrmeyer X, Blondé R, Angoulvant F, Grasset J, Naudin J, Dauger S, Remy S, Kolev-Descamp K, Demaret J, Monneret G, Javouhey E, Chomton M, Sauthier M, Vallieres E, Jouvet P, Geslain G, Guellec I, Rambaud J, Schmidt M, Schellongowski P, Dorget A, Patroniti N, Taccone FS, Miranda DR, Reuter J, Prodanovic H, Pierrot M, Balik M, Park S, Guérin C, Papazian L, Jean R, Ayzac L, Loundou A, Forel JM, Mezidi M, Aublanc M, Perinel-Ragey S, Lissonde F, Louf-Durier A, Tapponnier R, Yonis H, Coudroy R, Frat JP, Boissier F, Thille AW, Richard F, Le Gullou-Guillemette H, Fahri J, Kouatchet A, Bodet-Contentin L, Garot D, Le Pennec D, Vecellio L, Tavernier E, Dequin PF, Messika J, Martin Y, Maquigneau N, Puechberty C, Stoclin A, Villard S, Dechanet A, De Jong A, Monnin M, Girard M, Chanques G, Molinari N, Decavèle M, Campion S, Ainsouya R, Niérat MC, Raux M, Similowski T, Demoule A, Razazi K, Tchir M, May F, Carteaux G, Pauline RB, Marc A, Bedos JP, Mehrsa K, Mauger-Briche C, Mijon F, Trouiller P, Sztrymf B, Cretallaz P, Mermillod-Blondin R, Savary D, Sedghiani I, Doghri H, Jendoubi A, Hamdi D, Cherif MA, Hechmi YZE, Zouheir J, Persico N, Maltese F, Ferrigno C, Bablon A, Marmillot C, Roch A, Sedghiani I, Papin G, Gainnier M, Argaud L, Christophe A, Souweine B, Goldgran-Toledano D, Marcotte G, Dumenil AS, Carole S, Cecchini J, Tuffet S, Fartoukh M, Roux D, Thyrault M, Armand MD, Chauveau S, Wesner N, Monnier-Cholley L, Bigé N, Ait-Oufella H, Guidet B, Dubée V, Labroca P, Lemarié J, Chiesa G, Laroyenne I, Borrini L, Klotz R, Sy QP, Cristina MC, Paysant J, Fillâtre P, Gacouin A, Revest M, Tattevin P, Flecher E, Le Tulzo Y, Jamme M, Daviaud F, Marin N, Thy M, Duceau B, Ardisson F, Sandrine V, Venot M, Schlemmer B, Zafrani L, Pons S, Styfalova L, Bouadma L, Radjou A, Lebut J, Mourvillier B, Dorent R, Dilly MP, Nataf P, Wolff M, Le Gall A, Bourcier S, Tandjaoui-Lambiotte Y, Das V, Alves M, Bigé N, Kamilia C, Rania A, Baccouch N, Turki O, Ben HC, Bahloul M, Bouaziz M, Dupuis C, Perozziello A, Letheulle J, Valette M, Herrmann-Storck C, Crosby L, Elkoun K, Madeux B, Martino F, Migueres H, Piednoir P, Posch M, Thiery G, Huynh-Ky MT, Bouchard PA, Sarrazin JF, Lellouche F, Nay MA, Lortat-Jacob B, Rozec B, Colnot M, Belin N, Barrot L, Navellou JC, Patry C, Chaignat C, Claveau M, Claude F, Aubron C, Mcquilten Z, Bailey M, Board J, Buhr H, Cartwright B, Dennis M, Forrest P, Hodgson C, Mcilroy D, Murphy D, Murray L, Pellegrino V, Pilcher D, Sheldrake J, Tran H, Vallance S, Cooper J, Bombled C, Vidal C, Margetis D, Amour J, Coart D, Dubois J, Van Herpe T, Mesotten D, Bailly S, Lucet J, Lepape A, L’hériteau F, Aupée M, Bervas C, Boussat S, Berger-Carbonne A, Machut A, Savey A, Tudesq JJ, Valade S, Galicier L, De Bazelaire C, Munoz-Bongrand N, Mignard X, Biard L, Mokart D, Nyunga M, Bruneel F, Rabbat A, Perez P, Meert AP, Benoit D, Mariotte E, Ehooman F, Hamidfar-Roy R, Hourmant Y, Mailloux A, Beurton A, Teboul JL, Girroto V, Laura G, Richard C, Monnet X, Dubée V, Merdji H, Dang J, Preda G, Baudel JL, Desnos C, Zeitouni M, Belaroussi I, Parrot A, Blayau C, Fulgencio JP, Quesnel C, Labbe V, De Chambrun MP, Beloncle F, Merceron S, Fedun Y, Lecomte B, Devaquet J, Puidupin M, Verdière B, Amoura Z, Vuillard C, Xavier J, Bourlier D, David A, Caroline S, David M, Gerald S, Olivier S, Humbert M, Laurent S, Dujardin O, Bouglé A, Ait HN, Salem JE, El-Helali N, Coppere Z, Gibelin A, Taconet C, Djibre M, Maamar A, Colobert E, Fillatre P, Uhel F, Camus C, Moraly J, Dahoumane R, Maury E, Tan BK, Emmanuel V, Pauline M, Laurence P, Philippe P, Zahar JR, Catherine H, Christian P, Karim AB, Mounia H, Laura T, Rasoldier VH, Mager G, Eraldi JP, Gelinotte S, Bougerol F, Dehay J, Rigaud JP, Declercq PL, Michel J, Aissa N, Henard S, Guerci P, Latar I, Levy B, Girerd N, Kimmoun A, Abdallah SB, Nakaa S, Hraiech K, Braiek DB, Adhieb A, M’ghirbi A, Ousji A, Hammouda Z, Abroug F, Sellami W, Hajjej Z, Samoud W, Labbene I, Ferjani M, Medhioub FK, Allela R, Algia NB, Cherif S, Attia D, Herinjatovo A, Francois XL, Bouhouri MA, Slaoui MT, Soufi A, Khaleq K, Hamoudi D, Nsiri A, Harrar R, Maury E, Goursaud S, Gauberti M, Labeyrie PE, Gaberel T, Agin V, Maubert E, Vivien D, Gakuba C, Armel A, Abdou R, Kalouch S, Yaqini K, Chlilek A, Sellami W, Yedder SB, Tonnelier A, Hervé F, Halley G, Frances JL, Moriconi M, Saoli M, Garnero A, Demory D, Arnal JM, Canoville B, Daubin C, Brunet J, Ghezala HB, Snouda S, Ben CI, Kaddour M, Ouanes I, Marzouk M, Haniez F, Jaillet H, Maas H, Andrivet P, Darné C, Viau F, Ghezala HB, Ouanes I, Dangers L, Montlahuc C, Perbet S, Ouanes I, Hamouda Z, Nakee S, Ouanes-Besbes L, Meddeb K, Khedher A, Sma N, Ayachi J, Khelfa M, Fraj N, Lakhal HB, Hammed H, Boukadida R, Hafsa H, Chouchene I, Boussarsar M, Ben BD, Ouanes-Besbes L, Benatti K, Dafir A, Aissaoui W, Elallame W, Haddad W, Cherkab R, Elkettani C, Barrou L, Hamou ZA, Repessé X, Charron C, Aubry A, Paternot A, Maizel J, Slama M, Vieillard-Baron A, Trifi A, Abdellatif S, Fatnassi M, Daly F, Nasri R, Ismail KB, Lakhal SB, Bazalgette F, Daurat A, Roger C, Muller L, Doyen D, Plattier R, Robert A, Hyvernat H, Bernardin G, Jozwiak M, Gimenez J, Mercado P, Depret F, Tilouch N, Mater H, Habiba BSA, Jaoued O, Gharbi R, Hassen MF, Elatrous S, Pasquier P, Vuillemin Q, Schaal JV, Martinez T, Duron S, Trousselard M, Schwartzbrod PE, Baugnon T, Dupic L, Gout CD, De Saint Blanquat L, Séguret S, Le Ficher G, Orliaguet G, Hubert P, Bigé N, Leblanc G, Briand R, Brousse L, Brunet V, Chatelain L, Prat D, Jacobs F, Demars N, Hamzaoui O, Moneger G, Sztrymf B, Duburcq-Gury E, Satre-Buisson L, Duburcq T, Poissy J, Robriquet L, Jourdain M, Sécheresse T, Miquet M, Simond A, Usseglio P, Hamdaoui Y, Boussarsar M, Desailly V, Brun P, Iglesias P, Huet J, Masseran C, Claudon A, Ebeyer C, Truong T, Tesnière A, Mignon A, Gaudry S, Resiere D, Valentino R, Fabre J, Roze B, Ferge JL, Charbatier C, Marie S, Scholsser M, Aitsatou S, Raad M, Cabie A, Mehdaoui H, Cousin C, Rousseau C, Llitjos JF, Alby-Laurent F, Toubiana J, Belaidouni N, Cherruault M, Tamburini J, Bouscary D, Fert S, Delile E, Besnier E, Coquerel D, Nevière R, Richard V, Tamion F, Wei C, Louis H, Margaux S, Eliane A, Sophie O, Kimmoun A, Riad Z, Coroir M, Rémy B, Camille B, Joffre J, Aegerter P, Ilic D, Ginet M, Pignard C, Nguyen P, Mourey G, Samain E, Pili-Floury S, Jouffroy R, Nicolas C, Alvarez JC, Tomasso M, Philippe P, Raphalen JH, Frédéric JB, Vivien B, Pierre C, Baud F, Fredj H, Blel Y, Brahmi N, Ghezala HB, Hanak AS, Malissin I, Poupon J, Risede P, Chevillard L, Megarbane B, Barghouth M, M’rad A, Hmida MB, Thabet H, Liang H, Callebert J, Lagard C, Megarbane B, Habacha S, Chatbri B, Camillerapp C, Labat L, Soichot M, Garçon P, Goury A, Kerdjana L, Voicu S, Deye N, Megarbane B, Armel A, Anas B, Othman M, Moumine S, Kalouch S, Yakini KK, Chlilek A, Hajji A, Louati A, Khaldi A, Borgi A, Ghali N, Bouziri A, Menif K, Ben JN, Armel A, Brochon J, Dumitrescu M, Thévenot S, Saulnier JP, Husseini K, Laland C, Cremniter J, Bousseau A, Castel O, Brémaud-Csizmadia C, Diss M, Portefaix A, Berthiller J, Gillet Y, Aoul NT, Douah A, Addou Z, Youbi H, Moussati M, Belhabiche K, Mir S, Abada S, Amel Z, Aouffen N, Bouzit Z, Grati AH, Dhonneur GF, Boussarsar M, Lau N, Mezhari I, Roucaud N, Le Meur M, Paulet R, Coudray JM, Ghomari WI, Boumlik R, Peigne V, Daban JL, Boutonnet M, Lenoir B, Yassine H, Mohamed CC, Khalid A, Ihssan M, Said E, Said S, Jazia AB, Fatima J, Wafa S, Maha B, Khaoula BA, Sami T, Abdallah Taeib B, Medhioub FK, Rollet-Cohen V, Sachs P, Merchaoui Z, Renolleau S, Oualha M, Eloi M, Jean S, Demoulin M, Valentin C, Guilbert J, Walti H, Carbajal R, Leger PL, Karaca-Altintas Y, Botte A, Labreuche J, Drumez E, Devos P, Bour F, Leclerc F, Ahmed A, khaled M, Louati A, Aida B, Ammar K, Narjess G, Ahmed H, Asma B, Jaballah NB, Leger PL, Pansiot J, Besson V, Palmier B, Baud O, Cauli B, Charriaut-Marlangue C, Mansuy A, Michel F, Le Bel S, Boubnova J, Ughetto F, Ovaert C, Fouilloux V, Paut O, Jacquet-Lagrèze M, Tiebergien N, Hanna N, Evain JN, Baudin F, Courtil-Teyssedre S, Bompard D, Lilot M, Chardonal L, Fellahi JL, Claverie C, Pouessel G, Dorkenoo A, Renaudin JM, Eb M, Deschildre A, Leteurtre S, Yassine H, Kamal B, Adil O, Ouafa A, Mouhamed M, Rachid C, Lahoucine B, Dachraoui F, Nakkaa S, Zaineb H, Mlika D. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress. Ann Intensive Care 2017. [PMCID: PMC5225387 DOI: 10.1186/s13613-016-0223-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
37
|
Joosten A, Alexander B, Delaporte A, Lilot M, Rinehart J, Cannesson M. Perioperative goal directed therapy using automated closed-loop fluid management: the future? Anaesthesiol Intensive Ther 2016; 47:517-23. [PMID: 26578397 DOI: 10.5603/ait.a2015.0069] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 09/29/2015] [Accepted: 10/25/2015] [Indexed: 11/25/2022] Open
Abstract
Although surgery has become much safer, it has also becoming increasingly more complex and perioperative complications continue to impact millions of patients worldwide each year. Perioperative hemodynamic optimization utilizing Goal Directed Therapy (GDT) has attracted considerable interest within the last decade due to its ability to improve postoperative short and long-term outcomes in patients undergoing higher risk surgeries. The concept of GDT in this context can be loosely defined as collecting data from minimally invasive hemodynamic monitors with the intention of using such data (flow-related parameters and/or dynamic parameters of fluid responsiveness) to titrate therapeutic interventions (intravenous fluids and/or inotropic therapy administration) with the ultimate aim of optimizing end organ tissue perfusion. Recently, the increasing amount of evidence supporting the implementation of GDT strategies has been considered so robust as to allow for the creation of national recommendations in the United Kingdom (UK), France, and Europe. These recommendations from such influential scientific societies and the potential clinical and economic benefits of GDT protocols need to also be examined within the current shift from a "pay for service" to a "pay for performance" health care system. This shift is strongly encouraged within emerging systems such as the Perioperative Surgical Home (PSH) paradigm from the United States. As a result, hospitals and clinicians around the world have become increasingly incentivized to implement perioperative hemodynamic optimization using GDT strategies within their departments. Unfortunately, its adoption continues to be quite limited and a lack of standardized criteria for perioperative fluid administrations has resulted in significant clinical variability among practitioners. This current review will provide a brief up-to-date overview of GDT, discuss current clinical practice, analyze why implementation has been limited and finally, describe the newer closed-loop GDT concept along with its potential risks and benefits.
Collapse
Affiliation(s)
- Alexandre Joosten
- Department of Anaesthesiology, CUB Erasme, Université Libre de Bruxelles, Belgium.
| | | | | | | | | | | |
Collapse
|
38
|
Beissel A, Lilot M, Bauer C, Beaulieu K, Hanacek C, Desebbe O, Cannesson M, Lehot JJ, Ricks C. A trans-atlantic high-fidelity mannequin based telesimulation experience. Anaesth Crit Care Pain Med 2016; 36:239-241. [PMID: 27720982 DOI: 10.1016/j.accpm.2016.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/28/2016] [Accepted: 09/02/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Anne Beissel
- Department of neonatal intensive care unit, Femme-Mere-Enfant hospital, hospices civils de Lyon, 59, boulevard Pinel, 69500 Bron, Lyon, France.
| | - Marc Lilot
- Department of paediatric anaesthesia and intensive care medicine, Femme-Mere-Enfant hospital, hospices civils de Lyon, 59, boulevard Pinel, 69500 Bron, France.
| | - Christian Bauer
- Department of anaesthesia and critical care, Croix-Rousse hospital, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon, France.
| | - Keith Beaulieu
- School of medicine, university of California, 836, Health Science Road, 92697 Irvine, CA, USA.
| | - Christopher Hanacek
- School of medicine, university of California, 836, Health Science Road, 92697 Irvine, CA, USA.
| | - Olivier Desebbe
- Université Lyon 1, EA4169, SFR Lyon-Est Santé, Inserm US 7, CNRS UMS 3453, clinique de la Sauvegarde, Lyon, France.
| | - Maxime Cannesson
- Department of anesthesiology and perioperative medicine, David Geffen school of medicine, UCLA, Los Angeles, California, USA.
| | - Jean-Jacques Lehot
- Department of anaesthesia and perioperative care, Claude-Bernard-Lyon 1 university, Pierre-Wertheimer hospital, hospices civils de Lyon, Lyon, France.
| | - Cameron Ricks
- Department of aneasthesiology and perioperative care, university of California, 92697 Irvine, CA, USA.
| |
Collapse
|
39
|
Bos L, Schouten L, van Vught L, Wiewel M, Ong D, Cremer O, Artigas A, Martin-Loeches I, Hoogendijk A, van der Poll T, Horn J, Juffermans N, Schultz M, de Prost N, Pham T, Carteaux G, Dessap AM, Brun-Buisson C, Fan E, Bellani G, Laffey J, Mercat A, Brochard L, Maitre B, Howells PA, Thickett DR, Knox C, Park DP, Gao F, Tucker O, Whitehouse T, McAuley DF, Perkins GD, Pham T, Laffey J, Bellani G, Fan E, Pisani L, Roozeman JP, Simonis FD, Giangregorio A, Schouten LR, Van der Hoeven SM, Horn J, Neto AS, Festic E, Dondorp AM, Grasso S, Bos LD, Schultz MJ, Koster-Brouwer M, Verboom D, Scicluna B, van de Groep K, Frencken J, Schultz M, van der Poll T, Bonten M, Cremer O, Ko JI, Kim KS, Suh GJ, Kwon WY, Kim K, Shin JH, Ranzani OT, Prina E, Menendez R, Ceccato A, Mendez R, Cilloniz C, Gabarrus A, Ferrer M, Torres A, Urbano A, Zhang LA, Swigon D, Pike F, Parker RS, Clermont G, Scheer C, Kuhn SO, Modler A, Vollmer M, Fuchs C, Hahnenkamp K, Rehberg S, Gründling M, Taggu A, Darang N, Öveges N, László I, Tánczos K, Németh M, Lebák G, Tudor B, Érces D, Kaszaki J, Huber W, Oerding H, Holst R, Toft P, Nedergaard HK, Haberlandt T, Jensen HI, Toft P, Park S, Kim S, Cho YJ, Trásy D, Lim YJ, Chan A, Tang S, Nunes SL, Forsberg S, Blomqvist H, Berggren L, Sörberg M, Sarapohja T, Wickerts CJ, Molnár Z, Hofhuis JGM, Rose L, Blackwood B, Akerman E, Mcgaughey J, Egerod I, Fossum M, Foss H, Georgiou E, Graff HJ, Ferrara G, Kalafati M, Sperlinga R, Schafer A, Wojnicka AG, Spronk PE, Zand F, Khalili F, Afshari R, Sabetian G, Masjedi M, Edul VSK, Maghsudi B, Khodaei HH, Javadpour S, Petramfar P, Nasimi S, Vazin A, Ziaian B, Tabei H, Gunther A, Hansen JO, Canales HS, Sackey P, Storm H, Bernhardsson J, Sundin Ø, Bjärtå A, Bienert A, Smuszkiewicz P, Wiczling P, Przybylowski K, Borsuk A, Martins E, Trojanowska I, Matysiak J, Kokot Z, Paterska M, Grzeskowiak E, Messina A, Bonicolini E, Colombo D, Moro G, Romagnoli S, Canullán C, De Gaudio AR, Corte FD, Romano SM, Silversides JA, Major E, Mann EE, Ferguson AJ, Mcauley DF, Marshall JC, Blackwood B, Murias G, Fan E, Diaz-Rodriguez JA, Silva-Medina R, Gomez-Sandoval E, Gomez-Gonzalez N, Soriano-Orozco R, Gonzalez-Carrillo PL, Hernández-Flores M, Pilarczyk K, Lubarksi J, Pozo MO, Wendt D, Dusse F, Günter J, Huschens B, Demircioglu E, Jakob H, Palmaccio A, Dell’Anna AM, Grieco DL, Torrini F, Eguillor JFC, Iaquaniello C, Bongiovanni F, Antonelli M, Toscani L, Antonakaki D, Bastoni D, Aya HD, Rhodes A, Cecconi M, Jozwiak M, Buscetti MG, Depret F, Teboul JL, Alphonsine J, Lai C, Richard C, Monnet X, László I, Demeter G, Öveges N, Tánczos K, Ince C, Németh M, Trásy D, Kertmegi I, Érces D, Tudor B, Kaszaki J, Molnár Z, Hasanin A, Lotfy A, El-adawy A, Dubin A, Nassar H, Mahmoud S, Abougabal A, Mukhtar A, Quinty F, Habchi S, Luzi A, Antok E, Hernandez G, Lara B, Aya HD, Enberg L, Ortega M, Leon P, Kripper C, Aguilera P, Kattan E, Bakker J, Huber W, Lehmann M, Sakka S, Rhodes A, Bein B, Schmid RM, Preti J, Creteur J, Herpain A, Marc J, Zogheib E, Trojette F, Bar S, Kontar L, Fletcher N, Titeca D, Richecoeur J, Gelee B, Verrier N, Mercier R, Lorne E, Maizel J, Dupont H, Slama M, Abdelfattah ME, Grounds RM, Eladawy A, Elsayed MAA, Mukhtar A, Montenegro AP, Zepeda EM, Granillo JF, Sánchez JSA, Alejo GC, Cabrera AR, Montoya AAT, Cecconi M, Lee C, Hatib F, Cannesson M, Theerawit P, Morasert T, Sutherasan Y, Zani G, Mescolini S, Diamanti M, Righetti R, Jacquet-Lagrèze M, Scaramuzza A, Papetti M, Terenzoni M, Gecele C, Fusari M, Hakim KA, Chaari A, Ismail M, Elsaka AH, Mahmoud TM, Riche M, Bousselmi K, Kauts V, Casey WF, Hutchings SD, Naumann D, Wendon J, Watts S, Kirkman E, Jian Z, Buddi S, Schweizer R, Lee C, Settels J, Hatib F, Pinsky MR, Bertini P, Guarracino F, Trepte C, Richter P, Haas SA, Eichhorn V, Portran P, Kubitz JC, Reuter DA, Soliman MS, Hamimy WI, Fouad AZ, Mukhtar AM, Charlton M, Tonks L, Mclelland L, Coats TJ, Fornier W, Thompson JP, Sims MR, Williams D, Roushdy DZ, Soliman RA, Nahas RA, Arafa MY, Hung WT, Chiang CC, Huang WC, Lilot M, Lin KC, Lin SC, Cheng CC, Kang PL, Wann SR, Mar GY, Liu CP, Carranza ML, Fernandez HS, Roman JAS, Neidecker J, Lucena F, Garcia AC, Vazquez AL, Serrano AL, Moreira LS, Vidal-Perez R, Herranz UA, Acuna JMG, Gil CP, Allut JLG, Fellahi JL, Sedes PR, Lopez CM, Paz ES, Rodriguez CG, Gonzalez-Juanatey JR, Vallejo-Baez A, de la Torre-Prados MV, Nuevo-Ortega P, Fernández-Porcel A, Cámara-Sola E, Escoresca-Ortega A, Tsvetanova-Spasova T, Rueda-Molina C, Salido-Díaz L, García-Alcántara A, Aron J, Marharaj R, Gervasio K, Bottiroli M, Mondino M, De Caria D, Gutiérrez-Pizarraya A, Calini A, Montrasio E, Milazzo F, Gagliardone MP, Vallejo-Báez A, de la Torre-Prados MV, Nuevo-Ortega P, Fernández-Porcel A, Cámara-Sola E, Tsvetanova-Spasova T, Charris-Castro L, Rueda-Molina C, Salido-Díaz L, García-Alcántara A, Moreira LS, Vidal-Perez R, Anido U, Gil CP, Acuna JMG, Sedes PR, Lopez CM, Corcia-Palomo Y, Paz ES, Allut JLG, Rodriguez CG, Gonzalez-Juanatey JR, Hamdaoui Y, Khedher A, Cheikh-Bouhlel M, Ayachi J, Meddeb K, Sma N, Fernandez-Delgado E, Fraj N, Aicha NB, Romdhani S, Bouneb R, Chouchene I, Boussarsar M, Dela Cruz MPRDL, Bernardo JM, Galfo F, Dyson A, Garnacho-Montero J, Singer M, Marino A, Dyson A, Singer M, Chao CC, Hou P, Huang WC, Hung CC, Chiang CH, Hung WT, Roger C, Lin KC, Lin SC, Liou YJ, Hung SM, Lin YS, Cheng CC, Kuo FY, Chiou KR, Chen CJ, Yan LS, Muller L, Liu CY, Wang HH, Kang PL, Chen HL, Ho CK, Mar GY, Liu CP, Grewal S, Gopal S, Corbett C, Elotmani L, Wilson A, Capps J, Ayoub W, Lomas A, Ghani S, Moore J, Atkinson D, Sharman M, Swinnen W, Pauwels J, Lipman J, Mignolet K, Pannier E, Koch A, Sarens T, Temmerman W, Elmenshawy AM, Fayed AM, Elboriuny M, Hamdy E, Zakaria E, Lefrant JY, Falk AC, Petosic A, Olafsen K, Wøien H, Flaatten H, Sunde K, Agra JJC, Cabrera JLS, Santana JDM, Alzola LM, Roberts JA, Pérez HR, Pires TC, Calderón H, Pereira A, Castro S, Granja C, Norkiene I, Urbanaviciute I, Kezyte G, Ringaitiene D, Muñoz-Bermúdez R, Jovaisa T, Vogel G, Johansson UB, Sandgren A, Svensen C, Joelsson-Alm E, Leite MA, Murbach LD, Osaku EF, Costa CRLM, Samper M, Pelenz M, Neitzke NM, Moraes MM, Jaskowiak JL, Silva MMM, Zaponi RS, Abentroth LRL, Ogasawara SM, Jorge AC, Duarte PAD, Climent C, Murbach LD, Leite MA, Osaku EF, Barreto J, Duarte ST, Taba S, Miglioranza D, Gund DP, Lordani CF, Costa CRLM, Vasco F, Ogasawara SM, Jorge AC, Duarte PAD, Vollmer H, Gager M, Waldmann C, Mazzeo AT, Tesio R, Filippini C, Vallero ME, Sara V, Giolitti C, Caccia S, Medugno M, Tenaglia T, Rosato R, Mastromauro I, Brazzi L, Terragni PP, Urbino R, Fanelli V, Luque S, Ranieri VM, Mascia L, Ballantyne J, Paton L, Mackay A, Perez-Teran P, Roca O, Ruiz-Rodriguez JC, Zapatero A, Serra J, Campillo N, Masclans JR, Bianzina S, Cornara P, Rodi G, Tavazzi G, Pozzi M, Iotti GA, Mojoli F, Braschi A, Vishnu A, Cerrato SG, Buche D, Pande R, Moolenaar DLJ, Bakhshi-Raiez F, Dongelmans DA, de Keizer NF, de Lange DW, Fernández IF, Baño DM, Moreno JLB, Masclans JR, Rubio RJ, Scott J, Phelan D, Morely D, O’Flynn J, Stapleton P, Lynch M, Marsh B, Carton E, O’Loughlin C, Alvarez-Lerma F, Cheng KC, Sung MI, Elghonemi MO, Saleh MH, Meyhoff TS, Krag M, Hjortrup PB, Perner A, Møller MH, Öhman T, Brugger SC, Sigmundsson T, Redondo E, Hallbäck M, Suarez-Sipmann F, Björne H, Sander CH, Cressoni M, Chiumello D, Chiurazzi C, Brioni M, Jimenez GJ, Algieri I, Guanziroli M, Vergani G, Tonetti T, Tomic I, Colombo A, Crimella F, Carlesso E, Colombo A, Gasparovic V, Torner MM, Gattinoni L, El-Sherif R, Al-Basser MA, Raafat A, El-Sherif A, Simonis FD, Schouten LRA, Cremer OL, Ong DSY, Amoruso G, Cabello JT, Cinnella G, Schultz MJ, Bos LDJ, Huber W, Schmidle P, Findeisen M, Hoppmann P, Jaitner J, Brettner F, Schmid RM, Garrido BB, Lahmer T, Festic E, Rajagopalan G, Bansal V, Frank R, Hinds R, Levitt J, Siddiqui S, Gilbert JP, Sim K, Casals XN, Wang CH, Hu HC, Li IJ, Tang WR, Kao KC, Persona P, De Cassai A, Franco M, Facchin F, Ori C, Gaite FB, Rossi S, Goffi A, Li SH, Hu HC, Chiu LC, Hung CY, Chang CH, Kao KC, Ruiz BL, Varas JL, Vidal MV, Montero RM, Delgado CP, Navarrete O, Mezquita MV, Peces EA, Nakamura MAM, Hajjar LA, Galas FRBG, Ortiz TA, Amato MBP, Martínez MP, Bitker L, Costes N, Le Bars D, Lavenne F, Mojgan D, Richard JC, Chiurazzi C, Cressoni M, Massari D, Guanziroli M, Gusarov V, Vergani G, Gotti M, Brioni M, Algieri I, Cadringher P, Tonetti T, Chiumello D, Gattinoni L, Zerman A, Türkoğlu M, Shilkin D, Arık G, Yıldırım F, Güllü Z, Kara I, Boyacı N, Aydoğan BB, Gaygısız Ü, Gönderen K, Aygencel G, Aydoğdu M, Dementienko M, Ülger Z, Gürsel G, Riera J, Toral CM, Mazo C, Martínez M, Baldirà J, Lagunes L, Roman A, Deu M, Nesterova E, Rello J, Levine DJ, Mohus RM, Askim Å, Paulsen J, Mehl A, Dewan AT, Damås JK, Solligård E, Åsvold BO, Lashenkova N, Paulsen J, Askim Å, Mohus RM, Mehl A, DeWan A, Solligård E, Damås JK, Åsvold BO, Aktepe O, Kara A, Kuzovlev A, Yeter H, Topeli A, Norrenberg M, Devroey M, Khader H, Preiser JC, Tang Z, Qiu C, Tong L, Cai C, Zamyatin M, Theodorakopoulou M, Diamantakis A, Kontogiorgi M, Chrysanthopoulou E, Christodoulopoulou T, Frantzeskaki F, Lygnos M, Apostolopoulou O, Armaganidis A, Moon JY, Demoule A, Park MR, Kwon IS, Chon GR, Ahn JY, Kwon SJ, Chang YJ, Lee JY, Yoon SY, Lee JW, Kostalas M, Carreira S, Mckinlay J, Kooner G, Dudas G, Horton A, Kerr C, Karanjia N, Creagh-Brown B, Altintas ND, Izdes S, Keremoglu O, Lavault S, Alkan A, Neselioglu S, Erel O, Tardif N, Gustafsson T, Rooyackers O, MacEachern KN, Traille M, Bromberg I, Lapinsky SE, Palancca O, Moore MJ, Tang Z, Cai C, Tong L, García-Garmendia JL, Villarrasa-Clemente F, Maroto-Monserrat F, Rufo-Tejeiro O, Jorge-Amigo V, Sánchez-Santamaría M, Morawiec E, Colón-Pallarés C, Barrero-Almodóvar A, Gallego-Lara S, Anthon CT, Müller RB, Haase N, Møller K, Hjortrup PB, Wetterslev J, Perner A, Mayaux J, Nakanishi M, Kuriyama A, Fukuoka T, Abd el Halim MA, Elsaid hafez MH, Moktar AM, Eladawy A, Elazizy HM, Hakim KA, Chaari A, Arnulf I, Elbahr M, Ismail M, Mahmoud T, Kauts V, Bousselmi K, Khalil E, Casey W, Zaky SH, Rizk A, Elghonemi MO, Similowski T, Ahmed R, Vieira JCF, Souza RB, Liberatore AMA, Koh IHJ, Ospina-Tascón GA, Marin AFG, Echeverry GJ, Bermudez WF, Madriñan-Navia HJ, Rasmussen BS, Valencia JD, Quiñonez E, Marulanda A, Arango-Dávila CA, Bruhn A, Hernandez G, De Backer D, Cortes DO, Su F, Vincent JL, Maltesen RG, Creteur J, Tullo L, Mirabella L, Di Molfetta P, Cinnella G, Dambrosio M, Lujan CV, irigoyen JL, Cartanya ferré M, García RC, Hanifa M, Mukhtar A, Ahmed M, El Ayashi M, Hasanin A, Ayman E, Salem M, Eladawy A, Fathy S, Nassar H, Zaghlol A, Pedersen S, Arzapalo MFA, Valsø Å, Sunde K, Rustøen T, Schou-Bredal I, Skogstad L, Tøien K, Padilla C, Palmeiro Y, Egbaria W, Kristensen SR, Kigli R, Maertens B, Blot K, Blot S, Santana-Santos E, dos Santos ER, Ferretti-Rebustini REDL, dos Santos RDCCDO, Verardino RGS, Bortolotto LA, Wimmer R, Doyle AM, Naldrett I, Tillman J, Price S, Shrestha S, Pearson P, Greaves J, Goodall D, Berry A, Richardson A, Panigada M, Odundo GO, Omengo P, Obonyo P, Chanzu NM, Kleinpell R, Sarris SJ, Nedved P, Heitschmidt M, Ben-Ghezala H, Snouda S, Bassi GL, Djobbi S, Ben-Ghezala H, Snouda S, Rose L, Adhikari NKJ, Leasa D, Fergusson D, Mckim DA, Weblin J, Tucker O, Ranzani OT, McWilliams D, Doesburg F, Cnossen F, Dieperink W, Bult W, Nijsten MWN, Galvez-Blanco GA, Zepeda EM, Guzman CIO, Sánchez JSA, Kolobow T, Granillo JF, Stroud JS, Thomson R, Llaurado-Serra M, Lobo-Civico A, Pi-Guerrero M, Blanco-Sanchez I, Piñol-Tena A, Paños-Espinosa C, Alabart-Segura Y, Zanella A, Coloma-Gomez B, Fernandez-Blanco A, Braga-Dias F, Treso-Geira M, Valeiras-Valero A, Martinez-Reyes L, Sandiumenge A, Jimenez-Herrera MF, Prada R, Juárez P, Cressoni M, Argandoña R, Díaz JJ, Ramirez CS, Saavedra P, Santana SR, Obukhova O, Kashiya S, Kurmukov IA, Pronina AM, Simeone P, Berra L, Puybasset L, Auzias G, Coulon O, Lesimple B, Torkomian G, Velly L, Bienert A, Bartkowska-Sniatkowska A, Wiczling P, Szerkus O, Parrini V, Siluk D, Bartkowiak-Wieczorek J, Rosada-Kurasinska J, Warzybok J, Borsuk A, Kaliszan R, Grzeskowiak E, Caballero CH, Roberts S, Isgro G, Kandil H, Hall D, Guillaume G, Passouant O, Dumas F, Bougouin W, Champigneulle B, Arnaout M, Chelly J, Chiche JD, Varenne O, Salati G, Mira JP, Marijon E, Cariou A, Beerepoot M, Touw HR, Parlevliet K, Boer C, Elbers PW, Tuinman PR, Reina ÁJR, Livigni S, Palomo YC, Bermúdez RM, Villén LM, García IP, Izurieta JRN, Bernal JBP, Jiménez FJJ, Cota-Delgado F, de la Torre-Prados MV, Fernández-Porcel A, Amatu A, Nuevo-Ortega P, Cámara-Sola E, Tsvetanova-Spasova T, Rueda-Molina C, Salido-Díaz L, García-Alcántara A, Kaneko T, Tanaka H, Kamikawa M, Karashima R, Andreotti A, Iwashita S, Irie H, Kasaoka S, Arola O, Laitio R, Saraste A, Airaksinen J, Pietilä M, Hynninen M, Wennervirta J, Tagliaferri F, Bäcklund M, Ylikoski E, Silvasti P, Nukarinen E, Grönlund J, Harjola VP, Niiranen J, Korpi K, Varpula M, Roine RO, Moise G, Laitio T, Salah S, Hassen BG, Fehmi AM, Kim S, Hsu YC, Barea-Mendoza J, García-Fuentes C, Castillo-Jaramillo M, Dominguez-Aguado H, Mercurio G, Viejo-Moreno R, Terceros-Almanza L, Aznárez SB, Mudarra-Reche C, Xu W, Chico-Fernández M, Montejo-González JC, Crewdson K, Thomas M, Merghani M, Costa A, Fenner L, Morgan P, Lockey D, van Lieshout EJ, Oomen B, Binnekade JM, Dongelmans DA, de Haan RJ, Juffermans NP, Vroom MB, Vezzani A, Algarte R, Martínez L, Sánchez B, Romero I, Martínez F, Quintana S, Trenado J, Sheikh O, Pogson D, Clinton R, Lindau S, Riccio F, Gemmell L, MacKay A, Arthur A, Young L, Sinclair A, Markopoulou D, Venetsanou K, Filippou L, Salla E, Babel J, Stratouli S, Alamanos I, Guirgis AH, Rodriguez RG, Lorente MJF, Guarasa IM, Ukere A, Meisner S, Greiwe G, Opitz B, Cavana M, Benten D, Nashan B, Fischer L, Trepte CJC, Reuter DA, Haas SA, Behem CR, Tavazzi G, Ana B, Vazir A, Consonni D, Gibson D, Price S, Masjedi M, Hadavi MR, alam MR, Sasani MR, Parenti N, Agrusta F, Palazzi C, Pifferi B, Pesenti A, Sganzerla R, Tagliazucchi F, Luciani A, Möller M, Müller-Engelmann J, Montag G, Adams P, Lange C, Neuzner J, Gradaus R, Gattinoni L, Wodack KH, Thürk F, Waldmann AD, Grässler MF, Nishimoto S, Böhm SH, Kaniusas E, Reuter DA, Trepte CJ, Sigmundsson T, Torres A, Öhman T, Redondo E, Hallbäck M, Wallin M, Sipman FS, Oldner A, Sander CH, Björne H, Colinas L, Hernandez G, Mansouri P, Vicho R, Serna M, Cuena R, Canabal A, Chaari A, Hakim KA, Etman M, El Bahr M, El Sakka A, Bousselmi K, Zand F, Arali A, Kauts V, Casey WF, Bond O, De Santis P, Iesu E, Franchi F, Vincent JL, Creteur J, Scolletta S, Zahed L, Taccone FS, Marutyan Z, Hamidova L, Shakotko A, Movsisyan V, Uysupova I, Evdokimov A, Petrikov S, Gonen C, Haftacı E, Dehghanrad F, Balci C, Calvo FJR, Bejarano N, Baladron V, Villazala R, Redondo J, Padilla D, Villarejo P, Akcan-Arikan A, Kennedy CE, Bahrani M, Arzapalo MFA, Gomez-Gonzalez C, Mas-Font S, Puppo-Moreno A, Herrera-Gutierrez M, Garcia-Garcia M, Aldunate-Calvo S, Plata-Menchaca EP, Pérez-Fernández XL, Estruch M, Ghorbani M, Betbese-Roig A, Campos PC, Lora MR, Gaibor NDT, Medina RSC, Sanguino VDG, Casanova EJ, Riera JS, Kritmetapak K, Peerapornratana S, Cambiaghi B, Kittiskulnam P, Dissayabutra T, Tiranathanagul K, Susantithapong P, Praditpornsilpa K, Tungsanga K, Eiam-Ong S, Srisawat N, Winkelmann T, Busch T, Moerer O, Meixensberger J, Bercker S, Cabeza EMF, Sánchez MS, Giménez NC, Melón CG, de Lucas EH, Estañ PM, Bernal MH, de Lorenzo y Mateos AG, Mauri T, Ergin B, Guerci P, Specht PAC, Ince Y, Ince C, Balik M, Zakharchenko M, Los F, Brodska H, de Tymowski C, Kunze-Szikszay N, Augustin P, Desmard M, Montravers P, Stapel SN, de Boer R, Oudemans HM, Hollinger A, Schweingruber T, Jockers F, Dickenmann M, Ritter C, Siegemund M, Runciman N, Ralston M, Appleton R, Mauri T, Alban L, Turrini C, Sasso T, Langer T, Panigada M, Pesenti A, Taccone P, Carlesso E, Marenghi C, Grasselli G, Pesenti A, Wibart P, Reginault T, Garcia M, Barbrel B, Benard A, Quintel M, Bader C, Vargas F, Bui HN, Hilbert G, Simón JMS, Sánchez PC, Ferrón FR, de Acilu MG, Marin J, Antonia V, Vilander LM, Ruano L, Monica M, Ferrer R, Masclans JR, Roca O, Hong G, Kim DH, Kim YS, Park JS, Jee YK, Kaunisto MA, xiang ZY, Jia-xing W, dan WX, long NW, Yu W, Yan Z, Cheng X, Kobayashi T, Onodera Y, Akimoto R, Vaara ST, Sugiura A, Suzuki H, Iwabuchi M, Nakane M, Kawamae K, Sanchez PC, Rodriguez MDB, Delgado MR, Sánchez VMDP, Gómez AM, Pettilä V, Simón JMS, Beuret P, Fortes C, Lauer M, Reboul M, Chakarian JC, Fabre X, Philippon-Jouve B, Devillez S, Clerc M, Mulier JLGH, Rittayamai N, Sklar M, Dres M, Rauseo M, Campbell C, West B, Tullis DE, Brochard L, Onodera Y, Akimoto R, Rozemeijer S, Suzuki H, Okada M, Nakane M, Kawamae K, Ahmad N, Wood M, Glossop A, Lucas JH, Ortiz AB, Alonso DC, Spoelstra-de Man AME, De Pablo Sánchez R, González LR, Costa R, Spinazzola G, Pizza A, Ferrone G, Rossi M, Antonelli M, Conti G, Ribeiro H, Elbers PE, Alves J, Sousa M, Reis P, Socolovsky CS, Cauley RP, Frankel JE, Beam AL, Olaniran KO, Gibbons FK, Christopher KB, Tuinman PR, Pennington J, Zolfaghari P, King HS, Kong HHY, Shum HP, Yan WW, Kaymak C, Okumus N, Sari A, Erdogdu B, de Waard MC, Aksun S, Basar H, Ozcan A, Ozcan N, Oztuna D, Malmgren JA, Lundin S, Torén K, Eckerström M, Wallin A, Oudemans-van Straaten HM, Waldenström AC, Riccio FC, Pogson D, Antonio ACP, Leivas AF, Kenji F, James E, Morgan P, Carroll G, Gemmell L, Liberatore AMA, MacKay A, Wright C, Ballantyne J, Jonnada S, Gerrard CS, Jones N, Salciccioli JD, Marshall DC, Komorowski M, Hartley A, Souza RB, Sykes MC, Goodson R, Shalhoub J, Villanueva JRF, Garda RF, Lago AML, Ruiz ER, Vaquero RH, Rodríguez CG, Pérez EV, Martins AMCRPF, Hilasque C, Oliva I, Sirgo G, Martin MC, Olona M, Gilavert MC, Bodí M, Ebm C, Aggarwal G, Huddart S, Vieira JCF, Quiney N, Cecconi M, Fernandes SM, Silva JS, Gouveia J, Silva D, Marques R, Bento H, Alvarez A, Silva ZC, Koh IHJ, Diaz DD, Martínez MV, Herrejon EP, de la Gandara AM, Gonzalo G, Lopez MA, de Gopegui Miguelena PR, Matilla CIB, Chueca PS, Longares MDCR, Martínez MG, Abril RR, Aguilar ALR, de Murillas RGL, Fernández RF, Laborías PM, Castellanos MAD, Laborías MEM, Cho J, Kim J, Park J, Sánchez RJ, Woo S, West T, Powell E, Rimmer A, Orford C, Jones N, Williams J, Matilla CIB, de Gopegui Miguelena PR, Chueca PS, Gascón LM, Abril RR, Longares MDCR, Aguilar ALR, de Murillas RGL, Bourne RS, Shulman R, Tomlin M, Mills GH, Borthwick M, Berry W, Mulero MDR, Huertas DG, Manzano F, Villagrán-Ramírez F, Ruiz-Perea A, Rodríguez-Mejías C, Santiago-Ruiz F, Colmenero-Ruiz M, König C, Matt B, Kortgen A, Freire AO, Hartog CS, Wong A, Balan C, Barker G, Srisawat N, Peerapornratana S, Laoveeravat P, Tachaboon S, Eiam-ong S, Paratz J, Muñoz AO, Kayambu G, Boots R, Arzapalo MFA, Vlasenko R, Gromova E, Loginov S, Kiselevskiy M, Dolgikova Y, Tang KB, Chau CM, Acebes SR, Lam KN, Gil E, Suh GY, Park CM, Park J, Chung CR, Lee CT, Chao A, Shih PY, Chang YF, Martínez ÁF, Lai CH, Hsu YC, Yeh YC, Cheng YJ, Colella V, Zarrillo N, D’Amico M, Forfori F, Pezza B, Laddomada T, Aliaga SM, Beltramelli V, Pizzaballa ML, Doronzio A, Balicco B, Kiers D, van der Heijden W, Gerretsen J, de Mast Q, el Messaoudi S, Rongen G, Para LH, Gomes M, Kox M, Pickkers P, Riksen NP, Kashiwagi Y, Okada M, Hayashi K, Inagaki Y, Fujita S, Nakamae MN, Payá JM, Kang YR, Souza RB, Liberatore AMA, Koh IHJ, Blet A, Sadoune M, Lemarié J, Bihry N, Bern R, Polidano E, Mulero FR, Merval R, Launay JM, Lévy B, Samuel JL, Mebazaa A, Hartmann J, Harm S, Weber V, Guerci P, Ince Y, Heeman P, Ergin B, Ince C, Uz Z, Massey M, Ince Y, Papatella R, Bulent E, Guerci P, Toraman F, Ince C, Longbottom ER, Torrance HD, Owen HC, Hinds CJ, Pearse RM, O’Dywer MJ, Trogrlic Z, van der Jagt M, Lingsma H, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, van Achterberg T, Bakker J, Gommers DAMPJ, Ista E, Krajčová A, Waldauf P, Duška F, Shah A, Roy N, McKechnie S, Doree C, Fisher S, Stanworth SJ, Jensen JF, Overgaard D, Bestle MH, Christensen DF, Egerod I, Pivkina A, Gusarov V, Zhivotneva I, Pasko N, Zamyatin M, Jensen JF, Egerod I, Bestle MH, Christensen DF, Alklit A, Hansen RL, Knudsen H, Grode LB, Overgaard D, Hravnak M, Chen L, Dubrawski A, Clermont G, Pinsky MR, Parry SM, Knight LD, Connolly BC, Baldwin CE, Puthucheary ZA, Denehy L, Hart N, Morris PE, Mortimore J, Granger CL, Jensen HI, Piers R, Van den Bulcke B, Malmgren J, Metaxa V, Reyners AK, Darmon M, Rusinova K, Talmor D, Meert AP, Cancelliere L, Zubek L, Maia P, Michalsen A, Decruyenaere J, Kompanje E, Vanheule S, Azoulay E, Vansteelandt S, Benoit D, Van den Bulcke B, Piers R, Jensen HI, Malmgren J, Metaxa V, Reyners AK, Darmon M, Rusinova K, Talmor D, Meert AP, Cancelliere L, Zubek L, Maia P, Michalsen A, Decruyenaere J, Kompanje E, Vanheule S, Azoulay E, Vansteelandt S, Benoit D, Ryan C, Dawson D, Ball J, Noone K, Aisling B, Prudden S, Ntantana A, Matamis D, Savvidou S, Giannakou M, Gouva M, Nakos G, Koulouras V, Aron J, Lumley G, Milliken D, Dhadwal K, McGrath BA, Lynch SJ, Bovento B, Sharpe G, Grainger E, Pieri-Davies S, Wallace S, McGrath B, Lynch SJ, Bovento B, Grainger E, Pieri-Davies S, Sharpe G, Wallace S, Jung M, Cho J, Park H, Suh G, Kousha O, Paddle J, Gripenberg LG, Rehal MS, Wernerman J, Rooyackers O, de Grooth HJ, Choo WP, Spoelstra-de Man AM, Swart EL, Oudemans-van Straaten HM, Talan L, Güven G, Altıntas ND, Padar M, Uusvel G, Starkopf L, Starkopf J, Blaser AR, Kalaiselvan MS, Arunkumar AS, Renuka MK, Shivkumar RL, Volbeda M, ten Kate D, Hoekstra M, van der Maaten JM, Nijsten MW, Komaromi A, Rooyackers O, Wernerman J, Norberg Å, Smedberg M, Mori M, Pettersson L, Norberg Å, Rooyackers O, Wernerman J, Theodorakopoulou M, Christodoulopoulou T, Diamantakis A, Frantzeskaki F, Kontogiorgi M, Chrysanthopoulou E, Lygnos M, Diakaki C, Armaganidis A, Gundogan K, Dogan E, Coskun R, Muhtaroglu S, Sungur M, Ziegler T, Guven M, Kleyman A, Khaliq W, Andreas D, Singer M, Meierhans R, Schuepbach R, De Brito-Ashurst I, Zand F, Sabetian G, Nikandish R, Hagar F, Masjedi M, Maghsudi B, Vazin A, Ghorbani M, Asadpour E, Kao KC, Chiu LC, Hung CY, Chang CH, Li SH, Hu HC, El Maraghi S, Ali M, Rageb D, Helmy M, Marin-Corral J, Vilà C, Masclans JR, Vàzquez A, Martín-Loeches I, Díaz E, Yébenes JC, Rodriguez A, Álvarez-Lerma F, Varga N, Cortina-Gutiérrez A, Dono L, Martínez-Martínez M, Maldonado C, Papiol E, Pérez-Carrasco M, Ferrer R, Nweze K, Morton B, Welters I, Houard M, Voisin B, Ledoux G, Six S, Jaillette E, Nseir S, Romdhani S, Bouneb R, Loghmari D, Aicha NB, Ayachi J, Meddeb K, Chouchène I, Khedher A, Boussarsar M, Chan KS, Yu WL, Marin-Corral J, Vilà C, Masclans JR, Nolla J, Vidaur L, Bonastre J, Suberbiola B, Guerrero JE, Rodriguez A, Coll NR, Jiménez GJ, Brugger SC, Calero JC, Garrido BB, García M, Martínez MP, Vidal MV, de la Torre MC, Vendrell E, Palomera E, Güell E, Yébenes JC, Serra-Prat M, Bermejo-Martín JF, Almirall J, Tomas E, Escoval A, Froe F, Pereira MHV, Velez N, Viegas E, Filipe E, Groves C, Reay M, Chiu LC, Hu HC, Hung CY, Chang CH, Li SH, Kao KC, Ballin A, Facchin F, Sartori G, Zarantonello F, Campello E, Radu CM, Rossi S, Ori C, Simioni P, Umei N, Shingo I, Santos AC, Candeias C, Moniz I, Marçal R, e Silva ZC, Ribeiro JM, Georger JF, Ponthus JP, Tchir M, Amilien V, Ayoub M, Barsam E, Martucci G, Panarello G, Tuzzolino F, Capitanio G, Ferrazza V, Carollo T, Giovanni L, Arcadipane A, Sánchez ML, González-Gay MA, Díaz FJL, López MIR, Zogheib E, Villeret L, Nader J, Bernasinski M, Besserve P, Caus T, Dupont H, Morimont P, Habran S, Hubert R, Desaive T, Blaffart F, Janssen N, Guiot J, Pironet A, Dauby P, Lambermont B, Zarantonello F, Ballin A, Facchin F, Sartori G, Campello E, Pettenuzzo T, Citton G, Rossi S, Simioni P, Ori C, Kirakli C, Ediboglu O, Ataman S, Yarici M, Tuksavul F, Keating S, Gibson A, Gilles M, Dunn M, Price G, Young N, Remeta P, Bishop P, Zamora MDF, Muñoz-Bono J, Curiel-Balsera E, Aguilar-Alonso E, Hinojosa R, Gordillo-Brenes A, Arboleda-Sánchez JA, Skorniakov I, Vikulova D, Whiteley C, Shaikh O, Jones A, Ostermann M, Forni L, Scott M, Sahatjian J, Linde-Zwirble W, Hansell D, Laoveeravat P, Srisawat N, Kongwibulwut M, Peerapornrattana S, Suwachittanont N, Wirotwan TO, Chatkaew P, Saeyub P, Latthaprecha K, Tiranathanagul K, Eiam-ong S, Kellum JA, Berthelsen RE, Perner A, Jensen AEK, Jensen JU, Bestle MH, Gebhard DJ, Price J, Kennedy CE, Akcan-Arikan A, Liberatore AMA, Souza RB, Martins AMCRPF, Vieira JCF, Kang YR, Nakamae MN, Koh IHJ, Hamed K, Khaled MM, Soliman RA, Mokhtar MS, Seller-Pérez G, Arias-Verdú D, Llopar-Valdor E, De-Diós-Chacón I, Quesada-García G, Herrera-Gutierrez ME, Hafes R, Carroll G, Doherty P, Wright C, Vera IGG, Ralston M, Gemmell ML, MacKay A, Black E, Wright C, Docking RI, Appleton R, Ralston MR, Gemmell L, Appleton R, Wright C, Docking RI, Black E, Mackay A, Rozemeijer S, Mulier JLGH, Röttgering JG, Elbers PWG, Spoelstra-de Man AME, Tuinman PR, de Waard MC, Oudemans-van Straaten HM, Mejeni N, Nsiala J, Kilembe A, Akilimali P, Thomas G, Egerod I, Andersson AE, Fagerdahl AM, Knudsen V, Meddeb K, Cheikh AB, Hamdaoui Y, Ayachi J, Guiga A, Fraj N, Romdhani S, Sma N, Bouneb R, Chouchene I, Khedher A, Bouafia N, Boussarsar M, Amirian A, Ziaian B, Masjedi M, Fleischmann C, Thomas-Rueddel DO, Schettler A, Schwarzkopf D, Stacke A, Reinhart K, Filipe E, Escoval A, Martins A, Sousa P, Velez N, Viegas E, Tomas E, Snell G, Matsa R, Paary TTS, Kalaiselvan MS, Cavalheiro AM, Rocha LL, Vallone CS, Tonilo A, Lobato MDS, Malheiro DT, Sussumo G, Lucino NM, Zand F, Rosenthal VD, Masjedi M, Sabetian G, Maghsudi B, Ghorbani M, Dashti AS, Yousefipour A, Goodall JR, Williamson M, Tant E, Thomas N, Balci C, Gonen C, Haftacı E, Gurarda H, Karaca E, Paldusová B, Zýková I, Šímová D, Houston S, D’Antona L, Lloyd J, Garnelo-Rey V, Sosic M, Sotosek-Tokmazic V, Kuharic J, Antoncic I, Dunatov S, Sustic A, Chong CT, Sim M, Lyovarin T, Díaz FMA, Galdó SN, Garach MM, Romero OM, Bailón AMP, Pinel AC, Colmenero M, Gritsan A, Gazenkampf A, Korchagin E, Dovbish N, Lee RM, Lim MPP, Chong CT, Lim BCL, See JJ, Assis R, Filipe F, Lopes N, Pessoa L, Pereira T, Catorze N, Aydogan MS, Aldasoro C, Marchio P, Jorda A, Mauricio MD, Guerra-Ojeda S, Gimeno-Raga M, Colque-Cano M, Bertomeu-Artecero A, Aldasoro M, Valles SL, Tonon D, Triglia T, Martin JC, Alessi MC, Bruder N, Garrigue P, Velly L, Spina S, Scaravilli V, Marzorati C, Colombo E, Savo D, Vargiolu A, Cavenaghi G, Citerio G, Andrade AHV, Bulgarelli P, Araujo JAP, Gonzalez V, Souza VA, Costa A, Massant C, Filho CACA, Morbeck RA, Burgo LE, van Groenendael R, van Eijk LT, Leijte GP, Koeneman B, Kox M, Pickkers P, García-de la Torre A, de la Torre-Prados M, Fernández-Porcel A, Rueda-Molina C, Nuevo-Ortega P, Tsvetanova-Spasova T, Cámara-Sola E, García-Alcántara A, Salido-Díaz L, Liao X, Feng T, Zhang J, Cao X, Wu Q, Xie Z, Li H, Kang Y, Winkler MS, Nierhaus A, Mudersbach E, Bauer A, Robbe L, Zahrte C, Schwedhelm E, Kluge S, Zöllner C, Morton B, Mitsi E, Pennington SH, Reine J, Wright AD, Parker R, Welters ID, Blakey JD, Rajam G, Ades EW, Ferreira DM, Wang D, Kadioglu A, Gordon SB, Koch R, Kox M, Rahamat-Langedoen J, Schloesser J, de Jonge M, Pickkers P, Bringue J, Guillamat-Prats R, Torrents E, Martinez ML, Camprubí-Rimblas M, Artigas A, Blanch L, Park SY, Park YB, Song DK, Shrestha S, Park SH, Koh Y, Park MJ, Hong CW, Lesur O, Coquerel D, Sainsily X, Cote J, Söllradl T, Murza A, Dumont L, Dumaine R, Grandbois M, Sarret P, Marsault E, Salvail D, Auger-Messier M, Chagnon F, Lauretta MP, Greco E, Dyson A, Singer M, Preau S, Ambler M, Sigurta A, Saeed S, Singer M, Sarıca LT, Zibandeh N, Genc D, Gul F, Akkoc T, Kombak E, Cinel L, Akkoc T, Cinel I, Pollen SJ, Arulkumaran N, Singer M, Torrance HD, Longbottom ER, Warnes G, Hinds CJ, Pennington DJ, Brohi K, O’Dwyer MJ, Kim HY, Na S, Kim J, Chang YF, Chao A, Shih PY, Lee CT, Yeh YC, Chen LW, Adriaanse M, Trogrlic Z, Ista E, Lingsma H, Rietdijk W, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, Gommers DAMPJ, van der Jagt M, Funcke S, Sauerlaender S, Saugel B, Pinnschmidt H, Reuter DA, Nitzschke R, Perbet S, Biboulet C, Lenoire A, Bourdeaux D, Pereira B, Plaud B, Bazin JE, Sautou V, Mebazaa A, Constantin JM, Legrand M, Boyko Y, Jennum P, Nikolic M. ESICM LIVES 2016: part one. Intensive Care Med Exp 2016. [PMCID: PMC5042924 DOI: 10.1186/s40635-016-0098-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
40
|
Bauer C, Rimmelé T, Duclos A, Prieto N, Cejka JC, Carry PY, Grousson S, Friggeri A, Secco J, Bui-Xuan B, Lilot M, Lehot JJ. Anxiety and stress among anaesthesiology and critical care residents during high-fidelity simulation sessions. Anaesth Crit Care Pain Med 2016; 35:407-416. [PMID: 27133235 DOI: 10.1016/j.accpm.2016.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 07/28/2015] [Revised: 12/28/2015] [Accepted: 01/02/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES High-fidelity simulation (HFS) calls heavily upon cognitive capacities and generates stress and anxiety. The objectives of this prospective, observational study were to assess trait anxiety and fear of negative evaluation (FNE) in anaesthesiology and critical care residents and appraise their state anxiety levels and cardiovascular responses during HFS training sessions. SUBJECTS AND METHODS First-year anaesthesiology and critical care residents completed the French-Canadian adaptation of the State-Trait Anxiety Inventory (IASTA Y-1: state anxiety, IASTA Y-2: trait anxiety) and the French adaptation of the Fear of Negative Evaluation Scale (FNE). Their heart rate (HR) and blood pressure (BP) were assessed before and after the training session. RESULTS Twenty-three residents (8 women, 15 men) were included in the study. IASTA Y-1 and Y-2 scores were low (respectively 40.2±9.9 and 39.7±8) and FNE scores were moderate (16.7±5.5). HR measurements before and after the training sessions were significantly higher than at rest (respectively 78±19, 80±17 and 63±9b/min; P<0.001). BP measurements before and after the HFS sessions were not significantly different. The IASTA Y-2 and FNE scores of female residents were significantly higher than those of male residents (respectively P=0.004 and P=0.049). CONCLUSION First-year anaesthesiology and critical care residents had low trait anxiety and FNE. HFS training increased their HR but not their BP. Their state anxiety also remained low. Several differences between individuals were noted, particularly between men and women.
Collapse
Affiliation(s)
- Christian Bauer
- Départements d'anesthésie-réanimation, hospices civils de Lyon, 69002 Lyon, France; Centre lyonnais d'enseignement par la simulation en santé (CLESS-SAMSEI), 69373 Lyon, France; Université Claude-Bernard Lyon 1, 69622 Lyon, France.
| | - Thomas Rimmelé
- Départements d'anesthésie-réanimation, hospices civils de Lyon, 69002 Lyon, France; Centre lyonnais d'enseignement par la simulation en santé (CLESS-SAMSEI), 69373 Lyon, France; Université Claude-Bernard Lyon 1, 69622 Lyon, France
| | - Antoine Duclos
- Université Claude-Bernard Lyon 1, 69622 Lyon, France; Hospices civils de Lyon, pôle information médicale évaluation recherche, 69424 Lyon, France
| | - Nathalie Prieto
- Centre lyonnais d'enseignement par la simulation en santé (CLESS-SAMSEI), 69373 Lyon, France; Université Claude-Bernard Lyon 1, 69622 Lyon, France; Hospices civils de Lyon, hôpital Édouard Herriot, cellule d'urgence médico-psychologique, 69003 Lyon, France
| | - Jean-Christophe Cejka
- Départements d'anesthésie-réanimation, hospices civils de Lyon, 69002 Lyon, France; Centre lyonnais d'enseignement par la simulation en santé (CLESS-SAMSEI), 69373 Lyon, France; Université Claude-Bernard Lyon 1, 69622 Lyon, France
| | - Pierre-Yves Carry
- Départements d'anesthésie-réanimation, hospices civils de Lyon, 69002 Lyon, France; Centre lyonnais d'enseignement par la simulation en santé (CLESS-SAMSEI), 69373 Lyon, France; Université Claude-Bernard Lyon 1, 69622 Lyon, France
| | - Sébastien Grousson
- Départements d'anesthésie-réanimation, hospices civils de Lyon, 69002 Lyon, France; Centre lyonnais d'enseignement par la simulation en santé (CLESS-SAMSEI), 69373 Lyon, France; Université Claude-Bernard Lyon 1, 69622 Lyon, France
| | - Arnaud Friggeri
- Départements d'anesthésie-réanimation, hospices civils de Lyon, 69002 Lyon, France; Centre lyonnais d'enseignement par la simulation en santé (CLESS-SAMSEI), 69373 Lyon, France; Université Claude-Bernard Lyon 1, 69622 Lyon, France
| | - Julien Secco
- Université Claude-Bernard Lyon 1, 69622 Lyon, France
| | - Bernard Bui-Xuan
- Départements d'anesthésie-réanimation, hospices civils de Lyon, 69002 Lyon, France; Centre lyonnais d'enseignement par la simulation en santé (CLESS-SAMSEI), 69373 Lyon, France; Université Claude-Bernard Lyon 1, 69622 Lyon, France
| | - Marc Lilot
- Départements d'anesthésie-réanimation, hospices civils de Lyon, 69002 Lyon, France; Centre lyonnais d'enseignement par la simulation en santé (CLESS-SAMSEI), 69373 Lyon, France; Université Claude-Bernard Lyon 1, 69622 Lyon, France
| | - Jean-Jacques Lehot
- Départements d'anesthésie-réanimation, hospices civils de Lyon, 69002 Lyon, France; Centre lyonnais d'enseignement par la simulation en santé (CLESS-SAMSEI), 69373 Lyon, France; Université Claude-Bernard Lyon 1, 69622 Lyon, France
| |
Collapse
|
41
|
Jacquet-Lagrèze M, Baudin F, David JS, Fellahi JL, Hu PB, Lilot M, Piriou V. End-tidal carbon dioxide variation after a 100- and a 500-ml fluid challenge to assess fluid responsiveness. Ann Intensive Care 2016; 6:37. [PMID: 27101829 PMCID: PMC4840128 DOI: 10.1186/s13613-016-0141-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 04/06/2016] [Indexed: 12/26/2022] Open
Abstract
Background EtCO2 variation has been advocated replacing cardiac output measurements to evaluate fluid responsiveness (FR) during sepsis. The ability of EtCO2 variation after a fluid challenge to detect FR in the context of general anaesthesia has not been investigated. Forty patients were prospectively studied. They underwent general anaesthesia for major surgeries. CO was measured by transoesophageal Doppler, and EtCO2 was recorded as well as other haemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), pulse pressure (PP)] at baseline, after 100-ml fluid load over 1 min, and at the end of the 500-ml fluid load. We measured the variation of EtCO2 at 100 (ΔEtCO2100) and 500 ml (ΔEtCO2500), and ROC curves were generated. A threshold for ΔEtCO2 to predict FR was determined with receiver operating curves (ROC) analysis. The primary end point was the ability of EtCO2 variation after a 500-ml fluid load to diagnose FR. Results Fifteen patients (38 %) were fluid responders. ROC analysis showed that for a threshold of 5.8 % (ΔEtCO2500), sensitivity was 0.6 IC 95 % [0.33; 0.86] and specificity was 1.0 IC 95 % [1.0; 1.0]. An absolute increase of more than 2 mmHg of EtCO2 is specific to diagnose fluid responsiveness (spe = 96 [88–100] %, sens = 60 [33–88] %, AUC = 0.80 [0.96–0.65]). HR, MAP, and PP variations and ΔEtCO2100 did not bring information to predict or diagnose FR. During fluid challenge, the correlation between CI variation and EtCO2 variation was r = 0.566, p < 0.001. Conclusions During surgery, when alveolar ventilation and CO2 production are constant, ΔEtCO2500 is fairly reliable to assess FR. When the variation of EtCO2 is >5.8 %, all patients were responders, but no conclusion could be done when this variation was <5.8 %. ΔEtCO2100 failed to predict FR. Trial registration CPP Lyon Sud Est III ref: 2013-027 B, Number ID RCB: 2013-A00729-36 delivered by the ANSM).
Collapse
Affiliation(s)
- Matthias Jacquet-Lagrèze
- Service d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.
| | - Florent Baudin
- Service d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - Jean Stéphane David
- Service d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.,Université Claude-Bernard, Lyon 1. Campus Lyon Santé Est, 8 Avenue Rockefeller, 69008, Lyon, France
| | - Jean-Luc Fellahi
- Université Claude-Bernard, Lyon 1. Campus Lyon Santé Est, 8 Avenue Rockefeller, 69008, Lyon, France.,Service d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
| | - Patrick B Hu
- Irvine's Department of Anaesthesiology and Perioperative Care, University of California, 333 City Blvd W #2150, Orange, CA, 92868, USA
| | - Marc Lilot
- Université Claude-Bernard, Lyon 1. Campus Lyon Santé Est, 8 Avenue Rockefeller, 69008, Lyon, France.,Service d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
| | - Vincent Piriou
- Service d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.,Université Claude-Bernard, Lyon 1. Campus Lyon Santé Est, 8 Avenue Rockefeller, 69008, Lyon, France
| |
Collapse
|
42
|
Lilot M, Ehrenfeld J, Lee C, Harrington B, Cannesson M, Rinehart J. Variability in practice and factors predictive of total crystalloid administration during abdominal surgery: retrospective two-centre analysis †. Br J Anaesth 2015; 114:767-76. [DOI: 10.1093/bja/aeu452] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/12/2022] Open
|
43
|
Kim SH, Lilot M, Murphy LSL, Sidhu KS, Yu Z, Rinehart J, Cannesson M. Accuracy of Continuous Noninvasive Hemoglobin Monitoring. Anesth Analg 2014; 119:332-346. [DOI: 10.1213/ane.0000000000000272] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
44
|
Rinehart J, Le Manach Y, Douiri H, Lee C, Lilot M, Le K, Canales C, Cannesson M. First closed-loop goal directed fluid therapy during surgery: a pilot study. ACTA ACUST UNITED AC 2013; 33:e35-41. [PMID: 24378044 DOI: 10.1016/j.annfar.2013.11.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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: 09/19/2013] [Accepted: 11/20/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Intraoperative haemodynamic optimization based on fluid management and stroke volume optimization (Goal Directed Fluid Therapy [GDFT]) can improve patients' postoperative outcome. We have described a closed-loop fluid management system based on stroke volume variation and stroke volume monitoring. The goal of this system is to apply GDFT protocols automatically. After conducting simulation, engineering, and animal studies the present report describes the first use of this system in the clinical setting. STUDY DESIGN Prospective pilot study. PATIENTS Patients undergoing major surgery. METHODS Twelve patients at two institutions had intraoperative GDFT delivered by closed-loop controller under the direction of an anaesthesiologist. Compliance with GDFT management was defined as acceptable when a patient spent more than 85% of the surgery time in a preload independent state (defined as stroke volume variation<13%), or when average cardiac index during the case was superior or equal to 2.5l/min/m(2). RESULTS Closed-loop GDFT was completed in 12 patients. Median surgery time was 447 [309-483] min and blood loss was 200 [100-1000] ml. Average cardiac index was 3.2±0.8l/min/m(2) and on average patients spent 91% (76 to 100%) of the surgery time in a preload independent state. Twelve of 12 patients met the criteria for compliance with intraoperative GDFT management. CONCLUSION Intraoperative GDFT delivered by closed-loop system under anaesthesiologist guidance allowed to obtain targeted objectives in 91% of surgery time. This approach may provide a way to ensure consistent high-quality delivery of fluid administration and compliance with perioperative goal directed therapy.
Collapse
Affiliation(s)
- J Rinehart
- Department of anesthesiology and perioperative care, university of California Irvine, 101 S City Drive, Orange, CA 92868 Irvine, CA, USA
| | - Y Le Manach
- Department of anesthesiology and critical Care medicine, CHU Pitié-Salpêtrière, Paris, France; Departments of anesthesia and clinical epidemiology and biostatistics, faculty of health sciences, McMaster university and population health research institute, perioperative medicine and surgical research Unit, Hamilton, ON, Canada
| | - H Douiri
- Department of anesthesiology and critical Care medicine, CHU Pitié-Salpêtrière, Paris, France
| | - C Lee
- Department of anesthesiology and perioperative care, university of California Irvine, 101 S City Drive, Orange, CA 92868 Irvine, CA, USA
| | - M Lilot
- Department of anesthesiology and perioperative care, university of California Irvine, 101 S City Drive, Orange, CA 92868 Irvine, CA, USA
| | - K Le
- Department of anesthesiology and perioperative care, university of California Irvine, 101 S City Drive, Orange, CA 92868 Irvine, CA, USA
| | - C Canales
- Department of anesthesiology and perioperative care, university of California Irvine, 101 S City Drive, Orange, CA 92868 Irvine, CA, USA
| | - M Cannesson
- Department of anesthesiology and perioperative care, university of California Irvine, 101 S City Drive, Orange, CA 92868 Irvine, CA, USA.
| |
Collapse
|
45
|
Lilot M, Meuret P, Bouvet L, Caruso L, Dabouz R, Deléat-Besson R, Rousselet B, Thouverez B, Zadam A, Allaouchiche B, Boselli E. Hypobaric spinal anesthesia with ropivacaine plus sufentanil for traumatic femoral neck surgery in the elderly: a dose-response study. Anesth Analg 2013; 117:259-64. [PMID: 23592605 DOI: 10.1213/ane.0b013e31828f29f8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In this randomized, prospective trial, we sought to determine the effective dose of hypobaric ropivacaine with sufentanil providing 95% success (ED95) in spinal anesthesia for traumatic femoral neck surgery in the elderly. METHODS Sixty-eight elderly patients with unilateral hip fracture randomly received 6, 8, 10, or 12 mg spinal hypobaric ropivacaine combined with 5 µg sufentanil. Patients remained in a lateral position for 15 minutes after spinal injection. The dose was considered successful if a unilateral sensory block >T12 was achieved, and there was no need for additional analgesia or conversion to general anesthesia. The ED95 was determined using logit analysis. The incidence of severe and very severe hypotension (systolic blood pressure decrease by >30% and >40% baseline, respectively) and the use of remifentanil were compared among groups using χ(2) test for trend. RESULTS Three patients were excluded because of failure to reach the subarachnoid space. No differences in baseline demographic data were observed among groups. The ED95 for hypobaric ropivacaine was determined to be 9 mg (95% confidence interval, 8-14). Increasing doses of ropivacaine (6, 8, 10, and 12 mg) demonstrated a positive trend with respect to incidence of hypotension (53%, 47%, 87%, and 81%, P = 0.0004) and a negative trend with respect to the use of remifentanil (41%, 12%, 0%, and 0%, P = 0.0004). A significant difference in the level of sensory block (P < 0.0001) was observed among operative and nonoperative sides but not among ropivacaine dosing groups (P = 0.16). No difference in motor blockade, incidence of very severe hypotension, total dose of ephedrine, duration of surgery, patient satisfaction, operating conditions, or surgeon satisfaction scores was observed among groups. No cases of bradycardia were observed. No patient had a preoperative sensory level <T12 after 15 minutes in the lateral decubitus position, and no cases were converted to general anesthesia. There was no difference in undesirable outcomes or postoperative troponin values among groups. CONCLUSIONS The effective dose of hypobaric ropivacaine combined with sufentanil 5 µg providing 95% success in spinal anesthesia for traumatic femoral neck surgery in the elderly is ED95 = 9 mg (95% confidence interval, 8-14). Using doses exceeding the ED95 may increase the incidence of hypotension. If doses less than the ED95 are chosen, the use of additional analgesia may be necessary.
Collapse
Affiliation(s)
- Marc Lilot
- Service d'anesthésie-réanimation, Hôpital Édouard Herriot, 5 place d'Arsonval, 69003 Lyon, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Bojan M, Peperstraete H, Lilot M, Tourneur L, Vouhé P, Pouard P. Cold Histidine-Tryptophan-Ketoglutarate Solution and Repeated Oxygenated Warm Blood Cardioplegia in Neonates With Arterial Switch Operation. Ann Thorac Surg 2013; 95:1390-6. [DOI: 10.1016/j.athoracsur.2012.12.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 12/09/2012] [Accepted: 12/11/2012] [Indexed: 11/30/2022]
|
47
|
Bojan M, Peperstraete H, Lilot M, Vicca S, Pouard P, Vouhé P. Early elevation of cardiac troponin I is predictive of short-term outcome in neonates and infants with coronary anomalies or reduced ventricular mass undergoing cardiac surgery. J Thorac Cardiovasc Surg 2012; 144:1436-44. [PMID: 22704287 DOI: 10.1016/j.jtcvs.2012.05.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 03/04/2012] [Accepted: 05/15/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The present study aimed to assess the usefulness of routine monitoring of cardiac troponin I concentrations within 24 hours of surgery (cTn-I<24h) in neonates and infants undergoing cardiac surgery. METHODS The added predictive ability of a high peak cTn-I<24h (within the upper quintile per procedure) for a composite outcome, including 30-day mortality and severe morbidity, was assessed retrospectively. The predicted risk for the composite outcome was estimated from a logistic regression model including preoperative and intraoperative variables. Adding a high peak cTn-I<24h to the risk model resulted in reclassification of the predicted risk. It also allowed quantification of the improvement in reclassification and discrimination by the difference between c-indexes, the Net Reclassification and the Integrated Discrimination Indexes (NRI and IDI). RESULTS Overall, 1023 consecutive patients were included. Adding a high peak cTn-I<24h to the model resulted in no improvement in reclassification or discrimination in the overall population (difference between c-indexes: 0.011 [-0.004 to 0.029], NRI = 0.06, P = .22, IDI = 0.02, P = .06), except in a subgroup of patients undergoing the arterial switch operation with or without ventricular septal defect closure and/or aortic arc repair, anomalous origin of the left coronary artery from the pulmonary artery repair, truncus arteriosus repair, Norwood procedure, and Sano modification, in whom NRI = 0.23 (P = .005) and IDI = 0.05 (P < .001). CONCLUSIONS Patients with coronary anomalies and patients with reduced ventricular mass should benefit from the routine monitoring of cTn-I concentrations after surgery for congenital cardiac disease.
Collapse
Affiliation(s)
- Mirela Bojan
- Anesthesia and Critical Care Department, Necker-Enfants Malades Hospital, Assistance Publique, Hôpitaux de Paris, France.
| | | | | | | | | | | |
Collapse
|
48
|
Lilot M, Petitjeans F, Wey PF, Eve O, Puidupin M. [Acute obstructive epiglottitis in intensive care unit: which airway management strategy?]. ACTA ACUST UNITED AC 2010; 29:247-50. [PMID: 20116197 DOI: 10.1016/j.annfar.2009.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 11/16/2009] [Indexed: 10/19/2022]
Abstract
Acute epiglottitis is an infection of supraglottic structures, with a high risk of life-threatening respiratory obstruction. We report a case of a 52-year-old patient who presented with a prehospital hypoxic respiratory arrest caused by obstructive oedema with a successful resuscitation. Laryngoscopy after a sudden unplanned extubation permits diagnosis of acute obstructive epiglottitis. The growing threat of laryngeal dyspnea prompts emergency tracheal airway protection, by means of the combined preparation of transtracheal oxygenation access and the use of fiber-optic laryngoscopy. This case report emphasises the airway management strategy successfully used in this patient.
Collapse
Affiliation(s)
- M Lilot
- Département d'anesthésie-réanimation-urgences, hôpital d'instruction des armées de Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | | | | | | | | |
Collapse
|