[Acute care of patients with cerebral palsy in neuro-resuscitation surgery]

Severe head trauma, with or without polytrauma, subarachnoid haemorrhage due to aneurysm rupture, is an unexpected tragedy for patients and their families. These accidents are likely to result in extremely serious neurological damage, with many of the patients under our care facing a life-threatening prognosis. To protect the brain, one solution is to put the patient into a deep sleep during the so-called "acute" phase, making it impossible to assess the repercussions of the initial injuries at the time: this is what we call "waiting resuscitation".

[Restraint in intensive care: between patient safety and respect for autonomy]

The use of physical restraint in the context of medical resuscitation is relatively frequent. Although temporary or prolonged physical restraint is justified by patient safety (possibility of self-extubation, etc.), this practice is itself a source of risk, leads to suffering on the part of the patient, and raises dilemmas and ethical questions within teams. Inherent to the working conditions and training of professionals, restraint must nevertheless be balanced and lead to the search for alternatives.

[Ballistic wound in the pre-hospital and emergency room: Damage Control Resuscitation]

Damage Control Resuscitation (DCR) is a strategy designed to prioritize hemostasis procedures, from the point of injury to surgical management, whether faced with an influx of bleeding casualties or a single casualty with severe hemodynamic instability. Widely disseminated, it provides clear objectives for prioritizing physiological restoration to the anatomy required for short-term survival. Initially applied to surgery, DCR has now been extended to the entire upstream care chain, including first aid and emergency medicine.

[Diagnosis of encephalic death and donor resuscitation for harvesting purposes]

Encephalic death is a rare and unique pathophysiological process. Its diagnosis and management in the intensive care unit, which are well codified, determine the possibility and short- and long-term outcome of organ and tissue transplants.

[Shared experience, multiple experiences: paramedics facing death in intensive care]

Accompanying death is part of the daily life of intensive care workers. However, far from being a trivial experience, it mobilizes the teams emotionally and requires them to constantly adjust in order to carry out their mission of care for the patient and his or her loved ones. How do nurses and orderlies deal with end-of-life care and the particularities of death in an intensive care unit?

Moroccans' Views on Resuscitation According to Presumed Degree of Disability: A Cross-Sectional Study

INTRODUCTION

According to the World Health Organization (WHO), disability is a public health problem that can be difficult to manage medically and financially. Disability can either be innate or develop after resuscitation. Therefore, the decision regarding whether to resuscitate a patient or not raises certain ethical questions, especially in the context of a Muslim country such as Morocco.

AIM

The main aim of this study is to survey the public's opinions regarding their willingness to be resuscitated or have their relatives be resuscitated based on their foreseeable degree of disability.

METHODS

This cross-sectional study was conducted over a 10-month period and employed a self-administered questionnaire. The participants included were all adult (i.e., over 18 years of age) Moroccan nationals, and they were selected regardless of their religious identity. Moreover, the modified Rankin Scale (mRS) was used to measure the participants' foreseeable degree of handicap. The participants were divided into two groups: healthcare workers and non-healthcare workers.

RESULTS

In total, 1083 questionnaires were retained. The average age of the participants was 30 (± 8) years, with the male-to-female sex ratio being 0.78. Moreover, 39.6% of the participants were healthcare workers. It was found that compared to the non healthcare workers, the healthcare professionals were more willing to be resuscitated themselves and have resuscitation performed on their relatives, but only when the degree of foreseeable disability was estimated to be absent or insignificant, whereas they were less willing to be resuscitated and have resuscitation performed on their relatives when the degree of foreseeable disability was estimated to be mild or higher.

CONCLUSION

In conclusion, there should be a pre-established procedure, along with a legislative and multidisciplinary framework, within the hospital structures in order to help in the decision-making process regarding whether to resuscitate a patient or not.

[Traumatic motherhood in Covid-19 times]

In the context of maternal vital emergency due to Covid-19, dire situations of birth questioned the health practitioners of a neonatal intensive care unit. How can mothers take care of their baby when their own life has been threatened ? The analysis of two clinical cases underlines the importance of talking for these mothers who have been through disastrous experiences, which could lead to a post-traumatic stress disorder. Restoring a connection to outside reality thanks to psychological care in the acute post-trauma period helps these mothers take care of their child.

[Supporting caregivers of children and adolescents with cancer]

Caring for a child or adolescent with cancer remains a perilous professional exercise. Caregivers are not only subject to high technical demands (oncological treatments, surgery and resuscitation, rehabilitation and equipment) but also to an emotional and relational involvement inherent to their function. However, the regulation and transformation of affects mobilize a great deal of psychic energy in professionals who must preserve their internal resources as best they can. The point of view of the clinical psychologist will shed light on the mechanisms to be considered in order to support the capacity of the teams to care for and accompany sick children and their families throughout the care process.

[Psychological state of Covid-19 patients after resuscitation]

The epidemic of Covid-19 was characterized, from its beginning, by "emergency". A state of emergency enacted by the state authorities to fight, on one hand, against the pandemic as such and, on the other hand, to manage the influx of patients admitted in intensive care. In this unprecedented context, the suffering of the people goes beyond the emergency situation and persists in forms ranging from a pseudo-banality to the complexity of an insidious evolution.

[Working at night in intensive care and resuscitation]

The care teams working in the intensive care unit (ICU) most often practice on twelve-hour day-night cycles. Collaboration is close and regular, with a high level of trust shared between the professionnals to ensure the often complex care required by the patient's condition. While ICU practice is of great interest to caregivers who make it their specialty, it can also become less attractive over time due to the physical, family and social constraints of night work.

Beneficial of adding Tocilizumab to standard care in critical forms of Covid-19 pneumonia: Study on paired series

INTRODUCTION

Tocilizumab (TCZ), a humanized monoclonal antibody directed against interleukin-6 (IL-6) receptors, has been tried in various studies as a Covid-19 therapy with controversial results.

AIM

To evaluate the effectiveness of adding TCZ to standard care (SC) in critical Covid-19 patients.

METHODS

it was designed retrospectively as a comparative study on two paired series of critical patients affected with Covid-19: the 1st group received TCZ plus SC versus a 2nd group which received only SC. The matching criteria were age, sex and severity score and the matching was based on the propensity score matching (PSM) by the nearest neighbor. Outcomes were: survival, mechanical ventilation (MV) and nosocomial infections.

RESULTS

Ninety patients were included by pairing estimated successful (PSM > 0.5 in more than 50% in each group for all matching criteria). 55.5% of SC group progressed to stage 3-acute respiratory distress syndrome (ARDS) versus 31% of TCZ+SC patients (p=0.03). No effect of TCZ was found on mortality (49% in each group, p=1) nor on MV use (p=0.67). ICU stay was more prolonged in TCZ+SC group (16 versus 8 days, p<10-3). The administration of TCZ induced a significant decrease in CRP but not changed the IL-6 dosage. Nosocomial infections occurred in 18 (40%) of TCZ+SC group comparatively to 15 (33,5%) of SC group, p=0.66.

CONCLUSION

Tocilizumab reduced the risk of progression to severe ARDS probably due to its immune-modulating properties. But no beneficial effect was found on survival or on the use of ventilation.

[Essential oils, a response to unpleasant odors in resuscitation of burn victims]

In burn units, odor is often underestimated or trivialized in relation to the critical context of the patients. However, their care is part of a concern for overall care, which also includes the caregiver and the visitor. The implementation of a project based on essential oils has allowed a team from the University Hospital of Toulouse to address this issue.

[Teaming up for resuscitation on the Covid-19 front]

The first wave of the COVID-19 pandemic in France severely tested the healthcare system and its teams from the first weeks of 2020. With two years of hindsight, healthcare professionals have learned a great deal from this health crisis which, despite vaccination, maintains pressure on social activities and on the daily lives of caregivers. Looking back to the early days of this crisis, a nurse and her former trainer report on the spontaneous collaborations deployed to reinforce the resuscitation teams. Their complicity and the reversal of roles are recounted by four hands in the form of crossed views.

[Prognostic factors for pneumopathy acquired under mechanical ventilation in multi-purpose resuscitation at the Angre CHU (RCI)]

OBJECTIVES

To identify the factors of poor prognosis of ventilator-associated lung disease (VAP) in order to improve their management.

PATIENTS AND METHOD

Prospective, descriptive and analytical study of patients admitted to intensive care at the Angré University Hospital from November 1, 2019 to July 31, 2021 and having presented VAP.

RESULTS

We collected 43 patients out of 625 admissions, i.e. 6.88%. The average age was 49.06 years. The sex ratio was 0.38. The main reason for admission was coma with 88.37%. Hypertension and diabetes were the main antecedents. Early VAP accounted for 53.49%. Klebsiella pneumoniae was the main germ. Patients intubated on admission accounted for 79.07%. The average duration of ventilation was 26.95 days and the average duration of hospitalization was 30.8140 days. Probabilistic antibiotic therapy was performed in 75.76% of patients. Mortality was 76.74%. The mortality factors were duration of mechanical ventilation greater than 15 days and age greater than 50 years.

CONCLUSION

Secondary mortality from VAP remains high. The identification of the two prognostic factors should improve the subsequent management of all new cases.

[Psychosocial experiences of caregivers in intensive care in the face of the pandemic at Covid-19 at Cocody University Hospital (Abidjan - Côte d'Ivoire)]

The objective of our study was to investigate the psychosocial experience of intensive care workers in the face of the Covid-19 pandemic.

PATIENTS AND METHOD

this was a descriptive cross-sectional study by questionnaire including the caretakers of the intensive care unit of the Cocody University Hospital.

RESULTS

Forty-five caregivers were involved with a sex ratio of 0.87. The mean age was 40.8±8.6 years (27-62). Single people were 53% with at least one dependent child (67%). There were 26.7% physicians, 13.3 % interns, 26.7% state-registered nurse and 33.3 % caregivers. The availability of individual protection equipment was 47 %. Workers felt highly exposed (26.7 %). Stressful work situations were mainly caring for suspicious patients (51.2%). Breathing difficulties (91%) and lack of concentration (76%) were found in stressed caregivers. Social support came mainly from families (46.7%). The scores for decision-making latitude and psychological demand were rather low, 53% and 60% respectively. Their relational relationship showed a stress-generating work situation (22.5%).

CONCLUSION

Psychological support and the provision of material resources would be fundamental to improving the quality of work life for caregivers.

[Resuscitation and care organisation in the face of a pandemic]

Resuscitation units, and the care practices they implement, require specific procedures and technologies, as well as particular and distinct knowledge, skills and human qualities within the care setting. Already facing tensions related to the challenges and vital issues of their mission, these resuscitation units have been destabilised by the influx of patients and the unprecedented complexity of the Covid-19 pandemic, which has forced them to rethink their organisation to a large extent and to envisage the future differently.

[Intensive care nurse in 2021, from expertise to recognition]

The profession of intensive care nurse has been in constant evolution since the 1960s. The technical nature of medical equipment and the care of increasingly complex patients require a high level of qualification. The current health crisis has highlighted the difficulties of this profession and the lack of recognition of these carers. They are demanding a specialisation with a diploma course aimed at improving the quality of patient care.

[Reflections on the state of the art]

If the progress made so far allows to save more and more lives, the resuscitation of 2021 is still a young medical speciality and in full evolution. Major advances are expected in terms of early rehabilitation, practices aided by artificial intelligence, etc. The integration of the ethical dimension in the care for a more human resuscitation and the appropriate training of nurses in this specialty are also essential assets for the future of resuscitation.

[Main regulatory provisions relating to resuscitation in France]

The usefulness and efficiency of intensive care units have been widely highlighted in recent months. The regulatory provisions that structure and frame their organisation and operation have contributed to this. But they must evolve and be accompanied by other improvement actions, to make up for the delays and insufficiencies revealed or exacerbated by the pandemic.

[The National Federation of Intensive Care Nurses]

In France, unlike most other European countries, the speciality of critical care nurse does not exist. The increase in the skills of nurses, which is essential for the care of patients in these units, is not certified by any diploma. These positions are filled by  general care nurses. The French Federation of Critical Care Nurses was created in 2020 around the  project of recognition and valorisation of the specificity of the work of intensive care nurses.

[The specificities of the interventions of physiotherapists in intensive care]

The intervention of physiotherapists in the intensive care unit allows the optimisation of the care project through the assessment and management of the motor, respiratory and swallowing functions of patients. If COVID-19 has only slightly modified the practice of these professionals, the impact of the pandemic on intensive care units has reinforced the added value of their care.

[The clinical practice of the psychologist in intensive care]

The intensive care psychologist was strongly mobilised during the COVID-19 health crisis. His clinical practice is both specific, with regard to the situations of extreme suffering that he is led to encounter, but also plural, as he is faced with the intersecting vulnerabilities of patients, families and carers.

[From Florence Nightingale to Resuscitation 4.0]

Complex, rough, trying, work and care in intensive care must be rethought and reorganised to reconcile the concern for the well-being of the patient, his relatives and the carers. A configuration where new technologies, the ethical dimension, prevention and training would contribute significantly to the efficiency and humanity of the premises.

[Technological and human progress in resuscitation]

Resuscitation has evolved a lot since its creation. Innovations have taken place at several levels. It has become more technical, but it has also been able to transform itself by putting the patient at the centre of his or her care, by opening up to families and friends, and by taking an interest in the carers who work there, thus allowing an improvement in the quality of the care provided.

[Dealing with the bleeding patient, being effective with (almost) nothing]

The practice of pre-hospital care, whether you are a professional rescuer, a nurse, a doctor or a simple citizen, sometimes exposes you to the management of a patient who presents an acute hemorrhage. The prognosis is quickly life-threatening if the safety, assessment, life-saving gestures and activation of the rescue chain are not carried out. A basic, inexpensive first aid kit can further reduce morbidity and mortality. Training first responders in life-saving techniques is a public health issue.

[The lethal triad of hemorrhage]

Coagulopathy, acidosis and hypothermia form the lethal triad in trauma patients with acute hemorrhage. The prevention of this chain reaction relies on an adapted management from the first care in pre-hospital situation: rapid arrest of bleeding, fight against hypothermia, limited vascular filling with an early recourse to vasoactive amines. Pre-hospital transfusion is still rare, whereas in the hospital, an adapted transfusion strategy can wait for or support a surgical or radiological hemostasis procedure.

[2020, Mulhouse, Covid-19: a lesson in history, Europe and resilience]

In March 2020, Covid-19, caused by the severe acute respiratory syndrome coronavirus 2, struck the Haut-Rhin region with extreme violence, overwhelming hospitals and requiring the massive opening of new resuscitation beds. The military resuscitation element of the French military health service was deployed for the first time in Mulhouse (68), in eastern France. Alsace-Lorraine, a European crossroads and the birthplace of European institutions, was once again at the heart of history. Perspectives.

[Application of the white plan in intensive care units during the covid-19 pandemic.]

The deployment of the white plan in intensive care as part of the management of COVD-19 required a new organisation at every level of Raymond-Poincaré hospital in Garches. The closure of certain wards enabled equipment and staff to be pooled, and support services stepped up to the plate by reinventing themselves.

COVID-19 et adaptation des dispositifs de suivi psychologique en réanimation médicale

La pandémie de la COVID-19 est venue, par son ampleur, confronter notre société à une crise sanitaire sans précédent. La gravité de cette épidémie a focalisé toute son attention sur un monde encore très peu connu : la réanimation. Ces services ont été très fortement sollicités en phase aiguë de cette situation d’urgence. Cet article présente à partir de quelques données de la littérature et d’une illustration clinique, la spécificité des vécus psychiques en réanimation et comment le contexte de COVID est venu impacter ce vécu et invite à modifier les dispositifs de soins médico-psychologiques. La méthode utilise une étude de cas : un patient non covid, hospitalisé pendant deux mois aux soins intensifs pendant la période de confinement. Nous verrons ici l’illustration d’un soutien psychologique, dans ce contexte spécifique, par une unité de liaison du service de réanimation au service d’hospitalisation. La discussion théorico-clinique envisage la place de cette épidémie COVID ainsi que le contexte de confinement dans l’adaptation du dispositif de soins notamment avec le port du masque et la distanciation sociale.

[COVID-19 epidemic, a challenge successfully overcome by intensive care nurses]

The COVD-19 wave of spring 2020 had a major impact on French intensive care departments. The intense activity, the support of reinforcements in the acquisition of the necessary skills and their capacity to adapt made intensive care nurses key players in this crisis. Grouped together within the French National Federation of Intensive Care Nurses, they are campaigning to have the specificity of their practice to be recognised and for the creation of certified training in order to meet public healthcare needs not currently fulfilled.

[Prevalence of advance directives and impact on the progress of cardiac arrest resuscitation in EHPAD]

Anticipated directives are of great value among patients living in residential care facilities for the elderly. Their prevalence in cases of cardiac arrest was studied. It was found that this issue is not systematically addressed. This results in the inappropriate use of resuscitation manoeuvres that could be avoided. This is an area that needs to be addressed in depth.

[Feelings and experiences of emergency trained caregivers during the COVID-19 pandemic]

Many nurses and healthcare students have undergone emergency training to reinforce the resuscitation teams faced with a massive influx of patients affected by the severe acute respiratory syndrome coronavirus 2. Trainers from the Grand-Est region have assessed, during the training course and then remotely, the feelings and experiences of the professionals involved.

[Operation Resilience, care at the crossroads of skills in civil-military cooperation]

Launched on 25 March 2020, the operation Resilience is the armed forces' contribution to the interministerial commitment against the spread of COVID-19. The armed forces are committed in all sectors where they can provide support to the civil authorities, adapting their action to local contexts and as part of a permanent dialogue with the state authorities.

[COVID-19: risks of psychological trauma for patients in intensive care or for their families]

For serious cases of COVID-19, with severe respiratory failure due to damage to the lungs by SARS-CoV-2, hospitalisation in intensive care with intubation is often essential. What psychotraumatic risks does this episode present for these patients? Are these sudden, complex treatments, sometimes with fatal outcomes and frequently reported in the media, also a factor in the appearance of psychological trauma for families? These questions are the subject of this clinical reflection.

[Reinforcement in a COVID resuscitation unit in the Grand-Est region]

Available and voluntary, with ten years' experience in the intensive care unit, a nurse testifies to the reinforcement she brought to the Grand-Est region last April, when her nursing colleagues from the hospitals were facing the surge of patients struck by serious forms of COVID-19. A memorable experience.

[Epidemio-clinical, therapeutics and evolutionary characteristics for severe eclampsia in intensive care at Cocody University Hospital (Abidjan - Côte d'Ivoire)]

OBJECTIVE

to describe the epidemio-clinical and evolutionary characteristics of severe eclampsia in the intensive care unit.

PATIENTS AND METHOD

retrospective descriptive and analytical study from 2014 to 2018 carried out in intensive care of the Cocody University Hospital including severe eclamptics with organic failure.

RESULTS

The average prevalence was 12.1%. The mean age was 24.3±6.7 years. Primigravidae and primiparae were the most exposed. The mean time to admission was 16.9±16.7 hours. The mean Glasgow score at admission was 10.2±2.2 and 17.5% of patients had severe hypertension. Associated complications were dominated by the HELLP syndrom (33.6%). Specific treatment was magnesium sulphate (82.1%). Treatment non-compliance was 31.6%. The average length of hospitalization was 3.8±4.3 days. Mortality was 15.3%. Age = 25 years, primigravida, Glasgow score < 8, associated complications, non-use of MgSO4 and therapeutic non-observance were statistically significantly associated with maternal death.

CONCLUSION

Eclampsia remains a critical issue for maternal health. Prevention relies on early management and awareness during antenatal consultations.

[The military intensive care field hospital, a unique experience in the fight against covid-19]

The militaryintensive care field hospital is a new tool set up by the military medical service as part of Operation Resilience to provide medical support in the regions of France most affected by the SARS-Cov-2 pandemic. Deployed in Mulhouse and Mayotte, this hospital facility is a functional intensive care unit set up to support an existing hospital structure. The caregivers and logistics specialists are all from the military medical service, active personnel or reservists, predominantly nurses. The implementation of this intensive care field hospital in a constrained environment requires an efficient provision of care in accordance with medical guidelines, while protecting the healthcare staff and, notably, the frontline nursing staff.

[Involving families in intensive care]

The place of families in intensive care is still too often underestimated. However, the involvement of family members would have multiple benefits for patients, but also for those around them. Family participation is a promising concept that needs to be studied on the ground and on a large scale, in order to prove itself and guide health professionals in their daily practice.

[Nurses in multi-disciplinary team to face Sars-CoV-2 in intensive care]

At the heart of the epidemic wave of spring 2020, the intensive care units faced the surge of patients with severe forms of the disease. To meet the scale of the needs, the care teams were reorganised, reinforced and adapted, as demonstrated by a hospital team specialising in neurology which, beyond the ethical issues, shortages and fears, proceeded to the "covidisation" of its resuscitation and the total reorganisation of the other units, in order to expertly organise care adapted to the needs of the patients. From a distance, and while the epidemic is still active, many questions remain.

[How to promote the construction of knowledge in intensive care?]

The nursing profession is based on the acquisition of knowledge and skills. The rapid evolution of scientific knowledge requires regular updating of knowledge in order to base practice on solid and reliable data. The intensive care nurses point out the lack of adequacy between the initial training and the reality of daily life, which is sometimes a source of deviation from good practices. In intensive care, a field where care techniques evolve very rapidly, nurses must be able to update their knowledge and participate in the construction of new knowledge.

[Not Available]

Body care and development of the premature infant. The observation of newborns' reactions to different stimulations enables their behaviour to be interpreted and the support provided to be adjusted. Developmental care such as swaddling, tucked posture and skin-to-skin contact favours the harmonious development of premature infants and encourages the parents to become involved in their care as early as possible.

[Ethical décision making and septic shock]

Nurses can contribute to the decision-making process in emergency situations in cases of septic shock, particularly if the patient has not drawn up advance directives and/or nominated a health care proxy. They can undertake or facilitate the collective decision making on the legal and ethical level. The team's habitus in terms of ethical analysis and the gathering of initial data can help to ensure the patients wishes are respected.

[Nutritional aspects of the management of the severely burned patient]

The nutrition of the severely burned patient is one of the pillars of his or her care, from the first few hours after the accident to rehabilitation. When properly conducted, there is a recognized beneficial effect on morbidity and even mortality.

[The wellness trolley: a tool to improve "better living in intensive care"]

ICU services are a source of anxiety and stress. There are many barriers to well-being for the patients who are admitted. From this observation was born the surgical intensive care project of the Pellegrin Hospital in Bordeaux, which aims to create a wellness trolley. Its objective is to improve hospital conditions and the patient's experience.

[Epidemiological, clinical and evolutionary aspects of severe traumatic brain injury in the multipurpose intensive care unit of Gabriel Touré Teaching Hospital]

Among traumas, cranial involvement occupies a special place due to their severity and the importance of the sequelae that they can cause. They are said to be serious when the Glasgow Scale (GCS) ≤ 8. The frequency of severe brain injury in the population in African studies ranges from 3.5 to 7. Mortality is, however, poorly known in developing countries, which led us to initiate this work, which aimed to study the epidemiological, clinical and evolutionary aspects of severe traumatic brain injury in the multipurpose intensive care unit of Gabriel Touré University Hospital.

MATERIAL AND METHOD

24-month retrospective study, descriptive and analytical, including all severe traumatic brain injury patients hospitalized in the resuscitation department of Gabriel Touré University Hospital during this study period.

RESULTS

During the periodof 1165 patients admitted to the service, 72 were hospitalized for severe cranio-encephalic trauma for a prevalence of 6%. The age group of 21 - 40 years was the majority with (23) or 44.4% and the average age was 30.93 ± 18.8 years with extremes of 8 months and 79 years.The male sex was predominant with (65) or 90.3%, and a sex ratio of 9.28. During our study, (57) or 79.2% of serious traumatic brain injuries were due to road accidents with motorcycle-motorcycle collisions as a mechanism in (20) or 27.8%. Shopkeepers, and students were the most affected social strata with respectively (22) or 30.6% and (20) or 27.8%. Patient transport was provided by non-medical ambulances for (31) or 43.1% and admission time was between 30 minutes and 6 hours in (16) or 22.2% of cases. (62) or 86.1% had GCS between 6-8 and bilateral mydriasis was present in (10) or 13.9% of patients. (9)or 12.5% of patients had hypotension (systolic blood pressure<90 mm Hg) on admission and average blood pressure<90 mmHg was observed in (32) or 44.4% of patients. (23) or 31.9% had a SPO2 <90%. Cranio-encephalic scanning was performed in 62 or 86.1% and discovered as lesions (25) or 34.9% hemorrhagic contusions followed by extradural hematomas (13) or 18.1%. (63) or 87.5%, patients were intubated-ventilated-sedated in addition to resuscitation. (28) or 38.9% of patients had undergone a surgical intervention with (9) or 12.5% having osmotherapy.The evolution was marked by death of (48) or 66.7%.

CONCLUSION

Severe cranio-encephalic trauma represents a major cause of morbidity and mortality. The establishment of pre-hospital medicine will allow better care and reduction of mortality by early and continuous management of ACSOS and respiratory and / or hemodynamic distress, which are very often associated with severe TCE.

[Epidemio-clinicalappearances of care-associated infections in the resuscitation unit of Gabriel Touré teaching hospital (Bamako)]

An infection is said to be associated with care (IAS) when it occurs during or after a patient's management (PEC). A delay of at least 48 hours after admission is commonly accepted to distinguish a nosocomial infection from a community infection.in 2009, WHO estimated that 1.4 million people were sick in the world afterhospital-acquired infections. This prevalence remains largely underestimated in Sub - Saharan Africa, and particularly in Mali, which led us to initiatethiswork, whichaimed to describe the epidemiological and clinical aspects of nosocomial infections, determine their frequency and identify the germs responsible.

MATERIAL AND METHODS

This was a prospective study, over 12 months from January 1st to December 31st, 2016, in the resuscitation department of CHU Gabriel Touré. Including all patients with a temperature greater than or equal to 38 ° C occurring after at least 48 hours of admission. The data were collected through the surveycards and medical records. The input and analysis made respectivelyfrom Epi info software and the 2016 Office Pack (Word, Excel, Power Point).

RESULTS

Duringourstudy of 200 hospitalized patients we collected 35 IAS cases, aprevalence of 17.5%. The male sex was predominant with 60.5% and a sex ratio = 1.53. The average age was 34.28 ± 19.11 yearsold. The traumatized head with 10 cases (28.5%) were the most represented, followed by surgery postoperative 7 cases (20%) and burned 5 cases (14.2%). We carried out 51 samples (15 bronchial samples all positive, 13 ECBUs of which 11 positive, 7 blood cultures, one positive, 12 swabs all positive). The diagnoses retainedwere: ventilated lungdisease 12 cases (34.3%), urinary infection alone 8 cases (22.9%), 6 cases (17.1%) of surgical site infection, 6 cases (17.1%) ) of soft tissue infection and 3 cases (8.6%) of pneumopathy associated with urinary tract infection. The germs found were multidrug-resistant bacilli (BMR), for bronchial samples (Klebsialla pneumoniae, Acinetobacter baumanii, Echerichia coli). ECBU were found 08 cases of Echerichia coliand 01 case of enterococcusfaecalus, and 2 cases of association Echerichia coli and enterococcus faecalus; blood cultures: staphylococcus aureus. The swabsfound: Klebsialla pneumonia, Echerichia coli, Acinetobacter baumanii enterobacter, cloecae, Staphylococcus aureus, Providencia stuartii, Proteus mirabilis. The average duration of treatment of patients with IAS was 8 days with extremes of 2 to 15 days. The mortality was 57.1%.

CONCLUSION

This study allowed us to notice a resistance of different germs to antibiotics. It is therefore necessary to change the behavior of our health care facilities in order to meet this challenge.

[The sensory-motor approach to support the development of hospitalised children]

In intensive care units, the priority is to provide the care and treatments essential for the child's survival. However, the psychological aspect must not be ignored. The sensory-motor approach contributes to the provision of high-quality care in this context. It enables individualised care to be delivered in an environment optimising the child's resources.

[Hypnosis and intensive care nursing, fusion or fiction?]

For some time, hypnosis and physical therapy techniques have had the wind in their sails. Numerous media reports extol their benefits for patients. However, in concrete terms, how do these techniques impact on the everyday life of a team and can hypnosis find its place in nursing care in an intensive care unit? This article provides some answers through the experience of a nurse and the work of a whole team.

[Innovative technologies and communication in intensive care]

The nursing team of the multidisciplinary intensive care unit of Timone 2 hospital in Marseille has developed a communication IT tool which is easy to use thanks to its mobility and the use of eye tracking technology. This innovative tool enables patients to exchange with caregivers and their families.