Programme scientifique

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mercredi 23 janvier 2019

Session Thématique
11h00 - 12h20
S02
Médecin : Stratégies d'épargne antibiotique
Modérateur(s) : Jean-Ralph Zahar (Bobigny / FRANCE), Fabio Taccone (Bruxelles / BELGIQUE)
  • Peut-on différer l'antibiothérapie ?
    Orateur(s) :
    • Jean-François Timsit (Paris / FRANCE)
    11h00 / 11h20
  • Alternatives aux carbapénèmes dans les infections à BLSE
    Orateur(s) :
    • Philippe Lesprit (Suresnes / FRANCE)
    11h20 / 11h40
  • Mono ou bithérapie ?
    Orateur(s) :
    • François Barbier (Orléans / FRANCE)
    11h40 / 12h00
  • Désescalade : comment et pourquoi ?
    Orateur(s) :
    • Charles-Edouard Luyt (Paris / FRANCE)
    12h00 / 12h20
Session Thématique
11h00 - 12h20
S03
Médecin : SDRA sévère
Modérateur(s) : Guillaume Carteaux (Créteil / FRANCE), Laurent Papazian (Marseille / FRANCE)
  • Current practices
    Orateur(s) :
    • Giacomo Bellani (Monza / ITALIE)
    11h00 / 11h20
  • Decubitus ventral : quand l'initier, quand l'arrêter ?
    Orateur(s) :
    • Claude Guérin (Lyon / FRANCE)
    11h20 / 11h40
  • Comment évaluer le recrutement alvéolaire au lit du patient ?
    Orateur(s) :
    • Laurent Brochard (Toronto / CANADA)
    11h40 / 12h00
  • Place de l'ECMO : avons-nous une vision plus claire ?
    Orateur(s) :
    • Alain Combes (Paris / FRANCE)
    12h00 / 12h20
Controverse
12h30 - 13h30
S01
Kinésithérapeutes : Urgence en kiné respiratoire
Modérateur(s) : Pierre Maffei (Marseille / FRANCE)
  • Pour
    Orateur(s) :
    • Anne Freynet (Bordeaux / FRANCE)
    12h30 / 13h00
  • Contre
    Orateur(s) :
    • Matthieu Reffienna (Paris / FRANCE)
    13h00 / 13h30
Session Thématique
12h35 - 13h55
E01
Médecin : L'internat et après ?
Thématique : Commission Jeunes
  • Retour d'expérience sur la première année MIR
    Orateur(s) :
    • Antonin Hugerot (Colmar / FRANCE)
    12h35 / 12h55
  • Inter-CHU: où, quand et comment?
    Orateur(s) :
    • Quentin Maestraggi (Strasbourg / FRANCE)
    12h55 / 13h15
  • Je termine mon internat et après ?
    Orateur(s) :
    • Pierre Mora (Paris / FRANCE)
    13h15 / 13h35
Assemblée Générale
12h35 - 13h55
Forum 1
  • Rapport moral
    Orateur(s) :
    • Benoit Misset (Rouen / FRANCE)
    12h35 / 13h15
  • Rapport financier
    Orateur(s) :
    • Jonathan Messika (Colombes / FRANCE)
    13h15 / 13h55
Atelier
14h10 - 15h10
733-734
Kinésithérapeutes : Decubitus ventral
  • Decubitus ventral
    Orateur(s) :
    • Marie-Hélène Houzé (Paris / FRANCE)
    • Delphine Royer (Bordeaux / FRANCE)
    • Fabien Bardel (Paris / FRANCE)
    14h10 / 15h10
Atelier
14h10 - 15h10
735-736
Kinésithérapeutes : Outils de revalidation atypiques
  • Outils de revalidation atypiques
    Orateur(s) :
    • Frédéric Duprez (Bruxelles / BELGIQUE)
    14h10 / 15h10
SOS - Session d'organisation des soins
14h10 - 15h10
741
Infirmier(e) : Prise en charge des syndromes de sevrage
Thématique : Pédiatrie
Modérateur(s) : Berthille Bellier (Paris / FRANCE), Julien Baleine (Montpellier / FRANCE)
  • Mise en place d'un protocole de prise en charge du syndrome de sevrage médicamenteux en réanimation pédiatrique
    Orateur(s) :
    • Marie-Agnès Sourdril (Nantes / FRANCE)
    14h10 / 14h30
    Abstract : L'emploi de doses importantes d'antalgiques et de sédatifs lors de la réanimation de certains enfants nous confronte régulièrement au syndrome de sevrage à l'arrêt de ces traitements. Celui-ci expose l'enfant à des complications surajoutées (échec d'extubation, auto-extubation, ablation accidentelle de dispositifs invasifs), risque d'augmenter la durée du séjour en réanimation et impose un vécu difficile pour lui-même et sa famille. Un précédent travail a conduit à la mise en place d'un protocole de sédation permettant de réduire les doses de sédatifs. Ceci représente un premier pas pour la prévention de l'apparition du syndrome de sevrage. Cependant il n'existe actuellement pas d'uniformité dans notre service pour le diagnostic, le dépistage et le traitement du syndrome de sevrage, dépendant ainsi de l'expérience de chaque médecin. Pour atteindre une prise en charge efficiente du syndrome de sevrage nous allons travailler sur différents axes. Tout d'abord, nous réaliserons une enquête auprès des services de réanimation pédiatrique français sur leur prise en charge du syndrome de sevrage. En parallèle, nous ferons une revue de la littérature axée sur la recherche d'une échelle d'évaluation simple et validée pour notre population et sur les moyens médicamenteux ou non médicamenteux disponibles pour la prise en charge. Le résultat attendu de ce travail est l'élaboration conjointe médicale/paramédicale d'un protocole de service pour améliorer et uniformiser la reconnaissance et le traitement du syndrome de sevrage en réanimation pédiatrique.
  • Dis-moi comment tu dors, je te dirai comment tu te réveilles : Le syndrome de sevrage en Réanimation Pédiatrique
    Orateur(s) :
    • Fabienne Deschamps (La Tronche / FRANCE)
    14h30 / 14h50
    Abstract : L'équipe pluridisciplinaire de réanimation et surveillance continue pédiatrique du CHUGA (Grenoble) travaille sur l'amélioration de la qualité de la prise en charge d'enfants (0-18 ans) sédatés et intubés, à travers un protocole de gestion paramédicale de la sédation/analgésie. L'objectif principal est de diminuer la fréquence du syndrome de sevrage tout en assurant le confort de l'enfant intubé. Un groupe de travail réunissant médecins et IPDE/IDE a permis la création du protocole. A suivi une période de formation et de réactualisation des connaissances de l'équipe paramédicale concernant : - Les objectifs de la sédation et des traitements - L'évaluation objective du confort par les scores Comfort B, EDIN et EVENDOL - Les répercussions d'une sédation excessive - Le syndrome de sevrage (définition, évaluation par le score WAT-1, conséquences et prise en charge). Ce protocole est actuellement en cours d'application dans le service. Ses bénéfices en terme de survenue de syndrome de sevrage sont en cours d'évaluation et un retour de l'ensemble de l'équipe est attendu dans les prochains mois. La mise en place d'un tel travail a permis de fédérer l'équipe médicale et paramédicale (IPDE/IDE, AP) autour de mêmes objectifs : Améliorer nos pratiques et la prise en charge des enfants.
  • Syndrome de sevrage de la sédation et des opioïdes aux soins intensifs de pédiatrie : une réalité... mais pas une fatalité
    Orateur(s) :
    • Céline Tournaire (Villaz / FRANCE)
    14h50 / 15h10
    Abstract : Présentation : Unité médico-chirurgicale de soins intensifs de pédiatrie, Hôpitaux Universitaires de Genève (12 enfants, 0-15 ans) Constat : La sédation/antalgie est une composante essentielle de la prise en charge des enfants intubés aux soins intensifs. Les médicaments les plus fréquemment utilisés sont les benzodiazépines et les opioïdes. Leur administration prolongée peut conduire à un syndrome de sevrage et augmenter les durées de ventilation mécanique et de séjour aux soins intensifs. La dépendance s'installe après 5 à 10 jours et dépend des doses administrées. Objectif : Mettre en place un protocole de sevrage médico-infirmier de la sédation/antalgie aux soins intensifs de pédiatrie. But du protocole : Effectuer un sevrage aussi rapide que possible, sans complications, des benzodiazépines et/ou opioïdes chez les patients à risque. Indications : - Benzodiazépines et/ou opioïdes IV depuis 5 jours - Enfant de plus de 3 mois d'âge corrigé jusqu'à 16 ans Moyens : - Relai de la perfusion IV par l'administration orale/entérale d'une molécule à longue durée d'action - 4 schémas possibles, selon présence ou non de benzodiazépines et durée de traitement IV - Echelles de suivi : . SOS (Sophia Observation withdrawal Symptoms, évaluation des symptômes de sevrage) . COMFORT Behaviour (sédation/douleur, patient intubé ventilé) . Score de sédation clinique . FLACC (douleur aiguë, enfant extubé) Mise en place : Focus-group, protocole et prescriptions informatisée, cartes de poches, ateliers de formation équipe médico-soignant, 6 référents ( 2 médecins, 2 infirmières, 2 pharmaciens). Résultats : Evaluation prévue par une étude rétrospective avant-après
Controverse
14h10 - 14h40
E01
Infirmier(e) : Faut-il généraliser les directives anticipées ? 
Modérateur(s) : Gaëlle Chevalier (Paris / FRANCE), Sandrine Dray (Marseille / FRANCE)
  • Pour
    Orateur(s) :
    • Jean-Philippe Rigaud (Dieppe / FRANCE)
    14h10 / 14h25
  • Contre
    Orateur(s) :
    • Anne-Sophie Debue (Paris / FRANCE)
    14h25 / 14h40
Session Thématique
14h10 - 15h10
E02
Infirmier(e) : Epuration extra-rénale niveau découverte
Modérateur(s) : Joanna Schmitt (Lyon / FRANCE), Sabine Valéra (Marseille / FRANCE)
  • Insuffisance rénale aiguë
    Orateur(s) :
    • Frédérique Schortgen (Créteil / FRANCE)
    14h10 / 14h30
  • Critères de choix de la technique optimale
    Orateur(s) :
    • Matthieu Legrand (Paris / FRANCE)
    14h30 / 14h50
  • Gestion infirmière de l'épuration extra-rénale
    Orateur(s) :
    • Fatima Douadi (Nice / FRANCE)
    14h50 / 15h10
Communications orales
14h10 - 15h10
E03
Médecin : Insuffisance rénale aiguë
Modérateur(s) : Emmanuel Canet (Paris / FRANCE), Stéphane Gaudry (Bobigny / FRANCE)
  • Impact of mechanical ventilation setting on the occurrence of acute kidney injury in ICU patients : insights from the MIMIC-III database
    Orateur(s) :
    • Guillaume Geri (Paris / FRANCE)
    • Loic Ferrer (Paris / FRANCE)
    • Nam Tran (Waterloo / CANADA)
    • Matthieu Jamme (Paris / FRANCE)
    • Leo Anthony Celi (Cambridge / ETATS-UNIS)
    • Joon Lee (Waterloo / CANADA)
    • Antoine Vieillard-Baron (Boulogne / FRANCE)
    14h10 / 14h25
    Abstract : Mechanical ventilation in ICU patients may induce acute kidney injury (AKI). We aimed to describe the effect of mechanical ventilation (MV) settings, on AKI worsening, as well as the potential role of mean perfusion pressure (MPP).We included from the MIMIC-III database adult patients admitted for the first time in the ICU. We excluded patients with known chronic kidney disease, no KDIGO information and who suffered KDIGO3 AKI at day-1. The main outcome was one-KDIGO category AKI worsening (compared to the day before) and included as a categorical variable : discharged alive without AKI worsening and death before AKI worsening. We used a multinomial logistic regression at day 1 and day 2 according to a landmark-approach, with a two-days sliding perspective.26,884/61,051 patients met the inclusion criteria (15,046 male, 56.0%; median age 65 [iqr 52, 78]). ICU and hospital mortality were 7.4 and 10.7%, respectively. Between day 1 and day 3, 529 patients died without AKI worsening, 11,230 were discharged alive and 1,656 suffered an AKI worsening. Between day 2 and day 4, 128 patients suffered an AKI worsening, 5,686 were discharged alive and 313 died. In multivariable analysis, using the “no MV” modality as a reference (n=19,666), MV at day 1 was associated with AKI worsening at day 3 (relative risk ratio [RRR] 15.7 [7.7, 32], 23.2 [17.6, 30.6] and 55.6 [29, 106.4] for MV with PEEP < 5 (n=283), PEEP between 5 and 8 (n=4,153) and PEEP > 8cmH2O (n=1,134)). RRR of AKI worsening at day-4 were 2.3 [0.3, 19.4], 13.3 [5.8, 30.6] and 44.9 [17.2, 117.2] for MV with PEEP < 5 (n=254), PEEP between 5 and 8 (n=2,751) and PEEP > 8cmH2O (n=1,088) at day 2 compared to no MV (n=16,397). Hemodynamic parameters are shown on Figure. MPP significantly differed across MV groups (67, 70, 68 and 64mmHg in patients receiving no MV, MV with PEEP <5, PEEP 5-8 and PEEP >8cmH2O, p<0.001). Mechanical ventilation was associated with AKI worsening in an increasing PEEP dependent manner at the early phase of ICU management in a large cohort of patients. Interaction between MPP and mechanical ventilation should be explored further.
  • Transvenous Renal Biopsy of Critically Ill Patients: Safety and Diagnostic Yield
    Orateur(s) :
    • Marc Pineton de Chambrun (Paris / FRANCE)
    • Philippe Cluzel (Paris / FRANCE)
    • Isabelle Brocheriou (Paris / FRANCE)
    • Nicolas Bréchot (Paris / FRANCE)
    • Guillaume Hekimian (Paris / FRANCE)
    • Guillaume Franchineau (Paris / FRANCE)
    • Côme Bureau (Paris / FRANCE)
    • Simon Bourcier (Paris / FRANCE)
    • Ania Nieszkowska (Paris / FRANCE)
    • Loic Le Guennec (Paris / FRANCE)
    • Zahir Amoura (Paris / FRANCE)
    • Alexis Mathian (Paris / FRANCE)
    • Matthieu Schmidt (Paris / FRANCE)
    • Alain Combes (Paris / FRANCE)
    14h25 / 14h40
    Abstract : Introduction: Transvenous renal biopsy is an alternative way to obtain kidney samples from patients with bleeding-risk factors (e.g., antiplatelet therapy, anticoagulation or coagulation disorders…). This study was undertaken to determine the safety and diagnostic yield of transvenous renal biopsy of critically ill patients.Patients and Methods : Monocenter, retrospective, observational cohort study in a 26-bed French tertiary ICU. All patients undergoing in-ICU transvenous renal biopsy between January 2002 and February 2018 were included.Results: Eighty patients (male/female sex ratio, 0.95; mean ± SD age, 47.3 ± 18.3 years) were included. A histologic diagnosis was obtained for 77 (96.3%) patients, with acute tubular necrosis being the most frequent: 23 (29.9%). A potentially treatable cause was found for 47 (58.7%) patients. The numbers of patients with 0, 1, 2 or 3 factors (i.e., antiplatelet therapy, thrombopenia (< 150 G/L) and preventive or curative anticoagulation) at the time of the biopsy were, respectively: seven (8.8%), 37 (46.2%), 31 (38.7%) and five (6.3%). Four (5%) and two (2.5%) patients, respectively, had renal hematoma and macroscopic hematuria; none required any specific treatment. Six (7.5%) patients died in-ICU and 90-day mortality was 8/80 (10%). No death was related to transvenous renal biopsy and median biopsy-to-death interval was 38 [IQR, 19.7;86] days.Conclusions: Based on this cohort of ICU patients with acute renal failure, transvenous renal biopsy was safe and obtained a high diagnostic yield for these critically ill patients, even in the presence of multiple bleeding risk factors.
  • The incidence of chronic kidney disease three years after non-severe acute kidney injury in critically ill patients : a cohort study
    Orateur(s) :
    • Arthur Orieux (Bordeaux / FRANCE)
    • Sébastien Rubin (Bordeaux / FRANCE)
    • Benjamin Clouzeau (Bordeaux / FRANCE)
    • Claire Rigothier (Bordeaux / FRANCE)
    • Christian Combe (Bordeaux / FRANCE)
    • Didier Gruson (Bordeaux / FRANCE)
    • Alexandre Boyer (Bordeaux / FRANCE)
    14h40 / 14h55
    Abstract : The risk of chronic kidney disease (CKD) following severe acute kidney injury (AKI) in critically ill patients is well documented. However, the long-term risk of CKD for less severe AKI in critically ill patients has never been assessed.This prospective single-center intensive care unit (ICU) observational 3-years follow-up study was carried out from 2013 to 2015 in Bordeaux (France). All patients with both severe (KDIGO 3) and non-severe AKI (KDIGO stage 1, 2) were enrolled. Patients with prior CKD were excluded. The primary outcome was the 3-years prevalence of CKD (defined by estimated glomerular filtration rate lower than 60ml/min/1.73m2) in the non-severe AKI group. Secondary outcomes were risk factors for 3-years CKD, renal survival during follow-up and to identify the proportion among CKD patients followed by a nephrologist. Renal recovery was defined as return of creatinine at ICU discharge to <26.5 µmol/L above baseline.We screened 304 patients and after exclusion of 72 because of prior CKD 232 patients were enrolled. Severe AKI was observed in 120 (52%) and non-severe AKI in 112. At the end of the follow-up and after exclusion of patients who died, 41 and 30 patients remained in the non-severe and severe AKI group respectively. The global prevalence of CKD was 23/71 (32%). It was higher in the severe vs. non-severe AKI group (14/30 (47%) vs. 9/41 (22%); p< 0.05) (table 1). Independent risk factors for 3-years CKD were diabetes (OR = 5.7 [1.5–21.5]) and absence of renal recovery at ICU discharge (OR = 14.2 [2.9–69.1]). Eleven out of 23 (48%) CKD patients were followed by a nephrologist.This study is the first to give the prevalence of CKD 3 years after non-severe AKI in critically-ill patients. No study has focused on stage 1-2 AKI in critically ill patients and only few studies have explored stage 1- 2 AKI in non-critically ill patients. The high prevalence of CKD at 3 years and the limited amount of CKD patients followed by a nephrologist confirm the need for accurate follow-up planning after ICU discharge in all patients diagnosed with AKI.The risk of developing CKD at 3 years after non-severe AKI, despite lower than after severe AKI, remains high and is underestimated.
  • Initiation strategies for renal replacement therapy for acute kidney injury and long-term survival: a follow-up from the AKIKI randomized controlled trial
    Orateur(s) :
    • Khalil Chaïbi (Bobigny / FRANCE)
    • Frank Ehooman (Paris / FRANCE)
    • David Hajage (Paris / FRANCE)
    • Frédérique Schortgen (Créteil / FRANCE)
    • Laurent Martin-Lefèvre (La Roche Sur Yon / FRANCE)
    • Charles Verney (Colombes / FRANCE)
    • Bertrand Pons (Pointe-À-Pitre / FRANCE)
    • Eric Boulet (Beaumont Sur Oise / FRANCE)
    • Alexandre Boyer (Bordeaux / FRANCE)
    • Guillaume Chevrel (Corbeil-Evry / FRANCE)
    • Dorothée Carpentier (Rouen / FRANCE)
    • Nicolas de Prost (Créteil / FRANCE)
    • Alexandre Lautrette (Clermont-Ferrand / FRANCE)
    • Anne Bretagnol (Orléans / FRANCE)
    • Julien Mayaux (Paris / FRANCE)
    • Bruno Megarbane (Paris / FRANCE)
    • Marina Thirion (Argenteuil / FRANCE)
    • Jean-Marie Forel (Marseille / FRANCE)
    • Yonis Hodane (Lyon / FRANCE)
    • Philippe Markowicz (Cholet / FRANCE)
    • Guillaume Thiery (Les Abymes / FRANCE)
    • Florence Tubach (La Pitié / FRANCE)
    • Didier Dreyfuss (Colombes / FRANCE)
    • Stéphane Gaudry (Bobigny / FRANCE)
    14h55 / 15h10
    Abstract : Epidemiological and experimental studies showed a link between acute kidney injury (AKI) and long-term outcome such as mortality and chronic kidney disease (CKD). Whether the timing of renal replacement therapy (RRT) during AKI eventually affects these outcomes is unknown. This study analyzes the long-term outcome of patients included in the Artificial Kidney Initiation in Kidney Injury (AKIKI) according to RRT initiation strategyThe AKIKI trial was a prospective, multicenter, open-label, two-arm randomized controlled trial that compared two RRT initiation strategies in patients receiving catecholamines and/or mechanical ventilation and presenting with severe KDIGO3 AKI and no potentially life-threatening condition (NEJM, 2016; 375:122-133). In the early strategy, RRT was started within 6 hours after randomization criteria. In the delayed one, RRT was initiated only if one or more following criteria occurred: severe hyperkalemia, severe acidosis, severe pulmonary edema due to fluid overload resulting in severe hypoxemia, oligo-anuria >72 hours or serum urea concentration > 40 mmol/L. We assessed long-term (> 2 years) outcomes of the patients who survived 60 days after randomization. We collected vital status, last renal function value and health-related quality of life. We used a Kaplan–Meier estimator and a log rank test to analyze long-term survival according to randomization group. The median follow-up was 2.5 years (confidence interval [CI], 2.3 to 2.7 years). The early strategy group initially included 311 patients of whom 151 were alive 60 days after randomization and 145 were still alive at 2 years. The delayed strategy group initially included 308 patients of whom 153 were alive 60 days after randomization and 145 were still alive at 2 years (p= 0.94 for comparison between groups). Kaplan Meier curves (see Figure 1) were superposed (p-value: 0.79). The analyses of long-term renal function and health related quality of life are still in progress. Although initial mortality of AKI in critically ill patients was high (49%), patients who survived the acute episode had a good vital prognosis at 2 years with only 6% additional deaths. Long-term death rate was not influenced by the initial RRT initiation strategy. Data on renal function and health quality will be available at the time of presentation
Communications orales
14h10 - 15h10
E04
Médecin : Infections virales sévères
Modérateur(s) : Laurent Papazian (Marseille / FRANCE), Charles-Edouard Luyt (Paris / FRANCE)
  • Epidemiology of Post-influenza Bacterial Pneumonia Due to a Panton-Valentine Leukocidin Positive Staphylococcus aureus in Intensive Care Unit: a retrospective nationwide study
    Orateur(s) :
    • Audrey Jacquot (Nancy / FRANCE)
    • Bruno Lévy (Nancy / FRANCE)
    • Charles-Edouard Luyt (Paris / FRANCE)
    • Charles Vidal (La Réunion / FRANCE)
    • Sami Hraiech (Marseille / FRANCE)
    • Jean-Pierre Quenot (Dijon / FRANCE)
    • Lara Zafrani (Paris / FRANCE)
    • Francis Schneider (Strasbourg / FRANCE)
    • Pierre Kalfon (Chartres / FRANCE)
    • Vincent Piriou (Pierre Bénite / FRANCE)
    • Paul Jaubert (Paris / FRANCE)
    • Jonathan Messika (Colombes / FRANCE)
    • Xavier Valette (Caen / FRANCE)
    • Alexandre Lautrette (Clermont-Ferrand / FRANCE)
    • Antoine Marchalot (Dieppe / FRANCE)
    • Guillaume Schnell (Le Havre / FRANCE)
    • Charlène Le Moal (Le Mans / FRANCE)
    • Emmanuel Novy (Vandoeuvre-Les-Nancy / FRANCE)
    • Jérémie Lemarié (Nancy / FRANCE)
    • Arnaud Galbois (Quincy Sous Sénart / FRANCE)
    • Jean-Marc Tadié (Rennes / FRANCE)
    • Gabriel Preda (Saint Denis / FRANCE)
    • Raphael Clere-Jehl (Strasbourg / FRANCE)
    • Céline Pulcini (Vandoeuvre-Les-Nancy / FRANCE)
    • François Vandenesch (Bron / FRANCE)
    • Eliane Albuisson (Vandoeuvre-Les-Nancy / FRANCE)
    • Isabelle Clerc-Urmès (Vandoeuvre-Les-Nancy / FRANCE)
    • Elisabeth Baux (Vandoeuvre-Les-Nancy / FRANCE)
    • Antoine Kimmoun (Nancy / FRANCE)
    14h10 / 14h25
    Abstract : Superinfection of Influenza pneumonia with Staphylococcus aureus is a well-known adverse event. Conversely, published data on the epidemiology of superinfection with a Staphylococcus aureus producing the Panton-Valentine Leukocidin (SA PVL) remains scarse. This study evaluates the mortality and the epidemiology of this specific complication of influenza pneumonia in Intensive Care Unit (ICU). We conducted a multicenter retrospective epidemiological study over a period from January 2009 to December 2017. Were included patients admitted to ICU for SA PVL co infecting influenza pneumonia. The primary endpoint was mortality in ICU. Secondary endpoints included demographic, clinical characteristics of this population, description of complications during ICU stay, microbiological and therapeutic data.Of the 25 participating centres, 1970 patients admitted to ICU for influenza pneumonia were screened during the inclusion period. Prevalence of influenza pneumonia co infected with SA PVL was 1.1% (22 patients). Patients are young and had neither comorbidity, nor risk factors for severe influenza. The overall mortality in ICU of the cohort was 54.5% (12 patients). On admission to intensive care, patients were leucopenic (1.9 G/L [0.7-4.8]) and 17 (81%) presented a severe ARDS (PaO2/FiO2 104 [66-320]) requiring vvECMO in 10 patients (45.5 %). The ICU length of stay was 39.0 days [13.0-53.0] for survivors and 3.5 days [1.0-6.5] for non-survivors. No difference of anti-viral or antibiotic treatment between the two groups was recorded. SA PVL superinfection of influenza pneumonia is rare but extremely severe complication, with a high and early mortality. Patients most often presented with severe ARDS frequently requiring vvECMO. Declarations Any conflict of interest for this work
  • Invasive pulmonary aspergillosis is a rare complication in critically ill patients with influenza
    Orateur(s) :
    • Anne Coste (Brest / FRANCE)
    • Aurélien Frérou (Rennes / FRANCE)
    • Jean Morin (Nantes / FRANCE)
    • François-Xavier Blanc (Nantes / FRANCE)
    • Gilles Névez (Brest / FRANCE)
    • Patrice Le Pape (Nantes / FRANCE)
    • Jean-Marie Tonnelier (Brest / FRANCE)
    • Cédric Bretonniere (Nantes / FRANCE)
    • Cécile Aubron (Brest / FRANCE)
    14h25 / 14h40
    Abstract : Some studies show a high incidence of invasive pulmonary aspergillosis (IPA) in patients with severe influenza, and suggest to assess benefits of an antifungal prophylaxis. However, those studies come from the same area and lack of external validity. We aimed to measure the incidence of invasive pulmonary aspergillosis (IPA) and aspergillosis colonization in patients with severe influenza admitted to the intensive care unit (ICU).This retrospective multicenter cohort study recruited all patients with influenza admitted to four ICU in three French tertiary hospitals between September 1, 2009 and April 30, 2018. Patients were adults and had a confirmed influenza infection based on a positive airway PCR test. Patients with an Aspergillus-positive lower respiratory tract specimen culture (patients with Aspergillus) were diagnosed with Aspergillus colonization and invasive pulmonary aspergillosis (putative or proven) according to AspICU criteria. A multivariate logistic regression was performed to determine the factors associated with invasive pulmonary aspergillosis (IPA) and aspergillosis colonization. Four hundred and ninety-one patients were included. Three hundred and fifty-three patients (78.3%) were infected with Influenza A and 98 patients (21.7%) with Influenza B. Mean Simplified Acute Physiology Score II was 43.9 (SD=20.1) and 97 patients (19.6%) died in ICU. Three hundred and fifty-six patients (72.2%) were under invasive mechanical ventilation and 32 patients (6.5%) underwent extra-corporeal membrane oxygenation. Twenty-six patients (5.2%) had an Aspergillus-positive lower respiratory tract specimen culture, including 12 patients (2.4%) diagnosed with IPA according to AspICU criteria. In multivariate analysis, factors associated with Aspergillosis-positive lower respiratory tract specimen culture were liver cirrhosis, haematological malignancy, use of vasopressors and H1N1 influenza (Table). Mortality rate did not significantly differ between patients with and without Aspergillus (26.9% and 19.2%, p=0.32).In this large French cohort study of patients with severe influenza, IPA was diagnosed in 2.4% of critically ill patients with Influenza infection. Prospective research is warranted to confirm our findings.
  • Influenza virus infection is associated to global and persistent immunosuppression in ICU patients
    Orateur(s) :
    • Ana Catalina Hernandez Padilla (Limoges / FRANCE)
    • Robin Jeannet (Limoges / FRANCE)
    • Olivier Barraud (Limoges / FRANCE)
    • Sébastien Hantz (Limoges / FRANCE)
    • Philippe Vignon (Limoges / FRANCE)
    • Bruno François (Limoges / FRANCE)
    • Thomas Daix (Limoges / FRANCE)
    14h40 / 14h55
    Abstract : Seasonal Influenza virus infection (IVI) is associated to high morbidity and frequent complications. Immune dysregulation secondary to IVI may contribute in both ARDS and overmortality and increase the risk of secondary infections. This study aimed at characterizing the immune profile of ICU patients admitted for IVI.Prospective, single-center, observational study in immunocompetent adults admitted to the ICU for IVI confirmed by PCR from nasopharyngeal swabs between January and March 2018. Immune-profile was assessed by flow cytometry on peripheral blood at admission and during the first two weeks of ICU stay. Subsets analyzed included: immature (CD16-) and mature (CD16+) granulocytes, activated monocytes (CD14+ / CD16+), HLA-DR- monocytes (CD14+ / HLA-DR-) and T-CD3+ lymphocytes. Bacterial coinfection was defined as presence of positive cultures from samples acquired within standard of care associated to clinical evidence of infection.Thirteen patients (51 ± 14 years old; 9 men) were admitted to ICU (SOFA score 4 ± 3; APACHE 16 ± 5) with confirmed IVI (Influenza A 69%). Twelve patients required invasive mechanical ventilation, 4 patients had coinfections at admission and 4 had secondary infections between days 8 and 16. All coinfections were of pulmonary origin. Most of the community acquired pneumonia (CAP) cases were related to pneumococcus coinfection (75%), while isolations related to ventilator-associated pneumonia (VAP) were Staphylococcus aureus (n=2), Staphylococcus epidermidis (n=1) and Aspergillus fumigatus (n=1). Four patients (31%) died, all with documented coinfection (CAP n=2, VAP n=2). All patients showed T-lymphopenia at admission that persisted until day 7 (0.539 ± 0.501 G/L to 0.561 ± 0.095 G/L) (Figure 1A). Activated monocytes were also low at admission and trended towards decrease (0.051 ± 0.047 G/L to 0.007 ± 0.006 G/L) (Figure 1B). Concomitantly, the number of myeloid derived suppressive cells increased over time: HLA-DR- monocytes (0.099 ± 0.097 G/L to 0.128 ± 0.118 G/L) and immature granulocytes (0.592 ± 0.912 G/L to 2.808 ± 2.014 G/L) (Figure 1B and C).Patients admitted to ICU for IVI had an immunosuppressive profile characterized by decreased mature/active cell subsets with concurrent increase in immature suppressive ones. This immunosuppression lasted over the first week of ICU stay, and could explain the increased risk for secondary infections and its related worst prognosis.
  • Impact of respiratory viruses in ICU patients with community acquired-pneumonia (CAP): a one-year retrospective single center study
    Orateur(s) :
    • Marion Giry (Rouen / FRANCE)
    • Marie Gueudin (Rouen / FRANCE)
    • Déborah Boyer (Rouen / FRANCE)
    • Adeline Baron (Rouen / FRANCE)
    • Gaetan Beduneau (Rouen / FRANCE)
    • Soumaya Skallil (Rouen / FRANCE)
    • Marie-Anne Melone (Rouen / FRANCE)
    • Steven Grange (Rouen / FRANCE)
    • Dorothée Carpentier (Rouen / FRANCE)
    • Fabienne Tamion (Rouen / FRANCE)
    • Christophe Girault (Rouen / FRANCE)
    • Benoit Misset (Rouen / FRANCE)
    14h55 / 15h10
    Abstract : Pneumonia is the most frequent community-acquired infection responsible for ICU admission. Multiplex PCR enables early diagnosis of viral infection in daily practice. Few series have been described since this technique has been made available in routine. Our objective was to assess the prevalence and distribution of viruses among ICU patients with CAP and their relationship with severity and outcome. Retrospective analysis of the consecutive viral multiplex PCR (Eplex™, Genmark Dx) between November 2016 and October 2017 in a French 21 bed medical ICU admitting around 1,000 patients per year. Patients' nasopharynx was sampled within 72 hours following their ICU admission. We selected those patients with a diagnosis of CAP and split them into 4 groups according to causal agent: none, viruses, bacteria, combination of both. Comparisons were made with non-parametric Kruskall-Wallis and Fischer's exact tests.223 patients were sampled, of whom 109 had CAP, 38 aspiration or opportunistic pneumonia, 22 non-pulmonary infections, 11 pulmonary edema, 19 exacerbations of chronic lung disease, and 24 other diagnoses. Patients with CAP had the following characteristics: age 59± 16 y, male sex 60%, SAPS 2 score 40 ± 18, ICU length of stay (LOS) 8.7±9.0 d, mortality 10 %. No infectious agent was found in 32 (29%), a virus in 28 (26%), bacteria in 33 (30%) and both a virus and bacteria in 16 (15%). The main bacteria were S. pneumonia (23%) and H. influenza (6.5%). The main viruses were Rhinovirus/Enterovirus (13.8 %), Influenzae A (11 %) and Parainfluenzae (5.5%). The most frequent virus-bacteria association was S. pneumoniae and Influenzae A (3%) and S. pneumoniae and Rhinovirus/Enterovirus (3%). The SAPS 2 score was higher in the mixed group (p = 0.02). The ICU-LOS was 5.2 (no agent), 7.7 (virus), 10.1 (bacteria) and 14.8 (mixed) days respectively (p = 0.04). Mortality was similar among groups. In our ICU population, respiratory viruses were present in 40 % of CAP. Patients with mixed infection had higher severity at admission and longer ICU-LOS.
Communications orales
14h10 - 15h10
E05
Médecin : Actualité en onco-hématologie
Modérateur(s) : Djamel Mokart (Marseille / FRANCE), Frédéric Pène (Paris / FRANCE)
  • Invasive Pulmonary Aspergillosis in Critically Ill Patients with Hematological Malignancies
    Orateur(s) :
    • Emmanuel Pardo (Paris / FRANCE)
    • Djamel Mokart (Marseille / FRANCE)
    • Annabell Stoclin (Villejuif / FRANCE)
    • Anne-Sophie Moreau (Lille / FRANCE)
    • Lionel Kerhuel (Paris / FRANCE)
    • Etienne Ghrenassia (Paris / FRANCE)
    • Laure Calvet (Paris / FRANCE)
    • Audrey de Jong (Montpellier / FRANCE)
    • Sandrine Valade (Paris / FRANCE)
    • Eric Mariotte (Paris / FRANCE)
    • Lara Zafrani (Paris / FRANCE)
    • Michael Darmon (Paris / FRANCE)
    • Elie Azoulay (Paris / FRANCE)
    14h10 / 14h25
    Abstract : Invasive fungal infections remain associated with high mortality rates among patients with hematological malignancy. Recent medical advances in antifungal prophylaxis, diagnostic criteria and treatments of invasive pulmonary aspergillosis (IPA) have been reported. We sought to assess whether these advances translate into change in survival in patients with acute respiratory failure and IPA. Retrospective, multicenter study performed in four centers. Adult patients with hematological malignancy, proven or probable IPA, and acute respiratory failure requiring ICU between January 1998 and December 2017 were included. Results are reported as n (%) or median (IQR). A cox regression model was used to identify variables independently associated with 6 months survival. Overall, 219 patients were included. 138 (63%) were of male gender and median age was of 55 (IQR 44-64). Acute myeloid leukemia (30.1%) and non-Hodgkin lymphoma (22.8%) were the most frequent malignancies. 134 patients were neutropenic at study inclusion (62%), and 53 were allogeneic stem cell recipients (24.2%; including 64.2% who suffered from Graft-versus-Host Disease) and 22 receiving antifungal prophylaxis (10%). Median SOFA score at admission was 9 [7-12] and median time before introduction of invasive mechanical ventilation was 1 [0-3] day. 154 patients (70.3%) had positive serum galactomannan and 136 (62.1%) a positive culture. ICU and 6-months mortality remained unchanged during the 20-years study period, being respectively 58.4% and 80.1% (Figure 1A). Need for invasive mechanical ventilation, at admission or following failure of non-invasive techniques, was associated with a high mortality rate (Figure 1B). Use of Voriconazole (HR 0.67, IC95 0.48-0.94) and focal radiologic pulmonary infiltrate (HR 0.58, IC95 0.41-0.80) were independently associated with better survival by multivariable analysis adjusted on day-1 SOFA score (HR 1,1, IC95%1.06-1.15). IPA still mostly affects patients with neutropenia and BMT recipients. Case fatality remains high and sustained over time. Voriconazole treatment and focal infiltrate (when compared to diffuse infiltrate) are associated with better survival. Strategies to improve survival in these high-risk patients are warranted.
  • Changes in outcome of critically ill cancer patients over the last decades: Results of a systematic review on individual data.
    Orateur(s) :
    • Michael Darmon (Paris / FRANCE)
    • Aurélie Bourmaud (Paris / FRANCE)
    • Quentin Georges (Saint-Etienne / FRANCE)
    • Marcio Soares (Rio de Janeiro / BRÉSIL)
    • Kyeongman Jeon (Seoul / CORÉE DU SUD, REPUBLIC OF (SOUTH CORÉE DU SUD))
    • Sandra Oeyen (Ghent / BELGIQUE)
    • Chin Kook Rhee (Seoul / CORÉE DU SUD, REPUBLIC OF (SOUTH CORÉE DU SUD))
    • Pascale Gruber (Londres / ROYAUME UNI)
    • Marlies Ostermann (Londres / ROYAUME UNI)
    • Quentin Hill (Leeds / ROYAUME UNI)
    • Peter Depuydt (Ghent / ROYAUME UNI)
    • Christelle Ferra (Barcelone / ESPAGNE)
    • Anne-Claire Toffart (Grenoble / FRANCE)
    • Peter Schellongowski (Vienne / AUTRICHE)
    • Alice Muller (Porto Alegre / BRÉSIL)
    • Virginie Lemiale (Paris / FRANCE)
    • Fabien Tinquaut (Saint-Etienne / FRANCE)
    • Djamel Mokart (Marseille / FRANCE)
    • Elie Azoulay (Paris / FRANCE)
    14h25 / 14h40
    Abstract : Overall prognosis of critically ill patients is thought to have improved over the last decades (1). However, this assumption is based upon unadjusted findings and before / after studies (1, 2). The aim of this study was to assess the influence ICU admission year on outcome of the critically-ill cancer patient population. Secondary objectives were to assess changes of prognosis in pre-specified subgroup of patients, and independent risk factors of mortality. This study resulted from a systematic review and meta-analysis on individual data performed according to the PRISMA statements. Public-domain databases (PubMed and Cochrane) were searched by using predefined keywords. The research was restricted to articles published in English and studies focusing on critically ill adult patients from May 2005 to May 2015. The study protocol was registered in the PROSPERO database (CRD42015026347). Selected manuscripts' authors were then contacted and individual data included in this analysis. Results are reported in n (%) or median (IQR). Adjusted mortality was assessed using a mixed logistic regression model taking year of ICU admission as both fixed and random effect, and study as random effect. Overall, 7,356 patients were included in this study, including 1,666 patients with neutropenia at ICU admission. Median age was 60 years (IQR 49-69). Median SAPSII score at ICU admission was 42 (IQR 28-57). Mechanical ventilation, vasopressors, and renal replacement therapy were required in 50.7% (n=3,729), 41.1% (n=3,024) and 16.1% (n=1,174) of the included patients. Median ICU admission year was 2007 (IQR 2004-2010; range 1994-2012). Hospital mortality was 47.4% in the overall population, ICU admission year being associated with a progressive decrease in hospital mortality (OR per year 0.94; 95%CI 0.93-0.95). After adjustment for confounders, year of ICU admission was independently associated with hospital mortality (OR for hospital mortality per year: 0.96; 95%CI 0.95-.97). This finding was confirmed in all of the subgroups except in patients with allogeneic stem cell transplantation (figure – mortality per year, trend + 95%CI). Our results confirm that hospital mortality of critically ill cancer patients steadily decreased over time after adjustment for patients' characteristics, patients' severity and clustering effect. This finding was confirmed in pre-defined subgroups with the exception of allogeneic stem cell transplant recipients. 1- Shimabukuro-Vornhagen CA-Cancer 2016 2- Peigne ICM 2009
  • Role of targeted therapy for cancer patients admitted to ICU.
    Orateur(s) :
    • Virginie Lemiale (Paris / FRANCE)
    • Anne-Pascale Meert (Bruxelles / BELGIQUE)
    • Anne-Claire Toffart (Grenoble / FRANCE)
    • François Vincent (Paris / FRANCE)
    • Aude Gibelin (Paris / FRANCE)
    • Djamel Mokart (Marseille / FRANCE)
    • Andry Van de Louw (Hershey / ETATS-UNIS)
    • Stefan Hatzl (Graz / AUTRICHE)
    • Karin Amrein (Graz / AUTRICHE)
    • Gaelle Rousseau-Bussac (Creteil / FRANCE)
    • Philippe Bauer (Rochester / ETATS-UNIS)
    • Dorothée Carpentier (Rouen / FRANCE)
    • Fabrice Bruneel (Versailles / FRANCE)
    • Gabo Moreno (Barcelone / ESPAGNE)
    • Luca Montini (Rome / ITALIE)
    • Anne-Sophie Moreau (Lille / FRANCE)
    • Pleun Hemelaar (Amsterdam / PAYS-BAS)
    • Elie Azoulay (Paris / FRANCE)
    14h40 / 14h55
    Abstract : Mortality of cancer patients remains high. In the last years, new treatments such as targeted therapies, improved outcome of patients with solid tumors. However, those new therapies have been associated with complications leading to ICU admission. The incidence of those severe adverse events is currently unknown. The aim of this observational study was to describe severe adverse effects of targeted therapy. We conducted an observational multicentric study in 14 international centers belonging to our research group. Critically ill adult patients admitted for any reason between January 1st 2015 and December 31 2016 and treated for solid tumor with targeted therapy prior to ICU admission were included.91 patients, aged of 61 (51-69) years were included, 56 (62%) were non- smokers patients. Underlying cancer were gasto-intestinal tract(n=24,22%), breast (n=18, 20%) , kidney (n=17, 19%), lung (n=17, 19%) and melanoma (n=4,4%). 81 (83% patients had metastasis, 44 (48%) patients were PS<2.21 patients (23%) were treated with anti-EGFR,25 (28%) patients with anti-VEGF and 5 (5.5%) anti-BRAF. Targeted therapy was started 72 days [17-151] before ICU admission. At ICU admission, the median SOFA score was 3 (1-6). Symptoms at ICU admission were respiratory failure (n=31; 35%), infectious diseases ( n=15; 17%), cardiac failure (n=14;19%) and metabolic disorder (n=10; 11%). For 16 (20%) patients, ICU admission was directly related to targeted therapy. Side-effects related to targeted therapy were anaphylaxia (n=1), cardiac failure (n=3), bleeding (n=2), peritonitis (n=1), metabolic disorder (n=3), lung injury (n=4), encephalopathy (n=1) and SIRS without other etiology (n=1). 12% (2/16) of them died during ICU stay (2 patients with digestive cancer treated with anti-VEGF who had peritonitis (1 patient) and cardiogenic failure (1 patient)). Other diagnosis were mostly acute respiratory failure related to tumor progression or pneumonia (n=28), infectious diseases (n=15) or cardiac failure (n=13). 65 (71%) patients were discharged alive from ICU. Median ICU stay duration was 2 (1-6) days and1 month survival rate was 55% (n=50). In this preliminary study, 20 % (IC 11.8-28.2%) of ICU admission were related to severe adverse event for targeted therapy. Intensivists should be aware of those complications particularly anti –VEGF when more patients would be treated with those therapies in the further years.
  • Cytomegalovirus reactivation in intensive care unit patients with hematological malignancies: characteristics and clinical outcomes
    Orateur(s) :
    • Alistair Baber (Paris / FRANCE)
    • Camille Vissac (Nantes / FRANCE)
    • Maud Salmona (Paris / FRANCE)
    • Jérôme Le Goff (Paris / FRANCE)
    • Audrey de Jong (Montpellier / FRANCE)
    • Eric Mariotte (Paris / FRANCE)
    • Lara Zafrani (Paris / FRANCE)
    • Elie Azoulay (Paris / FRANCE)
    • Michael Darmon (Paris / FRANCE)
    • Laure Calvet (Paris / FRANCE)
    14h55 / 15h10
    Abstract : Cytomegalovirus (CMV) reactivation occurs frequently in the critically ill and is associated with poor outcomes (1, 2). However, data on immunocompromised patients are scarce. The primary objective of this study was to describe characteristics and outcomes in critically-ill patients with hematological malignancies and CMV reactivation. Secondary objectives included description of CMV disease incidence and characteristics, associations between whole blood viral load and CMV disease and outcomes.Retrospective single center study (Jan 2010-Dec 2017). Adult patients, admitted to the ICU, having underlying hematological malignancy and CMV reactivation were included. CMV disease was defined according to recent guidelines (2). Results are reported as median (interquartile – IQR) or n (%). Factors associated with hospital mortality or CMV disease were analyzed using logistic regression.178 patients were included (median age 55y [42-64], 123 patients [69.1%] male). Underlying malignancies were mainly non-Hodgkin's lymphoma (n=89; 50%), acute leukemia (n=34; 19.1%) and myeloma (n=16; 9.0%); 37 patients (20.8%) were allogeneic stem cell transplant (SCT) recipients. At admission, median SOFA score was 6 [4-9], and 98 patients required mechanical ventilation (55%), 85 vasopressors (47.8%) and 58 renal replacement therapy (32.6%). Overall, hospital mortality was 53% (n=95). Median CMV load (whole blood) was 2.7 Log [2.3-3.5]. 44 (24.7%) patients developed CMV disease, including 7 probable or proven CMV diseases (3 pneumonia, 2 encephalitis, 1 retinitis, 1 colitis) and 37 possible CMV diseases (including 19 cytopenia, 11 hepatitis and 8 pneumonia). Mortality was associated with CMV viral load quartiles (Figure, P=0.02). After adjustment for confounders, need for vasopressors (OR 2.53; 95%CI 1.11-5.97) and CMV load (OR 1.88 per Log; 95%CI 1.29-2.85) were associated with hospital mortality. When forced one by one in the model, neither CMV disease nor CMV treatment were associated with outcomes. SCT (OR 2.55; 95%CI 1.05-6.16), mechanical ventilation (OR 4.11; OR 1.77-10.54) and viral load (OR 1.77 per Log; 95%CI 1.23-2.61) were independently associated with CMV disease.In critically ill hematology patients, CMV viral load is independently associated with hospital mortality. Conversely, neither CMV disease nor treatment was associated with outcome suggesting CMV reactivations reflect an immunodeficiency rather than a cause of poor outcome.
Session Thématique
14h10 - 15h10
E06
Kiné / Infirmier : Extubation

Session Commune SKR - CCI

Modérateur(s) : David Huard (Nevers / FRANCE), Matthieu Reffienna (Paris / FRANCE)
  • Critères d'extubation
    Orateur(s) :
    • Anne Freynet (Bordeaux / FRANCE)
    14h10 / 14h30
  • Prise en charge des troubles de déglutition dans un service de rééducation post-réanimation
    Orateur(s) :
    • Agnès Pereira (Férolles-Attilly / FRANCE)
    14h30 / 14h50
    Abstract : Au SRPR de Forcilles, nous recevons des patients ayant été hospitalisés longtemps en réanimation. Ces patients sont généralement trachéotomisés et l'objectif principal est de réaliser le sevrage ventilatoire, souvent difficile. Nous prenons également en charge les complications liées à leur séjour en réanimation (neuromyopathie, troubles de la déglutition, dénutrition…) grâce à une rééducation intensive et précoce. À leur arrivée dans le service, nous réalisons un bilan global de leurs capacités qui comporte notamment une évaluation de la déglutition. L'essai de déglutition ne peut être réalisé qu'à plusieurs conditions. Le patient : - doit pouvoir être déventilé plusieurs heures dans la journée - doit être suffisamment vigilant - doit pouvoir être installé en position assise - La canule doit pouvoir être obturée avec une valve phonatoire, voire un bouchon. En fonction du résultat au test de déglutition : - soit le patient pourra s'alimenter sous surveillance des soignants (ils s'assureront qu'une éventuelle posture facilitatrice ou de sécurité est respectée, que la texture des repas est adaptée aux demandes de l'orthophoniste, vérifieront les ingesta et l'absence de fausses routes), - soit les essais se poursuivront dans le cadre de la rééducation orthophonique, qui comporte également un renforcement musculaire de la sphère orale et des exercices pour améliorer la fermeture glottique et la sensibilité pharyngée. La reprise alimentaire se fait prudemment, en augmentant les quantités et en faisant évoluer les textures progressivement, tout en diminuant la nutrition artificielle. Avant la décanulation ou si des fausses routes persistent malgré la rééducation, nous réalisons une fibroscopie permettant de visualiser le larynx afin d'identifier d'éventuels dysfonctionnements (oedème laryngé, défaut de fermeture glottique, gêne occasionnée par la sonde naso-gastrique,...).
  • Quels supports ventilatoires après l'extubation ?
    Orateur(s) :
    • Jonathan Messika (Colombes / FRANCE)
    14h50 / 15h10
Atelier
14h10 - 14h40
E07
Infirmier(e) : Gaz du sang
Modérateur(s) : Benjamin Sztrymf (Clamart / FRANCE)
  • Gaz du sang
    Orateur(s) :
    • Guillaume Savary (Paris / FRANCE)
    14h10 / 14h40