Programme scientifique

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mercredi 23 janvier 2019

Flash Com
14h10 - 15h10
Forum 5
Médecin : Pédiatrie 1
Modérateur(s) : Robin Pouyau (Lyon / FRANCE), Pierre-Louis Léger (Paris / FRANCE)
  • Diagnostic tools used and pathogens involved in Ventilatory Acquired Pneumonia in PICU: a one-year prospective multicenter database (the INCIPAVE study)
    Orateur(s) :
    • Stéphane Dauger (Paris / FRANCE)
    • Yves Gallien (Paris / FRANCE)
    • Marcel Tinnevelt (Utrecht / FRANCE)
    • Alexandra Binoche (Lille / FRANCE)
    • Olivier Brissaud (Bordeaux / FRANCE)
    • Capucine Didier (Bron / FRANCE)
    • Pierre-Louis Léger (Paris / FRANCE)
    • Sonia Pelluau (Toulouse / FRANCE)
    • Laure de Saint Blanquat (Paris / FRANCE)
    • Jérôme Naudin (Paris / FRANCE)
    • Matthieu Resche-Rigon (Paris / FRANCE)
    14h10 / 14h18
    Abstract : Ventilatory Acquired Pneumonia (VAP) is one of the main nosocomial infection in adult ICU. To date, only one prospective multicenter study performed during six months in 16 PICUs of the US has prospectively described pediatric VAP. We design the INCIPAVE study to report the occurrence of VAP in european PICUs. One of the aim of the INCIPAVE study was to precisely describe the diagnostic tools used and the pathogens involved in pediatric VAP. Multicenter prospective cohort study from 03/04/2017 to 03/04/2018 including all patients mechanically ventilated (MV) at least once in eight PICUs, one in the Netherlands and seven in France. VAP was defined using the 2015 CDC criteria, applied during PICU stays, excluding the 48 hours preceeding and following PICU. Patients were described on admission and main risk factors ever tested in the medical litterature were daily included by a pediatric intensivist of each PICU in an electronic database on a securized dedicated website. The Ethics Committee of the French Society of Intensive Care approved the study, which has been declared to the CNIL and recorded on Clinical-Trials. All parents or legal representatives were individually informed by a dedicated sheet. Descriptive data are reported as number (%) or medians [first-third quartiles]. These results are based on declarative information reported in the INCIPAVE database during its first opening on September 2018, before cleaning. A total of 158 VAP (76,8% according to CDC criteria) was declared during 11685 days of MV. At least one pathogen was identified in 58,7% case of VAP, with more than one in 11,6%. Diagnosis was made on Tracheal Aspirates, with or without quantitative cultures (51% and 12.9% respectively), and on Blind Protecting Specimen Brush with or without quantitative cultures (7.7% and 2.6% respectively). Identified pathogens were Pseudomonas aeruginosas (PA, 12.1%), Haemophilus influenzae (HI, 12.1%), Staphylococcus aureus (SA, 7.4%), Streptococcus pneumoniae (SP, 5.4%), Stenotrophomonas maltophilia (SM, 3.4%). HI and SP were involved in “early VAPs” (<6 days) and PA, SM and SA were reported in “late onset” VAPs.Tracheal aspirate with quantitative culture is still the method of choice to diagnose VAP in PICU. Nosocomial pathogens are mainly involved after 6 days of MV. A more precise analysis is planned after cleaning of the database, including a special reading of each case of VAP.
  • Management of pleural infection in children at a University Hospital: A retrospective study over 6 years
    Orateur(s) :
    • Ombeline Roignot (Strasbourg / FRANCE)
    • Anne-Sophie Guilbert (Strasbourg / FRANCE)
    • Charlie de Melo (Strasbourg / FRANCE)
    • Amélie Stern (Strasbourg / FRANCE)
    14h18 / 14h26
    Abstract : Parapneumonic effusions and pleural empyema are common complications of community-acquired bacterial pneumonia in children. There is not yet a consensus concerning the management of this pathology, and expert's recommendations are scarce. The objective of this study was to compare whether the evolution of our patients benefited or not from drainage procedures.This retrospective single-center study collected data from 79 children treated for pleural infection at the Strasbourg University Hospital from May 2010 to May 2016. 2 groups of children were compared concenring medical and/or invasive treatment received (thoracentesis, chest drain insertion with or without instillation of fibrinolytic agents and surgical techniques).43 children benefited from an invasive treatment strategy (IT), and 36 from antibiotics alone (AA). The epidemiological data of the 2 groups was comparable (comorbidities, vaccination status). Significant differences were the duration of oxygen dependence: 3.1 days in the AA group versus 7.6 days in the IT group (p <0.001), the time elapsed to obtaining apyrexia: 4 days in the AA group versus 7.9 days in the IT group (p = 0.009), overall hospital stay and duration of intensive care. Initial C-reactive Protein levels were measured at 160.5 mg/L in the AA group versus 258 mg/L in the IT group (p <0.001). We proposed a predictive score for an invasive procedure based on initial CRP and pleural ultrasound data.Pneumonia in children with low to moderate volume effusion may show a favorable clinical course treated by antibiotics only. Prospective randomized controlled trials are needed to reassess the indication of invasive procedures in the management of children's pleural infection.
  • Mechanical ventilation under pediatric V-V ECM
    Orateur(s) :
    • Jérôme Rambaud (Paris / FRANCE)
    • Julien Jegard (Paris / FRANCE)
    • Isabelle Guellec (Paris / FRANCE)
    • Pierre-Louis Léger (Paris / FRANCE)
    • Sandrine Jean (Paris / FRANCE)
    • Yohan Soreze (Paris / FRANCE)
    • Jean Eude Piloquet (Paris / FRANCE)
    • Julia Guilbert (Paris / FRANCE)
    • Cecile Valentin (Paris / FRANCE)
    • Alexandra Bower (Paris / FRANCE)
    14h26 / 14h34
    Abstract : Protective mechanical ventilation and adjuvant therapies for severe ARDS are well-defined in adult and pediatric population. However, no clearly identified recommendations are available to perform a protective ventilation during pediatric V-V ECMO The aim of this study was first to describe potential associations between ventilatory settings during ECMO and outcome in ARDS patients. The secondary goal was to compare three periods of interest to identified significant modification and their potential consequences on the survival rate. We performed an observational monocentric retrospective study, from january 2007 to december 2017. All patients treated by ECMO V-V for a refractory ARDS were included. We collected data's at day 1, day 3 day 7 and day 14 of ECMO. Three periods of interest were defined (before 2010, from 2010 to 2014 and after 2014). We retrospectively collected the data's from our local database, approved by the French Data Protection Authority.83 patients treated by extracorporeal membrane oxygenation were included. We identified an increase of the number of ECMO V-V for pediatric refractory ARDS associated with a higher survival rate throughout the three periods. The OSI (oxygenation saturation index) was the only pre-ECMO parameter significantly associated with a higher mortality. We identified a significant modification the adjuvant therapy illustrated by a sharpe increase for the use of neuromuscular blockers (from 14% to 52%) and the prone positioning before ECMO (from 5% to 85 %). We also show evidence of a strong modification of the ventilatory parameters during ECMO. As example, the tidal volumes are significantly lower throughout the periods (5 cc/kg vs 3,5 cc/kg) such as the driving pressure (28 vs 14cm d'H2O). In contrary, the PEEP is higher in the most recent period. Finally, we identified an improvement of the survival rate all over the three period. Recent modifications of ventilatory parameters during V-V ECMO for pediatric ARDS aimed at implementing a better lung protection. These modifications are associated with a better survival. However, the correlation between survival and ventilators settings remained unclear and a multicentric study should help physician to identify prognosis factors
  • Septic shock and toxic shock syndrome: two infectious shocks with different immune response
    Orateur(s) :
    • Solenn Remy (Lyon / FRANCE)
    • Karine Kolev-Descamps (Lyon / FRANCE)
    • Morgane Gossez (Lyon / FRANCE)
    • Fleur Cour-Andlauer (Lyon / FRANCE)
    • Fabienne Venet (Lyon / FRANCE)
    • Tiphanie Ginhoux (Lyon / FRANCE)
    • Guillaume Monneret (Lyon / FRANCE)
    • Etienne Javouhey (Lyon / FRANCE)
    14h34 / 14h42
    Abstract : Septic shock (SS) has recently been redefined in adults as life-threatening organ dysfunction caused by dysregulated host response to infection. Due to pediatric specificities, adult definition cannot be just transpose to children. Toxic shock syndrome (TSS) is a particular entity of infectious shock, with large pediatric prevalence. Some toxins specific to Streptococcus A and Staphylococcus aureus lead to superantigenic activation of T-lymphocytes, responsible for major cytokines storm with multi-organ failure. While immunosuppression induced by SS is now demonstrated in adults and children, we investigated whether similar immune disorders arise during TSS.Single-center prospective study included all children under 18 years-old, consecutively admitted into Pediatric Intensive Care Unit for SS (“Surviving Sepsis Campaign”/Goldstein criteria), or TSS (Center for Disease Control), between September 2014 and July 2018. Controls were recruited from outpatients admitted for an elective benign surgery, without any criteria of infection. Immune monitoring realized by flow cytometry included HLA-DR expression on monocytes (mHLA-DR), total lymphocyte count, and lymphocyte sub-populations' proportions (CD4⁺ and CD8⁺ T cells, regulatory T cells, NK cells, B cells). Samples were analyzed at Day 1, 3 and 7, after shock onset. Clinical data were collected prospectively, as well as severity scores and secondary nosocomial infection occurrence.Forty-six SS, 12 TSS and 30 controls were recruited. At each time points, mHLA-DR in SS and TSS groups were decreased, compared with controls (fig1). Moreover, mHLA-DR was significantly higher in TSS at day 1 and 3, than SS. Lymphocytes' time course also differs between SS and TSS: more profound lymphopenia occurred at day 1 in TSS than SS; but correction was faster in TSS between day 1 and 3, while between day 3 and 7 in SS. No difference was observed concerning regulatory T cells. Thirteen patients with SS presented secondary infections (28%), compared to only one in TSS group (8%).Our study showed that despite similar initial shock, immune response is significantly different between SS and TSS. TSS didn't induce persistent immune-suppression, as seen in SS: highlighted by different time course of mHLA-DR, lymphocytes and secondary infection occurrence. There is no only one type of septic shock but different infectious shocks with different immune responses and clinical outcomes. These results reinforce objective to better characterize immune state of patients in intensive care, in order to propose personalized medicine with adapted immune-modulatory therapies.
  • The Septic Shock Score in children in septic shock treated with extracorporeal assistance
    Orateur(s) :
    • Clémence Marais (Paris / FRANCE)
    14h42 / 14h50
    Abstract : Septic shock is a common pathology in intensive care units responsible for a high mortality rate. Extracorporeal life support (ECLS) is used when patients no longer respond to standard treatments, including inotropes. Recently, in a multicenter study involving more than 500 children with septic shock, the Septic Shock Score (SSS) proved highly reliable in identifying patients at risk of death and was able to define refractory septic shock. The objective of our study is to evaluate two versions of the SSS, the bedside SSS (bSSS) and the computed (cSSS) in a group of patients hospitalized with septic shock who received ECLS supportThis retrospective study includes patients aged 1 month to 18 years hospitalized in the intensive care units of the Necker Enfant Malade, Trousseau and Bicêtre hospitals for septic shock requiring ECLS assistance between January 2010 and March 2018. Five data collection times were chosen: sepsis time, ECLS decision time, ECLS starting time and end of hospitalization time. At the first 4 collections, clinical and biological criteria were collected to calculate the different predictive scores of septic shock. The group of deceased patients and the group of living patients were compared at these different times.38 patients were included in our study, 24 of which died during the hospitalization. At all times studied, both the bSSS and the cSSS had poor reliability in identifying deceased children. The vasoactive-inotropic score is significantly higher at ECLS starting time in deceased patients and it decreases between ECLS decision time and ECLS starting time in living patients. This is a pilot study that tested a database of children in septic shock who had received ECLS in APHP's intensive care units. The continuation of the study will be carried out as part of a collaborative project of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC), and will extend to 27 other pediatric intensive care units to clarify ECLS success criteria, characterize the evolution of organ failure and thus better define ECLS uses in children with septic shock.
  • Prediction of Complicated Outcomes in children with sickle cell anemia: a CARABDREPA Cohort
    Orateur(s) :
    • Amélie Rolle (Abymes / FRANCE)
    • Raphael Blanc (Fort-De-France / FRANCE)
    • Jérôme Pignol (Fort-De-France / FRANCE)
    • Frédéric Martino (Pointe-À-Pitre / FRANCE)
    • Pascale Piednoir (Pointe-À-Pitre / FRANCE)
    • Bertrand Pons (Pointe-À-Pitre / FRANCE)
    • Hossein Mehdaoui (Fort-De-France / FRANCE)
    • Michel Carles (Pointe-à-Pitre / FRANCE)
    14h50 / 14h58
    Abstract : Purpose: Sickle cell disease (SCD) is an increasing global health problem; approximately 300,000 infants born every year. SCD is associated with a decreased life expectancy, half of the deaths occurring in the ICU. Preexisting prediction model built by The Cooperative Study of SCD do not show relationship existed between early clinical predictors and complicated outcome (CO). The identification of risk factors could potentially have an immediate effect in preventing clinical complications and improving the quality of life for hundreds of thousands of children worldwide. We aimed to identify early predictors of a CO, defined as an ICU stay > 2 days, the need for vital support or death in children with SCD. Methods: Retrospective observational cohort study of SCD patients over a 5-year period were conduced in French territories in the Americas teaching hospital and SCD referral center. Results: Of the 2559 infant's admissions in the Carabdrepa cohort, 174 (6.8 %) had a CO, of whom 6 (0.2%) death. Using multivariate analysis, we found significant predictors of CO: an episode of dactylitis (defined as pain and tenderness in the hands or feet) before the age of one year (OR 3, IC 95% 1.9-45.5), a hemoglobin level of less than 7 g per deciliter (OR 1.75, IC 95% IC 0.98-2.84), and leukocytosis (OR 1.21, IC 95% 0.8-1.83), a respiratory rate more than or equal to 32 cycles/min (OR 1.01, IC 95% 0.84-1.18). ), a Delay between first symptom and medical contact (OR 1.3, IC 95% 1.04-1.65), and an admission for sepsis (OR 1.32, IC 95% 0.44-3.85). Our model demonstrated good predictive performances in terms of discrimination (c-statistic: 0.813) and calibration.Conclusions: Sickle-cell disease children are at high risk of life threatening complications. Episodes of dactylitis, with a sustained drop of hemoglobin; associated with a sepsis context and a delay in medical care are strong predictors of a complicated outcome.
  • Hemorrhagic shock in multiple trauma children: epidemiological aspects and application of the TRISS methodology in this population.
    Orateur(s) :
    • Luis Ferreira (Saint-Denis / FRANCE)
    • Gilles Orliaguet (Paris / FRANCE)
    • Caroline Duracher-Gout (Paris / FRANCE)
    • Stephane Blanot (Paris / FRANCE)
    • Estelle Vergnaud (Paris / FRANCE)
    • Thomas Baugnon (Paris / FRANCE)
    • Philippe Meyer (Paris / FRANCE)
    14h58 / 15h06
    Abstract : Traumatology is the leading cause of death in young adults and children. Hemorrhagic shock is a major aggravating factor in trauma, however there are very few data available in the pediatric population. TRISS method [1] offers a standard approach for evaluating outcome of trauma care, enabling the determination of an individual probability of survival (Ps) for each patient according to Trauma and Injury Severity Score. The aims of our study were: 1) to identify multiple trauma children admitted with hemorrhagic shock in our pediatric Trauma Center, 2) to analyze factors that could influence the outcome using the TRISS method.We performed a monocentric, observational, descriptive, retrospective study on medical records. The included patients were children under 18 years of age admitted for multiple trauma and presenting with hemorrhagic shock upon arrival. The patients included were identified by means of a computerized database internal to the service. The primary outcome was death.From January 2014 to April 2018, 947 multiple trauma children were admitted in the service. Among them, 41 (4.3%) were in hemorrhagic shock upon admission and included in the study. The median interquartile age and weight were 3.0 [2.0-10.7] years and 16.0 [12.9-32.5] kg, respectively. Their trauma profile was very similar to other polytraumatized children, with 73% of head trauma. The global principles of Damage Control Resuscitation have been met, including the application of the massive transfusion protocol. However, only 10% of children actually correspond to the usual definition of “massive blood transfusion” (70 ml/kg over 24 h) and only 37% required a surgical hemostasis procedure. The overall mortality was 41% with an average TRISS of 45%. We had 2 “unexpected” survivors and 1 “unexpected” death according to the TRISS method in our population.In our study, 4.3% of the multiple trauma children were admitted in hemorrhagic shock in our center. These children were heavily traumatized with an overall mortality rate of 41%. However, the TRISS method revealed an observed mortality 3.9% lower than the predicted mortality, with +2.4% of “excess survivors”. When we checked the medical records of the 2 “unexpected” survivors, they seemed to have beneficiated from a more aggressive prehospital resuscitation care. Bibliography [1]. Boyd CR, Tolson MA, Copes WS (1987) Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. (J Trauma 27: 370-378) .
Flash Com
14h10 - 15h10
Forum 6
Médecin : Traumatologie et médecine d'urgence
Modérateur(s) : Nicolas Marjanovic (Poitiers / FRANCE), Benoit Doumenc (Paris / FRANCE)
  • Diagnosis performance of repeated ECG for prediction of a coronary cause after cardiac arrest
    Orateur(s) :
    • Pierre Dupland (Paris / FRANCE)
    • Florence Dumas (Paris / FRANCE)
    • Wulfran Bougouin (Paris / FRANCE)
    • Julien Charpentier (Paris / FRANCE)
    • Olivier Varenne (Paris / FRANCE)
    • Lionel Lamhaut (Paris / FRANCE)
    • Marine Paul (Paris / FRANCE)
    • Jean-Daniel Chiche (Paris / FRANCE)
    • Jean-Paul Mira (Paris / FRANCE)
    • Alain Cariou (Paris / FRANCE)
    14h10 / 14h18
    Abstract : Electrocardiogram (ECG) is an essential tool for the diagnosis of acute coronary syndromes (ACS). However, diagnostic performances of post-resuscitation ECG are usually poor in the setting of out-of-hospital cardiac arrest (OHCA). Our aim was to evaluate the performances of repeated ECG during the pre-hospital period in order to identify patients who require an emergency percutaneous coronary intervention (PCI) after OHCA. We included a consecutive series of OHCA patients with no obvious extra-cardiac cause, in whom an immediate coronary angiogram (CAG) was performed at admission. The first ECG (early ECG) after the return of spontaneous circulation (ROSC) and the last ECG performed prior to CAG (late ECG) were classified into 4 groups, blinded to the angiographic result: (1) ST segment elevation (ST+), (2) left bundle branch block, (3) anomaly other than ST + but suspected ischemia, (4) no sign of ischemia. Respective performances of early and late ECGs were assessed using the need for early PCI as the main endpoint.Between 2011 and 2016, 287 patients were included, of whom 34% had a PCI at admission. A change in classification between early and late ECGs was observed in 111 patients (39%). A pattern of ST-elevation (group 1) was present on 26% of late ECGs, which predicted the need for PCI with a good specificity (87.3%) but a poor sensitivity (53.1%) (Table). In multivariate analysis, ST-elevation pattern (group 1) on late ECG was a stronger predictor for the need of PCI (OR = 6.81 (3.58-12.93), p <0.001) as compared with the same pattern observed on early ECG (OR = 4.5 (2.59- 7.82 p <0.001). Presence of any pattern of ischemia on the late ECG was also an independent predictor for the need of PCI (OR = 3.63 (1.74-7.6) p < 0.001), with a good sensitivity (86.4%), but a low specificity (36.2%). (Table 1) Absence of any ischemic aspect on late ECG performed after 43 minutes from ROSC was an independent predictor of no PCI (OR = 15.94 (3.26-77.99) p <0.001). Although performing better than the immediate post-resuscitation ECG, we observed that the reliability of the late ECG is insufficient in order to distinguish patients who will require an early PCI and those in whom an early CAG can be avoided.
  • Major traumatic complications after out-of-hospital cardiac arrest: Insights from the Parisian registry
    Orateur(s) :
    • Pierre-Alexandre Haruel (Paris / FRANCE)
    14h18 / 14h26
    Abstract : Due to collapse and cardiopulmonary resuscitation (CPR) maneuvers, major traumatic injuries may complicate the course of resuscitation for out-of-hospital cardiac arrest patients (OHCA). Our goals were to assess the prevalence of these injuries, to describe their characteristics and to identify predictive factors.We conducted an observational study over a 9-year period (2007-2015) in a French cardiac arrest (CA) center. All non-traumatic OHCA patients admitted alive in the ICU were studied. Major injuries identified were ranked using a functional two-level scale of severity (life-threatening or consequential) and were classified as CPR-related injuries or collapse-related injuries, depending of the predominant mechanism. Factors associated with occurrence of a CPR-related injury and ICU survival were identified using multivariable logistic regression.A major traumatic injury following OHCA was observed in 91/1310 patients (6.9%, 95%CI: 5.6, 8.3%), and was classified as a life-threatening injury in 36% of cases. The traumatic injury was considered as contributing to the death in 19 (21%) cases. Injuries were related to CPR maneuvers in 65 patients (5.0%, (95%CI: 3.8, 6.1%)). In multivariable analysis, age [OR 1.02; 95%CI (1.00, 1.04); p = 0.01], male gender [OR 0.53; 95%CI (0.31, 0.91); p = 0.02] and CA occurring at home [OR 0.54; 95%CI (0.31, 0.92); p = 0.02] were significantly associated with the occurrence of a CPR-related injury. CPR-related injuries were not associated with the ICU survival [OR 0.69; 95%CI (0.36, 1.33); p = 0.27].Major traumatic injuries are common after cardiopulmonary resuscitation. Further studies are necessary to evaluate the interest of a systematic traumatic check-up in resuscitated OHCA patients in order to detect these injuries.
  • PROSEDA, effectiveness of Procedural Sedation and Analgesia in emergency department, a prospective multicentric observational study
    Orateur(s) :
    • Romain Bouygues (Tours / FRANCE)
    • Pierre Deneau (Chambray Les Tours / FRANCE)
    • Geoffroy Rousseau (Chambray Les Tours / FRANCE)
    • Saïd Laribi (Tours / FRANCE)
    14h26 / 14h34
    Abstract : The objective of our study was to observe practices of procedural sedation and analgesia (PSA) in emergency departments (EDs) and to evaluate its effectiveness.From January to July 2018, we conducted a prospective and multicentric study, in both EDs and prehospital setting. We enrolled adult patients needing painful procedures that would require PSA. Procedures were divided into 3 groups (A: dislocations; B: displaced fractures; C: other procedures such as abscess drainage or foreign body removal…). PSA drugs were divided into 3 groups (1: sedative drugs such as Propofol, Ketamine, or Midazolam; 2: Morphine; 3: absence of drugs or 50% Oxygen Nitrous-Oxyd Premix). We used a composite primary outcome to define the success of the PSA: successful procedure, EP feeling of sufficient sedation, and the patient's absence of painful memories from the procedure. 108 patients were enrolled. 61 PSA (56.5%) were successful according to our primary outcome criteria (3 points out of 3) and 35 (32.4%) reached only 2 points. Pain decrease was measured by numeric rating scale (NRS) and its median was 4.5 (IQR 3-7). Number of patient in each procedure groups were as follow: Group A: n=48 (44.44%), Group B n=32 (29.63%), group C n=28 (25.93%). Drug's group 1 was predominant (n=59, 54.6%) and its success rate was higher (76.3%) compared to group 2 and group 3 (22.7% and 40.7% respectively, p<0.0001). In univariate analysis, NRS decrease, sedative drugs, and Ramsay sedation scale >2 were significantly correlated with a global PSA success whereas procedures of Group C, and morphine group were significantly correlated with PSA failure. In multivariable analysis, PSA success was independently associated with only 2 factors: Ramsay sedation scale >2 (OR=4.584 {1.927-11.501}, p=0.0008), as a protective factor, while morphine group was against PSA success (OR=0.181 {0.051-0.555} p=0.0044). Adverse event rate in our study (15.7%) was comparable with the rate in other international studies. All adverse events were easily treated and had no serious consequences.This prospective and multicentric study of 108 patients showed that efficiency was perfect in only 56.5% of the cases, and had a satisfactory result in 88.9%. Global efficiency was positively linked to the use of sedative drugs and negatively to cutaneous procedures such as abscess drainage.
  • CT scan quantification of pelvic and retroperitoneal hematoma predicts transfusion requirements, pelvic hemostatic management and outcome of severe trauma patients with pelvic fracture
    Orateur(s) :
    • Séverin Ramin (Montpellier / FRANCE)
    • Pierre Cavaille (Montpellier / FRANCE)
    • Margaux Hermida (Montpellier / FRANCE)
    • Ingrid Milliet (Montpellier / FRANCE)
    • Pauline Deras (Montpellier / FRANCE)
    • Xavier Capdevila (Montpellier / FRANCE)
    • Jonathan Charbit (Montpellier / FRANCE)
    14h34 / 14h42
    Abstract : Retroperitoneal hematoma (RPH) is frequently observed in case of pelvic fracture. RPH is the sign of traumatic pelvic hemorrhage. No study has validated a quantification score of RPH in a traumatic context. The aim of this study was to test the performance of a HRP quantification score to predict the outcome of polytraumatized patients with pelvic fracture.A retrospective study was performed in our trauma center between 2010 and 2015. All severe trauma patients with pelvic fracture who underwent a CT scan on admission were included. The amount of retroperitoneal effusion was quantified using a semi-quantitative method by counting the number of compartments affected by the spread of blood. Ten compartments in the retroperitoneal cavity were considered: prevesical space, laterovesical space, laterorectal space, presacral space, right and left iliopsoas space, periaortic and psoas space, right and left parietocolic space, and perirenal fascia extension. RPH was categorized in each compartment as absent (0), moderate (1), and large or bilateral (2) for a total score on 20. Patients were classified into 3 groups according to their RPH score (mild or none [0-5], moderate [6-9] and abundant [10-20]) and compared in terms of transfusion requirements, pelvic hemostatic management and prognostic variables. A total of 311 severe trauma patients were included (mean age: 42±20 years, mean ISS: 27±19, average RPH score: 6.5±4.6). Among these patients, 68 (22%) had abundant RPH, 115 (37%) had RPH moderate and 128 (41%) had mild or no RPH. Massive transfusions requirement was more important in abundant RPH group (53% vs. 9% vs. 10%) as well as pelvic embolization requirement (10% vs. 3% vs 0 %), pelvic fixator (15% vs. 4% vs. 1%), and mortality (26% vs. 10% vs. 8%); P <0.001. Similarly, days of mechanical ventilation and length of stay were significantly associated with RPH abundance (P <0.001). The predictive value of moderate and abundant HRP for determining transfusion and interventional needs, as well as the risk of death were presented in figure 1. Using ROC curves analysis, the global ability of RPH score was robust to predict transfusion > 5 RBCs [0.75 (0.69-0.82)], massive transfusion [0.74 (0.65-0.83)] and death [0.70 (0.62-0.79)]. CT scan semi-quantitative analysis of HRP at admission allows for reliable prediction of transfusion requirements and outcome for Trauma patients with pelvic fracture.
  • Early post traumatic pulmonary embolism in intensive care unit
    Orateur(s) :
    • Mariem Dlela (Sfax / TUNISIE)
    • Abir Bouattour (Sfax / TUNISIE)
    • Olfa Turki (Sfax / TUNISIE)
    • Hela Kallel (Sfax / TUNISIE)
    • Mabrouk Bahloul (Sfax / TUNISIE)
    • Hédi Chelly (Sfax / TUNISIE)
    • Mounir Bouaziz (Sfax / TUNISIE)
    14h42 / 14h50
    Abstract : Venous thromboembolism (VTE) is a well-established complication of trauma. Recent studies suggest that pulmonary embolism (PE) may occur very early and even immediately, after injury. The aim of this study was to analyze the incidence, risk factors and prognosis of early PE among intensive care unit (ICU) trauma patients. We conducted a twenty month long prospective cohort, including all trauma patients with a confirmed PE diagnosis, who were admitted to our ICU between January 1st, 2017 and august 31st, 2018. Early post traumatic PE was defined as pulmonary embolism diagnosed within the first 72h of injury. All patients, included, were screened for early PE at day 3. Factors associated with early PE were identified using both univariate and multivariate analysis.During the study period's, 66 patients with positive diagnosis of PE, were included. According to our analysis, 45% (30 cases) of the patients presented with PE within 72h of trauma events.The patients in early PE group were older than those in the late PE group (p=0.038), had a body-mass-index (BMI) above thirty (p=0.021) and high sequantial organ failure score (SOFA) on admission (p=.001). On the day of PE diagnosis, early group also presented with higher SOFA scoring (p<0.001) and higher infection rate (p=0.005). Biological assessment revealed lower platelet levels (p=0.001) and lower P/F ratio in the early group (p=0.008). Our study showed that early PE was associated with more transfusions (p=0.002) and surgical treatment measures (p=0.023). The incidence of long bone fractures in lower extremities was higher in those with early PE compared with the other patients (p=0.039). Using the multivariable logistic regression model, higher age (p=0.028), SOFA score (p=0.013), BMI over thirty (p=0.002), and the use of surgical treatment measures (p=0.046) were predictive of early timing of PE in trauma patients. Whereas, pulmonary infection was independently associated with late PE. Long bone fracture was not independently related to early occurrence of PE. Our cohort demonstrated that many of the post-traumatic PEs occur early in the post-traumatic period. To the best of our knowledge, this is the first prospective study conducted in ICU. Further studies with larger patient populations are required to create more accurate predictive models.
  • Gastric inflation induced by bag mask ventilation during different strategies of chest compressions in a cadaver model for cardiac arrest
    Orateur(s) :
    • Dominique Savary (Annecy / FRANCE)
    • Emmanuel Charbonney (Montreal / CANADA)
    • Ian Drennan (Toronto / CANADA)
    • Bilal Badat (Antony / FRANCE)
    • Paul Ouellet (Edmunston / CANADA)
    • Stephane Delisle (Drummondville / CANADA)
    • Caroline Fritz (Nancy / FRANCE)
    • Alain Mercat (Angers / FRANCE)
    • Laurent Brochard (Toronto / CANADA)
    • Jean-Christophe Richard (Annecy / FRANCE)
    14h50 / 14h58
    Abstract : Bag mask ventilation is the most spread technic for ventilation for cardio pulmonary resuscitation (CPR) despite several adverse effects. Gastric gas insufflation may favor lung regurgitation and as result occurrence of aspiration pneumonia (1). We hypothesized that continuous chest compression (CC) may limit the risk of high tidal volume and gastric inflation compared to a 30:2 interrupted CC strategy. The aim of this experimental study was assess the impact of different CC/ventilation strategies on gastric inflation and ventilation during a 6 min prolonged simulated CPR. 5 Thiel Embalmed Cadavers (TEC) from a donation program of the Université du Quebec Trois-Rivieres (CER-14-201-08-03.17) were ventilated 30 min to recruit lungs. (2). Flow and Airway Pressure were measured at the airway opening (AcqKnowledge software Biopac©). A surgical gastrostomy was performed through a 5cm midline laparotomy to introduce a cuffed tracheal tube (size 6) into the stomach cavity; this tube was connected to a Wright spirometer to measure cumulated gastric inflated volume. Experimental protocol: 3 strategies randomly applied during 6 min on each cadaver. 1. 30:2 with Interrupted Chest Compressions (ICC 30:2). Two successive bag insufflations after interrupting CC every 30 CC;. 2. 30:2 with Continuous Chest Compressions (CCC 30:2). Same CC/ventilation ratio than in the first strategy but without interrupting CC. 3. Continuous CC with 1 bag insufflation every 6 sec (CCC 10/min). Before each strategy the stomach was completely emptied through the gastrostomy tube, and the order of each strategy experimented were randomized for each cadaver. 5 cadavers were analyzed (mean age 75±8 years, 60% female, PBW 56±10 Kg). Expired bag tidal volume averaged during the 6 min long period was 319±165 ml during (ICC 30:2), 341±142 ml during (CCC 30:2) and 277±103 ml (CCC 10/min) Cumulated gastric inflated volume was significantly higher during (ICC 30:2) compared to CCC strategies (fig): 5,9L/6min (ICC 30:2); 2,1L/6min (CCC 30:2) and 2,24L/6min (CCC 10/min) (p<0.005) Compared to the recommended (ICC 30:2) strategy, continuous chest compression significantly reduced cumulated gastric inflation. Interestingly, CCC did not affect ventilation actually delivered during CPR. The optimal ratio between chest compression en ventilation during continuous chest compression remains open to discussion.
  • Heart-brain interaction in acute cerebral injury
    Orateur(s) :
    • Mohamed Anass Fehdi (Casablanca / MAROC)
    • Amine Raja (Casablanca / MAROC)
    • Mohammed Mouhaoui (Casablanca / MAROC)
    14h58 / 15h06
    Abstract : Cardiac events are often seen in acute cerebral palsy, and they would be an indicator of poor prognosis. The purpose of this study was to clarify the heart-brain interaction in terms of incidents and repercussions on the morbidity and mortality of cerebral palsy patients.It was a prospective study, over 6 months, including consecutively all the acute cerebral palsy patients, initially admitted to the vital emergency room, and having benefited from a systematic cardiac assessment, namely an ECG, an echocardiogram and a troponin assay during the 24 hours. Patients transferred from another hospital and / or having a cardiac check-up after 24 hours were excluded. The epidemiological, clinical, paraclinical, therapeutic and evolutionary parameters were studied. A univariate statistical study was carried out to deduce the prognostic factors of early mortality (<48 hours) among cardiac assessment components (p <0.05).76 patients were included, with an average age of 56.16 ± 13.56 years, and sex ratio 1.23 (42H / 34F). The diagnoses related to the cerebro-lesion were: ischemic stroke (28 cases / 36%), severe head trauma (24 cases / 32%), hemorrhagic stroke (20 cases / 26%), severe meningitis (4 cases / 6%). The cardiac events observed were: an electrical anomaly in 19 patients (25%), an increase in troponin in 13 patients (17%) and an echocardiographic anomaly in 7 patients (9%). The distribution of cardiac events by type of brain injury is shown in Table 1 The early mortality rate (<48 hours) was 16% (12 deaths): 6 hemorrhagic stroke, 3 ischemic stroke, 3 severe head trauma, and no severe meningitis. The prognostic value of various cardiac events in cerebral palsy patients by type of aggression is shown in Table 1Our study did not show a statistically significant difference in terms of early mortality according to the presence or absence of one or more cardiac incidents. On the other hand, very important NPVs have been noted, all brain lesions combined.The absence of cardiac events in cerebral palsy patients would favor a better early evolution. This finding should be confirmed by a broader study. We recommend performing a cardiac checkup in any cerebral palsy patient during the first 24 hours.
Controverse
14h40 - 15h10
E01
Infirmier(e) : Pour ou contre changer les VVP à 96h
Modérateur(s) : Gaëlle Chevalier (Paris / FRANCE), Sandrine Dray (Marseille / FRANCE)
  • Pour
    Orateur(s) :
    • Jean-François Timsit (Paris / FRANCE)
    14h40 / 14h55
  • Contre
    Orateur(s) :
    • Chirine Mossadegh (Paris / FRANCE)
    14h55 / 15h10
Atelier
14h40 - 15h10
E07
Infirmier(e) : Extubation
Modérateur(s) : Benjamin Sztrymf (Clamart / FRANCE)
  • Extubation
    Orateur(s) :
    • Benjamin Sztrymf (Clamart / FRANCE)
    14h40 / 15h10
Session Thématique
15h25 - 16h45
733-734
Kinésithérapeutes : Kiné en réanimation pédiatrique
Modérateur(s) : Jean Bergounioux (Garchess / FRANCE), Pierre Maffei (Marseille / FRANCE)
  • Oxygène Haut Débit
    Orateur(s) :
    • Caroline Haggenmacher (Bruxelles / BELGIQUE)
    15h25 / 15h45
  • Continuing Positive Airway Pressure
    Orateur(s) :
    • Guillaume Riffard (Saint-Etienne / FRANCE)
    15h45 / 16h05
  • VNI
    Orateur(s) :
    • Damien Moerman (Bruxelles / BELGIQUE)
    16h05 / 16h25
  • High Frequency Oscillation
    Orateur(s) :
    • Roberto Martinez Alejos (Montpellier / FRANCE)
    16h25 / 16h45
Session Thématique
15h25 - 16h45
741
Infirmier(e) : SEDATION
Thématique : Pédiatrie
Modérateur(s) : Cathy Lopresti (Bordeaux / FRANCE), Julien Baleine (Montpellier / FRANCE)
  • La sédation dans les services de réanimation pédiatrique : enquête nationale de la CS paramédicale
    Orateur(s) :
    • Malorie de Monte (Bron / FRANCE)
    15h25 / 15h45
  • Syndrome de sevrage, delirium : comment sédater
    Orateur(s) :
    • Marc Labenne (Marseille / FRANCE)
    15h45 / 16h05
  • Évaluation, après 2 ans, de l'implantation d'un protocole de sédation géré par les IDE
    Orateur(s) :
    • Laurence Domitile (Nantes / FRANCE)
    16h05 / 16h25
  • Protocole infirmier : retour d'expérience
    Orateur(s) :
    • Emmanuelle Bertholet (Lyon / FRANCE)
    16h25 / 16h45
Session Thématique
15h25 - 16h45
E01
Médecin : Immunomodulation du sepsis
Modérateur(s) : Fabrice Bruneel (Versailles / FRANCE), Jean-Paul Mira (Paris / FRANCE)
  • Immunosuppression post-septique
    Orateur(s) :
    • Ferhat Meziani (Strasbourg / FRANCE)
    15h25 / 15h45
  • Place des corticostéroïdes
    Orateur(s) :
    • Djillali Annane (Garchess / FRANCE)
    15h45 / 16h05
  • Are immunoglobulins useful?
    Orateur(s) :
    • Tobias Welte (Berlin / ALLEMAGNE)
    16h05 / 16h25
  • Immunomodulating therapy : myth or reality ?
    Orateur(s) :
    • Peter Pickkers (Nijmegen / PAYS-BAS)
    16h25 / 16h45
Session Thématique
15h25 - 16h45
E02
Médecin : Pneumonie communautaire
Modérateur(s) : François Barbier (Orléans / FRANCE), Lila Bouadma (Paris / FRANCE)
  • Antibiothérapie : quelle désescalade ?
    Orateur(s) :
    • Jean-Pierre Bedos (Versailles / FRANCE)
    15h25 / 15h45
  • Pneumonie virale : un dépistage systématique ?
    Orateur(s) :
    • Guillaume Voiriot (Paris / FRANCE)
    15h45 / 16h05
  • Quand couvrir une bactérie multi-résistante ?
    Orateur(s) :
    • Keyvan Razazi (Créteil / FRANCE)
    16h05 / 16h25
  • Intérêt des corticoïdes ?
    Orateur(s) :
    • Pierre-François Dequin (Tours / FRANCE)
    16h25 / 16h45
Session Thématique
15h25 - 16h45
E03
Médecin : Contrôle thermique
  • Dans le choc septique
    Orateur(s) :
    • Frédérique Schortgen (Créteil / FRANCE)
    15h25 / 15h45
  • Dans le choc hémorragique
    Orateur(s) :
    • Jacques Duranteau (Le Kremlin-Bicêtre / FRANCE)
    15h45 / 16h05
  • Dans l'arrêt cardiaque
    Orateur(s) :
    • Alain Cariou (Paris / FRANCE)
    16h05 / 16h25
  • Dans l'hypertension intracrânienne
    Orateur(s) :
    • Mauro Oddo (Lausanne / SUISSE)
    16h25 / 16h45
Session Thématique
15h25 - 16h45
E05
Infirmier(e) : Les clefs de la communication
Modérateur(s) : Raphaël Minjard (Lyon / FRANCE), Virginie Souppart (Paris / FRANCE)
  • En situation d'urgence
    Orateur(s) :
    • Gaëlle Le Ficher (Paris / FRANCE)
    15h25 / 15h45
  • Avec les familles
    Orateur(s) :
    • Alexandra Laurent (Besançon / FRANCE)
    15h45 / 16h05
  • En vue d'un don d'organes
    Orateur(s) :
    • Sarah Dupont (Paris / FRANCE)
    16h05 / 16h25
  • L'enfant visiteur : quelles spécificités ?
    Orateur(s) :
    • Sylvie L'Hotellier (Strasbourg / FRANCE)
    16h25 / 16h45
Meet the experts
15h25 - 16h25
E06
Médecin : Pancréatite aiguë
Modérateur(s) : Julie Helms (Strasbourg / FRANCE)
  • Pancréatite aiguë
    Orateur(s) :
    • Eric Maury (Paris / FRANCE)
    • [expert] - Pierre-François Laterre (Bruxelles / BELGIQUE)
    • [expert] - Christophe Guitton (Le Mans / FRANCE)
    15h25 / 16h25
Session Thématique
15h25 - 16h45
E07
Infirmier(e) : Antibiothérapie en réanimation
Modérateur(s) : Fatima Douadi (Nice / FRANCE), Nathalie Baugé (Aulnay-Sous-Bois / FRANCE)
  • Résistance : épidémiologie actuelle et nouvelles menaces
    Orateur(s) :
    • Jean-Ralph Zahar (Bobigny / FRANCE)
    15h25 / 15h45
  • Optimisation de l'antibiothérapie intraveineuse
    Orateur(s) :
    • Damien Roux (Colombes / FRANCE)
    15h45 / 16h05
  • Antibiothérapie inhalée : indications et modalités
    Orateur(s) :
    • Stephan Ehrmann (Tours / FRANCE)
    16h05 / 16h25
  • Quizz isolement
    Orateur(s) :
    • Julien Charpentier (Paris / FRANCE)
    16h25 / 16h45
Session Thématique
15h25 - 16h45
E08
Médecin : Bien dormir en réanimation

Session Commune SRLF - SPLF

Modérateur(s) : Olivier Sanchez (Paris / FRANCE), Fekri Abroug (Monastir / TUNISIE)
  • Sommeil normal et pathologique
    Orateur(s) :
    • Vincent Jounieaux (Amiens / FRANCE)
    15h25 / 15h45
  • Conséquences de la privation de sommeil
    Orateur(s) :
    • Xavier Drouot (Poitiers / FRANCE)
    15h45 / 16h05
  • Interactions sommeil et ventilation mécanique
    Orateur(s) :
    • Laurent Brochard (Toronto / CANADA)
    16h05 / 16h25
  • Approches non ventilatoires
    Orateur(s) :
    • Alexandre Demoule (Paris / FRANCE)
    16h25 / 16h45
Session Thématique
15h25 - 16h45
N02
Infirmier(e) : SDRA commune ouverte
Modérateur(s) : Elise Morawiec (Paris / FRANCE), Angelina Barage (Clermont-Ferrand / FRANCE)
  • Définition et physiopathologie
    Orateur(s) :
    • Laurent Brochard (Toronto / CANADA)
    15h25 / 15h45
  • Qu'est-ce que la ventilation protectrice ?
    Orateur(s) :
    • Alain Mercat (Angers / FRANCE)
    15h45 / 16h05
  • Hypoxémie sévère : quelles stratégies ?
    Orateur(s) :
    • Claude Guérin (Lyon / FRANCE)
    16h05 / 16h25
  • Qualité de vie après la réanimation
    Orateur(s) :
    • Laurent Papazian (Marseille / FRANCE)
    16h25 / 16h45
Session Thématique
15h25 - 16h45
S01
Médecin : Actualités Neurovasculaire
Modérateur(s) : Nicolas Weiss (Paris / FRANCE), Tarek Sharshar (Paris / FRANCE)
  • Infarctus cérébral éligible à une recanalisation endovasculaire : Quelle stratégie d'adressage en pré-hospitalier ?
    Orateur(s) :
    • Richard Macrez (Caen / FRANCE)
    15h25 / 15h45
  • Traitements pharmacologiques
    Orateur(s) :
    • Sandrine Deltour (Paris / FRANCE)
    15h45 / 16h05
  • Reperfusion mécanique
    Orateur(s) :
    • Mikael Mazighi (Paris / FRANCE)
    16h05 / 16h25
  • Indications chirurgicales
    Orateur(s) :
    • Damien Bresson (Créteil / FRANCE)
    16h25 / 16h45