Burned patients are prone to develop severe intestinal complications because of decreased splanch... more Burned patients are prone to develop severe intestinal complications because of decreased splanchnic circulation. We report three cases of sigmoid perforation in burn patients appearing late during hospitalization. The common aetiological factor was a state of septic shock treated with infusion of vasopressors. Two patients also received corticosteroids as treatment for acute respiratory distress syndrome. These cases underline the necessity to maintain adequate organ perfusion and to prevent intestinal ischaemia in severe burns.
ABSTRACT The treatment of shock states often requires fluid replacement. Hypertonic saline is an ... more ABSTRACT The treatment of shock states often requires fluid replacement. Hypertonic saline is an alternative to conventional solutions, isotonic crystalloids or colloids. The concept of low-volume resuscitation has grown over the last 30 years mainly in the areas of hemorrhagic shock and brain osmotherapy. More recently, hypertonic saline has been evaluated in other types of shock, of cardiogenic and septic origin. Improvement of the hemodynamic failure is due to the combination of increased preload, increased contractility and improvement of the microcirculation. Other properties such as immunomodulation or anti-edematous effects are interesting in many types of shocks. Data mainly issued from animal models argue for clinical trials in different diseases.
The aim of this study performed in patients undergoing major orthopedic surgery was to assess the... more The aim of this study performed in patients undergoing major orthopedic surgery was to assess the impact of changes in practice on both the incidence of postoperative myocardial ischemia (PMI) detected by serial measurements of troponin Ic and long-term cardiac outcome. During a 3-yr period, troponin Ic was measured on the first 3 days after major orthopedic surgery in a multidisciplinary hospital. After 16 months of study, postoperative care was improved. Cardiac death, myocardial infarction, and cardiac failure were considered major adverse cardiac events and were recorded during the hospital stay and the first postoperative year. The incidences of PMI and major adverse cardiac events were used as result indicators for quality of care and compared before (P1) and after (P2) quality enhancement. Three hundred seventy-eight surgical procedures were included (P1, 123; P2, 255). Incidences of PMI and major adverse cardiac events were 8.9 versus 3.9% (P=0.04) and 8.1 versus 1.9% (P=0.0...
Introduction. -L'évaluation des soins postopératoires repose principalement sur le signalement d'... more Introduction. -L'évaluation des soins postopératoires repose principalement sur le signalement d'évènements indésirables graves (EIG). Nous proposons une autre approche et prenons comme exemple l'exploration du risque lié à l'anémie postopératoire, situation qui paraît régulièrement associée aux décès imputables à l'anesthésie. Matériel et méthode. -La procédure a consisté à extraire le fichier généré par l'automate du service de biologie en filtrant les données sur le critère « service demandeur » et à le fusionner avec la base de données anesthésique. Le service sélectionné a été le service de chirurgie orthopédique en raison d'une large prescription d'héparine de bas poids moléculaire rendant fréquentes et régulières les numérations-formules sanguines (NFS). Toutes les NFS prescrites en 2005 ont été analysées. Des zones de risque croissant ont été déterminées en fonction de l'âge et de l'intensité de l'anémie. Les dossiers des patients exposés au risque le plus fort ont été analysés. Résultats. -Les NFS de 691 patients ont été analysées. Quarante et une (5,9 %) avaient au moins une mesure de l'hémoglobine (hb) inférieure ou égale à 8 g/dl. Une hb inférieure à 8 g/dl a été observée chez 18 patients (2,6 %) sur deux NFS consécutives deux jours distincts. Huit (1,2 %) dossiers « à haut risque » ont été identifiés et analysés, permettant de retrouver six cas de non-transfusion et/ou un retard à la transfusion (14,6 % des anémies postopératoires). Conclusion. -Une approche globale du risque d'exposition à l'anémie ainsi qu'une méthode fiable de détection des EIG liés à l'hémorragie postopératoire peuvent être obtenues « à la sortie de l'automate ». # 2008 Elsevier Masson SAS. Tous droits réservés.
The Journal of Trauma: Injury, Infection, and Critical Care, 2010
Ventilation of Acute Respiratory Distress Syndrome (ARDS) is a challenge, and there is definitely... more Ventilation of Acute Respiratory Distress Syndrome (ARDS) is a challenge, and there is definitely a need for lack of variations between delivered and set tidal volume (Vt). We have assessed the ability of the ventilator T-birdVS02 and LTV-1000 to deliver to a lung model with ARDS a set Vt at different simulated altitudes. We used a decompression chamber to mimic the hypobaric environment at a range of simulated cabin altitudes of 1,500, 2,500, and 3,000 m (4,000, 6,670, and 8,000 feet, respectively). Ventilators were tested with realistic parameters. Vt was set at 400 mL and 250 mL in an ARDS lung model. Comparisons of preset to actual measured values were accomplished using a t test for each altitude. The T-birdVS02 showed a decrease in the volume delivered. Comparisons of actual delivered Vt and set Vt demonstrated a significant difference starting at 1,500 m for a Vt set of 400 mL and at 2,500 m for Vt set of 250 mL. At these altitudes, the variations between Vt set and delivered were more than 10%. With decreasing barometric pressure, the LTV-1000 showed mostly an increase in volume delivered. Comparisons of actual delivered Vt and set Vt demonstrated a significant difference at 2,500 m for a Vt set of 400 mL and at 3,000 m for Vt set of 250 mL. The delivered Vt remained within 10% of the set Vt. Clinicians involved in aerial evacuations must keep in mind the performance and limitations of their ventilator system.
Cultured epithelial autografts (CEAs) have long been used to tackle limited donor site availabili... more Cultured epithelial autografts (CEAs) have long been used to tackle limited donor site availability and difficulty of permanent skin coverage in massive burns, but this approach still has limited documentation. In this retrospective, single-center study, medical records of patients treated with CEAs in our burn center from 1991 until 2008 were analyzed in search of factors associated with outcome. Out of 68 patients, 63 records were analyzable. Patients were aged 29 [17-41.5] years (seven children). Total body surface area (TBSA) burned was 81±10%, of which 69±14% TBSA full thickness. CEAs were first applied after 45±34 days, on a surface of 32±14% TBSA. Success rate at take down was 65±19%, correlating only with young age (r(2)=0.18; p=0.0006). At discharge, CEAs covered 26±15% TBSA. Infections (4.3±2 per patient), most frequently of skin, often complicated the clinical course. Mortality was 16% (10 patients). In multivariate analysis, the number of infections was the only factor associated with mortality (OR=2.05 per single infection, 95%CI 1.03-4.07, p=0.04). Although complex and costly, CEAs can be used with reasonable success and satisfying survival results for the treatment of massive burns. In this study, favorable outcome was principally associated with young age and low number of infectious complications.
Burns 3 5 S ( 2 0 0 9 ) S1-S47 Testosterone serum levels were higher in non-survivors women than ... more Burns 3 5 S ( 2 0 0 9 ) S1-S47 Testosterone serum levels were higher in non-survivors women than in survivors (p = 0.001) regardless of the postmenopausal state, whereas they resulted reduced in burn men without a significant difference considering the outcome. Plasma levels of prolactin were significantly lower as well in men as in women who died than in those who survived (p = 0.029 and p < 0.001, respectively). No significant difference between survivors and non-survivors was found in plasma FSH and LH levels.
Burned patients are prone to develop severe intestinal complications because of decreased splanch... more Burned patients are prone to develop severe intestinal complications because of decreased splanchnic circulation. We report three cases of sigmoid perforation in burn patients appearing late during hospitalization. The common aetiological factor was a state of septic shock treated with infusion of vasopressors. Two patients also received corticosteroids as treatment for acute respiratory distress syndrome. These cases underline the necessity to maintain adequate organ perfusion and to prevent intestinal ischaemia in severe burns.
ABSTRACT The treatment of shock states often requires fluid replacement. Hypertonic saline is an ... more ABSTRACT The treatment of shock states often requires fluid replacement. Hypertonic saline is an alternative to conventional solutions, isotonic crystalloids or colloids. The concept of low-volume resuscitation has grown over the last 30 years mainly in the areas of hemorrhagic shock and brain osmotherapy. More recently, hypertonic saline has been evaluated in other types of shock, of cardiogenic and septic origin. Improvement of the hemodynamic failure is due to the combination of increased preload, increased contractility and improvement of the microcirculation. Other properties such as immunomodulation or anti-edematous effects are interesting in many types of shocks. Data mainly issued from animal models argue for clinical trials in different diseases.
The aim of this study performed in patients undergoing major orthopedic surgery was to assess the... more The aim of this study performed in patients undergoing major orthopedic surgery was to assess the impact of changes in practice on both the incidence of postoperative myocardial ischemia (PMI) detected by serial measurements of troponin Ic and long-term cardiac outcome. During a 3-yr period, troponin Ic was measured on the first 3 days after major orthopedic surgery in a multidisciplinary hospital. After 16 months of study, postoperative care was improved. Cardiac death, myocardial infarction, and cardiac failure were considered major adverse cardiac events and were recorded during the hospital stay and the first postoperative year. The incidences of PMI and major adverse cardiac events were used as result indicators for quality of care and compared before (P1) and after (P2) quality enhancement. Three hundred seventy-eight surgical procedures were included (P1, 123; P2, 255). Incidences of PMI and major adverse cardiac events were 8.9 versus 3.9% (P=0.04) and 8.1 versus 1.9% (P=0.0...
Introduction. -L'évaluation des soins postopératoires repose principalement sur le signalement d'... more Introduction. -L'évaluation des soins postopératoires repose principalement sur le signalement d'évènements indésirables graves (EIG). Nous proposons une autre approche et prenons comme exemple l'exploration du risque lié à l'anémie postopératoire, situation qui paraît régulièrement associée aux décès imputables à l'anesthésie. Matériel et méthode. -La procédure a consisté à extraire le fichier généré par l'automate du service de biologie en filtrant les données sur le critère « service demandeur » et à le fusionner avec la base de données anesthésique. Le service sélectionné a été le service de chirurgie orthopédique en raison d'une large prescription d'héparine de bas poids moléculaire rendant fréquentes et régulières les numérations-formules sanguines (NFS). Toutes les NFS prescrites en 2005 ont été analysées. Des zones de risque croissant ont été déterminées en fonction de l'âge et de l'intensité de l'anémie. Les dossiers des patients exposés au risque le plus fort ont été analysés. Résultats. -Les NFS de 691 patients ont été analysées. Quarante et une (5,9 %) avaient au moins une mesure de l'hémoglobine (hb) inférieure ou égale à 8 g/dl. Une hb inférieure à 8 g/dl a été observée chez 18 patients (2,6 %) sur deux NFS consécutives deux jours distincts. Huit (1,2 %) dossiers « à haut risque » ont été identifiés et analysés, permettant de retrouver six cas de non-transfusion et/ou un retard à la transfusion (14,6 % des anémies postopératoires). Conclusion. -Une approche globale du risque d'exposition à l'anémie ainsi qu'une méthode fiable de détection des EIG liés à l'hémorragie postopératoire peuvent être obtenues « à la sortie de l'automate ». # 2008 Elsevier Masson SAS. Tous droits réservés.
The Journal of Trauma: Injury, Infection, and Critical Care, 2010
Ventilation of Acute Respiratory Distress Syndrome (ARDS) is a challenge, and there is definitely... more Ventilation of Acute Respiratory Distress Syndrome (ARDS) is a challenge, and there is definitely a need for lack of variations between delivered and set tidal volume (Vt). We have assessed the ability of the ventilator T-birdVS02 and LTV-1000 to deliver to a lung model with ARDS a set Vt at different simulated altitudes. We used a decompression chamber to mimic the hypobaric environment at a range of simulated cabin altitudes of 1,500, 2,500, and 3,000 m (4,000, 6,670, and 8,000 feet, respectively). Ventilators were tested with realistic parameters. Vt was set at 400 mL and 250 mL in an ARDS lung model. Comparisons of preset to actual measured values were accomplished using a t test for each altitude. The T-birdVS02 showed a decrease in the volume delivered. Comparisons of actual delivered Vt and set Vt demonstrated a significant difference starting at 1,500 m for a Vt set of 400 mL and at 2,500 m for Vt set of 250 mL. At these altitudes, the variations between Vt set and delivered were more than 10%. With decreasing barometric pressure, the LTV-1000 showed mostly an increase in volume delivered. Comparisons of actual delivered Vt and set Vt demonstrated a significant difference at 2,500 m for a Vt set of 400 mL and at 3,000 m for Vt set of 250 mL. The delivered Vt remained within 10% of the set Vt. Clinicians involved in aerial evacuations must keep in mind the performance and limitations of their ventilator system.
Cultured epithelial autografts (CEAs) have long been used to tackle limited donor site availabili... more Cultured epithelial autografts (CEAs) have long been used to tackle limited donor site availability and difficulty of permanent skin coverage in massive burns, but this approach still has limited documentation. In this retrospective, single-center study, medical records of patients treated with CEAs in our burn center from 1991 until 2008 were analyzed in search of factors associated with outcome. Out of 68 patients, 63 records were analyzable. Patients were aged 29 [17-41.5] years (seven children). Total body surface area (TBSA) burned was 81±10%, of which 69±14% TBSA full thickness. CEAs were first applied after 45±34 days, on a surface of 32±14% TBSA. Success rate at take down was 65±19%, correlating only with young age (r(2)=0.18; p=0.0006). At discharge, CEAs covered 26±15% TBSA. Infections (4.3±2 per patient), most frequently of skin, often complicated the clinical course. Mortality was 16% (10 patients). In multivariate analysis, the number of infections was the only factor associated with mortality (OR=2.05 per single infection, 95%CI 1.03-4.07, p=0.04). Although complex and costly, CEAs can be used with reasonable success and satisfying survival results for the treatment of massive burns. In this study, favorable outcome was principally associated with young age and low number of infectious complications.
Burns 3 5 S ( 2 0 0 9 ) S1-S47 Testosterone serum levels were higher in non-survivors women than ... more Burns 3 5 S ( 2 0 0 9 ) S1-S47 Testosterone serum levels were higher in non-survivors women than in survivors (p = 0.001) regardless of the postmenopausal state, whereas they resulted reduced in burn men without a significant difference considering the outcome. Plasma levels of prolactin were significantly lower as well in men as in women who died than in those who survived (p = 0.029 and p < 0.001, respectively). No significant difference between survivors and non-survivors was found in plasma FSH and LH levels.
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