Papers by Pascal Augustin
Critical Care, 2016
Background: De-escalation is strongly recommended for antibiotic stewardship. No studies have add... more Background: De-escalation is strongly recommended for antibiotic stewardship. No studies have addressed this issue in the context of health care-associated intra-abdominal infections (HCIAI). We analyzed the factors that could interfere with this process and their clinical consequences in intensive care unit (ICU) patients with HCIAI. Methods: All consecutive patients admitted for the management of HCIAI who survived more than 3 days following their diagnosis, who remained in the ICU for more than 3 days, and who did not undergo early reoperation during the first 3 days were analyzed prospectively in an observational, single-center study in a tertiary care university hospital. Results: Overall, 311 patients with HCIAI were admitted to the ICU. De-escalation was applied in 110 patients (53 %), and no de-escalation was reported in 96 patients (47 %) (escalation in 65 [32 %] and unchanged regimen in 31 [15 %]). Lower proportions of Enterococcus faecium, nonfermenting Gram-negative bacilli (NFGNB), and multidrugresistant (MDR) strains were cultured in the de-escalation group. No clinical difference was observed at day 7 between patients who were de-escalated and those who were not. Determinants of de-escalation in multivariate analysis were adequate empiric therapy (OR 9.60, 95 % CI 4.02-22.97) and empiric use of vancomycin (OR 3.39, 95 % CI 1.46-7.87), carbapenems (OR 2.64, 95 % CI 1.01-6.91), and aminoglycosides (OR 2.31 95 % CI 1.08-4.94). The presence of NFGNB (OR 0.28, 95 % CI 0.09-0.89) and the presence of MDR bacteria (OR 0.21, 95 % CI 0.09-0.52) were risk factors for non-de-escalation. De-escalation did not change the overall duration of therapy. The risk factors for death at day 28 were presence of fungi (HR 2.64, 95 % CI 1.34-5.17), Sequential Organ Failure Assessment score on admission (HR 1.29, 95 % CI 1.16-1.42), and age (HR 1.03, 95 % CI 1.01-1.05). The survival rate expressed by a Kaplan-Meier curve was similar between groups (log-rank test p value 0.176). Conclusions: De-escalation is a feasible option in patients with polymicrobial infections such as HCIAI, but MDR organisms and NFGNB limit its implementation.
Anesthésie & Réanimation, 2015
Médecine Buccale Chirurgie Buccale, 2010
Résumé -Classiquement, les syndromes coronariens aigus se manifestent par une douleur thoracique ... more Résumé -Classiquement, les syndromes coronariens aigus se manifestent par une douleur thoracique rétrosternale, constrictive et irradiante. Toutefois, chez certains patients, il peut exister des manifestations atypiques, notamment chez les personnes âgées. De plus, certains infarctus peuvent simuler un malaise vagal. Nous présentons le cas d'un homme de 87 ans qui, arrivant chez son chirurgien dentiste, fait un malaise de type vagal avec pâleur, sueurs, bradycardie et hypotension, sans douleur thoracique ni dyspnée. L'électrocardiogramme a permis de diagnostiquer un infarctus étendu du myocarde antérieur. Tout chirurgien dentiste devrait savoir qu'un malaise vagal ne cédant pas aux premières mesures peut être révélateur d'un syndrome coronarien aigu.
Médecine Buccale Chirurgie Buccale, 2011
Key words: medical emergencies / dental practice / dental office / dentist / intravenous injectio... more Key words: medical emergencies / dental practice / dental office / dentist / intravenous injection / dental student Abstract -Medical emergencies can occur in dental practice and dental surgeons have to be able to handle them effectively. The intravenous route has long been advocated for dental surgeon in emergency. Since 2006, recommendations from the British Resuscitation Council tend to discourage this route of administration for dental practitioners in emergency. In France there is no consensus on this subject and most French dental schools still teach intravenous route in case of medical emergency. We reviewed international literature regarding medical emergencies in dental practice since 2006 and identified those dealing with intravenous access. Half of the publications suggest or encourage the use of intravenous access. Nevertheless, most of dental surgeons do not feel confident in realizing an urgent intravenous injection. Indeed, this technique requires an intensive phase of learning and regular practice to be performed in safety and effectively. Thus, this technique is difficult to realize in a context of stress and of under-training. Dental surgeons should be familiar with other methods of administration to manage medical emergencies encountered in dental practice such as intramuscular, inhalatal, sublingual, buccal and oral. It seems necessary to encourage an European consensus on this subject in order to improve the management of medical emergencies.
Journal of dental education, 2009
An increasing proportion of the population is medically at risk. Dental providers can encounter a... more An increasing proportion of the population is medically at risk. Dental providers can encounter a cardiac arrest (CA) while treating their patients. Several studies have assessed qualified dental surgeons on the management of medical emergencies, but to our knowledge there is no reported study about dental students. The aim of this study was to evaluate final-year dental students in their ability to recognize a cardiac arrest and to apply cardiopulmonary resuscitation (CPR). We evaluated, with a questionnaire, how seventy-six final-year dental students self-assessed their capacity in the management of CA. Then we randomly selected twenty-two of the final-year students and compared their answers on the self-assessment questionnaire to their objective ability to perform CPR. Though 53 percent of the students who answered the questionnaire felt they were able to manage a CA, the performance of the twenty-two students selected to demonstrate CPR was poor. Only two performed an appropria...
Intensive Care Medicine, 2015
Médecine Buccale Chirurgie Buccale, 2011
Cardiac arrest is a significant medical emergency that can occur in outpatient medical facilities... more Cardiac arrest is a significant medical emergency that can occur in outpatient medical facilities. Early defibrillation has been demonstrated to be critical to an individual's survival of a cardiac arrest. The 2010 guidelines of the European Resuscitation Council advocate that defibrillators should be available throughout outpatient medical facilities, including dental offices. Nevertheless, the underwhelming amount of available data showed that dental offices were under equipped with defibrillators. Objective: The aim of this study was to assess the prevalence of defibrillation equipment in dental offices. Additionally, this assessment also surveyed non-equipped offices regarding their decisions to not have a defibrillator. Design and Subjects: We conducted a prospective study by contacting all dental offices in five randomly drawn French cities of different sizes (Paris, Besançon, Blois, Romorantin-Lanthenay and Gray). Main Results: Of the 1716 dental offices called, 1358 (79%) were joined and 24 preferred to not answer the questionnaire. Our study indicated only 41 offices (3.1%) were equipped with a defibrillator and 1212 (94%) of the dental offices lacking a defibrillator had no plans to obtain the equipment. The non-equipped practices stated that the device was expensive and not worthwhile as the primary reasons for not having defibrillation equipment. Conclusions: This study determined that despite the recommendation by the European Resuscitation Council, dental practices in France are under-equipped and reluctant to purchase defibrillation equipment. The possibility of sharing the expense of defibrillation equipment between residents and health professionals of a building and storing the device in an accessible location is suggested.
Médecine Buccale Chirurgie Buccale, 2009
Objectif : Cette enquête a pour but de recenser les urgences médicales survenant dans les service... more Objectif : Cette enquête a pour but de recenser les urgences médicales survenant dans les services d'odontologie et de faire l'état des moyens, de la formation et des protocoles mis en oeuvre pour y faire face. Méthode : Elle a été menée de décembre 2007 à juin 2008 auprès des pôles et services d'odontologie des centres hospitaliers universitaires français. Un questionnaire portant sur le matériel d'urgence disponible, la formation des praticiens, les procédures d'urgence et la survenue des urgences médicales sur une période de un an a été envoyé à tous les chefs de services. Résultats : Sur les 32 pôles et services contactés, 28 ont répondu au questionnaire. Le matériel d'urgence disponible est très variable selon les services. La majorité d'entre eux ne dispose pas des médicaments recommandés ni du matériel spécialisé nécessaire tel qu'un défibrillateur. Concernant la formation des praticiens, 75 % d'entre eux n'ont eu aucune formation particulière pour la gestion des urgences médicales. Dans près de la moitié des services, il n'y a pas de procédure définie pour faire appel à des moyens de secours extérieurs au service. On relève une moyenne de 20 urgences médicales par an et par service. La majorité d'entre elles sont des malaises vagaux mais on retrouve également des accidents plus graves qui peuvent mettre en jeu le pronostic vital du patient. Conclusion : Même si l'incidence des urgences médicales semble faible dans les services hospitaliers d'odontologie, il est nécessaire que les praticiens disposent du matériel et soient formés à leur prise en charge. (Med Buccale Chir Buccale 2009 ; 15 : 87-92). mots clés : urgence médicale, service d'odontologie, défibrillateur, dentiste, AFGSU VOL. 15, N°2 2009 page 87
59ème Congrès de la SFMBCB, 2012
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Papers by Pascal Augustin