Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Dec 2014
Multicenter Study Observational Study[Out-of-hospital equipment of emergency medical services for hemorrhagic shock management: Can do better!]
Hemorrhagic shock is an emergency, which may benefit from a medicalized prehospital care. Our goal was to survey the means available in the 370 French prehospital medicalized emergency services (SMUR) for hemorrhagic situations. ⋯ There is a great disparity in the means available in the French Smur for the support of prehospitalization bleeding. The majority the Smur physicians can transfuse in a prehospital setting. On the other hand, a minority of teams can actively warm patients, employ tranexamic acid or use pelvic restraint belts.
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Ann Fr Anesth Reanim · Nov 2014
Multicenter Study[Development of a tool for withholding and withdrawing life-sustaining treatment in the emergency room].
Active treatment withholding and withdrawing decisions in the emergency room (ER) must be taken collegially according to ethical and juridical statements. Specific tools can support this process and our main goal was to create and validate such a tool. ⋯ We have been able to create a tool to help for treatment withholding and withdrawing decisions adapted to the guidelines for end of life patient's management in the ER. This tool has been validated using a Delphi method by a group of experts from different centres. This multicentre validation will help for the diffusion and use of this tool in the different ER of the Rhône-Alpes region.
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Ann Fr Anesth Reanim · Mar 2014
Multicenter StudyFirst closed-loop goal directed fluid therapy during surgery: A pilot study.
Intraoperative haemodynamic optimization based on fluid management and stroke volume optimization (Goal Directed Fluid Therapy [GDFT]) can improve patients' postoperative outcome. We have described a closed-loop fluid management system based on stroke volume variation and stroke volume monitoring. The goal of this system is to apply GDFT protocols automatically. After conducting simulation, engineering, and animal studies the present report describes the first use of this system in the clinical setting. ⋯ Intraoperative GDFT delivered by closed-loop system under anaesthesiologist guidance allowed to obtain targeted objectives in 91% of surgery time. This approach may provide a way to ensure consistent high-quality delivery of fluid administration and compliance with perioperative goal directed therapy.
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Ann Fr Anesth Reanim · Dec 2013
Multicenter Study[Multicenter survey on ventilator-associated pneumonia prevention in intensive care.]
Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in intensive care unit (ICU). The aim of the study was to evaluate the follow-up of the guidelines for VAP prevention. ⋯ The compliance to prevention of VAP was poor. Proposals for improving practice are discussed.
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Ann Fr Anesth Reanim · Dec 2013
Multicenter Study Observational Study[Impact of sugammadex on neuromuscular blocking agents use: A multicentric, pharmaco-epidemiologic study in French university hospitals and military hospitals.]
Seven Neuromuscular Blocking Agents (NMBA) are commercialized in France. Four of them have an intermediate duration of action. Sugammadex required the use of NMBA slightly employed in clinical practice in France. Its introduction in routine practice could have an impact on NMBA use in clinical practice. This study was then conducted to assess and compare NMBA use before and after the commercialization of sugammadex. ⋯ The commercialization of sugammadex seems to have induced a discrete increase of steroidal NMBA but non-steroidal NMBA remain the leading agent in France. A long-term follow-up is deserved.