mercredi 5 février 2020 

14h10 - 15h10


 
Espace Poster 8

Évaluation I

MODÉRATEUR(S) :  Fekri ABROUG (Monastir, TUNISIE ), Jean REIGNIER (Nantes)  
  

Adherence to GOLD 2017 guidelines treatment recommendations in critically ill COPD patients

Orateur(s) :   Imen BEN SAIDA (Sousse, TUNISIE) 

Auteur(s) :  Hela KALLAL (Sousse)   Sana ROUIS (Sousse)   Wessem AMMAR (Sousse)   Nesrine FRAJ (Sousse)   Wafa ZARROUGUI (Sousse)   Rym CHELBI (Sousse)   Mohamed BOUSSARSAR (Sousse, TUNISIE)  

14h10 - 14h17
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Adherence to GOLD 2017 guidelines treatment recommendations in critically ill COPD patients

Introduction / Rationale :
The 2017 GOLD report represents a major revision to GOLD strategy guidelines. It brings new recommendations regarding diagnosis, severity assessment, and both pharmacologic and non-pharmacologic treatment of COPD. However, adherence to evidence-based therapeutic guidelines is often poor in low-income developing countries and represents a significant barrier to optimal management.
The aim was to describe the adherence rates to GOLD 2017 guidelines in critically ill COPD patients and to identify predictors of low adherence.

Méthodes / Patients and Methods :
A prospective cohort study conducted from December 2017 to April 2019 in a 9-bed medical intensive care unit of Farhat Hached hospital. All adult patients admitted for AECOPD during the period of the study were included. Demographic and clinical data were recorded. Adherence to GOLD 2017 was evaluated. Univariate and multivariate regression analyses were carried out to identify factors independently associated to non-adherence to GOLD 2017 guidelines.

Résultats / Results :
Seventy-seven patients were recruited. Patients’ characteristics were : mean age, 65.5±9years ; male 71(92.2%) ; median duration of the disease, 6[13-14]years ; mMRC scale ≥2, 67(88.2%) ; health insurance coverage rate, 57(75%) ; pulmonologist follow up, 34(59,6%) ; frequent exacerbator (≥3 exacerbations in the last year), 26(34.2%) ; median exacerbations episodes, 2[1-3]. Long-term oxygen use and home mechanical ventilation were respectively used in 10(13.2%) and 5(6.6%). Eight (10.5%), 14(18.4%) and 54(71.1%) belonged to COPD groups B, C and D, respectively.
Pharmacological treatment included: SABA-ICS combination, 25(32,9%), LABA-ICS, 10(13.2%), LABA-LAMA, 10(13.2%) and LAMA-LABA-ICS, 9(11.8%). Overall adherence to 2017 GOLD guidelines treatment recommendations for the different stages of COPD was 22(28.9%). Two patients (2.6%) were over treated and 52(68.4%) were undertreated. Inappropriate treatment rate was 6(75%) in Gold B, 12(85.7%) in Gold C and 36(66.7%) in Gold D.
Univariate analysis identified two factors associated with non-adherence to GOLD 2017: the absence of pulmonologist follow-up (50% vs 9.1% ; p=0.01) and the low income (35.2% vs 9.1% ; p=0.021).In multivariate analysis only the lack of pulmonologist follow-up was identified as an independent risk factor associated with GOLD guidelines discrepancies (OR, 10 ; 95%CI, [2.1- 47.0] ; p=0.04).

Discussion / Discussion :


Conclusion / Conclusion :
There is a lack of adherence to GOLD 2017 guideline treatment recommendations in Tunisian COPD patients. This may lead to severe exacerbations. Discrepancies were due to the poor access of severe COPD patients to an appropriate pulmonologist follow-up.
 

Use of video-Airtraq in difficult intubation situation: experience of Tizi-Ouzou University Hospital

Orateur(s) :   Yacine BENHOCINE (Tizi-Ouzou, ALGÉRIE) 

Auteur(s) : 

14h17 - 14h24
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Use of video-Airtraq in difficult intubation situation: experience of Tizi-Ouzou University Hospital

Introduction / Rationale :
Since 2015, several learned societies have proposed an algorithm to guide physicians to the most appropriate intubation method, especially in case of difficult intubation including recent devices type video laryngoscopes. Following the recommendations of the SFAR 2017, our CHU acquired the video-Airtraq in the composition of the trolley of difficult incubation. Purpose: To evaluate the efficiency of the video-Airtraq in a situation of difficult intubation in the operating theaters of Tizi-Ouzou University Hospital.

Méthodes / Patients and Methods :
Prospective, mono-centric study, from March 2018 to March 2019. The operating theaters concerned are: the otolaryngology block, ophthalmology, vascular and thoracic surgery, and gynecological surgery. All patients over 18 years of age were enrolled using the clinical parameters of difficult intubation (Arne score> 11), which will benefit from orotracheal intubation. The main judgment criteria are: first-pass success rate, intubation time, which is defined as the time between inserting the slide into the patient's mouth and obtaining the capnography curve, the Cormack-Lehane score and the POGO score (percentage of opening of the glottis). Statistical analysis used SPSS software.

Résultats / Results :
A total of 62 patients were included. No cases of failure with this device were observed, the duration of intubation was on average 21.5 seconds (only 3 cases required more than one minute). The Cormack-Lehane score 1 and 2 involved 55 patients (88.7%), and the POGO score greater than 50% involved 51 patients (82.25%). One case required the setting up of an LMA-Fastrach (desaturation). A case of glottic edema has been noted.

Discussion / Discussion :
This study shows a very high success rate with this technique (95.16% in the first trial and 4.83% in the second trial), in the context of a difficult intubation predictable. The video-Airtraq allows a very good visualization of laryngeal structures, a shortening of the duration of intubation, and is rarely responsible for immediate or secondary complications. All the data in the literature go in the same direction.

Conclusion / Conclusion :
At the end of this work, our perspectives are to: update the difficult intubation procedure, integrating the video-Airtraq into our algorithm, as well as into our difficult intubation trolley. To take into consideration the cost of this device to eventually generalize it to all our structures.
 

Added-value of clinical pharmacist (CP) in intensive care unit (ICU)?

Orateur(s) :   Justine LEMTIRI (Valenciennes) 

Auteur(s) :  Elodie MATUSIK (Valenciennes)   Fabien LAMBIOTTE (Valenciennes)   Hatem BOUGHANMI (Valenciennes)   Emilie HERBEZ (Valenciennes)   Etienne COUSEIN (Valenciennes)   Nabil EL BEKI (Valenciennes)  

14h24 - 14h31
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Added-value of clinical pharmacist (CP) in intensive care unit (ICU)?

Introduction / Rationale :
In an effort to harmonize practices and to improve medication management for patients, on a polar impulse, the ICU has recruited a full-time CP since May 2017 and hospital pharmacy resident since May 2018. The objective is to define the activities and the impact of the CP.

Méthodes / Patients and Methods :
Our hospital has 23 ICU beds (neurosurgical [7] polyvalent [16]) and 15 beds of continuous monitoring. The activity of the CP is organized in a medical visit in the morning and in conducting projects in the afternoon. The activity is presented using a 2-years balance sheet

Résultats / Results :
The activity of pharmaceutical interventions (PI) or answers to requests from teams is shown in Table 1. The solicitations doubled the second year.
The CP is involved in the conduct of internal or polar projects (set up of cooperative sedation, nutrition, ...), the good use of health products (relay IV / PO, infusion, crushed tablets and compatibility with gastric probe, drug incompatibilities, proton pump inhibitors, ...), the efficiency of the drug circuit (link with the Pharmacy, reflection on the improvement of the circuit, regular meetings with nurses), medico-economic analysis of health products spending and the formalization of actions by protocolisation. He is also very involved in clinical research: patient screening, clinical study setup : BLIPIC study (Beta-lactam’s dosing In Pneumonia in ICU in patients treated by Continuous renal replacement therapy; ClinicalTrials NCT03897582) or in CANDIAREA project (Invasive infections to Candida and preemptive treatment guided by biomarkers; in progress)
A satisfaction survey submitted at 6 months to nurses (12 answers/ 60) or to doctors / residents (13/25) reported CP competence in the accompaniment of teams (> 80%) [in medico- economical, contribution of knowledge, vigilance reflex, ...], relevance of information transmitted (> 85%) [administration of drugs, dosage adjustments, ...] and his relationship adapted to the units (> 90%) [communication, availability]

Discussion / Discussion :


Conclusion / Conclusion :
The development of clinical pharmacy in ICU involves mastery of the specificities of ICU by the CP, requiring a learning period and relationships adapted to clinical situations and teams. Many health products projects specific to critical care are coordinated by the CP and made possible by medical and paramedical involvement. The CP appears as a vector of good use both in medical (reasoned prescription) and paramedical (good practices) with increasing solicitation of teams since his arrival. This reception has been facilitated by an innovative approach of clinical pharmacy deployment in our ICU on an impulse of the clinical pole
 

Expérience of young internal doctors in learning of placement of central venous lines echo guided in emergency department CHU ORAN (Algeria)

Orateur(s) :   Soulef BOUSBIA (Oran, ALGÉRIE) 

Auteur(s) :  Soumia BENBERNOU (Oran, ALGÉRIE)   Nabil GHOMARI (Oran, ALGÉRIE)   Houria DJEBLI (Oran, ALGÉRIE)  

14h31 - 14h38
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Expérience of young internal doctors in learning of placement of central venous lines echo guided in emergency department CHU ORAN (Algeria)

Introduction / Rationale :
Introduction :
Ultrasound in resuscitation square continues to increase and be used in the realization of Central line catheter (CLC). We wanted to evaluate the
techniques used for the implementation of the central venous lines at the level of the medical emergencies of the CHU of ORAN ICU and see her interest
in reduction of complications that can occur when this technique is performed blindly.

Méthodes / Patients and Methods :
This is a prospective study in ICU medical emergencies of the CHU from ORAN in August 2017 to September 2017 grouping. the approach is "in plane ' where the needle walks in the ultrasonic plan.
45 CLC were asked, two groups have been determined, 1 brought together 22 CLC posed by ultrasound, then 2nd 23 CLC placed over anatomical
landmarks, 6 interns participated in this experience.

Résultats / Results :
In the first group: 17 CLC on the intern jugular venous and 5 under clavier, we have no failure rate pose, no complications, the time necessary to pose the line was 5 min on mono puncture.
In the second group: 19 CLC on the intern jugular venous and 3 under clavier, we have one failure rate pose, 2 pneumothorax, 3 arteriel puncture and one or 2 puncture tentative, the time of pose was 7 or 8 min

Discussion / Discussion :


Conclusion / Conclusion :
The use and training of residents must become a routine procedure for the placement of central venous catheter by ultrasound in resuscitation. However
operators must also master the pose of CVC blind to certain circumstances (emergencies material unavailable...).
 

LEARNING EMERGENCY PROCEDURES AT THE FACULTY OF MEDICINE AND PHARMACY IN MARRAKECH: MEDICAL SIMULATION MODEL

Orateur(s) :   Fahd MOUSSAID (Marrakech, MAROC) 

Auteur(s) :  Youssef BOUIDIR (Marrakech, MAROC)   Hamza ELHAMZAOUI (Marrakech)   Taoufik ABOUELHASSAN (Marrakech)  

14h38 - 14h45
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
LEARNING EMERGENCY PROCEDURES AT THE FACULTY OF MEDICINE AND PHARMACY IN MARRAKECH: MEDICAL SIMULATION MODEL

Introduction / Rationale :
Training in primary and secondary emergency procedures is provided in potential emergency modules, life-threatening emergencies and collective risks. The pedagogical techniques used are of the "Active" type with simulations, trial and error, questioning, analysis with practitioners... It aims to acquire knowledge by new doctors from their medical studies to the management of a person in an emergency situation. At the level of the Faculty of Medicine in Marrakech, it is intended for students in the 3rd and 6th grades as part of an integrated educational programme.
Our objective was to assess the degree of satisfaction of 3rd and 6th grade students with this training and its impact on their medical practice.

Méthodes / Patients and Methods :
It is a study carried out through an analysis of a questionnaire distributed to students in the 3rd and 6th year of the Faculty of Medicine of Marrakech, during the period from October to December 2018. Based on its data, a cross-sectional descriptive analytical study was carried out using Excel software.

Résultats / Results :
150 questionnaires were used for 3rd year students, and 120 questionnaires for 6th year students. We objectified a degree of satisfaction between average to good with well-defined pedagogical objectives, ordered content and objective-oriented scenarios. The causes of dissatisfaction of some students were mainly related to the limited duration of the training, and the general facilitation skills, which varied according to the trainers.

Discussion / Discussion :


Conclusion / Conclusion :
The results of our survey suggest that, despite explicitly prescriptive regulatory provisions for training in emergency procedures, the training of future general practitioners needs to be improved at the Marrakech Faculty of Medicine despite the high level of satisfaction among training students.
 

NEWS, Heart Rate Variability and iROX: predictor of poor outcomes in ICU patient under spontaneous ventilation?

Orateur(s) :   Nicolas FERRIERE (Brest) 

Auteur(s) :  Laetitia BODENES (Brest)   Victoire PATEAU (Brest)   Julien DOLOU (Brest)   Erwan L'HER (Brest)  

14h45 - 14h52
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
NEWS, Heart Rate Variability and iROX: predictor of poor outcomes in ICU patient under spontaneous ventilation?

Introduction / Rationale :
Predicting outcomes of ICU patients remains a challenge. Predicting models such as the NEWS has been developed in the emergency department, but it has only been fewly evaluated in the ICU. Heart rate variability (HRV) reflects the autonomic nervous system response in various pathological situations and may vary according to patients’ physiological status. The ROX index, which reflects the acute respiratory failure severity, seems to be a good predictor of high-flow nasal canula failure. The aim of this study was to evaluate the potential value of NEWS, HRV and iROX (inversed ROX) as poor outcome predictors, using artificial intelligence and machine learning.

Méthodes / Patients and Methods :
A retrospective analysis of a prospective datawarehousing project (ReaStoc clinicalTrials identifier NCT 02893462) on ICU patients who did not require invasive ventilation. Physiological parameters were collected on admission, within a 24-hrs delay. NEWS, HRV (in time, frequency, and non-linear domains), and iROX were computed and integrated into the prediction model. Analysis was performed using MedCalc and Matlab machine-learning work-package.

Résultats / Results :
One hundred and twelve patients were included. Patients who died in the ICU (n=8) had highest NEWS as compared with ICU survivors (9.0 [5.0–11.6] vs. 6.0 [5.0–7.0] respectively; p=0.03). The iROX was higher (18.4 [15.7–19.8] vs. 9.0 [5.8 – 20.9], p=0.008) and most HRV parameters also depicted higher values for ICU survivors. Considering a composite ICU prognostic outcome parameter (mortality and/or need for any form of respiratory assistance and/or an ICU LOS>median LOS), there was also a difference for NEWS, HRV and iROX (p<0.0001). The best value to predict ICU mortality for NEWS was 8 (AUC=0.73, p=0.005), iROX >9.5 (AUC=0.76, p=0.03) and HRV (Shannon entropy) >2.9 (AUC=0.74, p=0.04). The best model to predict the need fo respiratory assistance combines iROX and HRV (SD1/SD2; AUC=0.63, p=0.0001). Adding Shannon entropy on this model predicts either the need for respiratory assistance and ICU survival (respectively AUC 0.62, p=0.006 and AUC 0.72, p=0.005).

Discussion / Discussion :


Conclusion / Conclusion :
In ICU spontaneously breathing patients, NEWS, iROX and HRV are different in between survivors and patients who died. The best model to predict the need for respiratory assistance combines iROX and HRV (SD1/SD2).
 

Which optimal dose of enoxaparine in burn patients

Orateur(s) :   Kawther FALEH (Ben Arous, TUNISIE) 

Auteur(s) :  Sarra DHRAIEF (Ben Arous, TUNISIE)   Hana FREDJ (Ben Arous, TUNISIE)   Meriem OUESLATI (Ben Arous)   Amel MOKLINE (Ben Arous)   Lamia THABET (Ben Arous, TUNISIE)   Hana BENALI (Ben Arous)   Selma ABID (Ben Arous, TUNISIE)   Lilya DEBBICHE (Ben Arous, TUNISIE)   Amenallah MESSAADI (Ben Arous)  

14h52 - 14h59
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Which optimal dose of enoxaparine in burn patients

Introduction / Rationale :
The incidence of thromboembolic complications in burn patients may be partially due to ineffective preventive treatment. We conducted this study to determinate antiXa activity in burns using total body skin area (TBSA) and weight to achieve adequate anti factor Xa levels.

Méthodes / Patients and Methods :
A prospective study was conducted in burn center in Tunis during 19 months. Acute burn patients admitted to the burn center and anticipated to be non ambulatory for greater than 48 hours were included. Were excluded patients with any contraindiaction of anticoagulation, and those with creatinine clearance < 30ml/min or creat > 1.6mg/dl.
Patients received Enoxaparin as following: Enoxaparin dose in mg Q12Hrs=22.8+ (3.3 × % TBSA/10) + (1.89 × (weight in Kg)/10 [1]. Peak antiXa was obtained between 3 and 5 hours after the third enoxaparin dose. The recommended antiXa varied between 0 .2 and 0 .4 U/ml.

Résultats / Results :
Ninety three burned patients were included. The mean age was 36 ±17 years with a ratio sex of 2, 33 .The average TBSA was 32, 7 ± 17 % and the average of body weight was 72, 7 ± 19,9kg. Forty three patients were well dosed in the first assay (46, 25%). Thirty nine patients were under dosed in the first assay (41, 93%) and eleven patients were over dosed (11, 82%) without clinical impact.
The average enoxaparin dose was 0, 44 mg Q12Hrs for all patients. For the well dosed patients, anti Xa was 0,274 ±0, 05; 0,126 ±0, 06 for the under dosed patients and 0, 52 for the over dosed patients.

Discussion / Discussion :


Conclusion / Conclusion :
The dosage of enoxaparin in burns taking into account the TBSA and the weight makes it possible to have an effective anti-Xa activity.
 

Outcomes in critically ill patients non admitted in the intensive care unit from the emergency department

Orateur(s) :   Hadil MHADHBI (Tunis, TUNISIE) 

Auteur(s) :  Khedija ZAOUCHE (Tunis)   Hamida MAGHRAOUI (Tunis)   Yosra YAHYA (Tunis, TUNISIE)   Kamel MAJED (Tunis)  

14h59 - 15h06
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Outcomes in critically ill patients non admitted in the intensive care unit from the emergency department

Introduction / Rationale :
Critical care constitutes a significant and growing proportion of the practice of emergency medicine. Numerous factors can cause a delay or absence of transfer to an intensive care unit (ICU) for critically ill emergency department (ED) patients. The impact of non admittance to the ICU is not well studied. We aimed to study the outcomes of critically ill patients not transferred to ICU and remaining at the ED.

Méthodes / Patients and Methods :
We conducted a prospective observational study which included all critically ill patients older than 18 years admitted to the ED. The period of study was one year.Data of all patients were collected. Main outcomes were length of stay at the ED and in- hospital mortality.

Résultats / Results :
During the study period, a total of 100 patients with a mean age of 67 ±12 years were included. 60 % were male. The main diagnoses were acute respiratory failure in 34%, septic shock in 22% of cases. Among hospital survivors, the median hospital length of stay was 50 hours. In-hospital mortality was 19%.
Higher SOFA score at admission, advanced age and male gender were associated with lower hospital survival .

Discussion / Discussion :


Conclusion / Conclusion :
Critically ill emergency department patients not admitted to the intensive care unit had longer hospital stay period and higher in-hospital mortality. These results unveil the need to identify the factors associated with non transfer to the ICU as well as specific determinants of adverse outcomes.