mercredi 5 février 2020 

14h10 - 15h10


 
Espace Poster 7

Insuffisance respiratoire aiguë I

MODÉRATEUR(S) :  Alexandre DEMOULE (Paris), Thierry SOTTIAUX (Gosselies, BELGIQUE )  
  

Pulmonary embolism in ICU of the CHU of ORAN: retrospective study about 22 cases

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

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

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


Abstract : 
Pulmonary embolism in ICU of the CHU of ORAN: retrospective study about 22 cases

Introduction / Rationale :
The pulmonary embolism (PE) remains a condition potentially serious, difficult diagnosis requiring hospitalization in intensive care.We want to know what about our emergency en intensive care unit.

Méthodes / Patients and Methods :
our work consist to determine the clinical, therapeutic and features scalable of the PE within the Department of resuscitation of the CHU of ORAN.
It's a retrospective descriptive study including patients admitted to the intensive care of the CHU of ORAN from January 2014 to December 2017 with an
PE. Have been identified and analysed the following data: age, sex, reason for admission, symptomatology, risks, the Wells score, therapy and
evolution.

Résultats / Results :
We collected 22 patients suffering of EP on 1038 patients admitted to critical care all diseases combined, the median age was 64 years, 75% of the
patients were female, the main signs of discoveries were Dyspnea in more than 50% of or not associated with chest pain patients, onset of
symptomatology was brutal in 87.5%. Physical signs were dominated by tachycardia in all patients, blood gases has highlighted a hypoxia in 60% of the
patients, the D.dimere were positive in all patients, the chest angioscanner was proximal in 75% of patients and bilateral in 25%. All the patients received curative dose HBPM, mortality was estimated in 50% of patients

Discussion / Discussion :


Conclusion / Conclusion :
Tachycardia and the polypnea are the main clinical data of the pulmonary embolism in the emergency. Assessment on the empirical clinical probability or using a score is the essential first step of this approach. In order to improve the management of the PE a decision-making algorithm must make part of
 

Pulmonory embolism feature in patients with Guilliain Barre syndrom

Orateur(s) :   Rezk GORBEL (Sfax, TUNISIE) 

Auteur(s) :  Olfa TURKI (Sfax, TUNISIE)   Mariem DLELA (Sfax, TUNISIE)   Najeh BACCOUCHE (Sfax, TUNISIE)   Abir Bouattour (Sfax, TUNISIE)   Mabrouk BAHLOUL (Sfax, TUNISIE)   Mounir BOUAZIZ (Sfax, TUNISIE)  

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


Abstract : 
Pulmonory embolism feature in patients with Guilliain Barre syndrom

Introduction / Rationale :
Guillain-Barré syndrome is the most common cause of acute flaccid paralysis. In certain patients, respiratory failure, secondary to this disorder, is associated with pulmonary embolism due to the mobility limitations. The aim of this study is to perform an analysis of the incidence, risk factors, specific characteristics of pulmonory embolism in patients with different forms and severity of Guillain-Barre syndrome (GBS) admitted to an intensive care unit (ICU).

Méthodes / Patients and Methods :
Twenty-eight adults patients with confirmed diagnosis of GBS were admitted to the ICU in our university hospital center over a 10-year period and they were all included. Prevalence, risk factors and course of VTE were analyzed in ICU patients with various forms and severity of GBS.

Résultats / Results :
During the study period 23 adult patients were admitted and they were all included in this study. From them 5 (17.9%)developped pulmonary embolism .
The mean age of this population was at 51.2+/-16.7 years and the sex ratio was 0.86. the comparaison betewen the 2 groups with and without PE showed that factors associated with the development of this complication were : respiratory failure requiring mecanical ventilation (p=0.03), infectious complications(p<0.001), blood pressure lability (p=0.029), the delay of ICU admission(p=0.02) ,the delay to treatment initiation (p=0.036) and the SOFA score( p=0.03) and the presence of quadriplegia (p=0.031).

Discussion / Discussion :


Conclusion / Conclusion :
Pulmonary embolism is a frequent complication in patients with GBS. Factors associated with this complication were :respiratory failure requiring mecanical ventilation, infectious complications, the delay of ICU admission ,the delay to treatment initiation , a high SOFA score and the presence of quadriplegia are associated . Preventive measures in this category of patients seems to be insufficient requiring a search for other prevention strategies.
 

Acute respiratory distress syndrome among burns in Tunisia: state of play and prognosis.

Orateur(s) :   Lilya DEBBICHE (Ben Arous, TUNISIE) 

Auteur(s) :  Wael CHEMLI (Ben Arous)   Hana FREDJ (Ben Arous)   Sarra BEN ZARROUK (Ben Arous)   Hana BENALI (Ben Arous)   Manel BEN SAAD (Ben Arous)   Amel MOKLINE (Ben Arous)   Amenallah MESSAADI (Ben Arous)  

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


Abstract : 
Acute respiratory distress syndrome among burns in Tunisia: state of play and prognosis.

Introduction / Rationale :
Acute respiratory distress syndrome (ARDS) is a life-threatening pathology associated with very high morbidity and mortality (35-45%) in intensive care units (ICU) and with even higher mortality among the severly burned patients worldwide (36 à 80%). The aim of our study was to determine the current situation of ARDS among burns in Tunisia and its prognosis.

Méthodes / Patients and Methods :
We conducted a descriptive retrospective study between 01-01-2017 to 31-12-2018, in burns ICU, in Ben Arous, in Tunisia. All burns who presented an ARDS, according to the Berlin 2012 definition, during their stay in the ICU, were included. When clinical or gasometric data was uncomplete, these patients were excluded.

Résultats / Results :
During the study period, 691 patients were admitted to our burn unit including 246 ventilated patients. Fifty patients presented an ARDS: fifteen patients were excluded for lack of information, and 35 patients were retained. The sex ratio was 2.5. These patients had a mean age of 36 +/- 12 years, an average burned area of ​​44% +/- 22%, an average unit of burn skin score (UBS score) of 94 +/- 77 and an average sequential organ failure assessment score (SOFA score) of 4. None of the patients had a history of cardiovascular or pulmonary diseases.
The average time of onset of ARDS was 5 days +/- 4 . It was mild in 1 case, moderate in 11 and severe in 23. The etiology of ARDS was pulmonary in 25 cases (71%) and extra-pulmonary in 10 (29%). The pulmonary ARDS had as cause pneumonia isolated in 15 patients, an isolated pulmonary burn in 6 patients and a combination of pneumonia and lung burns in 4 patients.
Extra-pulmonary ARDS were all due to sepsis and mainly to bacteremia.
Septic shock was associated with ARDS in 20 patients (57%).
The treatment was a conventional treatment based on protective ventilation, curarization and prone positioning in addition to the etiological treatment.
The average length of stay in ICU was 9 days and mortality was 85% in these patients.

Discussion / Discussion :


Conclusion / Conclusion :
Mortality from ARDS in burns in Tunisia, is important especially in those with pulmonary burns as well as those with sepsis. The introduction of new treatments, such as extracorporeal membrane oxygenation, remains essential to improve the prognosis of our patients.
 

Risk factors and outcomes of aspiration pneumonia

Orateur(s) :   Oussama JAOUED (Mahdia, TUNISIE) 

Auteur(s) :  Makni SABA (Mahdia)   Abid EMNA (Mahdia)   Sik ali HABIBA (Mahdia)   Fekih hassen MOHAMED (Mahdia, TUNISIE)   Elatrous SOUHEIL (Mahdia)  

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


Abstract : 
Risk factors and outcomes of aspiration pneumonia

Introduction / Rationale :
Aspiration pneumonia (AP) is common in intensive care units (ICU). The incidence of AP among adults hospitalized with pneumonia ranges between 5 and 53.2%. Usually one or more risk factors are identified to be involved in AP.
The aim of this study was to determine the risk factors and predictors of mortality during AP.

Méthodes / Patients and Methods :
We retrospectively included patients aged more than 18 years and who were hospitalized in our ICU for AP. Patients were excluded if they had history of tuberculosis, if they have bronchiectasis or metastatic brain tumor.

Résultats / Results :
A total of 102 patients were included. History of diabetes, hypertension, epilepsy and ischemic stroke were found respectively in 22.2%, 21.5%, 16.7%, and 7.8 % of cases.
The reason of ICU admission were coma (35%),acute respiratory failure (33%),poisoning (27%) and cardiac arrest (5%).The incidence of acute respiratory distress syndrome (ARDS) was 17%.
The most common organism isolated was staphylococcus aureus (4 cases).
Risk factors for AP were epilepsy (20%), swallowing disorders (18%), ischemic stroke (12%), COPD (9%) and degenerative neurological disease (5%).
The mortality rate was 17.6%. The median duration of mechanical ventilation was 12 days [IQR 10-23].
In multivariate logistic regression analysis; SAPS II score (OR=1.05, 95%CI [1.001-1.1], p=0.046) and ARDS (OR=44.04, 95%CI [3.91-495.57], p=0.002) were independently associated with mortality.

Discussion / Discussion :


Conclusion / Conclusion :
Risk factors for aspiration pneumonia were epilepsy, swallowing disorders and ischemic stroke. ARDS and SAPS II score were independent predictive factors of mortality.
 

Hyperoxia in intensive care: impact on morbidity and mortality

Orateur(s) :   Rim JEMMELI (Ariana, TUNISIE) 

Auteur(s) :  Samia AYED (Ariana, TUNISIE)   Amira JAMOUSSI (Ariana)   Dhouha LAKHDHAR (Ariana)   Jalila BEN KHELIL (Ariana)   Mohamed BESBES (Ariana)  

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


Abstract : 
Hyperoxia in intensive care: impact on morbidity and mortality

Introduction / Rationale :
Oxygen therapy is a common treatment in intensive care unit (ICU). While its efficiency in hypoxia is well-known, several studies have shown a harmful effect of oxygen when prescribed at high doses. The threshold value defining pathological hyperoxia remains undetermined. The aim of this study was to evaluate the impact of hyperoxia on morbidity and mortality.

Méthodes / Patients and Methods :
This was a prospective study performed in the ICU of Abderrahmen Mami Hospital during a four-month period. All patients admitted in ICU during the study-period were included. Those who didn’t need oxygen therapy or in end of life stage were excluded. Arterial blood gases were analyzed daily and each day with at least one value of oxygen arterial saturation (SaO2) > 92% was considered as a day with hyperoxia. For each patient included, the number of times and days spent in hyperoxia was recorded as well as complications during the ICU stay and the outcome.

Résultats / Results :
During the study-period, 140 patients were included but only 112 were eligible. Mean age was 58±18 years. Acute on chronic respiratory failure was the most frequent reason of admission (67%).
Non-invasive ventilation was required for 18% of patients and invasive mechanical ventilation was necessary in 65% of cases. Overall mortality was 32%. Hyperoxia was observed in 96% of cases, with an average of 10±10 times during the ICU stay and 6±6 days. A statistically significant association was observed between a long duration of hyperoxia and the occurrence of ventilator acquired pneumonia (p<10-3), ventilator acquired bronchitis (p=0.001), acute respiratory distress syndrome (p<10-3), atelectasis (p<10-3), septic shock (p<10-3), rhythm disorders (p=0,003), reintubation (p<10-3) and tracheostomy (p=0,038).
On multivariate analysis, independent factors of mortality were: simplified acute physiology score II, cardiac failure, need for invasive mechanical ventilation and septic shock. Hyperoxia wasn’t independently associated with mortality.

Discussion / Discussion :


Conclusion / Conclusion :
Hyperoxia is frequent in ICU. It is significantly associated with ICU complications but it isn’t independently associated with mortality.
 

Experience of the practice of prone position in patients with acute respiratory distress syndrome in intensive care (CHUOran )

Orateur(s) :   Nabil GHOMARI (Oran, ALGÉRIE) 

Auteur(s) :  Soumia BENBERNOU (Oran, ALGÉRIE)   Djebli HOURIA (Oran)  

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


Abstract : 
Experience of the practice of prone position in patients with acute respiratory distress syndrome in intensive care (CHUOran )

Introduction / Rationale :
Mechanical ventilation (MV) in the prone position (PP) and low tidal volume have become recommendations with a high level of scientific evidence in recent years. The PP has been practiced for 7 years in the CHUOran emergency resuscitation service.
We wanted to report the service experience in the practice of PP in patients with ARDS.

Méthodes / Patients and Methods :
Retrospective study performed in patients with severe hypoxia ARDS with SPO2 <88 under FIO2> 80% or PAO2 / FIO2 <150 during the period March 2011 to December 2018.
Results

Résultats / Results :
38 patients received ventilation in PP. ARDS was secondary to thoracic trauma in 42% of patients, septic shock in 32% and inhalation pneumonitis in 26%.
Analysis of the success factors and improvement of oxygenation found that lobar ARDS, the delay  72 hours and a duration of PP ≥18h were statistically significant.

Discussion / Discussion :


Conclusion / Conclusion :
The PP must be integrated into the arsenal of care of the patients in ARDS especially in our country where we do not have all the therapeutic options
 

Impact of Cannula Size on Clinical Outcomes in Venovenous Extracorporeal Membrane Oxygenation

Orateur(s) :   Julien GOUTAY (Lille) 

Auteur(s) :  Nicolas COUSIN (Lille)   Thibault DUBURCQ (Lille)   Erika PARMENTIER-DECRUCQ (Lille)  

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


Abstract : 
Impact of Cannula Size on Clinical Outcomes in Venovenous Extracorporeal Membrane Oxygenation

Introduction / Rationale :
In Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) therapy, blood flow is the main determinant of arterial oxygenation and should be 60-80 mL/kg/min in adults. This flow rate is determined by several factors including the size of the inflow cannula.
The impact on clinical outcomes of arterial cannula’s size in Veno-Arterial ECMO (VA- ECMO) has already been studied, and showed no difference for survival to discharge, weaning success rate and initial flow rate between a small cannula group and a larger one. Our first objective was to describe the impact of inlet cannula size on the assistance flow rate in patients treated with VV-ECMO. Secondary objectives were to analyze its impact on ECMO weaning, mechanical ventilation characteristics and mortality.

Méthodes / Patients and Methods :
We retrospectively reviewed all cases of respiratory failure treated with VV-ECMO admitted in the medical intensive care unit (ICU) of Lille’s teaching hospital from January 1st, 2013 through March 31st, 2019.
Inlet cannula size was collected and divided into two groups: the “small cannula” group had inlet cannula less than or equal to 23Fr, while “large cannula” were larger than 23Fr.
Primary endpoint was the initial flow rate according to the inlet cannula size, and its evolution during the first 48 hours of assistance. Secondary endpoints were the analysis of predictive factors associated with the choice of a larger inlet cannula, and the impact of its size on clinical outcomes such as successful ECMO weaning.

Résultats / Results :
74 patients treated with VV-ECMO were admitted in our hospital. Eleven (15%) were cannulated with a large inlet device. Mean initial ECMO flow rate was statistically higher in the “large cannula” group than in the “small cannula” one: 5.8 L/min (+/- 0.7) versus 4.7 (+/- 0.8) respectively, p < 0.0001. The difference was also significant during the first 48 hours of assistance.
We found no difference between the two groups on clinical outcomes such as ECMO weaning time. In univariate analysis, weight was heavier in the “large cannula” group [94 (+/- 26) kg] than "small cannula" [81 (+/- 20)], p<0.05.

Discussion / Discussion :


Conclusion / Conclusion :
ECMO initial flow rate was higher in a “large inlet cannula” group (internal diameter more than 23 Fr) compared with a “small cannula” group. We found no correlation with cannula-related haemorrhagic or thrombotic complications. Inlet cannula size did not influence ECMO weaning, and duration time, but this may be a lack of statistical power. Further prospective studies should confirm this results.