mercredi 5 février 2020 

14h10 - 15h10


 
Espace Poster 5

Urgences pré-hospitalières

MODÉRATEUR(S) :  Jean-Daniel CHICHE (Paris), Samir JABER (MONTPELLIER)  
  

Prognostic factors of digestive oncological emergencies in the elderly.

Orateur(s) :   Khalid KHALEQ (Casablanca, MAROC) 

Auteur(s) :  Karima MOURABIT (Casablanca, MAROC)   Fatimazahra BENSARDI (Casablanca)   Rachid AL HARRAR (Casablanca)   Aziz FADIL (Casablanca)  

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


Abstract : 
Prognostic factors of digestive oncological emergencies in the elderly.

Introduction / Rationale :
The purpose of this study was to assess the prognosis factors care improvement and management of elderly before, during and after surgery, the predictors of mortality and morbidity following emergency oncological digestive surgery in patients aged 65 years and older, the therapeutic management and Study survival, prevention and surveillance, to compare them with the data of the literature.

Méthodes / Patients and Methods :
86 patients admitted to visceral emergencies for an urgent syndrome revealing or complicating a primary or secondary digestive cancer, and who required immediate surgical intervention and who had stayed at the surgical resuscitation department in our hospital a on a duration of 4 years.
Several data were entered on Excel and analyzed using the SPSS version 20 software:
-Epidemiological, concerning age and gender
-Clinics including risk factors, history, general condition of the patient and clinical examination data
-Para-clinical, interesting biological assessments, and morphological examinations
-Medical and surgical therapeutics
-Postoperative follow-up
-Treatment results

Résultats / Results :
The most frequent sites were rated in order of increasing frequency: Colo-rectal (40.7%),small intestine(22.1%), pancreas (10%), and biliary tract (8.1%).
72.09 % of patients were between 65 and 75 years and, while only 27.91 % were 76 years old and over.
This study includes 44 women and 42 men with a sex ratio of 0.96. The evolution method was mostly
Acute in 95% of cases. Patients have consulted for urgent clinical presentations mainly occlusive syndrome noted in 59% of patients.
Abdominal CT scan was the first examination performed in 71%, followed by the abdominal Xray in 31% and the Abdominal ultrasound. The therapeutic management was medical and surgical. The surgery done in 62% for palliative indication: 55% were operated for an ostomy discharge, 32% for a palliative resection, 17% for an Ostomy Supply and 13% for a digestive bypass. Postoperative outcomes were 35% morbidity and 48% mortality. The main cause of death was hemodynamic instability in 34% of cases, thanks to multivariate statistical analysis four factors were deduced significantly related to mortality: Morbidity: p=0,000; OR= 17.209; IC: [4.16;71.13],The CONUT score: p=0,000; OR= 2.851; IC:[1.34;6.03],Hypoalbuminemia: p=0,030; OR= 2.355; IC: [1.633;8.756] and admission for a Bowel obstruction : p=0,000; OR= 2.659; IC: [1.682;10.36]

Discussion / Discussion :


Conclusion / Conclusion :
Small changes in morbidity and mortality could have a significant impact, both on the results, on the high cost of prolonged hospitalization, and on the incidence of perioperative complications. This will require a good knowledge of the predictive mortality factors both by the anesthetist and by the visceralist surgeon.
 

Usefulness of shock index for prehospital triage of septic shock by the SAMU regulation

Orateur(s) :   Romain JOUFFROY (Paris) 

Auteur(s) :  Anastasia SAADE (Paris)   Pascal PHILIPPE (Paris)   Papa GUEYE (Fort-De-France)   Emmanuel BLOCH-LAINE (Paris)   Patrick ECOLLAN (Paris)   Benoit VIVIEN (Paris)  

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


Abstract : 
Usefulness of shock index for prehospital triage of septic shock by the SAMU regulation

Introduction / Rationale :
Scoring systems were developed for risk-stratification of septic shock (SS) patients but their performance is poor in the prehospital setting.
The aim of this study was to evaluate the ability of the shock index (SI) in prehospital triage of SS patients to predict their admission in intensive care unit (ICU).

Méthodes / Patients and Methods :
We performed a 2-month retrospective study of call records received by the Paris SAMU 75 regulation center concerning patients with presumed SS.
The outcome was the in-ICU admission.
Results are expressed by Odd Ratio (OR) with 95 percent confidence interval [95 CI].

Résultats / Results :
Among the 30 642 calls received, 140 concerned patients with presumed SS were included. Twenty-two patients (16%) were admitted to ICU and 118 (84%) to the emergency department. The AUC of the SI was 0.76 [0.65 - 0.86]. Using a threshold for SI>0.9, the sensitivity was 82%, the specificity was 67%, the positive predictive value was 32% and the negative predictive value was 95%. After logistic regression analysis, the OR for SI>0.9 reached 7.65 [2.33 - 35.00]. Using propensity score analysis, the OR for SI>0.9 was 1.34 [1.15 - 1.52].

Discussion / Discussion :


Conclusion / Conclusion :
SI as a reliable tool for risk stratification of SS patients managed in the prehospital setting. Using a threshold of 1 for the SI helps the screening of patients requiring ICU admission by the SAMU 15 regulation call center. Prospective studies including SI in the decision-making process in the prehospital triage of SS patients are needed to validate these results.
 

Clinical impact of Atrial Fibrillation in patients hospitalized for diabetic ketoacidosis at Emergency Department

Orateur(s) :   Nadia ZAOUAK (Tunis, TUNISIE) 

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

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


Abstract : 
Clinical impact of Atrial Fibrillation in patients hospitalized for diabetic ketoacidosis at Emergency Department

Introduction / Rationale :
Atrial fibrillation (AF) is a common heart arrhythmia. Many studies had shown that AF led to an increasing in-hospital complications. The main objective of this study was to determinate the clinical impact of AF in patients with diabetic ketoacidosis.

Méthodes / Patients and Methods :
This is a retrospective observational study performed in all patients aged more than 18 years old hospitalized to Emergency Department (ED) for diabetic ketoacidosis on a period of six months. Data of all patients were collected. The statistical analysis compared 2 groups of patients based on the AF presence or not at initial electrocardiogram. The main endpoints of the study were inhospital mortality and need of critical care defined by use of vasoactive drugs and mechanical ventilation. Secondary endpoints was the length of stay.

Résultats / Results :
The study included 56 patients admitted for diabetic ketoacidosis. The mean age was 55±20 years with a sex ratio of 1,2. 86% had not AF and 14% had AF at initial electrocardiogram. The rate of mortality in the AF group was 28,6%. 20% of them required the use of mechanical ventilation and 40% of vasoactive drugs. In the no AF group, the inhospital mortality was 8,9%. 10,3% of them needed vasoactive drugs and 11% mechanical ventilation. Duration of stay was higher in AF group: 47±32h versus 36±42h (p<0,05). There was no significant correlation betwen mortality, need of drugs and mechanical ventilation (p=0,56 ; p=0,34 ; p=0,13).

Discussion / Discussion :


Conclusion / Conclusion :
Our results showed that AF was not significantly correlated with inhospital mortality and critical care in patients admitted at ED for diabetic ketoacidosis. However, AF led to a significant increasing length of stay.
 

Prehospital shock index to assess mortality of septic shock

Orateur(s) :   Romain JOUFFROY (Paris) 

Auteur(s) :  Jean-pierre TOURTIER (Paris)   Papa GUEYE (Fort-De-France)   Emmanuel BLOCH-LAINE (Paris)   Vincent BOUNES (Toulouse)   Guillaume DEBATY (Grenoble)   Josiane BOULARAN (Castres)   Benoit VIVIEN (Paris)  

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


Abstract : 
Prehospital shock index to assess mortality of septic shock

Introduction / Rationale :
In the prehospital setting, early identification of septic shock (SS) with high risk of mortality is essential to decide hospital orientation (emergency department (ED) or intensive care unit (ICU)) prior to early treatments initiation. In this context, the severity assessment is most of the time restricted to clinical tools.
In this study, we describe the association between prehospital shock index (SI) and mortality at day 28 of patients with SS initially cared for in the prehospital setting by a mobile intensive care unit (MICU).

Méthodes / Patients and Methods :
Patients with SS cared for by a MICU between January 2016 and May 2019 were retrospectively analyzed. Association between SI and mortality was assessed by Odd Ratio (OR) with 95 percent confidence interval [95 CI] using propensity score analysis.

Résultats / Results :
One-hundred and fourteen patients among which 78 males (68%) were analysed. The mean age was 71±14 years old. SS was mainly associated with pulmonary (55%), digestive (20%) or urinary (11%) infection. Overall mortality reached 33% (n=38) at day 28.
Median SI differed between alive and deceased patients: 0.73 [0.61 – 1.00] vs 0.80 [0.66 -1.10], p<0.001*). After adjusting for confounding factors, the OR of SI>0.9 was 1.17 [1.03-1.32].

Discussion / Discussion :


Conclusion / Conclusion :
In this study, we report an association between prehospital SI and mortality of patients with prehospital SS. A SI>0.9 is a simple tool to assess severity and to optimize prehospital triage between ED and ICU of patients with SS initially cared for in the prehospital setting by a MICU.
The association of SI with biomarkers may be helpful to improve the screening for SS and decision making of SS in the prehospital setting.
 

Ultrasound guidance and the set up of central venous catheters in emergency situations

Orateur(s) :   Walid SELLAMI (Tunis, TUNISIE) 

Auteur(s) : 

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


Abstract : 
Ultrasound guidance and the set up of central venous catheters in emergency situations

Introduction / Rationale :
In intensive care unit, we are confronted to place venous catheters in urgent situations. Although the femoral site is preferred, it remains difficult to handle in case of abdominal pelvic surgery or ventral position. In addition it does not allow to develop a diagnostic approach. The purpose of our study was to see if ultrasound guided cannulation of the internal jugular vein could be an alternative to the femoral one.

Méthodes / Patients and Methods :
It was a prospective, monocentric, observational, and comparative study conducted in the anesthesia resuscitation department of the Military Hospital Main Instruction of Tunis over a period of 12 months. There were 118 patients, 58 in the group "guided femoral vein catheterization (FVC)" and 60 in the group "guided internal jugular vein catheterization (IJVC)". The rate of failure and complications (mechanical, infectious and thrombotic) was compared; the number of punctures and access times too. The threshold of statistical significance was chosen at 0,05.

Résultats / Results :
The failure rate was 10,3% for FVC, compared to 8,3% for IJVC (p = 0,47, (p >0,05)). The risk of hematoma was 3,4% for FVC, 1,7% for IJVC (p = 0,5).No case of pneumothorax was noted, 2 malpositions of the IJVC were reported.Catheter-related infection was 6,9% for FVC, 3,3% for IJVC (p = 0,3). Venous thrombosis was 20,7% for FVC, 10% for IJVC, (p = 0,08).The number of attempts and the access time were lower for IJVC (respectively 1,3 ± 0,4 and 204s ± 46,3 vs 1,9 ± 0,7 and 256,5s ± 90,4 for the FVC, p <0,0001).

Discussion / Discussion :


Conclusion / Conclusion :
The failure rate and complications were comparable between the 2 groups, but the ultrasound-guided internal jugular catheter appears to be faster to insert and requires fewer punctures, so it could be an alternative to the femoral one in emergency situations.
 

Neuromyelitis optica attacks treatment assessment and analysis

Orateur(s) :   Hossein MEHDAOUI (Fort-de-France) 

Auteur(s) :  Maeva LE GOIC (Fort-De-France)   Ruddy VALENTINO (Fort-De-France)   Cyrille CHABARTIER (Fort-De-France)   Jean-louis FERGE (Fort-De-France)   Dabor RESIERE (Fort-De-France)   Shazima VALLY (Fort-De-France)   Emmanuelle GUERIN (Fort-De-France)   Agathe CHAPLAIN (Fort-De-France)   Marie SABIA (Fort-De-France)   Ronan HINAUT (Fort-De-France)   Philippe CABRE (Fort-De-France)  

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


Abstract : 
Neuromyelitis optica attacks treatment assessment and analysis

Introduction / Rationale :
Neuromyelitis optica (NMO) is a rare but severe disease. The prognosis of treated NMO attacks remains unclear. We evaluated our practice, the early evolution and the prognosis of NMO patients.

Méthodes / Patients and Methods :
An observational study was performed on patients with NMO attacks presenting with visual or medullar symptoms admitted for plasma exchange (PE) therapy from January 2017 to August 2019.Treatment efficiency was defined as a negative shift of the visual or motor disability score (EDSS). Nonparametric Mann-Whitney and Fisher exact tests were used for statistical analysis as required.

Résultats / Results :
24 patients had 110 PE sessions. Characteristics of the cohort are described in Table 1. 5 (20.8%) died from complications of NMO attacks. Treatment had an effect in 15 (85.2%) patients. The shift in the ambulatory and visual EDSS was respectively -0.4 + 2.3 and -1.7 + 1.7. The 5 non-survivor patients had all AQP4 antibodies (p<0.05). Residual EDSS was higher in the non-survivor group (8.7 + 1.0 vs 6.1 + 1.7, p < 0.01). Pulse steroids were administered in 1 (20%) patient in the non-survivor group vs 15 (78%) patients in the survivor group (P<0.05). 12 (80%) patients previously given pulse steroid therapy responded to PE.

Discussion / Discussion :
We assessed the handling of NMO attacks and identified our flaws. We concluded that pulse steroid therapy should not be withheld or replaced by lower dosage. We also need to find a way to make attacks identified by physicians earlier to shorten the delay between its onset and patient’s admission in a specialized care unit. We observed that the mean improvement is modest during the early phase of our treatment. But a modest improvement in the EDSS can have a great impact in the patient’s quality of life and even survival.

Conclusion / Conclusion :
NMO attacks remain a threatening disease despite aggressive treatment. Shortening the delay of treatment and ensure adequate pulse steroid therapy coupled to PE could be a way to improve the prognosis.
 

Guillain-Barré syndrome in Intensive Care Unit : a 10 years experience

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

Auteur(s) :  Olfa TURKI (Sfax, TUNISIE)   Mariem DLELA (Sfax, TUNISIE)   Hela KALLAL (Sfax)   kamilia CHTARA (Sfax, TUNISIE)   Mabrouk BAHLOUL (Sfax, TUNISIE)   Mounir BOUAZIZ (Sfax, TUNISIE)  

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


Abstract : 
Guillain-Barré syndrome in Intensive Care Unit : a 10 years experience

Introduction / Rationale :
Guillain-Barré syndrome (GBS), an acute inflammatory demyelinating polyneuropathy, is the most common generalized paralytic disorder. One third of patients with GBS require admission to the intensive care unit (ICU). Respiratory failure, which is the major problem, may require mechanical ventilation (MV) and is associated with additional complications, significant risk of morbidity, mortality, and incomplete recovery.
This study sought to describe the demographic, clinical, laboratory and neurophysiological characteristics of patients with GBS who were hospitalised in ICU between 2010 and 2019.

Méthodes / Patients and Methods :
We conducted a single-center, retrospective, observational, epidemiological study. 37 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.

Résultats / Results :
Thirty Seven patients were included. There were 17 (45.9%) female and 20 (54%) male patients. The mean age was at 40.75+/-23.84 years. The mean delay of ICU admission was at 10.67 days. Ventilatory failure was the common cause for ICU admission. The mojority of the patient (43.2%) had a history of respiratory infection. The clinical feature was areflexic flaccid weakness for 32 patients (86.5%). Albuminocytological dissociation was observed for 56.8 % of the patients. The major clinical subtypes of GBS were acute motor-sensory axonal neuropathy and acute motor axonal neuropathy(55%).
The mean SOFA score was at 1.82+/-2.27, 19 patients (51.4%) required MV. The mean ICU LOS was at 11.72+/-11.56 days. The most observed complications during ICU stay were pneumonia (29.7 %), sepsis (16.2%), pulmonary embolism (13.5%), bed-sores (5.4%) and dysautonomia (5.4%).
Overall, ICU mortality was 18.9%, and increased to 35% in the MV group. The poor prognosis was significantly associated with MV and nosocomial infection (p= 0.017 ; p=0.028 respectively).

Discussion / Discussion :


Conclusion / Conclusion :
GBS represents a small but increasing proportion of ICU admissions with more then half of patients receiving MV and with a poor prognosis . Larger, prospective, multi-centre studies will be required.
 

MEDICAL TREATMENT OF IMMEDIATE POST PARTUM HEMORAGY

Orateur(s) :   Lina BERRADA (Casablanca, MAROC) 

Auteur(s) :  Janati ADNANE (Casablanca)   Amine MOHAMED AMINE (Casablanca)  

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


Abstract : 
MEDICAL TREATMENT OF IMMEDIATE POST PARTUM HEMORAGY

Introduction / Rationale :
Immediate postpartum hemorrhage (HPPI) remains a real public health problem. It is the leading cause of death in obstetrics. It is an extreme emergency that brings into play the maternal fetal vital prognosis. The aim of this work is to highlight the frequency of the HPPI, its main etiologies as well as the therapeutic principles in order to improve the prognosis and reduce the morbidity and the maternal-fetal mortality linked to it.

Méthodes / Patients and Methods :
We conducted a 5-year retrospective study from January 1, 2014 to December 31, 2018 in the department of anesthesia and obstetric resuscitation at the IBN ROCHD CHU, including immediate postpartum hemorrhages managed by medical treatment.

Résultats / Results :
During the study period, there were 123 cases of immediate postpartum haemorrhage, 101 cases of haemorrhage: medically treated, ie 82.11%. The average age of the parturients was 30 years with extremes of 16 and 42 years old. Multiparas accounted for 48.5% of cases (49), and primiparas accounted for (28.7%) (29). There were 81 (80.2%) of the cases referred by peripheral hospitals, 89 (88.11%) parturients led a pregnancy not followed. Vaginal delivery occurred in 86 (85%) cases; of which 9cas (8.9%) of instrumental extraction. The delivery was spontaneous in 35 cases (34.6%), artificial in 15 cases (14.85%) and directed in 51 (50.5%) cases, the initial clinical examination found a uterine inertia in 43% of cases , placental retention in 37%), then cervico-vaginal wounds in 19% of cases. initial management was mainly represented by uterine massage in 30% of cases and wound sutures in 14% of cases. Blood transfusion was required in 12 (11.8%) of the cases, Oxytocin in all cases and Misoprostol in 61 (60%) of the cases. The outcome was favorable with stopping bleeding in 100 (99%), and 44 (43%) of the cases were anemia-dominated.

Discussion / Discussion :


Conclusion / Conclusion :
Early, effective and multidisciplinary medical treatment allows a reduction in morbidity and mortality related to immediate postpartum haemorrhage.