Impact of a nurses' protocol-directed weaning procedure on outcomes in patients undergoing mechanical ventilation for longer than 48 hours: a prospective cohort study with a matched historical control group

INTRODUCTION: The aim of the study was to determine whether the use of a nurses' protocol-directed weaning procedure, based on the French intensive care society (SRLF) consensus recommendations, was associated with reductions in the duration of mechanical ventilation and intensive care unit (ICU) length of stay in patients requiring more than 48 hours of mechanical ventilation. METHODS: This prospective study was conducted in a university hospital ICU from January 2002 through to February 2003. A total of 104 patients who had been ventilated for more than 48 hours and were weaned from mechanical ventilation using a nurses' protocol-directed procedure (cases) were compared with a 1:1 matched historical control group who underwent conventional physician-directed weaning (between 1999 and 2001). Duration of ventilation and length of ICU stay, rate of unsuccessful extubation and rate of ventilator-associated pneumonia were compared between cases and controls. RESULTS: The duration of mechanical ventilation (16.6 ± 13 days versus 22.5 ± 21 days; P = 0.02) and ICU length of stay (21.6 ± 14.3 days versus 27.6 ± 21.7 days; P = 0.02) were lower among patients who underwent the nurses' protocol-directed weaning than among control individuals. Ventilator-associated pneumonia, ventilator discontinuation failure rates and ICU mortality were similar between the two groups. DISCUSSION: Application of the nurses' protocol-directed weaning procedure described here is safe and promotes significant outcome benefits in patients who require more than 48 hours of mechanical ventilation

La codécision en santé : le soin démocratique ?

International audienceDélibérer en équipe de professionnels sur une décision difficile, associer des proches à une décision de soin, faire entrer la démocratie dans la santé... autant de défis quotidiens auxquels nous sommes de plus en plus nombreux à être confrontés. Mais qu'est-ce qu'une "décision médicale partagée" ? Comment la réaliser et avec quelles conditions pour respecter autonomie et responsabilités de chacun des acteurs ? Ce livre est le premier ouvrage francophone à présenter une approche multidisciplinaire de la décision en santé, en intégrant les points de vue du patient, du praticien, de l'administrateur du système de santé. Il permet de mieux comprendre la place de l'incertitude dans l'action, les enjeux de l'alliance des libertés dans un parcours de soin, les défis de notre démocratie tels qu'ils sont révélés par le champ de la santé

Evaluation de la démarche diagnostique et du devenir des personnes ayant consulté aux urgences du CHU de Brest pour céphalée atraumatique et renvoyées à domicile

BREST-BU Médecine-Odontologie (290192102) / SudocSudocFranceF

Limitations et arrêts des traitements en réanimation de l’adulte: recommandation de SRLF (Société dee Réanimation de Langue Française)

info:eu-repo/semantics/publishe

[Acute interstitial lung disease revealing antisynthetase syndrome].

International audienceINTRODUCTION: The antisynthetase syndrome is characterized by the presence of myositis, interstitial lung disease, arthritis, Raynaud's phenomenon, mechanics hands and anti-Jo1 antibody (histidyl tRNA synthetase). The prognosis of this syndrome is closely related to the severity of lung disease. Myositis can occur several years after lung disease and some patients with interstitial lung disease associated with anti-Jo1 antibodies will not suffer from muscle disease. CASE-REPORT: We report the case of a 69-year-old man admitted to the medical intensive care unit for acute respiratory insufficiency related to rapidly progressive interstitial lung disease. Antisynthetase syndrome was diagnosed the presence of wrists' arthritis, 'mechanic's hands and anti-Jo1 antibodies. Despite the dramatic efficacy of corticosteroid therapy on ventilation parameters, the patient died from a Pseudomonas Aeruginosa nosocomial ventilator-acquired pneumonia. CONCLUSION: Our case emphasizes the importance to search for anti-Jo1 antibodies in the presence of interstitial lung disease. During the course of antisynthetase syndrome, the occurrence of interstitial lung disease is almost always constant and is correlated with poor prognosis

Vos pratiques de limitation et arrêt des traitements sont-elles conforment à la loi Léonetti ?

International audienc

Limitation et arrêt des traitements en réanimation : comment évaluer et améliorer nos pratiques

National audienc