Évaluation de la tolérance de la leucoréduction chez les patients atteints de coqueluche maligne admis en réanimation pédiatrique au Kremlin Bicêtre de 2001 à 2018

Pertussis remains a life-threatening disease in children under 3 months of age without vaccination. Cardio-respiratory failures and pulmonary hypertention in severe pertussis are believed to be linked to white blood cell aggregates in lung microvasculature. Leukodepletion, by fighting against this accumulation, seems to improve those patients survival rate in various publications. The purpose of this retrospective monocentric study is to assess the tolerance of leukodepletion and the risk factor of death among patients hospitalized in Kremlin Bicêtre ICU for pertussis from 2001 to 2018. 60 children were hospitalized for pertussis during this period. 8 died, representing a mortality rate of 13.3%. The main risk factors for deaths were young age (p=0.006), small weight (p=0.025), tachycardia (p=0.024), peripheral hypoperfusion (p<0.001), respiratory distress (p=0.006), acidosis (p=0.039), and pulmonary hypertention (p<0.001). The use of vasoactive drips (p<0.001), mecanical ventilation (p<0.001) and exchange transfusion (p<0.001) are associated with death. Among the 9 exsanguinated patients, the mortality rate is 66.6%. Before/after the procedure, there was a significant increase in the saturation/Fio2 ratio (p=0.035) and a decrease in PvCO2 (p=0.014) as well as the rate of leukocytes (62.1% on average, p<0.001). The side effects of this procedure are a decrease in calcemia (p=0.035) and platelets (p<0.001). Given the fact that this procedure does not require specific equipment, seems well tolerated and improves the prognosis of theses patients in various publications, exchange transfusion seems to be a necessary option in the management of severe pertussis.La coqueluche reste une maladie potentiellement mortelle chez l’enfant de moins de 3 mois non vacciné. Les défaillances cardio-respiratoires ainsi que l’HTAP constatées dans les coqueluches sévères seraient dues à des microthrombi vasculaires pulmonaires de globules blancs liés à l’hyperleucocytose induite par la toxine pertussis. La leucoréduction, en luttant contre cette accumulation, semble montrer dans la littérature un bénéfice sur la survie de ces patients. Cette étude monocentrique rétrospective a pour but d’évaluer la tolérance de la leucoréduction après une étude des facteurs de risque de décès de la cohorte des coqueluches hospitalisées en réanimation pédiatrique au Kremlin Bicêtre de 2001 à 2018.60 enfants ont été hospitalisés pour coqueluche sur cette période. 8 sont décédés soit un taux de mortalité de 13,3%. Les principaux facteurs de risque de décès retrouvés sont le jeune âge (p=0,006), le petit poids (p=0,025), la tachycardie (p=0,024), l’hypoperfusion périphérique (p<0,001), la présence de signes de lutte (p=0,006), d’une acidose (p=0,039) respiratoire, et d’une HTAP (p<0,001). Sur le plan thérapeutique, l’utilisation de vaso-inotrope (p<0,001), l’intubation (p<0,001) et l’échange transfusionnel (p<0,001) sont également des facteurs de risque de décès. Parmi les 9 patients exsanguinés dans cette population, on compte 16 échanges en tout. Le taux de mortalité est de 66,6%. On constate avant/après la procédure une augmentation significative du rapport saturation/FiO2 (p=0,035) et une baisse de la PvCO2 (p=0,014) ainsi que du taux de leucocytes (de 62,1% en moyenne, p<0,001). Les effets secondaires observés sont une baisse de la calcémie (p=0,035) et des plaquettes (p<0,001). Face à une procédure ne nécessitant pas de matériel spécifique, qui semble bien tolérée et qui améliore le pronostic des patients dans la littérature, l’échange transfusionnel semble être une option thérapeutique nécessaire dans la prise en charge des coqueluches graves

Early formative objective structured clinical examinations for students in the pre-clinical years of medical education: A non-randomized controlled prospective pilot study.

BackgroundThe value of formative objective structured clinical examinations (OSCEs) during the pre-clinical years of medical education remains unclear. We aimed to assess the effectiveness of a formative OSCE program for medical students in their pre-clinical years on subsequent performance in summative OSCE.MethodsWe conducted a non-randomized controlled prospective pilot study that included all medical students from the last year of the pre-clinical cycle of the Université Paris-Cité Medical School, France, in 2021. The intervention group received the formative OSCE program, which consisted of four OSCE sessions, followed by debriefing and feedback, whereas the control group received the standard teaching program. The main objective of this formative OSCE program was to develop skills in taking a structured medical history and communication. All participants took a final summative OSCE. The primary endpoint was the summative OSCE mark in each group. A questionnaire was also administered to the intervention-group students to collect their feedback. A qualitative analysis, using a convenience sample, was conducted by gathering data pertaining to the process through on-site participative observation of the formative OSCE program.ResultsTwenty students were included in the intervention group; 776 in the control group. We observed a significant improvement with each successive formative OSCE session in communication skills and in taking a structured medical history (pConclusionOur findings suggest that an early formative OSCE program is suitable for the pre-clinical years of medical education and is associated with improved student performance in domains targeted by the program