De l'utilité des objets flottants dans le cadre d'un dispositif « groupe fratrie » destiné à des frères et soeurs d'enfants porteurs de troubles du spectre de l'autisme

International audienceIn a perspective combining a complementary systemic and psychodynamic approach, thisarticle presents a study focusing on siblings' experience of children with autism spectrumdisorder. In order to meet their specific needs, as part of a French health and social structure named “Centre de Ressources Autisme”, a plan designated “siblings group” was created for 3 years. It included two age groups with children from 5 to 11 and teenagers from 12 to 17, and was facilitated by two clinical psychologists. During the sessions and with supervisions carried out in the course of a research action, floating objects were offered to create a group dynamic and therefore allow the children or teenagers to elaborate and reveal more easily their emotions and difficulties. This study is concluded by a clinical case, which describes the construction, staging and repercussions of afloating object adapted to this population.Dans une perspective combinant approche systémique et psychodynamique de manière complémentaire, cet article présente une étude portant sur le vécu des frères et soeurs d'enfants porteurs de troubles du spectre de l'autisme. Afin de répondre à leurs besoins spécifiques, un dispositif nommé « groupe fratrie » a été mis en place durant 3 ans dans le cadre d'un Centre Ressources Autisme. Comprenant deux groupes d'âges d'enfants de 5 à 11 ans et d'adolescents âgés de 12 à 17 ans, il a été coanimé par deux psychologues cliniciennes. Au fil des séances et à l'aide de supervisions réalisées dans le cadre d'une recherche action, des objets flottants ont été proposés pour créer une dynamique de groupe et ainsi permettre aux enfants / adolescents d'élaborer et d'exprimer plus aisément leurs émotions et leurs difficultés. Cette étude est ponctuée par une vignette clinique, dans laquelle est décrite la construction, la mise en scène et les répercussions d'un objet flottant adapté à cette population

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

The value of open-source clinical science in pandemic response: lessons from ISARIC

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