Diffusion des anesthésiques locaux lors de l anesthésie péribulbaire évaluée par Imagerie par résonance magnétique (lien avec l efficacité clinique)

L efficacité de l anesthésie péribulbaire (APB) est peu reproductible et serait expliquée par une diffusion aléatoire des anesthésiques locaux 5AL) dans l orbite, de l espace extraconique vers l espace intraconique. Le but de notre étude était d utiliser l imagerie par résonance magnétique (IRM) pour évaluer la diffusion d AL sans hyaluronidase après une injection péribulbaire et de rechercher un lien avec l efficacité clinique. Trente quatre patients (37 yeux) devant être opérés de la cataracte sous APB ont eu une IRM après l injection d AL. La mobilité de l œil et les diffusions intra et extraconique ont été cotées, en aveugle, de 0 à 2 points par quadrant (les scores variant donc de 0 à 8). Un score d akinésie inférieur ou égal à 2 sur 8 définissait une anesthésie satisfaisante. Un score de diffusion intra ou extraconique supérieur à 2 sur 8 définissait une diffusion intra ou extraconique satisfaisante. La recherche d un lien statistique entre ces variables a été réalisée par test du chi-deux ou par test exact de Fischer. Il existait un lien statistique entre la présence d AL dans l espace intraconique et l efficacité du bloc (p=0.0006). En revanche, aucun lien n a été mis en évidence entre la diffusion extraconique et l efficacité (p=0.47) ainsi qu entre les diffusions intra et extraconique (p=0.47). L anesthésie obtenue était satisfaisante dans 49%. La diffusion des AL dans le secteur intraconique était présente à l IRM dans 51% des cas. Les délais moyens de réalisation de l IRM et l examen oculomoteur étaient de 18 minutes. Notre étude démontre que l efficacité d une APB est liée à la diffusion intraconique des AL.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Postpandemic Influenza Mortality of Venovenous Extracorporeal Membrane Oxygenation–Treated Patients in Reunion Island: A Retrospective Single Center Study

International audienceObjectives: The aim of the present study was to assess the post-pandemic mortality of influenza in patients receiving venovenous extracorporeal membrane oxygenation (VV-ECMO) in Reunion Island, France, by comparing the incidence with other patients undergoing VV-ECMO. Design: Retrospective, descriptive, and single-center cohort study. The primary outcome was the standardized mortality ratio for influenza based on the quartiles of the Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score (RESP Score) in the reference population of patients undergoing VV-ECMO. Setting: Intensive care unit (ICU), Felix Guyon Hospital, University Teaching Hospital of La Réunion, La Réunion, France. Participants: Consecutive patients on ECMO with positive polymerase chain reaction for influenza. Interventions: None. Measurements and main results: One hundred twenty-seven consecutive patients were hospitalized in the ICU with a positive influenza polymerase chain reaction from January 2013 to December 2017. Twenty-four influenza patients underwent ECMO including 18 patients with VV-ECMO. During this period, 72 patients requiring VV-ECMO were hospitalized in the ICU. The overall mortality rate of influenza patients on VV-ECMO was 61% versus 46% for non-influenza patients. The standardized mortality ratio per quartile of RESP Score was 1.28 (95% confidence interval 0.61-2.35). Conclusions: In Reunion, the mortality of patients undergoing VV-ECMO for severe influenza is not lower than the expected mortality of all patients undergoing VV-ECMO

Emergence of melioidosis in the Indian Ocean region: Two new cases and a literature review.

Melioidosis is a disease caused by bacteria called B. pseudomallei. Infections can develop after contact with standing water. This disease can reach all the organs and especially the lungs. It is associated with a high mortality rate (up to 50%). Melioidosis is endemic in northern Australia and in Southeast Asia. Nevertheless, B. pseudomallei may be endemic in the Indian Ocean region and in Madagascar in particular, so clinicians and microbiologists should consider acute melioidosis as a differential diagnosis in the Indian Ocean region, in particular from Madagascar

La Croix de la Charente

17 septembre 19111911/09/17 (N38).Appartient à l’ensemble documentaire : PoitouCh

Simplified Acute Physiology Score II as Predictor of Mortality in Intensive Care Units: A Decision Curve Analysis

<div><p>Background</p><p>End-of-life decision-making in Intensive care Units (ICUs) is difficult. The main problems encountered are the lack of a reliable prediction score for death and the fact that the opinion of patients is rarely taken into consideration. The Decision Curve Analysis (DCA) is a recent method developed to evaluate the prediction models and which takes into account the wishes of patients (or surrogates) to expose themselves to the risk of obtaining a false result. Our objective was to evaluate the clinical usefulness, with DCA, of the Simplified Acute Physiology Score II (SAPS II) to predict ICU mortality.</p><p>Methods</p><p>We conducted a retrospective cohort study from January 2011 to September 2015, in a medical-surgical 23-bed ICU at University Hospital. Performances of the SAPS II, a modified SAPS II (without AGE), and age to predict ICU mortality, were measured by a Receiver Operating Characteristic (ROC) analysis and DCA.</p><p>Results</p><p>Among the 4.370 patients admitted, 23.3% died in the ICU. Mean (standard deviation) age was 56.8 (16.7) years, and median (first-third quartile) SAPS II was 48 (34–65). Areas under ROC curves were 0.828 (0.813–0.843) for SAPS II, 0.814 (0.798–0.829) for modified SAPS II and of 0.627 (0.608–0.646) for age. DCA showed a net benefit whatever the probability threshold, especially under 0.5.</p><p>Conclusion</p><p>DCA shows the benefits of the SAPS II to predict ICU mortality, especially when the probability threshold is low. Complementary studies are needed to define the exact role that the SAPS II can play in end-of-life decision-making in ICUs.</p></div

Clinical, Radiological, and Microbiological Characteristics of Mycobacterium simiae Infection in 97 Patients

International audienceMycobacterium simiae is a rare species of slow-growing nontuberculous mycobacteria (NTM). From 2002 to 2017, we conducted a retrospective study that included all patients with NTM-positive respiratory samples detected in two university hospitals of the French overseas department of Reunion Island. We recorded the prevalence of M. simiae in this cohort, as well as the clinical, radiological, and microbiological features of patients with at least 1 sample positive for M. simiae. In our cohort, 97 patients (15.1%) were positive for M. simiae. Twenty-one patients (21.6%) met the American Thoracic Society (ATS) criteria for infection. M. simiae infection was associated with bronchiectasis, micronodular lesions, and weight loss. Antibiotic susceptibility testing was performed for 60 patients, and the isolates were found to have low susceptibility to antibiotics, except for amikacin, fluoroquinolones, and clarithromycin. Treatment failed for 4 of the 8 patients treated for M. simiae infection. Here, we describe a specific cluster corresponding to a large cohort of patients with M. simiae, a rare nontuberculous mycobacterium associated with low pathogenicity and poor susceptibility to antibiotics

Case Report: Emergence of Candida auris in the Indian Ocean Region

International audienceCandida auris is an emerging multidrug-resistant yeast that can cause severe infections and spread easily between hospitalized patients, leading to outbreaks in hospital. Here, we report the first four cases of colonization and invasive infection with C. auris reported in the Indian Ocean region. All cases were observed in the French overseas Reunion Island, a very popular destination for European travelers. Three patients had urinary tract or skin colonization, and one had a fatal invasive infection. In three cases, including that of the infected patient, the yeast was not initially identified as C. auris , preventing specific hygiene measures to be implemented as suggested in the December 2016 clinical alert to European healthcare facilities. The infected patient likely acquired C. auris in the intensive care unit from the first colonized patient. This is the first case of C. auris infection and the first potential case of nosocomial transmission of the pathogen to be reported in the French overseas Reunion Island

Bleeding risk of ticagrelor compared to clopidogrel in intensive care unit patients with acute coronary syndrome: A propensity-score matching analysis

International audienceBackground: Intensive care unit (ICU) patients with the most severe forms of acute coronary syndrome (ACS) require invasive therapies such as extracorporeal life support. The risk of bleeding in ICU patients with ACS treated with a dual antiplatelet therapy of aspirin and ticagrelor is unknown. The primary objective of this study was to compare the bleeding risk of ticagrelor and clopidogrel in ICU patients with ACS.Methods and findings: We conducted a retrospective study based on a propensity score and a proportional hazards model. All patients with ACS hospitalized in the ICU of a French university hospital between January 2013 and January 2017 were included in the study. Bleeding during ICU stay was defined as all Thrombolysis in myocardial infarction (TIMI) major or minor events. A total of 155 patients were included in the study. According to propensity score matching, 57 patients treated with aspirin and ticagrelor were matched with 57 patients treated with aspirin and clopidogrel. Median (first-third quartile) Simplified Acute Physiology Score II was 61.5 (41.0-85.0). Bleeding during ICU stay occurred in 12 patients (21.1%) treated with clopidogrel and in 35 patients (61.4%) treated with ticagrelor (p<0.0001). This significant association was found for both TIMI major bleeding (12.3% vs. 35.1%, p = 0.004) and TIMI minor bleeding (8.8% vs. 26.3%, p = 0.01). The relative risk of bleeding occurrence during ICU stay was 2.60 (confidence interval 95%: 1.55-4.35) for ticagrelor compared to clopidogrel. No significant difference in ICU mortality was found between the two groups (45.6% in the clopidogrel group vs. 29.8% in the ticagrelor group, p = 0.08).Conclusions: Bleeding complications are frequent and serious in ICU patients with ACS. A dual antiplatelet therapy of aspirin and ticagrelor is associated with a higher risk of bleeding compared to a dual antiplatelet therapy of aspirin and clopidogrel

Characteristics of patients at admission and evolution in ICU.

<p>Characteristics of patients at admission and evolution in ICU.</p

Diagnostic performance of SAPS II in predicting ICU mortality.

<p>Diagnostic performance of SAPS II in predicting ICU mortality.</p