Étude de l’impact des soins infirmiers sur le confort, la sécurité et le devenir des patients de réanimation

Since the 1950s and the emergence of modern intensive care, nurses have been trained, specialized and federated. Since then, their commitment to research has enabled intensive care nurses to support innovations in this discipline.This thesis work validates the idea that nursing care has the potential to positively impact the comfort, safety and future of resuscitation patients.The Oxyréa study provided results that support the recommendations of experts on the topic: patients are slightly uncomfortable under oxygen and the use of anon-heating humidifier seems useful for oxygen therapies of more than 4L/minutes for more than 24hours.The CHIC study showed that the prevalence of mean blood pressure variations of more than 15 mm Hgwas higher with the double pump changeover technique than with quick-change technique. On the same criterion, no difference was shown between quick-change technique and automated changeover technique.The risk perception related to the early mobilization amoung EarlyMob study physicians, physiotherapists and nurses investigators is largely in agreement with the experts' recommendations on this topic.Thus, nursing care has a potential impact on the comfort, safety and future of intensive care patients.Depuis les années 1950 et l’émergence des soins intensifs modernes, les infirmières se sont formées, spécialisées et fédérées. Depuis, leur engagement dans la recherche a permis aux soins infirmiers de soins intensifs d’accompagner les innovations de cette discipline. Ce travail de thèse permet de valider l’idée que les soins infirmiers ont le potentiel d’impacter favorablement le confort, la sécurité et le devenir des patients de réanimation.L’étude Oxyréa a permis d’apporter des résultats qui viennent étayer les recommandations d’experts sur le sujet : les patients sont peu inconfortables sous oxygène et l’utilisation d’un humidificateur non chauffant semble utile pour des oxygénothérapies de plus de 4L/minutes de plus de 24 heures. L’étude CHIC a montré que la prévalence des variations de la pression artérielle moyenne de plus de 15 mmHg était plus élevée avec les relais en double seringues qu’avec les relais par changement rapide. Sur ce même critère, aucune différence n’a été montrée entre les relais par changement rapide et les relais automatisés. La perception du risque liée à la mobilisation précoce des médecins, kinésithérapeutes et infirmiers investigateurs de l’étude EarlyMob est majoritairement en accord avec les recommandations des experts sur ce sujet. Ainsi, les soins infirmiers impactent le confort, la sécurité et le devenir des patients de réanimation

Assessment of the impact of nursing care on the comfort, safety and outcome of critically ill patients

Depuis les années 1950 et l’émergence des soins intensifs modernes, les infirmières se sont formées, spécialisées et fédérées. Depuis, leur engagement dans la recherche a permis aux soins infirmiers de soins intensifs d’accompagner les innovations de cette discipline. Ce travail de thèse permet de valider l’idée que les soins infirmiers ont le potentiel d’impacter favorablement le confort, la sécurité et le devenir des patients de réanimation.L’étude Oxyréa a permis d’apporter des résultats qui viennent étayer les recommandations d’experts sur le sujet : les patients sont peu inconfortables sous oxygène et l’utilisation d’un humidificateur non chauffant semble utile pour des oxygénothérapies de plus de 4L/minutes de plus de 24 heures. L’étude CHIC a montré que la prévalence des variations de la pression artérielle moyenne de plus de 15 mmHg était plus élevée avec les relais en double seringues qu’avec les relais par changement rapide. Sur ce même critère, aucune différence n’a été montrée entre les relais par changement rapide et les relais automatisés. La perception du risque liée à la mobilisation précoce des médecins, kinésithérapeutes et infirmiers investigateurs de l’étude EarlyMob est majoritairement en accord avec les recommandations des experts sur ce sujet. Ainsi, les soins infirmiers impactent le confort, la sécurité et le devenir des patients de réanimation.Since the 1950s and the emergence of modern intensive care, nurses have been trained, specialized and federated. Since then, their commitment to research has enabled intensive care nurses to support innovations in this discipline.This thesis work validates the idea that nursing care has the potential to positively impact the comfort, safety and future of resuscitation patients.The Oxyréa study provided results that support the recommendations of experts on the topic: patients are slightly uncomfortable under oxygen and the use of anon-heating humidifier seems useful for oxygen therapies of more than 4L/minutes for more than 24hours.The CHIC study showed that the prevalence of mean blood pressure variations of more than 15 mm Hgwas higher with the double pump changeover technique than with quick-change technique. On the same criterion, no difference was shown between quick-change technique and automated changeover technique.The risk perception related to the early mobilization amoung EarlyMob study physicians, physiotherapists and nurses investigators is largely in agreement with the experts' recommendations on this topic.Thus, nursing care has a potential impact on the comfort, safety and future of intensive care patients

Increasing fruit load impacts quality criteria in clementine fruits (Citrus clementina Hort. ex Tan.) substantially more when applied at an early stage of development.

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Sugars influence the biosynthesis of carotenoids in the pulp of Clementine fruits.

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Effect of fruit load on maturity and carotenoid content of clementine (Citrus clementina Hort. ex Tan.) fruits

International audienceBACKGROUND: Citrus fruits contain many secondary metabolites displaying valuable health properties. There is a lot of interest in enhancing citrus quality traits, especially carotenoid contents, by agronomic approaches. In this study the influence of carbohydrate availability on maturity and quality criteria was investigated in clementine fruits during ripening. Fruiting branches were girdled and defoliated after fruit set to obtain three levels of fruit load: high (five leaves per fruit), medium (15) and low (30). RESULTS: Considering the soluble solid content/titratable acidity (SSC/TA) ratio, it was found that fruits of the high and medium fruit load treatments reached maturity 1.5 months later than fruits of the control. At the time of maturity the SSC/TA ratio of fruits of all treatments was about 13.6. At harvest, fruits were 23% smaller and total sugar concentration of the endocarp was 12.6% lower in the high fruit load treatment than in the control. In contrast, the concentrations of organic acids and total carotenoids were 55.4 and 93.0% higher respectively. Total carotenoids were not positively correlated with either soluble sugars or total carbohydrates. CONCLUSION: Taken together, the results do not support the common view that carbohydrate availability directly determines carotenoid synthesis by influencing precursor availability

Carbohydrate control over carotenoid build-up is conditional on fruit ontogeny in clementine fruits

International audienceThe final contents of primary and secondary metabolites of the ripe fruit depend on metabolic processes that are tightly regulated during fruit ontogeny. Carbohydrate supply during fruit development is known to influence these processes but, with respect to secondary metabolites, we do not really know whether this influence is direct or indirect. Here, we hypothesized that the sensitivity of clementine fruit metabolism to carbohydrate supply was conditional on fruit developmental stage. We applied treatments increasing fruit load reversibly or irreversibly at three key stages of clementine (Citrus clementina Hort. ex Tan.) fruit development: early after cell division, at the onset of fruit coloration (color break) and near maturity. The highest fruit load obtained by early defoliation (irreversible) had the highest impact on fruit growth, maturity and metabolism, followed by the highest fruit load obtained by early shading (reversible). Final fruit size decreased by 21 and 18% in these early irreversible and reversible treatments, respectively. Soluble sugars decreased by 18% in the early irreversible treatment, whereas organic acids increased by 46 and 29% in these early irreversible and reversible treatments, respectively. Interestingly, total carotenoids increased by 50 and 18%, respectively. Changes in leaf starch content and photosynthesis supported that these early treatments triggered a carbon starvation in the young fruits, with irreversible effects. Furthermore, our observations on the early treatments challenge the common view that carbohydrate supply influences positively carotenoid accumulation in fruits. We propose that early carbon starvation irreversibly promotes carotenoid accumulation

International Humanitarian Law against the background of Custom and Humanity

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L'infirmier en réanimation

International audienc

L'infirmier en réanimation

International audienc