A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Evaluation de la mise en place d'un protocole de nutrition dans le service de réanimation du Centre hospitalier d'Elbeuf

En réanimation, la nutrition est cruciale, comme la suppléance des défaillances vitales. Elle doit être protocolisée pour les prescriptions ainsi que pour l'évaluation nutritionnelle des patients à l'entrée, puis durant l'hospitalisation. Les besoins caloriques, difficiles à évaluer, s'élèvent à 25-30 kcal/kg/j. Les besoins azotés varient de 0,2 à 0,4 gN/kg/j selon le catabolisme, l'état nutritionnel préalable et les pathologies. L'épuration extra-rénale augmente ces besoins. La nutrition entérale doit être préférée à la nutrition parentérale au risque infectieux élevé. Ce travail évaluait l'impact d'un protocole, basé sur les données actuelles, pour optimiser la nutrition. Un audit rétrospectif de tous les patients hospitalisés sur 2 mois, avant et après le protocole, relevait les paramètres d'évaluation nutritionnelle et les apports calorico-azotés durant les 2 premières semaines d'hospitalisation. Les 2 échantillons (62 et 59 patients) étaient comparables pour l'âge, l'IGS II, la durée de séjour et comportaient 60% de pathologie médicale. Après le protocole, le calcul de l'IMC, le renseignement du poids habituel, et le dosage de la transthyrétine sont améliorés. Les modalités de nutrition et les apports calorico-azotés sont restés inférieurs aux objectifs fixés. Cette étude a montré les difficultés à introduire un nouveau protocole de nutrition en réanimation et confirme la nécessité d'évaluer nos pratiques professionnelles.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

Efficiency of goal-directed oxygen delivery in ICU patients

  BACKGROUND: Current clinical practice guidelines promote a goal-directed approach for oxygen delivery with respect to SpO2 objectives. We evaluated the efficiency of a strategy based on goal-directed O2 delivery in the ICU. METHODS: A group of 30 patients (Group 1) with a proven history of chronic obstructive pulmonary disease suffering from acute hypercarbic exacerbation was compared to 2 other groups of patients admitted for acute respiratory failure with no history of pulmonary disease: 30 patients requiring oxygen supply and/or non-invasive ventilation (Group 2) and 30 requiring invasive ventilation (Group 3). The delivery of oxygen was based on SpO2 measurement: 88−94% for Group 1 and 90−96% for others. The time spent with an SpO2 below, within and above the prescribed limits was collected. RESULTS: The mean time spent within the prescribed range was for Groups 1, 2 and 3, respectively as follows: 61.9% [60.5−63.2], 63.7% [62.3−65] and 56.4% [55.3−57.6] (P < 0.001 for each group). A history of chronic obstructive pulmonary disease was not correlated with better results (P = 0.11), while invasive ventilation was related to the time spent out of the prescribed range (P < 0.001; OR 1.3 [1.22−1.28]) especially in hyperoxaemia (40.7% [39.6−41.8] P < 0.001). Efficiency seems unrelated to nursing workload or night team exhaustion (r = −0.09, P = 0.77). CONCLUSIONS: Goal-directed oxygen delivery based on SpO2 objectives in ICU patients ensures that in only approximately 64% of the time, SpO2 stays within the prescribed range.  BACKGROUND: Current clinical practice guidelines promote a goal-directed approach for oxygen delivery with respect to SpO2 objectives. We evaluated the efficiency of a strategy based on goal-directed O2 delivery in the ICU. METHODS: A group of 30 patients (Group 1) with a proven history of chronic obstructive pulmonary disease suffering from acute hypercarbic exacerbation was compared to 2 other groups of patients admitted for acute respiratory failure with no history of pulmonary disease: 30 patients requiring oxygen supply and/or non-invasive ventilation (Group 2) and 30 requiring invasive ventilation (Group 3). The delivery of oxygen was based on SpO2 measurement: 88−94% for Group 1 and 90−96% for others. The time spent with an SpO2 below, within and above the prescribed limits was collected. RESULTS: The mean time spent within the prescribed range was for Groups 1, 2 and 3, respectively as follows: 61.9% [60.5−63.2], 63.7% [62.3−65] and 56.4% [55.3−57.6] (P < 0.001 for each group). A history of chronic obstructive pulmonary disease was not correlated with better results (P = 0.11), while invasive ventilation was related to the time spent out of the prescribed range (P < 0.001; OR 1.3 [1.22−1.28]) especially in hyperoxaemia (40.7% [39.6−41.8] P < 0.001). Efficiency seems unrelated to nursing workload or night team exhaustion (r = −0.09, P = 0.77). CONCLUSIONS: Goal-directed oxygen delivery based on SpO2 objectives in ICU patients ensures that in only approximately 64% of the time, SpO2 stays within the prescribed range

The optic nerve sheath diameter as a useful tool for early prediction of outcome after cardiac arrest: A prospective pilot study

International audienc