Ozone fumigation successfully controlled and eradicated multidrug-resistant Acinetobacter baumanii from an intensive care unit

Cette contribution porte sur la construction de savoirs professionnels dans l'alternance en formation initiale à l'enseignement. Elle postule que cette construction de savoirs se relie à l'émergence de l'identité professionnelle: le sujet en formation se construit comme acteur social en même temps des savoirs propices à son agir. Plus précisément, notre préoccupation de recherche concerne les indicateurs de cette co-construction soi/savoirs professionnels tels qu'on peut les inférer à partir de l'analyse de discours écrits ou oraux produits par les étudiants

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

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Patient outcomes following transfer between intensive care units during the COVID-19 pandemic

Transferring critically ill patients between intensive care units is often required in the UK, particularly during the COVID-19 pandemic. However, there is a paucity of data examining clinical outcomes following transfer of patients with COVID-19 and whether this strategy affects their acute physiology or outcome. We investigated all transfers critically ill patients with COVID-19 between three different hospital intensive care units, between March 2020 and March 2021. We focused on inter-hospital intensive care unit transfers, i.e. those patients transferred between intensive care units from different hospitals and compared this cohort with intra-hospital intensive care unit transfers, i.e. patients moved between different intensive care units within the same hospital. A total of 507 transfers were assessed, of which 137 met the inclusion criteria. Forty-five patients underwent inter-hospital transfers compared with 92 intra-hospital transfers. There was no significant change in median compliance 6 hours pre-transfer, immediately post-transfer and 24 hours post-transfer in patients who underwent either intra-hospital or inter-hospital transfers. For inter-hospital transfers, there was an initial drop in median PaO2/FiO2 ratio: from median (IQR [range]) 25.1 (17.8–33.7 [12.1–78.0]) kPa 6 hours pre-transfer to 19.5 (14.6–28.9 [9.8–52.0]) kPa immediately post-transfer (p<0.05). However, this had resolved at 24 hours post-transfer: 25.4 (16.2–32.9 [9.4–51.9]) kPa. For intra-hospital transfers, there was no significant change in PaO2/FiO2 ratio. We also found no meaningful difference in pH; PaCO2;, base excess; bicarbonate; or norepinephrine requirements. Our data demonstrate that patients with COVID-19 undergoing mechanical ventilation of the lungs may have short-term physiological deterioration when transferred between nearby hospitals but this resolves within 24 hours. This finding is relevant to the UK critical care strategy in the face of unprecedented demand during the COVID-19 pandemic

Maximal effort cytoreductive surgery for disseminated ovarian cancer in a UK setting: challenges and possibilities

© 2016 Springer-Verlag Berlin HeidelbergObjective: To assess surgical morbidity and mortality of maximal effort cytoreductive surgery for disseminated epithelial ovarian cancer (EOC) in a UK tertiary center. Methods/materials: A monocentric prospective analysis of surgical morbidity and mortality was performed for all consecutive EOC patients who underwent extensive cytoreductive surgery between 01/2013 and 12/2014. Surgical complexity was assessed by the Mayo clinic surgical complexity score (SCS). Only patients with high SCS ≥5 were included in the analysis. Results: We evaluated 118 stage IIIC/IV patients, with a median age of 63 years (range 19–91); 47.5 % had ascites and 29 % a pleural effusion. Median duration of surgery was 247 min (range 100–540 min). Median surgical complexity score was 10 (range 5–15) consisting of bowel resection (71 %), stoma formation (13.6 %), diaphragmatic stripping/resection (67 %), liver/liver capsule resection (39 %), splenectomy (20 %), resection stomach/lesser sac (26.3 %), pleurectomy (17 %), coeliac trunk/subdiaphragmatic lymphadenectomy (8 %). Total macroscopic tumor clearance rate was 89 %. Major surgical complication rate was 18.6 % (n = 22), with a 28-day and 3-month mortality of 1.7 and 3.4 %, respectively. The anastomotic leak rate was 0.8 %; fistula/bowel perforation 3.4 %; thromboembolism 3.4 % and reoperation 4.2 %. Median intensive care unit and hospital stay were 1.7 (range 0–104) and 8 days (range 4–118), respectively. Four patients (3.3 %) failed to receive chemotherapy within the first 8 postoperative weeks. Conclusions: Maximal effort cytoreductive surgery for EOC is feasible within a UK setting with acceptable morbidity, low intestinal stoma rates and without clinically relevant delays to postoperative chemotherapy. Careful patient selection, and coordinated multidisciplinary effort appear to be the key for good outcome. Future evaluations should include quality of life analyses