WorldCat Identities

Laffon, Marc (1960-....; docteur en médecine)

Overview
Works: 66 works in 78 publications in 2 languages and 112 library holdings
Roles: Thesis advisor, Opponent, Other, Author, Contributor
Publication Timeline
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Most widely held works by Marc Laffon
Dépistage systématique du Syndrome Apnées Obstructives du Sommeil : l'anesthésiste peut être un acteur de santé publique : étude prospective observationnelle évaluant l'interêt d'associer le spécialiste du sommeil à l'auto-questionnaire STOP-BANG de la consultation d'anesthésie by Charles-Edouard Rochon( )

2 editions published in 2018 in French and held by 3 WorldCat member libraries worldwide

En consultation pré-anesthésique (CPA) l'anesthésiste dépiste des pathologies et addictions pouvant avoir un impact péri-opératoire, comme le Syndrome d'Apnées Obstructives du Sommeil (SAOS) grâce à l'auto-questionnaire validé : le STOP-BANG. Nous émettons l'hypothèse que ce questionnaire peut aider le spécialiste du sommeil dans le dépistage du SAOS et ainsi jouer un rôle important dans la prévention secondaire. Méthode : Dans notre étude prospective nous avons collecté successivement tous les questionnaires STOP-BANG de CPA, en chirurgie de la tête et du rachis, afin de les envoyer à un spécialiste du sommeil. Après analyse les patients évalués les plus à risque ont été contactés, en post-opératoire, par un courrier contenant une lettre d'information et un questionnaire ”ronflement et qualité sommeil” spécialisé. Après réception de ce second questionnaire les patients ont été convoqué pour une consultation spécialisé et des investigations si nécessaire. Le critère de jugement principal est le taux de SAOS diagnostiqué par rapport aux patients contactés par le spécialiste. Pour les critères secondaires nous avons recherché des facteurs influençant le renvoi ou le non renvoi du courrier. Pour cela nous avons réalisé un questionnaire téléphonique standardisé et appelé les patients contacté par le spécialiste en distinguant deux groupes : le groupe répondeur (R), patents ayant renvoyé le questionnaire et le groupe non répondeur (NR). Résultats : Durant un an, 219 patients ont été contacté par le spécialiste, 70 (32%) ont renvoyé le questionnaire, 26 patients ont un SAOS confirmé après explorations, soit 12% des contacté et 37% des répondeurs. Nous avons appelé 101 patients, 46 R et 40 NR, ont complété le questionnaire téléphonique. La première cause de réponse, pour les répondeur, est leur implication dans leur santé, la première cause de non réponse, pour les non répondeurs, est la non réception du courrier pour 21 (52.5%), 19 ont reçu le courrier et complété l'entretien téléphonique. Ils déclarent ne pas avoir répondu car ils ont une priorité pour une autre pathologie pour 9 (47%) patients ou ils n'ont pas répondu car ne voient pas l'intérêt du dépistage pour 9 (47%). Seulement 21% des patients appelé déclarent se souvenir avoir reçu une information sur le SAOS en CPA. Conclusion : L'anesthésiste peut être un acteur de santé publique dans le dépistage du SAOS en post opératoire de la chirurgie céphalique et du rachis en envoyant l'auto-questionnaire STOP-BANG réalisé en CPA à un spécialiste du sommeil. Pour progresser dans notre dépistage nous pouvons envisager un contact postal auprès du médecin traitant du patients à risque. Enfin l'information du patient semble être un élément central pour la participation et l'adhérence au dépistage
Complications per anesthésie générale du POLIDOCANOL dans les malformations vasculaires à bas débit by Lauren Caro( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

INTRODUCTION : Le polidocanol est un sclérosant veineux, utilisé hors AMM, pour le traitement des malformations vasculaires à bas débit, chez l'adulte et chez l'enfant. À notre connaissance, aucune étude rapportant la tolérance chez l'enfant de ce médicament n'a été réalisée pour cette indication. Au CHU de Tours, les enfants souffrant de malformations étendues et/ou profondes bénéficient d'une anesthésie générale pour la réalisation de la sclérothérapie. Plusieurs incidents étant survenus lors de ces procédures, nous avons voulu connaitre la toxicité systémique du polidocanol dans cette population. MATERIELS ET METHODE : Nous avons conduit une étude observationnelle rétrospective monocentrique pour évaluer la toxicité du polidocanol chez les enfants ayant eu au moins une séance de sclérothérapie sous anesthésie générale, du 1er janvier 2006 au 31 décembre 2019. Le critère de jugement principal était la survenue d'au moins un évènement systémique après l'injection de polidocanol. Les caractéristiques des patients, de leur malformation ainsi que les médicaments administrés ont été relevées. RÉSULTATS : 101 séances de sclérothérapie ont été analysées, concernant 64 enfants. L'incidence de survenue d'au moins un évènement systémique est de 37,5% [IC95% : 25,6 - 49,4] dont 17 hypotensions (26,6%), 8 bradycardies (12,5%), 2 désaturations (3,1%) et 1 arrêt cardio-circulatoire (1,6%). Huit événements (12,5%) ont nécessité l'administration d'un vasopresseur. CONCLUSION : La sclérothérapie au polidocanol occupe une place importante dans le traitement des malformations à bas débit. Mais sous anesthésie générale, les effets secondaires systémiques relevés justifient son utilisation de façon encadrée et prudente
Impact sur la pratique quotidienne de trois moniteurs peropératoires de la balance nociception - anti-nociception au cours de l'anesthésie générale combinée à une analgésie locorégionale (étude ANISPINOL) by Margaux Harly( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction: The three most frequently proposed devices in France for monitoring nociception under general anesthesia are ANItm (Analgesia/Nociception Index), SPItm (Surgical Phletysmographic Index) and NOLtm (Nociception Level). The objective of this study is to assess whether monitoring of nociception - anti-nociception (NAN) with any of these three devices is likely to change the per-operative management of analgesia during general anesthesia with locoregional anesthesia (LRA). Method: This study is a monocentric observational study. The three devices were installed in 15 patients who went under orthopedic surgery with general anesthesia and locoregional analgesia. The measurement of each device is automatically recorded from induction to closure. The primary outcome was the percentage of time spent in the target area for each device between induction and the end of cutaneous surgical closure. Target areas were defined as 50-70 for ANItm, 20-50 for SPItm and 10-25 for NOLtm. Results: The time period per patient was 154 +/- 60 minutes. According to the ANI, SPI and NOL, the median times spent in the target were 39%, 53% and 28% respectively (p=0.038). Median times spent « over analgesia » were 38%, 6 % and 45% respectively (p=0.004). Conclusion: In case of general anesthesia with ALR, these three devices may change patient management, but with opposite options. Without any reference and recommendation technique, their systematic use remain an open question
Etude de la concentration sanguine de céfazoline utilisée en antibioprophylaxie durant les transplantations hépatiques orthotopiques by Isaure Breteau( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction Liver transplantation is the ultimate therapy in severe hepatopathy treatment such as cirrhosis. There is no guideline in France, neither in the rest of the world, regarding antibiotic prophylaxis to prevent post-surgical infection after this kind of surgery. In Regional Hospital Centre of Tours, this antibiotic prophylaxis is based on the French guidelines of the French Society of Anaesthesiology and Intensive Care (SFAR) regarding other hepato-biliary surgeries. Transplanted patients present a severe underlying hepatic condition, adding to the complexity of the surgery, resulting in a high risk of pharmacokinetic modifications of cefazolin. We aimed to determine if the protocol used for antibiotic prophylaxis with cefazolin manages to obtain in-therapeutic range blood concentration of cefazolin for all treated patients. Methods This is a prospective monocentric study including all patients receiving a liver transplantation in the Regional Hospital of Tours (France). Patients received cefazolin at the initial dose of 2g followed by re-injection of 1g every 4 hours during surgery, these doses were doubled in case of obesity (Body Mass Index > 35kg/m² and weight > 100kg). cefazolin blood concentration was dosed at the beginning and at the end of surgery. Medical history and per-procedure data possibly influencing pharmacokinetics were collected. Results This study included 21 patients between April 3rd and July 28th 2020. No sub-therapeutic value was detected in the samples of beginning surgery. Regarding the 18 patients with an end-surgery sample, 4 (19%) presented sub-therapeutic cefazolin concentration. Among the collected data, only massive crystalloid infusion (5875mL vs 2711mL in the rest of the study population) was a risk factor of sub-therapeutic dosage. Conclusion In conclusion, the cefazolin antibiotic prophylaxis used for liver transplant in our hospital present a risk of exposition to sub-therapeutic values for people receiving a higher amount of crystalloid infusion. There is an interest in continuing to explore cefazolin pharmacology in the context of that particular surgery but also to explore the clinical impact of these sub-therapeutic values regarding prevention of post-surgical infection
Recherche de facteurs prédisposant à la transfusion de globules rouges en per ou post opératoire lors d'une première chirurgie cardiaque chez l'enfant by Céline Migeot( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction: Red blood cells (RBCs) transfusion is often required during cardiac surgery in children. However, RBCs is a rare product, and its transfusion is associated to adverse events and a worse surgical outcome. Search for factors associated to RBCs transfusion during cardiac surgery in children would provide preventing strategies. Materials and methods: We conducted a retrospective, mono-centric study, including all children who underwent first cardiac surgery using Cardio Pulmonary Bypass (CBP) at the Tours University Hospital, without using RBCs to purge CBP circuits. Results: Between 2011 and 2019, 173 children were included; out of whom 57 had an intraoperative transfusion and 17 a postoperative transfusion. Age (OR 0.76, p<0.001), weight (OR 0.93, p<0.001), body mass index (BMI) (OR 0.83, p<0.001), haemoglobin level (OR 0.68, p<0.05), haematocrit level (OR 0.88, p<0.05), mean corpuscular volume (MCV) (OR 0.86, p<0.001) and CBP duration (OR 1.01, p<0.05) were associated with an increased risk of intraoperative transfusion in univariate analysis. In multivariate analysis, only CBP duration (OR 1.02, p<0.001) and MCV (OR 0.89, p<0.05) were associated with transfusion. Concerning postoperative transfusions, the RACHS surgical difficulty score (OR 6.83, p<0.01), duration of CPB (OR 1.01, p<0,001), length of hospital stay in resuscitation unit (OR 2.37, p<0.001) and hospitalisation (OR 1.2, p<0.001), and re operation (OR 20.59, p<0.001) were significant using univariate analysis, and only the need for a re operation (OR 19.16, p<0.01) remained significant in multivariate analysis. Conclusion: Low MCV appears to be one of the main risk factors for intraoperative transfusion in RBCs. It may reflect iron deficiency that could be supplemented pre operatively in order to reduce the risk of transfusion
Utilisation du Méthoxyflurane (Penthrox®) inhalé aux urgences de Tours comme antalgique en traumatologie hospitalière : étude UMATH by Céline Besnard( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction: Oligoanalgesia in traumatology is prevalent and is a priority for public health. Methoxyflurane, introduced in Europe in recent years and used for more than 40 years in Australia and New Zealand, is indicated in moderate to severe traumatic pain. With its method of administration by inhalation, its allocation in the emergency department would reduce the pain early and its harmful consequences especially in the emergency triage area via the Nurse at Reception and Orientation,. The objective of our study as to highlight the effectiveness of Penthrox® on acute traumatic pain within 15 minutes on the population of Tours, via the measurement on a Numerical Rating Scale (NRS). Material and Method: A prospective monocentric non-randomized observational study on single-traumatized, adult, conscious patients with an initial NRS greater than 4, taken into care at the reception of the Emergency Department of Tours (37). Period from 4 June 2019 to 4 June 2020, but the collection was prematurely interrupted due to the COVID-19 health crisis. Patients were included successively in the Emergency Department, where they received the treatment. The following data was collected: NRS at 15, 30, 45 and 60 minutes after inhalation, possible adverse effects, use patterns and overall assessment. Results: 34 patients were included, averaging 40 years of age, with a male/female ratio of 1.6. The major diagnoses were for 47% fractures and for 20% bruises. The NRS at 0 min was 7.29 on average and 73.5% of patients had severe pain (NRS > 6). After the procedure, there is a significant decrease in pin pain at all intervals (p < 10-4); 60 min after the intervention, the NRS (72.4%) had decreased by at least 30%. 14.7% used second-line treatment and therefore discontinued the study. 17.7% of patients showed no side-effects and no serious ones were detected. Both patients and medical team, consider satisfaction is excellent with an average of 70% for the patients and 75% for the health team. 97% of the patients and the entire health care team believe that Penthrox® should be integrated into the emergency department's therapeutic arsenal. Conclusion: Methoxyflurane delivered by the Nurse at Reception and Orientation, because of its effectiveness, its early action and its tolerance, on the traumatic pain of moderate to severe intensities in the patients attending the emergency department of Tours, has its place in the analgesic protocol
Incidence et facteurs de risque des atteintes radiculaires des membres inférieurs chez les parturientes ayant accouché par voie basse sous analgésie péridurale by Anne Bruno( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction : Postpartum neurological symptoms prevalence after epidural anesthesia is low. These neurological deficits can either be of radicular or distal origin. During lower limb neurological postpartum disorders, epidural anesthesia is often suspected. Given considerable risk of morbidity and mortality, it is crucial to evaluate the cause of these disorders and discriminate between anesthesia and obstetrical causes. Therefore, we first embarked upon investigating the incidence of lower limb neurological dysfunctions after vaginal delivery under epidural anesthesia. Then we investigated the origin, radicular or distal, of such dysfunctions in order to identify etiological factors within our two study groups. Method : We undertook a 17-year prospective study to establish the incidence of postpartum neurological dysfunctions after vaginal delivery under epidural anesthesia (from 10/01/2002 to 10/01/2019). Parturient women presenting neurological deficits (motor and/or sensitive) a week after delivery (for the first 11 years) were send to a neurologist for a clinical evaluation and send for electroneuromyography (ENMG) and/or a radiologic evaluation (MRI, TDM). Parturient women were included in either radicular or distal dysfunction groups and matched with 4 controls. Demographic, obstetrical and anesthetic data were collected for each case. Results : A hundred and four parturient women suffered from a neurological deficit (104/21804, 0.48%). Among these, we analyzed thirty-two patients. A majority of patients displayed radicular deficits (25/32). Radicular neurological dysfunctions were associated with the following risk factors: higher mother's age (p=0.01); late-term pregnancy (p=0.001); higher newborn's weight (p=0.006); longer lithotomy position (p=0.0004); instrumental vaginal delivery (p=0.03); episiotomy (p=0.006); time of epidural anesthesia (p=0.0005); and time between arrival in the delivery room and childbirth (p=0.008). Similar risk factors were also found in patients suffering from distal neurological dysfunctions: higher newborn's weight (p=0.006); longer lithotomy position (p=0.004); time of anesthesia consultation (p=0.001); and time between arrival in the delivery room and childbirth (p=0.005). Conclusion: Lower limb neurological deficits were identified in 0.48% of vaginal deliveries under epidural anesthesia. Among these, radicular impairments are more frequent, with obstetrical risk factors (excluding age and non-anesthetic factors). Similar risk factors are associated with distal impairments (excluding instrumental vaginal delivery and episiotomy)
Impact de la durée de la circulation régionale normothermique sur des greffons hépatiques provenant de donneurs Maastricht III : une étude rétrospective et multicentrique by Thomas Guillem( )

2 editions published in 2019 in French and held by 3 WorldCat member libraries worldwide

Rationnel. La transplantation hépatique est le traitement de référence pour les insuffisances hépatiques terminales. Il existe actuellement une pénurie de greffon entrainant une augmentation des décès sur liste d'attente. Afin d'augmenter le nombre d'organes disponibles, l'Agence de la Biomédecine a introduit le prélèvement d'organes sur personnes décédées après arrêt cardiaque (DCD), en utilisant une circulation régionale normothermique (CRN) pour prévenir les effets indésirables de l'ischémie sur ces greffons. La durée de la CRN peut varier en fonction des conditions locales ou de la présence d'un prélèvement pulmonaire. Le but de cette étude est d'évaluer l'impact de la durée de la CRN sur la fonction hépatique du greffon et l'incidence des lésions d'ischémie reperfusion sur l'histologie du greffon. Méthodes. Il s'agissait d'une étude rétrospective entre 2016 et 2018, menée dans 3 services hospitaliers français, incluant 39 receveurs de greffon hépatique provenant de donneurs DCD Maastricht 3. Le critère de jugement principal était la reprise de fonction du greffon hépatique. Les critères de jugement secondaire étaient les lésions d'ischémie reperfusion sur la biopsie du greffon et la survie du greffon. Résultats. Une durée prolongée de CRN était significativement associée à un taux plus bas de dysfonction hépatique précoce, 61.6% pour NRP < 150 minutes, 26.7% for 150 £ NRP < 200 minutes and 9.1% for NRP ³ 200 minutes p=0.02, et a une baisse du pic d'ALAT dans les 7 premiers jours suivant la transplantation hépatique, médiane 1523.0 intervalle interquartile (993.0-3000.0) avec une CRN < 150 minutes, 982.0 (678.0-1424.0) pour une durée entre 150 £ CRN < 200 minutes et 793.0 (585.0-872.5) pour une durée de CRN ³ 200minutes, p=0.04. En analyse multivariée, une durée de CRN ³ 200 minutes était le seul facteur indépendamment associé à la dysfonction hépatique précoce (OR=0.03, CI 95% [0.00-0.33] p=0.02). Aucune différence significative n'a été observée pour les autres critères biologiques. Aucune différence significative n'a été montré pour les lésions d'ischémie reperfusion sur la biopsie du greffon, ainsi que sur la survie du greffon selon la durée de CRN. Discussion. Une durée de CRN prolongée (³ 200 minutes) est associée à un taux moins élevé de dysfonction hépatique précoce et un pic plus faible d'ALAT dans les 7 premiers jours suivant la transplantation hépatique, sans impact sur les lésions d'ischémie reperfusion du greffon et la survie du greffon. D'autres études sont nécessaires pour confirmer ce résultat et définir la durée optimale de CRN
Laryngoscopie directe versus McGRATH® MAC Video-laryngoscope (Medtronic) en routine : étude économique comparative et incidence des bris dentaires by Pierre Rapilly( )

2 editions published in 2019 in French and held by 3 WorldCat member libraries worldwide

Background: Direct laryngoscopy (DL) is in some centers replaced by videolaryngoscopy for intubation. The cost of this strategy has not been evaluated yet. The primary outcome of this study was to compare the cost of these two intubation routine strategies routinely in the operating theatre: direct laryngoscopy and the McGRATH™ MAC Videolaryngoscope (Medtronic). Methods: We carried out a retrospective economic study with a cost minimization analysis. It compared two hospital centers from 2016 to 2017. One center, the direct laryngoscopy group (DL group), used DL in first intention. An airway adjunct (bougie or stylet) or a videolaryngoscope: Airtraq™ (Vygon) could be used in difficult intubation. The other center, the McGrath group, used the MacGRATH™ MAC as first-line, whether it was difficult intubation or not. An airway adjunct could be used. We included all intubations in the operating theatre for adult patients. The costs associated with intubation were calculated from medical device orders related to upper airway management. Reports and claims for dental trauma related to intubation were analyzed. The costs per intubation, as well as the orders concerning alternative intubation strategy, were calculated. Results: In McGrath group, intubation was associated with an additional cost of 17.5% compared to intubation DL group. Alternative intubation devices were higher in McGrath group, 18% vs. 10%. The dental trauma incidence was similar between the two groups (0.07%). Conclusion: The routine use of the McGRATH™ MAC in first intention was associated with an additional cost compared to the preferential use of the laryngoscope, without reducing dental trauma
Incidence et facteurs de risque d'hypoxémie lors des endoscopies digestives sous sédation profonde : analyse post-hoc d'un essai randomisé contrôlé by Axelle Eugène( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction Deep sedation during upper or lower gastrointestinal endoscopy (GIE) improves the comfort and quality of the procedure, but is associated with a greater number of cardiopulmonary complications. Hypoxemia is the main complication and knowing the risk factors would allow the implementation of preventive measures. Few studies investigating the risk factors for hypoxemia in GIE have been conducted during deep sedation. Material and methods Post-hoc analysis of patients included in the standard oxygenation arm of the ODEPHI study (a randomized, controlled, multicenter study that compared high-flow nasal oxygen therapy to standard oxygenation during programmed deep sedation GIEs in patients predisposed to hypoxemia). Patients included already had hypoxemia-predisposing factors such as: cardiac or respiratory pathology, age ≥60 years, obstructive sleep apnea syndrome (OSA), obesity (defined by body mass index ≥30kg.m-²), or classified as class ≥2 on the American Society of Anesthesiologist physical status classification (ASA). The primary objective of our study was to identify the main risk factors for hypoxemia (defined as pulsed oxygen saturation SpO2≤ 92%.). Secondary objectives were to evaluate the incidence of cardiopulmonary complications and to analyze usual sedation practices during GIE. Results 202 patients were analyzed. The incidence of hypoxemia was 31%. Endoscopy had to be interrupted for 6 patients (3%) with need for intubation for 3 of them in 3 cases (2%). In univariate analysis, hypoxemia was more frequent in male patients (P=0.039), high blood pressure (P<0.01), with high body mass index (P=0.014), ASA score ≥2 (P=0.03), Mallampati score ≥3 (P<0.01) or obstructive sleep apnea syndrome (OSA) (P=0.01). Multivariate analysis recognizes high blood pressure and OSA as independent risk factors. Conclusion The independent risk factors for the occurrence of hypoxemia in deep sedation for GIEs are the presence of high blood pressure and/or obstructive sleep apnea syndrome
Effet des liquides d'irrigation sur la température chez les patients opérés d'une photovaporisation prostatique sélective par laser sous anesthésie générale by Marion Dudragne( )

2 editions published in 2018 in English and held by 3 WorldCat member libraries worldwide

Objet : Comparer l'incidence de l'hypothermie lors de photovaporisations prostatiques (PVP) réalisées sous anesthésie générale par rapport à l'incidence de l'hypothermie survenant chez des patients bénéficiant d'interventions chirurgicales urologiques de durée comparable sous anesthésie générale mais sans irrigation vésicale. Puis comparer l'incidence des complications cardiovasculaires chez les patients hypothermes et non hypothermes. Méthode : Les patients étaient répartis dans deux groupes, un groupe PVP dont l'âge médian était de 72 ans (68 - 80) et un groupe contrôle sans liquide d'irrigation dont l'âge médian était de 65 ans (62 - 70). Les patients bénéficiant d'une PVP recevaient un liquide d'irrigation à température ambiante de 19,2 °C (18,7 - 20,0). Tous les patients étaient recouverts d'une couverture externe chauffante à air pulsé à 43°C pendant l'intervention. Le recueil de la température a été réalisé en peropératoire et en SSPI toutes les 15 minutes. La durée de séjour, l'incidence des infections à un mois, la quantité du saignement, la présence de frissons ou l'inconfort des patients et les évènements myocardiques ont été relevés. Résultats : Au total 19 patients sur 36 étaient hypothermes dans le groupe PVP et 21 patients sur 36 dans le groupe contrôle (p=0,64). Une baisse de la température tympanique dans le groupe PVP de -0,8 (-0,9 - -0,6°C) et dans le groupe contrôle de -0,6 (-0,8 - -0,3°C) (p=0,18) était observée. De même, il était noté une diminution de la température oesophagienne dans le groupe PVP de -0,1 (-0,4 - -0,0°C) et dans le groupe contrôle de -0,1 (-0,3 - -0,0°C) (p=0,93). Le volume de liquide d'irrigation dans le groupe PVP était de 18 L (15 - 23). Il n'y avait pas de différence significative concernant les évènements myocardiques, les infections et la durée de séjour chez les patients dont la température centrale était inférieure à 36°C. Conclusion : Notre étude n'a pas mis en évidence de différence de température entre le groupe PVP et le groupe sans irrigation. Ce résultat suggère qu'il n'y a pas d'indication à réchauffer les liquides d'irrigation au cours de cette intervention si l'hypothermie est correctement prévenue (couverture chauffante à air pulsé, réchauffement des liquides de perfusion quand leur volume est supérieur à 500 mL)
Évaluation de la perfusion cérébrale par Doppler Trans Crânien chez les traumatisés crâniens à la prise en charge initiale : quel apport pour améliorer la prédiction de la mortalité à J14 ? by Pierre-François Chalard( )

2 editions published in 2020 in French and held by 3 WorldCat member libraries worldwide

Introduction : Traumatic brain injury (TBI) is responsible for significant morbidity and mortality. Several mortality prediction models following TBI are available but none of them take into account initial brain perfusion. We aimed to investigate whether brain perfusion assessment with Trans Cranial Doppler on admission would provide additional independent information to these models. Method : Data was extracted from the Traumabase registry. We selected those patients with an initial GCS ≤ 12 and an available Pulsatility Index (PI) measurement on admission. The primary endpoint was mortality at day 14 (D14). The predictive value for death of PI was assessed in univariate analysis and in combination with IMPACT and CRASH scores to predict mortality at D14. The Integrated Discrimination Improvement (IDI) and the Net Reclassification Index (NRI) were calculated to estimate the reclassification capacity of the PI when added to these scores. Results : 2219 traumatic brain injury patients were analyzed; PI was significantly higher in patients who died at D14 compared to those alive at D14 (median at 1.5 (1.1-2.2) versus 1.1 (0.9-1.4) respectively, p<0.001), with an area under the ROC curve (AUC) to predict mortality at D14 of 0.69 (0,67-0,72).. The odds ratio of mortality for PI was always significant (p<0.001) with a value between 2.41 and 2.65 according to the models (CRASH and IMPACT). When adding PI to the pre-existing models, the AUC was in each case greater than the model without PI ranging from 0.883 to 0.904. The calculated NRI and IDI were significantly greater than 0. Conclusion The PI measured at hospital arrival is an independent factor associated with TBI mortality at D14. Adding it to the IMPACT and CRASH scores showed an improvement in the prediction of mortality in all models
MILAR : évaluation du taux de succès d'intubation orotrachéale à la première laryngoscopie entre le vidéolaryngoscope McGrath MAC et le laryngoscope McIntosh chez les patients avec moins de deux critères d'intubation difficile en chirurgie programmée : un essai clinique, contrôlé, randomisé, prospectif, multicentrique by Jonathan Richard( )

1 edition published in 2020 in French and held by 2 WorldCat member libraries worldwide

Introduction: McIntosh direct laryngoscopy (DL) is used daily for orotracheal intubation (OTI) with a failure rate of up to 15% responsible for various complications. In 2017, the French Society of Anesthesia-Resuscitation recommends the use of a videolaryngoscope (VL) for the OTI of patients with at least 2 criteria of difficult intubation (DIC). Our goal is to compare the VL McGrath MAC to the DL in patients with less than 2 DIC. Material and methods: Controlled, randomized, prospective, multicenter, French clinical trial carried out between 03/2018 and 09/2019. The primary outcome was the success of IOT at the first laryngoscopy. Secondary outcomes included glottic exposure, tooth breakage, desaturation, esophageal intubation, and pharyngeal injury. Results: Out of 1244 patients analyzed by intention to treat (mean [SD] age 55 [+/- 16] years; 722 [58%] women) the success rate of IOT at the first laryngoscopy was significantly higher in VL group than in DL group (97.4% vs 94%; absolute difference 3.39% [95% CI, 1.15% -5.62%]; p = 0.003) like glottic exposure (99, 5% vs 93.6%; absolute difference, 5.96% [95% CI, 3.95% -8%]; p <0.001) with a strong association between these 2 criteria (OR = 57.51 [95% CI , 26.87% -128.6%]; p <0.001). Esophageal desaturations, intubations and pharyngeal lesions were less frequent with VL. Conclusion: In patients with less than 2 DIC in scheduled surgery, the VL McGrath MAC significantly improves the success rate of OTI at first laryngoscopy compared to DL by McIntosh while improving glottic exposure
AGONISTES ALPHA-2 ET DEBIT SANGUIN CEREBRAL : EFFET DE LA CLONIDINE SUR LA REACTIVITE AU CO2, DE PATIENTS PRESENTANT UNE STENOSE CAROTIDIENNE by XAVIER SAUVAGNAC( Book )

1 edition published in 1998 in French and held by 2 WorldCat member libraries worldwide

Intubation vigile sous masque laryngé Fastrach"TM" (MLF) : évaluation du propofol en mode AIVOC by Franck Hamard( Book )

1 edition published in 2003 in French and held by 2 WorldCat member libraries worldwide

Evaluation de l'administration d'Intralipide lors d'une intoxication à la flécaïne chez le rat by Damien Bresson( Book )

1 edition published in 2011 in French and held by 2 WorldCat member libraries worldwide

Insuffisance surrénalienne aigüe et relative à la phase aigüe des hémorragies méningées : incidence, facteurs associés, et impact sur l'évolution des patients by Gwendoline Bourreli( Book )

1 edition published in 2010 in French and held by 2 WorldCat member libraries worldwide

Évaluation du pronostic des patients admis dans le service de réanimation des brûlés du Centre hospitalier régional universitaire de Tours par la mesure répétée du score SOFA by Julien Calles( )

1 edition published in 2020 in French and held by 2 WorldCat member libraries worldwide

Introduction The risk of death for patients with severe burns difficult to predict at this time. Establishing a more accurate prognosis for these patients could lead to more judicious and individualized medical and ethical decisions. The present study aimed at to evaluate the association of the evolution of the SOFA during the first 3 days after a severe burn with death in the population of severely burned patients admitted at the Burn ICU of the Tours University Hospital, France. Patients and Methods This retrospective, observational and monocentric study included patients admitted after severe burn injury, between January 2017 and May 2020. The SOFA score was calculated, for each patient on day zero and at day 3. The variation of the SOFA score (delta SOFA) defined by the difference between SOFA score on day 3 and SOFA score on day 0 was calculated. The primary outcome was the association of the evolution of the SOFA score between day 0 and day 3 and mortality. Results One hundred and seventy seven patients were included in the study. Seventy two percent were male, the mean age was 51 years old (±20). The average total body surface area burned was 22% (±18), the mean total body surface area burned in the 3rd degree was 8% (±14). The mean SOFA score on day 0 was 2 (±2,6) and the mean SOFA score on day 3 was 3 (±2,7). Nineteen patients died during hospitalization (11%). Factors associated with in hospital mortality were age (p=0,003), SOFA Score on day 0 (p=0,003) and delta SOFA (p=0,002). Among patients with an improved SOFA score at day 3, only one death occurred. Conclusion In our population the repeated evaluation at day 0 and day 3 of the SOFA score improved the definition of the prognosis. In particular, it has made possible to define groups of patients with a low mortality rate
Evaluation de la fiabilité de la température œsophagienne en chirurgie thoracique by Léa Pascot( )

1 edition published in 2020 in French and held by 2 WorldCat member libraries worldwide

Etude comparative in vitro de l'étanchéité des sondes d'intubation à ballonnet conique versus rond ou cubique sous pression négative by Benjamin Schipper( Book )

1 edition published in 2012 in French and held by 2 WorldCat member libraries worldwide

 
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