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Le Borgne P, Alamé K, Chenou A, Hoffmann A, Burger V, Kepka S, Bilbault P, Le Bastard Q, Martin M, Lascarrou JB. Training approaches and devices utilization during endotracheal intubation in French Emergency Departments: a nationwide survey. Eur J Emerg Med 2024; 31:46-52. [PMID: 37812152 DOI: 10.1097/mej.0000000000001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND IMPORTANCE Endotracheal intubation is a lifesaving procedure that is reportedly associated to a significant risk of adverse events. Recent trials have reported that the use of videolaryngoscope and of a stylet might limit this risk during emergency intubation. OBJECTIVES The objective of this study was to provide a national description of intubation practices in French Emergency Departments (EDs). SETTINGS AND PARTICIPANTS We conducted an online nationwide survey by sending an anonymous 37-item questionnaire via e-mail to 629 physicians in French EDs between 2020 and 2022. INTERVENTION A single questionnaire was sent to a sole referent physician in each ED. OUTCOME MEASURES AND ANALYSIS The primary endpoint was to assess the proportion of French EDs in which videolaryngoscopy was available for emergency intubation and its use in routine practice. Secondary endpoints included the presence of local protocol or standard of procedure for intubation, availability of capnography, and routine use of a stylet. MAIN RESULTS Of the surveyed EDs, 342 (54.4%) returned the completed questionnaire. A videolaryngoscope was available in 193 (56%) EDs, and direct laryngoscopy without a stylet was majorly used as the primary approach in 280 (82%) EDs. Among the participating EDs, 74% had an established protocol for intubation and 92% provided a capnography device for routine verification of tube position. In cases of difficult intubation, the use of a bougie was recommended in 227 (81%) EDs, and a switch to a videolaryngoscope in 16 (6%) EDs. The most frequently used videolaryngoscope models were McGrath Mac Airtraq (51%), followed by Airtraq (41%), and Glidescope (14%). CONCLUSION In this large French survey, the majority of EDs recommended direct laryngoscopy without stylet, with seldom use of videolaryngoscopy.
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Affiliation(s)
- Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, Strasbourg
| | - Karine Alamé
- Emergency Department, Hôpitaux Universitaires de Strasbourg
| | - Aline Chenou
- Emergency Department, Hôpitaux Universitaires de Strasbourg
| | - Anne Hoffmann
- Emergency Department, Hôpitaux Universitaires de Strasbourg
| | | | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg
| | - Pascal Bilbault
- Emergency Department, Hôpitaux Universitaires de Strasbourg
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, Strasbourg
| | | | - Maelle Martin
- Médecine Intensive Reanimation, Nantes University Hospital, Nantes, France
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Oberlin M, Buis G, Alamé K, Martinez M, Bitard MP, Berard L, Losset X, Balen F, Lehodey B, Taheri O, Delannoy Q, Kepka S, Tran DM, Bilbault P, Godet J, Le Borgne P. MEESSI-AHF score to estimate short-term prognosis of acute heart failure patients in the Emergency Department: a prospective and multicenter study. Eur J Emerg Med 2023; 30:424-431. [PMID: 37526107 DOI: 10.1097/mej.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND The assessment of acute heart failure (AHF) prognosis is primordial in emergency setting. Although AHF management is exhaustively codified using mortality predictors, there is currently no recommended scoring system for assessing prognosis. The European Society of Cardiology (ESC) recommends a comprehensive assessment of global AHF prognosis, considering in-hospital mortality, early rehospitalization rates and the length of hospital stay. OBJECTIVE We aimed to prospectively evaluate the performance of the Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF (MEESSI-AHF) score in estimating short prognosis according to the ESC guidelines. DESIGN, SETTINGS AND PATIENTS A multicenter study was conducted between November 2020, and June 2021. Adult patients who presented to eleven French hospitals for AHF were prospectively included. OUTCOME MEASURES AND ANALYSIS According to MEESSI-AHF score, patients were stratified in four categories corresponding to mortality risk: low-, intermediate-, high- and very high-risk groups. The primary outcome was the number of days alive and out of the hospital during the 30-day period following admission to the Emergency Department (ED). RESULTS In total, 390 patients were included. The number of days alive and out of the hospital decreased significatively with increasing MEESSI-AHF risk groups, ranging from 21.2 days (20.3-22.3 days) for the low-risk, 20 days (19.3-20.5 days) for intermediate risk,18.6 days (17.6-19.6 days) for the high-risk and 17.9 days (16.9-18.9 days) very high-risk category. CONCLUSION Among patients admitted to ED for an episode of AHF, the MEESSI-AHF score estimates with good performance the number of days alive and out of the hospital.
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Affiliation(s)
- Mathieu Oberlin
- Emergency Department, University Hospitals of Strasbourg, Strasbourg
| | | | - Karine Alamé
- Emergency Department, University Hospitals of Strasbourg, Strasbourg
| | - Mikaël Martinez
- Emergency Department, Hospital of Forez, Montbrison
- Emergency Network Urg-ARA 3 place Louis Pradel
| | | | - Lise Berard
- Emergency Department, Hospital of Haguenau, Haguenau
| | - Xavier Losset
- Emergency Department, University Hospital of Reims, Reims
| | - Frederic Balen
- Emergency Department, University Hospital of Toulouse, Toulouse
| | - Bruno Lehodey
- Emergency Department, University Hospital of Montpellier, Montpellier
| | - Omide Taheri
- Emergency Department, University Hospital of Besancon, Besancon
| | | | - Sabrina Kepka
- Emergency Department, University Hospitals of Strasbourg, Strasbourg
- IMAGEs laboratory ICUBE UMR 7357 CNRS, Illkirch-Graffenstaden
| | | | - Pascal Bilbault
- Emergency Department, University Hospitals of Strasbourg, Strasbourg
- Unité INSERM UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), Faculté de Médecine - Université de Strasbourg, Strasbourg Cedex
| | - Julien Godet
- Public Health Department, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, CHRU of Strasbourg Strasbourg
- ICUBE laboratory UMR 7357 CNRS, IMAGEs group, Illkirch-Graffenstaden, France
| | - Pierrick Le Borgne
- Emergency Department, University Hospitals of Strasbourg, Strasbourg
- Unité INSERM UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), Faculté de Médecine - Université de Strasbourg, Strasbourg Cedex
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Wilmé V, Sauleau ÉA, Le Borgne P, Bayle É, Bilbault P, Kepka S. Micro-costing analysis of suspected lower respiratory tract infection care in a French emergency department. Front Public Health 2023; 11:1276373. [PMID: 37860807 PMCID: PMC10582559 DOI: 10.3389/fpubh.2023.1276373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction In the context of budgetary constraints faced by healthcare systems, the medical-economic evaluation of care strategies becomes essential. In particular, valuing consumed resources in the overcrowded emergency departments (EDs) has become a priority to adopt more efficient approaches in treating the growing number of patients. However, precisely measuring the cost of care is challenging. While bottom-up micro-costing is considered the gold standard, its practical application remains limited. Objective The objective was to accurately estimate the ED care cost for patients consulting in a French ED for suspected lower respiratory tract infection. Methods The authors conducted a cost analysis using a bottom-up micro-costing method. Patients were prospectively included between January 1, and March 31, 2023. The primary endpoint was the mean cost of ED care. Resources consumed were collected using direct observation method and cost data were obtained from information available at Strasbourg University Hospital. Results The mean cost of ED care was €411.68 (SD = 174.49). The cost elements that made the greatest contribution to the total cost were laboratory tests, labor, latency time, imaging and consumables. Considering this cost and the current epidemiological data on respiratory infections in France, the absence of valuation for outpatient care represents an annual loss of over 17 million euros for healthcare facilities. Conclusion Micro-costing is a key element in valuing healthcare costs. The importance of accurately measuring costs, along with measuring the health outcomes of a defined care pathway, is to enhance the relevance of health economic evaluations and thus ensure efficient care.
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Affiliation(s)
- Valérie Wilmé
- Emergency Department, Strasbourg University Hospital, Strasbourg, France
| | - Érik-André Sauleau
- Public Health Department, Strasbourg University Hospital, Strasbourg, France
- ICube Laboratory, French National Center for Scientific Research (CNRS), UMR 7357, University of Strasbourg, Illkirch-Graffenstaden, France
| | - Pierrick Le Borgne
- Emergency Department, Strasbourg University Hospital, Strasbourg, France
- Regenerative NanoMedicine (RNM) and Federation of Translational Medicine (FMTS), French National Institute of Health and Medical Research (INSERM), UMR 1260, University of Strasbourg, Strasbourg, France
| | - Éric Bayle
- Emergency Department, Strasbourg University Hospital, Strasbourg, France
| | - Pascal Bilbault
- Emergency Department, Strasbourg University Hospital, Strasbourg, France
- Regenerative NanoMedicine (RNM) and Federation of Translational Medicine (FMTS), French National Institute of Health and Medical Research (INSERM), UMR 1260, University of Strasbourg, Strasbourg, France
| | - Sabrina Kepka
- Emergency Department, Strasbourg University Hospital, Strasbourg, France
- Public Health Department, Strasbourg University Hospital, Strasbourg, France
- ICube Laboratory, French National Center for Scientific Research (CNRS), UMR 7357, University of Strasbourg, Illkirch-Graffenstaden, France
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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Le Gloan K, Maitre B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez M. SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax. Ann Intensive Care 2023; 13:88. [PMID: 37725198 PMCID: PMC10509123 DOI: 10.1186/s13613-023-01181-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/26/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management. METHODS Literature review, analysis of the literature according to the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients and organizers to reach a consensus. Only expert opinions with strong agreement were selected. RESULTS A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and ≥ 2 cm at the hilum level on frontal chest X-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described. CONCLUSION These guidelines are a step towards PSP treatment and follow-up strategy optimization in France.
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Affiliation(s)
- Stéphane Jouneau
- Service de Pneumologie, Centre de Compétences pour les Maladies Pulmonaires Rares, IRSET UMR 1085, Université de Rennes 1, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, Rennes Cedex 9, 35033, Rennes, France
| | - Jean-Damien Ricard
- Université Paris Cité, AP-HP, DMU ESPRIT, Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, 178 Rue des Renouillers, 92700 Colombes, INSERM IAME U1137, Paris, France
| | - Agathe Seguin-Givelet
- Département de Chirurgie, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, et Université Paris Sorbonne Cite, 42 Bd Jourdan, 75014, Paris, France
| | - Naïke Bigé
- Département Interdisciplinaire d'Organisation du Parcours Patient, Médecine Intensive Réanimation, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Damien Contou
- Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-colonel Prudhon, 95107, Argenteuil, France
| | - Thibaut Desmettre
- Emergency Department, Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, CHU Besançon, Université Bourgogne Franche-Comté, 3 Bd Alexandre Fleming, 25000, Besançon, France
| | - Delphine Hugenschmitt
- Samu-Smur 69, CHU Edouard-Herriot, Hospices Civils de Lyon, 5 Pl. d'Arsonval, 69003, Lyon, France
| | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, Icube UMR 7357, 1 Place de l'hôpital, BP 426, 67091, Strasbourg, France
| | - Karinne Le Gloan
- Emergency Department, Centre Hospitalier Universitaire de Nantes, 5 All. de l'Ile Gloriette, 44000, Nantes, France
| | - Bernard Maitre
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Unité de Pneumologie, GH Mondor, IMRB U 955, Equipe 8, Université Paris Est Créteil, 40 Av. de Verdun, 94000, Créteil, France
| | - Gilles Mangiapan
- Service de Pneumologie, G-ECHO: Groupe ECHOgraphie Thoracique, Unité de Pneumologie Interventionnelle, Centre Hospitalier Intercommunal de Créteil, 40 Av. de Verdun, 94000, Créteil, France
| | - Sylvain Marchand-Adam
- CHRU de Tours, Service de Pneumologie et Explorations Respiratoires Fonctionnelles, 2, boulevard tonnellé, 37000, Tours, France
| | - Alessio Mariolo
- Département de Chirurgie, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014, Paris, France
| | - Tania Marx
- Emergency Department, Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, CHU Besançon, Université Bourgogne Franche-Comté, 3 Bd Alexandre Fleming, 25000, Besançon, France
| | - Jonathan Messika
- Université Paris Cité, Inserm, Physiopathologie et Épidémiologie des Maladies Respiratoires, Service de Pneumologie B et Transplantation Pulmonaire, AP-HP, Hôpital Bichat, 46 Rue Henri Huchard, 75018, Paris, France
| | - Elise Noël-Savina
- Service de Pneumologie et soins Intensifs Respiratoires, G-ECHO: Groupe ECHOgraphie Thoracique, CHU Toulouse, 24 Chemin De Pouvourville, 31059, Toulouse, France
| | - Mathieu Oberlin
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l'hôpital, BP 426, 67091, Strasbourg, France
| | - Ludovic Palmier
- Pôle Anesthésie Réanimation Douleur Urgences, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30900, Nîmes, France
| | - Morgan Perruez
- Emergency department, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Claire Pichereau
- Médecine Intensive Réanimation, Centre Hospitalier Intercommunal de Poissy Saint Germain, 10 Rue du Champ Gaillard, 78300, Poissy, France.
| | - Nicolas Roche
- Service de Pneumologie, Hôpital Cochin, APHP Centre Université Paris Cité, UMR1016, Institut Cochin, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Marc Garnier
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Service d'anesthésie-Réanimation et Médecine Périoperatoire Rive Droite, site Tenon, 4 Rue de la Chine, 75020, Paris, France
| | - Mikaël Martinez
- Pôle Urgences, Centre Hospitalier du Forez, & Groupement de Coopération Sanitaire Urgences-ARA, Av. des Monts du Soir, 42600, Montbrison, France
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Kepka S, Heimann C, Severac F, Hoffbeck L, Le Borgne P, Bayle E, Ruch Y, Muller J, Roy C, Sauleau EA, Andres E, Ohana M, Bilbault P. Organizational Benefits of Ultra-Low-Dose Chest CT Compared to Chest Radiography in the Emergency Department for the Diagnostic Workup of Community-Acquired Pneumonia: A Real-Life Retrospective Analysis. Medicina (Kaunas) 2023; 59:1508. [PMID: 37763627 PMCID: PMC10532772 DOI: 10.3390/medicina59091508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/01/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Chest radiography remains the most frequently used examination in emergency departments (ED) for the diagnosis of community-acquired pneumonia (CAP), despite its poor diagnostic accuracy compared with ultra-low-dose (ULD) chest computed tomography (CT). However, although ULD CT appears to be an attractive alternative to radiography, its organizational impact in ED remains unknown. Our objective was to compare the relevant timepoints in ED management of CT and chest radiography. Materials and Methods: We conducted a retrospective study in two ED of a University Hospital including consecutive patients consulting for a CAP between 1 March 2019 and 29 February 2020 to assess the organizational benefits of ULD chest CT and chest radiography (length of stay (LOS) in the ED, time of clinical decision after imaging). Overlap weights (OW) were used to reduce covariate imbalance between groups. Results: Chest radiography was performed for 1476 patients (mean age: 76 years [63; 86]; 55% men) and ULD chest CT for 133 patients (mean age: 71 [57; 83]; 53% men). In the weighted population with OW, ULD chest CT did not significantly alter the ED LOS compared with chest radiography (11.7 to 12.2; MR 0.96 [0.85; 1.09]), although it did significantly reduce clinical decision time (6.9 and 9.5 h; MR 0.73 [0.59; 0.89]). Conclusion: There is real-life evidence that a strategy with ULD chest CT can be considered to be a relevant approach to replace chest radiography as part of the diagnostic workup for CAP in the ED without increasing ED LOS.
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Affiliation(s)
- Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, France; (L.H.); (P.L.B.); (E.B.); (P.B.)
- ICUBE, UMR 7357, CNRS, 300 Bd Sébastien Brant, 67400 Illkirch-Graffenstaden, France; (F.S.); (E.A.S.)
| | - Charlène Heimann
- Emergency Department, Hôpital Emile Muller, 20 rue du Dr Laennec, 68100 Mulhouse, France;
| | - François Severac
- ICUBE, UMR 7357, CNRS, 300 Bd Sébastien Brant, 67400 Illkirch-Graffenstaden, France; (F.S.); (E.A.S.)
- Méthodes en Recherche Clinique (GMRC), Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Louise Hoffbeck
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, France; (L.H.); (P.L.B.); (E.B.); (P.B.)
| | - Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, France; (L.H.); (P.L.B.); (E.B.); (P.B.)
- UMR 1260, INSERM/Université de Strasbourg CRBS, 1 Rue Eugene Boeckel, 67000 Strasbourg, France
| | - Eric Bayle
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, France; (L.H.); (P.L.B.); (E.B.); (P.B.)
| | - Yvon Ruch
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France;
| | - Joris Muller
- Public Health Units, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, France;
| | - Catherine Roy
- Radiology Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France; (C.R.); (M.O.)
| | - Erik André Sauleau
- ICUBE, UMR 7357, CNRS, 300 Bd Sébastien Brant, 67400 Illkirch-Graffenstaden, France; (F.S.); (E.A.S.)
- Méthodes en Recherche Clinique (GMRC), Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Emmanuel Andres
- Department of Internal Medicine, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France;
| | - Mickaël Ohana
- Radiology Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France; (C.R.); (M.O.)
| | - Pascal Bilbault
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, France; (L.H.); (P.L.B.); (E.B.); (P.B.)
- UMR 1260, INSERM/Université de Strasbourg CRBS, 1 Rue Eugene Boeckel, 67000 Strasbourg, France
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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Gloan KL, Maitre B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez M. SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax: Endorsed by the French Speaking Society of Respiratory Diseases (SPLF), the French Society of Emergency Medicine (SFMU), the French Intensive Care Society (SRLF), the French Society of Anesthesia & Intensive Care Medicine (SFAR) and the French Society of Thoracic and Cardiovascular Surgery (SFCTCV). Respir Med Res 2023; 83:100999. [PMID: 37003203 DOI: 10.1016/j.resmer.2023.100999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management. METHODS Literature review, analysis of literature according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients, and organizers to reach a consensus. Only expert opinions with strong agreement were selected. RESULTS A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and ≥2 cm at the hilum level on frontal chest x-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described. CONCLUSION These guidelines are a step towards PSP treatment and follow-up strategy optimization in France.
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Affiliation(s)
- Stéphane Jouneau
- Service de Pneumologie, Centre de Compétences pour les Maladies Pulmonaires Rares, IRSET UMR 1085, Université de Rennes 1, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, Rennes 35033, France.
| | - Jean-Damien Ricard
- Université Paris Cité, AP-HP, DMU ESPRIT, Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, 178 Rue des Renouillers, 92700 Colombes ; INSERM IAME U1137, Paris, France
| | - Agathe Seguin-Givelet
- Département de Chirurgie, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, et Université Paris Sorbonne Cité, 42 Bd Jourdan, Paris 75014, France
| | - Naïke Bigé
- Gustave Roussy, Département Interdisciplinaire d'Organisation du Parcours Patient, Médecine Intensive Réanimation, 114 Rue Edouard Vaillant, Villejuif 94805, France
| | - Damien Contou
- Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-colonel Prudhon, Argenteuil 95107, France
| | - Thibaut Desmettre
- Emergency Department, CHU Besançon, Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, Université Bourgogne Franche-Comté, 3 Bd Alexandre Fleming, Besançon 25000, France
| | - Delphine Hugenschmitt
- Samu-Smur 69, CHU Édouard-Herriot, Hospices Civils de Lyon, 5 Pl. d'Arsonval, Lyon 69003, France
| | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, Icube UMR 7357, 1 place de l'hôpital, Strasbourg BP 426 67091, France
| | - Karinne Le Gloan
- Emergency Department, centre hospitalier universitaire de Nantes, 5 All. de l'Île Gloriette, Nantes 44000, France
| | - Bernard Maitre
- Service de Pneumologie, Centre hospitalier intercommunal de Créteil, Unité de Pneumologie, GH Mondor, IMRB U 955, Equipe 8, Université Paris Est Créteil, 40 Av. de Verdun, Créteil 94000, France
| | - Gilles Mangiapan
- Unité de Pneumologie Interventionnelle, Service de Pneumologie, G-ECHO: Groupe ECHOgraphie thoracique, Centre hospitalier intercommunal de Créteil, 40 Av. de Verdun, Créteil 94000, France
| | - Sylvain Marchand-Adam
- CHRU de Tours, service de pneumologie et explorations respiratoires fonctionnelles, 2, boulevard tonnellé, Tours 37000, France
| | - Alessio Mariolo
- Département de Chirurgie, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, 42 Bd Jourdan, Paris 75014, France
| | - Tania Marx
- Emergency Department, CHU Besançon, Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, Université Bourgogne Franche-Comté, 3 Bd Alexandre Fleming, Besançon 25000, France
| | - Jonathan Messika
- Université Paris Cité, Inserm, Physiopathologie et épidémiologie des maladies respiratoires, Service de Pneumologie B et Transplantation Pulmonaire, AP-HP, Hôpital Bichat, 46 Rue Henri Huchard, Paris 75018, France
| | - Elise Noël-Savina
- Service de pneumologie et soins intensifs respiratoires, G-ECHO: Groupe ECHOgraphie thoracique, CHU Toulouse, 24 Chemin De Pouvourville, Toulouse 31059, France
| | - Mathieu Oberlin
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, Strasbourg BP 426 67091, France
| | - Ludovic Palmier
- Pôle Anesthésie Réanimation Douleur Urgences, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, Nîmes 30900, France
| | - Morgan Perruez
- Emergency department, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Paris 75015, France
| | - Claire Pichereau
- Médecine intensive réanimation, Centre Hospitalier Intercommunal de Poissy Saint Germain, 10 rue du champ Gaillard, Poissy 78300, France
| | - Nicolas Roche
- Service de Pneumologie, Hôpital Cochin, APHP Centre Université Paris Cité, UMR1016, Institut Cochin, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France
| | - Marc Garnier
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, service d'anesthésie-réanimation et médecine périoperatoire Rive Droite, site Tenon, 4 Rue de la Chine, Paris 75020, France
| | - Mikaël Martinez
- Pôle Urgences, centre hospitalier du Forez, & Groupement de coopération sanitaire Urgences-ARA, Av. des Monts du Soir, Montbrison 42600, France
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7
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Wilmé V, Harscoat S, Séverac F, Carmona A, Le Borgne P, Bilbault P, Morel O, Kepka S. Occurrence of Severe Arrhythmias in Patients with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS): A Retrospective Study. J Clin Med 2023; 12:jcm12103456. [PMID: 37240561 DOI: 10.3390/jcm12103456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/07/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Non-ST elevation acute coronary syndrome (NSTE-ACS) is one of the most frequent manifestations of coronary artery disease. The occurrence of serious heart rhythm disorders (SHRDs) in NSTE-ACS is not well documented. However, continuous heart rhythm monitoring is recommended during the initial management of NSTE-ACS. The targeted monitoring of patients at greater risk for SHRDs could facilitate patients' care in emergency departments (EDs) where the flow of patients is continuously increasing. METHODS This retrospective single-center study included 480 patients from emergency and cardiology departments within the Strasbourg University Hospital between 1 January 2019 and 31 December 2020. The objective was to estimate the frequency of the occurrence of SHRDs among patients with NSTE-ACS. The secondary objective was to highlight the factors associated with a higher risk of SHRDs. RESULTS The proportion of SHRDs during the first 48 h of hospital care was 2.3% (CI95%: 1.2-4.1%, n = 11). Two time periods were considered: before coronary angiography (1.0%), and during, or after coronary angiography (1.3%). In the first group, two patients required immediate treatment (0.4% of the patients) and no death occurred. In the univariate analysis, the variables significantly associated with SHRDs were age, anticoagulant medication, a decrease in glomerular filtration rate, plasmatic hemoglobin, and left ventricle ejection fraction (LVEF), and an increase in plasmatic troponin, BNP, and CRP levels. In the multivariable analysis, plasmatic hemoglobin > 12 g/dL seemed to be a protective factor for SHRDs. CONCLUSIONS In this study, SHRDs were rare and, most often, spontaneously resolved. These data challenge the relevance of systematic rhythm monitoring during the initial management of patients with NSTE-ACS.
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Affiliation(s)
- Valérie Wilmé
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Sébastien Harscoat
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - François Séverac
- Public Health Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Adrien Carmona
- Interventional Cardiology Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- French National Institute of Health and Medical Research (INSERM), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
| | - Pascal Bilbault
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- French National Institute of Health and Medical Research (INSERM), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
| | - Olivier Morel
- Interventional Cardiology Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- French National Institute of Health and Medical Research (INSERM), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
| | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- Public Health Department, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
- ICube, UMR 7357 CNRS, 67400 Illkirch-Graffenstaden, France
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8
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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Le Gloan K, Maitre B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez M. [Guidelines for management of patients with primary spontaneous pneumothorax]. Rev Mal Respir 2023; 40:265-301. [PMID: 36870931 DOI: 10.1016/j.rmr.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 03/06/2023]
Affiliation(s)
- S Jouneau
- Service de pneumologie, Centre de compétences pour les maladies pulmonaires rares, hôpital Pontchaillou, IRSET UMR 1085, université de Rennes 1, Rennes, France.
| | - J-D Ricard
- Université Paris Cité, AP-HP, DMU ESPRIT, service de médecine intensive réanimation, hôpital Louis-Mourier, Colombes, France; Inserm IAME U1137, Paris, France
| | - A Seguin-Givelet
- Département de chirurgie, Institut du thorax Curie-Montsouris, Institut Mutualiste Montsouris, université Paris Sorbonne Cité, Paris, France
| | - N Bigé
- Gustave-Roussy, département interdisciplinaire d'organisation du parcours patient, médecine intensive réanimation, Villejuif, France
| | - D Contou
- Réanimation polyvalente, centre hospitalier Victor-Dupouy, Argenteuil, France
| | - T Desmettre
- Emergency department, CHU Besançon, laboratory chrono-environnement, UMR 6249 Centre national de la recherche scientifique, université Bourgogne Franche-Comté, Besançon, France
| | - D Hugenschmitt
- Samu-Smur 69, CHU Édouard-Herriot, hospices civils de Lyon, Lyon, France
| | - S Kepka
- Emergency department, hôpitaux universitaires de Strasbourg, Icube UMR 7357, Strasbourg, France
| | - K Le Gloan
- Emergency department, centre hospitalier universitaire de Nantes, Nantes, France
| | - B Maitre
- Service de pneumologie, centre hospitalier intercommunal de Créteil, unité de pneumologie, GH Mondor, IMRB U 955, équipe 8, université Paris Est Créteil, Créteil, France
| | - G Mangiapan
- Unité de pneumologie interventionnelle, service de pneumologie, Groupe ECHOgraphie thoracique (G-ECHO), centre hospitalier intercommunal de Créteil, Créteil, France
| | - S Marchand-Adam
- CHRU de Tours, service de pneumologie et explorations respiratoires fonctionnelles, Tours, France
| | - A Mariolo
- Département de chirurgie, Institut du thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - T Marx
- Emergency department, CHU Besançon, laboratory chrono-environnement, UMR 6249 Centre national de la recherche scientifique, université Bourgogne Franche-Comté, Besançon, France
| | - J Messika
- Université Paris Cité, Inserm, physiopathologie et épidémiologie des maladies respiratoires, service de pneumologie B et transplantation pulmonaire, AP-HP, hôpital Bichat, Paris, France
| | - E Noël-Savina
- Service de pneumologie et soins intensifs respiratoires, Groupe ECHOgraphie thoracique (G-ECHO), CHU Toulouse, Toulouse, France
| | - M Oberlin
- Emergency department, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - L Palmier
- Pôle anesthésie réanimation douleur urgences, Nîmes university hospital, Nîmes, France
| | - M Perruez
- Emergency department, hôpital européen Georges-Pompidou, Paris, France
| | - C Pichereau
- Médecine intensive réanimation, centre hospitalier intercommunal de Poissy Saint-Germain, Poissy, France
| | - N Roche
- Service de pneumologie, hôpital Cochin, AP-HP, centre université Paris Cité, UMR1016, Institut Cochin, Paris, France
| | - M Garnier
- Sorbonne université, AP-HP, GRC29, DMU DREAM, service d'anesthésie-réanimation et médecine périopératoire Rive Droite, site Tenon, Paris, France
| | - M Martinez
- Pôle urgences, centre hospitalier du Forez, Montbrison, France; Groupement de coopération sanitaire urgences-ARA, Lyon, France
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9
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Kepka S, Zarca K, Ohana M, Hoffmann A, Muller J, Le Borgne P, Andrès E, Bilbault P, Durand Zaleski I. A Real-World Cost-Effectiveness Study Evaluating Imaging Strategies for the Diagnostic Workup of Renal Colic in the Emergency Department. Medicina (B Aires) 2023; 59:medicina59030475. [PMID: 36984476 PMCID: PMC10058030 DOI: 10.3390/medicina59030475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Both non-contrast Computed Tomography (CT) and ultrasound (US) are used for the diagnosis of renal colic in the emergency department (ED). Although US reduces radiation exposure, its diagnostic accuracy is inferior to that of CT. In this context, data regarding the cost and organizational impact of these strategies represent essential elements in the choice of imaging; however, they remain poorly documented. Aim of the study The aim of this study was to compare the costs and effectiveness of diagnostic workup by US and CT for patients consulting with renal colic in the ED. Methods We conducted a monocentric real-life retrospective study of patients consulting for a renal colic in an ED between 1 July 2018 and 31 December 2018. We estimated length of stay (LOS), total hospital costs at 60 days including ED, and initial and repeat admissions. Patients with initial US in the ED were compared to patients with initial CT using inverse probability weighting of the propensity score calculated from demographic variables, vital parameters, and clinical presentation. We calculated the incremental cost effectiveness ratio as the difference in costs by the difference in LOS. The variability of the results was assessed using non-parametric bootstrapping. Results In this study, of the 273 patients included, 67 were patients assessed with US and 206 with CT. The average costs were €1159 (SD 1987) and €956 (SD 1462) for US and CT, respectively, and the ED LOS was 8.9 [CI 95% 8.1; 9.4] and 8.7 [CI 95% 7.9; 9.9] hours for US and CT, respectively. CT was associated with a decreased LOS by 0.139 [CI 95% −1.1; 1.5] hours and was cost-saving, with a €199 [CI 95% −745; 285] reduction per patient. Conclusion When imaging is required in the ED for suspected renal colic as recommended, there is real-life evidence that CT is a cost-effective strategy compared to US, reducing costs and LOS in the ED.
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Affiliation(s)
- Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de L’hôpital, CHRU of Strasbourg, 67091 Strasbourg, France
- ICUBE UMR 7357 CNRS, Équipe IMAGeS, 300 Bd Sébastien Brant, 67400 Illkirch-Graffenstaden, France
- Correspondence: ; Tel.: +33-3-69-55-13-35; Fax: +33-3-69-55-18-56
| | - Kevin Zarca
- Assistance Publique-Hôpitaux de Paris, DRCI-URC Eco Ile-de-France, 1 Place du Parvis Notre Dame, 75004 Paris, France
- Assistance Publique-Hôpitaux de Paris, Service de Santé Publique, Henri Mondor-Albert-Chenevier, 94000 Créteil, France
| | - Mickaël Ohana
- ICUBE UMR 7357 CNRS, Équipe IMAGeS, 300 Bd Sébastien Brant, 67400 Illkirch-Graffenstaden, France
- Radiology Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 Place de L’hôpital, 67091 Strasbourg, France
| | - Anne Hoffmann
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de L’hôpital, CHRU of Strasbourg, 67091 Strasbourg, France
| | - Joris Muller
- Public Health Unit, Hôpitaux Universitaires de Strasbourg, 1 Place de L’hôpital, CHRU of Strasbourg, 67091 Strasbourg, France
| | - Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de L’hôpital, CHRU of Strasbourg, 67091 Strasbourg, France
- UMR 1260, INSERM/Université de Strasbourg CRBS, 1 rue Eugene Boeckel, 67000 Strasbourg, France
| | - Emmanuel Andrès
- Department of Internal Medicine, Hôpitaux Universitaires de Strasbourg, 1 Place de L’hôpital, 67091 Strasbourg, France
| | - Pascal Bilbault
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de L’hôpital, CHRU of Strasbourg, 67091 Strasbourg, France
- UMR 1260, INSERM/Université de Strasbourg CRBS, 1 rue Eugene Boeckel, 67000 Strasbourg, France
| | - Isabelle Durand Zaleski
- Assistance Publique-Hôpitaux de Paris, DRCI-URC Eco Ile-de-France, 1 Place du Parvis Notre Dame, 75004 Paris, France
- Assistance Publique-Hôpitaux de Paris, Service de Santé Publique, Henri Mondor-Albert-Chenevier, 94000 Créteil, France
- CRESS, INSERM, INRA, Université Paris-Est Créteil (UPEC), 94000 Créteil, France
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10
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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Le Gloan K, Maître B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez† M. Recommandations formalisées d’experts pour la prise en charge des pneumothorax spontanés primaires. Ann Fr Med Urgence 2023. [DOI: 10.3166/afmu-2022-0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Introduction : Le pneumothorax spontané primaire (PSP) est un épanchement gazeux dans la cavité pleurale, survenant hors traumatisme et pathologie respiratoire connue. Des recommandations formalisées d'experts sur le sujet sont justifiées par les pluralités de moyens diagnostiques, stratégies thérapeutiques et disciplines médicochirurgicales intervenant dans leur prise en charge.
Méthodes : Revue bibliographique, analyse de la littérature selon méthodologie GRADE (Grading of Recommendation Assessment, Development and Evaluation) ; propositions de recommandations cotées par experts, patients et organisateurs pour obtenir un consensus. Seuls les avis d'experts avec accord fort ont été retenus.
Résultats : Un décollement sur toute la hauteur de la ligne axillaire et supérieur ou égal à 2 cm au niveau du hile à la radiographie thoracique de face définit la grande abondance. La stratégie thérapeutique dépend de la présentation clinique : exsufflation en urgence pour PSP suffocant ; en l'absence de signe de gravité : prise en charge conservatrice (faible abondance), exsufflation ou drainage (grande abondance). Le traitement ambulatoire est possible si organisation en amont de la filière. Les indications, procédures chirurgicales et l'analgésie périopératoire sont détaillées. Les mesures associées, notamment le sevrage tabagique, sont décrites.
Conclusion : Ces recommandations sont une étape de l'optimisation des stratégies de traitement et de suivi des PSP en France.
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11
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Kepka S, Lersy F, Godet J, Blanc F, Bilger M, Botzung A, Kleitz C, Merignac J, Ohrant E, Garnier F, Pietra F, Noblet V, Deck C, Willinger R, Kremer S. Cerebral and cognitive modifications in retired professional soccer players: TC-FOOT protocol, a transverse analytical study. BMJ Open 2022; 12:e060459. [PMID: 36351716 PMCID: PMC9664284 DOI: 10.1136/bmjopen-2021-060459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Soccer is the most popular sport in the world. This contact sport carries the risk of exposure to repeated head impacts in the form of subconcussions, defined as minimal brain injuries following head impact, with no symptom of concussion. While it has been suggested that exposure to repetitive subconcussive events can result in long-term neurophysiological modifications, and the later development of chronic traumatic encephalopathy, the consequences of these repeated impacts remain controversial and largely unexplored in the context of soccer players. METHODS AND ANALYSIS This is a prospective, single-centre, exposure/non-exposure, transverse study assessing the MRI and neuropsychological abnormalities in professional retired soccer players exposed to subconcussive impacts, compared with high-level athletes not exposed to head impacts. The primary outcome corresponds to the results of MRI by advanced MRI techniques (diffusion tensor, cerebral perfusion, functional MRI, cerebral volumetry and cortical thickness, spectroscopy, susceptibility imaging). Secondary outcomes are the results of the neuropsychological tests: number of errors and time to complete tests. We hypothesise that repeated subconcussive impacts could lead to morphological lesions and impact on soccer players' cognitive skills in the long term. ETHICS AND DISSEMINATION Ethics approval has been obtained and the study was approved by the Comité de Protection des Personnes (CPP) No 2021-A01169-32. Study findings will be disseminated by publication in a high-impact international journal. Results will be presented at national and international imaging meetings. TRIAL REGISTRATION NUMBER NCT04903015.
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Affiliation(s)
- Sabrina Kepka
- Emergency Department, University Hospital Centre Strasbourg, Strasbourg, France
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - François Lersy
- Imaging Department, University Hospital Centre Strasbourg, Strasbourg, France
| | - Julien Godet
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
- Public Health Unit, University Hospital of Strasbourg, Strasbourg, France
| | - Frederic Blanc
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
- Geriatrics and Neurology Departments, Research and Resources Memory Center (CM2R), University Hospital of Strasbourg, Strasbourg, France
| | - Mathias Bilger
- Neuropsychology Department, University Hospital Centre Strasbourg, Strasbourg, France
| | - Anne Botzung
- Geriatrics and Neurology Departments, Research and Resources Memory Center (CM2R), University Hospital of Strasbourg, Strasbourg, France
| | - Catherine Kleitz
- Neuropsychology Department, University Hospital Centre Strasbourg, Strasbourg, France
| | - Jeanne Merignac
- Geriatrics and Neurology Departments, Research and Resources Memory Center (CM2R), University Hospital of Strasbourg, Strasbourg, France
| | | | - Franck Garnier
- School of Osteopathy, College COS Strasbourg, Strasbourg, France
- Medical Sport Center of Strasbourg, CMSM, Strasburg, France
| | | | - Vincent Noblet
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - Caroline Deck
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - Remy Willinger
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - Stéphane Kremer
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
- Imaging Department, University Hospital Centre Strasbourg, Strasbourg, France
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12
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Kepka S, Zarca K, Lersy F, Moris M, Godet J, Deur J, Stoessel M, Muller J, Le Borgne P, Baloglu S, Fleury MC, Anheim M, Bilbault P, Bierry G, Durand Zaleski I, Kremer S. MRI dedicated to the emergency department for diplopia or dizziness: a cost-effectiveness analysis. Eur Radiol 2022; 32:7344-7353. [PMID: 35554653 DOI: 10.1007/s00330-022-08791-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/29/2022] [Accepted: 04/03/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The purpose of this study was to compare the costs and organizational benefits of diagnostic workup without and with MRI dedicated to the ED. METHODS We conducted a prospective observational uncontrolled before-after study in one ED of a university hospital in France from July 1, 2018, and January 3, 2020. We included all consecutive patients presenting with dizziness or diplopia. The main outcomes were the clinical decision time of ED physicians and the total costs for each strategy. Outcomes were compared using propensity score with inverse probability weighting in the 2 arms and an incremental cost-effectiveness ratio (ICER) was calculated. RESULTS Among the 199 patients during the "before" period (average age: 60.4 years ± 17.6): 112 men (57%), and 181 during the "after" period (average age, 54.8 years ± 18.5): 107 men (59%), the average costs were €2701 (95% CI 1918; 3704) and €2389 (95% CI: €1627; 3280) per patient, respectively. The average time to clinical decision was 9.8 h (95% CI: 8.9 10.7) in the group "before" and 7.7 h (95% CI: 7.1; 8.4) in the group "after" (ICER: €151 saved for a reduction of 1 h in clinical decision time). The probabilistic sensitivity analysis estimated a 71% chance that the MRI dedicated to ED was dominant (less costly and more effective). CONCLUSION Easy access to MRI in the ED for posterior circulation stroke-like symptoms must be considered a relevant approach to help physicians for an appropriate and rapid diagnostic with reduction of costs. TRIAL REGISTRATION NCT03660852 KEY POINTS: • A dedicated MRI in the ED for diplopia or dizziness may be considered an efficient strategy improving diagnostic performance, reducing physicians' decision time, and decreasing hospital costs. • This strategy supports clinical decision-making with early treatment and management of patients with posterior circulation-like symptoms in the ED. • There is 71% chance that the MRI dedicated to ED was dominant (less costly and more effective) compared with a strategy without dedicated MRI.
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Affiliation(s)
- Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 place de l'hopital, CHRU Strasbourg - Nouvel hôpital civil, 67091, Strasbourg, France. .,URCEco, Hôtel Dieu, AP-HP, 1 Place du Parvis Notre Dame, 75004, Paris, France. .,IMAGEs laboratory ICUBE UMR 7357 CNRS, 300 Bd Sébastien Brant, 67400, Illkirch-Graffenstaden, France.
| | - Kevin Zarca
- URCEco, Hôtel Dieu, AP-HP, 1 Place du Parvis Notre Dame, 75004, Paris, France
| | - François Lersy
- Imaging Department 2, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67200, Strasbourg, France
| | - Mylène Moris
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 place de l'hopital, CHRU Strasbourg - Nouvel hôpital civil, 67091, Strasbourg, France
| | - Julien Godet
- Public Health Department, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, CHRU of Strasbourg, 67091, Strasbourg, France
| | - Jeanne Deur
- Imaging Department 2, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67200, Strasbourg, France
| | - Marie Stoessel
- Imaging Department 2, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67200, Strasbourg, France
| | - Joris Muller
- Public Health Department, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, CHRU of Strasbourg, 67091, Strasbourg, France
| | - Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 place de l'hopital, CHRU Strasbourg - Nouvel hôpital civil, 67091, Strasbourg, France.,UMR 1260, INSERM/Université de Strasbourg CRBS, 1 Rue Eugene Boeckel, 67000, Strasbourg, France
| | - Seyyid Baloglu
- Imaging Department 2, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67200, Strasbourg, France
| | - Marie Céline Fleury
- Neurology Department, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67200, Strasbourg, France
| | - Mathieu Anheim
- Neurology Department, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67200, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France
| | - Pascal Bilbault
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 place de l'hopital, CHRU Strasbourg - Nouvel hôpital civil, 67091, Strasbourg, France.,UMR 1260, INSERM/Université de Strasbourg CRBS, 1 Rue Eugene Boeckel, 67000, Strasbourg, France
| | - Guillaume Bierry
- Imaging Department 2, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67200, Strasbourg, France.,Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - Isabelle Durand Zaleski
- URCEco, Hôtel Dieu, AP-HP, 1 Place du Parvis Notre Dame, 75004, Paris, France.,Univ Paris Est Creteil (UPEC), Université de Paris, CRESS, INSERM, INRA, 74 rue Marcel Cachin, 93017, Bobigny, France
| | - Stéphane Kremer
- Imaging Department 2, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67200, Strasbourg, France.,Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
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Le Borgne P, Dellenbach Q, Alame K, Noizet M, Gottwalles Y, Chouihed T, Abensur Vuillaume L, Lavoignet CE, Bérard L, Molter L, Gennai S, Kepka S, Lefebvre F, Bilbault P. The Impact of Age on In-Hospital Mortality in Critically Ill COVID-19 Patients: A Retrospective and Multicenter Study. Diagnostics (Basel) 2022; 12:diagnostics12030666. [PMID: 35328219 PMCID: PMC8947611 DOI: 10.3390/diagnostics12030666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 01/16/2023] Open
Abstract
Introduction: For the past two years, healthcare systems worldwide have been battling the ongoing COVID-19 pandemic. Several studies tried to find predictive factors of mortality in COVID-19 patients. We aimed to research age as a predictive factor associated with in-hospital mortality in severe and critical SARS-CoV-2 infection. Methods: Between 1 March and 20 April 2020, we conducted a multicenter and retrospective study on a cohort of severe COVID-19 patients who were all hospitalized in the Intensive Care Unit (ICU). We led our study in nine hospitals of northeast France, one of the pandemic’s epicenters in Europe. Results: The median age of our study population was 66 years (58−72 years). Mortality was 24.6% (CI 95%: 20.6−29%) in the ICU and 26.5% (CI 95%: 22.3−31%) in the hospital. Non-survivors were significantly older (69 versus 64 years, p < 0.001) than the survivors. Although a history of cardio-vascular diseases was more frequent in the non-survivor group (p = 0.015), other underlying conditions and prior level of autonomy did not differ between the two groups. On multivariable analysis, age appeared to be an interesting predictive factor of in-hospital mortality. Thus, age ranges of 65 to 74 years (OR = 2.962, CI 95%: 1.231−7.132, p = 0.015) were predictive of mortality, whereas the group of patients aged over 75 years was not (OR = 3.084, CI 95%: 0.952−9.992, p = 0.06). Similarly, all comorbidities except for immunodeficiency (OR = 4.207, CI 95%: 1.006−17.586, p = 0.049) were not predictive of mortality. Finally, survival follow-up was obtained for the study population. Conclusion: Age appears to be a relevant predictive factor of in-hospital mortality in cases of severe or critical SARS-CoV-2 infection.
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Affiliation(s)
- Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (Q.D.); (K.A.); (S.K.); (P.B.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
- CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France; (L.A.V.); (C.-E.L.); (L.B.)
- Correspondence: ; Tel.: +33-(0)-388-128-690; Fax: +33-(0)-388-128-100
| | - Quentin Dellenbach
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (Q.D.); (K.A.); (S.K.); (P.B.)
| | - Karine Alame
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (Q.D.); (K.A.); (S.K.); (P.B.)
- CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France; (L.A.V.); (C.-E.L.); (L.B.)
| | - Marc Noizet
- Emergency Department, Mulhouse Hospital, 68100 Mulhouse, France;
| | | | - Tahar Chouihed
- Emergency Department, Nancy University Hospital, 54500 Nancy, France;
- Centre d’Investigations Cliniques-1433, and INSERM U1116, F-CRIN INI-CRCT, Université de Lorraine, 54000 Nancy, France
| | - Laure Abensur Vuillaume
- CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France; (L.A.V.); (C.-E.L.); (L.B.)
- Emergency Department, Regional Hospital of Metz-Thionville, 57000 Metz, France
| | - Charles-Eric Lavoignet
- CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France; (L.A.V.); (C.-E.L.); (L.B.)
- Emergency Department, Nord Franche Comté Hospital, 90400 Trevenans, France
| | - Lise Bérard
- CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France; (L.A.V.); (C.-E.L.); (L.B.)
- Emergency Department, Haguenau Hospital, 67500 Haguenau, France
| | - Lise Molter
- Emergency Department, Verdun Hospital, 55107 Verdun, France;
| | - Stéphane Gennai
- Emergency Department, Reims University Hospital, 51092 Reims, France;
| | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (Q.D.); (K.A.); (S.K.); (P.B.)
| | - François Lefebvre
- Department of Public Health, University Hospital of Strasbourg, 67200 Strasbourg, France;
| | - Pascal Bilbault
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (Q.D.); (K.A.); (S.K.); (P.B.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
- CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France; (L.A.V.); (C.-E.L.); (L.B.)
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14
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Marx T, Bernard N, Kepka S, Gérazime A, Mauny F, Desmettre T. Pneumothorax and the environment: A systematic review of the impact of air pollution and meteorology, and a meta-analysis on meteorology factors. Environ Pollut 2021; 283:117089. [PMID: 33892373 DOI: 10.1016/j.envpol.2021.117089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 05/22/2023]
Abstract
A relationship between the occurrence of spontaneous pneumothorax (SP) and meteorological factors has been observed but with contradictory results. The objectives of this systematic review was to synthesis the current body of evidence to the relationships between the occurrence of SP and environmental determinants such as meteorological factors and air pollutants. We conducted a systematic search of MEDLINE, Scopus, Cochrane Library and gray literature from inception up to 31st December 2020, to find published scientific research articles based on the following eligibility criteria: original studies and population-based articles describing the relationship between meteorological factors or air pollutants and the occurrence of SP. For the meta-analysis, studies involving a quantitative analysis of the exposure variable (atmospheric pressure, temperature, humidity and wind speed) and the impact of the occurrence of SP with comparable methodology were selected. General characteristics and methodological information for each study were assessed. The quality was evaluated according to the Newcastle-Ottawa Scale. Fourty four and 13 studies were respectively included in the qualitative and quantitative analyses. The variability of the study design with moderate quality and the different measurements of the exposure variables highlight the contrasting results. The results of the meta-analyses are in favor of a higher temperature observed in the day with SP than in the days without SP (maximum: MD 0.25 (-0.08, 0.58) p = 0.14; I2 = 26%, p = 0.21; mean: MD 0.22 (-0.15, 0.59) p = 0.24; I2 = 45%, p = 0.07). The small number of studies focused on air pollution did not allow us to conclude to determine the potential impact of exposure to air pollutants on the occurrence of SP. Meteorological conditions seem to be related to SP occurrence, especially increased temperature.
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Affiliation(s)
- Tania Marx
- Emergency Department, CHU Besançon, 3 Boulevard Alexandre Fleming, 25030, Besançon, France; Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, 16 Route de Gray, 25000, Besançon, France; Université Bourgogne Franche-Comté, 32 Avenue de L'Observatoire, 25000, Besançon, France.
| | - Nadine Bernard
- Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, 16 Route de Gray, 25000, Besançon, France; Laboratory TheMA, UMR 6049 Centre National de La Recherche Scientifique, 16 Route de Gray, 25000, Besançon, France; Université Bourgogne Franche-Comté, 32 Avenue de L'Observatoire, 25000, Besançon, France
| | - Sabrina Kepka
- Emergency Department, CHU Strasbourg, 3 Rue Koeberlé, 67000, Strasbourg, France
| | - Aurelie Gérazime
- UMETh - Centre Investigation Clinique 1431, CHU Besançon, 2 Place Saint-Jacques, 25030, Besançon, France
| | - Frédéric Mauny
- Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, 16 Route de Gray, 25000, Besançon, France; UMETh - Centre Investigation Clinique 1431, CHU Besançon, 2 Place Saint-Jacques, 25030, Besançon, France; Université Bourgogne Franche-Comté, 32 Avenue de L'Observatoire, 25000, Besançon, France
| | - Thibaut Desmettre
- Emergency Department, CHU Besançon, 3 Boulevard Alexandre Fleming, 25030, Besançon, France; Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, 16 Route de Gray, 25000, Besançon, France; Université Bourgogne Franche-Comté, 32 Avenue de L'Observatoire, 25000, Besançon, France
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15
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Kepka S, Ohana M, Séverac F, Muller J, Bayle E, Ruch Y, Laugel E, Oberlin M, Solis M, Hansmann Y, Bilbault P, Fafi Kremer S. Rapid Antigen Test Combined with Chest Computed Tomography to Rule Out COVID-19 in Patients Admitted to the Emergency Department. J Clin Med 2021; 10:3455. [PMID: 34441750 PMCID: PMC8397078 DOI: 10.3390/jcm10163455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/24/2021] [Accepted: 07/29/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Correct and timely identification of SARS-CoV-2-positive patients is critical in the emergency department (ED) prior to admission to medical wards. Antigen-detecting rapid diagnostic tests (Ag-RDTs) are a rapid alternative to Reverse-transcriptase polymerase chain reaction (RT-PCR) for the diagnosis of COVID-19 but have lower sensitivity. METHODS We evaluated the performance in real-life conditions of a strategy combining Ag-RDT and chest computed tomography (CT) to rule out COVID-19 infection in 1015 patients presenting in the ED between 16 November 2020 and 18 January 2021 in order to allow non-COVID-19 patients to be hospitalized in dedicated units directly. The combined strategy performed in the ED for patients with COVID-19 symptoms was assessed and compared with RT-PCR. RESULTS Compared with RT-PCR, the negative predictive value was 96.7% for Ag-RDT alone, 98.5% for Ag-RDT/CT combined, and increased to 100% for patients with low viral load. CONCLUSION A strategy combining Ag-RDT and chest CT is effective in ruling out COVID-19 in ED patients with high precision.
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Affiliation(s)
- Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France; (E.B.); (M.O.); (P.B.)
- URCEco, Hôtel Dieu, AP-HP, 1 Place du Parvis Notre Dame, 75004 Paris, France
| | - Mickaël Ohana
- Radiology Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France;
| | - François Séverac
- Groupe Méthodes en Recherche Clinique (GMRC), Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France;
| | - Joris Muller
- Public Health Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France;
| | - Eric Bayle
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France; (E.B.); (M.O.); (P.B.)
| | - Yvon Ruch
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France; (Y.R.); (Y.H.)
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (E.L.); (M.S.); (S.F.K.)
| | - Elodie Laugel
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (E.L.); (M.S.); (S.F.K.)
- Department of Virology, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Mathieu Oberlin
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France; (E.B.); (M.O.); (P.B.)
- Department of Internal Medicine, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Morgane Solis
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (E.L.); (M.S.); (S.F.K.)
- Department of Virology, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Yves Hansmann
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France; (Y.R.); (Y.H.)
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (E.L.); (M.S.); (S.F.K.)
| | - Pascal Bilbault
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France; (E.B.); (M.O.); (P.B.)
- UMR 1260, INSERM/Université de Strasbourg CRBS, 1 rue Eugene Boeckel, 67000 Strasbourg, France
| | - Samira Fafi Kremer
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (E.L.); (M.S.); (S.F.K.)
- Department of Virology, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France
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16
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Luhmann L, Bilbault P, Kepka S. Hyperthyroïdie au décours d’un épisode maniaque. Ann Fr Med Urgence 2021. [DOI: 10.3166/afmu-2021-0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Kepka S, Morel M, Garnier F, Pietra F, Marjanovic N, Zeller P, Bilbault P, Kremer S, Bierry G. Correction to: A case of an injured calcaneus secundarius in a professional soccer player. BMC Musculoskelet Disord 2021; 22:445. [PMID: 33992105 PMCID: PMC8126109 DOI: 10.1186/s12891-021-04343-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sabrina Kepka
- Present Address: Emergency Department, University Hospital of Strasbourg, Nouvel Hôpital Civil, 1 place de l'Hôpital, CHRU, 67091, Strasbourg, France.
| | - Marc Morel
- Medical Sports Center CMSM, Strasbourg, France.,Imaging Unit, Clinic Saint François, Haguenau, France
| | - Franck Garnier
- Medical Sports Center CMSM, Strasbourg, France.,School of osteopathy College COS Strasbourg - Franc Osteopathy Institute Research (IRFO), Strasbourg, France
| | | | | | | | - Pascal Bilbault
- Present Address: Emergency Department, University Hospital of Strasbourg, Nouvel Hôpital Civil, 1 place de l'Hôpital, CHRU, 67091, Strasbourg, France
| | - Stéphane Kremer
- Imaging Unit 2, University Hospital of Strasbourg, Strasbourg, France
| | - Guillaume Bierry
- Imaging Unit 2, University Hospital of Strasbourg, Strasbourg, France
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18
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Ruch Y, Kaeuffer C, Ohana M, Labani A, Fabacher T, Bilbault P, Kepka S, Solis M, Greigert V, Lefebvre N, Hansmann Y, Danion F. CT lung lesions as predictors of early death or ICU admission in COVID-19 patients. Clin Microbiol Infect 2020; 26:1417.e5-1417.e8. [PMID: 32717417 PMCID: PMC7378475 DOI: 10.1016/j.cmi.2020.07.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The main objective of this study was to investigate the prognostic value of early systematic chest computed tomography (CT) with quantification of lung lesions in coronavirus disease 2019 (COVID-19) patients. METHODS We studied 572 patients diagnosed with COVID-19 (confirmed using polymerase chain reaction) for whom a chest CT was performed at hospital admission. Visual quantification was used to classify patients as per the percentage of lung parenchyma affected by COVID-19 lesions: normal CT, 0-10%, 11-25%, 26-50%, 51-75% and >75%. The primary endpoint was severe disease, defined by death or admission to the intensive care unit in the 7 days following first admission. RESULTS The mean patient age was 66.0 ± 16.0 years, and 343/572 (60.0%) were men. The primary endpoint occurred in 206/572 patients (36.0%). The extent of lesions on initial CT was independently associated with prognosis (odds ratio = 2.35, 95% confidence interval 1.24-4.46; p < 0.01). Most patients with lung involvement >50% (66/95, 69.5%) developed severe disease compared to patients with lung involvement of 26-50% (70/171, 40.9%) and ≤25% (70/306, 22.9%) (p < 0.01 and p < 0.01, respectively). None of the patients with normal CT (0/14) had severe disease. CONCLUSION Chest CT findings at admission are associated with outcome in COVID-19 patients.
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Affiliation(s)
- Yvon Ruch
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France.
| | - Charlotte Kaeuffer
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Mickael Ohana
- Department of Radiology, Strasbourg University Hospital, Strasbourg, France
| | - Aissam Labani
- Department of Radiology, Strasbourg University Hospital, Strasbourg, France
| | - Thibaut Fabacher
- Department of Biostatistics, Strasbourg University Hospital, Strasbourg, France
| | - Pascal Bilbault
- Department of Emergency Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Sabrina Kepka
- Department of Emergency Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Morgane Solis
- Department of Virology, Strasbourg University Hospital, Strasbourg, France
| | - Valentin Greigert
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Nicolas Lefebvre
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Yves Hansmann
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - François Danion
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
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19
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Oberlin M, Andrès E, Behr M, Kepka S, Le Borgne P, Bilbault P. [Emergency overcrowding and hospital organization: Causes and solutions]. Rev Med Interne 2020; 41:693-699. [PMID: 32861534 DOI: 10.1016/j.revmed.2020.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/14/2020] [Accepted: 05/05/2020] [Indexed: 10/23/2022]
Abstract
Emergency Department (ED) overcrowding is a silent killer. Thus, several studies in different countries have described an increase in mortality, a decrease in the quality of care and prolonged hospital stays associated with ED overcrowding. Causes are multiple: input and in particular lack of access to lab test and imaging for general practitioners, throughput and unnecessary or time-consuming tasks, and output, in particular the availability of hospital beds for unscheduled patients. The main cause of overcrowding is waiting time for available beds in hospital wards, also known as boarding. Solutions to resolve the boarding problem are mostly organisational and require the cooperation of all department and administrative levels through efficient bed management. Elderly and polypathological patients wait longer time in ED. Internal Medicine, is the ideal specialty for these complex patients who require time for observation and evaluation. A strong partnership between the ED and the internal medicine department could help to reduce ED overcrowding by improving care pathways.
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Affiliation(s)
- M Oberlin
- Structure d'urgences, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France.
| | - E Andrès
- Service de Médecine Interne, Diabète et Maladies métaboliques, Hôpitaux Universitaires de Strasbourg, Clinique Médicale B - HUS, 1 porte de l'Hôpital, 67000 Strasbourg, France; Unité INSERM EA 3072 « Mitochondrie, Stress oxydant et Protection musculaire », Faculté de Médecine - Université de Strasbourg, 4 rue Kirschleger, 67085 Strasbourg, France
| | - M Behr
- Structure d'urgences, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France
| | - S Kepka
- Structure d'urgences, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France
| | - P Le Borgne
- Structure d'urgences, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France; Unité INSERM UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), Faculté de Médeine - Université de Strasbourg, 4 rue Kirschleger, 67085 Strasbourg, France
| | - P Bilbault
- Structure d'urgences, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France; Unité INSERM UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), Faculté de Médeine - Université de Strasbourg, 4 rue Kirschleger, 67085 Strasbourg, France
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20
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Le Conte P, Terzi N, Mortamet G, Abroug F, Carteaux G, Charasse C, Chauvin A, Combes X, Dauger S, Demoule A, Desmettre T, Ehrmann S, Gaillard-Le Roux B, Hamel V, Jung B, Kepka S, L’Her E, Martinez M, Milési C, Morawiec É, Oberlin M, Plaisance P, Pouyau R, Raherison C, Ray P, Schmidt M, Thille AW, Truchot J, Valdenaire G, Vaux J, Viglino D, Voiriot G, Vrignaud B, Jean S, Mariotte E, Claret PG. Prise en charge de l’exacerbation sévère d’asthme. Méd Intensive Réa 2020. [DOI: 10.37051/mir-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Contexte : La Société Française de Médecine d’Urgence, la Société de Réanimation de Langue Française et le GroupeFrancophone de Réanimation et d’Urgences Pédiatriques ont émis des recommandations sur la prise en charge del’exacerbation sévère d’asthme (ESA) chez l’enfant et l’adulte.Résultats : Les recommandations ont concerné 5 champs : diagnostic, traitement pharmacologique, modalités d’oxygénothérapie et de ventilation, orientation du patient, spécifi cités de la femme enceinte. L’analyse de la littérature et laformulation des recommandations ont été conduites selon la méthode GRADE (Grade of Recommendation Assessment,Development and Evaluation). Une recherche bibliographique portant sur les publications indexées dans les bases dedonnées PubMed™ et Cochrane™ a été réalisée.Sur les 21 recommandations formalisées obtenues, 4 avaient un niveau de preuve élevé (GRADE 1+/-) et 7 un niveaude preuve faible (GRADE 2 +/-). Pour 10 recommandations, la méthode GRADE n’a pas pu être appliquée, résultanten un avis d’experts. Un accord fort a été obtenu pour toutes les recommandations.Conclusion : Le travail conjoint de 36 experts issus de 3 sociétés savantes a permis d’obtenir 21 recommandations formalisées pour aider à la prise en charge aux urgences et en soins intensifs des patients adultes et pédiatriques avec une ESA.
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21
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Oberlin M, Le Borgne P, Behr M, Kepka S, Bilbault P. The organisation of a French emergency department in a coronavirus hotspot. Anaesth Crit Care Pain Med 2020; 39:457-458. [PMID: 32544434 PMCID: PMC7293517 DOI: 10.1016/j.accpm.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Mathieu Oberlin
- Emergency Department, University Hospitals of Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France.
| | - Pierrick Le Borgne
- Emergency Department, University Hospitals of Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France; Unité inserm UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), Faculté de Médecine - Université de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg Cedex, France.
| | - Martin Behr
- Emergency Department, University Hospitals of Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France
| | - Sabrina Kepka
- Emergency Department, University Hospitals of Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France
| | - Pascal Bilbault
- Emergency Department, University Hospitals of Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France; Unité inserm UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), Faculté de Médecine - Université de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg Cedex, France
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Le Conte P, Terzi N, Mortamet G, Abroug F, Carteaux G, Charasse C, Chauvin A, Combes X, Dauger S, Demoule A, Desmettre T, Ehrmann S, Gaillard-Le Roux B, Hamel V, Jung B, Kepka S, L’Her E, Martinez M, Milési C, Morawiec É, Oberlin M, Plaisance P, Pouyau R, Raherison C, Ray P, Schmidt M, Thille AW, Truchot J, Valdenaire G, Vaux J, Viglino D, Voiriot G, Vrignaud B, Jean S, Mariotte E, Claret PG. Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d'Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies. Ann Intensive Care 2019; 9:115. [PMID: 31602529 PMCID: PMC6787133 DOI: 10.1186/s13613-019-0584-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/21/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma exacerbation (SAE) in adult and pediatric patients. RESULTS The guidelines were related to 5 areas: diagnosis, pharmacological treatment, oxygen therapy and ventilation, patients triage, specific considerations regarding pregnant women. The literature analysis and formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research was conducted based on publications indexed in PubMed™ and Cochrane™ databases. Of the 21 formalized guidelines, 4 had a high level of evidence (GRADE 1+/-) and 7 a low level of evidence (GRADE 2+/-). The GRADE method was inapplicable to 10 guidelines, which resulted in expert opinions. A strong agreement was reached for all guidelines. CONCLUSION The conjunct work of 36 experts from 3 scientific societies resulted in 21 formalized recommendations to help improving the emergency and intensive care management of adult and pediatric patients with SAE.
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Affiliation(s)
- Philippe Le Conte
- Service d’Accueil des Urgences, CHU de Nantes, 5 allée de l’île gloriette, 44093 Nantes Cedex 1, France
- PHU3, Faculté de Médecine 1, rue Gaston Veil, 44035 Nantes, France
| | - Nicolas Terzi
- Service de Médecine Intensive Réanimation, CHU de Grenoble Alpes, 38000 Grenoble, France
- INSERM, U1042, University of Grenoble-Alpes, HP2, 38000 Grenoble, France
| | - Guillaume Mortamet
- Service de Réanimation Pédiatrique, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Fekri Abroug
- Service de réanimation, CHU de Monastir, Monastir, Tunisia
| | | | - Céline Charasse
- Pediatric Emergency Department, CHU Pellegrin Enfants, Bordeaux, France
| | - Anthony Chauvin
- Service des Urgences, Hôpital Lariboisière, APHP, Paris, France
| | - Xavier Combes
- Service des Urgences, CHU de la Réunion, Saint-Denis, France
| | - Stéphane Dauger
- Pediatric Intensive Care Unit, Robert Debré Hospital, APHP, Paris, France
| | - Alexandre Demoule
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP, INSERM, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne Université, Paris, France
| | | | - Stephan Ehrmann
- Médecine Intensive Réanimation, INSERM CIC 1415, réseau CRICS-TriggerSEP, CHRU de Tours and Centre d’Etude des Pathologies Respiratoires, INSERM U1100, faculté de médecine, Université de Tours, Tours, France
| | | | - Valérie Hamel
- Service des Urgences, CHU de Toulouse, Toulouse, France
| | - Boris Jung
- Service de MIR, CHU de Montpelliers, Montpellier, France
| | - Sabrina Kepka
- Service des Urgences, CHU de Strasbourg, Strasbourg, France
| | - Erwan L’Her
- Service de MIR, CHRU de Brest, Brest, France
| | - Mikaël Martinez
- Pôle Urgences, centre hospitalier du Forez, 42605 Montbrison, France
- Réseau d’urgence Ligérien Ardèche Nord (REULIAN), centre hospitalier Le Corbusier, 42700 Firminy, France
| | - Christophe Milési
- Département de Pédiatrie Néonatale et Réanimations, CHU de Montpellier, Montpellier, France
| | - Élise Morawiec
- Service de Pneumologie et Réanimation, GH Pitié-Salpêtrière, APHP, Paris, France
| | - Mathieu Oberlin
- Service des Urgences, centre hospitalier de Cahors, Cahors, France
| | | | - Robin Pouyau
- Pediatric Intensive Care Unit, Women‐Mothers and Children’s University Hospital, Lyon, France
| | | | - Patrick Ray
- Service des Urgences, CHU de Dijon, faculté de médecine de Dijon, Dijon, France
| | - Mathieu Schmidt
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Pitié–Salpêtrière Hospital, Medical Intensive Care Unit, Sorbonne Universités, 75651 Paris Cedex 13, France
| | - Arnaud W. Thille
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | | | | | - Julien Vaux
- SAMU 94, CHU Henri Mondor, AP-HP, Créteil, France
| | - Damien Viglino
- INSERM, U1042, University of Grenoble-Alpes, HP2, 38000 Grenoble, France
- Service des Urgences Adultes, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Guillaume Voiriot
- Service de réanimation polyvalente, Hôpital Tenon, APHP, Paris, France
| | - Bénédicte Vrignaud
- Pediatric Emergency Department, Women and Children’, s University Hospital, Nantes, France
| | - Sandrine Jean
- Service de Réanimation Pédiatrique, APHP Hôpital Trousseau, 75012 Paris, France
| | - Eric Mariotte
- Service de Médecine Intensive Réanimation, APHP Hôpital Saint Louis, 75010 Paris, France
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Kepka S, Marx T, Desmettre T. Le drainage thoracique aux urgences dans la prise en charge d’un épanchement pleural non traumatique. Ann Fr Med Urgence 2019. [DOI: 10.3166/afmu-2019-0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le drainage thoracique est un geste classique en médecine d’urgence. En dehors du traumatisé thoracique, les indications de drainage thoracique aux urgences sont essentiellement le pneumothorax spontané primitif ou secondaire et les épanchements pleuraux liquidiens en cas d’épanchement parapneumonique compliqué. La technique doit être connue des médecins urgentistes qui sont confrontés à la prise en charge initiale de ces patients. Le matériel de drainage ou « drainage pleural catheter », selon la terminologie proposée par Baumann, regroupe l’ensemble des matériels de thoracocentèse laissés en place au décours du geste. Il existe une multiplicité de matériel à disposition des cliniciens qui permettent de réaliser un drainage thoracique et le choix dépend de l’indication. Les drains classiques avec mandrin sont utilisés dans le cas des épanchements liquidiens. Les drains percutanés, moins invasifs, sont préférentiellement choisis pour un épanchement gazeux. Les complications associées à ces dispositifs sont différentes selon le type du drain. Les recommandations préconisent le recours à des drains de petits calibres et vont dans le sens de méthodes de moins en moins invasives, notamment dans le cas des pneumothorax. Les modalités de transport des patients drainés sont également importantes à connaître pour la prise en charge des patients avec un drain thoracique. La possibilité d’un traitement ambulatoire en cas de pneumothorax spontanés avec un mini-drain relié à une valve de Heimlich® (Vigon, Écouen, France) ou le recours à un drain tunnélisé en cas de pleurésie récidivante constituent des options intéressantes en médecine d’urgence.
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Kepka S, Lemaitre L, Marx T, Bilbault P, Desmettre T. A common gesture with a rare but potentially severe complication: Re-expansion pulmonary edema following chest tube drainage. Respir Med Case Rep 2019; 27:100838. [PMID: 31016133 PMCID: PMC6475766 DOI: 10.1016/j.rmcr.2019.100838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 11/26/2022] Open
Abstract
Background Primary Spontaneous Pneumothorax (PSP) is usually considered as a benign pathology occurring in young people. In about half of cases, observation only is purposed. In case of intervention, chest tube drainage remains the preponderant strategy even if no studies conclude about superiority of drainage or aspiration. Re-expansion pulmonary edema (REPE) is a rare but potentially severe complication of chest tube drainage. Risk factors are not well identified, but REPE is more frequent for patients with diabetes, younger than 40 years, with large pneumothorax, lung collapse more than one week and fast re-expansion. Case report We report a case of a 19-year old male presenting to the Emergency Department with a first episode of PSP. He was treated by chest tube drainage with immediate suction. He developed a REPE 3 hours after chest tube drainage with suction. Conservative management and oxygen therapy led to withdrawing the chest tube 9 days later. Conclusion For the initial management of PSP, prevention of this complication is essential. In case of risk factors, prevention consist of absence of immediate suction after chest tube drainage and suction should be reserved in case of failure of initial treatment after 24 hours. Even if chest tube drainage is a common gesture, clinical presentation of REPE must alert physicians taking care of these patients.
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Affiliation(s)
- S Kepka
- Emergency Department, University Hospital of Strasbourg, Strasbourg, France
| | - L Lemaitre
- Emergency Department, University Hospital of Strasbourg, Strasbourg, France
| | - T Marx
- Emergency Department, University Hospital of Besançon, Besançon, France
| | - P Bilbault
- Emergency Department, University Hospital of Strasbourg, Strasbourg, France.,INSERM UMR 1260, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - T Desmettre
- Emergency Department, University Hospital of Besançon, Besançon, France
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Abstract
Les pneumothorax rencontrés aux urgences peuvent être d’origine spontanée ou traumatique. L’exsufflation est une méthode thérapeutique simple du pneumothorax spontané primitif. Cette technique consiste à réaliser une aspiration par l’intermédiaire d’un cathéter, sans que le matériel soit laissé en place. Elle permet une prise en charge ambulatoire du patient et répond à des enjeux de qualité des soins (efficacité, simplicité, sécurité) et d’économie de la santé (diminution de la durée et du taux d’hospitalisation). L’exsufflation peut être réalisée via différents dispositifs tout simples d’utilisation, par voie antérieure ou axillaire. L’exsufflation à l’aiguille avec des cathéters de perfusion intraveineux est peu recommandée devant le risque d’échec lié à une longueur de cathéter inadaptée à la morphologie du patient. Les usages de drains de faible calibre avec la méthode de Seldinger ou de kits dédiés de thoracentèse sont à privilégier. Les complications sont moindres comparées à la pose d’un drain thoracique. Il s’agit le plus souvent d’obstruction ou de déplacement du cathéter. L’exsufflation est également un geste de sauvetage à réaliser en urgence en cas de pneumothorax suffocant. La bonne maîtrise de l’une de ces techniques est donc indispensable dans le cadre de la formation et de la pratique en médecine d’urgence.
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Klein M, Argemi X, Kepka S. Céphalées fébriles aux urgences : un cas de leptospirose. Ann Fr Med Urgence 2017. [DOI: 10.1007/s13341-017-0747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Desmettre T, Meurice JC, Kepka S, Dalphin JC. [Treatment of first spontaneous pneumothorax: drainage or exsufflation?]. Rev Mal Respir 2011; 28:5-8. [PMID: 21277468 DOI: 10.1016/j.rmr.2010.10.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 10/04/2010] [Indexed: 11/30/2022]
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