Motifs de levées de 102 mesures de soins psychiatriques sans consentement

L’objectif de cette étude est d’identifier à partir d’un échantillon de 102 ordonnances de mains levées d’hospitalisation sans consentement par la Justice les principaux motifs en cause et de déterminer des pistes d’amélioration. L’étude a porté sur 102 ordonnances soit 149 motifs soulevés. Les motifs ont été classés en 9 groupes :

La diminution des mains levées pour ces motifs apparaît indispensable dans l’intérêt de nos patients qui se retrouvent privés de soins en milieu hospitalier, et doit passer par une bonne connaissance de la loi par les différents protagonistes intervenants dans le processus de soins psychiatriques sans consentement.

Mechanical ventilation in abdominal surgery

One of the key challenges in perioperative care is to reduce postoperative morbidity and mortality. Patients who develop postoperative morbidity but survive to leave hospital have often reduced functional independence and long-term survival. Mechanical ventilation provides a specific example that may help us to shift thinking from treatment to prevention of postoperative complications. Mechanical ventilation in patients undergoing surgery has long been considered only as a modality to ensure gas exchange while allowing maintenance of anesthesia with delivery of inhaled anesthetics. Evidence is accumulating, however, suggesting an association between intraoperative mechanical ventilation strategy and postoperative pulmonary function and clinical outcome in patients undergoing abdominal surgery. Non-protective ventilator settings, especially high tidal volume (VT) (>10-12mL/kg) and the use of very low level of positive end-expiratory pressure (PEEP) (PEEP<5cmH2O) or no PEEP, may cause alveolar overdistension and repetitive tidal recruitment leading to ventilator-associated lung injury in patients with healthy lungs. Stimulated by previous findings in patients with acute respiratory distress syndrome, the use of lower tidal volume ventilation is becoming increasingly more common in the operating room. However, lowering tidal volume, though important, is only part of the overall multifaceted approach of lung protective mechanical ventilation. In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of mechanical ventilation in patients undergoing abdominal surgery.