Benefits of smart pumps for automated changeovers of vasoactive drug infusion pumps: a quasi-experimental study

BACKGROUND

Manual changeover of vasoactive drug infusion pumps (CVIP) frequently lead to haemodynamic instability. Some of the newest smart pumps allow automated CVIP. The aim of this study was to compare automated CVIP with manual 'Quick Change' relays.

METHODS

We performed a prospective, quasi-experimental study, in a university-affiliated intensive care unit (ICU). All adult patients receiving continuous i.v. infusion of vasoactive drugs were included. CVIP were successively performed manually (Phase 1) and automatically (Phase 2) during two 6-month periods. The primary endpoint was the frequency of haemodynamic incidents related to the relays, which were defined as variations of mean arterial pressure >15 mm Hg or heart rate >15 bpm. The secondary endpoints were the nursing time dedicated to relays and the number of interruptions in care because of CVIP. A multivariate mixed effects logistic regression was fitted for analytic analysis.

RESULTS

We studied 1329 relays (Phase 1: 681, Phase 2: 648) from 133 patients (Phase 1: 63, Phase 2: 70). Incidents related to CVIP decreased from 137 (20%) in Phase 1 to 73 (11%) in Phase 2 (P<0.001). Automated relays were independently associated with a 49% risk reduction of CVIP-induced incidents (adjusted OR=0.51, 95% confidence interval 0.34-0.77, P=0.001). Time dedicated to the relays and the number of interruptions in care to manage CVIP were also significantly reduced with automated relays vs manual relays (P=0.001).

CONCLUSIONS

These results demonstrate the benefits of automated CVIP using smart pumps in limiting the frequency of haemodynamic incidents related to relays and in reducing the nursing workload.

[Seroprevalence of viral hepatitis A in France in homosexuals and intravenous drug users]

OBJECTIVES

In industrialized countries with a high level of sanitation, immunity against hepatitis A (HVA) is not acquired during childhood, and infection typically occurs in adults, mainly in travelers returning from developing countries where infection is endemic. However, the introduction of hepatitis A virus (HAV) among certain population groups, such as intravenous drug users (IVDU) or homosexual men, leads to a significant increase in the disease. We conducted a retrospective analysis of seroprevalence of anti-HAV antibodies.

METHODS

The study group included 296 patients (174 homosexual men and 122 IVDU) for comparison with 76 control subjects (nurses in pediatric wards and workers in hospital kitchen).

RESULTS

We found a significantly higher anti-HAV seroprevalence among less than 35-year old IVDU, HIV positive or negative, in comparison with control subjects but not among homosexual men, whatever their HIV status.

CONCLUSION

Our experience illustrates that HVA is a health risk for IVDU in industrialized nations, and given its morbidity among adults population, IVDU should receive HVA vaccine.

[In vitro bench tests of caval umbrella filters]

Seven ombrelles percutaneous cava filters, now available, are tested on hydraulic testing ground. Measurements are concerned with the blocking function of filters and pressure changes induced in the cava flow and the cava track wall of the testing ground. A statistical analysis of the results (100 measurements per filter) shows homogeneous reactions of each filter when faced with different situations imposed by variations of the testing ground. Greenfield's filter, a reference, is compared with other models. This one and the L.G. filter show satisfactory filtering qualities. Two other filters, Cardial and Vascor, offer a highest filtering power. Other models give poor filtering results.

Mechanical properties and biocompatibility of two polyepoxy matrices: DGEBA-DDM and DGEBA-IPD

The aim of this paper was to study the biocompatibility and mechanical properties of materials for orthopaedic and odontologic surgical use. The products used were obtained by polycondensation of a diepoxy resin (DGEBA) with two curing agents (DDM or IPD). The materials present a slight swelling in liquid medium and their thermomechanical properties are hardly affected after 12 month implantation. The absence of molecular desorption in isotonic liquid and human serum confirms their hydrolytic stability and thus their inertia. These materials do not give rise to an intolerance reaction by neighbouring tissues during implantation time (1 d to 12 month).