Réanimation Urgences最新文献

In children, community-acquired staphylococcal pneumonia due to Staphylococcus aureus is an uncommon but potentially severe disease, in particular when S. aureus produces toxins. In this study, we report the case of a 14-year old girl without a record of previous illness, in whom Pantin-Valentine leucocidin may have been involved In the fatal outcome. In spite of treatment, the outcome was negative. The patient presented with respiratory failure, and developed septic shock with disseminated intravascular coagulation followed by prolonged coma and death after six days of intensive care (tenth day of illness). In the case of staphylococcal pneumonia with ieucopenia, the presence of the Pantin-Valentine leucocidin and other toxins should be investigated in an attempt to determine their precise pathogenic roles.

Les pneumopathies staphylococciques communautaires de l’enfant sont rares, mais elles peuvent être sévères, notamment lorsque le staphylocoque doré produit des toxines. Nous en décrivons une observation chez une fille de 14 ans, sans antécédent, dans laquelle le rôle de la leucocidine de Ranton-Valentine est évoqué. L’évolution a été; défavorable, conduisant au décès au sixième jour du séjour en réanimation (dixième jourde la maladie) dans un tableau d'insuffisance respiratoire, de choc septique avec coagulation intravascular disséminée, puis de coma dépassé. En cas de Pneumopathie staphylococcique avec leucopénie, la leucocidine de Panton-Valentine et les autres toxines devraient être recherchées; afin de préciser leurs rôles pathogéniques.

In this study, the case was reported of a 60-year-old male with a chronic respiratory disorder following a poliomyelitic infection. He was treated by a SAMU team (Glasgow score=4) for a comatose state, and no sign of localization of disease or meningitis was found. Given the preliminary diagnostic findings, mechanical ventilation was instigated; and several minutes later generalized seizures were observed which did not respond to 10 mg diazepam, but which continued when the subject was admitted to the emergency ward, The following day, the patient appeared to have regained normal function and consciousness. It was concluded that these seizures were due to a rapid acidemia-alcalemia shift in a person with a preexisting chronic respiratory disorder.

Nous rapportons le cas d’un malade insuffisant respiratoire chronique qui a convulsé à deux reprises lors de la correction rapide d’une hypercapnie à la mise en route d’une ventilation artificielle. Le facteur déclenchant de ces convulsions semble être une alcalémie dont les conséquences sont discutées. Cette complication potentielle incite à ne pas corriger trop rapidement une hypercapnie au cours des premières heures de ventilation artificielle chez l’insuffisant respiratoire décompensé.

Although the economic aspect of intensive care units is of considerable importance, it is not sufficiently taken into account in the ‘diagnosis related groups’ (DRG) in the current version of the Programme de Médicalisation des Systèmes d’Information (PMSI). A medico-economic classification based on organ failure in intensive care patients was set up by the following groups: the Société de Réanimation de Langue Française (SRLF), the Société Française d’Anesthésie-Réanimation (SFAR) and Image. In the case of multi-unit hospitalization, most frequently in intensive care units (ICU), the DRG is nevertheless Inaccurately associated with the surgical department, or the unit in which the duration of hospital stay was the longest; and in the case of a similar length of stay in two departments, the last unit takes precedence regarding the DRG. However, the economic requirements of ICUs are real, and constitute 15 to 20% of the hospital budget for less than 5% beds.

Aim: The aim of this study was to apply the current PMSI classification to a retrospective study, i.e., 4,027 consecutive stays (1989–1997) in an 8-bed medico-surgical ICU, and to compare this with the 1993–1994 SRLF database. Method: The data on 3,646 of the 4,027 consecutive stays was divided into 16 groups, as defined by SFAR-SRLF-Image. The parameters for the database were those outlined in the PMSI, gravity index (Simplified Acute Physiologic Score, SAPS, with SAPS I prior to 1996 converted to SAPS II, and with SAPS II after January 1st 1997), omega score, organ failure procedures noted on a dally basis, and diagnostic information based on CIM 9 1989–1995) and CIM 10 (after January 1st 1997), These findings were then compared to those from the SRLF database.

Results: All patients were included in the 16 groups, and a descriptive and a comparative analysis were made of the data. The classification explained 66% of the ICU workload (omega score) and 52% of the duration of stay. Fourteen groups out of 16 had an orrega coefficent of variation of less than 1. The main differences between the retrospective study database and that of the SRLF were the patient distribution within; groups, length of hospital stay and a 30–40% lower omega score for those groups with long duration of hospitalization.

Conclusion: The medico-economic SRLF-SFAR-image classification that has been proposed can be easily applied to the database of a short-stay 400-bed ICU, It is simple to use and aims at providing an economic evaluation of the hospital stay. The differences noted between the two databases could be due to structural and study population recrultment différencés, and should be further reassessed via a prospective multicenter study, including hospitals of different sizes.

Si le poids économique des services de réanimation est réel, il n'est que peu pris en compte dan