Publications (4)17.98 Total impact
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Article: Impact of clinical guidelines to improve appropriateness of laboratory tests and chest radiographs
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ABSTRACT: ObjectiveTo assess the impact of clinical guidelines to improve appropriate use of routine laboratory tests and bedside chest radiographs in a medical intensive care. DesignA two-year (Period-1: 2005, Period-2: 2006), retrospective, comparative study, before and after policy implementation. PatientsAll consecutive patients admitted during the study periods. SettingA university hospital 15-bed medical ICU. InterventionMultifaceted intervention combining a daily routine prescription help-guide developed by a multidisciplinary group and displayed at patient’s bedside, educational sessions and feedbacks by information on volumes of prescription. Individual adaptation to patient’s clinical status was allowed by protocol. AssessmentThe overall number and cost of laboratory tests and chest radiographs during Period-2 (with the help guide; from 01 to 12-2006) were compared to Period-1 (from 01 to 12-2005). ResultsPatients’ general characteristics were similar during the two periods. A relative reduction of routine laboratory tests performance was observed per patient-ICU-day, ranging from 38 to 71.5% depending on the type of tests (P<0.001 in all cases). For chest radiographs, a 41% relative reduction was observed between the two periods (P<0.001). Daily ICU laboratory tests and chest radiographs cost per patient decreased from 114 to 56€. An overall 300,000€ ICU cost reduction was directly related to the protocol implementation. ConclusionThe implementation of a laboratory tests and chest radiographs prescription protocol within our ICU induced an important cost saving.Intensive Care Medicine 04/2012; 35(6):1047-1053. · 5.40 Impact Factor -
Article: Clinical relevance of classification according to weaning difficulty.
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ABSTRACT: To evaluate the clinical relevance of the weaning from mechanical ventilation classification system derived from the 2005 international consensus conference, in patients who receive mechanical ventilation for more than 48 hours, and evaluate its correlation with prognosis. We conducted a retrospective cohort study in a 12-bed intensive care unit (ICU) in a teaching hospital. We included patients who required > 48 hours of mechanical ventilation and who passed a spontaneous breathing trial (SBT). Weaning and sedation were monitored according to standardized protocol-directed procedures. We collected data on physiological characteristics, mechanical ventilation duration, ICU and hospital stay, and mortality from the medical records database. We assessed one-year mortality with a prospective, standardized method. Multivariate logistic regression was performed to evaluate the association between weaning categories and outcome. We included 329 ventilation episodes, in which 115 patients passed at least one SBT. Thirty-four patients (30%) succeeded in their first SBT (simple weaning group), 47 patients (40%) succeeded in their 2nd or 3rd SBT or in less than 7 days of weaning (the difficult weaning group), and 34 patients (30%) required more than 3 SBTs or more than 7 days of weaning (the prolonged weaning group). There were significant differences in ICU and hospital mortality between the simple, difficult, and prolonged-weaning groups. Prolonged weaning was an independent risk factor for longer ICU stay (odds ratio 15.11, 95% CI 1.61-141.91, P = .01) and hospital mortality (odds ratio 3.66, 95% CI 0.99-13.51). However, the weaning process did not impact one-year mortality (odds ratio 2.61, 95% CI 0.82-8.35). The new weaning classification system is clinically relevant and correlates to ICU and hospital mortality, but not to one-year mortality.Respiratory care 01/2011; 56(5):583-90. · 2.01 Impact Factor -
Article: Impact of clinical guidelines to improve appropriateness of laboratory tests and chest radiographs.
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ABSTRACT: To assess the impact of clinical guidelines to improve appropriate use of routine laboratory tests and bedside chest radiographs in a medical intensive care. A two-year (Period-1: 2005, Period-2: 2006), retrospective, comparative study, before and after policy implementation. All consecutive patients admitted during the study periods. A university hospital 15-bed medical ICU. Multifaceted intervention combining a daily routine prescription help-guide developed by a multidisciplinary group and displayed at patient's bedside, educational sessions and feedbacks by information on volumes of prescription. Individual adaptation to patient's clinical status was allowed by protocol. The overall number and cost of laboratory tests and chest radiographs during Period-2 (with the help guide; from 01 to 12-2006) were compared to Period-1 (from 01 to 12-2005). Patients' general characteristics were similar during the two periods. A relative reduction of routine laboratory tests performance was observed per patient-ICU-day, ranging from 38 to 71.5% depending on the type of tests (P < 0.001 in all cases). For chest radiographs, a 41% relative reduction was observed between the two periods (P < 0.001). Daily ICU laboratory tests and chest radiographs cost per patient decreased from 114 to 56 euros. An overall 300,000 euros ICU cost reduction was directly related to the protocol implementation. The implementation of a laboratory tests and chest radiographs prescription protocol within our ICU induced an important cost saving.European Journal of Intensive Care Medicine 02/2009; 35(6):1047-53. · 5.17 Impact Factor -
Article: Noninvasive continuous positive airway pressure ventilation using a new helmet interface: a case-control prospective pilot study.
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ABSTRACT: To evaluate the clinical efficacy of noninvasive continuous positive airway pressure ventilation (CPAP) using a new interface, constituted by a cephalic plastic helmet, in comparison with a standard facial mask. A prospective pilot study with matched-control group, in the emergency department of a teaching hospital. Eleven consecutive adult patients with acute hypoxemic respiratory failure related to cardiogenic pulmonary edema (whether hypercapnic or not) were enrolled in the study, after failure of the initial medical treatment. Each patient treated with CPAP, using the helmet in addition to a standardized medical treatment, was matched with historical control-patient treated with CPAP using a standard facial mask, and selected by gender, age, and PaCO2 levels on admission. Primary end points were improvements of gas exchanges and clinical parameters of respiratory distress. tolerance was evaluated after each CPAP trial. The 22 patients and controls had similar characteristics at baseline. PaCO2 levels, and clinical parameters improved similarly in both groups. No interface intolerance was reported whether using standard facial mask or the helmet. No complications were observed in either group. The helmet allowed CPAP administration for a longer period of time (p=0.045). In-hospital mortality was not different between the two groups. Despite a high dead-space volume (9-15 l), this new helmet interface is an efficient alternative to standard face mask during CPAP, even in cases of severe respiratory acidosis and hypercapnia. It allowed to provide long-duration CPAP, without any adverse events or clinical intolerance.Intensive Care Medicine 12/2003; 29(11):2077-80. · 5.40 Impact Factor
