J.-F. Payen

Centre Hospitalier Universitaire de Grenoble, Grenoble, Rhône-Alpes, France

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Publications (94)200.98 Total impact

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    ABSTRACT: Stroke volume variation (SVV) during mechanical ventilation predicts preload responsiveness. We hypothesized that the prone position would alter the performance of this dynamic indicator.
    Minerva anestesiologica 09/2014; · 2.27 Impact Factor
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    ABSTRACT: Introduction L’hypoxie cérébrale post-traumatique peut s’expliquer par un trouble de la diffusion de l’oxygène dû à un œdème périvasculaire [1]. Le mannitol par son action osmotique devrait améliorer l’oxygénation cérébrale. Néanmoins, les études cliniques sur l’oxygénation cérébrale par méthode globale ou locale après perfusion de mannitol sont discordantes [2]. Nous avons étudié l’effet du mannitol sur l’oxygénation cérébrale dans un modèle expérimental de traumatisme crânien (TC) diffus en utilisant différentes méthodes de mesure : IRM, pression partielle tissulaire en oxygène (PtiO2), saturation en oxygène du sinus longitudinal supérieur (SsO2). Matériel et méthodes Trente minutes après un TC diffus (modèle d’impact accélération), une solution intraveineuse était administrée soit de mannitol (1 g/kg) (TC-mannitol), soit de sérum salé isotonique (TC-saline). Des groupes contrôles (sham-saline et sham-mannitol) ne subissaient pas de TC. Trois séries d’expériences étaient réalisées 2 heures après le TC. La première série d’expérience évaluait l’effet du mannitol sur l’œdème cérébral par le coefficient de diffusion de l’eau (ADC) en IRM, ainsi que la mesure de la saturation locale du parenchyme cérébral en oxygène (lSO2) (n = 10 par groupe). Cette méthode IRM de mesure de l’oxygénation cérébrale combine l’effet BOLD qui dépend localement du rapport entre l’oxyhémoglobine et la déoxyhémoglobine, avec la mesure du volume sanguin cérébral. Une deuxième série d’expérience étudiait l’effet du mannitol sur la PtiO2 et la SsO2 (n = 5 rats par groupe). Enfin, une troisième série d’expérience s’intéressait à l’étude de l’ultrastructure corticale (n = 1 par groupe) au moyen de la microscopie électronique. Résultats En comparaison avec le groupe sham-saline, les rats TC-saline présentent une diminution significative de leur delta ADC (1,9 ± 9,1 % vs −10,4 ± 3,7 %, p < 0,05), de la lSO2 (82,1 ± 4,8 % vs 75 ± 8,9 %, p < 0,05) ainsi que de la PtiO2 (50,6 ± 6,6 mmHg vs 20,9 ± 2,1 mmHg, p < 0,05) et de la SsO2 (84,9 ± 3,3 % vs 69,6 ± 7,9 %, p < 0,05). Cela est associé à l’apparition d’œdème périvasculaire sur plus de 50 % de la surface du capillaire en microscopie électronique à H2 pour 50 % des capillaires étudiés dans le groupe TC Saline. Le traitement par mannitol montre une diminution de l’œdème cérébral en IRM (delta ADC à 7,0 ± 9,6 % dans le groupe TC mannitol vs −10,4 ± 3,7 % dans le groupe TC saline p < 0,05), mais aussi en microscopie électronique où seulement 16,7 % des capillaires sont entourés d’œdème dans le groupe TC mannitol. Cette diminution de l’œdème est associée à une normalisation des valeurs de lSO2 (83,3 ± 5,1 %, p = 0,06 vs TC saline), PtiO2 (41,9 ± 5,8 mmHg, p < 0,05 vs TC saline) et SsO2 (83,3 ± 5,1, p < 0,05 vs TC saline) ( Fig. 1). Discussion Le mannitol en diminuant l’œdème périvasculaire limite l’ischémie microcirculatoire et ainsi restaure l’oxygénation cérébrale par une diminution de la distance de diffusion de l’O2.
    Annales francaises d'anesthesie et de reanimation 09/2014; 33:A28–A29. · 0.77 Impact Factor
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    ABSTRACT: Introduction Les traumatisés crâniens mineurs et modérés (score de Glasgow 9-15) représentent la majorité des patients admis pour traumatisme crânien (TC). Bien que de présentation clinique initiale rassurante, 6 à 20 % de ces patients sont susceptibles de s’aggraver dans les sept jours suivant le traumatisme 0005 and 0010. L’objectif principal de ce travail a été de déterminer la valeur prédictive négative (VPN) du doppler transcrânien (DTC) à l’admission des patients ayant un traumatisme crânien mineur ou modéré et une TDM cérébrale peu grave chez qui le DTC à l’admission est considéré comme normal d’après une étude préalable [2] (vitesse diastolique, Vd ≥ 25 cm/s et index de pulsatilité, IP < 1,25). Matériel et méthodes Il s’agissait d’une étude nationale multicentrique de cohorte prospective. Après accord du comité d’éthique (No IRB 5891), les patients stables sur les plans hémodynamique et respiratoire, de plus de 15 ans, admis suite à TC mineur ou modéré avec une TDM cérébrale pathologique classée II selon la Traumatic Coma Data Bank ont été inclus. Les patients sous antiagrégants plaquettaires autre que l’aspirine et sous anticoagulants ont été exclus. Un DTC était réalisé dans les 8 heures post-traumatiques sur les deux artères cérébrales moyennes ; la valeur de Vd la plus basse et la valeur d’IP la plus haute entre les deux côtés ont été retenues pour l’analyse statistique. L’aggravation neurologique était définie par une baisse du score de Glasgow de 2 points ou par tout traitement médical ou chirurgical pour raison neurologique dans les 7 jours qui ont suivi le TC. Résultats Parmi les patients, 356 ont été inclus de 2011 à 2013 dans 14 centres hospitaliers en France. Vingt patients (6 %) ont présenté une aggravation neurologique dans les 7 jours post-traumatique (15 patients avec une diminution du score de Glasgow et 5 patients avec un traitement pour aggravation neurologique). La comparaison univariée (test non paramétrique de comparaison de médiane) entre les patients aggravés et non aggravés est présentée dans le Tableau 1. Parmi les patients aggravés, 15 patients avaient un DTC pathologique et 5 un DTC normal. Parmi les patients non aggravés (n = 336 patients), 265 patients avaient un DTC normal. La VPN du DTC pour la prédiction de l’aggravation neurologique précoce dans notre cohorte a donc été de 98,1 % (intervalle de confiance à 95 % : 95,7–99,4). Discussion Un DTC normal (Vd ≥ 25 cm/sec, IP < 1,25) réalisé dans les 8 premières post-traumatiques a montré une excellente valeur prédictive de non-aggravation neurologique après un TC mineur ou modéré. L’apport du DTC est majeur pour le triage hospitalier de ces patients.
    Annales francaises d'anesthesie et de reanimation 09/2014; 33:A24. · 0.77 Impact Factor
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    ABSTRACT: Introduction Vingt-cinq pour cent des patients traumatisés graves hémodynamiquement stables sont transfusés, avec une augmentation de leur morbi-mortalité. Le lactate sanguin est un marqueur reconnu de la prédiction de transfusion sanguine, mais nécessite un abord veineux ou artériel. Des appareils de mesure portatifs au lit du malade de lactate capillaire montrent une bonne corrélation avec les mesures de laboratoire [1]. L’objectif de notre étude était d’évaluer l’impact d’un lactate capillaire supérieur à 3,5 mmol/L, mesuré par une méthode délocalisée pour la prédiction transfusionnelle de 4 CGR ou plus dans les 48 premières heures dans cette population. Matériel et méthodes Étude prospective observationnelle portant sur 120 patients inclus entre août 2011 et février 2013 admis au déchocage du CHU de Grenoble. Deux mesures de lactate capillaire étaient réalisées à l’arrivée du patient au déchocage de manière concomitante à une hémoglobine capillaire. Une mesure de lactate capillaire était réalisée, 2 heures après l’admission pour déterminer la clairance du lactate capillaire [2]. Résultats Une différence significative a été retrouvée entre le groupe hyperlactatémie capillaire (62 patients) et le groupe normolactatémie capillaire (58 patients) concernant la transfusion sanguine de 4 CGR ou plus (19,4 % vs 0 %, p < 0,001) ( Fig. 1), la nécessité d’embolisation (6,5 % vs 0 %, p < 0,01) et la durée moyenne de séjour (17 jours [10–23] IC95 % vs 10 jours [5–19] IC95 %, p < 0,01). La courbe ROC du lactate capillaire a été établie pour le seuil de 4 CGR, la meilleure sensibilité et spécificité étaient retrouvées pour la valeur 3,5 mmol/L respectivement 100 % (73,5–100 % IC 95 %) et 52,8 % (42,9–62,4 % IC 95 %). La valeur prédictive négative était de 100 % pour le seuil de 3,5 mmol/L, pour une valeur prédictive positive de 19 %. Les patients dont la clairance était de 50 % diminuaient leur risque transfusionnel de 17,1 % à 1,8 % (p < 0,05) ( Fig. 1). Discussion Le lactate capillaire pourrait donc être un outil intéressant dans l’évaluation du risque de saignement des patients traumatisés graves hémodynamiquement stables accueillis au déchocage.
    Annales francaises d'anesthesie et de reanimation 09/2014; 33:A17. · 0.77 Impact Factor
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    BJA British Journal of Anaesthesia 07/2014; 113(1):194-5. · 4.24 Impact Factor
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    J.-F. Payen, P. Bouzat, G. Francony, C. Ichai
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    ABSTRACT: Hypernatremia is defined by a serum sodium concentration of more than 145 mmol/L and reflects a disturbance of the regulation between water and sodium. The high incidence of hypernatremia in patients with severe brain injury is due various causes including poor thirst, diabetes insipidus, iatrogenic sodium administration, and primary hyperaldosteronism. Hypernatremia in the intensive care unit is independently associated with increased mortality and complications rates. Because of the rapid brain adaptation to extracellular hypertonicity, sustained hypernatremia exposes the patient to an exacerbation of brain edema during attempt to normalize natremia. Like serum glucose, serum sodium concentration must be tightly monitored in the intensive care unit.
    Annales francaises d'anesthesie et de reanimation 06/2014; · 0.77 Impact Factor
  • G. Chanques, S. Jaber, B. Jung, J.-F. Payen
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    ABSTRACT: Las prácticas de la sedación en reanimación han evolucionado desde hace varios años hacia una racionalización de su administración más próxima a las necesidades del paciente. De este modo, el dolor se evalúa y se trata con independencia del nivel de vigilancia: la sedación se ha convertido en «sedación-analgesia» (SA). Por otra parte, los trabajos realizados en la última década han demostrado que la disminución de la duración de la SA y de la profundidad de la sedación tiene muchas ventajas. Varios conceptos de administración permiten evitar una SA excesiva y sus complicaciones. Estos conceptos son complementarios y no opuestos. Para evitar las infradosificaciones y sobredosis farmacológicas, la SA debería administrarse siguiendo un algoritmo dirigido por el equipo de enfermería y cuyos objetivos estén dirigidos a la sedación y el dolor, prescritos por el médico según unas herramientas clínicas validadas (escala de sedación, escala conductual de dolor). La SA profunda sólo debería reservarse a algunos pacientes (dificultad respiratoria, hipertensión intracraneal). En caso de asincronía paciente/ventilador, el refuerzo de la SA sólo debería emplearse después de haber optimizado los ajustes ventilatorios, dando prioridad al concepto de adaptación del ventilador al paciente y no a la inversa. La indicación de SA continua debería evaluarse a diario y su administración debería interrumpirse ante la mínima duda. En este mismo sentido, algunos autores han mostrado incluso que la SA continua probablemente no debería introducirse en todos los pacientes de reanimación. El tratamiento puntual y dirigido de los trastornos neurológicos y psicológicos, así como del dolor, podría constituir una alternativa a la SA continua en un gran número de pacientes. Por último, hay nuevas estrategias, como la sedación basada en la analgesia o en nuevos fármacos como la dexmedetomidina o los gases halogenados, que pueden añadirse al conjunto de estos conceptos complementarios.
    EMC - Anestesia-Reanimación. 02/2014; 40(1):1–13.
  • G. Chanques, S. Jaber, B. Jung, J.-F. Payen
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    ABSTRACT: Le pratiche della sedazione in rianimazione evolvono da diversi anni verso una razionalizzazione della sua somministrazione in un modo quanto più vicino possibile ai bisogni del paziente. Il dolore è, così, valutato e trattato distintamente dal livello di veglia: la sedazione è riformulata in «sedazione-analgesia» (SA). D’altra parte, i lavori intrapresi nell’ultimo decennio hanno mostrato numerosi vantaggi nel ridurre la durata della SA, così come la profondità della sedazione. Diversi concetti di somministrazione consentono di evitare una SA eccessiva e le sue complicanze. Questi concetti sono complementari e non sono contrapposti. Al fine di evitare i sottodosaggi e i sovradosaggi medicamentosi, la SA dovrebbe essere somministrata secondo un algoritmo pilotato dall’equipe infermieristica e che ha come obiettivi dei bersagli di sedazione e di dolore definiti dal medico secondo degli strumenti clinici validi (scala di sedazione, punteggio comportamentale di dolore). La SA profonda dovrebbe essere riservata solo a certi pazienti (distress respiratorio, ipertensione intracranica). In caso di asincronia paziente/ventilatore, il potenziamento della SA dovrebbe avere un ruolo solo dopo aver ottimizzato le impostazioni ventilatorie, privilegiando il concetto dell’adattamento del ventilatore al paziente e non l’inverso. L’indicazione di SA continua dovrebbe essere ricercata quotidianamente e la sua somministrazione dovrebbe essere interrotta al minimo dubbio. Nello stesso senso, alcuni autori hanno anche mostrato che la SA continua non dovrebbe, probabilmente, essere introdotta in tutti i pazienti di rianimazione. Il trattamento puntuale e mirato dei disturbi neurologici e psicologici e del dolore potrebbe rappresentare un’alternativa alla SA continua in un gran numero di pazienti. Infine, nuovi approcci, come la sedazione basata sull’analgesia o su nuovi agenti farmacologici come la dexmedetomidina o i gas alogenati, possono aggiungersi all’insieme di questi concetti complementari.
    EMC - Anestesia-Rianimazione. 02/2014; 19(1):1–12.
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    ABSTRACT: Background. Morbidity and mortality for critically ill patients with infections remains a global healthcare problem. We aimed to determine whether β-lactam antibiotic dosing in critically ill patients achieves concentrations associated with maximal activity and whether antibiotic concentrations affect patient outcome. Methods. This was a prospective, multinational pharmacokinetic point-prevalence study including 8 β-lactam antibiotics. Two blood samples were taken from each patient during a single dosing interval. The primary pharmacokinetic/pharmacodynamic targets were free antibiotic concentrations above the minimum inhibitory concentration (MIC) of the pathogen at both 50% (50% f T>MIC) and 100% (100% f T>MIC) of the dosing interval. We used skewed logistic regression to describe the effect of antibiotic exposure on patient outcome. Results. We included 384 patients (361 evaluable patients) across 68 hospitals. The median age was 61 (interquartile range [IQR], 48–73) years, the median Acute Physiology and Chronic Health Evaluation II score was 18 (IQR, 14–24), and 65% of patients were male. Of the 248 patients treated for infection, 16% did not achieve 50% f T>MIC and these patients were 32% less likely to have a positive clinical outcome (odds ratio [OR], 0.68; P = .009). Positive clinical outcome was associated with increasing 50% f T>MIC and 100% f T>MIC ratios (OR, 1.02 and 1.56, respectively; P < .03), with significant interaction with sickness severity status. Conclusions. Infected critically ill patients may have adverse outcomes as a result of inadeqaute antibiotic exposure; a paradigm change to more personalized antibiotic dosing may be necessary to improve outcomes for these most seriously ill patients.
    Clinical Infectious Diseases 01/2014; · 9.42 Impact Factor
  • P. Bouzat, G. Francony, M. Oddo, J.-F. Payen
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    ABSTRACT: Therapeutic hypothermia (TH) is considered a standard of care in the post-resuscitation phase of cardiac arrest. In experimental models of traumatic brain injury (TBI), TH was found to have neuroprotective properties. However, TH failed to demonstrate beneficial effects on neurological outcome in patients with TBI. The absence of benefits of TH uniformly applied in TBI patients should not question the use of TH as a second-tier therapy to treat elevated intracranial pressure. The management of all the practical aspects of TH is a key factor to avoid side effects and to optimize the potential benefit of TH in the treatment of intracranial hypertension. Induction of TH can be achieved with external surface cooling or with intra-vascular devices. The therapeutic target should be set at a 35 °C using brain temperature as reference, and should be maintained at least during 48 hours and ideally over the entire period of elevated intracranial pressure. The control of the rewarming phase is crucial to avoid temperature overshooting and should not exceed 1 °C/day. Besides its use in the management of intracranial hypertension, therapeutic cooling is also essential to treat hyperthermia in brain-injured patients. In this review, we will discuss the benefit-risk balance and practical aspects of therapeutic temperature management in TBI patients.
    Annales francaises d'anesthesie et de reanimation 11/2013; 32(11):787–791. · 0.77 Impact Factor
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    ABSTRACT: Aim To evaluate the impact of a regional trauma network on intra-hospital mortality rates of patients admitted with severe pelvic trauma. Study Retrospective observational study. Patients Sixty-five trauma patients with serious pelvic fracture (pelvic abbreviated injury scale [AIS] score of 3 or more). Methods Demographic, physiologic and biological parameters were recorded. Observed mortality rates were compared to predicted mortality according to the Trauma Revised Injury Severity Score methodology adjusted by a case mix variation model. Results Twenty-nine patients were admitted in a level I trauma centre (reference centre) and 36 in level II trauma centres (centres with interventional radiology facility and/or neurosurgery). Patients from the level I trauma centre were more severely injured than those who were admitted at the level II trauma centres (Injury Severity Score [ISS]: 30 [13–75] vs 22 [9–59]; P < 0.01). Time from trauma to hospital admission was also longer in level I trauma centre (115 [50–290] min vs 90 [28–240] min, P < 0.01). Observed mortality rates (14%; 95% confidence interval, 95% CI, [1–26%]) were lower than the predicted mortality (29%; 95% CI [13–44%]) in the level I trauma centre. No difference in mortality rates was found in the level II trauma centres. Conclusion The regional trauma network could screen the most severely injured patients with pelvic trauma to admit them at a level I trauma centre. The observed mortality of these patients was lower than the predicted mortality despite increased time from trauma to admission.
    Annales francaises d'anesthesie et de reanimation 09/2013; · 0.77 Impact Factor
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    ABSTRACT: Survival after severe trauma may depend on a structured chain of care from the management at the scene of trauma to hospital care and rehabilitation. In the USA, the trauma system is organized according to a pre-hospital triage by paramedics to facilitate the admission of patients to tertiary trauma centres. In France, trauma patients are transported to the most suitable facility, according to the on-scene triage by an emergency physician. Because French hospital's resources become scarce and expensive, the access to all techniques of resuscitation after severe trauma is restricted to tertiary trauma centres, at the expense of prolonged duration of transfer to these centres with a possible impact on mortality. The Northern French Alps Emergency Network created a regional trauma network system in 2008. This organization was based upon the interplay between the resources of each hospital participating to the network and the categorization of trauma severity at the scene. A regional registry allows the assessment of trauma system, which has included 3,690 severe trauma patients within the past 3years. Bystanders, medical call dispatch centres, and interdisciplinary trauma team should form a structured and continuous chain of care to allocate each severe trauma patient to the best place of treatment.
    Annales francaises d'anesthesie et de reanimation 07/2013; · 0.77 Impact Factor
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    ABSTRACT: OBJECTIVES: To clarify the procedures related to mechanical ventilation in the intensive care unit setting: allocation of ventilators, team education, maintenance and reference documents. STUDY DESIGN: Declarative survey. METHODS: Between September and December 2010, we assessed the assignment and types of ventilators (ICU ventilators, temporary repair ventilators, non-invasive ventilators [NIV], and transportation ventilators), medical and nurse education, maintenance of the ventilators, presence of reference documents. Results are expressed in median/range and proportions. RESULTS: Among the 62 participating ICUs, a median of 15 ventilators/ICU (range 1-50) was reported with more than one trademark in 47 (76%) units. Specific ventilators were used for NIV in 22 (35%) units, temporary repair in 49 (79%) and transportation in all the units. Nurse education courses were given by ICU physicians in 54 (87%) units or by a company in 29 (47%) units. Medical education courses were made by ICU senior physicians in 55 (89%) units or by a company in 21 (34%) units. These courses were organized occasionally in 24 (39%) ICU and bi-annually in 16 (26%) units. Maintenance procedures were made by the ICU staff in 39 (63%) units, dedicated staff (17 [27%]) or bioengineering technicians (14 [23%] ICU). Reference documents were written for maintenance procedures in 48 (77%) units, ventilator setup in 22 (35%) units and ventilator dysfunction in 20 (32%) ICU. CONCLUSIONS: This first survey shows disparate distribution of ventilators and practices among French ICU. Education and understanding of the proper use of ventilators are key issues for security improvement.
    Ann Fr Anesth Reanim. 01/2013; 32(11):736-41.
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    ABSTRACT: Objectives To clarify the procedures related to mechanical ventilation in the intensive care unit setting: allocation of ventilators, team education, maintenance and reference documents. Study design Declarative survey. Methods Between September and December 2010, we assessed the assignment and types of ventilators (ICU ventilators, temporary repair ventilators, non-invasive ventilators [NIV], and transportation ventilators), medical and nurse education, maintenance of the ventilators, presence of reference documents. Results are expressed in median/range and proportions. Results Among the 62 participating ICUs, a median of 15 ventilators/ICU (range 1−50) was reported with more than one trademark in 47 (76%) units. Specific ventilators were used for NIV in 22 (35%) units, temporary repair in 49 (79%) and transportation in all the units. Nurse education courses were given by ICU physicians in 54 (87%) units or by a company in 29 (47%) units. Medical education courses were made by ICU senior physicians in 55 (89%) units or by a company in 21 (34%) units. These courses were organized occasionally in 24 (39%) ICU and bi-annually in 16 (26%) units. Maintenance procedures were made by the ICU staff in 39 (63%) units, dedicated staff (17 [27%]) or bioengineering technicians (14 [23%] ICU). Reference documents were written for maintenance procedures in 48 (77%) units, ventilator setup in 22 (35%) units and ventilator dysfunction in 20 (32%) ICU. Conclusions This first survey shows disparate distribution of ventilators and practices among French ICU. Education and understanding of the proper use of ventilators are key issues for security improvement.
    Annales francaises d'anesthesie et de reanimation 01/2013; 32(11):736–741. · 0.77 Impact Factor
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    ABSTRACT: Background Assess efficacy, satisfaction and usefulness of an educational maze based on posters and audioguide for major trauma care teaching to medical students. The educational maze consists of posters with audio comments recorded in an audioguide. This tool was part of a larger educational program including medical simulation.Study designProspective, interventional, observational, monocentric study.StudentMedical student of Grenoble University Hospital, in the four last years of medical school, following a training course in anesthesia, emergency medical services and intensive care units.Method Forty essentials key messages for major trauma management were included in 10 posters and audioguides. A first assessment with short opened answers was handed to the students at the end of the educational maze to assess their memorization. A second assessment with simple choice answers regarding satisfaction and usefulness of this new educational tool was realized at the end of the entire program.ResultOne hundred and eighty-four medical students attending the major trauma program were included in this study. On the first test, 75% of essential knowledge on major trauma management was memorized by more than 50% of the medical students. On the second test, 94% of medical students had a high satisfaction level of this educational maze.Conclusion An educational maze based on posters and audioguides seems to be an efficient, useful tool for teaching essential knowledge on major trauma management to medical students.
    Annales francaises d'anesthesie et de reanimation 11/2012; 31(11):857–862. · 0.77 Impact Factor
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    ABSTRACT: Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients’ impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.
    Annales francaises d'anesthesie et de reanimation 10/2012; 31(10):e253–e263. · 0.77 Impact Factor
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    ABSTRACT: Automated assessment of circulatory response to surgical stimuli is unsolved. Would detection of cardiac baroreflex inhibition assess adequacy of intra-operative anti-nociception upon incision, as performed on-line on a beat-by-beat basis by a cardiovascular index, CARDEAN™? 18 ASA I-II patients undergoing spinal disc repair were studied, in a prospective randomized single-blinded trial (observational study). During infusion of propofol to maintain bispectral index between 40 and 60, patients were allocated to receive an effect site target-controlled infusion of remifentanil at Ce = 2 or 4 ng ml(-1). Upon incision and during surgery, circulatory response was assessed using beat-by-beat measurements of minor hypertension and tachycardia to give a cardiovascular index, CARDEAN, scaled between 0 and 100. Upon skin incision, CARDEAN increased in the remifentanil Ce = 2 ng ml(-1) group (n = 7, P < 0.05), while it did not increase in the remifentanil Ce = 4 ng ml(-1) group (n = 7, P = 0.18). During surgery, retrospectively, CARDEAN > 60 was associated with tachycardia and hypertension (P (k) = 0.81 ± 0.10). Changes in CARDEAN appeared linked to adequacy of anti-nociception.
    International Journal of Clinical Monitoring and Computing 06/2012; · 1.45 Impact Factor
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    ABSTRACT: Pupil size reflects the balance between sympathetic and parasympathetic systems. Due to technological advances, accurate and repeated pupil size measurements are possible using infrared, video-recorded pupillometers. Two pupil size reflexes are assessed: the pupillary reflex dilation during noxious stimulation, and the pupil light reflex when the pupil is exposed to the light. The pupillary reflex dilation estimates the level of analgesia in response to a painful procedure or to a calibrated noxious stimulus, i.e., tetanic stimulus, in nonverbal patients. This might be of particular interest in optimizing the management of opioids in anaesthetized patients and in assessing pain levels in the intensive care unit. The pupil light reflex measurement is part of the routine monitoring for severely head-injured patients. The impact of pupillometry in this condition remains to be determined.
    Annales francaises d'anesthesie et de reanimation 06/2012; 31(6):e155–e159. · 0.77 Impact Factor
  • G. Francony, P. Bouzat, J.-F. Payen
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    ABSTRACT: Near infrared spectroscopy (NIRS) can noninvasively measure cerebral saturation in oxygen, that permits to estimate brain oxygenation and metabolism. This technique could be incorporated into a multimodal monitoring for severely brain-injured patients. This review presents the principles of NIRS, its limits, the main results from clinical studies and its perspectives. More clinical studies are needed before recommending the routine use of NIRS in the ICU.
    Annales francaises d'anesthesie et de reanimation 06/2012; 31(6):e133–e136. · 0.77 Impact Factor