Denis Frasca

Denis Frasca
Centre Hospitalier Universitaire de Poitiers | CHU Poitiers · Department Anesthesiology Criticale Care Perioperative Medicine

MD, PhD

About

138
Publications
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Publications

Publications (138)
Article
Full-text available
Barbiturates are proposed as a second/third line treatment for intracranial hypertension in traumatic brain injury (TBI) patients, but the literature remains uncertain regarding their benefit/risk balance. We aimed to evaluate the impact of barbiturates therapy in TBI patients with early intracranial hypertension on the intensive care unit (ICU) su...
Article
Full-text available
Few data are available on the efficacy of 0.5% aqueous sodium hypochlorite (SH) for skin disinfection before peripheral catheter insertion. A total of 239 patients were randomly assigned to either one application of SH alone or one application of SH preceded by one application of 70% ethanol (ET-SH). Catheter colonisation, defined as a catheter tip...
Article
Résumé Le Collège national des enseignants d’anesthésie et de réanimation (CNEAR) réunit les 181 professionnels hospitalo-universitaires de l’anesthésie-réanimation impliqués dans l’enseignement et la recherche en anesthésie, réanimation et médecine périopératoire. Les objectifs du CNEAR pour la discipline anesthésie-réanimation & médecine péri-opé...
Article
Full-text available
Objectives Patients with severe spontaneous intracranial haemorrhages, managed in intensive care units, face ethical issues regarding the difficulty of anticipating their recovery. Prognostic tools help clinicians in counselling patients and relatives and guide therapeutic decisions. We aimed to methodologically assess prognostic tools for function...
Preprint
Full-text available
Persistent Spinal Pain Syndrome Type 2 (PSPS-T2), (Failed Back Surgery Syndrome), dramatically impacts on patient quality of life, as evidenced by Health-Related Quality of Life (HRQoL) assessment tools. However, the importance of functioning, pain perception and psychological status in HRQoL can substantially vary between subjects. Our goal was to...
Article
Full-text available
Background An acceleromyographic train-of-four (TOF) ratio of 0.90 at extubation does not prevent postoperative pulmonary complications in surgical patients receiving non-depolarising muscle relaxants. This recent observation suggests that a more selective neuromuscular transmission monitoring parameter is mandatory to detect more precisely any rem...
Article
Background Connected devices are dramatically changing many aspects in health care. One such device, the virtual reality (VR) headset, has recently been shown to improve analgesia in a small sample of patients undergoing transcatheter aortic valve implantation. Objective We aimed to investigate the feasibility and effectiveness of VR in patients u...
Article
Résumé Pour une revue médicale, la diffusion à grande échelle de chacun de ses articles est aujourd’hui indispensable pour toucher un large public scientifique. Dans ce contexte, l’utilisation du réseau social Twitter permet à chaque nouvelle publication d’être diffusée très rapidement, à faible coût, pour des lecteurs précis et partout dans le mon...
Article
Background Ventilator-associated pneumonia (VAP) is the most frequent healthcare-associated infection in severely ill patients and aspiration of contaminated oropharyngeal content around the cuff of the tracheal tube is the main route of contamination. Research question Is continuous regulation of tracheal cuff pressure using a pneumatic device su...
Article
Introduction: Prolonged fasting before surgery is common in paediatrics. In the literature, it is responsible for hypotension, irritability and post-operative nausea and vomiting. Despite clear instructions given during the preanesthetic consultation, fasting rules are respected in only 30% to 40% of cases. We aimed to evaluate the benefit of send...
Article
Background Two billion peripheral venous catheters are sold globally each year, but the optimal skin disinfection and types of devices are not well established. We aimed to show the superiority of disinfection with 2% chlorhexidine plus alcohol over 5% povidone iodine plus alcohol in preventing infectious complications, and of closed integrated cat...
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Full-text available
Introduction A palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim t...
Preprint
BACKGROUND Connected devices are dramatically changing many aspects in health care. One such device, the virtual reality (VR) headset, has recently been shown to improve analgesia in a small sample of patients undergoing transcatheter aortic valve implantation. OBJECTIVE We aimed to investigate the feasibility and effectiveness of VR in patients u...
Article
Full-text available
Background: Whereas 5415 Intensive Care Unit (ICU) beds were initially available, 7148 COVID-19 patients were hospitalised in the ICU at the peak of the outbreak. The present study reports how the French Health Care system created temporary ICU beds to avoid being overwhelmed. Methods: All French ICUs were contacted for answering a questionnaire...
Article
Dans le contexte de maladies curables à longue durée d’évolution, tel qu’un cancer ou un accident vasculaire cérébral, les patients ont un risque de décès supérieur à celui de la population générale au moment du diagnostic. Leur prise en charge peut réduire le risque de décès lié à la maladie pour retrouver un risque proche de celui de la populatio...
Article
Objectives The aim of this study was to assess the superiority of hypnosis versus placebo on pain perception and morphine consumption during typical atrial flutter (AFL) ablation. Background AFL ablation commonly requires intravenous opioid for analgesia, which can be associated with adverse outcomes. Hypnosis is an alternative technique with risi...
Article
Background Specify place of video‐fluoroscopic swallowing study (VFS) in the decision of oral refeeding after total pharyngolaryngectomy. Methods At postoperative day 7, a blue dye testing was performed. If negative, a VFS was performed looking for a blind fistula. If this exam was negative, oral refeeding was started, but if a blind fistula was o...
Article
Delayed defecation is common in patients on intensive care. We aimed to determine factors associated with time to defecation after admission to intensive care and in turn its association with length of stay and mortality. We studied 396 adults admitted to one of five intensive care units in whom at least 2 days’ invasive ventilation was anticipated...
Article
Full-text available
Objectives: The world is currently facing an unprecedented healthcare crisis caused by COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic. Methods: The group has endeavoured to produce a minimum number of rec...
Article
Introduction: Dorsal pain is the first symptoms about which patients with macromasty complain. Health insurance reimbursement takes place if the resection weight is at least 300grams per breast. However, this weight is not correlated with the body mass index (BMI). In this context, we sought to determine the ideal resection weight leading to signi...
Article
Background Severe burn patients undergo prolonged administration of sedatives and analgesics for burn care. There are currently no guidelines for the dose adaptation of sedation-analgesia in severe burn patients. Methods We performed a before-after 2-center study to demonstrate the feasibility and efficacy of a sedation-analgesia scale-based proto...
Article
BACKGROUND Neuromuscular blockade (NMB) monitoring is essential to avoid residual NMB. While the adductor pollicis is the recommended site for monitoring recovery, it is not always accessible. The flexor hallucis brevis could be an interesting alternative. OBJECTIVE The aim of our study was to compare NMB onset and recovery at both sites. DESIGN...
Article
Objective: To evaluate the prognostic value of high-sensitivity troponin (hsT) in severe aneurysmal subarachnoid hemorrhage (aSAH). Methods: This prospective non-interventional study was performed at a surgical intensive care unit (ICU) from 2012 to 2015. Consecutive patients who had severe aSAH were included. A modified Rankin Scale score ≥ 4 or d...
Article
Introduction À l’ère de la médecine 4P, les patients peuvent participer à leur prise en charge à l’aide notamment d’outils pronostiques. Le groupe TRIPOD a publié en 2015 des recommandations pour l’élaboration de ces outils pronostiques. Leur développement doit s’appuyer sur une sélection de prédicteurs combinés dans une approche multivariée à part...
Article
Full-text available
Introduction Short peripheral intravenous catheters (PVCs) are the most frequently used invasive medical devices in hospitals. Unfortunately, PVCs often fail before the end of treatment due to the occurrence of mechanical, vascular or infectious complications, which prolongs hospitalisation and increases healthcare costs and mortality. Prevention o...
Article
Intravenous fluid boluses guided by changes in stroke volume improve some outcomes after major surgery, but invasive measurments may limit use. From October 2016 to May 2018, we compared the agreement and trending ability of a photoplethysmographic device (Clearsight) with a PiCCO, calibrated by thermodilution, for haemodynamic variables in 20 adul...
Article
Full-text available
Introduction Ventilator-associated pneumonia (VAP) is the first cause of healthcare-associated infections in intensive care units (ICUs) and brain injury is one of the main risk factors for early-onset VAP. Antibiotic prophylaxis has been reported to decrease their occurrence in brain-injured patients, but a lack of controlled randomised trials and...
Article
Introduction: The evolution of neurological recovery during the first year after aneurysmal Subarachnoid Haemorrhage (SAH) is poorly described. Patients: Patients with SAH in one university hospital from March the 1st 2010, to December 31st 2012, with a one-year follow-up. Method: Evaluation was performed via phone call at 3, 6 and 12 months....
Article
Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre,...
Article
Purpose: Since renal biopsy is rarely performed for identifying acute tubular necrosis in ICU patients, there is little information on the real histopathological abnormalities observed in such situations. Materials and methods: The clinical data of 27 patients with a confirmed diagnostic of acute tubular necrosis issued from two recent series ga...
Article
Purpose: To determine whether the addition of the frailty status assessed by the clinical frailty scale (CFS) to the SOFA score (SOFA-CFS) improves the performance of the SOFA score alone in predicting the hospital mortality of elderly critically ill patients. Methods: A prospective observational study performed between February 2015 and Februar...
Article
Background: Continuous monitoring of core temperature is essential during major surgery as a way of improving patient safety. Oesophageal probes or specific arterial catheters are invasive methods used in this setting. A new noninvasive device based on zero-heat-flux (ZHF) technique (SpotOn) seems promising but has been poorly investigated during...
Article
Introduction: Acute respiratory distress syndrome often requires invasive mechanical ventilation, with both mortality and mechanical ventilation duration as outcomes of interest. The concept of ventilator-free days has been proposed as an outcome combining these two outcomes. Here we analyzed the construction of the ventilator-free day outcome and...
Article
Background: Preoperative fasting is well-codified worldwide. In contrast, the literature on the postoperative fasting (POF) is scarce leading to potentially wide discrepancies among anaesthesiology practices. This survey assessed French POF practices. Methods: From March 2013 to January 2014, a survey was conducted among anaesthesiologists, memb...
Article
Full-text available
Introduction Severe trauma represents the leading cause of mortality worldwide. While 80% of deaths occur within the first 24 hours after trauma, 20% occur later and are mainly due to healthcare-associated infections, including ventilator-associated pneumonia (VAP). Preventing underinflation of the tracheal cuff is recommended to reduce microaspira...
Article
Objectives: To compare accuracy of a continuous noninvasive cutaneous temperature using zero-heat-flux method to esophageal temperature and arterial temperature. Design: Prospective study. Setting: ICU and NeuroICU, University Hospital. Patients: Fifty-two ICU patients over a 4-month period who required continuous temperature monitoring were...
Article
Introduction Un tiers des patients admis en réanimation nécessite une aide respiratoire avec une ventilation mécanique invasive (VM). Une durée de VM trop importante est associée à une augmentation de la morbi-mortalité. En recherche clinique, la durée de VM est souvent utilisée comme critère de jugement principal. Cependant un tiers des patients v...
Article
In morbidly obese patients, the speed of reversal of neuromuscular blockade with sugammadex based on ideal body weight is still matter of debate. In this single-center, randomised, double-blinded study, neuromuscular blockade was monitored in 50 patients using acceleromyography at the adductor pollicis. At the end of surgery with deep rocuronium-in...
Article
Introduction Les antiagrégants/anticoagulants (A) et les coagulopathies (B), augmentent le risque des hématomes cervicaux nécessitant une ré-intervention (H) après thyroïdectomie. Nous avons évalué le rôle de A et B dans la survenue de H. Méthode De janvier 2008 à j uillet 2014, 3 150 patients ont été opérés. Une analyse rétrospective comparant H...
Article
Introduction Un réseau de formation doit enseigner les GPS de la spécialité et contrôler la qualification des acteurs à ces pratiques. Le but de ce travail est de montrer la distribution actuelle des méthodes d’enseignement des GPS pour chaque partenaire du réseau au moyen d’un cadre systémique unique - EQUALIS™ permettant la confection de tableaux...
Article
Introduction La température centrale (Tc), présente dans les organes, fait référence car non influencée par la température extérieure ou la vasoconstriction cutanée. Elle fait partie du monitorage des patients en réanimation, notamment en cas d’hypothermie thérapeutique ou chez les cérébro-lésés pour la prévention des ACSOS [1]. Les techniques util...
Article
Introduction La pratique de l’anesthésie-réanimation nécessite l’application de nombreuses procédures et donc d’un large éventail de GPS – mise en place cathéter radial. Le contrôle de la qualification des futurs médecins spécialistes à ces GPS fait partie des responsabilités dévolues aux centres de formation habilités. Le but de ce travail est de...
Article
Introduction L’anesthésie-réanimation est une spécialité associée à un niveau de stress élevé. Les médecins anesthésistes-réanimateurs (MAR) présentent un risque suicidaire plus élevé que leurs confrères [1] et il est admis que la personnalité joue un rôle dans le mécanisme d’adaptation au stress. L’hypothèse que nous avons formulée est que les MAR...
Article
Introduction En ambulatoire, la nécessité de l’accompagnement au lieu de résidence postopératoire doit être évaluée en fonction de chaque couple acte-patient [1]. L’anesthésie locorégionale (ALR) périphérique améliore la réhabilitation des patients opérés en chirurgie ambulatoire orthopédique [2] mais l’accompagnement au domicile reste exigé au CHU...
Article
Introduction En montrant un niveau de satisfaction des patients systématiquement élevé, les enquêtes de satisfaction ne permettent pas d’identifier les dysfonctionnements qui existent dans notre pratique quotidienne. Or, les enquêtes d’insatisfaction pourraient permettre de mettre en évidences ces dysfonctionnements. Le but de cette étude était d’é...
Article
Introduction Il n’existe pas de recommandation nationale sur la durée du jeûne post-opératoire après une anesthésie générale avec intubation ou masque laryngé. Selon une enquête nationale réalisée en 2013 [1], les pratiques cliniques actuelles sont hétérogènes. Le but de cette étude est de déterminer si une reprise précoce de l’hydratation orale am...
Article
Introduction Le syndrome d’apnée obstructive du sommeil (SAOS) entraîne des hypoxémies répétées et une déstructuration du sommeil responsable de complications cardiovasculaires, métaboliques et cognitives. L’existence d’un SAOS est un facteur de risque de surmortalité lors d’une anesthésie générale [1]. Il s’agit d’une pathologie sous diagnostiquée...
Article
Non-invasive monitoring of haemoglobin concentration provides real-time measurement of haemoglobin concentration (SpHb) using multi-wavelength pulse co-oximetry. We hypothesised that in-vivo adjustment using the mean of three haemoglobinometer (HemoCue(®) ) measurements from an arterial blood sample at the first SpHb measurement (HCueART) would inc...
Article
To compare respiration rate measurement by an acoustic method and thoracic impedance to capnometry as the reference method, in patients at the Emergency Department after drug or alcoholic poisoning. In this observational study, 30 patients aged 18 or older, hospitalized at the Emergency Department for drug or alcoholic poisoning, without any contra...
Article
Respiratory depression, a potentially serious complication after general anaesthesia, can be detected promptly by close monitoring of both oxygen saturation and respiratory rate. Obese patients have morphological changes that may impair the reliability of monitoring devices. In this study, respiration rate was simultaneously recorded every second f...