Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Apr 2013
Case ReportsPulmonary alveolar proteinosis requiring "hybrid" extracorporeal life support, and complicated by acute necrotizing pneumonia.
Pulmonary alveolar proteinosis (PAP), which was first described by Rosen in 1958, is a rare disease characterized by impaired surfactant metabolism that provokes the accumulation of proteinaceous material in the alveoli. PAP is usually an auto-immune disease though, less commonly, may be congenital or secondary to another underlying disorder, such as infection, an immunodeficiency or a haematological disease. A positive diagnosis can be made with the appearance of "crazy-paving" on a computed tomography scan, with a milky fluid bronchial aspiration. ⋯ Under ECLS, the patient subsequently developed "Harlequin syndrome", which was managed using an original and minimally invasive method. A whole lung lavage as well as prone positioning was effectively performed under ECLS, and resulted in substantial improvement in oxygenation. The patient could be discharged from the hospital 40 days later.
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Ann Fr Anesth Reanim · Apr 2013
Comparative Study[Interhospital transport with extracorporeal life support: results and perspectives after 5 years experience].
Describing the experience of a referral center for interhospital patients transport treated with extracorporeal circulatory or respiratory support (ECLS), the difficulties encountered and the results obtained. ⋯ In our experience, interhospital transport of patients under ECMO is feasible in satisfactory conditions of safety with trained team and standard procedures.
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Ann Fr Anesth Reanim · Apr 2013
[Contribution of information technologies to assess and improve professional practice: example of management of surgical antibiotic prophylaxis].
Information technologies appear to be interesting tools to assess and improve professional practices. In that setting, the management of surgical antibiotic prophylaxis represents an appropriate clinical area for using and evaluating such a tool. Despite the existence of guidelines in one hand and the demonstrated interest for a strict application of recommendations in the other hand, some irregularities in the management of surgical antibiotic prophylaxis remain in France in 2010. ⋯ Computer-based help for clinical decision and prescription seems to be a useful tool for surgical antibiotic prophylaxis but it should be accompanied by direct regular educational measures to update protocols and databases.
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Ann Fr Anesth Reanim · Apr 2013
[Difficult airway management: assessment of knowledge and experience in anaesthesiology residents].
Assessment of knowledge and experience in anaesthesiology residents on alternative techniques for difficult airway management. ⋯ Four years after the expert conference of the French Anaesthesiology Society, the educational objectives are not achieved during the resident training, both on mannequins or patients.
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Ann Fr Anesth Reanim · Apr 2013
[Learning ultrasonography: where do the anesthesiology residents of the French north-eastern sector currently stand?].
Ultrasonography is in continuing expansion in anesthesiology and critical care medicine (ACCM). It is an operator-dependent tool whose contribution is partly related to the quality of the user's initial and subsequent training. Within the framework of the ACCM residency, the French north-east anesthesiology residents have an initiation to ultrasonography by 24 hours of formal lectures. The evaluation of this teaching has not yet been performed. The objective of this survey is to depict this learning and delineate the expectations of the residents. ⋯ A clear gap exists between the real capability in echocardiography and the intended one. UGRA and echocardiography raise a particular interest. The practical training in ultrasonography using simulation and workshops is to be favored.