Accompagner les professionnels de santé dans la révélation de l’erreur : de la révélation à soi à la révélation à l’autre

2018

Resume L’erreur fait partie d’une realite en medecine. Afin d’ameliorer les pratiques et la securite des soins, les professionnels sont amenes a s’inscrire dans une demarche de revelation de l’erreur. Toutefois, la litterature met en avant une reelle difficulte des professionnels a reveler leur erreur. Differents freins sont decrits, a la fois personnels, institutionnels et societaux. Mais l’erreur correspond egalement a une perte des reperes professionnels et confronte les soignants a des emotions intenses ou se melent honte et culpabilite. Dans le cadre de cet article, nous soulignerons les freins psychologiques a la revelation qui peuvent jouer un role dans la capacite du professionnel a…

Type B Aortic Dissection Diagnosed by Left-Sided Transthoracic Ultrasonography in a Woman With Preeclampsia

2017

Error in Intensive Care

2014

Objective To identify the psychological repercussions of an error on professionals in intensive care and to understand their evolution. To identify the psychological defense mechanisms used by professionals to cope with error. Design Qualitative study with clinical interviews. We transcribed recordings and analysed the data using an interpretative phenomenological analysis. Setting Two ICUs in the teaching hospitals of Besancon and Dijon (France). Subjects Fourteen professionals in intensive care (20 physicians and 20 nurses). Interventions None. Measurements and main results We conducted 40 individual semistructured interviews. The participants were invited to speak about the experience of…

An Original Risk Score to Predict Early Major Bleeding in Acute Pulmonary Embolism

2021

Background Improved prediction of the risk of early major bleeding in pulmonary embolism (PE) is needed to optimize acute management. Research Question Does a simple scoring system predict early major bleeding in acute PE patients, identifying patients with either high or low probability of early major bleeding? Study Design and Methods From a multicenter prospective registry including 2,754 patients, we performed post hoc multivariable logistic regression analysis to build a risk score to predict early (up to hospital discharge) major bleeding events. We validated the endpoint model internally, using bootstrapping in the derivation dataset by sampling with replacement for 500 iterations. P…

Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: a multicentre series of 52 cases

2018

International audience; Aims The role of extracorporeal membrane oxygenation (ECMO) remains ill defined in pulmonary embolism (PE). We investigated outcomes in patients with high-risk PE undergoing ECMO according to initial therapeutic strategy. Methods and results From 01 January 2014 to 31 December 2015, 180 patients from 13 Departments in nine centres with high-risk PE were retrospectively included. Among those undergoing ECMO, we compared characteristics and outcomes according to adjunctive treatment strategy (systemic thrombolysis, surgical embolectomy, or no reperfusion therapy). Primary outcome was all-cause 30-day mortality. Secondary outcome was 90-day major bleeding. One hundred a…

Vécu des situations à risque d’erreur en réanimation : une étude qualitative auprès des médecins et infirmiers

2018

Resume Si de nombreux facteurs de risque d’erreur ont ete identifies en reanimation, tres peu d’etudes se sont interessees au vecu du risque d’erreur chez les professionnels. Pourtant, l’approche psychologique du risque montre l’importance de la dimension subjective pour comprendre la maniere dont le sujet apprehende le risque. Sur les 40 professionnels de reanimation, 75 % des professionnels vivent le risque d’erreur comme omnipresent. L’etude met en evidence l’existence d’un vecu differencie du risque d’erreur en fonction du niveau d’experience, de l’encadrement et de cooperation. Ces dimensions participent a la creation d’une culture collective permettant de vivre le risque comme control…

Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (N…

2017

International audience; BackgroundWhether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition.MethodsIn this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20–25 kcal/kg per day), within 24 h after intubatio…

L’enfant visiteur en réanimation adulte : vécu psychologique de la visite et dispositifs d’accompagnement

2021

Resume Introduction Si les reanimations ont largement ouverts leur porte aux proches, la presence des enfants et adolescents visiteurs en reanimation reste une question sensible et dans une volonte de proteger l’enfant face a un environnement potentiellement traumatique, certains services refusent ou restreignent la visite aux enfants. Objectif Dans ce contexte, la question de savoir si la visite en reanimation constitue un risque psychologique pour l’enfant se pose. A partir d’une revue de la litterature, cet article discute du vecu de la visite chez l’enfant et l’adolescent, les methodologies de recherche mises en place aupres des enfants visiteurs, et enfin des dispositifs d’accompagneme…

Comparison of heparin to citrate as a catheter locking solution for non-tunneled central venous hemodialysis catheters in patients requiring renal re…

2014

Background The incidence of acute kidney injury (AKI) is estimated at 10 to 20% in patients admitted to intensive care units (ICU) and often requires renal replacement therapy (RRT). ICU mortality in AKI patients can exceed 50%. Venous catheters are the preferred vascular access method for AKI patients requiring RRT, but carry a risk of catheter thrombosis or infection. Catheter lock solutions are commonly used to prevent such complications. Heparin and citrate locks are both widely used for tunneled, long-term catheters, but few studies have compared citrate versus heparin for patients with short-term, non-tunneled catheters. We aim to compare citrate 4% catheter lock solution versus hepar…

Development of a scale of perceived stressors specific to ICU: the PS-ICU scale

2019

International audience

Identification of stress factors in intensive care units: Is a specific stress scale necessary?

2019

International audience; Background: Intensive care units (ICUs) are a health environment particularly affected by suffering at work. These units treat patients with serious medical conditions with an immediate life-threatening risk in an emergency situation. As a result, caregivers are confronted intensively and repeatedly with an extreme clinic. Currently, many tools used to assess caregiver stress are not as close as possible to the professional experience and do not take into account the subjective perception of stressors. The objective of this qualitative study is to rely directly on the way professionals perceive their work, and to identify the specificity of stress factors in ICU. Met…

Proceedings of Réanimation 2017, the French Intensive Care Society International Congress

2017