Journée de Formation Médicale Continue du Jeudi 27 mai 2010
Infections liées aux cathéters à l'hôpital
Lieu: Faculté Xavier Bichat, Paris
9èmes Concertations Multidisciplinaires en Infectiologie OUTCOMEREA
avec le soutien des laboratoires JANSSEN CILAG
« Bacilles Gram négatif non fermentants :
de l'épidémiologie à la maîtrise de la diffusion de la résistance»
Le mardi 9 Février 2010 à 18h30
Hôpital Necker, Amphithéâtre Maurice Lamy
149 rue de Sèvres
75015 Paris
Tabah, Alexis, Philippart, Francois, Timsit, Jean-Francois, Willems, Vincent, Francais, Adrien, Leplege, Alain, Carlet, Jean, Bruel, Cedric, Misset, Benoit and Garrouste-Orgeas, Maite (2010), "Quality of life in patients aged 80 or over after ICU discharge ", Critical Care, 14, 1: R2.
Abstract:
INTRODUCTION:Our objective was to describe self-sufficiency and quality of life 1 year after intensive care unit (ICU) discharge of patients aged 80 years or over.
METHODS:We performed a prospective observational study in a medical-surgical ICU in a tertiary non-university hospital. We included patients aged 80 or over at ICU admission in 2005 or 2006 and we recorded age, admission diagnosis, intensity of care, and severity of acute and chronic illnesses, as well as ICU, hospital, and 1-year mortality rates. Self-sufficiency (Katz Index of Activities of Daily Living) was assessed at ICU admission and 1 year after ICU discharge. Quality of life (WHO-QOL OLD and WHO-QOL BREF) was assessed 1 year after ICU discharge.
RESULTS:Of the 115 consecutive patients aged 80 or over (18.2% of admitted patients), 106 were included. Mean age was 84 +/- 3 years (range, 80 - 92). Mortality was 40/106 (37%) at ICU discharge, 48/106 (45.2%) at hospital discharge, and 73/106 (68.9%) 1 year after ICU discharge. In the 23 patients evaluated after 1 year, self-sufficiency was unchanged compared to the pre-admission status. Quality of life evaluations after 1 year showed that physical health, sensory abilities, self-sufficiency, and social participation had slightly worse ratings than the other domains, whereas social relationships, environment, and fear of death and dying had the best ratings. Compared to an age- and sex-matched sample of the general population, our cohort had better ratings for psychological health, social relationships, and environment, less fear of death and dying, better expectations about past, present, and future activities and better intimacy (friendship and love).
CONCLUSIONS:Among patients aged 80 or over who were selected to ICU admission, 80% were self-sufficient for activities of daily living One year after ICU discharge, 31% were alive, with no change in self-sufficiency and with similar quality of life to that of the general population matched on age and sex. However, these results must be interpreted cautiously due to the small sample of survivors.
Am J Respir Crit Care Med.
Selected Medical Errors in the ICU: Results of the IATROREF Study (Parts I and II).
Garrouste Orgeas M, Timsit JF, Vesin A, Schwebel C, Arnodo P, Lefrant JY, Souweine B,Tabah A, Charpentier J, Gontier O, Fieux F, Mourvillier B, Troché G, Reignier J, Dumay MF, Azoulay E, Reignier B, Carlet J, Soufir L.
RATIONALE: Although ICUs were created for patients with life-threatening illnesses, the ICU environment generates a high risk of iatrogenic events. Identifying medical errors (MEs) that serve as indicators for iatrogenic risk is crucial for purposes of reporting and prevention
OBJECTIVES: We describe the selection of indicator MEs, the incidence of such MEs, and their relationship with mortality.
METHODS: We selected indicator MEs using Delphi techniques. An observational prospective multicenter cohort study of these MEs was conducted from March 27 to April 3, 2006, in 70 ICUs; 16 (23%) centers were audited. Harm from MEs was collected using specific scales.
Measurements and main results. Fourteen types of MEs were selected as indicators; 1192 MEs were reported in 1369 patients, and 367 (26.8%) patients experienced at least one ME (2.1/1000 patient-days). The most common MEs were insulin administration errors (185.9/1000 days of insulin treatment). Of the 1192 medical errors, 183 (15.4%) in 128 (9.3%) patients were adverse events that were followed by one or more clinical consequences (n=163) or required one or more procedures or treatments (n=58). By multivariable analysis, having two or more adverse events was an independent risk factor for ICU mortality (odds ratio, 3.09; 95% confidence interval, 1.30-7.36, P=0.039).
CONCLUSIONS. The impact of medical errors on mortality indicates an urgent need for developing prevention programs. We have planned a study to assess a program based on our results.
PMID: 19875690 [PubMed - as supplied by publisher]
Crit Care. 2009 May 19;13(3):R72.
Model for predicting short-term mortality of severe sepsis.
Adrie C, Francais A, Alvarez-Gonzalez A, Mounier R, Azoulay E, Zahar JR, Clec'h C, Goldgran-Toledano D, Hammer L, Descorps-Declere A, Jamali S, Timsit JF; the Outcomerea Study Group.INSERM U823, Epidemiology of Cancer and Severe Illnesses, Albert Bonniot Institute, BP 217, 38043 Grenoble, France.
Lire la suite : Model for predicting short-term mortality of severe sepsis.