CP015 - Première évaluation clinique pré-hospitalière d'un mode de ventilation spécifiquement dédié à la réanimation Cardio pulmonaire.

adrien drouet (1), françois-xavier ageron (1), denis cluzel (1), florence bergues (2), gael gheno (3), marceau rigollot (4), jean-christophe richard (1), dominique savary (1)

1. SMUR, Centre hospitalier ANNECY-GENEVOIS, annecy, France
2. smur, ch annecy genevois, annecy, France
3. SAMU 74 - CENTRE 15, Centre Hospitalier Annecy Genevois, annecy, France
4. Urgence/SMUR, air liquide, paris, France

Diffusion le 10/05/2016

/medias/images/design/icos/resumes.png


Introduction:Un mode de ventilation automatisé en pression spécifiquement adapté à la réanimation cardiopulmonaire (RCP) et pour les arrêts circulatoires (AC) nommé "CardioPulmonary Ventilation" (CPV) a été développé sur un ventilateur à turbine (T60 Airliquide). Ce mode est utilisable avec un masque ou une sonde d'intubation, il présente un monitoring dédié  visant à réduire les alarmes inappropriées. Cette étude est une évaluation clinique initiale du mode CPV sur les différents temps de la RCP et sur les alarmes.

Méthode: Etude observationnelle et qualitative de pratiques « avant/après » mise en place du nouveau mode CPV sur patients en AC pré-hospitaliers (CE N°5791). Nous avons recueilli systématiquement les différents temps de procédure ainsi que les alarmes et réglages en analysant les données du ventilateur avant  et après l'introduction du mode CPV.

Résultats: 28 patients ont été pris en charge pour une RCP avec le T60 en mode conventionnel (groupe VC) et  17 patients ont été pris en charge avec le mode  CPV (groupe CPV). Les deux groupes sont  comparables (âge, sexe secours sur place, durée, nombre d'exposition laryngée?). Lors de la phase « avant » (groupe VC), le ventilateur était utilisé 22 fois sur 28 (78%) alors que lors de la phase « après » (groupe CPV) le ventilateur était utilisé 16 fois sur 17 (94%) (P=0.211). La RCP était débutée au masque avec le ventilateur à la place du BAVU une fois « avant » alors qu'il s'est substitué au BAVU 11 fois (65%) (P>0.01) « après », qu'il il y ait ou non intubation ensuite. Le ventilateur était significativement mis en route plus rapidement « après » (groupe CPV) (groupe VC : 28 + 15 mn versus 15 + 13 mn p=0.029). L'évaluation de  la gêne occasionnée par les alarmes, (sur une échelle de 0 à 10) était significativement moindre « après » : 5 + 3 (groupe VC) VS 1 + 1 (groupe CPV), p=0.002. Cette réduction était principalement liée à la suppression des alarmes  de pression de crête, de PEEP et de volume incohérente. Le monitorage spécifique de la fréquence de compression proposé pour la RCP avec le mode CPV n'a pas été détecté efficacement 4 fois sur 17 (23%).

Discussion-Conclusion : Cette première évaluation du mode CPV dans la pratique clinique de la RCP  suggère que cette technique  est facilement applicable dès le début de la prise en charge au masque et qu'elle améliore le confort des équipes en réduisant significativement les alarmes inappropriées.

Tags : ventilation arret circulatoire évaluation mode spécifique

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/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Controller/Router/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Controller/Router/Rewrite.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Controller/Router/Route.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Controller/Router/Route/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Controller/Router/Route/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Controller/Router/Route/Module.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Controller/Router/Route/Static.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Date.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Date/DateObject.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Adapter/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Adapter/Pdo/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Adapter/Pdo/Mysql.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Expr.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Profiler.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Select.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement/Pdo.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table/Definition.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Inflector.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/PregReplace.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/StringToLower.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/CamelCaseToDash.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/CamelCaseToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/Separator/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/SeparatorToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/UnderscoreToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout/Controller/Action/Helper/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout/Controller/Plugin/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/Autoloader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/PluginLoader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/PluginLoader/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Data.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Format.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Math.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/FactoryInterface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Priority.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Writer/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Registry.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Namespace.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/SaveHandler/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Uri.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Version.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Doctype.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/HeadMeta.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/HeadTitle.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container/Standalone.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Registry.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Url.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Interface.php

ZFDebug Files

/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Cache.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Database.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/File.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Log.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Log/Writer.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Text.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Variables.php