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Proceedings of Réanimation 2019, the French Intensive Care Society International Congress Ann. Intensive Care 2019, 9(Suppl 1):40 https://doi.org/10.1186/s13613-018-0474-7 MEETING ABSTRACTS Open Access Proceedings of Réanimation 2019, the French Intensive Care Society International Congress France. 23–25 January 2019 Published: 29 March 2019 Oral communications Oral communications: Physiotherapists Conclusion: We found that peak expiratory was higher with than with- out collapsible tube. In vivo measurements in patients should be done COK‑1 to confrm this fnding. Bench assessment of the efect of a collapsible tube on the efcacy of a mechanical insufation‑exsufation device Romain Lachal (speaker) Réanimation médicale, Hôpital de la Croix‑Rousse, Hospices Civils de Lyon, Lyon, FRANCE Correspondence: Romain Lachal ‑ [email protected] Annals of Intensive Care 2019, 9(Suppl 1):COK-1 Introduction: Mechanical Insufation-Exsufation (MI-E) by using a specifc device is commonly used to increase weak cough, as in patients with chronic neuromuscular weakness or in intensive care unit (ICU) patients with ICU-acquired neuro-myopathy. The assess- ment of the efcacy of MI-E device is commonly done by measuring peak cough fow (PCF). Upper airways collapse is frequently associated with neuromuscular disease and may compromise MI-E efcacy. Tra- cheomalacia is another disease that may impede PCF to increase with MI-E device. The goal of present study was to carry out a bench study to assess the efect of MI-E on PCF with and without the presence of a collapsible tube. Our hypothesis was that PCF was lower with than without collapsible tube. COK‑2 Patients and methods: We used a lung simulator (TTL Michigan Early verticalization in neurologic intensive care units Instruments) with adjustable compliance (C) and resistance (R) to with a weight suspension system which a MI-E (CoughAssist E70, Philips-Respironics) was attached, Margrit Ascher (speaker), Francisco Miron Duran, Fanny Pradalier, Claire with or without a latex collapsible tube. Flow and pressure were proxi- Jourdan, Kevin Chalard, Flora Djanikian, Isabelle Lafont , Pierre‑François mal to the lung simulator. Six C-R combinations were tested, each Perrigault with and without the collapsible tube. For each C-R combination, CHU Montpellier, Montpellier, FRANCE we set 30, 40 and 50 cmH2O inspiratory expiratory pressure at Correspondence: Margrit Ascher ‑ m‑ascher@chu‑montpellier.fr the MI-E± device.± MI-E device± was set in automatic mode with inspira- Annals of Intensive Care 2019, 9(Suppl 1):COK-2 tory time of 3 s, expiratory time of 3.2 s and pause of 2 s. Each set was recorded by using a data logger (Biopac 150, Biopac inc.) and the last Introduction: Background. Current literature and French guidelines 5 cycles were used for the analysis done by using Acqknowledge soft- recommend early mobilization in Intensive Care Units (ICU), including ware (Biopac inc.). The peak expiratory fow during the frst 100 ms verticalization and walking. Verticalization for neurologic patients in after onset of expiration was taken as the surrogate of PCF. The cor- ICU is challenging because of neurological impairments, risks of falls responding pressure was also recorded. and of clinical worsening. In the neuro-ICU of Montpellier university Results: Contrary to our hypothesis, the peak expiratory fow during hospital, a weight suspension system (LiteGait­ ®) is used. Objectives. the frst 100 ms of exsufation phase is higher with than without the To study the feasibility and safety of walking with the weight suspen- collapsible tube in every C-R condition, as shown in fgure 1. For the sion system in a neuroICU. Feasibility involved proportion of patients C20R5 condition the efect of the collapsible tube on the intercept who benefted from suspension walking, reasons for not using it, ( 0.35 cm ­H O) was not signifcant but this was ofset by a signifcant 2 physiotherapists’ time required. Safety involved rate of adverse events, increase− in slope ( 0.12 L s cm ­H O). For the other conditions, the col- 2 changes in vital parameters, pain. lapsible tube signifcantly+ increased PCF at 30 cm ­H O expiratory pres- 2 Patients and methods: Design. Monocentric, prospective, descriptive sure and the gap further increased above this pressure because the study, including all neurogical patient hospitalized for > 48 h in ICU slope increased with the collapsible tube. with initial mechanical ventilation from mid-February to mid-Septem- ber 2018 (excluding deceased patients). Criteria for using suspension © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creat​iveco​mmons​.org/licen​ses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Ann. Intensive Care 2019, 9(Suppl 1):40 Page 2 of 153 walking where respiratory stability without mechanical ventilation Results: 10 patients in each group were included. PaO2 FiO2 (before- (tracheostomy and or oxygen therapy possible), hemodynamic and 318 (280–381) versus 310 (246–376) after p 0.46) and lactate levels neurologic stability, sufcient respond to command (head control, (1.3(0.8–2.0) versus 1.4(1.0–2.0) mmol/L + p = 0.65) were not modifed testing of one quadriceps > 3 or two quadriceps > 2). Data included whatever the type of exercise. Only, in the+ ESM= group, delta EI was sig- general description of patients clinical status before suspension nifcantly decreased for several low shear stress (0.76, 1.21 and 1.93 Pa) walking (pain, MRC testing, sitting+ balance, RASS, hemodynamic and compared to the two other groups. respiratory parameters, medical equipment) pain, hemodynamic Conclusion: Association of active passive mobilization and ESM and respiratory parameters during sessions +description of adverse alter at least for low shear stress, the RBC deformability in critically ill events and consequences duration of walking.+ patients. Efects on long term treatment by this technique on RBC rhe- Results: Among 83 patients+ included (see table for characteristics), ology and on muscle metabolism need to be investigated. 25% benefted from suspension walking during their stay for 25% + of patients, suspension walking was needed but hindered by organi- COK‑4 zation difculties (such as timetable challenges, early discharge from Neurogenic para‑osteoarthropathy in severe brain injury ICU) 22% patients could walk without suspension on frst verticaliza- + in the emergency department of CHU Oran Emergencies (Algeria) tion 20% were too impaired to use suspension walking. A total of 41 1 2 1 + Youcef Oubadi (speaker) , Soumia Benbernou , Khalida Bouyacoub , suspension walking sessions were performed. Five sessions needed to Nabil Ghomari1, Abdelkader Azza1, Houria Pr Djebli France2 be interrupted for the fve following reasons- pain, hypotension, diz- 1Centre Hospitalo Universitaire d’Oran, Oran, ALGERIA; 2Faculté de méde‑ ziness, diarrhea and dysfunction of the device. No adverse event had cine, Oran, ALGERIA clinical consequences beyond the session. Pain score raised signif- Correspondence: Youcef Oubadi ‑ [email protected] cantly for one patient only (5 points in BPS score). Mean delay between Annals of Intensive Care 2019, 9(Suppl 1):COK-4 extubation (or tracheotomy) and frst suspension walking was 7 days. Mean delay between frst suspension walking and frst walking with- Introduction: Neurogenic para-osteoarthropathy (NOPO) is a com- out suspension was 8 days. mon complication after severe head trauma, and can be complicated Conclusion: Verticalization with a suspension device in a neurologic by joint damage ranging from amplitude limitation to ankylosis. ICU is feasible and safe, with a trained and supported team. Obstacles This complication is frequently encountered in the unit. Objectives- such as medical equipment, language impairments, absence of bal- Determine the frequency of NOPOs in the Emergency Resuscitation ance, heavy weight, poor tonicity and participation can be overcome Department Establish a prevention protocol established by the physi- using such a device. Suspension could enable several neurologic ICU otherapists of the unit. patients to walk one week earlier. Patients and methods: The exposed work was carried out at the URC resuscitation unit of CHUOran. This is a prospective study spread over COK‑3 two years (2015 and 2017) involving 76 patients. The study population Efects of active exercise on red blood cell deformability consists of severe head injuries (GCT) with a Glasgow score of 8 or less. in critically ill patients We studied the time of onset, the afected joint, the degree of limita- Vinciane Scaillet (speaker)1, Mohera Potvin1, Damien Wathelet1, Adrien tion risk factors. Fievet2, Ingrid Leclercq2, Karim Zouaoui Boudjeltia3, Patrick Biston 7, Results+ : Of the 76 TCG patients, 29 patients presented with NOPO. The Michael Piagnerelli1 onset time was an average of 14 days with extremes ranging from 10 1Service de Kinésithérapie, Charleroi, BELGIUM; 2Ecole de Kinésithéra‑ to 20 days. The elbow was the most afected joint with knee involve- pie‑HEPH‑Condorcet, Charleroi, BELGIUM; 3Laboratoire de Médecine ment in some cases. In this series the risk factors favoring the onset Expérimentale. ULB 222 Unit., Charleroi, BELGIUM; 4Réanimation, Char‑ of NOPO were- severity of neurological lesions, periarticular lymphoe- leroi, Charleroi dema, arterial compression of
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