[EXTUBATION FAILURE IN BURNS: INCIDENCE, RISK FACTORS AND PROGNOSIS]. / ÉCHEC D'EXTUBATION CHEZ LES BRÛLÉS: INCIDENCE, FACTEURS DE RISQUE ET PRONOSTIC.

The incidence of extubation failure varies between 2 and 25% depending on the studied population. Few studies have been conducted in burn victims. To determine the incidence, causes, risk factors and outcome of burned patients after a failed extubation, a retrospective single-center case-control study was conducted over a period of 3 years (January 2018-December 2021). All burned patients aged over 16, ventilated for at least 24 hours and having had at least one extubation attempt were included. Extubation failure was defined as the need for re-intubation within 48 hours. Eighty-eight patients had planned extubation. These patients were divided into 2 groups comparable in terms of age and sex. Failure group: including patients with failed extubation (N= 34) and a success group (N= 64) including patients who succeeded. The incidence of extubation failure was 36.6%. Hypophosphatemia, anemia <8g/dl, duration of mechanical ventilation of 8,5 days and abundant secretions during extubation were identified as risk factors for extubation failure (p<0.05). The main cause of failure was retention of secretion (50%). Extubation failure was associated with prolonged length of stay (34 vs. 19 days, P= 0.005), increased infectious complications (P=0.007) and mortality rate (79.4%, 1.5%, P<0.001).

Suicide by Self-Immolation in the Pediatric Population.

Self-immolation is a violent way of committing suicide. Few studies have focused on this phenomenon in children. The aim of this study was to determine the epidemiological profile of children who committed suicide by fire. A retrospective descriptive study was conducted in an intensive burn care department in Tunis, over a period of 10 years (2011-2020). Of a total 3077 patients, 761 were admitted for burns by suicide attempt, among them 62 children and adolescents (8%). The number was on average six per year. The highest annual prevalence was noted in 2011 (27% of cases). The mean age was 16 and a half years old. The majority of cases were adolescents aged 15 or older. There is a male predominance (sex ratio:3). Total burn surface area (TBSA) was on average 44%. The act of self-immolation occurred in public places in 58% of cases. Socio-economic environment was unfavorable in 60% of cases. The suicidal act of self-immolation was due to a family conflict in 34% of cases (n=21). Seven patients (11%) had a history of mental illness. Forty-three patients (70%) required mechanical ventilation. The length of hospital stay was on average 30 days. The mortality rate was 56.5%. In conclusion, self-immolation is frequent in the pediatric population; it induces severe burns associated with a poor prognosis.

L' immolation est un moyen de suicide particulièrement violent. Peu d'études se sont penchées sur ce phénomène chez l'enfant. Cette étude a pour but de déterminer le profil des enfants recourant au feu pour se suicider. Il s'agit d'une étude rétrospective réalisée sur une période de 10 ans (2011-2020) dans la réanimation spécifique du CTB de Tunis. Sur 3 077 patients admis, 761 avaient réalisé une tentative de suicide (TS) parmi lesquels 62 (8%) enfants ou adolescents. Vingt-sept pour cent des cas sont survenus en 2011 (6/an en moyenne). L'âge moyen est de 16 ans 1/2, la majorité des patients étant des adolescents de 15 ans ou plus. On observe un prédominance masculine (3M/1F). La surface atteinte moyenne représente 44% SCT. La TS est réalisée dans un espace public dans 58% des cas. Le contexte socio ­ économique est considéré défavorable dans 60% des cas, avec un contexte de conflit familial à l'origine de 34% (21 fois) des TS. Sept patients (11%) avaient un passé psychiatrique. Quarante - trois patients (70%) ont eu besoin de ventilation mécanique. La durée moyenne de séjour a été de 30 j, la mortalité de 56,5%. En conclusion, les TS par le feu ne sont pas rares chez les enfants. Elles entraînent des brûlures graves, au pronostic péjoratif.

[Acute Pancreatitis Related to Tigecycline in ICU Burn Patients]. / Pancréatitis Aiguë Liée à La Tigécycline Chez Des Patients Brülés En Réanimation.

Drug-induced acute pancreatitis (AP) associated with tigecycline (TGC) is considered a rare complication (incidence between 1‰ and 1%). In this paper, we report five cases of AP occurring after the administration of TGC in septic patients hospitalized in intensive burn care in Tunisia over 9 years. The diagnosis of AP was based on clinical and/or biological signs. Among 303 cases treated with TGC, AP occurred with an incidence of 1.65%. The mean age was 28±6 years. Only one patient had a history of chronic alcoholism. The prescribed dose was 200 mg as a loading dose, followed by 100 mg twice a day. The time to onset of symptoms after initiation of TGC was 5.4 days [2-7]. PA was suspected due to abdominal pain associated with nausea and vomiting (n=2), occlusive syndrome (n=1) and fortuitously increased pancreatic enzymes in 2 patients under mechanical ventilation. The mean lipase level at diagnosis was 447 IU ± 135 IU (4.5 to 10 times the normal). All the aetiologies of AP were ruled out, including gallstones, hypercalcemia, hypertriglyceridemia, trauma and infections. The mean time to symptom resolution after stopping TGC was 4±2 days [5-7] and to the normalization of pancreatic enzymes it was 9 days [2-20 days]. In conclusion, clinical and biological monitoring was necessary in patients treated with TGC in order to avoid severe forms, especially in at-risk patients.