[Manageability and potential for haemostasis monitoring by near-patient modified thromboelastometer (Rotem) in intensive care unit]. / Maniabilité et intérêts potentiels du thromboélastomètre modifié (Rotem) dans le monitorage extemporané de l'hémostase en réanimation.

OBJECTIVE: Preliminary assessment of a rotary thromboelastometer (Rotem) in the haemostasis monitoring in ICU. STUDY DESIGN: Prospective, open. PATIENTS AND METHODS: The device: the Rotem is a rotary thromboelastometer, which measures continuously and retranscribes numerically viscoelastic properties of a clot after an in vitro haemostasis activation. 83 patients with various haemostasis disorders that 122 blood samples have been subjected to a double analysis: extemporaneous by Rotem and at the laboratory for conventional haemostasis tests (aPTT, PT, fibrinogen, platelets). We assessed Rotem's manipulation duration, time for the first results. We compared Rotem variables with conventional haemostasis parameters and haemostasis diagnosis with each method. RESULTS: Mean Rotem manipulation duration was measured at 2 minutes 51 seconds+/-1 minute 48 seconds and time for results at 13+/-6 minutes. Plasma fibrinogen level was strongly correlated with the kinetic of clot formation (CFT) and the maximun clot firmness (MCF) measured by Rotem (R>0.7, coefficient of Pearson). Platelets were strongly correlated with MCF. The PT and aPTT had a weak correlation with Rotem parameters (R< or =0.53). The diagnosis concordance between the two techniques was good with a pondered kappa coefficient measured at 0.68. Hypocoagulability thromboelastographic profile with Rotem was in agreement with conventional parameters diagnosis in 92 percent of cases. Hypercoagulability thromboelastographic profile was associated with a significant increase of conventional parameters (supranormal value in 78%). Normal thromboelastography profile was associated with normal conventional parameters in 49%. Different reagents used on several simultaneous tests specified the thromboelastographic diagnosis. A diagnostic algorithm showed the interest of the Rotem for the prediction of conventional test results. CONCLUSION: Rotem is an easy manipulation device whose concordant and rapid results allow its emergency use in the framework of haemorrhagic situations. It also allows an approach of hypercoagulability states so that the therapeutic implication remains to evaluate. The Rotem offers a dynamic multifactorial approach on total blood of haemostasis that is what makes it a prime aid of haemostasis monitoring, in complement of usual analytic haemostasis evaluation.

[Evaluation of a medical equipment checklist before intensive care room opening]. / Evaluation d'une liste de contrôle du matériel médical avant ouverture de chambre en réanimation.

OBJECTIVE: To describe and to assess the effectiveness of a checklist concerning the intensive care rooms' equipment before patients' admission. STUDY DESIGN: A 4 years prospective study with 3 successive assessments. METHODS: Medical equipment inspection of 20 intensive care unit (ICU) rooms was first checked without using a written checklist (phase I). A written procedure called "room opening checklist" (ROC) was instituted to inspect medical equipment, and then assessment of its use and effectiveness was performed 2 years (phase II) and 4 years later (phase III). RESULTS: Phase I (1998): medical equipment of 20 intensive care rooms was inspected before patients' admission. None of the 20 intensive care rooms was strictly equipped in accordance with the unit's official procedure. Phase II (2000): ROC has been used for all the 20 evaluated ICU rooms, 17 ICU rooms were equipped in accordance with the official procedure. Phase III (2002): ROC has been used for 19 ICU rooms, 18 ICU rooms were correctly equipped. CONCLUSION: The routine use of ROC has improved the adequacy of the ICU room's equipment endowment in our intensive care units.

[Brachiocephalic trunk erosion by a tracheotomy cannula]. / Ulcération du tronc brachio-céphalique par une canule de trachéotomie.

We report the case of a 27-year-old severe head trauma patient who developed an erosion of the brachiocephalic artery, 19 days after the insertion of a tracheal cannula. Emergency treatment included overinflation of the tracheostomy cuff and surgery via sternotomy, with occlusion of the tracheostomy and the tracheo-arterial fistula and reimplantation of the brachiocephalic artery via a vascular prosthesis. This life-threatening complication is due to close anatomic relationships between the trachea and the brachiocephalic artery. In our case, the tip of the cannula eroded the anterior trachea wall resulting in a tracheo-arterial fistula with massive haemorrhage. Warning symptoms such as pulsations of the cannula and aspiration of blood must be recognised without delay and followed by an adequate pre-established management.

[Pulmonary pasteurellosis in a young patient with multiple trauma]. / Pasteurellose pulmonaire chez un jeune polytraumatisé.

A case is reported of an 18-year-old male patient who had a road traffic accident, with head and chest injuries. The patient was admitted to the surgical intensive care unit 24 h later because of an alteration of his level of consciousness. He required artificial ventilation. Five days later, he developed right-sided lower lobe pneumonia, treated with positive end-expiratory pressure. A Gram negative organism was found on bronchial brushing, but not in haemocultures. It was identified as Pasteurella multocida, sensitive to beta-lactamines, but not to amikacin. Cefotaxime, which had been started immediately after the arrival of the Gram stain result, was continued. Artificial ventilation was discontinued on day 12, and the patient left the unit on day 15. The patient was probably a P. multocida carrier, being in close contact with animals before his accident. This bacteria is often found in infected animal bite wounds. Pneumonia due to this bacteria usually occurs in immunodepressed patients, which was not the case here.

[Renal toxicity of intraperitoneal cisplatin: a case report]. / Toxicité rénale du cisplatine intrapéritonéal: une observation.

The new technique of treating ovarian tumours by giving cisplatin intra-peritoneally does have its risks. This case history reports the case of a patient who was treated in this way and following the treatment had renal failure severe enough to require dialyses. The methods of administering cisplatin through this route have not yet been worked out completely. It is absolutely to over hydrate the patient beforehand.