Alexandre Duguet

Control of tracheal cuff pressure: a pilot study using a pneumatic device

ObjectiveTo evaluate the efficacy of axa0simple mechanical device to maintain constant endotracheal cuff pressure (Pcuff) during mechanical ventilation (large encased inflatable cuff connected to the endotracheal cuff and receiving constant pressure from axa0heavy mass attached to an articulated arm).Design and settingSingle-center, prospective, randomized, crossover, pilot study in axa0medical intensive care unit.Patients and participantsNine consecutive mechanically ventilated patients (age 62u202f±u202f20 years, SAPS II score 39u202f±u202f15).InterventionsControl day: Pcuff monitored and adjusted with axa0manometer (Hi-Lo™, Tyco Healthcare) according to current recommendations (twice axa0day and after each intervention on the tracheal tube); initial target Pcuff 22–28u202fcmH20. Prototype day: test device connected to the endotracheal cuff; same initial target. Continuous Pcuff recording during both days. Control and prototype days in random order.ResultsPcuff values over 50u202fcmH20 were recorded in six patients during the control day (178u202f±u202f159u202fmin), never during the prototype day. During the control day, Pcuff was between 30 and 50u202fcmH20 for 29u202f±u202f25% of the time, vs 0.3u202f±u202f0.3% during the prototype day (pu202f<u202f0.01). Pcuff was between 15 and 30u202fcmH20 for 56u202f±u202f36% of the time during the control day, vs 95u202f±u202f14% during the prototype day (pu202f<u202f0.01). During the control day, Pcuff was below 15u202fcmH20 for 15u202f±u202f17% of the time, vs 4.7u202f±u202f15% during the prototype day (pu202f<u202f0.05).ConclusionsThe tested device successfully controlled Pcuff with minimal human resource consumption. Prospective studies are required to assess its clinical impact.

Ultrasound-based teaching of cardiac anatomy and physiology to undergraduate medical students.

BACKGROUNDnUltrasonography is a non-invasive imaging modality that offers the opportunity to teach living cardiac anatomy and physiology.nnnAIMSnThe objectives of this study were to assess the feasibility of integrating an ultrasound-based course into the conventional undergraduate medical teaching programme and to analyse student and teacher feedback.nnnMETHODSnAn ultrasound-based teaching course was implemented and proposed to all second-year medical students (n=348) at the end of the academic year, after all the conventional modules at our faculty. After a brief theoretical and practical demonstration, students were allowed to take the probe and use the ultrasound machine. Students and teachers were asked to complete a survey and were given the opportunity to provide open feedback.nnnRESULTSnTwo months were required to implement the entire module; 330 (95%) students (divided into 39 groups) and 37 teachers participated in the course. Student feedback was very positive: 98% of students agreed that the course was useful; 85% and 74% considered that their understanding of cardiac anatomy and physiology, respectively, was improved. The majority of the teachers (97%) felt that the students were interested, 81% agreed that the course was appropriate for second-year medical students and 84% were willing to participate to future sessions.nnnCONCLUSIONSnCardiac anatomy and physiology teaching using ultrasound is feasible for undergraduate medical students and enhances their motivation to improve their knowledge. Student and teacher feedback on the course was very positive.

An innovative pedagogic course combining video and simulation to teach medical students about pediatric cardiopulmonary arrest: a prospective controlled study

AbstractCompliance by residents in pediatrics to pediatric resuscitation guidelines is low. In many French faculties, a 1-h traditional lecture is still used to educate medical students about pediatric cardiopulmonary arrest (CPA). We developed an innovative pedagogic course combining a 23-min video and 3-h simulation exercises to improve knowledge and skills of medical students. A prospective controlled study was conducted. Medical student knowledge was tested before, just after, and 6–12xa0months after the innovative course and compared to that of a cohort who attended the traditional lecture. A high-fidelity mannequin simulator simulating cardiopulmonary arrest was used to assess and compare the skills of the study and control groups. Costs of the courses were evaluated; 809 of 860 (94xa0%) medical students were assessed for knowledge. Six to 12xa0months after the courses, the median score was significantly higher for the innovative group than that for the traditional lecture group (pu2009<u20090.001). In terms of skills, student in the innovative group scored higher on the performance score than the control group (pu2009<u20090.01). The innovative course was 24 times more expensive.n Conclusion: Combination of video and simulation allows better retention of knowledge than a traditional lecture and leads to better compliance to resuscitation guidelines.What is known:• Compliance by residents to pediatric resuscitation guidelines is low.• We developed an innovative pedagogic course combining an educational video and simulation.What is new:• Knowledge retention after the innovative course was better than after a traditional lecture.• Sixty-six students tested on their skills demonstrated better compliance to resuscitation guidelines.

Identification of prolonged phrenic nerve conduction time in the ICU: magnetic versus electrical stimulation

PurposeRetrospective study of prospectively collected data to assess the reliability of cervical magnetic stimulation (CMS) to detect prolonged phrenic nerve (PN) conduction time at the bedside. Because PN injuries may cause diaphragm dysfunction, their diagnosis is relevant in intensive care units (ICU). This is achieved by studying latency and amplitude of diaphragm response to PN stimulation. Electrical stimulation (ES) is the gold standard, but it is difficult to perform in the ICU. CMS is an easy noninvasive tool to assess PN integrity, but co-activates muscles that could contaminate surface chest electromyographic recordings.MethodsIn a first set of 56 ICU patients with suspected PN injury, presence and latency of compound motor action potentials elicited by CMS and ES were compared. With ES as the reference method, CMS was evaluated as a test designed to indicate presence or absence of PN injury. In eight additional patients, intramuscular diaphragm recordings were compared with surface diaphragm recordings and with the electromyograms of possible contamination sources.ResultsThe sensitivity of CMS to diagnose abnormal PN conduction was 0.91, and specificity was 0.84, whereas positive and negative predictive values were 0.81 and 0.92, respectively. Passing–Bablok regression analysis suggested no differences between the two measures. The correlation between PN latency in response to CMS and ES was significant. The “diaphragm surface” and “needle” latencies were close, and were significantly different from those of possibly contaminating muscles. One hemidiaphragm showed likely signal contamination.ConclusionCMS provides an easy reliable tool to detect prolonged PN conduction time in the ICU.

Google Glass for Residents Dealing With Pediatric Cardiopulmonary Arrest: A Randomized, Controlled, Simulation-based Study

Objectives: To determine whether real-time video communication between the first responder and a remote intensivist via Google Glass improves the management of a simulated in-hospital pediatric cardiopulmonary arrest before the arrival of the ICU team. Design: Randomized controlled study. Setting: Children’s hospital at a tertiary care academic medical center. Subjects: Forty-two first-year pediatric residents. Interventions: Pediatric residents were evaluated during two consecutive simulated pediatric cardiopulmonary arrests with a high-fidelity manikin. During the second evaluation, the residents in the Google Glass group were allowed to seek help from a remote intensivist at any time by activating real-time video communication. The residents in the control group were asked to provide usual care. Measurements and Main Results: The main outcome measures were the proportion of time for which the manikin received no ventilation (no-blow fraction) or no compression (no-flow fraction). In the first evaluation, overall no-blow and no-flow fractions were 74% and 95%, respectively. During the second evaluation, no-blow and no-flow fractions were similar between the two groups. Insufflations were more effective (p = 0.04), and the technique (p = 0.02) and rate (p < 0.001) of chest compression were more appropriate in the Google Glass group than in the control group. Conclusions: Real-time video communication between the first responder and a remote intensivist through Google Glass did not decrease no-blow and no-flow fractions during the first 5 minutes of a simulated pediatric cardiopulmonary arrest but improved the quality of the insufflations and chest compressions provided.