Hervé Hubert

Vasopressin and Epinephrine vs. Epinephrine Alone in Cardiopulmonary Resuscitation

BACKGROUND During the administration of advanced cardiac life support for resuscitation from cardiac arrest, a combination of vasopressin and epinephrine may be more effective than epinephrine or vasopressin alone, but evidence is insufficient to make clinical recommendations. METHODS In a multicenter study, we randomly assigned adults with out-of-hospital cardiac arrest to receive successive injections of either 1 mg of epinephrine and 40 IU of vasopressin or 1 mg of epinephrine and saline placebo, followed by administration of the same combination of study drugs if spontaneous circulation was not restored and subsequently by additional epinephrine if needed. The primary end point was survival to hospital admission; the secondary end points were return of spontaneous circulation, survival to hospital discharge, good neurologic recovery, and 1-year survival. RESULTS A total of 1442 patients were assigned to receive a combination of epinephrine and vasopressin, and 1452 to receive epinephrine alone. The treatment groups had similar baseline characteristics except that there were more men in the group receiving combination therapy than in the group receiving epinephrine alone (P=0.03). There were no significant differences between the combination-therapy and the epinephrine-only groups in survival to hospital admission (20.7% vs. 21.3%; relative risk of death, 1.01; 95% confidence interval [CI], 0.97 to 1.05), return of spontaneous circulation (28.6% vs. 29.5%; relative risk, 1.01; 95% CI, 0.97 to 1.06), survival to hospital discharge (1.7% vs. 2.3%; relative risk, 1.01; 95% CI, 1.00 to 1.02), 1-year survival (1.3% vs. 2.1%; relative risk, 1.01; 95% CI, 1.00 to 1.02), or good neurologic recovery at hospital discharge (37.5% vs. 51.5%; relative risk, 1.29; 95% CI, 0.81 to 2.06). CONCLUSIONS As compared with epinephrine alone, the combination of vasopressin and epinephrine during advanced cardiac life support for out-of-hospital cardiac arrest does not improve outcome. (ClinicalTrials.gov number, NCT00127907.)

Moderate-to-Vigorous Physical Activity among Children: Discrepancies in Accelerometry-Based Cut-off Points

Objective: To highlight the discrepancies in accelerometry cut‐off points of moderate‐to‐vigorous physical activity (MVPA) according to the definitions of Puyau et al. (MVPAP) and Trost et al. (MVPAT).

Evidence of the influence of physical activity on the metabolic syndrome and/or on insulin resistance in pediatric populations: a systematic review

This study is aimed at updating the relationships between physical activity (PA) and the metabolic syndrome (MetS) and/or insulin resistance (IR) in youth. Cross-sectional, prospective cohort and intervention studies, which examined the effect of PA on MetS, its components and IR in children and adolescents (<18 yrs), were searched by applying a combination of criteria in the PubMed database. The electronic search of studies published from 2000-2010 yielded >150 references. Of these, 37 studies were included. Twenty-six studies (70%) were cross-sectional observation studies, and two studies (8%) were prospective cohort studies. The remaining eight studies (22%) were interventions, of which three (<10% of all included studies) were randomized controlled trials. Commonly, higher PA levels were consistently associated with an improved metabolic profile and a reduced risk for MetS and/or IR in these populations. The impact of PA on MetS and/or IR appeared to be either independent of other factors, or alternatively or simultaneously mediated by the physical fitness and adiposity of youth. However, more-robustly designed interventions (i.e., some mega-randomized controlled trials based on lifestyle interventions) and additional cohort studies are required to make definitive inference about the magnitude and role of PA as a single genuine preventive and treatment strategy for the metabolic and cardiovascular risk of youth in the current obesogenic context.

Comparison of the diagnostic quality of body mass index, waist circumference and waist-to-height ratio in screening skinfold-determined obesity among children.

This study compared the diagnostic quality of the body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) in screening obesity among children, according to gender and maturation. A sample of 65 boys and 57 girls aged from 6.8 to 11.8 years underwent anthropometry and total percentages of body fat (%TBF)--the reference criterion--were obtained by skinfolds. Diagnostic quality was derived from the area under the ROC curve (AUC), sensitivity, specificity, accuracy, and Youden index (YI). In general, AUC ranged 0.80-1.00, with relatively higher values for WC in boys and late maturers. In the aforementioned subgroups, WC and WHtR were more sensitive than BMI. Furthermore, WC was more consistent in terms of the balance between sensitivity and specificity than BMI or WHtR, across gender and maturational status. The YI ranged 0.59-0.92 and 0.58-0.85 according to gender and maturational status, respectively. Higher values of YI were obtained with WC in boys and late maturers. BMI displayed better accuracy values (86.8-95.2%) among boys and early maturers. WHtR was least useful in classifying childrens obesity status. Waist circumference exhibits an overall better performance, among boys and late maturers. Paediatricians should systematically add WC to clinical and epidemiological measurements.

Assessing excess nurse work load generated by multiresistant nosocomial bacteria in intensive care.

OBJECTIVE To compare three methods for assessing the excess nurse work load related to recommended procedures for managing nosocomial infections (NI) due to multiresistant bacteria (MRB): two activity scores, the Omega score and the Projet de Recherche en Nursing (PRN) system, and a specific evaluation based on functional analysis of nursing procedures. SETTING 10 beds in a medical intensive care unit (MICU). PATIENTS Patients admitted from November 15, 1995, to June 15, 1996, were included and divided in two groups based on presence of MRB colonization or infection (MRB+ and MRB-groups). METHODS Data were collected regarding length of stay (LOS) in days; Omega score for the entire stay; PRN score for the entire stay and per day; and time required to perform correctly four nursing procedures related to MRB NI, as evaluated specifically by the nursing staff, using a detailed functional analysis document that described all elementary nursing tasks in chronological order and all material needed to carry out those tasks. RESULTS The LOS and total Omega and PRN scores were higher in the MRB+ group than in the MRB- group: LOS, 23 +/- 20.6 versus 12 +/- 15.3 days, (P<.001); Omega score, 164 +/- 103.4 versus 123 +/- 93.7 points (P<.001); PRN score, 3,606 +/- 3,187 versus 1,854 +/- 2,356 points (P<.001), respectively. The daily PRN score was also higher in MRB+ group (PRN, 160 +/- 25 vs 146 +/- 34 points in the MRB- group; P<.028). Four nursing procedures made necessary by MRB acquisition were identified: isolation precautions, with two levels according to whether the risk of contamination was mild-moderate or high; bathing the patient with antiseptic solution; bedpan management; and microbiological screening. The functional analysis indicated that the time needed to carry out these four procedures correctly was 245 minutes per patient per day, as compared to 85 minutes according to the PRN system. CONCLUSIONS Our data confirm that MRB NIs are responsible for an increase in nurse work load, as estimated by LOS, Omega, and PRN scores. However, the daily excess nurse work load related directly to recommended procedures for managing MRB NIs in MICUs is underestimated by these activity scores, as compared to a specific functional analysis of nursing tasks. This may be of importance in evaluating potential links between nurse work load and MRB NIs and in determining the number of nurse hours needed to comply with infection control recommendations.

Rationale, Methodology, Implementation, and First Results of the French Out-of-hospital Cardiac Arrest Registry

Abstract Introduction. Out-of-hospital cardiac arrest (OHCA) is an important public health issue with an estimated incidence of 50,000 cases per year in France. Community survival rates for OHCA are still low (approximately 5%). An effective, recognized way to study, assess, and improve OHCA care is to create a standard-format database. Objective. The aim of this work is to present the French OHCA registry (RéAC). Methods. RéAC is a secure, web-based data management system that was initiated in 2009 and deployed nationally in June 2012. The main goal of this registry is to improve the care and survival rate of OHCA patients. The survey form is in compliance with the requirements of French organizations and is organized in accordance with the Utstein universal style. RéAC provides real-time statistical analyses and enables all French mobile emergency and resuscitation services (MERS) to assess and improve their professional OHCA care practices. Results. In June 2012, the RéAC was nationally opened for all French MERSs. In June 2013, 221 of a possible 320 MERS participated in the RéAC. A total of 15,944 OHCA have been collected (14,939 cases closed with follow-up monitoring). The current rate of inclusion is approximately 1,500 cases per month. Since August 2012, the inclusion rate has increased by 9.5% per month, while the participation rate has increased by 9% per month. The first results show that the population is mainly male (65.4%) and the mean age is 65 ± 19 years. On MERS arrival, 73.5% of the patients were in asystole. The rates of return of spontaneous circulation, survival to hospital admission, and 30-day survival are low (respectively 21.1%, 17.2%, 4.6%). Of those who survived 30 days, 84.0% had a good neurological recovery. Conclusions. The RéAC registry is a reliable observation tool to improve public health management of OHCA. It provides relevant information to adapt or to develop diagnosis, treatments, and prognostic resources. Moreover, it enables the development of targeted awareness programs for the unique purpose of increasing the survival rates of OHCA patients.

Actigraph-defined moderate-to-vigorous physical activity cut-off points among children: statistical and biobehavioural relevance.

Aim: To compare Actigraph‐defined moderate‐to‐vigorous physical activity (MVPA) cutpoints among children, combining statistical and biobehavioural analyses.

Physical activity and sedentary lifestyle in children as time-limited functions: Usefulness of the principal component analysis method

This study was designed to examine the hourly variation in and the interplay between physical activity and sedentary behavior (SB) in order to highlight key time periods for physical activity interventions for children. Data for physical activity and SB obtained with ActiGraph in 56 boys and 47 girls aged from 8 to 11 years. These data were divided into sixty minute-time samples for moderate-to-vigorous physical activity (MVPA) and SB, and analyzed using a principal component analysis (PCA) and correlation statistics. The PCA provides 10 factors which account for 80.4% of the inertia. Only two of these factors did not display competition between MVPA and SB. Contrary to some reports, a coefficient of correlation of —.68 (p,<10−4) was found between daily time spent at MVPA and SB. Some salient traits of children’s behaviors were shown through PCA. The results suggested that efficacy of interventions targeting the morning hours (07:00 AM–11:59 AM) and the afternoon period (02:00 PM–05:59 PM) warrants attention. H. Hubert, herve.hubert@univ-lille2.fr

Compliance of children in northern France with physical activity recommendations

Aims: This study examined the compliance of French children with physical activity (PA) guidelines, using objective assessments of PA. Methods: The study involved 252 children aged 9.9 ± 0.9 years, with mean height and weight of 1.39 ± 0.08 m and 35.8 ± 8.8 kg, respectively. Their usual PA was evaluated during a week using an Actigraph accelerometer. Results: The time spent in a moderate-to-vigorous PA (MVPA) ranged from 142 ± 44 min.d-1 to 25 ± 18 min/day according to the cut-offs used. Boys were significantly more active than girls (p ≤ .001). Overweight/obese children spent significantly less time in MVPA as determined with cut-off points at 3200 cpm (-26%) or 3600 cpm (-35%) (p < .01). Between 5% (8% of boys vs 1% of girls, p < .0001) and 9% (14% of boys vs 3% of girls, p < .0001) of children probably met the PA guidelines. No relationships were found with socioeconomic status. Conclusions: This high proportion of insufficiently active children (> 90%), together with the relatively high proportion of overweight children in this area, advocates a more aggressive PA promotion project, which should target all children whatever their social origins.

An architecture for online comparison and validation of processing methods and computerized guidelines in intensive care units

Clinical decision support systems are a combination of software techniques to help the clinicians in their medical decision making process via functionalities ranging from basic signal analysis to therapeutic planning and computerized guidelines. The algorithms providing all these functionalities must be very carefully validated on real patient data and must be confronted to everyday clinical practice. One of the main problems when developing these techniques is the difficulty to obtain high-quality complete patient records, comprising data coming both from the biomedical equipment (high-frequency signals), and from numerous other sources (therapeutics, imagery, clinical actions, etc.). In this paper, we present an infrastructure for developing and testing such software algorithms. It is based on a bedside workstation where testing different algorithms simultaneously on real-time data is possible in the ward. It is completed by a collaborative portal enabling different teams to test their software algorithms on the same patient records, making comparisons and cross-validations more easily.