Malik Haddam

Implementation of lung ultrasound in polyvalent intensive care unit: Impact on irradiation and medical cost.

OBJECTIVE To determine the effect of implementing a daily lung ultrasound round on the number of chest radiographs and chest computed tomography (CT) scans in a polyvalent intensive care unit (ICU). STUDY DESIGN Retrospective study comparing two consecutive periods. PATIENTS All patients hospitalized for longer than 48 hours in a polyvalent ICU. METHODS Implementation of a daily lung ultrasound round after a short educational program. The number of chest radiographs and chest CT scans and the patient outcome were measured before (group PRE) and after (group POST) the implementation of a daily lung ultrasound round. RESULTS No demographic difference was found between the two groups, with the exception of a higher severity score in the group POST. For each ICU stay, the number of chest radiographs was 10.3 ± 12.4 in the group PRE and 7.7 ± 10.3 in the group POST, respectively (P<0.005) The number of chest CT scans was not reduced in the group POST, as compared with the group PRE (0.5 ± 0.7 CT scan/patient/ICU stay versus 0.4 ± 0.6 CT scan/patient/ICU stay, P=0.01). The ICU mortality was similar in both groups (21% versus 22%, P=0.75) CONCLUSION: The implementation of a daily lung ultrasound round was associated with a reduction in radiation exposure and medical cost without altering patient outcome.

Strategies for Preventing Acute Renal Failure

The acute renal failure (ARF) is due to a decline in glomerular filtration rate, leading to the inability of the kidney to eliminate the degradation products of nitrogen metabolism. This is a common situation in anesthesiology and intensive care unit. We propose to detail the different measures of prevention of ARF. Three areas are emerging in our daily activities: prevention of contrast-induced nephropathy (CIN), prevention of ARF after major surgery, and prevention of ARF in intensive care unit (ICU).