Transplantation of kidneys from uncontrolled donation after circulatory determination of death: Comparison with brain death donors with or without extended criteria and impact of normothermic regional perfusion
Demiselle J.,Angers University Hospital Center |
Demiselle J.,University of Angers |
Augusto J.-F.,Angers University Hospital Center |
Augusto J.-F.,University of Angers |
And 10 more authors.
Transplant International | Year: 2016
The aim of this study was to compare the outcomes of kidney transplants from uncontrolled DCD (uDCD) with kidney transplants from extended (ECD) and standard criteria donors (SCD). In this multicenter study, we included recipients from uDCD (n = 50), and from ECD (n = 57) and SCD (n = 102) who could be eligible for a uDCD program. We compared patient and graft survival, and kidney function between groups. To address the impact of preservation procedures in uDCD, we compared in situ cold perfusion (ICP) with normothermic regional perfusion (NRP). Patient and graft survival rates were similar between the uDCD and ECD groups, but were lower than the SCD group (P < 0.01). Although delayed graft function (DGF) was more frequent in the uDCD group (66%) than in the ECD (40%) and SCD (27%) groups (P = 0.08 and P < 0.001), graft function was comparable between the uDCD and ECD groups at 3 months onwards post-transplantation. The use of NRP in the uDCD group (n = 19) was associated with a lower risk of DGF, and with a better graft function at 2 years post-transplantation, compared to ICP-uDCD (n = 31) and ECD. In conclusion, the use of uDCD kidneys was associated with post-transplantation results comparable to those of ECD kidneys. NRP preservation may improve the results of uDCD transplantation. © 2015 Steunstichting ESOT. Source
Tourtier J.-P.,Military Hospital Val de Grace |
Forsans E.,Military Hospital Val de Grace |
Leclerc T.,Military Hospital Val de Grace |
Libert N.,Military Hospital Val de Grace |
And 4 more authors.
European Journal of Emergency Medicine | Year: 2011
OBJECTIVE: Exacerbation of asthma can be seen during air transport. Severe patients, not responding to conventional therapy, require ventilator support. We evaluated the performance of two transport ventilators, built with turbine technology, the T-birdVSO2 and the LTV-1000, for use during aeromedical evacuation of acute severe asthma. We have assessed the ability of both the ventilators to deliver to an acute severe asthma model a tidal volume (Vt) set at different simulated altitudes, by changing the ambient air pressure. METHODS: The simulated cabin altitudes were 1500, 2500, and 3000 m (decompression chamber). Vt was set at 700 and 400 ml in an acute severe asthma lung model. Comparisons of the preset with the actual measured values were accomplished using a t-test. RESULTS: Comparisons between the actual delivered Vt and set Vt showed a significant difference starting at 1500 m for both the ventilators. The T-birdVSO2 showed a decrease in the volume delivered, with a negative variation of more than 10% compared with the Vt set. The LTV-1000 showed mostly an increase in the volume delivered. The delivered Vt remained within 10% of the set Vt. CONCLUSION: The accuracy of Vt delivery was superior with the LTV-1000 than with the T-birdVSO2, but the higher delivered Vt of the LTV-1000 are likely to be more harmful than lower delivered Vt of the T-birdVSO2. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source
Capuano F.,EHESP School of Public Health |
Lot A.-S.,EHESP School of Public Health |
Sagnes-Raffy C.,Observatoire des Urgences Midi Pyrenees ORU MiP |
Ferrua M.,EHESP School of Public Health |
And 7 more authors.
European Journal of Emergency Medicine | Year: 2015
Objectives The length of stay in the emergency department (ED) has been proposed as an indicator of performance in many countries. We conducted a survey of length of stay in two large areas in France and tested the hypothesis that patient and ED-related variables may influence it. Patients and methods During 2007, we examined lengths of stay in ambulatory patients, that is, excluding admitted patients. The following variables were considered: (a) at the patient level, age, sex, the day and month of the visit, and the French clinical classification of emergency patients (CCEP) class; (b) at the ED level, annual ED total number of visits, mean age, the proportions of patients less than 15 and more than 75 years, and the proportions of admitted and clinically stable patients with CCEP class 1 and 2. A multilevel hierarchical analysis was carried out. Results We analyzed 988 591 visits in 53 EDs. The ED-specific median length of stay was 98 (IQR: 62-137) min and the ED-specific median proportion of patients with length of stay of more than 4 h was 15 (5-24) %. There was a strong correlation between the ED-specific median length of stay and the ED-specific proportion of patients with a length of stay of more than 4 h (R = 0.96, P < 0.001). Using a multilevel analysis, only three variables were associated significantly with the length of stay: the age and the CCEP class of the patient, and the ED census. Conclusion We observed that the length of stay in the ED needs to be stratified by case mix and the total number of visits of the ED. © 2015 Wolters Kluwer Health, Inc. Source
Arvieux C.,Grenoble University Hospital Center |
Thony F.,Grenoble University Hospital Center |
Broux C.,Grenoble University Hospital Center |
Rancurel E.,SAMU |
And 4 more authors.
Journal de Chirurgie Viscerale | Year: 2012
Mortality associated with pelvic and perineal trauma (PPT) has fallen from 25 to 10% in the last decade thanks to progress accomplished in medical, surgical and interventional radiology domains (Dyer and Vrahas, 2006 ). The management strategy depends on the hemodynamic status of the patient (stable, unstable or extremely unstable). Open trauma requires specific treatment in addition to control of bleeding. All surgical centers can be confronted some day with patients with hemorrhagic PPT and for this reason, all surgeons should be familiar with the initial management. In expert centers, management of patients with severe PPT is complex, multidisciplinary and often requires several re-interventions (Eckroth-Bernard and Davis, 2010 ). Obstetrical and sexual trauma, also requiring specific management, will not be dealt with herein. © 2012 Elsevier Masson SAS. All rights reserved. Source
A novel, simple, inexpensive and reusable model for learning and practice ultrasound-guided central vein cannulation [Un modelo nuevo, sencillo, económico y reutilizable para el aprendizaje y práctica de la canalización ecoguiada de vías centrales]
Sorribes del Castillo J.,SAMU |
Sorribes del Castillo J.,CEU Cardenal Herrera University |
Sorribes del Castillo J.,Instituto Valenciano para la Formacion en Emergencias IVAFER |
Fernandez-Gallego V.,CEU Cardenal Herrera University |
And 4 more authors.
Educacion Medica | Year: 2016
Introduction Central venous access is an essential technique in emergency medicine and the utility of emergency ultrasound to guide this procedure has been widely demonstrated. We have developed a tissue model for training and development of skills the vascular access by echography. Material and methods The tissue model consists of a block of ham into which tunnels are carved (to imitate blood vessels). At the end of these tunnels, 13/16 mm irrigation connectors are attached, as well as three-way stopcocks and an intravenous crystalloid bag (i.e.: lactated Ringer's solution or normal saline) to which colorant may be added. Results The ultrasound image of the tunnel full of liquid simulates a blood vessel. It is possible to carry out ultrasound-guided punctures of the tunnel multiple times (>10 times), keeping the vessel full of fluid and maintain the functional integrity due to the continuous drip system. Conclusions We present a cheap and time-effective alternative for ultrasound-guided central vein cannulation using a block of ham and easily available components. The ham model can be added to the existing models used for ultrasound-guided techniques for vascular access, and can be used multiple times. © 2016 Elsevier España, S.L.U. Source