Quadriceps femoris thickness decrease, proposed as a surrogate for muscle mass, is an early, frequent, and intense phenomenon in PICU. Quadriceps femoris ultrasonography is a reliable technique to monitor this process and in future could help to guide rehabilitation and nutrition interventions.

Objectives: Malnutrition and faltering growth at PICU admission have been related to suboptimal outcomes. However, little is known about nutritional status deterioration during PICU stay, as critical illness is characterized by a profound and complex metabolism shift, which affects energy requirements and protein turnover. We aim to describe faltering growth occurrence during PICU stay. Design: Single-center prospective observational study. Setting: Twenty-three-bed general PICU, Lyon, France. Patients: All critically ill children 0–18 years old with length of stay longer than 5 days were included (September 2013–December 2015). Interventions: Weight and height/length were measured at admission, and weight was monitored during PICU stay, in order to calculate body mass index for age z score. Faltering growth was defined as body mass index z score decline over PICU stay. Children admitted during the first year of the study and who presented with faltering growth were followed after PICU discharge for 3 months. Measurements and Main Results: We analyzed 579 admissions. Of them, 10.2% presented a body mass index z score decline greater than 1 sd and 27.8% greater than 0.5. Admission severity risk scores and prolonged PICU stay accounted for 4% of the variability in nutritional status deterioration. Follow-up of post-PICU discharge nutritional status showed recovery within 3 months in most patients. Conclusions: Nutritional deterioration is frequent and often intense in critically ill children with length of stay greater than 5 days. Future research should focus on how targeted nutritional therapies can minimize PICU faltering growth and improve post-PICU rehabilitation.

Intensive care unit professionals have experience in critical care and its proportionality, collegial decision-making, withholding or withdrawal of treatment deemed futile, and communication with patients’ relatives. These elements rely on ethical values from which we must not deviate in a pandemic situation. The recommendations made by the Ethics Commission of the French Intensive Care Society reflect an approach of responsibility and solidarity towards our citizens regarding the potential impact of a pandemic on critical care resources in France, with the fundamental requirement of respect for human dignity and equal access to health care for all.

No abstract

Surgical site infections (SSI) increase length of stay, morbidity, mortality and cost of hospitalization. Staphylococcus aureus (SA) carriage is a known risk factor of SSI in adults, but its role in pediatrics remains uncertain. The main objective of this pilot prospective monocentric cohort study was to describe the prevalence of SA colonization in children under 1 year old before cardiac surgery. The secondary objectives were to compare the incidence of SSI and other nosocomial infections (NI) between preoperative carriers and non-carriers. From May 2012 to November 2013, all children <1 year old undergoing cardiac surgery under cardiopulmonary bypass underwent preoperative methicillin-resistant (MRSA) and methicillin-sensitive SA (MSSA) screening using real-time PCR. The only exclusion criterion was invalid PCR. All patients were followed up to 1 year after the surgery regarding SSI and other nosocomial infections. Among the 68 studied patients, SA colonization prevalence was 26.5%, comprising 23.5% MSSA and 2.9% MRSA. There was no significant difference between colonized and non-colonized children regarding SSI rate (16.7 vs 20%; p = 0.53), but ventilator-associated pneumonia rate was significantly higher among the SA carriers (22.2 vs 2%; p < 0.05). The colonization rate was different depending on the age of the patients (p < 0.05). This pilot study highlights that colonization with MSSA is frequent whereas MRSA prevalence is low in our population. In this cohort, there was no association between SA colonization and SSI incidence but further studies are needed to analyze this association.

No abstract

Dans les services de soins aigus, comme en réanimation, où l’intégrité physique et psychique des patients est atteinte, le somatique prime mais il est inéluctablement imprégné de la dimension émotionnelle. Les études actuelles témoignent d’ailleurs d’un vécu émotionnel intense et souvent bouleversant, tant pour les patients et leurs proches, que pour les soignants. Le psychologue prend donc place dans cette triangulation patient-famille-soignant afin de préserver la place de la dimension émotionnelle au sein des services de réanimation, et de proposer un accompagnement psychologique adapté. A partir d’un cas clinique, cet article a pour objectif de clarifier, pour les soignants de réanimation, le rôle du psychologue : les demandes implicites/explicites du patient, de ses proches, et des soignants sont identifiées ; des axes de travail du psychologue sont proposés et expliqués ; il est montré comment le psychologue se saisit de ces demandes pour accompagner patient, famille et soignants.

Les médicaments sédatifs, utilisés au quotidien dans les services de réanimation adultes et pédiatriques, peuvent être source de nombreuses complications, en particulier si le niveau de sédation est inadéquat. Leur utilisation la plus adaptée possible à chaque patient apparaît donc indispensable et les protocoles de sédation sont un outil intéressant. Les plus étudiés sont les protocoles d'interruption quotidienne de la sédation et les protocoles d'adaptation de dose par les infirmières au lit du patient en fonction d'échelles précises. Les études en médecine adulte sont nombreuses et ont démontré leur intérêt en termes de réduction des complications. La littérature pédiatrique, même si elle est prometteuse, est encore insuffisante pour déterminer leur place en pratique clinique.