Ca veut dire quoi DJNNME ? Envoyé de mon iPhone
Le 31 août 2009 à 02:20, Axel Ellrodt <[email protected]> a écrit : Commentaire et articles intéressants en cette veille de ..... enfin à l'aube frémissante, non , tremblante de l'armagedon pour parler enflé. ---------- Forwarded message ---------- From: Stephen Streat (ADHB) <[email protected]> Date: 2009/8/30 Subject: RE: [CCM-L] A scary parable of H1N1 Notes: NZ: New Zealand FLAARDS : Flu-A-Associated-ARDS (acronyme moqueur du Dr Steve Webb) 1) H1N1 is not SARS or Ebola ... 2) Everyone working in NZ ICUs who was not either sick themselves with H1N1 (very very few) or looking after sick children at home (very few) came to work. 3) No-one in our unit caught it from a patient. I know of a couple of healthcare workers in other ICUs who got it (and were not hospitalised) but in whom it was thought that they caught it via "home" (via their children, from school etc). 4) It just reached "stage 2" of the 4-stage "disaster" scenario I talked about in Singapore a couple of years ago (attached FYI). (i.e. it was "A very large problem with preserved function of most of the hospital infrastructure"). 5) (ici, "private joke" sans intérêt) 6) Yes, Lou, perhaps one in eight to one in ten of those ventilated will "need" ECMO. Let me just say a couple of things (disclaimer I am NOT an ECMO practitioner) -- a) ECMO centres vary as to their criteria -- NZ has been (what do you expect) quite "harsh" and taken on patient who had P/F ratios of <50, and are failing despite "other manoeuvres" (high PEEP, reverse ratio, inhaled NO, prone position, aggressive diuresis/ultrafiltration). b) Severe FLAAARDS is associated with obesity -- some of it massive -- e.g. we had a patient who was 38w pregnant and weighed 175 kg, who survived without ECMO but took a month on IPPV -- and ECMO is technically VERY difficult in very obese people. Some patients who otherwise met ECMO criteria were not treated with ECMO because of massive obesity. 7) As I've said many times -- shunt reduction manoeuvres (high mean airway pressures, inhaled NO) were often surprisingly effective. We used NO and do not use prostacyclin. I know some Aussies did use inhaled prostacyclin and were less than impressed with it. Be slow to wean the PEEP below 15 or so (if you once needed 20 to get adequate oxygenation). Beware barotrauma, even WITH strich conformance to ARDSnet parameters. 8) We had one patient with pancreatitis Lou, no other specific surgical issues came to light with this that I know of in NZ. 9) Here is a rapid response publication which tells a great deal about the national health impact -- http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19319 Those people who would like to know "population estimates" should read it carefully. Of course, it may have different epidemic characteristics in different countries, and it may also have marked regionally variable impacts. PDF from journal not yet available -- so I made one from printer-version plus figures (attached) if you would like that (easier to print and read). Home-made it is 5 MB -- hence yousendit. https://download.yousendit.com/cmczaXRDSWVENlJFQlE9PQ And Scale in : Ethics and the standard of care File will remain active for: 7 days https://rcpt.yousendit.com/732876303/b8def7639c9ce530992c3d4dfc2062e8 (Colin McArthur, final author, is our Clinical Director in DCCM). ;-) S Stephen Streat FRACP Intensivist, DCCM http://www.adhb.govt.nz/dccm P: +64 9 307 2892 F: +64 9 307 4927 Clinical Director, Organ Donation New Zealand http://www.donor.co.nz/ P : +64 9 630 9812 F : +64 9 630 6490 [email protected] -- Ecrit sans les doigts par télépathie et envoyé de ma montre Cartier iWatch, tralalèèè-re Dr Axel Ellrodt, MD, DJNNME Verrières le Buisson, France ========== "Well, good night" Hamlet, act 1, scene 1. W S (1603) "Il ouvrit la porte et sortit " Alexandre Dumas fils. Aventures de quatre femmes et d'un perroquet. -- Ecrit sans les doigts par télépathie et envoyé de ma montre Cartier iWatch, tralalèèè-re Dr Axel Ellrodt, MD, DJNNME Verrières le Buisson, France ========== "Well, good night" Hamlet, act 1, scene 1. W S (1603) "Il ouvrit la porte et sortit " Alexandre Dumas fils. Aventures de quatre femmes et d'un perroquet.
