Expériences d’utilisation d’hyperinsufflation chez l’enfant polyhandicapé trachéotomisé et ventilé

Children with severe cerebral palsy requiring invasive mechanical ventilation need respiratory physiotherapy. Hyperinsufflation to improve respiratory drainage and reduce pulmonary restriction, appears relevant. Invasive mechanical ventilation by VIVO 50 allows to set an hyperinsufflation profile as well as to display insufflate volume.     

Intrapulmonary percussion ventilation: operation and settings

Intrapulmonary Percussion Ventilation (IPV) was designed to promote airway clearance, to recruit areas of lung and to improve pulmonary gas exchange. Its principle is to administer bursts of small tidal volume at high frequency. This article describes IPV devices, especially the Phasitron(?), which provides a dynamic interface between the pneumatic source of gas and the patient. Although not fully understood, the principles of action are also discussed. Finally, available settings of IPV are proposed following two strategies. In patients with obstructive respiratory disease and ventilatory autonomy, the vibrations and percussions are applied with a frequency more than 300?cycles/min and pressure in the proximal airways ranging from 10-20cm. H(2)O. In patients with restrictive pulmonary disease but without ventilatory autonomy, IPV is expected to improve gas exchange. The frequency of percussion will be slower (80-200?cycles/min) but the proximal airway pressure may reach 40cm H(2)O. During the sessions, the frequency may be modified to alternate from a percussive pattern (high frequencies promoting the mobilization of secretions) to a ventilatory pattern (slow frequencies encouraging alveolar ventilation and clearance of secretions).     

Enquête nationale sur l’assistance circulatoire et respiratoire de courte durée en 2009

Objective

Indications for short-term circulatory and/or respiratory support (STCRS) increased during the last years. The goal of this survey was to characterize this activity in France in 2009.

Study design

Observational retrospective pluricentral.

Materiel and methods

Each center of cardiothoracic surgery received a questionnaire validated by the Société française de perfusion about the activity, materials and organization used for STCRS. Data were expressed as percentages or median (25–75 percentiles).

Results

Forty-one centers on 61 (67%) answered. STCRS was performed respectively by 33 (80.5 %), 36 (87.8 %) and 39 (95.1 %) of centers in 2007, 2008 and 2009 including 10 [4–26], 18 [6–29] and 18 [5–33] cases/center per year. In 2009, types of STCRS installed were veno-arterial in 39 centres (95.1 %), veno-venous in 27 (65.9 %) and Novalung^® in four (9.8 %), including 18 [5–32], five [2–7] and 15 [1–17] cases respectively. Twenty-nine centers (70.7%) installed STCRS outside the operating theater, and 24 (58.5%) in non-cardiothoracic surgery. A mobile circulatory support unit was created in eight centers (19.5%), however 21 (51.2%) have installed STCRS externally, at distances between 10 [5–55] to 100 [15–200] km, using emergency vehicles in most of the cases (90.5%), but helicopter seldom (19%).

Conclusion

STCRS has increased over the last few years in France. Externalized activity outside the operating theater was important, time-consuming and used hospital resources therefore modifying the professional activity of perfusionists.     

Impact d’une campagne de sensibilisation sur le cancer sur un échantillon de femmes en traitement pour un premier cancer du sein

In 2007, the French National Cancer Institute initiated a cancer communication campaign entitled “We are two million ordinary heroes”. Aims of this study were to investigate perceptions about this campaign, for 34 women treated for breast cancer. Triangulation of the reports from narratives and assessment of psychological variables ensures better validity of the data. Three psychological identification processes have been identified: identification with the hero character with a value of emotional repression; adherence to content “ordinary” with low-level of perceived self-efficacy; no identification in response to a double-bind message, with sense-making process about traumatic event. These findings underscore the need to promote communication health campaigns taking into account possible effects of media discourse on individuals and families struggling with cancer.