gilles brezac - Profile on Academia.edu (original) (raw)

Papers by gilles brezac

Revue de chirurgie orthopédique et réparatrice de l'appareil moteur.., Nov 1, 2007

European Journal of Trauma and Emergency Surgery, Jan 9, 2018

Purpose To describe the most severe casualties from the July 14th, 2016 terror attack in Nice tha... more Purpose To describe the most severe casualties from the July 14th, 2016 terror attack in Nice that were treated at the Lenval University Children's Hospital (LUCH) of Nice (France). Methods Retrospective study about casualties treated at LUCH from Bastille Day Attack with injuries resulting in the need for surgery, resuscitation, or death. The type of lesions and surgery, duration of hospitalizations, complications, psychological status, and outcome at discharge were collected. Results Eleven patients presented severe traumas including three adults. They were triaged and managed first by the Critical Care Physician on duty and by emergency room nurses with no additional staff. Six pediatric casualties needed surgery; seven patients were hospitalized in Pediatric Intensive Care Unit (PICU). Five deaths were reported. The most relevant injuries were: pelvic disjunction, lower limb fracture, vascular injuries, and head or trunk crush. As soon as it was possible, two surgeons attended the emergency room (ER) to help carry out the triage. Overall we performed twenty-eight surgeries, including two neurological, one vascular, and five orthopedic. We performed closed reduction and internal fixation (CRIF) in three cases of limb fractures. A compartment syndrome was observed. Stress disorders were observed in three patients, which merited psychiatric support and treatment. Conclusion We faced uncommon situations with severe casualties without pre-hospital management. The presence of adult patients and unusual lesions increased the complexity. The presence of surgeons in the ER seemed useful for effective clinical decision-making. CRIF has been a valid option for damage control. Competence in vascular, neurological, major trauma surgery and psychic trauma should be available in any pediatric trauma center.

Anesthesiology, Feb 1, 2004

Background: Early onset pneumonia occurs frequently in head trauma patients, but the potential co... more Background: Early onset pneumonia occurs frequently in head trauma patients, but the potential consequences and the risk factors of this event have been poorly studied. Methods: This prospective observational study was undertaken in the surgical intensive care unit of a university teaching hospital in Clichy, France. Head trauma patients requiring tracheal intubation for neurologic reasons and ventilation for at least 2 days were studied to assess the risk factors and the consequences of early onset pneumonia. Results: During a 2-yr period, 109 head trauma patients were studied. The authors found an incidence of early onset pneumonia of 41.3%. Staphylococcus aureus was the most common bacteria involved in early onset pneumonia. Patients with early onset pneumonia had a lower worst arterial oxygen tension: fraction of inspired oxygen ratio, more fever, more arterial hypotension, and more intracranial hypertension, factors known to worsen the neurologic prognosis of head trauma patients. Nasal carriage of S. aureus on admission (odds ratio, 5.1; 95% confidence interval, 1.9 -14.0), aspiration before intubation (odds ratio, 5.5; 95% confidence interval, 1.9 -16.4) and barbiturate use (odds ratio, 3.9; 95% confidence interval, 1.2-12.8) were found to be independent risk factors of early onset pneumonia. Conclusions: The results suggest that early onset pneumonia leads to secondary injuries in head-injured patients. Nasal carriage of S. aureus, aspiration before intubation, and use of barbiturates are specific independent risk factors for early onset pneumonia and must be assessed to find and evaluate strategies to prevent early onset pneumonia.

Attentat de Nice en 2016 : implication d’un hopital pediatrique

Médecine de Catastrophe - urgences collectives, Apr 1, 2020

Resume Le 14 juillet 2016 a 22h35, lors de l’attentat de Nice, l’hopital pediatrique Lenval (HPL)... more Resume Le 14 juillet 2016 a 22h35, lors de l’attentat de Nice, l’hopital pediatrique Lenval (HPL), a du faire face a un afflux massif de victimes (AMAVI). L’alerte reelle a ete donnee par la concordance entre les reseaux sociaux, les appels des professionnels presents sur les lieux et l’arrivee des premieres victimes. Au total, 47 patients (35 enfants et 12 adultes, dont 11 urgences absolues (UA) et 36 urgences relatives (UR) ont ete accueillis a l’HPL en 90 min. Les RetEx ont permis de mettre en evidence les difficultes rencontrees sur le plan organisationnel, de la communication et de l’identitovigilance. Dans le cadre de la demarche-qualite, un groupe plan blanc pluridisciplinaire a ete cree avec pour mission de revoir les procedures du plan blanc, changer les mentalites et les comportements : un enseignement transversal (AMAVI, damage control) a ete mis en place pour sensibiliser les soignants, de nouveaux materiels ont ete acquis, les professionnels referents ont beneficie de nouvelles formations, des exercices avec plastrons ont ete programmes, un rapprochement et une collaboration avec les hopitaux adultes et pediatriques, en region PACA et en France ont ete developpes. L’HPL est desormais equipe en lot PSM adulte, en chariots de tri specifique SSE, en dossier d’admission en mode degrade pret a l’utilisation et en dossiers medicaux adaptes (selon le modele AMAVI). Le dernier equipement en cours de finalisation est l’installation de chaines de decontamination. Le contexte psychogene tres particulier a necessite une prise en charge du psychotraumatisme, aussi bien pour les victimes de l’attentat que pour le personnel soignant. Malgre cette prise en charge, environ 40 % du personnel des urgences, de la reanimation et du bloc ont ete renouveles lors du premier semestre 2017.

Enquête nationale SFAR-ADARPEF – Partie 1 : quels enjeux pour la formation continue en anesthésie pédiatrique ?

Anesthésie & Réanimation

Une étude prospective (Ropivacaïne 0.2% versus association Bupivacaïne 0.25% et Lidocaïne 1% pour le bloc ilioinguinal et iliohypogastrique dans la chirurgie du canal péritonéovaginal en pédiatrie)

La bupivacaïne a longtemps été l'anesthésique local de référence pour les blocs nerveux périp... more La bupivacaïne a longtemps été l'anesthésique local de référence pour les blocs nerveux périphériques. La ropivacaïne, commercialisée depuis 1996, est un anesthésique local à liaison amide, de longue durée d'action, sous forme énantiomère pure. Elle est réputée pour sa moindre toxicité cardiaque et neurologique. Sa durée d'action plus longue que celle de la bupivacaïne permettrait d'obtenir une analgésie post opératoire durable avec une moindre consommation d'antalgiques par voie systémique. Matériel et méthodes : Nous avons mené une étude prospective en chirurgie pédiatrique. Les enfants inclus ont bénéficié d'un bloc ilio-inguinal et ilio-hypogastrique (BII et IH) pour une chirurgie de la région inguinale. Les enfants du groupe R ont reçu 0.5 ml.kg-1 de ropivacaïne à 2 mg.ml-1 et, ceux du groupe B, 0.5 ml.kg-1 d'un mélange 50% de bupivacaïne à 2.5 mg.ml-1 avec 50% de lidocaïne adrénalinée à 10 mg.ml-1. Résultats : 40 enfants, dont 20 dans chaque groupe,...

Risk Factors and Consequences in Head Trauma Patients

Background: Early onset pneumonia occurs frequently in head trauma patients, but the potential co... more Background: Early onset pneumonia occurs frequently in head trauma patients, but the potential consequences and the risk factors of this event have been poorly studied. Methods: This prospective observational study was undertaken in the surgical intensive care unit of a university teaching hospital in Clichy, France. Head trauma patients requiring tracheal intubation for neurologic reasons and ventilation for at least 2 days were studied to assess the risk factors and the consequences of early onset pneumonia. Results: During a 2-yr period, 109 head trauma patients were studied. The authors found an incidence of early onset pneumonia of 41.3%. Staphylococcus aureus was the most common bacteria involved in early onset pneumonia. Patients with early onset pneumonia had a lower worst arterial oxygen tension: fraction of inspired oxygen ratio, more fever, more arterial hypotension, and more intracranial hypertension, factors known to worsen the neurologic prognosis of head trauma patien...

Anaesthesia Critical Care & Pain Medicine, 2020

§ Guidelines from the French Society of Anaesthesia and Intensive Care Medicine (Socié té françai... more § Guidelines from the French Society of Anaesthesia and Intensive Care Medicine (Socié té française d'anesthé sie et de ré animation-SFAR), in collaboration with the Association of French-speaking paediatric anaesthesiologists and intensivists (Association des anesthé sistes ré animateurs pé diatriques d'expression française-ADARPEF).

The Lancet. Respiratory medicine, May 28, 2017

Little is known about the incidence of severe critical events in children undergoing general anae... more Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered w...

Anesthesiology, 2004

Background Early onset pneumonia occurs frequently in head trauma patients, but the potential con... more Background Early onset pneumonia occurs frequently in head trauma patients, but the potential consequences and the risk factors of this event have been poorly studied. Methods This prospective observational study was undertaken in the surgical intensive care unit of a university teaching hospital in Clichy, France. Head trauma patients requiring tracheal intubation for neurologic reasons and ventilation for at least 2 days were studied to assess the risk factors and the consequences of early onset pneumonia. Results During a 2-yr period, 109 head trauma patients were studied. The authors found an incidence of early onset pneumonia of 41.3%. Staphylococcus aureus was the most common bacteria involved in early onset pneumonia. Patients with early onset pneumonia had a lower worst arterial oxygen tension:fraction of inspired oxygen ratio, more fever, more arterial hypotension, and more intracranial hypertension, factors known to worsen the neurologic prognosis of head trauma patients. ...

Enquête nationale SFAR-ADARPEF – Partie 2 : quelles étaient les conditions de l’exercice professionnel de l’anesthésie pédiatrique en 2021 ?

Anesthésie & Réanimation

Revue de chirurgie orthopédique et réparatrice de l'appareil moteur.., Nov 1, 2007

European Journal of Trauma and Emergency Surgery, Jan 9, 2018

Purpose To describe the most severe casualties from the July 14th, 2016 terror attack in Nice tha... more Purpose To describe the most severe casualties from the July 14th, 2016 terror attack in Nice that were treated at the Lenval University Children's Hospital (LUCH) of Nice (France). Methods Retrospective study about casualties treated at LUCH from Bastille Day Attack with injuries resulting in the need for surgery, resuscitation, or death. The type of lesions and surgery, duration of hospitalizations, complications, psychological status, and outcome at discharge were collected. Results Eleven patients presented severe traumas including three adults. They were triaged and managed first by the Critical Care Physician on duty and by emergency room nurses with no additional staff. Six pediatric casualties needed surgery; seven patients were hospitalized in Pediatric Intensive Care Unit (PICU). Five deaths were reported. The most relevant injuries were: pelvic disjunction, lower limb fracture, vascular injuries, and head or trunk crush. As soon as it was possible, two surgeons attended the emergency room (ER) to help carry out the triage. Overall we performed twenty-eight surgeries, including two neurological, one vascular, and five orthopedic. We performed closed reduction and internal fixation (CRIF) in three cases of limb fractures. A compartment syndrome was observed. Stress disorders were observed in three patients, which merited psychiatric support and treatment. Conclusion We faced uncommon situations with severe casualties without pre-hospital management. The presence of adult patients and unusual lesions increased the complexity. The presence of surgeons in the ER seemed useful for effective clinical decision-making. CRIF has been a valid option for damage control. Competence in vascular, neurological, major trauma surgery and psychic trauma should be available in any pediatric trauma center.

Anesthesiology, Feb 1, 2004

Background: Early onset pneumonia occurs frequently in head trauma patients, but the potential co... more Background: Early onset pneumonia occurs frequently in head trauma patients, but the potential consequences and the risk factors of this event have been poorly studied. Methods: This prospective observational study was undertaken in the surgical intensive care unit of a university teaching hospital in Clichy, France. Head trauma patients requiring tracheal intubation for neurologic reasons and ventilation for at least 2 days were studied to assess the risk factors and the consequences of early onset pneumonia. Results: During a 2-yr period, 109 head trauma patients were studied. The authors found an incidence of early onset pneumonia of 41.3%. Staphylococcus aureus was the most common bacteria involved in early onset pneumonia. Patients with early onset pneumonia had a lower worst arterial oxygen tension: fraction of inspired oxygen ratio, more fever, more arterial hypotension, and more intracranial hypertension, factors known to worsen the neurologic prognosis of head trauma patients. Nasal carriage of S. aureus on admission (odds ratio, 5.1; 95% confidence interval, 1.9 -14.0), aspiration before intubation (odds ratio, 5.5; 95% confidence interval, 1.9 -16.4) and barbiturate use (odds ratio, 3.9; 95% confidence interval, 1.2-12.8) were found to be independent risk factors of early onset pneumonia. Conclusions: The results suggest that early onset pneumonia leads to secondary injuries in head-injured patients. Nasal carriage of S. aureus, aspiration before intubation, and use of barbiturates are specific independent risk factors for early onset pneumonia and must be assessed to find and evaluate strategies to prevent early onset pneumonia.

Attentat de Nice en 2016 : implication d’un hopital pediatrique

Médecine de Catastrophe - urgences collectives, Apr 1, 2020

Resume Le 14 juillet 2016 a 22h35, lors de l’attentat de Nice, l’hopital pediatrique Lenval (HPL)... more Resume Le 14 juillet 2016 a 22h35, lors de l’attentat de Nice, l’hopital pediatrique Lenval (HPL), a du faire face a un afflux massif de victimes (AMAVI). L’alerte reelle a ete donnee par la concordance entre les reseaux sociaux, les appels des professionnels presents sur les lieux et l’arrivee des premieres victimes. Au total, 47 patients (35 enfants et 12 adultes, dont 11 urgences absolues (UA) et 36 urgences relatives (UR) ont ete accueillis a l’HPL en 90 min. Les RetEx ont permis de mettre en evidence les difficultes rencontrees sur le plan organisationnel, de la communication et de l’identitovigilance. Dans le cadre de la demarche-qualite, un groupe plan blanc pluridisciplinaire a ete cree avec pour mission de revoir les procedures du plan blanc, changer les mentalites et les comportements : un enseignement transversal (AMAVI, damage control) a ete mis en place pour sensibiliser les soignants, de nouveaux materiels ont ete acquis, les professionnels referents ont beneficie de nouvelles formations, des exercices avec plastrons ont ete programmes, un rapprochement et une collaboration avec les hopitaux adultes et pediatriques, en region PACA et en France ont ete developpes. L’HPL est desormais equipe en lot PSM adulte, en chariots de tri specifique SSE, en dossier d’admission en mode degrade pret a l’utilisation et en dossiers medicaux adaptes (selon le modele AMAVI). Le dernier equipement en cours de finalisation est l’installation de chaines de decontamination. Le contexte psychogene tres particulier a necessite une prise en charge du psychotraumatisme, aussi bien pour les victimes de l’attentat que pour le personnel soignant. Malgre cette prise en charge, environ 40 % du personnel des urgences, de la reanimation et du bloc ont ete renouveles lors du premier semestre 2017.

Enquête nationale SFAR-ADARPEF – Partie 1 : quels enjeux pour la formation continue en anesthésie pédiatrique ?

Anesthésie & Réanimation

Une étude prospective (Ropivacaïne 0.2% versus association Bupivacaïne 0.25% et Lidocaïne 1% pour le bloc ilioinguinal et iliohypogastrique dans la chirurgie du canal péritonéovaginal en pédiatrie)

La bupivacaïne a longtemps été l'anesthésique local de référence pour les blocs nerveux périp... more La bupivacaïne a longtemps été l'anesthésique local de référence pour les blocs nerveux périphériques. La ropivacaïne, commercialisée depuis 1996, est un anesthésique local à liaison amide, de longue durée d'action, sous forme énantiomère pure. Elle est réputée pour sa moindre toxicité cardiaque et neurologique. Sa durée d'action plus longue que celle de la bupivacaïne permettrait d'obtenir une analgésie post opératoire durable avec une moindre consommation d'antalgiques par voie systémique. Matériel et méthodes : Nous avons mené une étude prospective en chirurgie pédiatrique. Les enfants inclus ont bénéficié d'un bloc ilio-inguinal et ilio-hypogastrique (BII et IH) pour une chirurgie de la région inguinale. Les enfants du groupe R ont reçu 0.5 ml.kg-1 de ropivacaïne à 2 mg.ml-1 et, ceux du groupe B, 0.5 ml.kg-1 d'un mélange 50% de bupivacaïne à 2.5 mg.ml-1 avec 50% de lidocaïne adrénalinée à 10 mg.ml-1. Résultats : 40 enfants, dont 20 dans chaque groupe,...

Risk Factors and Consequences in Head Trauma Patients

Background: Early onset pneumonia occurs frequently in head trauma patients, but the potential co... more Background: Early onset pneumonia occurs frequently in head trauma patients, but the potential consequences and the risk factors of this event have been poorly studied. Methods: This prospective observational study was undertaken in the surgical intensive care unit of a university teaching hospital in Clichy, France. Head trauma patients requiring tracheal intubation for neurologic reasons and ventilation for at least 2 days were studied to assess the risk factors and the consequences of early onset pneumonia. Results: During a 2-yr period, 109 head trauma patients were studied. The authors found an incidence of early onset pneumonia of 41.3%. Staphylococcus aureus was the most common bacteria involved in early onset pneumonia. Patients with early onset pneumonia had a lower worst arterial oxygen tension: fraction of inspired oxygen ratio, more fever, more arterial hypotension, and more intracranial hypertension, factors known to worsen the neurologic prognosis of head trauma patien...

Anaesthesia Critical Care & Pain Medicine, 2020

§ Guidelines from the French Society of Anaesthesia and Intensive Care Medicine (Socié té françai... more § Guidelines from the French Society of Anaesthesia and Intensive Care Medicine (Socié té française d'anesthé sie et de ré animation-SFAR), in collaboration with the Association of French-speaking paediatric anaesthesiologists and intensivists (Association des anesthé sistes ré animateurs pé diatriques d'expression française-ADARPEF).

The Lancet. Respiratory medicine, May 28, 2017

Little is known about the incidence of severe critical events in children undergoing general anae... more Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered w...

Anesthesiology, 2004

Background Early onset pneumonia occurs frequently in head trauma patients, but the potential con... more Background Early onset pneumonia occurs frequently in head trauma patients, but the potential consequences and the risk factors of this event have been poorly studied. Methods This prospective observational study was undertaken in the surgical intensive care unit of a university teaching hospital in Clichy, France. Head trauma patients requiring tracheal intubation for neurologic reasons and ventilation for at least 2 days were studied to assess the risk factors and the consequences of early onset pneumonia. Results During a 2-yr period, 109 head trauma patients were studied. The authors found an incidence of early onset pneumonia of 41.3%. Staphylococcus aureus was the most common bacteria involved in early onset pneumonia. Patients with early onset pneumonia had a lower worst arterial oxygen tension:fraction of inspired oxygen ratio, more fever, more arterial hypotension, and more intracranial hypertension, factors known to worsen the neurologic prognosis of head trauma patients. ...

Enquête nationale SFAR-ADARPEF – Partie 2 : quelles étaient les conditions de l’exercice professionnel de l’anesthésie pédiatrique en 2021 ?

Anesthésie & Réanimation