RECHERCHES SCIENTIFIQUES

INTERET DE L’ECHOGRAPHIE EN ANESTHESIE ET REANIMATION: EXPERIENCE DU SERVICE D’ANESTHESIE ET REANIMATION A4 DU CHU HASSAN II FES (Aproposde253cas)

Référence1353
Année2014
TypeThèse
Lien document
AuteurEz-zouaq I
DisciplineRéanimation Polyvalente 1
EncadrantSbai H

Introduction: the use of ultrasound in the ICU is currently developing as a result of its employment in many indications. The main purpose of this study was to report the experience of the anesthesia intensive care unit -team A4 on the use of ultrasound in resuscitation and operating room. Material and Methods : it is a descriptive and analytical prospective study spanning 2 years, from May 2012 to May 2014 and included all patients who underwent ultrasound examination (transthoracic echocardiography, poses ultrasound guided CVC, lung ultrasound, and Ultrasound-guided regional anesthesia) which was fulfilled by the team A4 in the department of anesthesia and resuscitation CHU Hassan II of Fez. Results: during the study period, 253 patients underwent 270 examinations which: 212 Ultrasound-guided (USG) insertion of CVCs (78.5%) : the main indication was the laying ultrasound-guided catheter implantable chamber (67%), the success rate was 100% with the onset of 6 mechanical complications (2.8%); 28 echocardiography (10.5%) for 22 patients: the main indications were hemodynamic instability 7 (32%), respiratory distress 5 (23%), and 4 decompensation of heart disease (18%). 26 examinations (93%) had abnormalities: hypovolaemia (36%), right heart dysfunction (21.4%), systolic LV dysfunction (7%), diastolic dysfunction of the LV (7%), mitral valve disease (7%) , in the atrium (3.6%). 19 patients underwent a change in therapeutic management after transthoracic echocardiography (86.4% of patients who had echocardiography); 19 lung ultrasound (7% of exams): indications were pleural effusion syndrome (37%), thoracic trauma (26%), respiratory distress (16%). Diagnoses were identified 6 cases of pneumothorax, and 13 cases of pleural fluid effusion; 11 Ultrasound-guided regional anesthesia (7% of exams): 6 TAP block having as a surgical indication the postoperative analgesia abdominopelvic surgery with 100% success, and 5 blocks of the intermediate cervical plexus with the occurrence of one failure after neurological complication. 39 physicians participated to this study. 51.3% of residents, 41% of internals doctors and 7.7% of seniors. Only one professor has diploma training in the use of ultrasound and was responsible for the learning of the senior beside of residents in their current specialty. Conclusion: This study confirms that ultrasound practice has become the “extension” of the intensivist in the management of unstable patients. We have demonstrated the feasibility and effectiveness of this technique in our service whatsoever in the implementation of Ultrasound-guided (USG) insertion of CVCs, hemodynamic and respiratory management of critically ill patients, or the practice of Ultrasound guided regional anesthesia. However, the training in ultrasonic requires intensified education programs, and must be put into consideration.