Proceedings of Réanimation 2019, the French Intensive Care Society International Congress

Ann. Intensive Care 2019, 9(Suppl 1):40 https://doi.org/10.1186/s13613-018-0474-7 MEETING ABSTRACTS Open Access Proceedings of Réanimation 2019, the French Intensive Care Society International Congress France. 23–25 January 2019 Published: 29 March 2019 Oral communications Oral communications: Physiotherapists COK‑1 Bench assessment of the effect of a collapsible tube on the efficacy of a mechanical insufflation‑exsufflation device Romain Lachal (speaker) Réanimation médicale, Hôpital de la Croix‑Rousse, Hospices Civils de Lyon, Lyon, FRANCE Correspondence: Romain Lachal ‑ Annals of Intensive Care 2019, 9(Suppl 1):COK-1 Introduction: Mechanical Insufflation-Exsufflation (MI-E) by using a specific device is commonly used to increase weak cough, as in patients with chronic neuromuscular weakness or in intensive care unit (ICU) patients with ICU-acquired neuro-myopathy. The assessment of the efficacy of MI-E device is commonly done by measuring peak cough flow (PCF). Upper airways collapse is frequently associated with neuromuscular disease and may compromise MI-E efficacy. Tracheomalacia is another disease that may impede PCF to increase with MI-E device. The goal of present study was to carry out a bench study to assess the effect of MI-E on PCF with and without the presence of a collapsible tube. Our hypothesis was that PCF was lower with than without collapsible tube. Patients and methods: We used a lung simulator (TTL Michigan Instruments) with adjustable compliance (C) and resistance (R) to which a MI-E (CoughAssist E70, Philips-Respironics) was attached, with or without a latex collapsible tube. Flow and pressure were proximal to the lung simulator. Six C-R combinations were tested, each with and without the collapsible tube. For each C-R combination, we set ± 30, ± 40 and ± 50 cmH2O inspiratory expiratory pressure at the MI-E device. MI-E device was set in automatic mode with inspiratory time of 3 s, expiratory time of 3.2 s and pause of 2 s. Each set was recorded by using a data logger (Biopac 150, Biopac inc.) and the last 5 cycles were used for the analysis done by using Acqknowledge software (Biopac inc.). The peak expiratory flow during the first 100 ms after onset of expiration was taken as the surrogate of PCF. The corresponding pressure was also recorded. Results: Contrary to our hypothesis, the peak expiratory flow during the first 100 ms of exsufflation phase is higher with than without the collapsible tube in every C-R condition, as shown in figure 1. For the C20R5 condition the effect of the collapsible tube on the intercept (− 0.35 cm H2O) was not significant but this was offset by a significant increase in slope (+ 0.12 L s cm H2O). For the other conditions, the collapsible tube significantly increased PCF at 30 cm H2O expiratory pressure and the gap further increased above this pressure because the slope increased with the collapsible tube. Conclusion: We found that peak expiratory was higher with than without collapsible tube. In vivo measurements in patients should be done to confirm this finding. COK‑2 Early verticalization in neurologic intensive care units with a weight suspension system Margrit Ascher (speaker), Francisco Miron Duran, Fanny Pradalier, Claire Jourdan, Kevin Chalard, Flora Djanikian, Isabelle Laffont , Pierre‑François Perrigault CHU Montpellier, Montpellier, FRANCE Correspondence: Margrit Ascher ‑ m‑ascher@chu‑montpellier.fr Annals of Intensive Care 2019, 9(Suppl 1):COK-2 Introduction: Background. Current literature and French guidelines recommend early mobilization in Intensive Care Units (ICU), including verticalization and walking. Verticalization for neurologic patients in ICU is challenging because of neurological impairments, risks of falls and of clinical worsening. In the neuro-ICU of Montpellier university hospital, a weight suspension system (LiteGait®) is used. Objectives. To study the feasibility and safety of walking with the weight suspension system in a neuroICU. Feasibility involved proportion of patients who benefited from suspension walking, reasons for not using it, physiotherapists’ time required. Safety involved rate of adverse events, changes in vital parameters, pain. Patients and methods: Design. Monocentric, prospective, descriptive study, including all neurogical patient hospitalized for > 48 h in ICU with initial mechanical ventilation from mid-February to mid-September 2018 (excluding deceased patients). Criteria for using suspension © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Ann. Intensive Care 2019, 9(Suppl 1):40 walking where respiratory stability without mechanical ventilation (tracheostomy and or oxygen therapy possible), hemodynamic and neurologic stability, sufficient respond to command (head control, testing of one quadriceps > 3 or two quadriceps > 2). Data included general description of patients + clinical status before suspension walking (pain, MRC testing, sitting balance, RASS, hemodynamic and respiratory parameters, medical equipment) + pain, hemodynamic and respiratory parameters during sessions + description of adverse events and consequences + duration of walking. Results: Among 83 patients included (see table for characteristics), 25% benefited from suspension walking during their stay + for 25% of patients, suspension walking was needed but hindered by organization difficulties (such as timetable challenges, early discharge from ICU) + 22% patients could walk without suspension on first verticalization + 20% were too impaired to use suspension walking. A total of 41 suspension walking sessions were performed. Five sessions needed to be interrupted for the five following reasons- pain, hypotension, dizziness, diarrhea and dysfunction of the device. No adverse event had clinical consequences beyond the session. Pain score raised significantly for one patient only (5 points in BPS score). Mean delay between extubation (or tracheotomy) and first suspension walking was 7 days. Mean delay between first suspension walking and first walking without suspension was 8 days. Conclusion: Verticalization with a suspension device in a neurologic ICU is feasible and safe, with a trained and supported team. Obstacles such as medical equipment, language impairments, absence of balance, heavy weight, poor tonicity and participation can be overcome using such a device. Suspension could enable several neurologic ICU patients to walk one week earlier. COK‑3 Effects of active exercise on red blood cell deformability in critically ill patients Vinciane Scaillet (speaker)1, Mohera P otvin1, Damien Wathelet1, Adrien Fievet2, Ingri (...truncated)