N de Prost1, R Bosc2, C Brun-Buisson3, O Chosidow4, J-W Decousser5, G Dhonneur6, R Lepeule5, A Rahmouni7, E Sbidian8, R Amathieu6. 1. DHU A-TVB, service de réanimation médicale, CARMAS research group, hôpitaux universitaires Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; UPEC-université Paris-Est Créteil-Val-de-Marne, Créteil, France. Electronic address: nicolas.de-prost@hmn.aphp.fr. 2. UPEC-université Paris-Est Créteil-Val-de-Marne, Créteil, France; Service de chirurgie plastique, hôpitaux universitaires Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France. 3. DHU A-TVB, service de réanimation médicale, CARMAS research group, hôpitaux universitaires Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; UPEC-université Paris-Est Créteil-Val-de-Marne, Créteil, France. 4. UPEC-université Paris-Est Créteil-Val-de-Marne, Créteil, France; Service de dermatologie, hôpitaux universitaires Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Satellite français du Cochrane Skin Group, Inserm, centre d'investigation clinique 006, Créteil, France. 5. UPEC-université Paris-Est Créteil-Val-de-Marne, Créteil, France; Département de virologie, bactériologie, hygiène, parasitologie, mycologie, hôpitaux universitaires Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France. 6. UPEC-université Paris-Est Créteil-Val-de-Marne, Créteil, France; Service d'anesthésie et des réanimations chirurgicales, hôpitaux universitaires Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France. 7. UPEC-université Paris-Est Créteil-Val-de-Marne, Créteil, France; Service d'imagerie médicale, hôpitaux universitaires Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France. 8. UPEC-université Paris-Est Créteil-Val-de-Marne, Créteil, France; Service de dermatologie, hôpitaux universitaires Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
Abstract
OBJECTIVES: Necrotizing fasciitis (NF) are rare and severe soft tissue infections associated with a high mortality rate. In order to assess the management of NF in French-speaking intensive care units (ICUs), we conducted a survey endorsed by the French Society of Anesthesia and Intensive Care (SFAR). STUDY DESIGN: Online self-administered survey. METHODS: A link to an online survey was sent by email to 4620 anesthesiologists and/or intensivists and was available online from January to February 2014. RESULTS: One hundred and seventy-five physicians (3.8%) who worked in 135 ICUs filled out the online survey. Among respondents, 42% reported having managed up to two patients with NF during the previous year; 59% and 72% of respondents reported not having a surgical and a medical specialist consultant, respectively. A delayed access to the operating room (OR) of more than 6hours was reported in 31% of cases and access to the OR was reported not to be routinely considered as a priority in 13% of cases. Only 17% of respondents reported that time to transfer to the OR was never a cause for delayed surgery. The main causes for delayed surgery were: delayed diagnosis (45%), delayed validation of surgical intervention (37%), and difficulty of access to the OR (8%). Finally, 83% of respondents estimated that creating dedicated multidisciplinary teams for managing NFs could lead to improving outcomes. CONCLUSION: This survey illustrates the heterogeneous management of NF in French-speaking ICUs and points out several logistical aspects that should be improved to reduce the time to the first surgical debridement.
OBJECTIVES:Necrotizing fasciitis (NF) are rare and severe soft tissue infections associated with a high mortality rate. In order to assess the management of NF in French-speaking intensive care units (ICUs), we conducted a survey endorsed by the French Society of Anesthesia and Intensive Care (SFAR). STUDY DESIGN: Online self-administered survey. METHODS: A link to an online survey was sent by email to 4620 anesthesiologists and/or intensivists and was available online from January to February 2014. RESULTS: One hundred and seventy-five physicians (3.8%) who worked in 135 ICUs filled out the online survey. Among respondents, 42% reported having managed up to two patients with NF during the previous year; 59% and 72% of respondents reported not having a surgical and a medical specialist consultant, respectively. A delayed access to the operating room (OR) of more than 6hours was reported in 31% of cases and access to the OR was reported not to be routinely considered as a priority in 13% of cases. Only 17% of respondents reported that time to transfer to the OR was never a cause for delayed surgery. The main causes for delayed surgery were: delayed diagnosis (45%), delayed validation of surgical intervention (37%), and difficulty of access to the OR (8%). Finally, 83% of respondents estimated that creating dedicated multidisciplinary teams for managing NFs could lead to improving outcomes. CONCLUSION: This survey illustrates the heterogeneous management of NF in French-speaking ICUs and points out several logistical aspects that should be improved to reduce the time to the first surgical debridement.
Keywords:
Cellulite; Cellulitis; Fasciite nécrosante; Infection de la peau et des parties molles; Necrotizing fasciitis; Sepsis; Skin and soft tissue infections
Authors: Simone La Padula; Rosita Pensato; Antonio Zaffiro; Oana Hermeziu; Francesco D'Andrea; Chiara Pizza; Jean Paul Meningaud; Barbara Hersant Journal: J Clin Med Date: 2022-04-13 Impact factor: 4.964