“Never in our resuscitation department we had received 34 patients with the same symptoms”

D-18. The patient in room 172 has been fighting the Covid-19 for the last eighteen days. Intubated and ventilated, the man is 52 years old. Several probes gravitate around his naked body. His cheeks are pale, his eyelids yawn, his swollen hands are motionless. Everything seems extinct in him. Only his chest moves, under the impulse of the artificial respirator. At D-15, the resuscitators tried to free him from the machine. The latest analyzes indicated that the patient had regained enough strength to oxygenate himself. The family had been notified. But when he was extubated, the patient whistled, unable to breathe: edema had formed in his windpipe. We put him back to sleep and put the hose back on. “In the face of this disease, the fight for recovery is not a sprint. It’s a marathon “, recalls Jérôme Fichet, physician-resuscitator at the North Cardiological Center of Saint-Denis.

In this private clinic in Seine-Saint-Denis, 33 other patients

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Anaïs Moran

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Resuscitation drugs: “We fear a shortage of stocks”

Damien Roux, university professor and hospital practitioner of intensive resuscitation medicine, works in the medical and surgical resuscitation department of Louis-Mourier Hospital (AP-HP), located in Colombes, in the Hauts-de-Seine. As of last weekend, this doctor was responsible for reflecting – in collaboration with other colleagues from the Public Assistance taking care of Covid-19 patients – on the means of optimizing the use of drugs in the services of resuscitation, due to the ever increasing number of serious patients. “The aim was to anticipate the overconsumption of certain drugs in the same way that we have been trying to increase the number of nurses for the past month»He explains. Except that a week later, the fear of an imminent shortage of certain molecules became a reality in Ile-de-France. “Despite our prospects and our vigilance on the issue, it is clear that suppliers and manufacturers are no longer able to monitor the consumption of drugs or certain medical devices in our hospitals.He warns.

AP-HP Director General Martin Hirsch acknowledged at a press conference on Friday that “stocks are very short on certain drugs.“This Saturday evening, it’s Edouard Philippe who admits the existence of”supply tensions here and there” “We regulate them by ensuring the circulation of these products throughout the territory, because there are stocks. We guarantee it by making sure to encourage increased domestic and global productionAdded the Prime Minister. Update with Professor Roux.

What is the situation of Louis-Mourier resuscitation service today?

We fear the beginning of a stock shortage for the end of the weekend. We have visibility over two days. That is to say, we are not sure that our internal pharmacy will be able to supply us with all of the drugs necessary for optimal patient management. There is great concern because it is very likely that the AP-HP central pharmacy, despite all its efforts, may not be able to meet the demands of all hospitals and that we will end up with shortages during the restocking. This shortage situation is new but ultimately quite logical. Instead of having a variety of patients who require very different treatments, resuscitation services are currently finding themselves with a majority of Covid + patients who need the same molecules. It is this quantity of identical patients, hitherto unknown in our units, which causes the drug shortage.

Which families of molecules are likely to be lacking?

There is a strong tension on hypnotics. These are the molecules we use to keep patients in sleep in intensive care. The equation is therefore simple: if we run out of stocks, we will no longer be able to take care of new patients. It’s a real danger. We also fear a rapid shortage of curares, which allow the patient, once asleep, to prevent him from moving and therefore consume less oxygen. Curares are necessary because they allow these patients with acute respiratory distress syndrome (ARDS) to be completely ventilated by the ventilator. The last other concern concerns antibiotics. As we speak, I do not believe that an AP-HP hospital is lacking. But there is a risk of overconsumption in the days and weeks to come, because these serious patients in intensive care are at high risk of nosocomial infection. As you can see, the supply of these three groups of molecules is essential to save lives.

Your working group’s mission was to think of new protocols to save your stocks. A summary of your recommendations is currently being sent to all AP-HP hospitals. What does it contain?

At this stage, we propose an optimization of the sedation protocols in order to limit any use which is not absolutely necessary. A close relationship between the pharmacy and the resuscitation service is also necessary in order to anticipate any shortage of a molecule to refer to another close molecule. We also underlined the interest of associating other molecules making it possible to reduce the quantity of usual molecules to be administered. More specifically for sedation, one of the recommendations would also be to use the usual method of anesthesia in the operating room. It is a procedure that uses halogenated gases to put people to sleep and that we never use in most resuscitation services. This technique would also limit the use of curares.

At Louis-Mourier Hospital, where are you with your stock of syringe pumps, which allow the infusion of treatments? Some hospital structures already seem to be lacking…

We did the drawer bottoms and requisitioned all the units a little to find as many as possible. But indeed, faced with the impressive influx of resuscitation patients, we had to resolve to work with fewer electric syringe pumps per patient. For the moment, it does not degrade the quality of care but it causes discomfort in work for nurses who must regularly move this type of equipment from one room to another. Unless suppliers, especially Chinese, can quickly send us a large quantity of electric syringe pumps, we will have to modify the way we administer treatments to patients using less precise techniques.


Anaïs Moran

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A resuscitation doctor: “It’s the start of the war”

Marc Amouretti, 32, is a doctor in the intensive care unit at Louis Mourier Hospital in Colombes (Hauts-de-Seine), an establishment dependent on the Public Assistance of Paris Hospitals (AP-HP). In the front line facing the Coronavirus epidemic, he tells Release his daily life and how his service is organized to cope.

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“The Covid-19 becomes a reality for more than a week. We are now going beyond the “anecdotal” cases linked to a few well-established clusters, where we could almost trace the chains of contamination from one family member to another. From now on, the cases are multiplying, in more or less serious forms, and occupy an increasing part of the resuscitation beds. This pushes us to rethink our organization every day to optimize patient care, and in particular to ensure that those who do not have the coronavirus are not

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Sylvain Mouillard

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