Дисертації з теми "Soins intensifs – Complications chirurgicales"
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Boutineau, Hervé. "Hospitalisation post-opératoire en service de réanimation à l'hopital Saint-André de Bordeaux." Bordeaux 2, 1991. http://www.theses.fr/1991BOR2M157.
Van, Meurs Willem. "Automatisation de la circulation extracorporelle chirurgicale : estimation des paramètres d'un modèle hémodynamique." Toulouse 3, 1991. http://www.theses.fr/1991TOU30192.
Bodinier, Maxime. "Caractérisation longitudinale des réponses immunitaires des patients en soins critiques." Electronic Thesis or Diss., Lyon 1, 2023. http://www.theses.fr/2023LYO10170.
This thesis addresses a key issue in critically ill patients: the complexity and heterogeneity of the immune response. It has been shown that these patients are subject to complications, including the occurrence of nosocomial infections, increased hospital stay, and death. It is in this context, where links have been established between the immune response and poor prognoses, that this thesis work is situated. In order to improve the characterization of the dynamics of the immune system in these critical situations, the concept of endotype – a subcategory of patients defined by a distinct set of biological characteristics – is a central theme of this work and particular methodological attention has been paid to it.The first part of the thesis focused on identifying an appropriate technique for grouping patients according to the trajectories of their immune response. The KmL method, identified through simulations, made it possible to characterize longitudinal endotypes of the monocytic HLA-DR marker in septic patients, and to link these evolutions to poor prognoses. Subsequently, the study was extended to examine several immune markers and to characterize the immune system not only more exhaustively in patients admitted to intensive care for sepsis, but also for severe trauma and major surgery. Two distinct longitudinal endotypes were identified, one of which, displaying persistent pro-inflammatory and immunosuppressive characteristics, was associated with an unfavorable prognosis. Finally, the work also demonstrated the potential of mRNA measurements in blood for monitoring alterations in the immune system. A diagnostic model was developed to identify these longitudinal endotypes from a single blood sample taken at the end of the first week, offering a rapid tool to assess the immune status of patients and guide therapeutic strategies.These findings highlight the importance of characterizing endotypes in the treatment of intensive care patients. Future work will aim to validate these results on a larger scale and to evaluate the effectiveness of endotyping through randomized clinical trials, potentially improving the prognosis of intensive care patients
Chêne, Geneviève. "Les infections urinaires nosocomiales dans un service de soins intensifs : épidémiologie,coût, prévention." Bordeaux 2, 1990. http://www.theses.fr/1990BOR23021.
Brevet, Patrick. "Les cholécystites aiguës alithiasiques en réanimation traumatologique : étude sur une population de 1746 patients du 1/07/90 au 31/12/94." Bordeaux 2, 1995. http://www.theses.fr/1995BOR2M055.
Delaitre, Pascale. "Préparation fonctionnelle respiratoire et chirurgie colique." Montpellier 1, 1988. http://www.theses.fr/1988MON11164.
Hurtault, Sylvie. "Etude épidémiologique de l'émergence de staphylococcus aureus résistants à la fosfomycine dans une unité de soins intensifs." Bordeaux 2, 1989. http://www.theses.fr/1989BOR23035.
Bernard, Rémi. "Hellp syndrome : à propos de 4 cas pris en charge en réanimation." Bordeaux 2, 1994. http://www.theses.fr/1994BOR2M200.
Bildstein, Sophie. "Évaluation de l'antibiothérapie dans le traitement des pneumopathies nosocomiales en réanimation : étude prospective sur une population de 45 patients." Bordeaux 2, 1995. http://www.theses.fr/1995BOR2P093.
Coze, Céline. "Epidémiologie d'infections nosocomiales à enterobacter aerogènes dans un service de réanimation médicale." Bordeaux 2, 1995. http://www.theses.fr/1995BOR2P003.
Dorbessan, Martine. "Les pneumopathies nosocomiales en réanimation : étude prospective sur une population de 174 patients." Bordeaux 2, 1995. http://www.theses.fr/1995BOR2M082.
Hauret, Sylvie. "Epidémiologie moléculaire d'infections nosocomiales à Acinetobacter Baumannii dans un service de réanimation." Bordeaux 2, 1996. http://www.theses.fr/1996BOR2P039.
Clément, Jean-François. "Fibres et nutrition entérale : étude prospective et randomisée chez 106 patients de réanimation traumatologique." Bordeaux 2, 1997. http://www.theses.fr/1997BOR2P034.
Fun, Yan Yuen Cheong Lee. "Infections liées aux cathéters veineux centraux en réanimation : incidence globale et comparaison de deux procédures de gestion." Bordeaux 2, 1995. http://www.theses.fr/1995BOR2M168.
Porra, Dominique. "Suivi des colonisations fongiques en réanimation digestive." Bordeaux 2, 2000. http://www.theses.fr/2000BOR23017.
El, Harrif-Héraud Zoubida. "Caractérisation moléculaire de bêta-lactamases à spectre élargi chez Citrobacter Diversus (C. Koseri) et épidémiologie par ribotypage et amplification génique au hasard." Bordeaux 2, 1997. http://www.theses.fr/1997BOR2B004.
Bernard, Jean-Christophe. "Analyse de la morbidité infectieuse et de la mortalité chez l'adulte après splénectomie en réanimation traumatologique." Bordeaux 2, 2000. http://www.theses.fr/2000BOR23086.
Garcia, Eric. "Survie des patients infectés par le VIH admis en réanimation médicale pour insuffisance respiratoire aigue͏̈." Bordeaux 2, 2000. http://www.theses.fr/2000BOR2M111.
Gaudry, Stéphane. "Critères de jugement dans les essais contrôlés randomisés en réanimation." Thesis, Sorbonne Paris Cité, 2016. http://www.theses.fr/2016USPCC252/document.
The choice of relevant primary and secondary endpoints is an essential step of the design of a randomized controlled trial. In our first work, we conducted a systematic review on patient-important outcomes in randomized controlled trials in critically ill patients. Indeed, clinical decision-making by ICU physicians now pursues the goal of improving mean and long-term outcomes in survivors in addition to increasing their chance of survival. We defined patient-important outcomes as on one hand, outcomes involving mortality at any time, and on the other, quality of life and functional outcomes assessed after ICU discharge. We found that a minority of primary outcomes (27/112,24%) used in randomized controlled trials published in 2013, were patient-important outcomes and that mortality accounted for the vast majority of them. Our analysis of most recently published trials (first half 2016) showed that patient-important outcomes were used in the samelow proportions (25% of the primary outcomes were patient-important outcomes) We then addressed the question of how well withholding and with drawal of life support therapies(W-WLST) decisions were reported in RCT in critically ill patients and how such decisions could impact mortality as outcome measure in these trials. We found that W-WLST decisions, although being a daily concern in routine practice, were scarcely reported in these trials, since they appeared in only 6 of 65 (9%) during follow-up. We further explored the impact of an imbalance in such decisions between the 2 arms of a randomized controlled trial, through a simulation study. This simulation showed that the intervention could appear as protective, if the decision of W-WLST was delayed in the interventional arm, even though the intervention had no true effecton survival. Finally, we performed a randomized controlled study (Artificial Kidney Initiation in Kidney Injury,AKIKI) using mortality as primary outcome and paid attention to report the rate of W-WLSTdecisions in the 2 arms
Romano, Sara. "Dynamique des populations et communautés bactériennes au cours de l’hospitalisation et des infections associées aux soins : cas particulier de la chirurgie cardiaque." Thesis, Montpellier, 2015. http://www.theses.fr/2015MONT3515.
Human microbiota are now considered as supplementary organs involved in diseases such as infections. Microbiota disequilibrium named dysbiosis creates impaired ecological niches (pathobiomes). This new paradigm of infection is particularly relevant for opportunistic infections. In this study, we consider one major type of healthcare associated infection (HAI), the surgical site infections after cardiothoracic surgery as a pathology of niche. We study the dynamics of microbial communities and populations as conditions for emergence and success of infectious agents.The diversity and dynamics of superficial and deep surgical microbiota in patients undergoing coronary artery bypass grafting show a partial replacement of the pre-operative microbiota by a specific surgical microbiota with partial resilience during healing. Significant links are found between microbiota composition and scores for infectious risk. The population structure of Propionibacterium acnes, a pathogen complicating cardiac surgery, shows variable frequencies of phylotypes according to operative stages. Surgical microbiota appears specific with high diversity of Gram-negative bacteria, some of them being previously described in healthy skin microbiota. At the species-level, these bacteria appear atypical among known human bacteria because they are related to environmental bacteria. We demonstrate the cutaneous reservoir of the opportunistic pathogen Roseomonas mucosa deemed, until now, to be environmental. Three populations of opportunistic pathogens (Pseudomonas aeruginosa, Ochrobactrum anthropi, O. intermedium) are structured in order to precise their transmission and their infectivity in the general context of impaired ecological niche and pathobiome.The results obtained at various microbiological scale (community, population, species, phylotype) are organized in this general context in order to delineate an original integrative vision of HAI