A panel of pediatric experts met to develop recommendations on the technical requirements specific to pediatric controlled donation after planned withdrawal of life-sustaining therapies (Maastricht category III). The panel recommends following the withdrawal of life-sustaining therapies protocol usually applied in each unit, which may or may not include immediate extubation. The organ retrieval process should be halted if death does not occur within 3 h of life-support discontinuation. Circulatory arrest is defined as loss of pulsatile arterial pressure and should be followed by a 5-min no-touch observation period. Death is declared based on a list of clinical criteria assessed by two senior physicians. The no-flow time should be no longer than 30, 45, and 90 min for the liver, kidneys, and lungs, respectively. At present, the panel does not recommend pediatric heart donation after death by circulatory arrest. The mean arterial pressure cutoff that defines the start of the functional warm ischemia (FWI) phase is 45 mmHg in patients older than 5 years and/or weighing more than 20 kg. The panel recommends normothermic regional perfusion in these patients. The FWI phase should not exceed 30 and 45 min for retrieving the pancreas and liver, respectively. There is no time limit to the FWI phase for the lungs and kidneys. The panel recommends routine sharing of experience with Maastricht-III donation among all healthcare institutions involved in order to ensure optimal outcome assessment and continuous discussion on the potential difficulties, notably those related to the management of normothermic regional perfusion in small children.

The French Transplant Health Authority (Agence de la Biomédecine) has broadened its organ- and tissue-donation criteria to include pediatric patients whose death is defined by circulatory criteria and after the planned withdrawal of life-sustaining therapies (WLST) (Maastricht category III). A panel of pediatric experts convened to translate data in the international literature into recommendations for organ and tissue donation in this patient subgroup. The panel estimated that, among children aged 5 years or over with severe irreversible neurological injury (due to primary neurological injury or post-anoxic brain injury) and no progression to brain death, the number of potential donors, although small, deserves attention. The experts emphasized the importance of adhering strictly to the collegial procedure for deciding to withdraw life support. Once this decision is made, the available data should be used to evaluate whether the patient might be a potential donor, before suggesting organ donation to the parents. This suggestion should be reserved for parents who have unequivocally manifested their acceptance of WLST. The discussion with the parents should include both the pediatric intensive care unit (PICU) team under the responsibility of a senior physician and the hospital organ- and tissue-procurement team. All recommendations about family care during the end of life of a child in the PICU must be followed. The course and potential challenges of organ donation in Maastricht-III pediatric patients must be anticipated. The panel of experts recommended strict compliance with French recommendations (by the Groupe Francophone de Réanimation et Urgences Pédiatriques) about WLST and providing deep and continuous sedation until circulatory arrest. The experts identified the PICU as the best place to implement life-support discontinuation and emphasized the importance of returning the body to the PICU after organ donation. French law prohibits the transfer of these patients from one hospital to another. A description of the expert-panel recommendations regarding the organization and techniques appropriate for children who die after controlled circulatory arrest (Maastricht III) is published simultaneously in the current issue of this journal..

In 2005, the French-speaking task force on pediatric critical and emergency care [Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP)] issued recommendations on withholding and withdrawing treatments in pediatric critical care. Since then, the French Public Health Code, modified by the laws passed in 2005 and 2016 and by their enactment decrees, has established a legal framework for practice. Now, 15 years later, an update of these recommendations was needed to factor in the experience acquired by healthcare teams, new questions raised by practice surveys, the recommendations issued in the interval, the changes in legislation, and a few legal precedents. The objective of this article is to help pediatric critical care teams find the closest possible compromise between the ethical principles guiding the care offered to the child and the family and compliance with current regulations and laws.

En 2005, le Groupe francophone de réanimation et d’urgences pédiatriques (GFRUP) publiait des recommandations concernant les limitations et arrêts des traitements (LAT) en réanimation pédiatrique. Depuis cette date, le Code de santé publique (CSP), modifié par les lois de 2005 et 2016 et leurs décrets d’application, est venu encadrer ces pratiques. Quinze ans après leur parution, ces recommandations nécessitaient d’être actualisées pour tenir compte de l’expérience acquise par les équipes, des nouvelles questions soulevées par des études de pratique, des recommandations parues dans l’intervalle, ainsi que des évolutions législatives et des rares jurisprudences. Ce texte a pour objectif d’aider les équipes de réanimation pédiatrique à conjuguer l’éthique de la prise en charge de l’enfant, de sa famille et le respect des dispositions réglementaires actuelles.

Les cardiopathies sont les malformations les plus fréquentes en France. Ces enfants sont à risque de dénutrition avec des difficultés alimentaires qui peuvent persister en postopératoire prolongeant l’hospitalisation. Le but de notre étude était d’évaluer les apports caloriques entéraux et oraux des nourrissons après chirurgie cardiaque et d’étudier les facteurs de risque de difficultés post-opératoires d’alimentation orale. Nous avons mené une étude rétrospective, monocentrique. Tous les nourrissons âgés de 28 jours à 1 an opérés sous circulation extracorporelle dans notre centre entre juin 2018 et mai 2019 ont été inclus. Les apports caloriques entéraux et oraux ont été calculés chaque jour de l’hospitalisation d’après les relevés alimentaires infirmiers. Les facteurs pré, per et postopératoires ont été analysés pour identifier les facteurs de risque de difficultés alimentaires. La population a été séparée en terciles selon l’apport calorique oral à 10 jours de la chirurgie. Les enfants du troisième tercile et ceux gardant un support nutritionnel entéral ont été considérés avec des difficultés d’alimentation orale et comparés au reste de la population. Soixante patients ont été inclus. A 10 jours de la chirurgie, l’apport calorique oral moyen était de 62 % (± 34,7) des apports nutritionnels conseillés. 13 (21,7 %) patients sont sortis d’hospitalisation avec un support nutritionnel entéral. Les patients avec difficultés alimentaires avaient des durées de circulation extracorporelle (146,3 ± 73 vs 104,6 ± 36 minutes, p = 0,004), de ventilation mécanique (3,0 ± 3,4 vs 0,6 ± 1,1 jours, p < 0,001), de ventilation non-invasive (5,9 ± 4,8 vs 2,7 ± 2,4 jours, p = 0,001) et d’administration d’inotrope (3,8 ± 1,7 vs 2,6 ± 1,4 jours, p = 0,007) plus longues. On observait également une proportion plus importante de malformations congénitales associées (30 % vs 7,5 %, p = 0,049) et d’alimentation entérale préopératoire (50 % vs 7,5 %, p < 0,001). Il n’y avait pas de différence significative concernant l’âge gestationnel, l’âge à la chirurgie et le statut nutritionnel préopératoire. Les difficultés alimentaires étaient associées à la durée de circulation extracorporelle, de supports ventilatoire et hémodynamique et à la présence de malformations congénitales associées à la cardiopathie. Il sera intéressant d’étudier si des interventions précoces chez ces enfants à risque permettent de limiter les difficultés d’alimentation orale et la durée d’hospitalisation.

Geometric Data Analysis designates the approach of Multivariate Statistics that conceptualizes the set of observations as a Euclidean cloud of points. Combinatorial Inference in Geometric Data Analysis gives an overview of multidimensional statistical inference methods applicable to clouds of points that make no assumption on the process of generating data or distributions, and that are not based on random modelling but on permutation procedures recasting in a combinatorial framework. It focuses particularly on the comparison of a group of observations to a reference population (combinatorial test) or to a reference value of a location parameter (geometric test), and on problems of homogeneity, that is the comparison of several groups for two basic designs. These methods involve the use of combinatorial procedures to build a reference set in which we place the data. The chosen test statistics lead to original extensions, such as the geometric interpretation of the observed level, and the construction of a compatibility region. Features: Defines precisely the object under study in the context of multidimensional procedures, that is clouds of points Presents combinatorial tests and related computations with R and Coheris SPAD software Includes four original case studies to illustrate application of the tests Includes necessary mathematical background to ensure it is self–contained This book is suitable for researchers and students of multivariate statistics, as well as applied researchers of various scientific disciplines. It could be used for a specialized course taught at either master or PhD level.

This book provides an in-depth view on Bourdieu’s empirical work, thereby specially focusing on the construction of the social space, including the concept of the habitus, and contributions regarding particular applications of his methodology to traditional and new areas of research.

Chapter abstract The extent to which the concepts of field and social space are linked to a concrete mode of empirical research—and in particular to a set of original statistical tools—has seldom been acknowledged. This chapter aims to re-establish the close link between the field concept and geometric data analysis (GDA), Bourdieu’s preferred technique for mapping the “social distances” between individuals. The elective affinity between the two is based on a relation of tight interdependence: on the one hand, the emergent practice of GDA sustains and strengthens the “implicit philosophy” of the theory of fields; on the other hand, the method’s widespread use by Bourdieu and his collaborators has facilitated GDA’s international reception in the social sciences. The chapter concludes by discussing the empirical research program that results from wedding a sociology of fields with the systematic use of GDA.