Background Upper airway management is challenging in patients with cervico-facial cellulitis. Our objectives were to determine the prevalence of non-opening of a trismus after induction, as well as to compare the radiological and biological factors associated with tracheostomy. Material and methods We conducted a prospective, single-center cohort study including consecutively all patients with cervicofacial cellulitis with an indication for surgical drainage under general anesthesia, between October 2021 and March 2022, and a retrospective cohort of patients who required a tracheostomy during the management of cervicofacial cellulitis, between January 2019 and September 2021. We first compared mouth opening measurements before and after anesthetic induction in the prospective cohort. We then used logistic regressions to determine clinic-radiological factors associated with tracheostomy. Results The prospective cohort included 55 patients. All patients for whom measurements were taken (17/17) had an increase in mouth opening after induction. In multivariate analyses, dysphagia, and a non-homogeneous collection were significantly associated with tracheostomy. Conclusions We found that trismus was reversible in all patients for whom measurements were taken after induction. We therefore consider that trismus should not be a criterion for difficult intubation in cases of cervico-facial cellulitis. We then found clinico-radiological factors associated with an increased risk of tracheostomy.

Background:Dyspnoea is frequent in mechanically ventilated patients and contributes to substantial distress and a heightened risk of post-traumatic stress disorder. It attests to respiratory-related brain suffering that must be actively managed. This is particularly challenging in noncommunicative patients, hence the interest of electroencephalographic surrogates. This study aims at characterizing the effects of opioids, proposed to relieve dyspnoea, on respiratory-related cortical activity in mechanically ventilated patients. Methods:In a 16-bed intensive care unit (ICU) over a 4-month period, we consecutively included eighteen mechanically ventilated patients with self-reported dyspnoea (visual analog scale -VAS-, communicative patients) or an observation-derived suspicion of respiratory-related brain suffering (noncommunicative patients, respiratory distress observation scores -RDOS-) persisting despite ventilator settings optimisation. Participants underwent electroencephalographic (EEG) recordings before and after administration of intravenous opioids. Respiratory-related cortical activity was assessed using covariance-based connectivity analysis, preinspiratory potentials (PIPs), and time-frequency analysis (TFA) time-locked to inspiration. To disentangle respiratory-specific from general effects of opioids, TFA was also computed from randomly selected EEG segments. Results:Opioids reduced dyspnoea evaluated by VAS and RDOS without significant sedation. EEG covariance analysis showed changes in brain state in 15 of 18 patients. PIP occurrence was variable and not modulated by opioids. TFA revealed statistically significant opioid-induced modulations in low beta and high beta power bands time-locked to inspiration, not observed in randomly timed analyses hence a specific effect of opioids on respiratory-related cortical networks. Conclusion:Opioids can relieve dyspnoea in mechanically ventilated ICU patients and modulate respiratory-related cortical activity beyond their general effects on cortical electrogenesis. This suggests that their effects on breathing control are not limited to brainstem mechanisms.

BACKGROUND:Survivors of major trauma often experience long-term impairments in health-related quality of life (HRQoL) and post-traumatic stress disorder (PTSD). Intensive care unit (ICU) diaries have been proposed to reduce psychological sequelae, but evidence remains conflicting and not specific to trauma patients. OBJECTIVE:To assess whether, in patients with major trauma, a nurse-led ICU diary implemented within the first 48 h after trauma improves HRQoL at 1 year vs. usual care. METHODS:The QUALITRAU randomized controlled trial was conducted in three ICUs of a French tertiary hospital. Adult patients with major trauma (Injury Severity Score > 15) were randomized within 48 h of admission to receive either an ICU diary combined with usual care or usual care alone. The primary outcome was HRQoL at 12 months, assessed with the 4 domains of the WHOQOL-BREF questionnaire. Secondary outcomes included PTSD severity measured with the Impact of Event Scale (IES). Analyses were performed on an intention-to-treat basis. RESULTS:Between November 2014 and November 2016, 208 patients were randomized (101 intervention, 107 control), with primary outcome available for 121 (53 intervention, 68 control). Median age was 35 years [IQR 25-51], 81% were men, and 63% had severe traumatic brain injury. At 12 months, there were no differences between intervention and control groups in the WHOQOL-BREF domains (physical: 5.7 [IQR 4.6-11.4] vs 9.1 [IQR 4.6-13.1],P = 0.16; psychological: 8.0 [IQR 6.7-13.3] vs 11.3 [IQR 6.7-13.3],P = 0.08; social: 5.3 [IQR 4.0-14.7] vs 12.0 [IQR 4.0-14.7],P = 0.10; environment: 8.0 [IQR 5.5-14.5] vs 12.0 [IQR 5.5-15.5], P = 0.05). IES scores were also not different. CONCLUSIONS:Early implementation of nurse-led ICU diaries was not associated with improved long-term HRQoL or reduced PTSD symptoms in patients with major trauma. IMPLICATION FOR CLINICAL PRACTICE:These findings suggest that ICU diaries may need to be integrated into broader, multimodal rehabilitation strategies and may depend on factors such as timing, content, or patient characteristics.

Dyspnea is a major sensory and emotional burden in patients with chronic respiratory insufficiency. While experimentally induced acute dyspnea has been shown to interfere with cognition in healthy participants, interferences between cognition and chronic clinical dyspnea have not been studied. We conducted an exploratory study to examine the association between dyspnea severity and cognitive performance in patients with amyotrophic lateral sclerosis (ALS) and chronic respiratory failure. Twenty patients were studied during unassisted breathing and during non-invasive ventilation (NIV). Dyspnea was assessed using the Multidimensional Dyspnea Profile, and cognitive performance was evaluated using the Paced Auditory Serial Addition Test (PASAT) and the Corsi block-tapping test. Respiratory-related cortical activity was assessed using electroencephalography. Linear mixed-effects models were used to examine associations between dyspnea descriptors and cognitive outcomes, adjusting for age, educational level, and disease severity. NIV markedly relieved dyspnea, anxiety, and respiratory-related cortical activity but was not associated with changes in cognitive performance. Dyspnea unpleasantness was independently associated with longer PASAT response time, whereas no associations were observed with PASAT accuracy measures or Corsi test outcomes. Neither ventilation condition nor respiratory-related cortical activity was associated with cognitive performance. These findings suggest that, in patients with ALS, dyspnea unpleasantness may be associated with slower PASAT response time without detectable relationships with other cognitive measures assessed in this study. Given the exploratory and focal nature of the study, further investigations are warranted to better characterize dyspnea-cognition interactions in this population.

L’hypothèse d’engagement majeur (HEM) anticipe l’implication de la France dans une guerre de haute intensité qui entraînerait des répercussions profondes sur le système de santé. Dans ce contexte, les anesthésistes-réanimateurs doivent se préparer à prendre en charge des blessés de guerre aux profils très différents de ceux observés dans les conflits asymétriques récents : traumatismes pénétrants complexes, lésions par explosion, complications infectieuses, complications rénales, dénutrition, troubles psychiques et portage fréquent de bactéries multirésistantes. Les délais d’évacuation et d’accès aux soins spécialisés à proximité des zones de combat puis sur le territoire national seraient allongés, rendant la médecine périopératoire prolongée, la rééducation, la coordination pluridisciplinaire et le contrôle des infections centrales dans la prise en charge des combattants et des populations civiles victimes du conflit. L’HEM impose d’anticiper une forte mobilisation du système civil fondée sur le dispositif d’Organisation de la réponse sanitaire en situations sanitaires exceptionnelles (dispositif ORSAN), en articulation étroite avec le service de santé des Armées, les groupements hospitaliers de territoire (GHT) et les structures territoriales. Le triage devra être repensé, non plus à l’aune de la médecine de catastrophe, mais selon la capacité à orienter les patients vers l’hospitalisation, le secteur ambulatoire ou l’hébergement de proximité. La formation, la résilience des équipes, la coopération civilo-militaire et la préparation logistique sont présentées comme des leviers essentiels pour maintenir l’offre de soins. Cette anticipation constitue à la fois un enjeu de santé publique, de continuité des soins et de sécurité nationale.

La réserve du service de santé des Armées (SSA) permet de renforcer ses capacités en mobilisant des professionnels de santé volontaires. Elle est régie par le Code de la défense. La possibilité d’être engagé dans plusieurs réserves nécessite une priorisation de ces dernières et une coordination avec l’employeur civil. L’engagement nécessite une préparation continue, prenant la forme d’une formation militaire initiale du réserviste, d’une formation de préparation opérationnelle, d’une politique de formation continue et de brevets de qualification. Le SSA propose des formations métiers spécifiques (FRAOS, CARMEX, CACHIRMEX). Certains organismes institutionnels proposent des formations aux enjeux géopolitiques. L’ensemble garanti une préparation complète des réservistes.

Mechanically ventilated patients may experience respiratory suffering, which is difficult to assess when verbal communication is impaired. We evaluated the performance of a steady-state visual evoked potential (SSVEP)-based brain–computer interface (BCI) designed to enable self-reporting of dyspnoea in this context. Forty-nine healthy volunteers were studied under five respiratory conditions: normal breathing (NB), inspiratory resistive loading (IRL), inspiratory threshold loading (ITL), CO₂ inhalation (CO₂), and a return to NB as wash-out (NBWO). Respiratory discomfort was evaluated using a visual analogue scale (VAS). Two BCIs models were tested: a detection BCI (D-BCI), designed to discriminate between ‘breathing is OK’ and ‘breathing is difficult’, and a quantification BCI in the form of a LED-based analogue scale (LAS), composed of five light-emitting diodes. Visual stimuli were delivered at different frequency sets: 12–15 Hz, 15–20 Hz, and 20–30 Hz for the D-BCI; low frequencies (13–17–19–23–29 Hz) and high frequencies (41–43–47–53–59 Hz) for the LAS. Performance was assessed using receiver operating characteristic (ROC) curves; the area under the ROC curve (AUC) was the primary outcome. Participants reported significant respiratory discomfort during IRL, ITL, and CO₂ conditions in the D-BCI groups, and during ITL and CO₂ in the LAS groups, as reflected by higher dyspnoea VAS scores compared to NB. The best-performing frequency sets were 20–30 Hz for the D-BCI (AUC 0.89 [0.89–0.90]) and low frequencies for the LAS (AUC 0.84 [0.83–0.85]). This study demonstrates that an SSVEP-based BCI can sucessfully detect and quantify experimentally induced dyspnoea in healthy individuals. Further research is needed to evaluate its clinical applicability for assessing dyspnoea in non-communicative patients.

BACKGROUND:Reliable mortality prediction is central to trauma research, quality assessment, and resource allocation. While the French national hospital discharge database (PMSI) provides comprehensive nationwide data, it does not capture clinical parameters required for established severity scores such as TRISS, which is used for predicting in-hospital survival after trauma and necessary for implementing national-level evaluations of health system performance. This study tested whether TRISS could nonetheless be accurately derived from PMSI data. METHODS:We conducted a retrospective study of adult patients admitted for severe trauma to an academic trauma center between 2012 and 2023. Clinical data from medical records were linked with corresponding PMSI records. Surrogate predictors of TRISS were derived from PMSI codes. An extreme gradient boosting (XGBoost) model was used, model performance was assessed using bootstrap validation and interpretability was explored through SHapley Additive exPlanations analyses. RESULTS:A total of 2,523 trauma patients were successfully matched between PMSI and medical records. Median age was 35 years, 79% were male, and in-hospital mortality was 15%. Correlation between Simplified Acute Physiology Score II (SAPS II) in PMSI and medical records was strong (ρ = 0.88), while concordance for shock and coma was weak (κ ≈ 0.25). The XGBoost model using individual PMSI codes achieved the best performance (optimism-adjusted R2 = 0.72). SAPS II was the main contributor, with additional contributions from shock, coma, and anatomical injury codes. CONCLUSION:TRISS can be reliably approximated from PMSI data using an XGBoost model. This approach enables patient-specific assessment of trauma severity and mortality risk from PMSI, opening perspectives for nationwide surveillance and quality evaluation of trauma care in France.

La médecine périopératoire (MPO), prolongement naturel de l’anesthésie-réanimation, s’impose comme une spécialité pivot face au vieillissement de la population, à l’augmentation des comorbidités et au développement de la chirurgie ambulatoire et mini-invasive. Elle vise à organiser des parcours de soins individualisés, intégrant préhabilitation, suivi post-hospitalier et coordination ville–hôpital, afin de sécuriser la récupération des patients, notamment les plus fragiles. La structuration des parcours repose sur des équipes pluridisciplinaires et la création de « cellules parcours », capables d’anticiper les besoins, de préparer le retour à domicile et de fluidifier les échanges entre acteurs hospitaliers et de ville. Les indicateurs de suivi, longtemps perçus comme outils de contrôle qualité, deviennent de véritables leviers d’anticipation, d’aide à la décision et de personnalisation des soins, notamment grâce à l’intégration de mesures rapportées par les patients (PROMs, PREMs). L’essor du numérique et de l’intelligence artificielle ouvre des perspectives majeures : détection précoce des complications, modélisation virtuelle du patient, aide documentaire et suivi connecté. Leur succès repose sur l’interopérabilité des systèmes d’information, la qualité des données et une supervision médicale active pour éviter les biais. Pour les trente prochaines années, l’ARMPO devra conjuguer innovation pharmacologique et technologique, durabilité environnementale (réduction de l’empreinte carbone des pratiques) et amélioration de la qualité de vie des soignants. En s’affirmant comme spécialité d’interface et moteur d’innovation, la MPO deviendra un pilier de la santé durable et centrée sur le patient.

Perioperative medicine, a natural extension of anesthesiology and critical care, is emerging as a pivotal specialty in response to an aging population, rising comorbidities, and the growth of minimally invasive and outpatient surgery. Its goal is to design individualized care pathways that integrate prehabilitation, post-hospital follow-up, and city-hospital coordination to ensure safe recovery, particularly for high-risk patients. The structuring of these pathways relies on multidisciplinary teams and the creation of dedicated "care pathway team" capable of anticipating patient needs, preparing discharge, and streamlining communication between hospital and community providers. Indicators, long viewed merely as quality control tools, are evolving into levers for anticipation, decision-making, and personalization of care, particularly through the integration of patient-reported outcome and experience measures (PROMs, PREMs). The rise of digital health and artificial intelligence opens major opportunities: early detection of complications, virtual patient modeling, clinical decision support, and connected follow-up. Their success, however, depends on interoperable information systems, high-quality data, and active medical oversight to mitigate bias. Over the next thirty years, anesthesiology, resuscitation, and perioperative medicine will need to combine pharmacological and technological innovation with environmental sustainability - reducing the carbon footprint of clinical practices - while also improving caregivers' quality of life. By positioning itself as both an interface specialty and a driver of innovation, perioperative medicine is set to become a cornerstone of sustainable, patient-centered healthcare.

Emergency surgeries are resource-intensive procedures with high variability in operating room occupation time (OT) and hospital length of stay (LOS), complicating scheduling and capacity planning. Manual estimates by surgeons are frequently inaccurate, especially in emergency settings. Machine learning models (MLMs) have shown good predictive performance in elective surgery, but their applicability to emergency contexts remains underexplored. We conducted a retrospective, single-center study on 3,117 emergency procedures performed at the Pitié-Salpêtrière hospital, a major trauma center, between 2015 and 2018. Preoperative data available at the time of surgical scheduling were used to train four regression models for OT and LOS prediction: Ridge Regression, Random Forest, XGBoost, and a Multi-Layer Perceptron. Model performance was evaluated using Mean Absolute Error, Root Mean Square Error, Mean Absolute Percentage Error, and operational metrics: proportion of OT predictions within 20

BACKGROUND:As the demand for high-quality healthcare grows, there is a pressing need for comprehensive methods to assess the quality of hospital care. Lack of standardization makes it difficult to compare urgent surgical outcomes across studies. Our group used a modified Delphi methodology to define the outcomes that should be reported or compared when evaluating urgent surgical care. METHODS:This three-round Delphi process took place from May to October 2024. It was conducted with an international panel of medico-surgical experts from 16 countries. We aimed to select, based on a 2-level consensus assessment, reporting outcomes for urgent surgical pathways. RESULTS:Initially, 87 items were classified under 8 headings. 26 outcomes were selected after the second Delphi round. A third round was required to validate 3 additional outcomes. Among the selected outcomes were in-hospital or 30-day mortality, 15 items addressing perioperative morbidity, as well as factors related to the patient journey: preoperative (surgical waiting time), intraoperative (surgical bleeding), and postoperative aspects (9 items selected). Notably, no items from the 'patient satisfaction' and 'medico-economics' headings were retained. Panelists deemed it essential to use multi-criteria outcomes (i.e., combining items from the 8 headings) to evaluate urgent surgical care pathways. CONCLUSIONS:A set of 29 relevant outcomes will help to develop a more comprehensive approach for urgent surgical care evaluation. It enables the development of new prioritization policies and a better study of outcomes for urgent surgeries. It is worth noting the lack of economic criteria and patient satisfaction measures.

BACKGROUND:Traumatic spine injury (TSI) is a prevalent condition that often requires surgical intervention. Two serious infectious complications after surgery are surgical site infections (SSI) and lower respiratory tract infections (LRTI). Yet, studies on SSI and LRTI on trauma patients, particularly with a specific focus on microbiology are lacking. The primary aim of this study is to investigate the prevalence rate of early SSI, occurring within one month of surgery or three months when instrumented, and LRTI in level-1 trauma center patients requiring surgery after TSI. METHODS:This monocenter retrospective observational study was conducted at an academic level-1 trauma center, including patients with TSI requiring surgery. Data on patients' baseline characteristics, trauma related information, initial and intra-operative management, infectious complications data and hospitalization outcomes were collected. The two primary outcomes were the prevalence of early SSI and LRTI. Secondary outcomes included the identification of factors associated with developing these infections, analysis of identified organisms, and assessment of clinical outcomes. RESULTS:A total of 2606 patients were screened between May 2018 and October 2022, 194 were included. Most of them were polytrauma patients defined by Injury Severity Score ≥ 16 (71 %). Early SSI occurred in 20 patients (10 %) and LRTI occurred in 58 patients (30 %). The number of vertebral levels instrumented (odds ratio [OR] 1.24, 95 % confidence interval [95 % CI] 1.01-1.52) was associated with SSI. The causative organisms were predominantly Gram-positive cocci (19/36 identified organisms). Factors associated with LRTI were an injury severity score ≥ 25 (OR 7.41; 95 % CI, 3.28-17.99), spinal injury at levels C3-C7 (OR 2.24; 95 % CI 1.01-5.14) and antibiotics during initial management (OR 7.09; 95 % CI, 2.71-20.49). The causative organisms were predominantly Gram-negative bacilli (58/80 identified organisms). Patients with LRTI experienced longer hospital stays, extended durations of mechanical ventilation, and higher mortality rates at 30 days and one year than those without. CONCLUSION:Early SSI and LRTI are underestimated complications in severe trauma patients with TSI requiring surgery. Identifying risk factors and causative organisms is an important step for advancing research on targeted prevention and treatment of SSI and LRTI after trauma.

Abstract Background Because of the adverse effects of morphine and its derivatives, non-opioid analgesia procedures are proposed after outpatient surgery. Without opioids, the ability to provide quality analgesia after the patient returns home may be questioned. We examined whether an opioid-free strategy could ensure satisfactory analgesia after ambulatory laparoscopic colectomy. Methods We performed a retrospective observational single-center study (of prospective collected database) including all patients eligible for scheduled outpatient colectomy. Postoperative analgesia was provided by paracetamol and nefopam. Postoperative follow-up included pain at mobilization (assessed by a numerical rating scale, NRS), hemodynamic variables, temperature, resumption of transit and biological markers of postoperative inflammation. The primary outcome was the proportion of patients with moderate to severe pain (NRS > 4) the day after surgery. Results Data from 144 patients were analyzed. The majority were men aged 59 ± 12 years with a mean BMI of 27 [25-30] kg/m2. ASA scores were 1 for 14%, 2 for 59% and 3 for 27% of patients. Forty-seven patients (33%) underwent surgery for cancer, 94 for sigmoiditis (65%) and 3 (2%) for another colonic pathology. Postoperative pain was affected by time since surgery (Q3 = 52.4,p < 0.001) and decreased significantly from day to day. The incidence of moderate to severe pain at mobilization (NRS > 4) on the first day after surgery was (0.19; 95% CI, 0.13–0.27). Conclusion Non-opioid analgesia after ambulatory laparoscopic colectomy seems efficient to ensure adequate analgesia. This therapeutic strategy makes it possible to avoid the adverse effects of opioids. Trial registration The study was retrospectively registered and approved by the relevant institutional review board (CERAR) reference IRB 00010254–2018 – 188). All patients gave written informed consent for analysis of their data. The anonymous database was declared to the French Data Protection Authority (CNIL) (reference 221 2976 v0 of April 12, 2019).

Hip fracture is common and associated with high morbidity and mortality rates. Selective serotonin reuptake inhibitors (SSRIs) influence platelet hemostasis and might result in abnormal bleeding. This study aims to determine whether the use of SSRIs in older patients undergoing hip fracture surgery is associated with the risk of perioperative red blood cell (RBC) transfusion. We conducted a retrospective observational study using prospectively collected data of patients aged 70 years and older admitted to a French geriatric perioperative ward for hip fracture between January 2012 and June 2021. The primary endpoint was the occurrence of RBC transfusion during hospitalization. Multivariate logistic regression was performed, with a sensitivity analysis according to co-prescriptions. Out of 1085 patients, 253 (23

BACKGROUND:The war in Ukraine provides purposefully anesthesiologists and intensivists with important data for improving the management of trauma patients. This scoping review aims to investigate the specific management of war-related trauma patients, during the war in Ukraine, through an objective and comprehensive analysis. METHODS:A comprehensive search of the Embase, Medline, and Open Grey databases from 2014 to February 2024 yielded studies focusing on anesthesia and surgery. These studies were assessed by PRISMA and STROBE criteria and needed to discuss anesthesiology and surgical procedures. RESULTS:Of the 519 studies identified, 21 were included, with a low overall level of evidence. The studies covered 11,622 patients and 2470 surgical procedures. Most patients were Ukrainian men, 25-63 years old, who had sustained severe injuries from high-energy weapons, such as multiple rocket systems and combat drones. These injuries included major abdominal, facial, and extremity traumas. The surgical procedures varied from initial debridement to complex reconstructions. Anesthesia management faced significant challenges, including resource scarcity and the need for quick adaptability. Evacuations of casualties were lengthy, complex, and often involved rail transportation. Hemorrhage control with tourniquets was critical but associated with many complications. The very frequent presence of multi-resistant organisms required dedicated preventive measures and appropriated treatments. The need for qualified human resources underscored the importance of civilian-military cooperation. CONCLUSION:This scoping review provides original and relevant insights on the lessons learned from the ongoing war in Ukraine, which could be useful for anesthesiologists and intensivists.

Aim of the study: Emergency resuscitative thoracotomy (ERT) has been described as a potentially life-saving procedure for trauma patients who have been admitted in refractory shock or with recent loss of sign of life (SOL). This nationwide registry analysis aimed to describe the French practice of ERT. Patients and methods: From 2015 to 2021, all severe trauma patients who underwent ERT were extracted from the TraumaBase -> registry. Demographic data, prehospital management and in-hospital outcomes were recorded to evaluate predictors of success-to rescue after ERT at 24-hour and 28-day. Results: Only 10/26 Trauma centers have an effective practice of ERT, three of them perform more than 1 ERT/year. Sixty-six patients (74% male, 49/66) with a median age of 37 y/o [26-51], mostly with blunt trauma (52%, 35/66) were managed with ERT. The median pre-hospital time was 64mins [45-89]. At admission, the median injury severity score was 35 [25-48], and 51% (16/30) of patients have lost SOL. ERT was associated with a massive transfusion protocol including 8 RBCs [6-13], 6 FFPs [4-10], and 0 PCs [0-1] in the first 6 h. The overall success-to- rescue after ERT at 24-h and 28-d were 27% and 15%, respectively. In case of refractory shock after penetrating trauma, survival was 64% at 24-hours and 47% at 28-days. Conclusions: ERT integrated into the trauma protocol remains a life-saving procedure that appears to be underutilized in France, despite significant success-to-rescue observed by trained teams for selected patients. (c) 2024 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Objective. Time-frequency (T-F) analysis of electroencephalographic (EEG) is a common technique to characterise spectral changes in neural activity. This study explores the limitations of utilizing conventional spectral techniques in examining cyclic event-related cortical activities due to challenges, including high inter-trial variability. Approach. Introducing the cycle-frequency (C-F) analysis, we aim to enhance the evaluation of cycle-locked respiratory events. For synthetic EEG that mimicked cycle-locked pre-motor activity, C-F had more accurate frequency and time localization compared to conventional T-F analysis, even for a significantly reduced number of trials and a variability of breathing rhythm. Main results. Preliminary validations using real EEG data during both unloaded breathing and loaded breathing (that evokes pre-motor activity) suggest potential benefits of using the C-F method, particularly in normalizing time units to cyclic activity phases and refining baseline placement and duration. Significance. The proposed approach could provide new insights for the study of rhythmic neural activities, complementing T-F analysis.

On désigne par cyber-attaque l’intrusion au sein d’un système d’information (SI), dans le but de voler des données puis d’encrypter les fichiers et serveurs, avant de demander une rançon en échange de la remise de la clef de décryptage. Pareille crise au sein d’un hôpital provoque immédiatement une paralysie totale et très prolongée. Cette paralysie vient de l’incapacité à accéder aux données médicales mais aussi de fonctionnement de l’hôpital comme de l’incapacité à communiquer, car les canaux numériques habituels ne peuvent plus fonctionner. Il n’existe pas de plan de prévention commun à tous les hôpitaux. Chaque établissement de santé doit identifier ses propres besoins. Ce travail d’identification ne peut être effectué que par les acteurs de terrain, coordonnés par une cellule ad hoc. Ceci garantit une parfaite conformité aux exigences des services et directions, et d’autre part permet de faire appel à l’intelligence collective de celles et ceux qui utilisent l’outil informatique au quotidien, en connaissent les failles et ont une idée de comment s’en sortir le jour où le SI dysfonctionne. La poursuite de l’activité en cas d’incapacité du SI impose de pouvoir accéder aux données indispensables au fonctionnement, et donc d’avoir pensé, en amont de la crise, aux moyens de les rendre accessibles. Une partie des données non confidentielles peut être sauvegardée. Les données médicales, désormais dématérialisées, peuvent être remises au patient sous forme papier ou numérique dans « mon espace santé ». Certaines données peuvent être stockées sur les serveurs sécurisés des fournisseurs de matériel. La communication orale passe par l’utilisation de réseau 4/5G, malheureusement souvent difficilement accessible au sein des bâtiments modernes. Ce même réseau permettra de connecter des ordinateurs portables à internet au moyen de clefs adaptées, autorisant l’utilisation d’outils collaboratifs hors SI. La communication par messagerie instantanée doit respecter la confidentialité des données. Ces dernières ne peuvent être transférées que par des applications certifiées pour cet usage. Le recours à la messagerie ordinale permet d’échanger des données médicales en toute sécurité. Les patients et usagers seront informés au moyen des réseaux sociaux, des médias, des institutions, des associations d’usagers, des communautés professionnelles territoriales de santé.