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Prise en charge des pathologies réanimatoires et chirurgicales au cours des futures missions d’exploration spatiale

Management of critical and surgical conditions during future space exploration missions

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Réanimation

Résumé

La prise en charge des pathologies médicochirurgicales sévères au cours des futures missions d’exploration spatiale constituera un véritable défi. En raison d’innombrables contraintes, toutes les pathologies ne pourront pas accéder à une prise en charge et le système médical devra se focaliser sur les plus fréquentes et les plus sévères. L’objectif de cette étude est de proposer des recommandations afin d’optimiser le kit médical embarqué tout en réduisant le risque vital associé à de telles missions. Par une recherche bibliographique en médecine spatiale et milieux analogues, une liste exhaustive de pathologies attendues a été établie. Leur incidence par mission et leur mortalité moyenne ont été estimées. En croisant ces données avec différentes options de systèmes médicaux, il devient possible de mettre en balance la complexité du kit médical et le risque vital accepté et de déterminer quelles seraient les techniques thérapeutiques les plus essentielles. D’après l’analyse, les pathologies associées au risque vital le plus significatif sont en premier lieu les états septiques graves et les pathologies traumatiques sévères. Au-delà des traitements les plus simples (perfusions, antibiotiques, oxygénothérapie...), il apparaît fondamental de disposer de la capacité d’administrer des dérivés ou des substituts sanguins et de réaliser des actes chirurgicaux. Les résultats permettent également d’exclure certaines pathologies sévères mais estimées exceptionnelles.

Globalement, les résultats obtenus sont tout à fait concordants avec les publications sur le sujet et ont le potentiel d’améliorer les pratiques médicales sur Terre, par exemple en médecine humanitaire, militaire ou en environnement austère.

Abstract

During future space exploration missions, management of severe medical and surgical conditions will represent a challenge. Due to severe limitations in acute care capabilities, the medical system will need to focus only on the most likely and severe conditions. Using a probabilistic approach, the primary objective of this analysis is to offer recommendations for the preparation of crews and onboard medical systems, with the aim of optimizing the medical kit while maintaining the estimated mortality risk within acceptable limits. Based on the analysis of medical literature in space medicine and analogue environments, a list of expected conditions has been established. Their incidence and average mortality in similar populations have been estimated. By balancing medical kits complexity and estimated vital risk, it becomes possible to determine which therapeutic techniques are mandatory. According to the analysis, the conditions associated with the most significant risk are severe sepsis and traumatic injuries. Besides the basicmedical procedures (intravenous access, antibiotics, oxygen...), it seems essential to be able to administer blood products or substitutes and perform surgery. The results also provide a list of conditions that could probably be excluded from the medical system due to their poor outcome, complexmanagement and extremely low estimated likelihood. The results globally correspond to the conclusions of previous publications. Like numerous spin-offs of space technologies in the past, this research is useful to increase the level of care on Earth, in particular in harsh and isolated environments.

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Authors and Affiliations

  1. Département d’anesthésie-réanimation, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonovski, F-59037, Lille cedex, France

    M. Komorowski

  2. MEDES, 21, chemin de la Pelude, F-31400, Toulouse, France

    M. Komorowski & B. Comet

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  1. M. Komorowski
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  2. B. Comet
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Komorowski, M., Comet, B. Prise en charge des pathologies réanimatoires et chirurgicales au cours des futures missions d’exploration spatiale. Réanimation 23, 431–444 (2014). https://doi.org/10.1007/s13546-014-0899-4

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  • DOI: https://doi.org/10.1007/s13546-014-0899-4

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