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  • Biomarkers and clinical scores to aid the identification of disease severity and intensive care requirement following activation of an in-hospital sepsis code
    Ann. Intensive Care (IF 3.931) Pub Date : 2020-01-15
    Jaume Baldirà, Juan Carlos Ruiz-Rodríguez, Darius Cameron Wilson, Adolf Ruiz-Sanmartin, Alejandro Cortes, Luis Chiscano, Roser Ferrer-Costa, Inma Comas, Nieves Larrosa, Anna Fàbrega, Juan José González-López, Ricard Ferrer

    Abstract Background Few validated biomarker or clinical score combinations exist which can discriminate between cases of infection and other non-infectious conditions following activation of an in-hospital sepsis code, as well as provide an accurate severity assessment of the corresponding host response. This study aimed to identify suitable blood biomarker (MR-proADM, PCT, CRP and lactate) or clinical score (SOFA and APACHE II) combinations to address this unmet clinical need. Methods A prospective, observational study of patients activating the Vall d’Hebron University Hospital sepsis code (ISC) within the emergency department (ED), hospital wards and intensive care unit (ICU). Area under the receiver operating characteristic (AUROC) curves, logistic and Cox regression analysis were used to assess performance. Results 148 patients fulfilled the Vall d’Hebron ISC criteria, of which 130 (87.8%) were retrospectively found to have a confirmed diagnosis of infection. Both PCT and MR-proADM had a moderate-to-high performance in discriminating between infected and non-infected patients following ISC activation, although the optimal PCT cut-off varied significantly across departments. Similarly, MR-proADM and SOFA performed well in predicting 28- and 90-day mortality within the total infected patient population, as well as within patients presenting with a community-acquired infection or following a medical emergency or prior surgical procedure. Importantly, MR-proADM also showed a high association with the requirement for ICU admission after ED presentation [OR (95% CI) 8.18 (1.75–28.33)] or during treatment on the ward [OR (95% CI) 3.64 (1.43–9.29)], although the predictive performance of all biomarkers and clinical scores diminished between both settings. Conclusions Results suggest that the individual use of PCT and MR-proADM might help to accurately identify patients with infection and assess the overall severity of the host response, respectively. In addition, the use of MR-proADM could accurately identify patients requiring admission onto the ICU, irrespective of whether patients presented to the ED or were undergoing treatment on the ward. Initial measurement of both biomarkers might therefore facilitate early treatment strategies following activation of an in-hospital sepsis code.

    更新日期:2020-01-15
  • Accuracy of ventilator-associated events for the diagnosis of ventilator-associated lower respiratory tract infections
    Ann. Intensive Care (IF 3.931) Pub Date : 2020-01-13
    Olivier Pouly, Sylvain Lecailtel, Sophie Six, Sébastien Préau, Frédéric Wallet, Saad Nseir, Anahita Rouzé

    The aim of this study was to investigate the concordance between ventilator-associated events (VAE) and ventilator-associated lower respiratory tract infections (VA-LRTI), and their impact on outcome.

    更新日期:2020-01-14
  • Surfactant protein D ( SP - D ) gene polymorphism rs721917 is an independent predictor of acute kidney injury development in sepsis patients: a prospective cohort study
    Ann. Intensive Care (IF 3.931) Pub Date : 2020-01-13
    Jiao Liu, Jianying Yao, Lidi Zhang, Yizhu Chen, Hangxiang Du, Zhenliang Wen, Dechang Chen

    Abstract Background Currently, there are no reliable predictors of risk of development and severity of acute kidney injury (AKI) in septic patients. The surfactant protein D (SP-D) polymorphism rs721917C/T is associated with a greater susceptibility to AKI in the Chinese population. Our aim was to evaluate the value of SP-D polymorphisms rs721917C/T and of plasma SP-D levels to predict the risk of development of AKI (defined with KDIGO criterion) in septic patients. Methods The study enrolled septic patients admitted to the Critical Care Department of two tertiary care hospitals. SP-D rs721917C/T polymorphisms were determined using the PCR-SSP method. Plasma SP-D and urine NGAL contents were measured using commercially available ELISA kits. Results 330 septic patients were included. Their SOFA scores were 12 ± 3. Patients with AKI (n = 156) had higher plasma SP-D levels (median: 153 ng/mL, range 111–198 ng/mL) and urinary NGAL levels (median: 575 ng/mL, range 423–727 ng/mL) than those without AKI (SP-D median: 124 ng/mL, range 81–159 ng/mL, P = 0.001; NGAL median: 484 ng/mL, range 429–573 ng/mL). Plasma SP-D levels of AKI patients were correlated with urinary NGAL contents (r = 0.853). In 32 patients receiving continuous renal replacement therapy (CRRT), plasma SP-D levels correlated with duration of CRRT (r = 0.448). The area under the receiver operating characteristic curve for plasma SP-D levels to predict AKI was 0.84. Patients with AKI had a higher rate of rs721917 CC genotype (AKI: 35% vs. non-AKI: 20%; P = 0.012), but a significantly lower rate of TT genotype (AKI: 19% vs. non-AKI: 26%; P = 0.005). SP-D rs721917 CC genotype was an independent predictor of AKI (P = 0.044) and mortality (P = 0.014). Conclusion Our study showed that increased plasma SP-D level is associated with a higher risk of AKI in patients with sepsis. The SP-D rs721917CC genotype is an independent and significant predictor of AKI development and mortality of septic patients. The SP-D rs721917C/T polymorphisms should be further studied as diagnostic and prognostic biomarkers to facilitate early recognition of AKI.

    更新日期:2020-01-13
  • Clinical pharmacokinetics of 3-h extended infusion of meropenem in adult patients with severe sepsis and septic shock: implications for empirical therapy against Gram-negative bacteria
    Ann. Intensive Care (IF 3.931) Pub Date : 2020-01-10
    Amol T. Kothekar, Jigeeshu Vasishtha Divatia, Sheila Nainan Myatra, Anand Patil, Manjunath Nookala Krishnamurthy, Harish Mallapura Maheshwarappa, Suhail Sarwar Siddiqui, Murari Gurjar, Sanjay Biswas, Vikram Gota

    Optimal anti-bacterial activity of meropenem requires maintenance of its plasma concentration (Cp) above the minimum inhibitory concentration (MIC) of the pathogen for at least 40% of the dosing interval (fT > MIC > 40). We aimed to determine whether a 3-h extended infusion (EI) of meropenem achieves fT > MIC > 40 on the first and third days of therapy in patients with severe sepsis or septic shock. We also simulated the performance of the EI with respect to other pharmacokinetic (PK) targets such as fT > 4 × MIC > 40, fT > MIC = 100, and fT > 4 × MIC = 100.

    更新日期:2020-01-11
  • ICU-acquired weakness, diaphragm dysfunction and long-term outcomes of critically ill patients
    Ann. Intensive Care (IF 3.931) Pub Date : 2020-01-03
    Clément Saccheri, Elise Morawiec, Julie Delemazure, Julien Mayaux, Bruno-Pierre Dubé, Thomas Similowski, Alexandre Demoule, Martin Dres

    Abstract Background Intensive care unit (ICU)-acquired weakness and diaphragm dysfunction are frequent conditions, both associated with poor prognosis in critically ill patients. While it is well established that ICU-acquired weakness severely impairs long-term prognosis, the association of diaphragm dysfunction with this outcome has never been reported. This study investigated whether diaphragm dysfunction is associated with negative long-term outcomes and whether the coexistence of diaphragm dysfunction and ICU-acquired weakness has a particular association with 2-year survival and health-related quality of life (HRQOL). Methods This study is an ancillary study derived from an observational cohort study. Patients under mechanical ventilation were enrolled at the time of their first spontaneous breathing trial. Diaphragm dysfunction was defined by tracheal pressure generated by phrenic nerve stimulation < 11 cmH2O and ICU-acquired weakness was defined by Medical Research Council (MRC) score < 48. HRQOL was evaluated with the SF-36 questionnaire. Results Sixty-nine of the 76 patients enrolled in the original study were included in the survival analysis and 40 were interviewed. Overall 2-year survival was 67% (46/69): 64% (29/45) in patients with diaphragm dysfunction, 71% (17/24) in patients without diaphragm dysfunction, 46% (11/24) in patients with ICU-acquired weakness and 76% (34/45) in patients without ICU-acquired weakness. Patients with concomitant diaphragm dysfunction and ICU-acquired weakness had a poorer outcome with a 2-year survival rate of 36% (5/14) compared to patients without diaphragm function and ICU-acquired weakness [79% (11/14) (p < 0.01)]. Health-related quality of life was not influenced by the presence of ICU-acquired weakness, diaphragm dysfunction or their coexistence. Conclusions ICU-acquired weakness but not diaphragm dysfunction was associated with a poor 2-year survival of critically ill patients.

    更新日期:2020-01-04
  • Nationwide survey on training and device utilization during tracheal intubation in French intensive care units
    Ann. Intensive Care (IF 3.931) Pub Date : 2020-01-03
    M. Martin, P. Decamps, A. Seguin, C. Garret, L. Crosby, O. Zambon, A. F. Miailhe, E. Canet, J. Reignier, J. B. Lascarrou

    Abstract Background Intubation is a lifesaving procedure that is often performed in intensive care unit (ICU) patients, but leads to serious adverse events in 20–40% of cases. Recent trials aimed to provide guidance about which medications, devices, and modalities maximize patient safety. Videolaryngoscopes are being offered in an increasing range of options and used in broadening indications (from difficult to unremarkable intubation). The objective of this study was to describe intubation practices and device availability in French ICUs. Materials and methods We conducted an online nationwide survey by emailing an anonymous 26-item questionnaire to physicians in French ICUs. A single questionnaire was sent to either the head or the intubation expert at each ICU. Results Of 257 ICUs, 180 (70%) returned the completed questionnaire. The results showed that 43% of intubators were not fully proficient in intubation; among them, 18.8% had no intubation training or had received only basic training (lectures and observation at the bedside). Among the participating ICUs, 94.4% had a difficult intubation trolley, 74.5% an intubation protocol, 92.2% a capnography device (used routinely to check tube position in 69.3% of ICUs having the device), 91.6% a laryngeal mask, 97.2% front-of-neck access capabilities, and 76.6% a videolaryngoscope. In case of difficult intubation, 85.6% of ICUs used a bougie (154/180) and 7.8% switched to a videolaryngoscope (14/180). Use of a videolaryngoscope was reserved for difficult intubation in 84% of ICUs (154/180). Having a videolaryngoscope was significantly associated with having an intubation protocol (P = 0.043) and using capnography (P = 0.02). Airtraq® was the most often used videolaryngoscope (39.3%), followed by McGrath®Mac (36.9%) then by Glidescope® (14.5%). Conclusion Nearly half the intubators in French ICUs are not fully proficient with OTI. Access to modern training methods such as simulation is inadequate. Most ICUs own a videolaryngoscope, but reserve it for difficult intubations.

    更新日期:2020-01-04
  • Gastrointestinal colonization with multidrug-resistant Gram-negative bacteria during extracorporeal membrane oxygenation: effect on the risk of subsequent infections and impact on patient outcome
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-12-18
    Giacomo Grasselli, Vittorio Scaravilli, Laura Alagna, Michela Bombino, Stefano De Falco, Alessandra Bandera, Chiara Abbruzzese, Nicolò Patroniti, Andrea Gori, Antonio Pesenti

    In ICU patients, digestive tract colonization by multidrug-resistant (MDR) Gram-negative (G−) bacteria is a significant risk factor for the development of infections. In patients undergoing extracorporeal membrane oxygenation (ECMO), colonization by MDR bacteria and risk of subsequent nosocomial infections (NIs) have not been studied yet. The aim of this study is to evaluate the incidence, etiology, risk factors, impact on outcome of gastrointestinal colonization by MDR G− bacteria, and risk of subsequent infections in patients undergoing ECMO.

    更新日期:2019-12-19
  • How to detect a positive response to a fluid bolus when cardiac output is not measured?
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-12-16
    Zakaria Ait-Hamou, Jean-Louis Teboul, Nadia Anguel, Xavier Monnet

    Volume expansion is aimed at increasing cardiac output (CO), but this variable is not always directly measured. We assessed the ability of changes in arterial pressure, pulse pressure variation (PPV) and heart rate (HR) or of a combination of them to detect a positive response of cardiac output (CO) to fluid administration.

    更新日期:2019-12-17
  • Low-pressure support vs automatic tube compensation during spontaneous breathing trial for weaning
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-12-13
    Claude Guérin, Nicolas Terzi, Mehdi Mezidi, Loredana Baboi, Nader Chebib, Hodane Yonis, Laurent Argaud, Leo Heunks, Bruno Louis

    During spontaneous breathing trial, low-pressure support is thought to compensate for endotracheal tube resistance, but it actually should provide overassistance. Automatic tube compensation is an option available in the ventilator to compensate for flow-resistance of endotracheal tube. Its effects on patient effort have been poorly investigated. We aimed to compare the effects of low-pressure support and automatic tube compensation during spontaneous breathing trial on breathing power and lung ventilation distribution.

    更新日期:2019-12-17
  • Correction to: Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-12-04
    A. Harrois, J. R. Anstey, F. S. Taccone, A. A. Udy, G. Citerio, J. Duranteau, C. Ichai, R. Badenes, J. R. Prowle, A. Ercole, M. Oddo, A. Schneider, M. van der Jagt, S. Wolf, R. Helbok, D. W. Nelson, M. B. Skrifvars, D. J. Cooper, R. Bellomo, The TBI Collaborative

    Following publication of the original article [1], we were notified that the collaborators’ names part of the “The TBI Collaborative” group has not been indexed in Pubmed. Below the collaborators names full list:

    更新日期:2019-12-04
  • IgM-enriched immunoglobulins (Pentaglobin) may improve the microcirculation in sepsis: a pilot randomized trial
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-12-03
    Roberta Domizi, Erica Adrario, Elisa Damiani, Claudia Scorcella, Andrea Carsetti, Paolo Giaccaglia, Erika Casarotta, Vincenzo Gabbanelli, Simona Pantanetti, Elena Lamura, Silvia Ciucani, Abele Donati

    Polyclonal or IgM-enriched immunoglobulins may be beneficial during sepsis as an adjuvant immunomodulatory therapy. We aimed to test whether the infusion of IgM-enriched immunoglobulins improves microvascular perfusion during sepsis.

    更新日期:2019-12-03
  • “ I had the feeling that I was trapped ”: a bedside qualitative study of cognitive and affective attitudes toward noninvasive ventilation in patients with acute respiratory failure
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-12-02
    Marina Iosifyan, Matthieu Schmidt, Amélie Hurbault, Julien Mayaux, Christian Delafosse, Marina Mishenko, Nathalie Nion, Alexandre Demoule, Thomas Similowski

    Noninvasive ventilation (NIV) is the application of mechanical ventilation through a mask. It is used to treat certain forms of acute respiratory failure in intensive care units (ICU). NIV has clinical benefits but can be anxiogenic for the patients. This study aimed at describing cognitive and affective attitudes toward NIV among patients experiencing NIV for the first time in the context of an ICU stay.

    更新日期:2019-12-02
  • Survey of non-resuscitation fluids administered during septic shock: a multicenter prospective observational study
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-11-27
    Anja Lindén-Søndersø, Mårten Jungner, Martin Spångfors, Mohammed Jan, Adam Oscarson, Sally Choi, Thomas Kander, Johan Undén, Donald Griesdale, John Boyd, Peter Bentzer

    The indication, composition and timing of administration of non-resuscitation fluid in septic shock have so far received little attention and accordingly the potential to reduce this source of fluid is unknown. The objective of the study was to quantify and characterize non-resuscitation fluid administered to patients with septic shock.

    更新日期:2019-11-28
  • Outcome and prognostic factors of Pneumocystis jirovecii pneumonia in immunocompromised adults: a prospective observational study
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-11-27
    Benjamin Jean Gaborit, Benoit Tessoulin, Rose-Anne Lavergne, Florent Morio, Christine Sagan, Emmanuel Canet, Raphael Lecomte, Paul Leturnier, Colin Deschanvres, Lydie Khatchatourian, Nathalie Asseray, Charlotte Garret, Michael Vourch, Delphine Marest, François Raffi, David Boutoille, Jean Reignier

    Pneumocystis jirovecii pneumonia (PJP) remains a severe disease associated with high rates of invasive mechanical ventilation (MV) and mortality. The objectives of this study were to assess early risk factors for severe PJP and 90-day mortality, including the broncho-alveolar lavage fluid cytology profiles at diagnosis.

    更新日期:2019-11-28
  • Intra-aortic balloon pump does not influence cerebral hemodynamics and neurological outcomes in high-risk cardiac patients undergoing cardiac surgery: an analysis of the IABCS trial
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-11-27
    Juliana R. Caldas, Ronney B. Panerai, Edson Bor-Seng-Shu, Graziela S. R. Ferreira, Ligia Camara, Rogério H. Passos, Angela M. Salinet, Daniel S. Azevedo, Marcelo de-Lima-Oliveira, Filomena R. B. G. Galas, Julia T. Fukushima, Ricardo Nogueira, Fabio S. Taccone, Giovanni Landoni, Juliano P. Almeida, Thompson G. Robinson, Ludhmila A. Hajjar

    The intra-aortic balloon pump (IABP) is often used in high-risk patients undergoing cardiac surgery to improve coronary perfusion and decrease afterload. The effects of the IABP on cerebral hemodynamics are unknown. We therefore assessed the effect of the IABP on cerebral hemodynamics and on neurological complications in patients undergoing cardiac surgery who were randomized to receive or not receive preoperative IABP in the ‘Intra-aortic Balloon Counterpulsation in Patients Undergoing Cardiac Surgery’ (IABCS) trial.

    更新日期:2019-11-28
  • Epidemiology, clinical features, and management of severe hypercalcemia in critically ill patients
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-11-27
    Cyril Mousseaux, Axelle Dupont, Cédric Rafat, Kenneth Ekpe, Etienne Ghrenassia, Lionel Kerhuel, Fanny Ardisson, Eric Mariotte, Virginie Lemiale, Benoît Schlemmer, Elie Azoulay, Lara Zafrani

    Severe hypercalcemia (HCM) is a common reason for admission in intensive-care unit (ICU). This case series aims to describe the clinical and biological features, etiologies, treatments, and outcome associated with severe HCM. This study included all patients with a total calcemia above 12 mg/dL (3 mmol/L) admitted in two ICUs from January 2007 to February 2017.

    更新日期:2019-11-28
  • Effect of nitric oxide on postoperative acute kidney injury in patients who underwent cardiopulmonary bypass: a systematic review and meta-analysis with trial sequential analysis
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-11-21
    Jie Hu, Stefano Spina, Francesco Zadek, Nikolay O. Kamenshchikov, Edward A. Bittner, Juan Pedemonte, Lorenzo Berra

    The effect of nitric oxide (NO) on renal function is controversial in critical illness. We performed a systematic meta-analysis and trial sequential analysis to determine the effect of NO gas on renal function and other clinical outcomes in patients requiring cardiopulmonary bypass (CPB). The primary outcome was the relative risk (RR) of acute kidney injury (AKI), irrespective of the AKI stage. The secondary outcome was the mean difference (MD) in the length of ICU and hospital stay, the RR of postoperative hemorrhage, and the MD in levels of methemoglobin. Trial sequential analysis (TSA) was performed for the primary outcome.

    更新日期:2019-11-28
  • Estimated dead space fraction and the ventilatory ratio are associated with mortality in early ARDS
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-11-21
    Luis Morales-Quinteros, Marcus J. Schultz, Josep Bringué, Carolyn S. Calfee, Marta Camprubí, Olaf L. Cremer, Janneke Horn, Tom van der Poll, Pratik Sinha, Antonio Artigas, Lieuwe D. Bos, MARS Consortium

    Indirect indices for measuring impaired ventilation, such as the estimated dead space fraction and the ventilatory ratio, have been shown to be independently associated with an increased risk of mortality. This study aimed to compare various methods for dead space estimation and the ventilatory ratio in patients with acute respiratory distress syndrome (ARDS) and to determine their independent values for predicting death at day 30. The present study is a post hoc analysis of a prospective observational cohort study of ICUs of two tertiary care hospitals in the Netherlands.

    更新日期:2019-11-28
  • Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-11-19
    Tomoya Okazaki, Toru Hifumi, Kenya Kawakita, Yasuhiro Kuroda, the Japanese Association for Acute Medicine out-of-hospital cardiac arrest (JAAM-OHCA) registry

    The International Liaison Committee on Resuscitation guidelines recommend target temperature management (TTM) between 32 and 36 °C for patients after out-of-hospital cardiac arrest, but did not indicate patient-specific temperatures. The association of serum lactate concentration and neurological outcome in out-of-hospital cardiac arrest patient has been reported. The study aim was to investigate the benefit of 32–34 °C in patients with various degrees of hyperlactatemia compared to 35–36 °C.

    更新日期:2019-11-28
  • Healthcare trajectories before and after critical illness: population-based insight on diverse patients clusters
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-11-09
    Youenn Jouan, Leslie Grammatico-Guillon, Noémie Teixera, Claire Hassen-Khodja, Christophe Gaborit, Charlotte Salmon-Gandonnière, Antoine Guillon, Stephan Ehrmann

    The post intensive care syndrome (PICS) gathers various disabilities, associated with a substantial healthcare use. However, patients’ comorbidities and active medical conditions prior to intensive care unit (ICU) admission may partly drive healthcare use after ICU discharge. To better understand retative contribution of critical illness and PICS—compared to pre-existing comorbidities—as potential determinant of post-critical illness healthcare use, we conducted a population-based evaluation of patients’ healthcare use trajectories.

    更新日期:2019-11-28
  • Prediction of mortality in adult patients with sepsis using six biomarkers: a systematic review and meta-analysis
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-11-08
    Andreas Pregernig, Mattia Müller, Ulrike Held, Beatrice Beck-Schimmer

    Angiopoietin-1 (Ang-1) and 2 (Ang-2), high mobility group box 1 (HMGB1), soluble receptor for advanced glycation endproducts (sRAGE), soluble triggering receptor expressed on myeloid cells 1 (sTREM1), and soluble urokinase-type plasminogen activator receptor (suPAR) have shown promising results for predicting all-cause mortality in critical care patients. The aim of our systematic review and meta-analysis was to assess the prognostic value of these biomarkers for mortality in adult patients with sepsis.

    更新日期:2019-11-28
  • Use of ultrasound-measured internal jugular vein collapsibility index to determine static intracardiac pressures in patients with presumed pulmonary hypertension
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-28
    Raj Parikh, Matthew Spring, Janice Weinberg, Christine C. Reardon, Harrison W. Farber

    Bedside ultrasound helps to estimate volume status in critically ill patients and has traditionally relied on diameter, respiratory variation, and collapsibility of the inferior vena cava (IVC) to reflect fluid status. We evaluated collapsibility of the internal jugular vein (IJ) with ultrasound and correlated it with concomitant right heart catheterization (RHC) measurements in patients with presumed pulmonary hypertension.

    更新日期:2019-11-28
  • Impact of a multidisciplinary care bundle for necrotizing skin and soft tissue infections: a retrospective cohort study
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-24
    Tomas Urbina, Camille Hua, Emilie Sbidian, Romain Bosc, Françoise Tomberli, Raphael Lepeule, Jean-Winoc Decousser, Armand Mekontso Dessap, Olivier Chosidow, Nicolas de Prost, the Henri Mondor Hospital Necrotizing Fasciitis group

    Necrotizing skin and soft tissue infections (NSTIs) require both prompt medical and surgical treatment. The coordination of multiple urgent interventions by care bundles has improved outcome in other settings. This study aimed to assess the impact of a multidisciplinary care bundle on management and outcome of patients with NSTIs.

    更新日期:2019-11-28
  • Effects of high-flow nasal cannula and non-invasive ventilation on inspiratory effort in hypercapnic patients with chronic obstructive pulmonary disease: a preliminary study
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-22
    Nuttapol Rittayamai, Prapinpa Phuangchoei, Jamsak Tscheikuna, Nattakarn Praphruetkit, Laurent Brochard

    Non-invasive ventilation (NIV) is preferred as the initial ventilatory support to treat acute hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease (COPD). High-flow nasal cannula (HFNC) may be an alternative method; however, the effects of HFNC in hypercapnic COPD are not well known. This preliminary study aimed at assessing the physiologic effects of HFNC at different flow rates in hypercapnic COPD and to compare it with NIV.

    更新日期:2019-11-28
  • Impact of natural light exposure on delirium burden in adult patients receiving invasive mechanical ventilation in the ICU: a prospective study
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-17
    Roland Smonig, Eric Magalhaes, Lila Bouadma, Olivier Andremont, Etienne de Montmollin, Fatiah Essardy, Bruno Mourvillier, Jordane Lebut, Claire Dupuis, Mathilde Neuville, Mathilde Lermuzeaux, Jean-François Timsit, Romain Sonneville

    To determine whether potential exposure to natural light via windows is associated with reduced delirium burden in critically ill patients admitted to the ICU in a single room.

    更新日期:2019-11-28
  • Growth differentiation factor 15 and early prognosis after out-of-hospital cardiac arrest
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-17
    Ferran Rueda, Germán Cediel, Cosme García-García, Júlia Aranyó, Marta González-Lopera, M. Cruz Aranda Nevado, Judith Serra Gregori, Teresa Oliveras, Carlos Labata, Marc Ferrer, Nabil El Ouaddi, Antoni Bayés-Genís

    Growth differentiation factor 15 (GDF-15) is an inflammatory cytokine released in response to tissue injury. It has prognostic value in cardiovascular diseases and other acute and chronic conditions. Here, we explored the value of GDF-15 as an early predictor of neurologic outcome after an out-of-hospital cardiac arrest (OHCA).

    更新日期:2019-11-28
  • Use of MIRUS™ for MAC-driven application of isoflurane, sevoflurane, and desflurane in postoperative ICU patients: a randomized controlled trial
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-16
    Martin Bellgardt, Adrian Iustin Georgevici, Mitja Klutzny, Dominik Drees, Andreas Meiser, Philipp Gude, Heike Vogelsang, Thomas Peter Weber, Jennifer Herzog-Niescery

    The MIRUS™ (TIM, Koblenz, Germany) is an electronical gas delivery system, which offers an automated MAC (minimal alveolar concentration)-driven application of isoflurane, sevoflurane, or desflurane, and can be used for sedation in the intensive care unit. We investigated its consumption of volatile anesthetics at 0.5 MAC (primary endpoint) and the corresponding costs. Secondary endpoints were the technical feasibility to reach and control the MAC automatically, the depth of sedation at 0.5 MAC, and awakening times. Mechanically ventilated and sedated patients after major surgery were enrolled. Upon arrival in the intensive care unit, patients obtained intravenous propofol sedation for at least 1 h to collect ventilation and blood gas parameters, before they were switched to inhalational sedation using MIRUS™ with isoflurane, sevoflurane, or desflurane. After a minimum of 2 h, inhalational sedation was stopped, and awakening times were recorded. A multivariate electroencephalogram and the Richmond Agitation Sedation Scale (RASS) were used to assess the depth of sedation. Vital signs, ventilation parameters, gas consumption, MAC, and expiratory gas concentrations were continuously recorded.

    更新日期:2019-11-28
  • Evaluation of least significant changes of pulse contour analysis-derived parameters
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-11
    Hugues de Courson, Loic Ferrer, Grégoire Cane, Eric Verchère, Musa Sesay, Karine Nouette-Gaulain, Matthieu Biais

    Many maneuvers assessing fluid responsiveness (minifluid challenge, lung recruitment maneuver, end-expiratory occlusion test, passive leg raising) are considered as positive when small variations in cardiac index, stroke volume index, stroke volume variation or pulse pressure variation occur. Pulse contour analysis allows continuous and real-time cardiac index, stroke volume, stroke volume variation and pulse pressure variation estimations. To use these maneuvers with pulse contour analysis, the knowledge of the minimal change that needs to be measured by a device to recognize a real change (least significant change) has to be studied. The aim of this study was to evaluate the least significant change of cardiac index, stroke volume index, stroke volume variation and pulse pressure variation obtained using pulse contour analysis (ProAQT®, Pulsion Medical System, Germany).

    更新日期:2019-11-28
  • Changes in dynamic arterial elastance induced by volume expansion and vasopressor in the operating room: a prospective bicentre study
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-11
    Hugues de Courson, Philippe Boyer, Romain Grobost, Romain Lanchon, Musa Sesay, Karine Nouette-Gaulain, Emmanuel Futier, Matthieu Biais

    Dynamic arterial elastance (Eadyn), defined as the ratio between pulse pressure variations and stroke volume variations, has been proposed to assess functional arterial load. We evaluated the evolution of Eadyn during volume expansion and the effects of neosynephrine infusion in hypotensive and preload-responsive patients.

    更新日期:2019-11-28
  • Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d’Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-10
    Philippe Le Conte, Nicolas Terzi, Guillaume Mortamet, Fekri Abroug, Guillaume Carteaux, Céline Charasse, Anthony Chauvin, Xavier Combes, Stéphane Dauger, Alexandre Demoule, Thibaut Desmettre, Stephan Ehrmann, Bénédicte Gaillard-Le Roux, Valérie Hamel, Boris Jung, Sabrina Kepka, Erwan L’Her, Mikaël Martinez, Christophe Milési, Élise Morawiec, Mathieu Oberlin, Patrick Plaisance, Robin Pouyau, Chantal Raherison, Patrick Ray, Mathieu Schmidt, Arnaud W. Thille, Jennifer Truchot, Guillaume Valdenaire, Julien Vaux, Damien Viglino, Guillaume Voiriot, Bénédicte Vrignaud, Sandrine Jean, Eric Mariotte, Pierre-Géraud Claret

    The French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma exacerbation (SAE) in adult and pediatric patients.

    更新日期:2019-11-28
  • Physiological effects of high-flow oxygen in tracheostomized patients
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-07
    Daniele Natalini, Domenico L. Grieco, Maria Teresa Santantonio, Lucrezia Mincione, Flavia Toni, Gian Marco Anzellotti, Davide Eleuteri, Pierluigi Di Giannatale, Massimo Antonelli, Salvatore Maurizio Maggiore

    High-flow oxygen therapy via nasal cannula (HFOTNASAL) increases airway pressure, ameliorates oxygenation and reduces work of breathing. High-flow oxygen can be delivered through tracheostomy (HFOTTRACHEAL), but its physiological effects have not been systematically described. We conducted a cross-over study to elucidate the effects of increasing flow rates of HFOTTRACHEAL on gas exchange, respiratory rate and endotracheal pressure and to compare lower airway pressure produced by HFOTNASAL and HFOTTRACHEAL.

    更新日期:2019-11-28
  • Urgent need for a randomized controlled trial with only septic patients!
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-23
    Sébastien Redant,Matthieu Legrand,Yael Langman,Alejandra Garcia Aguilar,Keitiane Kaefer,David De Bels,Rachid Attou,Kianoush Kashani,Patrick M Honore

    更新日期:2019-11-01
  • Respiratory variations of inferior vena cava fail to predict fluid responsiveness in mechanically ventilated patients with isolated left ventricular dysfunction.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-09
    Hongmin Zhang,Qing Zhang,Xiukai Chen,Xiaoting Wang,Dawei Liu,

    BACKGROUND Respiratory variation of inferior vena cava is problematic in predicting fluid responsiveness in patients with right ventricular dysfunction. However, its effectiveness in patients with isolated left ventricular systolic dysfunction (ILVD) has not been reported. We aimed to explore whether inferior vena cava diameter distensibility index (dIVC) can predict fluid responsiveness in mechanically ventilated ILVD patients. METHODS Patients admitted to the intensive care unit who were on controlled mechanical ventilation and in need of a fluid responsiveness assessment were screened for enrolment. Several echocardiographic parameters, including dIVC, tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF), and LV outflow tract velocity-time integral (VTI) before and after passive leg raising (PLR) were collected. Patients with LV systolic dysfunction only (TAPSE ≥ 16 mm, LVEF < 50%) were considered to have isolated left ventricular systolic dysfunction (ILVD). RESULTS One hundred and twenty-nine subjects were enrolled in this study, among them, 28 were labelled ILVD patients, and the remaining 101 were patients with normal LV function (NLVF). The value of dIVC in ILVD patients was as high as that in NLVF patients, (20% vs. 16%, p = 0.211). The ILVD group contained a much lower proportion of PLR responders than NLVF patients did (17.9% vs. 53.2%, p < 0.001). No correlation was detected between dIVC and ΔVTI in ILVD patients (r = 0.196, p = 0.309). dIVC was correlated with ΔVTI in NLVF patients (r = 0.722, p < 0.001), and the correlation was strengthened compared with that derived from all patients (p = 0.020). A receiver-operating characteristic (ROC) analysis showed that the area-under-the-curve (AUC) of dIVC for determining fluid responsiveness from ILVD patients was not statistically significant (p = 0.251). In NLVF patients, ROC analysis revealed an AUC of 0.918 (95% CI 0.858-0.978; p < 0.001), which was higher than the AUC derived from all patients (p = 0.033). Patients with LVEF below 40% had a lower ΔVTI and fewer PLR responders than those with LVEF 40-50% and LVEF above 50% (p < 0.001). CONCLUSION dIVC should be used with caution when critically ill patients on controlled mechanical ventilation display normal right ventricular function in combination with abnormal left ventricular systolic function.

    更新日期:2019-11-01
  • Assessing left ventricular systolic function with ejection fraction: using a double-edged knife as a hammer.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-05
    M Ignacio Monge García,Maurizio Cecconi,Michael R Pinsky

    更新日期:2019-11-01
  • Direct admission to the intensive care unit from the emergency department and mortality in critically ill hematology patients.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-04
    Olivier Peyrony,Sylvie Chevret,Anne-Pascale Meert,Pierre Perez,Achille Kouatchet,Frédéric Pène,Djamel Mokart,Virginie Lemiale,Alexandre Demoule,Martine Nyunga,Fabrice Bruneel,Christine Lebert,Dominique Benoit,Adrien Mirouse,Elie Azoulay

    BACKGROUND The aim of this study was to assess the benefit of direct ICU admission from the emergency department (ED) compared to admission from wards, in patients with hematological malignancies requiring critical care. METHODS Post hoc analysis derived from a prospective, multicenter cohort study of 1011 critically ill adult patients with hematologic malignancies admitted to 17 ICU in Belgium and France from January 2010 to May 2011. The variable of interest was a direct ICU admission from the ED and the outcome was in-hospital mortality. The association between the variable of interest and the outcome was assessed by multivariable logistic regression after multiple imputation of missing data. Several sensitivity analyses were performed: complete case analysis, propensity score matching and multivariable Cox proportional-hazards analysis of 90-day survival. RESULTS Direct ICU admission from the ED occurred in 266 (26.4%) cases, 84 of whom (31.6%) died in the hospital versus 311/742 (41.9%) in those who did not. After adjustment, direct ICU admission from the ED was associated with a decreased in-hospital mortality (adjusted OR: 0.63; 95% CI 0.45-0.88). This was confirmed in the complete cases analysis (adjusted OR: 0.64; 95% CI 0.45-0.92) as well as in terms of hazard of death within the 90 days after admission (adjusted HR: 0.77; 95% CI 0.60-0.99). By contrast, in the propensity score-matched sample of 402 patients, direct admission was not associated with in-hospital mortality (adjusted OR: 0.92; 95% CI 0.84-1.01). CONCLUSIONS In this study, patients with hematological malignancies admitted to the ICU were more likely to be alive at hospital discharge if they were directly admitted from the ED rather than from the wards. Assessment of early predictors of poor outcome in cancer patients admitted to the ED is crucial so as to allow early referral to the ICU and avoid delays in treatment initiation and mis-orientation.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Early prediction of noninvasive ventilation failure in COPD patients: derivation, internal validation, and external validation of a simple risk score.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-01
    Jun Duan,Shengyu Wang,Ping Liu,Xiaoli Han,Yao Tian,Fan Gao,Jing Zhou,Junhuan Mou,Qian Qin,Jingrong Yu,Linfu Bai,Lintong Zhou,Rui Zhang

    BACKGROUND Early identification of noninvasive ventilation (NIV) failure is a promising strategy for reducing mortality in chronic obstructive pulmonary disease (COPD) patients. However, a risk-scoring system is lacking. METHODS To develop a scale to predict NIV failure, 500 COPD patients were enrolled in a derivation cohort. Heart rate, acidosis (assessed by pH), consciousness (assessed by Glasgow coma score), oxygenation, and respiratory rate (HACOR) were entered into the scoring system. Another two groups of 323 and 395 patients were enrolled to internally and externally validate the scale, respectively. NIV failure was defined as intubation or death during NIV. RESULTS Using HACOR score collected at 1-2 h of NIV to predict NIV failure, the area under the receiver operating characteristic curves (AUC) was 0.90, 0.89, and 0.71 for the derivation, internal-validation, and external-validation cohorts, respectively. For the prediction of early NIV failure in these three cohorts, the AUC was 0.91, 0.96, and 0.83, respectively. In all patients with HACOR score > 5, the NIV failure rate was 50.2%. In these patients, early intubation (< 48 h) was associated with decreased hospital mortality (unadjusted odds ratio = 0.15, 95% confidence interval 0.05-0.39, p < 0.01). CONCLUSIONS HACOR scores exhibited good predictive power for NIV failure in COPD patients, particularly for the prediction of early NIV failure (< 48 h). In high-risk patients, early intubation was associated with decreased hospital mortality.

    更新日期:2019-11-01
  • Morpho-functional evaluation of lung aeration as a marker of sickle-cell acute chest syndrome severity in the ICU: a prospective cohort study.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-10-01
    Marc Garnier,El Mahdi Hafiani,Charlotte Arbelot,Clarisse Blayau,Vincent Labbe,Katia Stankovic-Stojanovic,François Lionnet,Francis Bonnet,Jean-Pierre Fulgencio,Muriel Fartoukh,Christophe Quesnel

    BACKGROUND Acute chest syndrome (ACS) is the main cause of morbi-mortality in patients with sickle-cell disease in the intensive care unit (ICU). ACS definition encompasses many types of lung damage, making early detection of the most severe forms challenging. We aimed to describe ACS-related lung ultrasound (LU) patterns and determine LU performance to assess ACS outcome. RESULTS We performed a prospective cohort study including 56 ICU patients hospitalized for ACS in a tertiary university hospital (Paris, France). LU and bedside spirometry were performed at admission (D0) and after 48 h (D2). Complicated outcome was defined by the need for transfusion of ≥ 3 red blood cell units, mechanical ventilation, ICU length-of-stay > 5 days, or death. A severe loss of lung aeration was observed in all patients, predominantly in inferior lobes, and was associated with decreased vital capacity (22 [15-33]% of predicted). The LU Score was 24 [20-28] on D0 and 20 [15-24] on D2. Twenty-five percent of patients (14/56) had a complicated outcome. Neither oxygen supply, pain score, haemoglobin, LDH and bilirubin values at D0; nor their change at D2, differed regarding patient outcome. Conversely, LU re-aeration score and spirometry change at D2 improved significantly more in patients with a favourable outcome. A negative LU re-aeration score at D2 was an independent marker of severity of ACS in ICU. CONCLUSIONS ACS is associated with severe loss of lung aeration, whose resolution is associated with favourable outcome. Serial bedside LU may accurately and early identify ACS patients at risk of complicated outcome.

    更新日期:2019-11-01
  • Correction to: Recruiting the microcirculation in septic shock.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-09-26
    Matthieu Legrand,Daniel De Backer,François Dépret,Hafid Ait-Oufella

    After publication of the original article [1], we were notified that an author's name has been incorrectly spelled. Author's first name is Hafid and the family name is Ait-Oufella (with a hyphen between Ait and Oufella). The original article has been corrected.

    更新日期:2019-11-01
  • Nephrotoxic drug burden among 1001 critically ill patients: impact on acute kidney injury.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-09-25
    Stephan Ehrmann,Julie Helms,Aurélie Joret,Laurent Martin-Lefevre,Jean-Pierre Quenot,Jean-Etienne Herbrecht,Dalila Benzekri-Lefevre,René Robert,Arnaud Desachy,Fréderic Bellec,Gaëtan Plantefeve,Anne Bretagnol,Auguste Dargent,Jean-Claude Lacherade,Ferhat Meziani,Bruno Giraudeau,Elsa Tavernier,Pierre-François Dequin,

    BACKGROUND Nephrotoxic drug prescription may contribute to acute kidney injury (AKI) occurrence and worsening among critically ill patients and thus to associated morbidity and mortality. The objectives of this study were to describe nephrotoxic drug prescription in a large intensive-care unit cohort and, through a case-control study nested in the prospective cohort, to evaluate the link of nephrotoxic prescription burden with AKI. RESULTS Six hundred and seventeen patients (62%) received at least one nephrotoxic drug, among which 303 (30%) received two or more. AKI was observed in 609 patients (61%). A total of 351 patients were considered as cases developing or worsening AKI a given index day during the first week in the intensive-care unit. Three hundred and twenty-seven pairs of cases and controls (patients not developing or worsening AKI during the first week in the intensive-care unit, alive the case index day) matched on age, chronic kidney disease, and simplified acute physiology score 2 were analyzed. The nephrotoxic burden prior to the index day was measured in drug.days: each drug and each day of therapy increasing the burden by 1 drug.day. This represents a semi-quantitative evaluation of drug exposure, potentially easy to implement by clinicians. Nephrotoxic burden was significantly higher among cases than controls: odds ratio 1.20 and 95% confidence interval 1.04-1.38. Sensitivity analysis showed that this association between nephrotoxic drug prescription in the intensive-care unit and AKI was predominant among the patients with lower severity of disease (simplified acute physiology score 2 below 48). CONCLUSIONS The frequently observed prescription of nephrotoxic drugs to critically ill patients may be evaluated semi-quantitatively through computing drug.day nephrotoxic burden, an index significantly associated with subsequent AKI occurrence, and worsening among patients with lower severity of disease.

    更新日期:2019-11-01
  • Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency Medicine.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-09-25
    Jean Reignier,Anne-Laure Feral-Pierssens,Thierry Boulain,Françoise Carpentier,Pierrick Le Borgne,Denis Del Nista,Gilles Potel,Sandrine Dray,Delphine Hugenschmitt,Alexandra Laurent,Agnès Ricard-Hibon,Thierry Vanderlinden,Tahar Chouihed,

    For many patients, notably among elderly nursing home residents, no plans about end-of-life decisions and palliative care are made. Consequently, when these patients experience life-threatening events, decisions to withhold or withdraw life-support raise major challenges for emergency healthcare professionals. Emergency department premises are not designed for providing the psychological and technical components of end-of-life care. The continuous inflow of large numbers of patients leaves little time for detailed assessments, and emergency department staff often lack training in end-of-life issues. For prehospital medical teams (in France, the physician-staffed mobile emergency and intensive care units known as SMURs), implementing treatment withholding and withdrawal decisions that may have been made before the acute event is not the main focus. The challenge lies in circumventing the apparent contradiction between the need to make immediate decisions and the requirement to set up a complex treatment project that may lead to treatment withholding and/or withdrawal. Laws and recommendations are of little assistance for making treatment withholding and withdrawal decisions in the emergency setting. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and French Society of Emergency Medicine (Société Française de Médecine d'Urgence, SFMU) tasked a panel of emergency physicians and intensivists with developing a document to serve both as a position paper on life-support withholding and withdrawal in the emergency setting and as a guide for professionals providing emergency care. The task force based its work on the available legislation and recommendations and on a review of published studies.

    更新日期:2019-11-01
  • Recruiting the microcirculation in septic shock.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-09-13
    Matthieu Legrand,Daniel De Backer,François Dépret,Hafid Ait-Oufella

    更新日期:2019-11-01
  • ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients.
    Ann. Intensive Care (IF 3.931) Pub Date : 2018-12-19
    A S Truche,S Perinel Ragey,B Souweine,S Bailly,L Zafrani,L Bouadma,C Clec'h,M Garrouste-Orgeas,G Lacave,C Schwebel,F Guebre-Egziabher,C Adrie,A S Dumenil,Ph Zaoui,L Argaud,S Jamali,D Goldran Toledano,G Marcotte,J F Timsit,M Darmon

    BACKGROUND Transient and persistent acute kidney injury (AKI) could share similar physiopathological mechanisms. The objective of our study was to assess prognostic impact of AKI duration on ICU mortality. DESIGN Retrospective analysis of a prospective database via cause-specific model, with 28-day ICU mortality as primary end point, considering discharge alive as a competing event and taking into account time-dependent nature of renal recovery. Renal recovery was defined as a decrease of at least one KDIGO class compared to the previous day. SETTING 23 French ICUs. PATIENTS Patients of a French multicentric observational cohort were included if they suffered from AKI at ICU admission between 1996 and 2015. INTERVENTION None. RESULTS A total of 5242 patients were included. Initial severity according to KDIGO creatinine definition was AKI stage 1 for 2458 patients (46.89%), AKI stage 2 for 1181 (22.53%) and AKI stage 3 for 1603 (30.58%). Crude 28-day ICU mortality according to AKI severity was 22.74% (n = 559), 27.69% (n = 327) and 26.26% (n = 421), respectively. Renal recovery was experienced by 3085 patients (58.85%), and its rate was significantly different between AKI severity stages (P < 0.01). Twenty-eight-day ICU mortality was independently lower in patients experiencing renal recovery [CSHR 0.54 (95% CI 0.46-0.63), P < 0.01]. Lastly, RRT requirement was strongly associated with persistent AKI whichever threshold was chosen between day 2 and 7 to delineate transient from persistent AKI. CONCLUSIONS Short-term renal recovery, according to several definitions, was independently associated with higher mortality and RRT requirement. Moreover, distinction between transient and persistent AKI is consequently a clinically relevant surrogate outcome variable for diagnostic testing in critically ill patients.

    更新日期:2019-11-01
  • Accuracy of P0.1 measurements performed by ICU ventilators: a bench study.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-09-15
    François Beloncle,Lise Piquilloud,Pierre-Yves Olivier,Alice Vuillermoz,Elise Yvin,Alain Mercat,Jean-Christophe Richard

    BACKGROUND Occlusion pressure at 100 ms (P0.1), defined as the negative pressure measured 100 ms after the initiation of an inspiratory effort performed against a closed respiratory circuit, has been shown to be well correlated with central respiratory drive and respiratory effort. Automated P0.1 measurement is available on modern ventilators. However, the reliability of this measurement has never been studied. This bench study aimed at assessing the accuracy of P0.1 measurements automatically performed by different ICU ventilators. METHODS Five ventilators set in pressure support mode were tested using a two-chamber test lung model simulating spontaneous breathing. P0.1 automatically displayed on the ventilator screen (P0.1vent) was recorded at three levels of simulated inspiratory effort corresponding to P0.1 of 2.5, 5 and 10 cm H2O measured directly at the test lung and considered as the reference values of P0.1 (P0.1ref). The pressure drop after 100 ms was measured offline on the airway pressure-time curves recorded during the automated P0.1 measurements (P0.1aw). P0.1vent was compared to P0.1ref and to P0.1aw. To assess the potential impact of the circuit length, P0.1 were also measured with circuits of different lengths (P0.1circuit). RESULTS Variations of P0.1vent correlated well with variations of P0.1ref. Overall, P0.1vent underestimated P0.1ref except for the Löwenstein® ventilator at P0.1ref 2.5 cm H2O and for the Getinge group® ventilator at P0.1ref 10 cm H2O. The agreement between P0.1vent and P0.1ref assessed with the Bland-Altman method gave a mean bias of - 1.3 cm H2O (limits of agreement: 1 and - 3.7 cm H2O). Analysis of airway pressure-time and flow-time curves showed that all the tested ventilators except the Getinge group® ventilator performed an occlusion of at least 100 ms to measure P0.1. The agreement between P0.1vent and P0.1aw assessed with the Bland-Altman method gave a mean bias of 0.5 cm H2O (limits of agreement: 2.4 and - 1.4 cm H2O). The circuit's length impacted P0.1 measurements' values. A longer circuit was associated with lower P0.1circuit values. CONCLUSION P0.1vent relative changes are well correlated to P0.1ref changes in all the tested ventilators. Accuracy of absolute values of P0.1vent varies according to the ventilator model. Overall, P0.1vent underestimates P0.1ref. The length of the circuit may partially explain P0.1vent underestimation.

    更新日期:2019-11-01
  • Influence of changes in ventricular systolic function and loading conditions on pulse contour analysis-derived femoral dP/dtmax.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-05-31
    Sergi Vaquer,Denis Chemla,Jean-Louis Teboul,Umar Ahmad,Flora Cipriani,Joan Carles Oliva,Ana Ochagavia,Antonio Artigas,Francisco Baigorri,Xavier Monnet

    BACKGROUND Femoral dP/dtmax (maximum rate of the arterial pressure increase during systole) measured by pulse contour analysis has been proposed as a surrogate of left ventricular (LV) dP/dtmax and as an estimator of LV systolic function. However, femoral dP/dtmax may be influenced by LV loading conditions. In this study, we evaluated the impact of variations of LV systolic function, preload and afterload on femoral dP/dtmax in critically ill patients with cardiovascular failure to ascertain its reliability as a marker of LV systolic function. RESULTS We performed a prospective observational study to evaluate changes in femoral dP/dtmax, thermodilution-derived variables (PiCCO2-Pulsion Medical Systems, Feldkirchen, Germany) and LV ejection fraction (LVEF) measured by transthoracic echocardiography during variations in dobutamine and norepinephrine doses and during volume expansion (VE) and passive leg raising (PLR). Correlations with arterial pulse and systolic pressure, effective arterial elastance, total arterial compliance and LVEF were also evaluated. In absolute values, femoral dP/dtmax deviated from baseline by 21% (201 ± 297 mmHg/s; p = 0.013) following variations in dobutamine dose (n = 17) and by 15% (177 ± 135 mmHg/s; p < 0.001) following norepinephrine dose changes (n = 29). Femoral dP/dtmax remained unchanged after VE and PLR (n = 24). Changes in femoral dP/dtmax were strongly correlated with changes in pulse pressure and systolic arterial pressure during dobutamine dose changes (R = 0.942 and 0.897, respectively), norepinephrine changes (R = 0.977 and 0.941, respectively) and VE or PLR (R = 0.924 and 0.897, respectively) (p < 0.05 in all cases). Changes in femoral dP/dtmax were correlated with changes in LVEF (R = 0.527) during dobutamine dose variations but also with effective arterial elastance and total arterial compliance in the norepinephrine group (R = 0.638 and R = - 0.689) (p < 0.05 in all cases). CONCLUSIONS Pulse contour analysis-derived femoral dP/dtmax was not only influenced by LV systolic function but also and prominently by LV afterload and arterial waveform characteristics in patients with acute cardiovascular failure. These results suggest that femoral dP/dtmax calculated by pulse contour analysis is an unreliable estimate of LV systolic function during changes in LV afterload and arterial load by norepinephrine and directly linked to arterial waveform determinants.

    更新日期:2019-11-01
  • Correction to: Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-03-15
    Ignacio Martin-Loeches,Maria Consuelo Guia,Maria Sole Vallecoccia,David Suarez,Mercedes Ibarz,Marian Irazabal,Ricard Ferrer,Antonio Artigas

    Following the publication of the original article [1], the author reported a mistake in Fig. 1.

    更新日期:2019-11-01
  • Association of endothelial and glycocalyx injury biomarkers with fluid administration, development of acute kidney injury, and 90-day mortality: data from the FINNAKI observational study.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-09-13
    Nina Inkinen,Ville Pettilä,Päivi Lakkisto,Anne Kuitunen,Sakari Jukarainen,Stepani Bendel,Outi Inkinen,Tero Ala-Kokko,Suvi T Vaara,

    BACKGROUND Injury to endothelium and glycocalyx predisposes to vascular leak, which may subsequently lead to increased fluid requirements and worse outcomes. In this post hoc study of the prospective multicenter observational Finnish Acute Kidney Injury (FINNAKI) cohort study conducted in 17 Finnish intensive care units, we studied the association of Syndecan-1 (SDC-1), Angiopoetin-2 (Ang-2), soluble thrombomodulin (sTM), vascular adhesion protein-1 (VAP-1) and interleukin-6 (IL-6) with fluid administration and balance among septic critical care patients and their association with development of acute kidney injury (AKI) and 90-day mortality. RESULTS SDC-1, Ang-2, sTM, VAP-1 and IL-6 levels were measured at ICU admission from 619 patients with sepsis. VAP-1 decreased (p < 0.001) and IL-6 increased (p < 0.001) with increasing amounts of administered fluid, but other biomarkers did not show differences according to fluid administration. In linear regression models adjusted for IL-6, only VAP-1 was significantly associated with fluid administration on day 1 (p < 0.001) and the cumulative fluid balance on day 5/ICU discharge (p = 0.001). Of 415 patients admitted without AKI, altogether 112 patients (27.0%) developed AKI > 12 h from ICU admission (AKI>12 h). They had higher sTM levels than patients without AKI, and after multivariable adjustment log, sTM level was associated with AKI>12 h with OR (95% CI) of 12.71 (2.96-54.67), p = 0.001). Ninety-day non-survivors (n = 180; 29.1%) had higher SDC-1 and sTM levels compared to survivors. After adjustment for known confounders, log SDC-1 (OR [95% CI] 2.13 [1.31-3.49], p = 0.002), log sTM (OR [95% CI] 7.35 [2.29-23.57], p < 0.001), and log Ang-2 (OR [95% CI] 2.47 [1.44-4.14], p = 0.001) associated with an increased risk for 90-day mortality. Finally, patients who had high levels of all three markers, namely, SDC-1, Ang-2 and sTM, had an adjusted OR of 5.61 (95% CI 2.67-11.79; p < 0.001) for 90-day mortality. CONCLUSIONS VAP-1 and IL-6 associated with fluid administration on the first ICU day. After adjusting for confounders, sTM was associated with development of AKI after 12 h from ICU admission. SDC-1, Ang-2 and sTM were independently associated with an increased risk for 90-day mortality.

    更新日期:2019-11-01
  • Predictors of successful separation from high-flow nasal oxygen therapy in patients with acute respiratory failure: a retrospective monocenter study.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-09-13
    Maeva Rodriguez,Arnaud W Thille,Florence Boissier,Anne Veinstein,Delphine Chatellier,René Robert,Sylvain Le Pape,Jean-Pierre Frat,Remi Coudroy

    BACKGROUND High-flow nasal oxygen therapy (HFOT) is a promising first-line therapy for acute respiratory failure. However, its weaning has never been investigated and could lead to unnecessary prolonged intensive-care unit (ICU) stay. The aim of this study is to assess predictors of successful separation from HFOT in critically ill patients. We performed a retrospective monocenter observational study over a 2-year period including all patients treated with HFOT for acute respiratory failure in the ICU. Those who died or were intubated without prior HFOT separation attempt, who were treated with non-invasive ventilation at the time of HFOT separation, or who received HFOT as a preventive treatment during the post-extubation period were excluded. RESULTS From the 190 patients analyzed, 168 (88%) were successfully separated from HFOT at the first attempt. Patients who failed separation from HFOT at the first attempt had longer ICU length of stay than those who succeeded: 10 days (7-12) vs. 5 (4-8), p < 0.0001. Fraction of inspired oxygen (FiO2) ≤ 40% and a respiratory rate-oxygenation (ROX) index (calculated as the ratio of SpO2/FiO2 to the respiratory rate) ≥ 9.2 predicted successful separation from HFOT with sensitivity of 85% and 84%, respectively. CONCLUSIONS FiO2 ≤ 40% and ROX index ≥ 9.2 were two predictors of successful separation from HFOT at the bedside. Prospective multicenter studies are needed to confirm these results.

    更新日期:2019-11-01
  • Association between potassium concentrations, variability and supplementation, and in-hospital mortality in ICU patients: a retrospective analysis.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-09-06
    Lilian Jo Engelhardt,Felix Balzer,Michael C Müller,Julius J Grunow,Claudia D Spies,Kenneth B Christopher,Steffen Weber-Carstens,Tobias Wollersheim

    BACKGROUND Serum potassium concentrations are commonly between 3.5 and 5.0 mmol/l. Standardised protocols for potassium range and supplementation in the ICU are lacking. The purpose of this retrospective analysis of ICU patients was to investigate potassium concentrations, variability and supplementation, and their association with in-hospital mortality. METHODS ICU patients ≥ 18 years, with ≥ 2 serum potassium values, treated at the Charité - Universitätsmedizin Berlin between 2006 and 2018 were eligible for inclusion. We categorised into groups of mean potassium concentrations: < 3.0, 3.0-3.5, > 3.5-4.0, > 4.0-4.5, > 4.5-5.0, > 5.0-5.5, > 5.5 mmol/l and potassium variability: 1st, 2nd and ≥ 3rd standard deviation (SD). We analysed the association between the particular groups and in-hospital mortality and performed binary logistic regression analysis. Survival curves were performed according to Kaplan-Meier and tested by Log-Rank. In a subanalysis, the association between potassium supplementation and in-hospital mortality was investigated. RESULTS In 53,248 ICU patients with 1,337,742 potassium values, the lowest mortality (3.7%) was observed in patients with mean potassium concentrations between > 3.5 and 4.0 mmol/l and a low potassium variability within the 1st SD. Binary logistic regression confirmed these results. In a subanalysis of 22,406 ICU patients (ICU admission: 2013-2018), 12,892 (57.5%) received oral and/or intravenous potassium supplementation. Potassium supplementation was associated with an increase in in-hospital mortality in potassium categories from > 3.5 to 4.5 mmol/l and in the 1st, 2nd and ≥ 3rd SD (p < 0.001 each). CONCLUSIONS ICU patients may benefit from a target range between 3.5 and 4.0 mmol/l and a minimal potassium variability. Clear potassium target ranges have to be determined. Criteria for widely applied potassium supplementation should be critically discussed. Trial registration German Clinical Trials Register, DRKS00016411. Retrospectively registered 11 January 2019, http://www.drks.de/DRKS00016411.

    更新日期:2019-11-01
  • Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-09-06
    A Harrois,J R Anstey,F S Taccone,A A Udy,G Citerio,J Duranteau,C Ichai,R Badenes,J R Prowle,A Ercole,M Oddo,A Schneider,M van der Jagt,S Wolf,R Helbok,D W Nelson,M B Skrifvars,D J Cooper,R Bellomo,

    BACKGROUND In traumatic brain injury (TBI) patients desmopressin administration may induce rapid decreases in serum sodium and increase intracranial pressure (ICP). AIM In an international multi-centre study, we aimed to report changes in serum sodium and ICP after desmopressin administration in TBI patients. METHODS We obtained data from 14 neurotrauma ICUs in Europe, Australia and UK for severe TBI patients (GCS ≤ 8) requiring ICP monitoring. We identified patients who received any desmopressin and recorded daily dose, 6-hourly serum sodium, and 6-hourly ICP. RESULTS We studied 262 severe TBI patients. Of these, 39 patients (14.9%) received desmopressin. Median length of treatment with desmopressin was 1 [1-3] day and daily intravenous dose varied between centres from 0.125 to 10 mcg. The median hourly rate of decrease in serum sodium was low (- 0.1 [- 0.2 to 0.0] mmol/L/h) with a median period of decrease of 36 h. The proportion of 6-h periods in which the rate of natremia correction exceeded 0.5 mmol/L/h or 1 mmol/L/h was low, at 8% and 3%, respectively, and ICPs remained stable. After adjusting for IMPACT score and injury severity score, desmopressin administration was independently associated with increased 60-day mortality [HR of 1.83 (1.05-3.24) (p = 0.03)]. CONCLUSIONS In severe TBI, desmopressin administration, potentially representing instances of diabetes insipidus is common and is independently associated with increased mortality. Desmopressin doses vary markedly among ICUs; however, the associated decrease in natremia rarely exceeds recommended rates and median ICP values remain unchanged. These findings support the notion that desmopressin therapy is safe.

    更新日期:2019-11-01
  • High-flow nasal cannula therapy: clinical practice in intensive care units.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-09-06
    Emmanuel Besnier,Sinad Hobeika,Saad NSeir,Fabien Lambiotte,Damien Du Cheyron,Bertrand Sauneuf,Benoit Misset,Fabienne Tamion,Guillaume Schnell,Jack Richecoeur,Julien Maizel,Christophe Girault,

    BACKGROUND Despite the extensive use of high-flow nasal cannula (HFNC) therapy in intensive care units (ICU) for acute respiratory failure (ARF), its daily clinical practice has not been assessed. We designed a regional survey in ICUs in North-west France to evaluate ICU physicians' clinical practice with HFNC. MATERIALS AND METHODS We sent an observational survey to ICU physicians from 34 French ICUs over a 6-month period in 2016-2017. The survey included questions regarding the indications and expected efficiency of HFNC, practical aspects of use (initiation, weaning) and satisfaction. Comparisons between junior and senior ICU physicians were performed using a Fischer exact test. RESULTS Among the 235 ICU physicians contacted, 137 responded (58.3%) all of whom regularly used HFNC. Hypoxemic ARF was considered a good indication for HFNC by all 137, but only 30% expected HFNC success (i.e., avoiding intubation in at least 60% of cases). Among hypoxemic indications, 30% of juniors considered acute pulmonary edema a good indication versus 74% of seniors (p < 0.0001). Hypercapnic ARF was considered a good indication by 33% with only 2% expecting HFNC success. A need for conventional oxygen therapy ≥ 6 L/min justified HFNC therapy for 40% and ≥ 9 L/min for 39% of responders. 58% of ICU physicians started HFNC therapy with a FiO2 ≥ 50% and 28% with a gas flow ≥ 50 L/min. Practices for HFNC weaning were heterogeneous: 48% considered a FiO2 ≤ 30%; whereas, 30% considered a FiO2 ≤ 30% with a high flow ≤ 20 L/min. Criteria for HFNC failure (i.e., need for intubation) were ventilatory pauses or arrest (97%), persistent hypoxemia (95%), respiratory acidosis (81%), worsening of breathing (95%, 100% of seniors and 86% of juniors, p = 0.003), bronchial congestion (75%) and circulatory failure (61%, 72% of seniors and 44% of juniors, p = 0.007). CONCLUSION HFNC is used by ICU physicians in many situations of ARF, despite their relatively low expectations of success, especially in cases of hypercapnia. Clinical practices appear somewhat heterogeneous. Despite the physiological benefit of HFNC, further prospective observational studies are still required on HFNC outcomes and daily practices.

    更新日期:2019-11-01
  • Impact of increased mean arterial pressure on skin microcirculatory oxygenation in vasopressor-requiring septic patients: an interventional study.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-08-31
    Sigita Kazune,Anastasija Caica,Einars Luksevics,Karina Volceka,Andris Grabovskis

    BACKGROUND Heterogeneity of microvascular blood flow leading to tissue hypoxia is a common finding in patients with septic shock. It may be related to suboptimal systemic perfusion pressure and lead to organ failure. Mapping of skin microcirculatory oxygen saturation and relative hemoglobin concentration using hyperspectral imaging allows to identify heterogeneity of perfusion and perform targeted measurement of oxygenation. We hypothesized that increasing mean arterial pressure would result in improved oxygenation in areas of the skin with most microvascular blood pooling. METHODS We included adult patients admitted to the intensive care unit within the previous 24 h with sepsis and receiving a noradrenaline infusion. Skin oxygen saturation was measured using hyperspectral imaging-based method at baseline and after the increase in mean arterial pressure by 20 mm Hg by titration of noradrenaline doses. The primary outcome was an increase in skin oxygen saturation depending upon disease severity. RESULTS We studied 30 patients with septic shock. Median skin oxygen saturation changed from 26.0 (24.5-27.0) % at baseline to 30.0 (29.0-31.0) % after increase in mean arterial pressure (p = 0.04). After adjustment for baseline saturation, patients with higher SOFA scores achieved higher oxygen saturation after the intervention (r2 = 0.21; p = 0.02). Skin oxygen saturation measured at higher pressure was found to be marginally predictive of mortality (OR: 1.10; 95% CI 1.00-1.23; p = 0.053). CONCLUSIONS Improvement of microcirculatory oxygenation can be achieved with an increase in mean arterial pressure in most patients. Response to study intervention is proportional to disease severity.

    更新日期:2019-11-01
  • Acute respiratory failure and mechanical ventilation in cardiogenic shock complicating acute myocardial infarction in the USA, 2000-2014.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-08-30
    Saraschandra Vallabhajosyula,Kianoush Kashani,Shannon M Dunlay,Shashaank Vallabhajosyula,Saarwaani Vallabhajosyula,Pranathi R Sundaragiri,Bernard J Gersh,Allan S Jaffe,Gregory W Barsness

    BACKGROUND There are limited epidemiological data on acute respiratory failure (ARF) in cardiogenic shock complicating acute myocardial infarction (AMI-CS). This study sought to evaluate the prevalence and outcomes of ARF in AMI-CS. METHODS This was a retrospective study of AMI-CS admissions during 2000-2014 from the National Inpatient Sample. Administrative codes for ARF and mechanical ventilation (MV) were used to define the cohorts of no ARF, ARF without MV and ARF with MV. Admissions with a secondary diagnosis of AMI and with chronic MV were excluded. Outcomes of interest included in-hospital mortality, temporal trends of ARF prevalence and resource utilization. MEASUREMENTS AND MAIN RESULTS During 2000-2014, 439,436 admissions for AMI-CS met the inclusion criteria. ARF and MV were noted in 57% and 43%, respectively. Admissions with non-ST-elevation AMI-CS, of non-White race and with non-private insurance received MV more frequently. Noninvasive ventilation and invasive MV increased from 0.4% and 39.2% (2000) to 3.6% and 46.4% (2014), respectively (p < 0.001). Coronary angiography and percutaneous coronary intervention were used less frequently in admissions receiving ARF with MV. Compared to admissions with no ARF, ARF without MV (adjusted odds ratio (aOR) 1.56 [95% confidence interval (CI) 1.53-1.59]; p < 0.001) and ARF with MV (aOR 2.50 [95% CI 2.47-2.54]; p < 0.001) were associated with higher in-hospital mortality. Admissions with ARF without MV had greater resource utilization and lesser discharges to home as compared to no ARF. CONCLUSIONS In this contemporary AMI-CS cohort, the presence of ARF and MV use was noted in 57% and 43%, respectively, and was associated with higher in-hospital mortality.

    更新日期:2019-11-01
  • Hyperchloremia is not associated with AKI or death in septic shock patients: results of a post hoc analysis of the "HYPER2S" trial.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-08-24
    Morgane Commereuc,Camille Nevoret,Peter Radermacher,Sandrine Katsahian,Pierre Asfar,Frédérique Schortgen,

    BACKGROUND Recent data suggest that hyperchloremia induced by fluid resuscitation is associated with acute kidney injury (AKI) and mortality, particularly in sepsis. Experimental studies showed that hyperchloremia could affect organ functions. In patients with septic shock, we examined the relationship between serum chloride concentration and both renal function and survival. METHODS Post hoc analysis of the "HYPER2S" trial database (NCT01722422) including 434 patients with septic shock randomly assigned for resuscitation with 0.9% or 3% saline. Metabolic parameters were recorded up to 72 h. Metabolic effects of hyperchloremia (> 110 mmol/L) were studied stratified for hyperlactatemia (> 2 mmol/L). Cox models were constructed to assess the association between chloride parameters, day-28 mortality and AKI. RESULTS 413 patients were analysed. The presence of hyperlactatemia was significantly more frequent than hyperchloremia (62% versus 71% of patients, respectively, p = 0.006). Metabolic acidosis was significantly more frequent in patients with hyperchloremia, no matter the presence of hyperlactatemia, p < 0.001. Adjusted risk of AKI and mortality were not significantly associated with serum chloride, hyperchloremia, maximal chloremia and delta chloremia (maximal-H0 [Cl]). CONCLUSIONS Despite more frequent metabolic acidosis, hyperchloremia was not associated with an increased risk for AKI or mortality. Trial registration ClinicalTrials.gov, identifier: NCT01722422, registered 2 November 2012.

    更新日期:2019-11-01
  • Incidence and impact of sepsis on long-term outcomes after subarachnoid hemorrhage: a prospective observational study.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-08-23
    Bruno Gonçalves,Pedro Kurtz,Ricardo Turon,Thayana Santos,Marco Prazeres,Cassia Righy,Fernando Augusto Bozza

    BACKGROUND Aneurysmal subarachnoid hemorrhage (SAH) is an acute cerebrovascular disease associated with high mortality and long-term functional impairment among survivors. Systemic inflammatory responses after acute injury and nosocomial infections are frequent complications, making the management of these patients challenging. Here, we hypothesized that sepsis might be associated with early and long-term mortality and functional outcomes. Our objective was to define the incidence of sepsis, diagnosed prospectively with the Sepsis-3 criteria, and to determine its impact on mortality and functional outcomes of patients with SAH. METHODS We prospectively included all adult patients with aneurysmal SAH admitted to the intensive care unit (ICU) of a reference center between April 2016 and May 2018. Daily clinical and laboratory follow-up data were analyzed during the first 14 days, with data collected on sepsis according to the Sepsis-3 criteria. The main outcome was the functional outcome using the Modified Rankin Scale (mRS), which was assessed at hospital discharge and 3, 6 and 12 months post-discharge. RESULTS In total, 149 patients were enrolled. The incidence of sepsis was 28%. Multivariable logistic regression analysis revealed that death or functional dependence (defined as an mRS score of 4 to 6) at hospital discharge was independently associated with sepsis (OR 3.4, 95% CI 1.16-9.96, p = 0.026) even after controlling for World Federation of Neurological Surgeons (WFNS) Scale (OR 4.66, 95% CI 1.69-12.88, p = 0.003), hydrocephalus (OR 4.55, 95% CI 1.61-12.85, p = 0.004) and DCI (OR 3.86, 95% CI 1.39-10.74, p = 0.01). Long-term follow-up mortality rates were significantly different in the septic and nonseptic groups (log-rank test p < 0.0001). The mortality rate of septic patients was 52.5%, and that of nonseptic patients was 16%. CONCLUSION Sepsis plays a significant role in the outcomes of patients with SAH, affecting both mortality and long-term functional outcomes. Combining high-level neurocritical care management of neurological complications and the optimal diagnosis and management of sepsis may effectively reduce secondary brain injury and improve patients' outcomes after SAH.

    更新日期:2019-11-01
  • Animal ICU… Why not also use the existing veterinary ICUs?
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-08-20
    Florent Baudin,Céline Pouzot-Nevoret,Vanessa Louzier,Isabelle Goy-Thollot,Anthony Barthélemy,Stéphane Junot,Jeanne-Marie Bonnet-Garin,Bernard Allaouchiche

    更新日期:2019-11-01
  • Initial management of diabetic ketoacidosis and prognosis according to diabetes type: a French multicentre observational retrospective study.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-08-17
    Adrien Balmier,Fadia Dib,Arnaud Serret-Larmande,Etienne De Montmollin,Victorine Pouyet,Benjamin Sztrymf,Bruno Megarbane,Abirami Thiagarajah,Didier Dreyfuss,Jean-Damien Ricard,Damien Roux

    BACKGROUND Guidelines for the management of diabetic ketoacidosis (DKA) do not consider the type of underlying diabetes. We aimed to compare the occurrence of metabolic adverse events and the recovery time for DKA according to diabetes type. METHODS Multicentre retrospective study conducted at five adult intermediate and intensive care units in Paris and its suburbs, France. All patients admitted for DKA between 2013 and 2014 were included. Patients were grouped and compared according to the underlying type of diabetes into three groups: type 1 diabetes, type 2 or secondary diabetes, and DKA as the first presentation of diabetes. Outcomes of interest were the rate of metabolic complications (hypoglycaemia or hypokalaemia) and the recovery time. RESULTS Of 122 patients, 60 (49.2%) had type 1 diabetes, 28 (22.9%) had type 2 or secondary diabetes and 34 (27.9%) presented with DKA as the first presentation of diabetes (newly diagnosed diabetes). Despite having received lower insulin doses, hypoglycaemia was more frequent in patients with type 1 diabetes (76.9%) than in patients with type 2 or secondary diabetes (50.0%) and in patients with newly diagnosed diabetes (54.6%) (p = 0.026). In contrast, hypokalaemia was more frequent in the latter group (82.4%) than in patients with type 1 diabetes (57.6%) and type 2 or secondary diabetes (51.9%) (p = 0.022). The median recovery times were not significantly different between groups. CONCLUSIONS Rates of metabolic complications associated with DKA treatment differ significantly according to underlying type of diabetes. Decreasing insulin dose may limit those complications. DKA treatment recommendations should take into account the type of diabetes.

    更新日期:2019-11-01
  • Diagnosis and management of metabolic acidosis: guidelines from a French expert panel.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-08-17
    Boris Jung,Mikaël Martinez,Yann-Erick Claessens,Michaël Darmon,Kada Klouche,Alexandre Lautrette,Jacques Levraut,Eric Maury,Mathieu Oberlin,Nicolas Terzi,Damien Viglino,Youri Yordanov,Pierre-Géraud Claret,Naïke Bigé,,

    Metabolic acidosis is a disorder frequently encountered in emergency medicine and intensive care medicine. As literature has been enriched with new data concerning the management of metabolic acidosis, the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Emergency Medicine Society (Société Française de Médecine d'Urgence [SFMU]) have developed formalized recommendations from experts using the GRADE methodology. The fields of diagnostic strategy, patient assessment, and referral and therapeutic management were addressed and 29 recommendations were made: 4 recommendations were strong (Grade 1), 10 were weak (Grade 2), and 15 were experts' opinions. A strong agreement from voting participants was obtained for all recommendations. The application of Henderson-Hasselbalch and Stewart methods for the diagnosis of the metabolic acidosis mechanism is discussed and a diagnostic algorithm is proposed. The use of ketosis and venous and capillary lactatemia is also treated. The value of pH, lactatemia, and its kinetics for the referral of patients in pre-hospital and emergency departments is considered. Finally, the modalities of insulin therapy during diabetic ketoacidosis, the indications for sodium bicarbonate infusion and extra-renal purification as well as the modalities of mechanical ventilation during severe metabolic acidosis are addressed in therapeutic management.

    更新日期:2019-11-01
  • Information conveyed by electrical diaphragmatic activity during unstressed, stressed and assisted spontaneous breathing: a physiological study.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-08-16
    Lise Piquilloud,François Beloncle,Jean-Christophe M Richard,Jordi Mancebo,Alain Mercat,Laurent Brochard

    BACKGROUND The electrical activity of the crural diaphragm (Eadi), a surrogate of respiratory drive, can now be measured at the bedside in mechanically ventilated patients with a specific catheter. The expected range of Eadi values under stressed or assisted spontaneous breathing is unknown. This study explored Eadi values in healthy subjects during unstressed (baseline), stressed (with a resistance) and assisted spontaneous breathing. The relation between Eadi and inspiratory effort was analyzed. METHODS Thirteen healthy male volunteers were included in this randomized crossover study. Eadi and esophageal pressure (Peso) were recorded during unstressed and stressed spontaneous breathing and under assisted ventilation delivered in pressure support (PS) at low and high assist levels and in neurally adjusted ventilatory assist (NAVA). Overall eight different situations were assessed in each participant (randomized order). Peak, mean and integral of Eadi, breathing pattern, esophageal pressure-time product (PTPeso) and work of breathing (WOB) were calculated offline. RESULTS Median [interquartile range] peak Eadi at baseline was 17 [13-22] μV and was above 10 μV in 92% of the cases. Eadimax defined as Eadi measured at maximal inspiratory capacity reached 90 [63 to 99] μV. Median peak Eadi/Eadimax ratio was 16.8 [15.6-27.9]%. Compared to baseline, respiratory rate and minute ventilation were decreased during stressed non-assisted breathing, whereas peak Eadi and PTPeso were increased. During unstressed assisted breathing, peak Eadi decreased during high-level PS compared to unstressed non-assisted breathing and to NAVA (p = 0.047). During stressed breathing, peak Eadi was lower during all assisted ventilation modalities compared to stressed non-assisted breathing. During assisted ventilation, across the different conditions, peak Eadi changed significantly, whereas PTPeso and WOB/min were not significantly modified. Finally, Eadi signal was still present even when Peso signal was suppressed due to high assist levels. CONCLUSION Eadi analysis provides complementary information compared to respiratory pattern and to Peso monitoring, particularly in the presence of high assist levels. Trial registration The study was registered as NCT01818219 in clinicaltrial.gov. Registered 28 February 2013.

    更新日期:2019-11-01
  • Is immunosuppression status a risk factor for noninvasive ventilation failure in patients with acute hypoxemic respiratory failure? A post hoc matched analysis.
    Ann. Intensive Care (IF 3.931) Pub Date : 2019-08-16
    Rémi Coudroy,Tài Pham,Florence Boissier,René Robert,Jean-Pierre Frat,Arnaud W Thille

    BACKGROUND Recent European/American guidelines recommend noninvasive ventilation (NIV) as a first-line therapy to manage acute hypoxemic respiratory failure in immunocompromised patients. By contrast, NIV may have deleterious effects in nonimmunocompromised patients and experts have been unable to offer a recommendation. Immunocompromised patients have particularly high mortality rates when they require intubation. However, it is not clear whether immunosuppression status is a risk factor for NIV failure. We assessed the impact of immunosuppression status on NIV failure in a post hoc analysis pooling two studies including patients with de novo acute hypoxemic respiratory failure treated with NIV. Patients with hypercapnia, acute exacerbation of chronic lung disease, cardiogenic pulmonary edema, or with do-not-intubate order were excluded. RESULTS Among the 208 patients included in the analysis, 71 (34%) were immunocompromised. They had higher severity scores upon ICU admission, higher pressure-support levels, and minute ventilation under NIV, and were more likely to have bilateral lung infiltrates than nonimmunocompromised patients. Intubation and in-ICU mortality rates were higher in immunocompromised than in nonimmunocompromised patients: 61% vs. 43% (p = 0.02) and 38% vs. 15% (p < 0.001), respectively. After adjustment or using a propensity score-matched analysis, immunosuppression was not associated with intubation, whereas it remained independently associated with ICU mortality with an adjusted odds ratio of 2.64 (95% CI 1.24-5.67, p = 0.01). CONCLUSIONS Immunosuppression status may directly influence mortality but does not seem to be associated with an increased risk of intubation in patients with de novo acute hypoxemic respiratory failure treated with NIV. Studies in this specific population are needed.

    更新日期:2019-11-01
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