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Medical professionals are expected to prioritize patient interests, and most patients trust physicians to act in their best interest. However, a single patient is never a physician's sole concern. The competing interests of other patients, clinicians, family members, hospital administrators, regulators, insurers, and trainees are omnipresent. While prioritizing patient interests is always a struggle, it is especially challenging and important in the ICU setting where most patients lack the ability to advocate for themselves or seek alternative sources of care. This review explores factors that increase the risk, or the perception, that an ICU physician will reason, recommend, or act in a way that is not in their patient's best interest and discusses steps that could help minimize the impact of these factors on patient care., Author(s): Alison E. Turnbull [sup.1] [sup.2] [sup.3], Sarina K. Sahetya [sup.1], E. Lee Daugherty Biddison [sup.1], Christiane S. Hartog [sup.4] [sup.5] [sup.6], Gordon D. Rubenfeld [sup.7] [sup.8], Dominique D. Benoit [...]

Author(s): Michael Darmon [sup.1] [sup.2] [sup.3], Dominique D. Benoit [sup.4], Marlies Ostermann [sup.5] Author Affiliations: (1) grid.413328.f, 0000 0001 2300 6614, Medical ICU, Saint-Louis University Hospital, AP-HP, , 1 Avenue [...]

Author(s): Sharon Einav [sup.1], Dominique D. Benoit [sup.2] Author Affiliations: (1) 0000 0004 1937 0538, grid.9619.7, Intensive Care Unit of the Shaare Zedek Medical Centre, Hebrew University Faculty of Medicine, [...]

Author(s): Chris Beet [sup.1], Dominique Benoit [sup.2], Julian Bion [sup.3] Author Affiliations: (1) grid.15628.38, University Hospitals Coventry and Warwickshire NHS Trust, , Coventry, UK (2) 0000 0004 0626 3303, grid.410566.0, [...]

Over the coming years, accelerating progress against cancer will be associated with an increased number of patients who require life-sustaining therapies for infectious or toxic chemotherapy-related events. Major changes include increased number of cancer patients admitted to the ICU with full-code status or for time-limited trials, increased survival and quality of life in ICU survivors, changing prognostic factors, early ICU admission for optimal monitoring, and use of noninvasive diagnostic and therapeutic strategies. In this review, experts in the management of critically ill cancer patients highlight recent changes in the use and the results of intensive care in patients with malignancies. They seek to put forward a standard of care for the management of these patients and highlight important updates that are required to care for them. The research agenda they suggest includes important studies to be conducted in the next few years to increase our understanding of organ dysfunction in this population and to improve our ability to appropriately use life-saving therapies or select new therapeutic approaches that are likely to improve outcomes. This review aims to provide more guidance for the daily management of patients with cancer, in whom outcomes are constantly improving, as is our global ability to fight against what is becoming the leading cause of mortality in industrialized and non-industrialized countries., Author(s): Elie Azoulay [sup.1] [sup.7], Peter Schellongowski [sup.2], Michael Darmon [sup.3], Philippe R. Bauer [sup.4], Dominique Benoit [sup.5], Pieter Depuydt [sup.5], Jigeeshu V. Divatia [sup.6], Virginie Lemiale [sup.7], Maarten van [...]

Author(s): Crystal E. Brown [sup.1] [sup.2], Dominique D. Benoit [sup.3], J. Randall Curtis [sup.1] [sup.2] Author Affiliations: (1) 0000000122986657, grid.34477.33, Cambia Palliative Care Center of Excellence, University of Washington, , [...]

Author(s): Jean-François Timsit [sup.1], Anders Perner [sup.2], Jan Bakker [sup.3], Matteo Bassetti [sup.4], Dominique Benoit [sup.5], Maurizio Cecconi [sup.6] [sup.7], J. Randall Curtis [sup.8], Gordon S. Doig [sup.9], Margaret Herridge [...]

Author(s): Anders Perner [sup.1], Giuseppe Citerio [sup.2], Jan Bakker [sup.3], Matteo Bassetti [sup.4], Dominique Benoit [sup.5], Maurizio Cecconi [sup.6] [sup.7], J. Randall Curtis [sup.8], Gordon S. Doig [sup.9], Margaret Herridge [...]

Author(s): Giuseppe Citerio [sup.1], Jan Bakker [sup.2], Matteo Bassetti [sup.3], Dominique Benoit [sup.4], Maurizio Cecconi [sup.5] [sup.6], J. Randall Curtis [sup.7], Gordon S. Doig [sup.8], Margaret Herridge [sup.9], Samir Jaber [...]

Author(s): Katherine R. Courtright [sup.1] [sup.2], Dominique D. Benoit [sup.3], Scott D. Halpern [sup.1] [sup.2] Author Affiliations: (1) 0000 0004 1936 8972, grid.25879.31, Palliative and Advanced Illness Research (PAIR) Center, [...]

Author(s): Dominique D. Benoit [sup.1], Gordon Doig [sup.2], Jean-Francois Timsit [sup.3] Author Affiliations: (1) grid.410566.0, 0000000406263303, Department of Intensive Care, Ghent University Hospital, , Ghent, Belgium (2) grid.1013.3, 000000041936834X, Northern [...]

Author(s): Dominique D. Benoit [sup.1], Marcio Soares [sup.2], Elie Azoulay [sup.3] Author Affiliations: (1) grid.410566.0, 0000000406263303, Medical Unit, Department of Intensive Care, Ghent University Hospital, , De Pintelaan 185, 12K12IB, [...]

Author(s): Jean-Francois Timsit [sup.1] [sup.21] [sup.22], Giuseppe Citerio [sup.2], Jan Bakker [sup.3], Matteo Bassetti [sup.4], Dominique Benoit [sup.5], Maurizio Cecconi [sup.6], J. Randall Curtis [sup.7], Glenn Hernandez [sup.8], Margaret Herridge [...]

Author(s): Elie Azoulay [sup.1], Giuseppe Citerio [sup.18], Jan Bakker [sup.2], Matteo Bassetti [sup.3], Dominique Benoit [sup.4], Maurizio Cecconi [sup.5], J. Randall Curtis [sup.6], Glenn Hernandez [sup.7], Margaret Herridge [sup.8], Samir [...]

Author(s): Giuseppe Citerio [sup.1], Jan Bakker [sup.2], Matteo Bassetti [sup.3], Dominique Benoit [sup.4], Maurizio Cecconi [sup.5], J. Randall Curtis [sup.6], Glenn Hernandez [sup.7], Margaret Herridge [sup.8], Samir Jaber [sup.9], Michael [...]

Author(s): Renee D. Stapleton [sup.1] , Dominique D. Benoit [sup.2] Author Affiliations: (1) grid.59062.38, 0000000419367689, Pulmonary and Critical Care Medicine, University of Vermont, , Burlington, VT, USA (2) grid.410566.0, 0000000406263303, [...]

Author(s): Elie Azoulay [sup.1], Marcio Soares [sup.1] [sup.2], Dominique Benoit [sup.1] [sup.3] Author Affiliations: (1) grid.462844.8, 0000000123081657, Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA Team, Biostatistics and Clinical Epidemiology, Center [...]

Author(s): Frédéric Pène [sup.1] [sup.2], Dominique D. Benoit [sup.3] Author Affiliations: (1) grid.411784.f, 0000000102743893, Medical ICU, Cochin Hospital, AP-HP, , Paris, France (2) grid.10992.33, 0000000121880914, University Paris Descartes, Sorbonne Paris [...]

Introduction Missing values occur in nearly all clinical studies, despite the best efforts of the investigators, and cause frequently unrecognised biases. Our aims were (1) to assess the reporting and handling of missing values in the critical care literature; (2) to describe the impact of various techniques for handling missing values on the study results; (3) to provide guidance on the management of clinical study analysis in case of missing data. Methods We reviewed 44 published manuscripts in three critical care research journals. We used the Conflicus study database to illustrate how to handle missing values. Results Among 44 published manuscripts, 16 (36.4 %) provided no information on whether missing data occurred, 6 (13.6 %) declared having no missing data, 20 (45.5 %) reported that missing values occurred but did not handle them and only 2 (4.5 %) used sophisticated missing data handling methods. In our example using the Conflicus study database, we evaluated correlations linking job strain intensity to the type and proportion of missing values. Overall, 8 % of data were missing; however, using only complete cases would have resulted in discarding 24 % of the questionnaires. A greater number and a higher percentage of missing values for a particular variable were significantly associated with a lower job strain score (indicating greater stress). Among respondents who fully completed the job strain questionnaire, the comparison of those whose questionnaires did and did not have missing values showed significant differences in terms of age, number of children and country of birth. We provided an algorithm to manage clinical studies analysis in case of missing data. Conclusion Missing data are common and generate interpretation biases. They should be reported routinely and taken into account when modelling data from clinical studies., Author(s): Aurélien Vesin [sup.1] [sup.2], Elie Azoulay [sup.3], Stéphane Ruckly [sup.1] [sup.2], Lucile Vignoud [sup.1], Katerina Rusinovà [sup.4], Dominique Benoit [sup.5], Marcio Soares [sup.6], Paulo Azeivedo-Maia [sup.7], Fekri Abroug [sup.8], [...]

Purpose Intensive care unit (ICU) patients frequently undergo contrast-enhanced radiographic examinations, which carries a risk for development of contrast-associated acute kidney injury (CA-AKI). Data on this in ICU patients are scarce. The aim of this study was therefore to evaluate the epidemiology and short- and long-term outcomes of CA-AKI in ICU patients. Methods A retrospective single-centre cohort study covering the period 1 March 2004 to 31 December 2008 on ICU patients who underwent a radiography examination with parenteral administration of iodinated radio contrast media was conducted. Data analysis included univariate and multivariate analyses of patients with and without CA-AKI. Results A total of 787 ICU patients were included in the study. CA-AKI occurred in 128 (16.3%) and was associated with higher need for RRT [30 (4.6%) vs. 21 (16.4%), p < 0.001], worse kidney function at discharge, longer length of ICU and hospital stay, and higher 28-day and 1-year mortality [28-day: 86 (13.1%) vs. 46 (35.9%), p < 0.001, and 1-year: 158 (24.0%) vs. 71 (55.5%), p < 0.001]. Higher serum creatinine, lower mean arterial pressure, and administration of diuretics and vasoactive therapy were associated with development of CA-AKI in multivariate analysis. After correction for confounders we found that CA-AKI was associated with 28-day mortality in this cohort of ICU patients (odds ratio = 2.742, 95% confidence interval 1.374-5.471). Conclusions CA-AKI occurred in one out of six ICU patients who underwent a contrast-enhanced radiography examination and was associated with both short-and long-term worse outcomes such as need for RRT, worse kidney function at discharge, increased length of stay in the ICU and hospital, and mortality., Author(s): Eric A. J. Hoste [sup.1] [sup.2], Severine Doom [sup.1] [sup.3], Jan De Waele [sup.1], Louke J. Delrue [sup.4], Luc Defreyne [sup.5], Dominique D. Benoit [sup.1], Johan Decruyenaere [sup.1] Author [...]

Author(s): Katherine R. Courtright [sup.1] [sup.2], Dominique D. Benoit [sup.3], J. Randall Curtis [sup.4] [sup.5] Author Affiliations: (1) 0000 0004 1936 8972, grid.25879.31, Department of Medicine, Perelman School of Medicine, [...]

Byline: Dominique M. Vandijck (1), Dominique D. Benoit (1), Pieter O. Depuydt (1), Fritz C. Offner (2), Stijn I. Blot (1), Anna K. Tilborgh (2), Joke Nollet (1), Eva Steel (2), Lucien A. Noens (2), Johan M. Decruyenaere (1) Keywords: Severe sepsis; Septic shock; Hematological malignancy; Intensive care unit; Outcome; Intravenous chemotherapy Abstract: Objective To compare the characteristics and outcome of patients with hematological malignancies referred to the ICU with severe sepsis and septic shock who had or had not received recent intravenous chemotherapy, defined as within 3 weeks prior to ICU admission. Design and setting Retrospective observational cohort study on prospectively collected data in a medical ICU of a university hospital. Patients 186 ICU patients with hematological malignancies with severe sepsis or septic shock (2000--2006). Measurements and results There were 77 patients admitted with severe sepsis and 109 with septic shock 91 (49%) had received recent intravenous chemotherapy. Patients with recent chemotherapy more often had a high-grade malignancy and were more often neutropenic, less often had pulmonary infiltrates, and less often required mechanical ventilation. ICU, 28-day, in-hospital, and 6-month mortality rates were 33% vs. 48.4%, 40.7% vs. 57.4%, 45.1% vs. 58.9%, and 50.5% vs. 63.2% in patients with and without recent chemotherapy, respectively. Logistic regression identified four variables independently associated with 28-day mortality: SOFA score at ICU admission, pulmonary site of infection, and fungal infection were associated with worse outcome whereas previous intravenous chemotherapy was protective at borderline significance. After adjustment with a propensity score for recent chemotherapy, chemotherapy was not associated with outcome. Conclusions Patients referred to the ICU with severe sepsis and septic shock complicating active chemotherapeutic treatment have better prognosis than commonly perceived. Author Affiliation: (1) Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium (2) Department of Hematology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium Article History: Registration Date: 03/01/2008 Received Date: 25/05/2007 Accepted Date: 28/11/2007 Online Date: 24/01/2008 Article note: This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-008-1003-1.

Abstract Objective: To assess whether pathogen prediction in bacteremia associated with nosocomial pneumonia (NP) by tracheal surveillance cultures improves adequacy of early antibiotic therapy and impacts mortality. Design and setting: [...]

Abstract Objective: To assess the outcome in severely ill patients with hematological malignancies who receive intravenous chemotherapy in an intensive care unit (ICU) for a life-threatening malignancy-related complication. Design: Retrospective [...]

Abstract Objective: To assess the impact of documented and clinically suspected bacterial infection precipitating ICU admission on in-hospital mortality in patients with hematological malignancies. Design and setting: Prospective observational study [...]

Byline: Jan J. De Waele (1), Sebastiaan Van Cauwenberghe (1), Eric Hoste (1), Dominique Benoit (1), Francis Colardyn (1) Keywords: Heparin, therapeutic use Heparin, administration and dosage Partial thromboplastin time Monitoring Physiological, methods Abstract: Objective. To determine the correlation between activated clotting time (ACT) and activated partial thromboplastin time (aPTT) in patients receiving intravenous unfractionated heparin therapy, and the accuracy of the ACT in predicting the level of anticoagulation. Design. Paired aPTT and ACT measurements were obtained from a convenience sample of critically ill patients requiring intravenous unfractionated heparin. The aPTT was determined in the hospital laboratory and ACT measurements were performed with a portable device. Setting. The intensive care unit of Ghent University Hospital, a tertiary care facility with 54 beds. Patients and participants. Twenty-eight patients were studied prospectively a total of 105 paired samples were obtained. The indication for heparin therapy was cerebral ischemia in 8, various cardiac conditions in 10, pulmonary embolism in 3, continuous hemofiltration in 3, and peripheral arterial thrombosis in 4. Results. There was a significant correlation between aPTT and ACT. Analysis of variance showed a significant difference in ACT between different levels of anticoagulation, aPTT shorter than 60 s (group 1), aPTT 60--90 s (group 2), and aPTT longer than 90 s (group 3): 142+-16.7 s in group 1 vs. 155+-29.6 and 192+-39.1 in groups 2 and 3. Conclusions. The correlation between the aPTT and the ACT in this ICU setting is poor ACT cannot differentiate between low and therapeutic levels of anticoagulation. The use of the ACT for monitoring low to moderate doses of heparin in ICU patients cannot be recommended. Author Affiliation: (1) Intensive Care Unit, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium Article History: Received Date: 21/06/2002 Accepted Date: 13/11/2002 Article note: Electronic Publication

Author(s): Dominique D. Benoit [sup.1] [sup.2], Pieter O. Depuydt [sup.1] [sup.3] Author Affiliations: (1) grid.410566.0, 0000000406263303, Medical Unit, Department of Intensive Care, Ghent University Hospital, , De Pintelaan 185, 12K12IB, [...]

Author(s): Eric Hoste [sup.1], Severine Doom [sup.1], Jan De Waele [sup.1], Louke Delrue [sup.1], Luc Defreyne [sup.1], Dominique Benoit [sup.1], Johan Decruyenaere [sup.1] Author Affiliations: (1) grid.410566.0, 0000000406263303, Ghent University [...]

Author(s): Maarten Bekaert [sup.1], Dominique Benoit [sup.2], Johan Decruyenaere [sup.2], Stijn Vansteelandt [sup.1] Author Affiliations: (1) grid.5342.0, 0000000120697798, Department of Applied Mathematics and Computer Sciences, Ghent University, , Krijgslaan 281, [...]

Byline: Jan J. De Waele (1), Dominique Benoit (1), Eric Hoste (1), Francis Colardyn (1) Author Affiliation: (1) Intensive Care Unit, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium Article History: Received Date: 05/06/2002 Accepted Date: 18/10/2002 Article note: Electronic Publication

This study aims to describe a patient developing concomitant severe liver failure and lactic acidosis after long-term treatment with linezolid. A 55-year-old Caucasian woman developed concomitant severe liver failure and lactic acidosis after a treatment with linezolid for 50 days because of infected hip prosthesis. Other causes of liver failure and lactic acidosis were excluded by extensive diagnostic workup. A liver biopsy showed microvesicular steatosis. As linezolid toxicity was considered to be the cause of the lactic acidosis and the severe hepatic failure, the antibiotic was withdrawn. After 4 days of supportive therapy and hemodialysis, the serum lactate level returned within normal limits. The prothrombin time ratio and thrombocytes recovered within 2 weeks. Bilirubin levels normalized within 14 weeks. Since no other cause could be identified, liver injury was considered to be drug-related. Resolution of the hepatotoxicity occurred after discontinuation of linezolid, supportive treatment measures, and hemodialysis. Both lactic acidosis and microvesicular steatosis after the use of linezolid are related to mitochondrial dysfunction. The Council for International Organizations of Medical Sciences/Roussel Ucalf Causality Assessment Method scale revealed that the adverse drug event was probable. Prolonged exposure to linezolid may induce severe hepatotoxicity. Clinicians should be aware of this possible adverse effect especially in case of long-term treatment.