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Background: Due to aging population and increasing part of immunocompromised patients, a raise in life-threatening organ damage related to VZV can be expected. Two retrospective studies were already conducted on VZV in ICU but focused on specific organ injury. Patients with high-risk of VZV disease still must be identified. The objective of this study was to report the clinical features and outcome of all life-threatening VZV manifestations requiring intensive care unit (ICU) admission. This retrospective cohort study was conducted in 26 French ICUs and included all adult patients with any life-threatening VZV-related event requiring ICU admission or occurring in ICU between 2010 and 2019. Results: One-hundred nineteen patients were included with a median SOFA score of 6. One hundred eight patients (90.8%) were admitted in ICU for VZV disease, leaving 11 (9.2%) with VZV disease occurring in ICU. Sixty-one patients (51.3%) were immunocompromised. Encephalitis was the most prominent organ involvement (55.5%), followed by pneumonia (44.5%) and hepatitis (9.2%). Fifty-four patients (45.4%) received norepinephrine, 72 (60.5% of the total cohort) needed invasive mechanical ventilation, and 31 (26.3%) received renal-replacement therapy. In-hospital mortality was 36.1% and was significantly associated with three independent risk factors by multivariable logistic regression: immunosuppression, VZV disease occurring in ICU and alcohol abuse. Hierarchical clustering on principal components revealed five phenotypically distinct clusters of patients: VZV-related pneumonia, mild encephalitis, severe encephalitis in solid organ transplant recipients, encephalitis in other immunocompromised hosts and VZV disease occurring in ICU. In-hospital mortality was highly different across phenotypes, ranging from zero to 75% (p < 0.001). Conclusion: Overall, severe VZV manifestations are associated with high mortality in the ICU, which appears to be driven by immunosuppression status rather than any specific organ involvement. Deciphering the clinical phenotypes may help clinicians identify high-risk patients and assess prognosis. [ABSTRACT FROM AUTHOR]

The article focuses on a study related to the use of etomidate by emergency department (ED) for rapid sequence intubation. It informs that etomidate is the most commonly used induction agent for ED rapid sequence intubation (RSI) in North America. It states that the study emphasizes on whether the use of etomidate for ED RSI in critically ill adults is associated with greater morbidity or mortality compared to the use of ketamine. Several charts related to the study are also presented.

Mapped environmental classifications are defined using various procedures, but there has been little evaluation of the differences in their ability to discriminate variation in independent ecological characteristics. We tested the performance of environmental classifications of the streams and rivers of France that had been defined from the same environmental data using geographic regionalization and numerical classification of individual river valley segments. Test data comprised invertebrate assemblages, water chemistry, and hydrological indexes obtained from sites throughout France. Classification performance was measured by analysis of similarity (ANOSIM). Geometric regions defined by a regular grid and without regard to environmental variables and a posteriori classifications based on clustering the test datasets defined lower and upper bounds of performance for a given number of classes. Differences in classification performances were generally small. The ANOSIM statistics for the a posteriori classifications were around twice that of all environmental classifications, including geometrically defined regions. The hydro-ecoregions performed slightly better for the invertebrate data and the network classification performed slightly better for the chemistry and hydrological data. Our results indicate that environmental classifications that are defined using different procedures can be comparable in terms of their ability to discriminate variation of ecological characteristics and that alleged differences in performance arising from different classification procedures can be small relative to unexplained variation. We conclude that definition procedures might have little effect on the performance of large-scale environmental classifications and decisions over which procedures to use should be based primarily on pragmatic considerations. [ABSTRACT FROM AUTHOR]