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Byline: Boris Jung (1), Mustapha Sebbane (1), Gerald Chanques (1), Patricia Courouble (1), Daniel Verzilli (1), Pierre-Francois Perrigault (1), Helene Jean-Pierre (2), Jean-Jacques Eledjam (1), Samir Jaber (1) Keywords: Endotracheal aspiration; Broncho-alveolar lavage; Ventilator-associated pneumonia; Nosocomial pneumonia; Antibiotic therapy; Mechanical ventilation Abstract: Objectives Any delay in adequate antibiotic treatment compromises the outcome of ventilator-associated pneumonia (VAP). However, the diagnosis and optimal treatment of VAP remain a challenge for intensivists. We assessed the potential impact of using results of routine weekly endotracheal aspirate (EA) cultures to guide initial antibiotic treatment for VAP. Design and setting Retrospective analysis of prospectively collected data in a medical--surgical intensive care unit (ICU) of a university hospital. Patients and methods We studied 113 VAP episodes and evaluated the concordance between the latest EA and the broncho-alveolar lavage (BAL). We stratified patients into three groups: concordant EA--BAL (concordant group), discordant EA--BAL (discordant group) and EA not performed group. We then compared the adequacy of the antibiotic prescribed initially and outcomes between the three groups. Measurements and main results Ninety assessable EA--BAL samples were evaluated. When guided by EA, the initial antibiotic regimen was adequate in 85% of situations, a proportion significantly superior (P < 0.05) to that resulting from application of the ATS guidelines (73%). When clinicians did not have a pre-VAP EA to guide their treatment (EA not performed group), only 61% of treatments were adequate. No significant difference was observed between the three groups for length of mechanical ventilation, length of ICU stay, nonpulmonary nosocomial infections and mortality. Conclusion Once-a-week routine quantitative EA cultures may help to improve the adequacy of empiric antibiotic therapy for VAP. Author Affiliation: (1) Intensive Care Unit, Department of Critical Care and Anesthesiology, DAR B CHU de Montpellier, Hopital Saint Eloi, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France (2) Bacteriology Department, CHU de Montpellier, Hopital Arnaud de Villeneuve, 191 Av Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France Article History: Registration Date: 18/07/2008 Received Date: 14/07/2007 Accepted Date: 13/07/2008 Online Date: 19/08/2008 Article note: This article is discussed in the editorial available at: doi: 10.1007/s00134-008-1249-7. Presented in part at the 2006 Annual Meeting of European Society of Intensive Care Medicine (Barcelona, Spain, 24--27 September 2006). All authors declare the absence of any involvement in any organization with a direct financial interest in the subject of the manuscript.

Abstract Objective: Prolonged controlled mechanical ventilation (MV) is known to induce diaphragmatic oxidative stress that seems to be an important factor reducing force-generating capacity. To better understand the cellular mechanisms [...]

Abstract Objective: To compare volume support ventilation (VSV) in Which the pressure support level is continuously adjusted to deliver a reset tidal volume, with pressure support ventilation (PSV), in terms [...]

Byline: Samir Jaber (1), Gerald Chanques (1), Stefan Matecki (2), Michele Ramonatxo (2), Christine Vergne (3), Bruno Souche (1), Pierre-Francois Perrigault (1), Jean-Jacques Eledjam (1) Keywords: Post-extubation stridor Airway obstruction Laryngeal edema Extubation failure Cuff-leak test Helium-oxygen Unplanned extubation Abstract: Abstract Objective. To evaluate the incidence and identify factors associated with the occurrence of post-extubation stridor and to evaluate the performance of the cuff-leak test in detecting this complication. Design. Prospective, clinical investigation. Setting. Intensive care unit of a university hospital. Patients. Hundred twelve extubations were analyzed in 112 patients during a 14-month period. Intervention. A cuff-leak test before each extubation. Measurements and results.The incidence of stridor was 12%. When we chose the thresholds of 130 ml and 12% to quantify the cuff-leak volume, the sensitivity and the specificity of the test were, respectively, 85% and 95%. The patients who developed stridor had a cuff leak significantly lower than the others, expressed in absolute values (372+-170 vs 59+-92 ml, p Conclusion. A low cuff-leak volume ( Author Affiliation: (1) Department of Anesthesiology. Intensive Care and Transplantation Unit (DAR B), Chu de Montpellier Hopital Saint Eloi, 80, avenue Augustin Fliche, 34295 Montpellier Cedex 5, France (2) Service central de Physiologie Clinique, Chu de Montpellier Hopital Arnaud de Villeneuve, 371, avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France (3) Department of Biostatistics, Faculty of Medicine, Chu de Montpellier Hopital Arnaud de Villeneuve, 371, avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France Article History: Received Date: 25/04/2002 Accepted Date: 08/10/2002 Article note: Electronic Publication

Byline: Samir Jaber (1), Gerald Chanques (1), Stefan Matecki (2), Michele Ramonatxo (2), Bruno Souche (1), Pierre-Francois Perrigault (1), Jean-Jacques Eledjam (1) Keywords: Heat and moisture exchanger Heated humidifier Non-invasive ventilation Abstract: Abstract Objective. To compare the short-term effects of a heat and moisture exchanger (HME) and a heated humidifier (HH) during non-invasive ventilation (NIV). Design. Prospective, clinical investigation. Setting. Intensive care unit of a university hospital. Patients. Twenty-four patients with acute respiratory failure (ARF). Intervention. Each patient was studied with a HME and a HH in a random order during two consecutive 20min periods of NIV. Measurements and results. Respiratory rate (RR), expiratory tidal volume (VTe) and expiratory minute ventilation (VE) were measured during the last 5 min of each period and blood gases were measured. Mean pressure support and positive end-expiratory pressure levels were, respectively, 15+-4 and 6+-2 cm[H.sub.2]O. VE was significantly greater with HME than with HH (14.8+-4.8 vs 13.2+-4.3 l/min p Conclusion. During NIV the increased dead space of a HME can negatively affect ventilatory function and gas exchange. The effect of HME dead space may decrease efficiency of NIV in patients with ARF. Author Affiliation: (1) Unite de Reanimation et de Transplantation-Departement d'Anesthesie-Reanimation 'B', CHU de Montpellier Hopital Saint Eloi, 80 avenue Augustin Fliche, 34295 Montpellier Cedex, France (2) Service central de Physiologie Clinique, CHU de Montpellier Hopital Arnaud de Villeneuve, 371 avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France Article History: Received Date: 28/11/2001 Accepted Date: 16/07/2002 Article note: Electronic Publication

Sir: Endotracheal tube cuff pressure (CP) should be in the range of 15-22 mmHg to avoid complications related to underinflation (aspiration and leakage) and overinflation (tracheal wall ischemia, stenosis and [...]