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In order to define criteria of prognosis for patients hospitalized in intensive care units, 2105 cases of patients treated for an acute life threatening illness for 4 years were reviewed. According to severity of initial illness, 3 groups were defined: Ist one initial illness, presumably reversible (55,3%), IInd, several initial illnesses presumably reversible (27,7%), IIIrd, one or several initial illnesses, with at least one of them presumably irreversible (17%). Total mortality was 31,3%, significantly lower in women than in men. According to groups, mortality was 8,7% in the Ist, 42,7% in the IInd (p less than 0,0001), 88,8% in the IIIrd (p less than 0,0001). In any group prognosis was influenced by the type of initial disease (respiratory, circulatory, renal or metabolic, septic, neurologic and hepato-digestive failure). In groups I and II mortality was greater when high risk factors exist, and is more and more bad with age, but always minus that 50%. In the group III mortality was the same with or without high risk factors, was not influenced by age, and was always near 90%. For 4 years, mortality significantly lowered in the group II, from 57% to 29%. We conclude that treatment in an intensive care unit of life threatening visceral acute failure has a poor result when this later is related to an chronic or non presumably reversible disorder. In other cases high risk factor, particularly old age, is not a contre indication to treatment in an intensive care unit.

An explanation is provided of the logical steps taken before assigning patients to critical care therapy in a major multidisciplinary intensive care unit of the University of Paris at the Hospital Henri Mondor. The factors considered by the staff in deciding to terminate intensive therapy are also enumerated. This system has not been influenced by the major legal pressures found in the United States but has been shaped by more chronic fiscal constraints.

Several cases of toxic shock syndrome (T.S.S) have been recently reported from the U.S.A. Clinical features of this new syndrome include fever, desquamative scarlatiniform rash, hypotension and involvement of central nervous system, liver, kidney and muscles. More than 90% of cases are women with staphylococcic vaginitis using tampons during menstruations. A toxin produced by staphylococcus aureus is thought to be the causative agent, because the germ has been isolated in local (vaginal, pharyngeal, subcutaneous or other sites) but not systemic (blood, cerebrospinal fluid) cultures. The mortality rate is 3-10%, and relapse can occur. We report the first three french cases of T.S.S.: a 17 year old girl with typical tampon-associated vaginitis, a 36 year old woman with a postoperative peritonitis and a 20 year old man with a popliteal abscess. Staphylococcus aureus of type I or IV was identified at the site of infection in all cases, but never in blood cultures. These three patients recovered with antistaphylococcic antibiotics and supportive therapy, but local treatment of infections seems to have been of utmost importance. These cases suggest that T.S.S. can occur with several staphylococcus serotypes and confirm that this syndrome is not always associated with tampons and vaginitis.

Age, previous health status (HS), and severity of acute illness were assessed prospectively on 228 unselected patients admitted over 1 yr to the multidisciplinary ICU, to determine their influence on outcome. One hundred and fifty patients (66%) were discharged from the ICU, but the survival rate fell to 50% at 6 months, and was similar after 1 yr (49%). Over a 6-month period, there was improved HS in survivors which gradually leveled off. Compared to prior HS, the final HS was worsened in 37% of survivors. Three factors were important predictors of late survival: age under 50, good previous HS, and less than two visceral failures. We conclude that evaluation of ICU outcome should provide information on 6-month survival and HS and include important variables as age, previous HS, and severity of acute illness.