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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 [...]

Background: Fast medical progress poses a significant challenge to doctors, who are asked to find the right balance between life-prolonging and palliative care. Literature indicates room for enhancing openness to discuss ethical sensitive issues within and between teams, and improving decision-making for benefit of the patient at end-of-life. Methods: Stepped wedge cluster randomized trial design, run across 10 different departments of the Ghent University Hospital between January 2022 and January 2023. Dutch speaking adult patients and one of their relatives will be included for data collection. All 10 departments were randomly assigned to start a 4-month coaching period. Junior and senior doctors will be coached through observation and debrief by a first coach of the interdisciplinary meetings and individual coaching by the second coach to enhance self-reflection and empowering leadership and managing group dynamics with regard to ethical decision-making. Nurses, junior doctors and senior doctors anonymously report perceptions of excessive treatment via the electronic patient file. Once a patient is identified by two or more different clinicians, an email is sent to the second coach and the doctor in charge of the patient. All nurses, junior and senior doctors will be invited to fill out the ethical decision making climate questionnaire at the start and end of the 12-months study period. Primary endpoints are (1) incidence of written do-not-intubate and resuscitate orders in patients potentially receiving excessive treatment and (2) quality of ethical decision-making climate. Secondary endpoints are patient and family well-being and reports on quality of care and communication; and clinician well-being. Tertiairy endpoints are quantitative and qualitative data of doctor leadership quality. Discussion: This is the first randomized control trial exploring the effects of coaching doctors in self-reflection and empowering leadership, and in the management of team dynamics, with regard to ethical decision-making about patients potentially receiving excessive treatment. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "Management of hematological patients requiring emergency chemotherapy in the intensive care unit." The authors of the article requested an amendment to the Acknowledgement section, which now includes gratitude towards individuals and organizations that provided non-financial support for the work. The correction has been made to the article, and the authors apologize for the mistake. The publisher, Springer Nature, remains neutral regarding jurisdictional claims and institutional affiliations. [Extracted from the article]

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 [...]

Coagulation disorders increase mortality rate during septic shock, but the impact of concomitant hematological malignancies remains unknown. The study assessed coagulation disorders in onco-hematological patients with thrombocytopenia (<100 G/L) admitted to ICU for septic shock. Among 146 included patients, 50 patients had lymphoma and 49 patients had acute leukemia. ICU mortality rate was 43.8% (n = 64). Median increase in prothrombin time (PT) at day(d) 1 was 4.7 s (IQR 3.2–7.9) in ICU survivors vs. 6.4 s (IQR 4.5–13.7; p < 0.01) in non-survivors. Fibrinogen kinetics (increase in fibrinogen levels between d1 and d2) was +0.55 (−0.22–1.55) vs. +0.10 g/L (−0.40–0.50; p = 0.03) in surviving and non-surviving patients, respectively. PT increase ≥6 s at d1 (OR 5.5; 95% CI 1.1–6.0; p = 0.03) and mechanical ventilation (OR 7.4; 95% CI 3.3–17.7; p < 0.001) were independently associated with ICU mortality. This study provides information and new ways to identify hematological patients with high-risk mortality. [ABSTRACT FROM AUTHOR]

Introduction: A decrease in short-term mortality of critically ill cancer patients with an unplanned intensive care unit (ICU) admission has been described. Few studies describe a change over time of 1-year mortality. Therefore, we examined the 1-year mortality of cancer patients (hematological or solid) with an unplanned ICU admission and we described whether the mortality changed over time. Methods: We used the National Intensive Care Evaluation (NICE) registry and extracted all patients with an unplanned ICU admission in the Netherlands between 2008 and 2017. The primary outcome was 1-year mortality, analyzed with a mixed-effects Cox proportional hazard regression. We compared the 1-year mortality of cancer patients to that of patients without cancer. Furthermore, we examined changes in mortality over the study period. Results: We included 470,305 patients: 10,401 with hematological cancer, 35,920 with solid cancer, and 423,984 without cancer. The 1-year mortality rates were 60.1%, 46.2%, and 28.3% respectively (P< .01). Approximately 30% of the cancer patients surviving their hospital admission died within 1 year, this was 12% in patients without cancer. In hematological patients, 1-year mortality decreased between 2008 and 2011, after which it stabilized. In solid cancer patients, inspection showed neither an increasing nor decreasing trend over the inclusion period. For patients without cancer, 1-year mortality decreased between 2008 and 2013, after which it stabilized. A clear decrease in hospital mortality was seen within all three groups. Conclusion: The 1-year mortality of cancer patients with an unplanned ICU admission (hematological and solid) was higher than that of patients without cancer. About one-third of the cancer patients surviving their hospital admission died within 1 year after ICU admission. We found a decrease in 1-year mortality until 2011 in hematology patients and no decrease in solid cancer patients. Our results suggest that for many cancer patients, an unplanned ICU admission is still a way to recover from critical illness, and it does not necessarily lead to success in long-term survival. The underlying type of malignancy is an important factor for long-term outcomes in patients recovering from critical illness. [ABSTRACT FROM AUTHOR]

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], [...]