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Postoperative pain after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is important. It appears essential to reduce postoperative pain and morphine consumption. Retrospective study in a university hospital comparing patient benefiting from CRS-HIPEC under opioid-free anesthesia (OFA; dexmedetomidine) to those anesthetized with opioid anesthesia (OA; remifentanil) using a propensity score matching method. The main objective was the impact of OFA on postoperative morphine consumption in the first 24 h after surgery. 102 patients were included, matching on the propensity score allowed selecting 34 unique pairs analyzed. Morphine consumption was lower in the OFA group than in the OA group (3.0 [0.00–11.0] mg/24 h vs. 13.0 [2.5–25.0] mg/24 h; p = 0.02). In multivariable analysis, OFA was associated with a reduction of 7.2 [0.5–13.9] mg of postoperative morphine (p = 0.04). The rate of renal failure with a KDIGO-score > 1 was lower in the OFA group than in the OA group (12% vs. 38%; p = 0.01). There was no difference between groups concerning length of surgery/anesthesia, norepinephrine infusion, volume of fluid therapy, post-operative complications, rehospitalization or ICU readmission within 90 days, mortality, and postoperative rehabilitation. Our results suggest that OFA for CRS-HIPEC patients appears safe and is associated with less postoperative morphine use and acute kidney injury.

Intensive care medicine (ICM) has the particularity of being a multidisciplinary specialty and its literature reflects this multidisciplinarity. However, the proportion of each field in this literature and its trend dynamics are not known. The objective of this study was to analyze the ICM literature, extract latent topics and search for the presence of research trends.Abstracts of original articles from the top ICM journals, from their inception until December 31st, 2019, were included. This corpus was fed into a structural topic modeling algorithm to extract latent semantic topics. The temporal distribution was then analyzed and the presence of trends was searched by Mann-Kendall trends tests.Finally, 49,276 articles from 10 journals were included. After topic modeling analysis and experts' feedback, 124 research topics were selected and labeled. Topics were categorized into 19 categories, the most represented being respiratory, fundamental and neurological research. Increasing trends were observed for research on mechanical ventilation and decreasing trends for cardiopulmonary resuscitation.This study reviewed all articles from major ICM journals in a comprehensive way. It provides a better understanding of ICM research landscape by analyzing the temporal evolution of latent research topics in the ICM literature.

BACKGROUND Despite the many opportunities data reuse offers, its implementation presents many difficulties and raw data cannot be reused directly. Information are not always directly available in the source database, and have to be computed afterwards with raw data in defining an algorithm. OBJECTIVE The purpose of this article is to present the generalization of feature extraction concepts and methods when conducting retrospective observational studies. We also suggest a complementary table to store the features in the Observational Medical Outcomes Partnership (OMOP) common data model (CDM). METHODS This study involved three main steps : the collection of relevant study cases related to feature extraction and based on the automatic and secondary use of data; the definition of a higher-level abstraction, with the concepts, their characteristics, and the methods which were common to the study cases; the proposal of a table to store the features in the OMOP CDM. RESULTS We interviewed 10 researchers from 3 French university hospitals and a national institution who were involved in 8 retrospective and observational studies. Based on these studies, two concepts – the track and the feature, and two operations – the track definition and the feature formalization, have emerged. The track is a time-dependent signal or period of interest, defined by a statistical unit, a type of track, a value or a list of values. The feature is a time-independent high-level information with dimensionality identical to the statistical unit of the study, defined by a label and a value. Time dimension has become implicit in the value or name of the variable. We proposed two tables to store variables resulting from feature extraction and extend the OMOP CDM. CONCLUSIONS We propose a definition of the feature extraction process, in order to transform heterogeneous, multidimensional and time-dependent raw data into valuable information when conducting observational retrospective studies. The process combined two steps, the track definition and the feature formalization. By dividing the feature extraction into these two steps, the difficulty is managed during the track definition. The standardization of the tracks requires a great expertise of the data but allows to apply an infinite number of complex transformations. On the contrary, the feature formalization becomes a very simple operation with a finite number of possibilities.

Background and importance Hyperoxemia may be associated with increased mortality in emergency room or ICU patients. However, its effect during septic shock is still debated. Objective To evaluate the effect of hyperoxemia on ICU mortality, during the first 24 h of ICU stay, in mechanically ventilated patients with septic shock according to SEPSIS-3 criteria. Design, settings and participants A retrospective cohort study of ICU admissions recorded in the medical information mart for intensive care-III, a retrospective ICU database, was performed. Intervention Two oxygen exposures during the first 24 h were compared: average PaO2 (TWA-PaO2) between 70 and 120 mmHg in the normoxemia group and above 120 mmHg in the hyperoxemia group. Outcome measures and analysis The primary outcome was mortality during ICU stay. Main results Four hundred eighty-eight ICU admissions met the inclusion criteria: 214 in the normoxemia group and 274 in the hyperoxemia group. The median TWA-PaO2 was 99.1 (88.9-107.6) mmHg in the normoxemia group and 151.5 (133.6-180.2) mmHg in the hyperoxemia group. ICU mortality was lower in the hyperoxemia group than in the normoxemia group in univariate analysis [29.6 vs. 39.7%, respectively; OR 0.64 (0.44-0.93); P = 0.024], but not in multivariate analysis [OR 0.98 (0.62-1.56); P = 0.93]. There was no difference between the two groups in ICU length of stay [8.0 (4.3-15.0) vs. 8.4 (4.7-15.0) days; P = 0.82]. Conclusion We did not find any impact of early hyperoxemia on mortality in this population of mechanically ventilated patients with SEPSIS-3 septic shock criteria.

BACKGROUND Electronic health records (EHRs, such as those created by an anesthesia management system) generate a large amount of data that can notably be reused for clinical audits and scientific research. The sharing of these data and tools is generally affected by the lack of system interoperability. To overcome these issues, Observational Health Data Sciences and Informatics (OHDSI) developed the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) to standardize EHR data and promote large-scale observational and longitudinal research. Anesthesia data have not previously been mapped into the OMOP CDM. OBJECTIVE The primary objective was to transform anesthesia data into the OMOP CDM. The secondary objective was to provide vocabularies, queries, and dashboards that might promote the exploitation and sharing of anesthesia data through the CDM. METHODS Using our local anesthesia data warehouse, a group of 5 experts from 5 different medical centers identified local concepts related to anesthesia. The concepts were then matched with standard concepts in the OHDSI vocabularies. We performed structural mapping between the design of our local anesthesia data warehouse and the OMOP CDM tables and fields. To validate the implementation of anesthesia data into the OMOP CDM, we developed a set of queries and dashboards. RESULTS We identified 522 concepts related to anesthesia care. They were classified as demographics, units, measurements, operating room steps, drugs, periods of interest, and features. After semantic mapping, 353 (67.7%) of these anesthesia concepts were mapped to OHDSI concepts. Further, 169 (32.3%) concepts related to periods and features were added to the OHDSI vocabularies. Then, 8 OMOP CDM tables were implemented with anesthesia data and 2 new tables (EPISODE and FEATURE) were added to store secondarily computed data. We integrated data from 5,72,609 operations and provided the code for a set of 8 queries and 4 dashboards related to anesthesia care. CONCLUSIONS Generic data concerning demographics, drugs, units, measurements, and operating room steps were already available in OHDSI vocabularies. However, most of the intraoperative concepts (the duration of specific steps, an episode of hypotension, etc) were not present in OHDSI vocabularies. The OMOP mapping provided here enables anesthesia data reuse.

Background Critical care teams are on the front line of managing the COVID-19 pandemic, which is stressful for members of these teams. Objective Our objective was to assess whether the use of social networks is associated with increased anxiety related to the COVID-19 pandemic among members of critical care teams. Methods We distributed a web-based survey to physicians, residents, registered and auxiliary nurses, and nurse anesthetists providing critical care (anesthesiology, intensive care, or emergency medicine) in several French hospitals. The survey evaluated the respondents’ use of social networks, their sources of information on COVID-19, and their levels of anxiety and information regarding COVID-19 on analog scales from 0 to 10. Results We included 641 respondents in the final analysis; 553 (86.3%) used social networks, spending a median time of 60 minutes (IQR 30-90) per day on these networks. COVID-19–related anxiety was higher in social network users than in health care workers who did not use these networks (median 6, IQR 5-8 vs median 5, IQR 3-7) in univariate (P=.02) and multivariate (P Conclusions Our results suggest that social networks contribute to increased anxiety in critical care teams. To protect their mental health, critical care professionals should consider limiting their use of these networks during the COVID-19 pandemic.

BACKGROUND Critical care teams are on the front line of managing the COVID-19 pandemic, which is stressful for members of these teams. OBJECTIVE Our objective was to assess whether the use of social networks is associated with increased anxiety related to the COVID-19 pandemic among members of critical care teams. METHODS We distributed a web-based survey to physicians, residents, registered and auxiliary nurses, and nurse anesthetists providing critical care (anesthesiology, intensive care, or emergency medicine) in several French hospitals. The survey evaluated the respondents’ use of social networks, their sources of information on COVID-19, and their levels of anxiety and information regarding COVID-19 on analog scales from 0 to 10. RESULTS We included 641 respondents in the final analysis; 553 (86.3%) used social networks, spending a median time of 60 minutes (IQR 30-90) per day on these networks. COVID-19–related anxiety was higher in social network users than in health care workers who did not use these networks (median 6, IQR 5-8 vs median 5, IQR 3-7) in univariate (P=.02) and multivariate (PP=.04). Social network users considered that they were less informed about COVID-19 than those who did not use social networks (median 8, IQR 7-9 vs median 7, IQR 6-8; P CONCLUSIONS Our results suggest that social networks contribute to increased anxiety in critical care teams. To protect their mental health, critical care professionals should consider limiting their use of these networks during the COVID-19 pandemic.

Background Bacterial infections are frequent triggers for diabetic ketoacidosis. In this context, delayed antibiotic treatment is associated with increased morbidity and mortality. Unnecessary administration of antimicrobial therapy might however, also negatively impact the prognosis. The usefulness of sepsis markers in diabetic ketoacidosis has not been assessed. Thus, we sought to investigate diagnostic performances of clinical and biological sepsis markers during diabetic ketoacidosis. Methods In this monocentric retrospective cohort study, all consecutive episodes of diabetic ketoacidosis (defined as pH ≤ 7.25, glycaemia > 300 mg/dL and presence of ketones) admitted in intensive care unit were included. A proven bacterial infection was defined as bacteriological documentation on any bacterial sample. Clinical (presence of fever: temperature > 38 °C and presence of hypothermia: temperature < 36 °C) and biological markers (whole blood count, neutrophils count, neutrophils-to-lymphocytes count ratio and procalcitonin), recorded at admission, were compared according to the presence or absence of a proven bacterial infection. Results Between 2011 and 2018, among 134 episodes of diabetic ketoacidosis, 102 were included (91 patients). Twenty out of 102 were infected. At admission, procalcitonin (median: 3.58 ng/mL vs 0.52 ng/mL, p p = 0.007) were different between episodes with and without proven bacterial infection in both univariate and multivariate analysis. Whole blood count, neutrophils count, neutrophils-to-lymphocytes count ratio and presence of hypothermia were not different between both groups. The diagnostic performance analysis for procalcitonin revealed an area under the curve of 0.87 with an optimal cutoff of 1.44 ng/mL leading to a sensitivity of 0.90 and a specificity of 0.76. Combining procalcitonin and presence of fever allowed to distinguish proven bacterial infection episodes from those without proven bacterial infection. Indeed, all patients with procalcitonin level of more than 1.44 ng/mL and fever had proven bacterial infection episodes. The presence of one of these 2 markers was associated with 46% of proven bacterial infection episodes. No afebrile patient with procalcitonin level less than 1.44 ng/mL had a proven bacterial infection. Conclusion At admission, combining procalcitonin and presence of fever may be of value to distinguish ketoacidosis patients with and without proven bacterial infection, admitted in intensive care unit.

Background Bacterial infections are frequent triggers for diabetic ketoacidosis. In this context, delayed antibiotic treatment is associated with increase morbidity and mortality. Unnecessary administration of antimicrobial therapy might however also negatively impact the prognosis. The usefulness of traditional sepsis markers in diabetic ketoacidosis has not been assessed. Thus, we sought to investigate diagnostic performances of clinical and biological sepsis markers during diabetic ketoacidosis. Methods Patients admitted in a single intensive care unit for diabetic ketoacidosis (defined by pH < 7.3 and glycaemia > 13.75mmol/L) were retrospectively analyzed. Clinical and biological markers were evaluated to determine their ability to identify infected from non-infected patients. Results Between 2011 and 2018, among 134 episodes of diabetic ketoacidosis, 102 were included (91 patients). Twenty out of 102 were infected. At admission, procalcitonin (median: 3.58ng/mL vs 0.52ng/mL, p 38°C, (25% vs 2.5%, p=0.007) were different between infected patients and non-infected patients in both univariate and multivariate analysis. Whole blood count, neutrophils count and presence of hypothermia were not different between both groups. The diagnostic performance analysis for procalcitonin revealed an area under the curve of 0.87 with an optimal cutoff of 1.44ng/mL leading to a sensibility of 0.90 and a specificity of 0.76. Combining procalcitonin and presence of fever allowed distinguish infected from non-infected patients. Indeed, all patients with procalcitonin level of more than 1.44ng/mL and fever were infected patients. The presence of one of these 2 markers was associated with 46% of infected patients. No afebrile patient with procalcitonin level less than 1.44 ng/mL was infected. Conclusion At admission, combining procalcitonin with a threshold above 1.44 ng/mL and presence of fever may be of value to distinguish infected from non-infected patients admitted in intensive care unit for diabetes ketoacidosis.

PURPOSE Veno-arterial Extracoporeal Membrane Oxygenation (VA-ECMO) provides circulatory assistance for patients in cardiogenic shock. Large quantities of fluids are often required, especially during the early stages, but can result in a potentially harmful fluid-overload. The objective was to determine the association of early fluid-balance and mortality. METHODS Retrospective single-center study in 101 VA-ECMO patients between 2013 and 2016. Daily fluid-balance and weight changes over the 5 first days were observed. Analyses between survivors and non-survivors were conducted using Mann-Whitney tests and logistic regression multivariable and Cox hazard-proportional analyses to determine any association with 28-days mortality. RESULTS Mortality was 47.5%. The fluid-balance was higher in non-survivors at day-1 (47.3[18.1-71.9] vs. 19.3[1.5-36.2] mL/kg, P