Descriptor: "MESH: Intensive Care" - Searchworks@Jio Institute Digital Library Search Results

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41 results on '"MESH: Intensive Care"'

1. The Accuracy of Noninvasive Hemoglobin Measurement by Multiwavelength Pulse Oximetry After Cardiac Surgery

Author: Charles Christian Arvieux, Nicolas Paleiron, Maité Guillouet, Michelle Coat, Mehdi Ould-Ahmed, Emmanuel Nowak, Gildas Gueret, Ba-Vinh Nguyen, Jean Louis Vincent, Pierre Gouny, Department of Intensive Care, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pneumologie (NP - HIA), Hôpital d'Instruction des armées, Service de chirurgie thoracique et cardio vasculaire [Brest] (CCTV - Brest), and Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)
Subjects: Male, MESH: Monitoring, Physiologic, law.invention, 0302 clinical medicine, MESH: Postoperative Period, 030202 anesthesiology, law, Medicine, Oximetry, Postoperative Period, Prospective Studies, MESH: Aged, MESH: Cardiac Surgical Procedures, MESH: Middle Aged, medicine.diagnostic_test, Pulse (signal processing), Middle Aged, Intensive care unit, 3. Good health, Cardiac surgery, MESH: Reproducibility of Results, Shock (circulatory), Anesthesia, Hemoglobinometry, Cardiology, Female, medicine.symptom, medicine.medical_specialty, Critical Care, Anemia, MESH: Oximetry, MESH: Software, 03 medical and health sciences, Intensive care, Internal medicine, Humans, MESH: Intensive Care, Cardiac Surgical Procedures, Aged, Monitoring, Physiologic, MESH: Hemoglobinometry, MESH: Humans, business.industry, Reproducibility of Results, 030208 emergency & critical care medicine, medicine.disease, MESH: Prospective Studies, MESH: Male, Pulse oximetry, Anesthesiology and Pain Medicine, Regional Blood Flow, MESH: Regional Blood Flow, Hemoglobin, business, MESH: Female, Software, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, 030217 neurology & neurosurgery
Abstract: International audience; BACKGROUND: In March 2008, a new multiwavelength pulse oximeter, the Radical 7 (Rad7; Masimo Corp., Irvine, CA), was developed that offers noninvasive measurement of hemoglobin concentration. Accuracy has been established in healthy adults and some surgical patients, but not in cardiac surgery intensive care patients, a group at high risk of postoperative bleeding events and anemia in whom early diagnosis could improve management. METHODS: In this prospective, observational study conducted in a cardiovascular intensive care unit, we compared hemoglobin concentrations shown by the Rad7 with arterial hemoglobin concentrations determined by an automated hematology analyzer, XE-2100 (Roche, Neuilly sur Seine, France). Two software versions of Rad7 (V 7.3.0.1 [42 points of comparison in 14 patients] and the updated V 7.3.1.1 [61 points of comparison in 27 patients]) were studied during two 1-week periods. Bias, defined as the difference between the 2 methods (Masimo SpHb-XE-2100 laboratory hemoglobin), was calculated. A negative bias indicated that the Masimo underestimated hemoglobin compared with the laboratory analyzer. Correlation between the perfusion index given by Rad7 and the hemoglobin bias was also studied. RESULTS: Correlations between Rad7 and XE-2100 were weak for both software versions (R2=0.11 for V 7.3.0.1 and R2=0.27 for V 7.3.1.1). Mean bias was -1.3 g/dL for V 7.3.0.1 and -1.7 g/dL for V 7.3.1.1, with wide 95% prediction intervals for the bias (respectively, -4.6 to 2.1 g/dL and -5.7 to 2.3 g/dL). The absolute hemoglobin bias tended to increase when the perfusion index decreased. For the V 7.3.0.1 software, the average absolute bias was 1.9 g/dL for perfusion index2 (P=0.03). For V 7.3.1.1, the mean absolute bias was 2.1 g/dL when the perfusion index was 2 (P=0.26). CONCLUSIONS: Our study demonstrates poor correlation between hemoglobin measured noninvasively by multiwavelength pulse oximetry and a laboratory hematology analyzer. The difference was greater when the pulse oximetry perfusion index was low, as may occur in shock, hypothermia, or vasoconstriction patients. The multiwavelength pulse oximetry is not sufficiently accurate for clinical use in a cardiovascular intensive care unit.
Published: 2011

2. Outcomes in severe sepsis and patients with septic shock: Pathogen species and infection sites are not associated with mortality*

Author: Dany Goldgran-Toledano, Adrien Français, Elie Azoulay, Jean-François Timsit, Yohann Dubois, Aurélien Vesim, Bertrand Souweine, Bernard Allaouchiche, Jean-Ralph Zahar, Adrien Descorps-Declere, Christophe Adrie, Maité Garrouste-Orgeas, Aurélien Vesin, Hakim Haouache, Equipe mobile d'infectiologie, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service Microbiologie-Hygiène Hospitalière, Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Epidémiologie pronostique des cancers et affections graves, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de réanimation chirurgicale [Béclère], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Laboratoire Microorganismes : Génome et Environnement (LMGE), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS), Hôpital Delafontaine, Centre Hospitalier de Saint-Denis [Ile-de-France], Service de Réanimation Polyvalente, Centre Hospitalier de Gonesse, Service de Réanimation, Hospices Civils de Lyon (HCL)-Hôpital E. Herriot, Medical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Service de réanimation médicale et chirurgicale, and Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)
Subjects: Male, Databases, Factual, MESH: Drug Resistance, Microbial, Drug resistance, MESH: Risk Assessment, Critical Care and Intensive Care Medicine, Severity of Illness Index, MESH: Gram-Positive Bacteria, MESH: Proportional Hazards Models, MESH: Cause of Death, 0302 clinical medicine, Cause of Death, MESH: Gram-Negative Bacteria, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, MESH: Sepsis, MESH: Treatment Outcome, MESH: Aged, Cross Infection, MESH: Microbial Sensitivity Tests, MESH: Middle Aged, Drug Resistance, Microbial, Middle Aged, Prognosis, Shock, Septic, Anti-Bacterial Agents, 3. Good health, Community-Acquired Infections, Survival Rate, Intensive Care Units, Treatment Outcome, MESH: Community-Acquired Infections, Cohort, Female, medicine.symptom, medicine.medical_specialty, Critical Care, MESH: Survival Rate, MESH: Shock, Septic, Microbial Sensitivity Tests, Gram-Positive Bacteria, Risk Assessment, MESH: Multivariate Analysis, MESH: Prognosis, 03 medical and health sciences, Sepsis, MESH: Anti-Bacterial Agents, MESH: Severity of Illness Index, Intensive care, Gram-Negative Bacteria, Severity of illness, medicine, Humans, MESH: Hospital Mortality, MESH: Intensive Care, Intensive care medicine, Survival rate, Aged, Proportional Hazards Models, MESH: Humans, Septic shock, business.industry, Organ dysfunction, MESH: Cross Infection, 030208 emergency & critical care medicine, medicine.disease, MESH: Databases, Factual, MESH: Male, MESH: Prospective Studies, Bacteremia, Multivariate Analysis, MESH: Intensive Care Units, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; OBJECTIVES: We evaluated the respective influence of the causative pathogen and infection site on hospital mortality from severe sepsis related to community-, hospital-, and intensive care unit-acquired infections. DESIGN: We used a prospective observational cohort 10-yr database. We built a subdistribution hazards model with corrections for competing risks and adjustment for potential confounders including early appropriate antimicrobial therapy. SETTING: Twelve intensive care units. PATIENTS: We included 4,006 first episodes of acquisition-site-specific severe sepsis in 3,588 patients. INTEVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 1562 community-acquired, 1432 hospital-acquired, and 1012 intensive care unit-acquired episodes of severe sepsis. After adjustment, we found no independent associations of the causative organism, multidrug resistance of the causative organism, infection site, or presence of bacteremia with mortality. Early appropriate antimicrobial therapy was consistently associated with better survival in the community-acquired (0.64 [0.51-0.8], p = .0001), hospital-acquired (0.72 [0.58-0.88], p = .0011), and intensive care unit-acquired (0.79 [0.64-0.97], p = .0272) groups. CONCLUSION: The infectious process may not exert as strong a prognostic effect when severity, organ dysfunction and, above all, appropriateness of early antimicrobials are taken into account. Our findings emphasize the importance of developing valid recommendations for early antimicrobial therapy.
Published: 2011

3. Effectiveness of simple daily sensitization of physicians to the duration of central venous and urinary tract catheterization

Author: Aurélie Coué, Philippe Seguin, Sonia Isslame, Yannick Mallédant, Bruno Laviolle, Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Pharmacologie du Sepsis et Choc Septique, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Service de Pharmacologie [Rennes], CHU Pontchaillou [Rennes]-CHU Pontchaillou [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Service de Pharmacologie [Rennes]
Subjects: Male, Time Factors, medicine.medical_treatment, Urinary tract catheter, Critical Care and Intensive Care Medicine, 0302 clinical medicine, Infection rate, Interquartile range, Prospective Studies, MESH: Incidence, 030212 general & internal medicine, Practice Patterns, Physicians', Prospective cohort study, Cross Infection, MESH: Catheterization, Central Venous, 0303 health sciences, MESH: Middle Aged, Incidence, Incidence (epidemiology), Middle Aged, Duration of catheterization, 3. Good health, Intensive Care Units, Catheter, Anesthesia, Female, Urinary Catheterization, Central venous catheter, Catheterization, Central Venous, Critical Care, Reminder Systems, Urinary system, MESH: Reminder Systems, Urinary catheterization, 03 medical and health sciences, Intensive care, medicine, Humans, MESH: Intensive Care, MESH: Physician's Practice Patterns, MESH: Humans, 030306 microbiology, business.industry, MESH: Time Factors, MESH: Cross Infection, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, MESH: Prospective Studies, MESH: Male, MESH: Urinary Catheterization, MESH: Intensive Care Units, business, MESH: Female
Abstract: International audience; PURPOSE: To evaluate the effectiveness of simple daily sensitization of physicians to the duration of central venous and urinary tract catheterization, and impact on infection rates. METHODS: A prospective, before-after study in a surgical intensive care unit. All consecutive patients who had a central venous catheter (CVC) and/or urinary tract catheter (UTC) were included during two consecutive periods. Period 1 (August 2005 to May 2006) served as the control period. During Period 2 (July 2006 to April 2007), a red square, added to the patient's daily care sheet, questioned the physician about the utility of the CVC and/or UTC. If the response was "No", the CVC and/or the UTC were removed by a nurse. RESULTS: A total of 1,271 patients were analyzed (Period 1, n = 676; Period 2, n = 595). The duration of catheterization (median [interquartile range]) was significantly reduced in Period 2 compared to Period 1 (from (5 [3-9] to 4 [3-7] days, p < 0.001, for CVC, and from 5 [3-11] to 4 [3-8] days, p < 0.001, for UTC). The incidence and density incidence of CVC infection decreased in Period 2 compared to Period 1 (from 1.8% to 0.3%, p = 0.010, and from 2.8 to 0.7/1,000 CVC-days, p = 0.051) whereas UTC infections were not significantly different (4.3 to 3.0%, p = 0.230, and 5.0 to 4.9/1,000 UTC-days, p = 0.938, respectively). CONCLUSIONS: A simple daily reminder to physicians on the patients' care sheets decreased the duration of central venous and urinary tract catheterization, and tended to decrease CVC infection rate without affecting UTC infection.
Published: 2010

4. Antimicrobial resistance in pathogens causing nosocomial infections in surgery and intensive care units of two hospitals in Antananarivo, Madagascar

Author: Jean Roger Raveloson, Armand Rakotoarijaona, Vincent Richard, Laetitia Vaillant, Jules Randrianomenjanahary, Elisoa Ratsima Hariniana, Frédérique Randrianirina, Jean-François Carod, Mamy Lalatiana Andriamanarivo, Henri Claude Razafimahandry, C.E. Ramarokoto, Antoine Talarmin, Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP), Hôpital Joseph Ravoahangy Andrianavalona, Centre Hospitalier Soavinandriana, Centre hospitalier Soavinandriana, and We would like to thank all the physicians and staff for their cooperation in this study, particularly Dr Samson Luc Hervé, Dr Rakoto-Ratsimba Herinirina, Dr Rakotosamimanana Johnny, Dr Tsiaviry Persisy, Dr Solofomalala Gaëtan Duval, Dr Rasolofondranoatra Helivao, Dr Ramarokoto, and Dr Godard Tovone.
Subjects: Male, Klebsiella, [SDV]Life Sciences [q-bio], Antibiotics, Drug resistance, intensive care wards, medicine.disease_cause, MESH: Madagascar, 0302 clinical medicine, Anti-Infective Agents, Risk Factors, MESH: Risk Factors, 030212 general & internal medicine, 2. Zero hunger, Cross Infection, 0303 health sciences, biology, Bacterial Infections, General Medicine, Enterobacter, bacterial resistance, Drug Resistance, Multiple, 3. Good health, Acinetobacter baumannii, Intensive Care Units, Infectious Diseases, nosocomial infection, Female, medicine.medical_specialty, Critical Care, MESH: Bacterial Infections, medicine.drug_class, MESH: Anti-Infective Agents, Microbiology, MESH: Multivariate Analysis, MESH: Drug Resistance, Multiple, 03 medical and health sciences, MESH: Cross-Sectional Studies, Antibiotic resistance, Virology, Intensive care, Drug Resistance, Bacterial, MESH: Drug Resistance, Bacterial, Madagascar, medicine, Humans, MESH: Intensive Care, MESH: Humans, Bacteria, 030306 microbiology, Pseudomonas aeruginosa, business.industry, MESH: Cross Infection, biology.organism_classification, MESH: Male, Surgery, MESH: Bacteria, Cross-Sectional Studies, Multivariate Analysis, MESH: Intensive Care Units, Parasitology, business, MESH: Female, surgery wards
Abstract: Background: In developing countries, knowledge of antimicrobial resistance patterns is essential to define empirical therapy. Methodology: All the surgery and intensive care wards of two hospitals in Antananarivo were included to study the antimicrobial susceptibility of the pathogenic bacteria causing nosocomial infections. A repeated cross-sectional survey was conducted between September 2006 and March 2008, one day per week. Isolates were identified using classical methods, and resistance to antibiotics was assessed according to the recommendations of the Antibiogram Committee of the French Microbiology Society. Results: Clinical specimens from 706 from 651 patients were collected. Of the 533 bacterial pathogens, 46.7% were Enterobacteriaceae , 19.3% were Staphylococcus aureus , and 19.1% were pathogens from the hospital environment ( Pseudomonas aeruginosa and Acinetobacter baumannii ).Frequencies of resistance were high, particularly in Enterobacteriaceae ; however, the rate of Staphylococcus aureus isolates resistant to oxacillin (13.6 %) was moderate and all these isolates were susceptible to glycopeptids. The percentages of isolates susceptible to ceftazidim were 81.8% for E. coli , 60.9% for Klebsiella , and 52.5% for Enterobacter spp. Resistance to third-generation cephalosporins was due to extended spectrum betalactamases (ESBL). Multivariate analysis showed that diabetes (adjusted OR: 3.9) and use of an invasive procedures (adjusted OR: 3.5) were independent risk factors for resistance to third-generation cephalosporins. Conclusion: A nationwide surveillance programme is needed to monitor the microbial trends and antimicrobial resistance in Madagascar.
Published: 2009

5. Signal processing in prolonged EEG recordings during intensive care

Author: S. White, Carsten E. Thomsen, K. Jensen, P.F. Prior, M. Van Gils, J. Gade, Lotfi Senhadji, R.M. Longford, Annelise Rosenfalck, I.R. Ghosh, VTT Information technology, Technical Research Centre of Finland, Departement of medical informatics and image analysis, Aalborg University [Denmark] (AAU), Departement of clinical neurophysiology, St Bartolomew's Hospital, Judex Datasystemer A/S, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Departement of oral function and physiology, University of Copenhagen = Københavns Universitet (UCPH), Anaesthetics laboratory, Departement of anaesthesiology, Hjorring hospital, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Copenhagen = Københavns Universitet (KU), and Senhadji, Lotfi
Subjects: Time Factors, Speech recognition, MESH: Monitoring, Physiologic, long-term trend information, 02 engineering and technology, prolonged EEG recordings, Electroencephalography, MESH: Signal Processing, Computer-Assisted, 0302 clinical medicine, [INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing, Computer equipment, MESH: Data Collection, medical signal processing, IMPROVE project, intensive care, Signal processing, Fourier Analysis, medicine.diagnostic_test, Data Collection, Signal Processing, Computer-Assisted, General Medicine, Clinical Practice, Data Display, Encephalitis, [SDV.IB]Life Sciences [q-bio]/Bioengineering, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Sleep Stages, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, electroencephalography, Adult, Critical Care, [INFO.INFO-TS] Computer Science [cs]/Signal and Image Processing, Process (engineering), 0206 medical engineering, Biomedical Engineering, Context (language use), long-term recordings, 03 medical and health sciences, MESH: Thiopental, Intensive care, MESH: Electroencephalography, MESH: European Union, medicine, Humans, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], European Union, MESH: Intensive Care, Thiopental, Set (psychology), [SPI.SIGNAL] Engineering Sciences [physics]/Signal and Image processing, Monitoring, Physiologic, [SDV.IB] Life Sciences [q-bio]/Bioengineering, MESH: Humans, data recording, IMPROVE data library, business.industry, patient care, MESH: Time Factors, MESH: Adult, MESH: Sleep Stages, short-term discrete events, 020601 biomedical engineering, ICU, MESH: Encephalitis, relevant information extraction, business, MESH: Data Display, MESH: Fourier Analysis, 030217 neurology & neurosurgery
Abstract: International audience; Methods for analyzing and displaying EEG signals are discussed. The increasing availability and affordability of powerful computer equipment makes possible the use of ever more sophisticated signal processing techniques, which extract relevant (but not readily discernible) information from long-term EEG recordings and can easily identify important features in the EEG. Whether these techniques are actually taken up in clinical practice is heavily dependent on how well they match clinical requirements. This article concentrates on requirements set in the context of long-term recordings in the ICU that demand the ability to process short-term discrete events as well as long-term trend information. A huge range of potentially useful signal processing techniques exists. This article illustrates the value of some of these techniques for ICU signals using the EEG recordings collected during the IMPROVE project
Published: 1997

6. Impact de l’âge sur la mortalité des patients traumatisés médullaires hospitalisés en réanimation [Impact of age on mortality in patients with acute traumatic spinal cord injury requiring intensive care]

Author: Seguin, Philippe, Godard, A., Le Maguet, Pascale, Launey, Yoann, Laviolle, Bruno, Mallédant, Yannick, Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Service de pharmacologie biologique et toxicologie [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), and Le Corre, Morgane
Subjects: Âge, MESH: Aged, 80 and over, MESH: Risk Factors, MESH: Analysis of Variance, MESH: Hospital Mortality, MESH: Intensive Care, MESH: Spinal Cord Injuries, Réanimation, MESH: Treatment Outcome, MESH: Age Factors, MESH: Survivors, MESH: Aged, MESH: Humans, MESH: Middle Aged, MESH: Patient Discharge, MESH: Adult, MESH: Retrospective Studies, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, MESH: Recovery of Function, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, MESH: Male, MESH: Prospective Studies, MESH: Independent Living, MESH: Young Adult, MESH: Survival Analysis, Traumatisme médullaire, MESH: Acute Disease, MESH: Coronary Disease, MESH: Female
Abstract: National audience; Objective To evaluate the impact of age (< or ≥ 65 ans) on hospital mortality in traumatic spinal cord injury requiring intensive care. Design Retrospective, monocenter. Patients and methods A total of 131 patients greater or equal to 15 years (< 65 years, n = 109 and ≥ 65 years, n = 22) was analyzed (cervical, n = 71; thoracolumbar, n = 60), over a 10 years period (1998-2008). The hospital and long-term mortality were studied. The risks factors of death were searched by a uni- and multivariate analysis. Intensive care unit (ICU) discharge and long-term neurological recovery, and long-term functional independence measure (FIM) were assessed. Results Hospital mortality was increased in patients greater or equal to 65 years (41% vs 6%, P < 0.001) and long term mortality was not different between the two groups (31% vs 12%, P = 0.150). The risks factors of death were age (HR = 3.44; IC 95%: 1.53-7.72, P = 0.028), previous coronary disease (HR = 3.64; IC 95%: 1.25-10.65; P = 0.018) and fall injury (HR = 2.40; IC 95%: 1.15-5.00, P = 0.020). Among survivors, incompletes forms (Frankel B, C, D, E) were significantly more frequent in older patients at ICU discharge and long term follow up. At long term, FIM was similar in the two groups except a better sphincter control in patient greater or equal to 65 years. Conclusion Mortality rate of older people (≥ 65 years) were greater than those in younger people, mainly caused by an increased hospital mortality. Among survivors, the neurological recovery was better in patients' greater or equal to 65 years, and was associated with a functional status at least comparable than in the youngest patients.
Published: 2012

7. Early-onset ventilator-associated pneumonia in adults randomized clinical trial: comparison of 8 versus 15 days of antibiotic treatment

Author: C. Charpentier, Djillali Annane, Mariette Mercier, Thibault Desmettre, Christophe Faisy, Antoine Roch, Joel Cousson, Gilles Capellier, Samuel Limat, Laurent Papazian, Hélène Mockly, Gilles Blasco, CIT-IT Garches, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP Hôpital Raymond Poincaré [Garches]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Médecine Générale et Soins Intensifs, Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP Hôpital Raymond Poincaré [Garches], Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre National de la Recherche Scientifique ( CNRS ), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes ( URMITE ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR48, INSB-INSB-Centre National de la Recherche Scientifique ( CNRS ), Service de Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique - Hôpitaux de Marseille ( APHM ), Service de soins intensifs, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Européen Georges Pompidou [APHP] ( HEGP ) -Université Paris Descartes - Paris 5 ( UPD5 ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Laboratoire Chrono-environnement - UFC (UMR 6249) ( LCE ), Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ) -Université Bourgogne Franche-Comté [COMUE] ( UBFC ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté [COMUE] ( UBFC ) -Université de Franche-Comté ( UFC ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP]-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Raymond Poincaré [AP-HP], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Assistance Publique - Hôpitaux de Marseille (APHM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP Hôpital Raymond Poincaré [Garches]-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP Hôpital Raymond Poincaré [Garches], Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Université de Franche-Comté (UFC), Laboratoire Chrono-environnement (UMR 6249) (LCE), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), and Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO)
Subjects: Male, Critical Care and Emergency Medicine, Pulmonology, MESH : Aged, MESH : Prospective Studies, MESH: Pneumonia, Ventilator-Associated, MESH : Pneumonia, Ventilator-Associated, MESH : Drug Resistance, Bacterial, MESH : Intensive Care, law.invention, 0302 clinical medicine, Antibiotics, Odds Ratio, Clinical endpoint, Prospective Studies, lcsh:Science, MESH : Intubation, MESH: Treatment Outcome, Cross Infection, MESH: Middle Aged, Death rates, Drug Information, Pneumonia, Ventilator-Associated, 3. Good health, Cohort, Medicine, MESH : Intensive Care Units, MESH : Bronchoalveolar Lavage, MESH : Cross Infection, Cohort study, medicine.medical_specialty, MESH : Drug Administration Schedule, MESH : Cohort Studies, MESH: Drug Administration Schedule, Drug Administration Schedule, 03 medical and health sciences, Sepsis, MESH: Anti-Bacterial Agents, Multicenter trial, Drug Resistance, Bacterial, Humans, Clinical Trials, MESH : Middle Aged, MESH: Intensive Care, Aged, MESH: Humans, [ SDV ] Life Sciences [q-bio], lcsh:R, MESH : Humans, MESH: Adult, Pneumonia, medicine.disease, 030228 respiratory system, Bacterial Pneumonia, lcsh:Q, Bacterial pathogens, Intubation, MESH: Female, Bacterial Diseases, Time Factors, Nosocomial Infections, [SDV]Life Sciences [q-bio], Enterococcus infections, lcsh:Medicine, Bronchoalveolar Lavage, Cohort Studies, Randomized controlled trial, law, MESH : Female, 030212 general & internal medicine, MESH : Anti-Bacterial Agents, Prospective cohort study, MESH: Cohort Studies, MESH: Aged, Intensive care units, Multidisciplinary, MESH: Bronchoalveolar Lavage, Ventilatory Support, Middle Aged, MESH : Adult, Anti-Bacterial Agents, Infectious Diseases, Treatment Outcome, Female, Research Article, MESH : Time Factors, Adult, Drugs and Devices, Critical Care, Clinical Research Design, Secondary infection, MESH : Male, MESH : Treatment Outcome, Respiratory Failure, Internal medicine, MESH: Drug Resistance, Bacterial, medicine, MESH: Intubation, business.industry, MESH: Time Factors, Respiratory infections, MESH: Cross Infection, MESH: Male, MESH: Odds Ratio, MESH: Prospective Studies, Surgery, MESH: Intensive Care Units, MESH : Odds Ratio, business
Abstract: Purpose The optimal treatment duration for ventilator-associated pneumonia is based on one study dealing with late-onset of the condition. Shortening the length of antibiotic treatment remains a major prevention factor for the emergence of multiresistant bacteria. Objective To demonstrate that 2 different antibiotic treatment durations (8 versus 15 days) are equivalent in terms of clinical cure for early-onset ventilator-associated pneumonia. Methods Randomized, prospective, open, multicenter trial carried out from 1998 to 2002. Measurements The primary endpoint was the clinical cure rate at day 21. The mortality rate was evaluated on days 21 and 90. Results 225 patients were included in 13 centers. 191 (84.9%) patients were cured: 92 out of 109 (84.4%) in the 15 day cohort and 99 out of 116 (85.3%) in the 8 day cohort (difference = 0.9%, odds ratio = 0.929). 95% two-sided confidence intervals for difference and odds ratio were [−8.4% to 10.3%] and [0.448 to 1.928] respectively. Taking into account the limits of equivalence (10% for difference and 2.25 for odds ratio), the objective of demonstrative equivalence between the 2 treatment durations was fulfilled. Although the rate of secondary infection was greater in the 8 day than the 15 day cohort, the number of days of antibiotic treatment remained lower in the 8 day cohort. There was no difference in mortality rate between the 2 groups on days 21 and 90. Conclusion Our results suggest that an 8-day course of antibiotic therapy is safe for early-onset ventilator-associated pneumonia in intubated patients. Trial Registration ClinicalTrials.gov NCT01559753
Published: 2012

8. Hospital discharge data can be used for monitoring procedures and intensive care related to severe maternal morbidity

Author: Marie-Hélène Bouvier-Colle, Catherine Quantin, Catherine Deneux-Tharaux, Anne A. Chantry, Anne Ego, Christine Cans, Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Techniques pour l'Evaluation et la Modélisation des Actions de Santé (ThEMAS), CHU Grenoble, Unité de Recherche Clinique, Hôpital Jeanne de Flandre [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Lipides - Nutrition - Cancer (U866) (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Chantry was supported by a doctoral grant from the French Ministry of Research, GRACE study group: G. Bal, G. Beucher, MJ. D'alche Gautier, AS. Ducloy-Bouthors, N. Lamendour, I. Le Fur, V. Tessier, J. Zeitlin, Université Pierre et Marie Curie - Paris 6 (UPMC), GENOME, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Hôpital Jeanne de Flandre [Lille], Université de Bourgogne (UB), Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants ( UMR_S 953 ), Université Paris-Sud - Paris 11 ( UP11 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Techniques pour l'Evaluation et la Modélisation des Actions de Santé ( ThEMAS ), Hôpital Jeanne de Flandre [Lille]-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Lipides - Nutrition - Cancer (U866) ( LNC ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon ( ENSBANA ), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Laboratoire d'Analyse et de Techniques Economiques (LATEC), Université de Bourgogne (UB)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris-Sud - Paris 11 (UP11), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), and EGO, Anne
Subjects: MESH: Pulmonary Embolism, Epidemiology, Severe maternal morbidity, 030204 cardiovascular system & hematology, MESH : Intensive Care, MESH: Hospital Information Systems, 0302 clinical medicine, Sensitivity, MESH: Pregnancy, Pregnancy, Medicine, MESH : Female, 030212 general & internal medicine, Medical diagnosis, Hospital discharge data, ComputingMilieux_MISCELLANEOUS, Medical records, MESH: Middle Aged, Medical record, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Adult, Middle Aged, Patient Discharge, MESH: Postpartum Hemorrhage, 3. Good health, Pulmonary embolism, MESH: International Classification of Diseases, MESH: Pregnancy Complications, MESH: Young Adult, MESH : Pulmonary Embolism, MESH : Hypertension, Pregnancy-Induced, Hospital Information Systems, Female, France, MESH : Patient Discharge, MESH : Hospital Information Systems, Adult, MESH: Medical Records, medicine.medical_specialty, Adolescent, Critical Care, MEDLINE, MESH : Young Adult, MESH : Hospitals, Teaching, MESH : Postpartum Hemorrhage, MESH : Pregnancy Complications, MESH : Morbidity, Validity, 03 medical and health sciences, Young Adult, International Classification of Diseases, Intensive care, MESH : Adolescent, MESH : International Classification of Diseases, MESH : Medical Records, Humans, MESH : Middle Aged, MESH: Intensive Care, MESH: Hypertension, Pregnancy-Induced, Intensive care medicine, MESH : France, Hospitals, Teaching, MESH: Adolescent, Eclampsia, MESH: Humans, business.industry, MESH: Patient Discharge, Gold standard, MESH : Humans, Postpartum Hemorrhage, MESH: Adult, Hypertension, Pregnancy-Induced, MESH: Hospitals, Teaching, medicine.disease, Pregnancy Complications, MESH: France, MESH : Pregnancy, MESH: Morbidity, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Emergency medicine, 26 Positive predictive value, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Morbidity, business, Pulmonary Embolism, MESH: Female
Abstract: International audience; OBJECTIVE: To estimate the accuracy and reliability of the reporting of diagnoses and procedures related to severe acute maternal morbidity in French hospital discharge data. STUDY DESIGN AND SETTING: The study, conducted in four French tertiary teaching hospitals, covered the years 2006 and 2007 and 30,607 deliveries. We identified severe maternal morbid events-eclampsia, pulmonary embolism, procedures related to postpartum hemorrhages, and intensive care-in administrative hospital discharge data and medical records and compared their recording. Information from medical records was the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value of the hospital discharge data for these events were calculated. False positives and false negatives were examined to identify the reasons for misrecorded information. RESULTS: The PPV of the hospital discharge data was 20% for eclampsia. For procedures related to postpartum hemorrhages, the PPVs were high, but sensitivities were lower; however, 95% of recording errors could be corrected. All indicators for intensive care exceeded 98%. CONCLUSION: Intensive care and procedures seem reliably reported in the hospital administrative database, which, therefore, can be used to monitor them. Using these data for monitoring diagnoses will require a greater investment by clinicians in the accuracy of their reporting.
Published: 2011

9. Transfer of take-home messages in graduate ICU education

Author: Jean-François Timsit, Carole Schwebel, Bertrand Souweine, Didier Gruson, Alexandre Lautrette, R. W. Talbot, Unité de soins intensifs [Clermont Ferrand], CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Service de Réanimation Médicale [Grenoble], CHU Grenoble-Hôpital Michallon, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Réanimation, CHU Bordeaux [Bordeaux]-Hôpital Pellegrin-Tripode, Climate Change Research Center [Durham], University of New Hampshire (UNH), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Microorganismes : Génome et Environnement (LMGE), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Centre National de la Recherche Scientifique (CNRS)-Université d'Auvergne - Clermont-Ferrand I (UdA), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS), and Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)
Subjects: 020205 medical informatics, Critical Care, media_common.quotation_subject, [SHS.EDU]Humanities and Social Sciences/Education, 02 engineering and technology, MESH: Education, Medical, Graduate, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Presentation, 0302 clinical medicine, Knowledge translation, 0202 electrical engineering, electronic engineering, information engineering, Medicine, Humans, Learning, Quality (business), Relevance (information retrieval), 030212 general & internal medicine, Prospective Studies, MESH: Intensive Care, MESH: Teaching, media_common, Medical education, Enthusiasm, MESH: Humans, business.industry, 4. Education, Teaching, MESH: Prospective Studies, MESH: France, Intensive Care Units, Education, Medical, Graduate, Observational study, MESH: Intensive Care Units, MESH: Learning, France, Raw data, business, Knowledge transfer, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; PURPOSE: Teaching by lecture (lecture format) is widely used at congresses and in medical educational programmes. The process involves the transfer of take-home messages. The aim of this study was to assess the number of take-home messages identified by postgraduate critical care junior doctors (juniors) during lectures. METHODS: This was a prospective observational study of 13 lectures. Lecturers were not informed in advance of the study. At the end of the lecture (30 or 50 min), the lecturer (senior doctor) and juniors listed the three main take-home messages on a form. Subjective elements of the juniors' appraisal (quality of the presentation, explanation of the topic's relevance, enthusiasm of the lecturer, background, case-based, delivery and personality, comprehensibility, practical applicability of information given, prioritization, presence of raw data, references, overall satisfaction) and objective elements (length of lecture, number of take-home messages written on the slides) of the lectures were recorded. Successful knowledge transfer was assessed by matching lecturers' and juniors' take-home messages. RESULTS: In total, 367 forms completed by 367 juniors were analysed. A match equal to 3 (highest match), 2, 1 or 0 was observed in 3.8, 26.7, 48.2 and 21.2% of the forms, respectively. No single subjective or objective element of the lecture was associated with the number of identified take-home messages. CONCLUSIONS: Two-thirds of critical care junior doctors identified at best only one of the three main take-home messages of a lecture, suggesting that knowledge transfer is poor during passive format learning. These results suggest that there is a need to develop strategies to improve the performance of lecture-based learning.
Published: 2011

10. Bloodstream infection after positive catheter cultures: what are the risks in the intensive care unit when catheters are routinely cultured on removal?

Author: Natacha Mrozek, Ousmane Traore, Claire Aumeran, Bertrand Souweine, Alexandre Lautrette, Henri Laurichesse, Christiane Forestier, Service de Néphrologie Réanimation Médicale, Pôle RHEUNNIRS [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Unité de soins intensifs [Clermont Ferrand], CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Laboratoire Microorganismes : Génome et Environnement (LMGE), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS), and Service des Maladies Infectieuses et Tropicales [CHU Clermont-Ferrand]
Subjects: Male, Resuscitation, medicine.medical_treatment, Antibiotics, Bacteremia, Critical Care and Intensive Care Medicine, MESH: Catheterization, 01 natural sciences, MESH: Length of Stay, law.invention, Cohort Studies, Catheters, Indwelling, 0302 clinical medicine, Risk Factors, Staphylococcus epidermidis, law, MESH: Risk Factors, Medicine, 030212 general & internal medicine, MESH: Bacteremia, MESH: Cohort Studies, MESH: Aged, MESH: Middle Aged, biology, Middle Aged, Intensive care unit, MESH: Predictive Value of Tests, 3. Good health, Catheter, Female, medicine.medical_specialty, Critical Care, medicine.drug_class, MESH: Catheters, Indwelling, Catheterization, 03 medical and health sciences, Predictive Value of Tests, Intensive care, Humans, MESH: Intensive Care, 0101 mathematics, MESH: Device Removal, Device Removal, Dialysis, Aged, Retrospective Studies, MESH: Humans, business.industry, 010102 general mathematics, MESH: Retrospective Studies, Length of Stay, biology.organism_classification, medicine.disease, MESH: Male, Surgery, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; OBJECTIVES: The aim of the study was to assess whether an isolated positive catheter culture is predictive of a subsequent bloodstream infection in intensive care unit patients. DESIGN: Retrospective clinical study between 2000 and 2007. SETTING: Intensive care unit of a university hospital. SUBJECTS: All arterial, central venous, and dialysis catheters yielding selected pathogenic microorganisms from isolated positive catheter cultures. Positive catheter culture was defined by a catheter tip culture performed with the Brun-Buisson technique yielding ≥103 colony-forming units/mL; isolated positive catheter culture by a positive catheter culture without concomitant bloodstream infection due to the microorganism of the positive catheter culture evidenced within 48 hrs before or after catheter removal; and subsequent bloodstream infection by a bloodstream infection developing between 48 hrs and 30 days after catheter removal and due to a selected pathogenic microorganism of an isolated positive catheter culture. Active antibiotic therapy was active if at least one of the antibiotics administered was effective against the selected pathogenic microorganism of the positive catheter culture. INTERVENTION: None. MEASUREMENT AND MAIN RESULTS: The end point of the study was the ratio of the number of subsequent bloodstream infections to that of selected pathogenic microorganisms isolated from positive catheter culture 30 days after catheter removal. A total of 138 isolated positive catheter cultures for 149 selected pathogenic micro-organisms was included in the study. Only two cases (1.3%) of subsequent bloodstream infection were evidenced, one resulting from Escherichia coli and the other from Staphylococcus epidermidis. The incidence of subsequent bloodstream infection did not differ with regard to the presence or absence of active antibiotics at catheter removal: zero of 23 vs. two of 121 (p = 1), respectively. CONCLUSIONS: Our results suggest that the risk of subsequent bloodstream infection in intensive care unit patients when the Brun-Buisson technique is used to define isolated positive catheter culture is low.
Published: 2011

11. Adaptive alterations in metabolism: practical consequences on energy requirements in the severely ill patient

Author: Eric Fontaine, Manfred J. Müller, Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut für Humanernährung und Lebensmittelkunde, Christian-Albrechts-Universität zu Kiel (CAU), and Hamant, Sarah
Subjects: MESH: Nutritional Support, medicine.medical_specialty, Critical Care, 030309 nutrition & dietetics, Critical Illness, MEDLINE, Medicine (miscellaneous), Artificial nutrition, MESH: Nutritional Requirements, MESH: Energy Intake, Energy requirement, 03 medical and health sciences, 0302 clinical medicine, Total energy expenditure, medicine, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, Humans, Resting energy expenditure, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, 030212 general & internal medicine, MESH: Intensive Care, Intensive care medicine, 0303 health sciences, Nutrition and Dietetics, Evidence-Based Medicine, MESH: Humans, Critically ill, business.industry, Nutritional Support, MESH: Energy Metabolism, Nutritional Requirements, Evidence-based medicine, 3. Good health, MESH: Basal Metabolism, Optimal nutrition, MESH: Critical Illness, Basal Metabolism, business, Energy Intake, Energy Metabolism, MESH: Evidence-Based Medicine
Abstract: International audience; PURPOSE OF REVIEW: A recent and large multicentre study reports that ICU patients receive less than half of the recommended energy requirement. This review aims at clarifying whether underfeeding is scientifically justified or sustained by evidence-based medicine. RECENT FINDINGS: There is evidence that optimal nutrition improves clinical outcome of critically ill patients. The deleterious effect of overfeeding ICU patients is now well acknowledged, but underfeeding is not scientifically justified in ICU patients. Total energy expenditure in ICU patients is variable and methods to predict resting energy expenditure are questionable in these patients. SUMMARY: There is a need to measure energy expenditure in clinical practice. When not possible, the current guidelines on artificial nutrition (i.e. 25 kcal/kg per day) should be applied in order to limit underfeeding.
Published: 2011

12. Do patients still require admission to an intensive care unit after elective craniotomy for brain surgery?

Author: Ossam Rhondali, Céline Genty, Caroline Halle, Marianne Gardellin, Céline Ollinet, Manuela Oddoux, Joëlle Carcey, Gilles Francony, Bertrand Fauvage, Emmanuel Gay, Jean-Luc Bosson, Jean-François Payen, Pôle Anesthésie Réanimation, CHU Grenoble-Hôpital Michallon, Division de Biostatistiques, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, ANTE-INSERM U836, équipe 5, Neuroimagerie fonctionnelle et perfusion cérébrale, CHU Grenoble-Hôpital Michallon-CHU Grenoble-Hôpital Michallon, ANTE-INSERM U836, équipe 7, Nanomédecine et cerveau, Département de neurochirurgie, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, and Dojat, Michel
Subjects: Male, Blood transfusion, health care facilities, manpower, and services, medicine.medical_treatment, Plasma Substitutes, resource, intensive care unit, Neurosurgical Procedures, law.invention, Cohort Studies, 0302 clinical medicine, Postoperative Complications, 030202 anesthesiology, law, MESH: Risk Factors, Risk Factors, MESH: Postoperative Complications, Odds Ratio, postoperative, MESH: Neurologic Examination, Anesthesia, neurosurgery, MESH: Quality of Health Care, MESH: Surgical Procedures, Elective, MESH: Cohort Studies, Craniotomy, MESH: Aged, Neurologic Examination, MESH: Middle Aged, Brain, MESH: Posture, Middle Aged, Intensive care unit, 3. Good health, Elective Surgical Procedures, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Female, Neurosurgery, Safety, Elective Surgical Procedure, Cohort study, Adult, medicine.medical_specialty, Critical Care, Posture, MESH: Craniotomy, MESH: Blood Transfusion, MESH: Postoperative Care, MESH: Anesthesia, 03 medical and health sciences, MESH: Brain, medicine, Humans, Blood Transfusion, MESH: Intensive Care, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Aged, Quality of Health Care, Postoperative Care, MESH: Humans, business.industry, MESH: Safety, MESH: Adult, MESH: Neurosurgical Procedures, Odds ratio, Perioperative, MESH: Plasma Substitutes, MESH: Male, MESH: Odds Ratio, Surgery, Anesthesiology and Pain Medicine, Neurology (clinical), business, MESH: Female, 030217 neurology & neurosurgery
Abstract: International audience; BACKGROUND: After elective craniotomy for brain surgery, patients are usually admitted to an intensive care unit (ICU). We sought to identify predictors of postoperative complications to define perioperative conditions that would safely allow ICU bypass. METHODS: This observational cohort study enrolled 358 patients admitted to neuro-ICU after elective intracranial procedures. Postoperative complications were defined as unexpected events occurring within 24 hours of surgery that required imaging or treatment for neurologic deterioration. RESULTS: Fifty-two patients were transferred postoperatively to neuro-ICU with sedation and mechanical ventilation. Of the remaining 306 patients subjected to an attempt to awake and extubate in the operating room, 26 (8%) developed 1 postoperative complication, primarily a new motor deficit, unexpected awakening delay, or subsequent deterioration in consciousness. Four intracerebral hematomas required surgical evacuation and each of these was detected within 2 hours after surgery. Predictors of postoperative complications included failure to extubate the trachea in operating room [odds ratio 61.8; 95% confidence interval (CI) 12.2-312.5], and, to a lesser extent, a duration of surgery of more than 4 hours (odds ratio 3.3; 95% CI 1.4-7.8), and lateral positioning of the patient during the procedure (odds ratio 2.8, 95% CI 1.2-6.4). CONCLUSIONS: Our results encourage prospectively testing the hypothesis that patients with immediate, successful tracheal extubation after elective craniotomy for brain surgery, with a surgical duration of less than 4 hours in a nonlateral position could be monitored safely in the postanesthesia care unit before being discharged to a neurosurgical ward.
Published: 2011

13. Hospital discharge data can be used for monitoring procedures and intensive care related to severe maternal morbidity

Author: Chantry, Anne, Deneux-Tharaux, Catherine, Cans, Christine, Ego, Anne, Quantin, Catherine, Bouvier-Colle, Marie-Hélène, Debs, Nayla, Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Techniques pour l'Evaluation et la Modélisation des Actions de Santé (ThEMAS), CHU Grenoble, Unité de Recherche Clinique, Hôpital Jeanne de Flandre [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Lipides - Nutrition - Cancer (U866) (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Chantry was supported by a doctoral grant from the French Ministry of Research, GRACE study group: G. Bal, G. Beucher, MJ. D'alche Gautier, AS. Ducloy-Bouthors, N. Lamendour, I. Le Fur, V. Tessier, and J. Zeitlin
Subjects: MESH: Medical Records, MESH: Pulmonary Embolism, Severe maternal morbidity, Validity, MESH: Hospital Information Systems, Sensitivity, MESH: Pregnancy, MESH: Intensive Care, Hospital discharge data, MESH: Hypertension, Pregnancy-Induced, MESH: Adolescent, Medical records, MESH: Middle Aged, MESH: Humans, MESH: Patient Discharge, MESH: Adult, MESH: Hospitals, Teaching, MESH: Postpartum Hemorrhage, MESH: International Classification of Diseases, MESH: France, MESH: Morbidity, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Pregnancy Complications, MESH: Young Adult, 26 Positive predictive value, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female
Abstract: International audience; OBJECTIVE: To estimate the accuracy and reliability of the reporting of diagnoses and procedures related to severe acute maternal morbidity in French hospital discharge data. STUDY DESIGN AND SETTING: The study, conducted in four French tertiary teaching hospitals, covered the years 2006 and 2007 and 30,607 deliveries. We identified severe maternal morbid events-eclampsia, pulmonary embolism, procedures related to postpartum hemorrhages, and intensive care-in administrative hospital discharge data and medical records and compared their recording. Information from medical records was the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value of the hospital discharge data for these events were calculated. False positives and false negatives were examined to identify the reasons for misrecorded information. RESULTS: The PPV of the hospital discharge data was 20% for eclampsia. For procedures related to postpartum hemorrhages, the PPVs were high, but sensitivities were lower; however, 95% of recording errors could be corrected. All indicators for intensive care exceeded 98%. CONCLUSION: Intensive care and procedures seem reliably reported in the hospital administrative database, which, therefore, can be used to monitor them. Using these data for monitoring diagnoses will require a greater investment by clinicians in the accuracy of their reporting.
Published: 2011

14. Very early correction of anomalous left coronary artery from the pulmonary artery improves intensive care management

Author: Anne Moulin-Zinch, Virginie Lambert, Laurent Bonnemains, Dany Youssef, Alain Serraf, Service de Cardiologie Infantile [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre chirurgical Marie-Lannelongue, Centre Chirurgical Marie Lannelongue (CCML), and Bonnemains, Laurent
Subjects: MESH: Mitral Valve Insufficiency, Male, Resuscitation, Time Factors, medicine.medical_treatment, Coronary Vessel Anomalies, Myocardial Infarction, Myocardial Ischemia, 030204 cardiovascular system & hematology, Myocardial ischaemia, MESH: Length of Stay, 0302 clinical medicine, Myocardial infarction, MESH: Respiration, Artificial, Réanimation, Outcome, MESH: Treatment Outcome, education.field_of_study, MESH: Cardiac Surgical Procedures, MESH: Infant, Newborn, Age Factors, Quand opérer, Mitral Valve Insufficiency, General Medicine, Left pulmonary artery, MESH: Infant, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, MESH: Myocardial Infarction, Treatment Outcome, Replantation, Cardiology, MESH: Myocardial Ischemia, Female, France, MESH: Cardiovascular Agents, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Anomalous origin of the left coronary artery from the pulmonary artery, Critical Care, Population, MESH: Pulmonary Artery, Infarctus du myocarde, Pulmonary Artery, 03 medical and health sciences, Left coronary artery, [SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, Intensive care, medicine.artery, medicine, Origine anormale de la coronaire gauche naissant de l’artère pulmonaire, Humans, MESH: Intensive Care, Cardiac Surgical Procedures, education, MESH: Coronary Vessel Anomalies, Devenir, Retrospective Studies, Mechanical ventilation, MESH: Age Factors, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, MESH: Humans, business.industry, MESH: Time Factors, Infant, Newborn, Infant, MESH: Retrospective Studies, Cardiovascular Agents, Length of Stay, medicine.disease, Respiration, Artificial, MESH: Male, Surgery, MESH: France, 030228 respiratory system, Timing of surgery, Pulmonary artery, Intensive care management, business, MESH: Female, MESH: Replantation
Abstract: International audience; BACKGROUND: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) can sometimes be diagnosed very early in newborns and thus be corrected surgically before any myocardial ischaemia occurs. AIM: To evaluate the influence of this very early surgery on intensive care management and long-term outcome. METHODS: All children operated on for ALCAPA before the age of 1 year between 1995 and 2010 were considered. Those operated on before the onset of ischaemia (group B) were compared with a matched group of children of similar weight who were operated on by the same surgeon on a close surgery date (group A). RESULTS: We obtained a homogenous population of 13 children (eight in group A; five in group B) with no significant weight difference between groups. The surgical technique and peroperative variables were similar in both groups. There was one death in each group. The group B death was due to postoperative occurrence of global myocardial infarction despite correct surgical reparation. Mechanical ventilation duration, inotropic support duration, intensive care duration and long-term complications were lower in group B. CONCLUSION: Very early ALCAPA surgical correction before occurrence of ischaemia must be encouraged whenever possible because it simplifies intensive care management and prevents persistent mitral regurgitation, but it does not reduce peroperative risk.
Published: 2010

15. Risk factors for multidrug-resistant bacteria in patients with post-operative peritonitis requiring intensive care

Author: Yannick Fédun, Philippe Seguin, Pierre-Yves Donnio, Bruno Laviolle, Nicolas Nesseler, Yannick Mallédant, Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Pharmacologie du Sepsis et Choc Septique, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Service de Pharmacologie [Rennes], CHU Pontchaillou [Rennes]-CHU Pontchaillou [Rennes], Microbiologie : Risques Infectieux, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Faculté de Chirurgie Dentaire de Rennes-Faculté d'Odontologie-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Service de Pharmacologie [Rennes], Université de Rennes (UR)-CHU Pontchaillou [Rennes]-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Université de Rennes - UFR d'Odontologie (UR Odontologie), and Université de Rennes (UR)-Université de Rennes (UR)
Subjects: Male, empirical therapy, antimicrobial therapy, surgery, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, Drug Resistance, Multiple, Bacterial, Pharmacology (medical), 030212 general & internal medicine, First episode, MESH: Aged, MESH: Microbial Sensitivity Tests, MESH: Middle Aged, Bacterial Infections, Middle Aged, 3. Good health, Anti-Bacterial Agents, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Piperacillin/tazobactam, Female, medicine.drug, Microbiology (medical), medicine.medical_specialty, MESH: Peritonitis, Critical Care, MESH: Bacterial Infections, Cefepime, Microbial Sensitivity Tests, Peritonitis, Tazobactam, 03 medical and health sciences, Intensive care, Clavulanic acid, Internal medicine, MESH: Anti-Bacterial Agents, medicine, Humans, Surgical Wound Infection, MESH: Intensive Care, MESH: Surgical Wound Infection, Aged, in vitro susceptibility, Pharmacology, MESH: Humans, Bacteria, business.industry, 030208 emergency & critical care medicine, MESH: Drug Resistance, Multiple, Bacterial, Amoxicillin, MESH: Male, Surgery, MESH: Bacteria, business, MESH: Female, Piperacillin
Abstract: International audience; OBJECTIVES: This prospective non-interventional study investigated the risk factors for multidrug-resistant bacteria (MDRB) in patients with post-operative peritonitis (POP), to provide guidance for empirical antimicrobial therapy. METHODS: All consecutive patients, >15 years old, admitted to a surgical intensive care unit (ICU) between September 2006 and January 2009 for a first episode of POP were included. Antibiotic susceptibilities of microorganisms recovered from blood cultures and peritoneal fluid were determined by disc diffusion. Amoxicillin/clavulanic acid, ticarcillin/clavulanic acid, piperacillin/tazobactam, cefotaxime, ceftazidime, cefepime, imipenem, gentamicin, amikacin and ciprofloxacin were tested against Gram-negative bacteria, and oxacillin, amoxicillin, vancomycin, gentamicin and erythromycin were tested against aerobic Gram-positive bacteria. Results were reported as susceptible or resistant. RESULTS: MDRB were isolated from 20/115 (17%) patients. In univariate analysis, use of antimicrobial therapy during the 3 months prior to hospitalization and a long duration between hospital admission or first operation and relaparotomy were significantly associated with MDRB recovery. In multivariate analysis, only antimicrobial treatment in the 3 months preceding hospitalization and duration between first operation and relaparotomy were independent risk factors for MDRB [odds ratio (OR) = 5.80, 95% confidence interval (95% CI) = 1.99-16.91 and OR = 1.10, 95% CI = 1.02-1.19, respectively]. No MDRB were found when the delay between the first operation and relaparotomy was 5 days between the first operation and relaparotomy.
Published: 2010

16. A knowledge-based system for assisted ventilation of patients in intensive care units

Author: L. Brochard, Michel Dojat, Alain Harf, François Lemaire, Dojat, Michel, Physiologie respiratoire, Institut National de la Santé et de la Recherche Médicale (INSERM), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Département de physiologie (CHU Henri Mondor), and Hôpital Henri Mondor
Subjects: Male, medicine.medical_treatment, MESH: Monitoring, Physiologic, Medicine (miscellaneous), Critical Care and Intensive Care Medicine, MESH: Tidal Volume, [INFO.INFO-AI]Computer Science [cs]/Artificial Intelligence [cs.AI], User-Computer Interface, 0302 clinical medicine, Tidal volume, MESH: Aged, MESH: Middle Aged, Middle Aged, 3. Good health, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Female, Ventilator Weaning, [INFO.INFO-AI] Computer Science [cs]/Artificial Intelligence [cs.AI], Adult, medicine.medical_specialty, Critical Care, Respiratory rate, Positive pressure, Expert Systems, Pressure support ventilation, 03 medical and health sciences, Artificial Intelligence, Intensive care, Tidal Volume, medicine, MESH: Artificial Intelligence, Humans, MESH: Intensive Care, Intensive care medicine, MESH: User-Computer Interface, Aged, Monitoring, Physiologic, [SDV.IB] Life Sciences [q-bio]/Bioengineering, Mechanical ventilation, MESH: Humans, MESH: Expert Systems, business.industry, MESH: Adult, 030208 emergency & critical care medicine, MESH: Ventilator Weaning, MESH: Male, 030228 respiratory system, Respiratory failure, Personal computer, business, MESH: Female
Abstract: International audience; The procedure for weaning a patient with respiratory insufficiency from mechanical ventilation may be complex and requires expertise obtained by long clinical practice. We designed a knowledge-based system for the management of patients receiving respiratory support and implemented a weaning procedure. The system is intended for patients whose spontaneous respiratory activity is assisted by a Hamilton Veolar ventilator delivering a positive pressure plateau during inspiration (Pressure Support Ventilation mode). Our closed-loop real-time system running on a Personal Computer continuously adapts the assistance provided by the ventilator to the patient's evolution, and indicates when the patient can be withdrawn from the ventilator. Three parameters are used to appreciate the 'respiratory comfort' of the patient: breathing frequency, which we consider the most informative index, tidal volume and end-tidal CO2 pressure. A preliminary study of 19 patients was performed to evaluate the ability of our system to adapt the assistance to the patient's needs, with the main objective of facilitating weaning by gradually lowering the level of assistance. In 10 of these patients, considered as good candidates for weaning on the strength of objective criteria, the system maintained the breathing pattern in a zone of comfort for 95% of the period of assisted ventilation and stated that they were 'weanable'. This was consistent with the clinical evolution of all 10 patients. These results show that such a system can provide effective management for mechanically ventilated patients.
Published: 1992

17. [Refusal of care in the intensive care: how makes decision?]

Author: M, Borel, B, Veber, K, Villette-Baron, S, Hariri, B, Dureuil, C, Hervé, Département d'anesthésie-Réanimation-Samu, CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Laboratoire d'éthique médicale et médecine légale (LEM), Université Paris Descartes - Paris 5 (UPD5), Duchange, Nathalie, Laboratoire d'éthique médicale et médecine légale ( LEM ), and Université Paris Descartes - Paris 5 ( UPD5 )
Subjects: Male, Critical Care, MESH : Male, MESH : Aged, MESH : Prospective Studies, MESH : Intensive Care, Humans, MESH : Female, MESH : Middle Aged, Prospective Studies, MESH: Intensive Care, autonomy, law, MESH: Refusal to Treat, Aged, intensive care, MESH: Aged, MESH: Humans, MESH: Middle Aged, MESH : Humans, unreasonable obstinacy, MESH : Refusal to Treat, non-maleficence, Refusal to Treat, Middle Aged, [SDV.ETH] Life Sciences [q-bio]/Ethics, Refusal, beneficence, justice, MESH: Male, MESH: Prospective Studies, [SDV.ETH]Life Sciences [q-bio]/Ethics, [ SDV.ETH ] Life Sciences [q-bio]/Ethics, Female, MESH: Female
Abstract: Decision-making bringing to an admission or not in intensive care is complex. The aim of this study is to analyze with an ethical point of view the making decision process leading to the refusal and its consequences. It is proposed a setting in prospect through the principles of beneficence, non-maleficience, respect for autonomy, justice, and the Leonetti law.Prospective study in surgical reanimation at the University Hospital of Rouen over 9 months (November 2007-September 2008). Systematic collection for each non-admitted patient of the general characters, the methods of decision making, immediate becoming and within 48 h Constitution of two groups: patients for whom an admission in intensive care could be an unreasonable situation of obstinacy, and patients for whom an admission in reanimation would not be about unreasonable if it occurred.One hundred and fifty situations were analyzed. The potentially unreasonable character of an admission does not involve necessarily a refusal of care in intensive care. The question of the lack of place and equity in the access to the care is real but relative according to the typology of the patients. The research of the respect of the autonomy of the patient is difficult but could be facilitated. The Leonetti law does not appear to be able to be a framework with the situation of refusal of care in intensive care.It is not a question of going towards a systematic admission in intensive care of any patient proposed, but to make sure that so if there is a refusal, it is carried out according to a step ethically acceptable.
Published: 2009

18. Welcome to our intensive care unit, make yourself at home!

Author: Maité Garrouste-Orgeas, Jean Carlet, Haute Autorité de Santé [Saint-Denis La Plaine] (HAS), Réanimation Médico-Chirurgicale, Groupe Hospitalier Paris Saint-Joseph (hpsj), and Vesin, Aurélien
Subjects: MESH: Humans, business.industry, MESH: Patient Education as Topic, Critical Care and Intensive Care Medicine, Intensive care unit, law.invention, MESH: France, MESH: Needs Assessment, Nursing, law, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Intensive care, Critical care nursing, Medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Intensive Care, business, MESH: Family, MESH: Pamphlets, MESH: Professional-Family Relations, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2009

19. [Formal recommendations by the experts. Glycemic control in intensive care unit and during anaesthesia. Société française d'anesthésie et de réanimation. Société de réanimation de langue française]

Author: Ichai, Carole, Léone, Marc, Veber, Benoît, Cariou, Alain, Barnoud, Didier, Annane, Djillali, Bouglé, A., Chioléro, René, Damoisel, Charles, Devos, P., Gunst, J., Halimi, Serge, Jacqueminet, S., Kalfon, Pierre, Lacherade, Jean-Claude, Laudenbach, Vincent, Leverve, Xavier, Losser, Marie-Reine, Ouattara, Alexandre, Payen de La Garanderie, Didier, Preiser, Jean-Charles, Seematter, Gérald, Tappy, Luc, van den Berghe, G., Vanhorebeek, I., Wion-Barbot, Nelly, Service de réanimation médicochirurgicale, Centre Hospitalier Universitaire de Nice (CHU Nice), Société française d'anesthésie et de réanimation (SFAR), SFAR, General ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Société de réanimation de langue française (SRLF), SRLF, Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Service de Réanimation, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP], Service de médecine intensive adulte, Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Diabétologie, Université Joseph Fourier - Grenoble 1 (UJF), Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of General Intensive Care, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Institute of Physiology, Université de Lausanne (UNIL), Neurosciences précliniques, Université de Lausanne = University of Lausanne (UNIL), and Hamant, Sarah
Subjects: Adult, Blood Glucose, MESH: Inflammation, MESH: Diabetes Mellitus, MESH: Hypoglycemia, Critical Care, MESH: Monitoring, Physiologic, MESH: Insulin, Perioperative Care, MESH: Anesthesiology, Postoperative Complications, Anesthesiology, Stress, Physiological, MESH: Postoperative Complications, MESH: Child, MESH: Hypoglycemic Agents, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, Diabetes Mellitus, Humans, Hypoglycemic Agents, Insulin, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, MESH: Intensive Care, MESH: Perioperative Care, Child, Intraoperative Complications, MESH: Stress, Physiological, ComputingMilieux_MISCELLANEOUS, Monitoring, Physiologic, Inflammation, MESH: Cytokines, MESH: Humans, Contraindications, MESH: Adult, Hypoglycemia, MESH: Glucose, MESH: Insulin Resistance, Glucose, Hyperglycemia, MESH: Blood Glucose, MESH: Intraoperative Complications, Cytokines, Insulin Resistance, MESH: Hyperglycemia
Abstract: International audience
Published: 2009

20. Year in review in Intensive Care Medicine, 2008: II. Experimental, acute respiratory failure and ARDS, mechanical ventilation and endotracheal intubation

Author: Jean Chastre, Jordi Mancebo, Duncan MacRae, Daniel De Backer, Marc Bonten, Herwig Gerlach, Haibo Zhang, Giorgio Conti, Giuseppe Citerio, Elie Azoulay, Salvatore Maurizio Maggiore, Jérôme Pugin, François Lemaire, Philipp Metnitz, Massimo Antonelli, Göran Hedenstierna, Alexandre Mebazaa, Jan Wernerman, Johan Groeneveld, Department of Intensive Care and Anesthesiology, Università cattolica del Sacro Cuore [Milano] (Unicatt), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Department of Medical Microbiology Julius Center for Health Sciences and Primary Care, University Medical Center [Utrecht], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Neurointensive Care Unit, Ospedale S. Gerardo, Service des Soins Intensifs, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Department of Anesthesiology, Intensive Care Medicine, and Pain Management, Vivantes-Klinikum Neukoelln, Intensive Care Medicine Unit, Free University Medical Centre, Department of Clinical Physiology, Uppsala University, Pediatric Intensive Care Unit, Royal Brompton Hospital, Hospital de la Santa Creu i Sant Pau, Service d'anesthésie - réanimation, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Department of Anesthesiology and General Intensive Care, University Hospital of Vienna, University Hospital of Geneva, Department of Anesthesiology and Intensive Care Medicine, Karolinska Institutet [Stockholm], Interdepartmental Division of Critical Care Medicine, University of Toronto, Vesin, Aurélien, Intensive care medicine, ICaR - Ischemia and repair, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Antonelli, M, Azoulay, E, Bonten, M, Chastre, J, Citerio, G, Conti, G, De Backer, D, Lemaire, F, Gerlach, H, Groeneveld, J, Hedenstierna, G, Macrae, D, Mancebo, J, Maggiore, S, Mebazaa, A, Metnitz, P, Pugin, J, Wernerman, J, and Zhang, H
Subjects: Resuscitation, ARDS, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Hypoxia-Ischemia, Brain/epidemiology, 0302 clinical medicine, Intubation, Respiratory Insufficiency/*diagnosis/epidemiology/*therapy, Sepsis/epidemiology, MESH: Respiration, Artificial, MESH: Sepsis, ComputingMilieux_MISCELLANEOUS, Respiratory Distress Syndrome, Intensive Care/*methods, ddc:617, Lung Injury, 3. Good health, Reperfusion Injury, Hypoxia-Ischemia, Brain, Acute Disease, MESH: Lung Injury, MESH: Acute Disease, Respiratory Insufficiency, Human, medicine.medical_specialty, Critical Care, Sepsi, Lung injury, Sepsis, 03 medical and health sciences, Intensive care, Anesthesiology, medicine, Intubation, Intratracheal, Humans, MESH: Intensive Care, Intensive care medicine, Lung Injury/epidemiology/therapy, Mechanical ventilation, MESH: Humans, MESH: Intubation, Intratracheal, business.industry, Reperfusion Injury/epidemiology, Intensive Care, Respiratory Distress Syndrome, Adult, Year in Review 2008, 030208 emergency & critical care medicine, medicine.disease, Respiration, Artificial, Intubation, Intratracheal/*methods, 030228 respiratory system, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Respiratory Distress Syndrome, Adult, MESH: Hypoxia-Ischemia, Brain, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Respiratory Distress Syndrome, Adult/epidemiology/physiopathology/*therapy, MESH: Reperfusion Injury, business, Respiration, Artificial/*methods, MESH: Respiratory Insufficiency
Abstract: Year in review in Intensive Care Medicine, 2008 : II. Experimental, acute respiratory failure and ARDS, mechanical ventilation and endotracheal intubation
Published: 2009

21. [Admission of elderly in intensive care: does age affect access to care?]

Author: Borel, Marie, Veber, Benoit, Robillard, F., Rigaud, Jean-Pierre, Dureuil, Bertrand, Hervé, Christian, Département d'anesthésie-Réanimation-Samu, CHU Rouen, Réanimation Polyvalente, Centre hospitalier de Dieppe, Laboratoire d'éthique médicale et médecine légale ( LEM ), Université Paris Descartes - Paris 5 ( UPD5 ), Duchange, Nathalie, Normandie Université (NU)-Normandie Université (NU), Laboratoire d'éthique médicale et médecine légale (LEM), and Université Paris Descartes - Paris 5 (UPD5)
Subjects: MESH : Health Services for the Aged, MESH: Heart Arrest, MESH : Male, Admission, MESH: Health Services for the Aged, elderly, MESH : Intensive Care, MESH : Intraoperative Complications, MESH: Aged, 80 and over, MESH : Middle Aged, MESH : Female, MESH: APACHE, MESH: Intensive Care, MESH : Aged, 80 and over, intensive care, MESH: Middle Aged, MESH: Humans, MESH : Heart Arrest, MESH: Patient Admission, MESH: Questionnaires, MESH : Humans, MESH : Questionnaires, MESH : Patient Admission, [SDV.ETH] Life Sciences [q-bio]/Ethics, MESH: Male, [SDV.ETH]Life Sciences [q-bio]/Ethics, access to the care, age, MESH: Intraoperative Complications, [ SDV.ETH ] Life Sciences [q-bio]/Ethics, MESH: Intensive Care Units, ethic, MESH: Female, MESH : Intensive Care Units, MESH : APACHE
Abstract: International audience; The age does not seem a determining element. It cannot solve the question which is to know if the admission in reanimation is relevant or not for the patient proposed. More than the admission or not of a possibly old subject in reanimation, the problem lies in the resolution with accuracy of the acute dilemma which is the decision-making to admit or refuse a patient whatever it is for the benefit of the person.
Published: 2008

22. Prognosis of acquired hemophilia in older people

Author: Girault, Stéphane, Ly, Kim, Jaccard, Arnaud, Loustaud-Ratti, Véronique, Turlure, Pascal, Julia, Annie, Bordessoule, Dominique, Vidal, Elisabeth, Liozon, Eric, Physiologie Moléculaire de la Réponse Immune et des Lymphoproliférations (PMRIL), Université de Limoges (UNILIM)-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Centre National de la Recherche Scientifique (CNRS), Service d'Hématologie biologique [CHU Limoges], CHU Limoges, Service de Bactériologie, Virologie, Hygiène [CHU Limoges], Biologie moléculaire et cellulaire des microorganismes (EA3175), Université de Limoges (UNILIM)-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Hématologie clinique et thérapie cellulaire [CHU Limoges], Université de Limoges (UNILIM), Service de Médecine Interne [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], and CHU Clermont-Ferrand-CHU Clermont-Ferrand
Subjects: MESH: Aged, MESH: Humans, MESH: Survival Rate, MESH: Retrospective Studies, MESH: Bias (Epidemiology), MESH: Factor VIII, MESH: Hemophilia A, MESH: Male, MESH: Prognosis, MESH: Aged, 80 and over, MESH: Autoantibodies, [SDV.IMM]Life Sciences [q-bio]/Immunology, MESH: Intensive Care, MESH: Female, ComputingMilieux_MISCELLANEOUS, MESH: Partial Thromboplastin Time, MESH: Hemorrhage, MESH: Treatment Outcome
Abstract: International audience
Published: 2008

23. Are daily routine chest radiographs useful in critically ill, mechanically ventilated patients? A randomized study

Author: Christophe Clec’h, Yves Cohen, Frédéric Gonzalez, Jean-Philippe Fosse, Aïcha Hamdi, Lilia Hamza, Philippe Karoubi, François Vincent, Paul Simon, Service de Réanimation Médico-Chirurgicale [Avicenne], Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), and Vesin, Aurélien
Subjects: Male, MESH: Chi-Square Distribution, medicine.medical_treatment, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Surveys and Questionnaires, Prospective Studies, MESH: Respiration, Artificial, Prospective cohort study, MESH: Middle Aged, Middle Aged, Prognosis, Intensive care unit, 3. Good health, MESH: Critical Illness, Female, Radiography, Thoracic, medicine.medical_specialty, Critical Care, Critical Illness, MESH: Prognosis, 03 medical and health sciences, Anesthesiology, Intensive care, medicine, Humans, MESH: Intensive Care, Medical prescription, Intensive care medicine, MESH: Diagnostic Tests, Routine, Mechanical ventilation, Chi-Square Distribution, MESH: Humans, business.industry, Diagnostic Tests, Routine, MESH: Questionnaires, MESH: Radiography, Thoracic, Respiration, Artificial, MESH: Male, MESH: Prospective Studies, 030228 respiratory system, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Emergency medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Chi-squared distribution, MESH: Female
Abstract: International audience; OBJECTIVE: Whether chest radiographs (CXRs) in mechanically ventilated patients should be routinely obtained or only when an abnormality is anticipated remains debated. We aimed to compare the diagnostic, therapeutic and outcome efficacy of a restrictive prescription of CXRs with that of a routine prescription, focusing on delayed diagnoses and treatments potentially related to the restrictive prescription. DESIGN: Randomized controlled trial. SETTING: Intensive care unit of the Avicenne Teaching Hospital, Bobigny, France. PATIENTS AND PARTICIPANTS: All consecutive patients mechanically ventilated for > or = 48h between January and June 2006. INTERVENTIONS: Patients were randomly assigned to have daily routine CXRs (routine prescription group) or clinically indicated CXRs (restrictive prescription group). MEASUREMENTS AND RESULTS: For each CXR, a questionnaire was completed addressing the reason for the CXR, the new findings, and any subsequent therapeutic intervention. The endpoints were the rates of new findings, the rates of new findings that prompted therapeutic intervention, the rate of delayed diagnoses, and mortality. Eighty-four patients were included in the routine prescription group and 81 in the restrictive prescription group. The rates of new findings and the rates of new findings that prompted therapeutic intervention in the restrictive prescription group and in the routine prescription group were 66% vs. 7.2% (p < 0.0001), and 56.4% vs. 5.5% (p < 0.0001) respectively. The rate of delayed diagnoses in the restrictive prescription group was 0.7%. Mortality was similar. CONCLUSIONS: Restrictive use of CXRs in mechanically ventilated patients was associated with better diagnostic and therapeutic efficacies without impairing outcome.
Published: 2008

24. [The organisation of intensive care in a situation of pandemic avian influenza]

Author: Guery, B., Guidet, B., Beloucif, S., Floret, D., Le Gall, C., Montravers, P., Chouaid, C., Jarreau, P.-H., Régnier, B., Service d'urgence et de réanimation pédiatriques [Hôpital Edouard Herriot - HCL], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Guery B, B Guidet, S Beloucif, D Floret, C Le Gall, P Montravers, C Chouaid, PH Jarreau, B Régnier, and Annesi-Maesano, Isabella
Subjects: MESH: Humans, Critical Care, Disease Outbreaks, Birds, MESH: Influenza in Birds, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Influenza in Birds, MESH: Birds, Animals, Humans, MESH: Animals, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Intensive Care, Triage, MESH: Disease Outbreaks, MESH: Triage
Abstract: International audience; The development of an epidemic of avian influenza will have a major impact on the organisation and structure of the facilities for treatment. This paper, the product of collaboration between the six learned societies concerned, analyses the impact of a possible pandemic on the various aspects of management of patients requiring intensive care. It describes the organisation of hospital pathways for flu and non-flu patients with, in particular, the necessary actions in terms of separation of care facilities, the triage of patients and the cancellation of non-urgent activities. It analyses the preconditions necessary for the efficient functioning of intensive care and the predictable limiting factors. It underlines the importance of training of medical and paramedical personnel. Finally, it tackles the specific problems of paediatric intensive care: organisation, capacity for admissions and training.
Published: 2008

25. [Pain management]

Author: Payen, Jean-François, Chanques, Gérald, Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, and Dojat, Michel
Subjects: MESH: Combined Modality Therapy, MESH: Analgesics, Critical Care, Conscious Sedation, Pain, MESH: Patient Education as Topic, Therapeutics, MESH: Pain Measurement, MESH: Disease Management, MESH: Length of Stay, Patient Education as Topic, MESH: Practice Guidelines as Topic, MESH: Hypnotics and Sedatives, Humans, Hypnotics and Sedatives, Pain Management, MESH: Therapeutics, MESH: Intensive Care, MESH: Respiration, Artificial, Infusions, Intravenous, MESH: Infusions, Intravenous, Pain Measurement, Analgesics, MESH: Conscious Sedation, MESH: Humans, MESH: Anesthesia, Local, Disease Management, Length of Stay, MESH: Deep Sedation, Combined Modality Therapy, Respiration, Artificial, MESH: Analgesia, Practice Guidelines as Topic, MESH: Guideline Adherence, Guideline Adherence, MESH: Pain, Analgesia, Deep Sedation, Anesthesia, Local
Abstract: International audience; Analgesia and hypnosis are two separate entities and should result in distinct assessment and management for patients admitted to an intensive care unit (ICU). Those patients are exposed to moderate-severe pain and they are likely to remember pain as one bothersome experience. Any cause of patient discomfort is sought with the priority given to pain and adequate analgesia. Assessing pain must rely upon the use of clinical scoring systems, although these instruments are still underused in ICU. Satisfactory levels of analgesia by continuous infusion of opioids during times without stimulation do not guarantee against pain reactions during procedures (endotracheal suctioning, mobilization, wound care and dressing change, removal of chest tube). The concept of multimodal analgesia should be extended to the ICU since it may reduce the opioids requirements. In order to facilitate systematic pain and sedation assessment and to adjust daily drug dosages accordingly, it appears crucial to promote educational programs and elaboration of protocols/guidelines in ICU. Protocols/guidelines may help caregivers to rationally use sedatives and opioids and possibly reduce mechanical ventilation and ICU length of stay.
Published: 2008

26. Burnout syndrome in critical care nursing staff

Author: Nancy Kentish-Barnes, Jean-Francçois Timsit, Elie Azoulay, Sylvie Chevret, Frédéric Pochard, Laurent Papazian, Marie Cécile Poncet, Philippe Toullic, Benoît Schlemmer, Service de réanimation médicale, Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM] (DRIS), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Medical ICU, CHU Grenoble-Hôpital Michallon, Groupe de Recherche Sur Le Cancer du Poumon : Bases Moléculaires de la Progression Tumorale, Dépistage et Thérapie Génique, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale (INSERM), Psychiatry Department and Clinics for Adolescent Medicine, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5), Vesin, Aurélien, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM] ( DRIS ), Aix Marseille Université ( AMU ) -Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital Nord [CHU - APHM], Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale ( INSERM ), and CHU Cochin [AP-HP]-Université Paris Descartes - Paris 5 ( UPD5 )
Subjects: Male, MESH : Prevalence, Burnout, Critical Care and Intensive Care Medicine, MESH : Intensive Care, law.invention, MESH: Specialties, Nursing, 0302 clinical medicine, Risk Factors, law, MESH: Risk Factors, Surveys and Questionnaires, Health care, Prevalence, Medicine, MESH : Female, 030212 general & internal medicine, Burnout, Professional, Specialties, Nursing, MESH : Personnel Administration, Hospital, MESH : Specialties, Nursing, Questionnaire, MESH : Questionnaires, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Adult, Intensive care unit, MESH : Risk Factors, humanities, 3. Good health, Female, France, Adult, Pulmonary and Respiratory Medicine, Critical Care, MESH : Male, Occupational burnout, 03 medical and health sciences, Nursing, Critical care nursing, Intensive care, MESH : Burnout, Professional, MESH: Burnout, Professional, Humans, MESH: Intensive Care, MESH : France, MESH: Prevalence, Personnel Administration, Hospital, MESH: Humans, business.industry, MESH: Questionnaires, MESH : Humans, 030208 emergency & critical care medicine, MESH: Adult, Odds ratio, MESH: Male, MESH: Personnel Administration, Hospital, MESH: France, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female
Abstract: International audience; RATIONALE: Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The intensive care unit (ICU) is a highly stressful environment. Little is known about BOS in critical care nursing staff. OBJECTIVES: To identify determinants of BOS in critical care nurses. METHODS: We conducted a questionnaire survey in France. Among 278 ICUs contacted for the study, 165 (59.4%) included 2,525 nursing staff members, of whom 2,392 returned questionnaires with complete Maslach Burnout Inventory data. MEASUREMENTS AND MAIN RESULTS: Of the 2,392 respondents (82% female), 80% were nurses, 15% nursing assistants, and 5% head nurses. Severe BOS-related symptoms were identified in 790 (33%) respondents. By multivariate analysis, four domains were associated with severe BOS: (1) personal characteristics, such as age (odds ratio [OR], 0.97/yr; confidence interval [CI], 0.96-0.99; p=0.0008); (2) organizational factors, such as ability to choose days off (OR, 0.69; CI, 0.52-0.91; p=0.009) or participation in an ICU research group (OR, 0.74; CI, 0.56-0.97; p=0.03); (3) quality of working relations (1-10 scale), such as conflicts with patients (OR, 1.96; CI, 1.16-1.30; p=0.01), relationship with head nurse (OR, 0.92/point; CI, 0.86-0.98; p=0.02) or physicians (OR, 0.81; CI, 0.74-0.87; p=0.0001); and (4) end-of-life related factors, such as caring for a dying patient (OR, 1.39; CI, 1.04-1.85; p=0.02), and number of decisions to forego life-sustaining treatments in the last week (OR, 1.14; CI, 1.01-1.29; p=0.04). CONCLUSION: One-third of ICU nursing staff had severe BOS. Areas for improvement identified in our study include conflict prevention, participation in ICU research groups, and better management of end-of-life care. Interventional studies are needed to investigate these potentially preventive strategies.
Published: 2007

27. High level of burnout in intensivists: prevalence and associated factors

Author: Elie Azoulay, Nathalie Embriaco, Karine Barrau, Laurent Papazian, Nancy Kentish, Anderson Loundou, Frédéric Pochard, Medical Intensive Care Unit, Université de la Méditerranée - Aix-Marseille 2-Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Santé Publique et maladies Chroniques : Qualité de vie Concepts, Usages et Limites, Déterminants (SPMC), Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), Département de Sociologie, Université Bordeaux Segalen - Bordeaux 2, Maison de Solenn [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Vesin, Aurélien
Subjects: Male, health care facilities, manpower, and services, Burnout, Critical Care and Intensive Care Medicine, MESH: Occupational Exposure, 0302 clinical medicine, MESH: Health Surveys, Risk Factors, MESH: Risk Factors, Prevalence, Medicine, 030212 general & internal medicine, Burnout, Professional, Response rate (survey), MESH: Middle Aged, Middle Aged, Occupational Diseases, Female, France, Pulmonary and Respiratory Medicine, Adult, MESH: Occupational Diseases, medicine.medical_specialty, Critical Care, Health Personnel, education, Intensivist, Occupational burnout, 03 medical and health sciences, Nursing, Intensive care, Occupational Exposure, Severity of illness, MESH: Burnout, Professional, Humans, MESH: Intensive Care, MESH: Prevalence, MESH: Humans, business.industry, Stressor, 030208 emergency & critical care medicine, MESH: Adult, Odds ratio, Health Surveys, MESH: Male, MESH: France, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Family medicine, MESH: Health Personnel, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female
Abstract: International audience; RATIONALE: Professional burnout is a psychological syndrome arising in response to chronic interpersonal stressors on the job. There is the perception that intensivists are particularly exposed to stress because lives are literally in their hands. OBJECTIVE: To evaluate the prevalence and associated factors (patients or organization) of burnout among physicians working in intensive care units (ICUs) (including interns, residents, fellows, and attending physicians). METHODS: A 1-day national survey was conducted in adult ICUs in French public hospitals. MEASUREMENTS: The level of burnout was evaluated on the basis of the Maslach Burnout Inventory (MBI). MAIN RESULTS: A total of 189 ICUs participated and 978 surveys were returned (82.3% response rate). A high level of burnout was identified in 46.5% of the respondents. Ordinal logistic regression showed that female sex (odds ratio, 1.58; 95% confidence interval, 1.09 to 2.30) was independently associated with a higher MBI score. Whereas no factor related to the severity of illness of patients was retained by the model, organizational factors were strongly associated with a higher MBI score. Workload (the number of night shifts per month, a long period of time from the last nonworking week, night shift the day before the survey) and impaired relationships (such as conflict with another colleague intensivist, and/or with a nurse) were the variables independently associated with a higher MBI score. In contrast, the quality of the relationships with chief nurses and nurses was associated with a lower MBI score. CONCLUSIONS: Approximately one-half of the intensivists presented a high level of burnout. Organizational factors, but not factors related to the patients, appeared to be associated with burnout.
Published: 2007

28. Year in Review in Intensive Care Medicine, 2006. III. Circulation, ethics, cancer, outcome, education, nutrition, and pediatric and neonatal critical care

Author: Elie Azoulay, Peter Radermacher, Johan Groeneveld, Massimo Antonelli, Michael R. Pinsky, Daniel De Backer, Laurent Brochard, Herwig Gerlach, Christian Richard, Philipp Metnitz, Christian Brun-Buisson, Peter J. D. Andrews, Jean-Yves Fagon, Jérôme Pugin, Jordi Mancebo, Stefano Nava, Geoffrey J. Dobb, Duncan Macrae, Intensive Care Medicine Unit, Western General Hospital, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Department of Intensive Care and Anesthesiology, Università cattolica del Sacro Cuore [Milano] (Unicatt), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Fonctions Cellulaires et Moleculaires de l'Appareil Respiratoire et des Vaisseaux, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service des Soins Intensifs, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Royal Perth Hospital, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Department of Anesthesiology, Intensive Care Medicine, and Pain Management, Vivantes-Klinikum Neukoelln, VUmc, Pediatric Intensive Care Unit, Royal Brompton Hospital, Hospital de la Santa Creu i Sant Pau, Department of Anesthesiology and General Intensive Care, University Hospital of Vienna, Fondazione S. Maugeri, University Hospital of Geneva, University of Pittsburgh Medical Center [Pittsburgh, PA, États-Unis] (UPMC), Department of Anesthesia, Universitätsklinikum Ulm - University Hospital of Ulm, Intensive Care Unit, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), and Vesin, Aurélien
Subjects: MESH: Nutritional Support, medicine.medical_specialty, Resuscitation, Critical Care, Pain medicine, Intensive Care Units, Pediatric, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, MESH: Intensive Care Units, Pediatric, law, Intensive Care Units, Neonatal, Neoplasms, Anesthesiology, Intensive care, MESH: Child, MESH: Microcirculation, medicine, Humans, MESH: Neoplasms, MESH: Intensive Care, General hospital, Child, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, MESH: Humans, Education, Medical, Nutritional Support, business.industry, Microcirculation, Year in review, MESH: Specialties, Medical, MESH: Infant, Newborn, Infant, Newborn, Medical school, 030208 emergency & critical care medicine, Intensive care unit, 3. Good health, Intensive Care Units, 030228 respiratory system, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Medicine, MESH: Intensive Care Units, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Intensive Care Units, Neonatal, Specialization
Abstract: Received: 22 January 2007Accepted: 22 January 2007Published online: 14 February 2007© Springer-Verlag 2007This review intends tosummarize all articlespublished in Intensive Care Medicine in2006, grouped by speciﬁc topicsP. AndrewsWestern General Hospital, Intensive CareMedicine Unit,Edinburgh, UKE. AzoulaySaint Louis Hospital, Intensive CareMedicine Unit,Paris, FranceM. AntonelliUniversita Cattolica del Sacre Cuore,Department of Intensive Care andAnesthesiology,Rome, ItalyL. Brochard (✉)AP-HP, Hopital Henri Mondor, UniversiteParis 12, Reanimation Medicale, INSERMU 651,94000 Creteil, Francee-mail: laurent.brochard@hmn.aphp.frTel.: +33-1-49812545Fax: +33-1-42079943C. Brun-BuissonAP-HP, Hopital Henri Mondor, UniversiteParis 12, Reanimation Medicale,Creteil, FranceD. De BackerErasme Hospital, Service des SoinsIntensifs,Brussels, BelgiumG. DobbRoyal Perth Hospital, Intensive CareMedicine Unit,Perth, AustraliaJ.-Y. FagonEuropean Georges Pompidou Hospital,Intensive Care Medicine Unit,H. GerlachVivantes-Klinikum Neukoelln, Departmentof Anesthesiology,Berlin, GermanyJ. GroeneveldVUMC, Intensive Care Medicine Unit,Amsterdam, The NetherlandsD. MacraeRoyal Brompton Hospital, PediatricIntensive Care Unit,London, UKJ. ManceboHospital Sant Pau, Intensive Care MedicineUnit,Barcelona, SpainP. MetnitzUniversity Hospital of Vienna, Departmentof Anesthesia and General Intensive CareMedicine,Vienna, AustriaS. NavaFondazione S. Maugeri, Intensive CareMedicine Unit,Pavia, ItalyJ. PuginUniversity Hospital of Geneva, IntensiveCare Medicine Unit,Geneva, SwitzerlandM. PinskyUniversity of Pittsburgh Medical Center,Intensive Care Medicine Unit,Pittsburgh Pennsylvania, USAP. RadermacherUniversity Medical School of Ulm,Department of Anesthesia,Ulm, GermanyC. RichardUniversity Hospital of Le Kremlin-Bicetre,Intensive Care Unit,Le Kremlin-Bicetre, France
Published: 2007

29. Year in review in Intensive Care Medicine, 2006. II. Infections and sepsis, haemodynamics, elderly, invasive and noninvasive mechanical ventilation, weaning, ARDS

Author: Christian Richard, Philipp Metnitz, Elie Azoulay, Daniel De Backer, Herwig Gerlach, Laurent Brochard, Peter J. D. Andrews, Geoffrey J. Dobb, Jérôme Pugin, Jordi Mancebo, Massimo Antonelli, Christian Brun-Buisson, Jean-Yves Fagon, Stefano Nava, Johan Groeneveld, Duncan Macrae, Michael R. Pinsky, Peter Radermacher, Intensive Care Medicine Unit, Western General Hospital, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Department of Intensive Care and Anesthesiology, Università cattolica del Sacro Cuore [Milano] (Unicatt), Fonctions Cellulaires et Moleculaires de l'Appareil Respiratoire et des Vaisseaux, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service des Soins Intensifs, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Royal Perth Hospital, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Department of Anesthesiology, Intensive Care Medicine, and Pain Management, Vivantes-Klinikum Neukoelln, VUmc, Pediatric Intensive Care Unit, Royal Brompton Hospital, Hospital de la Santa Creu i Sant Pau, Department of Anesthesiology and General Intensive Care, University Hospital of Vienna, Fondazione S. Maugeri, University Hospital of Geneva, University of Pittsburgh Medical Center [Pittsburgh, PA, États-Unis] (UPMC), Department of Anesthesia, Universitätsklinikum Ulm - University Hospital of Ulm, Intensive Care Unit, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, and Vesin, Aurélien
Subjects: ARDS, MESH: Heart Arrest, medicine.medical_treatment, Respiratory Tract Diseases, Hemodynamics, MESH: Geriatrics, Critical Care and Intensive Care Medicine, Severe Acute Respiratory Syndrome, 0302 clinical medicine, MESH: Sepsis, ComputingMilieux_MISCELLANEOUS, MESH: Aged, Respiratory Distress Syndrome, Pulmonary Arterial Hypertension, Year in review, Acute Respiratory Distress Syndrome Patient, 3. Good health, MESH: Communicable Diseases, Ventilator Weaning, medicine.medical_specialty, Critical Care, Pain medicine, Communicable Diseases, Sepsis, 03 medical and health sciences, Anesthesiology, medicine, Weaning, Humans, MESH: Intensive Care, Intensive care medicine, Intensive Care Unit Patient, Medical Emergency Team, Aged, Mechanical ventilation, MESH: Humans, business.industry, 030208 emergency & critical care medicine, MESH: Ventilator Weaning, medicine.disease, Heart Arrest, Year in Review 2006, 030228 respiratory system, Geriatrics, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Respiratory Distress Syndrome, Adult, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Respiratory Tract Diseases, business
Abstract: This review summarizes all articles published in Intensive Care Medicine in 2006, grouped by specific topic.
Published: 2007

30. Tracheostomy does not improve the outcome of patients requiring prolonged mechanical ventilation: a propensity analysis

Author: Arnaud de Lassence, Samir Jamali, Yves Cohen, Elie Azoulay, Maité Garrouste-Orgeas, Dany Toledano, Christophe Adrie, Isabelle Zaccaria, Christophe Clec’h, François Vincent, Corinne Alberti, Jean-François Timsit, Service de Réanimation Médico-Chirurgicale [Avicenne], Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de bactériologie, virologie, parasitologie et hygiène, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Unité d'épidémiologie clinique, Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'enzymologie et biochimie structurales (LEBS), Centre National de la Recherche Scientifique (CNRS), Medical-Surgical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Hôpital Saint Joseph, Service de soins intensifs, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Louis Mourier - AP-HP [Colombes], Hôpital de Gonesse, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Service de réanimation chirurgicale [Béclère], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Institut de Biologie du Développement de Marseille (IBDM), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Institut de Physique du Globe de Paris (IPGP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut national des sciences de l'Univers (INSU - CNRS)-IPG PARIS-Université Paris Diderot - Paris 7 (UPD7)-Université de La Réunion (UR)-Centre National de la Recherche Scientifique (CNRS), Groupe de Recherche Sur Le Cancer du Poumon : Bases Moléculaires de la Progression Tumorale, Dépistage et Thérapie Génique, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de bactériologie, virologie, parasitologie et hygiène [CHU Necker], Institut national des sciences de l'Univers (INSU - CNRS)-Université Paris Diderot - Paris 7 (UPD7)-Université de La Réunion (UR)-Institut de Physique du Globe de Paris (IPG Paris)-Centre National de la Recherche Scientifique (CNRS), Vesin, Aurélien, Université Paris 13 ( UP13 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Avicenne, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire d'enzymologie et biochimie structurales ( LEBS ), Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Descartes - Paris 5 ( UPD5 ) -Hôpital Saint Joseph, Assistance publique - Hôpitaux de Paris (AP-HP)-Hopital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-Hôpital Albert Michallon, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Antoine Béclère, Institut de Biologie du Développement de Marseille ( IBDM ), Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Institut de Physique du Globe de Paris ( IPGP ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -IPG PARIS-Université Paris Diderot - Paris 7 ( UPD7 ) -Université de la Réunion ( UR ) -Centre National de la Recherche Scientifique ( CNRS ), and Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale ( INSERM )
Subjects: Male, Time Factors, medicine.medical_treatment, MESH : Prospective Studies, MESH : Aged, MESH: Logistic Models, MESH : Critical Illness, Critical Care and Intensive Care Medicine, Logistic regression, MESH : Intensive Care, law.invention, MESH: Cause of Death, MESH : Tracheostomy, MESH: Selection Bias, Tracheostomy, 0302 clinical medicine, MESH: Tracheostomy, Risk Factors, law, MESH: Risk Factors, Cause of Death, MESH : Female, Hospital Mortality, Prospective Studies, MESH: APACHE, MESH: Respiration, Artificial, APACHE, MESH: Treatment Outcome, MESH: Aged, MESH: Middle Aged, Confounding Factors, Epidemiologic, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Selection Bias, Middle Aged, MESH : Adult, MESH : Risk Factors, Intensive care unit, Treatment Outcome, MESH: Survival Analysis, MESH: Critical Illness, Female, France, MESH : APACHE, MESH : Time Factors, Cohort study, Adult, medicine.medical_specialty, Critical Care, Critical Illness, MESH : Male, MESH : Treatment Outcome, MESH: Multivariate Analysis, MESH : Hospital Mortality, 03 medical and health sciences, Intensive care, medicine, Humans, MESH : Middle Aged, MESH: Patient Selection, MESH: Intensive Care, MESH: Hospital Mortality, MESH : Respiration, Artificial, MESH : Confounding Factors (Epidemiology), MESH : France, Selection Bias, Aged, MESH : Cause of Death, Mechanical ventilation, MESH: Humans, business.industry, Patient Selection, MESH : Humans, MESH: Time Factors, MESH: Confounding Factors (Epidemiology), MESH : Multivariate Analysis, 030208 emergency & critical care medicine, MESH: Adult, Odds ratio, MESH : Patient Selection, Respiration, Artificial, Survival Analysis, Confidence interval, MESH: Male, MESH: Prospective Studies, Surgery, MESH: France, Logistic Models, 030228 respiratory system, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Multivariate Analysis, Propensity score matching, Emergency medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Survival Analysis, business, MESH: Female, MESH : Logistic Models
Abstract: International audience; OBJECTIVE: To examine the association between the performance of a tracheostomy and intensive care unit and postintensive care unit mortality, controlling for treatment selection bias and confounding variables. DESIGN: Prospective, observational, cohort study. SETTING: Twelve French medical or surgical intensive care units. PATIENTS: Unselected patients requiring mechanical ventilation for > or =48 hrs enrolled between 1997 and 2004. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two models of propensity scores for tracheostomy were built using multivariate logistic regression. After matching on these propensity scores, the association of tracheostomy with outcomes was assessed using multivariate conditional logistic regression. Results obtained with the two models were compared. Of the 2,186 patients included, 177 (8.1%) received a tracheostomy. Both models led to similar results. Tracheostomy did not improve intensive care unit survival (model 1: odds ratio, 0.94; 95% confidence interval, 0.63-1.39; p = .74; model 2: odds ratio, 1.12; 95% confidence interval, 0.75-1.67; p = .59). There was no difference whether tracheostomy was performed early (within 7 days of ventilation) or late (after 7 days of ventilation). In patients discharged free from mechanical ventilation, tracheostomy was associated with increased postintensive care unit mortality when the tracheostomy tube was left in place (model 1: odds ratio, 3.73; 95% confidence interval, 1.41-9.83; p = .008; model 2: odds ratio, 4.63; 95% confidence interval, 1.68-12.72, p = .003). CONCLUSIONS: Tracheostomy does not seem to reduce intensive care unit mortality when performed in unselected patients but may represent a burden after intensive care unit discharge.
Published: 2007

31. Increasing incidence of severe Epstein-Barr virus-related infectious mononucleosis: surveillance study

Author: Jean Marc Chapplain, R. Thomas, Arnaud Person, Pierre Tattevin, Cédric Arvieux, Sophie Minjolle, Yves Le Tulzo, Christian Michelet, Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Unité de Rétrovirologie, Hôpital Pontchaillou, Signalisation et Réponses aux Agents Infectieux et Chimiques (SeRAIC), Université de Rennes (UR), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)
Subjects: Male, Herpesvirus 4, Human, Pediatrics, Time Factors, Mononucleosis, medicine.disease_cause, 0302 clinical medicine, hemic and lymphatic diseases, Gammaherpesvirinae, 030212 general & internal medicine, 0303 health sciences, biology, Incidence (epidemiology), Age Factors, 3. Good health, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Population Surveillance, Female, France, Viral disease, Adult, Microbiology (medical), medicine.medical_specialty, Adolescent, Critical Care, Virus, Herpesviridae, MESH: Population Surveillance, 03 medical and health sciences, MESH: Infectious Mononucleosis, Virology, Intensive care, medicine, Humans, Infectious Mononucleosis, MESH: Intensive Care, MESH: Adolescent, MESH: Age Factors, MESH: Humans, 030306 microbiology, business.industry, MESH: Time Factors, MESH: Adult, MESH: Herpesvirus 4, Human, medicine.disease, biology.organism_classification, Epstein–Barr virus, MESH: Male, MESH: France, Immunology, business, MESH: Female
Abstract: Older patients are more susceptible to severe Epstein-Barr virus (EBV)-related infectious mononucleosis (IM). This condition may increase in industrialized countries where primary EBV infection occurs later in life. Between 1990 and 2004, 38 patients were admitted to our department with EBV-related IM. Two patients died. The annual incidence increased significantly ( r = 0.623; P = 0.013).
Published: 2006

32. Determinants of mortality for adults with cystic fibrosis admitted in Intensive Care Unit: a multicenter study

Author: Jean-Paul Mira, Dany Jamal, Joelle Texereau, Daniel Dusser, Pierre-Régis Burgel, Antoine Rabbat, Gerald Choukroun, Philippe Loirat, Jean-Luc Diehl, Dominique Hubert, Alexandre Duguet, Joël Coste, Antoine Parrot, Service de physiologie et explorations fonctionelles [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Cochin (UMR_S567 / UMR 8104), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de réanimation médicale polyvalente [CHU Cochin], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de pneumologie [CHU Cochin], Service de réanimation médicale [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service de Pneumologie – Réanimation Médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôtel-Dieu, Service de Réanimation Médicale, Hôpital Foch [Suresnes], Laboratoire d'Acoustique de l'Université du Mans (LAUM), Centre National de la Recherche Scientifique (CNRS)-Le Mans Université (UM), Service d'anesthésie et réanimation [CHU Tenon], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Pneumologie – Réanimation Médicale [CHU Pitié-Salpêtrière], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Service d'informatique médicale [CHU Cochin], Le Mans Université (UM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Autard, Delphine, CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), Institut Cochin ( UMR_S567 / UMR 8104 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôtel-Dieu, Laboratoire d'acoustique de l'université du Mans ( LAUM ), Le Mans Université ( UM ) -Centre National de la Recherche Scientifique ( CNRS ), Service d'anesthésie et réanimation, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Tenon [APHP], and Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP]
Subjects: Male, Exacerbation, Cystic Fibrosis, MESH: Risk Assessment, Cystic fibrosis, MESH : Intensive Care, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, law.invention, MESH: Proportional Hazards Models, 0302 clinical medicine, law, Risk Factors, MESH: Risk Factors, Outcome Assessment, Health Care, MESH : Female, 030212 general & internal medicine, MESH : Risk Assessment, MESH: Respiration, Artificial, MESH : Prognosis, MESH : Adult, MESH : Survival Rate, Prognosis, Intensive care unit, MESH : Risk Factors, 3. Good health, Survival Rate, Intensive Care Units, medicine.anatomical_structure, MESH: Survival Analysis, Female, France, MESH : Intensive Care Units, Pulmonary and Respiratory Medicine, Adult, medicine.medical_specialty, MESH : Outcome Assessment (Health Care), Critical Care, MESH: Cystic Fibrosis, MESH: Survival Rate, MESH : Male, Risk Assessment, MESH: Prognosis, 03 medical and health sciences, Intensive care, MESH : Cystic Fibrosis, medicine, Humans, MESH: Intensive Care, MESH : Respiration, Artificial, Intensive care medicine, MESH : France, Survival rate, MESH: Outcome Assessment (Health Care), Survival analysis, Proportional Hazards Models, lcsh:RC705-779, Lung, MESH: Humans, Proportional hazards model, business.industry, Research, MESH : Humans, MESH: Adult, lcsh:Diseases of the respiratory system, medicine.disease, MESH : Proportional Hazards Models, Respiration, Artificial, Survival Analysis, MESH: Male, MESH: France, 030228 respiratory system, Emergency medicine, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, MESH: Intensive Care Units, MESH : Survival Analysis, business, MESH: Female, [ SDV.MHEP.PSR ] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract
Abstract: Background Intensive care unit (ICU) admission of adults with cystic fibrosis (CF) is controversial because of poor outcome. This appraisal needs re-evaluation following recent changes in both CF management and ICU daily practice. Objectives were to determine long-term outcome of adults with CF admitted in ICU and to identify prognostic factors. Methods Retrospective multicenter study of 60 ICU hospitalizations for 42 adult CF patients admitted between 2000 and 2003. Reason for ICU admission, ventilatory support provided and one-year survival were recorded. Multiple logistic analysis was used to determine predictors of mortality. Results Prior to ICU admission, all patients (mean age 28.1 ± 8 yr) had a severe lung disease (mean FEV1 28 ± 12% predicted; mean PaCO2 47 ± 9 mmHg). Main reason for ICU hospitalization was pulmonary infective exacerbation (40/60). At admission, noninvasive ventilation was used in 57% of cases and was successful in 67% of patients. Endotracheal intubation was implemented in 19 episodes. Overall ICU mortality rate was 14%. One year after ICU discharge, 10 of the 28 survivors have been lung transplanted. Among recognized markers of CF disease severity, only the annual FEV1 loss was associated with a poor outcome (HR = 1.47 [1.18–1.85], p = 0.001). SAPSII (HR = 1.08 [1.03–1.12], p < 0.001) and endotracheal intubation (HR = 16.60 [4.35–63.34], p < 0.001) were identified as strong independent predictors of mortality. Conclusion Despite advanced lung disease, adult patients with CF admitted in ICU have high survival rate. Endotracheal intubation is associated with a poor prognosis and should be used as the last alternative. Although efforts have to be made in selecting patients with CF likely to benefit from ICU resources, ICU admission of these patients should be considered.
Published: 2006

33. Vivid dreams, hallucinations, psychosis and REM sleep in Guillain-Barré syndrome

Author: Xavier Drouot, Jean-Claude Willer, V. Cochen, C. Pierrot-Deseiligny, Sophie Demeret, T. Similowski, V. Gourlet, M. L. Neulat, Francis Bolgert, Stéphane Moutereau, I. Arnulf, J.P. Derenne, Service de neurologie [Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Neurologie et thérapeutique expérimentale, Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR70-Université Pierre et Marie Curie - Paris 6 (UPMC), Fédération des Pathologies du Sommeil, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Pneumologie – Réanimation Médicale [CHU Pitié-Salpêtrière], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Service de neurologie 1 [CHU Pitié-Salpétrière], Neuroépidémiologie, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de physiologie, explorations fonctionnelles [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Physiologie et physiopathologie de la motricité chez l'homme, Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR70-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Service de neurologie [CHU Saint-Antoine], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Male, MESH: Facial Expression, Hallucinations, Neurological disorder, Polysomnography, MESH: Neuropeptides, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, Prospective Studies, 030212 general & internal medicine, MESH: Aged, Sleep disorder, MESH: Middle Aged, medicine.diagnostic_test, MESH: Hallucinations, Intracellular Signaling Peptides and Proteins, Middle Aged, MESH: Case-Control Studies, 3. Good health, Facial Expression, Anesthesia, Female, medicine.symptom, Sleep onset, Psychology, Adult, medicine.medical_specialty, Psychosis, Adolescent, Critical Care, Rapid eye movement sleep, Sleep, REM, Guillain-Barre Syndrome, Delusions, MESH: Multivariate Analysis, MESH: Psychotic Disorders, 03 medical and health sciences, MESH: Intracellular Signaling Peptides and Proteins, medicine, Humans, MESH: Intensive Care, Psychiatry, Aged, MESH: Adolescent, MESH: Delusions, MESH: Guillain-Barre Syndrome, Orexins, MESH: Humans, [SDV.BA.MVSA]Life Sciences [q-bio]/Animal biology/Veterinary medicine and animal Health, Neuropeptides, MESH: Adult, medicine.disease, MESH: Sleep, REM, MESH: Male, MESH: Prospective Studies, Psychotic Disorders, Case-Control Studies, Multivariate Analysis, Delirium, Neurology (clinical), MESH: Female, 030217 neurology & neurosurgery, Narcolepsy
Abstract: International audience; We conducted a prospective controlled study of the clinical and biological determinants of the mental status abnormalities in 139 patients with Guillain-Barr?yndrome (GBS) and 55 patients without GBS placed in the intensive care unit (ICU controls). There were mental status changes in 31% of GBS patients and in 16% of controls (odds ratio = 2.3; P = 0.04). In GBS patients, they included vivid dreams (19%), illusions (30%, including an illusory body tilt), hallucinations (60%, mainly visual) and delusions (70%, mostly paranoid). They appeared a median 9 days after disease onset (range 1-40 days, during the progression or the plateau of the disease), and lasted a median 8 days. Seven (16%) patients experienced the symptoms before their admission to the ICU. Hallucinations were frequently hypnagogic, occurring as soon as the patients closed their eyes. Autonomic dysfunction, assisted ventilation and high CSF protein levels were significant risk factors for abnormal mental status in GBS patients. CSF hypocretin-1 (a hypothalamic neuropeptide deficient in narcolepsy) levels, measured in 20 patients, were lower in GBS patients with hallucinations (555 +/- 132 pg/ml) than in those without (664 +/- 71 pg/ml, P = 0.03). Since the mental status abnormalities had dream-like aspects, we examined their association with rapid eye movement sleep (REM sleep) using continuous sleep monitoring in 13 GBS patients with (n = 7) and without (n = 6) hallucinations and 6 tetraplegic ICU controls without hallucinations. Although sleep was short and fragmented in all groups, REM sleep latency was shorter in GBS patients with hallucinations (56 +/- 115 min) than in GBS patients without hallucinations (153 +/- 130 min) and in controls (207 +/- 179 min, P < 0.05). In addition, sleep structure was highly abnormal in hallucinators, with sleep onset in REM sleep periods (83%), abnormal eye movements during non-REM sleep (57%), high percentages of REM sleep without atonia (92 +/- 22%), REM sleep behaviour disorders and autonomic dysfunction (100%), reminiscent of a status dissociatus. The sleep abnormalities, that were almost absent in non-hallucinated GBS patients, were not exclusively related to ICU conditions, since they also appeared out of ICU, and were reversible, disappearing when the mental status abnormalities vanished while the patients were still in ICU. In conclusion, the mental status abnormalities experienced by GBS patients are different from the ICU delirium, are strongly associated with autonomic dysfunction, severe forms of the disease and possibly with a transitory hypocretin-1 transmission decrease. Sleep studies suggest that mental status abnormalities are wakeful dreams caused by a sleep and dream-associated disorder (status dissociatus).
Published: 2005

34. Lactate in the intensive care unit: pyromaniac, sentinel or fireman?

Author: Leverve, Xavier M, Bioénergétique fondamentale et appliquée, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Hamant, Sarah
Subjects: Acid-Base Equilibrium, MESH: Humans, Critical Care, Critical Illness, MESH: Energy Metabolism, MESH: Biological Markers, Severity of Illness Index, Reference Values, Commentary, Disease Progression, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, Humans, MESH: Lactic Acid, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, Lactic Acid, MESH: Intensive Care, MESH: Oxygen Consumption, Energy Metabolism, Hypoxia, Biomarkers, MESH: Acid-Base Imbalance
Abstract: Lactate measurement in the critically ill has been traditionally used to stratify patients with poor outcome. However, plasma lactate levels are the result of a finely tuned interplay of factors that affect the balance between its production and its clearance. When the oxygen supply does not match its consumption, organisms such as man who are forced to produce ATP for their integrity adapt in many different ways up to the point when energy failure occurs. Lactate, being part of the adaptive response, may then be used to assess the severity of the supply/demand imbalance. In such a scenario, the time to intervention becomes relevant: early and effective treatment may allow the cell to revert to a normal state, as long as the oxygen machinery (i.e. mitochondria) is intact. Conversely, once the mitochondria are deranged, energy failure occurs even in the presence of normoxia. The lactate increase in critically ill patients may therefore be viewed as an early marker of a potentially reversible state.
Published: 2005

35. On-line segmentation algorithm for continuously monitored data in intensive care units

Author: Guillaume Becq, S. Charbonnier, Loïc Biot, Laboratoire d'automatique de Grenoble (LAG), and Université Joseph Fourier - Grenoble 1 (UJF)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique de Grenoble (INPG)
Subjects: Safety Management, Critical Care, Computer science, Biomedical Engineering, MESH: Monitoring, Physiologic, MESH: Algorithms, Expert Systems, 02 engineering and technology, MESH: Signal Processing, Computer-Assisted, MESH: Risk Assessment, Signal, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Ordinate, Line segment, 030202 anesthesiology, Intensive care, 0202 electrical engineering, electronic engineering, information engineering, Humans, Segmentation, MESH: Intensive Care, Diagnosis, Computer-Assisted, Monitoring, Physiologic, MESH: Humans, MESH: Expert Systems, MESH: Safety, MESH: Diagnosis, Computer-Assisted, Signal Processing, Computer-Assisted, Term (time), Systems Integration, Intensive Care Units, MESH: Artifacts, MESH: Safety Management, 020201 artificial intelligence & image processing, MESH: Intensive Care Units, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Line (text file), MESH: Systems Integration, Safety, Artifacts, Algorithm, Algorithms
Abstract: International audience; An on-line segmentation algorithm is presented in this paper. It is developed to preprocess data describing the patient's state, sampled at high frequencies in intensive care units, with a further purpose of alarm filtering. The algorithm splits the signal monitored into line segments--continuous or discontinuous--of various lengths and determines on-line when a new segment must be calculated. The delay of detection of a new line segment depends on the importance of the change: the more important the change, the quicker the detection. The linear segments are a correct approximation of the structure of the signal. They emphasise steady-states, level changes and trends occurring on the data. The information returned by the algorithm, which is the time at which the segment begins, its ordinate and its slope, is sufficient to completely reconstruct the filtered signal. This makes the algorithm an interesting tool to provide a processed time history record of the monitored variable. It can also be used to extract on-line information on the signal, such as its trend, in the short or long term.
Published: 2004

36. Position paper of the ESICM Working Group on Nutrition and Metabolism. Metabolic basis of nutrition in intensive care unit patients: ten critical questions

Author: Biolo, Gianni, Grimble, George, Preiser, Jean-Charles, Leverve, Xavier, Jolliet, Philippe, Planas, Mercedes, Roth, Erich, Wernerman, Jan, Pichard, Claude, Working Group On Nutrition And Metabolism, European Society of Intensive Care Medicine, Istituto di Clinico Medica, University of Trieste, Roehampton Institute London, Whitelands College, Service de réanimation, CHU de Liège, Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Medical Intensive Care Unit, CHU Genève, Intensive Care Unit, Hospital General Vall d'Hebron, Division of Surgical Research, Medizinische Universität Wien = Medical University of Vienna, Department of Anesthesiology and Intensive Care Medicine, Karolinska Institutet [Stockholm], Department of Clinical Nutrition, Geneva University Hospital (HUG), Hamant, Sarah, and Università degli studi di Trieste = University of Trieste
Subjects: MESH: Nutritional Support, MESH: Humans, Critical Care, Nutritional Support, Critical Illness, MESH: Energy Metabolism, MESH: Metabolic Diseases, Metabolic Diseases, MESH: Critical Care, Stress, Physiological, MESH: Critical Illness, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, Humans, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, MESH: Intensive Care, Energy Metabolism, MESH: Stress, Physiological
Abstract: International audience; The metabolic changes associated with critical illness involve several pathways acting at different steps of the utilization of nutritive substrates. The understanding of the role of these pathways and of their complex regulation has led to the development of new strategies for the metabolic and nutritional management of critically ill patients, including the development of new products for nutritional support. The rationale for changing the profile of nutritional support solutions by adding novel substrates is also discussed. This review focuses on the metabolic specificities of critically ill patients and also includes an analysis of the adequacy of tools to monitor the metabolic status and the adequacy of the nutritional support.
Published: 2002

37. Toward Tailored Sedation with Halogenated Anesthetics in the Intensive Care Unit?

Author: Jean François Payen, Neuro-imagerie fonctionnelle et métabolique (ANTE-INSERM U836, équipe 5), Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Dojat, Michel
Subjects: medicine.medical_specialty, Sedation, MEDLINE, MESH: Anesthetics, MESH: Hydrocarbons, Halogenated, law.invention, MESH: Clinical Protocols, 03 medical and health sciences, Sedation procedure, 0302 clinical medicine, MESH: Critical Care, law, medicine, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], MESH: Intensive Care, 030212 general & internal medicine, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, MESH: Conscious Sedation, MESH: Humans, business.industry, 030208 emergency & critical care medicine, Intensive care unit, 3. Good health, MESH: Analgesia, Anesthesiology and Pain Medicine, MESH: Intensive Care Units, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], medicine.symptom, business
Abstract: International audience
Published: 2010

38. Stress metabolism and nutritional support in acute renal failure

Author: Leverve, Xavier, Barnoud, Didier, Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, and Hamant, Sarah
Subjects: MESH: Enteral Nutrition, MESH: Nutritional Support, Parenteral Nutrition, Critical Care, MESH: Carbohydrate Metabolism, MESH: Hormones, Enteral Nutrition, Stress, Physiological, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, Humans, MESH: Proteins, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, MESH: Intensive Care, MESH: Stress, Physiological, ComputingMilieux_MISCELLANEOUS, MESH: Lipid Metabolism, MESH: Humans, Nutritional Support, MESH: Energy Metabolism, MESH: Kidney Failure, Acute, Proteins, Vitamins, Acute Kidney Injury, Lipid Metabolism, Hormones, Renal Replacement Therapy, Carbohydrate Metabolism, MESH: Vitamins, MESH: Renal Replacement Therapy, Energy Metabolism, MESH: Parenteral Nutrition
Abstract: International audience
Published: 1998

39. Enteral nutrition in intensive care patients: a practical approach. Working Group on Nutrition and Metabolism, ESICM. European Society of Intensive Care Medicine

Author: Jolliet, P., Pichard, C., Biolo, Gianni, Chiolro, R., Grimble, G., Leverve, X., Nitenberg, G., Novak, I., Planas, M., Preiser, J. C., Roth, E., Schols, A. M., Wernerman, J., Jolliet, P., Pichard, C., Biolo, Gianni, Chiolro, R., Grimble, G., Leverve, X., Nitenberg, G., Novak, I., Planas, M., Preiser, J. C., Roth, E., Schols, A. M., Wernerman, J., Hamant, Sarah, Medical Intensive Care Unit, CHU Genève, Department of Clinical Nutrition, Geneva University Hospital (HUG), Istituto di Clinico Medica, Università degli studi di Trieste = University of Trieste, Service de médecine intensive adulte, Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Roehampton Institute London, Whitelands College, Bioénergétique fondamentale et appliquée, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département d'anesthésie, réanimation et pathologie infectieuse (DARPI), Institut Gustave Roussy (IGR), Charles University Hospital, Charles University [Prague] (CU), Intensive Care Unit, Hospital General Vall d'Hebron, Service de réanimation, CHU de Liège, Division of Surgical Research, Medizinische Universität Wien = Medical University of Vienna, Departments of Pulmonology and Dietetics, University Hospital Maastricht, Department of Anesthesiology and Intensive Care Medicine, Karolinska Institutet [Stockholm], and University of Trieste
Subjects: MESH: Enteral Nutrition, intensive care patients, MESH: Humans, Critical Care, Cost-Benefit Analysis, Critical Illness, European Society of Intensive Care Medicine, Nutrition Disorders, Europe, Intensive Care Units, Enteral Nutrition, MESH: Critical Illness, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, intensive care patient, Humans, MESH: Intensive Care Units, MESH: Nutrition Disorders, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, MESH: Europe, MESH: Intensive Care, Enteral nutrition, MESH: Cost-Benefit Analysis
Abstract: International audience; Severe protein-calorie malnutrition is a major problem in many intensive care (ICU) patients, due to the increased catabolic state often associated with acute severe illness and the frequent presence of prior chronic wasting conditions. Nutritional support is thus an important part of the management of these patients. Over the years, enteral nutrition (EN) has gained considerable popularity, due to its favorable effects on the digestive tract and its lower cost and rate of complications compared to parenteral nutrition. However, clinicians caring for ICU patients are often faced with contradictory data and difficult decisions when having to determine the optimal timing and modalities of EN administration, estimation of patient requirements, and choice of formulas. The purpose of this paper is to provide practical guidelines on these various aspects of enteral nutritional support, based on presently available evidence.
Published: 1998

40. Predictors of mortality and short-term physical and cognitive dependence in critically ill persons 75 years and older: a prospective cohort study

Author: Michel Ramakers, Jean-Jacques Parienti, Nicolas Terzi, Xavier Valette, Stéphanie Chevalier, Amélie Seguin, Cathy Gaillard, Pierre Charbonneau, Damien du Cheyron, Cédric Daubin, Fabrice Prevost, Service de réanimation médicale [CHU Caen], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), Cellule Promotion de la Recherche Clinique [CHU Caen] (CPRC), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Cognition, Mobilités, Temporalité (COMETE), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), ESIM - Déterminants Sociaux de la Santé et du Recours aux Soins (DS3), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'Immunologie [CHU Caen], and BMC, Ed.
Subjects: Male, Health Status, Dependency, Psychological, MESH: Cognition, MESH: Comorbidity, Comorbidity, older persons intensive care unit, intensive care unit, MESH: Length of Stay, 0302 clinical medicine, MESH: Aged, 80 and over, Cognition, Quality of life, MESH: Risk Factors, Risk Factors, Activities of Daily Living, Medicine, 030212 general & internal medicine, Prospective Studies, Survivors, Prospective cohort study, MESH: Health Status, MESH: Aged, MESH: Survivors, Aged, 80 and over, education.field_of_study, General Medicine, MESH: Follow-Up Studies, functional autonomy, 3. Good health, Intensive Care Units, MESH: Critical Illness, lcsh:R858-859.7, SOFA score, Female, Cohort study, MESH: Forecasting, medicine.medical_specialty, MESH: Dependency (Psychology), Critical Care, Critical Illness, Population, lcsh:Computer applications to medicine. Medical informatics, 03 medical and health sciences, Internal medicine, Intensive care, Humans, MESH: Intensive Care, Intensive care medicine, education, Aged, MESH: Humans, business.industry, Research, MESH: Activities of Daily Living, Public Health, Environmental and Occupational Health, MESH: Quality of Life, 030208 emergency & critical care medicine, Odds ratio, Length of Stay, mortality, MESH: Male, MESH: Prospective Studies, Nottingham Health Profile, quality of life, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, older persons, MESH: Intensive Care Units, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, Follow-Up Studies, Forecasting
Abstract: Background The purpose of this study was to identify predictors of 3-month mortality in critically ill older persons under medical care and to assess the clinical impact of an ICU stay on physical and cognitive dependence and subjective health status in survivors. Methods We conducted a prospective observational cohort study including all older persons 75 years and older consecutively admitted into ICU during a one-year period, except those admitted after cardiac arrest, All patients were followed for 3 months or until death. Comorbidities were assessed using the Charlson index and physical dependence was evaluated using the Katz index of Activity of Daily Living (ADL). Cognitive dependence was determined by a score based on the individual components of the Lawton index of Daily Living and subjective health status was evaluated using the Nottingham Health Profile (NHP) score. Results One hundred patients were included in the analysis. The mean age was 79.3 ± 3.4 years. The median Charlson index was 6 [IQR, 4 to 7] and the mean ADL and cognitive scores were 5.4 ± 1.1 and 1.2 ± 1.4, respectively, corresponding to a population with a high level of comorbidities but low physical and cognitive dependence. Mortality was 61/100 (61%) at 3 months. In multivariate analysis only comorbidities assessed by the Charlson index [Adjusted Odds Ratio, 1.6; 95% CI, 1.2-2.2; p < 0.003] and the number of organ failures assessed by the SOFA score [Adjusted Odds Ratio, 2.5; 95% CI, 1.1-5.2; p < 0.02] were independently associated with 3-month mortality. All 22 patients needing renal support after Day 3 died. Compared with pre-admission, physical (p = 0.04), and cognitive (p = 0.62) dependence in survivors had changed very little at 3 months. In addition, the mean NHP score was 213.1 ± 132.8 at 3 months, suggesting an acceptable perception of their quality of life. Conclusions In a selected population of non surgical patients 75 years and older, admission into the ICU is associated with a 3-month survival rate of 38% with little impact on physical and cognitive dependence and subjective health status. Nevertheless, a high comorbidity level (ie, Charlson index), multi-organ failure, and the need for extra-renal support at the early phase of intensive care could be considered as predictors of death.
Published: 2011

41. Strategies of initiation and streamlining of antibiotic therapy in 41 French intensive care units

Author: Philippe Montravers, Herve Dupont, Remy Gauzit, Benoit Veber, Jean-Pierre Bedos, Alain Lepape, The CIAR Study Group, Service d'anesthésie - réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Pôle d'Anesthésie Réanimation, CHU Amiens-Picardie, Affectations Mineralisantes du Systeme Cardiovasculaire : Calcifications Arterielles et Valvulaires Aortiques, Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie-réanimation [Hôtel-Dieu], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Hôtel-Dieu [Paris], Service de réanimation médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service de réanimation [CH Versailles], Centre Hospitalier de Versailles André Mignot (CHV), Service d'anesthésie-réanimation [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), This research was supported by Wyeth Pharmaceuticals France, CIAR (Club d'infectiologie en Anesthésie-Réanimation) Study Group, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Université de Picardie Jules Verne ( UPJV ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Hôtel-Dieu [Paris], Service de réanimation médicale [Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Service de Reanimation Polyvalente, Centre Hospitalier de Versailles (CHV), Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, and BMC, Ed.
Subjects: Male, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], MESH : Prospective Studies, MESH : Aged, Bacteremia, Critical Care and Intensive Care Medicine, MESH : Intensive Care, MESH : Intraabdominal Infections, law.invention, MESH: Clinical Protocols, MESH : Physician's Practice Patterns, 0302 clinical medicine, Clinical Protocols, law, MESH: Risk Factors, Risk Factors, MESH : Female, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, MESH : Anti-Bacterial Agents, Practice Patterns, Physicians', Prospective cohort study, MESH: Bacteremia, MESH: Aged, MESH: Intraabdominal Infections, MESH: Middle Aged, [ SDV.MHEP.PHY ] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], MESH : After-Hours Care, MESH : Adult, Middle Aged, MESH : Risk Factors, Intensive care unit, 3. Good health, Anti-Bacterial Agents, Intensive Care Units, SAPS II, Cohort, SOFA score, Female, France, MESH : Intensive Care Units, MESH: After-Hours Care, Adult, medicine.medical_specialty, MESH: Pneumonia, Critical Care, MESH : Male, MESH : Drug Administration Schedule, MESH: Drug Administration Schedule, Drug Administration Schedule, MESH : Hospital Mortality, 03 medical and health sciences, After-Hours Care, Intensive care, MESH: Anti-Bacterial Agents, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, MESH : Middle Aged, MESH : Clinical Protocols, MESH: Intensive Care, MESH: Hospital Mortality, MESH : France, MESH: Physician's Practice Patterns, Aged, MESH: Humans, business.industry, MESH : Pneumonia, Research, MESH : Humans, 030208 emergency & critical care medicine, MESH: Adult, Odds ratio, Pneumonia, MESH : Bacteremia, medicine.disease, MESH: Male, MESH: Prospective Studies, MESH: France, Emergency medicine, Intraabdominal Infections, MESH: Intensive Care Units, business, MESH: Female
Abstract: CIAR (Club d'infectiologie en Anesthésie-Réanimation) Study Group: Pr B Allaouchiche (HCL, CHU Lyon), Pr C Arich (CHU Nimes), Pr C Auboyer (CHU St-Etienne), Dr JP Caramella (CHG Nevers), Dr JF Cochard (CHU Bordeaux), Dr A Combes (CHG Meaux), Dr P Courant (CHG Avignon), Dr J Durand-Gasselin (CHG Toulon), Pr J Duranteau (APHP, CHU Bicetre), Dr H Floch (CHU Nantes), Dr F Fraisse (CHG St Denis), Pr M Freysz (CHU Dijon), Dr B Garrigues (CHG Aix-en-Provence), Dr B Georges (CHU Toulouse), Pr F Gouin (APHM, CHU Marseille), Pr L Jacob (APHP, CHU St Louis), Pr P Juvin (APHP, CHU Beaujon), Dr J Keinlen (CHU Montpellier), Dr AM Korinek (APHP, CHU Pitie Salpetriere), Dr C Lamer (Institut Mutualiste Montsouris, Paris), Pr JY Lefrant (CHU Nimes), Dr O Lesieur (CHG La Rochelle), Dr Yazine Mahjoub (CHU Amiens), Pr Y Malledant (CHU Rennes), Pr C Martin (APHM, CHU Marseille), Pr O Mimoz (CHU Poitiers), Pr C Paugam-Burtz (APHP, CHU Beaujon, Clichy), Dr PF Perrigault (CHU Montpellier), Pr T Pottecher (CHU Strasbourg), Pr JL Pourriat (APHP, CHU Hotel Dieu), Dr JF Poussel (CHG Metz), Dr A Rabbat (APHP, CHU Hotel Dieu), Dr J Reignier (CHG La Roche sur Yon), Dr P Sichel (CHG Cherbourg), Dr JP Sollet (CHG Argenteuil), Dr D Thevenin (CHG Lens), Dr G Viquesnel (CHU Caen).; International audience; INTRODUCTION: Few studies have addressed the decision-making process of antibiotic therapy (AT) in intensive care unit (ICU) patients. METHODS: In a prospective observational study, all consecutive patients admitted over a one-month period (2004) to 41 French surgical (n = 22) or medical/medico-surgical ICUs (n = 19) in 29 teaching university and 12 non-teaching hospitals were screened daily for AT until ICU discharge. We assessed the modalities of initiating AT, reasons for changes and factors associated with in ICU mortality including a specific analysis of a new AT administered on suspicion of a new infection. RESULTS: A total of 1,043 patients (61% of the cohort) received antibiotics during their ICU stay. Thirty percent (509) of them received new AT mostly for suspected diagnosis of pneumonia (47%), bacteremia (24%), or intra-abdominal (21%) infections. New AT was prescribed on day shifts (45%) and out-of-hours (55%), mainly by a single senior physician (78%) or by a team decision (17%). This new AT was mainly started at the time of suspicion of infection (71%) and on the results of Gram-stained direct examination (21%). Susceptibility testing was performed in 261 (51%) patients with a new AT. This new AT was judged inappropriate in 58 of these 261 (22%) patients. In ICUs with written protocols for empiric AT (n = 25), new AT prescribed before the availability of culture results (P = 0.003) and out-of-hours (P = 0.04) was more frequently observed than in ICUs without protocols but the appropriateness of AT was not different. In multivariate analysis, the predictive factors of mortality for patients with new AT were absence of protocols for empiric AT (adjusted odds ratio (OR) = 1.64, 95% confidence interval (95%CI): 1.01 to 2.69), age ≥60 (OR = 1.97, 95% CI: 1.19 to 3.26), SAPS II score >38 (OR = 2.78, 95% CI: 1.60 to 4.84), rapidly fatal underlying diseases (OR = 2.91, 95% CI: 1.52 to 5.56), SOFA score ≥6 (OR = 4.48, 95% CI: 2.46 to 8.18). CONCLUSIONS: More than 60% of patients received AT during their ICU stay. Half of them received new AT, frequently initiated out-of-hours. In ICUs with written protocols, empiric AT was initiated more rapidly at the time of suspicion of infection and out-of-hours. These results encourage the establishment of local recommendations for empiric AT.
Published: 2011

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