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1. O-09: DURABLE ENGRAFTMENT AFTER PHARMACOLOGICAL PRE-TRANSPLANT IMMUNOSUPPRESSION FOLLOWED BY REDUCED-TOXICITY MYELOABLATIVE HAPLOIDENTICAL STEM CELL TRANSPLANTATION IN HIGHLY HLA-IMMUNIZED ADULTS WITH SICKLE CELL DISEASE

Author

FÜRST S., BERNIT E., GRANATA A., LEGRAND F., HARBI S., DEVILLIER R., MAISANO V., BOUCHACOURT B., PAGLIARDINI T., MOKART D., LEMARIÉ C., CALMELS B., PICARD C., BASIRE A., CHABANNON C., ANDERSSON B., and BLAISE D.

Subjects
Diseases of the blood and blood-forming organs, RC633-647.5
Published
2022
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6. Characteristics and outcomes of patients with acute myeloid leukemia admitted to intensive care unit with acute respiratory failure: a post-hoc analysis of a prospective multicenter study.

Author

Secreto, C., Chean, D., Louw, A. van de, Kouatchet, A., Bauer, P., Cerrano, M., Lengliné, E., Saillard, C., Chow-Chine, L., Perner, A., Pickkers, P., Soares, M., Rello, J., Pène, F., Lemiale, V., Darmon, M., Fodil, S., Martin-Loeches, I., Mehta, S., Schellongowski, P., Azoulay, E., Mokart, D., Secreto, C., Chean, D., Louw, A. van de, Kouatchet, A., Bauer, P., Cerrano, M., Lengliné, E., Saillard, C., Chow-Chine, L., Perner, A., Pickkers, P., Soares, M., Rello, J., Pène, F., Lemiale, V., Darmon, M., Fodil, S., Martin-Loeches, I., Mehta, S., Schellongowski, P., Azoulay, E., and Mokart, D.

Abstract

Contains fulltext : 296159.pdf (Publisher’s version ) (Open Access), BACKGROUND: Acute respiratory failure (ARF) is the leading cause of intensive care unit (ICU) admission in patients with Acute Myeloid Leukemia (AML) and data on prognostic factors affecting short-term outcome are needed. METHODS: This is a post-hoc analysis of a multicenter, international prospective cohort study on immunocompromised patients with ARF admitted to ICU. We evaluated hospital mortality and associated risk factors in patients with AML and ARF; secondly, we aimed to define specific subgroups within our study population through a cluster analysis. RESULTS: Overall, 201 of 1611 immunocompromised patients with ARF had AML and were included in the analysis. Hospital mortality was 46.8%. Variables independently associated with mortality were ECOG performance status ≥ 2 (OR = 2.79, p = 0.04), cough (OR = 2.94, p = 0.034), use of vasopressors (OR = 2.79, p = 0.044), leukemia-specific pulmonary involvement [namely leukostasis, pulmonary infiltration by blasts or acute lysis pneumopathy (OR = 4.76, p = 0.011)] and liver SOFA score (OR = 1.85, p = 0.014). Focal alveolar chest X-ray pattern was associated with survival (OR = 0.13, p = 0.001). We identified 3 clusters, that we named on the basis of the most frequently clinical, biological and radiological features found in each cluster: a "leukemic cluster", with high-risk AML patients with isolated, milder ARF; a "pulmonary cluster", consisting of symptomatic, highly oxygen-requiring, severe ARF with diffuse radiological findings in heavily immunocompromised patients; a clinical "inflammatory cluster", including patients with multi-organ failures in addition to ARF. When included in the multivariate analysis, cluster 2 and 3 were independently associated with hospital mortality. CONCLUSIONS: Among AML patients with ARF, factors associated with a worse outcome are related to patient's background (performance status, leukemic pulmonary involvement), symptoms, radiological findings, the need for vasopressors and the

Published
2023

7. Prise en charge du patient neutropénique en réanimation (nouveau-nés exclus). Recommandations d’un panel d’experts de la Société de réanimation de langue française (SRLF) avec le Groupe francophone de réanimation et urgences pédiatriques (GFRUP), la Société française d’anesthésie et de réanimation (Sfar), la Société française d’hématologie (SFH), la Société française d’hygiène hospitalière (SF2H) et la Société de pathologies infectieuses de langue française (SPILF)

Author

Schnell, D., Azoulay, E., Benoit, D., Clouzeau, B., Demaret, P., Ducassou, S., Frange, P., Lafaurie, M., Legrand, M., Meert, A.-P., Mokart, D., Naudin, J., Pène, F., Rabbat, A., Raffoux, E., Ribaud, P., Richard, J.-C., Vincent, F., Zahar, J.-R., and Darmon, M.

Abstract

La neutropénie est définie par une baisse du nombre absolu de polynucléaires ou par une dysfonction de ces derniers. Elle est source de complications pouvant nécessiter une admission en réanimation. Les spécificités de prise en charge des patients neutropéniques admis en réanimation ont motivé ce référentiel. Ces recommandations ont été réalisées sous l’égide de la Société de réanimation de langue française (SRLF) par un panel d’experts choisis au sein de la SRLF, du Groupe francophone de réanimation et d’urgences pédiatriques (GFRUP), de la Société française d’anesthésie et de réanimation (Sfar), de la Société française d’hématologie (SFH), de la Société française d’hygiène hospitalière (SF2H) et de la Société de pathologie infectieuse de langue française (SPILF). L’analyse du niveau de preuve et la formulation des recommandations ont suivi la méthode « GRADE » (grading of recommendations assessment, development and evaluation system). Les recommandations ont été cotées selon la méthode RAND/UCLA. Six champs ont été définis : 1) admission en réanimation et pronostic ; 2) isolement et prophylaxies ; 3) diagnostic des complications respiratoires ; 4) prise en charge des complications viscérales ; 5) traitements anti-infectieux : antibiothérapie et contrôle de la source ; 6) prise en charge hématologique. La plupart des recommandations sont de bas niveau de preuve, soulignant les besoins d’études spécifiques dans cette population. Cependant, sept recommandations de haut niveau de preuve ont pu être formulées concernant l’isolement protecteur, la stratégie diagnostique de l’insuffisance respiratoire aiguë, la prise en charge médicale et le délai de la chirurgie de l’entérocolite du neutropénique. Neutropenia is defined either by an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society (SRLF) in collaboration with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF). Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation (“GRADE”) system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: 1) ICU admission and prognosis; 2) protective isolation and prophylaxis; 3) management of acute respiratory failure; 4) organ failure and organ support; 5) antibiotic management and source control; and 6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were however associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management and timing of surgery in patients with typhlitis.

Published
2024
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10. Prise en charge du patient neutropénique en réanimation (nouveau-nés exclus). Recommandations d’un panel d’experts de la Société de réanimation de langue française (SRLF) avec le Groupe francophone de réanimation et urgences pédiatriques (GFRUP), la Société française d’anesthésie et de réanimation (Sfar), la Société française d’hématologie (SFH), la Société française d’hygiène hospitalière (SF2H) et la Société de pathologies infectieuses de langue française (SPILF)

Author

Schnell, D., Azoulay, E., Benoit, D., Clouzeau, B., Demaret, P., Ducassou, S., Frange, P., Lafaurie, M., Legrand, M., Meert, A.-P., Mokart, D., Naudin, J., Pène, F., Rabbat, A., Raffoux, E., Ribaud, P., Richard, J.-C., Vincent, F., Zahar, J.-R., and Darmon, M.

Published
2017
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11. ESICM LIVES 2016: part two: Milan, Italy. 1–5 October 2016

Author

Sivakumar, S., Taccone, F. S., Desai, K. A., Lazaridis, C., Skarzynski, M., Sekhon, M., Henderson, W., Griesdale, D., Chapple, L., Deane, A., Williams, L., Strickland, R., Lange, K., Heyland, D., Chapman, M., Rowland, M. J., Garry, P., Westbrook, J., Corkill, R., Antoniades, C. A., Pattinson, K. T., Fatania, G., Strong, A. J., Myers, R. B., Lazaridis, C., Jermaine, C. M., Robertson, C. S., Rusin, C. G., Hofmeijer, J., Sondag, L., Tjepkema-Cloostermans, M. C., Beishuizen, A., Bosch, F. H., van Putten, M. J. A. M., Carteron, L., Patet, C., Solari, D., Oddo, M., Ali, M. A., Dias, C., Almeida, R., Vaz-Ferreira, A., Silva, J., Monteiro, E., Cerejo, A., Rocha, A. P., Elsayed, A. A., Abougabal, A. M., Beshey, B. N., Alzahaby, K. M., Pozzebon, S., Ortiz, A. Blandino, Cristallini, S., Lheureux, O., Brasseur, A., Vincent, J. L., Creteur, J., Taccone, F. S., Hravnak, M., Yousef, K., Chang, Y., Crago, E., Friedlander, R. M., Abdelmonem, S. A., Tahon, S. A., Helmy, T. A., Meligy, H. S., Puig, F., Dunn-Siegrist, I., Pugin, J., Gupta, S., Govil, D., Srinivasan, S., Patel, S. J., N, J. K., Gupta, A., Tomar, D. S., Shafi, M., Harne, R., Arora, D. P., Talwar, N., Mazumdar, S., Papakrivou, E. E., Makris, D., Manoulakas, E., Tsolaki, B., Karadodas, B., Zakynthinos, E., Garcia, I. Palacios, Martin, A. Diaz, Encinares, V. Sanchez, Ibañez, M. Pachón, Montero, J. Garnacho, Labrador, G., Cangueiro, T. Cebrero, Poulose, V., Koh, J., Kam, J. W., Yeter, H., Kara, A., Aktepe, O., Topeli, A., Tsolakoglou, I., Intas, G., Stergiannis, P., Kolaros, A. A., Chalari, E., Athanasiadou, E., Martika, A., Fildisis, G., Faivre, V., Mengelle, C., Favier, B., Payen, D., Poppe, A., Winkler, M. S., Mudersbach, E., Schreiber, J., Wruck, M. L., Schwedhelm, E., Kluge, S., Zöllner, C., Tavladaki, T., Spanaki, A. M., Dimitriou, H., Kondili, E., Choulaki, C., Meleti, E., Kafetzopoulos, D., Georgopoulos, D., Briassoulis, G., la Torre, A. García-de, de la Torre-Prados, M. V., Tsvetanova-Spasova, T., Nuevo-Ortega, P., Rueda-Molina, C., Fernández-Porcel, A., Camara-Sola, E., Salido-Díaz, L., García-Alcántara, A., Tavladaki, T., Spanaki, A. M., Dimitriou, H., Kondili, E., Choulaki, C., Meleti, D. E., Kafetzopoulos, D., Georgopoulos, D., Briassoulis, G., Suberviola, B., Riera, J., Rellan, L., Sanchez, M., Robles, J. C., Lopez, E., Vicente, R., Miñambres, E., Santibañez, M., Le Guen, M., Moore, J., Mason, N., Windpassinger, M., Plattner, O., Mascha, E., Sessler, D. I., Research, Outcomes, Melia, U., Fontanet, J., van den Berg, J. P., Struys, M. M. R. F., Vereecke, H. E. M., Jensen, E. W., Rood, P. J. T., van de Schoor, F., van Tertholen, K., Pickkers, P., van den Boogaard, M., Beardow, Z. J., Redhead, H., Paramasivam, K., Numan, T., van den Boogaard, M., Kamper, A. M., Rood, P., Peelen, L. M., Zeman, P. M., Slooter, A. J., van Ewijk, C. E., Jacobs, G. E., Girbes, A. R. J., Myatra, S. N., Harish, M. M., Prabu, N. R., Siddiqui, S., Kulkarni, A. P., Divatia, J. V., Murbach, L. D., Leite, M. A., Osaku, E. F., Costa, C. R. L. M., Pelenz, M., Neitzke, N. M., Moraes, M. M., Jaskowiak, J. L., Silva, M. M. M., Zaponi, R. S., Abentroth, L. R. L., Ogasawara, S. M., Jorge, A. C., Duarte, P. A. D., Hernández-Sánchez, N., Sánchez-Hurtado, L. A., García-Guillen, F. J., Ñamendys-Silva, S. A., Maghsoudi, B., Emami, M., Khosravi, M. B., Zand, F., Tabatabaie, H. R., Masjedi, M., Sabetiyan, G., Mokri, A., Troubleyn, J., Diltoer, M., Jacobs, R., Nguyen, D. N., De Waele, E., De Regt, J., Honoré, P. M., Van Gorp, V., Spapen, H. D., Contreras, R. S., Toapanta, N. D., Moreno, G., Sabater, J., Torrado, H., Gonzalez, M., Marin, M., Farigola, E., Gonzalez, A., Fernandez, J., Vera, A., Gisbert, X., Juliá, C., Uya, J., Corral, L., Elias-Jones, I., Gemmell, L., MacKay, A., Randall, D., Adwaney, A., Blunden, M., Prowle, J. R., Kirwan, C. J., Thomas, N., Martin, A., Owen, H., Darwin, L., Conway, D., Atkinson, D., Sharman, M., Moore, J., Barbanti, C., Amour, J., Gaudard, P., Rozec, B., Mauriat, P., M’rini, M., Leger, P. L., Cambonie, G., Liet, J. M., Girard, C., Laroche, S., Damas, P., Assaf, Z., Loron, G., Lecourt, L., Pouard, P., Randall, D., Adwaney, A., Blunden, M., Prowle, J.R., Kirwan, C. J., Kim, S. H., Na, S., Kim, J., Oh, S. Y., Jung, C. W., Yoo, S. H., Min, S. H., Chung, E. J., Lee, H., Lee, N. J., Lee, K. W., Suh, K. S., Ryu, H. G., Marshall, D. C., Goodson, R. J., Salciccioli, J. D., Shalhoub, J., Potter, E. K., Kirk-Bayley, J., Karanjia, N. D., Forni, L. G., Creagh-Brown, B. C., Bossy, M., Nyman, M., Tailor, A., Creagh-Brown, B., D’Antini, D., Spadaro, S., Valentino, F., Sollitto, F., Cinnella, G., Mirabella, L., Calvo, F. J. Redondo, Bejarano, N., Padilla, D., Baladron, V., Villajero, P., Villazala, R., Redondo, J., Yuste, A. S., Liu, J., Shen, F., Teboul, J. L., Anguel, N., Beurton, A., Bezaz, N., Richard, C., Monnet, X., Fossali, T., Colombo, R., Ottolina, D., Rossetti, M., Mazzucco, C., Marchi, A., Porta, A., Catena, E., Tollisen, K. H., Andersen, G. Ø., Heyerdahl, F., Jacobsen, D., de Waard, M. C., Girbes, A. R. J., van IJzendoorn, M. C. O., Buter, H., Kingma, W. P., Navis, G. J., Boerma, E. C., Rulisek, J., Balik, M., Zacharov, S., Kim, H. S., Jeon, S. J., Namgung, H., Lee, E., Lee, E., Cho, Y. J., Lee, Y. J., Huang, A., Cioccari, L., Luethi, N., Mårtensson, J., Bellomo, R., Forsberg, M., Edman, G., Höjer, J., Forsberg, S., Freile, M. T. Chiquito, Hidalgo, F. N., Molina, J. A. Martinez, Lecumberri, R., Rosselló, A. Figuerola, Travieso, P. Medrano, Leon, G. Tuero, Sanchez, J. Gonzalez, Frias, L. Sahuquillo, Rosello, D. Balsells, Verdejo, J. A. Garcia, Serrano, J. A. Noria, Winterwerp, D., van Galen, T., Vazin, A., Karimzade, I., Zand, A., Ozen, E., Ekemen, S., Akcan, A., Sen, E., Yelken, B. Buyukkidan, Kureshi, N., Fenerty, L., Thibault-Halman, G., Erdogan, M., Walling, S., Green, R. S., Clarke, D. B., Briassoulis, P., Kalimeris, K., Ntzouvani, A., Nomikos, T., Papaparaskeva, K., Politi, E., Kostopanagiotou, G., Crewdson, K., Rehn, M., Weaver, A., Brohi, K., Lockey, D., Wright, S., Thomas, K., Baker, C., Mansfield, L., Stafford, V., Wade, C., Watson, G., Bryant, A., Chadwick, T., Shen, J., Wilkinson, J., Furneval, J., Henderson, A., Hugill, K., Howard, P., Roy, A., Bonner, S., Baudouin, S., Ramírez, C. Sánchez, Escalada, S. Hípola, Viera, M. A. Hernández, Santana, M. Cabrera, Balcázar, L. Caipe, Monroy, N. Sangil, Campelo, F. Artiles, Vázquez, C. F. Lübbe, Santana, P. Saavedra, Santana, S. Ruiz, Carteron, L., Patet, C., Quintard, H., Solari, D., Bouzat, P., Oddo, M., Wollersheim, T., Malleike, J., Haas, K., Carbon, N., Schneider, J., Birchmeier, C., Fielitz, J., Spuler, S., Weber-Carstens, S., Enseñat, L., Pérez-Madrigal, A., Saludes, P., Proença, L., Gruartmoner, G., Espinal, C., Mesquida, J., Huber, W., Eckmann, M., Elkmann, F., Gruber, A., Lahmer, T., Mayr, U., Herner, A., Schellnegger, R., Schneider, J., Schmid, R. M., Ayoub, W., Samy, W., Esmat, A., Battah, A., Mukhtar, S., Mongkolpun, W., Cortés, D. Orbegozo, Cordeiro, C. P. R., Vincent, J. L., Creteur, J., Funcke, S., Groesdonk, H., Saugel, B., Wagenpfeil, G., Wagenpfeil, S., Reuter, D. A., Fernandez, M. M., Fernandez, R., Magret, M., González-Castro, A., Bouza, M. T., Ibañez, M., García, C., Balerdi, B., Mas, A., Arauzo, V., Añón, J. M., Ruiz, F., Ferreres, J., Tomás, R., Alabert, M., Tizón, A. I., Altaba, S., Llamas, N., Goligher, E C., Fan, E., Herridge, M., Vorona, S., Sklar, M., Dres, M., Rittayamai, N., Lanys, A., Urrea, C., Tomlinson, G., Reid, W. D., Rubenfeld, G. D., Kavanagh, B. P., Brochard, L. J., Ferguson, N. D., Neto, A. Serpa, de Abreu, M. Gama, Pelosi, P., Schultz, M. J., Guérin, C., Papazian, L., Reignier, J., Ayzac, L., Loundou, A., Forel, J. M., Rolland-Debord, C., Bureau, C., Poitou, T., Clavel, M., Perbet, S., Terzi, N., Kouatchet, A., Similowski, T., Demoule, A., Hunfeld, N., Trogrlic, Z., Ladage, S., Osse, R. J., Koch, B., Rietdijk, W., Devlin, J., van der Jagt, M., Picetti, E., Ceccarelli, P., Mensi, F., Malchiodi, L., Risolo, S., Rossi, I., Antonini, M. V., Servadei, F., Caspani, M. L., Roquilly, A., Lasocki, S., Seguin, P., Geeraerts, T., Perrigault, P. F., Dahyot-Fizelier, C., Paugam-Burtz, C., Cook, F., Cinotti, R., dit Latte, D. Demeure, Mahe, P. J., Fortuit, C., Feuillet, F., Asehnoune, K., Marzorati, C., Spina, S., Scaravilli, V., Vargiolu, A., Riva, M., Giussani, C., Sganzerla, E., Citerio, G., Barbadillo, S., de Molina, F. J. González, Álvarez-Lerma, F., Rodríguez, A., Zakharkina, T., Martin-Loeches, I., Matamoros, S., Povoa, P., Torres, A., Kastelijn, J., Hofstra, J. J., de Jong, M., Schultz, M., Sterk, P., Artigas, A., Bos, L. J., Moreau, A. S., Martin-Loeches, I., Povoa, P., Salluh, J., Rodriguez, A., Nseir, S., de Jong, E., van Oers, J. A., Beishuizen, A., Girbes, A. R. J., Nijsten, M. W. N., de Lange, D. W., Bonvicini, D., Labate, D., Benacchio, L., Olivieri, A., Pizzirani, E., Lopez-Delgado, J. C., Gonzalez-Romero, M., Fuentes-Mila, V., Berbel-Franco, D., Romera-Peregrina, I., Martinez-Pascual, A., Perez-Sanchez, J., Abellan-Lencina, R., Ávila-Espinoza, R. E., Moreno-Gonzalez, G., Sbraga, F., Griffiths, S., Grocott, M. P. W., Creagh-Brown, B., Doyle, J., Wilkerson, P., Soon, Y., Huddart, S., Dickinson, M., Riga, A., Zuleika, A., Miyamoto, K., Kawazoe, Y., Morimoto, T., Yamamoto, T., Fuke, A., Hashimoto, A., Koami, H., Beppu, S., Katayama, Y., Ito, M., Ohta, Y., Yamamura, H., Rygård, S. L., Holst, L B., Wetterslev, J., Johansson, P. I., Perner, A., Soliman, I. W., de Lange, D. W., van Dijk, D., van Delden, J. J. M., Cremer, O. L., Slooter, A. J. C., Peelen, L. M., McWilliams, D., Snelson, C., Neves, A. Das, Loudet, C. I., Busico, M., Vazquez, D., Villalba, D., Veronesi, M., Lischinsky, A., López, F. J. L., Mori, L. Benito, Plotnikow, G., Díaz, A., Giannasi, S., Hernandez, R., Krzisnik, L., Cecotti, C., Viola, L., Lopez, R., Sottile, J. P., Benavent, G., Estenssoro, E., Chen, C. M., Lai, C. C., Cheng, K. C., Chou, W., Chan, K. S., Roeker, L. E., Horkan, C. M., Gibbons, F. K., Christopher, K. B., Weijs, P. J. M., Mogensen, K. M., Rawn, J. D., Robinson, M. K., Christopher, K. 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P., Koch, N., Huber, W., Hoellthaler, J., Mair, S., Phillip, V., Schmid, R. M., Beitz, A., Baladrón, V., Calvo, F. J. Redondo, Padilla, D., Villarejo, P., Villazala, R., Yuste, A. S., Bejarano, N., Steenstra, R. J., Banierink, H., Hof, J., van der Horst, I. C., Nijsten, M. W., Hoekstra, M., Roedl, K., Sterz, F., Horvatits, T., Horvatits, K., Drolz, A., Herkner, H., Fuhrmann, V., Kott, M., Zitta, K., Brandt, B., Schildhauer, C., Elke, G., Hummitzsch, L., Frerichs, I., Weiler, N., Albrecht, M., González, L. Rey, Alonso, D. Cabestrero, Ortiz, A. Blandino, Sánchez, R. de Pablo, Lucas, J. Higuera, Roedl, K., Sterz, F., Drolz, A., Horvatits, K., Horvatits, T., Herkner, H., Fuhrmann, V., Horvatits, T., Drolz, A., Roedl, K., Rutter, K., Ferlitsch, A., Fauler, G., Trauner, M., Fuhrmann, V., Horvatits, T., Pischke, S., Fischer, L., Thaiss, F., Koch, M., Bangert, K., Fuhrmann, V., Kluge, S., Lohse, A. W., Nashan, B., Sterneck, M., Faenza, S., Siniscalchi, A., Pierucci, E., Mancini, E., Ricci, D., Gemelli, C., Cuoghi, A., Magnani, S., Atti, M., Sotos, F., Cánovas, J., López, A., Burruezo, A., Torres, D., Herrera-Gutierrez, M. E., Barrueco-Francioni, J., Arias-Verdú, D., Lozano-Saez, R., Quesada-Garcia, G., Seller-Pérez, G., Figueiredo, A., Anzola, Y., Pereira, R., Bento, L., Arias-Verdú, D., Lai, M., Deiana, M., Barrueco-Francioni, J., Herrera-Gutierrez, M. E., Seller-Perez, G., Vardas, K., Ilia, S., Sertedaki, A., Charmadari, E., Stratakis, C. A., Briassouli, E., Goukos, D., Psarra, K., Botoula, E., Tsagarakis, S., Mageira, E., Routsi, C., Nanas, S., Briassoulis, G., Boscolo, A., Bertini, D., Campello, E., Lucchetta, V., Piasentini, E., Radu, C. M., Manesso, L., Simioni, P., Ori, C., Su, H., Lam, Y. M., Willis, K., Pullar, V., Hubner, R. P., Tsang, J. L., de Guadiana-Romualdo, L. García, Rebollo-Acebes, S., Esteban-Torrella, P., Jiménez-Sánchez, R., Jiménez-Santos, E., Ortín-Freire, A., Hernando-Holgado, A., Albaladejo-Otón, M. D., Coelho, L., Rabello, L., Salluh, J., Martin-Loeches, I., Rodriguez, A., Nseir, S., Póvoa, P., Varis, E., Pettilä, V., Poukkanen, M., Jacob, S., Karlsson, S., Perner, A., Takala, J., Wilkman, E., Lundberg, O. H. M., Bergenzaun, L., Rydén, J., Rosenqvist, M., Melander, O., Chew, M. S., Rodriguez-Ruiz, E., Vaquero, R. Hernández, Lago, A. Lopez, Allut, J. L. Garcia, Gestal, A. Estany, Gonzalez, M. A. Garcia, Kishihara, Y., Yasuda, H., Rebollo, S., de Guadiana-Romualdo, L. García, Jimenez, R., Torrella, P. Esteban, Fernandez, A., Sanchez, S., Ortin, A., Bassi, G. Li, Prats, R. Guillamat, Artigas, A., Aguilera, E., Marti, D., Ranzani, O. T., Rigol, M., Fernandez, L., Ferrer, M., Martin-Loeches, I., Torres, A., Lanziotti, V. S., Póvoa, P., Pulcheri, L., Ribeiro, M. O., Barbosa, A. P., e Silva, J. R. Lapa, Soares, M., Salluh, J. I. F., Garcia, I. Palacios, Martin, A. Diaz, Marqués, M. Gil, Moreno, A. Puppo, Pizarraya, A. Gutierrez, Diaz, J. Pachón, Ibañez, M. Pachón, Smani, Y., Connell, M. Mc, Zhang, L. A., Parker, R. S., Banerjee, I., Clermont, G., Norberg, E., Oras, J., Cuisinier, A., Maufrais, C., Payen, J. F., Nottin, S., Walther, G., Bouzat, P., Arib, S., Bilotta, F., Badenes, R., Rubulotta, F., Mirek, S., Crippa, I. A., Monfort, B., Stazi, E., Roig, A. Lozano, Creteur, J., Taccone, F. S., Magnoni, S., Marando, M., Pifferi, S., Conte, V., Ortolano, F., Carbonara, M., Bertani, G., Scola, E., Cadioli, M., Triulzi, F., Colombo, A., Stocchetti, N., Rotzel, H. B., Lázaro, A. Serrano, Prada, D. Aguillón, Guimillo, M. Rodriguez, Piqueras, C. Sanchís, Guia, J. Romero, Simon, M. García, Arizmendi, A. Mesejo, Carratalá, A., El Maraghi, S., Yehia, A., Bakry, M., Shoman, A., Backes, F. N., Bianchin, M. M., Vieira, S. R. R., de Souza, A., Backes, A. N., Klein, C., Kalaiselvan, M. S., Renuka, M. K., Arunkumar, A. S., Lozano, A., Lheureux, O., Badenes, R., Vincent, J. L., Creteur, J., Taccone, F. S., Gallaher, C., Cattlin, S., Gordon, S., Picard, J., Fontana, V., Bond, O., Nobile, L., Vincent, J. L., Creteur, J., Taccone, F. S., Mrozek, S., Delamarre, L., Capilla, F., Al-Saati, T., Fourcade, O., Geeraerts, T., Dominguez-Berrot, A. M., Gonzalez-Vaquero, M., Vallejo-Pascual, M. E., Gupta, D., Ivory, B. D., Chopra, M., McCarthy, J., Felderhof, C. L., MacNeil, C., Rubulotta, F., Waldauf, P., Maggiorini, M., Duska, F., Fumis, R. R. L., Junior, J. M. Vieira, Amarante, G., Skorko, A., Sanders, S., Aron, J., Kroll, R. J., Redfearn, C., Krishnan, P., Khalil, J. E., Kovari, F., Kongpolprom, N., Gulia, V., Lourenço, E., Melão, L., Duro, C., Baptista, G., Alves, A., Arminda, B., Rodrigues, M., Marreiros, A., Granja, C., Hayward, J., Baldwin, F., Gray, R., Katinakis, P. A., Stijf, M., Ten Kleij, M., Jansen-Frederiks, M., Broek, R., de Bruijne, M., Spronk, P. E., Sinha, K., Luney, M., Palmer, K., Keating, L., Abu-Habsa, M., Bahl, R., Baskaralingam, N., Ahmad, A., Kanapeckaite, L., Bhatti, P., Glace, S., Jeyabraba, S., Lewis, H. F., Kostopoulos, A., Raja, M., West, A., Ely, A., Turkoglu, L. M., Zolfaghari, P., Baptista, J. P., Marques, M. P., Martins, P., Pimentel, J., Gupta, D., Su, Y. C., Villacres, S., Stone, M. E., Parsikia, A., Medar, S., O’Dea, K. P., Porter, J., Tirlapur, N., Jonathan, J. M., Singh, S., Takata, M., Abu-Habsa, M., Ahmad, A., McWhirter, E., Lyon, R., Hariz, M. L., Azmi, E., Alkhan, J., Honeybul, S., Movsisyan, V., Petrikov, S., Marutyan, Z., Aliev, I., Evdokimov, A., Antonucci, E., Merz, T., Hartmann, C., Pelosi, P., Calzia, E., Radermacher, P., Nußbaum, B., Hartmann, C., Huber-Lang, M., Gröger, M., Radermacher, P., Nußbaum, B., Nußbaum, B., Antonucci, E., Calzia, E., Pelosi, P., Radermacher, P., Hartmann, C., Svoren-Jabalera, E., Davenport, E. E., Humburg, P., Knight, J., Hinds, C. J., Jun, I. J., Kim, W. J., Lee, E. H., Besch, G., Perrotti, A., Puyraveau, M., Carteron, L., Baltres, M., Samain, E., Chocron, S., Pili-Floury, S., Plata-Menchaca, E. P., Sabater-Riera, J., Estruch, M., Boza, E., Sbraga, F., Toscana-Fernández, J., Bruguera-Pellicer, E., Ordoñez-Llanos, J., Pérez-Fernández, X. L., Cavaleiro, P., Tralhão, A., Arrigo, M., Lopes, J.-P., Lebrun, M., Cholley, B., PerezVela, J. L., MarinMateos, H., Rivera, J. J. Jimenez, Llorente, M. A. Alcala, De Marcos, B. Gonzalez, Fernandez, F. J. Gonzalez, Laborda, C. Garcia, Zamora, D. Fernandez, Delgado, J. C. Lopez, Imperiali, C., Berbel-Franco, D., Dastis, M., Moreno-Gonzalez, G., Perez-Sanchez, J., Romera-Peregrina, I., Abellan-Lencina, R., Martinez-Pascual, A., Fuentes-Mila, V., Gonzalez-Romero, M., Górka, J., Górka, K., Iwaniec, T., Frołow, M., Polok, K., Fronczek, J., Kózka, M., Musiał, J., Szczeklik, W., Pérez, A. González, Ordoñez, P. Florez, Giribet, A., Cuervo, M. A. Alonso, Cuervo, R. Alonso, Esteban, M. A. Rodriguez, Fraile, L. Iglesias, Mittelbrum, C. Ponte, Albaiceta, G. Muñiz, Ampatzidou, F., Sileli, M., Kehagioglou, G., Madesis, A., Karaiskos, T., Moursia, C., Maleoglou, H., Leleki, K., Drossos, G., Uz, Z., Ince, Y., Papatella, R., Bulent, E., Guerci, P., Ince, C., De Mol, B., Vicka, V., Gineityte, D., Ringaitiene, D., Norkiene, I., Sipylaite, J., Möller, C., Fleischmann, C., Thomas-Rueddel, D. O., Vlasakov, V., Rochwerg, B., Theurer, P., Gattinoni, L., Reinhart, K., Hartog, C. S., Pérez, A. González, Al Sibai, J. Zanabili, Camblor, P. Martinez, Fernandez, P. Alvarez, Gala, J. M. García, Guisasola, J. Silba, Albaiceta, G. Muñiz, Tamura, T., Yatabe, T., Miyajima, I., Yamashita, K., Yokoyama, M., Ampatzidou, F., Kehagioglou, G., Dalampini, E., Nastou, M., Baddour, A., Ignatiadis, A., Asteri, T., Drossos, G., Hathorn, K. E., Purtle, S. W., Horkan, C. M., Gibbons, F. K., Christopher, K. B., Viana, M. V., Tonietto, T. A., Gross, L. A., Costa, V. L., Tavares, A. L. J., Lisboa, B. O., Moraes, R. B., Vieira, S. R., Viana, L. V., Azevedo, M. J., Ceniccola, G. D., Pequeno, R. S. F., Holanda, T. P., Mendonça, V. S., Araújo, W. M. C., Carvalho, L. S. F., Segaran, E., Vickers, L., Brinchmann, K., Wignall, I., Rubulotta, F., De Brito-Ashurst, I., del Olmo, R., Esteban, M. J., Vaquerizo, C., Carreño, R., Gálvez, V., Kaminsky, G., Nieto, B., Fuentes, M., De la Torre, M. A., Torres, E., Alonso, A., Velayos, C., Saldaña, T., Escribá, A., GRIP, J., Kölegård, R., Sundblad, P., Rooyackers, O., Naser, Ben, Jaziri, F., Jazia, A. Ben, Barghouth, M., Hentati, O., Skouri, W., El Euch, M., Mahfoudhi, M., Turki, S., Abdelghni, K. Ben, Abdallah, Ben, Maha, B. N. M., Cánovas, J., Sotos, F., López, A., Lorente, M., Burruezo, A., Torres, D., Polok, K., Włudarczyk, A., Górka, J., Hałek, A., Musiał, J., Szczeklik, W., Jazia, A. Ben, Jaziri, F., Bargouth, M., Bennasr, M., Turki, S., Abdelghani, K. Ben, Abdallah, T. Ben, de Grooth, H. J., Geenen, I. L., Parienti, J. J., Straaten, H. M. Oudemans-van, Shum, H. P., King, H. S., Chan, K. C., Yan, W. W., Londoño, J. Gonzalez, Cardenas, C. Lorencio, Pedrosa, M. Morales, Gubianas, C. Murcia, Bertolin, C. Fuster, Batllori, N. Vila, Sirvent, J. M., Wykes, K., Jack, J., Morgan, P., Mukhopadhyay, A., Chan, H. Y., Kowitlawakul, Y., Remani, D., Leong, C. S. F., Henry, C. J., Puthucheary, Z. A., Mendsaikhan, N., Begzjav, T., Lundeg, G., Dünser, M., Espinoza, E. D. Valenzuela, Welsh, S. P., Motta, M. F., Guerra, E., Zerpa, M. C. l., Zechner, F., Furche, M., Berdaguer, F., Birri, P. N. Rubatto, Risso-Vazquez, A., Dubin, A., Masevicius, F. D., Greaney, D., Magee, A., Fitzpatrick, G., Lugo-Cob, R. G., Sánchez-Hurtado, L. A., Arvizu-Tachiquín, P. C., Tejeda-Huezo, B. C., Cano-Oviedo, A. A., Baltazar-Torres, J. A., Aydogan, M. S., Togal, T., Taha, A., Chai, H. Z., Kam, C., Razali, S. S. Yang, Sivasamy, V., Kuan, L. Y., Poulose, V., Morales, M. A. Lopez, Castro, S., Pires, T., Melão, L., Krystopchuk, A., Pereira, I., Granja, C., Taniguchi, L. U., Pires, E. M. C., Vieira, Jr, J. M., Azevedo, L. C. P., Nurses of the Central and General ICUs of Shiraz Namazi Hospital, Sedation an Delirium Group Hospital Universitari de Bellvitge, SPACeR group (Surrey Peri-operative, Anaesthesia and Critical Care Collaborative Research Group), for the PRoVENT investigators and the PROVE Network, SEMICYUC/GETGAG Working Group, TAVeM study group, POPC-CB investigators, DESIRE (DExmedetomidine for Sepsis in ICU Randomized Evaluation) Trial Investigators, GEMINI, Bioethics work group of SEMICYUC, The FINNAKI Study Group, Queen Square Neuroanaesthesia and Neurocritical Care Resreach Group, Renal Transplantation HUVR, GEMINI, EDISVAL Group, EDISVAL Group, PLUG Working group, TAVeM study Group, The FINNAKI Study Group, on behalf of Department of Professional Development, ESICM, Critical Care Research Group, SIRAKI group, and Grupo ESBAGA

Published
2016
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14. Prognosis of neutropenic patients admitted to the intensive care unit

Author

Mokart, D., Darmon, M., Resche-Rigon, M., Lemiale, V., Pène, F., Mayaux, J., and Rabbat, A.

Subjects
Medical research -- Analysis, Medicine, Experimental -- Analysis, Cancer patients -- Prognosis, Mortality -- France -- Belgium, Hematopoietic stem cells -- Transplantation -- Analysis, Health care industry
Abstract

Purpose The prognosis of critically ill cancer patients has improved recently. Controversies remain as regard to the specific prognosis impact of neutropenia in critically ill cancer patients. The primary objective of this study was to assess hospital outcome of critically ill neutropenic cancer patients admitted into the ICU. The secondary objective was to assess risk factors for unfavorable outcome in this population of patients and specific impact of neutropenia. Methods We performed a post hoc analysis of a prospectively collected database. The study was carried out in 17 university or university-affiliated centers in France and Belgium. Neutropenia was defined as a neutrophil count lower than 500/mm.sup.3. Results Among the 1,011 patients admitted into the ICU during the study period 289 were neutropenic at the time of admission. Overall, 131 patients died during their hospital stay (hospital mortality 45.3 %). Four variables were associated with a poor outcome, namely allogeneic transplantation (OR 3.83; 95 % CI 1.75-8.35), need for mechanical ventilation (MV) (OR 6.57; 95 % CI 3.51-12.32), microbiological documentation (OR 2.33; CI 1.27-4.26), and need for renal replacement therapy (OR 2.77; 95 % CI 1.34-5.74). Two variables were associated with hospital survival, namely age younger than 70 (OR 0.22; 95 % CI 0.1-0.52) and neutropenic enterocolitis (OR 0.37; 95 % CI 0.15-0.9). A case-control analysis was also performed with patients of the initial database; after adjustment, neutropenia was not associated with hospital mortality (OR 1.27; 95 % CI 0.86-1.89). Conclusion Hospital survival was closely associated with younger age and neutropenic enterocolitis. Conversely, need for conventional MV, for renal replacement therapy, and allogeneic hematopoietic stem cell transplantation (HSCT) were associated with poor outcome., Author(s): D. Mokart [sup.5], M. Darmon [sup.15], M. Resche-Rigon [sup.1], V. Lemiale [sup.1], F. Pène [sup.2], J. Mayaux [sup.3], A. Rabbat [sup.4], A. Kouatchet [sup.6], F. Vincent [sup.7], M. Nyunga [...]

Published
2015
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15. ICU-acquired pneumonia in immunosuppressed patients with acute hypoxemic respiratory failure: A post-hoc analysis of a prospective international cohort study

Author

Martin-Loeches, I, Darmon, M, Demoule, A, Grp, Nine-I Study, Investigators, Efraim, Antonelli, M, Schellongowski, P, Pickkers, P, Soares, M, Rello, J, Bauer, P, van de Louw, A, Lemiale, V, Grimaldi, D, Balik, M, Mehta, S, Kouatchet, A, Barratt-Due, A, Valkonen, M, Reignier, J, Metaxa, V, Moreau, AS, Burghi, G, Mokart, D, Azoulay, E, HUS Perioperative, Intensive Care and Pain Medicine, Clinicum, Anestesiologian yksikkö, and Department of Diagnostics and Therapeutics

Subjects
medicine.medical_specialty, health care facilities, manpower, and services, VA-LRTI, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Critical Care and Intensive Care Medicine, Cohort Studies, Sepsis, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, 0302 clinical medicine, Risk Factors, Intensive care, Settore MED/41 - ANESTESIOLOGIA, Post-hoc analysis, Humans, Medicine, Hospital Mortality, Prospective Studies, Risk factor, Prospective cohort study, Immunosuppression, Infection, Pneumonia, business.industry, 030208 emergency & critical care medicine, 3126 Surgery, anesthesiology, intensive care, radiology, medicine.disease, 3. Good health, Intensive Care Units, 030228 respiratory system, Cohort, Emergency medicine, Female, Respiratory Insufficiency, business, Cohort study
Abstract

Objective: Intensive Care Units (ICU) acquired Pneumonia (ICU-AP) is one of the most frequent nosocomial infections in critically ill patients. Our aim was to determine the effects of having an ICU-AP in immunosuppressed patients with acute hypoxemic respiratory failure. Design: Post-hoc analysis of a multinational, prospective cohort study in 16 countries. Settings: ICU. Patients: Immunosuppressed patients with acute hypoxemic respiratory failure. Intervention: None. Measurements and main results: The original cohort had 1611 and in this post-hoc analysis a total of 1512 patients with available data on hospital mortality and occurrence of ICU-AP were included. ICU-AP occurred in 158 patients (10.4%). Hospital mortality was higher in patients with ICU-AP (14.8% vs. 7.1% p < 0.001). After adjustment for confounders and centre effect, use of vasopressors (Odds Ratio (OR) 2.22; 95%CI 1.46-.39) and invasive me-chanical ventilation at day 1 (OR 2.12 vs. high flow oxygen; 95%CI 1.07-4.20) were associated with increased risk of ICU-AP while female gender (OR 0.63; 95%CI 0.43-94) and chronic kidney disease (OR 0.43; 95%CI 0.22-0.88) were associated with decreased risk of ICU-AP. After adjustment for confounders and centre effect, ICU-AP was independently associated with mortality (Hazard Ratio 1.48; 95%CI 14.-1.91; P = 0.003). Conclusions: The attributable mortality of ICU-AP has been repetitively questioned in immunosuppressed pa-tients with acute respiratory failure. This manuscript found that ICU-AP represents an independent risk factor for hospital mortality.(c) 2020 Elsevier Inc. All rights reserved.

Published
2021

16. Neutrophil-to-Lymphocyte Ratio on Post-operative Day 3: A Simple Tool to Exclude Clinically Relevant Postoperative Pancreatic Fistula after Pancreatoduodenectomy

Author

Garnier, J., primary, Alfano, M.-S., additional, Robin, F., additional, Ewald, J., additional, Al-Faraï, A., additional, Palen, A., additional, Sebai, A., additional, Mokart, D., additional, Delpero, J.-R., additional, Sulpice, L., additional, Zemmour, C., additional, and Turrini, O., additional

Published
2022
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18. Performance of the ROX index to predict intubation in immunocompromised patients receiving high-flow nasal cannula for acute respiratory failure

Author

Lemiale, V, Dumas, G, Demoule, A, Pène, F, Kouatchet, A, Bisbal, M, Nseir, S, Argaud, L, Kontar, L, Klouche, K, Barbier, F, Seguin, A, Louis, G, Constantin, JM, Mayaux, J, Wallet, F, Peigne, V, Girault, C, Oziel, J, Nyunga, M, Terzi, N, Bouadma, L, Lautrette, A, Bige, N, Raphalen, JH, Papazian, L, Bruneel, F, Lebert, C, Benoit, Dominique, Meert, AP, Jaber, S, Mokart, D, Darmon, M, Azoulay, E, de Recherche en Reanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH, Groupe, Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Picardie Jules Verne (UPJV), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)

Subjects
medicine.medical_specialty, Multivariate analysis, Oxygenation index, high-flow nasal oxygen, medicine.medical_treatment, Acute respiratory failure, Critical Care and Intensive Care Medicine, medicine.disease_cause, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Anesthesiology, Medicine and Health Sciences, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Intubation, Immunocompromised, acute respiratory failure, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Correction, 030208 emergency & critical care medicine, lcsh:RC86-88.9, High-flow nasal oxygen, medicine.disease, 3. Good health, Pneumonia, immunocompromised, 030228 respiratory system, Anesthesia, Economie, business, Nasal cannula
Abstract

Background: Delayed intubation is associated with high mortality. There is a lack of objective criteria to decide the time of intubation. We assessed a recently described combined oxygenation index (ROX index) to predict intubation in immunocompromised patients. The study is a secondary analysis of randomized trials in immunocompromised patients, including all patients who received high-flow nasal cannula (HFNC). The first objective was to evaluate the accuracy of the ROX index to predict intubation for patients with acute respiratory failure. Results: In the study, 302 patients received HFNC. Acute respiratory failure was mostly related to pneumonia (n = 150, 49.7%). Within 2 (1–3) days, 115 (38.1%) patients were intubated. The ICU mortality rate was 27.4% (n = 83). At 6 h, the ROX index was lower for patients who needed intubation compared with those who did not [4.79 (3.69–7.01) vs. 6.10 (4.48–8.68), p < 0.001]. The accuracy of the ROX index to predict intubation was poor [AUC = 0.623 (0.557–0.689)], with low performance using the threshold previously found (4.88). In multivariate analysis, a higher ROX index was still independently associated with a lower intubation rate (OR = 0.89 [0.82–0.96], p = 0.04). Conclusion: A ROX index greater than 4.88 appears to have a poor ability to predict intubation in immunocompromised patients with acute respiratory failure, although it remains highly associated with the risk of intubation and may be useful to stratify such risk in future studies., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2021

19. Outcomes in patients treated with chimeric antigen receptor T-cell therapy who were admitted to intensive care (CARTTAS): an international, multicentre, observational cohort study

Author

Azoulay, É., Castro, P., Maamar, A., Metaxa, V., Moraes, A.G. de, Voigt, L., Wallet, F., Klouche, K., Picard, M., Moreau, A.S., Louw, A. van de, Seguin, A., Mokart, D., Chawla, S., Leroy, J., Böll, B., Issa, N., Levy, B., Hemelaar, P., Fernandez, S., Munshi, L., Bauer, P., Schellongowski, P., Joannidis, M., Moreno-Gonzalez, G., Galstian, G., Darmon, M., Valade, S., Azoulay, É., Castro, P., Maamar, A., Metaxa, V., Moraes, A.G. de, Voigt, L., Wallet, F., Klouche, K., Picard, M., Moreau, A.S., Louw, A. van de, Seguin, A., Mokart, D., Chawla, S., Leroy, J., Böll, B., Issa, N., Levy, B., Hemelaar, P., Fernandez, S., Munshi, L., Bauer, P., Schellongowski, P., Joannidis, M., Moreno-Gonzalez, G., Galstian, G., Darmon, M., and Valade, S.

Abstract

Item does not contain fulltext, BACKGROUND: Chimeric antigen receptor (CAR) T-cell therapy can induce side-effects such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (ICANS), which often require intensive care unit admission. The aim of this study was to describe management of critically ill CAR T-cell recipients in intensive care. METHODS: This international, multicentre, observational cohort study was done in 21 intensive care units in France, Spain, the USA, the UK, Russia, Canada, Germany, and Austria. Eligible patients were aged 18 years or older; had received CAR T-cell therapy in the past 30 days; and had been admitted to intensive care for any reason. Investigators retrospectively included patients admitted between Feb 1, 2018, and Feb 1, 2019, and prospectively included patients admitted between March 1, 2019, and Feb 1, 2020. Demographic, clinical, laboratory, treatment, and outcome data were extracted from medical records. The primary endpoint was 90-day mortality. Factors associated with mortality were identified using a Cox proportional hazard model. FINDINGS: 942 patients received CAR T-cell therapy, of whom 258 (27%) required admission to intensive care and 241 (26%) were included in the analysis. Admission to intensive care was needed within median 4·5 days (IQR 2·0-7·0) of CAR T-cell infusion. 90-day mortality was 22·4% (95% CI 17·1-27·7; 54 deaths). At initial evaluation on admission, isolated cytokine release syndrome was identified in 101 patients (42%), cytokine release syndrome and ICANS in 93 (39%), and isolated ICANS in seven (3%) patients. Grade 3-4 cytokine release syndrome within 1 day of admission to intensive care was found in 50 (25%) of 200 patients and grade 3-4 ICANS in 38 (35%) of 108 patients. Bacterial infection developed in 30 (12%) patients. Life-saving treatments were used in 75 (31%) patients within 24 h of admission to intensive care, primarily vasoactive drugs in 65 (27%) patients. Factors independently associated

Published
2021

20. Acute Respiratory Failure Outcomes in Patients with Hematologic Malignancies and Hematopoietic Cell Transplant: A Secondary Analysis of the EFRAIM Study

Author

Munshi, L., Darmon, M., Soares, M., Pickkers, P., Bauer, P., Meert, A.P., Martin-Loeches, I., Staudinger, T., Pene, F., Antonelli, M., Barratt-Due, A., Demoule, A., Metaxa, V., Lemiale, V., Taccone, F., Mokart, D., Azoulay, E., Mehta, S., Munshi, L., Darmon, M., Soares, M., Pickkers, P., Bauer, P., Meert, A.P., Martin-Loeches, I., Staudinger, T., Pene, F., Antonelli, M., Barratt-Due, A., Demoule, A., Metaxa, V., Lemiale, V., Taccone, F., Mokart, D., Azoulay, E., and Mehta, S.

Abstract

Item does not contain fulltext, Patients with allogeneic hematopoietic cell transplantation (HCT) who develop acute respiratory failure (ARF) are perceived to have worse outcomes than autologous HCT recipients and non-transplant patients with hematologic malignancy (HM). Within a large international prospective cohort, we evaluated clinical outcomes in these 3 populations. We conducted a secondary analysis of the EFRAIM study, a multicenter observational study of immunocompromised adults with ARF admitted to 62 intensive care units (ICUs) in 16 countries. We described characteristics and compared outcomes of patients with HM who did not undergo transplantation and patients who underwent autologous or allogeneic HCT using multivariable logistic regression and propensity score-matched analyses. A total of 801 patients were included: 570 who did not undergo transplantation, 86 autologous HCT recipients and 145 allogeneic HCT recipients. Acute myelogenous leukemia (171 of 570; 30%) was the most common HM and most common indication for allogeneic HCT (76 of 145; 52%). Compared with the patients who did not undergo HCT and autologous HCT recipients, allogeneic HCT recipients were younger, had fewer comorbid conditions, and were more likely to undergo diagnostic bronchoscopy in the ICU. Unadjusted ICU and hospital mortality were 35% and 45%, respectively, across the entire cohort. In multivariable regression analysis, autologous HCT (odds ratio [OR], 1.07; 95% confidence interval [CI], .57 to 2.03; P = .82) and allogeneic HCT (OR, .99; 95% CI, .60 to 1.66; P = .98) were not associated with higher hospital mortality compared with the no-HCT cohort, adjusting for demographic, functional, clinical, malignancy, and ARF characteristics. The results were similar when analyzed using propensity score-matching techniques. Our findings indicate that autologous and allogeneic HCT recipients who develop ARF and require ICU admission have similar hospital mortality as patients with HM not treated with HCT.

Published
2021

22. Bacteremia in critically ill immunocompromised patients with acute hypoxic respiratory failure: A post-hoc analysis of a prospective multicenter multinational cohort

Author

Louw, A. van de, Rello, J., Martin-Loeches, I., Mokart, D., Metaxa, V., Benoit, D., Barratt-Due, A., Soares, M., Pickkers, P., Antonelli, M., Demoule, A., Schellongowski, P., Kouatchet, A., Mehta, S., Balik, M., Bauer, P.R., Lemiale, V., Walter, V., Azoulay, E., Louw, A. van de, Rello, J., Martin-Loeches, I., Mokart, D., Metaxa, V., Benoit, D., Barratt-Due, A., Soares, M., Pickkers, P., Antonelli, M., Demoule, A., Schellongowski, P., Kouatchet, A., Mehta, S., Balik, M., Bauer, P.R., Lemiale, V., Walter, V., and Azoulay, E.

Abstract

Contains fulltext : 245016.pdf (Publisher’s version ) (Closed access), PURPOSE: The characteristics and impact of bacteremia have not been widely investigated in immunocompromised patients with acute respiratory failure (ARF). METHODS: We performed a secondary analysis of a prospective cohort of immunocompromised patients with ARF (EFRAIM study). After exclusion of blood cultures positive for coagulase negative Staphylococci, we compared patients with (n = 236) and without (n = 1127) bacteremia. RESULTS: The incidence of bacteremia was 17%. Bacterial pneumonia and extra-pulmonary ARDS were the main causes of ARF in bacteremic patients. Bacteremia involved gram negative rods (48%), gram positive cocci (40%) or were polymicrobial (10%). Bacteremic patients had more hematological malignancy, higher SOFA scores and increased organ support within 7 days. Bacteremia was associated with higher crude ICU mortality (40% versus 32%, p = 0.02), but neither hospital (49% versus 44%, p = 0.17) nor 90-day mortality (60% versus 56%, p = 0.25) were different from non-bacteremic patients. After propensity score matching based on baseline characteristics, the difference in ICU mortality lost statistical significance (p = 0.06), including in a sensitivity analysis restricted to patients with pneumonia. CONCLUSIONS: We analyzed a large population of immunocompromised patients with ARF and an incidence of bacteremia of 17%. We could not demonstrate an impact of bacteremia on mortality after adjusting for baseline characteristics.

Published
2021

25. Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study

Author

Demoule, A., Antonelli, M., Schellongowski, P., Pickkers, P., Soares, M., Meyhoff, T., Rello, J., Bauer, P.R., Louw, A. van de, Lemiale, V., Grimaldi, D., Martin-Loeches, I., Balik, M., Mehta, S., Kouatchet, A., Barratt-Due, A., Valkonen, M., Reignier, J., Metaxa, V., Moreau, A.S., Burghi, G., Mokart, D., Mayaux, J., Darmon, M., and Azoulay, E.

Subjects
lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4]
Abstract

Contains fulltext : 229309.pdf (Publisher’s version ) (Closed access) BACKGROUND: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement. RESEARCH QUESTION: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]). STUDY DESIGN AND METHODS: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality. RESULTS: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality. INTERPRETATION: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.

Published
2020

27. Antimicrobial Stewardship in Hematological Patients at the intensive care unit: a global cross-sectional survey from the Nine-i Investigators Network

Author

Rello J., Sarda C., Mokart D., Arvaniti K., Akova M., Tabah A., Azoulay E, Montini, Luca, Montini L (ORCID:0000-0003-4602-5134), Rello J., Sarda C., Mokart D., Arvaniti K., Akova M., Tabah A., Azoulay E, Montini, Luca, and Montini L (ORCID:0000-0003-4602-5134)

Abstract

A global cross-sectional survey was performed to gather data on the current treatment of infections caused by multidrug-resistant (MDR) bacteria among hematological patients admitted to ICUs worldwide. The survey was performed in April 2019 using an electronic platform (SurveyMonkey®) being distributed among 83 physicians and completed by 48 (57.8%) responders. ESBL Enterobacteriaceae, carbapenem-resistant K. pneumoniae and carbapenem-resistant P. aeruginosa were the main concerns. Previous MDR infection (34% of responders), MDR colonization (20%) and previous antibiotic exposure within the last 3 months (20.5%) were considered the most relevant risk factors of bloodstream infection (BSI) due to MDR bacteria. In 48.8% of the ICUs, there was no antimicrobial stewardship (AMS) team focused on hematological patients. Updates on local epidemiology of MDR pathogens were provided in 98% of the centers, using phone or verbal communications (56.1% and 53.7%, respectively). In presence of febrile neutropenia, initial therapy consisted of anti-Gram-negative plus anti-Gram-positive antibiotics for 41% of participants. Antibiotic de-escalation and/or discontinuation of therapy were considered as a promising strategy for the prevention of MDR development (32.4%). Factors associated with antibiotic de-escalation were clinical improvement (43.6%) and neutrophil count recovery (12.8%). Infectious Disease consultation and AMS interventions were not determining factors for de-escalation decisions (more than 50% of responders). Infection control and educational programs were valued as necessary measures for implementation by ICU practitioners. These findings should guide future efforts on collaborative team working, improving compliance with adequate treatment protocols, implementing antimicrobial stewardship programs in critically ill hematological patients, and educational activities.

Published
2020

31. Patient care pathway hypnosedation in endo urology: An innovative alternative to general anesthesia

Author

Fakhfakh, S., primary, Pouliquen, C., additional, Campagna, J., additional, Loverde, K., additional, Treacy, P., additional, Maubon, T., additional, Rybikowski, S., additional, Cambon, S., additional, Nguyen, L., additional, Deguibert, J., additional, Laurent, M.A., additional, Aveno, J., additional, Bokor, E., additional, Demontis, C., additional, Forestier, C., additional, Bereni, F., additional, Galland, J., additional, Montoya, C., additional, Mejri, I., additional, Cea, C., additional, Faucher, M., additional, Mokart, D., additional, Pignot, G., additional, and Walz, J., additional

Published
2020
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34. Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy

Author

Bauer, Pr, Chevret, S, Yadav, H, Mehta, S, Pickkers, P, Bukan, Rb, Rello, J, van de Louw, A, Klouche, K, Meert, Ap, Martin-Loeches, I, Marsh, B, Crespi, Ls, Moreno-Gonzalez, G, Buchtele, N, Amrein, K, Balik, M, Antonelli, Massimo, Nyunga, M, Barratt-Due, A, Bergmans, Dcjj, Spoelstra-de Man, Ame, Kuitunen, A, Wallet, F, Seguin, A, Metaxa, V, Lemiale, V, Burghi, G, Demoule, A, Karvunidis, T, Cotoia, A, Klepstad, P, Moller, Am, Mokart, D, Azoulay, E, Rabbat, A, Darmon, M, Platon, L, Mayaux, J, Chermak, A, Lemaitre, C, Artaud-Macari, E, Nelsen, J, Kaufmann, T, Viana, W, Lishoa, T, Correa, Td, Encina, B, Socias, A, Manez, R, Rodriguez-Ruis, E, Benoit, D, Staudinger, T, Heinz, G, Sengolge, G, Zauner, C, Jaksch, P, Mcmahon, A, Martin, B, Cinnella, G, Shah, S, Hemelaar, P, Taccone, Fs, Salluh, J, Schellongowski, P, Rusinova, K, Terzi, N, Kouatchet, A, Valkonen, M, Bruneel, F, Pene, F, Moreau, As, Girault, C, Silva, Uva, Montini, Luca, Barbier, F, Gaborit, B, Viana, Wn, de Moraes, App, Moralez, Gm, Vinatier, I, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de biostatistiques et information médicale [Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPC), University of Toronto, Radboud University Medical Center [Nijmegen], Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III [Madrid] (ISC), Vall d'Hebron University Hospital [Barcelona], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Institut Jules Bordet [Bruxelles], Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Université libre de Bruxelles (ULB), St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Universitat de Barcelona (UB), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Service de réanimation médicale [CHU Caen], 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), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université (SU), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Neurophysiologie Respiratoire Expérimentale et Clinique, Intensive Care, MUMC+: MA Medische Staf IC (9), MUMC+: MA Arts Assistenten IC (9), RS: NUTRIM - R2 - Liver and digestive health, Intensive care medicine, ACS - Atherosclerosis & ischemic syndromes, and ACS - Diabetes & metabolism

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, [SDV]Life Sciences [q-bio], lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], BRONCHOALVEOLAR LAVAGE, HEMATOLOGIC MALIGNANCIES, law.invention, 03 medical and health sciences, 0302 clinical medicine, All institutes and research themes of the Radboud University Medical Center, Bronchoscopy, law, Settore MED/41 - ANESTESIOLOGIA, Severity of illness, FLEXIBLE BRONCHOSCOPY, medicine, 030212 general & internal medicine, Prospective cohort study, UTILITY, medicine.diagnostic_test, business.industry, GROUPE, Diagnosis outcome acute respiratory failure immunocompromised patients, Intensive care unit, 3. Good health, ONCOLOGY PATIENTS, Bronchoalveolar lavage, YIELD, 030228 respiratory system, Respiratory failure, INFECTIONS, SAFETY, Propensity score matching, Emergency medicine, Observational study, Pneumologie, business
Abstract

OBJECTIVE: We wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an inability to identify the cause of acute hypoxaemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with noninvasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain. PATIENTS AND METHODS: This was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to the intensive care unit (ICU). We compared patients with noninvasive testing only to those who had also received bronchoscopy by bivariate analysis and after propensity score matching. RESULTS: Bronchoscopy was performed in 618 (39%) patients who were more likely to have haematological malignancy and a higher severity of illness score. Bronchoscopy alone achieved a diagnosis in 165 patients (27% adjusted diagnostic yield). Bronchoscopy resulted in a management change in 236 patients (38% therapeutic yield). Bronchoscopy was associated with worsening of respiratory status in 69 (11%) patients. Bronchoscopy was associated with higher ICU (40% versus 28%; p, SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2019

35. PACMAN trial protocol, Perioperative Administration of Corticotherapy on Morbidity and mortality After Non-cardiac major surgery: a randomised, multicentre, double-blind, superiority study

Author

Asehnoune, Karim, Futier, Emmanuel, Feuillet, Fanny, Roquilly, Antoine, Lasocki, Sigismond, Huet, Olivier, Bazin, Jean Etienne, Paugam Burtz, Catherine, Le Moal, C, Lebuffe, G., Belliard, Guillaume, Rimmele, Thomas, Piriou, Vincent, Bruder, Nicolas, Marc, Leone, Mokart, D., Jaber, Samir, Chatel-Josse, Nolwen, Rozec, Bertrand, Simonneau, Frederic, Capron, F., Cuvillon, Philippe, Beaussier, Marc, Plaud, Benoit, Mantz, J., Debaenne, Bertrand, Charbit, B., Beloeil, Helene, Dureuil, Bertrand, Molliex, Serge, Pottecher, Julien, Geeraerts, Thomas, Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Clermont-Ferrand, Biostatistique, Recherche Clinique et Mesures Subjectives en Santé, Université de Nantes (UN), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Centre hospitalier universitaire de Nantes [CHU Nantes], and Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)

Subjects
Male, Respiratory Tract Diseases, law.invention, Anaesthesia, surgery, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, Clinical Protocols, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Acute care, Protocol, 030212 general & internal medicine, Infusions, Intravenous, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, General Medicine, Middle Aged, 3. Good health, Surgical Procedures, Operative, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Corticosteroid, Female, Risk Adjustment, medicine.drug, medicine.medical_specialty, Critical Care, post-operative complications, medicine.drug_class, Trial protocol, dexamethasone, Placebo, Perioperative Care, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine, Humans, pneumonia, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, Mortality, Glucocorticoids, Dexamethasone, Inflammation, business.industry, Perioperative, Length of Stay, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Surgery, Pneumonia, glucocorticoid, business, 030217 neurology & neurosurgery
Abstract

IntroductionPostoperative complications are major healthcare problems and are associated with a reduced short-term and long-term survival after surgery. An excessive postoperative inflammatory response participates to the development of postoperative infection and mortality. The aim of the Perioperative Administration of Corticotherapy on Morbidity and mortality After Non-cardiac surgery (PACMAN) study is to assess the effectiveness of perioperative administration of corticosteroid to reduce postoperative morbidity and mortality in patients undergoing major non-cardiac surgery.Methods and analysisThe PACMAN is a multicentre, randomised, controlled, double-blind, superiority, two-arm trial of 1222 high-risk patients aged 50 years or older undergoing major non-cardiac surgery at 32 acute care hospital in France. Patients are randomly assigned to dexamethasone (0.2 mg/kg at the end of the surgical procedure and at day +1, n=611) or to placebo (n=611). The primary outcome is a composite of predefined 14-day major pulmonary complications and mortality. Secondary outcomes are surgical complications, infections, organ failures, critical care-free days, length of hospital stay and all-cause mortality at 28 days.Ethics and disseminationThe PACMAN trial protocol has been approved by the ethics committee of Sud Mediterranée V, and will be carried out according to the Good Clinical Practice guidelines and the principles of the Declaration of Helsinki. The PACMAN trial is a randomised controlled trial powered to investigate whether perioperative administration of corticosteroids in patients undergoing non-cardiac major surgery reduces postoperative complications. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals.Trial registration numberNCT03218553; Pre-results.

Published
2019

36. Changes in critically ill cancer patients' short-term outcome over the last decades: results of systematic review with meta-analysis on individual data

Author

Darmon, M, Bourmaud, A, Georges, Q, Soares, M, Jeon, K, Oeyen, S, Rhee, CK, Gruber, P, Ostermann, M, Hill, QA, Depuydt, P, Ferra, C, Toffart, AC, Schellongowski, P, Muller, A, Lemiale, V, Mokart, D, and Azoulay, E

Subjects
Intensive care units, Mechanical ventilation, Neutropenia, Outcomes, Hematologic neoplasms, Prognosis
Abstract

PurposeThe number of averted deaths due to therapeutic advances in oncology and hematology is substantial and increasing. Survival of critically ill cancer patients has also improved during the last 2decades. However, these data stem predominantly from unadjusted analyses. The aim of this study was to assess the impact of ICU admission year on short-term survival of critically ill cancer patients, with special attention on those with neutropenia.MethodsSystematic review and meta-analysis of individual data according to the guidelines of meta-analysis of observational studies in epidemiology.DatasourcePubmed and Cochrane databases.Eligibility criteriaAdult studies published in English between May 2005 and May 2015.ResultsOverall, 7354 patients were included among whom 1666 presented with neutropenia at ICU admission. Median ICU admission year was 2007 (IQR 2004-2010; range 1994-2012) and median number of admissions per year was 693 (IQR 450-1007). Overall mortality was 47.7%. ICU admission year was associated with a progressive decrease in hospital mortality (OR per year 0.94; 95% CI 0.93-0.95). After adjustment for confounders, year of ICU admission was independently associated with hospital mortality (OR for hospital mortality per year: 0.96; 95% CI 0.95-0.97). The association was also seen in patients with neutropenia but not in allogeneic stem cell transplant recipients.ConclusionAfter adjustment for patient characteristics, severity of illness and clustering, hospital mortality decreased steadily over time in critically ill oncology and hematology patients except for allogeneic stem cell transplant recipients.

Published
2019

39. Influenza and associated co-infections in critically ill immunosuppressed patients

Author

Martin-Loeches, I., Lemiale, V., Geoghegan, P., McMahon, M.A., Pickkers, P., Soares, M., Perner, A., Meyhoff, T.S., Bukan, R.B., Rello, J., Bauer, P.R., Louw, A. van de, Taccone, F.S., Salluh, J., Hemelaar, P., Schellongowski, P., Rusinova, K., Terzi, N., Mehta, S., Antonelli, M., Kouatchet, A., Klepstad, P., Valkonen, M., Landburg, P.P., Barratt-Due, A., Bruneel, F., Pene, F., Metaxa, V., Moreau, A.S., Souppart, V., Burghi, G., Girault, C., Silva, U.V.A., Montini, L., Barbier, F., Nielsen, L.B., Gaborit, B., Mokart, D., Chevret, S., Azoulay, E., Martin-Loeches, I., Lemiale, V., Geoghegan, P., McMahon, M.A., Pickkers, P., Soares, M., Perner, A., Meyhoff, T.S., Bukan, R.B., Rello, J., Bauer, P.R., Louw, A. van de, Taccone, F.S., Salluh, J., Hemelaar, P., Schellongowski, P., Rusinova, K., Terzi, N., Mehta, S., Antonelli, M., Kouatchet, A., Klepstad, P., Valkonen, M., Landburg, P.P., Barratt-Due, A., Bruneel, F., Pene, F., Metaxa, V., Moreau, A.S., Souppart, V., Burghi, G., Girault, C., Silva, U.V.A., Montini, L., Barbier, F., Nielsen, L.B., Gaborit, B., Mokart, D., Chevret, S., and Azoulay, E.

Abstract

Contains fulltext : 206594.pdf (publisher's version ) (Open Access), BACKGROUND: It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. METHODS: Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. RESULTS: Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. CONCLUSIONS: Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was associat

Published
2019

40. Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy

Author

Bauer, P. R., Chevret, S., Yadav, H., Mehta, S., Pickkers, P., Bukan, R. B., Rello, J., van de Louw, A., Klouche, K., Meert, A. -P., Martin-Loeches, I., Marsh, B., Crespi, L. S., Moreno-Gonzalez, G., Buchtele, N., Amrein, K., Balik, M., Antonelli, Massimo, Nyunga, M., Barratt-Due, A., Bergmans, D. C. J. J., Spoelstra-De Man, A. M. E., Kuitunen, A., Wallet, F., Seguin, A., Metaxa, V., Lemiale, V., Burghi, G., Demoule, A., Karvunidis, T., Cotoia, A., Klepstad, P., Moller, A. M., Mokart, D., Azoulay, E., Antonelli M. (ORCID:0000-0003-3007-1670), Bauer, P. R., Chevret, S., Yadav, H., Mehta, S., Pickkers, P., Bukan, R. B., Rello, J., van de Louw, A., Klouche, K., Meert, A. -P., Martin-Loeches, I., Marsh, B., Crespi, L. S., Moreno-Gonzalez, G., Buchtele, N., Amrein, K., Balik, M., Antonelli, Massimo, Nyunga, M., Barratt-Due, A., Bergmans, D. C. J. J., Spoelstra-De Man, A. M. E., Kuitunen, A., Wallet, F., Seguin, A., Metaxa, V., Lemiale, V., Burghi, G., Demoule, A., Karvunidis, T., Cotoia, A., Klepstad, P., Moller, A. M., Mokart, D., Azoulay, E., and Antonelli M. (ORCID:0000-0003-3007-1670)

Abstract

Objective: We wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an inability to identify the cause of acute hypoxaemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with noninvasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain. Patients and methods: This was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to the intensive care unit (ICU). We compared patients with noninvasive testing only to those who had also received bronchoscopy by bivariate analysis and after propensity score matching. Results: Bronchoscopy was performed in 618 (39%) patients who were more likely to have haematological malignancy and a higher severity of illness score. Bronchoscopy alone achieved a diagnosis in 165 patients (27% adjusted diagnostic yield). Bronchoscopy resulted in a management change in 236 patients (38% therapeutic yield). Bronchoscopy was associated with worsening of respiratory status in 69 (11%) patients. Bronchoscopy was associated with higher ICU (40% versus 28%; p<0.0001) and hospital mortality (49% versus 41%; p=0.003). The overall rate of undiagnosed causes was 13%. After propensity score matching, bronchoscopy remained associated with increased risk of hospital mortality (OR 1.41, 95% CI 1.08–1.81). Conclusions: Bronchoscopy was associated with improved diagnosis and changes in management, but also increased hospital mortality. Balancing risk and benefit in individualised cases should be investigated further.

Published
2019

43. A Multivariable Prediction Model for Pneumocystis jirovecii Pneumonia in Hematology Patients with Acute Respiratory Failure

Author

Azoulay, E., Roux, A., Vincent, F., Kouatchet, A., Argaud, Laurent, Rabbat, A., Mayaux, J., Perez, P., Pene, F., Nyunga, M., Bruneel, F., Klouche, K., Mokart, D., Darmon, M., Chevret, S., Lemiale, V., Grp Rech Reanimation, Resp, CarMeN, laboratoire, Hôpital Saint-Louis, Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Foch Hosp, Resp & Lung Transplant Unit, Suresnes, France, Laboratoire d'études spatiales et d'instrumentation en astrophysique (LESIA), Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7)-Observatoire de Paris, PSL Research University (PSL)-PSL Research University (PSL)-Institut national des sciences de l'Univers (INSU - CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC), Service de Réanimation Médicale et de Médecine Hyperbare [Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de Versailles (CHV), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Neuropsychopharmacologie, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service greffe de moelle osseuse, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7), Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut national des sciences de l'Univers (INSU - CNRS)-Observatoire de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Centre Hospitalier de Versailles André Mignot (CHV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
diagnosis, [SDV]Life Sciences [q-bio], Respiratory System, leukemia, noninvasive ventilation, insights, invasive fungal infection, colonization, carinii-pneumonia, mortality, infection, [SDV] Life Sciences [q-bio], immunocompromised, General & Internal Medicine, immunocompromised patients, malignancies, groupe, strategy, transplantation
Abstract

International audience; Rationale: The incidence of Pneumocystis jirovecii pneumonia (PjP) is rising. Longer time to treatment is associated with higher mortality. Objectives: To develop a multivariable risk prediction model for PjP diagnosis. Methods: In a prospective multicenter cohort of ICU patients with hematological malignancies and acute respiratory failure, factors associated with documented PjP were identified. The risk prediction model was tested in an independent prospective multicenter cohort. We assessed discrimination (by areas under the receiver operating characteristic curves [AUCs]) and goodness of fit (by Hosmer-Lemeshow statistics). Model performance was assessed using 30 sets of imputed data sets. Measurements and Main Results: Among the 1,330 patients, 134 of 1,092 (12.3%; 95% confidence interval [CI], 10.4-14.4%) had proven PjP in the derivation cohort, as did 15 of 238 (6.3%, 95% CI, 3.6-10.2%) in the validation cohort. The model included age, lymphoproliferative disease, anti-Pneumocystis prophylaxis, the number of days between respiratory symptom onset and ICU admission, shock, chest radiograph pattern, and pleural effusion. The median (interquartile range) score was 3.5 (1.5-5.0) (range, 23.5 to 8.5) in the derivation cohort and 1.0 (0-2.0) (range, 23.5 to 6.0) in the validation cohort. The best threshold was defined on the validation sample as 3, allowing us to reach 86.7% sensitivity and 67.7% specificity for PjP, with a negative predictive value of 97.9% in the case of 10% prevalence. The score had good calibration (goodness of fit, -0.75) and discrimination in the derivation cohort (mean AUC, 0.80; 95% CI, 0.76-0.84) and validation cohort (mean AUC, 0.83; 95% CI, 0.72-0.93). Conclusions: The PjP score for hematology patients with acute respiratory failure can be computed at admission, based on readily available variables. Potential clinical benefits of using this score deserve assessment.

Published
2018

44. Évaluation de la satisfaction des patients pris en charge dans le protocole de réhabilitation améliorée après chirurgie (RAAC) en urologie à l’aide d’un questionnaire validé « EVAN-G »

Author

Fakhfakh, S., primary, Pouliquen, C., additional, Rekik, S., additional, Campagna, J., additional, Walz, J., additional, Brun, C., additional, Tourret, M., additional, Faucher, M., additional, Mokart, D., additional, Picini, M., additional, Massacrier, S., additional, Boulant, S., additional, Cini, E., additional, and Pignot, G., additional

Published
2019
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45. Parcours patient hypno-sédation en endo UROLOGIE : une alternative innovante à l’anesthésie générale

Author

Fakhfakh, S., primary, Pouliquen, C., additional, Rekik, S., additional, Campagna, J., additional, Walz, J., additional, Cambon, S., additional, Nguyen, L., additional, Deguibert, J., additional, Laurent, M., additional, Bokor, E., additional, Demontis, C., additional, Forestier, C., additional, Galland, J., additional, Montoya, C., additional, Mejri, I., additional, Faucher, M., additional, Mokart, D., additional, and Pignot, G., additional

Published
2019
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46. Pneumonies associées aux soins de réanimation* RFE commune SFAR–SRLF

Author

Leone, M., primary, Bouadma, L., additional, Bouhemad, B., additional, Brissaud, O., additional, Dauger, S., additional, Gibot, S., additional, Hraiech, S., additional, Jung, B., additional, Kipnis, E., additional, Launey, Y., additional, Luyt, C.E., additional, Margetis, D., additional, Michel, F., additional, Mokart, D., additional, Montravers, P., additional, Monsel, A., additional, Nseir, S., additional, Pugin, J., additional, Roquilly, A., additional, Velly, L., additional, Zahar, J.R., additional, Bruyère, R., additional, and Chanques, G., additional

Published
2019
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49. Intracerebral hemorrhage in ICU: is it worth treating?

Author

Sivakumar, S, Taccone, F, Desai, K, Lazaridis, C, Skarzynski, M, Sekhon, M, Henderson, W, Griesdale, D, Chapple, L, Deane, A, Williams, L, Strickland, R, Lange, K, Heyland, D, Chapman, M, Rowland, M, Garry, P, Westbrook, J, Corkill, R, Antoniades, C, Pattinson, K, Fatania, G, Strong, A, Myers, R, Jermaine, C, Robertson, C, Rusin, C, Hofmeijer, J, Sondag, L, Tjepkema Cloostermans, M, Beishuizen, A, Bosch, F, van Putten, M, Carteron, L, Patet, C, Solari, D, Oddo, M, Ali, M, Dias, C, Almeida, R, Vaz Ferreira, A, Silva, J, Monteiro, E, Cerejo, A, Rocha, A, Elsayed, A, Abougabal, A, Beshey, B, Alzahaby, K, Pozzebon, S, Ortiz, A, Cristallini, S, Lheureux, O, Brasseur, A, Vincent, J, Creteur, J, Hravnak, M, Yousef, K, Chang, Y, Crago, E, Friedlander, R, Abdelmonem, S, Tahon, S, Helmy, T, Meligy, H, Puig, F, Dunn Siegrist, I, Pugin, J, Gupta, S, Govil, D, Srinivasan, S, Patel, S, N, J, Gupta, A, Tomar, D, Shafi, M, Harne, R, Arora, D, Talwar, N, Mazumdar, S, Papakrivou, E, Makris, D, Manoulakas, E, Tsolaki, B, Karadodas, B, Zakynthinos, E, Garcia, I, Martin, A, Encinares, V, Ibañez, M, Montero, J, Labrador, G, Cangueiro, T, Poulose, V, Koh, J, Kam, J, Yeter, H, Kara, A, Aktepe, O, Topeli, A, Tsolakoglou, I, Intas, G, Stergiannis, P, Kolaros, A, Chalari, E, Athanasiadou, E, Martika, A, Fildisis, G, Faivre, V, Mengelle, C, Favier, B, Payen, D, Poppe, A, Winkler, M, Mudersbach, E, Schreiber, J, Wruck, M, Schwedhelm, E, Kluge, S, Zöllner, C, Tavladaki, T, Spanaki, A, Dimitriou, H, Kondili, E, Choulaki, C, Meleti, E, Kafetzopoulos, D, Georgopoulos, D, Briassoulis, G, la Torre, A, de la Torre Prados, M, Tsvetanova Spasova, T, Nuevo Ortega, P, Rueda Molina, C, Fernández Porcel, A, Camara Sola, E, Salido Díaz, L, García Alcántara, A, Meleti, D, Suberviola, B, Riera, J, Rellan, L, Sanchez, M, Robles, J, Lopez, E, Vicente, R, Miñambres, E, Santibañez, M, Le Guen, M, Moore, J, Mason, N, Windpassinger, M, Plattner, O, Mascha, E, Sessler, D, Research, O, Melia, U, Fontanet, J, van den Berg, J, Struys, M, Vereecke, H, Jensen, E, Rood, P, van de Schoor, F, van Tertholen, K, Pickkers, P, van den Boogaard, M, Beardow, Z, Redhead, H, Paramasivam, K, Numan, T, Kamper, A, Peelen, L, Zeman, P, Slooter, A, van Ewijk, C, Jacobs, G, Girbes, A, Myatra, S, Harish, M, Prabu, N, Siddiqui, S, Kulkarni, A, Divatia, J, Murbach, L, Leite, M, Osaku, E, Costa, C, Pelenz, M, Neitzke, N, Moraes, M, Jaskowiak, J, Silva, M, Zaponi, R, Abentroth, L, Ogasawara, S, Jorge, A, Duarte, P, Hernández Sánchez, N, Sánchez Hurtado, L, García Guillen, F, Ñamendys Silva, S, Maghsoudi, B, Emami, M, Khosravi, M, Zand, F, Tabatabaie, H, Masjedi, M, Sabetiyan, G, Mokri, A, Troubleyn, J, Diltoer, M, Jacobs, R, Nguyen, D, De Waele, E, De Regt, J, Honoré, P, Van Gorp, V, Spapen, H, Contreras, R, Toapanta, N, Moreno, G, Sabater, J, Torrado, H, Gonzalez, M, Marin, M, Farigola, E, Gonzalez, A, Fernandez, J, Vera, A, Gisbert, X, Juliá, C, Uya, J, Corral, L, Elias Jones, I, Gemmell, L, Mackay, A, Randall, D, Adwaney, A, Blunden, M, Prowle, J, Kirwan, C, Thomas, N, Owen, H, Darwin, L, Conway, D, Atkinson, D, Sharman, M, Barbanti, C, Amour, J, Gaudard, P, Rozec, B, Mauriat, P, M'Rini, M, Leger, P, Cambonie, G, Liet, J, Girard, C, Laroche, S, Damas, P, Assaf, Z, Loron, G, Lecourt, L, Pouard, P, Kim, S, Na, S, Kim, J, Oh, S, Jung, C, Yoo, S, Min, S, Chung, E, Lee, H, Lee, N, Lee, K, Suh, K, Ryu, H, Marshall, D, Goodson, R, Salciccioli, J, Shalhoub, J, Potter, E, Kirk Bayley, J, Karanjia, N, Forni, L, Creagh Brown, B, Bossy, M, Nyman, M, Tailor, A, D'Antini, D, Spadaro, S, Valentino, F, Sollitto, F, Cinnella, G, Mirabella, L, Calvo, F, Bejarano, N, Padilla, D, Baladron, V, Villajero, P, Villazala, R, Redondo, J, Yuste, A, Liu, J, Shen, F, Teboul, J, Anguel, N, Beurton, A, Bezaz, N, Richard, C, Monnet, X, Fossali, T, Colombo, R, Ottolina, D, Rossetti, M, Mazzucco, C, Marchi, A, Porta, A, Catena, E, Tollisen, K, Andersen, G, Heyerdahl, F, Jacobsen, D, de Waard, M, van IJzendoorn, M, Buter, H, Kingma, W, Navis, G, Boerma, E, Rulisek, J, Balik, M, Zacharov, S, Kim, H, Jeon, S, Namgung, H, Lee, E, Cho, Y, Lee, Y, Huang, A, Cioccari, L, Luethi, N, Mårtensson, J, Bellomo, R, Forsberg, M, Edman, G, Höjer, J, Forsberg, S, Freile, M, Hidalgo, F, Molina, J, Lecumberri, R, Rosselló, A, Travieso, P, Leon, G, Sanchez, J, Frias, L, Rosello, D, Verdejo, J, Serrano, J, Winterwerp, D, van Galen, T, Vazin, A, Karimzade, I, Zand, A, Ozen, E, Ekemen, S, Akcan, A, Sen, E, Yelken, B, Kureshi, N, Fenerty, L, Thibault Halman, G, Erdogan, M, Walling, S, Green, R, Clarke, D, Briassoulis, P, Kalimeris, K, Ntzouvani, A, Nomikos, T, Papaparaskeva, K, Politi, E, Kostopanagiotou, G, Crewdson, K, Rehn, M, Weaver, A, Brohi, K, Lockey, D, Wright, S, Thomas, K, Baker, C, Mansfield, L, Stafford, V, Wade, C, Watson, G, Bryant, A, Chadwick, T, Shen, J, Wilkinson, J, Furneval, J, Henderson, A, Hugill, K, Howard, P, Roy, A, Bonner, S, Baudouin, S, Ramírez, C, Escalada, S, Viera, M, Santana, M, Balcázar, L, Monroy, N, Campelo, F, Vázquez, C, Santana, P, Santana, S, Quintard, H, Bouzat, P, Wollersheim, T, Malleike, J, Haas, K, Carbon, N, Schneider, J, Birchmeier, C, Fielitz, J, Spuler, S, Weber Carstens, S, Enseñat, L, Pérez Madrigal, A, Saludes, P, Proença, L, Gruartmoner, G, Espinal, C, Mesquida, J, Huber, W, Eckmann, M, Elkmann, F, Gruber, A, Lahmer, T, Mayr, U, Herner, A, Schellnegger, R, Schmid, R, Ayoub, W, Samy, W, Esmat, A, Battah, A, Mukhtar, S, Mongkolpun, W, Cortés, D, Cordeiro, C, Funcke, S, Groesdonk, H, Saugel, B, Wagenpfeil, G, Wagenpfeil, S, Reuter, D, Fernandez, M, Fernandez, R, Magret, M, González Castro, A, Bouza, M, García, C, Balerdi, B, Mas, A, Arauzo, V, Añón, J, Ruiz, F, Ferreres, J, Tomás, R, Alabert, M, Tizón, A, Altaba, S, Llamas, N, Goligher, E, Fan, E, Herridge, M, Vorona, S, Sklar, M, Dres, M, Rittayamai, N, Lanys, A, Urrea, C, Tomlinson, G, Reid, W, Rubenfeld, G, Kavanagh, B, Brochard, L, Ferguson, N, Neto, A, de Abreu, M, Pelosi, P, Schultz, M, Guérin, C, 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Subjects
intracerebral haemorrhage in intensive care
Published
2016

50. Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA

Author

Benoit, D.D. (Dominique), Jensen, H.I. (H. I.), Malmgren, J. (J.), Metaxa, V. (V.), Reyners, A.K.L. (Anna), Darmon, M. (M.), Rusinova, K. (K.), Talmor, D. (Daniel), Meert, A.P. (A. P.), Cancelliere, L. (L.), Zubek, L. (L.), Maia, P. (P.), Michalsen, A. (A.), Vanheule, S. (S.), Kompanje, E.J.O. (E. J.O.), Decruyenaere, J. (J.), Vandenberghe, S. (S.), Vansteelandt, S. (Stijn), Gadeyne, B. (B.), van Den Bulcke, B. (B.), Azoulay, E. (Elie), Piers, R.D. (Ruth), Spapen, H., van Malderen, M.-C. (Marie-Claire), Opdenacker, G. (Godelieve), Meyfroidt, G. (Geert), Mesotten, D., Wauters, J. (Joost), van Laer, M. (Marie), Wilmer, A. (Alexander), Ceunen, H. (H.), De Laet, I. (Inneke), Jans, A. (Anita), Benoit, D. (Dominique), Oeyen, S. (Sandra), Herck, I. (Ingrid), Bracke, S. (Stephanie), Clauwaert, C. (Charlotte), Meert, A.-P. (Anne-Pascale), Leclercq, N. (Nathalie), Jacques, D. (Devriendt), Philippe, D. (Dechamps), Zykova, I. (Ivana), Malaska, J. (Jan), Schmidt, M. (Matous), Satinsky, I. (Igor), Kieslichova, E. (Eva), Krizova, J. (Jarmila), Janda, R. (Robert), Fortova, M. (Magdalena), Matyas, J. (Jiri), Rusinova, K. (Katerina), Kopecky, O. (Ondrej), Pedersen, C.A.K. (Christian Alves Køhler), Hebsgaard, S. (Stine), Johnsen, R.F.A. (Rikke Frank Aagaard), Hansen, T.C.B. (Tina Charlotte Bitsch), Darmon, M. (Michael), Reuter, D. (Danielle), Mokart, D. (Djamel), Vincent, F. (François), Hartog, C.S. (Christiane), Gretenkort, P. (Peter), Michalsen, A. (Andrej), Kounougeri, A. (Aikaterini), Nanas, S. (Serafim), Papachristou, D. (Despina), Soultati, I. (Ioanna), Lathyris, D. (Dimitrios), Pasakiotou, M. (Marili), Oikonomou, M. (Marina), Elö, G. (Gabor), Szücs, O. (Orsolya), Fogas, J. (János), Bobek, I. (Ilona), Corte, F.D. (Francesco Della), Olivieri, C. (Carlo), Vaschetto, R. (Rosanna), Cancelliere, L. (Laura), Marinangeli, F. (Franco), Pozone, T. (Tullio), Ciccozzi, A. (Alessandra), Schouten, A. (A.), Bruns, M. (Monique), Gerritsen, R.T. (Rik T.), Koopmans, M. (Matty), Kompanje, E.J.O. (Erwin), van Duijn, M.A.J. (Marijtje A. J.), Zijlstra, J.G. (Jan G.), Reyners, A.K. (Anne KL.), Lutisan, J.G. (Johan), Monte, R. (Raquel), Pinho, J.A. (José António), Pimenta, P. (Pedro), Fernandes, P. (Paula), Paixão, A.I. (Ana Isabel), Faria, R. (Rui), Malmgren, J.A. (Johan A.), Andersson, B. (Bertil), Akerman, E. (Eva), Hvarfner, A. (Andreas), Svensson, R. (Robert), Metaxa, V. (Victoria), Mueller, A. (Ariel), Banner-Goodspeed, V. (Valerie), Rickett, D. (Dee), Wilson, M.E. (Michael E.), Hinds, R. (Richard), Benoit, D.D. (Dominique), Jensen, H.I. (H. I.), Malmgren, J. (J.), Metaxa, V. (V.), Reyners, A.K.L. (Anna), Darmon, M. (M.), Rusinova, K. (K.), Talmor, D. (Daniel), Meert, A.P. (A. P.), Cancelliere, L. (L.), Zubek, L. (L.), Maia, P. (P.), Michalsen, A. (A.), Vanheule, S. (S.), Kompanje, E.J.O. (E. J.O.), Decruyenaere, J. (J.), Vandenberghe, S. (S.), Vansteelandt, S. (Stijn), Gadeyne, B. (B.), van Den Bulcke, B. (B.), Azoulay, E. (Elie), Piers, R.D. (Ruth), Spapen, H., van Malderen, M.-C. (Marie-Claire), Opdenacker, G. (Godelieve), Meyfroidt, G. (Geert), Mesotten, D., Wauters, J. (Joost), van Laer, M. (Marie), Wilmer, A. (Alexander), Ceunen, H. (H.), De Laet, I. (Inneke), Jans, A. (Anita), Benoit, D. (Dominique), Oeyen, S. (Sandra), Herck, I. (Ingrid), Bracke, S. (Stephanie), Clauwaert, C. (Charlotte), Meert, A.-P. (Anne-Pascale), Leclercq, N. (Nathalie), Jacques, D. (Devriendt), Philippe, D. (Dechamps), Zykova, I. (Ivana), Malaska, J. (Jan), Schmidt, M. (Matous), Satinsky, I. (Igor), Kieslichova, E. (Eva), Krizova, J. (Jarmila), Janda, R. (Robert), Fortova, M. (Magdalena), Matyas, J. (Jiri), Rusinova, K. (Katerina), Kopecky, O. (Ondrej), Pedersen, C.A.K. (Christian Alves Køhler), Hebsgaard, S. (Stine), Johnsen, R.F.A. (Rikke Frank Aagaard), Hansen, T.C.B. (Tina Charlotte Bitsch), Darmon, M. (Michael), Reuter, D. (Danielle), Mokart, D. (Djamel), Vincent, F. (François), Hartog, C.S. (Christiane), Gretenkort, P. (Peter), Michalsen, A. (Andrej), Kounougeri, A. (Aikaterini), Nanas, S. (Serafim), Papachristou, D. (Despina), Soultati, I. (Ioanna), Lathyris, D. (Dimitrios), Pasakiotou, M. (Marili), Oikonomou, M. (Marina), Elö, G. (Gabor), Szücs, O. (Orsolya), Fogas, J. (János), Bobek, I. (Ilona), Corte, F.D. (Francesco Della), Olivieri, C. (Carlo), Vaschetto, R. (Rosanna), Cancelliere, L. (Laura), Marinangeli, F. (Franco), Pozone, T. (Tullio), Ciccozzi, A. (Alessandra), Schouten, A. (A.), Bruns, M. (Monique), Gerritsen, R.T. (Rik T.), Koopmans, M. (Matty), Kompanje, E.J.O. (Erwin), van Duijn, M.A.J. (Marijtje A. J.), Zijlstra, J.G. (Jan G.), Reyners, A.K. (Anne KL.), Lutisan, J.G. (Johan), Monte, R. (Raquel), Pinho, J.A. (José António), Pimenta, P. (Pedro), Fernandes, P. (Paula), Paixão, A.I. (Ana Isabel), Faria, R. (Rui), Malmgren, J.A. (Johan A.), Andersson, B. (Bertil), Akerman, E. (Eva), Hvarfner, A. (Andreas), Svensson, R. (Robert), Metaxa, V. (Victoria), Mueller, A. (Ariel), Banner-Goodspeed, V. (Valerie), Rickett, D. (Dee), Wilson, M.E. (Michael E.), and Hinds, R. (Richard)

Abstract

Purpose: Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown. Methods: In this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected daily during a 28-day period. The quality of the ethical climate in the ICUs was assessed via a validated questionnaire. We compared the combined endpoint (death, not at home or poor quality of life at 1 year) of patients with PECs and the time from PECs until written treatment-limitation decisions (TLDs) and death across the four climates defined via cluster analysis. Results: Of the 4747 eligible clinicians, 2992 (63%) evaluated the ethical climate in their ICU. Of the 321 and 623 patients not admitted for monitoring only in ICUs with a good (n = 12, 18%) and poor (n = 24, 35%) climate, 36 (11%) and 74 (12%), respectively were identified with PECs by at least two clinicians. Of the 35 and 71 identified patients with an available combined endpoint, 100% (95% CI 90.0–1.00) and 85.9% (75.4–92.0) (P = 0.02) attained that endpoint. The risk of death (HR 1.88, 95% CI 1.20–2.92) or receiving a written TLD (HR 2.32, CI 1.11–4.85) in patients with PECs by at least two clinicians was higher in ICUs with a good climate than in those with a poor one. The differences between ICUs with an average climate, with (n = 12, 18%) or without (n = 20, 29%) nursing involvement at the end of life, and ICUs with a poor climate were less obvious but still in favour of the former. Conclusion: Enhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life.

Published
2018
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