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Invasive fungal infections are common, and severe complications can occur in immunocompromised patients, especially in patients with hematologic malignancies who require intensive care unit (ICU) admission (2,2). Invasive fusariosis is [...]

Purpose Compliance to the Surviving Sepsis Campaign (SSC) guidelines is limited. This is known to be associated with increased mortality. The aim of this retrospective cohort study was to identify among the SCC guidelines the optimal bundle of recommendations that minimize 28-day mortality. Methods We used a training cohort to identify, using a least absolute shrinkage and selection operator penalized machine learning model, this bundle. Patients with sepsis/septic shock admitted to the intensive care unit (ICU) were extracted from two US databases, the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database (training and internal validation cohorts) and the eICU Collaborative Research Database (eICU-CRD) (external validation cohort). In the validation cohorts, we defined a bundle group that includes patients who were treated with at least all the recommendations selected in our bundle and a no-bundle group that includes patients in whom at least one recommendation from our bundle was omitted. Results All-cause 28-day mortality was the primary outcome measure. A total of 42,735 patients were included. Six recommendations (antimicrobials, balanced crystalloid, insulin therapy, corticosteroids, vasopressin, and bicarbonate therapy) were identified from the training cohort to be included in our bundle. In the propensity score-(PS)-matched internal validation cohort, the bundle group was associated with a lower mortality (OR 0.41 [0.33-0.53]; p < 0.001) compared to the no-bundle group. This was confirmed in the PS-matched external validation cohort (OR 0.75 [0.60-0.94]; p 0.02). Conclusion Our bundle of six recommendations is associated with a dramatic reduction in mortality in sepsis and septic shock. This bundle needs to be evaluated prospectively., Author(s): Alexandre Kalimouttou [sup.1] [sup.2], Ivan Lerner [sup.2] [sup.3] [sup.4], Chérifa Cheurfa [sup.5], Anne-Sophie Jannot [sup.2] [sup.3] [sup.4], Romain Pirracchio [sup.1] [sup.6] Author Affiliations: (1) grid.508487.6, 0000 0004 7885 7602, [...]

Purpose The aim of this study was to perform a systematic review and meta-analysis to investigate the incidence rate of cardiac arrest and severe complications occurring under non-invasive ventilation (NIV). Methods We performed a systematic review and meta-analysis of studies between 1981 and 2020 that enrolled adults in whom NIV was used to treat acute respiratory failure (ARF). We generated the pooled incidence and confidence interval (95% CI) of NIV-related cardiac arrest per patient (primary outcome) and performed a meta-regression to assess the association with study characteristics. We also generated the pooled incidences of NIV failure and hospital mortality. Results Three hundred and eight studies included a total of 7,601,148 participants with 36,326 patients under NIV (8187 in 138 randomized controlled trials, 9783 in 99 prospective observational studies, and 18,356 in 71 retrospective studies). Only 19 (6%) of the analyzed studies reported the rate of NIV-related cardiac arrest. Forty-nine cardiac arrests were reported. The pooled incidence was 0.01% (95% CI 0.00-0.02, I.sup.2 = 0% (0-15)). NIV failure was reported in 4371 patients, with a pooled incidence of 11.1% (95% CI 9.0-13.3). After meta-regression, NIV failure and the study period (before 2010) were significantly associated with NIV-related cardiac arrest. The hospital mortality pooled incidence was 6.0% (95% CI 4.4-7.9). Conclusion Cardiac arrest related to NIV occurred in one per 10,000 patients under NIV for ARF treatment. NIV-related cardiac arrest was associated with NIV failure., Author(s): Amélie Rolle [sup.1] [sup.2], Audrey De Jong [sup.1] [sup.3], Elsa Vidal [sup.1] [sup.2], Nicolas Molinari [sup.4], Elie Azoulay [sup.5], Samir Jaber [sup.1] [sup.3] Author Affiliations: (1) grid.121334.6, 0000 0001 [...]

Elasmobranchs make up a significant part of by catch in pelagic longline fisheries, whose induced mortality can be a major threat to endangered species. It is therefore crucial to understand the drivers of at-vessel mortality (AVM) for this fishing gear to enhance postrelease survival. To this end, we analysed scientific data collected during monitored longline fishing experiments conducted in French Polynesia to (i) estimate AVM for each species based on bootstrapped samples and (ii) to assess AVM drivers using multivariate logistic regression models for the blue shark (Prionace glauca) and oceanic whitetip shark (Carcharhinus longimanus). We found that AVM varies widely between species. Oceanic whitetip sharks are more likely to die when caught in waters outside their comfort temperature range, and their odds of survival increase with body length. For the blue shark, the only driver related to AVM is hooking duration. These results indicate that to reduce the AVM of these two species, the vertical distribution of hooks and soak duration should be considered as mitigation measures related to pelagic longlining. Les elasmobranches representent une part significative des prises accessoires des pecheries palangrieres pelagiques, dont la mortalite induite peut constituer une menace importante pour des especes vulnerables ou en danger. La comprehension des facteurs de mortalite au virage (MAV) pour cet engin est donc cruciale pour ameliorer la survie apres remise a l'eau. Pour cela, nous avons analyse des donnees recueillies durant des campagnes scientifiques de peche avec une palangre instrumentee menees en Polynesie francaise afin (i) d'estimer la MAV pour chaque espece sur la base d'echantillons bootstrappes et (ii) d'evaluer les facteurs influencant la MAV a l'aide de modeles de regression logistique multivariee pour le requin peau bleue (Prionace glauca) et le requin longimane (Carcharhinus longimanus). Nous avons constate que la MAV differe grandement entre les especes. Les requins longimanes sont plus susceptibles de mourir quand ils sont captures dans des eaux en dehors de leur intervalle de temperatures de confort et leur probabilite de survie augmente avec la taille des individus. Pour le requin peau bleue, le seul facteur qui influence la MAV est la duree d'hameconnage. Ces resultats indiquent que, pour reduire la MAV de ces deux especes, la repartition verticale des hamecons et le temps d'immersion de la palangre devraient etre considerees comme mesures d'attenuation dans la peche palangriere pelagique. [Traduit par la Redaction], 1. Introduction Across the globe, fishing activities unintentionally catch nontarget species--i.e., bycatch--and are therefore considered one of the greatest threats to marine populations, especially pelagic sharks (Dulvy et al. 2014). [...]

Purpose Epidemiologic studies have documented lower rates of active smokers compared to former or non-smokers in symptomatic patients affected by coronavirus disease 2019 (COVID-19). We assessed the efficacy and safety of nicotine administered by a transdermal patch in critically ill patients with COVID-19 pneumonia. Methods In this multicentre, double-blind, placebo-controlled trial conducted in 18 intensive care units in France, we randomly assigned adult patients (non-smokers, non-vapers or who had quit smoking/vaping for at least 12 months) with proven COVID-19 pneumonia receiving invasive mechanical ventilation for up to 72 h to receive transdermal patches containing either nicotine at a daily dose of 14 mg or placebo until 48 h following successful weaning from mechanical ventilation or for a maximum of 30 days, followed by 3-week dose tapering by 3.5 mg per week. Randomization was stratified by centre, non- or former smoker status and Sequential Organ Function Assessment score (< or [greater than or equal to] 7). The primary outcome was day-28 mortality. Main prespecified secondary outcomes included 60-day mortality, time to successful extubation, days alive and free from mechanical ventilation, renal replacement therapy, vasopressor support or organ failure at day 28. Results Between November 6th 2020, and April 2nd 2021, 220 patients were randomized from 18 active recruiting centers. After excluding 2 patients who withdrew consent, 218 patients (152 [70%] men) were included in the analysis: 106 patients to the nicotine group and 112 to the placebo group. Day-28 mortality did not differ between the two groups (30 [28%] of 106 patients in the nicotine group vs 31 [28%] of 112 patients in the placebo group; odds ratio 1.03 [95% confidence interval, CI 0.57-1.87]; p = 0.46). The median number of day-28 ventilator-free days was 0 (IQR 0-14) in the nicotine group and 0 (0-13) in the placebo group (with a difference estimate between the medians of 0 [95% CI -3-7]). Adverse events likely related to nicotine were rare (3%) and similar between the two groups. Conclusion In patients having developed severe COVID-19 pneumonia requiring invasive mechanical ventilation, transdermal nicotine did not significantly reduce day-28 mortality. There is no indication to use nicotine in this situation., Author(s): Guylaine Labro [sup.1], Florence Tubach [sup.2], Lisa Belin [sup.2], Jean-Louis Dubost [sup.3], David Osman [sup.4], Grégoire Muller [sup.5], Jean-Pierre Quenot [sup.6] [sup.7] [sup.8], Daniel Da Silva [sup.9], Jonathan Zarka [...]

Purpose Duration of antibiotic therapy for ventilator-associated pneumonia (VAP) due to non-fermenting Gram-negative bacilli (NF-GNB), including Pseudomonas aeruginosa (PA) remains uncertain. We aimed to assess the non-inferiority of a short duration of antibiotics (8 days) vs. prolonged antibiotic therapy (15 days) in VAP due to PA (PA-VAP). Methods We conducted a nationwide, randomized, open-labeled, multicenter, non-inferiority trial to evaluate optimal duration of antibiotic treatment in PA-VAP. Eligible patients were adults with diagnosis of PA-VAP and randomly assigned in 1:1 ratio to receive a short-duration treatment (8 days) or a long-duration treatment (15 days). A pre-specified analysis was used to assess a composite endpoint combining mortality and PA-VAP recurrence rate during hospitalization in the intensive care unit (ICU) within 90 days. Results The study was stopped after 24 months due to slow inclusion rate. In intention-to-treat population (n = 186), the percentage of patients who reached the composite endpoint was 25.5% (N = 25/98) in the 15-day group versus 35.2% (N = 31/88) in the 8-day group (difference 9.7%, 90% confidence interval (CI) -1.9%-21.2%). The percentage of recurrence of PA-VAP during the ICU stay was 9.2% in the 15-day group versus 17% in the 8-day group. The two groups had similar median days of mechanical ventilation, of ICU stay, number of extra pulmonary infections and acquisition of multidrug-resistant (MDR) pathogens during ICU stay. Conclusions Our study failed to show the non-inferiority of a short duration of antibiotics in the treatment of PA-VAP, compared to a long duration. The short duration strategy may be associated to an increase of PA-VAP recurrence. However, the lack of power limits the interpretation of this study., Author(s): Adrien Bouglé [sup.1], Sophie Tuffet [sup.2], Laura Federici [sup.3], Marc Leone [sup.4], Antoine Monsel [sup.5], Thomas Dessalle [sup.1], Julien Amour [sup.1], Claire Dahyot-Fizelier [sup.6], François Barbier [sup.7], Charles-Edouard Luyt [...]

Purpose The Coronavirus disease 2019 (COVID-19) has led to an unparalleled influx of patients. Prognostic scores could help optimizing healthcare delivery, but most of them have not been comprehensively validated. We aim to externally validate existing prognostic scores for COVID-19. Methods We used 'COVID-19 Evidence Alerts' (McMaster University) to retrieve high-quality prognostic scores predicting death or intensive care unit (ICU) transfer from routinely collected data. We studied their accuracy in a retrospective multicenter cohort of adult patients hospitalized for COVID-19 from January 2020 to April 2021 in the Greater Paris University Hospitals. Areas under the receiver operating characteristic curves (AUC) were computed for the prediction of the original outcome, 30-day in-hospital mortality and the composite of 30-day in-hospital mortality or ICU transfer. Results We included 14,343 consecutive patients, 2583 (18%) died and 5067 (35%) died or were transferred to the ICU. We examined 274 studies and found 32 scores meeting the inclusion criteria: 19 had a significantly lower AUC in our cohort than in previously published validation studies for the original outcome; 25 performed better to predict in-hospital mortality than the composite of in-hospital mortality or ICU transfer; 7 had an AUC > 0.75 to predict in-hospital mortality; 2 had an AUC > 0.70 to predict the composite outcome. Conclusion Seven prognostic scores were fairly accurate to predict death in hospitalized COVID-19 patients. The 4C Mortality Score and the ABCS stand out because they performed as well in our cohort and their initial validation cohort, during the first epidemic wave and subsequent waves, and in younger and older patients., Author(s): Yannis Lombardi [sup.1], Loris Azoyan [sup.1], Piotr Szychowiak [sup.2] [sup.3], Ali Bellamine [sup.4], Guillaume Lemaitre [sup.5], Mélodie Bernaux [sup.6], Christel Daniel [sup.7], Judith Leblanc [sup.8] [sup.9], Quentin Riller [sup.1], [...]

Purpose Hyperglycaemia is an adaptive response to stress commonly observed in critical illness. Its management remains debated in the intensive care unit (ICU). Individualising hyperglycaemia management, by targeting the patient's pre-admission usual glycaemia, could improve outcome. Methods In a multicentre, randomized, double-blind, parallel-group study, critically-ill adults were considered for inclusion. Patients underwent until ICU discharge either individualised glucose control by targeting the pre-admission usual glycaemia using the glycated haemoglobin A1c level at ICU admission (IC group), or conventional glucose control by maintaining glycaemia below 180 mg/dL (CC group). A non-commercial web application of a dynamic sliding-scale insulin protocol gave to nurses all instructions for glucose control in both groups. The primary outcome was death within 90 days. Results Owing to a low likelihood of benefit and evidence of the possibility of harm related to hypoglycaemia, the study was stopped early. 2075 patients were randomized; 1917 received the intervention, 942 in the IC group and 975 in the CC group. Although both groups showed significant differences in terms of glycaemic control, survival probability at 90-day was not significantly different (IC group: 67.2%, 95% CI [64.2%; 70.3%]; CC group: 69.6%, 95% CI [66.7%; 72.5%]). Severe hypoglycaemia (below 40 mg/dL) occurred in 3.9% of patients in the IC group and in 2.5% of patients in the CC group (p = 0.09). A post hoc analysis showed for non-diabetic patients a higher risk of 90-day mortality in the IC group compared to the CC group (HR 1.3, 95% CI [1.05; 1.59], p = 0.018). Conclusion Targeting an ICU patient's pre-admission usual glycaemia using a dynamic sliding-scale insulin protocol did not demonstrate a survival benefit compared to maintaining glycaemia below 180 mg/dL., Author(s): Julien Bohé [sup.1], Hassane Abidi [sup.1], Vincent Brunot [sup.2], Amna Klich [sup.3] [sup.4] [sup.5] [sup.6], Kada Klouche [sup.2] [sup.7], Nicholas Sedillot [sup.8], Xavier Tchenio [sup.8], Jean-Pierre Quenot [sup.9] [sup.10] [...]

Author(s): Antoine Guillon [sup.1], Emeline Laurent [sup.2] [sup.3], Lucile Godillon [sup.2], Antoine Kimmoun [sup.4], Leslie Grammatico-Guillon [sup.2] [sup.5] [sup.6] Author Affiliations: (1) grid.12366.30, 0000 0001 2182 6141, Intensive Care Unit, [...]