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In the propensity score-adjusted logistic regression, the odds ratio OR for favorable 6-month functional outcome was 0. One-year mortality was strongly reduced with surgery in the fixed-effect propensity adjusted cox model Hazard Ratio 0. Conclusion: In this study of critically ill patients with simultaneous infectious endocarditis, indication for surgery and cerebral events, a better propensity-adjusted functional outcome was associated with surgery compared with medical treatment, whatever the deepness of coma.

A delayed surgery should be considered in severe acute regurgitations. In the absence of randomized study precluded for ethical concerns, an individualized strategy remains highly suggested. We aimed to develop and validate a score predictive of catheter-tip colonization with pathogens other than Coagulase-negative Staphylococcus CoNS.

Potential factors associated with catheter colonization were identified using a generalized linear model with binomial distribution to account for several CVCs per patients, in univariate and multivariate analyses. Internal validation of these risk factors was performed using bootstrap with replications.

Then, a score was computed from the adjusted Odds Ratio coefficients. Finally, external validation was performed in three other independent RCTs investigating the effect of different prevention strategies on the incidence of catheter-related infections validation cohort. Discrimination was assessed by the Area Under the Curve c-index. Results: Among 3, CVCs and dialysis catheters included in the training cohort, 9.

Age, obesity, diabetes, site of insertion jugular and femoral versus sub-clavian , type of catheter dialysis versus CVC , catheterization duration, fever and local inflammation at removal were independently associated with colonization in multivariate analysis. Diabetes, site of insertion, type of catheter, catheterization duration, fever and local inflammation at removal were robust after internal validation and were computed in the score.

Area under the ROC curve for the score was 0. The validating cohort included 6, dialysis catheters and CVCs, of which 4. AUC for the score was 0. Among catheters removed for suspicion of CRBSI infection in the training and validating cohorts, Conclusion: This score had a moderate ability to discriminate central venous catheter colonization.

Roc curves for the scores in a training b cohorts. AUC, area under the curve. Their dissemination has led to a major increase in the use of carbapenems, last-resort antibiotics. The primary outcome was Day mortality. Secondary outcomes included in-ICU and Day mortality rates, severity of illness, septic shock resolution, ICU and in-hospital length of stay and Clostridium difficile infection.

Results: Among patients included in the study, 69 received a carbapenem and 87 received non-carbapenem antibiotics as empiric treatment. Baseline clinical characteristics were similar between the 2 groups. The rate of secondary infection with C. Conclusion: In ESBL-E urinary septic shock, empiric treatment with carbapenem-sparing regimen was not associated with higher mortality, compared to a carbapenem regimen. Effect of piperacillin-tazobactam vs meropenem on day mortality for patients with E coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance: a randomized clinical trial.

JAMA ; —9. Reference 2: Karaiskos I, Giamarellou H. Carbapenem-sparing strategies for ESBL producers: when and how. Antibiot Basel Switz ; 9:E Rationale: Sepsis leads to deep apoptosis-induced depletion of T-cells resulting in increased rate of secondary infection and late morbidity 1. Interleukin-7 IL-7 is a pluripotent cytokine essential for lymphocyte proliferation and survival. By intra-muscular IM or subcutaneous route, IL-7 improved immunity by increasing T-cell count and reversed the marked loss of immune effector cells in lymphopenic patients with septic shock 2.

Because IL-7 by IM route led to injection site reactions due to local lymphocytic infiltration, we designed a phase II study evaluating efficacy and safety of a potentially better tolerated route intravenous.

Secondary objective was to assess the safety and tolerability of CYT Results: Between June and March 21 patients ALC was similar in both group at baseline 0.

Patients in the treatment group had more organ support-free days Three patients developed fever, tachypnea and evidence of hypercytokinemia associated with IL-7 administration, which necessitated discontinuing therapy. Conclusion: While IV injection of IL-7 showed ability to reverse sepsis-related lymphopenia, safety issues related to this route led to favor IM or subcutaneous route for the next phase III trial.

Persistent lymphopenia after diagnosis of sepsis predicts mortality. Interleukin-7 restores lymphocytes in septic shock: the IRIS-7 randomized clinical trial. JCI Insight. Blue dots represent placebo-treated patients and red squares CYTtreated patients. We aimed to assess whether intravenous immunoglobulins IVIG could improve outcomes by reducing inflammation-mediated lung injury.

The primary outcome was the number of ventilation-free days by day 28, assessed according to the intention-to-treat principle. This trial was registered on ClinicalTrials. Conclusion: In patients with COVID who received invasive mechanical ventilation for moderate-to-severe ARDS, IVIG did not improve clinical outcomes at day 28 and tended to be associated with an increased frequency of serious adverse events, although not significant.

Rationale: Since the beginning of the COVID pandemic, corticosteroid therapy has become a standard treatment for critically ill patients. The aim of this study was to identity COVID clusters and investigate therapeutic response among clusters. Demographic data, ICU management, mortality and therapeutic response were compared between clusters.

Results: During the period, patients were included in the analysis. HCPC could identified 2 clusters. These patients had a more severe organ failure. Requirement of invasive mechanical ventilation In line with this, in-ICU mortality rate was Conclusion: Based on HCPC, we could identify 2 distinct profiles with different severity and different outcome.

More importantly, corticosteroid therapy was associated with a better outcome only in the less severe patients. This approach might help clinician to undertake personalized ICU management.

Corticosteroids are widely used to treat these patients although the impact of this adjuvant therapy on the incidence of VA-LRTI in this population is still unclear. Adult patients invasively ventilated for more than 48 h for a SARS-CoV-2 pneumonia during the first epidemic surge were consecutively included.

VA-LRTI diagnosis required strict definition with clinical, radiological and microbiological documentation. We demonstrated a significant time-varying effect of corticosteroids on the risk of developing VA-LRTI all along the day follow-up. Considering the common use of dexamethasone DXM since the 2nd wave, we conducted a large retrospective multicenter study to evaluate the influence of DXM exposure on the incidence of VAP. Among them The diagnosis of VAP was based on clinical and microbiological arguments.

Results: The 2 groups were similar. The overall incidence rate of VAP episodes was essentially the same in the 2 groups: There was also no difference in terms of mortality. The Lancet Respiratory Medicine ; — Intensive Care Medicine ; — Rationale: COVID induces a sustained immunosuppression responsible for secondary infections acquisition and late mortality. Several studies have found that supplementation with citrulline, which is converted in arginine through the activity of argininosuccinate synthetase and argininosuccinate lyase, was more efficient than arginine to increase plasma level of arginine.

In the present study, we aimed to assess the effect of citrulline supplementation in COVIDassociated Acute Respiratory Distress Syndrome ARDS patients as an adjuvant therapy with the goal to relieve immunosuppression and help virus clearance. The primary endpoint was SOFA score on day 7. Results: A total of 32 patients were included 10 women, median age 66 years. Arginine concentrations in patients treated by citrulline were higher at day 7 The higher viral clearance promoted by such treatment deserves further investigations.

Among strategies that aimed to prevent both such acquired infections AI , selective decontamination regimen has been poorly studied in COVID setting. In addition to standard care, 3 ICUs used a multiple-site decontamination regimen MSD , a variant of selective digestive decontamination, which consists of the administration of topical antibiotics including an aminoglycoside tobramycin or gentamicin , polymyxin and amphotericin B, four times daily in the oropharynx and the gastric tube, chlorhexidine body washing and a 5-day nasal mupirocin course in patients who had an expected intubation duration of 24 h or more.

AI and death risk factors were estimated using logistic regression. Due to missing data regarding AIs in patients, patients were finally included. Compared with the standard-care group, AI were less frequent in the MSD group with incidence rates of Hospital mortality was lower among patients receiving MSD These promising results deserve confirmation by randomized controlled trials. Post-resuscitation shock defined as need for vasopressors after return of spontaneous circulation is associated with high mortality and brain damage.

We perform a post-hoc analysis of HYPERION trial to explore interaction between post-resuscitation shock status and temperature targeted after cardiac arrest. Patients were divided according to presence or absence of post-resuscitation shock after cardiac arrest. Results: We included, patients: with post-resuscitation shock and without.

Of patient with post-resuscitation shock, received induced hypothermia and controlled normothermia. On day 90, 14 of the patients in the hypothermia group had a CPC score of 1 or 2, as compared with 10 of the patients in the normothermia group, with no significant difference 8.

Conclusion: Presence of a post-resuscitation shock at ICU admission after cardiac arrest in non-shockable rhythm is a major determinant of day functional outcome. There is no interaction between post-resuscitation shock presence and benefits of induced hypothermia provided for patients with cardiac arrest in non-shockable rhythm as compared to controlled normothermia.

Rationale: Organ shortage is a major public health issue, and patients who die after out-of-hospital cardiac arrest OHCA could be a valuable source of organs. Our objective was to identify factors associated with organ donation after brain death complicating OHCA, in unselected patients entered into a comprehensive real-life registry covering a well-defined geographic area.

The primary outcome was organ donation after brain death. Independent risk factors were identified using logistic regression analysis. A donation-likelihood score was established. One-year outcomes of transplants and transplant recipients were assessed using Cox and log-rank tests. Results: Of the included patients, 4. Patients characteristics are described in the Table. An interaction between admission pH and post-resuscitation shock was identified. By multivariate analysis, in patients with post-resuscitation shock, predictors of organ donation were neurological cause of OHCA odds ratio [OR], One-year outcomes of kidney transplants and their recipients did not differ according to Utstein characteristics of the donor.

Conclusion: Organ donation should be considered in every patient with OHCA due to a neurological cause, independently from presence of post-resuscitation shock and from Utstein characteristics.

Table: Utstein characteristics of patients with out-of-hospital cardiac arrest. Rationale: Out-of-hospital cardiac arrest OHCA is a common cause of death, with a very low survival rate. Early circulatory failure is the most common reason for death within the first 48 h after resuscitation. This study including intensive care unit ICU patients with OHCA was designed to identify and characterize clusters based on clinical and laboratory features and to determine the frequency of death from refractory post-resuscitation shock RPRS in each cluster.

We identified patient clusters by performing an unsupervised hierarchical cluster analysis without mode of death among the variables based on Utstein clinical and laboratory variables. For each cluster, we used the Fine-and-Gray approach to estimate the hazard ratio HRs for RPRS defined as post-resuscitation shock refractory to aggressive critical care. Inclusion was at ICU admission. We identified four clusters: initial shockable rhythm with short low-flow time cluster 1 , initial non-shockable rhythm with usual absence of ST-segment elevation cluster 2 , initial non-shockable rhythm with long no-flow time cluster 3 , and long low-flow time with high epinephrine dose cluster 4.

Conclusion: We identified patient clusters based on Utstein criteria, and one cluster was strongly associated with RPRS. This result may help to make decisions about using specific treatments after OHCA. Rationale: The optimal approach to the use of venoarterial extracorporeal membrane oxygenation VA-ECMO during cardiogenic shock is uncertain. Of eligible patients, were randomized.

The primary outcome was mortality at 30 days. There were 21 secondary outcomes including mortality at days 7, 60, and ; a composite outcome of death, cardiac transplant, stroke or escalation to left ventricular assist device LVAD at days 30, 60 and , ventilatory- and kidney replacement therapy-free days between inclusion and days 30, 60 and Adverse events included rates of severe bleeding, sepsis and number of packed red blood cells transfused during VA-ECMO.

Of the 27 secondary outcomes, 26 were inconclusive. Conclusion: In patients with refractory cardiogenic shock treated with VA-ECMO, early application of moderate hypothermia for 24 h did not significantly increase survival compared with normothermia. However, because the confidence interval was wide and included a potentially clinical important effect size, these findings should be considered inconclusive.

Reference 1: Levy B et al. Median IQR of observation time was 8 28, 30 days. Rationale: In patients with septic shock, the impact of mean arterial pressure MAP target on the course of mottling remains uncertain. We investigated whether a low-MAP between 65 and 70 mm Hg or a high-MAP target between 80 and 85 mm Hg would affect the course of mottling and arterial lactate in patients with septic shock.

Data that concerned mottling were considered until the discontinuation of catecholamine or for a maximum of 5 days under vasopressors. The presence or absence of mottling was recorded every 2 h from 2 h after inclusion to the catecholamine weaning.

We compared time course of mottling and arterial lactate between the two MAP target groups. Results: We included patients in this analysis: were assigned to the low-MAP target group and to the high-MAP target group. Our results were similar when considering only patients who reached the criteria of the SEPSIS-3 definition of septic shock. In addition, when compared to arterial lactate at inclusion, mottling duration appeared to be a better microcirculatory marker of mortality risk.

In addition, compared to arterial lactate at inclusion, mottling duration appears to be a stronger marker of mortality risk. High versus low blood-pressure target in patients with septic shock. N Engl J Med. Course of mottling in patients with septic shock according to the mean arterial pressure target. Horizontal line represents a patient follow-up. Solid line corresponds to a period with mottling; hatched line corresponds to period without mottling.

Other independent risk factors were age HR per 10 years: 1. Conclusion: The development of RVF during ICU stay was independently associated with a markedly higher risk of days mortality and appeared associated with a worsening of respiratory parameters. Rationale: Sedation in pediatric intensive care units PICU is balancing between endangerment patient and the risk of tachyphylaxis, withdrawal syndrome and delirium 1. The main objective was to describe sedation-analgesia procedures in France.

The secondary objectives was to specify the use of drugs without marketing authorization, and to observe the drugs associations. The referring doctors answered a first online survey describing their unit. They answered a second online survey about each sedated patient on the days of the study. The included patients were hospitalized in PICU; aged between 38 weeks of amenorrhea WA and 18 years old; received drugs for sedation or withdrawal syndrome.

Excluded patients received painkillers against pure nociceptive pain, or palliative or terminal sedation. Nurses were autonomous to set dose of sedation according to protocol in 13 centers. Four hundred and two questionnaires were filed. Use of Pentothal, Levomepromazine and Sevoflurane was uncommon.

Conclusion: The most frequent sedation includes an association between an opioid and a benzodiazepine. Non-drug cares are widely used. Though recommended, scores are not often used. Reference 1: Harris et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals, Intensive Care Med Jun;42 6 — Rationale: In ICU, sedation-analgesia is a major therapeutic element to provide adequate comfort to the patient and to permit a good synchronization with the respirator.

Currently, it is common to associate benzodiazepine with opioid. However, after prolonged sedation, effects of the sedative become exhausted, requiring an increase in doses, leading to an increased incidence of withdrawal syndrome, and delaying extubation. Since the beginning of the XXI century, there has been a growing interest in the use of halogenated gases in ICU, because of their hypnotic effects.

Furthermore, there is little data on their use during prolonged sedation. Therefore, their efficacy and tolerance should be assessed. They could reduce the dosage of benzodiazepines and opioids, thereby reducing the incidence of withdrawal syndrome. They all benefited from volatile sedation Isoflurane of Sevoflurane for 24 h at least. The proportion of adverse events and withdrawal syndrome were collected. The same results were found for other hypnotics Ketamine: 2.

No major adverse effects were reported. Conclusion: Halogenated gases seem to be an interesting therapeutic to reduce dosages of different hypnotics and opioids used during multimodal prolonged sedations.

Inhalation of halogenated gas via the ACD seems to be sure and easy to use. That appears to be a simple method for maintaining long-term sedation in PICU. Our results suggested IA sedation using the ACD to be an effective and safe alternative to the usual intravenous Propofol- or Midazolam-based regimen. Sevoflurane provided sedation quality comparable to Propofol and Midazolam, but with decreased wake-up and extubation times. Rationale: Computer vision has promising potential for the diagnosis of vital distress in critically ill patients including neurological, respiratory and hemodynamic distress.

The aim of our research was to setup a multi-modal video infrastructure to create a clinical video research database and pave the way to real-time vital distress video monitoring within a pediatric intensive care unit PICU. Both cameras are pointed towards the patient and are placed in a 3D printed support.

The software component included a web user interface for performing the acquisitions in the hospital intranet in a secure manner. The video research database currently includes more than acquisitions and is being used in various studies to assess vital distress signs including facial expressions to estimate sedation level and consciousness using RGB videos, the refinement of tidal volume and respiratory rate measurements in patients using 3D videos, and estimation of the thermal gradient across various parts of the body using IR.

Conclusion: A multi-modal RGB 3D and thermography video infrastructure was successfully set up and a video research database of critically ill children was constructed and enabled algorithm development to assess various vital distress. This setup could be replicated in other PICUs. Rationale: New et al 1 completed a national cohort study in the United Kingdom UK ; all hospitals were invited to participate. The median volume was Cardiac patients were randomized before surgery; other patients were randomized in PICU.

Results: patients across 50 centers US, Canada, France, Italy, Israel were randomized between February and August ; , including non-cardiac patients, received at least one RBC transfusion. Among the participants, 7. Among non-cardiac participants, Data on bleeding status and on-site policy limiting volume per transfusion e.

Red blood cell transfusion practice in children: current status and areas for improvement? A study of the use of red blood cell transfusions in children and infants. Transfusion ; The age of transfused blood in critically ill children. JAMA ;— Rationale: Family presence during invasive procedures or cardiopulmonary resuscitation CPR is a part of the family-centered approach in pediatric intensive care units PICUs. We established a simulation program aiming at providing communication tools to healthcare professionals.

The goal of this study was to evaluate the impact of this program on the stress of PICU professionals and its acceptance. Forty simulations with four different simulation scenarios and various types of parental behavior, as imitated by professional actors, were completed during a 1-year period. Primary outcomes were the difference in perceived stress level before and after the simulation and the degree of satisfaction of healthcare professionals nursing assistants, nurses, physicians.

The impact of previous experience with family members during critical situations or CPR was evaluated by variation in perceived stress level. Results: Overall, questionnaires were analyzed. Perceived stress associated with parental presence decreased from a pre-simulation value of 6 IQR, 4—7 to 4 IQR, 2—5 post-simulation on a scale of 1— However, in Satisfaction of the participants was high with a median of 10 IQR, 9—10 out of 10 Fig.

Discussion: Our study describes an in situ pediatric simulation program of critical situations in the presence of family members played by professional actors.

The simulation program was explicitly aiming at the development of communication skills. The simulation generally, but not always, showed a reduction in healthcare professionals perceived stress caused by family presence during a critical situation in the PICU.

To meet the demand of participants experiencing a high level of stress after the simulation, a pre-simulation video on potential benefits and pitfalls of family presence during critical situations as well as on ad-hoc communication tools is now available to all future participants.

Figure 1. Box plot showing overall pediatric intensive care team stress related to family member presence during cardiopulmonary resuscitation or other major interventions in the pediatric intensive care unit, before and after the simulation.

All hospitalized children who had one measured plasma concentration of the investigated antibiotics were included. Plasma antibiotic concentrations were interpreted by a pharmacologist, using a Bayesian approach based on previously published population pharmacokinetic models. Five adverse events have been reported during the study period, although none have been attributed to beta-lactam treatment.

Conclusion: Continuous infusion provided a higher probability to attain an optimal PK target compared to intermittent infusion, but also a higher risk for overexposure. Regular therapeutic drug monitoring is recommended in critically ill children receiving beta-lactams, regardless of the administration modality. Description of the antibiotic exposure underexposure, optimal exposure or overexposure depending on the drug A or for the whole cohort B , with respect to the administration route, intermittent infusion II or continuous infusion CI.

We thus aimed to evaluate the incidence and risk factors of WiPO in a large mixed population of critically ill patients. Patients with tracheostomy were excluded. The consensual diagnosis of WiPO was made a posteriori by five experts based on the patient characteristics, hemodynamic and echocardiographic variables, and biochemical results.

Kaplan—Meier Curves for the 1-year mortality status according to plasma exchange status. Rationale: Spontaneous pneumomediastinum SP , defined by the presence of air within the mediastinum without traumatic lesion, has been described during ARDS, even in the era of protective ventilation.

It has been also described in case series of COVID with severe pneumonia in the absence of use of invasive mechanical ventilation. We aimed at describing the prevalence of spontaneous pneumomediastinum during severe COVID pneumonia, and at investigating its prognostic impact. Spontaneous pneumomediastinum was diagnosed either on chest X-ray or chest CT-scan.

Although the proportion of patients requiring IMV was similar, the time to tracheal intubation was longer in the patients with SP 6 days vs. This suggests that, barotrauma secondary to invasive mechanical ventilation, does not appear to be preponderant in the occurrence of pneumomediastinum in COVID Mechanism is potentially carried-out by patient self-inflected lung injury and hyperinflation secondary to a prolonged respiratory failure, as underlined by a longer delay before invasive mechanical ventilation.

Presence of a pneumomediastinum should alert the clinician in a spontaneously breathing patient to its tolerance and the need to use a more protective ventilation.

Using multi-state modeling with causal inference, the outcomes related to VAP were also evaluated. The incidence of VAP was AM at 90 days was 3. FX06, a drug under development containing fibrin-derived peptide beta15—42, stabilizes cell-cell interactions, thereby reducing vascular leak and mortality in several animal models of ARDS.

The primary endpoint was the reduction of pulmonary vascular leakage from day 1 to day 7, evaluated by transpulmonary thermodilution-derived extra-vascular lung water index EVLWi. All analyses were conducted on an intent-to-treat basis.

Results: After one consent withdrawal, 49 patients were enrolled and randomized, 25 in the FX06 group and 24 in the placebo group. One third of them were equipped with veno-venous ECMO. Although EVLWi was elevated at baseline Cardiac index, pulmonary vascular permeability index, and fluid balance were also comparable between groups.

Eighteen patients were lost to follow-up and were not included in our study. ECMO and mechanical ventilation duration were 18 [11—25] and 36 [27—62] days, respectively. Besides, their ICU and hospital length of stay were 43 [33—62] and 85 [29—] days. At 1 year, only one patient was still in the hospital. Pulmonary function tests were good at 6 months except for a persistent impairment of the DLCO. Noticeably, QoL did not improve at 1 year of follow-up. Besides, a very large proportion of survivors still complained about anxiety, depression, and post-traumatic stress symptoms.

These results emphasize the importance to integrate these young patients into customized, patient-centered, rehabilitation programs after ICU discharge. At the time of VV-ECMO implantation, significant differences were observed with higher lactatemia in the early implanted group 1.

Reference 1: Olivier et al. Reference 2: Hermann et al. Its use is frequently associated with prolonged deep sedation and neuromuscular blockades, that may lead to diaphragm dysfunction. This latter is associated with delayed mechanical ventilation weaning and poor outcomes. We hypothesize that diaphragmatic dysfunction is frequent, severe, and associated with prolonged mechanical ventilation and poor outcomes in that severe population.

Diaphragmatic function was daily assessed by measuring diaphragm pressure generation in response to phrenic nerve stimulation Ptr,stim from ECMO initiation until ECMO weaning. Results: Sixty-three patients were included with a median age of 53 42—59 years old and after a median of 4 days 2—6 of mechanical ventilation. Patients with diaphragmatic dysfunction at day 1 were older 55 years [43—60] vs. Diaphragmatic function did not significantly change over the study period Fig.

Besides, these patients had longer mechanical ventilation duration when compared to those without diaphragmatic dysfunction When present at ECMO day-1, diaphragmatic dysfunction did not seem to evolve over time.

However, it was associated with a longer duration of mechanical ventilation in patients successfully weaned from ECMO. Values are presented as medians with their standard deviations. The red line corresponds to the threshold of 11 cmH 2 O below which diaphragmatic dysfunction is defined.

Amiodarone bolus and mg were studied. In vivo: ARDS was induced in 10 pigs. Amiodarone mg was injected once CPR started and twelve blood samples were drawn over a 12 min period.

Panel A: experimental protocol. Panel B: Visual Predictive Check for amiodarone model. Left panel: control group.

Our objective was to evaluate, in vaECMO patients exhibiting significant dyspnea, the impact of an increase in sweep gas flow through the vaECMO membrane on dyspnea. Four conditions were studied: on inclusion and after three sweep gas flow increments of two liters per minute each. The respiratory drive was concomitantly assessed by the measure of the electromyographic activity of the Alea Nasi and parasternal muscles.

Results: We included 21 non-mechanically ventilated patients. Dyspnea-VAS was 50 45—60 mm. Weinberg radiological pulmonary oedema score was 3 0—5. PaCO 2 decreased in response to the 2-L-per-minute increase in sweep, but it ceased to decrease after 6 L. Dyspnea did not decrease immediately but was significantly lower after 6 L of increased sweep regardless of the assessment score. The electromyographic activity of Alea nasi and parasternal muscles decreased significantly after sweep gas flow increment.

Conclusion: In critically ill patients with vaECMO, incrementation of sweep gas flow through the oxygenation membrane decreases dyspnea.

It might be mediated by a decrease in respiratory drive, as suggests the concomitant decrease in respiratory rate and electromyographic activity of respiratory muscles.

Rationale: Amniotic fluid embolism AFE is a rare but often catastrophic complication of pregnancy. The cardiopulmonary dysfunction associated with AFE being typically self-limited, venoarterial extracorporeal membrane oxygenation VA-ECMO support has been reported in the most severe forms. Clinical characteristics, peri-delivery resuscitative procedures and critical care management are detailed.

The median ICU length of stay was 12 1—25 days. All infants survived. HRQOL was lower than age-matched controls and still profoundly impaired in the role-physical, bodily pain, and general health components after a median of 44 months follow-up Fig.

Four out of seven patients returned to their initial work. Conclusion: In this rare per-delivery complication, our results support the use of VA-ECMO despite extreme initial severity, intense disseminated intravascular coagulation and ongoing bleeding. However, long-term physical and mental status were still impaired after long-term evaluation.

Future studies should therefore focus on customized, patient-centered, rehabilitation programs to improve HRQOL. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies. Am J Obstet Gynecol. Rationale: Anti-melanoma differentiation-associated gene 5 antibody anti-MDA5 dermatomyositis DM is a rare subtype of idiopathic inflammatory myopathy, associated with severe interstitial lung disease ILD.

The use of extracorporeal life support ECLS is questionable, as reported in several studies that emphasize the futility of a bridge-to-recovery strategy. In this respect, emergency lung transplantation of previously unlisted patients on ECLS is under debate. The female-to-male ratio was 4 and the age at ICU admission was a mean of 50 [32—67] years. Five patients underwent lung transplantation after a median of 8 [] days on ECMO, none previously listed for a lung transplantation.

After a median follow-up of 25 [3—93] months, all transplanted patients were alive at the conclusion of the study four discharged home, one still hospitalized and no relapse of DM or ILD was noted. All other patients, not listed for lung transplantation, died after a median of 30 [4—52] days on ECMO Fig. Second, every patient that could be bridge-to-transplantation was discharged alive from ICU. None was previously listed for lung transplantation.

Emergency lung transplantation was possible in patients treated with vasopressors, mechanical ventilation and ECLS.

In contrast, a bridge-to-emergency lung transplantation is not only feasible, but also associated with a favorable outcome and appears therefore as the sole hope of survival for patients requiring ECLS. Clinical features and outcome of patients with acute respiratory failure revealing anti-synthetase or anti-MDA-5 dermato-pulmonary syndrome: a French multicenter retrosp.

Risk factors of mortality and invasive mechanical ventilation iMV were identified by multivariate logistic regression models. Results: COVID patients were admitted in ICU during the study period with respectively , , and patients during the first, second, and third surge.

Rationale: The clinical outcomes of the Beta B. In early , northeastern France experienced an outbreak of Beta that was not observed elsewhere. This outbreak slightly preceded and then overlapped with a second outbreak of the better understood VOC Alpha B.

This situation allowed us to contemporaneously compare Alpha and Beta in terms of the characteristics, management, and outcomes of critically ill patients. Primary outcome was day mortality. Differences between Alpha and Beta in terms of other outcomes, patient variables, management, and vaccination characteristics were also explored by univariate analysis. The factors that associated with day death in Alpha- and Beta-infected patients were examined with logistic regression analysis. Results: In total, patients median age, 63 years were enrolled.

Of these, and had Alpha and Beta, respectively. The remaining 18 patients had received a partial vaccine course and 2 were fully vaccinated. The vaccinated patients were equally likely to have Alpha and Beta. Discussion: To date, this is one of the largest studies to compare the characteristics and outcomes of critically ill patients who were infected with either of two simultaneously circulating VOCs and who underwent similar treatment regimens in the same settings.

A recent meta-analysis suggests an increased mortality of Beta variant compared to wild type strain. Plus, the Beta and Delta variants were described as risker than the Alpha and Gamma variants 1. Nevertheless, none of the studies cited in the meta-analysis was specific to critically ill patient or compare variants with each other. Plus, the Beta variant proportion was quite low compared to other variants in these studies Alpha particularly. Conclusion: Beta did not differ from Alpha in terms of patient characteristics, management, or outcomes in critically ill patients.

Better understanding of these variants including ongoing and future ones is essential. Age OR 1. Conclusion: Severe SARS-Cov2 infection occurs post-vaccination essentially in patients with immunosuppression, chronic kidney, heart or liver failure.

Age and disease severity are independently associated with mortality. Vaccination might inflect the disease course, even in critically-ill patients. Our objectives were to compare the mortality of patients with versus without auto-Abs neutralizing type I IFNs, to assess the rate of positivity of auto-Abs and the factors associated with their positivity. Baseline characteristics did not differ between patients with and without auto-Abs Table 1.

Mortality at day 28 was not different between groups Compared to women without auto-Abs, positive women were significantly younger 45 24—62 vs 60 years Positive women seem to have an auto-immune background and more frequently required mechanical ventilation. Reference 1: Bastard, P. Science , eabd Standard scores and biomarkers used in ED are strongly associated with immediate severity but their prognostic performance to predict clinical course of patients is limited.

The primary endpoint was the non-deterioration determined by 3 clinicians who were blinded from cytometry results and defined from a composite criterion: i need for high flow oxygen, ii ICU admission, iii in-hospital mortality related to SARS-COV-2, iiii readmission within 5 days.

A simple predictive score ratio seems interesting to allow safe rule-out, over-triage reduction and better allocation of hospital resources. All Covid patients admitted to 15 ICUs from Pays-de-la-Loire and Bretagne regions between February 1st and December 31th and treated with mechanical ventilation were included.

Each case of CAPA reported by local investigators was reviewed by an adjudication committee of 3 independent experts. No case of histologically proven CAPA was reported. Patients with possible CAPA were Probable CAPA were diagnosed after 8 [4. Lancet Infect Dis ; e—e In a desire to protect the child from a potentially traumatic environment, some units refuse or restrict visits to children Laurent et al. We complemented the quantitative approach with semi-structured interviews to capture the experience of the visit at 7 days.

Results: Of the 22 children included, 15 children were able to complete questionnaires at 7 days of the visit and 21 at 30 days. At 7 days of the visit, 9 out of 15 children showed acute stress.

One month after, 9 out of 21 children suffered from a potential post-traumatic stress disorder. The thematic analysis shows that the visit is indeed disturbing for most of children. However, children expressed that this visit was reassuring to them.

Certain dimensions are identified as a source of distress and can explain the CRIES-8 scores: the absence of the hospitalized parent, the distress of the accompanying parent, and the disruption of daily life. Thus, the higher the anxiety-depressive symptomatology of the parents, the higher the acute stress symptomatology of the children tended to be. Reference 1: Laurent A. Intensive Care Medicine. Reference 2: Laurent A. Pratiques psychologiques Rationale: The perception of inappropriate care in end-of-life situations can be a source of conflict and burnout among caregivers.

The purpose of this study is to describe caregivers’ perceptions of end-of-life care in the surgical intensive care unit and intermediate care unit of our hospital before and after the implementation of therapeutic perspective meetings TPMs. It explores 3 dimensions: working conditions, managerial skills and end-of-life decision making. Descriptive and analytical analyses were performed. TPMs improved caregivers’ perception of expressing disagreement with opinions or values 3 vs.

Conclusion: The implementation of TPMs has improved the perception of caregivers regarding communication between caregivers on patient management, particularly for end-of-life situations, and has encouraged the involvement of nurses in these decisions as well as their presence during interviews with the families. There was no impact on perceptions of the temporality of end-of-life decision-making or on admissions of patients with minimal chance of recovery.

Further studies are needed to assess the impact of TPMs on the prevalence of conflict, risk of burnout, and quality of care delivered. In-depth interviews were conducted with 39 intensivists of different age groups and levels of professional experience, and with 5 department heads. Reference 1: Nadig, N. Critical care medicine, 47 10 , — Reference 2: Wilkinson, D. The luck of the draw: physician-related variability in end-of-life decision-making in intensive care.

The goal of present study is to investigate the role of nursing team composition on patient ICU mortality. The team composition was evaluated using the familiarity among the ICU caregivers, which was measured by shift from am to pm and from pm to am as the mean number of previous collaborations between each nursing team member during previous shifts within the given ICU. Suboptimal collaboration was defined as less than The patient-to-nurse ratio and patient-to-auxiliary nurse ratio were also considered suboptimal ratio defined as higher than 0.

The primary outcome was inpatient death at the time of ICU discharge, excluding patients for whom a decision to forego life-sustaining therapy was made. Inpatient death during the shift at admission was secondarily considered. Results: A total of 43, patients were admitted to the ICUs of whom 3, 7. The adjusted model showed an increased risk of patient mortality during shifts exposed to suboptimal team familiarity lower than 50 previous collaborations Relative Risk 1.

Suboptimal team composition reflected a total of [—] shifts with potentially avoidable death, corresponding to 7.

The risk of death at admission was also higher in case of suboptimal team composition RR 1. Conclusion: In conclusion, the familiarity between ICU nursing staff is significantly associated with inpatient death additionally to patient-to-caregiver ratio. Improving team composition should be a management goal in ICU. Rationale: Physicians play an important role in controlling health care spending, by prescribing more or less expensive treatments.

The aim of this study was to evaluate the knowledge of health care workers of the cost of the treatments they daily use in ICU. A survey was delivered and completed anonymously by healthcare workers HCWs of four French ICUs, three university affiliated and one non-university affiliated. The survey proposed to estimate the price of 37 treatments frequently used in critical care.

Results: HCWs answered to the survey, including 75 nurses and 82 physicians. Medical staff was composed of 36 seniors and 45 juniors. Median age of the respondents was 29 [25—36] years. They provided answers. Interestingly, the most expensive treatments prices were under evaluated whereas the cheapest ones were overvalued. For example, median estimation of the cost of eculizumab was only 9 [2. However, their efficacy remains flawed and antibiotics remain overused. One of the reasons lies in subjective determinants of the prescription.

The aim of our study is to explore personal, social, cultural and contextual factors that can influence antibiotic prescribing behaviour in the ICU.

The questionnaire was distributed to all ICUs in France through a personal email sent to the head of each ICU, asking them to send the questionnaire to doctors and residents of their team. Two reminders were sent, at 2 and 4 months. The population is comparable to the global demography in French ICUs 1. Conclusion: This work confirms that subjective determinants hinder reasoned antibiotic prescribing.

Factors such as prescriber anxiety and lack of self-confidence, linked in particular to a lack of knowledge, stand out. The fear of missing a septic etiology pushes the physician to prevail the short-term benefit taking over the long-term consequences. Rationale: The gold standard method proposed to detect and measure airway opening pressure AOP in patients with acute respiratory distress syndrome ARDS requires a low-flow insufflation i.

This ensures that the resistive pressure is negligible but might potentially be poorly tolerated. Theoretically, during usual constant flow insufflation i. We assessed the accuracy and tolerance of calculating AOP as the conductive pressure minus resistive pressure during usual constant flow insufflation. We also assessed an automated computer-based detection of AOP.

We compared methods 2 and 3 to the gold standard and collected the lowest SpO 2 during each measurement to assess the tolerance. Conclusion: These preliminary data suggest that measuring AOP is feasible at standard insufflation flow rate with a simple, quick and safe method based on visual inspection of airway pressure waveform.

Rationale: ARDS is a heterogeneous syndrome involving different phenotypes with distinct clinical and outcome characteristics. With Electrical Impedance Tomography EIT it is possible to measure the distribution of ventilation in each lung in order to describe asymmetrical lung injury. In the present study, we hypothesized that some patients may have asymmetrical ARDS where EIT would provide different information from those obtained from global P-V curves.

We recorded the low flow PV curve without PEEP of the ventilator in order to assess airway closure and the recruited volume.

The higher viral clearance promoted by such treatment deserves further investigations. Among strategies that aimed to prevent both such acquired infections AI , selective decontamination regimen has been poorly studied in COVID setting.

In addition to standard care, 3 ICUs used a multiple-site decontamination regimen MSD , a variant of selective digestive decontamination, which consists of the administration of topical antibiotics including an aminoglycoside tobramycin or gentamicin , polymyxin and amphotericin B, four times daily in the oropharynx and the gastric tube, chlorhexidine body washing and a 5-day nasal mupirocin course in patients who had an expected intubation duration of 24 h or more.

Post-resuscitation shock defined as need for vasopressors after return of spontaneous circulation is associated with high mortality and brain damage. We perform a post-hoc analysis of HYPERION trial to explore interaction between post-resuscitation shock status and temperature targeted after cardiac arrest.

Patients were divided according to presence or absence of post-resuscitation shock after cardiac arrest. Results: We included, patients: with post-resuscitation shock and without.

Conclusion: Presence of a post-resuscitation shock at ICU admission after cardiac arrest in non-shockable rhythm is a major determinant of day functional outcome.

Independent risk factors were identified using logistic regression analysis. A donation-likelihood score was established. One-year outcomes of transplants and transplant recipients were assessed using Cox and log-rank tests.

Results: Of the included patients, 4. Patients characteristics are described in the Table. An interaction between admission pH and post-resuscitation shock was identified. By multivariate analysis, in patients with post-resuscitation shock, predictors of organ donation were neurological cause of OHCA odds ratio [OR], One-year outcomes of kidney transplants and their recipients did not differ according to Utstein characteristics of the donor.

Conclusion: Organ donation should be considered in every patient with OHCA due to a neurological cause, independently from presence of post-resuscitation shock and from Utstein characteristics. Table: Utstein characteristics of patients with out-of-hospital cardiac arrest. Rationale: Out-of-hospital cardiac arrest OHCA is a common cause of death, with a very low survival rate. Early circulatory failure is the most common reason for death within the first 48 h after resuscitation. This study including intensive care unit ICU patients with OHCA was designed to identify and characterize clusters based on clinical and laboratory features and to determine the frequency of death from refractory post-resuscitation shock RPRS in each cluster.

We identified patient clusters by performing an unsupervised hierarchical cluster analysis without mode of death among the variables based on Utstein clinical and laboratory variables.

For each cluster, we used the Fine-and-Gray approach to estimate the hazard ratio HRs for RPRS defined as post-resuscitation shock refractory to aggressive critical care.

Inclusion was at ICU admission. We identified four clusters: initial shockable rhythm with short low-flow time cluster 1 , initial non-shockable rhythm with usual absence of ST-segment elevation cluster 2 , initial non-shockable rhythm with long no-flow time cluster 3 , and long low-flow time with high epinephrine dose cluster 4.

Of eligible patients, were randomized. The primary outcome was mortality at 30 days. There were 21 secondary outcomes including mortality at days 7, 60, and ; a composite outcome of death, cardiac transplant, stroke or escalation to left ventricular assist device LVAD at days 30, 60 and , ventilatory- and kidney replacement therapy-free days between inclusion and days 30, 60 and Adverse events included rates of severe bleeding, sepsis and number of packed red blood cells transfused during VA-ECMO.

Results: patients completed the trial mean age, 57 [SD 12] years. The odds-ratio of the composite outcome of death, cardiac transplant, escalation to LVAD and stroke in the hypothermia group, as compared with the control group, was 0. Of the 27 secondary outcomes, 26 were inconclusive. Conclusion: In patients with refractory cardiogenic shock treated with VA-ECMO, early application of moderate hypothermia for 24 h did not significantly increase survival compared with normothermia.

However, because the confidence interval was wide and included a potentially clinical important effect size, these findings should be considered inconclusive.

We investigated whether a low-MAP between 65 and 70 mm Hg or a high-MAP target between 80 and 85 mm Hg would affect the course of mottling and arterial lactate in patients with septic shock. Data that concerned mottling were considered until the discontinuation of catecholamine or for a maximum of 5 days under vasopressors.

The presence or absence of mottling was recorded every 2 h from 2 h after inclusion to the catecholamine weaning. We compared time course of mottling and arterial lactate between the two MAP target groups. Results: We included patients in this analysis: were assigned to the low-MAP target group and to the high-MAP target group.

Our results were similar when considering only patients who reached the criteria of the SEPSIS-3 definition of septic shock. In addition, when compared to arterial lactate at inclusion, mottling duration appeared to be a better microcirculatory marker of mortality risk. Conclusion: In this large-scale study, we showed that a MAP target between 80 and 85 mm Hg, achieved through increased vasopressor doses, did not alter the course of mottling nor arterial lactate normalization.

Horizontal line represents a patient follow-up. Solid line corresponds to a period with mottling; hatched line corresponds to period without mottling. Secondary objective was to evaluate the association between the new-onset RVF and variations of respiratory parameters. Multivariate Cox model analysis accounting for new-onset RVF as time-dependent variable was used to identify parameters associated with mortality.

RVF was independently associated with day mortality adjusted hazard ratio: 8. Other independent risk factors were age HR per 10 years: 1. Conclusion: The development of RVF during ICU stay was independently associated with a markedly higher risk of days mortality and appeared associated with a worsening of respiratory parameters.

Rationale: Sedation in pediatric intensive care units PICU is balancing between endangerment patient and the risk of tachyphylaxis, withdrawal syndrome and delirium 1. The main objective was to describe sedation-analgesia procedures in France. The secondary objectives was to specify the use of drugs without marketing authorization, and to observe the drugs associations. The referring doctors answered a first online survey describing their unit.

They answered a second online survey about each sedated patient on the days of the study. The included patients were hospitalized in PICU; aged between 38 weeks of amenorrhea WA and 18 years old; received drugs for sedation or withdrawal syndrome. Excluded patients received painkillers against pure nociceptive pain, or palliative or terminal sedation. Nurses were autonomous to set dose of sedation according to protocol in 13 centers. Four hundred and two questionnaires were filed.

Use of Pentothal, Levomepromazine and Sevoflurane was uncommon. Conclusion: The most frequent sedation includes an association between an opioid and a benzodiazepine. Non-drug cares are widely used. Though recommended, scores are not often used. Reference 1: Harris et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals, Intensive Care Med Jun;42 6 — Rationale: In ICU, sedation-analgesia is a major therapeutic element to provide adequate comfort to the patient and to permit a good synchronization with the respirator.

Since the beginning of the XXI century, there has been a growing interest in the use of halogenated gases in ICU, because of their hypnotic effects.

Sevoflurane provided sedation quality comparable to Propofol and Midazolam, but with decreased wake-up and extubation times. Rationale: Computer vision has promising potential for the diagnosis of vital distress in critically ill patients including neurological, respiratory and hemodynamic distress. For instance, measurement of respiratory rate using 3D videos in spontaneous breathing patients and correlation between low cardiac output and thermal distribution using infrared IR images were reported in several studies.

The median volume was Cardiac patients were randomized before surgery; other patients were randomized in PICU. Results: patients across 50 centers US, Canada, France, Italy, Israel were randomized between February and August ; , including non-cardiac patients, received at least one RBC transfusion. Among the participants, 7. Among non-cardiac participants, Data on bleeding status and on-site policy limiting volume per transfusion e.

We established a simulation program aiming at providing communication tools to healthcare professionals. The goal of this study was to evaluate the impact of this program on the stress of PICU professionals and its acceptance. Forty simulations with four different simulation scenarios and various types of parental behavior, as imitated by professional actors, were completed during a 1-year period.

Primary outcomes were the difference in perceived stress level before and after the simulation and the degree of satisfaction of healthcare professionals nursing assistants, nurses, physicians. The impact of previous experience with family members during critical situations or CPR was evaluated by variation in perceived stress level. Results: Overall, questionnaires were analyzed. Perceived stress associated with parental presence decreased from a pre-simulation value of 6 IQR, 4—7 to 4 IQR, 2—5 post-simulation on a scale of 1— However, in Satisfaction of the participants was high with a median of 10 IQR, 9—10 out of 10 Fig.

Discussion: Our study describes an in situ pediatric simulation program of critical situations in the presence of family members played by professional actors. The simulation program was explicitly aiming at the development of communication skills. The simulation generally, but not always, showed a reduction in healthcare professionals perceived stress caused by family presence during a critical situation in the PICU. To meet the demand of participants experiencing a high level of stress after the simulation, a pre-simulation video on potential benefits and pitfalls of family presence during critical situations as well as on ad-hoc communication tools is now available to all future participants.

Five adverse events have been reported during the study period, although none have been attributed to beta-lactam treatment. Conclusion: Continuous infusion provided a higher probability to attain an optimal PK target compared to intermittent infusion, but also a higher risk for overexposure. Regular therapeutic drug monitoring is recommended in critically ill children receiving beta-lactams, regardless of the administration modality.

Description of the antibiotic exposure underexposure, optimal exposure or overexposure depending on the drug A or for the whole cohort B , with respect to the administration route, intermittent infusion II or continuous infusion CI. Rationale: Weaning-induced pulmonary edema WiPO is one of the main reasons for weaning failure.

Nevertheless, the reported incidence of WiPO is variable mainly in monocentric studies with small sample size. We thus aimed to evaluate the incidence and risk factors of WiPO in a large mixed population of critically ill patients. Patients with tracheostomy were excluded. The consensual diagnosis of WiPO was made a posteriori by five experts based on the patient characteristics, hemodynamic and echocardiographic variables, and biochemical results.

A potential pathogenic role of MDA5 antibodies motivated plasma exchange PLEX but whether the effectiveness of this procedure is unknown. The primary endpoint was one-year mortality. The use of PLEX was not associated with a favorable outcome. Further studies are needed to evaluate their efficacy. Kaplan—Meier Curves for the 1-year mortality status according to plasma exchange status. Rationale: Spontaneous pneumomediastinum SP , defined by the presence of air within the mediastinum without traumatic lesion, has been described during ARDS, even in the era of protective ventilation.

Spontaneous pneumomediastinum was diagnosed either on chest X-ray or chest CT-scan. Although the proportion of patients requiring IMV was similar, the time to tracheal intubation was longer in the patients with SP 6 days vs. This suggests that, barotrauma secondary to invasive mechanical ventilation, does not appear to be preponderant in the occurrence of pneumomediastinum in COVID Mechanism is potentially carried-out by patient self-inflected lung injury and hyperinflation secondary to a prolonged respiratory failure, as underlined by a longer delay before invasive mechanical ventilation.

Presence of a pneumomediastinum should alert the clinician in a spontaneously breathing patient to its tolerance and the need to use a more protective ventilation. Using multi-state modeling with causal inference, the outcomes related to VAP were also evaluated. The incidence of VAP was AM at 90 days was 3. FX06, a drug under development containing fibrin-derived peptide beta15—42, stabilizes cell-cell interactions, thereby reducing vascular leak and mortality in several animal models of ARDS.

All analyses were conducted on an intent-to-treat basis. Results: After one consent withdrawal, 49 patients were enrolled and randomized, 25 in the FX06 group and 24 in the placebo group. One third of them were equipped with veno-venous ECMO. Although EVLWi was elevated at baseline Cardiac index, pulmonary vascular permeability index, and fluid balance were also comparable between groups.

PaO 2 :FiO 2 ratio remained low and comparable between groups. Further studies are needed to evaluate its efficacy at earlier time points of the disease or using other dosing regimens. However, ECMO duration and hospital length of stay were much longer. Eighteen patients were lost to follow-up and were not included in our study. ECMO and mechanical ventilation duration were 18 [11—25] and 36 [27—62] days, respectively.

Besides, their ICU and hospital length of stay were 43 [33—62] and 85 [29—] days. At 1 year, only one patient was still in the hospital. Pulmonary function tests were good at 6 months except for a persistent impairment of the DLCO. Noticeably, QoL did not improve at 1 year of follow-up. Besides, a very large proportion of survivors still complained about anxiety, depression, and post-traumatic stress symptoms. These results emphasize the importance to integrate these young patients into customized, patient-centered, rehabilitation programs after ICU discharge.

At the time of VV-ECMO implantation, significant differences were observed with higher lactatemia in the early implanted group 1. Reference 1: Olivier et al. Reference 2: Hermann et al.

Its use is frequently associated with prolonged deep sedation and neuromuscular blockades, that may lead to diaphragm dysfunction. This latter is associated with delayed mechanical ventilation weaning and poor outcomes.

Results: Sixty-three patients were included with a median age of 53 42—59 years old and after a median of 4 days 2—6 of mechanical ventilation. Patients with diaphragmatic dysfunction at day 1 were older 55 years [43—60] vs. Diaphragmatic function did not significantly change over the study period Fig. Besides, these patients had longer mechanical ventilation duration when compared to those without diaphragmatic dysfunction When present at ECMO day-1, diaphragmatic dysfunction did not seem to evolve over time.

Amiodarone bolus and mg were studied. In vivo: ARDS was induced in 10 pigs. Amiodarone mg was injected once CPR started and twelve blood samples were drawn over a 12 min period. Pharmacokinetic analysis was performed with non-linear mixed effects modelling.

Results: In vitro study revealed a significant decrease in amiodarone concentrations after 10 min and a loss of In vivo pharmacokinetics revealed a significant decrease of Cmax, with We found significant alterations of drug delivery. Panel A: experimental protocol. Panel B: Visual Predictive Check for amiodarone model. Left panel: control group.

Rationale: Patients with severe heart failure may benefit from veno-arterial extracorporeal membrane oxygenation vaECMO, which preserves systemic blood flow. In clinical practice, vaECMO patients may exhibit dyspnea despite adequate blood flow and the absence of blood gas abnormalities. Our objective was to evaluate, in vaECMO patients exhibiting significant dyspnea, the impact of an increase in sweep gas flow through the vaECMO membrane on dyspnea.

Four conditions were studied: on inclusion and after three sweep gas flow increments of two liters per minute each. The respiratory drive was concomitantly assessed by the measure of the electromyographic activity of the Alea Nasi and parasternal muscles.

Conclusion: In critically ill patients with vaECMO, incrementation of sweep gas flow through the oxygenation membrane decreases dyspnea. It might be mediated by a decrease in respiratory drive, as suggests the concomitant decrease in respiratory rate and electromyographic activity of respiratory muscles. Rationale: Amniotic fluid embolism AFE is a rare but often catastrophic complication of pregnancy. The cardiopulmonary dysfunction associated with AFE being typically self-limited, venoarterial extracorporeal membrane oxygenation VA-ECMO support has been reported in the most severe forms.

Clinical characteristics, peri-delivery resuscitative procedures and critical care management are detailed. Seven patients had a cardiac arrest before ECMO and two were cannulated under cardiopulmonary resuscitation. Median durations of ECMO and mechanical ventilation support were respectively 4 1—6 and 5 1—13 days. The median ICU length of stay was 12 1—25 days. All infants survived. HRQOL was lower than age-matched controls and still profoundly impaired in the role-physical, bodily pain, and general health components after a median of 44 months follow-up Fig.

After a median follow-up of 25 [3—93] months, all transplanted patients were alive at the conclusion of the study four discharged home, one still hospitalized and no relapse of DM or ILD was noted.

All other patients, not listed for lung transplantation, died after a median of 30 [4—52] days on ECMO Fig.

Second, every patient that could be bridge-to-transplantation was discharged alive from ICU. None was previously listed for lung transplantation. Emergency lung transplantation was possible in patients treated with vasopressors, mechanical ventilation and ECLS. In contrast, a bridge-to-emergency lung transplantation is not only feasible, but also associated with a favorable outcome and appears therefore as the sole hope of survival for patients requiring ECLS.

Clinical features and outcome of patients with acute respiratory failure revealing anti-synthetase or anti-MDA-5 dermato-pulmonary syndrome: a French multicenter retrosp. Kaplan—Meier days Survival Estimates according to lung transplantation status. Rationale: Data concerning the association between time-period of ICU hospitalization and prognosis of patients admitted for coronavirus disease COVID are scarce.

This situation allowed us to contemporaneously compare Alpha and Beta in terms of the characteristics, management, and outcomes of critically ill patients.

The factors that associated with day death in Alpha- and Beta-infected patients were examined with logistic regression analysis.

Results: In total, patients median age, 63 years were enrolled. Of these, and had Alpha and Beta, respectively.

The remaining 18 patients had received a partial vaccine course and 2 were fully vaccinated. The vaccinated patients were equally likely to have Alpha and Beta. Discussion: To date, this is one of the largest studies to compare the characteristics and outcomes of critically ill patients who were infected with either of two simultaneously circulating VOCs and who underwent similar treatment regimens in the same settings. A recent meta-analysis suggests an increased mortality of Beta variant compared to wild type strain.

Plus, the Beta and Delta variants were described as risker than the Alpha and Gamma variants 1. Nevertheless, none of the studies cited in the meta-analysis was specific to critically ill patient or compare variants with each other.

Plus, the Beta variant proportion was quite low compared to other variants in these studies Alpha particularly. Conclusion: Beta did not differ from Alpha in terms of patient characteristics, management, or outcomes in critically ill patients. Better understanding of these variants including ongoing and future ones is essential. Age OR 1.

Conclusion: Severe SARS-Cov2 infection occurs post-vaccination essentially in patients with immunosuppression, chronic kidney, heart or liver failure. Age and disease severity are independently associated with mortality.

Vaccination might inflect the disease course, even in critically-ill patients. Our objectives were to compare the mortality of patients with versus without auto-Abs neutralizing type I IFNs, to assess the rate of positivity of auto-Abs and the factors associated with their positivity. Baseline characteristics did not differ between patients with and without auto-Abs Table 1.

In addition to clinical, biological and radiological parameters, circulating lymphocyte subsets, mature and immature granulocytes and mHLA-DR were analyzed using routine flow cytometry on the first blood sample. The primary endpoint was the non-deterioration determined by 3 clinicians who were blinded from cytometry results and defined from a composite criterion: i need for high flow oxygen, ii ICU admission, iii in-hospital mortality related to SARS-COV-2, iiii readmission within 5 days.

No case of histologically proven CAPA was reported. Patients with possible CAPA were Probable CAPA were diagnosed after 8 [4. Lancet Infect Dis ; e—e In a desire to protect the child from a potentially traumatic environment, some units refuse or restrict visits to children Laurent et al.

We complemented the quantitative approach with semi-structured interviews to capture the experience of the visit at 7 days. Results: Of the 22 children included, 15 children were able to complete questionnaires at 7 days of the visit and 21 at 30 days. At 7 days of the visit, 9 out of 15 children showed acute stress.

One month after, 9 out of 21 children suffered from a potential post-traumatic stress disorder. The thematic analysis shows that the visit is indeed disturbing for most of children.

However, children expressed that this visit was reassuring to them. Certain dimensions are identified as a source of distress and can explain the CRIES-8 scores: the absence of the hospitalized parent, the distress of the accompanying parent, and the disruption of daily life.

Thus, the higher the anxiety-depressive symptomatology of the parents, the higher the acute stress symptomatology of the children tended to be. Reference 1: Laurent A.

Intensive Care Medicine. Reference 2: Laurent A. Pratiques psychologiques Rationale: The perception of inappropriate care in end-of-life situations can be a source of conflict and burnout among caregivers. The purpose of this study is to describe caregivers’ perceptions of end-of-life care in the surgical intensive care unit and intermediate care unit of our hospital before and after the implementation of therapeutic perspective meetings TPMs.

It explores 3 dimensions: working conditions, managerial skills and end-of-life decision making. Descriptive and analytical analyses were performed. TPMs improved caregivers’ perception of expressing disagreement with opinions or values 3 vs. Conclusion: The implementation of TPMs has improved the perception of caregivers regarding communication between caregivers on patient management, particularly for end-of-life situations, and has encouraged the involvement of nurses in these decisions as well as their presence during interviews with the families.

There was no impact on perceptions of the temporality of end-of-life decision-making or on admissions of patients with minimal chance of recovery. Further studies are needed to assess the impact of TPMs on the prevalence of conflict, risk of burnout, and quality of care delivered. In-depth interviews were conducted with 39 intensivists of different age groups and levels of professional experience, and with 5 department heads.

Reference 1: Nadig, N. Critical care medicine, 47 10 , — Reference 2: Wilkinson, D. The luck of the draw: physician-related variability in end-of-life decision-making in intensive care.

Intensive care medicine, 39 6 , — Rationale: In the Intensive Care Unit ICU , patient-to-nurse ratio is associated with patient outcomes but little is known about the habit among staff members of working together. The goal of present study is to investigate the role of nursing team composition on patient ICU mortality.

The team composition was evaluated using the familiarity among the ICU caregivers, which was measured by shift from am to pm and from pm to am as the mean number of previous collaborations between each nursing team member during previous shifts within the given ICU. Suboptimal collaboration was defined as less than The patient-to-nurse ratio and patient-to-auxiliary nurse ratio were also considered suboptimal ratio defined as higher than 0.

Suboptimal team composition reflected a total of [—] shifts with potentially avoidable death, corresponding to 7. The risk of death at admission was also higher in case of suboptimal team composition RR 1.

Conclusion: In conclusion, the familiarity between ICU nursing staff is significantly associated with inpatient death additionally to patient-to-caregiver ratio. Improving team composition should be a management goal in ICU.

Rationale: Physicians play an important role in controlling health care spending, by prescribing more or less expensive treatments. The aim of this study was to evaluate the knowledge of health care workers of the cost of the treatments they daily use in ICU. A survey was delivered and completed anonymously by healthcare workers HCWs of four French ICUs, three university affiliated and one non-university affiliated.

The survey proposed to estimate the price of 37 treatments frequently used in critical care. Results: HCWs answered to the survey, including 75 nurses and 82 physicians. Medical staff was composed of 36 seniors and 45 juniors. Median age of the respondents was 29 [25—36] years. They provided answers.

Interestingly, the most expensive treatments prices were under evaluated whereas the cheapest ones were overvalued. For example, median estimation of the cost of eculizumab was only 9 [2. However, their efficacy remains flawed and antibiotics remain overused. One of the reasons lies in subjective determinants of the prescription. The aim of our study is to explore personal, social, cultural and contextual factors that can influence antibiotic prescribing behaviour in the ICU.

Factors such as prescriber anxiety and lack of self-confidence, linked in particular to a lack of knowledge, stand out.

The fear of missing a septic etiology pushes the physician to prevail the short-term benefit taking over the long-term consequences. Rationale: The gold standard method proposed to detect and measure airway opening pressure AOP in patients with acute respiratory distress syndrome ARDS requires a low-flow insufflation i.

We also assessed an automated computer-based detection of AOP. We compared methods 2 and 3 to the gold standard and collected the lowest SpO 2 during each measurement to assess the tolerance. Conclusion: These preliminary data suggest that measuring AOP is feasible at standard insufflation flow rate with a simple, quick and safe method based on visual inspection of airway pressure waveform. Rationale: ARDS is a heterogeneous syndrome involving different phenotypes with distinct clinical and outcome characteristics.

With Electrical Impedance Tomography EIT it is possible to measure the distribution of ventilation in each lung in order to describe asymmetrical lung injury.

In the present study, we hypothesized that some patients may have asymmetrical ARDS where EIT would provide different information from those obtained from global P-V curves. We recorded the low flow PV curve without PEEP of the ventilator in order to assess airway closure and the recruited volume.

We compared respiratory mechanic between the 2 lungs in patients with asymmetrical ARDS. Results: We analyzed 26 patients, 18 patients had asymmetrical lung injury, the most injured lung received The compliance of the recruited lung Crec in the more injured lung was not different from the less injured Personalizing ventilator management in asymmetrical lung injury entails assessing each lung-specific risk of VILI with repeated opening and collapse of the most injured lung and overdistension in the less injured lung.

Rationale: Electrical Impedance Tomography EIT allows to provide an imaging of the gas distribution in the lung during ventilation. This study aimed to compare the physiological effects of two distinct EIT-based and one respiratory system mechanics-based PEEP titration strategies.

The PEEP level determined according to the three tested strategies was then applied in a randomized order three periods of 45 min. Gas exchange, respiratory mechanics including airway and esophageal pressure measurements, hemodynamic and gas distribution using EIT were assessed at the end of each period.

Results: Twenty patients have been included in the analysis. OD-CL strategy is associated with decreased oxygenation but similar respiratory mechanics and hemodynamic parameters. Gas exchange and respiratory mechanics were assessed at each step. Results: Median age was 60 [48—68] years, and body mass index Respiratory system compliance remained stable 36 [25—50] vs. Both wasted ventilation 17 [14—20] vs. This effect is correlated with lung recruitability.

Rationale: After a successful spontaneous breathing trial SBT , reconnection to mechanical ventilation for 1 h is associated with lower reintubation rates than direct extubation1. However, physiological explanations leading to this clinical effect remain unclear. We hypothesized that reconnection to mechanical ventilation for 1 h after a successful SBT induces alveolar recruitment. Our primary aim was to compare end-expiratory lung volume EELV at the end of a successful SBT and 1 h after reconnection to mechanical ventilation.

Median age was 71 years [interquartile range 67—75] and duration of mechanical ventilation was 8 days [4—13]. Regional ventilation was mainly distributed in the non-dependent lung regions and did not differ between T-piece and pressure-support.

Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicenter randomized control. T-piece versus pressure-support ventilation for spontaneous breathing trials before extubation in patients at high risk of reintubation: protocol for a multicentre, randomised control. Rationale: Half of patients undergoing mechanical ventilation MV in the intensive care unit report a dyspnea of moderate to severe intensity, which causes immediate suffering and post-traumatic stress disorders.

Dyspnea has two distinct components, a sensory component and an emotional component. Our objective was to evaluate and to compare the respective impact of a modulation of the sensory component respiratory afferents and the emotional component extra respiratory auditory and sensory stimulations on the intensity of dyspnea in critically ill patients undergoing MV, either invasive or non-invasive.

We studied the following interventions: 1 increase of pressure support level by 5 cmH2O vs. A washout period separated each condition. The respiratory drive was assessed by the P0. Results: We included 46 patients, 19 tracheostomized, 18 intubated and 9 under non-invasive ventilation.

Median interquartile range age was 63 years 54—73 and duration of mechanical ventilation was 33 days 7— Compared to their respective control group the three intervention decreased Dyspnea-VAS: 1 pressure support increment 20 [20—40] mm vs.

Compared to their respective control group the three interventions decreased A1: 1 pressure support increment 5 [4—6] vs.

Conclusion: In critically ill MV patients, auditory and sensory extra-respiratory stimulations decreased dyspnea without decreasing respiratory drive, suggesting a mechanism involving a modulation of the emotional component. Rationale: An accurate SpO 2 value is critical in order to optimally titrate the O2 flow or FiO 2 delivered to patients under oxygen support and to follow oxygenation guidelines.

The objective of this study was to assess the accuracy and bias of the SpO 2 value measured by several oximeters compared to the reference value, arterial oxygen saturation SaO 2 measured by arterial gases in intubated and spontaneously breathing patients in the intensive care unit. We included stable patients hospitalized in the ICU with an arterial catheter in place. Arterial blood gases were drawn and simultaneously, SpO 2 values for all oximeters were collected. SpO 2 value were compared to the reference SaO 2 value to determine bias and accuracy.

The ability for oximeters to detect hypoxemia and the impact of oximeters on oxygen titration were evaluated. Results: We included patients men; 57 women, mean age The skin pigmentation evaluated by Fitzpatrick showed Oxygen saturation was underestimated with Nonin oximeter in Conclusion: We found large systematic and random errors between the tested oximeters and the arterial blood gases, in the studied population.

These discrepancies may have important clinical impact on the detection of hypoxemia or management of oxygen. Main features of evaluated oximeters.

Mean, standard deviation, percentage of over and underestimation of the SaO 2 and detection of hypoxemia for tested oximeters. Rationale: In patients with COVID related de novo acute respiratory failure, the application of continuous positive airway pressure CPAP improves respiratory mechanics, gas exchange and outcome [1]. In the context of a pandemic with a massive influx of hypoxemic patients, the high oxygen consumption required to achieve optimal inspired oxygen FiO 2 may jeopardize health care organization and oxygen delivery hospital capabilities.

The system operates with a 30L reservoir for gas accumulation to reduce oxygen consumption and guarantee FiO 2 irrespective of respiratory demand. After ANSM authorization, the clinical observation was conducted in two university hospitals in France, on 20 adult patients with de novo acute respiratory failure.

PEEP level was adjusted at 7. No significant effect was observed on respiratory rate. Reference 1: G. Perkins et al. Reference 2: A. Esophageal pressure monitoring allows to estimate pleural and transpulmonary pressures. Two distinct strategies based on measured end-expiratory transpulmonary pressure P L, exp or calculated end-inspiratory transpulmonary pressure P L, insp calc have been described but their physiological effects have never been compared to each other.

This study aimed at comparing the short-term ventilatory and hemodynamic effects of these two strategies in patients with ARDS. P L, exp -based and P L, insp calc -based strategies were consecutively applied in a randomized order in patients with moderate to severe ARDS. Gas exchange, respiratory mechanics, hemodynamics and ventilation regional distribution assessed with electrical impedance tomography were evaluated 45 min after the application of each PEEP titration strategy.

Results: Twenty patients were included in this study. Compared to P L, exp -based strategy, P L, insp calc -based strategy was associated, in these patients, with better oxygenation but lower cardiac output, higher transpulmonary driving pressure, lower respiratory system compliance and lower non-dependant regional compliance, suggesting lung overdistension.

P L, insp calc -based strategy may be associated with lung overdistension in some patients. Reference 1: Talmor, D. Mechanical ventilation guided by esophageal pressure in acute lung injury.

Reference 2: Grasso, S. Intensive Care Med 38, —

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Windows 10 1703 download iso italy covid vaccine/appointment

However, because the confidence interval was wide and included a potentially clinical important effect size, these findings should be considered inconclusive. Reference 1: Levy B et al. Median IQR of observation time was 8 28, 30 days. Rationale: In patients with septic shock, the impact of mean arterial pressure MAP target on the course of mottling remains uncertain.

We investigated whether a low-MAP between 65 and 70 mm Hg or a high-MAP target between 80 and 85 mm Hg would affect the course of mottling and arterial lactate in patients with septic shock.

Conclusion: In this large-scale study, we showed that a MAP target between 80 and 85 mm Hg, achieved through increased vasopressor doses, did not alter the course of mottling nor arterial lactate normalization. In addition, compared to arterial lactate at inclusion, mottling duration appears to be a stronger marker of mortality risk. High versus low blood-pressure target in patients with septic shock.

N Engl J Med. Course of mottling in patients with septic shock according to the mean arterial pressure target. Horizontal line represents a patient follow-up. Solid line corresponds to a period with mottling; hatched line corresponds to period without mottling.

Secondary objective was to evaluate the association between the new-onset RVF and variations of respiratory parameters. Multivariate Cox model analysis accounting for new-onset RVF as time-dependent variable was used to identify parameters associated with mortality. RVF was independently associated with day mortality adjusted hazard ratio: 8. Other independent risk factors were age HR per 10 years: 1. Conclusion: The development of RVF during ICU stay was independently associated with a markedly higher risk of days mortality and appeared associated with a worsening of respiratory parameters.

Rationale: Sedation in pediatric intensive care units PICU is balancing between endangerment patient and the risk of tachyphylaxis, withdrawal syndrome and delirium 1.

The main objective was to describe sedation-analgesia procedures in France. The secondary objectives was to specify the use of drugs without marketing authorization, and to observe the drugs associations. The referring doctors answered a first online survey describing their unit. They answered a second online survey about each sedated patient on the days of the study. The included patients were hospitalized in PICU; aged between 38 weeks of amenorrhea WA and 18 years old; received drugs for sedation or withdrawal syndrome.

Non-drug cares are widely used. Though recommended, scores are not often used. Reference 1: Harris et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals, Intensive Care Med Jun;42 6 — Rationale: In ICU, sedation-analgesia is a major therapeutic element to provide adequate comfort to the patient and to permit a good synchronization with the respirator.

Therefore, their efficacy and tolerance should be assessed. They could reduce the dosage of benzodiazepines and opioids, thereby reducing the incidence of withdrawal syndrome. They all benefited from volatile sedation Isoflurane of Sevoflurane for 24 h at least. The proportion of adverse events and withdrawal syndrome were collected.

The same results were found for other hypnotics Ketamine: 2. No major adverse effects were reported. Conclusion: Halogenated gases seem to be an interesting therapeutic to reduce dosages of different hypnotics and opioids used during multimodal prolonged sedations.

Both cameras are pointed towards the patient and are placed in a 3D printed support. The software component included a web user interface for performing the acquisitions in the hospital intranet in a secure manner. The video research database currently includes more than acquisitions and is being used in various studies to assess vital distress signs including facial expressions to estimate sedation level and consciousness using RGB videos, the refinement of tidal volume and respiratory rate measurements in patients using 3D videos, and estimation of the thermal gradient across various parts of the body using IR.

Results: patients across 50 centers US, Canada, France, Italy, Israel were randomized between February and August ; , including non-cardiac patients, received at least one RBC transfusion.

Among the participants, 7. Among non-cardiac participants, Data on bleeding status and on-site policy limiting volume per transfusion e. Red blood cell transfusion practice in children: current status and areas for improvement? A study of the use of red blood cell transfusions in children and infants. Transfusion ; The age of transfused blood in critically ill children. JAMA ;— Rationale: Family presence during invasive procedures or cardiopulmonary resuscitation CPR is a part of the family-centered approach in pediatric intensive care units PICUs.

Results: Overall, questionnaires were analyzed. Perceived stress associated with parental presence decreased from a pre-simulation value of 6 IQR, 4—7 to 4 IQR, 2—5 post-simulation on a scale of 1— However, in Satisfaction of the participants was high with a median of 10 IQR, 9—10 out of 10 Fig. Discussion: Our study describes an in situ pediatric simulation program of critical situations in the presence of family members played by professional actors.

Rationale: Weaning-induced pulmonary edema WiPO is one of the main reasons for weaning failure. Nevertheless, the reported incidence of WiPO is variable mainly in monocentric studies with small sample size. We thus aimed to evaluate the incidence and risk factors of WiPO in a large mixed population of critically ill patients. Patients with tracheostomy were excluded. The consensual diagnosis of WiPO was made a posteriori by five experts based on the patient characteristics, hemodynamic and echocardiographic variables, and biochemical results.

Patients receiving invasive mechanical ventilation for less than 5 days for a SARS-CoV-2 induced ARDS were randomized to receive intravenous FX06, mg per day during 5 days, or its placebo, on the top of usual care. The primary endpoint was the reduction of pulmonary vascular leakage from day 1 to day 7, evaluated by transpulmonary thermodilution-derived extra-vascular lung water index EVLWi. All analyses were conducted on an intent-to-treat basis. Results: After one consent withdrawal, 49 patients were enrolled and randomized, 25 in the FX06 group and 24 in the placebo group.

One third of them were equipped with veno-venous ECMO. Although EVLWi was elevated at baseline Cardiac index, pulmonary vascular permeability index, and fluid balance were also comparable between groups. PaO 2 :FiO 2 ratio remained low and comparable between groups. Further studies are needed to evaluate its efficacy at earlier time points of the disease or using other dosing regimens.

However, ECMO duration and hospital length of stay were much longer. Eighteen patients were lost to follow-up and were not included in our study. ECMO and mechanical ventilation duration were 18 [11—25] and 36 [27—62] days, respectively.

Besides, their ICU and hospital length of stay were 43 [33—62] and 85 [29—] days. At 1 year, only one patient was still in the hospital.

Pulmonary function tests were good at 6 months except for a persistent impairment of the DLCO. Noticeably, QoL did not improve at 1 year of follow-up. Besides, a very large proportion of survivors still complained about anxiety, depression, and post-traumatic stress symptoms. These results emphasize the importance to integrate these young patients into customized, patient-centered, rehabilitation programs after ICU discharge.

At the time of VV-ECMO implantation, significant differences were observed with higher lactatemia in the early implanted group 1. Reference 1: Olivier et al. Reference 2: Hermann et al. Its use is frequently associated with prolonged deep sedation and neuromuscular blockades, that may lead to diaphragm dysfunction. This latter is associated with delayed mechanical ventilation weaning and poor outcomes.

We hypothesize that diaphragmatic dysfunction is frequent, severe, and associated with prolonged mechanical ventilation and poor outcomes in that severe population. Diaphragmatic function was daily assessed by measuring diaphragm pressure generation in response to phrenic nerve stimulation Ptr,stim from ECMO initiation until ECMO weaning. Results: Sixty-three patients were included with a median age of 53 42—59 years old and after a median of 4 days 2—6 of mechanical ventilation.

Patients with diaphragmatic dysfunction at day 1 were older 55 years [43—60] vs. Diaphragmatic function did not significantly change over the study period Fig. Besides, these patients had longer mechanical ventilation duration when compared to those without diaphragmatic dysfunction When present at ECMO day-1, diaphragmatic dysfunction did not seem to evolve over time.

However, it was associated with a longer duration of mechanical ventilation in patients successfully weaned from ECMO.

Values are presented as medians with their standard deviations. The red line corresponds to the threshold of 11 cmH 2 O below which diaphragmatic dysfunction is defined. Amiodarone bolus and mg were studied. In vivo: ARDS was induced in 10 pigs. Amiodarone mg was injected once CPR started and twelve blood samples were drawn over a 12 min period.

Pharmacokinetic analysis was performed with non-linear mixed effects modelling. Results: In vitro study revealed a significant decrease in amiodarone concentrations after 10 min and a loss of In vivo pharmacokinetics revealed a significant decrease of Cmax, with We found significant alterations of drug delivery. Panel A: experimental protocol. Panel B: Visual Predictive Check for amiodarone model. Left panel: control group. Rationale: Patients with severe heart failure may benefit from veno-arterial extracorporeal membrane oxygenation vaECMO, which preserves systemic blood flow.

In clinical practice, vaECMO patients may exhibit dyspnea despite adequate blood flow and the absence of blood gas abnormalities. Our objective was to evaluate, in vaECMO patients exhibiting significant dyspnea, the impact of an increase in sweep gas flow through the vaECMO membrane on dyspnea. Four conditions were studied: on inclusion and after three sweep gas flow increments of two liters per minute each. The respiratory drive was concomitantly assessed by the measure of the electromyographic activity of the Alea Nasi and parasternal muscles.

Seven patients had a cardiac arrest before ECMO and two were cannulated under cardiopulmonary resuscitation. Median durations of ECMO and mechanical ventilation support were respectively 4 1—6 and 5 1—13 days. The median ICU length of stay was 12 1—25 days. All infants survived. HRQOL was lower than age-matched controls and still profoundly impaired in the role-physical, bodily pain, and general health components after a median of 44 months follow-up Fig. Four out of seven patients returned to their initial work.

Conclusion: In this rare per-delivery complication, our results support the use of VA-ECMO despite extreme initial severity, intense disseminated intravascular coagulation and ongoing bleeding. However, long-term physical and mental status were still impaired after long-term evaluation.

Emergency lung transplantation was possible in patients treated with vasopressors, mechanical ventilation and ECLS. In contrast, a bridge-to-emergency lung transplantation is not only feasible, but also associated with a favorable outcome and appears therefore as the sole hope of survival for patients requiring ECLS. Clinical features and outcome of patients with acute respiratory failure revealing anti-synthetase or anti-MDA-5 dermato-pulmonary syndrome: a French multicenter retrosp.

Kaplan—Meier days Survival Estimates according to lung transplantation status. Rationale: Data concerning the association between time-period of ICU hospitalization and prognosis of patients admitted for coronavirus disease COVID are scarce. Risk factors of mortality and invasive mechanical ventilation iMV were identified by multivariate logistic regression models. Results: COVID patients were admitted in ICU during the study period with respectively , , and patients during the first, second, and third surge.

Multivariate model identified age, male gender, Charlson score, IGS 2 score and ICU admission after the first wave as risk factors of in-hospital death. Second and third wave were associated with in-hospital mortality for patients with 70 years and more. Finally, vaccination was associated with a lower likelihood of iMV and death. Rationale: The clinical outcomes of the Beta B. In early , northeastern France experienced an outbreak of Beta that was not observed elsewhere.

This outbreak slightly preceded and then overlapped with a second outbreak of the better understood VOC Alpha B. This situation allowed us to contemporaneously compare Alpha and Beta in terms of the characteristics, management, and outcomes of critically ill patients.

Primary outcome was day mortality. Differences between Alpha and Beta in terms of other outcomes, patient variables, management, and vaccination characteristics were also explored by univariate analysis. The factors that associated with day death in Alpha- and Beta-infected patients were examined with logistic regression analysis. Results: In total, patients median age, 63 years were enrolled. Of these, and had Alpha and Beta, respectively. The remaining 18 patients had received a partial vaccine course and 2 were fully vaccinated.

The vaccinated patients were equally likely to have Alpha and Beta. Discussion: To date, this is one of the largest studies to compare the characteristics and outcomes of critically ill patients who were infected with either of two simultaneously circulating VOCs and who underwent similar treatment regimens in the same settings.

A recent meta-analysis suggests an increased mortality of Beta variant compared to wild type strain. Plus, the Beta and Delta variants were described as risker than the Alpha and Gamma variants 1.

Nevertheless, none of the studies cited in the meta-analysis was specific to critically ill patient or compare variants with each other. Plus, the Beta variant proportion was quite low compared to other variants in these studies Alpha particularly.

Conclusion: Beta did not differ from Alpha in terms of patient characteristics, management, or outcomes in critically ill patients. Better understanding of these variants including ongoing and future ones is essential. Age OR 1. Conclusion: Severe SARS-Cov2 infection occurs post-vaccination essentially in patients with immunosuppression, chronic kidney, heart or liver failure.

Age and disease severity are independently associated with mortality. Vaccination might inflect the disease course, even in critically-ill patients.

Our objectives were to compare the mortality of patients with versus without auto-Abs neutralizing type I IFNs, to assess the rate of positivity of auto-Abs and the factors associated with their positivity. Baseline characteristics did not differ between patients with and without auto-Abs Table 1. Mortality at day 28 was not different between groups Compared to women without auto-Abs, positive women were significantly younger 45 24—62 vs 60 years Positive women seem to have an auto-immune background and more frequently required mechanical ventilation.

Reference 1: Bastard, P. Science , eabd Standard scores and biomarkers used in ED are strongly associated with immediate severity but their prognostic performance to predict clinical course of patients is limited. In addition to clinical, biological and radiological parameters, circulating lymphocyte subsets, mature and immature granulocytes and mHLA-DR were analyzed using routine flow cytometry on the first blood sample.

The thematic analysis shows that the visit is indeed disturbing for most of children. However, children expressed that this visit was reassuring to them. Certain dimensions are identified as a source of distress and can explain the CRIES-8 scores: the absence of the hospitalized parent, the distress of the accompanying parent, and the disruption of daily life.

Thus, the higher the anxiety-depressive symptomatology of the parents, the higher the acute stress symptomatology of the children tended to be. Reference 1: Laurent A. Intensive Care Medicine. Reference 2: Laurent A.

Pratiques psychologiques Rationale: The perception of inappropriate care in end-of-life situations can be a source of conflict and burnout among caregivers. The purpose of this study is to describe caregivers’ perceptions of end-of-life care in the surgical intensive care unit and intermediate care unit of our hospital before and after the implementation of therapeutic perspective meetings TPMs. It explores 3 dimensions: working conditions, managerial skills and end-of-life decision making.

Descriptive and analytical analyses were performed. TPMs improved caregivers’ perception of expressing disagreement with opinions or values 3 vs.

Reference 1: Nadig, N. Critical care medicine, 47 10 , — Reference 2: Wilkinson, D. The luck of the draw: physician-related variability in end-of-life decision-making in intensive care. Intensive care medicine, 39 6 , — Rationale: In the Intensive Care Unit ICU , patient-to-nurse ratio is associated with patient outcomes but little is known about the habit among staff members of working together.

The primary outcome was inpatient death at the time of ICU discharge, excluding patients for whom a decision to forego life-sustaining therapy was made.

Inpatient death during the shift at admission was secondarily considered. Results: A total of 43, patients were admitted to the ICUs of whom 3, 7. The adjusted model showed an increased risk of patient mortality during shifts exposed to suboptimal team familiarity lower than 50 previous collaborations Relative Risk 1. Suboptimal team composition reflected a total of [—] shifts with potentially avoidable death, corresponding to 7.

Improving team composition should be a management goal in ICU. Rationale: Physicians play an important role in controlling health care spending, by prescribing more or less expensive treatments.

Median age of the respondents was 29 [25—36] years. They provided answers. Interestingly, the most expensive treatments prices were under evaluated whereas the cheapest ones were overvalued. For example, median estimation of the cost of eculizumab was only 9 [2. However, their efficacy remains flawed and antibiotics remain overused. One of the reasons lies in subjective determinants of the prescription.

The aim of our study is to explore personal, social, cultural and contextual factors that can influence antibiotic prescribing behaviour in the ICU. The questionnaire was distributed to all ICUs in France through a personal email sent to the head of each ICU, asking them to send the questionnaire to doctors and residents of their team.

Two reminders were sent, at 2 and 4 months. The population is comparable to the global demography in French ICUs 1.

Conclusion: This work confirms that subjective determinants hinder reasoned antibiotic prescribing. Factors such as prescriber anxiety and lack of self-confidence, linked in particular to a lack of knowledge, stand out. The fear of missing a septic etiology pushes the physician to prevail the short-term benefit taking over the long-term consequences. Rationale: The gold standard method proposed to detect and measure airway opening pressure AOP in patients with acute respiratory distress syndrome ARDS requires a low-flow insufflation i.

Conclusion: These preliminary data suggest that measuring AOP is feasible at standard insufflation flow rate with a simple, quick and safe method based on visual inspection of airway pressure waveform. Rationale: ARDS is a heterogeneous syndrome involving different phenotypes with distinct clinical and outcome characteristics. With Electrical Impedance Tomography EIT it is possible to measure the distribution of ventilation in each lung in order to describe asymmetrical lung injury.

ECMO patients were ventilated with significantly lower tidal volume 1. Tidal hyperinflation was significantly lower in ECMO patients. ECMO patients exhibits lower hyperinflation levels of already aerated lung with PEEP increase from 5 to 15 cmH 2 O, as a consequence of compliance decrease of the baby lung at low end-expiratory lung volume. Rationale: Electrical Impedance Tomography EIT allows to provide an imaging of the gas distribution in the lung during ventilation. This study aimed to compare the physiological effects of two distinct EIT-based and one respiratory system mechanics-based PEEP titration strategies.

Results: Twenty patients have been included in the analysis. OD-CL strategy is associated with decreased oxygenation but similar respiratory mechanics and hemodynamic parameters.

Gas exchange and respiratory mechanics were assessed at each step. Results: Median age was 60 [48—68] years, and body mass index Respiratory system compliance remained stable 36 [25—50] vs. Both wasted ventilation 17 [14—20] vs. This effect is correlated with lung recruitability. Rationale: After a successful spontaneous breathing trial SBT , reconnection to mechanical ventilation for 1 h is associated with lower reintubation rates than direct extubation1.

However, physiological explanations leading to this clinical effect remain unclear. We hypothesized that reconnection to mechanical ventilation for 1 h after a successful SBT induces alveolar recruitment. Our primary aim was to compare end-expiratory lung volume EELV at the end of a successful SBT and 1 h after reconnection to mechanical ventilation.

All patients included were at high-risk of extubation failure, i. Regional ventilation using electrical impedance tomography was continuously recorded during the study. SBT was performed for around 1 h using T-piece or low pressure-support levels according to the randomization. Median age was 71 years [interquartile range 67—75] and duration of mechanical ventilation was 8 days [4—13]. Regional ventilation was mainly distributed in the non-dependent lung regions and did not differ between T-piece and pressure-support.

Conclusion: SBT induced a marked alveolar derecruitment which was significantly greater after SBT using T-piece than using pressure-support. This lung volume loss was almost completely recovered after 10 min of reconnection to mechanical ventilation regardless the type of SBT. Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicenter randomized control. T-piece versus pressure-support ventilation for spontaneous breathing trials before extubation in patients at high risk of reintubation: protocol for a multicentre, randomised control.

Rationale: Half of patients undergoing mechanical ventilation MV in the intensive care unit report a dyspnea of moderate to severe intensity, which causes immediate suffering and post-traumatic stress disorders. Dyspnea has two distinct components, a sensory component and an emotional component. Our objective was to evaluate and to compare the respective impact of a modulation of the sensory component respiratory afferents and the emotional component extra respiratory auditory and sensory stimulations on the intensity of dyspnea in critically ill patients undergoing MV, either invasive or non-invasive.

We studied the following interventions: 1 increase of pressure support level by 5 cmH2O vs. A washout period separated each condition. The respiratory drive was assessed by the P0.

Results: We included 46 patients, 19 tracheostomized, 18 intubated and 9 under non-invasive ventilation. Median interquartile range age was 63 years 54—73 and duration of mechanical ventilation was 33 days 7— Compared to their respective control group the three intervention decreased Dyspnea-VAS: 1 pressure support increment 20 [20—40] mm vs.

Compared to their respective control group the three interventions decreased A1: 1 pressure support increment 5 [4—6] vs.

It has been shown with closed-loop oxygen titration that small variations in SpO 2 target greatly affect the oxygen flow required, which may have a relevant impact on clinical decisions. This variability may represent an obstacle to an optimal delivery of oxygen therapy, including the implementation of guidelines. The objective of this study was to assess the accuracy and bias of the SpO 2 value measured by several oximeters compared to the reference value, arterial oxygen saturation SaO 2 measured by arterial gases in intubated and spontaneously breathing patients in the intensive care unit.

We included stable patients hospitalized in the ICU with an arterial catheter in place. Arterial blood gases were drawn and simultaneously, SpO 2 values for all oximeters were collected. SpO 2 value were compared to the reference SaO 2 value to determine bias and accuracy. The ability for oximeters to detect hypoxemia and the impact of oximeters on oxygen titration were evaluated.

Results: We included patients men; 57 women, mean age The skin pigmentation evaluated by Fitzpatrick showed Oxygen saturation was underestimated with Nonin oximeter in Conclusion: We found large systematic and random errors between the tested oximeters and the arterial blood gases, in the studied population.

These discrepancies may have important clinical impact on the detection of hypoxemia or management of oxygen. Main features of evaluated oximeters. Mean, standard deviation, percentage of over and underestimation of the SaO 2 and detection of hypoxemia for tested oximeters. Rationale: In patients with COVID related de novo acute respiratory failure, the application of continuous positive airway pressure CPAP improves respiratory mechanics, gas exchange and outcome [1]. In the context of a pandemic with a massive influx of hypoxemic patients, the high oxygen consumption required to achieve optimal inspired oxygen FiO 2 may jeopardize health care organization and oxygen delivery hospital capabilities.

Within the framework of frugal innovation [2], we have designed a new Bag-CPAP device aiming at meeting oxygen delivery constraints. The aim of these clinical observations was to evaluate the performances of the Bag-CPAP in terms of FiO 2 actually delivered, oxygen consumption, airway pressure and clinical tolerance. The system operates with a 30L reservoir for gas accumulation to reduce oxygen consumption and guarantee FiO 2 irrespective of respiratory demand.

After ANSM authorization, the clinical observation was conducted in two university hospitals in France, on 20 adult patients with de novo acute respiratory failure. PEEP level was adjusted at 7. No significant effect was observed on respiratory rate. Reference 1: G. Perkins et al. Reference 2: A. Esophageal pressure monitoring allows to estimate pleural and transpulmonary pressures.

Two distinct strategies based on measured end-expiratory transpulmonary pressure P L, exp or calculated end-inspiratory transpulmonary pressure P L, insp calc have been described but their physiological effects have never been compared to each other.

Gas exchange, respiratory mechanics, hemodynamics and ventilation regional distribution assessed with electrical impedance tomography were evaluated 45 min after the application of each PEEP titration strategy.

P L, insp calc -based strategy may be associated with lung overdistension in some patients. Reference 1: Talmor, D. Mechanical ventilation guided by esophageal pressure in acute lung injury. Reference 2: Grasso, S. Intensive Care Med 38, — Rationale: In the context of acute respiratory distress syndrome ARDS , the response to lung recruitment maneuvers LRM varies considerably from one patient to another.

The LRM can be harmful, especially in patients with low recruitability, inducing lung overdistention and cardiac dysfunction. We evaluated the changes in gas exchange, respiratory mechanics, and hemodynamic parameters induced by a stepwise LRM at a constant driving pressure of 15 cmH 2 O during pressure-controlled ventilation.

Conclusion: During an LRM, the mechanisms related to an increase in oxygenation depend on the potential for lung recruitment. Patients with high recruitability presented a significant increase in Crs indicating a gain in ventilated area , while those with low recruitability presented a decrease in pulse pressure suggesting a drop in cardiac output and therefore in intrapulmonary shunt. Rationale: Chest Electrical Impedance Tomography EIT is a non-invasive technique that produces continuous cross-sectional images of regional lung ventilation.

This study investigated the use of chest EIT and lung ultrasound in patients extubated after a successful spontaneous breathing trial. The hypothesis was that patients with extubation failure may exhibit early regional lung ventilation disturbances and higher lung ultrasound score LUS as compared to patients with extubation success.

Lung ultrasound with calculation of LUS score as a surrogate of loss of lung aeration and chest EIT with calculation of derived indices, such as Global inhomogeneity index GI , front-back Centre of ventilation CoV , Regional ventilation delay RVD and Surface available for ventilation were performed before H0 and two hours and six hours after extubation H2 and H6 respectively.

The primary outcome was the proportion of patients who presented extubation failure defined as acute respiratory failure requiring re-intubation or not or death within 48 h after extubation. However, EIT derived indices were not different between groups. Conclusion: Before extubation, a loss of lung aeration was observed in patients who developed extubation failure afterwards.

After extubation, this loss persisted with adjunction of heterogeneity in air distribution observed with EIT. EIT derived indices in a patient who presented extubation failure 24 h after extubation compared to a patient who were successfully extubated GI index: Global inhomogeneity index; RVD: Regional ventilation delay; H0: just before extubation; H2 and H Rationale: Pneumonia is the most frequent infectious complication among drowning patients requiring ICU admission.

However, clinical and microbiological data on such pneumonia are scarce. Baseline characteristics as well as clinical course of patients were compared according to the occurrence of drowning associated pneumonia DAP diagnosed within 48 h of ICU admission. Pneumonia microbiological features and therapeutic strategies were also analyzed. Results: Among the patients admitted to the ICUs for drowning, Suicidal etiology of drowning, psychiatric comorbidities, and need for mechanical ventilation appeared to be risk factors for drowning associated pneumonia DAP.

DAP occurred less frequently in patients initially treated by antibiotics. Interestingly, microbiological analysis of respiratory samples showed a high proportion of gram-negative bacilli Empirical antimicrobial management seemed frequently inappropriate Due to a high proportion of resistant gram-negative bacilli among isolated pathogens, initial empirical antimicrobial strategy with Amoxicillin—Clavulanate should be discouraged.

Rationale: Respiratory syncytial virus RSV is a common agent of viral respiratory infections. It causes significant morbidity and mortality in adults, especially in those with cardiorespiratory comorbidities and immunosuppression. Although there is a high burden of RSV respiratory infections in frail adults, few data are available in hospitalized patients. We set up a retrospective multicenter cohort to obtain large-scale data aiming at better depicting the clinical profile and prognosis of patients hospitalized with RSV infection.

The primary endpoint was in-hospital mortality. Results: patients were hospitalized for RSV infection, including patients admitted to 14 conventional inpatient units and patients who required ICU admission.

Patients frequently had comorbidities, most often cardiovascular hypertension: In-hospital mortality was 6. A bacterial co-infection was documented in Streptococcus pneumoniae and Pseudomonas aeruginosawere the two most frequently isolated bacteria. Conclusion: In this large multicenter retrospective study of patients hospitalized with RSV infection, we found a mortality rate of 6. Risk factors associated with mortality were age, the presence of acute respiratory distress, ARDS and neutropenia.

While a few studies have compared flu patients vs. COVID, none of them have focused on the most severe forms. We included all adult patients hospitalised in French ICUs for whom a complete hospital history was available from 1 March to 30 June For the comparative group influenza cohort , all adult patients hospitalised in ICUs from 1 January to 31 December were included.

To be included in one of these two groups, the patient had to have an ICD diagnosis code of COVID or influenza regardless of its position in the hospital stay summary.

To identify risk factors for invasive mechanical ventilation IMV and in-hospital death, we performed multivariate logistic regression models. Results: Our study cohort included At day, 13 Moreover, ICU and hospital lengths of stay were significantly longer for patients who received plasma exchange and they had a longer duration of RRT. Conclusion: Plasma exchange, eculizumab and RRT were not associated with an improvement of day renal function in our multicenter study.

Further studies are still needed to define the best therapeutic management of these patients. Outcome of severe adult thrombotic microangiopathies in the intensive care unit. Intensive Care Med. Results: patients were included i. About the ICU-Eo2 group, only the use of invasive ventilation during the stay was associated with poor prognosis HR 5.

Conclusion: In ICU, two distinct populations of eosinophilia seem to be defined according to the time of onset of this one. When eosinophilia is present on admission, the onco-haematological origin particularly affects the prognosis. Rationale: Hemophagocytic lymphohistiocytosis HLH related to hematological malignancies is a rare condition likely responsible for life-threatening multiple organ failure. Etoposide is often used as a first-line treatment in this setting but its impact on the course of HLH-defining criteria and organ failures has not been investigated.

Results: Twenty-four patients were analyzed, including 17 with lymphoma. Median H-score was All patients received first-line etoposide treatment, combined with corticosteroids in 21 patients, followed by combination chemotherapy in 16 patients after a median of 4 days [1. Following etoposide initiation, body temperature decreased from Lactate level decreased from 3.

In-ICU, in-hospital and 1-year mortality were Conclusion: Etoposide as single treatment or as part of sequential combination regimen was able to rapidly dampen some dynamic HLH-defining variables and to eventually improve organ failures. Rationale: Thrombocytopenia is a common disorder in critically ill patients and is known to be associated with poor prognosis.

Whether thrombocytopenia accounts for a bystander of severity or may drive specific complications is unclear. With respect to the various immune and procoagulant functions of platelets, the aim of this study is to address the impact of thrombocytopenia on the development of ICU-acquired infections, bleeding and ischemic events in high-risk patients with septic shock.

Patients admitted for septic shock Sepsis-2 definition were included if still alive in the ICU after 48 h, to retain patients at risk of further ICU-acquired complications. Morning platelet counts were collected daily. Groups of patients were defined according to 7-day platelet count trajectories estimated using latent class mixed model. Results: The cohort comprised h survivors. The latent class model identified five subgroups with consistent 7-day platelet count trajectories.

Platelet count trajectories were not significantly associated with the development of ICU-acquired infections and thrombotic events. Conclusion: Patterns of thrombocytopenia are associated with outcomes in septic shock.

Sustained profound thrombocytopenia and fast relative thrombocytopenia were both independent determinants of ICU mortality. Sustained profound thrombocytopenia was associated with an increased risk of severe bleeding.

Platelet count trajectories did not impact on the risk of ICU-acquired infections or thrombotic events. Since one third of children admitted to the PICU are less than 1 year old and that bronchiolitis is the leading cause of hospitalization in this age group 2 , our aim was to evaluate the reliability of PIPdc to estimate Pplat in volume control VC in infants with severe respiratory virus infection SRVI , which is characterized by increased airway resistance.

Measurements were taken during inspiratory and expiratory pauses after switching ventilatory mode from pressure control to volume control in patients without respiratory effort. Statistical analysis included paired t-test, Pearson correlation r and coefficient of determination R 2. Results: Thirty-seven patients were included with a median age of 3 months 2—5 , a Pediatric Index of Mortality-2 of 0. Conclusion: A large difference between PIP and Pplat can be observed in infants with a significant increase in airway resistance.

In the absence of Pplat measurement in a static condition, any estimation of Pplat from PIP needs to consider the resistive component of respiratory system. Reference 1: Patel B et al.

Pediatr Crit Care Med Reference 2: Fujiogi M et al. Pediatrics Difference between positive inspiratory pressure in decelerating-flow modes PIPdc and plateau pressure Pplat in volume control according to time constant, in mechanically ventilated children. Figure Legend: Difference between positive inspiratory pressure in decelerating-flow modes PIPdc and plateau pressure Pplat in volume control according to time constant, in mechanically ventilated children.

Panel A: cohort of Patel et al. And from our sample it has been shown Panel B, C and D. RIaw: inspiratory airway resistance; REaw: expiratory airway resistance.

Rationale: High flow oxygen nasal cannula therapy HFNC is a non-invasive respiratory support increasingly used to treat bronchiolitis induced respiratory failure. HFNC utilisation spread in pediatric emergencies department because of its affordable material and ease of use.

However, regular monitoring and clinical assessment of the HFNC treated child by emergency physicians and nurses is needed. Its use has been shown to avoid transfers to intensive care that is a limited resource in epidemic period.

However, at the early time of its implementation, it is difficult and yet critical for the security of the patient to predict its efficiency in treating the bronchiolitis induced respiratory failure. Objective: The aim of this study was to identify factors predicting early failure of HFNC once it has been implemented in a pediatric emergency department to treat bronchiolitis induced respiratory failure.

Patients included were aged 0 to 12 months, admitted to the pediatric emergency department and diagnosed with acute bronchiolitis with initiation of high-flow oxygen therapy within 12 h of arrival in the pediatric emergency department. Results: patients were included with 52 HFNC failures. Conclusion: Our results showed that blood gases before and after HFNC implementation were a major predictive element for success or failure in the very first hours of HFNC treatment but that blood gases bicarbonate blood levels were also strongly correlated to HFNC success.

Several clinical criteria were also associated with success such as the presence of wheezing sound, atelectasia, hypoxemia before HFNC. We believe that those results may help pediatric emergency physicians to anticipate HFNC success or failure in infant with acute bronchiolitis presenting to the pediatric emergency department. Table 1. HFNC: High flow nasal cannula.

Rationale: The main objective of the study was to first describe which settings are used for mechanical ventilation during ECMO for pediatric acute respiratory distress syndrome. The secondary objective of this study is to identify risk factors associated with poor prognosis or uncomplete recovery. Collected data were pre-ECMO clinical score invasive ventilation parameters before ECMO and at day 1, 3, 7 and 14 of assistance positive end-expiratory pressure, mean pressure, plateau pressure, driving pressure , adjunctive therapies during ECMO prone positioning, steroids, tracheostomy, bronchoscopy and cross-sectional imaging.

Finally, we gathered outcomes parameters survival rate, length of ECMO and invasive ventilation. Results: We included patients. Median oxygenation index and oxygenation saturation index were 37 and Preferential ventilator mode during ECMO was barometric setting during the whole study period. Positive end-expiratory pressure PEEP and mean airway pressure were significantly different between centers. Higher PEEP and higher mean airway pressure during the whole study period were associated with higher mortality.

Conclusion: Ventilatory setting during ECMO for acute respiratory distress syndrome are highly dependent on center. Rationale: ECMO is an extracorporeal respiratory and circulatory support used in children for severe respiratory failure or refractory shock states. The usual monitoring of patient under ECMO makes it possible to understand the macrocirculatory system. Perfusion and tissue oxygenation are represented by microcirculation. It has been shown to be a powerful prognostic factor for survival in children in septic shock reference 1.

The duration of ECMO depends on the remission of the organs. Early and successful weaning from ECMO reduces morbidity and mortality of the technique. A video analysis in sidestream dark field was performed for all patients at the weaning time as well as an echocardiography and a blood gas. The small vessel Microvascular Flow Index at weaning was high in both groups median 2. There were no differences in macro-circulatory indices, nor by ECMO type or age.

The microcirculation parameters were not a predictive factor of mortality. Conclusion: Our study is the first pediatric study to present microcirculation data at the ECMO weaning time.

Post-clamping analysis may be relevant. Persistent low microcirculatory vessel density in nonsurvivors of sepsis in pediatric intensive care. Crit Care Med. Rationale: Children under Extracorporeal Membrane Oxygenation ECMO are at high risk of complications, particularly infectious ones, which may worsen their prognosis.

Therefore, there is a risk of inadequate exposure using the standard dosing. The objective of this study is to describe, for children undergoing ECMO, the exposure to beta-lactams at currently used dosing; and to identify factors associated with inadequate exposure.

Results: We included 57 patients 21 A total of 32 infections were documented. The risk of supra-therapeutic concentrations was Conclusion: There is a non-negligible risk of under-exposure in children receiving conventional dosing of beta-lactam and ECMO support mainly related to renal function and volume of distribution variations. Rationale: The need of renal replacement therapy RRT in septic children may occur and add variability leading to unpredictable anti-infective concentrations with risks of treatment failure, toxicity and emergence of multidrug resistant bacteria.

We aim to better understand anti-infective prescription practices in children undergoing RRT. The survey form assessed the characteristics of the PICU, practices of RRT, anti-infective prescription and therapeutic drug monitoring. We excluded plasma exchanges and adsorption techniques from the survey.

When several respondents from the same center answered, we selected the most complete form. We noticed great variability even between the physicians from the same department. Adaptation of the anti-infective doses from the respondents are displayed on Fig. Conclusion: Our survey reported great variability of anti-infective prescription practices in children undergoing RRT pointing out the need for specific guidelines.

Figure 1: Adaptation of anti-infective doses in children under RRT. Rationale: Whereas noninvasive ventilation is recommended for immunocompromised patients with acute respiratory failure in the intensive care unit ICU , it may have deleterious effects in most severe patients.

High-flow nasal oxygen alone may be an alternative to reduce mortality. We aimed to determine whether high-flow nasal oxygen alone could reduce the rate of mortality at day 28 compared to its alternation with noninvasive ventilation in this setting. The primary outcome was mortality at day The trial is registered with ClinicalTrials. Results: Between January to March , patients were included in the intention-to-treat analysis.

Conclusion: In critically ill immunocompromised patients with acute respiratory failure, the mortality rate did not differ between high-flow nasal oxygen alone and noninvasive ventilation alternating with high-flow nasal oxygen.

The lung biopsies were performed by the intensivists immediately after the death following anatomical landmarks. Results: Overall, patients were included in the study.

We report the results of the first 90 patients analyzed. Time from the onset of mechanical ventilation MV to death was 18 [10—31] days. The durations of moderate and severe ARDS were 6 [2—12] and 8 [3—15] days, respectively. The main causes of death were refractory shock and hypoxemia The most common primary lesions of the alveoli were: type-2 pneumocyte hyperplasia The primary lesions identified in the septa were: proliferation of fibroblastic tissue Final pathological diagnosei were: late phase of proliferative diffuse alveolar damage DAD Early deaths before day of MV were characterized by a high rate of acute exsudative DAD and early phase of proliferative DAD and the absence of collagen deposition.

In contrast, late phase of proliferative DAD was the most common lesion encountered in late deaths after day of MV with extensive proliferation of fibroblastic tissue. Our results support further evaluation of steroids in non-resolving ARDS Covid given the significant proportion of potential steroid-sensitive patterns.

Maternal ventilatory and obstetrical management in ICU as well as maternal and fetal outcomes were collected and analyzed. Risk factors of intubation were also assessed. Results: Overall, patients were included with a median age of 34 [30—37] years old and a median gestation length of 29 [26—33] amenorrhea weeks.

The median time between the onset of symptoms and ICU admission was 8 [6—10] days. Conclusion: Despite low maternal and fetal mortality rates, half of pregnant women admitted in ICU for severe pneumonia related to SARS-CoV-2 infection required to be intubated and required fetal extraction. Inclusions are still in progress. Factors associated with day survival in univariate analysis were younger age, higher BMI and lower Charlson score.

Younger age was also associated with day survival in one model OR: 1. Kaplan—Meier cumulated survival curves according to the presence of obesity were significantly different Fig. Obese patients were ventilated with higher PEEP than non-obese patients 14 10—15 vs. There was a trend to higher compliance of respiratory system in obese patients as compared with non-obese patients, respectively Kaplan—Meier cumulated survival curves at day 90 since ICU admission in obese red curve and non-obese patients blue curve.

Evaluation of time trends were performed with analysis of the evolution of these variables over time out using a mixed model. Time series analyses were performed to assess the relationship between mortality in ICU and use of corticosteroids, antibiotics and invasive mechanical ventilation, using a dynamic regression model. The management of ventilatory support has improved. And if prescriptions for corticosteroids and antibiotics have been reduced, prescription strategies for these therapeutics in ICU have to be precised.

Rationale: In order to analyze hospital burden and long-term outcomes of prolonged and difficult to wean patients we performed a follow-up of patients included in the WIND study. The patients of French centers alive at the end of the princeps study constituted the eligible population of our study. Each center investigator collected vital status, intercurrent hospitalization, life at home, need for oxygen therapy or home ventilation up to 8 years after the study participation.

Between 1 and 8 years, the standardized mortality ratio SMR compared to the general French population of the same age, sex and period distribution was estimated at 3. Conclusion: Although the risk of death and readmission is high, especially in the first year following discharge, survivors at 8 years mostly live at home without oxygen or home ventilation.

A survival model was used to study prognostic factors at D Results: Of the 24, stays registered, 2. Throughout the 3 periods, the mean age increased Admissions for HANA Conclusion: The phenotype of HIV patients admitted to intensive care has evolved over time HIV better controlled but more comorbidity associated.

Mortality risk factors remain stable over time, including AIDS status. Rationale: Necrotizing soft tissue infections NSTIs are rare life-threatening bacterial infections characterized by an extensive necrosis of skin and subcutaneous tissues. Immunocompromised patients have an increased risk of dying. Among them, neutropenic patients could have a particularly high risk of poor outcome but data are scarce. Our objectives are to describe the characteristics and the mortality of neutropenic patients with NSTI requiring intensive care unit ICU admission.

The factors associated with hospital mortality were identified using Cox regression. Results: 83 neutropenic patients were included and compared to historical non-neutropenic patients. Neutropenia was related to haematological malignancy in 64 Median time from neutropenia onset to NSTI was 4 [] days. As compared to non-neutropenic patients, neutropenic patients were younger 65 [56—75] vs 58 [ Neutropenic patients presented more frequent bacteraemia The most frequent bacteria isolated in neutropenic patients were Enterobacteriaceae In contrast, non-neutropenic patients were more frequently infected by Streptococcus species than neutropenic patients Conclusion: NSTI in neutropenic patients presented different characteristics and higher mortality than in non-neutropenic patients requiring ICU.

Treatment with G-CSF could be associated with better outcomes, although this finding should be interpreted with caution due to the presence of potential unadjusted confounding factors. Reference 1: Urbina, T. Early identification of patients at high risk of group A streptococcus-associated necrotizing skin and soft tissue infections: a retrospective cohort study.

Crit Care 23, Characteristics and ICU outcomes of neutropenic and non-neutropenic patients. Our hypothesis is that these patients should still benefit from surgery. The main objective of this study was to compare their neurological functional outcome whether they received surgery or not.

Exclusion criteria were isolated right endocarditis, in-hospital acquired endocarditis and patients who developed cerebral complications only after cardiac surgery. All patients were explored with brain imaging before surgery.

The primary analysis consisted in a propensity score adjusted logistic regression of surgery as an independent variable of the primary outcome, i. The 1-year mortality rate was the main secondary outcome. Ischemic stroke was the most prevalent neurological complications In the propensity score-adjusted logistic regression, the odds ratio OR for favorable 6-month functional outcome was 0.

One-year mortality was strongly reduced with surgery in the fixed-effect propensity adjusted cox model Hazard Ratio 0. Conclusion: In this study of critically ill patients with simultaneous infectious endocarditis, indication for surgery and cerebral events, a better propensity-adjusted functional outcome was associated with surgery compared with medical treatment, whatever the deepness of coma.

Internal validation of these risk factors was performed using bootstrap with replications. Then, a score was computed from the adjusted Odds Ratio coefficients.

Finally, external validation was performed in three other independent RCTs investigating the effect of different prevention strategies on the incidence of catheter-related infections validation cohort.

Discrimination was assessed by the Area Under the Curve c-index. Results: Among 3, CVCs and dialysis catheters included in the training cohort, 9. Age, obesity, diabetes, site of insertion jugular and femoral versus sub-clavian , type of catheter dialysis versus CVC , catheterization duration, fever and local inflammation at removal were independently associated with colonization in multivariate analysis.

Diabetes, site of insertion, type of catheter, catheterization duration, fever and local inflammation at removal were robust after internal validation and were computed in the score. Area under the ROC curve for the score was 0. The validating cohort included 6, dialysis catheters and CVCs, of which 4.

AUC for the score was 0. Among catheters removed for suspicion of CRBSI infection in the training and validating cohorts, Conclusion: This score had a moderate ability to discriminate central venous catheter colonization. Roc curves for the scores in a training b cohorts. AUC, area under the curve. Their dissemination has led to a major increase in the use of carbapenems, last-resort antibiotics. The primary outcome was Day mortality. Secondary outcomes included in-ICU and Day mortality rates, severity of illness, septic shock resolution, ICU and in-hospital length of stay and Clostridium difficile infection.

Effect of piperacillin-tazobactam vs meropenem on day mortality for patients with E coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance: a randomized clinical trial. JAMA ; —9. Reference 2: Karaiskos I, Giamarellou H. Carbapenem-sparing strategies for ESBL producers: when and how. Antibiot Basel Switz ; 9:E Rationale: Sepsis leads to deep apoptosis-induced depletion of T-cells resulting in increased rate of secondary infection and late morbidity 1.

Interleukin-7 IL-7 is a pluripotent cytokine essential for lymphocyte proliferation and survival. By intra-muscular IM or subcutaneous route, IL-7 improved immunity by increasing T-cell count and reversed the marked loss of immune effector cells in lymphopenic patients with septic shock 2.

Secondary objective was to assess the safety and tolerability of CYT Results: Between June and March 21 patients ALC was similar in both group at baseline 0. Patients in the treatment group had more organ support-free days Three patients developed fever, tachypnea and evidence of hypercytokinemia associated with IL-7 administration, which necessitated discontinuing therapy.

Conclusion: While IV injection of IL-7 showed ability to reverse sepsis-related lymphopenia, safety issues related to this route led to favor IM or subcutaneous route for the next phase III trial. Persistent lymphopenia after diagnosis of sepsis predicts mortality. Interleukin-7 restores lymphocytes in septic shock: the IRIS-7 randomized clinical trial.

JCI Insight. Blue dots represent placebo-treated patients and red squares CYTtreated patients. We aimed to assess whether intravenous immunoglobulins IVIG could improve outcomes by reducing inflammation-mediated lung injury. The primary outcome was the number of ventilation-free days by day 28, assessed according to the intention-to-treat principle.

This trial was registered on ClinicalTrials. Conclusion: In patients with COVID who received invasive mechanical ventilation for moderate-to-severe ARDS, IVIG did not improve clinical outcomes at day 28 and tended to be associated with an increased frequency of serious adverse events, although not significant.

HCPC could identified 2 clusters. These patients had a more severe organ failure. Requirement of invasive mechanical ventilation In line with this, in-ICU mortality rate was Conclusion: Based on HCPC, we could identify 2 distinct profiles with different severity and different outcome. More importantly, corticosteroid therapy was associated with a better outcome only in the less severe patients. This approach might help clinician to undertake personalized ICU management.

Corticosteroids are widely used to treat these patients although the impact of this adjuvant therapy on the incidence of VA-LRTI in this population is still unclear.

Adult patients invasively ventilated for more than 48 h for a SARS-CoV-2 pneumonia during the first epidemic surge were consecutively included. VA-LRTI diagnosis required strict definition with clinical, radiological and microbiological documentation. We demonstrated a significant time-varying effect of corticosteroids on the risk of developing VA-LRTI all along the day follow-up.

Considering the common use of dexamethasone DXM since the 2nd wave, we conducted a large retrospective multicenter study to evaluate the influence of DXM exposure on the incidence of VAP. Among them The diagnosis of VAP was based on clinical and microbiological arguments. Results: The 2 groups were similar. The overall incidence rate of VAP episodes was essentially the same in the 2 groups: There was also no difference in terms of mortality. The Lancet Respiratory Medicine ; — Intensive Care Medicine ; — Rationale: COVID induces a sustained immunosuppression responsible for secondary infections acquisition and late mortality.

Several studies have found that supplementation with citrulline, which is converted in arginine through the activity of argininosuccinate synthetase and argininosuccinate lyase, was more efficient than arginine to increase plasma level of arginine.

Arginine concentrations in patients treated by citrulline were higher at day 7 The higher viral clearance promoted by such treatment deserves further investigations.

Results: We included, patients: with post-resuscitation shock and without. Of patient with post-resuscitation shock, received induced hypothermia and controlled normothermia. On day 90, 14 of the patients in the hypothermia group had a CPC score of 1 or 2, as compared with 10 of the patients in the normothermia group, with no significant difference 8. Conclusion: Presence of a post-resuscitation shock at ICU admission after cardiac arrest in non-shockable rhythm is a major determinant of day functional outcome.

There is no interaction between post-resuscitation shock presence and benefits of induced hypothermia provided for patients with cardiac arrest in non-shockable rhythm as compared to controlled normothermia. Rationale: Organ shortage is a major public health issue, and patients who die after out-of-hospital cardiac arrest OHCA could be a valuable source of organs. Our objective was to identify factors associated with organ donation after brain death complicating OHCA, in unselected patients entered into a comprehensive real-life registry covering a well-defined geographic area.

The primary outcome was organ donation after brain death. Independent risk factors were identified using logistic regression analysis. A donation-likelihood score was established.

One-year outcomes of transplants and transplant recipients were assessed using Cox and log-rank tests. Results: Of the included patients, 4. Patients characteristics are described in the Table. An interaction between admission pH and post-resuscitation shock was identified. By multivariate analysis, in patients with post-resuscitation shock, predictors of organ donation were neurological cause of OHCA odds ratio [OR], One-year outcomes of kidney transplants and their recipients did not differ according to Utstein characteristics of the donor.

This study including intensive care unit ICU patients with OHCA was designed to identify and characterize clusters based on clinical and laboratory features and to determine the frequency of death from refractory post-resuscitation shock RPRS in each cluster.

We identified patient clusters by performing an unsupervised hierarchical cluster analysis without mode of death among the variables based on Utstein clinical and laboratory variables.

For each cluster, we used the Fine-and-Gray approach to estimate the hazard ratio HRs for RPRS defined as post-resuscitation shock refractory to aggressive critical care. Inclusion was at ICU admission. We identified four clusters: initial shockable rhythm with short low-flow time cluster 1 , initial non-shockable rhythm with usual absence of ST-segment elevation cluster 2 , initial non-shockable rhythm with long no-flow time cluster 3 , and long low-flow time with high epinephrine dose cluster 4.

Rationale: The optimal approach to the use of venoarterial extracorporeal membrane oxygenation VA-ECMO during cardiogenic shock is uncertain.

Multivariate Cox model analysis accounting for new-onset RVF as time-dependent variable was used to identify parameters associated with mortality. RVF was independently associated with day mortality adjusted hazard ratio: 8.

The included patients were hospitalized in PICU; aged between 38 weeks of amenorrhea WA and 18 years old; received drugs for sedation or withdrawal syndrome.

That appears to be a simple method for maintaining long-term sedation in PICU. Our results suggested IA sedation using the ACD to be an effective and safe alternative to the usual intravenous Propofol- or Midazolam-based regimen. Sevoflurane provided sedation quality comparable to Propofol and Midazolam, but with decreased wake-up and extubation times. Rationale: Computer vision has promising potential for the diagnosis of vital distress in critically ill patients including neurological, respiratory and hemodynamic distress.

For instance, measurement of respiratory rate using 3D videos in spontaneous breathing patients and correlation between low cardiac output and thermal distribution using infrared IR images were reported in several studies. The aim of our research was to setup a multi-modal video infrastructure to create a clinical video research database and pave the way to real-time vital distress video monitoring within a pediatric intensive care unit PICU.

This setup could be replicated in other PICUs. Rationale: New et al 1 completed a national cohort study in the United Kingdom UK ; all hospitals were invited to participate.

A study of the use of red blood cell transfusions in children and infants. Transfusion ; The age of transfused blood in critically ill children. JAMA ;— Rationale: Family presence during invasive procedures or cardiopulmonary resuscitation CPR is a part of the family-centered approach in pediatric intensive care units PICUs.

Perceived stress associated with parental presence decreased from a pre-simulation value of 6 IQR, 4—7 to 4 IQR, 2—5 post-simulation on a scale of 1— However, in Satisfaction of the participants was high with a median of 10 IQR, 9—10 out of 10 Fig. Discussion: Our study describes an in situ pediatric simulation program of critical situations in the presence of family members played by professional actors. The simulation program was explicitly aiming at the development of communication skills.

The simulation generally, but not always, showed a reduction in healthcare professionals perceived stress caused by family presence during a critical situation in the PICU. To meet the demand of participants experiencing a high level of stress after the simulation, a pre-simulation video on potential benefits and pitfalls of family presence during critical situations as well as on ad-hoc communication tools is now available to all future participants.

Conclusion: Continuous infusion provided a higher probability to attain an optimal PK target compared to intermittent infusion, but also a higher risk for overexposure.

Regular therapeutic drug monitoring is recommended in critically ill children receiving beta-lactams, regardless of the administration modality.

At 1 year, only one patient was still in the hospital. Pulmonary function tests were good at 6 months except for a persistent impairment of the DLCO. Noticeably, QoL did not improve at 1 year of follow-up. Besides, a very large proportion of survivors still complained about anxiety, depression, and post-traumatic stress symptoms. These results emphasize the importance to integrate these young patients into customized, patient-centered, rehabilitation programs after ICU discharge.

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Windows 10 1703 download iso italy covid vaccine/appointment – Acknowledgements

Насмерть перепуганный священник упал, чаша взлетела вверх, и красное вино разлилось по белому мрамору пола. Монахи и служки у алтаря бросились врассыпную, а Беккер тем временем перемахнул через ограждение.

Глушитель кашлянул, Беккер плашмя упал на пол. Пуля ударилась о мрамор совсем рядом, и в следующее мгновение он уже летел вниз по гранитным ступеням к узкому проходу, выходя из которого священнослужители поднимались на алтарь как бы по милости Божьей.

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Windows 10 1703 download iso italy covid vaccine/appointment

Windows 10 1703 download iso italy covid vaccine/appointment – Acknowledgements

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