1
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Galerneau LM, Bailly S, Terzi N, Ruckly S, Garrouste-Orgeas M, Oziel J, Hong Tuan Ha V, Gainnier M, Siami S, Dupuis C, Forel JM, Dartevel A, Dessajan J, Adrie C, Goldgran-Toledano D, Laurent V, Argaud L, Reignier J, Pepin JL, Darmon M, Timsit JF. Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort. Crit Care 2023; 27:359. [PMID: 37726796 PMCID: PMC10508006 DOI: 10.1186/s13054-023-04631-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP), a nosocomial pneumonia that is not related to invasive mechanical ventilation (IMV), has been less studied than ventilator-associated pneumonia, and never in the context of patients in an ICU for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD), a common cause of ICU admission. This study aimed to determine the factors associated with NV-ICU-AP occurrence and assess the association between NV-ICU-AP and the outcomes of these patients. METHODS Data were extracted from the French ICU database, OutcomeRea™. Using survival analyses with competing risk management, we sought the factors associated with the occurrence of NV-ICU-AP. Then we assessed the association between NV-ICU-AP and mortality, intubation rates, and length of stay in the ICU. RESULTS Of the 844 COPD exacerbations managed in ICUs without immediate IMV, NV-ICU-AP occurred in 42 patients (5%) with an incidence density of 10.8 per 1,000 patient-days. In multivariate analysis, prescription of antibiotics at ICU admission (sHR, 0.45 [0.23; 0.86], p = 0.02) and no decrease in consciousness (sHR, 0.35 [0.16; 0.76]; p < 0.01) were associated with a lower risk of NV-ICU-AP. After adjusting for confounders, NV-ICU-AP was associated with increased 28-day mortality (HR = 3.03 [1.36; 6.73]; p < 0.01), an increased risk of intubation (csHR, 5.00 [2.54; 9.85]; p < 0.01) and with a 10-day increase in ICU length of stay (p < 0.01). CONCLUSION We found that NV-ICU-AP incidence reached 10.8/1000 patient-days and was associated with increased risks of intubation, 28-day mortality, and longer stay for patients admitted with AECOPD.
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Affiliation(s)
- Louis-Marie Galerneau
- Medical Intensive Care Unit, University Hospital of Grenoble Alpes, 10217 38043, Grenoble, CS, France.
- Grenoble Alpes University, INSERM 1300, HP2, Grenoble, France.
| | | | - Nicolas Terzi
- Medical Intensive Care Unit, University Hospital of Grenoble Alpes, 10217 38043, Grenoble, CS, France
- Grenoble Alpes University, INSERM 1300, HP2, Grenoble, France
| | | | - Maité Garrouste-Orgeas
- Medical Unit, French and British Hospital Cognacq-Jay Fondation, Levallois-Perret, France
| | - Johanna Oziel
- Intensive Care Unit, Avicenne Hospital, AP-HP, Paris, France
| | | | - Marc Gainnier
- Medical Intensive Care Unit, La Timone Hospital, Marseille, France
| | - Shidasp Siami
- Critical Care Medicine Unit, Etampes-Dourdan Hospital, Etampes, France
| | - Claire Dupuis
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-Marie Forel
- Medical Intensive Care Unit, Nord University Hospital, Marseille, France
| | - Anaïs Dartevel
- Medical Intensive Care Unit, University Hospital of Grenoble Alpes, 10217 38043, Grenoble, CS, France
| | - Julien Dessajan
- Medical and Infectious Diseases Intensive Care Unit (MI2), Bichat Hospital, AP-HP, Paris, France
| | - Christophe Adrie
- Polyvalent Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France
| | | | | | - Laurent Argaud
- Medical Intensive Care Unit, Edouard Herriot Hospital, Lyon Civil Hospices, Lyon, France
| | - Jean Reignier
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France
| | | | - Michael Darmon
- Intensive Care Unit, Saint-Louis Hospital, AP-HP, Paris, France
| | - Jean-François Timsit
- Medical and Infectious Diseases Intensive Care Unit (MI2), Bichat Hospital, AP-HP, Paris, France
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2
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Gaillet A, Azoulay E, de Montmollin E, Garrouste-Orgeas M, Cohen Y, Dupuis C, Schwebel C, Reignier J, Siami S, Argaud L, Adrie C, Mourvillier B, Ruckly S, Forel JM, Timsit JF. Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort. Crit Care 2023; 27:108. [PMID: 36915207 PMCID: PMC10012467 DOI: 10.1186/s13054-023-04325-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/17/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE Despite antiviral therapy (ART), 800,000 deaths still occur yearly and globally due to HIV infection. In parallel with the good virological control and the aging of this population, multiple comorbidities [HIV-associated-non-AIDS (HANA) conditions] may now be observed. METHODS HIV adult patients hospitalized in intensive care unit (ICU) from all the French region from university and non-university hospital who participate to the OutcomeRea™ database on a voluntary basis over a 24-year period. RESULTS Of the 24,298 stays registered, 630 (2.6%) were a first ICU stay for HIV patients. Over time, the mean age and number of comorbidities (diabetes, renal and respiratory history, solid neoplasia) of patients increased. The proportion of HIV diagnosed on ICU admission decreased significantly, while the median duration of HIV disease as well as the percentage of ART-treated patients increased. The distribution of main reasons for admission remained stable over time (acute respiratory distress > shock > coma). We observed a significant drop in the rate of active opportunistic infection on admission, while the rate of active hemopathy (newly diagnosed or relapsed within the last 6 months prior to admission to ICU) qualifying for AIDS increased-nonsignificantly-with a significant increase in the anticancer chemotherapy administration in ICU. Admissions for HANA or non-HIV reasons were stable over time. In multivariate analysis, predictors of 60-day mortality were advanced age, chronic liver disease, past chemotherapy, sepsis-related organ failure assessment score > 4 at admission, hospitalization duration before ICU admission > 24 h, AIDS status, but not the period of admission. CONCLUSION Whereas the profile of ICU-admitted HIV patients has evolved over time (HIV better controlled but more associated comorbidities), mortality risk factors remain stable, including AIDS status.
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Affiliation(s)
- Antoine Gaillet
- Medical Intensive Care Unit, Henri Mondor University Hospital, APHP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France. .,IAME UMR 1137, INSERM, Paris University, 75018, Paris, France.
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, APHP, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Etienne de Montmollin
- IAME UMR 1137, INSERM, Paris University, 75018, Paris, France.,Medical Intensive Care Unit, Paris Diderot University/Bichat University Hospital, APHP, Paris, France
| | - Maité Garrouste-Orgeas
- Medical Unit, French-British Hospital Institute Levallois-Perret, Levallois-Perret, France
| | - Yves Cohen
- Medical-Surgical Intensive Care Unit, Avicenne University Hospital, Paris Seine Saint-Denis Hospital Network, APHP, Bobigny, France
| | - Claire Dupuis
- Medical Intensive Care Unit, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Nutrition Humaine Unit, INRAe, CRNH Auvergne, Clermont Auvergne University, 63000, Clermont-Ferrand, France
| | - Carole Schwebel
- Medical ICU, Albert Michallon University Hospital, Grenoble 1 University, Grenoble, France
| | - Jean Reignier
- Medical ICU, Nantes University Hospital, Nantes, France
| | - Shidasp Siami
- Polyvalent ICU, Sud Essonne Dourdan-Etampes Hospital, Dourdan, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France
| | | | - Bruno Mourvillier
- Medical Intensive Care Unit, Reims University Hospital, Reims, France
| | - Stéphane Ruckly
- IAME UMR 1137, INSERM, Paris University, 75018, Paris, France
| | - Jean-Marie Forel
- Medical ICU, Hôpital Nord University Hospital, Marseille, France
| | - Jean-Francois Timsit
- IAME UMR 1137, INSERM, Paris University, 75018, Paris, France. .,Medical Intensive Care Unit, Paris Diderot University/Bichat University Hospital, APHP, Paris, France.
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3
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Garrouste-Orgeas M, Marché V, Pujol N, Michel D, Evin A, Fossez-Diaz V, Perruchio S, Vanbésien A, Verlaine C, Copel L, Kaczmarek W, Birkui de Francqueville L, Michonneau-Gandon V, de Larivière E, Poupardin C, Touzet L, Guastella V, Mathias C, Mhalla A, Bouquet G, Richard B, Gracia D, Bienfait F, Verliac V, Ranchou G, Kirsch S, Flahault C, Loiodice A, Bailly S, Ruckly S, Timsit JF. Incidence and risk factors of prolonged grief in relatives of patients with terminal cancer in French palliative care units: The Fami-Life multicenter cohort study. Palliat Support Care 2023:1-10. [PMID: 36878669 DOI: 10.1017/s1478951523000111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVES Psychological consequences of grief among relatives are insufficiently known. We reported incidence of prolonged grief among relatives of deceased patients with cancer. METHODS Prospective cohort study of 611 relatives of 531 patients with cancer hospitalized for more than 72 hours and who died in 26 palliative care units was conducted. The primary outcome was prolonged grief in relatives 6 months after patient death, measured with the Inventory Complicated Grief (ICG > 25, range 0-76, a higher score indicates more severe symptoms) score. Secondary outcomes in relatives 6 months after patient death were anxiety and depression symptoms based on Hospital Anxiety and Depression Scale (HADS) score (range 0 [best]-42 [worst]), higher scores indicate more severe symptoms, minimally important difference 2.5. Post-traumatic stress disorder symptoms were defined by an Impact Event Scale-Revised score >22 (range 0-88, a higher score indicates more severe symptoms). RESULTS Among 611 included relatives, 608 (99.5%) completed the trial. At 6 months, significant ICG scores were reported by 32.7% relatives (199/608, 95% CI, 29.0-36.4). The median (interquartile range ICG score) was 20.0 (11.5-29.0). The incidence of HADS symptoms was 87.5% (95% CI, 84.8-90.2%) at Days 3-5 and 68.7% (95% CI, 65.0-72.4) 6 months after patient's death, with a median (interquartile range) difference of -4 (-10 to 0) between these 2 time points. Improvement in HADS anxiety and depression scores were reported by 62.5% (362/579) relatives. SIGNIFICANCE OF RESULTS These findings support the importance of screening relatives having risk factors of developing prolonged grief in the palliative unit and 6 months after patient's death.
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Affiliation(s)
- Maité Garrouste-Orgeas
- IAME, INSERM, Université de Paris, Paris, France
- Palliative Care Unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
- Medical Unit, French British Hospital, Levallois-Perret, France
| | | | - Nicolas Pujol
- Research Department Palliative Care Unit, Jeanne Garnier Institution, Paris, France
| | - Dominique Michel
- Palliative Care Unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
| | - Adrien Evin
- Palliative Care Unit, University Teaching Hospital, Nantes, France
| | | | | | | | | | - Laure Copel
- Palliative Care Unit, Diaconesses Croix Saint Simon Hospital, Paris, France
| | | | | | | | | | | | - Licia Touzet
- Palliative Care Unit, University Teaching Hospital, Lille, France
| | - Virginie Guastella
- Palliative Care Unit, University Teaching Hospital, Clermont Ferrand, France
| | - Carmen Mathias
- Palliative Care Unit, Mulhouse Sud Alsace Hospital Network, Mulhouse, France
| | - Alaa Mhalla
- Palliative Care Unit, Albert Chenevier Hospital, Créteil, France
| | | | - Bruno Richard
- Palliative Care Unit, University Teaching Hospital, Montpellier, France
| | - Dominique Gracia
- Palliative Care Unit, General Hospital, Salon-de-Provence, France
| | - Florent Bienfait
- Palliative Care Unit, University Teaching Hospital, Angers, France
| | - Virginie Verliac
- Palliative Care Unit, Saintonge General Hospital, Saintes, France
| | - Gaelle Ranchou
- Palliative Care Unit, General Hospital, Périgueux, France
| | - Sylvie Kirsch
- Palliative Care Unit, Bligny Hospital, Briis-Sous-Forges, France
| | - Cécile Flahault
- Laboratory of Psychopathology and Health Process, Paris University Paris, Boulogne-Billancourt, France
| | | | | | | | - Jean-François Timsit
- IAME, INSERM, Université de Paris, Paris, France
- Medical and infectious diseases ICU (MI2), APHP Bichat Hospital, Paris, France
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4
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Fasse L, Roche N, Flahault C, Garrouste-Orgeas M, Ximenes M, Pages A, Evin A, Dauchy S, Scotte F, Le Provost JB, Blot F, Mateus C. The APSY-SED study: protocol of an observational, longitudinal, mixed methods and multicenter study exploring the psychological adjustment of relatives and healthcare providers of patients with cancer with continuous deep sedation until death. Palliat Care 2022; 21:217. [PMID: 36464684 PMCID: PMC9720978 DOI: 10.1186/s12904-022-01106-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Since 2016, France is the only country in the World where continuous deep sedation until death (CDSUD) is regulated by law. CDSUD serves as a response to refractory suffering in palliative situations where the patients' death is expected to occur in the following hours or days. Little is known on the psychological adjustment surrounding a CDSUD procedure for healthcare providers (HCPs) and relatives. Our study aims to gather qualitative and quantitative data on the specific processes behind the psychological adjustment of both relatives and HCPs, after the administration of CDSUD for patients with cancer. METHODS The APSY-SED study is a prospective, longitudinal, mixed-methods and multicenter study. Recruitment will involve any French-speaking adult cancer patient for who a CDSUD is discussed, their relatives and HCPs. We plan to include 150 patients, 150 relatives, and 50 HCPs. The evaluation criteria of this research are: 1/ Primary criterion: Psychological adjustment of relatives and HCPs 6 and 13 months after the death of the patient with cancer (psychological adjustment = intensity of anxiety, depression and grief reactions, CDSUD-related distress, job satisfaction, Professional Stress and Professional experience). Secondary criteria: a)occurrence of wish for a CDSUD in patients in palliative phase; b)occurrence of wish for hastened death in patients in palliative phase; c)potential predictors of adjustment assessed after the discussion concerning CDSUD as an option and before the setting of the CDSUD; d) Thematic analysis and narrative account of meaning-making process concerning the grief experience. DISCUSSION The APSY-SED study will be the first to investigate the psychological adjustment of HCPs and relatives in the context of a CDSUD procedure implemented according to French law. Gathering data on the grief process for relatives can help understand bereavement after CDSUD, and participate in the elaboration of specific tailored interventions to support HCPs and relatives. Empirical findings on CDSUD among patients with cancer in France could be compared with existing data in other countries and with results related to other medical fields where CDSUD is also conducted. TRIAL REGISTRATION This protocol received the National Registration Number: ID-RCB2021-A03042-39 on 14/12/2021.
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Affiliation(s)
- L. Fasse
- grid.14925.3b0000 0001 2284 9388DIOPP, Gustave Roussy Hospital, Villejuif, France ,grid.508487.60000 0004 7885 7602Institut de Psychologie Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, 71 avenue E. Vaillant, F-92100 Boulogne- Billancourt, France
| | - N. Roche
- grid.14925.3b0000 0001 2284 9388DIOPP, Gustave Roussy Hospital, Villejuif, France
| | - C. Flahault
- grid.14925.3b0000 0001 2284 9388DIOPP, Gustave Roussy Hospital, Villejuif, France ,grid.508487.60000 0004 7885 7602Institut de Psychologie Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, 71 avenue E. Vaillant, F-92100 Boulogne- Billancourt, France
| | - M. Garrouste-Orgeas
- grid.508487.60000 0004 7885 7602IAME, INSERM, Université de Paris, F-75018 Paris, France ,Palliative Care unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France ,Medical unit, French British Hospital, Levallois-Perret, France
| | - M. Ximenes
- Maison Médicale Marie Galène, Bordeaux, France
| | - A. Pages
- grid.14925.3b0000 0001 2284 9388Biostatistical Unit, Gustave Roussy Hospital, Villejuif, France
| | - A. Evin
- grid.277151.70000 0004 0472 0371Palliative Care unit, CHU, Nantes, France
| | - S. Dauchy
- grid.508487.60000 0004 7885 7602DMU Psychiatry and Addictology, AP-HP.Centre, Université de Paris, Paris, France
| | - F. Scotte
- grid.14925.3b0000 0001 2284 9388DIOPP, Gustave Roussy Hospital, Villejuif, France
| | - JB. Le Provost
- grid.14925.3b0000 0001 2284 9388DIOPP, Gustave Roussy Hospital, Villejuif, France
| | - F. Blot
- grid.14925.3b0000 0001 2284 9388DIOPP, Gustave Roussy Hospital, Villejuif, France
| | - C. Mateus
- grid.14925.3b0000 0001 2284 9388DIOPP, Gustave Roussy Hospital, Villejuif, France
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5
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Flahault C, Vioulac C, Fasse L, Bailly S, Timsit JF, Garrouste-Orgeas M. "A story with gaps": An interpretative phenomenological analysis of ICU survivors' experience. PLoS One 2022; 17:e0264310. [PMID: 35239692 PMCID: PMC8893654 DOI: 10.1371/journal.pone.0264310] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
ICU survivors may experience various long-term sequelae, recognized as Post-Intensive Care Syndrome, that includes psychiatric symptoms: anxiety, depression, and post-traumatic stress disorders symptoms (PTSD). While it was hypothesized that an ICU diary could help patients after discharge, improving their hospitalization memories and quality of life, it is unclear whether it may reduce psychiatric disorders, in particular PTSD. We performed a qualitative exploration of survivors' subjective experience of their ICU stay, their representations, memories, meaning-making of their experience and use of their ICU diary. Five participants (ICU survivors, 3 men and 2 women, who received a diary) were included in this study. We conducted non-directive interviews 6 months after discharge. These interviews were transcribed and analyzed using Interpretative Phenomenological Analysis. Major recurring themes of discourse included: (1) The nightmare of the ICU experience: from an impression of vagueness to dispossession, (2) The positive image of health-care workers during intensive care, (3) The place of the relatives and health-care workers' writings in the diary: either a support or a barrier, (4) The difficult return back home, and daily life after intensive care. Participant's representation of their ICU experience seemed to reflect the meaning they had given it through their own reflections and that of health-care workers in the diary. For some participant, the diary was associated to the pain and strangeness of the ICU experience; therefore, their recovery required them to take some distance with it. The ICU diary allowed participants to construct their illness narratives, and to become aware of the presence and support of health-care workers. The diary was also perceived as the witness of a period they wished to forget. Trial registration: NCT02519725.
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Affiliation(s)
- Cécile Flahault
- Laboratory of Psychopathology and Health Processes, Paris University, Paris, France
| | - Christel Vioulac
- Laboratory of Psychopathology and Health Processes, Paris University, Paris, France
| | - Léonor Fasse
- Laboratory of Psychopathology and Health Processes, Paris University, Paris, France
| | - Sébastien Bailly
- Grenoble Alpes University, INSERM, CHU Grenoble Alpes, HP2, Grenoble, France
| | - Jean-François Timsit
- Paris University, IAME, INSERM, Paris, France.,Department of Biostatistics, Outcomerea, Paris, France.,Medical ICU, Bichat University Hospital, Paris, France
| | - Maité Garrouste-Orgeas
- Paris University, IAME, INSERM, Paris, France.,Medical Unit, French British Hospital, Levallois-Perret, France.,Palliative Care Unit, Fondation Diaconesses Reuilly, Rueil Malmaison, France
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6
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Piton G, Le Gouge A, Boisramé-Helms J, Anguel N, Argaud L, Asfar P, Botoc V, Bretagnol A, Brisard L, Bui HN, Canet E, Chatelier D, Chauvelot L, Darmon M, Das V, Devaquet J, Djibré M, Ganster F, Garrouste-Orgeas M, Gaudry S, Gontier O, Groyer S, Guidet B, Herbrecht JE, Hourmant Y, Lacherade JC, Letocart P, Martino F, Maxime V, Mercier E, Mira JP, Nseir S, Quenot JP, Richecoeur J, Rigaud JP, Roux D, Schnell D, Schwebel C, Silva D, Sirodot M, Souweine B, Thieulot-Rolin N, Tinturier F, Tirot P, Thévenin D, Thiéry G, Lascarrou JB, Reignier J. Factors associated with acute mesenteric ischemia among critically ill ventilated patients with shock: a post hoc analysis of the NUTRIREA2 trial. Intensive Care Med 2022; 48:458-466. [PMID: 35190840 DOI: 10.1007/s00134-022-06637-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/27/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Acute mesenteric ischemia (AMI) is a rare, but life-threatening condition occurring among critically ill patients. Several factors have been associated with AMI, but the causal link is debated, most studies being retrospective. Among these factors, enteral nutrition (EN) could be associated with AMI, in particular among patients with shock. We aimed to study the factors independently associated with AMI in a post hoc analysis of the NUTRIREA-2 trial including 2410 critically ill ventilated patients with shock, randomly assigned to receive EN or parenteral nutrition (PN). METHODS Post hoc analysis of the NUTRIREA-2 trial was conducted. Ventilated adults with shock were randomly assigned to receive EN or PN. AMI was assessed by computed tomography, endoscopy, or laparotomy. Factors associated with AMI were studied by univariate and multivariate analysis. RESULTS 2410 patients from 44 French intensive care units (ICUs) were included in the study: 1202 patients in the enteral group and 1208 patients in the parenteral group. The median age was 67 [58-76] years, with 67% men, a SAPS II score of 59 [46-74], and a medical cause for ICU admission in 92.7%. AMI was diagnosed among 24 (1%) patients, mainly by computed tomography (79%) or endoscopy (38%). The mechanism of AMI was non-occlusive mesenteric ischemia (n = 12), occlusive (n = 4), and indeterminate (n = 8). The median duration between inclusion in the trial and AMI diagnosis was 4 [1-11] days. Patients with AMI were older, had a higher SAPS II score at ICU admission, had higher plasma lactate, creatinine, and ASAT concentrations and lower hemoglobin concentration, had more frequently EN, dobutamine, and CVVHDF at inclusion, developed more frequently bacteremia during ICU stay, and had higher 28-day and 90-day mortality rates compared with patients without AMI. By multivariate analysis, AMI was independently associated with EN, dobutamine use, SAPS II score ≥ 62 and hemoglobin concentration ≤ 10.9 g/dL. CONCLUSION Among critically ill ventilated patients with shock, EN, dobutamine use, SAPS II score ≥ 62 and hemoglobin ≤ 10.9 g/dL were independently associated with AMI. Among critically ill ventilated patients requiring vasopressors, EN should be delayed or introduced cautiously in case of low cardiac output requiring dobutamine and/or in case of multiple organ failure with high SAPS II score.
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Affiliation(s)
- Gaël Piton
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Besançon, Besançon, France. .,Service de Réanimation Médicale, CHRU de Besançon, Boulevard Fleming, 25030, Besançon, France.
| | - Amélie Le Gouge
- Inserm CIC 1415, Tours, France.,Centre Hospitalier Universitaire de Tours, Tours, France
| | - Julie Boisramé-Helms
- EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nadia Anguel
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Argaud
- Service de Médecine Intensive Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Pierre Asfar
- 6 Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Angers, Angers, France
| | - Vlad Botoc
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint Malo, Saint-Malo, France
| | - Anne Bretagnol
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Laurent Brisard
- Service d'Anesthésie Réanimation Chirurgicale, Hopital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Hoang-Nam Bui
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Emmanuel Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Université de Nantes, Nantes, France
| | - Delphine Chatelier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Louis Chauvelot
- Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Michael Darmon
- 16 Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Das
- Service de Médecine Intensive Réanimation, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
| | - Jérôme Devaquet
- Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France
| | - Michel Djibré
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | - Stéphane Gaudry
- Service de Médecine Intensive Réanimation, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Olivier Gontier
- 25 Service de Médecine Intensive Réanimation, Centre Hospitalier de Chartres, Chartres, France
| | - Samuel Groyer
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Montauban, Montauban, France
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins,, 75012, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France
| | - Jean-Etienne Herbrecht
- Service de Médecine Intensive Réanimation, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Yannick Hourmant
- Centre Hospitalier Universitaire de Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation ChirurgicaleHôtel Dieu, 44093, Nantes, France
| | - Jean-Claude Lacherade
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France
| | - Philippe Letocart
- Service de Médecine Intensive Réanimation, Centre Hospitalier Jacques Puel, Rodez, France
| | - Frédéric Martino
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Pointe-à-Pitre-Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Virginie Maxime
- Service de Médecine Intensive Réanimation, Hôpital Raymond Poincaré, Assistance Publique des Hôpitaux de Paris, Garches, France.,Inserm U 1173, Université de Versailles-Saint Quentin en Yvelines, Versailles, France
| | - Emmanuelle Mercier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bretonneau, CRICS-TRIGGERSEP Network, Tours, France
| | - Jean-Paul Mira
- Service de Médecine Intensive Réanimation, Hôpital Cochin, Groupe Hospitalier Centre-Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Saad Nseir
- CHU de Lille, Médecine Intensive Réanimation, Lille, France.,Université de Lille, Inserm U1285, CNRS, UMR 8576-UGSF, Unité de Glycobiologie Structurale et Fonctionnelle, 59000, Lille, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire François Mitterrand, Dijon, France.,Lipness Team, INSERM, LabExLipSTICUniversité de Bourgogne, Dijon, France.,INSERM Centres d'Investigation Clinique, Département d'épidémiologie clinique, Université de Bourgogne, Dijon, France
| | - Jack Richecoeur
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Beauvais, Beauvais, France
| | - Jean-Philippe Rigaud
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Dieppe, France
| | - Damien Roux
- Service de Médecine Intensive Réanimation, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France
| | - David Schnell
- Service de Médecine Intensive Réanimation, Centre Hospitalier d'Angoulême, Angoulême, France
| | - Carole Schwebel
- Service de Médecine Intensive Réanimation, Université de Grenoble-Alpes, Grenoble, France.,INSERM 1039, Grenoble, France
| | - Daniel Silva
- Service de Médecine Intensive Réanimation, Hôpital Delafontaine, Saint-Denis, France
| | - Michel Sirodot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Annecy Genevois, Pringy, France
| | - Bertrand Souweine
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Gabriel-Montpied, Clermont-Ferrand, France
| | | | - François Tinturier
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Patrice Tirot
- Service de Médecine Intensive Réanimation, Centre Hospitalier du Mans, Le Mans, France
| | - Didier Thévenin
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France
| | - Guillaume Thiéry
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Saint Etienne, Saint Priest en Jarez, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Université de Nantes, Nantes, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Université de Nantes, Nantes, France
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7
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Buetti N, Ruckly S, Lucet JC, Bouadma L, Garrouste-Orgeas M, Schwebel C, Mimoz O, Souweine B, Timsit JF. Local signs at insertion site and catheter-related bloodstream infections: an observational post hoc analysis using individual data of four RCTs. Crit Care 2020; 24:694. [PMID: 33317594 PMCID: PMC7737269 DOI: 10.1186/s13054-020-03425-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background Little is known on the association between local signs and intravascular catheter infections. This study aimed to evaluate the association between local signs at removal and catheter-related bloodstream infections (CRBSI), and which clinical conditions may predict CRBSIs if inflammation at insertion site is present. Methods We used individual data from four multicenter randomized controlled trials in intensive care units (ICUs) that evaluated various prevention strategies for arterial and central venous catheters. We used multivariate logistic regressions in order to evaluate the association between ≥ 1 local sign, redness, pain, non-purulent discharge and purulent discharge, and CRBSI. Moreover, we assessed the probability for each local sign to observe CRBSI in subgroups of clinically relevant conditions. Results A total of 6976 patients and 14,590 catheters (101,182 catheter-days) and 114 CRBSI from 25 ICUs with described local signs were included. More than one local sign, redness, pain, non-purulent discharge, and purulent discharge at removal were observed in 1938 (13.3%), 1633 (11.2%), 59 (0.4%), 251 (1.7%), and 102 (0.7%) episodes, respectively. After adjusting on confounders, ≥ 1 local sign, redness, non-purulent discharge, and purulent discharge were associated with CRBSI. The presence of ≥ 1 local sign increased the probability to observe CRBSI in the first 7 days of catheter maintenance (OR 6.30 vs. 2.61 [> 7 catheter-days], pheterogeneity = 0.02). Conclusions Local signs were significantly associated with CRBSI in the ICU. In the first 7 days of catheter maintenance, local signs increased the probability to observe CRBSI.
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Affiliation(s)
- Niccolò Buetti
- University of Paris, INSERM, IAME, 75006, Paris, France. .,Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | | | - Jean-Christophe Lucet
- University of Paris, INSERM, IAME, 75006, Paris, France.,AP-HP, Infection Control Unit, Bichat- Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Lila Bouadma
- University of Paris, INSERM, IAME, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Maité Garrouste-Orgeas
- University of Paris, INSERM, IAME, 75006, Paris, France.,Medical Unit, French British Hospital, Levallois-Perret, France
| | - Carole Schwebel
- Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, La Tronche, France.,Inserm U1039, Radiopharmaceutiques Biocliniques, Domaine de la Merci, 38700, La Tronche, France
| | - Olivier Mimoz
- Services Des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, 86021, Poitiers, France.,Université de Poitiers, Poitiers, France.,Inserm U1070, Poitiers, France
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-François Timsit
- University of Paris, INSERM, IAME, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
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8
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Boissier F, Seegers V, Seguin A, Legriel S, Cariou A, Jaber S, Lefrant JY, Rimmelé T, Renault A, Vinatier I, Mathonnet A, Reuter D, Guisset O, Cracco C, Durand-Gasselin J, Éon B, Thirion M, Rigaud JP, Philippon-Jouve B, Argaud L, Chouquer R, Papazian L, Dedrie C, Georges H, Lebas E, Rolin N, Bollaert PE, Lecuyer L, Viquesnel G, Leone M, Chalumeau-Lemoine L, Garrouste-Orgeas M, Azoulay E, Kentish-Barnes N. Assessing physicians' and nurses' experience of dying and death in the ICU: development of the CAESAR-P and the CAESAR-N instruments. Crit Care 2020; 24:521. [PMID: 32843097 PMCID: PMC7448438 DOI: 10.1186/s13054-020-03191-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/20/2020] [Indexed: 11/27/2022] Open
Abstract
Background As an increasing number of deaths occur in the intensive care unit (ICU), studies have sought to describe, understand, and improve end-of-life care in this setting. Most of these studies are centered on the patient’s and/or the relatives’ experience. Our study aimed to develop an instrument designed to assess the experience of physicians and nurses of patients who died in the ICU, using a mixed methodology and validated in a prospective multicenter study. Methods Physicians and nurses of patients who died in 41 ICUs completed the job strain and the CAESAR questionnaire within 24 h after the death. The psychometric validation was conducted using two datasets: a learning and a reliability cohort. Results Among the 475 patients included in the main cohort, 398 nurse and 417 physician scores were analyzed. The global score was high for both nurses [62/75 (59; 66)] and physicians [64/75 (61; 68)]. Factors associated with higher CAESAR-Nurse scores were absence of conflict with physicians, pain control handled with physicians, death disclosed to the family at the bedside, and invasive care not performed. As assessed by the job strain instrument, low decision control was associated with lower CAESAR score (61 (58; 65) versus 63 (60; 67), p = 0.002). Factors associated with higher CAESAR-Physician scores were room dedicated to family information, information delivered together by nurse and physician, families systematically informed of the EOL decision, involvement of the nurse during implementation of the EOL decision, and open visitation. They were also higher when a decision to withdraw or withhold treatment was made, no cardiopulmonary resuscitation was performed, and the death was disclosed to the family at the bedside. Conclusion We described and validated a new instrument for assessing the experience of physicians and nurses involved in EOL in the ICU. This study shows important areas for improving practices.
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Affiliation(s)
- Florence Boissier
- Medical Intensive Care, University Hospital of Poitiers, Poitiers, France.,INSERM CIC 1402 (ALIVE group), Poitiers University, Poitiers, France
| | - Valérie Seegers
- Data Management Research Department DRCI, Angers Hospital and SFR ICAT, University of Angers, Angers, France
| | - Amélie Seguin
- Medical Intensive Care, Caen University Hospital, Caen, France
| | | | - Alain Cariou
- Medical Intensive Care, Assistance Publique Hôpitaux de Paris, Cochin University Hospital, Paris, France.,Paris Descartes University, Paris, France
| | - Samir Jaber
- Saint Eloi Hospital, Centre Hospitalier Universitaire Montpellier, Anesthesia and Critical Care Department B, Montpellier, France.,PhyMedExp, University of Montpellier, Montpellier, France.,INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Jean-Yves Lefrant
- Anesthesia and Intensive Care, Carémeau University Hospital, Nîmes, France.,Nîmes University, Nîmes, France
| | - Thomas Rimmelé
- Anaesthesia and Intensive Care Medicine, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Anne Renault
- Medical Intensive Care, Cavale Blanche University Hospital, Brest, France
| | - Isabelle Vinatier
- Medical Intensive Care, Les Oudairies Hospital, La Roche Sur Yon, France
| | | | - Danielle Reuter
- Medical Intensive Care, Assistance Publique Hôpitaux de Paris, Saint Louis University Hospital, Paris, France
| | - Olivier Guisset
- Medical Intensive Care, Saint André University Hospital, Bordeaux, France
| | | | | | - Béatrice Éon
- Anaesthesia and Intensive Care, La Timone University Hospital, Marseille, France
| | - Marina Thirion
- Medical Intensive Care, Victor Dupouy Hospital, Argenteuil, France
| | | | | | - Laurent Argaud
- Medical Intensive Care, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France.,Lyon Est University, Lyon, France
| | | | - Laurent Papazian
- Medical Intensive Care, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Marseille, France.,Aix-Marseille University, Marseille, France
| | | | | | - Eddy Lebas
- Intensive Care, Bretagne Atlantique Hospital, Vannes, France
| | - Nathalie Rolin
- Medical Intensive Care, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Pierre-Edouard Bollaert
- Medical Intensive Care, Nancy University Hospital, Nancy, France.,Lorraine University, Nancy, France
| | - Lucien Lecuyer
- Medical Intensive Care, Sud Francilien Hospital, Evry, France
| | | | - Marc Leone
- Aix-Marseille University, Marseille, France.,Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | | | | | - Elie Azoulay
- Medical Intensive Care, Assistance Publique Hôpitaux de Paris, Saint Louis University Hospital, Paris, France.,Biostatistics and Clinical Epidemiology Research Team, U1153, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Nancy Kentish-Barnes
- Biostatistics and Clinical Epidemiology Research Team, U1153, INSERM, Paris Diderot Sorbonne University, Paris, France. .,Famiréa Research Group, Assistance Publique Hôpitaux de Paris, Saint Louis University Hospital, Paris, France. .,Medical ICU, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.
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9
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de Montmollin E, Terzi N, Dupuis C, Garrouste-Orgeas M, da Silva D, Darmon M, Laurent V, Thiéry G, Oziel J, Marcotte G, Gainnier M, Siami S, Sztrymf B, Adrie C, Reignier J, Ruckly S, Sonneville R, Timsit JF. One-year survival in acute stroke patients requiring mechanical ventilation: a multicenter cohort study. Ann Intensive Care 2020; 10:53. [PMID: 32383104 PMCID: PMC7205929 DOI: 10.1186/s13613-020-00669-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/26/2020] [Indexed: 12/15/2022] Open
Abstract
Background Most prognostic studies in acute stroke patients requiring invasive mechanical ventilation are outdated and have limitations such as single-center retrospective designs. We aimed to study the association of ICU admission factors, including the reason for intubation, with 1-year survival of acute stroke patients requiring mechanical ventilation. Methods We conducted a secondary data use analysis of a prospective multicenter database (14 ICUs) between 1997 and 2016 on consecutive ICU stroke patients requiring mechanical ventilation at admission. We excluded patients with stroke of traumatic origin, subdural hematoma or cerebral venous thrombosis. The primary outcome was survival 1 year after ICU admission. Factors associated with the primary outcome were identified using a multivariable Cox model stratified on inclusion center. Results We identified 419 patients (age 68 [58–76] years, males 60%) with a Glasgow coma score (GCS) of 4 [3–8] at admission. Stroke subtypes were acute ischemic stroke (AIS, 46%), intracranial hemorrhage (ICH, 42%) and subarachnoid hemorrhage (SAH, 12%). At 1 year, 96 (23%) patients were alive. Factors independently associated with decreased 1-year survival were ICH and SAH stroke subtypes, a lower GCS score at admission, a higher non-neurological SOFA score. Conversely, patients receiving acute-phase therapy had improved 1-year survival. Intubation for acute respiratory failure or coma was associated with comparable survival hazard ratios, whereas intubation for seizure was not associated with a worse prognosis than for elective procedure. Survival did not improve over the study period, but patients included in the most recent period had more comorbidities and presented higher severity scores at admission. Conclusions In acute stroke patients requiring mechanical ventilation, the reason for intubation and the opportunity to receive acute-phase stroke therapy were independently associated with 1-year survival. These variables could assist in the decision process regarding the initiation of mechanical ventilation in acute stroke patients.
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Affiliation(s)
- Etienne de Montmollin
- Université de Paris, UMR 1137, IAME, Paris, France. .,APHP, Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris, France.
| | - Nicolas Terzi
- Medical Intensive Care Unit, Grenoble University Hospital, La Tronche, France
| | - Claire Dupuis
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | | | - Daniel da Silva
- Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France
| | - Michaël Darmon
- Medical Intensive Care Unit, Saint-Louis Hospital, Paris, France
| | | | | | - Johana Oziel
- APHP, Intensive Care Unit, Avicenne Hospital, Bobigny, France
| | | | - Marc Gainnier
- Intensive Care Unit, La Timone Hospital, Marseille, France
| | - Shidasp Siami
- Intensive Care Unit, Sud-Essonne Hospital, Etampes, France
| | - Benjamin Sztrymf
- APHP, Intensive Care Unit, Antoine Béclère Hospital, Clamart, France
| | | | - Jean Reignier
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France
| | | | - Romain Sonneville
- APHP, Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris, France.,Université de Paris, UMR 1148, LVTS, Paris, France
| | - Jean-François Timsit
- Université de Paris, UMR 1137, IAME, Paris, France.,APHP, Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris, France
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10
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Bouadma L, Mankikian S, Darmon M, Argaud L, Vinclair C, Siami S, Garrouste-Orgeas M, Papazian L, Cohen Y, Marcotte G, Styfalova L, Reignier J, Lautrette A, Schwebel C, Timsit JF. Influence of dyskalemia at admission and early dyskalemia correction on survival and cardiac events of critically ill patients. Crit Care 2019; 23:415. [PMID: 31856891 PMCID: PMC6921444 DOI: 10.1186/s13054-019-2679-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/20/2019] [Indexed: 12/24/2022]
Abstract
Objectives Our objectives were (1) to characterize the distribution of serum potassium levels at ICU admission, (2) to examine the relationship between dyskalemia at ICU admission and occurrence of cardiac events, and (3) to study both the association between dyskalemia at ICU admission and dyskalemia correction by day 2 on 28-day mortality. Design Inception cohort study from the longitudinal prospective French multicenter OUTCOMEREA database (1999–2014) Setting 22 French OUTCOMEREA network ICUs Patients Patients were classified into six groups according to their serum potassium level at admission: three groups of hypokalemia and three groups of hyperkalemia defined as serious hypokalemia [K+] < 2.5 and serious hyperkalemia [K+] > 7 mmol/L, moderate hypokalemia 2.5 ≤ [K+] < 3 mmol/L and moderate hyperkalemia 6 < [K+] ≤ 7 mmol/L, and mild hypokalemia 3 ≤ [K+] < 3.5 mmol/L and mild hyperkalemia 5 < [K+] ≤ 6 mmol/L. We sorted evolution at day 2 of dyskalemia into three categories: balanced, not-balanced, and overbalanced. Intervention None Measurements and main results Of 12,090 patients, 2108 (17.4%) had hypokalemia and 1445 (12%) had hyperkalemia. Prognostic impact of dyskalemia and its correction was assessed using multivariate Cox models. After adjustment, hypokalemia and hyperkalemia were independently associated with a greater risk of 28-day mortality. Mild hyperkalemic patients had the highest mortality (hazard ratio (HR) 1.29, 95% confidence interval (CI) [1.13–1.47], p < 0.001). Adjusted 28-day mortality was higher if serum potassium level was not-balanced at day 2 (aHR = 1.51, 95% CI [1.30–1.76], p < 0.0001) and numerically higher but not significantly different if serum potassium level was overbalanced at day 2 (aHR = 1.157, 95% CI [0.84–1.60], p = 0.38). Occurrence of cardiac events was evaluated by logistic regression. Except for patients with serious hypokalemia at admission, the depth of dyskalemia was associated with increased risk of cardiac events. Conclusions Dyskalemia is common at ICU admission and associated with increased mortality. Occurrence of cardiac events increased with dyskalemia depth. A correction of serum potassium level by day 2 was associated with improved prognosis.
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Affiliation(s)
- Lila Bouadma
- UMR 1137, IAME, Université Paris Diderot, F75018, Paris, France. .,Medical and Infectious Diseases Care Unit, AP-HP, Bichat University Hospital, F75018, Paris, France. .,Service de Réanimation Médicale et des Maladies Infectieuses, Hôpital Bichat-Claude-Bernard, 46 rue Henri-Huchard, 75877, Paris Cedex 18, France.
| | - Stefan Mankikian
- AP-HP, Pitié-Salpêtrière University Hospital, Cardiology, Paris, France
| | - Michael Darmon
- APHP, Saint-Louis University Hospital, Medical Intensive Care Unit, Paris, France.,Paris-7 Paris Diderot University, Paris, France
| | - Laurent Argaud
- Medical ICU, Edouard Herriot University Hospital, Lyon, France
| | | | - Shidasp Siami
- Critical Care Medicine Unit CH Etampes-Dourdan, Etampes, France
| | | | - Laurent Papazian
- Respiratory and Infectious Diseases ICU, APHM Hôpital Nord, Aix Marseille University, Marseille, France
| | - Yves Cohen
- AP-HP, Avicenne Hospital, Intensive Care Unit, Paris, France.,Medicine University, Paris 13 University, Bobigny, France
| | | | | | - Jean Reignier
- Medical Intensive Care Unit and University Hospital Centre, Nantes, France
| | - Alexandre Lautrette
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Carole Schwebel
- Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, U823, La Tronche, France
| | - Jean-Francois Timsit
- UMR 1137, IAME, Université Paris Diderot, F75018, Paris, France.,Medical and Infectious Diseases Care Unit, AP-HP, Bichat University Hospital, F75018, Paris, France
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11
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Garrouste-Orgeas M, Flahault C, Poulain E, Evin A, Guirimand F, Fossez-Diaz V, Perruchio S, Verlaine C, Vanbésien A, Kaczmarek W, Birkui de Francqueville L, De Larivière E, Bouquet G, Copel L, Verliac V, Marché V, Mathias C, Gracia D, Mhalla A, Michonneau-Gandon V, Poupardin C, Touzet L, Ranchou G, Guastella V, Richard B, Bienfait F, Sonrier M, Michel D, Ruckly S, Bailly S, Timsit JF. The Fami-life study: protocol of a prospective observational multicenter mixed study of psychological consequences of grieving relatives in French palliative care units on behalf of the family research in palliative care (F.R.I.P.C research network). BMC Palliat Care 2019; 18:111. [PMID: 31818281 PMCID: PMC6902332 DOI: 10.1186/s12904-019-0496-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/27/2019] [Indexed: 11/22/2022] Open
Abstract
Background Grieving relatives can suffer from numerous consequences like anxiety, depression, post-traumatic stress disorder (PTSD) symptoms, and prolonged grief. This study aims to assess the psychological consequences of grieving relatives after patients’ death in French palliative care units and their needs for support. Methods This is a prospective observational multicenter mixed study. Relatives of adult patients with a neoplasia expected to be hospitalized more than 72 h in a palliative care unit for end-of-life issues will be included within 48 h after patient admission. End-of-life issues are defined by the physician at patient admission. Relatives who are not able to have a phone call at 6-months are excluded. The primary outcome is the incidence of prolonged grief reaction defined by an ICG (Inventory Complicate Grief) > 25 (0 best-76 worst) at 6 months after patient’ death. Prespecified secondary outcomes are the risk factors of prolonged grief, anxiety and depression symptoms between day 3 and day 5 and at 6 months after patients’ death based on an Hospital Anxiety and Depression score (range 0–42) > 8 for each subscale (minimal clinically important difference: 2.5), post-traumatic stress disorder symptoms 6 months after patient’ death based on the Impact of Events Scale questionnaire (0 best-88 worst) score > 22, experience of relatives during palliative care based on the Fami-Life questionnaire, specifically built for the study. Between 6 and 12 months after the patient’s death, a phone interview with relatives with prolonged grief reactions will be planned by a psychologist to understand the complex system of grief. It will be analyzed with the Interpretative Phenomenological Analysis. We planned to enroll 500 patients and their close relatives assuming a 25% prolonged grief rate and a 6-month follow-up available in 60% of relatives. Discussion This study will be the first to report the psychological consequences of French relatives after a loss of a loved one in palliative care units. Evaluating relatives’ experiences can provide instrumental insights for means of improving support for relatives and evaluation of bereavement programs. Trial registration NCT03748225 registered on 11/19/2018. Recruiting patients.
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Affiliation(s)
- Maité Garrouste-Orgeas
- IAME, INSERM, Université de Paris, F-75018, Paris, France. .,Palliative Care unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France. .,Medical unit, French British Hospital, Levallois-Perret, France. .,Service de médecine interne, Hôpital Franco Britannique, 4 rue Kléber, 92 300, Levallois-Perret, France.
| | - Cécile Flahault
- Psychology laboratory and work process, Paris Descartes University, Paris, France
| | - Edith Poulain
- Palliative Care unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
| | - Adrien Evin
- Palliative Care unit, University Teaching Hospital, Nantes, France
| | - Frédéric Guirimand
- Palliative Care unit, Jeanne Garnier Institution, Paris, France.,UFR Simone VEIL - Santé, Versailles Saint Quentin en Yvelines University, Versailles, France
| | | | | | | | | | | | | | | | | | - Laure Copel
- Palliative Care unit, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Virginie Verliac
- Palliative Care unit, Saintonge General Hospital, Saintes, France
| | | | - Carmen Mathias
- Palliative Care unit, Mulhouse Sud Alsace Hospital Network, Mulhouse, France
| | - Dominique Gracia
- Palliative Care unit, General Hospital, Salon-de-Provence, France
| | - Alaa Mhalla
- Palliative Care unit, Albert Chenevier Hospital, Créteil, France
| | | | | | - Licia Touzet
- Palliative Care unit, University Teaching Hospital, Lille, France
| | - Gaelle Ranchou
- Palliative Care unit, General Hospital, Périgueux, France
| | - Virginie Guastella
- Palliative Care unit, University Teaching Hospital, Clermont Ferrand, France
| | - Bruno Richard
- Palliative Care unit, University Teaching Hospital, Montpellier, France
| | - Florent Bienfait
- Palliative Care unit, University Teaching Hospital, Angers, France
| | - Marie Sonrier
- Psychology laboratory and work process, Paris Descartes University, Paris, France
| | - Dominique Michel
- Palliative Care unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
| | | | - Sébastien Bailly
- INSERM, CHU Grenoble Alpes, Grenoble Alpes University, HP2, Grenoble, France
| | - Jean-François Timsit
- IAME, INSERM, Université de Paris, F-75018, Paris, France.,AP-HP, Bichat Hospital, Medical and infectious diseases ICU (MI2), F-75018, Paris, France
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Affiliation(s)
| | - Sébastien Bailly
- Université Grenoble Alpes Inserm, CHU Grenoble Alpes HP2, Grenoble, France
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Ibn Saied W, Merceron S, Schwebel C, Le Monnier A, Oziel J, Garrouste-Orgeas M, Marcotte G, Ruckly S, Souweine B, Darmon M, Bouadma L, de Montmollin E, Mourvillier B, Reignier J, Papazian L, Siami S, Azoulay E, Bédos JP, Timsit JF. Ventilator-associated pneumonia due to Stenotrophomonas maltophilia: Risk factors and outcome. J Infect 2019; 80:279-285. [PMID: 31682878 DOI: 10.1016/j.jinf.2019.10.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/22/2019] [Accepted: 10/26/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Stenotrophomonas maltophilia (SM) is increasingly identified in intensive care unit (ICU). This study aim to identify risk factors for SM ventilator-associated pneumonia (VAP) and whether it affects ICU mortality METHODS: Two nested matched case-control studies were performed based in OUTCOMEREA database. The first episodes of SM-VAP patients were matched with two different control groups: VAP due to other micro-organisms (VAP-other) and Pseudomonas aeruginosa VAP (Pyo-VAP). Matching criteria were the hospital, the SAPS II, and the previous duration of mechanical ventilation (MV). RESULTS Of the 102 SM-VAP patients (6.2% of all VAP patients), 92 were matched with 375 controls for the SM-VAP/other-VAP matching and 84 with 237 controls for the SM-VAP/Pyo-VAP matching. SM-VAP risk factors were an exposition to ureido/carboxypenicillin or carbapenem during the week before VAP, and respiratory and coagulation components of SOFA score upper to 2 before VAP. SM-VAP received early adequate therapy in 70 cases (68.6%). Risk factors for Day-30 were age (OR = 1.03; p < 0.01) and Chronic heart failure (OR = 3.15; p < 0.01). Adequate treatment, either monotherapy or combination of antimicrobials, did not modify mortality. There was no difference in 30-day mortality, but 60-day mortality was higher in patients with SM-VAP compared to Other-VAP (P = 0.056). CONCLUSIONS In a large series, independent risk factors for the SM-VAP were ureido/carboxypenicillin or carbapenem exposure the week before VAP, and respiratory and coagulation components of the SOFA score > 2 before VAP. Mortality risk factors of SM-VAP were age and chronic heart failure. Adequate treatment did not improve SM-VAP prognosis.
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Affiliation(s)
| | | | - Carole Schwebel
- Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, La Tronche, France
| | - Alban Le Monnier
- Microbiology Laboratory, Saint Joseph Hospital Network, Paris, France
| | - Johana Oziel
- Medical Surgical ICU, Avicenne Hospital, Bobigny, France
| | - Maité Garrouste-Orgeas
- Intensive Care Unit Hospital A Mignot, Versailles, France; Intensive Care Unit, Saint Joseph Hospital Network, Paris, France; Outcomerea Research Network, Aulnay sous Bois, France
| | | | | | - Bertrand Souweine
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Michael Darmon
- Saint Etienne University Hospital, Medical Intensive Care Unit, Saint-Etienne, France; Intensive Care Unit, Saint Louis Hospital, Paris, France
| | - Lila Bouadma
- UMR 1137, IAME, Université Paris Diderot, Paris, France; Medical and Infectious diseases ICU (MI2), APHP, Bichat Hospital, Paris, France
| | | | - Bruno Mourvillier
- Intensive Care Medicine, University Hospital, Reims, France; Medical and Infectious diseases ICU (MI2), APHP, Bichat Hospital, Paris, France
| | - Jean Reignier
- Medical Intensive Care Unit and University Hospital Centre, Nantes, France
| | - Laurent Papazian
- Respiratory and Infectious Diseases ICU, APHM Hôpital Nord, Aix Marseille University, Marseille, France
| | - Shidasp Siami
- Critical Care Medicine Unit CH Etampes-Dourdan, Etampes, France
| | - Elie Azoulay
- Intensive Care Unit, Saint Louis Hospital, Paris, France
| | | | - Jean-Francois Timsit
- UMR 1137, IAME, Université Paris Diderot, Paris, France; Outcomerea Research Network, Aulnay sous Bois, France; Medical and Infectious diseases ICU (MI2), APHP, Bichat Hospital, Paris, France.
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14
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Garrouste-Orgeas M, Flahault C, Vinatier I, Rigaud JP, Thieulot-Rolin N, Mercier E, Rouget A, Grand H, Lesieur O, Tamion F, Hamidfar R, Renault A, Parmentier-Decrucq E, Monseau Y, Argaud L, Bretonnière C, Lautrette A, Badié J, Boulet E, Floccard B, Forceville X, Kipnis E, Soufir L, Valade S, Bige N, Gaffinel A, Hamzaoui O, Simon G, Thirion M, Bouadma L, Large A, Mira JP, Amdjar-Badidi N, Jourdain M, Jost PH, Maxime V, Santoli F, Ruckly S, Vioulac C, Leborgne MA, Bellalou L, Fasse L, Misset B, Bailly S, Timsit JF. Effect of an ICU Diary on Posttraumatic Stress Disorder Symptoms Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA 2019; 322:229-239. [PMID: 31310299 PMCID: PMC6635906 DOI: 10.1001/jama.2019.9058] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Keeping a diary for patients while they are in the intensive care unit (ICU) might reduce their posttraumatic stress disorder (PTSD) symptoms. OBJECTIVES To assess the effect of an ICU diary on the psychological consequences of an ICU hospitalization. DESIGN, SETTING, AND PARTICIPANTS Assessor-blinded, multicenter, randomized clinical trial in 35 French ICUs from October 2015 to January 2017, with follow-up until July 2017. Among 2631 approached patients, 709 adult patients (with 1 family member each) who received mechanical ventilation within 48 hours after ICU admission for at least 2 days were eligible, 657 were randomized, and 339 were assessed 3 months after ICU discharge. INTERVENTIONS Patients in the intervention group (n = 355) had an ICU diary filled in by clinicians and family members. Patients in the control group (n = 354) had usual ICU care without an ICU diary. MAIN OUTCOMES AND MEASURES The primary outcome was significant PTSD symptoms, defined as an Impact Event Scale-Revised (IES-R) score greater than 22 (range, 0-88; a higher score indicates more severe symptoms), measured in patients 3 months after ICU discharge. Secondary outcomes, also measured at 3 months and compared between groups, included significant PTSD symptoms in family members; significant anxiety and depression symptoms in patients and family members, based on a Hospital Anxiety and Depression Scale score greater than 8 for each subscale (range, 0-42; higher scores indicate more severe symptoms; minimal clinically important difference, 2.5); and patient memories of the ICU stay, reported with the ICU memory tool. RESULTS Among 657 patients who were randomized (median [interquartile range] age, 62 [51-70] years; 126 women [37.2%]), 339 (51.6%) completed the trial. At 3 months, significant PTSD symptoms were reported by 49 of 164 patients (29.9%) in the intervention group vs 60 of 175 (34.3%) in the control group (risk difference, -4% [95% CI, -15% to 6%]; P = .39). The median (interquartile range) IES-R score was 12 (5-25) in the intervention group vs 13 (6-27) in the control group (difference, -1.47 [95% CI, -1.93 to 4.87]; P = .38). There were no significant differences in any of the 6 prespecified comparative secondary outcomes. CONCLUSIONS AND RELEVANCE Among patients who received mechanical ventilation in the ICU, the use of an ICU diary filled in by clinicians and family members did not significantly reduce the number of patients who reported significant PTSD symptoms at 3 months. These findings do not support the use of ICU diaries for preventing PTSD symptoms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02519725.
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Affiliation(s)
- Maité Garrouste-Orgeas
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Department of Biostatistics, Outcomerea, Paris, France
- Medical unit, French British Hospital, Levallois-Perret, France
| | - Cécile Flahault
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Isabelle Vinatier
- Medical ICU, Les Oudaries Hospital, La Roche-sur-Yon, Vendée, France
| | | | | | - Emmanuelle Mercier
- CRICS-TRIGGERSEP group, Medical-Surgical ICU, Tours University Hospital, Tours, France
| | - Antoine Rouget
- Medical-Surgical ICU, Rangueil University Hospital, Toulouse, France
| | - Hubert Grand
- Medical-Surgical ICU, Hospital Robert Boulin, Libourne, France
| | | | - Fabienne Tamion
- Medical ICU, University Medical Center, Rouen, France
- INSERM U-1096, University of Rouen, Rouen, France
| | - Rebecca Hamidfar
- Medical ICU, Albert Michallon University Hospital, Grenoble, France
| | - Anne Renault
- Medical ICU, La Cavale Blanche University Hospital, Brest, France
| | | | | | - Laurent Argaud
- Medical ICU, Edouard Herriot University Hospital, Lyon, France
| | - Cédric Bretonnière
- Medical ICU, Nantes University Hospital, Nantes, France
- EA3826, Laboratory of Clinical and Experimental Therapeutics of Infections, University of Nantes, Nantes, France
| | - Alexandre Lautrette
- Medical ICU, Gabriel-Montpied University Hospital, Clermont Ferrand, France
- LMGE UMR CNRS 6023, University of Clermont-Ferrand, Clermont Ferrand, France
| | - Julio Badié
- Medical-Surgical ICU, General Hospital Belfort-Montbéliard, Belfort, France
| | - Eric Boulet
- Medical ICU, Beaumont General Hospital, Beaumont, France
| | - Bernard Floccard
- Medical ICU, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France
| | - Xavier Forceville
- Medical-Surgical ICU, Great Hospital of East Francilien, Meaux, France
| | - Eric Kipnis
- Surgical ICU, Lille University Hospital, Lille, France
| | - Lilia Soufir
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | | | - Naike Bige
- Medical ICU, Saint Antoine University Hospital, Paris, France
| | - Alain Gaffinel
- Medical-Surgical ICU, Gustave Roussy Cancer Campus, Villejuif, France
| | - Olfa Hamzaoui
- Medical Surgical ICU, University Hospital Paris -Sud, Beclère University Hospital, Clamart, France
| | - Georges Simon
- Medical-Surgical ICU, General Hospital, Troyes, France
| | - Marina Thirion
- Medical-Surgical ICU, General Hospital Victor Dupouy, Argenteuil, France
| | - Lila Bouadma
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Medical ICU, Bichat University Hospital, Paris, France
| | - Audrey Large
- Medical ICU, François Mitterrand University Hospital, Dijon, France
| | - Jean-Paul Mira
- Medical ICU, Cochin University Hospital, Paris Centre Hospital Group, AP-HP, Paris, France
| | | | - Mercé Jourdain
- Group of medical ICUs, Lille University Hospital, Lille, France
- Lille University, Inserm U1190, Lille, France
| | - Paul-Henri Jost
- Surgical ICU, Henri Mondor University Hospital, Créteil, France
| | - Virginie Maxime
- Medical ICU, Raymond Poincaré University Hospital, Garches, France
| | - François Santoli
- Medical ICU, General Hospital Robert Ballanger, Aulnay-Sous-Bois, France
| | | | - Christel Vioulac
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Marie Annick Leborgne
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Lucie Bellalou
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Léonor Fasse
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Benoit Misset
- Medical ICU, University Medical Center, Rouen, France
| | - Sébastien Bailly
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Grenoble Alpes University, INSERM, University hospital Grenoble Alpes, HP2, Grenoble, France
| | - Jean-François Timsit
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Department of Biostatistics, Outcomerea, Paris, France
- Medical ICU, Bichat University Hospital, Paris, France
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McIlroy PA, King RS, Garrouste-Orgeas M, Tabah A, Ramanan M. The Effect of ICU Diaries on Psychological Outcomes and Quality of Life of Survivors of Critical Illness and Their Relatives. Crit Care Med 2019; 47:273-279. [DOI: 10.1097/ccm.0000000000003547] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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16
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Truche AS, Ragey SP, Souweine B, Bailly S, Zafrani L, Bouadma L, Clec'h C, Garrouste-Orgeas M, Lacave G, Schwebel C, Guebre-Egziabher F, Adrie C, Dumenil AS, Zaoui P, Argaud L, Jamali S, Goldran Toledano D, Marcotte G, Timsit JF, Darmon M. ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients. Ann Intensive Care 2018; 8:127. [PMID: 30560526 PMCID: PMC6297118 DOI: 10.1186/s13613-018-0467-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/30/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Transient and persistent acute kidney injury (AKI) could share similar physiopathological mechanisms. The objective of our study was to assess prognostic impact of AKI duration on ICU mortality. DESIGN Retrospective analysis of a prospective database via cause-specific model, with 28-day ICU mortality as primary end point, considering discharge alive as a competing event and taking into account time-dependent nature of renal recovery. Renal recovery was defined as a decrease of at least one KDIGO class compared to the previous day. SETTING 23 French ICUs. PATIENTS Patients of a French multicentric observational cohort were included if they suffered from AKI at ICU admission between 1996 and 2015. INTERVENTION None. RESULTS A total of 5242 patients were included. Initial severity according to KDIGO creatinine definition was AKI stage 1 for 2458 patients (46.89%), AKI stage 2 for 1181 (22.53%) and AKI stage 3 for 1603 (30.58%). Crude 28-day ICU mortality according to AKI severity was 22.74% (n = 559), 27.69% (n = 327) and 26.26% (n = 421), respectively. Renal recovery was experienced by 3085 patients (58.85%), and its rate was significantly different between AKI severity stages (P < 0.01). Twenty-eight-day ICU mortality was independently lower in patients experiencing renal recovery [CSHR 0.54 (95% CI 0.46-0.63), P < 0.01]. Lastly, RRT requirement was strongly associated with persistent AKI whichever threshold was chosen between day 2 and 7 to delineate transient from persistent AKI. CONCLUSIONS Short-term renal recovery, according to several definitions, was independently associated with higher mortality and RRT requirement. Moreover, distinction between transient and persistent AKI is consequently a clinically relevant surrogate outcome variable for diagnostic testing in critically ill patients.
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Affiliation(s)
- A S Truche
- UMR 1137 - IAME Team 5 - DeSCID : Decision SCiences in Infectious Diseases, Control and Care, Inserm/Paris Diderot University, Sorbonne Paris Cité, Paris, France
- Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, U823, La Tronche, France
- Nephrology Dialysis Renal Transplantation, Grenoble University Hospital, La Tronche, France
| | - S Perinel Ragey
- Medical Intensive Care Unit, Croix Rousse Hospital, Lyon University Hospital, Lyon, France
| | - B Souweine
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - S Bailly
- UMR 1137 - IAME Team 5 - DeSCID : Decision SCiences in Infectious Diseases, Control and Care, Inserm/Paris Diderot University, Sorbonne Paris Cité, Paris, France
- Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, U823, La Tronche, France
| | - L Zafrani
- Medical Intensive Care Unit, AP-HP, Saint Louis Hospital, Paris, France
- Medicine University, Paris 7 University, Paris, France
| | - L Bouadma
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris Diderot University, 75018, Paris, France
| | - C Clec'h
- Intensive Care Unit, AP-HP, Avicenne Hospital, Paris, France
- Medicine University, Paris 13 University, Bobigny, France
| | - M Garrouste-Orgeas
- Intensive Care Unit, Saint Joseph Hospital Network, Paris, France
- Medicine University, Paris Descartes University, Sorbonne Cite, Paris, France
| | - G Lacave
- Medical Intensive Care Unit, André Mignot Hospital, Versailles, France
| | - C Schwebel
- Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, U823, La Tronche, France
| | - F Guebre-Egziabher
- Nephrology Dialysis Renal Transplantation, Grenoble University Hospital, La Tronche, France
| | - C Adrie
- Physiology Department, Cochin University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP), Paris Descartes University des, Sorbonne Cite, Paris, France
| | - A S Dumenil
- Medical-Surgical Intensive Care Unit, AP-HP, Antoine Béclère University Hospital, Clamart, France
| | - Ph Zaoui
- Nephrology Dialysis Renal Transplantation, Grenoble University Hospital, La Tronche, France
| | - L Argaud
- Medical Intensive Care Unit, Edouard Herriot University Hospital, Lyon, France
| | - S Jamali
- Critical Care Medicine Unit, Dourdan Hospital, Dourdan, France
| | | | - G Marcotte
- Surgical ICU, Edouard Herriot University Hospital, Lyon, France
| | - J F Timsit
- UMR 1137 - IAME Team 5 - DeSCID : Decision SCiences in Infectious Diseases, Control and Care, Inserm/Paris Diderot University, Sorbonne Paris Cité, Paris, France
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris Diderot University, 75018, Paris, France
| | - M Darmon
- Medical Intensive Care Unit, AP-HP, Saint Louis Hospital, Paris, France.
- Medicine University, Paris 7 University, Paris, France.
- ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris, France.
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17
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Garrouste-Orgeas M, Azoulay E, Ruckly S, Schwebel C, de Montmollin E, Bedos JP, Souweine B, Marcotte G, Adrie C, Goldgran-Toledano D, Dumenil AS, Kallel H, Jamali S, Argaud L, Darmon M, Zahar JR, Timsit JF. Diabetes was the only comorbid condition associated with mortality of invasive pneumococcal infection in ICU patients: a multicenter observational study from the Outcomerea research group. Infection 2018; 46:669-677. [DOI: 10.1007/s15010-018-1169-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 06/22/2018] [Indexed: 12/17/2022]
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18
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Reignier J, Boisramé-Helms J, Brisard L, Lascarrou JB, Ait Hssain A, Anguel N, Argaud L, Asehnoune K, Asfar P, Bellec F, Botoc V, Bretagnol A, Bui HN, Canet E, Da Silva D, Darmon M, Das V, Devaquet J, Djibre M, Ganster F, Garrouste-Orgeas M, Gaudry S, Gontier O, Guérin C, Guidet B, Guitton C, Herbrecht JE, Lacherade JC, Letocart P, Martino F, Maxime V, Mercier E, Mira JP, Nseir S, Piton G, Quenot JP, Richecoeur J, Rigaud JP, Robert R, Rolin N, Schwebel C, Sirodot M, Tinturier F, Thévenin D, Giraudeau B, Le Gouge A. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet 2018; 391:133-143. [PMID: 29128300 DOI: 10.1016/s0140-6736(17)32146-3] [Citation(s) in RCA: 298] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/20/2017] [Accepted: 07/17/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition. METHODS In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20-25 kcal/kg per day), within 24 h after intubation. Randomisation was stratified by centre using permutation blocks of variable sizes. Given that route of nutrition cannot be masked, blinding of the physicians and nurses was not feasible. Patients receiving parenteral nutrition could be switched to enteral nutrition after at least 72 h in the event of shock resolution (no vasopressor support for 24 consecutive hours and arterial lactate <2 mmol/L). The primary endpoint was mortality on day 28 after randomisation in the intention-to-treat-population. This study is registered with ClinicalTrials.gov, number NCT01802099. FINDINGS After the second interim analysis, the independent Data Safety and Monitoring Board deemed that completing patient enrolment was unlikely to significantly change the results of the trial and recommended stopping patient recruitment. Between March 22, 2013, and June 30, 2015, 2410 patients were enrolled and randomly assigned; 1202 to the enteral group and 1208 to the parenteral group. By day 28, 443 (37%) of 1202 patients in the enteral group and 422 (35%) of 1208 patients in the parenteral group had died (absolute difference estimate 2·0%; [95% CI -1·9 to 5·8]; p=0·33). Cumulative incidence of patients with ICU-acquired infections did not differ between the enteral group (173 [14%]) and the parenteral group (194 [16%]; hazard ratio [HR] 0·89 [95% CI 0·72-1·09]; p=0·25). Compared with the parenteral group, the enteral group had higher cumulative incidences of patients with vomiting (406 [34%] vs 246 [20%]; HR 1·89 [1·62-2·20]; p<0·0001), diarrhoea (432 [36%] vs 393 [33%]; 1·20 [1·05-1·37]; p=0·009), bowel ischaemia (19 [2%] vs five [<1%]; 3·84 [1·43-10·3]; p=0·007), and acute colonic pseudo-obstruction (11 [1%] vs three [<1%]; 3·7 [1·03-13·2; p=0·04). INTERPRETATION In critically ill adults with shock, early isocaloric enteral nutrition did not reduce mortality or the risk of secondary infections but was associated with a greater risk of digestive complications compared with early isocaloric parenteral nutrition. FUNDING La Roche-sur-Yon Departmental Hospital and French Ministry of Health.
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Affiliation(s)
- Jean Reignier
- Médecine Intensive Réanimation, CHU de Nantes, Nantes, France; Université de Nantes, Nantes, France.
| | - Julie Boisramé-Helms
- EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France; Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Laurent Brisard
- CHU de Nantes, Hôpital Laennec, Département d'Anesthésie et Réanimation, Nantes, France
| | - Jean-Baptiste Lascarrou
- Médecine Intensive Réanimation, CHU de Nantes, Nantes, France; Université de Nantes, Nantes, France
| | - Ali Ait Hssain
- Medical Intensive Care Unit, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nadia Anguel
- Medical Intensive Care Unit, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Karim Asehnoune
- Surgical Intensive Care Unit, Hotel Dieu, CHU de Nantes, Nantes, France; Université de Nantes, Nantes, France
| | - Pierre Asfar
- Medical Intensive Care and Hyperbaric Oxygen Therapy Unit, Centre Hospitalier Universitaire Angers, Angers, France; Laboratoire de Biologie Neurovasculaire et Mitochondriale Intégrée, CNRS UMR 6214 - INSERM U1083, Université Angers, UBL, Angers, France
| | - Frédéric Bellec
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Montauban, Montauban, France
| | - Vlad Botoc
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Saint-Malo, Saint-Malo, France
| | - Anne Bretagnol
- Medical Intensive Care Unit, CHR Orléans, Orléans, France
| | - Hoang-Nam Bui
- Medical Intensive Care Unit, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Emmanuel Canet
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Daniel Da Silva
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Michael Darmon
- Medical-Surgical Intensive Care Unit, University Hospital, Saint Etienne, France
| | - Vincent Das
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
| | - Jérôme Devaquet
- Medical-Surgical Intensive Care Unit, Hôpital Foch, Suresnes, France
| | - Michel Djibre
- Medical-Surgical Intensive Care Unit, Tenon University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Maité Garrouste-Orgeas
- UMR 1137, IAME Team 5, Decision Sciences in Infectious Diseases (DeSCID), Control and Care, Sorbonne Paris Cité, Inserm-Paris Diderot University, Paris, France; Medical-Surgical Unit, Hôpital Saint-Joseph, Paris France; Medical Unit and Palliative Research Group, French and British Institute, Levallois-Perret, France; OUTCOMEREA Research Group, Drancy, France
| | - Stéphane Gaudry
- Medical-Surgical Intensive Care Unit, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France; Université Paris Diderot, ECEVE, UMR 1123, Sorbonne Paris Cité, Paris, France
| | - Olivier Gontier
- Medical-Surgical Intensive Care Unit, Hôpital de Chartres, Chartres, France
| | - Claude Guérin
- Medical Intensive Care Unit, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France; Université de Lyon, IMRB INSERM 955, Lyon, France
| | - Bertrand Guidet
- Medical Intensive Care Unit, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Sorbonne Université, UPMC Université Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, Paris, France
| | | | - Jean-Etienne Herbrecht
- Medical Intensive Care Unit, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Faculté de Médecine U1121, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Jean-Claude Lacherade
- Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France
| | - Philippe Letocart
- Medical-Surgical Intensive Care Unit, Hôpital Jacques Puel, Rodez, France
| | - Frédéric Martino
- Medical-Surgical Intensive Care Unit, CHU de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Virginie Maxime
- Medical-Surgical Intensive Care Unit, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Emmanuelle Mercier
- Médecine Intensive Réanimation, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Jean-Paul Mira
- Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Saad Nseir
- Medical Intensive Care Unit, CHU Lille, Lille, France; Université Lille, Medicine School, Lille, France
| | - Gael Piton
- Medical Intensive Care Unit, CHRU Besançon, Besançon, France; EA3920, Université de Franche Comté, Besançon, France
| | - Jean-Pierre Quenot
- Medical-Surgical Intensive Care Unit, François Mitterrand University Hospital, Dijon, France; Lipness Team, INSERM UMR 866 and LabExLipSTIC, Université de Bourgogne, Dijon, France
| | - Jack Richecoeur
- Medical-Surgical Intensive Care Unit, Hôpital de Beauvais, Beauvais, France
| | | | - René Robert
- Medical Intensive Care Unit, CHU Poitiers, Poitiers, France; Université de Poitiers, INSERM CIC1402, Poitiers, France
| | - Nathalie Rolin
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Melun, Melun, France
| | - Carole Schwebel
- Medical Intensive Care Unit, CHU Albert Michallon Grenoble, Grenoble, France; Inserm U1039, Radiopharmaceutiques Biocliniques, Université Grenoble Alpes, La Tronche, France
| | - Michel Sirodot
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy, France
| | | | - Didier Thévenin
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Docteur Schaffner, Lens, France
| | - Bruno Giraudeau
- Inserm CIC 1415, Tours, France; Université de Tours, Tours, France; CHU Tours, Tours, France; Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Amélie Le Gouge
- Inserm CIC 1415, Tours, France; Université de Tours, Tours, France; CHU Tours, Tours, France
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Ibn Saied W, Souweine B, Garrouste-Orgeas M, Ruckly S, Darmon M, Bailly S, Cohen Y, Azoulay E, Schwebel C, Radjou A, Kallel H, Adrie C, Dumenil AS, Argaud L, Marcotte G, Jamali S, Papazian L, Goldgran-Toledano D, Bouadma L, Timsit JF. Respective impact of implementation of prevention strategies, colonization with multiresistant bacteria and antimicrobial use on the risk of early- and late-onset VAP: An analysis of the OUTCOMEREA network. PLoS One 2017; 12:e0187791. [PMID: 29186145 PMCID: PMC5706682 DOI: 10.1371/journal.pone.0187791] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 10/26/2017] [Indexed: 11/26/2022] Open
Abstract
Rationale The impact of prevention strategies and risk factors for early-onset (EOP) versus late-onset (LOP) ventilator-associated pneumonia (VAP) are still debated. Objectives To evaluate, in a multicenter cohort, the risk factors for EOP and LOP, as the evolution of prevention strategies. Methods 7,784 patients with mechanical ventilation (MV) for at least 48 hours were selected into the multicenter prospective OUTCOMEREA database (1997–2016). VAP occurring between the 3rd and 6th day of MV defined EOP, while those occurring after defined LOPs. We used a Fine and Gray subdistribution model to take the successful extubation into account as a competing event. Measurements and main results Overall, 1,234 included patients developed VAP (EOP: 445 (36%); LOP: 789 (64%)). Male gender was a risk factor for both EOP and LOP. Factors specifically associated with EOP were admission for respiratory distress, previous colonization with multidrug-resistant Pseudomonas aeruginosa, chest tube and enteral feeding within the first 2 days of MV. Antimicrobials administrated within the first 2 days of MV were all protective of EOP. ICU admission for COPD exacerbation or pneumonia were early risk factors for LOP, while imidazole and vancomycin use within the first 2 days of MV were protective factors. Late risk factors (between the 3rd and the 6th day of MV) were the intra-hospital transport, PAO2-FIO2<200 mmHg, vasopressor use, and known colonization with methicillin-resistant Staphylococcus aureus. Among the antimicrobials administered between the 3rd and the 6th day, fluoroquinolones were the solely protective one.Contrarily to LOP, the risk of EOP decreased across the study time periods, concomitantly with an increase in the compliance with bundle of prevention measures. Conclusion VAP risk factors are mostly different according to the pneumonia time of onset, which should lead to differentiated prevention strategies.
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Affiliation(s)
- Wafa Ibn Saied
- UMR 1137 - IAME Team 5 – DeSCID: Decision SCiences in Infectious Diseases, control and care, Inserm/ Paris Diderot University, Sorbonne Paris Cité, Paris, France
- Medical Intensive care unit, Grenoble University Hospital, Grenoble 1 University, U823, La Tronche, France
| | - Bertrand Souweine
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | | | - Stéphane Ruckly
- UMR 1137 - IAME Team 5 – DeSCID: Decision SCiences in Infectious Diseases, control and care, Inserm/ Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Michael Darmon
- Saint Etienne University Hospital, Medical Intensive Care Unit, Saint-Etienne, France
| | - Sébastien Bailly
- UMR 1137 - IAME Team 5 – DeSCID: Decision SCiences in Infectious Diseases, control and care, Inserm/ Paris Diderot University, Sorbonne Paris Cité, Paris, France
- Grenoble Alpes University, U823, Rond-point de la Chantourne, La Tronche France
| | - Yves Cohen
- AP-HP, Avicenne Hospital, Intensive Care Unit, Paris and Medicine University, Paris 13 University, Bobigny, France
| | - Elie Azoulay
- Medical Intensive Care Unit, AP-HP, Saint Louis Hospital, Paris, France
| | - Carole Schwebel
- Medical Intensive care unit, Grenoble University Hospital, Grenoble 1 University, U823, La Tronche, France
| | - Aguila Radjou
- AP-HP, Bichat Hospital, Medical and infectious diseases Intensive Care Unit, Paris Diderot university, Paris, France
| | - Hatem Kallel
- Medical Surgical ICU, Centre hospitalier de Cayenne, Guyane, France
| | - Christophe Adrie
- Physiology department, Cochin University Hospital, Sorbonne Cite, Paris, France
| | - Anne-Sylvie Dumenil
- AP-HP, Antoine Béclère University Hospital, Medical-surgical Intensive Care Unit, Clamart, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Lyon University Hospital, Lyon, France
| | | | - Samir Jamali
- Critical care Medicine Unit Dourdan Hospital, Dourdan, France
| | - Laurent Papazian
- Respiratory and infectious diseases ICU, APHM Hôpital Nord, Aix Marseille University, Marseille, France
| | | | - Lila Bouadma
- AP-HP, Bichat Hospital, Medical and infectious diseases Intensive Care Unit, Paris Diderot university, Paris, France
| | - Jean-Francois Timsit
- UMR 1137 - IAME Team 5 – DeSCID: Decision SCiences in Infectious Diseases, control and care, Inserm/ Paris Diderot University, Sorbonne Paris Cité, Paris, France
- AP-HP, Bichat Hospital, Medical and infectious diseases Intensive Care Unit, Paris Diderot university, Paris, France
- * E-mail:
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20
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Adrie C, Lugosi M, Sonneville R, Souweine B, Ruckly S, Cartier JC, Garrouste-Orgeas M, Schwebel C, Timsit JF. Persistent lymphopenia is a risk factor for ICU-acquired infections and for death in ICU patients with sustained hypotension at admission. Ann Intensive Care 2017; 7:30. [PMID: 28303547 PMCID: PMC5355405 DOI: 10.1186/s13613-017-0242-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/04/2017] [Indexed: 12/25/2022] Open
Abstract
Background
Severely ill patients might develop an alteration of their immune system called post-aggressive immunosuppression. We sought to assess the risk of ICU-acquired infection and of mortality according to the absolute lymphocyte count at ICU admission and its changes over 3 days. Methods Adults in ICU for at least 3 days with a shock or persistent low blood pressure were extracted from a French ICU database and included. We evaluated the impact of the absolute lymphocyte count at baseline and its change at day 3 on the incidence of ICU-acquired infection and on the 28-day mortality rate. We categorized lymphocytes in 4 groups: above 1.5 × 103 cells/µL; between 1 and 1.5 × 103 cells/µL; between 0.5 and 1 × 103 cells/µL; and below 0.5 × 103 cells/µL. Results A total of 753 patients were included.
The median lymphocyte count was 0.8 × 103 cells/µL [0.51–1.29]. A total of 174 (23%) patients developed infections; the 28-day mortality rate was 21% (161/753). Lymphopenia at admission was associated with ICU-acquired infection (p < 0.001) but not with 28-day mortality. Independently of baseline lymphocyte count, the absence of lymphocyte count increase at day 3 was associated with ICU-acquired infection (sub-distribution hazard ratio sHR: 1.37 [1.12–1.67], p = 0.002) and with 28-day mortality (sHR: 1.67 [1.37–2.03], p < 0.0001). Conclusion Lymphopenia at ICU admission and its persistence at day 3 were associated with an increased risk of ICU-acquired infection, while only persisting lymphopenia predicted increased 28-day mortality. The lymphocyte count at ICU admission and at day 3 could be used as a simple and reproductive marker of post-aggressive immunosuppression. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0242-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christophe Adrie
- Physiology Department, Cochin University Hospital, AP-HP, Paris Descartes University, 27 rue du Faubourg Saint Jacques, 75014, Paris, France. .,Polyvalent ICU, Delafontaine Hospital, Saint-Denis, France.
| | - Maxime Lugosi
- Medical ICU, Grenoble 1 University, Albert Michallon Hospital, Grenoble, France
| | - Romain Sonneville
- Medical and Infectious Diseases ICU, Bichat University Hospital, AP-HP, Paris, France
| | - Bertrand Souweine
- Clermont-Ferrand University, Medical ICU, Gabriel Montpied Hospital, Clermont-Ferrand, France
| | - Stéphane Ruckly
- UMR 1137 IAME Inserm- Paris Diderot University, 75018, Paris, France
| | | | | | - Carole Schwebel
- Medical ICU, Grenoble 1 University, Albert Michallon Hospital, Grenoble, France
| | - Jean-François Timsit
- Medical and Infectious Diseases ICU, Bichat University Hospital, AP-HP, Paris, France.,UMR 1137 IAME Inserm- Paris Diderot University, 75018, Paris, France
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21
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Adrie C, Garrouste-Orgeas M, Ibn Essaied W, Schwebel C, Darmon M, Mourvillier B, Ruckly S, Dumenil AS, Kallel H, Argaud L, Marcotte G, Barbier F, Laurent V, Goldgran-Toledano D, Clec'h C, Azoulay E, Souweine B, Timsit JF. Attributable mortality of ICU-acquired bloodstream infections: Impact of the source, causative micro-organism, resistance profile and antimicrobial therapy. J Infect 2016; 74:131-141. [PMID: 27838521 DOI: 10.1016/j.jinf.2016.11.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 10/05/2016] [Accepted: 11/02/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES ICU-acquired bloodstream infection (ICUBSI) in Intensive Care unit (ICU) is still associated with a high mortality rate. The increase of antimicrobial drug resistance makes its treatment increasingly challenging. METHODS We analyzed 571 ICU-BSI occurring amongst 10,734 patients who were prospectively included in the Outcomerea Database and who stayed at least 4 days in ICU. The hazard ratio of death associated with ICU-BSI was estimated using a multivariate Cox model adjusted on case mix, patient severity and daily SOFA. RESULTS ICU-BSI was associated with increased mortality (HR, 1.40; 95% CI, 1.16-1.69; p = 0.0004). The relative increase in the risk of death was 130% (HR, 2.3; 95% CI, 1.8-3.0) when initial antimicrobial agents within a day of ICU-BSI onset were not adequate, versus only 20% (HR, 1.2; 95% CI, 0.9-1.5) when an adequate therapy was started within a day. The adjusted hazard ratio of death was significant overall, and even higher when the ICU-BSI source was pneumonia or unknown origin. When treated with appropriate antimicrobial agents, the death risk increase was similar for ICU-BSI due to multidrug resistant pathogens or susceptible ones. Interestingly, combination therapy with a fluoroquinolone was associated with more favorable outcome than monotherapy, whereas combination with aminoglycoside was associated with similar mortality than monotherapy. CONCLUSIONS ICU-BSI was associated with a 40% increase in the risk of 30-day mortality, particularly if the early antimicrobial therapy was not adequate. Adequacy of antimicrobial therapy, but not pathogen resistance pattern, impacted attributable mortality.
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Affiliation(s)
- Christophe Adrie
- Physiology Department, Cochin University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris, France.
| | - Maité Garrouste-Orgeas
- INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France; Medical-Surgical Intensive Care Unit, Saint Joseph Hospital, Paris, France
| | | | - Carole Schwebel
- Medical Intensive Care Unit, Michallon University Hospital, Grenoble, France
| | - Michael Darmon
- Medical ICU, Saint-Etienne University Hospital, Saint-Priest en Jarez, France
| | - Bruno Mourvillier
- INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France; Medical Intensive Care Unit, Assistance Publique des Hôpitaux de Paris (AP-HP), Bichat University Hospital, Paris, France
| | - Stéphane Ruckly
- INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France; Outcomerea Network, Paris, France
| | - Anne-Sylvie Dumenil
- Medical-Surgical Intensive Care Unit, Antoine Béclère University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Clamart, France
| | - Hatem Kallel
- Medical-Surgical Intensive Care Unit, Centre hospitalier de Cayenne, Guyane, France
| | - Laurent Argaud
- Medical-Intensive Care Unit, Edouard Heriot Hospital, Lyon University Hospital, Lyon, France
| | - Guillaume Marcotte
- Surgical-Intensive Care Unit, Edouard Heriot Hospital, Lyon University Hospital, Lyon, France
| | - Francois Barbier
- Medical Intensive Care Unit, La Source Hospital - CHR Orléans, Orléans, France
| | - Virginie Laurent
- Medical-Surgical Intensive Care Unit, André Mignot Hospital, Versailles-Le Chesnay, France
| | | | - Christophe Clec'h
- INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France; Medical Intensive Care Unit, Assistance Publique des Hôpitaux de Paris (AP-HP), Avicenne University Hospital, Bobigny, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Bertrand Souweine
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-François Timsit
- INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France; Medical Intensive Care Unit, Assistance Publique des Hôpitaux de Paris (AP-HP), Bichat University Hospital, Paris, France
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22
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Capuzzo M, Garrouste-Orgeas M, Martin-Loeches I. What were you able to do in your daily life? Performance status for the critically ill patient. Intensive Care Med 2016; 43:104-106. [PMID: 27798739 DOI: 10.1007/s00134-016-4595-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Maurizia Capuzzo
- c/o Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, S. Anna Hospital, University of Ferrara, Via Aldo Moro 8, Cona, 44124, Ferrara, Italy. .,Ethics Committee of the Province of Ferrara, Ferrara, Italy.
| | - Maité Garrouste-Orgeas
- Department of Biostatistics-HUPNVS-AP-HP UFR de Médecine-Bichat University Hospital, Infection Antimicrobials, Modelling Evolution (IAME), UMR 1137 INSERM and Paris Diderot University, Paris, France.,Outcomerea Research Group, Paris, France
| | - Ignacio Martin-Loeches
- Department of Clinical Medicine, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO). Wellcome Trust-HRB Clinical Research, St James's University Hospital, Dublin, Ireland
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23
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Timsit JF, Azoulay E, Schwebel C, Charles PE, Cornet M, Souweine B, Klouche K, Jaber S, Trouillet JL, Bruneel F, Argaud L, Cousson J, Meziani F, Gruson D, Paris A, Darmon M, Garrouste-Orgeas M, Navellou JC, Foucrier A, Allaouchiche B, Das V, Gangneux JP, Ruckly S, Maubon D, Jullien V, Wolff M. Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure: The EMPIRICUS Randomized Clinical Trial. JAMA 2016; 316:1555-1564. [PMID: 27706483 DOI: 10.1001/jama.2016.14655] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Although frequently used in treating intensive care unit (ICU) patients with sepsis, empirical antifungal therapy, initiated for suspected fungal infection, has not been shown to improve outcome. OBJECTIVE To determine whether empirical micafungin reduces invasive fungal infection (IFI)-free survival at day 28. DESIGN, SETTING, AND PARTICIPANTS Multicenter double-blind placebo-controlled study of 260 nonneutropenic, nontransplanted, critically ill patients with ICU-acquired sepsis, multiple Candida colonization, multiple organ failure, exposed to broad-spectrum antibacterial agents, and enrolled between July 2012 and February 2015 in 19 French ICUs. INTERVENTIONS Empirical treatment with micafungin (100 mg, once daily, for 14 days) (n = 131) vs placebo (n = 129). MAIN OUTCOMES AND MEASURES The primary end point was survival without proven IFI 28 days after randomization. Key secondary end points included new proven fungal infections, survival at day 28 and day 90, organ failure, serum (1-3)-β-D-glucan level evolution, and incidence of ventilator-associated bacterial pneumonia. RESULTS Among 260 patients (mean age 63 years; 91 [35%] women), 251 (128, micafungin group; 123, placebo group) were included in the modified intent-to-treat analysis. Median values were 8 for Sequential Organ Failure Assessment (SOFA) score, 3 for number of Candida-colonized sites, and 99 pg/mL for level of (1-3)-β-D-glucan. On day 28, there were 82 (68%) patients in the micafungin group vs 79 (60.2%) in the placebo group who were alive and IFI free (hazard ratio [HR], 1.35 [95% CI, 0.87-2.08]). Results were similar among patients with a (1-3)-β-D-glucan level of greater than 80 pg/mL (n = 175; HR, 1.41 [95% CI, 0.85-2.33]). Day-28 IFI-free survival in patients with a high SOFA score (>8) was not significantly different when compared between the micafungin vs placebo groups (HR, 1.69 [95% CI, 0.96-2.94]). Use of empirical micafungin decreased the rate of new invasive fungal infection in 4 of 128 patients (3%) in the micafungin group vs placebo (15/123 patients [12%]) (P = .008). CONCLUSIONS AND RELEVANCE Among nonneutropenic critically ill patients with ICU-acquired sepsis, Candida species colonization at multiple sites, and multiple organ failure, empirical treatment with micafungin, compared with placebo, did not increase fungal infection-free survival at day 28. TRIAL REGISTRATION clinicaltrials.gov Idenitfier: NCT01773876.
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Affiliation(s)
- Jean-Francois Timsit
- UMR1137-IAME Inserm, Paris Diderot University, Paris, France2Medical and Infectious Diseases ICU, Bichat-Claude Bernard University Hospital, Paris, France
| | - Elie Azoulay
- Saint-Louis University Hospital, Medical ICU, Paris, France
| | - Carole Schwebel
- Medical ICU, Albert Michallon University Hospital, Grenoble, France
| | | | - Muriel Cornet
- UMR5525 CNRS-Grenoble Alpes University, Parasitology-Mycology, Grenoble Alpes University Hospital, Grenoble, France
| | - Bertrand Souweine
- Medical ICU, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Kada Klouche
- Medical ICU, Lapeyronie University Hospital, Montpellier, France
| | - Samir Jaber
- Intensive Care Unit, Department of Anesthesia and Critical Care Medicine, University of Montpellier, Saint Eloi Teaching Hospital, Montpellier, France
| | - Jean-Louis Trouillet
- Medical ICU, Institut de Cardiologie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Laurent Argaud
- Medical ICU, Edouard Herriot University Hospital, Lyon, France
| | - Joel Cousson
- Medical Surgical ICU, CHU de Reims, Reims France
| | - Ferhat Meziani
- Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Adeline Paris
- Pharmacy Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Michael Darmon
- Medical ICU, Saint-Etienne University Hospital, Saint-Priest en Jarez, France
| | | | | | | | | | - Vincent Das
- Polyvalent ICU, CHI André Grégoire, Montreuil, France
| | | | | | - Daniele Maubon
- UMR5525 CNRS-Grenoble Alpes University, Parasitology-Mycology, Grenoble Alpes University Hospital, Grenoble, France
| | - Vincent Jullien
- Pharmacology Department, Georges Pompidou Hospital, Paris Descartes University, Paris, France
| | - Michel Wolff
- UMR1137-IAME Inserm, Paris Diderot University, Paris, France2Medical and Infectious Diseases ICU, Bichat-Claude Bernard University Hospital, Paris, France
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24
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Sakhri L, Saint-Raymond C, Quetant S, Pison C, Lagrange E, Hamidfar Roy R, Janssens JP, Maindet-Dominici C, Garrouste-Orgeas M, Levy-Soussan M, Terzi N, Toffart AC. [Limitations of active therapeutic and palliative care in chronic respiratory disease]. Rev Mal Respir 2016; 34:102-120. [PMID: 27639947 DOI: 10.1016/j.rmr.2016.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/29/2016] [Indexed: 11/16/2022]
Abstract
The issue of intensive and palliative care in patients with chronic disease frequently arises. This review aims to describe the prognostic factors of chronic respiratory diseases in stable and in acute situations in order to improve the management of these complex situations. The various laws on patients' rights provide a legal framework and define the concept of unreasonable obstinacy. For patients with chronic obstructive pulmonary disease, the most robust decision factors are good knowledge of the respiratory disease, the comorbidities, the history of previous exacerbations and patient preferences. In the case of idiopathic pulmonary fibrosis, it is necessary to know if there is a prospect of transplantation and to assess the reversibility of the respiratory distress. In the case of amyotrophic lateral sclerosis, treatment decisions depend on the presence of advance directives about the use of intubation and tracheostomy. For lung cancer patients, general condition, cancer history and the tumor treatment plan are important factors. A multidisciplinary discussion that takes into account the patient's medical history, wishes and the current state of knowledge permits the taking of a coherent decision.
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Affiliation(s)
- L Sakhri
- Institut de cancérologie Daniel-Hollard, groupe hospitalier Mutualiste, 38000 Grenoble, France
| | - C Saint-Raymond
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France
| | - S Quetant
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France
| | - C Pison
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France; Laboratoire de bioénergétique fondamentale et appliquée, Inserm 1055, 38400 Saint-Martin-d'Hères, France; Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France
| | - E Lagrange
- Pôle psychiatrie, neurologie et rééducation neurologique, clinique de neurologie, CHU de Grenoble, 38000 Grenoble, France
| | - R Hamidfar Roy
- Pôle urgences médecine aiguë, clinique de réanimation médicale, CHU de Grenoble, 38000 Grenoble, France
| | - J-P Janssens
- Service de pneumologie, hôpital Cantonal universitaire, Genève, Suisse
| | - C Maindet-Dominici
- Pôle anesthésie réanimation, centre de la douleur, CHU de Grenoble, 38000 Grenoble, France
| | - M Garrouste-Orgeas
- Service de médecine intensive et de réanimation, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - M Levy-Soussan
- Unité mobile d'accompagnement et de soins palliatifs, hôpital universitaire Pitié-Salpêtrière, 75006 Paris, France
| | - N Terzi
- Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France; Pôle psychiatrie, neurologie et rééducation neurologique, clinique de neurologie, CHU de Grenoble, 38000 Grenoble, France; Inserm U1042, université Grenoble Alpes, HP2, CHU de Grenoble, 38000 Grenoble, France
| | - A-C Toffart
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France; Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France; Institut pour l'avancée des biosciences, centre de recherche UGA, Inserm U 1209, CNRS UMR 5309, 38000 Grenoble, France.
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Jullien V, Azoulay E, Schwebel C, Le Saux T, Charles PE, Cornet M, Souweine B, Klouche K, Jaber S, Trouillet JL, Bruneel F, Cour M, Cousson J, Meziani F, Gruson D, Paris A, Darmon M, Garrouste-Orgeas M, Navellou JC, Foucrier A, Allaouchiche B, Das V, Gangneux JP, Ruckly S, Wolff M, Timsit JF. Population pharmacokinetics of micafungin in ICU patients with sepsis and mechanical ventilation. J Antimicrob Chemother 2016; 72:181-189. [DOI: 10.1093/jac/dkw352] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/06/2016] [Accepted: 07/26/2016] [Indexed: 02/02/2023] Open
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Garrouste-Orgeas M, Vinatier I, Tabah A, Misset B, Timsit JF. Reappraisal of visiting policies and procedures of patient's family information in 188 French ICUs: a report of the Outcomerea Research Group. Ann Intensive Care 2016; 6:82. [PMID: 27566711 PMCID: PMC4999564 DOI: 10.1186/s13613-016-0185-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/15/2016] [Indexed: 12/02/2022] Open
Abstract
Background The relatives of intensive care unit (ICU) patients must cope with both the severity of illness of their loved one and the unfamiliar and stressful ICU environment. This hardship may lead to post-intensive care syndrome. French guidelines provide recommendations on welcoming and informing families of ICU patients. We questioned whether and how they are applied 5 years after their publication. Methods We conducted a large survey among French ICUs to evaluate their visiting policies and how information was provided to patient’s family. A questionnaire was built up by intensivists and nurses. French ICUs were solicited, and the questionnaire was sent to all participating ICUs, for being filled in by the unit medical and/or nursing head. Data regarding the hospital and ICU characteristics, the visiting policy and procedures, and the management of family information were collected. Results Among the 289 French ICUs, 188 (65 %) participated. Most ICUs have a waiting room 118/188 (62.8 %) and a dedicated room for meeting the family 152/188 (80.8 %). Of the 188 ICUs, 45 (23.9 %) were opened on a 24-h-a-day basis. In the remaining ICUs, the time period allowed for visits was 4.75 ± 1.83 h (median 5 h). In ICUs where visiting restrictions were reported, open visiting was allowed for end-of-life situations in 107/143 (74.8 %). Children are allowed to visit a patient in 164/188 (87.2 %) regardless of their age in 97/164 (59.1 %) of ICUs. Families received an information leaflet in 168/188 (89.3 %). Information was provided to families through structured meetings in 149/188 (79.2 %) of ICUs at patient admission with participation of nurses and nursing assistants in 133/188 (70.4 %) and 55/188 (29.2 %), respectively. Information delivered to the family was reported in the patient chart by only 111/188 ICUs (59 %). Participation in care was infrequent. Conclusions Although French ICUs do not follow the consensus recommendations, slow progress exists compared to previous reports. Implementation of these recommendations is largely needed to offer better welcome and information improvement. Further studies on that topic would enable evaluating remaining obstacles and increasing caregivers’ awareness, both critical for further progresses on that topic. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0185-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maité Garrouste-Orgeas
- IAME, UMR 1137, Sorbonne Paris Cité, Paris Diderot University, 75018, Paris, France. .,Outcomerea Research Group, 75020, Paris, France. .,Service de médecine intensive et de réanimation, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014, Paris, France.
| | - Isabelle Vinatier
- Medical-Surgical ICU, Les Oudaries Hospital, La Roche-Sur-Yon, France
| | - Alexis Tabah
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Burns, Trauma and Critical Care Research Centre, University of Queesland, Brisbane, Australia
| | - Benoit Misset
- Medical ICU, Charles Nicolle University Hospital, Rouen, France
| | - Jean-François Timsit
- IAME, UMR 1137, Sorbonne Paris Cité, Paris Diderot University, 75018, Paris, France.,Outcomerea Research Group, 75020, Paris, France.,Medical ICU, Bichat University Hospital, Paris, France
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27
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Boumendil A, Woimant M, Quenot JP, Rooryck FX, Makhlouf F, Yordanov Y, Delerme S, Takun K, Ray P, Kouka MC, Poly C, Garrouste-Orgeas M, Thomas C, Simon T, Azerad S, Leblanc G, Pateron D, Guidet B. Designing and conducting a cluster-randomized trial of ICU admission for the elderly patients: the ICE-CUB 2 study. Ann Intensive Care 2016; 6:74. [PMID: 27473119 PMCID: PMC4967062 DOI: 10.1186/s13613-016-0161-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/21/2016] [Indexed: 11/15/2022] Open
Abstract
Background
The benefit of ICU admission for elderly patients remains controversial. This report highlights the methodology, the feasibility of and the ethical and logistical constraints in designing and conducting a cluster-randomized trial of intensive care unit (ICU) admission for critically ill elderly patients. Methods
We designed an interventional open-label cluster-randomized controlled trial in 24 centres in France. Clusters were healthcare centres with at least one emergency department (ED) and one ICU. Healthcare centres were randomly assigned either to recommend a systematic ICU admission (intervention group) or to follow standard practices regarding ICU admission (control group). Clusters were stratified by the number of ED annual visits (<44,616 or >44,616 visits), the presence or absence of a geriatric ward and the geographical area (Paris area vs other regions in France). All elderly patients (≥75 years of age) who got to the ED were assessed for eligibility. Patients were included if they had one of the pre-established critical conditions, a preserved functional status as assessed by an ADL scale ≥4 (0 = very dependent, 6 = independent), a preserved nutritional status (subjectively assessed by physicians) and without active cancer. Exclusion criteria were an ED stay >24 h, a secondary referral to the ED and refusal to participate. The primary outcome was the mortality at 6 months calculated at the individual patient level. Secondary outcomes were ICU and hospital mortality, as well as ADL scale and quality of life (as assessed by the SF-12 Health Survey) at 6 months. Results
Between January 2012 and April 2015, 3036 patients were included in the trial, 1518 patients in 11 clusters allocated to intervention group and 1518 patients in 13 clusters allocated to standard care. There were 51 protocol violations. Conclusions The ICE-CUB 2 trial was deemed feasible and ethically acceptable. The ICE-CUB 2 trial will be the first cluster-randomized trial to assess the benefits of ICU admission for selected elderly patients on long-term mortality. Trial registration Clinical trials.gov identifier: NCT01508819 Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0161-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ariane Boumendil
- Hôpital Saint-Antoine, Service de Réanimation Médicale (Intensive Care Unit - ICU), Assistance Publique - Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Maguy Woimant
- Hôpital Avicenne, Service d'Accueil des Urgences (SAU, Emergency Department), AP-HP, 93009, Bobigny, France
| | | | | | | | | | - Samuel Delerme
- Hôpital Pitié Salpétrière, SAU, AP-HP, 75013, Paris, France
| | - Khalil Takun
- Hôpital Cochin, SAU, AP-HP, 75014, Paris, France
| | - Patrick Ray
- Hôpital Tenon, SAU, AP-HP, 75020, Paris, France
| | | | - Claire Poly
- SAU, Hôpital Robert Ballanger, 93602, Aulnay-Sous-Bois, France
| | | | - Caroline Thomas
- Hôpital Saint-Antoine, Acute Geriatric Ward, AP-HP, 75012, Paris, France
| | - Tabasome Simon
- Hôpital Saint-Antoine, URC Est, AP-HP, 75012, Paris, France
| | - Sylvie Azerad
- Hôpital Ambroise Paré, URC Ouest, AP-HP, 92104, Boulogne-Billancourt, Paris, France
| | - Guillaume Leblanc
- Department of Anesthesiology and Critical Care, Université Laval, Québec, QC, Canada
| | - Dominique Pateron
- Hôpital Saint-Antoine, SAU, AP-HP, 75012, Paris, France.,UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - Bertrand Guidet
- Hôpital Saint-Antoine, Service de Réanimation Médicale (Intensive Care Unit - ICU), Assistance Publique - Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France. .,UPMC Univ Paris 06, Sorbonne Universités, Paris, France. .,UMR_S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, INSERM, 75013, Paris, France.
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Weiss E, Zahar JR, Garrouste-Orgeas M, Ruckly S, Essaied W, Schwebel C, Timsit JF. De-escalation of pivotal beta-lactam in ventilator-associated pneumonia does not impact outcome and marginally affects MDR acquisition. Intensive Care Med 2016; 42:2098-2100. [PMID: 27430221 DOI: 10.1007/s00134-016-4448-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/07/2016] [Indexed: 11/26/2022]
Affiliation(s)
- E Weiss
- Department of Anesthesiology and Critical Care, AP-HP, Hôpital Beaujon, Paris Diderot University, 92110, Clichy, France.
| | - J R Zahar
- Infection Control Unit, Hôpital d'Angers, Angers University, 49000, Angers, France
| | - M Garrouste-Orgeas
- Intensive Care Unit, Hôpital St Joseph, Paris Descartes University, 75014, Paris, France
| | - S Ruckly
- Joseph Fourier University, 38041, Saint-Martin-d'Hères, France
| | - W Essaied
- UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases, Control and Care Inserm/Univ Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France
| | - C Schwebel
- Medical Intensive Care Unit, Hôpital Albert Michallon, Grenoble University, 38043, Grenoble, France
| | - J F Timsit
- UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases, Control and Care Inserm/Univ Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France
- Medical and Infectious Intensive Care Unit, AP-HP, Hôpital Bichat Claude Bernard, Paris Diderot University, 75018, Paris, France
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Barbier F, Pommier C, Garrouste-Orgeas M, Schwebel C, Ruckly S, Dumenil AS, Lemiale V, Mourvillier B, Clec'h C, Darmon M, Laurent V, Marcotte G, Souweine B, Zahar JR, Timsit JF. ESICM LIVES 2015. Intensive Care Med Exp 2016; 3 Suppl 1:A1-A1021. [PMID: 27419821 PMCID: PMC4796554 DOI: 10.1186/2197-425x-3-s1-a1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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30
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Garrouste-Orgeas M, Ruckly S, Grégoire C, Dumesnil AS, Pommier C, Jamali S, Golgran-Toledano D, Schwebel C, Clec'h C, Soufir L, Fartoukh M, Marcotte G, Argaud L, Verdière B, Darmon M, Azoulay E, Timsit JF. Treatment intensity and outcome of nonagenarians selected for admission in ICUs: a multicenter study of the Outcomerea Research Group. Ann Intensive Care 2016; 6:31. [PMID: 27076186 PMCID: PMC4830777 DOI: 10.1186/s13613-016-0133-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Outcome of very elderly patients admitted in intensive care unit (ICU) was most often reported for octogenarians. ICU admission demands for nonagenarians are increasing. The primary objective was to compare outcome and intensity of treatment of octogenarians and nonagenarians. Methods We performed an observational study in 12 ICUs of the Outcomerea™ network which prospectively upload data into the Outcomerea™ database. Patients >90 years old (case patients) were matched with patients 80–90 years old (control patients). Matching criteria were severity of illness at admission, center, and year of admission. Results A total of 2419 patients aged 80 or older and admitted from September 1997 to September 2013 were included. Among them, 179 (7.9 %) were >90 years old. Matching was performed for 176 nonagenarian patients. Compared with control patients, case patients were more often hospitalized for unscheduled surgery [54 (30.7 %) vs. 42 (23.9 %), p < 0.01] and had less often arterial monitoring for blood pressure [37 (21 %) vs. 53 (30.1 %), p = 0.04] and renal replacement therapy [5 (2.8 %) vs. 14 (8 %), p = 0.05] than control patients. ICU [44 (25 %) vs. 36 (20.5 %), p = 0.28] or hospital mortality [70 (39.8 %) vs. 64 (36.4 %), p = 0.46] and limitation of life-sustaining therapies were not significantly different in case versus control patients, respectively. Only 16/176 (14 %) of case patients were transferred to a geriatric unit. Conclusion This multicenter study reported that nonagenarians represented a small fraction of ICU patients. When admitted, these highly selected patients received similar life-sustaining treatments, except RRT, than octogenarians. ICU and hospital mortality were similar between the two groups. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0133-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maité Garrouste-Orgeas
- Service de Réanimation et de médecine intensive, Medical-Surgical ICU, Saint Joseph Hospital Network, 185 rue Raymond Losserand, 75014, Paris, France. .,Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine, Bichat University Hospital, Paris, France.
| | | | - Charles Grégoire
- Service de Réanimation et de médecine intensive, Medical-Surgical ICU, Saint Joseph Hospital Network, 185 rue Raymond Losserand, 75014, Paris, France
| | - Anne-Sylvie Dumesnil
- Medical-Surgical ICU, AP-HP, Antoine Béclère University Hospital, Clamart, France
| | | | - Samir Jamali
- Medical-Surgical, General Hospital, Dourdan, France
| | | | - Carole Schwebel
- Medical ICU, Albert Michallon University Hospital, Grenoble, France
| | - Christophe Clec'h
- Medical-Surgical ICU, AP-HP, Avicennes University Hospital, Bobigny, France
| | - Lilia Soufir
- Service de Réanimation et de médecine intensive, Medical-Surgical ICU, Saint Joseph Hospital Network, 185 rue Raymond Losserand, 75014, Paris, France
| | - Muriel Fartoukh
- Medical ICU, AP-HP, Tenon University Hospital, Paris, France
| | - Guillaume Marcotte
- Medical-Surgical ICU, Hospices civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Laurent Argaud
- Medical ICU, Hospices civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Bruno Verdière
- Medical-Surgical ICU, Delafontaine University Hospital, Saint Denis, France
| | - Michael Darmon
- Medical-Surgical ICU, Saint Etienne University Hospital, Saint Priest en Jarez, France
| | - Elie Azoulay
- Medical ICU, AP-HP, Saint Louis University Hospital, Paris, France
| | - Jean-François Timsit
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine, Bichat University Hospital, Paris, France.,Department of Biostatistics, Outcomerea, Paris, France.,Medical ICU, AP-HP, Bichat University Hospital, Paris, France
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Poujade J, Sonneville R, Garrouste-Orgeas M, Souweine B, Azoulay E, Darmon M, Mariotte E, Argaud L, Barbier F, Goldgran-Toledano D, Marcotte G, Anne-Sophie D, Jamali S, Laurent V, Ruckly S, Timsit JF. Determinants And Prognostic Value of Sepsis-Associated Encephalopathy: Insights From The Prospective Multicentre Outcomerea Registry. Intensive Care Med Exp 2015. [PMCID: PMC4796986 DOI: 10.1186/2197-425x-3-s1-a48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Coupez E, Timsit JF, Boyer A, Bouadma L, Canet E, Klouche K, Argaud L, Bohé J, Garrouste-Orgeas M, Mariat C, Vincent F, Cayot S, Cointault O, Lepape A, Darmon M, Ruckly S, Schwebel C, Lautrette A, Souweine B. Guidewire exchange vs new-site placement for temporary dialysis catheters insertion in ICU patients: is there a greater risk of colonization or dysfunction? Intensive Care Med Exp 2015. [PMCID: PMC4798349 DOI: 10.1186/2197-425x-3-s1-a463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Philippart F, Bouroche G, Timsit JF, Garrouste-Orgeas M, Azoulay E, Darmon M, Adrie C, Allaouchiche B, Ara-Somohano C, Ruckly S, Dumenil AS, Souweine B, Goldgran-Toledano D, Bouadma L, Misset B. Decreased Risk of Ventilator-Associated Pneumonia in Sepsis Due to Intra-Abdominal Infection. PLoS One 2015; 10:e0137262. [PMID: 26339904 PMCID: PMC4560443 DOI: 10.1371/journal.pone.0137262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/13/2015] [Indexed: 12/26/2022] Open
Abstract
RATIONALE Experimental studies suggest that intra-abdominal infection (IAI) induces biological alterations that may affect the risk of lung infection. OBJECTIVES To investigate the potential effect of IAI at ICU admission on the subsequent occurrence of ventilator-associated pneumonia (VAP). METHODS We used data entered into the French prospective multicenter Outcomerea database in 1997-2011. Consecutive patients who had severe sepsis and/or septic shock at ICU admission and required mechanical ventilation for more than 3 days were included. Patients with acute pancreatitis were not included. MEASUREMENTS AND MAIN RESULTS Of 2623 database patients meeting the inclusion criteria, 290 (11.1%) had IAI and 2333 (88.9%) had other infections. The IAI group had fewer patients with VAP (56 [19.3%] vs. 806 [34.5%], P<0.01) and longer time to VAP (5.0 vs.10.5 days; P<0.01). After adjustment on independent risk factors for VAP and previous antimicrobial use, IAI was associated with a decreased risk of VAP (hazard ratio, 0.62; 95% confidence interval, 0.46-0.83; P<0.0017). The pathogens responsible for VAP were not different between the groups with and without IAI (Pseudomonas aeruginosa, 345 [42.8%] and 24 [42.8%]; Enterobacteriaceae, 264 [32.8%] and 19 [34.0%]; and Staphylococcus aureus, 215 [26.7%] and 17 [30.4%], respectively). Crude ICU mortality was not different between the groups with and without IAI (81 [27.9%] and 747 [32.0%], P = 0.16). CONCLUSIONS In our observational study of mechanically ventilated ICU patients with severe sepsis and/or septic shock, VAP occurred less often and later in the group with IAIs compared to the group with infections at other sites.
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MESH Headings
- Aged
- Bacterial Infections/complications
- Bacterial Infections/microbiology
- Bacterial Infections/mortality
- Bacterial Infections/pathology
- Databases, Factual
- Enterobacteriaceae/growth & development
- Female
- Humans
- Intensive Care Units
- Intraabdominal Infections/complications
- Intraabdominal Infections/microbiology
- Intraabdominal Infections/mortality
- Intraabdominal Infections/pathology
- Length of Stay
- Male
- Middle Aged
- Pneumonia, Ventilator-Associated/complications
- Pneumonia, Ventilator-Associated/microbiology
- Pneumonia, Ventilator-Associated/mortality
- Pneumonia, Ventilator-Associated/pathology
- Prospective Studies
- Pseudomonas aeruginosa/growth & development
- Respiration, Artificial
- Risk Factors
- Shock, Septic/complications
- Shock, Septic/microbiology
- Shock, Septic/mortality
- Shock, Septic/pathology
- Staphylococcus aureus/growth & development
- Survival Analysis
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Affiliation(s)
- François Philippart
- Medical-Surgical ICU, Groupe Hospitalier Paris Saint Joseph, Paris, France
- * E-mail:
| | - Gaëlle Bouroche
- Department of Anesthesia and Intensive Care, Gustave Roussy Institute, Villejuif, France
| | - Jean-François Timsit
- Université Grenoble 1, U823, Albert Bonniot Institute, La Tronche, France
- Medical ICU, Groupe hospitalier Bichat-Claude Bernard, Paris, France
| | - Maité Garrouste-Orgeas
- Medical-Surgical ICU, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Université Grenoble 1, U823, Albert Bonniot Institute, La Tronche, France
| | - Elie Azoulay
- Medical ICU, Saint Louis Teaching Hospital, Paris, France
- Université Paris VII—Denis Diderot, Paris, France
| | | | | | - Bernard Allaouchiche
- Surgical ICU, Edouart Herriot Hospital, Lyon, France
- Université Lyon I—Claude Bernard, Lyon, France
| | - Claire Ara-Somohano
- Université Grenoble 1, U823, Albert Bonniot Institute, La Tronche, France
- Medical ICU, Albert Michallon Teaching Hospital, Grenoble, France
| | - Stéphane Ruckly
- Université Grenoble 1, U823, Albert Bonniot Institute, La Tronche, France
| | | | - Bertrand Souweine
- Medical ICU, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | | | - Lila Bouadma
- Université Paris VII—Denis Diderot, Paris, France
- Medical-Surgical ICU, Gonesse Hospital, Gonesse, France
| | - Benoît Misset
- Medical-Surgical ICU, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Université Paris Descartes, Paris, France
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Venot M, Weis L, Clec’h C, Darmon M, Allaouchiche B, Goldgran-Tolédano D, Garrouste-Orgeas M, Adrie C, Timsit JF, Azoulay E. Acute Kidney Injury in Severe Sepsis and Septic Shock in Patients with and without Diabetes Mellitus: A Multicenter Study. PLoS One 2015; 10:e0127411. [PMID: 26020231 PMCID: PMC4447271 DOI: 10.1371/journal.pone.0127411] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/14/2015] [Indexed: 01/04/2023] Open
Abstract
Introduction Whether diabetes mellitus increases the risk of acute kidney injury (AKI) during sepsis is controversial. Materials and Methods We used a case-control design to compare the frequency of AKI, use of renal replacement therapy (RRT), and renal recovery in patients who had severe sepsis or septic shock with or without diabetes. The data were from the Outcomerea prospective multicenter database, in which 12 French ICUs enrolled patients admitted between January 1997 and June 2009. Results First, we compared 451 patients with severe sepsis or septic shock and diabetes to 3,277 controls with severe sepsis or septic shock and without diabetes. Then, we compared 318 cases (with diabetes) to 746 matched controls (without diabetes). Diabetic patients did not have a higher frequency of AKI (hazard ratio [HR], 1.18; P = 0.05]) or RRT (HR, 1.09; P = 0.6). However, at discharge, diabetic patients with severe sepsis or septic shock who experienced acute kidney injury during the ICU stay and were discharged alive more often required RRT (9.5% vs. 4.8%; P = 0.02), had higher serum creatinine values (134 vs. 103 µmoL/L; P<0.001) and had less often recovered a creatinine level less than 1.25 fold the basal creatinine (41.1% vs. 60.5%; P<0.001). Conclusions In patients with severe sepsis or septic shock, diabetes is not associated with occurrence of AKI or need for RRT but is an independent risk factor for persistent renal dysfunction in patients who experience AKI during their ICU stay.
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Affiliation(s)
- Marion Venot
- Service de Réanimation Médicale, AP-HP, Hôpital Saint-Louis, Paris, France
- * E-mail:
| | - Lise Weis
- Service de Médecine Vasculaire et Hypertension artérielle, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Christophe Clec’h
- Service de Réanimation, AP-HP, Hôpital Avicenne, Paris, France
- Faculté de Médecine, Université Paris 13, Bobigny, France
| | - Michael Darmon
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
- Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, France
| | - Bernard Allaouchiche
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire Edouard Herriot, Lyon, France
| | | | - Maité Garrouste-Orgeas
- Service de Réanimation Polyvalente, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | | | - Jean-François Timsit
- Service de Réanimation Polyvalente, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
- U 823, Université de Grenoble 1, Grenoble, France
| | - Elie Azoulay
- Service de Réanimation Médicale, AP-HP, Hôpital Saint-Louis, Paris, France
- Faculté de Médecine, Université Paris 5, Paris, France
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Garrouste-Orgeas M, Max A, Grégoire C, Ruckly S, Kloeckner M, Brochon S, Pichot E, Simons C, El Mhadri M, Bruel C, Philippart F, Fournier J, Tiercelet K, Timsit JF, Misset B. IMPACT OF PROACTIVE NURSE PARTICIPATION IN ICU FAMILY CONFERENCES: A MIXED-METHOD STUDY. Intensive Care Med Exp 2015. [PMCID: PMC4798577 DOI: 10.1186/2197-425x-3-s1-a929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Garrouste-Orgeas M, Périer A, Mouricou P, Grégoire C, Bruel C, Brochon S, Philippart F, Max A, Misset B. Writing in and reading ICU diaries: qualitative study of families' experience in the ICU. PLoS One 2014; 9:e110146. [PMID: 25329581 PMCID: PMC4199718 DOI: 10.1371/journal.pone.0110146] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/16/2014] [Indexed: 12/03/2022] Open
Abstract
Purpose Keeping an ICU patient diary has been reported to benefit the patient's recovery. Here, we investigated the families' experience with reading and writing in patient ICU diaries kept by both the family and the staff. Methods We conducted a qualitative study involving 32 semi-structured in-depth interviews of relatives of 26 patients (34% of all family members who visited patients) who met our ICU-diary criterion, i.e., ventilation for longer than 48 hours. Grounded theory was used to conceptualise the interview data via a three-step coding process (open coding, axial coding, and selective coding). Results Communicative, emotional, and humanising experiences emerged from our data. First, family members used the diaries to access, understand, and assimilate the medical information written in the diaries by staff members, and then to share this information with other family members. Second, the diaries enabled family members to maintain a connection with the patient by documenting their presence and expressing their love and affection. Additionally, families confided in the diaries to maintain hope. Finally, family members felt the diaries humanized the medical staff and patient. Conclusions Our findings indicate positive effects of diaries on family members. The diaries served as a powerful tool to deliver holistic patient- and family-centered care despite the potentially dehumanising ICU environment. The diaries made the family members aware of their valuable role in caring for the patient and enhanced their access to and comprehension of medical information. Diaries may play a major role in improving the well-being of ICU-patient families.
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Affiliation(s)
- Maité Garrouste-Orgeas
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
- IAME, UMR 1137, Paris Diderot University, Sorbonne Paris Cité, Paris, France
- * E-mail:
| | - Antoine Périer
- Maison des Adolescents, University Hospital Cochin, Paris, France
- INSERM U-669, University Paris Sud and University Paris Descartes, UMR-S0669, Paris, France
| | - Philippe Mouricou
- Management department, ESSCA School of Management PRES UNAM, Boulogne- Billancourt, France
| | - Charles Grégoire
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | - Cédric Bruel
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | - Sandie Brochon
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | | | - Adeline Max
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | - Benoit Misset
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
- University Paris Descartes, Paris, France
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Borel AL, Schwebel C, Planquette B, Vésin A, Garrouste-Orgeas M, Adrie C, Clec'h C, Azoulay E, Souweine B, Allaouchiche B, Goldgran-Toledano D, Jamali S, Darmon M, Timsit JF. Initiation of nutritional support is delayed in critically ill obese patients: a multicenter cohort study. Am J Clin Nutr 2014; 100:859-66. [PMID: 25080456 DOI: 10.3945/ajcn.114.088187] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND A high catabolic rate characterizes the acute phase of critical illness. Guidelines recommend an early nutritional support, regardless of the previous nutritional status. OBJECTIVE We aimed to assess whether the nutritional status of patients, which was defined by the body mass index (BMI) at admission in an intensive care unit (ICU), affected the time of nutritional support initiation. DESIGN We conducted a cohort study that reported a retrospective analysis of a multicenter ICU database (OUTCOMEREA) by using data prospectively entered from January 1997 to October 2012. Patients who needed orotracheal intubation within the first 72 h and >3 d were included. RESULTS Data from 3257 ICU stays were analyzed. The delay before feeding was different according to BMI groups (P = 0.035). The delay was longer in obese patients [BMI (in kg/m²) ≥30; n = 663] than in other patients with either low weight (BMI <20; n = 501), normal weight (BMI ≥20 and <25; n = 1135), or overweight (BMI ≥25 and <30; n = 958). The association between nutritional status and a delay in nutrition initiation was independent of potential confounding factors such as age, sex, and diabetes or other chronic diseases. In comparison with normal weight, the adjusted RR (95% CI) associated with a delayed nutrition initiation was 0.92 (0.86, 0.98) for patients with low weight, 1.00 (0.94, 1.05) for overweight patients, and 1.06 (1.00, 1.12) for obese patients (P = 0.004). CONCLUSIONS The initiation of nutritional support was delayed in obese ICU patients. Randomized controlled trials that address consequences of early compared with delayed beginnings of nutritional support in critically ill obese patients are needed.
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Affiliation(s)
- Anne-Laure Borel
- From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT)
| | - Carole Schwebel
- From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT)
| | - Benjamin Planquette
- From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT)
| | - Aurélien Vésin
- From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT)
| | - Maité Garrouste-Orgeas
- From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT)
| | - Christophe Adrie
- From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT)
| | - Christophe Clec'h
- From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT)
| | - Elie Azoulay
- From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT)
| | - Bertrand Souweine
- From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT)
| | - Bernard Allaouchiche
- From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT)
| | - Dany Goldgran-Toledano
- From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT)
| | - Samir Jamali
- From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT)
| | - Michael Darmon
- From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT)
| | - Jean-François Timsit
- From the Endocrinology Department (A-LB) and Medical Intensive Care Unit (ICU) (CS and J-FT), Grenoble University Hospital, Grenoble, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1042, Grenoble, France (A-LB), the Grenoble Alpes University, Grenoble, France (A-LB and CS); the Medical Surgical ICU, André Mignot Hospital, Versailles-Le Chesnay, France (BP); the Integrated Research Center INSERM U823, Grenoble, France (AV and J-FT); the Medical Surgical ICU, Saint-Joseph Hospital, Paris, France (MG-O); the ICU, Delafontaine Hospital, Saint Denis, France (CA); Physiology, Cochin University Hospital, Paris, France (CA), the ICU, Avicenne University Hospital, Bobigny, France (CC); the Medical ICU, Saint-Louis University Hospital, Paris, France (EA); the Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France (BS); the Surgical ICU, Edouard Herriot Hospital, Lyon, France (BA); the ICU, Gonesse Hospital, Gonesse, France (DG-T); the ICU, Dourdan Hospital, Dourdan, France (SJ); the Medical ICU, Saint-Etienne University Hospital, Saint-Etienne, France (MD); the Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, Paris, France (J-FT); and the Unité mixte de Recherche 1137, Infection, Antimicrobials, Modelling, Evolution Team 5, Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France (MG-O and J-FT)
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Giannini A, Garrouste-Orgeas M, Latour JM. What's new in ICU visiting policies: can we continue to keep the doors closed? Intensive Care Med 2014; 40:730-3. [PMID: 24687297 DOI: 10.1007/s00134-014-3267-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Alberto Giannini
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy,
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Guidet B, Thomas C, Pateron D, Pichereau C, Bigé N, Boumendil A, Garrouste-Orgeas M, N’guyen YL. Personnes âgées et réanimation. Réanimation 2014. [DOI: 10.1007/s13546-013-0814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zahar JR, Garrouste-Orgeas M, Vesin A, Schwebel C, Bonadona A, Philippart F, Ara-Somohano C, Misset B, Timsit JF. Impact of contact isolation for multidrug-resistant organisms on the occurrence of medical errors and adverse events. Intensive Care Med 2013; 39:2153-60. [PMID: 23995982 DOI: 10.1007/s00134-013-3071-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 08/07/2013] [Indexed: 01/19/2023]
Abstract
UNLABELLED Contact isolation of infected or colonised hospitalised patients is instrumental to interrupting multidrug-resistant organism (MDRO) cross-transmission. Many studies suggest an increased rate of adverse events associated with isolation. We aimed to compare isolated to non-isolated patients in intensive care units (ICUs) for the occurrence of adverse events and medical errors. METHODS We used the large database of the Iatroref III study that included consecutive patients from three ICUs to compare the occurrence of pre-defined medical errors and adverse events among isolated vs. non-isolated patients. A subdistribution hazard regression model with careful adjustment on confounding factors was used to assess the effect of patient isolation on the occurrence of medical errors and adverse events. RESULTS Two centres of the Iatroref III study were eligible, an 18-bed and a 10-bed ICU (nurse-to-bed ratio 2.8 and 2.5, respectively), with a total of 1,221 patients. After exclusion of the neutropenic and graft transplant patients, a total of 170 isolated patients were compared to 980 non-isolated patients. Errors in insulin administration and anticoagulant prescription were more frequent in isolated patients. Adverse events such as hypo- or hyperglycaemia, thromboembolic events, haemorrhage, and MDRO ventilator-associated pneumonia (VAP) were also more frequent with isolation. After careful adjustment of confounders, errors in anticoagulant prescription [subdistribution hazard ratio (sHR) = 1.7, p = 0.04], hypoglycaemia (sHR = 1.5, p = 0.01), hyperglycaemia (sHR = 1.5, p = 0.004), and MDRO VAP (sHR = 2.1, p = 0.001) remain more frequent in isolated patients. CONCLUSION Contact isolation of ICU patients is associated with an increased rate of some medical errors and adverse events, including non-infectious ones.
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Affiliation(s)
- J R Zahar
- University Grenoble 1-U823-Team 11: Outcome of Cancer and Critical Illnesses, Albert Bonniot Institute, 38706 La Tronche, CEDEX, France,
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41
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Garrouste-Orgeas M, Tabah A, Vesin A, Philippart F, Kpodji A, Bruel C, Grégoire C, Max A, Timsit JF, Misset B. The ETHICA study (part II): simulation study of determinants and variability of ICU physician decisions in patients aged 80 or over. Intensive Care Med 2013; 39:1574-83. [PMID: 23765237 DOI: 10.1007/s00134-013-2977-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 05/19/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess physician decisions about ICU admission for life-sustaining treatments (LSTs). METHODS Observational simulation study of physician decisions for patients aged ≥80 years. Each patient was allocated at random to four physicians who made decisions based on actual bed availability and existence of an additional bed before and after obtaining information on patient preferences. The simulations involved non-invasive ventilation (NIV), invasive mechanical ventilation (IMV), and renal replacement therapy after a period of IMV (RRT after IMV). RESULTS The physician participation rate was 100/217 (46 %); males without religious beliefs predominated, and median ICU experience was 9 years. Among participants, 85.7, 78, and 62 % felt that NIV, IMV, or RRT (after IMV) was warranted, respectively. By logistic regression analysis, factors associated with admission were age <85 years, self-sufficiency, and bed availability for NIV and IMV. Factors associated with IMV were previous ICU stay (OR 0.29, 95 % CI 0.13-0.65, p = 0.01) and cancer (OR 0.23, 95 % CI 0.10-0.52, p = 0.003), and factors associated with RRT (after IMV) were living spouse (OR 2.03, 95 % CI 1.04-3.97, p = 0.038) and respiratory disease (OR 0.42, 95 % CI 0.23-0.76, p = 0.004). Agreement among physicians was low for all LSTs. Knowledge of patient preferences changed physician decisions for 39.9, 56, and 57 % of patients who disagreed with the initial physician decisions for NIV, IMV, and RRT (after IMV) respectively. An additional bed increased admissions for NIV and IMV by 38.6 and 13.6 %, respectively. CONCLUSIONS Physician decisions for elderly patients had low agreement and varied greatly with bed availability and knowledge of patient preferences.
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Affiliation(s)
- M Garrouste-Orgeas
- Medical-Surgical, Saint Joseph Hospital Network, 185 rue Raymond Losserand, 75014, Paris, France.
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Philippart F, Vesin A, Bruel C, Kpodji A, Durand-Gasselin B, Garçon P, Levy-Soussan M, Jagot JL, Calvo-Verjat N, Timsit JF, Misset B, Garrouste-Orgeas M. The ETHICA study (part I): elderly's thoughts about intensive care unit admission for life-sustaining treatments. Intensive Care Med 2013; 39:1565-73. [PMID: 23765236 DOI: 10.1007/s00134-013-2976-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 05/19/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess preferences among individuals aged ≥80 years for a future hypothetical critical illness requiring life-sustaining treatments. METHODS Observational cohort study of consecutive community-dwelling elderly individuals previously hospitalised in medical or surgical wards and of volunteers residing in nursing homes or assisted-living facilities. The participants were interviewed at their place of residence after viewing films of scenarios involving the use of non-invasive mechanical ventilation (NIV), invasive mechanical ventilation (IMV), and renal replacement therapy after a period of invasive mechanical ventilation (RRT after IMV). Demographic, clinical, and quality-of-life data were collected. Participants chose among four responses regarding life-sustaining treatments: consent, refusal, no opinion, and letting the physicians decide. RESULTS The sample size was 115 and the response rate 87 %. Mean participant age was 84.8 ± 3.5 years, 68 % were female, and 81 % and 71 % were independent for instrumental activities and activities of daily living, respectively. Refusal rates among the elderly were 27 % for NIV, 43 % for IMV, and 63 % for RRT (after IMV). Demographic characteristics associated with refusal were married status for NIV [relative risk (RR), 2.9; 95 % confidence interval (95 %CI), 1.5-5.8; p = 0.002] and female gender for IMV (RR, 2.4; 95 %CI, 1.2-4.5; p = 0.01) and RRT (after IMV) (RR, 2.7; 95 %CI, 1.4-5.2; p = 0.004). Quality of life was associated with choices regarding all three life-sustaining treatments. CONCLUSIONS Independent elderly individuals were rather reluctant to accept life-sustaining treatments, especially IMV and RRT (after IMV). Their quality of life was among the determinants of their choices.
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Affiliation(s)
- F Philippart
- Medical-Surgical, Saint Joseph Hospital Network, 75014, Paris, France
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43
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Perier A, Revah-Levy A, Bruel C, Cousin N, Angeli S, Brochon S, Philippart F, Max A, Gregoire C, Misset B, Garrouste-Orgeas M. Phenomenologic analysis of healthcare worker perceptions of intensive care unit diaries. Crit Care 2013; 17:R13. [PMID: 23336394 PMCID: PMC4056037 DOI: 10.1186/cc11938] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 01/10/2013] [Indexed: 11/13/2022]
Abstract
Introduction Studies have reported associations between diaries kept for intensive care unit (ICU) patients and long-term quality-of-life and psychological outcomes in patients and their relatives. Little was known about perceptions of healthcare workers reading and writing in the diaries. We investigated healthcare worker perceptions the better to understand their opinions and responses to reading and writing in the diaries. Methods We used a phenomenologic approach to conduct a qualitative study of 36 semistructured interviews in a medical-surgical ICU in a 460-bed tertiary hospital. Results Two domains of perception were assessed: reading and writing in the diaries. These two domains led to four main themes in the ICU workers' perceptions: suffering of the families; using the diary as a source of information for families but also as generating difficulties in writing bad news; determining the optimal interpersonal distance with the patient and relatives; and using the diary as a tool for constructing a narrative of the patient's ICU stay. Conclusions The ICU workers thought that the diary was beneficial in communicating the suffering of families while providing comfort and helping to build the patient's ICU narrative. They reported strong emotions related to the diaries and a perception of intruding into the patients' and families' privacy when reading the diaries. Fear of strong emotional investment may adversely affect the ability of ICU workers to perform their duties optimally. ICU workers are in favor of ICU diaries, but activation by the diaries of emotions among younger ICU workers may require specific support.
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Zahar JR, Schwebel C, Adrie C, Garrouste-Orgeas M, Français A, Vesin A, Nguile-Makao M, Tabah A, Laupland K, Le-Monnier A, Timsit JF. Outcome of ICU patients with Clostridium difficile infection. Crit Care 2012; 16:R215. [PMID: 23127327 PMCID: PMC3672590 DOI: 10.1186/cc11852] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 10/25/2012] [Indexed: 12/18/2022]
Abstract
INTRODUCTION As data from Clostridium difficile infection (CDI) in intensive care unit (ICU) are still scarce, our objectives were to assess the morbidity and mortality of ICU-acquired CDI. METHODS We compared patients with ICU-acquired CDI (watery or unformed stools occurring ≥ 72 hours after ICU admission with a stool sample positive for C. difficile toxin A or B) with two groups of controls hospitalized at the same time in the same unit. The first control group comprised patients with ICU-acquired diarrhea occurring ≥ 72 hours after ICU admission with a stool sample negative for C. difficile and for toxin A or B. The second group comprised patients without any diarrhea. RESULTS Among 5,260 patients, 512 patients developed one episode of diarrhea. Among them, 69 (13.5%) had a CDI; 10 (14.5%) of them were community-acquired, contrasting with 12 (17.4%) that were hospital-acquired and 47 (68%) that were ICU-acquired. A pseudomembranous colitis was associated in 24/47 (51%) ICU patients. The median delay between diagnosis and metronidazole administration was one day (25th Quartile; 75th Quartile (0; 2) days). The case-fatality rate for patients with ICU-acquired CDI was 10/47 (21.5%), as compared to 112/443 (25.3%) for patients with negative tests. Neither the crude mortality (cause specific hazard ratio; CSHR = 0.70, 95% confidence interval; CI 0.36 to 1.35, P = 0.3) nor the adjusted mortality to confounding variables (CSHR = 0.81, 95% CI 0.4 to 1.64, P = 0.6) were significantly different between CDI patients and diarrheic patients without CDI. Compared to the general ICU population, neither the crude mortality (SHR = 0.64, 95% CI 0.34 to 1.21, P = 0.17), nor the mortality adjusted to confounding variables (CSHR = 0.71, 95% confidence interval (CI) 0.38 to 1.35, P = 0.3), were significantly different between the two groups. The estimated increase in the duration of stay due to CDI was 8.0 days ± 9.3 days, (P = 0.4) in comparison to the diarrheic population, and 6.3 days ± 4.3 (P = 0.14) in comparison to the general ICU population. CONCLUSIONS If treated early, ICU-acquired CDI is not independently associated with an increased mortality and impacts marginally the ICU length of stay.
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Tabah A, Koulenti D, Laupland K, Misset B, Valles J, Bruzzi de Carvalho F, Paiva JA, Cakar N, Ma X, Eggimann P, Antonelli M, Bonten MJM, Csomos A, Krueger WA, Mikstacki A, Lipman J, Depuydt P, Vesin A, Garrouste-Orgeas M, Zahar JR, Blot S, Carlet J, Brun-Buisson C, Martin C, Rello J, Dimopoulos G, Timsit JF. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med 2012. [PMID: 23011531 DOI: 10.1007/s00134-012-2695-9]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The recent increase in drug-resistant micro-organisms complicates the management of hospital-acquired bloodstream infections (HA-BSIs). We investigated the epidemiology of HA-BSI and evaluated the impact of drug resistance on outcomes of critically ill patients, controlling for patient characteristics and infection management. METHODS A prospective, multicentre non-representative cohort study was conducted in 162 intensive care units (ICUs) in 24 countries. RESULTS We included 1,156 patients [mean ± standard deviation (SD) age, 59.5 ± 17.7 years; 65 % males; mean ± SD Simplified Acute Physiology Score (SAPS) II score, 50 ± 17] with HA-BSIs, of which 76 % were ICU-acquired. Median time to diagnosis was 14 [interquartile range (IQR), 7-26] days after hospital admission. Polymicrobial infections accounted for 12 % of cases. Among monomicrobial infections, 58.3 % were gram-negative, 32.8 % gram-positive, 7.8 % fungal and 1.2 % due to strict anaerobes. Overall, 629 (47.8 %) isolates were multidrug-resistant (MDR), including 270 (20.5 %) extensively resistant (XDR), and 5 (0.4 %) pan-drug-resistant (PDR). Micro-organism distribution and MDR occurrence varied significantly (p < 0.001) by country. The 28-day all-cause fatality rate was 36 %. In the multivariable model including micro-organism, patient and centre variables, independent predictors of 28-day mortality included MDR isolate [odds ratio (OR), 1.49; 95 % confidence interval (95 %CI), 1.07-2.06], uncontrolled infection source (OR, 5.86; 95 %CI, 2.5-13.9) and timing to adequate treatment (before day 6 since blood culture collection versus never, OR, 0.38; 95 %CI, 0.23-0.63; since day 6 versus never, OR, 0.20; 95 %CI, 0.08-0.47). CONCLUSIONS MDR and XDR bacteria (especially gram-negative) are common in HA-BSIs in critically ill patients and are associated with increased 28-day mortality. Intensified efforts to prevent HA-BSIs and to optimize their management through adequate source control and antibiotic therapy are needed to improve outcomes.
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Affiliation(s)
- Alexis Tabah
- Albert Michallon University Hospital, Université Grenoble 1, Grenoble, France
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46
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Tabah A, Koulenti D, Laupland K, Misset B, Valles J, Bruzzi de Carvalho F, Paiva JA, Cakar N, Ma X, Eggimann P, Antonelli M, Bonten MJM, Csomos A, Krueger WA, Mikstacki A, Lipman J, Depuydt P, Vesin A, Garrouste-Orgeas M, Zahar JR, Blot S, Carlet J, Brun-Buisson C, Martin C, Rello J, Dimopoulos G, Timsit JF. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med 2012; 38:1930-45. [PMID: 23011531 DOI: 10.1007/s00134-012-2695-9] [Citation(s) in RCA: 254] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 08/21/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE The recent increase in drug-resistant micro-organisms complicates the management of hospital-acquired bloodstream infections (HA-BSIs). We investigated the epidemiology of HA-BSI and evaluated the impact of drug resistance on outcomes of critically ill patients, controlling for patient characteristics and infection management. METHODS A prospective, multicentre non-representative cohort study was conducted in 162 intensive care units (ICUs) in 24 countries. RESULTS We included 1,156 patients [mean ± standard deviation (SD) age, 59.5 ± 17.7 years; 65 % males; mean ± SD Simplified Acute Physiology Score (SAPS) II score, 50 ± 17] with HA-BSIs, of which 76 % were ICU-acquired. Median time to diagnosis was 14 [interquartile range (IQR), 7-26] days after hospital admission. Polymicrobial infections accounted for 12 % of cases. Among monomicrobial infections, 58.3 % were gram-negative, 32.8 % gram-positive, 7.8 % fungal and 1.2 % due to strict anaerobes. Overall, 629 (47.8 %) isolates were multidrug-resistant (MDR), including 270 (20.5 %) extensively resistant (XDR), and 5 (0.4 %) pan-drug-resistant (PDR). Micro-organism distribution and MDR occurrence varied significantly (p < 0.001) by country. The 28-day all-cause fatality rate was 36 %. In the multivariable model including micro-organism, patient and centre variables, independent predictors of 28-day mortality included MDR isolate [odds ratio (OR), 1.49; 95 % confidence interval (95 %CI), 1.07-2.06], uncontrolled infection source (OR, 5.86; 95 %CI, 2.5-13.9) and timing to adequate treatment (before day 6 since blood culture collection versus never, OR, 0.38; 95 %CI, 0.23-0.63; since day 6 versus never, OR, 0.20; 95 %CI, 0.08-0.47). CONCLUSIONS MDR and XDR bacteria (especially gram-negative) are common in HA-BSIs in critically ill patients and are associated with increased 28-day mortality. Intensified efforts to prevent HA-BSIs and to optimize their management through adequate source control and antibiotic therapy are needed to improve outcomes.
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Affiliation(s)
- Alexis Tabah
- Albert Michallon University Hospital, Université Grenoble 1, Grenoble, France
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47
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Brochon S, Angeli S, Garrouste-Orgeas M. [Quality of life after a stay in the intensive care unit]. Soins 2012:51-53. [PMID: 22870772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The study of quality of life is a critical indicator in evaluating the care of patients in intensive care. This must be measured to detect signs of psychological and physical sequelae and adapt patient support accordingly.
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48
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Boumendil A, Angus DC, Guitonneau AL, Menn AM, Ginsburg C, Takun K, Davido A, Masmoudi R, Doumenc B, Pateron D, Garrouste-Orgeas M, Somme D, Simon T, Aegerter P, Guidet B. Variability of intensive care admission decisions for the very elderly. PLoS One 2012; 7:e34387. [PMID: 22509296 PMCID: PMC3324496 DOI: 10.1371/journal.pone.0034387] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 03/02/2012] [Indexed: 11/18/2022] Open
Abstract
Although increasing numbers of very elderly patients are requiring intensive care, few large sample studies have investigated ICU admission of very elderly patients. Data on pre triage by physicians from other specialities is limited. This observational cohort study aims at examining inter-hospital variability of ICU admission rates and its association with patients' outcomes. All patients over 80 years possibly qualifying for ICU admission who presented to the emergency departments (ED) of 15 hospitals in the Paris (France) area during a one-year period were prospectively included in the study. Main outcome measures were ICU eligibility, as assessed by the ED and ICU physicians; in-hospital mortality; and vital and functional status 6 months after the ED visit. 2646 patients (median age 86; interquartile range 83–91) were included in the study. 94% of participants completed follow-up (n = 2495). 12.4% (n = 329) of participants were deemed eligible for ICU admission by ED physicians and intensivists. The overall in-hospital and 6-month mortality rates were respectively 27.2% (n = 717) and 50.7% (n = 1264). At six months, 57.5% (n = 1433) of patients had died or had a functional deterioration. Rates of patients deemed eligible for ICU admission ranged from 5.6% to 38.8% across the participating centers, and this variability persisted after adjustment for patients' characteristics. Despite this variability, we found no association between level of ICU eligibility and either in-hospital death or six-month death or functional deterioration. In France, the likelihood that a very elderly person will be admitted to an ICU varies widely from one hospital to another. Influence of intensive care admission on patients' outcome remains unclear.
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Affiliation(s)
- Ariane Boumendil
- Unité de Recherche en Épidémiologie Systèmes d'Information et Modélisation U707, Institut national de la santé et de la recherche médicale, Paris, France.
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49
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Garrouste-Orgeas M, Philippart F, Bruel C, Max A, Lau N, Misset B. Overview of medical errors and adverse events. Ann Intensive Care 2012; 2:2. [PMID: 22339769 PMCID: PMC3310841 DOI: 10.1186/2110-5820-2-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 02/16/2012] [Indexed: 12/20/2022] Open
Abstract
Safety is a global concept that encompasses efficiency, security of care, reactivity of caregivers, and satisfaction of patients and relatives. Patient safety has emerged as a major target for healthcare improvement. Quality assurance is a complex task, and patients in the intensive care unit (ICU) are more likely than other hospitalized patients to experience medical errors, due to the complexity of their conditions, need for urgent interventions, and considerable workload fluctuation. Medication errors are the most common medical errors and can induce adverse events. Two approaches are available for evaluating and improving quality-of-care: the room-for-improvement model, in which problems are identified, plans are made to resolve them, and the results of the plans are measured; and the monitoring model, in which quality indicators are defined as relevant to potential problems and then monitored periodically. Indicators that reflect structures, processes, or outcomes have been developed by medical societies. Surveillance of these indicators is organized at the hospital or national level. Using a combination of methods improves the results. Errors are caused by combinations of human factors and system factors, and information must be obtained on how people make errors in the ICU environment. Preventive strategies are more likely to be effective if they rely on a system-based approach, in which organizational flaws are remedied, rather than a human-based approach of encouraging people not to make errors. The development of a safety culture in the ICU is crucial to effective prevention and should occur before the evaluation of safety programs, which are more likely to be effective when they involve bundles of measures.
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Affiliation(s)
- Maité Garrouste-Orgeas
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Université Joseph Fourier, Unité INSERM, Epidémiologie des cancers et des maladies sévères, Institut Albert Bonniot, La Tronche, France
| | - François Philippart
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Medicine Faculty, Université Paris Descartes, Paris, France
- Infection and Epidemiology department Pasteur Institut, Paris, France
| | - Cédric Bruel
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Adeline Max
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Nicolas Lau
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - B Misset
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Medicine Faculty, Université Paris Descartes, Paris, France
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Laupland KB, Zahar JR, Adrie C, Minet C, Vésin A, Goldgran-Toledano D, Azoulay E, Garrouste-Orgeas M, Cohen Y, Schwebel C, Jamali S, Darmon M, Dumenil AS, Kallel H, Souweine B, Timsit JF. Severe hypothermia increases the risk for intensive care unit-acquired infection. Clin Infect Dis 2012; 54:1064-70. [PMID: 22291110 DOI: 10.1093/cid/cir1033] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although hypothermia is widely accepted as a risk factor for subsequent infection in surgical patients, it has not been well defined in medical patients. We sought to assess the risk of acquiring intensive care unit (ICU)--acquired infection after hypothermia among medical ICU patients. METHODS Adults (≥18 years) admitted to French ICUs for at least 2 days between April 2000 and November 2010 were included. Surgical patients were excluded. Patient were classified as having had mild hypothermia (35.0°C-35.9°C), moderate hypothermia (32°C-34.9°C), or severe hypothermia (<32°C), and were followed for the development of pneumonia or bloodstream infection until ICU discharge. RESULTS A total of 6237 patients were included. Within the first day of admission, 648 (10%) patients had mild hypothermia, 288 (5%) patients had moderate hypothermia, and 45 (1%) patients had severe hypothermia. Among the 5256 patients who did not have any hypothermia at day 1, subsequent hypothermia developed in 868 (17%), of which 673 (13%), 176 (3%), and 19 (<1%) patients had lowest temperatures of 35.0°C-35.9°C, 32.0°C-34.9°C, and <32°C, respectively. During the course of ICU admission, 320 (5%) patients developed ICU-acquired bloodstream infection and 724 (12%) patients developed ICU-acquired pneumonia. After controlling for confounding variables in multivariable analyses, severe hypothermia was found to increase the risk for subsequent ICU-acquired infection, particularly in patients who did not present with severe sepsis or septic shock. CONCLUSIONS The presence of severe hypothermia is a risk factor for development of ICU-acquired infection in medical patients.
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Affiliation(s)
- Kevin B Laupland
- Team 11: Outcome of Respiratory Cancers and Mechanically Ventilated Patients, Integrated Research Center U823-Albert Bonniot Institute, Rond Point de la Chantourne, La Tronche, France
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