228 research outputs found
sj-docx-1-jic-10.1177_08850666231199937 - Supplemental material for Perceived Quality of Life in Intensive Care Medicine Physicians: A French National Survey
No full textSupplemental material, sj-docx-1-jic-10.1177_08850666231199937 for Perceived Quality of Life in Intensive Care Medicine Physicians: A French National Survey by Nicolas Terzi, Alicia Fournier, Olivier Lesieur, Julien Chappé, Djillali Annane, Jean-Luc Chagnon, Didier Thévenin, Benoit Misset, Jean-Luc Diehl, Samia Touati, Hervé Outin, Stéphane Dauger, Arnaud Sement, Jean-Noël Drault, Jean-Philippe Rigaud, Alexandra Laurent and in Journal of Intensive Care Medicine</p
Lung ultrasound for early diagnosis of ventilator-associated pneumonia
No full textBACKGROUND: Lung ultrasound (LUS) has been successfully applied for monitoring aeration
in ventilator-associated pneumonia (VAP) and to diagnose and monitor communityacquired
pneumonia. However, no scientific evidence is yet available on whether LUS reliably
improves the diagnosis of VAP.
METHODS: In a multicenter prospective study of 99 patients with suspected VAP, we investigated
the diagnostic performance of LUS findings of infection, subpleural consolidation,
lobar consolidation, and dynamic arborescent/linear air bronchogram. We also evaluated the
combination of LUS with direct microbiologic examination of endotracheal aspirates (EA).
Scores for LUS findings and EA were analyzed in two ways. First, the clinical-LUS score
(ventilator-associated pneumonia lung ultrasound score [VPLUS]) was calculated as
follows: 1 area with dynamic arborescent/
linear air bronchogram, 2 points; and purulent EA, 1 point. Second, the VPLUSdirect
gram stain examination (EAgram) was scored as follows: 1 area with dynamic arborescent/linear air bronchogram, 2 points;
purulent EA, 1 point; and positive direct gram stain EA examination, 2 points.
RESULTS: For the diagnosis of VAP, subpleural consolidation and dynamic arborescent/linear
air bronchogram had a positive predictive value of 86% with a positive likelihood ratio of 2.8.
Two dynamic linear/arborescent air bronchograms produced a positive predictive value of
94% with a positive likelihood ratio of 7.1. The area under the curve for VPLUS-EAgram and
VPLUS were 0.832 and 0.743, respectively. VPLUS-EAgram 2 had 69% (50-84) specificity and 71% (58-81)
sensitivity.
CONCLUSIONS: By detecting ultrasound features of infection, LUS was a reliable tool for early
VAP diagnosis at the bedside
Onderzoekingen omtrent het gedrag van autobanden op een effen weg
No full textMechanical, Maritime and Materials Engineerin
Nuit napoléonienne
No full textIn verse. Publication date on the cover: 1843. Cover inscribed by author
Characteristics and risk factors for 28-day mortality of hospital acquired fungemias in ICUs: data from the EUROBACT study
No full textBackground: To characterize and identify prognostic factors for 28-day mortality among patients with hospital-acquired fungemia (HAF) in the Intensive Care Unit (ICU). Methods: A sub-analysis of a prospective, multicenter non-representative cohort study conducted in 162 ICUs in 24 countries. Results: Of the 1156 patients with hospital-acquired bloodstream infections (HA-BSI) included in the EUROBACT study, 96 patients had a HAF. Median time to its diagnosis was 20 days (IQR 10.5-30.5) and 9 days (IQR 3-15.5) after hospital and ICU admission, respectively. Median time to positivity of blood culture was longer in fungemia than in bacteremia (48.7 h vs. 38.1 h; p = 0.0004). Candida albicans was the most frequent fungus isolated (57.1 %), followed by Candida glabrata (15.3 %) and Candida parapsilosis (10.2 %). No clear source of HAF was detected in 33.3 % of the episodes and it was catheter-related in 21.9 % of them. Compared to patients with bacteremia, HAF patients had a higher rate of septic shock (39.6 % vs. 21.6 %; p = 0.0003) and renal dysfunction (25 % vs. 12.4 %; p = 0.0023) on admission and a higher rate of renal failure (26 % vs. 16.2 %; p = 0.0273) at diagnosis. Adequate treatment started within 24 h after blood culture collection was less frequent in HAF patients (22.9 % vs. 55.3 %; p < 0.001). The 28-day all cause fatality was 40.6 %. According to multivariate analysis, only liver failure (OR 14.35; 95 % CI 1.17-175.6; p = 0.037), need for mechanical ventilation (OR 8.86; 95 % CI 1.2-65.24; p = 0.032) and ICU admission for medical reason (OR 3.87; 95 % CI 1.25-11.99; p = 0.020) were independent predictors of 28-day mortality in HAF patients. Conclusions: Fungi are an important cause of hospital-acquired BSI in the ICU. Patients with HAF present more frequently with septic shock and renal dysfunction on ICU admission and have a higher rate of renal failure at diagnosis. HAF are associated with a significant 28-day mortality rate (40 %), but delayed adequate antifungal therapy was not an independent risk factor for death. Liver failure, need for mechanical ventilation and ICU admission for medical reason were the only independent predictors of 28-day mortality
Epidemiology of infectious complications in endo-arterial interventional radiology in France: Feasibility of the nationwide hospital discharge database (PMSI), 2010 – 2013
No full textIntroduction : The epidemiology of the Healthcare-Associated Infections (HAI) post-EndoArterial Interventional Radiology Procedures (EAIRP) is unknown. The objective is to test the feasibility of the nationwide hospital discharge French database, named, le Programme de Médicalisation des Systèmes d’Information (PMSI) to determine the incidence of IN post- EAIRP. The procedures selected are: Angioplasty, angioplasty with stent, embolization and thrombectomy. Subjects and methods: Denominator: patients with at least one stay including the code "trans/arterial route" of the French Common Classification of Medical Acts. Numerator: cases of HAIs according to the International Classification of Diseases in its French version, Tenth Revision. The study was approved by the French National Commission for Data Protection and Liberties. Results: 460,461 patients included in 692 centers from 2010 to 2013. 9,227 (2.01%) infections within 3 months of an EAIRP. Mortality 2.79% without HAI, versus 9.77% with HAI (P <0.001). Conclusion: Measuring the incidence of HAI secondary to an EAIRP with the PMSI is feasible. The HAI appears to be associated with excess mortality. The causal link between HAI and death deserves to be deepened. Comparisons with databases from other countries are necessary
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