46 research outputs found
Toxic Shock Syndrome: A Literature Review
No full textToxic shock syndrome (TSS) is a rare, life-threatening, toxin-mediated infectious process linked, in the vast majority of cases, to toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes. The pathophysiology, epidemiology, clinical presentation, microbiological features, management and outcome of TSS are described in this review. Bacterial superantigenic exotoxins induces unconventional polyclonal lymphocyte activation, which leads to rapid shock, multiple organ failure syndrome, and death. The main described superantigenic exotoxins are toxic shock syndrome toxin—1 (TSST-1) and enterotoxins for Staphylococcus aureus and Streptococcal pyrogenic exotoxins (SpE) A, B, and C and streptococcal superantigen A (SsA) for Streptococcus pyogenes. Staphylococcal TSS can be menstrual or nonmenstrual. Streptococcal TSS is linked to a severe group A streptococcal infection and, most frequently, to a necrotizing soft tissue infection. Management of TSS is a medical emergency and relies on early detection, immediate resuscitation, source control and eradication of toxin production, bactericidal antibiotic treatment, and protein synthesis inhibiting antibiotic administration. The interest of polyclonal intravenous immunoglobulin G administration as an adjunctive treatment for TSS requires further evaluation. Scientific literature on TSS mainly consists of observational studies, clinical cases, and in vitro data; although more data on TSS are required, additional studies will be difficult to conduct due to the low incidence of the disease
Fatal invasive aspergillosis caused by Aspergillus niger after bilateral lung transplantation
No full textAspergillus niger is usually considered to be a low virulence fungus, not commonly reported to cause invasive infections. Invasive pulmonary aspergillosis due to Aspergillus niger was diagnosed in a 43-year-old woman following bilateral lung transplantation. Intravenous voriconazole failed to control progression of the disease. Despite salvage therapy with a combination of voriconazole and caspofungin for 23 days, the patient developed massive hemoptysis leading to death. The authors report the clinical features and treatment of this case
Characteristics of French intensive care units and patients: an ancillary analysis of the GAME-OVER study
No full textInternational audienceBackground: Intensive care units (ICUs) account for 15 to 20% of the national healthcare expenditures in France, although representing only 2% of the annual national hospitalizations. Published data on critically ill patient characteristics and intensive care unit (ICU) organizational aspects in France are scarce but could help optimize the critical care system organization.Methods: We performed an ancillary analysis of the GAME-OVER study, conducted from November 2022 to March 2023, over a 24-h period in each ICU, to precisely describe the ICU activity in France. Characteristics of enrolled patients and ICUs were analyzed according to the healthcare structure type and the self-reported main activity of each ICU, and were compared using univariate analysis (p < 0.05 considered as significant).Results: Data from 81 ICUs, representing 1218 beds, were analyzed. Participating ICUs were mainly mixed ICUs (56%), from teaching hospitals (54%). Among the 1048 analyzed ICU patients, sex ratio female/male was 1/3, median age was 63 [51–71] years, median sepsis organ failure assessment score was 4 [2–7], and 42% of patients had at least two organ failures. Patients were mainly admitted for medical reasons (52%), mostly represented by respiratory failure (26%). Mechanical ventilation, non-invasive ventilation, high flow oxygen therapy, renal replacement therapy and vasoactive therapy were required in 45.5%, 6.1%, 5.3%, 12% and 30.7% of patients, respectively. Median nurse-to-patient ratio was 2.4 [2.0–2.7] on day shift. Overall, 46 structures (56.8%) declared a nurse-to-patient ratio > 2.5 either on day time or night time. Bed occupancy rate was 91% over the 24-h study period. However, 70 (5.7%) ICU beds were administratively closed and could not admit any patient.Conclusion: In more than 20% of French ICUs, the bed occupancy rate is nearly 91%, despite 5.7% of beds being unavailable, and the nurse-to-patient ratio exceeding recommended levels.Trial registration: The full study protocol was registered in clinicaltrials.gov (NCT05553054)
Morbidity and mortality related to pneumonia and TRACHEOBRONCHITIS in ICU after lung transplantation
No full textBacteraemia Is Associated with Increased ICU Mortality in the Postoperative Course of Lung Transplantation
No full textWe aimed to describe the prevalence, risk factors, morbidity and mortality associated with the occurrence of bacteraemia during the postoperative ICU stay after lung transplantation (LT). We conducted a retrospective single-centre study that included all consecutive patients who underwent LT between January 2015 and October 2021. We analysed all the blood cultures drawn during the postoperative ICU stay, as well as samples from suspected infectious sources in case of bacteraemia. Forty-six bacteria were isolated from 45 bacteraemic patients in 33/303 (10.9%) patients during the postoperative ICU stay. Staphylococcus aureus (17.8%) was the most frequent bacteria, followed by Pseudomonas aeruginosa (15.6%) and Enterococcus faecium (15.6%). Multidrug-resistant bacteria accounted for 8/46 (17.8%) of the isolates. The most common source of bacteraemia was pneumonia (38.3%). No pre- or intraoperative risk factor for bacteraemia was identified. Recipients who experienced bacteraemia required more renal replacement therapy, invasive mechanical ventilation, norepinephrine support, tracheotomy and more days of hospitalization during the ICU stay. After adjustment for age, sex, type of LT procedure and the need for intraoperative ECMO, the occurrence of bacteraemia was associated with a higher mortality rate in the ICU (aOR = 3.55, 95% CI [1.56–8.08], p = 0.003). Bacteraemia is a major source of concern for lung transplant recipients
First Recombinant High-Density Lipoprotein Particles Administration in a Severe ICU COVID-19 Patient, a Multi-Omics Exploratory Investigation
No full textHigh-density lipoproteins (HDLs) have multiple endothelioprotective properties. During SARS-CoV-2 infection, HDL-cholesterol (HDL-C) concentration is markedly reduced, and studies have described severe impairment of the functionality of HDL particles. Here, we report a multi-omic investigation of the first administration of recombinant HDL (rHDL) particles in a severe COVID-19 patient in an intensive care unit. Plasma ApoA1 increased and HDL-C decreased after each recombinant HDL injection, suggesting that these particles were functional in terms of reverse cholesterol transport. The proportion of large HDL particles also increased after injection of recombinant HDL. Shotgun proteomics performed on HDLs isolated by ultracentrifugation indicated that ApoA1 was more abundant after injections whereas most of the pro-inflammatory proteins identified were less abundant. Assessment of Serum amyloid A-1, inflammatory markers, and cytokines showed a significant decrease for most of them during recombinant HDL infusion. Our results suggest that recombinant HDL infusion is feasible and a potential therapeutic strategy to be explored in COVID-19 patients
Blood transfusion of the donor is associated with stage 3 primary graft dysfunction after lung transplantation
No full textInternational audienceBackground The first aim of this study was to assess the association between stage 3 PGD and pre‐donation blood transfusion of the donor. The secondary objectives were to assess the epidemiology of donor transfusion and the outcome of LT recipients according to donor transfusion status and massive donor transfusion status. Methods This was an observational, prospective, single‐center study. The results are expressed as absolute numbers, percentages, medians, and interquartile ranges. Statistical analyses were performed using Chi squared, Fischer's exact tests, and Mann‐Whitney U tests ( P < .05 was considered significant). A multivariate analysis was performed. Results Between January 2016 and February 2019, 147 patients were included in the analysis. PGD was observed in 79 (54%) patients, 45 (31%) of whom had stage 3 PGD. Pre‐donation blood transfusion was administered in 48 (33%) donors (median of 3[1–9] packed red cells (PRCs)). On multivariate analysis, stage 3 PGD was significantly associated with donor blood transfusion (OR 2.69, IC (1.14–6.38), P = .024). Mortality at days 28 and 90 was not significantly different according to the pre‐donation transfusion status of the donor. Conclusion Pre‐donation blood transfusion is associated with stage 3 PGD occurrence after LT. Transfusion data of the donor should be included in donor lung assessment
ECMO support as a bridge to lung transplantation is an independent risk factor for bronchial anastomotic dehiscence
No full textBACKGROUND: Airway complications are frequent after lung transplantation (LT), as they affect up to 23% of recipients. The implication of perioperative extracorporeal membrane oxygenation (ECMO) support and haemodynamic instability has never been specifically assessed. The first aim of this study was to explore the impact of perioperative ECMO support on bronchial anastomotic dehiscence (BAD) at Day 90 after LT. METHODS: This prospective observational monocentric study analysed BAD in all consecutive patients who underwent LT in the Bichat Claude Bernard Hospital, Paris, France, between January 2016 and May 2019. BAD visible on bronchial endoscopy and/or tomodensitometry was recorded. A univariate analysis was performed (Fisher’s exacts and Mann–Whitney tests), followed by a multivariate analysis to assess independent risk factors for BAD during the first 90 days after LT (p < 0.05 as significant). The Paris North Hospitals Institutional Review Board approved the study. RESULTS: A total of 156 patients were analysed. BAD was observed in the first 90 days in 42 (27%) patients and was the main cause of death in 22 (14%) patients. BAD occurred during the first month after surgery in 34/42 (81%) patients. ECMO support was used as a bridge to LT, during and after surgery in 9 (6%), 117 (75%) and 40 (27%) patients, respectively. On multivariate analysis, ECMO as a bridge to LT (p = 0.04) and septic shock (p = 0.01) were independent risk factors for BAD. CONCLUSION: ECMO as a bridge to LT is an independent risk factor for BAD during the first 90 days after surgery. Close monitoring of bronchial conditions must be performed in these high-risk recipients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-022-02280-9
Massive intraoperative red blood cell transfusion during lung transplantation is strongly associated with 90-day mortality
No full textInternational audienceBackgroundThe effect of red blood cell (RBC) transfusion on mortality after lung transplantation (LT) was assessed in some retrospective studies, with contradictory results. The first aim of this study was to assess the 90-day survival of LT recipients according to massive intraoperative transfusion (MIOT).MethodsThis prospective, observational, single-centre study analysed the intraoperative transfusion (IOT) of all consecutive LT recipients between January 2016 and February 2019. MIOT was defined as transfusion of 5 RBC units or more. The results are presented as the median [IQR] and absolute numbers (proportions) and were analysed using χ2, Fisher, and Mann–Whitney tests (p < 0.05 as significance). Multivariate analyses were performed to identify independent risk factors for MIOT, 90-day and one-year mortality and grade 3 PGD at day 3. Ninety-day and one-year survivals were studied (Kaplan–Meier curves, log rank test). The Paris-North-Hospitals Institutional Review Board approved the study.ResultsOverall, 147 patients were included in the analysis, 27 (18%) of them received MIOT. In multivariate analysis, predictive factors of MIOT included preoperative ECMO support (p = 0.017), and bilateral LT (p = 0.023). The SOFA score on ICU admission after LT was higher in cases with MIOT (p < 0.001). MIOT was an independent risk factor for 90-days and one-year mortality (p = 0.002 and 0.008 respectively). The number of RBCs unit transfused during surgery was an independent risk factor for grade 3 PGD at day 3 (OR 1.14, 95% CI [1.00–1.29], p = 0.040).ConclusionIncreased preoperative severity of recipients predicts MIOT. MIOT is associated with increased early postoperative morbidity and mortality rates
