In patients with suspected VAP, Candida spp. airway colonization is frequent and associated with increased risk for MDR bacteria isolation. This could worsen outcome and should therefore be considered when choosing an empiric antibiotic therapy.

The implementation of an active, intensive communication strategy regarding end-of-life care in the ICU was associated with a significant reduction in the rate of burnout syndrome and depression in a stable population of caregiving staff.

This study shows for the first time that citrate lock reduced catheter complications and increased catheter life span as compared to saline lock in critically ill adults requiring hemodialysis.

Medical Education 2010: 44: 716–722 Objectives  What is the best way to train medical students early so that they acquire basic skills in cardiopulmonary resuscitation as effectively as possible? Studies have shown the benefits of high‐fidelity patient simulators, but have also demonstrated their limits. New computer screen‐based multimedia simulators have fewer constraints than high‐fidelity patient simulators. In this area, as yet, there has been no research on the effectiveness of transfer of learning from a computer screen‐based simulator to more realistic situations such as those encountered with high‐fidelity patient simulators. Methods  We tested the benefits of learning cardiac arrest procedures using a multimedia computer screen‐based simulator in 28 Year 2 medical students. Just before the end of the traditional resuscitation course, we compared two groups. An experiment group (EG) was first asked to learn to perform the appropriate procedures in a cardiac arrest scenario (CA1) in the computer screen‐based learning environment and was then tested on a high‐fidelity patient simulator in another cardiac arrest simulation (CA2). While the EG was learning to perform CA1 procedures in the computer screen‐based learning environment, a control group (CG) actively continued to learn cardiac arrest procedures using practical exercises in a traditional class environment. Both groups were given the same amount of practice, exercises and trials. The CG was then also tested on the high‐fidelity patient simulator for CA2, after which it was asked to perform CA1 using the computer screen‐based simulator. Performances with both simulators were scored on a precise 23‐point scale. Results  On the test on a high‐fidelity patient simulator, the EG trained with a multimedia computer screen‐based simulator performed significantly better than the CG trained with traditional exercises and practice (16.21 versus 11.13 of 23 possible points, respectively; p < 0.001). Conclusions  Computer screen‐based simulation appears to be effective in preparing learners to use high‐fidelity patient simulators, which present simulations that are closer to real‐life situations.

Intensive communication brings about quicker end-of-life decision-making in the ICU. The new law has the advantage of providing a legal framework.

Objectives: The aim was to assess the incidence of sink contamination by multidrug-resistant (MDR) Pseudomonas aeruginosa and Enterobacteriaceae, risk factors for sink contamination and splashing, and their association with clinical infections in the intensive care setting. Methods: A prospective French multicentre study (1 January to 30 May 2020) including in each intensive care unit (ICU) a point-prevalence study of sink contamination, a questionnaire of risk factors for sink contamination (sink use, disinfection procedure) and splashing (visible plashes, distance and barrier between sink and bed), and a 3-month prospective infection survey. Results: Seventy-three ICUs participated in the study. In total, 50.9% (606/1191) of the sinks were contaminated by MDR bacteria: 41.0% (110/268) of the sinks used only for handwashing, 55.3% (510/923) of those used for waste disposal, 23.0% (62/269) of sinks daily bleached, 59.1% (126/213) of those daily exposed to quaternary ammonium compounds (QACs) and 62.0% (285/460) of those untreated; 459 sinks (38.5%) showed visible splashes and 30.5% (363/1191) were close to the bed (<2 m) with no barrier around the sink. MDR-associated bloodstream infection incidence rates 0.70/1000 patient days were associated with ICUs meeting three or four of these conditions, i.e. a sink contamination rate 51%, prevalence of sinks with visible splashes 14%, prevalence of sinks close to the patient's bed 21% and no daily bleach disinfection (6/30 (20.0%) of the ICUs with none, one or two factors vs. 14/28 (50.0%) of the ICUs with three or four factors; p 0.016). Discussion: Our data showed frequent and multifactorial infectious risks associated with contaminated sinks in ICUs.

We imaged two patients who had silicone oil injected their vitreous cavities. The images demonstrated an increased chemical shift artifact. We developed and tested an in vitro silicone oil model in an attempt to explain this. To our knowledge, this artifact has not been previously described. We constructed a phantom using medication cups containing water, lard and two types of silicone. Background control baths of water and lard were used to simulate different local environments. The phantoms were imaged with T1-and T2-weighted and T1-weighted fat suppression sequences. The artifacts were due to the pronounced chemical shift of silicone in relation to intraconal fat. Our model accurately reproduced our clinical images. Spectral analysis of the silicone model revealed different resonating frequencies for fat/silicone, thereby explaining the pronounced chemical shift artifact.

Biofilm (BF) growth is believed to play a major role in the development of ventilator-associated pneumonia (VAP) in the intensive care unit. Despite concerted efforts to understand the potential implication of endotracheal tube (ETT)-BF dispersal, clinically relevant data are lacking to better characterize the impact of its mesostructure and microbiological singularity on the occurrence of VAP. We conducted a multicenter, retrospective observational study during the third wave of the COVID-19 pandemic, between March and May 2021. In total, 64 ETTs collected from 61 patients were included in the present BIOPAVIR study. Confocal microscopy acquisitions revealed two main morphological aspects of ETT-deposited BF: (1) a thin, continuous ribbon-shaped aspect, less likely monobacterial and predominantly associated with Enterobacter spp., Streptococcus pneumoniae or Viridans streptococci, and (2) a thicker, discontinuous, mushroom-shaped appearance, more likely characterized by the association of bacterial and fungal species in respiratory samples. The microbiological characterization of ETT-deposited BF found higher acquired resistance in more than 80% of analyzed BF phenotypes, compared to other colonization sites from the patient’s environment. These findings reveal BF as a singular microbiological compartment, and are of added clinical value, with a view to future ETT-deposited BF-based antimicrobial stewardship in critically ill patients. Trial registration NCT04926493. Retrospectively registered 15 June 2021.