French intensive care unit organisation

Léone, Marc; Constantin, Jean-Michel; Dahyot‐Fizelier, Claire; Duracher-Gout, Caroline; Joannès-Boyau, Olivier; Langeron, Olivier; Legrand, Matthieu; Mahjoub, Yazine; Mirek, Sébastien; Mrozek, Ségolène; Muller, Laurent; Orban, Jean-Christophe; Quesnel, Christophe; Roquilly, Antoine; Virat, Antoine; Capdevila, Xavier

doi:10.1016/j.accpm.2018.10.011

Cited by 45 publications

(23 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The medical records of patients who experienced S. maltophilia pneumonia from January 2012 to January 2017 were collected from 25 ICUs of the French Society of Anaesthesia & Intensive Care Medicine (SFAR) and AZUREA networks [8]. Participating centers and case-mixes are listed in Additional file 1.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Stenotrophomonas maltophilia hospital-acquired pneumonia in intensive care unit: a nationwide retrospective study

Guerci¹,

Bellut²,

Mokhtari³

et al. 2019

Crit Care

View full text Add to dashboard Cite

BackgroundThere is little descriptive data on Stenotrophomonas maltophilia hospital-acquired pneumonia (HAP) in critically ill patients. The optimal modalities of antimicrobial therapy remain to be determined. Our objective was to describe the epidemiology and prognostic factors associated with S. maltophilia pneumonia, focusing on antimicrobial therapy.MethodsThis nationwide retrospective study included all patients admitted to 25 French mixed intensive care units between 2012 and 2017 with hospital-acquired S. maltophilia HAP during intensive care unit stay. Primary endpoint was time to in-hospital death. Secondary endpoints included microbiologic effectiveness and antimicrobial therapeutic modalities such as delay to appropriate antimicrobial treatment, mono versus combination therapy, and duration of antimicrobial therapy.ResultsOf the 282 patients included, 84% were intubated at S. maltophilia HAP diagnosis for duration of 11 [5–18] days. The Simplified Acute Physiology Score II was 47 [36–63], and the in-hospital mortality was 49.7%. Underlying chronic pulmonary comorbidities were present in 14.1% of cases. Empirical antimicrobial therapy was considered effective on S. maltophilia according to susceptibility patterns in only 30% of cases. Delay to appropriate antimicrobial treatment had, however, no significant impact on the primary endpoint. Survival analysis did not show any benefit from combination antimicrobial therapy (HR = 1.27, 95%CI [0.88; 1.83], p = 0.20) or prolonged antimicrobial therapy for more than 7 days (HR = 1.06, 95%CI [0.6; 1.86], p = 0.84). No differences were noted in in-hospital death irrespective of an appropriate and timely empiric antimicrobial therapy between mono- versus polymicrobial S. maltophilia HAP (p = 0.273). The duration of ventilation prior to S. maltophilia HAP diagnosis and ICU length of stay were shorter in patients with monomicrobial S. maltophilia HAP (p = 0.031 and p = 0.034 respectively).ConclusionsS. maltophilia HAP occurred in severe, long-stay intensive care patients who mainly required prolonged invasive ventilation. Empirical antimicrobial therapy was barely effective while antimicrobial treatment modalities had no significant impact on hospital survival.Trial registrationclinicaltrials.gov, NCT03506191

show abstract

Section: Methodsmentioning

confidence: 99%

Outcomes of Stenotrophomonas maltophilia hospital-acquired pneumonia in intensive care unit: a nationwide retrospective study

Guerci¹,

Bellut²,

Mokhtari³

et al. 2019

Crit Care

View full text Add to dashboard Cite

show abstract

“…Written informed consent was obtained from all patients or from their relatives. The study was conducted between July 2017 and April 2018 in three polyvalent ICUs located in university hospitals from the AZUREA research network (https://www.azurea.org). The methodology followed the recommendations of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement .…”

Section: Methodsmentioning

confidence: 99%

Reliability of gastric suctioning compared with ultrasound assessment of residual gastric volume: a prospective multicentre cohort study

et al. 2019

View full text Add to dashboard Cite

We aimed to compare the reliability of aspiration via a nasogastric tube with ultrasound for assessment of residual gastric volume. Sixty-one adult patients who were mechanically ventilated and received continuous enteral feeding through a nasogastric tube for > 48 h were included. A first qualitative and quantitative ultrasound examination of the gastric antrum was followed by gastric suctioning, performed by an operator blinded to the result of the ultrasound examination. A second ultrasound examination was performed thereafter, followed by reinjection of the aspirated gastric contents (≤ 250 ml) into the stomach. A third ultrasound assessment was then immediately performed. If the suctioned volume was ≥ 250 ml, 250 mg erythromycin was infused over 30 min. A fourth ultrasound was performed 90 min after the third. Sixty (98%) patients had a qualitatively assessed full stomach at first ultrasound examination vs. 52 (85%) after gastric suctioning (p = 0.016). The calculated gastric volume significantly decreased after gastric suctioning, without a significant decrease in the number of patients with volume ≥ 250 ml. Four of the nine patients with calculated gastric volume ≥ 250 ml had vomiting within the last 24 h (p = 0.013). The antral cross-sectional area significantly decreased between the third and the fourth ultrasound examination (p = 0.015). Erythromycin infusion did not make a significant difference to gastric volume (n = 10). Our results demonstrate that gastric suctioning is not a reliable tool for monitoring residual gastric volume. Gastric ultrasound is a feasible and promising tool for gastric volume monitoring in clinical practice.

show abstract

“…Only six patients received additive use of non-steroidal anti-inflammatory drugs. Nursing care was provided continuously [26]. Intensivists were in a house for 24 h/7 days with rounds at 11 am, 6 pm, and 11 pm.…”

Section: Patient Managementmentioning

confidence: 99%

“…Intensivists were in a house for 24 h/7 days with rounds at 11 am, 6 pm, and 11 pm. Our ICU follows the organization of French ICUs [26].…”

Section: Patient Managementmentioning

confidence: 99%

Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: Circadian clock alterations were poorly reported in trauma patients, although they have a critical role in human physiology. Core body temperature is a clinical variable regulated by the circadian clock. Our objective was to identify the circadian temperature disruption in trauma patients and to determine whether these disruptions were associated with the 28-day mortality rate. Methods: A retrospective and observational single-center cohort study was conducted. All adult severe trauma patients admitted to the intensive care unit of Aix Marseille University, North Hospital, from November 2013 to February 2018, were evaluated. The variations of core body temperature for each patient were analyzed between days 2 and 3 after intensive care unit admission. Core body temperature variations were defined by three parameters: mesor, amplitude, and period. A logistic regression model was used to determine the variables influencing these three parameters. A survival analysis was performed assessing the association between core body temperature rhythm disruption and 28-day mortality rate. A post hoc subgroup analysis focused on the patients with head trauma. Results: Among the 1584 screened patients, 248 were included in this study. The period differed from 24 h in 177 (71%) patients. The mesor value (°C) was associated with body mass index and ketamine use. Amplitude (°C) was associated with ketamine use only. The 28-day mortality rate was 18%. For all trauma patients, age, body mass index, intracranial hypertension, and amplitude were independent risk factors. The patients with a mesor value < 36.9°C (p < 0.001) and an amplitude > 0.6°C (p < 0.001) had a higher 28-day mortality rate. Among the patients with head trauma, mesor and amplitude were identified as independent risk factors (HR = 0.40, 95% CI [0.23-0.70], p = 0.001 and HR = 4.73, 95% CI [1. 38-16.22], p = 0.01). Conclusions:Our results highlight an association between core body temperature circadian alteration and 28-day mortality rate. This association was more pronounced in the head trauma patients than in the non-head trauma patients. Further studies are needed to show a causal link and consider possible interventions.

show abstract

French intensive care unit organisation

Abstract: Intensive care, anaesthesia, pain, emergency and intensive care department, centre hospitalier universitaire Care´meau,

Cited by 45 publications

References 22 publications

Outcomes of Stenotrophomonas maltophilia hospital-acquired pneumonia in intensive care unit: a nationwide retrospective study

Outcomes of Stenotrophomonas maltophilia hospital-acquired pneumonia in intensive care unit: a nationwide retrospective study

Reliability of gastric suctioning compared with ultrasound assessment of residual gastric volume: a prospective multicentre cohort study

Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

Contact Info

Product

Resources

About