Personal decision-making criteria related to seasonal and pandemic A(H1N1) influenza-vaccination acceptance among French healthcare workers.

Background: Influenza-vaccination rates among healthcare workers (HCW) remain low worldwide, even during the 2009 A(H1N1) pandemic. In France, this vaccination is free but administered on a voluntary basis. We investigated the factors influencing HCW influenza vaccination.

Interest of a simple on-line screening registry for measuring ICU burden related to an influenza pandemic.

Introduction: The specific burden imposed on Intensive Care Units (ICUs) during the A/H1N1 influenza 2009 pandemic has been poorly explored. An on-line screening registry allowed a daily report of ICU beds occupancy rate by flu infected patients (Flu-OR) admitted in French ICUs.

Methods: We conducted a prospective inception cohort study with results of an on-line screening registry designed for daily assessment of ICU burden.

Acute Kidney Injury Network definition of contrast-induced nephropathy in the critically ill: incidence and outcome.

Introduction: Contrast-induced nephropathy (CIN) has been extensively studied in the ward but only scarcely in intensive care unit (ICU) patients, even if they may be particularly prone to develop or to worsen acute kidney insufficiency. We aimed to measure the incidence of CIN in a large ICU population using the Acute Kidney Injury Network (AKIN) definition and to investigate its impact on patients' outcome.

Methods: In this 3-year retrospective study, we included all patients undergoing, during their stay in our medical ICU, a contrast media-enhanced computed tomographic scan.

Respiratory pulse pressure variation fails to predict fluid responsiveness in acute respiratory distress syndrome.

Introduction: Fluid responsiveness prediction is of utmost interest during acute respiratory distress syndrome (ARDS), but the performance of respiratory pulse pressure variation (ΔRESPPP) has scarcely been reported. In patients with ARDS, the pathophysiology of ΔRESPPP may differ from that of healthy lungs because of low tidal volume (Vt), high respiratory rate, decreased lung and sometimes chest wall compliance, which increase alveolar and/or pleural pressure. We aimed to assess ΔRESPPP in a large ARDS population.

Important questions asked by family members of intensive care unit patients.

Objectives: Relatives often lack important information about intensive care unit patients. High-quality information is crucial to help relatives overcome the often considerable situational stress and to acquire the ability to participate in the decision-making process, most notably regarding the appropriate level of care. We aimed to develop a list of questions important for relatives of patients in the intensive care unit.

Long-term impact of a multifaceted prevention program on ventilator-associated pneumonia in a medical intensive care unit.

Background: Ventilator-associated pneumonia (VAP), the most common hospital-acquired infection in intensive care units, increases mortality and health care costs. We describe the long-term impact of a multifaceted program for decreasing VAP rates that markedly improved compliance with 8 targeted preventive measures.

Methods: We compared VAP rates during a 45-month baseline period and a 30-month intervention period in a cohort of patients who received mechanical ventilation for > 48 h.

Screening and decolonization: does methicillin-susceptible Staphylococcus aureus hold lessons for methicillin-resistant S. aureus?

Methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) have few structural differences, but their epidemiologies differ profoundly in terms of colonization, infection, and transmission. We compare strategies for controlling hospital infection due to MSSA and MRSA.

Changes in knowledge, beliefs, and perceptions throughout a multifaceted behavioral program aimed at preventing ventilator-associated pneumonia.

Purpose: Prevention of ventilator-associated pneumonia (VAP) requires a complex approach that should include factors affecting healthcare workers' (HCWs) behavior. This study attempted to assess change of individual factors throughout a multifaceted program focusing on VAP prevention.

Methods: The prevention program involved all HCWs in a 20-bed medical intensive care unit (ICU) and included a multidisciplinary task force, an educational session, direct observations and performance feedback, technical improvements, and reminders.

Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program.

Background: The Assistance Publique-Hôpitaux de Paris (AP-HP) institution administers 38 teaching hospitals (23 acute care and 15 rehabilitation and long-term care hospitals; total, 23 000 beds) scattered across Paris and surrounding suburbs in France. In the late 1980s, the proportion of methicillin resistance among clinical strains of Staphylococcus aureus (MRSA) reached approximately 40% at AP-HP.

Methods: A program aimed at curbing the MRSA burden was launched in 1993, based on passive and active surveillance, barrier precautions, training, and feedback.

Central venous pressure measurements improve the accuracy of leg raising-induced change in pulse pressure to predict fluid responsiveness.

Purpose: Passive leg raising (PLR) is a maneuver performed to test the cardiac Frank-Starling mechanism. We assessed the influence of PLR-induced changes in preload on the performance of PLR-induced change in pulse pressure (Delta(PLR)PP) and cardiac output (Delta(PLR)CO) for fluid responsiveness prediction.

Methods: Sedated, nonarrhythmic patients with persistent shock were included in this prospective multicenter study.

Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial.

Background: Reduced duration of antibiotic treatment might contain the emergence of multidrug-resistant bacteria in intensive care units. We aimed to establish the effectiveness of an algorithm based on the biomarker procalcitonin to reduce antibiotic exposure in this setting.

Methods: In this multicentre, prospective, parallel-group, open-label trial, we used an independent, computer-generated randomisation sequence to randomly assign patients in a 1:1 ratio to procalcitonin (n=311 patients) or control (n=319) groups; investigators were masked to assignment before, but not after, randomisation.

A multifaceted program to prevent ventilator-associated pneumonia: impact on compliance with preventive measures.

Objective: To determine the effect of a 2-yr multifaceted program aimed at preventing ventilator-acquired pneumonia on compliance with eight targeted preventive measures.

Design: Pre- and postintervention observational study.

Setting: A 20-bed medical intensive care unit in a teaching hospital.

Tracking hypotension and dynamic changes in arterial blood pressure with brachial cuff measurements.

Background: Arterial cannulation is strongly recommended during shock. Nevertheless, this procedure is associated with significant risks and may delay other emergent procedures. We assessed the discriminative power of brachial cuff oscillometric noninvasive blood pressure (NIBP) for identifying patients with an invasive mean arterial blood pressure (MAP) below 65 mm Hg or increasing their invasive MAP after cardiovascular interventions.

French national program for prevention of healthcare-associated infections and antimicrobial resistance, 1992-2008: positive trends, but perseverance needed.

Objective: To describe the French program for the prevention of healthcare-associated infections and antibiotic resistance and provide results for some of the indicators available to evaluate the program. In addition to structures and process indicators, the 2 outcome indicators selected were the rate of surgical site infection and the proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates among the S. aureus isolates recovered.

Early organ dysfunction course, cooling time and outcome in classic heatstroke.

Purpose: To describe the course of early organ dysfunction in a cohort of patients admitted in ICU suffering classic heatstroke.

Methods: Prospective observational single-centre cohort study with a 1-year follow-up.

Interventions: None.

Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006).

Objective: To describe the evolving epidemiology, management, and risk factors for death of invasive Candida infections in intensive care units (ICUs).

Design: Prospective, observational, national, multicenter study.

Setting: One hundred eighty ICUs in France.

Circumstances of death in hospitalized patients and nurses' perceptions: French multicenter Mort-a-l'Hôpital survey.

Background: In developed countries at present, death mostly occurs in hospitals, but the circumstances and factors associated with the quality of organization and care surrounding death are not well described.

Methods: We designed a large multicenter cross-sectional study to analyze the setting and clinical course of each patient on the day of death. We included 2750 clinical departments of 294 hospitals.

Acute disseminated encephalomyelitisin the intensive care unit:clinical features and outcome of 20 adults.

Objective: Because acute disseminated encephalomyelitis (ADEM) is a rare disease in adults admitted to the intensive care unit (ICU), we describe its characteristics and patient outcomes.

Design And Setting: A retrospective (2000-2006), observational, multicenter study was conducted in seven medical ICUs. Clinical, biological and neuroimaging features of patients diagnosed with ADEM were evaluated.

Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units.

Objective: To evaluate the effectiveness of screening strategy and contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA).

Design And Setting: Prospective observational cohort from 1 February 1995 to 31 December 2001 in three intensive care units (45 beds) in a French teaching hospital.

Patients: 8,548 patients admitted to the three ICUs had nasal screening on ICU admission and weekly thereafter.

High prevalence of carriage of methicillin-resistant Staphylococcus aureus at hospital admission in elderly patients: implications for infection control strategies.

Background: Despite contact isolation precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA), MRSA infections are increasing in many countries.

Objective: To evaluate the role of a potential unrecognized reservoir of MRSA carried by patients in acute care wards, we determined the prevalence of MRSA at hospital admission, with special emphasis on screening-specimen yields.

Setting: A 1100-bed teaching hospital in Paris, France.

Infective endocarditis in the intensive care unit: clinical spectrum and prognostic factors in 228 consecutive patients.

Objective: To identify factors associated with in-hospital outcome of adult patients admitted to the ICU with infective endocarditis (IE).

Design And Setting: Retrospective study performed in the two medical ICUs of a teaching hospital.

Patients And Participants: The charts of all 228 consecutive patients aged 18 years or older admitted with infective IE between January 1993 and December 2000 were reviewed.

Impact of HAART advent on admission patterns and survival in HIV-infected patients admitted to an intensive care unit.

Background: Several studies found increased survival times and decreased hospitalization rates since the introduction of highly active antiretroviral therapy (HAART).

Objective: To examine the impact of HAART on admission patterns and survival of HIV-infected patients admitted to an intensive care unit (ICU).

Design: Prospective observational cohort study.

Characteristics and outcomes of HIV-infected patients in the ICU: impact of the highly active antiretroviral treatment era.

Objective: To examine whether the introduction of highly active antiretroviral therapy (HAART) has changed the rate of admission, the clinical spectrum, and the mortality of HIV-infected ICU patients.

Design: Observational study.

Setting: Infectious diseases ICU in a teaching hospital, Paris, France.

[Non tuberculous mycobacterial diseases].

Mycobacteria species other than members of Mycobacterium tuberculosis complex are called non tuberculous mycobacteria (NTM) or "atypical" mycobacteria. To date, about 80 mycobacterial species have been described. They are usually opportunistic pathogens with variable degrees of virulence.