Extended-spectrum beta-lactamase--producing enterobacteriaceae in the intensive care unit: acquisition does not mean cross-transmission.

Background: In intensive care unit (ICU), infection and colonization by resistant Gram-negative bacteria increase costs, length of stay and mortality. Extended-spectrum beta-lactamase--producing Enterobacteriaceae (ESBL-E) is a group of pathogens increasingly encountered in ICU setting. Conditions that promote ESBL-E acquisition are not completely understood.

Multiplex PCR performed of bronchoalveolar lavage fluid increases pathogen identification rate in critically ill patients with pneumonia: a pilot study.

Background: In critically ill patients with pneumonia, accurate microorganism identification allows appropriate antibiotic treatment. In patients undergoing bronchoalveolar lavage (BAL), direct examination of the fluid using Gram staining provides prompt information but pathogen identification accuracy is low. Culture of BAL fluid is actually the reference, but it is not available before 24 to 48 h.

Improved prognosis of septic shock in patients with cirrhosis: a multicenter study*.

Objective: To determine the evolution of the outcome of patients with cirrhosis and septic shock.

Design: A 13-year (1998-2010) multicenter retrospective cohort study of prospectively collected data.

Setting: The Collège des Utilisateurs des Bases des données en Réanimation (CUB-Réa) database recording data related to admissions in 32 ICUs in Paris area.

Alteration of skin perfusion in mottling area during septic shock.

Background: Mottling score has been reported to be a strong predictive factor during septic shock. However, the pathophysiology of mottling remains unclear.

Methods: In patients admitted in ICU for septic shock, we measured on the same area the mean skin perfusion by laser Doppler, the mottling score, and variations of both indices between T1 (6 hours after vasopressors were started) and T2 (24 hours later).

Prediction of evolution toward brain death upon admission to ICU in comatose patients with spontaneous intracerebral hemorrhage using simple signs.

The aim of the study was to identify the predictors of brain death (BD) upon admission to the intensive care unit (ICU) of comatose patients with spontaneous intracerebral hemorrhage (ICH). Patients admitted in our ICU from 2002 to 2010 for spontaneous ICH and placed under mechanical ventilation were retrospectively analyzed. Of the 72 patients, 49% evolved to BD, 39% died after withdrawal of life support, and 12% were discharged alive.

Endotoxemia and mortality prediction in ICU and other settings: underlying risk and co-detection of gram negative bacteremia are confounders.

Introduction: The interdependence between endotoxemia, gram negative (GN) bacteremia and mortality has been extensively studied. Underlying patient risk and GN bacteremia types are possible confounders of the relationship.

Methods: Published studies with ≥ 10 patients in either ICU or non-ICU settings, endotoxemia detection by limulus assay, reporting mortality proportions and ≥ 1 GN bacteremia were included.

Comparison of superior vena cava and femoroiliac vein pressure according to intra-abdominal pressure.

Background: Previous studies have shown a good agreement between central venous pressure (CVP) measurements from catheters placed in superior vena cava and catheters placed in the abdominal cava/common iliac vein. However, the influence of intra-abdominal pressure on such measurements remains unknown.

Methods: We conducted a prospective, observational study in a tertiary teaching hospital.

Continuous insulin administration via complex central venous catheter infusion tubing is another risk factor for blood glucose imbalance. A retrospective study.

Background: We assessed the potential impact of infusion tubing on blood glucose imbalance in ICU patients given intensive insulin therapy (IIT). We compared the incidence of blood glucose imbalance in patients equipped, in a nonrandomized fashion, with either conventional tubing or with a multiport infusion device.

Methods: We retrospectively analyzed the nursing files of 35 patients given IIT through the distal line of a double-lumen central venous catheter.

Improvement in the prognosis of cirrhotic patients admitted to an intensive care unit, a retrospective study.

Objective: To examine how the outcomes of cirrhotic patients admitted to an ICU have changed over time.

Methods: A retrospective study in a medical ICU during two separate 3-year periods [period 1 (P1): 1995-1998 and period 2 (P2): 2005-2008].

Results: A total of 56 cirrhotic patients were admitted during P1 and 138 during P2, accounting for 2.

Femoral venous catheter: a misleading cause of gas in the liver.

Objectives: The presence of a femoral venous catheter could be associated with gas presence in the hepatic veins. This entity should be recognized to avoid a misdiagnosis of gas presence in the portal veins or in the biliary tract. Objectives are to assess: 1) the incidence of gas presence in the hepatic veins in intensive care unit patients explored by abdominal computed tomography scan; 2) the rate of gas presence in the liver in intensive care unit patients with a catheter inserted in the femoral vein; and 3) the specific imaging features.

Emerging severe and fatal infections due to Klebsiella pneumoniae in two university hospitals in France.

Severe infections caused by hypermucoviscous Klebsiella pneumoniae have been reported in Southeast Asian countries over the past several decades. This report shows their emergence in France, with 12 cases observed during a 2-year period in two university hospitals. Two clones (sequence type 86 [ST86] and ST380) of serotype K2 caused five rapidly fatal bacteremia cases, three of which were associated with pneumonia, whereas seven liver abscess cases were caused by K1 strains of ST23.

Colorimetric capnography, a new procedure to ensure correct feeding tube placement in the intensive care unit: an evaluation of a local protocol.

Purpose: Radiography is the criterion standard method to ensure correct placement of a feeding tube. Recently, excellent results were reported using a combination of colorimetric capnography and epigastric auscultation, but the impact of this technique has not been studied to date. Objectives were to assess whether our local procedure, using colorimetric capnography to ensure proper feeding tube placement, improves the patient's care, satisfies nurses, and decreases costs compared with the standard procedure requiring systematic radiography.

Cirrhotic patients in the medical intensive care unit: early prognosis and long-term survival.

Objectives: To reassess the prognosis of patients with cirrhosis admitted to the intensive care unit.

Design: A retrospective study in a medical intensive care unit in a teaching hospital in France.

Patients: All patients with cirrhosis without previous liver transplantation admitted in the period from 2005 to 2008.

Pleural ultrasound compared with chest radiographic detection of pneumothorax resolution after drainage.

Background: Pleural ultrasonography (PU) is more sensitive than chest radiograph (CXR) for diagnosing pneumothorax and could be useful for detecting resolution of pneumothorax after drainage. The aim of this prospective double-blind observational study was to assess PU accuracy during pneumothorax follow-up after drainage.

Methods: All patients hospitalized with pneumothorax requiring drainage were eligible.

TGF-beta activity protects against inflammatory aortic aneurysm progression and complications in angiotensin II-infused mice.

Complicated abdominal aortic aneurysm (AAA) is a major cause of mortality in elderly men. Ang II-dependent TGF-beta activity promotes aortic aneurysm progression in experimental Marfan syndrome. However, the role of TGF-beta in experimental models of AAA has not been comprehensively assessed.

Does nonadherence to local recommendations for empirical antibiotic therapy on admission to the intensive care unit have an impact on in-hospital mortality?

Objective: 1/ To evaluate if empirical antibiotic prescription on admission to our intensive care unit (ICU) respects the local recommendations for antibiotic prescription and to identify predictors of nonadherence to these guidelines. 2/ To assess whether nonadherence to the guidelines is associated with increased in-hospital mortality due to the initial infection.

Materials And Methods: This was a prospective six-month observational study performed in a 14-bed medical ICU.