Risk factors and prognostic significance of infection of totally implantable vascular access port in solid tumor patients: A prospective cohort study.

Objectives: Totally implantable venous access ports (TIVAP) are devices mainly used to deliver antineoplastic chemotherapies, of which the insertion may be complicated by TIVAP-related infection (TIVAP-RI). This study aims to provide data on the risk factors for TIVAP-RI and its influence on patient prognosis.

Patients And Methods: Prospective observational study including adult patients with solid tumors, in whom a TIVAP was inserted to deliver antineoplastic chemotherapy between January 2018 and October 2019.

Pain and dyspnea control during awake fiberoptic bronchoscopy in critically ill patients: safety and efficacy of remifentanil target-controlled infusion.

Purpose: Flexible fiberoptic bronchoscopy is frequently used in intensive care unit, but is a source of discomfort, dyspnea and anxiety for patients. Our objective was to assess the feasibility and tolerance of a sedation using remifentanil target-controlled infusion, to perform fiberoptic bronchoscopy in awake ICU patients.

Materials, Patients And Methods: This monocentric, prospective observational study was conducted in awake patients requiring fiberoptic bronchoscopy.

Morpho-functional evaluation of lung aeration as a marker of sickle-cell acute chest syndrome severity in the ICU: a prospective cohort study.

Background: Acute chest syndrome (ACS) is the main cause of morbi-mortality in patients with sickle-cell disease in the intensive care unit (ICU). ACS definition encompasses many types of lung damage, making early detection of the most severe forms challenging. We aimed to describe ACS-related lung ultrasound (LU) patterns and determine LU performance to assess ACS outcome.

Disparity of the "screen-and-isolate" policy for multidrug-resistant organisms: A national survey in French adult ICUs.

Background: The prevalence of multidrug-resistant organisms (MDROs) has dramatically increased. The aim of this survey was to describe and analyze the different screening and isolation policies regarding MDROs in French adult intensive care units (ICUs).

Materials And Methods: A multicenter online survey was performed among French ICUs, including 63 questions distributed into 4 parts: characteristics of the unit, MDRO screening policy, policy regarding contact precautions, and ecology of the unit.

Evaluation of early antimicrobial therapy adaptation guided by the BetaLACTA® test: a case-control study.

Background: Rapid diagnostic tests detecting microbial resistance are needed for limiting the duration of inappropriateness of empirical antimicrobial therapy (EAT) in intensive care unit patients, besides reducing the use of broad-spectrum antibiotics. We hypothesized that the betaLACTA® test (BLT) could lead to early increase in the adequacy of antimicrobial therapy.

Methods: This was a case-control study.

Universal versus targeted additional contact precautions for multidrug-resistant organism carriage for patients admitted to an intensive care unit.

Background: Although additional contact precautions (ACPs) are routinely used to reduce cross-transmission of multidrug-resistant organisms (MDROs), the relevance of isolation precautions remains debated. We hypothesized that the collection of recognized risk factors for MDRO carriage on intensive care unit (ICU) admission might be helpful to target ACPs without increasing MDRO acquisition during ICU stays, compared with universal ACPs.

Materials And Methods: This is a sequential single-center observational study performed in consecutive patients admitted to a French medical and surgical ICU.

The risk of atrial fibrillation after pneumonectomy is not impaired by preoperative administration of dexamethasone. A cohort study.

Introduction: Atrial fibrillation (AF) is one of the most frequent complications occurring after thoracic surgery especially after lung resection. It is associated with an increase in postoperative morbidity and mortality. Recent data having documented the preventive role of corticosteroids on the occurrence of AF in cardiac surgery, we sought to evaluate the effect of preoperative administration of dexamethasone on the incidence of AF after pneumonectomy.

The Challenging Diagnosis of Non-Community-Acquired Pneumonia in Non-Mechanically Ventilated Subjects: Value of Microbiological Investigation.

Background: Early recognition and an attempt at obtaining microbiological documentation are recommended in patients with non-community-acquired pneumonia (NCAP), whether hospital-acquired (HAP) or health care-associated (HCAP). We aimed to characterize the clinical features and microbial etiologies of NCAP to assess the impact of microbiological investigation on their management.

Methods: This was a prospective 1-y study in a university hospital with 141 non-mechanically ventilated subjects suspected of having HAP (n = 110) or HCAP (n = 31).

Molecular characterization of DHA-1-producing Klebsiella pneumoniae isolates collected during a 4-year period in an intensive care unit.

Seventeen Klebsiella pneumoniae isolates producing DHA-1 β-lactamase were collected in an intensive care unit between 2006 and 2010. Molecular analysis revealed the predominance of ST48 and ST1263 clones of K. pneumoniae and the spread of DHA-1-encoding plasmids belonging to incompatibility group IncL/M or IncHI2.

[The law number 2005-370 of April 22, 2005 concerning the patients' rights at the end-of-life: improvement of the withholding and withdrawing treatment decision-making process by an educational program. A monocenter prospective and retrospective pilot study].

Objective: To assess the impact of an educational program on the quality of the end-of-life decision (EOLD).

Methods: Prospective study for 3 months in a surgical Intensive Care Unit (ICU) involving: staff training conferences and guidelines for documenting level-of-care staff conference; audit before and at 3 months; analysis of records for deceased patients. The main outcome measures the proportion of treatment-limitation in dying ICU patients; and the secondary outcomes the decision-making process and nurses' satisfaction.

Risk and protective factors for major complications after pneumonectomy for lung cancer.

Pneumonectomy carries a high-risk for postoperative complications. The aim of the study was to identify factors that may predispose to the development of major postoperative complications after pneumonectomy for lung cancer. All consecutive patients from January 2000 to December 2005 were retrospectively studied.

Immune status and apoptosis activation during brain death.

The present study evaluates the role of the inflammatory status and apoptosis activation in the development of organ dysfunction after brain death using plasma assays and macroarray analysis on skeletal muscle biopsies to look for evidence of remote tissue damage in two intensive care units in France and one in Belgium. As controls, we used patients undergoing hip surgery and healthy volunteers. Causes of brain death in the 85 consecutive patients included in the study were cardiac arrest (n = 29; 34%), stroke (n = 42; 49%, with 38 patients having hemorrhagic stroke), and head injury (n = 14; 17%).

Limitations of computed tomographic angiography in the diagnosis of brain death.

Objective: To evaluate the accuracy of cerebral computed tomographic angiography (CT-a) for the diagnosis of brain death (BD).

Design And Setting: Prospective observational study in intensive care units.

Patients: Twenty-one clinically BD patients enrolled over 12 months.

Diffuse large and small bowel necrosis in catastrophic antiphospholipid syndrome.

The catastrophic variant is an accelerated form of the antiphospholipid syndrome resulting in multiorgan failure because of multiple small vessel occlusions. We report a case of catastrophic antiphospholipid syndrome in a patient with subacute cutaneous lupus erythematosus and ischemic bowel, who presented with acute abdominal pain due to diffuse right colon and small bowel necrosis requiring large resection, associated with acute respiratory distress syndrome, thrombocytopenia and disseminated intravascular coagulation. Histopathological examination of resected tissues showed diffuse arteriolar and venous thrombosis but no vasculitis, and mesenteric artery lumen severely narrowed by intimal fibrosis.

Mortality prediction using SAPS II: an update for French intensive care units.

Introduction: The standardized mortality ratio (SMR) is commonly used for benchmarking intensive care units (ICUs). Available mortality prediction models are outdated and must be adapted to current populations of interest. The objective of this study was to improve the Simplified Acute Physiology Score (SAPS) II for mortality prediction in ICUs, thereby improving SMR estimates.