Long-term outcome in medical patients aged 80 or over following admission to an intensive care unit.

Introduction: The aim of this study was to evaluate factors influencing short- and long-term survival in medical patients aged 80 and over following admission to an intensive care unit.

Methods: All patients aged 80 years or over and admitted between 2001 and 2006 were included in this study. Survival was evaluated between the time of admission and June 2009; factors associated with mortality were determined.

The role of viruses in nosocomial pneumonia.

Purpose Of Review: The frequency and impact of viruses among intensive care unit (ICU) nonimmunocompromised patients remains controversial. This review analyzes their place as causal pathogens in ventilator-associated pneumonia, as well as their effects on ICU patients' outcomes.

Recent Findings: Herpesviruses, namely herpes simplex virus (HSV) and cytomegalovirus (CMV), are the most frequent viruses detected among nonimmunosuppressed ICU patients, as confirmed by recent prospective studies.

High levels of circulating leukocyte microparticles are associated with better outcome in acute respiratory distress syndrome.

Introduction: The current study has addressed the presence and the cellular origin of microparticles (MP) isolated from bronchoalveolar lavage (BAL) fluid and from blood samples from patients with acute respiratory distress syndrome (ARDS). Their prognostic interest was also investigated.

Methods: Fifty-two patients were included within the first 24 hours of ARDS.

[Ventilator-associated viral pneumonia].

Viral infections (especially respiratory infections) are not rare in critically ill non-immunocompromised patients. Efficient and rapid virologic diagnosis tests such as (PCR) are now widely available. Herpesviridae (herpes simplex virus and cytomegalovirus) are the most frequent viruses detected among non-immunocompromised patients admitted to the intensive care unit (ICU).

Neuromuscular blockers in early acute respiratory distress syndrome.

Background: In patients undergoing mechanical ventilation for the acute respiratory distress syndrome (ARDS), neuromuscular blocking agents may improve oxygenation and decrease ventilator-induced lung injury but may also cause muscle weakness. We evaluated clinical outcomes after 2 days of therapy with neuromuscular blocking agents in patients with early, severe ARDS.

Methods: In this multicenter, double-blind trial, 340 patients presenting to the intensive care unit (ICU) with an onset of severe ARDS within the previous 48 hours were randomly assigned to receive, for 48 hours, either cisatracurium besylate (178 patients) or placebo (162 patients).

Extracorporeal membrane oxygenation for severe influenza A (H1N1) acute respiratory distress syndrome: a prospective observational comparative study.

Purpose: To compare characteristics, clinical evolution and outcome in adult patients with influenza A (H1N1) acute respiratory distress syndrome (ARDS) treated with or without extracorporeal membrane oxygenation (ECMO).

Methods: A prospective observational study of patients treated in Marseille South Hospital from October 2009 to January 2010 for confirmed influenza A (H1N1)-related ARDS. Clinical features, pulmonary dysfunction and mortality were compared between patients treated with and without ECMO.

Detection of plant DNA in the bronchoalveolar lavage of patients with ventilator-associated pneumonia.

Background: Hospital-acquired infections such as nosocomial pneumonia are a serious cause of mortality for hospitalized patients, especially for those admitted to intensive care units (ICUs). Despite the number of the studies reported to date, the causative agents of pneumonia are not completely known. Herein, we found by molecular technique that vegetable and tobacco DNA may be detected in the bronchoalveolar lavage from patients with ventilator-associated pneumonia (VAP).

Advances in Mimivirus pathogenicity.

Viral diseases in the clinical setting have been extensively investigated. Viruses are now considered as potentially responsible for nosocomial infections, especially in intensive care unit (ICU) patients. Mimivirus is the largest virus known to date.

An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient: an international consensus conference in intensive care medicine.

Objectives: To address the issues of Prevention and Management of Acute Renal Failure in the ICU Patient, using the format of an International Consensus Conference.

Methods And Questions: Five main questions formulated by scientific advisors were addressed by experts during a 2-day symposium and a Jury summarized the available evidence: (1) Identification and definition of acute kidney insufficiency (AKI), this terminology being selected by the Jury; (2) Prevention of AKI during routine ICU Care; (3) Prevention in specific diseases, including liver failure, lung Injury, cardiac surgery, tumor lysis syndrome, rhabdomyolysis and elevated intraabdominal pressure; (4) Management of AKI, including nutrition, anticoagulation, and dialysate composition; (5) Impact of renal replacement therapy on mortality and recovery.

Results And Conclusions: The Jury recommended the use of newly described definitions.

Microbiogical data, but not procalcitonin improve the accuracy of the clinical pulmonary infection score.

Objective: Early and adequate treatment of ventilator-associated pneumonia (VAP) is mandatory to improve the outcome. The aim of this study was to evaluate, in medical ICU patients, the respective and combined impact of the Clinical Pulmonary Infection Score (CPIS), broncho-alveolar lavage (BAL) gram staining, endotracheal aspirate and a biomarker (procalcitonin) for the early diagnosis of VAP.

Design: Prospective, observational study

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

Tropheryma whipplei in patients with pneumonia.

Tropheryma whipplei is the etiologic pathogenic agent of Whipple disease (WD), characterized by various clinical signs, such as diarrhea, weight loss, lymphadenopathy, and polyarthritis. PCR-based methods for diagnosis of WD have been developed. T.

Pulmonary capillary blood flow and cardiac output measurement by partial carbon dioxide rebreathing in patients with acute respiratory distress syndrome receiving lung protective ventilation.

Background: Partial carbon dioxide rebreathing noninvasively measures the pulmonary capillary blood flow and estimates the cardiac output with the use of a predicted shunt value. It has been reported that the accuracy of the method is decreased in patients with high pulmonary shunt. The aim of this study was to investigate the agreement between partial rebreathing and thermodilution for the determination of pulmonary capillary blood flow and cardiac output in the setting of acute respiratory distress syndrome.

Active cytomegalovirus infection is common in mechanically ventilated medical intensive care unit patients.

Objective: To assess the incidence, risk factors, and outcome of active cytomegalovirus (CMV) infection in nonimmunosuppressed intensive care unit (ICU) patients.

Design: Prospective epidemiologic study.

Setting: A medical ICU in a university hospital.

Bacterial ventilator-associated pneumonia: bronchoalveolar lavage results are not influenced by dilution.

Objective: This study was designed to determine if bronchoalveolar lavage (BAL) quantitative culture results can be used confidently for the diagnosis of bacterial ventilator-associated pneumonia (VAP) without taking dilution into account.

Design: Prospective observational cohort study.

Setting: A 12-bed medical ICU in a teaching hospital.

Paralytics in critical care: not always the bad guy.

Purpose Of Review: The use of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS) and acute lung injury remains controversial, although frequent. This review analyzes the effects of NMBAs on thoracopulmonary mechanics, gas exchange, patient outcome and their potential adverse effects.

Recent Findings: NMBAs are used in 25-45% of acute lung injury/ARDS patients for a mean period of 12 days, especially in severe ARDS.

Non-invasive ventilation for treatment of postoperative respiratory failure after oesophagectomy.

Background: The aim of this case-control study was to compare the efficacy of non-invasive positive pressure ventilation (NPPV) with that of conventional treatment in patients who develop postoperative acute respiratory failure (ARF) after oesophagectomy.

Methods: Thirty-six consecutive patients with ARF treated by NPPV were matched for diagnosis, age within 5 years, sex, preoperative radiochemotherapy and Charlson co-morbidity index with 36 patients who received conventional treatment (control group).

Results: NPPV was associated with a lower reintubation rate (nine versus 23 patients; P = 0.

FIO2 and acute respiratory distress syndrome definition during lung protective ventilation.

Objective: PaO2/FIO2 ratio (P/F) is the marker of hypoxemia used in the American-European Consensus Conference on lung injury. A high FIO2 level has been reported to variably alter PaO2/FIO2. We investigated the effect of high FIO2 levels on the course of P/F in lung protective mechanically ventilated patients with acute respiratory distress syndrome.

Clinical significance of a positive serology for mimivirus in patients presenting a suspicion of ventilator-associated pneumonia.

Objective: A seroconversion to mimivirus has been observed in patients with community-acquired or nosocomial pneumonia. The aim of this study was to determine whether a positive serology for mimivirus was associated with increased morbidity and mortality in patients with a suspicion of ventilator-associated pneumonia (VAP).

Design: Prospective matched-cohort study.

Role of proinflammatory activity contained in gastric juice from intensive care unit patients to induce lung injury in a rabbit aspiration model.

Objective: Although aspiration pneumonitis is a severe complication in patients hospitalized in intensive care units, its pathogenesis is poorly understood. The aim of this study was to determine whether the intensity of lung injury and inflammation developing after aspiration during mechanical ventilation differed depending on the inflammatory activity of intensive care unit patients' gastric fluid.

Design: In vitro study on human gastric juice and randomized controlled animal study.

Effect of hypertonic saline pre-treatment on ischemia-reperfusion lung injury in pig.

Background: Hypertonic saline may be administered in the setting of lung transplantation but may affect the development of ischemia-reperfusion lung injury. This study investigated the effects of the pre-treatment by intravenous hypertonic saline in a pig model of single lung ischemia-reperfusion.

Methods: Forty-three pigs (34 +/- 4 kg) under mechanical ventilation were randomly assigned to a left lung ischemia-reperfusion alone or preceded by 4-ml/kg 7.

Airway colonisation and postoperative pulmonary complications after neoadjuvant therapy for oesophageal cancer.

Objective: To evaluate the clinical relevance of preoperative airway colonisation in patients undergoing oesophagectomy for cancer after a neoadjuvant chemoradiotherapy.

Methods: From 1998 to 2005, 117 patients received neoadjuvant chemoradiotherapy for advanced stage oesophageal cancer. Among them, 45 non-randomised patients underwent a bronchoscopic bronchoalveolar lavage (BAL group) prior to surgery to assess airways colonisation.

Role of open-lung biopsy in acute respiratory distress syndrome.

Purpose Of Review: When classic examinations such as bronchoalveolar lavage are not contributory in the etiologic diagnosis of unresolving acute respiratory distress syndrome, surgical lung biopsy would appear to be useful to determine the specific cause, particularly infection or postaggressive fibrosis, which could benefit from an adapted treatment.

Recent Findings: Postaggressive pulmonary fibrosis is a possible evolution for unresolving acute respiratory distress syndrome and its association with a poor prognosis has been demonstrated. The administration of corticoids would make it possible to improve certain ventilatory parameters as well as the prognosis in the fibroproliferation stage.