Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit.

Objective: To determine the risk factors for catheter-associated urinary tract infection in a polyvalent intensive care unit (ICU).

Design And Setting: Prospective cohort study in a 16-bed polyvalent ICU in a French university hospital.

Interventions: Prospective patient surveillance of patients included in two successive studies of two urine drainage systems.

Safety of sedation with ketamine in severe head injury patients: comparison with sufentanil.

Objective: The aim of the study was to compare the safety concerning cerebral hemodynamics of ketamine and sufentanil used for sedation of severe head injury patients, both drugs being used in combination with midazolam.

Design: Prospective, randomized, double-blind study.

Setting: Intensive care unit in a trauma center.

Comparison of effectiveness of two urinary drainage systems in intensive care unit: a prospective, randomized clinical trial.

Objective: In a previous non-randomized study, we demonstrated that no difference occurred in the rate of acquisition of bacteriuria between a complex closed drainage system (CCDS) and a two-chamber drainage system (TCDS) in patients in an intensive care unit (ICU). To confirm this result, we performed a randomized, prospective, and powerful study assessing the effectiveness of the CCDS and the TCDS in ICU patients.

Design: Randomized, prospective, and controlled study.

Comparison of effectiveness of two urinary drainage systems in intensive care unit: a prospective, randomized clinical trial.

Objective: In a previous nonrandomized study we observed no difference in the rate of acquisition of bacteriuria between a complex closed drainage system (CCDS) and a two-chamber drainage system (TCDS) in ICU patients. To confirm this result we performed a statistically powerful study assessing the effectiveness of the CCDS and the TCDS in ICU patients.

Design And Setting: Randomized, prospective, and controlled study in the medicosurgical intensive care unit (16 beds) in a teaching hospital.

Empirical antimicrobial therapy of septic shock patients: adequacy and impact on the outcome.

Objective: To assess the adequacy of empirical antimicrobial therapy prescribed in septic shock patients and to evaluate the relationship between inadequate antimicrobial therapy and 30-day mortality.

Design: Prospective observational study.

Setting: Medical-surgical (16-bed) intensive care unit in an urban teaching hospital.

Microembolization during carotid stenting with the distal-balloon antiemboli system.

Background: The distal-balloon protection system is being evaluated for its efficacy in preventing embolic neurological events during carotid stenting (CAS). We sought to determine the effect of this system on the frequency of the Doppler-detected microembolic signals (MES) during CAS.

Methods: Using transcranial Doppler, we compared the frequency of MES during CAS in 2 groups; 39 patients without distal protection and 37 with the distal-balloon protection system (GuardWire, Percusurge, Sunnyville, CA).

Positive inotropic stimulation.

Adrenergic receptors transduce signals through the G proteins to regulate cardiac function. The catecholamines, via alpha- and beta-adrenergic receptor (beta-AR) stimulation, may play a role in the development of heart failure. Norepinephrine and isoproterenol can induce cardiac myocyte apoptosis.

Influence on outcome of ventilator-associated pneumonia in multiple trauma patients with head trauma treated with selected digestive decontamination.

Objective: Ventilator-associated pneumonia is said to be associated with an increased mortality or a prolonged intensive care unit stay. In multiple trauma, the use of selective digestive decontamination has been reported to decrease morbidity and mortality associated with pneumonia. We performed a study to evaluate the attributable morbidity and mortality of ventilator-associated pneumonia in multiple trauma patients with head trauma treated with selective digestive decontamination.

Role of glycopeptides in the treatment of septic complications after cardiac surgery.

Agents like Staphylococcus epidermidis and Staphylococcus aureus are common agents in both early and late prosthetic valve endocarditis (PVE). Streptococci, especially vividans and enterococci are more apt to occur late. Diphtheroids and gram-negative bacteria are also frequent in early and late PVE.

Randomized clinical trial of extended use of a hydrophobic condenser humidifier: 1 vs. 7 days.

Objective: To determine whether extended use (7 days) would affect the efficiency on heat and water preservation of a hydrophobic condenser humidifier as well as the rate of ventilation-acquired pneumonia, compared with 1 day of use.

Design: Prospective, controlled, randomized, not blinded, clinical study.

Setting: Twelve-bed intensive care unit of a university hospital.

Prevention of nosocomial urinary tract infection in ICU patients: comparison of effectiveness of two urinary drainage systems.

Study Objectives: To determine whether the rate of acquisition of bacteriuria differs between the use of a complex closed drainage system (CCDS) with a preattached catheter, antireflux valve, drip chamber, and povidone-iodine releasing cartridge, and a two-chamber open drainage system (TCOS) in ICU patients.

Design: Prospective, nonrandomized, controlled trial.

Setting: Medical/surgical/trauma ICU in a university hospital.

Measurement of tracheal temperature is not a reliable index of total respiratory heat loss in mechanically ventilated patients.

Background: Minimizing total respiratory heat loss is an important goal during mechanical ventilation. The aim of the present study was to evaluate whether changes in tracheal temperature (a clinical parameter that is easy to measure) are reliable indices of total respiratory heat loss in mechanically ventilated patients.

Method: Total respiratory heat loss was measured, with three different methods of inspired gas conditioning, in 10 sedated patients.

Changing heat and moisture exchangers after 96 hours rather than after 24 hours: a clinical and microbiological evaluation.

Objective: The aim of this study was to determine whether changing heat and moisture exchangers (HMEs) every 96 hrs rather than 24 hrs would affect their efficacy to preserve the heat and moisture of inspiratory gases. The impact of a prolonged use of the HME on its microbial colonization was also assessed.

Design: Prospective cohort observational study.

Effect of norepinephrine on the outcome of septic shock.

Objective: Despite increasingly sophisticated critical care, the mortality of septic shock remains elevated. Accordingly, care remains supportive. Volume resuscitation combined with vasopressor support remains the standard of care as adjuvant therapy, and many consider dopamine to be the pressor of choice.

Cerebrospinal fluid penetration and pharmacokinetics of vancomycin administered by continuous infusion to mechanically ventilated patients in an intensive care unit.

Cerebrospinal fluid (CSF) penetration and the pharmacokinetics of vancomycin were studied after continuous infusion (50 to 60 mg/kg of body weight/day after a loading dose of 15 mg/kg) in 13 mechanically ventilated patients hospitalized in an intensive care unit. Seven patients were treated for a sensitive bacterial meningitis and the other six patients, who had a severe concomitant neurologic disease with intracranial hypertension, were treated for various infections. Vancomycin CSF penetration was significantly higher (P < 0.

Upper-extremity deep vein thrombosis after central venous catheterization via the axillary vein.

Objective: To determine the frequency of central venous catheter-induced thrombosis of the axillary vein.

Design: Prospective, controlled study.

Setting: Tertiary care university center.

Effects of norepinephrine plus dobutamine or norepinephrine alone on left ventricular performance of septic shock patients.

Objective: To determine the hemodynamic effects of the combination of norepinephrine-dobutamine in adult patients with septic shock. Specifically, we tested the hypothesis that norepinephrine in addition to dobutamine would improve cardiac index (CI) and stroke volume index (SVI) and increase left-ventricular afterload.

Design: Prospective, descriptive, interventional study with no control group.

Do the components of heat and moisture exchanger filters affect their humidifying efficacy and the incidence of nosocomial pneumonia?

Objectives: To compare the efficiency of two heat and moisture exchange filters (HMEFs) of different compositions of the humidifying capacity and the rate of bronchial colonization and ventilator-associated pneumonia in patients in the intensive care unit (ICU).

Design: Prospective, randomized study.

Setting: ICU of a university hospital.

Sufentanil, fentanyl, and alfentanil in head trauma patients: a study on cerebral hemodynamics.

Objectives: To determine the effects of bolus injection and infusion of sufentanil, alfentanil, and fentanyl on cerebral hemodynamics and electroencephalogram activity in patients with increased intracranial pressure (ICP) after severe head trauma.

Design: Randomized, unblended, crossover study.

Setting: Intensive care unit and trauma center in a university hospital.

Comparing two heat and moisture exchangers, one hydrophobic and one hygroscopic, on humidifying efficacy and the rate of nosocomial pneumonia.

Objective: Many heat and moisture exchangers with filter (HMEF) have been developed. In-house data from companies provide some information about their performances; unfortunately, to our knowledge, no comparative evaluation in clinical conditions has been undertaken of these newer products. The aim of this study was to compare the efficiency of two HMEFs, one hydrophobic and one hygroscopic, on humidifying capacity and the rate of bronchial colonization and ventilator-associated pneumonia in ICU patients.

Preservation of humidity and heat of respiratory gases in spontaneously breathing, tracheostomized patients.

Background: Ventilation with endotracheal intubation bypasses the upper airway and the normal heat and moisture exchanging process of inspired gases. A continuous loss of moisture and heat occurs and predisposes patients to serious airway damage. We therefore prospectively studied one heated humidifier system, one cold humidifier system and one heat and moisture exchanger in spontaneously breathing, tracheostomized intensive care unit patients to determine the ability to preserve patients' heat and water.

Comparison of concentrations of sulbactam-ampicillin administered by bolus injections or bolus plus continuous infusion in tissues of patients undergoing colorectal surgery.

The concentrations of sulbactam and ampicillin were determined in sera and different abdominal tissues of 16 patients who underwent elective colorectal surgery. Patients were randomly allocated to two groups. At the time of induction of anesthesia, patients in group 1 (eight patients) were given 1,000 mg of sulbactam with 2,000 mg of ampicillin by intravenous bolus injection (3 min).

A prospective evaluation of the use of femoral venous catheters in critically ill adults.

Objective: To determine the rate of complications following the use of femoral catheters in adults.

Design: Prospective survey of major and minor complications.

Setting: A mixed medical/surgical intensive care unit (ICU) in a university hospital.

Lower extremity deep vein thrombosis: a prospective, randomized, controlled trial in comatose or sedated patients undergoing femoral vein catheterization.

Objectives: To determine the rate of lower extremity deep vein thrombosis after the use of femoral catheters in intensive care unit (ICU) comatose or sedated adults. Results were then compared with results of patients undergoing superior vena cava catheterization.

Design: Prospective, randomized, controlled, unblinded study.