Objective
To describe current use and diagnostic and therapeutic impacts of point-of-care ultrasound (POCUS) in the intensive care unit (ICU).
Background
POCUS is of growing importance in the ICU. ...Several guidelines recommend its use for procedural guidance and diagnostic assessment. Nevertheless, its current use and clinical impact remain unknown.
Methods
Prospective multicentric study in 142 ICUs in France, Belgium, and Switzerland. All the POCUS procedures performed during a 24-h period were prospectively analyzed. Data regarding patient condition and the POCUS procedures were collected. Factors associated with diagnostic and therapeutic impacts were identified.
Results
Among 1954 patients hospitalized during the study period, 1073 (55 %) POCUS/day were performed in 709 (36 %) patients. POCUS served for diagnostic assessment in 932 (87 %) cases and procedural guidance in 141 (13 %) cases. Transthoracic echocardiography, lung ultrasound, and transcranial Doppler accounted for 51, 17, and 16 % of procedures, respectively. Diagnostic and therapeutic impacts of diagnostic POCUS examinations were 84 and 69 %, respectively. Ultrasound guidance was used in 54 and 15 % of cases for central venous line and arterial catheter placement, respectively. Hemodynamic instability, emergency conditions, transthoracic echocardiography, and ultrasounds performed by certified intensivists themselves were independent factors affecting diagnostic or therapeutic impacts.
Conclusions
With regard to guidelines, POCUS utilization for procedural guidance remains insufficient. In contrast, POCUS for diagnostic assessment is of extensive use. Its impact on both diagnosis and treatment of ICU patients seems critical. This study identified factors associated with an improved clinical value of POCUS.
Our study aimed to explore the association between early hyperoxemia of the first 24 h on outcomes in patients with severe blunt chest trauma.
In a level I trauma center, we conducted a retrospective ...study of 426 consecutive patients. Hyperoxemic groups were classified in severe (average PaO2 ≥ 200 mmHg), moderate (≥150 and < 200 mmHg) or mild (≥ 100 and < 200 mmHg) and compared to control group (≥60 and < 100 mmHg) using a propensity score based analysis. The first endpoint was the incidence of a composite outcome including death and hospital-acquired pneumonia occurring from admission to day 28. The secondary endpoints were the incidence of death, the number of hospital-acquired pneumonia, mechanical ventilation-free days and intensive care unit-free day at day 28.
The incidence of the composite endpoint was lower in the severe hyperoxemia group(OR, 0.25; 95%CI, 0.09–0.73; P < 0.001) compared with control. The 28-day mortality incidence was lower in severe (OR, 0.23; 95%CI, 0.08–0.68; P < 0.001) hyperoxemia group (OR, 0.41; 95%CI, 0.17–0.97; P = 0.04). Significant association was found between hyperoxemia and secondary outcomes.
In our cohort early hyperoxemia during the first 24 h of admission after severe blunt chest trauma was not associated with worse outcome.
•Effect of hyperoxia remains unexplored in blunt chest trauma•Early hyperoxia may have an anti-bacterial and anti-inflammatory effect•Early hyperoxia is associated with lower incidence of pneumonia after chest trauma•Severe blunt chest trauma may benefit of early hyperoxia
Postoperative pulmonary complications are associated with increased morbidity. Identifying patients at higher risk for such complications may allow preemptive treatment.
Patients with an American ...Society of Anesthesiologists (ASA) score >1 and who were scheduled for major surgery of >2 hours were enrolled in a single-center prospective study. After extubation, lung ultrasound was performed after a median time of 60 minutes by 2 certified anesthesiologists in the postanesthesia care unit after a standardized tracheal extubation. Postoperative pulmonary complications occurring within 8 postoperative days were recorded. The association between lung ultrasound findings and postoperative pulmonary complications was analyzed using logistic regression models.
Among the 327 patients included, 69 (19%) developed postoperative pulmonary complications. The lung ultrasound score was higher in the patients who developed postoperative pulmonary complications (12 7-18 vs 8 4-12; P < .001). The odds ratio for pulmonary complications in patients who had a pleural effusion detected by lung ultrasound was 3.7 (95% confidence interval, 1.2-11.7). The hospital death rate was also higher in patients with pleural effusions (22% vs 1.3%; P < .001). Patients with pulmonary consolidations on lung ultrasound had a higher risk of postoperative mechanical ventilation (17% vs 5.1%; P = .001). In all patients, the area under the curve for predicting postoperative pulmonary complications was 0.64 (95% confidence interval, 0.57-0.71).
When lung ultrasound is performed precociously <2 hours after extubation, detection of immediate postoperative alveolar consolidation and pleural effusion by lung ultrasound is associated with postoperative pulmonary complications and morbi-mortality. Further study is needed to determine the effect of ultrasound-guided intervention for patients at high risk of postoperative pulmonary complications.
In patients with traumatic brain injury, coagulation disorders may both cause bleeding and thrombosis. The addition of risk factors, including invasive devices, probably increases the risk of ...complications. The benefit of using intravascular cooling device should be balanced by the risk to generate thrombosis. The use of routine ultrasound was associated with an incidental diagnosis of thrombus, accelerating the onset of curative anticoagulation.
Selective digestive decontamination (SDD) reduces the rate of infection and improves the outcomes of patients admitted to an intensive care unit (ICU). A risk associated with its use is the ...development of multi-drug-resistant organisms. We hypothesized that a 1-day reduction in systemic antimicrobial exposure in the SDD regimen would not affect the outcomes of our patients. In this before-and-after study design, 199 patients and 248 patients were included in a 3-day SDD group and a 2-day SDD group, respectively. The rates of hospital-acquired pneumonia and ICU infections were similar in both groups. The rates of bloodstream infection and bacteriuria were significantly lower in the 2-day SDD group than in the 3-day SDD group. Compared with the patients in the 3-day group, the patients in the 2-day SDD group received fewer antibiotics and less exposure to mechanical ventilation, and they used fewer ICU resources. The rates of ICU mortality and 28-day mortality were similar in both groups. The incidence of multi-drug-resistant organisms was similar in both groups. Within the limitations inherent to our study design, reducing the exposure of prophylactic systemic antibiotics in the SDD setting from 3 days to 2 days was not associated with impaired outcomes. Future randomized controlled trials should be conducted to test this hypothesis and investigate the effects on the development of multi-drug resistant organisms.
Surgical antimicrobial prophylaxis (SAP) is supported by evidence-based guidelines. Nevertheless, SAP guidelines do not cover all clinical scenarios. To our knowledge, no information is available ...regarding SAP in the critically ill patients. We designed a retrospective, observational and preliminary study which the objective was to describe our professional practices in intensive care unit (ICU) patients requiring SAP.
All patients admitted for more than 48 h in the ICU and requiring surgery were retrospectively included from January 1
to December 31, 2016. We collected data related to infection, colonization and antimicrobial treatments pre- and post-operatively. We assessed the compliance of SAP to guidelines.
Among 41 included patients, 13 (32%) were treated for an ongoing infection and 21 (51%) received at least one antibiotic during the ICU stay. Seven (17%) were colonized. Twenty-one (51%) patients received SAP according to guidelines. Thirteen postoperative infections including 1 surgical site infection were reported. For 10 (24%) patients, the ongoing antimicrobial treatment was continued in the operating room. No surgical site infection and 1 lung infection was reported. In 3 (7%) patients, no SAP was administered and 1 episode of bacteremia was noted. Three (7%) patients had their ongoing treatment changed in the operating room. Two of them developed a lung infection. The other patients were assessed individually due to complex conditions.
These preliminary data showed a large heterogeneity in the management of SAP in the ICU, suggesting the need for specific guidelines based on clinical trials.
Issue Title: Société de Réanimation Langue Francais National Congress 2016 Table of contents PHYSICIANS ABSTRACTS O1 Impact of tracheal cuff shape on microaspiration of gastric contents in intubated ...critically ill patients: a multicenter randomized controlled study (BEST CUFF) Emmanuelle Jaillette, Christophe Girault, Guillaume Brunin, Farid Zerimech, Arnaud Chiche, Céline Broucqsault-Dedrie, Cyril Fayolle, Franck Minacori, Isabelle Alves, Stephanie Barrailler, Laurent Robriquet, Fabienne Tamion, Emmanuel Delaporte, Damien Thellier, Claire Delcourte, Alain Duhamel, Saad Nseir O2 Bicarbonate versus saline for contrast-induced acute kidney injury prevention in critically ill patients Xavier Valette, Isabelle Desmeulles, Benoit Savary, Romain Masson, Amélie Seguin, Cédric Daubin, Bertrand Sauneuf, Jennifer Brunet, Pierre Verrier, Véronique Pottier, Marie Orabona, Désiré Samba, Gérald Viquesnel, Mathilde Lermuzeaux, Pascal Hazera, Jean-Luc Hanouz, Jean-Jacques Parienti, Damien Du Cheyron O3 Neurally adjusted ventilatory assist in the early phase of weaning from mechanical ventilation: a multicenter randomized study Alexandre Demoule, Marc Clavel, Camille Rolland-Debord, Sébastien Perbet, Nicolas Terzi, Achille Kouatchet, Florent Wallet, Hadrien Roze, Frédéric Vargas, Claude Guérin, Jean Dellamonica, Samir Jaber, Thomas Similowski O4 Very high volume hemofiltration with the Cascade system in septic shock patients Jean-Pierre Quenot, Christine Binquet, Christophe Vinsonneau, Saber-Davide Barbar, Sandrine Vinault,, Valérie Deckert, Stephanie Lemaire, Ali Ait Hssain, Rémi Bruyère, Bertrand Souweine, Laurent Lagrost, Christophe Adrie O5 Effect of rapid response systems on hospital mortality, a prospective interventional study and systematic review Boris Jung, Aurelien Daurat, Audrey De Jong, Gérald Chanques, Martin Mahul,, Marion Monnin, Nicolas Molinari, Samir Jaber O6 Beta-lactams serum concentrations in critically ill cirrhotic patients: a matched control study Olivier Lheureux, Eric Trepo, Maya Hites, Frederic Cotton, Fleur Wolff, Rudy Surin, Jacques Créteur, Jean-Louis Vincent, Thierry Gustot, Frederique Jacobs, Fabio Silvio Taccone O7 Systematic overdosing of oxa- and cloxacillin in severe infections treated in ICU: Risk factors and side effects Mathilde Neuville, Jean-François Timsit, Najoua El-Helali, Alban Le Monnier, Eric Magalhaes, Aguila Radjou, Roland Smonig, Jean-François Soubirou, Guillaume Voiriot, Romain Sonneville, Lila Bouadma, Bruno Mourvillier O8 Amikacin peak concentrations in patients receiving extracorporeal membrane oxygenation (ECMO) support: a case-control study Elodie Gélisse, Mathilde Neuville, Etienne De Montmollin, Guillaume Voiriot, Jean-François Soubirou, Roland Smonig, Aguila Radjou, Eric Magalhaes, Lila Bouadma, Bruno Mourvillier, Jean-François Timsit, Romain Sonneville O9 A high aminoglycoside regimen associated with renal replacement therapy for the treatment of multi-drug-resistant pathogens Alexandre Brasseur, Maya Hites, Sandrine Roisin, Frederic Cotton, Jean-Louis Vincent, Daniel De Backer, Frederique Jacobs, Fabio Silvio Taccone O10 Optimization of administration of vancomycin in septic patients: a prospective randomized study Valerie Van Ruychevelt, Eric Carlier, Michael Piagnerelli, Michel Vanhaeverbeek, Christine Danguy, Patrick Biston O11 Impact of elevated intra-abdominal pressure on the ability of dynamic parameters to predict fluid responsiveness Siu-Ming Au, Emmanuelle Begot, François Dalmay, Xavier Repessé, Gwenael Prat, Koceila Bouferrache, Michel Slama, Philippe Vignon, Antoine Vieillard-Baron O12 Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis Xavier Monnet, Paul Marik, Jean-Louis Teboul O13 Predicting volume responsiveness by using combined end-expiratory and end-inspiratory occlusion tests with echocardiography Mathieu Jozwiak, Jean-Louis Teboul, Christian Richard, Xavier Monnet O14 Early dynamic left intraventricular obstruction is associated with hypovolemia and hight mortality in septic shock patients Jean-Louis Chauvet, Shari El-Dash, Olivier Delastre, Bernard Bouffandeau, Dominique Jusserand, Jean-Baptiste Michot, Fabrice Bauer, Julien Maizel, Michel Slama O15 Predictive factors for poor hemodynamic tolerance to fluid removal in ICU: the DepleRea study François Brazier, Pablo Mercado, Loay Kontar, Dimitri Titeca, Bertand De Cagny, Gaelle Bacari-Risal, Antoine Riviere, Michel Slama, Julien Maizel O16 High-flow nasal cannula: first-line treatment of noninvasive ventilation for infants with bronchiolitis. Applicability and risk factors for failure Camille Guillot, Claire Le Reun, Marie Lampin, Ahmed Sadik, Astrid Botte, Alain Duhamel, Stéphane Leteurtre O17 Is high-flow nasal cannula better than nasal continuous positive airway pressure for bronchiolitis management in pediatric intensive care unit? Aurélie Collins, Céline Kempeneers, Nathalie Cajgfinger O18 Interest and risk of high-flow cannula during acute hypoxemic pneumonia in children: a retrospective study Camille Ohlmann, Robin Pouyau, Fabien Subtil, Florent Baudin, Bruno Massenavette, Etienne Javouhey O19 Interest of high-flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) during the initial management of severe bronchiolitis in infants: a multicenter randomized controlled trial Christophe Milesi, Sandrine Essouri, Robin Pouyau,, Jean-Michel Liet, Mickael Afanetti, Julien Baleine, Sabine Durand, Philippe Durand, Etienne Javouhey, Jean Christophe Roze, Didier Dupont, Gilles Cambonie O20 Outcome of severe cerebral venous thrombosis in intensive care unit: a cohort study Benjamin Soyer, Marco Rusca, Anne-Claire Lukaszewicz, Isabelle Crassard, Jean-Pierre Guichard, Damien Bresson, Didier Payen de la Garanderie O21 Brain lesion spectrum characterization in an experimental model of infective endocarditis Marie Cantier, Candice Sabben, Liliane Louedec, Sandrine Delbosc, Clément Journé, Phalla Ou, Isabelle Klein, Françoise Chau, Agnes Lefort, Jean-Philippe Desilles, Jean-Baptiste Michel, Romain Sonneville, Mikaël Mazighi O22 Outcome of patients with Parkinson's disease admitted in intensive care unit Omar Ben Hadj Salem, Sophie Demeret, Alexandre Demoule, Thomas Similowski, Francis Bolgert, Tarek Sharshar, David Grabli O23 Cerebrospinal fluid glucose and lactate concentrations after subarachnoid hemorrhage Safa Arib, Ilaria Alice Crippa, Jacques Créteur, Jean-Louis Vincent, Fabio Silvio Taccone O24 Spontaneous angionegative subarachnoidal hemorrhage: neurological outcome based on a retrospective study of 68 patients Alexis Soummer, Nicolas Engrand, Pierre Guedin, Grégoire Trebbia, Sorin Aldea, Charles Cerf O25 Serious game evaluation of a one-hour training basic life support session for secondary school students: new tools for future bystanders Victoire Desailly, Pierre Pasquier, Patrick Brun, Damien Roux, Jonathan Messika, Gwendoline Latournerie, Laetitia Kasprzyk, Vincent Grosjean, Amine Latreche, Pierre Habert, Stephane Huot, Timon Jobin, Antoine Tesnière, Didier Dreyfuss, Jean-Damien Ricard, Alexandre Mignon, Stéphane Gaudry O26 Refractory out-of-hospital refractory cardiac arrest treated by veno-arterial extracorporeal membrane oxygenation. A retrospective single-center experience from 2012 to 2015. CARECMO program (Cardiac ARrest Extra Corporeal Membrane Oxygenation) François-Xavier Laithier, Antoine Kimmoun, Tahar Chouihed, Stéphane Albizzati, Edoardo Camenzind, Fabrice Vanhuyse, Bruno Levy O27 Decreased monocyte HLA-DR expression after out-of-hospital cardiac arrest Martin Cour, Fabienne Venet, Romain Hernu, Julie Demaret, Guillaume Monneret, Laurent Argaud O28 Is emergent PCI associated with a clinical benefit in post-cardiac arrest patients without ST-segment elevation pattern? Insights from the PROCAT II registry Florence Dumas, Wulfran Bougouin, Guillaume Geri, Lionel Lamhaut, Julien Rosencher, Frédéric Pène, Jean-Daniel Chiche, Olivier Varenne, Pierre Carli, Xavier Jouven, Jean-Paul Mira, Christian Spaulding, Alain Cariou O29 Predictors of long-term quality of life after cardiac arrest: insights from the Parisian registry Guillaume Geri, Florence Dumas, Franck Bonnetain,, Wulfran Bougouin, Benoit Champigneulle, Michel Arnaout, Pierre Carli, Eloi Marijon, Olivier Varenne, Jean-Paul Mira, Jean Philippe Empana, Alain Cariou O30 Red blood cell transfusions in early resuscitation of severe sepsis and septic shock in patients with hematological malignancies Adrien Mirouse, Matthieu Resche-Rigon, Virginie Lemiale, Djamel Mokart, François Vincent, Julien Mayaux, Antoine Rabbat, Martine Nyunga, Anne Pascale Meert, Dominique Benoit, Achille Kouatchet, Michaël Darmon, Fabrice Bruneel, Elie Azoulay, Frédéric Pène O31 Causal effect of transfusion on mortality and other adverse events among critically ill septic patients: an observational study with a marginal structural model Claire Dupuis, Michaël Darmon, Carole Schwebel, Elie Azoulay, Romain Sonneville, Lila Bouadma, Roland Smonig, Yves Cohen, Stéphane Ruckly, Christophe Adrie, Dany Goldgran-Toledano, Sébastien Bailly, Guillaume Marcotte, Maïté Garrouste-Orgeas, Jean-François Timsit O32 Autoimmune hemolytic anemia in the intensive care unit Antoine Lafarge, Claire Pichereau, Sandrine Valade, Marion Venot, Akli Chermak, Igor Theodose, Marion Scotto, Delphine Kemlin, Claire Givel, Leïla Mourtada, Etienne Ghrenassia, Emmanuel Canet, Virginie Lemiale, Benoît Schlemmer, Elie Azoulay, Eric Mariotte O33 Pre-ICU location, lead time bias and outcomes in patients with thrombotic microangiopathies Damien Vimpere, Sandrine Valade, Marion Venot, Claire Pichereau, Akli Chermak, Virginie Lemiale, Emmanuel Canet, Lionel Galicier, Elie Azoulay, Eric Mariotte O34 Septic shocks with no early etiological diagnosis: a multicenter prospective cohort study (the shock 24 study) Damien Contou, Damien Roux, Sebastien Jochmans, Remi Coudroy, Emmanuel Guérot, David Grimaldi, Sylvie Ricome, Eric Maury, Gaëtan P
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