Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Avant l'IA : en quoi des mesures d'ergonomie avancées et les techniques de lecture rapide peuvent améliorer les performances diagnostiques humaines en imagerie oncologique

Thèse présentée sous la forme d'une "Thèse Article"Introduction : la principale cause d’erreur en imagerie oncologique est l’échec de détection d’une lésion. A l’heure du développement des techniques d’Intelligence Artificielle (IA) en Radiologie, l’objectif était de comparer les capacités de détection de lésions suspectes par des radiologues de même expérience soumis à différentes conditions d’interprétation et bénéficiant d’une formation en « lecture rapide ».Matériel et méthodes : des examens tomodensitométriques oncologiques étaient sélectionnés et interprétés par un radiologue sénior produisant un compte-rendu “Gold-Standard” selon les recommandations internationales. Des internes de radiologie interprétaient ces examens et notaient les lésions sur une grille standardisée. Ils étaient randomisés en 3 groupes: groupe 1 dans des conditions d’interprétation standard, groupe 2 dans des conditions ergonomiques améliorées, le groupe 3 bénéficiait en plus d’une formation spécifique en « lecture rapide et efficace ».La sensibilité de détection de chaque groupe comparé au Gold-Standard et la durée moyenne des séances d’interprétation étaient évaluées.Résultats : au total, 13 examens tomodensitométriques étaient inclus. L’interprétation « Gold-Standard » identifiait un total de 67 lésions à détecter sur ces examens. 18 internes étaient divisés en 3 groupes de 6. Chaque groupe d’interne avait 402 (67x6) lésions à détecter. La sensibilité de détection globale était plus élevée dans: le groupe 3 vs. groupe 1 (91,2% versus 84,2%; p=0,005) et le groupe 3 vs. groupe 2 (91,2% versus 85,4%; p=0,036). La durée d’interprétation était plus courte dans le groupe 2 vs. groupe 1 (141 minutes versus 162 minutes; p = 0,036).Conclusion : parallèlement au progrès de l’IA, les radiologues peuvent significativement améliorer leurs capacités de détection lésionnelle en adaptant leurs conditions de travail et leur méthode d’interprétation

Automatic Deep-Learning Segmentation of Epicardial Adipose Tissue from Low-Dose Chest CT and Prognosis Impact on COVID-19

Background: To develop a deep-learning (DL) pipeline that allowed an automated segmentation of epicardial adipose tissue (EAT) from low-dose computed tomography (LDCT) and investigate the link between EAT and COVID-19 clinical outcomes. Methods: This monocentric retrospective study included 353 patients: 95 for training, 20 for testing, and 238 for prognosis evaluation. EAT segmentation was obtained after thresholding on a manually segmented pericardial volume. The model was evaluated with Dice coefficient (DSC), inter-and intraobserver reproducibility, and clinical measures. Uni-and multi-variate analyzes were conducted to assess the prognosis value of the EAT volume, EAT extent, and lung lesion extent on clinical outcomes, including hospitalization, oxygen therapy, intensive care unit admission and death. Results: The mean DSC for EAT volumes was 0.85 ± 0.05. For EAT volume, the mean absolute error was 11.7 ± 8.1 cm3 with a non-significant bias of −4.0 ± 13.9 cm3 and a correlation of 0.963 with the manual measures (p < 0.01). The multivariate model providing the higher AUC to predict adverse outcome include both EAT extent and lung lesion extent (AUC = 0.805). Conclusions: A DL algorithm was developed and evaluated to obtain reproducible and precise EAT segmentation on LDCT. EAT extent in association with lung lesion extent was associated with adverse clinical outcomes with an AUC = 0.805

Late Post-Dissection Dynamic Intermittent Malperfusion of the Aortic Arch in Association with a Rare Heterogenous LOX Gene Variation

Late ischaemic consequences of type A aortic dissection are rare. We present a 6-year late complication of type A aortic dissection treated by Bentall surgery in a 41-year-old patient. The patient presented with several episodes of lipothymia associated with hypertensive attacks with anisotension, cervicalgia, hemicranial headache, abdominal pain and lower limb slipping initially on exertion and later at rest. On dynamic examination, we diagnosed an intermittent dynamic occlusion of the aortic arch and rare LOX gene variation, which is considered to be associated with aneurysm or dissection of the ascending aorta in young patients. Surgical treatment by replacement of the ascending aorta and the aortic arch with reimplantation of the brachiocephalic trunk (BcTr) allowed the symptoms to resolve

COVID-19 and Obesity: Role of Ectopic Visceral and Epicardial Adipose Tissues in Myocardial Injury

In March 2020, the WHO declared coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a global pandemic. Obesity was soon identified as a risk factor for poor prognosis, with an increased risk of intensive care admissions and mechanical ventilation, but also of adverse cardiovascular events. Obesity is associated with adipose tissue, chronic low-grade inflammation, and immune dysregulation with hypertrophy and hyperplasia of adipocytes and overexpression of pro-inflammatory cytokines. However, to implement appropriate therapeutic strategies, exact mechanisms must be clarified. The role of white visceral adipose tissue, increased in individuals with obesity, seems important, as a viral reservoir for SARS-CoV-2 via angiotensin-converting enzyme 2 (ACE2) receptors. After infection of host cells, the activation of pro-inflammatory cytokines creates a setting conducive to the "cytokine storm" and macrophage activation syndrome associated with progression to acute respiratory distress syndrome. In obesity, systemic viral spread, entry, and prolonged viral shedding in already inflamed adipose tissue may spur immune responses and subsequent amplification of a cytokine cascade, causing worse outcomes. More precisely, visceral adipose tissue, more than subcutaneous fat, could predict intensive care admission; and lower density of epicardial adipose tissue (EAT) could be associated with worse outcome. EAT, an ectopic adipose tissue that surrounds the myocardium, could fuel COVID-19-induced cardiac injury and myocarditis, and extensive pneumopathy, by strong expression of inflammatory mediators that could diffuse paracrinally through the vascular wall. The purpose of this review is to ascertain what mechanisms may be involved in unfavorable prognosis among COVID-19 patients with obesity, especially cardiovascular events, emphasizing the harmful role of excess ectopic adipose tissue, particularly EAT

Light-Matter Interaction Near the Schwinger Limit Using Tightly Focused Doppler-Boosted Lasers

International audienceThe Schwinger limit could be approached by focusing to its diffraction limit the light reflected by a plasma mirror irradiated by a multi-petawatt laser. We explore numerically the interaction between such intense light and matter. We find that the interaction with a relativistic counterpropagative electron beam would enable the exploration of the fully nonperturbative regime of strong-field quantum electrodynamics (SF-QED), while the interaction with an initially solid target leads to a profusion of SF-QED effects that retroact on the laser-plasma interaction. We observe in both scenarios the formation of relativistic attosecond electron-positron jets with very high densities

Light-Matter Interaction Near the Schwinger Limit Using Tightly Focused Doppler-Boosted Lasers

International audienc

Light-Matter Interaction Near the Schwinger Limit Using Tightly Focused Doppler-Boosted Lasers

International audiencePlasma mirrors can boost the intensity of high-power lasers by several orders of magnitude [1]. This intensity gain comes from the relativistic oscillation of the plasma surface, whichperiodically compresses the incident laser energy in a small volume by the relativistic Dopplereffect. With this method, the simple reflection of a PW-class laser on a solid target can lead tolight with a peak intensity in the 1025-1026 W/cm2range. We have previously shown that theseintensities could enhance the signatures of Strong-Field QED (SF-QED) processes [2], such asthe creation of electron-positron pairs by the Breit-Wheeler mechanism, in coming experiments.Yet, one of the most attractive aspects of this technique is that enormous intensities, in the1027-1029 W/cm2range, can in principle be reached with already achievable laser powers (1-10 PW) if the Doppler-boosted lasers are focused close to their diffraction limit [3, 4]. In thiscontribution, we will present results from 2D QED-PIC [5] simulations of light-matter interactions at these unexplored intensities, that approach the Schwinger limit (IS = 4.7 × 1029 W/cm2).We show that novel SF-QED dominated interaction regimes are attained.For instance, the interaction of a tightly focused Doppler boosted laser with a solid targetleads to an abundance of SF-QED events, with up to 70% of the laser energy eventually converted to high-energy γ photons, while the interaction with a counterpropagative relativisticelectron beam provides access to the fully nonperturbative regime of SF-QED [6]. Furthermore, a bunching of the generated particles by the laser is observed and leads to relativisticelectron-positron jets with extremely high density (up to 1034 m−3).References[1] Vincenti, H. Physical Review Letters, 123(10), 105001 (2019).[2] Fedeli, L., et al. Physical Review Letters, 127(11), 114801 (2021).[3] Gordienko, et al. Physical Review Letters, 94(10), 103903 (2005).[4] Quéré, F., and Vincenti, H. High Power Laser Science and Engineering, 9, e6 (2021).[5] Gonoskov, A., et al. Physical Review E, 92(2), 023305 (2015).[6] Fedotov, A. Journal of Physics: Conference Series (Vol. 826, No. 1, p. 012027) (2017)