Epidemiology and outcome predictors in 450 patients with hanging-induced cardiac arrest: a retrospective study

BackgroundCardiac arrest is the most life-threatening complication of attempted suicide by hanging. However, data are scarce on its characteristics and outcome predictors.MethodsThis retrospective observational multicentre study in 31 hospitals included consecutive adults admitted after cardiac arrest induced by suicidal hanging. Factors associated with in-hospital mortality were identified by multivariate logistic regression with multiple imputations for missing data and adjusted to the temporal trends over the study period.ResultsOf 450 patients (350 men, median age, 43 [34–52] years), 305 (68%) had a psychiatric history, and 31 (6.9%) attempted hanging while hospitalized. The median time from unhanging to cardiopulmonary resuscitation was 0 [0–5] min, and the median time to return of spontaneous circulation (ROSC) was 20 [10–30] min. Seventy-nine (18%) patients survived to hospital discharge. Three variables were independently associated with higher in-hospital mortality: time from collapse or unhanging to ROSC>20 min (odds ratio [OR], 4.71; 95% confidence intervals [95%CIs], 2.02–10.96; p = 0.0004); glycaemia >1.4 g/L at admission (OR, 6.38; 95%CI, 2.60–15.66; p < 0.0001); and lactate >3.5 mmol/L at admission (OR, 6.08; 95%CI, 1.71–21.06; p = 0.005). A Glasgow Coma Scale (GCS) score of >5 at admission was associated with lower in-hospital mortality (OR, 0.009; 95%CI, 0.02–0.37; p = 0.0009).ConclusionIn patients with hanging-induced cardiac arrest, time from collapse or unhanging to return of spontaneous circulation, glycaemia, arterial lactate, and coma depth at admission were independently associated with survival to hospital discharge. Knowledge of these risk factors may help guide treatment decisions in these patients at high risk of hospital mortality

Intérêt de l'échographie gastrique dans l'évaluation du résidu gastrique des patients de réanimation

Enteral nutrition (EN) is an important part of the management of patients in intensive care unit. Monitoring tolerance of EN is recommended and can be realized measuring the gastric residual volume (GRV) by suction with a syringe through a nasogastric tube (NGT). This imperfect technique could be replaced by an ultrasound measurement of the antral cross-sectional area (CSA). The aim of our study was to evaluate the correlation between the ultrasound measurement of the CSA and the measurement of the GRV by suction with a syringe. We compared the values of CSA and GRV in 64 patients hospitalized in intensive care unit receiving an EN through a NGT. 96 couples of GRV/CSA were realized. There was a statistically significant correlation between log10 (GRV) and log10 (CSA) (R = 0.78, p <0.0001). Ultrasonographic measurement was possible in 96% of the patients and was considered easy in 79% of cases. Our study suggests that ultrasound measurement of CSA is a reflection of GRV measured by suction with a syringe and could be part of ultrasonographic evaluation used in intensive care unit and avoid realization of gastric aspirations.La nutrition entérale (NE) est un élément important de la prise en charge des patients en réanimation. La surveillance de la tolérance de la NE s'effectue habituellement par mesure du volume résiduel gastrique (VRG) par aspiration à la seringue via la sonde nasogastrique (SNG). Cette technique imparfaite pourrait être remplacée par la mesure échographique de la surface antrale (SA). L'objectif de notre étude était d'évaluer la corrélation entre la mesure échographique de la SA et la mesure du VRG par aspiration à la seringue. Nous avons comparé les valeurs de SA avec les mesures de VRG chez 64 patients hospitalisés en réanimation et bénéficiant d'une NE par l'intermédiaire d'une SNG. 96 couples de mesures VRG / SA ont été réalisés. Il existe une corrélation statistiquement significative entre log10(VRG) et log10(SA) (R = 0,78 ; p < 0,0001). La mesure échographique a été possible chez 96% des patients et jugée facile dans 79% des cas. Notre étude suggère que la mesure échographique de la SA serait un reflet du VRG mesuré par aspiration à la seringue et pourrait faire partie des examens échographiques utilisés en réanimation et ainsi éviter la réalisation des aspirations gastriques

Intérêt de l'échographie gastrique dans l'évaluation du résidu gastrique des patients de réanimation

Enteral nutrition (EN) is an important part of the management of patients in intensive care unit. Monitoring tolerance of EN is recommended and can be realized measuring the gastric residual volume (GRV) by suction with a syringe through a nasogastric tube (NGT). This imperfect technique could be replaced by an ultrasound measurement of the antral cross-sectional area (CSA). The aim of our study was to evaluate the correlation between the ultrasound measurement of the CSA and the measurement of the GRV by suction with a syringe. We compared the values of CSA and GRV in 64 patients hospitalized in intensive care unit receiving an EN through a NGT. 96 couples of GRV/CSA were realized. There was a statistically significant correlation between log10 (GRV) and log10 (CSA) (R = 0.78, p <0.0001). Ultrasonographic measurement was possible in 96% of the patients and was considered easy in 79% of cases. Our study suggests that ultrasound measurement of CSA is a reflection of GRV measured by suction with a syringe and could be part of ultrasonographic evaluation used in intensive care unit and avoid realization of gastric aspirations.La nutrition entérale (NE) est un élément important de la prise en charge des patients en réanimation. La surveillance de la tolérance de la NE s'effectue habituellement par mesure du volume résiduel gastrique (VRG) par aspiration à la seringue via la sonde nasogastrique (SNG). Cette technique imparfaite pourrait être remplacée par la mesure échographique de la surface antrale (SA). L'objectif de notre étude était d'évaluer la corrélation entre la mesure échographique de la SA et la mesure du VRG par aspiration à la seringue. Nous avons comparé les valeurs de SA avec les mesures de VRG chez 64 patients hospitalisés en réanimation et bénéficiant d'une NE par l'intermédiaire d'une SNG. 96 couples de mesures VRG / SA ont été réalisés. Il existe une corrélation statistiquement significative entre log10(VRG) et log10(SA) (R = 0,78 ; p < 0,0001). La mesure échographique a été possible chez 96% des patients et jugée facile dans 79% des cas. Notre étude suggère que la mesure échographique de la SA serait un reflet du VRG mesuré par aspiration à la seringue et pourrait faire partie des examens échographiques utilisés en réanimation et ainsi éviter la réalisation des aspirations gastriques

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Comparison of genomic-enabled cross selection criteria for the improvement of inbred line breeding populations

Abstract A crucial step in inbred plant breeding is the choice of mating design to derive high-performing inbred varieties while also maintaining a competitive breeding population to secure sufficient genetic gain in future generations. In practice, the mating design usually relies on crosses involving the best parental inbred lines to ensure high mean progeny performance. This excludes crosses involving lower performing but more complementary parents in terms of favorable alleles. We predicted the ability of crosses to produce putative outstanding progenies (high mean and high variance progeny distribution) using genomic prediction models. This study compared the benefits and drawbacks of seven genomic cross selection criteria (CSC) in terms of genetic gain for one trait and genetic diversity in the next generation. Six CSC were already published and we propose an improved CSC that can estimate the proportion of progeny above a threshold defined for the whole mating plan. We simulated mating designs optimized using different CSC. The 835 elite parents came from a real breeding program and were evaluated between 2000 and 2016. We applied constraints on parental contributions and genetic similarities between selected parents according to usual breeder practices. Our results showed that CSC based on progeny variance estimation increased the genetic value of superior progenies by up to 5% in the next generation compared to CSC based on the progeny mean estimation (i.e. parental genetic values) alone. It also increased the genetic gain (up to 4%) and/or maintained more genetic diversity at QTLs (up to 4% more genic variance when the marker effects were perfectly estimated)

Comparison of genomic-enabled cross selection criteria for the improvement of inbred line breeding populations

Abstract A crucial step in inbred plant breeding is the choice of mating design to derive high-performing inbred varieties while also maintaining a competitive breeding population to secure sufficient genetic gain in future generations. In practice, the mating design usually relies on crosses involving the best parental inbred lines to ensure high mean progeny performance. This excludes crosses involving lower performing but more complementary parents in terms of favorable alleles. We predicted crosses with putative outstanding progenies (high mean and high variance progeny distribution) using genomic prediction models to assess the value of top progeny. This study compared the benefits and drawbacks of seven genomic cross selection criteria (CSC) in terms of genetic gain for one trait and genetic diversity in the next generation. Six CSC were already published and we have proposed an improved CSC that can estimate the proportion of progeny above a threshold defined for the whole mating plan. We simulated mating designs optimized using different CSC and 835 elite parents from a real breeding program that were evaluated between 2000 and 2016. We applied constraints on parental contributions and genetic similarities between parents according to usual breeder practices. Our results showed that CSC based on progeny variance estimation increased the genetic value of superior progenies by up to 5% in the next generation compared to CSC based on the progeny mean estimation (i.e. parental genetic values) alone. It also increased the genetic gain (up to 4%) and/or maintained more genetic diversity at QTLs (up to 4% more genic variance when the marker effects were perfectly estimated)

Epidemiology and outcome of patients admitted to intensive care after anaphylaxis in France: a retrospective multicentre study

International audienceBackground: Few data are available on patients who have experienced anaphylaxis and were admitted to ICUs. The purpose of this observational study was to describe the epidemiology and management of these patients.Methods: This was a multicentre retrospective study carried out in 23 French ICUs between 2012 and 2017. All patients who suffered anaphylaxis and were transferred to an ICU were included. Data were collected using an electronic database after approval by an ethics committee.Results: A total of 339 patients were included, and 17 (5%) died secondary to anaphylaxis. The main triggers were drugs (77%), contrast media (11%), and food (7%). Epinephrine was administered before ICU admission in 88% of patients with Grade III anaphylaxis and 100% of patients with Grade IV anaphylaxis. Most patients with Grades III and IV anaphylaxes did not receive the recommended dose of i.v. fluid of 30 ml kg-1 within the first 4 h of ICU admission. The time to epinephrine administration was not statistically different between survivors and non-survivors, but non-survivors received a higher dose of epinephrine (median: 5 [3-10] vs 3 [2-7] mg; P<0.0001), which suggests that some forms of anaphylactic shock may be resistant to epinephrine. In multivariate analysis, only lactate concentration at ICU admission was a predictor of death (odds ratio: 1.47 [1.15-1.88]; P=0.002).Conclusions: Lactate concentration at ICU admission appeared to be the most reliable criterion for assessing prognosis. Epinephrine is widely used during anaphylaxis, but the volume of fluid resuscitation was consistently lower than recommended.Clinical trial registration: NCT04290507