Prevention of ventilator‑associated pneumonia by noble metal coating of endotracheal tubes: a multi‑center, randomized, double‑blind study

BACKGROUND: Ventilator-associated pneumonia (VAP) causes increased mortality, prolonged hospital stay and increased healthcare costs. Prevention of VAP in intensive care units (ICUs) is currently based on several measures, and application of noble metal coating on medical devices has been shown to inhibit the bacterial adherence of microorganisms to the surface. The objective of this study was to evaluate the potential benefit of noble metal coating of endotracheal tubes for the prevention of VAP. METHODS: This was a multi-center, randomized, controlled, double-blind, prospective study including ventilated patients from nine ICUs from four hospital sites in Belgium. Patients were randomly intubated with identical appearing noble metal alloy (NMA) coated (NMA-coated group) or non-coated (control group) endotracheal tubes (ETT). Primary endpoint was the incidence of VAP. Secondary endpoints were the proportion of antibiotic days during ICU stay and tracheal colonization by pathogenic bacteria. RESULTS: In total, 323 patients were enrolled, 168 in the NMA-coated group and 155 in the control group. During ventilation, VAP occurred in 11 patients (6.5%) in the NMA-coated group and in 18 patients (11.6%) in the control group (p  = 0.11). A higher delay in VAP occurrence was observed in the NMA-coated group compared with the control group by Cox proportional hazards regression analysis (HR 0.41, 95% CI 0.19–0.88, p  = 0.02). The number of antibiotic days was 58.8% of the 1,928 ICU days in the NMA-coated group and 65.4% of the 1774 ICU days in the control group (p  = 0.06). Regarding tracheal colonization, bacteria occurred in 38 of 126 patients in the NMA-coated group (30.2%) and in 37 of 109 patients in the control group (33.9%) (p  = 0.57). CONCLUSIONS: This study provides preliminary evidence to support the benefit of noble metal coating in the prevention of VAP. A confirmatory study in a larger population would be valuable. Trial registration: Clinical trial number: NCT04242706 (http://www.clinicaltrials.gov

Prise en charge des psycho-traumatismes par l'approche thérapeutique EMDR en psychiatrie

International audienc

Near-death experiences in non-life-threatening events and coma of different etiologies.

Near death experiences (NDEs) are increasingly being reported as a clearly identifiable physiological and psychological reality of clinical significance. Empirical studies of NDEs have mostly been conducted in patients with life threatening situations such as cardiac arrest [1-5] or (albeit more rarely) in patients with severe traumatic brain injury[6]. To the best of our knowledge, no study has formally compared the influence of the cause of coma to the intensity or content of the NDE. Using the Greyson NDE scale [7], the present retrospective study aimed at: (1) exploring the NDE intensity and content in “NDE-like” accounts following non-life-threatening events versus “real NDE” following coma; (2) comparing the “real NDE” characteristics according to the etiology of the brain damage (anoxic, traumatic or other) and; (3) comparing our retrospectively obtained data in anoxic coma to historical previously published prospectively collected post-anoxic NDEs

AIR VERSUS GROUND TRANSPORT OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: EXPERIENCE IN A RURAL-BASED HELICOPTER MEDICAL SERVICE

peer reviewe

Helicopter regulation in 112 Emergency Medical Communication Center : time-distances from landing to the patient

peer reviewe

Contribution of a Trunk Accelerometer System to the Characterization of Gait in Patients With Mild-to-Moderate Parkinson’s Disease

OBJECTIVE: Gait disturbances like shuffling and short steps are obvious at visual observation in patients with advanced Parkinson's disease (PD). However, quantitative methods are increasingly used to evaluate the wide range of gait abnormalities that may occur over the disease course. The goal of this study was to test the ability of a trunk accelerometer system to quantify the effects of PD on several gait features when walking at self-selected speed. METHODS: We recruited 96 subjects split into three age-matched groups: 32 healthy controls (HC), 32 PD patients at Hoehn and Yahr stage < II (PD-1), and 32 patients at Hoehn & Yahr stage II-III (PD-2). The following outcomes were extracted from the signals of the tri-axial accelerometer worn on the lower back: stride length, cadence, regularity index, symmetry index and mechanical powers yielded in the cranial-caudal, antero-posterior and medial-lateral directions. Walking speed was measured using a stopwatch. RESULTS: beside other gait features, the PD-1 and the PD-2 groups showed significantly reduced stride length normalized to height (p<0.02) and symmetry index (p<0.009) in comparison to the HC. Regularity index was the only feature significantly decreased in the PD-2 group as compared with the two other groups (p<0.01). The clinical relevance of this finding was supported by significant correlations with mobility and gait scales (r is around -0.3; p<0.05). CONCLUSION: Gait quantified by a trunk accelerometer may provide clinically useful information for the screening and follow-up of PD patients

Air versus ground transport of patients with acute myocardial infarction: Experience in a rural-based helicopter medical service

Aims Primary pre-hospital Helicopter Emergency Medical Service (HEMS) interventions may play a role in timely reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI). We designed a prospective study involving patients with acute myocardial infarction aimed at the evaluation of the potential benefit of such primary HEMS interventions as compared with classical EMS ground transport. Methods & results This prospective study was conducted from July 1, 2007 to June 15, 2012. Successive patients with ST-segment elevation myocardial infarction (STEMI) eligible for percutaneous coronary intervention (PCI) were included. Simulated ground-based access times were computed using a digital cartographic program, allowing the estimation of healthcare system delay from call to admission to the catheterisation laboratory. During the study period, 4485 patients benefited from HEMS activations. Of these patients, 342 (8%) suffering from STEMI were transferred for primary PCI. Median primary response time time was 11 min (IQR: 8 - 14 min) using the helicopter and 32 min (25 – 44 min) using road transport. Median transport time using HEMS was 12 min (9 – 15 min) and 50 min (36 – 56 min) by road. The median system delay using HEMS was 52 min (45 – 60 min), while this time was 110 min (95 – 126 min) by road. Finally, the system delay median gain was 60 min (47 – 72 min). Conclusions Using HEMS in a rural region allows STEMI patients to benefit from appropriate rescue care with similar delays as those seen in urban patients

Virtual reality and hypnosis for anxiety and pain management in intensive care units A prospective randomised trial among cardiac surgery patients

Virtual reality and hypnosis are little studied in complex contexts, such as intensive care, where patients need significant physical and psychological assistance.L'influence des techniques non-pharmacologiques sur le bien-être des patients aux soins intensif

Impact of a prehospital discrimination between trauma patients with or without early acute coagulopathy of trauma and the need for damage control resuscitation: rationale and design of a multicenter randomized phase II trial.

BACKGROUND: The evidence of the Trauma Induced Coagulopathy Clinical Score (TICCS) accuracy has been evaluated in several studies but the potential effect of its use on patient outcomes needs to be evaluated. The primary objective of this study is to evaluate the impact on mortality of a prehospital discrimination between trauma patients with or without a potential need for damage control resuscitation. METHODS: The trial will be designed as randomized phase II clinical trial with comparison of the experimental protocol against the standard of care. The TICCS will be calculated on the site of injury for the patients of the intervention group and treatment will be guided by the TICCS value. Seven days mortality, 30 days mortality, global use of blood products and global hospital length-of-stay will be compared. DISCUSSION: Many data suggest that a very early flagging of trauma patients in need for DCR would be beneficial but this need to be proved. Do we improve our quality of care by an earlier diagnosis? Does a prehospital discrimination between trauma patients with or without a potential need for DCR has a positive impact