Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Pneumocystoses des immunodéprimés non infectés par le VIH (incidence et pronostic)

Introduction: Le pronostic et les incidences des pneumocystoses pulmonaires des immunodéprimés non infectés par le virus de l'immunodéficience humaine (VIH) sont peu décrits. Méthode: Etude rétrospective monocentrique au CHU de Rennes du 01/01/1990 au 30/06/2010 et calcul des incidences par pathologie grâce aux codages du programme de médicalisation du système informatique. Résultats: Le taux de mortalité en réanimation des patients non infectés par le VIH est de 52.9% et de 86.8% en cas de syndrome de détresse respiratoire aiguë. En analyse multivariée, seul le syndrome de détresse respiratoire aiguë est associé à la mortalité (p<0.0001). Les incidences estimées de la pneumocystose varient selon les pathologies sous-jacentes: de 2.6 à 93.2/100000/an pour le cancer pulmonaire et la périartérite noueuse respectivement. Conclusion: La hiérarchisation du risque de pneumocystose peut servir à cibler les patients à risque en vue d'une prescription d'une prophylaxie.RENNES1-BU Santé (352382103) / SudocSudocFranceF

The reply: All Patients with Leukemia Are Not Equally at Risk of Contracting Pneumocystis jirovecii Pneumonia

International audienceRefers To: Roux Antoine, Bornstain Caroline, Vincent François, GRRROH, All Patients with Leukemia Are Not Equally at Risk of Contracting Pneumocystis jirovecii Pneumonia, The American Journal of Medicine, Volume 128, Issue 1, January 2015, Page e9, ISSN 0002-9343, http://dx.doi.org/10.1016/j.amjmed.2014.09.026

Multiple-site decontamination regimen without systemic antibiotics associated with reduced mortality in intubated patients

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Attributable mortality of ICU acquired bloodstream infections: a propensity-score matched analysis

International audienceThe mortality attributable to ICU-acquired bloodstream infection (BSI) differs between studies due to statistical methods used for cohort matching. Propensity-score matching has never been used to avoid eventual bias when studying BSI attributable mortality in the ICU. We conducted an observational prospective study over a 4-year period, on patients admitted for at least 48 h in 2 intensive care units. Based on risk factors for death in the ICU and for BSI, each patient with BSI was matched with 3 patients without BSI using propensity-score matching. We performed a competitive risk analysis to study BSI mortality attributable fraction. Of 2464 included patients, 71 (2.9%) had a BSI. Propensity-score matching was highly effective and group characteristics were fully balanced. Crude mortality was 36.6% in patients with BSI and 21.6% in propensity-score matched patients (p=0.018). Attributable mortality of BSI was 2.3% [1.2-4.0] and number needed to harm was 6.7. With Fine and Gray model, a higher risk for death was observed in patients with BSI than in propensity-score matched patients (sub distribution Hazard Ratio (sdHR) = 2.11; 95% CI [1.32-3.37] p = 0.002). Patients with BSI had a higher risk for death and BSI attributable mortality fraction was 2.3%

Advantages of the scheduled selected reaction monitoring algorithm in liquid chromatography/ electrospray ionization tandem mass spectrometry multi-residue analysis of 242 pesticides: a comparative approach with classical selected reaction monitoring mode

International audienceThis paper illustrates the advantages of using the scheduled selected reaction monitoring (sSRM) algorithm available in Analyst1 Software 1.5 to build SRM acquisition methods in the application field of pesticide multi-residue analysis. The principle is to monitor the SRM transitions only when necessary. Based on the analytes’ retention times, the scheduled SRM algorithm decreases the number of concurrent SRM transitions monitored at any point in time, allowing both cycle time and dwell time to remain optimal at higher levels of SRM multiplexing. To compare the scheduled SRM and the classical SRM modes, a mixture containing 242 multi-class pesticides has been analyzed ten times by three acquisition methods, using liquid chromatography/tandem mass spectrometry (LC/MS/MS) with an API 4000 QTrapTM mass spectrometer. The scheduled SRM mode demonstrates better results in all fields: more data points per peak, better reproducibility (coefficients of variation (CVs) <5%) and higher signal-to-noise ratio (S/N), even when the number of SRM transitions is doubled. The use of scheduled SRM mode instead of the classical one gives an enhancement of the limits of quantification by a factor two or even higher (up to six), depending on the analyte transitions

Multiresidue determination of 256 pesticides in lavandin essential oil by LC/ESI/sSRM: advantages and drawbacks of a sampling method involving evaporation under nitrogen

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Multiresidue determination of 256 pesticides in lavandin essential oil by LC/ESI/sSRM: advantages and drawbacks of a sampling method involving evaporation under nitrogen

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The Sampling Method by Evaporation under Nitrogen as a Complementary Approach for the Multiresidue Analysis of 256 Pesticides in Lavandin Essential Oil by LC/ESI/sSRM

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