Caractéristiques et devenir à court et long terme des patients ayant séjourné en réanimation plus de 90 jours (étude observationnelle à propos de 50 cas)

Introduction : Les progrès de la réanimation ces 20 dernières années ont permis de mieux prendre en charge les patients les plus graves entrainant des durées de séjours prolongées. Les études ayant étudiées le devenir des patients après un long séjour ont pris le seuil d'une durée supérieure à 30 jours. Des seuils supérieurs n'ont pas été étudiés. L'objectif de cette étude était de décrire les caractéristiques des patients ayant séjourné plus de 3 mois en réanimation ainsi que leur devenir à un an. Méthodes : Tous les patients ayant séjourné plus de 90j en réanimation entre 1997 et 2011 dans notre service de réanimation ont été rétrospectivement inclus. Les données démographiques, comorbidités, diagnostic à l'entrée, et complications ont été recueillies. Les taux de mortalité en réanimation, à 3, 6 et 12 mois étaient établis. Résultats : La durée moyenne de séjour en réanimation était de 134j [+-46].44% de malades chirurgicaux et 56% médicaux. Le taux de survie en réanimation était de 64%. 40% des patients sont sortis vivants de l'hôpital. La mortalité à 3, 6, et 12 mois était respectivement de 60%; 64%; 66%. Discution: Un tiers des patients ayant séjourné plus de 90j décèdent en réanimation, un tiers décède à l'hôpital et un tiers est en vie à 1 an de la sortie de réanimation. La présence de pathologie cardiaque est fOliement associée à une durée de survie plus courte contrairement à l'âge ou l'IGS. De futures études sont nécessaires pour mieux définir les patients qui bénéficieraient le plus des ressources de réanimation au long cours. La qualité de vie après un long séjour en réanimation devrait également être évaluéeIntroduction: Advances in resuscitation over the past 20 years have improved care for the most severe patients leading to a drastic extension of the length ofhospital stays. Literature (reviews and studies) describes patients outcome after a "long" stay in ICU after more than 30 days. But none has focused on longer stays in terms of morbidity and mortality with a 90 days threshold. The aim ofthis study was to assess the "long-stay" patient's characteristics over a 3 months period in the ICU and what they became 1 year later. Materials and methods: This is a descriptive, retrospective study which took place during 5 years. Ali patients who stayed more than 90 days in our intensive care unit (between 1997 and 2011) were included and screened. Demographie data, comorbidity factors, primary diagnosis, side effects and complications were recorded. We then obtained the ICU mortality ratio at 3, 6 and 12 months. We performed a Kaplan Meier survival curve. We used the log-rank test to compare one-year mortality related factors. Hazard Ratio calculation (HR) was performed by Cox model, and then a Cox multivariate model analysis (adjusted ta the age and Simplified Acute Severity Score (SAPSII) was done. Results: The median duration of lCU stay was 116 days [105, 153].coming both fromMONTPELLIER-BU Médecine UPM (341722108) / SudocSudocFranceF

Acidose métabolique

International audienc

Pneumonia in Immunocompromised Patients: More than Meets the Eye

International audienc

Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis

International audienc

A simple widespread computer help improves nutrition support orders and decreases infection complications in critically ill patients.

AIMS: To assess the impact of a simple computer-based decision-support system (computer help) on the quality of nutrition support orders and patients' outcome in Intensive-Care Unit (ICU). METHODS: This quality-improvement study was carried out in a 16-bed medical-surgical ICU in a French university hospital. All consecutive patients who stayed in ICU more than 10 days with non-oral feeding for more than 5 days were retrospectively included during two 12-month periods. Prescriptions of nutrition support were collected and compared to French national guidelines as a quality-improvement process. A computer help was constructed using a simple Excel-sheet (Microsoft(TM)) to guide physicians' prescriptions according to guidelines. This computer help was displayed in computers previously used for medical orders. Physicians were informed but no systematic protocol was implemented. Patients included during the first (control group) and second period (computer help group) were compared for achievement of nutrition goals and ICU outcomes. RESULTS: The control and computer help groups respectively included 71 and 95 patients. Patients' characteristics were not significantly different between groups. In the computer help group, prescriptions achieved significantly more often 80% of nutrition goals for calorie (45% vs. 79% p<0.001) and nitrogen intake (3% vs. 37%, p<0.001). Incidence of nosocomial infections decreased significantly between the two groups (59% vs. 41%, p = 0.03). Mortality did not significantly differ between control (21%) and computer help groups (15%, p = 0.30). CONCLUSIONS: Use of a widespread inexpensive computer help is associated with significant improvements in nutrition support orders and decreased nosocomial infections in ICU patients. This computer-help is provided in electronic supplement

Effect of lung recruitment maneuver on oxygenation, physiological parameters and mortality in acute respiratory distress syndrome patients: a systematic review and meta-analysis

International audienc

Adverse events, short- and long-term outcomes of extra corporeal liver therapy in the intensive care unit: 16 years experience with MARS® in a single center

International audienceAbstract Background Molecular Adsorbent Recirculating System (MARS®) is a non-biological artificial liver device. The benefit risk ratio between uncertain clinical effects and potential adverse events remains difficult to assess. We sought to describe adverse events related to MARS® therapy as well as biological and clinical effects. Methods All intensive care unit (ICU) admissions to whom MARS® therapy was prescribed from March 2005 to August 2021 were consecutively and prospectively included. The main endpoint was the incidence of adverse events related to MARS® therapy. Secondary endpoints were the biological and clinical effects of MARS® therapy. Results We reported 180 admissions treated with MARS® therapy. Among the 180 admissions, 56 (31.1%) were for acute-on-chronic liver failure, 32 (17.8%) for acute liver failure, 28 (15.5%) for post-surgery liver failure, 52 (28.9%) for pruritus and 12 (6.7%) for drug intoxication. At least one adverse event occurred in 95 (52.8%) admissions. Thrombocytopenia was the most frequent adverse event which was recorded in 55 admissions (30.6%). Overall, platelets count was 131 (± 95) × 10 9 /L before and 106 (± 72) × 10 9 /L after MARS® therapy ( p < .001). After MARS® therapy, total bilirubin was significantly decreased in all groups ( p < 0.05). Hepatic encephalopathy significantly improved in both the acute-on-chronic and in the acute liver failure group ( p = 0.01). In the pruritus group, pruritus intensity score was significantly decreased after MARS® therapy ( p < 0.01). Conclusion In this large cohort of patients treated with MARS® therapy we report frequent adverse events. Thrombocytopenia was the most frequent adverse event. In all applications significant clinical and biological improvements were shown with MARS® therapy

Medical Versus Surgical ICU Obese Patient Outcome : A Propensity-Matched Analysis to Resolve Clinical Trial Controversies

International audienceTo determine the short- and long-term mortality of obese ICU patients following medical as opposed to surgical admission and the relation between obesity and mortality.None

Outcomes and time trends of acute respiratory distress syndrome patients with and without liver cirrhosis: an observational cohort

Abstract Background In studies prior to lung-protective ventilation, liver cirrhosis in acute respiratory distress syndrome (ARDS) was associated with high mortality rates. Since patients with cirrhosis have been excluded from many trials on ARDS, their outcome when treated with lung-protective ventilation is unclear. The objectives were to assess whether cirrhosis is associated with mortality in ARDS and trends over time in mortality and severity. Methods We conducted a retrospective analysis of a prospective observational cohort conducted in a 20-bed tertiary ICU from October 2003 to December 2021. All consecutive adult critically ill patients with ARDS were included. ARDS was defined by the Berlin criteria. The primary outcome was 90 day mortality, assessed with Kaplan–Meier curves and multivariate Cox analysis. Time trends were assessed on 90 day mortality, Sequential Organ-Function Assessment score (SOFA) and non-hepatic SOFA. Ventilation settings were compared between patients with and without cirrhosis. Results Of the 7155 patients screened, 863 had a diagnosis of ARDS. Among these ARDS patients, 157(18%) had cirrhosis. The overall 90 day mortality was of 43% (378/863), 57% (90/157) in patients with cirrhosis and 41% (288/706) in patients without cirrhosis (p < 0.001). On survival curves, cirrhosis was associated with 90 day mortality (p < 0.001). Cirrhosis was independently associated with 90 day mortality in multivariate analysis (hazard ratio = 1.56, 95% confidence interval 1.20–2.02). There was no change in mortality over time in ARDS patients with and without cirrhosis. SOFA (p = 0.04) and non-hepatic SOFA (p = 0.02) increased over time in ARDS patients without cirrhosis, and remained stable in ARDS patients with cirrhosis. Tidal volume, positive end-expiratory pressure, plateau pressure and driving pressure were not different between ARDS patients with and without cirrhosis. Conclusions Although ARDS management improved over the last decades, the 90 day mortality remained high and stable over time for both ARDS patients with (57%) and without cirrhosis (41%). Nevertheless, the severity of patients without cirrhosis has increased over time, while the severity of patients with cirrhosis has remained stable. Graphical Abstrac

Implementation of a combo videolaryngoscope for intubation in critically ill patients: a before-after comparative study

International audienc