Effects of high doses of selenium, as sodium selenite, in septic shock: a placebo-controlled, randomized, double-blind, phase II study

INTRODUCTION: Sepsis is associated with the generation of oxygen free radicals and (lacking) decreased selenium plasma concentrations. High doses of sodium selenite might reduce inflammation by a direct pro-oxidative effect and may increase antioxidant cell capacities by selenium incorporation into selenoenzymes. We investigated the effects of a continuous administration of high doses of selenium in septic shock patients. METHODS: A prospective, multicentre, placebo-controlled, randomized, double-blind study was performed with an intention-to-treat analysis in severe septic shock patients with documented infection. Patients received, for 10 days, selenium as sodium selenite (4,000 μg on the first day, 1,000 μg/day on the nine following days) or matching placebo using continuous intravenous infusion. The primary endpoint was the time to vasopressor therapy withdrawal. The duration of mechanical ventilation, the mortality rates in the intensive care unit, at hospital discharge, and at 7, 14, 28 and 180 days and 1 year after randomization, and adverse events were recorded. RESULTS: Sixty patients were included (placebo, n = 29; selenium, n = 31). The median time to vasopressor therapy withdrawal was 7 days in both groups (95% confidence interval = 5–8 and 6–9 in the placebo and selenium groups, respectively; log-rank, P = 0.713). The median duration of mechanical ventilation was 14 days and 19 days in the placebo and selenium groups, respectively (P = 0.762). Mortality rates did not significantly differ between groups at any time point. Rates of adverse events were similar in the two groups. CONCLUSION: Continuous infusion of selenium as sodium selenite (4,000 μg on the first day, 1,000 μg/day on the nine following days) had no obvious toxicity but did not improve the clinical outcome in septic shock patients. Trial Registration = NCT00207844

Epidemiologie des interventions médicales dans les salles de spectacles parisiennes

Tous les soirs, dans les salles de spectacle parisiennes, un médecin est de garde afin d'assurer un service médical. Ceci répond à l'obligation légale faite par l'ordonnance préfectorale du premier janvier 1927. L'activité médicale dans les salles de spectacle est une activité importante. Celle-ci n'a jamais été étudiée jusqu'à ce jour. Le médecin de garde intervient auprès du public, des acteurs et du personnel. Il rempli une fiche d'intervention, qu'il remet à l'Association des médecins chefs des théâtres de Paris et de la Région Parisienne, après chaque intervention. Nous avons procéder à une analyse statistique de ces fiches d'interventions (430 au total). L'activité médicale est très diversifiée. La situation la plus courante est représentée par les malaises bénins. Mais le médecin peut intervenir pour de la traumatologie, des troubles digestifs et des consultations sans caractères d'urgences. Les malaises graves ne sont pas absents et représentent 7 % des interventions. Le motif d'intervention varie en fonction du type de spectacle. On constate beaucoup de malaise de type vagal dans les spectacles de musique contemporaine, de traumatologie dans les spectacles de music-hall, de crises d'asthme dans les cirques avec des animaux. Afin d'obtenir des données plus précises pour une analyse prospective future, nous avons proposé une amélioration du recueil des données. Quelques recommandations de bonne pratique médicale ont été données afin d'améliorer la prise en charge des patients. Enfin, nous avons proposé une trousse médicale-type pour répondre aux motifs d'intervention médicale les plus courants.PARIS7-Villemin (751102101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Anxiety and depression are unrecognised in emergency patients admitted to the observation care unit.

To assess the sensitivity and specificity of emergency physicians in detecting anxiety and depression in patients requiring admission to the emergency department (ED) observation care unit for complementary investigations/treatment

A communication strategy and brochure for relatives of patients dying in the ICU.

International audienceBACKGROUND: There is a need for close communication with relatives of patients dying in the intensive care unit (ICU). We evaluated a format that included a proactive end-of-life conference and a brochure to see whether it could lessen the effects of bereavement. METHODS: Family members of 126 patients dying in 22 ICUs in France were randomly assigned to the intervention format or to the customary end-of-life conference. Participants were interviewed by telephone 90 days after the death with the use of the Impact of Event Scale (IES; scores range from 0, indicating no symptoms, to 75, indicating severe symptoms related to post-traumatic stress disorder [PTSD]) and the Hospital Anxiety and Depression Scale (HADS; subscale scores range from 0, indicating no distress, to 21, indicating maximum distress). RESULTS: Participants in the intervention group had longer conferences than those in the control group (median, 30 minutes [interquartile range, 19 to 45] vs. 20 minutes [interquartile range, 15 to 30]; P<0.001) and spent more of the time talking (median, 14 minutes [interquartile range, 8 to 20] vs. 5 minutes [interquartile range, 5 to 10]). On day 90, the 56 participants in the intervention group who responded to the telephone interview had a significantly lower median IES score than the 52 participants in the control group (27 vs. 39, P=0.02) and a lower prevalence of PTSD-related symptoms (45% vs. 69%, P=0.01). The median HADS score was also lower in the intervention group (11, vs. 17 in the control group; P=0.004), and symptoms of both anxiety and depression were less prevalent (anxiety, 45% vs. 67%; P=0.02; depression, 29% vs. 56%; P=0.003). CONCLUSIONS: Providing relatives of patients who are dying in the ICU with a brochure on bereavement and using a proactive communication strategy that includes longer conferences and more time for family members to talk may lessen the burden of bereavement. (ClinicalTrials.gov number, NCT00331877.

Risk of Post-traumatic Stress Symptoms in Family Members of Intensive Care Unit Patients

Rationale: Intensive care unit (ICU) admission of a relative is a stressful event that may cause symptoms of post-traumatic stress disorder (PTSD). Objectives: Factors associated with these symptoms need to be identified. Methods: For patients admitted to 21 ICUs between March and November 2003, we studied the family member with the main potential decision-making role