Can noble metal coating reduce the incidence of ventilator associated pneumoniae (VAP): a multicenter double blind randomized pilot study

peer reviewedThis is the first report of a randomized double blind study with Bactiguard tubes which will allow to define the number of patients for a confirmatory larger study

The first wave of COVID-19 in Intensive care

In December 2019, in Wuhan, a new human infectious pathology was born, COVID-19, consisting above all in pneumoniae, induced by the coronavirus named SARS-CoV-2 because of the respiratory distress it caused (SARS for severe acute respiratory syndrome, and CoV for Coronavirus). A real health and planetary crisis has appeared, much more substantial than that linked to SARS-CoV-1 in 2002-2004 and to MERS-CoV (Middle East Respiratory Syndrome Coronavirus) in 2012. In addition to respiratory damage that can be dramatic, this pathology is complicated by the frequency of cardiovascular, renal and coagulation diseases. Health care systems have had to adapt urgently, in the absence of hindsight from the patho- logy, and without effective therapeutic weapons. Through this review of the literature, we detail our local practices for the overall management of patients hospitalized in Intensive care

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

A propos de diphtérie

Cette présentation relate un cas clinique de diphtérie respiratoire à Corynebacterium ulcerans, et aborde la pathogénèse, les manifestations cliniques, l'épidémiologie, le diagnostic microbiologique ainsi que la prise en charge des close contacts en lien avec cette bactérie

"Fulminant" endocarditis due to Staphyloccocus aureus

peer reviewedWe report two cases of "fulminant" endocarditis due to Staphyloccoccus aureus. In both cases, the echocardiographic and bacteriologic diagnosis was esthablished in a clinical picture of severe sepsis and thrombocytopenia evolving after a fever of less than 3 days duration

Cardiac tamponade and pulmonary compression due to volvulus of oesophageal coloplasty

We describe an unusual case of cardiac tamponade and pulmonary compression due to acute volvulus of colon interposition occuring late after oesophagectomy. Clinical signs were suggestive of cardiac tamponade but there was no evidence of pericardial effusion by transthoracic echocardiography. Thoracic-CT provided the diagnostic clue in revealing the extrapericardial nature (a major dilatation of the colonic transplant) of the tamponade. This diagnosis should be considered in case of acute cardiopulmonary distress occuring early or late after oesophagectomy

Post-intensive care syndrome : the issue of life after survival.

peer reviewe

Barotrauma-induced tension pneumoperitoneum.

peer reviewedWe report the case of a massive tension-pneumoperitoneum developing immediately after starting mechanical ventilation (barotrauma). Careful analysis of CT-data provided meaningful informations in assessing the non surgical pulmonary source of pneumo peritoneum

Inhaled sevoflurane sedation in the intensive care unit. A case report and narrative literature review

This article aims at reviewing, in recent literature, the interest and good practice of using volatile sedation with sevoflurane in an intensive care setting. Although rarely used in the intensive care unit (ICU) compared to intravenous sedation, inhaled sedation may be a good alternative to insure comfort to ICU patients. Current literature demonstrates that sevoflurane, administrated through a specifically designed device, the AnaConDa, provides safe and good quality sedation to those patients. Long-term inhaled sevoflurane sedation (ISS) (>96 hours) would be associated to lower agitation, improved pain control, and lower mortality than intravenous sedation. The properties of sevoflurane may be of further advantage in specific intensive care situations such as bronchospasm, postoperative sedation after cardiothoracic surgery, or in agitated patients due to alcohol or other drugs withdrawal. Other studies suggest superiority of ISS in case of pulmonary arterial hypertension, chronic obstructive pulmonary disease, and acute respiratory distress syndrome. We here illustrate our literature review with a case of severe bronchospasm successfully managed using ISS. © Acta Ancesthesiologica Belgica, 2018