Prevention of early ventilation-acquired pneumonia (VAP) in comatose brain-injured patients by a single dose of ceftriaxone: PROPHY-VAP study protocol, a multicentre, randomised, double-blind, placebo-controlled trial

International audienceIntroduction: Ventilator-associated pneumonia (VAP) is the first cause of healthcare-associated infections in intensive care units (ICUs) and brain injury is one of the main risk factors for early-onset VAP. Antibiotic prophylaxis has been reported to decrease their occurrence in brain-injured patients, but a lack of controlled randomised trials and the risk of induction of bacterial resistance explain the low level of recommendations. The goal of this study is to determine whether a single dose of ceftriaxone within the 12 hours postintubation after severe brain injury can decrease the risk of early-onset VAP.Methods and analysis: The PROPHY-VAP is a French multicentre, randomised, double-blind, placebo-controlled, clinical trial. Adult brain-injured patients (n=320) with a Glasgow Coma Scale ≤12, requiring mechanical ventilation for more than 48 hours, are randomised to receive either a single dose of ceftriaxone 2 g or a placebo within the 12 hours after tracheal intubation. The primary endpoint is the proportion of patients developing VAP from the 2nd to the 7th day after mechanical ventilation. Secondary endpoints include the proportion of patients developing late VAP (>7 days after tracheal intubation), the number of ventilator-free days, VAP-free days and antibiotic-free days, length of stay in the ICU, proportion of patients with ventilator-associated events and mortality during their ICU stay.Ethics and dissemination: The initial research project was approved by the Institutional Review Board of OUEST III (France) on 20 October 2014 (registration No 2014-001668-36) and carried out according to the principles of the Declaration of Helsinki and the Clinical Trials Directive 2001/20/EC of the European Parliament relating to the Good Clinical Practice guidelines. The results of this study will be presented in national and international meetings and published in an international peer-reviewed journal

Patient factors and outcomes associated with the withdrawal or withholding of life-sustaining therapies in mechanically ventilated brain-injured patients An observational multicentre study

International audienceBackground - Knowledge of the factors associated with the decision to withdraw or withhold life support (WWLS) in brain-injured patients is limited. However, most deaths in these patients may involve such a decision. Objectives - To identify factors associated with the decision to WWLS in brain-injured patients requiring mechanical ventilation who survive the first 24 h in the ICU, and to analyse the outcomes and time to death. Design - A retrospective observational multicentre study. Settings - Twenty French ICUs in 18 university hospitals. Patients - A total of 793 mechanically ventilated brain-injured adult patients. Interventions - None. Main outcome measures - Decision to WWLS within 3 months of ICU admission, and death or Glasgow Outcome Scale (GOS) score at day 90. Results - A decision to WWLS was made in 171 patients (22%), of whom 89% were dead at day 90. Out of the 247 deaths recorded at day 90, 153 (62%) were observed after a decision to WWLS. The median time between admission and death when a decision to WWLS was made was 10 (5 to 20) days vs. 10 (5 to 26) days when no end-of-life decision was made (P < 0.924). Among the 18 patients with a decision to WWLS who were still alive at day 90, three patients (2%) had a GOS score of 2, nine patients (5%) had a GOS score of 3 and five patients (3%) a GOS score of 4. Older age, presence of one nonreactive and dilated pupil, Glasgow Coma Scale less than 7, barbiturate use, acute respiratory distress syndrome and worsening lesions on computed tomography scans were each independently associated with decisions to WWLS. Conclusion - Using a nationwide cohort of brain-injured patients, we observed a high proportion of deaths associated with an end-of-life decision. Older age and several disease severity factors were associated with the decision to WWLS

The first six months of the Advanced LIGO’s and Advanced Virgo’s third observing run with GRANDMA

International audienceWe present the Global Rapid Advanced Network Devoted to the Multi-messenger Addicts (GRANDMA). The network consists of 21 telescopes with both photometric and spectroscopic facilities. They are connected together thanks to a dedicated infrastructure. The network aims at coordinating the observations of large sky position estimates of transient events to enhance their follow-up and reduce the delay between the initial detection and optical confirmation. The GRANDMA programme mainly focuses on follow-up of gravitational-wave alerts to find and characterize the electromagnetic counterpart during the third observational campaign of the Advanced LIGO and Advanced Virgo detectors. But it allows for follow-up of any transient alerts involving neutrinos or gamma-ray bursts, even those with poor spatial localization. We present the different facilities, tools, and methods we developed for this network and show its efficiency using observations of LIGO/Virgo S190425z, a binary neutron star merger candidate. We furthermore report on all GRANDMA follow-up observations performed during the first six months of the LIGO–Virgo observational campaign, and we derive constraints on the kilonova properties assuming that the events’ locations were imaged by our telescopes