1
|
Malengreaux C, Minguet P, Colson C, Dardenne N, Misset B, Rousseau AF. Incidence and risk factors of peripheral nerve injuries 3 months after ICU discharge: a retrospective study comparing COVID-19 and non-COVID-19 critically ill survivors. J Anesth Analg Crit Care 2024; 4:10. [PMID: 38336831 PMCID: PMC10858596 DOI: 10.1186/s44158-024-00144-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Peripheral nerve injuries (PNI) have been associated with prone positioning (PP) in mechanically ventilated (MV) patients with COVID-19 pneumonia. The aims of this retrospective study were to describe PNI prevalence 3 months (M3) after intensive care unit (ICU) discharge, whether patients survived COVID-19 or another critical illness, and to search for risk factors of PNI. RESULTS A total of 55 COVID (62 [54-69] years) and 22 non-COVID (61.5 [48-71.5] years) patients were followed at M3, after an ICU stay of respectively 15 [9-26.5] and 13.5 [10-19.8] days. PNI symptoms were reported by 23/55 (42.6%) COVID-19 and 8/22 (36%) non-COVID-19 patients (p = 0.798). As the incidence of PNI was similar in both groups, the entire population was used to determine risk factors. The MV duration predicted PNI occurrence (OR (CI95%) = 1.05 (1.01-1.10), p = 0.028), but not the ICU length of stay, glucocorticoids, or inflammation biomarkers. CONCLUSION In the present cohort, PNI symptoms were reported in at least one-third of the ICU survivors, in similar proportion whether patients suffered from severe COVID-19 or not.
Collapse
Affiliation(s)
- C Malengreaux
- Department of Intensive Care and Burn Centre, University Hospital of Liège, Avenue de L'Hôpital,1, University of Liège, Sart-Tilman B35, Liège, B-4000, Belgium.
| | - P Minguet
- Department of Intensive Care and Burn Centre, University Hospital of Liège, Avenue de L'Hôpital,1, University of Liège, Sart-Tilman B35, Liège, B-4000, Belgium
| | - C Colson
- Department of Intensive Care and Burn Centre, University Hospital of Liège, Avenue de L'Hôpital,1, University of Liège, Sart-Tilman B35, Liège, B-4000, Belgium
| | - N Dardenne
- University and Hospital Biostatistics Centre (B-STAT), University of Liège, Liège, Belgium
| | - B Misset
- Department of Intensive Care and Burn Centre, University Hospital of Liège, Avenue de L'Hôpital,1, University of Liège, Sart-Tilman B35, Liège, B-4000, Belgium
| | - A F Rousseau
- Department of Intensive Care and Burn Centre, University Hospital of Liège, Avenue de L'Hôpital,1, University of Liège, Sart-Tilman B35, Liège, B-4000, Belgium
- GIGA-Research, GIGA-I3 Thematic Unit, Inflammation and Enhanced Rehabilitation Laboratory (Intensive Care), University of Liège, Liège, Belgium
| |
Collapse
|
2
|
Naoussi F, De Neef A, Gilbert A, Résimont G, Weekers L, Misset B. [Rare complication of a dog bite: Capnocytophaga species bacteremia followed by an hemolytic uremic syndrome]. Rev Med Liege 2022; 77:551-556. [PMID: 36226390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Dog bites are a frequent reason for medical consultation. These can be responsible for severe infectious complications. Bacteria of the genus Capnocytophaga species are Gram-negative bacilli commonly found in the oral cavity of certain animals such as dogs and cats. Following a dog bite or wound contamination with animal spit, these bacteria can cause local (cellulitis), systemic and invasive manifestations (bacteremia, endocarditis, meningitis) or lead to rare and dreadful complications such as thrombotic microangiopathies. The identification of Capnocytophaga is slow due to their specific characteristics and their culture conditions. The treatment of Capnocytophaga species infections is based on antibiotic therapy with amoxicillin - clavulanic acid as the first choice. Although different types of Capnocytophaga have been described, C. Canimorsus appears to be associated with a higher rate of atypical complications. Here is the description of an immunocompetent patient who presented with C. Canimorsus bacteremia complicated by hemolytic uremic syndrome following a dog bite.
Collapse
Affiliation(s)
- F Naoussi
- Service d'Anesthésie-Réanimation, CHU Liège, Belgique
| | - A De Neef
- Service d'Anesthésie-Réanimation, CHU Liège, Belgique
| | - A Gilbert
- Service des Urgences,CHU Liège, Belgique
| | - G Résimont
- Service de Néphrologie, CHU Liège, Belgique
| | - L Weekers
- Service de Néphrologie, CHU Liège, Belgique
| | - B Misset
- Service des Soins intensifs, CHU Liège, Belgique
| |
Collapse
|
3
|
Misset B, Parzibut G, Layios N, Cavalleri J, Delvenne P, Desmecht D, Rousseau AF, Lambermont B. [Inflammation during COVID-19]. Rev Med Liege 2022; 77:277-284. [PMID: 35657183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Infection due to SARS-CoV-2 is associated with clinical features of diverse severity. Severe disease includes biological criteria of both inflammation and coagulation activation, and high circulating levels of pro- and anti-inflammatory cytokines. The most critical patients present with acute respiratory distress syndrome and multiple organ failure, resembling bacterial sepsis. Clinical trials have shown that steroids reduce mortality of severe cases, suggesting that inflammation as a mechanism of defense against viral invasion is excessive rather than insufficient. Several molecules targeting more specific pathways than steroids are under evaluation. Those reducing interleukin 6 activity have a certain degree of effectiveness. Anticoagulants and fibrinolytics have moderate impact on the hypercoagulation state. Like for bacterial sepsis, future trials will attempt therapy "individualization" based on biomarkers, but we still lack precision diagnostic tools.
Collapse
Affiliation(s)
- B Misset
- Service des Soins Intensifs, CHU Liège, Belgique
| | - G Parzibut
- Service des Soins Intensifs, CHU Liège, Belgique
| | - N Layios
- Service des Soins Intensifs, CHU Liège, Belgique
| | - J Cavalleri
- Service des Soins Intensifs, CHU Liège, Belgique
| | - Ph Delvenne
- Service d'Anatomie Pathologique, CHU Liège, Belgique
| | - D Desmecht
- Service d'Anatomie Pathologique, Faculté Vétérinaire, ULiège, Belgique
| | - A F Rousseau
- Service des Soins Intensifs, CHU Liège, Belgique
| | - B Lambermont
- Service des Soins Intensifs, CHU Liège, Belgique
| |
Collapse
|
4
|
Rousseau AF, Schmitz S, Colson C, Farrauto L, Minguet P, Cavalier E, Misset B, Boemer F. Étude du profil en acylcarnitines après séjour prolongé aux soins intensifs. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
5
|
Salacroup C, David C, Fayemendy P, Misset B, Migolatiev M, Bonhommo S, Bonnet C, Calmel N, Charron L, Rouchaud A, Deluche E, Jésus P. Étude de la sarcopénie selon les critères de masse, de force et de fonction musculaire, au diagnostic de cancer du pancréas : impact sur la survie. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
6
|
Morreale A, Canivet JL, Charlier C, Misset B. [Chronic paracetamol intoxication : under-diagnosed iatrogenic cause of metabolic acidosis with increased anion gap]. Rev Med Liege 2021; 76:620-624. [PMID: 34357715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The occurrence of metabolic acidosis with increased anion gap in the context of chronic paracetamol intoxication is an easily treatable clinical situation. Its rapid recognition is essential given its complete reversibility in the event of adequate management by eviction of the toxic agent, in this case paracetamol. It has an unknown cause and therefore potentially under-diagnosed, to be considered in the same way as the other more frequent etiologies. Because of this lack of knowledge, its frequency is probably underestimated considering the widespread consumption of paracetamol in the population.
Collapse
Affiliation(s)
- A Morreale
- Service des Urgences, CHU Liège, Belgique
| | - J L Canivet
- Service des Soins intensifs, CHU Liège, Belgique
| | - C Charlier
- Faculté de Médecine, ULiège; Service de Toxicologie clinique, médicolégale, de l'Environnement et en Entreprise, CHU Liège, Belgique
| | - B Misset
- Service des Soins intensifs, CHU Liège, Belgique
| |
Collapse
|
7
|
Cavalleri J, Kisoka G, Verscheure S, Canivet JL, Misset B. [Danger of mechanical ventilation : Macklin effect during induced barotrauma]. Rev Med Liege 2021; 76:579-582. [PMID: 34357706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Intubation followed by mechanical ventilation is a classic technic for managing severe respiratory failure in hospital practice. Far from being exempted of risks, this technic can lead to serious complications. We hereby present illustrating images of a complication directly linked to the non-physiological respiratory mode on which mechanical ventilation is based, namely barotrauma linked to positive ventilatory pressures.
Collapse
Affiliation(s)
| | - G Kisoka
- Service des Soins intensifs, CHU Liège, Belgique
| | - S Verscheure
- Services d'Anesthésiologie et des Soins Intensifs, CHC MontLégia, Liège, Belgique
| | - J L Canivet
- Service des Soins intensifs, CHU Liège, Belgique
| | - B Misset
- Service des Soins intensifs, CHU Liège, Belgique
| |
Collapse
|
8
|
Lengelé L, Bruyère O, Fadeur M, Verbrugge A, Martin F, Hans N, Misset B, Rousseau A. Should We Worry About Nutrition Of Adults With Minor Burns? An Audit Of Their Intakes. Ann Burns Fire Disasters 2021; 34:163-169. [PMID: 34584505 PMCID: PMC8396147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 06/13/2023]
Abstract
Small burn injuries are managed in an outpatient setting by surgeons and/or nurses. Nutrition in minor burn patients is rarely investigated. This observational study aimed to quantify their nutritional intakes, and o compare them to theoretical adequate values. Their average daily food intakes since injury were evaluated by a dietician using a ten-point visual assessment of consumed portions during the last meal (SEFI tool) and a food anamnesis. Macro- and micronutrient intakes were compared to national recommended dietary allowances (RDA) for healthy subjects: intakes <66% RDA were considered inadequate. Forty-two patients with a median age of 45 (34-56) years, BMI of 25.9 (23.5-28.9) kg/m2, and burn surface area (BSA) of 2 (1-3) % were included. Energy and protein RDA were reached in 28.6 and 71.4% of the patients, respectively. Intakes of n-3 fatty acids were inadequate in 80.9% of the patients. A SEFI <7 was associated with insufficient intakes regards both energy and proteins. Inadequate intakes of different micronutrients were frequently observed, but no risk factors could be detected. Vitamin A and C were the most impacted: 71.4% of the patients had inadequate intakes. Vitamin D intake was low: 225 (56-431) UI/d. In contrast, intakes of iron, selenium and zinc were adequate in at least 61.9% of the patients. In conclusion, this audit highlighted that a majority of macronutrient and micronutrient intakes did not reach the levels recommended by the RDA. Such data should help in designing further studies aimed at assessing the impact of optimized nutrition on outcomes.
Collapse
Affiliation(s)
- L. Lengelé
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - O. Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | | | | | | | - N. Hans
- Department of Plastic Surgery
| | - B. Misset
- Department of Intensive Care and Burn Center, University Hospital, University of Liège, Liège, Belgium
| | - A.F. Rousseau
- Multidisciplinary Nutrition Team
- Department of Intensive Care and Burn Center, University Hospital, University of Liège, Liège, Belgium
| |
Collapse
|
9
|
Nexon G, Desport J, Jésus P, Fayemendy P, Sourisseau H, Calmel N, Misset B. Prévalences de la dénutrition obtenues dans une même population en utilisant les nouveaux critères de la Haute Autorité de santé (HAS) de l’adulte. NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2021.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
10
|
Misset B, Jésus P, Arnal Couderc M, Sourisseau H, Calmel N, Desport J, Fayemendy P. Changement de sonde de gastrostomie à ballonnet : l’implication des établissements de soins de proximité ou du médecin généraliste permettrait de réduire les coûts. NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Cane M, Jésus P, Misset B, Arnal Couderc M, Sourisseau H, Calmel N, Desport J, Fayemendy P. Comparaison des paramètres latéralisés impédancemétriques et du testing musculaire dans une cohorte de patients atteints de sclérose latérale amyotrophique. NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2021.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Migolatiev M, Jésus P, Dumoitier N, Misset B, Arnal-Couderc M, Desport J, Fayemendy P. Prescription of oral nutritional supplements: attitude and practices of general practitioners of a french department. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Misset B, Jésus P, Arnal-Couderc M, Calmel N, Sourisseau H, Morin B, Fayemendy P, Desport J. Assessment of the Vitamin C Status of patients seen in consultations of nutrition and research of factors associated between nutritional status and Vitamin C deficiency. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
14
|
Misset B, Jésus P, Desport J, Arnal-Couderc M, Calmel N, Sourisseau H, Jacques J, Fayemendy P. Balloon gastrostomy feeding tube replacement: Involving local health-care facilities or general practitioner would reduce costs. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
15
|
Almaarry R, Desport J, Sourisseau H, Calmel N, Misset B, Fayemendy P, Jésus P. Study of the repeatability and reproducibility of the measurements of the brachial perimeter and the tricipital skin fold by nurses specialized in nutrition. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
16
|
Marchetta S, Lambermont B, Massion P, Rousseau AF, Layios N, Robinet S, Canivet JL, Kisoka G, Ledoux D, Morimont P, Piret S, Wiesen P, Misset B. [The first wave of COVID-19 in Intensive care]. Rev Med Liege 2020; 75:18-28. [PMID: 33211418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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 pathology, 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.
Collapse
Affiliation(s)
| | | | - P Massion
- Service de Soins intensifs, CHU Liège, Belgique
| | | | - N Layios
- Service de Soins intensifs, CHU Liège, Belgique
| | - S Robinet
- Service de Soins intensifs, CHU Liège, Belgique
| | - J L Canivet
- Service de Soins intensifs, CHU Liège, Belgique
| | - G Kisoka
- Service de Soins intensifs, CHU Liège, Belgique
| | - D Ledoux
- Service de Soins intensifs, CHU Liège, Belgique
| | - P Morimont
- Service de Soins intensifs, CHU Liège, Belgique
| | - S Piret
- Service de Soins intensifs, CHU Liège, Belgique
| | - P Wiesen
- Service de Soins intensifs, CHU Liège, Belgique
| | - B Misset
- Service de Soins intensifs, CHU Liège, Belgique
| |
Collapse
|
17
|
Frix AN, Schoneveld L, Ladang A, Henket M, Duysinx B, Vaillant F, Misset B, Moutschen M, Louis R, Cavalier E, Guiot J. Could KL-6 levels in COVID-19 help to predict lung disease? Respir Res 2020; 21:309. [PMID: 33234132 PMCID: PMC7683867 DOI: 10.1186/s12931-020-01560-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/29/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Coronavirus disease COVID-19 has become a public health emergency of international concern. Together with the quest for an effective treatment, the question of the post-infectious evolution of affected patients in healing process remains uncertain. Krebs von den Lungen 6 (KL-6) is a high molecular weight mucin-like glycoprotein produced by type II pneumocytes and bronchial epithelial cells. Its production is raised during epithelial lesions and cellular regeneration. In COVID-19 infection, KL-6 serum levels could therefore be of interest for diagnosis, prognosis and therapeutic response evaluation. MATERIALS AND METHODS Our study retrospectively compared KL-6 levels between a cohort of 83 COVID-19 infected patients and two other groups: healthy subjects (n = 70) on one hand, and a heterogenous group of patients suffering from interstitial lung diseases (n = 31; composed of 16 IPF, 4 sarcoidosis, 11 others) on the other hand. Demographical, clinical and laboratory indexes were collected. Our study aims to compare KL-6 levels between a COVID-19 population and healthy subjects or patients suffering from interstitial lung diseases (ILDs). Ultimately, we ought to determine whether KL-6 could be a marker of disease severity and bad prognosis. RESULTS Our results showed that serum KL-6 levels in COVID-19 patients were increased compared to healthy subjects, but to a lesser extent than in patients suffering from ILD. Increased levels of KL-6 in COVID-19 patients were associated with a more severe lung disease. DISCUSSION AND CONCLUSION Our results suggest that KL-6 could be a good biomarker to assess ILD severity in COVID-19 infection. Concerning the therapeutic response prediction, more studies are necessary.
Collapse
Affiliation(s)
- A N Frix
- Department of Respiratory Medicine, CHU Liège, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, B35, 4000, Liège, Belgium.
| | - L Schoneveld
- Department of Clinical Chemistry, CHU Liège, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, B35, 4000, Liège, Belgium
| | - A Ladang
- Department of Clinical Chemistry, CHU Liège, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, B35, 4000, Liège, Belgium
| | - M Henket
- Department of Respiratory Medicine, CHU Liège, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, B35, 4000, Liège, Belgium
| | - B Duysinx
- Department of Respiratory Medicine, CHU Liège, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, B35, 4000, Liège, Belgium
| | - F Vaillant
- Department of Respiratory Medicine, CHU Liège, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, B35, 4000, Liège, Belgium
| | - B Misset
- Intensive Care Unit, CHU Liège, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, B35, 4000, Liège, Belgium
| | - M Moutschen
- Department of Infectious Diseases and Immunology, CHU Liège, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, B35, 4000, Liège, Belgium
| | - R Louis
- Department of Respiratory Medicine, CHU Liège, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, B35, 4000, Liège, Belgium
| | - E Cavalier
- Department of Clinical Chemistry, CHU Liège, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, B35, 4000, Liège, Belgium
| | - J Guiot
- Department of Respiratory Medicine, CHU Liège, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, B35, 4000, Liège, Belgium
| |
Collapse
|
18
|
Misset B, Jésus P, Arnal-Couderc M, Calmel N, Sourisseau H, Morin B, Fayemendy P, Desport J. Évaluation du statut en vitamine C de patients vus en consultation de Nutrition et recherche de facteur associés entre le statut nutritionnel et la carence en vitamine C. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
19
|
Parzibut G, Canivet JL, Guiot J, Lambermont B, Layios N, Ledoux D, Massion P, Morimont P, Piret S, Robinet S, Rousseau AF, Verscheure S, Wiesen P, Misset B. [Acute respiratory distress syndrome]. Rev Med Liege 2019; 74:514-520. [PMID: 31609554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Since its first description in 1967, a lot of progress has been made in understanding the pathophysiology, diagnosis and management of acute respiratory distress syndrome (ARDS). This nosological entity is based on the appearance of a diffuse alveolar damage associating pulmonary epithelial barrier disruption with an alveolar filling, both responsible of profound hypoxemia and important morbi-mortality. Nowadays, ARDS remains a frequent syndrome, associated with various etiologies. Diagnosis is based on the occurrence of acute hypoxic respiratory failure not explained by cardiac insufficiency or volume overload, within 7 days after a recognized risk factor, and in the presence of bilateral pulmonary opacities not fully explained by effusions, atelectasis or nodules on the chest radiography. Survivors present an increased risk of developing cognitive decline, depression, post-traumatic stress, and typical ICU related side-effects such as polyneuropathy and sarcopenia. In this context and not withstanding significant recent progress in the field of mechanical ventilation and extra-corporeal respiratory assistance, early diagnosis remains essential to identify patients with ARDS in order to offer them the most appropriate therapy.
Collapse
Affiliation(s)
- G Parzibut
- Service de Pneumologie, CHU Liège, Belgique
| | | | - J Guiot
- Service de Réanimation, CHU Liège, Belgique
| | | | - N Layios
- Service de Réanimation, CHU Liège, Belgique
| | - D Ledoux
- Service de Réanimation, CHU Liège, Belgique
| | - P Massion
- Service de Réanimation, CHU Liège, Belgique
| | - P Morimont
- Service de Réanimation, CHU Liège, Belgique
| | - S Piret
- Service de Réanimation, CHU Liège, Belgique
| | - S Robinet
- Service de Réanimation, CHU Liège, Belgique
| | | | | | - P Wiesen
- Service de Réanimation, CHU Liège, Belgique
| | - B Misset
- Service de Réanimation, CHU Liège, Belgique
| |
Collapse
|
20
|
Lesieur O, Messika J, Touati S, Chagnon JL, Diehl JL, Outin H, Rigaud JP, Sement A, Terzi N, Thévenin D, Annane D, Bodet-Contentin L, Dreyfuss D, Misset B. Quel effectif médical dans les services de réanimation et surveillance continue en France ? Une position du syndicat des médecins réanimateurs des hôpitaux publics. Méd Intensive Réa 2019. [DOI: 10.3166/rea-2019-0121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
21
|
Desbordes F, Jouveau S, Broussaudier A, Noailletas V, Fayemendy P, Morin B, Misset B, Rebière F, Desport J, Jésus P. État nutritionnel des patients âgés d’un Établissement d’Hébergement pour Personnes Âgées Dépendantes (EHPAD) et liens entre la dénutrition, la consommation de compléments oraux et le service à l’assiette. NUTR CLIN METAB 2019. [DOI: 10.1016/j.nupar.2019.01.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
22
|
Matthaiou DK, Dimopoulos G, Taccone FS, Bulpa P, Van den Abeele AM, Misset B, Meersseman W, Spapen H, Cardoso T, Charles PE, Vogelaers D, Blot S. Elderly versus nonelderly patients with invasive aspergillosis in the ICU: a comparison and risk factor analysis for mortality from the AspICU cohort. Med Mycol 2018; 56:668-678. [PMID: 29228380 DOI: 10.1093/mmy/myx117] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 10/17/2017] [Indexed: 12/16/2022] Open
Abstract
Data regarding the epidemiology and diagnosis of invasive aspergillosis in the critically ill population are limited, with data regarding elderly patients (≥75 years old) even scarcer. We aimed to further compare the epidemiology, characteristics and outcome of elderly versus nonelderly critically ill patients with invasive aspergillosis (IA) Prospective, international, multicenter observational study (AspICU) including adult intensive care unit (ICU) patients, with a culture and/or direct examination and/or histopathological sample positive for Aspergillus spp. at any site. We compared clinical characteristics and outcome of IA in ICU patients using two different diagnostic algorithms. Elderly and nonelderly ICU patients with IA differed in a number of characteristics, including comorbidities, clinical features of the disease, mycology testing, and radiological findings. No difference regarding mortality was found. According to the clinical algorithm, elderly patients were more likely to be diagnosed with putative IA. Elderly patients had less diagnostic radiological findings and when these findings were present they were detected late in the disease course. The comparison between elderly survivors and nonsurvivors demonstrated differences in clinical characteristics of the disease, affected sites and supportive therapy needed. All patients who were diagnosed with proven IA died. Increased vigilance combined with active search for mycological laboratory evidence and radiological confirmation are necessary for the timely diagnosis of IA in the elderly patient subset. Although elderly state per se is not a particular risk factor for mortality, a high SOFA score and the decision not to administer antifungal therapy may have an impact on survival of elderly patients.
Collapse
Affiliation(s)
- D K Matthaiou
- Department of Critical Care Medicine, Attikon University Hospital, University of Athens, Medical School, Athens, Greece
| | - G Dimopoulos
- Department of Critical Care Medicine, Attikon University Hospital, University of Athens, Medical School, Athens, Greece
| | - F S Taccone
- Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | - P Bulpa
- Department of Intensive Care, CHU Dinant-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | | | - B Misset
- Service de Réanimation Médicale, CHU de Rouen - Hôpital Charles Nicolle, Rouen, France
| | - W Meersseman
- Medical Intensive Care Unit, University Hospital Leuven, Leuven, Belgium
| | - H Spapen
- Intensive Care Department, University Hospital, Vrije Universiteit, Brussels, Belgium
| | - T Cardoso
- Department of Intensive Care (UCIP), Oporto Hospital Centre, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - P E Charles
- Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. Dijon, Dijon University Hospital, Dijon, France
| | - D Vogelaers
- Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium
| | - S Blot
- Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium.,Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
| | | |
Collapse
|
23
|
Misset B. [Steroids for community-acquired pneumonia: Should we go on searching or should we give up?]. Rev Mal Respir 2018; 35:781-783. [PMID: 30224211 DOI: 10.1016/j.rmr.2018.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Affiliation(s)
- B Misset
- Médecine intensive et réanimation, université Rouen Normandie, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
| |
Collapse
|
24
|
Robert R, Beaussier M, Pateron D, Ecoffey C, Denys F, Honnart D, Misset B, Reignier J, Perrigault PF, Guidet B, Kerever S, Guiot P. Recommandations pour le fonctionnement des unités de surveillance continue dans les établissements de santé. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
25
|
Robert R, Beaussier M, Pateron D, Ecoffey C, Denys F, Honnart D, Misset B, Reignier J, Perrigault PF, Guidet B, Kerever S, Guiot P. Recommandations pour le fonctionnement des unités de surveillance continue dans les établissements de santé. Méd Intensive Réa 2018. [DOI: 10.3166/rea-2018-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
26
|
Truche A, Darmon M, Bailly S, Clec’h C, Dupuis C, Misset B, Schwebel C, Adrie C, Marcotte G, Zaoui P, Souweine B, Timsit J. Impact sur la mortalité et le pronostic rénal de la modalité d’épuration extrarénale employée en réanimation. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
27
|
Garrouste-Orgeas M, Max A, Grégoire C, Ruckly S, Kloeckner M, Brochon S, Pichot E, Simons C, El Mhadri M, Bruel C, Philippart F, Fournier J, Tiercelet K, Timsit JF, Misset B. IMPACT OF PROACTIVE NURSE PARTICIPATION IN ICU FAMILY CONFERENCES: A MIXED-METHOD STUDY. Intensive Care Med Exp 2015. [PMCID: PMC4798577 DOI: 10.1186/2197-425x-3-s1-a929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
28
|
Wong G, Brinkman A, Benefield RJ, Carlier M, De Waele JJ, El Helali N, Frey O, Harbarth S, Huttner A, McWhinney B, Misset B, Pea F, Preisenberger J, Roberts MS, Robertson TA, Roehr A, Sime FB, Taccone FS, Ungerer JPJ, Lipman J, Roberts JA. An international, multicentre survey of -lactam antibiotic therapeutic drug monitoring practice in intensive care units. J Antimicrob Chemother 2014; 69:1416-23. [DOI: 10.1093/jac/dkt523] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
29
|
Vignier N, Couzigou C, Nguyen Van JC, Gerber S, Gaillard S, Bruel C, Misset B, Kitzis MD, Le Monnier A. Diagnosis and treatment strategies for community-acquired Streptococcus salivarius meningitis. Med Mal Infect 2013; 44:42-4. [PMID: 24274977 DOI: 10.1016/j.medmal.2013.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 09/09/2013] [Accepted: 10/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- N Vignier
- Équipe mobile de microbiologie clinique/équipe opérationnelle d'hygiène, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France; Unité de microbiologie clinique, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - C Couzigou
- Équipe mobile de microbiologie clinique/équipe opérationnelle d'hygiène, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France; Unité de microbiologie clinique, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France.
| | - J C Nguyen Van
- Unité de microbiologie clinique, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - S Gerber
- Service de radiologie, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - S Gaillard
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - C Bruel
- Service de réanimation polyvalente, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - B Misset
- Service de réanimation polyvalente, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - M D Kitzis
- Unité de microbiologie clinique, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - A Le Monnier
- Unité de microbiologie clinique, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| |
Collapse
|
30
|
Zahar JR, Garrouste-Orgeas M, Vesin A, Schwebel C, Bonadona A, Philippart F, Ara-Somohano C, Misset B, Timsit JF. Impact of contact isolation for multidrug-resistant organisms on the occurrence of medical errors and adverse events. Intensive Care Med 2013; 39:2153-60. [PMID: 23995982 DOI: 10.1007/s00134-013-3071-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 08/07/2013] [Indexed: 01/19/2023]
Abstract
UNLABELLED Contact isolation of infected or colonised hospitalised patients is instrumental to interrupting multidrug-resistant organism (MDRO) cross-transmission. Many studies suggest an increased rate of adverse events associated with isolation. We aimed to compare isolated to non-isolated patients in intensive care units (ICUs) for the occurrence of adverse events and medical errors. METHODS We used the large database of the Iatroref III study that included consecutive patients from three ICUs to compare the occurrence of pre-defined medical errors and adverse events among isolated vs. non-isolated patients. A subdistribution hazard regression model with careful adjustment on confounding factors was used to assess the effect of patient isolation on the occurrence of medical errors and adverse events. RESULTS Two centres of the Iatroref III study were eligible, an 18-bed and a 10-bed ICU (nurse-to-bed ratio 2.8 and 2.5, respectively), with a total of 1,221 patients. After exclusion of the neutropenic and graft transplant patients, a total of 170 isolated patients were compared to 980 non-isolated patients. Errors in insulin administration and anticoagulant prescription were more frequent in isolated patients. Adverse events such as hypo- or hyperglycaemia, thromboembolic events, haemorrhage, and MDRO ventilator-associated pneumonia (VAP) were also more frequent with isolation. After careful adjustment of confounders, errors in anticoagulant prescription [subdistribution hazard ratio (sHR) = 1.7, p = 0.04], hypoglycaemia (sHR = 1.5, p = 0.01), hyperglycaemia (sHR = 1.5, p = 0.004), and MDRO VAP (sHR = 2.1, p = 0.001) remain more frequent in isolated patients. CONCLUSION Contact isolation of ICU patients is associated with an increased rate of some medical errors and adverse events, including non-infectious ones.
Collapse
Affiliation(s)
- J R Zahar
- University Grenoble 1-U823-Team 11: Outcome of Cancer and Critical Illnesses, Albert Bonniot Institute, 38706 La Tronche, CEDEX, France,
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Garrouste-Orgeas M, Tabah A, Vesin A, Philippart F, Kpodji A, Bruel C, Grégoire C, Max A, Timsit JF, Misset B. The ETHICA study (part II): simulation study of determinants and variability of ICU physician decisions in patients aged 80 or over. Intensive Care Med 2013; 39:1574-83. [PMID: 23765237 DOI: 10.1007/s00134-013-2977-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 05/19/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess physician decisions about ICU admission for life-sustaining treatments (LSTs). METHODS Observational simulation study of physician decisions for patients aged ≥80 years. Each patient was allocated at random to four physicians who made decisions based on actual bed availability and existence of an additional bed before and after obtaining information on patient preferences. The simulations involved non-invasive ventilation (NIV), invasive mechanical ventilation (IMV), and renal replacement therapy after a period of IMV (RRT after IMV). RESULTS The physician participation rate was 100/217 (46 %); males without religious beliefs predominated, and median ICU experience was 9 years. Among participants, 85.7, 78, and 62 % felt that NIV, IMV, or RRT (after IMV) was warranted, respectively. By logistic regression analysis, factors associated with admission were age <85 years, self-sufficiency, and bed availability for NIV and IMV. Factors associated with IMV were previous ICU stay (OR 0.29, 95 % CI 0.13-0.65, p = 0.01) and cancer (OR 0.23, 95 % CI 0.10-0.52, p = 0.003), and factors associated with RRT (after IMV) were living spouse (OR 2.03, 95 % CI 1.04-3.97, p = 0.038) and respiratory disease (OR 0.42, 95 % CI 0.23-0.76, p = 0.004). Agreement among physicians was low for all LSTs. Knowledge of patient preferences changed physician decisions for 39.9, 56, and 57 % of patients who disagreed with the initial physician decisions for NIV, IMV, and RRT (after IMV) respectively. An additional bed increased admissions for NIV and IMV by 38.6 and 13.6 %, respectively. CONCLUSIONS Physician decisions for elderly patients had low agreement and varied greatly with bed availability and knowledge of patient preferences.
Collapse
Affiliation(s)
- M Garrouste-Orgeas
- Medical-Surgical, Saint Joseph Hospital Network, 185 rue Raymond Losserand, 75014, Paris, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Philippart F, Vesin A, Bruel C, Kpodji A, Durand-Gasselin B, Garçon P, Levy-Soussan M, Jagot JL, Calvo-Verjat N, Timsit JF, Misset B, Garrouste-Orgeas M. The ETHICA study (part I): elderly's thoughts about intensive care unit admission for life-sustaining treatments. Intensive Care Med 2013; 39:1565-73. [PMID: 23765236 DOI: 10.1007/s00134-013-2976-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 05/19/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess preferences among individuals aged ≥80 years for a future hypothetical critical illness requiring life-sustaining treatments. METHODS Observational cohort study of consecutive community-dwelling elderly individuals previously hospitalised in medical or surgical wards and of volunteers residing in nursing homes or assisted-living facilities. The participants were interviewed at their place of residence after viewing films of scenarios involving the use of non-invasive mechanical ventilation (NIV), invasive mechanical ventilation (IMV), and renal replacement therapy after a period of invasive mechanical ventilation (RRT after IMV). Demographic, clinical, and quality-of-life data were collected. Participants chose among four responses regarding life-sustaining treatments: consent, refusal, no opinion, and letting the physicians decide. RESULTS The sample size was 115 and the response rate 87 %. Mean participant age was 84.8 ± 3.5 years, 68 % were female, and 81 % and 71 % were independent for instrumental activities and activities of daily living, respectively. Refusal rates among the elderly were 27 % for NIV, 43 % for IMV, and 63 % for RRT (after IMV). Demographic characteristics associated with refusal were married status for NIV [relative risk (RR), 2.9; 95 % confidence interval (95 %CI), 1.5-5.8; p = 0.002] and female gender for IMV (RR, 2.4; 95 %CI, 1.2-4.5; p = 0.01) and RRT (after IMV) (RR, 2.7; 95 %CI, 1.4-5.2; p = 0.004). Quality of life was associated with choices regarding all three life-sustaining treatments. CONCLUSIONS Independent elderly individuals were rather reluctant to accept life-sustaining treatments, especially IMV and RRT (after IMV). Their quality of life was among the determinants of their choices.
Collapse
Affiliation(s)
- F Philippart
- Medical-Surgical, Saint Joseph Hospital Network, 75014, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Annane D, Diehl JL, Drault JN, Farkas JC, Gouello JP, Fourrier F, Fraïsse F, Jars-Guincestre MC, Mira JP, Misset B, Outin H, Monnet X, Reignier J, Souweine B, Thevenin D, Vieillard-Baron A, Wolff M. Démographie et structures des services de réanimation français (hors réanimation chirurgicale): état des lieux. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13546-013-0647-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
34
|
Bouroche GB, Ruckly S, Misset B, Timsit JF, Philippart F. Abdominal infection plays a role in the incidence of ventilator-associated pneumonia. Crit Care 2013. [PMCID: PMC3643121 DOI: 10.1186/cc11984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
35
|
Abstract
Los servicios de reanimación deben organizar de forma minuciosa la prevención de infecciones en sus enfermos, ya que éstos suelen estar inmunodeprimidos, están sometidos a múltiples procedimientos invasivos realizados por un personal sanitario variado, a menudo en situaciones de urgencia y a cualquier hora del día o de la noche. Las principales infecciones que hay que tratar de prevenir son las neumonías bacterianas adquiridas asociadas a ventilación mecánica (NAVM), las infecciones relacionadas con catéteres intravasculares y las infecciones urinarias asociadas al sondeo vesical. La incidencia de estas infecciones ha disminuido en la mayoría de los servicios que realizan un control cifrado, sobre todo gracias a la implantación de programas de mejora de la calidad. Las técnicas de prevención son múltiples y deben aplicarse simultáneamente. Incluyen medidas globales, como las modalidades de prevención de la transmisión cruzada (higiene de las manos, sobre todo) o de uso de antibióticos, concebidas para reducir la presión de selección de bacterias resistentes a éstos, así como medidas específicas relativas a la colocación y uso de cada uno de los dispositivos invasivos. Numerosas técnicas han demostrado su eficacia en estudios de buen nivel metodológico (higiene de las manos, apósitos para catéteres, etc.), mientras que otras siguen siendo objeto de controversias, por lo que las recomendaciones nacionales e internacionales se actualizan regularmente de acuerdo con los nuevos datos científicos. Estas medidas, implantadas de manera razonada en el marco de programas de mejora de la calidad, permiten obtener tasas muy bajas de infecciones relacionadas con el uso de catéteres vasculares y resultados menos satisfactorios con las NAVM, que justifican la necesidad de proseguir la investigación en este campo.
Collapse
Affiliation(s)
- F. Philippart
- Service de réanimation, Groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
- Université Paris Descartes, 12, rue de l’École-de-Médecine, 75270 Paris cedex 06, France
- Unité cytokines et inflammation, Institut Pasteur, 25-28, rue du Docteur-Roux, 75015 Paris, France
| | - A. Max
- Service de réanimation, Groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - C. Couzigou
- Unité d’hygiène, Groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - B. Misset
- Université Paris Descartes, 12, rue de l’École-de-Médecine, 75270 Paris cedex 06, France
- Chef du service de réanimation, Groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
- Auteur correspondant.
| |
Collapse
|
36
|
Parlato M, Souza-Fonseca-Guimaraes F, Philippart F, Misset B, Adib-Conquy M, Cavaillon JM. CD24-mediated neutrophil death in inflammation: ex vivo study suggesting a potential role in sepsis. Crit Care 2012. [PMCID: PMC3504882 DOI: 10.1186/cc11768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
37
|
Fourrier F, Boiteau R, Charbonneau P, Drault JN, Dray S, Farkas JC, Leclerc F, Misset B, Rigaud JP, Saulnier F, Soury-Lavergne A, Thévenin D, Wolff M. Structures et organisation des unités de réanimation : 300 recommandations. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13546-012-0510-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
38
|
Souza-Fonseca-Guimaraes F, Parlato M, Philippart F, Misset B, Cavaillon JM, Adib-Conquy M. Natural killer cell status and tolerance in mouse and human bacterial sepsis. Crit Care 2012. [PMCID: PMC3504885 DOI: 10.1186/cc11771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
39
|
Garrouste-Orgeas M, Philippart F, Bruel C, Max A, Lau N, Misset B. Overview of medical errors and adverse events. Ann Intensive Care 2012; 2:2. [PMID: 22339769 PMCID: PMC3310841 DOI: 10.1186/2110-5820-2-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 02/16/2012] [Indexed: 12/20/2022] Open
Abstract
Safety is a global concept that encompasses efficiency, security of care, reactivity of caregivers, and satisfaction of patients and relatives. Patient safety has emerged as a major target for healthcare improvement. Quality assurance is a complex task, and patients in the intensive care unit (ICU) are more likely than other hospitalized patients to experience medical errors, due to the complexity of their conditions, need for urgent interventions, and considerable workload fluctuation. Medication errors are the most common medical errors and can induce adverse events. Two approaches are available for evaluating and improving quality-of-care: the room-for-improvement model, in which problems are identified, plans are made to resolve them, and the results of the plans are measured; and the monitoring model, in which quality indicators are defined as relevant to potential problems and then monitored periodically. Indicators that reflect structures, processes, or outcomes have been developed by medical societies. Surveillance of these indicators is organized at the hospital or national level. Using a combination of methods improves the results. Errors are caused by combinations of human factors and system factors, and information must be obtained on how people make errors in the ICU environment. Preventive strategies are more likely to be effective if they rely on a system-based approach, in which organizational flaws are remedied, rather than a human-based approach of encouraging people not to make errors. The development of a safety culture in the ICU is crucial to effective prevention and should occur before the evaluation of safety programs, which are more likely to be effective when they involve bundles of measures.
Collapse
Affiliation(s)
- Maité Garrouste-Orgeas
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Université Joseph Fourier, Unité INSERM, Epidémiologie des cancers et des maladies sévères, Institut Albert Bonniot, La Tronche, France
| | - François Philippart
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Medicine Faculty, Université Paris Descartes, Paris, France
- Infection and Epidemiology department Pasteur Institut, Paris, France
| | - Cédric Bruel
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Adeline Max
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Nicolas Lau
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - B Misset
- Réanimation médico-chirurgicale, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Medicine Faculty, Université Paris Descartes, Paris, France
| |
Collapse
|
40
|
Philippart F, Fitting C, Misset B, Cavaillon J. Homeostatic pulmonary microenvironment is responsible for alveolar macrophages resistance to endotoxin tolerance. Crit Care 2012. [PMCID: PMC3363424 DOI: 10.1186/cc10613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- F Philippart
- Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - C Fitting
- Institut Pasteur de Paris, Paris, France
| | - B Misset
- Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | |
Collapse
|
41
|
Chevet K, Guyot K, Mellon G, Vidal B, Couzigou C, Misset B, Janot K, Lambert T, Nguyen Van J. Détection phénotypique d’une carbapénémase associée à une bêtalactamase à spectre élargi chez Klebsiella pneumoniae. Med Mal Infect 2012; 42:33-5. [DOI: 10.1016/j.medmal.2011.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 11/03/2011] [Indexed: 11/28/2022]
|
42
|
Chalfine A, Misset B, Kitzis MD, Bezie Y, Perniceni L, Nguyen JC, Vidal B, Loriau J, Couzigou C, Dumay MF, Carlet J. 169 reduction of hospital acquired MRSA bacteremias further to implementation of a continuous quality improvement program centered on cross-transmission prevention and antibiotic stewardship. BMJ Qual Saf 2010. [DOI: 10.1136/qshc.2010.041624.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
43
|
Misset B, Bruel C, Touati S, Dumain M, Moulard ML, Philippart F, Garrouste-Orgeas M, Carlet J. 168 Impact of morbidity and mortality conferences on the incidence of adverse events in an intensive care unit (ICU). BMJ Qual Saf 2010. [DOI: 10.1136/qshc.2010.041624.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
44
|
Chousterman M, Heysselaer D, Dridi SM, Bayet F, Misset B, Lamard L, Peremans A, Nyssen-Behets C, Nammour S. Effect of acid etching duration on tensile bond strength of composite resin bonded to erbium:yttrium-aluminium-garnet laser-prepared dentine. Preliminary study. Lasers Med Sci 2009; 25:855-9. [PMID: 19685196 DOI: 10.1007/s10103-009-0719-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 07/15/2009] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to compare the tensile bond strength of composite resin bonded to erbium:yttrium-aluminium-garnet (Er:YAG) laser-prepared dentine after different durations of acid etching. The occlusal third of 68 human third molars was removed in order to expose the dentine surface. The teeth were randomly divided into five groups: group B (control group), prepared with bur and total etch system with 15 s acid etching [37% orthophosphoric acid (H(3)PO(4))]; group L15, laser photo-ablated dentine (200 mJ) (laser irradiation conditions: pulse duration 100 micros, air-water spray, fluence 31.45 J/ cm(2), 10 Hz, non-contact hand pieces, beam spot size 0.9 mm, irradiation speed 3 mm/s, and total irradiation time 2 x 40 s); group L30, laser prepared, laser conditioned and 30 s acid etching; group L60, laser prepared, laser conditioned and 60 s acid etching; group L90, laser prepared, laser conditioned and 90 s acid etching. A plot of composite resin was bonded onto each exposed dentine and then tested for tensile bond strength. The values obtained were statistically analysed by analysis of variance (ANOVA) coupled with the Tukey-Kramer test at the 95% level. A 90 s acid etching before bonding showed the best bonding value (P < 0.05) when compared with all the other groups including the control group. There is no significance difference between other groups, nor within each group and the control group. There was a significant increase in tensile bond strength of the samples acid etched for 90 s.
Collapse
Affiliation(s)
- M Chousterman
- Department of Dental Sciences, Faculty of Medicine, University of Liege, Quai Godfroid Kurth, 45, 4000, Liege, Belgium
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Cheval C, Timsit JF, Garrouste-Orgeas M, Assicot M, De Jonghe B, Misset B, Bohuon C, Carlet J. Procalcitonin (PCT) is useful in predicting the bacterial origin of an acute circulatory failure in critically ill patients. Intensive Care Med 2009; 26 Suppl 2:S153-8. [PMID: 18470711 DOI: 10.1007/bf02900729] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the accuracy of procalcitonin (PCT) in predicting bacterial infection in ICU medical and surgical patients. SETTING A 10-bed medical surgical unit. DESIGN PCT, C-reactive protein (CRP), interleukin 6 (IL-6) dosages were sampled in four groups of patients: septic shock patients (SS group), shock without infection (NSS group), patients with systemic inflammatory response syndrome related to a proven bacterial infection (infect. group) and ICU patients without shock and without bacterial infection (control group). RESULTS Sixty patients were studied (SS group:n=16, NSS group,n=18, infect. group,n=16, control group,n=10). The PCT level was higher in patients with proven bacterial infection (72+/-153 ng/ml vs 2.9+/-10 ng/ml,p=0.0003). In patients with shock, PCT was higher when bacterial infection was diagnosed (89 ng/ml+/-154 vs 4.6 ng/ml+/-12,p=0.0004). Moreover, PCT was correlated with severity (SAPS:p=0.00005, appearance of shock:p=0.0006) and outcome (dead: 71.3 g/ml, alive: 24.0 g/ml,p=0.006). CRP was correlated with bacterial infection (p<10(-5)) but neither with SAPS nor with day 28 mortality. IL-6 was correlated with neither infection nor day 28 mortality but was correlated with SAPS. Temperature and white blood cell count were unable to distinguish shocked patients with or without infection. Finally, when CRP and PCT levels were introduced simultaneously in a stepwise logistic regression model, PCT remained the unique marker of infection in patients with shock (PCT> or =5 ng/ml, OR: 6.2, 95% CI: 1.1-37,p=0.04). CONCLUSION The increase of PCT is related to the appearance and severity of bacterial infection in ICU patients. Thus, PCT might be an interesting parameter for the diagnosis of bacterial infections in ICU patients.
Collapse
Affiliation(s)
- C Cheval
- Service de Réanimation Polyvalente, Hôpital Saint Joseph, 185 rue Raymond Losserand, F-75014 Paris, France
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Dock M, Ben Ali A, Karras A, Misset B, Garrouste-Orgeas M, Deletie E, Goldstein F, Carlet J. [Treatment of severe botulism with 3,4-diaminopyridine]]. Presse Med 2002; 31:601-2. [PMID: 11984982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION The specific treatments of botulism with serotherapy and with guanidine are of debatable efficacy. We report a case of nutritional toxin B botulism successfully treated with 3,4-diaminopyridine. OBSERVATION Following a meal, a 69 year-old woman consulted for digestive disorders followed by damage to several cranial pairs, autonomous nervous system and ventilation command, motivating mechanical ventilation on tracheal intubation. Administration of symptomatic treatment with 3,4-diaminopyridine led to progressive improvement, although the diagnosis of toxin B botulism was confirmed. COMMENTS Administration of 3,4-diaminopyridine, the efficacy of which had been suggested by the review of experimental literature, led to rapid and clear improvement, probably due to its potentiating effect on acetylcholine release in the neuromuscular junction.
Collapse
Affiliation(s)
- M Dock
- Fondation Hôpital Saint-Joseph, Paris
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Hertig A, Misset B, Therby A, Ben Ali A, Christias M, Garrouste M, Carlet J. [Respiratory distress and bronchiolitis due to respiratory syncytial virus in an immunocompetent adult]. Presse Med 2002; 31:73. [PMID: 11850989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
|
48
|
Garrouste-Orgeas M, Timsit JF, Kallel H, Ben Ali A, Dumay MF, Paoli B, Misset B, Carlet J. Colonization with methicillin-resistant Staphylococcus aureus in ICU patients: morbidity, mortality, and glycopeptide use. Infect Control Hosp Epidemiol 2001; 22:687-92. [PMID: 11842988 DOI: 10.1086/501846] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the impact of methicillin-resistant Staphylococcus aureus (MRSA) colonization on the occurrence of S. aureus infections (methicillin-resistant and methicillin-susceptible), the use of glycopeptides, and outcome among intensive care unit (CU) patients. DESIGN Prospective observational cohort survey. SETTING A medical-surgical ICU with 10 single-bed rooms in a 460-bed, tertiary-care, university-affiliated hospital. PATIENTS A total of 1,044 ICU patients were followed for the detection of MRSA colonization from July 1, 1995, to July, 1 1998. METHODS MRSA colonization was detected using nasal samples in all patients plus wound samples in surgical patients within 48 hours of admission or within the first 48 hours of ICU stay and weekly thereafter. MRSA infections were defined using Centers for Disease Control and Prevention standard definitions, except for ventilator-associated pneumonia and catheter-related infections, which were defined by quantitative distal culture samples. RESULTS One thousand forty-four patients (70% medical patients) were included in the analysis. Mean age was 61+/-18 years; mean Simplified Acute Physiologic Score (SAPS) II was 36.4+/-20; and median ICU stay was 4 (range, 1-193) days. Two hundred thirty-one patients (22%) died in the ICU. Fifty-four patients (5.1%) were colonized with MRSA on admission, and 52 (4.9%) of 1,044 acquired MRSA colonization in the ICU. Thirty-five patients developed a total of 42 S. aureus infections (32 MRSA, 10 methicillin-susceptible). After factors associated with the development of an S. aureus infection were adjusted for in a multivariate Cox model (SAPS II >36: hazard ratio [HR], 1.64; P=.09; male gender: HR, 2.2; P=.05), MRSA colonization increased the risk of S. aureus infection (HR, 3.84; P=.0003). MRSA colonization did not influence ICU mortality (HR, 1.01; P=.94). Glycopeptides were used in 11.4% of the patients (119/1,044) for a median duration of 5 days. For patients with no colonization, MRSA colonization on admission, and ICU-acquired MRSA colonization, respectively, glycopeptide use per 1,000 hospital days was 37.7, 235.2, and 118.3 days. MRSA colonization per se increased by 3.3-fold the use of glycopeptides in MRSA-colonized patients, even when an MRSA infection was not demonstrated, compared to non-colonized patients. CONCLUSIONS In our unit, MRSA colonization greatly increased the risk of S. aureus infection and of glycopeptide use in colonized and non-colonized patients, without influencing ICU mortality. MRSA colonization influenced glycopeptide use even if an MRSA infection was not demonstrated; thus, an MRSA control program is warranted to decrease vancomycin use and to limit glycopeptide resistance in gram-positive cocci.
Collapse
|
49
|
Wysocki M, Delatour F, Faurisson F, Rauss A, Pean Y, Misset B, Thomas F, Timsit JF, Similowski T, Mentec H, Mier L, Dreyfuss D. Continuous versus intermittent infusion of vancomycin in severe Staphylococcal infections: prospective multicenter randomized study. Antimicrob Agents Chemother 2001; 45:2460-7. [PMID: 11502515 PMCID: PMC90678 DOI: 10.1128/aac.45.9.2460-2467.2001] [Citation(s) in RCA: 297] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A continuous infusion of vancomycin (CIV) may provide an alternative mode of infusion in severe hospital-acquired methicillin-resistant staphylococcal (MRS) infections. A multicenter, prospective, randomized study was designed to compare CIV (targeted plateau drug serum concentrations of 20 to 25 mg/liter) and intermittent infusions of vancomycin (IIV; targeted trough drug serum concentrations of 10 to 15 mg/liter) in 119 critically ill patients with MRS infections (bacteremic infections, 35%; pneumonia, 45%). Microbiological and clinical outcomes, safety, pharmacokinetics, ease of treatment adjustment, and cost were compared. Microbiological and clinical outcomes and safety were similar. CIV patients reached the targeted concentrations faster (36 +/- 31 versus 51 +/- 39 h, P = 0.029) and fewer samples were required for treatment monitoring than with IIV patients (7.7 +/- 2.2 versus 11.8 +/- 3.9 per treatment, P < 0.0001). The variability between patients in both the area under the serum concentration-time curve (AUC(24h)) and the daily dose given over 10 days of treatment was lower with CIV than with IIV (variances, 14,621 versus 53,975 mg(2)/liter(2)/h(2) [P = 0.026] and 414 versus 818 g(2) [P = 0.057], respectively). The 10-day treatment cost per patient was $454 +/- 137 in the IIV group and was 23% lower in the CIV group ($321 +/- 81: P < 0.0001). In summary, for comparable efficacy and tolerance, CIV may be a cost-effective alternative to IIV.
Collapse
Affiliation(s)
- M Wysocki
- Medico-Surgical Intensive Care Unit, Institut Mutualiste Montsouris, Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, Rigaud JP, Casciani D, Misset B, Bosquet C, Outin H, Brun-Buisson C, Nitenberg G. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 2001; 286:700-7. [PMID: 11495620 DOI: 10.1001/jama.286.6.700] [Citation(s) in RCA: 764] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT Whether venous catheterization at the femoral site is associated with an increased risk of complications compared with that at the subclavian site is debated. OBJECTIVE To compare mechanical, infectious, and thrombotic complications of femoral and subclavian venous catheterization. DESIGN AND SETTING Concealed, randomized controlled clinical trial conducted between December 1997 and July 2000 at 8 intensive care units (ICUs) in France. PATIENTS Two hundred eighty-nine adult patients receiving a first central venous catheter. INTERVENTIONS Patients were randomly assigned to undergo central venous catheterization at the femoral site (n = 145) or subclavian site (n = 144). MAIN OUTCOME MEASURES Rate and severity of mechanical, infectious, and thrombotic complications, compared by catheterization site in 289, 270, and 223 patients, respectively. RESULTS Femoral catheterization was associated with a higher incidence rate of overall infectious complications (19.8% vs 4.5%; P<.001; incidence density of 20 vs 3.7 per 1000 catheter-days) and of major infectious complications (clinical sepsis with or without bloodstream infection, 4.4% vs 1.5%; P =.07; incidence density of 4.5 vs 1.2 per 1000 catheter-days), as well as of overall thrombotic complications (21.5% vs 1.9%; P<.001) and complete thrombosis of the vessel (6% vs 0%; P =.01); rates of overall and major mechanical complications were similar between the 2 groups (17.3% vs 18.8 %; P =.74 and 1.4% vs 2.8%; P =.44, respectively). Risk factors for mechanical complications were duration of insertion (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.08 per additional minute; P<.001); insertion in 2 of the centers (OR, 4.52; 95% CI, 1.81-11.23; P =.001); and insertion during the night (OR, 2.06; 95% CI, 1.04-4.08; P =.03). The only factor associated with infectious complications was femoral catheterization (hazard ratio [HR], 4.83; 95% CI, 1.96-11.93; P<.001); antibiotic administration via the catheter decreased risk of infectious complications (HR, 0.41; 95% CI, 0.18-0.93; P =.03). Femoral catheterization was the only risk factor for thrombotic complications (OR, 14.42; 95% CI, 3.33-62.57; P<.001). CONCLUSION Femoral venous catheterization is associated with a greater risk of infectious and thrombotic complications than subclavian catheterization in ICU patients.
Collapse
Affiliation(s)
- J Merrer
- Service de Réanimation Médicale, Hôpital de Poissy/St Germain-en-Laye, 10 Rue du Champ-Gaillard, 78303 Poissy, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|