Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients.
LAYIOS, Nathalie ; LAMBERMONT, Bernard ; CANIVET, Jean-Luc et al
in Critical Care Medicine (2012), 40(8), 2304-9
OBJECTIVES: : To test the usefulness of procalcitonin serum level for the reduction of antibiotic consumption in intensive care unit patients. DESIGN: : Single-center, prospective, randomized controlled ... [more ▼]
OBJECTIVES: : To test the usefulness of procalcitonin serum level for the reduction of antibiotic consumption in intensive care unit patients. DESIGN: : Single-center, prospective, randomized controlled study. SETTING: : Five intensive care units from a tertiary teaching hospital. PATIENTS: : All consecutive adult patients hospitalized for > 48 hrs in the intensive care unit during a 9-month period. INTERVENTIONS: : Procalcitonin serum level was obtained for all consecutive patients suspected of developing infection either on admission or during intensive care unit stay. The use of antibiotics was more or less strongly discouraged or recommended according to the Muller classification. Patients were randomized into two groups: one using the procalcitonin results (procalcitonin group) and one being blinded to the procalcitonin results (control group). The primary end point was the reduction of antibiotic use expressed as a proportion of treatment days and of daily defined dose per 100 intensive care unit days using a procalcitonin-guided approach. Secondary end points included: a posteriori assessment of the accuracy of the infectious diagnosis when using procalcitonin in the intensive care unit and of the diagnostic concordance between the intensive care unit physician and the infectious-disease specialist. MEASUREMENTS AND MAIN RESULTS: : There were 258 patients in the procalcitonin group and 251 patients in the control group. A significantly higher amount of withheld treatment was observed in the procalcitonin group of patients classified by the intensive care unit clinicians as having possible infection. This, however, did not result in a reduction of antibiotic consumption. The treatment days represented 62.6 +/- 34.4% and 57.7 +/- 34.4% of the intensive care unit stays in the procalcitonin and control groups, respectively (p = .11). According to the infectious-disease specialist, 33.8% of the cases in which no infection was confirmed, had a procalcitonin value >1microg/L and 14.9% of the cases with confirmed infection had procalcitonin levels <0.25 microg/L. The ability of procalcitonin to differentiate between certain or probable infection and possible or no infection, upon initiation of antibiotic treatment was low, as confirmed by the receiving operating curve analysis (area under the curve = 0.69). Finally, procalcitonin did not help improve concordance between the diagnostic confidence of the infectious-disease specialist and the ICU physician. CONCLUSIONS: : Procalcitonin measuring for the initiation of antimicrobials did not appear to be helpful in a strategy aiming at decreasing the antibiotic consumption in intensive care unit patients. [less ▲]Detailed reference viewed: 66 (6 ULg)
Le débit de filtration glomérulaire est-il un déterminant de la concentration plasmatique du NGAL aux soins intensifs ?
DELANAYE, Pierre ; ; et al
Poster (2012)Detailed reference viewed: 23 (4 ULg)
Detection of decreased glomerular filtration rate in intensive care units: interest of cystatin C
DELANAYE, Pierre ; CAVALIER, Etienne ; et al
Poster (2012)Detailed reference viewed: 18 (9 ULg)
Persistent hypocoagulability in patients with septic shock predicts greater hospital mortality: impact of impaired thrombin generation.
MASSION, Paul ; PETERS, Pierre ; LEDOUX, Didier et al
in Intensive Care Medicine (2012), 38(8), 1326-35
PURPOSE: Sepsis induces hypercoagulability, hypofibrinolysis, microthrombosis, and endothelial dysfunction leading to multiple organ failure. However, not all studies reported benefit from anticoagulation ... [more ▼]
PURPOSE: Sepsis induces hypercoagulability, hypofibrinolysis, microthrombosis, and endothelial dysfunction leading to multiple organ failure. However, not all studies reported benefit from anticoagulation for patients with severe sepsis, and time courses of coagulation abnormalities in septic shock are poorly documented. Therefore, the aim of this prospective observational cohort study was to describe the coagulation profile of patients with septic shock and to determine whether alterations of the profile are associated with hospital mortality. METHODS: Thirty-nine patients with septic shock on ICU admission were prospectively included in the study. From admission to day 7, analytical coagulation tests, thrombin generation (TG) assays, and thromboelastometric analyses were performed and tested for association with survival. RESULTS: Patients with septic shock presented on admission prolongation of prothrombin time, activated partial thromboplastin time (aPTT), increased consumption of most procoagulant factors as well as both delay and deficit in TG, all compatible with a hypocoagulable state compared with reference values (P < 0.001). Time courses revealed a persistent hypocoagulability profile in non-survivors as compared with survivors. From multiple logistic regression, prolonged aPTT (P = 0.007) and persistence of TG deficit (P = 0.024) on day 3 were strong predictors of mortality, independently from disease severity scores, disseminated intravascular coagulation score, and standard coagulation tests on admission. CONCLUSIONS: Patients with septic shock present with hypocoagulability at the time of ICU admission. Persistence of hypocoagulability assessed by prolonged aPTT and unresolving deficit in TG on day 3 after onset of septic shock is associated with greater hospital mortality. [less ▲]Detailed reference viewed: 45 (15 ULg)
Les prélèvements microbiologiques ont-ils encore une place dans le diagnostic de pneumopathie acquise sous ventilation mécanique ?
LAYIOS, Nathalie ; DAMAS, Pierre
in Réanimation (2012), 21
Diagnosis of ventilator-associated pneumonia (VAP) is based on non-specific clinical signs. Several indicators have been tested in order to improve the accuracy of VAP diagnosis. The quantification of ... [more ▼]
Diagnosis of ventilator-associated pneumonia (VAP) is based on non-specific clinical signs. Several indicators have been tested in order to improve the accuracy of VAP diagnosis. The quantification of clinical parameters by using the clinical pulmonary infection score (CPIS), however, failed to improve the specificity of the diagnosis. This was the same for all the biomarkers tested either in the serum (procalcitonin, C-reactive protein) or in the bronchoalveolar lavage (BAL) fluid [soluble triggering receptor expressed on myeloid cells 1 (sTREM 1), elastin fibers, endotoxin, pro-inflammatory cytokines, Clara cell protein 10]. The microscopic examination of endotracheal samples alone, especially of the BAL fluid, may provide useful information for the detection of infected cells. Thus, microbiology is still needed. [less ▲]Detailed reference viewed: 28 (9 ULg)
Severity of ICU-acquired pneumonia according to infectious microorganisms
DAMAS, Pierre ; LAYIOS, Nathalie ; SEIDEL, Laurence et al
in Intensive Care Medicine (2011), 37(7), 1128-35Detailed reference viewed: 34 (7 ULg)
Evaluation quantitative de la réanimation volémique chez l'enfant brûlé : étude rétrospective.
ROUSSEAU, Anne-Françoise ; LEDOUX, Didier ; et al
Conference (2011, June)Detailed reference viewed: 43 (14 ULg)
Automated EEG entropy measurements in coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state
Gosseries, Olivia ; Schnakers, Caroline ; LEDOUX, Didier et al
in Functional Neurology (2011)
Monitoring the level of consciousness in brain injured patients with disorders of consciousness is crucial as it provides diagnostic and prognostic information. Behavioral assessment remains the gold ... [more ▼]
Monitoring the level of consciousness in brain injured patients with disorders of consciousness is crucial as it provides diagnostic and prognostic information. Behavioral assessment remains the gold standard for assessing consciousness but previous studies have shown a high rate of misdiagnosis. This study aimed to investigate the usefulness of electroencephalography (EEG) entropy measurements in differentiating unconscious (coma or vegetative) from minimally conscious patients. Left fronto-temporal EEG recordings (10-minute resting state epochs) were prospectively obtained in 56 patients and 16 age-matched healthy volunteers. Patients were assessed in the acute (≤1 month post-injury;n=29) or chronic (>1 month post-injury; n=27) stage. The etiology was traumatic in 23 patients. Automated online EEG entropy calculations (providing an arbitrary value ranging from 0 to 91) were compared with behavioral assessments (Coma Recovery Scale-Revised) and outcome. EEG entropy correlated with Coma Recovery Scale total scores (r=0.49). Mean EEG entropy values were higher in minimally conscious (73±19; mean and standard deviation) than in vegetative/unresponsive wakefulness syndrome patients (45±28). Receiver operating characteristic analysis revealed an entropy cut-off value of 52 differentiating acute unconscious from minimally conscious patients (sensitivity 89% and specificity 90%). In chronic patients, entropy measurements offered no reliable diagnostic information. EEG entropy measurements did not allow prediction of outcome. User-independent time-frequency balanced spectral EEG entropy measurements seem to constitute an interesting diagnostic – albeit not prognostic – tool for assessing neural network complexity in disorders of consciousness in the acute setting. Future studies are needed before using this tool in routine clinical practice, and these should seek to improve automated EEG quantification paradigms in order to reduce the remaining false negative and false positive findings. [less ▲]Detailed reference viewed: 299 (11 ULg)
Relation entre défaillances vitales précédant l'infection acquise aux soins intensifs et gravité de celle-ci
; LEDOUX, Didier ; NYS, Monique et al
in Réanimation (2011), 20(Suppl 1), 108102Detailed reference viewed: 10 (4 ULg)
Clinical sedation and bispectral index in burn children receiving gamma-hydroxybutyrate.
ROUSSEAU, Anne-Françoise ; ; et al
in European Journal of Anaesthesiology. Supplement (2011), 28(Suppl 48), 150Detailed reference viewed: 21 (5 ULg)
End of life care in the operating room for non-heart-beating donors: organization at the University Hospital of Liege.
JORIS, Jean ; KABA, Abdourahmane ; LAUWICK, Séverine et al
in Transplantation Proceedings (2011), 43(9), 3441-4
Non-heart-beating (NHB) organ donation has become an alternative source to increase organ supply for transplantation. A NHB donation program was implemented in our institution in 2002. As in many ... [more ▼]
Non-heart-beating (NHB) organ donation has become an alternative source to increase organ supply for transplantation. A NHB donation program was implemented in our institution in 2002. As in many institutions the end of life care of the NHB donor (NHBD) is terminated in the operating room (OR) to reduce warm ischemia time. Herein we have described the organization of end of life care for these patients in our institution, including the problems addressed, the solution proposed, and the remaining issues. Emphasis is given to our protocol elaborated with the different contributors of the chain of the NHB donation program. This protocol specifies the information mandatory in the medical records, the end of life care procedure, the determination of death, and the issue of organ preservation measures before NHBD death. The persisting malaise associated with NHB donation reported by OR nurses is finally documented using an anonymous questionnaire. [less ▲]Detailed reference viewed: 101 (24 ULg)
Quantitative evaluation of fluid resuscitation in burn children : a retrospective study.
ROUSSEAU, Anne-Françoise ; LEDOUX, Didier ; et al
in Burns : Journal of the International Society for Burn Injuries (2011), 37(suppl 1), 12Detailed reference viewed: 41 (11 ULg)
Contribution of donors after cardiac death to the deceased donor pool: 2002 to 2009 university of liege experience.
; Meurisse, Nicolas ; Delbouille, Michèle et al
in Transplantation Proceedings (2010), 42(10), 4369-72
OBJECTIVE: In this study, we have evaluated the organ procurement and transplantation activity from donors after cardiac death (DCD) at our institution over an 8-year period. Our aim was to determine ... [more ▼]
OBJECTIVE: In this study, we have evaluated the organ procurement and transplantation activity from donors after cardiac death (DCD) at our institution over an 8-year period. Our aim was to determine whether this program influenced transplantation programs, or donation after brain death (DBD) activity. METHODS: We prospectively collected our procurement and transplantation statistics in a database for retrospective review. RESULTS: We observed an increasing trend in potential and actual DCD number. The mean conversion rate turning potential into effective donors was 58.1%. DCD accounted for 16.6% of the deceased donor (DD) pool over 8 years. The mean age for effective DCD donors was 53.9 years (range, 3-79). Among the effective donors, 63.3% (n = 31) came from the transplant center and 36.7% (n = 18) were referred from collaborative hospitals. All donors were Maastricht III category. The number of kidney and liver transplants using DCD sources tended to increase. DCD kidney transplants represented 10.8% of the DD kidney pool and DCD liver transplants made up 13.9% of the DD liver pool over 8 years. The DBD program activity increased in the same time period. In 2009, 17 DCD and 33 DBD procurements were performed in a region with a little >1 million inhabitants. CONCLUSION: The establishment of a DCD program in our institution enlarged the donor pool and did not compromise the development of the DBD program. In our experience, DCD are a valuable source for abdominal organ transplantation. [less ▲]Detailed reference viewed: 38 (15 ULg)
Interest of routine dosage of meropenem in difficult to treat infections
Frippiat, Frédéric ; ; Denooz, Raphael et al
Poster (2010, October 23)Detailed reference viewed: 56 (11 ULg)
Intérêt de la cystatine C plasmatique pour la détection d'une insuffisance rénale chez le patient hospitalisé aux soins intensifs : résultats préliminaires
Delanaye, Pierre ; Cavalier, Etienne ; et al
in Néphrologie & Thérapeutique (2010, September), 6(5), 349-350Detailed reference viewed: 39 (6 ULg)
Hepatic dysfunction or failure and ICU-acquired infection
; LEDOUX, Didier ; MASSION, Paul et al
in Newsletter SIZ, special issue, Abstracts Spring Meeting (2010, June 25)Detailed reference viewed: 11 (1 ULg)
Mesure du volume de fin d'expiration (VFE) en cours de ventilation contrôlée après chirurgie cardiaque
; ; et al
in Réanimation (2010), 19(Suppl 1), 180325Detailed reference viewed: 9 (1 ULg)
Hepatic dysfunction or failure favours ICU-acquired infections
MASSION, Paul ; LEDOUX, Didier ; DAMAS, Pierre
in Intensive Care Medicine (2010), 36(Suppl 2), 2560681Detailed reference viewed: 8 (1 ULg)
Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury
; ; et al
in Critical Care (2010), 14(6), 221
INTRODUCTION: Outcome studies in patients with acute kidney injury (AKI) have focused on differences between modalities of renal replacement therapy (RRT). The outcome of conservative treatment, however ... [more ▼]
INTRODUCTION: Outcome studies in patients with acute kidney injury (AKI) have focused on differences between modalities of renal replacement therapy (RRT). The outcome of conservative treatment, however, has never been compared with RRT. METHODS: Nine Belgian intensive care units (ICUs) included all adult patients consecutively admitted with serum creatinine >2 mg/dl. Included treatment options were conservative treatment and intermittent or continuous RRT. Disease severity was determined using the Stuivenberg Hospital Acute Renal Failure (SHARF) score. Outcome parameters studied were mortality, hospital length of stay and renal recovery at hospital discharge. RESULTS: Out of 1,303 included patients, 650 required RRT (58% intermittent, 42% continuous RRT). Overall results showed a higher mortality (43% versus 58%) as well as a longer ICU and hospital stay in RRT patients compared to conservative treatment. Using the SHARF score for adjustment of disease severity, an increased risk of death for RRT compared to conservative treatment of RR = 1.75 (95% CI: 1.4 to 2.3) was found. Additional correction for other severity parameters (Acute Physiology And Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA)), age, type of AKI and clinical conditions confirmed the higher mortality in the RRT group. CONCLUSIONS: The SHARF study showed that the higher mortality expected in AKI patients receiving RRT versus conservative treatment can not only be explained by a higher disease severity in the RRT group, even after multiple corrections. A more critical approach to the need for RRT in AKI patients seems to be arranted [less ▲]Detailed reference viewed: 32 (11 ULg)