Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients*.

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 ▲]

Lipomatous hypertrophy of the interatrial septum: the typical echographic aspect is worth being known

in Acta Anaesthesiologica Belgica (2011), 62(3), 157-159

L’ECMO (ExtraCorporeal Membrane Oxygenation) aux soins intensifs : intérêt chez le patient en choc cardiogénique réfractaire, en hypoxémie réfractaire ou en arrêt cardiaque.

in Revue Médicale de Liège (2010), 65

ExtraCorporeal Membrane Oxygenation (ECMO) is a cardiopulmonary assistance device able to support patients in cardiac arrest, refractory cardiogenic shock or refractory hypoxemia otherwise sentenced to ... [more ▼]

ExtraCorporeal Membrane Oxygenation (ECMO) is a cardiopulmonary assistance device able to support patients in cardiac arrest, refractory cardiogenic shock or refractory hypoxemia otherwise sentenced to death. Recent technical progresses, early indication decision, bedside multidisciplinary implant, specific complications screening and echocardiographic weaning testing are crucial points to allow success of this exceptional technique. [less ▲]

Pneumopericarde dans les suites d'une dehiscence de sternum.

in Revue Médicale de Liège (2009), 64(2), 66-7

We report a case of pneumopericardium occuring after cardiac surgery. Pneumopericardium is a rare condition; trauma is the most frequent etiology. Nontraumatic causes include fistulae in relationship with ... [more ▼]

We report a case of pneumopericardium occuring after cardiac surgery. Pneumopericardium is a rare condition; trauma is the most frequent etiology. Nontraumatic causes include fistulae in relationship with the bronchial tree or oesophagus and intrapericardial gazeous production due to bacterial pericarditis. Pericardiocentesis is indicated in case of air tamponade and local infection. [less ▲]

Liver Transplantation Is Feasible in Super-Obese Patients: A Case Report.

in Transplantation Proceedings (2009), 41(8), 3430-3431

Short- and long-term results of liver transplantation in morbidly obese patients may be impaired compared with the general transplant population. As a consequence, severe obesity has been considered to be ... [more ▼]

Short- and long-term results of liver transplantation in morbidly obese patients may be impaired compared with the general transplant population. As a consequence, severe obesity has been considered to be a relative contraindication to liver transplantation in many centers. Surgically, liver transplantation in severe obesity may be challenging. Moreover, obesity may lead to an increased rate of early and late medical complications. Herein we have reported successful liver transplantation in a super-obese patient (body mass index, 55.1 kg/m(2)) who had developed terminal acute-on-chronic liver disease. In the first 6 months of follow-up, the patient underwent a severe diet that led to a significant weight loss reduction to a body mass index of 39 kg/m(2). This report of successful liver transplantation in a super-obese patient suggests that severe obesity should not be considered to be an absolute contraindication to liver transplantation. [less ▲]

Mesure du débit de filtration glomérulaire aux soins intensifs basée sur l’iohexol : clairance plasmatique ou urinaire ?

in Réanimation (2009), 18(1), 112

Cyclic appearance of left ventricular outflow tract dynamic obstruction during mechanical ventilation: evidence for a preload dependent phenomenon.

in Journal of Intensive Care Medicine (2008), 23(4), 281-4

The cyclic appearance of dynamic left ventricular outflow tract obstruction during mechanical ventilation, according to the phasic changes in preload, is described in this article. Hemodialysis-induced ... [more ▼]

The cyclic appearance of dynamic left ventricular outflow tract obstruction during mechanical ventilation, according to the phasic changes in preload, is described in this article. Hemodialysis-induced fluid removal resulted in preload dependence as evidenced by the pulse pressure variation in a 56-year-old critically ill patient. The clinical picture was suggestive of myocardial failure. Transthoracic echocardiography disclosed dynamic left ventricular outflow tract obstruction associated with systolic anterior motion of the mitral valve. Progressive fluid restitution resulted in a parallel decrease in both the degree of dynamic obstruction and pulse pressure variation. During fluid loading, dynamic obstruction disappeared at first during the inspiratory phase of intermittent positive pressure ventilation corresponding to the phasic increase in left ventricular preload. Further fluid loading resulted in the disappearance of dynamic obstruction during both inspiratory and expiratory phase of intermittent positive pressure ventilation. This is the first reported case clearly relating left ventricular outflow tract dynamic obstruction to preload dependence during mechanical ventilation in a critically ill patient without predisposing anatomical factor. [less ▲]

Mucormycose invasive du poumon et du rachis dorsal.

in Revue Médicale de Liège (2008), 63

Nous rapportons le cas d'un patient de 67 ans atteint d'un syndrome myélodysplasique et qui a développé une mucormycose pulmonaire avec extension tout à fait exceptionnelle vers le rachis dorsal ... [more ▼]

Nous rapportons le cas d'un patient de 67 ans atteint d'un syndrome myélodysplasique et qui a développé une mucormycose pulmonaire avec extension tout à fait exceptionnelle vers le rachis dorsal responsable d'un paraplégie aiguë. Après échec d'un traitement probabiliste anti-aspergillaire, c'est finalement l'analyse des prélèvements obtenus lors de la laminectomie décompressive qui a fourni le diagnostic mycologique. En raison d'une altération majeure de l'état général, la lobectomie prévue n'a pu être réalisée et malgré l'adaptation du traitement antifongique (Abelcet, Posaconazole), le patient est décédé. La mucormycose (ou zygomycose) pulmonaire est une infection fongique peu commune qui touche essentiellement les patients immuno-déprimés. Le champignon pathogène fait partie des zygomycètes dont la caractéristique principale est la capacité d'angio-invasion. L'invasion périneurale est une autre voie de propagation récemment mise en évidence. Les difficultés thérapeutiques associées à cette pathologie sont liées au terrain d'immunodépression, aux difficultés d'obtenir rapidement un diagnostic précis ainsi qu'à l'absence de sensibilité du Mucor aux antifongiques récemment introduits (V-Fend, Cancidas). Ceci souligne le risque inhérent à un traitement antifongique empirique par ces agents et la nécessité d'un prélèvement biopsique précoce en cas de non-réponse au traitement. [less ▲]

Actualites therapeutiques en medecine intensive.

in Revue Médicale de Liège (2007), 62(5-6), 277-80

Over the last ten years, much progress has been achieved in intensive care medicine. Large randomized studies, most often their multicentric, were performed and their results were translated into rules to ... [more ▼]

Over the last ten years, much progress has been achieved in intensive care medicine. Large randomized studies, most often their multicentric, were performed and their results were translated into rules to be followed for the most appropriate treatment of life-threatening organ failures. The place of non-invasive ventilation in the management of hypercapnic or hypoxic respiratory insufficiencies was thus defined, and the methods for less traumatic mechanical ventilation were specified. The techniques of renal replacement therapy were compared and the optimal doses of dialysis or hemofiltration were established. The metabolic support of the patients was also altered following landmark studies, such as the management of blood glucose, which deeply influenced the approach to critically ill patients. [less ▲]

L'image du mois. SAM apres reparation de la valvule mitrale.

in Revue Médicale de Liège (2007), 62(2), 65