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See detailProcalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients.
LAYIOS, Nathalie ULg; LAMBERMONT, Bernard ULg; CANIVET, Jean-Luc ULg 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 ▲]

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See detailLes échelles d’évaluation des états de conscience altérée
Ledoux, Didier ULg; Piret, Sonia ULg; Boveroux, Pierre ULg et al

in Réanimation (2008), 17

L’évaluation de l’état de conscience revêt une importance clinique considé- rable. En effet, déterminer avec précision la sévérité de l’altération de conscience permet non seulement d’établir un pronostic ... [more ▼]

L’évaluation de l’état de conscience revêt une importance clinique considé- rable. En effet, déterminer avec précision la sévérité de l’altération de conscience permet non seulement d’établir un pronostic vital et fonctionnel mais aussi de suivre plus efficacement l’évolution clinique des patients avec lésion cérébrale et d’optimaliser l’utilisation des ressources disponibles. Dans cet article, nous passons en revue les principales échelles d’évaluation des états de conscience altérée. Nous nous intéressons particu- lièrement à instrument récemment publié, l’échelle «Full Outline of UnResponsiveness» (FOUR). En effet, cette dernière constitue une avancée considérable dans l’évaluation cli- nique des patients présentant un état de conscience altérée. Parmi les apports de cette échelle, on notera sa contribution au diagnostic d’un locked-in syndrome, d’un état de conscience minimale ou encore d’un état de mort cérébrale. Nous pensons qu’en rai- son de son apport à l’examen clinique durant la phase initiale d’un état de conscience altérée, l’échelle FOUR devrait être préférée à la désormais classique échelle de Glasgow. [less ▲]

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See detailEvaluation comportementale et par neuroimagerie fonctionnelle des patients en état végétatif
Vanhaudenhuyse, Audrey ULg; Schnakers, Caroline ULg; Boly, Mélanie ULg et al

in Revue Médicale de Liège (2007), 62 Spec No

Currently, there remains a high rate of misdiagnosis of the vegetative state. This should incite clinicians to use the most sensitive "coma scales" to detect signs of consciousness in these patients. The ... [more ▼]

Currently, there remains a high rate of misdiagnosis of the vegetative state. This should incite clinicians to use the most sensitive "coma scales" to detect signs of consciousness in these patients. The gold standard remains the Glasgow Coma Scale (GCS, Teasdale and Jennet, 1974), with the Glasgow Liege Scale (GLS, Born, 1988) adding standardized assessment of brainstem reflexes. New sensible behavioral assessment tools for use in the acute neurocritical care setting include the Full Outline of UnResponsiveness (FOUR, Wijdicks et al., 2005). The Coma Recovery Scale-Revised (CRS-R, Giacino and Kalmar, 2004) specifically tests the diagnostic criteria differentiating vegetative from minimally conscious patients. Detecting signs of consciousness also depends on the employed methodology. We showed that for the assesment of the presence of visual pursuit, using a moving mirror is better suited than using a moving object or person. The clinical diagnosis can be confirmed by cerebral positron emission tomography studies objectively quantifying residual metabolic activity in vegetative and minimally conscious patients. Ongoing studies evaluate the prognostic value of functional magnetic resonance imaging studies in these challenging patient populations. [less ▲]

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See detailQuantifying consciousness
Laureys, Steven ULg; Piret, Sonia ULg; Ledoux, Didier ULg

in Lancet Neurology (2005), 4(12), 789-790

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See detailCardiac tamponade and pulmonary compression due to volvulus of oesophageal coloplasty
Canivet, Jean-Luc ULg; Piret, Sonia ULg; Hick, Gaëtane ULg et al

in Acta Anaesthesiologica Belgica (2004), 55(2), 125-127

We describe an unusual case of cardiac tamponade and pulmonary compression due to acute volvulus of colon interposition occuring late after oesophagectomy. Clinical signs were suggestive of cardiac ... [more ▼]

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

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See detailBarotrauma-induced tension pneumoperitoneum.
Canivet, Jean-Luc ULg; Yans, Th; Piret, Sonia ULg et al

in Acta Anaesthesiologica Belgica (2003), 54(3), 233-6

We report the case of a massive tension-pneumoperitoneum developing immediately after starting mechanical ventilation (barotrauma). Careful analysis of CT-data provided meaningful informations in ... [more ▼]

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

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