References of "Wiesen, Patricia"
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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 detailNutritional disorders during acute renal failure and renal replacement therapy
WIESEN, Patricia ULg; VAN OVERMEIRE, Lionel ULg; DELANAYE, Pierre ULg et al

in JPEN Journal of Parenteral & Eternal Nutrition (2011), 35

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See detailTight glycemic control: a systematic review on the reason for success or failure
MARIK, P; WIESEN, Patricia ULg; PREISER, Jean-Charles

in Intensive Care Medicine (2009), 35

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See detailRenal failure and ICU-acquired infection
MICHIELS, Grégoire; WIESEN, Patricia ULg; LAYIOS, Nathalie ULg et al

Conference (2008, June 20)

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See detailIntensive care unit acquired infection and organ failure
Damas, Pierre ULg; Ledoux, Didier ULg; Nys, Monique ULg et al

in Intensive Care Medicine (2008), 34

OBJECTIVE: To assess the temporal relationship between ICU-acquired infection (IAI) and the prevalence and severity of organ dysfunction or failure (OD/F). DESIGN AND SETTING: Observational, single center ... [more ▼]

OBJECTIVE: To assess the temporal relationship between ICU-acquired infection (IAI) and the prevalence and severity of organ dysfunction or failure (OD/F). DESIGN AND SETTING: Observational, single center study in a mixed intensive care unit of a university hospital. PATIENTS: We analyzed 1,191 patients hospitalized for more than 2 days during a 2-year observation period: 845 did not acquire IAI, 306 of whom had infection on admission (IOA); 346 did acquire IAI, 125 of whom had IOA. MEASUREMENTS AND RESULTS: The SOFA score was calculated daily, both SOFAmax, the sum of the worst OD/F during the ICU stay, and SOFApreinf, the sum of the worst OD/F existing before the occurrence of the first IAI. The SAPS II and SOFA score of the first 24 h were significantly higher in patients with than in those without IAI. SOFApreinf of IAI patients was also higher than the SOFAmax of patients without IAI both in patients with (12.1+/-4.6 vs. 8.9+/-4.7) and those without IOA (9.2+/-4.0 vs. 6.7+/-3.5). SOFApreinf represented 85.7% of the value of SOFAmax in patients with IAI. SOFApreinf increased significantly with the occurrence of sepsis, severe sepsis, or septic shock during ICU stay. Severe sepsis and septic shock during ICU stay as well as SOFApreinf were part of the factors associated with hospital mortality. CONCLUSIONS: IAI is significantly associated with hospital mortality; however, its contribution to OD/F is minor. Moreover, severity of IAI seems to be related to previous health status. [less ▲]

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See detailRenal failure and ICU-acquired infection
WIESEN, Patricia ULg; LAYIOS, Nathalie ULg; NYS, Monique ULg et al

in Intensive Care Medicine (2008), 34(Suppl 1), 2650864

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See detailCascade high volume hemofiltration : Preliminary data in septic shock patients
WIESEN, Patricia ULg; MONCHI, Mehran; DUBOIS, Bernard ULg et al

in Blood Purification (2007), 25

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See detailActualites therapeutiques en medecine intensive.
CANIVET, Jean-Luc ULg; Monchi, Mehran; PREISER, Jean-Charles ULg et al

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 ▲]

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See detailDiarrhoea in the critically ill
Wiesen, Patricia ULg; Van Gossum, A.; Preiser, Jean-Charles ULg

in Current Opinion in Critical Care (2006), 12(2), 149-154

Purpose of review The purpose of this review is to update the knowledge on diarrhoea, a common problem in critically ill patients. Epidemiological data will be discussed, with special emphasis on ... [more ▼]

Purpose of review The purpose of this review is to update the knowledge on diarrhoea, a common problem in critically ill patients. Epidemiological data will be discussed, with special emphasis on diarrhoea in tube-fed patients and during antibiotic therapy. The possible preventive and therapeutic measures will be presented. Recent findings The need for concise definitions of diarrhoea was recently re-emphasized. The use of pump-driven continuous instead of intermittent enteral feeding is less often associated with diarrhoea. The discontinuation of enteral feeding during diarrhoea is not justified. Clostridium difficile-associated diarrhoea is frequent during antibiotic therapy with quinolones and cephalosporins. Formulas enriched with water-soluble fibres are probably effective to prevent diarrhoea, and promising data on the modulation of gut microflora with probiotics and prebiotics were recently released. Summary Diarrhoea is common in critically ill patients, especially when sepsis and hypoalbuminaemia are present, and during enteral feeding and antibiotic therapy. The management of diarrhoea includes generous hydration, compensation for the loss of electrolytes, antidiarrheal oral medications, the continuation of enteral feeding, and metronidazole or glycopeptides in the case of moderate to severe C. difficile colitis. The place of enteral formulas enriched with water-soluble fibres, probiotics and prebiotics is not yet fully defined. [less ▲]

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See detailPseudomembranous colitis with Clostridium difficile during treatment by moxifloxacine (quinolone)
Le Goff, Caroline ULg; Wiesen, Patricia ULg; Collette, Julien ULg et al

Poster (2005, October 27)

C. difficile is the most frequently pathogenic agent isolated in colitis associated with antibiotics and pseudomembranous colitis (PMC). C. difficile takes advantage of the disturbance of the intestinal ... [more ▼]

C. difficile is the most frequently pathogenic agent isolated in colitis associated with antibiotics and pseudomembranous colitis (PMC). C. difficile takes advantage of the disturbance of the intestinal flora to settle. We report a case of PMC appeared during treatment with moxifloxacine in a pulmonary infection in an emphysematous patient. The diarrhea is generally benign, but can be severe, with toxic megacolon or even the extreme case of colic perforation. The diagnosis is based on the research of toxins of C. difficile (A and/or B) in the intestinal stools or liquids (collected at the time of the endoscopic examination) to which is associated the anaerobic culture on selective agar. The reference method is the measurement of the cytotoxic effect of the B-toxin on a cell culture. Metronidazole or vancomycine constitutes the treatment. The prevention of relapses is very important, hygiene measures and probiotic agents must be associated to the antibiotic treatment. [less ▲]

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See detailEffect of hydroxyethylstarch on renal function in cardiac surgery: A large scale retrospective study
Wiesen, Patricia ULg; Canivet, Jean-Luc ULg; Ledoux, Didier ULg et al

in Acta Anaesthesiologica Belgica (2005), 56(3), 257-263

BACKGROUND: Recent reports indicated negative effects of hydroxyethylstarch (HES) on renal function. The goal of this large scale retrospective study was to detect whether there was an association between ... [more ▼]

BACKGROUND: Recent reports indicated negative effects of hydroxyethylstarch (HES) on renal function. The goal of this large scale retrospective study was to detect whether there was an association between postoperative deterioration of renal function and the use of HES 200 kD, 0.5 DS in the cardiac surgery setting. METHODS: Retrospective analysis of daily collected data in 3124 patients who underwent coronary artery bypass and/or valvular surgery. Three groups were compared according to differences in fluid therapy: --GEL: gelatin was used as priming fluid of extracorporeal circulation (ECC) and for postoperative filling (n = 1276). --MIX: HES was used as priming fluid of ECC an gelatin was used for postoperative filling (n = 1008). --HES: HES was used as priming fluid of ECC and for postoperative filling (n = 840). MAIN RESULTS: There were no significant differences in postoperative serum creatinine concentrations between the 3 groups: GEL: 12,2 +/- 0,5 mg/l; MIX: 12,3 +/- 0.5 mg/l; HES: 12,3 +/- 0.6 mg/l. The need for postoperative extrarenal epuration was not significantly different between the 3 periods: GEL: 2,9%; MIX: 3,1%; HES: 3,8%. CONCLUSION: The use of HES 200 kD, 0.5 DS in cardiac surgery does not seem to be associated with a clinically significant deterioration of postoperative renal function. [less ▲]

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