References of "Intensive Care Medicine"
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See detailPatient specific model of the cardiovascular system during septic shock
Desaive, Thomas ULg; Chase, J. G.; Lambermont, Bernard ULg et al

in Intensive Care Medicine (2009), 35(suppl. 1), 80

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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 detailSAPS 3 admission score: an external validation in a general intensive care population
Ledoux, Didier ULg; Canivet, Jean-Luc ULg; Preiser, Jean-Charles ULg et al

in Intensive Care Medicine (2008)

OBJECTIVES: To validate the SAPS 3 admission score in an independent general intensive care case mix and to compare its performances with the APACHE II and the SAPS II scores. DESIGN: Cohort observational ... [more ▼]

OBJECTIVES: To validate the SAPS 3 admission score in an independent general intensive care case mix and to compare its performances with the APACHE II and the SAPS II scores. DESIGN: Cohort observational study. SETTING: A 26-bed general ICU from a Tertiary University Hospital. PATIENTS AND PARTICIPANTS: Eight hundred and fifty-one consecutive patients admitted to the ICU over an 8-month period. Of these patients, 49 were readmissions, leaving 802 patients for further analysis. INTERVENTION: None. MEASUREMENTS AND RESULTS: APACHE II, SAPS II and SAPS 3 variables were prospectively collected; scores and their derived probability of death were calculated according to their original manuscript description. The discriminative power was assessed using the area under the ROC curve (AUROC) and calibration was verified with the Hosmer-Lemeshow goodness-of-fit test. The AUROC of the APACHE II model (AUROC = 0.823) was significantly lower than those of the SAPS II (AUROC = 0.850) and SAPS 3 models (AUROC = 0.854) (P = 0.038). The calibration of the APACHE II model (P = 0.037) and of the SAPS 3 global model (P = 0.035) appeared unsatisfactory. On the contrary, both SAPS II model and SAPS 3 model customised for Central and Western Europe had a good calibration. However, in our study case mix, SAPS II model tended to overestimate the probability of death. CONCLUSION: In this study, the SAPS 3 admission score and its prediction model customised for Central and Western Europe was more discriminative and better calibrated than APACHE II, but it was not significantly better than the SAPS II. [less ▲]

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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 detailModel-based diagnosis of acute pulmonary embolism - results from a porcine model
Desaive, Thomas ULg; Ghuysen, Alexandre ULg; Kolh, Philippe ULg et al

in Intensive Care Medicine (2008), 34(suppl. 1), 78

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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 detailAcetylcysteine and Enzymatic Creatinine: Beware of Laboratory Artefact!
Lognard, Michaël ULg; Cavalier, Etienne ULg; Chapelle, Jean-Paul ULg et al

in Intensive Care Medicine (2007)

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See detailSteps for the implementation and validationof tight glucose control
Preiser, Jean-Charles ULg; Devos, P.

in Intensive Care Medicine (2007), 33(4), 570-571

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See detailSelection of resistance during sequential use of preferential antibiotic classes
Damas, Pierre ULg; Canivet, Jean-Luc ULg; Ledoux, Didier ULg et al

in Intensive Care Medicine (2006), 32

OBJECTIVE: To determine the effect of antibiotic class pressure on the susceptibility of bacteria during sequential periods of antibiotic homogeneity. DESIGN AND SETTING: Prospective study in a mixed ICU ... [more ▼]

OBJECTIVE: To determine the effect of antibiotic class pressure on the susceptibility of bacteria during sequential periods of antibiotic homogeneity. DESIGN AND SETTING: Prospective study in a mixed ICU with three separated subunits of eight, eight, and ten beds. PATIENTS AND PARTICIPANTS: The study examined the 1,721 patients with a length of stay longer than 2 days. INTERVENTIONS: Three different antibiotic regimens were used sequentially over 2 years as first-choice empirical treatment: cephalosporins, fluoroquinolone, or a penicillin-beta-lactamase inhibitor combination. Each regimen was applied for 8 months in each subunits of the ICU, using "latin square" design. RESULTS: We treated 731 infections in 546 patients (32% of patients staying more than 48 h). There were 25.5 ICU-acquired infections per 1,000 patient-days. Infecting pathogens and colonizing bacteria were found in 2,739 samples from 1,666 patients (96.8%). No significant change in global antibiotic susceptibility was observed over time. However, a decrease in the susceptibility of several species was observed for antibiotics used as the first-line therapy in the unit. Selection pressure of antibiotics and occurrence of resistance during treatment was documented within an 8-month rotation period. CONCLUSIONS: Antibiotic use for periods of several months induces bacterial resistance in common pathogens [less ▲]

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See detailThe European Union Directive on Clinical Research: present status of implementation in EU member states’ legislations with regard to the incompetent patient
Lemaire, Florence ULg; Bion, J.; Blanco, J. et al

in Intensive Care Medicine (2005), 31

A European-wide response is slowly emerging to the European Union Directive on Clinical Research (2001/20/CE) establishing good practice in the conduct of clinical trials on medicinal products [1]. The ... [more ▼]

A European-wide response is slowly emerging to the European Union Directive on Clinical Research (2001/20/CE) establishing good practice in the conduct of clinical trials on medicinal products [1]. The Directive was to have been incorporated and made effective in member states’ national laws by 1 May 2004. Among many other aspects of this wide-ranging Directive passed by the European Parliament on 4 April 2001 is the requirement for prior informed consent by a legal representative for research involving incompetent patients. A preliminary survey conducted by this group in 2002 demonstrated that many states did not possess clear definitions for a legal representative in matters of health, and in the absence of a waiver of informed consent none could validly recruit patients to clinical trials in emergency situations. The Directive therefore had the potential to make clinical research very difficult in intensive care, and impossible in emergency situations such as cardiopulmonary resuscitation. We now report current progress among member states in implementing the Directive. [less ▲]

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See detailPlasmatic cystatin C for the estimation of glomerular filtration rate in intensive care units
Delanaye, Pierre ULg; Lambermont, Bernard ULg; Chapelle, Jean-Paul ULg et al

in Intensive Care Medicine (2004), 30(5), 980-983

OBJECTIVE: To compare the sensitivity of cystatin C and creatinine in detecting decreased glomerular filtration rate. DESIGN: Prospective observational study. SETTING: Medical intensive care unit at a ... [more ▼]

OBJECTIVE: To compare the sensitivity of cystatin C and creatinine in detecting decreased glomerular filtration rate. DESIGN: Prospective observational study. SETTING: Medical intensive care unit at a university hospital. PATIENTS AND PARTICIPANTS: Fourteen patients hospitalised in a medical intensive care unit. INTERVENTIONS: Cystatin C and creatinine plasmatic levels were measured in 40 blood samples taken with an interval of at least 24 h. MEASUREMENTS AND RESULTS: Glomerular filtration rate was estimated by creatinine clearance using 24-h urine collection and the classical Cockcroft-Gault equation. The ability of cystatin C to detect a glomerular filtration rate under 80 ml/min per 1.73 m(2) was significantly better than that of creatinine ( p<0.05). CONCLUSIONS: Cystatin C, a new plasmatic marker of renal function, could be used to detect renal failure in intensive care in the future. [less ▲]

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See detailEpidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study
Brun-Buisson, Christian; Minelli, Cosetta; Bertolini, Guido et al

in Intensive Care Medicine (2004), 30(1), 51-61

Abstract Objectives: To re-examine the epidemiology of acute lung injury (ALI) in European intensive care units (ICUs). Design and setting: A 2-month inception cohort study in 78 ICUs of 10 European ... [more ▼]

Abstract Objectives: To re-examine the epidemiology of acute lung injury (ALI) in European intensive care units (ICUs). Design and setting: A 2-month inception cohort study in 78 ICUs of 10 European countries. Patients: All patients admitted for more than 4 h were screened for ALI and followed up to 2 months. Measurements and main results: Acute lung injury occurred in 463 (7.1%) of 6,522 admissions and 16.1% of all mechanically ventilated patients; 65.4% cases occurred on ICU admission. Among 136 patients initially presenting with “mild ALI” (200< PaO2/FiO2 £300), 74 (55%) evolved to acute respiratory distress syndrome (ARDS) within 3 days. Sixty-two patients (13.4%) remained with mild ALI and 401 had ARDS. The crude ICU and hospital mortalities were 22.6% and 32.7% (p<0.001), and 49.4% and 57.9% (p=0.0005), respectively, for mild ALI and ARDS. ARDS patients initially received a mean tidal volume of 8.3±1.9 ml/kg and a mean PEEP of 7.7±3.6 cmH2O; air leaks occurred in 15.9%. After multivariate analysis, mortality was associated with age (odds ratio (OR) =1.2 per 10 years; 95% confidence interval (CI): 1.05–1.36), immuno-incompetence (OR: 2.88; Cl: 1.57–5.28), the severity scores SAPS II (OR: 1.16 per 10% expected mortality; Cl: 1.02–1.31) and logistic organ dysfunction (OR: 1.25 per point; Cl: 1.13–1.37), a pH less than 7.30 (OR: 1.88; Cl: 1.11–3.18) and early air leak (OR: 3.16; Cl: 1.59–6.28). Conclusions: Acute lung injury was frequent in our sample of European ICUs (7.1%); one third of patients presented with mild ALI, but more than half rapidly evolved to ARDS. While the mortality of ARDS remains high, that of mild ALI is twice as low, confirming the grading of severity between the two forms of the syndrome. [less ▲]

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See detailCitrate vs. heparin for anticoagulation in continuous venovenous hemofiltration: a prospective randomized study
Monchi, Mehran; Berghmans, Denis; Ledoux, Didier ULg et al

in Intensive Care Medicine (2004), 30(2), 260-265

Abstract Objective: To compare the efficacy and safety of adjusted-dose unfractionated heparin with that of regional citrate anticoagulation in intensive care patients treated by continuous venovenous ... [more ▼]

Abstract Objective: To compare the efficacy and safety of adjusted-dose unfractionated heparin with that of regional citrate anticoagulation in intensive care patients treated by continuous venovenous hemofiltration (CVVH). Design and setting: Prospective, randomized, clinical trial in a 32-bed medical and surgical ICU in a university teaching hospital. Patients: ICU patients with acute renal failure requiring continuous renal replacement therapy, without cirrhosis, severe coagulopathy, or known sensitivity to heparin. Interventions: Before the first CVVH run patients were randomized to receive anticoagulation with heparin or trisodium citrate. Patients eligible for another CVVH run received the other study medication in a crossover fashion until the fourth circuit. Measurements and results: Fortynine circuits (hemofilters) were analyzed: 23 with heparin and 26 with citrate. The median lifetime of hemofilters was 70 h (interquartile range 44–140) with citrate anticoagulation and 40 h (17–48) with heparin (p=0.0007). One major bleeding occurred during heparin anticoagulation and one metabolic alkalosis (pH=7.60) was noted with citrate after a protocol violation. Transfusion rates (units of red cells per day of CVVH) were, respectively, 0.2 (0.0–0.4) with citrate and 1.0 (0.0–2.0) with heparin (p=0.0008). Conclusions: Regional citrate anticoagulation seems superior to heparin for the filter lifetime and transfusion requirements in ICU patients treated by continuous renal replacement therapy. [less ▲]

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See detailIs parenteral nutrition guilty?
Varga, P.; Griffiths, R.; Chiolero, R. et al

in Intensive Care Medicine (2003), 29(11), 1861-1864

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See detailRelationship between procalcitonin plasma level and severity of infection
Servais, P.; Nys, Monique ULg; Canivet, Jean-Luc ULg et al

in Intensive Care Medicine (2001), 27(suppl.), 560

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See detailEuthanasia: a law in Belgium?
Damas, François ULg; Damas, Pierre ULg; Lamy, Maurice ULg

in Intensive Care Medicine (2001), 27(10), 1683

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See detailComparison of a nurse-directed weight-based heparin nomogram with a standard doctor-based regimen
FRAIPONT, V; LAMBERMONT, Bernard ULg; MOONEN, M et al

in Intensive Care Medicine (2000), 26(4), 218

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