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SCOPUS: no.j

Country Specific Results _xls. (XLS 281Â kb)

Pozzebon, Selene; Fernández, Carmen Castroviejo; Cavicchi, Federica Zama; Creteur, Jacques; Vincent, Jean-Louis; Taccone, Fabio Silvio

Objective: To determine whether passive leg movement (PLM) in critically ill patients increases oxygen consumption (VO2), and, if so, the relative contributions of increases in cardiac index (CI) and oxygen extraction (O2ER). Design: Prospective, controlled study. Setting: Multidisciplinary department of intensive care in a university hospital. Patients: Sixteen ICU patients undergoing PLM as part of their standard management were divided into two groups according to the presence of cardiac disease and /or cardiac dysfunction. Outcome measures: VO2, CI oxygen extraction. Intervention: Complete hemodynamic data were obtained before and 5 minutes after starting PLM. Results: For the whole group, VO2 increased from 123±23 to 143±34 ml/min.m2 (p<0.05). In the eight patients with cardiac dysfunction, the increase in VO2 was met by an increase in O2ER (from 37.2±7.3 to 41.1±7.1 %, p<0.01) without a significant increase in CI (from 2.44±0.56 to 2.52±0.65 l/min/m2, p=ns). In the eight patients without cardiac dysfunction, the increase in VO2 was met by an increase of CI (from 3.88±0.90 to 4.36±1.00 l/min/m2, p<0.01) without a significant increase in O2ER (from 26.4±7.3 to 27.2±7.9 %, p=ns). Conclusions: Simple maneuvers like PLM can influence the hemodynamic status of ICU patients. The study of the relation between CI and O2 ER may be helpful to assess the hemodynamic response to nursing or physical therapy procedures.

In this prospective, observational study, we measured arterial lactate and pyruvate concentrations within the first four hours of shock and at four hour intervals during the first 24 hours in 26 patients with septic and 13 with cardiogenic shock. We also studied 10 intensive care unit patients with normal lactate levels as controls. Seven patients (18%) died during the first 24 hours of shock, 12 (31%) patients died later in the intensive care unit and 21 (54%) were discharged alive from the intensive care unit. Blood lactate values were higher at shock onset in the non-survivors than in the survivors (P=0.02) and remained significantly elevated throughout the study. The lactate/pyruvate ratio at shock onset was significantly higher in the non-survivors (24 [17 to 34] vs 15 [10 to 19], P=0.01) than in the survivors. All patients with cardiogenic shock had hyperlactataemia at the onset of shock, and 69% had a high lactate/pyruvate ratio. Only 65% of patients with septic shock had hyperlactataemia at the onset of shock and 76% of these also had a high lactate/pyruvate ratio. In conclusion, the lactate/pyruvate ratio confirms that hyperlactataemia is frequently, but not solely, due to hypoxia, especially at the onset of shock.

<title>Abstract</title> <bold>Background: </bold>Whether the risk of multidrug resistant bacteria (MDRB) acquisition in the intensive care unit (ICU) is increased during the COVID-19 crisis is unknown. Our aim was to measure the rate of MDRB acquisition in patients admitted in COVID-19 ICU and to compare it with pre-COVID-19 controls.<bold>Methods: </bold>This single center case control study included adult patients admitted to COVID-19 ICUs for more than 48h. Patients were screen twice a week for MDRB carriage during ICU stay. We compared the rate of MDRB acquisition of COVID-19 patients with a cohort of patients admitted for subarachnoid hemorrhage (SAH) and matched on length of ICU stay using a competing risk analysis.<bold>Results: </bold>Among 72 patients admitted to the COVID-19 ICUs, 24 (33%) patients acquired 31 MDRB during ICU stay. The rate of MDRB acquisition was 30/1000 patient-days. Patients that acquired MDRB had received more antimicrobial therapy [22 (92%) vs 34 (78%, p=0.05] and had a longer exposure time [12 days (8-18) vs 5 days (2-18), p=0.02]. The rate of MDRB acquisition in matched SAH patients was 18/1000 patient-days. When compared to SAH retrospective cohort, being admitted to a COVID-19 ICU was associated with a numerically higher proportion of MDRB acquisition. This association did not reach statistical significance in the multivariable competing risk analysis (sHR 1.71 (CI 95% 0.93-3.21).<bold>Conclusion: </bold>Acquisition of MDRB was frequent during the COVID-19 first wave in ICU patients. Despite physical isolation, it was similar to patients admitted to the same ICU in previous years.