Publications

SOCIETY OF CRITICAL CARE MEDICINE 34TH CRITICAL CARE CONGRESS PHOENIX, ARIZONA, USA JANUARY 15-19, 2005: Poster: Clinical Science: Pulmonary Disease or Dysfuntion/Mechanical Ventilation/Weaning (Adult) I

<i>Introduction:</i> The aims of this study were to assess the concordance of different tools and to describe the accuracy of a multimodal approach to predict unfavorable neurological outcome (UO) in cardiac arrest patients. <i>Methods:</i> Retrospective study of adult (>18 years) cardiac arrest patients who underwent multimodal monitoring; UO was defined as cerebral performance category 3-5 at 3 months. Predictors of UO were neurological pupillary index (NPi) ≤ 2 at 24 h; highly malignant patterns on EEG (HMp) within 48 h; bilateral absence of N20 waves on somato-sensory evoked potentials; and neuron-specific enolase (NSE) > 75 μg/L. Time-dependent decisional tree (i.e., NPi on day 1; HMp on day 1-2; absent N20 on day 2-3; highest NSE) and classification and regression tree (CART) analysis were used to assess the prediction of UO. <i>Results:</i> Of 137 patients, 104 (73%) had UO. Abnormal NPi, HMp on day 1 or 2, the bilateral absence of N20 or NSE >75 mcg/L had a specificity of 100% to predict UO. The presence of abnormal NPi was highly concordant with HMp and high NSE, and absence of N20 or high NSE with HMp. However, HMp had weak to moderate concordance with other predictors. The time-dependent decisional tree approach identified 73/103 patients (70%) with UO, showing a sensitivity of 71% and a specificity of 100%. Using the CART approach, HMp on EEG was the only variable significantly associated with UO. <i>Conclusions:</i> This study suggests that patients with UO had often at least two predictors of UO, except for HMp. A multimodal time-dependent approach may be helpful in the prediction of UO after CA. EEG should be included in all multimodal prognostic models.

In this study, one third of coronavirus disease 2019 mechanically ventilated patients have a pulmonary embolism visible on CT pulmonary angiography. High regimen thromboprophylaxis may decrease the occurrence of such complication.

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 cardi...

Our findings suggest that a nonnegligible fraction of PSEN1 mutations occurs de novo, which is of high importance for genetic counseling, as PSEN1 mutational screening is currently performed in familial cases only. Among the 90 distinct mutations found in the whole sample of families and isolated cases, definite pathogenicity is currently established for only 77%, emphasizing the need to pursue the effort to classify variants.