Open Access

Proceedings of Réanimation 2017, the French Intensive Care Society International Congress

  • Chtara Kamilia1Email author,
  • Kais Regaieg2, 3,
  • Najeh Baccouch2,
  • Hedi Chelly1,
  • Mabrouk Bahloul1,
  • Mounir Bouaziz1,
  • Ali Jendoubi4Email author,
  • Ahmed Abbes4,
  • Houda Belhaouane4,
  • Oussama Nasri4,
  • Layla Jenzri4,
  • Salma Ghedira5,
  • Mohamed Houissa5,
  • Kamal Belkadi6Email author,
  • Youness Harti6,
  • Afak Nsiri7, 8,
  • Khalid Khaleq9, 8,
  • Driss Hamoudi7,
  • Rachid Harrar7,
  • Camille Thieffry10,
  • Frédéric Wallet11,
  • Erika Parmentier-Decrucq10,
  • Raphaël Favory10,
  • Daniel Mathieu10,
  • Julien Poissy10Email author,
  • Thomas Lafon12, 13,
  • Philippe Vignon14, 15Email author,
  • Emmanuelle Begot14,
  • Alexandra Appert16,
  • Mathilde Hadj16,
  • Paul Claverie16, 17,
  • Morgan Matt18,
  • Olivier Barraud19,
  • Bruno François15,
  • Amira Jamoussi20, 21Email author,
  • Amira Ben Jazia20, 22Email author,
  • Takoua Marhbène20,
  • Dhouha Lakhdhar20, 23, 24Email author,
  • Jalila Ben Khelil20, 21,
  • Mohamed Besbes20, 21,
  • Julien Goutay25Email author,
  • Caroline Blazejewski26,
  • Isabelle Joly-Durand27,
  • Isabelle Pirlet28,
  • Marie Pierre Weillaert29,
  • Sebastien Beague26,
  • Soufi Aziz7,
  • Reda Hafiane8Email author,
  • Khalid Hattabi30,
  • Mohamed Aziz Bouhouri7, 8,
  • Driss Hammoudi8,
  • Abdelaziz Fadil30,
  • Rachid Al Harrar8,
  • Khalid Zerouali31,
  • Fatma Kaaniche Medhioub32Email author,
  • Rania Allela33,
  • Najla Ben Algia34,
  • Samar Cherif35,
  • Mohamed Taoufik Slaoui36Email author,
  • Souhail Boubia37,
  • Y. Hafiani36,
  • A. Khaoudi36,
  • R. Cherkab36, 38,
  • W. Elallam36,
  • C. Elkettani36, 38,
  • L. Barrou36, 38,
  • M. Ridaii37,
  • Rihi El Mehdi39Email author,
  • Caroline Schimpf40,
  • Assaf Mizrahi41,
  • Benoît Pilmis41,
  • Alban Le Monnier41,
  • Kelly Tiercelet40,
  • Mélanie Cherin42,
  • Cédric Bruel40,
  • Francois Philippart40Email author,
  • Sébastien Bailly43Email author,
  • Jc Lucet44,
  • Alain Lepape45,
  • François L’hériteau46,
  • Martine Aupée47,
  • Caroline Bervas48,
  • Sandrine Boussat49,
  • Anne Berger-Carbonne50,
  • Anaïs Machut51,
  • Anne Savey52,
  • Jean-François Timsit53, 54,
  • REA‑RAISIN Study group,
  • OUTCOMEREA study group,
  • Keyvan Razazi55,
  • Jérémy Rosman55Email author,
  • Nicolas de Prost55,
  • Guillaume Carteaux55,
  • Chloe Jansen56,
  • Jean Winoc Decousser57,
  • Christian Brun-Buisson55,
  • Armand Mekontso Dessap55,
  • Aymen M’rad22Email author,
  • Zouhour Ouali58,
  • Manel Barghouth22,
  • Achille Kouatchet59Email author,
  • Rafael Mahieu60,
  • Emmanuel Weiss61, 62,
  • David Schnell63,
  • Jean-Ralph Zahar64,
  • Margaux Artiguenave65,
  • Paktoris-Papine Sophie65,
  • Florence Espinasse66,
  • Faten El Sayed67,
  • Aurélien Dinh68,
  • Cyril Charron65,
  • Guillaume Geri69,
  • Antoine Vieillard-Baron65,
  • Xavier Repessé65Email author,
  • Hatem Kallel70Email author,
  • Claire Mayence70,
  • Stéphanie Houcke70,
  • Pascal Guegueniat70,
  • Didier Hommel70,
  • Kaouther Dhifaoui71,
  • Zied Hajjej71Email author,
  • Amira Fatnassi71,
  • Walid Sellami71Email author,
  • Iheb Labbene71,
  • Mustapha Ferjani71,
  • Fahmi Dachraoui72Email author,
  • Sabrine Nakkaa72,
  • Abdelwaheb M’ghirbi72,
  • Ali Adhieb72,
  • Dhouha Ben Braiek72,
  • Kmar Hraiech72,
  • Ali Ousji72,
  • Islem Ouanes72,
  • Hammouda Zaineb72,
  • Saousen Ben Abdallah72,
  • Lamia Ouanes-Besbes72,
  • Fekri Abroug72,
  • Simon Klein73,
  • Mattéo Miquet73,
  • Jean-Marc Thouret73,
  • Vincent Peigne73, 74Email author,
  • Jean-Louis Daban74,
  • Mathieu Boutonnet74,
  • Bernard Lenoir75,
  • Takoua Merhbene76,
  • Celine Derreumaux77Email author,
  • Thierry Seguin77,
  • Jean-Marie Conil77,
  • Charlotte Kelway78Email author,
  • Valery Blasco78,
  • Cyril Nafati78,
  • Karim Harti78,
  • Laurent Reydellet78,
  • Jacques Albanese78,
  • Narjess Ben Aicha79,
  • Khaoula Meddeb79,
  • Ahmed Khedher79,
  • Jihene Ayachi79,
  • Nesrine Fraj79,
  • Nesrine Sma79,
  • Imed Chouchene79,
  • Mohamed Boussarsar80, 81Email author,
  • Soumaya Ben Yedder71,
  • Walid Samoud71,
  • Bousselmi Radhouene71,
  • Bousselmi Mariem71,
  • Asma Ammar82,
  • Asma Ben Cheikh82,
  • Hend Ben Lakhal22, 79,
  • Messaouda Khelfa22, 79,
  • Yamina Hamdaoui79,
  • Nabiha Bouafia82,
  • Timothée Trampont17Email author,
  • Thomas Daix15,
  • Vincent Legarçon17,
  • Henri Hani Karam17,
  • Nicolas Pichon14, 15,
  • Fatma Essafi22,
  • Nasreddine Foudhaili22,
  • Hafedh Thabet83, 84,
  • Youssef Blel22Email author,
  • Nozha Brahmi22,
  • Hanane Ezzouine85Email author,
  • Mahmoud Kerrous85,
  • Saad El Haoui85,
  • Soufiane Ahdil85,
  • Abdellatif Benslama85,
  • Khalid Abidi86,
  • Tarek Dendane86,
  • Ssouni Oussama86,
  • Jihane Belayachi87,
  • Naoufal Madani87,
  • Redouane Abouqal87,
  • Amine Ali Zeggwagh86,
  • Hatem Ghadhoune88,
  • Anis Chaari89,
  • Guissouma Jihene88,
  • Hend Allouche88,
  • Insaf Trabelsi88,
  • Habib Brahmi88,
  • Mohamed Samet88,
  • Hatem El Ghord88,
  • Ben Sik Ali Habiba90,
  • Nouira Hajer90,
  • Najla Tilouch90,
  • Sondes Yaakoubi90,
  • Oussama Jaoued90,
  • Rim Gharbi90,
  • Mohamed Fekih Hassen90,
  • Souheil Elatrous90,
  • Julien Arcizet91,
  • Bertrand Leroy91,
  • Caroline Abdulmalack92,
  • Catherine Renzullo91,
  • Maël Hamet92,
  • Jean-Marc Doise92,
  • Jérôme Coutet91,
  • Chaigar Mohammed Cheikh85, 93Email author,
  • Zakaria Quechar85,
  • Magalie Joris94Email author,
  • Dimitri Titeca Beauport94Email author,
  • Loay Kontar94,
  • Delphine Lebon95,
  • Bérengère Gruson95,
  • Michel Slama94,
  • Jean-Pierre Marolleau95,
  • Julien Maizel94,
  • Julie Gorham96,
  • Lieveke Ameye97,
  • Thierry Berghmans96,
  • Marianne Paesmans97,
  • Jean-Paul Sculier96,
  • Anne-Pascale Meert96Email author,
  • Max Guillot98Email author,
  • Marie-Pierre Ledoux99,
  • Thierry Braun98,
  • Quentin Maestraggi98, 100,
  • Baptiste Michard98, 101,
  • Vincent Castelain98, 102,
  • Raoul Herbrecht99,
  • Francis Schneider98,
  • Severine Couffin103Email author,
  • David Lobo104,
  • Nicolas Mongardon69,
  • Gilles Dhonneur105,
  • Roman Mounier104,
  • Pierrick Le Borgne106Email author,
  • Sophie Couraud106,
  • Jean-Etienne Herbrecht98,
  • Alexandra Boivin98,
  • François Lefebvre107,
  • Pascal Bilbault106,
  • Setti-Aouicha Zelmat108Email author,
  • Djamila-Djahida Batouche110Email author,
  • Fatima Mazour111,
  • Belkacem Chaffi112,
  • Nadia Benatta113,
  • Ali Habiba Sik90,
  • I. Talik90,
  • Maxime Perrier114,
  • Eliane Gouteix114,
  • Claude Koubi114,
  • Annabelle Escavy114,
  • Victoria Guilbaut114,
  • Jean-Philippe Fosse114Email author,
  • Rahma Ben Jazia115,
  • Ahmed Abdelghani115,
  • Pierre-Julien Cungi116Email author,
  • Julien Bordes116,
  • Cédric Nguyen116,
  • Candice Pierrou117,
  • Maximilien Cruc116,
  • Alain Benois118,
  • Frédéric Duprez119Email author,
  • Thierry Bonus119,
  • Grégory Cuvelier120,
  • Sandra Ollieuz119,
  • Sharam Machayekhi119,
  • Frédéric Paciorkowski119,
  • Gregory Reychler121, 122,
  • Remi Coudroy123Email author,
  • Arnaud W. Thille123Email author,
  • Xavier Drouot124,
  • Véronique Diaz124,
  • Jean-Claude Meurice125,
  • René Robert123,
  • Olfa Turki1, 126Email author,
  • Hmida Chokri Ben1,
  • Mona Assefi127Email author,
  • Romain Deransy127,
  • Hélène Brisson127,
  • Antoine Monsel127,
  • Filomena Conti128,
  • Olivier Scatton129,
  • Olivier Langeron127,
  • Hassen Ben Ghezala130,
  • Salah Snouda131,
  • Chiekh Imen Ben132,
  • Moez Kaddour131,
  • Anwar Armel93, 133Email author,
  • Lafrikh Youness93,
  • Bensaid Abdelhak134,
  • Miloudi Youssef134,
  • Al Harrar Najib134,
  • Amouzoun Mustapha135,
  • Mtioui Noufel135,
  • Zamd Mohamed135,
  • El Khayat Salma135,
  • Medkouri Ghizlane135,
  • Benghanam Mohamed135,
  • Ramdani Benyounes135,
  • Florent Montini24,
  • Sébastien Moschietto24,
  • Emilien Gregoire136,
  • Guillaume Claisse137,
  • Julien Guiot138,
  • Philippe Morimont138,
  • Jean-Marie Krzesinski136,
  • Christophe Mariat139,
  • Bernard Lambermont138,
  • Etienne Cavalier140,
  • Pierre Delanaye141Email author,
  • Soumia Benbernou142Email author,
  • Sofiane Ilies142,
  • Abdelkader Azza143,
  • Khalida Bouyacoub144,
  • Meriem Louail109,
  • Houria Mokhtari-Djebli145,
  • Romain Arrestier146Email author,
  • Fabrice Daviaud146,
  • Xavier Laborne Francois147,
  • Elsa Brocas146,
  • Gérald Choukroun146,
  • Oscar Peñuelas148,
  • José-Angel Lorente148,
  • Pablo Cardinal-Fernandez148,
  • José-Maria Rodriguez149,
  • José-Antonio Aramburu149,
  • Andres Esteban148,
  • Fernando Frutos-Vivar148,
  • Laurent Bitker150Email author,
  • Nicolas Costes151,
  • Didier Le Bars151,
  • Franck Lavenne151,
  • Mojgan Devouassoux152,
  • Jean-Christophe Richard150Email author,
  • Malika Mechati153, 154Email author,
  • Marc Gainnier153, 155,
  • Laurent Papazian153, 156, 157,
  • Christophe Guervilly153, 156Email author,
  • Aude Garnero158Email author,
  • Jean Michel Arnal158,
  • Hadrien Roze159Email author,
  • Jean Christophe Richard160,
  • Benjamin Repusseau159,
  • Antoine Dewitte159,
  • Olivier Joannes-Boyau159,
  • Alexandre Ouattara159,
  • Nadia Harbouze38Email author,
  • A. M. Amine38,
  • A. G. Olandzobo38,
  • Alexandre Herbland161, 162Email author,
  • Marie Richard163,
  • Nicolas Girard162, 164,
  • Lucile Lambron161,
  • Olivier Lesieur161, 162Email author,
  • Sarah Wainschtein165,
  • Sidonie Hubert165,
  • Albane Hugues165,
  • Marc Tran40,
  • Philippe Bouillard162,
  • Vlad Loteanu162,
  • Maxime Leloup162,
  • Alexandra Laurent166Email author,
  • Florent Lheureux166,
  • Alessia Prestifilippo167,
  • Martin Delgado Maria Cruz168,
  • Rigal Romain169,
  • Massimo Antonelli170,
  • Torra Lluis Blanch168,
  • Franck Bonnetain171,
  • Maria Grazzia-Bocci168,
  • Jordi Mancebo172,
  • Emmanuel Samain173,
  • Hebert Paul169,
  • Gilles Capellier174,
  • Taissa Zavgorodniaia175,
  • Marion Soichot176,
  • Isabelle Malissin175, 177,
  • Sebastian Voicu175, 177,
  • Pierre Garçon175, 177,
  • Antoine Goury175, 177Email author,
  • Lamia Kerdjana175, 177,
  • Nicolas Deye175, 177,
  • Emmanuel Bourgogne176,
  • Bruno Megarbane175, 177, 178Email author,
  • Olfa Mejri22,
  • Marwa Ben Hmida22,
  • Salma Tannous179,
  • Lucie Chevillard179,
  • Laurence Labat179,
  • Patricia Risede179,
  • Hana Fredj22,
  • Maxime Léger60Email author,
  • Marion Brunet180,
  • Gaël Le Roux180,
  • David Boels180,
  • Nicolas Lerolle60,
  • Souaad Farah175,
  • Hélène Amiel-Niemann181,
  • Nathalie Kubis181,
  • Xavier Declèves179,
  • Nicoals Peyraux182,
  • Frederic Baud183Email author,
  • Micaela Serafini182,
  • Jean-Claude Alvarez184,
  • Annette Heinzelman185,
  • Mathieu Jozwiak186Email author,
  • Sandrine Millasseau187,
  • Jean-Louis Teboul186,
  • Jean-Emmanuel Alphonsine186,
  • François Depret186,
  • Nathalie Richard187,
  • Pierre Attal188,
  • Christian Richard186, 189,
  • Xavier Monnet186,
  • Denis Chemla190,
  • Salma Jerbi4,
  • Wafa Khedhiri4,
  • Hatem Necib4,
  • Paolo Scarfo191Email author,
  • Charles Chevalier192,
  • Michael Piagnerelli193,
  • Alexandre Lafont65,
  • Antoine Galy14,
  • Claire Mancia14,
  • Amel Zerhouni194,
  • Kheira Tabeliouna110,
  • Ali Gaja195,
  • Bassem Hamrouni5,
  • Abir Malouch4,
  • Sami Fourati4,
  • Rihab Messaoud4,
  • Youssef Zarrouki196Email author,
  • Amra Ziadi196,
  • Manal Rhezali196,
  • Zahira Zouizra197,
  • Drissi Boumzebra197,
  • Mohamed Abdennasser Samkaoui196,
  • Jennifer Brunet198,
  • Bertrand Canoville199,
  • Pierre Verrier198,
  • Calin Ivascau200,
  • Amélie Seguin199, 201,
  • Xavier Valette199,
  • Damien Du Cheyron199,
  • Cedric Daubin199Email author,
  • Wulfran Bougouin69, 202Email author,
  • Nadia Aissaoui203,
  • Lionel Lamhaut204,
  • Daniel Jost205,
  • Carole Maupain206,
  • Frankie Beganton207,
  • Adrien Bouglé208,
  • Florence Dumas209Email author,
  • Eloi Marijon202,
  • Xavier Jouven210,
  • Alain Cariou69,
  • Sudden Death Expertise Center,
  • Florent Poirson177,
  • Ulriikka Chaput211,
  • Thomas Beeken177,
  • Leclerc Maxime177,
  • Oueslati Haikel177,
  • Dominique Vodovar177,
  • Jonathan Chelly177,
  • Philippe Marteau211,
  • Richard Chocron212,
  • Philippe Juvin212,
  • Thomas Loeb213,
  • Frederic Adnet214,
  • Eric Lecarpentier215,
  • Antoine Riviere94,
  • Bertand De Cagny94,
  • Thierry Soupison94,
  • Elodie Privat216Email author,
  • Joséphine Escutnaire217,
  • Cyrielle Dumont218,
  • Valentine Baert217,
  • Christian Vilhelm219,
  • Hervé Hubert219,
  • Stéphane Leteurtre220, 221,
  • Marion Fresco222Email author,
  • Michael Bubenheim223,
  • Gaetan Beduneau224, 225,
  • Dorothée Carpentier224, 225,
  • Steven Grange224, 225,
  • Elise Artaud-Macari224,
  • Benoit Misset222,
  • Fabienne Tamion224, 225,
  • Christophe Girault224, 225,
  • Guillaume Dumas226Email author,
  • Sylvie Chevret227,
  • Virginie Lemiale226,
  • Djamel Mokart228,
  • Julien Mayaux229, 230, 231,
  • Frédéric Pène69,
  • Martine Nyunga232,
  • Pierre Perez233,
  • Anne-Sophie Moreau234, 235, 236,
  • Fabrice Bruneel237,
  • François Vincent238,
  • Kada Klouche239,
  • Jean Reignier240, 241, 242,
  • Antoine Rabbat243,
  • Elie Azoulay226,
  • Jean-Pierre Frat123Email author,
  • Stéphanie Ragot244,
  • Jean-Michel Constantin245,
  • Gwenael Prat246,
  • Alain Mercat59,
  • Thierry Boulain247,
  • Alexandre Demoule248, 249Email author,
  • Jérôme Devaquet250,
  • Saad Nseir251,
  • Julien Charpentier69,
  • Laurent Argaud252,
  • Pascal Beuret253,
  • Jean-Damien Ricard254,
  • Christelle Teiten255,
  • Nicolas Marjanovic256,
  • Nicola Palamin257,
  • Erwan L’Her246Email author,
  • Arthur Bailly240, 258,
  • Julie Boisramé-Helms63, 98, 259, 260,
  • Benoit Champigneulle261,
  • Toufik Kamel247,
  • Emmanuelle Mercier262,
  • Aurélie Le Thuaut263, 264,
  • Jean-Baptiste Lascarrou240, 265Email author,
  • Amélie Rolle266Email author,
  • Audrey De Jong266Email author,
  • Gérald Chanques266,
  • Samir Jaber266,
  • Geoffroy Hariri267,
  • Jean-Luc Baudel267,
  • Vincent Dubée267,
  • Gabriel Preda267,
  • Simon Bourcier267,
  • Jeremie Joffre268,
  • Naïke Bigé267,
  • Hafid Ait-Oufella267,
  • Eric Maury267Email author,
  • Houda Mater90,
  • Hamid Merdji69, 269Email author,
  • David Grimaldi69, 270,
  • Christophe Rousseau269,
  • Jean-Paul Mira69, 271,
  • Jean-Daniel Chiche69Email author,
  • Ines Sedghiani272Email author,
  • A. Benabderrahim272,
  • Dhekra Hamdi272,
  • Asma Jendoubi272,
  • Mohamed Ali Cherif272,
  • Youssef Zied El Hechmi272,
  • Jerbi Zouheir272,
  • François Bagate55Email author,
  • Radhwen Bousselmi71,
  • Frédérique Schortgen55Email author,
  • Pierre Asfar273,
  • Emmanuel Guérot203,
  • Grelon Fabien274,
  • Nadia Anguel189,
  • Lasocki Sigismond275,
  • Henry-Lagarrigue Matthieu276,
  • Frédéric Gonzalez277,
  • Legay François278,
  • Christophe Guitton279,
  • Maleka Schenck98,
  • Doise Jean-Marc280,
  • Didier Dreyfuss281, 282,
  • Peter Radermacher283,
  • for the HYPER2S Investigators and REVA research network,
  • Antoine Frère265Email author,
  • Laurent Martin-Lefèvre265, 284,
  • Gwenhaël Colin265,
  • Maud Fiancette265,
  • Matthieu Henry-Laguarrigue265,
  • Jean-Claude Lacherade265, 284,
  • Christine Lebert240, 265,
  • Isabelle Vinatier265,
  • Aihem Yehia265,
  • Aurélie Joret285,
  • Nicolas Menunier-Beillard286,
  • Dalila Benzekri-Lefevre287,
  • Arnaud Desachy288,
  • Fréderic Bellec289,
  • Gaëtan Plantefève290,
  • Jean-Pierre Quenot286, 291,
  • Ferhat Meziani63,
  • Elsa Tavernier292,
  • Stephan Ehrmann285, 293,
  • Clinical Research in Intensive Care and Sepsis (CRICS network),
  • Nicolas Chudeau294Email author,
  • Tommy Raveau60,
  • Valérie Moal295,
  • Pascal Houillier296,
  • Emmanuelle Rouve297Email author,
  • Karim Lakhal298,
  • Charlotte Salmon Gandonnière293,
  • Youenn Jouan293,
  • Laetitia Bodet-Contentin293,
  • Adrien Balmier299,
  • Jonathan Messika300Email author,
  • Cubrea network,
  • Etienne De Montmollin301,
  • Victorine Pouyet302,
  • Benjamin Sztrymf303,
  • Abirami Thiagarajah304,
  • Damien Roux299Email author,
  • Marc Pineton De Chambrun305Email author,
  • Charles-Edouard Luyt305, 306,
  • François Beloncle307,
  • Nathalie Zapella237,
  • Stanislas Ledochowsky308,
  • Nicolas Terzi309Email author,
  • Jean-Marc Mazou310,
  • Romain Sonneville54, 311Email author,
  • Sylvie Paulus312,
  • Yannick Fedun313,
  • Mickael Landais242Email author,
  • Jean-Herlé Raphalen314,
  • Alain Combes305, 306,
  • Zahir Amoura315,
  • Aemilia Jacquemin77Email author,
  • Felipe Guerrero316,
  • Bertrand Marcheix317,
  • Nicolas Hernandez77Email author,
  • Olivier Fourcade318,
  • Bernard Georges77,
  • Clément Delmas319,
  • Sarah Makoudi208Email author,
  • Audrey Genton208,
  • Rémy Bernard208,
  • Guillaume Lebreton320,
  • Julien Amour208,
  • Charlotte Mazet321Email author,
  • Fanny Bounes77,
  • Gurbuz Murat322,
  • Laure Cronier77,
  • Guillaume Robin77,
  • Caroline Biendel77,
  • Stein Silva323,
  • Samia Boubeche324Email author,
  • Caroline Abriou324,
  • Véronique Wurtz324,
  • Vincent Scherrer324,
  • Nathalie Rey324,
  • Gioia Gastaldi224, 325Email author,
  • Benoit Veber326,
  • Fabien Doguet327,
  • Arnaud Gay327,
  • Bertrand Dureuil328,
  • Emmanuel Besnier324,
  • Antoine Rouget77,
  • Guillaume Gantois10,
  • Eric Magalhaes54,
  • Ruben Wanono329,
  • Roland Smonig54,
  • Mathilde Lermuzeaux54,
  • Jordane Lebut54,
  • Andremont Olivier54,
  • Claire Dupuis54,
  • Aguila Radjou54,
  • Bruno Mourvillier54, 330,
  • Mathilde Neuville54,
  • Marie Pia D’ortho329,
  • Lila Bouadma54,
  • Anny Rouvel-Tallec329,
  • Marika Rudler331Email author,
  • Nicolas Weiss332,
  • Vincent Perlbarg333,
  • Damien Galanaud334,
  • Dominique Thabut335,
  • Brain Liver Pitié-Salpêtrière Study Group (BLIPS),
  • Emna Rachdi336Email author,
  • Ghada Mhamdi337,
  • Ahlem Trifi336,
  • Rim Abdelmalek337,
  • Sami Abdellatif336,
  • Foued Daly336,
  • Rochdi Nasri336,
  • Hanene Tiouiri337,
  • Salah Ben Lakhal336,
  • Geoffroy Rousseau338Email author,
  • Romain Asmolov293,
  • Leslie Grammatico-Guillon339,
  • Adrien Auvet293,
  • Said Laribi338,
  • Denis Garot293,
  • Pierre François Dequin293,
  • Antoine Guillon293,
  • Jean-Louis Fergé340Email author,
  • Gwénolé Abgrall340,
  • Ronan Hinault340,
  • Shazima Vally340,
  • Benoit Roze341,
  • Agathe Chaplain340,
  • Cyrille Chabartier340,
  • Anne-Charlotte Savidan340,
  • Sabia Marie340,
  • Andre Cabie341,
  • Dabor Resiere340,
  • Ruddy Valentino340,
  • Hossein Mehdaoui340,
  • Lucas Benarous155, 342Email author,
  • Marième Soda-Diop343,
  • Fouad Bouzana155,
  • Gilles Perrin153, 155, 456,
  • Jeremy Bourenne153, 155Email author,
  • Béatrice Eon155,
  • Dominique Lambert155,
  • Agnes Trebuchon343,
  • Géraldine Poncelet344Email author,
  • Fleur Le Bourgeois345,
  • Levy Michael345,
  • Guillot Camille345,
  • Jérôme Naudin346,
  • Anna Deho346,
  • Stéphane Dauger346,
  • Michaël Sauthier347Email author,
  • Krystale Bergeron-Gallant347,
  • Guillaume Emeriaud347,
  • Philippe Jouvet347,
  • Nicolas Tiebergien348,
  • Matthias Jacquet-Lagrèze348Email author,
  • Jean-Luc Fellahi348,
  • Florent Baudin349Email author,
  • Sandrine Essouri347,
  • Etienne Javouhey350,
  • Claude Guérin351,
  • Marie Lampin221Email author,
  • Ouardia Mamouri352,
  • Patrick Devos353,
  • Yasemin Karaca-Altintas221,
  • Matthieu Vinchon354,
  • David Brossier347Email author,
  • Redha Eltaani347,
  • Sonia Teyssedre355Email author,
  • Meyet Sabine356,
  • Jean-Christophe Bouchut357,
  • Olivier Peguet357,
  • Lucie Petitdemange358Email author,
  • Anne Sophie Guilbert358,
  • Nabil Tabet Aoul359,
  • Zakaria Addou360,
  • Nabil Aouffen361,
  • Benqqa Anas93,
  • Samira Kalouch362,
  • Khalid Yaqini362,
  • Aziz Chlilek362,
  • Rchi Abdou93,
  • Perrine Gravellier363,
  • Julie Chantreuil363Email author,
  • Nadine Travers364,
  • Antoine Listrat364,
  • Claire Le Reun363,
  • Geraldine Favrais363,
  • Zoe Coppere365Email author,
  • Stéphane Blanot366,
  • Juliette Montmayeur366,
  • Régis Bronchard367,
  • Stephane Rolando368,
  • Gilles Orliaguet366,
  • Pierre-Louis Leger369Email author,
  • Jérôme Rambaud369,
  • Emilie Thueux369,
  • Alexandra De Larrard369,
  • Véronique Berthelot369,
  • Julien Denot369,
  • Marie Reymond369,
  • Alain Amblard369,
  • Sarah Morin-Zorman370Email author,
  • Etienne Lengliné371,
  • Claire Pichereau267,
  • Eric Mariotte372,
  • Canet Emmanuel373,
  • Julien Poujade374Email author,
  • Guillaume Trumpff375Email author,
  • Ralf Janssen-Langenstein98,
  • Marie-Line Harlay98,
  • Noorah Zaid105,
  • Nawel Ait-Ammar376,
  • Christine Bonnal376,
  • Jean-Claude Merle105,
  • Francoise Botterel376,
  • Eric Levesque105Email author,
  • Zakaria Riad351Email author,
  • Mehdi Mezidi351,
  • Hodane Yonis351,
  • Mylène Aublanc351,
  • Sophie Perinel-Ragey351,
  • Floriane Lissonde351,
  • Aurore Louf-Durier351,
  • Romain Tapponnier351,
  • Bruno Louis377,
  • Jean-Marie Forel156,
  • Magali Bisbal378,
  • Samuel Lehingue156,
  • Romain Rambaud156,
  • Mélanie Adda156,
  • Sami Hraiech156,
  • Elisa Marchi156,
  • Antoine Roch156,
  • Vincent Guerin155,
  • Sacha Rozencwajg306Email author,
  • Matthieu Schmidt306,
  • Guillaume Hekimian306,
  • Nicolas Bréchot306Email author,
  • Jean Louis Trouillet306,
  • Sébastien Besset306,
  • Guillaume Franchineau306,
  • Ania Nieszkowska306,
  • Leprince Pascal320,
  • Maud Loiselle374Email author,
  • Chemam Sarah379,
  • Dangers Laurence380,
  • Thomas Guillemette157,
  • Alice Jacquens299,
  • Sebastien Kerever381,
  • Bertrand Guidet267,
  • Philippe Aegerter382,
  • Vincent Das42,
  • Muriel Fartoukh383,
  • Jan Hayon384,
  • Mathieu Desmard385,
  • Jean-Pierre Fulgencio383,
  • Benjamin Zuber386,
  • A. Soufi7,
  • K. Khaleq7,
  • D. Hamoudi7,
  • Charlotte Garret242Email author,
  • Matthieu Peron387,
  • Emmanuel Coron387,
  • Cédric Bretonnière242,
  • Etienne Audureau388,
  • Winters Audrey389,
  • Duvoux Christophe390,
  • Jacquelinet Christian391,
  • Azoulay Daniel392,
  • Feray Cyrille390,
  • Wissal Aissaoui93,
  • Kawtar Rghioui93,
  • Wafae Haddad93,
  • Houcine Barrou93,
  • Anna Carteaux-Taeib393,
  • Renato Lupinacci393,
  • Gilles Manceau394,
  • Florence Jeune394,
  • Christophe Tresallet393,
  • Sahar Habacha395, 396,
  • Ines Fathallah395Email author,
  • Aymen Zoubli395,
  • Rafaa Aloui395,
  • Nadia Kouraichi395,
  • Emilie Jouet397Email author,
  • Julie Badin397,
  • Brice Fermier397,
  • Marc Feller397,
  • Mathieu Serie397,
  • Jérôme Pillot398Email author,
  • William Marie398,
  • Chloé Gisbert-Mora398,
  • Camille Vinclair398,
  • Pierre Lesbordes398,
  • Pascal Mathieu398,
  • Fabienne De Brabant398,
  • Emmanuel Muller398,
  • Marie-Aline Robaux398,
  • Mikhael Giabicani225, 399Email author,
  • Antoine Marchalot399,
  • Stéphanie Gelinotte399,
  • Pierre Louis Declercq399,
  • Jean-Pierre Eraldi399,
  • François Bougerol399,
  • Nicolas Meunier-Beillard400,
  • Hervé Devilliers401,
  • Jean-Philippe Rigaud399,
  • Camille Verrière165,
  • Fanny Ardisson402Email author,
  • Nancy Kentish-Barnes403,
  • Gwenaëlle Jacq237, 404,
  • Akli Chermak405,
  • Alexandre Lautrette406,
  • Matthieu Legrand407,
  • Alexis Soummer408,
  • Guillaume Thiery409,
  • Alice Cottereau42,
  • Emmanuel Canet226,
  • Marie Caujolle410Email author,
  • Jérôme Allyn410,
  • Dorothée Valance410,
  • Caroline Brulliard410,
  • Olivier Martinet410,
  • Julien Jabot410,
  • Thomas Gallas410,
  • David Vandroux410,
  • Nicolas Allou410,
  • Arthur Durand411Email author,
  • Rémi Nevière412,
  • Florian Delguste412,
  • Eric Boulanger412,
  • Sebastien Preau413,
  • Ruste Martin351,
  • Hélène Cochet414Email author,
  • Jean Pierre Ponthus414,
  • Virginie Amilien414,
  • Martial Tchir414,
  • Elise Barsam414,
  • Mohsen Ayoub414,
  • Jean Francois Georger414,
  • Izaute Guillame415,
  • Julie Assaraf416Email author,
  • Simona Tripon417,
  • Maxime Mallet418,
  • Guilaume Barbara419,
  • Guillaume Louis420,
  • Stéphane Gaudry300,
  • Nicolas Barbarot421,
  • Angéline Jamet123,
  • Hervé Outin422,
  • Sébastien Gibot419,
  • Pierre-Edouard Bollaert419Email author,
  • Mathilde Holleville237Email author,
  • Stéphane Legriel237,
  • Anne Laure Chateauneuf237,
  • Sébastien Cavelot237,
  • Jean-Denis Moyer237,
  • Jean Pierre Bedos237,
  • Philippe Merle423,
  • Aurelie Laine424Email author,
  • De Sa Natalie425,
  • Mathieu Cornuault426Email author,
  • Jérome Libot426,
  • Karim Asehnoune427,
  • Bertrand Rozec258,
  • Jacques Dantal428,
  • Michel Videcoq426,
  • Thècle Degroote251Email author,
  • Emmanuelle Jaillette251,
  • Farid Zerimech429,
  • Balduyck Malika429,
  • Jean-François Llitjos69, 269Email author,
  • Marlène Amara430,
  • Guillaume Lacave237,
  • Béatrice Pangon430,
  • José Mavinga431Email author,
  • Joseph Nsiala Makunza432,
  • M. E. Mafuta433,
  • Yves Yanga431,
  • Amisi Eric431,
  • Jp Ilunga431,
  • Ma Kilembe431,
  • Fanny Alby-Laurent269,
  • Julie Toubiana269,
  • Amel Mokline434Email author,
  • Achraf Laajili434,
  • Helmi Amri434,
  • Imene Rahmani434,
  • Nidhal Mensi434,
  • Lazheri Gharsallah434,
  • Sofiene Tlaili434,
  • Bahija Gasri434,
  • Rym Hammouda434,
  • Amen Allah Messadi434,
  • Pierre-Antoine Allain62,
  • Nathallie Gault435,
  • Catherine Paugam-Burtz62,
  • Arnaud Foucrier62Email author,
  • Bassem Chatbri396,
  • Yousra Bourbiaa436,
  • Lamia Thabet436,
  • Arthur Neuschwander437Email author,
  • Looten Vincent438,
  • Jennifer Beck439,
  • Chhor Vibol437,
  • Yavchitz Amelie437,
  • Matthieu Resche-Rigon438,
  • Jean MantzRomain Pirracchio437,
  • Côme Bureau249Email author,
  • Maxens Decavèle249,
  • Sébastien Campion440,
  • Roukia Ainsouya440,
  • Marie-Cécile Niérat440,
  • Hélène Prodanovic230,
  • Mathieu Raux441,
  • Thomas Similowski249, 231,
  • Bruno-Pierre Dubé231,
  • Suela Demiri231,
  • Martin Dres231,
  • Faten May55Email author,
  • Hervé Quintard442,
  • Ilias Kounis443,
  • Faouzi Saliba443Email author,
  • Stephane André443,
  • Marc Boudon443,
  • Philippe Ichai443,
  • Aline Younes443,
  • Lionel Nakad443,
  • Audrey Coilly443,
  • Teresa Antonini443,
  • Rodolphe Sobesky443,
  • Eleonora De Martin443,
  • Didier Samuel443,
  • Noemie Hubert444,
  • Mai-Anh Nay247,
  • Johann Auchabie60,
  • Bruno Giraudeau445,
  • Reignier Jean242,
  • Michaël Darmon446Email author,
  • Stephane Ruckly447,
  • Maïté Garrouste-Orgeas448,
  • Elisabeth Gratia309,
  • Dany Goldgran-Toledano449,
  • Samir Jamali450,
  • Anne Sylvie Dumenil451,
  • Carole Schwebel452,
  • Laurent Brisard258Email author,
  • Philippe Bizouarn258,
  • Thierry Lepoivre258,
  • Johanna Nicolet258,
  • Jean Christophe Rigal258,
  • Jean Christian Roussel453,
  • Cherifa Cheurfa454,
  • Julien Abily224,
  • Thomas Lescot455,
  • Isaline Page457,
  • Stéphanie Warnier457,
  • Monique Nys457,
  • Anne-Françoise Rousseau457,
  • Pierre Damas457Email author,
  • Fabrice Uhel458,
  • Mathieu Lesouhaitier458,
  • Murielle Grégoire459,
  • Baptiste Gaudriot460,
  • Arnaud Gacouin458,
  • Yves Le Tulzo458,
  • Erwan Flecher461,
  • Karin Tarte462,
  • Jean-Marc Tadié458Email author,
  • Quentin Georges446,
  • M. Soares463,
  • Kyeongman Jeon464,
  • Sandra Oeyen465,
  • Chin Kook Rhee466,
  • Pascale Gruber467,
  • Marlies Ostermann468,
  • Quentin Hill469,
  • Peter Depuydt470,
  • Christelle Ferra471,
  • Alice Muller472,
  • Bourmaud Aurelie473,
  • Christopher Niles10,
  • Fabien Herbert474,
  • Sylviane Pied474,
  • Séverine Loridant475,
  • Nadine François475,
  • Anne Bignon476,
  • Boualem Sendid477,
  • Caroline Lemaitre225,
  • Celine Dupre236Email author,
  • Aymen Zayene234Email author,
  • Lucie Portier478,
  • Nathalie De Freitas Caires478,
  • Philippe Lassalle479,
  • Aymeric Le Neindre480Email author,
  • Pascal Selot480,
  • Daniel Ferreiro480,
  • Maria Bonarek480,
  • Stépahen Henriot480,
  • Julie Rodriguez480,
  • Mara Taddei481Email author,
  • Mauro Di Bari482,
  • Cheryl Hickmann481Email author,
  • Diego Castanares-Zapatero483,
  • Louise Deldicque484,
  • Peter Van Den Bergh485,
  • Gilles Caty486,
  • Jean Roeseler483, 487,
  • Marc Francaux484,
  • Pierre-François Laterre483, 487,
  • Bastien Dupuis120,
  • Sharam Machayeckhi488,
  • Celine Sarfati489Email author,
  • Alex Moore489,
  • Paula Mendialdua489,
  • Emilie Rodet489,
  • Catherine Pilorge490,
  • Francois Stephan490,
  • Saida Rezaiguia-Delclaux490,
  • Jonathan Dugernier487Email author,
  • Michel Hesse491,
  • Thibaud Jumetz487,
  • Emilie Bialais487,
  • Virginie Depoortere491,
  • Jean Bernard Michotte492,
  • Xavier Wittebole487 and
  • François Jamar493
Annals of Intensive Care20177(Suppl 1):7

DOI: 10.1186/s13613-016-0224-7

Published: 10 January 2017

.

.

P144 Post traumatic cerebral thrombophlebitis: prospective study about 15 cases

Chtara Kamilia1, Kais Regaieg2, Olfa Turki1, Najeh Baccouch2, Hedi Chelly1, Mabrouk Bahloul1, Mounir Bouaziz1
1Réanimation polyvalente, Faculté de médecine de Sfax, Sfax, Tunisia; 2Réanimation polyvalente, CHU Habib Bourguiba, Sfax, Tunisia
Correspondence: Chtara Kamilia - kamilia.chtaraelaoud@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P144

Introduction Head injury is a rare but possible etiology of cerebral thrombophlebitis. The diagnosis should be considered especially in front of open head injuries extended to venous sinuses. The MR angiography is the gold standard for early diagnosis.

Patients and methods This is a descriptive prospective study of all trauma patients hospitalized in the intensive care unit of the University Hospital Habib Bourguiba Sfax over a period of 6 years between January 2010 and June 2016 and in whom the diagnosis of cerebral venous thrombophlebitis has been confirmed by angiography CT or MR angiography.

Results During the period study, 15 patients were included. The median age of patients was 29 [17–49] years. All patients were male, victims of poly trauma following an accident of traffic. In admission, SAPSII was 31 [24–52] and SOFA was 4 [2–8]. We have noted the presence of a serious head injury in 15 patients, extended open skull fractures of the venous sinus in 9 patients. A related chest trauma was present in 12 patients and abdominal trauma in 4 patients, trauma of the pelvis and/or members were present in 7 patients. All patients underwent mechanical ventilation. The diagnosis of cerebral venous thrombosis was confirmed by cerebral angiography CT in 9 patients and cerebral MR angiography in 6 patients. 7 patients have presented secondary pulmonary embolism. All patients did not show a contraindication against anticoagulation at diagnosis of thrombophlebitis. The thrombophilia (antithrombin III, protein C and S, homocysteine, and antiphospholipid, gene mutation factors II and V) as well as for anti-neutrophil cytoplasmic antibodies were negative in all patients. The outcome was favorable in 13 patients. Two patients were died due to a state of refractory septic shock.

Discussion Post traumatic cerebral thrombophlebitis is a rare thrombotic vascular disease. It must be mentioned especially with presence of extensive skull fractures in open sinuses. Venous MR angiography is the gold standard. The treatment is based on anticoagulation curative dose. Its prescription can be complicated in these cases associated with traumatic intracranial hemorrhage.

Conclusion Head injury is a rare but possible etiology of cerebral thrombophlebitis. Other prospective studies are needed to better understand the path physiology and the prognosis of these thromboses.

Competing interests None.

P145 Pain measurement in mechanically ventilated patients with traumatic brain injury: behavioral pain tools versus analgesia/nociception index—preliminary results

Ali Jendoubi1, Ahmed Abbes,1, Houda Belhaouane,1, Oussama Nasri,1, Layla Jenzri,1, Salma Ghedira2, Mohamed Houissa2
1Anesthesia and Intensive Care, Charles Nicolle Teaching Hospital, Tunis, Tunisia; 2 Intensive care, Charles Nicolle Hospital, Tunis, Tunisia
Correspondence: Ali Jendoubi - jendoubi_ali@yahoo.fr

Annals of Intensive Care 2017, 7(Suppl 1):P145

Introduction Pain is highly prevalent in critically ill trauma patients especially those with a traumatic brain injury (TBI). Behavioral pain tools such as the Behavioral pain scale (BPS), and critical care pain observation tool (CPOT) are recommended for sedated non-communicative patients. The analgesia nociception index (ANI) assesses the relative parasympathetic tone as a surrogate for antinociception/nociception balance in sedated patients. The primary aim is to evaluate the effectiveness of ANI in detecting pain in TBI patients. The secondary aim was to evaluate the impact of Norepinephrine use on ANI effectiveness, and to determine the correlation between ANI and BPS.

Patients and methods We performed a prospective observational study in 21 deeply sedated TBI patients. Exclusion criteria were non-sinus cardiac rhythm; presence of pacemaker; atropine or isoprenaline treatment; neuromuscular blocking agents and major cognitive impairment. HR, blood pressure and ANI were continuously recorded using the Physiodoloris® device at rest (T1), during (T2) and after the end (T3) of the painful stimulus (tracheal suctioning).

Results In total, 100 observations were scored. Patients’ characteristics were resumed in Fig. 1. ANI was significantly lower at T2 (Med (min–max) 54.5 (22–100)) compared with T1 (90.5 (50–100), p < 0.0001) and T3 (82 (36–100), p < 0.0001). Similar results were found in the subgroups of patients with (65 measurements) or without (35) Norepinephrine. During procedure, A negative linear relationship was observed between ANI and BPS (r2 = −0.469, p < 0.001). At the threshold of 50, the sensitivity and specificity of ANI to detect patients with BPS ≥ 5 were 73 and 62%, respectively with a negative predictive value of 86%.
Fig. 1

Baseline demographic and clinical characteristics. Values are expressed as mean ± standard deviation (SD); n (%) or median [interquartile range]. EDH extradural haemorrhage SDH subdural haemorrhage, SAH subarachnoid hemorrhage

Discussion

Conclusion ANI is effective in detecting pain in deeply sedated critically ill TBI patients, including those patients treated with Norepinephrine.

Competing interests None.

P146 The prognosis of cervical spine trauma in elderly subjects in surgical intensive care

Kamal Belkadi1, Ma Bouhouri2, Youness Harti3, Afak Nsiri2, Khalid Khaleq4, Driss Hamoudi2, Rachid Harrar2
1Anesthesie reanimation, chu ibn rochd, Casablanca, Morocco; 2Reanimation des urgences chirurgicale, chu ibn rochd, Casablanca, Morocco; 3Anesthésie réanimation, CHU Ibn Rochd Casa, Casablanca, Morocco; 4Service d’accueil des urgences, Chu Ibn Rochd, Casablanca, Morocco
Correspondence: Kamal Belkadi - kamal.belkadi@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P146

Introduction The aim of our study was to assess the prognostic factors of cervical spine trauma in elderly subjects admitted in the surgical intensive care unit.

Patients and methods We conducted a retrospective, and single-center study over 16 years (January 2000–January 2016) in Ibn Rochd hospital, we included all patients aged over 65 years with isolated cervical spine trauma, operated and non-operated, admitted in surgical intensive care, the death risk factors were searched by uni and multivariate analysis.

Results 198 patients were collected, the average age was 69.4 ± 3.9 years, with a male predominance 70.2%, the main causes were road accidents (50.5%) and fall (34.3%), 68.2% had a complete form (Frankel A), 75.7% were operated. The death rate in our study was 55%. The prognostic factors in univariate analysis were: hypertension, heart disease, fall injury, surgical delay >10 h; independent factors of death in multivariate analysis: heart disease and fall injury.

Conclusion The cervical spine trauma in elderly patients hospitalized in intensive care unit is poor prognosis.

Competing interests None.

P147 Interest of the urine antigen testing for Legionella pneumophila in the management of severe acute pneumonia: practice survey and analysis of performance in intensive care unit

Camille Thieffry1, Frédéric Wallet2, Erika Parmentier-Decrucq1, Raphaël Favory1, Daniel Mathieu1, Julien Poissy1
1Pôle de réanimation, hôpital salengro, C.H.R.U. - Lille, Avenue Oscar Lambret, Lille, France, Lille, France; 2 Centre de biologie pathologie génétique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
Correspondence: Julien Poissy - julien_poissy@hotmail.fr

Annals of Intensive Care 2017, 7(Suppl 1):P147

Introduction Legionnaire’s disease is a rare but severe acute pneumonia with a difficult definitive diagnosis. Legionella’s urine antigen testing is a quick, sensitive and specific test, widely prescribed in the case of an acute and severe community-acquired pneumonia. However, its overall contribution to the diagnosis of atypical pneumonia remains unknown in daily practice. The aims of this study were to evaluate the usefulness of this test in a “real life” utilization and to identify potential clinical markers of legionnaire’s disease in order to optimize its prescription. Legionnaire’s disease is a rare but severe acute pneumonia with a difficult definitive diagnosis. Legionella’s urine antigen testing is a quick, sensitive and specific test, widely prescribed in the case of an acute and severe community-acquired pneumonia. However, its overall contribution to the diagnosis of atypical pneumonia remains unknown in daily practice. The aims of this study were to evaluate the usefulness of this test in a “real life” utilization and to identify potential clinical markers of legionnaire’s disease in order to optimize its prescription.

Patients and methods We conducted a retrospective, monocentric and observational study. All the prescriptions of the urine antigen testing where monitored in the intensive care department and the emergency room admitting severe patients, in our University Teaching Hospital, from January 1st 2013 to December 31st 2015. Qualitative variables were compared by a Fischer’s exact test, and quantitative variables by a Mann–Whitney test. All tests were bilateral, and p ≤ 0.05 was considered as significant. ROC curves were determined for the variables of interest.

Results During the period of the survey, 1142 urinary tests were performed in 1002 patients. Three tests were positive for 0.26% of patients. Only 569 patients suffered from an actual pneumonia. Other patients suffered mostly from acute bronchitis (137 cases), and exacerbation of chronic obstructive pulmonary disease (123 cases). The characteristics of the 3 patients suffering from legionnaire’s disease differed significantly compared to the other kinds of acute pneumonia for: the need for invasive mechanical ventilation (100 vs 34.96% of patients; p = 0.043), PaO2/FiO2 ratio (107.5 vs 274.5; p = 0.0107), duration of mechanical ventilation (27.5 vs 2.5 days; p = 0.0062), natremia (129.5 vs 138 mmol/l; p = 0.0125), Creatine Phospho-Kinase level (16,125 vs 106UI; p = 0.0225) and Serum Glutamat Oxalacetat Transaminase (251 vs 35UI; p = 0.0157). We determined ROC curves for these last biological variables. Natremia: better threshold = 131, Se/Sp = 100/84.2%, AUC = 0.92. SGOT: better threshold = 191, Se/Sp = 100/89.6%, AUC = 0.9. CPK: better threshold 195, Se/Sp = 100/66.5, AUC = 0.88.

Discussion Urine antigen testing for Legionnaire’s disease appears to be over-prescribed in many cases with a very poor level of positivity in our cohort. However, it could be limited to patients exhibiting a pneumonia, and among them to patients with the classical biological perturbations described in this disease, which have excellent diagnostic performance. This targeted strategy would present an important benefit in term of costs.

Conclusion Our results show that a better selection in the patients who could benefit of this test is mandatory. Simples markers in routine testings could help the clinician to adapt his prescription, optimizing this test’s efficiency.

Competing interests None.

P148 Staphylococcal community-acquired urinary tract infection in the emergency department: a sign for acute infective endocarditis?

Thomas Lafon1, Philippe Vignon2, Emmanuelle Begot2, Alexandra Appert3, Mathilde Hadj3, Paul Claverie3, Morgan Matt4, Olivier Barraud5, Bruno François6
1Inserm cic 1435/urgences/samu, Centre Hospitalier Universitaire de Limoges, Limoges, France; 2Service de réanimation polyvalente, Centre Hospitalier Universitaire de Limoges, Limoges, France; 3Urgences/samu, Centre Hospitalier Universitaire de Limoges, Limoges, France; 4Service de maladies infectieuses, Centre Hospitalier Universitaire de Limoges, Limoges, France; 5Bactériologie-virologie-hygiène/umr-s 1092, Centre Hospitalier Universitaire de Limoges, Limoges, France; 6Inserm cic1435/service de réanimation polyvalente, Centre Hospitalier Universitaire de Limoges, Limoges, France
Correspondence: Thomas Lafon - thomas.lafon@chu-limoges.fr

Annals of Intensive Care 2017, 7(Suppl 1):P148

Introduction Urinary tract infection is a frequent cause of admission at the Emergency Department (ED). Most prevalent bacteria are usually gram-negative bacilli and Staphylococcus aureus (Sa) is rarely evidenced (2.5%) except in hospital-acquired infections due to urinary catheter [1]. Bacteriuria can be observed in Sa infective endocarditis (IE) because of the metastatic properties of Sa. We hypothesized that presence of Sa in the urine could be related to Staphylococcal bacteremia associated with unsuspected IE and not only the expression of a “usual” urinary tract infection.

Patients and methods This is a descriptive single-center study conducted over a 10 year-period in the Teaching Hospital of Limoges. All patients admitted to the ED with Sa (both MSSA and MRSA) isolated from their urine cultures were retrospectively analyzed. Data were collected from the database of the microbiology department and the patient medical charts. We secondarily searched if a Sa IE had been documented in patients with Sa isolated from their blood cultures in order to establish a link between IE and presence of Sa in the urine. We used modified Dukes criteria as diagnostic criteria of IE [2].

Results Between 2005 and 2015, 420,000 patients were admitted in the ED. Out of the 204 records analyzed, 174 patients whose urine culture grew Sa were excluded because they had a urinary catheter (n = 75) or sterile blood cultures (n = 99). Finally, 30 patients were studied (17 men; median age: 73 years; diabetes: n = 7; mitral valvular disease: n = 2, aortic valvular disease: n = 2) (Table 1). Reasons for admission were markedly heterogeneous and fever accounted for 14 cases. Echocardiography was performed in 25 patients with a median delay of 6.5 days (range: 0–23 days) and IE was confirmed in 21 of them. Only three cases of IE have been diagnosed in the ED because of a fever and valvular murmur (n = 2) but no patient was admitted to the ED for IE suspicion. Other initially suspected diagnoses were prostatitis, pneumonia or appendicitis and not related to any type of infection in 26% of the cases. The origin of Sa bacteremia was cutaneous in 67% of the cases. During the hospital stay, 70% of the patients presented secondary sites of Sa infection in addition to the urinary tract (arthritis, splenic abcess, cerebral hematoma). Among 21 patients presenting with an IE, 8 died within 7 days, and total hospital mortality reached 50%.
Table 1

Patients characteristics

Characteristics

n (%)

Median age (year)

63

Heart murmur

5 (24)

Congenital heart valve defect

19 (90)

Mitral localization

19 (90)

Abuse (drug, alcohol…)

4 (19)

Microbiology

 

 MSSA

20 (95)

 MRSA

1 (5)

Origin

 

 Skin

14 (67)

 Unknown

7 (33)

Complications

 

 Central nervous system

9 (43)

 Visceral abscesses

2 (9.5)

 Septic arthritis

9 (43)

 Skin and eye petechiae

9 (43)

Death

8 (38)

Conclusion This case series suggests that IE should be ruled out when Sa bacteriuria is evidenced, irrespective of the clinical presentation. This could question the reality of isolated community-acquired urinary tract infections due to Sa.

Competing interests None.

References
  1. 1.

    Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG, Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis Off Publ Infect Dis Soc Am. 2000;30(4):633–8.

     
  2. 2.

    Ekkelenkamp MB, Verhoef J, Bonten MJ. Quantifying the relationship between Staphylococcus aureus bacteremia and S. aureus bacteriuria: a retrospective analysis in a tertiary care hospital. Clin Infect Dis Off Publ Infect Dis Soc Am. 2007;44(11):1457–9.

     

P149 The infectious tricuspid endocarditis in ICU: clinical features, management and outcome

Amira Jamoussi1, Amira Ben Jazia1, Takoua Marhbène1, Dhouha Lakhdhar1, Jalila Ben Khelil1, Mohamed Besbes1
1Medical icu, Hospital Abderrahmen Mami De Pneumo-Phtisiologie, Ariana, Tunisia
Correspondence: Amira Jamoussi - dr.amira.jamoussi@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P149

Introduction Since the outbreak scourge of intravenous drug addiction in Tunisia, we are witnessing the emergence of cases of infectious tricuspid endocarditis (ITE). This pathology should be studied because it requires specific medical and surgical management. The aim of the study was to describe the clinical features, management and outcome of ITE in intensive care unit.

Patients and methods This was a retrospective study from January 2009 to December 2014. We enrolled patients who were hospitalized in intensive care unit and had ITE. We recorded baseline characteristics, management and outcome.

Results During the study period, we collected 10 cases of ITE making an incidence rate of 3 cases for 1000 patient admissions. They were divided into 8 men and 2 women. The median age was of 37.5 years. The main reasons of ICU admission was acute respiratory failure (80%), among them 5 required mechanical ventilation. Hemodynamic failure was present in 3 cases.

The median SAPS II was of 33 [19–90]. The median APACHE II was of 17 [7–53]. Different contributing factors were identified: intravenous drug abuse (6 patients), a central venous catheter (1 patient) and a pacemaker (1 patient).

All patients underwent transesophageal echocardiography showing one or several vegetations on native tricuspid valve. No associated left endocarditis was found.

Blood cultures were positive in 8 cases of which 5 contained 2 different micro-organisms. The identified micro-organisms were: Meticillin Resistant Staphylococcus aureus (n = 6), Meticillin Sensitive Staphylococcus aureus (n = 3), coagulase-negative staphylococcus (n = 2), Enterobacter cloacae (n = 1), and candida famata (n = 1). Occurring complications were hospital-acquired infections (n = 5), septic pulmonary embolism (n = 4), withdrawal syndrome (5 cases), acute renal failure (n = 2) and atrioventricular block (n = 2).

Medical treatment consisted of a double antibiotic treatment. Surgical treatment was required in 7 patients: tricuspid valve replacement by bioprosthesis (6 cases) and valvuloplasty (1 case).

The average length of stay was of 31.3 days [2–56]. ITE had recurred on bioprotheses in two patients after intravenous drug resumption; they underwent surgery again and one of them died.

In hospital mortality was of 30%. The outcome was favorable in 7 patients.

Conclusion The ITE in ICU is a severe disease with frequent complications and in hospital mortality reaches 30%. The most frequent incriminated micro-organism is Meticillin Resistant Staphylococcus aureus. It often requires medical and surgical treatment. Intravenous drug addiction remains the most common cause and worsens the prognosis by the risk of recurrence.

Competing interests None.

P150 Microbiological mapping of community-acquired intra-abdominal infections (IAI) and indicator of local antibiotherapy appropriateness with French national guidelines

Julien Goutay1, Caroline Blazejewski2, Isabelle Joly-Durand3, Isabelle Pirlet4, Marie Pierre Weillaert5, Sebastien Beague2
1Interne en anesthésie réanimation, C.H. Régional Universitaire de Lille (CHRU de Lille), Lille, France; 2Réanimation polyvalente, Hospital Center De Dunkerque, Dunkerque, France; 3Equipe opérationnelle d’hygiene, Hospital Center De Dunkerque, Dunkerque, France; 4Service de chirurgie digestive, Hospital Center De Dunkerque, Dunkerque, France; 5Laboratoire, Hospital Center De Dunkerque, Dunkerque, France
Correspondence: Julien Goutay - julien.goutay@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P150

Introduction French guidelines for community-acquired IAI underline the importance of establishing antibiotherapy protocols based on regular analysis of microbiological data; and of systematic site infection cultures to determine microbial sensitivity to antibiotics. Our study describes microbial population involved in our community-acquired IAI and defines an annual follow-up indicator of probabilistic antibiotherapy inadequacy to microbial sensitivity.

Materials and methods We conducted a retrospective, monocentric, observational study from January the 1st 2014 to December the 31st 2015. All community-acquired IAI in adults were included. Exclusion criteria were: cirrhosis and peritoneal dialysis. Initial probabilistic antibiotherapy and total antibiotherapy duration were left to the discretion of the physician in charge. Results of intra-abdominal cultures (IAC) were analyzed. Three microbial groups were defined: (A) A-group: wild-type bacteria strains treated with adequat antibiotherapy; (B) B-group: antibiotic resistant bacteria treated with adequat antibiotherapy; (C) C-group: multi-drug resistant bacteria treated with inadequat antibiotherapy. A Chi square analysis was performed on SPSS software (IBM).

Results 98 community-acquired IAI were included: 54 (55%) had positive IAC with 133 bacteria; 34 (35%) didn’t have intra-abdominal swab; 10 (10%) had sterile cultures. Predominant strains were Gram-negative bacteria (76/133 (57%)). More represented bacteria were Escherichia Coli (50/133 (38%)) and Bacteroïdes fragilis (16/133 (12%)). 127/133 (95%) bacteria belong to A- and B-groups. B-group importance increased significantly between 2015 and 2016. C-group characteristics were comparable over the 2 years. Initial antibiotherapy was inadequate with French guidelines in 38/98 (39%) cases and with microbial antibiotic susceptibility in 6/133 (4.5%) cases (C-group). Average antibiotherapy duration was 11.3 days. Antibiotic treatment duration was too long according to French guidelines for 65/98 (67%) patients.

Discussion Our microbial population in community-acquired IAI is similar to national studies with a lowest resistance rate (C-group under 10%). Probabilistic antibiotherapy proposed by French guidelines is appropriated to our microbial ecology. Antibiotherapy duration is unconformed with guidelines in 67% cases. Peroperative swabs are frequently missing (35%). Non-compliance with French guidelines highlights the importance to formalize our local procedure. This formalization at any stage (surgical, medical and biological cares) seems essential to improve our standard of care. C-group rate could be used as a real-time feedback to adapt our protocol continuously.

Conclusion The goal of our study is to improve local standard of care by offering a formalization of community-acquired IAI management procedure. C-group rate seems to be a good follow-up indicator of probabilistic antibiotherapy inadequacy to microbial sensitivity, allowing an optimization of our protocol in real-time.

Competing interests None.

Reference
  1. 1.

    Montravers et al. Recommandations Formalisées d’Experts «Prise en charge des infections intra-abdominales», Octobre 2015.

     

P151 The resumption of peritonitis in surgical intensive care unit

Ma Bouhouri1, Kamal Belkadi2, Soufi Aziz1, Khalid Khaleq3, Afak Nsiri1, Driss Hamoudi1, Rachid Harrar1
1Reanimation des urgences chirurgicale, chu ibn rochd, Casablanca, Morocco; 2Anesthesie reanimation, chu ibn rochd, Casablanca, Morocco; 3Service d’accueil des urgences, Chu Ibn Rochd, Casablanca, Morocco
Correspondence: Kamal Belkadi - kamal.belkadi@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P151

Introduction The resumption of peritonitis is a serious complication of abdominal and pelvic surgery. It’s a medical and surgical emergency, the prognosis depends on the speed, the quality of the care, and the underlying terrain and etiology.

Patients and methods We conducted a descriptive analytic retrospective study over a period of 5 years (January 2011–June 2016) 60 cases of peritonitis hospitalized in surgical intensive care unit.

Results The average age of our patients was 44.36 years with a sex ratio of 1.5 (36H/24F). The most frequent risk factors were: factors relating to the ground, and factors related to the initial peritonitis.

Clinical signs were dominated by fever (75%), abdominal pain (52%). The period of the average recovery was 8.2 days. The decision of the surgical revision was based on a clinical, biological and radiological criteria.

40 patients in our series, 67% of cases were taken on clinical and biological criteria while 15 patients 25% were taken on radiological criteria. In 8% of the remaining cases, the potential severity of the clinical and biological state in association with an inconclusive ultrasound, led to reoperation.

The therapeutic treatment was based on a perioperative resuscitation, treatment of organ failure, empirical antibiotic therapy and by midline laparotomy surgery. Bacteriological samples performed intraoperatively allowed to have the following bacteriological profile: predominance of BGN (79%) dominated by E. coli (28%) followed by Klebsiella pneumoniae (21%), Acinetobacter and Enterococcus baumanii (12%). The multimicrobien character was found in 55%. The E. coliKlebsiella pneumoniae association was the most frequent (37%).

The anastomotic dehiscence was the direct cause of the most common surgical revision found intraoperative (62%). The average hospital stay was 8 days. The mortality rate was 61%. The main prognostic factors in our study emerged in the univariate analysis were: kidney failure, the number of organ failure, a TP <50% the needs of ventilation and the use of catecholamines.

Discussion Mortality is variable depending on the studies, between 25 and 60%.

Conclusion The diagnosis often difficult. Only effective and early therapeutic management reduces mortality remains high in recent years despite the various advances in the field of surgery and reanimation.

Competing interests None.

P152 Prognostic factors in intra abdominal sepsis: a prospective study

Reda Hafiane1, Khalid Khaleq1, Khalid Hattabi2, Mohamed Aziz Bouhouri1, Afak Nsiri1, Driss Hammoudi1, Abdelaziz Fadil2, Rachid Al Harrar1
1Service de réanimation des urgences chirurgicales, CHU IBN ROCHD de Casablanca, casablanca, Morocco; 2Service des urgences viscérales, CHU Ibn Rochd de casablanca, Casablanca, Morocco
Correspondence: Reda Hafiane - hafiane.reda89@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P152

Introduction Intra- abdominal sepsis represents a life threatening condition. Its manifestations are non specific and can quickly lead to multi organ failure if not treated correctly. Patient’s assessment is essential in order to adjust the therapy. The aim of our study is to highlight the prognostic factors in this situation.

Patients and methods It’s a prospective observational study performed during 6 months (02/2016–08/2016) in visceral emergency operating rooms.

Inclusion criteria: adults admitted with intra-abdominal infectious disease diagnosed with biological and radiological means.

Studied parameters: demographic data, co morbidities, number of organ failure, type of anesthesia, intraoperative incidents and evolution. Results were analyzed using SPSS software, prognostic factors were extracted with univariate then multivariate analysis. Significant results were noted.

Results During this period, we admitted 302 patients, the mean age: 41.14 ± 17 years. Male predominance was noticed in our population: 69.9%. The mortality rate was: 13.2%.

The main prognostic factors were reported in the attached Table 2.
Table 2

Main prognostic factors in intra abdominal sepsis

Variable

Hazard ratio unadjusted

p

Hazard ratio adjusted

p

Age

1.047

0.001

1.032

0.009

Sex

3.25

0.001

0.068

0.47

High hemoglobin

0.68

0.01

0.33

0.52

creatinine

1.11

0.001

1.16

0.001

Pesence of clammy skin

14.74

0.001

77

0.05

Urea

37.34

0.01

37

0.25

Hemodynamic instability

26

0.001

1.27

0.834

Use of vasoactive drugs

29

0.001

34

0.001

Operating time

1.018

0.0001

1.014

0.001

Discussion Many significant prognostic factors were identified: Age, existence of hemodynamic failure with renal involvement, long operative time and the use of vasoactive drugs.

A high hemoglobin level at the admission was a protective factor.

The presence of respiratory distress, the sex and the presence of yeasts were not significant factors in our study.

Conclusion Intra abdominal sepsis is causing quickly a multi organ dysfunction syndrome leading to death. Therefore, our priority is to stop this sepsis with the help of the surgeon and the efficient use of antibiotics.

Competing interests None.

P153 Community acquired intra abdominal sepsis: concerning 302 cases

Reda Hafiane1, Khalid Khaleq1, Khalid Hattabi2, Mohamed Aziz Bouhouri1, Afak Nsiri1, Driss Hammoudi1, Khalid Zerouali3, Abdelaziz Fadil2, Rachid Al Harrar1
1Service de réanimation des urgences chirurgicales, CHU IBN ROCHD de Casablanca, casablanca, Morocco; 2 Service des urgences viscérales, CHU Ibn Rochd de casablanca, Casablanca, Morocco; 3Service de microbiologie, CHU Ibn Rochd de casablanca, Casablanca, Morocco
Correspondence: Reda Hafiane - hafiane.reda89@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P153

Introduction Intra abdominal sepsis is a dangerous condition causing a high mortality rate even with surgery and post operative care improvement.

The aim of the study is to assess the bacteriological and epidemiological profile of this population.

Patients and methods It’s a prospective observational study performed during 6 months (02/2016–08/2016) in visceral emergency operating rooms.

Inclusion criteria: adults admitted with intra-abdominal infectious disease diagnosed with biological and radiological means.

Exclusion criteria: post operative peritonitis and deceased patients before their admittance.

Studied parameters: demographic data (gender, age…), the time management, co morbidities, number of organ failure, intraoperative incidents and postoperative evolution.

Results During this period, we admitted 302 patients, the mean age: 41.14 ± 17 years. Male predominance was noticed in our population: 69.9%.

Main emergencies are reported in the attached Table 3. Concerning the bacteriological profile: we had 121 positive samplings. Enterobacterias were the most frequent strain. E coli was predominant: 43%, Enterococcus faecalis: 25%, Streptococcus (viridians and acidominimus): 14%, we had 1 case of Acinetobacter baumanii resistant to imipenem. 6 cases of yeasts were found (Candida albicans).
Table 3

Main emergencies with epidemiological profile

Disease

Number (n)

Sex ratio (M/F)

Age (years)

Time management (days)

Number of organ failure (n)

APACHE II score

Number of deaths (n)

Peptic perforation peritonitis

48

47

42.5

1.54

1

10

1

Appendicitis

100

1.43

31.7

2.95

0

7

0

intestinal perforation peritonitis

18

0.63

36

5.6

3

19

6

Biliary peritonitis

10

0.43

62.2

7.2

2

16

4

Post traumatic peritonitis

6

6

25

3.1

3

15

2

Necrotizing fasciitis

28

13

55.9

20

0

12

0

Antibiotic use was: Ampicilline: 44%, Ceftriaxone 41%, metronidazole: 76% and tazocilline: 4%.

Discussion In our context, community acquired intra abdominal sepsis leads to a high death rate. We noticed relevant parameters: a late time management, high gravity scores, some surgical procedures not directed by supervisors. Therefore, we have to establish therapeutic protocols tailored to each disease in order to improve patients’ management and help to reduce the mortality rate.

Conclusion Early diagnosis and care for intra abdominal sepsis represent a major way to prevent complications. Bacteriological proof is necessary to adjust post operative antibiotherapy.

Competing interests None.

P154 Conformity of antibiotic prescribing in emergency room

Fatma Kaaniche Medhioub1, Rania Allela2, Najla Ben Algia3, Samar Cherif4
1Faculté de médecine de Sfax, Sfax, Tunisia; 2Hopital régional mahres, Faculté de médecine de Sfax, Sfax, Tunisia; 3Intensive care, hopital régional Gafsa, Sfax, Tunisia; 4Intensive care, hopital régional mahres, Sfax, Tunisia
Correspondence: Fatma Kaaniche Medhioub - fatma_kaaniche@yahoo.fr

Annals of Intensive Care 2017, 7(Suppl 1):P154

Introduction The development of bacterial resistance is a major public health problem due to unreasonable use of antibiotics. The introduction of appropriate antibiotic therapy has a positive impact on patient survival and a significant economic impact. The objective of this study is to evaluate the compliance of antibiotics prescribed in emergencies.

Patients and methods Prospective study conducted on 1 year (01/01/2015–31/12/2015). We have included patients admitted to the emergency with hyperthermia (>38°), hypothermia (<36°) or two criteria of systemic inflammatory response syndrome. Were collected in the emergency department: history, presence of prior antibiotic therapy, demographic and clinical characteristics at admission, prescription of antibiotics in emergencies and its modalities and the discharge diagnosis. During hospitalization were collected: the introduction, modification or discontinuation of the antibiotic, the reasons for this change and certainty diagnosis. The compliance analysis of antibiotic therapy was performed by an expert group (two infectiologists, a bacteriologist and an emergency doctor) with regard to the current recommendations. Two groups were defined and compared: group of patients receiving complies antibiotic therapy and group with antibiotics considered improper. The criteria associated with non-compliance were sought.

Results Four hundred and twenty-two patients were enrolled. The final diagnosis retained an infectious etiology in 356 patients (84%). The mean age was 62.4 ± 18 years. Blood cultures were taken in 370 cases (87.7%). Infectious sites were most often lung (52%) and urine (32%). Severe sepsis was diagnosed in 14 patients (3.3%). A complies prescription was found in 335 patients (79.4%). Antibiotic therapy was started in 302 patients (71.5%) at the emergency and classified complies with 234 (55.4%). Among the 68 patients (16.1%) with an illegal antibiotic, it was continued in 24 (35.3%) during hospitalization. Among 120 patients (28.4%) did not receive antibiotics, this attitude was classified complies in 115 patients (95.8%). Non-compliance was related to the presence of antibiotics in the last 3 months and the presence of renal failure.

Conclusion Particular attention should be paid to the antibiotic prescription in patients subject to prior exposure to these. Dose adjustments should be respected in cases of renal failure. Regular evaluation of the antibiotic prescription in the emergency is necessary.

Competing interests None.

P155 Pulmonary resections’ bacterial cartography

Mohamed Taoufik Slaoui1, Souhail Boubia2, Y. Hafiani1, A. Khaoudi1, R. Cherkab1, W. Elallam1, C. Elkettani1, L. Barrou.1, M. Ridaii2
1Anesthesia service surgical resuscitation, chu ibn rochd, Casablanca, Morocco; 2 Thoracic surgery, chu ibn rochd, Casablanca, Morocco
Correspondence: Mohamed Taoufik Slaoui - dr.t.slaoui@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P155

Introduction The study of the bacterial cartography in thoracic surgery is extremely important for the treatment of post-operative infections due to the severity of the underlying pathology, the fragility of patients after surgery in addition to the choice of the empiric antibiotic therapy.

Materials and methods We led a prospective study following all the patients who underwent a pulmonary resection surgery for a period of 7 months from January to July 2016, jointly with the microbiology department, CHU Ibn Rochd, Casablanca. The bronchial secretions were collected by a protected distal bronchial sample using a (Combicath) after the intubation.

Results During the period of the study, 92 patients underwent a pulmonary resection, 65% for a neoplastic pathology.

The medium age was 43 years ±8 and 58% of our sample were male. 48% of our patients had smoking habits and 16 of them had pulmonary tuberculosis, 12 had repeated respiratory infections. The antibiotics used in pre-operative: 58% of beta-lactams; 22% of fluoroquinolones; 5% of macrolides.

Moreover, 60% of our patients were classified ASA1.

Of the 92 obtained samples, 22 were positive (23.9%). The most frequently observed germs were the Acinetobacter baumannii (8.7%), Pseudomonas aeruginosa (6.5%), Klebsiella pneumoniae (4.3%), Staphylococcus aureus (4.3%). The Acinetobacter baumannii was the most resistant germ (60% sensibility to carbapenem).

These patients were followed until their D30 after surgery, 12 of them developed a post-operative pneumonitis with 4 cases of multi-resistant Acinetobacter Baumanii, 2 of which deceased.

Conclusion Pneumonitis after pulmonary resection are common and severe that’s why it is necessary to establish a global prevention strategy mainly based on general patricians and pneumologists’ awareness concerning the choice of the prescribed antibiotics, in order to avoid the spread of multi-resistant germs.

Competing interests None.

P156 The Acinetobacter baumannii (AB) in the severe burns

Rihi El Mehdi1
1Intensive care unit, IBN ROCHD, Casablanca, Morocco
Correspondence: Rihi El Mehdi - mehdi_44@hotmail.fr

Annals of Intensive Care 2017, 7(Suppl 1):P156

Introduction Infection is a major cause of morbidity and mortality in burned. The bacterial ecology varies among centers. Despite the progress in the management of severe burned, mortality remains very high. The aim of this study is to establish the pathogenic profile of AB in this population.

Materials and methods Single-center retrospective study of 7 months, including any serious burned hospitalized for more than 48 h in intensive care, and who benefited from bacteriological samples during his stay.

Infectivity was retained on a range of clinical and biological arguments (CDC criteria) changed). They excluded all burned died for non-infectious causes, and patients with isolated settlement.

Results Sixty-two (72) patients were infected by the AB during our study period. The sex ratio (M/F) was 1.7 and the mean age was 39 ± 23 years. Nosocomial pneumonia was present in 61.11% of cases. Urinary tract infection was present in 18.05% of cases. Bacteremia was present in 12.5% of cases. Skin infection was present 8.33% of cases. The resistance profile was marked by 100% of cases of resistance to third-generation cephalosporins (C3G), 88% of cases of resistance to fluoro-quinolones (FQ), 74% of cases of resistance to imipenem and 64, 28% of cases of resistance to tigecycline.

Conclusion The incidence of infection with Acinetobacter baumannii in our unit remains high compared to that of intensive care units. Colonization and infection by the AB are significantly associated with increased length of stay, and mortality, and given the gravity of hospitalized patients, failure to comply with hygiene and abusive use of antibiotic prophylaxis.

Competing interests None.

Reference
  1. 1.

    Coignard B, Lepoutre A, Desenclos JC. Lessons learned from implementing a mandatory notification of hospital acquired infections in France [cited June 11, 2006]. Lyon, France.

     

P157 Clinical impact of extended-spectrum β-lactamase producing Enterobacteriaceae colonization on pneumonia in ICU

Caroline Schimpf1, Assaf Mizrahi2, Benoît Pilmis2, Alban Le Monnier2, Kelly Tiercelet1, Mélanie Cherin3, Cédric Bruel1, Francois Philippart1
1Réanimation, Groupe Hospitalier Paris Saint-Joseph, Paris, France; 2Unité de microbiologie clinique et dosages des anti-infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris, France; 3Réanimation polyvalente adulte, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
Correspondence: Francois Philippart - fphilippart@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P157

Introduction ESBL are enzymes mostly found in Enterobacteriaceae and confer resistance to all beta lactams antibiotics except cefoxitin and carbapenems. Recently, a significant increase in the rate of ESBL-related infections in ICU makes difficult the choice of empiric antibiotic therapy, especially in patients colonized by extended-spectrum β-lactamase producing Enterobacteriaceae (ESBLe) [1]. Notably, very few data are currently available regarding the role of ESBLe colonization on further pneumonia involving the same bacteria [2]. The aim of our study was to describe the incidence of ESBLe infections among ESBLe-colonized ICU patients.

Patients and methods This study was conducted retrospectively from January 1st 2011 to May 1st 2016, in our intensive care department. All admitted ESBLe-colonized patients who develop an infection during their ICU stay have been included in the study. The only exclusion criterion was an antibiotic treatment for an ESBLe infection at ICU admission.

Results During the period of the study, 386 stays were associated with an ESBLe colonization in 384 patients. 148 infections were diagnosed in patients colonized by ESBLe, among which 78 pneumonias. In 18 cases (23%) the ESBLe was involved in the pulmonary infection (PN-ESBLe+) and was the only responsible bacterium in 66% of cases. The ESBLe was the same in screening and pneumonia in 15 cases (83%). The PN-ESBLe+ was associated with septic shock in 9 (50%) cases, acute respiratory distress syndrome in 2 (11%) cases and neurologic failure in 7 (39%) cases. Episodes were ventilator-associated pneumonia in 56% (10 cases) of PN-ESBLe+ and 52% (31 cases) of PN-ESLBe-. The most common pathogens involved were Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae in both groups. Comparing groups (PN-ESBLe+ or PN-ESLBe−), only the notion of prior antibiotic therapy within 30 days (OR 3.9 [1.07–18.3]; p = 0.03) and colonization by ESBL Klebsiella pneumoniae (OR 4.04 [1.02–16.1]; p = 0.04) were more frequent in PN-ESBLe+. At least one empiric antibiotic was effective on the ESBLe in 83% of cases. In vitro antibiotic susceptibility tests demonstrate 100% efficiency of the association of piperacillin/tazobactam and amikacin on ESBLe involved in pneumonia.

Mortality at day 28 was 24% for PN-ESBLe+ and 44% for PN-ESBLe−. Hospital mortality was 53 and 38% respectively (p = NS).

Among 70 extra-pulmonary infections, ESLBe take part in 30 (43%) cases. The involvement of ESBLe was significantly lower in pneumonia than in other infections (p = 0.01).

Discussion Due to the single center character of our study, results cannot be extrapolated to the whole ICU population. Nevertheless, the observed incidence of colonizing ESBLe in our study is close enough from others studies. This point consolidates reflection about ICU pneumonia empiric treatment.

Conclusion The involvement of colonizing-ESBLe in ICU pneumonia is rare in our population and significantly lower than in other infections. Identified risk factors for PN-ESBLe + are a prior antibiotic therapy within 30 days and colonization with K. pneumoniae. Alternative associations to carbapenem remain efficient in all cases of pneumonia in our ICU and should probably be kept in mind.

Competing interests None.

References
  1. 1.

    Bretonniere C, Leone M, Milesi C, Allaouchiche B, Armand-Lefevre L, Baldesi O, et al. Strategies to reduce curative antibiotic therapy in intensive care units (adult and paediatric). Intensive Care Med 2015;41(7):1181–96.

     
  2. 2.

    Depuydt PO, Vandijck DM, Bekaert MA, Decruyenaere JM, Blot SI, Vogelaers DP, et al. Determinants and impact of multidrug antibiotic resistance in pathogens causing ventilator-associated-pneumonia. Crit Care 2008;12(6):R142.

     

P158 Risk factors of resistance for Gram negative bacilli responsible for ICU: acquired bacteremia—analysis of a large French ICU network

Sébastien Bailly1, Jc Lucet2, Alain Lepape3, François L’hériteau4, Martine Aupée5, Caroline Bervas6, Sandrine Boussat7, Anne Berger-Carbonne8, Anaïs Machut9, Anne Savey10, Jean-François Timsit11, REA-RAISIN Study group
1Iame team 5, INSERM UMR 1137, Paris, France; 2Hygiène hospitalière, Hôpital Bichat-Claude Bernard (AP-HP), Paris, France; 3Réanimation, Hospices Civils De Lyon, Lyon, France; 4Médecine interne, Hôpital Bichat-Claude Bernard (AP-HP), Paris, France; 5Hygiène hospitalière, C.H.U de Rennes, Rennes, France; 6Pharmacie, CHU - Hôpitaux de Bordeaux, Bordeaux, France; 7Réanimation, CHRU Nancy, Nancy, France; 8Dgos, Ministère des Affaires sociales et de la Santé, Paris, France; 9Cclin sud est, Hospices Civils De Lyon, Lyon, France; 10Cclin, Hospices Civils De Lyon, Lyon, France; 11 Réanimation médicale et infectieuse, Hôpital Bichat-Claude Bernard, Paris, France
Correspondence: Sébastien Bailly - sbailly@chu-grenoble.fr

Annals of Intensive Care 2017, 7(Suppl 1):P158

Introduction Immediate adequate treatment of ICU-acquired Gram negative bacilli (GNB) bloodstream infections (BSI) improves patients’ prognosis. Risk factors of resistance of GNB-BSIs should be better assessed.

Materials and methods Data from a large French national ICU network were explored during a 10-year period (2005–2014). Patients with a GNB-BSI were included and were divided into two groups according to the resistance (R) profile (BSI due to a R isolate or not). The following three groups were considered: (1) all GNB-BSI including Pseudomonas spp., Acinetobacter spp., Stenotrophomonas spp. and Enterobacteriacae (Eb) for which the following R were considered: ticarcillin (Pseudomonas spp., Acinetobacter spp., Stenotrophomonas spp.); ceftazidime (cefta) (P. aeruginosa (PA), Acinetobacter spp., Stenotrophomonas spp.), third generation cephalosporin (3GC) (Eb) and imipenem (all GNB, during the period 2011–2014 only), (2) PA cefta R from 2005 to 2014 and (3) Eb species resistant to 3GC from 2005 to 2014. Univariable hierarchical logistic models with two levels (random center and region effects) were used to select variables associated with resistance using a p value threshold of 0.2. Selected variables were further introduced in multivariable analyses using a hierarchical model with two random effects.

Results From 265,035 patients admitted in an annual median of 158 French ICUs, 9553 experienced an ICU-acquired (>48 h.) BSI, 5062 (53%) BSI due to GNB, including 1764 (35%) BSI due to R isolates. PA was identified in 1167 (23%) BSIs (480 (41%) R) and Eb in 3298 (65%) BSIs (1226 (34%) R). The median annual incidences of R GNB BSIs/10,000 ICU patients were: 68 for all R GNB BSI, 41 for Eb 3GC-R BSIs and 9.2 for PA cefta-R BSI. There was a significant increase of annual incidence for all GNB R and Eb 3GC-R BSI.

Independent factors associated with all R GNB BSI were: 1) ICU variables: percentage of patients with an immunosuppression other than neutropenia (7.9–14%: OR 1.23; 95% CI, [1.04–1.46]; >14%: 1.31 [1.09–1.57]); percentage of resistant GNB the previous year (55–66%: 1.87 [1.59–2.2]; >66%: 2.93 [2.43–3.53]) and 2) patient-variables: antimicrobial therapy at ICU admission (1.79 [1.55–2.08]); presence of an invasive device (CVC or intubation) (1.99 [1.25–3.16]) before infection; and one protective factor: trauma at ICU admission (0.76 [0.65–0.89]). The year effect was significant both for all R GNB and 3GC-R Eb but not for R PA. This effect was more pronounced for 3GC-R Eb, with an increase in the risk of R from 2005 to 2014 (Fig. 2). The duration from ICU admission to infection was the main risk factor of R for all BGN and sub-groups (Eb and PA): the probability of having a BSI due to a R strain increased with the time in ICU before infection (Fig. 3). ICU-based random effect remains significant indicating major impact of local epidemiology.
Fig. 2

Evolution of the risk to have a BSI due to a resistant strain according to the year of ICU admission

Fig. 3

Days from ICU admission to infection

Limitation The absence of information about antibiotic consumption may partly explain the remaining significant center random effect in the final models.

Conclusion The duration from ICU admission to BSI was a main risk factor for a resistant isolate in GNB BSI. Resistance rates increased over time, especially for 3GC-R Eb and were highly dependent of local previous epidemiology.

Competing interests None.

P159 Sepsis at ICU admission due to extended-spectrum β-lactamase producing enterobacteriaceae among colonized patients: prevalence, risk factors and prognosis

Keyvan Razazi1, Jérémy Rosman1, Nicolas de Prost1, Guillaume Carteaux1, Chloe Jansen2, Jean Winoc Decousser3, Christian Brun-Buisson1, Armand Mekontso Dessap1
1Réanimation Médicale, Hôpital Henri Mondor, Créteil, France; 2Cepi, Hospital Henri Mondor, Créteil, France; 3Microbiologie, Hôpital Henri Mondor, Créteil, France
Correspondence: Jérémy Rosman - jeremy.rosman@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P159

Introduction Prevalence of Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) carriers dramatically increases all over the world with a spread to the community. The increasing prevalence of ESBL-PE carriage at Intensive Care Unit (ICU) admission raises important questions on empiric therapy strategies in patients presenting with infection, which may include the use of a carbapenem as first-line therapy. Data on ESBL-PE sepsis at ICU admission among colonized patients are lacking.

Patients and methods We prospectively assessed between 2009 and 2015 the prevalence, risk factors and prognosis of ESBL-PE sepsis among ESBL-PE carriers at ICU admission. The following data were collected: demographic characteristics, which included sex, age, simplified acute physiology score (SAPS II), location before ICU admission, antibiotic exposure, surgery during the previous year, presence of underlying disease, Charlson comorbidity index, presence of indwelling devices and outcomes.

Results A total of 597 patients had ESBL-PE carriage detected at admission, corresponding to 9.5% of admitted patients. Among these patients, 325 patients had sepsis at ICU admission. Fifty patients (15.4%) had ESBL-PE related sepsis at ICU admission. ESBL-PE infection included 23 (46%) urinary tract infections, 14 (28%) pulmonary infections, 9 (18%) abdominal infections and 4 (8%) other infections. All but two ESBL-PE pneumonia cases were hospital-acquired (86%) while community-acquired ESBL-PE urinary tract infection was not uncommon (12/36 = 33%).

By multivariable analysis, prior urinary tract disease [OR 3.0 (1.1–8.0)], hospital-acquired sepsis at admission [OR 2.9 (1.4–5.7)], treatment with fluoroquinolone within the past 3 months [OR 2.8 (1.2–6.4)] past ESBL-PE infection [OR 2.8 (1.2–6.5)] were independent predictive factors for ESBL-PE sepsis at admission, whereas a pulmonary source of sepsis [OR 0.30 (0.15–0.61)] was protective. The final model showed a good calibration (chi2 = 3.7, p = 0.45) and discrimination (area under the curve = 0.85). Patients with ESBL-PE related sepsis had more often septic shock and bacteraemia at admission. ESBL-PE related sepsis was also more often associated with more frequent inadequate empirical therapy (68 vs 87%, p < 0.001). However, mortality did not differ significantly between patients with ESBL-PE infection and others (20 vs 22%).

Conclusion At ICU admission, ESBL-PE related sepsis was relatively infrequent among colonized patients. Our predictive factors for ESBL-PE may help choosing empiric therapy for sepsis among ESBL-PE carriers at ICU admission. The study did not show a significant association between ESBL-PE infection at admission and mortality.

Competing interests None.

Reference
  1. 1.

    Goulenok T, Ferroni A, Bille E, Lécuyer H, Join-Lambert O, Descamps P, Nassif X, Zahar JR. Risk factors for developing ESBL E. coli: can clinicians predict infection in patients with prior colonization? Hosp Infect. 2013;84(4):294–9.

     

P160 Carbapenemase-producing Enterobacteriaceae: experience of a Tunisian intensive care unit

Amira Ben Jazia1, A. M’rad1, Zouhour Ouali2, Manel Barghouth1, Y Blel1, N Brahmi1
1Department of intensive care and toxicology, Centre d’Assistance Médicale Urgente, Tunis, Tunisia; 2Department of biology, Centre d’Assistance Médicale Urgente, Tunis, Tunisia
Correspondence: A. M’rad - mrad.aymen@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P160

Introduction Carbapenemase-producing Enterobacteriaceae (CPEc) are increasingly reported worldwide and constitutes a real challenge antibiotic for clinicians to preserve the bacterial ecology. Its incidence has remarkably increased in our intensive care unit during the last 5 years.

This work aims to focus on the impact of CPEc increasing in our intensive care unit.

Patients and methods A retrospective and descriptive study conducted in a Tunisian intensive care unit, including all hospitalized patients infected by an Enterobacteriaceae. We have determined annual incidence of CPEc from January 2008 to December 2015.

Results One thousand two hundred and three episodes of Enterobacteriaceae infections were eligible in 748 patients (324 male/424 female) aged between 14 and 88 years.

The global prevalence of CPEc across study period was 4.48% (54/1203).The prevalence of CPEc in each site was respectively of 23% in hemocultures, 18% in coproculture, 12% in catheters, 3.3% in respiratory tract, and 3% in urinary tract.

The overall incidence of (CPEc) increased from 0.69% (1/144) in 2008 to 7.77% (15/193) in 2015 (Fig. 4).
Fig. 4

CPEc increasing from 2011 to 2015

Conclusion

Our study confirms the rapid spread of CPEc in Tunisian hospital and the urgent need for a well-structured and coordinated national surveillance plan in order to limit their dissemination.

Competing interests None.

P162 Extended spectrum beta lactamase producing enterobacteriacae (ESBL-PE) infections in ICU

Achille Kouatchet1, Rafael Mahieu2, Emmanuel Weiss3, David Schnell4, Jean-Ralph Zahar5
1Service de Réanimation médicale et Médecine hyperbare, Centre Hospitalier Universitaire d’Angers, Angers, France; 2Réanimation médicale, Centre Hospitalier Universitaire d’Angers, Angers, France; 3Département d’anesthésie-réanimation, Hôpital Beaujon, Boulevard du Général Leclerc, Clichy, France, Clichy, France; 4Réanimation médicale, CHU de Strasbourg, Strasbourg, France; 5Laboratoire de bacteriologie-virologie-hygiene, Hôpital Avicenne, Bobigny, France
Correspondence: Achille Kouatchet - ackouatchet@chu-angers.fr

Annals of Intensive Care 2017, 7(Suppl 1):P162

Introduction The ESBL spread has a major consequence in term of antibiotic choices. Carbapenem antibiotic are regarded as the most effective treatment. However numbers of authors suggest that alternatives antibiotics (i.e. noncarbapenems) could be used in ESBL-PE infections. There are some conflicting data regarding the use of alternatives in case of ESBL-PE infections. Moreover as far as we know, there are no data in ICU.

Objectives the aim of this study was to describe ESBL-PE infections in ICU and therapeutic options chosen in these specific situations.

Patients and methods Prospective multicentric observational cohort study conducted in volunteers ICU. All consecutive patients hospitalized in ICU with ESBL-PE infection according to CDC definitions were included. Severity of illness was defines according to bone criteria, SAPS II and SOFA. Demographic datas, empirical and definitive antibiotic therapy (ET and DT), clinical evolution, and outcome were recorded. In vitro antimicrobial susceptibility testing was performed by the disk diffusion method or the Vitek 2 system according to the guidelines of the Antibiogram Committee of the French Microbiologic society.

Results During the study period 146 patients with ESBL-PE infection met eligibility criteria with respectively a median age and SAPS II score of 63 (51–74) and 50 (38–70). The median SOFA Score at first day of antibiotic therapy and ICU admission were 7 (4–11) and 7 (5–11) respectively. The most frequent site of infection were respiratory tract (45%), urinary tract (20%) and abdominal (17%). The most frequent isolated species were: Escherichia coli (43%), Klebsiella sp (37%) and Enterobacter sp (18%). Respectively 50, 23 and 27% patients had septic shock, severe sepsis and sepsis according to Bone criteria.

Among ESBL-PE, 98.6% were carbapenem and 46.5 were BLBI sensitive. Among the whole population, 47 (48%) patients received a carbapenems as ET. 66 (68%) received a DT with carbapenems and 31 (32%) patients received an alternative DT. The most frequent reasons for maintaining carbapenems as DT were: Antibiotic susceptibility tests (38% of cases), severity level (33% of cases) immunosuppression (8% of cases). The Median length of ICU stay after infection was respectively 12 (6–27) and 11 (7–16) days for carbapenems and alternatives DT (p = 0.1). The D28 mortality was 24% for patients with carbapenems DT and 24% for patients with alternatives DT (p = 0.02).

Surprisingly, there were no differences between the 2 groups (carbapenems vs alternatives) in term of severity.

Conclusion Alternatives are frequently used for ESBL-PE infections in ICU. In our cohort 31 (32%) patients received antibiotics other than carbapenems regardless of the severity.

Competing interests None.

P163 Extended-spectrum beta-lactamase-producing enterobacteriaceae cross-transmission in the absence of private room in intensive care unit

Margaux Artiguenave1, Paktoris-Papine Sophie1, Florence Espinasse2, Faten El Sayed3, Aurélien Dinh4, Cyril Charron1, Guillaume Geri5, Antoine Vieillard-Baron1, Xavier Repessé1
1Réanimation médico-chirurgicale, Assistance Publique - Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt, France; 2Equipe opérationnelle d’hygiène hospitalière, Assistance Publique - Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt, France; 3Service de microbiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt, France; 4Equipe mobile de microbiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt, France; 5Réanimation Médicale, Hôpital Cochin, Paris, France
Correspondence: Xavier Repessé - xavier.repesse@aphp.fr

Annals of Intensive Care 2017, 7(Suppl 1):P163

Introduction Multidrug micro-organisms are responsible for longer hospitalisations and poorer outcomes in intensive care unit (ICU). The transmission of extended-spectrum beta-lactamase producing enterobacteriaceae (ESBL-PE) is prevented by the application of additional contact precautions, mainly relying on isolation in a private room and hand hygiene with waterless alcohol-based solution. Contact isolation cannot be achieved in our 12-bed ICU only composed of two twin bedrooms. We aimed at reporting the ESBL-PE acquisition in this peculiar architectural form of ICU and at studying the impact of twin bedrooms on ESBL-PE cross-transmission.

Patients and methods An observational and non-interventional study was prospectively conducted in the 12-bed ICU of a university hospital Ambroise Paré (Boulogne-Billancourt, France). Inclusion criteria were: (1) adult patients and (2) a period of hospitalisation allowing the patient to be nursed by at least two paramedical teams. Characteristics of patients at admission (age, sex, SAPSII) and clinical data during hospital stay (duration of mechanical ventilation, duration of ICU stay, outcome) were prospectively collected. Microbiological data concerning ESBL-PE imported and acquired carriage were monitored by rectal swabs collected at admission and once weekly every Monday for the whole duration of the ICU stay. ESBL imported carriage was defined as a first screening positive for ESBL whereas ESBL acquired carriage as a negative first screening at admission followed by at least one positive rectal swan. Mechanistic of a potential cross-transmission was studied following a three-step process consisting in (1) identifying patients considered as possible ESBL sources (index patients) for transmission, (2) classifying each ESBL strain according to the CTXm 1 and 9 groups and (3) diagnosing potential cross-transmission by gene sequencing of remaining cases of possible transmission.

Results From June 2014 to April 2015, 550 patients were admitted in the ICU, among which 470 followed the inclusion criteria. The rate of ESBL colonization at admission was 13.2% (n = 62), mainly with Escherichia coli. Two hundred and twenty-one non-colonized patients were screened at least twice. The incidence of ESBL acquisition was 4.1% (9 patients on 221), also mainly with Escherichia coli. Mortality did not differ between ESBL carriers and non-carriers. In univariate analysis, ESBL acquisition was associated with the Injury Global Score II (IGSII) and the Sequential Organ Failure Assessment (SOFA) at admission, the need for catecholamine and the ICU length of stay (LOS). In multivariate analysis, ICU LOS and IGSII at admission were the strongest risk factor for ESBL acquisition. The nine ESBL-acquired carriers had one to three index patients defined as a patient hospitalized who shared at least 1 day hospitalization. The CTXm grouping of the ESBL strains excluded a cross-transmission for 4 patients. The gene sequencing did it for 3 others and confirmed a cross-transmission in only two patients (0.8%). The cross-transmission emanated from the same source of a CTXm 1 ESBL-producing E. coli. This patient shared 1 day in a different unit with the first acquired carrier and 2 days in the same unit with the other. No case of cross-transmission in the same room was observed.

Conclusion The rate of 13.2% of ESBL carriage on admission was comparable to other rates in French ICUs (15%). Despite the absence of contact isolation, the incidence of ESBL acquisition was 4.1% which is actually lower than transmission rates previously published in other ICUs. A cross-transmission concerned two ESBL-acquired carriers only and resulted from the same index patient during short shared hospitalizations of 1 day in a different unit and 2 days in the same unit. Our results question whether the contact isolation in private rooms plays a major role for the prevention of ESBL cross-transmission in ICU, although the external validity of our results could be questionable.

Competing interests None.

P164 Prevalence of colonization with extended spectrum B-lactamase producing bacteria and subsequent ICU acquired infection in French Guiana

Hatem Kallel1, Claire Mayence1, Stéphanie Houcke1, Pascal Guegueniat1, Didier Hommel1
1Intensive care unit, Hospital, Cayenne, French Guiana
Correspondence: Hatem Kallel - kallelhat@yahoo.fr

Annals of Intensive Care 2017, 7(Suppl 1):P164

Introduction Bacterial resistance to antibiotics is a common problem worldwide. In South America, this prevalence is reported to be the highest in the world. However, in French Guyana, there is no data on the epidemiology of colonization and infection caused by extended spectrum B-lactamase producing enterobacteriaceae (ESBL-PE). We conducted this study to investigate the prevalence of colonization with ESBL-PE and subsequent ICU acquired infection in French Guiana.

Materials and methods A 24 months (January 2014 to December 2015) observational study in a 14 beds ICU in a general hospital. Our unit, is the sole and the referral one of all French Guiana department.

Results Over the study period, 670 patients were admitted to ICU and 603 of them (90%) were hospitalized more than 48 h. The mean occupancy rate was 82.5 ± 20.6% and the mean colonization index (with ESBL-PE) was de 37 ± 18.1%. The mean age was 43.4 ± 21.1 years. The sex-Ratio (M/F) was 1.3. The mean IGS II calculated at admission to ICU was 44.6 ± 24.2. The most recorded organ failures at admission to ICU were respiratory and hemodynamic ones (56.7 and 37.2% respectively). At admission to ICU, 44.2% of patients presented active infection and 57.3% received antibiotics. Multidrug resistant (MDR) bacteria carriage was found in 88 patients (13.4%) at ICU admission and was acquired in ICU in 89 other patients (13.4%). The most isolated MDR bacteria at admission were ESBL producing E coli and K. pneumoniae. However, the most isolated MDR bacteria during ICU stay were ESBL producing K. pneumoniae and E cloacae. During the ICU stay, 98 patients (14.6%) had presented 147 episodes of ICU acquired infections (ICU-AI). Over the 177 patients carrying MDR bacteria, 159 (89.8%) carried ESBL-PE and 66 developed ICU-AI. ESBL-PE caused 21.2, 37.5, 20, and 66.7% of 1st, 2nd, 3rd and 4th ICU-AI episodes respectively. Statistical analysis didn’t show any link between ESBL-PE carriage and a first episode of ICU-AI caused by ESBL-PE.

Conclusion Our study show a high prevalence of ESBL-PE bacteria carriage at admission in our ICU. ESBL-PE carriage was not associated to higher prevalence of ICU-AI caused by the same microorganism. This finding can help to reduce the inappropriate use of carbapenems in such conditions.

Competing interests None.

P165 On-line hemofiltration versus conventional hemofiltration in septic shock patients: clinical safety and effectiveness

Kaouther Dhifaoui1, Zied Hajjej1, Amira Fatnassi1, Walid Sellami1, Iheb Labbene1, Mustapha Ferjani1
1Department of critical care medicine and anesthesiology, Military Hospital of Tunis, Tunisia, Tunis, Tunisia
Correspondence: Zied Hajjej - hajjej_zied@hotmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P165

Introduction The implementation of hemofiltration (HF) as a renal replacement therapy in septic shock patients requires the supply of large quantities of replacement solutions. These solutions are either industrially prepared in autoclaved expensive plastic bags (conventional hemofiltration, CHF) or continuously provided in unlimited amounts at the dialysis machine directly from the water treatment plant to form the replacing solutions (on-line hemofiltration, OLHF).The aim of our study was to evaluate the safety and effectiveness of on-line hemofiltration compared to conventional hemofiltration in septic shock patients.

Patients and methods The investigative protocol was approved by the Institutional Ethics Authorities and all patients or their legally authorized representatives provided written informed consent. It was a prospective, randomized, clinical study, including septic shock patients with acute renal failure. Patients were randomized to receive either on-line hemofiltration (n = 8) or conventional hemofiltration (n = 25) for renal replacement therapy during 4 days. Hemodynamic monitoring was conducted by conventional devises, including: electrocardiogram and a radial arterial catheter for invasive arterial pressure every 6 h during period study. We collected serum samples also every 6 h (urea, potassium and sodium levels, troponin, hemoglobin, platelets, C-reactive protein and lactates).

Results The evolution of heart rate (HR), mean arterial pressure (MAP), biological markers were comparable between the two groups over time except a significant decrease in MAP in the OLHF group compared to CHF group only at H6 (P = 0.008) and H12 (P = 0.015) and a significant decrease in C-reactive protein level in the OLHF group at H48 (P = 0.02).

Conclusion On-line hemofiltration seems to be a safe and reliable method of renal replacement therapy in septic shock patients. It may be associated with attenuated pro-inflammatory cytokine profile (C-reactive protein).

Competing interests None.

P166 Usefulness of biological testing during renal replacement therapy in ICU patients

Fahmi Dachraoui1, Sabrine Nakkaa1, Abdelwaheb M’ghirbi1, Ali Adhieb1, Dhouha Ben Braiek1, Kmar Hraiech1, Ali Ousji1, Islem Ouanes1, Hammouda Zaineb1, Saousen Ben Abdallah1, Lamia Ouanes-Besbes1, Fekri Abroug1
1Réanimation polyvalente, CHU Fatouma Bourguiba, Monastir, Tunisia
Correspondence: Fahmi Dachraoui - dachraoui.fahmi@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P166

Introduction Clinical and biological monitoring of efficacy and safety of RRT sessions is thought useful and in many ICUs biological testing at mid RRT session and at its end is routinely performed. The aim of the present study is to evaluate the impact of laboratory tests performed during RRT session on clinical decision making and treatment alteration.

Patients and methods Retrospective study including all consecutive patients hospitalized in the medical ICU of the University Hospital Monastir, Tunisia between January 2015 and September 2016, requiring intermittent hemodialysis performed in the ICU. For each patient we collected demographic characteristics (age, sex, SAPS III, diagnosis, comorbidities), indication of the RRT, clinical and biological parameters before, during and at the end of RRT session. Based on the patient monitoring records during each RRT session we identified therapeutic interventions started before the end of the RRT session in the light of the results of laboratory tests performed during the session (usually in the middle the session): infusion of glucose, potassium, transfusion, extension of the session.

Results During the study period, 370 patients were admitted to the ICU. Of these 24 patients required acute hemodialysis. The median age of these patients were 54 years (IQR = 31), 53% of them were female. The main comorbidities were hypertension, diabetes, chronic renal failure (CRF) with preserved diuresis, respectively in 55, 38 and 36%. ¾ of the patients included were in septic shock and had median SAPS III score of 92 (IQR = 34). Anuria, pulmonary oedema, hyperkalemia, and acidosis indicated RRT sessions respectively in 47.1, 24.5, 8.8, 9.8 and 9.8%. Results of laboratory tests performed during RRT sessions prompted a specific attitude in the following rates: infusion of glucose in 35.7%, addition of potassium in 22%, and extension of the session duration 15.2%.

Conclusion The practice of laboratory tests during the RRT sessions seems useful since it could impact clinical decision making in more than one-third of sessions.

Competing interests None.

P167 Feasibility of regional citrate anticoagulation for membrane-based therapeutic plasma exchange in ICU

Simon Klein1, Mattéo Miquet1, Jean-Marc Thouret1, Vincent Peigne1
1Réanimation, Centre Hospitalier Métropole-Savoie, Chambéry, France
Correspondence: Vincent Peigne - vincentpeigne@yahoo.fr

Annals of Intensive Care 2017, 7(Suppl 1):P167

Introduction Therapeutic plasma exchange (TPE) is crucial for the management of auto-immune diseases like thrombotic thrombocytopenic purpura or myasthenia gravis. TPE is performed either by centrifugation, with specific machines which are not routinely available in ICUs, or by using specific plasma separation membranes with widely spread in ICUs hemofiltration machines. Regional citrate anticoagulation for TPE is well established with centrifugation but has been seldom described for membrane TPE. We are reporting the experience of our ICU in this field.

Patients and methods Retrospective study including all patients who received TPE with citrate regional anticoagulation between 2013 and 2016 in an 18-bed ICU. TPE is performed solely in the ICU in our institution.

Results 26 patients were included. TPE was required for thrombotic microangiopathy (13 patients), vasculitis (6 patients), hyperviscosity syndrome (2 patients), Guillain–Barré syndrome (2 cases) and others (3 patients). Mean SAPS2 score was 32 [standard deviation (SD) 16.6]. 281 TPE were performed, with a mean number of 10.5 (SD 11.5; range 2–57) TPE per patients. Coagulation of the circuit of TPE occurred in 10 (38%) patients. Coagulation of the circuit occurred in 10.3% (29/281) of the TPE. Minor adverse events have been reported in two patients: one had a rash during the first TPE (no recurrence during the 56 next TPEs) and the other had paresthesia during the first two TPEs (the calcium infusion was increased and there had been no recurrence during the 25 next TPEs). No serious adverse events related to citrate were observed.

Conclusion Regional anticoagulation with citrate allowed us to perform TPE in 26 patients, without significant adverse events. The rate of circuit coagulation was 10.3% per TPE.

Competing interests None.

P168 Modelization of the cost-effectiveness of anti-thrombin to reduce the incidence of membrane thrombosis during continuous hemofiltration

Vincent Peigne1, Jean-Louis Daban2, Mathieu Boutonnet2, Bernard Lenoir3
1Réanimation, Centre hospitalier Métropole Savoie, Chambéry, France; 2Réanimation, Hôpital d’Instruction des Armées Percy, Clamart, France; 3Département d’anesthésie-réanimation, Hôpital d’Instruction des Armées Percy, Clamart, France
Correspondence: Vincent Peigne - vincentpeigne@yahoo.fr

Annals of Intensive Care 2017, 7(Suppl 1):P168

Introduction A reduced incidence of membrane thrombosis after injection of Anti-thrombin (AT) has been reported in septic patients with acquired deficit in AT undergoing continuous hemofiltration. As this strategy was routinely performed in our unit until 2012, we investigated its cost-effectiveness.

Patients and methods Data about the use of hemofiltration, the consumption of AT and hemofiltration devices during 2011 (period with routine use of AT) and 2012 (period with use of AT only if a membrane thrombosis occurred) were extracted from the administrative database of the institution. A decisional tree was built to modelize the impact of AT on the consumption of hemofiltration devices and blood products. The decisional tree took into account the probability of membrane thrombosis with and without AT and the probability of transfusion after membrane thrombosis. Costs were obtained from the pharmacy of the institution (AT, hemofiltration devices) and from the literature (blood products).

Results During 2011, 77 days of hemofiltration were performed, with the use of 45 doses of AT (23,202€) and 76 hemofiltration devices (11,632€). During 2012, 76 (−1%) days of hemofiltration were performed, with the use of 5 (−89%) doses of AT (2578€) and 85 (+10%) hemofiltration devices (13,443€). The mean cost of 1 day of hemofiltration decreased from 449€ to 211€ with the diminution of the use of AT.

According to the decisional tree, AT was almost never cost-effective. The only circumstances associated with a benefit for the use of AT was the association of a probability of thrombosis with AT inferior to 0.1, of a probability of thrombosis without AT equal 1, of a probability of transfusion after thrombosis equal 1 and a cost of transfusion of 424€. In these extremely favorable circumstances, AT could decrease the daily cost of hemofiltration of 2.22–19.30€.

Discussion The model has several limits: the losses of utility related to transfusion and to interruption of hemofiltration due to thrombosis were not taken into account; the cost of AT measurement was not estimated; the work load of changing a membrane and of transfusion after membrane thrombosis was not analyzed.

Conclusion Our results suggest that anti-thrombin is not cost-effective to reduce the costs of hemofiltration related to membrane thrombosis.

Competing interests None.

P169 Vascular access sites for acute renal replacement in intensive care unit

Amira Ben Jazia1, Amira Jamoussi2, Takoua Merhbene3, Dhouha Lakhdhar4, Jalila Ben Khelil2, Mohamed Besbes2
1Medical ICU, Hospital Abderrahmen Mami De Pneumo-Phtisiologie, Ariana, Tunisia; 2Réanimation médicale, Hôpital Abderrahmen Mami, Ariana, Tunisia; 3Réanimation respiratoire, Hôpital Abderrahmen Mami de pneumo-phtisiologie, Ariana, Tunisia; 4Service de réanimation médicale, Centre d’assistance médicale-urgente, Tunis, Tunisia
Correspondence: Amira Ben Jazia - amira26juillet@yahoo.fr

Annals of Intensive Care 2017, 7(Suppl 1):P169

Introduction Several temporary venous catheterizations are sometimes required for acute renal replacement therapy (RRT) in the intensive care unit (ICU). This study compares catheterizations in the femoral and jugular veins in terms of patient safety.

Materials and methods This was a descriptive retrospective review of dialysis sessions (DS) records monitoring performed in patients older than 17 years hospitalized in medical intensive care unit between April 2011 and December 2015.

A study of dialysis catheter, was conducted in critically ill adults requiring RRT was performed.

Catheter insertion site, catheter age and urea reduction ratio (URR) were analyzed.

Results URRs were analyzed from 330 dialysis sessions (n = 64 patients). The mean rate of URRs was 52.8 ± 12.4. Only 31.4% of dialysis sessions (DS) were efficient with URR ≥ 60.

This study analyzed 64 patients who underwent two different sites of catheterization: the femoral and jugular site.

The mean age of cathéters was 1.613 days.

No significant difference (P = 0.18) in the efficiency of (DS) was detected between sessions performed through femoral (n = 225; 68%) and jugular (n = 105; 32%) dialysis catheters.

Conclusion Femoral and internal jugular acute vascular access sites are both acceptable for RRT therapy in the ICU. The effectiveness of (DS) in the ICU is low (31.4%). An analysis of predictive factors of inefficiency of (DS) is expected to improve our results.

Competing interests None.

Reference
  1. 1.

    Ridel C, Baldea MC, Rondeaua E, Vinsonneaub C. La dose de dialyse en réanimation: existe-t-il vraiment un idéal? Dose of dialysis in intensive care unit.

     

P170 Renal replacement therapy protocol with regional citrate anticoagulation: observational study of efficacy with a new post-filter ionized calcemia target

Celine Derreumaux1, Thierry Seguin1, Jean-Marie Conil1
1Réanimation polyvalente, Hopital Rangueil, Toulouse, France
Correspondence: Celine Derreumaux - celine.derreumaux@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P170

Introduction In Intensive Care Unit (ICU), some patients suffering from acute kidney injury need renal replacement therapy (RRT). It requires the circuit anticoagulation, this could be done by a regional citrate method. Today, this is a recommended approach for the everyday care, even if the technique isn’t widespread yet [1]. The ionized calcemia dosing through the filter (“post-filter” ionized-calcemia) is used to monitor the technique efficacy, with a target of 0.25–0.35 mmol/L showing a good filter anticoagulation.

The objective of our study was the assessment of efficacy and safety of our regional citrate anticoagulation protocol, with a less restrictive post-filter ionized calcemia target (0.3–0.6 mmol/L). The main goal was the analysis of the circuit lifespan, considering a lifespan above 24 h, as well as the search of some clinical and biological factors affecting the technique efficacy. Moreover, we analyzed the side effects incidence of the protocol (hypernatremia, metabolic alcalosis), and their consequences. The study received the scientific ethical agreement of University Hospital of Toulouse, and is registered with number 18-0214.

Patients and methods 57 patients, admitted to one of the two University Hospital ICUs of Toulouse, needing a continuous RRT method, without any need for systemic heparin anticoagulation, and without severe hepatocellular failure, were included in the study. 103 filters included over a 1-year period were analyzed.

Results Results show a mean filter lifespan of 48 h, with a lifespan above 24 h for 85.4% of all filters. Coagulation was the cessation reason for 29.1% of filters, most of them before 24 h of the filter use. A value of post-filter ionized calcemia at day 1 below 0.54 mmol/L was the main factor influencing a filter lifespan above 24 h. An age older than 51 and a SAPS II severity score below 80 were other factors conditioning a filter lifespan of more than 24 h. Side effects of citrate were rare and didn’t have any clinical impact among our patients.

Discussion These results suggest that citrate used for anticoagulation in RRT could have an additional anti inflammatory effect through the induced hypocalcemia, as well as an energetic gain which could lead to a renal protection against ischemia–reperfusion mechanism [2]. Moreover, these results call into question the need of post-filter ionized calcemia dosing for the monitoring of citrate anticoagulation efficacy, since the method safety is monitored by the total-to-ionized calcium ratio.

Conclusion During continuous RRT in ICU, a regional citrate anticoagulation protocol with a non-restrictive post-filter ionized calcemia target seems to be efficient and could reduce side effects. These results need to be confirmed with a randomised control study.

Competing interests None.

References
  1. 1.

    KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney international Supplements, 2012.

     
  2. 2.

    Oudemans-van Straaten, HM et al. Citrate anticoagulation for continuous venovenous hemofiltration. Crit Care Med, 2009;37(2):545–52.

     

P171 Impact of the use of an oXiris filter versus an AN69ST filter on the duration of hemofiltration in intensive care

Charlotte Kelway1, Valery Blasco1, Cyril Nafati1, Karim Harti1, Laurent Reydellet1, Jacques Albanese1
1RPPF, Hopital de la Timone, Marseille, France
Correspondence: Charlotte Kelway - chakel@hotmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P171

Introduction Continuous veno-venous haemofiltration (CVVH) is used to treat acute kidney injury in critically ill patients. To optimize its efficiency, CVVH requires effective anticoagulation. Systemic anticoagulation with standard heparin, the most used, can lead to major bleeding complications. Hemofilters that are able to adsorb heparin molecules on their surface such as AN69ST and oXiris membranes represent an alternative. The objective of this study was to compare these two types of filters in terms of duration, efficiency, dysfunctions and cost.

Materials and methods From October 2012 to May 2014, we conducted a retrospective, observational, and non-interventional study. All patients admitted in the intensive care unit needing CVVH were included. The primary endpoint was the filter lifespan: AN69ST versus oXiris. The secondary endpoint was the filter efficiency (urea reduction ratio: URR). The main analysis did not consider the anticoagulation type. We conducted a subgroup analysis taking into account the use or not of an anticoagulation.

Results 181 sessions in 93 patients were carried out using 386 filters representing 10,706 h of treatment. The mean AN69ST filter lifespan was 27 ± 20 h and 28 ± 22 h for oXiris filters (p > 0.05). There is no significant difference in terms of duration between the two filters. The subgroup analysis taking into consideration the use or not of anticoagulation did not show any difference either. The mean URR was 48 ± 23% in the AN69ST group and 44 ± 25% in the oXiris group (p > 0.05). Concerning the dysfunctions, there were no significant difference between the two filters. One hundred and seventy-six AN69ST filters were used for a total cost of 24,288 euros. Two hundred and ten oXiris filters were used for a total cost of 39,060 euros.

Conclusion The AN69ST and oXiris lifespans are not significantly different. They were as efficient in terms of blood epuration and had as many dysfunctions. The use of an oXiris filter rather than an AN69ST to extend the circuit’s lifespan in the same clinical conditions is not justified considering the extra cost generated.

Competing interests None.

References
  1. 1.

    Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2015;27(5);343–8.

     
  2. 2.

    Intensive Care Med 2012; 38(11):1818–25.

     
  3. 3.

    PLoS One 2014;9(5):e97187.

     

P172 Effects of early use of diuretics in patients at risk of acute renal failure and oliguria

Narjess Ben Aicha1, Khaoula Meddeb1, Ahmed Khedher1, Jihene Ayachi1, Nesrine Fraj1, Nesrine Sma1, Imed Chouchene1, Mohamed Boussarsar2
1Réanimation médicale, CHU Farhat Hached, Sousse, Tunisia; 2Réanimation médicale, CHU Farhat Hached. Research Laboratory N° LR14ES05. Faculty of Medicine, Sousse, Tunisia
Correspondence: Mohamed Boussarsar - hamadi.boussarsar@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P172

Introduction Because oliguria is a poor prognostic sign in patients with acute renal failure (ARF), diuretics are often used to increase urine output in patients with or at risk of ARF. From a pathophysiological point of view there are several reasons to expect that loop diuretics could have a beneficial effect on renal function. However, a review of literature shows that the use of loop diuretics in patients with ARF has been associated with inconclusive results despite the theoretical benefits [1].

To assess the adjunctive effect of diuretics, to alter the progression to kidney injury or failure, in patients at risk for acute renal failure.

Patients and methods This is a retrospective chart review of consecutive patients who developed ARF with oliguria in the intensive care unit. Chart abstractors were well trained residents. Two chart reviewers (senior intensivists) studied all the charts. An explicit protocol was used to precise all needed definitions. Uniform handling of data was ensured especially for conflicting, missing or unknown data. Oliguria was defined as urine output lower than 0.5 ml/kg/h for at least 3 h.

RIFLE score was assessed before and after urinary output normalisation. Therapeutic intervention to optimize pre-renal perfusion was described. Mean arterial blood pressure (MBP) before and after therapeutic initiation, oliguria duration, delay from oliguria onset to diuretic administration, delay from diuretic administration to urinary output normalisation were measured.

Results 23 patients were studied over a 2 years period. They were 63 [24, 87] median (IQR) aged, with diabetes mellitus, 22%; hypertension, 47.8%; cardiac failure, 32% and chronic respiratory failure, 43%. Chronic and obstructive kidney diseases were excluded. Median SAPS II was 37 [23, 75]. 80% were on mechanical ventilation.

RIFLE score before diuretics administration was assessed at oliguria onset as (patients without risk, zero; R, 69%; I, 17%; F, 10%; L, 4%; E, zero). Fluid resuscitation after oliguria onset was administered in 77% and vasopressors in 80%. Median (IQR) delay from oliguria onset to diuretic administration was 5 [0.5, 22] h while optimization of pre-renal hemodynamic disturbances was already achieved.

The median (IQR) MBP before and after therapeutic intervention was respectively, 74 [46, 100] and 95 [69, 110] mmHg. Median (IQR) delay from initiation of therapeutic intervention and MBP improvement was 1.5 [0, 3] h. The delay from diuretic administration to urinary output normalization was 3 [0.5, 27] h.

After resumption of diuresis, RIFLE score was assessed as (patients without risk, 74%; R, 17%; I, 8%; F, 1% L, zero; E, zero) (Fig. 5). Increased serum creatinine level, above 1.5 fold normal range, was observed only in 6 (26%) patients.
Fig. 5

Progression of RIFLE score classes respectively from baseline to after therapeutic intervention

Conclusion Rapid optimization of pre-renal hemodynamic disturbances associated with short delay administration of diuretics could significantly alter the progression to kidney injury or failure in at risk acute renal failure ICU patients.

Competing interests None.

Reference
  1. 1.

    Ho KM, Power BM. Benefits and risks of furosemide in acute kidney injury. Anaesthesia. 2010;65(3):283–93. doi:10.1111/j.1365-2044.2009.06228.x. Epub 2010 Jan 19.

     

P173 Epidemiology and risk factors of Acinetobacter baumannii ventilator associated pneumonia

Walid Sellami1, Zied Hajjej1, Soumaya Ben Yedder2, Walid Samoud1, Bousselmi Radhouene1, Bousselmi Mariem3, Iheb Labbene1, Mustapha Ferjani1
1Department of critical care medicine and anesthesiology, Military Hospital of Tunis, Tunisia, Tunis, Tunisia; 2Department of critical care medicine and anesthesiology, Military hospital of tunis, tunisia, Tunis, Tunisia, Tunisia; 3Department of critical care medicine and anesthesiology, Military Hospital of Tunis, Tunisia, tunis, Tunisia
Correspondence: Walid Sellami - drsellamiwalid@yahoo.fr

Annals of Intensive Care 2017, 7(Suppl 1):P173

Introduction The ventilator associated pneumonia (VAP) is a common and severe complication of assisted ventilation. It’s the leading cause of nosocomial infections in intensive care unit and remain responsible for a high morbidity and mortality because of the emergence of multi-drug resistant (MDR) bacterial agent such us Acinetobacter baumannii (AB). The aim of this study was to determine the incidence, risk factors and prognosis of AB VAP.

Patients and methods Retrospective study extending over a 5 year period (January 2010–January 2016) that included all patients over 18 years and ventilated more than 48 h and developing AB VAP. Patients were divided into two groups: one consisting of patients who developed VAP to AB and the second developed VAP to another bacterial pathogen.

Results One hundred and forty patients developed VAP. The incidence rate of AB VAP was 15.3% with a density of incidence of 20.3 per 1000 ventilator days. Age, male gender, the time between hospitalization and mechanical ventilation and the medical pathology were risk factors for developing AB VAP. AB was resistant to ceftazidime in 100%, to imipenem in 65%, tobramycin in 70% and netilmycin in 35.3%, rifampin in 85% with a sensitivity to colistin in 100% of cases. The resistance of this germ to imipenem increased from 35% in 2010 to 88.5% in 2016. The evolution of patients with AB VAP developed frequently septic shock compared to other patients (44 vs 19.3%; p = 0.038). The AB VAP mortality was higher (50 vs 33%; p = 0.03).

Conclusion The increasing incidence of multi-drug resistant AB VAP is responsible for a high morbidity and mortality. So we need to identify risk factors and to strengthen the means of prevention of hand contamination and cross transmission during invasive procedures.

Competing interests None.

P174 Incidence and risk factors of central line associated bloodstream infections and its risk factors in a Tunisian medical intensive care unit

Nesrine Sma1, Asma Ammar2, Khaoula Meddeb1, Asma Ben Cheikh2, Hend Ben Lakhal1, Jihene Ayachi1, Ahmed Khedher1, Nesrine Fraj1, Messaouda Khelfa1, Yamina Hamdaoui1, Imed Chouchene1, Nabiha Bouafia2, Mohamed Boussarsar3
1Réanimation médicale, CHU Farhat Hached, Sousse, Tunisia; 2Hospital hygiene unit, Farhat Hached Hospital, Sousse, Tunisia; 3Medical intensive care unit, Farhat Hached Hospital. Research Laboratory N° LR14ES05. Faculty of Medicine, Sousse, Tunisia
Correspondence: Mohamed Boussarsar - hamadi.boussarsar@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P174

Introduction Central line associated bloodstream infections (CLABSI) are among the serious hospital-acquired infections. The aim of this study is to determine the incidence of CLABSI, the pathogens and the risk factors that play a role in the development of BSI among patients followed in a Tunisian medical intensive care unit.

Patients and methods All patients admitted for more than 48 h were included in the study over a 1-year period in an 8-bed medical ICU. The enrollment was based on clinical and laboratory diagnosis of BSI. Blood samples were collected from catheter hub of all patients for culture, followed by identification and antibiotic sensitivity testing of the isolates. For all subjects, age, sex, underlying diseases, SAPS II score, ICU length of stay, invasive procedures and their durations (mechanical ventilation, central catheterization, urinary catheterization) were recorded. Risk factors were evaluated by a multivariate logistic regression model.

Results Among a total of 237 admissions from September 15th 2015 to September 15th 2016, 163 (68.7) patients were eligible. One hundred twenty-five (76) patients had a central line. A total of 27 episodes of CLABSI were assessed in 23 (18.4) patients. The mean SPASII of patients with CLABSI was 33 ± 15.4. Their mean CHARLSON index was 1.8 ± 1.7, median duration of catheterization was 4 [1.5–7] days and 8 (34.8) had more than one catheterization attempt. The rate of CLABSI was 19.2/1000 catheter.days. Gram positive bacteremia was determined in 13% of BSI patients. Of these isolates, 3 were Staphylococci. Gram negative bacteremia was determined in 35% of these isolates, 4 were Acinetobacter baumannii, 3 were Klebsiella pneumonia and 1 was Proteus mirabilis and in 56% of cases BSI was diagnoses clinically. A univariate analysis identified ventilator-associated pneumonia, sedation, and longer interval between onset of CLABSIs and the duration of catheterization as risk factors of CLABSIs. In multivariate analysis, the independent factors of CLABSI which are the duration of catheterization (OR, 1.06; 95% CI, [1.003–1.139]; p = 0.042) and catheterization attempt number (OR, 1.99; 95% CI, [1.18–3.37]; p = 0.01). Thirteen (56.5) patients developed septic shock and they all died.

Discussion The rate of CLABSI in our ICU (19.2/1000 catheter.days) was higher compared with the mean rate of CLABSI in ICU reported by the NNIS system surveillance for 2004, which is 3.9/1000 catheter.days [1]. Duration of catheterization, frequent manipulation of catheter, catheter location, catheter type, underlying diseases, suppression of immune system, and types of fluids administered through the catheter are significant risk factors in development of BSIs [2]. In our study both duration of catheterization and number of attempts are independent factors for CLABSI.

Conclusion In a monocenter cohort, CLABSI had a moderate density rate but are associated with poor outcome. Identifying the risk factors is necessary to find solutions for this major health problem.

Competing interests None.

References
  1. 1.

    National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–85.

     
  2. 2.

    Öztürk F, Gündeş S, Işık C. Prospective evaluation of the risk factors, etiology and the antimicrobial susceptibilities of the isolates in nosocomial bacteriemic patients. Mikrobiyol Bul.2008;42:17–27.

     

P175 Is prehospital endobronchial intubation a risk factor for subsequent ventilator associated pneumonia?

Timothée Trampont1, Thomas Lafon2, Thomas Daix3, Vincent Legarçon1, Paul Claverie1, Henri Hani Karam1, Nicolas Pichon3, Philippe Vignon3, Bruno François3
1Service urgences adultes/samu-smur, C.H.U de Limoges, Limoges, France; 2Services urgences adultes/samu-smur/inserm cic1435, C.H.U de Limoges, Limoges, France; 3Inserm cic 1435/réanimation polyvalente, C.H.U de Limoges, Limoges, France
Correspondence: Timothée Trampont - timothee.trampont@orange.fr

Annals of Intensive Care 2017, 7(Suppl 1):P175

Introduction According to some studies, field-intubated patients have 1.5–3 times greater risk of ventilator associated pneumonia (VAP). Endobronchial intubation (EI) can be unrecognized by the physicians and may result in complications such as atelectasis which in turn could increase the risk of VAP. The aim of our study was to confirm this hypothesis.

Patients and methods This monocentric retrospective study included all consecutive patients >18 years who underwent an out-of-hospital tracheal intubation before their admission to the intensive care unit (ICU) between January 2012 and December 2015. Exclusion criteria were suspected aspiration or pneumonia on admission, patients who died within the first 5 days of ICU stay, extubation in less than 48 h and underlying disease making radiological interpretation difficult for VAP diagnosis. VAP were divided into early onset (<7 days) and late onset (≥7 days) events and were independently diagnosed by two experienced intensivists who had no access to the initial chest X-ray performed to check the position of the tracheal tube, based on the Clinical Pulmonary Infection Score. Onset of ventilator associated tracheobronchitis (VAT) was also noted. Inadvertent endobronchial intubation was determined by another independent physician based on the interpretation of admission chest X-ray.

Results 397 patients were intubated out-of-hospital. Of the 284 patients excluded, 104 had an extubation in less than 48 h, 114 were died within the first 5 days, 22 had a suspicion of pneumonia, 28 a suspicion of aspiration and 8 an underlying disease making radiological interpretation difficult. Of the 121 patients included, 28 (23.1%) had an EI upon admission. No significant difference was observed between the EI and non-EI group for gender, age, SAPS2, comorbidities and diagnostic category (cardiorespiratory arrest, trauma, coma and cardiorespiratory failure). Early-onset VAP were diagnosed in 43% in the EI group and in 29% of non-EI patients (p = 0.085). Adding early onset VAT, the respiratory infection rate was 61% in the EI group and 44% in the non-EI group (p = 0.061) (Fig. 6). Late-onset VAP were observed in 8.6% in the non-EI group and 7.1% in the EI group, without difference between groups (p = 0.403). There was no inter-group difference in the duration of ventilation, duration of ICU stay and ICU mortality. Staphyloccocus aureus was the most prevalent pathogen in patients with early-onset VAP (23.1%, only one strain was methicillin-resistant).
Fig. 6

Rate of early-onset VAP + VAT depending of the position of the tube

Conclusion This study found a high rate of inadvertent prehospital endobronchial intubation with a higher incidence of early-onset VAP. These results support the implementation of specific procedures to decrease the incidence of EI.

Competing interests None.

References
  1. 1.

    Bissinger U, Lenz G, Kuhn W. Unrecognized endobronchial intubation of emergency patients. Annals of Emergency Medicine. 1989;18(8):853–55.

     
  2. 2.

    Sitzwohl C, Langheinrich A, Schober A, et al. Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements: randomised trial. BMJ. 2010;341(nov091):c5943–c5943.

     

P176 Early versus late-onset ventilator-associated pneumonia: causative pathogens and resistance profiles

Hend Ben Lakhal1, Aymen M’rad1, Fatma Essafi1, Nasreddine Foudhaili1, Hafedh Thabet2, Youssef Blel1, Nozha Brahmi1
1Department of intensive care and toxicology, Centre d’Assistance Médicale Urgente, Tunis, Tunisia; 2Service de réanimation, centre d’assistance médicale-urgente, Tunis, Tunisia
Correspondence: A M’rad - mrad.aymen@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P176

Introduction Ventilator-associated pneumonia (VAP) is associated with increased hospital stay and high morbidity and mortality in critically ill patients. The classic dichotomy between early and late onset VAP is no longer helpful available. The aims of this study were to determine the incidence of multidrug-resistant pathogens in the first episodes of VAP and to assess potential differences in bacterial profiles of subjects with early-onset versus late-onset VAP.

Patients and methods Retrospective cohort study over a period of 18 months including all patients who had a first episode of VAP confirmed by positive culture. Subjects were distributed into 2 groups according to the number of intubation days: early-onset VAP (<5 days) or late-onset VAP (≥5 days).The primary endpoint was the nature of causative pathogens and their resistance profiles.

Results Sixty patients were included, 29 men and 31 women. The average age was 38 ± 16 years. The IGS 2 at admission was 40.5 [32; 44] APACHE 19 [15; 22]. Monomicrobial infections were diagnosed in of 46 patients (77%).Two different bacteria were isolated in 14 cases (13%). A. baumannii was the most frequently isolated in 53% (n = 32) of patients; followed by P. aeruginosa in 37% (n = 22), Enterobacteriaceae in 28% (n = 17) and S. aureus in 5% (n = 3). The isolated bacteria were multidrug-resistant in most cases (58/60). The VAP group comprised 36 episodes (60%) of early-onset VAP and 24 episodes (40%) of late-onset VAP. A. baumannii was isolated in 47% of early VAP (n = 17) versus 62% of late VAP (n = 15) (p = NS), P. aeruginosa in 36% of early VAP (n = 13) versus 37% of late VAP (n = 9) (p = NS) and Enterobacteriaceae in 30% of early VAP (n = 11) versus 25% of late VAP (n = 6) (p = NS). For the resistance profile of the different pathogens isolated, there was no difference between early and late onset VAP.

Conclusion According to new data from the literature, there were no microbiological differences in the prevalence of potential multidrug-resistant pathogens or in their resistance profiles associated with early-onset versus late-onset VAP.

Competing interests None.

P177 Nosocomial infection in the sever burns

Rihi El Mehdi1
1Intensive care unit, IBN ROCHD, Casablanca, Morocco
Correspondence: Rihi El Mehdi - mehdi_44@hotmail.fr

Annals of Intensive Care 2017, 7(Suppl 1):P177

Introduction The bacterial nosocomial infection is a major cause of morbidity and mortality in burned. The bacterial ecology in an ICU has a major impact in terms of morbidity and mortality, particularly in the center of burned or length of stay of patients is increased compared to a general intensive care.

Materials and methods We conducted an observational study spread over 7 months in ICU for severe burned burnt including any who have spent more than 48 h with nosocomial infection (modified CDC criteria), and in which all biological and bacteriological samples were taken. The different types of infections studied were: skin, urinary, lung and bloodstream infections. They excluded all patients belatedly supported or having stayed in other healthcare facilities.

Results One hundred twenty (120) patients showed nosocomial infection during this period. The sex ratio (M/F) was 1.7 and the mean age was 39 ± 23 years. Bacteremia was present in 44.84% of cases, followed by the urinary tract infection that was present in 21.21% of cases, followed by the cutaneous infection in 10.30% of cases, and last pulmonary infection in 9% of cases. Infection was polymicrobial in 14.5% of cases. The main bacteria identified were: Acinetobacter baumanii (43.45%) of which 74% is resistant to imipenem, Enterobacteriaceae (31.5%), Pseudomonas aeruginosa (24%) of which 83.25% is resistant to ceftazidime and 68.2% is resistant to imipenem, Enterococcus (16%) and Staphylococcus Aureus (14.29%).

Conclusion The incidence of nosocomial infection is very high compared to literature. The rate of resistance to common antibiotics is very high. A drastic management of antibiotics in our context, the selection of patients and the frequent use in the operating room for skincare allow a better management of these patients.

Competing interests None.

Reference
  1. 1.

    Wurtz R, Karajovic M, Dacumos E, Jovanovic B, Hanumadass M. Nosocomial infections in a burn intensive care unit. Burns. 1995;21:181–84.

     

P178 Ventilator acquired pneumonia: diagnosis treatment and bacterial ecology in a Moroccan intensive care unit

Hanane Ezzouine1, Mahmoud Kerrous1, Saad El Haoui1, Soufiane Ahdil1, Abdellatif Benslama1
1Anesthesiology and intensive care department, University Teaching Hospital IBN Rushd-Casablanca, Casablanca, Morocco
Correspondence: Hanane Ezzouine - ezzouinehanane@yahoo.fr

Annals of Intensive Care 2017, 7(Suppl 1):P178

Introduction The management of ventilator acquired pneumonia is a diagnostic and therapeutic challenge. Antibiotic therapy is a key link. The objective of this work is to study the epidemiological, clinical patients who developed VAP during their stay in the Medical Intensive Care Unit of the CHU Ibn Rushd in Casablanca and are features of the bacterial ecology of VAP during the 2015.

Patients and methods It is a retrospective descriptive study and analytical spread over 1 year, from January 2015 to December 2015. Were included all patients with pneumonia Ventilator, with or without bacteraemia, after hospitalization for more than 48 h. Were collected clinical, biological, radiological, bacteriological and scalable patients included.

Results The average age of the patients was 42.19 years with a sex ratio (M/F) 1.47 APACHE II score average was 16.4, the average SAPSII was 31.12 and the average was 2.39 SOFA. 86.5% of patients were intubated on admission in intensive care. 3.5% were intubated within less than 5 days notice after admission and the average time to onset of VAP was 3.76 days. The VAP were early in 68.4% of cases. The average hospital stay of patients being 19.63 days. 73.68% in the sample used in our patients was bronchial aspiration. The most offending germs are 27.2% Acinetobacter baumannii, Pseudomonas aeruginosa 16.3%. 100% of patients received empirical antibiotic therapy chosen according to the ecology of the service. 77.4% died. 43.8% of deaths were directly related to VAP.

Conclusion Ventilator acquired pneumonia is main problem in our ICU. The bacteriological ecology must be usually known. In our unit Acinetobacter baumanii is the main germ associated.

Competing interests None.

P179 Determinants and prognostic factors of Acinetobacter baumannii ventilator-associated pneumonia

Khalid Abidi1, Tarek Dendane1, Ssouni Oussama1, Jihane Belayachi2, Naoufal Madani2, Redouane Abouqal2, Amine Ali Zeggwagh1
1Medical intensive care unit, Mohamed V University Hopital Ibn Sina, Rabat, Morocco; 2Service des urgences médicales hospitalières - ibn sina – université mohamed v – rabat, Hopital Ibn Sina, Rabat, Morocco
Correspondence: Tarek Dendane - tdendane@hotmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P179

Introduction Acinetobacter baumannii (AB) ventilator-associated pneumonia (VAP) is common in critically ill patients. The aims of this study were to describing the epidemiological characteristics of AB-VAP, to identify risk factors for acquisition and factors predictive of a poor outcome.

Materials and methods A retrospective-prospective study was conducted at the Medical Intensive Care Unit of the University Hospital Ibn Sina, Rabat-Morocco from January 2013 to December 2015. They were included in the study that all patients developed VAP with identified germ. For identification of risk factors of acquisition of AB VAP, two groups of patients were compared: patients with AB VAP versus patients with VAP caused by other germs. To identify factors associated with mortality, two other groups were compared: Survivors versus died.

Results 122 patients presented VAP among which 60 were caused by Acinetobacter baumannii. Among isolates of AB, 8.3% were drug susceptible, and 16.7% were multidrug-resistant while 75% were extensively drug-resistant. They were Independent risk factors for acquisition of AB VAP in multivariate analysis: the presence of a central venous catheter before the occurrence of VAP, duration of prior hospitalization ≥4 days and ICU duration of stay ≥5 days. The mortality rate of AB VAP was 85%. The independent risk factors for poor outcome in multivariate analysis were: duration of antibiotic treatment >7 days, the reintubation and the presence of a previous hospitalization.

Discussion Our data were similar to those of the literature with a high incidence of VAP due to the AB (49%) and a high rate of resistance to this bacterium particularly to carbapenems. However, and compared to the literature, the VAP AB were responsible for a death rate much higher (85%).

Conclusion Our data were similar to those of the literature with a high incidence of VAP due to the AB (49%) and a high rate of resistance to this bacterium particularly to carbapenems. However, and compared to the literature, the VAP AB were responsible for a death rate much higher (85%).

Competing interests None.

P180 Ventilator-associated pneumonia in the elderly: a study of the prognosis

Hatem Ghadhoune1, Anis Chaari2, Guissouma Jihene1, Hend Allouche1, Insaf Trabelsi1, Habib Brahmi1, Mohamed Samet1, Hatem El Ghord1
1Réanimation médicale bizerte, Faculté de médecine de Tunis, Bizerte, Tunisia; 2Intensive care unit, King Hamad University Hospital, Muharraq, Bahrain
Correspondence: Hatem Ghadhoune - ghadhoune@yahoo.fr

Annals of Intensive Care 2017, 7(Suppl 1):P180

Introduction Ventilator-associated pneumonia (VAP) is common in critically-ill patients. In fact, 10–20% of patients requiring invasive mechanical ventilation develop this complication. The onset of VAP has been reported to be associated with increased mortality. However, data related to critically-ill elderly patients are scarce. The aim of this study is to assess the prognostic impact of VAP in critically-ill elderly patients.

Patients and methods Mono-center, retrospective study conducted from 01/012014 to 30/09/2015. All old patients (age ≥65 years) requiring mechanical ventilation were included. Two groups were compared: Patients who developed VAP (VAP (+) group) and those who did not develop VAP (VAP (−) group).

Results During the study period, 86 patients were included. The causes of admission in the intensive care unit (ICU) were shock (n = 30), acute respiratory failure (n = 41) and disturbed level of consciousness (n = 15). Diabetes mellitus, hypertension and chronic obstructive pulmonary disease were the most common comorbidities (44.2, 32.6 and 40.7% respectively). Mean age was 73.3 ± 6.5 years. Sex-ratio (M/F) was 1.8. Mean APACHE(II) score was 24 ± 9. The mean duration of mechanical ventilation was 10 ± 15 days. Thirty patients (34.9%) developed VAP. ICU-mortality was significantly higher in the VAP (+) group (90 vs 55.4%; p = 0.001). Multivariate analysis identified two independent factors predicting ICU mortality: Shock on admission (OR = 22.7, CI 95% [5.1–101.2], p < 0.001) and VAP (OR = 5.7, CI 95% [1.2–28.1], p = 0.033).

Conclusion VAP is common in critically-ill elderly patients and is associated with worse outcome. Therefore, preventing its onset is of paramount importance.

Competing interests None.

Reference
  1. 1.

    Magill SS, Li Q, Gross C, Dudeck M, Allen-Bridson K, Edwards JR. Crit Care Med. 2016 Aug 10. [Epub ahead of print].

     

P181 Epidemiologic characterization and prognosis factors of Acinetobacter baumannii ventilator-associated pneumonia

Ben Sik Ali Habiba1, Nouira Hajer2, Najla Tilouch2, Sondes Yaakoubi2, Oussama Jaoued2, Rim Gharbi2, Mohamed Fekih Hassen2, Souheil Elatrous2
1Réanimation médicale, EP taher sfar, Mahdia, Tunisia; 2Réanimation médicale, EPS Taher Sfar Mahdia, Mahdia, Tunisia
Correspondence: Mohamed Fekih Hassen - mohamed.fekihhassen@rns.tn

Annals of Intensive Care 2017, 7(Suppl 1):P181

Introduction Ventilator associated pneumonia (VAP) is the most frequent nosocomial infection in critically ill patients. It is associated with high mortality, prolonged mechanical ventilation, length of stay, and increased health-care costs. Among pathogens responsible of VAP, Acinetobacter baumannii which is characterized by its ability to spread in the hospital environment and to acquire resistance leading sometimes to therapeutic impasses is associated with a particularly high mortality reaching 30–75%.

Objective To describe the epidemiological characteristics of A. baumannii VAP, to determine their prognosis and identify factors associated with mortality.

Patients and methods It is a monocentric observational study conducted over a period of 13 years in a Tunisian intensive care unit (ICU) including mechanical ventilated patients for more than 48 h with confirmed A. baumannii VAP.

Results One hundred and twenty-three patients were included in the study. A. baumannii was responsible for 31% of VAP in our ICU. The VAP were late in 59% of cases. More than 90% of isolates pathogens were resistant to ticarcillin, piperacillin, piperacillin–tazobactam, ceftazidime and ciprofloxacin. Sixty percent of germs were sensitive to imipenem. Resistance to imipenem has increased consistently from 0% at the beginning of the study to 88% in 2015. All pathogens were susceptible to colistin. A. baumannii VAP was complicated by septic shock in 63% of cases. The median duration of mechanical ventilation and of ICU stay were 17 (IQR: 11–25) and 25 days (IQR: 17–41) respectively. The use of parenteral nutrition was the only factor associated with the occurrence of A. baumannii VAP resistant to imipenem (odds ratio 2.27, 95% CI [1.07–4.80], p = 0.033). ICU mortality was 45%. It was higher in patients with A. baumannii VAP resistant to imipenem (55 vs 39%, p > 0.05). In the multivariate analysis, the age, the use of renal replacement therapy and the occurrence of VAP relapse have been identified as factors associated with mortality.

Conclusion A. baumannii resistance to imipenem became threatening. The use of parenteral nutrition was the only factor associated with the occurrence of A. baumannii VAP resistant to imipenem. The choice of empiric antimicrobial for VAP caused by this pathogen must take in consideration the epidemiologic data of each country and each ICU. A. baumannii VAP was associated with high mortality. The age, the use of renal replacement therapy and the occurrence of VAP relapse have been identified as predictive of poor outcome.

Competing interests None.

P182 Admission in intensive care unit for severe adverse drug event: what finding?

Julien Arcizet1, Bertrand Leroy1, Caroline Abdulmalack2, Catherine Renzullo1, Maël Hamet2, Jean-Marc Doise2, Jérôme Coutet1
1Pharmacy unit, C.H. Chalon sur Saône William Morey, Chalon-sur-Saône, France; 2Intensive care unit, C.H. Chalon sur Saône William Morey, Chalon-sur-Saône, France
Correspondence: Julien Arcizet - julien.arcizet@ch-chalon71.fr

Annals of Intensive Care 2017, 7(Suppl 1):P182

Introduction Adverse drug events (ADE) remain a serious public health problem. They represent between 0.16 and 15.7% of hospital admissions and between 0.37 and 27.4% of intensive care unit (ICU) admissions. They are defined as any injury related to a drug, and include both adverse drug reactions, expected or not, but also underuse, overuse and misuse, unintended or undesired, preventable or not. Indeed, mortality from iatrogenic event would rise between 2.0 and 28.1%, whereas these ADE that resulted in ICU hospitalization could be prevented in 17.5–85.7% of cases. These unplanned admissions overload ICU, limit access to health care for other patients and have serious economic consequences for the health system. It is therefore necessary to study these ADE to know their main causes and attempt to find a solution to avoid them.

The main objectives of our study were to clinically and pharmaceutically analyze and stratify the different ADE leading to hospitalization in our ICU.

Patients and methods This is a monocentric prospective study, between June 2014 to January 2016, in medico-surgery ICU. From all admissions, we had included patients admitted in our hospital for involuntary ADE (plausible, likely and very likely causal). We had collected clinical aspects (Failure mode, IGSII score, mortality in ICU) and pharmaceutical aspect (number of drug, offending drugs) at daily medical staff meeting.

Results On 1545 admissions, 154 patients were hospitalized for unintended ADE. The average age was 70 years old [26; 95], with a men/women ratio equal to 1.8. The clinical severity IGSII score found was 51 [13; 120]. Average length of stay in ICU was 5.5 days [1; 28] on average in this unit. The main reasons of admission were: hematologic failure (in particular hemorrhagic) (29.9%), metabolic failure (19.5%), renal failure (11.0%), neurological failure (11.0%) and sepsis (10.4%). Respiratory, hepatic, hemodynamic failures and hypersensitivity reactions represented respectively less than 10% of cases. 34 patients (22%) included died during their stays in ICU. On average, 7.6 drugs were found in the usual treatment of the patient. 32.5% of this population had a known cognitive disorder and 62% of them self-management of their treatment. The main drugs involved were: furosemide (16.9%), metformin (13.0%), perindopril (9.1%), lysine acetylsalicylate (8.4%), warfarin (8.4%) and fluindione (7.8%). The most common drug families involved were: drugs of the cardiovascular system (33.8% of cases), anticoagulants and antiplatelet agents (31.8%), antidiabetics (16.9%) and psychotropic (13.6%).

Conclusion Hospitalizations in ICU for ADE are still too common despite their preventability for most cases. Many patients with known cognitive disorder manage their treatment themselves and this is probably one of the reasons of iatrogenic events. Anticoagulants and antiplatelet agents, by side effects, misuse, underuse or overuse are very often involved. The onset of kidney failure from dehydration and the continuation of nephrotoxic and antidiabetic treatment also remain one of the most common causes. Consequently, it is necessary to continue and develop primary, secondary and tertiary prevention strategies to prevent their appearance, to limit their consequences and to reduce recidivism.

Competing interests None.

P183 Prolonged intensive care unit stay: prognostic factors

Chaigar Mohammed Cheikh1, Zakaria Quechar1, Hanane Ezzouine1, Abdellatif Benslama1
1Anesthesiology and intensive care department, UNIVERSITY TEACHING HOSPITAL IBN RUSHD-CASABLANCA, Casablanca, Morocco
Correspondence: Chaigar Mohammed Cheikh - chaigarmed@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P183

Introduction Intensive care unit (ICU) is usually identified as a place of acute care, concentrated over a short period. For many reasons, a prolonged stay in the ICU has a pejorative connotation for the intensivist physician. The aim of our study is to describe the epidemiological, clinical, paraclinical profile of patients hospitalized for a long time in ICU (over 15 days) and to identify the main prognostic factors and those that can predict the duration of stay in ICU.

Patients and methods We conducted a retrospective study, over a period of 5 years and 6 months (January 2010 to June 2015), enrolling patients whose length of stay was greater than or equal to 15 days in medical ICU of the UH Ibn Rochd of Casablanca. Statistical analysis was performed using SPSS 21.0.

Results We enrolled 151 patients witch correspond to 8.2% of all admissions. The sex ratio was 1.6, the average age was (43.2 ± 18.5 years). The majority of patients (75%) were transferred from the emergency department. Medical pathology was the main motive of admission (82.1% of cases). Means of severity scores were calculated as follows: APACHE III (56.2 ± 22.9), IGS III (40 ± 9.6), OSF (0.6 ± 0.7). The average length of stay was (42.2 ± 59.7 days). The incidence of nosocomial infection was 82.8%, the average day of onset was 9.34 ± 8.7 days. Pneumonia, bacteremia and vascular catheter infections were the main sites, Gram-Negative Bacilli were the most frequently identified, dominated by Acinetobacter baumanii (27.9%). Mechanical ventilation (91.4%) and vascular catheterization (84.1%) are the most used invasive devices. Antibiotics (92.1%), sedation (91.4%) and vasopressors (60.9%) were the main administrated treatments. The outcome was favorable in 37.7% of cases. Hemodynamic instability (64.2%) and respiratory complications (61.6%) were the complications most frequently observed, septic shock occurred in 49% of cases. Mortality rate was 55%. In univariate analysis, the variables that have emerged as risk factors of mortality were: sex, length of hospitalization, severity scores (APACHE III, IGS III, OSF), the Charlson comorbidity score adjusted to age, traumatic pathology, the occurrence of nosocomial infection, septic shock, hemodynamic instability, neurological worsening, use of vasopressors, and tracheostomy. In multivariate analysis: nosocomial infection (p = 0.04), hemodynamic worsening (p = 0.03), use of vasopressors (p < 0.01) and antibiotics (p < 0.01) appeared to be risk factors of mortality.

Conclusion Although patients hospitalized in ICU for more than 15 days are few, they represent a serious problem of care and an important part of the activity of intensive care (bed occupancy, care costs).

Competing interests None.

P184 Admissions and readmissions to the intensive care unit of patients with hematologic malignancies: a 5 years retrospective study

Magalie Joris1, Dimitri Titeca Beauport1, Loay Kontar1, Delphine Lebon2, Bérengère Gruson2, Michel Slama1, Jean-Pierre Marolleau2, Julien Maizel1
1Réanimation médicale, Centre Hospitalier Universitaire, Amiens, France; 2Hématologie clinique et thérapie cellulaire, Centre Hospitalier Universitaire, Amiens, France
Correspondence: Magalie Joris - joris.magalie@chu-amiens.fr

Annals of Intensive Care 2017, 7(Suppl 1):P184

Introduction Despite an improvement in prognosis of patients with hematologic malignancies for the last decade, mortality of such patients admitted to the intensive care unit (ICU) remains high. Yet, it seems that a first ICU stay does not modify prognosis of the malignancy. Until now, there is no data on readmission in the ICU of such patients and its effect on short and long term prognosis impact.

Patients and methods This retrospective, single-center study conducted on a 5 years period in the medical ICU from our university hospital included 265 patients with hematological malignancies admitted for a first stay. Objectives were to evaluate the ICU, day 28 and 6 months mortality, to identify prognostic factors associated with mortality within uni- and multivariate analysis, to evaluate readmission rate within the 60 days after discharge, to indentify the admission risk factors associated with ICU readmission and the prognosis factors associated with mortality during the second ICU stay.

Results The mean age was 58.6 ± 14.8 years, with a male–female ratio of 1.55. The most represented malignancies were acute leukemia (40.8%) and non-Hodgkin lymphomas (26.8%); 16.2% were hematopoietic stem cell transplant recipients. 54% of patients had newly diagnosed malignancy, 20.8% were in complete remission (CR), 11.7% had stable disease or partial remission and 13.6% had progressive disease. 46.4% of patients presented with severe neutropenia at the time of ICU admission. The main life-threatening complications precipitating ICU admission were acute respiratory failure for 43.8%, sepsis for 51.7%, acute kidney injury for 14%, neurological disturbance for 18.1% and preventing tumor lysis syndrome for 15.8%. 11.3% presented with hemophagocytic lymphohistiocytosis (HLH). 34.3% of patients received non-invasive ventilation, 46.8% mechanical ventilation (MV), 54.3% needed vasoactive drugs administration and 40.8% had renal replacement therapy. ICU, day 28 and 6 months mortality were 39.8, 46.4 and 63.4% respectively. By multivariate analysis poor performance status, IGS II, HLH, MV and anti-fungal administration were associated with increased ICU mortality, infections with Pseudomonas were associated with higher day 28 mortality. Catheter related infections were associated with better ICU survival and CR was associated with lower day 28 mortality. 38 of 132 (28.9%) candidate patients for ICU readmission after a first stay were readmitted within the 60 days following discharge. Median overall survival was lower in readmitted versus non readmitted patients. 6 months mortality was 73.8% for readmitted versus 13.8% for no readmitted patients (p < 0.0001). The second ICU stay mortality was 60.5% and 6 month mortality was 78.9%. By multivariate analysis, only MV was associated with prognosis. The 6 months mortality rate of patients who survived to the second ICU stay was significantly higher than the patients who survived to the first admission but were not readmitted (46.7 vs 13.8%, p = 0.0007).

Conclusion Main features, short and long term mortality and prognostic factors associated with ICU admission are in lines with previous studies. Early readmission rate was high with a negative impact on survival. Despite admission in the ICU of patients with hematologic malignancies seems not to affect long term prognosis, early readmission seems to have a pejorative impact on the course of the malignancy.

Competing interests None.

Reference
  1. 1.

    Azoulay E. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium—a groupe de recherche respiratoire en réanimation onco-hématologique study. J Clin Oncol. 2013;31:2810–18.

     

P185 Prognosis of lung cancer patients admitted to ICU

Julie Gorham1, Lieveke Ameye,2, Thierry Berghmans,1, Marianne Paesmans2, Jean-Paul Sculier,1, Anne-Pascale Meert1
1Intensive Care and Thoracic Oncology, Institute Jules Bordet, Brussel, Belgium; 2Data centre, Institute Jules Bordet, Brussel, Belgium
Correspondence: Anne-Pascale Meert - secret.sculier@bordet.be

Annals of Intensive Care 2017, 7(Suppl 1):P185

Introduction Lung cancer is among all types of cancer, the most common solid tumour admitted in intensive care [1]. Recent studies showed that the prognosis of patients with lung cancer during intensive care unit (ICU) stay has improved [2]. The aim of our study was to determine the causes of ICU admission of lung cancer patients, their prognosis and to identify factors predicting hospital mortality and survival after hospital discharge.

Patients and methods We conducted a retrospective study including all patients with lung cancer admitted for a medical or surgical complication in the intensive care unit of a cancer hospital between September 1, 2008 and December 31, 2013. mbol’ > [1]. Recent studies showed that the prognosis of patients with lung cancer during intensive care unit (ICU) stay has improved [2]. The aim of our study was to determine the causes of ICU admission of lung cancer patients, their prognosis and to identify factors predicting hospital mortality and survival after hospital discharge.

Results During this period, 212 ICU admissions occurred in 180 patients with lung cancer. The majority of them were men (64%), had non small cell lung cancer (80%) and metastases at the time of admission (81%). 54% received an antineoplastic therapy during the month preceding the ICU admission. 47 patients (26%) died during hospitalisation with 36 deaths in the intensive care unit and 11 in the hospital ward after ICU discharge. The three main reasons of admissions were: cardiovascular problems (32%), respiratory failure (29%) and neurological (16%) complications. The SAPS II score (OR 1.07; 95% CI 1.04–1.11) as continuous covariate and the presence of respiratory complications (OR 4.00; 95% CI 1.76–9.07) were the 2 factors independently affecting hospital mortality in multivariate analysis. Median overall survival since ICU admission was 3.7 months (95% CI, 2.8–4.4). Median overall survival for patients discharged alive from ICU was 4.8 months (95% CI, 3.9–5.6 months). Considering patients discharged alive from the hospital, only the presence of metastases was a statistically independent prognostic factor in multivariate analysis (HR 2.3; 95% CI 1.44–3.65).

Discussion The prognosis of patients with lung cancer admitted in ICU improved probably due to a better selection of these patients eligible for intensive care. As already observed in general cancer patients’ population, prognosis factors for hospital mortality are related to the acute complications but survival after hospital discharge is dependent from the cancer stage.

Conclusion Lung cancer patients are admitted in critical care in over half of the cases for cardiovascular and respiratory complications. The hospital mortality rate of these patients admitted in ICU was 26%. However survival after hospital discharge remains low and dependent of the cancer metastatic status. ICU admission should be considered for patients with lung cancer.

Competing interests None.

References
  1. 1.

    Kress JP, Christenson J, Pohlman AS et al. Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med. 1999;160:1957–61.

     
  2. 2.

    Adam AK, Soubani AO. Outcome and prognostic factors of lung cancer patients admitted to the medical intensive care unit. Eur Respir J 2008;31:47–53.

     

P186 Treatment intensity may not predict prognosis for patients admitted in ICU with relapsed acute myeloid leukemia

Max Guillot1, Marie-Pierre Ledoux2, Thierry Braun1, Quentin Maestraggi1, Baptiste Michard1, Vincent Castelain1, Raoul Herbrecht2, Francis Schneider1
1Réanimation médicale, C.H.R.U. Hôpitaux Universitaires Strasbourg, Strasbourg, France; 2Département d’oncologie et d’hématologie, C.H.R.U. Hôpitaux Universitaires Strasbourg, Strasbourg, France
Correspondence: Max Guillot - max.guillot@me.com

Annals of Intensive Care 2017, 7(Suppl 1):P186

Introduction Admission of cancer patients with poor prognosis in intensive care units (ICU), like acute myeloid leukemia (AML) resistant to the first course of induction chemotherapy, continue to be controversial. The ICU trial may be an alternative in this case to ICU refusal. The ICU trial is a full-code ICU admission followed by reappraisal of the level of care. The objective of this study was to find variables available at ICU admission and at day 3 in order to predict prognosis of critically ill medical patients with relapsed acute myeloid leukemia.

Patients and methods Retrospective monocentric study of consecutive patients with a relapsed AML admitted to the 30 beds medical ICU of an academic hospital. We evaluated hematological treatments, organs supports and mortality in ICU.

Results Between 2002 and 2014, 24 patients with relapsed AML were admitted in the ICU. At admission, patients were 54 years old, IGS 2: 64 ± 24, Lactates: 4.9 mmol/L (±4.7). Eight patients underwent bone marrow transplant (BMT). Five patients had graft-versus-host disease (GVHD). 12 patients were admitted for septic shock, 7 patients for acute respiratory failure, 2 for cardiac arrests, 1 for coma, 1 for acute kidney injury and 1 for hemorrhagic shock. BMT was significantly associated with higher mortality [Odds ratio (0R) 13.0 (95% confidence interval (95% CI) 1.7–99, 43)—p: 0.02]. 7 BMT patients died in ICU. Neutropenia [OR 0.33 (95% CI 0.05–1.87)—p: 0.4] and GVHD (OR 2.0 [95% CI 0.07–51.6)—p: 1.0] were not able to predict mortality in ICU. The first day in ICU: 15 patients were under mechanical ventilation, 17 patients need vasopressor perfusion and 3 patients dialysis. Mortality in ICU was 37%. 4 patients died from acute illness before day 3. Among the 24 patients admitted in ICU, none of the life-sustaining interventions at admission were associated with mortality: invasive mechanical ventilation [OR 9.14 (95% CI 0.9–92.4) - p: 0.08], vasopressor perfusion [OR 6.2 (95% CI 0.6–62.2)—p: 0.18] and renal replacement therapy [OR 4.8 (95% CI 0.3–65.8)—p: 0.27]. On day 3, life supports were not associated with higher mortality: invasive mechanical ventilation [OR 3.7 (95% CI 0.32–41.1)—p: 0.35], vasopressor perfusion [OR 2.0 (95% CI 0.27–14.7)—p: 0.64] and renal replacement therapy [OR 1.2 (95% CI 0.08–16.45)—p: 1.0].

Conclusion Mortality in ICU was 37% in patients with relapsed AML. In fact, temporary full-code ICU management in patients with relapsed AML seems to be appropriate. None of the life-sustaining interventions at admission and on day 3 were able to predict survival. An ICU trial of 3 days might not be enough to appraise precisely the outcome. Bone marrow transplant was associated with a high mortality in our study. In case of relapsed AML with BMT, ICU management is still challenging.

Competing interests None.

Reference
  1. 1.

    Azoulay E, Soares M, Darmon M, Benoit D, Pastores S, Afessa B. Intensive care of the cancer patient: recent achievements and remaining challenges. Ann Intensive Care. 2011;1(1):5.

     

P187 Mortality analysis of the chronically critically ill patients: an epidemiological prospective study

Severine Couffin1, David Lobo2, Nicolas de Prost3, Nicolas Mongardon4, Gilles Dhonneur5, Roman Mounier2
1Surgical intensive care, Hospital Henri Mondor, Créteil, France; 2Anesthesia and surgical intensive care, Hospital Henri Mondor, Créteil, France; 3Réanimation Médicale, Hôpital Henri Mondor, Créteil, France; 4Service de réanimation médicale, Hôpital Cochin, Paris, France; 5Anesthesia and intensive care medicine, CHU Henri Mondor, Créteil, France
Correspondence: Severine Couffin - scouffin@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P187

Introduction The growing population of chronically critically-ill patients has a poor prognosis despite all the resources mobilised [1]. Our primary objective was to analyse the prognostic value of different definitions used to describe them. Our secondary objective was to look for early clinical and biological factors that could be associated with the in-hospital mortality.

Patients and methods We conducted an epidemiological prospective study in 3 intensive care units (neurosurgical, cardiosurgical and medical) of a large French teaching hospital (Henri Mondor, Créteil). We included all the patients hospitalized for at least 7 days. We tested 5 definitions: the prolonged mechanical ventilation, the definition taken up by Kahn et al. [2], the prolonged length of stay, the persistent critical illness and the persistent inflammation-immunosuppression and catabolism syndrome. Two biological examinations were performed: upon entering the study and 1 week later. The study endpoint was the in-hospital mortality.

Results Thirty patients were included between April and July 2016. Among them, only 40% matched the definition of prolonged mechanical ventilation, which is still the most used in the literature. Further, it was not associated with the mortality, but the prolonged length of stay was, with 59% of these patients, that did not survive to their hospital stay. Other parameters that were significantly different between the patients who died and those who survived were an advanced age, an elevated IGS II score at hospital admission, an elevated SOFA score at study entry, a late healthcare-associated infection and several biological variables: a high C reactive protein, low albumin and prealbumin and a poor percent of monocytes expressing HLA-DR, all measured at day 7.

Conclusion The in-hospital mortality of chronically critically-ill is still high. A prolonged length of stay is the only definition who may be helpful to identify the patients with the poorest outcome. Among the early factors associated with mortality, we found a late healthcare-associated infection and a low percent of monocytes expressing HLA-DR, pointing to the value of studying the immune system of these patients.

Competing interests None.

References
  1. 1.

    Nelson JE. Chronic critical illness. Am J Respir Crit Care Med. 2010; 182(4):446–54.

     
  2. 2.

    Kahn JM. The epidemiology of chronic critical illness in the United States. Crit Care Med. 2015;43(2):282–7.

     

P188 Clinical characteristics and outcome of nonagenarians and centenarians in a medical ICU

Pierrick Le Borgne1, Sophie Couraud1, Jean-Etienne Herbrecht2, Quentin Maestraggi2, Alexandra Boivin2, François Lefebvre3, Pascal Bilbault1, Francis Schneider2
1Service d’accueil des urgences, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; 2Réanimation médicale, C.H.R.U. Hôpitaux Universitaires Strasbourg, Strasbourg, France; 3Département d’information médicale, C.H.R.U. Hôpitaux Universitaires Strasbourg, Strasbourg, France
Correspondence: Pierrick Le Borgne - pierrick_med@yahoo.fr

Annals of Intensive Care 2017, 7(Suppl 1):P188

Introduction As a result of demographic transition, the proportion of «very elderly» (≥90 years) patients is increasing worldwide and more of these patients are nowadays admitted to intensive care units (ICU). Among physicians the discussion about appropriateness of these ICU admissions still remains controversial mostly due to questionable outcome, limited resources and costs. The aim of the study was to determine and evaluate the clinical characteristics and outcome in a very old population admitted to a medical ICU in an urban teaching hospital.

Patients and methods We present here a monocentric, retrospective and observational study. We reviewed the charts of all patients (≥90 years) admitted to a medical ICU between 2000 and 2015 (16 years). We collected epidemiological, clinical and biological parameters and all therapeutic measures during the ICU stay. A long-term survival follow-up was also performed. Two hundred eighty-four patients were included for statistical analysis. Multivariate Cox regression was also performed to identify risk factors for 28-day outcome.

Results A total of 284 patients were included, which represented 1.8% of admissions to the ICU during the period of the study. The mean age was 92.6 ± 2.1 years, the sex ratio was 0.41. Most of patients (41%) were admitted from the Emergency Department. 20% of these admitted patients suffered of previous dementia. The mean Charlson comorbidity score was 7.7 ± 1.7 and the mean McCabe score was 1.33 ± 0.5. The admission diagnosis in the ICU was mainly respiratory distress (51%), septic shock (11%), cardiac arrest (10%) and coma (8%). The mean SAPS-II score within 24 h of ICU admission was 55.9 ± 21.7. Half of these patients required support by mechanical ventilation (mean duration 7.3 days) and vasoactive drugs and 6% of patients received renal replacement. ICU and in-hospital mortality rates were 38 and 44% respectively. Overall survival at 6 months after hospital discharge was 33%. Multivariate regression revealed necessity of catecholamines and mechanical ventilation as independent risk factors and urinary sepsis as protective factor for 28-day outcome. In fine, for 34% of these patients, a limitation of active treatment was decided (on average after 2 days of stay). For all others there was no justification for limiting care because of a well-established treatment plan (with family, GP, ICU team).

Conclusion The proportion of elderly patients remains low, but they are increasingly being treated in intensive care units. Nevertheless, the in-hospital mortality is high compared to the average mortality in our ICU over the same period (20%). The prognosis is often not as poor as initially perceived by physicians. The indication for ICU treatment in our study was mostly justified; in the setting of consistent patient care and good clinical practice. It remains therefore appropriate to discuss every single ICU admission of elderly patients without any restriction related to age. Thus, the ongoing cluster-randomized trial of ICU admissions for the elderly patients (ICE-CUB 2 study) is deeply awaited to confirm or not these results [1].

Keywords Intensive care; prognosis; outcome; elderly patients; over 90-years old.

Competing interests None.

Reference
  1. 1.

    Boumendil A, Woimant M, Quenot J-P, Rooryck F-X, Makhlouf F, Yordanov Y, et al. Designing and conducting a cluster-randomized trial of ICU admission for the elderly patients: the ICE-CUB 2 study. Ann Intensive Care. 2016;6(1):74.

     

P189 The hemorrhage postpartum: inventory

Setti-Aouicha Zelmat1, Djamila-Djahida Batouche2, Fatima Mazour3, Belkacem Chaffi4, Nadia Benatta5
1Réanimation, etablissement hospitalier spécialisé 1er novembre, oran, Algeria; 2Réanimation pédiatrique, Centre Hospitalier et Universitaire d’Oran, Oran, Algeria; 3 Anesthesie -réanimation chirurgicale, EHS 1er Novembre, oran, Algeria; 4Service de gynéco-obstétrique, EHS 1er Novembre, oran, Algeria; 5Cardiologie, Centre Hospitalier et Universitaire d’Oran, Oran, Algeria
Correspondence: Setti-Aouicha Zelmat - settiaouichazelmat@yahoo.fr

Annals of Intensive Care 2017, 7(Suppl 1):P189

Introduction Regardless of the route of delivery, the postpartum hemorrhage (PPH) is defined as blood loss ≥500 ml after childbirth, and severe PPH as blood loss ≥1000 ml. PPH is the leading cause of maternal mortality in Africa. The aim of this prospective study was to assess the quality of the initial management of PPH in Algeria in Oran EHU and to determine the factors of care with the severity of this complication.

Patients and methods We conducted a prospective cohort study between April 2014 and September 2014 at the EHU ORAN. All women who delivered vaginally and showed HPP including the suspected cause was uterine atony were included. The severe PPH was defined as bleeding that required invasive surgical treatment (hysterectomy, arterial ligation), a transfusion, a transfer to an intensive care unit or death of the patient. The quality of care was evaluated using objective criteria defined by a delay of diagnosis and care and mortality.

Results Among the 466 women who delivered vaginally during the study period, 23 had a PPH, link with uterine atony alleged at diagnosis, 18 of which presented signs of severity. In 41% of cases, the delay in diagnosis of PPH was less than 30 min; 70% of women received oxytocin within 10 min after diagnosis. The tranexanique acid was used in 1 case. The examination of the cervix, uterine exploration and uterine massage was performed in 67, 99 and 97%, respectively. The failure of first line treatment involved 24% of patients. Among them, the time between the diagnosis of PPH and administration of blood derivatives was greater than 1 h in a third of cases. The administration of oxytocin delay exceeds 10 min multiplied by 2.5 the risk of severe PPH. However we had 2 deaths in our series.

Discussion In our study the optimal period of care was not adequate, obtaining blood derivatives in our institution remains among the factors aggravating Among the main risk factors for PPH, uterine atony was the main source of complication. Bleeding postpartum aggravated in our two patients has led to the deaths from late diagnosis and care that was not optimal. These hemorrhages PP is the leading cause of mortality: 21% of obstetric deaths (25% in the confidential survey 1996–1997) [1].

A hysterectomy was indicated after failure to conservative treatment. The death rate is estimated at 8% following a disorder complicated hemostasis of disseminated intravascular coagulation (DIC). In some series, the mortality rate is estimated between 2 and 4% [2].

Conclusion The management of PPH in obstetrics gynecology service The EHU Oran was not optimal. The issue of timing of diagnosis and initial treatment is crucial. Solutions must be sought locally to ensure the administration of essential medicines in time, especially the injection of oxytocin within 10 min after diagnosis.

Competing interests None.

References
  1. 1.

    Bouvier-Colle MH, Deneux C, Szego E, et al. Estimation de la mortalité maternelle en France: une nouvelle méthode. J Gynecol Obstet Biol Reproduction, 2004;33:421–9.

     
  2. 2.

    Rossi AC, Lee RH, Chmait RH. Emergency postpartum hys-terectomy for uncontrolled postpartum bleeding. ObstetGynecol 2010;115:637—44.

     

P190 Evolution of the management and prognosis of patients admitted in intensive care unit for exacerbation of chronic obstructive pulmonary disease

Ali Habiba Sik1, I Talik1, Najla Tilouch1, Sondes Yaakoubi1, Rim Gharbi1, Oussama Jaoued1, Mohamed Fekih Hassen1, Souheil Elatrous1
1Réanimation Médicale, EPS Taher Sfar Mahdia, Mahdia, Tunisia
Correspondence: Mohamed Fekih Hassen mohamed.fekihhassen@rns.tn

Annals of Intensive Care 2017, 7(Suppl 1):P190

Introduction Chronic obstructive pulmonary disease (COPD) is a common pathology that would represent the third cause of death worldwide by 2020. Its evolution is interspersed with episodes of acute exacerbations (AECOPD) that may indicate an admission in intensive care unit in the most.

Objective To study the evolution of management modalities of patients admitted in our intensive care unit for AECOPD, to determine their prognosis and to identify factors associated with mortality.

Patients and methods It is a retrospective, monocentric study, performed in a Tunisian intensive care unit (ICU) over a period of 10 years. We including all patients admitted in ICU for AECOPD. Parameters collected were demographic features, comorbidities, regular treatment, dyspnea assessed by the MRC scale, initial clinical severity reflected by SAPS II and APACHE II scores, modalities and ICU admission deadlines, initial arterial blood gas analysis, management of patients in the ICU (ventilation modalities, prescription of antibiotics, use of vasoactive drugs) and their outcomes (incidence of nosocomial infections and their sites, length of stay and ICU mortality).

Results A total of 512 patients, which represents 17.5% of all hospitalizations, with mean age of 72 years (IQR: 66–77) were admitted for AECOPD during the study period. The mean SAPS II and APACHE II were respectively 32 (IQR: 24–45) and 18 (IQR: 14–24). Of these, 60% were ventilated with NIV whose overall failure rate was 48% with a significant decrease between the beginning and the end of the study (94 vs 31% p = 0.001). Sixty-four percent of patients received antibiotics at admission. The prescription rate of antibiotics has decreased significantly over the years from 82 to 36%. The incidence of nosocomial infections was 18%. It remained steady between 11 and 27%. Their sites were pulmonary in 83% of cases. ICU mortality was 16%. In multivariate analysis, ICU admission deadlines, NIV failure and the use of vasoactive drugs were identified as factors associated with mortality.

Conclusion Our study showed the importance of AECOPD in the activity of our ICU. The management of these patients has evolved over the years, which was reflected by the significant decrease in the prescription of antibiotics and the enhancement of NIV success rate. This result could be attributed to the combination of several factors: precocious management of patients, experience of the healthcare team and the use of efficient ventilators. ICU admission deadlines, NIV failure and the use of vasoactive drugs were identified as factors associated with mortality.

Competing interests None.

P191 Music therapy improves the tolerance of non-invasive ventilation during its introduction

Maxime Perrier1, Eliane Gouteix1, Claude Koubi1, Annabelle Escavy1, Victoria Guilbaut1, Jean-Philippe Fosse1
1Réanimation surveillance continue, Hôpital Privé Gériatrique Les Sources, Nice, France
Correspondence: Jean-Philippe Fosse - janfilipfos@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P191

Introduction Aim. Investigate the effect of music therapy on the tolerance of non-invasive ventilation (NIV) during its introduction.

Patients and methods Type of study Prospective, randomized, single blind, monocentric.

Thirty patients who needed NIV introduction were included.

They were divided into two groups (15 with music and 15 without music) and randomized by block of 4.

The patients were all equipped with headphones and half of them received a 60 min session of music therapy of their choice, and the other half had to keep the headphones on without music.

The main outcome measure was the number of non-programmed interventions by the caregivers during the hour.

Patient’s and caregiver’s feeling were evaluated at the end of the session by a semi-quantitative scale:
  • +2 very difficult; +1 difficult; 0 normal; −1 easy; −2 very easy

Pulse rate, systolic and diastolic blood pressure, respiratory rate, pain, peripheral oxygen saturation, arterial blood gas parameters, Glasgow Coma score and Richmond scale were reported before and after the session.

Results Music therapy allowed a significant reduction of the number of non-programmed interventions during the hour (0.6 ± 0.74 against 1.73 ± 1.62; p < 0.05).

The patient’s and the caregiver’s feeling of the session was better under music therapy (−1.07 ± 0.88 and −1.07 ± 1.03 against 0.13 ± 0.83 and 0.07 ± 1.03; p < 0.05).

The other parameters were not statistically significant.

Discussion Our study showed that music therapy allows a better tolerance of the NIV’s introduction in a quantitative and a qualitative way.

Conclusion Music therapy allows a 65.3% reduction in the number of non-programmed interventions by the caregivers, during the first hour of the NIV’s introduction, and a better feeling of the session.

Competing interests None.

References
  1. 1.

    Bradt J, Dileo C. Music interventions for mechanically ventilated patients. In: The cochrane collaboration. Wiley. 2014.

     
  2. 2.

    Jaber S, Bahloul H, Guétin S, Chanques G, Sebbane M, Eledjam J–J. Effets de la musicothérapie en réanimation hors sédation chez des patients en cours de sevrage ventilatoire versus des patients non ventilés. Annales Françaises d’Anesthésie et de Réanimation. 2007;26:30–38.

     

P192 Non-invasive ventilation in acute exacerbations of Obesity-Hypoventilation Syndrome (AE/OHS)

Jihene Ayachi1, Ahmed Khedher1, Rahma Ben Jazia2, Khaoula Meddeb1, Ahmed Abdelghani2, Imed Chouchene1, Mohamed Boussarsar3
1Réanimation médicale, CHU Farhat Hached, Sousse, Tunisia; 2Pneumologie, CHU Farhat Hached, Sousse, Tunisia; 3Réanimation médicale, CHU Farhat Hached. Research Laboratory N° LR14ES05. Faculty of Medicine, Sousse, Tunisia
Correspondence: Mohamed Boussarsar - hamadi.boussarsar@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P192

Introduction Although NIV is effective in acute hypercapnic COPD-related respiratory failure, its efficacy in AE/OHS has been less demonstrated.

The aim of the study was to evaluate efficacy of NIV in AE/OHS and to identify factors associated with poor prognosis in non-invasive-ventilated AE/OHS patients.

Patients and methods A retrospective analysis of all consecutive patients admitted to ICU for AE/OHS. Clinical, ABG’s and outcome characteristics were collected. Factors associated with poor prognosis were identified.

Results One hundred patients were included over a 13 years period. 44 patients underwent NIV. They were 66.6 ± 12.6 years aged; BMI, 40.6 ± 7.7 kg/m2; SAPSII, 29 ± 13; pH, 7.33 ± 0.08; pCO2, 69 ± 22 mmHg. They were scored with grade II encephalopathy score on admission. Mean duration of NIV was 5.1 ± 4.4 days. 14 (32%) patients failed NIV and were intubated with a delay of 85.6 ± 156.7 h. 11 (25%) died and length of stay was 10.7 ± 9.5 days. Four factors were significantly associated with mortality, mMRC, (47 vs 14%; p = 0.02); encephalopathy score, (60 vs 15%; p = 0.008); NIV failure, (64 vs 7%; p = 0.0001); inotropic agents, (58 vs 12.5%; p = 0.004).

Conclusion NIV in AE/OHS demonstrates rather efficient. However delay of intubation seems to be of poor prognostic value.

Competing interests None.

P193 Oxygenotherapy with an oxygen concentrator in intensive care unit: a prospective study

Pierre-Julien Cungi1, Julien Bordes1, Cédric Nguyen1, Candice Pierrou2, Maximilien Cruc1, Alain Benois3, Eric Meaudre1
1Intensive care unit and anesthesiology, Hôpital d’Instruction des Armées Sainte-Anne, Toulon, France; 2Intensive care unit and anesthesiology, Hôpital d’Instruction des Armées Laveran, Marseille, France; 3Anesthésie réanimation, Hôpital Médico Chirurgical Bouffard, Djibouti, Djibouti
Correspondence: Pierre-Julien Cungi - pjcungi@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P193

Introduction Oxygen therapy is an essential issue for the French Military Health Service (FMHS). Wounded soldiers are severe trauma patients often burnt and suffering from haemorrhagic shock. They need all along their management oxygen therapy. The theatres of external operations are isolated with limited resources. Their supply is difficult. Currently, 50% of the trauma are intubated. Thirty-three percent of the patient admitted in intensive care suffers from acute respiratory distress syndrome (ARDS). The FMHS chose oxygen concentrator as oxygen source in addition to oxygen pressurized bottles. Their supply can be uncertain in conflict areas. Insufficient data are available concerning the use of oxygen concentrator in intensive care unit.

The primary endpoint was to determine over the total duration of oxygen therapy, the number of days on which the use of pressurized oxygen was needed for patients oxygenated by oxygen concentrator. The secondary endpoints were to identify when pressurized oxygen was needed, describe the characteristics of the population with oxygen therapy and estimate the oxygen quantity economised thanks to the use of oxygen concentrator.

Materials and methods The study took place in the forward surgical unit of Bouffard. It’s a French role 3 located in Djibouti Republic in Africa. All patients over 15 admitted in the intensive care and needing oxygen therapy were included. All the patients were oxygenated with an oxygen concentrator. The oxygen concentrators used were Sequaltm Integra 10 OM, that could deliver up to 10 l/min of normobaric oxygen. The ventilator used were Pulmonetictm LTV 1000 and 1200.

Results Thirty-six patients were included over the 6 months’ study period. Sixty percent of the patients were men with an average age of 38 (15–90). Sixty percent of them were medical admissions, 22.9% were trauma and 17.1% were surgical admissions. Eight persons died which represented 22.9% of the patients. The mean SAPS II was 38.8. The mean length of stay in intensive care was 9 days (0–44). The mean time of mechanical ventilation was 6 (1–35) days. Among the patients, 76.5% were intubated. Eight patients (22.8%) needed noninvasive ventilation, for six (17%) of them it was after extubation. Two hundred and fifty-one days represents the total number of days of oxygen therapy divided into 142 days of invasive ventilation, 15 days of noninvasive ventilation and 94 days of oxygen mask. The use of pressurized oxygen was necessary 19 times over the 251 days of oxygen therapy which represents 7.5% of the total time. The causes of its use were in ten cases (52.6%) criteria of severe ARDS, in six cases an emergency intubation and in three cases a transfer. One dysfunction of an oxygen concentrator happened during our study. The oxygen concentrator produced 1024 m3 of oxygen over the study period, which represents 104 oxygen pressurized bottles of 50 litres. This enabled an economy of 10,000 euros.

Conclusion It is safe to use oxygen concentrator to take care of critically ill patients in limited resources environment. The use of pressurized oxygen is still compulsory in two situations: in case of electricity failure and in case of high FiO2 (above 60%). Oxygen concentrators are sufficient in 92.5% of the time. They enable to deliver oxygen any time which is essential when supply is uncertain in conflict areas.

Competing interests None.

P194 Evaluation of fractional delivered oxygen between nasal cannula and nasal oxygen catheter

Frédéric Duprez1, Thierry Bonus1, Grégory Cuvelier2, Sandra Ollieuz1, Sharam Machayekhi1, Frédéric Paciorkowski1, Gregory Reychler3
1ICU, C.H. Epicura Hornu, Hornu, Belgium; 2Laboratoire de l’effort et du mouvement, Condorcet, Tournai, Belgium; 3Irec, pôle de pneumologie, ucl, Cliniques Universitaires Saint Luc, Bruxelles, Belgium
Correspondence: Frédéric Duprez - dtamedical@hotmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P194

Introduction Oxygen therapy is the main supportive treatment of hypoxia. Nasal cannula (NC) and nasal oxygen catheter (NOC) were used to administer oxygen therapy in hypoxia. Few studies have examined the difference in fractional delivered oxygen (FDO2) between these two systems. The aim of our study was to compare the difference of FDO2 between NC and NOC.

Materials and methods On a bench study, a two-compartment model of adult lung (Dual Test Lung DTL, Michigan Instrument) was connected to a Servo i® Ventilator. The ventilator was set in volume-controlled mode. Three minute ventilation (MV: 6/9/12 l/min at Ti/Ttot = 0.33) and two oxygen flow rate (OFR: 2 and 4 l/min) were analyzed. OFR was analyzed with a thermal mass flow meter Vogtlyn™ Red Y. The compliance of the artificial lung was set to 70 ml/cmH2O and the resistance set to 5 cmH2O/l s−1. The FDO2 and MV measurements were made using an iWorx® acquisition system (GA207 gas analyzer and analog/digital IX/228 s) and LabScribe II® software. To simulate the anatomic dead space of the nasopharynx (±50 ml for an adult) we have used a 15 cm length corrugated tubing ISO 22 mm (CT22) at the level of inflow of DTL. NC was introduced at the entry of the CT22 while the NOC was introduced totally into the CT22. Statistical: ANOVA on ranks followed by Student–Newman–Keuls.

Results

Conclusion In oxygen therapy, with NC or NOC, for a Ti/Ttot = 0.33, FDO2 is influenced by MV, OFR and oxygen system delivery. For the same level of OFR and system delivery, when MV increases, FDO2 decreases (see Table 4). For the same MV and level of OFR, FDO2 was more efficient with NOC than NC. The differences of FDO2 between NOC and NC decrease with increasing MV. The FDO2 fluctuations according to the value of the MV are greater with the NOC to 4 L/min.
Table 4

FDO2 comparison between NC and NOC at different OFR and MV

VE(L/min)

NC2 L/min

NOC2 L/min

NC 4 L/min

NOC4 L/min

6

31% (0.5)

37% (0.5)

38% (0.6)

43% (0.5)

9

29% (0.7)

34% (0.6)

34% (0.5)

39% (0.7)

12

26% (0.6)

30% (0.6)

30% (0.7)

34% (0.5)

ANOVA on ranks: p < 0.05, except between: NOC2 (VE 9 L/min) and NOC4 (VE12 L/min)/NC2 (VE 9 L/min) and NOC2 (VE12 L/min)/NOC2 (VE12 L/min) and NC4 (VE12 L/min)/NC4 (VE 9 L/min) and NOC4 (VE 9 L/min)/NOC2 (VE 9 L/min) and NC4 (VE 9 L/min)

In clinical situation, NOC is less used than the NC. Compared to the NC, NOC is an alternative to increase the FDO2 with the same OFR. NOC is more efficient than NC because during expiratory time, anatomical dead space it fills with O2, which increases the FDO2. However, if the respiratory frequency increases then expiratory time decreases, filling with O2 decreases which reduces FDO2. Note that NOC may become uncomfortable at OFR greater than 5 L/min.

Competing interests None.

Reference
  1. 1.

    Tiep BL, Nicotra B. Evaluation of a low-flow oxygen-conserving nasal cannula. Am Rev Respir Dis. 1984;130(3):500–2.

     

P195 Variability of fractional delivered oxygen (FDO2) with nasal cannula

Frédéric Duprez1, Thierry Bonus1, Grégory Cuvelier2, Sharam Machayekhi1, Sandra Ollieuz1, Gregory Reychler3
1ICU, C.H. Epicura Hornu, Hornu, Belgium; 2Laboratoire de l’effort et du mouvement, Condorcet, Tournai, Belgium; 3 Irec, pôle de pneumologie, ucl, Cliniques Universitaires Saint Luc, Bruxelles, Belgium
Correspondence: Frédéric Duprez - dtamedical@hotmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P195

Introduction Nasal Cannula (NC) is an option to deliver oxygen therapy. According to American Thoracic Society (ATS), standard NC delivers a fractional delivered oxygen (FDO2) of 24–40% at supply oxygen flows ranging from 1 to 5 L/min. An equation was proposed by ATS to predict oxygen delivery: FDO2 = 20% + (4 * O2 L/min). Moreover, for ATS, FDO2 is also influenced by respiratory frequency (Rf), tidal volume (Vt) and ratio Ti/Ttot. However, the equation of ATS does not take into account these parameters. Our hypothesis is that these parameters can significantly affect the FDO2. The aim of this study was to determine the effect of Rf, Vt and Ti/Ttot on FDO2.

Materials and methods The study was conducted on bench with NC connected to a two compartment adult lung model (Dual Test Lung®) (DTL) controlled by a Maquet Servo I® ventilator. One oxygen flow rate (OFR) (5 L/min) and 3 min ventilation (MV: 6/9/12 L/min) with two Ti/Ttot (0.33 and 0.25) were investigated. All settings of MV were generated by modifying Rf (10–40 CPM) and Vt (0.3 and 0.6 L). Inspiratory flows rate (IFR) obtained with settings range from 18 to 48 L/min. OFR was analyzed by a thermal mass flow meter Vogtlyn™ Red Y. FDO2 and MV measurements were made using a iWorx® acquisition system (GA207 gas analyzer) and LabScribe II® software. Compliance of DTL was set to: 0.07 L/cmH2O and resistance to: 5 cmH2O/L s−1. Statistical: ANOVA repeated measures followed by Newman Keuls method.

Results FDO2 comparisons between: Ti/Ttot 0.33 and 0.25 and three MV: 6–9–12 L/min at OFR: 5 L/min.

Conclusion IFR and OFR are the main determinants of FDO2. Equation of ATS is correct when IFR is equal to 18 L/min.

When IFR is different of this value, Equation of ATS is not appropriate.

In our experiment, with an OFR of 5L/min, when IFR = 18 L/min (MV = 6 L/min and Ti/Ttot = 0.33), the FDO2 is equal to 41% (±1%) (see Table 5). To this value of IFR, the FDO2 is in accordance with the formula of ATS, but when IFR increase beyond 18 L/min, the FDO2 decrease and the formula is not in accordance with ATS. This can be explain because during inspiratory phase, air room (Fractional oxygen = 0.21) entry in airway mixes with OFR (FO2 = 1), which modifies the FDO2. In this case, when IFR increase then FDO2 decrease and vice versa. Medical and paramedical staff must be aware that with patients who receive OFR by nasal cannula, any change of OFR and/or inspiratory flow changes the FDO2. In this case, for maintain the same FDO2, it is necessary that modify the value of OFR.
Table 5

FDO2 comparisons between diffferent TI/Ttot and MV at OFR 5 L/min

MV (L/min)

Ti/Ttot = 0.33

Ti/Ttot = 0.25

RfxVt

FDO2

RfxVt

FDO2

RfxVt

FDO2

RfxVt

FDO2

6

10 × 0.6

41% (a)

20 × 0.3

42% (d)

10 × 0.6

36% (g)

20 × 0.3

37% (j)

9

15 × 0.6

36% (b)

30 × 0.3

35% (e)

15 × 0.6

32% (h)

30 × 0.3

32% (k)

12

20 × 0.6

31% (c)

40 × 0.3

30% (f)

20 × 0.6

30% (i)

40 × 0.3

29% (l)

Rf respiratory frequency (in CPM), Vt tidal volume (in Liter)

ANOVA RM results: p < 0.05. No statistical difference are found between: (a–d)/(b–e)/(c–f)/(g–j)/(h–k)/(i–l)/(b–j)/(b–g)/(f–k)/(c–k)/(f–h)/(f–l)/(f–i)/(c–i)/(c–l)/(e–g)

Competing interests None.

Reference
  1. 1.

    Wagstaff T, Soni N. Performance of six types of oxygen delivery devices at varying respiratory rates. Anaesthesia, 2007;62: 492–503.

     

P196 How to assess FiO2 delivered under oxygen mask in clinical practice?

Remi Coudroy1, Arnaud W Thille1, Xavier Drouot2, Véronique Diaz2, Jean-Claude Meurice3, René Robert1, Jean-Pierre Frat1, the FLORALI study group
1Réanimation médicale, CHU de Poitiers, Poitiers, France; 2Neurophysiology, CHU de Poitiers, Poitiers, France; 3Pneumologie, CHU de Poitiers, Poitiers, France
Correspondence: - Remi Coudroy remi.coudroy@chu-poitiers.fr

Annals of Intensive Care 2017, 7(Suppl 1):P196

Introduction The actual FiO2 delivered under oxygen mask in patients with acute respiratory failure and the factors that may influence the FiO2 are poorly known. In clinical practice, different methods including formula or conversion tables based on oxygen flow can be used to estimate delivered FiO2. We aimed to assess first the factors influencing measured values of FiO2, and second the best method to estimate FiO2 in patients breathing under oxygen mask.

Patients and methods We included ICU patients admitted for acute hypoxemic respiratory failure from a previous prospective trial [1] in whom FiO2 was measured under oxygen mask using a portable oxygen analyzer. We collected demographic variables and respiratory parameters that may influence measured FiO2. Low FiO2 was defined according to the median measured FiO2.

For each patient, measured FiO2 was compared to “Calc + 3%” formula (FiO2 = oxygen flow in liters per minute × 0.03 + 0.21) to “Calc + 4%” formula (FiO2 = oxygen flow in liters per minute × 0.04 + 0.21), and to a conversion table [2]. A ± 10% limit of agreement for each estimation method was arbitrarily considered acceptable.

Results Among the 265 patients included, median measured FiO2 was 65% [60–73]. After adjustment on oxygen flow, the three variables independently associated with low measured FiO2 using multivariate analysis were patient’s height, a low PaCO2, and a respiratory rate greater than 30 breaths/min.

Using paired analysis, each estimation methods differed significantly from measured FiO2 (p < 0.0001 for each). Values outside the limits of agreement accounted for 55% of cases for the Calc + 3% formula, 69% for the Calc + 4% formula, and 94% for the conversion table (p < 0.0001).

Conclusion Independently from oxygen flow, the 3 major physiologic variables associated with low FiO2 delivered under mask were tallness, high respiratory rate and low PaCO2. None of the tested methods estimated accurately measured FiO2 in patients with acute respiratory failure breathing oxygen through a mask.

Competing interests None.

References
  1. 1.

    Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372(23):2185–96.

     
  2. 2.

    Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323–9.

     

P197 Hyperglycemia in ICU: incidence and impact prognosis

Olfa Turki1, Mabrouk Bahloul2, Kais Regaieg3, Chtara Kamilia2, Hmida Chokri Ben2, Hedi Chelly2, Mounir Bouaziz2
1SFAX, CHU HABIB BOURGUIBA, Sfax, Tunisia; 2Réanimation polyvalente, Faculté de médecine de Sfax, Sfax, Tunisia; 3ICU, CHU Habib Bourguiba, Sfax, Tunisia
Correspondence: Olfa Turki - olfa.turki.rea@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P197

Introduction Acute hyperglycemia is common in intensive care. It was associated with poor prognosis and increased mortality.

The purpose of our study is to investigate the frequency of hyperglycemia in our ICU, to determine the main causes of high blood sugar and to analyze the impact of this hyperglycemia.

Patients and methods Our study is prospective during 3 months. It was conducted in the intensive care unit of the University Hospital Habib Bourguiba Sfax-Tunisia. Were included in our study all patients admitted to the service during the period of the study. For each patient included were collected from the ICU admission, clinical and biological data.

Results During the study period, 194 patients were hospitalized in our ICU and the diagnosis of hyperglycemia (>8 mmol/l) was admitted in 93 patients (48%). The comparison between patients who developed hyperglycemia and those free hyperglycemia group showed that, the patients of the first group were significantly older (p < 0.001). Additionally, hyperglycemic patients had more medical history including history of diabetes (p < 0.001), a higher SAPS II (p < 0.05), a more significant frequency of active infections (p < 0.05). Moreover, the presence of hyperglycemia was associated with shock (p < 0.05) and respiratory distress (p < 0.05).

Their evolution was marked by the significantly higher frequency of infectious complications (p < 0.05), thromboembolic complications (p < 0.05) and acute renal failure (p < 0.05). The average duration of mechanical ventilation and the length of stay were also significantly prolonged in hyperglycemia group patients (p < 0.05 for both).

Finally, the presence of hyperglycemia was significantly associated with a higher mortality rate.

Conclusion We concluded that hyperglycemia is correlated with poor prognosis of morbidity and mortality. But strict glycemic control remain controversial. Thus, further studies on this subject will be recommended to define the exact place of glycemic control in intensive care.

Competing interests None.

P198 Acute kidney injury following orthotopic liver transplant: impact of preservation solutions as a risk factor

Mona Assefi1, Romain Deransy1, Hélène Brisson1, Antoine Monsel1, Filomena Conti2, Olivier Scatton3, Olivier Langeron1
1Réanimation chirurgicale polyvalente, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; 2Hépato-gastro-entérologie et médecine de la transplantation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; 3Chirurgie digestive, hépato-bilio-pancréatique et transplantation hépatique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
Correspondence: Mona Assefi - monaassefi@hotmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P198

Introduction Acute kidney injury (AKI) is a common complication after orthotopic liver transplantation that can increase morbidity and mortality rates. Identification of AKI risk factors is important to prevent renal failure. The composition of preservation solution for organ transplants limiting ischemia and reperfusion injuries, may play an important role in the development of AKI and has never been studied before. The aim of this study was first to evaluate the impact of four preservation solutions (SCOT, Solutions de Conservations des Organes et Tissus; UW, University of Wisconsin; Celsior; IGL-1) on the occurrence of early AKI after liver transplant, second to identify perioperative risk factors transplant, and third to determine urine biochemical profiles.

Materials and methods In this prospective observational study, we analysed clinical and laboratory data, during the preoperative, intraoperative and postoperative periods, from 168 liver transplant recipients, between February 2009 and June 2012. AKI was defined by KDIGO criteria [1].

Results AKI was reported in 86 patients (51.2%) in the 7 days after orthotopic liver transplant. In univariate analysis, SCOT was a risk factor for development of AKI. There was no difference with the other preservation solutions. The other risk factors for AKI occurrence were: MELD score, female gender, Body Mass Index (BMI) and preoperative serum total bilirubin. After fitting a forward stepwise regression model, the type of preservation solution was not anymore an independent risk factor for development of AKI, unlike MELD score, female gender and BMI (p ≤ 0.05). The 1-year mortality, duration of mechanical ventilation, intensive care unit (ICU) and hospital length of stays were significantly increased among patients who developed AKI. Urine biochemistry profiles, although disturbed by the use of diuretics, could highlight an early inadequate renal perfusion after liver transplantation. See Fig. 7.
Fig. 7

See text for description

Discussion In this study, a high incidence of post-liver transplant AKI in ICU during the first week after surgery was noted and risk factors of AKI were identified. However, this study failed to demonstrate an impact of preservation solution on AKI occurrence after liver transplant. Risk-factors (MELD, female gender and BMI) are only related to the patient characteristics. Our results should be interpreted with caution given the small sample size, and the monocentric character of the study.

Conclusion Solution for organ preservation has no impact on AKI occurrence in ICU within 7 days following orthotopic liver transplant. Because of many factors that can influence AKI, a new study with largest sample size is necessary to demonstrate or eliminate a possible impact of preservation solution.

Competing interests None.

Reference
  1. 1.

    KDIGO. Kidney Int Suppl. 2012;2:7–24.

     

P199 Management of acute kidney injury and application of RIFLE criteria in a Tunisian medical intensive care unit

Hassen Ben Ghezala1, Salah Snouda2, Chiekh Imen Ben3, Moez Kaddour2
1Réanimation Médicale, Hôpital Henri Mondor, Avenue du Maréchal de Lattre de Tassigny, Créteil, France; 2Réanimation Médicale, Hopital regional zaghouan, faculté de médecine de Tunis, Zaghouan, Tunisia; 3Teaching department of emergency and intensive care, Regional hospital of Zaghouan, Zaghouan, Tunisia
Correspondence: Hassen Ben Ghezala - hassen.ghezala@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P199

Introduction Despite the advances made in recent years in the definition and classification of acute renal failure (ARF), epidemiological data remain varied and imprecise. These data basically vary with the population studied and the pathologies that are responsible of the ARF can be particularly complex and intricated especially in emergency and intensive care units (ICU).The aim of our study was to describe the clinical, etiologic, and therapeutic and outcome of ARF, to apply the RIFLE classification (Bellomo and col, Crit Care 2004) to our population of kidney failure patients admitted to intensive care, and assess its relevance in terms of hospital mortality risk.

Materials and methods We conducted a retrospective analysis over a period of 48 months (January 2011–December 2014), of records of patients who experienced ARF. The ARF is defined according to the RIFLE classification. We picked up all the clinical and laboratory data, the need for renal replacement therapy, the complications and the disease progression.

Results During this study period, 82 out of 1269 patients admitted to our ICU were hospitalized for ARF. They were classified into RIFLE R (30 patients or 37%); RIFLE I (15 patients or 18%) and RIFLE F (37 patients or 45%). The initial reason for visiting the emergency was asthenia (41%), followed by disorders of consciousness and dyspnea. The average age of our patients was 67 ± 13 years with a sex ratio of 2.9. Most found risk factors were hypertension (50%), diabetes (39%) and heart disease (35%). The ARF was essentially functional (56%). The main origin was septic (28%) followed by hypovolemia. Renal replacement therapy was required by 34 patients (41%).

Overall mortality in our population was 45%. Most RIFLE F patients died (62%). Among the risk factors associated with a severe prognosis, we definitely include the RIFLE classification (OR 4.2; CI 95% [2.66–6.65]). The other factors associated with mortality were SAPS II score (OR 6.45; CI 95% [2.77–7.32]) and use of vasopressor agents (OR 3.34; CI 95% [2.07–5.41]).

Conclusion ARF is a serious pathology burdened with a heavy morbidity and mortality. It is essentially functional and its main causes are sepsis and hypovolemia. RIFLE classification can predict morality in our Tunisian critically ill patients.

Competing interests None.

P200 Death rate risk factors of acute renal failure in intensive care department

Anwar Armel1, Lafrikh Youness1, Bensaid Abdelhak2, Miloudi Youssef2, Al Harrar Najib2, Amouzoun Mustapha3, Mtioui Noufel3, Zamd Mohamed3, El Khayat Salma3, Medkouri Ghizlane3, Benghanam Mohamed3, Ramdani Benyounes3
1Anesthésie réanimation, CHU Ibn Rochd, Casablanca, Morocco; 2Anesthésie réanimation, Hopital 20 Aout CHU IBN Rochd, Casablanca, Morocco; 3Néphrologie hémodialyse et transplantation rénale, CHU Ibn Rochd, Casablanca, Morocco
Correspondence: Anwar Armel - armelanwar@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P200

Introduction Acute renal failure (ARF/IRA) is a frequent complication in intensive care unit. Despite of many technical innovations, mortality remains important.

Our study’s aim is to establish the different mortality risk factors ARF/IRA in intensive care.

Materials and methods It is a descriptive cross-sectional study interesting 76 patients admitted at the ICU of the 20 August UHC Ibn Rochd, who showed out (ARF/IRA) according to RIFLE classification, on admission or have developed it during hospitalization. The study was made over a period of 18 months.

It excluded all patients with chronic or pre-terminal renal failure.

Statistical analysis used the epi-info test with significance level P < 0.05.

Results During the study period, 423 patients were enrolled, 76 of which have completed our inclusion criteria, that is an incidence of 17.96%. Patients average age was 54.57 ± 19.78 years with a male predominance. Antecedents most found are diabetes (43.4%) and high blood pressure (28.94%). Most of the cases were in class F (65.6% of the cases). Classes I and R are 21.9 and 12.5% respectively. Death rate was 64.47%, septic shock was death’s cause in 22.36% of them.

Mortality risk factors selected were age, the disease’s medical background, diabetes or pre-renal failure history, presence of hemodynamic failure, RIFLE stage F and organic nature of the acute renal failure.

Conclusion Acute renal failure occurrence in intensive care is a critical step with a very derogatory prognosis significance. A better understanding of its risk factors and prognosis is basic for more effective management.

Competing interests None.

P201 Early management of tumor lysis syndrome in intensive care unit

Dhouha Lakhdhar1, Florent Montini1, Sébastien Moschietto1
1Reanimation, Centre Hôspitalier Henri Duffaut, Avignon, France
Correspondence: Dhouha Lakhdhar - lakdardoha@gmail.com

Annals of Intensive Care 2017, 7(Suppl 1):P201

Introduction Tumor lysis syndrome (TLS) occur with tumor breakdown usually by response to chemotherapy. It may also occur spontaneously. The rapid destruction of malignant cells release intracellular content into the extracellular compartment, inducing metabolic and electrolytic imbalances, which result in acute kidney injury. Early prophylactic therapy is essential to ovoid the occurence of TLS and prevent life threatening complications.

The aim of this study was to prove the value of the early management and monitoring of patients with high risk of TLS in intensive care units (ICU).

Patients and methods This was a mono-centric, descriptive and retrospective study. During a 3 year period, from January 2013 to June 2016, case notes of fifteen patients with hematologic malignancies were reviewed. They were admitted in intensive care unit for chemotherapy induction for patients with high risk of TLS, or for established TLS. We collected informations regarding clinical and biological presentation, treatment and outcome.

Results Fifteen patients were included. The median age was 65 [45–73] years, with IGS II score at the admission 40 [31–51]. Mainly male (87%). The major part had acute myeloid leukemia and highly aggressive lymphoma. Twelve patients were admitted in ICU for chemotherapy induction. Four patients had spontaneous TLS and three patients had TLS after chemotherapy started in oncology department. Concerning patients who had acute myeloid leukemia the median rate of white blood cells count was 84,000 [15,000–166,000] white blood cells per microliter. Seven patients had tumoral renal infiltration. The median CKD-epi score was 77 [23.9–95.6] mL/min/1.73 m2. According to KDICO score, five patients were in stage G1, five were in stage G4, four were in stage G2 and one in stage G3a. At the time of admission, seven patients had hyperphosphatemia, nine had hypocalcemia, five had hyperuricemia, and only one had hyperkalemia. Chemotherapy was started in ICU for twelve patients. The median hydration amount was 2.5 [1–3] l the first 48 h. The aggressive IV hydration was monitored with daily heart ultrasound examination and urine output. Recombinant urate oxidase (rasburicase) was given to all patients, the number of doses depended on urecemia levels. Six patients needed only one dose of rasburicase. Seven patients had renal replacement therapy (RRT) and it lasted 48 [48–72] h. The RRT was prophylactic in four cases started when phophatemia was more than 2 mmol/L, and therapeutic for renal failure and established TLS in three cases. The median duration stay in ICU was 5 [4–7] j. Thirteen patients left the ICU without major metabolic dysfunction. Two patients deceased due to infectious complications.

Discussion Monitoring of electrolytes was done on average, three times a day which is hard to do in onco-hematology unit. The early use of rasburicase and the aggressive IV hydration helped to prevent TLS for seven patients. The aggressive IV hydration was made according to echocardiography data and close monitoring of vital signs and urine output which has allowed to avoid volume overload and acute pulmonary edema. The early prophylactic RRT prevented renal failure and metabolic complications.

Conclusion Early management of TLS in ICU can prevent TLS and most of its serious complications and should be considered in TLS prophylaxis recommendations.

Competing interests None.

P202 The added value of plasma or urinary NGAL concentration in clinical practice

Emilien Gregoire1, Guillaume Claisse2, Julien Guiot3, Philippe Morimont3, Jean-Marie Krzesinski1, Christophe Mariat4, Bernard Lambermont3, Etienne Cavalier5, Pierre Delanaye6
1Nephrology, C.H.U de Liège - Sart Tilman, Liège, Belgium; 2Nephrology, Hospital Center University De Saint-Étienne, Saint-Priest-en-Jarez, France; 3Medical intensive care, C.H.U de Liège - Sart Tilman, Liège, Belgium; 4Néphrologie, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France; 5Biologie clinique, C.H.U de Liège - Sart Tilman, Liège, Belgium; 6C.H.U de Liège - Sart Tilman, Liège, Belgium
Correspondence: Pierre Delanaye - pierre_delanaye@yahoo.fr

Annals of Intensive Care 2017, 7(Suppl 1):P202

Introduction Plasma and urinary NGAL concentrations have been proposed for the early diagnosis of acute kidney injury (AKI). However, the added value of these parameters on simple usual clinical data (such as baseline serum creatinine and/or diuresis) has been questioned [1].

Patients and methods We measured both urinary and plasma NGAL concentration (Bioporto, Gentofte, Denmark on Roche Cobas 6000) in 98 patients admitted to the medical ICU of an Academic Hospital. The measurement was done in the first 24 h after ICU admission. Renal transplanted and dialysis patients were excluded. AKI was defined according to serum creatinine criteria of the KDIGO guidelines (1.5–1.9 times baseline or ≥0.3 mg/dL increase).

Results Three patients were excluded from the analysis because of early (in the first 24 h) death. For the 95 patients, median [IQR] age was 64 years [20], mean (SD) SAPSII score was 46 (17), 39% were septic, median baseline (=at admission in ICU) serum creatinine was 9.7 [8.4] mg/dL, and median first 24 h diuresis was 1432 [1340] mL. ICU mortality was 14.7%. Prevalence of AKI stage 1 was 21%. Both urinary (expressed as the ratio of NGAL on urinary creatinine) and plasma NGAL were predictive of AKI Stage 1. Predictive value of plasmatic measurements was higher than the urinary one (AUC of 0.627 and 0.758, respectively, p = 0.0273 between AUC), but not higher than either baseline serum creatinine (AUC = 0.737) or 24 h diuresis (AUC = 0.735). Backward multivariate regression showed that plasma NGAL concentration was associated with serum creatinine, CRP and albumin, whereas urinary NGAL was associated with leucocyturia and baseline creatinine.

Discussion Previous positive studies with NGAL did not compare the performance of this costly biomarker with simple usual clinical parameters to predict AKI. Moreover, several parameters were associated with NGAL concentrations with a high risk of collinearity (CRP) and/or false positive results (leucocyturia).

Conclusion Our data do not support any added value of NGAL concentration over baseline serum creatinine or urine output to predict AKI.

Competing interests None.

Reference
  1. 1.

    Vanmassenhove J. Urinary and serum biomarkers for the diagnosis of acute kidney injury: an in-depth review of the literature. Nephrol Dial Transp