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In patients with convulsive status epilepticus, the addition of cooling to 32 to 34°C for 24 hours did not have a significant effect on the percentage of patients with good outcomes at 90 days as compared with standard seizure treatment alone. Convulsive status epilepticus is among the most challenging life-threatening neurologic emergencies. 1 Antiepileptic drug treatment is initiated rapidly and adjusted in response to clinical and electroencephalographic (EEG) findings. 2 The in-hospital mortality associated with this condition is approximately 20% and, if status epilepticus remains refractory to treatment, can be as high as 40%. 3 – 7 Functional impairments after status epilepticus may be due to the effect of seizures on cortical neurons or to cerebral damage due to the underlying process that caused the seizures. In a prospective, multicenter study, 50% of survivors of convulsive status epilepticus who were admitted to an intensive care . . .

The fibroproliferative stage and persistent inflammation of acute respiratory distress syndrome (ARDS) are key factors leading to either the resolution of the syndrome or fibrosis. Previous studies suggest that a corticosteroid therapy promotes the evolution of ARDS toward an adapted repair process whereas others suggest that this therapy increases the risk of death if it starts more than 14 days after ARDS onset. Since the efficacy and safety of delayed 2 mg/kg methylprednisolone therapy in patients with ARDS is a matter of debate, we performed this observational multicentric retrospective study. We analysed the data of 392 patients with ARDS who received 2 mg/kg methylprednisolone therapy. The primary endpoint was mortality six months after 2 mg/kg methylprednisolone therapy was started. The secondary endpoints included mortality 60 days after the corticosteroid therapy initiation and the number of ventilator-free days (VFDs) and intensive care unit (ICU)-free days. We investigated the occurrence of complications such as ventilator-acquired pneumonia (VAP), septic shock and gastrointestinal bleeding arising after the start of the protocol. A total of 189 (48.2%) patients received 2 mg/kg methylprednisolone therapy within the first 14 days of ARDS onset. A total of 203 (51.8%) patients received it more than 14 days included post-ARDS-onset. The mortality rate six months after the initiation of 2 mg/kg methylprednisolone therapy was 51.9% in the early initiation group and 52.2% in the late initiation group ( p  = 0.942). The mortality rate 60 days after the initiation of 2 mg/kg methylprednisolone therapy was 47.1% in the early group and 47.3% in the late group ( p  = 0.968). There was no significant difference in the number of VFDs ( p  = 0.336) or ICU-free days ( p  = 0.175) 60 days after the start of the 2 mg/kg protocol. Initiating the protocol 14 days after the onset of ARDS seemed to be associated with more complications ( p  < 0.001). Late initiation was associated with greater occurrence of VAP ( p  = 0.018) or gastrointestinal bleeding ( p  = 0.012). These results suggest that an initiation of 2 mg/kg methylprednisolone therapy after 14 days from ARDS onset is not associated with an increased risk of death as compared with initiation prior to day 14. Delayed 2 mg/kg methylprednisolone therapy in patients with persistent ARDS should be considered.

Background Hypoxia is common during daily nursing procedures (DNPs) routinely performed on mechanically ventilated patients. The impact of automated ventilation on the incidence and severity of blood oxygen desaturation during DNPs remains unknown. Methods A prospective randomized controlled crossover trial was carried out in a French intensive care unit to compare blood oxygen pulse saturation (SpO 2 ) during DNPs performed on patients mechanically ventilated in automated and conventional ventilation modes (AV and CV, respectively). All patients with FiO 2  ≤ 60% and without prone positioning or neuromuscular blocking agents were included. Patients underwent two DNPs on the same day using AV (INTELLiVENT-ASV®) and CV (volume control, biphasic positive airway pressure, or pressure support ventilation) in a randomized order. The primary outcome was the percentage of time spent with SpO 2 in the acceptable range of 90–95% during the DNP. Results Of the 265 included patients, 93% had been admitted for a medical pathology, the majority for acute respiratory failure (52%). There was no difference between the two periods in terms of DNP duration, sedation requirements, or ventilation parameters, but patients had more spontaneous breaths and lower peak airway pressures during the AV period ( p  <  0.001). The percentage of time spent with SpO 2 in the acceptable range during DNPs was longer in the AV period than in the CV period (48 ± 37 vs. 43 ± 37, percentage of DNP period; p  = 0.03). After adjustment, AV was associated with a higher number of DNPs carried out with SpO 2 in the acceptable range (odds ratio, 1.82; 95% CI, 1.28 to 2.6; p  = 0.001) and a lower incidence of blood oxygen desaturation ≤ 85% (adjusted odds ratio, 0.50; 95% CI, 0.30 to 0.85; p  = 0.01). Conclusion AV appears to reduce the incidence and severity of blood oxygen desaturation during daily nursing procedures (DNPs) in comparison to CV. Trial registration This study was registered in clinical-trial.gov ( NCT03176329 ) in June 2017. Graphical abstract

IntroductionThe high incidence of morbidity and mortality associated with the post-cardiac arrest (CA) period highlights the need for novel therapeutic interventions to improve the outcome of out-of-hospital cardiac arrest (OHCA) patients admitted to the intensive care unit (ICU). The aim of this study is to assess the ability of high-dose intravenous vitamin C (Vit-C) to improve post-CA shock.Methods and analysisThis is a single-blind, open-label, multicentre, randomised controlled trial, involving 234 OHCA patients with post-CA shock planned to be enrolled in 10 French ICUs. Patients will be randomised to receive standard-of-care (SOC) or SOC with early high-dose intravenous Vit-C administration (200 mg/kg per day, within 6 hours after return of spontaneous circulation, for 3 days). The primary endpoint is the cumulative incidence of vasopressor withdrawal at 72 hours after enrolment, with death considered as a competing event. The main secondary endpoints are neurological outcome, mortality due to refractory shock, vasopressor-free days and organ failure monitored by the sequential organ failure assessment score.Ethics and disseminationThe study protocol was approved by a French Ethics Committee (EC) on 21 February 2023 (Comité de Protection des Personnes Ile de France 1, Paris, France). Due to the short enrolment period to avoid any delay in treatment, the EC approved the study inclusion before informed consent was obtained. As soon as possible, patient and their relative will be asked for their deferred informed consent. The data from the study will be disseminated through conference presentations and peer-reviewed publications.Trial registration numberNCT05817851.

Background Hip fractures (HFs) managed in the emergency department (ED) are associated with severe pain. Locoregional anaesthesia (LRA) using the pericapsular nerve group (PENG) block may be an effective option for pain management in the ED, helping to reduce morphine use and improve postoperative rehabilitation. Methods Patients admitted to the ED of a French tertiary hospital with suspected HF were enrolled and randomised into two groups: a standard of care (SOC) group receiving systemic analgesia in line with current recommendations, and an experimental group receiving systemic analgesia plus a PENG block. The primary outcome was morphine consumption per hour from randomisation until 24 hours post-randomisation or until surgery, if performed earlier. Results Among the 35 randomised patients, 32 were included in the final analysis (11 men and 21 women; median age of 81 [74–91] years). Median morphine consumption per hour was significantly lower in the PENG group compared to the SOC group (0.2 [0.0–0.5] mg vs 0.4 [0.3–0.8] mg, respectively; p  = 0.03). No significant differences were observed between groups in terms of total morphine use, pain scores (numeric rating scale), adverse events, or ED length of stay. Conclusion Early PENG block appears to be a feasible and safe LRA technique when performed by trained emergency physicians and may reduce opioids requirements in patients with HF in the ED. Larger, adequately powered studies are warranted to confirm these findings. Trial registration The study was registered prospectively at https://www.clinicaltrials.gov/ on 5 January 2023 (NCT05673486).

Background Intensive care units (ICUs) account for 15 to 20% of the national healthcare expenditures in France, although representing only 2% of the annual national hospitalizations. Published data on critically ill patient characteristics and intensive care unit (ICU) organizational aspects in France are scarce but could help optimize the critical care system organization. Methods We performed an ancillary analysis of the GAME-OVER study, conducted from November 2022 to March 2023, over a 24-h period in each ICU, to precisely describe the ICU activity in France. Characteristics of enrolled patients and ICUs were analyzed according to the healthcare structure type and the self-reported main activity of each ICU, and were compared using univariate analysis (p < 0.05 considered as significant). Results Data from 81 ICUs, representing 1218 beds, were analyzed. Participating ICUs were mainly mixed ICUs (56%), from teaching hospitals (54%). Among the 1048 analyzed ICU patients, sex ratio female/male was 1/3, median age was 63 [51–71] years, median sepsis organ failure assessment score was 4 [2–7], and 42% of patients had at least two organ failures. Patients were mainly admitted for medical reasons (52%), mostly represented by respiratory failure (26%). Mechanical ventilation, non-invasive ventilation, high flow oxygen therapy, renal replacement therapy and vasoactive therapy were required in 45.5%, 6.1%, 5.3%, 12% and 30.7% of patients, respectively. Median nurse-to-patient ratio was 2.4 [2.0–2.7] on day shift. Overall, 46 structures (56.8%) declared a nurse-to-patient ratio > 2.5 either on day time or night time. Bed occupancy rate was 91% over the 24-h study period. However, 70 (5.7%) ICU beds were administratively closed and could not admit any patient. Conclusion In more than 20% of French ICUs, the bed occupancy rate is nearly 91%, despite 5.7% of beds being unavailable, and the nurse-to-patient ratio exceeding recommended levels. Trial registration The full study protocol was registered in clinicaltrials.gov (NCT05553054).

IntroductionStatus epilepticus (SE) is a common life-threatening neurological emergency that can cause long-term impairments. Overall outcomes remain poor. Major efforts are required to clarify the epidemiology of SE and the determinants of outcomes, thereby identifying targets for improved management.Methods and analysisICTAL Registry is a multicentre open cohort of critically ill patients with convulsive, non-convulsive or psychogenic non-epileptic SE. Observational methods are applied to collect uniform data. The goal of the ICTAL Registry is to collect high-quality information on a large number of patients, thereby allowing elucidation of the pathophysiological mechanisms involved in mortality and morbidity. The registry structure is modular, with a large core data set and the opportunity for research teams to create satellite data sets for observational or interventional studies (eg, cohort multiple randomised controlled trials, cross-sectional studies and short-term and long-term longitudinal outcome studies). The availability of core data will hasten patient recruitment to studies, while also decreasing costs. Importantly, the vast amount of data from a large number of patients will allow valid subgroup analyses, which are expected to identify patient populations requiring specific treatment strategies. The results of the studies will have a broad spectrum of application, particularly given the multidisciplinary approach used by the IctalGroup research network.Ethics and disseminationThe ICTAL Registry protocol was approved by the ethics committee of the French Intensive Care Society (#CE_SRLF 19-68 and 19-68a). Patients or their relatives/proxies received written information to the use of the retrospectively collected and pseudonymised data, in compliance with French law. Prospectively included patients receive written consent form as soon as they recover decision-making competency; if they refuse consent, they are excluded from the registry. Data from the registry will be disseminated via conference presentations and peer-reviewed publications.Trial registration numberNCT03457831.

Cancer-associated thrombotic microangiopathy (TMA) refers to a group of disorders characterized by microangiopathic haemolytic anemia, thrombocytopenia, and ischemic organ damage. TMA manifestations can be induced by cancer or by chemotherapy. We report the case of a 64-year-old man with metastatic prostate cancer who experienced a Cabazitaxel-induced TMA manifestation. TMA responds to conservative therapy, dialysis without plasmaphoresis, with progressive recovered renal function.

PurposeSevere Pneumocystis jirovecii pneumonia (PJP) requiring intensive care has been the subject of few prospective studies. It is unclear whether delayed curative antibiotic therapy may impact survival in these severe forms of PJP. The impact of corticosteroid therapy combined with antibiotics is also unclear.MethodsThis multicentre, prospective observational study involving 49 adult intensive care units (ICUs) in France was designed to evaluate the severity, the clinical spectrum, and outcomes of patients with severe PJP, and to assess the association between delayed curative antibiotic treatment and adjunctive corticosteroid therapy with mortality.ResultsWe included 158 patients with PJP from September 2020 to August 2022. Their main reason for admission was acute respiratory failure (n = 150, 94.9%). 12% of them received antibiotic prophylaxis for PJP before ICU admission. The ICU, hospital, and 6-month mortality were 31.6%, 35.4%, and 40.5%, respectively. Using time-to-event analysis with a propensity score-based inverse probability of treatment weighting, the initiation of curative antibiotic treatment after 96 h of ICU admission was associated with faster occurrence of death [time ratio: 6.75; 95% confidence interval (95% CI): 1.48–30.82; P = 0.014]. The use of corticosteroids for PJP was associated with faster occurrence of death (time ratio: 2.48; 95% CI 1.01–6.08; P = 0.048).ConclusionThis study showed that few patients with PJP admitted to intensive care received prophylactic antibiotic therapy, that delay in curative antibiotic treatment was common and that both delay in curative antibiotic treatment and adjunctive corticosteroids for PJP were associated with accelerated mortality.

This work was funded by projects RTC‑2017‑6193‑1 (AEI/FEDER EU) and 202118 (413/C/2021), CIBER‑Consorcio Centro de Investigación Biomédica en RED‑CB06/06/1097, Instituto de Saludo Carlos III, Ministerio de Ciencia e Innovación and Unión Europea – European Regional Development Fund, CERCA Program/Generalitat de Catalunya and Fundació Institut d’Investigació i Innovació Parc Taulí‑I3PT. C. de Haro is granted with a Contrato para la intensificación de la actividad investigadora en el sistema nacional de salud (INT20/00030), AES 2020, by Instituto de Salud Carlos III. L. Sarlabous is supported by Pla Estratègic de Recerca i Innovació en Salut program from the Health Department of Generalitat de Catalunya, Spain.