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Anemia correlates with increased ICU mortality; but the use of erythropoietin (EPO) as a treatment remains debated. We sought to assess EPO use in ICU severe anemia. A retrospective single-center study was conducted in four adult ICUs. Inclusion criteria were ICU stay ≥10 days (to limit immortality bias) and RBC transfusion within the first 48 h (an indication of severe anemia likely to justify EPO). EPO contraindication was an exclusion criterion. Univariate tests were followed by a multivariable analysis. Over a 28-month period, 190 patients (69 with EPO) were included. EPO subgroups displayed had a higher prevalence of hemorrhagic shock and surgical ICU admissions. EPO administration was significantly associated with a lower requirement for late RBC transfusions in trauma and non-trauma subgroups, with odds ratios [95 % confidence interval] of 0.29 [0.10–0.85] and 0.03 [0.004–0.18], respectively. In the EPO subgroup, the median hemoglobin level rose by 1.2 g/dL. Cox model showed a significant association with mortality at day 28 and 365. Our study supports the hypothesis whereby EPO administration in severely anemic ICU patients reduces late transfusion needs, with a potentially higher survival rate. Systematic EPO use post-RBC transfusion in ICU patients warrants further investigation. [Display omitted] •EPO may reduce late RBC transfusion in critically ill patients with severe anemia.•EPO moderately increases hemoglobin, with balance reached around 14 days.•EPO is associated with lower mortality in these patients with severe anemia.•Biosimilar access shifts the medico-economic paradigm in favor of EPO use.•EPO may contribute to RBC tanking, enhancing their retention and synergizing with transfusion effects.

Background Sedation/analgesia is a daily challenge faced by intensivists managing patients with brain injury (BI) in intensive care units (ICUs). The optimization of sedation in patients with BI presents particular challenges. A choice must be made between the potential benefit of a rapid clinical evaluation and the potential exacerbation of intracranial hypertension in patients with impaired cerebral compliance. In the ICU, a pragmatic approach to the use of sedation/analgesia, including the optimal titration, management of multiple drugs, and use of any type of brain monitor, is needed. Our research question was as follows: the aim of the study is to identify what is the current daily practice regarding sedation/analgesia in the management of patients with BI in the ICU in France? Methods This study was composed of two parts. The first part was a descriptive survey of sedation practices and characteristics in 30 French ICUs and 27 academic hospitals specializing in care for patients with BI. This first step validates ICU participation in data collection regarding sedation-analgesia practices. The second part was a 1-day prospective cross-sectional snapshot of all characteristics and prescriptions of patients with BI. Results On the study day, among the 246 patients with BI, 106 (43%) had a brain monitoring device and 74 patients (30%) were sedated. Thirty-nine of the sedated patients (53%) suffered from intracranial hypertension, 14 patients (19%) suffered from agitation and delirium, and 7 patients (9%) were sedated because of respiratory failure. Fourteen patients (19%) no longer had a formal indication for sedation. In 60% of the sedated patients, the sedatives were titrated by nurses based on sedation scales. The Richmond Agitation Sedation Scale was used in 80% of the patients, and the Behavioral Pain Scale was used in 92%. The common sedatives and opioids used were midazolam (58.1%), propofol (40.5%), and sufentanil (67.5%). The cerebral monitoring devices available in the participating ICUs were transcranial Doppler ultrasound (100%), intracranial and intraventricular pressure monitoring (93.3%), and brain tissue oxygenation (60%). Cerebral monitoring by one or more monitoring devices was performed in 62% of the sedated patients. This proportion increased to 74% in the subgroup of patients with intracranial hypertension, with multimodal cerebral monitoring in 43.6%. The doses of midazolam and sufentanil were lower in sedated patients managed based on a sedation/analgesia scale. Conclusions Midazolam and sufentanil are frequently used, often in combination, in French ICUs instead of alternative drugs. In our study, cerebral monitoring was performed in more than 60% of the sedated patients, although that proportion is still insufficient. Future efforts should stress the use of multiple monitoring modes and adherence to the indications for sedation to improve care of patients with BI. Our study suggests that the use of sedation and analgesia scales by nurses involved in the management of patients with BI could decrease the dosages of midazolam and sufentanil administered. Updated guidelines are needed for the management of sedation/analgesia in patients with BI.

Considérant une économie où existe un système de cotisations sociales (ou d'imposition) proportionnelles au salaire d'activité - ce qui est peu différent de la situation française actuelle - cet article s'interroge sur les incidences économiques d'une modification des taux de cotisation: augmentation uniforme d'une part, modulation selon les secteurs d'activité d'autre part. De telles actions affectent la distribution des revenus, donc l'épargne dégagée et l'accumulation du capital, et leur incidence doit être analysée dans un contexte dynamique. S'appuyant sur un modèle néoclassique de croissance à plusieurs secteurs, mais où un seul bien est produit, cette étude généralise des travaux antérieurs de Feldstein. Il est montré que, lorsque le taux de cotisation est identique pour tous les secteurs, et à moins qu'un seul secteur ne soit productif, le poids de l'impôt est entièrement supporté par les salariés. De façon générale, toute augmentation uniforme de ce taux provoque une diminution de bien-être social supérieure au surcroît de taxe collecté. Par contre, toute modification des taux qui, à recettes fiscales totales inchangées, allège la charge du secteur le moins capitalistique au détriment du secteur le plus capitalistique, est bénéfique aux salariés. Elle se traduit par un accroissement de bien-être social, même si, le plus souvent, elle provoque une baisse du revenu national. /// This article considers an economy where wages are taxed proportionnally, and studies the economic incidence of changes in tax rates: uniform increase on one side, and, on the other, changes differentiated between economic sectors. Such actions affect income distribution, hence saving and capital accumulation; therefore must be analyzed within a dynamic framework. Using a neoclassical multisector growth model, with only one produced good, this study generalizes Feldstein's previous works. It is shown that, when the tax rate is uniform, and unless one sector only is productive, labor bears the entire burden of the tax, in the short run and in the long term. Generally speaking, if this rate is changed, the incremental tax revenue is less than the net losses of labor and capital. But labor benefits from any reform which, without changing total tax revenue, increases the tax rate in the more capital intensive sector and reduces it in the more labor intensive sector. Such an action increases social welfare although, most often, it implies a decrease in national income.

[fre] Considérant une économie où existe un système de cotisations sociales (ou d'imposition) proportionnelles au salaire d'activité — ce qui est peu différent de la situation française actuelle — cet article s'interroge sur les incidences économiques d'une modification des taux de cotisation : augmentation uniforme d'une part, modulation selon les secteurs d'activité d'autre part. De telles actions affectent la distribution des revenus donc épargne dégagée et accumulation du capital et leur incidence doit être analysée dans un contexte dynamique appuyant sur un modèle néoclassique de croissance plusieurs secteurs mais où un seul bien est produit cette étude généralise des travaux antérieurs de Feldstein Il est montré que lorsque le taux de cotisation est identique pour tous les secteurs et moins un seul secteur ne soit productif le poids de impôt est entière ment supporté par les salariés De fa on générale toute augmentation uniforme de ce taux provoque une diminution de bien-être social supérieure au surcroît de taxe collecté Par contre toute modification des taux qui recettes fiscales totales inchangées allège la charge du secteur le moins cap tal st que au détriment du secteur le plus capitalistique est bénéfique aux salariés Elle se traduit par un accroissement de bien-être social même si le plus souvent elle provoque une baisse du revenu national Revue économique XXVII 5) septembre 1977 pp 765-792 [eng] Payroll tax incidence in a growing multisector economy . . This article considers an economy where wages are taxed proportionnally, and studies the economic incidence of changes in fax rates : uniform increase on one side, and, on the other, changes differentiated between economic sectars. Such actions affect income distribution, hence saving and capital accumulation ; therefore must be analyzed within a dynamie framework.. Using a neoclassical multisector growth model, with only one produced good, this study generalizes Feldstein's prévious works.. It is shown that, when the tax rate is uniform, and unless one sector only is productive, labor bears the entire burden of the tax, in thé short run and in thé long term. Generally speaking, if this rate is changea, the incremental tax revenue is less than the net losses of labor and capital.. But labor benefits from any reform which, without changing total tax revenue, increases the tax rate in the more capital intensive sector and reduces it in the more labor intensive sector. Such an action increases social welfare although, most often, it implies a decrease ïn national income.

Payroll tax incidence in a growing multisector economy This article considers an economy where wages are taxed proportionnally, and studies the economic incidence of changes in fax rates : uniform increase on one side, and, on the other, changes differentiated between economic sectars. Such actions affect income distribution, hence saving and capital accumulation ; therefore must be analyzed within a dynamie framework. Using a neoclassical multisector growth model, with only one produced good, this study generalizes Feldstein's prévious works. It is shown that, when the tax rate is uniform, and unless one sector only is productive, labor bears the entire burden of the tax, in thé short run and in thé long term. Generally speaking, if this rate is changea, the incremental tax revenue is less than the net losses of labor and capital. But labor benefits from any reform which, without changing total tax revenue, increases the tax rate in the more capital intensive sector and reduces it in the more labor intensive sector. Such an action increases social welfare although, most often, it implies a decrease ïn national income. Considérant une économie où existe un système de cotisations sociales (ou d'imposition) proportionnelles au salaire d'activité — ce qui est peu différent de la situation française actuelle — cet article s'interroge sur les incidences économiques d'une modification des taux de cotisation : augmentation uniforme d'une part, modulation selon les secteurs d'activité d'autre part. De telles actions affectent la distribution des revenus donc épargne dégagée et accumulation du capital et leur incidence doit être analysée dans un contexte dynamique appuyant sur un modèle néoclassique de croissance plusieurs secteurs mais où un seul bien est produit cette étude généralise des travaux antérieurs de Feldstein Il est montré que lorsque le taux de cotisation est identique pour tous les secteurs et moins un seul secteur ne soit productif le poids de impôt est entière ment supporté par les salariés De fa on générale toute augmentation uniforme de ce taux provoque une diminution de bien-être social supérieure au surcroît de taxe collecté Par contre toute modification des taux qui recettes fiscales totales inchangées allège la charge du secteur le moins cap tal st que au détriment du secteur le plus capitalistique est bénéfique aux salariés Elle se traduit par un accroissement de bien-être social même si le plus souvent elle provoque une baisse du revenu national Revue économique XXVII 5) septembre 1977 pp 765-792 Jeanjean Patrick. Incidence des cotisations sociales dans une économie en croissance. In: Revue économique, volume 28, n°5, 1977. pp. 765-792.