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Empiric coverage for candidaemia should be considered if multiple sites are colonized with Candida or for patients with bone marrow or organ transplants, hematologic malignancy, femoral catheterization or when patients are receiving total parenteral nutrition or prolonged administration of broad-spectrum antibiotics [2, 8]. For uncomplicated infection (i.e., not associated with suppurative thrombosis, endocarditis or metastatic infection) with septic manifestations resolving within 72 h of catheter removal, intravenous antimicrobial therapy is recommended for the following duration based on the organism isolated (Fig. 1): * Staphylococcus aureus: 14 days * Coagulase-negative staphylococci: 7 days * Enterococci and Gram-negative bacilli: 10 to 14 days * Candida: 14 days [IMAGE OMITTED: Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system.

Background Road traffic injuries are the leading cause of death among young people worldwide. While advances in vehicle safety have reduced some of the risks, the speed and quality of pre-hospital care are critical to prevent fatalities. In France, patients are cared for by medical teams and firefighters who must work together as closely as possible to ensure the best possible survival rate. However, there is a lack of standardised scales to assess the performance of these multidisciplinary teams. This study aimed to create and validate a roadside rescue skills assessment scale, the RoadRes-Q scale, for healthcare teams. Methods We used a two-round Delphi method to develop the RoadRes-Q scale. A panel of 9 international roadside rescue experts, including 7 firefighters and 2 engineers in road rescue equipment, agreed to participate. The scale covers five key areas: healthcare provider protection, site securing, vehicle securing, first aid delivery, and patient extrication. The final version was tested during two one-day simulation-based training sessions, each involving 22 participants: 6 healthcare staff, 14 firefighters, and 2 simulated victims. Assessors completed the scale during and after each scenario, focusing on internal consistency and inter-observer reliability. Results The RoadRes-Q scale consists of 60 items. Internal consistency was excellent (Cronbach’s alpha of 0.86), indicating that items were non-redundant and consistently measured the required competencies. However, inter-observer reliability was low (intra-class correlation coefficient of 0.48), suggesting variability between assessors. Satisfaction among participants to the simulation-based training courses was high, and their knowledge increased. Conclusions The RoadRes-Q scale proved to be a valid and reliable scale for evaluating both technical and non-technical skills. While internal consistency was strong, improvements are needed in inter-observer reliability. Structured training for assessors and video-based assessments could enhance reproducibility. The RoadRes-Q scale has the potential for assessing the quality and safety of care provided by healthcare teams in roadside rescue situations. Registration As the study did not involve interventional research or patient participation, ethics committee approval was not required, but it received approval from the scientific referents of the Faculty of Medicine of Poitiers, and participants provided informed consent for using their anonymised data.

Background This study aimed to provide a new global and comprehensive evaluation of recent ICU ventilators taking into account both technical performances and ergonomics. Methods Six recent ICU ventilators were evaluated. Technical performances were assessed under two FIO 2 levels (100%, 50%), three respiratory mechanics combinations ( Normal : compliance [ C ] = 70 mL cmH 2 O −1 /resistance [ R ] = 5 cmH 2 O L −1  s −1 ; Restrictive : C  = 30/ R  = 10; Obstructive : C  = 120/ R  = 20), four exponential levels of leaks (from 0 to 12.5 L min −1 ) and three levels of inspiratory effort (P0.1 = 2, 4 and 8 cmH 2 O), using an automated test lung. Ergonomics were evaluated by 20 ICU physicians using a global and comprehensive model involving physiological response to stress measurements (heart rate, respiratory rate, tidal volume variability and eye tracking), psycho-cognitive scales (SUS and NASA-TLX) and objective tasks completion. Results Few differences in terms of technical performance were observed between devices. Non-invasive ventilation modes had a huge influence on asynchrony occurrence. Using our global model, either objective tasks completion, psycho-cognitive scales and/or physiological measurements were able to depict significant differences in terms of devices’ usability. The level of failure that was observed with some devices depicted the lack of adaptation of device’s development to end users’ requests. Conclusions Despite similar technical performance, some ICU ventilators exhibit low ergonomics performance and a high risk of misusage.

Background Lung point-of-care ultrasonography (L-POCUS) is highly effective in detecting pulmonary peripheral patterns and may allow early identification of patients who are likely to develop an acute respiratory distress syndrome (ARDS). We hypothesized that L-POCUS performed within the first 48 hours of non-critical patients with suspected COVID-19 would identify those with a high-risk of worsening. Methods POCUSCO was a prospective, multicenter study. Non-critical adult patients who presented to the emergency department (ED) for suspected or confirmed COVID-19 were included and had L-POCUS performed within 48 hours following ED presentation. The lung damage severity was assessed using a previously developed score reflecting both the extension and the intensity of lung damage. The primary outcome was the rate of patients requiring intubation or who died within 14 days following inclusion. Results Among 296 patients, 8 (2.7%) met the primary outcome. The area under the curve (AUC) of L-POCUS was 0.80 [95%CI:0.60–0.94]. The score values which achieved a sensibility >95% in defining low-risk patients and a specificity >95% in defining high-risk patients were <1 and ≥16, respectively. The rate of patients with an unfavorable outcome was 0/95 (0%[95%CI:0–3.9]) for low-risk patients (score = 0), 4/184 (2.17%[95%CI:0.8–5.5]) for intermediate-risk patients (score 1–15) and 4/17 (23.5%[95%CI:11.4–42.4]) for high-risk patients (score ≥16). In confirmed COVID-19 patients (n = 58), the AUC of L-POCUS was 0.97 [95%CI:0.92–1.00]. Conclusion L-POCUS performed within the first 48 hours following ED presentation allows risk-stratification of patients with non-severe COVID-19.

The objective of the study was to perform a cost-effectiveness analysis of bundled devices (BDs) versus standard devices (SDs) for the prevention of unscheduled peripheral venous catheter (PVC) removal due to complication from a French investigator-initiated, open-label, single center, randomized-controlled, two-by-two factorial trial (CLEAN-3 study). A 14-day time non homogeneous semi-markovian model was performed to be fitted to longitudinal individual patient data from CLEAN-3 database. This model includes five health states and eight transitional events; a base case scenario, two scenario analyses and bootstrap sensitivity analyses were performed. The cost-effectiveness criterion was the cost per patient with unscheduled PVC removal avoided. 989 adult (age≥18 years) patients were analyzed to compare the BDs group (494 patients), and the SDs group (495 patients). The assessed intervention was a combination of closed integrated catheters, positive displacement needleless-connectors, disinfecting caps, and single-use prefilled flush syringes compared with the use of open catheters and three-way stopcocks for treatment administration. For the base case scenario, an unscheduled 1 st PVC removal before discharge was significantly more frequent in the SDs group (235 patients (47.5%) in the SDs group and 172 patients (34.8%) in the BDs group, p = 0.00006). After adjustment for 1 st catheter time, the number of patients with unscheduled PVC removal per day was of 16 (95%CI: 15; 18) patients (out of 100) in the BDs group and of 26 (95%CI: 24; 28) patients (out of 100) in the SDs group. The mean cost per patient (adjusted on catheter-time) was of €144 (95%CI: €135-€154) for patients in the SDs group versus €102 (95%CI: €95-€109) for patients in the BDs group; the mean saving per patient was of €42 (95%CI: €32-€54). As a consequence, the assessed BDs strategy was less costly and more effective than the SDs strategy. Trail registration: CLEAN-3 study is registered with ClinicalTrials.gov, NCT03757143 .

IntroductionAcute respiratory failure is a life-threatening condition frequently found in the emergency department. High-flow nasal oxygen (HFNO) is increasingly used in emergency departments for patients with hypoxaemic acute respiratory failure. However, despite the increasing number of studies, its potential advantages regarding the need for therapeutic escalation and mortality have not been precisely evaluated. Our objective is to compare conventional oxygen therapy to HFNO when they are initiated during the first hour following the patient’s arrival at the emergency department, with the hypothesis that HFNO would reduce the need for ventilatory therapy escalation.Methods and analysisThis is a multicentric, prospective, open and randomised superiority study. 500 inpatients will be randomised (1:1) to receive conventional oxygen therapy or HNFO. The primary outcome is a failure in the oxygen therapy defined as the need for a therapeutic escalation within 4 hours after therapy initiation.Ethics and disseminationThe study has been submitted and approved by the Comité de Protection des Personnes Nord Ouest IV (20 October 2020). As required, a notification was sent to the Agence nationale de sécurité du médicament et des produits de santé (22 October 2020). The research results will be published in peer-reviewed publications and presented at international conferences.Trial registration numberNCT04607967.

Lung point-of-care ultrasonography (L-POCUS) is highly effective in detecting pulmonary peripheral patterns and may allow early identification of patients who are likely to develop an acute respiratory distress syndrome (ARDS). We hypothesized that L-POCUS performed within the first 48 hours of non-critical patients with suspected COVID-19 would identify those with a high-risk of worsening. POCUSCO was a prospective, multicenter study. Non-critical adult patients who presented to the emergency department (ED) for suspected or confirmed COVID-19 were included and had L-POCUS performed within 48 hours following ED presentation. The lung damage severity was assessed using a previously developed score reflecting both the extension and the intensity of lung damage. The primary outcome was the rate of patients requiring intubation or who died within 14 days following inclusion. Among 296 patients, 8 (2.7%) met the primary outcome. The area under the curve (AUC) of L-POCUS was 0.80 [95%CI:0.60-0.94]. The score values which achieved a sensibility >95% in defining low-risk patients and a specificity >95% in defining high-risk patients were <1 and ≥16, respectively. The rate of patients with an unfavorable outcome was 0/95 (0%[95%CI:0-3.9]) for low-risk patients (score = 0), 4/184 (2.17%[95%CI:0.8-5.5]) for intermediate-risk patients (score 1-15) and 4/17 (23.5%[95%CI:11.4-42.4]) for high-risk patients (score ≥16). In confirmed COVID-19 patients (n = 58), the AUC of L-POCUS was 0.97 [95%CI:0.92-1.00]. L-POCUS performed within the first 48 hours following ED presentation allows risk-stratification of patients with non-severe COVID-19.

Background The calcaneus secundarius (CS) is an accessory ossicle of the anterior facet of the calcaneus and is usually asymptomatic. This accessory bone can be frequently mistaken for a fracture of the anterior process of the calcaneus. Few reports of symptomatic CS have been published, and physicians need to be familiar with imaging strategies when encountering chronic ankle pain or in case of suspicion of fracture of the anterior process of the calcaneus. Case presentation We describe the case of symptomatic CS in a professional soccer player injured during a match. First, computed tomography showed a large CS. Second, magnetic resonance imaging (MRI) demonstrated synchondrosis between the CS and the calcaneus, as well as edema (high MR T2 signal) within it, corresponding to posttraumatic edema. The patient was successfully treated with nonsteroidal anti-inflammatory drugs and physiotherapy; no surgical management was necessary. At the 4-week follow-up, he was pain-free and returned to activity. Conclusion This case illustrates the role of imaging for the diagnosis of CS in cases of acute pain of the foot. CT, as well as MRI, helped to confirm the diagnosis of CS traumatized synchondrosis, which can be mistaken for a fracture.

IntroductionDyspnea is a common chief complaint leading to emergency department (ED) visits. Multiple conditions may cause or be associated with dyspnoea, including bacterial pneumonia, acute heart failure (AHF), exacerbation of chronic obstructive pulmonary disease (COPD) or asthma and pulmonary embolism. Each of these diagnoses has a specific treatment recommended by international guidelines. Inappropriate treatment in the ED is more frequent among elderly patients and is independently associated with in-hospital mortality. Point-of-care ultrasound is immediately available at the bedside. Lung and cardiac ultrasound (LuCUS) offers excellent diagnostic accuracy for bacterial pneumonia, AHF and COPD exacerbations, even in elderly patients. The primary objective of the LUC REED trial is to evaluate the impact of a LuCUS-guided strategy versus standard care on reducing inappropriate treatment of dyspnoea in elderly ED patients.Methods and analysisThe LUC REED trial is a prospective, interventional, multicentre, stepped-wedge randomised controlled trial designed to assess the superiority of a LuCUS-guided strategy over standard care in ensuring treatment appropriateness for dyspnoea in elderly ED patients. The study will include 504 patients over 2 years. Patients aged >65 years presenting with acute dyspnoea and signs of severity (respiratory rate ≥22 and SpO2 <92% on room air) will be enrolled. Each ED (cluster) will start with a control phase. Every 3 months, one centre will transition to the intervention phase (LuCUS-guided strategy). The primary outcome is treatment inappropriateness within the first hour after inclusion, assessed by comparing administered treatment to the final diagnosis adjudicated by two experts.Ethics and disseminationEthics final approval was obtained from the Institutional Review Board of France—Est IV on 4 April 2025 (2024-A01678-39). Results will be published in peer-reviewed international journals.Trial registration numberNCT06807983.

Background This narrative review was written by an expert panel to the members of the jury to help in the development of clinical practice guidelines on oxygen therapy. Results According to the expert panel, acute hypoxemic respiratory failure was defined as PaO 2  < 60 mm Hg or SpO 2  < 90% on room air, or PaO 2 /FiO 2  ≤ 300 mm Hg. Supplemental oxygen should be administered according to the monitoring of SpO 2 , with the aim at maintaining SpO 2 above 92% and below 98%. Noninvasive respiratory supports are generally reserved for the most hypoxemic patients with the aim of relieving dyspnea. High-flow nasal cannula oxygen (HFNC) seems superior to conventional oxygen therapy (COT) as a means of avoiding intubation and may therefore be should probably be used as a first-line noninvasive respiratory support in patients requiring more than 6 L/min of oxygen or PaO 2 /FiO 2  ≤ 200 mm Hg and a respiratory rate above 25 breaths/minute or clinical signs of respiratory distress, but with no benefits on mortality. Continuous positive airway pressure (CPAP) cannot currently be recommended as a first-line noninvasive respiratory support, since its beneficial effects on intubation remain uncertain. Despite older studies favoring noninvasive ventilation (NIV) over COT, recent clinical trials fail to show beneficial effects with NIV compared to HFNC. Therefore, there is no evidence to support the use of NIV or CPAP as first-line treatment if HFNC is available. Clinical trials do not support the hypothesis that noninvasive respiratory supports may lead to late intubation. The potential benefits of awake prone positioning on the risk of intubation in patients with COVID-19 cannot be extrapolated to patients with another etiology. Conclusions Whereas oxygen supplementation should be initiated for patients with acute hypoxemic respiratory failure defined as PaO 2 below 60 mm Hg or SpO 2  < 90% on room air, HFNC should be the first-line noninvasive respiratory support in patients with PaO 2 /FiO 2  ≤ 200 mm Hg with increased respiratory rate. Further studies are needed to assess the potential benefits of CPAP, NIV through a helmet and awake prone position in patients with acute hypoxemic respiratory failure not related to COVID-19.