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Papers by olivier mimoz

Infection Control and Hospital Epidemiology, 2012

Additional file 1: Supplementary Material of "Local signs at insertion site and catheter-rel... more Additional file 1: Supplementary Material of "Local signs at insertion site and catheter-related bloodstream infections. A post hoc analysis using individual data of four RCTs". Description: supplementary methods (data sources, patients and study catheters), supplementary Figures (Figure E1 flow-chart; Figure E2 Risk for developing CRBSI for non-purulent discharge and purulent discharge by different subgroups), supplementary Tables (Table E1: Univariate logistic model for catheter-related bloodstream infection, stratification by ICU; Table E2: Multivariate logistic models for CRBSI forcing the variable ≥ 1 local sign, stratification by ICU; Table E3: Multivariate logistic models for CRBSI forcing the variable redness, stratication by ICU; Table E4: Multivariate logistic models for CRBSI forcing the variable pain, stratification by ICU; Table E5: Multivariate logistic models for CRBSI forcing the variable non-purulent discharge, stratification by ICU; Table E6: Multivariate...

Supplementary_Material for Impact of Low-Dose Hydrocortisone on the Incidence of Atrial Fibrillat... more Supplementary_Material for Impact of Low-Dose Hydrocortisone on the Incidence of Atrial Fibrillation in Patients With Septic Shock: A Propensity Score-Inverse Probability of Treatment Weighting Cohort Study by Yoann Launey, Sigismond Lasocki, Karim Asehnoune, Baptiste Gaudriot, Claire Chassier, Raphael Cinotti, Pascale Le Maguet, Leila Laksiri, Olivier Mimoz, Audrey Tawa, Nicolas Nesseler, Yannick Malledant, Bastien Perrot, and Philippe Seguin in Journal of Intensive Care Medicine

Introduction: Prolonged fever occurs with infectious and noninfectious diseases but is poorly stu... more Introduction: Prolonged fever occurs with infectious and noninfectious diseases but is poorly studied in intensive care units. The aims of this prospective multicenter noninterventional study were to determine the incidence and etiologies of prolonged fever in critically ill patients and to compare outcomes for prolonged fever and short-lasting fever. Methods: The study involved two periods of 2 months each, with 507 patients hospitalized ≥ 24 hours. Fever was

Chest, 2021

BACKGROUND Ventilator-associated pneumonia (VAP) is the most frequent healthcare-associated infec... more BACKGROUND Ventilator-associated pneumonia (VAP) is the most frequent healthcare-associated infection in severely ill patients and aspiration of contaminated oropharyngeal content around the cuff of the tracheal tube is the main route of contamination. RESEARCH QUESTION Is continuous regulation of tracheal cuff pressure using a pneumatic device superior to manual assessment three times daily using a portable manometer (routine care) in preventing VAP in severe trauma patients? STUDY DESIGN AND METHODS In this open-label, randomised-controlled superiority trial conducted in 13 French intensive care units, we enrolled adults (age ≥18 years) suffering from severe trauma (Injury severity score >15) and requiring invasive mechanical ventilation for 48 hours or longer. Patients were randomly assigned (1:1) via a secure web-based random number generator in permuted blocks of variable sizes to one of two groups according to the method of tracheal cuff pressure control. The primary outcome was the proportion of patients developing VAP within 28 days following the tracheal intubation, as determined by two assessors masked to group assignment, in the modified intention-to-treat population. This study is closed to new participants. RESULTS 434 patients were recruited between 31/07/2015 and 15/02/2018, of which 216 were assigned to the intervention group and 218 to the control group. 73 patients (33·8%) developed at least one episode of VAP within 28 days following the tracheal intubation in the intervention group compared with 64 patients (29·4%) in the control group (adjusted sub-distribution HR 0·96 [95% CI 0·76-1·20]; p=0·71). No serious adverse events related to the use of the pneumatic device were noted. INTERPRETATION Continuous regulation of cuff pressure of the tracheal tube using a pneumatic device was not superior to routine care in preventing VAP in severe trauma patients.

Annales Francaises D Anesthesie Et De Reanimation, 2014

Anesthésie & Réanimation, 2021

BMJ Quality & Safety, 2020

BackgroundData regarding vascular access device use and outcomes are limited. In part, this gap r... more BackgroundData regarding vascular access device use and outcomes are limited. In part, this gap reflects the absence of guidance on what variables should be collected to assess patient outcomes. We sought to derive international consensus on a vascular access minimum dataset.MethodsA modified Delphi study with three rounds (two electronic surveys and a face-to-face consensus panel) was conducted involving international vascular access specialists. In Rounds 1 and 2, electronic surveys were distributed to healthcare professionals specialising in vascular access. Survey respondents were asked to rate the importance of variables, feasibility of data collection and acceptability of items, definitions and response options. In Round 3, a purposive expert panel met to review Round 1 and 2 ratings and reach consensus (defined as ≥70% agreement) on the final items to be included in a minimum dataset for vascular access devices.ResultsA total of 64 of 225 interdisciplinary healthcare professi...

Bioanalysis, 2021

Aim: To compare methods of quantifying serum hepcidin (based on MS and ELISA) and their ability t... more Aim: To compare methods of quantifying serum hepcidin (based on MS and ELISA) and their ability to diagnose true iron deficiency anemia in critically ill patients. Materials & methods: Serum hepcidin was measured in 119 critically ill patients included in the HEPCIDANE clinical trial, using either an ultra-sensitive ELISA kit (from DRG) or two different MS methods. Results: The results show a good correlation between the different methods studied. The Bland–Altman analysis and the Kappa test for clinical groups show a good or very good agreement between the different tests. Conclusion: ELISA or MS show a satisfactory commutability to quantify serum hepcidin. This is of great importance for the determination of therapeutic strategies in iron deficiency.

Clinical Infectious Diseases, 2020

Background Ultrasound (US) guidance is frequently used in critically ill patients for central ven... more Background Ultrasound (US) guidance is frequently used in critically ill patients for central venous catheter (CVC) insertion. The effect of US on infectious risk remains controversial, and randomized controlled trials (RCTs) have assessed mainly noninfectious complications. This study assessed infectious risk associated with catheters inserted with US guidance vs use of anatomical landmarks. Methods We used individual data from 3 large RCTs for which a prospective, high-quality data collection was performed. Adult patients were recruited in various intensive care units (ICUs) in France as soon as they required short-term CVC insertion. We applied marginal Cox models with inverse probability weighting to estimate the effect of US-guided insertion on catheter-related bloodstream infections (CRBSIs, primary outcome) and major catheter-related infections (MCRIs, secondary outcome).We also evaluated insertion site colonization at catheter removal. Results Our post hoc analysis included ...

Critical Care, 2021

Background Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficien... more Background Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnose in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥ 5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm, patients were treated with intravenous iron (1 g of ferric carboxymaltose) when hepcidin was < 20 μg/l and with intravenous iron and erythropoietin for 20 ≤ hepcidin < 41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ...

JAMA Otolaryngology–Head & Neck Surgery, 2021

evaluated the duration of culturable SARS-CoV-2 in hospitalized patients with COVID-19. The media... more evaluated the duration of culturable SARS-CoV-2 in hospitalized patients with COVID-19. The median time from the onset of illness to viral clearance in culture was 7 days (95% CI, 5-10 days), being the last positive viral culture 12 days after symptom onset. 4 We agree with the authors that it is time to look beyond surgery and surgeons and, for the sake of frontline workers, evaluate the infectiveness risk at the time of tracheostomy. Culture of tracheal secretions could be the next step. This knowledge may help us to determine the proper timing of the tracheostomy.

Critical Care, 2020

Background Little is known on the association between local signs and intravascular catheter infe... more Background Little is known on the association between local signs and intravascular catheter infections. This study aimed to evaluate the association between local signs at removal and catheter-related bloodstream infections (CRBSI), and which clinical conditions may predict CRBSIs if inflammation at insertion site is present. Methods We used individual data from four multicenter randomized controlled trials in intensive care units (ICUs) that evaluated various prevention strategies for arterial and central venous catheters. We used multivariate logistic regressions in order to evaluate the association between ≥ 1 local sign, redness, pain, non-purulent discharge and purulent discharge, and CRBSI. Moreover, we assessed the probability for each local sign to observe CRBSI in subgroups of clinically relevant conditions. Results A total of 6976 patients and 14,590 catheters (101,182 catheter-days) and 114 CRBSI from 25 ICUs with described local signs were included. More than one local ...

JAMA Otolaryngology–Head & Neck Surgery, 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily transmitted person-to-p... more Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily transmitted person-to-person through the aerosolization of droplets containing contaminated nasopharyngeal secretions. 1 Povidone iodine (PI) solutions at concentrations as low as 0.5% rapidly inactivate SARS-CoV-2 in vitro with contact times as short as 15 seconds. 2 We investigated whether nasopharyngeal application of PI could reduce the viral load of patients with nonsevere coronavirus disease 2019 (COVID-19) symptoms.

Annals of Intensive Care, 2020

The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of P... more The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing g...

Critical Care, 2020

Background Chlorhexidine-gluconate (CHG) impregnated dressings may prevent catheter-related blood... more Background Chlorhexidine-gluconate (CHG) impregnated dressings may prevent catheter-related bloodstream infections (CRBSI). Chlorhexidine-impregnated sponge dressings (sponge-dress) and gel dressings (gel-dress) have never been directly compared. We used the data collected for two randomized-controlled trials to perform a comparison between sponge-dress and gel-dress. Methods Adult critically ill patients who required short-term central venous or arterial catheter insertion were recruited. Our main analysis included only patients with CHG-impregnated dressings. The effect of gel-dress (versus sponge-dress) on major catheter-related infections (MCRI) and CRBSI was estimated using multivariate marginal Cox models. The comparative risks of dressing disruption and contact dermatitis were evaluated using logistic mix models for clustered data. An explanatory analysis compared gel-dress with standard dressings using either CHG skin disinfection or povidone iodine skin disinfection. Result...

European Journal of Anaesthesiology, 2018

, for the BIVILI investigators M , the ATLANREA group M BACKGROUND Knowledge of the factors assoc... more , for the BIVILI investigators M , the ATLANREA group M BACKGROUND Knowledge of the factors associated with the decision to withdraw or withhold life support (WWLS) in brain-injured patients is limited. However, most deaths in these patients may involve such a decision. OBJECTIVES To identify factors associated with the decision to WWLS in brain-injured patients requiring mechanical ventilation who survive the first 24 h in the ICU, and to analyse the outcomes and time to death. DESIGN A retrospective observational multicentre study. SETTINGS Twenty French ICUs in 18 university hospitals. PATIENTS A total of 793 mechanically ventilated braininjured adult patients. INTERVENTIONS None. MAIN OUTCOME MEASURES Decision to WWLS within 3 months of ICU admission, and death or Glasgow Outcome Scale (GOS) score at day 90. RESULTS A decision to WWLS was made in 171 patients (22%), of whom 89% were dead at day 90. Out of the 247 deaths recorded at day 90, 153 (62%) were observed after a decision to WWLS. The median time between admission and death when a decision to WWLS was made was 10 (5 to 20) days vs. 10 (5 to 26) days when no end-of-life decision was made (P < 0.924). Among the 18 patients with a decision to WWLS who were still alive at day 90, three patients (2%) had a GOS score of 2, nine patients (5%) had a GOS score of 3 and five patients (3%) a GOS score of 4. Older age, presence of one nonreactive and dilated pupil, Glasgow Coma Scale less than 7, barbiturate use, acute respiratory distress syndrome and worsening lesions on computed tomography scans were each independently associated with decisions to WWLS. CONCLUSION Using a nationwide cohort of brain-injured patients, we observed a high proportion of deaths associated with an end-of-life decision. Older age and several disease severity factors were associated with the decision to WWLS.

Anaesthesia Critical Care & Pain Medicine, 2020

Infection Control and Hospital Epidemiology, 2012

Additional file 1: Supplementary Material of "Local signs at insertion site and catheter-rel... more Additional file 1: Supplementary Material of "Local signs at insertion site and catheter-related bloodstream infections. A post hoc analysis using individual data of four RCTs". Description: supplementary methods (data sources, patients and study catheters), supplementary Figures (Figure E1 flow-chart; Figure E2 Risk for developing CRBSI for non-purulent discharge and purulent discharge by different subgroups), supplementary Tables (Table E1: Univariate logistic model for catheter-related bloodstream infection, stratification by ICU; Table E2: Multivariate logistic models for CRBSI forcing the variable ≥ 1 local sign, stratification by ICU; Table E3: Multivariate logistic models for CRBSI forcing the variable redness, stratication by ICU; Table E4: Multivariate logistic models for CRBSI forcing the variable pain, stratification by ICU; Table E5: Multivariate logistic models for CRBSI forcing the variable non-purulent discharge, stratification by ICU; Table E6: Multivariate...

Supplementary_Material for Impact of Low-Dose Hydrocortisone on the Incidence of Atrial Fibrillat... more Supplementary_Material for Impact of Low-Dose Hydrocortisone on the Incidence of Atrial Fibrillation in Patients With Septic Shock: A Propensity Score-Inverse Probability of Treatment Weighting Cohort Study by Yoann Launey, Sigismond Lasocki, Karim Asehnoune, Baptiste Gaudriot, Claire Chassier, Raphael Cinotti, Pascale Le Maguet, Leila Laksiri, Olivier Mimoz, Audrey Tawa, Nicolas Nesseler, Yannick Malledant, Bastien Perrot, and Philippe Seguin in Journal of Intensive Care Medicine

Introduction: Prolonged fever occurs with infectious and noninfectious diseases but is poorly stu... more Introduction: Prolonged fever occurs with infectious and noninfectious diseases but is poorly studied in intensive care units. The aims of this prospective multicenter noninterventional study were to determine the incidence and etiologies of prolonged fever in critically ill patients and to compare outcomes for prolonged fever and short-lasting fever. Methods: The study involved two periods of 2 months each, with 507 patients hospitalized ≥ 24 hours. Fever was

Chest, 2021

BACKGROUND Ventilator-associated pneumonia (VAP) is the most frequent healthcare-associated infec... more BACKGROUND Ventilator-associated pneumonia (VAP) is the most frequent healthcare-associated infection in severely ill patients and aspiration of contaminated oropharyngeal content around the cuff of the tracheal tube is the main route of contamination. RESEARCH QUESTION Is continuous regulation of tracheal cuff pressure using a pneumatic device superior to manual assessment three times daily using a portable manometer (routine care) in preventing VAP in severe trauma patients? STUDY DESIGN AND METHODS In this open-label, randomised-controlled superiority trial conducted in 13 French intensive care units, we enrolled adults (age ≥18 years) suffering from severe trauma (Injury severity score >15) and requiring invasive mechanical ventilation for 48 hours or longer. Patients were randomly assigned (1:1) via a secure web-based random number generator in permuted blocks of variable sizes to one of two groups according to the method of tracheal cuff pressure control. The primary outcome was the proportion of patients developing VAP within 28 days following the tracheal intubation, as determined by two assessors masked to group assignment, in the modified intention-to-treat population. This study is closed to new participants. RESULTS 434 patients were recruited between 31/07/2015 and 15/02/2018, of which 216 were assigned to the intervention group and 218 to the control group. 73 patients (33·8%) developed at least one episode of VAP within 28 days following the tracheal intubation in the intervention group compared with 64 patients (29·4%) in the control group (adjusted sub-distribution HR 0·96 [95% CI 0·76-1·20]; p=0·71). No serious adverse events related to the use of the pneumatic device were noted. INTERPRETATION Continuous regulation of cuff pressure of the tracheal tube using a pneumatic device was not superior to routine care in preventing VAP in severe trauma patients.

Annales Francaises D Anesthesie Et De Reanimation, 2014

Anesthésie & Réanimation, 2021

BMJ Quality & Safety, 2020

BackgroundData regarding vascular access device use and outcomes are limited. In part, this gap r... more BackgroundData regarding vascular access device use and outcomes are limited. In part, this gap reflects the absence of guidance on what variables should be collected to assess patient outcomes. We sought to derive international consensus on a vascular access minimum dataset.MethodsA modified Delphi study with three rounds (two electronic surveys and a face-to-face consensus panel) was conducted involving international vascular access specialists. In Rounds 1 and 2, electronic surveys were distributed to healthcare professionals specialising in vascular access. Survey respondents were asked to rate the importance of variables, feasibility of data collection and acceptability of items, definitions and response options. In Round 3, a purposive expert panel met to review Round 1 and 2 ratings and reach consensus (defined as ≥70% agreement) on the final items to be included in a minimum dataset for vascular access devices.ResultsA total of 64 of 225 interdisciplinary healthcare professi...

Bioanalysis, 2021

Aim: To compare methods of quantifying serum hepcidin (based on MS and ELISA) and their ability t... more Aim: To compare methods of quantifying serum hepcidin (based on MS and ELISA) and their ability to diagnose true iron deficiency anemia in critically ill patients. Materials & methods: Serum hepcidin was measured in 119 critically ill patients included in the HEPCIDANE clinical trial, using either an ultra-sensitive ELISA kit (from DRG) or two different MS methods. Results: The results show a good correlation between the different methods studied. The Bland–Altman analysis and the Kappa test for clinical groups show a good or very good agreement between the different tests. Conclusion: ELISA or MS show a satisfactory commutability to quantify serum hepcidin. This is of great importance for the determination of therapeutic strategies in iron deficiency.

Clinical Infectious Diseases, 2020

Background Ultrasound (US) guidance is frequently used in critically ill patients for central ven... more Background Ultrasound (US) guidance is frequently used in critically ill patients for central venous catheter (CVC) insertion. The effect of US on infectious risk remains controversial, and randomized controlled trials (RCTs) have assessed mainly noninfectious complications. This study assessed infectious risk associated with catheters inserted with US guidance vs use of anatomical landmarks. Methods We used individual data from 3 large RCTs for which a prospective, high-quality data collection was performed. Adult patients were recruited in various intensive care units (ICUs) in France as soon as they required short-term CVC insertion. We applied marginal Cox models with inverse probability weighting to estimate the effect of US-guided insertion on catheter-related bloodstream infections (CRBSIs, primary outcome) and major catheter-related infections (MCRIs, secondary outcome).We also evaluated insertion site colonization at catheter removal. Results Our post hoc analysis included ...

Critical Care, 2021

Background Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficien... more Background Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnose in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥ 5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm, patients were treated with intravenous iron (1 g of ferric carboxymaltose) when hepcidin was < 20 μg/l and with intravenous iron and erythropoietin for 20 ≤ hepcidin < 41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ...

JAMA Otolaryngology–Head & Neck Surgery, 2021

evaluated the duration of culturable SARS-CoV-2 in hospitalized patients with COVID-19. The media... more evaluated the duration of culturable SARS-CoV-2 in hospitalized patients with COVID-19. The median time from the onset of illness to viral clearance in culture was 7 days (95% CI, 5-10 days), being the last positive viral culture 12 days after symptom onset. 4 We agree with the authors that it is time to look beyond surgery and surgeons and, for the sake of frontline workers, evaluate the infectiveness risk at the time of tracheostomy. Culture of tracheal secretions could be the next step. This knowledge may help us to determine the proper timing of the tracheostomy.

Critical Care, 2020

Background Little is known on the association between local signs and intravascular catheter infe... more Background Little is known on the association between local signs and intravascular catheter infections. This study aimed to evaluate the association between local signs at removal and catheter-related bloodstream infections (CRBSI), and which clinical conditions may predict CRBSIs if inflammation at insertion site is present. Methods We used individual data from four multicenter randomized controlled trials in intensive care units (ICUs) that evaluated various prevention strategies for arterial and central venous catheters. We used multivariate logistic regressions in order to evaluate the association between ≥ 1 local sign, redness, pain, non-purulent discharge and purulent discharge, and CRBSI. Moreover, we assessed the probability for each local sign to observe CRBSI in subgroups of clinically relevant conditions. Results A total of 6976 patients and 14,590 catheters (101,182 catheter-days) and 114 CRBSI from 25 ICUs with described local signs were included. More than one local ...

JAMA Otolaryngology–Head & Neck Surgery, 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily transmitted person-to-p... more Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily transmitted person-to-person through the aerosolization of droplets containing contaminated nasopharyngeal secretions. 1 Povidone iodine (PI) solutions at concentrations as low as 0.5% rapidly inactivate SARS-CoV-2 in vitro with contact times as short as 15 seconds. 2 We investigated whether nasopharyngeal application of PI could reduce the viral load of patients with nonsevere coronavirus disease 2019 (COVID-19) symptoms.

Annals of Intensive Care, 2020

The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of P... more The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing g...

Critical Care, 2020

Background Chlorhexidine-gluconate (CHG) impregnated dressings may prevent catheter-related blood... more Background Chlorhexidine-gluconate (CHG) impregnated dressings may prevent catheter-related bloodstream infections (CRBSI). Chlorhexidine-impregnated sponge dressings (sponge-dress) and gel dressings (gel-dress) have never been directly compared. We used the data collected for two randomized-controlled trials to perform a comparison between sponge-dress and gel-dress. Methods Adult critically ill patients who required short-term central venous or arterial catheter insertion were recruited. Our main analysis included only patients with CHG-impregnated dressings. The effect of gel-dress (versus sponge-dress) on major catheter-related infections (MCRI) and CRBSI was estimated using multivariate marginal Cox models. The comparative risks of dressing disruption and contact dermatitis were evaluated using logistic mix models for clustered data. An explanatory analysis compared gel-dress with standard dressings using either CHG skin disinfection or povidone iodine skin disinfection. Result...

European Journal of Anaesthesiology, 2018

, for the BIVILI investigators M , the ATLANREA group M BACKGROUND Knowledge of the factors assoc... more , for the BIVILI investigators M , the ATLANREA group M BACKGROUND Knowledge of the factors associated with the decision to withdraw or withhold life support (WWLS) in brain-injured patients is limited. However, most deaths in these patients may involve such a decision. OBJECTIVES To identify factors associated with the decision to WWLS in brain-injured patients requiring mechanical ventilation who survive the first 24 h in the ICU, and to analyse the outcomes and time to death. DESIGN A retrospective observational multicentre study. SETTINGS Twenty French ICUs in 18 university hospitals. PATIENTS A total of 793 mechanically ventilated braininjured adult patients. INTERVENTIONS None. MAIN OUTCOME MEASURES Decision to WWLS within 3 months of ICU admission, and death or Glasgow Outcome Scale (GOS) score at day 90. RESULTS A decision to WWLS was made in 171 patients (22%), of whom 89% were dead at day 90. Out of the 247 deaths recorded at day 90, 153 (62%) were observed after a decision to WWLS. The median time between admission and death when a decision to WWLS was made was 10 (5 to 20) days vs. 10 (5 to 26) days when no end-of-life decision was made (P < 0.924). Among the 18 patients with a decision to WWLS who were still alive at day 90, three patients (2%) had a GOS score of 2, nine patients (5%) had a GOS score of 3 and five patients (3%) a GOS score of 4. Older age, presence of one nonreactive and dilated pupil, Glasgow Coma Scale less than 7, barbiturate use, acute respiratory distress syndrome and worsening lesions on computed tomography scans were each independently associated with decisions to WWLS. CONCLUSION Using a nationwide cohort of brain-injured patients, we observed a high proportion of deaths associated with an end-of-life decision. Older age and several disease severity factors were associated with the decision to WWLS.

Anaesthesia Critical Care & Pain Medicine, 2020