Jean Louis Vincent

..We sought to determine whether plasma fibrinolysis was related to the severity of organ dysfunction and/or to the levels of von Willebrand factor (vWF antigen), as a marker of endothelium dysfunction, in critically ill patients...

..The aim of the present observational study was to analyze the influence of patient characteristics and fluid balance on the outcome of ARF in intensive care unit (ICU) patients...

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..Management of nosocomial infection relies on adequate and appropriate antibiotic therapy, which should be selected after discussion with infectious-disease specialists and adapted as microbiological data become available...

..NHBD is an ethically controversial area but one that can improve organ availability for transplantation. Adequate education, ongoing audit, and full transparency are needed in units that use NHBD...

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..In this article, we discuss the risk factors, strategies for prevention, approaches to diagnosis and management plan for the patient with VAP...

..Our aim was to develop consensus guidelines for use of recombinant activated factor VII (rFVIIa) in massive hemorrhage...

..There are relatively few published data regarding ethical issues in the severely brain damaged patient and open discussion of the multiple facets of this difficult area must be encouraged...

..Severe sepsis is defined as sepsis plus organ dysfunction. There is a need to quantify this dysfunction, and several scoring systems have been developed...

..Albumin administration in the critically ill has been the subject of some controversy. We investigated the use of albumin solutions in European intensive care units (ICUs) and its relationship to outcome...

..The topical application of acetylcholine totally reversed these alterations. In conclusion, microvascular blood flow alterations are frequent in patients with sepsis and are more severe in patients with a worse outcome...

..To determine the relationship between sublingual and intestinal mucosal microcirculatory perfusion...

..The primary aim of this study was to determine whether 25 mg/kg (total body weight) of amikacin is an adequate loading dose for these patients...

..To describe the risk factors for the development of and mortality resulting from acute respiratory failure (ARF) in a large patient population...

..To assess morbidity in patients with severe sepsis managed with and without drotrecogin alfa (activated)...

..Combination of this selective iNOS inhibitor with NE allowed a higher arterial pressure and renal blood flow to be maintained...

..v. fluid did not affect outcome...

..To evaluate the influence of tidal volume on the capacity of pulse pressure variation (DeltaPP) to predict fluid responsiveness...

..We studied whether these recommendations met optimal pharmacokinetic criteria for broad-spectrum antibiotic levels in septic shock patients undergoing CRRT...

..The combination of dobutamine with norepinephrine was associated with a better myocardial performance, greater Do(2) and [OV0312]o(2), lower blood lactate concentration and Pco(2) gap, and less anatomic injury...

..Every effort must be made to identify sepsis early so as to optimise the patient's chances of a good outcome...

..Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. However, relatively little information is available about the global epidemiology of such infections...

..The objective of this study was to develop a model to identify patients in whom drotrecogin alfa (activated) (DAA) might be administered for periods shorter than the recommended 96 hours...

..As new therapies are introduced, treatment recommendations will need to be adapted accordingly...

..To determine whether hypoalbuminemia is an independent risk factor for poor outcome in the acutely ill, and to assess the potential of exogenous albumin administration for improving outcomes in hypoalbuminemic patients...

..To evaluate the effects of fluid administration on microcirculatory alterations in sepsis...

..The therapeutic benefit of high-dose aminoglycoside therapy should be balanced with its potential renal effects in septic patients receiving CRRT...

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..We explored a possible association between TNF-alpha, interleukin (IL)-6, IL-10, transforming growth factor (TGF)-beta, and interferon (IFN)-gamma cytokine polymorphisms, their in vivo production, and mortality from cardiogenic shock...

..We hypothesized that microvascular blood flow alterations are present in patients with severe heart failure and cardiogenic shock...

..Here, we will outline the limitations and advances of EBM in intensive care medicine, by discussing the key findings in the last few years from studies of therapeutic agents for ICU patients...

..Infusion of ethyl pyruvate (EP) solution can improve outcome in a clinically relevant, large- animal model of septic shock resulting from fecal peritonitis...

..Improved understanding of the systemic factors involved in the development and evolution of ARDS and MODS should facilitate the development of new therapeutic agents that will improve outcomes in these patients...

..We used the INDEPTH (International Integrated Database for the Evaluation of Severe Sepsis and Drotrecogin alfa activated) database to investigate the reported cause of death in patients with severe sepsis...

..In this article, several key factors influencing the systemic and regional efficacy of blood transfusion will be reviewed...

..In this clinically relevant model of septic shock due to peritonitis, vasopressin administration (alone or with norepinephrine) can prolong survival...

..Sepsis and multiple organ failure are common complications in intensive care unit (ICU) patients and are associated with considerable morbidity and mortality...

..The effects of red blood cell transfusions on microvascular perfusion are not well defined. We investigated the effects of red blood cell transfusion on sublingual microvascular perfusion in patients with sepsis...

..To assess the effects of different doses of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in patients with septic shock...

..While intensive early resuscitation remains the cornerstone of management, new approaches are beginning to form part of sepsis management protocols and will lead to improved outcomes for patients with this disease process...

..Cerebral microcirculatory alterations may play a role; however, experimental data are scarce. This study sought to investigate whether the cerebral microcirculation is altered in a clinically relevant animal model of septic shock...

..We used data from a large, multicenter observational study to assess whether late-onset ARDS was similarly associated with worse outcomes compared with early-onset ARDS...

..This was a planned substudy from the European observational Sepsis Occurrence in Acutely ill Patients (SOAP) study to investigate the possible impact of insulin-treated diabetes on morbidity and mortality in ICU patients...

..4 [46.6-64.9] vs. 79.3 [67.2-83.2]%; p =.02). CONCLUSIONS: Microcirculatory alterations improve rapidly in septic shock survivors but not in patients dying with multiple organ failure, regardless of whether shock has resolved...

..CONCLUSIONS: Despite its strong vasopressor effects vasopressin infusion did not worsen microcirculatory alterations in this patient with distributive shock following cardiac surgery...

..Although associated with an increased risk of bleeding, this is usually procedure-related rather than spontaneous. Although costly, this is a drug that effectively reduces mortality rates in patients with severe sepsis...

..We investigated microvascular density and reactivity in the early phase following cardiac arrest...

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..The purpose of this study was to evaluate the influence of PaCO2 on the cerebral autoregulatory capacity in patients with septic shock...

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..To investigate the effects of activated protein C (APC) in a clinically relevant animal model of septic shock...

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..In endotoxic shock, GLP is increased, but the liver can metabolize this additional load of lactate, so that the hepatosplanchnic area is not a major source of lactate unless the liver becomes profoundly hypoxic...

..There is a need for a prospective study comparing dopamine with other catecholamines in the management of circulatory shock...

..The purpose of the study was to explore determinants of outcome in adults with dengue hemorrhagic fever or dengue shock syndrome...

..Although the incidence of unexpected findings with clinical significance was low, post-mortem examination remains a valuable source of pertinent information that may improve the management of ICU patients...

..This study was designed to evaluate the degree of microcirculatory abnormalities in patients with severe influenza A (H1N1) infection...

..However, CRP is not specific for sepsis, and serum CRP concentrations need to be interpreted in the context of a full clinical examination and the presence of other signs and symptoms of sepsis...

..The aim of the study was to evaluate the ability of different static and dynamic measurements of preload to predict fluid responsiveness in patients with spontaneous respiratory movements...

..To discuss the techniques currently available to evaluate the microcirculation in critically ill patients. In addition, the most clinically relevant microcirculatory alterations will be discussed...

..To quantify sepsis-induced alterations in changes in muscle tissue oxygenation (StO(2)) after an ischemic challenge using near-infrared spectroscopy (NIRS), and to test the hypothesis that these alterations are related to outcome...

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..We used the Sepsis Occurrence in Acutely ill Patients (SOAP) database to investigate differences in the impact of respiratory tract and abdominal sites of infection on organ failure and survival...

..Little information is available on the precise role of alterations of iron metabolism in the development of iron anaemia in critically ill patients...

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..The aim of this review is to summarize recent developments in the epidemiology, diagnosis and management of infection in critically ill patients...

..In the presence of endotoxin, ODQ administration increased MBF and prevented the restoration of FBF. Hence, selective inhibition of sGC may increase splanchnic blood flow in septic shock...

..In this article, we discuss the positive and negative results of trials in this field; some of the possible reasons for the negative results are examined, and directions for the future are suggested...

..The family decides to sue. We present how experts from four different countries assess the medicolegal issues involved in this case...

..These differences may influence clinical trials of therapeutic agents for sepsis, and should be taken into account when analyzing the results...

..CONCLUSIONS: In addition to comorbidities and organ dysfunction, high tidal volumes and positive fluid balance are associated with a worse outcome from ALI/ARDS...

..CONCLUSIONS: In this clinically relevant septic shock model, alkaline phosphatase administration improved gas exchange, decreased interleukin-6 concentrations, and prolonged survival time...

..0 h in the EH group vs. 17.0 h in the control group; p = 0.73). CONCLUSIONS: In this clinically relevant sheep septic shock model, EH decreased blood interleukin-6 concentrations but did not change hemodynamics or improve the outcome...

..Sublingual capnometry could represent a simple, non-invasive method to monitor these microcirculatory alterations in septic patients...

..55). CONCLUSIONS: The administration of 5 mug/kg.min dobutamine can improve but not restore capillary perfusion in patients with septic shock. These changes are independent of changes in systemic hemodynamic variables...

..01). CONCLUSIONS: Both hypothermia and fever are associated with increased morbidity and mortality rates. Patients with hypothermia have a worse prognosis than those with fever...

..1 +/- 0.5 vs. 9.1 +/- 0.7, P < 0.05). A low-tidal-volume ventilation strategy applied early during septic shock may be beneficial in terms of reducing the amount of lung edema and prolonging survival time...

..Nevertheless, possible adverse effects need to be carefully evaluated before these agents can be widely administered...

..760 [571-1077] kcal, p = .05). CONCLUSIONS: Albumin administration may improve organ function in hypoalbuminemic critically ill patients. It results in a less positive fluid balance and a better tolerance to enteral feeding...

..CONCLUSIONS: Therapeutic limitations are frequent in patients dying in the ICU, with withdrawing more common than withholding life support. Generally members of the ICU staff were satisfied with the end-of-life decisions made...

..CONCLUSIONS: In a mixed medical-surgical ICU, older women have a higher mortality rate than men. This difference is not apparent for patients staying longer in the ICU...

..In addition to age, a positive fluid balance was among the strongest prognostic factors for death. Patients with intensive care unit acquired sepsis have a worse outcome despite similar severity scores on intensive care unit admission...

..4%, p = .01). CONCLUSIONS: ENHANCE provides supportive evidence for the favorable benefit/risk ratio observed in PROWESS and suggests that more effective use of drotrecogin alfa (activated) might be obtained by initiating therapy earlier...

..CONCLUSIONS: MODS and SOFA are reliable outcome predictors. Cardiovascular dysfunction is better related to outcome with the SOFA score than with the MODS...

..The aim of our study was to determine whether the first dose of piperacillin-tazobactam, ceftazidime, cefepime, and meropenem would result in adequate serum drug concentrations in patients with severe sepsis and septic shock...

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..We will review current approaches to each of these categories...

..The revised guidelines are far from perfect, but they represent the best available synthesis of contemporary knowledge in this area and as such should be promoted...

..Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other...

..In conclusion, microcirculatory alterations may play an important role in the development of sepsis-related organ dysfunction. At this stage, therapies to target microcirculation specifically are still being investigated...

..Emphasis is placed on the importance of personalizing blood transfusion according to physiological endpoints rather than arbitrary thresholds...

..Here we will discuss the current situation across Europe, based on the findings from three large international studies...

..To assess the current role of selenium supplementation in critically ill patients...

..However, differences in definitions and in studied populations must be taken into consideration when interpreting and comparing the available epidemiological data...

..To clarify the role of the pulmonary artery catheter in the intensive care unit...

..In this article we will discuss the good, the bad, and the potentially ugly side of international clinical trials in intensive care...

..This prospective, randomized, double-blind study evaluated the influence of aprotinin on various blood markers of inflammation during and after cardiopulmonary bypass...

..All these scoring systems will need to be updated with time as ICU populations change and new diagnostic, therapeutic and prognostic techniques become available...

..Systems, such as PIRO, that can characterize patients according to their likely prognosis and response to a specific therapy need to be further developed so that treatments can be appropriately directed for individual patients...