Jean Louis Vincent

..To study differences related to intensive care unit (ICU) structure and patient demography between the various countries of Western Europe...

..In this article we will review current knowledge on the factors involved in the cardiovascular alterations of sepsis, the clinical implications of these alterations, and the possibilities for future treatments...

..To determine current views of European intensive care physicians regarding end-of-life decisions...

..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 optimal adrenergic support in shock is controversial. We investigated whether dopamine administration influences the outcome from shock...

..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...

..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...

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

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

..We studied whether tetrahydrobiopterin administration exerts beneficial effects in an ovine septic shock model...

..A high CL(Cr) was the variable most strongly associated with insufficient drug concentrations...

..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...

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

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

..To determine the effects of fluid challenge on systemic hemodynamic variables and gastric intramucosal partial pressure of carbon dioxide (PCO(2)) in septic patients...

..However, in clinical practice CI values are often not available. We evaluated whether changes in mean arterial pressure (MAP) correlate with changes in CI after fluid challenge in patients with septic shock...

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

..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...

..Post mortem examination rates have decreased worldwide and their usefulness has been challenged. The aim of this study was to compare ante- versus post mortem findings in a multidisciplinary ICU...

..To evaluate whether the SOFA score can be used to develop a model to predict intensive care unit (ICU) mortality in different countries...

..To characterize the hemodynamic course of cardiogenic shock and to relate the cause of death to ongoing cardiac failure or multiple organ dysfunction...

..To determine possible differences in morbidity and mortality between early and late onset of septic shock in ICU patients...

..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...

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

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

..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...

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

..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...

..Antipyretic interventions including acetaminophen and external cooling were associated with lower circulating HSP70 levels. These data challenge the temperature control practices often used routinely in acutely ill patients...

..To compare a low-dose (1 microg) corticotropin stimulation test with the more standard (250 microg) test for the diagnosis of relative adrenal insufficiency...

..In this text, we will return to the basic physiology of cardiac output and its components so that we can better understand the effects of cardiovascular alterations in critically ill patients, and how best to treat them...

..To evaluate the outcome of critically ill patients infected with antimicrobial resistant microorganisms, and to analyse the factors involved in the development of antimicrobial resistance...

..The aim of this study was to assess the effects of increasing MAP using norepinephrine (NE) on hemodynamic and metabolic variables and on microvascular reactivity in patients with septic shock...

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

..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...

..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 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...

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

..This narrative review provides a descriptive overview of the clinical value of this biomarker in the diagnosis, prognosis and therapeutic guidance of sepsis...

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

..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...

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

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

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

..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...

..The aim of this study was to evaluate the cardiovascular and microvascular responses to mild therapeutic hypothermia (MTH) in an ovine model...

..High MEM dosage may represent a valuable therapeutic option for infection due to multidrug-resistant (MDR) strains, and drug monitoring would allow rapid regimen adjustment in clinical practice...

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

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

..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...

..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...

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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...

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

..Heterogeneity in microvascular perfusion is associated with impaired tissue oxygenation. We hypothesized that cardiac surgery with or without cardiopulmonary bypass (CPB) could induce microvascular alterations...

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

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..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...

..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...

..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...

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

..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...

..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...

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

..Treatment using the PMX cartridge is safe and may improve cardiac and renal dysfunction due to sepsis or septic shock. Further studies are needed to prove this effectiveness...

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

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

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

..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...

..The authors investigated the relation of blood transfusion to mortality in European intensive care units (ICUs)...

..We then look at the process of care and realize that, here, huge progress has been made. Lastly, we suggest how critical care medicine will continue to evolve for the better over the next 30 years...

..Excessive sedation is associated with prolonged mechanical ventilation and longer intensive care unit (ICU) and hospital stays. We evaluated the feasibility of using minimal sedation in the ICU...

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..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...

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

..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...

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

..We present ten reasons why we believe this approach is not appropriate and may even be detrimental...

..Albumin may be useful in some patients, especially those with hypoalbuminaemia at risk of complications or those with liver insufficiency. Further studies are needed to clarify what precise role albumin has in today's ICU...

..To assess whether hyponatremia in acute neurological patients is associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or with the cerebral salt-wasting syndrome (CSWS)...

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

..To evaluate the safety and efficacy of active site inactivated recombinant factor VIIa (FFR-rFVIIa) in patients with acute respiratory distress syndrome...

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

..Patients with low IgG concentrations may represent a logical target group to study the effects of Ig supplementation in septic shock...

..In this article, we will discuss the limitations of randomized controlled trials in the intensive care unit population and highlight the importance of considering other study designs in the challenging intensive care unit environment...

..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...

..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...

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