E Azoulay

..The aim of our study was to report outcomes after NIV in patients with a do-not-intubate (DNI) order...

..Previous studies identified substantial subjective biases during end-of-life decision-making. We evaluated whether in-ICU patient's birthday influenced management decisions...

..These results warrant a controlled trial of dexamethasone versus placebo in AML FAB-M5 patients with noninfectious pulmonary infiltrates...

..It is closely related to the logistic model, through direct modeling of times to death, and can be easily extended to model non-fatal outcomes...

..To establish a prognostic model for predicting 14-day mortality in ICU patients with severe sepsis overall and according to place of infection acquisition and to sepsis episode number...

..Allowing family members to participate in the care of patients in intensive care units (ICUs) may improve the quality of their experience. No previous study has investigated opinions about family participation in ICUs...

..To describe the diagnostic yields of test strategies with and without fiberoptic bronchoscopy and bronchoalveolar lavage (FO-BAL), as well as outcomes, in cancer patients with acute respiratory failure (ARF)...

..Intensivists are increasingly implementing end-of-life decisions in patients who remain dependent on life sustaining therapies without hope for recovery...

..Design : Closed-item questionnaire with a clinical vignette...

..Many sources of conflict exist in intensive care units (ICUs). Few studies recorded the prevalence, characteristics, and risk factors for conflicts in ICUs...

..Pneumocystis jiroveci polymerase chain reaction (PCR) has higher sensitivity than conventional stains but cannot distinguish colonization from infection...

..The impact of conventional mechanical ventilation on survival depends on the time from ICU admission to conventional mechanical ventilation and on the patient's response to noninvasive mechanical ventilation...

..To report incidence and characteristics of decisions to forgo life-sustaining therapies (DFLSTs) in the 282 ICUs who contributed to the SAPS3 database...

..The need for family-centered care and for a better communication within the patient-family-caregiver trio is also highlighted...

..Lastly, the author suggests a research agenda for pleural effusions in intensive care unit patients...

..The most recent literature is reviewed, and emphasis is placed on current controversies, most notably the risk/benefit ratio of fiberoptic bronchoscopy and BAL in patients with severe hypoxemia...

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..01). These results indicate that ICU caregivers should consider using an FIL to improve the effectiveness of the information they impart to families...

..This change mandates a reappraisal of indications for ICU admission in each type of hematological disease. Improved knowledge of the prognosis is of assistance in making treatment decisions...

..Thus, reagent strips may be a rapid, easy-to-use, and inexpensive technique for discriminating transudative from exudative pleural effusions and for categorizing exudative pleural effusions as infectious or noninfectious...

..73; CI, 1.58-9.09). Infection is the leading trigger of DKA in ICU patients. Neurological symptoms at admission and lack of complete clearance of ketonuria within 12 h are useful warning signals of infection...

..Predictors of satisfaction are amenable to intervention and deserve to be investigated further with the goal of improving the satisfaction of ICU patients' family members...

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..However, recent studies have found that outcomes of critically ill cancer patients have been improving over the years and that classic predictors of high mortality have lost their relevance...

..Pleural effusions frequently complicate cardiac and abdominal surgery and haemothorax may complicate trauma...

..Intensive care unit (ICU) admission of a relative is a stressful event that may cause symptoms of post-traumatic stress disorder (PTSD)...

..This variability should be taken into account when designing studies on the use of G-CSF in ICU-patients. Studies are still needed to identify the subset of patients who may benefit from G-CSF therapy...

..Involvement of anxious or depressed family members in end-of-life decisions should be carefully discussed...

..In many cases, the decision was taken without regard for one or more factors identified as relevant in U.S. guidelines...

..PARTICIPANT AND SETTINGS: International prospective cohort of consecutive adults who were free of ARDS on admission and who received fluid resuscitation for shock in 115 intensive care units (ICUs) during a 4-week period...

..Consequently, these scores are not the most appropriate tools for measuring prognosis in studies dealing with ICU patients hospitalized for more than 72 h...

..To clarify the patterns of pulmonary tuberculosis (TB) that should result in a high index of suspicion, to increase the chances of early therapy and to identify predictors of 30-day mortality...

..In ICU patients with hypoxaemic acute respiratory failure, PP had no effect on the risk of VAP. PP delayed mortality without decreasing 28-day mortality. PP >1 day might decrease mortality, particularly in the sickest patients...

..This may be due to the lack of precise guidelines on the topic and prompt the design of further studies to establish precisely the epidemiology and causes of pleural effusions in ICU patients...

..To provide critical care clinicians with information on validated instruments for assessing burden in families of critical care patients...

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..Staff members must strive to identify practical and psychological obstacles that may limit their ability to promote autonomy. Finally, they must develop interventions and attitudes capable of empowering families...

..However, the clinical significance of a positive PCR test for HHV6 in respiratory samples from patients with hematological malignancies remains unclear...

..The mechanisms of the relationship between volume and outcome among haematological patients with acute respiratory deserve additional studies...

..However, failure of noninvasive ventilation may lead to an increased mortality...

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..Time spent informing families has been associated with effectiveness of information but has not been measured in specifically designed studies...

..These recommendations may need to be redesigned to improve their practicability under real-life conditions, with special attention to phone triage and triaging to a full unit...

..The objectives of this study were to describe the factors and mortality associated with DFLSTs and to evaluate the potential independent impact of DFLSTs on hospital mortality...

..To examine the association between the performance of a tracheostomy and intensive care unit and postintensive care unit mortality, controlling for treatment selection bias and confounding variables...

..About 15% of patients with haematological malignancy develop acute respiratory failure (ARF), necessitating admission to intensive care where their mortality is of the order of 50%...

..In the era of adjunctive steroid use, AIDS-related PCP remains fairly common. Two independent factors evaluable at admission, Pa(O(2)) on room air and BAL neutrophilia, are predictive of death...

..We evaluated a format that included a proactive end-of-life conference and a brochure to see whether it could lessen the effects of bereavement...

..Few outcome data are available about convulsive status epilepticus managed in the intensive care unit. We studied 90-day functional outcomes and their determinants in patients with convulsive status epilepticus...

..Cancer patients requiring mechanical ventilation are widely viewed as poor candidates for intensive care unit (ICU) admission. We designed a prospective study evaluating a new admission policy titled The ICU Trial...

..33; 95% CI, 0.16-0.74). Sucralfate use and unplanned extubation are independent risk factors for EOP. Use of aminoglycosides, beta-lactams/ beta-lactamase inhibitors, or third-generation cephalosporins protects against EOP...

..Thrombocytopenia is common in ICU patients. The objective of this study was to evaluate possible links between declining platelet counts early in the ICU stay and survival...

..Fiberoptic bronchoscopy with bronchoalveolar lavage (FO-BAL) is an invasive test that may cause respiratory deterioration. Recent noninvasive diagnostic tests may have modified the risk/benefit ratio of FO-BAL...

..ICU-acquired events might be modeled as time-dependent variables in a Cox model, rather than standard covariates in logistic regression models...

..64-54.66; p = 0.006), compared to patients without renal injury. Our study suggests that in patients with ATLS, ICU management when acute renal injury is present is associated with higher short- and long-term mortality...

..However, no large comparative trial has yet been done. We aimed to compare the efficacy and safety of norepinephrine plus dobutamine (whenever needed) with those of epinephrine alone in septic shock...

..6 (95% CI, 1.3-4.9; P = 0.004). CONCLUSION: Iatrogenic pneumothorax is a life-threatening complication seen in 3% of ICU patients. Incorporating risk factors for IP into preventive strategies should reduce the occurrence of IP...

..Special awareness of professionals and innovative research are needed to promote a high-standard of end-of-life care in the intensive care unit...

..9 vs. 34.4%, p = 0.004). Specialty residents, if given opportunities for acquiring experience, can become proficient in communicating with families and share this task with senior physicians...

..This is particularly relevant for patient management, especially in non-human immunodeficiency virus (HIV)-infected immunocompromised patients, who often present low-burden P. jirovecii infections that are not diagnosed microscopically...

..The soluble factors in innate defence, such as cytokines, are described, and a last paragraph discusses whether a specific inflammatory response could characterise nosocomial pneumonia...

..9). Studies are needed to determine whether aggressive monitoring and treatment of patients with >15% neutrophils in BAL fluid specimens can improve the outcome of critically ill patients with malignancy and PCP...

..This study assessed the risk of renal adverse events in patients with shock resuscitated using hypo-oncotic colloids, artificial hyperoncotic colloids, hyperoncotic albumin or crystalloids, according to physician's choice...

..To illustrate the effectiveness of combining different research methods, we will refer to recent qualitative studies conducted in the intensive care unit...

..Therapeutic advances have improved survival in patients with myeloma (MM) over the past decade. We investigated whether survival has also improved in critically ill myeloma patients...

..To examine the association between predefined adverse events (AE) (including nosocomial infections) and intensive care unit (ICU) mortality, controlling for multiple adverse events in the same patient and confounding variables...

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..Professional burnout is a psychological syndrome arising in response to chronic interpersonal stressors on the job. There is the perception that intensivists are particularly exposed to stress because lives are literally in their hands...

..Patients in the plasma-exchange group received a larger volume of plasma. CONCLUSION: Plasma exchange may be associated with faster resolution of organ failure and with improved survival for patients with TMA requiring ICU admission...

..The aim of this study is to describe the prevalence and outcomes of intensive care unit (ICU)-acquired hypernatraemia (IAH)...

..Means of improving end-of-life care have been identified in epidemiologic and interventional studies. End-of-life family conferences constitute the keystone around which excellent end-of-life care can be built...

..To evaluate the outcome of cancer patients considered for admission to the intensive care unit (ICU)...

..Thrombotic microangiopathy may develop after solid organ transplantation, but it is usually not associated with severe deficiency in von Willebrand factor-cleaving metalloprotease (ADAMTS 13) activity...

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..Septic shock may be associated with relative adrenal insufficiency. Thus, a replacement therapy of low doses of corticosteroids has been proposed to treat septic shock...

..To assess the impact of routine thoracentesis on diagnostic assessment and therapeutic measures in patients with clinically documented pleural effusions...

..Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The intensive care unit (ICU) is a highly stressful environment. Little is known about BOS in critical care nursing staff...

..To determine outcomes in critically ill patients hospitalized in the ICU for central neurological complications of cancer...

..Primary care physicians should inform their patients about the benefits of discussing illness-related issues among friends and family...

..Even though legitimacy of surrogates is now recognized by physicians, patients' management must take into account new legislations emphasizing patients' autonomy all over Europe...

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..To identify predictors of 30-day mortality in critically ill cancer patients with septic shock...

..Immunocompromised patients with influenza are at higher risk of pneumonia and death. However, risk factors for progression to pneumonia still need evaluation...

..To assess the accuracy of plasma N-terminal-pro-B-type natriuretic peptide concentrations (NT-proBNP) as a diagnostic tool to recognize acute respiratory failure (ARF) of cardiac origin...

..Am. J. Hematol. 68:198-201, 2001. Published 2001 Wiley-Liss, Inc...

..This review discusses current outcomes of critically ill cancer patients and recent insights into prognostic factors. Persistent areas of uncertainty are emphasized...

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..The accuracy with which surrogates consent to research on behalf of patients has not been evaluated in the intensive care unit (ICU)...

..Palivizumab did not prevent progression to lower respiratory infection and had no impact on the overall survival rate...

..Further interventions such as further ICU management, discharge to a step-down unit, or follow-up by intensivists on the ward should be evaluated in patients with a high risk of post-ICU mortality...

..However, interactions between Candida and bacteria, particularly Pseudomonas, have been reported. Thus, Candida colonization of the respiratory tract may predispose to bacterial ventilator-associated pneumonia (VAP)...

..The impact of a contributive result of kidney biopsy on the management of patients in the intensive care unit (ICU) has not been extensively investigated yet...

..04). In conclusion, HIV-associated TMA with severe ADAMTS13 deficiency have less AIDS-related complications and a higher CD4(+) T cell count. TMA prognosis is better and comparable to this of idiopathic forms...

..CONCLUSIONS: Granulocyte colony-stimulating factor enhances bleomycin-induced lung toxicity by a mechanism that probably involves neutrophils...

..CONCLUSIONS: Patients with acute respiratory failure after prolonged neutropenia complicated by pneumonia are at increased risk for ARDS...