Christian Brun-Buisson

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

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..46 to 1.67 and 1.77. The clinical pulmonary infection score has low diagnostic accuracy; however, incorporating gram stains results into the score may help clinical decision making in patients with clinically suspected pneumonia...

..To re-examine the epidemiology of acute lung injury (ALI) in European intensive care units (ICUs)...

..Ten years ago 8.4% of patients in French intensive care units (ICUs) were found to have severe sepsis or shock and 56% died in the hospital. As novel therapies for severe sepsis are emerging, updated epidemiological information is required...

..The indication of antiseptic-coated catheters remains debated...

..Sampling techniques for microbiological diagnosis of ventilator-associated pneumonia (VAP) remain debated, and it is unclear to what extent invasive diagnostic techniques impact the management of patients...

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..e. in absence of a reasonable probability that the trial may reach a conclusion within its planned frame...

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..The pathophysiology of acute chest syndrome (ACS) in patients with sickle cell disease is complex, and pulmonary artery thrombosis (PT) may contribute to this complication...

..But whether these benefits translate to a clinical setting is unclear...

..Recommendations and legislation may help to build consensus and avoid conflicts among caregivers at each step of the decision-making process...

..Cardiac function and volume status could play a critical role in the setting of weaning failure. B-type natriuretic peptide (BNP) is a powerful marker of cardiac dysfunction. We assessed the value of BNP during the weaning process...

..The main objectives of IDS counselling were to improve antibiotic use for bloodstream infection (i.e., initiating or modifying therapy) and to stop unjustified therapy for contaminated pBC...

..We aimed to establish the effectiveness of an algorithm based on the biomarker procalcitonin to reduce antibiotic exposure in this setting...

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..Our objectives were to evaluate the impact of failed extubation, whether planned or unplanned, on patient outcomes and to identify a patient subset at risk for extubation failure...

..To compare the efficacy of handrubbing with an alcohol based solution versus conventional handwashing with antiseptic soap in reducing hand contamination during routine patient care...

..Excellent negative predictive values of skin cultures for S aureus and P aeruginosa bacteremia should help clinicians consider targeted empirical antibiotic choices when appropriate...

..Steady-state mild pulmonary hypertension is a risk factor for death in adults with sickle cell disease. Acute pulmonary hypertension has been reported during exercise and vasoocclusive pain crisis in these patients...

..Early identification of sepsis and of patients at risk of developing septic shock, together with rapid intervention aiming especially to correct hemodynamic disorders, is likely to improve prognosis...

..To assess adherence to clinical practice guidelines for three interventions routinely used in critical care medicine...

..Fever control may improve vascular tone and decrease oxygen consumption, but fever may contribute to combat infection...

..The objective was to compare outcomes associated with early, late, and no admission to the intensive care unit (ICU) for patients hospitalized with community-acquired pneumonia (CAP)...

..This report describes terminal extubation, a particular method of withdrawing ventilator support...

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..This protracted outbreak was controlled only after implementation of an extensive control program and eventual cohorting of all carriers in an isolation unit with dedicated healthcare personnel...

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..More randomized trials of VTE prophylaxis in critically ill medical patients would better inform practice...

..2004-800) and on data (the so-called CNIL act, L. 2004-801). The value of this set of texts (statutes, decrees, and regulations) is that it diversifies and clarifies the different forms of clinical research...

..The aim of this study was to measure the impact on antibiotic use of a computer-generated alert prompting post-prescription review and direct counselling in hospital wards...

..Short-term hypoxemia affects diuresis and natriuresis in healthy individuals. No data are available on the impact of the mild hypoxemia levels usually tolerated in critically ill patients receiving mechanical ventilation...

..4%. However, the likelihood ratio of positive (1.27) and negative (0.89) tests indicated only small changes in pretest-to-posttest probability. Therefore, a strategy of routine culture of EPWs to predict PSM seems questionable...

..Current data on the development of effective programmes, including guidelines for their implementation, have demonstrated some efficacy and controversies are reviewed...

..Although the Pneumonia Severity Index (PSI) has been extensively validated, little is known of the impact of its routine use as an aid to site-of-treatment decisions for patients with pneumonia who present to emergency departments (EDs)...

..Despite their controversial role, corticosteroids are often administered to patients with adult respiratory distress syndrome (ARDS) secondary to viral pneumonia...

..This diagnosis relies chiefly on urinary indices, which may be of limited value or difficult to obtain. We assessed the performance of the Doppler renal resistive index (RI) in diagnosing persistent AKI...

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..In addition, we demonstrate that follow-up of serologic titers against B. henselae was helpful in assessing definitive cure of the infection...

..Invasive life-support techniques are a major risk factor for nosocomial infection. Noninvasive ventilation (NIV) can be used to avoid endotracheal intubation and may reduce morbidity among patients in intensive care units (ICUs)...

..French laws fail to indicate what should be done when an otherwise legally competent patient transiently loses his decision-making capacity...

..Improving hand hygiene compliance will require changing healthcare workers behaviour towards glove use...

..Refinement of risk stratification of patients presenting with infection and no organ dysfunction is needed...

..To examine the incidence of infections and to describe them and their outcome in intensive care unit (ICU) patients...

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..In the late 1980s, the proportion of methicillin resistance among clinical strains of Staphylococcus aureus (MRSA) reached approximately 40% at AP-HP...

..To analyse the incidence and the impact on outcome of right ventricular failure (RVF) in patients with acute respiratory distress syndrome (ARDS)...

..Whether venous catheterization at the femoral site is associated with an increased risk of complications compared with that at the subclavian site is debated...

..CONCLUSIONS: These results suggest a beneficial effect of nitric oxide inhalation on bacterial clearance of P. aeruginosa attributable to both a direct bactericidal effect and an influx of alveolar neutrophils with preserved functions...

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..The patient died after 72 days and autopsy showed major spinal cord, optic nerve, and brainstem necrosis, and multifocal necrotic lesions on the cerebellum and cerebral white matter...

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..The objective of this study was to compare the 1-year outcomes of survivors of A(H1N1)-associated ARDS, according to use or no use of extracorporeal lung assist (ECLA), using its need as an ARDS severity surrogate...

..Vascular purpura main etiologies encompass the wide specturm of vasculitides and microvascular-occlusion syndromes. Among them, cardiac embolism represents an unusal but potentially severe etology...

..The aim of this prospective study was to search for a relationship between an impairment of neutrophil functions and the subsequent development of nosocomial infection...

..Among the 63 CPE events that occurred between 2004 and 2011, 87% involved patients with a link with cross-border exchanges, justifying the recommendation to screen and isolate such patients...

..In developed countries at present, death mostly occurs in hospitals, but the circumstances and factors associated with the quality of organization and care surrounding death are not well described...

..We evaluated the influence of preoperative antimicrobial therapy duration on positivity of valve culture and outcome...

..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...

..It mainly occurs in those with a severe underlying disease and a venous catheter. These patients have a high risk of associated bone-joint infection and therefore must be closely monitored...

..6; 95% confidence interval, 1.2-5.7). There was no significant effect of infection on heart transplantation rate and overall survival...

..A few examples, derived for recent experience of clinical trials conducted in acutely ill patients, illustrate the importance of an efficient and reactive DSMB to monitor patients' safety, especially during large multicenter trials...

..Finally, difficulties in rapid and accurate diagnosis of B. pilosicoli bloodstream infections, in vitro antimicrobial susceptibility of human clinical isolates, and therapeutic options are discussed...

..This report adds evidence that C. fetus bloodstream infection should be suspected in elderly patients with fever, immunodeficiency and cardiovascular damages. Imipenem seems to be the most active drug, especially in severe cases...

..The intranet-based automated method developed for this purpose was more accurate and less time-consuming than the weekly, retrospective LBWS method...

..CONCLUSIONS: Aminoglycoside use was frequently associated with excessive treatment duration and incorrect drug level monitoring. Reinforcing practice guidelines through direct counselling improved the appropriateness of prescriptions...

..The aim of this study was to design a predictive score for these complications after prostate surgery...

..At admission, patients with NF were more likely to have skin areas of ischaemia or necrosis, fluid-filled vesicles, and severe sepsis or septic shock...

..In conclusion, diagnostic tools such as paired blood cultures or Gram staining and the acridine-orange leucocyte cytospin test should allow a diagnosis of CRS without catheter removal in cancer patients...

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..CONCLUSION: These results suggest that G-CSF (Lenograstim) may enhance host defenses in rats with peritonitis and immunoparalysis...

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..CONCLUSIONS: The effect of G-CSF on in vitro neutrophil bactericidal activity varied widely, depending on endogenous levels of G-CSF and was not predictable based on severity scores...

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..A score estimating this risk, using objectively defined criteria for systemic inflammatory response syndrome, could be used by physicians to stratify patients for clinical management and to test new interventions...

..Diagnosing community-acquired pneumonia is complex, and a diagnostic algorithm is proposed. Appropriate samples are indicated during soft tissue and intraabdominal infections, but cultures obtained through the drains are discouraged...

..To characterize empiric antibiotic use in patients with suspected nosocomial ICU-acquired infections (NI), and determine the impact of prolonged therapy in the absence of infection...

..Based on concerns about the risk of infection, the jugular site is often preferred over the femoral site for short-term dialysis vascular access...

..To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," published in 2004...

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..Ventilator-associated pneumonia (VAP) is an important patient safety issue in critically ill patients...

..Understanding these determinants is crucial for the success of possible interventions. Finally, we emphasize the overarching importance of a sociocultural approach to preventing antibiotic resistance in the community...

..To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock," published in 2004...

..High levels of inhibitory anti-ADAMTS13 IgG at presentation were associated with the persistence of an undetectable ADAMTS13 activity in remission, the latter being predictive for relapses within an 18-month delay...