Chlorhexidine-impregnated sponge versus chlorhexidine gel dressing for
short-term intravascular catheters: which one is better?
Buetti N(1), Ruckly S(2), Schwebel C(3)(4), Mimoz O(5)(6)(7), Souweine B(8),
Lucet JC(2)(9), Timsit JF(2)(10).
MESSAGE: sur la base de 2 essais conduits par OUTCOMEREA, la protection contre l’infection liée au cathéters semblent etre comparable avec les gels et les éponges imprégnés de chlorhexidine. Le choix des équipes doit etre fait sur l’aptitude à l’absorption des liquides, les dermatites de contact et l’expérience des utilisateurs .
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.
RESULTS: A total of 3483 patients and 7941 catheters were observed in 16
intensive care units. Sponge-dress and gel-dress were utilized for 1953 and 2108
catheters, respectively. After adjustment for confounders, gel-dress showed
similar risk for MCRI compared to sponge-dress (HR 0.80, 95% CI 0.28-2.31,
p = 0.68) and CRBSI (HR 1.13, 95% CI 0.34-3.70, p = 0.85), less dressing
disruptions (OR 0.72, 95% CI 0.60-0.86, p < 0.001), and more contact dermatitis
(OR 3.60, 95% CI 2.51-5.15, p < 0.01). However, gel-dress increased the risk of
contact dermatitis only if CHG was used for skin antisepsis (OR 1.94, 95% CI
1.38-2.71, p < 0.01).
CONCLUSIONS: We described a similar infection risk for gel-dress and
sponge-dress. Gel-dress showed fewer dressing disruptions. Concomitant use of
CHG for skin disinfection and CHG-impregnated dressing may significantly
increase contact dermatitis.
TRIALS REGISTRATION: These studies were registered within ClinicalTrials.gov
(numbers NCT01189682 and NCT00417235 ).
DOI: 10.1186/s13054-020-03174-0
PMCID: PMC7376730
PMID: 32703235 [Indexed for MEDLINE]
Conflict of interest statement: The authors declare that they have no competing
interests. JFT received fees for lectures to 3 M, MSD, Pfizer, and Biomerieux.
JFT received research grants from Astellas, 3 M, MSD, and Pfizer. JFT
participated to advisory boards of 3 M, MSD, Bayer Pharma, Nabriva, and Pfizer.
JCL received fees for lectures for 3 M, Pfizer MSD, and research grants from
Anios. OM received fees for lectures for 3 M and BD. OM received research grants
from BD.
One-year survival in acute stroke patients requiring mechanical ventilation: a
multicenter cohort study.
de Montmollin E(1)(2), Terzi N(3), Dupuis C(4), Garrouste-Orgeas M(5), da Silva
D(6), Darmon M(7), Laurent V(8), Thiéry G(9), Oziel J(10), Marcotte G(11),
Gainnier M(12), Siami S(13), Sztrymf B(14), Adrie C(15), Reignier J(16), Ruckly
S(17), Sonneville R(18)(19), Timsit JF(17)(18); OUTCOMEREA Study Group.
Message :
Une analyse épidémiologique des patients de réanimation avec un accident vasculaire cérébral.
BACKGROUND: Most prognostic studies in acute stroke patients requiring invasive
mechanical ventilation are outdated and have limitations such as single-center
retrospective designs. We aimed to study the association of ICU admission
factors, including the reason for intubation, with 1-year survival of acute
stroke patients requiring mechanical ventilation.
METHODS: We conducted a secondary data use analysis of a prospective multicenter
database (14 ICUs) between 1997 and 2016 on consecutive ICU stroke patients
requiring mechanical ventilation at admission. We excluded patients with stroke
of traumatic origin, subdural hematoma or cerebral venous thrombosis. The
primary outcome was survival 1 year after ICU admission. Factors associated with
the primary outcome were identified using a multivariable Cox model stratified
on inclusion center.
RESULTS: We identified 419 patients (age 68 [58-76] years, males 60%) with a
Glasgow coma score (GCS) of 4 [3-8] at admission. Stroke subtypes were acute
ischemic stroke (AIS, 46%), intracranial hemorrhage (ICH, 42%) and subarachnoid
hemorrhage (SAH, 12%). At 1 year, 96 (23%) patients were alive. Factors
independently associated with decreased 1-year survival were ICH and SAH stroke
subtypes, a lower GCS score at admission, a higher non-neurological SOFA score.
Conversely, patients receiving acute-phase therapy had improved 1-year survival.
Intubation for acute respiratory failure or coma was associated with comparable
survival hazard ratios, whereas intubation for seizure was not associated with a
worse prognosis than for elective procedure. Survival did not improve over the
study period, but patients included in the most recent period had more
comorbidities and presented higher severity scores at admission.
CONCLUSIONS: In acute stroke patients requiring mechanical ventilation, the
reason for intubation and the opportunity to receive acute-phase stroke therapy
were independently associated with 1-year survival. These variables could assist
in the decision process regarding the initiation of mechanical ventilation in
acute stroke patients.
DOI: 10.1186/s13613-020-00669-5
PMCID: PMC7205929
PMID: 32383104
Conflict of interest statement: Work under consideration for publication: no
competing interest. Relevant financial activities outside the submitted work:
Nicolas Terzi (Pfizer, Boehringer Ingelheim), Michaël Darmon (MSD, Astellas,
Gilead-Kite), Guillaume Thiéry (Gilead-Kite).
Impact of obstructive sleep apnea on the obesity paradox in critically ill
patients.
Bailly S(1), Galerneau LM(2), Ruckly S(3), Seiller A(3), Terzi N(2), Schwebel
C(4), Dupuis C(5), Tamisier R(6), Mourvillier B(5), Pepin JL(6), Timsit JF(5).
Message:
Le SAOS pourrait chez les patients avec un IMC>40 etre un facteur prolongeant la durée de ventilation mécanique. Sa connaissance n’a par contre pas d’impact délétère pour les patients avec des IMC<40 kg/m2.
OBJECTIVE: Patients admitted to an intensive care unit (ICU) frequently suffer
from multiple chronic diseases, including obstructive sleep apnea (OSA). Until
recently OSA was not considered as a key determinant in an ICU patient's
prognosis. The objective of this study was to document the impact of OSA on the
prognosis of ICU patients.
METHODS: Data were retrospectively collected concerning adult patients admitted
to ICU at two university hospitals. In a nested study OSA status was checked
using the hospital electronic medical records to identify exposed and unexposed
cases. The following outcomes were considered: length of stay in the ICU, ICU
mortality, in-hospital mortality, ventilator-associated pneumonia (VAP).
RESULTS: Out of 5146 patients included in the study, 289 had OSA at ICU
admission (5.6%). After matching, the overall impact of OSA on length of ICU
stay was not significant (p = .24). In a predefined subgroup analysis, there was
a significant impact of OSA on the length of ICU stay for patients with BMI over
40 kg/m2 (IRR: 1.56 [1.05; 2.32], p = .03). OSA status had no impact on ICU or
hospital mortality and VAP.
CONCLUSION: In general, known OSA did not increase the ICU stay except for
patients with both OSA and morbid obesity.
Copyright © 2019. Published by Elsevier Inc.
DOI: 10.1016/j.jcrc.2019.12.016
PMID: 31896445 [Indexed for MEDLINE]
Ventilator-associated pneumonia due to Stenotrophomonas maltophilia: Risk
factors and outcome.
Ibn Saied W(1), Merceron S(2), Schwebel C(3), Le Monnier A(4), Oziel J(5),
Garrouste-Orgeas M(6), Marcotte G(7), Ruckly S(8), Souweine B(9), Darmon M(10),
Bouadma L(11), de Montmollin E(12), Mourvillier B(13), Reignier J(14), Papazian
L(15), Siami S(16), Azoulay E(17), Bédos JP(2), Timsit JF(18).
BACKGROUND: Stenotrophomonas maltophilia (SM) is increasingly identified in
intensive care unit (ICU). This study aim to identify risk factors for SM
ventilator-associated pneumonia (VAP) and whether it affects ICU mortality
METHODS: Two nested matched case-control studies were performed based in
OUTCOMEREA database. The first episodes of SM-VAP patients were matched with two
different control groups: VAP due to other micro-organisms (VAP-other) and
Pseudomonas aeruginosa VAP (Pyo-VAP). Matching criteria were the hospital, the
SAPS II, and the previous duration of mechanical ventilation (MV).
RESULTS: Of the 102 SM-VAP patients (6.2% of all VAP patients), 92 were matched
with 375 controls for the SM-VAP/other-VAP matching and 84 with 237 controls for
the SM-VAP/Pyo-VAP matching. SM-VAP risk factors were an exposition to
ureido/carboxypenicillin or carbapenem during the week before VAP, and
respiratory and coagulation components of SOFA score upper to 2 before VAP.
SM-VAP received early adequate therapy in 70 cases (68.6%). Risk factors for
Day-30 were age (OR = 1.03; p < 0.01) and Chronic heart failure (OR = 3.15;
p < 0.01). Adequate treatment, either monotherapy or combination of
antimicrobials, did not modify mortality. There was no difference in 30-day
mortality, but 60-day mortality was higher in patients with SM-VAP compared to
Other-VAP (P = 0.056).
CONCLUSIONS: In a large series, independent risk factors for the SM-VAP were
ureido/carboxypenicillin or carbapenem exposure the week before VAP, and
respiratory and coagulation components of the SOFA score > 2 before VAP.
Mortality risk factors of SM-VAP were age and chronic heart failure. Adequate
treatment did not improve SM-VAP prognosis.
Copyright © 2019. Published by Elsevier Ltd.
DOI: 10.1016/j.jinf.2019.10.021
PMID: 31682878 [Indexed for MEDLINE]