**Reference 2:** Cornelissen C, Bergs I, Müller A, Daher A, Kersten A, Bal-fanz P, Lemmen S, Marx G, Marx N, Dreher M, Müller T. Broncho-alveo-lar lavage in patients with acute respiratory distress syndrome due to COVID-19. Internal Medicine Journal 51 (2021) 965–967.

**Compliance with ethics regulations:** N/A.

FC-070

Predictive factors of mortality in critically ill patients
with SARS-CoV-2 pneumonia: a prospective study of 301 patients

MORATELLI Giulia¹, REGAIEG Kais¹, NAKAA Sabrine¹, FRAJ Nesrine¹, KALLEL Myriam¹, AL HARACH Amir¹, GAZAIGNE Laure¹, GOLDGRAN-TOLEDANO Dany¹

¹Groupe Hospitalier Intercommunal Le Raincy Montfermeil, Montfermeil, France

**Correspondence:** Giulia MORATELLI (giulia.moratelli@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-070

**Rationale:** We want to describe the epidemiological, clinical and out-come of critically ill patients with SARS-CoV-2 pneumonia and to iden-tify risk factors for in-hospital mortality in these patients.

**Patients and methods/Materials and methods:** We conducted a prospective cohort study of critically ill adults admitted into ICU from Mars 2020 to February 2022 for SARS-CoV-2 pneumonia.

**Results:** A total of 301 patients were admitted into our ICU for acute respiratory failure due to SARS CoV-2 pneumonia. Mean age was 62 years (25–86). Mean delay to ICU hospitalization was 8 (1–27) days and mean duration of ICU stay was 8 (1–149) days. Mean SAPS was 32 (12–75). Sex ratio (M/F) was 2. Mean body mass index was 30 (18–68). 169 patients (56%) had hypertension, 100 (33%) were diabetics and 33 (11%) had chronic kidney diseases. Within the study period, 258 patients (86%) have needed non-invasive ventilation and 250 (83%) had high flow nasal oxygen as first line therapy. 143 patients (48%) received mechanical ventilation for a mean duration of 12 days (1–47) and 67 (47%) of them were extubated. 129 patients (43%) needed cat-echolamine, 41 (14%) renal replacement therapy and 11 (7,7%) ECMO. Different immunomodulator's therapies were used during study period: 124 patients (41%) received dexamethasone 6 mg/day for ten days, 113 (38%) received dexamethasone 0,1 mg/kg/days for ten days and 26 (8,6%) received bolus of methylprednisolone 250 mg/days for three days as rescue therapy. We have administrated tocilizumab in 22 patients (7,3%). In the univariate analysis, risk factors associated with mortality were age, hypertension, SAPS II, chronic renal diseases, AKI, use of catecholamine and mechanical ventilation. In the multivariate analysis, risk factors associated with mortality were mechanical venti-lation and use of catecholamine.

**Conclusion:** Our experience during this pandemic period is similar to the results of most European studies. The use of mechanical ventila-tion and catecholamine were associated with a poor outcome. More studies are needed on this subject.

**Compliance with ethics regulations:** Yes in clinical research.

FC-071

Epidemiological and clinical characteristics of 600 COVID-19
patients

MERBOUH Manal¹, EL AIDOUNI Ghizlane¹, ALKOUH Rajae¹, TAOUIHAR Salma¹, ZAID Ikram¹, EL MEZZIOUI Sanae¹, BOUABDELLAOUI Amine¹, AFTISS Fatima¹, LAARIB Ilias¹, CHOUKRI Bahouh¹, BENCHAIB Rajae¹, MIMOUNI Hamza¹, MAARAD Mohammed¹, MEKKAOUI Ikram¹, JEBAR Khaoula¹, OUJIDI Younes¹, BENSAID Amine¹, DOUQCHI Badie¹, CHETOUANI Badie¹, HOUSSAM Bkiyar¹, ABDA Naima¹, HOUSNI Brahim¹
¹CHU Mohammed VI, Oujda, Maroc

**Correspondence:** Manal MERBOUH (manal.mrb@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-071

**Rationale:** COVID-19 is a global health crisis. The evolution of the disease is unpredictable with disastrous socio-economic consequences. The aim of the present work is to study the epidemiological, clinical, diagnostic, therapeutic and evolutionary aspects, as well as risk factors

associated with SARS-CoV-2 infection in 600 patients, admitted to the intensive care unit of a university hospital during the first wave of the pandemic.

**Patients and methods/Materials and Methods:** This is a retrospective descriptive and analytical study conducted on patients with COVID-19 between 22 March and 31 December of 2020. Data were collected using computerized medical records on HOSIX and were analyzed by the SPSS software.

**Results:** Of 600 patients, the median age was 64 years (IQR 15–100), 403 patients were male (sex ratio = 2.05), 387 patients had a BMI above normal, 191 had a history of hypertension, 188 had a history of diabetes. Fever, cough, dyspnea were the predominant symptoms, 379 patients had more than 50% lung involvement on chest CT. The majority of patients had desaturation on admission. Respiratory distress, lymphopenia, thrombocytopenia, elevated CRP and hyperglycemia were significantly associated with an unfavorable outcome. The management was based on synthetic antimalarials associated with azithromycin, corticosteroids, ventilatory support as well as specific management of complications with a good evolution in 67.5% of cases, mean duration of hospitalization in the intensive care unit was 8.2 days varying from 2 to 49 days.

**Conclusion:** The results of our study are consistent with other series. COVID 19 remains a malignant disease if management is delayed and leads to the development of several complications. Barrier measures remain the best means of prevention against covid-19. Mass vaccination to acquire herd immunity is the way to control this infection.

**Compliance with ethics regulations:** Yes in clinical research.

FC-072

Prognosis of critically ill patients with acute respiratory
failure due to the SARS-CoV-2 501Y.V2 variant: a multicenter
retrospective matched cohort study

PUECH Bérénice¹, LEGRAND Antoine¹, SIMON Olivier¹, COMBE Chloé¹, JAFFAR-BANDJEE Marie-Christine¹, CARON Margot¹, VIDAL Charles¹, MAVINGUI Patrick¹, BLONDE Renaud¹, BOUE Yvonnick¹, BERGUIGUA Hamza¹, ALLYN Jerome¹, FERDYNUS Cyril¹, ALLOU Nicolas¹
¹CHU Felix Guyon, Saint Denis, Reunion

**Correspondence:** Bérénice PUECH (berenice.puech@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-072.

**Rationale:** The aim of this study was to compare the prognosis of patients with acute respiratory failure (ARF) due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant 501Y.V2 to that of patients with ARF due to original strain.

**Patients and methods/Materials and methods:** This retrospective matched cohort study included all consecutive patients who were hospitalized for ARF due to SARS-CoV-2 in our University Hospital between March 2020 and April 2021. Twenty-eight in hospital mortality was evaluated before and after matching.

**Results:** A total of 218 patients with ARF due to SARS-CoV-2 were enrolled in the study. Of these, 83 (38.1%) were infected with the 501Y.V2 variant. During intensive care stay, 104 (47.7%) patients received invasive mechanical ventilation and 20 (92%) patients were supported by venovenous extracorporeal membrane oxygenation. Patients infected with the 501Y.V2 variant were younger (58 [51–68] versus 67 [56–74] years old, p = 0.003), had less hypertension (54.2% vs 68.1%, p = 0.04), and had less chronic kidney disease (13.3% vs 31.9%, p = 0.002) than patients infected with the original strain. After controlling for confounding variables (62 matched patients in each group), 28-day mortality was higher in the group of patients infected with the 501Y.V2 variant (30.6%) than in the group of patients infected with the original strain (19.4%, p = 0.04).

**Conclusion:** In our department, where SARS-CoV-2 incidence remained low until February 2021 and the health care system was never saturated, mortality was higher in patients with ARF infected with the 501Y.V2 variant than in patients infected with the original strain.

**Compliance with ethics regulations:** Yes in clinical research.
FC-073

Characteristics and outcome of critically ill COVID-19 patients

HADDED Amina¹, ALILA llef¹, KHARRAT Sana¹, TURKI Olfa¹, BAHLOUL Mabrouk¹, BOUAZIZ Mounir¹

¹hospital Habib Bourguiba Sfax, Sfax, Tunisie

**Correspondence:** llef ALILA (ilefalila1323@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-073

**Rationale:** The Covid-19 pandemic has hit our country as well as countries around the world since December 2019 with its beginning in Wuhan, China. This virus has threatened the life of human beings by attacking various organs, causing especially respiratory distress requiring hospitalization in intensive care unit and causing significant mortality. The aim of this study was to describe the clinical characteristics and outcome of patients with coronavirus disease-2019 (COVID-19) hospitalized in intensive care unit (ICU).

**Patients and methods/Materials and methods:** We conducted a retrospective study in a medical ICU over a period of 16 months [September 2020–December 2021] including patients with SARS-COV2 infection.

**Results:** During the study period, 586 patients were included with a mean age of 59.5 ± 14.7 years and a sex ratio of 1.6. The median SAPS-II and SOFA score were respectively of 29 ± 14.8 and 4 ± 2.6. Most patients had comorbidities, including hypertension (36%), obesity (32.1%) and diabetes mellitus (36.2%). A total of 419 (71.5%) patients had severe acute respiratory distress syndrome (ARDS). Severe lung damage ranging between 50 and 75% of the lung parenchyma was estimated in 175 patients (30%). 117 (20%) had lung parenchyma damage ≥ 70%. Invasive mechanical ventilation was required in 264 patients (45.1%) for a median of 3 days. During the ICU stay, vasopressor therapy was required in 232 patients (39.6%). Thromboembolic complications were found in 32 (5.5%) patients. Pulmonary embolism was diagnosed in 22 patients (3.8%) and thrombophlebitis in 10 (1.7%). 239 patients (40.8%) developed renal failure during their hospitalization, and only 37 (6.3%) required hemodialysis. Median ICU length of stay was 6 [IQR 3–10] days and overall mortality was 49% (287 patients). Multivariate logistic analysis showed that an age older than 60 years, CRP value > 75 mg/l at admission, invasive mechanical ventilation, occurrence of infection or acute kidney injury were independent predictors of mortality in patients with severe COVID-19.

**Conclusion:** In this cohort of patients admitted to the intensive care unit, COVID-19 pneumonia was associated with high morbidity and mortality rates. The main clinical predictors were age, CRP value at admission, invasive mechanical ventilation, occurrence of infection or acute kidney injury.

**Compliance with ethics regulations:** Yes in clinical research.

FC-074

Epidemiology and demographic profile characteristics and outcome of covid-19 patients in intensive care unit at the medical emergency department

TABET AOUL Nabil¹,², ALACHAHER Djamel¹,², GOULMANE Mourad¹,², OUALI DADA Soufiane¹,², SIDI AISSA Nabil¹,², AZZA Mohammed¹,², BOUDADI Hajer²

¹Faculty of Medicine of Oran, University Oran 1, Oran, Algerie; ²Medical Emergency Department, University Hospital Center of Oran, Oran, Algerie

**Correspondence:** Nabil TABET AOUL (tabetrea@yahoo.fr)

Annals of Intensive Care 2022, **12**(1):FC-074

**Rationale:** The recent emergence of COVID-19 has confronted us with an unprecedented global health crisis with a saturation of hospitals, particularly in ICUs and consequently a rate of very high mortality. Our first priority is to improve the prognosis particularly with early management. The aim of this study was to evaluate the characteristics of COVID-19 patients admitted to ICUs and prognosis factors.

**Patients and methods/Materials and methods:** We conducted a retrospective analysis of COVID-19 patients' mortality and predictive factors of mortality in ICU at the medical emergency department of UHC of Oran in Algeria between 01/01/2021 au 01/01/2022. Non-survivors were compared to survivors using multivariable analysis. We analyzed

age, comorbidities, vaccination status, CT scan results, D-dimer rate at admission and invasive ventilation.

**Results:** During this period between January 2021, to January, 2022, 223 COVID-19 patients required ICU admission with a peak of 26,9% patients in July and august. In these patients with confirmed COVID-19, the sex ratio was 0.66, patients were older than 60 years in the majority of cases against only 4% under 40 years, and the majority of patients was Unvaccinated (those who have not received any dose of a COVID-19 vaccine). The presence of comorbidities (86%), the peri-bronchovascular distribution of lesions, the number of zones involved, and especially percentage greater than 50% in 55% cases and D-dimer greater than 1000 (62%) were associated with increased risk of ICU admission. The mortality of this group was higher (66%). Non-survivors were older and had more frequently various comorbid diseases (56% of patients were hypertensive and 43% were diabetic) than survivors. The use of invasive mechanical ventilation was independently associated with an increased mortality in ICU using the multivariable analysis.

**Conclusion:** In our cohort, patients with the higher mortality were older and had more frequently various comorbid diseases and received invasive mechanical ventilation despite adequate and early management. The initial chest CT scan can predict COVID-19 positivity, ICU admission, mortality, and disease severity.

**Compliance with ethics regulations:** N/A.

FC-075

Derivation and validation of the CERES score for the prediction of late intubation in Covid-19

GAUDET Alexandre¹,², GHOZLAN Benoit¹, DUPONT Annabelle³,⁴, PARMENTIER—DECRUCQ Erika¹,², BAYON Constance¹, TSICOPOULOS Anne², SUSEN Sophie³,⁴, POISSY Julien¹,⁵

¹CHU Lille, Department of Intensive Care Medicine, Critical Care Center, Lille, France; ²Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Lille, France; ³CHU Lille, Service D'hémostase et Transfusion, Centre de Biologie Pathologie, Lille, France; ⁴Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 EGID, Lille, France; ⁵Univ. Lille, Inserm U1285, CHU Lille, CNRS, UMR 8576, UGSF, Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France

**Correspondence:** Alexandre GAUDET (alexandre.gaudet@chu-lille.fr)

Annals of Intensive Care 2022, **12**(1):FC-075

**Rationale:** Predictive scores assessing the risk of respiratory failure in Covid-19 mostly focused on the prediction of early intubation (1). A combined assessment of clinical parameters and biomarkers of endotherliopathy could allow to predict late worsening of acute respiratory failure (ARF) subsequently warranting intubation in Covid-19 (2).

**Patients and methods/Materials and methods:** Retrospective single-center derivation (N = 92 subjects) and validation cohorts (N = 59 subjects), including severe Covid-19 patients with non-invasive respiratory support for at least 48 h following ICU admission. We used stepwise regression to construct the Covid endothelial and respiratory failure (CERES) score in a derivation cohort, and secondly assessed its accuracy for the prediction of late ARF worsening requiring intubation within 15 days (D15) following ICU admission in an independent validation cohort.

**Results:** Platelets, fraction of inspired oxygen and endocan measured on ICU admission were identified as the top 3 predictive variables for late ARF worsening and subsequently included in the CERES score. The area under the ROC curve of the CERES score to predict late ARF worsening was respectively calculated in the derivation and validation cohorts at 0.834 and 0.780 (Fig. 1A). A CERES value ≥ 140 showed the best sensitivity to predict late ARF worsening on D15, observed respectively at 1 and 0.93 in the derivation and validation cohorts, while specificity was found at 0.48 and 0.44, respectively. Further, the best specificity for the prediction of late ARF worsening on D15 was observed for a CERES value ≥ 333, being then respectively found at 0.9 and 0.93 in the derivation and validation cohorts, while sensitivity was measured at 0.45 and 0.5 with this cut-off (Fig. 1B).
**Discussion:** Two distinct clinical applications may be derived from our results. First, we found that a CERES value ≥ 140 has a very high sensitivity for the detection of patients eventually requiring invasive respiratory support. Accordingly, the non-invasive strategy was successful in nearly all patients with a CERES score < 140. We could therefore propose to maintain non-invasive strategies in patients with a CERES score < 140. In the same view, a CERES score ≥ 333, which detected the further need for invasive support with a high specificity, could be used to propose earlier intubation in patients with the highest risk of failure of non-invasive strategies.

**Conclusion:** In patients with severe Covid-19 undergoing non-invasive respiratory support, CERES values < 140 and ≥ 333 appear as accurate predictors of late worsening of ARF requiring subsequent intubation.

**Reference 1:** Prakash J, Bhattacharya PK, Yadav AK, Kumar A, Tudu LC, Prasad K. ROX index as a good predictor of high flow nasal cannula failure in COVID-19 patients with acute hypoxemic respiratory failure: A systematic review and meta-analysis. J Crit Care. 2021 Dec;

**Reference 2:** Dupont A, Rauch A, Staessens S, Moussa M, Rosa M, Corseaux D, et al. Vascular Endothelial Damage in the Pathogenesis of Organ Injury in Severe COVID-19. Arterioscler Thromb Vasc Biol. 2021 May 5;41(5):1760–73.

**Compliance with ethics regulations:** Yes in clinical research.

<figure><img src="image_67.png" /><figcaption>Figure 1. ROC curves for the prediction of late ARF worsening at D15 in the derivation and validation cohorts. A) ROC curves were computerized in derivation and validation cohorts for the CERES score (black plain line), for the top 2 predictive variables.</figcaption></figure>

## FC-076

### Early vs late intubation in COVID-19 acute respiratory distress syndrome

MESSAOUD Lynda<fnref n="1" />, JARRAYA Fatma<fnref n="1" />, RACHDI Emna <fnref n="1" />, JEMMALI Rim<fnref n="1" />, JAMOUSSI Amira<fnref n="1" />, AYED Samia<fnref n="1" />, BEN KHELJIL Jalila<fnref n="1" />

**Correspondence:** Fatma JARRAYA (fatma.jarraya8@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-076

**Rationale:** Although management of acute respiratory failure with coronavirus 2019 disease often involves the use of mechanical ventilation, the optimal time to initiate invasive mechanical ventilation (IMV) remains unknown. The aim of this study was to assess the impact of the timing from admission to intubation on mortality in patients with SARS-CoV-2 acute respiratory distress syndrome (ARDS).

**Patients and methods/Materials and methods:** This retrospective study was conducted in an intensive care unit (ICU) between March 2020 and September 2021. We included adult patients with ARDS secondary to SARS-CoV-2 who required IMV. We did not include patients who were intubated prior to admission. The median time from admission to intubation was 72 h. We defined “early” intubation as intubation within 72 h of ICU admission and “late” intubation as intubation occurring at any time after 72 h. Patients were divided into two groups: early intubation (G1) (≤ 72 h) or late intubation (G2) (> 72 h) for analysis.

**Results:** During the study period, 298 patients required IMV of which 175 were intubated early (58.7%) and 123 were intubated late (41.3%). The two groups were comparable in terms of age (61 ± 12 years vs 63 ± 11 years; p = 0.086, G1, G2 respectively) and gender ratio (1.69 vs 2.41, G1, G2 respectively). However, patients in G1 had higher SAPSII at admission (32.3 ± 11 vs 28 ± 7; p = 0.002). Patients in the G1 had a worse PaO₂/FiO₂ ratio (median, 100 mm Hg vs 130 mm Hg; p = 10–3), at the time of intubation in comparison with the G2. Lower static compliance (22 ml/cm H₂O vs 28 ml/cm H₂O; p = 0.562) and higher plateau pressure (29 cm H₂O vs 22 cm H₂O; p = 0.180) were noted in the G2, although these values were not statistically significant. The length of stay in the ICU was similar between both groups (8 days [4–15] vs 13 days [9–18]; p = 0.156). Even among survivors who were successfully weaned from mechanical ventilation (n = 25; 8.4%), length of stay was similar between both groups (30 days [12–45] vs 31 days [18–41]; G1, G2 respectively; p = 0.635). There was no significant difference in mortality between patients in G1 and G2 (57.5% versus 42.5% p = 0.159). The overall mortality rate was 91.6% and the average length of hospital stay was 11 days [6–17].

**Conclusion:** An early intubation strategy was not associated with decreased mortality and morbidity compared to late intubation in patients with ARDS due to SARS-CoV-2.

**Compliance with ethics regulations:** Yes in clinical research.

## FC-077

### Correlation between chest electrical impedance variation and tidal volume in mechanically ventilated patients

JOUSSELLIN Vincent<fnref n="1" />,<fnref n="2" />, JANIAK Vincent³,⁴, BONNY Vincent<fnref n="1" />,<fnref n="2" />, BUREAU

Come<fnref n="1" />,<fnref n="2" />, MAYAUX Julien<fnref n="1" />, MORAWIEC Elise<fnref n="1" />, TALLEC Gwendoline⁴,

SALEEM Umair⁴, PINNA Andrea³, DRES Martin<fnref n="1" />,<fnref n="2" />

**Correspondence:** Vincent JOUSSELLIN (vincent.joussellin@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-077

**Rationale:** Chest Electrical Impedance Tomography (EIT) is a non-invasive technique that produces continuous cross-sectional images of regional lung ventilation. Tidal impedance variation has been recently proposed to estimate the tidal volume of patients with acute respiratory failure by using a calibration factor given by the ratio of tidal volume divided by tidal impedance variation (1). Whether this calibration factor can be used in all patients is unknown. This study hypothesized that K-factor varies between patients.

**Patients and methods/Materials and methods:** We took the opportunity of a study evaluating chest electrical impedance tomography in mechanically ventilated patients. EIT was connected to the ventilator and a 5-min recording was performed while patients were still under pressure support. Median chest impedance variation and median tidal volume were calculated through 100 respiratory cycles over the 5-min period for each patient (or less if respiratory rate was below 20 per minute). K-factor was calculated by dividing median tidal volume by median chest impedance variation and was then expressed in mL/ arbitrary units.

**Results:** Thirty-four patients were included, but only twenty-six had full EIT and ventilator data available. The median K-factor was 0.16 mL/UA (IQR 0.14–0.23 mL/UA) (Fig. 1). After applying a Pearson correlation, factors associated with K-factor were height (r<fnref n="2" /> = 0.15, p = 0.04), weight (r<fnref n="2" /> = 0.50, p < 0.01), level of PEEP (r<fnref n="2" /> = 0.40, p < 0.01) and hematocrit (r<fnref n="2" /> = 0.30, p < 0.01).

**Conclusion:** K-factor largely varies among patients and a single value cannot accurately estimate the tidal volume. K-factor was correlated with other variables than chest impedance variation alone.

<footnote n="1">¹Hôpital Abderrahmane Mami, Ariana, Tunisie</footnote>

<footnote n="1">¹AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Médecine Intensive – Réanimation (Département "R3S"), Paris, France;</footnote>

<footnote n="2">²Sorbonne Université, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France; ³Sorbonne Université, CNRS, LIP6, Paris, France; ⁴Bioserenity, Paris, France.</footnote>
**Reference 1:** 1. Mauri T, Turrini C, Eronia N, et al. Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure. Am J Respir Crit Care Med. 2017;195(9):1207–1215.

**Compliance with ethics regulations:** Yes in clinical research.

<figure><img src="image_68.png" /></figure>

Correlation between K-Factor and weight in 26 patients (K-factor median is represented with a red dash line).

### FC-078

**Effects of Almitrine administration as rescue therapy in spontaneously breathing patients with severe pneumonia related to SARS-CoV-2 treated with high-flow nasal canula oxygen therapy**

SACCHERI Clément¹, MORAND Lucas¹, DOYEN Denis¹, HYVERNAT Hervé¹, LOMBARDI Romain¹, DEVANLAY Raphaël¹, PANICUCCI Emilie¹, DELLAMONICA Jean¹, JOZWIAK Mathieu¹

¹CHU de Nice, Nice, France

**Correspondence:** Clément SACCHERI (clement.saccheri@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-078

**Rationale:** Hypoxemia in SARS-CoV-2 pneumonia results from abnormal ventilation/perfusion ratio related to blunted hypoxic vasoconstriction. Almitrine is a selective pulmonary vasoconstrictor that has been reported to improve the oxygenation in mechanically ventilated patients with acute respiratory distress syndrome related to SARS-CoV-2 pneumonia, but its effects in spontaneously breathing patients treated with high-flow nasal canula oxygen therapy (HFNO) as first-line ventilatory support remain to be determined.

**Patients and methods/Materials and methods:** In this single-center, observational and physiological study, a bolus of Almitrine was administered (0.5 mg/kg over 30 min) as rescue therapy in spontaneously breathing patients with severe pneumonia related to SARS-CoV-2 treated with HFNO and with persistent severe hypoxemia (PaO₂/FiO₂ ratio < 100 with FiO₂ > 80%) after awake prone positioning failure. Arterial blood gases and transthoracic echocardiography were performed just before and after the Almitrine bolus. Almitrine responder was defined by an increase in PaO₂/FiO₂ ratio > 20%, that was analyzed in light of thoracic CT-Scan patterns (acute fibrinous and organizing pneumonia (AFOP); diffuse alveolar damage (DAD); bi-basal dependent areas of consolidation) obtained at hospital or ICU admission.

**Results:** Overall 62 patients were included (34% of female, 60±11 years old). No patient experienced right ventricular dysfunction or acute core pulmonale after Almitrine administration. Almitrine increased the PaO₂/FiO₂ ratio from 68 (61–79) to 109 (85–156) (p < 0.001) and 46 (74%) patients were responders. Almitrine also decreased the PaCO₂ (33 vs. 31 mm Hg, p < 0.001) while the respiratory rate remained unchanged (27 vs. 28 cycles/min, p = 0.45). The CT-Scan patterns distribution was: AFOP in 36 (58%) patients, DAD in 20 (32%) patients, and bi-basal dependent areas of consolidation in 6 (10%) patients. The proportion of Almitrine responders was similar across the

different CT-Scan patterns (75% for AFOP, 70% for DAD and 83% for bi-basal dependent areas of consolidation, respectively). The responders had a lower intubation rate (33 vs. 88%, p < 0.001) and shorter ICU length of stay (5(3–9) vs. 10(6–17), p < 0.01) than non-responder patients.

**Conclusion:** Almitrine iv administration as a rescue therapy in severe COVID-19 pneumonia under HFNO improved oxygenation in responders with a decreased rate of intubation rate. Patterns of the thoracic CT-Scan performed on hospital or ICU admission did not help to predict the response to Almitrine in terms of oxygenation. Further clinical trials are needed to confirm these results.

**Compliance with ethics regulations:** Yes in clinical research.

### FC-079

**The use of inhaled nitric oxide (iNO) in Covid19 ARDS patients: a French retrospective registry**

VIEILLARD BARON Antoine¹, MEKONTSO DESSAP Armand², PAPAZIAN Laurent³, MERCAT Alain⁴, HOUETO Patrick¹⁴, SCHALLER Manuella¹⁴, RAMIREZ Juan Fernando¹⁴, LECOURT Laurent¹³, MEGARBANE Bruno⁵, HAUDEBOURG Luc⁶, TIMSIT Jean-François⁷, TEOUL Jean-Louis⁸, KUTEIFAN Khaldoun⁹, GAINNIER Marc¹⁰, SLAMA Michel¹¹, NSEIR Saadalla¹²
¹CH Ambroise Paré (AP-HP), Boulogne Billancourt, France; ²CHU de Créteil_Henri Mondor (AP-HP), Creteil, France; ³CHU MARSEILLE (APHM), Marseille, France; ⁴CHU d'ANGERS, Angers, France; ⁵CH LARIBOISIÈRE (AP-HP), Paris, France; ⁶CH Pitié Salpêtrière (AP-HP), Paris, France; ⁷CH BICHAT (AP-HP), Paris, France; ⁸CH BICETRE (AP-HP), Paris, France; ⁹CH de MULHOUSE, Mulhouse, France; ¹⁰Hôpital La Timone (APHM), Marseille, France; ¹¹CHU Amiens, Amiens, France; ¹²CHU Lille, Lille, France; ¹³Air Liquide Healthcare, Gentilly, France; ¹⁴Air Liquide Healthcare, Les Loges Josas, France.

**Correspondence:** Laurent LECOURT (laurent.lecourt@airliquide.com)

Annals of Intensive Care 2022, **12**(1):FC-079

**Rationale:** Inhaled Nitric Oxide (iNO) has been widely used all over the world during COVID19 pandemia¹. Previous studies reported conflicting results on the effect of iNO on oxygenation improvement. The objective of this registry was to describe the use of iNO in a large cohort of Covid19 ARDS (CARDS) patients.

**Patients and methods/Materials and methods:** Multi-center, retrospective cohort registry conducted in 12 French hospitals during the first year of pandemia on CARDS patients treated with iNO. Patients' characteristics, clinical respiratory support, nitric oxide therapy safety and efficacy parameters and patients' clinical outcomes were collected. iNO response was defined as PaO₂/FiO₂ ratio improving by >= 20% after iNO initiation.

**Results:** From March to December 2020, 300 CARDS patients (22.3% female) were included in the registry. At ICU admission, their median (IQR) age, SAPS II, and SOFA scores were 66 (57–72) years, 37 (29–48), and 5 (3–8), respectively. Patients were still hypoxic despite protective ventilation (in all patients) and prone positioning sessions (in 68%). At iNO initiation, 2%, 37%, and 61% patients had mild, moderate, and severe ARDS, respectively. Median (IQR) delay between iNO therapy initiation and ICU admission, ARDS diagnosis, and intubation were 7 (3–12), 6 (2–11) and 4 (1–10) days respectively. The median duration of iNO was 2.8 (1.1–5.5) days with a median dosage of 10 (7–13) ppm at initiation. Responders were analyzed at different stages: 45.7% of patients were responders within 6 h following iNO initiation, 56.9% based on the best PaO₂/FiO₂ ratio within 24 h after iNO initiation and 70.3% patients had at least one response during iNO administration. The severity of ARDS is the only predictive factor associated with iNO response considering the best PaO₂/FiO₂ ratio obtained within 24 h (Fig. 1). This arterial oxygenation improvement did not impact the patients' outcomes (length of ICU/hospital stay, ventilation duration, mortality) in the global population. Regarding safety aspects, renal replacement therapy was initiated in 23.5% patients during iNO administration, and 60.5% patients presented a Kdigo score I, II and III within 24 h following iNO initiation, without a formal causal link with iNO.

**Conclusion:** This registry confirmed the benefits of iNO for arterial oxygenation improvement in severe ARDS patients still hypoxic after optimization of ventilation and prone positioning.
**Reference 1:** Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. *Intensive Care Med.* 2020 Oct 29: 1–14. https://doi.org/10.1007/s00134-020-06294-x PMCID: PMC7674575 PMID: 33211135.

**Compliance with ethics regulations:** Yes in clinical research.

<figure><img src="image_69.png" /></figure>

Severity of ARDS at iNO initiation in iNO responders and non-responders.
The distribution of ARDS severity between iNO responders and iNO non-responders was compared using Fisher's exact test.

FC-080

Predicting the outcome of patients with acute respiratory distress syndrome using a miniature transesophageal ultrasound probe

EDDERKAOUI Mehdi¹, POULY Olivier¹, GOUTAY Julien¹, BOUREL Claire¹, ONIMUS Thierry¹, FAVORY Raphael¹, DURAND Arthur¹, PREAU Sébastien¹
¹CHRU LILLE, Lille, France

**Correspondence:** Mehdi EDDERKAOUI (mehdi-edderkaoui@hotmail.fr)
*Annals of Intensive Care* 2022, **12**(1):FC-080

**Rationale:** The objective of the study was to test whether sequential monitoring of the superior vena cava (SVC), by allowing measurement of the superior vena cava collapsibility index (SVCci), could be a prognostic marker in patients with acute respiratory distress syndrome (ARDS).

**Patients and methods/Materials and methods:** 50 patients admitted to 5 intensive care units (ICU) with moderate to severe ARDS and receiving invasive mechanical ventilation for less than 24 h were prospectively included. The minimum (inspiratory) and maximum (expiratory) telediastolic diameter of the SVC were monitored every 8 h using a miniature ClariTEETM transesophageal ultrasound probe (CLT0110-1, IMACOR, New York NY, USA) for up to 72 h after inclusion. The SVCci was calculated as follows: (maximum diameter – minimum diameter)/maximum diameter. The primary outcome was 90-day mortality.

**Results:** In-hospital mortality censored at 28 and 90 days was of 30% (n = 15) and 34% (n = 17), respectively. The median (interquartile range) length of stay in the intensive care unit (ICU) was 14 days (8–23). The number of days alive without mechanical ventilation at 28 days was 17 (0–23). The mean SVCci measured over the first 24 h after inclusion (SVCci-D1) was significantly higher in survivors compared to non-survivors at 90 days: 0.23 (0.16–0.31) versus 0.17 (0.14–0.21), p = 0.048. The mean SVCci measured over the first 72 h after inclusion (SVCci-D3) was significantly higher in survivors compared to non-survivors at 90 days: 0.22 (0.17–0.24) versus 0.17 (0.14–0.21), p = 0.028. A SVCci-D1 < 0.20 and a SVCci-D3 < 0.22 predicted 90-day mortality with areas under ROC curve (± standard error of the mean) of 0.692 (± 0.079) and 0.692 (± 0.078), sensitivities of 64% and 58%, and specificities of 71% and 88%, respectively.

**Conclusion:** The mean SVCci measured over the first days after ICU admission, appears to be a prognostic marker of 90-day mortality in patients with moderate to severe ARDS.

**Compliance with ethics regulations:** Yes in clinical research.

FC-081

Assessment of airway opening pressure with electrical impedance tomography in patients with acute respiratory distress syndrome

LOUIS Bruno², COUR Martin¹, ARGAUD Laurent¹, GUÉRIN Claude¹

¹Hôpital Edouard Herriot Hospices Civils de Lyon, Lyon, France, France;

²Institut Mondor de Recherches Biomédicales, Créteil, France

**Correspondence:** Claude GUÉRIN (claude.guerin@chu-lyon.fr)

*Annals of Intensive Care* 2022, **12**(1):FC-081

**Rationale:** Airway opening pressure (AOP) determined in patients with acute respiratory distress syndrome (ARDS) from the inspection of volume-pressure curve (1) should mean that lung ventilation increases once AOP is overcome. To address this issue, we compared AOP measured from both inspiratory volume-pressure curve and electrical impedance tomography (EIT) simultaneously recorded during low flow inflation of the respiratory system. If AOP reflects a critical opening pressure it should correlated with AOP measured with EIT (AOP<sub>EIT</sub>).

**Patients and methods/Materials and methods:** In this secondary analysis of a previous study (2) 10 ARDS patients were investigated at positive end-expiratory pressure of 5, 10 and 15 cm H₂O in the semi-recumbent position under continuous sedation and paralysis. Airway pressure (Paw) and flow signals were measured at the proximal tip of the endotracheal tube and sent to MP 150 datalogger (Biopac Inc.). Pulmovista EIT device (Drager) was used to assess lung ventilation. The respiratory system was inflated at a 7 L/min constant flow inflation delivered by the ventilator (Evita XL) and airway pressure, flow and EIT signals recorded simultaneously. AOP was defined as the pressure where the volume delivered to the patient was 4 ml greater than the volume delivered to the occluded circuit (1). AOP<sub>EIT</sub> was estimated during low insufflation from Paw-EIT-derived Volume curves fitted by a sigmoidal equation. When the lower inflexion point was below PEEP, AOP<sub>EIT</sub> was considered equal to PEEP. The values of AOP and AOP<sub>EIT</sub> were analysed by using the rho Spearman correlation coefficient and the Bland and Altman representation over 30 pairs. P < 0.05 was set as the statistically significant threshold.

**Results:** AOP and AOP<sub>EIT</sub> were significantly correlated (Spearman rho = 0.73, P = 0.000005). The mean bias was 0.44 cm H₂O. In 96% (29/30) of the cases the differences observed between the two methods were less than 2 cm H₂O.

**Conclusion:** AOP and AOP<sub>EIT</sub> are significantly correlated.

**Reference 1:** (1) Chen et al. AJRCCM 2018.

**Reference 2:** (2) Guérin et al. J Appl Physiol 2020.

**Compliance with ethics regulations:** Yes in clinical research.

FC-082

Pattern of FRC variation following prone positioning in Covid-ARDS: evaluation by the nitrogen washin-washout method

LAHMAR Manel¹, CHIHAOUI Abir¹, BEN AHMED Hedia¹, HAMMOUDA Zeineb¹, SAADAOUI Oussema¹, DACHRAOUI Fahmi¹, ABROUG Fekri¹, BESBES OUANNES Lamia¹

¹CHU Fattouma Bourguiba Monastir, Monastir, Tunisie

**Correspondence:** Manel LAHMAR (firassmal4@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-082

**Rationale:** Acute Respiratory Distress Syndrome (ARDS) is characterized by reduction of all lung volumes (in particular that of FRC), and a decrease in respiratory system compliance (CrS). Prone positioning which is recommended in severe ARDS allows a more uniform distribution of the ventilation/perfusion ratios with alteration in Crs properties resulting in lung recruitment, FRC increase, and improvement of oxygenation and survival. The alveolar recruitment process is time-dependent with uncertainty about the optimal daily prone duration. The aim of our study is to characterize the pattern of FRC increase (kinetic and magnitude) during the first 24 h following prone positioning in patients with Covid-19 related ARDS (C-ARDS).
**Patients and methods/Materials and methods:** a prospective observational study conducted between January and October 2021, including consecutive patients admitted to the ICU for severe C-ARDS (PaO₂/FiO₂ ≤ 150 mm Hg) and requiring tracheal intubation and mechanical ventilation. Patients were ventilated in supine position with a lung protective strategy (Vt ≤ 6 ml/kg of P BW, the highest PEEP level to obtain a plateau pressure ≤ 30 cm H₂O). Patients were systematically turned prone and FRC was measured immediately after prone position and every 2 h during the first 24 h. The measurements were carried out using the Nitrogen Wash-in Wash-out technique available on the CARESCAPE R860 respirator (General Electrics, Wisconsin, USA). The usual oxygenation (SaO₂/FiO₂) and ventilatory mechanics (Csr, and strain) variables were also recorded.

**Results:** 20 patients (14 men, mean age: 65±9 years, PaO₂/FiO₂: 105±42, mean static compliance: 28.5±5, mean PEEP: 14±2) were included in the study.

**Conclusion:** Prone positioning evokes a rapid and progressive improvement in FRC and oxygenation. These effects are associated with improved strain on the lungs.

**Compliance with ethics regulations:** Yes in clinical research.

<figure><img src="image_70.png" /><figcaption>the FRC variation during the first 24 h following prone positioning</figcaption></figure>

### FC-083

#### Regional airway closure and patients positioning in acute hypoxemic respiratory failure

PAVLOVSKY Bertrand¹, LEPROVOST Pierre¹, LESIMPLE Arnaud¹, DESPREZ Christophe¹, TAILLANTOU-CANDAU Mathilde¹, RICHARD Jean-Christophe¹, MERCAT Alain¹, BELONCLE François¹
¹CHU Angers, Angers, France

**Correspondence:** Bertrand PAVLOVSKY (bertrand.pavlovsky@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-083

**Rationale:** Airway closure leading to an interruption of ventilation in the downstream alveoli may be associated with ventilation inhomogeneity and ventilation-induced lung injury. This phenomenon may be detected at the bedside by performing a low-flow insufflation pressure-volume or pressure-time curve. Airway opening may vary across the lung. We aimed to study the regional distribution of airway opening in semi-recumbent and strict supine position in a series of patients with acute hypoxemic respiratory failure (AHRF).

**Patients and methods/Materials and methods:** Twenty patients admitted to a Medical ICU and intubated for AHRF (PaO₂/FiO₂ ratio < 300 mm Hg) were enrolled within the 12 first hours after intubation. Patients were ventilated in volume-controlled ventilation (tidal volume 6 mL.kg⁻¹ predicted body weight PBW) and a positive end-expiratory pressure of 5 cm H₂O and positioned (1) in the semi-recumbent position (head of bed at 30°) and (2) in the strict supine position (0°). Measurements of end-expiratory lung volume (EELV) using the nitrogen wash-out wash-in technique and reported to PBW,

respiratory mechanics, gas distribution using electrical impedance tomography and a low-flow insufflation to detect airway closure were performed after 30 min in each position. One global (obtained with the volume changes measured by the ventilator at the airway opening) and two regional (using regional impedance waveforms to estimate the non-dependent and dependent real-time volume changes) pressure-volume curves were constructed offline using a dedicated software.

**Results:** Age was 63 [52–71]. PaO₂/FiO₂ ratio was 240 [140–287] mm Hg, and respiratory system compliance (CRS) was 52 [46–59] mL.cm H₂O⁻¹. Twelve patients fulfilled acute respiratory distress syndrome (ARDS) criteria. An airway closure was detected on the airway pressure-volume curve in 3 patients (15%). A regional airway closure was observed in the dependent regions in 6 patients (30%). No difference in PaO₂/FiO₂ (240 [157–317] vs 227 [135–295], p > 0.999) nor CRS (51 [41–57] vs 53 [47–61] mL.cm H₂O⁻¹, p > 0.999) was observed between patients with or without regional airway closure. But EELV/PBW was lower in patients with regional airway closure (16 [15–17] vs 28 [23–34] mL.kg⁻¹ PBW, p < 0.001). Supine position was associated with a decrease in EELV/PBW (25 [18–33] vs 21 [16–34] mL.kg⁻¹, p = 0.009) and an increase (albeit non-significant) in regional airway closure prevalence (45% vs 30%, p = 0.515).

**Conclusion:** In patients with AHRF, airway closure seems frequent in dependent regions, in particular in strict supine position.

**Compliance with ethics regulations:** Yes in clinical research.

<figure><img src="image_71.png" /><figcaption>Examples of airway closure patterns in three representative study patients. Left panel: partial airway closure; central panel: global airway closure, with differential closure between the regions; right panel: absence of airway closure.</figcaption></figure>

### FC-084

#### Corticosteroid for acute exacerbations of COPD in ICU. A French cohort: OUTCOMEREA database

GALERNEAU Louis-Marie¹,², BAILLY Sébastien², TERZI Nicolas¹, RUCKLY Stéphane³, GARROUSTE-ORGEAS Maître⁴, COHEN Yves⁵, HONG TUAN HA Vivien⁶, GAINNIER Marc⁷, SIAMI Shidasp⁸, DUPUIS Claire⁹, DARMON Michael¹⁰, AZOULAY Elie¹⁰, FOREL Jean-Marie¹¹, SIGAUD Florian¹, ADRIE Christophe¹², GOLDGRAN-TOLEDANO Dany¹³, BRUNEEL Fabrice¹⁴, DE MONTMOLLIN Etienne¹⁵, ARGAUD Laurent¹⁶, REIGNIER Jean¹⁷, PEPIN Jean-Louis¹,², TIMSIT Jean-François¹⁵

¹CHU Grenoble Alpes, La Tronche, France; ²Université Grenoble Alpes, INSERM U1300 HP2, Grenoble, France; ³Département de biostatistiques, Outcomerea, Paris, France; ⁴Hôpital Franco-Britannique, Levallois-Perret, France; ⁵AP-HP, Hôpital Avicenne, Paris, France; ⁶Grand Hôpital de l'Est Francilien, Meaux, France; ⁷Hôpital de la Timone, Marseille, France; ⁸Centre Hospitalier Sud Essonne, Étampes, France; ⁹CHU Gabriel-Montpied, Clermont-Ferrand, France; ¹⁰AP-HP, Hôpital Saint-Louis, Paris, France; ¹¹Hôpital Universitaire Marseille Nord, Marseille, France; ¹²Hôpital Delafontaine Hôpital, Saint-Denis, France; ¹³Groupe Hospitalier Intercommunal Le Raincy Montfermeil, Montfermeil, France; ¹⁴Centre Hospitalier de Versailles, Le Chesnay, France; ¹⁵AP-HP, Hôpital Bichat, Paris, France; ¹⁶Hospices civils de Lyon, Hôpital Edouard Herriot, Lyon, France; ¹⁷CHU de Nantes, Nantes, France.

**Correspondence:** Louis-Marie GALERNEAU (imgalerneau@chu-grenoble.fr)

Annals of Intensive Care 2022, **12**(1):FC-084
**Rationale:** Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a very frequent in intensive care unit (ICU). However, there are few data and conflicting results about corticosteroids therapy for critically ill patients with an AECOPD.

**Patients and methods/Materials and methods:** In this study, using data from the observational longitudinal cohort OutcomeRea™ database, with 32 french ICU centres participating, we assessed the impact of corticosteroid therapy for patients in ICU for an AECOPD. The prescription of corticosteroids therapy at admission was defined as a daily dose ≥ 0.5 mg/kg of prednisone during the first 24 h after admission in ICU. We assessed the effect of corticosteroids on a main composite criteria including death and invasive mechanical ventilation (IMV) at day 28 after admission in ICU using an inverse probability of treatment weight (IPTW) estimator. Secondary outcomes were: survival analyse at D-28 and D-90, NIV failure, length of stay in ICU and in hospital, duration of ventilation, consumption of antibiotics and adverse effects of corticosteroids.

**Results:** We included 1,247 patients of which 31,4% was treated by a corticosteroid therapy at admission. Corticosteroids administration at admission was significantly found as protector on the main composite outcome (RR = 0.693 [0.489; 0.98], p = 0.038). For the subgroup of patients with a very severe COPD, the protective effect of corticosteroid therapy on the primary composite outcome was not found (RR = 1,205 [0.577; 2.517], p = 0.6203). There was no significant impact of corticosteroids on failures of NIV, on lengths of stay in ICU and in hospital or on durations of ventilation. We did not observe statistical relation between the corticosteroid prescription at global prescription of antibiotics. However, corticosteroid therapy tended to be associated with longer duration of antibiotics treatment for patients in ICU at least 10 days (effect of corticosteroid therapy on antibiotic-free days at 10-day for the 395 patients with a length of stay in ICU ≥ 10 days: IRR = 0. 776 [0.597; 1.009], p = 0.059)). Nosocomial infectious had the same prevalence in the two groups of patients. But the maximum systolic blood pressure and the levels of urea was higher and the glycemic disorders more frequent when patient received corticosteroids.

**Conclusion:** A corticosteroids administration at admission in ICU to patients with AECOPD had a protective effect on death or invasive mechanical ventilation at Day 28. Studies on doses to use or the profile of patients to treat are needed.

**Compliance with ethics regulations:** Yes in clinical research.

### FC-085

#### Use of high-flow oxygen nasal cannula oxygenation in adult patients with sickle cell disease admitted in ICU: a pilot study

PONS Bertrand¹, BERTHOD Antoine¹, CARLES Michel², MARTINO Frédéric¹

¹CHU Guadeloupe, Les Abymes, Guadeloupe; ²CHU NICE, Nice, France

**Correspondence:** Bertrand PONS (pons.bertrand@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-085

**Rationale:** Sickle cell disease (SCD) is a life-threatening genetic disorder associated with many chronic and acute complications [1]. Oxygen therapy is one of the cornerstones of management of patients with SCD admitted to the hospital. Recently, high flow nasal cannula (HFNC) oxygenation has emerged, and clinical practice guidelines have been released for the use of HFNC in the overall population [2]. But at this very time, no evidence has been reported of the use of HFNC in patients with SCD. The objective of this pilot study was to evaluate the efficacy and tolerance of HFNC in comparison of conventional oxygen therapy via facial mask (FM) in adult patients with SCD admitted in ICU.

**Patients and methods/Materials and methods:** Consecutive adult patients with SCD (SS, SC, or SBeta thalassemia) admitted in ICU with clinical symptoms compatible with acute chest syndrome (ACS) were eligible. Early-stage ACS and management of all patients included was defined accordingly to the actual national French guidelines. Randomization defined the initial oxygen therapy during a 4-session course of 5-h oxygen therapy with, alternately, HFNC (FiO₂ 60%, flow rate 60 L/min) and FM (FiO₂ 60%, flow rate 15 L/min). Blood samples were analyzed at the beginning and end of each session. Comfort, dyspnea, and tolerance were assessed at multiple predefined times during the

study. Accordingly, to the French law, written informed consent was obtained from all patients prior to enrollment.

**Results:** Seven patients were included and 24 sessions of oxygen therapy have been completed. There was no significant difference in clinical and biological variables between the beginning (H0) and the end (H5) of oxygen therapy session (Tab 1). Median PaO₂ throughout the session was higher with HFNC (49 [23, 85] mm Hg) compared to FM (18 [−26, 30] mm Hg, p = 0.04). Incidence of episodes of desaturation was greater in HFNC vs FM (4 episodes (33%) vs 1 (8%) respectively, p = 0.04) without any episode of severe desaturation (SpO₂ < 90%). Comfort was statistically non different between the 2 techniques (9.4 [7–10] under FM vs 8.3 [4.7–9.4] under HFNC, p = 0.31).

**Discussion:** In our study, HFNC was associated with a greater benefit in term of oxygenation compared to conventional oxygen therapy. Despite the limitations of this study, our results suggest a potential benefit of HFNC use, in term of oxygenation, in SCD patients with acute respiratory failure.

**Conclusion:** In adult patients with SCD admitted in ICU for acute respiratory failure, HFNC could be of interest to improve oxygenation, compared to conventional oxygen therapy.

**Reference 1:** 1. Yawn BP, Buchanan GR, Afenyi-Annan AN, et al.: Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members [published correction appears in JAMA 2014; 312(18):1932] [published correction appears in JAMA 2015 Feb].

**Reference 2:** 4. Rochwerg B, Einav S, Chaudhuri D, et al.: The role for high flow nasal cannula as a respiratory support strategy in adults: A clinical practice guideline. Intensive Care Med 2020; 46(12):2226–2237.

**Compliance with ethics regulations:** Yes in clinical research.

<table><thead><tr><th></th><th colspan="3">H0</th><th colspan="3">H5</th></tr><tr><th></th><th>FM</th><th>HFNC</th><th>p</th><th>FM</th><th>HFNC</th><th>p</th></tr></thead><tbody><tr><td>PaO2 (mmHg)</td><td>119 (84–166)</td><td>106 (79–135)</td><td>0.33</td><td>126 (95.5–152)</td><td>141 (100.2–197)</td><td>0.34</td></tr><tr><td>Comfort</td><td>10 (9–10)</td><td>9 (4–10)</td><td>0.09</td><td>8.5 (5–10)</td><td>9 (5–10)</td><td>0.77</td></tr><tr><td>Dyspnea</td><td>0 (0–0)</td><td>0 (0–3)</td><td>0.34</td><td>0 (0–0)</td><td>0 (0.2–2.5)</td><td>0.47</td></tr><tr><td>Moat dryness</td><td>0 (0–2)</td><td>0 (0–0)</td><td>0.92</td><td>0 (0–1.25)</td><td>0 (0–0.5)</td><td>0.94</td></tr><tr><td>Respiratory rate (min)</td><td>22.5 (20–26.75)</td><td>22.0 (14.5–24.5)</td><td>0.29</td><td>26 (18.25–27)</td><td>24 (17.5–25.5)</td><td>0.39</td></tr><tr><td>SpO2 (%)</td><td>100 (96–100)</td><td>100 (96–100)</td><td>0.91</td><td>100 (96.75–100)</td><td>100 (99–100)</td><td>0.64</td></tr><tr><td>Heart rate (bpm)</td><td>98 (94–105)</td><td>100 (96–115)</td><td>0.88</td><td>102.5 (92–107.8)</td><td>96 (87.75–106)</td><td>0.58</td></tr><tr><td>SBP (mmHg)</td><td>122 (114–138)</td><td>130 (118–140)</td><td>0.64</td><td>127.5 (115–138.8)</td><td>137 (132.2–147.2)</td><td>0.21</td></tr><tr><td>DBP (mmHg)</td><td>95 (79–100)</td><td>98 (79–92)</td><td>0.34</td><td>99 (82–103)</td><td>97 (83–92.5)</td><td>0.85</td></tr><tr><td>pH</td><td>7.41 (7.40–7.42)</td><td>7.41 (7.38–7.44)</td><td>0.72</td><td>7.42 (7.37–7.43)</td><td>7.43 (7.38–7.43)</td><td>0.84</td></tr><tr><td>PaO2 (mmHg)</td><td>42 (39–44)</td><td>40 (37–42)</td><td>0.19</td><td>40 (38.5–44.5)</td><td>42.5 (39.5–48.25)</td><td>0.96</td></tr><tr><td>SaO2 (%)</td><td>98 (98–99)</td><td>98 (97–99)</td><td>0.83</td><td>99 (98–99)</td><td>99 (98–99)</td><td>0.97</td></tr></tbody></table>

Results are reported as median (IQR). FM, facial mask; HFNC, high flow nasal cannula; PaO₂, partial pressure of oxygen in arterial blood; PaCO₂, partial pressure of carbon dioxide in arterial blood; SBP, systolic blood pressure; DBP, diastolic blood pressure; SaO₂, arterial oxygen saturation.

#### Clinical and biological during oxygen therapy

### FC-086

#### Long-term exposure to ambient air pollution is associated with an increased incidence and mortality of acute respiratory distress syndrome in a large French region

GUTMAN Laetitia¹,², PAULY Vanessa², ORLEANS Veronica², PIGA Damien³, CHANNAC Yann³, ARMENGAUD Alexandre³, BOYER Laurent², PAPAZIAN Laurent¹,²

¹Assistance publique des hôpitaux de Marseille - Hôpital nord, Marseille, France; ²Faculté de sciences médicales et paramédicales Aix Marseille, Marseille, France; ³ATMOSUD, Marseille, France

**Correspondence:** Laetitia GUTMAN (laetitiagutman@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-086

**Rationale:** Air pollution exposure is suspected to alter both the incidence and mortality in acute respiratory distress syndrome (ARDS). The impact of chronic air pollutant exposure on the incidence and mortality of ARDS from various etiologies in Europe remains unknown. The main objective of this study was to evaluate the incidence of ARDS in a large European region, 90-day mortality being the main secondary outcome.

**Patients and methods/Materials and methods:** The study was undertaken in the Provence-Alpes-Cote-d'Azur (PACA) region. Nitrogen dioxide (NO₂), particulate matter (PM2.5 and PM10) and ozone
(O₃) were measured. The Programme de Médicalisation des Systèmes d'Information (PMSI), which captures all patient hospital stays in France, was used to identify adults coded as ARDS.

**Results:** From 2016 to 2018, 4,733 adults with ARDS treated in intensive care units were analysed. The incidence rate ratios for 1-year average exposure to PM2.5 and PM10 were 1.207 ([95% confidence interval (95% CI), 1.145–1.390]; P < 0.01) and 1.168 (95% CI, 1.083–1.259; P < 0.001), respectively. The same trend was observed for both 2- and 3-year exposures, while only chronic 1- and 2-year exposure NO₂ exposures were related to a higher incidence of ARDS. Increased PM2.5 exposure was associated with a higher 90-day mortality for both 1- and 3-year exposures (OR 1.096 (95% CI, 1.001–1.201) and 1.078 (95% CI, 1.009–1.152), respectively). O₃ was not associated with either of incidence or mortality.

**Conclusion:** Increased exposures to NO₂, PM2.5 and PM10 were associated with an increased incidence of ARDS. Increased exposure to PM2.5 was also associated with increased 90-day ARDS mortality.

**Compliance with ethics regulations:** Yes in clinical research.

## FC-087

### Clinical practice survey: assessment and ventilatory management of sickle cell patients in intensive care

HAGRY Julien¹, MEKONTSO DESSAP Armand², MONNET Xavier¹, RAZAZI Keyvan², CHANTALAT Christelle¹, DE PROST Nicolas², PHAM Tai¹
¹CHU Bicêtre, Le Kremlin-Bicêtre, France; ²CHU Henri Mondor, Créteil, France

**Correspondence:** Julien HAGRY (hagryjulien@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-087

**Rationale:** Sickle cell disease, a common genetic disease in France, is a haemoglobinopathy characterised by a β-globin abnormality and the production of haemoglobin S. Hyperalgesic vaso-occlusive crisis (VOC) and acute chest syndrome (ACS) are the main complications leading to intensive care units (ICU) admissions. Despite frequent hospitalizations in ICUs, there is heterogeneity in treatment and global management due to a lack of ICU-specific guidelines. We aimed at gathering the medical practices of ICUs nationwide.

**Patients and methods/Materials and methods:** We carried out an online survey that was sent to medical teams of all ICUs of French hospitals identified as expert centers in the Orphanet database (https://www.orpha.net). Physicians from the same unit sent consensus answers to capture the usual care in their ICU, providing one survey answer per unit. The survey included sections related to: demography; usual pain management, and three clinical situations (hyperalgesic VOC, VOC with chest pain, and ACS with chest pain, dyspnea and fever).

**Results:** Of 55 centers contacted, 29 (53%) answered the survey, including 18 (62%) university-hospitals, 10 (34.5%) general hospital centers and 1 (3.5%) private hospital. The median [IQR] number of ICU beds was 23 [18–28]. We grouped centers according to the annual number of admissions: 16 (55%) centers admitted less than 10 patients with sickle cell disease per year. Pain management: nitrogen monoxide-oxygen mixture was used in 72% of centers. Nonsteroidal anti-inflammatory drugs were more likely used by centers admitting more than 10 patients per year, though not achieving statistically difference (61.5% vs 25%, p = 0.108). Oxygenation and physiotherapy: conventional oxygen therapy was decided regardless of the oxygen saturation in 52% for VOC and 55% in VOC associated with chest pain or ACS). Physiotherapy and incentive spirometry was systematically prescribed in 69% of the centers during a VOC, 82% in case of VOC with chest pain and 62% during ACS. Ventilatory support: according to physicians, non-invasive ventilation main benefit during ACS was the effect on alveolar recruitment and hypercapnia (90%), but patients' tolerance seems to be its main limitation for 69%. High-flow nasal oxygen (HFNO) was considered easy to use (86%) and well-tolerated by patients (83%), but to 76% of the responders, its efficacy during ACS needs to be proven by large studies.

**Conclusion:** Pain and respiratory management of patients with sickle cell disease acute complications seems to be heterogeneous amongst

expert centers. Incentive spirometry to treat or prevent ACS needs to be generalized. Further studies evaluating the benefits of HFNO are needed.

**Compliance with ethics regulations:** Yes in clinical research.

<table><caption>Table 1: main management and respiratory devices effects according to the number of patients with sickle cell disease admitted per year.</caption><thead><tr><th></th><th>Total (N=29)</th><th>&lt;10 admissions per year (N=16)</th><th>&gt; 10 admissions per year (N=13)</th></tr></thead><tbody><tr><td>Nitrogen monoxide oxygen mixture (MEOPA) use</td><td>21 (72%)</td><td>12 (75%)</td><td>9 (69%)</td></tr><tr><td>NSAI drugs use</td><td>12 (41%)</td><td>4 (25%)</td><td>8 (61.5%)</td></tr><tr><td>Systematic conventional oxygen therapy (during VOC and chest pain)</td><td>16 (55%)</td><td>9 (56%)</td><td>7 (54%)</td></tr><tr><td>Physiotherapy and incentive spirometry (during VOC)</td><td>20 (69%)</td><td>12 (75%)</td><td>8 (61%)</td></tr><tr><td>NIV main benefit: alveolar recruitment and effect on hypercapnia</td><td>26 (90%)</td><td>14 (88%)</td><td>12 (92%)</td></tr><tr><td>HFNO main limitation: no proof of efficacy during ACS</td><td>22 (76%)</td><td>13 (81%)</td><td>9 (69%)</td></tr></tbody></table>

## FC-088

### Acute exacerbations in chronic obstructive pulmonary diseases: eosinophil-guided corticosteroid therapy versus standard care

BEN ABA Feriel¹, GHARBI Rim², HAMMOUDA Zeineb¹, LAHMAR Manel¹, SIKALI Habiba², FEKIH HASSEN Mohamed², BESBES Lamia¹, ELATROUS Souheil², ABROUG Fekri¹

¹Service de réanimation polyvalente CHU Fattouma Bourguiba, Monastir, Tunisie; ²Service de réanimation médicale CHU Tahar Sfar, Mahdia, Tunisie

**Correspondence:** Feriel BEN ABA (benaba.feriel@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-088

**Rationale:** Administration of systemic corticosteroid (SC) in acute exacerbations of chronic obstructive pulmonary diseases (AECOPD) patients requiring mechanical ventilation (VM) is controversial. There are biomarkers such as plasmatic eosinophilia (PE) that could predict a beneficial response to SC. The aim of our study was to assess whether a strategy of CS administration based on PE level was not inferior to the standard strategy consisting in systematic administration of CS regardless of the severity.

**Patients and methods/Materials and methods:** In a bi-centric, prospective, randomized, controlled, and single-blind trial conducted between December 2018 and December 2020, eligible patients over 18 years of age, hospitalized for an AECOPD and requiring ventilatory support (n = 43) were included and randomized to usual care (n = 25) or eosinophil-guided strategy (n = 18). The prescription of SC in the eosinophil-guided group was based on PE (1 mg/kg of prednisone if PE > 2%; no SC if PE ≤ 2%). The primary end-point was whether patients still needed MV in the sixth day or not.

**Results:** There was no between-group difference for demographics, COPD and acute episode characteristics. Regarding the primary end-point, there was no difference for the type of ventilation modality in the sixth day following the inclusion (Still on MV: 32% versus 39% in the standard group and the eosinophilic group, respectively). A difference of 7% that is less than the 10% which confirm the non-inferiority hypothesis. The relative risk to be still on MV by the 6th day was 1.2 (IC 95%: 0.54–2.7) p = 0.640, reaching the prior fixed non difference margin. Both study groups showed similar secondary outcomes: Treatment failure (p = 0.712), MV duration (p = 0.620), length of stay (p = 0.429) and mortality (p = 0.701). Hyperglycemic episodes due to SC occurred more frequently in the control group (6 cases versus 2) but no statistical significance was found (p = 0.434).

**Conclusion:** This preliminary study confirms the similarity between a CS sparing strategy based on PE count and the standard systematic administration of CS.

**Compliance with ethics regulations:** Yes in clinical research.
FC-089

Effect of beta-blockers prescription on the outcome of severe
acute exacerbation of chronic obstructive pulmonary disease
(AECOPD) requiring ICU admission

HAMMOUDA Zeineb¹, BOUATTIA Maroua¹, BEDHIAF Emir¹, MAATOUK Iyed¹, HOURI Fadoua¹, LAHMAR Manel¹, DACHRAOUI Fahmi¹, ABROUG Fekri¹, BESBES OUANES Lamia¹

¹CHU Fattouma Bourguiba MONASTIR, Monastir, Tunisie

**Correspondence:** Zeineb HAMMOUDA (zanoubia83@hotmail.com)

Annals of Intensive Care 2022, **12**(1):FC-089

**Rationale:** Cardiovascular diseases are frequent comorbidities in patients with COPD and are conditions with large use of beta-blockers (BB). We aimed to evaluate the influence of BB prescription on AECOPD outcome.

**Patients and methods/Materials and methods:** This is a single-centre retrospective study conducted in a 16-bed ICU of Fattouma-Bourguiba University-hospital. From January 2016 to June 2019, all consecutive patients admitted for an AECOPD and aged ≥ 18 years were included. Exclusion criteria were: AECOPD requiring specific treatment and unavailable long-term follow-up. Patients were divided on 2 groups: (BB+) previously receiving Beta-blockers or requiring Beta-blockers agents upon their admission and (BB-) who did not receive beta-blockers neither previously nor during ICU stay. Data were collected on socio-demographic characteristics, past history and COPD GOLD stage, clinical presentation and labs findings. Severity was assessed using SAPS II and ABG's parameters. We also recorded details of ICU course. Follow-up data included mortality at 6 months of ICU discharge and life quality assessment using the Clinical COPD Questionnaire (CCQ).

**Results:** 220 patients were included. Median age was 68 (IQR: 61–75), 88.2% were male with a BMI at 26.12 (23.6–30.1). Main comorbidities were hypertension 83 (37.7%), chronic heart disease 60 (27.3%) and diabetes 40 (18.2%). Median SAPS II was 45 (40–53). Main exacerbation causes were acute left heart failure in 99 (45%) followed by tracheobronchitis 75 (34.1%). NIV was the first-line ventilatory treatment in 88.2% with a failure rate at 26.8%. Median LOS was 16 (IQR 10–27) days with a survival rate at 80.5%. 62 (28.2%) were assigned to BB+ group versus 158 (71.8%) to BB-. Bisoprolol was the most used molecule (96.8%) with a median posology of 2.5(2.5–5) mg. 15 (24.2%) patients were previously receiving BB, indications for BB upon admission were hypertension 39 (62.5%) followed by left heart failure and tachycardia. Comparing the two groups, no major differences in severity assessment, ventilatory management or NIV failure were found. BB+ were older [73 (65–78) versus 67 (60–73.5), p = 0.001] with higher BMI [27.7 (24.7–31.2) versus 24.9 (22–30), p = 0.02] without difference in GOLD staging or long-term NIV requirement (p = 0.4). BB- had lower LOS 15(9.7–23) versus 20.5(12.7–30.2) p = 0.004 with similar rates of ICU complications and mortality. Thus, 6 months mortality was significantly higher in BB- (34.2 versus 17.7%, p = 0.016) [Fig. 1], and recurrence of AECOPD at one-year was lower in BB+ (43.5% versus 58.2%; p = 0.04). No significant difference in CCQ assessment was found (p = 0.2).

**Conclusion:** Despite similarities in ICU evolution, patients under beta-blockers appears to have better log-term outcome after AECOPD. Further studies might be needed to confirm this result.

**Compliance with ethics regulations:** Yes in clinical research.

<figure><img src="image_72.png" /><figcaption>**Figure 1:** Kaplan–Meier survival curves (6 month mortality) according to beta-blockers use status</figcaption></figure>

FC-090

Impact of intubation on the evolution of fractions of inspired oxygen in patients treated with high flow oxygen therapy for COVID-19 associated pneumonia

LAFAY Valentin¹, WINISZEWSKI Hadrien¹, GUILLIEN Alicia², CAPELLIER Gilles¹

¹CHU de BESANCON, service de Réanimation Médicale, Besançon, France; ²Institut pour l'avancée des biosciences, Equipe d'épidémiologie environnementale appliquée au développement et à la santé respiratoire, Grenoble, France

**Correspondence:** Valentin LAFAY (valentin.lafay@sfr.fr)

Annals of Intensive Care 2022, **12**(1):FC-090

**Rationale:** Since second wave, High Flow Oxygen Therapy (HFOT) is a first line treatment for COVID-19 associated respiratory failure. However, patients treated with HFOT may be exposed for a long time to high Fractions of Inspired Oxygen (FiO₂), potentially leading to hyperoxic alveolar injuries. We aimed to determine whether intubating patients after HFOT failure was associated with a decrease in high FiO₂ exposure within the 24 first hours following intubation.

**Patients and methods/Materials and methods:** Among 218 patients admitted for COVID-19 associated pneumonia in Medical Intensive Care Unit (ICU) at Besançon teaching hospital between October 2020 and October 2021, 27 treated with HFOT for more than 24 h before intubation were retrospectively included. The number of hours exposed to FiO₂ > 60% and > 90% during the 24 h preceding intubation and the 24 h following intubation were calculated and compared.

**Results:** Most of the 27 patients were men, with a median age of 71 years-old. Twenty-one patients performed awake prone positioning (PP) under HFOT. The median PaO₂/FiO₂ was 79 mm Hg before intubation, and 193 mm Hg 24 h after protective ventilation using a median Positive End-Expiratory Pressure (PEEP) of 12 cm H₂O. The median dynamic compliance of the respiratory system was 40 mL/cm H₂O. All ventilated patients benefited from neuromuscular blockade and PP. Seven (26%) died in ICU. The median number of hours with FiO₂ > 60% decreased from 22,5 (Interquartile range—IQR—[20,0; 24,0]) within the 24 h under HFOT preceding intubation to 6,0 [4,0; 9,8] within the 24 h following intubation, corresponding to a median difference of — 15,0 [— 18,0; — 8,8], statistically significant (p < 0,001). The median number of hours with FiO₂ > 90% decreased from 3,0 [1,3; 15,5] to 2,0 [1,3; 3,0], corresponding to a median difference of — 2,0 [— 10,0; 0], statistically significant (p = 0,005).

**Discussion:** Intubation itself likely doesn't explain the decrease in FiO₂. High PEEP, neuromuscular blockade, and prone positioning are confounding factors. FiO₂ is also dependent from the target of oxygenation set as a goal. To the best of our knowledge, this study is nevertheless the first caring about this pragmatic issue. Its main limitations are a retrospective and monocentric design, and a small sample size.

**Conclusion:** In COVID-19 patients treated with high flow oxygen therapy > 24 h, intubation is associated with a statistically significant decrease in high FiO₂ exposure. Whether intubation could decrease hyperoxic alveolar injury need to be investigated.

**Compliance with ethics regulations:** Yes in clinical research.
<figure><img src="image_73.png" /></figure>

Evolution of the number of hours exposed to FiO² > 60% during the 24 h preceding and the 24 h following intubation for each patient

FC-091

**Importance of antithrombotic treatment monitoring in ventricular assisted patients**

HANAFIA Omar¹, PRIEUR-GARROUSTE Julie¹, BERTAULT-PERES Pierre¹, HONORE Stéphane¹, MICHEL Fabrice¹

¹Hopitaux Universitaires de Marseille, Marseille, France

**Correspondence:** Omar HANAFIA (omarhanafia@yahoo.fr)

Annals of Intensive Care 2022, **12**(1):FC-091

**Rationale:** We looked at a long-term external ventricular assist device (VAD), it's a mechanical, pulsatile heart support system. It is indicated for patients with severe heart failure waiting for transplantation or recovery of their ventricular function. VAD imposes a stable and effective antithrombotic strategy. In pediatric resuscitation patients, inter- and intra-individual pharmacokinetic variability makes the use of these treatments with hemorrhagic and ischemic risks difficult. We conducted an evaluation of the professional practices of this strategy within the hospital's pediatric resuscitation unit.

**Patients and methods/Materials and methods:** Our monocentric, retrospective study included a population of VAD-implanted patients from December 2017 to January 2020. Clinical data was collected from the computerized patient record. The prescriptions for anticoagulants and antithrombotics were followed on the shipboard prescription. The results of the aggregation tests and the anti-Xa assays were recorded on the laboratory software.

**Results:** Of the 36 months of the study: 5 middle-aged patients 12 months (sd = 7.9) were implanted with a left mono VAD. 4 patients had dilated cardiomyopathy and one had cardiogenic shock. We had 14 serious vascular incidents of which 4 were hemorrhagic and 10 ischemic. The frequency of tests does not exclude accidents and 67% of them had clinical repercussions. Anti-Xa measurements were 53% (n = 352) in the targets, the arachidonic acid test was effective in 58% (n = 44) of cases and ineffective in 15%, the adenosine diphosphate test was effective in 22% (n = 17) and ineffective in 58%. Dosage re-evaluations were proposed by the pharmacy when targets were not met. These results highlight the difficulty in obtaining and maintaining target rates. Our study did not establish a correlation between the duration under VAD and the number of accidents. By studying the 7 days before each accident, we found that even for patients previously anticoagulated and antiaggregated effectively, 71% of accidents are explained by a punctual but frank exit from the objective.

**Conclusion:** The number of accidents is not proportional to the frequency of tests, nor to the duration of implantation and it is essential

to be constantly in the targets. A study described a decrease in accidents through the appointment of a referral physician to analyze the results on a daily basis and increased awareness of the care team. This allowed us to establish a sustainable strategy throughout the management of the patient, the pharmaceutical team already participates in and that could be improved.

**Compliance with ethics regulations:** Yes in clinical research.

FC-092

**Levosimendan use in pediatric resuscitation: clinical impact and proper use of the medication**

HANAFIA Omar¹, LESLUYES Bruno¹, HONORE Stéphane¹, BERTAULT-PERES Pierre¹, MICHEL Fabrice¹

¹Hopitaux Universitaires de Marseille, Marseille, France

**Correspondence:** Omar HANAFIA (omarhanafia@yahoo.fr)

Annals of Intensive Care 2022, **12**(1):FC-092

**Rationale:** Levosimendan is used as a last resort in severe or decompen-sated chronic heart failure. For pharmacoeconomic reasons its delivery in our center is subject to a prior agreement, which is why the problem of positioning of this molecule in the therapeutic arsenal of our establishment arises. We carried out a study within the pediatric cardiac resuscitation unit, the objective of which was to analyse the habits of the department and the prescription conditions as well as the profile and the outcome of patients who received a levosimendan cure.

**Patients and methods/Materials and methods:** This is a retrospective, monocentric study from January 2017 to June 2019. We analysed the service's paper prescriptions thanks to the prescriptions and the computerized patient record, we recorded the cures, the prescription modalities, the length of hospitalization. We also sought to determine the clinical impact of the first cure via the serum level of nt-proBNP at D-1, D1 and D9 as well as the fate of patients at D30 and D60.

**Results:** 18 patients were included, the average age was 12.8 months, and the H/F ratio was 0.63. On the first cure: only 6 cures respected the good practices, 7 patients had dobutamine prescribed before the first cure. 11 patients received several cures (2.9 total cures on average). The average length of hospitalization was 72 days. The rate of nt-proBNP decreased by an average of 49% between D-1 and D1 in 10 patients, and increased by 203% in the remaining 8 patients. Between D1 and D9, this rate decreased by an average of 52% in 8 patients and increased by 178% in the remaining 9 patients. At D30 of the first treatment, 1 patient had returned home, 10 were hospitalized, 3 were hospitalized under circulatory assistance and 4 had died. At D60 of the first treatment, 4 patients were at home, 6 were hospitalized, 3 were hospitalized under circulatory assistance, 5 died. The efficacy of levosimendan is evaluated by the improvement of the ventricular ejection fraction, unfortunately this ultrasound parameter does not appear in the PDI for each patient and therefore could not be analyzed in our study.

**Conclusion:** Levosimendan brings a proven benefit in certain physio-pathological terrains thanks to its singular mechanism of action. However, according to the literature, it is no more effective than dobutamine. Given its cost, it would be fair to continue this multidisciplinary work to redefine the place of this treatment in the therapeutic arsenal of our institution.

**Compliance with ethics regulations:** Yes in clinical research.

FC-093

**Risk factors associated with prolonged ECMO in children: a referral center cohort study**

BERGEZ Léa¹, LEVY Yael¹, LEGER Pierre Louis¹, RAMBAUD Jerome¹.

¹Armand-Trousseau, Paris, France

**Correspondence:** Jerome RAMBAUD (jerome.rambaud@aphp.fr)

Annals of Intensive Care 2022, **12**(1):FC-093
**Rationale:** This study aimed to investigate the characteristics and clinical outcomes of children supported with prolonged ECMO (≥ 28 days) for severe acute respiratory failure or cardiac failure.

**Patients and methods/Materials and methods:** We conducted a retrospective study in our referral center for ECMO between 2009 and 2020. All pediatric patients age from 28 days to 18 years-old supported with ECMO for ≥ 28 days were included. All neonatal indications for ECMO were excluded. We looked for pre-ECMO treatment such as mechanical ventilation settings, the use of prone positioning, nitric oxide, exogenous surfactant, neuromuscular blockers. We also gathered the ventilation settings at day 1, 3, 7, 14 and 21, outcome criteria as the median duration of ECMO, the length of invasive mechanical ventilation, the length of intensive care stays and the survival rate following intensive care discharge and 6 months after ICU discharge.

**Results:** On the 223 patients treated by ECMO during the study period, 14 (7%) patients underwent an ECMO run longer than 28 days. Median ECMO run duration was 44 days (28–122). Patients requiring a long ECMO run were younger (574 vs 1079 days), had a significantly lower PaO2/FiO2 ratio (51 vs 62, p < 0.001) and higher mean airways pressure (22 vs 18, p. 0.03). A lower tidal volume at day 7 of ECMO was significantly associated with long run (2.3 vs 4.6, p. 0.02). Higher FiO2 requirement on oxygenator and mechanical ventilator were significantly associated with long-run ECMO at day 7 and 14. Patients having a long run were suffering from more bleeding and infectious complications. Half of the deaths for long run patients were related to palliative care. Survival rate was lower for patients having a long run.

**Conclusion:** Long run ECMO represent a minority of all case of ECMO. Ventilator parameters at day 7 of ECMO may help to identified these runs. Early identification of early patients at risk of a long run could be useful to prevent bleeding complication and to prepare potential bridge to transplantation.

**Compliance with ethics regulations:** Yes in clinical research.

## FC-094

### Cefepime population pharmacokinetics and dosing regimens optimization in pediatric intensive care unit

DE CACQUERAY Noémie¹, HIRT Deborah², ZHENG Yi², BILLE Emmanuelle¹, LEGER Pierre Louis³, RAMBAUD Jerome³, TOUBIANA Julie¹, CHOSIDOW Anais³, VIMONT Sophie³, CHOUCHANA Laurent¹, BÉRANGER Agathe¹, TRELUYER Jean-Marc¹,², BENABOUD Sihem², OUALHA Mehdi¹

¹Necker, Paris, France; ²Cochin, Paris, France; ³Trousseau, Paris, France

**Correspondence:** Noémie DE CACQUERAY (n_a_cacqueray@hotmail.fr)

Annals of Intensive Care 2022, **12**(1):FC-094

**Rationale:** Cefepime is commonly used in pediatric intensive care units (PICU) while patients are subject to unpredictable variability in pharmacokinetic (PK) parameters leading to drug concentrations modification. This study aimed to build a population PK model for cefepime in critically ill children, to optimize and individualize initial dosing regimens.

**Patients and methods/Materials and methods:** Children (age > 1 month and < 18 years, weight > 3 kg) receiving cefepime were included. Cefepime total plasma concentrations were measured using high performance liquid chromatography. Data were modelled using Monolix software and Monte Carlo simulations were performed using a PK target of 100% fT > MIC.

**Results:** Fifty-nine patients with median (range) age of 13.5 months (1.1 month-17.6 years) and 129 cefepime concentrations were included in the analysis. Cefepime data were best fitted by a one-compartment model and the selected covariates were body weight (BW) through allometric scaling and estimated glomerular filtration rate (eGFR) on clearance (CL). Mean population values for CL and volume (V) were 1.2 L·h⁻¹ and 5.01 L, respectively. According to the simulations, 150 mg·kg⁻¹·day⁻¹ q6h over 3 h or in continuous infusions better achieved the PK target in case of normal or augmented renal clearance.

**Conclusion:** Extended and more frequent or continuous cefepime infusions are needed in critically ill children with normal or augmented renal clearance. Cefepime displays narrow therapeutic index and require therapeutic drug monitoring.

**Compliance with ethics regulations:** Yes in clinical research.

## FC-095

### Meropenem and piperacillin population pharmacokinetics and dosing regimen optimization in critically ill children receiving continuous renal replacement therapy

THY Michael¹,³, URIEN Saik³,⁴, FOISSAC Frantz³,⁴, BOUAZZA Naim³,⁴, BILLE Emmanuelle⁵, BÉRANGER Agathe²,³, RAPP Mélanie²,³, LUI Gabrielle³,⁴, LESAGE Fabrice², RENOLLEAU Sylvain², TRÉLUYER Jean-Marc³,⁴,⁶, OUALHA Mehdi²,³

¹Assistance Publique-Hôpitaux de Paris, Infectious and tropical diseases department, Bichat University Hospital, Université de Paris, Paris, France; ²Assistance Publique-Hôpitaux de Paris, Paediatric Intensive Care Unit, Necker-Enfants Malades University Hospital, Université de Paris, Paris, France; ³EA 7323 - Pharmacology and Therapeutic Evaluation in Children and Pregnant Women, Université de Paris, France, Paris, France; ⁴Unité de recherche Clinique-Centre d'Investigation Clinique, Hôpital Cochin-Necker, Université Paris Descartes, Sorbonne-Paris Cité, 149 rue de Sèvres, 75015 Paris, France, Paris, France; ⁵Laboratoire de microbiologie, Hôpital Necker Enfants- Malades, Université Paris Descartes, Sorbonne-Paris Cité, 149 rue de Sèvres, 75015 Paris, France, Paris, France; ⁶Service de pharmacologie clinique, Hôpital Cochin, Université Paris Descartes, Sorbonne-Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France, Paris, France.

**Correspondence:** Michael THY (michael245thy@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-095

**Rationale:** High variability in critically ill children receiving Continuous Renal Replacement Therapy (CRRT) increases the risk of inadequate concentrations. We aimed to develop a meropenem (MRP) and piperacillin (PIP) population pharmacokinetic (PK) model in this population and simulate dosing regimens to optimize patient exposure.

**Patients and methods/Materials and methods:** MRP and PIP plasma concentration was quantified by high-performance liquid chromatography. PK was investigated using a non-linear mixed-effect modeling approach. Monte Carlo simulations were performed to determine the most appropriate therapeutic dosing regimens.

**Results:** Respectively, for MRP and PIP, 27 patients with an age of 4 [0–11] years old, weight of 16 [7–35] and 32 children with a median (IQR) postnatal age of 2 years (0–11), body weight (BW) of 15 kg (6–38), receiving continuous replacement renal therapy (CRRT) were included. For both MRP and PIP, concentration–time courses were best described by one-compartment model with first-order elimination with body weight (BW) and CRRT flow (Qd) for MRP and residual diuresis (Qu) for PIP as covariates explaining the lower between-subject variabilities on volume of distribution (V) and clearance (CL). For a 70-kg subject patient i, the final equations were: -For MRP: $CL_i = (CL_p \times (BW_i/70)0.75) \times (Q_d/1200)0.4)$, where CLpop and Vpop are 6 L/h and 35 L respectively. -For PIP: $Vi = Vpop \times (BW/70)1$ and clearance (CL): $CL_i = (CL_{pop} \times (BW_i/70)0.75) \times (Q_u/0.06)0.12)$, where CLpop and Vpop are 7 L/h and 53 L respectively. After Monte-Carlo simulations for MRP and PIP, we suggested dosing regimens for a target of 100% fT > 4xMIC in Fig. 1.

**Conclusion:** Optimal antibiotic exposure in critically ill children under CRRT needs an adaptation of the doses to CRRT flow rate for MRP and to residual diuresis for PIP.

**Compliance with ethics regulations:** Yes in clinical research.

<figure><img src="image_74.png" /><figcaption>Fig. 1 Dosing regimens suggestions for a target of 100% fT > 4xMIC.</figcaption></figure>
FC-096

**Septic shock in severe trauma patients in pediatric intensive care**

KALOUCH Samira¹, FAKHR Kawtar¹, AISSAOUI Wissal¹, CHLILEK Abdelaziz¹
¹CHU Ibn Rochd, Casablanca, Maroc

**Correspondence:** Samira KALOUCH (dr.kalouch@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-096

**Rationale:** Sepsis is the result of complex interactions between infec-
tious microorganisms and the host's immune, inflammatory, and
coagulant responses. The signs of sepsis constitute a continuum of
increasing severity, ranging from the trivial association of tachycar-
dia, tachypnea and fever with hyper leukocytosis or leukopenia to the
occurrence of circulatory abnormalities, then organ dysfunction, and
finally a state of shock that responds more or less easily to vascular fill-
ing and vasopressors.

**Patients and methods/Materials and methods:** This is a descrip-
tive and analytical retrospective study spread over 5 years (January 1,
2015–December 31, 2020) in the pediatric intensive care unit includ-
ing 47 cases. Statistical analysis is done using SPSS software.

**Results:** In this study, we report 47 cases of septic shock in severe trauma patients collected in the pediatric intensive care unit of the children's hospital of CHU Ibn Rochd in Casablanca during the years 2015–2020. The study was carried out according to an operating sheet including demographic, clinical, biological, radiological and therapeutic data, followed by statistical analysis using SPSS software 20. The average age is 75 months with a male predominance. The sites of infection were, in descending order, respiratory infection, bacteremia, urinary tract and skin. The germs mainly isolated were Acinetobacter baumanii, Pseudomonas aeruginosa, Staphylococcus aureus and Klebsiella spp. The evolution was fatal in 59.5% of cases. The prognostic factors retained were the delay of transfer to the intensive care unit > 4 h (p = 0.003), the presence of more than 2 failing organs (p = 0.004), the need for filling > 60 ml/kg (p = 0.02), the use of more than one active substance (p = 0.006), the use of adrenaline (p = 0.01) and the delay of antibiotic therapy > 1 h (p = 0.0006).

**Conclusion:** Identification of the deficiencies in the management of septic shock and the application of the recommendations of the survivor sepsis campaign would improve the prognosis.

**Compliance with ethics regulations:** Yes in clinical research.

FC-097

**First nosocomial infections in children supported by veno-arterial
extracorporeal membrane oxygenation (VA-ECMO)**

COUSIN Vladimir¹, RODRIGUEZ-VIGOUROUS Robert¹, KARAM Oliver²,
RIMENSBERGER Peter¹, POSFAY-BARBE Klara¹

¹Hôpitaux Universitaires de Genève, Genève, Suisse; ²Children's Hospital
of Richmond at VCU, Richmond, Va, Etats-Unis

**Correspondence:** Vladimir COUSIN (vladimir.cousin@hcuge.ch)

*Annals of Intensive Care* 2022, **12**(1):FC-097

**Rationale:** Veno-arterial (VA) Extracorporeal Membrane Oxygenation (ECMO) is a standard rescue procedure for patient with refractory shock in Pediatric Intensive Care Unit (PICU). They are at high risk of nosocomial infection with potential severe consequences. Aim of study was to determine the frequency, timing and microbiological specificity of VA-ECMO-related infection.

**Patients and methods/Materials and methods:** Study period spanned from 01/2008 to 12/2014 with a retrospective charts review; inclusion criteriawere patients with a VA-ECMO support for > 6 h. It was approved by local Ethics Committee (CE 14-231), who waived the need for informed consent. We recorded the first PICU infection during VA-ECMO support. Infection was defined as a positive microbiological sample with clinical signs of infection or clinical signs of severe infection without positive sample. Time to infection, length of VA-ECMO support, PICU stay and risk factors for infection were evaluated.

**Results:** During study period 41 patients were included, with a mortal-
ity of 53%. Mean time with VA-ECMO was 5,6 d (SD 4,7), mean time in
PICU was 17.3 d (SD 14,3) (Fig. 1, stratified by infection status). Overall,
34% patients developed an infection, with an incidence of 60/1000

VA-ECMO days. Mean time to first infection was 3.8 d (SD 1.7), with Pseudomonas spp. as the most commonly detected microorganism (42%). Infected sites were ventilator-associated pneumonia (9/14), sternotomy infection (2/14), bloodstream (2/14) and urinary tract infections (1/14). Only length of VA-ECMO support and length of PICU stay were associated with infection: longer VA-ECMO support (> 5 d) (OR 5.9 (CI 95% 1.4–24.6; p = 0.01)) or longer PICU stay (> 14 d) (OR 12 (95% CI 2.2–65.5; p = 0.004)).

**Discussion:** In this monocentric study, we described the outcome and infectious complications in 41 patients with pediatric VA-ECMO. Our results underline the high proportion of infections in this population, its occurrence early during the VA-ECMO support period. We highlighted the association of the time with VA-ECMO support and PICU length of stay with the occurrence of infection. However, such findings may be surrogate markers for sicker patients, who are intrinsically more at risk for nosocomial infections rather than a direct impact of duration of VA-ECMO support.

**Conclusion:** Pediatric patient with refractory shock supported by VA_ECMO are at high risk of nosocomial infection. Strategies aimed at preventing these infections may improve the outcome of these critically ill children.

**Compliance with ethics regulations:** Yes in clinical research.

<figure><img src="image_75.png" /></figure>

Kaplan–Meier cumulative probability of survival during PICU stay for patient with veno-arterial exatracorporeal membrane oxygenation (VA-ECMO), depending on infection status. Comparison of curve using log-rank test found significant difference.

FC-098

**Non-invasive evaluation of the response to vascular filling
in the first three hours of sepsis and septic shock by comparison
of two diagnostic strategies**

YALAOUI Ilia¹,², BENMATI Abdellatif¹,², BOUHROUM Abdelhafid¹, TEOUL Jean Louis³

¹University 3 of Constantine, Faculty of Medicine, Constantine, Algerie;

²Preventive Medicine of Chronic Diseases Laboratory (Med Prev AC), Constantine, Algerie; ³The Kremlin-Bicêtre, Paris XI University, France, Paris, France

**Correspondence:** Ilia YALAOUI (yalabox@live.fr)

*Annals of Intensive Care* 2022, **12**(1):FC-098

**Rationale:** Evaluating preload to predict response to vascular filling (RVF) prompts the clinician to have criteria that predict the effectiveness of vascular filling (VF). Changes in the time velocity integral (TVI) of aortic or subaortic blood flow and cardiac output (CO) measured by echocardiography, as well as the passive leg raise (PLR) test, are excellent methods for predicting preload reserve. The objective of this work is to decrease hospital mortality (HM) and to improve survival, quality of RVF prediction and occurrence of incidents related to VF in patients with sepsis or septic shock and in spontaneous ventilation.
**Patients and methods/Materials and methods:** Through a prospective randomized prognostic trial, comparing two methods of evaluating the prediction of RVF, clinical and echocardiographic, of two groups of adult patients with sepsis or septic shock, in spontaneous ventilation and not previously infused. The clinical hemodynamic measurements collected before and after a 30 ml/kg of crystalloid filling test are: mean arterial pressure (MAP) and urine output (UO) in the control group (CG), as well as the TVI of the flow subaortic (TVIsa) and CO in the preload dependency group (PDG). In the PDG, TVIsa and CO measurements are also taken before and after PLR and VF.

**Results:** HM in responder patients is zero in sepsis and higher in septic shock and CG more than PDG (83,3% vs 72,7%). Survival is better in patients with PDG, in sepsis and in septic shock. RVF is significantly elevated in PDG compared to CG (92% vs 61,5%), and better in septic shock (77,3%) compared to sepsis (71,4%). There are more incidents in the GC compared to the GPD (19,2% vs 8%). The incidents are absent in sepsis and weak in septic shock (23,8% GC versus 8,7% GPD).

**Discussion:** Our study provided evidence in the acute phase of sepsis and septic shock in spontaneously ventilated patients, in predicting RVF and managing VF non-invasively and effectively by echocardiography, as well as in improving HM in septic shock, survival and the occurrence of VF-induced incidents.

**Conclusion:** The non-invasive prediction of RVF, by TVIsa measured by echocardiography, makes it possible to identify responders and non-responders in VF in real time, to test the hemodynamic efficiency of VF, to limit incidents related to overload during VF, to decrease mortality and to improve survival.

**Reference 1:** Rhodes A, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017; 43(3):304–77.

**Reference 2:** Jozwiak M, Monnet X, Teboul JL. Implementing sepsis bundles. Ann Transl Med. 2016; 4(17):33240.

**Compliance with ethics regulations:** Yes in clinical research.

<table><caption>Table 1: Distribution of response to vascular filling (RVF) according to hospital mortality</caption><thead><tr><th rowspan="2">G/lup</th><th rowspan="2">RVF</th><th colspan="2">Hospital mortality (+)</th><th colspan="2">Hospital mortality (-)</th><th colspan="2">Total</th><th rowspan="2">p</th></tr><tr><th>Effective</th><th>%</th><th>Effective</th><th>%</th><th>Effective</th><th>%</th></tr></thead><tbody><tr><td rowspan="3">Septic shock</td><td>Control</td><td>10</td><td>83,3</td><td>2</td><td>16,7</td><td>12</td><td>100</td><td rowspan="3">0,610</td></tr><tr><td>No responder</td><td>8</td><td>88,9</td><td>1</td><td>11,1</td><td>9</td><td>100</td></tr><tr><td> load dependency</td><td>16</td><td>72,7</td><td>6</td><td>27,3</td><td>22</td><td>100</td></tr><tr><td colspan="2">RVF (Response to Vascular Filling)</td><td>1</td><td>100</td><td>0</td><td>0</td><td>1</td><td>100</td><td>0,740</td></tr></tbody></table>

<table><caption>Table 2: Contribution of echocardiography in improving survival</caption><thead><tr><th>Day</th><th>Control group (%)</th><th>Preload dependency group (%)</th></tr></thead><tbody><tr><td>1</td><td>78,1</td><td>72</td></tr><tr><td>2</td><td>53,8</td><td>60</td></tr><tr><td>3</td><td>46,2</td><td>48</td></tr><tr><td>7</td><td>30,8</td><td>44</td></tr><tr><td>28</td><td>26,9</td><td>28</td></tr></tbody></table>

p = 0,882

<table><caption>Table 3: Contribution of echocardiography in the reduction of incidents related to vascular filling</caption><thead><tr><th rowspan="2">Group</th><th rowspan="2">Effective / %</th><th colspan="2">Incidents</th><th rowspan="2">Total</th></tr><tr><th>Yes</th><th>No</th></tr></thead><tbody><tr><td rowspan="2">Control</td><td>Effective</td><td>5</td><td>21</td><td>26</td></tr><tr><td>%</td><td>19,2</td><td>80,8</td><td>100</td></tr><tr><td rowspan="2">Preload dependency</td><td>Effective</td><td>2</td><td>23</td><td>25</td></tr><tr><td>%</td><td>8</td><td>92</td><td>100</td></tr><tr><td rowspan="2">Total</td><td>Effective</td><td>7</td><td>44</td><td>51</td></tr><tr><td>%</td><td>13,7</td><td>86,3</td><td>100</td></tr></tbody></table>

p = 0,244

Contribution of echocardiography in the evaluation of the response to vascular filling.

FC-099

Ultrasound-guided subclavian vein catheterization: infraclavicular versus supraclavicular approach

DAFFEF Saoussen¹, TRABELSI Becem¹, BEN TALEB Ibtissem¹, KTATA Hiba¹, BEN ALI Mechaal¹

¹Mohamed Taher Maamouri Teaching Hospital, Anesthesiology and intensive care unit, Nabeul, Tunisie

**Correspondence:** Saoussen DAFFEF (sawssendaffef91@gmail.com)
Annals of Intensive Care 2022, **12**(1):FC-099

**Rationale:** The subclavian vein (SCV) is the preferred site for central venous catheterization (CVC) in intensive care unit due to its ability to stay patent in hypovolemic situations and lower risk of infections. Difficulty in its ultrasonic visualisation with the infraclavicular (IC) approach is the reason why this approach has fallen out of favour. The ultrasound (US) guided supraclavicular (SC) approach seems to be a good alternative. The aim of this study was to compare the IC and the SC approaches in US-guided SCV catheterization.

**Patients and methods/Materials and methods:** This was a prospective randomized study (NCT04637347). We included adult patients requiring a CVC in the superior vena cava area. Patients with infection at puncture site, coagulopathy, contralateral pneumothorax, trauma of clavicle and distorted anatomy of the neck were excluded from the study. Patients were randomly divided into two groups: US-guided SCV catheterization using either SC approach (SCGr) or IC approach (ICGr). We used long-axis scanning in combination with in-plane technique for all catheterizations. The primary outcome was the first attempt success rate. Overall success rate, venous scanning time, number of punctures, number of redirections, puncture time, guidewire insertion time, overall catheterization time, incidence of difficulties in catheterization and mechanical complications were secondary outcomes.

**Results:** We included 110 patients in this study: 55 in the SCGr and 55 in the ICGr. First attempt success rate was significantly higher in SCGr compared to ICGr (81.8% versus 63.6%; p < 10–3). The overall success rate was significantly higher in SCGr compared to ICGr (96.4% versus 85.5%; p < 10–3). Venous scanning time was significantly longer in the ICGr compared to the SCGr (21.7 ± 15.6 s versus 15.35 ± 8.9 s; p < 10–3). The number of punctures was significantly lesser in the SCGr compared to the ICGr (1.2 ± 0.5 versus 46 ± 0.7; p < 10–3). Regarding the number of redirections, the puncture time and the guidewire insertion time, no significant difference was observed between the two groups. The overall catheterization time was significantly shorter in SCGr compared to ICGr (63.13 ± 31.7 s versus 76.34 ± 33.6 s; p < 10–3). The rate of mechanical complications were higher in the ICGr without significant difference (14% versus 5%; p = 0.065). No cases of pneumothorax or malposition were observed in the SCGr however we observed three cases of pneumothorax and two cases of malposition in the ICGr. The incidence of arterial punctures and hematoma formation were comparable between the two groups.

**Conclusion:** US-guided in-plane catheterization of SCV using SC approach is safe and seems to be a good alternative to the classic IC approach.

**Compliance with ethics regulations:** Yes in clinical research.

FC-100

Transcranial doppler: easy or difficult technique?

SADAT Souhila¹, ZEGHDOUD Dalila¹, BOUGDAL Dalila¹.

¹EHS Salim Zemirli, Alger, Algeria

**Correspondence:** Souhila SADAT (sadatsouhila@hotmail.fr)
Annals of Intensive Care 2022, **12**(1):FC-100

**Rationale:** Transcranial Doppler (TDC) is a specific monitoring of cerebral hemodynamics in the brain-damaged, allowing the evaluation of cerebral blood flow. Purpose of the study: Evaluate the TDC learning curve, because the acquisition of a medical technical gesture is part of a quality approach in the training of junior doctors.

**Patients and methods/Materials and methods:** The study included ten residents, it took place in three phases, -The first phase: The participating doctors benefited from a theoretical presentation on DTP followed by a practical demonstration lasting three hours. -A second phase: Over a period of three weeks consisted for the junior doctors, a phase in which between 25 to 35 DTCs were carried out. The evaluation by the referent was carried out at each DTC in order to detect any anomalies. -The third phase: Follows the previous phase, it consists of performing ten DTCs by each candidate in order to complete their learning curve. The data for each exam was collected by the candidate. The candidate also provides the results of his DTC as well as that
carried out by the referent. This examination concerns the search for the right and left middle cerebral artery with the values of the systolic (Vs), average (Vm) and diastolic (Vd) velocities, the value of the pulsatility index (IP) and the duration of each examination.

**Results:** The failure rate of completing the DTC was higher in the first and second attempts by our ten learners, which ranged from 60 to 80%, the success and failure rates were similar in the third and fourth trials. From the fifth attempts the success rates are higher than those of failures which vary from 20 to 30%. The comparison of the mean values of Vs, Vm, Vd and IP of the candidates compared to those of the referent made it possible to conclude that there is no significant difference between the results obtained. The comparison of the time taken to perform the DTC by the candidates compared to the referring doctor revealed the presence of a significant difference in the results obtained (P < .0001).

**Conclusion:** The DTC is an easy technique, quick to learn, but an evaluation of the sustainability of the acquisition of this technique by the learners is essential.

**Compliance with ethics regulations:** N/A.

FC-101

Teaching intensive care nurses to recognize the misplacement of endotracheal and nasogastric tubes on chest radiographs

KAMEL Toufik¹, SAUVAGE Brice¹, LAKHAL Karim², OTTAVY Gregoire³, JANSSEN-LANGENSTEIN Ralf⁴, JACQUIER Marine⁵, LARRAT Charlotte⁶, JACQ Gwenaëlle ⁷, E. DAUVERGNE Jérôme ², MAUGARS Diane³, LABRUYERE Marie⁵, SIMEON Véronique ⁶, CUGNART Cécile ⁸, GIRault Christophe⁹, BOULAIN Thierry¹

¹Service de Médecine Intensive Réanimation, Centre hospitalier régional d'Orléans,, Orleans, France; ²Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire,, Nantes, France; ³Service de médecine intensive-réanimation, CHU de Nantes, France, Nantes, France; ⁴Service de Médecine Intensive et Réanimation - Hautepierre, CHU de Strasbourg,, Strasbourg, France; ⁵Service de Médecine Intensive et Réanimation, CHU de Dijon,, Dijon, France; ⁶Service de Médecine Intensive et Réanimation CHRU de Tours,, Tours, France; ⁷Service de Réanimation médico-chirurgicale, centre hospitalier de Versailles, Versailles, France;

⁸Rouen University Hospital, Medical Intensive Care Unit,, Rouen, France;

⁹Normandie Univ, UNIROUEN, EA 3830, Rouen University Hospital, Medical Intensive Care Unit, Rouen, France

**Correspondence:** Toufik KAMEL (toufik.kamel@chr-orleans.fr)

Annals of Intensive Care 2022, **12**(1):FC-101

**Rationale:** To assess the effectiveness of a single standardized training on the ability of intensive care registered nurses (RN) to recognize the misplacement of endotracheal and nasogastric tubes on bedside chest radiographs of intensive care unit (ICU) patients.

**Patients and methods/Materials and methods:** In 8 French ICUs, RNs received a 110-min standardized teaching on the position of endotracheal and nasogastric tubes on chest radiographs. Their knowledge was evaluated within the subsequent weeks. On 20 chest radiographs, each with an endotracheal and a nasogastric tube, they had to indicate whether each tube was in proper or incorrect position. A lower bound of the 95% confidence interval (95%CI) of the mean correct response rate (CRR) was chosen to indicate the training success when > 90%. Residents of the participating ICUs were subjected to the same evaluation (without prior specific training).

**Results:** One hundred eighty-one RNs were trained and evaluated, and 110 residents evaluated. The mean CRR in RNs was 84.6% (95%CI: 83.3–85.9), significantly higher than in residents (81.4% [95%CI: 79.7–83.2]) (P = 0.003 by t test). Linear mixed modelling handling the centers as random effect variable confirmed the significant difference (P < 0.0001) in CRR between RNs and residents as shown in Fig. 1. For misplaced nasogastric tubes, the mean CCR in RNs was 95.9% (95% CI: 93.9–98.0). Age, sex, seniority, delay between training and evaluation (for RNs) and period of evaluation within the semester of internship (for residents) did not significantly impact (all P > 0.05) on the mean CRR, either in the whole set of participants or in RNs and residents taken separately.

**Conclusion:** The ability of trained RNs to detect tube misplacement was higher than that observed among residents and was considered satisfactory for detecting misplaced nasogastric tubes. This is encouraging but insufficient to ensure patients safety. Transferring responsibility for reading radiographs to detect the misplacement of endotracheal tubes to intensive care RNs will need a more advanced or more in-depth teaching method than that used in this study.

**Compliance with ethics regulations:** N/A.

<figure><img src="image_76.png" /></figure>

Titre: Mean percentage of correct responses by type of tube and by position (correct or incorrect)

FC-102

Involvement of healthcare teams in the evaluation and selection of smart-pumps in intensive care

BRUAIRE Léo-Paul¹, BECK Nathalie¹, PIERRE DE LA BRIÈRE Jean-Charles¹, LEVEAUFRE Guillaume¹, ROUSSEL Damien¹, LECOUTOUR François¹, JORET Aurélie¹, GOYER Isabelle¹, BROSSIER David¹

¹CHU de Caen, Caen, France

**Correspondence:** David BROSSIER (david_brossier@yahoo.fr)

Annals of Intensive Care 2022, **12**(1):FC-102

**Rationale:** Medication errors are a major public health issue. As part of the project of dematerialization of the patient record in our intensive care units, the computerization of the medical prescription and the securing of the administration of the drug were among our objectives. In order to secure the drug circuit and reduce the drug errors, many scientific societies recommend the use of injectable drug delivery devices connected to the computerized medical record, called "smart-pumps". The main objective of the study was to compare 2 ranges of smart-pumps available in France. The secondary objective was the involvement of the paramedical teams in the choice of their future work tools.

**Patients and methods/Materials and methods:** We carried out a prospective monocentric, comparative, interventional study, without human involvement of the ranges proposed by B.Braun and a second company between September the 23rd and October, the 15th of 2019, in adult, pediatric and neonatal intensive care units of the Caen university hospital. This assessment was coupled with a satisfaction survey. All staff nurses received a training in the use of the equipment. Subsequently, the nurses trained on the 2 ranges proceeded to the successive evaluation of these throughout two scenarios of application of medical prescriptions. The order in which each nurse evaluated the 2 ranges was randomized. The main criterion of judgement was
the overall satisfaction of nursing staff with the use of the devices. The secondary criteria concerned the handling of materials and consumables as well as navigation in drug libraries and the duration of each scenario, timed by a project member.

**Results:** 77 agents (25% of the nurses concerned) were trained, 54 of whom evaluated the two ranges. The fulfilment of the medical prescription and the installation of the tubing in the pump was considered longer with the range proposed by B.Braun. No other significant difference was observed. However, 56% of nurses advised the range proposed by B.Braun which appeared safer, more ergonomic and less bulky.

**Conclusion:** To our knowledge, no such study has ever been published. Without observing major differences in use between the two companies, this comparison process allowed us to determine the equipment that seemed to best meet the expectations of the para-medical teams. Moreover, by involving and following the teams in the choice of their work equipment we hope to have strengthened the adherence of the teams to the change of practice induced by the use of smart pumps.

**Compliance with ethics regulations:** Yes in clinical research.

## FC-103

### Influence of clinical pharmacist presence on acceptance and delivery of pharmaceutical interventions in a pediatric resuscitation unit

HANAFIA Omar¹, HACHE Guillaume¹, BERTAULT-PERES Pierre¹, HONORE Stéphane¹, MICHEL Fabrice¹

¹Hopitaux Universitaires de Marseille, Marseille, France

**Correspondence:** Omar HANAFIA (omarhanafia@yahoo.fr)

*Annals of Intensive Care* 2022, **12**(1):FC-103

**Rationale:** Studies have shown that medication errors are common in intensive care units. The drug management of pediatric and neonatal populations is particularly at risk of iatrogenia due to the pathophysiological characteristics of these populations, the lack of suitable pharmaceutical forms and based on weak agreements. In addition, the clinical situations of these patients are serious and often require complex therapeutic strategies. Securing drug prescriptions is critical in these situations. The objective of this study was to measure the influence of the presence of the clinical pharmacist in the clinical department on the safety of drug prescriptions.

**Patients and methods/Materials and methods:** We conducted an observational study, before/after a pharmacist was involved in a 30-bed critical care unit. The analysis and daily pharmaceutical validation of prescriptions were performed from the pharmacy on the first part of the study (before). The issuance of Pharmaceutical Interventions (PI) was conducted by telephone and plotted on the printed prescription. For the second part (after), the pharmaceutical validation of the prescriptions was carried out in the service and the PI transmitted orally to the prescribers in person and plotted in the same way. The main criterion for evaluating the securing of prescriptions was the number of PI issued. We also characterized the nature of the PI, the consensus achieved orally, and the achievement of the prescription change suggested by the PI.

**Results:** We have 351 PI out of 126 days before, these PI mainly concerned overdoses (52%), route and/or inappropriate administration (17%) and non-conformities to the repository (10.8%). 179 children were affected by these IP. We found 1120 IP over 287 days, these IP mainly concerned monitoring (27.8%), overdoses (21.8%) and under dosing (10.1%). 300 children were affected by these IP.

We observed an increase in the number of IP performed per day (2.8 vs 3.9), the average number of IP per patient (2 vs 3.7). An increase in the number of IP accepted (267 vs 756; p = 0.036) and the number of implementations (183 vs 629; p < 0.001) was highlighted.

**Conclusion:** The presence of the pharmacist in the clinical department increased the number and relevance of PI performed. The nature of PI has evolved with a more patient-centred orientation. Acceptance and achievement rates are better, the percentage of PI achieved is higher, and these results show that PI are both better monitored and

better monitored. Risk reduction is best with pharmaceutical expertise through the presence of a clinical pharmacist in the care unit.

**Compliance with ethics regulations:** Yes in clinical research.

## FC-104

### A prospective pharmacist review of drug-related problems after ICU discharge: preliminary data

ANDRÉ Sébastien¹, ROUSSEAU Anne-Françoise²,³, COLSON Camille²,³, MISSET Benoît²,³, GILLET Manon¹

¹Hospital Pharmacy Department, University Hospital of Liège, Liège, Belgique; ²Intensive Care Department, University Hospital of Liège, Liège, Belgique; ³University of Liège, Liège, Belgique

**Correspondence:** Sébastien ANDRÉ (sebastien.andre@chuliege.be)

*Annals of Intensive Care* 2022, **12**(1):FC-104

**Rationale:** A stay in an intensive care unit (ICU) and the transitions of care are known to be at risk of drug-related problems (DRPs). These problems may contribute to readmissions and development of post-intensive care syndrome. The objective of this monocenter prospective study was to describe the prevalence of specific DRPs in patient's post-ICU drug treatments.

**Patients and methods/Materials and methods:** Adults with an ICU stay ≥ 7 days between 16th November 2021 and 25th January 2022 were included if they were enrolled in our post-ICU follow-up program. A pharmacist conducted a full medication review including medication reconciliation. This review was planned in general ward, during the week following ICU discharge. The pharmacist identified potential DRPs that were classified using the Pharmaceutical Care Network Europe Classification for Drug-Related Problems. Tailored interventions were also delivered to general wards clinicians based on identified DRPs.

**Results:** We included 29 patients (72.4% men, age 59 [33–76] years, ICU stay 19 [7–95] days). Drug treatments were reviewed 5 [2–9] days after ICU discharge. A total of 148 DRPs were identified: 27/29 patients (93.1%) experienced at least 1 DRP and a median of 5 [0–12] DRPs were observed per patient. Most DRPs referred to (potential) adverse drug events (86/148, 58.1%), (potential) non-optimal effect of drug treatment (26/148, 17.6%) and unnecessary drug-treatment (26/148, 17.6%). The main cause of DRPs was related to drug selection (80/160, 50.0%) comprising absence of indication, inappropriate drug according to guidelines and inappropriate combination of drugs. Other causes of DRPs included prolonged duration of treatment (36/160, 22.5%), inappropriate dose or dosage regimen (23/160, 14.4%) and medication reconciliation problem (7/160, 4.4%). Drugs involved in DRPs belonged mainly to the nervous system group, the alimentary tract and metabolism group, and the cardiovascular system group. The most common drugs implied were tramadol and pantoprazole. Based on identified DRPs, 147 pharmacist interventions were discussed with the clinicians. Withdrawal of a drug was the predominant intervention (75/147. 51.0%) followed by provision of information about the DRP dosage regimen modification, dose change, initiation or resumption of a drug and drug switch. 74.2% of all interventions were accepted by the clinicians.

**Conclusion:** DRPs were common after ICU discharge. Drugs of the nervous system group and proton pump inhibitors probably require sustained attention. Future research should evaluate the impact of pharmaceutical interventions on mid-term outcomes of ICU survivors.

**Compliance with ethics regulations:** Yes in clinical research.

## FC-105

### Evaluation of a negative pressure aerosol protection box to prevent airborne transmission of SARS-COV-2 to healthcare providers in pediatric intensive care

CECILIA Rotava Buratti¹,², JOUVET Philippe¹, BRIDIER Armelle¹, VEILLETTE Marc³, DUCHAINE Caroline³

¹Sainte Justine Research Center, University of Montreal, Montreal, Canada;

²Postgraduate program in child and adolescent health, Universidade
Federal do Rio Grande do Sul, Porto Alegre, Bresil; ³Research Center of the institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Canada.

**Correspondence:** Rotava Buratti CECÍLIA (ceciliaburatti@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-105

**Rationale:** High contagiousness of SARS-COV-2 is caused by bioaerosols' emission¹. The risk of healthcare providers (HCPs) developing infectious diseases through contact with patients is well recognized, and clinical situations involving tissue manipulation with high viral load called "aerosol-generating procedures" (AGP) may increase this risk². The aim of this study was to investigate the impact of the aerosol protection box, the Splash-Guard Caregivers (SGGC), on the presence of viral particles after an AGP.

**Patients and methods/Materials and methods:** Prospective observational study conducted between April and June 2020, including the HCPs in charge of children admitted to a Pediatric Intensive Care Unit who tested positive for COVID-19. SGCG (https://rsr-qc.ca/Splas hguard-cg/) was not used systematically and room patients analyzed were divided in: SGCG+ and SGCG-. Virus detection was performed in the single room patient's environment using two methods (air pumps and swabs) on several sites: 1) on the air one meter from the patient's head (wearable pumps), 2) inside the SGGC from the patient's air (if used), also 3) on the air near each HCPs (wearable pumps), and 4) at each HCPs forehead (swab) after an AGP. Samples were analyzed for SARS-COV-2 RNA by qPCR.

**Results:** Eight batches of samples were performed in the single room of SARS-COV-2+child (SGCG+ n=3 and SGCG- n=5). Five samples (11.4%) were qPCR positive for SARS-COV-2 among the 44 analyses. Three of these (14.3%) among the 21 analyses from the group SGCG-: in the air before the AGP (n=1), in the air near HCP's head after the AGP (n=1), and in the HCP forehead swab after the AGP (n=1). In the group SGCG+, 2 positive samples (8.7%) were observed among the 23 analyses in the HCP forehead swab (n=1) and in the air near HCP's head (n=1), both after an AGP (see Supplementary Table). None of the HCPs studied were infected by SARS-COV2.

**Conclusion:** Our results document the presence of SARS-COV2 in infected children environment. The protection effect of SGCG needs additional research.

**Reference 1:** van Doremalen N et al.: Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med 2020.

**Reference 2:** Nguyen LH et al.: Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health 2020.

**Compliance with ethics regulations:** Yes in clinical research.

<table><thead><tr><th rowspan="2">Splash-Guard</th><th rowspan="2">Patient</th><th rowspan="2">Procedure</th><th colspan="3">Samples location</th></tr><tr><th>Room Air</th><th>SG Air</th><th>HCP air</th><th>HCP forehead</th></tr></thead><tbody><tr><td rowspan="5">No</td><td>1</td><td>ETI</td><td>+</td><td>- (n=1)</td><td>- (n=1)</td><td></td></tr><tr><td>2</td><td>Transfer</td><td>-</td><td>- (n=1)</td><td>- (n=1)</td><td></td></tr><tr><td></td><td>HFNC</td><td>-</td><td>- (n=2)</td><td>- (n=2)</td><td></td></tr><tr><td>3</td><td>Trach</td><td>-</td><td>- (n=2)</td><td>+ (n=1) & - (n=1)</td><td></td></tr><tr><td>Trach</td><td>-</td><td>-</td><td>+ (n=1) & - (n=1)</td><td>- (n=2)</td><td></td></tr><tr><td rowspan="3">Yes</td><td>1</td><td>ETE</td><td>-</td><td>-</td><td>- (n=4)</td><td>+ (n=1) & - (n=3)</td></tr><tr><td>4</td><td>HFNC</td><td>-</td><td>-</td><td>- (n=3)</td><td>- (n=3)</td></tr><tr><td>4</td><td>HFNC</td><td>-</td><td>-</td><td>+ (n=1) & - (n=2)</td><td>- (n=3)</td></tr></tbody></table>

SG = Splashguard; HCP = Healthcare provider; ETI = endotracheal intubation; Transfer = transferring the patient to the ward; Trach = care of a patient with a tracheostomy tube; ETE = endotracheal extubation; HFNC = care of patient with high flow nasal canula.

Supplementary Table: Sample characterization

FC-106

**Acute kidney injury in patients with necrotizing soft tissue infection in intensive care unit: a comparative retrospective study**

ROZENBLAT David¹, URBINA Tomas⁴, HUA Camille⁵, RAZAZI Keyvan¹,²,³, MEKONTSO-DESSAP Armand¹,²,³, DE PROST Nicolas¹,²,³, ARRESTIER Romain¹,²,³

¹Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, CEDEX, Créteil, 94010 Paris, France, Créteil, France; ²Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, CEDEX, Créteil, 94010 Paris, France, Créteil, France; ³INSERM, IMRB, Université Paris Est Créteil, CEDEX, Créteil, 94010 Paris, France, Créteil, France; ⁴Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France, Paris, France; ⁵Service de Dermatologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, CEDEX, Créteil, 94010 Paris, France, Créteil, France.

**Correspondence:** Romain ARRESTIER (romain.arrestier@aphp.fr)

Annals of Intensive Care 2022, **12**(1):FC-106

**Rationale:** Necrotizing soft tissue infections (NSTI) are life-threatening bacterial infections and often requires admission to intensive care unit (ICU). Severity and specificities of this pathology, such as micro-organisms involved, rhabdomyolysis and nephrotoxic drugs used, could lead to a higher incidence of acute kidney injury (AKI) than in other sepsis conditions. Our objectives were to describe the clinical and biological characteristics of NSTI related AKI and to compare its frequency to a cohort of non-NSTI septic shock.

**Patients and methods/Materials and methods:** We conducted a single-center retrospective comparative study of patients with NSTI admitted in ICU between 2006 and 2021. Patients <18 years old, patients with end-stage renal disease requiring dialysis and patients with nosocomial NSTI acquired after 7 days of hospitalization were excluded. Clinical, biological characteristics and outcomes of NSTI patients with AKI were compared to NSTI patients without AKI. A matching analysis of NSTI patients to a historical cohort of patients with septic shock non related to NSTI and admitted in ICU between 2010 and 2013 was performed.

**Results:** Overall, 77 patients with NSTI were included. Clinical and biological characteristics are described in Table 1. 65 patients (84,4%) developed AKI and 29 (44,6%) displayed stage 3 KDIGO with fourteen patients (21,5%) needed renal replacement therapy (RRT). Time from ICU admission to AKI onset was 1 (0–2) days. Shock at ICU admission was independently associated with AKI (OR = 6.2 [1.3–44.0], p = 0.045). Initiation of antibiotic therapy before ICU admission (OR = 0.05 [0.0–0.6], p = 0.045) and Enterobacteriaceae infections (OR = 0.17 [0.0–0.7], p = 0.02) were associated with a lower risk of AKI. Rhabdomyolysis was not associated with AKI. Total ICU length of stay and mortality were slightly higher for patient with AKI but not statistically different. 45 patients with septic shock non related to NSTI were matched to 45 NSTI patients. The rate of AKI (95,6% vs 84,4%, p = 0,16) and the need for RRT (31,1% vs 26,7%, p = 0,64) were not statistically different between the two groups.

**Conclusion:** AKI is common in patients with NSTI but is not significantly associated with outcome. Risk factors for AKI in patients with NSTI are shock at ICU admission and late initiation of antibiotherapy, however NSTI is not a risk factor of AKI compared to other etiology of septic shock.

**Compliance with ethics regulations:** Yes in clinical research.
<table><thead><tr><th></th><th>Overall (n=77)</th><th>NO-AKI (n=12)</th><th>AKI (n=65)</th><th>p-value</th></tr></thead><tbody><tr><td><strong>General characteristics</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Age (median, IQR)</td><td>61 (53-72)</td><td>58 (51-67)</td><td>63 (53-75)</td><td>0.16</td></tr><tr><td>Male gender, n (%)</td><td>43 (55.8%)</td><td>5 (41.7%)</td><td>38 (58.5%)</td><td>0.28</td></tr><tr><td>SAPS2 (median, IQR)</td><td>49 (31-62)</td><td>28 (19-33)</td><td>53 (37-62)</td><td><strong>&lt;0.001</strong></td></tr><tr><td><strong>Comorbidities</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Hypertension</td><td>42 (54.5%)</td><td>6 (50%)</td><td>36 (55.4%)</td><td>0.73</td></tr><tr><td>Diabetes</td><td>30 (39%)</td><td>5 (41.7%)</td><td>25 (38.5%)</td><td>&gt;0.99</td></tr><tr><td>Obliterating arteritis of the lower limbs</td><td>6 (7.8%)</td><td>1 (8.3%)</td><td>5 (7.7%)</td><td>&gt;0.99</td></tr><tr><td>Congestive heart failure</td><td>6 (7.8%)</td><td>1 (8.3%)</td><td>5 (7.7%)</td><td>&gt;0.99</td></tr><tr><td>Liver cirrhosis</td><td>6 (7.8%)</td><td>0</td><td>6 (9.2%)</td><td>0.58</td></tr><tr><td>Chronic kidney disease</td><td>9 (11.7%)</td><td>0</td><td>9 (13.8%)</td><td>0.34</td></tr><tr><td>Immunosuppression</td><td>14 (18.2%)</td><td>1 (8.3%)</td><td>13 (20%)</td><td>0.68</td></tr><tr><td>Obesity</td><td>19 (24.7%)</td><td>2 (16.7%)</td><td>17 (26.2%)</td><td>0.72</td></tr><tr><td><strong>Characteristics of skin infection</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Time from symptom onset to intensive care admission, days (median, IQR)</td><td>4 (1-8)</td><td>6 (3-11)</td><td>3 (1-8)</td><td>0.16</td></tr><tr><td>Nosocomial infection</td><td>6 (7.8%)</td><td>1 (8.3%)</td><td>5 (7.7%)</td><td>&gt;0.99</td></tr><tr><td>Surgery at day 1 of ICU admission</td><td>72 (93.5%)</td><td>12 (100%)</td><td>60 (92.3%)</td><td>&gt;0.99</td></tr><tr><td>Antibiotherapy before ICU admission</td><td>48/76 (63.2%)</td><td>12 (100%)</td><td>36/64 (56.2%)</td><td><strong>0.003</strong></td></tr><tr><td>IgIV</td><td>6 (7.8%)</td><td>0</td><td>6 (9.2%)</td><td>0.58</td></tr><tr><td><strong>Infection site</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Superior limbs</td><td>53 (68.8%)</td><td>6 (50%)</td><td>47 (72.3%)</td><td>0.18</td></tr><tr><td>Superior limbs</td><td>4 (5.2%)</td><td>0</td><td>4 (6.2%)</td><td>&gt;0.99</td></tr><tr><td>Cervico-facial infection</td><td>2 (2.6%)</td><td>1 (8.3%)</td><td>1 (1.5%)</td><td>0.29</td></tr><tr><td>Abdomino-perineal</td><td>22 (28.6%)</td><td>5 (41.7%)</td><td>17 (26.2%)</td><td>0.3</td></tr><tr><td>Other</td><td>1 (1.3%)</td><td>1 (8.3%)</td><td>0</td><td>0.16</td></tr><tr><td>Multifocal infection</td><td>8 (10.4%)</td><td>1 (8.3%)</td><td>7 (10.8%)</td><td>&gt;0.99</td></tr><tr><td>Associated bacteremia</td><td>23 (29.9%)</td><td>0</td><td>23 (35.4%)</td><td><strong>0.014</strong></td></tr><tr><td><strong>ICU hospitalization characteristics and outcomes</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Shock at ICU admission</td><td>52 (67.5%)</td><td>3 (25%)</td><td>49 (75.4%)</td><td><strong>0.001</strong></td></tr><tr><td>Invasive mechanical ventilation during ICU stays</td><td>49 (63.6%)</td><td>3 (25%)</td><td>46 (70.8%)</td><td><strong>0.006</strong></td></tr><tr><td><strong>Rhabdomyolysis</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Admission CK UI/L (median, IQR)</td><td>201 (65-752)</td><td>32 (25-67)</td><td>218 (85-841)</td><td><strong>0.001</strong></td></tr><tr><td>Admission CK > 308 UI/L, n(%)</td><td>33 (42.9%)</td><td>5 (41.7%)</td><td>28 (43.1%)</td><td>0.93</td></tr><tr><td>CK maximum value during ICU stay UI/L (median, IQR)</td><td>214 (80-955)</td><td>38 (25-68)</td><td>311 (105-1058)</td><td><strong>&lt;0.001</strong></td></tr><tr><td>ICU length of stay, days (median, IQR)</td><td>6 (2-13)</td><td>4 (2-6)</td><td>7 (2-14)</td><td>0.052</td></tr><tr><td>Death during hospitalization</td><td>26 (33.8%)</td><td>2 (16.7%)</td><td>24 (36.9%)</td><td>0.32</td></tr><tr><td>Death at day 28</td><td>23 (29.9%)</td><td>1 (8.3%)</td><td>22 (33.8%)</td><td>0.095</td></tr></tbody></table>

Characteristics and outcome of NSTI patients with and without AKI

FC-107

Cardiorenal syndrome in piglets: development and characterization of a preclinical model

ORIEUX Arthur¹,², PIERONI Laurence²,⁴, DROUIN Sarah²,⁴, SAMSON Chloé², DANG VAN Simon³, MIGEON Tiffany², HADCHOUEL Juliette², GUIHAIRE Julien³, MERCIER Olaf³, GALICHON Pierre²,⁴

¹Service de Médecine Intensive Réanimation - CHU de Bordeaux, Bordeaux, France; ²INSERM UMR_S1155, CoRaKiD - Sorbonne Université, Hôpital Tenon, Paris, France; ³INSERM UMR_S999, Hôpital Marie Lanne- longue, GHPSJ, Université Paris Saclay, Le Plessis-Robinson, France; ⁴AP-HP, Paris, France.

Correspondence: Arthur ORIEUX (arthur.orieux@chu-bordeaux.fr)

Annals of Intensive Care 2022, **12**(1):FC-107

**Rationale:** Cardio-renal syndromes (CRS) type 1 and 2 are complex disorders in which cardiac dysfunction leads to kidney dysfunction. However, the mechanisms remain incompletely explained, in particular in right heart failure (RHF). Our objective was to develop an original preclinical model of CRS secondary to RHF associated with post embolic pulmonary hypertension (PH) in piglets.

**Patients and methods/Materials and methods:** Twelve 2-month-old large white piglets were randomized: group with induction of PH by ligation of the left pulmonary artery followed by weekly iterative embolization (soft tissue adhesive) of the right lower pulmonary artery, or SHAM control group (sham interventions) (Fig. 1). The sacrifice is made after 5 embolizations. We performed hemodynamic evaluation (right cardiac catheterization), echocardiography, laboratory

blood, and urine tests. Histological evaluation and immunostaining of renal damage and repair were fulfilled. Measured glomerular filtration rate (GFR) procedures by injection of an exogenous tracer were repeated weekly.

**Results:** At sacrifice, mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR) and central venous pressure (CVP) were significantly higher in the PH group: 32±10 vs 13±2 mmHg (p=0.001); 9.3±4.7 vs 2.5±0.4 mmHg (p=0.004) and 10±4 vs 6±2 mmHg (p=0.04) while the cardiac index (CI) was not different. Piglets with PH had right ventricular dysfunction and higher troponin I (302 [53–3054] vs 33 [17–47] ng/mL; p=0.03). PH piglets showed increased histological marker of kidney injury (acute tubular necrosis-ATN-) and repair (proliferation assessed by Ki67). Albuminuria was increased (4.4±0.6 vs 2.9±0.4 mg/L; p<0.001) while serum creatinine (SCR) and uremia were not significantly different between the two groups. Unlike the estimated GFR, the measured GFR decreases from the 3rd week of the protocol. We reported a correlation between PH parameters and kidney function: mPAP (R2=0.4, p=0.03), PVR (R2=0.50, p=0.01) and CVP (R2=0.37; p=0.04), but not with CI.

**Conclusion:** We reported the first porcine model of SCR on RHF secondary to PH. Renal dysfunction was characterized by ATN, increased albuminuria, and low measured GFR. The GFR estimated from SCR did not inform on renal dysfunction in these young piglets, unlike the measured GFR.

**Compliance with ethics regulations:** Yes in animal testing.

<figure><img src="image_77.png" /><figcaption>Figure 1. Study protocol of pulmonary hypertension induction. D: day; E: embolization; mGFR: measured glomerular filtration rate; LPA: left pulmonary artery; PH: pulmonary hypertension; RHC: right heart catheterization; TTE: transthoracic echocardiography.</figcaption></figure>

FC-108

Impact of positive fluid balance on outcomes in COVID-19 critically ill patients with ARDS

BOUGUEZZI Nabil¹, TOUMI Radhouane¹,², MAATOUK Iyed¹, BEDHIAFI Amir¹, ZOUARI Hajer¹, MAATOUK Khalil¹, MEDDEB Khaoula¹,², BEN SAIDA Imene¹,², BOUSSARSAR Mohamed¹,²

¹Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisie; ²Research Laboratory N° LR12SP09. Heart Failure. Farhat Hached University Hospital, University of Sousse, Sousse, Tunisie.

Correspondence: Nabil BOUGUEZZI (dr_nabil@live.fr)

Annals of Intensive Care 2022, **12**(1):FC-108

**Rationale:** COVID-19 pandemic represents a major public concern worldwide. Acute respiratory distress syndrome (ARDS) and lung failure are the main lung diseases found in COVID-19 patients. In ARDS patients, positive fluid balance can be associated with prolonged mechanical ventilation, more intensive care unit (ICU) complications, and higher mortality. Objective: The aim of this study was to evaluate the effect of fluid balance on morbidity and mortality in COVID-19 patients admitted to the ICU.

**Patients and methods/Materials and methods:** We conducted a retrospective observational study from March 2020 to October 2021 in a Medical ICU. Data concerning daily fluid balance, cumulative fluid balance at day 7, PaO₂/FiO₂ (P/F) ratio and outcomes of Critically Ill COVID-19 patients were obtained from medical records. The acute
kidney injury (AKI) severity was classified according to the Kidney Disease Improving Global Outcomes guidelines. The study sample was divided into 2 groups according to fluid balance. Different outcomes (length of stay, invasive mechanical ventilation, acute kidney injury and death) were compared between the 2 groups.

**Results:** During the study period, 442 critically ill COVID-19 patients were admitted to our ICU. Positive fluid balance was found in 46% of patients (n = 207), and negative fluid balance was found in 53% of cases (n = 235), with a mean of 2271 ± 2285 ml and -2144 ± 2369 ml respectively. The mean cumulative fluid intake at day 7 was - 76 ± 3206 ml. Patients with positive fluid balance had a higher incidence of AKI (58.9%, n = 122) versus (37%, n = 87) (p < 0.001), of capillary leak (39%, n = 80) versus (27.8%, n = 63) (p = 0.013) and a higher mortality (54.4%, n = 112) versus (43.8%, n = 102) (p = 0.027). Mean length of stay was the same for the 2 groups (10.16 ± 6.15 days versus 9.99 ± 6.68 days, p = 0.79). The majority (50.6%, n = 118) required invasive mechanical ventilation (p = 0.11). P/F improved from 132 ± 77 on day 1 to 197 ± 90 on day 7 in negative fluid balance group (p < 10-3). Mean P/F was stable from day 1 and day 7 in positive fluid balance group (123 ± 55 and 129 ± 51 respectively, p = 0.36). Mean fluid balance at day 7 was significantly less for survivors than non survivors (-505 ± 3364 ml and 413 ± 2961 ml respectively, p = 0.002).

**Conclusion:** Our study showed that patients with excessive fluid balance had more ICU complications and higher hospital mortality. Therefore, restrictive fluid strategies should be used to improve oxygenation and reduce mortality among COVID-19 patients.

**Compliance with ethics regulations:** Yes in clinical research.

## FC-109

### Acute Kidney Injury (AKI) in the intensive care unit (About 151 cases)

KHALEK Khalid¹, OULAHIANE Malika¹, BOUHOURI Aziz¹, AL HARRAR Rachid¹

¹Service de réanimation chirurgicale des urgences (P.33), CHU Ibn Rochd, Casablanca, Casablanca, Maroc

**Correspondence:** Oulahiane MALIKA (oulahiane.2238@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-109

**Rationale:** Acute kidney injury (AKI) is a frequent complication in intensive care units (ICU). The mortality remains high due to the aging of the affected population, the multiplicity of causes generating it, the association with other visceral failures and the frequent evolution in a septic context. The aim of this study is to study the different epidemiological and therapeutic aspects of AKI and try to determine the predictive factors of mortality in our population.

**Patients and methods/Materials and methods:** a descriptive and analytical cross-sectional study, which focused on 151 records of patients admitted to the ICU, who presented an AKI on admission or developed it during hospitalization. This study is spread over a period of 24 months, from 01/2019 to 12/2020.

**Results:** The incidence of AKI in our series was 17.32%. The average age of the patients was 49 ± 18 years with a male predominance (sex ratio M/F 2.14). The most common risk factors were: injection of contrast (77.9%), mechanical ventilation (67.8%), use of vasopressors (64.2%), nephrotoxic drugs (58%), diabetes (23.3%) and arterial hypertension (19.2%). The time of appearance of AKI was 2 ± 3 days. KDIGO stage 3 was predominant in our patients with a percentage of 53.6% followed by stage 1 (23.8%), and lastly stage 2 with a percentage of 22.5%. Dialysis was used in 18% of the patients. The mortality rate in our series was 62.33% and the factors found to have a significant relationship with death were: age, mechanical ventilation, use of vasopressors, multivisceral failure and septic shock.

**Conclusion:** A better knowledge of the risk and prognostic factors of AKI could be a major asset for a more effective management.

**Reference 1:** John R. Prowle, Christopher J. Kirwan and Rinaldo Belomlo. Fluid management for the prevention and attenuation of acute kidney injury. Nat. Rev. Nephrol. 10, 37–47 (2014):11. https://doi.org/10.1038/nrneph.2013.232.

**Reference 2:** Gaudry S, Ricard J-D, Leclaire C, Rafat C, Messika J, Bedet A, et al. Acute kidney injury in critical care: Experience of a conservative strategy. J Crit Care. déc 2014;29(6):1022–7.

**Compliance with ethics regulations:** Yes in clinical research.

## FC-110

### Association of nitrogen balance trajectories with clinical outcomes in critical ill COVID-19 patients: a retrospective single center cohort study

DUPUIS Claire¹, BRET Alexandre¹, JANER Alexandra¹, GUIDO Olivia¹, BOUZGARROU Radhia¹, DOPEUX Loïc¹, HERNANDEZ Gilles¹, MASCLE Olivier¹, CALVET Laure¹, THOUY François¹, GRAPIN Kévin¹, ADDA Mireille¹, BOIRIE Yves¹, SOUWEINE Bertrand¹

¹CHU Gabriel Montpied, CHU Clermont Ferrand, Clermont Ferrand, France

**Correspondence:** Claire DUPUIS (cdupuis1@chu-clermontferrand.fr)

*Annals of Intensive Care* 2022, **12**(1):FC-110.

**Rationale:** The intensity and duration of the catabolic phase in COVID-19 patients might differ between survivors and no survivors. The purpose of the study was to assess the association between nitrogen balance (NBAL) trajectories and outcome in critical ill COVID-19 patients.

**Patients and methods/Materials and methods:** This retrospective study was conducted in intensive care at Clermont Ferrand University Hospital, France. From January 2020 to May 2021. The present study was approved by the Ethics Committee of Clermont Ferrand. Patients over 18 years old with a severe COVID-19 disease were eligible. Patients were excluded if they were referred from another ICU, if their ICU length of stay was < 72 h, and if they were treated by renal replacement therapy during the first seven days after ICU admission. The primary objective was to compare the profile of NBAL during the first two weeks after ICU admission between the patients with ICU death and the other patients. All data were prospectively collected and comprised details on ICU admission and during ICU stay. Vital status was collected at day 60. NBAL was estimated as proposed by Dickerson et al (Ref 1). Statistical analysis Comparisons between the evolution of NBAL depending on outcome was achieved using 2 level ANOVA. At day 3, 5 and 7, to represent the relationship between NBAL and protein intake, linear and non nonlinear models were achieved and the protein intakes necessary to reach a zero NBAL were determined. Subgroup analyses were achieved according to BMI, age, gender.

**Results:** 99 patients were included in the study. Their characteristics are reported in Table 1. On day 3, a negative similar NBAL was observed in survivors and non survivors: -16.4 g/d [-26.5; -3.3] and -17.3 g/d [-22.2; -3.8] (p = 0.54). Then, the trajectories of NBAL over time differ between survivors and non survivors (p = 0.01). In survivors, NBAL increased over time (Patients with a net protein catabolism: 73.9% at day 3 versus 45.5% at day 14) whereas in non survivors, NBAL decreased from day 2 to day 6, and thereafter increased slowly up to day 14 (Patients with a net protein catabolism: 73.3% at day 3 vs 78.9% at day 14). Administrating higher protein amounts were associated with higher NBALS.

**Conclusion:** We reported a prolonged catabolic state in COVID patients which seemed more pronounced in non survivors than in survivors. Our study underlined the need for monitoring urinary nitrogen excretion to guide protein intakes in COVID-19 patients.

**Reference 1:** Dickerson, Nutrition, 2005.

**Compliance with ethics regulations:** Yes in clinical research.
<table><thead><tr><th>Variables (N (%) or median (IQR))</th><th>All<br>N=99</th><th>ICU Survivors<br>N=69</th><th>Non-ICU Survivors<br>N=30</th><th>P-Value</th></tr></thead><tbody><tr><td>Age (years old)</td><td>71 (40.6, 92.2)</td><td>68.9 (58.7, 79.9)</td><td>73.0 (67.6, 78.1)</td><td>0.62</td></tr><tr><td>Gender (Male)</td><td>64 (64.4)</td><td>45 (65.7)</td><td>19 (63.1)</td><td>0.86</td></tr><tr><td>BMI = 20 kg/m<sup>2</sup></td><td>45 (45.5)</td><td>31 (48.5)</td><td>14 (48.5)</td><td>0.87</td></tr><tr><td>Comorbidities</td><td></td><td></td><td></td><td></td></tr><tr><td>Cardiovascular</td><td>15 (15.2)</td><td>6 (8.7)</td><td>9 (30)</td><td>&lt;0.01</td></tr><tr><td>Respiratory</td><td>5 (5.1)</td><td>3 (4.3)</td><td>2 (6.7)</td><td>0.63</td></tr><tr><td>Renal</td><td>6 (6.1)</td><td>2 (3.9)</td><td>4 (13.3)</td><td>0.05</td></tr><tr><td>Immunosuppression</td><td>15 (15.2)</td><td>10 (14.5)</td><td>5 (18.5)</td><td>0.78</td></tr><tr><td>Diabetes mellitus</td><td>15 (15.2)</td><td>2 (2.7)</td><td>3 (100)</td><td>0.35</td></tr><tr><td>On admission (Day 1 or Day 2)</td><td></td><td></td><td></td><td></td></tr><tr><td>Strains</td><td>86 (86.7)</td><td>60 (87)</td><td>26 (86.7)</td><td>0.57</td></tr><tr><td>SAPS II</td><td>31 (32.4, 41)</td><td>32 (32.4, 41)</td><td>31 (32.4, 41)</td><td>0.55</td></tr><tr><td>SAPSA score (DM-9)</td><td>4.1 (4.1-6.1)</td><td>4.1 (4.1-5.1)</td><td>5.1 (6.1-6.2)</td><td>0.63</td></tr><tr><td>PaO2/FiO2</td><td>86.9 (66.8, 138.8)</td><td>92.7 (76.3, 140)</td><td>86 (66.1, 109.2)</td><td>0.24</td></tr><tr><td>IMV</td><td>7 (7.1)</td><td>6 (8.7)</td><td>1 (3.3)</td><td>0.34</td></tr><tr><td>During ICU stay</td><td></td><td></td><td></td><td></td></tr><tr><td>IMV</td><td>31 (31.3)</td><td>11 (15.9)</td><td>20 (66.7)</td><td>&lt;0.01</td></tr><tr><td>RRT</td><td>8 (8.1)</td><td>2 (2.9)</td><td>6 (20)</td><td>&lt;0.01</td></tr><tr><td>Vasopressors</td><td>39 (39.3)</td><td>10 (14.5)</td><td>18 (60)</td><td>&lt;0.01</td></tr><tr><td>ICU LOS</td><td>9.15 (14)</td><td>7.15 (10)</td><td>15 (24)</td><td>&lt;0.01</td></tr><tr><td>Hospital LOS</td><td>17.11 (29)</td><td>17 (11.5, 29)</td><td>15.9 (26, 29)</td><td>0.30</td></tr><tr><td>ICU Death</td><td>30 (30.3)</td><td></td><td></td><td></td></tr></tbody></table>

Characteristic and comparisons of ICU COVID-19 patients between survivors and no survivors

FC-111

Management of renal replacement therapy in adults French intensive care units: a survey practices at the bedside (READIAL)

JOLLY Florian¹, JACQUIER Marine¹,⁵, PECQUEUR Delphine²,³, LABRUYÈRE Marie¹,², VINSONNEAU Christophe⁴, FOURNEL Isabelle², QUENOT Jean-Pierre¹,²,⁵

¹CHU Dijon, Dijon, France; ²INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France; ³CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Epidémiologie Clinique/Essais Cliniques, Chu Dijon-Bourgogne, Centre d'Investigation Clinique, Module Epidémiologie Clinique/essais Cliniques, France; ⁴Centre Hospitalier de Bethune, Service de Médecine Intensive Réanimation-Unité de Sevrage Ventilatoire et Réhabilitation, Bethune, France; ⁵Équipe Lipness, centre de recherche INSERM UMR1231 et LabEx LipSTIC, université de Bourgogne-Franche Comté, Dijon, France.

**Correspondence:** Jean-Pierre QUENOT (jean-pierre.quenot@chu-dijon.fr)

Annals of Intensive Care 2022, **12**(1):FC-111

**Rationale:** In France, recommendations for renal replacement therapy (RRT) in the intensive care unit (ICU) were published in 2015 and their uptake was recently assessed in a nationwide self-report online survey¹. We performed an evaluation of real-life practices in the field in terms of RRT in a representative sample of ICUs across France.

**Patients and methods/Materials and methods:** The READIAL study was performed from 1 July to 5 October 2021. It was an evaluation of professional practices, and each centre was required to prospectively include 5 consecutive patients. Patients who required initiation of a first RRT using a hemodialysis catheter were eligible for inclusion. Patients with chronic renal failure requiring RRT through a tunneled catheter or an arterio-venous fistula were excluded.

**Results:** A total of 67 centres (83% of those contacted) agreed to participate, and included a total of 295 analysable patients (8 patients were erroneously included and therefore excluded from analysis). We found divergences between previously declared practices¹ and actual practice observed in this study. The main indications for initiation of RRT are detailed in Fig. 1 (left panel), and the main sites of insertion of the first hemodialysis catheter are shown in Fig. 1 (right panel). The vast majority of centres used citrate, unfractionated heparin or NaCl as a catheter lock solution (47%, 24% and 21% respectively).

**Conclusion:** In this evaluation of professional practices that collected data at the bedside, the modalities of initiation of RRT in the ICU in patients with acute kidney failure were found to be globally in line with guidelines and literature data. The results should be interpreted in light of the limitations inherent to this type of study.

**Reference 1:** Quenot JP, Amrouche I, Lefrant JY, et al. Blood Purification 2021;4:1–10.

**Compliance with ethics regulations:** Yes in clinical research.

<figure><img src="image_78.png" /><figcaption>Figure.</figcaption></figure>

FC-112

Scleroderma cardiac crisis: a-life-threatening but reversible complication of systemic sclerosis

VIGNERON Clara¹, PÈNE Frédéric¹, CHARPENTIER Julien¹, MOUTHON Luc¹, CHAIGNE Benjamin¹

¹Hôpital Cochin, Paris, France

**Correspondence:** Clara VIGNERON (claravigneron@hotmail.fr)

Annals of Intensive Care 2022, **12**(1):FC-112

**Rationale:** Systemic sclerosis (SSc) heart involvement account for 30% of SSc patient's deaths.

**Patients and methods/Materials and methods:** We retrospectively studied patients with previous diagnosis of SSc admitted to the ICU for acute cardiac dysfunction between 2012 and mid-2021.

**Results:** Nine female patients were included, mainly with diffuse SSc (n=7, 78%). Six (67%) had digital ulcers. All but one patient complained about physical cardiac symptoms (n=8, 89%), 5 (56%) had electrocardiogram modifications. Biological exams revealed elevated troponin (705 µg/l [421–1582]) and Nt-pro-BNP (16,062 ng/l [10419–40738]). Patients exhibited severe left ventricular ejection fraction (LVEF) impairment (20% [10–20] vs 58% [53–60] before ICU admission (p=0.0002)) requiring vasopressors and/or inotropes for 7 patients (78%) and mechanical ventilation or renal replacement therapy for 4 patients (44%). LVEF spontaneously improved during ICU stay (LVEF 40% [30–40] vs 20% [10–20], p=0.0007) and returned to baseline within 6 months following ICU discharge (LVEF 53% [40–63] vs 58% [53–60]) (Fig. 1). Seven (78%) patients survived the ICU-stay and 4 (44%) were alive at 6 months.

**Conclusion:** We report an uncommon and specific severe acute life-threatening cardiac dysfunction in SSc patients, which can be reversible but remains associated with a poor long-term prognosis.

**Compliance with ethics regulations:** N/A.

<figure><img src="image_79.png" /><figcaption>Figure 1. Evolution of left ventricular ejection fraction (%): at baseline, at ICU admission and discharge and within 6 months post-ICU discharge in ICU-survivors. *p* < 0.05.</figcaption></figure>
FC-113

A simplified algorithm to predict left ventricular systolic function in septic shock patients

BRAULT Clément¹, ZERBIB Yoann¹, MAIZEL Julien¹, SLAMA Michel¹

¹CHU Amiens-Picardie, Amiens, France

**Correspondence:** Clément BRAULT (brault.clement@chu-amiens.fr)

*Annals of Intensive Care 2022, 12(1):FC-113*

**Rationale:** Septic cardiomyopathy (SCM) is characterized by a transient biventricular dysfunction with reduced contractility. Left ventricular (LV) ejection fraction (LVEF) is the conventional method to determine LV systolic function in septic shock, but is unhelpful to predict mortality. In contrast, the longitudinal strain (LVLS) might aid in early diagnosis of SCM, and was strongly associated with mortality. In this study, we developed an echocardiographic algorithm, using simple bedside parameters, to predict LVEF and LVLS in patients with septic shock.

**Patients and methods/Materials and methods:** We included all consecutive patients admitted with septic shock (defined in accordance with the Sepsis-2 criteria) or developing a septic shock during the ICU stay. We measured septal and lateral mitral annular plane systolic excursion (MAPSE), septal and lateral mitral S-wave velocity, and the left ventricular longitudinal wall fractional shortening (LV-LWFS). We used a conditional inference tree method to build a stratification algorithm; recursive partitioning was used to stratify the population of interest into subgroups. The best predictor and the corresponding optimal cutoff value were calculated. Bonferroni correction for multiple testing was applied to univariate p values. The tree-building process continued as long as a predictor led to significantly different child nodes.

**Results:** We included 71 patients (males: 59%; mean ± SD age: 61 ± 15 years). We found that 31% and 73% had an impaired LV systolic function assessed by LVEF and LVLS, respectively. The septal MAPSE, with a threshold of 1.2 cm, was the best parameter to predict the LV systolic function (Fig. 1). Other parameter (such as the S-wave or LV-LWFS) did not allow improving the algorithm's performance. Septal MAPSE ≥ 1.2 cm predicted normal LVEF with near certainty. Conversely, septal MAPSE < 1.2 cm almost always predicted impaired LVLS, while almost half patients remained with preserved LVEF.

**Discussion:** Septal MAPSE, used as the main parameter to predict LV systolic function, has several advantages. First, it only requires a simple M-mode measurement, available in all ultrasound devices including handheld machines. Second, MAPSE is easily recorded even in patients with poor acoustic window (including obese patients) because of the high echogenicity of the atrioventricular plane. Third, its reproducibility is excellent even in inexperienced users, and require only minimal training.

**Conclusion:** Septal MAPSE, easily measurable at bedside and with good reproducibility, might be useful to support clinicians in early detection of SCM, especially when strain is not available or feasible.

**Compliance with ethics regulations:** Yes in clinical research.

<figure><img src="image_80.png" /><figcaption>Proposed algorithm for predicting LV systolic function</figcaption></figure>

FC-114

An impaired global longitudinal strain at speckle tracking is associated with poorer haemodynamic condition irrespectively of the left ventricular ejection fraction during septic cardiomyopathy

GOBE Thibaut¹, CARELLI Simone¹, ROGER Guillaume¹, LAI Christopher¹,

PHAM Taï¹, TEOUL Jean-Louis¹, MONNET Xavier¹

¹Hôpital de Bicêtre, Le Kremlin Bicêtre, France

**Correspondence:** Thibaut GOBÉ (thibautgobe@gmail.com)

*Annals of Intensive Care 2022, 12(1):FC-114*

**Rationale:** Global Longitudinal Strain (GLS) is more sensitive than left ventricular ejection fraction (LVEF) to detect impaired contractility during septic cardiomyopathy. However, its evolution over time has been poorly described. Moreover, the clinical importance of an impaired GLS is unclear. In particular, the haemodynamic consequences of an impaired GLS per se have never been reported.

**Patients and methods/Materials and methods:** In 61 adult patients with septic shock, we performed transthoracic echocardiography to measure LVEF and GLS with speckle tracking within the first 24 h (day-0), at day-1, day-3 and on the day when vasopressors were stopped. Simultaneously, central venous oxygen saturation (ScvO₂), blood lactate and cardiac index (PiCCO2 device) were assessed.

**Results:** Eleven patients were excluded for poor echogenicity or prone positioning at the time of inclusion. The prevalence of a low LVEF (<45%) was 36% at day-0, 39% at day-1, 38% at day-3 and 14% on the day of vasopressors weaning. At these time points, systolic arterial pressure was 118 [109; 127], 121 [116; 133], 123 [114; 132] and 130 [120; 134] mmHg, respectively. The prevalence of an impaired GLS (> − 16%) was 70% at day-0, 72% at day-1, 75% at day-3 and 58% at vasopressors weaning. Pooling all time points, GLS was correlated with blood lactate (rho=0.369, 95% confidence interval: [0.213;0.506], p<0.0001), and ScvO₂ (rho=− 0.293 [− 0.457; − 0.110], p<0.0021). At each measurement time, we classified the cardiac status into three groups: normal LVEF and normal GLS (LVEF<sub>n</sub>-GLS<sub>n</sub>, n=40), normal LVEF and impaired GLS (LVEF<sub>n</sub>-GLS<sub>impaired</sub> n=52) and low LVEF and impaired GLS (LVEF<sub>low</sub>-GLS<sub>impaired</sub>, n=36). Compared to the LVEF<sub>n</sub>-GLS<sub>n</sub> group, the LVEF<sub>n</sub>-GLS<sub>impaired</sub> group exhibited a lower cardiac index (2.6 [2.3;3.1] vs. 3.1 [2.6;3.9] L/min/m², p=0.03), a higher lactate level (1.7 [1.3;2.3] vs. 1.4 [1.0;2.1] mmol/L, p=0.04) and lower ScvO₂ (67 [63;74] vs. 72 [67;78]%, p=0.02). In the LVEF<sub>low</sub>-GLS<sub>impaired</sub> group, cardiac index was lower (2.4 [2.2;2.8] vs. 2.6 [2.3;3.1] L/min/m², p=0.03), lactate higher (2.8 [2.0;3.8] vs. 1.7 [1.3;2.3] mmol/L, p=0.01) than in the LVEF<sub>n</sub>-GLS<sub>impaired</sub> group and ScvO₂ was not significantly different (69 [57;74] vs. 67 [63;74]%, p=0.76) (Fig. 1).

**Conclusion:** During septic cardiomyopathy, GLS remains impaired in a large proportion of patients when vasopressors are stopped. An impaired GLS is associated with lower cardiac index and poorer tissue oxygenation irrespectively of the value of LVEF. This suggests that an impaired GLS has clinical meaning per se. The study is ongoing.

**Compliance with ethics regulations:** Yes in clinical research.

<figure><img src="image_81.png" /><figcaption>Comparison of markers of tissue oxygenation between cardiac status subgroups</figcaption></figure>
FC-115

Decrease in lactate level and norepinephrine dosage in the first 24 h of resuscitation is strongly associated with survival in 502 patients with refractory shock

HUGEROT Antonin¹, CLERE-JEHL Raphaël¹, SUBLON Cédric¹, STEIN Julien¹, GARIJO Carlos¹, GUILLOT Max¹, HERBRECHT Jean-Etienne¹, JANSSEN-LANGENSTEIN Ralf¹, LEROUX Justine¹, PEREZ Yonatan¹, SCHENCK-DHIF Maleka¹, SCHNEIDER Francis¹, CASTELAIN Vincent¹
¹Hôpitaux Universitaires de Strasbourg, Strasbourg, France

**Correspondence:** Antonin HUGEROT (antonin.hugerot@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-115

**Rationale:** To determine the prognostic impact of maximum norepinephrine dosage received in the first 24 h following admission to the intensive care unit, regardless of indication, and to determine factors associated with in-ICU and in-hospital mortality.

**Patients and methods/Materials and methods:** All patients receiving norepinephrine in the first 24 h after admission to our University Hospital intensive care unit between January 1, 2015 and January 1, 2020 were included, retrospectively. We collected for each patient the maximum dosage of norepinephrine and all diagnostic, clinical and biological parameters of interest. Univariate and multivariate inferential statistical analysis was performed.

**Results:** We included 2009 patients, mean age 66 years, 40% of whom were women, and presenting with septic shock in 53% (n = 1073). Mean SAPS II reached 59 ± 19 points. Mechanical ventilation and renal replacement therapy were required in 77% and 23%, respectively. Intra-ICU and intra-hospital mortality were 32% and 39%, respectively. The median maximum norepinephrine dosage received during the first 24 h was 0.4 µg/kg/min (IQR 0.2–0.85). A significant increase in mortality was observed in uni- and multivariate analysis in patients who received more than 0.85 µg/kg/min of norepinephrine corresponding to the 3rd quartile distribution of maximum norepinephrine dosage, (in-ICU mortality 62%, p < 0.001). Among patients who received more than 0.85 µg/kg/min norepinephrine, defined as refractory shock, decreasing kinetics of lactate and norepinephrine dosage at 24 h were found to be highly significantly and independently associated with patient survival (in-ICU mortality 43%). On the other hand, the need for extrarenal purification or the use of adrenaline were independently associated with excess mortality in this group.

**Conclusion:** In our study, the threshold of 0.85 µg/kg/min is an independent marker of mortality in patients admitted to the ICU and could be considered to define refractory shock, regardless of diagnosis. However, when dosages higher than this threshold are used, lactate level and norepinephrine doses rapid decrease are strongly associated with a better prognosis. These findings need to be confirmed by further work in other patient populations before being used in clinical practice.

**Compliance with ethics regulations:** Yes in clinical research.

<figure><img src="image_82.png" /><figcaption>Survival in patients with refractory shock according to kinetics of lactate level and norepinephrine dosage at 24 h</figcaption></figure>

FC-116

Prehospital norepinephrine administration reduces 30-day mortality among septic shock patients

HAJJAR Adèle¹, JOUFFROY Romain¹,⁸, GILBERT Basile², TOURTIER Jean Pierre³, BLOCH-LAINE Emmanuel⁴, ECOLLAN Patrick³, BOULARAN Josiane⁶, BOUNES Vincent⁶, VIVIEN Benoit⁸, GUEYE Papa⁷.

¹APHP - CHRU Ambroise Paré, Boulogne-Billancourt, France; ²Department of Emergency Medicine, SAMU 31, University Hospital of Toulouse, Toulouse, France; ³Paris Fire Brigade, Paris, France; ⁴Emergency Department, Cochin Hospital, Paris, France & Emergency Department, SMUR, Hôtel Dieu Hospital - Assistance Publique - Hôpitaux Paris, Paris, France; ⁵Intensive Care Unit, SMUR, Pitie Salpêtrière Hospital - Assistance Publique - Hôpitaux Paris, Paris, France; ⁶SAMU 31, Centre Hospitalier Intercommunal Castres-Mazaret, Castres, France; ⁷SAMU 972 University Hospital of Martinique,, Fort-De-France Martinique, France; ⁸Intensive Care Unit, Anaesthesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux Paris, Paris, France

**Correspondence:** Romain JOUFFROY (romain.jouffroy@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-116

**Rationale:** Despite differences in time of sepsis recognition, recent studies support that early initiation of norepinephrine in patients with septic shock (SS) improves outcome without adverse effects increase. This study aims to investigate the relationship between 30-day mortality in patients with SS and prehospital norepinephrine infusion in order to reach a mean blood pressure (MAP) at 65 mmHg at the end of the prehospital stage.

**Patients and methods/Materials and methods:** From April 06th, 2016 to December 31st, 2020, patients with SS requiring prehospital Mobile Intensive Care Unit intervention (MICU) were retrospectively analysed. To consider cofounders, propensity score method was used to assess the relationship between prehospital norepinephrine administration in order to reach a MAP at 65 mmHg at the end of the prehospital stage and 30-day mortality.

**Results:** Four hundred seventy-eight patients were retrospectively analysed, among which 309 patients (65%) were male. The mean age was 69 ± 15 years. Pulmonary, digestive, and urinary infections were suspected among 44%, 24% and 17% patients, respectively. One third of patients (n = 143) received prehospital norepinephrine administration with a median dose of 1.0 [0.5–2.0] mg·h⁻¹, among which 84 (69%) were alive and 38 (31%) deceased on day 30 after hospital-admission. 30-day overall mortality was 30%. Cox regression analysis after propensity score showed a significant association between prehospital norepinephrine administration and 30-day mortality: adjusted hazard ratio of 0.42 [0.25–0.70], p < 10⁻³. Multivariate logistic regression of IPTW retrieved a significant decrease of 30-day mortality among prehospital norepinephrine group: ORa = 0.75 [0.70–0.79], p < 10⁻³.

**Conclusion:** In this study, we report that prehospital norepinephrine infusion in order to reach a MAP at 65 mmHg at the end of the prehospital stage is associated with a decrease in 30-day mortality in patients with SS cared for by a MICU in the prehospital setting. Further prospective studies are needed to confirm that very early norepinephrine infusion allows to decrease septic shock mortality.

**Compliance with ethics regulations:** Yes in clinical research.
<figure><img src="image_83.png" /></figure>

Kaplan Meier curves for 30-days survival between patients with pre-hospital norepinephrine administration and those without prehospital norepinephrine administration

FC-117

Time for restauration of radial arterial pressure after a transient
arm vascular occlusion correlates with outcome in critically ill
patients: preliminary results of an observational study

LAI Christopher¹, SHI Rui¹, TEBOUL Jean-Louis¹, MORETTO Francesca¹,
GUÉRIN Laurent¹, XAVIER Monnet¹

¹AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, DMU 4 CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMAS, Université Paris-Saclay, Le Kremlin-Bicêtre, France

**Correspondence:** Christopher LAI (christopher.lai@aphp.fr)

Annals of Intensive Care 2022, **12**(1):FC-117

**Rationale:** Impairment of vascular reactivity is one of the characteristics of septic shock and is associated with a poor outcome in critically ill patients. It can be assessed by the resaturation slope of the muscular tissue oxygen saturation after a transient vascular occlusion (TVO). Another means for assessing vascular reactivity might be to observe the time of the increase in radial arterial pressure after a TVO at the arm level.

**Patients and methods/Materials and methods:** Mechanically ventilated patients hospitalized in intensive care unit and equipped with a radial artery catheter were prospectively included. A brachial cuff was rapidly inflated to induce a transient arterial stop-flow. Arterial pressure thus decreased down to the level of mean systemic pressure (Pms\_arm). After 60 s of TVO, the cuff was abruptly deflated and time to return from Pms\_arm to baseline systolic arterial pressure was measured (T\_revasc).

**Results:** We included 41 patients, among whom 19 (46%) where in shock, including 13 (32%) septic shock, 10 (24%) had acute respiratory distress syndrome and 9 (22%) were intubated for neurological impairment. Norepinephrine was infused in 25 (61%) patients (0.3 [0.17–1.10] µg/kg/min). Measurements were obtained 3 (2–6) days after onset of mechanical ventilation or vasopressors infusion. Mean arterial pressure was 84 ± 12 mmHg, Pms\_arm was 29 ± 9 mmHg, central venous pressure was 12 ± 4 mmHg and the (Pms\_arm–CVP) gradient was 16 ± 8 mmHg, with no difference between patients with or without

shock. In the whole population, T<sub>revasc</sub> was 26 (20–33) sec. It was significantly increased in patients with shock compared to those without shock (33 ± 18 vs. 23 ± 10 s., respectively, p=0.028). Among patients with shock, T<sub>revasc</sub> was longer in patients with septic shock than in the other ones (33 (28–44) vs. 16 (9–30) sec., respectively, p=0.048). T<sub>revasc</sub> was significantly increased in the 21 (51%) patients who died (11 patients with shock) compared to survivors (33 ± 19 vs. 23 ± 10 s., respectively, p = 0.037).

**Conclusion:** In critically ill patients under mechanical ventilation, T<sub>revasc</sub> was increased in patients with shock compared to patients without shock, especially in septic shock patients. T<sub>revasc</sub> was also higher in non-survivors. This new variable might indicate vasoreactivity at bedside and, as such, be associated with severity and mortality. More data are needed to confirm these preliminary results and inclusions are ongoing.

**Compliance with ethics regulations:** Yes in clinical research.

FC-118

Vitamin C improves microvascular reactivity and peripheral tissue
perfusion in septic shock patients

LAVILLEGRAND Jean-Rémi¹, RAIA Lisa¹, URBINA Tomas¹, HARIRI Geoffroy¹, GABARRE Paul¹, BONNY Vincent¹, BIGÉ Naike¹, BAUDEL Jean Luc¹, BRUNEEL Arnaud², DUPRE Thierry¹, GUIDET Bertrand¹, MAURY Eric¹, AIT OUFELLA Hafid¹

¹APHP-CHU Saint Antoine, Paris, France; ²APHP-CHU Bichat, Paris, France

**Correspondence:** Jean-Rémi LAVILLEGRAND (jrlavillegrand@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-118

**Rationale:** Vitamin C has potential protective effects through antioxidant and anti-inflammatory properties. However, the effect of vitamin C supplementation on microvascular function and peripheral tissue perfusion in human sepsis remains unknown. We aimed to determine vitamin C effect on microvascular endothelial dysfunction and peripheral tissue perfusion in septic shock patients.

**Patients and methods/Materials and methods:** Patients with septic shock were prospectively included after initial resuscitation. Bedside peripheral tissue perfusion and skin microvascular reactivity in response to acetylcholine iontophoresis in the forearm area were measured before and 1 h after intravenous vitamin C supplementation (40 mg/kg). Norepinephrine dose was not modified during the studied period.

**Results:** We included 30 patients with septic shock. SOFA score was 11 [8–14], SAPS II was 66 [54–79], and in-hospital mortality was 33%. Half of these patients had vitamin C deficiency at inclusion. Vitamin C supplementation strongly improved microvascular reactivity (AUC 2263 [430–4246] vs 5362 [1744–10585] Ul, p = 0.0004). In addition, vitamin C supplementation improved mottling score (p = 0.06), finger-tip (p = 0.0003) and knee capillary refill time (3.7 [2.6–5.5] vs 2.9 [1.9–4.7] s, p < 0.0001), as well as and central-to-periphery temperature gradient (6.1 [4.9–7.4] vs 4.6 [3.4–7.0] °C, p < 0.0001). The beneficial effects of vitamin C were observed both in patients with or without vitamin C deficiency.

**Conclusion:** In septic shock patients being resuscitated, vitamin C supplementation improved peripheral tissue perfusion and microvascular reactivity whatever plasma levels of vitamin C.

**Compliance with ethics regulations:** Yes in clinical research.

FC-119

Noradrenaline dose change-related effects on mean arterial
pressure: preliminary results from the NoVaMAP study

MORETTO Francesca¹, SHI Rui¹, TEBOUL Jean-Louis ¹, PAVOT Arthur¹, LAI Christopher¹, FAGE Nicolas¹, PHAM Tài¹, MONNET Xavier¹

¹Université Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de recherche clinique CARMAS, Le Kremlin-Bicêtre, France
**Correspondence:** Francesca MORETTO (francescamoretto90@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-119

**Rationale:** Responsiveness to norepinephrine (NE) dose change in terms of mean arterial pressure (MAP) change is highly variable among patients with acute circulatory failure. This preliminary study aimed to investigate the factors influencing the pharmacodynamic effect of NE on MAP in critically ill patients.

**Patients and methods/Materials and methods:** This monocentric, observational, prospective study was conducted in patients with acute circulatory failure requiring NE and invasive arterial pressure monitoring. To characterize the responsiveness of MAP to NE change, the maximal amplitude of MAP change over the amplitude of change in the NE (deltaMAPmax/deltaNE) was calculated.

**Results:** From January to July 2021, 29 patients presenting 86 occurrences of change in the NE dose, including 55 dose-increases and 31 dose-decreases, were included. The most common origin of shock was sepsis in 59 (69%) cases, followed by hypovolemic/hemorrhagic shock in 16 (18%) cases and non-septic vasoplegia in 11 (13%) cases. Septic shock was characterized by significantly lower baseline values of MAP (66 [58–86] vs. 82 [71–103] mmHg) and of diastolic arterial pressure (50 [44–64] vs. 64 [55–78] mmHg) and by a larger amplitude of the change in NE dose (0.08 [0.05–0.12] vs. 0.04 [0.03–0.06] µg/kg/min). DeltaMAPmax/deltaNE was significantly lower in septic shock than in hypovolemic/hemorrhagic shock or non-septic vasoplegia (315 [161–590] vs. 575 [401–776] vs. 446 [336–1119] mmHg/µg/kg/min, respectively, p = 0.03). At multiple linear regression analysis, preexisting hypertension, body temperature at the study time and shock etiology were associated with deltaMAPmax/deltaNE (p = 0.002). In septic shock patients, body temperature and C-reactive protein levels independently influenced deltaMAPmax/deltaNE (p = 0.003).

**Conclusion:** Septic shock is characterized by lower vascular reactivity compared to other shock etiologies and MAP responsiveness to NE change is not identical to other types of distributive shocks. The results of this ongoing study will be entered in a model of artificial intelligence with the aim of adapting the dose of NE required to reach an individualized target level of MAP.

**Compliance with ethics regulations:** Yes in clinical research.

## FC-120

### Is precariousness a risk factor for COVID-19 mortality in intensive care units?

GILLIBERT Adrien¹, LAINE Laurent¹

¹Delafontaine, Paris, France

**Correspondence:** Adrien GILLIBERT (gillibertadrien@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-120

**Rationale:** During the SARS-CoV-2 pandemic, the first wave overwhelmed hospitals in Paris area (Ile-de-France) with a variable impact depending on the territory. Several studies highlighted variable ICU mortality rates during COVID-19 surges across territories (10 to 60%) with higher rates in those most affected by poverty¹,². We assessed the impact of precariousness, as an independent risk factor, on mortality linked to Covid-19 between ICUs at Delafontaine hospital, Saint-Denis, and Ambroise Paré hospital, Boulogne-Billancourt, two Paris suburbs.

**Patients and methods/Materials and methods:** We carry out a retrospective observational cohort study of consecutive ICU patients aged ≥ 18 years admitted at Delafontaine and Ambroise Paré hospitals during the first wave of the Covid-19 outbreak in order to compare mortality rates according to predefined risk factors (age, diabetes, arterial hypertension, BMI, active solid or haematological cancer, IGS2, poverty rate at the threshold of 60% (%) according to the island grouped for statistical information (IRIS)37 of the patient, invasive ventilation or not) that include precariousness.

**Results:** We found a difference for mortality in the two groups (p = 0,033) and with the univariate analysis the poverty rate was a risk factor for mortality at 90 days (p = 0,04). But we could not find a

statistical relation between deprivation and mortality at 90 days in Covid-19 in intensive care in multivariate analysis.

**Conclusion:** Despite lake of significative statistical relationship between precariousness and covid-19 mortality in intensive care, it seems we could find correlation between importance of precariousness and mortality. We should realise a prospective study with more important population to find a relationship between deprivation and mortality at Covid-19 in intensive care.

**Reference 1:** 1. Quenot, Jean-Pierre et al. "Influence of deprivation on initial severity and prognosis of patients admitted to the ICU: the prospective, multicentre, observational IVOIRE cohort study." *Annals of intensive care* vol. 10, 1 20. 11 Feb. 2020, doi:10.1186/s12879-021-06419-7

**Reference 2:** 2. Rahi, Mayda et al. "Sociodemographic characteristics and transmission risk factors in patients hospitalized for COVID-19 before and during the lockdown in France." BMC infectious diseases vol. 21, 1 812. 13 Aug. 2021, https://doi.org/10.1186/s12879-021-06419-7

**Compliance with ethics regulations:** Yes in clinical research.

<figure><img src="image_84.png" /></figure>

Forrest plot for relationship between mortality at 90 days et risk factors in multivariate analysis

## FC-121

### Management of a massive inflow of patients in a very large cluster of covid-19 cases

POINTURIER Valentin¹, POIDEVIN Antoine¹, DEGOUL Samuel¹, VIROT Edouard¹, MOOTIEN Yoganaden¹, PINTO Luis¹, MATHIEN Cyrille¹, LABRO Guylaine¹, RABOUEL Yannick¹, ETIENNE Arnaud¹, KUTEIFAN Khaldoun¹
¹Hôpital Emile Muller, Mulhouse, France

**Correspondence:** Valentin POINTURIER (valentin.pointurier@ghrmsa.fr)

*Annals of Intensive Care* 2022, **12**(1):FC-121

**Rationale:** Our general tertiary hospital had to face an unprecedented wave of respiratory distress in early 2020 that quickly overwhelmed its 40 ICU beds. The aim of this study was to report on ICU admission process and in-flow management at time of Covid-19 outbreak.

**Patients and methods/Materials and methods:** We conducted a retrospective analysis of every consecutive patient requiring the advice of the intensivist team between March 2 and May 1, 2020 from a call register filled prospectively on daily basis.

**Results:** Local ICU capacities have more than doubled (92 beds) thanks to the deprogramming of the scheduled surgical activity and the deployment of a military mobile hospital. Medical ICU physician on duty centralized all calls for Covid-19 admission. Priority was given to patient requiring immediate intubation. The others were placed on a waiting list according to their severity and expected prognosis based on their comorbidities, their frailty and their age until a ventilator was available. At the peak, 46 patients required the advice of the intensivist daily. A total of 591 patients were proposed for ICU admission. 75% had acute respiratory distress due to severe Covid-19, other were medical (14%) and surgical (11%) non covid related situations. ICU admission was decided for 370 patients. Mean age was 62 years (± 12), 69% were male. The most serious patients and those with contraindications to transfer were kept in local ICU (154 patients). 244 patients were transferred to France, Germany, Switzerland, and Luxembourg representing more than one third of all French transfers of the Covid-19 first wave. The patients managed in standard ward were older (mean
age: 69 years (± 12)) and had more significant cardiovascular diseases (12,7% vs 5%), malignant tumors (10,5% vs 3,1%) and hematological diseases (8,2% vs 4,7%).

**Conclusion:** In situation of high tension on ICU capacities, priority must be given to increasing resources and optimizing means. The establishment of triage rules respecting the ethical principles of equality, beneficence, and transparency guarantees equitable access to intensive care and maximization of the number of lives saved.

**Compliance with ethics regulations:** Yes in clinical research.

FC-122

**Evaluation of communication training in paediatric intensive care**

DUCERT Floriane¹, OHNOUNA Rachel¹, VANEL Noémie¹, GRIMALDI Céline¹, RONCIN Cesar¹, MICHEL Fabrice¹

¹Hopital Timone 2, Marseille, France

**Correspondence:** Fabrice MICHEL (fabrice.michel@ap-hm.fr)

*Annals of Intensive Care 2022, 12(1):FC-122*

**Rationale:** Communication with patients requires interpersonal skills and is a challenge for physicians, especially in paediatric critical care units. The need for good communication contrasts with the lack of training in communication skills in medical studies, and there is little experience in the literature of evaluating communication with families training in paediatric critical care. The main objective of this study was to heteroevaluate the impact of communication training for residents in a paediatric intensive care unit.

**Patients and methods/Materials and methods:** 14 residents were evaluated on their performance in communicating with families through video recordings of simulated breaking bad news to parents, before and after a 2-day training in communication with families including theoretical teaching and situational practice in relational simulation. The skills were also evaluated 3 month after the training to measure maintenance of acquisition over time. Residents were confronted to 3 standardized situations in a predetermined order, different for each of them. The "modified Breaking Bad News Assessment Scale" (mBAS) was used as the evaluation tool scored by resident an not involved in the training, and analyzing the videos in a totally random order. The duration of interviews, speaking and silence times were recorded. Self-assessment was also performed using the "Breaking Bad News" and "Cungi and Rey" scales scored after each session.

**Results:** Both self-assessment scores showed important and significant improvement of the participants after the training, and maintenance of acquisitions over time. The global mBAS score decrease (corresponding to skills improvement) non-significantly, immediately after training (55.8±8.1 vs. 49.0±8.0; p=0.071), but there was a significant improvement in two of the five score domains (A: setting the scene, C: eliciting concerns). Stress of residents after interviews decreased non significantly between the 3 measures (5,0±1,7;4.4±2,1;3,7±1; p=0,214). Duration of interviews and silence did not vary significantly.

**Conclusion:** Our study showed that training in communication with parents in the paediatric intensive care unit resulted in an improvement in the resident's autoevaluation. This effect was less pronounced during heteroevaluation, which should encourage teachers to evaluate their training by objective methods.

**Compliance with ethics regulations:** Yes in clinical research.

FC-123

**Mental health problems among Tunisian healthcare workers in the second year of Covid-19 pandemic**

ZGHIDI Marwa¹, BEN SAIDA Imen¹,², HAMDI Dhouha¹, BOUBTANE Rihab¹, BOUSSARSAR Mohamed¹,²

¹Farhat Hached University Hospital, Medical Intensive Care Unit, Sousse, TUNISIA, Sousse, Tunisie; ²Research Laboratory N° LR12SP09. Heart Failure. Farhat Hached University Hospital, Sousse, Tunisia, Sousse, Tunisie

**Correspondence:** Marwa ZGHIDI (marwa_zghidi@outlook.fr)

*Annals of Intensive Care 2022, 12(1):FC-123*

**Rationale:** The fear to contaminate and being contaminated, the quality of preparedness, the availability of personal protection equipment (EPI), diagnostic and therapeutic blur of an emergent disease and patients' severity leading to high workload have added a burden of acute emotional stress in healthcare workers. The aim was to evaluate the impact of Covid-19 pandemic on healthcare workers mental health and identify factors associated with adverse mental outcomes.

**Patients and methods/Materials and methods:** It is a cross-sectional study conducted in critical care and emergency departments of 3 hospitals (Hached; Sahloul and Military hospital of Instruction of Tunis) from January 18, 2021, to March 13, 2021. Mental health outcomes: depression, anxiety, stress, post-traumatic stress disorder and burnout were assessed by depression anxiety stress scales (DASS), Impact of event scale revised (IES-r) and Maslach Burn out Inventory (MBI), respectively. Multivariate logistic regression analysis was performed to identify factors associated with those adverse mental health outcomes.

**Results:** One hundred and ten healthcare workers filled the questionnaire with a response rate at 86.6%. Respondents characteristics' were: median age, 32 [28–37] years; female 68(61.8%); nurses 57(51.8%); 63(57.3%) worked in emergency departments. Fifty-two respondents (47.3%) had been contaminated by the SARS COV2. 88.2% of the respondents reported a feeling of fear of personal and family physical safety, 74.5% felt an increased work overload and 72.7% confirmed a poor working condition. 43 respondents (43.6%) were considering quitting their profession because of severe psychological distress. 48.2%, 42.7% and 48.98% of respondents had respectively severe stress, severe anxiety and severe burnout. 49.1% of participants had probable PTSD according to IES-r score. On the multivariate regression, female sex (OR, 9.7; CI [2.5–36.7]; p < 0.001), age (OR, 0.083; IC [0.013–0.537]; p = 0.009), work overload (OR, 5.6; IC [1.3–23.7]; p = 0.018), were factors associated with stress. Age (OR, 0.6; IC [0.5–0.87]; p = 0.000), work overload (OR, 29; IC [3–63]; p = 0.002); change of work location (OR, 11.3; IC [1.4–88.7]; p = 0.021); poor work conditions (OR,20.7; IC [12–66]; p < 0.001) were associated with anxiety. Lack of psychological support (OR, 5.8; IC [2–16]; p < 0.001) was the only risk factor associated with depression. Age (OR, 0.6; IC [0.4–0.73]; p < 0.001); fear of personal and family safety (OR,7.2; IC [1.1–15]; p < 0.001); working with suspected or confirmed patients with COVID-19 (OR, 29; IC [2–69]; p = 0.009) were factors independently associated with PTSD. Female sex (OR, 1.1; IC [1.04–1.2]; p = 0.003), poor work conditions (OR,3.5; IC [1.7–4.6]; p = 0.047) were predictors of burnout.

**Conclusion:** The current study highlights that health care workers are at high risk of psychological distress during the covid-19 outbreak. Early psychological interventions may be beneficial.

**Compliance with ethics regulations:** Yes in clinical research.

FC-124

**Prevalence of post-traumatic stress disorder in intensive care workers**

DELTOUR Victoire¹,³, LAURENT Alexandra¹,², POUJOL Anne-Laure³,⁴

¹Université de Bourgogne Franche-Comté, Psy-DREPI EA 7458, Dijon, France; ²Service de réanimation chirurgicale, CHU Dijon, Dijon, France;

³Ecole de Psychologues Praticiens, Paris, France; ⁴Service de réanimation chirurgicale polyvalente, La pitié Salpêtrière, Paris, France

**Correspondence:** Victoire DELTOUR (victoire.deltour@hotmail.fr)

*Annals of Intensive Care 2022, 12(1):FC-124*

**Rationale:** Working in intensive care unit confronts professionals with extreme and unpredictable situations that have a traumatic dimension and constitute a risk of post-traumatic stress disorder (PTSD). Since 2019 this extreme context has been accentuated by unprecedented epidemic waves. We will present a systematic review to better identify the traumatic impact of ICU on healthcare and associated factors before and during the health crisis.

**Patients and methods/Materials and methods:** We used Pubmed; Science direct and Ovid (APA) databases to identify all quantitative,
qualitative and mixed studies examining PTSD in Intensive care workers between 2009 and 2022.

**Results:** Of the 704 articles identified, only 8 met our inclusion criteria. 4 studies that were conducted before the COVID period showed that 3.3% to 18.2% of the surveyed intensive care workers had PTSD symptoms. The associated risk factors were life-threatening emergencies; exposure to death; management of organ and body donations; and situations experienced by caregivers as therapeutic overkill. Individual factors such as personality also appear to play a role in the development of traumatic symptomatology (Cho and Kang 2017). Four studies conducted during the COVID period showed a significant increase in the prevalence of trauma among intensive care workers, with between 16% and 73.3% showing traumatic symptoms. The already potentially traumatic factors of ICU were exacerbated and others specific to the crisis increased this risk (Carmassi et al. 2022; Laurent et al. 2022). Feeling safe in one's department, supported by one's team, and having sufficient material and human backup seemed to be protective factors (Heesakkers et al. 2021).

**Conclusion:** Intensive care workers seem to be particularly at risk of developing PTSD, and this has increased during the health crisis period. However, there are few studies on this subject and they deserve to be developed in order to propose prevention and adapted care devices.

**Compliance with ethics regulations:** Yes in clinical research.

## FC-125

**A qualitative study of reinforcement workers' perceptions and experiences of working in intensive care during the COVID-19 pandemic: a PsyCOVID-ICU substudy**

PERRAUD Florian¹, ECARNOT Fiona²,³, LOISEAU Mélanie⁴, LAURENT Alexandra⁵,⁶, FOURNIER Alicia⁵, LHEUREUX Florent⁷, BINQUET Christine⁸, RIGAUD Jean-Philippe⁹,¹⁰, MEUNIER-BEILLARD Nicolas¹¹,¹², QUENOT Jean-Pierre¹¹,¹³,¹⁴,¹⁵

¹University Hospital Dijon, and Université de Bourgogne Franche-Comté, Dijon, France, Dijon, France; ²Department of Cardiology, University Hospital Besançon, Besançon, France; ³EA3920, University of Burgundy-Franche-Comté, Besançon, France; ⁴Service de Médecine Légale, University Hospital Dijon; Cellule d'Urgence Médico-Psychologique de Bourgogne Franche-Comté, Dijon, France; ⁵Laboratoire de Psychologie: Dynamiques Relationnelles Et Processus Identitaires (PsyDREPI), Université de Bourgogne Franche-Comté, Dijon, France; ⁶Department of Anaesthesiology and Critical Care Medicine, University Hospital Dijon, Dijon, France; ⁷Laboratoire de Psychologie, University of Burgundy-Franche-Comté, Besançon, France; ⁸Inserm CIC1432, module Épidémiologie Clinique (CIC-EC)- CHU Dijon-Bourgogne, UFR des Sciences de Santé, Dijon, France; ⁹Service de Médecine Intensive-Réanimation, Hospital Centre de Dieppe, Dieppe, France; ¹⁰Espace de Réflexion Éthique de Normandie, Université de Caen, Caen, France; ¹¹CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France; ¹²Direction de la Recherche Clinique et de l'Innovation, University Hospital Dijon, Dijon, France; ¹³Service de Médecine Intensive-Réanimation, University Hospital Dijon, Dijon, France; ¹⁴Equipe Lipness, centre de recherche INSERM UMR1231 et LabEx LipSTIC, université de Bourgogne-Franche Comté, Dijon, France; ¹⁵Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Besançon, France.

**Correspondence:** Florian PERRAUD (flperraud@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-125

**Rationale:** During the COVID pandemic, many hospitals had to mobilize reinforcement healthcare workers (HCW), especially in intensive care units (ICUs). We investigated the perceptions and experiences of reinforcement workers deployed to ICUs, and the impact of deployment on their personal and professional lives.

**Patients and methods/Materials and methods:** For this qualitative study, a random sample of reinforcement workers was drawn from 4 centres participating in the larger PsyCOVID-ICU study. These HCW worked in the intensive care unit as support staff during either of the two waves of 2020 (March to May 2020 (wave 1) or September to November 2020 (wave 2)) in any of the four participating

centres. Individual semi-structured interviews were held by telephone, recorded, transcribed and analyzed by thematic analysis.

**Results:** Thirty interviews were performed from April to May 2021 (22 nurses, 2 anesthesiology nurses, 6 nurses' aides). Average age was $36.8 \pm 9.5$ years; 7 participants had no ICU experience. Four major themes emerged, namely: (1) difficulties with integration, especially for those with no ICU experience; (2) lack of training; (3) difficulties with management, notably a feeling of insufficient communication; (4) mental distress relating to the unusual work and fear of contaminating their entourage.

**Conclusion:** HCWs deployed as reinforcements to ICUs at the height of the pandemic had a unique experience of the crisis, and identified important gaps in organization and preparation. They also suffered from a marked lack of training, given the stakes in the management of critically ill patients in the ICU.

**Compliance with ethics regulations:** Yes in clinical research.

## FC-126

**Direct Optimization of communication using PersonAlized Multimodal feedback between investigators to increase efficiency (DO NOT SPAM study)**

MULLER Grégoire¹,², TAVERNIER Elsa³,⁴, LECLERC Marie⁵, BOULAIN Thierry¹,², EHRMANN Stephan⁶

¹Centre Hospitalier Régional d'Orléans, Orléans, France; ²CRICS-TriggerSEP F-CRIN research network, Tours, France; ³Clinical Investigation Center, INSERM 1415, CHRU Tours, Tours, France; ⁴Methods in Patients-Centered Outcomes and Health Research, INSERM UMR 1246, Nantes, France; ⁵Délégation à la Recherche Clinique et à l'Innovation, CHRU Tours, Tours, France; ⁶Médecine Intensive Réanimation, CIC 1415, CRICS-TriggerSEP F-CRIN research network and Centre d'étude des Pathologies Respiratoires, INSERM U1100, Université de Tours, Centre Hospitalier Régional Universitaire de Tours, Tours, France

**Correspondence:** Grégoire MULLER (muller.gregoire.chro@protonmail.com)

Annals of Intensive Care 2022, **12**(1):FC-126

**Rationale:** Only few clinical trials are completed in the expected timeframe, in part because of low inclusion rates. The specific context of "emergency trials" (short inclusion timeframes, very selective criterion) aside of time pressure associated with critical illness represents an extra challenge. Studies evaluating means to improve trial recruitment were performed outside of the ICU setting and aimed to increase the rate of patient consent rather than targeting investigator motivation. We hypothesize that an optimized communication strategy targeted at increasing investigator motivation may significantly improve trial recruitment.

**Patients and methods/Materials and methods:** Study centres participating in the EVERDAC trial (evaluating early vs differed arterial catheter in ICU patients with acute circulatory failure, NCT03680963), [1] were randomized between two communication strategies: conventional communication or upgraded communication strategy (intervention) including personalized computer-generated emails of congratulations for inclusions according to inclusion rate. The primary outcome was the number of patients included in the EVERDAC trial 12 months after centre opening, analyzed in a quasi-Poisson regression considering the number of ICU beds available in the unit as an offset.

**Results:** 264 patients were included in the EVERDAC study in the nine participating centres, 119 from intervention centres (median 28.5 [18.0;46.9]), 145 from conventional centres (median 23.0 [7.0;25.0] (RR 0.53 [0.11;2.34], p = 0.42, Fig. 1). Respectively 115 and 145 emails were addressed to the investigator with respectively 13.0 [13.0; 14.0] and 8.0 [8.0;10.0] recipients in carbon copy (coinvestigators and study team).

**Discussion:** Our study failed to demonstrate that an optimized communication strategy could improve inclusion rate. First our study may be underpowered. Secondly, one large centre with no inclusion randomized to intervention and smaller centre which made by far most of the trial inclusions randomized to the control group, may represent outliers significantly impacting overall results. One could argue these
centres would have included the same inclusion rate whatever the communication strategy applied (ie, our communication strategy may improve inclusions in centres with middle rate of inclusion). However, results were not modified when excluding those outlier centres from analysis (RR 0.6 [0.23;2.34]). Thirdly, the number of emails sent could have a negative effect on inclusions.

**Conclusion:** This study failed to demonstrate a benefit of an email based optimized communication strategy between the study coordinator and site investigators and staff on trial inclusion rate in the ICU.

**Reference 1:** Muller G, BMJ Open. 2021;11:e044719.

**Compliance with ethics regulations:** N/A.

<figure><img src="image_85.png" /><figcaption>12 months inclusion according to the number of beds available in the ICU</figcaption></figure>

### FC-127

#### Epidemiology of people living with HIV admitted to an ICU of the Caribbean region between 2015 and 2019

TEISSEDRE Célia¹, CARLES Michel¹, LAMAURY Isabelle¹, TRESSIERES Benoit¹, MELOT Bénédicte¹

¹CHU de la Guadeloupe, Les Abymes, Guadeloupe

**Correspondence:** Célia TEISSEDRE (melotb@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-127

**Rationale:** People leaving with HIV (PLWHIV) from the Caribbean, due to the geographical and historical situation of this region, have very specific epidemiological characteristics, including a higher prevalence compared to other regions. The primary objective of this work was to describe the characteristics of PLWHIV treated in the ICU of our hospital to improve their care. The secondary objectives were to study factors associated to prognosis and assess the impact of HIV on ICU morbidity and mortality.

**Patients and methods/Materials and methods:** We included all patients treated in the ICU of our hospital between January 2015 and December 2019 with the main or associated diagnosis "HIV" during their hospitalization. We first carried out a descriptive analysis using paper and computer files. We then performed a bivariate and multivariate analysis to study the variables associated with mortality in PLWHIV and then to compare the prognosis in intensive care, at 1 month and at 1 year in PLWHIV versus non-HIV, adjusted for the other variables.

**Results:** A total 114 PLWHIV and 228 patients without HIV were analyzed, i.e. an average of 23 PLWHIV per year, including 9 patients diagnosed at the time of their admission to the ICU, and 2 with a "fortuitous" diagnosis. The median age was 54 years old, the sex ratio 2, the median CD4 count was 218/mm³ and the median viral load 185 copies, 1/4 had co-infection with hepatitis B, 81% had at least 1 opportunistic infection, 1/3 had a renal replacement therapy (RRT), half a

vasopressor therapy, 3/4 mechanical ventilation. The mortality in the ICU was 31% (Table). PLWHIV were significantly more ventilated, on vasopressor therapy, and on RRT than non-HIV patients, and variables associated to higher ICU mortality in PLWHIV were intubation, RRT, vasopressor therapy, and single hospitalizations. However, mortality in ICU, at 1 month and 1 year, although slightly higher in PLWHIV didn't vary significantly.

**Conclusion:** PLWHIV hospitalized in the ICU of our hospital are frequent, more severe and require heavier care, compared to non-HIV patients. Factors related to the poor prognosis, like diagnosis delay due to HIV lack of knowledge, should be assessed. Due to the large number of PLWHIV admitted to the ICU (2 per month) in this area, specific approaches should be implemented: adaptation of human resources, infectious disease referent, specific and regular training of ICU physicians and paramedics to increase their skills regarding HIV specific aspects, in order to improve PLWHIV ICU prognosis.

**Compliance with ethics regulations:** Yes in clinical research.

<table><thead><tr><th>Variable/Year</th><th>2015</th><th>2016</th><th>2017</th><th>2018</th><th>2019</th></tr></thead><tbody><tr><td>N</td><td>20</td><td>21</td><td>23</td><td>30</td><td>20</td></tr><tr><td>Mean age, years</td><td>53</td><td>54</td><td>56</td><td>53.8</td><td>53.1</td></tr><tr><td>Length of stay at the hospital</td><td>6</td><td>6</td><td>8</td><td>9</td><td>10</td></tr><tr><td>Hospitalization in relationship with HIV, %</td><td>55.00</td><td>52.40</td><td>69.60</td><td>60.00</td><td>45.00</td></tr><tr><td>Hospitalization for infectious disease %</td><td>50.00</td><td>71.40</td><td>69.60</td><td>70.00</td><td>50.00</td></tr><tr><td>CD4 count/mm³</td><td>222</td><td>321</td><td>267</td><td>297</td><td>301</td></tr><tr><td>CD4 count -200 / mm³, %</td><td>60.00</td><td>47.00</td><td>47.80</td><td>40.00</td><td>45.00</td></tr><tr><td>Undetectable viral load %</td><td>25.00</td><td>28.50</td><td>55.00</td><td>40.00</td><td>55.00</td></tr><tr><td>Viral load copies/mL</td><td>153 827</td><td>66 963</td><td>28 791</td><td>154 847</td><td>103 384</td></tr><tr><td>Death in the ICU</td><td>35.00</td><td>52.00</td><td>30.40</td><td>30.00</td><td>10.00</td></tr></tbody></table>

N = number of PLWHIV admitted to the ICU

<caption>Table: Evolution of the characteristics of PLWHIV admitted to the ICU of a Caribbean hospital from 2015 to 2019, n = 114.</caption>

### FC-128

#### Effect of antibiotics on catheter associated urinary tract infections in the ICU: a non-inferiority retrospective trial

PONCELET Arthur¹, MICHEL Charlotte¹, HITES Maya¹, PLETSCHETTE Zoé¹, MARTINY Delphine¹, CRÉTEUR Jacques¹, JACOBS Frédérique¹, GRIMALDI David¹

¹CUB Erasme - ULB, Bruxelles, Belgique

**Correspondence:** Arthur PONCELET (arthur.poncelet@ulb.be)

Annals of Intensive Care 2022, **12**(1):FC-128

**Rationale:** Catheter associated urinary tract infections (CAUTI) are the most frequent nosocomial infections, although rarely severe. In this setting the benefit/risk ratio of antibiotic therapy is unclear since overconsumption leads to antimicrobial resistance. Catheter associated asymptomatic bacteriuria should not be treated but distinction between asymptomatic bacteriuria and urinary infection is not easily made in ICU patients. We therefore hypothesized that the abstention of treatment of positive urine cultures associated with systemic signs of inflammation is not related with an increased sepsis occurrence in the following 7 days.

**Patients and methods/Materials and methods:** Comparative retrospective monocentric study with a non-inferiority design. Patients hospitalized between 2012 and 2018 for at least 48 h in the ICU, with a bladder catheter and a positive urinary culture presenting fever (> 38 °C) or a CRP level above 100 mg/l were included. Exclusion criteria were pregnancy, kidney transplant recipients, planned urological surgery, neutropenia, bacteriemic urinary tract infection the day of inclusion, other source of infection requiring antibiotics for which the urinary bacteria was susceptible or septic shock. Based on a previous study we expected a sepsis occurrence of 10%. To provide a power of 80% with a non-inferiority margin of 10% we planned to include 112 patients in each group.

**Results:** Among 222 included patients, 100 (45%) received antimicrobial therapy and 122 (55%) did not. Groups were comparable in terms of age, sex, SAPS II score and co-morbidities. SOFA score the day of inclusion was higher in the groups who received antibiotics (median