4 versus 3 p = 0,004). Escherichia Coli (50,4%), was the most frequent bacteria identified. Amoxicillin-clavulanic acid (42%), piperacillin/tazobactam (19%) and ciprofloxacin (16%) were the most prescribed antibiotics with a median duration of 5 days. Sepsis occurrence 7 days after the positive urinary culture were similar between the two groups (treated: 7% no treatment: 1,6% p = 0,089). Moreover, we found no difference between groups in terms of mortality (6% versus 1,6% p = 0,08) or bacteremia (2% versus 2,4%p = 0,671).

**Conclusion:** Absence of antibiotic treatment for urinary catheter associated positive culture and inflammatory syndrome in ICU patients was not associated with an increase in sepsis occurrence the next 7 days following the urinary culture. Further studies are needed to better define the indication of antibiotic treatment for CAUTI in ICU setting.

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

FC-129

**Coagulase-negative staphylococcus in intensive care unit.**

BENHAMZA Sabah¹,², LAZRAQ Mohamed¹,², ATAK Badreddine¹,², MILOUDI Youssef¹,², BENSAID Abdelhak¹,², EL HARRAR Najib¹,²

¹Hôpital 20 Août 1953, CHUIR, Casablanca, Maroc; ²Université Hassan II, faculté de médecine et de pharmacie, Casablanca, Maroc

**Correspondence:** Sabah BENHAMZA (benhamzasabah5@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-129

**Rationale:** Staphylococci are one of the most incriminated pathogens in human infections (1), in recent years there has been the emergence of resistant strains, especially coagulase negative (CNS). Our objective was to evaluate the incidence of CNS in a general intensive care unit and to study their sensitivity to antibiotics.

**Patients and methods/Materials and methods:** retrospective study over 4 years conducted in the intensive care unit of the August 20 hospital. The patients included have at least one bacteriological sample positive for Staphylococcus. Demographic, epidemiological, bacteriological, therapeutic and evolutionary data were analyzed and then compared in an CNS group.

**Results:** 74 patients were included (mean age 44±19.18 years, 54 men and 20 women). The incidence of CNS was 5.50%: 66% in the blood culture (n=58) and 34% in the catheter. 78.37% of patients were admitted to the intensive care unit from the emergency reception service. The average length of hospitalization was 18.52 days ± 14.22 days. The methicillin resistance rate was 43%. On the other hand, vancomycin and teicoplanin were effective. 23 patients were treated with anti-staphylococcal antibiotic therapy, 51 did not receive it, there was no statistically significant difference between these two groups of patients in terms of mortality (p = 0.45). The most common cause of death was septic shock with no significant difference between the two treated and untreated groups.

**Conclusion:** the incidence of CNS remains low but their mortality is worrying. 43% of CNS are resistant to methicillin. Glycopeptides have always been considered effective in the treatment of staphylococcal infections. Except that in recent years we have seen the appearance of cases of resistance of CNS to these glycopeptides.

**Reference 1:** 1- BILAL AHMAD MIR1, Dr. SRIKANTH. Prevalence and antimicrobial susceptibility of methicillin resistant staphylococcus aureus and coagulase-negative staphylococci in a tertiary care hospital. Asian J Pharm Clin Res, Vol 6, Suppl 3, 2013, 231-234.

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

FC-130

**Exploring blood stream infection incidence in ICU patients treated by therapeutic plasma exchange-A retrospective multicenter study**

FODIL Sofiane², MAYAUX Julien³, HARIRI Geoffroy³, LAVILLEGRAND Jean-Rémi², GUIDET Bertrand², MAURY Eric², AZOULAY Elie¹, DEMOULE Alexandre³, MARIOTTE Eric¹, AIT-OUFELLA Hafid²

¹Hôpital Saint-Louis, Paris, France; ²Hôpital Saint-Antoine, Paris, France;

³Hôpital de la Pitié-Salpétrière, Paris, France

**Correspondence:** Sofiane FODIL (fodilsofiane@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-130

**Rationale:** Therapeutic plasma exchange (TPE) is a technique which separates out plasma from other components of blood. The plasma is removed and replaced with a surrogate solution (1). TPE has immunosuppressive impact which may increase the risk for infectious complications (2). However, the incidence of infections following TPE in ICU patients remains poorly investigated.

**Patients and methods/Materials and methods:** We conducted a retrospective cohort study including patients treated by plasma exchange in the medical ICU of three tertiary teaching hospital in Paris, France (Saint-Antoine, Saint-Louis et Pitié-Salpétrière), between January 1st 2010 and December 31th 2019. Clinical, biological and microbiological parameters were collected with a focus on bloodstream infection (BSI).

**Results:** Overall, 264 patients were included with 5 (3-7) plasma exchange procedures. Median SOFA at admission was 5 (2-6) and ICU mortality was low (8%). The median age was 48 (34-63) years old, mainly women (59%) with a BMI at 25 (22-29). The main indications for TPE were thrombotic microangiopathy (59%), followed by CNS inflammatory diseases (14%) and hyperviscosity syndrome (7%). The majority of patients were treated by at least one immunosuppressive drug (89%). Overall, 32 patients had positive blood cultures, 9 were considered contaminated, leaving 23 BSI for analysis (9%). BSI occurred after 4 (1-8) TPE procedures, double-lumen catheter being identified as the main origin for bloodstream infection (35%). Main identified germs were *K. Pneumonia* (26%), %), *Staph. aureus* (16%), *Ps. aeruginosa* (8%), *M. morganii* (8%), *E. coli* (8%). Comparing patients with and without BSI, we found higher BMI (25 (22-28) vs 28 (23-33), P = 0.04), and more frequent catheter-related thrombosis in the infection group (5% vs 17%, P = 0.06). No significant different was observed between groups regarding comorbidities, number of immunosuppressive drugs and central catheter position (femoral or jugular).

**Conclusion:** In ICU patients treated with TPE, BSI is not frequent and can be observed within the first week of treatment.

**Reference 1:** Pham HP, Staley EM, Schwartz J. Therapeutic plasma exchange—A brief review of indications, urgency, schedule, and technical aspects. Transfus Apher Sci. 2019 Jun;58(3):237-46.

**Reference 2:** Reeves HM, Winters JL. The mechanisms of action of plasma exchange. British Journal of Haematology. 2014;164(3):342-51.

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

FC-131

**Endotracheal bacterial kinetic changes from intubation to onset of pneumonia during mechanical ventilation: the core of VAP pathophysiology?**

MEYER Sylvain¹, DANÇE Estelle¹, GUICHARD Elie², HERNANDEZ PADILLA Ana Catalina¹, FEDOU Anne-Laure¹, VIGNON Philippe¹, BARRAUD Olivier¹, FRANÇOIS Bruno¹

¹CHU Dupuytren, Limoges, France; ²CHRU de Tours, Tours, France

**Correspondence:** Sylvain MEYER (sylvain.meyer@unilim.fr)

*Annals of Intensive Care* 2022, **12**(1):FC-131

**Rationale:** The presence of a tracheal tube for invasive mechanical ventilation (MV) may facilitate bacterial colonization of the lower respiratory tract (LRT) but also will change patients' respiratory microbiota, ultimately leading to the development of Ventilator-Associated Pneumonia (VAP) directly or through a Ventilator-Associated Tracheobronchitis step in some patients. Nevertheless, even if this concept is widely accepted, little is known regarding the exact bacterial kinetic changes in LRT secretions during MV. Although the first days of intubation seem critical for microbiological evolution, current knowledge of such colonization process is limited, and descriptions are not conclusive due to important clinical heterogeneity among patient populations. The objective of the study was to exhaustively follow bacterial kinetic changes in all endotracheal secretions during the first seven days of MV starting right after intubation in a highly homogeneous and clean population.

**Patients and methods/Materials and methods:** We conducted a prospective study in adult patients requiring MV for at least 7 days. In order to have a very "clean" population, patients had to be free from
acute or chronic pulmonary disease, from any acute infectious disease and from antibiotic treatment for at least 2 weeks before inclusion. Patients were included from intubation and all endotracheal secretions collected as part of routine care by bedside nurses were collected around the clock until D7. MV patients were classified in VAP or no VAP group by an independent blinded adjudication committee, according to clinical, microbiological and radiological criteria. Quantitative microbiological culture was performed from each single endotracheal aspirate (ETA) following ESCMID recommendations. Common putative pathogens were identified with the Vitek MS (BioMérieux) and quantified.

**Results:** Forty-eight patients were included, 28 (58%) were men with a mean age of 58 (±15) years. Apache II score of 14.3 (±5.3), and Charlson Comorbidity Index of 2.8 (±1.9). Ten patients (21%) developed VAP. A total of 1556 ETA samples were collected (34 ETA on average per patient). *Staphylococcus aureus* and *Haemophilus influenzae* were the two most frequent pathogens identified in VAP and no VAP patients, 6 vs 20 patients and 8 vs 18 patients respectively. Mean number of common putative pathogens per patient was 2.6 (±1.3) and 3.6 (±1.7) in VAP and no VAP group respectively. Microbial colonization showed no similar patterns or differences in terms of CFU evolution between both groups (Figure).

**Conclusion:** Bacterial quantification from ETA samples during intubation of patients with no confounding factors showed a high intra and intervariability that is not correlated to VAP onset.

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

<figure><img src="image_86.png" /><figcaption>Comparative kinetics of main putative pathogens in VAP (red) and no VAP (blue) groups expressed in mean ± standard error of mean</figcaption></figure>

## FC-132

### Lung mycobiota? diversity is linked to survival in critically ill patients with hypercapnic acute exacerbation of chronic obstructive pulmonary disease

SIONIAC Pierre¹, ENAUD Raphaël¹, IMBERT Sébastien¹, JANVIER Pierre-Laurent¹, BUI Hoang-Nam¹, PILLET Odile¹, ORIEUX Arthur¹, CAMINO Adrian², BOYER Alexandre¹, DUPIN Isabelle², BERGER Patrick², GRUSON Didier¹, DELHAES Laurence¹, PRÉVEL Renaud¹

¹CHU Bordeaux, Bordeaux, France; ²Université Bordeaux, Bordeaux, France

**Correspondence:** Renaud PREVEL (renaud.prevel@hotmail.fr)

Annals of Intensive Care 2022, **12**(1):FC-132

**Rationale:** Chronic obstructive pulmonary disease (COPD) is a frequent disease affecting more than 200 million persons worldwide. The chronic course of COPD is frequently worsened by acute exacerbations (AECOPD). Mortality in patients hospitalized for hypercapnic AECOPD

(the most severe) remains dramatically high and the mechanisms underlying those exacerbations are poorly understood. Lung microbiota has been demonstrated to be associated with COPD course and outcomes in non-hypercapnic AECOPD but no study specifically investigated hypercapnic AECOPD patients. The aim of this study is thus to compare lung microbiota composition between hypercapnic AECOPD survivors and non-survivors.

**Patients and methods/Materials and methods:** Induced sputum or endotracheal aspirate was collected at admission of every consecutive hypercapnic AECOPD from October 2018 to March 2019. After DNA extraction, V3-V4 and ITS2 regions were amplified by PCR. Deep-sequencing was performed on MiSeq sequencer (Illumina®); data were analysed using DADA2 pipeline.

**Results:** Among 47 patients admitted for hypercapnic AECOPD, 25 (53%) with samples of sufficient quality were included, 21/25 (84%) of ICU survivors and 4/25 (16%) of ICU non-survivors. AECOPD non-survivors had lower lung mycobiota (p: 0.03, p: 0.05, p: 0.05), but not bacteriobiota (p: 0.71, p: 0.543, p: 0.70), α-diversity than survivors. Both lung bacteriobiota and mycobiota were not dissimilar between survivors and non-survivors (respectively, p: 0.91 and p: 0.88). Similar results were demonstrated comparing patients receiving invasive mechanical ventilation (n: 13 (52%)) with those receiving non-invasive ventilation (n: 12 (48%). Previous systemic antimicrobial therapy and inhaled corticosteroids, but not systemic one, can alter the lung microbiota composition in hypercapnic AECOPD patients.

**Conclusion:** Non-survivors and patients requiring invasive mechanical ventilation have lower lung mycobiota, but not bacteriobiota, α-diversity than survivors and patients only receiving non-invasive ventilation respectively. This study encourages for large multicentre cohort study investigating the role of lung microbiota in hypercapnic AECOPD and urges to investigate the role of fungal kingdom of lung microbiota in hypercapnic AECOPD pathophysiology.

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

## FC-133

### Citrulline enteral administration markedly reduces immunosuppressive plasma cell expansion in a preclinical model of sepsis

GAUTHIER Juliette², GREGOIRE Murielle²,³, REIZINE Florian¹,²,³, LESOUHAITIER Mathieu¹,²,³, DESVOIS Yoni², TARTE Karin²,³, TADIE Jean-Marc¹,²,³, DELALOY Céline²

¹Service des Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, Rennes, France; ²UMR 1236, University of Rennes 1, INSERM, Établissement Français du Sang, LabexIGO, Rennes, France; ³Laboratoire Suivi Immunologique des Thérapeutiques Inno-vantes, Centre Hospitalier Universitaire de Rennes, Rennes, France

**Correspondence:** Jean-Marc TADIE (jeanmar.tadie@chu-rennes.fr)

Annals of Intensive Care 2022, **12**(1):FC-133

**Rationale:** The mechanisms responsible for the sustained immunosuppression induced in sepsis that account for increased susceptibility to infection remain not entirely understood. Plasmablast and plasma cell subsets whose primary function is to secrete antibodies, have emerged as important suppressive populations expanded in infection and sepsis. The natural LAG₃⁺ regulatory plasma cells can suppress immunity through IL-10 production and sepsis supports CD39⁺¹ plasmablast metabolic reprogramming towards aerobic glycolysis responsible for their adenosine-mediated suppressive activity.

Arginine deficiency described in sepsis has been linked to increased risk of recurrent infections. Overcoming arginine shortage by means of citrulline enteral administration was shown to efficiently improve sepsis-induced immunosuppression in the caecal ligation and puncture (CLP) model and secondary infection. Therefore, we tested here the hypothesis that citrulline administration may decrease plasmablast and plasma cell suppressive functions in sepsis.

**Patients and Methods/Materials and methods:** Splenic suppressive plasma cells have been characterized in a mouse model of sepsis. Animals underwent cecal ligation and puncture (CLP), received antibiotic therapy and fluid resuscitation. From day 0 to day 5, mice were orally fed by citrulline (150 mg/kg/day), arginine (150 mg/kg/day) or an
isonitrogenous placebo. Five days after surgery, immune dysfunctions following sepsis were studied.

**Results:** Citrulline administration markedly reduced the immunosuppressive LAG<sub>3</sub> + plasma cells and the CD39<sup>hi</sup> plasmablast population expanded in CLP, a mechanism that could contribute significantly to the beneficial effect of citrulline.

**Conclusion:** Our study reveals sepsis induced-immunosuppressive plasma cells as highly responsive to nutrition and further supports the development of citrulline-based clinical studies to balance the immune system in sepsis.

**Reference 1:** Beneficial effects of citrulline enteral administration on sepsis-induced T cell mitochondrial dysfunction. Proc Natl Acad Sci U S A. 2022 Feb 22;119(8).

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

FC-134

**Incidence and bacteriological profile of healthcare-associated infections (HAIs) in patients hospitalized for ARDS due to COVID-19**

HAMMOUDA Zeineb¹, BEN AHMED Hédia¹, SAADAoui Oussama¹, JERBI Salma¹, MAATOUK Iyed¹, 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-134

**Rationale:** Healthcare-associated infections (HAIs) are associated with an increase in morbidity and mortality in patients hospitalized in intensive care. The objective of this study is to determine the incidence of HAIs and to describe their bacteriological profile in the particular context of the COVID-19 pandemic.

**Patients and methods/Materials and methods:** This is a retrospective study carried out between September 1, 2020 and September 30, 2021 in the intensive care unit of CHU FATTOUMA BOURGUIBA in MONASTIR, collecting the observations of patients admitted for ARDS due to COVID-19 whose stay was complicated by healthcare-associated infection. We analyzed the demographic, clinical and evolutionary characteristics as well as the results of the microbiological samples taken from these patients.

**Results:** 440 patients were admitted to the ICU, 79 patients developed a HAI (18%). They were 45 men with an average age of 65 years. BMR screening was done in 53 patients and was positive in 17.7% of cases. The most frequent site of infection was the pulmonary site (52%) followed by hemato-vascular (9%) and urinary (2%) infection. The responsible micro-organisms are dominated by acinetobacter (24%) followed by pseudomonas aeruginosa (3.8%) and KP ESBL (3%). Of note, 17% of IAS were polymicrobial infections and in 30% of cases the micro-organism was not identified. The median length of stay was 15 days with a median prolongation of 5 days for the occurrence of an HAI. Curative antibiotic therapy was empirical in 62% of cases based on the combination tigecycline/colimycin (63%). The most common complication was septic shock which occurred in 81% associated with multi-visceral failure in 71% of cases. The mortality rate was at 84.8%.

**Conclusion:** In this study, the incidence of IAS was significant with a substantial impact on the outcome of patients with high mortality in case of infection.

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

FC-135

**Healthcare-related infections in critical patients with COVID-19: epidemiology, risk factors and outcomes**

TRIFI Ahlem¹, MASSEOUD Lynda¹, MEFTEH Amal¹, SELLAOuti Selim¹,

ABDENNEBI Cyrine¹, ABDELLATIF Sami¹, BEN LAKHAL Salah¹

¹Medical ICU, la Rabta hospital, Faculty of Medicine of Tunis, Tunis, Tunisie

**Correspondence:** Ahlem TRIFI (trifiahlem2@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-135

**Rationale:** The speed expansion of ICU beds and the redistribution of resources during the COVID-19 pandemic have made it difficult to comply with healthcare-related infection (HCRI) prevention measures. In Tunisia, one of the countries hardest affected by this pandemic, little or no data is available on the characteristics of HCRI in the COVID-19 era. Objectives: To study the epidemiology of HCRI in patients severely affected with COVID-19, to identify risk factors and to determine their prognostic impact.

**Patients and Methods/Materials and methods:** retrospective, observational and analytical study in critical patients with COVID-19. Microbiological samples were taken if HCRI was suspected. Factors influencing the occurrence of HCRI were: demographic criteria, co-morbidities, exposure to antibiotics and steroids, invasive procedures, clinical and paraclinical characteristics. Outcome parameters were sepsis/septic shock and mortality.

**Results:** 157 patients were included, of which 60 (38.2%) presented at least one HCRI of mean age at 60+12 years, sex ratio = 1.3 and of SOFA at 4+1.7. Hypertension (n=30) and diabetes (n=23) were the predominant defects. 117 HCRIs were recorded corresponding to an incidence density (ID) of 69.2 IN / 1000 HD and divided into VAP (n=38), bacteremia (n=32), urinary tract infection (UTI, n=24), catheter-related infection (CRI, n=12) and fungal infection (n=11). Compared to 2017, there was an increase of HCRIs, and the time to onset was earlier (attached figure). Acinetobacter baumanii (39.5%) and Klebsiella pneumoniae were the most isolated (27%) of which 89% had a profile sensitive only to colistin and 64.5% produced broad spectrum beta-lactamase respectively. Factors independently associated to HCRI were hyperglycemia (OR=12.8 [3.1-51]), elevated CRP (>115 mg/l, OR=1.009 [1.001-1.017]), steroid use duration >10 d (OR=1.25 [1.08-1.44]), arterial catheter (OR=6.57 [1.35-31]) and bladder catheterization (OR=43 [4-466]). Patients developing HCRI presented more septic origin (91% vs 72%, p < 0-3). HCRI was an independent factor of mortality which multiplied it by 8 (OR=8.49, p = 0.004). Other factors were also independently linked to mortality: mechanical ventilation (OR=23.5, p = 10-3) and stage 3 ARDS (OR=7.22, p = 0.007).

**Conclusion:** During the COVID period, the rate of HCRIs increased mainly VAP and UTI. Multi-resistant Acinetobacter baumanii and Klebsiella pneumoniae remained the most isolated pathogens. In addition to the common risk factors often reported even outside of COVID, hyperglycemia, elevated CRP, and prolonged corticosteroid duration were the original factors found associated with HCRIs in our cohort. When the HCRI grafted onto the evolutionary process of those critically ill with COVID, it amplified the risk of death by eight.

**Reference 1:** Trifi A, Abdellatif S, Oueslati M, Zribi M, Daly F, Nasri R, Mannai R, Fandri C, Ben Lakhal S. Nosocomial infections: current situation in a resuscitation-unit. Tunis Med. 2017 Mar;95(3):179-184. PMID: 29446811.

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

<figure><img src="image_87.png" /><figcaption>Figure. Difference in incidence densities of HCRI before COVID versus COVID era.</figcaption></figure>
FC-136

**Prevalence and outcome of bacteremia among Covid 19 critically ill patients**

ALILA Ilef¹, KHARRAT Sana¹, HADDED Amina¹, CHTARA Kamilia¹, BAHLOUL Mabrouk¹, BOUAZIZ Mounir¹

¹hospital Habib Bourguiba Sfax, Sfax, Tunisie

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

Annals of Intensive Care 2022, **12**(1):FC-136

**Rationale:** The COVID-19 epidemic has been a health threat worldwide causing multi-organ damage. This viral infection (COVID-19) is not the only cause of deaths in this pandemic. A usual complication of viral infections is a secondary bacterial infection or a superinfection (1). The aim of this study was to assess prevalence, characteristics and outcome of bacteremia in critically ill COVID-19 patients.

**Patients and methods/Materials and methods:** We conducted a retrospective study in an 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 and a gender ratio of 1.6. The median SAP-SII 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 (36.2%). Bacteremia was diagnosed in 42 (7.2%) patients after a mean hospital stay of 7.4 ± 4.5 day. The most frequently found germs were: Klebsiella pneumoniae in 10 (23.8%) patients, Enterococcus faecalis in 7 (16.7%) patients and Acinetobacter baumanii in 6 (14.3%). Those with bacteremia had significantly higher rates of septic shock (71.4% vs 41.2%; p < 0.001. Bacteremia was associated with longer length of stay. In addition, the use of invasive mechanical ventilation and mortality were significantly higher in bacteremia group (Table I).

**Conclusion:** Bacteremia is a severe complication in patients suffering SARS-COV2 infection and requiring ICU admission. The development of Bacteremia is associated with poor outcome.

**Reference 1:** (1)Nag V.L. · Kaur N: Superinfections in COVID-19 Patients: Role of Antimicrobials.

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

<table><caption>Table I: Outcome comparison according to bacteremia</caption><thead><tr><th>Parameters</th><th>With bacteremia (n=42)</th><th>No bacteremia (n=544)</th><th>P</th></tr></thead><tbody><tr><td>Invasive mechanical ventilation, n (%)</td><td>40 (95)</td><td>224 (41.2)</td><td>&lt;0.001</td></tr><tr><td>Septic shock, n (%)</td><td>30 (71.4)</td><td>144 (26.5)</td><td>&lt;0.001</td></tr><tr><td>Mortality, n (%)</td><td>40 (95)</td><td>247 (45.4)</td><td>&lt;0.001</td></tr><tr><td>Length of stay, mean (day)</td><td>13.7±6.4</td><td>7.1±5.5</td><td>&lt;0.001</td></tr></tbody></table>

FC-137

**Impact of closed tracheal suction systems on bacterial respiratory samples in patients with SARS-CoV2 infection: a monocentric study**

MURGAT Pierre-Henri¹, CARRICAJO Anne¹, THIERY Guillaume¹, PERINEL-RAGEY Sophie¹

¹CHU de Saint Etienne, Saint-Priest-En-Jarez, France

**Correspondence:** Pierre-Henri MURGAT (murgat.ph@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-137

**Rationale:** During the COVID-19 pandemic, use of closed tracheal suction systems (CTSS) has become widespread in intensive care units (ICU) to reduce health care workers and environmental contaminations. These systems are frequently mobilized to aspirate the tracheobronchial secretions. Furthermore, they may be used to perform bacteriological samples by tracheal aspirations in case for example of suspected pneumonia. CTSS are set up for 3 days according to manufacturer and due to pandemic shortage conditions sometimes longer in several ICU. The aim of this study is to assess the influence of CTSS use on respiratory bacteriological samples.

**Patients and methods/Materials and methods:** This prospective observational monocentric study realized in an ICU of University Hospital enrolled patients between April 2021 and February 2022 after

ethical committee approval. Inclusion criteria were: active SARS-Cov-2 infection, CTSS use under invasive mechanical ventilation and need to change this system according to local practice recommendations. At time of CTSS replacement, we performed a microbiological analysis of the tracheal secretions before the removal. A second sample of tracheal secretions was taken through the new CTSS at first need of aspiration for the patient. Finally, a microbiological analysis was also carried out on the distal part of the CTSS removed.

**Results:** 15 patients were enrolled, 3 were excluded for missing data. The mean duration of CTSS use was 6,3 days (± 4.8). Of the 12 samples carried out on previous CTSS, 6 were sterile (50%). For these 6 patients, bacterial samples made through new CTSS were also sterile. CTSS culture was also sterile with the exception of two patients. The other 6 tracheal secretions made on previous CTSS have found bacteria classically implicated in ventilation acquired pneumonia (VAP) (1). There was no qualitative bacteriological difference between these 6 samples and the tracheal secretions made on the new CTSS. Cultures of the CTSS distal part found the same bacteria with one exception.

**Discussion:** We found a good agreement between bacteriological samples performed on previous CTSS and samples made through new CTSS. Consequently, no contamination of the device in place for several days was observed. This result is of importance as higher risk of VAP and of multi drug resistant bacteria was observed for SARS-CoV-2 ICU patients (1). Yet, these data do not inform on impact of CTSS for respiratory tract bacterial colonization and further studies are mandatory.

**Conclusion:** The study suggests that the realization of tracheal secretions through CTSS does not lead to bacterial contamination of the respiratory samples.

**Reference 1:** (1) "Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease", K Razazi and al; Crit Care. 2020 Dec 18;24(1):699. https://doi.org/10.1186/s13054

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

FC-138

**Healthcare-associated infections in critical COVID-19 forms**

GUISSOUMA Jihene¹,², BEN ALI Hana², TRABELSI Insaf¹,², ALLOUCHE Hend¹,², BRAHMI Habib¹,², SAMET Mohamed², GHADHOUNE Hatem¹,²

¹Faculté de médecine de Tunis, Bizerte, Tunisie; ²Université Tunis El Manar, Tunis, Tunisie

**Correspondence:** Jihene GUISSOUMA (guissouma.jihene@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-138

**Rationale:** Healthcare-associated infections (HCAI) have been well described in previous viral epidemics but reports about secondary infections associated to COVID-19 are limited. We aimed to discern the risk factors of HCAI in patients admitted to intensive care unit (ICU) for critical COVID-19 forms and their prognostic impact.

**Patients and methods/Materials and methods:** A 16-month (September 2020–December 2021) prospective descriptive study including all patients admitted to ICU for critical COVID-19 forms. The patients were divided into two groups: -Group1: patients who developed HCAI during ICU stay. -Group2: patients who didn't develop HCAI.

The statistical analysis was performed using SPSS 23.

**Results:** Overall 140 patients were included. The mean age was 58 ± 13 with male predominance. The most common comorbidities were hypertension (64%) and diabetes (62%). Four patients had auto immune disease history with immunosuppressor ongoing treatment. The mean IGS II and APACH II were 40 ± 13 and 13 ± 6 respectively. Fifty-nine bacterial HCAI were reported in 55 patients (group1 and group2 counted 55 and 85 patients respectively). Healthcare-associated pneumonia was the most common one (44 cases equal 74% of HCAI) followed by bacteremia (6 cases), urosepsis (3 cases), infection related to a central-line catheter (2 cases), infection of bedsores (2 cases) and colitis (2 cases). Only 24 among the 59 HCAI reported were documented. The most common microorganisms isolated were: Acinetobacter baumannii (8 cases), Pseudomonas aeruginosa (4 cases) and Stenotrophomonas maltophilia (2 cases). Besides, fungal infection was considered in 15 cases but only 7 were confirmed by cultures which
isolates *Candida albicans* in 4 cases and *non albicans* in 3 cases. In the remaining cases, the diagnosis was based on candida score, clinical and biological criteria without a microbiological laboratory confirmation. The mean length of ICU stay was significantly higher (p < 10⁻³) in group1 (17 days) compared to group2 (8 days).

Overall mortality was 69%. It was higher in group 1 (85%) compared to group 2 (60%) with a statically significant difference (p = 0,01). In univariate analysis, auto immune disease history (p = 0,03), prior anti-biotherapy (p = 0,05), septic shock on admission (p < 10⁻³) and invasive ventilation (p < 10⁻³) were the main risk factors for acquiring HCAI. Only septic shock was an independent risk factor in multivariate analysis (p = 0,05).

**Conclusion:** The occurrence of HCAI in critical COVID-19 forms was frequent in our study. It was associated to a poorer outcome and a longer ICU stay. Septic shock on admission was the only independent risk factor for acquiring HCAI. These results need to be confirmed by further larger studies.

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

## FC-139

### The Impact of hospital-acquired infections on critically ill COVID-19 patients' outcome

GHOZZI Mohamed Khalil¹, JAMOUSSI Amira¹, SDIRI Ines¹, AYED Samia¹, RACHDI Emna¹, JARRAYA Fatma¹, BESBES Mohamed¹, BEN KHELIL Jalila¹
¹Hôpital Abderrahmen Mami, Ariana, Tunisie

**Correspondence:** Mohamed Khalil GHOZZI (medkhalilghozzi@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-139

**Rationale:** Hospital-acquired infections (HAI) have been constantly reported in critically ill patients with COVID-19. The aim of the present study was to assess characteristics and outcome of critically ill COVID-19 patients whom ICU stay was complicated with HAI.

**Patients and methods/Materials and methods:** We conducted a retrospective single-center, case-control study including patients with COVID-19 infection admitted to the ICU between March 2020 and September 2021. We evaluated clinical features and outcome of critically ill COVID-19 patients with HAI.

**Results:** During the study period, 544 patients were collected. The mean age was 59 ± 13 years [18–95] with a gender-ratio (H/F) of 1.66. The mean SAPS II and APACHEII scores were 28 ± 10 and 10.3 ± 5, respectively. Invasive mechanical ventilation was required in 57.2% of patients. Two hundred thirty-seven (43.5%) patients developed a HAI. The most common HAI was pneumoniae (28.3%), followed by urinary tract infection (13.2%), bacteremia (11%) and central line-associated bloodstream infection (4.6%). Comparison of clinical and outcome findings between HAI and non-HAI patients is reported in Table 1.

**Conclusion:** HAls are frequent among critically ill COVID-19 patients. They substantially worsen patients' outcome and significantly extend ICU length of stay. As it has always been in ICU, HAls management and prevention represents a serious challenge to healthcare professionals globally during the COVID-19 pandemic.

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

<table><caption>Table 1: Comparison of clinical and outcome findings between HAI and non-HAI patients</caption><thead><tr><th></th><th>Patients with HAI<br>(n = 237; 43.5%)</th><th>Patients without HAI<br>(n = 307; 56.5%)</th><th>p</th></tr></thead><tbody><tr><td>Age, mean (years)</td><td>60.7</td><td>58.6</td><td>0.892</td></tr><tr><td>SAPS II, mean</td><td>29.7</td><td>26.7</td><td>0.204</td></tr><tr><td>APACHE II, mean</td><td>11.3</td><td>9.65</td><td>0.346</td></tr><tr><td>IMV, n (%)</td><td>190 (91)</td><td>121 (35.9)</td><td><strong>&lt;0.001</strong></td></tr><tr><td>Acute kidney failure, n (%)</td><td>123 (51.8)</td><td>98 (32.3)</td><td><strong>0.001</strong></td></tr><tr><td>LOS, mean</td><td>16 +/- 13</td><td>7+/- 5</td><td><strong>0.034</strong></td></tr><tr><td>Mortality, n (%)</td><td>168 (81.2)</td><td>130 (38.6)</td><td><strong>&lt;0.001</strong></td></tr></tbody></table>

Abbreviations: SAPS II: Simplified Acute Physiology Score II, APACHE II: Acute Physiology And Chronic Health Evaluation II, IMV: Invasive mechanical ventilation, ILO: length of hospitalization

<caption>Table 1: Comparison of clinical and outcome findings between HAI and non-HAI patients.</caption>

## FC-140

### Nosocomial infection profile in critically-ill covid-19 patients

SDIRI Ines¹,², RACHDI Emna¹,², GHOZZI Mohamed Khalil¹,², JAMOUSSI Amira¹,², JARRAYA Fatma¹,², BESBES Mohamed¹,², AYED Samia¹,², BEN KHELIL Jalila¹,²

¹Hôpital Abderrahman Mami, Ariana, Tunisie; ²Faculté de médecine de Tunis, Tunis, Tunisie

**Correspondence:** Emna RACHDI (e.rachdi@yahoo.fr)

Annals of Intensive Care 2022, **12**(1):FC-140

**Rationale:** Nosocomial bacterial and fungal infections (NI) have been reported in patients with COVID-19, resulting from an immunosuppressed state. However, few data are available on these infections in critically ill patients. The objective of this study was to evaluate the characteristics of ICU-acquired infections in COVID-19 patients and to establish the microbiological profile.

**Patients and methods/Materials and methods:** It was a retrospective descriptive study including adults with COVID-19 admitted in ICU of Abderahmen Memi Hospital, from March 2020 to December 2021. Demographic, clinical, microbiological and therapeutic data were collected. We evaluated the epidemiological and microbiological features of NI.

**Results:** During the study period, 544 patients were collected. The median age was 59 years [18–95] with a gender ratio of 1.66. Mean SAPS II and APACHEII scores were 27.9 ± 10 and 10.3 ± 5, respectively. The most common histories were hypertension (39%) and diabetes (36.6%) with a mean BMI of 30.79 kg/m². All patients received dexamethasone and 44% had antibiotic therapy on admission. Four hundred fifty-one patient (82.9%) required noninvasive ventilation and 311 (57.2%) needed invasive ventilation with a median delay of 3 days [0–24 d] from admission. NI complicated 237 patients (43.5%) with a total of 333 episodes (90 patient had 1 episode, 33 had 2, 20 had 3 and 23 had more than 3 episodes), 9% of them were acquired in other departments and discovered at admission. Pneumopathy acquired under mechanical ventilation was the major NI and represented 81%. Bacteria isolated in these cases were non-fermenting germs (65%) (*Pseudomonas aeruginosa* and *Acinetobacter baumanii* imipenem resistant) and Enterobacteriaceae (47%), in particular Klebsiella pneumoniae BLSE. Urinary infection (13.2% of IN) was dominated by Enterococci in 27 cases (among them 2 cases of ERV), *Escherichia coli* in 12 and *Klebsiella pneumoniae* in 4 (1 was ESBL). Bacteremia and catheter-related bloodstream infections were observed in 11% and 4.6% of cases respectively. Four percent of NI was fungal infection and the most identified germ was *Candida albicans*. NI was associated with septic shock in 74.5% of cases. Mortality rate was 54.8% due to septic shock with multiple organ failure in 33% of cases.

**Conclusion:** Bacterial and fungal nosocomial infection is a common complication seen in ICU patients, more observed and repeated in COVID-19 patients. It is often a severe form of infection, dominated by Gram-negative resistant bacteria acquired during ICU stay and associated with a poor prognosis.

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

## FC-141

### Delivery of high flow oxygen through nasal versus tracheal canula. A bench study

GUÉRIN Claude¹,², COUR Martin¹, DEGIVRY Florian¹, ARGAUD Laurent¹, LOUI Bruno²

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-141

**Rationale:** High flow oxygen therapy (HFOT) has increasingly been used in the Intensive Care Units, in particular during the SARS-Cov2 pandemic. Furthermore, the kind of devices to perform HFOT has also increased with dedicated devices and ICU ventilators equipped with this function. Finally, HFOT can be delivered through nasal or tracheal
canula. This bench study was motivated by the comparison of the work of breathing (WOB) across HFOT devices and canula.

**Patients and methods/Materials and methods:** Seven devices were tested: the original device (Optiflow), two HFOT dedicated devices (Airvo2 and HM80) and 4 ICU ventilators offering this function (G5, T60, V500 and V60). Each device was connected to a lung model (ASL 5000) set with compliance 40 ml/cmH₂O, resistance 10 cmH₂O/L/s at a simulated inspiratory effort of ~ 10 cmH₂O delivered at 30 breaths/ min. Nasal (Optiflow 3S medium size, Fisher and Paykel) and tracheal (OPT 970, Fisher and Paykel) canula were attached to a specific manikin head and connected to the HFOT device on one hand and to the lung model on the other hand. Each device was tested in each canula at a 40 L/min oxygen flow delivered at ambient temperature (heated humidifier set in the circuit but off) and FIO₂ 0.21 for 2 min. The data were recorded with ASL software and analyzed via an application developed in the Matlab environment. On each breath the WOB was measured by using the Campbell diagram, then multiplied by the respiratory rate and expressed as J/min. The effects of canula and device were tested by two-factor ANOVA. The values are expressed in median (1-3 quartiles) for the reference device (Optiflow) and in relative variation from it for each device.

**Results:** With the Optiflow reference device the WOB was 3.7 (3.7–3.8) and 3.46 (3.5–3.5) J/min with the nasal and the tracheal canula, respectively (P < 0.05). With the nasal canula the relative variations from the reference device were 4.6, 6.2, 2.4, 4.5, and 2.2% for Airvo2, G5, HM80, T60, V500 and V60, respectively (P < 0.05 vs the reference for each device). For the tracheal canula the corresponding values of the devices were 1.2, 1.5, 2.6, 0.6, 1.2 and 2.6%, respectively (P < 0.05 for each device). The relative variations were significantly different between nasal and tracheal canula as was the interaction between canula and devices.

**Conclusion:** The WOB was lower with tracheal than with nasal canula for every device. The differences between devices may not be clinically relevant.

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

FC-142

Evaluation of the new heated wire humidifier FP950 under varying ambient temperature conditions

BOUCHARD Pierre-Alexandre¹, ROUSSEAU Emilie¹, LELLOUCHE François¹

¹Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada

**Correspondence:** François LELLOUCHE (francois.lelouche@criucpq.ulaval.ca)

*Annals of Intensive Care* 2022, **12**(1):FC-142

**Rationale:** It has been previously shown that heated wire humidifiers performances were influenced by ambient air temperature. When ambient temperature is high, heater plate temperature decreases to maintain chamber temperature stable at 37 °C. Consequently, the humidification performances are significantly reduced, well below 30 mgH₂O/L of absolute humidity with risk of endo-tracheal tube occlusion. These performances are partially improved with specific settings (increased chamber temperature to 40 °C or activation of compensation algorithm) (1). The aim of the study was to evaluate the new generation heated wire humidifier FP950 that adds parameters in its algorithm (including ambient temperature) to maintain a stable humidity delivered to patients.

**Patients and methods/Materials and methods:** We measured on bench the hygrometry of inspiratory gases delivered by (i) FP950 (Fisher&Paykel Healthcare, Auckland, New Zealand) (ii) MR850 with usual settings (37 at the chamber/40 at the Ypiece) (iii) MR 850 with no temperature gradient (40/40), and (iv) MR850 with compensation algorithm activated. Hygrometry was measured with the psychrometric method (1) after at least 1 h of stability while varying the room temperature from 20 to 30 °C. In another set of experiments, we continuously measured ambient temperature in several ICU rooms (with different exposure), at our institution with (EL (EasyLog) -USB-1 temperature data logger, Lascar Electronics) during several months. One measure every 30 min is recorded by this device.

**Results:** We performed 178 hygrometric measurements at steady state for the different conditions tested. The main results are shown in the figure. With the new heated wire heated humidifier MR950, the mean humidity delivered remained stable at 35.4±1.3 mgH₂O/L of delivered absolute humidity, despite variations of the ambient temperature from 19.9 to 30.3 °C. Minimum values of absolute humidity were 31.1 mgH₂O/L with FP950, 19.8, 26.6 and 25.5 with MR850 set at 37/40, 40/40 and with activated compensation respectively. With ambient temperature above 27.5 °C, absolute humidity was 34.2 mgH₂O/L, compared to 23.1 mgH₂O/L with MR850 (37/40), P < 0.001, 31.6 mgH₂O/L with MR850 (40/40), p = 0.004, and 29.3 mgH₂O/L with MR850 and compensation algorithm activated (P < 0.001). The continuous measurement of the ambient temperature in ICU rooms showed that the temperature tested in the bench study were relevant to the clinical practice in Quebec City with temperatures varying from 20 to 29 °C.

**Conclusion:** The new heated wire heated humidifier FP950 demonstrated stable performances while varying ambient temperature from 20 to 30 °C. The humidification performances were better than did previous generation of heated humidifier when ambient temperatures were high.

**Reference 1:** Lellouche L, Taillé S, Maggiore SM, Qader S, L'Her E, Deye N, et al. Influence of ambient air and ventilator output temperature on performances of heated-wire humidifiers. Am J Respir Crit Care Med 2004;170:1073-1079.

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

<figure><img src="image_88.png" /></figure>

Absolute Humidity at different ambient temperatures delivered by heated humidifiers FP950 and MR 850 (at different settings: 37/40, 40/40 and with compensation activated). The value of 30 mgH₂O/L is indicated with red dotted line

FC-143

Monitoring of heated wire humidifier hygrometric performances with heater plate temperature

LELLOUCHE François¹, SIMARD Serge¹, BOUCHARD Pierre-Alexandre¹

¹Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada

**Correspondence:** François LELLOUCHE (francois.lelouche@criucpq.ulaval.ca)

*Annals of Intensive Care* 2022, **12**(1):FC-143

**Rationale:** Under-humidification and associated complications may occur with heated humidifiers. Endo-tracheal tube occlusions and subocclusions have been shown even with these devices. Hygrometric performances of heated wire humidifiers are reduced by high ambient and high outlet ventilator temperatures. Currently, there is no reliable monitoring tool to evaluate humidification performances of heated wire humidifiers in the daily practice. The objectives of this study were to demonstrate the relation between humidity delivered by heated wire humidifiers and different parameters that could be used to monitor humidity of gas delivered to patients.
**Patients and methods/Materials and methods:** On a bench test, we measured heater plate temperature, inlet chamber temperature and delivered humidity with MR850 system (Fisher & Paykel). Temperature displayed on the humidifier was also recorded. The measurements were performed at different ambient temperatures and 5-min ventilation levels (5, 7.5, 10, 12.5, 15 l/min) set on an ICU ventilator. Inlet chamber temperatures varied from 20 to 40 °C. In each condition, hygrometric measurements with the psychrometric method were performed at steady state. We evaluated the relationship between heater plate temperature and humidity delivered and the factors that may alter this relationship.

**Results:** We performed 279 hygrometric measurements at steady state including all conditions and concomitant heater plate, ambient and chamber temperature were recorded. We found a good correlation between heater plate temperature and absolute humidity delivered (R2 = 0.82). This relationship was hardly affected by ambient temperature, but minute ventilation had more effect (Figure). For different minute ventilations, the correlation between heater plate temperature and absolute humidity delivered were very good with coefficient of determination R2 from 0.87 to 0.98 (Figure). Heater plate temperature above 62 °C was a very good predictor of absolute humidity delivered above 30 mgH₂O/L (AUC = 0.96, sensibility 79%, specificity 94%). No correlation existed between humidity delivered and the outlet chamber temperature (displayed on the humidifier).

**Conclusion:** In this bench study, we have shown a good correlation between heater plate temperature and humidity delivered with a heated wire humidifier. This parameter could be used as a surrogate of humidity to improve the humidification monitoring.

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

<figure><img src="image_89.png" /></figure>

Relationship between absolute humidity (mgH₂O/L) delivered by the Y piece and heater plate temperature (°C) for different minute ventilation (from 5 to 15 L/min). The blue dotted lines represent the regression lines, the equations and the coefficient of d.

## FC-144

### Hygrometric performances of Heat and Moister Exchangers with low dead space

BOUCHARD Pierre-Alexandre¹, ROUSSEAU Emilie¹, BRANSON Richard², LELLOUCHE Francois¹

¹Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada; ²Department of Surgery, Division of Trauma & Critical Care, University Cincinnati, Cincinnati, Etats-Unis

**Correspondence:** Francois LELLOUCHE (francois.lelouche@criucpq.ulaval.ca)

Annals of Intensive Care 2022, **12**(1):FC-144

**Rationale:** Providing gas humidification greater than 28 mgH₂O/L is mandatory for patients with prolonged intubation, with either heat and moisture exchangers (HME) or heated humidifiers (HH). In patients requiring lung protective ventilation, HH is the first line humidification device to minimize dead space. When transporting these patients, it is important to use HMEs with low dead space and sufficient humidity

delivered. In this study, we have evaluated hygrometric performances of 7 devices (4 HMEs and 3 filters) with low deadspace.

**Patients and methods/Materials and methods:** We tested on a bench, the hygrometric performances of four HMEs: BACT HME 6310 (47 ml), Pharma system—DYNJAAHME10 (36 ml), Medline—HUMID VENT 2S (28 ml), Teleflex Medical—DAR HME small (51 ml), Medtronic and three Filters: HEPASHIELD (47 ml), Flexicare—AQUASURE (32 ml), Bomimed—DAR filter (36 ml), Medtronic. We have used psychrometric method to measure hygrometry at steady state, with expiratory humidity of 35 mgH₂O/L simulated as previously described. For each condition, 3 hygrometric measurements were performed with similar conditions for ambient air temperature 25 ± 0.5 °C, and ventilator settings (respiratory rate 20/min, tidal volume 500 ml, FiO₂ 21%, PEEP 5 cmH₂O, square flow 60 l/min). We compared data obtained on bench with data provided by manufacturers.

**Results:** We performed 3 hygrometric measures for each tested device and compared to the data provided by the manufacturers. Large differences were shown between HME (from 29.2 to 25.4 mgH₂O/L) and Filters (18.2 to 10.4 mgH₂O/L). Large differences existed between humidity measured by the psychrometric method (our bench) and the data provided by the manufacturers (available for 6 devices). The main results are presented on the figure.

**Conclusion:** Several HMEs with small dead space provide sufficient gas humidity and may be used during transport for patients with lung protective ventilation. However, important differences were found in terms of humidification performances for small dead space HMEs and filters. For prolonged utilization, humidity delivered should be above 28 mgH₂O/L. For short-term utilization (few hours), it may be acceptable to use HMEs with humidity delivered above 25 mgH₂O/L, but filters without sufficient humidity must not be used. Data provided by manufacturers obtained with gravimetric method may not be reliable.

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

<figure><img src="image_90.png" /></figure>

Absolute Humidity according to manufacturer's (white bars) and to humidity measurements with the psychrometric method (black bars) with small dead space HMEs (Humid Vent 2S, DYNJAHME10, Bact HME midi port 6310, DAR filter HME small) and small filters (Aqu.

## FC-145

### Aerosolotherapy and mechanical ventilation: effect of the position and orientation of an inhalation chamber into an adult ventilation circuit on in vitro drug delivery

ECKES Myriam¹, HERVIEU Brenda¹, BEQUET Quentin¹, PORÉE Thierry¹

¹Laboratoire optimHal, Valognes, France

**Correspondence:** Myriam ECKES (meckes@ohps-lab.com)

Annals of Intensive Care 2022, **12**(1):FC-145

**Rationale:** Positioning the pressurized metered dose inhaler (pMDI) device on the inspiratory branch of a mechanical ventilation circuit is safer especially with a high internal volume spacer. Indeed, the volume of the device is added to the dead space. However, inserting the devices between the Y piece and the endotracheal tube could be convenient especially when using tubing bonded with Y piece. Tubing
dimensions are not the same depending on the position of the device on the circuit. inhaler devices conceived to be inserted into the inspiratory branch of an adult MV circuit can only be used oriented at the opposite as indicated in instructions for use (IFU) when devices are inserted between the Y piece and the endotracheal tube (ETT). Otherwise, adapters are needed. This study aimed to evaluate the effect of position of two different inhaler devices and orientation of pMDI nozzle on drug delivery.

**Patients and methods/Materials and methods:** A ventilator was used in volume-controlled mode with adult respiratory parameters. The inhaler devices, CombiHaler® (Laboratoire OptimHal) and a T adapter (Intersurgical) were inserted into two different positions: 1) in the inspiratory limb with the pMDI nozzle oriented to the patient and 2) between the ETT and the Y piece with the orientation reversed. Ten doses containing 100 µg of salbutamol were actuated in the prototypes during inspiration. The delivered dose was collected on a filter inserted between the ETT and the test Lung.

**Results:** Results showed an equivalent drug delivery when CombiHaler® is inserted in the inspiratory branch and between the ETT and the Y piece with orientation reversed. The drug dose delivered is higher when using the T adapter in the inspiratory branch in comparison with after the Y piece with the orientation reversed. The results could be explained by the high volume of the spacer which could keep the drug particles into the spacer and avoid impaction into the Y piece and tubings.

**Conclusion:** Using the spacer in the reverse orientation doesn't seem to affect drug delivery while orientation of the aerosol spray with the T adapter has an impact on drug delivery.

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

FC-146

Comparison of aerosol deposition in the respiratory tract under spontaneous and non-invasive ventilation

BONSIGNORE Jordan¹, LARA Leclerc², POURCHEZ Jérémie², PREVOT

Nathalie¹, PERINEL-RAGEY Sophie¹

¹CHU SAINT-ETIENNE, Saint-Priest-en-Jarez, France; ²MINES

SAINT-ETIENNE, Saint-Etienne, France

**Correspondence:** Jordan BONSIGNORE (jord.bonsignore@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-146

**Rationale:** Nebulization is a common route of administration for medications in ICU. For example, aerosols are fundamentals in association with non-invasive ventilation (NIV) for an exacerbations of chronic obstructive pulmonary disease (COPD). Nevertheless, nebulization practices are numerous, frequently led only by data from in vitro studies. To improve our practices, the AIM of this study is to evaluate the aerosol deposition when aerosols are realized during NIV or spontaneous breathing in an ex vivo preclinical model.

**Patients and methods/Materials and methods:** The ex vivo respiratory model, was previously validated (1), composed of a porcine respiratory tract (RT), placed in a sealed enclosure. Spontaneous breathing was performed through a head replica with facial mask or a NIV mask according to the condition. During NIV we used a medical ventilator set in spontaneous breathing with pressure support; for the face mask an additional gas flow of 1 L/min or 6 L/min was used according to manufacturer recommendations. The vibrating mesh nebulizer was filed with 99m-Technetium-labeled diethylene-triamine-pentaacetic acid. We performed a gamma camera acquisition to quantify the deposited fractions in each part of the setting.

**Results:** The model was setup 3 times for each condition. The mean deposited fractions in each component lead to the Fig. 1. For NIV conditions, (PART A), they reached respectively (results express in % of nominal dose): 17% (±6%) in RT, 3% (±2%) in face mask, 26% (±8%) in head replica, 14% (±1%) in inspiratory limb and 22% (±2%) in expiratory limb and pump filter with 18% (±2%) of leaks. For face mask conditions with gas flow of 1 L/min then 6 L/min (PART B), they reached: 36% (±8%) and 25% (±3%) in RT, 36% (±8%) and 20% (±1%) in face mask, 21% (±3%) and 21% (±2%) in head replica with 5% (±2%) and 21% (±0%) leaks.

**Discussion:** With vibrating mesh nebulizer, aerosols performed with face mask and smallest gas flow increased the deposited fractions in RT from 17% under NIV to 25% at 6 L/min 36% at 1 L/min. These results are in accordance with França et al. (2) who showed a deposited fraction reduced of 50% in healthy volunteers when performing aerosols during NIV.

**Conclusion:** The ventilation mode and interface impact the aerosol deposition, other conditions being reproductive. The optimal condition using a facemask with gas flow of 1 L/min must be taken in consideration by clinician to optimize nebulization practices when it is safe for patients.

**Reference 1:** Montigaud Y, Georges Q, Pourchez J, Leclerc L, Goy C, Clotagatide A, et al. Aerosol delivery during invasive mechanical ventilation: development of a preclinical ex vivo respiratory model for aerosol regional deposition. Sci Rep. 29 nov 2019;9(1):17930.

**Reference 2:** França EET, Andrade AFD de, Cabral G, Filho PA, Silva KC, Filho VCG, et al. Nebulization associated with Bi-level noninvasive ventilation: Analysis of pulmonary radioaerosol deposition. Respir Med. 1 avr 2006;100(4):721–8.

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

<figure><img src="image_91.png" /><figcaption>Figure 1: for PART A and PART B, results express in % of nominal dose, mean and standard deviation.</figcaption></figure>

FC-147

Clinical impact of the oximeters' inaccuracy (bias and errors)—secondary analysis of the oxygap study

DELOBEL Antoine¹, BLANCHET Marie-Anne¹, MERCIER Gabriel¹, NAYET Émi¹, BOUCHARD Pierre-Alexandre¹, SIMARD Serge¹, L'HER Erwan², BRANSON Richard³, LELLOUCHE François¹

¹Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec (Qc), Canada; ²Medical Intensive Care Unit, CHRU Brest – La Cavale Blanche, Brest, France; ³Department of Surgery, Division of Trauma & Critical Care, University Cincinnati, Cincinnati,
Etats-Unis.

**Correspondence:** Antoine DELOBEL (antoine.delobel.1@ulaval.ca)

Annals of Intensive Care 2022, **12**(1):FC-147

**Rationale:** Pulse oximetry is daily used worldwide to measure SpO₂ in order to monitor and titrate oxygen support. We previously showed that four among the most frequently used oximeters have significant bias (systematic errors from -3% to +1%) and inaccuracy (random error) in comparison with the gold standard SaO₂. The main objective of this study was to highlight the impact of the oximeters' variability on monitoring and clinical decisions in acutely ill patients.

**Patients and methods/Materials and methods:** We prospectively included 210 stable ICU patients with an arterial catheter in place. For all included patients, we compared SpO₂ values for each of the four evaluated oximeters (Nonin, Nellcor, Massimo and Philips) and concomitant PaO₂ and SaO₂ values from the arterial blood gases. When the patients met the criteria for hypoxemia (SaO₂ < 90% or PaO₂ < 60 mmHg), we evaluated which oximeter could detect hypoxemia (SpO₂ < 90%). For each measurement, we evaluated for each oximeter when the oxygen support should be maintained even, increased or decreased to maintain a SpO₂ value between 92 and 96%.

**Results:** Mean age of the patients was 66.3 year, 73% were men, skin pigmentation was light (Fitzpatrick 1 or 2 in 96.2% of the patients). The SpO₂-SaO₂ bias went from -3.1% (Nonin), to +0.9% (Philips) (P < 0.001). With Nellcor and Masimo, bias were -0.3 (P < 0.03) and -0.2% (P = 0.17) respectively. Nonin oximeter underestimated arterial oxygenation in 91% of the cases but detected 100% of hypoxemia defined by PaO₂ < 60 mmHg. Philips overestimated oxygenation in 55% of the cases but detected 11% of episodes of hypoxemia. Based on the oximeter used, the management of oxygen support to maintain the patients within a SpO₂ target of 92-96% differed a lot. To keep the patients within this SpO₂ target, in the cohort of 210 patients, it would be required to increase oxygen in 60.6% vs. 19.1% vs. 18.7% vs. 10.4% and to decrease oxygen in 1.0% vs. 6.2% vs. 9.1% vs. 20.9% of the cases (P < 0.0001) when using Nonin, Nellcor, Masimo or Philips oximeter respectively (see Figure).

**Conclusion:** The variability of SpO₂ measurements between oximeters has a significant impact on the monitoring and management of oxygen support. The bias of each oximeter should be known by clinicians and SpO₂ targets should be adapted to the oximeter brand used by clinicians.

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

<figure><img src="image_92.png" /><figcaption>Figure: impact of oximeter on oxygen management to maintain a SpO₂ target between 92 and 96% (left panel) and impact with adapted SpO₂ target to the oximeter (right panel).</figcaption></figure>

FC-148

**Accuracy and reliability of low-cost versus high-cost oximeters—a secondary analysis of the OXYGAP study**

MERCIER Gabriel<fnref n="1" />, BLANCHET Marie-Anne<fnref n="1" />, DELOBEL Antoine<fnref n="1" />, NAYET Emi<fnref n="1" />, BOUCHARD Pierre-Alexandre<fnref n="1" />, LELLOUCHE François<fnref n="1" />

**Correspondence:** Gabriel MERCIER (gabriel.mercier.3@ulaval.ca)

Annals of Intensive Care 2022, **12**(1):FC-148

**Rationale:** Pulse oximetry is a technology used regularly to monitor oxygen saturation and titrate oxygen needs. However, these machines

are expensive, limiting access in universal health care especially in low-income countries. In recent years, low-cost oximeters have become more available, but there is little validation on their effectiveness. In the main study, we examined the bias between different high-cost and two low-cost oximeters. The main goal of this study was to compare the accuracy and reliability between some low-cost and high-cost oximeters to determine if low-cost oximeters can be adequate options in chosen situations.

**Patients and methods/Materials and methods:** This prospective study included 210 stable ICU patients with arterial catheter. Six oximeters were evaluated including four high-cost (Nonin (Plymouth, MN), Massimo (Irvine, CA), Philips (Eindhoven, Netherlands) and Nellcor (Pleasanton, CA)), as well as two low-cost oximeters (Contec CMS50DL and Beijing Choice C20). The low-cost ones were chosen based on a previous study on accuracy of low-cost oximeters were only the Contec CMS50DL and Beijing Choice C20 met the International Organization for Standardization (ISO) criteria for accuracy. Comparisons between pulse oximeter readings (SpO₂) and arterial saturation (SaO₂) were used to calculate bias (SpO₂-SaO₂). Reliability of each oximeter was evaluated by the percentage of times the oximeter could give a reading.

**Results:** Mean arterial saturation was 93.6%. High-cost oximeters had a mean bias between -3.1% with Nonin and 0.9% with Philips. In comparison, low-cost oximeters had a bias of -2.9% for Contec CMS50DL and -0.8% for Beijing Choice C20. While the majority of high-cost oximeter (Nellcor, Massimo, Philips) had a bias less than ±1.0%, only Beijing Choice C20 had similar result. However, low-cost oximeters were less reliable than high-cost ones with Beijing Choice C20 giving readings 92.9% of the times vs high-cost oximeters giving readings > 97% of the times (See figure).

**Conclusion:** We found that some low-cost oximeters can have a similar accuracy with high-cost oximeters in some clinical settings. These low-cost oximeters could help giving more access to universal health care, especially in low-income countries.

**Reference 1:** Lipnick MS, Feiner JR, Au P, Bernstein M, Bickler PE. The Accuracy of 6 Inexpensive Pulse Oximeters Not Cleared by the Food and Drug Administration: The Possible Global Public Health Implications. Anesth Analg. 2016 Aug;123(2):338-45. https://doi.org/10.1213/ANE.000

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

<table><caption>Table: Mean bias and reliability of four high-cost and two low-cost oximeters.</caption><thead><tr><th rowspan="2"></th><th colspan="4">High-cost oximeter</th><th colspan="2">Low-cost oximeter</th></tr><tr><th>Nonin</th><th>Nellcor</th><th>Massimo</th><th>Philips</th><th>Contec CMS50DL</th><th>Beijing Choice C20</th></tr></thead><tbody><tr><th>Mean bias (%)</th><td>-3.1</td><td>-0.3</td><td>-0.2</td><td>+0.9</td><td>-2.9</td><td>-0.8</td></tr><tr><th>Reliability (%)</th><td>97.6</td><td>99.1</td><td>98.6</td><td>99.5</td><td>99.1</td><td>92.9</td></tr></tbody></table>

Low-cost oximeters had similar accuracy than high-cost ones, while reliability were overall higher in high-cost oximeters.

FC-149

**Invasive mechanical ventilation management and trends in COVID-19-related acute respiratory distress syndrome**

TOUMI Radhouane<fnref n="1" />,², MEDDEB Khaoula<fnref n="1" />,², BOUGUEZZI Nabil<fnref n="1" />, ZOUARI Hajer<fnref n="1" />, BOUABDALLAH Nermine<fnref n="1" />, EL KACEH Rim<fnref n="1" />, BEN SAIDA Imen<fnref n="1" />,², BOUSSARSAR Mohamed<fnref n="1" />,²

**Correspondence:** Radhouane TOUMI (Radhouane.toumi@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-149

**Rationale:** COVID-19-related acute respiratory distress syndrome (CARDS) requiring invasive mechanical ventilation (IMV) is generally associated to a prolonged length of IMV and to a poor prognosis. Adapting IMV management according to patients' elastic properties is

<footnote n="1">¹Institut of cardiologie et de pneumologie de Québec, Québec, Canada</footnote>

<footnote n="1">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</footnote>
mandatory to help reduce mortality. The aim of the study is to describe IMV management as in ventilator settings and parameters and trends in the management of CARDS requiring IMV.

**Patients and methods/Materials and methods:** This is a descriptive retrospective study carried out in a 12-bed medical intensive care unit (MICU) of a University Hospital from March 2020 to September 2021. All patients admitted for a critical CARDS requiring IMV were included. Data on patients' characteristics at ICU admission, clinical presentation, ARDS and COVID-19 severity, ventilatory management, ventilatory settings, airways pressures, compliance, oxygenation index[(Plateau * FiO₂ * 100)/PaO₂]], ventilatory ratio [[VR=(Minute ventilation * PaCO₂)/(Predicted body weight * 100 * 37.5)]] and outcomes were collected. Evaluation was carried out at H1 post-intubation, day5 and day10, at a fixed time. This is the second paper of the database served to inquire about several aspects of CARDS.

**Results:** During the study period, a total of 214 patients underwent IMV for CARDS; 200 (93.5%), severe to critical COVID-19. They were median aged 67.5 [59.75-73] y; male, 146 (68.2%); Hypertension, 106 (49.5%); diabetes, 104 (48.6%) and obesity, 89 (41.6%). Moderate ARDS, 69 (32.2%); severe ARDS, 141 (65.9%); median P/F ratio at admission, 95 [77-132]; moderate to severe acute respiratory failure 185 (86.4%); median SAPSS II, 33 [27-38]. Chest-CT scan was performed in 114 (53.3%) patients showing 68 (59.6%) with at least 50% of lesion extension. Table 1 displays trends in ventilator settings and physiological parameters at H1, day 5 and day 10. Overall mortality rate was 180 (84.1%).

**Conclusion:** Albeit poor outcome in mechanically ventilated CARDS patients, management was mostly in line with ARDS guidelines, however, trends seem to show progressive worsening of patient elastic properties.

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

<table><caption>Trends in ventilatory settings and physiological parameters at H1, day 5 and day 10</caption><thead><tr><th>Evaluation points</th><th>H1</th><th>Day 5</th><th>Day 10</th></tr></thead><tbody><tr><td>FiO<sub>2</sub></td><td>1[0.8-1]</td><td>0.6[0.5-1]</td><td>0.7 [0.5-1]</td></tr><tr><td>Tidal volume(ml/kgIBW)</td><td>6.5[6-7]</td><td>7[6-7.5]</td><td>6[5.8-7]</td></tr><tr><td>PEEP(cmH<sub>2</sub>O)</td><td>10[8-10]</td><td>10[8-10]</td><td>10[8-12]</td></tr><tr><td>Plateau pressure(cmH<sub>2</sub>O)</td><td>27[25-28]</td><td>28[26-30]</td><td>30[27-33]</td></tr><tr><td>Driving pressure</td><td>16[14-19]</td><td>18[16-20]</td><td>20[17.3-23]</td></tr><tr><td>Compliance(ml/cmH<sub>2</sub>O)</td><td>26.25[22-31]</td><td>26[20-30]</td><td>21[15.1-25]</td></tr><tr><td>Modified oxygenation index</td><td>30[22-37]</td><td>22.3[15.6-30.5]</td><td>27.6[17.1-41.8]</td></tr><tr><td>Ventilatory ratio</td><td>2.2[1.8-2.8]</td><td>2.5[1.8-3.1]</td><td>2.8[2.1-3.5]</td></tr><tr><td>P/F</td><td>129[92.8-172.5]</td><td>147[100-193]</td><td>121[77-173.5]</td></tr></tbody></table>

Trends in ventilator settings and physiological parameters

### FC-150

#### Hospital morbidity of COVID-19 patients: hospitalized patients from December 2021 to date

KADI Ahmed¹, MEGDOUD Fella¹, BOUGHERARA Abdelhak¹, ZIDOUNI Noureddine¹, GHARNAOUT Merzak¹

¹CHU BENIMESSOUS ALGER ALGERIE, Alger, Algeria

**Correspondence:** Ahmed KADI (kadihh@hotmail.fr)

Annals of Intensive Care 2022, **12**(1):FC-150

**Rationale:** identify the characteristics of hospitalized patients and bring out the seriousness factors concerning COVID-19.

**Patients and methods/Materials and methods:** This observational, descriptive and retrospective study concerned 100 cases of SARS/COV2 infections from December 2021 to the present day, hospitalized in the pneumo-phthisiology department.

**Results:** The average age of the cases admitted to the study was 62 years with a male predominance (60%), the 2 most frequent comorbidities were respectively hypertension (44%) and diabetes (18%). Unvaccinated patients were 60% of cases, no patient had a history of COVID-19 disease. Family exposure represented 55% of cases, while occupational exposure was found in only 11% of cases. The involvement on chest CT was estimated at less than 10% in 3% of cases, between 10 and 25% in 15% of cases, between 25 and 50% in 40% of cases, between 50 and 75% in 28% of cases, and above 75% in 9% of cases. Lymphopenia was present in 93% of patients, CRP was elevated in 97% of patients. D. dimers were elevated in 52% of patients. Renal involvement was observed in 22% of patients. Cytolysis was present in 19% of hospitalized patients. Deaths accounted for 18% of hospitalized patients, half of whom were vaccinated.

**Conclusion:** Viral infection by the coronavirus is a new pathology with clinical manifestations of varying severity, digestive manifestations were more frequent in the series studied. Familial exposure was frequent. Inflammatory syndrome is common causing lesional pulmonary edema in some patients.

**Reference 1:** Wu Y, Ho W, Huang Y, Jin D-Y, Li S, Liu S-L, et al. SARS-CoV-2 is an appropriatename for the new coronavirus. Lancet 2020; 395 (10,228): 949-50.

**Reference 2:** Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382 (8):727-33.

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

### FC-151

#### COVID-19 and underlying lung disease: what is known about risk and care management?

GHABARA Racha¹, JARRAYA Fatma¹, RACHDI Emna¹, JAMOUSSI Amira¹, AYED Samia¹, BEN KHELIL Jalila¹

¹Hôpital Abderrahmane Mami, Ariana, Tunisie

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

Annals of Intensive Care 2022, **12**(1):FC-151

**Rationale:** Patients with COVID-19 who have underlying chronic lung disease (ULD) are at increased risk for developing a severe illness related to the disease. However, to date, few studies have been published about patients with ULD. The aim of this study was to evaluate the impact of ULD on clinical characteristics, adverse outcomes, and mortality in patients with critical COVID-19.

**Patients and methods/Materials and methods:** It was a retrospective comparative cohort study including all patients hospitalized in ICU for COVID-19 between March 2020 and September 2021. Two groups were studied according to the presence or absence of ULD. Primary outcomes were the use of mechanical ventilation (MV), ICU length of stay (LOS), and death.

**Results:** We included 148 patients of whom 102 were male (ULD group, n=74 versus no ULD group, n=74). ULD corresponded to sleep apnea (SA; n=12), chronic obstructive pulmonary disease (COPD; n=31), asthma (n=20), diffuse interstitial lung disease (n=3), bronchiectasis (n=4) and COPD/SA (n=2). Long-term oxygen or home MV were required in 11 cases. Obesity was more frequent in ULD group (45% vs 39%; p=0.01). COVID clinical presentation was similar between both groups (cough, dyspnea, struggle signs, respiratory rate, digestive signs, myalgia, anosmia). Pulmonary lesions on the first thoracic CT-scan performed during hospitalization were significantly more extensive in the no ULD group (p=0.05). Ventilator parameters and lung mechanics were similar between both groups (Table 1). The occurrence of ARDS, thrombo-embolic events, and septic shock was comparable between both groups. Requirement and duration of MV did not differ (55% vs 45%; p=0.25 and 7.84 vs 8.97 days; p=0.52, respectively), but mortality rate was significantly higher in ULD group (n=47, 63.5% vs n=31, 41.9%; p=0.008).
**Conclusion:** Unexpectedly, we didn't find any major differences regarding the clinical presentation, severity scores at ICU admission, and the MV requirement between critical COVID-19 patients with ULD versus without ULD. However, the severity of CT scan injury and respiratory parameters were greater in the no ULD group. The mortality rate was more marked in the ULD group.

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

<table><caption>Table 1: comparison of ventilator parameters and lung mechanics between both groups.</caption><thead><tr><th></th><th>Not ULD group<br>(n=74)</th><th>ULD group<br>(n=74)</th><th>p</th></tr></thead><tbody><tr><td>PaO<sub>2</sub>/FiO<sub>2</sub> ratio, mmHg (Mean ± DS)</td><td>144 ± 77</td><td>125 ± 64</td><td>0.20</td></tr><tr><td>Minimum Compliance, ml/mmHg (Mean ± DS)</td><td>14 ± 6</td><td>16 ± 6</td><td>0.50</td></tr><tr><td>Maximum plateau pressure, mmHg (Mean ± DS)</td><td>33 ± 5</td><td>29 ± 5</td><td><strong>0.02</strong></td></tr><tr><td>Maximum Driving pressure, mmHg (Mean ± DS)</td><td>20 ± 6</td><td>16 ± 5</td><td>0.09</td></tr><tr><td>Maximum intrinsic PEEP, mmHg (Mean ± DS)</td><td>1 ± 2</td><td>3 ± 1</td><td><strong>0.009</strong></td></tr></tbody></table>

## FC-152

### Characteristics and prognosis of mechanical ventilated patients with SARS CoV2 pneumonia: a prospective analysis of 143 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-152.

**Rationale:** The aim of this study was to describe the epidemiological and clinical characteristics of patients with SARS CoV2 pneumonia mechanically ventilated admitted to an ICU of a general care center in France and to identify risk factors associated with mortality.

**Patients and methods/Materials and methods:** We performed a prospective cohort study of patients admitted to the ICU from March 2020 to February 2022 for SARS CoV2 pneumonia and mechanically ventilated.

**Results:** During the study period, we included 143 patients and the mortality rate was 51% (n=72). Median ICU stay was 16 (1-149) days and median delay to ICU hospitalization was 8 (1-24) days. Median age was 62 (29-84), sex ratio M/F was 1.94 and median SAPS was 33 (18-75). Median BMI was 30 (19-68). 64% of patients had hypertension (n=91) and 42% (n=60) were diabetic. Patients presenting an acute kidney failure were 36% (n=51) and 26% of them (n=37) needed a renal replacement therapy. 82% of patients (n=117) had non-invasive ventilation and 79% (n=113) had high flow nasal oxygen as first-line therapy. Median duration of ventilation was 12 days (1-47), 47% of patients (n=67) were extubated and 7.7% (n=11) needed ECMO. 85% (n=122) needed at least one prone position session. 85% of patients (n=122) needed catecholamines. 73% of the patients (n=105) had ventilatory acquired pneumonia, 17% (n=25) had thrombotic complications while 23% (n=33) had hemorrhagic complications. 37% of the patients (n=53) received dexamethasone 6 mg/day for 10 days, 37% (n=53) received dexamethasone 0.1 mg/kg/days for 10 days and 15% (n=22) of them received bolus of methylprednisolone 250 mg/day for 3 days as rescue therapy. Tocilizumab was administrated to 9.8% of the patients (n=14). In the univariate analysis, risk factors associated with mortality were age, hypertension, SAPS II, AKI, chronic renal disease, the use of catecholamines and hemorrhagic complications. In the multivariate analysis, only age (OR 1.09 [1.04; 1.14], p < 0.001) was associated with mortality.

**Conclusion:** The mortality of patient mechanically ventilated with SARS CoV2 pneumonia associated is very high. Others studies are necessary to determine risk factors associated with mortality.

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

## FC-153

### Is there a benefit to high-flow nasal cannula therapy in critically-ill COVID-19 patients ?

BEN ISMAIL Khaoula¹,⁴, BEN DHIA Boudour¹,⁴, TALIK Imen¹,⁴, ESSAFI Fatma¹,⁴, BAYOUDH Aida²,⁴, FESSI Ilhem²,⁴, JERBI Tahany³, CHKIRBENE Mariem³, MERHBENE Takoua¹,⁴

¹Service de réanimation médicale Hôpital régional de Zaghouan, Zaghouan, Tunisie; ²Service de pneumologie Hôpital régional de Zaghouan, Zaghouan, Tunisie; ³Département de pharmacie de l'hôpital régional de Zaghouan, Zaghouan, Tunisie; ⁴Faculté de médecine de Tunis, Université Tunis El Manar, Tunis, Tunisie

**Correspondence:** Boudour DHIA (bidourabdbg2014@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-153

**Rationale:** During COVID-19 pandemic, high-flow nasal cannula therapy (HFNC) has been proposed as a ventilation device aiming to improve oxygenation and respiratory mechanic. However, its effectiveness has not been clearly demonstrated in terms of secondary need to invasive ventilation and reduction of morbidity and mortality. Our aim was to evaluate the efficacy and safety of HFNC in the management of non-hypercapnic acute respiratory failure secondary to SARS-CoV-2 infection.

**Patients and methods/Materials and methods:** Prospective, monocentric, interventional study conducted in the medical intensive care unit (ICU) of Zaghouan, Tunisia over 18 months (March 2020-September 2021). Patients admitted for non-hypercapnic acute respiratory failure secondary to SARS-CoV-2, aged over 18 years, were included. Two groups were identified G1 = patients who received HFNC alone or in combination with other non-invasive ventilation device and group G2 = patients who received conventional oxygen therapy in combination with non-invasive ventilation. We compared demographics, clinical, paraclinical and evolutionary data.

**Results:** 181 patients were included. HFNC was used in 111 patients (61.3%). It was associated with non-invasive ventilation and awake prone position in 83% and 92% of cases respectively. On admission, the two groups were comparable in terms of demographic characteristics, clinical presentation and initial severity. Mean P/F ratios were 152 and 139 mmHg respectively (p = 0.08). Comparison of outcome parameters showed that G1 patients need less likely invasive mechanical ventilation (27% vs 56.4%, p = 0.002) and developed fewer healthcare-associated infections and barotrauma (42.1% vs 62%, p = 0.03; 12% vs 22%, p = 0.03). Mortality was significantly lower in G1 (22% vs 39%; p = 0.02). Duration of total mechanical ventilation was comparable between two groups but length of ICU stay was longer in G1. Occurrence of pulmonary fibrosis was more frequent in G1 (18% vs 6%, p = 0.02). Multivariate analysis showed that use of HFNC was a protective factor against need to invasive ventilation (OR = 0.42; 95% IC [0.3-0.7], p = 0.03) and healthcare-associated infections (OR = 0.8; 95% IC [0.1-0.7], p = 0.04).

**Conclusion:** In this preliminary study, it appears that HFNC seems beneficial in severe COVID-19 patients. Further studies are needed to confirm these findings.

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

## FC-154

### Risk factors of high-flow nasal cannula oxygen therapy failure in critically ill patients with COVID-19

AIT HAMOU Zakaria², LEVY Nathan², CHARPENTIER Julien², MIRA Jean-Paul², JAMME Matthieu³, JOZWIAK Mathieu¹

¹CHU de Nice, hôpital l'Archet 1, Nice, France; ²Hôpitaux Universitaires Paris centre, APHP, Hôpital Cochin, Paris, France; ³Hôpital Privé de l'Ouest Parisien, Trappes, France

**Correspondence:** Mathieu JOZWIAK (jozwiak.m@chu-nice.fr)

Annals of Intensive Care 2022, **12**(1):FC-154
**Rationale:** The use of high-flow nasal oxygen therapy (HFNO) as first-line support ventilatory might be associated with lower intubation rate in critically-ill COVID-19 patients. However, risk factors of HFNO failure remain to be determined.

**Patients and methods/Materials and methods:** In this retrospective study, we included all consecutive COVID-19 patients admitted in our 24-bed intensive care unit (ICU) in the first (March-May 2020) and second (August 2020-February 2021) pandemic waves. Patients with limitations for intubation were excluded. Risk factors of HFNO failure were identified through a landmark time-dependent cause-specific Cox model. The ability of the 6-h ROX index to detect HFNO failure was assessed by generating receiver operating characteristic (ROC) curve. The impact of HFNO use was analyzed in the whole cohort and after constructing a propensity score. The relationship between HFNO use and risk of intubation was assessed with a Cox cause-specific analysis.

**Results:** Overall 200 patients were included: HFNO was used in 114(57%) patients, non-invasive ventilation (NIV) in 25 (12%) patients and 145 (72%) patients were intubated with a median delay of 0 (0-2) days after ICU admission. Patients with HFNO were older and less severe than those without HFNO and 78 (68%) had HFNO failure. Patients with HFNO failure had a higher ICU mortality rate (34 vs 11%, p=0.02) than those without. At landmark time of 48 and 72 h, SAPS-2 score, extent of CT-Scan abnormalities > 75% and HFNO duration (CSH = 0.11, 95% CI (0.04-0.28), per + 1 day, p < 0.001 at 48 h and CSH = 0.06, 95% CI (0.02-0.23), per + 1 day, p < 0.001 at 72 h) were associated with HFNO failure. The 6-h ROX index was lower in patients with HFNO failure but could not reliably predict HFNO failure with an area under ROC curve of 0.65 (95%CI (0.52-0.78), p = 0.02). In the matched cohort, there was a negative association between HFNO use and the risk of intubation (CSH = 0.32, 95% CI (0.19-0.57), p < 0.001).

**Conclusion:** In critically-ill COVID-19 patients, while HFNO use as first-line ventilatory support was associated with a lower risk of intubation, more than half of the patients had HFNO failure. The risk of HFNO failure could not be predicted by the 6-h ROX index but decreased after a 48-h HFNO duration.

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

## FC-155

**Endotracheal intubation rate is lower in critically-ill SARS-CoV-2 patients requiring high-flow nasal oxygen receiving additional face-mask noninvasive ventilation: a retrospective bicentric cohort with propensity score analysis**

URBINA Tomas¹, ELABBADI Alexandre², GABARRE Paul¹, BIGÉ Naike¹, TURPIN Matthieu², BONNY Vincent¹, DESNOS Cyrielle², BAUDEL Jean-Luc¹, LAVILLGRAND Jean-Rémi¹, HARIRI Geoffroy¹, FARTOUKH Muriel², GUIDET Bertrand¹, DUMAS Guillaume³, VOIRIOT Guillaume², AIT-OUFELLA Hafid¹
¹Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; ²Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; ³Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France

**Correspondence:** Tomas URBINA (tomas.urbina@aphp.fr)

*Annals of Intensive Care* 2022, **12**(1):FC-155

**Rationale:** SARS-CoV-2 pneumonia is responsible for unprecedented numbers of acute respiratory failure requiring invasive mechanical ventilation (IMV). We aimed to assess whether adding face-mask non-invasive ventilation (NIV) to high-flow nasal oxygen (HFNO) was associated with a reduced need for endotracheal intubation.

**Patients and methods/Materials and methods:** This retrospective cohort study was conducted from July 2020 to January 2021 in two tertiary care intensive care units (ICUs). Patients admitted for laboratory confirmed SARS-CoV-2 infection with acute hypoxemic respiratory failure requiring HFNO with or without NIV were included. The primary outcome was the rate of endotracheal intubation. Secondary outcomes included day-28 mortality, day-28 respiratory support and IMV free days, ICU and hospital length-of-stay. Sensitivity analyses with both propensity score matching and overlap weighting were used.

**Results:** 128 patients were included, 88 (69%) received HFNO alone and 40 (31%) received additional NIV. Additional NIV was associated with a reduced rate of endotracheal intubation in multivariate analysis (53 (60%) vs 15 (38%), HR = 0.46 (95% CI, 0.23-0.95), p = 0.04) (Fig. 1). Sensitivity analyses by propensity score matching (HR = 0.45 (95%IC, 0.24-0.84), p = 0.01) and overlap weighting (HR = 0.52 (95% CI, 0.28-0.94), p = 0.03) were consistent. Day-28 mortality was 25 (28%) in the HFNO group and 8 (20%) in the NIV group (HR = 0.75 (95%CI, 0.15-3.82), p = 0.72). NIV was associated with higher IMV free days (20 (0-28) vs 28 (14-28), p = 0.015). All sensitivity analyses were consistent regarding secondary outcomes.

**Conclusion:** Need for endotracheal intubation was lower in critically-ill SARS-CoV-2 patients receiving face-mask noninvasive mechanical ventilation in addition to high-flow oxygen therapy. Further prospective trials are needed before this treatment can be generally recommended.

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

<figure><img src="image_93.png" /><figcaption>Figure 1. Cumulative incidence of intubation to day 28 in the high-flow nasal oxygen only and the additional face-mask noninvasive ventilation groups. Hazard ratio from a Cox model multivariate analysis in the whole population was 0.46 (95%CI, 0.23-0.95),</figcaption></figure>

## FC-156

**Patient outcomes in a respiratory weaning unit after prolonged intensive care: a review of 2021**

PERETOUT Jean-Baptiste¹, NSSAIR Karim¹, ABDALLAH Razach¹, LEPECQ Raphael¹, DONETTI Laurence¹, LAISSI Mohamed¹, CHOUKROUN Gérald¹
¹Hôpital Forcilles - Fondation Cognacq-Jay, Férolles-Attilly, France

**Correspondence:** Jean-Baptiste PERETOUT (jperetout@cognacq-jay.fr)

*Annals of Intensive Care* 2022, **12**(1):FC-156

**Rationale:** Weaning units have shown their value in the management of tracheostomized patients after prolonged intensive care¹. The global and multidisciplinary approach contributes to accelerate and improve weaning². The objective of this study is to describe the results of weaning and decannulation in these patients.

**Patients and methods/Materials and methods:** This is a retrospective, descriptive study in a respiratory weaning unit over the year 2021. All patients hospitalized in the weaning unit were included. Demographic characteristics and weaning unit outcomes were collected. All inpatients with complete data were analyzed. The analysis was completed by a subgroup analysis of patients on 24-h spontaneous ventilation at admission and patients still with mechanical ventilation (MV) at admission (intermittent or continuous).

**Results:** In 2021, 144 patients were admitted. A total of 134 patients were analyzed with male 70%, age 63 ± 12 years, COVID 70%. The main diagnosis of admission on intensive care unit was acute respiratory failure in 84%. The goal of admission on weaning unit was: ventilatory and tracheostomy weaning in 63% and tracheostomy weaning in 37%. On admission, patients were on 24-h spontaneous ventilation in 34% (n = 46) and on mechanical ventilation in 66% (n = 88): 66% intermittent MV (n = 58); 34% continuous MV (n = 30). In overall patients, 24-h
spontaneous ventilation was achieved in 8.4±12.8 days, decanulation in 20.4±15 days and the length of stay was 30.7±18.3 days. The overall decanulation success rate was 88%. Subgroup analyses are presented in Table 1.

**Conclusion:** Patients with prolonged intensive care and complex medical needs treated at a specialized weaning unit had high quality weaning and decannulation rates. This was achieved with a multidisciplinary team approach to continued intensive care and simultaneous rehabilitation with physiotherapists, speech therapists, nutritionists... Cares in a weaning unit remains relevant despite a prolonged stay in ICU during this COVID period.

**Reference 1:** Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T. Weaning from mechanical ventilation. Eur Respir J. 2007 May;29(5):1033–56.

**Reference 2:** Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness. Am J Respir Crit Care Med. 2010 Aug 15;182(4):446–54.

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

<table><caption>Table I Subgroup analysis. 24-h SV adm: 24-h spontaneous ventilation on admission; VM (i+c) adm: mechanical ventilation (intermittent + continuous) on admission; MV adm: intermittent mechanical ventilation on admission; MVc adm: continuous mech.</caption><thead><tr><th></th><th>Overall (n=134)</th><th>24-h SV adm (n=46)</th><th>MV (i+c) adm (n=88)</th><th>MV adm (n=148)</th><th>MV adm (n=30)</th></tr></thead><tbody><tr><td>Ventilation at admission (%)</td><td>8.4 ± 12.8</td><td>34.3</td><td>5.7</td><td>10.9 ± 12</td><td>17.9 ± 16.2</td></tr><tr><td>Time to 24-h SV (h)</td><td>92.6</td><td></td><td>13.4 ± 14</td><td></td><td>22.4</td></tr><tr><td>24-h SV success (%)</td><td>20.4 ± 15</td><td>14.4 ± 11.3</td><td>89.7</td><td>87.9</td><td>93.3</td></tr><tr><td>Time to decannulation (d)</td><td></td><td>89.1</td><td>23.6 ± 17</td><td>22.1 ± 16.9</td><td>26.4 ± 17.2</td></tr><tr><td>Decannulation success (%)</td><td></td><td></td><td>87.5</td><td>84.5</td><td>93.3</td></tr><tr><td>Length of stay (d)</td><td>30.7 ± 18.3</td><td>23.6 ± 13.9</td><td>34.5 ± 19.3</td><td>33.6 ± 19.6</td><td>36.1 ± 19</td></tr></tbody></table>

## FC-157

### Pulmonary consequences at 12 months of a severe COVID-19 infection

SAINT JOUAN Mélanie¹, MORICHAU-BEAUCHANT Tristan¹, MAILLET Jean-Michel¹

¹Centre Cardiologique du Nord, Saint Denis, France

**Correspondence:** Mélanie SAINT JOUAN (Melaniesaintjouan@Gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-157

**Rationale:** Two years after the first wave of the SARS-CoV-2 epidemic in France, the pandemic is still active, but data about the long-term consequences of the pulmonary function are limited.

In this context, we have carried out an evaluation of the pulmonary function of patients who survived severe ARDS secondary to SARS-CoV-2 infection, 1 year after their hospitalization.

**Patients and methods/Materials and methods:** We have carried out a single-center prospective and descriptive cohort study with patients who survived severe ARDS during the first wave of the pandemic between the months of March to April 2020. This study took place from April 2021 to July 2021. The patients included in this study had required a prolonged stay (more than seven days) in intensive care unit and were under mecanical invasive ventilation for more than three days during the first wave of the pandemic. The main goal was to assess the lung function. The assessment included a chest CT-scan, pulmonary function tests, a 6-min walk test, and an evaluation of patient's quality of life depending on their respiratory symptoms using the St George's respiratory survey. The patients were hospitalized for a day in the center for these exams.

**Results:** 30 patients were included in the study, of which 8 patients were under veno-venous ECMO during their hospitalization.

The chest CT-scans revealed few ground-glass opacities, with a median scanographic severity score of 1 out of 25 [IQR 0–2.5]; 43% of the CT-scans were normal. On the pulmonary function tests 32% of patients had restrictive ventilatory defects, and 45% of patients had diffusing capacity of the lungs for carbon monoxide impairment. The impact on functional abilities assessed by the six-minute walk test resulted in a

distance traveled less than normal in 33% of patients. The results of the St George's Hospital survey showed that quality of life was altered, with results similar to those of ARDS survivors.

**Conclusion:** This is the first cohort study assessing long-term respiratory sequelae only patients who suffered from severe COVID-19 infection, 1 year after ICU discharge. The majority had abnormal lung function tests and residual parenchymal abnormalities on CT scans. Diffusing capacity of the lungs for carbon monoxide and total lung capacity were impaired in one-third of patients. Limitation of physical activity has been documented. Despite, they were autonomous and living at home, which is encouraging for the functional prognosis of patients with severe forms of COVID-19.

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

## FC-158

### Interest of non-invasive ventilation in the prevention of post-extubation respiratory distress in medical intensive care

OUALI Mourad¹, HAMIDI Redha Malek¹

¹Faculté de médecine; Centre hospitalo-universitaire Béni Messous, Alger, Algérie

**Correspondence:** Mourad OUALI (moudoc2002@yahoo.fr)

Annals of Intensive Care 2022, **12**(1):FC-158

**Rationale:** The failure of extubation defined by the need for reintubation of the patient less than 72 h later is correlated with excess mortality as well as an increase in the length of stay in intensive care, this failure is often due to the occurrence acute respiratory failure after extubation.

**Patients and methods/Materials and methods:** In order to assess the impact of non-invasive prophylactic intermittent ventilation on the frequency of occurrence of post-extubation respiratory distress, a comparative, descriptive, single-center and randomized study was conducted in a medical intensive care unit over a period of 2 years (2018–2020). 73 patients hospitalized in intensive care, put on invasive mechanical ventilation for more than 24 h and extubated after having tolerated the spontaneous ventilation challenge well, were randomized to receive non-invasive intermittent ventilation for 24 h in a group then conventional oxygen therapy and in another group conventional oxygen therapy alone. The primary endpoint was the occurrence of respiratory distress after extubation.

**Results:** The results allowed us to observe a significant decrease in the occurrence of post-extubation respiratory distress in patients in the NIV group compared to patients in the conventional oxygen therapy group (7.9% VS 28.6%; P = 0.02), as well as a reduction in the reintubation rate (7.9% in the NIV group versus 20% in the oxygen only group; p = 0.13). The length of stay in the intensive care unit was longer in patients who presented with acute respiratory failure (25.77 ± 5.0 days in the respiratory distress group versus 15.37 ± 0.85 days in the group without respiratory distress; p = 0.001) but without significant difference between the NIV group and the conventional oxygen group, p = 0.64. Post-extubation respiratory distress was correlated with significant excess mortality with 46.2% mortality in the group of patients who presented with respiratory distress after extubation versus no death in the group of patients who did not develop this complication, p < 0.001. In contrast, we did not notice a significant difference in mortality between the two study groups.

**Conclusion:** Our study has made it possible to highlight all the interest that NIV can bring in the period following the planned extubation of patients in intensive care, by demonstrating a significant reduction in the frequency of occurrence of acute respiratory failure after extubation, the reduction in the rate of reintubation as well as the shortening of the length of stay in intensive care.

**Reference 1:** Xu Z, Li Y, Zhou J, Li X, Huang Y, Liu X, et al. High-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis. Respir Res. 2018;19(1):202.
**Reference 2:** Zhu Y, Yin H, Zhang R, Ye X, Wei J. High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients after planned extubation: a systematic review and meta-analysis. Crit Care. 2019;23(1):180.

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

FC-159

One-year follow-up of patients and relatives after severe
COVID-19 related ARDS treated in the intensive care unit

THIERY Guillaume¹, LAURENT Raphael ¹, CORREIA Patricia ¹, EZINGERD Eric¹, ERIC Diconne¹, LACHAND Raphael¹, PERINEL-RAGEY Sophie¹, BRUNA Franklin¹, DIREZ Magali¹, ROUSSET Elodie¹, CURTO Nadège¹, PINATEL Emilie¹, CHARRA Céline¹, PHILIBERT Gérald¹, GUENIER Pierre Alban¹
¹CHU de Saint-Etienne, St Priest En Jarez, France

**Correspondence:** Guillaume THIERY (thiery.icu@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-159

**Rationale:** Severe COVID-19 often leads to prolonged stay in the ICU. Survivors may experience physical and psychological sequelea. The impact on relatives is also considerable. The aim of this study is to evaluate physical and psychological condition of severe COVID-19 patients 1 year after ICU discharge and to assess the psychological impact on their relatives.

**Patients and methods/Materials and methods:** All consecutive patients admitted to the ICU for COVID-19 related ARDS from March 5th to November 21st 2020 were included in our post-ICU follow-up program, if their ICU stay was ≥ 7 days. They were invited to attend a post-ICU consultation, which consisted of a 2-h face to face meeting with a senior ICU physician and an ICU nurse. Before the consultation, they were asked to complete four self-evaluation questionnaires: Hospital Anxiety and Depression scale (HADS), Revised Impact of Event Scale (IES-R), Short-Form General Health Survey (SF-12) and Inconforts des Patients de REAnimation (IPREA). In addition, a CT-scan and basic laboratory tests were performed before the consultation. Patients were invited to be accompanied by a close relative, who was also invited to fill HADS and IES-R questionnaires.

**Results:** Among the 170 patients admitted to the ICU, 127 patients survived to the hospital and 81 met inclusion criteria. Twenty-five patients did not respond or declined. The remaining 56 patients attended the consultation. The median age was 66 (IQR 57–71), 79% had been mechanically ventilated. Duration of ICU and hospital (including rehabilitation) stays were 19 (IQR 12–26) and 49 (IQR 26–64) days respectively. Severe symptoms of anxiety, depression and PTSD are reported on table 1. The most frequently reported discomforts were limited visiting hours, sleep deprivation, anxiety, being tied down and noise. Fifty-nine percent of the patients resumed their hobbies at 1 year. Five (28%) of the 18 pre-ICU employed patients fully returned to work. Shortness of breath was reported by 64% of the patients, although among the 42 CT scan performed, only 7 (16%) showed persistent abnormalities. Symptoms of fatigue were reported by 63% of the patients, and physical functioning was reduced with a physical component of SF-12 score at 44.

**Conclusion:** One year after their ICU discharge, the psychological impact of severe COVID-19 for patients treated in the ICU is high, and is even higher for relatives. A majority of patients present still with persistent respiratory symptoms although most of them have a lung CT scan normal.

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

<table><caption>Table 1</caption><thead><tr><th></th><th>Patients (n=48)</th><th>Relatives (n=42)</th></tr></thead><tbody><tr><td><strong>HADS score (anxiety and depression)</strong></td><td></td><td></td></tr><tr><td>HADS, median (IQR)</td><td>7 (3-10)</td><td>10 (6-13)</td></tr><tr><td>HADS Anxiety &gt; 7, n (%)</td><td>23 (48%)</td><td>26 (62%)</td></tr><tr><td>HADS Depression &gt; 7, n (%)</td><td>11 (23%)</td><td>13 (31%)</td></tr><tr><td>HADS Anxiety &gt; 10, n (%)</td><td>8 (16%)</td><td>17 (40%)</td></tr><tr><td>HADS Depression &gt; 10, n (%)</td><td>6 (13%)</td><td>8 (19%)</td></tr><tr><td><strong>IES-R score (post-traumatic stress disorder)</strong></td><td></td><td></td></tr><tr><td>IES-R, median (IQR)</td><td>21 (8-34)</td><td>46 (18-58)</td></tr><tr><td>IES-R &gt; 22, n (%)</td><td>21 (45%)</td><td>30 (71%)</td></tr><tr><td>IES-R &gt; 32, n (%)</td><td>13 (28%)</td><td>23 (55%)</td></tr></tbody></table>

FC-160

Tracheostomy in patients admitted due to COVID-19

SANA Khedher¹, ALI Rashed¹, ELDHAWI Nawar¹, HASSAN Majid Al Dossari¹

¹AFH Wady addawassir, Riadh, Arabie Saoudite.

**Correspondence:** Khedher SANA (sanakhedher@hotmail.fr)

Annals of Intensive Care 2022, **12**(1):FC-160

**Rationale:** During the COVID-19 pandemic, the world has seen an increase in the number of critically ill patients who required invasive mechanical ventilation (IMV). Ventilation is certainly a challenge and tracheostomy was one of the management strategies.

**Patients and methods/Materials and methods:** We reviewed the medical records of all patients admitted to our intensive care, between April 01, 2020 and August 31, 2021, suffering from acute respiratory syndrome due to SARS COV2 and requiring tracheostomy after IMV. The objective was to determine the rate as well as the clinico-epidemiological profile of tracheotomized patients.

**Results:** A total of 96 patient admitted during this period. Fourteen 40 (41%) had acute respiratory failure and needed IMV support. Ten (25%) had a tracheostomy, they were predominantly male (55%) with mean of age 70+ – 15 years and all having at least one comorbidity. Mean SAPSII score on ICU admission was 34+ – 16. The average time from endotracheal intubation to tracheostomy was 20+ – 8 days. Failure to weaning (50%) was the most common indication, followed by respiratory failure (30%), hypersecretion (10%), and neuromyopathy (10%). 50% were liberated from ventilator, 20% have been decannulated and all patient have been discharged alive. Here we have opted open surgical technique. Two episodes of local bleeding were observed. No transmission has occurred among health workers.

**Discussion:** Several previous studies have shared their experiences and have shown that tracheostomy done in the correct manner is safe for the health care workers and provides good recovery for the severely ill with SARS-COV2 pneumonia.

**Conclusion:** Use of tracheostomy can be adopted as essential clinical strategy for managing critical ill patients with SARS COV 2 pneumonia who require IMV.

**Reference 1:** Tiffany N. Chao et al. Outcomes after tracheostomy in COVID-19 patients. Ann Surg 2020;272:e181–e186.

**Reference 2:** Zhou F, et al. Clinical course and risk factors for mortality of adult In patients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–1062.

**Compliance with ethics regulations:** Yes in clinical research.
FC-161

Clinical features, ventilatory management and outcomes of COVID-19 related ARDS in a medical ICU

TOUMI Radhouane¹,², MEDDEB Khaoula¹,², BOUGUEZZI Nabil¹,
ZOUARI Hajer¹, MAATOUK Iyed¹, HAMDI Dhouha¹, BEN SAIDA Imen¹,²,
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:** Radhouane TOUMI (Radhouane.toumi@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-161

**Rationale:** The COVID-19 pandemic took the world by storm defying physicians in many aspects; going from health systems responsiveness to diagnosis and treatment, especially with the introduction of concepts such as "happy hypoxemia" that modulated intensivists' approach to ventilatory management. The aim of the present study is to describe clinical features, ventilatory management and outcomes of critically ill adults admitted for COVID-19 related ARDS.

**Patients and methods/Materials and methods:** This is a descriptive retrospective study carried out in a 12-bed medical intensive care unit (MICU) of a University Hospital from March 2020 to September 2021. All patients admitted for a critical COVID-19 related ARDS were included. Data on patients' characteristics at ICU admission, clinical presentation, ARDS and COVID-19 severity, ventilatory management, ventilatory settings, airways pressures and outcomes were collected. The database served to inquire about several aspects of COVID-19 related ARDS that will be discussed through a series of studies.

**Results:** During the study period, 442 patients were admitted for COVID-19 pneumonia, 409 (92.6%) presenting severe to critical COVID-19. They were aged 64 [54–71] years; male, 279 (63.1%); had hypertension, 197 (44.6%); diabetes mellitus, 187 (42.3%), and obese 172 (38.9%). At admission, moderate to severe acute respiratory failure, 340 (76.9%); median SAPS II, 28 [22–35]; moderate to severe ARDS, 400 (90.5%); mean P/F ratio, 114 [84–157]. Chest CT-scan performed in 268 (60.6%) patients, 163 (60.8%) had more than 50% of pulmonary parenchyma lesions. Ventilatory support was required in 439 (99.3%); immediate IMV at admission, 33 (7.5%); HFNC, 334 (77.8%); median HFNC duration, 4 [2–7] days; NIV and CPAP as rescue therapy to avoid intubation, respectively, 52 (11.8%); 10 (2.2%), median NIV starting day, day 1 [0–2]; median NIV duration, 2 [1–33] days; CPAP starting day, day 3 [1–3]; median CPAP duration, 2 [1–4] days. Non invasive procedures failure rate, 41.2%; median delay of intubation, 3 [2–5] days; overall IMV, 215 (48.6%); median overall IMV starting day, day 2 [1–4]; median IMV duration, 8 [5–12] days. Overall mortality was at 211 (47.7%), 130 (37.8%) for patients on HFNC, 93 (72.7%) when patients were switched to NIV and 180 (83.72%) when on IMV.

**Conclusion:** The present study demonstrated a poor prognosis in mechanically ventilated patients with COVID-19 related ARDS. HFNC was prioritized for most patients. NIV was used as a rescue therapy in an attempt to avoid intubation.

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

FC-162

Doses of dexamethasone in Covid-19 patients

SDIRI Ines¹,², FITOUHI Nizar², DRIDI Amira², LAROUI Rim¹, OUERGHI Sonia², MESTIRI Tahar²

¹Hôpital Circonstance menzah, Tunis, Tunisie; ²Abderahmen memi ariana, Ariana, Tunisie

**Correspondence:** Ines SDIRI (sdiri.ynes@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-162

**Rationale:** The SARS-CoV-2 induces both systemic and localized immune response leading to increased inflammation. Severe pulmonary lesions in SARS-CoV-2 ARDS have been found to be associated with severe inflammatory cell infiltration and elevated pro-inflammatory cytokines (1). Dexamethasone decreases mortality in patients

with severe coronavirus disease 2019 (COVID-19) and has become the standard of care (2). The role of dexamethasone in the high incidence of ventilator-associated pneumonia observed in intensive care units (ICUs) deserves to be investigated.

**Patients and methods/Materials and methods:** We conducted a retrospective study in an intensive care unit including critically ill patients with confirmed SARS-COV2 infection between January 2021 and December 2021. We compared two different doses of dexamethasone (6 mg × 3 per day versus 6 mg per day) given intravenously over 10 days. Secondary, our population was divided into two groups: those who received 6 mg × 3 (group 1) and those who received only 6 mg (group 2). These two groups were matched on age, gender, SAPS II and APACHE scores, severity of acute respiratory distress syndrome on admission and clinical severity.

**Results:** We evaluated 323 patients with COVID-19 admitted to our institution. The median age was 57 [25–85] years and 53.6% of the patients were male. Among these patients, 37.3% had hypertension, 33.1% had diabetes and 12.1% had chronic lung disease. On admission, all patients presented respiratory distress with CT injury superiors to 50% in 49.7% of patients. 57.7% patients were intubated during hospitalization. ICU length of stay was 9 ± 8 days. ICU mortality was 45%. All patients received dexamethasone. 77.2% were included in group 1 and 20.5% patients in group 2. There was no difference in acute kidney injury rate (17.6% vs. 3.4%; p = 0.275) or the need of mechanical ventilation (59.5% vs 45.4%; p = 0.11) between the two groups. We noticed a higher incidence of nosocomial infection without signification (61.1% vs 45.8%; p = 0.095). However, in the high dose dexamethasone group, we contented a higher rate of mortality not significant (48.3% vs. 29.1%; p = 0.059). Besides, we noted more hyperglycemia and hypokalemia in the group 1 ((53% vs. 34%; p = 0.04), (12% vs. 6%; p = 0.039)).

**Conclusion:** Different doses of corticosteroids seem to increase the rate of nosocomial infection and do not affect mortality. However, the high-dose group patients had more metabolic complications.

**Reference 1:** Maskin LP, Olarte GL, Palizas F, Velo AE, Lurbet MF, Bonelli I, et al. 26 août 2020;21.

**Reference 2:** J Biol Regul Homeost Agents. août 2020;34.

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

FC-163

The impact of solumedrol in patients with COVID-19 related acute respiratory distress syndrome (ARDS)

SDIRI Ines¹, FITOUHI Nizar¹, DRIDI Amira¹, DORGHAM Sana¹, OUERGHI Sonia¹, MESTIRI Tahar¹

¹Hôpital ariana abderahmen memi, Sfax, Tunisie

**Correspondence:** Ines SDIRI (sdiri.ynes@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-163

**Rationale:** Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. The aim of our study was to evaluate the impact of methylprednisolone boli (1) on the prognosis of patients admitted to the ICU for covid 19 pneumonia.

**Patients and methods/Materials and methods:** A retrospective study in intensive care unit of circumstance hospital over the period from January to September 2021. All admitted patients were systematically put on dexamethasone intravenously for 10 days, some of them had a stagnant respiratory status during the hospitalization, received a bolus of solumedrol 5 days in a row, at a dose of 250 mg/day and followed by hydrocortisone hemisuccinate at a dose of 1 mg/kg/day of methylprednisolone equivalent with progressive digression over 15 days, according to the clinician's judgement, ensuring the absence of concomitant infection. Secondary, our population was divided into two groups: those who received solumedrol (group 1) and those who received only dexamethasone (control group). These two groups were
matched on age, gender, SAPSII and APACHE scores, severity of acute respiratory distress syndrome on admission and clinical severity.

**Results:** Our study population included 82 patients, 41 in each group. The two groups were matched for age (p = 0.9), gender (p = 1), and different comorbidities (obesity, p = 0.19, cardiovascua- lar history p = 0.009 and respiratory history p = 0.3). At admission, 35 patients (92%) in group 1 had moderate to severe ARDS (p = 0.9). However, the solumedrol group had a more severe clinical presenta- tion at admission: oxygen saturation on admission (89.5% ± 9 versus 92% ± 5 in the control group, (p = 0.02); more signs of struggle (15 patients versus 8 in the control group, p = 0.07). Solumedrol adminis- tration was performed within a median of 4 days [2–6], with respira- tory worsening occurring within a median of 4 ± 3 days (p = 0.05). The use of invasive mechanical ventilation was more frequent in the G1 (25 patients versus 20, p = 0.008). The occurrence of nosocomial infection was more frequent in the G1 (31 vs. 21 patients, p = 0.001). The duration of invasive mechanical ventilation, length of stay were comparable between the two groups (p = 0.3 and p = 0.08 respec- tively). The prescription of bolus solumedrol was associated with higher rate of mortality (69% G1 vs. 45%; p = 0.005) and more shock (p = 0.004).

**Conclusion:** Patients who received solumedrol had a more severe clinical presentation, with more invasive mechanical ventilation, more nosocomial infection and higher rate of mortality (2). A randomized study is needed to assess the efficacy of solumedrol compared with dexamethasone.

**Reference 1:** Pinzón MA, Ortiz S, Holguín H, Betancur JF, Cardona Arango D, Laniado H, et al.

**Reference 2:** Edalatifard M, Akhtari M, Salehi M, Naderi Z, Jamshidi A, Mostafaei S, et al.

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

FC-164

Therapeutic plasma exchange in patients with covid-19
pneumonia in intensive care unit: cases series

ZAID Ikram¹, ESSAAD Ounci¹, EL AIDOUNI Ghizlane¹, AABDI Mohammed¹,
BERRICHI Samia¹, TAOUIHAR Salma¹, MARBOUH Manal¹, BKIYER
Houssam¹, ABDA Naima¹, HOUSNI Brahim¹

¹Centre Hospitalier Universitaire Oujda, Oujda, Maroc

Correspondence: Ikram ZAID (ikramzaid1993@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-164

**Rationale:** COVID 19 pneumonia can lead to an inappropriate inflam-
matory response, and can be complicated by acute respiratory distress
syndrome, multi organ failure with a high mortality rate. The objective
of this study is to observe the effect of therapeutic plasma exchange
on the excessive inflammatory response.

**Patients and methods/Materials and methods:** In this study, we included 7 confirmed cases of COVID-19 in the intensive care unit (ICU). COVID-19 cases were confirmed by RT PCR (reverse transcription polymerase chain) and CT (computerized tomography) imaging according to WHO guidelines. Therapeutic plasma exchange was performed to decrease cytokine storm-induced ARDS (Acute respiratory distress syndrome). Inflammation marker assays were performed before and after therapeutic plasma exchange to assess its efficacy.

**Results:** Levels of inflammatory cytokines (IL-6) and acute phase response proteins, including ferritin and CRP, were elevated before therapeutic plasma exchange. After therapeutic plasma exchange, levels of acute phase reactants and inflammatory mediators were significantly reduced (p < 0.05).

**Conclusion:** Our data suggest that therapeutic plasma exchange reduces the inflammatory response in patients with severe COVID-19 not undergoing mechanical ventilation. Further studies are needed to explore the efficacy of therapeutic plasma exchange in patients with COVID-19.

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

FC-165

Impact of corticosteroid use in critically-ill COVID-19 patients
on mortality, intubation, and adverse events: a French
multicenter study

RAYMOND Matthieu¹, LE THUAULT Aurélie¹, ASFAR Pierre², DARREAU Cédric³, REIZINE Florian⁴, COLIN Gwenhaël⁵, DANO Charly⁶, LORBER Julien⁷, HOURMANT Baptiste⁸, DELBOVE Agathe⁹, FREROU Aurélien¹⁰, MORIN Jean¹, ERGRETEAU Pierre Yves¹¹, SEGUIN Philippe⁴, REIGNIER Jean¹, LASCARROU Jean Baptiste¹, CANET Emmanuel¹

¹CHU de Nantes, Nantes, France; ²CHU d'Angers, Angers, France; ³CH du Mans, Le Mans, France; ⁴CHU de Rennes, Rennes, France; ⁵CHD La Roche sur Yon, La Roche Sur Yon, France; ⁶CH de Cholet, Cholet, France; ⁷CH de Saint Nazaire, Saint Nazaire, France; ⁸CHU de Brest, Brest, France; ⁹CH de Vannes, Vannes, France; ¹⁰CH de Saint Malo, Saint Malo, France; ¹¹CH de Morlaix, Morlaix, France

**Correspondence:** Matthieu RAYMOND (matthieu.raymond@chu-nantes.fr).

Annals of Intensive Care 2022, 12(1):FC-165

**Rationale:** The use of corticosteroids is recommended for the management of critically-ill COVID-19 patients based on the results of the RECOVERY trial [1], which reported a reduced day-28 mortality in patients requiring oxygen therapy or mechanical ventilation. However, the effectiveness and safety of corticosteroids still remain a matter of debate.

**Patients and methods/Materials and methods:** We conducted a multicenter observational study. All Covid-19 patients admitted in 13 ICUs from Pays-de-la-Loire and Bretagne regions between February 1st 2020 and December 31st 2020 were included. The main objective was to assess the impact of an early course of dexamethasone on day-28 mortality.

**Results:** Overall, 1058 patients were included of whom 644 (60.87%) were intubated. An early course of dexamethasone (dexamethasone group) was given to 611 (57.75%) patients while 447 (42.25%) patients did not receive an early course of dexamethasone (usual care group). Day-28 mortality was 15.4% in the whole population, 15.1% in the dexamethasone group, and 15.9% in the usual care group (p = 0.63). On multivariable analysis, age (aHR 1.06 (1.03–1.08), p < 0.001), SOFA score (aHR 1.15 (1.09–1.21), p < 0.001), and immunocompromised status (aHR 1.62 (1.06–2.47), p = 0.026) were associated with a higher risk of day-28 mortality while the use of dexamethasone had no impact (aHR 0.81 (0.57–1.15), p = 0.245). The risk of intubation was reduced in the dexamethasone group compared to the usual care group. This result was confirmed after adjustment for respiratory rate, PaO2/FiO2 ratio, and respiratory support at ICU admission (standard oxygen vs high-flow oxygen or non-invasive ventilation) (aHR 0.48 (0.40–0.58), p < 0.001). Ventilator-free days at day-28 were 22 [2;28] in the dexamethasone group and 15 [0;28] in the usual care group (p < 0.001). Patients in the dexamethasone group had a higher risk of ventilator associated pneumonia than those of the usual care group (HR 1.24 (1.00–1.54), p = 0.05), while there was no difference on the risk bloodstream infection (HR 1.23 (0.80–1.88), p = 0.35), fungal infection (OR 0.64 (0.37–1.10), p = 0.11) and gastrointestinal bleeding (OR 1.10 (0.58–2.09), p = 0.77) between the 2 groups.

**Conclusion:** In our study, an early course of dexamethasone in critically-ill Covid-19 patients was not associated with a reduced day-28 mortality, but increased the risk of ventilator associated pneumonia compared to standard of care management. However, an early course of dexamethasone reduced the risk of intubation, increased the number of ventilator-free days at day-28, and was not associated with a higher risk bloodstream infection, fungal infection or gastro-intestinal bleeding.

**Reference 1:** [1] RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in Hospitalized Patients with Covid-19—Preliminary Report. N Engl J Med. 17 juil 2020.

**Compliance with ethics regulations:** Yes in clinical research.
FC-166

High dose steroids for persisting ARDS in critically ill
COVID-19 patients treated with dexamethasone: a prospective
observational multicentre study

LOPINTO Julien¹, ARRESTIER Romain¹, VOIRIOT Guillaume³, URBINA
Tomas², LUYT Charles-Edouard⁴, BELLAICHE Raphael¹, PHAM Tai⁶,
AIT-HAMOU Zakaria⁷, ROUX Damien⁵, CLERE-JEHL Raphael⁹, GAUDRY
Stéphane⁸, MAYAUX Julien⁴, MEKONTSO DESSAP Armand¹, DE PROST
Nicolas¹

¹Hôpital Henri Mondor AP-HP, Créteil, France; ²Hôpital Saint Antoine
AP-HP, Paris, France; ³Hôpital Tenon AP-HP, Paris, France; ⁴Hôpital Pitié
Salpétrière AP-HP, Paris, France; ⁵Hôpital Louis Mourier AP-HP, Colombes,
France; ⁶Hôpital Bicêtre AP-HP, Le Kremlin-Bicêtre, France; ⁷Hôpital Cochin
AP-HP, Paris, France; ⁸Hôpital Avicenne AP-HP, Bobigny, France; ⁹Hôpital
Civil de Strasbourg, Starsbourg, France

**Correspondence:** Julien LOPINTO (julien.lopinto@aphp.fr)

Annals of Intensive Care 2022, **12**(1):FC-166

**Rationale:** Severe COVID-19 is responsible for acute respiratory distress syndrome (ARDS), requiring the use of invasive mechanical ventilation in 60% of the cases. Short-term corticosteroid therapy (CTC) initiated in the acute phase of the infection reduces the 28-day mortality of patients on oxygen therapy or mechanical ventilation. In some cases, the evolution in intensive care is marked by the persistence of ARDS; the mechanisms generating this unfavorable development involve inflammatory processes and pulmonary fibro-proliferation. The impact of high-dose corticosteroid therapy has already been assessed in the field of persistent ARDS unrelated to SARS-CoV-2 but to date there is not data to assess the impact of such a strategy during severe COVID-19.

**Patients and methods/Materials and methods:** We collected data from the prospective multicenter database ANTICOV involving 11 intensive care unit (ICU) of AP-HP. Eligible patients were admitted in ICU with pneumonia related to COVID 19 and were treated with initial CTC with dexamethasone. We compared patients receiving usual ICU care and patients receiving a secondarily high dose of CTC during ICU care (CTC group).

**Results:** Between September 2020 and March 2021, we enrolled 593 patients. 61 patients (12%) received secondarily high doses of CTC during ICU care. Median delay between dexamethasone and high dose of corticosteroids was 16 days [9-27.5]. There was no between-group difference for median SOFA admission. ICU mortality was higher in the CTC group (48%) as compared with usual care (28%) (p=0.002). Invasive mechanical ventilation was performed in 359 (67%) patients with usual care and in 47 (77%) patients in CTC group (p = 0.13). The median duration in days of mechanical ventilation and ICU length of stay was higher in the CTC group: respectively 16 [9-28] and 13 [6-27] vs 26.5 [19-40] and 31 [21-45] (both p<0.001). The proportion of bacterial ventilator associated pneumonia was higher in the CTC group (69%) as compared with usual care (49%) (p = 0.004). Fungal infection was documented in 40 (7.5%) with usual care and in 8 patients (13%) in CTC group (p = 0.132). ICU mortality in CTC group with fungal infection was 87.5%.

**Conclusion:** We found that 12% of patient admitted in ICU for severe COVID 19 received a secondarily high doses of corticosteroids during ICU care. High doses CTC was associated with a higher mortality rate in ICU and higher duration of invasive mechanical ventilation and ICU stay. Propensity score will be made to assess the probability of CTC assignment conditional on observed baselines.

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

FC-167

Efficacy of corticosteroids as rescue therapy for prolonged
mechanically ventilated-COVID-19 patients with suspected
pulmonary fibroproliferation: an observational retrospective
study

SIBLANI Dima¹, STEFAN Roxana-Maria¹, SROUR Claire¹, PALPACUER
Clément¹, KUTEIFAN Khaldoun¹, STIEL Laure¹

¹GHRMSA - Hôpital Emile Muller, Mulhouse, France

**Correspondence:** Laure STIEL (lau57@hotmail.fr)

Annals of Intensive Care 2022, **12**(1):FC-167

**Rationale:** Pathophysiology of coronavirus disease 2019 (COVID-19) suggests a strong role of exaggerated immune response in the evolution to acute respiratory distress syndrome (ARDS). COVID-19 ARDS is characterized by its protracted course, lasting twice as long as ARDS of other origins. Persistent ARDS is characterized by ongoing inflammation, excessive pulmonary fibroproliferation (PFP), prolonged mechanical ventilation, and a substantial mortality. Corticosteroid treatment dampens the hyperinflammatory response and is prescribed as an adjunctive treatment for moderate and severe forms of COVID-19 pneumonia. Only rare data are available for patients with COVID-19 requiring prolonged ventilation. In this retrospective study, we aimed to assess the efficacy of corticosteroids as rescue therapy in patients with persistent COVID-ARDS.

**Patients and methods/Materials and methods:** This observational retrospective study was conducted in one intensive care unit of a French general hospital including mechanically ventilated COVID-ARDS patients admitted between March 2020 and January 2022 who received high-dose of methylprednisolone (1-2 mg/kg/day) for persistent COVID-ARDS after more than ten days of mechanical ventilation. Included patients exhibit at least one out of three criteria for suspicion of PFP changes: low lung compliance, fibrotic changes on Chest CT, or persistent hypoxemia. Endpoints were improvement of lung compliance and hypoxemia.

**Results:** Four hundred forty-three patients with severe COVID pneumonia were admitted to our ICU during the inclusion period. One hundred eighty-seven patients were mechanically ventilated for more than ten days. Nineteen patients (10%) had persistent ARDS and received high-dose methylprednisolone as rescue therapy. Mean age was 68.2+6.3 years, median SOFA score at initiation of corticotherapy was 8. Mean delay between intubation and methyprednisolone initiation was 19.1+5.6 days. Ten patients (53.7%) survived and were discharged from ICU, and all were still alive at day-90. Lung compliance upon initiation of corticotherapy was similar in patients who survived and those who died (20.1+12.5 and 19.9+5.6 ml/cmH₂O respectively). PaO₂/FiO₂ ratio was also similar between both groups (152+42.6 and 124.2+31.7 respectively). Survivors showed significant improvement in both lung compliance (p = 0.0324, Fig. 1A) and PaO₂/FiO₂ ratio (p = 0.0352, Fig. 1B).

**Conclusion:** In this cohort of persistent COVID-19 ARDS patients with suspicion of PFP evolution, both lung compliance and PaO₂/FiO₂ ratio did significantly ameliorate in patients who survived. Whether this observed improvement in lung mechanics and hypoxemia is due to the late use of steroids, or not, has to be confirmed.

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

<figure><img src="image_94.png" /></figure>

Evolution of lung compliance and PaO₂/FiO₂ ratio after initiation of corticotherapy
FC-168

Comparison between different doses of dexamethasone and its
outcome on critically ill COVID-19 patients

ALILA llef¹, HADDED Amina¹, JERBI Salma¹, KHARRAT Sana¹, BOUBTANE

Rhab ¹, BAHLOUL Mabrouk¹, BOUAZIZ Mounir¹

¹Hôpital Habib Bourguiba Sfax, Sfax, Tunisie

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

Annals of Intensive Care 2022, **12**(1):FC-168

**Rationale:** The coronavirus disease 2019 significantly impacted human society. Recently, the synthetic pure glucocorticoid dexamethasone was identified as an effective compound for treatment of severe COVID-19 (1). The aim of this study was to compare the different doses of dexamethasone prescribed and their impact on prediction of outcome in critically ill COVID-19 patients.

**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. Dexamethasone-based corticosteroid therapy was introduced from day one in patients with acute distress respiratory syndrome (ARDS) with different doses: ≤ 8 mg/day, 12 mg/day and 24 mg/day.

**Results:** During the study period, 430 patients were included with a mean age of 58.7 ± 15.9 and a gender ratio of 1.5. The median SAPSII and SOFA score were respectively of 28 ± 15 and 4 ± 2.6. Most patients had comorbidities, including hypertension (35.8%), obesity (31.6%) and diabetes (36.7%). At admission, 301 patients had severe ARDS (70%). Dexamethasone was prescribed with 12 mg/day in 342 patients (79.5%), with ≤ 8 mg/day in 51 patients (11.9%) and 24 mg/day in 37 patients (8.6%). The use of invasive mechanical ventilation was more frequent in patients who received 12 mg/day (46%; p = 0.035). The occurrence of infection during hospitalization was high in the same group of patients (46%; p = 0.014). There was no significant difference between the three doses of dexamethasone in terms of diabetic decompensation, hypokalemia or mortality (Table I).

**Conclusion:** This study showed that the use of different doses of dexamethasone was not associated with different outcome in critically ill COVID-19 patients admitted in ICU.

**Reference 1:** (1) Tomoshige Kino, Irina Burd, James H. Segars: Dexamethasone for severe COVID-19: how does it work at cellular and molecular levels?

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

<table><caption>Table 1: outcome comparison according to dexamethasone dose</caption><thead><tr><th rowspan="2">Parameters</th><th colspan="3">Dexamethasone dose</th><th rowspan="2">p</th></tr><tr><th>≤ 8mg/d (n=51)</th><th>12mg/d (n=342)</th><th>24mg/d (n=37)</th></tr></thead><tbody><tr><td>Severe ARDS, n (%)</td><td>28 (55)</td><td>252(74)</td><td>21(57)</td><td>0.026</td></tr><tr><td>VMI, n (%)</td><td>14(28)</td><td>157(46)</td><td>14(38)</td><td>0.035</td></tr><tr><td>Hyperglycemia, n (%)</td><td>23(45)</td><td>131(38)</td><td>12(32)</td><td>0.623</td></tr><tr><td>Hypokalemia, n (%)</td><td>6(12)</td><td>31(9)</td><td>5(13)</td><td>0.495</td></tr><tr><td>Infection, n (%)</td><td>21(41)</td><td>157(46)</td><td>8(22)</td><td>0.014</td></tr><tr><td>Mortality, n (%)</td><td>22(43)</td><td>160(47)</td><td>17(46)</td><td>0.892</td></tr></tbody></table>

FC-169

Delirium in critically ill patients: a prospective study

SANA Khedher¹, HASSAN Majid Al Dossari¹

¹AFH Wady addawassir, Riadh, Arabie Saoudite

**Correspondence:** Khedher SANA (sanakhedher@hotmail.fr)

Annals of Intensive Care 2022, **12**(1):FC-169

**Rationale:** Delirium is among the most common problem in the intensive care unit (ICU). It is often under diagnosed and it has a considerable impact on morbidity and mortality rate. We aimed to determine the incidence, risk factors and outcomes of delirium in the ICU.

**Patients and methods/Materials and methods:** We conducted a retrospective study including critically-ill patients fulfilling the criteria for admission to the ICU between January 2022 and September 2022. Delirium was assessed during each shift (morning and evening), by trained nurses, using the Confusion Assessment Method for the ICU (CAM-ICU). SOFA and RASS scores were calculated on admission. Demographics and clinical status were also collected based on the medical record.

**Results:** One hundred twenty patients were included. Median age was 75 ± 13 years with a sex ratio of 1.2. Fourty-two developed delirium (incidence: 35%); 20% were hypoactive, 5% mixed and 10% were hyperactive in type. They were older (70 versus 55) and had a significantly higher SOFA score at admission (8[8–10] versus 3 [2–4], p < 0.001), RASS (2.8 versus 1.3, p < 0.001). Cumulative doses of midazolam (80 mg versus 48 mg, p < 0.001). The presence of visual or auditory deficits were reported at baseline in 27.7% of patients with delirium. They had also longer ICU length-of-stay (6 vs 14, p < 0.001) and mortality was significantly higher in the delirium group (44.4% versus 28%).

**Conclusion:** The incidence of delirium in our ICU is 35%, it was associated with a twofold increase in the risk of death and prolongs the length of hospitalization. Our results were an opportunity to implement a strategy for assessment and surveillance and prevention of delirium to improve the care in ICU.

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

FC-170

Mortality predictors of snake bite envenomation in southern
Tunisia

BRADAI Sabrine¹, GHORBEL Rezk¹, TURKI Olfa¹, CHTARA Kamilia¹,

BAHLOUL Mabrouk¹, BEN HAMIDA Chokri¹, BOUAZIZ Mounir¹

¹Habib Bourguiba University Hospital, Sfax, Tunisia, Sfax, Tunisie

**Correspondence:** Sabrine BRADAI (sabrine.bradai2@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-170

**Rationale:** Snakebite envenoming is a neglected tropical disease that kills more than 100.000 people every year. In Tunisia, it is particularly frequent in the sub-Saharan regions with high mortality and morbidity. Therefore, we aim to identify the predictor factors of mortality in snakebite envenomation in our region.

**Patients and methods/Materials and methods:** It is a retrospective descriptive study, conducted at the intensive care unit (ICU) of Habib Bourguiba University Hospital, Sfax, Tunisia, over a period of 16 years (from January 01, 2006, to December 31, 2021). Snakebite envenomation was defined by a history of snakebite. Survivor and non-survivor subgroups were compared to identify predictors of mortality.

**Results:** Out of the 19 included patients, 4 patients died. The mortality rate was 21.1%. Univariate analysis revealed that at ICU admission: high SOFA (p = 0.017), high shock index (p = 0.024), high value of leucocytes (p = 0.001), high value of blood urea (p = 0.003) and the presence of clinical signs of shock (p = 0.037), are associated with mortality.

**Conclusion:** Early evaluation of severity at admission is crucial in the management of snakebite envenomation. Further multicentric studies are required to approve a severity scale proper to snakebite envenomation in Tunisia.

**Reference 1:** World Health Organization. Venomous snakes distribution and species risk categories. 2017. [Online] Available from: https://apps.who.int/bloodproducts/snakeantivenoms/database/default.html.

**Reference 2:** Chakroun-Walha O, Issaoui F, Nasri A, Bradai H, Farroukh A, Karray R, et al. Early severity predictors of snakebite envenomation in the southern region of Tunisia: a multivariate analysis. J Acute Dis. 2021;10(2):71.

**Compliance with ethics regulations:** Yes in clinical research.
<table><caption>Table 1: Univariate analysis of predictors of mortality in snake envenomation at admission in ICU.</caption><thead><tr><th>Variables</th><th>Survivors (n=15)</th><th>Dead (n=4)</th><th>P</th></tr></thead><tbody><tr><td>Age (mean ± SD, years)</td><td>25.1 ± 24.9</td><td>34.8 ± 31</td><td>0.443</td></tr><tr><td>Sex ratio (M/F)</td><td>6/9</td><td>4/0</td><td>0.087</td></tr><tr><td>SAPS II (mean ± SD)</td><td>19.6 ± 13.5</td><td>29 ± 19.3</td><td>0.267</td></tr><tr><td>APACHE II (mean ± SD)</td><td>7.1 ± 5.1</td><td>10 ± 3.9</td><td>0.552</td></tr><tr><td>SOFA (mean ± SD)</td><td>3.8 ± 3.1</td><td>8 ± 1.4</td><td><strong>0.017</strong></td></tr><tr><td>Shock Index (mean ± SD)</td><td>0.72 ± 0.4</td><td>1.3 ± 0.6</td><td><strong>0.024</strong></td></tr><tr><td>Snake's species:</td><td></td><td></td><td>1</td></tr><tr><td>Viperidae</td><td>10</td><td>3</td><td></td></tr><tr><td>Elapidea</td><td>5</td><td>1</td><td></td></tr><tr><td>Clinical features (n):</td><td></td><td></td><td></td></tr><tr><td>Coma (GCS&lt;12)</td><td>4</td><td>1</td><td>1</td></tr><tr><td>Fever</td><td>4</td><td>1</td><td>1</td></tr><tr><td>Ptosis</td><td>5</td><td>0</td><td>0.530</td></tr><tr><td>Neurologic deficits</td><td>4</td><td>1</td><td>1</td></tr><tr><td>Dyspnea</td><td>6</td><td>3</td><td>0.303</td></tr><tr><td>Shock</td><td>2</td><td>3</td><td><strong>0.037</strong></td></tr><tr><td>Nausea</td><td>4</td><td>3</td><td>0.530</td></tr><tr><td>Vomiting</td><td>6</td><td>0</td><td>0.255</td></tr><tr><td>Diarrhea</td><td>2</td><td>0</td><td>1</td></tr><tr><td>Abdominal pain</td><td>5</td><td>0</td><td>0.530</td></tr><tr><td>Oedema</td><td>1</td><td>1</td><td>0.523</td></tr><tr><td>Local</td><td>3</td><td>1</td><td></td></tr><tr><td>Regional</td><td>11</td><td>2</td><td></td></tr><tr><td>Extensive</td><td>1</td><td>1</td><td></td></tr><tr><td>Echymosis</td><td>3</td><td>4</td><td><strong>0.009</strong></td></tr><tr><td>Blisters</td><td>1</td><td>1</td><td>0.386</td></tr><tr><td>Necrosis</td><td>3</td><td>1</td><td>1</td></tr><tr><td>Thrombosis</td><td>1</td><td>1</td><td>0.383</td></tr><tr><td>Compartment syndrome</td><td>3</td><td>1</td><td>1</td></tr><tr><td>Ischemia</td><td>2</td><td>0</td><td>1</td></tr><tr><td>Grade of severity (Audebert classification):</td><td></td><td></td><td>0.860</td></tr><tr><td>III</td><td>10</td><td>3</td><td></td></tr><tr><td>II</td><td>4</td><td>2</td><td></td></tr><tr><td>I</td><td>1</td><td>0</td><td></td></tr><tr><td colspan="4"><strong>Blood tests on ICU admission (mean ± SD):</strong></td></tr><tr><td>Leucocytes (/mm3)</td><td>12420 ± 4223.6</td><td>22150 ± 4194</td><td><strong>0.001</strong></td></tr><tr><td>Hemoglobin (g/dl)</td><td>11.6 ± 2.1</td><td>11.8 ± 5.5</td><td>0.945</td></tr><tr><td>Platelets (/mm3)</td><td>197400 ± 97105</td><td>80000 ± 76984</td><td>0.044</td></tr><tr><td>Prothrombin rate (%)</td><td>62 ± 25</td><td>35 ± 34</td><td>0.100</td></tr><tr><td>Sodium (mmol/l)</td><td>136.2 ± 3.6</td><td>103.4 ± 6.6</td><td>0.398</td></tr><tr><td>Potassium (mmol/l)</td><td>3.8 ± 0.65</td><td>3.8 ± 0.4</td><td>0.933</td></tr><tr><td>Blood urea (mmol/l)</td><td>5.1 ± 4.1</td><td>13.4 ± 4.8</td><td><strong>0.003</strong></td></tr><tr><td>Blood Creatinine (µmol/l)</td><td>68 ± 47.4</td><td>110.5 ± 43</td><td>0.124</td></tr><tr><td>pH</td><td>7.37 ± 0.08</td><td>7.32 ± 0.13</td><td>0.384</td></tr><tr><td>PaO2 (mmHg)</td><td>111.4 ± 40.1</td><td>114 ± 40.5</td><td>0.884</td></tr><tr><td>PCO2 (mmHg)</td><td>33.2 ± 8</td><td>37.8 ± 11</td><td>0.363</td></tr><tr><td>HCO3- (mmol/l)</td><td>18 ± 3</td><td>17 ± 4</td><td>0.639</td></tr><tr><td>CPK (UI/l)</td><td>979.9 ± 1534</td><td>628 ± 559</td><td>0.664</td></tr></tbody></table>

## FC-171

### Acquired agitation in ARDS with Covid-19 compared to influenza patients: a propensity score matching observational study

MAAMAR Adel¹, LIARD Clémence¹, REIZINE Florian¹, PAINVIN Benoit¹, DELAMAIRE Flora¹, COIRIER Valentin¹, QUELVEN Quentin¹, GUILLOT Pauline¹, LESOUHAITIER Mathieu¹, TADIE Jean-Mac¹, GACOUIN Arnaud¹
¹CHU de Rennes, Hôpital Pontchaillou, Rennes, France.

**Correspondence:** Adel MAAMAR (adel.maamar@chu-rennes.fr)

Annals of Intensive Care 2022, **12**(1):FC-171

**Rationale:** A growing body of evidence reports that agitation and encephalopathy are frequent in critically ill Covid-19 patients. Our aim was to assess the incidence and risk factors of agitation in critically-ill ARDS patients with Covid-19, and compare these findings to a population of patients with ARDS patients with influenza.

**Patients and methods/Materials and methods:** We included all patients with laboratory-confirmed Covid-19 infection and ARDS admitted to our medical intensive care unit (ICU) between March 10th, 2020 and April 16th, 2021, and all the patients with laboratory-confirmed influenza infection and mechanical ventilation (MV) admitted to our ICU between April 10th, 2006 and February 8th, 2020. Clinical and biological were retrospectively collected. We also recorded previously known factors associated with agitation (ICU length of stay, length of invasive ventilation, SOFA score and SAPS II at admission, sedative and opioids consumption, time to defecation). Agitation was defined as a day with Richmond Agitation Sedation Scale greater than 0 after exclusion of other causes of delirium and pain. We compared the prevalence of agitation among Covid-19 patients during their ICU stay and in those with influenza patients. To improve the balance of baseline characteristics and reduce the effects of selection bias and potential confounding factors in this

observational study, a propensity score analysis was performed. Second, we used a Cox-proportional hazard model to determine whether agitation during the ICU stay was independently associated with mortality at day-28.

**Results:** We included 241 patients (median age 62 years [53–70], 158 males (65.5%)), including 146 patients with Covid-19 and 95 patients with Influenza. One hundred eleven (46.1%) patients had agitation during their ICU stay. Patients with Covid-19 had significantly more agitation than patients with influenza (respectively 80 patients (54.8%) and 31 patients (32.6%), p < 0.01). After matching with a propensity score, Covid-19 patients remained more agitated than influenza patients (49 (51.6% vs 32 (33.7%), p = 0.006). Agitation remained independently associated with mortality after adjustment for other factors (HR = 1.85, 95% CI 1.37–2.49, p < 0.001).

**Conclusion:** Agitation in ARDS Covid-19 patients is more frequent than in ARDS influenza patients. The agitation was not associated with common risk factors, such as severity of illness or sedation. These findings suggest that SARS-CoV-2 is directly and indirectly involved in agitation and should probably be acknowledged as a risk factor. As agitation can be one of the presentations of a delirium, its presence should alert us to the risk of encephalopathy.

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

<table><caption>Baseline characteristics and outcomes in the matched population</caption><thead><tr><th></th><th>Covid-19<br>(n = 95)</th><th>Influenza<br>(n = 95)</th><th>p value</th></tr></thead><tbody><tr><td>Age - years</td><td>59 [50-68.5]</td><td>59 [50.5-65]</td><td>0.42</td></tr><tr><td>Male</td><td>66 (69.5)</td><td>59 (62.1)</td><td>0.36</td></tr><tr><td>Medical history</td><td></td><td></td><td></td></tr><tr><td>Hypertension</td><td>42 (44.2)</td><td>24 (25.3)</td><td>0.01</td></tr><tr><td>Diabetes mellitus</td><td>21 (22.1)</td><td>12 (12.6)</td><td>0.13</td></tr><tr><td>Obesity</td><td>68 (71.6)</td><td>22 (23.2)</td><td>&lt;0.001</td></tr><tr><td>BMI - kg/m<sup>2</sup></td><td>28.6 [26-33.6]</td><td>27 [23.8-31.1]</td><td>0.06</td></tr><tr><td>GCS at admission</td><td>15 [15-15]</td><td>15 [15-15]</td><td>0.12</td></tr><tr><td>Severity during the first 24h</td><td></td><td></td><td></td></tr><tr><td>SAPS II</td><td>32 [22-42]</td><td>46 [35-60]</td><td>&lt;0.001</td></tr><tr><td>SOFA</td><td>4 [3-7]</td><td>9 [7-11]</td><td>&lt;0.001</td></tr><tr><td>Worst PaO<sub>2</sub>/FiO<sub>2</sub></td><td>107 [83-147]</td><td>83 [63-114.5]</td><td>&lt;0.001</td></tr><tr><td>Agitation</td><td>52 (54.7)</td><td>32 (33.7)</td><td>0.006</td></tr><tr><td>Sedation</td><td></td><td></td><td></td></tr><tr><td>Length of sedation - days</td><td>9 [6-15]</td><td>10 [5-15]</td><td>0.53</td></tr><tr><td>Cumulative doses of morphine - mg</td><td>922 [540-1601]</td><td>1148 [414-2848]</td><td>0.47</td></tr><tr><td>Cumulative doses of midazolam - mg</td><td>879 [451.5-1506.5]</td><td>1136 [452-2652.5]</td><td>0.28</td></tr><tr><td>Cumulative doses of propofol - mg</td><td>6060 [2639-14080]</td><td>3930 [1120-11790]</td><td>0.06</td></tr><tr><td>Length of MV - days</td><td>13 [7-20]</td><td>14 [9-24]</td><td>0.13</td></tr><tr><td>Length of stay in ICU - days</td><td>13 [9-24]</td><td>17 [9-28]</td><td>0.4</td></tr><tr><td>Length of ileus - days</td><td>7 [4-9]</td><td>6 [4-8.5]</td><td>0.41</td></tr><tr><td>Self-extubation</td><td>13 (13.7)</td><td>8 (8.4)</td><td>0.36</td></tr><tr><td>28-days survival</td><td>83 (87.4)</td><td>77 (81.1)</td><td>0.32</td></tr></tbody></table>

Data are presented as number (%) or median [interquartile range].

List of abbreviations: BMI: body mass index, GCS: Glasgow coma scale, SAPS: simplified acute physiology score, SOFA: sequential organ failure assessment, MV: mechanical ventilation, ICU: intensive care unit

### Baseline characteristics and outcomes in the matched population

## FC-172

### Neuro-psychiatric complications of COVID-19 in intensive care unit

ESSAFI Fatma¹,², JAAFAR Nour Zayneb¹,², KHARRAT Malek¹,², BEN ISMAIL Khaoula¹,², TALIK Imen¹,², KADDOUR Moez¹,², MERHABENE Takoua¹,²

¹Intensive Care Unit, Regional Zaghouan's Hospital, Zaghouan, Tunisie;

²Faculty of Medicine of Tunis, Tunis El-Manar university, Tunis, Tunisie.

**Correspondence:** Fatma ESSAFI (fatma.essafi@fmt.utm.tn)

Annals of Intensive Care 2022, **12**(1):FC-172
**Rationale:** Several studies have reported association between COVID-19 infection and a plethora of neuropsychiatric complications whereas the neuropsychiatric damage is still contested. We aimed to describe the epidemiology of neuropsychiatric manifestations in patients hospitalized for confirmed severe COVID-19 pneumonia and determine its impact on patient's management and outcome.

**Patients and methods/Materials and methods:** All data of confirmed COVID-19 patients hospitalized in Zaghouan's Hospital ICU between March 2020 and January 2022 were retrospectively analyzed. We collected epidemiological, clinical, prescribed medications and outcomes. Factors associated with neuropsychiatric complications and its impact on mortality were evaluated through binary logistic regression models, by comparing two groups: patients with or without neuropsychiatric manifestations.

**Results:** Of the total of 365 patients included, 201 have developed neurologic and/or psychiatric manifestations during their hospital stay (55%). Median age was 58 [17-89] with sex ratio 1.3. Median SAPS II and APACHE II scores were 26±8.3 and 7±4.9 respectively. Fifteen patients had underlying psychiatric disease history and two had a history of ischemic stroke without sequelae. Neurologic disorders were described in 125 patients. It consisted on 118 episodes of headache, 6 ischemic strokes and 2 cases of encephalitis, one of which was symptomatic of status epilepticus; no peripheral nervous system involvement was reported. Psychiatric disturbance was seen in 121 patients. The most common manifestations were: an unexpected agitation in 79 patients, sleep disturbances in 25 patients, depressed mood in 20 patients, anxiety in 8 patients, delirium in 3 cases and confusion in 2 cases. Depression was manifested by reduced appetite and anorexia, tiredness and lack of energy and irritability. Management of patients consisted in majority of cases in long-acting benzodiazepine prescription alone or associated to neuroleptic agents. No differences were noted in demographic characteristics between patients who developed neuropsychiatric signs and the others. But active smoking was associated with the presence of neuropsychiatric signs (44.7% vs 31.7%, p=0.034). At admission, the 2 groups had comparable respiratory exchange and laboratory findings. Presence of psychiatric signs was significantly associated with more use of invasive mechanical ventilation (49% vs 24.3%, p<0.001), longer length of ICU stay (11 vs 7 days, p<0.001) and higher ICU mortality (60% vs 33%, p<0.001). Headache, the most common neurologic manifestation, alone was not associated with worse prognosis.

**Conclusion:** Neuroinflammation associated to SARS-CoV-2 infection could be responsible for a wide and still unknown spectrum of neuropsychiatric disorders which are associated with poor prognosis and high mortality. Long term follow up is recommended to detect disability consequences of neuro-COVID.

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

FC-173

Incidence and severity of the post-intensive care syndrome
at 1 year after a long hospitalization in ICU for a COVID-19-related
ARDS

TCHOUBOU Tona¹, MORICHAU-BEAUCHANT Tristan², SAINT-JOUAN
Mélanie ², DAVIAUD Fabrice³, FICHET Jerôme², THIERRY Stéphane²,
NAHUM Julien², MAILLET Jean-Michel²

¹Hôpital Delafontaine, Saint-Denis, France; ²Centre Cardiologique du Nord, Saint-Denis, France

**Correspondence:** Tona TCHOUBOU (ttchoubou@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-173

**Rationale:** Post-Intensive Care Syndrome (PICS) is a frequent condition in ICU-survivors including physical, cognitive and psychological disorders. The long-term consequences of a hospitalization in intensive care for severe COVID-19 are unknown. The aim of this study was to assess the incidence and severity of cognitive and psychological disorders, the sequelae of hospitalization and their impact on the health-related quality of life of patients who survived at one year after a prolonged hospitalization in intensive care for COVID-19-related ARDS.

**Patients and methods/Materials and methods:** Prospective, descriptive, monocentric cohort study, carried out in the Seine-Saint-Denis department in France between May and July 2021. Patients who received mechanical ventilation of at least 72 h during a stay in intensive care of at least 7 days for COVID-19-related ARDS were included.

**Results:** Thirty out of thirty-six eligible patients were assessed at a median time of 423 days since infection (IQR [404-437]). The patients' quality of life was impaired mainly in the physical domain. Sixteen percent of patients complained of asthenia and 23% reported muscle weakness. Fifty-three percent of patients complained of cognitive impairment and 36% of patients had symptoms of post-traumatic stress disorder. Symptoms of anxiety were found in 40% and symptoms of depression in 16% of patients. Seventy percent of patients had at least one skin, neurological or joint sequelae of hospitalization. Twelve patients (40%) had persistent dyspnea.

**Discussion:** This study has several limitations. It is descriptive, monocentric and the study population is quite small. Yet, to this day, the data concerning the sequelae of severe COVID-19 especially in the critically ill remain scarce. Since the "first wave" of the pandemics, the management of COVID-19 ARDS changed and effective vaccines have been found. Further studies are mandatory to assess the effect of these findings on the prevalence and severity of the PICS.

**Conclusion:** The sequelae of a hospitalization in intensive care for a COVID-19-related ARDS are common and impair survivors' health-related quality of life at one year after infection. This study among others will help to know better the long-term consequences of the COVID-19 pandemics in terms of PICS.

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

FC-174

Management of hemorrhagic stroke in neurocritical care ICU

ZEGHDOUD Dalila¹, BOUGDAL Dalila¹, SADAT Souhila¹

¹EHS SALIM ZEMIRLI EL HARRACH, Alger, Algérie

**Correspondence:** Dalila ZEGHDOUD (dalila-z2011@hotmail.fr)

*Annals of Intensive Care* 2022, **12**(1):FC-174

**Rationale:** Hemorrhagic strokes represent 10 to 15% of all strokes. The incidence increases with age, especially beyond 55 years. Intracerebral hemorrhage is a serious pathology whose mortality is between 30 to 60% at 30 days. Half of the deaths occur within the first 48 h. The management of intracerebral hemorrhage in neurocritical care units has reduced this morbidity and mortality. The objective of our study is to study the impact of the management of hemorrhagic stroke in a neurocritical care unit.

**Patients and Methods/Materials and methods:** This is a prospective, monocentric study from January 2010 to October 2019. The study involved patients admitted for hemorrhagic stroke, confirmed by brain CT. Patients with traumatic brain hematomas, hemorrhagic changes in ischemic stroke, and cerebro-meningeal hemorrhage were excluded from the study. Demographic data, history, Glasgow score, CT data, initial medical care and short-term change were studied. The surgical indication was at the discretion of the surgeon.

**Results:** During the study period 120 patients with an average age of 60 years were included, with a sex ratio of 1.1. 55% of patients were hypertensive, 13% diabetic, of which 14% were on AVK and 26% on platelet aggregation inhibitors. No risk factors were found in 32% of patients. The average Glasgow admission score was 8. At imaging, 60% had a deep localization of the hematoma and 54% a hydrocephalus. Medical management was based on monitoring of blood pressure figures in 58%, the use of mechanical ventilation in all patients, osmotherapy in 22% and reversion of anticoagulant therapy in 6% of cases. Surgery was indicated in 60% of cases: An external ventricular shunt in 70% of cases and a decompression and evacuation of the cerebral hematoma in 40% of cases. Overall mortality was 70%.

**Conclusion:** In terms of public health, stroke is a medical, social and economic scourge. It has serious life-threatening and functional consequences: just under 75% of people with intracerebral hemorrhage die within a year, and more than half of stroke survivors have significant consequences.

**Compliance with ethics regulations:** N/A.
### FC-175

#### Scorpion envenomation in the emergency department: a prospective study of predictive factors of severity

KARRAY Rim¹, MALLEK Mariem¹, BEN ALI Hana¹, ZOUARI Ala¹, BEN SALEM Imen¹, GORBEL Rizk¹, CHAKROUN-WALHA Olfa¹, REIKI Noureddine¹
¹CHU Habib Bourguiba, Sfax, Tunisie

**Correspondence:** Hana BEN ALI (Dr.hanabenali@gmail.com)

Annals of Intensive Care 2022, **12**(1):FC-175

**Rationale:** Scorpion envenomation is common in the tropical and subtropical regions. It poses a major public health problem with some patients having serious clinical manifestations and severe complications including death. The aim of our study was to describe the predictive factors of severity in the management of scorpion envenomation patients admitted in the acute care unit.

**Patients and methods/Materials and methods:** A 6 months prospective analytic observational single-center study including patients admitted for stage II or III of scorpion envenomation. Stage I scorpion envenomation were excluded. Statistical analysis was performed using the statistic software SPSS 20.

**Results:** Sixty-six patients were included. Mean age was 29 ± 20 years (1 to 84 years old) with female predominance (sex-ratio = 0.8). The majority of patients (90%) were staged II according to severity. Among demographic factors, age (p = 0.007) and the mode of transport in the acute care unit (p = 0.001) were predictor factor of mortality. However, comorbidities and gender had no prognostic impact. Clinical predictor factor of mortality on admission were: agitation (p < 0.001), dyspnea (p = 0.02), abdominal pain (p = 0.03), rapid breathing (p = 0.01), oxygen saturation (p = 0.04), priapism (p = 0.01) and the presence of signs of shock (p < 0.001): marbling, cool skin. Leukocyte, glucose level and troponin level increased significantly with the severity of envenomation and are correlated with high mortality: p = 0.001. Acidosis (p = 0.026), hypoxemia (p = 0.04) and anemia (p = 0.008) were also predictive factors of mortality. The presence of abnormalities on electrocardiogram (p = 0.005), chest X-ray (p = 0.03) and cardiac ultrasound (p < 0.001) were associated with higher mortality. Finally, a significant association was found between cardiogenic shock requiring the use of dobutamine and death rate (p < 0.001).

**Conclusion:** Scorpion envenomation is an accidental pathology that continues to be serious in our country specially in summer. The predictive factors of mortality seem similar to those described in the literature. However, new diagnostic tools may be helpful in the early detection of patients with significant risk of death.

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

### FC-176

#### Impact of intensive physical therapy on patients with neuromyopathy in a weaning unit after prolonged stay in ICU

PERETOUT Jean-Baptiste¹, COTTIAS Josépine¹, FRANTZ Camille¹, DUARTE Amaury¹, DIAZ-LOPEZ Carlos¹, CHOUKROUN Gérald¹

¹Hôpital Forcilles - Fondation Cognacq-Jay, Férolles-Attily, France.

**Correspondence:** Jean-Baptiste PERETOUT (jperetout@cognacq-jay.fr)

Annals of Intensive Care 2022, **12**(1):FC-176

**Rationale:** Neuromyopathy is a severe but common complication in the ICU, particularly for patients with prolonged stays¹. Intensive physical therapy with a muscle strengthening program and a daily schedule allows a faster recovery. The objective of this study is to determine the impact of intensive physical therapy on the functional recovery of these patients in a weaning unit.

**Patients and methods/Materials and methods:** This is a retrospective, descriptive study in a respiratory weaning unit over the year 2021. All patients hospitalized in the weaning unit were included. The MRC score at admission was used to determine the diagnosis and severity of neuromyopathy and was compared with the same score at discharge. The prevalence of neuromyopathy at admission was also investigated. Demographic and physical therapy characteristics were collected. All inpatients with complete data were analyzed.

**Results:** In 2021, 144 patients were admitted. A total of 134 patients were analyzed with male 70%, age 63 ± 12 years, COVID-19 70%. The MRC score was statistically higher at discharge than at admission: 52.3 ± 11.4 vs 39.5 ± 14 (p < 0.001). The prevalence of neuromyopathy at admission was 73% (n = 98). During the hospitalization, delivered rehabilitation treatment were: sitting on the edge of the bed in 93%, reverticalization in 82% and walking in 57%. The different techniques are presented in Table I.

**Conclusion:** Intensive physical therapy is associated with an improvement in the MRC score for patients during their stay in the weaning unit. Multidisciplinary management also contributes to improve the different functional aspects of the patients.

**Reference 1:** De Jonghe B, Lacherade JC, Durand MC, Sharshar T. Critical illness neuromuscular syndromes. Crit Care Clin. 2007 Jan;23(1):55-69.

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

<table><caption>Table I Physiotherapy rehabilitation techniques in a respiratory weaning unit.</caption><thead><tr><td>Physiotherapy rehabilitation</td><td>%</td></tr></thead><tbody><tr><td>Ergocyclometer</td><td>93,5</td></tr><tr><td>Bed edge sitting</td><td>92,8</td></tr><tr><td>Reverticalization</td><td>82</td></tr><tr><td>Walking</td><td>56,8</td></tr><tr><td>Electrostimulation</td><td>13,7</td></tr><tr><td>Respiratory physiotherapy</td><td>91,4</td></tr><tr><td>Respiratory Muscle Training</td><td>20,1</td></tr><tr><td>Cough assist device use</td><td>15,8</td></tr></tbody></table>

### FC-177

#### Breast cancer in the ICU: outcomes and prognosis factors

VIGNERON Clara¹, CHARPENTIER Julien¹, COUSSY Florence², ALEXANDRE Jérôme¹, PÈNE Frédéric¹, JAMME Matthieu³

¹Hôpital Cochin, Paris, France; ²Institut Curie, Paris, France; ³Hôpital Privé de l'Ouest Parisien, Ramsay Générale de Santé, Trappes, France

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

Annals of Intensive Care 2022, **12**(1):FC-177

**Rationale:** Breast cancer has surpassed lung cancer as the most frequently diagnosed cancer with an estimated 2.3 million new cases in 2020. One in eight to ten women will have breast cancer during their lifetime. Compared with other solid cancers, its prognosis is usually seen as encouraging even at a metastatic stage. Surprisingly, characteristics of breast cancer patients hospitalized in the ICU have seldom been described and especially whether this common pathology affects admission patterns and prognosis in critically-ill patients.

**Patients and methods/Materials and methods:** We conducted a retrospective monocenter study including patients with breast cancer requiring unplanned admission to a medical ICU over a 14-year period (2007-2020). Non-inclusion criteria were the following: admission to secure a procedure, planned admissions following elective surgery and patients with cancer cured for more than 5 years. Independent predictors of in-ICU and 1-year outcome (available for n = 170 (96%) patients) were addressed by a cause-specific multivariate Cox regression analysis.

**Results:** One hundred seventy-seven patients (median age = 65 [57-75] years) were analyzed. Breast cancer was at a metastatic stage for 122 (68.9%) patients and recently diagnosed or in progression under treatment in respectively 25 (14.1%) and 76 (42.9%) patients. Median SOFA score at admission was 5 [4-8] and patients required invasive mechanical ventilation, vasopressors/inotropic agents and renal replacement therapy in respectively 72 (40.7%), 57 (32.2%) and 26
(14.7%) cases. Admissions were related to sepsis in 56 (31.6%) patients, to iatrogenic/procedural complication in 19 (10.7%) patients and to specific (i.e. directly linked to the underlying malignant disease) complication in 47 (26.6%) patients. ICU, hospital and one-year mortality rates were respectively 20.9%, 30.5% and 57.1%. In multivariate analysis, factors associated with ICU-mortality were invasive mechanical ventilation (Cause specific hazard (CSH) 2.53 [1.11–5.75], p = 0.03) and poor performance status (at 3 or 4) (CSH 2.37 [1.18–4.80], p = 0.02). One-year mortality in ICU-survivors was independently associated with the occurrence of specific complications during ICU stay (CSH 2.20 [1.31–3.71], p = 0.003), a triple negative cancer status (CSH 1.97 [1.06–3.67], p = 0.03) and poor performance status (CSH 1.51 [1.19–1.92], p < 0.001).

**Conclusion:** One in four breast cancer patients are admitted to the ICU for life-threatening specific complications directly linked to their underlying malignant disease. The in-ICU prognosis is encouraging and not related to oncologic characteristics supporting broad-admission policy in this population. Long-term prognosis is poor, especially for those patients with advanced malignancy.

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

## FC-178

### Outcome of patients with solid tumors considered for ICU admission: a single-center experience

BENGUERFI Soraya<fnref n="1" />, HIRSINGER Baptiste<fnref n="1" />, VALENTINE Colin De Verdière<fnref n="1" />, RAIMBOURG Judith<fnref n="2" />,³, SENELLART Hélène<fnref n="2" />, VIALA Caroline<fnref n="4" />, SEGUIN Amélie<fnref n="1" />, DECAMPS Paul<fnref n="1" />, DESMEDT Luc<fnref n="1" />, REIGNIER Jean<fnref n="1" />, CANET Emmanuel<fnref n="1" />

**Correspondence:** Soraya BENGUERFI (soraya.benguerfi@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-178.

**Rationale:** Patients with solid tumors are increasingly considered for ICU admission. Our purpose was to evaluate the outcome of patients with solid tumors considered for ICU admission and to assess the performance of physiological scores at the time of triage for predicting hospital mortality.

**Patients and methods/Materials and methods:** Prospective cohort study including all patients with solid tumors for whom ICU admission was requested between July 2019 and December 2021 in a French University-affiliated Hospital.

**Results:** Of the 6,262 patients considered for ICU admission, 410 patients (6.5%) had solid tumors. Median age was 64 and 137 patients (33.4%) were women. At the time of triage, 206 patients (50.8%) had sepsis. Of the 410 patients evaluated, 176 patients (42.9%) were ultimately admitted. Diagnoses of hemoptysis (odds ratio 10.35; 95% CI 2.80–66.89; p 0.006) and pneumothorax (odds ratio 17.94; 95% CI 3.48–328.64; p 0.002) were independently associated with ICU admission, whereas older age (odds ratio 0.98, 95% CI 0.96–0.99; p 0.004) was independently associated with ICU refusal. Of the 234 patients (57.1%) who were denied ICU admission, 61 patients (26.1%) were deemed too well to benefit from ICU, and 173 (73.9%) were deemed too sick to benefit from ICU. ICU and 6-months survival rates of patients admitted to the ICU were 80.1% and 58.0%, respectively. In patients not admitted in ICU because considered too well, hospital survival was 86.9% and overall survival at 6 months was 67.2%. In patients not admitted in ICU because considered too sick, hospital survival was 37.0% and overall survival at 6 months was 19.7%. qSOFA, NEWS score and Shock index at the time of triage were similar between patients admitted and not admitted to the ICU and demonstrated poor performances for predicting hospital mortality (AUC 0.52, 0.62 and 0.51, respectively).

**Conclusion:** In our experience, patients with solid tumors had a high rate of treatment limitations taken at the time of triage. Hospital survival of patients admitted to the ICU was encouraging. However, both the significant rates of hospital mortality in patients considered too well to benefit from ICU admission, and the survival rates of patients

considered too sick underline the limits of clinical judgment at the time of triage. Unfortunately, physiological scores at the time of triage demonstrated poor performances for predicting hospital mortality.

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

## FC-179

### Mechanisms, management and prognosis of severe gastrointestinal hemorrhage in patients with pancreatic cancer: a retrospective multicenter study

PICARD Benjamin<fnref n="1" />, WEISS Emmanuel<fnref n="2" />,³, CALIEZ Olivier<fnref n="4" />, GOURY Antoine⁵, BONNY Vincent⁶, KEMOUN Gabriel<fnref n="1" />, RUDLER Marika<fnref n="4" />,⁷, RHAEMI Rami⁸, BACHET Jean Baptiste<fnref n="4" />,⁷, RONOT Maxime³,⁵, MAYAUX Julien<fnref n="1" />, DEMOULE Alexandre<fnref n="1" />,¹⁰, DECAVÈLE Maxens<fnref n="1" />,¹⁰

**Correspondence:** Benjamin PICARD (benjamin.picard@aphp.fr)

*Annals of Intensive Care* 2022, **12**(1):FC-179

**Rationale:** Gastrointestinal bleeding (GIB) is a frequent and potentially life-threatening complication in patients with pancreatic cancer. Although GIB represents the second reason for intensive care unit (ICU) admission in pancreatic cancer patients, only limited data are available regarding bleeding mechanisms, management and outcomes in these patients. Primary aim was to identify factors associated with a successful hemostatic intervention (i.e. gastrointestinal endoscopy and/or arterial embolization). Secondary aim was to identify factors associated with ICU mortality.

**Patients and methods/Materials and methods:** Retrospective multicenter cohort study in five French ICUs. All consecutive patients with pancreatic cancer, admitted to the ICU for GIB between January 2009 and January 2020 were screened for inclusion. Patients with a recent pancreatic surgery (< 4 weeks) were excluded.

**Results:** Seventy-eight patients were included (48 (62%) males, 67 [56–73] median [interquartile interval] years-old). Tumors were mainly adenocarcinoma (91%) in cephalic position (74%). Prior to ICU admission, 81% of patients received chemotherapy and 31% underwent pancreatic resection surgery. Cancer progression was identified in 51% of cases. GIB mechanisms were gastroduodenal tumor infiltration (35%), gastroesophageal varices (21%) mostly related to left-sided portal hypertension, arterial aneurysm (14%), non-tumoral ulcer (11%) and miscellaneous (19%). Arterial aneurysms were more frequently detected in patients who underwent pancreatic resection (41%) than their counterpart (2%), p < 0.001. During the ICU stay, 41 (53%) patients presented hemorrhagic shock, 60 (77%) received red blood cells transfusion (median number of red blood cells units 3 [2–5]), and 32 (41%) required mechanical ventilation. Sixty-two (80%) patients and 21 (27%) patients had at least one upper endoscopy and one arterial embolization, respectively. A successful hemostasis was achieved in 35 (45%) patients. By multivariate analysis, three independent variables were significantly associated with hemostatic interventions success: aneurysmal bleeding OR 32.76, p = 0.005; ongoing chemotherapy at ICU admission OR 0.13, p = 0.013 and prothrombin time ratio (PT) OR 1.05, p = 0.003. ICU mortality rate was 20%. By multivariate analysis, four independent variables were significantly associated with ICU mortality: performance status > 2 odds ratio (OR) 9.29,

<footnote n="1">¹Médecine Intensive Réanimation, CHU de Nantes, Nantes, France;</footnote>

<footnote n="2">²Département d'Oncologie médicale, Institut de cancérologie de l'Ouest, Saint-Herblain, France; ³Nantes Université, INSERM, CNRS, Université d'Angers, CRCI2NA, Nantes, France; ⁴Service d'Oncologie médicale, CHU de Nantes, Nantes, France</footnote>

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

<footnote n="2">²AP-HP-Nord - Université de Paris - Département d'Anesthésie-Réanimation - Hôpital Beaujon, Clichy, France; ³Université de Paris - UMRS1149 - Centre de recherche sur l'inflammation, Paris, France;</footnote>

<footnote n="4">⁴AP-HP-Sorbonne Université - Service d'Hépato-Gastro-Entérologie - Hôpital de la Pitié Salpêtrière, Paris, France; ⁵CHU de Reims - Unité de Médecine Intensive et Réanimation Polyvalente - Hôpital Robert Debré, Reims, France; ⁶APHP-6 Sorbonne Université - Service de Médecine Intensive et Réanimation - Hôpital Saint-Antoine, Paris, France; ⁷Sorbonne Université - INSERM Centre de Recherche Saint-Antoine (CRSA) - Institute of Cardiometabolism and Nutrition (ICAN), Paris, France; ⁸CHU de Reims - Service de Chirurgie hépatobiliaire, pancréatique et oncologique digestive - Hôpital Robert Debré, Reims, France; ⁹AP-HP-Nord - Université de Paris - Département de Radiologie - Hôpital Beaujon, Clichy, France; ¹⁰Sorbonne Université - INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.</footnote>
p=0.045; need for mechanical ventilation OR 24.74, p=0.006; success of therapeutic interventions OR 0.07, p=0.020 and hemorrhagic shock OR 22.02, p=0.011.

**Conclusion:** In patients with pancreatic cancer and GIB, the success of hemostatic interventions and thus ICU mortality is influenced by the mechanism of bleeding and the PT. Early identification of arterial aneurysm (abdominal CT-scan before endoscopy), especially in patients with previous pancreatic resection surgery history, and prompt PT correction should be proposed.

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

FC-180

**Clinical features and outcomes of patients with pancreatic cancer requiring medical ICU admission: a retrospective multicenter study**

KEMOUN Gabriel<fnref n="1" />, WEISS Emmanuel<fnref n="2" />,⁴, EL HOUARI Lina<fnref n="1" />, CALIEZ Olivier<fnref n="1" />, GOURY Antoine³, BONNY Vincent⁶, PICARD Benjamin<fnref n="1" />, RUDLER Marika<fnref n="1" />,⁵, RHAIEM Rami³, REBOURS Vinciane<fnref n="2" />,⁴, MAYAUX Julien<fnref n="1" />, BELIN Lisa<fnref n="1" />, DEMOULE Alexandre<fnref n="1" />,⁵, DECAVÈLE Maxens<fnref n="1" />,⁵

**Correspondence:** Gabriel KEMOUN (gabriel.kemoun@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-180

**Rationale:** Pancreatic cancer is the sixth leading cause of solid malignancy in France, with increasing incidence and low survival probability. About 5-10% of cancer patients will require intensive care unit (ICU) admission in the 2-year following diagnosis. However, there is no data regarding clinical features and outcomes of pancreatic cancer patients admitted to the ICU. Primary aim was to describe the reasons for ICU admission. Secondary aim was to identify factors associated with ICU mortality.

**Patients and methods/Materials and methods:** Retrospective multicenter cohort study in five French ICUs from January 2009 to January 2020. All consecutive patients with proved pancreatic cancer admitted to the ICU were screened for inclusion. Patients with a recent surgery were excluded (<4 weeks). Logistic regression multivariate analysis was performed on ICU mortality.

**Results:** Two hundred and sixty-nine patients were included (161 (60%) males, 65 [57-73] median [interquartile interval] years old, simplified acute physiology score 2 (SAPS 2) 39 [29-55]). Tumors were mainly adenocarcinoma (90%) in cephalic location (70%). Time between diagnosis and ICU admission was 8 [1-17] months. At ICU admission, most of the cancer were metastatic (57%) and the disease was responsive/stable, newly diagnosed or progressive in 32%, 25% and 43% of cases respectively. Prior to ICU admissions 74% of patients received chemotherapy, 24% surgery and 13% radiotherapy. By frequencies, reasons for ICU admission were sepsis/septic shock (32%) followed by gastrointestinal bleeding (28%), acute respiratory failure (16%), metabolic disorder (12%) and miscellaneous (12%). Among the 87 patients admitted with sepsis/septic shock, a biliary tract infection was identified in 45 (52%) patients. Biliary tract infection was more frequently observed in tumors with cephalic location than their counterparts (61% vs. 24%, p=0.003). During the ICU stay, mechanical ventilation and vasopressors were required in 101 (38%) and 95 (35%) patients. ICU mortality rate was 26% 95% confidence interval [20%; 31%]. Using multivariate analysis, performance status 3-4 (OR 3.58), cancer status (responsive/stable -ref-, newly diagnosed OR 3.28, progressive OR 5.99), mechanical ventilation (OR 8.03), vasopressors (OR 4.19), SAPS 2 (OR 1.69) and pH (OR 0.02) were independently associated with ICU mortality.

**Conclusion:** The reasons for ICU admissions of pancreatic cancer patients seem to substantially differ from that observed in previous work on solid cancer (acute respiratory failure). ICU mortality seems roughly similar to that observed also in previous works on solid cancer

and is strongly influenced by performance status, disease status and organs failure at ICU admission.

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

FC-181

**Quality of life of cancer patients at 3 months after ICU stay: a prospective case-control study**

TOFFART Anne Claire<fnref n="1" />, MARNAS Wassila<fnref n="1" />, JERUSALEM Sophie<fnref n="1" />, GODON Alexandre<fnref n="1" />, BETTEGA Francois<fnref n="1" />, ROTH Gael<fnref n="1" />, PAVILLET Julien<fnref n="1" />, GIRARD Edouard<fnref n="1" />, GALERNEAU Louis Marie<fnref n="1" />, SCHWEBEL Carole<fnref n="1" />, PAYEN Jean Francois<fnref n="1" />

¹CHU GRENOBLE, La Tronche, France

**Correspondence:** Wassila MARNAS (wmsallaoui@chu-grenoble.fr)

*Annals of Intensive Care* 2022, **12**(1):FC-181

**Rationale:** Although short- and long-term survival in critically ill cancer patients was extensively studied, only limited data exist concerning their quality of life (QoL) following an intensive care unit (ICU) stay. We thus sought to determine the impact of an ICU stay on QoL at 3 months in solid cancer patients.

**Patients and methods/Materials and methods:** A prospective observational case-control study was conducted between February 2020 and February 2021 involving three French ICUs. Surviving ICU patients with lung, colorectal, or head and neck cancers at 3 months after ICU discharge were matched with non-ICU cancer patients in terms of their cancer type, anticancer treatment goal (curative/palliative), and treatment line. QoL was assessed using the Short Form 36 (SF-36) health survey (ranging 0-100, higher values indicating better QoL) including mental (MCS) and physical (PCS) components. Anticancer treatment at 3 months was additionally assessed.

**Results:** Overall, 23 surviving ICU cancer patients were matched with 46 non-ICU cancer patients. All patients answered the survey except four in the ICU group. MCS was significantly higher in ICU patients than in non-ICU patients, with a median of 54 (interquartile range [IQR]: 42-57) versus (vs.) 47 (IQR: 37-52), respectively (p=0.01). PCS did not differ between both groups, with a median of 35 (IQR: 31-47) vs. 42 (IQR: 34-47) (p=0.24). The multivariate analysis revealed a non-significant association between ICU/non-ICU patient status and patient quality-of-life scores (MCS or PCS) at 3 months post-discharge. The therapeutic strategy based on anticancer treatment at 3 months post-discharge was similar between both groups. A good performance status (PS) (coef. 1.46, confidence interval [CI] 95%: 1.11-1.90, p=0.01) and non-metastatic cancer status (coef. 1.21, CI95%: 1.05-1.40, p=0.01) were independently associated with a higher PCS.

**Conclusion:** At 3 months, cancer patients admitted into ICU displayed comparable QoL with matched patients not admitted into ICU. Thus, the challenging issue is to identify patients with good prognostic factors who would benefit from an ICU stay in terms of QoL and continue their anticancer treatments. These results require confirmation by a multicenter study.

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

FC-182

**Clinical features and outcomes of chimeric antigen receptor T-cell patients admitted to the intensive care unit: a single center experience**

LE CACHEUX Corentin<fnref n="1" />, SORTAIS Clara<fnref n="1" />, GASTINNE Thomas<fnref n="1" />, SEGUIN Amélie<fnref n="1" />, BENGUERFI Soraya<fnref n="1" />, LACOU-AGBAKOU Maité<fnref n="1" />, BLONZ Gauthier<fnref n="1" />, REIGNIER Jean<fnref n="1" />, CANET Emmanuel<fnref n="1" />

¹CHU de Nantes, Nantes, France

**Correspondence:** Corentin LE CACHEUX (lecacheuxcorentin@gmail.com).

*Annals of Intensive Care* 2022, **12**(1):FC-182

**Rationale:** Chimeric antigen receptor (CAR) T-cell therapy is a promising treatment for refractory hematological malignancies, but can induce severe adverse events. We aimed to report the clinical features and outcomes of CAR T-cell patients admitted to the intensive care unit (ICU).

<footnote n="1">¹APHP Sorbonne Université, site Pitié-Salpêtrière, Paris, France;</footnote>

<footnote n="2">²APHP-Nord, Université de Paris, Hôpital Beaujon, Clichy, France; ³Hôpital Robert Debré, CHU de Reims, Reims, France; ⁴Université de Paris, Paris, France; ⁵Sorbonne Université, Paris, France; ⁶APHP-6 Sorbonne Université, site Saint-Antoine, Paris, France</footnote>
**Patients and methods/Materials and methods:** We retrospectively included all adult patients admitted to a French University-affiliated ICU between August 27, 2018 and January 18, 2022, within 3 months after CAR T-cell therapy.

**Results:** We report 33 ICU stays for 30 patients, out of 87 (i.e., 34.5% ICU admission) treated by CAR-T cell therapy during the study period. Hematological malignancies were predominantly lymphoma (76.7%) and multiple myeloma (16.7%). ICU admission occurred 5 days (IQR 2.5–9.0) after CAR T-cell injection. Reasons for ICU admission were hemodynamic instability (42.4%), neurological failure (36.4%), and close monitoring (24.2%). Median SOFA and SAPS2 scores were 4 (IQR 3.0–6.5) and 45 (IQR 37–50), respectively. All but one patient (n = 29, 96.7%) met the criteria for cytokine release syndrome (CRS), of whom 5 (17.2%) developed grade 3–4 toxicity. Immune effector cell-associated neurotoxicity syndrome (ICANS) occurred in 20 (66.7%) patients, of whom 12 (60%) had grade 3–4 toxicity. ICANS was identified 4 days (IQR 2–4) after CRS, and 3 (10%) patients developed both CRS and ICANS grade 3–4 toxicities. Tocilizumab was used in 28 (93.3%) patients, with a median of 2 doses (IQR 1.0–3.0). Steroids were given in 24 (80%) patients, of whom 5 (20.8%) received high-dose pulse therapy. Broad-spectrum antimicrobial therapy was delivered during 32 (97%) ICU stays. Overall, 15 (50.0%) patients had a documented infection. Bacterial infections were reported in 13 (43.3%) patients and 2 (6.7%) patients had fungal infections (one pulmonary aspergillosis and one mucormycosis). Hemophagocytic syndrome was noted in 6 (20%) patients. Life-sustaining therapies were required for 12 (36.4%) patients: 11 (33.3%) received vasopressors, 7 (21.2%) were mechanically ventilated and 4 (12.1%) underwent dialysis. Overall, 3 (9.1%) patients died in the ICU (2 of them during a second ICU admission). At day-90, 11 (44.0%) patients were alive with complete remission, 5 (20%) were alive with hematological malignancy relapse, and 9 (36%) died.

**Conclusion:** ICU admission is common after CAR T-cell therapy, mostly for the management of specific toxicities. Our experience is encouraging with low ICU mortality despite a high rate of grade 3–4 toxicities, and almost half of the patients being alive in complete remission at day-90. Further studies are needed to improve the treatment of such toxicities which remains largely empirical.

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

### FC-183

#### Acute Kidney Injury in the setting of Tumor Lysis Syndrome: impact on long-term outcomes

BLOUET Anais³, BOUD'HORS Charlotte⁴, LEMERLE Marie⁵, SCHMIDT Aline⁶,⁷, KOUATCHET Achille⁵, AUGUSTO Jean-François⁴, ORVAIN Corentin⁶,⁷, DEMISELLE Julien¹,²

¹Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France; ²INSERM UMR 1260 Regenerative Nanomedecine (RNM), FMTS, Strasbourg, France; ³Onco-hématologie, Strasbourg Oncologie libérale, Strasbourg, France; ⁴Service de Néphrologie, Dialyse, Transplantation, CHU Angers, Angers, France; ⁵Service de Médecine Intensive Réanimation, Médecine Hyperbare, CHU Angers, Angers, France; ⁶Service des Maladies du sang, CHU Angers, Angers, France; ⁷CRCINA, INSERM U1232, Université de Nantes, Université d'Angers, Angers, France

**Correspondence:** Julien DEMISELLE (julien.demiselle@chru-strasbourg.fr)

Annals of Intensive Care 2022, **12**(1):FC-183

**Rationale:** Acute kidney injury (AKI) is the main complication of tumor lysis syndrome, and is associated with high mortality and short term morbidity. However, the impact of AKI in this setting with long-term outcome is poorly investigated.

**Patients and methods/Materials and methods:** We collected and analyzed data of a retrospective monocentric cohort of adult patients, hospitalized between January 2007 and December 2017, who survived to an episode of tumor lysis syndrome. Tumor lysis syndrome was defined according to Cairo and Bishop criteria (1). For each patient, we recorded the occurrence of death, hematological disease progression, and modification in further chemotherapy regimen. In addition,

we recorded renal function evolution, every three months during the first year, then annually. Chronic kidney disease was defined as an estimated glomerular filtration rate under 60 ml/min/1.73 m² (eGFR CKD-EPI). We compared patient's evolution (survival, progression free survival, modification of chemotherapy regimen and chronic kidney disease occurrence) according to AKI occurrence (AKI group) or not (no AKI group) during the initial tumor lysis syndrome episode.

**Results:** 115 patients were included in this analysis. Acute leukemia and non-Hodgkin lymphoma accounted for 84% of malignancies. Median duration of follow-up was 24.8 months (IQR 25–75 months [4.4–70.5]). During the initial tumor lysis syndrome episode, 57 patients experienced AKI. AKI and no AKI groups were similar at baseline, and in tumor lysis syndrome management. At the end of follow-up, mortality in the AKI group was 59.6% and 55.4% in the no AKI group (p = 0.644). Disease progression occurred in 44.4% and 39.2% in the AKI and no AKI groups, respectively (p = 0.587). We found a modification of chemotherapy regimen in 18 patients, only in the AKI group. Among these patients, persistent renal failure was considered as an additional comorbidity leading to palliative care in 8 of them. Renal function evolution was available in 81 patients, with a median follow-up of renal function of 39.9 months (IQR [25–75]: 13.2–78.7 months). CKD was observed in 21 patients (25.9%). CKD was mostly diagnosed during the first year after TLS (12/21 patients). No difference between AKI and no AKI groups was observed in CKD occurrence.

**Discussion:** AKI during tumor lysis syndrome was strongly associated with modifications in chemotherapy regimen. We found no impact of initial AKI on major patient's centered outcomes, but our study may be underpowered.

**Conclusion:** AKI during tumor lysis syndrome impacts further chemotherapy regimen. Of note, more than one fourth of patients developed chronic kidney disease.

**Reference 1:** Cairo MS, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification. British Journal of Haematology. 2004;127(1):3–11.

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

### FC-184

#### A multicentric prospective observational study of diagnosis and prognosis features in ICU mesenteric ischemia: the DIAGOMI study

BOURIER Simon¹,², ULMANN Guillaume⁴, JAMME Matthieu⁵, SAVARY Guillaume¹, PAUL Marine¹, BENGHANEM Sarah¹, LAVILLEGRAND Jean-Rémi³, SCHMIDT Matthieu², LUYT Charles-Edouard², MAURY Eric³, COMBES Alain², PÈNE Frédéric¹, CYNOBER Luc⁴, NEVEUX Nathalie⁴, CARIOU Alain¹

¹Medical intensive Care Unit, Cochin Hospital, AP-HP, Paris, France; ²Assistance Publique-Hôpitaux de Paris, AP-HP, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France; ³Assistance Publique-Hôpitaux de Paris, APHP, Saint-Antoine Hospital, Médecine Intensive Réanimation, Paris, France; ⁴Clinical Chemistry Department, Hôpital Cochin, AP-HP Centre, Université de Paris, Paris, France; ⁵Réanimation polyvalente, Hôpital Privé de l'Ouest Parisien, Ramsay Générale de santé, Trappes, France

**Correspondence:** Simon BOURCIER (simon_bourcier@hotmail.com)

Annals of Intensive Care 2022, **12**(1):FC-184

**Rationale:** Non-occlusive mesenteric ischemia (NOMI) is a challenging diagnosis and is associated with extremely high mortality in critically ill patients, particularly due to delayed diagnosis and when complicated by intestinal necrosis. Citrulline and intestinal-fatty acid binding protein (I-FABP) have been proposed as potential promising biomarkers but have never been studied prospectively in this setting.

**Patients and methods/Materials and methods:** We conducted a prospective observational study in 3 tertiary ICU centers. Diagnosis features and outcomes were compared according to NOMI, intestinal necrosis or ruled out diagnosis using stringent classification criteria.

**Results:** Diagnosis of NOMI was suspected in 61 patients and confirmed for 33 patients, with intestinal necrosis occurring in 27 patients. Clinical digestive signs, routine laboratory results and CT signs of mesenteric ischemia didn't discriminate intestinal necrosis
from ischemia without necrosis. Plasma I-FABP was significantly increased in presence of intestinal necrosis (AUC 0.83 [0.70–0.96]). A threshold of 3114 pg/mL showed a sensitivity of 70% [50–86], specificity of 85% [55–98], a negative predictive value of 58% [36–93] and a positive predictive value 90% [67–96]. Necrosis resection was significantly associated with ICU survival (38.5%), whereas no patient survived without intestinal resection (HR = 0.31 [0.12–0.75], p = 0.01).

**Conclusion:** In critically ill patients with suspected NOMI, intestinal necrosis was associated with extremely high mortality, and increased survival when intestinal resection was performed. Elevated plasma I-FABP was associated with the diagnosis of intestinal necrosis. Further studies are needed to set plasma I-FABP threshold valuable in clinical-decision making.

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

## FC-185

### Relationship between the rate of full stomach and daily SOFA in the enteral-fed ICU patient

JOFFRÉDO Emilie¹, DALSHEIMER Xavier², BOUVET Lionel³, VACHERON Charles-Hervé¹, LUKASZEWICZ Anne-Claire², ALLAOUCHICHE Bernard¹
¹Centre Hospitalier LYON Sud, Pierre-Bénite, France; ²Hôpital Edouard Herriot, Lyon, France; ³Hôpital Louis Pradel, Bron, France

**Correspondence:** Emilie JOFFRÉDO (emilie_joffredo@hotmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-185

**Rationale:** The provision of adequate nutrition is an important part of the management of intensive care patients. Enteral nutrition (EN) is the preferred mode of feeding in these patients. However, some patients have an ileus that causes gastric stasis, which can lead to reflux of nutritional fluid with risks of micro-inhalation. Ultrasonographic measurement of antral cross-sectional area (ACSA) is an easy and reliable bedside procedure to estimate the rate of full stomach in critically ill patients receiving EN in 30-degree head-of-bed elevation and supine position. This technique is already well recognized. The aim of this work was to analyze the relationship between the rate of full stomach and the SOFA score and its impact on the tolerance of enteral nutrition.

**Patients and methods/Materials and methods:** This prospective observational cohort study received approval (n°: L16-174) from the ethics committee (Comité pour la Protection des Personnes Sud-Est IV, Centre Léon Bérard, Lyon, France) and was registered in the public registry ClinicalTrials.gov, no. NCT03205592. In this prospective multicenter study, adult patients under mechanical ventilation were included, except supra-mesocolic surgery patients. Ultrasound examination of the gastric antrum was daily measured for five days long. Correlation was computed according to the method described by Bland and Altman specifically designed in order to compute correlation coefficient for repeated observation. Briefly, the coefficients of correlation (r) were estimated by modeling the effect of the gradient on the severity and introducing the patient as a dummy variable. Then, the coefficient was computed by the square root of the sum of square of the gradient / (sum of square of the gradient + residual sum of square), and the p value derived from the F test in the associated analysis of variance table of the model.

**Results:** Thirty-five patients were analyzed: age = 61 ± 14, 9 female, SAPS 2 = 40 ± 17, admission SOFA = 4 ± 2. The incidence of full stomach varied between 77 to 89% during the follow-up period. The repeated measures correlation was 0.087, p = 0.38 (Fig. 1). We found no relation between rate of full stomach and the incidence of ventilator-associated pneumonia or vomiting. The incidence of full stomach was not influenced by diabetes, Covid, sepsis, trauma, sedation, nor-epinephrine, renal replacement therapy or prone position.

**Conclusion:** Full stomach was frequently found but had no association with the SOFA score nor pneumonia or vomiting in enteral fed ICU patients.

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

<figure><img src="image_95.png" /><figcaption>Figure 1</figcaption></figure>

## FC-186

### Extravascular lung water predicts progression to acute respiratory distress syndrome in critically ill cirrhotic patients

SCHOULMANN Alix¹, PLATTIER Rémi¹, ANTY Rodolphe¹

¹Hôpital Archet 2, Nice, France

**Correspondence:** Alix SCHOULMANN (alix.schoulmann@gmail.com)

*Annals of Intensive Care* 2022, **12**(1):FC-186

**Rationale:** Acute respiratory distress syndrome (ARDS) is a syndrome of acute respiratory failure caused by a protein-rich alveolar edema fluid. Its incidence is variable and often related to a poor outcome. Extravascular lung water (EVLW) estimated by transpulmonary thermodilution using the PiCCO device is a hallmark of lung edema, and can help to predict the progression to lung injury in patients with risk factors. It is also an independent prognostic factor, and can further be used to guide fluid management. Thereby, we aim to evaluate the reproducibility of EVLW's usefulness in critically ill cirrhotic patients.

**Patients and methods/Materials and methods:** The medical records of 90 critically ill cirrhotic patients who benefited of haemodynamic monitoring using the PiCCO device from January 2013 to November 2019 were retrospectively reviewed. Independent risk factors and outcomes were then analyzed according to whether their EVLW value on ICU admission was greater than 10 mL/kg or not.

**Results:** An EVLW > 10 ml/kg at ICU admission is associated with ARDS (32% vs 8% p < 0.01), and with the onset of ARDS during hospital stay (66% vs 33% p < 0.01). Using a ROC curve, an EVLW cutoff of 10 ml/kg has been defined with the best sensitivity (74%) and specificity (62%) threshold. There is no difference between the groups regarding ICU mortality rate (51% vs 55%, p = 0.71), nor regarding the proportion of patients with cirrhotic ascites (61% vs 73%, p = 0.21 et 78%, p = 0.95) or with pleural fluid (39% vs 24%, p = 0.14 et 66% vs 47%, p = 0.072), respectively on ICU admission and during the stay. In multivariate analysis, TIPSS history and ARDS during hospital stay were both independent risk factors of EVLW > 10 ml/kg (OR = 7.7 [1.36 – 43]; p = 0.02 and OR = 4.9 [1.9 – 12.6]; p = 0.001 respectively).

**Conclusion:** An EVLW > 10 ml/kg at ICU admission is associated with the onset of ARDS in critically ill cirrhotic patients, without interference in the measure from cirrhotic ascites or pleural fluid.

**Reference 1:** ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–2533.

**Reference 2:** Monnet X. Transpulmonary thermodilution: advantages and limits. Published online 2017:12.

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