21st ESICM Annual Congress
Authors: B Assenzio, E Martin, E Stankevicius, U Simonsen, I Mastromauro, S Viberti, M Fontanella, R Boccaletti, A Ducati, L Mascia, V Padilla, Y Corzia, M Jimenez, V Arellano, C Ferrandiz, S Leal-Noval, M Oddo, J Levine, S Frangos, E Maloney-Wilensky, E Macmurtrie, A Kofke, P Leroux, C Ferra ´ndiz, M Arellano, Y Corcia, M Jime ´nez, S Leal, V Jeger, S Fontana, N Baur, M Luginbu ¨hl, A Ferretti, H Zimmermann, A Exadaktylos, R Antunes, E Diz, O Ribeiro, A Costa-Pereira, T Cardoso, A Carneiro, I Meynaar, J Van Der Spoel, J Rommes, M Van Spreuwel-Verheijen, R Bosman, P Spronk, I Mitchell, C Leuvan, B Avard, N Slater, R Berry, P Lamberth, H Mckay
Journal: Intensive Care Medicine (2008)

Oral Presentations Abstract awards winners — The best preselected abstracts submitted to the congress: 0387–03900387Impact of Subglottic Secretions Drainage on Ventilator-Associated Pneumonia: A Randomized Multicentre TrialJ. Lacherade*1, P. Guezennec2, K. Debbat3, J. Hayon4, A. Monsel1, B. De Jonghe1, P. Fangio1, C. Appere de Vecchi1, H. Outin1, S. Bastuji-Garin5 1Medico-surgical ICU, Poissy Hospital, Poissy, 2Medico-surgical ICU, Andre Mignot Hospital, Le Chesnay, 3Medico-surgical ICU, Avignon Hospital, Avignon, 4Medico-surgical ICU, Saint-Germain Hospital, Saint-Germain en Laye, 5Public Health Department, Henri-Mondor Hospital, University Paris XII, Créteil, FranceIntroductionPrevious randomized studies have showen that subglottic secretions drainage (SSD) could lower the incidence of ventilator-associated pneumonia (VAP), especially early-onset VAPs. Nevertheless, based on the monocentric design of the available studies, the recent guidelines for prevention of VAP have only suggested, not recommended, the use of SSD.MethodsRandomized controlled trial conducted in 4 ICUs. Adult patients who were expected to require mechanical ventilation for ≥ 48 hours and had been intubated with the specific Hi-Lo Evac tube® (Mallinckrodt Medical, Ireland) were eligible. Patients admitted after cardiac arrest, drug overdose or acute alcohol intoxication and those with a tracheostomy on ICU admission were excluded. Within the 12 hours after intubation, patients were randomly assigned to discontinuous (SDD+ group) or no (SDD- group) subglottic secretions drainage. Clinical suspicion of VAP was based on previously published criteria. Diagnosis of VAP was confirmed when the quantitative culture of a protected distal sample or bronchoalveolar lavage grew >1000 colony-forming units (CFU/ml) or >10000 CFU/ml, respectively, of at least one microorganism.Results333 patients were included, 169 in the SSD+ group and 164 in the SSD− group. Age, gender, SAPS II score (52.9 in the SSD+ group vs 53.8 in the SSD− group) and SOFA score (8.8 vs 8.6) at admission, and percentage of medical patients (84% vs 86.6%) were similar in the 2 groups. 67 episodes of VAP occurred, 25 in the SSD+ group (14.8%) and 42 in the SSD− group (25.6%) (p=0.02), yielding an incidence rate of 17 (SDD+ group) and 34 (SDD− group) episodes of VAP per 1000 ventilator days (p = 0.002). 12 episodes of laryngeal oedema after extubation were observed (8 in the SDD+ group, vs 4 in the SDD− group, p=0.3). Median duration of mechanical ventilation prior to the first episode of VAP (8.0 days in both groups), duration of mechanical ventilation (11.1 days in the SDD+ group vs. 10.9 days in the SDD− group) and ICU mortality (42.0% vs 40.0%) were not statistically different between the 2 groups.ConclusionIn this multicentre randomized trial, subglottic secretion drainage significantly reduced the incidence of VAP without increasing the risk of laryngeal oedema.0388Influence of Intensive Care Unit Size on Outcome of Severe SepsisM. Reinikainen*1, S. Karlsson2, I. Parviainen3, T. Varpula4, E. Ruokonen3, M. Varpula4, T. Ala-Kokko5, V. Pettilä4 1Dept of Intensive Care, North Karelia Central Hospital, Joensuu, 2Dept of Intensive Care, University Hospital, Tampere, 3Dept of Intensive Care, University Hospital, Kuopio, 4Dept of Intensive Care, University Hospital, Helsinki, 5Dept of Intensive Care, University Hospital, Oulu, FinlandIntroductionIn many disease categories, higher hospital volumes are associated with improved outcomes. We wanted to find out whether the risk of death from sepsis is influenced by the size of the intensive care unit (ICU).MethodsIn the Finnsepsis study, all ICU patients (n = 4500) admitted to 24 ICUs during a 4-month period (1 Nov 2004 – 28 Feb 2005) were screened. The criteria for severe sepsis were fulfilled in 470 patients. 18 patients were excluded because of treatment in more than one ICU. We divided the units into three groups: university hospital ICUs (230 patients), large non-university hospital ICUs (145 patients) and small non-university hospital ICUs (77 patients).ResultsThere were no significant differences between the ICU groups in mean severity of illness (SAPS II scores). The overall hospital mortality rate was 29.2%. In post-operative patients, the hospital mortality rate was 22.9% for patients treated in large ICUs (including university and large non-university hospital ICUs) but 42.3% for patients treated in small ICUs, P = 0.045. The survival curves of post-operative patients are shown in the figure. In medical patients, there were no differences between ICU groups in patient outcomes. ConclusionTreatment of surgical patients with severe sepsis in small ICUs was associated with increased mortality.Grant AcknowledgementFinnish Society of Intensive Care.0389Are We Able to Predict the Quality of Life 1 Year After Intensive Care ?P. Merlani*1, M. Verdon1, T. Perneger2, B. Ricou1 1Service of Intensive Care, 2Quality of Care Unit, Geneva University Hospitals and the University of Geneva, Geneva, SwitzerlandIntroductionResearch on the outcome of critically ills was mainly focused on mortality. However patients are more concerned about their future quality of life (QOL). Future QOL is often central in the decision making of limiting treatments. We tested the ability of patients (P), families (F), nurses (N) and physicians (Ph) to predict the QOL of the patient 1 year after discharge of ICU.MethodsWe included adults admitted to our surgical ICU, who stayed >36h in the unit and consented to participate to the study. We collected patient's characteristics and ICU data. At ICU discharge we asked the patient, the family, the attending nurse and the senior physician to predict the QOL of the patient at 1 year after ICU. After 1 year, we re-contacted the patient to obtain his/her actual QOL. QOL was assessed by Euro-QOL: 5 dimensions EQ-5D and the visual analogue scale (EQ-VAS).ResultsWe included 762 among 3723 screened patients and obtained data at 1 year after ICU from 642 (84%) patients. 579 (76%) had finally survived and were analysed. The interclass correlations between the EQ-VAS at 1 year and the prediction by P (0.389), F (0.392) and N (0.330) were bad, and the worst by Ph (0.196). The agreement by Bland and Altmann between the prediction by P, F, N, Ph and the measured QOL was poor (+6±40,+6±39,+3±44,−2±44 with P, F, N optimistic and Ph pessimistic). Regarding EQ-5D: in Mobility, Self-care, Activity, the agreement (and Kappas) were satisfactory, but always better for P and F than N and Ph. Regarding Pain and Anxiety, the agreement and Kappas were worse, with no statistical correlation between the predictions by N and Ph and the measured QOL. Correlations and agreements were not significantly affected by types of diagnosis or degrees of QOL at 1 year. Especially in elderly patients ([65y), there was no significant correlation between EQ-VAS predicted by Ph or any of the EQ-5D predicted by Ph and the measured QOL after 1 year.ConclusionPatients and families were very imprecise in their prediction of future QOL at 1 year after ICU. Nurses, and particularly physicians were worse in their prediction of QOL of patients, especially regarding the elderlies, that was not correlated to the measured QOL. Caregivers should be very careful when trying to integrate the notion of future QOL in therapeutic decisions.Grant AcknowledgementThis work was supported by the Swiss National Science Foundation 3200B0-100789, the Käthe-Zingg-Schwichtenberg Fonds (ASSM), the Société Académique de Gene`ve and the Fonds de péréquation Recherche et Developpement des HUG.0390Amplitude Integrated EEG (aEEG) Predicts Outcome in Hypothermia Treated Cardiac Arrest PatientsM. Rundgren*1, E. Westhall2, T. Cronberg3, I. Rosén4, H. Friberg1 1Anaesthesia and Intensive Care, Lund University Hospital, Lund, Sweden, 2Neurophysiology,, 3Neurology, 4Neurophysiology, Lund University Hospital, Lund, SwedenIntroductionThe amplitude integrated EEG (aEEG) pattern has shown good correlation to outcome in neonates exposed to asphyxia. Studies evaluating its value in adult cardiac arrest patients are scarce. We have studied the aEEG-patterns and evolution of aEEG-patterns in 101 adult hypothermia treated cardiac arrest patients and correlated the major patterns to outcome.MethodsFrom feb 2004 to feb 2008, 101 consecutive hypothermia treated cardiac arrest patients were monitored using the Nervus®-monitor. The monitor was applied on arrival in the ICU, and data was linked to the department of neurophysiology, where assessment was made without knowledge of patient outcome. Patients were sedated using propofol and fentanyl during hypothermia treatment. The evolution of aEEG-patterns at normothermia was correlated to patient outcome (regaining consciousness). Six months evaluation is ongoing.Results101 patients were monitored, 6 died from circulatory failure before normothermia was resumed, and in one case registration was lost, leaving 94 registrations for evaluation. The patients had a mean age of 61 years, 80% were male, the majority of the cardiac arrests were witnessed (83%) and out-of-hospital (84%). The initial rhythm was ventricular fibrillation in 58% of cases. Normothermia was resumed at a mean of 36 h after cardiac arrest. The aEEG-pattern at start of registration did not correlate to patient outcome. At normothermia, 28 patients had a flat or suppression-burst aEEG, two of whom regained consciousness. Fifty-two of 56 patients with a continuos aEEG without electrographic status epilepticus regained consciousness. Twenty-six patients developed electrographic status epilepticus, 10 from a continuous background pattern, and 16 from a discontinuous pattern. Only one regained consciousness.ConclusionElectrographic status epilepticus is common among hypothermia treated cardiac arrest patients and the outcome is poor. aEEG-monitoring should be performed routinely and treatment initiated as early as possible. A continuous pattern at normothermia is strongly correlated to recovering consciousness.Grant AcknowledgementThis study was supported by Skane county council's research and development foundation and by the governmental funding of clinical research within the National Health Service.