Role of biomarkers in the management of antibiotic therapy : an expert panel review : I - currently available biomarkers for clinical use in acute infections

Abstract In the context of worldwide increasing antimicrobial resistance, good antimicrobial prescribing in more needed than ever; unfortunately, information available to clinicians often are insufficient to rely on. Biomarkers might provide help for decision-making and improve antibiotic management. The purpose of this expert panel review was to examine currently available literature on the potential role of biomarkers to improve antimicrobial prescribing, by answering three questions: 1) Which are the biomarkers available for this purpose?; 2) What is their potential role in the initiation of antibiotic therapy?; and 3) What is their role in the decision to stop antibiotic therapy? To ans…

Sédation profonde et continue maintenue jusqu’au décès en réanimation : mise au point de la Commission d’Ethique de la SRLF

La mise en œuvre de la sédation profonde et continue maintenue jusqu’au décès en réanimation peut s’avérer complexe car il faut tenir compte de la singularité de chaque patient et de son entourage. Cet aspect de la prise en charge devrait être évoqué autant que possible avec le patient et ses proches bien avant que la question de la fin de vie ne se pose. Formation des soignants, information des patients et des proches et adaptation de l’environnement en fin de vie représentent les pistes d’amélioration de la prise en charge de la fin de vie en réanimation.

Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2)

International audience; BackgroundWhether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition.MethodsIn this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20–25 kcal/kg per day), within 24 h after intubatio…

Proceedings of Réanimation 2017, the French Intensive Care Society International Congress

Place du psychologue en réanimation

Dans les services de soins aigus, comme en réanimation, où l’intégrité physique et psychique des patients est atteinte, le somatique prime mais il est inéluctablement imprégné de la dimension émotionnelle. Les études actuelles témoignent d’ailleurs d’un vécu émotionnel intense et souvent bouleversant, tant pour les patients et leurs proches, que pour les soignants. Le psychologue prend donc place dans cette triangulation patient-famille-soignant afin de préserver la place de la dimension émotionnelle au sein des services de réanimation, et de proposer un accompagnement psychologique adapté. A partir d’un cas clinique, cet article a pour objectif de clarifier, pour les soignants de réanimati…

Role of biomarkers in the management of antibiotic therapy: an expert panel review II: clinical use of biomarkers for initiation or discontinuation of antibiotic therapy

Abstract Biomarker-guided initiation of antibiotic therapy has been studied in four conditions: acute pancreatitis, lower respiratory tract infection (LRTI), meningitis, and sepsis in the ICU. In pancreatitis with suspected infected necrosis, initiating antibiotics best relies on fine-needle aspiration and demonstration of infected material. We suggest that PCT be measured to help predict infection; however, available data are insufficient to decide on initiating antibiotics based on PCT levels. In adult patients suspected of community-acquired LRTI, we suggest withholding antibiotic therapy when the serum PCT level is low (<0.25 ng/mL); in patients having nosocomial LRTI, data are insuf…