A. Mekontso Dessap

Effect of time to onset on clinical features and prognosis of post-sternotomy mediastinitis

Incubation time affects the clinical features and outcome of many nosocomial infections. However, its role in the setting of post-sternotomy mediastinitis (PSM) has not been specifically studied. The present study aimed to evaluate the impact of time to onset of PSM on the clinical presentation and outcomes of patients. Hospital records of 197 patients who developed PSM over a 10-year period and were treated by closed drainage using Redon catheters were reviewed retrospectively. Follow-up was complete for all included patients (median of 19 months); 98 patients developed early-onset PSM (time from initial operation to PSM <14 days) and 99 patients had late-onset PSM (≥14 days). Patients with late-onset PSM had a higher rate of internal thoracic artery harvest and mediastinal re-exploration after initial operation. Patients with early-onset PSM presented more frequently with septic shock. Microbiological findings differed between early- and late-onset PSM by a higher incidence of Enterococcus species in the former and of Staphylococcus aureus in the latter. Overall mortality reached 34% (n = 66). Rates of superinfection, treatment failure, mediastinitis-related death, mortality at 1 year and overall mortality were all significantly higher in patients with early-onset PSM. Multiple regression procedures identified early-onset PSM as a significant and independent risk factor for both 1-year (OR 2.40; 95% CI 1.12-5.11) and overall (OR 2.11; 95% 1.26-3.53) mortality. In conclusion, the results obtained in the present study support the distinction between early- and late-onset PSM with different clinical and pathophysiological features. Early-onset PSM is associated with a significantly higher morbidity and mortality compared to late-onset PSM.

Renal replacement therapy during Stevens-Johnson syndrome and toxic epidermal necrolysis: a retrospective observational study of 238 patients.

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare but serious life-threatening adverse cutaneous drug reactions1. The mortality of SJS/TEN patients ranges from 3-4% in those with SJS to 30-50% in the most severe TEN patients, requiring intensive care unit (ICU) admission2,3. Several prognostic factors associated with an elevated risk of mortality have been reported in SJS/TEN, including a SCORTEN (i.e., a specific severity score based on seven items) ≥24, or mechanical ventilation requirement5. To our knowledge, no study has assessed the impact of acute renal failure (ARF) requiring renal replacement therapy (RRT) on outcomes among a large cohort of patients. n nThis article is protected by copyright. All rights reserved.

Balance des fluides et sevrage de la ventilation mécanique

RésuméLa surcharge volémique est fréquemment rencontrée en réanimation, notamment chez les patients septiques et/ou ventilés. La surcharge volémique est associée à une prolongation de la durée de ventilation mécanique en général et du sevrage en particulier. Il s’agit d’un facteur favorisant de la dysfonction cardiovasculaire du sevrage impliqué dans l’échec de l’épreuve de ventilation spontanée et l’échec d’extubation. Une stratégie de gestion des fluides restrictive raccourcit la durée de la ventilation mécanique, y compris celle du sevrage.AbstractVolume overload is frequently encountered in intensive care unit patients, especially in patients with sepsis and/or mechanical ventilation. Volume overload is associated with a prolongation of mechanical ventilation in general and of the weaning period in particular. It is a major contributing factor to cardiovascular weaning failure, including failed spontaneous breathing trial and failed extubation. A strategy of restrictive fluid management shortens the duration of mechanical ventilation, including weaning length.