While brain-dead organ donor rates per million populations are useful to follow and to compare organ donation activities, they cannot be used to estimate the potential of brain-dead organ donors. The comparison of available data from national vital statistics system, specific studies on potential of organ donation, and the hospital diagnosis related group (DRG) based information system allow to estimate the potential of brain-dead organ donors between 3500 and 4500. In 2007, 3147 potential donors were identified and 9691 patients still registered at the beginning of 2007 or registered during 2007 for a kidney transplant. Spain has the highest rate of effective organ donors used as a goal to reach. Comparing national vital statistics, Spain and France had a similar potential of donors but Spanish opposition rate is lowest than France (15% versus 30%). Nevertheless, the rate of kidneys extracted but not grafted is higher in Spain (28% versus 13%), which may reflect the limits of the Spanish model and decrease the benefit of the weak opposition rate. In France, the decline of the opposition rate and the increase of donation activities in some region with low rates should be promoted; their impact on transplant volume is low. Promotion of living donors and non-heart-beating donors activities should be considered in front of organ shortage in France in 2007: 3.7 patients registered for a kidney extracted from a brain-dead donor grafted and 3.3 for kidneys extracted from all types of donors.

Objective Although several advantages are attributed to tracheotomy in ICU patients requiring mechanical ventilation (MV), true benefits and the optimal timing of tracheotomy remain controversial. In this study, we compared early tracheotomy (ET) with prolonged intubation (PI) in severely ill patients requiring prolonged MV. Design Prospective, randomized study. Setting Twenty-five medical and surgical ICUs in France. Patients Patients expected to require MV > 7 days. Measurements and results Patients were randomised to either (open or percutaneous) ET within 4 days or PI. The primary end-point was 28-day mortality. Secondary end-points were: the incidence of ICU-acquired pneumonia, number of d1-d28 ventilator-free days, time spent in the ICU, 60-day mortality, number of septic episodes, amount of sedation, comfort and laryngeal and tracheal complications. A sample size of 470 patients was considered necessary to obtain a reduction from 45 to 32% in 28-day mortality. After 30 months, 123 patients had been included (ET = 61, PI = 62) in 25 centres and the study was prematurely closed. All group characteristics were similar upon admission to ICU. No difference was found between the two groups for any of the primary or secondary end-points. Greater comfort was the sole benefit afforded by tracheotomy after subjective self-assessment by patients. Conclusions The trial did not demonstrate any major benefit of tracheotomy in a general population of ICU patients, as suggested in a previous meta-analysis, but was underpowered to draw any firm conclusions. The potential advantage of ET may be restricted to selected groups of patients.

Objective > To estimate the incidence of influenza infection with a rapid diagnostic test in patients hospitalized in on intensive core unit (ICU) during the epidemic periods of two consecutive winters (2005-2006).Methods > This study tested nasal aspirate of all patients admitted to the ICU for acute respiratory failure during the influenza epidemic period with the Quickvue (R) influenza rapid diagnostic test.Results > The study included 39 patients: 22 men and 17 women. Their mean age was 69.7 +/- 13 years, their mean SAPS II score 54 2 1, their mean length of stay 14.7 +/- 20 days, and 43.5% hod been vaccinated against influenza. The mortality rote was 33.3% (n = 13). Four patients (10.2%) hod a positive QuickVue test and were considered to hove influenza associated with their primary diagnosis: pneumococcol pneumonia, hoemophilus pneumonia, acute bronchitis, and acute bronchitis with acute cardiogenic edema. These patients were older than those with a negative test (80 +/- 7 versus 68 +/- 13 years, p = 0. 02). Their SAPS II, length of stay and mortality rote did not differ statistically from those with negative results. Chronic heart failure (but not COPD or non-vaccination) was more frequent in these patients (p = 0.01).Discussion > Several published studies report a satisfactory specificity and sensitivity for QuickVue (R). With this test, we estimated the incidence of influenza in patients hospitalized in our ICU for acute respiratory failure during flu epidemics at around 10%, close to that reported in previous studies.

Despite a significant increase in procurement and transplantation activities observed in France in the last eight years, the shortage in grafts is on the rise and demand keeps being much higher than supply. Since 1968 and until now, procurement was limited to heart beating brain donors. The results of kidneys transplanted from non-heart-beating donors have significantly improved and are nowadays comparable to those of kidney transplantations from brain death donors, thanks to a more accurate selection of donors and recipients, to better respect of preventing cold and warm ischemia times and to several major therapeutic innovations. Procurement on non-heart-beating donors are therefore being reconsidered under considerations of feasibility, results and ethical and legal consequences, under a specific medical protocol issued by the agency of biomedicine with the pilot hospital center agreement to comply with the protocol. Referring to foreign experiences, this program is Likely to decrease the organ shortage, which is jeopardizing the treatment of a Large number of patients awaiting transplantation. (C) 2007 Elsevier Masson SAS et Association Societe de Nephrologie. Tous droits reserves.

Despite a significant increase in procurement and transplantation activities observed in France in the last eight years, the shortage in grafts is on the rise and demand keeps being much higher than supply. Since 1968 and until now, procurement was limited to heart beating brain donors. The results of kidneys transplanted from non-heart-beating donors have significantly improved and are nowadays comparable to those of kidney transplantations from brain death donors, thanks to a more accurate selection of donors and recipients, to better respect of preventing cold and warm ischemia times and to several major therapeutic innovations. Procurement on non-heart-beating donors are therefore being reconsidered under considerations of feasibility, results and ethical and legal consequences, under a specific medical protocol issued by the agency of biomedicine with the pilot hospital center agreement to comply with the protocol. Referring to foreign experiences, this program is likely to decrease the organ shortage, which is jeopardizing the treatment of a large number of patients awaiting transplantation.

OBJECTIVE:HemoCue is routinely used to manage bleeding patients, but few studies have evaluated its accuracy in this population. We compared HemoCue with laboratory determination of blood hemoglobin in patients with gastrointestinal bleeding.DESIGN AND SETTING:A prospective observational study in a 14-bed medicosurgical ICU and an emergency department in an urban general hospital.PATIENTS:94 patients admitted to the emergency department or to the ICU for gastrointestinal bleeding.INTERVENTIONS:Blood was drawn at admission to measure laboratory hemoglobin and capillary hemoglobin was measured simultaneously by HemoCue. The unit of hospitalization and the presence or absence of impaired vital signs (tachycardia and/or hypotension and/or shock) were recorded.MEASUREMENTS AND RESULTS:The mean difference between HemoCue and hemoglobin (bias) was -0.06 g/dl and standard deviation (precision) 0.87 g/dl. (95% CI -1.8 to 1.68). Discrepancies between HemoCue and hemoglobin were greater than 1 g/dl in 21% of cases. Bias was comparable between patients admitted to the ICU and those in the emergency department. The accuracy of HemoCue was not affected by the presence of impaired vital signs or by a hemoglobin level below 9 g/dl or 7 g/dl.CONCLUSIONS:Although we demonstrated a low bias between HemoCue and blood hemoglobin determination, large HemoCue vs. hemoglobin differences may still occur, and therefore therapeutic decisions based upon capillary HemoCue alone should be very cautious.