Purpose: To investigate age-related differences in outcomes of critically ill patients with sepsis around the world. Methods: We performed a secondary analysis of data from the prospective ICON audit, in which all adult ( >16 years ) patients admitted to participating ICUs between May 8 and 18, 2012, were included, except admissions for routine postoperative observation. For this sub-analysis, the 10,012 patients with completed age data were included. They were divided into five age groups - <= 50, 51-60, 61-70, 71-80, >80 years. Sepsis was defined as infection plus at least one organ failure. Results: A total of 2963 patients had sepsis, with similar proportions across the age groups (<= 50 = 25.2%: 51-60 = 30.3%; 61-70 = 32.8%; 71-80 = 30.7%; >80 = 30.9%). Hospital mortality increased with age and in patients >80 years was almost twice that of patients <= 50 years (493% vs 25.2%, p < .05). The maximum rate of increase in mortality was about 0.75% per year, occurring between the ages of 71 and 77 years. In multilevel analysis, age > 70 years was independently associated with increased risk of dying. Conclusions: The odds for death in ICU patients with sepsis increased with age with the maximal rate of increase occurring between the ages of 71 and 77 years. (C) 2019 Elsevier Inc. All rights reserved.

Background Primary bacteraemia and bacteraemia caused by catheter infections entail a high pharmaceutical cost. The ‘Zero Bacteraemia Project’ (BZP) for central intravenous catheter (CVC) use in invasive therapies showed a decrease in the number of bacteraemia cases and a financial effect on hospitalizations. Purpose To study the number of primary bacteraemia and bacteraemia cases caused by catheter infections among patients hospitalised in our Intensive Care Unit (ICU) and the pharmaceutical cost after implementation of the CVC guides. We compared these data to those obtained from 2007–2008. Materials and Methods We retrospectively studied 2353 patients who were admitted to our Intensive Care Unit. 1280 patients were studied before BZP (2007–2008) and 1073 after BZP implementation. The BZP implied: catheter insertion with maximal sterile barrier precautions in ICU, correct hand washing, hygienic precautions when using CVCs and the removal of unnecessary catheters. We compared the pharmaceutical cost in antibiotics in both periods. We also studied the five most-used antibiotics in this hospital for the treatment of catheter-related infections suffered by the sample group in this ICU. The data were obtained by the programme ‘ENVIN-ICU’. Results A total of 35 pre-BZP and 13 post-BZP catheter-related bacteraemia cases were detected. 5.14 and 2.17 bacteraemia cases for every 100 patients with CVC. A 37% reduction was observed in the incidence of bacteraemia. The pharmaceutical cost just in antibiotics for the 35 patients infected during the first period amounted to 3100.68 euros. However it dropped to 2388.93 euros during the following period. A 23% saving was observed on the antibiotics consumption. Conclusions The data from this study show that the use of the ‘Zero Bacteremia’ policy in the process of inserting and monitoring CVCs is useful to reduce the number of infections. A statistically significant decrease in the number of bacteraemia cases and a monetary saving in antibiotics were found too. No conflict of interest.

INTRODUCTION AND OBJECTIVES. It remains controversial the role of non invasive ventilation (NIV) in patients with acute respiratory failure.The objective of this study was to evaluate the usefulness and effectiveness of NIV to manage influenza A (H1N1) respiratory failure in Spanish ICUs.METHODS.Prospective, observational, multicenter study in 144 Spanish ICUs.Data were obtained from GTEI/ SEMICYUC register (June 15 and December 31, 2009).All adult patients with influenza A (H1N1) confirmed by rt-PCR were included and only patients treated with NIV were considered in the analysis.We evaluated the use and failure of NIV, as well as demographic data, comorbidities and severity scores.The analysis (SPSS 18.0, Inc.Chicago, IL) was performed using Chi square or Fisher exact tests for categorical variables and Student or Mann-Whitney tests for continuous variables.Significant variables from univariate analysis were included in the multivariate model (logistic regression).Differences of p \ 0.05 were considered statistically significant.RESULTS.Among 938 patients registered in the GTEI/SEMICYUC, 632 (67.4%) had completed their ICU admission and was the source of this analysis.Of the 449 (71%) who received mechanical ventilation, 157 (24.8%) were treated with NIV.NIV failed in 92 patients (58.6%) and they had to be subsequently intubated (control group = IT).Sixty-five (41.4%) patients responded to NIV (study group = NIV).The IT group had a higher APACHE II (16.1 ± 7.3 vs. 11.9 ± 6.0, p \ 0.01) and SOFA (7.1 ± 3.8 vs. 4.2 ± 2.8 p \ 0.01) compared to the NIV group.No significant differences in age, comorbidities and LDH levels were observed.Time from onset of symptoms to hospitalization (4.2 vs. 4.1 days) or ICU admission (1.0 vs. 1.0 days) was similar between groups.Shock occurred more frequently in the IT (66.1 vs. 15.6%,p \ 0.01), and they also had more quadrants affected in the thorax X-ray (2.6 ± 1.1 vs. 1.9 ± 1.3, p \ 0.01).Pneumonia (viral and bacterial) was more frequent in the IT (87.0% vs. 72.3%,p \ 0.05) whereas COPD exacerbation was similar (4.9 vs. 10.9%,p = 0.11).The presence of shock (OR = 3.0 95% CI 1.61-5.69,p \ 0.01) and pneumonia (OR = 1.2 95% CI 1.01-1.58,p \ 0.05) were independently associated with NIV failure in the multivariate analysis.Mortality was significantly higher in IT compared to NIV (35.2 vs. 4.7%, p \ 0.01).CONCLUSIONS.NIV is not recommended as an alternative to invasive ventilation in patients affected by influenza A(H1N1) virus pneumonia with severe multiorganic failure or shock.In spite of this, selected patients with mild acute respiratory failure might benefit from this alternative therapy.