Severe traumatic brain injury (sTBI) is a major cause of mortality and long-term disability, and early prognostic evaluation is essential to support therapeutic decision-making in intensive care. MRI is the reference imaging modality for detecting diffuse axonal injury (DAI), yet the prognostic accuracy and reproducibility of MRI-based radiologic scoring systems remain uncertain. This study aimed to compare the prognostic performance of five published MRI-based DAI scores for predicting 1-year neurological outcome, in a cohort of sTBI patients admitted to intensive care. We analyzed adult patients with sTBI included in the prospective MRI-COMA cohort (NCT00577954). Inclusion criteria were age ≥ 18 years, admission to ICU for sTBI, and absence of command following within 7 days after sedation withdrawal. Brain MRI was performed between day 7 and day 35 post-injury using standardized T1, FLAIR, T2*/SWI, and diffusion-weighted sequences. Three blinded evaluators (one neurointensivist, two neuroradiologists) independently applied five radiologic scores (Adams, Firsching, Hamdeh, Stockholm, Trondheim). The primary endpoint was the ability of each MRI-based radiologic score to predict 1-year neurological outcome, dichotomized as favorable (GOSE 5–8) or unfavorable (GOSE 1–4). Inter-rater reliability was quantified using Cohen’s and Fleiss’ kappa coefficients. Between 2007 and 2023, 443 patients were screened and 185 met eligibility criteria. At one year, 111 patients (59

Background: Pulmonary capillary blood volume is a major determinant of lung gas transport efficiency, and also potentially related to ventilator-induced lung injury. Yet, knowledge on how lung expansion influences pulmonary blood volume in injured lungs is scant. We hypothesize that lung expansion produced by positive end-expiratory pressure (PEEP) modulates the global and regional spatial distribution of pulmonary blood volume. Methods: In a lung injury model exposed to distinct lung expansion within clinical range (PEEP=5-20 cmH 2 O), we aimed to determine whole-lung and regional blood volume, their dynamic changes, and association with gas volume changes. Seven healthy sheep were subjected to 3h of low-lung volume mechanical ventilation at PEEP=0 cmH 2 O and systemic endotoxemia. PEEP=5 (low), 20 (high), and 12 (intermediate) cmH 2 O were applied to produce distinct lung expansion. Respiratory-gated positron emission tomography with 11 C-labelled carbon monoxide and 4-dimensional computed tomography were obtained to quantify blood volume and aeration. Results: Transpulmonary pressures were lowest at PEEP=12 cmH 2 O. Changes in whole-lung blood volume correlated with gas volume changes between PEEP=5 and 12 cmH 2 O at end-expiration ( P <0.001) and end-inspiration ( P <0.001), but not between PEEP=12 and 20 cmH 2 O. Tissue-normalized blood volume ( VBtissue ) was heterogeneously distributed, with mean values in non-dependent regions ( VBtissue =0.116±0.055) approximately 7-times smaller than those in mid-dependent regions ( VBtissue =0.832±0.132). PEEP=12 cmH 2 O resulted in the most homogeneous VBtissue distribution, with largest means in mid-dependent regions and inspiratory 10 th -percentile, a measure of lowest values, throughout the lung. VBtissue increased with inspiration at PEEP=5 and 12 cmH 2 O but decreased with PEEP=20 cmH 2 O in mid-nondependent regions. Conclusions: During low-volume mechanical ventilation and systemic endotoxemia, lung blood volume is markedly heterogeneously distributed, and modulated by PEEP. Nondependent regions are susceptible to low blood volume and capillary closure. Recruitment of pulmonary vascular blood volume with gas volume is nonlinear, limited at intermediate PEEP indicating its advantage to spatial distribution of blood volume.

The fibroproliferative stage and persistent inflammation of acute respiratory distress syndrome (ARDS) are key factors leading to either the resolution of the syndrome or fibrosis. Previous studies suggest that a corticosteroid therapy promotes the evolution of ARDS toward an adapted repair process whereas others suggest that this therapy increases the risk of death if it starts more than 14 days after ARDS onset. Since the efficacy and safety of delayed 2 mg/kg methylprednisolone therapy in patients with ARDS is a matter of debate, we performed this observational multicentric retrospective study. We analysed the data of 392 patients with ARDS who received 2 mg/kg methylprednisolone therapy. The primary endpoint was mortality six months after 2 mg/kg methylprednisolone therapy was started. The secondary endpoints included mortality 60 days after the corticosteroid therapy initiation and the number of ventilator-free days (VFDs) and intensive care unit (ICU)-free days. We investigated the occurrence of complications such as ventilator-acquired pneumonia (VAP), septic shock and gastrointestinal bleeding arising after the start of the protocol. A total of 189 (48.2%) patients received 2 mg/kg methylprednisolone therapy within the first 14 days of ARDS onset. A total of 203 (51.8%) patients received it more than 14 days included post-ARDS-onset. The mortality rate six months after the initiation of 2 mg/kg methylprednisolone therapy was 51.9% in the early initiation group and 52.2% in the late initiation group (p = 0.942). The mortality rate 60 days after the initiation of 2 mg/kg methylprednisolone therapy was 47.1% in the early group and 47.3% in the late group (p = 0.968). There was no significant difference in the number of VFDs (p = 0.336) or ICU-free days (p = 0.175) 60 days after the start of the 2 mg/kg protocol. Initiating the protocol 14 days after the onset of ARDS seemed to be associated with more complications (p < 0.001). Late initiation was associated with greater occurrence of VAP (p = 0.018) or gastrointestinal bleeding (p = 0.012). These results suggest that an initiation of 2 mg/kg methylprednisolone therapy after 14 days from ARDS onset is not associated with an increased risk of death as compared with initiation prior to day 14. Delayed 2 mg/kg methylprednisolone therapy in patients with persistent ARDS should be considered.

Acute mesenteric ischaemia (AMI) is an emergency with a poor prognosis. In France, a structure dedicated to AMI has been created in Paris in 2016 (SURVI), with promising results. A similar organization has been created in Marseille in 2021 (SOS AMI). Our aim was to compare the results of SOS AMI with those of a previous cohort of AMI patients managed without any dedicated structure. The first 100 patients with AMI, managed by the SOS AMI, between November 2021 and December 2023 were prospectively included. They were compared with 100 AMI patients from a previous retrospective cohort (from January 2017 to December 2020), managed without any dedicated structure in the same center. The first 100 AMI patients managed by SOS AMI have similar demographic characteristics to those previously managed without SOS. The vascular causes of AMI were also similar between groups: arterial occlusive (61 vs. 56

OBJECTIVES:To determine whether intraoperative arterial hypotension during cardiopulmonary bypass (CPB) is associated with postoperative lung injury (PLI) in patients undergoing emergency surgery for acute type A aortic dissection (ATAAD). DESIGN:Single-center retrospective cohort study with propensity score matching and sensitivity analyses. SETTING:A tertiary academic cardiovascular intensive care unit in France. PARTICIPANTS:A total of 150 adult patients who underwent emergency ATAAD repair between January 2018 and December 2020. Patients with refractory low cardiac output syndrome or requiring extracorporeal life support were excluded. INTERVENTIONS:No therapeutic intervention was applied. Intraoperative arterial pressure was continuously recorded during CPB to evaluate exposure to hypotension. MEASUREMENTS AND MAIN RESULTS:PLI was defined as a PaO₂/FiO₂ ratio ≤200 mmHg for more than 24 consecutive hours within the first 10 postoperative days. The primary exposure was mean arterial pressure <50 mmHg sustained for more than 10 minutes during CPB. After propensity score matching (n = 144), PLI occurred in 54.2% of hypotensive patients versus 27.8% in nonhypotensive patients (odds ratio 3.07, 95% confidence interval [1.54-6.15], p < 0.001). Sensitivity analyses demonstrated a dose-response association with deeper and longer hypotension, including a significant association for mean arterial pressure <55 mmHg lasting >10 minutes (odds ratio 2.35, 95% confidence interval [1.11-4.99], p = 0.03). This analysis examining pulmonary outcomes was performed on one of the largest single-center ATAAD surgical cohorts to date. CONCLUSIONS:The current findings suggest that both the depth and duration of intraoperative hypotension during CPB are associated with PLI. This highlights intraoperative blood pressure as a potentially modifiable factor, but confirmation in prospective interventional studies is required.

Background: Cardiac injury caused by a sharp object is a medical and surgical therapeutic challenge. Mortality risk factors have been identified but there are major discrepancies in the literature. The aim of this study was to analyse the management of victims of penetrating cardiac injuries before and after admission to hospital and the anatomical characteristics of these injuries in order to facilitate diagnosis of the most critical patients. Methods: To carry out this study, we conducted a retrospective analytical study with epidemiological data on victims of penetrating cardiac injuries. We included two types of patients, with those who underwent autopsy in our institution after death from sharp injury to the heart or great vessels and those who survived with treatment in the emergency department or intensive care unit between January 2015 and February 2022. Results: We included 30 autopsied patients and 12 survivors aged between 18 and 73 years. Higher mortality was associated with prehospital or in-hospital cardiorespiratory arrest (OR = 4, CI [1.71–9.35]), preoperative mechanical ventilation (OR = 10, CI [1.53–65.41]), preoperative catecholamines (OR = 7, CI [1.12–6.29]), preoperative and perioperative adrenaline (OR = 13, CI [1.98–85.46] and [1.98–85.46]), penetrating cardiac injury (OR = 14, CI [2.10–93.22]), multiple cardiac injuries (OR = 1.5, CI [1.05–2.22]) and an Organ Injury Scaling of the American Association for the Surgery of Trauma (AAST-OIS) score of 5 (OR = 2.9, CI [1.04–8.54]; p = 0.0329) with an AUC-ROC curve value of 0.708 (CI [0.543–0.841]). Conclusions: This study identified risk mortality factors in penetrating cardiac injury patients. These findings can help improve the diagnosis and management of these patients. The AAST-OIS score may be a good tool to diagnose critical patients.

Mechanical ventilation exposes the lung to injurious stresses and strains that can negatively affect clinical outcomes in acute respiratory distress syndrome or cause pulmonary complications after general anesthesia. Excess global lung strain, estimated as increased respiratory system driving pressure, is associated with mortality related to mechanical ventilation. The role of small-dimension biomechanical factors underlying this association and their spatial heterogeneity within the lung are currently unknown. Using four-dimensional computed tomography with a voxel resolution of 2.4 cubic millimeters and a multiresolution convolutional neural network for whole-lung image segmentation, we dynamically measured voxel-wise lung inflation and tidal parenchymal strains. Healthy or injured ovine lungs were evaluated as the mechanical ventilation positive end-expiratory pressure (PEEP) was titrated from 20 to 2 centimeters of water. The PEEP of minimal driving pressure (PEEP DP ) optimized local lung biomechanics. We observed a greater rate of change in nonaerated lung mass with respect to PEEP below PEEP DP compared with PEEP values above this threshold. PEEP DP similarly characterized a breaking point in the relationships between PEEP and SD of local tidal parenchymal strain, the 95th percentile of local strains, and the magnitude of tidal overdistension. These findings advance the understanding of lung collapse, tidal overdistension, and strain heterogeneity as local triggers of ventilator-induced lung injury in large-animal lungs similar to those of humans and could inform the clinical management of mechanical ventilation to improve local lung biomechanics.

Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of complications and death. Here, we set out to identify high-performance predictive biomarkers of DCI and its underlying metabolic disruptions using metabolomics and lipidomics approaches. This single-center prospective observational study enrolled 61 consecutive patients with severe aSAH; among them, 22 experienced a DCI. Nine patients without aSAH were included as validation controls. Blood and cerebrospinal fluid (CSF) were sampled within the first 24 h after admission. We identified a panel of 20 metabolites that, together, showed high predictive performance for DCI. This panel of metabolites included lactate, cotinine, salicylate, 6 phosphatidylcholines, and 4 sphingomyelins. The interplay of the metabolome and the lipidome found between CSF and plasma in our patients underscores that aSAH and its associated DCI complications can extend beyond cerebral implications, with a peripheral dimension as well. As an illustration, early biological disruptions that might explain the subsequent DCI found systemic hypoxia driven mainly by higher blood lactate, arginine, and proline metabolism likely associated with vascular NO and disrupted ceramide/sphingolipid metabolism. We conclude that targeting early peripheral hypoxia preceding DCI could provide an interesting strategy for the prevention of vascular dysfunction.

Editor—We read with great interest the article by Grigio and colleagues 1 Grigio T.R. Timmerman H. Wolff A.P. ChatGPT in anaesthesia research: risk of fabrication in literature searches. Br J Anaesth. 2023; 131: e29-e30 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar highlighting important considerations about the use of artificial intelligence (AI), specifically ChatGPT, in anaesthesia research, and associated risks regarding data integrity. One well-known pitfall of ChatGPT is the creation of false references. 2 Sanchez-Ramos L. Lin L. Romero R. Beware of references when using ChatGPT as a source of information to write scientific articles. Am J Obstet Gynecol Advance Access Published on April 06. 2023; https://doi.org/10.1016/j.ajog.2023.04.004 Abstract Full Text Full Text PDF Scopus (6) Google Scholar To understand the falsification of references by ChatGPT, one must consider how it works.

Abstract Objectives The occurrence of mediastinitis after cardiac surgery remains a rare and severe complication associated with poor outcomes. Whereas bacterial mediastinitis have been largely described, little is known about their fungal etiologies. We report incidence, characteristics and outcome of post-cardiac surgery fungal mediastinitis. Methods Multicenter retrospective study among 10 intensive care units (ICU) in France and Belgium of proven cases of fungal mediastinitis after cardiac surgery (2009–2019). Results Among 73,688 cardiac surgery procedures, 40 patients developed fungal mediastinitis. Five were supported with left ventricular assist device and five with veno-arterial extracorporeal membrane oxygenation before initial surgery. Twelve patients received prior heart transplantation. Interval between initial surgery and mediastinitis was 38 [17–61] days. Only half of the patients showed local signs of infection. Septic shock was uncommon at diagnosis (12.5%). Forty-three fungal strains were identified: Candida spp. (34 patients), Trichosporon spp. (5 patients) and Aspergillus spp. (4 patients). Hospital mortality was 58%. Survivors were younger (59 [43–65] vs. 65 [61–73] yo; p = 0.013), had lower body mass index (24 [20–26] vs. 30 [24–32] kg/m2; p = 0.028) and lower Simplified Acute Physiology Score II score at ICU admission (37 [28–40] vs. 54 [34–61]; p = 0.012). Conclusion Fungal mediastinitis is a very rare complication after cardiac surgery, associated with a high mortality rate. This entity should be suspected in patients with a smoldering infectious postoperative course, especially those supported with short- or long-term invasive cardiac support devices, or following heart transplantation.

Positive end-expiratory pressure (PEEP) individualized to a maximal respiratory system compliance directly implies minimal driving pressures with potential outcome benefits, yet, raises concerns on static and dynamic overinflation, strain and cyclic recruitment. Detailed accurate assessment and understanding of these has been hampered by methodological limitations. We aimed to investigate the effects of a maximal compliance-guided PEEP strategy on dynamic lung aeration, strain and tidal recruitment using current four-dimensional computed tomography (CT) techniques and analytical methods of tissue deformation in a surfactant depletion experimental model of acute respiratory distress syndrome (ARDS). ARDS was induced by saline lung lavage in anesthetized and mechanically ventilated healthy sheep (n = 6). Animals were ventilated in a random sequence with: (1) ARDSNet low-stretch protocol; (2) maximal compliance PEEP strategy. Lung aeration, strain and tidal recruitment were acquired with whole-lung respiratory-gated high-resolution CT and quantified using registration-based techniques. Relative to the ARDSNet low-stretch protocol, the maximal compliance PEEP strategy resulted in: (1) improved dynamic whole-lung aeration at end-expiration (0.456 ± 0.064 vs. 0.377 ± 0.101, P = 0.019) and end-inspiration (0.514 ± 0.079 vs. 0.446 ± 0.083, P = 0.012) with reduced non-aerated and increased normally-aerated lung mass without associated hyperinflation; (2) decreased aeration heterogeneity at end-expiration (coefficient of variation: 0.498 ± 0.078 vs. 0.711 ± 0.207, P = 0.025) and end-inspiration (0.419 ± 0.135 vs. 0.580 ± 0.108, P = 0.014) with higher aeration in dorsal regions; (3) tidal aeration with larger inspiratory increases in normally-aerated and decreases in poorly-aerated areas, and negligible in hyperinflated lung (Aeration × Strategy: P = 0.026); (4) reduced tidal strains in lung regions with normal-aeration (Aeration × Strategy: P = 0.047) and improved regional distributions with lower tidal strains in middle and ventral lung (Region-of-interest [ROI] × Strategy: P < 0.001); and (5) less tidal recruitment in middle and dorsal lung (ROI × Strategy: P = 0.044) directly related to whole-lung tidal strain (r = 0.751, P = 0.007). In well-recruitable ARDS models, a maximal compliance PEEP strategy improved end-expiratory/inspiratory whole-lung aeration and its homogeneity without overinflation. It further reduced dynamic strain in middle-ventral regions and tidal recruitment in middle-dorsal areas. These findings suggest the maximal compliance strategy minimizing whole-lung dynamically quantified mechanisms of ventilator-induced lung injury with less cyclic recruitment and no additional overinflation in large heterogeneously expanded and recruitable lungs.

BACKGROUND:The aims of this study were to describe pharmacokinetic/pharmacodynamic target attainment in intensive care unit (ICU) patients treated with continuously infused ß-lactam antibiotics, their associated covariates, and the impact of dosage adjustment.METHODS:This prospective, observational, cohort study was performed in three ICUs. Four ß-lactams were continuously infused, and therapeutic drug monitoring (TDM) was performed at days 1, 4, and 7. The primary pharmacokinetic/pharmacodynamic target was an unbound ß-lactam plasma concentration four times above the bacteria's minimal inhibitory concentration during the whole dosing interval. The demographic and clinical covariates associated with target attainment were evaluated.RESULTS:A total of 170 patients were included (426 blood samples). The percentages of empirical ß-lactam underdosing at D1 were 66% for cefepime, 43% for cefotaxime, 47% for ceftazidime, and 14% for meropenem. Indexed creatinine clearance was independently associated with treatment underdose if increased (adjusted odds ratio per unit, 1.01; 95% CI, 1.00 to 1.01; p = 0.014) or overdose if decreased (adjusted odds ratio per unit, 0.95; 95% CI, 0.94 to 0.97; p < 0.001). Pharmacokinetic/pharmacodynamic target attainment was significantly increased after ß-lactam dosage adjustment between day 1 and day 4 vs. no adjustment (53.1% vs. 26.2%; p = 0.018).CONCLUSIONS:This study increases our knowledge on the optimization of ß-lactam therapy in ICU patients. A large inter- and intra-patient variability in plasmatic concentrations was observed, leading to inadequate exposure. A combined indexed creatinine clearance and TDM approach enables adequate dosing for better pharmacokinetic/pharmacodynamic target attainment.

The intraoperative period is associated with significant alterations of the respiratory function as a cumulative effect of general anaesthesia and the surgical technique. These changes are characterised by the heterogeneous development in the regional distribution of both pulmonary aeration and ventilation. While allowing the maintenance of physiological levels of gas exchanges, non-optimised mechanical ventilation parameters may deteriorate such heterogeneity and expose lung regions to pathological levels of aeration (i.e., overdistension and atelectasis). Inadequate ventilator settings contribute to ventilator-induced lung injury (VILI), which has been associated with a specific pulmonary morbidity and worse prognosis in the surgical population. The impact of optimising mechanical ventilation during surgery has been widely studied and resulted in significant changes in the intraoperative management of mechanical ventilation. Controversies persist with regards to the identification of population at risk, the respective contribution of the different mechanisms of VILI or the relevance of individualised strategies in the highly heterogeneous surgical population. The aim of this text is to introduce the main pathophysiological aspects of VILI, to provide evidence-based consensual statements to guide clinical anaesthesiologists in optimising patients care and help investigators for the design of future studies.

The development of pulmonary atelectasis is common in the surgical patient. Pulmonary atelectasis can cause various degrees of gas exchange and respiratory mechanics impairment during and after surgery. In its most serious presentations, lung collapse could contribute to postoperative respiratory insufficiency, pneumonia, and worse overall clinical outcomes. A specific risk assessment is critical to allow clinicians to optimally choose the anesthetic technique, prepare appropriate monitoring, adapt the perioperative plan, and ensure the patient's safety. Bedside diagnosis and management have benefited from recent imaging advancements such as lung ultrasound and electrical impedance tomography, and monitoring such as esophageal manometry. Therapeutic management includes a broad range of interventions aimed at promoting lung recruitment. During general anesthesia, these strategies have consistently demonstrated their effectiveness in improving intraoperative oxygenation and respiratory compliance. Yet these same intraoperative strategies may fail to affect additional postoperative pulmonary outcomes. Specific attention to the postoperative period may be key for such outcome impact of lung expansion. Interventions such as noninvasive positive pressure ventilatory support may be beneficial in specific patients at high risk for pulmonary atelectasis (e.g., obese) or those with clinical presentations consistent with lung collapse (e.g., postoperative hypoxemia after abdominal and cardiothoracic surgeries). Preoperative interventions may open new opportunities to minimize perioperative lung collapse and prevent pulmonary complications. Knowledge of pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should provide the basis for current practice and help to stratify and match the intensity of selected interventions to clinical conditions.

Abstract IntroductionThe aim of this study was to evaluate if an automated measurement of lung lesions, epicardial fat and pericardial volume during the days surrounding hospital admission for COVID-19 pneumonia may predict intubation or mortality. The second purpose of this study was to assess whether the association of these Computed Tomography (CT) measures with the SOFA (Sequential Organ Failure Assessment) score, could predict intubation and mortality better than the SOFA score alone.MethodsThis observational retrospective study was conducted in Timone university hospital in Marseille in France, between March 10th and May 10th 2020. All adult patients with COVID-19, admitted with respiratory symptoms and having performed a chest CT three days before to two days after admission were eligible for inclusion. All chest CTs were analyzed using a local automated CT measurement software. The primary outcome was invasive mechanical ventilation (IMV) or death during the 60-day follow-up. Wilcoxon-Mann-Whitney test was used for univariate analysis and logistic regression were calculated for multivariate analysis. Results176 patients were included in the study. 57 (32.4%) received IMV or died during the 60-day follow-up. After univariate analysis, all lung automated volumetric measures of ground-glass (p=0.015), consolidation (p<0.001) and all lesions to parenchymal volume ratio (p<0.001) were significantly higher for the patients who required IMV or who died. All pulmonary-lesion rate was tested in multivariate analysis and remained significantly higher in the IMV or death group (p=0.003), with an Odd Ratio of 3.52 (1.55-8.01, 95% CI) for patients who had more than 19.5% of pulmonary lesion. Pericardial volume and epicardial fat were not significantly associated with IMV or mortality. In this study, the association of the criterion “pulmonary lesion >20%” to the SOFA score improves its predictive value on IMV or mortality with a AUC of 0.82.ConclusionAutomated chest CT measures of COVID-19 patients with respiratory symptoms admitted to hospital showed a significantly higher rate of lung lesions (ground glass, consolidation, or both) for those who later died or required IMV. Furthermore, the association of these automated CT measures to the SOFA score could help select patients requiring ICU upon entering hospital.

Background A novel multisystem inflammatory syndrome in children (MIS-C) temporally associated with the coronavirus disease 2019 (COVID-19) infection has been reported, arising weeks after the peak incidence of COVID-19 infection in adults. Patients with MIS-C have been reported to have cardiac involvement and clinical features overlapping with other acute inflammatory syndromes such as Kawasaki disease, toxic shock syndrome, and macrophage activation syndrome. Multisystem inflammatory syndrome in children may follow COVID-19 infection, most of the time after its asymptomatic form, even though it can lead to serious and life-threatening illness. Case summary In this case series, we discuss two cases of young adults with no former medical history who fit with the criteria defined in MIS-C. They both developed a refractory cardiogenic shock and required intensive care treatment including mechanical circulatory support, specifically the use of venous-arterial extracorporeal membrane oxygenation. They were both treated early with intravenous immune globulin and adjunctive high-dose steroids. They recovered ad integrum in less than 2 weeks. Discussion Multisystem inflammatory syndrome in children occurs 2-4 weeks after infection with severe acute respiratory syndrome coronavirus 2. Patients with MIS-C should ideally be managed in an intensive care environment since rapid clinical deterioration may occur. It would be preferable to have a multidisciplinary care to improve outcomes. Patients should be monitored for shock. Elucidating the mechanism of this new entity may have importance for understanding COVID-19 far beyond the patients who have had MIS-C to date. The pathogenesis seems to involve post-infectious immune dysregulation so early administration intravenous immune globulin associated with corticosteroids appears appropriate. It implies early recognition of the syndrome even in young adults.

We report a fatal case of coxsackievirus B4 chronic infection in a 30-year-old woman with a diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disorder controlled by rituximab monotherapy for 3 years. Initially presenting as self-limited meningitis, the infection remained silent for 8 months before the sudden onset of fulminant myocarditis. Analysis of the complete genome showed that the same virus was responsible for both episodes.

This retrospective study aimed to describe the association between the "beta-lactam allergy" labeling (BLAL) and the outcomes of a cohort of intensive care unit (ICU) patients. Retrospective cohort study. Seven ICU of the Aix Marseille University Hospitals from Marseille in France. We collected the uses of the label "beta-lactam allergy" in the electronic medical files of patients aged 18 years or more who required more than 48 hours in the ICU with mechanical ventilation and/or vasopressors admitted to 7 ICUs of a single institution. We retrospectively compared the patients with this labeling (BLAL group) with those without this labeling (control group). The primary outcome was the duration of ICU stay. Among the 7146 patients included in the analysis, 440 and 6706 patients were classified in the BLAL group and the control group, respectively. The prevalence of BLAL was 6.2%. In univariate and multivariate analyses, BLAL was weakly or not associated with the duration of ICU and hospital stays (respectively, 6 [3-14] vs 6 [3-14] days, standardized beta -0.09, P = .046; and 18 [10-29] vs 15 [8-28] days, standardized beta -0.09, P = .344). In multivariate analysis, the ICU and 28-day mortality rates were both lower in the BLAL group than in the control group (aOR 0.79 95% CI [0.64-0.98] P = .032 and 0.79 [0.63-0.99] P = .042). Antibiotic use differed between the 2 groups, but the outcomes were similar in the subgroups of septic patients in the BLAL group and the control group. In our cohort, the labeling of a beta-lactam allergy was not associated with prolonged ICU and hospital stays. An association was found between the labeling of a beta-lactam allergy and lower ICU and 28-day mortality rates. Trial registration: Retrospectively registered.

Abstract This retrospective study aimed to describe the association between the “β-lactam allergy” labeling (BLAL) and the outcomes of a cohort of intensive care unit (ICU) patients. Retrospective cohort study. Seven ICU of the Aix Marseille University Hospitals from Marseille in France. We collected the uses of the label “β-lactam allergy” in the electronic medical files of patients aged 18 years or more who required more than 48 hours in the ICU with mechanical ventilation and/or vasopressors admitted to 7 ICUs of a single institution. We retrospectively compared the patients with this labeling (BLAL group) with those without this labeling (control group). The primary outcome was the duration of ICU stay. Among the 7146 patients included in the analysis, 440 and 6706 patients were classified in the BLAL group and the control group, respectively. The prevalence of BLAL was 6.2%. In univariate and multivariate analyses, BLAL was weakly or not associated with the duration of ICU and hospital stays (respectively, 6 [3–14] vs 6 [3–14] days, standardized beta −0.09, P = .046; and 18 [10–29] vs 15 [8–28] days, standardized beta −0.09, P = .344). In multivariate analysis, the ICU and 28-day mortality rates were both lower in the BLAL group than in the control group (aOR 0.79 95% CI [0.64–0.98] P = .032 and 0.79 [0.63–0.99] P = .042). Antibiotic use differed between the 2 groups, but the outcomes were similar in the subgroups of septic patients in the BLAL group and the control group. In our cohort, the labeling of a β-lactam allergy was not associated with prolonged ICU and hospital stays. An association was found between the labeling of a β-lactam allergy and lower ICU and 28-day mortality rates. Trial registration: Retrospectively registered.