Volatile anesthetics have demonstrated anti-inflammatory and epithelial-protective effects in several sterile experimental models of acute lung injury (ALI). However, their effects in endotoxin-induced ALI remain unclear, and recent clinical data have raised concerns regarding their potential impact on patient outcomes. We investigated whether sevoflurane restores alveolar fluid clearance (AFC) and preserves epithelial integrity in a murine model of lipopolysaccharide (LPS)-induced ALI. Wild-type (WT) and receptor for advanced glycation end-products-deficient (RAGE-/-) mice received intratracheal lipopolysaccharide (LPS) and were exposed to sevoflurane (1 vol %) or control gas for 1 h. Our primary outcome, the net AFC rate was measured 48 h after injury. Secondary outcomes included lung histology, bronchoalveolar lavage (BAL) protein and cytokine levels, and lung expression of epithelial sodium channel (ENaC), water transporter aquaporin-5 (AQP5), and adherens junction protein E-cadherin. LPS induced significant weight loss and severe lung injury, with impaired AFC and downregulation of ENaC and AQP5. Sevoflurane did not restore AFC, reduce alveolar-capillary permeability, or preserve epithelial junctional integrity. RAGE-/- mice exhibited attenuated lung injury and partial preservation of epithelial marker expression, without a statistically significant interaction with sevoflurane exposure. BAL cytokine levels were largely unaffected by sevoflurane. These findings suggest context-dependent effects of a 1-h exposure to 1.0 vol% sevoflurane in experimental ALI, with absence of epithelial benefit in a mouse model of endotoxin-induced ALI, in contrast with previously reported effects in a sterile model. This work may provide mechanistic insight into the differential translational impact of inhaled sedation strategies.

BACKGROUND:Obesity is a growing public health issue associated with increased peri-induction risk during general anesthesia, particularly airway-related complications. Substantial variability in national and international guidelines may contribute to heterogeneous clinical practice. This study aimed to describe anesthetic induction practices in patients with obesity in France and to explore the influence of body mass index and obesity-related comorbidities on the decision for or against rapid sequence induction. METHODS:This nationwide declarative survey used an anonymous online questionnaire distributed to French anesthesiologists between May and December 2024. Using standardized theoretical clinical scenarios, induction strategies were classified as rapid sequence induction or conventional induction, as reported by participants. Data were analyzed descriptively, with group comparisons performed using Pearson's chi-square test. RESULTS:Of the 665 responses collected, 652 were analyzed, revealing wide variability in practices. For a body mass index of 43 kg/m2, 57% of participants would not perform rapid sequence induction. Among respondents, 33% regarded a body mass index threshold of ≥40 kg/m2 as appropriate for initiating rapid sequence induction, whereas 24% did not define any specific threshold. Rapid sequence induction was primarily selected for patients with daily gastroesophageal reflux disease, gastroesophageal reflux disease associated with a hiatal hernia, or a history of bariatric surgery. Anesthesiologist experience was associated with differences in the choice of induction sequence (p = 0.003). Considerable heterogeneity remained in the calculation of neuromuscular blocking agent doses: 28% of practitioners used total body weight for non-depolarizing agents. Apneic oxygenation remained underused, with 32% of respondents reporting that they never used it. CONCLUSIONS:This nationwide survey highlights substantial variability in anesthetic induction practices for patients with obesity, reflecting the absence of consensus. These findings underscore the need for further evidence to inform future recommendations and optimize anesthetic management in this high-risk population.

Introduction Patients discharged from intensive care units (ICUs) are at high risk of adverse long-term outcomes including cardiovascular and/or renal events and a 1-year mortality of approximately 22%. Plasma biomarkers measured at ICU discharge have demonstrated strong prognostic value, with elevated cardiac or renal biomarkers identifying patients at particularly high risk of poor outcomes. Sodium-glucose cotransporter 2 inhibitors are now widely recognised for their cardioprotective and nephroprotective effects in chronic conditions such as type 2 diabetes, heart failure or chronic kidney disease. These agents improve both morbidity and mortality across a range of high-risk populations. We hypothesise that a therapeutic strategy aimed at preventing the progression of cardiovascular and/or renal injury following ICU discharge may improve long-term outcomes in ICU survivors.Method and analysis This is a multicentre, double-blind, randomised, placebo-controlled clinical trial conducted across 16 teaching and non-teaching ICUs in France. We will enrol 600 adult patients (18 years of age or older) who have received mechanical ventilation and/or vasopressors for at least 24 hours during their ICU stay, and who meet at least one of the following criteria at ICU discharge: N-terminal pro-B-type natriuretic peptide (NT-proBNP) >800 pg/mL or BNP >90 ng/L, an estimated glomerular filtration rate between 25 and 90 mL/min/m². Eligible patients will be randomised in a 1:1 ratio to receive either dapagliflozin (10 mg once daily) or a matching placebo for a duration of 1 year. The primary outcome is a composite endpoint assessed at 1 year after randomisation, comprising: all-cause mortality, unscheduled hospitalisation for acute heart failure and decrease in renal function. Feasibility will be assessed based on patient and clinical acceptability and recruitment performance, including enrolment rates across participating centres.Ethics and dissemination This study has been approved by the Institutional Review Board (CPP Ile-de-France 5). Written informed consent will be obtained from all participants prior to enrolment and the initiation of any study-related procedures. Dapagliflozin is a widely available medication with an established safety profile. If proven effective, it would represent a readily deployable strategy to improve long-term outcomes in ICU survivors. The study is described in accordance with the Standard Protocol Items: Recommendations for Interventional Trials framework, and key design features and methodological decisions are outlined accordingly. DAPA-ICU aims to evaluate the efficacy of dapagliflozin in cardiorenal protection among critically ill patients following ICU discharge. The main trial results will be submitted for publication in a peer-reviewed journal as soon as they become available after final analysis.Trial registration number NCT07025629.

OBJECTIVE:To provide guidelines for antibiotic prophylaxis in surgery and interventional medicine. DESIGN:A consensus committee of 167 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and 28 surgery and interventional medicine learned societies was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guideline construction process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. METHODS:The latest SFAR guidelines on antibiotic prophylaxis in surgery and interventional medicine were published in 2018. The literature is now sufficient for an update. The aim of this expert panel guidelines is to evaluate antibiotic prophylaxis in surgery and interventional medicine. The experts studied questions within 2 fields and 9 domains. Each question was formulated according to the PICO (Patients Intervention Comparison Outcome) model and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analysed according to the GRADE® methodology. RESULTS:The experts' synthesis work and the application of the GRADE® method resulted in 9 tables of recommendations dealing, by specialty, on antibiotic prophylaxis in surgery and interventional medicine. Among the formalised recommendations, several have high levels of evidence (GRADE 1+) and low levels of evidence (GRADE 2+). For many recommendations, the GRADE method could not be applied, resulting in expert opinions. After 2 rounds of scoring and amendment, strong agreement was reached for all the recommendations. CONCLUSIONS:There was strong agreement among experts for all the recommendations to improve practices for antibiotic prophylaxis in surgery and interventional medicine.

IntroductionTechniques for measuring digestive motility are becoming increasingly precise and enable therapeutic interventions. However, while most of these interventions require general anesthesia, there is limited data on the impact of anesthetic agents on these measurements, and no standardized anesthesia protocol currently exists to guide such procedures. Our working group carried out two Delphi processes involving experts in neurogastroenterology and anesthesiology to reach a consensus on which drugs affect these measurements and to establish an anesthesia protocol.MethodTwo expert groups were formed, comprising 13 neurogastroenterology experts from the French Neuro-Gastroenterology Group (GFNG) and 15 full- or associate professors in anesthesia and intensive care. The first Delphi process involved the neurogastroenterologists and aimed to identify which anesthetic drugs influenced digestive pressure measurements. The second Delphi process, involving anesthetists, sought to develop an anesthesia protocol. Each expert indicated their level of agreement with each statement using a 6-point Likert scale. A statement was endorsed when at least 80% of experts agreed with it. The strength of evidence for each statement was evaluated using the GRADE system.ResultsThe Delphi process with neurogastroenterologists was conducted over three rounds and ultimately resulted in 91 amendments. The second Delphi process with anesthetists took place over two rounds and included 28 amendments, leading to the development of an anesthesia protocol.ConclusionTo our knowledge, this work is the first to establish an expert consensus on anesthetic agents that can affect digestive motility measurements and to propose an anesthesia protocol that accounts for the needs of neurogastroenterologists.

Airway driving pressure has garnered considerable attention for lung-protective ventilation. We evaluated the clinical effectiveness of airway driving pressure as a target to individualize positive-end-expiratory pressure (PEEP) setting in mechanically ventilated patients at risk for postoperative respiratory failure. We conducted a multicenter, pragmatic, assessor-masked, randomized trial among adult patients undergoing emergency abdominal surgery in 22 hospitals in France. Patients were assigned 1:1 to receive individually adjusted highest PEEP targeting a driving pressure < 13 cmH2O after an initial recruitment maneuver (intervention group) or to a fixed PEEP level of 5 cmH2O (control group). The primary outcome was a composite of postoperative respiratory failure (failure to wean from the ventilator or the composite of reintubation or curative non-invasive ventilation) or all-cause mortality at 30 days. Secondary outcomes included components of the composite primary outcome. The primary outcome occurred in 87 out of 338 (25.7

Importance:Whether the use of inhaled or intravenous sedation affects outcomes differentially in mechanically ventilated adults with acute respiratory distress syndrome (ARDS) is unknown. Objective:To determine the efficacy and safety of inhaled sevoflurane compared with intravenous propofol for sedation in patients with ARDS. Design, Setting, and Participants:Phase 3 randomized, open-label, assessor-blinded clinical trial conducted from May 2020 to October 2023 with 90-day follow-up. Adults with early moderate to severe ARDS (defined by a ratio of Pao2 to the fraction of inspired oxygen of <150 mm Hg with a positive end-expiratory pressure of ≥8 cm H2O) were enrolled in 37 French intensive care units. Interventions:Patients were randomized to a strategy of inhaled sedation with sevoflurane (intervention group) or to a strategy of intravenous sedation with propofol (control group) for up to 7 days. Main Outcomes and Measures:The primary end point was the number of ventilator-free days at 28 days; the key secondary end point was 90-day survival. Results:Of 687 patients enrolled (mean [SD] age, 65 [12] years; 30% female), 346 were randomized to sevoflurane and 341 to propofol. The median total duration of sedation was 7 days (IQR, 4 to 7) in both groups. The number of ventilator-free days through day 28 was 0.0 days (IQR, 0.0 to 11.9) in the sevoflurane group and 0.0 days (IQR, 0.0 to 18.7) in the propofol group (median difference, -2.1 [95% CI, -3.6 to -0.7]; standardized hazard ratio, 0.76 [95% CI, 0.50 to 0.97]). The 90-day survival rates were 47.1% and 55.7% in the sevoflurane and propofol groups, respectively (hazard ratio, 1.31 [95% CI, 1.05 to 1.62]). Among 4 secondary outcomes, sevoflurane was associated with higher 7-day mortality (19.4% vs 13.5%, respectively; relative risk, 1.44 [95% CI, 1.02 to 2.03]) and fewer intensive care unit-free days through day 28 (median, 0.0 [IQR, 0.0 to 6.0] vs 0.0 [IQR, 0.0 to 15.0]; median difference, -2.5 [95% CI, -3.7 to -1.4]) compared with propofol. Conclusions and Relevance:Among patients with moderate to severe ARDS, inhaled sedation with sevoflurane resulted in fewer ventilator-free days at day 28 and lower 90-day survival than sedation with propofol. Trial Registration:ClinicalTrials.gov Identifier: NCT04235608.

Whether the use of inhaled or intravenous sedation affects outcomes differentially in mechanically ventilated adults with acute respiratory distress syndrome (ARDS) is unknown. To determine the efficacy and safety of inhaled sevoflurane compared with intravenous propofol for sedation in patients with ARDS. Phase 3 randomized, open-label, assessor-blinded clinical trial conducted from May 2020 to October 2023 with 90-day follow-up. Adults with early moderate to severe ARDS (defined by a ratio of Pao2 to the fraction of inspired oxygen of <150 mm Hg with a positive end-expiratory pressure of ≥8 cm H2O) were enrolled in 37 French intensive care units. Patients were randomized to a strategy of inhaled sedation with sevoflurane (intervention group) or to a strategy of intravenous sedation with propofol (control group) for up to 7 days. The primary end point was the number of ventilator-free days at 28 days; the key secondary end point was 90-day survival. Of 687 patients enrolled (mean [SD] age, 65 [12] years; 30% female), 346 were randomized to sevoflurane and 341 to propofol. The median total duration of sedation was 7 days (IQR, 4 to 7) in both groups. The number of ventilator-free days through day 28 was 0.0 days (IQR, 0.0 to 11.9) in the sevoflurane group and 0.0 days (IQR, 0.0 to 18.7) in the propofol group (median difference, −2.1 [95% CI, −3.6 to −0.7]; standardized hazard ratio, 0.76 [95% CI, 0.50 to 0.97]). The 90-day survival rates were 47.1% and 55.7% in the sevoflurane and propofol groups, respectively (hazard ratio, 1.31 [95% CI, 1.05 to 1.62]). Among 4 secondary outcomes, sevoflurane was associated with higher 7-day mortality (19.4% vs 13.5%, respectively; relative risk, 1.44 [95% CI, 1.02 to 2.03]) and fewer intensive care unit–free days through day 28 (median, 0.0 [IQR, 0.0 to 6.0] vs 0.0 [IQR, 0.0 to 15.0]; median difference, –2.5 [95% CI, –3.7 to –1.4]) compared with propofol. Among patients with moderate to severe ARDS, inhaled sedation with sevoflurane resulted in fewer ventilator-free days at day 28 and lower 90-day survival than sedation with propofol. ClinicalTrials.gov Identifier: NCT04235608

Introduction Surgical site infections (SSIs) are the second leading cause of healthcare-associated infections in Europe with the highest rates being reported in colorectal surgery (ranging from 9% to 30%). Surgical antibiotic prophylaxis (SAP) is one of the most efficient measures for SSI prevention and should be started before surgical incision. Cefoxitin is an antibiotic widely used as SAP for colorectal surgery, but its continuous administration is currently the subject of debate due to its potential pharmacokinetic advantages. Therefore, the aim of the PROPHYLOXITIN study is to demonstrate that a loading dose followed by continuous infusion of cefoxitin during colorectal surgery (intervention group) decreases the rate of SSI compared to an intermittent bolus administration (control group).Methods and analysis The PROPHYLOXITIN study is a superiority, prospective, double-blind, randomised and multicentre study of 2000 patients undergoing colorectal surgery. The primary objective is to demonstrate the superiority of a loading dose of cefoxitin followed by continuous infusion over intermittent bolus administration in reducing the proportion of SSIs within 30 days after colorectal surgery. Subjects will be randomised 1:1 using a secure web-based random-number generator to one of two study groups. Randomised allocation of treatment will be done by minimisation and stratified according to the centre, the localisation of surgery (colon or rectum) and the type of surgical procedure (laparoscopy or laparotomy).Ethics and dissemination This research has been approved by an independent ethics committee and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals.Trial registration number EudraCT 2022-003262-20 and Clinical trial NCT05755789.

Patients with a penicillin allergy label have an increased risk of surgical site infection. Although a decision tree was published in 2019 to define which patients could benefit from direct cephalosporin use in the perioperative setting, this strategy remains unvalidated. This consensus statement aimed to adapt it based on an expert consensus to cover persisting caveats and to adapt it to an environment with poor allergist resources. Perioperative antibiotic prophylaxis and allergy experts were invited to participate. The Delphi method was implemented using an online-secured network. The panellists were given 3 weeks to answer each round. A consensus was reached if more than 75% of the experts rated the item ≥ 7 and if less than 25% rated the item ≤ 3. Sixteen experts participated. A high level of agreement was obtained after four rounds, defining four categories of the index reaction: unknown, not compatible, or compatible with an immediate or delayed hypersensitivity reaction. Twelve items were defined to stratify the risk of true penicillin allergy according to the index reaction history. The experts agreed that patients with high-risk reactions could benefit from either an allergy work-up or beta-lactam alternatives use. Those at low risk could benefit from direct cephalosporin administration. This resulted in an adapted decision tree to promote cephalosporin prescription in patients with penicillin allergy labels. It will be used in a stepped-wedge prospective multicentric randomized study to assess its applicability and acceptability to promote first- and second-generation cephalosporin administration in the perioperative period.

Surgical site infections (SSIs) are among the most common healthcare-associated infections, leading to increased morbidity, prolonged hospital stays, and significant healthcare costs. Surgical antimicrobial prophylaxis (SAP) is a critical strategy for SSI prevention, yet its effectiveness is threatened by antimicrobial resistance and variability in clinical practice. This narrative review provides an evidence-based update on the pathophysiology of SSIs, highlighting the interplay between endogenous microbiota, surgical stress, and perioperative factors such as hypoxia, immune modulation, and microbiome disruption. The current state-of-the-art in SAP is reviewed, including antibiotic selection, timing, dosing, intraoperative redosing, and the avoidance of unnecessary postoperative administration. Key intra- and postoperative measures to reduce the risk of SSI are covered, including glycaemic control, body temperature management, goal-directed fluid therapy, and skin antisepsis. A critical appraisal of the supporting evidence is included, with emphasis on areas of ongoing debate. The final section outlines future research priorities: optimizing dosing in obese patients, evaluating continuous infusion, tailoring prophylaxis to surgical site and microbiome, and addressing the management of patients colonized with multidrug-resistant organisms. Non-antibiotic strategies and rapid diagnostic tests are also discussed as promising avenues to enhance precision in infection prevention. By integrating current knowledge with emerging perspectives, this review aims to support the refinement of SSI prevention strategies and contribute to antimicrobial stewardship in modern surgical practice.

INTRODUCTION:Extubation of the trachea in the operating theatre may increase the time spent there. Conversely, tracheal extubation in the post-anaesthesia care unit may prolong the duration of anaesthesia and increase the incidence of complications. Our primary objective was to quantify the additional occupancy time associated with tracheal extubation in the operating theatre compared with the post-anaesthesia care unit. Secondary objectives were to assess the incidence of complications after tracheal extubation, including the need for ventilatory support. METHODS:This was a prospective dual-centre observational cohort study of patients whose tracheas were intubated for surgery in the operating theatre of two university hospitals. The primary endpoint was operating theatre occupancy time between the end of surgical procedure and discharge from the operating theatre. RESULTS:In total, 756 patients were included, and 494 (65.3%) tracheal extubations occurred in the operating theatre. Room occupancy time was increased by 7 min (95%CI 5-8 min, p = 0.001) when tracheal extubation was performed in the operating theatre compared with the post-anaesthesia care unit. After adjustment by matched or weighted propensity score, this time increased to 8 min (95%CI 6-10 min, p = 0.001) and 8 min (95%CI 6-9 min, p = 0.001), respectively. Desaturation after tracheal extubation (20.9% vs. 36.3%, p < 0.001) and arterial hypotension (0.6% vs. 3.1%, p = 0.019) were less frequent when tracheal extubation took place in the operating theatre. DISCUSSION:Tracheal extubation in the operating theatre is associated with an increase in theatre occupancy of < 8 min and a lower incidence of postoperative respiratory and cardiovascular complications.

BACKGROUND:Corticosteroids have become standard of care for COVID-19 but their effect on the systemic immune-inflammatory response has been little investigated.METHODS:Multicenter prospective cohort, including critically ill COVID-19 patients between March and November 2020. C-reactive protein (CRP), lymphocyte count and fibrinogen levels were collected upon hospital admission before initiation of steroid treatment and at ICU admission, three days and seven days later, along with interleukin (IL)-6, IL-10 and tumor necrosis factor-alpha (TNF-α) plasma levels.RESULTS:A hundred and fifty patients were included, 47 received corticosteroids, 103 did not. Median age was 62 [53-70], and 96 (65%) patients were mechanically ventilated. Propensity score matching rendered 45 well-balanced pairs of treated and non-treated patients, particularly on pre-treatment CRP levels. Using a mixed model, CRP (P=0.019), fibrinogen (P=0.003) and lymphocyte counts (P=0.006) remained lower in treated patients over ICU stay. Conversely, there was no significant difference over the ICU stay for Il-6 (P=0.146) and IL-10 (0.301), while TNF- α levels were higher in the treated group (P=0.013). Among corticosteroid-treated patients, CRP (P=0.012), fibrinogen (P=0.041) and lymphocyte count (P=0.004) over time were associated with outcome, whereas plasma cytokine levels were not.CONCLUSIONS:Steroid treatment was associated with an early and sustained decrease in the downstream IL-6-dependent inflammatory signature but an increase in TNF-α levels. In corticosteroid-treated patients, CRP and lymphocyte count were associated with outcome, conversely to plasma cytokine levels. Further research on using these biomarker's kinetics to individualize immunomodulatory treatments is warranted.

Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring mechanical ventilation suffer from a high incidence of ventilator associated pneumonia (VAP), mainly related to Enterobacterales. Data regarding extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) VAP are scarce. We aimed to investigate risk factors and outcomes of ESBL-E related VAP among critically ill coronavirus infectious disease-19 (COVID-19) patients who developed Enterobacterales related VAP. We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU) that included 4929 COVID-19 critically ill patients. For the present analysis, only patients with complete data regarding resistance status of the first episode of Enterobacterales related VAP (ESBL-E and/or carbapenem-resistant Enterobacterales, CRE) and outcome were included. We included 591 patients with Enterobacterales related VAP. The main causative species were Enterobacter sp (n = 224), E. coli (n = 111) and K. pneumoniae (n = 104). One hundred and fifteen patients (19

Acute respiratory distress syndrome (ARDS) is a serious lung condition that often leads to hospitalization in intensive care units and a high mortality rate. Sevoflurane is a volatile anesthetic with growing interest for sedation in ventilated patients with ARDS. It has been shown to have potential lung -protective effects, such as reduced inflammation and lung edema, or improved arterial oxygenation. In this study, we investigated the effects of sevoflurane on lung injury in cultured human carcinoma -derived lung alveolar epithelial (A549) cells. We found that sevoflurane was associated with improved wound healing after exposure to inflammatory cytokines, with preserved cell proliferation but no effect on cell migration properties. Sevoflurane exposure was also associated with enhanced cell viability and active autophagy in A549 cells exposed to cytokines. These findings suggest that sevoflurane may have beneficial effects on lung epithelial injury by promoting alveolar epithelial wound healing and by influencing the survival and proliferation of A549 epithelial cells in vitro . Further research is needed to confirm these findings and to investigate the key cellular mechanisms explaining sevoflurane 's potential effects on lung epithelial injury.

Purpose The present study aimed at assessing the prevalences of post-traumatic stress disorder (PTSD) (main objective), anxiety, depression, and burnout syndrome (BOS) and their associated factors in intensive care unit (ICU) staff workers in the second year of the COVID-19 pandemic. Materials and methods An international cross-sectional multicenter ICU-based online survey was carried out among the ICU staff workers in 20 ICUs across 3 continents. ICUs staff workers (both caregivers and non-caregivers) were invited to complete PCL-5, HADS, and MBI questionnaires for assessing PTSD, anxiety, depression, and the different components of BOS, respectively. A personal questionnaire was used to isolate independent associated factors with these disorders. Results PCL-5, HADS, and MBI questionnaires were completed by 585, 570, and 539 responders, respectively (525 completed all questionnaires). PTSD was diagnosed in 98/585 responders (16.8%). Changing familial environment, being a non-caregiver staff worker, having not being involved in a COVID-19 patient admission, having not been provided with COVID-19-related information were associated with PTSD. Anxiety was reported in 130/570 responders (22.8%). Working in a public hospital, being a woman, being financially impacted, being a non-clinical healthcare staff member, having no theoretical or practical training on individual preventive measures, and fear of managing COVID-19 patients were associated with anxiety. Depression was reported in 50/570 responders (8.8%). Comorbidity at risk of severe COVID-19, working in a public hospital, looking after a child, being a non-caregiver staff member, having no information, and a request for moving from the unit were associated with depression. Having received no information and no adequate training for COVID-19 patient management were associated with all 3 dimensions of BOS. Conclusion The present study confirmed that ICU staff workers, whether they treated COVID-19 patients or not, have a substantial prevalence of psychological disorders.

Abstract Introduction Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management. Methods Literature review, analysis of the literature according to the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients and organizers to reach a consensus. Only expert opinions with strong agreement were selected. Results A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and ≥ 2 cm at the hilum level on frontal chest X-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described. Conclusion These guidelines are a step towards PSP treatment and follow-up strategy optimization in France.

Extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-PE) intestinal colonization is of particular concern as it negatively impacts morbidity and is the main source of external cross-contamination in hospitalized patients. Contact isolation strategies may be caught out due to the turnaround time needed by laboratories to report intestinal colonization, during which patients may be inappropriately isolated or not isolated. Here, we developed a protocol combining enrichment by a rapid selective subculture of rectal swab medium and realization of a β-Lacta test on the obtained bacterial pellet (named the BLESSED protocol). The performances of this protocol were validated in vitro on 12 ESBL-PE strains spiked into calibrated sample suspensions and confirmed in clinical settings using 155 rectal swabs, of which 23 (reference method) and 31 (postenrichment broth culture) came from ESBL-PE carriers. In vitro, the protocol detected, with 100% sensitivity, the presence of the 12 ESBL-PE strains from 104 CFU/mL. In the clinical validation cohort, 22 out of the 23 (reference method) and 28 out of the 31 (postenrichment broth culture) ESBL-PE-positive rectal samples were accurately detected. The diagnostic performances for ESBL-PE detection, considering all ESBL-PE carriers, were 90% sensitivity, 98% specificity, an 87% positive predictive value, and a 98% negative predictive value. Our protocol is a rapid and low-cost method that can detect intestinal colonization with ESBL-PE in less than 5 h more accurately than the reference method, opening the field for further studies assessing a rapid and targeted isolation strategy applied only to patients with a positive BLESSED protocol result. IMPORTANCE To both improve the efficiency of contact isolation among ESBL-PE carriers and avoid the unnecessary isolation of noncolonized patients, we should reduce the turnaround time of ESBL screening in laboratories and improve the sensitivity of diagnostic methods. The development of rapid and low-cost methods that satisfy these two goals is a promising approach. In this study, we developed such a technique and report its good diagnostic performance, opening the door for further studies assessing a rapid and targeted isolation strategy applied in a few hours only for patients truly colonized with ESBL-producing bacteria.