Background:Estimating left ventricular filling pressures (LVFP) is a crucial component of hemodynamic monitoring in critically ill patients. While non-invasive techniques such as Doppler echocardiography have been validated in non-critical populations, their application in mechanically ventilated patients remains less well-documented. Objective:This study aims to evaluate the accuracy of Doppler echocardiography in predicting LVFP, as assessed by pulmonary artery occlusion pressure (PAOP), in mechanically ventilated patients admitted to the intensive care unit (ICU). Methods:We conducted a systematic review and meta-analysis of peer-reviewed studies focusing on critically ill patients undergoing mechanical ventilation in the ICU (Population-P). The intervention (I) was the assessment of LVFP using transthoracic or transesophageal echocardiography. The comparator (C) was PAOP measurement obtained via a pulmonary artery catheter. The primary outcomes (O) included the accuracy of echocardiographic measurements and their correlation with PAOP. We searched three databases (PubMed/Medline, Scopus, and Embase), screened relevant articles, synthesized the data, assessed study quality using standard tools, and graded the level of evidence with GRADE criteria. A meta-analysis was performed for comparable findings. Results:Of 3596 studies initially identified, 18 prospective studies (n = 696 patients) met the inclusion criteria, with 8 studies (n = 342 patients) included in the meta-analysis. All studies featured small sample sizes (less than 100 patients). Six studies evaluated E/A ratios, and four E/E' ratios. in relation to PAOP. The area under the receiver operating characteristic (AUROC) curve ranged from 0.69 to 0.83 for E/A and from 0.60 to 0.91 for lateral E/E' in predicting PAOP ≥ 18 mmHg. Both E/A and lateral E/E' showed a correlation with PAOP, with pooled correlation coefficients of 0.48 (95% confidence intervals [CI]: 0.48-0.58) and 0.72 (95% CI: 0.52-0.92), respectively. Study quality ranged from low to high and heterogeneity was high the overall level of evidence was deemed very low. Conclusions:Doppler echocardiography shows potential for assessing LVFP in critically ill patients on mechanical ventilation. However, limitations such as small sample sizes and study heterogeneity, including the use of different PAOP cut-off values to define elevated LVFP, highlight the need for further research to strengthen its role in this setting.

IntroductionMany potential organ donors are not referred to the transplant coordination, constituting potential missed referrals.MethodsIn this retrospective analysis, we explored risk factors for potential missed referral among patients suffering from acute brain injury, who were admitted to a 32-bed mixed intensive care unit (ICU) between 2018 and 2023 and died after hypoxic-ischemic encephalopathy, traumatic brain injury, or subarachnoid hemorrhage (SAH). Patients with absolute contraindications for donation were excluded. Each patient was categorized as “actual donor”, “medical refusal”, “personal refusal”, or “potential missed referral”. The primary outcome was the potential missed referral rate.ResultsOf 183 potential donors, 101 (55%) were referred and 82 (45%) were not; on ICU admission, patients in the potential missed referral group were older, had higher severity scores, more comorbidities, and were less likely to have a diagnosis of SAH. In a binomial logistic regression analysis, older age and chronic obstructive pulmonary disease were independent predictors of potential missed referral; donation after brain death and SAH were associated with higher referral rates.ConclusionsThis audit identifies areas for improvement to expand the donor pool, including greater recognition of the donor potential of critically ill patients with extra-neurological complications, even in the presence of older age and comorbidities.

During the weaning process, the transition from positive to negative pressure ventilation may induce cardiac dysfunction, which may lead to pulmonary oedema. The incidence of weaning-induced pulmonary oedema (WIPO) is poorly documented and shows huge variations. Our study aims to investigate the incidence and risk factors for WIPO during weaning from mechanical ventilation in general critically ill patients. This multicentre study was conducted in France, Italy, and India. Adult critically ill patients receiving invasive ventilation were included once a spontaneous breathing trial (SBT) was performed. The SBT technique could be either T-piece or pressure support mode with (PSV-PEEP) or without positive end expiratory pressure (PEEP) (PSV-ZEEP). A consensual diagnosis of WIPO was made a posteriori by five experts who analysed changes observed during the SBT that were retrospectively recorded. From July 2019 to February 2021, 634 SBTs were performed in 500 patients from 13 ICUs. Weaning success occurred in 417 patients (66

Introduction New-onset supraventricular arrhythmia (NOSVA) is the most common arrhythmia in patients with septic shock and is associated with haemodynamic alterations and increased mortality rates. With no data available from randomised trials, clinical practice for patient management varies widely. In this setting, rate control or rhythm control could be beneficial in limiting the duration of shock and preventing evolution to multiorgan dysfunction.Methods and analysis The Control Atrial Fibrillation in Septic shock (CAFS) study is a binational (French and Belgium), multicentre, parallel-group, open-label, randomised controlled superiority trial to compare the efficacy and safety of three management strategies in patients with NOSVA during septic shock. The expected duration of patient enrolment is 42 months, starting from November 2021. Patients will be randomised to receive either risk control (magnesium and control of risk factors for NOSVA), rate control (risk control and low dose of amiodarone) or rhythm control (risk control and cardioversion using high dose of amiodarone with external electrical shock if NOSVA persists) for 7 days. Patients with a history of SVA, NOSVA lasting more than 48 hours, recent cardiac surgery or a contraindication to amiodarone will not be included. We plan to recruit 240 patients. Patients will be randomised on a 1:1:1 basis and stratified by centre. The primary endpoint is a hierarchical criterion at day 28 including all-cause mortality and the duration of septic shock defined as time from randomisation to successful weaning of vasopressors. Secondary outcomes include: individual components of the primary endpoint; arterial lactate clearance at day 3; efficacy at controlling cardiac rhythm at day 7; proportion of patients free from organ dysfunction at day 7; ventricular arrhythmia, conduction disorders, thrombotic events, major bleeding events and acute hepatitis related to amiodarone at day 28; intensive care unit and hospital lengths of stay at day 28.Ethics and dissemination The study has been approved by the French (Comité Sud-Ouest et Outre-Mer II, France, registration number 2019-A02624-53) and Belgian (Comité éthique de l’hôpital Erasme, Belgium, registration number CCB B4062023000179) ethics committees. Patients will be included after obtaining signed informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration number NCT04844801.

Importance:Posttraumatic growth (PTG) refers to positive psychological changes following adversity, including deeper relationships and a greater appreciation for life. Objective:To assess PTG among intensive care unit (ICU) health care professionals 4 years after the COVID-19 pandemic and explore its association with resilience, anxiety, and depression. Design, Setting, and Participants:This cross-sectional study invited ICU health care professionals (nursing staff, medical staff [residents, interns, clinical fellows, and senior intensivists], and other professionals providing patient care) in ICUs in general or university-affiliated hospitals in France and Belgium to complete online questionnaires between March 15 and May 15, 2024. Exposures:PTG, resilience, anxiety, and depression. Main Outcomes and Measures:The primary outcome was PTG, and secondary outcomes were anxiety, depression, and resilience. Participants completed validated self-reported questionnaires, including the Posttraumatic Growth Inventory (PTGI), Hospital Anxiety and Depression Scale (HADS), and 10-item Connor-Davidson Resilience Scale (CD-RISC 10). Visual analog scales (VASs) assessed professional experiences and psychological impact. Multivariate linear regression identified factors associated with PTG. Results:Among 1371 health care professionals in 23 ICUs, 850 (62%) responded (median age, 39 years [IQR, 32-46 years]; 574 [68%] women). The median PTGI score was 50 (IQR, 33-64), with nursing staff reporting higher PTG than medical staff (51 [IQR, 34-65] vs 47 [IQR, 28-61]; P = .02), mainly in personal strength, spiritual change, and appreciation of life. Anxiety and depression symptoms were present in 492 respondents (58%) and 219 respondents (26%), respectively. Lower PTG was associated with psychological fatigue (regression coefficient, 1.43; 95% CI, 0.91-1.96; P < .001), ICU conflicts (regression coefficient, 0.62; 95% CI, 0.05-1.19; P = .03), and perceived deterioration in family-centered care (regression coefficient, -7.47; 95% CI, -1.10 to -13.80; P = .02). Higher PTG was correlated with higher resilience (Spearman correlation coefficient, 0.24; 95% CI, 0.17-0.30; P < .001) and was associated with a change in personal life since the pandemic (regression coefficient, 1.80 [95% CI, 1.13-2.47] per VAS point; P < .001). Conclusions and Relevance:In this cross-sectional study performed 4 years after the start of the COVID-19 pandemic, ICU health care professionals, particularly nursing staff, exhibited significant PTG. Resilience, rather than psychological distress, emerged as a key driver of PTG, and deterioration in family-centered care was a major contributing factor, underscoring the need for targeted well-being and resilience-building strategies to enhance health care professionals' mental health and professional fulfillment while also improving patient and family care.

Data on severe hemoptysis (SH) in the intensive care unit (ICU) remain scarce. We aimed to describe its clinical characteristics, etiologies, management strategies, and outcomes. This retrospective observational study analyzed patients admitted for SH to a referral center between 2009 and 2019. Data were compared to a historical cohort (1995–2009) using the Cochran–Armitage test. A total of 945 patients (75

Background The effects of pharmacological therapy on cardiogenic shock (CS) survivors have not been extensively studied. Thus, this study investigated the association between guideline‐directed heart failure (HF) medical therapy (GDMT) and one‐year survival rate in patients who are post‐CS. Methods and Results FRENSHOCK (French Observatory on the Management of Cardiogenic Shock in 2016) registry was a prospective multicenter observational survey, conducted in metropolitan French intensive care units and intensive cardiac care units. Of 772 patients, 535 patients were enrolled in the present analysis following the exclusion of 217 in‐hospital deaths and 20 patients with missing medical records. Patients with triple GDMT (beta‐blockers, renin‐angiotensin system inhibitors, and mineralocorticoid receptor antagonists) at discharge (n=112) were likely to have lower left ventricular ejection fraction on admission and at discharge compared with those without triple GDMT (n=423) (22% versus 28%, P<0.001 and 29% versus 37%, P<0.001, respectively). In the overall cohort, the one‐year mortality rate was 23%. Triple GDMT prescription was significantly associated with a lower one‐year all‐cause mortality compared with non‐triple GDMT (adjusted hazard ratio 0.44 [95% CI, 0.19–0.80]; P=0.007). Similarly, 2:1 propensity score matching and inverse probability treatment weighting based on the propensity score demonstrated a lower incidence of one‐year mortality in the triple GDMT group. As the number of HF drugs increased, a stepwise decrease in mortality was observed (log rank; P<0.001). Conclusions In survivors of CS, the one‐year mortality rate was significantly lower in those with triple GDMT. Therefore, this study suggests that intensive HF therapy should be considered in patients following CS.

Background: Chronic kidney disease (CKD) is one of the leading causes of death worldwide, closely interrelated with cardiovascular diseases, ultimately leading to the failure of both organs − the so-called “cardiorenal syndrome‿. Despite this burden, data related to cardiogenic shock outcomes in CKD patients are scarce.Methods: FRENSHOCK (NCT02703038) was a prospective registry involving 772 patients with cardiogenic shock from 49 centres. One-year outcomes (rehospitalization, death, heart transplantation, ventricular assist device) were analysed according to history of CKD at admission and were adjusted on independent predictive factors.Results: CKD was present in 164 of 771 patients (21.3%) with cardiogenic shock; these patients were older (72.7 vs 63.9 years) and had more comorbidities than those without CKD. CKD was associated with a higher rate of all-cause mortality at 1 month (36.6% vs 23.2%; hazard ratio 1.39, 95% confidence interval 1.01–1.9; P = 0.04) and 1 year (62.8% vs 40.5%, hazard ratio 1.39, 95% confidence interval 1.09–1.77; P < 0.01). Patients with CKD were less likely to be treated with norepinephrine/epinephrine or undergo invasive ventilation or receive mechanical circulatory support, but were more likely to receive renal replacement therapy (RRT). RRT was associated with a higher risk of all-cause death at 1 month and 1 year regardless of baseline CKD status.Conclusions: Cardiogenic shock and CKD are frequent “cross-talking‿ conditions with limited therapeutic options, resulting in higher rates of death at 1 month and 1 year. RRT is a strong predictor of death, regardless of pre-existing CKD. Multidisciplinary teams involving cardiac and kidney physicians are required to provide integrated care for patients with failure of both organs.

Background: Cardiogenic shock and sepsis are severe haemodynamic states that are frequently present concomitantly, leading to substantial mortality. Despite its frequency and clinical significance, there is a striking lack of literature on the outcomes of combined sepsis and cardiogenic shock. Methods: FRENSHOCK was a prospective registry including 772 patients with cardiogenic shock from 49 centres. The primary endpoint was 1-month all-cause mortality. Secondary endpoints included heart transplantation, ventricular assistance device and all-cause death rate at 1 year. Results: Among the 772 patients with cardiogenic shock included, 92 cases were triggered by sepsis (11.9%), displaying more frequent renal and hepatic acute injuries, with lower mean arterial pressure. Patients in the sepsis group required broader use of dobutamine (90.1% vs. 81.2%; P = 0.16), norepinephrine (72.5% vs. 50.8%; P < 0.01), renal replacement therapy (29.7% vs. 14%; P < 0.01), non-invasive ventilation (36.3% vs. 24.4%; P = 0.09) and invasive ventilation (52.7% vs. 35.9%; P = 0.02). Sepsis-triggered cardiogenic shock resulted in higher 1-month (41.3% vs. 24.0%; adjusted hazard ratio: 1.94, 95% confidence interval: 1.36-2.76; P < 0.01) and 1-year (62.0% vs. 42.9%; adjusted hazard ratio 1.75, 95% confidence interval 1.32-2.33; P < 0.01) all-cause death rates. No significant difference was found at 1 year for heart transplantation or ventricular assistance device (8.7% vs. 10.3%; adjusted odds ratio 0.72, 95% confidence interval 0.32-1.64; P = 0.43). In patients with sepsis-triggered cardiogenic shock, neither the presence of a preexisting cardiomyopathy nor the co-occurrence of other cardiogenic shock triggers had any additional impact on death. Conclusions: The association between sepsis and cardiogenic shock represents a common high-risk scenario, leading to higher short- and long-term death rates, regardless of the association with other cardiogenic shock triggers or the presence of preexisting cardiomyopathy.

Rationale: Psychological resilience (the ability to thrive in adversity) may protect against mental-health symptoms in healthcare professionals during coronavirus disease (COVID-19) waves. Objectives: To identify determinants of resilience in ICU staff members. Methods: In this cross-sectional survey in 21 French ICUs, staff members completed the 10-item Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and Impact of Event Scale-Revised (for post-traumatic stress disorder [PTSD]). Factors independently associated with resilience were identified. Measurements and Main Results: The response rate was 73.1% (950 of 1,300). The median 10-item Connor-Davidson Resilience Scale score was 29 (interquartile range, 25-32). Symptoms of anxiety, depression, and PTSD were present in 61%, 39%, and 36% of staff members, respectively. Distress associated with the COVID-19 infodemic was correlated with symptoms of depression and PTSD. More resilient respondents less often had symptoms of anxiety, depression, and PTSD. Greater resilience was independently associated with male sex, having provided intensive care during the early waves, having managed more than 50 patients with COVID-19, and, compared with earlier waves, working longer hours, having greater motivation, and more often involving families in end-of-life decisions. Independent risk factors for lower resilience were having managed more than 10 patients who died of COVID-19, having felt frightened or isolated, and greater distress from the COVID-19 infodemic. Conclusions: This study identifies modifiable determinants of resilience among ICU staff members. Longitudinal studies are needed to determine whether prior resilience decreases the risk of mental ill health during subsequent challenges. Hospital and ICU managers, for whom preserving mental well-being among staff members is a key duty, should pay careful attention to resilience.

Despite scarce data, invasive mechanical ventilation (MV) is widely suggested as first-line ventilatory support in cardiogenic shock (CS) patients. We assessed the real-life use of different ventilation strategies in CS and their influence on short and mid-term prognosis. FRENSHOCK was a prospective registry including 772 CS patients from 49 centers in France. Patients were categorized into three groups according to the ventilatory supports during hospitalization: no mechanical ventilation group (NV), non-invasive ventilation alone group (NIV), and invasive mechanical ventilation group (MV). We compared clinical characteristics, management, and occurrence of death and major adverse event (MAE) (death, heart transplantation or ventricular assist device) at 30 days and 1 year between the three groups. Seven hundred sixty-eight patients were included in this analysis. Mean age was 66 years and 71

In patients with septic shock, compensatory tachycardia initially serves to maintain adequate cardiac output and tissue oxygenation but may persist despite appropriate fluid and vasopressor resuscitation. This sustained elevation in heart rate and altered heart rate variability, indicative of autonomic dysfunction, is a well-established independent predictor of adverse outcomes in critical illness. Elevated heart rate exacerbates myocardial oxygen demand, reduces ventricular filling time, compromises coronary perfusion during diastole, and impairs the isovolumetric relaxation phase of the cardiac cycle, contributing to ventricular-arterial decoupling. This also leads to increased ventricular and atrial filling pressures, with a heightened risk of arrhythmias. Ivabradine, a highly selective inhibitor of the sinoatrial node's pacemaker current (If or "funny" current), mitigates heart rate by modulating diastolic depolarization slope without affecting contractility. By exerting a selective chronotropic effect devoid of negative inotropic properties, ivabradine shows potential for improving hemodynamics in septic shock patients with cardiac dysfunction. This review evaluates the plausible mechanisms and existing evidence regarding the utility of ivabradine in managing patients with septic shock.

Aim: Although brain injury is the main determinant of poor outcome following cardiac arrest (CA), cardiovascular failure is the leading cause of death within the first days after CA. However, it remains unclear which hemodynamic parameter is most suitable for its early recognition. We investigated the association of cardiac power output (CPO) with early mortality in intensive care unit (ICU) after CA and with mortality related to post-CA cardioMethods: Retrospective analysis of adult comatose survivors of CA admitted to the ICU of a University Hospital. Exclusion criteria were treatment with extracorporeal cardiopulmonary resuscitation, ECMO or intra-aortic balloon pump. We retrieved CA characteristics; we recorded mean arterial pressure, cardiac output, CPO (as derived parameter) and the vasoactive-inotropic score for the first 72 hours after ROSC, at intervals of 8 hours. ICU death was defined as related to post-CA cardiovascular failure when death occurred as a direct consequence of shock, secondary CA or fatal arrhythmia, or related to neurological injury if this led to withdrawal of life-sustaining therapy or brain death. Results: Among the 217 patients (median age 66 years, 65% male, 61.8% out-of-hospital CA), 142 (65.4%) died in ICU: 99 (69.7%) patients died from neurological injury and 43 (30.3%) from cardiovascular-related causes. Comparing the evolution over time of CPO between survivors and nonsurvivors, a statistically significant difference was found only at +8 hours after CA (p = 0.0042). In multivariable analysis, CPO at 8-hour was significantly associated with cardiovascular-related mortality (p = 0.007). Conclusions: In post-CA patients, the 8-hour CPO is an independent factor associated with ICU cardiovascular-related mortality.

Traumatic brain injury (TBI) is a significant public health issue because of its increasing incidence and the substantial short-term and long-term burden it imposes. This burden includes high mortality rates, morbidity, and a significant impact on productivity and quality of life for survivors. During the management of TBI, extracranial complications commonly arise during the patient’s stay in the intensive care unit. These complications can have an impact on both mortality and the neurological outcome of patients with TBI. Among these extracranial complications, cardiac injury is a relatively frequent occurrence, affecting approximately 25–35

Le pronostic des patients atteints de pneumonie COVID-19 sévère reste mauvais, malgré les progrès thérapeutiques reposant sur la corticothérapie. L’essai contrôlé randomisé académique Corimmuno19-BEVA a évalué l’efficacité et l’innocuité du BEV en addition du STD, chez les patients atteints de pneumonie COVID-19 sévère (catégorie OMS 6 à 8) nécessitant de l’oxygène nasal à haut débit (ONHD), une ventilation non invasive (VNI) ou une ventilation mécanique invasive (VM). Les critères d’exclusion étaient une embolie pulmonaire active, une pneumonie bactérienne et une contre-indication du BEV. Le critère d’évaluation principal était le délai de passage à la catégorie ≤ 5 du score OMS, au cours des 28 jours suivant la randomisation, analysé en intention de traiter, à l’aide d’un modèle de Cox stratifié. L’évaluation de l’innocuité a été menée jusqu’à D120. L’étude a débuté le 17 avril 2021 et s’est arrêtée le 14 mars 2022, en raison du faible taux d’inclusion à partir de cette période. Quatre-vingt-seize patients (62,0 ans [54,5–70,0], 69 % d’hommes) ont été randomisés pour recevoir le STD (n = 48) seul ou associé avec le BEV (7,5 mg/kg) (n = 48) à la randomisation (D1). À D1 les patients recevaient une ONHD (n = 84), une VNI (n = 4) ou une VM (n = 7). Le STD comprenait des stéroïdes (n = 90), une anticoagulation (n = 91) et du tocilizumab (n = 32). À D28, 36 patients (STD) et 37 patients (BEV) sont passés dans une catégorie OMS ≤ 5, dans un délai médian de 8 jours (IC à 95 % 5–10) et de 7 jours (IC à 95 % 5–12) dans les bras STD et BEV, respectivement (HR 0,76 95 % IC [0,46–1,26]). À D28, 9 patients (STD) et 4 patients (BEV) étaient morts ; 4 patients (STD) et 7 patients (BEV) nécessitaient toujours une ONHD, une VNI ou une VM. À D120, des événements indésirables graves sont survenus dans 23 patients dans le bras STD et 21 patients dans le bras BEV, avec une fréquence similaire de saignement et d’embolie pulmonaire dans les deux bras. L’essai CorimmunoBeva ne suggère pas d’efficacité à l’association du BEV au STD pour raccourcir le temps d’amélioration de l’hypoxémie dans la pneumonie COVID-19 sévère. Aucun signal négatif de tolérance n’a été observé.

The prognosis of severe COVID-19 pneumonia remains poor, despite therapeutic advances. Methods The Corimmuno19-BEVA randomized controlled trial evaluated efficacy and safety of BEV in severe COVID-19 pneumonia (OMS 6 to 8) requiring high-flow nasal oxygen (HFNO), noninvasive (NIV) or invasive mechanical ventilation (IMV). Exclusion criteria were active pulmonary thromboembolism (PE), bacterial pneumonia and CI to BEV. Primary endpoint was time-to-drop to OMS category ≤5, during the 28 days after randomization, analyzed in intent-to-treat basis, using Aalen-Johansen method. Safety analysis was conducted up to D120. Findings The study started on April 2021 and stopped on March 2022, due to low inclusion rate. 96 pts (62.0 yr [54.5-70.0], 69% men) were assigned to receive SoC (n=48) alone or combined with BEV (7.5 mg/kg) (n=48) at randomization. At D1 pts received HFNO (n=83), NIV (n=4) or IMV (n=7). SoC were steroids (n=92), anticoagulation (n=94) and tocilizumab (n=32). At D28, 36 pts (SoC) and 37 pts (BEV) dropped to an OMS ≤5, with a median time of 8 dys (95%CI 6-10) and 7 dys (95% CI 5-12) in SoC and BEV arms, respectively (HR 0.76 95%CI [0.46-1.26]). At D28, 9 pts (18.8%) (SoC) and 4 pts (8.5%) (BEV) were dead; 4 pts (SoC) and 7 pts (BEV) required HFNO, NIV or IMV. At D120, SAE occurred in 26 pts in SoC arm and 33 pts in BEV arm, with similar frequency of bleeding and PE in both arms. Conclusions Addition of BEV to SoC did not shorten the time to improve hypoxemia in severe COVID-19 pneumonia, as compared with Soc. Deaths were numerically lower in BEV. No negative safety signal was observed.