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Background: Candida peritonitis (CP) is generally considered to be a severe disease, but its impact on outcome in critically ill patients remains unknown. Hypothesis: The predictive factors of mortality due to CP can be determined by study of a population of patients with CP. Design: A retrospective review of a prospective surgical intensive care unit (ICU) database of patients (January 1, 1994, through December 31, 2000). Setting: University hospital in Paris, France. Patients: Eighty-three patients with generalized CP. Main Outcome Measures: Demographic and microbiologic data and outcome were collected, and nonsurvivors were compared with survivors. Results: Overall ICU mortality due to CP was 43 (52%) of 83 patients. In a stepwise multivariate logistic regression, the following 4 variables were independently associated with mortality: APACHE II (Acute Physiology and Chronic Health Evaluation II) score on admission of at least 17 (odds ratio [OR], 28.4; 95% confidence interval [CI], 5.7-142.5; P<.001), respiratory failure on admission (OR, 10.6; 95% CI, 2.2-51.2; P = .003), upper gastrointestinal tract site of peritonitis (OR, 7.7; 95% CI, 1.734.7; P = .007), and results of direct examination of peritoneal fluid that were positive for Candida (OR, 4.7; 95% CI, 1.2-19.7; P = .002). Conclusions: These results confirm the severity of CP in ICU patients and emphasize the prognostic value of direct examination of peritoneal fluid for Candida in this context. [ABSTRACT FROM AUTHOR]

Investigates the effect of diesel particles on phosphatidylcholine release. Inhibition of PC basal secretion by nitric oxide (NO) inhibitor; Increase in NO production; Upregulation of protein content and messenger RNA levels.

Studies the frequency of and risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) during postoperative intra-abdominal infection (pIAI). Prospective MRSA nasal screening and case evaluation of patients having pIAI; Assessment of the identity of nasal and peritoneal MRSA strains by genomic analysis; Organ system failure score.

To compare recovery of psychomotor function in elderly and young surgical patients at emergence from propofol-alfentanil anaesthesia. Ten elderly (> 70 yr) and 10 younger (< 40 yr) patients scheduled for orthopaedic surgery of less than three hours, were anesthetized with nitrous oxide, propofol and alfentanil. Propofol and alfentanil cumulative doses, time from cessation of propofol infusion to eye opening (EO) on verbal command and to extubation were recorded. Psychomotor performance was assessed by the Mini-Mental State (MMS) performed the day prior to surgery and postoperatively at 30, 60, and 120 min. following extubation. Propofol blood concentrations were measured at EO and at each MMS task. Elderly patients were comparable with young patients for preoperative MMS scores, surgery and anaesthesia duration, propofol and alfentanil cumulative doses. Postoperative MMS scores were lower at 30, 60 and 120 min. in elderly patients. Propofol blood concentrations were not different between elderly and young patients at EO, 30, 60 and 120 min. Psychomotor performance is impaired in elderly compared with young patients at emergence from propofolalfentanil anaesthesia. These differences are not likely to be related to propofol accumulation in elderly subjects. Comparer la récupération de la fonction psychomotrice chez des patients âgés et de jeunes patients lors du réveil après une anesthésie au propofol et à l’alfentanil. Dix patients âgés (> 70 ans) et 10 jeunes patients (< 40 ans), dont la chirurgie orthopédique de moins de trois heures avait été prévue, ont reçu une anesthésie avec du protoxyde d’azote, du propofol et de l’alfentanil. On a enregistré les doses cumulatives de propofol et d’alfentanil, le temps entre l’arrêt de la perfusion de propofol et l’ouverture des yeux (OY), d’après une commande verbale, et le moment de l’extubation. Le rendement psychomoteur a été évalué par le test MMS de Folstein et coll. (Mini-Mental State) administré le jour précédent la chirurgie et, après la chirurgie, 30, 60 et 120 min. après l’extubation. Les concentrations sanguines de propofol ont été mesurées à l’OY et à chaque tâche du test MMS. Les rendements au MMS préopératoire; la durée de la chirurgie et de l’anesthésie et les doses cumulatives de propofol et d’alfentanil étaient comparables entre les jeunes patients et les patients âgés. Les rendements MMS postopératoires ont été plus bas à 30, 60 et 120 min chez les patients âgés. Les concentrations sanguines de propofol n’étaient pas différents entre les deux groupes de patients à l’OY, et à 30, 60 et 120 min. Le rendement psychomoteur est altéré chez les patients âgés par rapport aux jeunes patients au moment du réveil après l’anesthésie au propofol et à l’alfentanil. On ne peut probablement pas relier ces différences à l’accumulation de propofol chez les patients âgés. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess in an in vivo rat model the effects of total starvation for 4 d on diaphragmatic strength and endurance. Twenty-four rats were divided equally into a control (CTL) group and a starved (ST) group. Diaphragmatic strength was assessed and endurance index was calculated. Starvation induced a parallel decrease in body weight and diaphragmatic weight amounting to 18% of the control group. Diaphragmatic contractility was impaired in the ST group. This reduction was associated with a significant reduction in transdiaphragmatic pressure (Pdi) for all the frequencies of stimulation, except 20 Hz, in the ST animals as compared with the CTL animals; however, no significant difference in Pdi expressed per gram of diaphragmatic mass was observed. Endurance index was 0.63 ± 0.01 1.4 ± 0.02 in the ST and CFL animals (p < 0.01), respectively. We conclude that a 4-d total fast produces a reduction in diaphragmatic weight, which is associated with a decreased diaphragmatic strength and reduced endurance capacity. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Heparin-induced thrombocytopenia: recognition, treatment and prevention," by T. E. Warkentin in the previous issue.

Objective: To evaluate the impact of an alfentanil dose on bispectral index (BIS) variations during tracheal suction in ICU sedated patients. Design and setting: A prospective open-label pilot study in a 12-bed surgical ICU in a university-affiliated, tertiary referral hospital. Patients: Eleven sedated (midazolam plus fentanyl) mechanically ventilated patients. Interventions: Continuous monitoring of BIS with arterial pressure and heart rate before, during, and after tracheal suction without (control period) and with an intravenous bolus of alfentanil (15 µg/kg, alfentanil period) before suction. Results: Steady-state BIS value was 61±8 for the control period and 59±7 for the alfentanil period. Blood pressure and heart rate were similar between baseline periods. One minute after tracheal suction, a significant increase in BIS level was observed in the control period, which remained significantly different from the alfentanil period until 10 min later. Significant higher systolic and diastolic blood pressure and heart rate were observed during the control period than the alfentanil period. However, no difference in Ramsay scores was observed between the two periods. Conclusions: An alfentanil bolus of 15 µg/kg markedly reduced the increase in BIS values, blood pressure, and heart rate observed immediately after tracheal suction. Therefore BIS monitoring in ICU may help to improve analgesia during invasive events. [ABSTRACT FROM AUTHOR]