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Author(s): Nicolas Terzi [sup.1] [sup.2] [sup.3], Claude Guerin [sup.1] [sup.3] [sup.4] [sup.5] [sup.6], Miguel R. Gonçalves [sup.7] [sup.8] [sup.9] Author Affiliations: (1) 0000 0001 0792 4829, grid.410529.b, Service de Médecine [...]

Purpose Severe ARDS is often associated with refractory hypoxemia, and early identification and treatment of hypoxemia is mandatory. For the management of severe ARDS ventilator settings, positioning therapy, infection control, and supportive measures are essential to improve survival. Methods and results A precise definition of life-threating hypoxemia is not identified. Typical clinical determinations are: arterial partial pressure of oxygen < 60 mmHg and/or arterial oxygenation < 88 % and/or the ratio of PaO.sub.2/FIO.sub.2 12 cmH.sub.2O), a recruitment manoeuvre in special situations, and a 'balanced' respiratory rate (20-30/min). Individual bedside methods to guide PEEP/recruitment (e.g., transpulmonary pressure) are not (yet) available. Prone positioning [early ([less than or equal to] 48 hrs after onset of severe ARDS) and prolonged (repetition of 16-hr-sessions)] improves survival. An advanced infection management/control includes early diagnosis of bacterial, atypical, viral and fungal specimen (blood culture, bronchoalveolar lavage), and of infection sources by CT scan, followed by administration of broad-spectrum anti-infectives. Neuromuscular blockage (Cisatracurium [less than or equal to] 48 hrs after onset of ARDS), as well as an adequate sedation strategy (score guided) is an important supportive therapy. A negative fluid balance is associated with improved lung function and the use of hemofiltration might be indicated for specific indications. Conclusions A specific standard of care is required for the management of severe ARDS with refractory hypoxemia., Author(s): Thomas Bein [sup.1], Salvatore Grasso [sup.2], Onnen Moerer [sup.3], Michael Quintel [sup.3], Claude Guerin [sup.4] [sup.5], Maria Deja [sup.6], Anita Brondani [sup.7], Sangeeta Mehta [sup.7] Author Affiliations: (1) grid.411941.8, [...]

Purpose Weaning-induced cardiac dysfunction is more likely to occur if the heart does not tolerate the changes in loading conditions induced by spontaneous breathing trial (SBT). We hypothesized that the presence of cardiac preload independence before an SBT is associated with weaning failure related to cardiac dysfunction. Methods We included 30 patients after a first failed 1-h T-tube SBT who had a transpulmonary thermodilution already in place. Preload independence [no increase in the pulse contour analysis-derived cardiac index [greater than or equal to]10 % during passive leg raising (PLR)] was assessed before the second SBT. Failure of the SBT related to cardiac dysfunction was defined by an increase in pulmonary artery occlusion pressure above 18 mmHg at the end of the SBT associated with clinical intolerance. Results Fifty-seven SBTs were analyzed. The SBT failed in 46 cases. Overall, 31 failed SBTs were associated with weaning-induced cardiac dysfunction. During PLR, the cardiac index did not change in cases of failed SBTs with cardiac dysfunction, whereas it significantly increased in the other cases: 4 % (interquartile range, IQR 0-5) vs. 12 % (IQR 11-15), respectively. If PLR did not increase the cardiac index by more than 10 % before the SBT, the occurrence of SBT failure related to cardiac dysfunction was predicted with a sensitivity of 97 % [95 % confidence interval (CI) 83-100], specificity of 81 % (95 % CI 61-93) and area under the receiver-operating characteristic curve of 0.88 (95 % CI 0.78-0.98). Conclusions Preload independence assessed by a negative PLR test performed before an SBT predicts weaning failure related to cardiac dysfunction., Author(s): Martin Dres [sup.1] [sup.2], Jean-Louis Teboul [sup.1] [sup.2], Nadia Anguel [sup.2], Laurent Guerin [sup.1] [sup.2], Christian Richard [sup.1] [sup.2], Xavier Monnet [sup.1] [sup.2] Author Affiliations: (1) grid.5842.b, 0000000121712558, EA4533, [...]

Purpose The aim of the present study was to assess the rate of diffuse alveolar damage (DAD) on open lung biopsy (OLB) performed in the ICU for nonresolving ARDS. Methods A single-center retrospective study of patients meeting the Berlin definition criteria for ARDS who had undergone OLB for nonresolving ARDS. Patients were classified into mild, moderate and severe ARDS categories and according to the presence or absence of DAD on the OLB. The ARDS categories were assessed at baseline and at the time of the OLB. The OLBs were reviewed by two pathologists blinded to the ARDS classification. The primary endpoint was the rate of DAD according to the ARDS stage in the patients with nonresolving ARDS who had OLB. The secondary endpoint was the ability of DAD to predict ARDS among all the patients who had OLB. The same clinico-histopathological confrontation was cross validated in another ICU. Results From January 1998 to August 2013, 113 patients underwent OLB for acute hypoxemic respiratory failure, 83 of whom met the inclusion criteria for ARDS. At the time the OLB was performed, 11 of these patients had mild, 56 moderate, and 16 severe ARDS, respectively. The median (1st-3rd quartiles) time to OLB was 13 (10-18) and 9 (6-14) days from the onset of respiratory symptoms and from ARDS onset, respectively, with no statistical difference between the three ARDS groups. DAD was found in 48 (58 %) patients with ARDS, 4 (36 %) in the mild, 33 (59 %) in the moderate, and 11 (69 %) in the severe stage (P = 0.23). For the 113 patients who underwent OLB, the sensitivity and specificity of DAD to the Berlin definition was 0.58 (0.46-0.69) and 0.73 (0.54-0.88), respectively. Similar results were found in the other ICU. Conclusions DAD is present in the majority of patients with nonresolving ARDs and its frequency is no different across the three ARDS stages. On this basis, the systematic use of steroids in nonresolving ARDS is not recommended., Author(s): Claude Guerin [sup.1] [sup.2], Frédérique Bayle [sup.1], Véronique Leray [sup.1], Sophie Debord [sup.1], Alina Stoian [sup.1], Hodane Yonis [sup.1], Jean-Baptiste Roudaut [sup.1], Gael Bourdin [sup.1], Mojgan Devouassoux-Shisheboran [sup.3], Elodie [...]

Introduction Prone positioning has been used for many years in patients with acute respiratory distress syndrome (ARDS). The initial reason for prone positioning in ARDS patients was improvement in oxygenation. It was later shown that mechanical ventilation in the prone position can be less injurious to the lung and hence the primary reason to use prone positioning is prevention of ventilator-induced lung injury (VILI). Material and methods A large body of physiologic benefits of prone positioning in ARDS patients accumulated but these failed to translate into clinical benefits. More recently, meta-analyses and randomized controlled trial in a specific subgroup of ARDS patients demonstrated that prone positioning can improve survival. This review covers the effects of prone positioning on oxygenation, respiratory mechanics, and VILI. Conclusions We conclude with the effects of prone positioning on patient outcome, in particular on survival., Author(s): C. Guerin [sup.1] [sup.2] [sup.3], L. Baboi [sup.1], J. C. Richard [sup.1] [sup.2] [sup.3] Author Affiliations: (1) grid.413306.3, 0000000446856736, Service de Réanimation Médicale, Hôpital de la croix-rousse, CHU de [...]

Purpose In stable ventilatory and metabolic conditions, changes in end-tidal carbon dioxide (EtCO.sub.2) might reflect changes in cardiac index (CI). We tested whether EtCO.sub.2 detects changes in CI induced by volume expansion and whether changes in EtCO.sub.2 during passive leg raising (PLR) predict fluid responsiveness. We compared EtCO.sub.2 and arterial pulse pressure for this purpose. Methods We included 65 patients [Simplified Acute Physiology Score (SAPS) II = 57 ± 19, 37 males, under mechanical ventilation without spontaneous breathing, 15 % with chronic obstructive pulmonary disease, baseline CI = 2.9 ± 1.1 L/min/m.sup.2] in whom a fluid challenge was decided due to circulatory failure and who were monitored by an expiratory-CO.sub.2 sensor and a PiCCO2 device. In all patients, we measured arterial pressure, EtCO.sub.2, and CI before and after a fluid challenge. In 40 patients, PLR was performed before fluid administration. The PLR-induced changes in arterial pressure, EtCO.sub.2, and CI were recorded. Results Considering the whole population, the fluid-induced changes in EtCO.sub.2 and CI were correlated (r.sup.2 = 0.45, p = 0.0001). Considering the 40 patients in whom PLR was performed, volume expansion increased CI [greater than or equal to]15 % in 21 'volume responders.' A PLR-induced increase in EtCO.sub.2 [greater than or equal to]5 % predicted a fluid-induced increase in CI [greater than or equal to]15 % with sensitivity of 71 % (95 % confidence interval: 48-89 %) and specificity of 100 (82-100) %. The prediction ability of the PLR-induced changes in CI was not different. The area under the receiver-operating characteristic (ROC) curve for the PLR-induced changes in pulse pressure was not significantly different from 0.5. Conclusion The changes in EtCO.sub.2 induced by a PLR test predicted fluid responsiveness with reliability, while the changes in arterial pulse pressure did not., Author(s): Xavier Monnet [sup.1], Aurélien Bataille [sup.1] [sup.2], Eric Magalhaes [sup.1] [sup.2], Jérôme Barrois [sup.1] [sup.2], Marine Le Corre [sup.1] [sup.2], Clément Gosset [sup.1] [sup.2], Laurent Guerin [sup.1] [sup.2], Christian [...]

Byline: B. Delannoy (1), B. Floccard (2), F. Thiolliere (3), M. Kaaki (4), M. Badet (5), S. Rosselli (6), C. E. Ber (7), A. Saez (1), G. Flandreau (1), Claude Guerin (1) Keywords: Renal failure; Clinical studies Abstract: Objective To assess quality of life (QOL), mortality rate and renal function 6 months after onset of renal replacement therapy (RRT) for acute kidney injury (AKI) in the ICU. Participants and setting This prospective observational study was conducted in seven ICUs in France over 9 months. Inclusion criteria were: age aY=18 years, RRT delivered for AKI and informed consent signed. AKI was defined from the RIFLE score. Recipients of kidney grafts or patients undergoing chronic RRT were not included. Measurements and results QOL was assessed using the Short Form Health Survey (SF-36) questionnaire together with the Index of Activities of Daily Living (ADL) (0: full assistance to 6: no assistance). SF-36 was compared to a reference age- and sex-matched French population. Patient status, place of residence, and persistence of RRT, ADL and SF-36 were assessed at 28 days, 3 months and 6 months from inclusion. In the study period, 205 patients were included and 1 withdrew. At 6 months, 77/204 were alive (mortality 62%). SF-36 and ADL significantly increased from day 28 to 6 months. In the survivors at 6 months, SF-36 items were significantly lower than in the reference population, with the physical items more severely affected than the mental items 64% were fully autonomous (ADL score = 6) 69% were living in their homes, and 12% were still undergoing RRT 94% would agree to undergo the same management again. Conclusions ICU survivors from RRT for AKI have an impaired QOL at 6 months, but sustained autonomy in their daily lives. Author Affiliation: (1) Service de Reanimation Medicale et Assistance Respiratoire, Hopital de la Croix Rousse, CHU de Lyon and Universite de Lyon, 103 Grande rue de la croix rousse, 69004, Lyon, France (2) Service de Reanimation Chirurgicale, Pavillon G, Hopital Edouard Herriot, CHU de Lyon and Universite de Lyon, Lyon, France (3) Service de Reanimation Medicale, Centre Hospitalier Lyon Sud, CHU de Lyon and Universite de Lyon, Pierre-Benite, France (4) Service de Reanimation, Centre Hospitalier de Roanne, Roanne, France (5) Service de Reanimation, Centre Hospitalier de Chambery, Chambery, France (6) Service de Reanimation Polyvalente, Centre Hospitalier Saint-Joseph et Saint-Luc, Lyon, France (7) Service de Reanimation Chirurgicale, Pavillon P, Hopital Edouard Herriot, CHU de Lyon and Universite de Lyon, Lyon, France Article History: Registration Date: 14/07/2009 Received Date: 18/02/2009 Accepted Date: 04/07/2009 Online Date: 20/08/2009

Abstract Objective: To assess a sigmoidal equation for describing airway closure. Design: Experimental study. Setting: University laboratory. Participants: Eight piglets mechanically ventilated on zero end-expiratory pressure (ZEEP). Interventions: Control and [...]

Byline: Luigi Barberis (1), Emmanuello Manno (1), Claude Guerin (2) Keywords: End-inspiratory pause duration Plateau pressure Mechanically ventilated patients Abstract: Objective. To compare the values of plateau pressure (Pplat) recorded at different times after end-inspiratory occlusion and those of static elastance (Est,rs) and total resistance (Rrs) of the respiratory system. Design. Physiological study. Setting. Medical intensive care unit of a university hospital. Patients. Eleven patients with ARDS and ten patients with COPD requiring tracheal intubation and mechanical ventilation were investigated. COPD patients were investigated on zero end-expiratory pressure (ZEEP) and ARDS patients on both ZEEP and positive end-expiratory pressure (PEEP). Measurements and results. Respiratory mechanics were assessed using the rapid airway occlusion technique. Tracheal pressure (Ptr) was measured downstream the endotracheal tube. Ptr was recorded 0.5 s, 1 s, 2 s, 3 s, and 5 s after a 5-s end-inspiratory occlusion. Est,rs and Rrs were computed at the same times using standard formula. In ARDS patients on ZEEP, Pplat amounted to 20+-5, 20+-5, 19+-5, 19+-5, and 18+-5 cm[H.sub.2]O at 0.5, 1, 2, 3 and 5 s, respectively (P Conclusions. Very early post-occlusion values of Pplat were statistically greater than at 3 s or 5 s. This probably has no major impact on the occurrence of volutrauma. Clinicians must be aware, however, that Est,rs and Rrs are greatly modified by the time of recording of Pplat. Author Affiliation: (1) Ospedale Maria Vittoria, Department of Anaesthesiology and Intensive Care Unit, Turin, Italy (2) Hopital de la Croix-Rousse, Service de Reanimation Medicale et d'Assistance Respiratoire, 103, Grande Rue de la Croix-Rousse, 69004, Lyon, France Article History: Received Date: 23/04/2002 Accepted Date: 15/10/2002 Article note: Electronic Publication

Byline: Claude Guerin (1), Raphaele Girard (2), Jean Selli (3), Louis Ayzac (4) Keywords: Acute renal failure Renal replacement therapy Hemodialysis Logistic regression analysis Prognostic factors Abstract: Abstract Objectives. To describe the current practice of hemodialysis in acute renal failure (ARF) and to estimate the impact of hemodialysis modality on patient outcome. Design. Prospective multicenter observational study conducted from March 1996 to May 1997. Setting. The 28 multidisciplinary ICUs in the Rhone-Alpes region in France. Patients. The 587 patients who required hemodialysis. Measurements and results. Patients were followed until hospital discharge. Among the 587 patients 354 received continuous (CRRT) and 233 intermittent (IRRT) renal replacement therapy as first choice. CRRT patients had a higher number of organ dysfunctions on admission and at the time of ARF and higher SAPS II at time of ARF. Mortality was 79% in the CRRT group and 59% in the IRRT group. Logistic regression analysis showed decreased patient survival to be associated with SAPS II on admission, oliguria, admission from hospital or emergency room, number of days between admission and ARF, cardiac dysfunction at time of ARF, and ischemic ARF. No underlying disease or nonfatal disease, and absence of hepatic dysfunction were associated with an increase in patient survival. The type of renal replacement therapy was not significantly associated with outcome. Conclusions. Renal replacement therapy mode was not found to have any prognostic value. Randomized controlled trials should be undertaken to assess this important question. Author Affiliation: (1) Service de Reanimation Medicale et Assistance Respiratoire, Hopital de la Croix Rousse, 103 grande rue de la croix rousse, 69317 Lyon, France (2) Service d'Hygiene et d' Epidemiologie, Centre Hospitalier Lyon Sud, Lyon, France (3) Service d'Urgences et de Reanimation Medicale, Centre Hospitalier Lyon Sud, Lyon, France (4) C-Clin Sud-Est, Centre Hospitalier Lyon Sud, Lyon, France Article History: Received Date: 11/05/2001 Accepted Date: 03/07/2002 Article note: Electronic Publication

Byline: Quentin Blanc (1), Jean-Michel Sab (1), Francois Philit (1), Bruno Langevin (1), Jean-Marc Thouret (1), Philippe Noel (1), Dominique Robert (1), Claude Guerin (1) Keywords: Acute respiratory distress syndrome Low constant flow inflation Interrupter technique Volume pressure curves Abstract: Abstract Objective. To compare the inspiratory volume pressure (VP) curves of the respiratory system (rs) produced by static occlusion (OCC) and dynamic low constant flow inflation (LCFI) methods using a new device in acute respiratory distress syndrome (ARDS) patients. Setting. A multidisciplinary 24-bed ICU in a tertiary university hospital. Patients. Eleven intubated and mechanically ventilated patients with ARDS. Measurements and results. OCC and LCFI methods were performed using the same ventilator, which had been specifically implemented for this purpose. LCFI of 5, 10, and 15 l/min and OCC were applied in a random order at zero end-expiratory positive pressure. Airway pressure was measured both proximal (P.sub.ao) and distal (P.sub.tr) to the endotracheal tube. Lower inflection point (LIP) and maximal slope (C.sub.max,rs) were estimated using unbiased iterative linear regressions. LIP.sub.rs was obtained in all patients under LCFI and in nine patients under OCC. With LCFI of 5, 10, 15 l/min and OCC the average LIP.sub.rs values were 12.2+-3.9, 12.9+-4, 14.3+-3.4, and 11.9 cm [H.sub.2]O for P.sub.ao and 11.9+-3.9, 11.5+-3.3, 12.5+-3.4 and 11.8+-4.4 for P.sub.tr, respectively. Only the mean values of LIP.sub.rs for P.sub.ao with LCFI at 15 l/min were significantly different from those obtained for OCC. The C.sub.max,rs values found with the two methods were similar. Conclusions. An LCFI less than or equal to 10 l/min seems to be a quick, safe, and reliable method to determine LIP.sub.rs and C.sub.max,rs at the bedside. Author Affiliation: (1) Service de Reanimation Medicale et Assistance Respiratoire, Hopital de la Croix Rousse, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France Article History: Received Date: 28/06/2001 Accepted Date: 29/03/2002 Article note: Electronic Publication

Byline: G. Zanetta (1), D. Robert (1), C. Guerin (1) Keywords: Bench study Portable ventilators Transporting ICU patients Abstract: Objectives: To evaluate portable ventilators. Design and settings: Bench study. Materials and methods: Five portable ventilators used for transporting ICU patients [Osiris 1, (ventilator a), Osiris 2, (ventilator b), Oxylog 1000, (ventilator c), Oxylog 2000, (ventilator d), AXR1a, (ventilator e)] and three ICU ventilators which can be used for this purpose [Horus, (ventilator f), T-Bird, (ventilator g), and SV 300, (ventilator h)] were compared using a test lung regarding: 1) their capability to maintain set tidal volumes (V.sub.T) of 300 ml, 500 ml, and 800 ml under a normal condition A [resistance (R) 5 cm[H.sub.2]O/l/s and compliance (C) 100 ml/cmH.sub.20] and two abnormal conditions B (R 20--C 30) and C (R 50--C 100) 2) trapped volume (expired [V.sub.T ]relative to inspired [V.sub.T ]at 0.7 s, 1 s, and 1.4 s), an estimate of the expiratory resistance of both circuit and valve and 3) the triggering system assessed from the measurements of It, IP for two inspiratory efforts at a PEEP of 0 cmH.sub.20 and 5 cmH.sub.20 in ventilators b, d, f, g, and h. Flow and airway pressure were measured with an independent physiologic recording system. Results: 1) V.sub.T. For ventilators a--h, the mean+-SD changes of a set [V.sub.T ]of 300 ml were --2.6+-0.2%, --9.7+-0.2%, 0+-0%, --6.1+-0.2%, 1.0+-0.3%, --2.1+-1.7%, 0.3+-0%, and --1.3+-0.1% (P Author Affiliation: (1) Service de Reanimation Medicale et Assistance Respiratoire, Hopital de la Croix Rousse, 103 grande rue de la Croix-Rousse, 69004 Lyon, France Article History: Received Date: 21/06/2001 Accepted Date: 14/01/2002 Article note: Electronic Publication

Byline: Claude Guerin (1), Stephane Lemasson (2), Maria La Cara (3), Gerard Fournier (2) Keywords: Chronic obstructive pulmonary disease Acute respiratory failure Mechanical ventilation Ventilatory settings Inspiratory flow pattern Inspiratory flow rate Abstract: Objective: To study the cardiorespiratory effects of inspiratory flow rate and waveform in COPD patients. Design: Prospective physiological investigation with randomized allocations of experimental conditions. Setting: A 14-bed medical ICU in a 1000-bed university hospital. Patients and participants: Ten COPD intubated, sedated and paralyzed patients with chronic obstructive pulmonary disease (COPD), mechanically ventilated for acute respiratory failure. Interventions. In volume-controlled mode, three inflation flow rates of 0.40, 0.70, and 1.10 l/s for 20 min with a constant (CF) or a decelerating (DF) inflation flow profile. Each patient received all six experimental conditions in a random order. Tidal volume and respiratory frequency were similar during the experimental conditions. Measurements and results: Arterial blood gases, hemodynamics (n=8), and respiratory mechanics were measured with zero end expiratory pressure. Between flow rates the median (25th--75th percentiles) values of PaO.sub.2/FIO.sub.2 were 232 (132--289), 253 (161--338), 231 (163--352) for CF and 253 (143--331), 249 (164--360), 231 mmHg (187--351), for DF, respectively the maximal airway pressures were 25.6, 28.3, 34.6 cm[H.sub.2]O for CF and 21.7, 29.6, 34.8 cm[H.sub.2]O for DF, respectively, the mean airway pressures were 8.9, 6.1, 5.4 cm[H.sub.2]O for CF and 9.1, 7, 6.5 cm[H.sub.2]O for DF, respectively. Conclusions: Changing the ventilator in volume-controlled mode with a DF or CF profile has no significant cardiorespiratory effect in intubated COPD patients mechanically ventilated for acute respiratory failure. Author Affiliation: (1) Service de Reanimation Medicale et d'Assistance Respiratoire, Hopital De La Croix-Rousse, 93 Grande Rue De La Croix-Rousse, Lyon 69004, France (2) Service de Reanimation Medicale, Centre Hospitalier Lyon-Sud, 69495 Pierre-Benite Cedex, France (3) Research Fellow, Sezione di Anestesiologia e Rianimazione, Universita degli studi di Ferrara, 44100 Ferrara, Italy Article History: Received Date: 22/06/2001 Accepted Date: 24/10/2001 Article note: Electronic Publication

Byline: C. Guerin (1), R. Girard (2), C. Chemorin (2), R. De Varax (1), G. Fournier (1) Keywords: Key words Epidemiology in ICU; Facial mask mechanical ventilation; Logistic Regression Model; Nosocomial pneumonia; Ventilator-associated pneumonia Abstract: Objective: To evaluate the impact of noninvasive positive pressure mechanical ventilation (NPPV) on ventilator-associated pneumonia (VAP). Design: Prospective observational study. Setting: Medical intensive care unit (ICU) of a university teaching hospital. Patients: Cohort of 320 consecutive patients staying in the ICU more than 2 days and mechanically ventilated for aY= 1 day. Measurements and results: VAP was diagnosed when, satisfying classical clinical and radiological criteria, fiberoptic bronchoalveolar lavage and/or protected specimen brush grew aY= 10.sup.4 and aY= 10.sup.3 CFU/ml, respectively, of at least one microorganism. Patients were classified into four subgroups according to the way in which mechanical ventilation was delivered: NPPV then tracheal intubation (TI) (n = 38), TI then NPPV (n = 23), TI only (n = 199), and NPPV only (n = 60). Occurrence of VAP was estimated by incidence rate and density of incidence. Risk factors for VAP were assessed by logistic regression analysis. Twenty-seven patients had 28 episodes of VAP. The incidence rates for patients with VAP were 18 % in NPPV-TI, 22 % in TI-NPPV, 8 % in TI, and 0 % in NPPV (p &lt 0.0001). The density of incidence of VAP was 0.85 per 100 days of TI and 0.16 per 100 days of NPPV (p = 0.04). Logistic regression showed that length of ICU stay and ventilatory support were associated with VAP. Conclusions: There is a significantly lower incidence of VAP associated with NPPV compared to tracheal intubation. This is mainly explained by differences in patient severity and risk exposure. Author Affiliation: (1) Service de Reanimation Medicale, Centre Hospitalier Lyon-Sud, Pierre-Benite, France, FR (2) Service d'Hygiene hospitaliere et d'epidemiologie, Centre Hospitalier Lyon-Sud, Pierre-Benite, France, FR Article note: Received: 29 January 1997 Accepted: 14 July 1997

Byline: Sebastien Perbet (1), Jean-Michel Constantin (1), Renaud Guerin (1), Mickael Faure (1), Charlotte Brugere (2), David Da Ines (3), Juliette Joubert (4), Jean-Etienne Bazin (1) Author Affiliation: (1) General Intensive Care Unit, Anesthesiology and Critical Care Medicine, Hotel-Dieu, University Hospital of Clermont-Ferrand Boulevard Leon-Malfreyt, 63058, Clermont-Ferrand, France (2) Digestive Surgery, Hotel-Dieu, University Hospital of Clermont-Ferrand Boulevard Leon-Malfreyt, 63058, Clermont-Ferrand, France (3) Radiology, Hotel-Dieu, University Hospital of Clermont-Ferrand Boulevard Leon-Malfreyt, 63058, Clermont-Ferrand, France (4) Department of Pathology, Hotel-Dieu, University Hospital of Clermont-Ferrand Boulevard Leon-Malfreyt, 63058, Clermont-Ferrand, France Article History: Registration Date: 15/12/2008 Accepted Date: 05/12/2008 Online Date: 20/12/2008

Byline: F. Wallet (1), F. Bayle (1), V. Leray (1), J. C. Richard (1,2), G. Bourdin (1), C. Guerin (1,2) Author Affiliation: (1) Service de Reanimation Medicale et d'Assistance Respiratoire, Universite de Lyon, Universite Lyon 1, Hopital de la Croix rousse, 103 Grande rue de la Croix Rousse, 69004, Lyon, France (2) CREATIS (CNRS UMR 5515 and INSERM 630), Lyon, France Article History: Registration Date: 20/11/2008 Accepted Date: 27/10/2008 Online Date: 26/11/2008

Invasive aspergillosis is a life-threatening fungal infection that predominantly affects severely immunocompromised patients [1]. Caspofungin and voriconazole are newly available powerful antifungal agents. We report the case of a would-be [...]