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Background:Postpancreaticoduodenectomy (PD) hemorrhage (PPH) is a life-threatening complication after PD. The main objective of this study was to evaluate incidence and factors associated with late PPH as well as the management strategy and outcomes. Methods:Between May 2017 and March 2020, clinical data from 192 patients undergoing PD were collected prospectively in the CHIRPAN Database (NCT02871336) and retrospectively analyzed. In our institution, all patients scheduled for a PD are routinely admitted for monitoring and management in intensive/intermediate care unit (ICU/IMC). Results:The incidence of late PPH was 17% (32 of 192), whereas the 90-day mortality rate of late PPH was 19% (6 of 32). Late PPH was associated with 90-day mortality (P= 0.001). Using multivariate analysis, independent risk factors for late PPH were postoperative sepsis (P= 0.036), and on day 3, creatinine (P= 0.025), drain fluid amylase concentration (P= 0.023), lipase concentration (P< 0.001), and C-reactive protein (CRP) concentration (P< 0.001). We developed two predictive scores for PPH occurrence, the PANCRHEMO scores. Score 1 was associated with 68.8% sensitivity, 85.6% specificity, 48.8% predictive positive value, 93.2% negative predictive value, and an area under the receiver operating characteristic curves of 0.841. Score 2 was associated with 81.2% sensitivity, 76.9% specificity, 41.3% predictive positive value, 95.3% negative predictive value, and an area under the receiver operating characteristic curve of 0.859. Conclusions:Routine ICU/IMC monitoring might contribute to a better management of these complications. Some predicting factors such as postoperative sepsis and biological markers on day 3 should help physicians to determine patients requiring a prolonged ICU/IMC monitoring.

Twenty percent of allogenic hematopoietic stem cell transplantation (allo-HSCT) patients require intensive care unit (ICU) admission. Feasibility and long-term consequences of cyclosporine graft-versus-host disease (GVHD) prophylaxis withdrawal in the ICU are unknown. To assess the impact of cyclosporine prophylaxis withdrawal in critically ill allo-HSCT patients admitted to the ICU on GVHD incidence and to evaluate 6-month overall survival according to cyclosporine withdrawal and GVHD occurrence. From 2010 to 2020, 101 critically ill allo-HSCT patients admitted to the ICU in our institution were included. All received cyclosporine as GVHD prophylaxis. None of them had GVHD at ICU admission. Patients were admitted in the ICU after a median time of 11 days (5.5-18) after allo-HSCT. ICU, hospital mortality, and 6-month mortality were 43.6%, 56.4%, and 59.4%, respectively. Cyclosporine was withdrawn for 52 and continued for 49 patients in the ICU. A total of 38.6% (n = 39) developed secondarily acute GVHD (aGVHD) after a median of 28 days (15-40) after cyclosporine was discontinued. In 74.4% (n = 29) of cases, patients in the hematology ward developed aGVHD after ICU discharge. Cyclosporine dosages were similar in both groups. Factors independently associated with aGVHD occurrence in multivariate analysis were cyclosporine withdrawal in the ICU (subdistribution hazard ratios [sHR] = 2.04, 95% confidence interval [CI] = 1.02-4.1, P = .044), renal replacement therapy (RRT) (sHR = 0.43, 95% CI = 0.19-0.9, P = .03) and fungal prophylaxis (sHR = 2.62, 95% CI = 1.35-5.07, P = .004). Cyclosporine withdrawal in the ICU was associated with poorer 6-month overall survival (OS) (HR = 1.96, 95% CI = 1.16-3.33, P = .012), but after adjusting on severity (simplified acute physiology score, vasopressors, mechanical ventilation and RRT requirement), 6-month OS did not differ (HR = 1.35, 95% CI = 0.76-2.42, P = .30). GVHD occurrence after ICU stay was significantly associated with better 6-month OS in unadjusted (HR = 0.53, 95% CI = 0.31-0.90, P = .02) and severity-adjusted analysis (HR = 0.54, 95% CI = 0.31-0.93, P = .028). Cyclosporine prophylaxis withdrawal in critically ill allo-HSCT patients in the ICU appears to be feasible and did not impair long-term outcome.

Although viral infections are frequent among patients with hematological malignancies (HM), data about herpesviridae in critically ill hematology patients are scarce.We aimed at determining the impact of herpesviridae reactivation/infection in this population.

Hyperbilirubinemia is frequent in patients with hematological malignancies admitted to the intensive care unit (ICU). Literature about hepatic dysfunction (HD) in this context is scarce.

Les aspergilloses invasives se définissent par la croissance d’Aspergillusdans les tissus. Le plus souvent, il s’agit d’aspergillose pulmonaire invasive. L’incidence de l’aspergillose invasive chez les patients non hématologiques admis en réanimation varie de 0,3 à 5,8 %. En dehors de l’hématologie, les principaux facteurs de risque incluent les patients BPCO, une corticothérapie prolongée, une dysfonction hépatique sévère, l’alcoolisme et la dénutrition ainsi que l’immunoparalysie postseptique. Globalement, la mortalité à court terme est de l’ordre de 60 %. Le diagnostic en réanimation est difficile, en effet les critères EORTC utilisés pour les patients d’hématologie ne sont pas toujours performants pour les patients non hématologiques. De la même manière, les critères diagnostiques utilisés pour les patients BPCO présentent des lacunes, comme la non-utilisation de l’antigène galactomannane dans l’algorithme diagnostique. Le traitement de référence reste le voriconazole ; l’amphotéricine B liposomiale et l’isavuconazole sont des alternatives possibles. L’aspergillose invasive hors patient d’hématologie est une infection fongique invasive difficilement diagnostiquée en réanimation. Dans ces conditions, un délai diagnostique prolongé et un retard thérapeutique sont associés à une surmortalité.

Prophylactic platelet transfusions (PT) aim to reduce bleeding. We assessed whether restrictive PT compared to prophylactic strategy could apply in ICU.

Outcome of patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT) has improved. To investigate if this improvement can be transposed to the ICU setting, we conducted a systematic review and meta-analysis to assess short-term mortality of critically ill allo-HSCT patients admitted to the ICU and to identify prognostic factors of mortality. Public-domain electronic databases, including Medline via PubMed and the Cochrane Library were searched. All full-text articles written-English studies published from 2006 to 2016, including allo-HSCT adults transferred to the ICU were included. Eighteen studies were selected, including 2342 patients. Overall estimated ICU mortality was 51.7%. Prognostic factors associated with an increased ICU mortality were mechanical ventilation (OR = 12.2, 95% CI = 6.2–23.7), vasopressors (OR = 6.3, 95% CI = 3.6–11.1), renal replacement therapy (OR = 4.2, 95% CI = 2.8–6.2), ICU admission for acute respiratory failure (OR = 2.2, 95% CI = 1.1–4.4), acute kidney injury (OR = 2.2, 95% CI = 1.3–4), and acute graft-versus-host disease (OR = 1.6, 95% CI = 1.1–2.3). Factors associated with an increased ICU survival were a single-organ failure (OR = 0.2, 95% CI = 0.1–0.4), neurological failure (OR = 0.4, 95% CI = 0.2–0.8), and reduced-intensity conditioning regimens (OR = 0.7, 95% CI = 0.5–0.9). Septic shock, underlying malignancy, disease status, donor, and graft source did not impact prognosis. Outcome has improved, supporting the usefulness of ICU management. Organ failures at ICU admission, organ support requirement, and GVHD are the main prognostic factors.

Non-invasive ventilation (NIV) and oxygen therapy (high-flow nasal oxygen [HFNO] or standard oxygen) following extubation have never been compared in critically ill patients with obesity. We aimed to compare NIV (alternating with HFNO or standard oxygen) and oxygen therapy (HFNO or standard oxygen) following extubation of critically ill patients with obesity.

Major postoperative events (acute respiratory failure, sepsis, and surgical complications) are frequent early after elective gastroesophageal and pancreatic surgery. It is unclear whether these complications impact equally on long-term outcome.

The prognosis of allogeneic hematopoietic stem cell transplantation (HSCT) patients admitted to the intensive care unit (ICU) is still poor. Overall, when these patients receive reduced intensity conditioning (RIC) regimens, the survival is better. To date, no study has specifically evaluated the outcome of RIC allogeneic HSCT admitted to the ICU.

Early optimization of treatment is crucial when admitting patients to the ICU and could depend on the organization of the medical team. The aim of this retrospective observational study was to determine whether admissions during morning rounds are independently associated with hospital mortality in a medical ICU.

We report here a patient with severe hypothermia (27°C), who was successfully rewarmed by using a novel intravascular rewarming method (in combination with an airways rewarming method) through endotracheal tube.