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Purpose: The aim of the study was to identify factors predicting lung contusion in trauma children., Methods: Retrospective study conducted for a period of 8 years (January 01, 2005-December 31, 2012) in a medical surgical intensive care unit. All trauma patients younger than 15 years were included. Two groups were compared: those with lung contusions (C+ group) and those without lung contusions (C- group)., Results: We included 330 patients. The mean (SD) age was 7.6 (4.3) years. Chest injury was diagnosed in 70 patients (21.2%). All our patients needed mechanical ventilation. Lung contusions were diagnosed in 43 patients (13% of all patients and 61.4% of patients with chest trauma). In multivariate analysis, independent factors predicting lung contusion were road traffic accident (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.2-8.6; P = 0.019), increased Pediatric Risk of Mortality (PRISM) score (OR, 1.1; 95% CI, 1.1-1.2; P = 0.017), hepatic contusion (OR, 4.8; 95% CI, 1.3-17.1; P = 0.017), and pelvic ring fracture (OR, 3.5; 95% CI, 1.1-10.5; P = 0.026). Death occurred in 46 patients (13.9%). Intensive care unit mortality was significantly higher in the C+ group (OR, 2.5; 95% CI, 1.2-5.4; P = 0.021). However, mortality was not different between the 2 groups after adjusting for PRISM score (OR, 1.2; 95% CI, 0.5-2.9; P = 0.752) or after adjusting for Injury Severity Score (OR, 0.7; 95% CI, 0.3-2.1; P = 0.565)., Conclusions: Lung contusion is common in critically ill children with chest trauma. The diagnosis should be considered in patients with road traffic accident, increased PRISM score, hepatic contusion, and pelvic ring fracture.

The incidence of ventilator-associated pneumonia (VAP) is particularly high in trauma patients. Immediate acute inflammation response is one of the hallmarks of multiple trauma. This phenomenon is associated with an immunosuppression state and may increase the risk of VAP. In our study, we aimed to evaluate whether low-dose steroids prevent VAP onset in multiple trauma patients. All adult patients admitted in our intensive care unit (ICU) for multiple trauma with predicted duration of mechanical ventilation over 48 hours were included. We compared 2 different periods: a retrospective cohort of patients who did not receive low-dose steroids for VAP prevention and a prospective cohort of patients who received hydrocortisone with a dose of 100 mg/8 hours for a scheduled period of 7 days. We included 175 patients: 92 in the steroids (-) group and 83 in the steroids (+) group. The incidence of VAP was not different between the 2 studied groups (29.3% and 26.5%; P = 0.676). When predictive factors of VAP onset were studied in multivariate analysis, steroids had no preventive effect on VAP [OR = 1.6; 95% confidence interval, 0.73-3.6; P = 0.234]. We did not find any difference between the 2 groups, neither in terms of ICU length of stay (respectively, 11 ± 9.7 days vs. 12.3 ± 10.7 days; P = 0.372) nor in terms of ICU mortality (29.3% vs 24.1%; P = 0.434).

The aim of this study is to analyze if the infusion of hydrocortisone hemisuccinate improve outcome in severe scorpion-envenomated adult patients admitted to intensive care unit (ICU). Pairwise retrospective case-control study with 1:1 matching was designed. Patients were defined as cases when they received hydrocortisone hemisuccinate (as alone steroids) during hospitalization and as controls when they did not received any steroids. Patients were matched according to age, severity factors at admission represented by the presence of pulmonary edema and grades of severity of scorpion envenomation, and scorpion antivenom administration. Eighty-four patients were included as follows: 42 patients in the cases group and 42 patients in the control group. The mean age (±SD) was 40±21 years, ranging from 16 to 90 years. Moreover, 67 (80%) patients have a systemic inflammatory response syndrome on ICU admission. The comparison between cases group and control group showed that age is not significantly different. There were the same proportions of patients with pulmonary edema in 2 groups. Moreover, 23 (54%) patients in case group and 23 (54%) in the control group received scorpion antivenom (P>0.05). The mean temperature on admission was also not significantly different. The presence of systemic inflammatory response syndrome was again not significantly different between 2 groups. The comparison of outcome of the 2 groups showed that the use of mechanical ventilation and its duration, the ICU stay length, and ICU mortality was not significantly different between the 2 groups. Although our study has some limitations, it confirms that the use of hydrocortisone hemisuccinate in severe scorpion-envenomed patients did not improve their outcome.

The incidence of ventilator-associated pneumonia (VAP) is particularly high in patients with trauma. The efficacy and safety of selective digestive decontamination (SDD) was not studied extensively. We aimed in our randomized double-blind, placebo-controlled study to evaluate whether SDD prevents VAP onset in multiple trauma patients. All adult patients admitted in our intensive care unit for multiple trauma with a predicted duration of mechanical ventilation (MV) over 48 hours were included. We included 44 patients who were divided into 4 groups: group A receiving subglottic and gastric treatment suspension (polymyxin E 100 mg, vancomycin 1 g, and amphotericin B 500 mg), group B receiving placebo, group C receiving subglottic placebo and gastric treatment suspension, and group D receiving subglottic treatment suspension and gastric placebo. The suspension was given 4 times a day during 7 consecutive days. To this topical treatment, we associated an intravenous administration of cefotaxime (1 g 3 times a day during 4 consecutive days). The incidence of VAP in the 4 groups was, respectively, 45.5%, 46.2%, 22.2%, and 27.3% (P=0.236). In multivariate analysis, none of the 3 tested regimens was identified as a protective factor against VAP. However, prolonged duration of MV was the only independent factor predicting VAP onset (odds ratio=1.1; 95% confidence interval [1.1-1.4]; P=0.049).

Up to 2008, dopamine was the catecholamine that was the most recommended in our intensive care unit (ICU) after fluid resuscitation. However, recently, norepinephrine has become the catecholamine that was most recommended in our ICU after fluid resuscitation. The aim of this study was to determine if there was an efficacy or safety benefit to this protocol therapeutic change in patients with shock admitted to our ICU. The primary outcome variable was ICU mortality. This is a prospective observational study conducted in 2 periods in our ICU (Habib Bourguiba University Hospital, Sfax, Tunisia). During the 2 study periods, 251 patients were included. There were 130 patients in group 1 and 121 patients in group 2. There were no significant differences between the 2 groups with regard to most of the baseline characteristics. The comparison between the 2 groups showed that in the first period, dopamine was the catecholamine that was the most used. However, in the second period, norepinephrine is the catecholamine that was most used. When we analyzed the catecholamine prescription in septic shock, we concluded that in the first study period, dopamine was used as the catecholamine as the first choice in 85.7% of cases (P < 0.001), and norepinephrine is the first choice in 100% of cases in the second period. In cardiogenic shock, in the first study period, dobutamine was used as the catecholamine as the first choice in 61% of cases (P < 0.001) and norepinephrine is the first choice in 43% of cases in the second period. Finally, in hypovolemic shock, dopamine was used as the catecholamine as the first choice in 68% of cases in group 1 and norepinephrine is the first choice in 88% of cases in the second period (P < 0.001). During the ICU stay, some adverse events related to catecholamine use were observed. The occurrence of arrhythmias was significantly more frequent in the first group. Mortality rate was at 51% in the first group and 44% in the second group (P = 0.27). The mortality rate was not significantly different for each type of shock (septic, cardiogenic, and hypovolemic) in both groups (P > 0.05 for all), although the occurrence of arrhythmias was significantly more frequent in the first group, in clinical practice, our study confirms that the rate of death did not differ significantly between the 2 groups of patients mostly treated with dopamine (group 1) and the group mostly treated with norepinephrine.

The purpose of this study was to analyze the efficacy of corticosteroids in severe acute decompensation of chronic obstructive pulmonary disease requiring mechanical ventilation and intensive care unit (ICU) admission. Pairwise retrospective case-control study with 1:1 matching. Patients were defined as cases when they received corticosteroids and as controls when they did not received any steroids. Patients were matched according to age, severity factors at admission represented by the PaO2/FiO2 ratio, and simplified acute physiology score. Thirty-four patients were included. There were 17 patients in the case group and 17 patients in the control group. There were 27 men (80%) and 7 women (20%). The mean age (±SD) was 70 ± 9 years with a range of 40-85 years. Thirty-two patients (94 %) were older than 60 years. The comparison between the 2 groups showed that they had the same epidemiological, clinical, and biological findings on ICU admission. Homodynamic parameters were also not significantly different between the 2 groups. Moreover, there is the same proportion of invasive mechanical ventilation use in 2 groups. Concomitant drugs used were also not significantly different between the 2 groups. Finally, the comparison of outcome between the steroid and steroid-free groups showed that mortality rate was not significantly different (64% vs. 58%, P = 0.72). However, systemic corticosteroid therapy was associated with a significant increase in a reduction in the duration of mechanical ventilation (P = 0.004) and a trend toward a shorter length of ICU stay (P = 0.053). Although the authors detected no significant difference in mortality rate at the time of discharge between steroid and streroid-free patients, this study confirms that systemic corticosteroid therapy in patients with chronic obstructive pulmonary disease exacerbations requiring mechanical ventilation is associated with a significant reduction in the duration of mechanical ventilation. Other studies are needed on this subject.

Background: This study aimed to determine predictive factors of mortality after posttraumatic brain injury., Methods: A retrospective study conducted over a 3-year period (1997-1999) involved 437 adult patients with head injury admitted to the intensive care unit of a university hospital in Sfax, Tunisia. Basic demographic, clinical, biologic, and radiologic data were recorded at admission and during the intensive care unit stay., Results: This study included 393 men (90%) and 44 women with a mean age of 36 +/- 17 years. Traffic accidents were the main cause of trauma (85.6%). In 58% of the cases, the injury was serious (Glasgow Coma Score, <8). The mean simplified acute physiology score was 39 +/- 15, and the mean Injury Severity Score was 34.5 +/- 17. Of the 437 patients, 127 (29.1%) died. According to multivariate analysis, the factors that correlated with a poor prognosis were age older than 40 years (p < 0.01), simplified acute physiology score exceeding 40 (p < 0.001), Glasgow Coma Score lower than 7 (p = 0.03), intracranial mass lesion (p = 0.02), a cerebral herniation (p < 0.001), diabetes insipidus (p < 0.001), and blood sugar level higher than 10 mmol/L (p < 0. 001)., Conclusions: In Tunisia, head injury is a frequent cause of hospitalization, comprising 14.4% of all adult admissions. It is observed most often among young patients involved in traffic accidents. The short-term prognosis is poor, with a high (29%) mortality rate, and determined by demographic, clinical, radiologic, and biologic factors. Prevention is highly advised.