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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.

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.

Purpose: To describe the epidemiologic features of acute renal failure related to pregnancy (PRARF) and to evaluate its prognostic impact., Methods: Retrospective study conducted in a Tunisian intensive care unit over a period of 17 years (1995-2011). Women were included if they were more than 20 weeks pregnant and were admitted to the ICU during pregnancy or immediately (<7 d) post partum. PRARF was defined by a serum creatinine level >0.8 mg/dL and was classified as mild (0.9 to 1.4 mg/dL), moderate (1.5 to 2.9 mg/dL) or severe (>3 mg/dL)., Results: Five hundred and fifty patients were included. Mean age was 31 ± 6 years. Mean SOFA score was 4 ± 3. PRARF was diagnosed in 313 patients (56.9%). ARF was mild in 215 cases (39.1%), moderate in 65 cases (11.8%) and severe in 33 cases (6%). Main causes leading to this complication were preeclampsia (66.5%) and acute hemorrhage (27.8%). Only two patients (0.4%) developed chronic renal failure and needed long-term dialysis. Patients who developed this complication had higher SOFA score (4.7 ± 3.5 vs. 3.2 ± 2.1; p < 0.001). Thirty-three patients (6%) died in the ICU. The rate of ICU mortality was significantly higher in patients with PRARF (9.3 vs. 1.7%; p < 0.001)., Conclusions: PRARF is associated with higher mortality. Thus, appropriate monitoring of pregnancies is needed in order to prevent its onset by an early and prompt management of the underlying risk factors.