Ann. Intensive Care 2016, 6(Suppl 1):S50 DOI 10.1186/s13613-016-0114-z
Open Access
MEETING ABSTRACTS
French Intensive Care Society, International congress – Réanimation 2016 Published: 17 June 2016
PHYSICIANS ABSTRACTS O1 Impact of tracheal cuff shape on microaspiration of gastric contents in intubated critically ill patients: a multicenter randomized controlled study (BEST CUFF) Emmanuelle Jaillette1, Christophe Girault2, Guillaume Brunin3, Farid Zerimech4, Arnaud Chiche5, Céline Broucqsault‑Dedrie6, Cyril Fayolle7, Franck Minacori8, Isabelle Alves9, Stephanie Barrailler10, Laurent Robriquet1, Fabienne Tamion11, Emmanuel Delaporte3, Damien Thellier5, Claire Delcourte1, Alain Duhamel12, Saad Nseir1 1 Centre de réanimation, C.h.r.u. Lille, Lille, France; 2Réanimation Médicale, Centre Hospitalier Universitaire Rouen, Rouen, France; 3Reanimation, Hospital Center De Boulogne‑Sur‑Mer, Boulogne‑sur‑Mer, France; 4Labo‑ ratoire de biochimie et biologie moléculaire, C.h.r.u. Lille, Lille, France; 5 Réanimation, Centre Hospitalier de Tourcoing, Tourcoing, France; 6Réani‑ mation, Hôpital Victor Provo, Roubaix, France; 7Reanimation, Hospital Center De Dunkerque, Dunkerque, France; 8Reanimation, Hospital Saint Philibert, Lille, France; 9Reanimation, Hospital Center De Valenciennes, Valenciennes, France; 10Reanimation, C.H. de Lens, Lens, France; 11Réani‑ mation médicale, Hospital Center University Rouen, Rouen, France; 12 Clinique de santé publique, plateforme d’aide méthodologique, C.h.r.u. Lille, Lille, France Correspondence: Emmanuelle Jaillette - [email protected] Annals of Intensive Care 2016, 6(Suppl 1):O1 Introduction Ventilator-associated pneumonia (VAP) is the most common ICU-acquired infection in intubated critically ill patients. Microaspiration of gastric and oropharyngeal contaminated secretions represents the primary mechanism involved in the pathogenesis of VAP. Tracheal cuff plays an important role in stopping the progression of contaminated secretions into the lower respiratory tract. In vitro and animal studies suggested that leakage was significantly reduced with polyvinyl chloride (PVC) conical-cuffed tubes compared with barrel (standard) or cylindrical cuffs. Clinical studies found conflicting results. Therefore, the aim of this study is to determine the superiority of PVC conical- versus barrel (standard)-cuffed tracheal tube on abundant microaspiration of gastric contents in intubated critically ill patients. Materials and methods BEST CUFF is a prospective multicenter (ten French ICUs) cluster randomized controlled crossover and open-label trial performed in patients with predicted duration of mechanical ventilation ≥48 h. Patients were allocated to be intubated using a PVC standard (barrel)-shaped or a PVC conical-shaped tracheal tube. Prevention measures of VAP were standardized in all ICUs. The main objective was to demonstrate the superiority of conical versus standard cuff shape in reducing abundant microaspiration of gastric contents (pepsin level >200 ng/ml in at least 30 % of tracheal aspirates). After inclusion, tracheal aspirates were collected for 48 h to measure pepsin and salivary amylase, and diagnose gastric and oropharyngeal microaspiration. To diagnose tracheobronchial colonization, quantitative aspirate was performed after intubation and two times a week
until extubation. In patients with suspected VAP, quantitative tracheal aspirate or bronchoalveolar lavage was performed to confirm the diagnosis. We hypothesized that the use of conical-cuffed tracheal tubes would reduce the incidence of abundant microaspiration of gastric contents from 50 to 30 % of study patients. With a two-sided alpha risk of 5 %, a power of 80 %, and to account for an anticipated rate of 10 % of patients without any tracheal secretions, 312 patients had to be recruited. Results A total of 326 patients were included during the study period (June 2014–September 2015). Pepsin and salivary amylase measurement is actually performed, and all results should be available in November 2015. Statistical analyses will be performed in mid-December, and study results will be presented at the 2016 Réanimation Congress. Discussion Our study is sufficiently powered to detect a significant difference in microaspiration of gastric contents between patients intubated with conical-cuffed tracheal tubes and standard-cuffed tracheal tubes. One of the strengths of this study is the use of quantitative measurement of pepsin as a marker of microaspiration. Conclusion BEST CUFF is the first randomized controlled study evaluating the impact of PVC tracheal cuff shape on microaspiration of gastric contents. The results will be presented at the 2016 Réanimation Congress. Competing interests None. O2 Bicarbonate versus saline for contrast‑induced acute kidney injury prevention in critically ill patients Xavier Valette1, Isabelle Desmeulles2, Benoit Savary3, Romain Masson2, Amélie Seguin1, Cédric Daubin1, Bertrand Sauneuf1, Jennifer Brunet2, Pierre Verrier1, Véronique Pottier2, Marie Orabona2, Désiré Samba2, Gérald Viquesnel2, Mathilde Lermuzeaux2, Pascal Hazera3, Jean‑Luc Hanouz2, Jean‑Jacques Parienti4, Damien Du Cheyron1 1 Réanimation médicale, C.H.U de Caen, Caen, France; 2Réanimation chirurgicale, C.H.U de Caen, Caen, France; 3Réanimation polyvalente, C.H. Mémorial France ‑ Etats‑Unis (Saint‑Lô), Saint‑Lô, France; 4Unité de biostatistique et de recherche clinique, C.H.U de Caen, Caen, France Correspondence: Xavier Valette ‑ [email protected] Annals of Intensive Care 2016, 6(Suppl 1):O2 Introduction The administration of contrast media for imaging and interventional procedures is frequent in intensive care unit (ICU). Whether volume expansion with bicarbonate is better than isotonic saline to reduce the risk of contrast-induced acute kidney injury (CIAKI) in critically ill patients is unknown. Materials and methods The HYDRAREA study was a randomized, double-blind, multicenter trial including adults admitted in three ICUs in France who received intravascular contrast media. Patients with unstable renal function (increase in serum creatinine level of at least 0.3 mg/dL during the previous 48 h, anuria during the previous 12 h, renal replacement therapy) or contraindication to volume expansion
© 2016 All authors. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Ann. Intensive Care 2016, 6(Suppl 1):S50
or bicarbonate load (uncontrolled cardiogenic pulmonary edema, metabolic alkalosis with pH >7.50, hypokalemia
Open Access
MEETING ABSTRACTS
French Intensive Care Society, International congress – Réanimation 2016 Published: 17 June 2016
PHYSICIANS ABSTRACTS O1 Impact of tracheal cuff shape on microaspiration of gastric contents in intubated critically ill patients: a multicenter randomized controlled study (BEST CUFF) Emmanuelle Jaillette1, Christophe Girault2, Guillaume Brunin3, Farid Zerimech4, Arnaud Chiche5, Céline Broucqsault‑Dedrie6, Cyril Fayolle7, Franck Minacori8, Isabelle Alves9, Stephanie Barrailler10, Laurent Robriquet1, Fabienne Tamion11, Emmanuel Delaporte3, Damien Thellier5, Claire Delcourte1, Alain Duhamel12, Saad Nseir1 1 Centre de réanimation, C.h.r.u. Lille, Lille, France; 2Réanimation Médicale, Centre Hospitalier Universitaire Rouen, Rouen, France; 3Reanimation, Hospital Center De Boulogne‑Sur‑Mer, Boulogne‑sur‑Mer, France; 4Labo‑ ratoire de biochimie et biologie moléculaire, C.h.r.u. Lille, Lille, France; 5 Réanimation, Centre Hospitalier de Tourcoing, Tourcoing, France; 6Réani‑ mation, Hôpital Victor Provo, Roubaix, France; 7Reanimation, Hospital Center De Dunkerque, Dunkerque, France; 8Reanimation, Hospital Saint Philibert, Lille, France; 9Reanimation, Hospital Center De Valenciennes, Valenciennes, France; 10Reanimation, C.H. de Lens, Lens, France; 11Réani‑ mation médicale, Hospital Center University Rouen, Rouen, France; 12 Clinique de santé publique, plateforme d’aide méthodologique, C.h.r.u. Lille, Lille, France Correspondence: Emmanuelle Jaillette - [email protected] Annals of Intensive Care 2016, 6(Suppl 1):O1 Introduction Ventilator-associated pneumonia (VAP) is the most common ICU-acquired infection in intubated critically ill patients. Microaspiration of gastric and oropharyngeal contaminated secretions represents the primary mechanism involved in the pathogenesis of VAP. Tracheal cuff plays an important role in stopping the progression of contaminated secretions into the lower respiratory tract. In vitro and animal studies suggested that leakage was significantly reduced with polyvinyl chloride (PVC) conical-cuffed tubes compared with barrel (standard) or cylindrical cuffs. Clinical studies found conflicting results. Therefore, the aim of this study is to determine the superiority of PVC conical- versus barrel (standard)-cuffed tracheal tube on abundant microaspiration of gastric contents in intubated critically ill patients. Materials and methods BEST CUFF is a prospective multicenter (ten French ICUs) cluster randomized controlled crossover and open-label trial performed in patients with predicted duration of mechanical ventilation ≥48 h. Patients were allocated to be intubated using a PVC standard (barrel)-shaped or a PVC conical-shaped tracheal tube. Prevention measures of VAP were standardized in all ICUs. The main objective was to demonstrate the superiority of conical versus standard cuff shape in reducing abundant microaspiration of gastric contents (pepsin level >200 ng/ml in at least 30 % of tracheal aspirates). After inclusion, tracheal aspirates were collected for 48 h to measure pepsin and salivary amylase, and diagnose gastric and oropharyngeal microaspiration. To diagnose tracheobronchial colonization, quantitative aspirate was performed after intubation and two times a week
until extubation. In patients with suspected VAP, quantitative tracheal aspirate or bronchoalveolar lavage was performed to confirm the diagnosis. We hypothesized that the use of conical-cuffed tracheal tubes would reduce the incidence of abundant microaspiration of gastric contents from 50 to 30 % of study patients. With a two-sided alpha risk of 5 %, a power of 80 %, and to account for an anticipated rate of 10 % of patients without any tracheal secretions, 312 patients had to be recruited. Results A total of 326 patients were included during the study period (June 2014–September 2015). Pepsin and salivary amylase measurement is actually performed, and all results should be available in November 2015. Statistical analyses will be performed in mid-December, and study results will be presented at the 2016 Réanimation Congress. Discussion Our study is sufficiently powered to detect a significant difference in microaspiration of gastric contents between patients intubated with conical-cuffed tracheal tubes and standard-cuffed tracheal tubes. One of the strengths of this study is the use of quantitative measurement of pepsin as a marker of microaspiration. Conclusion BEST CUFF is the first randomized controlled study evaluating the impact of PVC tracheal cuff shape on microaspiration of gastric contents. The results will be presented at the 2016 Réanimation Congress. Competing interests None. O2 Bicarbonate versus saline for contrast‑induced acute kidney injury prevention in critically ill patients Xavier Valette1, Isabelle Desmeulles2, Benoit Savary3, Romain Masson2, Amélie Seguin1, Cédric Daubin1, Bertrand Sauneuf1, Jennifer Brunet2, Pierre Verrier1, Véronique Pottier2, Marie Orabona2, Désiré Samba2, Gérald Viquesnel2, Mathilde Lermuzeaux2, Pascal Hazera3, Jean‑Luc Hanouz2, Jean‑Jacques Parienti4, Damien Du Cheyron1 1 Réanimation médicale, C.H.U de Caen, Caen, France; 2Réanimation chirurgicale, C.H.U de Caen, Caen, France; 3Réanimation polyvalente, C.H. Mémorial France ‑ Etats‑Unis (Saint‑Lô), Saint‑Lô, France; 4Unité de biostatistique et de recherche clinique, C.H.U de Caen, Caen, France Correspondence: Xavier Valette ‑ [email protected] Annals of Intensive Care 2016, 6(Suppl 1):O2 Introduction The administration of contrast media for imaging and interventional procedures is frequent in intensive care unit (ICU). Whether volume expansion with bicarbonate is better than isotonic saline to reduce the risk of contrast-induced acute kidney injury (CIAKI) in critically ill patients is unknown. Materials and methods The HYDRAREA study was a randomized, double-blind, multicenter trial including adults admitted in three ICUs in France who received intravascular contrast media. Patients with unstable renal function (increase in serum creatinine level of at least 0.3 mg/dL during the previous 48 h, anuria during the previous 12 h, renal replacement therapy) or contraindication to volume expansion
© 2016 All authors. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Ann. Intensive Care 2016, 6(Suppl 1):S50
or bicarbonate load (uncontrolled cardiogenic pulmonary edema, metabolic alkalosis with pH >7.50, hypokalemia
