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French Intensive Care Society, International Congress – Réanimation 2016 Published: 17 June 2016 Ann. Intensive Care 2016, 6(Suppl 1):S50 DOI 10.1186/s13613-016-0114-z MEETING ABSTRACTS Open Access French Intensive Care Society, International congress – Réanimation 2016 Published: 17 June 2016 PHYSICIANS ABSTRACTS until extubation. In patients with suspected VAP, quantitative tracheal aspirate or bronchoalveolar lavage was performed to confirm the O1 diagnosis. We hypothesized that the use of conical-cuffed tracheal Impact of tracheal cuff shape on microaspiration of gastric tubes would reduce the incidence of abundant microaspiration of gas- contents in intubated critically ill patients: a multicenter tric contents from 50 to 30 % of study patients. With a two-sided alpha randomized controlled study (BEST CUFF) risk of 5 %, a power of 80 %, and to account for an anticipated rate of Emmanuelle Jaillette1, Christophe Girault2, Guillaume Brunin3, Farid 10 % of patients without any tracheal secretions, 312 patients had to Zerimech4, Arnaud Chiche5, Céline Broucqsault‑Dedrie6, Cyril Fayolle7, be recruited. Franck Minacori8, Isabelle Alves9, Stephanie Barrailler10, Laurent Results A total of 326 patients were included during the study period Robriquet1, Fabienne Tamion11, Emmanuel Delaporte3, Damien Thellier5, (June 2014–September 2015). Pepsin and salivary amylase measure- Claire Delcourte1, Alain Duhamel12, Saad Nseir1 ment is actually performed, and all results should be available in Novem- 1Centre de réanimation, C.h.r.u. Lille, Lille, France; 2Réanimation Médicale, ber 2015. Statistical analyses will be performed in mid-December, and Centre Hospitalier Universitaire Rouen, Rouen, France; 3Reanimation, study results will be presented at the 2016 Réanimation Congress. Hospital Center De Boulogne‑Sur‑Mer, Boulogne‑sur‑Mer, France; 4Labo‑ Discussion Our study is sufficiently powered to detect a significant ratoire de biochimie et biologie moléculaire, C.h.r.u. Lille, Lille, France; difference in microaspiration of gastric contents between patients 5Réanimation, Centre Hospitalier de Tourcoing, Tourcoing, France; 6Réani‑ intubated with conical-cuffed tracheal tubes and standard-cuffed tra- mation, Hôpital Victor Provo, Roubaix, France; 7Reanimation, Hospital cheal tubes. One of the strengths of this study is the use of quantita- Center De Dunkerque, Dunkerque, France; 8Reanimation, Hospital Saint tive measurement of pepsin as a marker of microaspiration. Philibert, Lille, France; 9Reanimation, Hospital Center De Valenciennes, Conclusion BEST CUFF is the first randomized controlled study evalu- Valenciennes, France; 10Reanimation, C.H. de Lens, Lens, France; 11Réani‑ ating the impact of PVC tracheal cuff shape on microaspiration of gas- mation médicale, Hospital Center University Rouen, Rouen, France; tric contents. The results will be presented at the 2016 Réanimation 12Clinique de santé publique, plateforme d’aide méthodologique, C.h.r.u. Congress. Lille, Lille, France Competing interests None. Correspondence: Emmanuelle Jaillette - [email protected] Annals of Intensive Care 2016, 6(Suppl 1):O1 O2 Introduction Ventilator-associated pneumonia (VAP) is the most com- Bicarbonate versus saline for contrast‑induced acute kidney mon ICU-acquired infection in intubated critically ill patients. Micro- injury prevention in critically ill patients aspiration of gastric and oropharyngeal contaminated secretions Xavier Valette1, Isabelle Desmeulles2, Benoit Savary3, Romain Masson2, represents the primary mechanism involved in the pathogenesis of Amélie Seguin1, Cédric Daubin1, Bertrand Sauneuf1, Jennifer Brunet2, VAP. Tracheal cuff plays an important role in stopping the progression Pierre Verrier1, Véronique Pottier2, Marie Orabona2, Désiré Samba2, Gérald of contaminated secretions into the lower respiratory tract. In vitro and Viquesnel2, Mathilde Lermuzeaux2, Pascal Hazera3, Jean‑Luc Hanouz2, animal studies suggested that leakage was significantly reduced with Jean‑Jacques Parienti4, Damien Du Cheyron1 polyvinyl chloride (PVC) conical-cuffed tubes compared with barrel 1Réanimation médicale, C.H.U de Caen, Caen, France; 2Réanimation (standard) or cylindrical cuffs. Clinical studies found conflicting results. chirurgicale, C.H.U de Caen, Caen, France; 3Réanimation polyvalente, Therefore, the aim of this study is to determine the superiority of PVC C.H. Mémorial France ‑ Etats‑Unis (Saint‑Lô), Saint‑Lô, France; 4Unité de conical- versus barrel (standard)-cuffed tracheal tube on abundant biostatistique et de recherche clinique, C.H.U de Caen, Caen, France microaspiration of gastric contents in intubated critically ill patients. Correspondence: Xavier Valette ‑ [email protected] Materials and methods BEST CUFF is a prospective multicenter (ten Annals of Intensive Care 2016, 6(Suppl 1):O2 French ICUs) cluster randomized controlled crossover and open-label trial performed in patients with predicted duration of mechanical Introduction The administration of contrast media for imaging and ventilation 48 h. Patients were allocated to be intubated using a interventional procedures is frequent in intensive care unit (ICU). PVC standard≥ (barrel)-shaped or a PVC conical-shaped tracheal tube. Whether volume expansion with bicarbonate is better than isotonic Prevention measures of VAP were standardized in all ICUs. The main saline to reduce the risk of contrast-induced acute kidney injury (CI- objective was to demonstrate the superiority of conical versus stand- AKI) in critically ill patients is unknown. ard cuff shape in reducing abundant microaspiration of gastric con- Materials and methods The HYDRAREA study was a randomized, tents (pepsin level >200 ng/ml in at least 30 % of tracheal aspirates). double-blind, multicenter trial including adults admitted in three ICUs After inclusion, tracheal aspirates were collected for 48 h to measure in France who received intravascular contrast media. Patients with pepsin and salivary amylase, and diagnose gastric and oropharyngeal unstable renal function (increase in serum creatinine level of at least microaspiration. To diagnose tracheobronchial colonization, quanti- 0.3 mg/dL during the previous 48 h, anuria during the previous 12 h, tative aspirate was performed after intubation and two times a week 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 Page 2 of 236 or bicarbonate load (uncontrolled cardiogenic pulmonary edema, Introduction Neurally adjusted ventilatory assist (NAVA) is a ventila- metabolic alkalosis with pH >7.50, hypokalemia <3 mmol/L, chronic tory mode that tailors the level of assistance delivered by the ventila- hypercapnia) were not included. Patients were randomized in a 1:1 tor to the electromyographic activity of the diaphragm. The objective ratio to receive 0.9 % sodium chloride or 1.4 % sodium bicarbonate of the present study was to compare the impact of mechanical ven- administered with the same infusion protocol: 3 mL/kg for 1 h started tilation with NAVA or pressure support ventilation (PSV) on the early before contrast media administration followed by 1 mL/kg/h for 6 h. phase of weaning from mechanical ventilation. The primary outcome was the incidence of CI-AKI defined by the Acute Patients and methods A multicenter randomized controlled trial of Kidney Injury Network criteria within 72 h after contrast medium 128 intubated adults recovering from an acute respiratory failure was administration. Secondary outcomes included CI-AKI using alterna- conducted in 11 intensive care units (ICUs) from April 2010 to June tive definitions (AKIN without urine output criteria, RIFLE classification, 2012. Patients were randomly assigned to NAVA or PSV. The primary creatinine increase 0.5 mg/dL or 25 %), need for renal replacement endpoint was the probability to remain in an assisted mode during therapy, ICU length ≥of stay and mortality. the entire first 48 h. Secondary endpoints included asynchrony index, Results Among the 307 patients randomized, the mean (SD) age duration of mechanical ventilation and hospital mortality at 28 days. was 56 15 years and 208 (68 %) patients were male. Patients were Results The proportion of patients remaining in an assisted mode dur- admitted± in ICU for medical reason in 132 (43 %) patients, for emer- ing the entire first 48 h was 67.7 % in the NAVA group versus 69.4 % in gency surgery in 118 (38 %) patients, following trauma in 45 (15 %) the PSV group (p 0.47). The time spend in an assisted mode similar patients and after a scheduled surgery in 12 (4 %) patients. The mean in the two groups =(47 [43–48] vs. 47 [40–48], p 0.55). The asynchrony (SD) SAPS II and SOFA scores at ICU admission were 42 17 and 7 4, index was lower in the NAVA group (19.7 vs.= 32.6 %). Duration of respectively. Contrast media were used for computed± tomography± mechanical ventilation was similar in the two groups (12.0 [7.0–17.0] in 193 (63 %) patients and for arteriography in 114 (37 %) patients. in the NAVA group vs. 13.5 [10.0–21.0] in the PSV group, p 0.121) as Low-osmolar contrast media were used in 276 (90 %) patients. At was the ICU mortality rate (12.9 vs. 21.2 %, p 0.21). More= patients
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