key: cord-0003720-yichfzya authors: nan title: Proceedings of Réanimation 2019, the French Intensive Care Society International Congress date: 2019-03-29 journal: Ann Intensive Care DOI: 10.1186/s13613-018-0474-7 sha: bb8a05062237c64d231f3ba922b8ec26c7f32eaa doc_id: 3720 cord_uid: yichfzya nan Introduction: Some studies show a high incidence of invasive pulmonary aspergillosis (IPA) in patients with severe influenza, and suggest to assess benefits of an antifungal prophylaxis. However, those studies come from the same area and lack of external validity. We aimed to measure the incidence of invasive pulmonary aspergillosis (IPA) and aspergillosis colonization in patients with severe influenza admitted to the intensive care unit (ICU). Patients and methods: This retrospective multicenter cohort study recruited all patients with influenza admitted to four ICU in three French tertiary hospitals between September 1, 2009 and April 30, 2018. Patients were adults and had a confirmed influenza infection based on a positive airway PCR test. Patients with an Aspergilluspositive lower respiratory tract specimen culture (patients with Aspergillus) were diagnosed with Aspergillus colonization and invasive pulmonary aspergillosis (putative or proven) according to AspICU criteria. A multivariate logistic regression was performed to determine the factors associated with invasive pulmonary aspergillosis (IPA) and aspergillosis colonization. Results: Four hundred and ninety-one patients were included. Three hundred and fifty-three patients (78.3%) were infected with Influenza A and 98 patients (21.7%) with Influenza B. Mean Simplified Acute Physiology Score II was 43.9 (SD = 20.1) and 97 patients (19.6%) died in ICU. Three hundred and fifty-six patients (72.2%) were under invasive mechanical ventilation and 32 patients (6.5%) underwent extracorporeal membrane oxygenation. Twenty-six patients (5.2%) had an Aspergillus-positive lower respiratory tract specimen culture, including 12 patients (2.4%) diagnosed with IPA according to AspICU criteria. In multivariate analysis, factors associated with Aspergillosis-positive lower respiratory tract specimen culture were liver cirrhosis, haematological malignancy, use of vasopressors and H1N1 influenza (Table) . Mortality rate did not significantly differ between patients with and without Aspergillus (26.9% and 19.2%, p = 0.32). Conclusion: In this large French cohort study of patients with severe influenza, IPA was diagnosed in 2.4% of critically ill patients with Influenza infection. Prospective research is warranted to confirm our findings. identified as patients who increased their static compliance by more than 3 ml cmH2O after 16 h of proning. Results: Thirteen (62%) out of 21 studied-patients were considered as "PP responders" on ECMO. "PP responders" had a greater body mass index, more frequently a viral pneumonia and a shorter ECMO duration compared to "PP non-responders" (p < 0.01). For both groups, tidal volume and EELI were redistributed from ventral to dorsal regions during PP. However, "optimal PEEP" was significantly lower in PP than in supine position with 14 (12 -16) and 11 (8-14.5 ) vs 12 (10-14) and 8 (7.5 -10.5) cmH2O in "PP responders" and "PP non-responders", respectively (figure 1). Lastly, baseline center of gravity index was lower in "PP responders" (p = 0.03). Conclusion: EIT allows monitoring PP impact on ventilation and seems to be a relevant tool to identify patients who will more likely respond to PP on ECMO. Respiratory muscles contraction after successful ventilator liberation trial predicts extubation failure Martin Dres (speaker) 1 Introduction: Even for patients who successfully pass a ventilator liberation trial, the period after extubation is at risk of complications. In the present study we investigated whether assessment of respiratory muscles contraction within 2 h after extubation could predict extubation failure (acute respiratory failure, re-intubation or death during a 7-days period following extubation). Patients and methods: Patients from two intensive care units who were intubated since at least 48 h and who successfully passed a ventilator liberation trial were enrolled in the study. Within the two hours following extubation, right hemi-diaphragm (TFdi) and right upper intercostal muscle thickening fraction (TFci) were obtained with ultrasound. TFdi and TFic were compared between patients with and without extubation failure (unpaired test). Receiver operating characteristic (ROC) curves were constructed to predict the risk of extubation failure for each indice. Results: Of the 122 patients who participated in the study, 22 (18%) had extubation failure. Respectively in patients with and without extubation failure, TFdi was 11.9% (9. 8-19.4 ) and 21.5% (15. [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] .3) (p < 0.01) and TFic was 12.8% (8.2-22 .2) and 6.5% (4.2-9.1) (p < 0.01). AUC of the ROC curves were 0.73 (0.59-0.86) and 0.76 (0.60-0.91) for TFdi and TFic respectively (p = 0.54). A value of TFdi lower than 16% predicted extubation failure with a sensitivity of 70% (46-88) and a specificity of 73% (63-82). A value of TFic greater than 9% predicted extubation failure with a sensitivity of 75% (51-91) and a specificity of 74% (63-82). Eventually, TFdi TFic ratio was 3.4 (2.0-5.4) and 0.8 (0.3-2.6) in patients with and without extubation failure respectively (p = 0.003). The AUC of the ROC curve for TFdi TFic was 0.82 (0.70-0.94) providing a sensitivity of 71% (60-81) and a specificity of 74% (49-91) to predict extubation failure with a cut-off of 2.2. Conclusion: Assessment of respiratory muscles contraction within two hours after extubation could be used to identify patients at risk of extubation failure. The potential interest of our cut-offs could be used at the time of considering preventive post extubation ventilation strategy. Effect of empirical aminoglycoside combination therapy on mortality in patients with septic shock-a propensity-based analysis Jean-François Llitjos (speaker) 1 Introduction: Current guidelines recommend combination antibiotic therapy for patients with septic shock. However the supporting evidence is scarce. The aim of this study is to address the impact of aminoglycoside combination therapy on mortality in septic shock. Patients and methods: This was a 9-year (2008-2016) monocenter retrospective study. All adult patients diagnosed with septic shock within the first 48 h were included. Septic shock was defined as a microbiologically proven or clinically suspected infection, associated with acute circulatory failure requiring vasopressors. Empirical combination therapy was defined by the addition of aminoglycosides within 36 h from the diagnosis of septic shock. A propensity score for aminoglycoside administration was built using day 1 demographic and clinical characteristics. The determinants of mortality were assessed using a propensity-adjusted Cox proportional hazards competing risk analysis. Results: During the study period, 1040 patients were admitted for septic shock. Among them, 64% were males, the median age was 69 [57 + 78] years old. The crude in-ICU mortality rate was 35%. The antibiotic regimen was based on beta lactam therapy in almost all patients (99%), combined with aminoglycosides in 616 (59%) patients. First-line aminoglycosides were distributed into amikacin (61%), gentamicin (37%) and tobramycin (2% *Total including all organisms in the panel Introduction: In out-of-hospital cardiac arrest (OHCA), geographic disparities in outcomes may reflect baseline variations in patients' characteristics but may also result from differences in the number of ambulances providing basic life support (BLS) and advanced life support (ALS). We aimed at assessing the influence of allocated ambulance resources on outcome in OHCA patients in a large urban community. Patients and methods: From May 2011 to January 2016, we analyzed a prospectively collected Utstein database for all OHCA adults. Cases were geocoded according to 19 neighborhoods and the number of BLS (firefighters performing cardiopulmonary resuscitation and applying automated external defibrillator) and ALS ambulances (medicalized team providing advanced care such as drugs and endotracheal intubation) was collected. We assessed the respective influence of Utstein parameters, socio-economic characteristics and ambulance resources of these neighborhoods using a mixed-effect model with successful return of spontaneous circulation (ROSC) as the primary endpoint and survival at hospital discharge as a secondary endpoint. Introduction: Using the SPECTRUM study, we aimed to evaluate whether hypoxemia in ICU among obese patients had different causes and management compared to non-obese patients. Patients and methods: Subgroup analysis of a prevalence-point-day conducted in 117 French-speaking ICU aiming to report the patterns and outcomes of hypoxemic patients (defined by P F < 300 mmHg). Obesity was defined as a body mass index (BMI) > 30 kg m2. Results: Among 1571 patients hospitalized in ICUs the day of the study with BMI data, 428 were obese (27%). 247 of them were hypoxemic (57.7%) as compared with 597 1143 (52.2%) non-obese patients (p 0.05). They exhibited more frequent obesity-hypoventilation syndrome (23% versus 1.5% p < 0.001) and sleep apnea (19.4% versus 3.5% p < 0.001), less frequent non-obstructive chronic respiratory disease (2% versus 8.6% p < 0.001) and interstitial pulmonary disease (1.2% versus 4.4% p 0.02) and had more frequently home non-invasive ventilation (NIV) (5.7 versus 2.9% p 0.05). Hypoxemia was mild in 52%, moderate in 39% and severe in 9%, similar to non-obese patients. ARDS criteria were fulfilled in 21.5% (versus 20.6% in non-obese patients). They required high flow oxygen, NIV and invasive ventilation respectively in 5.7, 6.9 and 58.7% of cases, which was not different from non-obese patients. PEEP was higher (7 (IQR 5-10) versus 6 (IQR 5-8) cmH2O, p 0.03). Tidal volume in intubated patients was 7 ml kg (IQR 6-8.4) in obese patients versus 6.8 (6.1-7.7) (p 0.06). Plateau pressure was not different between the 2 groups (24 versus 22 cm H2O), as well as PaO2, PaCO2 and pH. Diagnosis of atelectasis was frequent in the 2 groups (23% versus 25.7%). There was no difference in the use of prone position (5.2 versus 4.3%, p 0.66). ICU mortality of obese patients was 20.6% versus 27.4% (p 0.04). Multivariate Cox model confirmed a negative independent association between obesity and ICU mortality. Introduction: High-flow oxygen therapy (HFNC) has shown a benefit for the prognosis of patients with hypoxemic acute respiratory failure (ARF), while noninvasive ventilation (NIV) remains debated in this indication. We evaluated the effect of HFNC on alveolar recruitment and lung volumes in hypoxemic ARF compared to NIV and facial mask (FM). Patients and methods: A prospective cross-over physiological study was conducted. Eligible patients had to present a hypoxemic ARF due to pneumonia requiring HFNC and or NIV according to ICU physician. Cardiogenic pulmonary oedema and underlying respiratory disease were excluded. Each patient was investigated with the Pulmovista ® (Dräger, Lübeck, Germany) device and underwent 15 min periods of HFNC or NIV in a randomized order, interspersed with 15 min periods of FM used as reference. The primary endpoint was the comparison of global and regional end-expiratory electrical lung impedance (EELI) between NIV and HFNC. Secondary endpoints were the comparison, between the 3 techniques, of lung volumes (global and regional tidal variations (TV), respiratory parameters, hemodynamic tolerance, dyspnea and comfort. Results: NIV 1.1 ). Global and regional TV increased under NIV compared to HFNC (p < 0.05) or FM (p < 0.05), while HFNC did not modify TV over FM. NIV significantly improved the SpO2 FiO2 ratio compared to HFNC (p = 0.001) (fig 1.2) . HFNC significantly reduced respiratory rate vs FM (p = 0.04) but not NIV. No difference was found for dyspnea score between the 3 techniques. Patient comfort was similar between HFNC and FM but decreased with NIV. Conclusion: This study demonstrates a similar benefit of HFNC and NIV on alveolar recruitment with the settings used, as compared to FM. By contrast to HFNC and despite a better oxygenation, NIV also increases lung volumes which may contribute to its potentially deleterious effect during hypoxemic ARF leading to the recent concept of Patient Self Inflicted Lung Injury or P-SILI (Brochard L et al. AJRCCM 2017 + 195-438-42) . Introduction: Ventilatory Acquired Pneumonia (VAP) is one of the main nosocomial infection in adult ICU. Only one prospective multicenter study performed during six months in 16 PICUs of the US has prospectively described pediatric VAP. We design the INCIPAVE study to report the occurrence of VAP in european PICUs, focusing on patients, risk factors (RF), micro-organisms involved, diagnostic tools and antibiotics used. The first aim of this study was to calculate the incidence of VAP. Patients and methods: Multicenter prospective cohort study from 03/04/2017 to 03/04/2018 including all patients mechanically ventilated (MV) at least once in eight PICUs, one in the Netherlands and seven in France. VAP was defined using the 2015 CDC criteria, applied during PICU stays, excluding the 48 h preceeding and following PICU. Patients were described on admission and main RF ever tested in the medical litterature were daily included by a pediatric intensivist of each PICU in an electronic database on a securized dedicated website. The Ethics Committee of the French Society of Intensive Care approved the study, which has been declared to the CNIL and recorded on Clinical-Trials.org. All parents were individually informed by a dedicated sheet. Descriptive data are reported as number (%) or medians [first-third quartiles]. Incidence was calculated as the number of VAP for 1000 days of MV. Results: These results are based on declarative information reported in the INCIPAVE database during its first opening on September 2018, before cleaning. During one year, 2047 episodes of MV were included in 1856 patients (26.5 months [6 + 92], 12kgs [6.4 + 23.22], 56% of males). Main reasons for admission to PICU were post-operative care (35.1%) and respiratory (23.7%), neurological (17.1%) or circulatory (12.2%) failures. PIM-2 score was 2.8% [1.3 + 7.5] with an observed mortality of 10.9%. PELOD-2 score on day-1 was 5 [4.7] . Patients were ventilated via uncuffed tubes in 19.6% of cases (7.8% of tracheostomy). A total of 158 VAP was declared during 11685 days of MV. The incidence of VAP was 13.5 1000 days of MV (IC95% -[11.4 + 15.6]). Conclusion: This incidence of VAP in INCIPAVE study is higher than the incidence reported recently by Gupta (7.0 1000 days of MV) (1) . New analyses are planned after cleaning of the database, including a special reading of each case of VAP. Severe sepsis and septic shock in hematological pediatric patients admitted to picu -a bicentric retrospective study from 2011 to 2017 Aurélia Alimi (speaker) 1 Introduction: Pediatric sepsis remains a burdensome public health problem, especially in patients with immuno-deficiency. Adherence to Survival Sepsis Campaign (SSC) would be associated with lower mortality. However, this correlation had never been evaluated in children with hematologic malignancies. Patients and methods: Retrospective bicentric cohort study of children with identified hematologic malignancy or hematopoietic stem cell transplantation and requiring intensive care for severe sepsis between January 2011 and August 2017. Detailed description of sepsis resuscitation just before and within six hours after the diagnosis of sepsis. Evaluation of adherence to SSC recommandations, before and after admission to Pediatric Intensive Care Unit (PICU). Accurate analysis of microbiologic etiologies. Assessment of mortality 6 months after the sepsis. Results: 65 patients were included from the 78 who have been screened. Before admission in ICU -38% of them did not receive oxygen, 47% of patients showed low blood pressure for age without continuous infusion of inotropes, and lactic acid was measured in few patients (14%). Within 6 h of PICU admission, 28% did not receive oxygen and only 24% of patients with continuous infusion of inotropes were ventilated. Lactic acid and central venous oxygen saturation measurements were obtained in only one third of patients. An infectious organism was isolated in 51% of patients. The most common primary site of infection was central venous catheter (70%) and 5 patients (13%) showed a fungic infection. The mortality within 6 months was evaluated at 18.5%. Introduction: HFNC has emerged as a promising method to provide respiratory support in bronchiolitis. Only two RCT had evaluated HFNC in less severe bronchiolitis admitted in general wards but failed to demonstrate a reduction in the length of oxygen therapy or in the proportion of patient transferred in PICU (Kepreotes 2017, Franklin 2018). Therefore, we performed a superiority trial to test the hypothesis that HFNC could reduce the proportion of treatment failure requiring noninvasive ventilation among infants in these setting. Patients and methods: Inclusion-first episode of bronchiolitis in infant (less 6 months-old), SpO2 in room air < 95%, m-WCAS score > or = 2 and < or = 5. Exclusion -urgent need for NIV, mWCAS > 5 or 6, lack of consent. Randomization -standard oxygen therapy (up to 2 L min)(control) or HFNC (3 l kg min)(experimental). Cross-over wasn't allowed. Failure criteria-FiO2 > or = 40% or nasal flow oxygen > 2L min to maintain SpO2 target, increasing m-WCAS score or > 5-6, refractory apnea and or increasing PaCO2 at H6. Primary endpoint-proportion of patient in treatment failure requiring non-invasive within 7-days following randomization. Secondary endpoint-percentage admitted in ICU, assessment of short term respiratory status, general ward unit LOS, oxygen and nutritional -support free days. Results: During the 6 months study period (2016-2017), 2630 patients admitted for bronchiolitis into the 17 PED's network were screened of whom 271 underwent randomization (268 in the intention-to-treat analysis) (table 1) . HFNC didn't improved the primary outcome. Failure occurred in 21 of 133 patients (15%) in the HFNC group and 27 of 135 (20%) in the control group (OR IC 95% + 0.75 [0.40 + 1.40] + p = .36). HFNC didn't reduced the risk of admission in ICU (21 (15%) in HFNC group versus 26 (19%) in control (OR IC 95% + 0.78 [0.41 + 1.41] + p = .45). Any patient was intubated. The main reason for treatment failure was the worsening of mWCAS score. Mean LOS on general ward unit was lower in the control group (3.8 + -2.7 days versus 4.4 + -2.4 days + p = 0.04). Short-term assessment of respiratory status didn't shown difference except for mWCAS score and RR in favor HFNC. Three pneumothorax was reported in HFNC group. Conclusion: There was neither evidence of lower rate of non-invasive ventilation support among patients receiving HFNC therapy nor difference in the rate of ICU admission. Introduction: Some patients with septic shock may develop very severe myocardial dysfunction refractory to medical treatments. Several cohorts and case-report studies reported salvage therapy with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in those patients. The aim of this study was to assess the usefulness of VA-ECMO as rescue therapy during refractory myocardial dysfunction associated with septic shock. Patients and methods: In this multicenter international retrospective study, patients from 4 ECMO centers implanted with VA-ECMO as a rescue therapy from 2008 to 2018 for refractory septic shock with severe myocardial dysfunction (cardiac index below 3 L min m2 and or left ventricular ejection fraction below 35%) were included. As controls, 228 patients exhibiting severe myocardial dysfunction during the same period of time but who did not receive ECMO were isolated from 3 large septic shock databases, and were included the first day they met criteria for severe myocardial dysfunction. ECMO and non-ECMO patients outcomes were compared after matching for disease severity. The primary end point was mortality at 90 days. Results: (mean ± SD and n (%) are shown) Eighty-two patients rescued with VA-ECMO were included. Patients exhibited extremely severe myocardial dysfunction (mean cardiac index at 1.54 ± 0.54 L min m2 and left ventricular ejection fraction 28.1 ± 5.7%), despite very high doses of catecholamines (mean inotropic score 279 ± 247 µg kg min). They also had profound lactic acidemia (pH 7.13 ± 0.15 and lactatemia 8.9 ± 4.4 mmol/L) and severe multiple organ failure (SOFA score 16.6 ± 2.9 and SAPS-II score 78.3 ± 16.1). Seventy-eight of them could be matched with non-ECMO patients based on a propensity score for disease severity (lactatemia, cardiac index and SOFA score). Mortality at 90 days was dramatically reduced in matched ECMO patients compared to controls, (41% vs. 87%, p < 0.0001). In a sensitivity analysis, all patients with cardiac index monitoring were weighted using matching weight ponderation on inotropic score, lactatemia, SOFA score, age and cardiac index at inclusion. Mortality at 90 days remained significantly reduced in weighted ECMO patients. Finally, survivors in the ECMO group reported acceptable SF-36 evaluated health-related quality of life in the months following ICU discharge. Conclusion: In this retrospective propensity-matched study, rescue therapy with VA-ECMO was associated with a dramatic reduction in 90 days mortality for patients with refractory septic shock and severe myocardial dysfunction. Hélène Beringuer (speaker) 1 Introduction: Fluid expansion is the first therapeutic option in patients presenting acute circulatory failure but its hemodynamic effects (persistency and time of maximal increase in cardiac output) are unknown. We sought to describe the time course of cardiac output over a 2-hours period after a fluid expansion. Our objectives were 1) to identify patterns of fluid responsiveness and 2) to determine the time of maximal increase in cardiac output during and after fluid expansion. Patients and methods: It was a prospective multicentre observational study conducted in four intensive care units. To be included, mechanically ventilated patients with acute circulatory failure (infusion of norepinephrine) had to be equipped with a transpulmonary thermodilution device (PiCCO 2) and a decision of fluid expansion (500 ml of saline over a standardized 10-minutes period) had to be made. Calibration was achieved before and at two hours after fluid expansion. Transpulmonary thermodilution derived indices were collected over the two-hours period of observation. Fluid responsiveness was defined as an increase in cardiac index 15% from the start of the fluid expansion. Four patterns of fluid responsiveness were predefined-never responders, ultrafast responders (before the end of the fluid expansion), short-term responders (at the end of the fluid expansion) and persistent responders (over the 2-hours observation period). No change in drugs dosage nor ventilatory settings were allowed during the study. Results: Fifty-eight patients (79 cases) were included. Septic shock was the main reason of acute circulatory failure (46 58, 79%). Patterns of fluid responsiveness were the followings-non-responders (36 79, 46%), ultrafast responders (3 79, 4%), short-term responders (13 79, 16%) and persistent responders (6 79, 8%). In addition, 21 (27%) patients had hemodynamic instability and required a second fluid expansion during the protocol. No significant difference was found between patterns in terms of baseline hemodynamic characteristics nor drugs administrated. The increase in cardiac output was maximal after 300 seconds in never responders, after 516 [396-672] seconds in ultrafast responders, after 456 [360-660] seconds in short-term responders and after 348 [315-372] seconds in persistent responders. Conclusion: Persistent fluid responsiveness occurred in a minority of patients presenting acute circulatory failure. Maximal increase in cardiac output could be observed during fluid expansion between 5 and 10 min. Introduction: Fluids composed of molar sodium lactate have recently been identified as beneficial in endotoxinic animal models1. The objective of our work was to evaluate the effects of molar sodium lactate on micro-and macro-circulation, capillary leakage and different biological parameters in a sepsis rat model of caecal ligation and puncture (CLP). Patients and methods: We realized CLP in 30 rats randomized in 3 groups (n = 10 per group)-Sham + CLP-NaCl 0.9% + CLP-Lactate 11.2%. Immediately after CLP, fluids were infused intravenous (2.5 mL kg h) during 18 h. Then, we evaluated mesenteric microcirculation (laser speckle imager), cardiac function (echocardiography) and inflammation (uremia, albuminemia, VEGF-A, IL-1β, IL-10, TNFα). Assay of capillary leakage using Blue Evans extravasation in the lung and gut were realized on additional rats (n = 5 group). Results are expressed as medians with interquartiles and comparisons versus CLP-NaCl were realized using Kruskall-Wallis or ANOVA test. .9] pg mL, p = 0.009). No difference was observed for syndecan plasma level. Conclusion: We demonstrate for the first time that molar lactate fluid perfusion protects against CLP-induced cardiovascular dysfunction, mesenteric microvascular alteration and capillary leakage, in association with a significant reduction in inflammatory process. These results suggest that molar lactate fluid perfusion may be an attractive target for the treatment of sepsis. Introduction: Invasive candidiasis (IC) is associated with a high incidence of mortality in intensive care unit (ICU). Delayed antifungal therapy for IC contributes to poor outcomes in ICU. None of the predictive published risk scores are able to accurately predict IC. Therefore, new scores introducing previous anti-infective therapy, elapsed time between admission, risk evaluation and differentiating candidemia and other invasive candidiasis should be developed. Patients and methods: Retrospective analysis of data from the OUT-COMEREA prospective multicenter cohort. Critically ill patients with an ICU length of stay of at least 3 days were included. Multivariable sub-distribution survival models with competing risk were used at each day, from day 1 to day 10 using a landmark method with a sliding window and an horizon of 10 days. The impact of every identified risk was analysed for candidemia and invasive visceral candidiasis (IVC-Candida peritonitis or pleural candidiasis) separately. Competing risks were ICU-death and ICU-discharge. Predicted probability of infection during the next 10 days was calculated at day 1, 4 and 7 based on cumulative incidence function of every combination of risk. Results: 16901 patients were included. Candidemia occurs in 96 patients and IVC in 87 patients. Antifungal therapy was used in 2019 (12%) patients. In multivariate analysis, 10 risk factors for candidemia and 12 for IVC were identified (figure). We confirmed the impact of some previously described risk factors (i.e. septic shock, multifocal colonization, SOFA score, hospital stay before ICU, parenteral nutrition, corticosteroids, blood transfusion, mechanical ventilation and surgery). Those risks were differently associated with candidemia and IVC. Some variables such as corticosteroids therapy, blood transfusion and mechanical ventilation were only associated with candidemia. Risks were time dependent with some having more impact on early state (landmark time < 5) or on late onset (landmark time > day 5). Antibiotherapy (broad spectrum, piperacillin-tazobactam), number of PPI days of use and a medical history of cancer were only associated with IVC after landmark time 5. Prediction model found maximum predicted probability of 38, 17 and 16% at landmark 1, 4 and 7 respectively for candidemia and 58, 52 and 41% for IVC. A shiny app was developed to compute the predicted risk of candidemia or IVC depending on risk factors combination. Conclusion: Risk factors of Candida infection are different for candidemia and IVC and must be analysed as distinct diseases. Moreover, those risks are highly time-related with an early and late pattern during ICU stay. Introduction: Adult onset Still disease (AOSD) is a rare and complex auto-inflammatory disorder with several systemic life-threatening manifestations and empirical treatment. Our objectives were to describe of clinical features, management and outcome of AOSD patients who required intensive care support. Patients and methods: We undertook a 17-year retrospective multicenter cohort study in 44 French academic ICUs from January 2001 to June 2017 including all cases of ICU admission related to life-threatening AOSD. All patients older than 18 years were considered for inclusion if they met the following criteria-(1) admission to ICU, (2) related to systemic AOSD flare (according to Yamaguchi and or Fautrel criteria). The study methodology and the data privacy policy (French methodology of reference MR-003) were approved by our institutional ethics committee (application no. 156-2017) and registered on Clini-calTrials.gov (NCT03276650). Results: Forty-five patients were included (median age 34.5 (1st-3rd quartiles 24-42.5) years). Men were more affected (54%) than women. It was the first AOSD flare for 60% of population. Median SAPS II was 32.5 (21. . Cardio-circulatory (shock, 42% and pericarditis, 40%), respiratory (Acute Respiratory Distress Syndrome, 22%) and hematologic (Reactive Hemophagocytic Syndrome, 16%) disorders were the most frequent life-threatening manifestations. Multiple organ failure was frequent (24%) and associated with bad prognosis if presented at admission (p = 0.021). Nine patients died (20%, median age of 24 (21-41) years) among whom 8 with previously diagnosed AOSD, versus 10 without previous diagnosis (p = 0.001). Comparison between survivors and non-survivors during ICU stay are shown in Table 1 . Corticosteroids (CS) were used as first line therapy in 43 (96%) patients with efficacy of CS monotherapy in 27 (63%). Three patients were successfully treated by anakinra, with 43% global efficacy. Four patients with more severe organ failures at admission died despite treatment with anakinra, introduced after several lines of other immunosuppressive agents (cyclosporine, etoposide, intravenous immunoglobulins). Ann. Intensive Care 2019, 9(Suppl 1):40 Conclusion: Herein, we report the largest cohort of patients admitted to ICU for life-threatening AOSD. It can lead to life-threatening presentation with miscellaneous presenting clinical spectrum and high mortality rate among young people with previous diagnosis of AOSD. Because of the lack of specific clinical and biological signs and its frequent cardiovascular collapse, the key point is to quickly eliminate septic diagnosis and add immunosuppressive treatment to empiric antibiotherapy. Septic shock among patients with systemic lupus erythematosusshort and long-term outcome and associated costs. Analysis of a French nationwide database Arthur Mageau (speaker) 1 , Karim Sacre 2 , Anne Perozziello 1 , Stéphane Ruckly 1 , ClaireDupuis 1 , Lila Bouadma 1 , Thomas Papo 3 , Jean-François Timsit 1 1 Introduction: Plasma exchange (PE) often leads to adverse effects. Sepsis resulting from impaired immunity caused by the removal of antibodies and related to catheter-associated infections represents the most severe complications. The study evaluate the infectious risk associated with the current use of PE and identify its predictive factors. Patients and methods: All major patients admitted to our tertiary ICU and received PE therapy between 2002 and 2017 were included. Patients who developed secondary infection were compared to those who did not by the use of univariate and multivariate analysis. Results: Eighty-eight patients underwent 616 PE procedures. 56% patients were in mechanical ventilation, 44% received constrictive drugs and 40% were in renal replacement therapy. Indications were Thrombotic Thrombocytopenic Purpura 48 (55%), Neurologic diseases 18 (20%), Vasculitis 14 (16%), autoimmune diseases 4 and other indications 4. Adverse effects per-procedure were observed in 22% of patients in witch half of them were life-threathening. PE-associated infections occurred in 39 patients (44%). Median time elapsed from ICU admission and EP initiation to infection diagnosis were respectively 8 [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] and 4 [2] [3] [4] [5] [6] [7] [8] [9] [10] days. Infectious complications included 19 ventilationassociated pneumonia, 6 nosocomial pneumonia, 16 viral reactivations, 5 bacteremia, 4 catheter-associated infections, 4 urinary infections. Most of them were severe with a septic shock in 22 39 patients (58%) and 8 patients deceased (20%). The comparison by univariate analysis showed that patients with associated infection had a significantly higher age, need more frequently a mechanical ventilation and vasoactive drugs. The number of PE and ICU and in-hospital length of stay were significantly higher in the infectious group. No significant differences were observed between infectious and no infectious groups regarding to severity score at admission, corticoids, immunosuppressive therapy, type of substitute liquid, PE volume. In multivariate analysis, age ([OR] = 1.05, CI95% 1.01-1.09, p = 0.02), number of session ([OR] = 1.22, CI 95% 1.08-1.39, p = 0.001) and requirement of mechanical ventilation ([OR] = 4.19, CI95% 1.27-13.81, p = 0.02) were predictive of the infection occurrence. ICU mortality was higher in the infectious group (28% versus 16% p = 0.28). Conclusion: PE was associated with an infection, in particular pneumonia, in 44% of patients and lead to a life-threatening condition in 25% of them. Age, number of PE session and requirement of mechanical ventilation were predictive of the occurrence of infection. Romaric Larcher (speaker) 1 Introduction: Lung fibroproliferation in ARDS patients is associated with mortality. Alveolar procollagen III (NT-PCP-III) is a biomarker of lung fibroproliferation. Chest CT scan could be useful for the diagnosis of fibroproliferative radiologic lesions. The main objective of the present study was therefore to quantify chest CT scan lesions in ARDS patients with a high alveolar level of NT-PCP-III indicating an active fibroproliferation. Patients and methods: This retrospective cohort study over 6 years (January 2011-January 2017), included ARDS who had at least one dosage of alveolar NT-PCP-III obtained by performing a bronchoalveolar lavage (BAL) and a chest CT scan within 3 days before or after BAL. According to a previous study alveolar level of NT-PCP-III > 9µG L indicated a histological lung fibroproliferation (1) . CT scan was scored on interstitial (honeycombing) and alveolar (ground-glass) abnormalities (2) . Crude score and corrected score (related to the number of scored lobes in case of important lobar condensation) were used. Results: One hundred ninety-two patients were included, either 228 "couples" alveolar NT-PCP-III and CT scan. Using a threshold of NT-PCP-III > 9µG L, crude and corrected fibrosis score was highest when lung fibroproliferation are present. Values of lung fibroproliferation CT scan score according to alveolar NT-PCP-III level appear in table 1. The median delay between the onset of ARDS and CT scan was of 5 [0-14] days, between the onset of ARDS and days, between BAL and CT scan 0 [− 1-1] days. Conclusion: When alveolar NT-PCP-III is used as a surrogate of lung fibroproliferation, CT scan fibrosis score is significantly higher in patient with active pulmonary fibroproliferation. Introduction: Ultraprotective ventilation with tidal volume (VT) reduction below 6 ml kg predicted body weight (PBW) in severe ARDS may reduce alveolar strain, driving pressure and hence ventilatorinduced lung injury, with main drawback of worsening respiratory acidosis. We hypothesized that VT could be reduced up to 4 ml kg, with clinically significant decrease in driving pressure (DeltaP), without the need for extracorporeal CO2 removal, while maintaining pH in the range targeted in recent ARDS trials. Patients and methods: We conducted a non-experimental beforeand-after multi-center study on 35 ARDS patients with PaO2 FiO2 <= 150 mm Hg, within 24 h of ARDS diagnosis. After inclusion (H0), VT was reduced to 4 ml kg PBW and further adjusted to maintain pH > = 7.20, respiratory rate was increased up to 40 min and PEEP was set using a PEEP-FiO2 table favoring high PEEP. This strategy was applied until positivity of a PEEP weaning trial. The primary judgment criterion was DeltaP on day 2, as compared to study inclusion. Results: Patients' age was 62 ± 14 year, SAPS II amounted to 47 ± 15, 29 patients (85%) had pneumonia as ARDS risk factor, SOFA at inclusion was 13 ± 3, and PaO2 FiO2 at inclusion was 107 ± 35 mm Hg under a PEEP of 10 ± 4 cmH2O. From inclusion to day 2, DeltaP decreased significantly from 12.1 ± 4.3 to 8.6 ± 3.1 cmH2O, while VT decreased from 6.1 ± 0.6 to 4.4 ± 0.7 ml kg. On day 2 of the study (table 1) , VT was below 4.2 ml kg in 22 patients (65% [IC95% 48%-79%]), and below 5.25 ml kg in 30 patients (88% CI95% [74%-95%]). Time with VT below 4.2 ml kg averaged 1.7 ± 1.4 days. Sedation drugs were not significantly modified. **Two patients (6%) developed acute cor pulmonale after inclusion. Right ventricle left ventricle ratio increased non-significantly from 0.59 ± 0.16 at H0 to 0.69 ± 0.22 on day 2. Eleven patients (32%) presented with severe respiratory acidosis (pH < 7.15). Fourteen patients (41%) died before day 90. Conclusion: Ultraprotective ventilation may be applied in approximately 2 3 of moderately severe to severe ARDS patients, with a mean reduction of DeltaP approximating 3.5cmH2O, at the price of severe respiratory acidosis in 1 3 of the patients. Vasopressor (µg.kg.min −1 ) 0.57 ± 0.64 ---0.53 ± 0.75 0.29 ± 0.25 † Introduction: Early, prolonged and repeated sessions of prone positioning (PP) have proven substantial outcome benefit in ARDS patients. In the most severe forms of ARDS, veno venous extracorporeal membrane oxygenation (vvECMO) is considered as a therapeutic option performed on a case by case. About 50% of patients treated with vvECMO have previously been turned prone. However, only few studies have evaluated the interest of maintaining PP during ECMO. Therefore, the objective of this study was to compare the 90-day survival rate of patients supported by vvECMO with concomitant PP (prone ECMO group) to those not turned prone during the ECMO period (ECMO alone group). We included all adults treated with vvECMO for ARDS between January 2012 and April 2017 in a university teaching hospital in Marseille, France. Patients were either cannulated in our ICU or in a referring hospital then transported by the ECMO mobile team. Before considering patients for ECMO, a PP session was systematically performed in our center if feasible, and strongly encouraged for patients from referral centers. Criteria for vvECMO have been previously published. During ECMO, patients were considered for prone position in case of 1 persistent hypoxemia defined by SpO2 < 88% or PaO2 < 55 mmHg despite a 100% FdO2 and FiO2 with a maximal ECMO blood flow, 2 failure of attempt to wean ECMO after at least 10 days of ECMO and the presence of lung consolidations on chest X-ray or ultrasounds echography, 3 according to the physician in charge. Technical issues have been previously described. We compared the prone ECMO group to the ECMO alone group. We performed Kaplan-Meier 90-day survival curves and Coxmodel for 90-day mortality. Results: 169 patients were included in the analysis, 92 in the prone group and 77 in the ECMO alone group. The prone group has a 57.6% 90-day survival rate as compared with a 37.7% 90-day survival rate of the ECMO alone group, p = 0.01. SAPS2 [HR = 1.040 Introduction: Emphasis regarding the importance of early cardiopulmonary resuscitation (CPR) and defibrillation led to an improvement in outcome after cardiac arrest (CA). Meanwhile, recent data raised some concerns regarding the benefit of targeted temperature management (TTM) at 33 °C for comatose cardiac arrest survivors. This may have resulted in a loss of interest in TTM in these patients, with uncertain consequences on outcome. We use data from the Sudden Death Expertise Center (SDEC) of the Great Paris area to assess the relationship between changes over time in the use of TTM and patients' outcome after adjustment for potential confounders. Patients and methods: We used data prospectively collected in SDEC registry between May 2011 and December 2016. Variables were collected according to Utstein style. All non-traumatic OHCA patients with stable return of spontaneous circulation (ROSC) were included in the analysis. We compared patients' characteristics and outcome according to TTM use. We performed a multivariable logistic regression using survival at ICU discharge as the main endpoint. Results: During study period, 3667 patients were retained in the analysis, of whom 1794 received TTM. As compared with controls, patients with TTM were significantly more frequently male and younger + CA occurred more frequently in a public place + a shockable rhythm was more frequent and the proportion of patients with a short noflow (< 3 min) was greater (all P < 0.001). Regarding time trends, gender, age and location of CA did not change according to the year of inclusion in the registry. Bystander CPR increased from 56% in 2011 to 82% of patients in 2016 (P < 0.001), the rate of shockable rhythms increased from 40% to 51% (P = 0.005). The rate of patients with a noflow > 3 min decreased from 58% to 43% (P < 0.001) ( Figure 1 ). TTM use decreased over time, from 55% in 2011 to 48% in 2016 (P < 0.001). Meanwhile, survival rate at ICU discharge increased significantly from 20% to 28% of patients (P = 0.018) (Figure) . In multivariate analysis, year of CA occurrence was associated with outcome at ICU discharge. The TTM use decrease over years was not driven by any particular Utstein criteria. Conclusion: We report an improvement over time in ICU survival of post-CA patients, which appears mostly associated with an increase in bystander CPR and higher rate of shockable rhythms. TTM use declined over years in all subgroups of CA patients with no evident consequences regarding outcome. Marine Paul (speaker) 1 Introduction: Post-resuscitation shock has a high incidence after cardiac arrest (CA) due to the whole-body ischemia-reperfusion and may be complicated by multiple organ failure (MOF) and death. Mesenteric ischemia (MI) may occur in this setting but incidence and outcome are poorly documented. We performed a retrospective monocentric study aiming to describe characteristics and outcome of MI after CA. All consecutive patients admitted in a tertiary CA center between 2007 and 2017 with a confirmed MI during their ICU stay were studied. MI was confirmed by endoscopy, abdominal CT-scan or surgical laparotomy. Results: Among 1503 CA post-CA patients, MI was clinically suspected in 59 patients (4%) and confirmed in 28 59 patients. Median age was 62 years, median time from CA to cardio-pulmonary resuscitation (CPR) was 3 min (0-5), and time from CPR to return of spontaneous circulation was 22 min (18. 3-29.5) . Patients had an initial shockable rhythm in 57%, they received epinephrine during CPR in 82% and 93% of patients developed a post-resuscitation shock. Median initial blood lactate was 8.5 mmol/L. Delay between CA and the diagnosis of MI was 2 days (2-4), mostly because of clinical abdominal symptoms (79%) including hemorrhage and feeding intolerance, confirmed with CT scan abnormalities (54%) and lower digestive endoscopy (39%). Despite surgical intestinal resection performed in 7 28 patients, ICU mortality was 96%, as only 1 patient survived with good neurologic outcome. Cause of death was the MOF itself (41%) or post-anoxic brain injury for 37% despite a recovery after the initial shock. In this cohort, we observed that MI after CA is an uncommon complication associated with a very poor outcome. Efforts should be made in order to obtain an earlier recognition of MI in patients with preserved brain function. These preliminary results need to be confirmed in a multicentric study. Introduction: Botulism is a rare potentially severe neuroparalytic disease caused by neurotoxins produced in most cases by Clostridium botulinum. Treatment mainly consists in life support techniques, and some specific medications such as antitoxins. In France, there are no guidelines regarding the use of these antitoxins, and they are only available with a Temporary Authorization for Use. The primary goal of this study was to describe and evaluate morbidity and mortality of severe adult botulism in ICUs in France. Our secondary goal was the evaluation of current patient care in French ICUs, especially concerning administration of antitoxins. Patients and methods: We conducted a retrospective observational multicenter study in French ICUs. Among 197 adult ICUs, 93 units agreed to participate. Patients' data were collected through a standardised CRF. We included patients aged above 15 years of age who were admitted in an ICU between January 2000 and June 2017 for an acute botulism. Study protocol was approved by the SRLF ethics committee. Data collection was conducted according French law and CNIL recommendations. Results: Among the participating units, 59 didn't identify any botulism cases and 6 were unable to collect patient's data. Twentyeight ICUs identified 52 patients. At admission, median (IQR) age was 49.2 years (37-65) and 51% of patients were male. 94.1% of the patients had foodborne botulism. Median SAPS II was 21 (17-26). For clinical presentation, ocular symptoms (especially diplopia 84% and ptosis 67%) and oro-pharyngeal symptoms (especially swallowing impairment 78%) were the most frequent, and were usually the first to be described. 65% of patients were intubated. Median duration of mechanical ventilation was 13 days (0-53) with a maximum of 333 days. Tracheotomy was performed for 36% of patients. Median ICU hospitalisation duration was 27 days . The current botulism episode was associated with sequelae evaluated by the modified Rankin Scale. At ICU discharge, hospital discharge and last follow-up, 43, 22 and 10% of patients respectively had a score above 3. Two patients died during their hospitalisation (1 during ICU stay). Twenty-five patients (48.1%) were treated with botulism antitoxin. We were unable to show any significant difference in outcomes between patients treated or not treated with antitoxin. Conclusion: Although botulism rarely causes death nowadays, it is a potentially severe disease, with a high morbidity and possible extended hospitalisation and mechanical ventilation. Recent studies are in favour of the use of antitoxins, and clear recommendations are needed. Introduction: Nangibotide peptide is a specific TREM-1 inhibitor. In preclinical septic shock models, nangibotide was able to restore appropriate inflammatory response, vascular function, and improved survival. In phase I, nangibotide was found to be safe and well tolerated up to the highest dose. Patients and methods: International, multi-center phase IIa randomized, double-blind, two-stage, placebo-controlled study (NCT03158948). Main inclusion criteria were septic shock according to Sepsis 3 definition and nangibotide to be initiated within 24 h of shock onset. Patients were randomized to receive either placebo, 0.3, 1 or 3 mg kg h of nangibotide. Study drug was infused until end of vasopressors + 12 h or up to 5 days. Safety data were reviewed by an independent Data Safety Monitoring Board (DSMB). Primary endpoint was safety and tolerability. Patient follow-up period was 90 days. Results: 50 patients were randomized and 49 treated (1 patient died before dosing). All groups were well balanced in terms of baseline characteristics, except for APACHE II score which tend to be non-significantly lower in placebo group. Primary infection source was 40% abdominal, 50% pulmonary and 10% urinary. Nangibotide was safe and well tolerated in all groups. The DSMB did not raise any safety concern. Number of SAEs AEs and number of patients with SAEs AEs was comparable between all groups. Most frequent AEs were atrial fibrillation, anemia, pleural effusion and thrombocytopenia. A trend toward a decrease in circulating levels of pharmacodynamic markers was observed in nangibotide-treated patients. All-cause mortality at day-28 was 14% (5/37) in pooled nangibotide groups and 25% (3/12) in placebo group. In the subgroup with sTREM-1 levels above median, the day-5 mortality was calculated as 40% (2/5) and 20% (4/20) in placebo and nangibotide groups respectively. In this group with high sTREM-1 levels, a trend towards an increase in organ support free days alive was seen for nangibotide-treated patients versus placebo. Conclusion: Nangibotide was shown to be safe and well tolerated in septic shock patients. Although this small exploratory study was not powered to conclude on efficacy, a non significant lower mortality was observed in the nangibotide group. These results support the need of a larger study to demonstrate the role of nangibotide in the treatment of septic shock and the exploration of sTREM-1 as potential efficacy predictive biomarker for nangibotide. Anxiety and depression in patients admitted in ICU for more than 48 h-results of the multicentre, observational, prospective MOOD-ICU study Camille Vissac (speaker) 1 Introduction: Several studies have been published on psychiatric disorders after intensive are unit (ICU) and risk factors associated with these disorders. No studie have evaluated the frequency of anxiety and depression disorders during the ICU stay. Patients and methods: The main objective of this prospective, multicentre, observational study was to assess rates of patients with anxiety and or depression in ICU. The secondary objectives were to assess rates of patients with anxiolytic and antidepressant drugs and to identify factors associated with anxiety and depression in ICU. All patients hospitalized since more than 48 h in ICU at study day were eligible. The evaluation of patients anxiety and depression symptoms was performed by the bedside physician and the nurse caring for the patient at the day of the study. [1.20-3 .14], p = 0.003), and reading of a book by cargivers or relatives during the ICU stay (OR = 2.01, 95% CI [1.08-3.74], p = 0.03). Organ failure was independently associated with less anxiety and or depression (OR = 0.57, 95% CI [0.33-0.99], p = 0.03). Conclusion: Anxiety and depression symptoms were common in critically ill patients during their ICU stay. History of anxiety or depression, announcement of severe illness and or loss of autonomy, tracheostomy, antipsychotic medication and reading of book by caregivers were associated with increased risks of anxiety and depression disorders in ICU. However, severity of critical illness was associated with decreased risk of anxiety and depression. Future studies are required to assess the relationship between anxiety and depression disorders during and after ICU stay. Introduction: An increasing number of deaths occur in the ICU. In this setting, research has focused on describing, understanding, and improving end-of-life care as well as improving the patients and the families' experience. The aim of this study was to describe and evaluate the experience of physicians and nurses involved in end-of-life situations in the ICU and describe the factors associated with a poor or good score. Patients and methods: A 15-item questionnaire was validated in a multicenter prospective study conducted from July 2011 to July 2013 in 41 French ICUs. In each ICU, consecutive adults who died after at least 48 h after admission in the ICU were included. The physician and the nurse in charge of the patient at the time of death were asked to complete the questionnaire within 24 h after the death. The psychometric validation was conducted using two datasets-a learning cohort and a validation cohort. Results: Among 475 patients, 398 nurse scores and 417 physician scores were analyzed. The median global CAESAR score for nurses was 62 75 and 64 75 for physicians. Lower nurse scores were significantly associated with the following factors-conflict with physicians, pain managed by nurses alone rather than with physicians, death disclosed to the family by phone or upon arrival rather than at the bedside and use of invasive treatment at the end of life. Higher physician scores were significantly associated with the following factors-availability of a dedicated information room, joint family information with the nurse, total rather than partial family information, joint implementation with the nurse of the decision to withdrawing withholding therapies, open visiting policy. Higher scores were also associated with patients' characteristics-McCabe ≤ 1, not immunocompromised, no dementia, no liver failure, no haematological disease and no use of psychotropic medication. Last, higher score were associated with End Of Life conditions-decision to withdrawing withholding therapies, no cardiopulmonary resuscitation, death disclosed to the family at the bedside rather than by phone or upon arrival at the ICU. Conclusion: We described and validated a new instrument for assessing the experience of physicians and nurses involved in end-of-life situations in the ICU. This study shows important areas for improving practices, including adapted level of intensive care, quality teamwork, quality communication and implication of family members. Efficiency of a combined geriatric and intensivist evaluation to identify clusters of elderly patients admitted to the intensive care unit -the SENIOREA study Julien Demiselle (speaker) 1 Introduction: Improving the care for older patients in the ICU is a challenge both in terms of survival and of quality of life (QoL). We set up a prospective observational to assess the effectiveness of a combined geriatric and intensivist initial evaluation in determining clusters of older patients and the one-year outcome of these clusters. Patients and methods: Patients aged 75 years and older admitted to 13 ICUs in Western France and requiring mechanical ventilation from September 2012 to December 2013 were included. Proxy members were consulted at ICU admission using a predefined comprehensive geriatric assessment. Survival was assessed at one year and comprehensive geriatric assessment was performed on place of living in survivors. Clustering was performed based on baseline characteristics and ICU admission parameters using Jaccard similarity measure. Results: Five hundred and one patients were included in the analysis. Age was 80 ± 4 years, 53.5% were male. Ninety-two percent of patients were living at home before ICU admission, mean comorbidity burden assessed with CIRS-G score was 8.3 ± 4.3, 78.9% of patients had ADL score ≥ 5 and SOFA at ICU admission was 7 ± 3.7. Clustering resulted in three groups. Group 1 (n = 166) was characterized by older age, lower comorbidity burden and intermediate acute severity. Group 2 (n = 111) was characterized by lower age, intermediate comorbidity, and higher acute severity. Group 3 (n = 98) had higher age, higher comorbidity, and lower acute severity. 126 patients could not be clustered due to incomplete data. Clusters experienced different trajectories throughout ICU stay with higher ICU mortality for group 2, and the highest amount of organ support. Moreover, clusters evolution was different after hospital discharge. Overall, one-year survival was 53.8%, mortality was higher in group 2 and 3 when compared to group 1 (p = 0.03, see figure) . 163 patients (62% of survivors) underwent oneyear at-home evaluation. If a moderate decrease in independency was observed, perceived QoL remains satisfactory with 88% of patients indicated that they were happy or very happy. No difference in oneyear geriatric evaluation was observed between clusters. Conclusion: Comprehensive geriatric assessment and acute severity parameters are useful to identify three different patterns of patients with different outcomes. Such patterns may be useful for design future interventional studies. Long term survival of older patients after an ICU stay has improved compared to previous studies. Unique blood culture in ICU is associated with a dramatic reduction of blood culture contamination rates: an interrupted time-series study Rafael Mahieu (speaker) 1 Sensibility depends on volume of collected blood + false-positive BC may arise from blood contamination during venipuncture. Our objective was to assess the effect of a unique high-volume blood culture (UBC) strategy on the rate of BC contamination and pathogen detection. Patients and methods: An interrupted time-series study was conducted in a medical 24-bed ICU from January 2013 to December 2016. After the UBC protocol was implemented on January 2015, all patients with suspected bacterial infection had 40 mL of blood collected by a single phlebotomy. Ten milliliters of blood were inoculated into two BacT Alert FA aerobic bottles and two BacT Alert FN anaerobic bottles. Performing additional blood culture within 48 h was strongly discouraged unless a new bloodstream infection was suspected. Nurses' and physicians' knowledge on BC collection and practice skills were reinforced through an educational program on December 2014. Protocol adherence was evaluated at 2 and 12 months through monitoring of BC volume. Results: During the study period, there were 3497 ICU stays with at least one BC. No difference was observed between the two periods regarding severity (IGS2 and SOFA at admission) or in-ICU death. After the educational program, the median volume of blood culture per bottle increased from 3.2 mL [95% confidence interval (CI) 3-3.5] to 9.1 mL [95% CI-8.7-9.5] at 2 months and decreased to 7.1 mL [95% CI-6. [3] [4] [5] [6] [7] [8] Introduction: Extended follow-up of ICU survivors has shown that many patients suffer from long-term physical and psychological sequalae. PTSD is an increasingly psychiatric disorder reported in ICU survivors. The aim was to determine the frequency of PTSD and its predictors. Patients and methods: It is a mixed method study conducted in a medical ICU from January 2017 to January 2018. Data were obtained from medical records. At 3 months post-ICU discharge, patients were contacted by phone to complete the Impact Event Scale-Revised questionnaire (IES-R). Univariate and logistic regression analyses were used to identify variables independently associated with IES-R (≥ 33). Results: 393 patients were admitted during the study period. 191 (48.6%) were discharged alive, 56(29.3%) were never successfully contacted and 21(11%) died within the 3 months' period. 114 patients fulfilled the inclusion criteria. Patients' characteristics were -mean age 56.29 ± 17.88 years; male, 66(57.9%); median Charlson comorbidity index, 1 [1] [2] ; mean SAPSII, 25.04 ± 12.1; invasive mechanical ventilation (IMV), 47(41.2%) and vasopressors use, 30(26.3%). The median duration of IMV and length of stay were respectively 0 days [0-4] and 6 days [4] [5] [6] [7] [8] [9] [10] . 25 (21.9%) patients met diagnostic criteria for PTSD. In univariate analysis, risk factors of PTSD were respectively for PTSD group and controls -age (42.7 ± 19 vs 60.1 ± 15.6, p = 0.000), female sex (64% vs 36%, p = 0.012); Alcoholism (24% vs 7.9%, p = 0.035); IMV (76% vs 31.5%, p = 0.000); Sedative use (76% vs 31.5%, p = 0.000); polyneuromyopathy (28% vs 2.2%, p = 0.000); delirium (16.7% vs 1.1%, p = 0.008); catheterization (56% vs 21.6%, p = 0.001); duration of IMV (6.58 ± 7 vs 2.32 ± 6.3, p = 0.005) and physical restraint (72% vs 23.6%, p = 0.000). On multivariable logistic regression, age (OR, 0.95 + 95%CI, [0.92 -0.98]; p = 0.001), female sex (OR, 3.88; 95%CI, [1.08 -13.9]; p = 0.038), physical restraint (OR, 6.27; 95%CI, [1.66-23 .67]; p = 0.007) and polyneuromythy (OR, 11.15; 95%CI, [1.5-80.1]; p = 0.01) were identified as risk factors independently associated to PTSD. Conclusion: PTSD is common in ICU survivors. Physical restraint, female sex, polyneuromyopathy and younger age were the only factors independently associated to PTSD. The GUH fire causing its total evacuation is an unprecedented event in France. We report factual elements of the first days after the disaster involving intensive care unit (ICU) activities with specific proposed imposed responses, as it is the sole ICU of Guadeloupe island (near half million people). Patients and methods: Data are extracted from ICU medical files, experience reports, and Emergency department softwares. Results: The fire started on 28.11.2017 around 13:45 on the 2nd floor of the building, between the ICU (1st floor) and operating room (3rd floor). At 14:00, the ICU (25 occupied beds over 26, including 12 ventilated patients) was invaded by a thick smoke, not triggering the fire alarm. The evacuation of the ICU was decided by doctors before the activation of the official evacuation plan (> 1 h) in absence of any administrative instructions. The 12 ventilated patients were relocated at the radiology level (access to medical gases), 8 non-ventilated patients evacuated to the outdoor car park, 5 patients to other services. At 17:00 all patients were extracted from the ICU. Patients were then evacuated to other centers-3 ventilated patients to the Basse Terre public hospital (Post Anesthesia Care Unit), 9 ventilated patients and 8 non-ventilated patients to a private hospital located at 11 km, into a unit of 12 ambulatory surgery beds, thus the same day re-affected as ICU with 2 to 3 patients per room. At 22:53, all ICU patients were evacuated from the GUH. On 29.11.2017, 11 patients were prioritized for medical evacuation to the Martinique University Hospital (MUH) thanks to military vectors -8 patients simultaneously (CASA military aircraft), and 3 by medical helicopter (SAMU). No worse initial progression was noted, except for 1 patient (septic shock needing intubation and norepinephrine) at the radiology level. ICU activities were heavily impacted during this period by difficulties related to emergency services, medico-surgical services and support structures (laboratories, radiology, pharmacy) rearrangement. Conclusion: This disastrous never experienced situation had a limited immediate impact (no deaths) due to the fast management of patient's transfer, related to ICU doctors initiatives. Regional support (MUH and military vector) helped to propose an immediate response for the most severe ICU patients. Mid-and long-term consequences are significant for evacuated patients as well as for the Guadeloupe care provision, in term of ICU and other hospital components, related to the distance away from France. Evaluation and description of alarms in an Intensive Care Unit, Improvement of professional practices-optimizing monitoring and reducing noise pollution Pierre-Yves Delannoy (speaker) 1 , Lydie Martel 2 , Nicolas Boussekey 2 , Damien Thellier 2 , Hugues Georges 2 , Olivier Robineau 2 , Olivier Leroy 2 1 CH, Marcq En Baroeul, FRANCE; 2 CH, Tourcoing, FRANCE Correspondence: Pierre-Yves Delannoy -pydelannoy@ch-tourcoing.fr Annals of Intensive Care 2019, 9(Suppl 1):F-05 Introduction: The excess of alarms in intensive care has multiple consequences-the noise generated alterate the quality of patient's stay and participate in the genesis of the phenomenon called alarm fatigue. This, by altering the quality of surveillance, directly impacts patient safety in a pejorative term. The objective of this project is to improve the quality of care and working conditions in intensive care unit in Tourcoing by optimizing the monitoring of our patients through a collaboration between the medical team and the company providing the monitoring products. Patients and methods: An analysis of alarms from Philips Intelivue monitors for one month is performed, then corrective measures to reduce their number are implemented through a collaborative DMAIC approach (Define, Measure, Analyze, Improve, Control). These corrective measures include a personalization of the monitoring with a medical reflection on the alarm's thresholds and creation of specific profile patient, training of caregivers on the good use of the monitoring, creation of an alarm culture via these trainings and the creation of communication tools. To these actions are added technical interventions on intensive care ventilators and monitors. The impact of alarms on caregivers and patients present during the analysis period are evaluated using questionnaires. A second alarm analysis assess an evaluation of the effectiveness of the implemented measures. Results: 127.927 alarms (equivalent to 243 alarms day patient) including 40.118 vital alarms, 58.647 critical and 29.162 techniques are found in the first period. The analysis of the patient questionnaire is not very contributive with 20 usable questionnaires. Among the responders, the majority did not feel any significant discomfort during their stay. The health questionnaire has a response rate of 91% (n = 51). Responders believe that there is a decrease in attention and an increase in reaction time due to false alarms. They also believe that irrelevant alarms disrupt the quality of the patient's stay and that better alarm management could prevent incidents. Nearly 86% of caregivers say that alarms could not be heard and were missed. In the second period, a 30% reduction in the total number of alarms (90,096 alarms, equivalent to 202 alarms day patient, p = 0.002) is obtained. Conclusion: By creating and implementing targeted corrective measures with DMAIC approach, a reduction in the number of alarms is achieved. This reduction probably enhance patient safety and improve healthcare environement for patients and caregivers. Can we routinely use electronic medical data management systems to drive the prescription of red blood cell transfusion in Canadian and British pediatric intensive care units? Camille Jutras (speaker) 1 Introduction: Physicians do not know how to follow the patients' wishes when they are unable to express themselves. We assessed the impact of Advances Directives (AD) and how they have been written on the physician's decisions. Patients and methods: A multicentre, prospective, interventional, simulation study was carried out. Eight patients were recruited and wrote AD after receiving clear and complete information by video and interview with one ICU physician. Two simulation scenarios including ten questions about ICU admission and situations of withholding withdrawing therapies using the patients' characteristics were submitted to ICU physicians from 28 French ICU, in three rounds (R)-simulation without knowledge of the patient's AD (R1), with these AD (R2) and with these AD and the knowledge of how they were carried out (R3). Results: The qualitative analysis of these 8 AD highlights a form of living will or end-of-life will and not formal guidelines on medical care. The results were performed on complete data of 102 physicians [ Figure 1 ]. The variability between physicians themselves was high-among the 80 questions of R1, there were 37, 26 and 17 questions with an agreement > 80%, 80-60% and < 60% respectively. The AD significantly decreased the number of questions with an agreement > 80%, and increased the number of questions with an agreement < 60% (p = 0.02). There was no difference between the rounds 2 and 3 (p = 0.84). Few physicians' characteristics were associated with the inter-individual variability. The intra-individual variability between R1 and R2 was very high (52 questions on 80 with kappa coefficient k < 0.4) and the AD were significantly associated with this variability after adjustment on characteristics of the physicians and the patients (p < 0.001). It is relevant to notice that the knowledge of how AD were carried out has a very low impact on the physicians' decisions. Discussion: We were expecting find some help in the AD of patients to diminish this variability among physicians and respect the patients' autonomy. But the variability between the physicians themselves was increased in our study. We assume that this variability reflects a difference in the interpretation of these AD among physicians themselves. The AD have a major impact on the physicians' decisions for admission, withholding and withdrawing therapies decisions and increase the inter-individual variability but not the knowledge of how these AD have been written. It might be a limit of the autonomous model. Among patients whose will is known, 21% express their opposition to therapeutic relentlessness. Patient's general practitioner interview before the meeting is made for 42% of the patients. The most frequent therapeutic limitations are cardiac arrest resuscitation (70%) and renal replacement therapy (57%). Invasive mechanical ventilation is limited in 35% of cases. Nutrition and hydration are never limited. Conclusion: Ten years after setting up a WWT procedure in our ICU, limitations are more frequent, appear earlier, concern younger patients, and are more often at the paramedic initiative, which reflects a stronger involvement of caregivers in end of life issues. Introduction: Some patients referred to intensive care unit (ICU) are refused by intensivist because they are considered to be too well or too ill to benefit from intensive care treatment. This study aims to evaluate factors associated with decision to refuse ICU admission and to assess the outcome of excluded patients. Patients and methods: All inpatients referred to our ICU between February and August 2018 were included in the analysis. All patients were evaluated in emergency unit or in hospitalization areas by a senior intensivist. Refused patients were considered to be too well (inappropriate referral (IR)) or too ill (futility) for ICU admission. The main outcome was survival 28 days after first referral to ICU. Patient characteristics, number of beds available at the time of referral, quality of life 28 days after ICU referral were also assessed. Results: Out of 379 patients, 267 were admitted and 112 were refused (29.6%). Reasons for refusal were futility ("too ill") (n = 68 (60.7%)) and IR ("too well") (n = 44 (39.3%)). The median mortality probability model (MPMII) score for IR group and for futility group at day 0 was -1.65 and -0.4. Admission request came from emergency unit (65.2% (n = 73)), medical department (24% (n = 27)) or surgery department (10.8% (n = 12)). The main outcome for futility and IR groups were 52.9% and 4.5% respectively. In the futility group, modified Rankin score increased from 3.52 to 4.15 between inclusion and final evaluation. Lack of autonomy, elderly people and dementia were the main causes for refusal in the futility group (n = 57, 42 and 31 respectively). Conclusion: Refusal of ICU admission occurs in 29.6% of cases. Refusal for futility is strongly but not invariably associated with deaths whereas patients considered to be too well for intensive care treatment rarely died. Strategy should be developed to create admission criteria for patients. Antibiotic consumption differs between two periods. Discussion: There is a statistically significant impact in antibiotic consumption. Fluoroquinolones and Amoxicillin-clanulanic acid which are known to induce resistance have decreased during the second period. Prescriptions of some antibiotics have improved such as Cefepime for Enterobacter, Ceftazidime and Ciprofloxacin for Pseudomonas thus saving Colimycin and Imipenem Cilastatin. There is a non-significant trend to lower multi-resistant broad-spectrum betalactamase-producing bacteria, cephalosorinases and carbapenemases in screening tests. The intervention of an infectiologist in our service allowed an effective adaptation of the strategy of the antibiotic therapy in the hope that, in the coming years, the selection of BMR will decrease. . Inclusion during the post-implementation period was associated with an increase in 60-day survival in univariable analysis (70% vs 85%; p = 0.020 by log-rank analysis) ( Figure 1 ). Yet, this association was not statistically significant after adjustment for patient comorbidities and severity in a multivariable Cox model (adjusted hazard ratio = 0.88; 95% CI [0.41-1.87]; p = 0.741). The implementation of a multidisciplinary and multimodal care bundle for NSTI was associated with higher patient recruitment and better 60-day censored survival in univariable but not multivariable analysis. Prior home ventilation is not associated with a lower rate of NIV failure suggesting that failure from technical reasons was not highly prevalent in our series. NIV failure risk-factors disclosed pertain to clinical severity of the decompensation and its cause. Introduction: The Sepsis-3 definition of septic shock includes vasopressor treatment to maintain a mean arterial pressure over 65 mmHg and a lactate concentration over 2 mmol/L. The impact of hyperoxia in patients fulfilling these criteria is unknown. Patients and methods: We conducted a post hoc analysis of the HYPER2S trial, including patients requiring vasopressor therapy with an available plasma lactate value at study inclusion. We compared the effect of hyperoxia and normoxia treatment on mortality of patients with hyperlactatemia (> 2 mmol/L) and of patients requiring vasopressor for hypotension without hyperlactatemia. Results: 397 patients were enrolled in this analysis, in whom 230 had lactate over 2 mmol/L and 167 had lactate lower or equal to 2 mmol/L. Among patients with lactate > 2 mmol/L, 108 and 122 were "hyperoxia"-and "normoxia"-treated, respectively. Patients with lactate > 2 mmol/L had significantly less coronary artery disease, more cirrhosis and required surgery more frequently. They also had higher illness severity (SOFA 10.6 ± 2.8 vs 9.5 ± 2.5, p = 0.0001), required more renal replacement therapy (RRT), and received vasopressor and mechanical ventilation for longer time. Mortality rate at day 28 was higher in the "hyperoxia"-treated patients with lactate > 2 mmol/L as compared to "normoxia"-treated patients (57.4% vs 44.3%, p 0.054), despite similar RRT requirements as well as vasopressor and mechanical ventilation-free days. A multivariate analysis showed an independent association between hyperoxia and mortality at day 28 and 90. In patients with lactate ≤ 2 mmol/L, hyperoxia had no effect on mortality, nor on other outcomes. This study suggests that hyperoxia may be associated with a higher mortality rate in patients with septic shock using the Sepsis-3 criteria, but not in patients with hypotension requiring vasopressor without hyperlactatemia. Acute respiratory failure in obesity-hypoventilation syndrome managed in the intensive care unit Nader Chebib (speaker) 1 Introduction: Critical illness-related corticosteroid insufficiency (CIRCI) is common during critical illness and is usually associated with poor outcomes, as prolonged duration of mechanical ventilation (MV) and higher mortality. CIRCI may alter cardiac and vascular functions. Weaninginduced pulmonary oedema (WiPO) is a major mechanism of weaning failure. The aim of this study was to evaluate the role of CIRCI in patients with difficult ventilator weaning and its possible relation with WiPO. Patients and methods: Prospective study conducted in the intensive care of a university hospital in France. Patients under MV for more than 24 h, meeting weaning criteria and having failed the first spontaneous breathing trial (SBT) underwent a corticotropin stimulation test, with assessment of total blood cortisol levels immediately before (T0) 0.25 mg iv of tetracosactrin and 30 and 60 min afterward. Δmax was defined as the difference between the maximal value after the test and T0. CIRCI was defined as T0 < 10 μg/dL (276 nmol/L) and or Δmax < 9 μg/dL (248 nmol/L) and inadequate adrenal reserve as Δmax < 9 μg/dL. Biomarkers (natriuretic peptide and protidemia) sampling and echocardiograms were performed during the second SBT and were used to diagnose WiPO, which was defined according to two definitions (one liberal and one conservative) derived from Figure 1A and 1B) , as compared to their counterparts, and this association persisted after adjustment on severity (SOFA score at first SBT). WiPO occurred in 44 (58%) and 8 (11%) patients, according to the liberal and conservative definition, respectively. WiPO was not associated with CIRCI or with inadequate adrenal reserve, and did not influence weaning outcome, whatever the definition used. Conclusion: CIRCI was common during difficult weaning and was associated with its prolongation. We did not find a significant association between CIRCI and WiPO. Introduction: High-flow nasal cannula oxygen therapy (HFNC) is a recent technique that can provide high FiO2, decrease the work of breathing, and recruit lungs. Despite promising clinical results, its weaning has never been investigated. Our objective is to describe factors associated with successful weaning of HFNC. Patients and methods: In a retrospective monocenter study over a 2-year period, all patients admitted to ICU and treated with HFNC for acute respiratory failure were included. Patients who were never weaned from HFNC during ICU stay, those who were treated with HFNC associated to NIV, and those who received preventive post-extubation HFNC were excluded. Our primary outcome was to compare patients according to the outcome of the first HFNC weaning attempt. Our secondary outcome was to compare the evolution of patients who failed HFNC weaning at first attempt, and then who were successfully weaned from HFNC. Results: From the 190 patients included, 168 (88%) were successfully weaned from HFNC at the first attempt. At time of the first attempt, those who were successfully weaned had lower FiO2 (39 vs. 48%, p = 0.02), were more likely to have a SpO2/FiO2 > 235 (corresponding to a PaO2/FiO2 > 200 mm Hg) (74% vs. 41%, p = 0.005), and had a higher ROx index (SpO2/FiO2/RR) than those who failed (p = 0.002). The 19 patients who failed the first attempt significantly increased the ROx index at time of successful weaning (p = 0.04). Conclusion: If confirmed in further studies, SpO2/FiO2 and ROx index could be 2 useful noninvasive predictors of success of HFNC weaning available at bedside. Introduction: Recent European American clinical practice guidelines recommend first-line noninvasive ventilation (NIV) to manage acute hypoxemic respiratory failure in immunocompromised patients. In contrast, in non-immunocompromised patients, the experts were unable to offer a recommendation given the uncertainty of evidence. Immunocompromised patients have particularly high mortality rates when they require invasive ventilation. However, it is not clear whether immunosuppression status is a risk factor for NIV failure. We aimed to assess the influence of immunosuppression status on outcomes of patients treated with NIV for acute respiratory failure. Patients and methods: We performed a post hoc analysis pooling 2 prospective studies on acute hypoxemic respiratory failure. Patients treated by NIV were included. Those with cardiogenic pulmonary edema, acuteon-chronic respiratory failure or hypercapnia were excluded. Results: Among the 208 patients analyzed, 71 (34%) were immunocompromised whose main reason was cancer (n = 37, 52%). Immunocompromised patients had higher severity scores upon ICU admission, were more likely to have bilateral lung infiltrates and received higher pressure-support levels under NIV than non-immunocompromised patients. Intubation and in-ICU mortality rates were higher in immunocompromised patients than in the others-61% (43 out of 71 patients) vs. 43% (p = 0.02), and 38% (27 patients) vs. 15% (p < 0.001), respectively. Using multivariate analysis, immunosuppression was independently associated to intubation with an adjusted OR of 2.18 (95% CI 1.18-4.14, p = 0.01) and to ICU mortality (OR 3.44, 95%CI 1.73-7.03, p < 0.001). Conclusion: Immunosuppression status influences outcomes in patients with acute hypoxemic respiratory failure treated with NIV. Studies in this specific population are mandatory. Stephane Dauger (speaker) 1 Introduction: Ventilatory Acquired Pneumonia (VAP) is one of the main nosocomial infection in adult ICU. To date, only one prospective multicenter study performed during six months in 16 PICUs of the US has prospectively described pediatric VAP. We design the INCIPAVE study to report the occurrence of VAP in european PICUs. One of the aim of the INCIPAVE study was to precisely describe the diagnostic tools used and the pathogens involved in pediatric VAP. Patients and methods: Multicenter prospective cohort study from 03/04/2017 to 03/04/2018 including all patients mechanically ventilated (MV) at least once in eight PICUs, one in the Netherlands and seven in France. VAP was defined using the 2015 CDC criteria, applied during PICU stays, excluding the 48 h preceeding and following PICU. Patients were described on admission and main risk factors ever tested in the medical litterature were daily included by a pediatric intensivist of each PICU in an electronic database on a securized dedicated website. The Ethics Committee of the French Society of Intensive Care approved the study, which has been declared to the CNIL and recorded on Clinical-Trials. All parents or legal representatives were individually informed by a dedicated sheet. Descriptive data are reported as number (%) or medians [first-third quartiles]. These results are based on declarative information reported in the INCIPAVE database during its first opening on September 2018, before cleaning. A total of 158 VAP (76.8% according to CDC criteria) was declared during 11685 days of MV. At least one pathogen was identified in 58.7% case of VAP, with more than one in 11.6%. Diagnosis was made on Tracheal Aspirates, with or without quantitative cultures (51% and 12.9% respectively), and on Blind Protecting Specimen Brush with or without quantitative cultures (7.7% and 2.6% respectively). Identified pathogens were Pseudomonas aeruginosas (PA, 12.1%), Haemophilus influenzae (HI, 12.1%), Staphylococcus aureus (SA, 7.4%), Streptococcus pneumoniae (SP, 5.4%), Stenotrophomonas maltophilia (SM, 3.4%). HI and SP were involved in "early VAPs" (< 6 days) and PA, SM and SA were reported in "late onset" VAPs. Conclusion: Tracheal aspirate with quantitative culture is still the method of choice to diagnose VAP in PICU. Nosocomial pathogens are mainly involved after 6 days of MV. A more precise analysis is planned after cleaning of the database, including a special reading of each case of VAP. Introduction: Parapneumonic effusions and pleural empyema are common complications of community-acquired bacterial pneumonia in children. There is not yet a consensus concerning the management of this pathology, and expert's recommendations are scarce. The objective of this study was to compare whether the evolution of our patients benefited or not from drainage procedures. Patients and methods: This retrospective single-center study collected data from 79 children treated for pleural infection at the Strasbourg University Hospital from May 2010 to May 2016. 2 groups of children were compared concenring medical and or invasive treatment received (thoracentesis, chest drain insertion with or without instillation of fibrinolytic agents and surgical techniques). Results: 43 children benefited from an invasive treatment strategy (IT), and 36 from antibiotics alone (AA). The epidemiological data of the 2 groups was comparable (comorbidities, vaccination status). Significant differences were the duration of oxygen dependence-3.1 days in the AA group versus 7.6 days in the IT group (p < 0.001), the time elapsed to obtaining apyrexia-4 days in the AA group versus 7.9 days in the IT group (p = 0.009), overall hospital stay and duration of intensive care. Initial C-reactive Protein levels were measured at 160.5 mg/L in the AA group versus 258 mg/L in the IT group (p < 0.001). We proposed a predictive score for an invasive procedure based on initial CRP and pleural ultrasound data. Introduction: Protective mechanical ventilation and adjuvant therapies for severe ARDS are well-defined in adult and pediatric population. However, no clearly identified recommendations are available to perform a protective ventilation during pediatric V-V ECMO. The aim of this study was first to describe potential associations between ventilatory settings during ECMO and outcome in ARDS patients. The secondary goal was to compare three periods of interest to identified significant modification and their potential consequences on the survival rate. Patients and methods: We performed an observational monocentric retrospective study, from January 2007 to December 2017. All patients treated by ECMO V-V for a refractory ARDS were included. We collected data's at day 1, day 3 day 7 and day 14 of ECMO. Three periods of interest were defined (before 2010, from 2010 to 2014 and after 2014). We retrospectively collected the data's from our local database, approved by the French Data Protection Authority. Results: 83 patients treated by extracorporeal membrane oxygenation were included. We identified an increase of the number of ECMO V-V for pediatric refractory ARDS associated with a higher survival rate throughout the three periods. The OSI (oxygenation saturation index) was the only pre-ECMO parameter significantly associated with a higher mortality. We identified a significant modification the adjuvant therapy illustrated by a sharpe increase for the use of neuromuscular blockers (from 14% to 52%) and the prone positioning before ECMO (from 5% to 85%). We also show evidence of a strong modification of the ventilatory parameters during ECMO. As example, the tidal volumes are significantly lower throughout the periods (5 cc/kg vs 3.5 cc/kg) such as the driving pressure (28 vs 14 cm of H2O). In contrary, the PEEP is higher in the most recent period. Finally, we identified an improvement of the survival rate all over the three period. Conclusion: Recent modifications of ventilatory parameters during V-V ECMO for pediatric ARDS aimed at implementing a better lung protection. These modifications are associated with a better survival. However, the correlation between survival and ventilators settings remained unclear and a multicentric study should help physician to identify prognosis factors. Introduction: Septic shock (SS) has recently been redefined in adults as life-threatening organ dysfunction caused by dysregulated host response to infection. Due to pediatric specificities, adult definition cannot be just transpose to children. Toxic shock syndrome (TSS) is a particular entity of infectious shock, with large pediatric prevalence. Some toxins specific to Streptococcus A and Staphylococcus aureus lead to superantigenic activation of T-lymphocytes, responsible for major cytokines storm with multi-organ failure. While immunosuppression induced by SS is now demonstrated in adults and children, we investigated whether similar immune disorders arise during TSS. Patients and methods: Single-center prospective study included all children under 18 years-old, consecutively admitted into Pediatric Intensive Care Unit for SS ("Surviving Sepsis Campaign" Goldstein criteria), or TSS (Center for Disease Control), between September 2014 and July 2018. Controls were recruited from outpatients admitted for an elective benign surgery, without any criteria of infection. Immune monitoring realized by flow cytometry included HLA-DR expression on monocytes (mHLA-DR), total lymphocyte count, and lymphocyte sub-populations' proportions (CD4* and CD8* T cells, regulatory T cells, NK cells, B cells). Samples were analyzed at Day 1, 3 and 7, after shock onset. Clinical data were collected prospectively, as well as severity scores and secondary nosocomial infection occurrence. Results: Forty-six SS, 12 TSS and 30 controls were recruited. At each time points, mHLA-DR in SS and TSS groups were decreased, compared with controls ( fig 1) . Moreover, mHLA-DR was significantly higher in TSS at day 1 and 3, than SS. Lymphocytes' time course also differs between SS and TSS-more profound lymphopenia occurred at day 1 in TSS than SS, but correction was faster in TSS between day 1 and 3, while between day 3 and 7 in SS. No difference was observed concerning regulatory T cells. Thirteen patients with SS presented secondary infections (28%), compared to only one in TSS group (8%). Conclusion: Our study showed that despite similar initial shock, immune response is significantly different between SS and TSS. TSS didn't induce persistent immune-suppression, as seen in SS-highlighted by different time course of mHLA-DR, lymphocytes and secondary infection occurrence. There is no only one type of septic shock but different infectious shocks with different immune responses and clinical outcomes. These results reinforce objective to better characterize immune state of patients in intensive care, in order to propose personalized medicine with adapted immune-modulatory therapies. Introduction: Septic shock is a common pathology in intensive care units responsible for a high mortality rate. Extracorporeal life support (ECLS) is used when patients no longer respond to standard treatments, including inotropes. Recently, in a multicenter study involving more than 500 children with septic shock, the Septic Shock Score (SSS) proved highly reliable in identifying patients at risk of death and was able to define refractory septic shock. The objective of our study is to evaluate two versions of the SSS, the bedside SSS (bSSS) and the computed (cSSS) in a group of patients hospitalized with septic shock who received ECLS support. Patients and methods: This retrospective study includes patients aged 1 month to 18 years hospitalized in the intensive care units of the Necker Enfant Malade, Trousseau and Bicêtre hospitals for septic shock requiring ECLS assistance between January 2010 and March 2018. Five data collection times were chosen-sepsis time, ECLS decision time, ECLS starting time and end of hospitalization time. At the first 4 collections, clinical and biological criteria were collected to calculate the different predictive scores of septic shock. The group of deceased patients and the group of living patients were compared at these different times. Results: 38 patients were included in our study, 24 of which died during the hospitalization. At all times studied, both the bSSS and the cSSS had poor reliability in identifying deceased children. The vasoactive-inotropic score is significantly higher at ECLS starting time in deceased patients and it decreases between ECLS decision time and ECLS starting time in living patients. Conclusion: This is a pilot study that tested a database of children in septic shock who had received ECLS in APHP's intensive care units. The continuation of the study will be carried out as part of a collaborative project of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC), and will extend to 27 other pediatric intensive care units to clarify ECLS success criteria, characterize the evolution of organ failure and thus better define ECLS uses in children with septic shock. We aimed to identify early predictors of a CO, defined as an ICU stay > 2 days, the need for vital support or death in children with SCD. Patients and methods: Retrospective observational cohort study of SCD patients over a 5-year period were conduced in French territories in the Americas teaching hospital and SCD referral center. Results: Of the 2559 infant's admissions in the Carabdrepa cohort, 174 (6.8%) had a CO, of whom 6 (0.2%) death. Using multivariate analysis, we found significant predictors of CO-an episode of dactylitis (defined as pain and tenderness in the hands or feet) before the age of one year (OR 3, IC 95% 1.9-45.5), a hemoglobin level of less than 7 g per deciliter (OR 1.75, IC 95% IC 0.98-2.84), and leukocytosis (OR 1.21, IC 95% 0.8-1.83), a respiratory rate more than or equal to 32 cycles min (OR 1.01, IC 95% 0.84-1.18).), a Delay between first symptom and medical contact (OR 1.3, IC 95% 1.04-1.65), and an admission for sepsis (OR 1.32, IC 95% 0.44-3.85). Our model demonstrated good predictive performances in terms of discrimination (c-statistic-0.813) and calibration. Conclusion: Sickle-cell disease children are at high risk of life threatening complications. Episodes of dactylitis, with a sustained drop of hemoglobin + associated with a sepsis context and a delay in medical care are strong predictors of a complicated outcome. Introduction: Traumatology is the leading cause of death in young adults and children. Hemorrhagic shock is a major aggravating factor in trauma, however there are very few data available in the pediatric population. TRISS method [1] offers a standard approach for evaluating outcome of trauma care, enabling the determination of an individual probability of survival (Ps) for each patient according to Trauma and Injury Severity Score. The aims of our study were-1) to identify multiple trauma children admitted with hemorrhagic shock in our pediatric Trauma Center, 2) to analyze factors that could influence the outcome using the TRISS method. Patients and methods: We performed a monocentric, observational, descriptive, retrospective study on medical records. The included patients were children under 18 years of age admitted for multiple trauma and presenting with hemorrhagic shock upon arrival. The patients included were identified by means of a computerized database internal to the service. The primary outcome was death. Results: From January 2014 to April 2018, 947 multiple trauma children were admitted in the service. Among them, 41 (4.3%) were in hemorrhagic shock upon admission and included in the study. The median interquartile age and weight were 3.0 [2.0-10.7] years and 16.0 [12.9-32.5] kg, respectively. Their trauma profile was very similar to other polytraumatized children, with 73% of head trauma. The global principles of Damage Control Resuscitation have been met, including the application of the massive transfusion protocol. However, only 10% of children actually correspond to the usual definition of "massive blood transfusion" (70 ml kg over 24 h) and only 37% required a surgical hemostasis procedure. The overall mortality was 41% with an average TRISS of 45%. We had 2 "unexpected" survivors and 1 "unexpected" death according to the TRISS method in our population. Conclusion: In our study, 4.3% of the multiple trauma children were admitted in hemorrhagic shock in our center. These children were heavily traumatized with an overall mortality rate of 41%. However, the TRISS method revealed an observed mortality 3.9% lower than the predicted mortality, with +2.4% of "excess survivors". When we checked the medical records of the 2 "unexpected" survivors, they seemed to have beneficiated from a more aggressive prehospital resuscitation care. Introduction: Due to collapse and cardiopulmonary resuscitation (CPR) maneuvers, major traumatic injuries may complicate the course of resuscitation for out-of-hospital cardiac arrest patients (OHCA). Our goals were to assess the prevalence of these injuries, to describe their characteristics and to identify predictive factors. We conducted an observational study over a 9-year period (2007-2015) in a French cardiac arrest (CA) center. All non-traumatic OHCA patients admitted alive in the ICU were studied. Major injuries identified were ranked using a functional two-level scale of severity (life-threatening or consequential) and were classified as CPR-related injuries or collapse-related injuries, depending of the predominant mechanism. Factors associated with occurrence of a CPR-related injury and ICU survival were identified using multivariable logistic regression. Introduction: The objective of our study was to observe practices of procedural sedation and analgesia (PSA) in emergency departments (EDs) and to evaluate its effectiveness. Patients and methods: From January to July 2018, we conducted a prospective and multicentric study, in both EDs and prehospital setting. We enrolled adult patients needing painful procedures that would require PSA. Procedures were divided into 3 groups (A-dislocations + B-displaced fractures + C-other procedures such as abscess drainage or foreign body removal…). PSA drugs were divided into 3 groups (1-sedative drugs such as Propofol, Ketamine, or Midazolam + 2-Morphine + 3-absence of drugs or 50% Oxygen Nitrous-Oxyd Premix). We used a composite primary outcome to define the success of the PSA-successful procedure, EP feeling of sufficient sedation, and the patient's absence of painful memories from the procedure. Results: 108 patients were enrolled. 61 PSA (56.5%) were successful according to our primary outcome criteria (3 points out of 3) and 35 (32.4%) reached only 2 points. Pain decrease was measured by numeric rating scale (NRS) and its median was 4.5 (IQR 3-7). Number of patient in each procedure groups were as follow-Group A-n = 48 (44.44%), Group B n = 32 (29.63%), group C n = 28 (25.93%). Drug's group 1 was predominant (n = 59, 54.6%) and its success rate was higher (76.3%) compared to group 2 and group 3 (22.7% and 40.7% respectively, p < 0.0001). In multivariable analysis, PSA success was independently associated with only 2 factors: Ramsay sedation scale > 2 (OR = 4.584 {1.927-11.501}, p = 0.0008), as a protective factor, while morphine group was against PSA success (OR = 0.181 {0.051-0.555} p = 0.0044). Adverse event rate in our study (15.7%) was comparable with the rate in other international studies. All adverse events were easily treated and had no serious consequences. Conclusion: This prospective and multicentric study of 108 patients showed that efficiency was perfect in only 56.5% of the cases, and had a satisfactory result in 88.9%. Global efficiency was positively linked to the use of sedative drugs and negatively to cutaneous procedures such as abscess drainage. Results: During the study period's, 66 patients with positive diagnosis of PE, were included. According to our analysis, 45% (30 cases) of the patients presented with PE within 72 h of trauma events.The patients in early PE group were older than those in the late PE group (p = 0.038), had a body-mass-index (BMI) above thirty (p = 0.021) and high sequantial organ failure score (SOFA) on admission (p = .001). On the day of PE diagnosis, early group also presented with higher SOFA scoring (p < 0.001) and higher infection rate (p = 0.005). Biological assessment revealed lower platelet levels (p = 0.001) and lower P F ratio in the early group (p = 0.008). Our study showed that early PE was associated with more transfusions (p = 0.002) and surgical treatment measures (p = 0.023). The incidence of long bone fractures in lower extremities was higher in those with early PE compared with the other patients (p = 0.039 Introduction: Bag mask ventilation is the most spread technic for ventilation for cardio pulmonary resuscitation (CPR) despite several adverse effects. Gastric gas insufflation may favor lung regurgitation and as result occurrence of aspiration pneumonia (1). We hypothesized that continuous chest compression (CC) may limit the risk of high tidal volume and gastric inflation compared to a 30-2 interrupted CC strategy. The aim of this experimental study was assess the impact of different CC ventilation strategies on gastric inflation and ventilation during a 6 min prolonged simulated CPR. Patients and methods: 5 Thiel Embalmed Cadavers (TEC) from a donation program of the Université du Quebec Trois-Rivieres (CER-14-201-08-03.17) were ventilated 30 min to recruit lungs. (2) . Flow and Airway Pressure were measured at the airway opening (Acq-Knowledge software Biopac©). A surgical gastrostomy was performed through a 5 cm midline laparotomy to introduce a cuffed tracheal tube (size 6) into the stomach cavity + this tube was connected to a Wright spirometer to measure cumulated gastric inflated volume. Experimental protocol-3 strategies were randomly applied during 6 min on each cadaver. 1. 30-2 with Interrupted Chest Compressions (ICC 30-2). Two successive bag insufflations after interrupting CC every 30 CC + . 2. 30-2 with Continuous Chest Compressions (CCC 30-2). Same CC ventilation ratio than in the first strategy but without interrupting CC. 3. Continuous CC with 1 bag insufflation every 6 s (CCC 10 min). Before each strategy the stomach was completely emptied through the gastrostomy tube, and the order of each strategy experimented were randomized for each cadaver. Results: 5 cadavers were analyzed (mean age 75 ± 8 years, 60% female, PBW 56 ± 10 kg). Expired bag tidal volume averaged during the 6 min long period was 319 ± 165 ml during (ICC 30-2), 341 ± 142 ml during (CCC 30-2) and 277 ± 103 ml (CCC 10 min). Cumulated gastric inflated volume was significantly higher during (ICC 30-2) compared to CCC strategies (fig)-5.9L 6 min (ICC 30-2) + 2.1L 6 min (CCC 30-2) and 2.24L 6 min (CCC 10 min) (p < 0.005). Conclusion: Compared to the recommended (ICC 30-2) strategy, continuous chest compression significantly reduced cumulated gastric inflation. Interestingly, CCC did not affect ventilation actually delivered during CPR. The optimal ratio between chest compression en ventilation during continuous chest compression remains open to discussion. Introduction: Cardiac events are often seen in acute cerebral palsy, and they would be an indicator of poor prognosis. The purpose of this study was to clarify the heart-brain interaction in terms of incidents and repercussions on the morbidity and mortality of cerebral palsy patients. Patients and methods: It was a prospective study, over 6 months, including consecutively all the acute cerebral palsy patients, initially admitted to the vital emergency room, and having benefited from a systematic cardiac assessment, namely an ECG, an echocardiogram and a troponin assay during the 24 h. Patients transferred from another hospital and or having a cardiac check-up after 24 h were excluded. The epidemiological, clinical, paraclinical, therapeutic and evolutionary parameters were studied. A univariate statistical study was carried out to deduce the prognostic factors of early mortality (< 48 h) among cardiac assessment components (p < 0.05). Results: 76 patients were included, with an average age of 56.16 ± 13.56 years, and sex ratio 1.23 (42H 34F). The diagnoses related to the cerebro-lesion were-ischemic stroke (28 cases 36%), severe head trauma (24 cases 32%), hemorrhagic stroke (20 cases 26%), severe meningitis (4 cases 6%). The cardiac events observed were-an electrical anomaly in 19 patients (25%), an increase in troponin in 13 patients (17%) and an echocardiographic anomaly in 7 patients (9%). The distribution of cardiac events by type of brain injury is shown in Table 1 . The early mortality rate (< 48 h) was 16% (12 deaths)-6 hemorrhagic stroke, 3 ischemic stroke, 3 severe head trauma, and no severe meningitis. The prognostic value of various cardiac events in cerebral palsy patients by type of aggression is shown in Table 1 . Discussion: Our study did not show a statistically significant difference in terms of early mortality according to the presence or absence of one or more cardiac incidents. On the other hand, very important NPVs have been noted, all brain lesions combined. Conclusion: The absence of cardiac events in cerebral palsy patients would favor a better early evolution. This finding should be confirmed by a broader study. We recommend performing a cardiac checkup in any cerebral palsy patient during the first 24 h. Introduction: Doppler-based resistive index (RI) and semi-quantitative evaluation of renal perfusion using colour-Doppler (SQP) have been suggested as potential predictors of AKI occurrence in ICU patients without renal dysfunction (1). These results are however limited to preliminary data (1). This study aimed at evaluating the performance of RI and SQP to predict AKI within 3 days in critically-ill patients without overt AKI. Patients and methods: Post-hoc analysis of a multicentre prospectively collected dataset. Adult patients without cardiac arrhythmia and requiring mechanical ventilation were included. Patients with severe chronic renal dysfunction or known renal artery stenosis were excluded. AKI was defined according both urinary output and serum creatinine criteria of the KDIGO definition. Renal Doppler was performed at study inclusion. Results are reported in n (%) or median (IQR). Adjusted factors associated with AKI development were assessed using mixed logistic regression model taking centre as random effect. Results: Overall, of the 351 patients included in this study, 118 had no AKI at study inclusion and were ultimately included in the post hoc analysis. Half of the patients were of male gender (55.6%; n = 66) and median age was 58 [IQR 44-67]. In addition to mechanical ventilation, 47 patients (39.8%) required vasopressors, and 46 (39.0%) had a sepsis at inclusion. Median LOD score was 7 [IQR 5-9]. Overall, 34 patients developed AKI during the first 3 days of ICU stay (28.8%). Semi-quantitative perfusion score (ranging from 3-full perfusion to 0 no perfusion) was 2 [2-3] and 2 [1] [2] [3] respectively in patients with and without AKI at day 3 (P = 0.06). Doppler-based resistive index was 0.64 [0.57-0.70] and 0.67 [0.62-0.70] respectively in patients with and without AKI at day 3 (P = 0.18; figure) . Area under ROC curve in predicting AKI within 3 days was 0.60 (0.49-0.71) for SQP and 0.58 (0.47-0.60) for RI. After adjustment for confounders, neither SQP (OR 0.58; 95%CI 0.31-1.10) nor Doppler-based RI (OR 29.15; 95%CI 0.12-703) were associated with AKI at day 3. Our results suggest that neither Doppler-based resistive index nor semi-quantitative renal perfusion is accurate in predicting occurrence of AKI in ICU patients requiring mechanical ventilation. The performance of urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein7 (TIMP-2*IGFBP7) to predict renal recovery has been poorly studied. In preliminary studies, Doppler-based renal resistive index (RI) might help in differentiating transient from persistent acute kidney injury (AKI). The aim of this study was to compare the performance of TIMP-2*IGFBP7 and RI in predicting short-term reversibility of AKI in critically ill patients. Patients and methods: This prospective and monocentric study included consecutive critically ill patients with AKI. RI was measured within 12 h after admission and urinary TIMP-2*IGFBP7 was measured at H0, H6, H12 and H24. Renal recovery was evaluated at day 3. Receiver-operating characteristic curves (ROCs) were plotted to evaluate diagnostic performance of RI and TIMP-2*IGFBP7 to predict a persistent AKI. Results: Of the 100 patients included, 50 had transient AKI and 50 had persistent AKI. The RI was 0.61 ± 0.05 in the transient AKI group and 0.72 ± 0.05 in the persistent AKI group (p < 0.001). TIMP-2*IGFBP7 was not significantly different at each time between both groups. The performance of TIMP-2*IGFBP7 was poor with respectively an area under ROC curves of 0.57(95%CI 0.45-0.68), 0.58(95%CI 0.47-0.69), 0.61(95%CI 0.50-0.72), 0.57(95%CI 0.46-0.68) at H0, H6, H12 and H24. The area under the ROC curve for RI was 0.93 (95%CI 0.89-0.98). A RI > 0.685 predicting persistent AKI with 78% (95% CI 64-88) sensitivity and 90% (95%CI 78-97) specificity. The RI was neither correlated with age (rho = 0.12, p = 0.23), nor with mean arterial pressure (rho = -0.14, p = 0.16) nor with quantity of fluid (rho = 0.07, p = 0.49). Logistic regression found that RI (Odds ratio [OR] = 83.29 0.1-unit step, CI95% 14.91-465.14, p < 0.0001) and Sepsis-related Organ Failure Assessment score (OR = 1.51, CI95% 1.12-2.03, p = 0.001) predicted persistent AKI. Conclusion: Doppler-based renal resistive index had the better performance for predicting the reversibility of AKI in critically ill patients. Urinary TIMP-2*IGFBP7 was unable to differentiate transient from persistent AKI. Further studies are needed to precise adequately the factors influencing RI. Introduction: Acute kidney injury (AKI) in intensive care units (ICU) carries high mortality and morbidity. Potential activation of the reninangiotensin-aldosterone system during AKI may play a role through pro-fibrotic pathways. Renin-angiotensin-aldosterone blockers (ACEi ARB) have well known benefits for chronic kidney diseases but may be potentially nephrotoxic during AKI. Nevertheless, an ancillary study from the FROG-ICU cohort (ICM May 2018) has recently shown a lower mortality after 1 year of follow-up for patients receiving an ACEi ARB after an episode of AKI (KDIGO 1 to 3) at ICU discharge (20 109 (18%) vs 153 502 (31%), p = 0.001). The present study analyzes the use of ACEi ARB after KDIGO 3 AKI and their potential effect on long-term mortality. Patients and methods: Ancillary of the AKIKI study (NEJM, 2016 + 375-122-133). All patients discharged alive from ICU were included and their long-term prognosis (2-year mortality) was assessed according to treatment with ACEi ARB at ICU discharge using both univariate and multivariate analyses after adjustment for potential confounding factors. Results: Among 348 patients discharged alive, 45 (12.9%) received an ACEi ARB at ICU discharge. Table 1 details patient characteristics. Patients without ACEi ARB were more severe as attested by a higher SAPS 3 (p = 0.02) and a higher rate of catecholamine infusion (p = 0.008) during AKI. However, 2-year mortality did not significantly differ between the two groups (12 45 (27%) with ACEi ARB vs 55 303 (18%), p = 0.18). Mortality risk was not associated to non-prescription of ACEi ARB after adjustment for prognostic variables (p = 0.16). Discussion: A substantial proportion of patients received an ACEi ARB at ICU discharge after an episode of severe AKI. We did not find a difference in mortality in favor of the renin-angiotensin-aldosterone system blockers, such as observed in the ancillary study of FROG-ICU (including 109 patients with ACEi ARB whereas the present study included 45). This could be explained by a different population (less severe AKI in FROG-ICU) and or a lack of power of our study. Conclusion: This study does not confirm a positive effect on long-term mortality. A randomized controlled trial of ACEi ARB at ICU discharge after an episode of severe AKI is warranted. Introduction: Chronic kidney disease (CKD) is associated with high mortality related to sepsis. Some studies have already shown uremic toxins' action on vascular and immune disorders during CKD but their potential role during acute kidney injury (AKI) is undetermined. The kinetic of uremic toxin's concentrations and their consequences during AKI disserve to be addressed. The aim of our study was to evaluate the kinetic of three uremic toxin's concentrations (Indoxyl sulfate (IS), Para-crésyl sulfate (PCS) and FGF-23) during the first weeks of kidney failure in a uremic mice model and their consequences during endotoxemia. Patients and methods: In this study we explored in vivo the kinetic of the three uremic toxins' concentrations between the 7th and 45th days in controls (sham) and after kidney injury induction (KI). KI was obtained by electrocauterization followed by contralateral nephrectomy two weeks later. Uremic toxin's concentrations were determined in sera after sacrifice at 7th, 15th and 45th days after KI induction. LPS challenge was performed (5 mg kg IP) in sham and KI groups at 15th and 45th days for survival follow up. Two other groups of KI mice fed with arabinoxylan-oligosaccharides (a chelator of PCS -group AXOS-) and sevelamer (a chelator of phosphate known to decrease FGF 23 -group sevelamer-) were exposed to LPS at 45th days of KI and followed for survival. Results: PCS, IS and FGF 23 concentrations increased rapidly after kidney injury at day 7 and last until 45th in the KI group compared to the group sham (figure 1). This was associated with the elevation of cytokines concentration in serum (TNFα, IL-1β, and IL-6). At 15th and 45th days, all KI mice exposed to LPS died whereas all sham LPS animals survived (Fig 2) . The treatment with Axos and sevelamer during the 45th days preceding the LPS challenge decreased respectively the PCS concentration (AXOS group), the FGF 23 concentration (Sevelamer group) and improved the survival of KI animals. Conclusion: In this experimental study, the accumulation of uremic toxins appeared early in the course of kidney failure and was associated with local expression of pro-inflammatory molecules. This accumulation of toxins was associated with a higher mortality to endotoxemia. Decrease of PCS and FGF 23 concentrations was associated with the improvement of survival to LPS challenge. The early accumulation of uremic toxins and their potential role in sepsis mortality need to be confirmed during AKI in humans. Introduction: AKI is a dreaded complication in patients with hematological malignancies, associated with increased morbidity and mortality. Moreover, AKI may preclude the ability to receive further chemotherapy. However, current knowledge on the kinetics of renal recovery or persistent renal dysfunction is limited. Patients and methods: We conducted a retrospective single-center study which included all patients with hematological malignancies admitted to the intensive care unit (ICU) of Nantes University Hospital from January to December 2017. Our purpose was to study the epidemiology of AKI and the occurrence of Major Adverse Kidney Events (MAKE). Results: One hundred and three patients were included, among which 92 (89%) had AKI. Median age was 62.5 (49.75-68) years old and 59 (64%) were male. Most common malignancies were lymphoma (26, 28%), acute myeloblastic leukemia (20, 22%) and myeloma (19, 21%). 17 (18%) patients were newly diagnosed for the malignancy and 25 (27%) had relapsing diseases. Chemotherapy was administered in 64 (70%), 14 (2-31) days before ICU admission. Simplified Acute Physiology Score II (SAPS) at day 1 was 48 (39-62). During ICU stay, 37 (40%) patients received vasopressors and 28 (30%) required invasive mechanical ventilation. ICU, hospital, day-90, and day-180 mortalities were 22, 33, 38, and 43%, respectively. According to the KDIGO criteria, 47 (51%) had AKI stage 1, 16 (17%) AKI stage 2, and 29 (32%) AKI stage 3, of whom 14 (15%) required renal replacement therapy (RRT). ICU mortality of RRT patients was 78%. Overall, median duration of AKI was 5 (3-10) days, and increased from 4 (3-7) days in KDIGO stage 1 patients, to 3.5 (2.8-7.5) days in KDIGO stage 2 patients, and 12 (5-25) days in KDIGO stage 3 patients. Among survivors, renal recovery occurred in 48 (69%) patients at ICU discharge, 35 (61%) patients at day-90, and 32 (60%) patients at day-180. MAKE were reported in 32 (35%) patients at ICU discharge, 35 (38%) patients at hospital discharge, 41 (45%) 90 days after discharge, and 44 (48%) at day-180. Conclusion: Critically-ill patients with hematological malignancies had a high incidence of AKI. Although almost 80% of the patients were discharged alive from the ICU, MAKE at day-90 accounted for roughly 1 in every 2 patients. Further research is needed to identify predictors of MAKE, so as to develop new therapeutic strategies which might translate into better long-term outcomes. (1) showed that a delayed RRT strategy (in the absence of life-threatening condition) did not affect mortality but allowed nearly 50% patients to escape RRT compared to an early RRT strategy in patients with KDIGO3 AKI. This has obvious economic counterparts which are evaluated in this study. Patients and methods: Financial costs of RRT (both continuous and intermittent) were assessed in 45 patients in seven French ICUs from September 2017 to August 2018 taking into account catheters, circuits, dialyzer membranes and dialysate replacement fluid prices. Medical and nursing working times including time for venous catheterization and RRT duration (including circuit preparation and restitution time only) were also recorded and their cost was computed. We then extrapolated these figures to the AKIKI population in order to estimate the cost difference between the two strategies (early and delayed). Analysis was restricted to the first 72 h after inclusion. Results: The mean working time was 121 (+ -60) minutes for intermittent RRT and 119 (+ -91) minutes for continuous RRT. The mean financial costs for the first 72 h after RRT initiation were 111.53 (+ -44.91) euros for the intermittent RRT and 636.21 (+ -254.05) euros for continuous RRT (p < 0.001). Extrapolating these figures to the 619 patients included in AKIKI, revealed that the early strategy was associated with a cost of 104,619 euros and the delayed one with a cost of 54,702 euros during the first 72 h after randomization. Conclusion: This study highlights the considerable savings that can safely be obtained with a delayed RRT strategy in ICU patients with severe AKI. Introduction: Unhealthy use of alcohol and acute kidney (AKI) injury both are major public health problems. Chronic alcohol exposure may be directly or indirectly associated with kidney damage but little is known about the impact of current excessive alcohol consumption on kidney function in non-trauma critically ill patients. We aimed to determine whether unhealthy use of alcohol is independently associated with AKI in the intensive care unit (ICU) and worst kidney function at hospital discharge. Patients and methods: Prospective cohort study on non-cirrhotic, non-liver transplant recipients, and non-chronically dialyzed patients admitted in a 21-bed polyvalent ICU in a university hospital. The study was designed to have a 90% power to detect a 15% difference in the incidence of AKI between not at-risk drinkers and at-risk drinkers at a two-sided alpha error of 5%. At-risk dinking was defined according to the National Institute on Alcohol Abuse and Alcoholism criteria and AKI according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Patients were followed until hospital discharge or day 60. Results: Over a 30-months period we calculated the cumulative incidence of stage 2-3 AKI in the 320 at-risk drinkers (29%) and 787 in not at-risk drinkers (71%). Stage 2-3 AKI was significantly more frequent at admission to the ICU in at-risk drinkers than in not at-risk drinkers (42.5% versus 18%, p < 0.0001). The cumulative incidence of stage 2-3 AKI was significantly higher in at-risk than in not at-risk drinkers (Figure 1) (p < 0.0001, log-rank test). After adjustment on susceptible and predisposing factors for AKI, at-risk drinking was significantly associated with AKI (Hazard ratio (HR) = 2.53 (2.08-3.08), p < 0.0001). The proportion of patients with stage 2-3 AKI at hospital discharge among survivors was significantly higher in at-risk than in not at-risk drinkers (10% versus 5% respectively, p = 0.01). At-risk drinking remained independently associated with stage 2-3 AKI in the subgroup of 832 patients without stage 2-3 AKI at admission to the ICU (HR = 2.34 (1.68-3.72), p < 0.0001). Conclusion: Our results suggest that kidney dysfunction is significantly more frequent in at-risk than in not at-risk drinkers. We believe that systematic and accurate identification of patients with prior alcohol misuse may allow for prevention of AKI. Alexandre Elabbadi (speaker) 1 In addition to respiratory failure, 5 (19%) presented with shock. Clinical picture included fever in 23 patients (89%), cough in 19 (73%), whereas extrapulmonary symptoms were less common (11 to 31%). CT-scan patterns included alveolar consolidations in 14 (54%) patients, ground glass opacities in 10 (38%), and septa thickening in 3 (12%). All but one patient presented another pathogen-bacterial infection in 15 patients (70%), viral infection in 8 (31%) and fungal infection in one (invasive aspergillosis). At ICU admission, SAPS2 score was 41 (IQR 37-58), mechanical ventilation being required in 11 patients (42%), vasopressors in 11 (42%) and renal replacement therapy in 4 (15%). Hospital mortality rates was 31% and was found to be associated with hemodynamic failure, renal replacement therapy and neutropenia. Conclusion: hMPV is found in the respiratory tract of 2.1% of immunocompromised patients with acute respiratory failure, and in all but 8 cases, another pathogen is also identified. CT patterns have nothing unique and could be ascribable to the second pathogen. Whether positive hMPV is a relevant result is unclear and remains unaddressed by this set of data. Comparing clinical and radiographic pictures and outcomes of patients with positive hMPV to matched patients with documented influenza infections is ongoing and will be displayed at the conference. Helmi Amri (speaker) 1 Introduction: Critically ill influenza patients have a mortality rate about 20%. Co-infections, especially invasive aspergillosis, have recently been documented amongst these patients and are thought to play a major role in the prognosis of these patients. Nevertheless, the need of systematic microbiological documentation is still not widely accepted by ICU health workers. Moreover, a high incidence of cardiovascular events (acute coronary syndrome or stroke) within the first 15 days after the influenza illness has been described for a few years. The aims of our study were to assess the daily practice regarding microbiological investigation of these coinfections and to assess the cardio-vascular events rates. . Proportion of patients with hematological malignancies was 97% (IQR 0-100), and proportion of allogeneic stem cell transplantation was 11% (IQR 0-47). LRTI prevalence was 60% (95%CI 48-73 + I2 = 94%). ICU admission was required in 20% of patients (95%CI 14-27 + I2 = 90%). Last, hospital mortality was 6% (4-9 + I2 = 79%). Factors associated with heterogeneity were assessed using meta-regression. Heterogeneity of the results were partly explained by study design, proportion of patients with hematological malignancy and proportion of patients with co-infection. In this systematic review, two third of immunocompromised patients in whom hMPV was detected had LRTI, and as many as 20% required ICU admission. A high heterogeneity was noted that may be explained by study design, underlying immune status and underlying disease and rate of co-infections. Most of the included studies were however at high risk of bias justifying need for additional studies in this field. Jérémie Pichon (speaker) 1 analysis of day-90 mortality were performed. Kaplan-Meier curves of day-90 mortality according to age and main risk factors were computed. Results: 1011 patients were included. Age categories according to quintile repartition were the following-18 to 45 years old (y) (n = 206), 46 to 56 y (n = 194), 57 to 63 y (n = 213), 64 to 71 y (n = 189), and 72 to 87 y (n = 209). Next, two age groups was separated-younger group, age < 64 y and older group age ≥ 64 y with a median age of 52 y (25-75% IQR, 41-59) and 72 y (67-77) respectively. Older age (≥ 64) was significantly associated with higher mortality rate in univariate analysis (HR = 1.54 (1.26-1.88), p < 0.0001). After multivariate cox analysis, main risk factor for mortality were age ≥ 64 (HR = 1.55 (1.25-1.92), p < 0.0001), PS ≥ 3 (HR = 1.47 (1.40-1.87), p = 0.0024) and severity at inclusion assessed by sequential organ failure assessment (SOFA) score at admission in ICU per one unit increase (HR = 1.18 (1.15-1.21), p < 0.0001). However, haematological malignancy, Charlson comorbidity score index without age and reason for ICU admission were not significantly associated with day-90 mortality. Figure 1 shows the Kaplan-Meier survival analysis of the relation between age, PS and day-90 mortality (p < 0.0001). Conclusion: Older age is significantly associated with higher day-90 mortality. A threshold of 64 y was found to be the most accurate to discriminate dead from alive patients. Despite its prognostic impact, survival was meaningful in subgroups of oldest patients with moderately limited autonomy. This study may allow a better selection of oldest patients likely to benefit of ICU admission according to three simple variables-age, PS and SOFA score. Introduction: Hemophagocytic syndrome (HS) is a rare life-threatening condition that can lead to multi organ failure, including shock. In severe HS, symptomatic treatment relies on Etoposide (VP16) infusion. Hemodynamic instability during HS has been poorly studied. Objectives of this study were to describe the characteristics of HS patients with shock, prognostic factors and the impact of etoposide injection on the hemodynamic parameters. Patients and methods: Adult critically ill patients with HS and managed in a multidisciplinary national reference center between 2007 and 2017 were retrospectively included. Patients without vasopressors or not requiring Etoposide infusion were excluded. Results: Forty patients were included. Two-third (n = 28) were of male gender and median age was 48y [IQR 37-62]. Shock (n = 15, 37%), acute respiratory failure (n = 10, 25%) and monitoring (n = 8, 20%) were the main reasons for ICU admission. The most common HS-triggers were underlying hematologic disease (malignancies HHV8-related disease) in 31 patients (77%), infectious diseases in 4 (10%), and systemic rheumatic diseases in 3 (8%). Median SOFA score was 11 [9-13], 85% of the patients required mechanical ventilation (n = 34) and median lactate level was 4 mmol/L [2.7-6.9]. Hospital mortality was 47% (n = 19) and was associated with severity as assessed by need for mechanical ventilation (100% vs. 73% + P = 0.04) and male gender (90% vs. 47% in survivors + P = 0.01). Etoposide infusion (H0) was followed by increased norepinephrine doses (P = 0.03) and a trend toward higher lactate levels (P = 0.07 + figure 1). No statistically significant change was observed as regard to mean arterial pressure, heart rate and renal function, assessed by serum creatinine and oliguria. Conclusion: Our results suggest a high severity of HS patients with acute circulatory failure, a high hospital mortality and a hemodynamic worsening in the 24 h following etoposide infusion. Change in hemodynamic through ICU stay and comparison to patients with cytopenias and shock in the absence of HS are currently ongoing and will be presented at the congress. Long-term prognosis of high-grade glioma admitted in the intensive care unit Maxens Decavèle (speaker) 1 Introduction: Only limited data are available concerning prognosis of primary malignant brain tumors in the intensive care unit (ICU). Among them, high-grade gliomas (HGG) are the most frequent and those associated with the poorest survival. Whereas long-term prognosis after ICU admission of patients with other malignancies is now better known, no such data exist regarding patients with HGG. The aims of our study were 1) to analyze factors associated with 1-year mortality in patients with HGG admitted to the ICU and 2) to assess the functional status and anti-cancer therapy course in ICU survivors. Eight-year, bicentric, retrospective cohort study. All consecutive patients with HGG, admitted to the ICUs were included. Functional status was assessed with the Karnofsky Performance Status (KPS). Mutation in isocitrate dehydrogenase (IDH) 1 and 2 was also collected. The anti-cancer therapy course after ICU discharge was classified in 1) continued without change, 2) changed (modified or stopped after ICU discharge), and 3) initiated after ICU discharge for a HGG diagnosed during the ICU stay). Introduction: Thrombocytopenia is a common disorder in intensive care unit (ICU) and is associated with an increased risk of bleeding. Most data about platelet transfusions in the ICU have been obtained from general cohorts with peripheral thrombocytopenia and ongoing active bleeding or subjected to invasive procedures. In patients with hypoproliferative thrombocytopenia, the management of platelet transfusions remains somewhat empirical, derived from studies performed in hematology patients under stable clinical conditions. We herein described and analysed the determinants of post-transfusion platelet increments in cancer patients with hypoproliferative thrombocytopenia in the ICU. This was a single-center retrospective observational study over a 9-year period (2009-2017). Patients with malignancies and hypoproliferative thrombocytopenia who had received at least one platelet transfusion in the ICU were included. For each transfusion episode, a poor platelet yield was defined as a body surface area-adjusted corrected count increment (CCI) < 7, or alternatively as a weight-adjusted platelet transfusion yield (RTP) < 0.2. Patients were considered refractory to platelet transfusions when they experienced poor platelet increments (CCI < 7 or RTP < 0.2) following two consecutive ABO-compatible transfusions containing at least 0.5x1011 platelets per 10 kg bodyweight. Results: 326 patients who received a total of 1470 platelet transfusions were analyzed. Indications for platelet transfusions were distributed into prophylactic (44.5%), securing an invasive procedure (18.1%) and therapeutic for active bleeding (37.4%). Transfusion thresholds were lower for prophylactic indications than for securing an invasive procedure or for therapeutic indications (13 [8- Introduction: trauma to the spine is a common pathology that is constantly increasing in Algeria, mainly to road accidents, they are potentially serious, and associated with a spinal cord injury, they are life-threatening. We treated 75 traumatized cervical and thoracolumbar spine patients in our spine unit at CHU Oran. Patients and methods: -Department of orthopedic and traumatological surgery-spine unit of CHU Oran. -Period-24 months especially during the summer season. -Secondary support after the UAS. -Middle age-38 years (14-81 years). Results: 75 quadriplegic patients (58 men and 17 women) aged between 14 and 81 years, 60% of patients were between 14 and 60 years old, 27% between 40 and 60 years old and 13% over 60 years old, the main The causes of these traumatic quadriplegia are mainly due to AVP (67%), falls (27%) and sports accidents (judo, gymnastics) represent 6%. Histopathological lesions are at C1-C2 level in 6 patients (8%) and C3-C7 in 69 patients (92%). clinically 36 patients (48%) already had complete quadriplegia at admission and 39 patients (52%) had incomplete tetraplegia. The neurological involvement was classified according to the FRANKEL classification. Our practical conduct was a decompression, arthrodesis, graft with a screwed plate. 30% of the patients benefited from a conservative treatment in a reduction by cranial traction. the course was marked by recovery in 8 patients (10.6%) who had incomplete tetraplegia and 13 patients (17.3%) died as a result of their complications. Discussion: Traumatic quadriplegia is a major public health problem, few injuries are as devastating as those affecting the spinal cord; adult, youthful and adolescent men have the highest prevalence and suffer most of the time from a permanent deficit; quickly, the quadriplegic or paraplegic becomes aware of its deficit and its consequences. Hospitalization and rehabilitation, through their costs, represent a huge investment. The emotional damage the patient and his family are not measurable. After several weeks of treatment (surgery, resuscitation, rehabilitation ...) we found adverse results and treatment failure, which further complicated their insertion and care for their families. Conclusion: Traumatic quadriplegia is especially aggravated during transport, the goal of surgery is to decompress the marrow and stabilize the spine. Introduction: Despite daily interruption of sedative infusions, delayed awakening is frequently observed in critically ill patients requiring invasive mechanical ventilation. We aimed to identify the prognostic significance of standard electroencephalography findings in adult patients with delayed awakening in the intensive care unit. Patients and methods: Our retrospective study included consecutive patients under invasive mechanical ventilation in the intensive care unit who underwent standard EEG because of delayed awakening. Delayed awakening was classified in 3 groups-coma, hypo-active delirium or hyperactive delirium according to RASS at inclusion. The primary endpoint was a good neurological outcome, defined as the proportion of patients alive and awake (i.e. responding to simple commands on 2 consecutive days) 7 days after EEG. Secondary endpoints included the prevalence of the different etiologies of delayed awakening, defined in 6 categories (hypoxic + metabolic + septic + antibiotic + sedation + acute brain injury) and the proportion of patients alive and awake at ICU discharge and at 90 days. Data are presented as median (interquartile range) or numbers (percentages). Cause-specific prevalence models were used to identify independent parameters associated with awakening and death, respectively. (Table) . By contrast, background frequency > 4 Hz associated with a preserved reactivity were protective. The etiologies of delayed awakening were-65 (54%) sepsis, 49 (41%) hypoxia, 32 (27%) sedations, 25 (21%) neurotoxic antibiotics, 14 (12%) metabolic causes, with for some patients a multifactorial origin. Hypoxic encephalopathy was associated with short-term mortality. At the end of ICU stay, 60 (50%) patients were awake, 7 (6%) were alive but not awake and 53 (44%) were dead. At 90 days, 55 (45%) were awake, 6 (5%) were not awake and 60 (50%) were dead. Conclusion: Delayed awakening in ICU is likely of multifactorial origin and characterized by a favorable outcome in about 50% of cases. Background EEG abnormalities (frequency, continuity) and reactivity provide major prognostic information on short-term mortality in this population. have assessed its characteristics and long-term survival and functional outcomes. The objective of this retrospective study was to identify early factors associated with CA in adults managed for CSE and admitted to the intensive care unit (ICU Introduction: Post-cardiac arrest coma is a common cause of brain injury in the ICU. Predicting neurological outcome is of crucial importance to provide the most objective information to loved ones and opt for the best therapeutic options (including withholding or withdrawal of treatments deemed hopeless). Among the prognostic tools available, somatosensory evoked potentials have proven efficiency-under certain conditions, the absence of N20 cortical wave is associated with an unfavorable neurological prognosis with a specificity closed to 100% (1). Traditionally, this test requires the expertise and availability of a neurophysiologist. We assume that this technique can also be performed by trained intensivists. Patients and methods: Two physicians from our ICU received two days of specific training in a university neurophysiology laboratory by a specialist in the interpretation of evoked potentials. Patients concerned had prolonged post-cardiac arrest coma after cessation of sedation. The records were interpreted and sent to the neurophysiology referral center for review by a specialist within 24 h. The feasibility and reliability of tests were evaluated retrospectively. Introduction: Sodium disturbances are the most common and probably the most poorly understood electrolyte disorders in neurological diseases. Complications can be minimized by better recognition, diagnosis, and treatment of sodium disorders. In this study, we aim to analyze the incidence, etiologies and impact of dysnatremia on brain damaged population, and we hypothesize that changes in sodium levels could be indicative of recent neurological deterioration. Patients and methods: We conducted a six month long prospective cohort, including all brain damaged patients, who were admitted to our ICU between March 1st, 2018 and August 31st, 2018 and with a minimum length of stay (LOS) of 14 days. All patients, included, were screened for sodium disorders in the first 2 weeks of ICU stay. Outcome was measured by incidence of death, Glasgow outcome scale (GOS) on discharge and LOS. Patients were also monitored for neurological deterioration, including cognitive decline, convulsive seizures, increase in cerebral edema and brain herniation that were contemporary to sodium disorders. Both univariate and multivariate analysis were used to determine level of significance. Results: During the study period, one hundred patients were admitted to our ICU for neuro-intensive care, among which 77 were included in this study. Patients were admitted for traumatic brain injury (TBI) in 75.3% of cases. According to our analysis, 35 (45.45%) patients presented with hyponatremia, 26 (74.3%) among them, were diagnosed with the syndrome of inappropriate antidiuretic hormone secretion (SIADH), 8 (22.9%) with corticosteroid deficiency and in one case with cerebral salt wasting syndrome. SIADH was attributed to convulsive seizures in 7(26.9%) cases, meningitis in 3(11.5%) cases and TBI in 11 (42.3%) cases. Hyponatremia was found to be a predictive factor of mortality in ICU (p = 0.022), of LOS (p = 0.032) and a sign of neurological deterioration (p = 0.03) on the day of diagnosis. Our study results' showed an incidence of hypernatremia of 26% (20 cases), among which 55% (11 cases) were attributed to central diabetes insipidus. Hypernatremia was found to be a predictive factor of mortality in ICU (p < 0.00), of GOS (p < 0.00) and a sign of neurological deterioration (p < 0.00) on the day of diagnosis. Conclusion: In summary, this study demonstrates that sodium disturbances are common in neuro-intensive care units and associated with increased ICU mortality. Besides it indicates that changes in sodium levels could be revealing of serious neurological complications. Guillaume Geri (speaker) 1 Introduction: Cardiogenic shock (CS) remains a severe but poorly understood pathology. Many predictive death scores have been previously described but have focused in ischemic CS and took into account data related to the management of these patients. So, there is an urgent need for simple and objective criteria to assess the shortterm CS mortality regardless of the initial etiology. Patients and methods: FRENSHOCK registry (NCT02703038) was a large prospective multicenter registry of CS patients admitted in intensive cardiac and general critical care units between April and October 2016 in France. Patients were prospectively included regardless of the CS etiology if they met at least one criterion of (1) low cardiac output (systolic blood pressure (SBP) < 90 mmHg and or the need of amines, or a low cardiac index < 2.2L min m2 on echocardiography or right heart catheterization + and (2) clinical, radiological, biological (NtproBNP or BNP), echocardiographical, or invasive hemodynamics overload signs + and (3) a clinical (oliguria, marbling, confusion) and or biological hypoperfusion (lactates > 2 mmol/L, hepatic and or renal failure). We studied factors related to 30d mortality using Kaplan-Meier analyses and Cox proportional hazards modeling. Results: 772 patients were included (male 72%, median age 66yo). Non-ischemic CS were predominant (n = 491, 64%) although type 1 infarction was infrequent (n = 134, 17%). Mortality at 30-days was 26% (n = 201). Non survivors were older, had more previous renal failure, marbles, and atrial fibrillation at admission. They had lower SBP and DBP. Diagnostic tests revealed higher arterial lactate -CRP -natriuretic peptids -kaliemia + and lower pH -prothrombin timehemoglobin -eGFR but also LVEF. Multivariate analysis retained age (especially > 75y), low systolic blood pressure (especially < 90 mmHg), high arterial lactate (especially > 4 mmol/L), low eGFR (especially < 30 ml/min/m 2 ), low LVEF (especially < 30%) as significant predictors of 30-days mortality. Ischemic etiology or type 1 infarction were not predictive. Conclusion: Our multicentric and prospective design confirmed the heterogeneity of CS in terms of presentation and prognosis. Five simple, practical and easy to find signs were found significant predictors of short term mortality and could be useful in providing a more accurate and stratified definition of CS's patients in order to tailor additional therapies. left ventricular ejection fraction increased from 21.5 ± 9.1% to 30.7 ± 13.5% (P < 0.0001) while aortic velocity-time integral increased from 8.9 ± 4 cm to 12.5 ± 3.8 cm, (P = 0.002). After matching on propensity score, levosimendan was the only remaining factor associated with a significant reduction of VA-ECMO weaning failure (Hazard Ratio = 0.16, 95%confidence interval-0.04-0.7, P = 0.01). Kaplan-Meier survival curves showed that the survival rates at 30 days were 78.4% in the levosimendan group and 49.5% in the non-levosimendan group (P = 0.0.37). However, no significant difference was found between the levosimendan and non-levosimendan groups regarding 30 days mortality after propensity score analysis (Hazard Ratio = 0.55, 95% confidence interval-0.27-1.10, P = 0.09). This study suggests that levosimendan could be associated with a beneficial effect on VA-ECMO weaning in ICU patients. However, the use of levosimendan tended to decrease 30 days mortality after propensity matched analysis (P = 0.09). Introduction: Cardiogenic shock patients treated with venoarterial ECMO (VA-ECMO) may develop brain injury during ECMO support. We aimed to assess the predictive value of serial measurements of neuron specific enolase (NSE) to identify poor neurologic outcome and CTdefined acute brain injury in this setting. Patients and methods: We conducted a prospective cohort study in consecutive adult patients cannulated with VA-ECMO for refractory cardiogenic shock in the medical ICU of a university hospital in Paris, France. Plasma was sampled at predefined time points, 1 day, 3 days and 7 days after VA-ECMO cannulation, until ECMO removal or death. Plasma samples were collected and stored at − 80 °C. The primary endpoint was poor outcome, a composite endpoint of CT-defined brain injury or death 28 days after VA-ECMO cannulation. The secondary endpoint was CT-defined brain injury. Plasma NSE levels were measured at the end of study. Data are presented as median (interquartile range) or number (percentages). The association between NSE levels and outcome was explored by multivariate logistic regression analysis, with NSE levels being dichotomized according to median values at day 1 and day 3. Results: A total of 104 patients (males (n = 67, 64%)) with a SOFA score at admission of 11 (8) (9) (10) (11) (12) (13) (14) were included, of whom 26 (25%) underwent cardiopulmonary resuscitation before VA-ECMO cannulation. At VA-ECMO cannulation, all patients were mechanically ventilated, 83 (80%) were sedated, and 81 (78%) were receiving vasopressors. Plasma NSE levels were 36 (26-50) µg L at day 1, 25 (19-38) µg L at day 3 and 22 (16-31) µg L at day 7. A poor outcome occurred in 56 (53%) patients and CT-defined brain injury was observed in 16 45 (36%) patients. Plasma NSE levels at day 1 and day 3 were associated with poor outcome in crude analyses. In multivariate analysis, only NSE levels at day 3 remained independently associated with a poor outcome (table). In patients who underwent brain CT during VA-ECMO support, both NSE levels at day 1 and day 3 were associated with CT-defined brain injury. Conclusion: In cardiogenic shock patients treated by VA-ECMO, plasma NSE levels measured 3 days after VA-ECMO initiation are independently associated with short term acute brain injury or death, irrespective of pre-ECMO characteristics. Patients with persistent elevated NSE levels 3 days after VA-ECMO initiation may benefit from advanced neuromonitoring while on ECMO support. Patients with more hypoxemia causes had more often chronic respiratory, heart and renal failure, had a higher SAPS-2 and were more often under vasopressors, (p < 0.05 for all). Patients with more causes of hypoxemia were more invasively ventilated (p < 0.001) and the number of causes was associated with hypoxemia severity (p < 0.001). After multivariate linear regression, number of causes of hypoxemia was negatively associated with P/F (coeff -3 (95%CI -6 + 0), p = 0.05). ICU-mortality across the 4 groups was 16, 21, 27 and 35% (p < 0.001). Multivariate logistic regression showed that in addition to age, chronic heart failure, SAPS-2, admission diagnosis, P/F < 100, and ARDS, having > 2 causes of hypoxemia was associated with ICU-mortality (OR 2 (95%CI-1.03-3.8)), whereas obesity was protective. Conclusion: Over 60% of hypoxemic patients had 2 or more causes of hypoxemia. The number of causes of hypoxemia was independently associated with a lower P/F ratio. Having 3 or more causes of hypoxemia was independently associated with ICU-mortality. Preventing patients to acquire supplementar conditions that induce hypoxemia may improve their prognosis. Introduction: In patients with severe acute respiratory distress syndrome (ARDS) on extracorporeal membrane oxygenation (ECMO) and ventilated with very low tidal volume, the optimal positive end-expiratory pressure (PEEP) should combine the best alveolar recruitment with minimal overdistension. Electrical impedance tomography (EIT) provides a non-invasive, real-time, bedside imaging of the lungs. The aim of our study was to assess EIT's ability to choose the best PEEP in patients on ECMO receiving ultra-protective mechanical ventilation. Patients and methods: ARDS patients on veno-venous ecmo were included. A written information was given to all patients' relatives before inclusion. A recruitment maneuver and a decremental PEEP trial from 20 to 5 cmH20 (in 5 cmH20 steps) were monitored by EIT, with lung images divided into four ventral-to-dorsal horizontal regions of interest. Driving pressure was maintained constant at 10cmH2O. For each patient, four EIT-based PEEP were defined-PEEP ODCLmin (pressure with the lowest EIT-assessed collapse lung [CL] and overdistension [OD]), PEEP ODCL15 (the lowest pressure able to limit EIT-assessed collapse below 15% with the least overdistension), PEEP Comp (PEEP with the EIT-based compliance maximum), and PEEP GI (PEEP with EIT-based global inhomogeneity (GI) index minimum). The concordance between these four EIT-based PEEP and the reference pulmonary PEEP P (defined according the respiratory clinical and ultrasound usual parameters) was evaluated by the Cohen's kappa coefficient. Results: In fourteen patients, the decremental PEEP trial induced a decrease in tidal impedance variation (TIV) of dependent regions, and an increase in TIV of non-dependent lung regions (Figure 1 ). Our study aimed to evaluate the impact on serum and pulmonary markers of biotrauma of a) the transition to ultra-protective ventilation settings following the initiation of VV-ECMO, and b) different mechanical ventilation strategies while on VV-ECMO. Patients and methods: Monocentric randomized clinical trial conducted during a 6-month period in patients receiving VV-ECMO for refractory severe ARDS. Once VV-ECMO started, patients were switched to the APRV mode with one second of 24 cmH2O high pressure (Phigh) and 2 s of 12 cmH2O low pressure (Plow) for 24 h. Patients were then randomized and assigned to each of the following three experimental steps according to a computer-generated allocation sequence-Phigh 24 cmH2O and Plow 20 cmH2O ("very high PEEPvery low driving pressure [VHPEEP-VLDP] step") + Phigh 24 cmH2O and Plow 5 cmH2O ("low PEEP-high driving pressure [LPEEP-HDP] step") + and Phigh 17 cmH2O and Plow 5 cmH2O ("low PEEP -low driving pressure [LPEEP-LDP] step"). Plasma and bronchoalveolar soluble receptor for advanced glycation end-products (sRAGE), and serum cytokines were dosed before VV-ECMO and after 12 h at each mechanical ventilation strategies. Results: Sixteen patients on VV-ECMO after 7 (1-11) days on mechanical ventilation were included. "Ultra-protective" mechanical ventilation settings following ECMO initation was associated with a significant reduction in both plasma sRAGE and plasma cytokines. However, plasma sRAGE and cytokines were similar within each experimental steps during ECMO. Nevertheless, broncho-alveolar levels of sRAGE were at their lowest when driving pressure was minimal. Conclusion: VV-ECMO allows an "ultra-protective ventilation", which combines a significant reduction of tidal volume and driving pressure. This ventilation strategy significantly reduced pulmonary biotrauma, which could therefore decrease ventilator induced lung injury. However, the optimal "ultra-protective ventilation" strategy once VV-ECMO is initiated remains undetermined and warrants further investigations. In the univariate analysis, qSOFA, lactates, IGS II score and the use of mechanical ventilation in ED were significant. In multivariate analysis, IGS II score and the use of mechanical ventilation in ED were significantly associated with the mortality in ICU. Discussion: The LoS in ED was not associated with the mortality in ICU in our study. "Dead group" was more often associated with high comorbidities and altered qSOFA at admission in ED. The use of mechanical ventilation in ED was associated with poor prognosis, whatever the origin of septic shock. It is important to confirm these results with a large prospective study. Introduction: Microcirculatory alterations are frequently observed in patients with sepsis. In vivo microdialysis (MD) is a bedside technique that can monitor tissue metabolic changes. We conducted this study aiming to assess the performance of muscle Lactate and lactate to pyruvate (L P) ratio clearance in predicting mortality in septic shock patients by using microdialysis. Patients and methods: The study was designed as a prospective, controlled, clinical trial and performed in a multidisciplinary intensive care unit. 56 septic shock patients were enrolled. Interstitial tissue concentrations of lactate, pyruvate, glucose and glycerol were obtained at baseline and every 6 h for 3 days by using muscle microdialysis. Clearances of muscle lactate, and L P ratio were defined as the percentage change in muscle lactate level or L P ratio compared to baseline (H0) values. A positive value of clearance means a decrease in the rate of the parameter under study. We found an association between muscle lactate clearance and hospital mortality with a statistically significant difference at H54 (p = 0.037), H60 (p = 0.033) and H72 in the study (p = 0.012). We also found an association between clearance of muscle lactate to pyruvate ratio and hospital mortality with a statistically significant difference at H54 (p = 0.015), H60 (p = 0.001), and H72 of the study (p = 0, 04 Introduction: Mortality from septic shock remains high. Undernutrition during septic shock is responsible for significant morbidity and mortality.The objective of our study is to evaluate the interest of muscle mass loss by ultrasound measurement of quadriceps thickness in patients admitted to intensive care for septic shock, as a prognostic factor for mortality. This was a prospective observational study conducted in the medical intensive care unit of the Centre Hospitalier Universitaire of ROUEN.The inclusion period extended from April 2017 to October 2017.The main objective was to evaluate the relationship between the variability of muscle thickness measured by ultrasound at d1-d4 and mortality at d28.The secondary objective was to assess the difference in variability in mean quadriceps thickness between living and deceased patients at D28. Results: 34 patients admitted to septic shock were included.The median of the quadriceps thickness variability between J1 and J4 was -6.77% and was defined as a threshold value.We observed higher mortality in the group whose quadriceps thickness decreased by more than 6.77% (p = 0. Finally, 20 parents could be interviewed, of whom 15 were recalled, and four parents accepted the interview. One mother described changes in skin colour and bleeding, and was shocked. Both parents of an infant described weird movements but said it helped them to recognize death, and one mother did not notice any sign, but was grateful for having been informed about possible symptoms. We did not call three fathers because their wives refused the interview, and a couple because it was bad timing. Discussion: The difficulties encountered are not those expected, such as parents' refusal at inclusion. The lack of parental involvement in the interviews is the main problem. It is partially due to a strong apprehension to recall them, with a feeling of guilt that overtakes the benefit expected from the study. For the parents who participated, there was always a motivation-a counter-gift for caregivers, a suffering and the desire to avoid that to other bereaved parents. IFiReaPed main hypothesis is that a better information of parents about those perceptible end-of-life signs could help them to live better this situation. In the literature, there is no study on this topic in PICU, therefore our first step is to observe dying children to determine which signs are worsening or appearing during end-of-life period. The study is ongoing in a French PICU. All patients, likely to die at short term in PICU are included, after informing the parents of the study. After obtaining their non-opposition, caregivers observe the dying child until his death. The child is excluded if the death doesn't occur in the five next days. A non-exhaustive list of perceptible signs is proposed to the caregivers, and they have to fulfill the presence, absence, or worsening of the signs during the dying process. Results: Between April 2017 and August 2018, 18 patients have been included (44 have been excluded because of unpredictable death, non-french speakers parents, oversight or brain death). The median age is 0.9 year, 78% had chronic disease, the main causes of death are respiratory or neurological failure and the death followed limitation or withdrawal of the treatments in 17 patients. The most frequent perceptible signs appearing or worsening during the dying process concern the child's appearance (cyanosis, pallor, marbling, petechiae, edema…), sometimes respiratory signs are perceptible, but 7 patients were still under invasive mechanical ventilation at the time of death (details in the table) . Unsurprisingly, some physiological parameters are presents during the dying process (bradycardia, hypotension, desaturation), and they could be noticed by the parents only because of the monitor. Gasps have been noted in 8 patients. Few patients presented digestive or neurological signs, but all the patient except one received an sedoanalgesia. Conclusion: IFiReaPed is the first prospective study trying to determine what are the perceptible signs during the end-of -life in PICU. The most frequent signs are gasp or concern changes in skin color or in appearance. This signs could hurt the parents and could be easier to support if they received information before their onset. The next steps of the study are to determine the signs noticed by the parents, their need of explanation and the impact of these informations on their experience. Introduction: Sedation-analgesia is part of the management of ventilated pediatric patients and must be adjusted to each patient. The objective was to evaluate the implementation of nursing-driven protocol sedation-analgesia on duration of mechanical ventilation. Patients and methods: This was a before-and-after prospective, observational study in a pediatric intensive care unit that included children aged 28 days to 17 years, receiving mechanical ventilation longer than 24 h. During the observational period, sedation-analgesia was administred according to medical prescription. During the intervention period, sedation-analgesia was adjusted by nurses according to protocol-based sedation-analgesia guideline, including an evaluation by Comfort-B scale. Results: A total of 98 children were included (50 before protocol and 48 after). The decrease in the duration of mechanical ventilation after protocol was not statistically significant (median duration was 3 days [2.2-4.9] vs. 3.8 days [2.2-7.2] before protocol, p = 0.25). After protocol, the mean of Comfort-B was 13.5 (for an optimal objective fixed by the protocol between 13 and 17). The monitoring of Comfort-B was significantly more frequent. There was no decrease in total doses of hypnotics or opioids. The compliance to protocol by nurses was insufficient (median rate-46.3% [30.5-57.8]). There was not appearing to be an increase in complications related to insufficient sedation-analgesia (auto-extubation, low number of medical alert procedures). The implementation of nursing-driven protocol sedationanalgesia in children did not reduce the duration of mechanical ventilation and the total doses of sedation-analgesia, but the protocol was insufficiently applied. However, it ensured the comfort of ventilated children and was safe. Results: Thirteen cases of aluminum phosphide poisoning were identified. There were 7 women and 6 men. The average age was 27 ± 11 years with extremes of 16 and 51 years. The poisoning was accidental by inhalation for 9 patients and voluntary by ingestion as part of a suicide attempt for 4 patients. The delay between intoxication and admission was, on average, 5 ± 2 h. The Glasgow coma score averaged 14 ± 1. Respiratory signs were at the forefront of inhaling dyspnea and irritative cough, whereas each patient which ingested the toxic were in a shock stage. Abdominal pain and vomiting were present for 8 patients. Electrical abnormalities were present for 5 patients with conduction disturbances (n = 3) and repolarization disorders (n = 2). The increase in troponin was observed with the four patients who ingested the toxic. Mechanical ventilation was necessary in 5 cases and the use of vasoactive amines for 4 patients. The use of extra-renal cleansing and ECMO were performed for one patient. Four patients died (30%) + the highest mortality was observed after ingestion of Aluminum phosphide (75%). The factors which were significantly related to mortality in univariate analysis, were-oral poisoning (p < 0.001), cardiogenic shock (p < 0.001), elevation of troponin (p = 0.001), and use of ventilatory support (p < 0.004). Conclusion: Acute aluminum phosphide poisoning remains grafted with heavy mortality, especially in developing countries. In the absence of antidotal treatment, rapid hemodynamic management may help improve the prognosis, including the use of circulatory assistance. Results: Seven hundred and sixty-two patients were included in this study with an average age of 31 ± 14 years. There was a clear female predominance with a sex ratio of 0.47. Two hundred and forty-three addicts (32%) had a psychiatric history and 137 (18%) already had a history of attempted suicide. The average time to treatment was 4 +or-2 h. Four hundred and seventy-one patients (62%) were admitted through CAMU emergencies. Intoxication was voluntary in 85% of the cases and secondary oral ingestion in 91% of them. Toxicology analysis showed that drugs ranked first (n = 486 + 64%), pesticides second (n = 179 + 23.5%) and carbon monoxide third (n = 56 + 7%). For drugspsychotropic drugs, anticonvulsants, cardiotropics, antidiabetics and paracetamol were the most common causes of drug poisoning with a frequency of respectively 58, 22, 21, 14 and 11%. Whereas for pesticides, rodenticides were predominant (n = 140, 78%) followed by chloralose (n = 137) and organophosphorus (n = 29, 16%). Illegal drugs were criminalized in 15 patients (2%). The predominant toxidrome were respectively anticholinergic (18%) serotoninergic (7%) and cholinergic (6%) toxidrome. Lactic acidosis was the most common biological abnormality (9%) followed by biological inflammatory syndrome (7%) and rhabdomyolysis (7%). Mechanical ventilation was required in 290 cases (38%) with the use of vasoactive amines in 7% of the cases. An antidote was prescribed in 190 cases (25%) and a transit accelerator in 32 patients (4%). The evolution was beneficial for 752 patients (98.4%). This was a descriptive retrospective study of all cases of acute intoxication by pesticides admitted to ICU resuscitation care in 2017. Results: One hundred seventy-nine cases of pesticide intoxication were admitted during the study period which represents 23.5% of all acute intoxication cases admitted to intensive care. The average age of the addicts was 30 ± 13 years with a sex ratio of 0.47. The poisoning were occurring at home in 138 of the cases (77%) or in a public space in 41 of them (23%). The poisoning were voluntary in 174 of the cases (97%) and accidental in 5 of them. Patients came directly from emergencies in 40% of the cases and were transferred from other hospitals in 60% of the cases. Rodenticides were the most implicated type of pesticide (n = 140 + 79%) with chloralose as leader (n = 137, 76%) followed by organophosphorus (n = 29 + 16%) and carbamates (n = 8 + 4%). Neurological signs of tremor and loss of consciousness were predominant (n = 144 + 80%) followed by tachycardia (n = 45 + 25%) and digestive signs (n = 27 + 15%). Respiratory distress was present in 11 patients (6%) and hemodynamic failure in three. Inhalation pneumonia complicated poisoning in 51 cases. The use of mechanical ventilation was necessary in 80% of the cases, the use of vasoactive drugs in 5.6% and the use of antibiotic therapy in 28.5%. Gastric lavage was performed in 9 patients (5%). Atropine was administered in 30 patients (16%). The median length of stay was 2.5 days and the overall mortality was 1.1% (n = 2). Conclusion: Pesticide poisoning is a reality in Tunisia. They are characterized by the variability of the toxic substances available in our country with neurological signs in the foreground. This can be at the origin of major and fatal complications if they are not taken care of in due time and in the appropriate place. Camille Jutras (speaker) 1 , mainly hospitals in the south of the country. The study of the molecular profile of isolated carbapenemases showed the predominance of a positive result for 3 blaVIM + blaNDM + blaOxa48 genes in 41 cases (i.e. 43.2%), 12 cases were positive for the blaNDM gene (12.6%), 11 cases were positive for the blaVIM gene (11.6%), 9 cases with both blaVIM + blaNDM genes (9.5%), 9 blaOxa48 gene-positive cases (9.5%), 7 blaVIM + blaoxa48 genes (7.4%), and 5 blaNDM genes + blaoxa48. Parallel BMR research using conventional bacteriology confirmed the presence of carbapenem-resistant BGNs in PCR-positive specimens. Conclusion: 63.3% of the patients explored are carriers of carbapenemases. 76% of these patients were transferred from another hospital in Tunisia. This highlights, on one hand, the need of an isolation policy during the care of transferred patients and, on the other hand, the need to set up a control strategy for the spread of these MDRs. [2 + 7] . Seventy-three patients (33%) required mechanical ventilation. Its median duration was of one [1, 9] day. The 2 sites method of screening MDRB was realised in 36.2% (81 cases) while the 5 sites method was practiced in 53.1% (119 cases). Ninety-five episods of infection were detected. The most frequent sites of infection were -pulmonary (13.8%), vascular (12.6) and urinary (11%). Multivariate study reaveled that the two sites method led to adapted antibiotherapy in 68% of cases versus only 36% in the five sites method (p = 0.008). We concluded that two sites MDRB screening method was efficient to detect nosocomial infections and to adjust emperic antibiotherapy. It helped to reduce management costs. The «threatening» water-a potential source for an outbreak of Stenotrophomonas maltophilia in a French intensive care unit Flora Delamaire (speaker) 1 Introduction: Stenotrophomonas maltophilia (SM), a non-fermenting gram-negative bacterium (NF-GNB), causes serious opportunistic infections and represents a major threat on intensive care unit (ICU) due to its multidrug resistance (MDR). An outbreak of SM occurred between September 2016 and January 2017 in the ICU of a general hospital. An outbreak control team was convened to investigate, at the same time as an epidemiological survey was conducted and corrective measures were initiated. Patients and methods: The outbreak was investigated by a combination of clinical and environmental samplings and molecular typing using pulse-field gel electrophoresis (PFGE). All patients infected or colonized with SM during this period were included and clinical data were analyzed. Results: Sixteen patients contaminated with SM were included. Among them, 13 had pulmonary contaminations and one bacteraemia. Two deaths probably related to SM infections were reported. Admission screening showed that the outbreak strains were acquired on ICU. The median time to SM contamination was 19.5 days (range 2-43 days). Thirteen patients (81.2%) were intubated, with a median length of 29 days of intubation (range 2-120 days). All patients received multi-antibiotic treatments including broad-spectrum antibiotics [Table] . SM clinical strains genotyping found the same SM genotype for only 3 patients. Environmental sampling revealed contamination of almost all sinks in the ICU-24 of the 28 sinks in the ICU were contaminated with SM (85.7%), including 15 sinks among the 16 patient rooms (93.7%). Further environmental screening showed an early recontamination after siphons and plugholes had been replaced. Infection control measures, including the eviction of tap water for patients' cares and a strengthening of preventive hygiene measures, made it possible to control the outbreak by January 2017. Discussion: PFGE results suggest that this outbreak was not related to a unique clone of SM but to a polyclonal colonization of the ICU water system. SM causes severe infections in debilitated patients and is a source of inappropriate antibiotherapy. Should an anti-SM antibiotic be integrated in the probabilistic antibiotherapy within an ICU contaminated with SM? Conclusion: This outbreak report highlights the risk from MDR gram-negative bacterium contaminated water system for ICU patients. Although the complete eviction of the environmental pathogen was impossible, a discontinuation of the outbreak was obtained with infection control procedures, pedagogy and reasoned evictions. Results: Out of 100 samples taken from surfaces, 24 were positive for fungal presence, divided into moulds (75%) and yeasts (25%), the identified strains belonged to 9 genera, most frequently to Aspergillus, Candida, Mucor, Cladosporium, Penicillium and Trichosporon, the most predominant fungi encountered is Aspergillusniger (25%). Conclusion: To achieve our professional service and provide a safe environment for patients, punctual fungal monitoring needs to be done consistently. Introduction: Carbapenemase-producing Enterobacteriaceae (CPE) represent a growing problem worldwide. These pathogens are resistant to most of available antibiotic, therefore challenging to treat. New Delhi metallo-β-lactamase (NDM) can hydrolyze penicillins, cephalosporins, and carbapenems1. First isolated from a patient travelling in India in 20082, it has now been described all around the world. In our intensive care unit (Erasme Hospital, Brussels, Belgium), an epidemic of 5 cases in 4 months occured. The aim of this study is to describe characteristics and evolution of colonized infected patients. We screened all patients with colonization infection with CPE-producing Klebsiella Pneumoniae (KP) within a range of 6 months around identification of the first case. We included the patients with confirmed NDM-KP (by genotyping). We described patient's profile, previous antibiotic use, infection type, treatment and outcome. Results: Five patients had at least one sample positive with NDM-KP in our ICU between November 2017 and March 2018. Strains were susceptible to fosfomycin, some also to colistin and chloramphenicol. We didn't perform genotyping. Detailed features are listed in table 1. Patients were young (mean age-55 years), but suffered from severe medical conditions. 4 out of the 5 patients had stayed in the same ICU subunit. 4 out of the 5 patients presented an infection related to the NDM-KP. Median-time between colonization and infection was 9 days (4-63). All patients had received previous broad-spectrum antibiotherapy. Infections were treated with rarely used antibiotics, highly toxic. We observed microbiological success in 3 patients, relapse in 2. The 4 infected patients died. Cause of death was untracktable infection in 3, comorbidities in 1. The colonized patient survived (mortality rate-80%). Conclusion: NDM-producing Enterobacteriaceae is emerging in Europe.3 To our knowledge, our series is the first describing locallyacquired cases in Belgium. 4 It is worrying for few reasons. First, the colonization infection ratio was high, attesting the high pathogenic power of these pathogens (and or host frailty). Second, 100% of infected patients died, despite early targeted antimicrobial therapy. It is well known that genes encoding CPE are usually plasmid-transmitted. The fact that all patients had previous broad-spectrum antibiotic therapy supports this statement. However, the only species found was K.P, all the patients had been staying in the same unit and time proximity was clear. This pleads for a "contact" component of transmission. Hygiene rules, in addition to antibiotic stewardship, are therefore crucial. Eric Thebault (speaker) 1 The expression of the sVEGFR2 sUPAR protein significantly predicts the worsening of septic patient within 72 h after their admission to the ED. Such biomarker(s) could enhance early identification of severe patients for an appropriate and rapid management able to decrease risks of poor outcome. assess the prognostic value of a blood marker panel to predict early clinical worsening of patients admitted in the ED with suspected sepsis. Patients and methods: TRIAGE was a prospective, multicenter (14 sites in France and Belgium) study on biological samples. Adults patients admitted in the ED with suspected or confirmed communityacquired infection and at least 2 SIRS criteria were included. The protocol included 5 clinical and biological time points (H0, H6, H24, H72 , D28). Main outcome was subsequent deterioration (defined as any of the following-death, intensive care admission, increase of SOFA score) within 72 h. Patients were divided into 2 groups depending on worsening or not. The evolution criteria were centrally evaluated by an independent adjudication committee of sepsis experts (emergency physicians and intensivists). Accuracy and prognostic performances of biomarkers were assessed. Patients were followed up to day 28 for mortality. The study duration was 3 years, 602 patients were included (wrongly included, n = 38 + secondary excluded, n = 112) so 462 patients were analyzed (mean age 62.6 ± 20.5 y, Charlson score-3.1 ± 2.6). After adjudication, 124 patients have been classified as worsening and 338 patients without deterioration. At admission there was no difference between the 2 groups on SIRS criteria count, WBC, CRP and lactates (cf table). The centralized analysis is in progress to select the combination of biomarkers with the best prognostic performance. Conclusion: While no vital signs nor biological markers or parameters can predict worsening of patients, the prognostic value of a panel of blood markers in EDs could help identification of septic patient at risk of worsening at time of admission and develop specific management. On the day when septic shock was settled (D1), there were no differences between the two groups in the mean plasma concentrations, neither in those of SChEA, nor in those of PCT and CRP. However, the comparison of mean plasma concentrations of SChEA, PCT and CRP on D3 and D5, showed a significant difference between survivors and non-survivors. (Table 1) . Our study suggests that in a group of critically ill patients with severe septic shock, a fall in procalcitonin and or CRP levels + and or a rise in SChEA were associated with a favorable outcome. Further studies are needed on this subject. Introduction: Recently in a randomised clinical trial, we failed to demonstrate the non inferiority of a procalcitonin (PCT) guided antibiotic therapy with respect to 3 month mortality among patients with severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) who needed mechanical ventilation [1] . To explain this result we assessed the capacity of PCT to distinguish between infectious and non infectious causes of severe AECOPD. The PCT levels of all patients at time of inclusion (H0), 6 h after and at day 1 were measured using a sensitive immunoassay. Results: Regarding all the cohort (n = 302), at any time, the PCT levels were higher in patients with bacterial infection (n = 66) and viral infection (n = 69) than in patients without documented infection (Fig. 1) . Interestingly, whether the PCT levels tended to be higher in patients with bacterial infection (n = 33) than in patients with viral infection (n = 37) in the pneumonic group patients, PCT failed to distinguish between bacterial infection (n = 33) and viral infection (n = 32) in non pneumonic group patients. Conclusion: These results underline the interest of PCT as biomarker to distinguish between infectious and non infectious causes of severe AECOPD. However, PCT could fail to distinguish between bacterial and viral infection in this setting. Jérémy Rosman (speaker) 1 were independent factors associated with ICU admission within the following week. All other elements in differential count were eliminated in the model. Severe eosinopenia was also significantly associated with longer length of stay, more bacteremia (17% vs 6%), septic shock within 7 days (2% vs 0.5%), 28-days mortality (5% vs 2%) (p ≤ 0.002 for all outcomes). Conclusion: Severe eosinopenia, a reflect of systemic inflammation, was an independent factor associated with ICU admission within 7 days and was also associated with longer length of stay, bacteremia, septic shock and mortality. Thomas Lafon (speaker) 1 Introduction: In the Emergency Department (ED), early and appropriate recognition of infection is crucial to start antibiotic treatment in a timely fashion. Traditional biomarkers remain not specific enough in infected patients. Lymphopenia, known to be associated with sepsis in the ICU, has not yet been evaluated as a potential infection biomarker in the ED. On the contrary, white blood cell (WBC) count is routinely and widely performed as part of admission assessment. We investigated whether isolated or clinically associated severe lymphopenia in ED could be a marker of infection. We conducted a retrospective single-center study over a 1 year-period. Adult patients admitted in the ED with severe lymphopenia (lymphocyte count < 0.5 G L) were analyzed. Patients with hematological or oncological diseases, HIV infection, hepato-cellular deficiency, immunosuppression and over 85 years old were excluded. Diagnosis of infection was confirmed by an independent adjudication committee. Correlation between lymphopenia and infection was assessed using a univariate analysis and a multivariate logistic regression. Results: From January to December 2017, 953 patients were admitted in ED with severe lymphopenia and 245 were eligible (148 men + mean age 63 ± 19 years). Infection was confirmed in 159 patients (65%) (bacterial-60%, viral-30%, other-10%). Initially, only 61 patients (25%) were referred to ED for suspected infection. Among biological markers, only CRP was different between infected and uninfected groups (109 ± 133 vs 46 ± 62, p < 0.01). The depth of lymphopenia was associated with a higher prevalence of infection, bacteremia, and microbiological identification (Figure) . In multivariate analysis, only clinical criteria were independently associated with infection (SIRS criteria-OR = 2.4, p < 0.01 + fever-OR = 3.35, p = 0.02). On the contrary, classical biological biomarkers did not appear associated with infection (WBC count-OR = 0.93, p = 0.07 + CRP-OR = 1.01, p = 0.07). Prevalence of infection is high in patients with severe lymphopenia regardless the reason of admission to the ED and traditional biomarkers results. This easy measurable marker could be used routinely by emergency physicians to assist in the early diagnosis of infection. Introduction: The prognosis of infection in Acute on chronic liver failure (AoCLF) depends on the rapidity of diagnosis which may be difficult, because of the absence of classical signs as fever. It has been found that Neutrophil-lymphocyte ratio (NLR) and Platelet-lymphocyte ratio (PLR) are regarded as cheap, simple and promising parameters to predict sepsis severity in several diseases. We aim to Evaluate the role of NLR and PLR in the diagnosis of infection in AoCLF. This was a retrospective follow-up study of 92 cases with the diagnosis of decompensated cirrhosis from January to December 2016. Results: A total of 92 cases of decompensated cirrhosis were enrolled in our study. The mean age was 62 ± 13.4 years. The gender was 0.95. The diagnosis of sepsis was identified in 46% of cases. Multivariate logistic regression analyses showed that there is a significant positive correlation between C-reactive protein (CRP) (p = 0.00), Procalcitonin (p = 0.004), PLR (p = 0.006) and NLR (p = 0.02) with infection. To evaluate the ability of NLR, CRP, Procalcitonin and PLR to predict infection, ROC curves were obtained. Of all the evaluated parameters, NLR showed a strong, statistically significant correlation, a high concordance correlation coefficient. Conclusion: Infection is one of the leading causes of hospitalization of patients with decompensated cirrhosis and is associated with considerable mortality, for which clinicians are seeking useful and easily obtained biomarkers. Our study had shown that Both PLR and NLR were good markers to predict infection in AoCLF. Results: Among 120 patients studied, 48.33% (CI 95% (39.12 -57.63)) had anxiety, 36.67% (CI 95% (28.06 -45.95)) had depressive symptoms and 8.33% (95% CI (4.07 -14.79)) had PTSD. Anxiety, depression and PTSD was defined by HADS score ≥ 8 and PTSS-10 > 35. The only predictive factor was age for anxiety (p = 0.001). Any other risk factors of psychiatric comorbidity were no significant. Memory disorder seemed to favor PTSD, as well as sepsis' presence favors anxiety and non-invasive ventilation favors anxiety and depression. There was no significant change in prevalence due to professional practices' evolution. Conclusion: Anxiety, depression and PTSD after critical illness are common. The detection of predictors allows an early multidisciplinary management of the patient in order to reduce their prevalence. Introduction: «Post-intensive care syndrome» is the sum of all the cognitive, psychiatric and physical sequelae after a hospitalization in intensive care unit. These frequent sequelae can have a serious impact on the quality of life, autonomy, morbidity and mortality of such patients, and can last for several years after the initial hospitalization. Although it is not consensual, intensive care unit teams more and more frequently schedule visits to assess the physical and mental status of these patients after their discharge of the ward. The clinical interest of such a practice has not been evidenced yet. Patients and methods: Since 2015, a follow-up visit after intensive care unit discharge has been set in the Médecine Intensive -Réanimation ward of Tours University Hospital Centre, in order to detect the potential occurrence of a post-intensive care syndrome in our patients. Patients admitted for acute respiratory distress syndrome and or septic shock were eligible. We conducted a descriptive study of this cohort to assess their evolution. Patients were informed about the study and could decline participation. Results: Thirty-eight patients (on 41 summoned) were reevaluated at a follow-up visit 1 month after discharge. Among them, 16 (39%) had been admitted to ICU for an acute respiratory distress syndrome, 2 (5%) for a septic shock, 3 (7%) for both acute respiratory distress syndrome and septic shock, and 14 (34%) for another diagnosis, such as acute respiratory failure or severe intoxication. Thirteen patients (34%) were still hospitalized in rehabilitation on the follow-up visit day. Among the remaining 25 patient, 10 (40%) had not consulted their general practitioner yet. Fourteen patients (37%) presented with a cognitive alteration, 10 patients (26%) had psychiatric troubles and 32 patients (84%) had physical sequelae (respiratory, neurological….). One patient out of two had sequelae in at least 2 of the 3 domains of post intensive care syndrome. Only 1 patient (3%) had no sequelae at all (Figure 1 ). Fifteen patients were reevaluated 3 months after discharge, showing a global improvement in their status but with persistent deficiencies. Overall, 84% were referred to a specialist and or had a modification in their treatment after the follow-up visit. Conclusion: Our observational study confirmed the frailty of the patients discharged of intensive care unit, with 97% of our patients presenting with troubles belonging to the field of post intensive care syndrome + this highlights the potential interest of an early reevaluation. Introduction: Congresses are a place of exchange and update of medical knowledge. However, their cost is not negligible and their profitability on the training of participants remains unclear and not studied. The purpose of this study was to identify how and why young intensivits are funding their participation in congresses. A self-questionnaire in French has been sent to young doctors of any specialty through mailing lists to the interns. People are surveyed about their characteristics, their attendance at a conference, the funding of staff and the total of these and the contribution. The relative data was anonymous. The questionnaire was registered at the CNIL. Results: During the period study, 141 patients were admitted in the burn ICU. 34 patients were included. The mean age was 38 ± 15 years with a ratio sex of 4.7. The average TBSA (total body surface area) was 44 ± 20%. Early ICU mortality was 26.5% (n = 9). Patients were assigned into 2 groups-G1-survivors (n = 25) and G2-non survivors (n = 9). Comparative study of 2 groups was as follows (Table 1)-Table 1 -Comparative study of 2 groups. Conclusion: Optimal initial fluid resuscitation in burn patients is associated with lower fluids overload during the first 48 h and improves early outcome with a lower early mortality. Introduction: As a static marker of cardiac preload, the central venous pressure (CVP) remains a helpful variable at the bedside to guide the hemodynamic management of critically-ill patients. Since transthoracic echocardiography (TTE) is currently the first-line tool for evaluating the hemodynamic conditions in critically-ill patients, we aimed at assessing the ability of TTE to estimate and to track changes in CVP. In 31 patients (25 mechanically ventilated and four with atrial fibrillation), concomitant CVP measurement (internal jugular catheter) and TTE examination were performed before and after a passive leg raising test or the infusion of 500-mL of saline. We calculated the tricuspid E A waves ratio, the tricuspid E e' waves ratio, the right ventricular isovolumic time (IVRT), the E IVRT ratio, the S D waves ratio of the supra-hepatic vein flow, the VTI-systolic filling fraction and the peak velocities-systolic filling fraction of the supra-hepatic vein flow, the end-expiratory diameter of the inferior vena cava (IVC) and the respiratory variations of the IVC diameter. For the statistical analysis, we considered that a CVP threshold value of 10 mmHg was clinically relevant. Results: Changes in CVP were induced by a passive leg raising test in 10 patients and by fluid administration in 21 patients. After pooling all values, only the end-expiratory IVC diameter and the respiratory variations of the IVC diameter were correlated to CVP (r = 0.40 and r = -0.26, respectively, p < 0.05 for both). At baseline, an end-expiratory IVC diameter = <14 mm predicted a CVP = or < 10 mmHg with a specificity of 100% (95%CI-81-100%) but with a sensitivity of 29% (95%CI-8-58%). An end-expiratory IVC diameter > 26 mm predicted a CVP > 10 mmHg with a specificity of 100% (95%CI-77-100%) but with a sensitivity of 0% (95%CI-0-20%). At baseline, the respiratory variations of the IVC diameter could predict neither a CVP = or < 10 mmHg nor a CVP > 10 mmHg (AUC = 0.683, p = 0.08). Only relative changes in the S D ratio and in VTI-systolic filling fraction correlated with relative changes in CVP (r = 0.44 and r = 0.43, respectively, p < 0.05). The concordance rate between changes in S D ratio and CVP was 48% and the concordance rate between changes in VTI-systolic filling fraction and CVP was 55%. Conclusion: In critically-ill patients, TTE cannot reliably estimate CVP or track changes in CVP induced by changes in cardiac preload. Nevertheless, an end-expiratory IVC diameter = ou < 14 mm or > 26 mm can detect a CVP = ou < 10 mmHg or > 10 mmHg respectively with a specificity of 100%. Sebastian Knudsen (speaker) 1 Introduction: Arterial elastance (Ea) and ventricular end systolic elastance (Ees) have been shown to be linked in a way that may optimize efficiency for converting left ventricular power into forward flow. This relationship may be disrupted in sepsis. We devised a pilot study to investigate the feasibility of using Speckle Tracking Echocardiography (STE) to examine Ea as a surrogate for conventional equations based on blood pressure and stroke volumes in ICU patients. We then chose a group of septic patients and a group of non-septic patients in an attempt to demonstrate a "de-coupling" of Ea and Ees when using conventional equations, and when using STE. Patients and methods: 19 septic and 23 non-septic patients underwent echocardiographic and carotid artery examination. Invasive blood pressure measurements and echocardiographic measurements of stroke volumes and ejection fractions were used to calculate Ea and Ees by conventional means. Carotid STE was performed to analyze circumferential strain and strain-rate. Results: Studying Ea was feasible using STE in all patients. Ea was correlated with circumferential strain (r = -0.37, p = 0.04) and strain-rate (r = 0.46 + p = 0.008). When using conventional methods, we demonstrated a relationship between Ea and Ees (r = 0.77, p < 0.0001), and between Ees and (1) circumferential strain (r = 0.28, p > 0.05) + (2) circumferential strain rate (-0.36, p = 0.08). There was no difference between septic and non-septic patients regarding STE, Ea or Ea Ees. Conclusion: Speckle Tracking Echocardiography (STE) is a feasible way of examining the elastance of the great arteries in ICU patients. No difference was observed between septic and non-septic patients regarding arterial elastance assessed using conventional method or STE. Association between fluid overload and sofa score kinetic from admission to day 5 during septic shock-results of EpiGOAL study Xavier Chapalain (speaker) 1 Introduction: Fluid infusion is one of the cornerstones of sepsis resuscitation therapies. However, a paradigm shift is currently occurring as concerns have been raised about the potential adverse effects of fluid therapy. One of the major adverse effects reported is fluid overload (FO). FO is defined as a fluid accumulation > 10% of baseline body weight. The objective of this study was to assess influence of FO on SOFA score changes from day 0 to day 5. This study is a retrospective, multicenter, epidemiologic data analysis. All adult patients admitted for septic shock, caused by peritonitis or pneumonia and mechanically ventilated, were enrolled in the study. Delta SOFA score was defined as the SOFA score measured on admission minus SOFA score measured on day 5. Bivariate analysis was performed with parametric tests or non-parametric tests. A multivariate analysis was performed to study the association between FO and Delta SOFA score. Results: 129 patients met the inclusion criteria of the study. Cumulative fluid balance at day 5 was greater in the FO group, with a betweengroup difference of 5.977 ml (p-value < 0.001). Delta SOFA score was more than two-fold higher in the no FO group than in the FO group with a difference of 2.37 between the two groups (p-value = 0.001). Patients without FO were more rapidly discharge from ICU compared to patients with FO and had one week less of mechanical ventilation compare to FO patients (p-value < 0.05). There was a stepwise decrease of delta SOFA score when duration of fluid overload was greater (p-value = 0.001). In linear modelling, the association between fluid overload status and delta SOFA score was confirmed with an adjusted relative-risk of 0.15 (p-value = 0.009). In this study, we report that-1) Exposition to fluid overload is a frequent event which occurs in about 40% of the patients of our cohort, 2) Fluid overload patients had more prolonged multiorgan failure during septic shock. Introduction: In comatose patients, antiepileptic drugs (AED) are usually administered by nasogastric tube (NGT). This population often has residual plasma concentrations of AED outside the therapeutic range. The objective of our study was to estimate the modalities of administration of the AED by NGT in the various intensive care units in Tunis. Our study consisted on investigating the modalities of administration of AED's with NGT by residents in intensive care during four months. We prepared 10 questions including demographic informations. Participation was voluntary and anonymous. The questionnary was distributed in seven intensive care departments after authorization of each head of the departement. So 40 residents were included. Results: Residents sex-ratio was 0.37 and mean age was 28 ± 2 years. For the period after which the NGT replacement is performed, the average of the responses was 6 ± 3 days. Residents who thought that AED were administered at the same time as food accounted for 42% of the total population. According to 90% of residents, the dosage form administered by NGT the most used in the intensive care unit was the tablets of which 95% think that it should be crushed before administration. Before introducing the drug into the NGT, 58% of residents thought it was mixed with tap water. No resident responded that treatment is introduced dry in NGT. According to residents, the most used AED in resuscitation services were phenobarbital (75%). All residents responded that to detect a possible under or overdose, the therapeutic drug monitoring is the best way in AED adjustment in this particular population. Among the residents, 62% expressed the need for a training on the modalities of administration of the treatment by NGT to improve their knowledge. The management of the comatose under AED requires a control of the methods of administration by NGT. Thus, an action strategy should be put in place to improve the knowledge of the medical sector on this subject. Bacterial co-infection occurred in 4 patients (11%). Detected viruses were influenza (n = 24 + 69%), parainfluenza (n = 2 + 6%) and Respiratory syncytial virus (RSV) (n = 9 + 26%). Upper respiratory airway infection is not a frequent cause of myasthenia gravis exacerbation despite our population being immunosuppressed. Olivier Carelli (speaker) 1 This test has been proved to be feasible and fast to do in university hospitals or university affiliated teaching hospitals. It would be of high value to confirm this in a non-university ICU. The main outcome of this study was the predictive ability of E-PRE-DELIRIC to diagnose delirium. Therefore, a correlation between a positive E-PRE-DELIRIC score (> or = 50%) and an ICDSC score < or = 4 (Intensive Care Delirium Screening Checklist) was searched. In a subsequent analysis, the performance of E-PRE-DELERIC was used in the cardiac surgery vs other patients. We also compared the abilities of E-PRE-DELERIC and APACHE II score to predict delirium. Patients and methods: This study was approved by the medical ethical committee and all patients signed an informed consent. Data of all patients were collected in a secured electronic system. All consecutive patients aged > or = 18y were included during a 6-week period. Patients were excluded if they had a cognitive dysfunction known at the admission or if chronic alcoholism. The E-PRE-DELERIC score was calculated by the physician 24 h after admission. The presence of delirium was screened by the nurses during a period of five days with ICDSC scale and NICS (Nursing Instrument for Communication of Sedation) score. Results: 80 patients were eligible for analysis. The overall incidence of delirium was 20% with the highest incidence of new-onset delirium on day 2. The results of the ROC analysis (Figure 1.) show that the E-PRE-DELIRIC score is highly discriminant (AUC-0.881, 95% CI-0.796-0.966). As seen in other studies, a higher incidence of delirium in the post cardiac surgery group (38 patients), with three times more delirium in this group compared to the general population. For the E PRE-DELERIC score, the threshold of 50% was the one that combined the maximal sensitivity and specificity (maximum Youden index = 0.703) and for the APACHE II score, the threshold would be 15 but the E-PRE-DELIRIC score has more discriminative power than the APACHE II score (AUC -0.747, 95% CI-0.5983-0.8948). The E-PRE-DELIRIC delirium prediction model is reliable and remains fast and easy to do in a general non-university ICU, characterized by a great turnover of patients and of caregivers, and a rather low nurse-to-patient ratio (1-3 to 1-4), allowing early preventive measures aimed to reduce delirium incidence in those high risk patients. Ability of E-PRE-DELERIC score to predict delirium (ROC curve analysis) Omar Ben Hadj Salem (speaker) 1 . Two AED or more were associated in 42% of patients. AED were associated to other drugs in 85% of cases. Polymedication (≥ 5 drugs) was noted in 21% of cases. The AED C0 were subtherapeutic in 71% of cases. The VPA C0 were subtherapeutic in 88% of cases. Among the samples, 65% corresponded to a value of C0 Dp lower than the recommanded one. In these samples, 55% presented at least one drug association with the concerned AED. In 45% of the cases, there was no drug association but a non-respect of NGT modality of AED administration in patients. Conclusion: TDM is a useful tool to assess drug-drug interactions and to control modalities of AED administration in comatose patients. the diagnostic pitfalls and treatment issues in a large series of patients selected from a prospective population-based registry with a final diagnosis of OHCA from neurological cause (OHCA-NC). Furthermore, we also aimed to identify factors that were associated with the use of iCAG as first line investigation during the initial diagnostic check-up. (Figure 1 ). The Pmuscalcl calculated at peak inspiratory flow correlated with the actual peak of Pmus (r = 0.34 + p < 0.0001). In addition, P0.1 seemed better correlated with Pmus (r = 0.76 + p < 0.0001) than Pmuscalcl. Definitive results, including EIT assessment, will be presented at the meeting. Conclusion: These preliminary data suggest the potential interest of analyzing Vt values evolution over a PSL titration. Furthermore, new calculated tools, as Pmuscalc may help clinicians assessing respiratory effort at the bedsides and personalizing the level of assistance. In the immunocompromised intensive care unit (ICU) population, the association of prognosis and body mass index (BMI) has never been assessed. The objectives of this study were to determine-1) the influence of BMI on ICU immunocompromised patient's mortality. 2) the risk factors of ICU mortality according to the BMI. Patients and methods: A post hoc analysis of a prospective, multinational cohort study, performed in 16 countries in immunocompromised acute-respiratory-failure (ARF) patients, was conducted. The primary endpoint was ICU-mortality rate. Impact of BMI on ICUmortality and risk factors according to BMI were analysed using multivariate Cox analysis. The best threshold for separating dead from alive patients was determined using the Youden index. Results: In the 1483 patients with BMI available, the overall ICUmortality rate was 32% (470/1483). Ninety-one (6%) patients were underweight (32% ICU-mortality), 646 (44%) normal weight (32% ICUmortality), 457 (31%) overweight (31% ICU-mortality), 172 (12%) obese grade 1 (33% ICU-mortality), 80 (5%) obese grade 2 (29% ICU-mortality) and 37 (2%) obese grade 3 (24% ICU-mortality). After multivariate Cox analysis including initial oxygenation strategy, Sequential Organ Failure Assessment (SOFA) score without respiratory item, PaO2 FiO2 ratio < 100 at ICU admission, invasive mechanical ventilation, pattern of chest X ray and etiology of ARF, higher BMI was significantly associated with lower mortality rate (Adjusted HR (aHR) = 0.98(0.97-1.00), P = 0.02). No centre effect was observed. Two BMI groups were separated-low (< 28 kg/m2) and high (BMI ≥ 28 kg/m2), the adjusted risk of dying being lower in the high BMI (≥ 28 kg/m2) group compared to the low BMI (< 28 kg/m2) group-(aHR = 0.81(0.65-1.00), P = 0.05). After multivariate Cox analysis, some risk factors of mortality were common to both groups-SOFA score without respiratory item, NIV use and invasive mechanical ventilation, other found only in the low BMI group-PaO2/FiO2 ratio < 100 mmHg and alveolar-interstitial radiologic pattern (Figure 1 ). In immunocompromised ARF patients, higher BMI was associated with lower mortality. Contrary to the low BMI group, PaO2/ FiO2 ratio and radiological pattern were not associated with mortality in the high BMI group. These results, suggesting that PaO2/FiO2 ratio and radiological pattern are not reliable to predict prognosis of obese ARF patients, might be one explanation to the inverse adjusted association observed between ICU mortality and BMI. Introduction: In critically ill patients, Intensive care unit (ICU)-acquired weakness is a complication commonly observed and is associated with poor outcomes and increased length of stay. The assessment of skeletal muscle and diaphragm ICU-associated morphological changes is usually appreciated by ultrasonography. Shear wave elastography (Swe) is a novel technique which allows to measure the absolute elasticity value (kPa) of soft tissues and to quantify their mechanical properties. We therefore aimed to determine the reliability and reproducibility of ultrasonographic Swe measurements in critically ill patients. Patients and methods: In a first phase, two operators tested, in 16 healthy subjects, various probe positions in order to select the most reproducible. Among them, the best 3 probe positions were used to examine their intra and inter-operator reliability in 15 other healthy subjects. In the second phase, intra and inter-operator reliability of elastography was evaluated in 12 critically ill patients. Introduction: Acquired von Willebrand syndrome (AVWS) is a hemostasis disorder widely described with different extracorporeal circulatory assistances. Conversely, very few data are available in the field of extracorporeal CO2 removal (ECCO2R). We report the results of a prospective monocentric study focusing on von Willebrand disorders induced by ECCO2R devices. Patients and methods: Prospective study performed in 20 consecutive patients treated with ECCO2R (either Hemolung ® or iLA activve ® device). Biological testing included-platelet function analyzer-adenosine diphosphate (PFA-ADP) and -epinephrine (PFA-EPI), von Willebrand factor antigen (VWF -Ag) and activity (VWF -RCo), and multimeric profile (Hydrasys 2 system). Measurements were performed prior to ECCO2R initiation, then at 5, 30, 60 and 180 min, daily during ECCO2R from D1 to D7, and 24 h after stopping ECCO2R. Bleeding and thrombotic events were recorded. Results: Hemolung ® was used in 8 patients, and iLA activve ® in 12 between January 2017 and July 2018. The indications for ECCO2R were acute exacerbation of chronic obstructive pulmonary disease (n = 16), acute respiratory distress syndrome (n = 3), and severe acute asthma (n = 1). Significant prolonged PFA-ADP (151 s of median time at D1 versus 82 s at D0, p = 0.0001) and PFA-EPI (214 s at D1 versus 106 at D0, p = 0.0017) were observed in 19 patients (one patient with missing data) during ECCO2R, and normalized in respectively 11 and 10 among the 14 patients tested 24 h after stopping ECCO2R. The VWF -RCo VWF -Ag ratio decreased for all patients between 60 min and D1 (0.65 of median ratio at D1 versus 0.93 at D0, Figure 1A , 1B). The ratio was normalized 24 h after ECCO2R cessation in 8 of the 10 patients tested. Loss of high molecular weight multimers occured in all patients tested (n = 14) as early as 60 min (0.48 of median ratio at D1, versus 1.05 at D0) and was associated with an increase in low molecular weight multimers ( Figure 1C, 1D) . Fourteen bleeding events were reported. Nine thrombotic events were reported (6 at the right internal jugular cannulation site, 3 device's thrombosis). There was a trend to a more pronounced decrease in high molecular weight multimers in patients with bleeding events. Conclusion: Von Willebrand disorders were observed in all ECCO2R patients. They may contribute at least in part to the frequency and severity of bleeding complications observed in this population. Introduction: We aimed to identify the characteristics of patients with severe acute exacerbation of chronic obstructive pulmonary disease (COPD) and evaluate the prognostic of COPD patients. Patients and methods: This is a retrospective study performed during a 10-year period in the ICU of Habib Bourguiba University Hospital (Sfax, Tunisia). All patients with severe acute exacerbation of COPD were included. During the study period, 169 patients with acute exacerbation of COPD were admitted in our ICU, 65(38.5%) were emphysema patients. The mean age (± SD) was 67.99 ± 9.8 years, the sex ratio was at 7.04. The most common comorbidities were hypertension in 54(32%) patients, cardiac failure in 36(21.3%) situations and diabetes in 32(18.9%) cases. The mean SAPSII score was 38.34(± 13.29). On ICU admission 94 of patients have acute circulatory failure and 124(73.4%) patients required mechanical ventilation. Mortality rate in this study was around 49.1%, length of stay (LOS) was at 8 [1 -69] and length of invasive ventilation medians was 8 [1 + 39] . During their ICU stay evolution was marked by death of 83(49.1%) patients mortality was significantly higher in patients with cardiac failure (63.88% vs 44.71%, P = 0.043) and those who necessitate the introduction of catecholamines in admission (60% vs 23% P = 0.000). A high plasma urea and plasma creatinine concentration were significantly associated with mortality P = 0.000, P = 0.003 respectively. Conclusion: COPD exacerbation is a frequent cause of hospitalization in ICU, severe form requiring mechanical ventilation were associated with a poor outcomes. Development of shock and acute kidney injury were significantly associated with mortality. Eighty nine patients were enrolled. Mean age was 67 ± 9 years and male female ratio was 3.9. Seventy nine percent were smokers and 50% were classified GOLD stage 3. History of noninvasive ventilation (NIV) and invasive ventilation (IV) were found in 64% and 34% of all cases respectively. Mean progression of COPD was 9 ± 5 years and mean exacerbations frequency was 1.89 ± 0.9 per year. Mean duration of symptoms before hospitalization (DSBH) was 5 ± 4 days. Mean SAPS II and APACHE II were 38 ± 15 and 20 ± 8 respectively. Mean pH, paCO2 and paO2 fiO2 were 7.28 ± 0.2, 80 ± 28 mmHg and 221 ± 105 respectively. Mean GCS was 11 ± 4 and it was less than 9 in 25% of all cases. The predominant precipitating factor for acute exacerbation (AE) was respiratory tract infection (69% of all cases). Thirty two percent of our patients had a septic choc at admission. Symptomatic treatment was based on inhaled bronchodilators, corticosteroids and mechanical ventilation-NIV in 70% and IV in 61% of all cases. Twenty two patients were intubated immediately after hospitalization and 32 after NIV failure. Mortality was 40%. The duration of COPD progression (p = 0.039), exacerbations frequency per year (p = 0.013), prior IV (p = 0.04), DSBH (p = 0.002), SAPS II (p = 0.003), GCS (p < 10 −3 ), pH (p = 0.01) and septic choc at admission (p = 0.004) were all predictive of IV in univariate analysis but only GCS (p = 0.002) was significant in multivariate analysis. Conclusion: Requirement of IV in AECOPD depends on the severity of the underlying respiratory illness, the gravity of the AE and the quality of an early management. Thus, basic treatment improvement and an early appropriate treatment of the AE might reduce its severity and the need of IV. Jean-Loup Augy (speaker) 1 This was a monocentric observational ancillary study of the REXECOR study (NCT02965079). All patients presenting with severe exacerbation of COPD and implanted by ECCO2R [Hemolung (Alung Technologies, Pittsburgh, USA)] were assessed by transthoracic echocardiography (TTE) at baseline and one hour after starting ECCO2R. IMV ventilation parameters were kept unmodified two hours before and one hour after the beginning of ECCO2R. TTE data, IMV parameters and arterial blood gas were simultaneous collected. Results: Seven patients [(5 women, median age 63 years (56-73), median body mass index 39.5 kg m2 (24.1-47.0)] were included from November 2017 to February 2018. Median SAPS2 at admission was 32(29-40) and respiratory SOFA was 3(2-3). Regarding TTE findings, the 7 patients had RV hypertrophy with RV free wall superior to 5 mm (6.9 mm ± 0.9) and no RV dysfunction was reported (Mean St = 20.1 ± 5.1 cm s and mean TAPSE = 21.8 ± 5.7 mm). The ECCO2R induced a significant variation of PaCO2 from 68 mmHg (67-75) to 57 mmHg (52-59), P < 0.009 and of pH from 7.24 (7.23-7.28) to 7.37 (7.27-7.37), P = 0.025. Figure 1 shows evolution of echo parameters and PaCO2 after ECCO2Rimplantation. There was no difference between S' wave value after significant reduction of PaCO2 by ECCO2R (p = 0.16) whereas systolic pulmonary arterial pressures (sPAP) decreased significantly from 45.2 mmHg (± 5.4) to 38.0 mmHg (± 7.6), P = 0.01. Pulmonary vascular resistance (PVR) was also not significantly decreased [2.24UW (± 0.41) vs. 1.80UW (± 0.39), P = 0.07]. Of note, parameters assessing the LV function did not change during the ECCO2R flow variations. Conclusion: In the physiological study, the decreased of PaCO2 induced by the ECCO2r flow variations lead to a decreased of sPAP without modifying the systolic RV function parameters. Introduction: "Comorbidomes" correspond to comorbidities that are frequently associated in COPD (such as cardiovascular disease, diabetes, oetoporosis, sarcopenia) carrying a significant impact on mortality. The distribution and the type of comorbidities vary between studies but agreement exists on five phenotypes of comorbidities-The current study was conducted to determine the association between specific comorbidities and ICU survival of acute exacerbation of COPD. Patients and methods: In Consecutive patients admitted to the ICU for hypercapnic exacerbation of COPD were classified according to associated comorbidities in five clusters-cluster 1 included cardiac profile + cluster 2 included less comorbidities + cluster 3 included metabolic syndrome, apnea and anxiety-depression + cluster 4 included denutrition and sarcopenia, and cluster 5 included bronchiectasis. Patients had standard ventilatory (NIV or standard MV), and pharmacologic (nebulized ß2 agonists, steroids, and anticholinergics) management. The discharge status (dead or alive) was compared between the 5 identified comorbid clusters. Results: During the study period, 81 patients (mean age = 67 ± 9 years, 72% male) were consecutively admitted to the ICU for a definitive diagnosis of AECOPD. NIV was used as the primary ventilator modality in 83% while the remaining had conventional invasive ventilation. ICU mortality occurred in 25% following a mean ICU and ventilatory support duration of 17 ± 10 days and 10 ± 7 days, respectively. The figure depicts relative mortality in each comorbidities cluster. The difference in observed mortality rates between clusters was statistically significant. The current study shows that comorbidity phenotypes of COPD is associated with short term outcome and ICU mortality following exacerbation. under this nosological framework. Most of these carry prognostic information with a potential impact on the clinical decisions that could be made during the management of these patients. The aim of the study is to assess the frequency of patients admitted for hypercapnic respiratory failure without prior pulmonary diagnosis, and assign a final diagnosis with emphasis on morbid overlaps. Patients and methods: In consecutive patients admitted in the ICU for hypercapnic respiratory failure demographic and clinical data pertaining to current and prior hospitalisations were recorded. Patients were managed for the acute episode, and when they were considered for ICU discharge, the following was performed-pulmonary CT scan with particular emphasis on emphysema and fibrosis patterns, spirometry for the diagnosis of obstructive lung disease, transthoracic cardiac echography, and nocturnal polygraphy for the diagnosis of sleep apnea syndrome (AHI ≥ 5). Results: During the study period, 107 patients (mean age 66 ± 6 years, 63% male) were consecutively admitted for severe hypercapnic respiratory failure requiring ventilatory support. NIV was started in 83% patients with a failure rate 20%. Table 1 reports the pulmonary diseases eventually adjudicated at admission, and at ICU discharge. Conclusion: Reliable information on actual lung diseases of patients admitted for hypercapnic respiratory failure is often lacking at ICU admission. Our study highlights the frequency of COPD, bronchiectasis, and obesity-hypoventilation syndrome in these patients. Overlaps are frequently present in these patients with a need for characterization of their evolutionary genius in the short and long term. Introduction: Despite the wide spread use of home mechanical ventilation (HMV) to treat chronic hypercapnic respiratory failure, compliance with HMV among patients has seldom been systematically studied. Evaluating outcomes for ICU survivors requiring home mechanical ventilation is also interesting. The aim was to determine patients' compliance to home mechanical ventilation indicated at discharge and to determine patients' outcomes and quality of life within three months after discharge. Patients and methods: It is a retros pective observational study conducted in a 9-bed medical ICU. All consecutive patients discharged from ICU with home mechanical ventilation between January, 1st 2015 and of December, 31st 2017 were included. Data collected involved patients' demographics, past history and underlying diseases, functional state, clinical, paraclinical, therapeutic and ICU stay course characteristics. At discharge, data on types, modes and indications of home mechanical ventilation, were gathered. Compliance reports were obtained from providers after one to three months of use. Vital status and quality of life as assessed by the St. Georges Hospital on Respiratory Problems (SGRQ), were estimated via phone calls at three months after discharge. Results: Among a to tal of 717 ICU admitted patients, 635 required mechanical ventilation. 66(10.4%) patients were discharged with HMV, 38(57.6%) via non-invasive ventilation and 28(42.4%) on tracheostomy (TPPV). They were 61.5 ± 14.4 mean age. They had predominantly chronic respiratory failure, 60(91%) + 45(68.2%), COPD 35(58.3%), mMRC score at III and IV + 18(27.3%), already on HMV, 34(51.5%) patients had at least two comorbidities with Charlson comorbidity index at 2 [1] [2] [3] [4] . On admission, mean SAPSII, 26 ± 11 with a median ICU stay at 15[10-27] days. After discharge, compliance reports were obtained, only for 20(26%) patients. Respectively, mean percentage daily use of home NIV and TPPV (≥ 4 h per day) were respectively, 92 ± 11% and 96 ± 6%. Twelve patients (18.2%) were readmitted. Mortality at three months was estimated at 19(28.8%). Health related quality of life assessed by SGQR showed a significant impairment, mean total score, 47 ± 7 + (symptoms score, 27 ± 16 + activities score, 44 ± 18 + impacts score, 52 ± 8) compared to population norms (total score, 12 + symptoms score, 16 + activity score, 16 + impacts score, 8) . Conclusion: The present study shows rather poor vital and functional outcomes at three months after discharge with HMV albeit a satisfying HMV compliance. Introduction: Simulation in intensive care is an innovative method for teaching. Respiratory settings can be responsible for some asynchronies, which may increase mortality of our patients (1) . For this reason we develop a simulator of spontaneous artificial ventilation (SimVA) and virtual breathing patients. Mathematical model resolved differential equations of chest and lung movements according to inspiratory effort in order to match with a clinical database. The goal of this study was to evaluate asynchrony index (AI) in virtual COPD patients according to pressure support (PS) level and Inspiratory time (Ti) and to compare the results to the study of Thille et al. (2) . Patients and methods: Virtual case were COPD, defined by thoracic and pulmonar compliance, total resistance, lung volumes, and inspiratory adaptive muscle pressure. Asynchrony Index was patient ineffective efforts (IE) (IE +Ventilator Respiratory Rate). Ventilatory protocols were Baseline-PS, Optimal-PS and Optimal-Ti (Optimal meant decreasing PS or Ti in order to reduce AI) as described by Thille et al. (2) . Each virtual case was titrated with each protocol. AI was recorded and compared to the results of Thille et al. The optimal protocols titrated PS or Ti in order to reduce AI, the software simulates the corresponding values of tidal volume and respiratory frequency and its effect on intrinsic PEEP and gas trapping. The difference in settings and respiratory mechanic between virtual cases and patients were not significant (Table) . Conclusion: AI was able to change according to PS or Ti settings within the same range as the study from Thille et al. Simulation with the software SimVA is realistic and may help to teach interactively ventilatory settings and asynchronies in COPD patients under Pressure Support Ventilation anywhere without any risk for the patient. Introduction: We aimed to determine the incidence and the prognostic impact [mortality and length of intensive care unit (ICU) stay (LOS)] of pulmonary embolism (PE) in critically ill patients with severe acute exacerbation of chronic obstructive pulmonary disease (COPD). Patients and methods: This is a retrospective study performed during a 10-year period in the ICU of Habib Bourguiba University Hospital (Sfax, Tunisia). All patients with severe acute exacerbation of COPD were included. The diagnosis of PE is confirmed by spiral computed tomography scan showing one or more filling defects or obstruction in the pulmonary artery or its branches. Results: During the study period, 169 patients with acute exacerbation of COPD were admitted in our ICU. The mean age (± standard deviation) was 67.99 ± 9.2 years. During their ICU stay, 28 patients (17%) developed PE. The diagnosis was confirmed within 48 h from ICU admission in all cases. The comparison between the two groups (with and without PE) showed that they had the same baseline characteristics. However, most of patients on PE group developed shock (71.4%) on ICU admission or during ICU stay. ICU mortality was significantly higher in the PE group (67.9% vs 44.5%, P = 0.024). In addition, the ICU LOS was significantly higher in the PE group than the PE-free group (P = 0.005). Conclusion: Our study showed that PE is common in patients with severe COPD exacerbation requiring ICU admission. Moreover, PE was significantly associated with higher mortality and ICU LOS in critically ill patients with severe COPD exacerbation. Introduction: The impact of home ventilation on survival of patients with chronic respiratory failure is still debated. Most studies that included patients with chronic hypercapnia away from hospitalisation, showed a positive effect on the frequency of exacerbation. The impact of home ventilation on survival in patients discharged from the ICU is not well proven. The current study reports long term survival according to the use of home ventilation. Patients and methods: All patients surviving their ICU stay for hypercapnic respiratory failure were considered for home ventilation on the following basis-frequent exacerbators under long-term oxygenotherapy in obstructive lung disease, and signs of nocturnal hypoventilation in restrictive lung disease. Vital status was checked in January 2018 and Kaplan-Meier survival curve was drawn (with Log Rank statistical test). Results: During the study-period 229 patients fulfilled the inclusion criteria and were included in the study. The mean age was 67 ± 11 years and 70% were male the majority (74%) had COPD. Home ventilation was administered to 176 patients while the remaining 53 did not. At a mean follow-up of 50 ± 24 months, patients under home ventilation had significantly longer survival than patients without home ventilation (Log Rank < 0.05), Figure. Conclusion: Home ventilation is associated with prolonged survival in ICU patients surviving hypercapnic respiratory failure. The fragility and reliability of conclusions of anesthesia and critical care randomized trials with statistically significant findings-A systematic review François Grolleau (speaker) 1 Introduction: The Fragility Index (FI), which represents the number of patients responsible for a statistically significant finding, has been suggested as an aid for interpreting the robustness of results from clinical trials. A small FI indicates that the statistical significance of a trial depends on only a few events. Our objectives were to calculate the FI of statistically significant results from randomized controlled trials (RCT) of anesthesia and critical care interventions and to determine the frequency of distorted presentation of results or 'spin' . Patients and methods: We systematically searched MEDLINE from 01 January 2007 to 22 February 2017 to identify RCTs exploring the effect of critical care medicine or anesthesia interventions. Studies were included if they randomized patients 1-1 into two parallel arms and reported at least one statistically significant (P < 0.05) binary outcome (primary or secondary). Two reviewers independently assessed eligibility and extracted data. The FI was determined for the chosen outcome. We assessed the level of spin in negative trials and the presence of recommendations for clinical practice in positive trials. Results: We identified 166 eligible RCTs with a median sample size of 207 patients (interquartile range [IQR] 109 to 497). The median FI was 3 (IQR 1-7), which means that adding three events to one of the trials treatment arms eliminated its statistical significance. Further, 21 (13%) trials had a FI of zero as the statistically significant outcome was found non-significant when recalculating the P-value using a 2-sided Fisher exact test. High spin was identified in 42% (n = 30) of negative RCTs while 21% (n = 20) of positive RCTs provided recommendations. Lower levels of spin and recommendations were associated with publication in journals with high impact factors (P < 0.001 for both). Conclusion: Statistically significant results in anesthesia and critical care RCTs are often fragile, and study conclusions are frequently affected by spin. Routine calculation of the FI in medical literature may allow for better understanding of trials and therefore enhance the quality of reporting. Introduction: The risk of admitting to the ICU patients at end of life has increased with ageing of the population. Yet, it is usually not easy to discern a priori the hospitalization which presages a fatal outcome from that with a significant potential for recovery. Limitation of lifesupporting therapy (LLST) has become of current practice in the ICU, but many countries (including Tunisia) lack legal framework for such practice. The aim of the study is to evaluate the magnitude of LLST among intensivists practicing in different healthcare facilities. Patients and methods: A questionnaire was addressed to ICU physicians practicing in university and non-university hospitals in Tunisia. They were invited to participate and respond anonymously to a questionnaire on the limitation and active cessation of care. The questionnaire included description of participants and their workplace characteristics, the frequency of end of life situation in their daily practice, and insights on the way they handle these situations with or without external help from other health workers. Results: 101 intensivists (46% having more than 10 years of experience) practicing principally in ICUs belonging to university hospitals (91%), answered the questionnaire. 69 out of 101 participants found that limitation of life-support therapy was ethically acceptable but active shortening of the dying process was not. The majority were more comfortable with withholding than withdrawing life-supporting therapy. 72 declared they practiced LLST themselves while an additional (22%) said that they were aware of such practice in their ICU. The estimated ICU deaths preceded by LLST were around 20%. A formal written LLST policy was present in 9%, unwritten policy in 52% while 39% declared they did not have any policy. More than one senior ICU doctor usually take part in decision-making regarding LLST in 92%, a single senior ICU doctor in 6%, ICU nurse (s) caring for the patient in 15%. 70% do consider requests for limitation of life-sustaining therapy from patients, families or surrogates and 25% are rarely comfortable when talking about LLST with the family. 54% strongly agreed on the principle of giving analgesics painkillers with LLST to ensure the absence of pain during terminal stages, even if death may be hastened by their use. 69% regret the lack of ethics consultations or committees. Conclusion: Limitation of life-supporting therapy is a frequent practice in Tunisian ICUs although a formal legislative or academic frame is lacking. Intensivists claim a legal framework for this practice. According to the subtype of DFLST (withholding or withdrawal), and the subtype of infection (sepsis or septic shock), there were significative statistical differences on hospital mortality-for sepsis, 17 (8%) patients without DFLST, 22 (55%) patients with withholding, and 30 (100%) patients with withdrawal, p < 0.05 + for septic shock, 20 (23%) patients without DFLST, 14 (73%) patients with withholding, and 32 (100%) patients with withdrawal, p < 0.05 (Figure 1 ). Early predictive factors of DFLST were in multivariate analysis-age (OR -1.03 IC 95% [1.01 +1.05], p < 0.01), metastatic cancer (OR 5.2 IC 95% [4.12 +6.12], p < 0.01), respiratory (OR 1.3 IC 95% [1.05 +1.49], p = 0.03), renal (OR 1.3 IC 95% [1.16 +1.54], p < 0.01) and neurologic (OR 1.6 IC 95% [1.32 +1.80], p < 0.01) items of initial SOFA score, and fungal infection (OR 7.6 IC 95% [6.16 +9.14], p < 0.01). Conclusion: DFLST are an independent factor of mortality in patients with sepsis and septic shock in ICU. This result may influence our clinical practice and show up the necessity to collect DFLST in studies. Since 2005, the medical decision to withhold or withdraw treatments in a patient who is unable to express his wishes has been legally framed by the Leonetti law-such a resolution can only be adopted after a so-called collegial reflection procedure. Regarding the deliberation that precedes the decision, the medical societies and ethical reflection committees have issued recommendations in terms of standardization, training and transparency. Our study aims to evaluate the deliberative members' perception of the collegial procedures implemented in a French medical intensive care unit. The main objective of our survey was to assess the role of collegial procedure within the decision-making process, with a core issue-is deliberation perceived as the approval of a decision already taken or as an ethical discussion that lies at the heart of the decision-making? Patients and methods: The perception of nurses, nurse aids, residents and doctors was assessed using a five-section questionnaire with open-ended and multiple answer questions. Characteristics of patient admitted to the ICU in 2017, as well as those of the collegial procedures undertaken during the same period, were collected. Results: Of the 230 formal collegial procedures (14.6% of patients admitted) registered in 2017, over 90% were attended by at least a resident, a nurse and a doctor. The analysis of the 47 questionnaires filled in by 5 doctors, 6 residents, 29 nurses and 10 nurse aids shows global satisfaction regarding the organization, duration, exchanges and consideration of the participants' opinions. While nurse aids are often absent from the deliberations and show moderate implication in the decision making, their contribution on very specific aspects of individual care is desired by other healthcare professionals. Caregivers also deplore the limited involvement of an external consultant whose role would be to provide neutral expertise on the patient's conditions. Based on the examination of responses to the open-ended questions, it seems necessary to reposition the collegial procedure within a complex deliberative process which gradually leads, throughout the hospital stay, to contingent and revocable decisions of foregoing certain treatments deemed useless, disproportionate or having no other object than the artificial preservation of life. Conclusion: Despite a limited number of participants, this singlecenter study suggests several refinements and improvements in our collegial reflection procedure in terms of legal and ethical knowledge, organization, and attendance. Introduction: Organ donation and transplantation remain below requirements in Morocco. Each year we see the number of patients needing organ transplantation (OD) getting bigger. We are facing a real shortage in OD. Moroccan students, who represent the young generation, could be the key for a future improvement in organ transplantation. We lead a study in order to determine their knowledge and aspirations concerning this life saving therapy. Patients and methods: It's a descriptive prospective study-a survey lead in eight higher education institutions. We used a pre-established questionnaire. We analyzed 4 main themes-knowledge assessment, opinions towards OD, its causes and ways of improving it in our country. Data was analyzed using SPSS 20.0 software. We questioned 991 students-97, 2% had already heard about OD, and 69.9% were aware that it was possible to practice it in Morocco. 80.3% had an idea about lethal diseases requiring the use of transplantation and 75% were able to identify transplantable organs and tissues, 43.5% underestimated the number of people waiting for transplants, 57.6% thought that the acts of organs removal and transplantation are done in private clinics. 62.8% were aware of the law governing OD in Morocco, only 31.4% had trust in this law and 91.3% ignored the registration steps in the donation acceptance register. 71.4% were convinced of the perfect compatibility of OD with Muslim religion, the majority of students (92.5%) were in favor of OD. Among the group of respondents refusing the donation of their organs, the right of refusal and religious obstruction were at the top of the list of the determinants of the refusal with respective prevalence of 47.10% and 24.3%, and only 23.3% of the students had expressed their opinion to their relatives. Conclusion: This study shows that young Moroccans are supportive of OD despite their limited knowledge of the subject. The development of this therapy must go through information and regular motivation of people. General conferences and seminars represent a solution in spreading awareness among generations in order to establish a strong policy of organ donation in an early future. Hanane Ezzouine (speaker) 1 Introduction: Encephalic death and organ donation are widely debated.The promotion of organ donation including a brain dead donor requires us to explore the concept among our population.We aimed to evaluate the knowledge and attitude of consultants in a nonuniversity hospital center concerning organ donation and the concept of brain death. Patients and methods: We carried out a descriptive study for one year in a Moroccan non-university hospital center. The target population was the consultants of this hospital center. A questionnaire was filled out anonymously and aimed to evaluate organ donation, knowledge of the concept of brain death and organ transplantation in brain-dead patients, the wearing of a voluntary organ donor card, the discussion of donations of family organs, family consent in case of cadaveric donor, receiving organs from a living donor and donation of organs and religion. Results: 746 people were included. Their average age is 21.30 ± 9.2 years with male predominance. The values associated with organ donation are for 38.49% of saving lives for 37.57% a gesture of charity, 12.17% a gesture of altruism and 11.77% a duty.85.81% do not know what it is an encephalic death .70.37% do not know that there were donations of organs of patients in a state of brain death .34.26% know it there are contraindications to the organ donation of patients in a state of encephalic death .55.95% do not agree to donate one of their organs during their lifetime.57.69%are for organ donation for the purpose of treating patients and 27.45% are without opinion. 71.16%. refuse to carry a voluntary organ donor card. 86.24% agree to receive an organ from a living donor and 12.42% to receive an organ from a deceased donor .88.22% have never reported their positions to their loved ones. 73.94% are in favor of organ donation after their death .45.50% replied that the Muslim religion allows living organ donation to live and 21.72% replied that it authorizes the donation of organs from living to organs of a patient in a state of encephalic death to a living. Conclusion: A clear disparity is found in the conception of brain death and organ donation despite information campaigns and media coverage. The population studied has socio-demographic and cultural characteristics that require adapting the information tools with a cultural approach. Introduction: The recreational use of 3.4-methylenedioxymethamphetamine (MDMA) has become common since the end of the 90 s and the number of poisonings has significantly increased during these last years. MDMA is responsible for serotoninergic toxicity leading to the onset of hyperthermia and multiorgan failure. Our objectives were to describe the time course of body temperature, serotoninergic signs and biological parameters in the severely MDMA-poisoned patients in order to understand the evolution of these parameters in relation to the plasma concentration of MDMA and its main metabolite, methylenedioxyamphetamine (MDA). We conducted a retrospective single-centre observational study including all MDMA-poisoned patients admitted to the intensive care unit (ICU) and who developed fever (body temperature > 38.5 °C) and symptoms signs of serotoninergic syndrome (according to Sternbach's criteria). Plasma MDMA and MDA concentrations were determined using liquid chromatography coupled to mass spectrometry. Results: Sixteen MDMA-poisoned patients (out of 58 MDMA-exposed patients admitted to the ICU over a 10-year period) who presented serotoninergic syndrome with fever (> 38.5 °C) attributed to MDMA exposure and treated with supportive care, external cooling and cyproheptadine (a non-specific serotonin receptor antagonist) were included in this study. The patients were 6 females et 10 males, of 22-year old [20 -26] (median [percentiles 25 -75] and had used recreational MDMA and found in a night-club (75%), in the street (19%) or at home (6%). The body temperature reached 39.7 °C [38. 8 -40 .9] and the presentation was complicated by cardiac arrest (19%), cardiovascular failure (44%), aspiration pneumonia (56%), hospital-acquired infections (25%) and fatality (6%). In four patients (25%), worsening in the clinical (heart rate, pyramidal syndrome, EEG encephalopathy) and biological parameters (transaminases, prothrombin index, creatinine phosphokinase) included in the serotoninergic syndrome was surprisingly observed in parallel to the increase in body temperature (due to a concomitant infectious or inflammatory non-toxic event). The observed worsening occurred in the absence of any increase in the plasma MDMA and MDA concentrations (N = 2) and even in the presence of undetectable concentrations (N = 2). Conclusion: MDMA use results in serotonin syndrome possibly leading to the onset of hyperthermia, organ failure and death, despite optimal care. Worsening in the serotonin syndrome during the ICU stay of severely MDMA-poisoned patients, without increase in plasma MDMA concentration is observed in 25% of the patients. The exact molecular mechanisms involved in this "serotoninergic memory" remain to be clarified. prognostic factors related to CO induced coma. The primary objective of our study was to determine prognostic factors for ICU-mortality following CO induced coma. Our secondary objective was to determine prognostic factors of CO related cognitive sequelae, at the time of intensive care unit (ICU) discharge. Patients and methods: Retrospective observational study from January 2000 to December 2012. All comatose patients (Glasgow coma score < 8) due to carbon monoxide poisoning, treated by hyperbaric oxygen therapy in a tertiary hospital in the greater Paris area were included in the current study. Clinical, biological, iconographic and electrophysiological data were collected from medical files. Results: 184 patients were included, median [IQR] age was 42 [30 -56] years, 105 patients (57.4%) were male. Causes of poisoning were mainly CO exposure n = 55 (30%) and smoke inhalation n = 107 (58.5%). 30 patients (17%) died during their ICU stay while 26 (14.7%) presented cognitive sequelae at ICU discharge. Multivariate analysis found that cardiac arrest (OR 1.28; IC95% [1.14 -1.44] + p < 0.001), EEG anomalies (OR 1.34 + IC95% [1.21-1.49] p < 0.001), and the Simplified Acute Physiology Score (SAPS II) (OR 1.04 + IC95% [1.01-1.07) + p = 0.02) were associated with ICU-mortality. Neuroimaging anomalies (OR 1.53 + IC95% [1.36-1.72] + p < 0.001) were associated with cognitive sequelae at ICU discharge. Neither lactate nor carboxyhemoglobin levels were associated with cognitive sequelae or mortality in our cohort. Conclusion: In our study, predictive factors of ICU-mortality in CO induced comatose patients were a cardiac arrest, EEG anomalies and the SAPS II score. Neuroimaging anomalies were predictive of cognitive sequelae at ICU discharge. Introduction: The recreational use of poppers has been increasing in France since the last judgment of the National Council in June 2013 re-authorizing their marketing. Poppers contain various alkyle nitrites which are highly oxidant compounds able to induce methemoglobinemia (MetHb) with deleterious and even life-threatening consequences in humans. Our objective was 1)-to describe the circumstances, complications and outcome of the patients admitted to the intensive care unit (ICU) for MetHb onset attributed to the exposure to poppers and 2)-to investigate the relationship between the serum lactate concentration and the MetHb before treatment. Patients and methods: We conducted a retrospective monocentre observational study including all patients admitted to the ICU with increased blood MetHb (> 0.7%) following the exposure to poppers. We investigated the relationships between SpO2, serum lactate concentration and MetHb on ICU admission by calculating the Pearson's coefficients and using the Bartlett's test of sphericity. Results: Twenty-six patients (24 males and 2 females aged of 42 years (35 -48) [median (percentiles 25 and 75)]) were included. The poppers had been snorted (77%), ingested (19%) or snorted + ingested (4%), in a recreational multi-drug exposure (65% + mostly accompanied by gamma-hydroxybutyrate use). On admission, MetHb was 20.0% (1.5 -44.0). The patients received methylene blue infusion (62%), mechanical ventilation (35%), catecholamine infusion (12%) and exsanguino-transfusion (4%). On admission, the SpO2 was 91% (83 -94) and weakly correlated to the MetHb (R2 = 0.3, p = 0.01) while the serum lactate concentration was 2.2 mmol/L (1.3 -3.9) and highly correlated to the MeHb (R2 = 0.7, p < 0.0001). Plasma lactate concentration of > 2 mmol/L was highly predictive of MetHb > 20%, with 91.7% sensitivity, 90.9%, specificity, 91.7% positive predictive value and 90.9% negative predictive value. Conclusion: The use of poppers is responsible for life-threatening consequences attributed to MetHb. Our data clearly supported the recommendation by the international and French guidelines to administer methylene blue in patients developing MetHb > 20% by evidencing that tissue hypoxia is almost consistently present above this threshold. Introduction: Cardio-circulatory failure is one of the leading causes of death in acute poisoning. The aim of our work was to analyze the hemodynamic profile of intoxications to non-cardiotropic products, and to identify the prognostic factors. Patients and methods: This was a prospective, 1-year study, including any patient over the age of 15 years, in primary admission to the vital emergency room, for non-cardiotropic drug intoxication but also nondrug. The analyzed parameters were-clinical examination, electrical abnormalities, echocardiographic data and troponin level, this evaluation performed with H24 intake. The statistical analysis was univariate with a p < 0.05. Results: 251 patients were included, with an average age of 29, with a _ sex ratio. The toxic products found were organophosphorus (39.1%), benzodiazepines (16.4%), aluminum phosphide (14.7%), cocaine (12.3%), carbon monoxide (8.9%),, 8%) and tricyclic antidepressants (5.2%). Cardiocirculatory insufficiency was observed in 62 patients (24.6%), electrical abnormalities in 45 patients (17.9%), elevation of troponin in 22 patients (8.7%) and echocardiographic abnormalities in 20 patients (7.9%).The incidence was particularly high for aluminum phosphide and tricyclic antidepressants.The overall mortality rate was 9% (36 deaths), depending on the offending product-45.9% for aluminum phosphide, 30.7% for tricyclic antidepressants, 12.9% for cocaine, 8, 1% for organophosphorus compounds and 4.9% for benzodiazepines. (Figure 1 ) The correlation between clinical and paraclinical abnormalities and the occurrence of death is shown in Table 1 . Discussion: In toxicology, the range of cardio-toxic products is much wider than the class of cardiotropic drugs. Indeed, very many products are at the origin of a cardiovascular toxicity. The mechanism of this failure is variable-membrane stabilizing effect (antidepressants, beta-blockers, calcium channel blockers, organophosphorus), diastolic dysfunction, rhythm disorders, toxic myocarditis, myocardial necrosis (Phostoxin, cocaine, CO) or vasodilatation (antihypertensives). Conclusion: The difficulty of accurately assessing the incidence and prevalence of cardio-circulatory failure due to toxic causes is due, among other things, to the lack of validated studies to propose better diagnostic and therapeutic techniques. In our study, the 2 main factors of poor prognosis were cardiocirculatory insufficiency and echocardiographic abnormalities. Cocaine poisoning in the intensive care unit-are there differences between cocaine hydrochloride-and crack-related toxicity? Bruno Megarbane (speaker) 1 Introduction: Cocaine is the most frequently used psychostimulant illicit drug worldwide. In France, its use has significantly increased during the last ten years, with two main modalities-the recreational snorting of cocaine hydrochloride and the inhalation of smoked "crack" (free-base form of cocaine, obtained by cocaine salification using common baking soda or ammoniac) in highly dependent and dissocialized users. The neurological, cardiovascular, respiratory and metabolic complications of cocaine are relatively well-known + however, differences between cocaine hydrochloride and crack-related toxicities have been poorly investigated. Our objectives were to describe and compare the circumstances and the resulting complications of cocaine use in the patients admitted to the intensive care unit (ICU) in relation to the route of exposure, i.e. snorting versus inhalation. Patients and methods: We conducted a retrospective single-centre observational study including all cocaine-poisoned patients admitted to the intensive care unit over an 8-year period (2011-2018) . Comparisons between the two routes of cocaine exposure were performed using an univariate analysis (Chi-2 and Mann-Whitney tests, as requested). N = 34) presented significantly more severe symptoms than users by inhalation (N = 25), with lower Glasgow coma score (p = 0.02), more intense adrenergic syndrome (p = 0.009 for tachycardia), more elevated plasma lactate concentration (p = 0.002), lower platelet count (p < 0.0001) and more marked rhabdomyolysis (p = 0.02). Snorting cocaine was less frequently associated with methadone use (p < 0.0001). Cocaine snorting patients more frequently developed cardiac arrest (p = 0.02), aspiration pneumonia (p = 0.04) and requested mechanical ventilation (p = 0.0002). Conclusion: Cocaine use may lead to severe complications requiring ICU admission. Our findings suggest that complications attributed to cocaine hydrochloride snorting are more severe than the complications attributed to crack inhalation. Experimental investigations may interestingly complement our study to allow better understanding of the mechanistic reasons supporting these observed differences. Introduction: Bromazepam is the most commonly used and the most frequently involved benzodiazepine in acute drug poisonings in France. Our objectives were 1) to report the complications and management of bromazepam-poisoned patients admitted to the ICU and, 2) to investigate bromazepam pharmacokinetics in overdose and the relationships between the coma depth and plasma bromazepam concentration on admission. Patients and methods: We conducted a retrospective single-centre observational study including all bromazepam-poisoned patients admitted in 2011-2018, evidenced by at least one plasma bromazepam concentration in the toxic range during their stay. We studied the correlation between the presumed ingested dose of bromazepam, the plasma concentration of bromazepam and the coma depth determined by the Glasgow coma score by calculating the Pearson's coefficients and using the Bartlett's test for sphericity. Results: One-hundred and sixty-four patients [112 females and 52 males age, 51 years (41-63) (median (percentiles 25-75)] were included. Toxicity resulted from multidrug ingestions (75%), with a presumed bromazepam ingested dose of 180 mg (113-180) and plasma bromazepam concentration on admission of 1.88 mg L (0.87-2.70). Consciousness impairment was marked [Glasgow coma score, 9 (3-14)], hypotonic coma (43%) and decrease loss in tendon reflexes (26%)]. Complications included aspiration pneumonia (49%), increase in liver enzyme (79%), cardiovascular (21%) and renal failure (10%). Sino-and atrio-ventricular blocks were found in 17% of the cases. Flumazenil [bolus dose of 0.3 mg (0.2-0.4) followed by infusion rate of 0.4 mg h (0.3-0.6) during 24 h (17-60)] was administered in 28% of the patients while 40% of the patients were intubated and mechanically ventilated. In the subgroup of mono-intoxications with bromazepam, no significant correlation between the coma depth and the plasma bromazepam concentration was observed (R2 = 0.1 + Bartlett's test, p = 0.3). Factors associated with the requirement of tracheal intubation (vs. flumazenil use) included lower Glasgow coma score (p = 0.002) and more elevated serum lactate concentration (p = 0.03). No significant relationship was evidenced between the ingested dose and the plasma concentration of bromazepam on admission. Conclusion: Acute bromazepam poisoning is frequent and may be responsible for life-threatening consequences. The ingested dose and the plasma concentration of bromazepam are not correlated with the coma depth and do not predict the necessity of tracheal intubation, thus suggesting high inter-individual variability in the drug toxicity and optimal management. Ecstasy an unsafe recreational drug-Experience of 10 years ICU practice Takoua Khzouri (speaker), Hela Maamouri, Meriem Fatnassi, Rim Jemmali, Nozha Brahmi Camu, Tunis, TUNISIA Correspondence: Takoua Khzouri -takoua_kh2@yahoo.fr Annals of Intensive Care 2019, 9(Suppl 1):P-84 Introduction: 3.4-Methylenedioxymethamphetamine (MDMA), also known as Ecstasy, is a recreational drug, popular among youth in Europe and America since the 1990s. During the last decade, there has been a remarquable increase in cases of MDMA poisoning admitted in our ICU. The present study aimed to better know the epidemiological, clinical and therapeutic characteristics of this poisoning in order to improve its prognosis. Patients and methods: It was an observational retrospective study spread over nine years from 1st January 2010 to 22th September 2018 in a toxicological ICU, including all patients admitted for acute MDMA poisoning. Results: During the study period, MDMA poisoning accounted for 0.15% (n = 14) of all the acute poisonings requiring hospitalization in our Intensive Care Unit. Most of them were between 2016 and 2018. Their mean age was of 20 years [15, 30] , with a sex-ratio of 6. Eight patients (57%) were drug-addicted. Exposures were single-drug in 4 cases (28.6%). In the other cases, Ecstasy was co-ingested with alcohol in 6 cases, benzodiazepine in 2 cases, trihexyphenidyl in 2 cases and both cannabis and heroin in one case. The supposed ingested dose (SID) was unknown in 4 cases, for the other ones, the median SID was 1 pill and the half [1, 4] . The consultation delay was of 6 ± 3 h after ingestion. The main symptoms were mydriasis (79%), agitation (71.4%), tachycardia (64.3%) with an average of 114 bpm [102, 145], hallucinations (57%) and hypertension (57%). The five coma patients were intubated and required sedation with midazolam in 60%. Only one patient required curare for malignant hyperthermia at42°c. Eleven patients developed rhabdomyolysis with average rates of creatine phosphokinase and lactate deshydrogenase respectively of 9479 UI [326, 54000] and 680 UI [144, 2825] . Two patients developed disseminated intravascular coagulation and fulminant hepatitis with high rates of alanine aminotransferase (4631 UI and 2223 UI), aspartate aminotransferase (3695UI and 1876 UI) and low factorV (5% and 60%] for which they received N-acetylcysteine. One patient received cyproheptadine as antidote at 12 mg a day. Thirteen patients were discharged from the ICU with a mean length of stay of three days. One patient died of hepatic encephalopathy with cerebral herniation. Conclusion: As it was shown, the MDMA poisoning presents a vital risk due to the serotonin syndrome. The clinician must be warned to recognize better its symptoms and its severity in order to improve its management. Our objective was to analyze changes in clinical presentation and outcomes since artesunate became first-choice treatment of SM. Retrospective observational single-center study in the medical ICU of a referral university hospital conducting on patients admitted for SM over a 14-year period (2004-2017). Demographic variables, severity scores, WHOs severity criteria on admission, ICU and hospital lengths of stay were collected. Patients' characteristics and outcomes were compared between two periods, namely 2004-2012 and 2013-2017 when artesunate has become first-choice treatment. A poor outcome was defined as the composite endpoint of death, or ICU length of stay > 2 days, or requirement for vasopressors, invasive mechanical ventilation and or renal replacement therapy started after the first day in ICU. Univariate analysis and stepwise multivariate logistic regression stratified by period were performed to identify factors associated with a poor outcome. Results: 189 patients were included, 98 before and 91 after 2013. Main epidemiological and clinical characteristics are on Table. Even if the number of WHO criteria for SM was comparable in both groups, SAPS II, SOFA and ICU length of stay were significantly higher before 2013. Patients visiting friends or relatives (VFR) in their home country or living in endemic areas seemed more frequent after 2013 (p = 0.07). Poor outcome occurred in 63 cases before 2013 and 32 cases after 2013 (p < .01). Risk factors of poor outcome were impaired consciousness (adjOR = 3.25, 95%CI (1.50-7.07), p = 0.003), shock (adjOR = 3.46, 95%CI (1.36-8.85), p = 0.01) and creatinine > 265 µmol L (adjOR = 14.16, 95%CI (4.95-40.48), p < .001). Patients VFR or living in endemic areas were associated with a better outcome (adjOR = 0.34, 95%CI (0.15-0.77), p = 0.01). In the final model, artesunate therapy did not significantly improve the outcome as compared to quinine-based therapy (adjOR = 0.53, 95%CI (0.16-1.71), p = 0.28). Conclusion: Patients with SM admitted in our ICU after 2013 were less severe than those before 2013. These trends could be partially explained by the increasing proportion of immune patients VFR or living in endemic areas. After adjustment on severity and stratification by period, artesunate was not significantly associated with a better outcome than IV quinine. Introduction: Clostridium species are important agents of anaerobic infections that may be associated with a wide range of severe clinical diseases requiring ICU admission. Data focusing on non difficile Clostridium species bacteriemia in ICU are scarce and rely mainly on case reports. We sought to define the clinical and biological characteristics, risk factors for acquisition, Clostridium ecology and outcomes of non difficile Clostridium species bacteriemia in critically ill patients. Patients and methods: This is a multi-centric retrospective cohort study (from 6 ICUs) including all patients diagnosed with non-difficile clostridium bacteriemia between January 2002 and June 2018. Results: Fifty patients were included. Median age was 65 (53-80) years old. For 70% of patients, Clostridium bacteriemia occurred the day of ICU admission. Median Charlson score was 5 (3-7). Underlying conditions included-onco-haematological malignancy (38%), chronic alcohol abuse (28%), diabetes (28%), chronic cardiac failure (24%), obesity (24%), cirrhosis (18%), and chronic kidney injury (12%). First symptoms started the day of ICU admission (median 0 (0-1) day between symptoms and ICU admission). Patients presented with fever in only 25% of the cases, hypothermia in 16%, shock in 83%, coma in 40%, acute respiratory failure in 21%, and cardiac arrest in 26%. Digestive symptoms were presents in 52% cases. At ICU admission, median SAPS II score was 69 (49-91), median SOFA score was 11 (8) (9) (10) (11) (12) (13) (14) . Overall, 85% patients required vasopressors, 81% invasive mechanical ventilation, and 44% renal replacement therapy. Twenty-four percent of patients experienced massive hemolysis. Median serum lactate level was 6 mM (3-10). Most of infections (44%) were due to C. perfringens, followed by C. ramosum (10%), C. septicum (10%) and C. tertium (8%). Digestive infection was diagnosed in 62% of the cases, and skin infection in 4% of the cases. Gas gangrene was present in 12% of the patients, and surgery was necessary in 28%. Most of species were sensitive to Penicillin (93%). Two third (66%) of patients died in ICU, and hospital mortality was 80%. In non survivors, median time between ICU admission and hospital death was 1 (0-9) days. Conclusion: Alcohol consumption, diabetes and underlying malignancies are the main risk factors of Clostridium bacteriemia. CLinical manifestations are non specific, but digestive symptoms and hemolysis should alert the physicians. Considering the risk of fulminant course and the high lethality of these infections, adequate antibiotics should be started as soon as the diagnosis is suspected. Laurence Essola-Rerambiah (speaker) NA, Libreville, GABON Correspondence: Laurence Essola-Rerambiah -laurenceessola@yahoo.fr Annals of Intensive Care 2019, 9(Suppl 1):P-87 Introduction: tetanus, an infective non-immunizing disease, is still endemic in many developing countries and is responsible for a high mortality. The aim of our work was to describe the management of patients admitted to the ICU for tetanus. Patients and methods: this is a descriptive study based on retrospective analysis done over a 10 years period, from January 2008 to December 2017 in Intensive Care Unit. Included were patients admitted for tetanus. Studied variables were sociodemographic characteristics, clinical, therapeutic and prognostic data. Results: 53 out of 3031 patients (1.7%) were admitted for tetanus. Mean nage of patients was 21.2 ± 18.1 years. Showing male predominance with a sex ratio of 2.5. Trismus associated to generalised contractures and spasms was present in 32 patients (60.4%). The port of entry was found in 40 patients (75.5%). The mean score of Dakar was 2.3 ± 0.8. To struggle against spasms and contractures, the combination of magnesium sulfate and diazepam was administered in 33 patients (62.3%). Mechanical ventilation was needed in 17 patients (32.1%). The mean length of hospitalisation was 12.8 ± 8.6 days. The lethality was to 51%. Conclusion: tetanus a pathology still met in our unit. Its lethality remains high. Intensification of the vaccination campaign in necessary to eradicate this disease. Introduction: Candiduria is increasingly frequent among patients admitted to intensive care unit. There is no clear discriminating threshold that can predict the occurrence of invasive candidiasis. Purpose-To identify the interest of the yeasts numeration in the urine for the early diagnosis of invasive candidiasis. Patients and methods: A prospective study was carried out in Sfax-Tunisia intensive care unit over a period of 4 months (March-June 2016). Selection criteria-Patients included were those having at least one major risk factor or two minor risk factors to develop IC (Table I) . Once included in the study, a search for Candida in urine was performed on the 3rd day of hospitalization and then once a week. Patients with candiduria carried a multiple mycological samples from other body sites and blood culture. Pittet index was calculated as well as Candida Score. The diagnosis of invasive candidiasis was made on the basis of the presence of candidemia or after expert advice during daily visits to patients with at least one of the following symptom + fever (> 38.5 °C) or hypothermia (< 36 °C), unexplained hypotension or absence of response to adequate antibiotic treatment for a suspected bacterial infection. : heighty height patient were included. Candiduria was found in 25 patients (28.4%) and 13 patients had candiduria density > 105 CFU/mL. C. albicans was found in 13 patients. The mean interval between admission and the onset of candiduria was 11.9 ± 16.42 days. Seven patients (9%) developed candidemia + from whom 5 had a concomitant candiduria. The diagnosis of invasive candidiasis was made in 14 patients (9%). The risk factors to develop invasive candidiasis in patients with candiduria were-renal failure (p = 0.17), candida score > 2.5 points (p = 0.04) and Pittet index > 0.5 (p = 0.01). By logistic regression, only renal failure was the independent factor associated with invasive candidiasis in patients with candiduria (p = 0.02, OR 17.6, 95% CI 1. 5-203.8 ). An association candiduria > 105 CFU ml and a Pittet index > 0, 5 were significantly associated with invasive candidiasis (P = 0.04). The mortality rates were at 37.5%. Conclusion: Candiduria > 105 CFU ml in the intensive care patients with several risk factors can predict invasive candidiasis. So a permanent mycological surveillance is widely recommended in order to make the early diagnosis and to start appropriate antifungal therapy. The data about epidemiology, patient significant clinical data, surgery, mechanical ventilation, dialysis, central venous catheter, urinary catheter, arterial catheter, total parenteral nutrition, leucopenia, neutropenia, previous antimicrobial therapy or prophylaxis were collected. Results: Twenty-three per cent of the 164 patients enrolled in our study, had fungal infection (25 cases) or fungal colonization (13 patients). Median score was 3 [2] [3] . Candida albicans was isolated in 60% of infections cases and 46.1% in colonization cases. Candiduria was detected in 40% and candidaemia was observed in 52% of patients. Patients who had developed fungal infections had central line insertion in (92%), prolonged length of stay (76%), prolonged antibiotic therapy (68%), use of corticosteroids (36%), and neutropenia (12%). Fluconazole was the first line used antifungal treatment (n = 23). Amphotericine B was used in three patients. Median hospital stay was 27 [18 -49] days. Multivariate analysis revealed that catecholamine use was associated with fungal infection and colonization (p = 0.04). Conclusion: Fungal infection and colonization were frequent in our population but only use of catecholamine appeared as a risk factor. Nouha Bouker (speaker) 1 Introduction: Invasive fungal infections are increasingly observed in the ICUs where they concern more specifically the non-neutropenic patients. In the absence of simple and accessible techniques for early microbiological diagnosis, the use of antifungals is steadily increasing, with a more frequent use of echinocandins. Little is known on the extent of the problem and the typology of antifungal prescription in Tunisian ICUs. In this bicentre study, we describe the prescription circumstances of antifungals in 2 Tunisian ICUs. Patients and methods: During the study period (2014-2017) all prescription of antifungals were analysed. Analysis concerned demographics, clinical circumstances (history and acute disease, procedures, previous drugs, and life-threatening conditions at the time of antifungal therapy), as well as the basis of antifungal prescribing (targeted vs. preemptive empiric). Results: 112 patients were enrolled in the study (64 men, mean age-56 ± 18 years) were admitted. Leuconeutropenia was present in 5%, and steroids were administered to 20%. The majority of patients were mechanically ventilated (83%), had central venous line (80%), had either severe sepsis or septic shock (86%), were under large-spectrum antibiotherapy (96%) for more than 3 days (72%). Antifungal treatment was started more often on a preemptive empiric basis (52%) consisting more often in echinocandins (63%). Prescription of azoles was more often a targeted therapy (70%). Antifungal de-escalation was performed in only 2%. Infection resolved in 42%, and overall mortality was 63%. Conclusion: Antifungal prescription is not exceptional in Tunisian ICUs. The preemptive empirical prescription based primarily on echinocandins reflects the lack of efficient laboratory support prompting physicians to rely on clinical information. Introduction: Critically ill patients with type 2 diabetes have an increased risk of infection. Pro-insulin connecting peptide (C-peptide) has protective immunomodulatory features. Its levels may be affected by the presence of sepsis and exogenous insulin treatment. We aimed to assess how sepsis and exogenous insulin administration affected C-peptide levels and C-peptide to insulin ratio in critically ill diabetic patients. Patients and methods: We studied 31 critically ill adults with type 2 diabetes. We measured serum insulin, and C-peptide levels during the first 3 days of ICU stay and recorded daily exogenous insulin dose. We obtained control data in eight volunteers. In patients unexposed to exogenous insulin therapy, we first compared those with sepsis to those without. Then, we compared septic patients unexposed to insulin therapy to those with sepsis treated with insulin. We determined parameters associated with C-peptide levels and C-peptide to insulin ratio, using multivariate linear regression. Results: Sepsis was diagnosed in 22 (44%) patients. Diabetic patients with sepsis had significantly higher C-peptide levels compared to healthy controls (2.5 [1.8 + 2.8] vs. 0.5 [0.5 + 0.6] nmol/L, p < 0.01). Diabetic patients with sepsis had a 5-fold higher C-peptide to insulin ratio compared to controls (48 [33 + 72] vs. 10 [10 + 13], p < 0.01), and a 3-fold increase compared to non-septic patients (17 [12 + 35], p = 0.01). When exposed to insulin therapy, septic patients had a marked decrease in their C-peptide to insulin ratio, compared to septic patients unexposed to insulin (5 [2 + 10], p < 0.01). On multivariate analysis, C-peptide levels were significantly and negatively associated with exogenous insulin therapy, and positively associated with serum insulin levels and glucose intake. C-peptide to insulin ratio was significantly and positively associated with sepsis, and negatively with exogenous insulin therapy (p = 0.03 and p < 0.01, respectively). Conclusion: In type 2 diabetic critically ill patients, sepsis is associated with a marked increase in C-peptide and C-peptide to insulin ratio, implying uncoupling of their relative secretion or clearance or both. This uncoupling, however, was markedly inhibited by the administration of exogenous insulin. Introduction: While adjunctive corticosteroid therapy has been proven effective in HIV-patients with Pneumocystis Pneumoniae (PCP), data remains unclear and controversial concerning non-HIV relatedpatients. We evaluated the effects on mortality of early adjunctive corticosteroid therapy in non-HIV PCP-related patients. Calmette, a cancer referral centre, from January-1-2010 to December-31-2016. We compared 30-days and 1-year mortality rate, change in the respiratory item of the Sequential Organ Failure Assessment score (delta SOFA-resp), change in the global SOFA score (SOFAaggravation) and use of intubation between day-1 and day-5 of antipneumocystis therapy, and occurrence of coinfections between early adjunctive corticosteroid recipients within 48 h (landmark analysis) and late or no corticosteroid recipients, using a naïve and Inverse Probability Weighted in survival analysis (IPW). Results: 133 HIV-negative patients with PCP were included (early corticosteroid n = 88, late or no corticosteroid n = 45). The main underlying conditions were haematological malignancies (n = 107, 80.5%), solid tumor (n = 27, 20.3%) and stem cell transplantation (n = 17, 12.8%). Overall 30-days and 1-year mortality was respectively 24.1% and 58.2%. IPW analysis found no differences on 30-days (HR = 1.45, 95% CI [0.7-3.04], p = 0.321) and 1-year (HR = 1.25, CI 95% [0.75-2.09], p = 0.39) mortality rate between the both groups. In the same way, no differences in delta-SOFA-resp, SOFA-aggravation, use of intubation and occurrence of coinfections were found between the both groups. Conclusion: The addition of early adjunctive corticosteroid to antipneumocystis therapy in non-HIV patients with PCP was not associated with improved outcomes concerning 30-days and 1-year mortality and respiratory evolution. Further studies are needed to evaluated this therapeutic strategy. Introduction: Accuracy of a test depends on its intrinsic characteristics (sensitivity and specificity) and of disease prevalence. These parameters are uncommonly taken into account when assessing diagnostic accuracy (1.2). To illustrate this relationship in non-HIV patients with pneumocystis pneumonia, whose prevalence is low and where available diagnostic tests have high intrinsic performance. This study aims to assess post-test probability of pneumocystis pneumonia, according to results of PCR and BDG tests in non-HIV patients with ARF. Patients and methods: A systematic review was performed to assess diagnostic performance of PCR and Beta-D-Glucan (BDG). Prevalence of Pneumocystis pneumonia was assessed in a dataset of 2243 immunocompromised patients with ARF using supervised classification tree. Prevalence of pneumocystis pneumonia was simulated using r software and assuming a normal distribution in 5000 subjects on the basis of previously observed prevalence. Post-test probability was assessed using Bayes theorem. Analyses were performed using R software. Results: Prevalence of pneumocystis pneumonia in ARF patients was 4.1% (95% CI 3.3-5). Supervised classification identified 4 subgroups -Patients without ground glass opacities (prevalence 2.0% + 95% CI 1.4-2.8), those with ground glass opacities but a) with prophylaxis (Prevalence 4.9% + 95% CI 1.6-11), b) without prophylaxis (Prevalence 10.0% + 95% CI 6.4-14.7), and c) without prophylaxis and with lymphoid malignancy or stem cell transplantation (Prevalence 20.2% + 95% CI 14.1-27.7). In the overall population, positive predictive value (PPV) was 32.9% (95%CI 31.1-34.8) and 22.8% (95%CI 21.5-24.3) for PCR and BDG respectively. Negative predictive value was low (0.10% (95% CI 0.09-0.11) and 0.23% (95%CI 0.21-0.25)) for PCR and BDG respectively. In the highest risk subgroup, PPV was 74.5% (95%CI 72.0-76.7) and 63.8% (95%CI 60.8-65.8) for PCR and BDG respectively. Conclusion: Although both PCR and BDG yield a high intrinsic performance, the low incidence of pneumocystis pneumonia translates into limited PPV, even in the highest risk group. Our results underline the need for adequate pre-test probability assessment. They suggest a method to illustrate pre and post-test probability relationship that may improve perception of diagnostic test performance in patients with predefined clinical vignette. the first hours of hospitalization. As emerging evidences recently suggested that artificial intelligence-derived methods could efficiently assisted medical decision process, we wondered if mathematical model of diagnostic prediction could be more efficient than evaluation made by experimented physicians. The objective of this study was to compare the ability of a panel of experts and a mathematical model to predict the microbial etiology of sCAP. Patients and methods: We conducted a prospective non-interventional study. First, we included patients hospitalized for sCAP in ICU and recorded clinical paraclinical data available in the three first hours of care. Final microbial diagnosis was established from microbiological examinations including bacterial cultures and multiplex PCR on respiratory fluids. sCAP with mixed etiology or without microbiological documentation were excluded. Second, we built a mathematical model of prediction (Random Forest method with LOOCV) using all data initially collected. Finally, an independent sample of the study population was used to test the performance of the pathogen prediction by-(i) a panel of 3 experts, (ii) the mathematical algorithm. Both were blind regarding the microbial diagnosis. Positive likelihood ratio (LR +) > 10 and negative LR < 0.1 were considered clinically relevant. Results: We included 153 patients with sCAP (70.6% men, mean age, 62 [51-73] years + mean SAPSII, 37 [27-47]). Responsible pathogens were-37% viral, 24% bacterial, 20% mixed etiology and 19% unidentified. The data-driven approach defined five items to create the final mathematical model-BMI, systolic blood pressure, symptom-tohospitalization time and procalcitonin. Neither the experts nor the algorithm were able to predict the responsible pathogens of the pneumonia. Discriminant abilities of the algorithm were moderate to low (LR + = 2.12 for viral and 6.29 for bacterial pneumonia) and discriminant abilities of experts were low to very low (LR + = 3.81 for viral and 1.89 for bacterial pneumonia). Conclusion: Our study shows that neither experts nor mathematical algorithm can predict the microbial etiology of sCAP within the first hours of hospitalization while there is an urge to define anti-infective therapeutic strategy. Our results highlight the need of developing point-of-care tests for rapid microbial diagnosis. Staphylococcus aureus community-acquired bacteriuria in Emergency Department -warning marker for infective endocarditis Thomas Lafon (speaker) 1 Introduction: Urinary tract (UT) infection is a frequent diagnosis at the Emergency Department (ED). Staphylococcus aureus (Sa) is an uncommon isolate in urine cultures (0.5-6% of positive urine cultures) and is more frequent in population with risk factors for UT colonization. In the absence of urological invasive procedures or risk factors for Sa colonization, community-acquired Sa bacteriuria may be related to deepseated Sa infection with septic embolisms and could be considered as trigger symptom. This cohort study aims to assess the prevalence of Infective Endocarditis (IE) in patients with community-acquired Sa bacteriuria in ED. Patients and methods: We conducted a prospective single-center study from April 2017 to July 2018. All patients admitted in the ED with Sa bacteriuria (104 CFU ml Sa isolated from a single urine sample) and without risk factors for UT colonization (i.e., < 1 month UT surgery, UT catheterization) were included. Blood cultures were collected in patients with clinical symptoms of infection (SIRS criteria) for concomitant bacteremia (72 h). In this case, transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) were performed. Diagnosis of IE was based on the Duke criteria. Results: During the study period, 56 patients with Sa bacteriuria were identified in the ED. After excluding patients with risk factors of UT colonization (UT catheterization n = 13, UT surgery n = 5), 38 patients were included (27 men, 68 [IQR-44-80] years-old). Twentytwo patients had clinical symptoms of infection, 7 of them with UT infection. Eleven patients had concomitant Sa bacteremia and TTE or TEE was performed in 10 patients which confirmed IE in 9 patients. IE affected essentially the left heart with the mitral and aortic valves involved. Sa bacteriuria was identified significantly earlier before IE diagnosis with a mean difference of 3 days. Among Duke minor criteria, 89% of patients had septic emboli, 56% fever and 33% predisposing heart condition. The 28-day mortality was 67%. Conclusion: In the absence of risk factors, community-acquired Sa bacteriuria should not be interpreted as an isolated UT infection, but as an early warning of IE, and requires further explorations to accurately and timely begin antibiotic treatment. Ulrich Clarac (speaker) 1 Results: During the study period, 25 cases of CABM were identified, due to Streptococcus pneumoniae (n = 7, 28%), Klebsiella pneumoniae (n = 6, 24%), Staphylococcus aureus (n = 5, 20%), Escherichia coli (n = 2, 8%), Neisseria meningitidis B (n = 2, 8%) Streptococcus spp (n = 1, 4%), Pseudomonas aeruginosa (n = 1, 4%), Escherichia coli, Streptococcus spp (n = 1, 4%). All strains had a wild-type phenotype of antibiotic resistance. All patients were febrile, with neurologic signs (headache 56%, stroke 20%, nuchal stiffness 52%, Glasgow coma scale alteration 10 [9-14]). The median IGS score was 56 [36-57]. The hospital mortality rate was 52%. Patients stayed in ICUs for 10 [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] days, requiring mechanical ventilation for 72% of cases. Interestingly 4 5 Staphylococcus aureus CABM were associated with endocarditis. Whatever the bacteria, bacteraemia occurred frequently, i.e. 72% of cases, associated in 4 cases with abscesses. Initial therapeutic regimen was a third-generation cephalosporin (n = 24) alone (n = 15) or in combination with an aminoglycoside (n = 5), and or an aminopenicillin (n = 7), an aminopenicillin alone (n = 1). In comparison to other CABM (Staphylococcus aureus endocarditis excluded), Klebsiella pneumoniae CABM (n = 6) had no specific clinical presentation (p = ns). Introduction: Spontaneous bacterial peritonitis (SBP) is serious complication of cirrhosis. Despite standard treatment, mortality remained high. We aimed to evaluate the predictors for the mortality in patients with SBP. It is a retrospective work, carried out over a year. Consecutive patients with approved SBP admitted in our department are included. All clinical and biological data were collected from the medical records. Univariate and multivariate analysis were used to identify the associated factors of death. Results: A total of 64 patients diagnosed with SBP and cirrhosis were enrolled in this study. Mean of age was 62.05 (18-88). Sex ratio = 1. HCV (39%) was the main etiology of cirrhosis. at least one complication occurred during the evolution in 32.8%. The septic shock was found in12.5%. six patients died of SBP (9.4%). There were no significant differences in the sex, aetiology of cirrhosis, ascites abundance, receiving prophylactic antibiotics between the surviving group and the patients who died. However there was a statistically significant association between mortality and onset of complication (P = 0.00), low systolic (P = 0.003) and diastolic blood (P = 0.000) pressure and tachycardia ((P = 0.005) at admission. empiric antibiotic therapy was statically a preventive factor (P = 0.039). Conclusion: SBP is a serious event in the history of cirrhotic disease. Particular caution must be exercised with regard to any state of hemodynamic instability present at admission. adequate empirical treatment would improve prognosis. We perform a prospective epidemiological multi-center study and included all consecutively hospitalized adult patients with IAI requiring a hospitalization in ICU. Cultures were performed on blood simple and intra-operative samples of peritoneal fluid or purulent exudate discrete abscesses. We evaluate the epidemiology and the factors associated with the isolation of a MDRO in enrolled patients. Results: Among 48 patients included in the study, a total of 62 microorganisms were isolated from intra-peritoneal fluid and blood samples in 56.3% of cultures, two or more pathogens were identified and in 5% candida spp. were identified. The MDROs represented 9.9% of the total of isolated microorganisms. Among this patients, 75% of MDROs colonization was found before or just after surgery and 25% were acquired during hospitalization. The MDROs were more frequently isolated in patients with health-care-associated IAIs (25.4%). Uninominal logistic regression analysis of risk factors demonstrated that statistically significant risk factors independently associated with the occurrence of MDROs IAI were previous know carrying at MDROs and antimicrobial therapy administered within 3 month before operation. The study showed that MDROs represented a tenth of IAI and knowledge of previous colonization by MDROs or previous antibiotherapy within 3 month might guide to identify patients with IAIs caused by MDROs and therefore permit to introduce adequate empiric antimicrobial therapy. determine the value of mean arterial blood pressure leading to acute kidney failure during early septic shock and factors associated with mortality. Patients and methods: We conduct a prospective study during 6 months (from January to August 2018) including all patients presented septic shock. Patients with cardiogenic or and hypovolemic shock were excluded. We analyzed demographic characteristics, comorbidities, SAPSII score, respiratory, hemodynamic and neurological parameters, use of noninvasive or invasive ventilation, the impact of hemodynamic status on kidney function, length of stay and mortality. Results: We include 43 patients, sex ratio was 2.02, and SAPSII at admission averaged 52 ± 14 points. Thirty-seven percent of cases were admitted for respiratory distress. AKI was developed in 74.4%. Multivariable logistic regression analysis revealed that development of septic AKI was associated with older age, pre-existing chronic kidney disease, low mean arterial pressure (MAP) in septic shock day and in 24 h later. The ROC curve showed that AKI was developed in patients with MAP in septic-shock-day under 53 mmHg and under 75 mmHg 24 h later. In our study, incidence of AKI was higher in patients whom didn't receive fluid resuscitation (27 vs 5, p = 0.01). Mortality rates was higher in AKI group (p = 0, 01). The coexisting AKI, septic myocarditis and septic cholestasis was associated with a low outcome. Conclusion: The development of septic AKI is associated with poor clinical outcomes. Prevention and attenuation of septic AKI need a good fluid management and hemodynamic status adjusting. Despite large researches, the incidence and the mortality of septic AKI are high. Extensive studies to have best histopathologic information may be needed to a better management of kidney dysfunction in patient with septic shock. Introduction: Acute kidney injury (AKI) requiring renal replacement therapy (RRT) occurs in 5 to 6% of critically ill patients and is associated with high mortality. Higher sodium (Na) dialysate concentration (145 to 150 mmol/L) is recommended in order to improve intradialytic hemodynamic tolerance but may lead to sodium loading to the patient. Fluid overload has been associated with adverse ICU outcome. We aimed therefore to evaluate the flux of sodium according to 2 Na dialysat concentrations -140 and 145 mmol/L during hemodialysis (HD) and hemodiafiltration (HDF) sessions in ICU AKI patients. Patients and methods: All AKI patients requiring RRT were included prospectively in the study. Each patient underwent consecutive HD and HDF sessions with Na dialysate concentrations at 140 and 145 mmol/L. Sodium concentrations were measured in plasma before and after sessions and in affluent and effluent fluids. Flux of sodium during RRT sessions was estimated using mean sodium logarithmic concentration including diffusive and convective influx. We compared flux of sodium between HD 140 and 145, and between HDF 140 and 145 mmol/L Na concentration dialysate. Results: Four-teen patients entered the study with KDIGO3 AKI mostly septic of origin. Almost all of the patients required need vasopressor drugs (71%) and mechanical ventilation (79%). They underwent 39 RRT sessions -9 HD140, 10 HDF 140, 9 HD145 and 11 HDF145. A negative Na gradient from the dialysate replacement fluid to the patient was observed with each technique and each dialysate sodium concentration inducing a fluid overload. The comparison of HD 145 to HD 140 and HDF 145 to HDF 140 showed that higher Na dialysat induced a significant higher flux of Na to the patient and consequently fluid overload (Table) . ICU mortality rate was around 30% and survived patients have a mean creatinine clairance at 38.3 ml/min/1.73m2 at ICU discharge. Our study showed that during RRT a substantial Na loading occured and this Na loading increased significantly with elevated Na dialysate concentration from 140 to 145 mmol/L. Clinical and intradialytic hemodynamic tolerance of increased Na dialysate needs however to be further studied and analyzed. cardiomyopathy in 1 case (12.5%). Pulmonary arterial hypertension was found in all patients having CRS with a mean systolic PAP of 42.6 ± 11.6 mmHg. All patients with CRS had septicemia. Univariate analysis showed a significant association between CRS and acute circulatory failure at admission (p = 0.02). The occurrence of CRS was associated with an increased risk of mortality (p = 0.017). Conclusion: CRS is frequent in patients admitted for AE COPD and was significantly associated with circulatory failure at admission, as well as a significant risk of death. Introduction: Adverse events (AEs) are common. Recognizing and reporting AEs is a crucial step for caregivers to implement adequate strategies to improve patient safety. The aim was to evaluate the rate, risk factors of AEs and their impacts. Patients and methods: A prospective study conducted from October 2017 to June 2018 in a 9-bed medical ICU. All included patients were monitored for AEs. Variables found to be statistically significant in univariate analysis were introduced into a multivariate regression model to identify factors independently associated to AEs. 6%) , removing bladder catheter, 16(11.7%), accidental extubation, 13(9.5%), fall, 13(9.5%), catheter related bloodstream infection, 12(8.8%), acute renal failure, 11(8%) and venous thromboembolic events, 6(4.4%). Patients who presented AEs had significantly longer duration of IMV (13.52 ± 110.97 vs 3.5 ± 7.07 days, p = 0.000), longer LOS (18.20 ± 13.34 vs 10.04 ± 9.78 days, p = 0.000) and higher mortality rate (36.2% vs 13.2%, p = 0.008). Univariate analysis revealed the following factors to be associated to AEs respectively -age ≥ 65 years, (49.3% vs 13.2%, p = 0.044), SAPSII (30.67 ± 9.5 vs 24.6 ± 7.9, p = 0.000); IMV use (88.4% vs 23.5%, p = 0.00); vasopressors use (56.5% vs 19.1%, p = 0.00); corticosteroids' use (71.7% vs 50%, p = 0.012); sedative agents use (71% vs 22.1%, p = 0.000) and delirium (50.7% vs 32.4%, p = 0.000). Multivariate regression model identified two factors as independently associated to AEs: delirium (OR, 3.6; 95%CI, [1. Introduction: Early ICU admission has been proposed as a mean to limit risk of clinical worsening and to improve outcome of ICU patients. The aim of this review was to investigate the impact of early ICU admission in the general ICU population and in critically-ill cancer patients (CICP). Patients and methods: This systematic review was performed according to PRISMA statements and the protocol was registered in the PROSPERO database (CRD42018094828). Studies reporting impact of delay before ICU on outcome were searched on PubMed (1980-2017) for adult patients with or without cancer. Differences in term of mortality is reported as Risk Ratio (95%CI). Publication bias was assessed by visually inspecting the funnel plot and summary estimates of relative risk and their 95% confidence interval were calculated using both fixed and random-effects model. Results: Overall ICU population -Among the 663 citations identified for general ICU population, 29 studies reporting on 72,801 patients were included, including 66 768 patients for the early admission group. Early ICU admission was associated with decreased mortality using a random effect model (RR 0.65, 95% confidence interval 0.58-0.73, I2 = 66%) (figure). CICP -Among the 932 citations identified, 14 studies reporting on 2,414 patients (including 1,272 with early ICU admission) were included. Early ICU admission was associated with decreased mortality using a random effect model (RR 0.69, 95% confidence interval 0.52-0.90, I2 = 85%). To explore heterogeneity, a metaregression was performed. Characteristics of the trials (prospective vs. retrospective, monocenter vs. multicenter) had no impact on findings. Publication after 2010 (median publication period) was associated with a lower treatment effect (estimate 0.37, 95%CI 0.14-0.60, P = 0.002) in the general ICU population. A significant publication bias was observed. Several sensitivity analyses were performed using trim and fill method, Copas method and taking into account Outcome Reporting Bias, which confirmed findings to be robust in both the general ICU population and the CICP. Conclusion: These results suggest that early ICU admission is associated with decreased mortality in the general ICU population and in CICP. These results were however obtained from high risk of bias studies and a high heterogeneity was noted. Additional studies are required to confirm potential benefit of early ICU admission along with its cost-benefit ratio. Introduction: ICU Heath care workers (ICU HCW) use expensive devices for the care of their patients. Unfortunately lifetime of some of these multi users devices is often shorter than that could be waited for a single user utilization. The aim of this survey was to evaluate ICU HCWs' knowledge of the costs of device they regularly use during and for ICU patients' care. Patients and methods: HCWs of three ICUs-medical (1) medico surgical (2) university affiliated (2) were proposed to answer to an anonymous questionnaire aimed at measure their estimation of the cost of 44 devices or systems used in daily patients care. These include catheter, ultrasound device + Renal Replacement therapy device, ven-tilator…, Costs' estimation are expressed as percentage of real costs. Costs' estimation are compared using median and [1st and 3rd quartile] according to HCW status and magnitude of costs of device. A correct estimation was defined by an estimated cost equivalent to real cost ± 50%. Results: 128 HCWs accepted to take part to the survey providing more than 5600 costs estimation. Median global cost estimation for all the devices was 50% [14-215] and decreased with the real cost of devices -428% [375-2500] for a real cost < 100 €, 70% [18-210] for a real cost more than 100€ and < 1000 €, 52% [12-163] real cost between 10 000 and 100 000€ and 34% [9-78] for devices with a cost more than 100 000€. Accuracy of costs estimation was 6% (real cost ± 10%, 15% for an estimated cost ± 25% and 26% for an estimates cost ± 50%. Senior physicians performed better than junior physicians. Conclusion: HCWs are unaware of the real cost of the devices they use for ICU patients' care in 75% of the cases. Introduction: Clinical assessment of the severity of illness is an essential component of medical practice, especially in the intensive care unit (ICU). Multiple scoring systems have been developed for the ICU to risk stratify patient, predict outcome, help care providers in decision making and guide the allocation of resources. The aim of the study was to compare the performance of a local Validated clinical severity score (CSS) to severity scoring systems-Physiology and Chronic Health Evaluation (APACHE) system II, the Simplified Acute Physiology Score II (SAPS II), and the Sequential Organ Failure Assessment score (SOFA). Patients and methods: A retrospective study was performed in our MICU between January 2017 and December 2017. Data were collected by reviewing the medical patients' charts. Scoring systems were calculated based on the worst values recorded during the first 24 h of admission. Discrimination was evaluated using receiver operating characteristic (ROC) curves. Results: A total of 301 patients were enrolled in the study. Mean age was 55.5 ± 19.1. 63.1%(n = 190) were male. The most common reasons for admission were acute respiratory failure in 183 (60.8%) patients, neurological and cardiovascular disorders in respectively 46 (15.3%) and 35 (11.6%) patients. 177 patients (58.8%) were intubated and 129 (42.9%) needed vasopressors. Mean length of ICU stay was 11.2 ± 17 days. The mean SAPSII, Apache II, SOFA and CSS were respectively 31.2 ± 12, 12.9 ± 6.7, 4.4 ± 2.7 and 20.8 ± 11.9. The overall mortality rate was 29.9%. The best performing ICU scoring system in this study was CSS which had an area under the ROC curve (AUC) of 0. 786 (95% CI-0.728-0.845) (p = 0.000). SOFA, SAPSII and Apache II have respectively an AUC of 0.712 (95% CI-0.649-0.775) (p = 0.00) + 0.677 (95% CI-0.61-0.74) (p = 0.000) and 0.64 (95% CI-0.576-0.711) (p = 0.000) (figure 1). The findings of the present study showed that SOFA, SAPS II and APACHE II had good accuracy in predicting mortality in ICU. However, they are partially perfect. This emphasize the importance of repeated validations of these scores. CSS is an interesting, not time-consuming, costless and minimally invasive tool for predicting mortality in ICU. Introduction: Eliminating unnecessary health care may reduce the cost and improve the quality of healthcare. This study aimed to measure the appropriateness of hospitalization, and to identify patient and hospitalization characteristics associated with appropriateness of hospitalization in an Acute Medical unit of University Hospital. Patients and methods: Prospective data including all patients admitted to the Acute Medical unit were collected over 2 months. The appropriateness of 2263 hospital days contributed by 300 patients was assessed by means of Appropriateness Evaluation Protocol. We assessed equity in the distribution of hospital resources among patients, and the cumulative appropriateness of hospitalization by the means of Gini coefficient. The Gini index ranged from 0 to 1, where zero represents perfect equality in the distribution. Predictor variables included patient's anthropometric characteristics, and hospitalization characteristics. Associations between patient-related variables, and inappropriate hospital days related variables were studied using Generalized Estimation Equations for univariate and multivariate logistic regression analysis. Results: Overall, 10% of hospital admissions and 5% of hospital days were rated as inappropriate. In univariate analysis, inapproprite hospital days were more frequent among patients whose admission was inappropriate. Factors significantly related to inappropriate stays-Hospitalization in a single room (OR = 0.55, 95%CI-0.34 to 0.88, p=0.01). Absence of previous hospitalization (OR = 0.65, 95%CI-0.3to0.98, p = 0.04). No transfer request to another department (OR = 1.88, 95%CI-1.23to2.88, p = 0.003). No transfer done to another department (OR = 2.26, 95% CI-1.28 to 4, p = 0.005). Diagnosis of hematological disease (OR = 0.53, 95% CI-0.27 to 1.03, p = 0.05). In multivariate analysis, only the diagnosis of hematological disease remained significantly related to inappropriate stay (OR = 0.4, 95% CI-0.20 to 0.80, p = 0.001). The days of inappropriate hospitalization were less evenly distributed than the appropriate days, the Gini coefficients were 0.34 and 0.26 respectively. Conclusion: This study shows that inappropriate hospitalizations in an acute medical unit are frequent. At admission, one bed out of ten could be free, and one patient out of twenty could have a shorter stay. Considering that emergency departments are chronically saturated and have limited funds, inadequate hospitalization results in unnecessary cost and less efficiency and quality of care in the acute medical unit. Introduction: Many studies have focused on the work of hospital doctors, but little is known about the work of Intensive Care Unit (ICU) physicians, especially concerning the medical time spent outside the unit and its workload that has never been evaluated to date. The main objective of our study was to evaluate the time spent by ICU doctors outside the unit, for the management of their patients during the intra-hospital transport (IHT) and for the care of patients in other departments (vital emergency, advices on medical care and ethical discussion). Secondary objectives were to describe the organization and distribution of medical time outside the ICU. Patients and methods: In this prospective and observational study, which took place during 5 years, from January 2012 to December 2016 in two academics medical ICU (Strasbourg and Dijon), after each intervention outside the ICU, the intensivist doctor timed the intervention. Every day during the morning medical staff, the anonymized data were collected in a register. Results: During the five years of the study, 2874 h have been spent by intensivists outside the ICU in Strasbourg and 1740 in Dijon. This corresponds to an average of 574 h 32 min (± 175) per year, about 94 min per day in Strasbourg, and an average of 349 h (± 82) per year, about 58 min per day for Dijon. Over these five years, there were 5463 shifting, which corresponds to an average of 1,092 shifting (± 169) per year in Strasbourg. And 3028 shifting in Dijon, which corresponds to an average of 605,6 shifting (± 165) per year. About one third of this time was spent in the emergency department, one third in intra-hospital medical wards and the last third during IHT for ICU patients requiring a computerized tomography scan and or a cardiac catheterization. Discussion: A better understanding of the different activities and the respective part they occupy in the daily life of intensivists is essential in order to optimize the care for hospitalized patients. Conclusion: This prospective French bicentric study highlights the fact that the intensivists' medical activity outside their own unit is timeconsuming. This part of the intensivist activity is often unrecognized by the hospital administration and should now be taken into account concerning the routine activity of an ICU as well as the care given at the patient's bedside, the time devoted to the reception of families, and the time devoted to meetings. Introduction: Bacteraemia induces a high rate of morbi-mortality. Blood cultures (BCs) are the standard method for the diagnosis of bacteraemia. In France, practice recommendations exist concerning BCs with an update in 2016 to avoid inadequate sample resulting in false diagnosis, inadequate antibiotherapy, and prolonged hospital length of stay. Appropriate training for nursing students could promote good clinical practice since, in France, BC are mainly taken by nurses. The aim of this study is to evaluate the theoretical and practical training received by French nursing students at school and at hospital on BC execution as well as related hygiene practices. Patients and methods: We performed a cross-sectional study to evaluate the theoretical and practical training received by French nursing students and the hygiene practices concerning BC. The study was based on an electronic survey using a questionnaire sent out to all French nursing students between October 2017 and January 2018. The survey encompassed 22 short answer and multiple-choice questions. Results: One thousand and thirty-six nursing students filled out the survey-90% female, mean age of 24 ± 6 years. At nursing school, only 57% of the nursing students declared to have received theoretical training only on BC execution, 87% who received practical training only and 30% theoretical and practical training. During internship, 49% declared to have received practical training, 6% theoretical training and 45% declared no training. Among BC execution recommendations, peripheral stick and first aerobic are well known among 88% and 83% of the nursing students, respectively. Similarly, the practice of washing hands and cleaning the venepuncture site prior to BC execution are known among 96% and 94% of the students. In contrast, the practice of wearing gloves (80%) and facial mask (15%) is relatively lower. Conclusion: There are discrepancies between the knowledge base of nursing students and good practice recommendations for blood culture execution and related hygiene practices. Strengthening the teaching practices will likely improve students' knowledge base, reduce blood culture contamination and improve quality of care. Introduction: In-hospital admission of elderly patients resuscitated from out-of-hospital cardiac arrest (OHCA) has increased. If some authors reported favourable outcomes, others reported an increase risk of death or survival with loss of autonomy. In addition, the benefit of some interventions (i.e. transport to percutaneous coronary intervention (PCI)) and the time and resources associated with, should be evaluated. Consequently, we conducted a study evaluating the prognosis of the elderly OHCA patient in a region, with only one PCI center. We retrospectively included all patients aged 75 or older, admitted in 4 intensive care units (1 university-and 3 non university hospitals) after OHCA between January 2009 and December 2016. Cardiac arrest and patients characteristics have been collected and the Cardiac Arrest Hospital Prognosis (CAHP) score has been calculated. The primary outcome was the neurocognitive function assessed by the cerebral performance category on hospital discharge. Results: During the study period, 176 patients were included (median age 81 [79-84], 72% male). Most of the patients presented significant comorbid condition (median Charlson index 5 [3] [4] [5] [6] ). Sixty-eight patients had initial shockable rhythm (38.6%). Hundred sixty-six patients presented without obvious extra-cardiac cause. PCI was performed in 63 (35.8%) patients. The number of non-neurologic organ failure on admission was lower in patients with favorable outcome. All patients who received renal replacement therapy had an unfavourable outcome. The rate of favorable neurological outcome at hospital discharge was 9% (16 patients) including 14 patients with initial first shockable rhythm. At 6 months, this rate decreases to 6% (11 patients), including 9 patients with initial first shockable rhythm. According to the CAHP score, 21 patients had a low risk of poor neurological outcome, 44 had an intermediate risk and 70 had a high risk. Based on this CAHP score stratification, 14 patients (66.7%) in the low risk group, 21 patients (44.7) in the intermediate risk group and 18 patients (25.7%) in the high-risk group underwent early PCI. Conclusion: Survival of elderly patients is low after OHCA, especially for patients with first non shockable rhythm. However, patients with first shockable rhythm and low risk of death may have favorable long term outcome. The level of organ failure seems to be strongly associated with prognosis. Stratification by CAHP score suggest that the use of PCI coud be improved with a better selection of patients likely to benefit from it. Healthcare costs and resource utilization associated with treatment of out-of-hospital cardiac arrest Guillaume Geri (speaker) 1 We performed an analysis on a merged database of the Toronto Regional RescuNet Epistry database (prehospital data) and administrative population-based databases in Ontario. All non-traumatic OHCA patients over 18 years of age treated by the EMS between January 1, 2006, and March 31, 2014, were included in this study. The primary outcome was per patient longitudinal cumulative healthcare costs, from time of collapse to a maximum fol-low‐ + up until death or 30 days after the event. We included all available cost sectors, from the perspective of the health system payer. We used multivariable generalized linear models with a logarithmic link and a gamma distribution to determine predictors of healthcare costs. In-hospital costs accounted for 93% of total costs. After adjustment for age and gender, rate of patient survival was the main driver of total costs-the rate ratio was 3.88 (95% confidence interval 3.80, 3.95), 49.46 and 148.89 for patients who died in the ED, patients who died after the ED but within 30 days, and patients who were still alive at day-30 compared to patients who were pronounced dead on scene, respectively. Factors independently associated with costs were the number of prehospital teams, the need for hospital transfer, coronary angiography and targeted temperature management. Conclusion: Clinical outcome is the main driver of total costs of treating OHCA patients in a large Canadian health system. Potentially modifiable factors include the number of prehospital teams that arrive to the scene of the arrest and the need for between-hospital transfers after successful resuscitation. Hyperkalemia is related more to hypercapnia than to acidemia during lactate accumulation after cardiac arrest: impact on clinical management Matthieu Jamme (speaker) 1 Introduction: Low pH acidemia has been historically described as one of the major factors associated with hyperkalemia. But a few older studies suggested that, in the context of an elevated anion gap metabolic acidosis, acidemia is not linked to hyperkalemia. As a consequence, the administration of sodium bicarbonate, long considered as first-line therapy for acute hyperkalemia, was recently re-assessed for the treatment of either hyperkalemia. Regarding the high prevalence of hyperkalemia and acidemia in resuscitated out-of-hospital cardiac arrest (OHCA) patients, we share here our experience of severe acute type I lactic acidosis, the most frequent cause of metabolic acidosis in this setting. Patients and methods: We retrospectively analyzed first arterial blood gas results of 828 successfully resuscitated OHCA patients admitted to a tertiary Parisian intensive care unit. Baseline characteristics were compared according to the presence of hyperkalemia and factors associated with kalemia were identified using multivariable linear regression. sensitivity analysis was repeated in the subgroups of patients without chronic respiratory disease (CRD) and those without acute kidney injury (AKI). : Admission blood lactate was below 1.5 mmol/L in 88 828 (10.6%) patients and potassium levels were above 5.5 mmol/L in 93 828 (11.2%). Patients with hyperkalemia presented more frequently with initial non-shockable rhythm and experienced longer collapse before resuscitation. At ICU admission, patients with hyperkalemia presented with deeper acidemia (7.1 [6.95-7.18] vs 7.23 [7.13-7 .32], p < 0.001), higher lactatemia (7.3 [3.7-12.5] vs 5.1 [2.5-9], p < 0.001) and higher serum creatinine level (159 [102-230] vs 103 [77-137], p < 0.001). Following multivariate linear regression, kalemia was only associated with initial non-shockable rhythm (β = -0.34, 95%CI = -0.58 ± 0.11), higher creatininemia (β = 0.003, 95%CI = 0.002, 0.004) and elevated PaCO2 (β = 0.01, 95%CI = 0.005 + 0.02) but not elevation of lactate levels. Indeed, a statistical negative trend between potassium blood level and lactatemia was observed (β = -0.02, p = 0.07). Sensitivity analyses performed on patients without AKI and CRD showed similar results. Conclusion: Our study demonstrates the absence of an association between blood lactate and potassium levels during acidosis with severe acidemia in the successfully resuscitated OHCA patient setting. This phenomenon appears to be independent of AKI. Our results suggest that kaliemia are in fact strongly linked to arterial PaCO2. Introduction: Mitral velocity (E wave velocity and A wave velocity), and early diastolic mitral annulus velocity E' assessed by transthoracic echocardiography (TTE) and tissue Doppler imaging (TDI) are correlated to pulmonary artery occlusion pressure (PAOP) in cardiologic patients. These parameters are dependent on loading conditions, modified by mechanical ventilation and the use of catecholamine. In ICU ventilated patients receiving catecholamine, E A ratio and E' velocity has not been evaluated. Patients and methods: This observational prospective study included 12 consecutives patients (mean age = 61 ± 15.3 years) with septic shock and ARDS. All patients were treated with catecholamines (mean dose (mg h) = 3.4 ± 3.0) and ventilated (mean FIO2 (%) = 0.8 ± 0.3, mean tidal volume (mL kg) = 6.2 ± 0.5). A volume expansion was performed with Ringer lactate solution at the discretion of clinician. Echocardiographic, Doppler examinations and hemodynamic measurements were repeated after volume expansion. We obtained 32 measurements. Doppler mitral inflow and TDI mitral annulus velocities were determined and compared with PAOP measured by a Swan-Ganz catheter. All TTE parameters were analyzed off-line by an independent operator, blinded to clinical history and PAOP values. Results: Fluid challenge increased the ScVO2 (from 73.3 ± 10.1 to 76.0 ± 7.8%) and PAOP (from 11.2 ± 3.0 to 12.8 ± 3.4 mmHg). However, there was no difference in cardiac index (from 4.0 ± 2.1 to 4.0 ± 2.0 l min m 2 ). There was no significant correlation between PAOP and the E wave (Beta 4.64 IC 95% [-0.18, 9.47 Introduction: The central venous catheter (CVC) allows to infuse several drugs simultaneously in intensive care units thanks to the use of Y-set infusion lines. Many constraints are encountered in the management of pediatric populations-limited infusion rates according to the age of children, maximum infusion volumes in relation to their weight. Indeed, a limitation of the water supplies has to be performed because of the hyper-permeabilization of the vessels in this population. So, optimization of infusion sets is therefore essential to improve and secure this support. Our main objective was to evaluate infusion practices and to identify optimization suggestions. Patients and methods: Observation of infusion lines on CVC were conducted for 3 months (December 2017 to March 2018) in the pediatric resuscitation department. A restitution of these observations was carried out in the unit to form a working group to optimize the infusion setups. Several proposals for perfusion set will be discussed. Results: Conducted interviews with nurses lasted approximately 5 to 10 min according to a grid composed of multiple-choice questions and open-ended questions. 32 infusion lines were observed and 14 nurses interviewed (34% of the nurses staff ). This observation concerned 14 children under 1 year old, 12 children between 1 and 6 years old and 6 children over 6 years old. 37% of CVC were placed in jugular vein, 25% in femoral, 31% in subclavian and 7% other. There were 50% trilumen, 38% bilumen and 12% monolumen CVC. Only 51.9 ± 0.2% of available ports were used on infusion lines. CVC dressings were changed every 4 days or when they were soiled or unstuck. 71% of nurses declared problems with the dressing-dressings are too bigs for the youngers, inadapted for burned children, not yet sticky for those who drool. 79% of nurses have encountered drug incompatibilities during infusion through CVC but all surveyed nurses knew the existence of the unit's drug incompatibilities table. Conclusion: The evaluation of nurses practices highlighted a good knowledge of the types of infusion lines compared to the recommendations. However, efforts must be made to rationalize the number of lines available on the infusion set by integrating infusion devices with optimized geometry to limit drug incompatibilities. A discussion with the medical team about sizes of catheters according to the child weight will be engaged. Smaller dressings have been referenced in the unit and a modification in dessings change frequency was considered at 7 days. Introduction: Malnutrition is prevalent in children admitted to the pediatric intensive care unit (PICU). Inadequacy energy intake is known to be a risk factor for morbidity and mortality in critically children. SFAR (Société Française d'Anesthésie et de Réanimation) published in 2014 European nutritional guidelines. This study aimed to evaluate nutritional practices in a French PICU by comparing energy and protein intake using SFAR's recommendations and 2017 American recommendations and to identify risk factors of inadequate energy intake using SFAR's recommendations. Patients and methods: This study was retrospective in one PICU in a University's Hospital from 2014 to 2016. Children aged one month to eighteen years old who were receiving an exclusive enteral nutrition (EN) were included. Patient hospitalized less than 48 h, patient fed exclusively by oral or parenteral route were excluded. Individual energy and protein intake were calculated for each day and compared to SFAR's recommendations. Satisfactory energy intake was considered to be followed if equal to or greater than 90% of SFAR's recommended intake. Two groups were constituted and compared to identify risk factors between patients following or not the SFAR's recommendations-"optimal EN group" -children who received more than 90% of energy recommendation maintained for a least half of the ICU stay and "no optimal EN" if children didn't. Results: 418 patients were involved in this study. Malnutrition at admission occurred in 151 patients (36.6%). Average energy intake were 47.5 kcal kg day (IC95% = 27-62) that represented 75% and 87.8% of energy estimated intake by SFAR's recommendations and Schofield equation respectively. Energy intake received was closer to intake estimated using Schofield equation than those recommended by SFAR (Figure 1 ). SFAR's recommendations were respected for 43% of patients. The 2017 American recommendations were taken on board for 80% of patients. Average protein intake were 1.2 g kg day (IC95% = 0.6-1.5) that represented 67% of intake recommended by SFAR. 88 patients (21%) had an "optimal EN". The median time to initiate EN was longer in "no optimal EN" group. Vasopressors were identified to be a risk factor of no meeting the SFAR's recommendations (OR = 5.34, IC95% = 1-28.4, p = 0.04). Conclusion: Only 43% of patients respected SFAR's recommendations. Vasopressor was a risk factor of no meeting SFAR's recommendations. The 2017 American recommendations using Schofield equation were respected in 80% of patients. An enteral feeding protocol could reduce the median time to initiate an EN support. intolerance (HI) to depletion for children don't exist to our knowledge. Another study showed that calibrated abdominal compression (CAC) was able to predict fluid responsiveness in children with acute circulatory failure. Patients and methods: The primary objective of our study was to determine if the variation of stroke volume index (SVi) during CAC -our test index-can predict HI to depletion defined as a decrease of 15% of cardiac output after depletion of at least 10 mL kg in children with FO. We conducted a prospective non-interventional study in a french teaching hospital with a cardiologic ICU. All patients under eight years old who might be suffering from FO and who needed depletion with diuretics were selected. We only included those who had urinated more that 10 mL kg in less that two hours. We assessed the SVi with the Aortic Flow Velocity Integral by transthoracic echocardiography before depletion, during the CAC and after depletion. We recorded other hemodynamic parameters considered as secondary outcomes. Results: 47 patients were included after cardiac surgery. Only six had a decreased cardiac output by more than 15% after depletion. Introduction: In 2016 an international task force changed the definitions of sepsis and septic shock in adults, using an organ failure score named the Sequential Organ Failure Assessment (SOFA). The concept of new and progressive multiple organ dysfunction syndrome (NPMODS), corresponding to organ dysfunction aggravation, has been proposed as proxy of mortality in some critical diseases. Many criteria exist to define these organ dysfunctions-the Proulx criteria, the Goldstein criteria, the Pediatric Logistic Organ Dysfunction-2 (PELOD2) score, and the Pediatric SOFA score. The aim of the study was to compare these four definitions with each other, to find the best definition of NPMODS that could be used as surrogate outcome in the pediatric septic shock therapeutic trials. Patients and methods: This is a retrospective observational study, from January 2011 to December 2016, in a single PICU. Inclusion criteria were age < 18 years, hospitalization in PICU for septic shock (2005 definition). The primary outcome measure was PICU mortality. The secondary outcome was an evaluation of morbidity-mortality using the evolution of the Pediatric Overall Performance Category (POPC). Results: 149 patients were included. Mean age was 5 years (± 5.5 years), 16 patients (10.7%) were less than 28 days old. 18 patients died (12.1% of fatality rate). 44 patients (29.5%) had a significant worsening delta-POPC. The most common causes of septic shock were meningitis or meningoencephalitis (15.8%), purpura fulminans (15.1%), and intraabdominal infection (15.1%). Patients developed NPMODS in 26.2% according to Proulx criteria, 30.9% according to Goldstein criteria, 30.2% for PELOD2, and 28.9% for pSOFA. The four definitions used to define NPMODS were significantly associated with mortality and delta-POPC (p < 0.001). The deceased patients did not have scores that worsened in the first five days, but the scores did not improve. On the contrary, the scores of survivors improved within the first 5 days whatever the definition used. Conclusion: NPMODS definition could be a surrogate outcome of mortality, usable in pediatric septic shock therapeutic trials, whether using the Proulx, Goldstein, PELOD2 or pSOFA criteria. However, this definition only considers the onset or the aggravation of organ dysfunction. Further studies would be needed to create and validate an alternative definition, which incorporates the notion of non-improvement of organ dysfunction over time, which would better reflect the natural course of the most severe patients with pediatric septic shock. Introduction: Electrical velocimetry (EV) is a non-invasive method of continuous left cardiac output monitoring. The main objective was to validate EV by investigating the agreement in cardiac output measurements performed by EV and trans-thoracic echocardiography. Patients and methods: We conducted a prospective single-center pilot study in the 8 beds pediatric intensive care unit (PICU). We included children from 28 days to 10 years, with hemodynamic instability or circulatory failure, and excluded children with congenital heart disease or impossible chest access impossible. We simultaneously measured cardiac output by EV and echocardiography. Agreement, bias and precision of the measurements were analyzed by the Bland-Altman method. Bias < 10% and percentage error < 30% were considered clinically acceptable. Parameters of contractility (ICON for EV and Left ventricular ejection fraction) and preload dependance (Stroke Volume Variation SVV for EV and variation in aortic blood flow velocity in echocardiography) were compared. Results: 10 patients were included (median age 3.5 years [0. , median weight 17.25 kg [5.36-28] ), and 38 measurements were performed and analyzed. The bias and percentage error for cardiac output measurement were 0.46% and 21.73%, respectively. There was no correlation between the parameters assessing contractility (left ventricular ejection fraction in echocardiography and contractility index in EV) (r = 0.14, p = 0.38), or those evaluating the preload dependence (variation in aortic blood flow velocity in echocardiography and SVV in EV) (r = 0.193, p = 0.244). Conclusion: EV appears to be a reliable method of continuous CO monitoring compared to trans-thoracic echocardiography, but has its limitations on contractility and preload dependence parameters. The CARDIOREAPED study will follow this pilot study + it will start in November 2018 and will focus on 50 children. Introduction: Kawasaki disease (KD) is a rare acute systemic vasculitis occurring mainly in children under 5 years of age. The major challenge is the cardiac involvement that may require admission in intensive care unit (ICU) and can be life-threatening. It is common that patients requiering ICU don't meet all the American Heart Association (AHA) criteria, vascular damages being then often from the beginning complicated and the differential diagnosis -especially infectious -challenging. The risk is a delay of the treatment, in this case intravenous immunoglobulin (IVIg). Patients and methods: The aim of the study was to specify the caracteristics and the outcome of patients admitted to ICU for a potential KD complication and comparing patients who met the AHA criteria (AHA +) with patients who did not (AHA-). To that end, we collected national retrospective cases between 2001 et 2018, following a call from the scholarly associations (SOFREMIP, GFUP). We collected clinical, biological and echocardiography datas. Comparisons were based on Fisher's exact test for categorical variables and the student's t-test for continuous variables. Statistical analyses were performed using PRISM 5.0 and MedCalc + All tests were twotailed, and P < 0.05 was considered significant. Results: Patients who were not yet KD diagnosed at the admission to ICU presented either a sepsis in 25−48 (52%) (including toxic shock syndrom) or an acute abdomen in 12−48 (25%). Nearly half of the patients received vasoactive drugs. All patients except two received broad-spectrum antibiotics. All patients received at least one IVIG infusion. Resistance to first IVIG infusion was observed in 24−48 patients (50%). A second IVIG infusion was chosen in all of them. A third treatment line was needed in 16−24 (66.7%)-IV corticoid infusion was chosen in 15−16, in association with anti-interleukin 1 in 4 15 (Anakinra). 25−78 (52%) patients KD-ICU presented the AHA criteria, compared with 23−48 (48%) who didn't. Patients AHA-were younger, had a lower heamoglobine concentration and have been more intubated for mechanical ventilation. Conclusion: KD-ICU patients had no initial or evolutive differences whether they had complete or incomplete AHA criteria. A strong suspicion of KD in ICU is therefore enough to initiate specific therapeutics such as IVIG. Further analysis will define the phenotype of patients with KD-ICU to target them earlier, comparing them to KD who did not need ICU transfer, via the KAWANET French database. Introduction: Bronchiolitis is the first cause of hospitalization in infants. Six to 20% of them are admitted in a pediatric intensive care unit (PICU). Some will develop complications related to respiratory distress, like seizures and hyponatremia. The aim of our study was to describe the occurrence of hyponatremia in bronchiolitis infants under the age of three months admitted to PICU and the associated morbidity. Patients and methods: We conducted a retrospective study including all infants younger than 6 months, admitted to Lyon-France PICU with a diagnosis of bronchiolitis between January 2010 and April 2018. Children with previous history of significant heart diseases or neurological impairment were excluded. The study was approved by the ethical committee of the French society of intensive care. Hyponatremia was defined as a plasma sodium level < 135 mmol/L at any time during PICU stay. T test and Chi2 were used to compare the hyponatremia group and the no-hyponatremia group. A p-value below 0.05 was considered significant. Results: A total of 803 infants were included and among them, 726 had at least one available natremia value. hyponatremia occurred in 33.6% (n = 244) children and 6.8% (n = 50) had a natremia below 130 mmol/L. Age (36 + -21 vs 36 + -19 days in hyponatremia group, p = 0.83) and weight (3879 + -884 g vs 3835 + -784 g, p = 0.49) was similar between the two groups. Comparison on severity factors between the 2 groups are presented in table 1. Conclusion: Hyponatremia occurred in one third of infant younger than 3 months years old admitted to PICU for bronchiolitis. Hyponatremia was associated with other severity factors of bronchiolitis, with more frequent seizures and with longer length of PICU stay. Hyponatremia needs to be monitored, prevented and treated accurately in infants with severe bronchiolitis. Samia Benouaz (speaker) 1 , Faiza Nadia Benatta 2 , Setti Aouicha Zelmat 2 , Djahida Djamila Batouche 2 , Ibtissem Bouanani 1 1 Faculté de médecine, Sidi-Bel-Abbès, ALGERIA; 2 Faculté de médecine, Oran, ALGERIA Correspondence: Samia Benouaz -dr_benouaz@hotmail.fr Annals of Intensive Care 2019, 9(Suppl 1):P-133 Introduction: Hyponatremia is a common fluid and electrolyte disorder. Its incidence is estimated at 0. 34% in operated children. 10% of hyponatraemia occur in the postoperative period. Objective-To determine the circumstances of occurrence of this hyponatremia. Patients and methods: Retrospective study, from (2015-2017), carried out in the pediatric surgery and multipurpose resuscitation departments of CHU Sidi-Bel-Abbès. Included were all acute hyponatraemia, with or without neurologic symptomatology, following controlled surgery in healthy children and or with a pathology that did not lead to fluid and electrolyte disturbance. Results: Of all the hyponatraemia identified during the study regardless of the mechanism, 17 children presented with iatrogenic acute hyponatremia. The children were operated on for circumcision (2), fracture reduction (6), orthopedic surgery (clubfoot and LCH) 7cas and thyroglossal cyst (2) . The serum sodium ranged from 114 mmol/L to 128 mmo L. All patients presented with vomiting. Three children had generalized seizures. Brain CT found diffuse cerebral edema. The evolution was favorable in 16 17 cases with one death. In addition to anticonvulsant therapy in 03 patients, the treatment of hyponatremia involved the administration of sodium salts at a rate of 1.5 to 2 mmol hour to the PES during the 12 h under control of clinical status. and the ionogram. Discussion: These children, who presented with iatrogenic acute hyponatremia, underwent simple surgeries, and were, with one exception, children of ASA1 class. They were all perfused in the perioperative period with hypotonic, high-throughput fluid. Blood glucose was moderately high, children were not hypovolemic on arrival. The circumstances of occurrence can be explained by-A dilution related to the infusion of hypotonic solution too abundant with a flow not monitored by our nurses due to lack of personnel. Prolonged preoperative fasting (more than 8 h) in our series that may be accompanied by hypovolemia responsible for the secretion of ADH, a component added to the iatrogenic factor. Conclusion: Follow-up of good practices for perioperative pediatric perfusion, the use of adapted equipment (precision infusion pump, volumetric pumps), a strict control of the infusion rate, an education of the nursing staff and a permanent abandonment of pseudo prescriptions of the type to keep the vein are fundamental to avoid this type of ionic disorder in children postoperatively. Introduction: In traumatology, triage is a dynamic process that starts at the trauma scene including prehospital care, continues with trauma team activation in a trauma center when required and ends with patient admission to an adequate unit hospital. Referral of severely injured children to a level 1 Pediatric Trauma Center (PTC), like the Hôpital Femme Mère Enfant (HFME) (Lyon, France), reduces mortality. In HFME, local guidelines have been established for trauma team activation by prehospital carriers from the trauma scene or by emergency physicians from the emergency department (Level 1 criteria-vital distress, Level 2 criteria-vital distress stabilized after prehospital care, Level 3 criteria-no vital distress but mechanism of injury criteria). Patients and methods: We conducted a retrospective study of 215 patients admitted to HFME in 2016 with trauma team activation criteria according to local guidelines. Level 1 or 2 patients, and level 3 patients presenting with an injury severity score (ISS) > 15, were considered severely injured. Four types of undertriage were defined at the different stages of support-prehospital undertriage «transport», prehospital undertriage «orientation», «emergency department undertriage» and «final undertriage», considered to be the main undertriage ( Figure 1 The rate of undertriage in our PTC in 2016 is above recommendations of less than 5%. The prehospital triage seems to strongly impact the course of patient care. Evaluation of the traumatized child is complicated even for professional first-aiders. The high rate of «emergency department undertriage» shows that the triage also needs to be improved in emergency departments. Introduction: Diaphragm dysfunction and weaning induced pulmonary edema (WIPE) are two main causes of weaning failure. Since spontaneous breathing-increased venous return is a key determinant of WIPE, we hypothesized that diaphragm dysfunction could not provide a thoracic depression enabling the occurrence of WIPE. Therefore, the objective of the study was to determine the prevalence of WIPE and diaphragm dysfunction and their coexistence. Patients and methods: Patients intubated since more 48 h were eligible after they failed at a first spontaneous breathing trial (SBT). Before and after the following SBT, diaphragm function was evaluated with the reference method (drop in tracheal pressure induced by a bilateral phrenic nerves stimulation) and cardiac echo (early (E) over late (A) peak diastolic velocities ratio and tissue Doppler imaging of mitral annulus velocities including early (Ea) peak diastolic velocity over A wave ratio) and biological (hemoconcentration) markers of WIPE were searched for. Diaphragm dysfunction was defined by a Ptr, stim < -11 cmH20. WIPE was defined by a failed SBT associated with 1) either the combination of E A > 0.95 and E Ea > 8.5 at the end of the SBT or 2) an increase in plasma protein concentration or in hemoglobin > 5% during the SBT. Results: Among 34 patients included, twenty-one (62%) failed in the SBT. WIPE was present in 15 21 (71%) patients who failed. Diaphragm dysfunction was found in 17 21 (81%) patients who failed and both mechanisms were present in 14 21 (67%) patients. Except in one patient, in all patients in whom WIPE occurred, diaphragm dysfunction was found (figure). Conclusion: Coexistence of diaphragm dysfunction and WIPE is frequent at the time of liberation from mechanical ventilation in difficult to wean patients. The presence of diaphragm dysfunction doesn't reduce the risk of WIPE. Extracorporeal membrane oxygenation in adult cancer patients with severe acute respiratory failure-view of a cancer center Afef Hammami (speaker) 1 Introduction: Using extracorporeal membrane oxygenation (ECMO) in adult cancer patients is controversial. This study was designed to report outcomes of adult cancer patients treated with ECMO for severe acute respiratory distress syndrome (ARDS) after the failure of optimal conventional therapy. We also identified their pre-ECMO predictors of ICU and 6-month mortality. Patients and methods: The charts of all cancer patients admitted to our oncology ICU and receiving ECMO support for ARDS from 2011 to 2017 were retrospectively reviewed. The cases were recorded using both PMSI data and analysis of computerized records by keywords systematic detection. After placement of cannulas, all patients were transferred from our hospital to a specialized ICU for ECMO therapy. Results: Fourteen patients received ECMO during the study period (Table) . One patient received venoarterial-venous ECMO because of acute circulatory failure in addition to ARDS. All other patients received venovenous ECMO. ECMO-related major bleeding and ventilatorassociated pneumonia were frequent (50% and 42.9%, respectively). Respective median ECMO duration and ICU stay were 10 (5-43) and 27.5 (11-57) days. ICU and 6-month survival was 28.6%. The four survivors had a significantly shorter time interval between ICU admission and start of ECMO therapy (4 vs. 11 days), lower PCO2 at baseline (45 vs. 62 mmHg), and, after ECMO initiation, lower health care-associated infection (1 vs. 9 episodes) and shorter ECMO duration (6 vs. 19 days). Discussion: The limitations of this study are its retrospective design and the small number of cases involved. Obvious selection bias was induced because only the patients treated with ECMO were included. The systematic computerized analysis ensured the lack of missing data. Despite the high rate of ICU mortality, this study showed that all survivors were still alive 6 months later. Early beginning of ECMO, avoiding ventilator-induced lung injury, was associated with a better prognosis. These findings encourage identifying as soon as possible patients with a favorable prognosis of malignancy and having an isolated respiratory failure, in order to optimize their chances of recovery from ARDS. A close cooperation of intensivists and oncologists is warranted. Conclusion: ECMO therapy may be beneficial in selected cancer patients. Ongoing investigations are needed to better select patients with a likely benefit, and determine optimal timing for initiation of ECMO. Introduction: Systemic lupus erythematosus is a chronic autoimmune disease characterised by frequent skin, joint, haematological and renal involvement. Acute interstitial pneumonia (AIP) is infrequent and poorly investigated in this disease. The aim of this study was to describe the clinical characteristics, the course and the outcome of AIP in SLE. We conducted a monocentric retrospective, observational, cohort study between November 1996 and September 2018. We included all patients with SLE (defined using the American College of Rheumatology 1997 criterion) and AIP (defined as acute respiratory manifestation with diffuse pulmonary opacities on chest radiography or lung tomography and exclusion of alternate diagnosis including acute respiratory infection). Results: Fourteen patients (male female sex ratio, 0.3 + mean ± SD age, 23.7 ± 10.6 years) presenting 16 episodes were included. AIP was present at disease onset or during the first year after SLE diagnosis in respectively 9 14 (64%) and 5 14 (36%) patients. Eleven (68.8%) episodes required ICU admission because of respiratory failure with 7 11 (63.6%) episodes requiring mechanical ventilation and 2 11 (18.2%) VV-ECMO. Median Introduction: Severe pneumonia is frequently associated with acute respiratory distress syndrome (ARDS). Uncontrolled inflammatory response in the lung is a key factor in the transition from pneumonia to ARDS. However, the underlying mechanisms are still poorly understood. To assess this, a heterogeneous population of T lymphocytes called "unconventional T cells" (UTC) deserves greater attention. These cells comprise Natural Killer T (NKT) cells, mucosal-associated invariant T cells (MAIT) and Gamma Delta T cells. Pre-clinical studies have shown their versatile properties and their key role in immune responses against invading pathogens. Thus, we hypothesize that a tight regulation of their functions is mandatory to fine-tune the host inflammatory response in the infected lungs, and, subsequently to prevent emergence of an aberrant response leading to tissue damages. Despite this strong rationale, human data are however lacking. Patients and methods: Single-center prospective study on patients hospitalized in intensive care for severe pneumonia. From blood and respiratory samples, we performed a flow cytometry-based analysis of these cells in order to determine-(1) their frequency at different time-points during hospitalization, (2) the presence of activating regulating markers (CD69 and PD-1), (3) their ability to produce cytokines involved in ARDS pathogenesis and (4) their cytotoxic capacity. Results: 26 patients have been included to date, that were compared to healthy controls. Half of the patients presented ARDS, and median SAPSII was 35.5 (30-51). In patients with severe pneumonia, we observed a striking decrease in circulating MAIT cells, compared to healthy controls (Fig. 1A) , but not for NKT or Gamma Delta T cells. This observation may suggest a recruitment of these cells to inflammatory site since a high proportion of MAIT cells can be detected in respiratory fluids of some patients with ARDS. In addition, circulating MAIT cells of patients expressed high levels of CD69 and PD-1 (Fig. 1B) . Interestingly, the proportion of CD69 + MAIT cells decreased with clinical improvement, while proportion of PD-1 + remained stable. Upon ex vivo stimulation, proportion of IFN-gamma-producing MAIT cells was significantly decreased in patients, compared to healthy controls (Fig. 1C) , while proportions of IL-17 and TNF-alpha-producing MAIT cells were similar. Conclusion: MAIT cells are recruited, activated and have an altered cytokine profile secretion during severe pneumonia. These preliminary data justify pursuing in-depth analysis of MAIT cell functions in patients, in correlation with clinical condition. Introduction: Venoarterial ECMO-treated patients present many risk factors of breathing failure associated to heart failure. It seems essential to optimize the ventilatory parameters in order to limit lung injuries. The aim of this study is to evaluate the ability of electrical impedance tomography to set the optimal level of Positive End Expiratory Pressure (PEEP). We performed an alveolar recruitment maneuver followed by a decremental PEEP trial (from 20 to 5 cmH2O) with 5cmH2O decrements. Thanks to clinical and ultrasonographic parameters (heart and lung), we define an optimal PEP according to respiratory criteria (PEEPlung), then an adjustment according to hemodynamic and cardiac tolerances defines the PEPheart + lung. EIT datas (regional distribution of ventilation, z-compliance, overdistension collapsus ODCL and global inhomogeneity index GI) were recorded during the procedure and analyzed retrospectively to define the optimal PEEPs-PEEPCOMP, PEEPODCL, PEEPGI. A Friedman test compares the different optimal PEEPs between them, as well as the regional ventilation distribution at the 4 PEP levels. Agreement between PEEPlung and other measured PEEPs was analyzed by Cohen's kappa coefficient. Results: 23 patients were included and analyzed during a 9 months period. PEEP decreasing increments ventilation in the ventral region from 12 to 22% (corresponding to overdistension), and a decrease in the dorsal region from 11 to 5% reflecting collapse. The collapse (CL) is maximum at PEEP5 29% [21-45.8], and the distension is maximum at PEEP20cmH20 34% [24. . There is no significant difference between the different optimal PEEPs. The agreement is average between PEEPlung and optimal PEEP calculated from the EIT parameters (kappas 0.41 and 0.47). Our choice of PEEPlung is questionable because based on the global static respiratory compliance parameter that is measured on a single respiratory cycle. Measuring transpulmonary pressures could precise our measurements. PEPlung is statistically higher than the PEPheart + lung (p < 0.05), reflecting a bad hemodynamic tolerance of high levels of PEEP due to a complex phenomenon of heart-lung interactions. Conclusion: EIT helps find the best compromise between overdistension and lung collapse, and detect regional distributions of the mechanical ventilation effects. However, evaluation of the chosen PEEP hemodynamic tolerance is necessary. The association EIT-echocardiography seems to be an efficient tool to provide monitoring of the PEEP effects. 1) . Conclusion: Changes in CVP during PLR are not useful at the bedside to predict preload unresponsiveness in critically ill patients. However, it is crucial to distinguish patients who will respond to fluid challenge by improving their cardiac output from those who will not. Inferior vena cava (IVC) diameter variation is one of the several indicators proposed to predict fluid responsiveness. However, the efficacy of this indicator remains controversial. In this study, we tested the hypothesis that respiratory variation in IVC cross-sectional surface could be a better predictor of fluid responsiveness than IVC diameter variation. Patients and methods: Prospective study in mechanically ventilated patients after cardiac surgery. A 500-ml crystalloid fluid challenge was administered over a 25-minute period of time. Collected data included pulse pressure variation, respiratory variation in IVC diameter and respiratory variation in IVC cross-sectional surface. The IVC was studied in a sub-xyphoidal view. Fluid responsiveness was defined as a 15% increase of the cardiac output obtained by Swan-Ganz catheter continuous thermodilution. Analyses were performed using parametric or non-parametric tests according to variables distribution. The ability of parameters to predict fluid response was assessed using ROC curves. Results: Population of the study consisted of 31 consecutive patients aged 68 ± 10 years-65% were male and the main types of surgeries were coronary artery bypass grafting (42%) and valvular surgery (32%). There were no statistical differences between responders and nonresponders for static parameters including heart rate, central venous pressure, minimal and maximal IVC diameters. Respiratory variation in IVC diameter and IVC distensibility index were unable to predict fluid response as showed by an area under the ROC Curve (AUC) of 0.45 for both indicators. Discrimination power of pulse pressure variation was fair (AUC-0.6). In our study, the best predictor of fluid responsiveness was the respiratory variation in IVC cross-sectional surface with an AUC of 0.7 ( Figure 1 ). The novel dynamic index obtained from cyclic variation of the IVC cross-sectional surface could be a candidate to predict fluid responsiveness. Consistently with previous studies, IVC diameters failed to distinguish fluid responders from non-responders. In our study, the fair ability of pulse pressure variation to predict fluid response could be explained by rapid changes in patients' hemodynamics, as shown by the significant drop of systemic vascular resistance observed during the fluid challenge. Introduction: Valproic acid (VPA) overdose causes life-threatening disorders including hyperammonemia and hyperlactatemia. L-carnitine has been used for several years as antidote to reverse VPA toxicity without evidence of effectiveness. We aimed 1)-to describe the features and outcome of VPA-poisoned patients admitted to the ICU and 2)-to investigate the effects of L-carnitine treatment on VPA pharmacokinetics (PK) and its contribution to the patient prognosis. Patients and methods: We conducted a retrospective single-center cohort study. All consecutive patients admitted to the ICU for acute VPA intoxication (defined as presence of compatible symptoms with plasma VPA concentration > 90 mg L) between February 1998 and December 2016 were included. L-carnithine was administered according to the physician in charge. VPA elimination half-lives were determined using a non-compartmental approach. Populationbased model for VPA PK and individual pharmacodynamics (PD) were obtained. The effects of L-carnitine were investigated using multivariate analysis in a propensity score matching study. Results: Sixty-nine patients were included. The most frequent presentation was consciousness impairment (70%) with multiorgan failure (SOFA score, 4 [1-6] (median [percentiles 25-75]). The most frequent biological impairment was increase in lactate concentration (2.9 mmol/L [1. 8-4.2] ). Patients treated with L-carnithine presented significantly higher peak lactate concentration (4.6 mmol/L [3.0-6.1] vs. 3.5 [2.5-4.9], p = 0.002) and more severe neurological disorders (79% vs. 34%, p = 0.001) but not significantly different VPA concentrations. However, based on the propensity score approach, the only difference associated with L-carnithine administration was plasma lactate on admission (p = 0.001). When comparing matched L-carnithine-treated and non-treated patients, no significant benefit of L-carnithine was demonstrated using the difference between the worse and the admission values of the SOFA score, the delay in plasma lactate normalization and the VPA half-life. The pharmacokinetic parameters of the well-fitted population-based model of VPA PK in overdose were Ka of 0.5 h-1, Ke of 0.03 h-1, and half-live of 4.2 h. Conclusion: VPA poisoning is responsible for life-threatening features including hyperlactatemia. Treatment using L-carnithine did alter neither VPA elimination nor patient outcome in the ICU. Our PK and PD models appear helpful to improve the management of the VPA-poisoned patients by allowing the identification of the conditions of interindividual variability. Introduction: Acute intoxication is a common reason for admission to emergency care and resuscitation services. The objective of this study was to determine prognostic factors related to acute intoxication for a young population. Patients and methods: This is a retrospective study which includes acute intoxications admissions to the intensive care unit for the year of 2017. Epidemiological, biological and therapeutic parameters were collected and an uni following by a multi-varied analysis were performed to determine the independent factors of mortality. Results: During the study period, 762 patients were admitted to intensive care for acute intoxication. The average age was 31 ± 14 years old. When intoxication was voluntary in order to commit suicide, the most incriminated toxicants were drugs (n = 486 + 64%) especially psychotropic drugs (n = 284, 58%) and pesticides (n = 179 + 23.5%) with chloralose as a leader (n = 137 + 76%). For accidental poisoning, carbon monoxide (CO) ranked first (n = 56 + 7.3%). The clinical picture was dominated by coma (n = 292, 38%) and digestive disorders (n = 129, 17%). The IGSII and APACHE II admission severity scores were 16 ± 6 and 8 ± 3, respectively. During the stay, the main complications were inhalation pneumonia in 102 cases (30% of rodenticide poisoning), shock in 50 cases (7.8% of drug poisoning) and rhabdomyolysis in 44 case (18% of CO poisoning). Nosocomial infection was observed in 14 patients (2%). Therapeutic management was mainly symptomatic with the use of mechanical ventilation in 290 cases (38%), antibiotics in 14% of cases and vasoactive amines in 7% of cases. Overall mortality was 1.4% of all acute poisonings (n = 11). The independent mortality factors were-a greater score than 18 (OR = 2 + p < 0.001) for APACHE II, the occurrence of hepatic cytolysis (OR = 1.3 + p = 0.001), an acute renal failure (OR = 1.2 + p < 0.001), recovered cardio-respiratory arrest (OR = 2.4 + p < 0.001) and length of stay more than 05 days (OR = 1.4 + p < 0.001). Conclusion: Although mortality from acute intoxication is low, it is essential not only to raise awareness of the dangers of poisoning by certain cardiotoxic drugs, but also to legislate the sale of insecticide products. Minoxidil-from a hair lotion to a toxic shock in intensive care unit Takoua Khzouri (speaker), Hela Maamouri, Nasreddine Foudhaili, Ikram Benjaberi, Nozha Brahmi Camu, Tunis, TUNISIA Correspondence: Takoua Khzouri -takoua_kh2@yahoo.fr Annals of Intensive Care 2019, 9(Suppl 1):P-156 Introduction: Minoxidil is commonly used for the treatment of androgenic alopecia and has been wrongly considered safe. Several poisoning cases mainly pediatric proved that the ingestion of a few milliliters can lead to significant intoxication. In this perspective, we carried out this to illustrate the different characteristics of this poisoning in order Introduction: The terrorist threat in France is real, with very different forms of attacks. So, it is challenging to train numerous non-specialized caregivers, with different backgrounds, in damage control (DC) strategies. The purpose of this work is to propose a specific training program, providing them a standard of care, with the very ambitious goal of zero avoidable deaths. Patients and methods: A Task Force of 15 civilian and military physicians, experts in tactical medicine and medical training, met for a 24 h session, to propose the construction of a DC training program for nonspecialized caregivers. Results: DC training programs exist already but are heterogeneous, mainly theoretical and almost only for physicians. The Task Force has identified holes in existing training. A program named Damage Control for Terrorist Attack Victims (DC-TAV) was then proposed. Identified training targets were caregivers (physicians, nurses and nursing assistants), from prehospital and hospital staffs, with no trauma experience. The training objectives were the improvement of individual and collective skills for DC strategies for management of terrorist attacks casualties. The tools selected for training concerned e-learning on a dedicated digital teaching platform (including a core section of 4 modules with types and mechanisms of injury, basic DC techniques, triage, organization of emergency medical response + and 2 complementary modules for doctors with DC resuscitation and DC surgery), handson workshops with procedural simulation and full scale simulation exercises, technical (tourniquets, hemostatic gauzes, needle thoracostomy, chest tube drainage, management of airway, coniotomy) and non-technical (leadership, communication, coordination and triage, decision-making, appropriate use of resources) skills. A feasibility pilot study has been proposed in a rural area with no Trauma center, nor University Hospital. Finally, an evaluation of DC-TAV was planned, using the same tools as those used for training. The DC-TAV program is an ambitious, civilian-military, national and long-term program. It is based on a harmonized standard of care and includes multidimensional training. Introduction: Despite an increase of organ donation, hundreds of patients die on waiting list every year. One of a solutions suggested by the Agence de la Biomédecine (ABM) was to develop organ donation from non-heart beating donor (NHBD) and particularly NHBD from category III of Maastricht classification (NHBD M3). This has been allowed since 2014 after some changes in French laws and a program launched by the ABM. We want to initiate organ donation from NHBD MIII in our hospital, CHU Besancon, in order to increase our graft pool. In 2015, 42 patients died after brain death and 28 patients were organ donor (DBD) in our hospital. We performed a retrospective analysis all of the deaths following a withdrawal of life sustaining support treatment (WLST) in intensive care unit (ICU) in 2015, using data from medical record. Primary endpoint was to identify how many patients could be NHBD M3. Eligibly criteria were-death in ICU after WLST, age between 18 and 65 years, major brain damage with no hope for recovery. Were excluded patients who present a contraindication of organ donation. Results: In 2015, 68 patients died after WLST and 29 were 65 year old or less. We excluded 13 patients-7 patients with cancer, 4 patients with multiple organ failures, 1 patient died before WLST, 1 patient was not brain injured. 16 patients could be NHBD M3 with a median age of 49[39-58], 80% were men. The cause of brain damage was for 11 patients a post anoxic encephalopathy, 3 subarachnoid hemorrhage, and for 2 patients brain trauma. The examination of medical record suggests that 15 patients could donate their kidneys and 11 patients could donate their liver (based on data few days before death). 50% patients died in the 3 h after WLST, and 1 patient has an uncontrolled infection which left 7 potential kidney donors and 5 potential liver donors. Conclusion: In 2015, 16 patients were identified to be potentially a NHBD M3 in CHU Besancon in addition to 28 DBD. The data shows that patients were young and in good health which suggest a great quality of graft despite potential warm ischemic injuries due to the NHBD. Positive experience of the other hospitals since 2014 encourages us to initiate our program. Introduction: Transcranial Doppler (TCD) is a non-invasive examination that allows velocimetric study of intracranial vessels via an ultrasound beam. The authors propose to study the statistical and therapeutic impact of TCD and trauma coma databank (TCDB) data coupling in moderate cranial trauma in ED. This was a 12-month prospective study, including all patients > 15 years old, who had moderate head injury (GCS 9 to 13), initially admitted to the vital emergency room, and having immediately benefited from a cranio-cerebral CT and a DTC within 12 h post-admission, without respiratory and or hemodynamic distress and without gasometric anomalies (normal PaCO2 and absence of anemia). TDM allowed to distinguish 6 classes of trauma coma databank. The measurement of DTP was considered from a stable pattern over ten cardiac cycles. The parameters measured were-systolic velocimetry (SV), mean velocimetry (MV), and diastolic velocimetry (DV) as well as the pulsatility index (PI). The cerebral perfusion pressure was deduced by the equation-MAP x (DV MV) + 14. The data collection was concerned with demographic data, vital parameters and neurological deterioration at H48. The statistical analysis was univariate, (p < 0.05). Results: 32 patients were included in this study, divided into two groups-group 1 (n = 22 69%) without neurological deterioration, and group 2 (n = 10 21%) with neurological deterioration. The mean age of the two groups was 36.56 ± 20.09 years, with a sex ratio of 16H 6 for group 1 and 7H 3F for group 2. The average initial GCS was 12 15 for the group 1 and 10 15 for group 2. 20 patients in group 1 had a TCDB of 1 to 2, while only 2 had a TCDB of 3 to 5. In group 2, 6 patients had a TCDB of 1 to 2, and 4 patients had a TCDB of 3 to 5. The PI of group 1 was 1.26 ± 0.60, while the PI of group 2 was 1.74 ± 0.26. The statistical performance of DTC, CTDB, and DTC CTDB coupling for the occurrence of neurological worsening is illustrated in the following table 1. Coupling DTC TCDB data would increase the statistical predictive performance of early neurological deterioration, with high sensitivity, specificity and VPN. It would also guide the intensity of neuro-resuscitation. Results to be confirmed on a larger cohort. Introduction: The immune system plays a central role in surveillance against neoplasms development. We developed a research project investigating the impact of sepsis-induced immune dysfunctions on malignant tumor growth. In sepsis-then-cancer model, it is likely that sepsis-induced immune suppression promotes tumor growth. In cancer-then-sepsis model, sepsis may rather inhibit tumor growth. We herein investigated how sepsis and Toll-like receptor (Tlr) signaling may promote the antitumoral functions of cytotoxic natural killer (NK) cells and TCD8 lymphocytes (TCD8). Patients and methods: We used C57BL 6 J wild-type (WT), Tlr4--, Tlr2--and Myd88--mice. Mice were first subcutaneously inoculated with MCA205 fibrosarcoma cells. Fourteen days later, mice were subjected to a septic challenge through polymicrobial sepsis induced by cecal ligation and puncture (CLP) or endotoxinic shock induced by intraperitoneal lipopolysaccharides (LPS) injection. The main functions of tumor-associated cytotoxic NK cells and TCD8 were assessed by flow cytometry through intracellular expression of interferon-gamma (IFN-γ +) and of cytotoxic molecules perforin and granzyme, as well as outer membrane expression of the degranulation marker CD107a. In order to address their cytotoxic functions in vitro, NK cells were isolated from septic or control mice and exposed to MHC1low YAC-1 or MCA205 tumor cells. Results: Polymicrobial sepsis dampened tumor growth in WT and Tlr2--mice, but neither in Tlr4--nor in Myd88--counterparts. A similar tumor growth inhibition was observed following a LPS challenge in WT mice. The distribution of tumor-infiltrating NK and TCD8 cells was weakly affected by sepsis. TCD8 did not undergo any significant functional changes. Among NK cells, LPS induced an expansion of the cytotoxic CD11b + CD27 + and CD11b + CD27-subsets along with increased expression of the activation marker NKG2D. Tumorinfiltrating NK cells obtained from septic mice exhibited enhanced antitumoral properties. NK cells obtained from CLP-operated mice displayed increased expression of IFN-γ + . The behaviour of NK cells obtained from LPS-challenged mice was consistent with an active degranulation process, as suggested by increased CD107a membrane expression along with decreased intracellular expression of perforin and granzyme. MHC1 expression was low in MCA205 cells, similar to that in YAC-1 cells. The antitumoral properties of NK cells obtained from septic mice were exacerbated when cultured with MHC1low YAC-1 or MCA205 cells. Introduction: To date, maintaining fibrinogen levels above 2 g L is a recommended therapeutic target in postpartum hemorrhage. However, the timing of fibrinogen supplementation is still controversial. The purpose of this retrospective study was to describe our experience in early administration of fibrinogen concentrate in severe PPH. Patients and methods: We analyzed a database of 33 patients who needed fibrinogen concentrate transfusion for the treatment of severe postpartum hemorrhage after cesarean delivery to treat coagulopathy (plasmatic fibrinogen < 2 g/L), or after massive transfusion, or earlier (before the result of plasmatic concentration of fibrinogen). Patients were divided into two groups. • Group E (early) -received fibrinogen concentrates within the first hour after delivery. • Group L (late)received fibrinogen transfusion later than 1 h. Then, we assessed the blood loss and the transfusion requirements. Results: Demographic parameters (age, weight, patient's height, gestity and parity) and pre-operative hemostatic status were comparable in both groups. Blood loss was correlated to the delay of fibrinogen administration (Fig. 1) . The Pearson correlation coefficient was 0.688. The mean blood loss was 2486 ml in group E (n = 12) versus 5310 ml in group L (n = 21) with p = 0.002. Red blood cell transfusion requirement was 4.58 units patient in group E versus 8.14 in group L (p = 0.01). The need of fresh frozen plasma was 7 units patient in group E versus 12.3 in group L (p = 0.045). Discussion: FIDEL study [1] , a prospective multi centric French study, whose results are not yet published, may give the answer for the best timing of fibrinogen concentrate infusion in severe PPH. Conclusion: Early administration of fibrinogen within the first hour following delivery may reduce bleeding in severe postpartum hemorrhage and transfusions requirement. Which optimal daily dosing of Enoxaparinin acute burn patients? Amel Mokline (speaker) 1 1 ). These results were confirmed after adjustment for confounders using multivariate logistic regression and comparing both calibration and variance explained by the models. Conclusion: In a cohort of severe TMA patients requiring ICU admission, the PLASMIC score had limited performance for the diagnosis of TTP. The performance of the Coppo score was good but similar to a single highly discriminant item-platelet count. The new definition of sepsis and septic shock is usable in cancer patients Nathan Neveux (speaker), Marianne Paesmans, Lieveke Ameye, Jean-Paul Sculier, Anne-Pascale Meert Institut Jules Bordet, Bruxelles, BELGIUM Correspondence: Nathan Neveux -Nathan.Neveux@ulb.ac.be Annals of Intensive Care 2019, 9(Suppl 1):P-169 Introduction: In 2016, a new definition of sepsis and septic shock, based on the SOFA score and the qSOFA score, has emerged. Some studies conducted in general populations demonstrated that SOFA score is more accurate than SIRS score to predict hospital mortality of infected patients requiring intensive care. However, nowadays, in an oncological population, only one study has shown that this new definition can predict hospital mortality with the same reliability as in the general population. We have analyzed all the records of cancer patients admitted for an infection from 01 01 2013 to 31 12 2016 in our oncological ICU. For all them, we have calculated the SOFA, qSOFA and SIRS scores. We have tried to determine the most accurate score to predict hospital mortality. We also have compared the new and the old definitions of septic shock. Finally, we have analyzed the prognostic factors for hospital mortality. Results: Our study includes 353 patients-241 with a solid tumor (of whom 177 have metastasis) and 112 with a hematological malignancy (of whom 30 allografts). The hospital mortality rate is 37% (68% in patients with septic shock according to the new definition and 60% according to the old definition). 92% of patients have a SOFA score increased by more than 2 points since the admission in the ICU, 63% have a qSOFA > or = 2 and 99% a SIRS score > or = 2. The SOFA score reaches the best diagnostic performance to predict hospital mortality + Area under the ROC curve (AUC) of 0.74 compared to AUC 0.65 for qSOFA and 0.58 for the SIRS score. In multivariate analysis, a higher SOFA score or a higher qSOFA score predicts poor prognosis-odds ratio (OR) per one-point increase 1.28 (95% CI, 1.18 to 1.39) and 1.48 (95% CI, 1.04 to 2.11), respectively, while complete remission of cancer is a good prognostic factor for hospital mortality-OR 0.39 (95% CI, 0.22 to 0.67). The new definition of sepsis and septic shock is usable in an ICU oncological population with a same reliability similar to that reported in general populations. In oncological patients admit to the ICU for a suspected infection, the SOFA score is more accurate than qSOFA and SIRS scores to predict hospital mortality. 78) interventions, splenic and pancreatic surgery 13.4% (n = 24), hepatic surgery 9.5% (n = 17), urological surgery 7.3% (n = 13), gynecological surgery 3.3% (n = 6) and gastric surgery 3.3% (n = 6). Median duration of follow-up was 26.6 months 95% CI [19. 3-33.9 ]. Mortality observed during this period was 29.8% (n = 53), 95% CI [23 to 37.1]. In univariate analysis, risk factors associated with mortality were-a score ASA > 2 (p = 0.004), pre-operative malnutrition (p < 0.001), pre-operative cognitive disorders (p = 0.001), emergency surgery (p = 0.019) and intraoperative vasopressor (p = 0.031). Curative surgery was associated with better long-term survival (P < 0.001). The type of the cancer, the type of surgery and a metastatic disease did not influence long-term mortality. Using multivariate analysis, five factors were associated with prognosis-history of diabetes (p = 0.008), cognitive disorders (p = 0.008), pre-operative malnutrition (p = 0.007), and intraoperative vasopressor (p = 0.006). The curative nature of the surgery was associated with better survival (p < 0.001). With 70% long-term survival, major oncological surgery may be considered in patients ≥ 80 years. Even though the curative nature of surgery remains a determining factor, our work strongly highlights the importance of comorbidities in this context. In view of our data, preoperative optimization, within the framework of specific pre-habilitation protocols must be evaluated prospectively. Preoperative optimization, within the framework of specific pre-habilitation protocols, must be prospectively evaluated. Introduction: Incidence of cancers is constantly increasing. The survival of critically ill cancer patients has improved over the past decades. Data are scarce regarding biliary sepsis septic shock in OHP (BSSOHP). The main objective of this study was to evaluate hospital and 1-year mortality as well as the associated factors in a context of BSSOHP. Patients and methods: Observational retrospective monocentric study including 122 patients between November 2008 and October 2017. We described two groups of patients-a group consisting of 84 OHP and a control group of 38 non-cancer patients. All presented with BSSOHP at ICU admission. Perioperative parameters were collected as well as performans status (PS), Karnofsky score and the stage of the malignancy at hospital discharge and 1 year. Statistic-univariate and multivariate analysis using logistic regression. p < 0.05 was considered as significant. Results: For OHP, hospital mortality was 24%(n = 20) and 1-year mortality 49%(n = 37). In the control group, it was 5.3%(n = 2), and 5.4%(n = 2) respectively. For OHP and using multivariate analysis, factors independently associated with hospital mortality were-SAPSII (OR Introduction: Acute respiratory failure (ARF) is a severe life-threatening complication in onco-hematology patients. ARF is frequently mixed, associating lesional and cardiogenic edema. Survival benefits from NIV could be harder to demonstrate or may have been balanced by changes in ventilation strategy selection. Strategies can differ according to ARF etiology and severity. NIV has been validated in acute cardiac pulmonary edema and acute exacerbations of chronic obstructive pulmonary disease with decreased intubation and mortality rates. at the opposite, high-flow oxygen through a nasal cannula (HFNC) has been validated in a context of de novo ARF. Data of NIV in cancer patients with mixed ARF are lacking. The aim of this study was to assess prognostic factors, including ventilation strategies, associated with intensive care unit (ICU) mortality. We conducted an observational retrospective study in Institut Paoli-Calmettes, a cancer-referral center. Between 2008 and 2015, 124 critically ill cancer patients with mixed ARF were analyzed. Factors associated with ICU mortality, using univariate, multivariate and matched propensity score analysis, were evaluated. Results: ICU and hospital mortality were 29% and 57%. Initial ventilation strategy at ICU admission consisted of mechanical ventilation (MV) in 21%. Others patients received noninvasive ventilation (NIV) in 50%, associated with oxygen in 21% and high flow nasal oxygen (HFNO) in 29%, HFNO alone in 6% and standard oxygen in 23%. During ICU stay, 48% of patients required intubation. Multivariate analysis identified 3 independent factors associated with ICU mortality-SAPSII at admission (OR = 1.07 point, 95%CI = 1.03-1.11, p < 0.001), invasive fungal infection (OR = 7.65, 95%CI = 1.7-34.6, p = 0.008) and initial ventilation strategy (p = 0.015). Compared to NIV, HFNO alone and standard oxygen alone were associated with an increased ICU mortality, with respective OR of 19.56 (p = 0.01) and 10.72 (p = 0.01). We subsequently realized a propensity score analysis including 40 matched patients, 20 in the NIV arm and 20 receiving other ventilation strategies, excluding initial MV patients. ICU mortality rate was significantly lower in patients treated with NIV (10%), versus 50% in patients receiving other ventilation strategies (p = 0.037). Conclusion: For onco-hematology patients presenting with mixed ARF, severity at ICU admission, invasive fungal infections and initial ventilation strategy were independently associated with ICU mortality. NIV was a protective factor on ICU mortality. NIV should be evaluated for mixed ARF in cancer patients. Results: One hundred and two patients were included, among them 58 and 44 in medical intensive care and surgical intensive care units, respectively. The overall mortality was 29%. All the deceased patients had pancreatitis classified as severe. SOFA score at admission was significantly lower for survivors than for non-survivors, respectively 8 (IQ -5-11) and 12 (9-16) p < 0.0001. IGS II score was also significantly lower among survivors than among non-survivors. The mortality rates were similar in patients with or without necrosis infection. In univariate analysis, sofa score at admission, multiple organ failure, renal dysfunction, metabolic acidosis, hypoxemia and haemoconcentration were associated with death, as well as the need for renal replacement therapy and mesenteric ischemia during ICU stay. In different models of multivariate analysis, the SOFA score at ICU 17.5 ± 11.22 and 6.35 ± 4.11. Acquired liver dysfunction occurred with a median delay of one day [1 + 6] . Thirty-eight patients (81%) had hepatic cytolysis, 22 (46, 8%) had GGT elevation, 18 (38, 3%) had bilirubin elevation and nine (19, 1%) had ALP elevation. Twelve patients (25, 53%) had hepato-biliary imaging and the diagnosis of cholecystitis was retained only in one case. All patients had serology of hepatic viruses, they were all-negative except one. Fifty-nine episodes have been collected. Median number of hepatic dysfunction episodes per patient was one [1 + 2], ten patients had two episodes. Retained etiologies were-multifactorial in forty cases (sepsis, hypoxia, drug toxicity), sepsis in seven cases and drug toxicity in two cases. Compared to group control (25 patients), mortality was higher (34% vs 16%, p = 0.09) and length of stay was more prolonged (15 vs 13 days, p = 0.7) but the difference was not significant. Conclusion: Liver abnormalities are common in intensive care. Multifactorial liver dysfunction were the most frequent in our population. Drug toxicity was commonly suspected but it was difficult to retain it as the only incriminated factor. Introduction: Encephalopathy is a common complication of liver disease and/or portosystemic shunts. Its pathophysiology is not completely understood; mechanisms include the role of elevated ammonia levels in association with systemic inflammation. An impairment of blood-brain barrier (BBB) permeability is also hypothetised. Metabolomics enables to detect a wide range of metabolites without any a priori. In a recent metabolomic study including patients who underwent cerebrospinal fluid (CSF) collection, our group outlined that xenobiotics/drugs that usually don't cross BBB were retrieved in the CSF, suggesting a potential neurological toxicity of drugs. CSF collection is invasive. Hence, we aimed to describe the xenobiotics present in the plasma of cirrhotic patients, using the same metabolomic approach. We conducted a retrospective study of plasma samples in the Hepatological ICU. Plasma samples from cirrhotic patients displaying encephalopathy were compared to plasma from cirrhotic patients without neurological symptoms, and to plasma from healthy controls. Liquid chromatography coupled to high-resolution mass spectrometry was performed and then after the metabolic fingerprints were compared to database and between the different groups. , alcohol 38%) and 9 healthy controls. Among 495 identified metabolites, 25 corresponded to xenobiotics or its derivatives. Fluoxetine was detected with a more than 200 fold increase, aminosalicylic acid with a more than 10 fold increase and benzyl alcohol (present in cough pills and antiseptics) with a 3 fold increase in cirrhotic patients with encephalopathy as compared to cirrhotic patients. In cirrhotic patients with or without encephalopathy, propranolol was detected with a more than 8500 fold increase, acetaminophen with a 40 fold increase, penicillamine and ampicillin both with a 2 fold increase as compared to healthy controls. Interestingly, several substances which were not expected to have systemic diffusion were detected in cirrhotic patients and in healthy controls-eugenol, isoeugenol (used in mouth bathing solution), triethanolamine (trolamin, used in cutaneous creams) and resorcinol monoacetate (used in mouth bathing solution and in cutaneous creams). Conclusion: Cirrhotic patients, especially those with neurological symptoms, display dramatically increased levels of several xenobiotics in plasma. These results confirm that PK PD parameters of commonly used drugs are highly modified in those patients. This suggests a potential role of xenobiotics in the pathophysiology of encephalopathy in patients with liver diseases. Neutrophil-lymphocyte ratio-prognostic value in cirrhosis Ameni Khaled (speaker) 1 Introduction: Different scoring models are used to predict the severity of Acute-on-chronic liver failure (AoCLF) as Child-Pugh, Different scoring models are used to predict the severity of Acute on chronic liver failure (AoCLF) as Child-Pugh, Model of End-Stage Liver Disease (MELD), and Clif SOFA. Previous studies had shown that Neutrophillymphocytr ratio (NLR) and Platelet-lymphocyte (PLR) can be used as prognostic markers in various disease processes. We aimed to evaluate the role of NLR in the prediction of 3-month mortality in patients with AoCLF. Patients and methods: This was a retrospective follow up study including all patients with decompensated cirrhosis between January and December 2016. Results: A total of 92 case of decompensated cirrhosis with AoCLF, were enrolled in the present study. The mean age was 62 ± 13.4 years. The sex ratio was 0, 95. The mean Child and MELD were respectively 8 and 18. Chronic hepatitis C infection remains a major case of the cirrhosis in our study (42%). The leading cause of hospitalization was an Oedemato-ascitic decompensation (40%). The diagnosis of sepsis was identified in 46% of cases. Our findings indicated that 3 month -mortality had interseted 25 patients. Univariate logistic regression analyses showed that there is a significant positive correlation between NLR and 3-months mortality (p = 0.02) also with a high MELD score (p = 0.01), Child score (p = 0.00) and Clif SOFA (p = 0.03). Multivariate logistic regression analyses proved that a high NLR was an additional independent risk factor for 3-month mortality (p = 0.02) as well as for Child score (p = 0.00). To evaluate the ability of NLR and Child scores to predict mortality, ROC curves were obtained.The AUC values were 0.841 ± 0.061 for the Child score and 0.728 ± 0.046 for NLR (both p < 0.005). Conclusion: In our study, the NLR seems to be a good marker, easily achievable, to assess the prognosis immediately up on admission in decompensated cirrhosis. Introduction: The combination of increased antibiotic resistance and decreased discovery of new antibiotic molecules is a serious concern in the intensive care unit. However, the link between bacterial resistance and prognosis remains controversial. The predominant pathogen causing ventilator-associated pneumonia (VAP) is Pseudomonas Aeruginosa (Pa), which has increasingly become multidrug resistant (MDR). The aim of this study was therefore to evaluate the relationship between MDR VAP Pa episodes and 30-day mortality. Patients and methods: From a longitudinal prospective French multicenter database (2010-2016), Pa-VAP onset and physiological data were recorded. MDR was defined as non-susceptibility to at least one agent in three or more antimicrobial categories. To analyze if MDR episodes were associated with higher in-hospital 30-day mortality, we performed a multivariate survival analysis using the multivariate nonlinear Frailty model. Results: A total of 230 patients presented 280 Pa-VAP. A maximum of 3 episodes per patient was observed. 73 episodes were MDR, and 213 were susceptible. In the multivariate model, factors independently associated with 30-day mortality included age (HR, 1.02, 95% CI, 1.01-1.04, p = 0.0064), hospitalization in the 6 months preceding the first episode (HR, 2.31, 95% CI, 1.50-3.60, p = 0.0002), chronic renal failure (HR, 2.34, 95% CI, 1.15-4.77, p = 0.0196) and VAP Pa recurrence (HR, 2.29, 95% CI, 1.79-4.87, p = 0.032). Finally, MDR Pa-VAP was not associated with death (HR, 0.87, 95% CI, 0.52-1.45, p = 0.59). Conclusion: This study does not identify a relationship between the resistance profile of Pseudomonas aeruginosa and mortality. Introduction: Between October 2017 and March 2018 a nosocomial outbreak of Corynebacterium striatum occured in the ICU of our tertiary hospital. We aimed to characterize the population affected and to define the risk factors by matching equivalents controls and help to avoid futures outbreaks. Patients and methods: We retrospectively identified patients with positive cultures for Corynebaterium striatum between 01 01 2016 and 01 07 2018 regardless of infectious signs. We included 3 controls for each positive patient matched on the ICU length of stay (+ -3d), the unit of hospitalization and the presence of mechanical ventilation trying to identify risk factors for C. striatum acquisition. Results: Whereas there were respectively 1 and 1 patients with C. striatum positive specimen in 2016 and in the 10 first months of 2017, we identified 11 patients with C. striatum culture between Oct 2017 and March 2018. All isolates were identified using MALDI-TOF and share the same susceptibility, being resistant to all antibiomicrobial except vancomycin. Genotyping was not performed. Our cohort included 5 (45.5%) male with a mean age of 58 years, a median of ICU stay of 22 days (IQR 15-61). Main comorbidity was cancer and diabetes in 3 (27.3%) patients followed by immunodepression, COPD, cirrhosis, and chronic kidney disease (n = 2, 18.2% each). 91% were medical admission with only one case of elective post-operative admission. Survival rate was 55.5%. All patients but one were intubated + median ventilation length was 22 days (14-42). All patients but one had positive respiratory specimen (either tracheobronchial aspiration or bronchoalveolar lavage) for C. striatum + one patient had peritoneal liquid as first positive culture and one had soft tissue colonization. 2 over 11 cases were considered as an actual infection and accordingly treated by vancomycine + both cases showed clinical recovery despite 1 microbiological failure. 45.5% had had NIV and 27.3 high flow oxygen therapy. 7 (63.6%) patients had an infection and 8 (72.7%) were treated with antibiotics before Corynebacterium positive cultures. Among those, 7 (87.5%) were treated with broad spectrum antibiotics. The characteristics of control patients are currently recorded, the data of the comparison between case and control will be shown in the congress. Conclusion: C. striatum can cause micro-epidemic in the ICU in mechanically ventilated, comorbid patients with high LOS. Virulence seems low with infection in 1 5 of patients and no infection-related mortality. Intestinal richness and diversity are not related to relative abundance of Multidrug-resistant Gram-negative bacilli but are related to Enterococci abundance in the digestive microbiota intensive care unit patients Candice Fontaine (speaker) 1 Besides, alterations of the intestinal microbiota, such as those related to the antibiotic intake, could be associated with nosocomial infections (including those involving MDR-GNB) and poor outcome. Our main objective was to assess the link between the intestinal colonization by MDR-GNB and the composition of this microbiota (richness and diversity). Patients and methods: We performed a 2-month prospective, monocentric cohort study in the medical ICU of Bichat hospital in Paris. Patients ventilated more than 3 days and spontaneously passing feces were included. For each patient, a fecal sample was collected the day of inclusion and then twice a week. MDR-GNB (defined by third generation cephalosporins resistant Enterobacteriaceae) but also Enterococcus faecium were search by culture methods. For MDR-GNB, the relative abundance (RA) was calculated (defined by the concentration of MDR-GNB on the concentration of total Enterobacteriaceae). The composition of the intestinal microbiota was assessed by 16S profiling and we calculated richness (by the number of Operational Taxonomic Unit) and diversity (by the Shannon's index). Results: We collected 62 stool sample from 31 patients, including 18 feces for MDR-GNB (including 15 extended-spectrum beta-lactamaseproducing Enterobacteriaceae and 3 cephalosporinase overproducing Enterobacteriaceae) in 13 different patients. The average RA of MDR-GNB was 57% (0.5 + 100%). Twenty-two stool samples were positive for E. faecium. We did not observe a link between the diversity and the richness of the intestinal microbiota and the MDR-GNB intestinal RA. Conversely, intestinal diversity and richness decreased along the relative abundance of reads assigned to Enterococcus sp. (p < 0.001) (figure) and when Enterococcus faecium intestinal carriage was detected (p < 0.001). We detected 7 MDR-GNB nosocomial infections (including 5 ventilator associated pneumonia) within 7 days of positive MDR-GNB stool sample but the MDR-GNB intestinal RA was not associated to the occurrence of infections caused by MDR-GNB. Conclusion: The intestinal MDR-GNB relative abundance was not associated to the diversity nor the richness of the intestinal microbiota, but that of Enterococcus sp. relative abundance and Enterococcus faecium intestinal carriage were. Introduction: Pneumonia is usually presented as a forgotten killer. Ventilator-associated pneumonia represent the most frequent nosocomial infection in the intensive care unit. Their diagnosis remains problematic and an early diagnosis could largely improve the prognostic outcomes. Several clinical, radiologic and biologic tools were developped to impove the speed and the diagnostic performance. Recently, lung ultrasound became a tool allowing to estimate the lung morphology at the bedside. The purpose of this study was to determine the sensibility, the specificity and the performance of diagnosis of lung ultrasound alone and associated to bronchoalveolar lavage. Patients and methods: In a monocenter prospective study of 60 patients with suspected ventilator-associated pneumonia, we investigated the diagnostic performance of lung ultrasound and the sensibility and specificity of the signs ultrasound of pneumonia which are -subpleural consolidation, lobar consolidation and arborescent linear air bronchogram. We also evaluated the combination of lung ultrasound with direct examination of bronchoalveolar lavage. Results: The prevalence of ventilator-associated pneumonia was 60%. The two groups (patients with and without Ventilator-associated pneumonia) were similar in terms of general characteristics. The only significant differences between the two groups occurred in purulent secretions. Lobar hemilobar consolidation had a specificity of 33% while subpleural consolidation and arborescent linear air bronchogram had a specificity of 100% and a positive predictive value of 100%. The association between lung ultrasound and bronchoalveolar lavage had a specificity of 100% and a positive predictive value of 100%. Conclusion: The lung ultrasound is a vailable tool of practical bedhead among critical patients in intensive care unit. It is a valid alternative for the early and reliable diagnosis of ventilator-associated pneumonia. She could also allow to follow their evolution under treatment. Anne Coste (speaker) 1 , Grégoire Matthieu 2 , Guillaume Deslandes 3 , Ronan Bellouard 2 , Laurence Jalin 4 , Claire Roger 5 , Cédric Bretonnière 6 1 Brest Hospital, Brest, FRANCE; 2 Service de pharmacologie clinique -Hôpital Hôtel Dieu, Nantes, FRANCE; 3 Hopital Dieu -Service de pharmacologie clinique, Nantes, FRANCE; 4 Unité de neuro-anesthésie réanimation, Paris, FRANCE; 5 Service de réanimation chirurgicale, Nîmes, FRANCE; 6 Service de réanimation médicale, Nantes, Nantes Correspondence: Anne Coste -annecoste89@gmail.com Annals of Intensive Care 2019, 9(Suppl 1):P-195 Introduction: French guidelines recommend to reach an amikacin concentration 1 h after beginning the infusion C1 h ≥ 8 to 10 times the Minimal Inhibitory Concentration (MIC) of the responsible bacterium. For probabilistic therapy, MIC is considered to be 8 mg L. This target is rarely achieved in the ICU despite a 30 mg kg recommended dosage. We aimed to elaborate nomograms guiding clinicians in choosing the right first amikacin dose for ICU patients in septic shock. Patients and methods: Data from two prospective French cohorts of ICU patients treated with amikacin for sepsis were analyzed. Two pharmacokinetic models, one parametric and one non-parametric, were built using a population approach with Monolix ® and Pmetrics ® softwares, respectively. Using the non-parametric model, we produced dosing nomograms with Monte-Carlo simulations. The amikacin amount needed to achieve a C1 h ≥ 8 × MIC and C1 h ≥ 10 x MIC according to the model covariates was depicted. Results: We analyzed 407 observations from 138 patients. Median Simplified Acute Physiology Score II was 43. Ninety-four patients (68.6%) required invasive mechanical ventilation and 79 patients (57.7%) needed vasopressors. Two-compartment pharmacokinetics models with total body weight (TBW) influence on central compartment volume and creatinine clearance according to the Chronic Kidney Disease -Epidemiology Collaboration (CKD-EPI) formula were chosen. The non-parametric and parametric models adequately described C1 h and had similar performances. Coefficient of correlation R2 was 0.963. Dosing nomograms were elaborated according to patient's TBW and creatinine clearance. Recommended amikacin doses to achieve a C1 h ≥ 64 mg L ranged from 1900 mg to 5000 mg and from 30 mg kg to 58 mg kg. Conclusion: The first amikacin dose should depend on the patient's TBW and creatinine clearance, resulting frequently in dose ≥ 30 mg kg. External validation of the nomograms and evaluation of amikacin toxicity with high doses is necessary before using these nomograms in clinical practice. Infections are a frequent complication after stroke. Pneumonia is the most frequent site of infection and is associated with lower survival and impaired neurologic outcome. Studies focusing on intensive care patients show the highest incidence of pneumonia, but are very heterogeneous in the severity of selected patients. To date, there is no study focusing exclusively on the epidemiology and prognostic impact of pneumonia in mechanically ventilated stroke patients. Furthermore, previous studies lack the adjustment for early decisions to forgo life-sustaining treatment (DFLST) which is a significant confounder in these patients. Patients and methods: We conducted a retrospective analysis of a large prospective multicenter database over a 20-year period (1997) (1998) (1999) (2000) (2001) (2002) (2003) (2004) (2005) (2006) (2007) (2008) (2009) (2010) (2011) (2012) (2013) (2014) (2015) (2016) . We included all adult ischemic stroke patients admitted to the ICU who required invasive mechanical ventilation at ICU admission. The relation between the occurrence of pneumonia during ICU stay and 30-day mortality was investigated using a Cox proportional hazard model, adjusted on DFLST. Data are presented as median (interquartile range) or numbers (percentages). Results: We identified 195 patients (age 69 (61-76) years, male gender 132 (67.7%) patients) from 11 ICUs. On ICU admission, the Glasgow coma scale score (GCS) was 6 (3-, 0) and the Simplified Acute Physiology score 2 (SAPS 2) score was 56 (45-66). Patients required vasopressors in 92 (47.2%) cases and renal replacement therapy in 17 (8.7%) cases. DFLST occurred 5 (2-8) days after ICU admission in 65 (33.3%) patients. Withholding of care and withdrawal of care were observed in 31 (15.9%) and 34 (17.4%) cases, respectively. Survival at day 3six, 6 months and one year was 44%, 32, 6% and 29.7% respectively. During ICU stay, there were 90 pneumonia episodes, occurring at least once in 74 (37.9%) patients. Pneumonia caused sepsis and septic shock (SEPSIS-3 definition) in 40 (44.4%) and 33 (36.7%) cases respectively. After adjustment, the occurrence of pneumonia during ICU stay was not associated with 30-day mortality (figure 1). Conclusion: In this cohort of mechanically ventilated patients with acute ischemic stroke, pneumonia was a frequent complication but was not associated with 30-day mortality. Impact of pneumonia on functional outcomes in survivors should be investigated in further studies. Pilot study of cerebrovascular accidents at Sidi-Bel-Abbès University Hospital: which risk factors? Assumption of responsibility and proposal to be adopted Samia Benouaz (speaker) 1 Introduction: Stroke is the most common neurological condition. Management has progressed in recent years, but morbidity and mortality remain high. Stroke is the second leading cause of death in the world. in developing countries, behind cardiovascular diseases. According to the 2015 estimate-60,000 new cases registered each year in Algeria and 20,000 deaths. First cause of acquired mental and physical disability. The objective-To analyze the risk factors related to stroke and to evaluate its management. Patients and methods: Retrospective study covering a period of 16 months (October 2016 to January 2018). Included were all patients with acute neurologic impairment admitted to the emergency department. Evaluation criteria-NIHSS score, Glasgow score, blood pressure, reason for orientation. Results: We collected 430 files of patients admitted for acute neurological deficit, 86% of strokes were ischemic. Patients admitted to intensive care-82 430.We note a predominance of male 279 430 and an average age of 62.The patients arrived several hours after the onset of symptoms. The NIHSS score > 25 (7%), between 5-25 (77%), NIHSS < 5 (14%). The analysis of risk factors shows-HTA in 277 430 on ARA II, diabetes 246 430, atrial fibrillation arrhythmia in 321 430 cases, dyslipidemia 398 430 and cardiovascular history in 378 430 cases. The relationship between HTA and the NIHSS score-presence of arterial hypertension-NIHSS < 5 (68%), NIHSS 5-25 (62%) and NIHSS > 25 (70%), atrial fibrillation arrhythmia relationship and NIHSS score-presence atrial fibrillation arrhythmia-12% for NIHSS score < 5, 8% for NIHSS 5-25 and 40% for NIHSS score > 25. Discussion: The frequency and risk factors for the occurrence of stroke are similar to those found in the literature. However, the management is not optimal. no need or minimal vasopressor, hemoglobin > 10 g/dL. Demographic, clinical and outcomes data of patients were analysed. Results: During the period of study, 240 patients were admitted. 63 patients were intubated (26%) and 43 were included. The mean age was 32 ± 11 years with a sex-ratio of 3.21. The average TBSA was 39 ± 20% including face and neck in all patients. The average duration of sedation was 9 ± 6 days. In our study, 10 patients (23%) had a simple weaning trial, 8 (18%) had a difficult weaning trial and 2 (4%) had prolonged weaning trial. Weaning from MV was successful in 47% of cas and failed in 53% of cases. Causes of extubation's failure were esentially nosocomial pneumonia (n = 10) and ICU acquired weakness (n = 8). In our study, the total body burn surface area was associated with extubation failure -TBSA in successful weaning group was 30 ± 15% vs 48 ± 20% in failed weaning group (p = 0.003). Conclusion: Our results suggest that the incidence of extubation failure was high «53%» in our patients due essentially to extented burns (48%) including neck and face region. Type III procollagen is a reliable marker of ARDS-associated lung fibroproliferation Intensive Cardiac care Unit, Cardiology department, Toulouse, FRANCE; 4 Brabois medical Intensive Cardiac Unit Intensive Cardiac Care Unit, Cardiology department Intensive Cardiac Care Unit, Cardiology department Intensive Cardiac Care Unit, Cardiology department Intensive Cardiac Care Unit, Cardiology department The Mechanical Ventilation-Respiratory Distress Observation Scale as a surrogate of self-reported dyspnoea in intubated patients Micheline Pha 1 , Guillaume Franchineau 2 , Ania Nieszkowska 2 , Loic Le Guennec 2 , Guillaume Hekimian 2 , Philippe Rouvier 4 , Miguel Hie 1 Service de médecine intensive-réanimation, ICAN, Hôpital La Pitié-Salpêtrière Emmanuelle Guérin -emmanuelle.guerin@aphp.fr Annals of Intensive Care Respiratory variation in IVC cross-sectional surface to predict fluid responsiveness -a prospective study Ali Basbous (speaker) 1 uliege.be Annals of Intensive Care Introduction: Adequate tissue perfusion in postoperative period is a priority after cardiac surgery. To insure this, optimizing cardiac output is required and can be obtained, among others, by volume expansion Electroencephalography in diffuse encephalopathies Malgras 4 , Christophe Martinaud 8 , Cyril Carfantan 9 Sainte-Anne Military Teaching Hospital Ecole du Val-de-Grâce Eric Mariotte -eric.mariotte@aphp.fr Annals of Intensive Care Correspondence: Florian Reizine -florian.reizine@chu-rennes.fr Annals of Intensive Care Minimum Quality Threshold in Pre-Clinical Sepsis Studies (MQTiPSS) Pneumonia in critically ill ischemic stroke patients-epidemiology and prognostic impact Sorbonne Paris Cité Service de Médecine Intensive et Réanimation, Hôpital Delafontaine Service de Réanimation Médico-Chirurgicale Acute dyspnea in hospitalized patients in observation unitsepidemiology and prognostic factors Ines Sedghiani (speaker), Oussama Hergli Introduction: Epidemiologic data about cardiogenic shock (CS) are still poor and focused on ischemic CS, forgetting all part of the CS encountered in clinical practice. Patients and methods: FRENSHOCK registry (NCT02703038) was a large prospective multicenter registry of non-selected CS patients admitted in critical care units realized between April and October 2016 in France. Patients were included if they met the following three criteria-(1) low cardiac output defined by SBP < 90 mmHg and or the need of amines, or a low cardiac output defined by CI < 2.2L/min/m2 (TTE or Swan-Ganz) + (2) elevation of left and or right heart pressures defined by clinic radiology biology echocardiography Swan-Ganz + and (3) clinical and or biological hypoperfusion. Results: 772 patients were included in 49 centers (male 71.5%, mean age of 66y ± 15). Comorbidities were classical-previous coronary revascularization 26%, history of extra cardiac arterial disease 15%, previous renal failure 21% and COPD 6%. Cardiovascular risk factors included diabetes (28%), active tobacco (28%), dyslipidemia (35%) and hypertension (47%). 56% were known for previous cardiomyopathy (especialy 30% ischemic origin). CS etiology often associated several triggers but ischemic was retained for only 36.4% (n = 281) of patients with type 1 infarction for 17.4% (n = 134). Non-ischemic trigger factors were predominant (n = 491 + 63.9%)-supra ventricular (13.2%) and ventricular arrythmia (12.6%), infection (11.9%), iatrogenic (6.1%), conductive disorders (2.3%), non-observance (3.5%), and others (13.7%). At admission median SBP was 101 mmHg ± 25. Sinusal rhythm was present in only 52%. Right heart failure signs were present in 49% and left signs in 72% (Killip IV for 49%). Biological analysis found signs of hypoperfusion with high lactate (3.0 95% CI [2.0-4.8] ), renal (eGFR 49.6 ± 26.8 mL/min/m2) and hepatic alteration (ASAT 90 UI ml, 95% IC [39-300], Prothrombin time 57 ± 25%). Biventricular failure was frequent (LVEF was 26% ± 13 + TAPSE 13 mm ± 5). When realized (n = 399 + 52%) coronarography was pathological in 81% (n = 321) (monotroncular 31%, bitroncular 35% and tritroncular 34%). A culprit lesion was found in 79% and concern LVA in 48%, RCA in 23% and left main in 15%. Conclusion: This large multicentric and prospective registry confirmed the heterogeneity of CS in terms of etiology, presentation and prognosis with a predominance of non-ischemic CS in practice. Incidence and severity of RV size in patients with distributive shock. Value of tricuspid annular plan systolic excursion (TAPSE) Amélie Prigent (speaker) 1 Introduction: Experts proposed to define RV failure as a state in which RV is unable to meet the demands for blood flow without excessive dilatation. While TAPSE (tricuspid annular plan systolic excursion) was frequently reported as a pertinent parameter to study the RV function, this is still questionable. Our goal was (i) to report the incidence of RV dilatation and its severity in distributive shock, (ii) to report the distribution of TAPSE in different groups according to the RV size and the serum lactate level. Patients and methods: Retrospective analysis of an observational, prospective multicenter study, which included 540 patients admitted in the ICU for shock, under mechanical ventilation, in whom an echocardiography (transthoracic and transesophageal) was systematically performed. After exclusion of cardiogenic, hypovolemic and obstructive shock, 345 patients were screened. Combining the lactate level and the end-diastolic ratio between the right and the left ventricle (RV LV EDA), 4 groups were defined. Group 1 without RV dilatation (RV LV EDA ≤ 0.6), group 2 and 3 with a moderate RV dilatation (RV LV EDA > 0.6 ≤ 0.8) without or with an increased lactate level (≤ or > 2 mmol/L) and group 4 with a severe RV dilatation (RV LV EDA > 0.8). Results: 327 patients were analyzed. Median age was 66 [iqr 57-75], SAPS2 57 [iqr 43-72] and SOFA score 10 [iqr 7.5-12]. Cause of shock was septic in 85% of cases. The overall in-ICU mortality was 37.6%. 150 patients (45.9%) were in group 1, 51 (15.6%) in group 2, 53 (16.2%) in group 3 and 71 (22.3%) in group 4. 29.1% patients were ventilated for an ARDS. Median RV LV EDA was 0.5 [iqr 0.4-0.5], 0.7 [iqr 0.6-0.7], 0.7 [iqr 0.6-0.7] and 0.9 [iqr 0.9-1.1] in groups 1, 2, 3 and 4 respectively. No inter-group difference was observed for TAPSE with the same median value of 18 mm (p = 0.48). Central venous pressure was significantly higher in group 4 (12 [9-15] mmHg) compared to group 1 (9 [7] [8] [9] [10] [11] [12] ), 2 (9 [7] [8] [9] [10] [11] [12] ) and 3 (9 [7] [8] [9] [10] [11] [12] [13] ). Conclusion: RV dilatation was observed in 54.1%, moderate in 59% and severe in 41%. TAPSE was not discriminant with a normal value in all groups. Impact of a failed spontaneous breathing trial on dyspnea Maxens Decavèle (speaker) 1 Introduction: Dyspnea is a frequent and potentially intense symptom in mechanically ventilated patients. Whether the presence and intensity of dyspnea could interfere with the result of a spontaneous breathing trial (SBT) is unknown. Alternatively to the use of visual assessment scale of dyspnea that is challenging in critically ill patients, the five-item Mechanical Ventilation -Respiratory Distress Observation Scale (MV-RDOS) has been proposed as a reliable surrogate of dyspnea in noncommunicative intubated patients [1] . In the present study, we sought 1) to describe the prevalence and changes in MV-RDOS during a SBT and 2) to evaluate the performance of MV-RDOS to predict SBT failure. Patients and methods: Patients from a single center, intubated since more 48 h were eligible after they failed at a first spontaneous breathing trial (SBT). Dyspnea was assessed with the MV-RDOS at the beginning and the end of the SBT. Dyspnea was define by a MV-RDOS > 2.3 [1] . The area under receiver operating characteristic (ROC) curve of the MV-RDOS measured at the onset of the SBT was computed to predict the risk of SBT failure. Results: Thirty-five patients (39 SBTs) (age 60 [49] [50] [51] [52] [53] [54] [55] [56] [57] [58] [59] [60] [61] [62] [63] [64] [65] [66] [67] [68] , SAPS II 71 [56-82] + med [IQR]) were included and in total 39 SBTs were analyzed. All patients were deemed ready to be weaned criteria (FiO 2 30% [30-40] + positive end expiratory pressure 5 cmH2O [5-6] + respiratory rate 22 cycles min [17-26]) but dyspnea was present in 22 39 (56%) at the beginning of the SBT. Twenty-three (59%) SBTs lead to failure and 16 (41%) were considered as success. The changes in MV-RDOS in patients who succeeded and failed the SBT are depicted in Figure 1 . The proportion of SBT failure was higher in patients who presented dyspnea at the beginning of the SBT (74% vs. 31%, p = 0.008). A MV-RDOS value above 2.47 at the beginning of the SBT predicted SBT failure with a 65% sensitivity and 81% specificity (AUC = 0.778 + 95%CI [0.634, 0.927]). Conclusion: Despite patients met classical readiness to wean criteria, dyspnea was frequent at the beginning of SBT and increased only in patients who fail the SBT. MV-RDOS could predict SBT failure with good performances. Bruno Megarbane (speaker), Elmire Chauvière Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris, FRANCE Correspondence: Bruno Megarbane -bruno.megarbane@lrb.aphp.fr Annals of Intensive Care 2019, 9(Suppl 1):P-152 Introduction: Acute ethanol poisoning represents a frequent cause of admission to the emergency department and intensive care unit (ICU) in France. Ethanol is theoretically able to increase the serum lactate concentration. However, hyperlactatemia in the acutely ethanolpoisoned patient has been rarely reported and its exact mechanism is still debated. We aimed to determine the prevalence and describe the etiologies of lactate elevation following excessive ethanol ingestion. Patients and methods: We conducted an retrospective singlecentre observational study including all patients admitted to the ICU during 7 years (2011-2018) for acute drunkenness (defined by ethanol concentration > 1 g L, in the absence of significant drug coingestions) and who presented hyperlactatemia (defined by lactate concentration > 2 mmol/L). Results: Fifty-four patients [16 females and 38 males + median age, 41 years (inter-quartile interval, 26) with past history of chronic alcoholism, 52%] were included, representing 54% of the patients admitted for acute drunkenness to the ICU during the same period. Patients were comatose [Glasgow coma score, 3 (4)] requesting tracheal intubation (81%). Complications included aspiration pneumonia (41%), sepsis (26%), cardiovascular failure (13%), vomiting (9%), seizures (6%), hospital-acquired infections (2%) and death (6%). Blood ethanol concentration was 3.4 g L (2.3) on admission and plasma lactate concentration 2.5 mmol/L (0.9) on admission, peaking at 2.9 mmol/L (1.1), with no significant correlations between both parameters (R2 = 0.006 and 0.03, respectively). The main reasons for increase in lactate concentration were sepsis (26%), hypovolemia (19%) and trauma (9%). The existence of underlying alcoholic cirrhosis explained 2% of the hyperlactatemia cases. In 30% of the cases, no etiology except ethanol was found to explain hyperlactatemia onset. In these patient subset, peak lactate concentration was significantly less elevated (2.4 mmol/L (0.9) vs. 3.0 mmol/L (1.6), p = 0.02) and decrease in serum bicarbonate more limited (23.4 mmol/L (1.6) vs. 22.0 mmol/L (4.5), p = 0.05). Conclusion: Acute drunkenness can be complicated by hyperlactatemia. In ~ 30% of the cases, elevation in serum lactate can only be attributed to the presence of ethanol in the body. Metabolic investigations should be conducted to better characterize the involved mechanism, one hypothesis being the disequilibrium induced by ethanol in the intracellular NADH NAD + ratio. Introduction: The acute poisoning with flecainide, a 1c anti-arrhythmic drug of the Vaughan-Williams' classification is rare but may be responsible for life-threatening consequences. Our objectives were 1)to report the features, complications and management of flecainide poisonings admitted in the intensive care unit (ICU) + 2)-to investigate the prognostic contribution of the plasma flecainide concentration measured on admission. Patients and methods: We conducted a retrospective single-centre observational study including al flecainide poisoned-patients admitted to the ICU during a 20-year period , as evidenced by to emphasize on its gravity when it is wrongly used and to improve its management. Patients and methods: It was an observational retrospective study spread over nine years from 1st January 2010 to 22th September 2018 in a toxicological ICU, including all patients admitted for acute Minoxidil poisoning. Results: During the study period, 12 patients were eligible for minoxidil poisoning which accounted 0.13% of all the acute poisonings requiring hospitalization in our Intensive Care Unit. Patients were aged of 42 years [17, 71] . Only one patient was a male. All Exposures were single-drug and 92% of them were accidental. The supposed ingested dose was unknown in all the cases. The delay of consultation was of 9 ± 6 h after ingestion. Gastrointestinal decontamination was not performed at all. Tachycardia was constant with an average of 120 beats per minute [92, 150] . Vomiting was present in 7 patients (58%). Nine patients (75%) presented hypotension requiring crystalloids resuscitation with an average of 1650 ml [1000, 2000] . Nine patients required vasopressor support by norepinephrine with an average of 1.5 mg h [0.5, 5.5] and a weaning delay of 2 days [1, 4] . Five presented myocardial suffering with decreased ST segment in all cases, negative waves in two times and three of them had cardiogenic pulmonary edema with an average pro-PNB level of 4080 pg mL [1680, 700] . No one had coronary angiography immediately and only one had anti-ischemic treatment. All patients performed favorably and were discharged from the ICU after a mean length stay of two days. Three patients who suffered from cardiogenic edema have been referred to a cardiology department for exploration. Conclusion: As it was shown, Minoxidil is an unsafe product because of its vasodilator action which may be responsible for prolonged tachycardia and profound hypotension requiring vasopressor support. Manufacturers should enhance packaging security and the over-thecounter availability must be questioned. Introduction: Gamma-hydroxybutyric acid (GHB) and gammabutyrolactone (GBL) poisonings have been reported to increase for a few months in France. GHB, an anesthetic compound, has been classified as Schedule III controlled substance due to its recreational abuse potential and use for sexual assault. GBL, a GHB precursor, is legally marketed as solvent although responsible for the same neurological toxicity and abuse liability. Our objectives were 1)-to describe the clinical features of acute GHB GBL poisonings + 2)-to investigate the predictive value of the plasma GHB concentration on admission + 3)to study the relationships between the plasma GHB concentration and the coma depth. Patients and methods: We conducted a retrospective monocentre observational study including all GHB GBL-poisoned patients admitted to the intensive care unit (ICU) during7 years (January 2011 to July 2018). Plasma GHB concentration was measured using liquid chromatography coupled to mass spectrometry. We determined the GHB pharmacokinetic parameters, studied the correlation between the plasma GB concentration and coma depth on admission, and modeled the relationships between the plasma GB concentrations and the Glasgow coma score (GCS) in each poisoned patient when possible. Results: One hundred and thirteen GHB GBL-poisoned patients (14 females 99 males, aged of 33 years [16] (median, inter-quartile interval) were included. An increase trend was observed in the number of GHB GBL and mainly GBL poisonings. On ICU admission, the patients presented deep consciousness impairment (GCS of 3 [4] ), with marked hypotonia (36%), osteotendinous reflexe abolition (47%) and myosis (48%), marked hypothermia (35.5 °C [1.4] ) and increase in plasma creatinine phosphokinase (235 UI L [903.25]). Treatment was supportive including mechanical ventilation (76%). Outcome was favorable with rapid wake-up and short hospitalization (17 h [21]). Three major complications were noted including aspiration pneumonia (36%), rhabdomyolysis (9%) and withdrawal syndrome (2%). No significant correlation between the coma depth and the plasma GHB concentration were observed on admission (R2 = 0.015). Individual modeling of the GCS plasma GHB concentration relationships allowed recognizing the role of ethanol co-ingestion and tolerance acquisition to GHB due to its chronic use. Conclusion: GHB GBL poisonings are increasing in the ICU with lifethreatening presentations. Despite the well-fitted sigmoidal relationships between the GCS and GHB concentration at each individual level, inter-individual variability in the expression of GHB-induced neurotoxicity exists, mainly related to ethanol co-ingestion and tolerance acquisition. Introduction: Analgesia is an essential component of chest trauma management to prevent medical complications, particularly respiratory ones. Serratus plane block (SPB) is a recent ultrasound-guided regional anesthetic technique which has proved capable of providing effective analgesia in chest trauma. The main objective of the study was to assess the feasibility of the SPB by non-anesthesiologist physicians. Patients and methods: A cadaveric feasibility study was conducted in the anatomy lab of the Faculty of Medicine of Lyon Est. All participating physicians were voluntary and specialized in emergency medicine. They had to perform one SPB on a corpse by injecting a methylene blue solution. The pleura was previously filled with eosin red solution. The primary endpoint was the success of the block, the composite of 5 items-correct identification of anatomy, respect of safety rules, no pleural puncturing (aspiration of red solution), validation of procedure after checking by ultrasound and anatomical dissection (presence of methylene blue solution in the anatomic space between the Latissimus dorsi and the Serratus anterior). Results: Twelve emergency physicians participated in the study, 10 were military ones. Each doctor realized one SPB. 10 out of 12 SPB were successful. The obtained results are summarized in Table 1 . There was no pleural puncturing. Conclusion: This study shows that the SPB is achievable by emergency physicians. This easy and safe anesthetic block provides effective analgesia for chest trauma. Its dissemination in emergency departments and in prehospital setting would improve early multimodal analgesia, including in the absence of available anesthetists. Introduction: Eclampsia is a serious complication of pre-eclampsia, It is an obstetric emergency with a significant maternal-fetal morbidity and mortality, that can occur before during or after childbirth. Our study aims to describe the epidemiological and clinical profile + women with eclampsia in the gynecological obstetrics department of Oran EHU. We carried out a single-centric prospective study including all women who had been treated for eclampsia, in the obstetrics and gynecology department of the Oran EHU. (Level 3 maternity) over a period of one year from January 1st, 2017 to December 31st, 2017. Results: 63 cases of eclampsia were recorded over this period with an incidence of 0.3%. Eclampsia occurred in antepartum in 90% of cases, postpartum in 10%, and 82% of postpartum eclampsia convulsed in the first 24 h, others occurred late at 6th day, 7th day and even at 60th day. The epidemiological profile is that of a young woman (64% were under 29 years old), primipara (68%), not followed (77%), 24 patients developed a complication, mostly a HELLP syndrom (21 patients, 33, 3%). Various treatments were put in place-Magnesium sulphate (80%), Nicardipine (85%), Alpha methyl dopa (100%), Nifedipine (90%). The main route of delivery was caesarean section 80% under general anesthesia, in our study we deplored no maternal deaths, perinatal death was 20%. Discussion: Eclampsia has become a rare complication in developed countries thanks to early management of one of the main signs of preeclampsia. On the other hand, the surveillance of pregnancies by a qualified health staff, the screening of pregnancies at risk and the information of the patients made it possible to make this pathology regress. However, it remains common in our developing countries (1.35% in our series) and this prevalence is almost constant in sub-Saharan Africa. Conclusion: the improvement of the maternal-fetal prognosis, during the eclampsia, rests mainly on-The detection and the early diagnosis of the severe forms, an early and adequate care, as well as on the availability of a multidisciplinary team. Introduction: Cerebral venous sinus thrombosis (CVST) following a cranial trauma constitutes a rare but serious clinicopathological entity, described in literature along with the lack of consensus regarding diagnosis and management. The aim of this study is to point out the incidence of CVST after head trauma, its clinical presentation and course. Patients and methods: It is a retrospective descriptive study, conducted at the intensive care unit (ICU) of HabibBourguiba university hospital, Sfax, Tunisia, between January 01, 2016, and December 31, 2017. All patients who were victims of polytrauma during the study period were enrolled. They underwent full-body computed tomography (CT). Additional CT or MRI angiographies were performed in patients presenting radiological suspicion of CVST. Results: During the study period, 452 patients were admitted to the ICU department for polytrauma. Among those patients, we included 22 patients with the diagnosis of post traumatic CVST (4.8%). The sex ratio was 10. The mean age was 33.1 ± 15.9. On ICU admission, mean SAPSII was 30.7 ± 11.7 and mean SOFA score was 5.6 ± 2.8. Causes of trauma were dominated by traffic injury in 18 patients. Mean Glasgow Coma Scale score was 9.8 ± 4 (median-10). Extracranial injuries were found in 10 patients. The brain CT scan presented-subarachnoid hemorrhage in 19 patients, basilar skull fractures in 16 patients, cranial vault fractures in 15 patients, cerebral contusion in 16 patients, subdural hematoma in 10 patients, extradural hematoma in 7 patients and diffuse axonal injury in 7 patients. The CSTV was diagnosed fortuitously on full-body CT in 14 patients. In the other 8 cases-2 were diagnosed on MRI and 5 in control CT angiography. The CSVT was located in the transverse sinuses in 15 patients, the internal jugular vein in 10 patients, the superior sagittal sinus in 4 patients and cavernous sinus in 2 patients. Intravenous unfractionated heparin was used in 17 patients with a mean dose of 161.7 mg ± 54.5 mg per day (range 100-300 mg). Low molecular weight heparin was used in 5 patients. The delay of anticoagulation was 3 ± 1.4 days (range 0-6 days). The outcome was favorable in 20 patients. Conclusion: Although, head trauma is a rare cause of CVST it should be considered in any head traumatic patient who develops symptoms of increased intracranial pressure. To date, initiation of anticoagulation stills a matter of debate because of the risk of worsening traumatic haemorrhage. Introduction: Hyponatremia (defined as serum sodium < 135 mEq L) is the most common electrolyte abnormality in traumatic brain injury (TBI) and is also an independent predictor of poor neurologic outcome. We encounter hyponatremia frequently in our practice, and we therefore decided to review data from our center to estimate the incidence of hyponatremia, to analyse the incidence and the impact outcame in patient admitted with TBI in our intensive care unit. Patients and methods: It is a retrospective study conducted over a period of 4 years (from January 2009 to December 2012) in a polyvalent reanimation setting with 22 beds. All patients with postraumatic head injury who developed hyponatremia (serum sodium < 135 mmol/L) during the first 36 h of their stay were included. The hyponatremia was devided into mild (130 ≤ Na + < 135), moderate (125 ≤ Na + < 130) and severe hyponatremia (Na + < 125). Epidemiological, clinical and evolutionary data were collected and a descriptive and analytical statistical study was conducted. Results: Two hundred and twenty one patients were included. All of them came from a road accident with an average age of 31.8 years. The male sex was predominant with a percentage of 84%. Eighty seven percent of patients presented mild hyponatremia whereas 12% had a moderate hyponatremia and only 1% developed a severe hyponatremia. The 25 patients with moderate hyponatremia experienced longer ventilator-free days (24 vs 16 +p=0.32), longer intensive care unit stays (22 vs 28 +p=0.15), and less favorable outcomes compared to the 193 patients who have mild hyponatremia + however, these differences were not significant. Conclusion: Our study showed an elevated frequency of hyponatremia in patients with brain injuries in ICU which demands the effective approaches for an accurate and timely diagnosis of this electrolyte disorder. Further studies are needed to determine the optimal management strategy for TBI-associated hyponatremia in the intensive care unit setting. Terrorist threat-construction of a damage control training program for non-specialized caregivers Pierre Pasquier (speaker) 1 , Astrée Swiech 1 , Thibault Martinez 1 , Gaël De Rocquigny 1 , Gwion Loarer 2 , Sylvain Vico 3 , Jérôme Planchon 4 , Arnaud Le Goff 5 , Kilian Bertho 6 , Clément Derkenne 6 ,Stéphane Travers 7 , Brice Introduction: Venous thromboembolic events (VTE) is an often silent complication in burn patients, which is strongly associated with poor outcomes. Previous research [1] has shown that burn injury size (TBSA) and weight affected Enoxaparin dosing in burns. The aim of our study was to assess this hypothetis in burns treated with Enoxaparin for VTE prophylaxis to achieve adequate anti factor Xa levels (anti-Xa) with initial dosing and its impact to reduce VTE. Patients and methods: This study was conducted in burn center in Tunis from February 2018 To September 2018. Acute burn patients admitted to the burn center and anticipated to be nonambulatory for greater than 48 h were included. Were excluded patients with any contraindication to the use of enoxaparin, including intracranial bleeding or hemorrhagic stroke (within 48 h), neurotrauma, suspected or proven bleeding, and those with creatinine clearance < 30 ml mn or creat > 1.6 mg/dL. Enrolled patients received Enoxaparin as following-Enoxaparin dose in mg Q12Hrs = 22.8 + (3.3 x % TBSA 10) + (1.89 x (weight in kg) 10) [1] . Peak anti-Xa was obtained between 3 and 5 h after the third enoxaparin dose. Doses of enoxaparin were titrated up or down by 20% to achieve the recommended anti-Xa of 0.2 to 0.4U ml. Results: 30 burned patients were included. The mean age was 35 ± 17 years with a ratio sex of 3.29. The average TBSA was 41.5 ± 17% with a body weight of 68.5 ± 17 kg. Fourteen patients (46%) reached anti-Xa target initially, 15 patients' anti-Xa was below target and only 1 patient' anti-Xa was above target.The median final enoxaparin dose was 40 mg Q12Hrs (range, 30-80 mg) for all patients who were at anti-Xa target. Comparative study of 2 groups of patients-anti-Xa target initially (G1) and below target (G2) was as follows (Table 1 )-No episodes of hemorrhage, thrombocytopenia, or heparin-associated allergy documented in any of the study patients.VTE occured in 5 patients among which 4 cases in patients' anti-Xa below target initially. Conclusion: Enoxaparin dosing equation in burns allows to reach a prophylactic initial anti-Xa level, and was associated with a low incidence of VTE events and no bleeding complications. Enoxaparin dosing correlates strongly with burn size, patient weight and clearance of creatinine. Thus, a standard dose for all adult acute burn patients is recommended. We retrospectively studied 72 consecutive patients admitted for suspected IPN requiring interventions by catheter drainage first between 2012 and 2016 admitted in 3 university hospitals. All computed tomography (CT) prior to the first drainage procedure were reviewed by a single blinded radiologist. Results: Catheter drainage procedure was a success for 44.4% of patients. Nomogram predicted catheter drainage failure with an area under the ROC curve of 0.71. A score ≤ 8 results in a 100% success chance of primary catheter drainage. Similarly, unfavorable score of 40 points results in a 100% failure of primary catheter drainage. In multivariate analysis, catheter drainage failure was independently associated with body mass index (BMI) (OR-1.14 + 95% CI-1.01-1.29 + P-0.02), heterogeneous collection (OR-18.84 + 95% CI-2.02-175.86 + P-0.01) and respiratory failure 24 h prior catheter drainage (OR-16.76 + 95% CI-1.94-144.4 + P-0.01). Conclusion: Half of the patients required necrosectomy after primary catheter drainage. Nomogram can be useful to predict catheter drainage failure, especially in the extreme ranges. Heterogeneous collection on CT and respiratory failure 24 h prior to drainage were strongly associated with catheter drainage failure. Early identification of patients at risk of drainage failure alone could improve their management and reduce antibiotics duration. Introduction: Recent guidelines ruled out prophylactic antibiotics to prevent infected pancreatic necrosis (IPN) and advocate the step-up approach for the management of IPN. Emerging drug resistant bacteria is a rising problem among SAP and ICU patients. Our primary objective was to determine the impact of antibiotherapy on samples cultures collected during interventions for an IPN among patients admitted for severe acute pancreatitis (SAP). Description of microbiological species and their patterns of resistance were our secondary goals. Patients and methods: We retrospectively studied 62 consecutive patients admitted in ICU for suspected IPN requiring interventions. We collected data about microbiological samples, as well as antimicrobial therapy. We classified species according to the definitions proposed by Magiorakos et al. Results: IPN was confirmed for 48 patients, with 137 samples collected during interventions. 57% of positive cultures were levied under efficient antibiotherapy > 24 h, previous antibiotherapy did not influence cultures results (p = 0.84). 13 of samples were polymicrobial. Gram staining had a sensitivity of 64.5% and a specificity of 96.7%, a Positive Predictive Value (PPV) of 98.6% and a Negative Predictive Value (PNV) of 43.2%. Half of the patients developed multi and extensively drug resistant bacteria. Prolonged antibiotics did not sterilized collections or necrotic tissues. Discussion: Previous antibiotherapy did not influence microbiological culture results and prolonged adapted broad-spectrum antibiotics did not allow sterilizing necrotic tissue or fluid collections. Our results showed a 50% prevalence of drug resistant bacteria. Gram staining can not be used to invalidate IPN diagnosis. Negative cultures among patients under antibiotics should question the diagnosis of IPN and antibiotics discontinuation. Conclusion: Prolonged broad Spectrum antibiotics did not permit to sterilize IPN, but prevalence of drug resistance bacteria is raising, up to 50% in our study. Strategies to reduce antimicrobial therapy use and exposure in the course of SAP are needed. Futures prospective studies are needed to determine the optimal antimicrobial therapy duration. Khaoula Ben Ismail (speaker) 1 Introduction: Severe acute liver injury is characterized by an acute liver damage without underlying chronic liver disease. It is a critical condition as it may lead to acute liver failure. The aim of this work was to provide epidemiological and prognostic features of this condition. Patients and methods: It was a retrospective 1-year study from January to December 2017. We included all patients admitted for severe acute liver injury (ALI). Results: Forty-six patients were included with a sex-ratio at 0.5 and a mean age of 48 ± 19 years (16-87). The main comorbidities were diabetes mellitus (31%) and hypertension (28%). Principal etiologies of ALI were hepatitis (46%) and drugs (28%). Hepatitis type B was incriminated in 11 patients (24%), type A in 8 patients and type E in 2 patients. Acute liver failure (ALF) occurred in 7 patients. ALF was classified as hyperacute in 2 patients, acute in 3 patients and subacute in 2 patients. Six patients died (13%) because of ALF. Patients with unfavorable outcome (death or ALF), in whom demographic characteristics were similar to patients with favorable outcome, had lower platelet count (198.103 ml vs 110 .103 ml, p = 0.025), lower prothrombin time ratio (22 ± 11% vs 45 ± 22%, p < 0.001), higher INR level (1.52 ± 2.1 vs 3.6 ± 0.44 p < 0.001), lower hemoglobin amount (9.5 ± 3.4 g/dL vs 12 ± 2.2 g/dL, p = 0.029), lower diastolic blood pressure (58 ± 8 mmHg vs 72 ± 13 mmHg, p = 0.015) and lower mean blood pressure (76 ± 9 mmHg vs 89 ± 13 mmHg, p = 0.026). The results of the logistic regression analysis showed that only diastolic blood pressure level was significantly related to unfavorable outcome. ROC curve analysis showed that a diastolic blood pressure level < 60 mmHg was a predictive factor of unfavorable outcome with a sensibility of 75% and specificity of 95% (AUR = 0.802, 95% IC 0.627-0.977). Conclusion: ALI is associated with a non-negligible mortality mainly due to ALF. A diastolic blood pressure level less than 60 mmHg may help to predict unfavorable outcome. Ghada Sbouii (speaker) 1 , Ines Fathallah 2 , Khaoula Ben Ismail 2 , Sahar Habacha 2 , Haifa Fazzeni 2 , Eya Sghir 2 , Amani Sghaier 2 , Emna Ennouri 2 , Asma Mehdi 2 , Nadia Kouraichi 2 1 Yasminet hospital, Kairouan, ABKHAZIA; 2 Ben arouss regional hospital, medical ICU, Ben Arouss, TUNISIA Correspondence: Ghada Sbouii -ghadasrlf@hotmail.com Annals of Intensive Care 2019, 9(Suppl 1):P-177 Introduction: Hepatic dysfunction is common in intensive care; however, few data are available. Hepatic dysfonction in critically ill patients remains a significant problem. The purpose of our study was to evaluate incidence, time of onset, characteristics and possible etiologies of liver function abnormalities in an intensive care unit (ICU). Patients and methods: A retrospective cohort study conducted in patients admitted in an ICU, from the 1th January 2018 to 15th September 2018. We included all patients who presented during their stay elevation of hepatic transaminases (ASAT ALAT) and or elevation of gamma-glutamyl transpeptidase (GGT) more than twice normal level and or alkalin phosphatase (ALP) more than one and half times normal level and or bilirubin more than two and half times normal level. In patients with previous liver dysfunction, new episode was defined by a further increase of one of this variables more than fifty per cent. Admitted patients who did not developed liver disturbances defined the "group control". Results: During the period of study, 72 patients were admitted, from which 49 presented liver dysfunction (68%). Median age was 65 years [23 + 84], mean APACHE II and SOFA scores were respectively Ameni Sghaier (speaker), Sahar Habacha, Hayfa Fazzeni, Ines Fathallah, Eya Seghir, Emna Ennouri, Asma Mehdi, Nadia Kouraichi Regional Hospital of Ben Arous, Intensive care Unit, Ben Arous, TUNISIA Correspondence: Ameni Sghaier -sghaier.ameni@gmx.com Annals of Intensive Care 2019, 9(Suppl 1):P-183Introduction: The performance of air handling unit (AHU) at reducing airborne particle transmission has been widely demonstrated in literature in terms of decrease of bacterial and fungal concentration in air and on surfaces. Our study aimed to evaluate the efficiency of AHU to reduce incidence of infections in intensive care unit (ICU). Patients and methods: The annual maintenance of AHU was performed in our ICU on the 1st of January 2018. We conducted a retrospective comparative study including two groups of patients admitted for more than 48 h. -Group 1-patients admitted between October 2016 and October 2017 -Group 2-patients admitted between January and August 2018. Clinical and bacteriological data of patients were recorded to identify those who developed nosocomial infections during their ICU stay. Incidence rates were adjusted for patient-time and differences were analyzed using the Chi square test. Results: Of a total of 164 patients included in our study, 54 (32.9%) belonged to group 2. Mean age was 55 ± 20 years and sex ratio was 1.92. The main etiologies of admission were acute respiratory failure (48%), coma (15.1%) and shock (7.9%). The overall incidence of nosocomial infection was 4.55 100 patient days and ventilation acquired pneumonia (VAP) had an overall incidence of 2.67 100 patient-ventilation-days, results were summarized in table 1. Catheter-related infection accounted for an overall incidence of 1.24 100 patient days and differences between the two incidence rates within the two groups were statistically significant with a preventive fraction of AHU amounting to 50.58% (table). The median time before onset of VAP was also significantly longer for patients admitted after AHU (median = 6.8 days prior to AHU Vs 13.7 days after AHU, p = 0.001). Conclusion: Our study has shown that AHU appears to reduce significantly the incidence of catheter related infection. It has also shown to slow the development of VAP after intubation but had no impact on the overall incidence of nosocomial infections. Introduction: Antibiotic resistance has become a major public health problem worldwide. Currently, the drastic increase of the carbapenem resistance in Gram-negative bacilli (CRGNB) is a major threat because not only of their fast spread rate but also their high morbidity and mortality rate. Patients and methods: This is a retrospective study in which we investigated the epidemiological profile and prognosis of Gram-negative bacilli with reduced sensitivity to carbapenems (GNBRSC) among 50 patients admitted to the intensive care unit in the military hospital of Tunis during a period of six months (January-June 2017). EUCAST carbapenem breakpoints were used to interpret susceptibility to carbapenems. Results: Acinetobacter baumanii was the most isolated bacterial species (63%), followed by Pseudomonas aeruginosa (13%) and Klebsiella pneumonia (12%). The most common infections were ventilator associated pneumonia (52%), bacteremia (12%), suppurative infections (8%), urinary tract infections (12%) and pneumopathies (8%). The resistance of Gram-negative bacilli to carbapenems is associated with resistance to most antibiotics, only colistin remains active on all naturally sensitive organisms. The risk factors for the acquisition of these infections are the advanced age, the state of immunosuppression of the patients, a long duration of hospitalisation, prior colonisation with GNBRSC and specially a previous taking of antibiotics during the last 3 months. Mortality within 30 days of infection onset was 30%. By multivariate analysis, predictors of in-hospital mortality were Sepsisrelated Organ Failure Assessment (SOFA) score at the day of infection (p = 0.001), inadequate empirical antimicrobial therapy (p = 0.03), chronic cardiac failure (p = 0.04). Discussion: In our series, the epidemiological and microbiological profile of GNBRSC was comparable to litterature data. CRGNB screening and confirmation requires a combination of phenotypic and genotypic tests to increase accuracy of detection which were not performed in our series. Introduction: The widespread recognition that critical illness is characterized as a state of immunosuppression has led to the development of nutritional support products or interventions designed to enhance the host immune response. While immune modulating diets (IMDs) containing nutrients displaying immunoregulating properties such as arginine are conceptually appealing, data from individual trials and several meta-analyses have failed to produce convincing results. Different studies found that early enteral administration of l-arginine to patients in ICU increased ornithine synthesis suggesting a preferential use by the arginase pathway, while citrulline NO synthesis was barely stimulated and immune functions were unaffected. Recent data suggest that citrulline supplementation may be more efficient to increase arginine availability and NO production than arginine supplementation. Our hypothesis is that supplementation with citrulline is more efficient than arginine to increase systemic arginine availability and decrease post-sepsis immunosuppression. Patients and methods: Using C57Bl6 mice, we performed a cecal ligation and puncture (CLP). At day 5 mice were sacrificed after performing cardiac puncture. We monitored immune function, especially those associated with impaired outcomes and nosocomial infections acquisition-lymphocyte apoptosis, MDSCs, regulatory T-Cells. In a second set of experiments, we performed a secondary infection (pneumonia) at day 5 after CLP. Severity of pulmonary infection was assessed using bronchoalveolar lavage and histological analysis. Of note, spleen and kidney were harvested to evaluate bacterial dissemination. These experiments were performed in 3 different groups of mice-citrulline (200 g kg j), arginine (200 g kg j) or an isonitrogenous placebo diets during five days following CLP. Continuous variables represented as mean ± SD were compared using Student t test. P < 0.05 indicated statistically significant differences. Results: Citrulline supplementation was associated with a diminished proportion of apoptotic lymphocytes and a lower recruitment of regulatory T-cells. We observed a trend towards hypoargininemia correction and a higher citrullinemia in the citrulline group. Assessment of MRSA pneumonia severity showed a reduced bacterial load in BAL of citrulline fitted mice. Bacterial dissemination was also significantly lower in this group. Conclusion: Enteral administration of citrulline was associated with a less pronounced post septic immunoparalysis and a diminished susceptibility to secondary infections in a murine two hit model of sepsis. Antoine Guillon (speaker) 1 Introduction: Community-acquired pneumonia is a widespread disease with significant morbimortality. Pneumonia rates drop during childhood and then remain low for decades, until they rise again in the elderly. The dogma that only adaptive immunity builds immunological memory has recently been challenged + emerging evidences indicated that innate immune cells display long-term changes after infection. Alveolar macrophages (AM) are tissue-resident lung cells that play a crucial role in innate immunity. Our current understanding of AM is based on studies conducted in animals without preexisting conditions. We hypothesized that AM can display adaptive characteristics after resolution of pneumonia. In this study, we described to what extent AM change after recovery of lung infection in mice. Patients and methods: Mice were infected with 2 intranasal or left bronchial instillations of Streptococcus pneumoniae (Sp 19F) with one week intervals between infections. Infections were self-limiting and mice were studied 4-6 weeks later (named thereafter Veteran or Naïve for control mice). Single-cell suspensions were generated from lungs and assessed by flow cytometry. Data were analyzed using traditional manual 2D gating. In addition, an unsupervised computational approach (t-SNE) was used for dimension reduction of the data and analysis. AM were sorted for transcriptome analysis. Veteran and Naive mice were subsequently infected with lethal dose of Sp 3 with without AM depletion induced by clodronate. Results: Lung-resident myeloid cell populations were identical in Veteran and Naïve mice as defined by manual gating. However, examination of t-SNE-visualized map of the dataset revealed a difference in one cluster corresponding of the AM. We identified multiple subtle changes in the immunophenotype of Veteran AM including decreased SiglecF expression, increased MHCII and CD64 expression. This remodeling was-(i) long-lasting (still observed 6 months post infection) and (ii) regionally localized (only observed in the left lungs of mice infected through the left bronchus). Veteran newly infected by Sp3 had better bacterial clearance compared to Naïve + however, this enhanced protection was not observed in Veteran mice with AM depletion. Finally, transcriptome profiling demonstrated marked differences between Naive and Veteran AM, including immune functions, cell cycle and metabolism. Conclusion: AM are remodeled and reprogrammed after mild and self-limiting respiratory infection, these changes being long-lasting, compartmentalized and associated with enhanced lung protection. Determining how Veteran AM respond differently to subsequent infections may offer new mechanisms to understand what is altered in adults with high susceptibility to pneumonia For gene-expression studies, microarray experiments were performed using Affymetrix Clariom S Mouse genome-wide array after RNA isolation from isolated T-cells after CLP (Days 1&8). We identified differentially expressed genes using ANOVA for each gene, then used unadjusted p-value and fold changes to filter and select differentially expressed genes. We used mean centered data to perform samples and genes classification by hierarchical clustering, using the Spearman correlation similarity measure and average ward linkage algorithm. Diseases & functions representing key genes were identified using Ingenuity software. In T-cells, we used Luminex Histone PTM Multiplex assay to evaluated the effect of TSA on global H3 acetylation with focus on 13 acetylation marks. Results: More than 60 genes were differentially expressed between CLP TSA-treated mice and CLP mice 1 day after CLP. This effect was more pronounced at D8 of sepsis (> 250 genes differentially expressed). At day 8 of sepsis, TSA up-regulates 15 genes down-regulated by CLP and down-regulates 2 genes up-regulated by CLP. 12 of these genes were directly involved in immune responses (Fig 1A) modulated by TSA in our model (including T-cell apoptosis and T-cell expression of PD1 and PD-L1). Other genes affected are genes involved in cellular movement, immune cell trafficking, inflammatory response, antimicrobial response and cell death and survival (Fig 1B) . Pan-histone 3 acetylation was significantly increased in T-cells 1 day after sepsis. Conclusion: Treatment with TSA significantly alters histone 3 acetylation and expression of 17 genes involved in the modulation of cellular function linked to SIIS, T-cell apoptosis and exhaustion. Florian Reizine (speaker) 1 Introduction: Sepsis initiates a complex immune response with the concomitant occurrence of both pro and anti-inflammatory reaction that can lead to an increased susceptibility to secondary infections which represent a significant cause of mortality and morbidity. Although we observed a significant decrease in sepsis associated mortality over the last decade, clinical trial of adjuvant therapies failed to demonstrate an improvement in mortality despite significant effect in animal studies. These discrepancies might be due to the lack of recommendations in pre-clinical sepsis models. To enhance translational value of sepsis models in experimental studies, guidelines have been recently published (1) . However, there is no data regarding the effectiveness of such recommendations. The aim of our study is to demonstrate that, when following newly published Minimum Quality Threshold in Pre-Clinical Sepsis Studies, a mouse model of cecal ligation and puncture (CLP) can mimic sepsis induced immunosuppression that worsen secondary infections. Patients and methods: C57Bl6 mice were used to perform CLP and compared to a control group (sham). At day 5 to 7 mice were sacrificed after performing cardiac puncture. We monitored immune function, especially those associated with impaired outcome and nosocomial infections acquisition-lymphocyte apoptosis, MDSCs, regulatory T-Cells, blood phenotype and T-lymphocytes proliferation index.A second group of mice were used to study the severity of a secondary infection (MRSA pneumonia) at day 5 after CLP or sham surgery. 12 h later, severity of infection was assessed. Continuous variables represented as mean ± SD were compared using Student T test. P < 0.05 indicated statistically significant differences. Results: We found a significant increase of G-MDSC, M-MDSC, Regulatory T-Cells, monocytes and neutrophils recruitment in CLP mice. We also observed a higher concentration of apoptotic lymphocytes and a diminished lymphocyte proliferation index in this group. MRSA pneumonia was more severe in CLP mice as bacterial load in BAL and MRSA bacteremia (concentration in harvested spleen and kidney) were significantly higher than in sham group. Conclusion: We observed that, when newly published guidelines are followed, CLP induces immune dysfunction which is responsible for more severe secondary infection. Standardization of animal models of sepsis should improve their translational value. Introduction: Bronchiolitis is still one of the most leading causes of morbidity and mortality in children (1, 2) . Advances in molecular diagnosis have led to increased testing for single and multiviral respiratory infection in routine clinical practice (3, 4) . The aim of the study was to identify the viral identification on the outcomes for severe bronchiolitis requiring non-invasive ventilation (NIV) or high-flow nasal cannula oxygen (HFNC). We reviewed all cases of bronchiolitis requiring NIV or HFNC in our pediatric intensive care department during 2016 and 2017. The organisms detected by a naso-pharyngeal swab for a panel included in the Multiplex PCR assay (RespiFinder). The data were collected from our electronic medical record (EMR). The principal studied outcome was the rate of NIV failure defined as the rate of intubation. The secondary outcomes were length of hostpital stay, length of ventilation and mortality. Results: 152 cases of bronchiolitis were treated by NIV in our center during the period of study. A viral identification was done in 88.8% (n = 135) of the cases of bronchiolitis (Table 1) . 71.6% (n = 106) have been under NIV with 28.4% (n = 42) under HFNC. 27.7% (n = 41) had viral bacteria co-infections who were significantly more susceptible to get intubated with 5 patients intubated against 1 patient in the group without bacterial co-infection (p = 0.008). 10.7% (n = 19) were coinfected by another virus but no significant difference was found on the studied outcomes. Rhino Enterovirus was associated with longer length of stay, especially on heart disease, with a larger temporal distribution during the year. Conclusion: We found a higher rate of NIV failure in the patients having viral bacteria co-infections but no differences between viral coinfections. In addition to the medical background, the type of the virus and the multiple infections especially bacterial should lead to better care of the children at high risk of complications including the risk of NIV failure. Amikacin dosing of 30 mg kg in critically ill children-do we achieve the peak plasmatic target? Mathieu Genuini (speaker) 1 Introduction: Amikacin efficacy required Cmax between 60-80 mg l corresponding to 8-10 times the minimal inhibitory concentration (MIC) breakpoint for sensitive strain. To reach plasma peak target, 25-30 mg kg of amikacin is recommended in patients with altered pharmacokinetics properties, leading to underdosage in 20-30% critically ill adult. We aimed to assess the incidence and predictive factors of Cmax < 60 mg L in a population of critically ill children. Patients and methods: All children admitted in the PICU located within two French tertiary academic pediatric hospitals receiving amikacin at a dose of 30 mg kg were included in a retrospective observational study between November 2017 and June 2018. Results: Clinical and biological data, amikacin dosing information, and plasma concentrations were recorded. The target Cmax was between 60-80 mg L. Risk factors of Cmax < 60 mg L were identified by univariate analysis. Cmax was < 60 mg L and between 60-80 mg L in 16 (67%) and 8 (23%) of the 24 included patients, respectively. None had Cmax > 80 mg L. 13 14 (93%) patients with measured MIC achieved the pharmacokinetic pharmacodynamic ratio of 8xMIC. Risk factor for Cmax < 60 mg L was low blood urea concentration with p = 0.01. Amikacin prescription was based on admission weight, which was 10% less than actual weight. AKI occurred in 12 (50%) of patients after amikacin injection, related to severe sepsis and use of nephrotoxic agents. Trough concentration was > 2.5 mg L in 40% of patients measured Cmin. Conclusion: Despite the use of the maximal amikacin dose of 30 mg kg, Cmax were below pharmacokinetic target in 67% of our population. None of them suffered from amikacin overexposure. Dosing strategy of amikacin should be optimized using actual weight rather than dry weight and the maximal dose of 30 mg kg. Regarding high prevalence of AKI, the maximal dose of amikacin should concern patients with altered pharmacokinetics properties. Trough concentration should be systematically monitored in patients receiving high doses of aminoglycosides. Christophe Milesi (speaker) 1 Introduction: PTIF in infants with bronchiolitis has never been determined. However this data is important to consider for the settings of HFNC because its efficiency is optimal when the settled flow is equal or higher than the patient's PTIF. . Refractory p-ARDS can benefit from extracorporeal respiratory membrane oxygenation (ECMO) but the PP is not proved in this situation. The objective of the study was to evaluate the effect of PP on lung recruitment in p-ARDS under ECMO, and also compare ECMO versus non-ECMO patients. This single-center observational study has been performed in the PICU at Trousseau Hospital from June 2016 to June 2018. A prone positioning protocol was used. The PP was prescribed by intensivists for duration 20 h 24 h. The lung recruitment was assessed by static compliance at H0 (supine position) and H4, H12 and H20 during PP. Results: Twenty-five p-ARDS patients were included, 17 children were treated with conventional mechanical ventilation and 8 treated with ECMO associated with apneic ventilation. The mean age was 14 ± 26 months and the weight was 7.5 ± 6.8 kg. Before PP the mean FiO2 = 85 ± 19%, the mean arterial saturation was 94 ± 4%, the mean PaO2 FiO2 = 125 ± 65. The ventilatory parameters before ECMO were different between non-ECMO group and ECMO group-plateau pressure = 29 ± 7 vs 28 ± 4 cmH2O (p = 0.8341), PEEP = 8 ± 3 vs 14 ± 2 cmH2O (p = 0.0001), driving pressure = 20 ± 7 vs 14 ± 2 cmH2O (p = 0.02), tidal volume = 5.7 ± 0.8 vs 3.2 ± 1.8 ml Kg (p = 0.0001). The compliances increased in both groups from H0 to H12 (Table 1) . At H20, the indexed pulmonary compliance was significantly lower in ECMO than non-ECMO patients. The patients presented moderate p-ARDS with PaO2 FiO2 = 125 and followed PP adult recommendations. In ECMO group, the driving pressure was significantly higher than non-ECMO group due to an apneic ventilation (high PEEP and limited plateau pressure). The PP might not be an effective strategy for p-ARDS with ECMO due to absence of maintained lung recruitment by low tidal volume ventilation. These results should be confirmed on larger cohorts. The prone positioning in pediatric ECMO-ARDS could be insufficient to maintain the lung recruitment over a long time. Introduction: Automated pupillometry (AP) can be used to quantify pupil light reflex (PLR) in critically ill patients. However, the complexity of sympathetic and parasympathetic pathways involved in the PLR may expand the use of AP to quantify other phenomena related to nervous system, such as the regulation of vascular tone and regional blood flow. Patients and methods: Observational ongoing study including critically ill patients admitted to the Intensive Care Unit. Exclusion criteria were-ocular diseases + intracranial disease; + arrhyth-mias; + extracorporeal membrane oxygenation; + supraaortic arteriopathy. Quantitative pupillometry was performed using the NPi ® -200 pupillometer (Neuroptics ® ), which calculates the Neurological Pupil Index (NPI), pupillary contraction, latency, constriction velocity and dilation velocity. The mean value of these variables measured on each eye was calculated. Transcranial Doppler (DWL, Germany) was performed insonating the left middle cerebral artery (LMCA) with a 2 MHz probe. LMCA blood flow velocity (FV) and arterial blood pressure (BP) signals were simultaneously recorded; + Pearson´s correlation coefficient between BP and FV (Mxa) was calculated using MATLAB (MathWorks, USA The 52 weaning failures were -37 neurological symptoms (confusion or somnolence n = 21, headache n = 10, coma n = 4, nausea n = 1, aphasia n = 1), 5 elevated intracranial pressure (ICP), 7 ventricular dilatation on CT scan, 3 cerebrospinal fluid (CSF) related problems (2 hemorrhagic CSF, 1 CSF leak through the scar). After a first failure, the EVD was finally successfully removed in 26 (50%) cases after an average of 9.9 days. Conclusion: The two weaning methods seem to be performed under the same conditions and within the same delays. The failure rate is similar but rapid weaning significantly reduces the duration of EVD by an average of 2.4 days. Conclusion: Stroke is a major public health problem in our country. Our study shows that hypertension is the most frequently associated risk factor, which needs to be strengthened with screening and treatment. The number of patients admitted to intensive care can be reduced thanks to the creation of neurovascular unit and the control of risk factors. Summary-To improve the management of patients with stroke, an assessment was needed. This evaluation has shown the relationship between risk factors, namely hypertension and atrial fibrillation arrhythmia, which must be controlled. Results: 283 patients were included with mean age of 69 ± 12 years and sex ratio 1.02. Comorbidities were dominated by high blood pressure (69%) followed by diabetes (46%). The concept of coronary insufficiency was known in 51 patients (18%). Troponin was positive for 42 patients (14.8%), 73% of whom did not have a known history of coronary artery disease. The diagnosis of Troponin-positive NSTEMI associated with stroke was retained in three patients. Half of the patients with a positive troponin had consistent ECG changes with myocardial ischemia (p < 0.001, OR = 3.63, 95% CI-1.84-7.16). The electrical signs were mainly subepicardial ischemia (52%) followed by the subendocardial lesion (35%). ACFA was present for 69 patients and it was not associated with a positive troponin (p = 0.767) and the same goes to the occurrence of haemorrhagic transformation (p = 0.713). The overall mortality was 13.4% and 34% of the deceased patients had a positive troponin (p < 0.001). In the acute phase of stroke, the elevation of troponin or the occurrence of electrocardiographic changes must be part of a comprehensive diagnostic approach as well as an approach to the prevention and management of comorbidities. Median of Glasgow coma scale was 8. Seven strokes (50%) occurred in the left middle cerebral artery (MCA) territory, while 5 (35, 72%) occurred in the right MCA territory, one stroke (7, 14%) occurred in posterior cerebral artery territory and one stroke (7, 14%) occurred in anterior cerebral artery territory. The mean time of decompressive hemicraniectomy was 2.5 days. The median modified Rankin scale (mRS) at 3 month was 5.5. Mortality was 50%. Conclusion: Although DCH is considered a live-saving procedure and decrease mortality, but many patients suffering a worse functional outcome and disability. Introduction: Brain-injury is a leading factor of mortality and morbidity from traumatic injury in young and previously healthy patients. Early evaluation of the prognosis of a patient is necessary to determine the most suitable medical care strategy. The aim of this study was to predict mortality and outcome in brain injured population based on the first clinical and biological evaluation. We conducted an eight month long prospective cohort, including all patients admitted to a university hospital ICU with moderate to severe traumatic brain injury (TBI), defined as a Glasgow coma scale below twelve (GCS < 12). Outcome was evaluated by incidence of death, and Glasgow outcome scale (GOS) on day thirty. Both univariate and multivariate analysis were used to determine level of significance. Results: During the study period, 118 trauma patients were admitted to our ICU, 83presented with moderate to severe TBI and were included. There were 69 males (83.1%) and 14 females (16.9%) patients. The mean age was at 32.06 ± 18.07 and mean injury severity score (ISS) was 28.96 ± 10.16. According to our analysis mortality rate among patients sustaining moderate to severe TBI was 15.7%. Average ICU LOS was 14.6 days and average ventilator days was 9.68 days.Using the multivariable logistic regression model, only initial glucose serum levels (p = 0.002) and pupil response (p-0.004) were found to be independent risk factors of mortality. Linear regression models also identified glucose levels as predictive of GOS on day 30 (p = 0.019). Conclusion: We conclude that initial glucose level is an independent predictor of mortality and morbidity in brain injured patients. Hyperglycemia could be considered as a simple yet valuable marker ofbrain injury and, when present upon admission, could reflect extensivebrain damage, frequently associated with mortality and bad outcome.Introduction: Delirium is an acute brain dysfunction commonly seen in critically ill patients and associated with poor outcomes. Delirium is usually underdiagnosed by physicians due to the lack of adequate screening tool. Introduction: Respiratory failure during pregnancy and post-partum period is an uncommon but particular situation. There is a lack of literature concerning the assessment and management of these patients, the choice of investigations and treatments may affect the mother and the fetus.**The aim of this study was to study characteristics and outcome of these patients admitted in ICU.**. Recently it has been demonstrated that conservative protocol for oxygen (O2) therapy resulted in lower ICU mortality than conventional therapy. FreeO2 device, automatically adjusts oxygen flow based on patients' needs (SaO2), in the emergency department it was associated with improved oxygenation and adherence to guidelines. The aim of this study was to evaluate the feasibility FreeO2 in weaning of oxygen following mechanical ventilation (MV) in patients admitted in a Tunisian ICU. Patients and methods: In a prospective cohort study including a cohort of patients admitted to the ICU (between June and September 2018), and requiring MV (NIV or intubation), we recorded Free O2 generated curves during 2 h when acute clinical condition was controlled.We assessed, O2 flow rate and the percentage of patients less than 1 l min at the end of the record, O2 consumption variation, the time in the SpO2 target, the time with severe desaturation (SpO2 < 85%), and the time with hyperoxia (SpO2 > 5% above the target). Statisticsdichotomic parameters are expressed in percentage whereas continuous variables are expressed in median and 25th-75th percentile interquartile ranges, linked parameters were assessed with Wilcoxon test.Results: Twenty six records were collected in 18 patients. Median age was 62 years (54-80), 61.5% were male. 53.8% with COPD, 46.2% with Hypertension and 7.7% with diabetes. The first ventilator modality at admission was NIV in 57.7%, the main reason for ICU admission was acute respiratory failure in 76.9% (11.5% de novo, 65.4% on chronic). Free O2 records were made on day 8 (4-23) after ICU admission for a median duration of interpretable records was 1.64 h (1.9-1.97). Mean SpO2 target set was 93% (92-94). Table I summarizes main findings after Free O2 records. In 73.1% of records we observed a decrease in O2 flow and median reduction of flow was 109.8 L of O2 per hour (51.6-205.2). At the end of Free O2 record we noted that the median O2 flow 2.2 (1-4.5), and an O2 flow ≤ 1 l min was noted in 10 records (38.5%). Conclusion: In our cohort automatic O2 titration with Free O2 was associated with substantial reduction in O2 delivery during record in patients following mechanical ventilation (MV). Further studies are needed to assess its impact on patient's outcomes and cost-effectiveness. Introduction: Withdrawal of mechanical ventilation (MV) is a crucial moment of ICU stay and may influence patient outcome. Fail extubation is associated with high mortality rate ranging around 25 to 50% [1] . Adoption weaning protocols can prevent extubation failure. We aim to review our practice in weaning of MV in ICU burns. Patients and methods: A retrospective study was conducted in burn center in Tunis from April 2017 to December 2017. Were included mechanically ventilated patients who have undergone weaning trial. Were excluded early died patients (< 24 h). We categorized ventilated patients into three groups according to the difficulty of weaning process [2] . Simple weaning includes patients who succeed the first weaning trial; Difficult weaning -patient who failed the first weanig trial and required up to 3 trials or 7 days to achieve success weaning. Prolonged weaning -patients required more than 7 days of weaning after the first weaning trial. Weaning criteria were-SpO2 > 90% and FIO2 40%, PEEP 5 cmH2O, respiratory rate/tidal volume < 105, no myocardial ischemia, Introduction: Acute dyspnea is a common symptom encountered in hospitalized patients in emergency room with a clinical presentation sometimes atypical especially in the elderly. It has a wide variety of etiologies that can sometimes be life threatening. Our work aimed to establish the epidemiological and etiological profile of the patients admitted in emergency room and to identify its prognostic factors. Patients and methods: This was a 16-month retrospective study including patients hospitalized in observation unit for acute dyspnea, which was defined as a breathing discomfort that had developed or worsened for less than two weeks. Were excluded all the patients who were admitted immediately in resuscitation unit and those suffering from post-traumatic dyspnea. Results: We included 265 patients hospitalized for acute dyspnea which accounted for 26% of admissions. The median age of the patients was of 72 years. Acute respiratory failure was the main clinical presentation in our patients, which was hypoxemic in 60% of cases and hypercapnic in 37% of cases. Dyspnea was multifactorial in 15% of patients and the main etiologies were acute community-acquired pneumonia (42.6%), acute heart failure (36%) and decompensation of chronic obstructive pulmonary disease (COPD) (10%). Non-invasive ventilation and invasive ventilation were respectively necessary in 44% and 2.2% of cases. The intra-hospital mortality was 18.5%. It highly increased in patients aged more than 70 years, alteration of consciousness, hemodynamic instability, IGS II score≥ + 29, in case of acidemia (pH7.25) or hypoxemia (PaO2 FiO2240). The use of mechanical ventilation as well as the need of vasoactive drugs were also associated with higher mortality rates. Predictors of ventilatory support were polypnea > 25 cycles minute, COPD, signs of respiratory distress and blood pressure > 140 70 mm Hg. COPD was the only predictor of 3-month readmission in patients with acute dyspnea, whereas higher age of the patients was correlated with a longer hospital stay. Conclusion: Acute dyspnea is one of the leading causes of emergency hospitalization of elderly patients. It's mainly caused by the decompensation of respiratory and cardiac comorbidities. Age is the main prognostic factor. Introduction: Problems related to mechanical ventilation weaning are common in intensive care. Many factors can affect weaning process and make it short, difficult or prolonged. We aimed to study weaning conditions and procedures in our department. Patients and methods: Retrospective cohort study conducted in patients admitted in an ICU, from the first January 2017 to the 15th September 2018. We included all patients who have been mechanically ventilated more than 24 h during this period. We used the weaning definition to classify patients-Group no weaning-patients never experienced any separation attempt. Group 1 (short weaning)-First separation attempt resulted in a termination of the weaning process within 24 h (successful separation or early death). Group 2 (difficult weaning)-weaning was terminated after more than 1 day but in less than 1 week after the first separation attempt (successful separation or death). Group 3 (prolonged weaning)-weaning was still not terminated 7 days after the first separation attempt (by success or death). Conclusion: The first separation attempt was successful in most cases of our patients but the delay was prolonged. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.