Influence of a patient’s diary on the lives of patients and families after an ICU stay: a multicentre prospective randomized study with blinded evaluator
The experience of patients and families after an ICU stay is often traumatic. Most patients report a complete absence of memories, or the existence of false memories, or of hallucinations. This paves the way for post-traumatic stress disorders. Having a diary telling the story of the patient's stay in ICU, with all associated events, and writing it up with the help of his family seems now to be a way to prevent the psychological scars of ICU stay
This study in 36 ICUs in France is addressing this question and will also know the patient perceptions about his ICU diary
In patients with invasive candidiasis, early antifungal therapy reduces mortality. In the absence of early accurate diagnostic tests, antifungal therapy is started empirically in the sickest patients with sepsis, risk factors of invasive fungal infections and multiple candida colonization. However, this strategy, recommended by recent 2016 IDSA guidelines never proved effectiveness in non-neutropenic non transplanted critically ill patients. Serum B-D-glucan, a cell wall constituent of several fungi, including Candida, has been approved by the FDA as an adjunct to cultures for the diagnosis of invasive fungal infections but lacks specificity in intensive care unit (ICU) patients with organ dysfunctions and high prevalence of bacterial infections.
Last, empirical therapy represents two-third of antifungal agents used in this population and the lack of proven benefits must be balanced against cost, toxicity, and the emergence of resistance.
Added value of this study
In this multicenter randomized double-blind trial, 260 non-neutropenic non-transplanted mechanically ventilated patients with sepsis, organ failure and multiple Candida colonization were enrolled in 19 ICUs. We compared micafungin 100 mg daily for 14 days with placebo and found that empirical micafungin did not influence day-28 fungal infection-free survival. The result remained unchanged in subgroup of patients with positive serum B-D-glucan. However, micafungin significantly reduced the incidence of ICU-acquired fungal infection.