RESUMO
BACKGROUND: Pain management and patient satisfaction were targeted in the emergency department of a Paris university hospital. In 1999, 77.0% of patients complained of pain on arrival and more than half of patients did not experience pain relief at discharge. The purpose of the study was to evaluate the outcomes of the implementation of a team piloting pain management on pain reduction and pain care satisfaction. METHOD: Two cross-sectional surveys (04/10/1999 to 19/10/1999 and 03/04/2007 to 18/04/2007) were conducted before and after a team piloting pain management was deployed in the emergency department. Consecutive patients age 18 years and older who visited the department suffering from pain were given structured questionnaires that validated scales scoring pain upon arrival and at discharge. Patients' files were analyzed using structured forms. The parameters associated with pain reduction and patient satisfaction were sought. RESULTS: In 2007, 65.0% of patients had their pain relieved vs. 35.1% in 1999 (P<0.001); 60.2% were satisfied with the pain care received vs. 39.8%. Pain management (e.g. waiting time ≤ 20 min: 47.6% vs. 20.8%; interventions on pain before the physician's examination: 63.0% vs. 13.8%; and pain reassessment after intervention: 13.8% vs. 4.5%) improved. Both pain reduction and patient satisfaction were significantly associated with intervention before the physician's examination. Pain reduction was independently and positively associated with time of survey, triage level (depending on the severity of their condition), pain intensity on arrival, and negatively associated with discharge without hospitalization. Satisfaction was independently and positively associated with waiting time before examination (0-20 min) and the absence of procedural pain. CONCLUSION: The implementation of a team piloting pain management seemed to have had positive effects on pain management in the emergency department. However, respectively, 56.2% and 39.8% of patients remained without pain relief and dissatisfied with pain management at the end of their visit.
Assuntos
Serviço Hospitalar de Emergência , Manejo da Dor/métodos , Equipe de Assistência ao Paciente/organização & administração , Satisfação do Paciente , Triagem/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Paris , Alta do Paciente , Inquéritos e Questionários , Recursos Humanos , Adulto JovemAssuntos
Corrida/estatística & dados numéricos , Dermatopatias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Traumatismos do Pé/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/epidemiologia , Gravidez , Corrida/lesões , Higiene da Pele/estatística & dados numéricos , Adulto JovemRESUMO
OBJECTIVE: To assess the proportion of patients meeting the 2010 SPILF-AFSSAPS guiding criteria for Streptococcuspneumoniae in patients consulting at the emergency departments of four French university hospitals for acute community-acquired pneumonia (CAP) suspicion. PATIENTS AND METHODS: The PACSCAN study prospectively included 319 patients. Medical history, clinical, biological, and radiological presentations were collected. An adjudication committee retrospectively classified the diagnostic certainty based on the initial chest CT scan data and the follow-up data up to Day 28. S. pneumoniae was looked for according to the clinician's choice of blood culture, pneumococcal urinary antigen test, nasopharyngeal PCR, and/or sputum microbiological examination. RESULTS: All patients (100%) met at least one criterion for S. pneumoniae CAP and six (2%) met all criteria. The distribution of criteria ranged from 32% (chest pain criterion) to 86% (age≥40years criterion). These figures were respectively 100%, 3%, 38%, and 82% when the study population was restricted to the 139 patients with definite or probable CAP, according to the adjudication committee. Taking into account the microbiological results, the criteria taken one by one or combined did not make it possible to differentiate the 19 S. pneumoniae CAP from the other CAPs. CONCLUSION: The 2010 SPILF-AFSSAPS guiding criteria for S. pneumoniae CAP are found in very variable proportions and do not, in their current form, make it possible to accurately guide towards a pneumococcal etiology in patients included in the PACSCAN study.
Assuntos
Pneumonia Pneumocócica/diagnóstico , Streptococcus pneumoniae/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Infecções Comunitárias Adquiridas/diagnóstico , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nasofaringe/microbiologia , Pneumonia Pneumocócica/sangue , Pneumonia Pneumocócica/urina , Reação em Cadeia da Polimerase/métodos , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Radiografia/métodos , Escarro/microbiologia , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVE: The aim was to create and validate a community-acquired pneumonia (CAP) diagnostic algorithm to facilitate diagnosis and guide chest computed tomography (CT) scan indication in patients with CAP suspicion in Emergency Departments (ED). METHODS: We performed an analysis of CAP suspected patients enrolled in the ESCAPED study who had undergone chest CT scan and detection of respiratory pathogens through nasopharyngeal PCRs. An adjudication committee assigned the final CAP probability (reference standard). Variables associated with confirmed CAP were used to create weighted CAP diagnostic scores. We estimated the score values for which CT scans helped correctly identify CAP, therefore creating a CAP diagnosis algorithm. Algorithms were externally validated in an independent cohort of 200 patients consecutively admitted in a Swiss hospital for CAP suspicion. RESULTS: Among the 319 patients included, 51% (163/319) were classified as confirmed CAP and 49% (156/319) as excluded CAP. Cough (weight = 1), chest pain (1), fever (1), positive PCR (except for rhinovirus) (1), C-reactive protein ≥50 mg/L (2) and chest X-ray parenchymal infiltrate (2) were associated with CAP. Patients with a score below 3 had a low probability of CAP (17%, 14/84), whereas those above 5 had a high probability (88%, 51/58). The algorithm (score calculation + CT scan in patients with score between 3 and 5) showed sensitivity 73% (95% CI 66-80), specificity 89% (95% CI 83-94), positive predictive value (PPV) 88% (95% CI 81-93), negative predictive value (NPV) 76% (95% CI 69-82) and area under the curve (AUC) 0.81 (95% CI 0.77-0.85). The algorithm displayed similar performance in the validation cohort (sensitivity 88% (95% CI 81-92), specificity 72% (95% CI 60-81), PPV 86% (95% CI 79-91), NPV 75% (95% CI 63-84) and AUC 0.80 (95% CI 0.73-0.87). CONCLUSION: Our CAP diagnostic algorithm may help reduce CAP misdiagnosis and optimize the use of chest CT scan.
Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência , Pneumonia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Biomarcadores , Tomada de Decisão Clínica , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Pneumonia/microbiologia , Vigilância em Saúde Pública , Radiografia Torácica , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodosAssuntos
COVID-19 , Alta do Paciente , Humanos , Estudos Prospectivos , Pacientes , Técnicas de Apoio para a DecisãoRESUMO
Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.
Assuntos
Doença Pulmonar Obstrutiva Crônica/terapia , Reação de Fase Aguda , Progressão da Doença , França , Humanos , Idioma , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/patologia , Qualidade de Vida , Índice de Gravidade de Doença , Sociedades Médicas/normas , Análise de SobrevidaRESUMO
Clinical images reporting intracardiac gas level are sparce and, to our knowledge, the presence of gas embolism into the coronary arteries has never been reported. We describe the case of a young man who experiences life-threatening gas embolism with the presence of gas bubbles into cardiac cavities and coronary arteries.
Assuntos
Cateterismo Venoso Central/instrumentação , Remoção de Dispositivo/efeitos adversos , Embolia Aérea/etiologia , Cardiopatias/etiologia , Adolescente , Doença das Coronárias/etiologia , Evolução Fatal , Parada Cardíaca/etiologia , Humanos , Embolia Intracraniana/etiologia , Transplante de Fígado , Masculino , Fibrilação Ventricular/etiologiaRESUMO
UNLABELLED: Infectious agents associated with community-acquired pneumonia (CAP) are under-studied. This study attempted to identify viruses from the upper respiratory tract in adults visiting emergency departments for clinically suspected CAP. Adults with suspected CAP enrolled in the ESCAPED study (impact of computed tomography on CAP diagnosis) had prospective nasopharyngeal (NP) samples studied by multiplex PCR (targeting 15 viruses and four intracellular bacteria). An adjudication committee composed of infectious disease specialists, pneumologists and radiologists blinded to PCR results reviewed patient records, including computed tomography and day 28 follow up, to categorize final diagnostic probability of CAP as definite, probable, possible, or excluded. Among the 254 patients enrolled, 78 (31%) had positive PCR, which detected viruses in 72/254 (28%) and intracellular bacteria in 8 (3%) patients. PCR was positive in 44/125 (35%) patients with definite CAP and 21/83 (25%) patients with excluded CAP. The most frequent organisms were influenza A/B virus in 27 (11%), rhinovirus in 20 (8%), coronavirus in seven (3%), respiratory syncytial virus in seven (3%) and Mycoplasma pneumoniae in eight (3%) of 254 patients. Proportion of rhinovirus was higher in patients with excluded CAP compared with other diagnostic categories (p = 0.01). No such difference was observed for influenza virus. Viruses seem common in adults attending emergency departments with suspected CAP. A concomitant clinical, radiological and biological analysis of the patient's chart can contribute to either confirm their role, or suggest upper respiratory tract infection or shedding. Their imputability and impact in early management of CAP deserve further studies. CLINICAL TRIALS REGISTRATION: NCT01574066.
Assuntos
Infecções Comunitárias Adquiridas/virologia , Reação em Cadeia da Polimerase Multiplex , Pneumonia Viral/virologia , Vírus/classificação , Vírus/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/patologia , Serviço Hospitalar de Emergência , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/patologia , Estudos Prospectivos , Vírus/genética , Adulto JovemRESUMO
Streptococcus pneumoniae can be responsible for spinal, joints, pulmonary or infrequently cutaneous septic localisations. The association between different septic localisation is extremely rare with this microorganism. We describe the first case of concomitant spinal, joints and cutaneous septic localisations in a critically ill patient with S. pneumoniae septicaemia. This observation illustrates that heterogeneity of clinical features depends on the pathogen characteristic and its interaction with the host.
Assuntos
Infecções Pneumocócicas/patologia , Sepse/complicações , Streptococcus pneumoniae/patogenicidade , Estado Terminal , Humanos , Articulações/microbiologia , Articulações/patologia , Masculino , Pessoa de Meia-Idade , Dermatopatias Bacterianas/microbiologia , Dermatopatias Bacterianas/patologia , Coluna Vertebral/microbiologia , Coluna Vertebral/patologia , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
Unexplained cytopenias can be related to bone marrow necrosis (BMN) in critically ill patients as it can be encountered in several diseases or life-threatening conditions. We present the case of a 39-year-old woman with pancytopenia revealing a BMN in the setting of an acute pyelonephritis with septic shock, multiple organ failure and sickle cell trait. After a short review on the subject, we suggest that various haematological abnormalities occurring in critically ill patients may be related to a mild to severe marrow necrosis.
Assuntos
Doenças da Medula Óssea/complicações , Choque Séptico/complicações , Adulto , Aspergilose/complicações , Cuidados Críticos , Evolução Fatal , Feminino , Humanos , Unidades de Terapia Intensiva , Insuficiência de Múltiplos Órgãos/patologia , Necrose , Pancitopenia/complicações , Infecções por Pseudomonas/complicações , Pielonefrite/complicações , Choque Séptico/microbiologia , Traço FalciformeRESUMO
BACKGROUND: The psychological burden suffered by elderly subjects after a fall adds to rehabilitation difficulties. We hypothesised that Post Traumatic Stress Disorder (PTSD) may be at the root of these psychological post-fall problems. The immediate psychological state was examined after 2 months post-fall in order to determine the prevalence of anxiety and PTSD and their possible correlates. METHOD: A single centre prospective survey including elderly subjects referred to an emergency department (ED) after a fall with a 2-month follow-up. RESULTS: 30.5% of patients showed a significant level of anxiety after their fall and (26%) showed evidence supporting the presence of PTSD at 2-months. Immediate anxiety, ability to re-establish upright posture and a history of repeated falls were significant predictors of PTSD at 2-months. CONCLUSION: persistent psychological problems post fall may be related to PTSD which is significantly correlated to immediate anxiety. This study can be seen as a first step in patient characterisation, and predicts who may benefit from which of the various approaches of rehabilitation.
Assuntos
Acidentes por Quedas , Ansiedade/etiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Estresse Psicológico/etiologia , Idoso , Idoso de 80 Anos ou mais , Ansiedade/psicologia , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Masculino , Projetos Piloto , Postura , Estudos Prospectivos , Reabilitação , Risco , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/psicologia , Fatores de TempoAssuntos
Aglomeração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adulto , Técnicas de Apoio para a Decisão , Serviço Hospitalar de Emergência/organização & administração , Feminino , Previsões , França , Humanos , Tempo de Internação , Transferência de Pacientes , Saúde Pública , Carga de TrabalhoAssuntos
Colo/diagnóstico por imagem , Diafragma/diagnóstico por imagem , Hérnia Diafragmática/diagnóstico por imagem , Fígado/diagnóstico por imagem , Adulto , Colo/anormalidades , Diafragma/anormalidades , Serviço Hospitalar de Emergência , Feminino , Hérnia Diafragmática/cirurgia , Humanos , Fígado/anormalidades , Radiografia , Síndrome , Resultado do TratamentoRESUMO
BACKGROUND: In Europe, including France, a measles outbreak has been ongoing since 2008. Unprotected healthcare workers (HCWs) may contract and spread the infection to patients. AIM: The objective of this study was to evaluate HCWs' measles immunity and vaccine acceptance in our setting. METHODS: In a survey-based study conducted in three university hospitals in Paris, 351 HCWs were included between April and June 2011. The following data were collected at enrolment: age, hospital unit, occupation, history of measles infection and vaccination, previous measles serology and acceptance of a measles vaccination in case of seronegativity. Sera were tested for the presence of specific anti-measles IgG antibodies using the CAPTIA(®) measles enzyme-linked immunosorbent assay. FINDINGS: The mean age of the participating HCWs was 36 years (range: 18-67) and 278 (79.2%) were female. In all, 104 four persons (29.6%) declared a history of measles, and 90 (25.6%) declared never having received a measles vaccination. Among the 351 HCWs included in the study, 322 (91.7%) were immunized against measles (IgG >90 mIU/mL). The risk factors for not being protected were age [18-29 years, adjusted odds ratio: 2.7 (95% confidence interval: 1.1-6.9) compared with ≥30 years], no history of measles infection or vaccination. The global acceptance rate for a measles vaccination, before knowing their results, was 78.6%. CONCLUSION: In this cohort of HCWs, 8.3% were susceptible to measles; the group most represented were aged <30 years. Acceptance of the measles vaccine was high. A vaccination campaign in healthcare settings should target specifically healthcare students and junior HCWs.
Assuntos
Surtos de Doenças/prevenção & controle , Pessoal de Saúde/estatística & dados numéricos , Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Anticorpos Antivirais/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Hospitais/normas , Humanos , Imunidade , Imunoglobulina G/sangue , Modelos Logísticos , Masculino , Sarampo/epidemiologia , Paris/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: In several small studies, anticoagulant therapy reduced the incidence of venous thromboembolism (VTE) in patients with isolated lower-limb injuries. OBJECTIVES: To compare the efficacy and safety of fondaparinux 2.5 mg (1.5 mg in patients with a creatinine clearance between 30 and 50 mL min(-1) ) over nadroparin 2850 anti-factor Xa IU. PATIENTS AND METHODS: In this international, multicenter, randomized, open-label study, patients with an isolated non-surgical unilateral below-knee injury having at least one additional major risk factor for VTE and requiring, in the Investigator's opinion, rigid or semi-rigid immobilization for 21-45 days with thromboprophylaxis up to complete mobilization received subcutaneously once-daily either fondaparinux or nadroparin. The primary efficacy outcome was the composite of VTE (symptomatic or ultrasonographically detected asymptomatic deep vein thrombosis of the lower limb or symptomatic pulmonary embolism) and death up to complete mobilization. The main safety outcome was major bleeding. RESULTS: We randomized 1349 patients (mean age 46 years): 88.7% had a bone fracture, and 83.8% had a plaster cast fitted (mean duration of immobilization, 34 days). The primary efficacy outcome occurred in 15 of 584 patients (2.6%) in the fondaparinux group and 48 of 586 patients (8.2%) in the nadroparin group (odds ratio, 0.30; 95% confidence interval [CI], 0.15-0.54; P < 0.001). A single major bleed was experienced by fondaparinux-treated patients and none by nadroparin-treated patients. These results were maintained up to the end of follow-up. CONCLUSIONS: Fondaparinux 2.5 mg day(-1) may be a valuable therapeutic option over nadroparin 2850 anti-FXa IU day(-1) for preventing VTE after below-knee injury requiring prolonged immobilization in patients with additional risk factors.
Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Imobilização/efeitos adversos , Traumatismos da Perna/terapia , Polissacarídeos/uso terapêutico , Tromboembolia Venosa/prevenção & controle , Adulto , Feminino , Fondaparinux , Humanos , MasculinoAssuntos
Biomarcadores/análise , Técnicas de Diagnóstico do Sistema Respiratório/normas , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/etiologia , Doença Pulmonar Obstrutiva Crônica/patologia , Doença Aguda , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Diagnóstico Diferencial , Progressão da Doença , Dispneia/complicações , Dispneia/diagnóstico , Humanos , Prognóstico , Infecções Respiratórias/diagnósticoRESUMO
Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.(AU)
La bronchopneumopathie chronique obstructive (BPCO) est la maladie respiratoire chronique dont le poids sur la santé publique est le plus grand par sa morbidité, sa mortalité et les dépenses de santé qu'elle induit. Pour les individus atteints, la BPCO est une source majeure de handicap du fait de la dyspnée, de la limitation d'activité, des exacerbations, du risque d'insuffisance respiratoire chronique et des manifestations extra-respiratoires qu'elle entraîne. Les précédentes recommandations de la Société de pneumologie de langue française (SPLF) sur la prise en charge des exacerbations BPCO date de 2003. Se fondant sur une méthodologie adaptée de GRADE, le présent document propose une actualisation de la question des exacerbations de BPCO en développant un argumentaire couvrant quatre champs d'investigation : (1) épidémiologie, (2) évaluation clinique, (3) prise en charge thérapeutique et (4) prévention. Les modalités spécifiques de la prise en charge hospitalière et ambulatoire y sont discutées, particulièrement les aspects relevant de l'évaluation de la sévérité de l'exacerbation et de la prise en charge pharmacologique.(AU)
Assuntos
Humanos , Broncodilatadores/uso terapêutico , Corticosteroides/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Índice de Gravidade de Doença , Reação de Fase Aguda , Doença Pulmonar Obstrutiva Crônica/prevenção & controleRESUMO
BACKGROUND AND OBJECTIVES: Elderly patients unable to get up after a fall or to activate an alarm mechanism are particularly at risk of complications and need to be monitored with extreme care. The different risk factors have fostered the development of stand-alone devices facilitating early detection of falls. We aimed at assessing performance of the Vigi'Fall(®) system, a cutting edge fall detector associating a "passive release" mechanism attached to the patient and including external sensors; in the event of a fall, the system automatically triggers an alarm, and it also incorporates embedded confirmation software. We have put it to the test under real-life conditions so as to evaluate not only its efficacy, but also and more particularly its acceptability and tolerability in elderly subjects. METHOD: The study ran from March 2007 through December 2008 in a geriatric ward with 10 subjects over 75 years of age, all of whom presented with a risk of falling. RESULTS: For eight patients wearing an accelerometric sensor, eight "falling" events and 30 "alarm release" events were recorded. Sensitivity and specificity of the device came to 62.5 and 99.5% respectively. For the two patients wearing the complete device, no events were detected. Not a single adverse occurrence was noted. Local tolerance was excellent in all but one of the subjects. CONCLUSION: Our results clearly show that the device may be worn by patients without discomfort over prolonged periods of time, and also demonstrate that the verification component will help to increase sensitivity in real-life conditions to a level comparable to the level attained in our laboratory studies.
Assuntos
Acidentes por Quedas , Idoso , Alarmes Clínicos , Monitorização Ambulatorial/instrumentação , Equipamentos de Proteção , Aceleração , Idoso de 80 Anos ou mais , Emergências , Desenho de Equipamento , Geriatria , Departamentos Hospitalares , Hospitais Urbanos , Humanos , Pacientes Internados , Monitorização Ambulatorial/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Sensibilidade e EspecificidadeRESUMO
PURPOSE: Septic shock induces a decrease in dendritic cells (DCs) that may contribute to sepsis-induced immunosuppression. We analyzed the time course of circulating DCs in patients with septic shock and its relation to susceptibility to intensive care unit (ICU)-acquired infections. METHODS: We enrolled adult patients with septic shock (n = 43), non-septic shock (n = 29), and with sepsis without organ dysfunction (n = 16). Healthy controls (n = 16) served as reference. Blood samples were drawn on the day of shock (day 1), then after 3 and 7 days. Myeloid (mDC) and plasmacytoid (pDC) DCs were counted by flow cytometry. Cell surface HLA-DR expression was analyzed in both DC subsets. RESULTS: At day 1, median mDC and pDC counts were dramatically lower in septic shock patients as compared to healthy controls (respectively, 835 mDCs and 178 pDCs/ml vs. 19,342 mDCs and 6,169 pDCs/ml; P < 0.0001) but also to non-septic shock and sepsis patients (P < 0.0001). HLA-DR expression was decreased in both mDCs and pDCS within the septic shock group as compared to healthy controls. DC depletion was sustained for at least 7 days in septic shock patients. Among them, 10/43 developed ICU-acquired infections after a median of 9 [7.5-11] days. At day 7, mDC counts increased in patients devoid of secondary infections, whereas they remained low in those who subsequently developed ICU-acquired infections. CONCLUSION: Septic shock is associated with profound and sustained depletion of circulating DCs. The persistence of low mDC counts is associated with the development of ICU-acquired infections, suggesting that DC depletion is a functional feature of sepsis-induced immunosuppression.