Ann. Intensive Care 2016, 6(Suppl 1):S50 DOI 10.1186/s13613-016-0114-z MEETING ABSTRACTS French Intensive Care Society, International congress – Réanimation 2016 Published: 17 June 2016 © 2016 All authors. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. PHYSICIANS ABSTRACTS O1 Impact of tracheal cuff shape on microaspiration of gastric contents in intubated critically ill patients: a multicenter randomized controlled study (BEST CUFF) Emmanuelle Jaillette 1 , Christophe Girault 2 , Guillaume Brunin 3 , Farid Zerimech 4 , Arnaud Chiche 5 , Céline Broucqsault‑Dedrie 6 , Cyril Fayolle 7 , Franck Minacori 8 , Isabelle Alves 9 , Stephanie Barrailler 10 , Laurent Robriquet 1 , Fabienne Tamion 11 , Emmanuel Delaporte 3 , Damien Thellier 5 , Claire Delcourte 1 , Alain Duhamel 12 , Saad Nseir 1 1 Centre de réanimation, C.h.r.u. Lille, Lille, France; 2 Réanimation Médicale, Centre Hospitalier Universitaire Rouen, Rouen, France; 3 Reanimation, Hospital Center De Boulogne‑Sur‑Mer, Boulogne‑sur‑Mer, France; 4 Labo‑ ratoire de biochimie et biologie moléculaire, C.h.r.u. Lille, Lille, France; 5 Réanimation, Centre Hospitalier de Tourcoing, Tourcoing, France; 6 Réani‑ mation, Hôpital Victor Provo, Roubaix, France; 7 Reanimation, Hospital Center De Dunkerque, Dunkerque, France; 8 Reanimation, Hospital Saint Philibert, Lille, France; 9 Reanimation, Hospital Center De Valenciennes, Valenciennes, France; 10 Reanimation, C.H. de Lens, Lens, France; 11 Réani‑ mation médicale, Hospital Center University Rouen, Rouen, France; 12 Clinique de santé publique, plateforme d’aide méthodologique, C.h.r.u. Lille, Lille, France Correspondence: Emmanuelle Jaillette ‑ emmanuelle.jaillette@chru‑lille.fr Annals of Intensive Care 2016, 6(Suppl 1): O1 Introduction Ventilator-associated pneumonia (VAP) is the most com- mon ICU-acquired infection in intubated critically ill patients. Micro- aspiration of gastric and oropharyngeal contaminated secretions represents the primary mechanism involved in the pathogenesis of VAP. Tracheal cuff plays an important role in stopping the progression of contaminated secretions into the lower respiratory tract. In vitro and animal studies suggested that leakage was significantly reduced with polyvinyl chloride (PVC) conical-cuffed tubes compared with barrel (standard) or cylindrical cuffs. Clinical studies found conflicting results. Therefore, the aim of this study is to determine the superiority of PVC conical- versus barrel (standard)-cuffed tracheal tube on abundant microaspiration of gastric contents in intubated critically ill patients. Materials and methods BEST CUFF is a prospective multicenter (ten French ICUs) cluster randomized controlled crossover and open-label trial performed in patients with predicted duration of mechanical ventilation ≥ 48 h. Patients were allocated to be intubated using a PVC standard (barrel)-shaped or a PVC conical-shaped tracheal tube. Prevention measures of VAP were standardized in all ICUs. The main objective was to demonstrate the superiority of conical versus stand- ard cuff shape in reducing abundant microaspiration of gastric con- tents (pepsin level >200 ng/ml in at least 30 % of tracheal aspirates). After inclusion, tracheal aspirates were collected for 48 h to measure pepsin and salivary amylase, and diagnose gastric and oropharyngeal microaspiration. To diagnose tracheobronchial colonization, quanti- tative aspirate was performed after intubation and two times a week until extubation. In patients with suspected VAP, quantitative tracheal aspirate or bronchoalveolar lavage was performed to confirm the diagnosis. We hypothesized that the use of conical-cuffed tracheal tubes would reduce the incidence of abundant microaspiration of gas- tric contents from 50 to 30 % of study patients. With a two-sided alpha risk of 5 %, a power of 80 %, and to account for an anticipated rate of 10 % of patients without any tracheal secretions, 312 patients had to be recruited. Results A total of 326 patients were included during the study period (June 2014–September 2015). Pepsin and salivary amylase measure- ment is actually performed, and all results should be available in Novem- ber 2015. Statistical analyses will be performed in mid-December, and study results will be presented at the 2016 Réanimation Congress. Discussion Our study is sufficiently powered to detect a significant difference in microaspiration of gastric contents between patients intubated with conical-cuffed tracheal tubes and standard-cuffed tra- cheal tubes. One of the strengths of this study is the use of quantita- tive measurement of pepsin as a marker of microaspiration. Conclusion BEST CUFF is the first randomized controlled study evalu- ating the impact of PVC tracheal cuff shape on microaspiration of gas- tric contents. The results will be presented at the 2016 Réanimation Congress. Competing interests None. O2 Bicarbonate versus saline for contrast‑induced acute kidney injury prevention in critically ill patients Xavier Valette 1 , Isabelle Desmeulles 2 , Benoit Savary 3 , Romain Masson 2 , Amélie Seguin 1 , Cédric Daubin 1 , Bertrand Sauneuf 1 , Jennifer Brunet 2 , Pierre Verrier 1 , Véronique Pottier 2 , Marie Orabona 2 , Désiré Samba 2 , Gérald Viquesnel 2 , Mathilde Lermuzeaux 2 , Pascal Hazera 3 , Jean‑Luc Hanouz 2 , Jean‑Jacques Parienti 4 , Damien Du Cheyron 1 1 Réanimation médicale, C.H.U de Caen, Caen, France; 2 Réanimation chirurgicale, C.H.U de Caen, Caen, France; 3 Réanimation polyvalente, C.H. Mémorial France ‑ Etats‑Unis (Saint‑Lô), Saint‑Lô, France; 4 Unité de biostatistique et de recherche clinique, C.H.U de Caen, Caen, France Correspondence: Xavier Valette ‑ valette3l2ax@sfr.fr Annals of Intensive Care 2016, 6(Suppl 1): O2 Introduction The administration of contrast media for imaging and interventional procedures is frequent in intensive care unit (ICU). Whether volume expansion with bicarbonate is better than isotonic saline to reduce the risk of contrast-induced acute kidney injury (CI- AKI) in critically ill patients is unknown. Materials and methods The HYDRAREA study was a randomized, double-blind, multicenter trial including adults admitted in three ICUs in France who received intravascular contrast media. Patients with unstable renal function (increase in serum creatinine level of at least 0.3 mg/dL during the previous 48 h, anuria during the previous 12 h, renal replacement therapy) or contraindication to volume expansion Open Access Page 2 of 236 Ann. Intensive Care 2016, 6(Suppl 1):S50 or bicarbonate load (uncontrolled cardiogenic pulmonary edema, metabolic alkalosis with pH >7.50, hypokalemia <3 mmol/L, chronic hypercapnia) were not included. Patients were randomized in a 1:1 ratio to receive 0.9 % sodium chloride or 1.4 % sodium bicarbonate administered with the same infusion protocol: 3 mL/kg for 1 h started before contrast media administration followed by 1 mL/kg/h for 6 h. The primary outcome was the incidence of CI-AKI defined by the Acute Kidney Injury Network criteria within 72 h after contrast medium administration. Secondary outcomes included CI-AKI using alterna- tive definitions (AKIN without urine output criteria, RIFLE classification, creatinine increase ≥ 0.5 mg/dL or 25 %), need for renal replacement therapy, ICU length of stay and mortality. Results Among the 307 patients randomized, the mean (SD) age was 56 ± 15 years and 208 (68 %) patients were male. Patients were admitted in ICU for medical reason in 132 (43 %) patients, for emer- gency surgery in 118 (38 %) patients, following trauma in 45 (15 %) patients and after a scheduled surgery in 12 (4 %) patients. The mean (SD) SAPS II and SOFA scores at ICU admission were 42 ± 17 and 7 ± 4, respectively. Contrast media were used for computed tomography in 193 (63 %) patients and for arteriography in 114 (37 %) patients. Low-osmolar contrast media were used in 276 (90 %) patients. At randomization, 243 (79 %) patients were under mechanical ventila- tion, 100 (33 %) patients needed vasopressor, 104 (34 %) patients had sepsis, and 40 (13 %) patients had a RIFLE stage equal or higher than the “Risk of Kidney Injury” class. Patient characteristics were well bal- anced between groups excepted for the use of nephrotoxic medica- tions which was more common in saline group (40 (26 %) patients vs 59 (38 %) patients; p < 0.05). As expected, patients receiving bicarbonate ( n = 151) had higher urinary pH at the end of the infusion than patients receiving saline ( n = 156) (6.7 ± 2.1 vs 6.2 ± 1.8, respectively; p < 0.001). The incidence of CI-AKI was similar in both groups: 52 (33.3 %) patients in saline group and 53 (35 %) patients in bicarbonate group (RR 0.96; 95 % CI [0.70–1.30]; p = 0.81). There was no difference between groups what- ever the definition used to define CI-AKI. The need for renal replace- ment therapy (five (3.2 %) patients in saline group vs six (4 %) patients in bicarbonate group; RR 0.81; 95 % CI [0.25–2.59]; p = 0.77), ICU length of stay (24.7 ± 22.9 days in saline group vs 23 ± 23.8 days in bicarbonate group, p = 0.52) and mortality (25 (16 %) patients in saline group vs 24 (15.9 %) patients in bicarbonate group; RR 1.00; 95 % CI [0.60–1.68]; p = 0.97) were also similar between groups. Conclusion Hydration with sodium bicarbonate for CI-AKI preven- tion in critically ill patients does not provide supplementary beneficial effect in comparison with hydration by isotonic sodium chloride. Competing interests None. O3 Neurally adjusted ventilatory assist in the early phase of weaning from mechanical ventilation: a multicenter randomized study Alexandre Demoule 1 , Marc Clavel 2 , Camille Rolland‑Debord 1 , Sébastien Perbet 3 , Nicolas Terzi 4 , Achille Kouatchet 5 , Florent Wallet 6 , Hadrien Roze 7 , Frédéric Vargas 8 , Claude Guérin 9 , Jean Dellamonica 10 , Samir Jaber 11 , Thomas Similowski 12 1 Intensive Care and Respiratory Division, Pitié‑Salpêtrière Hospital, Paris, France; 2 Service de réanimation polyvalente, Centre Hospitalier Universi‑ taire de Limoges, Limoges, France; 3 Service de réanimation adultes, C.H.U. Estaing, Clermont‑Ferrand, France; 4 Service de réanimation médicale, Clinique de Réanimation Médicale, Grenoble, France; 5 Réanimation médi‑ cale, Centre Hospitalier Universitaire d’Angers, Angers, France; 6 Réanima‑ tion médicale et chirurgicale, CHU Lyon Sud, Lyon, France; 7 Sar 2, unité réanimation thoracique greffe, CHU de Bordeaux, Bordeaux, France; 8 Réanimation médicale, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; 9 Réanimation médicale, Hôpital de la Croix‑Rousse, Lyon, France; 10 Réanimation médicale, Centre Hospitalier Universitaire Archet, Nice, France; 11 DAR B, Hôpital Saint Eloi, Montpellier, France; 12 Service de pneumologie et réanimation médicale, Groupe Hospitalier Pitié‑Salpêtrière, Paris, France Correspondence: Alexandre Demoule ‑ alexandre.demoule@aphp.fr Annals of Intensive Care 2016, 6(Suppl 1): O3 Introduction Neurally adjusted ventilatory assist (NAVA) is a ventila- tory mode that tailors the level of assistance delivered by the ventila- tor to the electromyographic activity of the diaphragm. The objective of the present study was to compare the impact of mechanical ven- tilation with NAVA or pressure support ventilation (PSV) on the early phase of weaning from mechanical ventilation. Patients and methods A multicenter randomized controlled trial of 128 intubated adults recovering from an acute respiratory failure was conducted in 11 intensive care units (ICUs) from April 2010 to June 2012. Patients were randomly assigned to NAVA or PSV. The primary endpoint was the probability to remain in an assisted mode during the entire first 48 h. Secondary endpoints included asynchrony index, duration of mechanical ventilation and hospital mortality at 28 days. Results The proportion of patients remaining in an assisted mode dur- ing the entire first 48 h was 67.7 % in the NAVA group versus 69.4 % in the PSV group ( p = 0.47). The time spend in an assisted mode similar in the two groups (47 [43–48] vs. 47 [40–48], p = 0.55). The asynchrony index was lower in the NAVA group (19.7 vs. 32.6 %). Duration of mechanical ventilation was similar in the two groups (12.0 [7.0–17.0] in the NAVA group vs. 13.5 [10.0–21.0] in the PSV group, p = 0.121) as was the ICU mortality rate (12.9 vs. 21.2 %, p = 0.21). More patients required post-extubation noninvasive mechanical ventilation in the PSV group (66.6 vs. 43.5 %, p = 0.008). Conclusion NAVA can be applied efficiently in a clinical setting and improves patient ventilator interaction. However, NAVA does not increase the probability to remain in an assisted mode during the first 48 h. Competing interests A. Demoule: reserche contract with Maquet, Drager, Philips, Covidien. Consulting for Covidien. Speaker for Covidien. O4 Very high volume hemofiltration with the Cascade system in septic shock patients Jean‑Pierre Quenot 1 , Christine Binquet 2 , Christophe Vinsonneau 3 , Saber‑Davide Barbar 4 , Sandrine Vinault, 2 , Valérie Deckert 5 , Stephanie Lemaire 5 , Ali Ait Hssain 6 , Rémi Bruyère 7 , Bertrand Souweine 6 , Laurent Lagrost 5 , Christophe Adrie 8 1 Réanimation médicale, CHU Dijon, Dijon, France; 2 Centre d’investigation clinique, Chu Dijon, Dijon, France; 3 Réanimation polyvalente, Centre Hospitalier Marc Jacquet, Melun, France; 4 30, Chru De Nîmes, Nîmes, France; 5 21, Faculté de médecine, Dijon, France; 6 Réanimation médicale, CHU Gabriel‑Montpied, Clermont‑Ferrand, France; 7 01, CH de Fleyrat, Bourg‑en‑Bresse, France; 8 Physiologie, Hôpital Cochin, Paris, France Correspondence: Jean‑Pierre Quenot ‑ jean‑pierre.quenot@chu‑dijon.fr Annals of Intensive Care 2016, 6(Suppl 1): O4 Introduction We compared hemodynamic and biological effects of the Cascade system, which uses very high volume hemofiltration (HVHF) (120 ml/kg/h), with those of usual care in patients with septic shock. Patients and methods Multicenter, prospective, randomized, open- label trial was conducted in three intensive care units (ICU). Adults with septic shock with administration of epinephrine/norepinephrine were eligible. Patients were randomized to usual care plus HVHF (Cas- cade group) or usual care alone (Control group). Primary endpoint was the number of catecholamine-free days up to 28 days after randomi- zation. Secondary endpoints were number of days free of mechanical ventilation, renal replacement therapy (RRT) or ICU up to 90 days, and 7-, 28- and 90-day mortality. Results We included 60 patients (29 Cascade and 31 usual care). Base- line characteristics were comparable. Median number of catechola- mine-free days was 22 [IQR 11–23] versus 20 [0–25] for Cascade versus Control; there was no significant difference even after adjustment. There was no significant difference in number of mechanical ventila- tion-free days or ICU requirement. Median number of RRT-free days was 85 [46–90] versus 74 [0–90] for Cascade versus Control groups, p = 0.42. By multivariate analysis, the number of RRT-free days was significantly higher in the Cascade group (up to 25 days higher after adjustment). There was no difference in mortality at 7, 28 or 90 days. Page 3 of 236 Ann. Intensive Care 2016, 6(Suppl 1):S50 Conclusion Very HVHF using the Cascade system can safely be used in patients presenting septic shock, but was not associated with a reduc- tion in the need for catecholamines during the first 28 days. Competing interests None. O5 Effect of rapid response systems on hospital mortality, a prospective interventional study and systematic review Boris Jung 1 , Aurelien Daurat 1 , Audrey De Jong 1 , Gérald Chanques 1 , Martin Mahul, 1 , Marion Monnin 2 , Nicolas Molinari 3 , Samir Jaber 1 1 Dar b, Hôpital Saint Eloi, Montpellier, France; 2 Dar b, CHRU Hôpital Saint Eloi, Montpellier, France; 3 Dim, Hôpital La Colombière, Montpellier, France Correspondence: Boris Jung ‑ boris.jung@me.com Annals of Intensive Care 2016, 6(Suppl 1): O5 Introduction Although rapid response systems (RRSs) are known to reduce in hospital cardiac arrest rate, their effect on mortality remains in question. The present study aimed at evaluating the effect of a med- ical emergency team (MET) implementation on mortality in hospital- ized patients. Patients and methods A prospective study was conducted in the four hospitals of the regional healthcare center of Montpellier, France. An intensivist-led MET was implemented on a 24/7 basis in only one of the four hospitals from January 2012 to June 2012. Patients >18 years admitted for more than 24 h in the medical-surgical wards from July 2010 to December 2011 (pre-MET period) and from July 2012 to December 2013 (MET period) were included. The main outcome was unexpected mortality in hospitalized patients. An updated systematic review and meta-analysis were also performed. Results A total of 137,251 patients were admitted for 24 h or more in the medical-surgical wards during the pre-MET and MET periods. MET implementation was associated with a decrease in unexpected mor- tality rate in the hospital that implemented MET (from 21.9 to 17.4 per 1000 admissions; P = 0.002). Reduction in unexpected mortality asso- ciated with MET implementation could be estimated at 1.5 lives saved per week in the MET hospital. In the three other hospitals, mortality rate was not significantly modified (from 19.5 to 19.9 per 1000 admis- sions; P = 0.69). Patients in the MET hospital were more frequently admitted to the intensive care unit (ICU) during the MET period (45.8 vs 52.9 per 1000; P = 0.002), and their sequential organ failure assess- ment (SOFA) score upon ICU admission significantly decreased from 7 [4–10] to 5 [2–9]; P < 0.001. The updated meta-analysis including the present results showed that RRS was associated with a significant decrease in both unexpected (OR 0.51; 95 % CI 0.35–0.76) and overall mortality (OR 0.89; 95 % CI 0.85–0.93). Conclusion In the present prospective study, implementation of a MET was associated with a decrease in unexpected and overall mortal- ity. Updated meta-analysis confirms the benefit of RRS on unexpected and overall mortality (Fig. 1). Competing interests None. O6 Beta‑lactams serum concentrations in critically ill cirrhotic patients: a matched control study Olivier Lheureux 1 , Eric Trepo 2 , Maya Hites 3 , Frederic Cotton 4 , Fleur Wolff 4 , Rudy Surin 3 , Jacques Créteur 1 , Jean‑Louis Vincent 1 , Thierry Gustot 2 , Frederique Jacobs 3 , Fabio Silvio Taccone 1 1 Service de soins intensifs, Hospital Erasme, Brussel, Belgium; 2 Service de gastroentérologie, Hospital Erasme, Brussel, Belgium; 3 Service de mala‑ dies infectieuses, Hospital Erasme, Brussel, Belgium; 4 Service de biochimie médicale, Hospital Erasme, Brussel, Belgium Correspondence: Olivier Lheureux ‑ olheureu@ulb.ac.be Annals of Intensive Care 2016, 6(Suppl 1): O6 Introduction Few data are available on the pharmacokinetics of β-lactams in critically ill cirrhotic patients. The objective of this study was to evaluate whether β-lactam concentrations were altered in patients with cirrhosis compared with other critically ill patients and to identify the principal risk factors for any differences. Materials and methods We reviewed data from critically ill cirrhotic patients and matched controls in which routine therapeutic drug monitoring of broad-spectrum β-lactam antibiotics (piperacillin/ tazobactam; meropenem) was performed. Serum drug concentra- tions were measured twice during the elimination phase by high-per- formance liquid chromatography. Antibiotic pharmacokinetics was calculated using a one-compartment model. We considered therapy was adequate when serum drug concentrations were between 4 and 8 times the minimal inhibitory concentration of Pseudomonas aerugi- nosa during optimal periods of time for each drug ≥ 50 % for piperacil- lin/tazobactam; ≥ 40 % for meropenem). Results We studied 38 cirrhotic patients (16 for piperacillin/tazobac- tam and 22 for meropenem) and 38 matched controls. Drug dosing was similar in the two groups. The pharmacokinetic analysis showed a lower volume of distribution of meropenem ( p = 0.05) and a lower antibiotic clearance of piperacillin/tazobactam ( p = 0.009) in patients with cirrhosis when compared to non-cirrhotic patients. Patients with cirrhosis more often had excessive (23/38) than insufficient (5/38) or adequate (10/38) serum β-lactam concentrations; they also had exces- sive drug concentrations more frequently than did control patients (23/38 vs. 13/38— p = 0.02), particularly for piperacillin/tazobactam (9/16 vs. 2/16— p = 0.01). The only variable significantly associated with insufficient drug concentrations was the creatinine clearance on the day of the therapeutic drug monitoring. No specific variable was associated with excessive drug concentrations. Conclusion This case–control study shows that standard doses of β-lactams result in excessive serum concentrations in two-thirds of critically ill patients with cirrhosis, especially in those treated with piperacillin/tazobactam. Our results support routine β-lactam thera- peutic drug monitoring in this patient population. Competing interests None. References 1. Roberts JA, Paul SK, Akova M, Bassetti M, De Waele JJ, Dimopoulos G et al. DALI: defining antibiotic levels in intensive care unit patients: are current β‑lactam antibiotic doses sufficient for critically ill patients? Clin Infect Dis. 2014;58(8):1072–1083. 2. Gustot T, Felleiter P, Pickkers P, Sakr Y, Rello J, Velissaris D et al. Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study. Liver Int. 2014;34(10):1496–1503. O7 Systematic overdosing of oxa‑ and cloxacillin in severe infections treated in ICU: Risk factors and side effects Mathilde Neuville 1 , Jean‑François Timsit 1 , Najoua El‑Helali 2 , Alban Le Monnier 2 , Eric Magalhaes 1 , Aguila Radjou 1 , Roland Smonig 1 , Jean‑François Soubirou 1 , Guillaume Voiriot 1 , Romain Sonneville 1 , Lila Bouadma 1 , Bruno Mourvillier 1 1 Réanimation médicale et infectieuse, Hôpital Bichat‑Claude Bernard, Paris, France; 2 Unité de microbiologie clinique et dosages des anti‑infec‑ tieux, Groupe hospitalier Paris Saint‑Joseph, Paris, France Fig. 1 Evolution of unexpected death rate per 1000 admissions by month in the MET pavilion ( left side ) and in the three other pavilions ( right side ). Dotted lines represent the mean rate per month. Grey rectangles represent the standard deviations Page 4 of 236 Ann. Intensive Care 2016, 6(Suppl 1):S50 Correspondence: Mathilde Neuville ‑ mathilde.neuville@aphp.fr Annals of Intensive Care 2016, 6(Suppl 1): O7 Introduction Oxacillin and cloxacillin are the most frequently used penicillins for the treatment of severe methicillin-susceptible Staphylo- coccus aureus (MSSA) infections in intensive care units (ICU), especially endocarditis. No adaptation of the dosage is required in case of renal failure. We wanted to assess the risk factors for overdosing in ICU, and the related observed side effects. Patients and methods All patients with a therapeutic drug moni- toring (TDM) of oxa- or cloxa-cillin between 2008 and 2014 were included. The optimal trough concentration was considered to be 20 mg/L, i.e., 10 times the minimum inhibitory concentration of cloxax- illin for MSSA. Data concerning the medical history, the characteristics of the infection, the given treatment, the renal function and the attrib- uted side effects of overdosing were collected. A negative binomial model was used to compute the measured trough concentrations. Results Sixty-two patients were included in this study. We found a median trough plasma concentration of 134.3 mg/L [IQR 65.3– 201 mg/L]. Only one patient reached the target concentration; all other patients were overdosed. Eleven patients (17.7 %) experienced neurological side effects attributed to a high antibiotic concentration, i.e., persistent coma and delirium. When adjusted on the dosage used, the first trough concentration was significantly increased by a creati- nine clearance below 10 ml/min (with or without hemodialysis) and by endocarditis as the source of infection (Fig. 2). Conclusion With the recommended dose of 12 g/day for cloxacillin treatment in case of endocarditis and severe infections occurring in ICU, almost all patients are largely overdosed. Considering the high frequency of observed side effects, doses should be accurately moni- tored and reduced, particularly when renal replacement therapy is needed. Competing interests None. O8 Amikacin peak concentrations in patients receiving extracorporeal membrane oxygenation (ECMO) support: a case– control study Elodie Gélisse 1 , Mathilde Neuville 2 , Etienne De Montmollin 3 , Guillaume Voiriot 2 , Jean‑François Soubirou 2 , Roland Smonig 2 , Aguila Radjou 2 , Eric Magalhaes 2 , Lila Bouadma 2 , Bruno Mourvillier 2 , Jean‑François Timsit 2 , Romain Sonneville 2 1 Unité de réanimation robert debré, CHU Reims, Reims, France; 2 Service de réanimation médicale et infectieuse, Hôpital Bichat‑Claude Ber‑ nard‑APHP, Paris, France; 3 Réanimation, C.H. Général Saint Denis hôpital Delafontaine, Saint‑Denis, France Correspondence: Elodie Gélisse ‑ elodie.gelisse@gmail.com Annals of Intensive Care 2016, 6(Suppl 1): O8 Introduction More than half of adult patients receiving extracorpor- eal membrane oxygenation (ECMO) require an antibiotic therapy dur- ing their stay in ICU. Amikacin is the most used aminoglycoside for the treatment of septic shock given its good bactericidal activity on Pseudomonas aeruginosa and the low resistance rate observed with the other Gram-negative bacilli. However, data on pharmacokinetics of amikacin in patients receiving ECMO support have scantly been studied in these conditions. We aimed to report on the distribution of peak serum concentration ( C max ) of amikacin and on factors associated with insufficient Cmax in a population of critically ill patients receiving ECMO. Materials and methods We conducted an observational single-center study of patients admitted to a general ICU. Inclusion criteria were: (1) age ≥ 18 years and (2) a suspected Gram-negative infection requiring a loading dose of intravenous amikacin. Amikacin was routinely admin- istered intravenously at a dose of 25 mg/kg of total body weight over a 30-min infusion time. C max was measured 30 min after the end of infu- sion and trough serum concentration 24 h after the end of infusion ( C min ). ECMO patients were matched with critically ill patients without ECMO support (controls) for characteristics that had been previously identified as independent predictors for insufficient C max , namely body mass index (BMI), cirrhosis and 24-h fluid balance. An amikacin C max >60 mg/L and <80 mg/l was considered the target concentration (adequate drug concentrations). An amikacin C max <60 mg/L was con- sidered as an insufficient drug concentration, and a C max >80 mg/l was considered as an excessive one. The primary outcome was the distri- bution of C max (mg/L) between ECMO patients and controls. Results A total of 50 episodes in 46 ECMO patients were matched with 50 controls. Baseline characteristics did not differ between groups, except for age (61 vs. 63.5 years), reason for ICU admission and SOFA score (12 [10–14] vs. 9 [6–11]). At the day of C max , in ECMO patients the SOFA score was 9 [5.3–9.8], and 100 % episodes required mechani- cal ventilation, 96 % vasopressors and 44 % renal replacement ther - apy. There were no significant differences in serum concentrations between ECMO and non-ECMO patients: The amikacin Cmax was 71.7 [58.9–79.7] mg/l for ECMO patients versus 68.4 [53–81] mg/l for non- ECMO patients ( p = 0.36). The proportion of insufficient [13/50 (26 %) episodes vs. 17/50 (34 %) episodes), adequate (25/50 (50 %) episodes vs. 18/50 (36 %) episodes] and excessive [12/50 (24 %) episodes vs. 15/50 (30 %) episodes] drug concentrations was similar in ECMO and non-ECMO patients (Table 1). C min was measured in 43 (86 %) epi- sodes, and 28/43 (65 %) measurements were above the toxic threshold of 5 mg/L in ECMO patients versus 30/50 (60 %) in non-ECMO patients. Conclusion ECMO therapy did not significantly impact on peak and trough serum concentrations of amikacin. Competing interests None. References 1. Schmidt M, Brechot N, Hariri S, Guiguet M, Luyt CE, Makri R, et al. Noso‑ comial Infections in Adult Cardiogenic Shock Patients Supported by Venoarterial Extracorporeal Membrane Oxygenation. Clin Infect Dis. 2012 Dec 15;55(12):1633–41. 2. De Montmollin E, Bouadma L, Gault N, Mourvillier B, Mariotte E, Chemam S, et al. Predictors of insufficient amikacin peak concentration in critically ill patients receiving a 25 mg/kg total body weight regimen. Intensive Care Med. 2014 Jul;40(7):998–1005. Fig. 2 Univariate and multivariate statistical analysis. Day 0 = day of ICU admission, T‑day = day of treatment initiation, D‑day = day of TDM Page 5 of 236 Ann. Intensive Care 2016, 6(Suppl 1):S50 O9 A high aminoglycoside regimen associated with renal replacement therapy for the treatment of multi‑drug‑resistant pathogens Alexandre Brasseur 1 , Maya Hites 2 , Sandrine Roisin 3 , Frederic Cotton 4 , Jean‑Louis Vincent 5 , Daniel De Backer 6 , Frederique Jacobs 2 , Fabio Silvio Taccone 7 1 Soins Intensifs, Hôpital Erasme, Bruxelles, Belgium; 2 Service de maladies infectieuses, Hospital Erasme, Brussel, Belgium; 3 Service de microbiol‑ ogie clinique, Hospital Erasme, Brussel, Belgium; 4 Service de biochimie médicale, Hospital Erasme, Brussel, Belgium; 5 Service de Réanimation Médico‑Chirurgicale, Hôpital Erasme, Bruxelles, Belgium; 6 Soins intensifs, Hospital Erasme, Brussel, Belgium; 7 Service de Soins Intensifs, Hôpital Erasme, Bruxelles, Belgium Correspondence: Alexandre Brasseur ‑ albrasse@ulb.ac.be Annals of Intensive Care 2016, 6(Suppl 1): O9 Introduction Infections caused by multi-drug-resistant (MDR) Gram- negative (GN) organisms in critically ill patients are a therapeutic chal- lenge. The administration of high-dose aminoglycoside (HDA) therapy coupled with high-flow continuous venovenous hemodiafiltration (CVVHDF) could allow required high drug peaks to be achieved with acceptable drug elimination. Patients and methods All adult patients present on the intensive care unit (ICU) between October 2009 and July 2014 who had MDR-GN sepsis were considered for HDA and high-flow (>45 mL/kg/h) CVVHDF when an isolated pathogen was susceptible or intermediate suscepti- ble to aminoglycosides, and the patient’s condition was not improving with conventional therapy. Optimal antibacterial activity was defined as a peak concentration of at least eight times the minimal inhibitory concentration. Results Fifteen patients infected with MDR-GN pathogens (11 with Pseudomonas aeruginosa ; ten with abdominal and five with res- piratory infections) were treated with amikacin ( n = 11), gentamicin ( n = 3) or tobramycin ( n = 1) and high-flow CVVHDF. A favorable clini- cal response was observed in eight (53 %) patients, including three in whom microbial eradication was obtained. Six patients were dis- charged alive from the ICU and five from the hospital. No renal toxicity was observed among survivors. Conclusion In this cohort of septic patients with MDR-GN infections, HDA combined with high-flow CVVHDF represented a valuable thera- peutic option. The effectiveness of this approach should be further evaluated in larger studies. Competing interests None. O10 Optimization of administration of vancomycin in septic patients: a prospective randomized study Valerie Van Ruychevelt 1 , Eric Carlier 1 , Michael Piagnerelli 1 , Michel Vanhaeverbeek 2 , Christine Danguy 3 , Patrick Biston 1 1 Intensive Care Unit, Hôpital Civil Marie Curie, Charleroi, Belgium; 2 Internal medicine, Hospital André Vésale, Montigny‑le‑Tilleul, Belgium; 3 Pharmacy, Hospital André Vésale, Montigny‑le‑Tilleul, Belgium Correspondence: Valerie Van Ruychevelt ‑ vvruyche@ulb.ac.be Annals of Intensive Care 2016, 6(Suppl 1): O10 Introduction Continuous intravenous administration of vancomycin (CIV) in intensive care unit (ICU) patients requires dose adjustment according to weight and renal function, but its assessment remains difficult. The aim of this study was to validate a new dose regimen of CIV correlated with renal function assessed by creatinine clearance (Creat Cl). Materials and methods In this prospective randomized study, we evaluated septic critically ill patients in whom CIV was given for more than 48 h in the absence of renal replacement therapy. The CIV proto- col was developed based on recommendations of IDSA for the load- ing dose (30 mg/kg), but a new protocol for the maintenance dose was tested (depending on weight and daily Creat Cl). The serum target vancomycin (vanco) concentration was 25–30 μg/ml. Patients were randomized in three groups by daily assessment of renal function by a Creat Cl of 4 h (from 4 to 8 a.m.) or 12 h of Creat Cl (from 8 p.m. to 4 a.m.) or by the MDRD. Acute kidney injury (AKI) was defined as a daily urine output <0.5 ml/kg/h and/or an increase in the serum creatinine of ≥ 0.3 mg/dL from baseline levels. Multivariable logistic regression analysis was performed to identify predictors of CIV under-/over-dose and predictors of AKI. Results During 23 months, in a medico-surgical 36 beds ICU (CHU Charleroi, Belgium), 67 patients were randomized: 21 (31 %) in the MDRD group, 21 (31 %) in the 4 h Creat Cl and 25 (38 %) in the 12 h Creat Cl. The three groups were comparable in demographic terms, severity score, kidney function before CIV and bacteriology. For 7/67 (10 %) patients, CIV was targeted on bacteriological findings (one MRSA and six Enterococcus faecium). In the other patients, vanco was introduced empirically for clinically evolving sepsis. Vanco con- centration <25 μg/ml on day 1 was found in 15 patients (22 %) in the MDRD group, 11 (16 %) in 4 h Creat Cl and 15 (22 %) in 12 h Creat Cl ( p = 0.5), and in 12 (17 %), 12 (17 %) and 13 (19 %), respectively, on day 2 ( p = 0.8). In logistic regression analysis, BMI <30 and an elevated Creat Cl >90 were found independent predictors of under-dosing vanco (<25 μg/ml) at day 1 with an OR of 1.098 [1.01–1.19] and 0.935 [0.8–1], respectively. The day 1–day 2 CIV overdose was found to be an independent risk factor for AKI with an OR of 7.5 [2.2–23.7]. Discussion Our protocol cannot optimally achieve target levels on days 1–2. However, the chosen therapeutic target (25–30 μg/ml) seems a posteriori not justified given the local epidemiology. With the Table 1 Episodes characteristics at ICU admission and time of C max Variables ECMO ( n = 50) Non-ECMO ( n = 50) P value Characteristics at ICU admission Age (years) 61 (43–68) 63.5 (54–72) 0.03 Cirrhosis 2 (4) 4 (8) 0.68 Acute respiratory failure 7 (14) 13 (26) <0.001 Severe sepsis/septic shock 5 (10) 12 (24) Cardiogenic shock 21 (42) 4 (8) Cardiac surgery 10 (20) 11 (22) Post‑cardiac arrest 5 (10) 3 (6) Others 2 (4) 7 (14) BMI (kg/m 2 ) 26.5 (24.2–29.4) 26.3 (24.5–30.9) 0.50 SAPS II 51 (42.5–73.3) 53.5 (41–73.3) 0.98 Characteristics at time of therapeutic monitoring SOFA score 12 (10–14) 9 (6–11) <0.001 24‑h fluid balance (mL) 100 ( − 925 to 1860) 100 ( − 1550 to 1019) 0.52 Weight (kg) 88.5 (73–100) 82 (70–93) 0.37 Amikacin dose (mg) 2250 (1825–2500) 2000 (1713– 2300) 0.17 Amikacin regimen (mg/kg) 25 (25–25.6) 24.9 (24.5–25.5) 0.10 Amikacin C max (mg/L) 71.7 (58.9–79.7) 68.4 (53–81) 0.36 Patients with C max <60 mg/L 13 (26) 17 (34) 0.51 Patients with C max >80mgL 12 (24) 15 (30) 0.65 Amikacin C min (mg/L) 8.5 (3–15.4) 9.6 (2.5–16.9) 0.45 Page 6 of 236 Ann. Intensive Care 2016, 6(Suppl 1):S50 target proposed in the literature (20–30 μg/ml), vanco concentration at day 1 was <20 μg/ml in nine patients (43 %) in MDRD group, four (19 %) in 4 h CCU and nine (36 %) in 12 h CCU, and in 3 (14 %), 3 (14 %) and 5 (20 %), respectively, at day 2. It would therefore be preferable to target therapeutic levels between 25 and 30 μg/ml only for patients in the presence of multi-resistant germs demonstrated. For empirical antibiotic choice, therapeutic target [20–30 μg/ml] is probably enough and more careful. The assessment of renal function using three differ- ent methods failed to highlight difference in Creat Cl. The evaluation of Creat Cl by the MDRD formula may be sufficient. Conclusion Insufficient vancomycin concentration is a frequent find- ing at days 1–2. Predictors were BMI and high Creat Cl. Vanco level >30 μg/ml at days 1–2 is an independent predictive factor for AKI with an OR of 7.5. Competing interests None. References 1. Rybak, M. et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health‑System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am. J. Health‑Syst. Pharm. AJHP Off. J. Am. Soc. Health‑Syst. Pharm. 66, 82–98 (2009). 2. Ocampos‑Martinez, E. et al. Determinants of early inadequate vancomy‑ cin concentrations during continuous infusion in septic patients. Int. J. Antimicrob. Agents 39, 332–337 (2012). O11 Impact of elevated intra‑abdominal pressure on the ability of dynamic parameters to predict fluid responsiveness Siu‑Ming Au 1 , Emmanuelle Begot 2 , François Dalmay 3 , Xavier Repessé 4 , Gwenael Prat 5 , Koceila Bouferrache 6 , Michel Slama 7 , Philippe Vignon 2 , Antoine Vieillard‑Baron 4 1 Icu, Hospital Ambroise Paré, Boulogne‑Billancourt, France; 2 Service de réanimation polyvalente, Centre Hospitalier Universitaire de Limoges, Limoges, France; 3 Réanimation Polyvalente, CHU Limoges, Limoges, France; 4 Réanimation médico‑chirurgicale, Assistance Publique ‑ Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne‑Billancourt, France; 5 Réanimation médicale, CHRU de Brest, Brest, France; 6 Icu, Hospital Foch, Suresnes, France; 7 Réanimation médicale, Centre Hospitalier Universitaire, Amiens, France Correspondence: Antoine Vieillard‑Baron ‑ antoine.vieillard‑baron@apr. aphp.fr Annals of Intensive Care 2016, 6(Suppl 1): O11 Introduction Elevated intra-abdominal pressure (IAP) has been sug- gested to decrease the accuracy of dynamic parameters of fluid responsiveness, especially for the distensibility index of the inferior vena cava (∆IVC). The goal of our study was to confirm this limitation in a large series of unselected patients. Materials and methods This is a sub-study of an observational, prospec- tive and multicenter study (Hemopred) that we conducted between November 2012 and November 2014. All sedated patients under mechanical ventilation who required an echocardiographic assessment for an acute circulatory failure, with an inserted central venous catheter and arterial catheter, were eligible. Acute circulatory failure was defined as a sustained hypotension (systolic blood pressure <90 mmHg or mean blood pressure <65 mmHg) and/or the presence of clinical signs of hypoperfusion (e.g., mottled skin, oliguria), metabolic acidosis (pH <7.35 and base excess less than − 5 mmol/L), elevated lactate (>2 mmol/L) or decreased central venous oxygen saturation (ScvO 2 <70 %). Dynamic parameters used to predict fluid responsiveness assessed in this study were pulse pressure variations (∆PP) and the following echocardio- graphic indices: respiratory variations of aortic Doppler maximal velocity (∆ V max ), collapsibility index of superior vena cava (∆SVC) and ∆IVC. At the time of echocardiography, a systematic measurement of the bladder pressure was performed as recommended and eleva