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Mazeraud A, Turc G, Sivanandamoorthy S, Porcher R, Stoclin A, Antona M, Polito A, Righy C, Bozza FAB, Siami S, Sharshar T. Association of Lack of Fear of Dying With New Organ Failure: Results of a Multicenter Prospective Cohort Study. Am J Crit Care 2024; 33:36-44. [PMID: 38161174 DOI: 10.4037/ajcc2024517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Patients' anxiety on intensive care unit (ICU) admission is associated with subsequent deterioration. OBJECTIVE To assess whether patients' fears/anxiety are predictive of new organ failure within 7 days of ICU admission. METHODS In a prospective 3-center cohort study of non-comatose patients without delirium or invasive mechanical ventilation, 9 specific fears were evaluated through yes/no questions. Illness severity was assessed using the Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA). Intensity of acute and chronic anxiety was assessed with the state and trait components of the State-Trait Anxiety Inventory (STAI). Patients were followed up for 7 days. RESULTS From April 2014 to December 2017, 373 patients (median [IQR] age, 63 [48-74] years; 152 [40.8%] women; median (IQR) SAPS II, 27 [19-37]) were included. Feelings of vulnerability and fear of dying were reported by 203 (54.4%) and 172 (46.1%) patients, respectively. The STAI-State score was 40 or greater in 192 patients (51.5%). Ninety-four patients (25.2%) had new organ failure. Feelings of vulnerability (odds ratio, 1.96 [95% CI, 1.12-3.43]; P=.02) and absence of fear of dying (odds ratio, 2.38 [95% CI, 1.37-4.17]; P=.002) were associated with new organ failure after adjustment for STAI-State score (≥40), SAPS II, and SOFA score. CONCLUSION Absence of fear of dying is associated with new organ failure within the first 7 days after ICU admission. Fear of dying may protect against subsequent deterioration by mobilizing patients' homeostatic resources. ClinicalTrials.gov Identifier: NCT02355626.
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Affiliation(s)
- Aurélien Mazeraud
- Aurélien Mazeraud is an intensivist/anesthesiologist, GHU Paris Psychiatrie et Neurosciences Pole Neuro-Anesthesiology and Intensive Care and Université de Paris, Paris, France
| | - Guillaume Turc
- Guillaume Turc is a professor, Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France; research director, INSERM U1266; and member of the FHU NeuroVasc
| | - Sivanthiny Sivanandamoorthy
- Sivanthiny Sivanandamoorthy is an intensivist, General Intensive Care Unit, Sud-Essonne Hospital, Etampes, France
| | - Raphaël Porcher
- Raphaël Porcher is a professor of biostatistics, Center for Clinical Epidemiology, Assistance Publique Hôpitaux de Paris, Hôtel Dieu Hospital, Université de Paris, Paris, France
| | - Annabelle Stoclin
- Annabelle Stoclin is an intensivist, General Intensive Care Unit, Institut Gustave Roussy Hospital, Villejuif, France
| | - Marion Antona
- Marion Antona is an intensivist/anesthesiologist, General Intensive Care Unit, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Université de Paris Saclay, Garches, France
| | - Andrea Polito
- Andrea Polito is an intensivist/anesthesiologist, General Intensive Care Unit, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Université de Paris Saclay, Garches, France
| | - Cassia Righy
- Cassia Righy is an intensivist and internal medicine practitioner, D'Or Institute of Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Fernando A B Bozza
- Fernando A. B. Bozza is an internist and research director, D'Or Institute of Research and Education (IDOR) and Laboratory of Critical Care, National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Ministry of Health, Rio de Janeiro, Brazil
| | - Shidasp Siami
- Shidasp Siami is an intensivist, General Intensive Care Unit, Sud-Essonne Hospital, Etampes, France
| | - Tarek Sharshar
- Tarek Sharshar is a professor of intensive care medicine, GHU Paris Psychiatrie et Neurosciences, Pole Neuro-Anesthesiology and Intensive Care and Université de Paris, Paris, France
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Dhoisne M, Delval A, Mathieu D, Mazeraud A, Bournisien L, Derambure P, Tortuyaux R. Seizure recurrences in generalized convulsive status epilepticus under sedation: What are its predictors and its impact on outcome? Rev Neurol (Paris) 2023:S0035-3787(23)01112-8. [PMID: 38052663 DOI: 10.1016/j.neurol.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Management of status epilepticus (SE) is focused on the early seizure termination. Refractory SE is an indication for sedation in patients with SE, but up to 75% of patients may be ventilated due to a neurological or respiratory failure. In patients requiring sedation, the clinical assessment is not sufficient to assess seizure control. Identifying those at risk of recurrent seizures could be useful to adapt their management. On the other hand, patients with low risk could benefit from an early withdrawal of sedation to avoid the impact of inappropriate sedation on outcome. OBJECTIVE To determine the prevalence and the predictors of uncontrolled SE and its impact on outcome in patients with generalized convulsive SE (GCSE) requiring mechanical ventilation (MV). METHODS We retrospectively included patients admitted to the intensive care unit with GCSE requiring MV. Uncontrolled SE was defined as persistent or recurrent seizures during sedation or within 24hours following withdrawal. A multivariable logistic regression model was used to assess the associated factors. RESULTS Uncontrolled SE occurred in 37 out of 220 patients (17%). Persistent seizures at admission, higher SAPS II and central nervous system infection were associated with a higher risk of uncontrolled SE. Acute toxic or metabolic etiologies were associated with a decreased risk of uncontrolled SE. In a supplementary analysis, decrease of albumin blood levels was associated with uncontrolled SE. Uncontrolled SE was associated with a poor functional outcome and mortality at 90 days. CONCLUSIONS Seventeen percent of patients with a GCSE requiring MV suffered from uncontrolled SE. Etiology and persistent seizures at admission were the main predictors of uncontrolled SE. Patients with uncontrolled SE had a longer duration of sedation and MV, a poor functional outcome and a higher mortality. Further studies are required to determine the impact of continuous electroencephalogram monitoring on the clinical course.
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Affiliation(s)
- M Dhoisne
- Department of Clinical Neurophysiology, hôpital Roger-Salengro, CHU de Lille, avenue du Professeur-Emile-Laine, 59000 Lille, France
| | - A Delval
- Department of Clinical Neurophysiology, hôpital Roger-Salengro, CHU de Lille, avenue du Professeur-Emile-Laine, 59000 Lille, France; Inserm, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - D Mathieu
- Intensive Care Unit, CHU de Lille, Lille, France
| | - A Mazeraud
- Service d'anesthésie-réanimation, GHU de Paris psychiatrie et neurosciences, Paris, France; Département neurosciences, unité perception et mémoire, Institut Pasteur, Paris, France
| | - L Bournisien
- Intensive Care Unit, CHU de Lille, Lille, France
| | - P Derambure
- Department of Clinical Neurophysiology, hôpital Roger-Salengro, CHU de Lille, avenue du Professeur-Emile-Laine, 59000 Lille, France; Inserm, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - R Tortuyaux
- Department of Clinical Neurophysiology, hôpital Roger-Salengro, CHU de Lille, avenue du Professeur-Emile-Laine, 59000 Lille, France; Intensive Care Unit, CHU de Lille, Lille, France.
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Bouchereau E, Marchi A, Hermann B, Pruvost-Robieux E, Guinard E, Legouy C, Schimpf C, Mazeraud A, Baron JC, Ramdani C, Gavaret M, Sharshar T, Turc G. Quantitative analysis of early-stage EEG reactivity predicts awakening and recovery of consciousness in patients with severe brain injury. Br J Anaesth 2023; 130:e225-e232. [PMID: 36243578 DOI: 10.1016/j.bja.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Decisions of withdrawal of life-sustaining therapy for patients with severe brain injury are often based on prognostic evaluations such as analysis of electroencephalography (EEG) reactivity (EEG-R). However, EEG-R usually relies on visual assessment, which requires neurophysiological expertise and is prone to inter-rater variability. We hypothesised that quantitative analysis of EEG-R obtained 3 days after patient admission can identify new markers of subsequent awakening and consciousness recovery. METHODS In this prospective observational study of patients with severe brain injury requiring mechanical ventilation, quantitative EEG-R was assessed using standard 11-lead EEG with frequency-based (power spectral density) and functional connectivity-based (phase-lag index) analyses. Associations between awakening in the intensive care unit (ICU) and reactivity to auditory and nociceptive stimulations were assessed with logistic regression. Secondary outcomes included in-ICU mortality and 3-month Coma Recovery Scale-Revised (CRS-R) score. RESULTS Of 116 patients, 86 (74%) awoke in the ICU. Among quantitative EEG-R markers, variation in phase-lag index connectivity in the delta frequency band after noise stimulation was associated with awakening (adjusted odds ratio=0.89, 95% confidence interval: 0.81-0.97, P=0.02 corrected for multiple tests), independently of age, baseline severity, and sedation. This new marker was independently associated with improved 3-month CRS-R (adjusted β=-0.16, standard error 0.075, P=0.048), but not with mortality (adjusted odds ratio=1.08, 95% CI: 0.99-1.18, P=0.10). CONCLUSIONS An early-stage quantitative EEG-R marker was independently associated with awakening and 3-month level of consciousness in patients with severe brain injury. This promising marker based on functional connectivity will need external validation before potential integration into a multimodal prognostic model.
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Affiliation(s)
- Eléonore Bouchereau
- Anaesthesiology and ICU Department, Sainte Anne Hospital, Paris, France; Institute of Psychiatry and Neurosciences of Paris (IPNP), INSERM U1266, Paris, France.
| | - Angela Marchi
- Epileptology and Cerebral Rhythmology Department, APHM, Timone Hospital, Marseille, France
| | - Bertrand Hermann
- ICU Department, Hôpital Européen Georges Pompidou, Paris, France; Institut du Cerveau et de la Moelle épinière - ICM, Paris, France; Université Paris Cité, Paris, France
| | - Estelle Pruvost-Robieux
- Institute of Psychiatry and Neurosciences of Paris (IPNP), INSERM U1266, Paris, France; Université Paris Cité, Paris, France; Neurophysiology Department, Sainte Anne Hospital, Paris, France
| | - Eléonore Guinard
- Institute of Psychiatry and Neurosciences of Paris (IPNP), INSERM U1266, Paris, France; Université Paris Cité, Paris, France; Neurophysiology Department, Sainte Anne Hospital, Paris, France
| | - Camille Legouy
- Anaesthesiology and ICU Department, Sainte Anne Hospital, Paris, France
| | - Caroline Schimpf
- Anaesthesiology and ICU Department, Sainte Anne Hospital, Paris, France
| | - Aurélien Mazeraud
- Anaesthesiology and ICU Department, Sainte Anne Hospital, Paris, France; Université Paris Cité, Paris, France
| | - Jean-Claude Baron
- Institute of Psychiatry and Neurosciences of Paris (IPNP), INSERM U1266, Paris, France; Université Paris Cité, Paris, France; Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte Anne Hospital, Paris, France; FHU NeuroVasc, Paris, France
| | - Céline Ramdani
- Institut de Recherche Biomédicale des Armées (IRBA), Brétigny-sur-Orge, France
| | - Martine Gavaret
- Institute of Psychiatry and Neurosciences of Paris (IPNP), INSERM U1266, Paris, France; Université Paris Cité, Paris, France; Neurophysiology Department, Sainte Anne Hospital, Paris, France; FHU NeuroVasc, Paris, France
| | - Tarek Sharshar
- Anaesthesiology and ICU Department, Sainte Anne Hospital, Paris, France; Institute of Psychiatry and Neurosciences of Paris (IPNP), INSERM U1266, Paris, France; Université Paris Cité, Paris, France; FHU NeuroVasc, Paris, France
| | - Guillaume Turc
- Institute of Psychiatry and Neurosciences of Paris (IPNP), INSERM U1266, Paris, France; Université Paris Cité, Paris, France; Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte Anne Hospital, Paris, France; FHU NeuroVasc, Paris, France
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Sharshar T, Porcher R, Asfar P, Grimaldi L, Jabot J, Argaud L, Lebert C, Bollaert PE, Harlay ML, Chillet P, Maury E, Santoli F, Blanc P, Sonneville R, Vu DC, Rohaut B, Mazeraud A, Alvarez JC, Navarro V, Clair B, Outin H, Azabou E, Beloncle F, Ben-Hadj O, Blanc P, Bollaert PE, Bolgert F, Bouadma L, Chillet P, Clair B, Corne P, Clere-Jehl R, Cour M, Crespel A, Déiler V, Dellamonica J, Demeret S, Harley ML, Henry-Lagarrigue M, Jabot J, Heming N, Hernu R, Kouatchet A, Lebert C, Lerolle N, Maury E, Letrou S, Mazeraud A, Mercat A, Mortaza S, Mourvillier B, Outin H, Paugham-Burtz C, Pierrot M, Provent M, Rohaut B, De La Salle S, Santoli F, Schenk M, Siami S, Souday V, Sharshar T, Sonneville R, Timsit JF, Thuong M, Weiss N. Valproic acid as adjuvant treatment for convulsive status epilepticus: a randomised clinical trial. Crit Care 2023; 27:8. [PMID: 36624526 PMCID: PMC9830759 DOI: 10.1186/s13054-022-04292-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Generalised convulsive status epilepticus (GCSE) is a medical emergency. Guidelines recommend a stepwise strategy of benzodiazepines followed by a second-line anti-seizure medicine (ASM). However, GCSE is uncontrolled in 20-40% patients and is associated with protracted hospitalisation, disability, and mortality. The objective was to determine whether valproic acid (VPA) as complementary treatment to the stepwise strategy improves the outcomes of patients with de novo established GCSE. METHODS This was a multicentre, double-blind, randomised controlled trial in 244 adults admitted to intensive care units for GCSE in 16 French hospitals between 2013 and 2018. Patients received standard care of benzodiazepine and a second-line ASM (except VPA). Intervention patients received a 30 mg/kg VPA loading dose, then a 1 mg/kg/h 12 h infusion, whilst the placebo group received an identical intravenous administration of 0.9% saline as a bolus and continuous infusion. Primary outcome was proportion of patients discharged from hospital by day 15. The secondary outcomes were seizure control, adverse events, and cognition at day 90. RESULTS A total of 126 (52%) and 118 (48%) patients were included in the VPA and placebo groups. 224 (93%) and 227 (93%) received a first-line and a second-line ASM before VPA or placebo infusion. There was no between-group difference for patients hospital-discharged at day 15 [VPA, 77 (61%) versus placebo, 72 (61%), adjusted relative risk 1.04; 95% confidence interval (0.89-1.19); p = 0.58]. There were no between-group differences for secondary outcomes. CONCLUSIONS VPA added to the recommended strategy for adult GCSE is well tolerated but did not increase the proportion of patients hospital-discharged by day 15. TRIAL REGISTRATION NO NCT01791868 (ClinicalTrials.gov registry), registered: 15 February 2012.
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Affiliation(s)
- Tarek Sharshar
- grid.508487.60000 0004 7885 7602Neuro-Intensive Care Medicine, Anaesthesiology and ICU Department, GHU-Psychiatry and Neurosciences, Pole Neuro, Sainte-Anne Hospital, Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Université Paris Cité, Paris, France
| | - Raphaël Porcher
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France ,grid.411394.a0000 0001 2191 1995Centre d’Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, F-75004 Paris, France
| | - Pierre Asfar
- grid.411147.60000 0004 0472 0283Department of Medical Intensive Care, University Hospital, Angers, France
| | - Lamiae Grimaldi
- grid.50550.350000 0001 2175 4109Clinical Research Unit, Assistance Publique - Hôpitaux de Paris University Paris-Saclay. Faculty of medicine, University of Versailles Saint-Quentin en Yvelines. Inserm U1018 Team Anti-infective evasion and pharmacoepidemiology, Boulogne-Billancourt, France
| | - Julien Jabot
- Medical-Surgical Intensive Care Unit, CHU Felix-Guyon, Saint-Denis, La Réunion, France
| | - Laurent Argaud
- grid.412180.e0000 0001 2198 4166Service de Médecine Intensive-Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Christine Lebert
- grid.477015.00000 0004 1772 6836Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Pierre-Edouard Bollaert
- grid.29172.3f0000 0001 2194 6418CHRU-Nancy, Service de Médecine Intensive Réanimation, Université de Lorraine, 54000 Nancy, France
| | - Marie Line Harlay
- grid.412201.40000 0004 0593 6932Médecine Intensive Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Patrick Chillet
- Service de Médecine Intensive - Réanimation, Centre hospitalier Léon Bourgeois, Châlons en Champagne, France
| | - Eric Maury
- grid.462844.80000 0001 2308 1657Service de Médecine Intensive et Réanimation Hôpital Saint-Antoine, Paris-Sorbonne Université, Paris, France
| | - Francois Santoli
- grid.414308.a0000 0004 0594 0368Médecine Intensive—Réanimation, Centre Hospitalier Robert Ballanger, Aulnay sous Bois, France
| | - Pascal Blanc
- grid.440383.80000 0004 1765 1969Réanimation Médico Chirurgicale, Centre Hospitalier René Dubos, Pontoise, France
| | - Romain Sonneville
- Université de Paris Cité, INSERM UMR1137, Paris, France ,grid.411119.d0000 0000 8588 831XAPHP Nord, Médecine Intensive – Réanimation, Hôpital Bichat—Claude Bernard, Paris, France
| | - Dinh Chuyen Vu
- General Intensive Care Unit, Sud-Essonne Hospital, Etampes, France
| | - Benjamin Rohaut
- grid.462844.80000 0001 2308 1657Department of Neurology, Neuro-ICU & Brain institute - ICM, Pitié-Salpêtrière Hospital APHP, Sorbonne Université, Paris, France
| | - Aurelien Mazeraud
- grid.508487.60000 0004 7885 7602Anaesthesiology and ICU Department, GHU-Psychiatry and Neurosciences, Pole Neuro, Sainte-Anne Hospital, Perception and Memory Unit, Neurosciences Department, Institut Pasteur, Université Paris Cité, Paris, France
| | - Jean-Claude Alvarez
- grid.12832.3a0000 0001 2323 0229Department of Pharmacology and Toxicology, Inserm U-1173, Raymond Poincare Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, 104 Boulevard Raymond Poincare, 92380 Garches, France
| | - Vincent Navarro
- grid.425274.20000 0004 0620 5939AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, Sorbonne Université, and Paris Brain Institute, Paris, France
| | - Bernard Clair
- grid.12832.3a0000 0001 2323 0229General Intensive Care Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Hervé Outin
- grid.418056.e0000 0004 1765 2558Intensive Care Unit Centre Hospitalier Intercommunal, Poissy/Saint-Germain-en-Laye, France
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Verdonk F, Feyaerts D, Badenes R, Bastarache JA, Bouglé A, Ely W, Gaudilliere B, Howard C, Kotfis K, Lautrette A, Le Dorze M, Mankidy BJ, Matthay MA, Morgan CK, Mazeraud A, Patel BV, Pattnaik R, Reuter J, Schultz MJ, Sharshar T, Shrestha GS, Verdonk C, Ware LB, Pirracchio R, Jabaudon M. Upcoming and urgent challenges in critical care research based on COVID-19 pandemic experience. Anaesth Crit Care Pain Med 2022; 41:101121. [PMID: 35781076 PMCID: PMC9245393 DOI: 10.1016/j.accpm.2022.101121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/01/2022]
Abstract
While the coronavirus disease 2019 (COVID-19) pandemic placed a heavy burden on healthcare systems worldwide, it also induced urgent mobilisation of research teams to develop treatments preventing or curing the disease and its consequences. It has, therefore, challenged critical care research to rapidly focus on specific fields while forcing critical care physicians to make difficult ethical decisions. This narrative review aims to summarise critical care research -from organisation to research fields- in this pandemic setting and to highlight opportunities to improve research efficiency in the future, based on what is learned from COVID-19. This pressure on research revealed, i.e., i/ the need to harmonise regulatory processes between countries, allowing simplified organisation of international research networks to improve their efficiency in answering large-scale questions; ii/ the importance of developing translational research from which therapeutic innovations can emerge; iii/ the need for improved triage and predictive scores to rationalise admission to the intensive care unit. In this context, key areas for future critical care research and better pandemic preparedness are artificial intelligence applied to healthcare, characterisation of long-term symptoms, and ethical considerations. Such collaborative research efforts should involve groups from both high and low-to-middle income countries to propose worldwide solutions. As a conclusion, stress tests on healthcare organisations should be viewed as opportunities to design new research frameworks and strategies. Worldwide availability of research networks ready to operate is essential to be prepared for next pandemics. Importantly, researchers and physicians should prioritise realistic and ethical goals for both clinical care and research.
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Affiliation(s)
- Franck Verdonk
- Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Paris, Assistance Publique-Hôpitaux de Paris, France and GRC 29, DMU DREAM, Sorbonne University, Paris, France; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, California, United States of America
| | - Dorien Feyaerts
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, California, United States of America
| | - Rafael Badenes
- Department of Anaesthesiology and Intensive Care, Hospital Clìnico Universitario de Valencia, University of Valencia, Valencia, Spain
| | - Julie A Bastarache
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Adrien Bouglé
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, at the TN Valley VA Geriatric Research Education Clinical Center (GRECC) and Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, California, United States of America
| | - Christopher Howard
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Katarzyna Kotfis
- Department Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - Alexandre Lautrette
- Medical Intensive Care Unit, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Matthieu Le Dorze
- Department of Anaesthesiology and Critical Care Medicine, AP-HP, Lariboisière University Hospital, Paris, France
| | - Babith Joseph Mankidy
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Michael A Matthay
- Departments of Medicine and Anaesthesia, University of California, and Cardiovascular Research Institute, San Francisco, California, United States of America
| | - Christopher K Morgan
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Aurélien Mazeraud
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France
| | - Brijesh V Patel
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, and Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, Guys & St Thomas' NHS Foundation trust, London, UK
| | - Rajyabardhan Pattnaik
- Department of Intensive Care Medicine, Ispat General Hospital, Rourkela, Sundargarh, Odisha, India
| | - Jean Reuter
- Department of Intensive Care Medicine, Centre Hospitalier de Luxembourg, Luxembourg
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Tarek Sharshar
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France
| | - Gentle S Shrestha
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Charles Verdonk
- Unit of Neurophysiology of Stress, Department of Neurosciences and Cognitive Sciences, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | - Lorraine B Ware
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, California, United States of America
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France; iGReD, Université Clermont Auvergne, CNRS, INSERM, Clermont-Ferrand, France.
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Bourhy L, Mazeraud A, Bozza FA, Turc G, Lledo PM, Sharshar T. Neuro-Inflammatory Response and Brain-Peripheral Crosstalk in Sepsis and Stroke. Front Immunol 2022; 13:834649. [PMID: 35464410 PMCID: PMC9022190 DOI: 10.3389/fimmu.2022.834649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/07/2022] [Indexed: 12/18/2022] Open
Abstract
Despite recent therapeutic advances, ischemic stroke is still a leading cause of death and disability. There is renewed attention on peripheral inflammatory signaling as a way of modulating the post-ischemic neuro-inflammatory process. The immune-brain crosstalk has long been the focus for understanding the mechanisms of sickness behavior, which is an adaptive autonomic, neuroendocrine, and behavioral response to a peripheral inflammation. It is mediated by humoral and neural pathways that mainly involve the circumventricular organs and vagal nerve, respectively. In this review we address the question of how sepsis and stroke can dysregulate this adaptive response, notably by impairing the central integration of peripheral signaling, but also by efferent control of the immune response. We highlight the potential role of gut–brain and brain–spleen signaling in stroke.
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Affiliation(s)
- Lena Bourhy
- Institut Pasteur, Université de Paris, Centre National de Recherche Scientifique, Unité Mixte de Recherche (CNRS UMR) 3571, Perception and Memory Unit, Paris, France
| | - Aurélien Mazeraud
- Institut Pasteur, Université de Paris, Centre National de Recherche Scientifique, Unité Mixte de Recherche (CNRS UMR) 3571, Perception and Memory Unit, Paris, France.,Neuro-Anesthesiology and Intensive Care Medicine, Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France
| | - Fernando A Bozza
- National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France
| | - Pierre-Marie Lledo
- Institut Pasteur, Université de Paris, Centre National de Recherche Scientifique, Unité Mixte de Recherche (CNRS UMR) 3571, Perception and Memory Unit, Paris, France
| | - Tarek Sharshar
- Neuro-Anesthesiology and Intensive Care Medicine, Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France
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Mazeraud A, Wolff M, Lucas B, Sharshar T. Why the application of IVIG might be beneficial in patients with COVID-19 – Authors' reply. The Lancet Respiratory Medicine 2022; 10:e16. [PMID: 35120612 PMCID: PMC8806197 DOI: 10.1016/s2213-2600(21)00550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Aurélien Mazeraud
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, 75014 Paris, France; Department of Neurosiences, Université de Paris, Paris, France.
| | - Michel Wolff
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, 75014 Paris, France; Department of Neurosiences, Université de Paris, Paris, France
| | - Bruno Lucas
- Institut Cochin, Centre National de la Recherche Scientifique UMR8104, INSERM U1016, Paris, France
| | - Tarek Sharshar
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, 75014 Paris, France; Department of Neurosiences, Université de Paris, Paris, France
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Massart N, Maxime V, Fillatre P, Razazi K, Ferré A, Moine P, Legay F, Voiriot G, Amara M, Santi F, Nseir S, Marque-Juillet S, Bounab R, Barbarot N, Bruneel F, Luyt CE, Pham T, Pavot A, Monnet X, Richard C, Demoule A, Dres M, Mayaux J, Beurton A, Daubin C, Descamps R, Joret A, Du Cheyron D, Pene F, Chiche JD, Jozwiak M, Jaubert P, Voiriot G, Fartoukh M, Teulier M, Blayau C, Bodenes L, Ferriere N, Auchabie J, Le Meur A, Pignal S, Mazzoni T, Quenot JP, Andreu P, Roudau JB, Labruyère M, Nseir S, Preau S, Poissy J, Mathieu D, Benhamida S, Paulet R, Roucaud N, Thyrault M, Daviet F, Hraiech S, Parzy G, Sylvestre A, Jochmans S, Bouilland AL, Monchi M, Déserts MDD, Mathais Q, Rager G, Pasquier P, Reignier J, Seguin A, Garret C, Canet E, Dellamonica J, Saccheri C, Lombardi R, Kouchit Y, Jacquier S, Mathonnet A, Nay MA, Runge I, Martino F, Flurin L, Rolle A, Carles M, Coudroy R, Thille AW, Frat JP, Rodriguez M, Beuret P, Tientcheu A, Vincent A, Michelin F, Tamion F, Carpentier D, Boyer D, Girault C, Gissot V, Ehrmann S, Gandonniere CS, Elaroussi D, Delbove A, Fedun Y, Huntzinger J, Lebas E, Kisoka G, Grégoire C, Marchetta S, Lambermont B, Argaud L, Baudry T, Bertrand PJ, Dargent A, Guitton C, Chudeau N, Landais M, Darreau C, Ferre A, Gros A, Lacave G, Bruneel F, Neuville M, JérômeDevaquet, Tachon G, Gallo R, Chelha R, Galbois A, Jallot A, Lemoine LC, Kuteifan K, Pointurier V, Jandeaux LM, Mootien J, Damoisel C, Sztrymf B, Schmidt M, Combes A, Chommeloux J, Luyt CE, Schortgen F, Rusel L, Jung C, Gobert F, Vimpere D, Lamhaut L, Sauneuf B, Charrrier L, Calus J, Desmeules I, Painvin B, Tadie JM, Castelain V, Michard B, Herbrecht JE, Baldacini M, Weiss N, Demeret S, Marois C, Rohaut B, Moury PH, Savida AC, Couadau E, Série M, Alexandru N, Bruel C, Fontaine C, Garrigou S, Mahler JC, Leclerc M, Ramakers M, Garçon P, Massou N, Van Vong L, Sen J, Lucas N, Chemouni F, Stoclin A, Avenel A, Faure H, Gentilhomme A, Ricome S, Abraham P, Monard C, Textoris J, Rimmele T, Montini F, Lejour G, Lazard T, Etienney I, Kerroumi Y, Dupuis C, Bereiziat M, Coupez E, Thouy F, Hoffmann C, Donat N, Chrisment A, Blot RM, Kimmoun A, Jacquot A, Mattei M, Levy B, Ravan R, Dopeux L, Liteaudon JM, Roux D, Rey B, Anghel R, Schenesse D, Gevrey V, Castanera J, Petua P, Madeux B, Hartman O, Piagnerelli M, Joosten A, Noel C, Biston P, Noel T, Bouar GLE, Boukhanza M, Demarest E, Bajolet MF, Charrier N, Quenet A, Zylberfajn C, Dufour N, Mégarbane B, Voicu S, Deye N, Malissin I, Legay F, Debarre M, Barbarot N, Fillatre P, Delord B, Laterrade T, Saghi T, Pujol W, Cungi PJ, Esnault P, Cardinale M, Ha VHT, Fleury G, Brou MA, Zafimahazo D, Tran-Van D, Avargues P, Carenco L, Robin N, Ouali A, Houdou L, Le Terrier C, Suh N, Primmaz S, Pugin J, Weiss E, Gauss T, Moyer JD, Burtz CP, La Combe B, Smonig R, Violleau J, Cailliez P, Chelly J, Marchalot A, Saladin C, Bigot C, Fayolle PM, Fatséas J, Ibrahim A, Resiere D, Hage R, Cholet C, Cantier M, Trouiler P, Montravers P, Lortat-Jacob B, Tanaka S, Dinh AT, Duranteau J, Harrois A, Dubreuil G, Werner M, Godier A, Hamada S, Zlotnik D, Nougue H, Mekontso-Dessap A, Carteaux G, Razazi K, De Prost N, Mongardon N, Lamraoui M, Alessandri C, de Roux Q, de Roquetaillade C, Chousterman BG, Mebazaa A, Gayat E, Garnier M, Pardo E, LeaSatre-Buisson, Gutton C, Yvin E, Marcault C, Azoulay E, Darmon M, Oufella HA, Hariri G, Urbina T, Mazerand S, Heming N, Santi F, Moine P, Annane D, Bouglé A, Omar E, Lancelot A, Begot E, Plantefeve G, Contou D, Mentec H, Pajot O, Faguer S, Cointault O, Lavayssiere L, Nogier MB, Jamme M, Pichereau C, Hayon J, Outin H, Dépret F, Coutrot M, Chaussard M, Guillemet L, Goffin P, Thouny R, Guntz J, Jadot L, Persichini R, Jean-Michel V, Georges H, Caulier T, Pradel G, Hausermann MH, Nguyen-Valat TMH, Boudinaud M, Vivier E, SylvèneRosseli, Bourdin G, Pommier C, Vinclair M, Poignant S, Mons S, Bougouin W, Bruna F, Maestraggi Q, Roth C, Bitker L, Dhelft F, Bonnet-Chateau J, Filippelli M, Morichau-Beauchant T, Thierry S, Le Roy C, Jouan MS, Goncalves B, Mazeraud A, Daniel M, Sharshar T, Cadoz C, RostaneGaci, Gette S, Louis G, Sacleux SC, Ordan MA, Cravoisy A, Conrad M, Courte G, Gibot S, Benzidi Y, Casella C, Serpin L, Setti JL, Besse MC, Bourreau A, Pillot J, Rivera C, Vinclair C, Robaux MA, Achino C, Delignette MC, Mazard T, Aubrun F, Bouchet B, Frérou A, Muller L, Quentin C, Degoul S, Stihle X, Sumian C, Bergero N, Lanaspre B, Quintard H, Maiziere EM, Egreteau PY, Leloup G, Berteau F, Cottrel M, Bouteloup M, Jeannot M, Blanc Q, Saison J, Geneau I, Grenot R, Ouchike A, Hazera P, Masse AL, Demiri S, Vezinet C, Baron E, Benchetrit D, Monsel A, Trebbia G, Schaack E, Lepecq R, Bobet M, Vinsonneau C, Dekeyser T, Delforge Q, Rahmani I, Vivet B, Paillot J, Hierle L, Chaignat C, Valette S, Her B, Brunet J, Page M, Boiste F, Collin A, Bavozet F, Garin A, Dlala M, KaisMhamdi, Beilouny B, Lavalard A, Perez S, Veber B, Guitard PG, Gouin P, Lamacz A, Plouvier F, Delaborde BP, Kherchache A, Chaalal A, Ricard JD, Amouretti M, Freita-Ramos S, Roux D, Constantin JM, Assefi M, Lecore M, Selves A, Prevost F, Lamer C, Shi R, Knani L, Floury SP, Vettoretti L, Levy M, Marsac L, Dauger S, Guilmin-Crépon S, Winiszewski H, Piton G, Soumagne T, Capellier G, Putegnat JB, Bayle F, Perrou M, Thao G, Géri G, Charron C, Repessé X, Vieillard-Baron A, Guilbart M, Roger PA, Hinard S, Macq PY, Chaulier K, Goutte S, Chillet P, Pitta A, Darjent B, Bruneau A, Lasocki S, Leger M, Gergaud S, Lemarie P, Terzi N, Schwebel C, Dartevel A, Galerneau LM, Diehl JL, Hauw-Berlemont C, Péron N, Guérot E, Amoli AM, Benhamou M, Deyme JP, Andremont O, Lena D, Cady J, Causeret A, De La Chapelle A, Cracco C, Rouleau S, Schnell D, Foucault C, Lory C, Chapelle T, Bruckert V, Garcia J, Sahraoui A, Abbosh N, Bornstain C, Pernet P, Poirson F, Pasem A, Karoubi P, Poupinel V, Gauthier C, Bouniol F, Feuchere P, Heron A, Carreira S, Emery M, Le Floch AS, Giovannangeli L, Herzog N, Giacardi C, Baudic T, Thill C, Lebbah S, Palmyre J, Tubach F, Hajage D, Bonnet N, Ebstein N, Gaudry S, Cohen Y, Noublanche J, Lesieur O, Sément A, Roca-Cerezo I, Pascal M, Sma N, Colin G, Lacherade JC, Bionz G, Maquigneau N, Bouzat P, Durand M, Hérault MC, Payen JF. Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study. Ann Intensive Care 2022; 12:4. [PMID: 35015163 PMCID: PMC8748185 DOI: 10.1186/s13613-022-00979-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bourhy L, Mazeraud A, Costa LHA, Levy J, Rei D, Hecquet E, Gabanyi I, Bozza FA, Chrétien F, Lledo PM, Sharshar T, Lepousez G. OUP accepted manuscript. Brain 2022; 145:1391-1409. [PMID: 35441215 PMCID: PMC9128826 DOI: 10.1093/brain/awab475] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/17/2021] [Accepted: 11/25/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lena Bourhy
- Institut Pasteur, Université Paris Cité, Laboratory for Experimental Neuropathology, F-75015 Paris, France
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
- Université Paris Cité, Collège doctoral, F-75005 Paris, France
| | - Aurélien Mazeraud
- Institut Pasteur, Université Paris Cité, Laboratory for Experimental Neuropathology, F-75015 Paris, France
- Université Paris Cité, Collège doctoral, F-75005 Paris, France
- GHU Paris Psychiatrie Neurosciences, Service hospitalo-universitaire de Neuro-anesthésie réanimation, Paris, France
| | - Luis H. A. Costa
- Institut Pasteur, Université Paris Cité, Laboratory for Experimental Neuropathology, F-75015 Paris, France
- Department of Basic and Oral Biology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Jarod Levy
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
| | - Damien Rei
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
| | - Estéban Hecquet
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
| | - Ilana Gabanyi
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
- Institut Pasteur, Université Paris Cité, Microenvironment and Immunity Unit, F-75015 Paris, France
| | - Fernando A. Bozza
- National Institute of Infectious Disease Evandro Chagas (INI), OswaldoCruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Fabrice Chrétien
- Institut Pasteur, Université Paris Cité, Laboratory for Experimental Neuropathology, F-75015 Paris, France
- GHU Paris Psychiatrie Neurosciences, Service hospitalo-universitaire de Neuropathologie, Paris, France
| | - Pierre-Marie Lledo
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
- Correspondence may also be addressed to: Pierre-Marie Lledo E-mail:
| | - Tarek Sharshar
- GHU Paris Psychiatrie Neurosciences, Service hospitalo-universitaire de Neuro-anesthésie réanimation, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM UMR 1266, F-75014 Paris, France
| | - Gabriel Lepousez
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
- Correspondence to: Gabriel Lepousez Laboratory for Perception and Memory Institut Pasteur 25 rue du Docteur Roux, 75724 Paris Cedex 15, France E-mail:
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Mazeraud A, Jamme M, Mancusi RL, Latroche C, Megarbane B, Siami S, Zarka J, Moneger G, Santoli F, Argaud L, Chillet P, Muller G, Bruel C, Asfar P, Beloncle F, Reignier J, Vinsonneau C, Schimpf C, Amour J, Goulenok C, Lemaitre C, Rohaut B, Mateu P, De Rudnicki S, Mourvillier B, Declercq PL, Schwebel C, Stoclin A, Garnier M, Madeux B, Gaudry S, Bailly K, Lamer C, Aegerter P, Rieu C, Sylla K, Lucas B, Sharshar T. Intravenous immunoglobulins in patients with COVID-19-associated moderate-to-severe acute respiratory distress syndrome (ICAR): multicentre, double-blind, placebo-controlled, phase 3 trial. Lancet Respir Med 2021; 10:158-166. [PMID: 34774185 PMCID: PMC8585489 DOI: 10.1016/s2213-2600(21)00440-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/26/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023]
Abstract
Background Acute respiratory distress syndrome (ARDS) is a major complication of COVID-19 and is associated with high mortality and morbidity. We aimed to assess whether intravenous immunoglobulins (IVIG) could improve outcomes by reducing inflammation-mediated lung injury. Methods In this multicentre, double-blind, placebo-controlled trial, done at 43 centres in France, we randomly assigned patients (1:1) receiving invasive mechanical ventilation for up to 72 h with PCR confirmed COVID-19 and associated moderate-to-severe ARDS to receive either IVIG (2 g/kg over 4 days) or placebo. Random assignment was done with a web-based system and was stratified according to the participating centre and the duration of invasive mechanical ventilation before inclusion in the trial (<12 h, 12–24 h, and >24–72 h), and treatment was administered within the first 96 h of invasive mechanical ventilation. To minimise the risk of adverse events, the IVIG administration was divided into four perfusions of 0·5 g/kg each administered over at least 8 hours. Patients in the placebo group received an equivalent volume of sodium chloride 0·9% (10 mL/kg) over the same period. The primary outcome was the number of ventilation-free days by day 28, assessed according to the intention-to-treat principle. This trial was registered on ClinicalTrials.gov, NCT04350580. Findings Between April 3, and October 20, 2020, 146 patients (43 [29%] women) were eligible for inclusion and randomly assigned: 69 (47%) patients to the IVIG group and 77 (53%) to the placebo group. The intention-to-treat analysis showed no statistical difference in the median number of ventilation-free days at day 28 between the IVIG group (0·0 [IQR 0·0–8·0]) and the placebo group (0·0 [0·0–6·0]; difference estimate 0·0 [0·0–0·0]; p=0·21). Serious adverse events were more frequent in the IVIG group (78 events in 22 [32%] patients) than in the placebo group (47 events in 15 [20%] patients; p=0·089). Interpretation In patients with COVID-19 who received invasive mechanical ventilation for moderate-to-severe ARDS, IVIG did not improve clinical outcomes at day 28 and tended to be associated with an increased frequency of serious adverse events, although not significant. The effect of IVIGs on earlier disease stages of COVID-19 should be assessed in future trials. Funding Programme Hospitalier de Recherche Clinique.
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Affiliation(s)
- Aurélien Mazeraud
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France; Société Française d'Anesthésie-Réanimation Research Network, France; Department of Neurosiences, Université de Paris, Paris, France.
| | - Matthieu Jamme
- Service de Réanimation Polyvalente, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, Poissy, France; INSERM U1018, CESP, Équipe Epidémiologie Clinique, Université Paris Saclay, Villejuif, France
| | - Rossella Letizia Mancusi
- Direction de la recherche clinique et de l'innovation, Groupe Hospitalier Universitaire Paris Psychiatrie et Neurosciences, Paris, France
| | - Claire Latroche
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France; Institut Cochin, Centre National de la Recherche Scientifique UMR8104, INSERM U1016, Paris, France
| | - Bruno Megarbane
- Department of Neurosiences, Université de Paris, Paris, France; Service de Médecine Intensive et Réanimation, Centre Hospitalo-universitaire Lariboisière Paris, France
| | - Shidasp Siami
- Service de Réanimation Polyvalente, Centre Hospitalier Sud-Essonnes, Etampes, France
| | - Jonathan Zarka
- Service de Médecine Intensive et Réanimation, Grand hôpital de l'Est francilien site Marne-la-Vallée, Marne-la-Vallée, France
| | - Guy Moneger
- Service de Réanimation polyvalente, Hôpital Nord Franche Comté, Trevenans, France
| | - Francesco Santoli
- Service de Réanimation Médicale, Centre Hospitalo-universitaire Robert Ballanger, Aulnay, France
| | - Laurent Argaud
- Service de Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Patrick Chillet
- Service de Réanimation Polyvalente, Centre Hospitalier Chalons en Champagne, Chalons en Champagne, France
| | - Gregoire Muller
- Service de Médecine Intensive et Réanimation, Centre hospitalier, Orléans, France; Clinical Research in Intensive Care and Sepsis - TRIal Group for global Evaluation and Research in Sepsis research network, Tours, France
| | - Cedric Bruel
- Service de Réanimation Médico-chirurgicale, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Pierre Asfar
- Service de Médecine Intensive Réanimation, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Francois Beloncle
- Service de Médecine Intensive Réanimation, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, France
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Béthune, Béthune, France
| | - Caroline Schimpf
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France
| | - Julien Amour
- Institute of Perfusion, Critical Care Medicine and Anesthesiology in Cardiac Surgery, Ramsay Health Care, Hôpital Privé Jacques Cartier, Massy, France
| | - Cyril Goulenok
- Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Caroline Lemaitre
- Département de Gastroentérologie et Hépatologie, Hôpital Jacques Monod, Montivilliers, France; Département de Médecine Intensive et Réanimation, Hôpital Jacques Monod, Avenue Pierre Mendès France, Montivilliers, France
| | - Benjamin Rohaut
- Département de Neurologie, Neurointensive care unit, Assistance Publique -Hopitaux de Paris-Pitié Salpêtrière, Paris, France; Department of Neurology, Sorbonne Université, Paris, France; Institut du Cerveau-Paris Brain Institute-Institut du Cerveau et de la Moelle, Paris, France; Pinic Lab, INSERM, Paris, France; Centre National de la Recherche Scientifique, Paris, France
| | - Philippe Mateu
- Service de Réanimation polyvalente, Centre Hospitalier Interrégional Nord Ardennes, Charleville-Mézières, France
| | - Stephane De Rudnicki
- Service d'Anesthésie Réanimation, Hôpital d'instruction des Armées de Percy, Clamart, France
| | - Bruno Mourvillier
- Service de Médecine Intensive et Réanimation Polyvalente, Centre Hospitalo-Universitaire Robert Debré, Reims, France
| | | | - Carole Schwebel
- Service de Médecine Intensive et Réanimation, Centre Hospitalo-Universitaire de Grenoble Alpe, Grenoble, France
| | | | - Marc Garnier
- Service d'Anesthésie-Réanimation, Centre Hospitalo-Universitaire Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Benjamin Madeux
- Service de Réanimation Polyvalente, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, Poissy, France; Service de Médecine Intensive et Réanimation, Centre Hospitalier De Tarbes, Tarbes, France
| | - Stéphane Gaudry
- Service de Médecine Intensive et Réanimation Centre Hospitalo-Universitaire Avicenne, Bobigny, France
| | - Karine Bailly
- Institut Cochin, Centre National de la Recherche Scientifique UMR8104, INSERM U1016, Paris, France
| | - Christian Lamer
- Service de Réanimation Polyvalente, Institut mutualiste Montsouris, Paris, France
| | - Philippe Aegerter
- Groupement inter-régional de recherche clinique et d'innovation - Île de France, Cellule Méthodologie, Paris, France; Équipe d'Épidémiologie respiratoire intégrative, Centre de recherche en Epidémiologie et Santé des Populations, U1018 INSERM Université Paris Saclay - Université Versailles Saint Quentin en Yveline, Villejuif, France
| | - Christine Rieu
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France
| | - Khaoussou Sylla
- Direction de la recherche clinique et de l'innovation, Groupe Hospitalier Universitaire Paris Psychiatrie et Neurosciences, Paris, France
| | - Bruno Lucas
- Department of Neurosiences, Université de Paris, Paris, France; Institut Cochin, Centre National de la Recherche Scientifique UMR8104, INSERM U1016, Paris, France
| | - Tarek Sharshar
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France; Department of Neurosiences, Université de Paris, Paris, France; INSERM UMR S894, Sorbonne Université, Paris, France
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Premachandra A, Mazeraud A, Schimpf C, Tortuyaux R, Legouy C, Daniel M, Sauvageon X, Benmostefa A, Sermet A, Sharshar T, Wolff M. Is amoxicillin/clavulanic acid the best option to treat early-onset ventilator-acquired pneumonia in brain-injured patients. J Glob Antimicrob Resist 2021; 27:247-249. [PMID: 34715350 DOI: 10.1016/j.jgar.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- A Premachandra
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1 rue Cabanis, 75014, Paris, France.
| | - A Mazeraud
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1 rue Cabanis, 75014, Paris, France
| | - C Schimpf
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1 rue Cabanis, 75014, Paris, France
| | - R Tortuyaux
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1 rue Cabanis, 75014, Paris, France
| | - C Legouy
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1 rue Cabanis, 75014, Paris, France
| | - M Daniel
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1 rue Cabanis, 75014, Paris, France
| | - X Sauvageon
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1 rue Cabanis, 75014, Paris, France
| | - A Benmostefa
- GHU Paris Psychiatrie et Neuroscience, Microbiology Department, 1 rue Cabanis, 75014, Paris, France
| | - A Sermet
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1 rue Cabanis, 75014, Paris, France
| | - T Sharshar
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1 rue Cabanis, 75014, Paris, France
| | - M Wolff
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1 rue Cabanis, 75014, Paris, France
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12
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Dal-Pizzol F, de Medeiros GF, Michels M, Mazeraud A, Bozza FA, Ritter C, Sharshar T. What Animal Models Can Tell Us About Long-Term Psychiatric Symptoms in Sepsis Survivors: a Systematic Review. Neurotherapeutics 2021; 18:1393-1413. [PMID: 33410107 PMCID: PMC8423874 DOI: 10.1007/s13311-020-00981-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 02/06/2023] Open
Abstract
Lower sepsis mortality rates imply that more patients are discharged from the hospital, but sepsis survivors often experience sequelae, such as functional disability, cognitive impairment, and psychiatric morbidity. Nevertheless, the mechanisms underlying these long-term disabilities are not fully understood. Considering the extensive use of animal models in the study of the pathogenesis of neuropsychiatric disorders, it seems adopting this approach to improve our knowledge of postseptic psychiatric symptoms is a logical approach. With the purpose of gathering and summarizing the main findings of studies using animal models of sepsis-induced psychiatric symptoms, we performed a systematic review of the literature on this topic. Thus, 140 references were reviewed, and most of the published studies suggested a time-dependent recovery from behavior alterations, despite the fact that some molecular alterations persist in the brain. This review reveals that animal models can be used to understand the mechanisms that underlie anxiety and depression in animals recovering from sepsis.
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Affiliation(s)
- Felipe Dal-Pizzol
- Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, 88806-000 Criciúma, Brazil
| | | | - Monique Michels
- Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, 88806-000 Criciúma, Brazil
| | - Aurélien Mazeraud
- Laboratory of Experimental Neuropathology, Institut Pasteur, 75015 Paris, France
| | - Fernando Augusto Bozza
- Laboratório de Medicina Intensiva, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), 21040-360 Rio de Janeiro, Brazil
| | - Cristiane Ritter
- Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, 88806-000 Criciúma, Brazil
| | - Tarek Sharshar
- Laboratoire de Neuropathologie Expérimentale, Institut Pasteur, 75015 Paris, France
- Laboratory of Experimental Neuropathology, Institut Pasteur, 75015 Paris, France
- Department of Neuro-Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University, 75015 Paris, France
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13
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Mazeraud A, Gonçalves B, Aegerter P, Mancusi L, Rieu C, Bozza F, Sylla K, Siami S, Sharshar T. Effect of early treatment with polyvalent immunoglobulin on acute respiratory distress syndrome associated with SARS-CoV-2 infections (ICAR trial): study protocol for a randomized controlled trial. Trials 2021; 22:170. [PMID: 33648563 PMCID: PMC7917531 DOI: 10.1186/s13063-021-05118-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 02/11/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND As of mid-June 2020, 7,500,000 people were infected with SARS-CoV-2 worldwide and 420,000 people died, mainly from coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). COVID-19-related ARDS is subject to a mortality rate of 50% and prolonged period of mechanical ventilation, with no specific pharmacological treatment currently available (Infection au nouveau Coronavirus (SARS-CoV-2), COVID-19, France et Monde. https://www.santepubliquefrance.fr/dossiers/coronavirus-covid-19 ). Because of its immunomodulatory action, we propose to evaluate the efficacy and safety of intravenous immunoglobulin (IVIG) administration in patients developing COVID-19-related ARDS. METHODS The trial is a phase III double-blind, randomized, multicenter, parallel group, concurrent, controlled study in hospitalized participants with COVID-19 requiring mechanical ventilation using a sequential design. Participants in the treatment group will receive infusions of polyvalent immunoglobulin for 4 consecutive days, and the placebo group will receive an equivalent volume of sodium chloride 0.9% for the same duration. The primary outcome is the number of ventilator-free days up to the 28th day. Secondary objectives are to evaluate the effect of IVIG on (1) organ failure according to the Sequential Organ Failure Assessment (SOFA) score at 14 and 28 days, (2) lung injury score at 14 and 28 days, (3) the occurrence of grade 3 or 4 adverse events of IVIG, (4) length of intensive care unit (ICU) stay, (5) length of hospital stay, (6) functional outcomes at day 90 defined by the activities of daily living and instrumental activities of the daily living scales, and (7) 90-day survival. One hundred thirty-eight subjects will be randomized in a 1:1 ratio to IVIG or placebo groups (69 in each group), considering 90% power, alpha level 0.05 (two sides), and 0.67 effect size level. DISCUSSION The ICAR trial investigates the effect of IVIG in COVID-19-related ARDS. We expect an increase in the survival rate and a reduction in the duration of mechanical ventilation, which is associated with significant morbidity. TRIAL REGISTRATION EudraCT 2020-001570-30. ClinicalTrials.gov NCT04350580 . Registered on 17 April 2020.
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Affiliation(s)
- Aurélien Mazeraud
- GHU Paris Psychiatrie et neurosciences, Service de Neuroanesthésie Neuroréanimation, Paris, France. .,Univeristé de Paris, Paris, France.
| | - Bruno Gonçalves
- GHU Paris Psychiatrie et neurosciences, Service de Neuroanesthésie Neuroréanimation, Paris, France.,Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brasil
| | - Philippe Aegerter
- GIRCI-IDF, Cellule Méthodologie, Paris, France et Université Paris-Saclay, UVSQ, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP - Centre de recherche en Epidémiologie et Santé des Populations U1018 INSERM UPS UVSQ, Villejuif, France
| | - Letizia Mancusi
- GHU Paris Psychiatrie et neurosciences, Service de Neuroanesthésie Neuroréanimation, Paris, France
| | - Christine Rieu
- GHU Paris Psychiatrie et neurosciences, Service de Neuroanesthésie Neuroréanimation, Paris, France
| | - Fernando Bozza
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brasil
| | - Khaoussou Sylla
- GHU Paris Psychiatrie et neurosciences, Service de Neuroanesthésie Neuroréanimation, Paris, France
| | - Shidasp Siami
- CH Sud-Essonnes, Service de Réanimation, Etampes, France
| | - Tarek Sharshar
- GHU Paris Psychiatrie et neurosciences, Service de Neuroanesthésie Neuroréanimation, Paris, France.,Univeristé de Paris, Paris, France
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14
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Sharshar T, Ben Hadj Salem O, Porcher R, Grimaldi-Bensouda L, Heming N, Clair B, Azabou E, Mazeraud A, Rohaut B, Outin H. Valproic Acid as an Adjuvant Treatment for Generalized Convulsive Status Epilepticus in Adults Admitted to Intensive Care Units: Protocol for a Double-Blind, Multicenter Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e22511. [PMID: 33625371 PMCID: PMC7946594 DOI: 10.2196/22511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 11/13/2022] Open
Abstract
Background Generalized convulsive status epilepticus (GCSE) is a frequent medical emergency. GCSE treatment focuses on the administration of benzodiazepines followed by a second-line antiepileptic drug (AED). Despite this stepwise strategy, GCSE is not controlled in one-quarter of patients and is associated with protracted hospitalization, high mortality, and long-term disability. Valproic acid (VPA) is an AED with good tolerability and neuroprotective properties. Objective This study aims to demonstrate that administration of VPA as an adjuvant for first- and second-line treatment in GCSE can improve outcomes. Methods A multicenter, double-blind, randomized controlled trial was conducted, comparing VPA with a placebo in adults admitted to intensive care units (ICUs) for GCSE in France. GCSE was diagnosed by specifically trained ICU physicians according to standard criteria. All patients received standard of care, including a benzodiazepine and a second-line AED (not VPA), at the discretion of the treating medical team. In the intervention arm, VPA was administered intravenously at a loading dose of 30 mg/kg over 15 minutes, followed by a continuous infusion of 1 mg/kg/hour over the next 12 hours. In the placebo group, an identical intravenous administration of 0.9% saline was used. The primary outcome was the proportion of patients discharged alive from the hospital by day 15. Secondary outcomes were frequency of refractory and super refractory GCSE, ICU-related morbidity, adverse events related to VPA, and cognitive dysfunction at 3 months. Statistical analyses will be performed according to the intent-to-treat principle. Results The first patient was randomized on February 18, 2013, and the last patient was randomized on July 7, 2018. Of 248 planned patients, 98.7% (245/248) were enrolled across 20 ICUs. At present, data management is still ongoing, and all parties involved in the trial remain blinded. Conclusions The Valproic Acid as an Adjuvant Treatment for Generalized Convulsive Status Epilepticus (VALSE) trial will evaluate whether the use of VPA as an adjuvant for first- and second-line treatment in GCSE improves outcomes. Trial Registration ClinicalTrials.gov NCT01791868; https://clinicaltrials.gov/ct2/show/NCT01791868. International Registered Report Identifier (IRRID) DERR1-10.2196/22511
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Affiliation(s)
- Tarek Sharshar
- Groupement Hospitalo-Universitaire Paris Psychiatrie et Neurosciences, Paris, France.,Université de Paris, Paris, France
| | | | - Raphaël Porcher
- Université de Paris, Paris, France.,Center for Clinical Epidemiology, Assistance Publique Hôpitaux de Paris, Hôtel Dieu Hospital, Paris, France
| | - Lamiae Grimaldi-Bensouda
- Clinical Research Unit, Ambroise Paré Hospital, University of Versailles Saint-Quentin en Yvelines, Saint-Quentin en Yveline, France
| | - Nicholas Heming
- Centre Hospitalo-Universitaire Raymond Poincaré, Assistance de Paris - Hôpitaux de Paris, Garches, France
| | - Bernard Clair
- Centre Hospitalo-Universitaire Raymond Poincaré, Assistance de Paris - Hôpitaux de Paris, Garches, France
| | - Eric Azabou
- Centre Hospitalo-Universitaire Raymond Poincaré, Assistance de Paris - Hôpitaux de Paris, Garches, France
| | - Aurélien Mazeraud
- Groupement Hospitalo-Universitaire Paris Psychiatrie et Neurosciences, Paris, France.,Université de Paris, Paris, France
| | - Benjamin Rohaut
- Centre Hospitalo-Universitaire Pitié Salpétrière, Paris, France.,Sorbonne Université, Paris, France
| | - Hervé Outin
- Centre Hospitalier Poissy Saint Germain en Laye, Poissy, France
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15
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Mazeraud A, Robba C, Rebora P, Iaquaniello C, Vargiolu A, Rass V, Bogossian EG, Helbok R, Taccone FS, Citerio G. Acute Distress Respiratory Syndrome After Subarachnoid Hemorrhage: Incidence and Impact on the Outcome in a Large Multicenter, Retrospective Cohort. Neurocrit Care 2020; 34:1000-1008. [PMID: 33083966 PMCID: PMC7575216 DOI: 10.1007/s12028-020-01115-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/14/2020] [Indexed: 11/28/2022]
Abstract
Background Respiratory complications are frequently reported after aneurismal subarachnoid hemorrhage (aSAH), even if their association with outcome remains controversial. Acute respiratory distress syndrome (ARDS) is one of the most severe pulmonary complications after aSAH, with a reported incidence ranging from 11 to 50%. This study aims to assess in a large cohort of aSAH patients, during the first week after an intensive care unit (ICU) admission, the incidence of ARDS defined according to the Berlin criteria and its effect on outcome. Methods This is a multicentric, retrospective cohort study in 3 European intensive care units. We collected data between January 2009 and December 2017. We included adult patients (≥ 18 years) with a diagnosis of aSAH admitted to the ICU. Results A total of 855 patients fulfilled the inclusion criteria. ARDS was assessable in 851 patients. The cumulative incidence of ARDS was 2.2% on the first day since ICU admission, 3.2% on day three, and 3.6% on day seven. At the univariate analysis, ARDS was associated with a poor outcome (p = 0.005) at ICU discharge, and at the multivariable analysis, patients with ARDS showed a worse neurological outcome (Odds ratio = 3.00, 95% confidence interval 1.16–7.72; p = 0.023). Conclusions ARDS has a low incidence in the first 7 days of ICU stay after aSAH, but it is associated with worse outcome. Electronic supplementary material The online version of this article (10.1007/s12028-020-01115-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aurélien Mazeraud
- Neurointensive Care Unit, GHU Paris - Psychiatrie et neurosciences, rue Cabanis 1, 75014, Paris, France.,School of Medicine and Surgery, University of Milano - Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, Policlinico San Martino IRCCS for Oncology and Neuroscience, Largo R.Benzi 10, 16132, Genova, Italy
| | - Paola Rebora
- School of Medicine and Surgery, University of Milano - Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Carolina Iaquaniello
- School of Medicine and Surgery, University of Milano - Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Alessia Vargiolu
- School of Medicine and Surgery, University of Milano - Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Verena Rass
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Elisa Gouvea Bogossian
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Raimund Helbok
- Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano - Bicocca, Via Cadore 48, 20900, Monza, Italy. .,Neurointensive Care Unit, San Gerardo Hospital, ASST-Monza, Via G. B. Pergolesi 33, 20835, Monza, Italy.
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16
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Delavallée L, Mathiah N, Cabon L, Mazeraud A, Brunelle-Navas MN, Lerner LK, Tannoury M, Prola A, Moreno-Loshuertos R, Baritaud M, Vela L, Garbin K, Garnier D, Lemaire C, Langa-Vives F, Cohen-Salmon M, Fernández-Silva P, Chrétien F, Migeotte I, Susin SA. Mitochondrial AIF loss causes metabolic reprogramming, caspase-independent cell death blockade, embryonic lethality, and perinatal hydrocephalus. Mol Metab 2020; 40:101027. [PMID: 32480041 PMCID: PMC7334469 DOI: 10.1016/j.molmet.2020.101027] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/18/2020] [Accepted: 05/27/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Apoptosis-Inducing Factor (AIF) is a protein involved in mitochondrial electron transport chain assembly/stability and programmed cell death. The relevant role of this protein is underlined because mutations altering mitochondrial AIF properties result in acute pediatric mitochondriopathies and tumor metastasis. By generating an original AIF-deficient mouse strain, this study attempted to analyze, in a single paradigm, the cellular and developmental metabolic consequences of AIF loss and the subsequent oxidative phosphorylation (OXPHOS) dysfunction. METHODS We developed a novel AIF-deficient mouse strain and assessed, using molecular and cell biology approaches, the cellular, embryonic, and adult mice phenotypic alterations. Additionally, we conducted ex vivo assays with primary and immortalized AIF knockout mouse embryonic fibroblasts (MEFs) to establish the cell death characteristics and the metabolic adaptive responses provoked by the mitochondrial electron transport chain (ETC) breakdown. RESULTS AIF deficiency destabilized mitochondrial ETC and provoked supercomplex disorganization, mitochondrial transmembrane potential loss, and high generation of mitochondrial reactive oxygen species (ROS). AIF-/Y MEFs counterbalanced these OXPHOS alterations by mitochondrial network reorganization and a metabolic reprogramming toward anaerobic glycolysis illustrated by the AMPK phosphorylation at Thr172, the overexpression of the glucose transporter GLUT-4, the subsequent enhancement of glucose uptake, and the anaerobic lactate generation. A late phenotype was characterized by the activation of P53/P21-mediated senescence. Notably, approximately 2% of AIF-/Y MEFs diminished both mitochondrial mass and ROS levels and spontaneously proliferated. These cycling AIF-/Y MEFs were resistant to caspase-independent cell death inducers. The AIF-deficient mouse strain was embryonic lethal between E11.5 and E13.5 with energy loss, proliferation arrest, and increased apoptotic levels. Contrary to AIF-/Y MEFs, the AIF KO embryos were unable to reprogram their metabolism toward anaerobic glycolysis. Heterozygous AIF+/- females displayed progressive bone marrow, thymus, and spleen cellular loss. In addition, approximately 10% of AIF+/- females developed perinatal hydrocephaly characterized by brain development impairment, meningeal fibrosis, and medullar hemorrhages; those mice died 5 weeks after birth. AIF+/- with hydrocephaly exhibited loss of ciliated epithelium in the ependymal layer. This phenotype was triggered by the ROS excess. Accordingly, it was possible to diminish the occurrence of hydrocephalus AIF+/- females by supplying dams and newborns with an antioxidant in drinking water. CONCLUSIONS In a single knockout model and at 3 different levels (cell, embryo, and adult mice) we demonstrated that by controlling the mitochondrial OXPHOS/metabolism, AIF is a key factor regulating cell differentiation and fate. Additionally, by providing new insights into the pathological consequences of mitochondrial OXPHOS dysfunction, our new findings pave the way for novel pharmacological strategies.
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Affiliation(s)
- Laure Delavallée
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Cell Death and Drug Resistance in Hematological Disorders Team, F-75006, Paris, France
| | - Navrita Mathiah
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, Université Libre de Bruxelles, Brussels, Belgium
| | - Lauriane Cabon
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Cell Death and Drug Resistance in Hematological Disorders Team, F-75006, Paris, France
| | - Aurélien Mazeraud
- Experimental Neuropathology Unit, Institut Pasteur, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Neuropathology Service, Sainte-Anne Hospital Center, Paris, France
| | - Marie-Noelle Brunelle-Navas
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Cell Death and Drug Resistance in Hematological Disorders Team, F-75006, Paris, France
| | - Leticia K Lerner
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Cell Death and Drug Resistance in Hematological Disorders Team, F-75006, Paris, France
| | - Mariana Tannoury
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Cell Death and Drug Resistance in Hematological Disorders Team, F-75006, Paris, France
| | - Alexandre Prola
- INSERM UMRS 1180, LabEx LERMIT, Châtenay-Malabry, France; Faculté de Pharmacie, Université Paris-Sud, Châtenay-Malabry, France; Université de Versailles Saint Quentin en Yvelines, Versailles, France; U955-IMRB Team 10 BNMS, INSERM, UPEC, Université Paris-Est, Ecole Nationale Vétérinaire de Maisons-Alfort, France
| | - Raquel Moreno-Loshuertos
- Departamento de Bioquímica, Biología Molecular y Celular, Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación en Biocomputación y Física de Sistemas Complejos (BiFi), Universidad de Zaragoza, Zaragoza, Spain
| | - Mathieu Baritaud
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Cell Death and Drug Resistance in Hematological Disorders Team, F-75006, Paris, France
| | - Laura Vela
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Cell Death and Drug Resistance in Hematological Disorders Team, F-75006, Paris, France
| | - Kevin Garbin
- Centre de Recherche des Cordeliers, Genotyping and Biochemical facility, INSERM UMRS_1138, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Delphine Garnier
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Cell Death and Drug Resistance in Hematological Disorders Team, F-75006, Paris, France
| | - Christophe Lemaire
- INSERM UMRS 1180, LabEx LERMIT, Châtenay-Malabry, France; Faculté de Pharmacie, Université Paris-Sud, Châtenay-Malabry, France; Université de Versailles Saint Quentin en Yvelines, Versailles, France
| | | | - Martine Cohen-Salmon
- Physiology and Physiopathology of the Gliovascular Unit, Collège de France-Center for Interdisciplinary Research in Biology (CIRB)/CNRS UMR 7241/INSERM U1050/Sorbonne Université, Paris, France
| | - Patricio Fernández-Silva
- Departamento de Bioquímica, Biología Molecular y Celular, Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación en Biocomputación y Física de Sistemas Complejos (BiFi), Universidad de Zaragoza, Zaragoza, Spain
| | - Fabrice Chrétien
- Experimental Neuropathology Unit, Institut Pasteur, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Neuropathology Service, Sainte-Anne Hospital Center, Paris, France
| | - Isabelle Migeotte
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, Université Libre de Bruxelles, Brussels, Belgium
| | - Santos A Susin
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Cell Death and Drug Resistance in Hematological Disorders Team, F-75006, Paris, France.
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Abstract
Septic-associated encephalopathy (SAE) is a key manifestation of sepsis, ranging from delirium to coma and occurring in up to 70% of patients admitted to the ICU. SAE is associated with higher ICU and hospital mortality, and also with poorer long-term outcomes, including cognitive and functional outcomes. The pathophysiology of SAE is complex, and it may involve neurotransmitter dysfunction, inflammatory and ischemic lesions to the brain, microglial activation, and blood-brain barrier dysfunction. Delirium (which is included in the SAE spectrum) is mostly diagnosed with validated scales in the ICU population. There is no established treatment for SAE; benzodiazepines should generally be avoided in this setting. Nonpharmacological prevention and management is key for treating SAE; it includes avoiding oversedation (mainly with benzodiazepines), early mobilization, and sleep promotion.
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Affiliation(s)
- Aurélien Mazeraud
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1, rue Cabanis, 75014, Paris, France
- Medical Intensive Care Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
- Université de Paris, 75006, Paris, France
| | - Cássia Righy
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1, rue Cabanis, 75014, Paris, France
- Instituto Estadual do Cérebro Paul Niemeyer, Rio de Janeiro, Brazil
| | - Eleonore Bouchereau
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1, rue Cabanis, 75014, Paris, France
- Medical Intensive Care Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
- Université de Paris, 75006, Paris, France
| | - Sarah Benghanem
- Université de Paris, 75006, Paris, France
- Médecine Intensive et Réanimation, Centre Hospitalier Universitaire Cochin, Paris, France
| | | | - Tarek Sharshar
- GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1, rue Cabanis, 75014, Paris, France.
- Université de Paris, 75006, Paris, France.
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18
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Heming N, Mazeraud A, Azabou E, Moine P, Annane D. Vasopressor Therapy and the Brain: Dark Side of the Moon. Front Med (Lausanne) 2020; 6:317. [PMID: 31998736 PMCID: PMC6966606 DOI: 10.3389/fmed.2019.00317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/13/2019] [Indexed: 12/14/2022] Open
Abstract
Sepsis, a leading cause of morbidity and mortality, is caused by a deregulated host response to pathogens, and subsequent life-threatening organ dysfunctions. All major systems, including the cardiovascular, respiratory, renal, hepatic, hematological, and the neurological system may be affected by sepsis. Sepsis associated neurological dysfunction is triggered by multiple factors including neuro-inflammation, excitotoxicity, and ischemia. Ischemia results from reduced cerebral blood flow, caused by extreme variations of blood pressure, occlusion of cerebral vessels, or more subtle defects of the microcirculation. International guidelines comprehensively describe the initial hemodynamic management of sepsis, revolving around the normalization of systemic hemodynamics and of arterial lactate. By contrast, the management of sepsis patients suffering from brain dysfunction is poorly detailed, the only salient point being mentioned is that sedation and analgesia should be optimized. However, sepsis and the hemodynamic consequences thereof as well as vasopressors may have severe untoward neurological consequences. The current review describes the general neurological complications, as well as the consequences of vasopressor therapy on the brain and its circulation and addresses methods for cerebral monitoring during sepsis.
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Affiliation(s)
- Nicholas Heming
- General Intensive Care Unit, Raymond Poincaré Hospital, Garches, France.,U1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, France
| | - Aurélien Mazeraud
- Department of Neuro-Anesthesiology and Intensive Care Medicine, Sainte-Anne Teaching Hospital, Paris-Descartes University, Paris, France
| | - Eric Azabou
- U1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, France.,Department of Physiology, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, Garches, France
| | - Pierre Moine
- General Intensive Care Unit, Raymond Poincaré Hospital, Garches, France.,U1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, France
| | - Djillali Annane
- General Intensive Care Unit, Raymond Poincaré Hospital, Garches, France.,U1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, France
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Benghanem S, Mazeraud A, Azabou E, Chhor V, Shinotsuka CR, Claassen J, Rohaut B, Sharshar T. Brainstem dysfunction in critically ill patients. Crit Care 2020; 24:5. [PMID: 31907011 PMCID: PMC6945639 DOI: 10.1186/s13054-019-2718-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023] Open
Abstract
The brainstem conveys sensory and motor inputs between the spinal cord and the brain, and contains nuclei of the cranial nerves. It controls the sleep-wake cycle and vital functions via the ascending reticular activating system and the autonomic nuclei, respectively. Brainstem dysfunction may lead to sensory and motor deficits, cranial nerve palsies, impairment of consciousness, dysautonomia, and respiratory failure. The brainstem is prone to various primary and secondary insults, resulting in acute or chronic dysfunction. Of particular importance for characterizing brainstem dysfunction and identifying the underlying etiology are a detailed clinical examination, MRI, neurophysiologic tests such as brainstem auditory evoked potentials, and an analysis of the cerebrospinal fluid. Detection of brainstem dysfunction is challenging but of utmost importance in comatose and deeply sedated patients both to guide therapy and to support outcome prediction. In the present review, we summarize the neuroanatomy, clinical syndromes, and diagnostic techniques of critical illness-associated brainstem dysfunction for the critical care setting.
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Affiliation(s)
- Sarah Benghanem
- Department of Neurology, Neuro-ICU, Sorbonne University, APHP Pitié-Salpêtrière Hospital, Paris, France
- Medical ICU, Cochin Hospital, AP-HP, Paris, France
| | - Aurélien Mazeraud
- Department of Neuro-ICU, GHU-Paris, Paris-Descartes University, Paris, France
- Laboratory of Experimental Neuropathology, Pastuer Institute, Paris, France
| | - Eric Azabou
- Department of Physiology, Clinical Neurophysiology Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint Quentin en Yvelines, Garches, France
| | - Vibol Chhor
- Department of Intensive Care Medicine, Saint-Joseph Hospital, Paris, France
| | - Cassia Righy Shinotsuka
- Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jan Claassen
- Department of Neurology, Neuro-ICU, Columbia University, New York, NY, USA
| | - Benjamin Rohaut
- Department of Neurology, Neuro-ICU, Sorbonne University, APHP Pitié-Salpêtrière Hospital, Paris, France
- Department of Neurology, Neuro-ICU, Columbia University, New York, NY, USA
- Institut du Cerveau et de la Moelle épinière, ICM, INSERM UMRS 1127, CNRS UMR 7225, Pitié- Salpêtrière Hospital, Paris, F-75013, France
| | - Tarek Sharshar
- Department of Neuro-ICU, GHU-Paris, Paris-Descartes University, Paris, France.
- Laboratory of Experimental Neuropathology, Pastuer Institute, Paris, France.
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Affiliation(s)
- Aurélien Mazeraud
- 1 Department of Infection and Epidemiology Institut Pasteur Paris, France.,2 Medical and Surgical Neurointensive Care Centre Hospitalier Sainte Anne Paris, France.,3 Université Paris Descartes Paris, France and
| | | | - Tarek Sharshar
- 1 Department of Infection and Epidemiology Institut Pasteur Paris, France.,2 Medical and Surgical Neurointensive Care Centre Hospitalier Sainte Anne Paris, France.,3 Université Paris Descartes Paris, France and
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Mayeuf-Louchart A, Hardy D, Thorel Q, Roux P, Gueniot L, Briand D, Mazeraud A, Bouglé A, Shorte SL, Staels B, Chrétien F, Duez H, Danckaert A. MuscleJ: a high-content analysis method to study skeletal muscle with a new Fiji tool. Skelet Muscle 2018; 8:25. [PMID: 30081940 PMCID: PMC6091189 DOI: 10.1186/s13395-018-0171-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/20/2018] [Indexed: 11/22/2022] Open
Abstract
Background Skeletal muscle has the capacity to adapt to environmental changes and regenerate upon injury. To study these processes, most experimental methods use quantification of parameters obtained from images of immunostained skeletal muscle. Muscle cross-sectional area, fiber typing, localization of nuclei within the muscle fiber, the number of vessels, and fiber-associated stem cells are used to assess muscle physiology. Manual quantification of these parameters is time consuming and only poorly reproducible. While current state-of-the-art software tools are unable to analyze all these parameters simultaneously, we have developed MuscleJ, a new bioinformatics tool to do so. Methods Running on the popular open source Fiji software platform, MuscleJ simultaneously analyzes parameters from immunofluorescent staining, imaged by different acquisition systems in a completely automated manner. Results After segmentation of muscle fibers, up to three other channels can be analyzed simultaneously. Dialog boxes make MuscleJ easy-to-use for biologists. In addition, we have implemented color in situ cartographies of results, allowing the user to directly visualize results on reconstituted muscle sections. Conclusion We report here that MuscleJ results were comparable to manual observations made by five experts. MuscleJ markedly enhances statistical analysis by allowing reliable comparison of skeletal muscle physiology-pathology results obtained from different laboratories using different acquisition systems. Providing fast robust multi-parameter analyses of skeletal muscle physiology-pathology, MuscleJ is available as a free tool for the skeletal muscle community. Electronic supplementary material The online version of this article (10.1186/s13395-018-0171-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alicia Mayeuf-Louchart
- Inserm, CHU Lille, Institut Pasteur de Lille, University of Lille, U1011 - EGID, 1 rue du Pr. Calmette, F-59000, Lille, France.
| | - David Hardy
- Experimental Neuropathology Unit, Infection and Epidemiology Department, Institut Pasteur, 25, rue du Docteur Roux, 75015, Paris, France
| | - Quentin Thorel
- Inserm, CHU Lille, Institut Pasteur de Lille, University of Lille, U1011 - EGID, 1 rue du Pr. Calmette, F-59000, Lille, France
| | - Pascal Roux
- UTechS PBI (Imagopole)-Citech, Institut Pasteur, 25, rue du Docteur Roux, 75015, Paris, France
| | - Lorna Gueniot
- Experimental Neuropathology Unit, Infection and Epidemiology Department, Institut Pasteur, 25, rue du Docteur Roux, 75015, Paris, France
| | - David Briand
- Experimental Neuropathology Unit, Infection and Epidemiology Department, Institut Pasteur, 25, rue du Docteur Roux, 75015, Paris, France
| | - Aurélien Mazeraud
- Experimental Neuropathology Unit, Infection and Epidemiology Department, Institut Pasteur, 25, rue du Docteur Roux, 75015, Paris, France
| | - Adrien Bouglé
- Experimental Neuropathology Unit, Infection and Epidemiology Department, Institut Pasteur, 25, rue du Docteur Roux, 75015, Paris, France
| | - Spencer L Shorte
- UTechS PBI (Imagopole)-Citech, Institut Pasteur, 25, rue du Docteur Roux, 75015, Paris, France
| | - Bart Staels
- Inserm, CHU Lille, Institut Pasteur de Lille, University of Lille, U1011 - EGID, 1 rue du Pr. Calmette, F-59000, Lille, France
| | - Fabrice Chrétien
- Experimental Neuropathology Unit, Infection and Epidemiology Department, Institut Pasteur, 25, rue du Docteur Roux, 75015, Paris, France
| | - Hélène Duez
- Inserm, CHU Lille, Institut Pasteur de Lille, University of Lille, U1011 - EGID, 1 rue du Pr. Calmette, F-59000, Lille, France
| | - Anne Danckaert
- Experimental Neuropathology Unit, Infection and Epidemiology Department, Institut Pasteur, 25, rue du Docteur Roux, 75015, Paris, France. .,UTechS PBI (Imagopole)-Citech, Institut Pasteur, 25, rue du Docteur Roux, 75015, Paris, France.
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Andreiuolo F, Mazeraud A, Chrétien F, Pietsch T. A Global View on the Availability of Methods and Information in the Neuropathological Diagnostics of CNS Tumors: Results of an International Survey Among Neuropathological Units. Brain Pathol 2018; 26:551-4. [PMID: 27062283 DOI: 10.1111/bpa.12383] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 03/22/2016] [Indexed: 12/01/2022] Open
Affiliation(s)
- Felipe Andreiuolo
- Neuropathology Department, Centre Hospitalier Sainte-Anne, Paris, France
| | - Aurélien Mazeraud
- Infection and Epidemiology Department, Institut Pasteur, Human Histopathology and Animal Models Unit, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Fabrice Chrétien
- Neuropathology Department, Centre Hospitalier Sainte-Anne, Paris, France
- Infection and Epidemiology Department, Institut Pasteur, Human Histopathology and Animal Models Unit, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Torsten Pietsch
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
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d’Avila JC, Siqueira LD, Mazeraud A, Azevedo EP, Foguel D, Castro-Faria-Neto HC, Sharshar T, Chrétien F, Bozza FA. Age-related cognitive impairment is associated with long-term neuroinflammation and oxidative stress in a mouse model of episodic systemic inflammation. J Neuroinflammation 2018; 15:28. [PMID: 29382344 PMCID: PMC5791311 DOI: 10.1186/s12974-018-1059-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/08/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Microglia function is essential to maintain the brain homeostasis. Evidence shows that aged microglia are primed and show exaggerated response to acute inflammatory challenge. Systemic inflammation signals to the brain inducing changes that impact cognitive function. However, the mechanisms involved in age-related cognitive decline associated to episodic systemic inflammation are not completely understood. The aim of this study was to identify neuropathological features associated to age-related cognitive decline in a mouse model of episodic systemic inflammation. METHODS Young and aged Swiss mice were injected with low doses of LPS once a week for 6 weeks to induce episodic systemic inflammation. Sickness behavior, inflammatory markers, and neuroinflammation were assessed in different phases of systemic inflammation in young and aged mice. Behavior was evaluated long term after episodic systemic inflammation by open field, forced swimming, object recognition, and water maze tests. RESULTS Episodic systemic inflammation induced systemic inflammation and sickness behavior mainly in aged mice. Systemic inflammation induced depressive-like behavior in both young and aged mice. Memory and learning were significantly affected in aged mice that presented lower exploratory activity and deficits in episodic and spatial memories, compared to aged controls and to young after episodic systemic inflammation. Systemic inflammation induced acute microglia activation in young mice that returned to base levels long term after episodic systemic inflammation. Aged mice presented dystrophic microglia in the hippocampus and entorhinal cortex at basal level and did not change morphology in the acute response to SI. Regardless of their dystrophic microglia, aged mice produced higher levels of pro-inflammatory (IL-1β and IL-6) as well as pro-resolution (IL-10 and IL-4) cytokines in the brain. Also, higher levels of Nox2 expression, oxidized proteins and lower antioxidant defenses were found in the aged brains compared to the young after episodic systemic inflammation. CONCLUSIONS Our data show that aged mice have increased susceptibility to episodic systemic inflammation. Aged mice that showed cognitive impairments also presented higher oxidative stress and abnormal production of cytokines in their brains. These results indicate that a neuroinflammation and oxidative stress are pathophysiological mechanisms of age-related cognitive impairments.
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Affiliation(s)
- Joana Costa d’Avila
- Laboratory of Immunopharmacology, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Luciana Domett Siqueira
- Institute of Medical Biochemistry Leopoldo DeMeis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aurélien Mazeraud
- Human Histopathology and Animal Models, Pasteur Institute, Paris, France
| | - Estefania Pereira Azevedo
- Institute of Medical Biochemistry Leopoldo DeMeis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Debora Foguel
- Institute of Medical Biochemistry Leopoldo DeMeis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Tarek Sharshar
- Human Histopathology and Animal Models, Pasteur Institute, Paris, France
| | - Fabrice Chrétien
- Human Histopathology and Animal Models, Pasteur Institute, Paris, France
| | - Fernando Augusto Bozza
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation (FIOCRUZ), Ministry of Health, Rio de Janeiro, Brazil
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
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Boulay AC, Saubaméa B, Cisternino S, Mignon V, Mazeraud A, Jourdren L, Blugeon C, Cohen-Salmon M. The Sarcoglycan complex is expressed in the cerebrovascular system and is specifically regulated by astroglial Cx30 channels. Front Cell Neurosci 2015; 9:9. [PMID: 25698924 PMCID: PMC4313713 DOI: 10.3389/fncel.2015.00009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/08/2015] [Indexed: 12/12/2022] Open
Abstract
Astrocytes, the most prominent glial cell type in the brain, send specialized processes called endfeet, around blood vessels and express a large molecular repertoire regulating the cerebrovascular system physiology. One of the most striking properties of astrocyte endfeet is their enrichment in gap junction proteins Connexin 43 and 30 (Cx43 and Cx30) allowing in particular for direct intercellular trafficking of ions and small signaling molecules through perivascular astroglial networks. In this study, we addressed the specific role of Cx30 at the gliovascular interface. Using an inactivation mouse model for Cx30 (Cx30Δ/Δ; Δ means deleted allele) we showed that absence of Cx30 does not affect blood-brain barrier (BBB) organization and permeability. However, it results in the cerebrovascular fraction, in a strong upregulation of Sgcg encoding γ-Sarcoglycan (γ-SG), a member of the Dystrophin-associated protein complex (DAPC) connecting cytoskeleton and the extracellular matrix. The same molecular event occurs in Cx30T5M/T5M mutated mice, where Cx30 channels are closed, demonstrating that Sgcg regulation relied on Cx30 channel functions. We further characterized the expression of other Sarcoglycan complex (SGC) molecules in the cerebrovascular system and showed the presence of α-, β-, δ-, γ-, ε- and ζ- SG, as well as Sarcospan. Their expression was however not modified in Cx30Δ/Δ. These results suggest that a full SGC might be present in the cerebrovascular system, and that expression of one of its member, γ-SG, depends on Cx30 channels. As described in skeletal muscles, the SGC may contribute to membrane stabilization and signal transduction in the cerebrovascular system, which may therefore be regulated by Cx30 channel-mediated functions.
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Affiliation(s)
- Anne-Cécile Boulay
- Center for Interdisciplinary Research in Biology (CIRB)/Centre National de la Recherche Scientifique, Collège de France, Unité Mixte de Recherche 7241/Institut National de la Santé et de la Recherche Médicale U1050/Neuroglial Interactions in Cerebral physiopathology Paris, France ; University Pierre et Marie Curie Paris, France ; MEMOLIFE Laboratory of Excellence and Paris Science Lettre Research University Paris, France
| | - Bruno Saubaméa
- Faculté de Pharmacie, Variabilité de la réponse aux psychotropes, INSERM UMR-S 1144, Université Paris Descartes, Université Paris Diderot Paris, France
| | - Salvatore Cisternino
- Faculté de Pharmacie, Variabilité de la réponse aux psychotropes, INSERM UMR-S 1144, Université Paris Descartes, Université Paris Diderot Paris, France
| | - Virginie Mignon
- Cellular and Molecular Imaging Facility, Faculté de Pharmacie CNRS, UMS 3612, INSERM, US 025, Paris, France
| | - Aurélien Mazeraud
- Institut Pasteur, Human Histopathology and Animal models Paris, France
| | - Laurent Jourdren
- Ecole Normale Supérieure, Institut de Biologie de l'ENS, IBENS, Plateforme Génomique Inserm, U1024, CNRS, UMR 8197, Paris, France
| | - Corinne Blugeon
- Ecole Normale Supérieure, Institut de Biologie de l'ENS, IBENS, Plateforme Génomique Inserm, U1024, CNRS, UMR 8197, Paris, France
| | - Martine Cohen-Salmon
- Center for Interdisciplinary Research in Biology (CIRB)/Centre National de la Recherche Scientifique, Collège de France, Unité Mixte de Recherche 7241/Institut National de la Santé et de la Recherche Médicale U1050/Neuroglial Interactions in Cerebral physiopathology Paris, France ; University Pierre et Marie Curie Paris, France ; MEMOLIFE Laboratory of Excellence and Paris Science Lettre Research University Paris, France
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Mazeraud A, Polito A, Annane D. Experimental and clinical evidences for glucose control in intensive care: is infused glucose the key point for study interpretation? Crit Care 2014; 18:232. [PMID: 25177798 PMCID: PMC4220093 DOI: 10.1186/cc13998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Stress-induced hyperglycemia has been considered an adaptive mechanism to stress up to the first intensive insulin therapy trial, which showed a 34% reduction in relative risk of in-hospital mortality when normalizing blood glucose levels. Further trials had conflicting results and, at present, stress-induced hyperglycemia management remains non-consensual. These findings could be explained by discrepancies in trials, notably regarding the approach to treat hyperglycemia: high versus restrictive caloric intake. Stress-induced hyperglycemia is a frequent complication during intensive care unit stay and is associated with a higher mortality. It results from an imbalance between insulin and counter-regulatory hormones, increased neoglucogenesis, and the cytokine-induced insulin-resistant state of tissues. In this review, we summarize detrimental effects of hyperglycemia on organs in the critically ill (peripheric and central nervous, liver, immune system, kidney, and cardiovascular system). Finally, we show clinical and experimental evidence of potential benefits from glucose and insulin administration, notably on metabolism, immunity, and the cardiovascular system.
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Mazeraud A, Annane D. L’insuline en réanimation — Pourquoi contrôler la glycémie en réanimation ? Réanimation 2011. [DOI: 10.1007/s13546-010-0023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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