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Georges H, Krings A, Devos P, Delannoy PY, Boussekey N, Thellier D, Jean-Michel V, Caulier T, Leroy O. Severe secondary peritonitis: impact of inappropriate initial antimicrobial therapy on prognosis and potential carbapenem-sparing. Minerva Anestesiol 2022; 88:361-370. [PMID: 35072430 DOI: 10.23736/s0375-9393.21.15859-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Initiation of antimicrobial therapy (IAT) with broad-spectrum antibiotics is usual in Intensive Care Unit (ICU) patients with secondary peritonitis. Carbapenems are widely proposed by recent guidelines contrasting with current antibiotic stewardship policies of carbapenem-sparing. However, prognosis of inappropriate IAT remains unclear in these patients and broad-spectrum antibiotics are probably overused. We aimed to assess the role of inappropriate IAT in ICU patients with secondary peritonitis and the use of carbapenems in our IAT regimens. METHODS We performed a retrospective analysis during a six-year period including 131 ICU patients with secondary peritonitis. We collected data concerning comorbidities, source and severity of peritonitis, management of IAT, peritoneal samples and outcome. RESULTS Forty-one patients presented with community acquired peritonitis (CAP) and 90 with postoperative peritonitis (POP). Thirty-seven (28.2%) patients died during ICU stay. IAT was inappropriate in 35 (26.7%) patients. Inappropriate IAT was not associated with reduced survival with respectively 26 (27%) deaths when IAT was adequate and 11 (31.4%) deaths when IAT was inadequate (P=0.87). Inappropriate IAT was not associated with the need of re-operation and duration of ICU stay. Carbapenems were delivered in 29 patients but were only necessary for eight patients without alternative treatment. CONCLUSIONS In our study, inappropriate IAT was not associated with a worse prognosis and carbapenems were overused. Extensive delivery of carbapenems proposed by recent guidelines could be reconsidered in the management of these patients.
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Affiliation(s)
- Hugues Georges
- Department of Infectious Diseases and Intensive Care, Chatiliez Hospital, Tourcoing, France -
| | - Adrien Krings
- Department of Infectious Diseases and Intensive Care, Chatiliez Hospital, Tourcoing, France
| | | | - Pierre-Yves Delannoy
- Department of Infectious Diseases and Intensive Care, Chatiliez Hospital, Tourcoing, France
| | - Nicolas Boussekey
- Department of Infectious Diseases and Intensive Care, Chatiliez Hospital, Tourcoing, France
| | - Damien Thellier
- Department of Infectious Diseases and Intensive Care, Chatiliez Hospital, Tourcoing, France
| | - Vanessa Jean-Michel
- Department of Infectious Diseases and Intensive Care, Chatiliez Hospital, Tourcoing, France
| | - Thomas Caulier
- Department of Infectious Diseases and Intensive Care, Chatiliez Hospital, Tourcoing, France
| | - Olivier Leroy
- Department of Infectious Diseases and Intensive Care, Chatiliez Hospital, Tourcoing, France
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Arnal-Couderc M, Fayemendy P, Morin B, Laroumagne G, De Rouvray C, Thellier D, Teissier M, Desport J, Jésus P. Dépistage des troubles du comportement alimentaire à l’aide du SCOFF-F chez 330 patients obèses pris en charge en Limousin. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.410] [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: 10/24/2022]
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Ben Hamou A, Kipnis E, Elbaz A, Bignon A, Nseir S, Tamion F, Du Cheyron D, Jaillette E, Voisin B, Robriquet L, Vanbaelinghem C, Thellier D, Abi Rached H, Jannin A, Duhamel A, Behal H, Machuron F, Espiard S, Preiser JC, Preau S, Pattou F, Jourdain M. Association of transcription factor 7-like 2 gene (TCF7L2) polymorphisms with stress-related hyperglycaemia (SRH) in intensive care and resulting outcomes: The READIAB study. Diabetes Metab 2019; 46:243-247. [PMID: 31121319 DOI: 10.1016/j.diabet.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The study aimed to evaluate the impact of the single nucleotide polymorphism (SNP) rs7903146 on the transcription factor 7-like 2 (TCF7L2) gene in stress-related hyperglycaemia (SRH), defined as blood glucose≥11mmol/L in at least two blood samples during the first 3 days in the intensive care unit (ICU), and on 28-day and 1-year mortality, and incidence of type 2 diabetes (T2D) at 6 months and 1 year in patients hospitalized in the ICU. METHODS This prospective observational (non-interventional) multicentre READIAB study, carried out during 2012-2016 in six French ICUs, involved adult patients admitted to ICUs for at least two organ failures; patients admitted for<48h were excluded. During the 3-day ICU observational period, genetic testing, blood glucose values and insulin treatment were recorded. MAIN RESULTS The association of rs7903146 with SRH was assessed using logistic regression models. Cox proportional hazards regression models assessed the associations between rs7903146 and mortality and between SRH and mortality, both at 28 days and 1 year. A total of 991 of the 1000 enrolled patients were included in the READIAB-G4 cohort, but 242 (24.4%) had preexisting diabetes and were excluded from the analyses. SRH occurred within the first 3 days in the ICU for one-third of the non-diabetes patients. The association between the rs7903146 polymorphism and SRH did not reach significance (P=0.078): OR(peroneTcopy): 1.24, 95% CI: 0.98-1.58. A significant association was found between rs7903146 and 28-day mortality after adjusting for severity scores (P=0.026), but was no longer significant at 1 year (P=0.61). At 28 days, mortality was increased in patients with SRH (HR: 2.09, 95% CI: 1.43-3.06; P<0.001), and remained significant at 1 year after adjusting for severity scores (HR: 1.73, 95% CI: 1.32-2.28; P<0.001). On admission, non-diabetes patients with SRH had a higher incidence of T2D at 6 months vs. those without SRH (16.0% vs. 7.6%, RR: 2.11, 95% CI: 1.07-4.20; P=0.030). At 1 year, these figures were 13.4% vs. 9.2%, RR: 1.45, 95% CI: 0.71-2.96; P=0.31). Moreover, the rs7903146 polymorphism was not significantly associated with T2D development at either 6 months (P=0.72) or 1 year (P=0.64). CONCLUSION This study failed to demonstrate any significant association between rs7903146 and SRH. Nevertheless, the issue remains an important challenge, as SRH may be associated with increased rates of both mortality and T2D development.
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Affiliation(s)
- A Ben Hamou
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France
| | - E Kipnis
- Medical School, université de Lille, 59000 Lille, France; Department of Anesthesiology and Critical care, CHU de Lille, 59000 Lille, France; EA 7366-Host Pathogen Translational Research, université de Lille, 59000 Lille, France
| | - A Elbaz
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - A Bignon
- Department of Anesthesiology and Critical care, CHU de Lille, 59000 Lille, France
| | - S Nseir
- Intensive Care Unit, CHU de Lille, 59000 Lille, France; Medical School, université de Lille, 59000 Lille, France
| | - F Tamion
- Intensive Care Unit, CHU de Rouen, 76031, Rouen, France; UMR 1096 Inserm-Université de Rouen-Biologie, médecine, santé-Endothélium, Valvulopathies et Insuffisance Cardiaque, 76031 Rouen, France
| | - D Du Cheyron
- Intensive Care Unit, CHU de Caen, 14033 Caen, France
| | - E Jaillette
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - B Voisin
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - L Robriquet
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - C Vanbaelinghem
- Intensive Care Unit, Victor Provo Hospital Center, 59100 Roubaix, France
| | - D Thellier
- Intensive Care Unit, Guy Chatiliez Hospital Center, 59200 Tourcoing, France
| | - H Abi Rached
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France
| | - A Jannin
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France
| | - A Duhamel
- Medical School, université de Lille, 59000 Lille, France; EA 2694 - Public Health, Epidemiology and Quality of Care, université de Lille, 59000 Lille, France
| | - H Behal
- EA 2694 - Public Health, Epidemiology and Quality of Care, université de Lille, 59000 Lille, France
| | - F Machuron
- EA 2694 - Public Health, Epidemiology and Quality of Care, université de Lille, 59000 Lille, France
| | - S Espiard
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France; Medical School, université de Lille, 59000 Lille, France
| | - J-C Preiser
- Department of Intensive Care, CUB-Erasme, université Libre de Bruxelles (ULB), Brussels, Belgium
| | - S Preau
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - F Pattou
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France; UMR 1190 Inserm Translational research in diabetes, 59000 Lille, France; EGID European Genomics Institute for Diabetes, CHU de Lille, 59000 Lille, France
| | - M Jourdain
- Intensive Care Unit, CHU de Lille, 59000 Lille, France; Medical School, université de Lille, 59000 Lille, France; PRESAGE Simulation Center, université de Lille, 59000 Lille, France; UMR 1190 Inserm Translational research in diabetes, 59000 Lille, France; EGID European Genomics Institute for Diabetes, CHU de Lille, 59000 Lille, France.
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Gachet B, Elbaz A, Boucher A, Robineau O, Fréalle E, Ajana F, Delannoy PY, Thellier D, Boussekey N, Meybeck A, Senneville E. Acute toxoplasmosis in an immunocompetent traveller to Senegal. J Travel Med 2018; 25:5104383. [PMID: 30247670 DOI: 10.1093/jtm/tay086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 09/19/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Benoit Gachet
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Dron, Tourcoing, France
| | - Alexandre Elbaz
- Service de réanimation et des Maladies Infectieuses, Hôpital Dron, Tourcoing, France
| | - Anne Boucher
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Dron, Tourcoing, France
| | - Olivier Robineau
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Dron, Tourcoing, France
| | - Emilie Fréalle
- Laboratoire de Parasitologie, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Faïza Ajana
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Dron, Tourcoing, France
| | - Pierre-Yves Delannoy
- Service de réanimation et des Maladies Infectieuses, Hôpital Dron, Tourcoing, France
| | - Damien Thellier
- Service de réanimation et des Maladies Infectieuses, Hôpital Dron, Tourcoing, France
| | - Nicolas Boussekey
- Service de réanimation et des Maladies Infectieuses, Hôpital Dron, Tourcoing, France
| | - Agnès Meybeck
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Dron, Tourcoing, France
| | - Eric Senneville
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Dron, Tourcoing, France
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Abstract
Background Lithium poisoning could trigger multiple complications. We report the case of a lithium poisoning with five complications that are described for the first time together. Case report A 60-year-old woman was admitted in our intensive care unit for altered consciousness. Severe lithium intoxication was diagnosed (lithium plasmatic level 8.21 mmol/l) associated with acute oliguric kidney failure. Continuous renal replacement therapy was started immediately. Orotracheal intubation was quickly required because of status epilepticus. Medullary aplasia happened 48 h after the patient was intubated. Infectious and immunological causes were ruled out and lithium poisoning was considered as the most likely etiology. Iterative blood and platelet transfusion were required. Severe polyneuropathy was diagnosed on the 5th day after admission. The patient showed a peripheral tetraparesia and cranial nerve failure while lithium plasmatic level had decreased to a therapeutic level. Conversely, urine output increased and hypernatremia promptly occurred, which led to diabetes insipidus diagnosis. Neuropathy decreased in 72 h and the patient was definitely extubated by the 11th day. Hematologic disturbances decreased and no blood transfusion would be required after the 8th day. The patient would keep sequellas of the poisoning. Thin motricity would still be altered and polyuria would remain. Diffuse alopecia was promptly observed, with no iron deficiency or thyroid disturbance. Conclusion In addition to presenting this case report, we herein discuss the drug causality, the consequences, and the plausible pathophysiology of these five situations.
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Affiliation(s)
- Jeremy Zaworski
- Pierre-Yves Delannoy, Intensive Care Unit, Hôpital Chatiliez, 155 rue du Président Coty, BP 619, 59208 Tourcoing cedex, France
| | - Pierre-Yves Delannoy
- Pierre-Yves Delannoy, Intensive Care Unit, Hôpital Chatiliez, 155 rue du Président Coty, BP 619, 59208 Tourcoing cedex, France
| | - Nicolas Boussekey
- Pierre-Yves Delannoy, Intensive Care Unit, Hôpital Chatiliez, 155 rue du Président Coty, BP 619, 59208 Tourcoing cedex, France
| | - Damien Thellier
- Pierre-Yves Delannoy, Intensive Care Unit, Hôpital Chatiliez, 155 rue du Président Coty, BP 619, 59208 Tourcoing cedex, France
| | - Hugues Georges
- Pierre-Yves Delannoy, Intensive Care Unit, Hôpital Chatiliez, 155 rue du Président Coty, BP 619, 59208 Tourcoing cedex, France
| | - Olivier Leroy
- Pierre-Yves Delannoy, Intensive Care Unit, Hôpital Chatiliez, 155 rue du Président Coty, BP 619, 59208 Tourcoing cedex, France
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Jaillette E, Girault C, Brunin G, Zerimech F, Behal H, Chiche A, Broucqsault-Dedrie C, Fayolle C, Minacori F, Alves I, Barrailler S, Labreuche J, Robriquet L, Tamion F, Delaporte E, Thellier D, Delcourte C, Duhamel A, Nseir S. Impact of tapered-cuff tracheal tube on microaspiration of gastric contents in intubated critically ill patients: a multicenter cluster-randomized cross-over controlled trial. Intensive Care Med 2017; 43:1562-1571. [PMID: 28303301 DOI: 10.1007/s00134-017-4736-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/22/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Studies on the impact of tapered-cuff tracheal tubes on rates of microaspiration and ventilator-associated pneumonia (VAP) in intubated patients have reported conflicting results. The aim of this study was to determine the influence of this shape of tracheal cuff on abundant microaspiration of gastric contents in critically ill patients. METHODS All patients intubated in the intensive care unit (ICU) and requiring mechanical ventilation for at least 48 h were eligible for this multicenter cluster-randomized controlled cross-over open-label study. The primary outcome was abundant microaspiration of gastric contents, defined by the presence of pepsin at significant level in >30% of tracheal aspirates. Quantitative measurement of pepsin and salivary amylase was performed in all tracheal aspirates during the 48 h following enrollment. RESULTS A total of 326 patients were enrolled in the ten participating ICUs (162 in the PVC tapered-cuff group and 164 in the standard-cuff group). Patient characteristics were similar in the two study groups. The proportion of patients with abundant microaspiration of gastric contents was 53.5% in the tapered-cuff and 51.0% in the standard-cuff group (odds ratio 1.14, 95% CI 0.72-1.82). While abundant microaspiration of oropharyngeal secretions was not significantly different (77.4 vs 68.6%, p = 0.095), the proportion of patients with tracheobronchial colonization was significantly lower (29.6 vs 43.3%, p = 0.01) in the tapered-cuff than in the standard-cuff group. No significant difference between the two groups was found for other secondary outcomes, including ventilator-associated events and VAP. CONCLUSIONS This trial showed no significant impact of tapered-cuff tracheal tubes on abundant microaspiration of gastric contents. TRIAL REGISTRATION ClinicalTrials.gov, number NCT01948635.
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Affiliation(s)
| | - Christophe Girault
- Department of Medical Intensive Care, Rouen University Hospital, and UPRES EA 3830-IRIB, Institute for Biomedical Research, Rouen University, Rouen, France
| | - Guillaume Brunin
- CH Dr Duchenne, Réanimation Polyvalente, Allée Jacques Monod, BP 609, 62321, Boulogne-Sur-Mer, France
| | - Farid Zerimech
- CHU de Lille, Pôle de Biologie Pathologie Génétique, Laboratoire de Biochimie et Biologie Moléculaire, 59000, Lille, France
| | - Hélène Behal
- CHU Lille, Clinique de Santé Publique, plateforme d'aide méthodologique, 59037, Lille Cedex, France
| | - Arnaud Chiche
- Réanimation Médicale et Infectieuse, 115 rue du Président Coty, 59208, Tourcoing Cedex, France
| | - Céline Broucqsault-Dedrie
- CH de Roubaix, Réanimation Polyvalente, Hôpital Victor Provo, 17 bd Lacordaire, BP 359, 59056, Roubaix, France
| | - Cyril Fayolle
- CH de Dunkerque, Service de réanimation polyvalente, 130 Avenue Louis Herbeaux BP 6367, 59140, Dunkerque, France
| | - Franck Minacori
- CH Saint Philibert, Réanimation Polyvalente, 115 Rue du Grand But, BP 249, 59462, Lomme Cedex, France
| | - Isabelle Alves
- Réanimation Médicale, CH de Valenciennes, Avenue Desandrouin, BP479, 59322, Valenciennes Cedex, France
| | - Stéphanie Barrailler
- CH Dr Schaffner, Réanimation Polyvalente, 99 route de La Bassée, BP8, 62307, Lens Cedex, France
| | - Julien Labreuche
- CHU Lille, Clinique de Santé Publique, plateforme d'aide méthodologique, 59037, Lille Cedex, France
| | - Laurent Robriquet
- CHU Lille, Critical Care Center, rue E. Laine, 59037, Lille cedex, France
| | - Fabienne Tamion
- Department of Medical Intensive Care, Rouen University Hospital, and UPRES EA 3830-IRIB, Institute for Biomedical Research, Rouen University, Rouen, France
| | - Emmanuel Delaporte
- CH Dr Duchenne, Réanimation Polyvalente, Allée Jacques Monod, BP 609, 62321, Boulogne-Sur-Mer, France
| | - Damien Thellier
- Réanimation Médicale et Infectieuse, 115 rue du Président Coty, 59208, Tourcoing Cedex, France
| | - Claire Delcourte
- CHU Lille, Critical Care Center, rue E. Laine, 59037, Lille cedex, France
| | - Alain Duhamel
- CHU Lille, Clinique de Santé Publique, plateforme d'aide méthodologique, 59037, Lille Cedex, France
| | - Saad Nseir
- CHU Lille, Critical Care Center, rue E. Laine, 59037, Lille cedex, France.
- Lille University, Medical School, 59000, Lille, France.
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Thellier D, Delannoy PY, Robineau O, Meybeck A, Boussekey N, Chiche A, Leroy O, Georges H. Comparison of terminal extubation and terminal weaning as mechanical ventilation withdrawal in ICU patients. Minerva Anestesiol 2016; 83:375-382. [PMID: 27879954 DOI: 10.23736/s0375-9393.16.11468-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Terminal extubation (TE) is applied in some Intensive Care Units (ICU) patients when a decision of withdrawal of mechanical ventilation is decided. Other units prefer terminal weaning (TW) with no removal of the endotracheal tube. We report our experience with these two procedures. METHODS We conducted a retrospective study analyzing patients deceased in our ICU after a decision of life sustained therapy (LST) during the year 2013. TE was proposed to family members for patients presenting with two medical conditions: lack of vasoactive drugs (VAD) and SaO2>95% with a FIO2<50%. TW, defined by the reduction of oxygenation and/or the discontinuation of VAD, was proposed for patients receiving a FIO2≥50% and/or VAD. The two procedures were performed after obtaining a Cambridge Score-5 with sedatives. RESULTS Sixty eight patients died after withdrawal of LST. TE was performed for 22 patients and TW for 46. There was no difference in mean age, mean length of ICU stay, cause of ICU admission and dose of sedatives used during withdrawal procedure between the two groups. All family members approved the decision of TE. In this group, family members of each patient were present in ICU room at time of death, while they were present at this moment for 32 (69.5%) patients with TW. CONCLUSIONS In our Unit, TE is a practice largely approved by family members. This procedure does not require higher doses of sedatives and allows the nearest relatives to be present at time of death.
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Affiliation(s)
| | | | | | - Agnès Meybeck
- Intensive Care Unit, Chatiliez Hospital, Tourcoing, France
| | | | - Arnaud Chiche
- Intensive Care Unit, Chatiliez Hospital, Tourcoing, France
| | - Olivier Leroy
- Intensive Care Unit, Chatiliez Hospital, Tourcoing, France
| | - Hugues Georges
- Intensive Care Unit, Chatiliez Hospital, Tourcoing, France -
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Leroy O, Georges H, Devos P, Bitton S, De Sa N, Dedrie C, Beague S, Ducq P, Boulle-Geronimi C, Thellier D, Saulnier F, Preau S. Infective endocarditis requiring ICU admission: epidemiology and prognosis. Ann Intensive Care 2015; 5:45. [PMID: 26621197 PMCID: PMC4666184 DOI: 10.1186/s13613-015-0091-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 09/22/2015] [Accepted: 11/17/2015] [Indexed: 01/22/2023] Open
Abstract
Background Very few studies focused on patients with severe infective endocarditis (IE) and multiple complications leading to Intensive Care Unit (ICU) admission. Studied primary outcomes depended on the series and multiple prognostic factors have been identified. Our goal was to determinate characteristics of patients, in-hospital mortality and independent prognostic factors in an overall population of patients admitted to ICU for a left-sided, definite, active and severe IE. Methods Retrospective study performed in 9 ICUs during an 11-year period. Results Data of 248 patients (mean age = 62.4 ± 13.3 years; 63.7 % male) were studied. Native and prosthetic valves were involved in 195 and 53 patients, respectively. Causative pathogens, identified in 225 patients, were mainly streptococci (45.6 %) and staphylococci (43.4 %). On ICU admission, 127 patients exhibited extra-cardiac involvement. Ninety-five patients had one or more neurological complications, as followed: ischemic stroke (n = 66), cerebral hemorrhage (n = 31), meningitis (n = 16), brain abscess (n = 16), and intracranial mycotic aneurysm (n = 10). Criteria prompting to cardiac surgery appeared during ICU stay for 186 patients and between ICU and hospital discharges in 5 patients. Due to contra-indications, surgery required by IE was only performed during hospitalization in 125 patients. Moreover, surgery was considered adequate according to usual guidelines in 76 of 191 patients with indication(s) of valvular surgery: for patients with surgical procedure considered as emergency (n = 69), 17 surgical procedures underwent within the first 24 h following indication; for patients with urgent surgical indication (n = 102), surgery was performed during the first week following indication in 40 patients; finally, elective surgery (n = 20) was performed for 19 patients. During hospitalization, 103 (41.5 %) patients died. Four independent prognostic factors were identified: SAPS II > 35 (AOR = 2.604; 95 % CI: 1.320–5.136; p = 0.0058), SOFA > 8 (AOR = 3.327; 95 % CI: 1.697–6.521; p = 0.0005), IE due to methicillin resistant Staphylococcus aureus (AOR = 4.981; 95 %CI = 1.433–17.306; p = 0.0115) and native IE (AOR = 0.345; 95 % CI: 0.169–0.703; p = 0.0034). Conclusions Mortality in patients admitted to ICU for left-sided IE remains high, especially in cases of endocarditis due to methicillin resistant Staphylococcus aureus, when organ failures occur and ICU scores are high.
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Affiliation(s)
- Olivier Leroy
- Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Chatiliez, 135 rue du Président Coty, Tourcoing, 59200, France.
| | - Hugues Georges
- Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Chatiliez, 135 rue du Président Coty, Tourcoing, 59200, France.
| | - Patrick Devos
- Département de bio statistique, CHU de Lille, 59037, Lille Cedex, France.
| | - Steve Bitton
- Pôle de Réanimation, Hôpital R. Salengro, CHU de Lille, Avenue du Professeur E. Laine, 59037, Lille Cedex, France.
| | - Nathalie De Sa
- Service de Réanimation Polyvalente, Centre Hospitalier Jean Bernard, Avenue Désandrouin, 59322, Valenciennes Cedex, France.
| | - Céline Dedrie
- Service de Réanimation Polyvalente, Hôpital Victor Provost, Rue de Barbieux, 59056, Roubaix Cedex, France.
| | - Sébastien Beague
- Service de Réanimation Polyvalente, Centre Hospitalier de Dunkerque, Avenue Louis Herbeaux, 59385, Dunkirk, France.
| | - Pierre Ducq
- Service de Réanimation Polyvalente, Centre Hospitalier de Boulogne-sur-Mer, Allée Jacques Monod, 62321, Boulogne-Sur-Mer Cedex, France.
| | - Claire Boulle-Geronimi
- Service de Réanimation Polyvalente, Centre Hospitalier de Douai, Route de Cambrai, 59507, Douai Cedex, France.
| | - Damien Thellier
- Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Chatiliez, 135 rue du Président Coty, Tourcoing, 59200, France.
| | - Fabienne Saulnier
- Pôle de Réanimation, Hôpital R. Salengro, CHU de Lille, Avenue du Professeur E. Laine, 59037, Lille Cedex, France.
| | - Sebastien Preau
- Pôle de Réanimation, Hôpital R. Salengro, CHU de Lille, Avenue du Professeur E. Laine, 59037, Lille Cedex, France.
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Jaillette E, Brunin G, Girault C, Zerimech F, Chiche A, Broucqsault-Dedrie C, Fayolle C, Minacori F, Alves I, Barrailler S, Robriquet L, Tamion F, Delaporte E, Thellier D, Delcourte C, Duhamel A, Nseir S. Impact of tracheal cuff shape on microaspiration of gastric contents in intubated critically ill patients: study protocol for a randomized controlled trial. Trials 2015; 16:429. [PMID: 26407612 PMCID: PMC4583738 DOI: 10.1186/s13063-015-0955-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/11/2015] [Indexed: 12/01/2022] Open
Abstract
Background Ventilator-associated pneumonia (VAP) is the most common infection in intubated critically ill patients. Microaspiration of the contaminated gastric and oropharyngeal secretions is the main mechanism involved in the pathophysiology of VAP. Tracheal cuff plays an important role in stopping the progression of contaminated secretions into the lower respiratory tract. Previous in vitro studies suggested that conical cuff shape might be helpful in improving tracheal sealing. However, clinical studies found conflicting results. The aim of this study is to determine the impact of conical tracheal cuff shape on the microaspiration of gastric contents in critically ill patients. Methods/Design This prospective cluster randomized controlled crossover open-label trial is currently being conducted in ten French intensive care units (ICUs). Patients are allocated to intubation with a polyvinyl chloride (PVC) standard (barrel)-shaped or a PVC conical-shaped tracheal tube. The primary objective is to determine the impact of the conical shaped tracheal cuff on abundant microaspiration of gastric contents. Secondary outcomes include the incidence of microaspiration of oropharyngeal secretions, tracheobronchial colonization, VAP and ventilator-associated events. Abundant microaspiration is defined as the presence of pepsin at significant level (>200 ng/ml) in at least 30 % of the tracheal aspirates. Pepsin and amylase are quantitatively measured in all tracheal aspirates during the 48 h following inclusion. Quantitative tracheal aspirate culture is performed at inclusion and twice weekly. We plan to recruit 312 patients in the participating ICUs. Discussion BEST Cuff is the first randomized controlled study evaluating the impact of PVC tracheal-cuff shape on gastric microaspirations in patients receiving invasive mechanical ventilation. Enrollment began in June 2014 and is expected to end in October 2015. Trial registration ClinicalTrials.gov Identifier: NCT01948635 (registered 31 August 2013).
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Affiliation(s)
- Emmanuelle Jaillette
- Critical Care Center, University Hospital of Lille, rue E. Laine, 59037, Lille Cedex, France.
| | - Guillaume Brunin
- Réanimation Polyvalente, CH Dr Duchenne, allée Jacques Monod, BP 609, 62321, Boulogne-Sur-Mer, France.
| | - Christophe Girault
- Réanimation Médicale, Hôpital C. Nicolle, 1 rue de Germont, 76031, Rouen Cedex, France.
| | - Farid Zerimech
- Laboratoire de Biochimie et Biologie Moléculaire, Université de Lille et Pôle de Biologie Pathologie Génétique du CHRU de Lille, 59000, Lille, France.
| | - Arnaud Chiche
- Réanimation Médicale et Infectieuse, CH de Tourcoing, 115 rue du Président Coty, 59208, Tourcoing Cedex, France.
| | | | - Cyril Fayolle
- Service de réanimation polyvalente, 130 Avenue Louis Herbeaux BP 6367, 59140, Dunkerque, France.
| | - Franck Minacori
- Réanimation Polyvalente, CH Saint Philibert, 115 Rue du Grand But, BP 249, 59462, Lomme Cedex, France.
| | - Isabelle Alves
- Réanimation Médicale, CH de Valenciennes, Avenue Desandrouin, BP479, 59322, Valenciennes Cedex, France.
| | - Stephanie Barrailler
- Réanimation Polyvalente, CH Dr Schaffner, 99 route de La Bassée, BP8, 62307, Lens Cedex, France.
| | - Laurent Robriquet
- Critical Care Center, University Hospital of Lille, rue E. Laine, 59037, Lille Cedex, France.
| | - Fabienne Tamion
- Réanimation Médicale, Hôpital C. Nicolle, 1 rue de Germont, 76031, Rouen Cedex, France.
| | - Emmanuel Delaporte
- Réanimation Polyvalente, CH Dr Duchenne, allée Jacques Monod, BP 609, 62321, Boulogne-Sur-Mer, France.
| | - Damien Thellier
- Réanimation Médicale et Infectieuse, CH de Tourcoing, 115 rue du Président Coty, 59208, Tourcoing Cedex, France.
| | - Claire Delcourte
- Critical Care Center, University Hospital of Lille, rue E. Laine, 59037, Lille Cedex, France.
| | - Alain Duhamel
- Clinique de Santé Publique, plateforme d'aide méthodologique, 59037, Lille Cedex, France.
| | - Saad Nseir
- Critical Care Center, University Hospital of Lille, rue E. Laine, 59037, Lille Cedex, France. .,Medical School, Lille University, 1 place de Verdun, 59000, Lille, France.
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Georges H, Alfandari S, Gois J, Thellier D, Leroy O. Doit-on utiliser la décontamination cutanée par la chlorhexidine en réanimation ? Réanimation 2014. [DOI: 10.1007/s13546-014-0853-5] [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: 11/29/2022]
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Thellier D, Moos F, Richard P, Stoeckel ME. Evidence for reciprocal connections between the dorsochiasmatic area and the hypothalamo neurohypophyseal system and some related extrahypothalamic structures. Brain Res Bull 1994; 35:311-22. [PMID: 7850480 DOI: 10.1016/0361-9230(94)90107-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [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: 01/27/2023]
Abstract
In the preceding article, a dorsochiasmatic area (DCh) was described that projects to both paraventricular (PVN) and supraoptic (SON) nuclei. The main afferents of the DCh, revealed by local injections of retrograde tracers, are the hypothalamic PVN and SON, lateral septal nuclei (LSV and SHy), bed nuclei of the stria terminalis (BST), anteroventral third ventricle region, particularly the median preoptic nucleus (MnPO), the subfornical organ, medial preoptic areas, arcuate hypothalamic nucleus, ventromedial hypothalamic nuclei, paraventricular thalamic nucleus, and, more caudally, several structures of the posterior hypothalamus and mesencephalon. The relations between DCh and BST, LSV, SHy, or MnPO appeared reciprocal. In view of their reciprocal relationships with the hypothalamo-neurohypophyseal system and some of their related extrahypothalamic structures, the DCh might be involved in the regulation of the vasopressin (AVP) and/or oxytocin (OT) systems, or in reproductive behavior.
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Affiliation(s)
- D Thellier
- Laboratoire de Physiologie, Université Louis Pasteur, URA CNRS 1446, Strasbourg, France
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Thellier D, Moos F, Richard P, Stoeckel ME. Evidence for connections between a discrete hypothalamic dorsochiasmatic area and the supraoptic and paraventricular nuclei. Brain Res Bull 1994; 34:261-74. [PMID: 7519964 DOI: 10.1016/0361-9230(94)90063-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [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: 01/25/2023]
Abstract
In order to check the existence of direct or indirect connections between the hypothalamic supraoptic (SON) and paraventricular (PVN) nuclei, four retrograde traces were iontophoretically injected into these nuclei. The small injection sites were restricted to parts of the SON and PVN, enabling the identification of afferent neurons localized in their immediate vicinity. The tracer injections into any of these hypothalamic nuclei resulted in conspicuous labeling of cells gathered dorsally to the optic chiasma and the optic tract. This neuronal population was tentatively called dorsochiasmatic area. Double retrograde tracers injections into the ipsilateral SON and PVN gave evidence for some neurons containing both tracers in this dorsochiasmatic area. Otherwise, labeled parvocellular neurons were occasionally found in one PVN, after injecting retrograde tracer into either the ipsilateral SON or the contralateral PVN. As few connections exist between the four magnocellular nuclei, the dorsochiasmatic area connected with both the ipsilateral SON and PVN could play an important role in regulating the oxytocin and/or vasopressin systems.
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Affiliation(s)
- D Thellier
- Laboratoire de Physiologie, Université Louis Pasteur, URA CNRS 1446, Strasbourg, France
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