1
|
Truan D, Viglino D, Debaty G, Laramas M, Thi Hong VN, Bailly S, Toffart AC. Relationship between cancer status and medical response by an emergency dispatch center: From a French SAMU database. Bull Cancer 2024; 111:452-462. [PMID: 38553288 DOI: 10.1016/j.bulcan.2024.02.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/16/2024] [Accepted: 02/01/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE In many countries, the first line response to an emergency call is decided by the emergency dispatch center EMS clinician. Our main objective was to compare the pre-hospital response to calls received from cancer and non-cancer patients. We also compared the reasons for calling, for each group. METHODS We conducted a retrospective cohort study of data collected between January 1, 2016 and December 31, 2020, from emergency dispatch center records of the Isère county, France. Statistical tests were conducted after matching one cancer patient with two non-cancer patients, resulting in a cohort of 44,022 patients. We used multivariate logistic regression to determine the impact of patient cancer status on the medical decision taken in response to the emergency call. RESULTS Overall, data on 849,110 patients were extracted, including 16,451 patients with a diagnosis of cancer and 29,348 non-cancer patients. In the matched cohort, cancer was associated with a higher odd of having a mobile intensive care unit (MICU) [odds ratio (OR)=2.02 (1.81-2.26), p<0.001] or an ambulance being dispatched to the patient's home or other location [OR=2.36 (2.24-2.48), p<0.001]. The two most frequent medical responses were to send an ambulance (58.6%) and giving advice only (36.8%). The five main reasons for the emergency call for the cancer group were cardiovascular disease symptoms (13.5%), respiratory problems (10.6%), digestive disorders (10.4%), infections (8.9%) and neurological disorders (6.0%). CONCLUSION An MICU or an ambulance was more often dispatched for cancer patients than for others. Considering that cancer is a very frequent comorbidity in Western countries, knowledge of the patient's cancer status should be sought and taken into consideration when a patient seeks emergency help.
Collapse
Affiliation(s)
- Déborah Truan
- Grenoble-Alpes University Hospital, Emergency Department and Mobile Intensive Care Unit, Grenoble, France; Grenoble Alpes University, HP2 Laboratory, INSERM 1300, Grenoble, France.
| | - Damien Viglino
- Grenoble-Alpes University Hospital, Emergency Department and Mobile Intensive Care Unit, Grenoble, France; Grenoble Alpes University, HP2 Laboratory, INSERM 1300, Grenoble, France
| | - Guillaume Debaty
- Grenoble-Alpes University Hospital, Emergency Department and Mobile Intensive Care Unit, Grenoble, France; Grenoble Alpes University, CNRS TIMC Laboratory, UMR 5525, Grenoble, France
| | - Mathieu Laramas
- University Hospital of Grenoble Alpes, Cancer and Blood Diseases Unit, Grenoble, France
| | - Van Ngo Thi Hong
- Grenoble Alpes University, HP2 Laboratory, INSERM 1300, Grenoble, France
| | - Sébastien Bailly
- Grenoble Alpes University, HP2 Laboratory, INSERM 1300, Grenoble, France
| | - Anne Claire Toffart
- Institute for advanced bioscience, Grenoble-Alpes University Hospital, INSERM U1209/CNRS 5309, Grenoble, France; Grenoble-Alpes University Hospital, Pneumology and Physiology Unit, Grenoble, France
| |
Collapse
|
2
|
Douillet D, Penaloza A, Viglino D, Banihachemi JJ, Abboodi A, Helderlé M, Montassier E, Balen F, Brice C, Laribi S, Duchenoy T, Vives P, Soulat L, Marjanovic N, Moumneh T, Savary D, Riou J, Roy PM. Targeted prophylactic anticoagulation based on the TRiP(cast) score in patients with lower limb immobilisation: a multicentre, stepped wedge, randomised implementation trial. Lancet 2024; 403:1051-1060. [PMID: 38368901 DOI: 10.1016/s0140-6736(23)02369-3] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Prophylactic anticoagulation in emergency department patients with lower limb trauma requiring immobilisation is controversial. The Thrombosis Risk Prediction for Patients with Cast Immobilisation-TRiP(cast)-score could identify a large subgroup of patients at low risk of venous thromboembolism for whom prophylactic anticoagulation can be safely withheld. We aimed to prospectively assess the safety of withholding anticoagulation for patients with lower limb trauma at low risk of venous thromboembolism, defined by a TRiP(cast) score of less than 7. METHODS CASTING was a stepped-wedge, multicentre, cluster-randomised trial with blinded outcome assessment. 15 emergency departments in France and Belgium were selected and randomly assigned staggered start dates for switching from the control phase (ie, anticoagulation prescription according to the physician's usual practice) to the intervention phase (ie, targeted anticoagulation according to TRiP(cast) score: no prescription if score <7 and anticoagulation if score was ≥7). Patients were included if they presented to a participating emergency department with lower limb trauma requiring immobilisation for at least 7 days and were aged 18 years or older. The primary outcome was the 3-month cumulative rate of symptomatic venous thromboembolism during the intervention phase in patients with a TRiP(cast) score of less than 7. The targeted strategy was considered safe if this rate was less than 1% with an upper 95% CI of less than 2%. The primary analysis was performed in the intention-to-treat population. This study is registered at ClinicalTrials.gov (NCT04064489). FINDINGS Between June 16, 2020, and Sept 15, 2021, 15 clusters and 2120 patients were included. Of the 1505 patients analysed in the intervention phase, 1159 (77·0%) had a TRiP(cast) score of less than 7 and did not receive anticoagulant treatment. The symptomatic venous thromboembolism rate was 0·7% (95% CI 0·3-1·4, n=8/1159). There was no difference between the control and the intervention phases in the cumulative rate of symptomatic venous thromboembolism or in bleeding rates. INTERPRETATION Patients with a TRiP(cast) score of less than 7 who are not receiving anticoagulation have a very low risk of venous thromboembolism. A large proportion of patients with lower limb trauma and immobilisation could safely avoid thromboprophylaxis. FUNDING French Ministry of Health.
Collapse
Affiliation(s)
- Delphine Douillet
- Emergency Department, Health Faculty, Angers University Hospital, Angers, France; UMR MitoVasc CNRS 6015 - INSERM 1083, Equipe CARME, UNIV Angers, Angers, France; F-CRIN INNOVTE Network, Saint-Etienne, France.
| | - Andrea Penaloza
- F-CRIN INNOVTE Network, Saint-Etienne, France; Emergency Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Damien Viglino
- Emergency Department, University Hospital of Grenoble Alpes, University Grenoble-Alpes, Grenoble, France; HP2 Laboratory, Grenoble Alpes University, INSERM U1300, Grenoble, France
| | - Jean-Jacques Banihachemi
- Department of Trauma and Musculo-Skeletal Emergency, University Hospital and Medical Centre of Grenoble-Alpes Hospital South, Grenoble, France
| | - Anmar Abboodi
- Emergency Department, Cholet Hospital, Cholet, France
| | | | - Emmanuel Montassier
- Emergency Department, Nantes University Hospital, Nantes, France; MiHAR Laboratary, EE1701, University of Nantes, Nantes, France
| | - Fréderic Balen
- Department of Emergency Medicine, Toulouse University Hospital, Toulouse, France
| | - Christian Brice
- Emergency Department, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, France
| | - Saïd Laribi
- Emergency Department, Tours University Hospital, Tours, France
| | | | | | - Louis Soulat
- Emergency Department, Rennes University Hospital, Rennes, France
| | | | - Thomas Moumneh
- Emergency Department, Health Faculty, Angers University Hospital, Angers, France; F-CRIN INNOVTE Network, Saint-Etienne, France
| | - Dominique Savary
- Emergency Department, Health Faculty, Angers University Hospital, Angers, France
| | - Jérémie Riou
- Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, Angers, France
| | - Pierre-Marie Roy
- Emergency Department, Health Faculty, Angers University Hospital, Angers, France; UMR MitoVasc CNRS 6015 - INSERM 1083, Equipe CARME, UNIV Angers, Angers, France; F-CRIN INNOVTE Network, Saint-Etienne, France
| |
Collapse
|
3
|
Freund Y, Viglino D, Cachanado M, Cassard C, Montassier E, Douay B, Guenezan J, Le Borgne P, Yordanov Y, Severin A, Roussel M, Daniel M, Marteau A, Peschanski N, Teissandier D, Macrez R, Morere J, Chouihed T, Roux D, Adnet F, Bloom B, Chauvin A, Simon T. Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning: A Randomized Clinical Trial. JAMA 2023; 330:2267-2274. [PMID: 38019968 PMCID: PMC10687712 DOI: 10.1001/jama.2023.24391] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023]
Abstract
Importance Tracheal intubation is recommended for coma patients and those with severe brain injury, but its use in patients with decreased levels of consciousness from acute poisoning is uncertain. Objective To determine the effect of intubation withholding vs routine practice on clinical outcomes of comatose patients with acute poisoning and a Glasgow Coma Scale score less than 9. Design, Setting, and Participants This was a multicenter, randomized trial conducted in 20 emergency departments and 1 intensive care unit (ICU) that included comatose patients with suspected acute poisoning and a Glasgow Coma Scale score less than 9 in France between May 16, 2021, and April 12, 2023, and followed up until May 12, 2023. Intervention Patients were randomized to undergo conservative airway strategy of intubation withholding vs routine practice. Main Outcomes and Measures The primary outcome was a hierarchical composite end point of in-hospital death, length of ICU stay, and length of hospital stay. Key secondary outcomes included adverse events resulting from intubation as well as pneumonia within 48 hours. Results Among the 225 included patients (mean age, 33 years; 38% female), 116 were in the intervention group and 109 in the control group, with respective proportions of intubations of 16% and 58%. No patients died during the in-hospital stay. There was a significant clinical benefit for the primary end point in the intervention group, with a win ratio of 1.85 (95% CI, 1.33 to 2.58). In the intervention group, there was a lower proportion with any adverse event (6% vs 14.7%; absolute risk difference, 8.6% [95% CI, -16.6% to -0.7%]) compared with the control group, and pneumonia occurred in 8 (6.9%) and 16 (14.7%) patients, respectively (absolute risk difference, -7.8% [95% CI, -15.9% to 0.3%]). Conclusions and Relevance Among comatose patients with suspected acute poisoning, a conservative strategy of withholding intubation was associated with a greater clinical benefit for the composite end point of in-hospital death, length of ICU stay, and length of hospital stay. Trial Registration ClinicalTrials.gov Identifier: NCT04653597.
Collapse
Affiliation(s)
- Yonathan Freund
- Sorbonne Université, IMProving Emergency Care FHU, Paris, France
- Emergency Department and Service Mobile d’Urgence et de Réanimation (SMUR), Hôpital Pitié-Salpêtrière, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
| | - Damien Viglino
- Emergency Department, Grenoble-Alpes University Hospital, and University Grenoble-Alpes, HP2 Laboratory INSERM U 1300, Grenoble, France
| | - Marine Cachanado
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East, AP-HP, Sorbonne University, St Antoine Hospital, Paris, France
| | - Clémentine Cassard
- Emergency Department and Service Mobile d’Urgence et de Réanimation (SMUR), Hôpital Pitié-Salpêtrière, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
| | - Emmanuel Montassier
- Emergency Department and SMUR, Nantes Université, CHU Nantes, INSERM UMR 1064, Nantes, France
| | - Bénedicte Douay
- Emergency Department and SMUR, Hôpital Beaujon AP-HP, Clichy, France
| | - Jérémy Guenezan
- Emergency Department, University Hospital of Poitiers, Poitiers, France
| | - Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France and INSERM UMR 1260, Regenerative NanoMedicine, Fédération de Médecine Translationnelle, University of Strasbourg, Strasbourg, France
| | - Youri Yordanov
- Sorbonne Université, IMProving Emergency Care FHU, Paris, France
- Emergency Department, Hôpital Saint Antoine AP-HP, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
| | - Armelle Severin
- SAMU 92–SMUR Raymond Poincaré, Raymond Poincaré Hospital, AP-HP, Paris, France
| | - Mélanie Roussel
- Emergency Department, Univ Rouen Normandie, CHU Rouen, Rouen, France
| | - Matthieu Daniel
- Emergency Department, SAMU-SMUR et Secours en Milieu Périlleux, CHU de La Réunion Site Nord Félix Guyon, La Réunion, France
| | - Adrien Marteau
- Emergency Department, Centre Hospitalier Universitaire Sud Réunion, Saint Pierre, La Réunion, France
| | - Nicolas Peschanski
- Emergency Department and SAMU35-SMUR, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes, Rennes, France
| | - Dorian Teissandier
- Emergency Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, INRAE, UNH, Clermont-Ferrand, France
| | - Richard Macrez
- Emergency Department, University hospital of Caen, UNICAEN, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Institut Blood and Brain Normandie University, Caen, France
| | - Julia Morere
- Emergency Department and SMUR, Hôpital Edouard Herriot, Lyon, France
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, INSERM, UMR_S 1116, University Hospital of Nancy, Nancy, France
| | - Damien Roux
- Université Paris Cité, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, Colombes, France
| | - Frédéric Adnet
- Emergency Department and Service Mobile d’Urgence et de Réanimation SMUR, Hôpital Avicenne, AP-HP, Bobigny, France
| | - Ben Bloom
- Emergency Department, Royal London Hospital, London, United Kingdom
| | - Anthony Chauvin
- Emergency Department, Hôpital Lariboisiere AP-HP, Paris, France and INSERM U942 MASCOT, University of Paris, Paris, France
| | - Tabassome Simon
- Sorbonne Université, IMProving Emergency Care FHU, Paris, France
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East, AP-HP, Sorbonne University, St Antoine Hospital, Paris, France
| |
Collapse
|
4
|
Gil-Jardiné C, Payen JF, Bernard R, Bobbia X, Bouzat P, Catoire P, Chauvin A, Claessens YE, Douay B, Dubucs X, Galanaud D, Gauss T, Gauvrit JY, Geeraerts T, Glize B, Goddet S, Godier A, Le Borgne P, Rousseau G, Sapin V, Velly L, Viglino D, Vigue B, Cuvillon P, Frasca D, Claret PG. Management of patients suffering from mild traumatic brain injury 2023. Anaesth Crit Care Pain Med 2023; 42:101260. [PMID: 37285919 DOI: 10.1016/j.accpm.2023.101260] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 06/09/2023]
Abstract
OBJECTIVE To develop a multidisciplinary French reference that addresses initial pre- and in-hospital management of a mild traumatic brain injury patient. DESIGN A panel of 22 experts was formed on request from the French Society of Emergency Medicine (SFMU) and the French Society of Anaesthesiology and Critical Care Medicine (SFAR). A policy of declaration and monitoring of links of interest was applied and respected throughout the process of producing the guidelines. Similarly, no funding was received from any company marketing a health product (drug or medical device). The expert panel had to respect and follow the Grade® (Grading of Recommendations Assessment, Development and Evaluation) methodology to evaluate the quality of the evidence on which the recommendations were based. Given the impossibility of obtaining a high level of evidence for most of the recommendations, it was decided to adopt a "Recommendations for Professional Practice" (RPP) format, rather than a Formalized Expert Recommendation (FER) format, and to formulate the recommendations using the terminology of the SFMU and SFAR Guidelines. METHODS Three fields were defined: 1) pre-hospital assessment, 2) emergency room management, and 3) emergency room discharge modalities. The group assessed 11 questions related to mild traumatic brain injury. Each question was formulated using a PICO (Patients Intervention Comparison Outcome) format. RESULTS The experts' synthesis work and the application of the GRADE® method resulted in the formulation of 14 recommendations. After two rounds of rating, strong agreement was obtained for all recommendations. For one question, no recommendation could be made. CONCLUSION There was strong agreement among the experts on important, transdisciplinary recommendations, the purpose of which is to improve management practices for patients with mild head injury.
Collapse
Affiliation(s)
- Cédric Gil-Jardiné
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, Service des Urgences-Adultes, Population Health, INSERM U1219, équipe aHeAD, Université de Bordeaux, Bordeaux, France.
| | - Jean-François Payen
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000 Grenoble, France
| | - Rémy Bernard
- Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Xavier Bobbia
- Montpellier University, UR UM 103 (IMAGINE), Department of Emergency Medicine, CHU Montpellier, Montpellier, France
| | - Pierre Bouzat
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000 Grenoble, France
| | - Pierre Catoire
- Emergency Consultant, Academic Clinical Fellow (Pitié-Salpétrière University, General Emergency Department, Paris) - Tactical Ultrasound Course for Ukraine (TUSC-UA) Course Director - Mehad, France
| | - Anthony Chauvin
- Service d'Accueil des Urgences/SMUR, CHU Lariboisière, Université de Paris - Inserm U942 MASCOT, Université de Paris, Paris, France
| | - Yann-Erick Claessens
- Département de Médecine d'urgence, Centre Hospitalier Princesse Grace, Avenue Pasteur, MC-98002, Monaco
| | - Bénédicte Douay
- SMUR/Service des Urgences, Hôpital Beaujon, AP-HP Nord, Clichy, France
| | - Xavier Dubucs
- Emergency Departement, Centre Hospitalo-Universitaire de Toulouse, Place du Docteur Baylac, 31300 Toulouse, France
| | - Damien Galanaud
- Service de Neuroradiologie, GH Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Tobias Gauss
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000 Grenoble, France
| | - Jean-Yves Gauvrit
- Service de Neuroradiologie, Hôpital Pontchaillou, CHU Rennes, Rennes, France
| | - Thomas Geeraerts
- Pole Anesthesie Réanimation et INSERM Tonic, CHU de Toulouse et Universite Toulouse 3, Toulouse, France
| | - Bertrand Glize
- PMR Department, CHU de Bordeaux, ACTIVE Team, BPH INSERM U1219, University of Bordeaux, France
| | - Sybille Goddet
- Samu-21, CHU de Dijon, SAU-Smur, CH du Creusot, Dijon, France
| | - Anne Godier
- Université Paris Cité, APHP, Hôpital Européen Georges Pompidou, Service d'anesthésie Réanimation and Inserm UMRS_1140, Paris, France
| | - Pierrick Le Borgne
- Emergency Department, University Hospitals of Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France - INSERM UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), Faculté de Médecine, Université de Strasbourg, 4 rue Kirschleger, 67085 Strasbourg Cedex, France
| | | | - Vincent Sapin
- Service de Biochimie et de Génétique Moléculaire, Centre de Biologie, CHU de Clermont-Ferrand, France
| | - Lionel Velly
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Damien Viglino
- University Grenoble-Alpes, Emergency Department, CHU Grenoble-Alpes, Grenoble, France - HP2 Laboratory INSERM U1300, Grenoble, France
| | - Bernard Vigue
- Département d'Anesthésie Réanimation, Hôpital Universitaire de Bicêtre, Le Kremlin Bicêtre, France
| | - Philippe Cuvillon
- EA 2992 IMAGINE, Prévention et Prise en Charge de la Défaillance Circulatoire des Patients en état de Choc, Anaesthesiology Department, CHU Nîmes, University Montpellier, 30000 Nîmes, France
| | - Denis Frasca
- Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France, Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France, INSERM U1246, Methods in Patients-Centered Outcomes and Health Research - SPHERE, Nantes, France
| | | |
Collapse
|
5
|
Vézina FA, Bouchard PA, Breton-Gagnon É, Dion G, Viglino D, Roy P, Bilodeau L, Provencher S, Denault MH, Saey D, Lellouche F, Maltais F. Automated O 2 Titration Alone or With High-Flow Nasal Cannula During Walking Exercise in Chronic Lung Diseases. Respir Care 2023; 69:respcare.10810. [PMID: 37491073 PMCID: PMC10753602 DOI: 10.4187/respcare.10810] [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] [Indexed: 07/27/2023]
Abstract
BACKGROUND Exercise-induced O2 desaturation contributes to dyspnea and exercise intolerance in various respiratory diseases. This study assessed whether automated O2 titration was superior to fixed-flow O2 to improve exertional dyspnea and walking exercise endurance. We also aimed at evaluating possible additive effects of high-flow nasal cannula coupled with automated O2 titration on these outcomes. METHODS Subjects with chronic respiratory diseases and exercise-induced desaturation performed a 3-min constant-speed shuttle test (CSST) and an endurance shuttle walking test (ESWT) with either (1) fixed-flow O2, (2) automated O2 titration targeting an SpO2 of 94% (± 2%), and (3) automated O2 titration + high-flow nasal cannula according to a randomized sequence. The main outcome was Borg dyspnea score at the end of the 3-min CSST. Secondary outcomes included endurance time and dyspnea during ESWT and oxygenation status during exercise. RESULTS Ten subjects with COPD, 10 with interstitial lung disease, 5 with pulmonary hypertension, and 3 with cystic fibrosis completed the study. Compared to fixed-flow O2, automated O2 titration did not reduce dyspnea at the end of the 3-min CSST. Endurance time during the ESWT was prolonged with automated O2 titration (mean difference 298 [95% CI 205-391] s, P < .001), and dyspnea at isotime was reduced. No further improvement was noted when high-flow nasal cannula was added to automated O2 titration. Compared to fixed-flow O2, O2 flows were higher with automated O2 titration, resulting in better oxygenation. CONCLUSIONS Automated O2 titration was superior to fixed-flow O2 to alleviate dyspnea and improve exercise endurance during the ESWT in subjects with a variety of chronic respiratory diseases. Adding high-flow nasal cannula to automated O2 titration provided no further benefits.
Collapse
Affiliation(s)
- Felix-Antoine Vézina
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; and Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec City, Québec, Canada
| | - Pierre-Alexandre Bouchard
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Émilie Breton-Gagnon
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Geneviève Dion
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Damien Viglino
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; and Université Grenoble Alpes, Laboratoire Hypoxie-Physiopathologie HP2 INSERM U1300, Grenoble, France
| | - Pascalin Roy
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Lara Bilodeau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Steeve Provencher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Marie-Hélène Denault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Didier Saey
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - François Lellouche
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada.
| |
Collapse
|
6
|
Lagares A, Payen JF, Biberthaler P, Poca MA, Méjan O, Pavlov V, Viglino D, Sapin V, Lassaletta A, de la Cruz J. Study protocol for investigating the clinical performance of an automated blood test for glial fibrillary acidic protein and ubiquitin carboxy-terminal hydrolase L1 blood concentrations in elderly patients with mild traumatic BRAIN Injury and reference values (BRAINI-2 Elderly European study): a prospective multicentre observational study. BMJ Open 2023; 13:e071467. [PMID: 37460257 DOI: 10.1136/bmjopen-2022-071467] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Two blood brain-derived biomarkers, glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), can rule out intracranial lesions in patients with mild traumatic brain injury (mTBI) when assessed within the first 12 hours. Most elderly patients were excluded from previous studies due to comorbidities. Biomarker use in elderly population could be affected by increased basal levels. This study will assess the performance of an automated test for measuring serum GFAP and UCH-L1 in elderly patients to predict the absence of intracranial lesions on head CT scans after mTBI, and determine both biomarkers reference values in a non-TBI elderly population. METHODS AND ANALYSIS This is a prospective multicentre observational study on elderly patients (≥65 years) that will be performed in Spain, France and Germany. Two patient groups will be included in two independent substudies. (1) A cohort of 2370 elderly patients (1185<80 years and 1185≥80 years; BRAINI2-ELDERLY DIAGNOSTIC AND PROGNOSTIC STUDY) with mTBI and a brain CT scan that will undergo blood sampling within 12 hours after mTBI. The primary outcome measure is the diagnostic performance of GFAP and UCH-L1 measured using an automated assay for discriminating between patients with positive and negative findings on brain CT scans. Secondary outcome measures include the performance of both biomarkers in predicting early (1 week) and midterm (3 months) neurological status and quality of life after trauma. (2) A cohort of 480 elderly reference participants (BRAINI2-ELDERLY REFERENCE STUDY) in whom reference values for GFAP and UCHL1 will be determined. ETHICS AND DISSEMINATION Ethical approval was obtained from the Institutional Review Boards of Hospital 12 de Octubre in Spain (Re#22/027) and Southeast VI (Clermont Ferrand Hospital) (Re# 22.01782.000095) in France. The study's results will be presented at scientific meetings and published in peer-review publications. TRIAL REGISTRATION NUMBER NCT05425251.
Collapse
Affiliation(s)
- Alfonso Lagares
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
- Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, Madrid, Spain
- Instituto de Investigación Sanitaria imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jean-François Payen
- Department of Anaesthesia and Intensive Care, Univ. Grenoble Alpes, Centre Hospitalier Universitaire de Grenoble, Grenoble Alpes, France
- Grenoble Institut des Neurosciences, INSERM, U1216, Grenoble, France
| | - Peter Biberthaler
- Department of Trauma Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - M Antonia Poca
- Department of Neurosurgery, Vall d'Hebron Hospital Universitari; Neurotrauma and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Odile Méjan
- bioMérieux, Clinical Unit, Chemin de l'Orme, Marcy l'Etoile, France
| | - Vladislav Pavlov
- bioMérieux, Medical Affairs, Chemin de l'Orme, Marcy l'Etoile, France
| | - Damien Viglino
- Emergency Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- HP2 Laboratory INSERM U1800, Grenoble, France
| | - Vincent Sapin
- Department of Biochemistry and Molecular Genetics, University Hospital, Clermont-Ferrand, Clermont Auvergne University, CNRS, INSERM, iGReD, Clermont-Ferrand, France
| | | | - Javier de la Cruz
- Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, SAMID, Madrid, Spain
| |
Collapse
|
7
|
Viglino D. Vers une filtration aérienne active pour les patients contaminants : le dispositif AIR’Protec®. Me´decine De Catastrophe, Urgences Collectives 2023. [PMCID: PMC9996803 DOI: 10.1016/j.pxur.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Né de la nécessité au début de la pandémie de COVID-19 de disposer d’un système simple et efficace pour protéger les équipes soignantes lors des transports de patients, AIR’Protec® a été développé avec l’aide de différentes équipes de l’université Grenoble-Alpes et le soutien de la direction générale de l’Armement (Fig. 1). Consistant en une aspiration filtrée du volume d’air autour du patient contenu dans une « bulle » transparente, le dispositif se veut léger, peu encombrant, et ne nécessitant pas l’ouverture et la rupture du confinement lors des transferts entre vecteurs (hélicoptère, ambulance, brancard hospitalier…). Il se devait d’être moins onéreux et plus maniable que les scaphandres totaux, inappropriés pour certains vecteurs et pour un grand nombre de patient. AIR’Protec® s’installe directement sur le patient, et est connecté à une aspiration haut débit à travers un filtre haute efficacité (HEPA) garantissant l’épuration de l’air contaminé généré par la respiration du patient et dont l’aérosolisation est augmentée par les soins (administration d’O2, VNI, nébulisation…). L’air à l’intérieur est renouvelé par le flux constant au niveau des zones volontairement non étanches de la « bulle ». L’aspiration est soit générée par la pompe haut débit mobile « SAM » (> 4 h d’autonomie), soit par connexion au vide d’air mural hospitalier. Les tests réalisés sur la version commercialisée et normée CE ont été effectués en générant une grande quantité de gouttelettes par nébulisation à l’intérieur de la bulle, et mesure du taux de ces particules potentiellement contaminants (mesure laser par LASAIR III à 0,3 μm, 0,5 μm, 1 μm et 5 μm de diamètre) dans l’air ambiant à 50 cm du patient. Plusieurs séries sont effectuées avec et sans le dispositif, sur pompe mobile et sur vide mural hospitalier, et en différents milieux d’utilisation (box d’examen des urgences et ambulance SMUR). En box d’examen d’urgence, sans le dispositif AIR’Protec®, l’augmentation du nombre de particules < 5 μm atteint un maximum de +26 969,8 % à 10 minutes du début de la nébulisation. Une normalisation de ce taux n’est atteinte qu’après une heure de mise au repos de la pièce. Avec le dispositif AIR’Protec® sur une pompe mobile ou sur vide mural, aucune augmentation des particules dans la pièce n’est observée, avec en plus un effet de filtration dû au grand flux filtré réinjecté dans la pièce (respectivement –20,8 % et –36,2 % par rapport aux taux de contaminants présents avant la procédure). Des résultats identiques sont observés en ambulance SMUR. Le taux de filtration observé des gouttelettes générées sous la bulle est donc supérieur à 99 %. Les filtres HEPA et consommables utilisés avec le dispositif sont habituellement disponibles dans tous les hôpitaux et utilisés pour les respirateurs mono-circuit. Ils n’ont pas fait l’objet de pénurie pendant la première vague de COVID-19 en France. La grande capacité de filtration des filtres HEPA pour les contaminants les plus petits que sont les virus (99,9999 % pour les tailles de 0,027 μm) rend ce dispositif utile pour toutes les situations à risque aéroporté, dont la grippe, la méningite à méningocoque, la tuberculose, etc.). Les systèmes de confinement poussés ont déjà montré leur efficacité sur la réduction du taux de contaminant et d’arrêt de travail en situation de pandémie en Chine. Nous pensons que le caractère léger, maniable, stockable et utilisable en plus grande quantité que les dispositifs existants devraient permettre d’équiper largement les services médicaux d’Etat, et être disponibles dans dotations de réserve pour les situations sanitaires exceptionnelles.
Collapse
|
8
|
Bouget J, Balusson F, Roy PM, Viglino D, Pavageau L, Lacut K, Oger E. Management of epistaxis associated with oral antithrombotic drugs in emergency department and impact on prescription thereafter. Clin Otolaryngol 2023; 48:457-464. [PMID: 36789614 DOI: 10.1111/coa.14040] [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: 09/15/2022] [Revised: 11/25/2022] [Accepted: 01/21/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES To describe management, and to assess factors associated with antithrombotic prescription thereafter in patients who had epistaxis referred to emergency department (ED). DESIGN Prospective cohort study. From EDs, clinical, biological and hospital data were collected. The clinical database was linked to the French Health Insurance Database where we retrieved antithrombotic drug deliveries in a 3-month period before and after referral. SETTING Multicentric population-based cohort study within five well-defined areas. PARTICIPANTS We considered 306 patients referred for epistaxis with a stable oral antithrombotic regimen before referral. MAIN OUTCOME MEASURES We considered management, hospital outcome and case fatality. Antithrombotic prescription in a 3-month follow-up period was categorised into three classes: no change, class change, or discontinuation. During follow-up, hospitalisation for epistaxis or ischaemic events was searched. RESULTS Among 306 adult individuals (mean age: 76 years), 166 took oral anticoagulant and 140 an antiplatelet drug. Blood transfusion was needed in 13.7% of patients and anterior packing alone in 61%. Half of the patients were hospitalised; 301 were discharged alive. Considering antithrombotic prescription thereafter we observed no change in 219 patients (72.8%), class changes in 47 patients (15.6%) and discontinuation in 35 patients (11.6%). We identified four independent predictors for antithrombotic prescription: hospitalisation (vs. returning home, p = .05), age (p = .03), haemoglobin level (p = .03) and oral anticoagulant (vs. antiplatelet agent, p < .001). During the 3 months following discharge, 2 thrombotic and 15 bleeding events were identified. CONCLUSIONS Epistaxis referred to emergency department had an impact on subsequent antithrombotic prescription. CLINICAL TRIAL REGISTRATION Clinical Trials.gov identifier: NCT02886533.
Collapse
Affiliation(s)
- Jacques Bouget
- Univ Rennes, CHU Rennes, EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, Rennes, France.,Emergency Department, Rennes University Hospital, Rennes, France
| | - Frédéric Balusson
- Univ Rennes, CHU Rennes, EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, Rennes, France
| | - Pierre-Marie Roy
- Emergency Department, Centre Hospitalier Universitaire, Institut MITOVASC, Université d'Angers, Angers, France.,F-CRIN INNOVTE, Paris, France
| | - Damien Viglino
- Emergency Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Laure Pavageau
- Emergency Department, University hospital, Nantes, France
| | - Karine Lacut
- CIC 1412, Université de Bretagne Loire, Université de Brest, INSERM CIC 1412, CHRU de Brest, Brest, France
| | - Emmanuel Oger
- Univ Rennes, CHU Rennes, EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, Rennes, France
| |
Collapse
|
9
|
Segond N, Bellier A, Duhem H, Sanchez C, Busi O, Aguilera L, Truan D, Deutsch S, Koch FX, Viglino D, Debaty G. OR02 Supraglottic airway device to prevent pulmonary aspiration during cardio-pulmonary resuscitation by basic life support rescuers: a randomized cross-over human cadaver study. Resuscitation 2022. [DOI: 10.1016/s0300-9572(22)00384-7] [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]
|
10
|
Segond N, Bellier A, Duhem H, Sanchez C, Busi O, Deutsch S, Aguilera L, Truan D, Koch FX, Viglino D, Debaty G. Supraglottic airway device to improve ventilation success and reduce pulmonary aspiration during cardio-pulmonary resuscitation by basic life support rescuers: a randomised cross-over human cadaver study. PREHOSP EMERG CARE 2022:1-9. [PMID: 35543652 DOI: 10.1080/10903127.2022.2075994] [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] [Indexed: 10/18/2022]
Abstract
Objectives: Early airway management during cardiopulmonary resuscitation (CPR) prevents aspiration of gastric contents. Endotracheal intubation is the gold standard to protect airways, but supraglottic airway devices (SGA) may provide some protection with less training. Bag-mask ventilation (BMV) is the most common method used by rescuers. We hypothesized that SGA use by first rescuers during CPR could increase ventilation success rate and also decrease intragastric pressure and pulmonary aspiration.Methods: We performed a randomized cross-over experimental trial on human cadavers. Protocol A: we assessed the rate of successful ventilation (chest rise), intragastric pressure, and CPR key time metrics. Protocol B: cadaver stomachs were randomized to be filled with 300 mL of either blue or green serum saline solution through a Foley catheter. Each rescuer was randomly assigned to use SGA or BMV during a 5-minute standard CPR period. Then, in a crossover design, the stomach was filled with the second colour solution and another 5-minute CPR period was performed using the other airway method. Pulmonary aspiration, defined as the presence of coloured solution below the vocal cords, was assessed by a blinded operator using bronchoscopy. A generalized linear mixed model was used for statistical analysis.Results: Protocol A: Forty-eight rescuers performed CPR on 11 cadavers. Median ventilation success was higher with SGA than BMV: 75.0% (IQR: 59.8-87.3) vs. 34.7% (IQR: 25.0-50.0), (p = 0.003). Gastric pressure and differential (maximum minus minimum) gastric pressure were lower in the SGA group: 2.21 mmHg (IQR: 1.66; 2.68) vs. 3.02 mmHg (IQR: 2.02; 4.22) (p = 0.02) and 5.70 mmHg (IQR: 4.10; 7.60) vs. 8.05 mmHg (IQR: 5.40; 11.60) (p = 0.05). CPR key times were not different between groups. Protocol B: Ten cadavers were included with 20 CPR periods. Aspiration occurred in 2 (20%) SGA procedures and 5 (50%) BMV procedures (p = 0.44).Conclusion: Use of SGA by rescuers improved the ventilation success rate, decreased intragastric pressure, and did not affect key CPR metrics. SGA use by basic life support rescuers appears feasible and efficient.
Collapse
Affiliation(s)
- N Segond
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.,CNRS TIMC Laboratory, UMR 5525, Univ. Grenoble Alpes, Grenoble, France
| | - A Bellier
- CNRS TIMC Laboratory, UMR 5525, Univ. Grenoble Alpes, Grenoble, France.,LADAF-Laboratoire d'Anatomie Des Alpes Françaises, Univ. Grenoble Alpes, Grenoble, France
| | - H Duhem
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.,CNRS TIMC Laboratory, UMR 5525, Univ. Grenoble Alpes, Grenoble, France
| | - C Sanchez
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - O Busi
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - S Deutsch
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - L Aguilera
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - D Truan
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - F X Koch
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France
| | - D Viglino
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.,INSERM U1300, HP2 Laboratory, Univ. Grenoble Alpes, Grenoble, France
| | - G Debaty
- Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France.,CNRS TIMC Laboratory, UMR 5525, Univ. Grenoble Alpes, Grenoble, France
| |
Collapse
|
11
|
Pépin JL, Degano B, Tamisier R, Viglino D. Remote Monitoring for Prediction and Management of Acute Exacerbations in Chronic Obstructive Pulmonary Disease (AECOPD). Life (Basel) 2022; 12:life12040499. [PMID: 35454991 PMCID: PMC9028268 DOI: 10.3390/life12040499] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 01/13/2022] [Revised: 03/14/2022] [Accepted: 03/27/2022] [Indexed: 11/21/2022] Open
Abstract
The progression of chronic obstructive pulmonary disease (COPD) is characterized by episodes of acute exacerbation (AECOPD) of symptoms, decline in respiratory function, and reduction in quality-of-life increasing morbi-mortality and often requiring hospitalization. Exacerbations can be triggered by environmental exposures, changes in lifestyle, and/or physiological and psychological factors to greater or lesser extents depending on the individual’s COPD phenotype. The prediction and early detection of an exacerbation might allow patients and physicians to better manage the acute phase. We summarize the recent scientific data on remote telemonitoring (TM) for the prediction and management of acute exacerbations in COPD patients. We discuss the components of remote monitoring platforms, including the integration of environmental monitoring data; patient reported outcomes collected via interactive Smartphone apps, with data from wearable devices that monitor physical activity, heart rate, etc.; and data from medical devices such as connected non-invasive ventilators. We consider how telemonitoring and the deluge of data it potentially generates could be combined with electronic health records to provide personalized care and multi-disease management for COPD patients.
Collapse
Affiliation(s)
- Jean-Louis Pépin
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300, 38000 Grenoble, France; (B.D.); (R.T.); (D.V.)
- EFCR Laboratory, Thorax and Vessels Division, University Hospital of Grenoble Alpes, 38043 Grenoble, France
- Correspondence:
| | - Bruno Degano
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300, 38000 Grenoble, France; (B.D.); (R.T.); (D.V.)
- EFCR Laboratory, Thorax and Vessels Division, University Hospital of Grenoble Alpes, 38043 Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300, 38000 Grenoble, France; (B.D.); (R.T.); (D.V.)
- EFCR Laboratory, Thorax and Vessels Division, University Hospital of Grenoble Alpes, 38043 Grenoble, France
| | - Damien Viglino
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300, 38000 Grenoble, France; (B.D.); (R.T.); (D.V.)
- Emergency Department, University Hospital of Grenoble Alpes, 38043 Grenoble, France
| |
Collapse
|
12
|
Berwa A, Gallouche M, Larrat S, Fauconnier J, Viglino D, Bosson JL, Landelle C. Effect of point-of-care influenza tests on antibiotic prescriptions by emergency physicians in a French hospital. J Hosp Infect 2022; 122:133-139. [PMID: 35122886 DOI: 10.1016/j.jhin.2022.01.014] [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: 09/03/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Influenza is a public health issue worldwide. Although antibiotics should not be used to treat viral infections, they are often prescribed to patients with influenza-like illness (ILI). Such misuse promotes antibiotic resistance. The role of rapid point-of-care tests (POCT) in preventing antibiotic misuse in adults with ILI symptoms remains relatively unexplored. AIM To evaluate whether POCT implemented in 2018-2019 to detect influenza viruses lead to a decrease in antibiotic prescriptions compared to laboratory based influenza tests. METHODS Adult patients with ILI in one emergency department (ED) were retrospectively enrolled over three epidemic seasons (from 2016-2017 to 2018-2019). The primary outcome was the rate of antibiotic prescriptions, which was compared between the three seasons in bivariate and multivariate analyses. Prescriptions for ancillary laboratory tests, chest X-rays and oseltamivir were also compared, along with hospitalisations and length of stay (LOS) at the ED. FINDINGS Overall, 1849 patients were included. Median age was over 70 throughout all three seasons. The number of antibiotic prescriptions was significantly different between the three periods in bivariate analysis (48.3% in 2016/2017, 44% in 2017/2018 and 31.1% in 2018/2019; p<0,0001) and in multivariate analysis (adjusted Odds Ratio [aOR]=0.48, 95%CI=0.30-0.76 for 2018/2019 and aOR=0.99, 95%CI=0.67-1.46 for 2017/2018, compared to 2016/2017). There were significantly fewer prescriptions of ancillary laboratory tests, X-rays, hospitalisations and more oseltamivir prescriptions in 2018/2019, compared to the previous seasons. LOS was significantly lower in 2018/2019 only for influenza-positive patients. CONCLUSION ED influenza POCT decreased antibiotic use and lead to less ancillary testing, X-rays and hospitalisations among patients with ILI. However, medico-economic studies are necessary before formulating definite recommendations.
Collapse
Affiliation(s)
- A Berwa
- Service D'Hygiène Hospitalière, CHU Grenoble Alpes, Grenoble, France
| | - M Gallouche
- Service D'Hygiène Hospitalière, CHU Grenoble Alpes, Grenoble, France; Université Grenoble Alpes/CNRS, Grenoble INP, MESP TIM-C UMR 5525, Domaine de La Merci, La Tronche, France.
| | - S Larrat
- Laboratoire de Virologie, CHU Grenoble Alpes, Grenoble, France
| | - J Fauconnier
- Université Grenoble Alpes/CNRS, Grenoble INP, MESP TIM-C UMR 5525, Domaine de La Merci, La Tronche, France; Département D'Information Médicale, CHU Grenoble Alpes, Grenoble, France
| | - D Viglino
- Service des Urgences, CHU Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, HP2 Laboratory INSERM U1042, CHU Grenoble Alpes, Grenoble, France
| | - J L Bosson
- Université Grenoble Alpes/CNRS, Grenoble INP, MESP TIM-C UMR 5525, Domaine de La Merci, La Tronche, France; Département de Méthodologie de L'Information de Santé, CHU Grenoble Alpes, Grenoble, France
| | - C Landelle
- Service D'Hygiène Hospitalière, CHU Grenoble Alpes, Grenoble, France; Université Grenoble Alpes/CNRS, Grenoble INP, MESP TIM-C UMR 5525, Domaine de La Merci, La Tronche, France
| |
Collapse
|
13
|
Vangout M, Bouillet L, Bosseray A, Viglino D, Dumanoir P, Bocquet A. Étude de la discordance des diagnostics infectieux entre les urgences et les services de médecine interne au CHUGA : recherche de facteurs prédictifs et évaluation d’impact. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.292] [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: 10/19/2022]
|
14
|
Debaty G, Duhem H, Viglino D. Future Prospects in Out-of-hospital Cardiac Arrest Management. Méd Intensive Réa 2021. [DOI: 10.37051/mir-00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Despite numerous advances in the management of out-of-hospital cardiac arrest (OHCA), survival with good neurological outcome did not improve significantly in the last years. The latest improvements and innovations from diagnosis to return of spontaneous circulation are discussed in this review. Education of the general population to life-saving techniques is mandatory in order to reduce the no-flow period. Sharpened education to cardiac arrest identification by dispatch centers and the use of mobile-phone applications dispatching nearby citizen to perform chest compressions also seem to be interesting leads. The systematic indexing of automated external defibrillators and drone-mediated on-scene delivery might reduce time-to-defibrillation. Cardiopulmonary resuscitation (CPR) aims to improve perfusion of major organs while reducing ischemia reperfusion injuries. Pre-hospital implementation of innovating medical responses such as resuscitative endovascular balloon occlusion of the aorta and extracorporeal circulation are currently being explored. The head and thorax elevation during CPR has also shown some promising results on experimental animal studies, but need to be confirmed by clinical studies. The question of optimal ventilation techniques is still under debate and invasive ventilation struggles to prove its superiority in the pre-hospital setting. Many current research studies are reconsidering the use of historical treatments of OHCA, such as epinephrine or amiodarone. Finally, the growing concern for good neurological outcome displayed by recent major clinical studies reflects the newly emphasized critical issue of neuroprotection during cardiac arrest.
Collapse
|
15
|
Roy PM, Penaloza A, Hugli O, Klok FA, Arnoux A, Elias A, Couturaud F, Joly LM, Lopez R, Faber LM, Daoud-Elias M, Planquette B, Bokobza J, Viglino D, Schmidt J, Juchet H, Mahe I, Mulder F, Bartiaux M, Cren R, Moumneh T, Quere I, Falvo N, Montaclair K, Douillet D, Steinier C, Hendriks SV, Benhamou Y, Szwebel TA, Pernod G, Dublanchet N, Lapebie FX, Javaud N, Ghuysen A, Sebbane M, Chatellier G, Meyer G, Jimenez D, Huisman MV, Sanchez O. Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial. Eur Heart J 2021; 42:3146-3157. [PMID: 34363386 PMCID: PMC8408662 DOI: 10.1093/eurheartj/ehab373] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/02/2021] [Accepted: 06/02/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS The aim of this study is to compare the Hestia rule vs. the simplified Pulmonary Embolism Severity Index (sPESI) for triaging patients with acute pulmonary embolism (PE) for home treatment. METHODS AND RESULTS Normotensive patients with PE of 26 hospitals from France, Belgium, the Netherlands, and Switzerland were randomized to either triaging with Hestia or sPESI. They were designated for home treatment if the triaging tool was negative and if the physician-in-charge, taking into account the patient's opinion, did not consider that hospitalization was required. The main outcomes were the 30-day composite of recurrent venous thrombo-embolism, major bleeding or all-cause death (non-inferiority analysis with 2.5% absolute risk difference as margin), and the rate of patients discharged home within 24 h after randomization (NCT02811237). From January 2017 through July 2019, 1975 patients were included. In the per-protocol population, the primary outcome occurred in 3.82% (34/891) in the Hestia arm and 3.57% (32/896) in the sPESI arm (P = 0.004 for non-inferiority). In the intention-to-treat population, 38.4% of the Hestia patients (378/984) were treated at home vs. 36.6% (361/986) of the sPESI patients (P = 0.41 for superiority), with a 30-day composite outcome rate of 1.33% (5/375) and 1.11% (4/359), respectively. No recurrent or fatal PE occurred in either home treatment arm. CONCLUSIONS For triaging PE patients, the strategy based on the Hestia rule and the strategy based on sPESI had similar safety and effectiveness. With either tool complemented by the overruling of the physician-in-charge, more than a third of patients were treated at home with a low incidence of complications.
Collapse
Affiliation(s)
- Pierre-Marie Roy
- Emergency Department, CHU Angers, 4 rue Larrey, Angers, France, F-49000.,Univ. Angers, INSERM, CNRS, MITOVASC, Equipe CARME, SFR ICAT, Angers, France.,F-CRIN, INNOVTE, Saint-Etienne, France
| | - Andrea Penaloza
- F-CRIN, INNOVTE, Saint-Etienne, France.,Emergency Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,UCLouvain, Brussels, Belgium
| | - Olivier Hugli
- Emergency Department, University Hospital of Lausanne, Lausanne, Switzerland
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, DTN, Leiden University Medical Center, Leiden, the Netherlands
| | - Armelle Arnoux
- Computing, Statistics and Public Health & CIC1418, Hôpital Européen Georges Pompidou, APHP, Paris, France.,University of Paris, Paris, France
| | - Antoine Elias
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Cardiology and Vascular Medicine, CH Sainte Musse - Toulon, Toulon, France
| | - Francis Couturaud
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Internal Medicine and Chest Disease, CHU Brest, Brest, France.,EA3878-GETBO, CIC-INSERM1412, Univ-Brest, Brest, France
| | - Luc-Marie Joly
- Emergency Department, CHU Rouen, Normandy Univ, UNIROUEN, Rouen, France
| | - Raphaëlle Lopez
- Emergency Department, Sart Tilman University Hospital, Liège, Belgium
| | - Laura M Faber
- Department of Internal Medicine, Rode Kruis Hospital, Beverwijk, DTN, the Netherlands
| | - Marie Daoud-Elias
- Department of Cardiology and Vascular Medicine, CH Sainte Musse - Toulon, Toulon, France
| | - Benjamin Planquette
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Pneumology and Intensive Care, Hôpital Europeen Georges Pompidou, APHP, Paris, France.,University of Paris, INSERM UMR-S 1140 Innovaties Therapies in Haemostasis, Paris, France
| | - Jérôme Bokobza
- Emergency Department, Hôpital Cochin, APHP, Paris, France
| | - Damien Viglino
- Emergency Department, CHU Grenoble Alpes, Grenoble, France.,HP2 INSERM U 1042 Laboratory, University of Grenoble-Alpes, Grenoble, France
| | - Jeannot Schmidt
- F-CRIN, INNOVTE, Saint-Etienne, France.,Emergency Department, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Henry Juchet
- Emergency Department, CHU Toulouse, Toulouse, France
| | - Isabelle Mahe
- F-CRIN, INNOVTE, Saint-Etienne, France.,Internal Medicine Department, HU Paris Nord, Louis Mourier Hospital, APHP, Colombes, France.,Inserm UMR_S1140 Hemostasis Therapeutical Innovations, University of Paris, Colombes, France
| | - Frits Mulder
- Department of Internal Medicine, Tergooi Hospital, Hilversum, the Netherlands
| | - Magali Bartiaux
- Emergency Department, Saint-Pierre Hospital, Brussels, Belgium
| | - Rosen Cren
- Emergency Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Thomas Moumneh
- Emergency Department, CHU Angers, 4 rue Larrey, Angers, France, F-49000.,Univ. Angers, INSERM, CNRS, MITOVASC, Equipe CARME, SFR ICAT, Angers, France.,F-CRIN, INNOVTE, Saint-Etienne, France
| | - Isabelle Quere
- F-CRIN, INNOVTE, Saint-Etienne, France.,Vascular Medicine Department, CHU Montpellier, EA2992, CIC 1001, University of Montpellier, Montpellier, France
| | - Nicolas Falvo
- Vascular Medicine Department, CHU Dijon, Dijon, France
| | - Karine Montaclair
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Cardiology, CH Le Mans, Le Mans, France
| | - Delphine Douillet
- Emergency Department, CHU Angers, 4 rue Larrey, Angers, France, F-49000.,Univ. Angers, INSERM, CNRS, MITOVASC, Equipe CARME, SFR ICAT, Angers, France.,F-CRIN, INNOVTE, Saint-Etienne, France
| | - Charlotte Steinier
- Emergency Department, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Stephan V Hendriks
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Charles Nicolle, Rouen, France.,Normandie University, UNIROUEN, INSERM U1096 EnVI, Rouen, France
| | - Tali-Anne Szwebel
- Department of Internal Medicine, Cochin Hospital, APHP, Paris, France
| | - Gilles Pernod
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Vascular Medicine, CHU Grenoble Alpes, Grenoble, France.,University Grenoble Alpes, CNRS / TIMC-IMAG UMR 5525 / Themas, Grenoble, France
| | - Nicolas Dublanchet
- Emergency Department, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand, France
| | | | - Nicolas Javaud
- Emergency Department, CréAk, Louis Mourier Hospital, APHP, University of Paris, Colombes, France
| | - Alexandre Ghuysen
- Emergency Department, Sart Tilman University Hospital, Liège, Belgium
| | - Mustapha Sebbane
- F-CRIN, INNOVTE, Saint-Etienne, France.,Emergency Department, Lapeyronie Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Gilles Chatellier
- Computing, Statistics and Public Health & CIC1418, Hôpital Européen Georges Pompidou, APHP, Paris, France.,University of Paris, Paris, France
| | - Guy Meyer
- Department of Pneumology and Intensive Care, Hôpital Europeen Georges Pompidou, APHP, Paris, France.,University of Paris, INSERM UMR-S 1140 Innovaties Therapies in Haemostasis, Paris, France
| | - David Jimenez
- Respiratory Department and Medicine Department, Ramon y Cajal Hospital IRYCIS Alcal de Henares University, Madrid, Spain
| | - Menno V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Olivier Sanchez
- F-CRIN, INNOVTE, Saint-Etienne, France.,University of Paris, INSERM UMR-S 1140 Innovaties Therapies in Haemostasis, Paris, France.,Pneumology Department and Intensive Care, Hôpital Européen Georges Pompidou, APHP, 20-40 rue Leblanc, Paris, France, F-75908
| | | |
Collapse
|
16
|
Léonard C, Charriau-Perret A, Debaty G, Belle L, Ricard C, Sanchez C, Dupré PM, Panoff G, Bougerol T, Viglino D, Blancher M. Survivors of avalanche accidents: posttraumatic stress disorder symptoms and quality of life: a multicentre study. Scand J Trauma Resusc Emerg Med 2021; 29:96. [PMID: 34281606 PMCID: PMC8287800 DOI: 10.1186/s13049-021-00912-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND As any traumatic event, avalanches could trigger psychological disorders on survivors. Our objectives were to determine the prevalence of post-traumatic stress disorder among avalanche survivors and to evaluate post-traumatic stress disorder risks factors as well as the impact on quality of life. METHODS A multicentre study was conducted in victims included in the North Alpine Avalanche Registry from 2014 to 2018. Data were collected through a standard questionnaire during semi-directed phone interviews. The primary outcome was the total score on the Impact of Event Scale Revised. Secondary outcomes were the Mental Component Scale and the Physical Component Scale scores of the Short Form 12 questionnaire. RESULTS During the study period, 132 of 211 victims survived. Among the 107 victims included, 55 (51.4%) phone interviews were obtained. Six patients (10.9, 95% CI 1.76-20.05) had an Impact of Event Scale Revised score ≥ 33 indicating a strong probability for post-traumatic stress disorder. Median Mental Component Scale score was 39.0 (IQR 30.5-46.3) for post-traumatic stress disorder patients and 40.1 (IQR 36.5-43.4) for non post-traumatic stress disorder (p = 0.76). Median Physical Component Scale score was 39.4 (37.2-44.3) for post-traumatic stress disorder patients and 44.2 (39.1-46.8) for non post-traumatic stress disorder (p = 0.39). No significant difference in the quality of life in both populations was observed, and no independent risk factors of post-traumatic stress disorder was identified. CONCLUSION Avalanche accidents may induce post-traumatic stress disorders among survivors in a comparable prevalence to the most traumatic event already studied. Early recognition and preventive measures should be set up in order to reduce the psychological burden in these victims. TRIAL REGISTRATION NCT03936738 .
Collapse
Affiliation(s)
- Charlotte Léonard
- Grenoble University Hospital, Emergency Department and Mobile Intensive Care Unit, University Grenoble Alpes, SAMU 38, 38 000, Grenoble, France
| | - Anaëlle Charriau-Perret
- Grenoble University Hospital, Emergency Department and Mobile Intensive Care Unit, University Grenoble Alpes, SAMU 38, 38 000, Grenoble, France
| | - Guillaume Debaty
- Grenoble University Hospital, Emergency Department and Mobile Intensive Care Unit, University Grenoble Alpes, SAMU 38, 38 000, Grenoble, France
- TIMC-IMAG laboratory Team PRETA, CNRS UMR 5525, University Grenoble Alpes, Grenoble, France
| | - Loïc Belle
- Cardiac Intensive Care Unit, Annecy-Genevois Hospital, Annecy, France
| | - Cécile Ricard
- North Alpine Emergency Network Department (RENAU), Annecy, France
| | - Caroline Sanchez
- Grenoble University Hospital, Emergency Department and Mobile Intensive Care Unit, University Grenoble Alpes, SAMU 38, 38 000, Grenoble, France
| | - Pierre-Marie Dupré
- Peloton de Gendarmerie de Haute Montagne (PGHM Mountain Rescue), Chamonix-Mont-Blanc, France
| | - Gregory Panoff
- Compagnie Républicaine de Sécurité (CRS-Alpes Montain Rescue), Les Bossons, Chamonix, France
| | - Thierry Bougerol
- Institute of Neurosciences, Inserm U836, Grenoble Alpes University, Grenoble, France
| | - Damien Viglino
- Grenoble University Hospital, Emergency Department and Mobile Intensive Care Unit, University Grenoble Alpes, SAMU 38, 38 000, Grenoble, France
- Hypoxia-Physiopathology Laboratory HP2, INSERM U1300, Grenoble Alpes University, Grenoble, France
| | - Marc Blancher
- Grenoble University Hospital, Emergency Department and Mobile Intensive Care Unit, University Grenoble Alpes, SAMU 38, 38 000, Grenoble, France.
| |
Collapse
|
17
|
Peyrony O, Fontaine JP, Trabattoni E, Nakad L, Charreyre S, Picaud A, Bosc J, Viglino D, Jacquin L, Laribi S, Pereira L, Thiriez S, Paquet AL, Tanneau A, Azoulay E, Chevret S. Cancer Patients' Prehospital Emergency Care: Post Hoc Analysis from the French Prospective Multicenter Study EPICANCER. J Clin Med 2021; 10:jcm10051145. [PMID: 33803366 PMCID: PMC7967166 DOI: 10.3390/jcm10051145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/25/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Very little data are available concerning the prehospital emergency care of cancer patients. The objective of this study is to report the trajectories and outcomes of cancer patients attended by prehospital emergency services. Methods: This was an ancillary study from a three-day cross-sectional prospective multicenter study in France. Adult patients with cancer were included if they called the emergency medical dispatch center Service d’Aide Médicale Urgente (SAMU). The study was registered on ClinicalTrials.gov (NCT03393260, accessed on 8th January 2018). Results: During the study period, 1081 cancer patients called the SAMU. The three most frequent reasons were dyspnea (20.2%), neurological disorder (15.4%), and fatigue (13.1%). Among those patients, 949 (87.8%) were directed to the hospital, among which 802 (90.8%) were directed to an emergency department (ED) and 44 (5%) were transported directly to an intensive care unit (ICU). A mobile intensive care unit (MICU) was dispatched 213 (31.6%) times. The decision to dispatch an MICU seemed generally based on the patient’s reason for seeking emergency care and the presence of severity signs rather than on the malignancy or the patient general health status. Among the patients who were directed to the ED, 98 (16.1%) were deceased on day 30. Mortality was 15.4% for those patients directed to the ED but who were not admitted to the ICU in the next 7 days, 28.2% for those who were admitted to ICU in the next 7 days, and 56.1% for those patients transported by the MICU directly to the ICU. Conclusion: Cancer patients attending prehospital emergency care were most often directed to EDs. Patients who were directly transported to the ICU had a high mortality rate, raising the question of improving triage policies.
Collapse
Affiliation(s)
- Olivier Peyrony
- Emergency Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
- Correspondence: ; Tel.: +33-1-4249-8404
| | - Jean-Paul Fontaine
- Emergency Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
| | | | - Lionel Nakad
- Emergency Department, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, 94000 Créteil, France;
| | - Sylvain Charreyre
- Emergency Department, SAMU de Lyon, Edouard Herriot University Hospital, 69622 Lyon, France;
- University Claude Bernard Lyon 1, 69007 Lyon, France
| | - Adrien Picaud
- Emergency Department, SAMU, SMUR. Le Mans Hospital, 72181 Le Mans, France;
| | - Juliane Bosc
- Emergency Department, SMUR. Libourne and Sainte Foy la Grande Hospital, 33243 Libourne, France;
| | - Damien Viglino
- Emergency Department, Grenoble-Alpes University Hospital, 38043 Grenoble, France;
- HP2 INSERM U 1042 University Grenoble-Alpes, 38043 Grenoble, France
| | - Laurent Jacquin
- Emergency Department, Hospices Civils de Lyon, Edouard Herriot University Hospital, 69622 Lyon, France;
| | - Saïd Laribi
- Emergency Department, Tours University Hospital, 37000 Tours, France;
| | - Laurent Pereira
- Emergency Department, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France;
| | - Sylvain Thiriez
- Emergency Department, SMUR, Victor Provo Hospital, Roubaix Hospital, 59100 Roubaix, France;
| | - Anne-Laure Paquet
- Emergency Department, la Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France;
- Sorbonne-UPMC-Paris VI University, 75005 Paris, France
| | - Alexandre Tanneau
- Emergency Department, SMUR of Lorient and Quimperlé, Bretagne Sud Hospital Group, 56322 Lorient, France;
| | - Elie Azoulay
- Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, University of Paris, 75006 Paris, France;
| | - Sylvie Chevret
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, University of Paris, 75006 Paris, France;
- Department of Biostatistics and Medical Information, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | | |
Collapse
|
18
|
Bouget J, Huet MC, Roy PM, Viglino D, Lacut K, Pavageau L, Oger E. Acute, major muscular hematoma associated with antithrombotic agents: A multicenter real-world cohort. Thromb Res 2020; 199:54-58. [PMID: 33429124 DOI: 10.1016/j.thromres.2020.12.022] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is little data on major muscular hematomas and the little there is has mainly focused on patients exposed to oral anticoagulants. OBJECTIVE To describe the clinical characteristics, management and outcomes of patients admitted to emergency department (ED) for major muscular hematoma associated with an antithrombotic agent, and to identify predictors of in-hospital mortality. PATIENTS AND METHODS Over a three-year period, all consecutive cases of adult patients admitted to the ED of 5 tertiary care hospitals for major muscular hematoma while exposed to an antithrombotic agent were prospectively collected and medically validated. Clinical and biological data, therapeutic management of the bleeding event, and in-hospital mortality were collected from the medical records and compared across five groups of hematoma locations. Potential confounders were taken in account using a multivariate binomial regression model. RESULTS Three hundred and seventy-five patients were included (mean age = 81.4 years): 271 were exposed to vitamin K antagonists, 58 to parenteral anticoagulants (heparin, LMWH, fondaparinux), 33 to antiplatelets, and 13 to direct oral anticoagulants. The muscular hematomas were located in the lower limbs (n = 198), the rectus sheath (n = 71), the iliopsoas (n = 45), the upper limbs (n = 33), or elsewhere (n = 28). Reversal therapy was prescribed for 48.5% of patients, red cell transfusions for 63.6%, surgery for 12.3% and embolization for 3.5%. For 84% of patients, hospitalization was required, with a median length of stay of 10 days. Overall, in-hospital mortality was 8.5%. Reversal therapy, the need for intensive care and mortality were significantly more frequent among patients with iliopsoas hematomas. The independent predictors of in-hospital mortality were: decrease in mean arterial pressure (RR = 1.84), decrease in hemoglobin level (RR = 1.37) and the iliopsoas location (RR = 3.06). CONCLUSION Frail elderly patients with major muscular hematomas linked to antithrombotic agents risk substantial morbidity and in-hospital mortality. The iliopsoas location was the most life-threatening bleeding site. Close observation of this population is warranted to ensure better outcomes.
Collapse
Affiliation(s)
- Jacques Bouget
- Univ Rennes, CHU Rennes, EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, F 35043 Rennes, France
| | | | - Pierre-Marie Roy
- Emergency Department, Centre Hospitalier Universitaire, Institut MITOVASC, Université d'Angers, Angers, France; F-CRIN INNOVTE, France
| | - Damien Viglino
- Emergency Department, Grenoble-Alpes University Hospital, F 38043 Grenoble, France
| | - Karine Lacut
- CIC 1412, Université de Bretagne Loire, Université de Brest, INSERM CIC 1412, CHRU de Brest, F 29200 Brest, France
| | - Laure Pavageau
- Emergency Department, University hospital, F 44093 Nantes, France
| | - Emmanuel Oger
- Univ Rennes, CHU Rennes, EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, F 35043 Rennes, France.
| |
Collapse
|
19
|
Bouget J, Viglino D, Yvetot Q, Oger E. Major gastrointestinal bleeding and antithrombotics: Characteristics and management. World J Gastroenterol 2020; 26:5463-5473. [PMID: 33024397 PMCID: PMC7520611 DOI: 10.3748/wjg.v26.i36.5463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/30/2020] [Accepted: 08/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are few reports on major gastrointestinal (GI) bleeding among patients receiving an antithrombotic.
AIM To describe clinical characteristics, bleeding locations, management and in-hospital mortality related to these events.
METHODS Over a three-year period, we prospectively identified 1080 consecutive adult patients admitted in two tertiary care hospitals between January 1, 2013 and December 31, 2015 for major GI bleeding while receiving an antithrombotic. The bleeding events were medically validated. Clinical characteristics, causative lesions, management and fatalities were described. The distribution of antithrombotics prescribed was compared across the bleeding lesions identified.
RESULTS Of 576 patients had symptoms of upper GI bleeding and 504 symptoms of lower GI bleeding. No cause was identified for 383 (35.5%) patients. Gastro-duodenal ulcer was the first causative lesion in the upper tract (209 out of 408) and colonic diverticulum the first causative lesion in the lower tract (120 out of 289). There was a larger proportion of direct oral anticoagulant use among patients with lower GI than among those with upper GI lesion locations (P = 0.03). There was an independent association between gastro-duodenal ulcer and antithrombotic use (P = 0.03), taking account of confounders and proton pump inhibitor co-prescription. Pair wise comparisons pointed to a difference between vitamin K antagonist, direct oral anticoagulants, and antiplatelet agents in monotherapy vs dual antiplatelet agents.
CONCLUSION We showed a higher rate of bleeding lesion identification and suggested a different pattern of antithrombotic exposure between upper and lower GI lesion locations and between gastro-duodenal ulcer and other identified upper GI causes of bleeding. Management was similar across antithrombotics and in-hospital mortality was low (5.95%).
Collapse
Affiliation(s)
- Jacques Bouget
- EA 7449 REPERES, Pharmacoepidemiology and Health Services Research, Univ Rennes, Rennes 35000, France
| | - Damien Viglino
- Emergency Department and Mobile Intensive Care Unit-HP2 Laboratory INSERM U1042, University Grenoble Alps, La Tronche 38700, France
| | | | - Emmanuel Oger
- EA 7449 REPERES, Université de Rennes 1, Rennes 35000, France
| |
Collapse
|
20
|
Bouget J, Balusson F, Viglino D, Roy PM, Lacut K, Pavageau L, Oger E. Major bleeding risk and mortality associated with antiplatelet drugs in real-world clinical practice. A prospective cohort study. PLoS One 2020; 15:e0237022. [PMID: 32764775 PMCID: PMC7413418 DOI: 10.1371/journal.pone.0237022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/23/2020] [Accepted: 07/18/2020] [Indexed: 12/20/2022] Open
Abstract
Background Major bleedings other than gastrointestinal (GI) and intracranial (ICH) and mortality rates associated with antiplatelet drugs in real-world clinical practice are unknown. The objective was to estimate major bleeding risk and mortality among new users of antiplatelet drugs in real-world clinical practice. Methods and findings A population-based prospective cohort using the French national health data system (SNIIRAM), identified 69,911 adults living within five well-defined geographical areas, who were new users of antiplatelet drugs in 2013–2015 and who had not received any antithrombotics in 2012. Among them, 63,600 started a monotherapy and 6,311 a dual regimen. Clinical data for all adults referred for bleeding was collected from all emergency departments within these areas, and medically validated. Databases were linked using common key variables. The main outcome measure was time to major bleeding (GI, ICH and other bleedings). Secondary outcomes were death, and event-free survival (EFS). Hazard ratios (HR) were derived from adjusted Cox proportional hazard models. We used Inverse Propensity of Treatment Weighting as a stratified sensitivity analysis according to the antiplatelet monotherapy indication: primary prevention without cardiovascular (CV) risk factors, with CV risk factors, and secondary prevention. We observed 250 (0.36%) major haemorrhages, 81 ICH, 106 GI and 63 other types of bleeding. Incidences were twice as high in dual therapy as in monotherapy. Compared to low-dose aspirin (≤ 100 mg daily), high-dose (> 100 up to 325 mg daily) was associated with an increased risk of ICH (HR = 1.80, 95%CI 1.10 to 2.95). EFS was improved by high-dose compared to low-dose aspirin (1.41, 1.04 to 1.90 and 1.32, 1.03 to 1.68) and clopidogrel (1.30, 0.73 to 2.3 and 1.7, 1.24 to 2.34) respectively in primary prevention with and without CV risk factors. Conclusion The incidence of major bleeding and mortality was low. In monotherapy, low-dose aspirin was the safest therapeutic option whatever the indication. Trial registration NCT02886533.
Collapse
Affiliation(s)
- Jacques Bouget
- EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, Univ Rennes, CHU Rennes, Rennes, France
| | - Frédéric Balusson
- EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, Univ Rennes, CHU Rennes, Rennes, France
| | - Damien Viglino
- Emergency Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Pierre-Marie Roy
- Emergency Department, Centre Hospitalier Universitaire, Institut MITOVASC, Université d'Angers, Angers, France.,F-CRIN INNOVTE, France
| | - Karine Lacut
- CIC 1412, Université de Bretagne Loire, Université de Brest, INSERM CIC 1412, CHRU de Brest, Brest, France
| | - Laure Pavageau
- Emergency Department, University Hospital, Nantes, France
| | - Emmanuel Oger
- EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, Univ Rennes, CHU Rennes, Rennes, France
| |
Collapse
|
21
|
Le Conte P, Terzi N, Mortamet G, Abroug F, Carteaux G, Charasse C, Chauvin A, Combes X, Dauger S, Demoule A, Desmettre T, Ehrmann S, Gaillard-Le Roux B, Hamel V, Jung B, Kepka S, L’Her E, Martinez M, Milési C, Morawiec É, Oberlin M, Plaisance P, Pouyau R, Raherison C, Ray P, Schmidt M, Thille AW, Truchot J, Valdenaire G, Vaux J, Viglino D, Voiriot G, Vrignaud B, Jean S, Mariotte E, Claret PG. Prise en charge de l’exacerbation sévère d’asthme. Méd Intensive Réa 2020. [DOI: 10.37051/mir-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Contexte : La Société Française de Médecine d’Urgence, la Société de Réanimation de Langue Française et le GroupeFrancophone de Réanimation et d’Urgences Pédiatriques ont émis des recommandations sur la prise en charge del’exacerbation sévère d’asthme (ESA) chez l’enfant et l’adulte.Résultats : Les recommandations ont concerné 5 champs : diagnostic, traitement pharmacologique, modalités d’oxygénothérapie et de ventilation, orientation du patient, spécifi cités de la femme enceinte. L’analyse de la littérature et laformulation des recommandations ont été conduites selon la méthode GRADE (Grade of Recommendation Assessment,Development and Evaluation). Une recherche bibliographique portant sur les publications indexées dans les bases dedonnées PubMed™ et Cochrane™ a été réalisée.Sur les 21 recommandations formalisées obtenues, 4 avaient un niveau de preuve élevé (GRADE 1+/-) et 7 un niveaude preuve faible (GRADE 2 +/-). Pour 10 recommandations, la méthode GRADE n’a pas pu être appliquée, résultanten un avis d’experts. Un accord fort a été obtenu pour toutes les recommandations.Conclusion : Le travail conjoint de 36 experts issus de 3 sociétés savantes a permis d’obtenir 21 recommandations formalisées pour aider à la prise en charge aux urgences et en soins intensifs des patients adultes et pédiatriques avec une ESA.
Collapse
|
22
|
Viglino D, Maignan M. Aspects extrapulmonaires des exacerbations de bronchopneumopathie chronique obstructive. Ann Fr Med Urgence 2020. [DOI: 10.3166/afmu-2019-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La bronchopneumopathie chronique obstructive (BPCO) est une maladie systémique aux multiples atteintes, émaillée d’exacerbations. L’inflammation, l’hypoxémie, les troubles de la coagulation et les perturbations des interactions coeur–poumon expliquent en partie les atteintes non pulmonaires observées notamment lors d’exacerbations aiguës. Les événements cardiovasculaires sont la première cause de mortalité des patients BPCO, et leur recrudescence est observée pendant plusieurs semaines après une exacerbation. Aux urgences, la prise en charge des patients en exacerbation de BPCO repose donc en plus du support ventilatoire sur une bonne évaluation des potentielles pathologies associées telles que l’insuffisance cardiaque, l’ischémie myocardique, l’insuffisance rénale ou encore la maladie thromboembolique. Cette évaluation globale permet d’adapter les thérapeutiques parfois délétères sur la fonction cardiaque ou l’équilibre acide−base et de prendre en compte le risque extrapulmonaire dans le choix du parcours de soins du patient. Dans cette mise au point, nous abordons quelques explications physiologiques des multiples perturbations observées au cours de l’exacerbation de BPCO, et proposons une vision globale de l’évaluation de ces patients admis pour une dyspnée ou un autre motif pouvant être en rapport avec la BPCO.
Collapse
|
23
|
Belbézier A, Deroux A, Sarrot-Reynauld F, Colombe B, Bosseray A, Wintenberger C, Dumanoir P, Lugosi M, Boccon-Gibod I, Leroy V, Maignan M, Collomb-Muret R, Viglino D, Vaillant M, Minotti L, Lagrange E, Epaulard O, Dumestre-Perard C, Lhomme S, Lupo J, Larrat S, Morand P, Schwebel C, Vilotitch A, Bosson JL, Bouillet L. Screening of hepatitis E in patients presenting for acute neurological disorders. J Infect Public Health 2020; 13:1047-1050. [PMID: 32224109 DOI: 10.1016/j.jiph.2019.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/08/2019] [Revised: 12/13/2019] [Accepted: 12/21/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Hepatitis E virus (HEV) infection has been reported to be associated with neurological disorders. However, the real prevalence of acute hepatitis E in those diseases is still unknown. We determined the prevalence of anti-HEV IgM antibody in a population with acute non-traumatic, non-metabolic, non-vascular neurological injury. METHOD A registry was created in Grenoble Hospital University from 2014 to 2018 to collect data on patients with acute (<3 months) non-traumatic, non-metabolic, non-vascular neurological injuries. Acute hepatitis E was defined as anti-HEV IgM-positive serum in immunocompetent patient, and as anti-HEV IgM-positive serum or HEV RNA-positive serum in immunocompromised patients. RESULTS One hundred fifty-nine patients were included. Anti-HEV IgM seroprevalence in our cohort of non-traumatic, non-metabolic, non-vascular neurological injuries was 6.9% (eleven patients, including 4 Parsonage-Turner syndrome (PTS) and 2 Guillain-Barré syndrome (GBS)). Elevated transaminases were observed in only 64% of hepatitis E patients and cholestasis in 64%. CONCLUSION In this study, 6·9% of patients with acute non-traumatic, non-metabolic, non-vascular neurological injuries had a probable recent HEV infection. HEV serology should be systematically performed in this population, even in patients with normal transaminase level.
Collapse
Affiliation(s)
- Aude Belbézier
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France.
| | - Alban Deroux
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France
| | | | - Barbara Colombe
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France
| | - Annick Bosseray
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France
| | - Claire Wintenberger
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France
| | - Perrine Dumanoir
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France
| | - Maxime Lugosi
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France
| | | | - Vincent Leroy
- Department of Hepatology, Grenoble University Hospital, Grenoble, France
| | - Maxime Maignan
- Department of Emergency, Grenoble University Hospital, Grenoble, France
| | | | - Damien Viglino
- Department of Emergency, Grenoble University Hospital, Grenoble, France
| | - Mathieu Vaillant
- Department of Neurology, Grenoble University Hospital, Grenoble, France
| | - Lorella Minotti
- Department of Neurology, Grenoble University Hospital, Grenoble, France
| | - Emeline Lagrange
- Department of Neurology, Grenoble University Hospital, Grenoble, France
| | - Olivier Epaulard
- Univ. Grenoble Alpes, Department of Infectious Disease, Grenoble University Hospital, Grenoble, France
| | - Chantal Dumestre-Perard
- Univ. Grenoble Alpes, CNRS, Laboratory of Immunology CHU Grenoble Alpes, TIMC-IMAG, 38000 Grenoble, France
| | - Sébastien Lhomme
- INSERM, U1043, Centre de Physiopathologie de Toulouse Purpan, Toulouse, F-31300, France; CHU Toulouse, Hôpital Purpan, Laboratoire de virologie, F-31300, France
| | - Julien Lupo
- Univ. Grenoble Alpes, CEA, CNRS, Virology Laboratory CHU Grenoble Alpes, IBS, 38000 Grenoble, France
| | - Sylvie Larrat
- Univ. Grenoble Alpes, CEA, CNRS, Virology Laboratory CHU Grenoble Alpes, IBS, 38000 Grenoble, France
| | - Patrice Morand
- Univ. Grenoble Alpes, CEA, CNRS, Virology Laboratory CHU Grenoble Alpes, IBS, 38000 Grenoble, France
| | - Carole Schwebel
- Univ. Grenoble Alpes, Laboratory of Bioclinical Pharmaceutic CHU Grenoble Alpes, INSERM U1039, 38000 Grenoble, France
| | - Antoine Vilotitch
- Department of Public Health, Grenoble University Hospital, Grenoble, France
| | - Jean-Luc Bosson
- Department of Public Health, Grenoble University Hospital, Grenoble, France; Univ. Grenoble Alpes, CNRS, Public Health Department CHU Grenoble Alpes, TIMC-IMAG, 38000 Grenoble, France
| | - Laurence Bouillet
- Department of Internal Medicine, Grenoble University Hospital, Grenoble, France; Univ. Grenoble Alpes, Department of Internal Medicine CHU Grenoble, Inserm (U1036), CEA, BIG-BCI, France
| |
Collapse
|
24
|
Viglino D, Daoust R, Bailly S, Faivre-Pierret C, Charif I, Roustit M, Paquet J, Debaty G, Pépin JL, Maignan M, Chauny JM. Opioid drug use in emergency and adverse outcomes among patients with chronic obstructive pulmonary disease: a multicenter observational study. Sci Rep 2020; 10:5038. [PMID: 32193505 PMCID: PMC7081336 DOI: 10.1038/s41598-020-61887-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 03/03/2020] [Indexed: 11/09/2022] Open
Abstract
There is still debate as to the safety of non-palliative opioid administration to chronic obstructive pulmonary disease (COPD) patients punctually treated for an acute complaint. All patients over 40 presenting at two university hospital emergency departments (Montréal Qc, Grenoble Fr) from March 2008 to September 2014 with dyspnea, abdominal pain or trauma were retrieved, and COPD patients were selected. Our primary endpoint was a composite criterion including invasive ventilation and death. Comparisons between visits in which opioid drugs were prescribed and those without opioids were performed using an inverse probability of treatment and censoring weight (IPTCW) estimator to adjust for baseline confounders. A survival weighted Cox model was used. 7799 visits by COPD patients were identified, corresponding to 4173 unique patients. Opioid drug prescription was reported in 1317 (16.9%) visits. After applying IPCTW weighting, opioid prescription was found to be associated with the composite criterion of poor clinical outcomes (HR = 4.73 (2.94; 7.61), p < 0.01). When taken separately, this association remained significant for invasive ventilation and death, but not for NIV. All sensitivity analyses confirmed the association, except for patients with trauma or abdominal pain as the main complaint. This excess risk is observed whatever the route of administration.
Collapse
Affiliation(s)
- Damien Viglino
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France. .,INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France.
| | - Raoul Daoust
- Department of Emergency Medicine, Research Centre, Sacré-Coeur Hospital of Montreal, Montreal, Quebec, Canada
| | - Sebastien Bailly
- INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France.,Department of Physiology and Sleep, Grenoble Alpes University Hospital, Grenoble, France
| | - Caroline Faivre-Pierret
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Isma Charif
- INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France
| | - Matthieu Roustit
- INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France.,Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean Paquet
- Department of Emergency Medicine, Research Centre, Sacré-Coeur Hospital of Montreal, Montreal, Quebec, Canada
| | - Guillaume Debaty
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France.,Department of Physiology and Sleep, Grenoble Alpes University Hospital, Grenoble, France
| | - Maxime Maignan
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France.,INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France
| | - Jean-Marc Chauny
- Department of Emergency Medicine, Research Centre, Sacré-Coeur Hospital of Montreal, Montreal, Quebec, Canada
| |
Collapse
|
25
|
Viglino D, L'her E, Maltais F, Maignan M, Lellouche F. Evaluation of a new respiratory monitoring tool "Early Warning ScoreO 2" for patients admitted at the emergency department with dyspnea. Resuscitation 2020; 148:59-65. [PMID: 31945431 DOI: 10.1016/j.resuscitation.2020.01.004] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/10/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Many scores derived from Early Warning Scores have been developed to detect patients at risk of poor outcome. Few of these scores incorporate the oxygen flow rate while this is a major marker in patients with respiratory complaint. We developed and evaluated a new automatable monitoring tool (Early Warning Score O2: EWS.O2) that incorporates cardio-respiratory parameters (Respiratory rate, Heart rate, SpO2, and FiO2 derived from oxygen flow rate), aiming to achieve early detection of poor outcome among patients with dyspnea. METHODS All patients presenting at an emergency department for dyspnea from June 2011 to June 2018 with available initial value (nurse triage) of respiratory parameters were included. Our primary endpoint was a composite criterion including the use of non-invasive ventilation, ICU admission and death. The Area under the Receiver Operating Characteristic curve (AUROC) of the SpO2/FiO2 index, NEWS, NEWS2, and the EWS.O2 were compared, including in subgroup analysis by final diagnosis or oxygen supplementation. RESULTS Among the 1729 patients retrieved, the composite outcome was observed in 288 (16.7%). The EWS.O2 displayed better or comparable predictive accuracy at triage (AUROC: 0.704, 95% CI 0.672-0.736) compared to NEWS (0.662, p < 0.01), NEWS2 (0.672, p = 0.02) and SpO2/FiO2 (0.695, p = 0.46). CONCLUSIONS This new ScoreO2 is equivalent or superior to common early warning scores and index to predict poor outcome at first medical contact. This score may be automatically and continuously recorded with new closed-loop devices to titrate oxygen flow. Further prospective studies will allow to verify its accuracy at multiple time points of the patient's journey.
Collapse
Affiliation(s)
- Damien Viglino
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada; Grenoble-Alpes University Hospital, HP2 Laboratory INSERM U1042, Grenoble, France
| | - Erwan L'her
- Medical Intensive Care, CHRU de Brest-La Cavale Blanche, Brest, France; LATIM INSERM UMR 1101, FHU Techsan, Université de Bretagne Occidentale, Brest, France
| | - François Maltais
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Maxime Maignan
- Grenoble-Alpes University Hospital, HP2 Laboratory INSERM U1042, Grenoble, France
| | - François Lellouche
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada.
| |
Collapse
|
26
|
Viglino D, Martin M, Almeras N, Després JP, Coxson HO, Pépin JL, Vivodtzev I, Maltais F. Low Liver Density Is Linked to Cardiovascular Comorbidity in COPD: An ECLIPSE Cohort Analysis. Int J Chron Obstruct Pulmon Dis 2019; 14:3053-3061. [PMID: 32099343 PMCID: PMC6997198 DOI: 10.2147/copd.s233834] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose Fatty liver disease is associated with cardiometabolic disorders and represents a potential key comorbidity in Chronic Obstructive Pulmonary Disease (COPD). Some intermediary mechanisms of fatty liver disease (including its histological component steatosis) include tissue hypoxia, low-grade inflammation and oxidative stress that are key features of COPD. Despite these shared physiological pathways, the effect of COPD on the prevalence of hepatic steatosis, and the association between hepatic steatosis and comorbidities in this population remain unclear. Liver density measured by computed tomography (CT)-scan is a non-invasive surrogate of fat infiltration, with lower liver densities reflecting more fat infiltration and a liver density of 40 Hounsfield Units (HU) corresponding to a severe 30% fat infiltration. Patients and Methods We took advantage of the international cohort ECLIPSE in which non-enhanced chest CT-scans were obtained in 1554 patients with COPD and 387 healthy controls to analyse the liver density at T12-L1. Results The distribution of liver density was similar and the prevalence of severe steatosis (density<40 HU) was not different (4.7% vs 5.2%, p=0.7) between COPD and controls. In patients with COPD, the lowest liver density quartile was associated, after age and sex adjustment, with coronary artery disease (ORa=1.59, 95% CI 1.12 to 2.24) and stroke (ORa=2.20, 95% CI 1.07 to 4.50), in comparison with the highest liver density quartile. Conclusion The present data indicate that a low liver density emerged as a predictor of cardiovascular comorbidities in the COPD population. However, the distribution of liver density and the prevalence of severe steatosis were similar in patients with COPD and control subjects.
Collapse
Affiliation(s)
- Damien Viglino
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Hypoxia Pathophysiology Laboratory INSERM U1042, Grenoble Alpes University Hospital, Grenoble, France
| | - Mickaël Martin
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - Natalie Almeras
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - Jean-Pierre Després
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - Harvey O Coxson
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean-Louis Pépin
- Hypoxia Pathophysiology Laboratory INSERM U1042, Grenoble Alpes University Hospital, Grenoble, France
| | - Isabelle Vivodtzev
- Hypoxia Pathophysiology Laboratory INSERM U1042, Grenoble Alpes University Hospital, Grenoble, France
| | - François Maltais
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | | |
Collapse
|
27
|
Viglino D, Collomb-Muret R, Mabiala-Makele P, Clape C, Gros R, Maignan M. Adequacy of oral information given to research participants regarding the Declaration of Helsinki. Eur J Emerg Med 2019; 27:65-66. [PMID: 31876609 DOI: 10.1097/mej.0000000000000618] [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] [Indexed: 11/25/2022]
Affiliation(s)
- Damien Viglino
- Emergency Department, Grenoble Alps University Hospital, INSERM U1042, Grenoble, France
| | | | | | | | | | | |
Collapse
|
28
|
Jung B, Martinez M, Claessens YE, Darmon M, Klouche K, Lautrette A, Levraut J, Maury E, Oberlin M, Terzi N, Viglino D, Yordanov Y, Claret PG, Bigé N. Diagnostic et Prise en Charge de l’Acidose Métabolique Recommandations formalisées d’experts communes Société de réanimation de langue française (SRLF) – Société française de médecine d’urgence (SFMU). Ann Fr Med Urgence 2019. [DOI: 10.3166/afmu-2019-0162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
L’acidose métabolique est un trouble fréquemment rencontré en médecine d’urgence et en médecine intensive réanimation. La littérature s’étant enrichie de nouvelles données concernant la prise en charge de l’acidose métabolique, la Société de Réanimation de Langue Française (SRLF) et la Société Française de Médecine d’Urgence (SFMU) ont élaboré des recommandations formalisées d’experts selon la méthodologie GRADE. Les champs de la stratégie diagnostique, de l’orientation et de la prise en charge thérapeutique ont été traités et vingt-neuf recommandations ont été formulées : quatre recommandations fortes (Grade 1), dix recommandations faibles (Grade 2) et quinze avis d’experts. Toutes ont obtenu un accord fort. L’application des méthodes d’Henderson-Hasselbalch et de Stewart pour le diagnostic du mécanisme de l’acidose métabolique est discutée et un algorithme diagnostique est proposé. L’utilisation de la cétonémie et des lactatémies veineuse et capillaire est également traitée. L’intérêt du pH, de la lactatémie et de sa cinétique pour l’orientation des patients en pré-hospitalier et aux urgences est envisagé. Enfin, les modalités de l’insulinothérapie au cours de l’acidocétose diabétique, les indications de la perfusion de bicarbonate de sodium et de l’épuration extra-rénale ainsi que les modalités de la ventilation mécanique au cours des acidoses métaboliques sévères sont traitées dans la prise en charge thérapeutique.
Collapse
|
29
|
Le Conte P, Terzi N, Mortamet G, Abroug F, Carteaux G, Charasse C, Chauvin A, Combes X, Dauger S, Demoule A, Desmettre T, Ehrmann S, Gaillard-Le Roux B, Hamel V, Jung B, Kepka S, L’Her E, Martinez M, Milési C, Morawiec É, Oberlin M, Plaisance P, Pouyau R, Raherison C, Ray P, Schmidt M, Thille AW, Truchot J, Valdenaire G, Vaux J, Viglino D, Voiriot G, Vrignaud B, Jean S, Mariotte E, Claret PG. Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d'Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies. Ann Intensive Care 2019; 9:115. [PMID: 31602529 PMCID: PMC6787133 DOI: 10.1186/s13613-019-0584-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/21/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma exacerbation (SAE) in adult and pediatric patients. RESULTS The guidelines were related to 5 areas: diagnosis, pharmacological treatment, oxygen therapy and ventilation, patients triage, specific considerations regarding pregnant women. The literature analysis and formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research was conducted based on publications indexed in PubMed™ and Cochrane™ databases. Of the 21 formalized guidelines, 4 had a high level of evidence (GRADE 1+/-) and 7 a low level of evidence (GRADE 2+/-). The GRADE method was inapplicable to 10 guidelines, which resulted in expert opinions. A strong agreement was reached for all guidelines. CONCLUSION The conjunct work of 36 experts from 3 scientific societies resulted in 21 formalized recommendations to help improving the emergency and intensive care management of adult and pediatric patients with SAE.
Collapse
Affiliation(s)
- Philippe Le Conte
- Service d’Accueil des Urgences, CHU de Nantes, 5 allée de l’île gloriette, 44093 Nantes Cedex 1, France
- PHU3, Faculté de Médecine 1, rue Gaston Veil, 44035 Nantes, France
| | - Nicolas Terzi
- Service de Médecine Intensive Réanimation, CHU de Grenoble Alpes, 38000 Grenoble, France
- INSERM, U1042, University of Grenoble-Alpes, HP2, 38000 Grenoble, France
| | - Guillaume Mortamet
- Service de Réanimation Pédiatrique, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Fekri Abroug
- Service de réanimation, CHU de Monastir, Monastir, Tunisia
| | | | - Céline Charasse
- Pediatric Emergency Department, CHU Pellegrin Enfants, Bordeaux, France
| | - Anthony Chauvin
- Service des Urgences, Hôpital Lariboisière, APHP, Paris, France
| | - Xavier Combes
- Service des Urgences, CHU de la Réunion, Saint-Denis, France
| | - Stéphane Dauger
- Pediatric Intensive Care Unit, Robert Debré Hospital, APHP, Paris, France
| | - Alexandre Demoule
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP, INSERM, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne Université, Paris, France
| | | | - Stephan Ehrmann
- Médecine Intensive Réanimation, INSERM CIC 1415, réseau CRICS-TriggerSEP, CHRU de Tours and Centre d’Etude des Pathologies Respiratoires, INSERM U1100, faculté de médecine, Université de Tours, Tours, France
| | | | - Valérie Hamel
- Service des Urgences, CHU de Toulouse, Toulouse, France
| | - Boris Jung
- Service de MIR, CHU de Montpelliers, Montpellier, France
| | - Sabrina Kepka
- Service des Urgences, CHU de Strasbourg, Strasbourg, France
| | - Erwan L’Her
- Service de MIR, CHRU de Brest, Brest, France
| | - Mikaël Martinez
- Pôle Urgences, centre hospitalier du Forez, 42605 Montbrison, France
- Réseau d’urgence Ligérien Ardèche Nord (REULIAN), centre hospitalier Le Corbusier, 42700 Firminy, France
| | - Christophe Milési
- Département de Pédiatrie Néonatale et Réanimations, CHU de Montpellier, Montpellier, France
| | - Élise Morawiec
- Service de Pneumologie et Réanimation, GH Pitié-Salpêtrière, APHP, Paris, France
| | - Mathieu Oberlin
- Service des Urgences, centre hospitalier de Cahors, Cahors, France
| | | | - Robin Pouyau
- Pediatric Intensive Care Unit, Women‐Mothers and Children’s University Hospital, Lyon, France
| | | | - Patrick Ray
- Service des Urgences, CHU de Dijon, faculté de médecine de Dijon, Dijon, France
| | - Mathieu Schmidt
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Pitié–Salpêtrière Hospital, Medical Intensive Care Unit, Sorbonne Universités, 75651 Paris Cedex 13, France
| | - Arnaud W. Thille
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | | | | | - Julien Vaux
- SAMU 94, CHU Henri Mondor, AP-HP, Créteil, France
| | - Damien Viglino
- INSERM, U1042, University of Grenoble-Alpes, HP2, 38000 Grenoble, France
- Service des Urgences Adultes, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Guillaume Voiriot
- Service de réanimation polyvalente, Hôpital Tenon, APHP, Paris, France
| | - Bénédicte Vrignaud
- Pediatric Emergency Department, Women and Children’, s University Hospital, Nantes, France
| | - Sandrine Jean
- Service de Réanimation Pédiatrique, APHP Hôpital Trousseau, 75012 Paris, France
| | - Eric Mariotte
- Service de Médecine Intensive Réanimation, APHP Hôpital Saint Louis, 75010 Paris, France
| | | |
Collapse
|
30
|
Duhem H, Viglino D, Bellier A, Tanguy S, Descombe V, Boucher F, Chaffanjon P, Debaty G. Cadaver models for cardiac arrest: A systematic review and perspectives. Resuscitation 2019; 143:68-76. [DOI: 10.1016/j.resuscitation.2019.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/09/2019] [Accepted: 08/06/2019] [Indexed: 02/08/2023]
|
31
|
Viglino D, Termoz Masson N, Verdetti A, Champel F, Falcon C, Mouthon A, Mabiala Makele P, Collomb Muret R, Maindet Dominici C, Maignan M. Multimodal oral analgesia for non-severe trauma patients: evaluation of a triage-nurse directed protocol combining methoxyflurane, paracetamol and oxycodone. Intern Emerg Med 2019; 14:1139-1145. [PMID: 31290084 DOI: 10.1007/s11739-019-02147-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/03/2019] [Indexed: 01/03/2023]
Abstract
Insufficient analgesia affects around 50% of emergency department patients. The use of a protocol helps to reduce the risk of oligoanalgesia in this context. Our objective was to describe the feasibility and efficacy of a multimodal analgesia protocol (combining paracetamol, oxycodone, and inhaled methoxyflurane) initiated by triage nurse. We performed a prospective, observational study in an emergency department (Grenoble Alpes University Hospital, France) between December 2017 and April 2018. Adult non-severe trauma patients with a numerical pain rating scale (NRS) score ≥ 4 were included. The primary efficacy criterion was the proportion of patients with an NRS score ≤ 3 at 15 min. Pain intensity was measured for 60 min and during radiography. Data on adverse events and satisfaction were recorded. A total of 200 adult patients were included (median [interquartile range (IQR)] age: 32 [23-49] years; 126 men (63%)). Sixty-six patients (33%) reported an NRS score ≤ 3 at 15 min. The time required to achieve a decrease of at least 2 points in the NRS score was 10 (5-20) min. The median [IQR] pain intensity was 4 [2-5] before radiography and 4 [2-6] during radiography. Adverse events were frequent (n = 128, 64%). No serious adverse events were reported. The patients and caregivers reported good levels of satisfaction. The administration of a nurse-driven multimodal analgesia protocol (combining paracetamol, oxycodone, and methoxyflurane) was feasible on admission to the emergency department. It rapidly produced long-lasting analgesia in adult trauma patients.Trial registration: NCT03380247.
Collapse
Affiliation(s)
- Damien Viglino
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Nicolas Termoz Masson
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Agnès Verdetti
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Flore Champel
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Cédric Falcon
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Alexis Mouthon
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Prudence Mabiala Makele
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Roselyne Collomb Muret
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | | | - Maxime Maignan
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France.
| |
Collapse
|
32
|
Viglino D, Martin M, Brouillard C, Despres JP, Almeras N, Tan WC, Pépin JL, Bourbeau J, Maltais F. Comparative metabolic and obesity profiles of COPD and non-COPD controls in the CanCOLD population-based cohort. Epidemiology 2019. [DOI: 10.1183/13993003.congress-2019.oa290] [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: 11/05/2022]
|
33
|
Maignan M, Viglino D, Collomb Muret R, Vejux N, Wiel E, Jacquin L, Laribi S, N-Gueye P, Joly LM, Dumas F, Beaune S. Intensity of care delivered by prehospital emergency medical service physicians to patients with deliberate self-poisoning: results from a 2-day cross-sectional study in France. Intern Emerg Med 2019; 14:981-988. [PMID: 31104303 DOI: 10.1007/s11739-019-02108-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
Emergency management of deliberate self-poisoning (DSP) by drug overdose is common in emergency medicine. There is a paucity of data about the prehospital care of these patients. The principal aim was to describe the intensity of care received by patients with DSP who were managed by prehospital emergency medical service (EMS) physicians. A 48-h cross-sectional study was conducted in 319 EMS and emergency units in France. Patient and poisoning characteristics and treatments administered were recorded. Complications of poisoning, hospitalization, intensive care unit admission and death were recorded until day 30. The primary endpoint was the probability of receiving prehospital intensive care, including fluid resuscitation, vasopressor therapy, invasive ventilation, or antidotal treatments, depending whether prehospital treatment was carried out by an EMS physician or not. Data from 703 patients (median age was 43 [30-52] years, 288 (40%) men) were analyzed. One hundred and fifteen (16%) patients were attended by an EMS physician. Patients attended by EMS physicians were more likely to receive intensive treatment in the prehospital setting [odds ratio (OR) 7.4, 95% confidence interval 4.3-12.9]. These patients had more severe poisoning as suggested mainly by a lower Glasgow Coma Score (13 [8-15] vs. 15 [15-15]; p < 0.001) and a higher rate of admission to an intensive care unit [29 (25%) vs. 15 (2%), p < 0.001]. Patients with DSP attended by prehospital EMS physicians frequently received intensive care. The level of care seemed appropriate for the severity of the poisoning.
Collapse
Affiliation(s)
- Maxime Maignan
- Emergency Department, CHU Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble cedex 9, France.
| | - Damien Viglino
- Emergency Department, CHU Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble cedex 9, France
| | - Roselyne Collomb Muret
- Emergency Department, CHU Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble cedex 9, France
| | - Nathan Vejux
- Emergency Department, CHU Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble cedex 9, France
| | - Eric Wiel
- Emergency Department and SAMU 59, Lille University Hospital, Inserm UMR1011 and UDSL, Institut Pasteur de Lille, EGID, Lille, France
| | - Laurent Jacquin
- Emergency Department, Hospices Civiles de Lyon, Lyon, France
| | - Said Laribi
- Emergency Department, Tours University Hospital, 37044, Tours, France
- INSERM, U942, BIOmarkers in CArdioNeuroVAScular Diseases, Paris, France
| | - Papa N-Gueye
- Emergency Department, APHP Hôpital Lariboisière, Paris, France
| | - Luc-Marie Joly
- Emergency Department, Charles Nicolle Hospital, Rouen, France
| | - Florence Dumas
- Emergency Department, APHP Hôpital Cochin, Sudden Death Expertise Center, Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France
| | - Sebastien Beaune
- Department of Emergency Medicine, Ambroise Paré Hospital, APHP, University Paris Diderot, INSERM UMR-S 1144, Paris, France
| |
Collapse
|
34
|
Jung B, Martinez M, Claessens YE, Darmon M, Klouche K, Lautrette A, Levraut J, Maury E, Oberlin M, Terzi N, Viglino D, Yordanov Y, Claret PG, Bigé N. Diagnosis and management of metabolic acidosis: guidelines from a French expert panel. Ann Intensive Care 2019; 9:92. [PMID: 31418093 PMCID: PMC6695455 DOI: 10.1186/s13613-019-0563-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/30/2019] [Indexed: 02/07/2023] Open
Abstract
Metabolic acidosis is a disorder frequently encountered in emergency medicine and intensive care medicine. As literature has been enriched with new data concerning the management of metabolic acidosis, the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Emergency Medicine Society (Société Française de Médecine d’Urgence [SFMU]) have developed formalized recommendations from experts using the GRADE methodology. The fields of diagnostic strategy, patient assessment, and referral and therapeutic management were addressed and 29 recommendations were made: 4 recommendations were strong (Grade 1), 10 were weak (Grade 2), and 15 were experts’ opinions. A strong agreement from voting participants was obtained for all recommendations. The application of Henderson–Hasselbalch and Stewart methods for the diagnosis of the metabolic acidosis mechanism is discussed and a diagnostic algorithm is proposed. The use of ketosis and venous and capillary lactatemia is also treated. The value of pH, lactatemia, and its kinetics for the referral of patients in pre-hospital and emergency departments is considered. Finally, the modalities of insulin therapy during diabetic ketoacidosis, the indications for sodium bicarbonate infusion and extra-renal purification as well as the modalities of mechanical ventilation during severe metabolic acidosis are addressed in therapeutic management.
Collapse
Affiliation(s)
- Boris Jung
- Département de Médecine Intensive et Réanimation, CHU Montpellier, 34000, Montpellier, France. .,INSERM U-1046, CNRS U-9234 (PhyMedExp), Université de Montpellier, Montpellier, France.
| | - Mikaël Martinez
- Pôle Urgence, CH du Forez, 42605, Montbrison, France.,Réseau d'urgence Ligérien Ardèche Nord (REULIAN), Centre Hospitalier Le Corbusier, 42700, Firminy, France
| | - Yann-Erick Claessens
- Département de Médecine d'urgence, Centre Hospitalier Princesse-Grace, Avenue Pasteur, 98012, Monaco, France
| | - Michaël Darmon
- Unité de Médecine Intensive et Réanimation, Hôpital Universitaire Saint-Louis, Assistance Publique-Hôpitaux de Paris, Avenue Claude-Vellefaux, 75010, Paris, France.,Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.,France Inserm, ECSTRA Team, UMR 1153, Centre d'Epidémiologie et de Biostatistique, CRESS, Biostatistics and Clinical Epidemiology, Sorbonne-Paris-Cité, Paris, France
| | - Kada Klouche
- INSERM U-1046, CNRS U-9234 (PhyMedExp), Université de Montpellier, Montpellier, France.,Département de Médecine Intensive-Réanimation, CHU Lapeyronie, 371, Avenue Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - Alexandre Lautrette
- Réanimation, Centre Jean-Perrin, CHU de Clermont-Ferrand, 63000, Clermont-Ferrand, France.,LMGE, UMR CNRS 6023, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Jacques Levraut
- Département de Médecine d'urgence, CHU de Nice, Hôpital Pasteur-II, 30, Avenue de la Voie Romaine, 06000, Nice, France.,UFR de Médecine, Université de Nice Côte d'Azur, Avenue de Vallombrose, 06000, Nice, France
| | - Eric Maury
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184, Rue du Faubourg-Saint-Antoine, 75571 Paris Cedex 12, Paris, France.,Sorbonne Université, Université Pierre-et-Marie Curie-Paris-VI, Paris, France.,Inserm U1136, 75012, Paris, France
| | - Mathieu Oberlin
- Structure des Urgences, Centre Hospitalier de Cahors, 335, Rue Wilson, 46000, Cahors, France
| | - Nicolas Terzi
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire de Grenoble, Université de Grenoble, Grenoble, France.,Inserm, U1042, Université Grenoble-Alpes, HP2, 38000, Grenoble, France
| | - Damien Viglino
- Service des Urgences Adultes, CS 10217, CHU Grenoble-Alpes, 38043 Grenoble Cedex 09, Grenoble, France.,Inserm U1042, Laboratoire HP2 Hypoxie-Physiopathologies, Université Grenoble-Alpes, Grenoble, France
| | - Youri Yordanov
- Faculté de Médecine, Sorbonne Universités, 75013, Paris, France.,Inserm, U1153, Université Paris-Descartes, 75006, Paris, France.,Service des Urgences, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 75012, Paris, France
| | - Pierre-Géraud Claret
- Pôle Anesthésie Réanimation Douleur Urgences, Centre Hospitalier Universitaire de Nîmes, 4, Rue du Professeur-Robert-Debré, 30029, Nîmes, France
| | - Naïke Bigé
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184, Rue du Faubourg-Saint-Antoine, 75571 Paris Cedex 12, Paris, France
| | | | | |
Collapse
|
35
|
Blancher M, Repellin M, Maignan M, Clapé C, Perrin A, Labarère J, Debaty G, Viglino D. Accuracy of low-weight versus standard syringe infusion pump devices depending on altitude. Scand J Trauma Resusc Emerg Med 2019; 27:65. [PMID: 31296248 PMCID: PMC6621955 DOI: 10.1186/s13049-019-0643-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/17/2019] [Accepted: 07/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background Intravenous drug infusions in critically ill patients require accurate syringe infusion pumps (SIPs). This is particularly important during transportation of critically ill patients by helicopter emergency medical services (HEMS), where altitude may influence device performance. Because weight is a real concern in HEMS, new low-weight devices are very appealing. The aim of this study was to compare infusion flow rates delivered by low-weight versus standard SIP devices, in the prehospital emergency medicine setting, at different altitudes. Methods We conducted a comparative bench study involving five SIP devices (two standard and three low-weight models) at 300, 1700 and 3000 m altitude. The primary endpoint was the flow rate delivered by SIPs for prespecified values. We used two methods to measure flow. The normative method consisted in measuring weight (method A) and the alternate method consisted in measuring instantaneous flow (method B). Results Using method A, no significant differences were found in median flow rates and interquartile range depending on device and altitude for a prespecified 10-mL/h flow. However, method B showed that low-weight SIPs delivered multiple sequential boluses with substantial variations (1.2–15.8 mL/h) rather than a prespecified continuous 5-mL/h flow. At 1700 m altitude, the interquartile range of delivered flows increased only for low-weight devices (p for interaction< 0.001). Conclusions Despite satisfactory normative tests, low-weight SIPs deliver discontinuous flow with potential clinical implications for critically ill patients receiving vasoactive drugs. This study also highlights a thus far unknown negative impact of altitude on SIP function. We believe that normative requirements for SIP approval should be revised accordingly.
Collapse
Affiliation(s)
- Marc Blancher
- Grenoble-Alps University - Emergency Department and Mobile Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France.
| | - Maxence Repellin
- Grenoble-Alps University - Emergency Department and Mobile Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France
| | - Maxime Maignan
- Grenoble-Alps University - Emergency Department and Mobile Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France.,INSERM U1042, HP2 Laboratory, Grenoble-Alps University, Grenoble, France
| | - Cyrielle Clapé
- Grenoble-Alps University - Emergency Department and Mobile Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France
| | - Arnaud Perrin
- Grenoble-Alps University - Emergency Department and Mobile Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France
| | - José Labarère
- Quality of Care Unit, Grenoble-Alps University Hospital, Grenoble, France
| | - Guillaume Debaty
- Grenoble-Alps University - Emergency Department and Mobile Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France.,Grenoble-Alps University, CNRS UMR 5525, TIMC-IMAG Laboratory, PRETA Team, Grenoble, France
| | - Damien Viglino
- Grenoble-Alps University - Emergency Department and Mobile Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France.,INSERM U1042, HP2 Laboratory, Grenoble-Alps University, Grenoble, France
| |
Collapse
|
36
|
Blancher M, Maignan M, Clapé C, Quesada JL, Collomb-Muret R, Albasini F, Ageron FX, Fey S, Wuyts A, Banihachemi JJ, Bertrand B, Lehmann A, Bollart C, Debaty G, Briot R, Viglino D. Intranasal sufentanil versus intravenous morphine for acute severe trauma pain: A double-blind randomized non-inferiority study. PLoS Med 2019; 16:e1002849. [PMID: 31310600 PMCID: PMC6634380 DOI: 10.1371/journal.pmed.1002849] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/07/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intravenous morphine (IVM) is the most common strong analgesic used in trauma, but is associated with a clear time limitation related to the need to obtain an access route. The intranasal (IN) route provides easy administration with a fast peak action time due to high vascularization and the absence of first-pass metabolism. We aimed to determine whether IN sufentanil (INS) for patients presenting to an emergency department with acute severe traumatic pain results in a reduction in pain intensity non-inferior to IVM. METHODS AND FINDINGS In a prospective, randomized, multicenter non-inferiority trial conducted in the emergency departments of 6 hospitals across France, patients were randomized 1:1 to INS titration (0.3 μg/kg and additional doses of 0.15 μg/kg at 10 minutes and 20 minutes if numerical pain rating scale [NRS] > 3) and intravenous placebo, or to IVM (0.1 mg/kg and additional doses of 0.05 mg/kg at 10 minutes and 20 minutes if NRS > 3) and IN placebo. Patients, clinical staff, and research staff were blinded to the treatment allocation. The primary endpoint was the total decrease on NRS at 30 minutes after first administration. The prespecified non-inferiority margin was -1.3 on the NRS. The primary outcome was analyzed per protocol. Adverse events were prospectively recorded during 4 hours. Among the 194 patients enrolled in the emergency department cohort between November 4, 2013, and April 10, 2016, 157 were randomized, and the protocol was correctly administered in 136 (69 IVM group, 67 INS group, per protocol population, 76% men, median age 40 [IQR 29 to 54] years). The mean difference between NRS at first administration and NRS at 30 minutes was -4.1 (97.5% CI -4.6 to -3.6) in the IVM group and -5.2 (97.5% CI -5.7 to -4.6) in the INS group. Non-inferiority was demonstrated (p < 0.001 with 1-sided mean-equivalence t test), as the lower 97.5% confidence interval of 0.29 (97.5% CI 0.29 to 1.93) was above the prespecified margin of -1.3. INS was superior to IVM (intention to treat analysis: p = 0.034), but without a clinically significant difference in mean NRS between groups. Six severe adverse events were observed in the INS group and 2 in the IVM group (number needed to harm: 17), including an apparent imbalance for hypoxemia (3 in the INS group versus 1 in the IVM group) and for bradypnea (2 in the INS group versus 0 in the IVM group). The main limitation of the study was that the choice of concomitant analgesics, when they were used, was left to the discretion of the physician in charge, and co-analgesia was more often used in the IVM group. Moreover, the size of the study did not allow us to conclude with certainty about the safety of INS in emergency settings. CONCLUSIONS We confirm the non-inferiority of INS compared to IVM for pain reduction at 30 minutes after administration in patients with severe traumatic pain presenting to an emergency department. The IN route, with no need to obtain a venous route, may allow early and effective analgesia in emergency settings and in difficult situations. Confirmation of the safety profile of INS will require further larger studies. TRIAL REGISTRATION ClinicalTrials.gov NCT02095366. EudraCT 2013-001665-16.
Collapse
Affiliation(s)
- Marc Blancher
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- * E-mail:
| | - Maxime Maignan
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Cyrielle Clapé
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Roselyne Collomb-Muret
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - François Albasini
- Emergency Department and Mobile Intensive Care Unit, Saint-Jean-de-Maurienne Hospital, Saint-Jean-de-Maurienne France
| | | | - Stephanie Fey
- Emergency Department and Mobile Intensive Care Unit, Metropole Savoie Hospital, Chambery, France
| | - Audrey Wuyts
- Emergency Department, Albertville–Moutiers Hospital, Moutiers, France
| | - Jean-Jacques Banihachemi
- Emergency Trauma Unit, Department of Orthopedic Surgery and Sport Traumatology, Hôpital Sud, Grenoble Alpes University Hospital, Grenoble, France
| | - Barthelemy Bertrand
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Audrey Lehmann
- Pharmacy Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Claire Bollart
- Clinical and Innovation Research Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Guillaume Debaty
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- CNRS TIMC-IMAG Laboratory, UMR 5525, University Grenoble Alpes, Grenoble, France
| | - Raphaël Briot
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- CNRS TIMC-IMAG Laboratory, UMR 5525, University Grenoble Alpes, Grenoble, France
| | - Damien Viglino
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| |
Collapse
|
37
|
Collart C, Moro-Sibilot D, Maignan M, Schwebel C, Giaj Levra M, Ferrer L, Paquier C, Viglino D, Toffart AC. [Emergency room management of patients with lung cancer and organ failure]. Rev Mal Respir 2019; 36:672-678. [PMID: 31255316 DOI: 10.1016/j.rmr.2019.03.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/23/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND When patients with lung cancer present to the emergency department with organ failure the question of admission to intensive care has to be considered. Our aim is to describe the process leading to the proposed management. METHODS Retrospectively, all patients admitted to the emergency room between December 2010 and January 2015 with a diagnosis of ICD-10 C34.9 (lung cancer) were reviewed. Those with at least one organ failure were included. RESULTS The records of 561 patients were reviewed, 79 (14%) had at least one organ failure. The majority of these patients received maximal medical care (59%), 25% exclusive palliative care, and 15% intensive care. Performance status, metastatic status and efficacy of anti-tumor treatment were recorded in the emergency medical record in 20%, 66% and 74% of cases, respectively. An opinion was obtained from the oncologist in 44% of cases and from the intensivist in 41% of cases. No external advice was provided in 27% of cases. CONCLUSION In the majority of cases, the decision on the intensity of care to be provided to patients with lung cancer and organ failure was made in a collective manner.
Collapse
Affiliation(s)
- C Collart
- Service d'accueil des urgences, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - D Moro-Sibilot
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - M Maignan
- Service d'accueil des urgences, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France; Inserm U1042, laboratoire hypoxie physiopathologie, université Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - C Schwebel
- Clinique universitaire de médecine intensive et réanimation, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France; Inserm U1039, biocliniques radiopharmaceutiques, université Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - M Giaj Levra
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - L Ferrer
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - C Paquier
- Service d'accueil des urgences, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - D Viglino
- Service d'accueil des urgences, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France; Inserm U1042, laboratoire hypoxie physiopathologie, université Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - A-C Toffart
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38043 Grenoble cedex 9, France; Inserm U 1209, CNRS UMR 5309, centre de recherche UGA, institut pour l'avancée des biosciences, 38700 La Tronche, France.
| |
Collapse
|
38
|
Maignan M, Viglino D, Hablot M, Termoz Masson N, Lebeugle A, Collomb Muret R, Mabiala Makele P, Guglielmetti V, Morand P, Lupo J, Forget V, Landelle C, Larrat S. Diagnostic accuracy of a rapid RT-PCR assay for point-of-care detection of influenza A/B virus at emergency department admission: A prospective evaluation during the 2017/2018 influenza season. PLoS One 2019; 14:e0216308. [PMID: 31063477 PMCID: PMC6504036 DOI: 10.1371/journal.pone.0216308] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/17/2019] [Indexed: 01/13/2023] Open
Abstract
STUDY OBJECTIVE To investigate the performance of a rapid RT-PCR assay to detect influenza A/B at emergency department admission. METHODS This single-center prospective study recruited adult patients attending the emergency department for influenza-like illness. Triage nurses performed nasopharyngeal swab samples and ran rapid RT-PCR assays using a dedicated device (cobas Liat, Roche Diagnostics, Meylan, France) located at triage. The same swab sample was also analyzed in the department of virology using conventional RT-PCR techniques. Patients were included 24 hours-a-day, 7 days-a-week. The primary outcome was the diagnostic accuracy of the rapid RT-PCR assay performed at triage. RESULTS A total of 187 patients were included over 11 days in January 2018. Median age was 70 years (interquartile range 44 to 84) and 95 (51%) were male. Nine (5%) assays had to be repeated due to failure of the first assay. The sensitivity of the rapid RT-PCR assay performed at triage was 0.98 (95% confidence interval (CI): 0.91-1.00) and the specificity was 0.99 (95% CI: 0.94-1.00). A total of 92 (49%) assays were performed at night-time or during the weekend. The median time from patient entry to rapid RT-PCR assay results was 46 [interquartile range 36-55] minutes. CONCLUSION Rapid RT-PCR assay performed by nurses at triage to detect influenza A/B is feasible and highly accurate.
Collapse
Affiliation(s)
- Maxime Maignan
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
- * E-mail:
| | - Damien Viglino
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
| | - Maud Hablot
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
| | - Nicolas Termoz Masson
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
| | - Anne Lebeugle
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
| | - Roselyne Collomb Muret
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
| | - Prudence Mabiala Makele
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
| | - Valérie Guglielmetti
- HP2 INSERM U1042, University Grenoble Alpes, Emergency department, Grenoble Alpes University Hospital, Grenoble, France
| | - Patrice Morand
- Institut de Biologie Structurale (IBS), CEA, CNRS, University Grenoble Alpes, Laboratoire de Virologie, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Lupo
- Institut de Biologie Structurale (IBS), CEA, CNRS, University Grenoble Alpes, Laboratoire de Virologie, Grenoble Alpes University Hospital, Grenoble, France
| | - Virginie Forget
- TIMC-IMAG, CNRS, Grenoble INP, University Grenoble Alpes, Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Caroline Landelle
- TIMC-IMAG, CNRS, Grenoble INP, University Grenoble Alpes, Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Sylvie Larrat
- Institut de Biologie Structurale (IBS), CEA, CNRS, University Grenoble Alpes, Laboratoire de Virologie, Grenoble Alpes University Hospital, Grenoble, France
| |
Collapse
|
39
|
Viglino D, Baillieul S, Jullian-Desayes I, Joyeux-Faure M, Tamisier R, Pépin JL. Liver Fibrosis, Sleep Apnea and Cardiovascular Events in Stroke Patients. Cerebrovasc Dis 2019; 47:309-310. [DOI: 10.1159/000501259] [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] [Received: 03/14/2019] [Accepted: 05/29/2019] [Indexed: 11/19/2022] Open
|
40
|
Viglino D, Plazanet A, Bailly S, Benmerad M, Jullian-Desayes I, Tamisier R, Leroy V, Zarski J, Maignan M, Joyeux-Faure M, Pepin J. Impact de la stéatopathie métabolique sur la survenue d’événements cardiovasculaires et la mortalité des patients BPCO. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.128] [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: 10/27/2022]
|
41
|
Abstract
L’oligoanalgésie chez le patient traumatisé aux urgences est une situation fréquente du fait de la complexité de la prise en charge de la douleur. L’une des solutions les mieux décrites à ce problème est l’utilisation d’analgésiques dès l’admission du patient. Ce type de protocole est à privilégier notamment en cas de filière de prise en charge rapide au sein des urgences. Le méthoxyflurane est un éther halogéné volatil utilisé en médecine. Son inhalation produit une analgésie supérieure au placebo. Du fait de sa rapidité d’action, de sa facilité d’emploi et de ses propriétés antalgiques, le méthoxyflurane doit faire partie de l’arsenal des thérapeutiques antalgiques aux urgences. Aux urgences du CHU de Grenoble-Alpes, nous privilégions l’utilisation du méthoxyflurane au sein d’un protocole d’analgésie multimodale du patient adulte traumatisé. Dans cette indication, le méthoxyflurane permet d’amorcer l’analgésie et de faire le pont jusqu’à ce que les autres thérapeutiques soient efficaces.
Collapse
|
42
|
Viglino D, Plazanet A, Bailly S, Benmerad M, Jullian-Desayes I, Tamisier R, Leroy V, Zarski JP, Maignan M, Joyeux-Faure M, Pépin JL. Impact of Non-alcoholic Fatty Liver Disease on long-term cardiovascular events and death in Chronic Obstructive Pulmonary Disease. Sci Rep 2018; 8:16559. [PMID: 30410123 PMCID: PMC6224555 DOI: 10.1038/s41598-018-34988-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/18/2018] [Indexed: 12/17/2022] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) and Non-Alcoholic Fatty Liver Disease (NAFLD) both independently increase cardiovascular risk. We hypothesized that NAFLD might increase the incidence of cardiovascular disease and death in COPD patients. The relationship between NAFLD, incident cardiovascular events, and death was assessed in a prospective cohort of COPD patients with 5-year follow-up. Noninvasive algorithms combining biological parameters (FibroMax®) were used to evaluate steatosis, non-alcoholic steatohepatitis (NASH) and liver fibrosis. Univariate and multivariate Cox regression models were used to assess the hazard for composite outcome at the endpoint (death or cardiovascular event) for each liver pathology. In 111 COPD patients, 75% exhibited liver damage with a prevalence of steatosis, NASH and fibrosis of 41%, 37% and 61%, respectively. During 5-year follow-up, 31 experienced at least one cardiovascular event and 7 died. In univariate analysis, patients with liver fibrosis had more cardiovascular events and higher mortality (Hazard ratio [95% CI]: 2.75 [1.26; 6.03]) than those with no fibrosis; this remained significant in multivariate analysis (Hazard ratio [95% CI]: 2.94 [1.18; 7.33]). We also found that steatosis and NASH were not associated with increased cardiovascular events or mortality. To conclude, early assessment of liver damage might participate to improve cardiovascular outcomes in COPD patients.
Collapse
Affiliation(s)
- Damien Viglino
- Emergency Department, Grenoble Alpes University Hospital, Grenoble, France
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Anais Plazanet
- Emergency Department, Grenoble Alpes University Hospital, Grenoble, France
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Sebastien Bailly
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Meriem Benmerad
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Ingrid Jullian-Desayes
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Renaud Tamisier
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Vincent Leroy
- Hepatogastroenterology Department, Grenoble Alpes University Hospital, Grenoble, France
- INSERM U823, IAPC Institute for Advanced Biosciences, University Grenoble Alpes, Grenoble, France
| | - Jean-Pierre Zarski
- Hepatogastroenterology Department, Grenoble Alpes University Hospital, Grenoble, France
- INSERM U823, IAPC Institute for Advanced Biosciences, University Grenoble Alpes, Grenoble, France
| | - Maxime Maignan
- Emergency Department, Grenoble Alpes University Hospital, Grenoble, France
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Marie Joyeux-Faure
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France.
| |
Collapse
|
43
|
Claret PG, Oberlin M, Viglino D, Zanker C, Vaux J, Rerbal D. Actualités en médecine d’urgence. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0065] [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: 11/20/2022]
|
44
|
Auzou G, Brunat F, Clot S, Rocher T, Turck J, Maggio L, Bollen Pinto B, Viglino D, Savary D, Belle L. Bloc auriculoventriculaire du troisième degré et infarctus du myocarde à la prise en charge initiale. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les descriptions de l’incidence, de la gravité et des modalités de prise en charge des blocs auriculoventriculaires du troisième degré (BAV3) compliquant la phase aiguë des infarctus du myocarde, avec sus-décalage du segment ST (STEMI), sont rares et anciennes. Par ailleurs, les modalités de prise en charge des STEMI aigus ont beaucoup évolué. Le but de notre étude est d’évaluer l’incidence, de décrire la gravité et les modalités de prise en charge des BAV3 survenant à la phase aiguë des STEMI dans un contexte contemporain.
Matériel et méthodes : Nous avons réalisé une étude observationnelle rétrospective de la prise en charge des STEMI aigus à partir du registre prospectif des STEMI du Réseau nord alpin des urgences (RENAU) sur les 19 hôpitaux des Alpes du Nord entre 2009 et 2012. Les patients présentant un BAV3 à la phase initiale de leur prise en charge ont été identifiés.
Résultats : Deux mille sept cent neuf patients avec STEMI aigu ont été inclus sur la période d’étude. Cinquante-sept ont présenté un BAV3 (2 %). Cent cinquante-deux des 2 648 patients sans BAV3 (6 %) sont décédés à la phase hospitalière contre 7 des 57 patients (12 %) avec BAV3 (p = 0,047). Parmi les patients en BAV3, un traitement par atropine a été utilisé pour 26 patients et s’est révélé efficace pour (15 %) d’entre eux. L’isoprénaline a été utilisée pour huit patients et a induit une hypotension artérielle pour quatre d’entre eux. Une stimulation ventriculaire droite percutanée a été utilisée pour six patients et a toujours été efficace. Quatorze patients ont été thrombolysés (25 %). Une angioplastie de sauvetage a été nécessaire chez 10 des 14 patients en BAV3 traités par thrombolyse (71 %), comparés aux 325 des 840 patients sans BAV3 traités par thrombolyse (39 % ; p = 0,013).
Conclusion : L’incidence des BAV3 à la phase aiguë des STEMI est faible. Le BAV3 représente un facteur de sévérité. Les stratégies thérapeutiques sont d’efficacité inégale, avec des effets indésirables induits par l’isoprenaline. La thrombolyse chez ces patients est moins efficace.
Collapse
|
45
|
Claret PG, Zanker C, Viglino D, Vaux J, Rerbal D, Chauvin A. Actualités en médecine d’urgence. Ann Fr Med Urgence 2018. [DOI: 10.3166/s13341-017-0806-5] [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: 11/20/2022]
|
46
|
Deroux A, Dumestre-Peyrard C, Maignan M, Viglino D, Boccon-Gibod I, Bouillet L. Identification de biomarqueurs de la crise d’angiœdème bradykinique. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.310] [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: 11/28/2022]
|
47
|
Viglino D, Vesin A, Ruckly S, Morelli X, Slama R, Debaty G, Danel V, Maignan M, Timsit JF. Daily volume of cases in emergency call centers: construction and validation of a predictive model. Scand J Trauma Resusc Emerg Med 2017; 25:86. [PMID: 28851446 PMCID: PMC5576313 DOI: 10.1186/s13049-017-0430-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 03/31/2017] [Accepted: 08/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Variations in the activity of emergency dispatch centers are an obstacle to the rationalization of resource allocation. Many explanatory factors are well known, available in advance and could predict the volume of emergency cases. Our objective was to develop and evaluate the performance of a predictive model of daily call center activity. Methods A retrospective survey was conducted on all cases from 2005 to 2011 in a large medical emergency call center (1,296,153 cases). A generalized additive model of daily cases was calibrated on data from 2005 to 2008 (1461 days, development sample) and applied to the prediction of days from 2009 to 2011 (1095 days, validation sample). Seventeen calendar and epidemiological variables and a periodic function for seasonality were included in the model. Results The average number of cases per day was 507 (95% confidence interval: 500 to 514) (range, 286 to 1251). Factors significantly associated with increased case volume were the annual increase, weekend days, public holidays, regional incidence of influenza in the previous week and regional incidence of gastroenteritis in the previous week. The adjusted R for the model was 0.89 in the calibration sample. The model predicted the actual number of cases within ± 100 for 90.5% of the days, with an average error of −13 cases (95% CI: -17 to 8). Conclusions A large proportion of the variability of the medical emergency call center’s case volume can be predicted using readily available covariates. Electronic supplementary material The online version of this article (10.1186/s13049-017-0430-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Damien Viglino
- University Grenoble Alps, Emergency Department and Mobile Intensive Care Unit, CHU Grenoble Alps, Grenoble, France. .,University Grenoble Alps, INSERM U823, Institut Albert BONNIOT, Grenoble, France.
| | - Aurelien Vesin
- University Grenoble Alps, INSERM U823, Institut Albert BONNIOT, Grenoble, France
| | - Stephane Ruckly
- University Grenoble Alps, INSERM U823, Institut Albert BONNIOT, Grenoble, France
| | - Xavier Morelli
- University Grenoble Alps, INSERM U823, Institut Albert BONNIOT, Grenoble, France
| | - Rémi Slama
- University Grenoble Alps, INSERM U823, Institut Albert BONNIOT, Grenoble, France
| | - Guillaume Debaty
- University Grenoble Alps, Emergency Department and Mobile Intensive Care Unit, CHU Grenoble Alps, Grenoble, France.,University Grenoble Alps, CNRS UMR 5525, TIMC-IMAG laboratory, Team PRETA, Grenoble, France
| | - Vincent Danel
- University Grenoble Alps, Emergency Department and Mobile Intensive Care Unit, CHU Grenoble Alps, Grenoble, France
| | - Maxime Maignan
- University Grenoble Alps, Emergency Department and Mobile Intensive Care Unit, CHU Grenoble Alps, Grenoble, France.,University Grenoble Alps, CNRS UMR 5525, TIMC-IMAG laboratory, Team PRETA, Grenoble, France
| | - Jean-François Timsit
- University Grenoble Alps, INSERM U823, Institut Albert BONNIOT, Grenoble, France.,Paris Diderot University, Medical and Infectious Intensive Care Unit, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| |
Collapse
|
48
|
Viglino D, Maignan M, Michalon A, Turk J, Buse SK, Blancher M, Aufderheide TP, Belle L, Savary D, Ageron FX, Debaty G. Survival of cardiac arrest patients on ski slopes: A 10-year analysis of the Northern French Alps Emergency Network. Resuscitation 2017; 119:43-47. [PMID: 28827198 DOI: 10.1016/j.resuscitation.2017.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/01/2017] [Revised: 07/20/2017] [Accepted: 07/28/2017] [Indexed: 11/27/2022]
Abstract
AIM Intense physical activity, cold and altitude make mountain sports a cause of increased risk of out-of-hospital cardiac arrest (OHCA). The difficulties of pre-hospital management related to this challenging environment could be mitigated by the presence of ski-patrollers in ski areas and use of helicopters for medical rescue. We assess whether this particular situation positively impacts the chain of survival compared to the general population. METHODS Analysis of prospectively collected data from the cardiac arrest registry of the Northern French Alps Emergency Network (RENAU) from 2004 to 2014. RESULTS 19,341 OHCAs were recorded during the period, including 136 on-slope events. Compared to other OHCAs, on-slope patients were younger (56 [40-65] vs. 66 [52-79] years, p<0.001) and more often in shockable initial rhythm (41.2% vs 20.1%, p<0.001). Resuscitation was more frequently started by a witness (43.4% vs 26.8%, p<0.001) and the time to the first electric shock was shorter (7.5min vs 14min, p<0.001), whereas time to the advanced life support (ALS) rescue arrival did not differ. The 30-day survival rate was higher for on-slope arrests (21.3% vs 5.9%, p<0.001, RR=3.61). In multivariate analysis, on-slope CA remained a positive 30-day survival factor with a 2.6 odds ratio (95% confidence interval, 1.42-4.81, p=0.002). CONCLUSION Despite difficult access and management conditions, patients undergoing OHCAs on ski slopes presented a higher survival rate, possibly explained by a healthier population, the efficiency of resuscitation by ski-patrols and similar time to ALS facilities compared to other cardiac arrests.
Collapse
Affiliation(s)
- Damien Viglino
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; University Grenoble Alps - HP2 Laboratory INSERM U1042, Grenoble, France.
| | - Maxime Maignan
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; University Grenoble Alps - HP2 Laboratory INSERM U1042, Grenoble, France
| | - Arnaud Michalon
- Annecy-Genevois Hospital, Emergency Department and Mobile Intensive Care Unit, Annecy, France
| | - Julien Turk
- Chambery Metropole Savoie Hospital, Emergency Department and Mobile Intensive Care Unit, Chambery, France
| | - Sarah K Buse
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Marc Blancher
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Loïc Belle
- Annecy-Genevois Hospital, Cardiac Intensive Care Unit, Annecy, France
| | - Dominique Savary
- Annecy-Genevois Hospital, Emergency Department and Mobile Intensive Care Unit, Annecy, France
| | - François-Xavier Ageron
- Annecy-Genevois Hospital, Emergency Department and Mobile Intensive Care Unit, Annecy, France
| | - Guillaume Debaty
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; University Grenoble Alps - TIMC-IMAG laboratory Team PRETA CNRS UMR 5525, Grenoble, France
| | | |
Collapse
|
49
|
Dussourd L, Martinon B, Candille C, Paquier C, Wintenberger C, Dumanoir P, Plazanet A, Viglino D, Maignan M. Ultrasonography helps emergency physician identify the best lumbar puncture site under the conus medullaris. Scand J Trauma Resusc Emerg Med 2017; 25:60. [PMID: 28655356 PMCID: PMC5488483 DOI: 10.1186/s13049-017-0406-9] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Ultrasonography – assisted lumbar puncture helps physicians identify traditional anatomical landmarks. However, it could help to overcome the anatomical dogmas and thus identify the best interspinous space under the medullary cone. Methods Traditional anatomical landmarks were reported on a tracing paper in patients with an indication for lumbar puncture. Then, ultrasonography was used to locate the optimal interspinous level defined as the widest subarachnoid space located below the conus medullaris. Primary endpoint was the distance between traditional and ultrasound landmarks. Results Fifty-seven patients were included. Seven emergency physicians practiced the procedure. The median absolute distance between traditional anatomical landmarks and ultrasound marking was 32 [interquartile (IQR) 27 – 37] mm. The inter-spinous space identified in the two procedures was different in 68% of the cases. Conclusions Ultrasound not only allows us to better identify anatomical structures before lumbar puncture, but it also allows us to choose a site of puncture different from recommendations.
Collapse
Affiliation(s)
- Line Dussourd
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Batistin Martinon
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Clara Candille
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Carole Paquier
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Claire Wintenberger
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Perrine Dumanoir
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Anais Plazanet
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Damien Viglino
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France
| | - Maxime Maignan
- Emergency Department, CHU Grenoble Alpes, CS 10217, 38043, Grenoble, cedex 9, France.
| |
Collapse
|
50
|
Viglino D, Jullian-Desayes I, Minoves M, Aron-Wisnewsky J, Leroy V, Zarski JP, Tamisier R, Joyeux-Faure M, Pépin JL. Nonalcoholic fatty liver disease in chronic obstructive pulmonary disease. Eur Respir J 2017; 49:49/6/1601923. [DOI: 10.1183/13993003.01923-2016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/23/2017] [Indexed: 12/18/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is independently linked to cardiometabolic morbidity and mortality. Low-grade inflammation, oxidative stress and ectopic fat, common features of chronic obstructive pulmonary disease (COPD), might contribute to the development of NAFLD.We aimed to investigate the prevalence of NAFLD and to evaluate the relationship between various types of liver damage and COPD severity, comorbidities and circulating inflammatory cytokines. Validated noninvasive tests (FibroMax: SteatoTest, NashTest and FibroTest) were used to assess steatosis, nonalcoholic steatohepatitis (NASH) and liver fibrosis. Patients underwent an objective assessment of COPD comorbidities, including sleep studies. Biological parameters included a complete lipid profile and inflammatory markers.In COPD patients the prevalence of steatosis, NASH and fibrosis were 41.4%, 36.9% and 61.3%, respectively. In multivariate analysis, SteatoTest and FibroTest were significantly associated with sex, body mass index (BMI), untreated sleep apnoea and insulin resistance, and, in addition, COPD Global Initiative for Chronic Obstructive Lung Disease stage for SteatoTest. Patients with steatosis had higher tumour necrosis factor-α levels and those with NASH or a combination of liver damage types had raised leptin levels after adjustment for age, sex and BMI.We concluded that NAFLD is highly prevalent in COPD and might contribute to cardiometabolic comorbidities.
Collapse
|