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Egea A, Dupuis C, de Montmollin E, Wicky PH, Patrier J, Jaquet P, Lefèvre L, Sinnah F, Marzouk M, Sonneville R, Bouadma L, Souweine B, Timsit JF. Augmented renal clearance in the ICU: estimation, incidence, risk factors and consequences-a retrospective observational study. Ann Intensive Care 2022; 12:88. [PMID: 36156744 PMCID: PMC9510087 DOI: 10.1186/s13613-022-01058-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 08/31/2022] [Indexed: 11/11/2022] Open
Abstract
Background Augmented renal clearance (ARC) remains poorly evaluated in ICU. The objective of this study is to provide a full description of ARC in ICU including prevalence, evolution profile, risk factors and outcomes. Methods This was a retrospective, single-center, observational study. All the patients older than 18 years admitted for the first time in Medical ICU, Bichat, University Hospital, APHP, France, between January 1, 2017, and November 31, 2020 and included into the Outcomerea database with an ICU length of stay longer than 72 h were included. Patients with chronic kidney disease were excluded. Glomerular filtration rate was estimated each day during ICU stay using the measured creatinine renal clearance (CrCl). Augmented renal clearance (ARC) was defined as a 24 h CrCl greater than 130 ml/min/m2. Results 312 patients were included, with a median age of 62.7 years [51.4; 71.8], 106(31.9%) had chronic cardiovascular disease. The main reason for admission was acute respiratory failure (184(59%)) and 196(62.8%) patients had SARS-COV2. The median value for SAPS II score was 32[24; 42.5]; 146(44%) and 154(46.4%) patients were under vasopressors and invasive mechanical ventilation, respectively. The overall prevalence of ARC was 24.6% with a peak prevalence on Day 5 of ICU stay. The risk factors for the occurrence of ARC were young age and absence of cardiovascular comorbidities. The persistence of ARC during more than 10% of the time spent in ICU was significantly associated with a lower risk of death at Day 30. Conclusion ARC is a frequent phenomenon in the ICU with an increased incidence during the first week of ICU stay. Further studies are needed to assess its impact on patient prognosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01058-w.
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Affiliation(s)
- Alexandre Egea
- Service d'Anesthésie Réanimation, CHU Saint Antoine, APHP, Paris, France
| | - Claire Dupuis
- Service de Médecine Intensive et Réanimation, CHU Clermont Ferrand, CHU Hôpital Gabriel-Montpied, 58 Rue Montalembert, 63000, Clermont Ferrand, France.
| | - Etienne de Montmollin
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France.,IAME UMR 1137, Université de Paris, 75018, Paris, France
| | - Paul-Henry Wicky
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France
| | - Juliette Patrier
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France
| | - Pierre Jaquet
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France
| | - Lucie Lefèvre
- Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Sorbonne Université Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Fabrice Sinnah
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France
| | - Mehdi Marzouk
- Réanimation Polyvalente/Surveillance Continue, Hôpitaux Publics de l'Artois, Lens, France
| | - Romain Sonneville
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France.,Université de Paris, UMR1148, Team 6, 75018, Paris, France
| | - Lila Bouadma
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France.,IAME UMR 1137, Université de Paris, 75018, Paris, France
| | - Bertrand Souweine
- Service de Médecine Intensive et Réanimation, CHU Clermont Ferrand, CHU Hôpital Gabriel-Montpied, 58 Rue Montalembert, 63000, Clermont Ferrand, France
| | - Jean-François Timsit
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France.,IAME UMR 1137, Université de Paris, 75018, Paris, France
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2
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Jaquet P, Legouy C, Le Fevre L, Grinea A, Sinnah F, Franchineau G, Patrier J, Marzouk M, Wicky PH, Alexis Geoffroy P, Arnoult F, Vledouts S, de Montmollin E, Bouadma L, Timsit JF, Sharshar T, Sonneville R. Neurologic Outcomes of Survivors of COVID-19-Associated Acute Respiratory Distress Syndrome Requiring Intubation. Crit Care Med 2022; 50:e674-e682. [PMID: 35132020 PMCID: PMC9275804 DOI: 10.1097/ccm.0000000000005500] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe 3-6-month neurologic outcomes of survivors of COVID-19-associated acute respiratory distress syndrome, invasively ventilated in the ICU. DESIGN A bicentric prospective study during the two first waves of the pandemic (March to May and September to December, 2020). SETTING Two academic hospital ICUs, Paris, France. PATIENTS Adult COVID-19-associated acute respiratory distress syndrome survivors, invasively ventilated in the ICU, were eligible for a neurologic consultation between 3 and 6 months post ICU discharge. INTERVENTIONS Follow-up by face-to-face neurologic consultation. MEASURES AND MAIN RESULTS The primary endpoint was favorable functional outcome defined by a modified Rankin scale score less than 2, indicating survival with no significant disability. Secondary endpoints included mild cognitive impairment (Montreal Cognitive Assessment score < 26), ICU-acquired weakness (Medical Research Council score < 48), anxiety and depression (Hospital Anxiety and Depression score > 7), and posttraumatic stress disorder (posttraumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders 5 score > 30). Of 54 eligible survivors, four non-French-speaking patients were excluded, eight patients were lost-to-follow-up, and one died during follow-up. Forty-one patients were included. Time between ICU discharge and neurologic consultation was 3.8 months (3.6-5.9 mo). A favorable functional outcome was observed in 16 patients (39%) and mild cognitive impairment in 17 of 33 patients tested (52%). ICU-acquired weakness, depression or anxiety, and posttraumatic stress disorder were reported in six of 37 cases (16%), eight of 31 cases (26%), and two of 27 cases (7%), respectively. Twenty-nine patients (74%) required rehabilitation (motor, cognitive, or psychologic). ICU and hospital lengths of stay, tracheostomy, and corticosteroids were negatively associated with favorable outcome. By contrast, use of alpha-2 agonists during ICU stay was associated with favorable outcome. CONCLUSIONS COVID-19-associated acute respiratory distress syndrome requiring intubation led to slight-to-severe functional disability in about 60% of survivors 4 months after ICU discharge. Cognitive impairment, muscle weakness, and psychologic symptoms were frequent. A large multicenter study is warranted to allow identification of modifiable factors for improving long-term outcome.
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Affiliation(s)
- Pierre Jaquet
- UFR de médecine, Université de Paris, Paris, France
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Camille Legouy
- Médecine intensive-réanimation, CH Saint Anne, F-75014 Paris, France
| | - Lucie Le Fevre
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Alexandra Grinea
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Fabrice Sinnah
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Guillaume Franchineau
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Juliette Patrier
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Mehdi Marzouk
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Paul-Henri Wicky
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Pierre Alexis Geoffroy
- Department of Psychiatry and Addictive Medicine, AP-HP, Hospital Bichat - Claude Bernard, 75018 Paris, France
- Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 67000 Strasbourg, France
| | - Florence Arnoult
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, DMU DREAM, AP-HP Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Serafima Vledouts
- Neurophysiologie clinique, service de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Etienne de Montmollin
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1137, Team 5, F-75018 Paris, France
| | - Lila Bouadma
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1137, Team 5, F-75018 Paris, France
| | - Jean-François Timsit
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1137, Team 5, F-75018 Paris, France
| | - Tarek Sharshar
- Médecine intensive-réanimation, CH Saint Anne, F-75014 Paris, France
| | - Romain Sonneville
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1148, Team 6, F-75018 Paris, France
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Bouadma L, Wiedemann A, Patrier J, Surénaud M, Wicky PH, Foucat E, Diehl JL, Hejblum BP, Sinnah F, de Montmollin E, Lacabaratz C, Thiébaut R, Timsit JF, Lévy Y. Immune Alterations in a Patient with SARS-CoV-2-Related Acute Respiratory Distress Syndrome. J Clin Immunol 2020; 40:1082-1092. [PMID: 32829467 PMCID: PMC7443154 DOI: 10.1007/s10875-020-00839-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/27/2020] [Indexed: 02/03/2023]
Abstract
We report a longitudinal analysis of the immune response associated with a fatal case of COVID-19 in Europe. This patient exhibited a rapid evolution towards multiorgan failure. SARS-CoV-2 was detected in multiple nasopharyngeal, blood, and pleural samples, despite antiviral and immunomodulator treatment. Clinical evolution in the blood was marked by an increase (2-3-fold) in differentiated effector T cells expressing exhaustion (PD-1) and senescence (CD57) markers, an expansion of antibody-secreting cells, a 15-fold increase in γδ T cell and proliferating NK-cell populations, and the total disappearance of monocytes, suggesting lung trafficking. In the serum, waves of a pro-inflammatory cytokine storm, Th1 and Th2 activation, and markers of T cell exhaustion, apoptosis, cell cytotoxicity, and endothelial activation were observed until the fatal outcome. This case underscores the need for well-designed studies to investigate complementary approaches to control viral replication, the source of the hyperinflammatory status, and immunomodulation to target the pathophysiological response. The investigation was conducted as part of an overall French clinical cohort assessing patients with COVID-19 and registered in clinicaltrials.gov under the following number: NCT04262921.
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Affiliation(s)
- Lila Bouadma
- APHP- Hôpital Bichat - Médecine Intensive et Réanimation des Maladies Infectieuses, Paris, France
- UMR 1137 - IAME Team 5 - DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Inserm/Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Aurélie Wiedemann
- Vaccine Research Institute, Faculté de Médecine, INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Juliette Patrier
- APHP- Hôpital Bichat - Médecine Intensive et Réanimation des Maladies Infectieuses, Paris, France
| | - Mathieu Surénaud
- Vaccine Research Institute, Faculté de Médecine, INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Paul-Henri Wicky
- APHP- Hôpital Bichat - Médecine Intensive et Réanimation des Maladies Infectieuses, Paris, France
| | - Emile Foucat
- Vaccine Research Institute, Faculté de Médecine, INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Jean-Luc Diehl
- APHP, Hôpital Georges Pompidou, Médecine Intensive Reanimation, Paris, France
| | - Boris P Hejblum
- Univ. Bordeaux, Department of Public Health, Inserm Bordeaux Population Health Research Centre, Inria SISTM, UMR 1219, Vaccine Research Institute (VRI), Créteil, France
| | - Fabrice Sinnah
- APHP- Hôpital Bichat - Médecine Intensive et Réanimation des Maladies Infectieuses, Paris, France
| | - Etienne de Montmollin
- APHP- Hôpital Bichat - Médecine Intensive et Réanimation des Maladies Infectieuses, Paris, France
| | - Christine Lacabaratz
- Vaccine Research Institute, Faculté de Médecine, INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Rodolphe Thiébaut
- Univ. Bordeaux, Department of Public Health, Inserm Bordeaux Population Health Research Centre, Inria SISTM, UMR 1219, Vaccine Research Institute (VRI), Créteil, France
- CHU Bordeaux, Bordeaux, France
| | - J F Timsit
- APHP- Hôpital Bichat - Médecine Intensive et Réanimation des Maladies Infectieuses, Paris, France
- UMR 1137 - IAME Team 5 - DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Inserm/Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Yves Lévy
- Vaccine Research Institute, Faculté de Médecine, INSERM U955, Université Paris-Est Créteil, Créteil, France.
- Assistance Publique-Hôpitaux de Paris, Service Immunologie Clinique, Groupe Henri-Mondor Albert-Chenevier, Créteil, France.
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4
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Magalhaes E, Reuter J, Wanono R, Bouadma L, Jaquet P, Tanaka S, Sinnah F, Ruckly S, Dupuis C, de Montmollin E, Para M, Braham W, Pisani A, d'Ortho MP, Rouvel-Tallec A, Timsit JF, Sonneville R. Correction to: Early EEG for Prognostication Under Venoarterial Extracorporeal Membrane Oxygenation. Neurocrit Care 2020; 33:867. [PMID: 33033960 DOI: 10.1007/s12028-020-01098-9] [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)
- Eric Magalhaes
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
| | - Jean Reuter
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
- INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France
| | - Ruben Wanono
- Department of Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Lila Bouadma
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
- UMR 1137, IAME, Université de Paris, Paris, France
| | - Pierre Jaquet
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
| | - Sébastien Tanaka
- Department of Anesthesiology and Intensive Care, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
- INSERM 1188, DéTROI, Reunion Island University, Saint-Denis de la Réunion, France
| | - Fabrice Sinnah
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
| | | | - Claire Dupuis
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
- UMR 1137, IAME, Université de Paris, Paris, France
| | - Etienne de Montmollin
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
- UMR 1137, IAME, Université de Paris, Paris, France
| | - Marylou Para
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Wael Braham
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Angelo Pisani
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Marie-Pia d'Ortho
- Department of Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Anny Rouvel-Tallec
- Department of Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Jean-François Timsit
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
- UMR 1137, IAME, Université de Paris, Paris, France
| | - Romain Sonneville
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France.
- INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France.
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5
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Magalhaes E, Reuter J, Wanono R, Bouadma L, Jaquet P, Tanaka S, Sinnah F, Ruckly S, Dupuis C, de Montmollin E, Para M, Braham W, Pisani A, d'Ortho MP, Rouvel-Tallec A, Timsit JF, Sonneville R. Early EEG for Prognostication Under Venoarterial Extracorporeal Membrane Oxygenation. Neurocrit Care 2020; 33:688-694. [PMID: 32789602 DOI: 10.1007/s12028-020-01066-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND/OBJECTIVES Tools for prognostication of neurologic outcome of adult patients under venoarterial ECMO (VA-ECMO) have not been thoroughly investigated. We aimed to determine whether early standard electroencephalography (stdEEG) can be used for prognostication in adults under VA-ECMO. METHODS Prospective single-center observational study conducted in two intensive care units of a university hospital, Paris, France. Early stdEEG was performed on consecutive adult patients treated with VA-ECMO for refractory cardiogenic shock or refractory cardiac arrest. The association between stdEEG findings and unfavorable outcome was investigated. The primary endpoint was 28-day mortality. The secondary endpoint was severe disability or death at 90 days, defined by a score of 4-6 on the modified Rankin scale. RESULTS A total of 122 patients were included, of whom 35 (29%) received cardiopulmonary resuscitation before VA-ECMO cannulation. Main stdEEG findings included low background frequency ≤ 4 Hz (n = 27, 22%) and background abnormalities, i.e., a discontinuous (n = 20, 17%) and/or an unreactive background (n = 12, 10%). Background abnormalities displayed better performances for prediction of unfavorable outcomes, as compared to clinical parameters at time of recording. An unreactive stdEEG background in combination with a background frequency ≤ 4 Hz had a false positive rate of 0% for prediction of unfavorable outcome at 28 days and 90 days, with sensitivities of 8% and 6%, respectively. After adjustment for confounders, a lower background frequency was independently associated with unfavorable outcome at 28 days (adjusted odds ratio per 1-Hz increment, 95% CI 0.71, 0.52-0.97), whereas no such independent association was observed at 90 days. CONCLUSION Standard EEG abnormalities recorded at time of VA-ECMO initiation are predictive of unfavorable outcomes. However, the low sensitivity of these parameters highlights the need for a multimodal evaluation for improving management of care and prognostication.
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Affiliation(s)
- Eric Magalhaes
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
| | - Jean Reuter
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France.,INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France
| | - Ruben Wanono
- Department of Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Lila Bouadma
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France.,UMR 1137, IAME, Université de Paris, Paris, France
| | - Pierre Jaquet
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
| | - Sébastien Tanaka
- Department of Anesthesiology and Intensive Care, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France.,INSERM 1188, DéTROI, Reunion Island University, Saint-Denis de la Réunion, France
| | - Fabrice Sinnah
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
| | | | - Claire Dupuis
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France.,UMR 1137, IAME, Université de Paris, Paris, France
| | - Etienne de Montmollin
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France.,UMR 1137, IAME, Université de Paris, Paris, France
| | - Marylou Para
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Wael Braham
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Angelo Pisani
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Marie-Pia d'Ortho
- Department of Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Anny Rouvel-Tallec
- Department of Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Jean-François Timsit
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France.,UMR 1137, IAME, Université de Paris, Paris, France
| | - Romain Sonneville
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France. .,INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France.
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6
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Lebut J, Mourvillier B, Argy N, Dupuis C, Vinclair C, Radjou A, de Montmollin E, Sinnah F, Patrier J, Le Bihan C, Magalahes E, Smonig R, Kendjo E, Thellier M, Ruckly S, Bouadma L, Wolff M, Sonneville R, Houzé S, Timsit JF. Correction to: Changes in the clinical presentation and outcomes of patients treated for severe malaria in a referral French university intensive care unit from 2004 to 2017. Ann Intensive Care 2020; 10:29. [PMID: 32125554 PMCID: PMC7054504 DOI: 10.1186/s13613-020-0646-0] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jordane Lebut
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France.,Longjumeau Hospital, ICU, Longjumeau, France
| | - Bruno Mourvillier
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France.,UMRS 1136, iPLESP, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 27, Rue Chaligny, 75571, Paris 12, France
| | - Nicolas Argy
- AP-HP, Bichat Hospital, Mycology Parasitology Department, Malaria National Reference Center, 75018, Paris, France
| | - Claire Dupuis
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France.,University of Paris, IAME, INSERM, 75018, Paris, France
| | - Camille Vinclair
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Aguila Radjou
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Etienne de Montmollin
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France.,University of Paris, IAME, INSERM, 75018, Paris, France
| | - Fabrice Sinnah
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Juliette Patrier
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Clément Le Bihan
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France.,University of Paris, IAME, INSERM, 75018, Paris, France
| | - Eric Magalahes
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Roland Smonig
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Eric Kendjo
- UMRS 1136, iPLESP, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 27, Rue Chaligny, 75571, Paris 12, France
| | - Marc Thellier
- UMRS 1136, iPLESP, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 27, Rue Chaligny, 75571, Paris 12, France
| | | | - Lila Bouadma
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France.,University of Paris, IAME, INSERM, 75018, Paris, France
| | - Michel Wolff
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France.,University of Paris, IAME, INSERM, 75018, Paris, France
| | - Romain Sonneville
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France.,University of Paris, IAME, INSERM, 75018, Paris, France
| | - Sandrine Houzé
- AP-HP, Bichat Hospital, Mycology Parasitology Department, Malaria National Reference Center, 75018, Paris, France
| | - Jean-François Timsit
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France. .,University of Paris, IAME, INSERM, 75018, Paris, France. .,OUTCOMEREA Research Network, Drancy, France.
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Lebut J, Mourvillier B, Argy N, Dupuis C, Vinclair C, Radjou A, de Montmollin E, Sinnah F, Patrier J, Le Bihan C, Magalahes E, Smonig R, Kendjo E, Thellier M, Ruckly S, Bouadma L, Wolff M, Sonneville R, Houzé S, Timsit JF. Changes in the clinical presentation and outcomes of patients treated for severe malaria in a referral French university intensive care unit from 2004 to 2017. Ann Intensive Care 2020; 10:21. [PMID: 32052207 PMCID: PMC7016155 DOI: 10.1186/s13613-020-0634-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 01/30/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In France, the incidence of severe imported malaria cases increased since early 2000. Artesunate was available (temporarily use authorization) since mid-2011 in France and commonly used for severe malaria since early 2013. Thus, the study objectives were to describe the patients with severe imported malaria admitted in intensive care unit (ICU) and assess the changes in clinical presentation and outcomes before and after this date. METHODS Retrospective observational single-center study in the infectious diseases ICU of a referral university hospital, conducted on patients admitted for severe imported malaria from 2004 to 2017. Demographic variables, severity scores, WHO's severity criteria on admission, treatment, and ICU and hospital lengths of stay were collected. Patients' characteristics and outcomes were compared between both periods. A poor outcome was defined as the composite endpoint of death, or requirement for vasopressors, invasive mechanical ventilation and/or renal replacement therapy. RESULTS 189 patients were included, 98 in 2004-2012 and 91 in 2013-2017, most often from West and Central African countries (96%). The number of WHO criteria for severe malaria was comparable in both groups, but SAPS II, SOFA and ICU length of stay were significantly higher in 2004-2012, while patients of African origin living in France were less frequent (p < 0.01). The outcome was poor for 41/98 cases in 2004-2012 and 12/91 cases in 2013-2017 (p < 0.01). The risk factors of poor outcome on the multivariate logistic regression were a neurological failure (adjusted odds ratio (adjOR = 3.23; 95% CI (1.03-10.08), p = 0.004), cardio-circulatory failure (adjOR = 9.92; 95% CI (2.34-42), p = <0.01) and creatinine blood levels > 265 µmol/L (adjOR = 10.76; 95% CI (3.17-36.53), p < 0.01). In the multivariate analysis, IV artesunate was not associated with a better outcome. Patients of African origin did not seem to have a better outcome than Caucasian patients or those from other origins (adjOR = 0.59; 95% CI (0.21-1.65), p = 0.31). CONCLUSION Patients with imported malaria admitted in ICU in 2013-2017 were less severely ill than those in 2004-2012. These trends could be partially explained by the increasing proportion of African patients visiting friends or relatives or living in endemic areas.
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Affiliation(s)
- Jordane Lebut
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- Longjumeau Hospital, ICU, Longjumeau, France
| | - Bruno Mourvillier
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- UMRS 1136, iPLESP, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 27, Rue Chaligny, 75571, Paris 12, France
| | - Nicolas Argy
- AP-HP, Bichat Hospital, Mycology Parasitology Department, Malaria National Reference Center, 75018, Paris, France
| | - Claire Dupuis
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Camille Vinclair
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Aguila Radjou
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Etienne de Montmollin
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Fabrice Sinnah
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Juliette Patrier
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Clément Le Bihan
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Eric Magalahes
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Roland Smonig
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Eric Kendjo
- UMRS 1136, iPLESP, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 27, Rue Chaligny, 75571, Paris 12, France
| | - Marc Thellier
- UMRS 1136, iPLESP, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 27, Rue Chaligny, 75571, Paris 12, France
| | | | - Lila Bouadma
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Michel Wolff
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Romain Sonneville
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Sandrine Houzé
- AP-HP, Bichat Hospital, Mycology Parasitology Department, Malaria National Reference Center, 75018, Paris, France
| | - Jean-François Timsit
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France.
- University of Paris, IAME, INSERM, 75018, Paris, France.
- OUTCOMEREA Research Network, Drancy, France.
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Dang E, Sayagh F, Lê MP, Neuville M, Sinnah F, Timsit JF, Peytavin G. Plasma pharmacokinetics of bedaquiline administered by nasogastric tube in an intensive care unit. Int J Tuberc Lung Dis 2020; 24:110-112. [DOI: 10.5588/ijtld.19.0221] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We present the case of a 21-year-old man admitted to the intensive care unit with multi-organ failure due to multidrug-resistant tuberculosis (TB). TB treatment initially comprised moxifloxacin, ethambutol, linezolid and amikacin administered intravenously. Due to suspected moxifloxacin-induced
liver injury, we stopped all fluoroquinolones and switched to bedaquiline (BDQ), which is only available in tablets for oral administration. Since our patient had to be fed through a nasogastric tube (NGT), BDQ was administered after being crushed and dissolved in water; drug pharmacokinetics
were studied using repeated blood sampling. Therapeutic drug monitoring showed that BDQ was detectable in blood plasma with a trough concentration above the supposed efficacy threshold, suggesting that this molecule could be administered through NGT.
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Affiliation(s)
- E. Dang
- Laboratoire de Pharmacologie-Toxicologie
| | - F. Sayagh
- Service de Réanimation médicale et infectieuse, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris
| | - M. P. Lê
- Laboratoire de Pharmacologie-Toxicologie, Unité Mixte de Recherche 1137 Infection anti-microbien modelisation evolution, Université Paris Diderot, Sorbonne Paris Cité, Institut national de la santé et de la recherche
médicale, Paris
| | - M. Neuville
- Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France
| | - F. Sinnah
- Service de Réanimation médicale et infectieuse, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris
| | - J-F. Timsit
- Service de Réanimation médicale et infectieuse, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, Unité Mixte de Recherche 1137 Infection anti-microbien modelisation evolution, Université
Paris Diderot, Sorbonne Paris Cité, Institut national de la santé et de la recherche médicale, Paris
| | - G. Peytavin
- Laboratoire de Pharmacologie-Toxicologie, Unité Mixte de Recherche 1137 Infection anti-microbien modelisation evolution, Université Paris Diderot, Sorbonne Paris Cité, Institut national de la santé et de la recherche
médicale, Paris
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Sinnah F, Shekar K, Abdul-Aziz MH, Buscher H, Diab SD, Fisquet S, Fung YL, McDonald CI, Reynolds C, Rudham S, Wallis SC, Welch S, Xie J, Fraser JF, Roberts JA. Incremental research approach to describing the pharmacokinetics of ciprofloxacin during extracorporeal membrane oxygenation. CRIT CARE RESUSC 2017; 19:8-14. [PMID: 29084496] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Significant interactions between drugs, extracorporeal membrane oxygenation (ECMO) circuits and critical illness may affect the pharmacokinetic properties of antibiotics in critically ill patients receiving ECMO. OBJECTIVE To describe the pharmacokinetic properties of ciprofloxacin during ECMO by integrating pre-clinical findings (ie, ex vivo and in vivo ovine models) to a critically ill patient. DESIGN, PARTICIPANTS AND INTERVENTION An ex vivo model of an ECMO circuit was used to describe ciprofloxacin concentration changes over 24 hours. An in vivo ovine model of ECMO was used to describe the population pharmacokinetic properties of ciprofloxacin in three different groups of sheep, and to investigate sources of pharmacokinetic variability. In the final phase, data from a 39-year-old critically ill man was used to validate the findings from the ovine pharmacokinetic model. RESULTS In the ex vivo model of ECMO circuits, the median concentrations of ciprofloxacin at baseline and at 24 hours after ciprofloxacin infusion were similar. The time course of ciprofloxacin in the in vivo ovine on ECMO model was adequately described by a two-compartment model. The final population primary parameter mean estimates were: clearance (CL), 0.21 L/kg/h (SD, 0.09 L/kg/h) and volume of distribution (Vd), 0.84 L/kg (SD, 0.12 L/kg). In the critically ill ECMO patient, the primary pharmacokinetic parameter estimates were: CL, 0.15 L/kg/h and Vd, 0.99 L/kg. CONCLUSIONS We provide preliminary evidence that ciprofloxacin dosing in ECMO patients should remain in line with the recommended dosing strategies for critically ill patients not receiving ECMO.
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Affiliation(s)
- Fabrice Sinnah
- Burns, Trauma and Critical Care Research Centre, University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.
| | - Kiran Shekar
- Critical Care Research Group, Brisbane, Australia
| | - Mohd H Abdul-Aziz
- Burns, Trauma and Critical Care Research Centre, University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - Hergen Buscher
- Intensive Care Services, St Vincent's Hospital, Sydney, Australia
| | - Sara D Diab
- Critical Care Research Group, Brisbane, Australia
| | - Stephanie Fisquet
- Burns, Trauma and Critical Care Research Centre, University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - Yoke L Fung
- Critical Care Research Group, Brisbane, Australia
| | | | - Claire Reynolds
- Intensive Care Services, St Vincent's Hospital, Sydney, Australia
| | - Sam Rudham
- Intensive Care Services, St Vincent's Hospital, Sydney, Australia
| | - Steven C Wallis
- Burns, Trauma and Critical Care Research Centre, University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - Susan Welch
- Intensive Care Services, St Vincent's Hospital, Sydney, Australia
| | - Jiao Xie
- Burns, Trauma and Critical Care Research Centre, University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | | | - Jason A Roberts
- Burns, Trauma and Critical Care Research Centre, University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
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