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Duranteau J, De Backer D, Donadello K, Shapiro NI, Hutchings SD, Rovas A, Legrand M, Harrois A, Ince C. The future of intensive care: the study of the microcirculation will help to guide our therapies. Crit Care 2023; 27:190. [PMID: 37193993 PMCID: PMC10186296 DOI: 10.1186/s13054-023-04474-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [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: 02/16/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023] Open
Abstract
The goal of hemodynamic resuscitation is to optimize the microcirculation of organs to meet their oxygen and metabolic needs. Clinicians are currently blind to what is happening in the microcirculation of organs, which prevents them from achieving an additional degree of individualization of the hemodynamic resuscitation at tissue level. Indeed, clinicians never know whether optimization of the microcirculation and tissue oxygenation is actually achieved after macrovascular hemodynamic optimization. The challenge for the future is to have noninvasive, easy-to-use equipment that allows reliable assessment and immediate quantitative analysis of the microcirculation at the bedside. There are different methods for assessing the microcirculation at the bedside; all have strengths and challenges. The use of automated analysis and the future possibility of introducing artificial intelligence into analysis software could eliminate observer bias and provide guidance on microvascular-targeted treatment options. In addition, to gain caregiver confidence and support for the need to monitor the microcirculation, it is necessary to demonstrate that incorporating microcirculation analysis into the reasoning guiding hemodynamic resuscitation prevents organ dysfunction and improves the outcome of critically ill patients.
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Affiliation(s)
- J Duranteau
- Department of Anesthesiology and Intensive Care, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), INSERM UMR-S 999, Paris-Saclay University, Le Kremlin-Bicêtre, France.
| | - D De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Boulevard du Triomphe 201, 1160, Brussels, Belgium
| | - K Donadello
- Anaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, University Hospital Integrated Trust of Verona, Verona, Italy
| | - N I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA, USA
| | - S D Hutchings
- King's College Hospital NHS Foundation Trust, London, UK
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
| | - A Rovas
- Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, Department of Medicine D, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - M Legrand
- Division of Critical Care Medicine, Department of Anesthesia and Perioperative Care, UCSF, San Francisco, USA
| | - A Harrois
- Department of Anesthesiology and Intensive Care, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), INSERM UMR-S 999, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - C Ince
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Lascarrou JB, Dumas F, Bougouin W, Legriel S, Aissaoui N, Deye N, Beganton F, Lamhaut L, Jost D, Vieillard-Baron A, Nichol G, Marijon E, Jouven X, Cariou A, Agostinucci J, Aissaoui-Balanant N, Algalarrondo V, Alla F, Alonso C, Amara W, Annane D, Antoine C, Aubry P, Azoulay E, Beganton F, Billon C, Bougouin W, Boutet J, Bruel C, Bruneval P, Cariou A, Carli P, Casalino E, Cerf C, Chaib A, Cholley B, Cohen Y, Combes A, Coulaud J, Da Silva D, Das V, Demoule A, Denjoy I, Deye N, Diehl J, Dinanian S, Domanski L, Dreyfuss D, Dubois-Rande J, Dumas F, Duranteau J, Empana J, Extramiana F, Fagon J, Fartoukh M, Fieux F, Gandjbakhch E, Geri G, Guidet B, Halimi F, Henry P, Jabre P, Joseph L, Jost D, Jouven X, Karam N, Lacotte J, Lahlou-Laforet K, Lamhaut L, Lanceleur A, Langeron O, Lavergne T, Lecarpentier E, Leenhardt A, Lellouche N, Lemiale V, Lemoine F, Linval F, Loeb T, Ludes B, Luyt C, Mansencal N, Mansouri N, Marijon E, Maury E, Maxime V, Megarbane B, Mekontso-Dessap A, Mentec H, Mira J, Monnet X, Narayanan K, Ngoyi N, Perier M, Piot O, Plaisance P, Plaud B, Plu I, Raphalen J, Raux M, Revaux F, Ricard J, Richard C, Riou B, Roussin F, Santoli F, Schortgen F, Sharshar T, Sideris G, Spaulding C, Teboul J, Timsit J, Tourtier J, Tuppin P, Ursat C, Varenne O, Vieillard-Baron A, Voicu S, Wahbi K, Waldmann V. Differential Effect of Targeted Temperature Management Between 32 °C and 36 °C Following Cardiac Arrest According to Initial Severity of Illness: Insights From Two International Data Sets. Chest 2022; 163:1120-1129. [PMID: 36445800 DOI: 10.1016/j.chest.2022.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/05/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Recent guidelines have emphasized actively avoiding fever to improve outcomes in patients who are comatose following resuscitation from cardiac arrest (ie, out-of-hospital cardiac arrest). However, whether targeted temperature management between 32 °C and 36 °C (TTM32-36) can improve neurologic outcome in some patients remains debated. RESEARCH QUESTION Is there an association between the use of TTM32-36 and outcome according to severity assessed at ICU admission using a previously derived risk score? STUDY DESIGN AND METHODS Data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (France) between May 2011 and December 2017 and in the Resuscitation Outcomes Consortium Continuous Chest Compressions (ROC-CCC) trial (United States and Canada) between June 2011 and May 2015 were used for this study. Severity at ICU admission was assessed through a modified version of the Cardiac Arrest Hospital Prognosis (mCAHP) score, divided into tertiles of severity. The study explored associations between TTM32-36 and favorable neurologic status at hospital discharge by using multiple logistic regression as well as in tertiles of severity for each data set. RESULTS A total of 2,723 patients were analyzed in the SDEC data set and 4,202 patients in the ROC-CCC data set. A favorable neurologic status at hospital discharge occurred in 728 (27%) patients in the French data set and in 1,239 (29%) patients in the North American data set. Among the French data set, TTM32-36 was independently associated with better neurologic outcome in the tertile of patients with low (adjusted OR, 1.63; 95% CI, 1.15-2.30; P = .006) and high (adjusted OR, 1.94; 95% CI, 1.06-3.54; P = .030) severity according to mCAHP at ICU admission. Similar results were observed in the North American data set (adjusted ORs of 1.36 [95% CI, 1.05-1.75; P = .020] and 2.42 [95% CI, 1.38-4.24; P = .002], respectively). No association was observed between TTM32-36 and outcome in the moderate groups of the two data sets. INTERPRETATION TTM32-36 was significantly associated with a better outcome in patients with low and high severity at ICU admission assessed according to the mCAHP score. Further studies are needed to evaluate individualized temperature control following out-of-hospital cardiac arrest.
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Affiliation(s)
- Jean Baptiste Lascarrou
- Université Paris Cité, INSERM, PARCC, Paris, France; Médecine Intensive Réanimation, University Hospital Center, Nantes, France; AfterROSC Network Group, Paris, France.
| | - Florence Dumas
- Université Paris Cité, INSERM, PARCC, Paris, France; Emergency Department, Cochin University Hospital, APHP, Paris, France
| | - Wulfran Bougouin
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical-Surgical Intensive Care Unit, Hopital Privé Jacques Cartier, Massy, France
| | - Stephane Legriel
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Surgical Intensive Care Unit, Mignot Hospital, Le Chesnay, France
| | - Nadia Aissaoui
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
| | - Nicolas Deye
- AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Lariboisière University Hospital, INSERM U942, Paris, France
| | | | - Lionel Lamhaut
- AfterROSC Network Group, Paris, France; SAMU de Paris-DAR Necker University Hospital-Assistance, Paris, France
| | - Daniel Jost
- Brigade des Sapeurs-Pompiers de Paris, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
| | - Eloi Marijon
- Université Paris Cité, INSERM, PARCC, Paris, France
| | | | - Alain Cariou
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
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Boutin L, Caballero M, Guarrigue D, Hammad E, Rennuit I, Delhaye N, Neuschwander A, Meyer A, Bitot V, Mathais Q, Boutonnet M, Julia P, Olaf M, Duranteau J, Hamada S. Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.02.013] [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: 11/17/2022]
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Hamada SR, Garrigue D, Nougue H, Meyer A, Boutonnet M, Meaudre E, Culver A, Gaertner E, Audibert G, Vigué B, Duranteau J, Godier A, Abback PS, Audibert G, Gauss T, Geeraerts T, Harrois A, Langeron O, Leone M, Pottecher J, Stecken L, Hanouz JL. Impact of platelet transfusion on outcomes in trauma patients. Crit Care 2022; 26:49. [PMID: 35189930 PMCID: PMC8862339 DOI: 10.1186/s13054-022-03928-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Trauma-induced coagulopathy includes thrombocytopenia and platelet dysfunction that impact patient outcome. Nevertheless, the role of platelet transfusion remains poorly defined. The aim of the study was 1/ to evaluate the impact of early platelet transfusion on 24-h all-cause mortality and 2/ to describe platelet count at admission (PCA) and its relationship with trauma severity and outcome.
Methods
Observational study carried out on a multicentre prospective trauma registry. All adult trauma patients directly admitted in participating trauma centres between May 2011 and June 2019 were included. Severe haemorrhage was defined as ≥ 4 red blood cell units within 6 h and/or death from exsanguination. The impact of PCA and early platelet transfusion (i.e. within the first 6 h) on 24-h all-cause mortality was assessed using uni- and multivariate logistic regression.
Results
Among the 19,596 included patients, PCA (229 G/L [189,271]) was associated with coagulopathy, traumatic burden, shock and bleeding severity. In a logistic regression model, 24-h all-cause mortality increased by 37% for every 50 G/L decrease in platelet count (OR 0.63 95% CI 0.57–0.70; p < 0.001). Regarding patients with severe hemorrhage, platelets were transfused early for 36% of patients. Early platelet transfusion was associated with a decrease in 24-h all-cause mortality (versus no or late platelets): OR 0.52 (95% CI 0.34–0.79; p < 0.05).
Conclusions
PCA, although mainly in normal range, was associated with trauma severity and coagulopathy and was predictive of bleeding intensity and outcome. Early platelet transfusion within 6 h was associated with a decrease in mortality in patients with severe hemorrhage. Future studies are needed to determine which doses of platelet transfusion will improve outcomes after major trauma.
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Jutant E, Meyrignac O, Beurnier A, Jais X, Pham T, Morin L, Boucly A, Bulifon S, Samy F, Harrois A, Jevnikar M, Noël N, Pichon J, Roche A, Seferian A, Soliman S, Duranteau J, Becquemont L, Monnet X, Sitbon O, Bellin M, Humbert M, Savale L, Montani D. Symptômes respiratoires et anomalies radiologiques dans le COVID long. Revue des Maladies Respiratoires Actualités 2022. [PMCID: PMC8709679 DOI: 10.1016/j.rmra.2021.11.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Riou B, Cariou A, Duranteau J, Langeron O, Crestani B, Adnet F, Raux M. Retour d’expérience sur la direction médicale de crise à l’Assistance publique–Hôpitaux de Paris pendant la crise Covid-19. Ann Fr Med Urgence 2020. [DOI: 10.3166/afmu-2020-0276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Un retour d’expérience sur la direction médicale de crise (DMC) pendant la première phase de l’épidémie de Covid-19 a été effectué à l’Assistance publique–Hôpitaux de Paris (AP–HP), le plus important centre hospitalier universitaire européen. L’AP–HP s’est dotée d’un directeur médical de crise (DMC) AP–HP, de six DMC de groupes hospitaliers (GH) et d’un DMC pour chacun des 39 sites hospitaliers. Le pilotage s’est appuyé sur des réunions quotidiennes de crise AP–HP et de GH, des groupes de travail disciplinaires et des tableaux de bord quotidiens fiabilisés qui ont permis d’optimiser les actions. Des actions innovantes ont été mises en place : cellules de régulation des entrées et des sorties de réanimation, suivi des patients infectés à domicile, traçage des contacts, transferts interrégionaux de patients de réanimation. Les éléments clés de la réussite ont été les relations entre direction générale et DMC, l’articulation entre l’échelon central (AP–HP) et celui des GH, la mobilisation de tous les acteurs vers un objectif unique identifié et la mobilisation de l’ensemble des soignants, y compris les étudiants. Parmi les pistes d’amélioration soulignées, il convient de citer la généralisation des DMC hors AP–HP, conformément à la réglementation, le développement de la connaissance du mode de fonctionnement de crise, l’anticipation de la formation à la gestion de crise, la réalisation d’une information quotidienne de l’ensemble des acteurs des actions menées dans une crise de longue durée et la participation des représentants des usagers. La gestion de la recherche en temps de crise reste à inventer au niveau national, voire européen.
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Roquilly A, Vigué B, Boutonnet M, Bouzat P, Buffenoir K, Cesareo E, Chauvin A, Court C, Cook F, de Crouy AC, Denys P, Duranteau J, Fuentes S, Gauss T, Geeraerts T, Laplace C, Martinez V, Payen JF, Perrouin-Verbe B, Rodrigues A, Tazarourte K, Prunet B, Tropiano P, Vermeersch V, Velly L, Quintard H. French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury. Anaesth Crit Care Pain Med 2020; 39:279-289. [PMID: 32229270 DOI: 10.1016/j.accpm.2020.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To update the French guidelines on the management of trauma patients with spinal cord injury or suspected spinal cord injury. DESIGN A consensus committee of 27 experts was formed. A formal conflict-of-interest (COI) policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. METHODS The committee studied twelve questions: (1) What are the indications and arrangements for spinal immobilisation? (2) What are the arrangements for pre-hospital orotracheal intubation? (3) What are the objectives of haemodynamic resuscitation during the lesion assessment, and during the first few days in hospital? (4) What is the best way to manage these patients to improve their long-term prognosis? (5) What is the place of corticosteroid therapy in the initial phase? (6) What are the indications for magnetic resonance imaging in the lesion assessment phase? (7) What is the optimal time for surgical management? (8) What are the best arrangements for orotracheal intubation in the hospital environment? (9) What are the specific conditions for weaning these patients from mechanical ventilation for? (10) What are the procedures for analgesic treatment of these patients? (11) What are the specific arrangements for installing and mobilising these patients? (12) What is the place of early intermittent bladder sampling in these patients? Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® Methodology. RESULTS The experts' work synthesis and the application of the GRADE method resulted in 19 recommendations. Among the recommendations formalised, 2 have a high level of evidence (GRADE 1+/-) and 12 have a low level of evidence (GRADE 2+/-). For 5 recommendations, the GRADE method could not be applied, resulting in expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. CONCLUSIONS There was significant agreement among experts on strong recommendations to improve practices for the management of patients with spinal cord injury.
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Affiliation(s)
- A Roquilly
- Anaesthesiology and Intensive Care Unit, Hôtel-Dieu, Nantes University Hospital, Nantes, France.
| | - B Vigué
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - M Boutonnet
- Hôpital d'instruction des armées Percy, Clamart, France
| | - P Bouzat
- Grenoble Alps Trauma Centre, Department of Anaesthesia and Critical Care, Grenoble University Hospital, Grenoble, France
| | - K Buffenoir
- Neurosurgery department, Nantes University Hospital, Nantes, France
| | - E Cesareo
- Edouard-Herriot University Hospital, Lyon, France
| | - A Chauvin
- Anaesthesiology and Intensive Care Unit, Lariboisière Hospital, AP-HP, Paris, France
| | - C Court
- Orthopaedic Surgery Department, Spine and Bone Tumor Unit, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - F Cook
- Unité de réanimation chirurgicale polyvalente et de polytraumatologie, Albert-Chenevier-Henri-Mondor University Hospital, Créteil, France
| | - A C de Crouy
- Unité SRPR/Réanimation chirurgicale, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - P Denys
- Orthopaedic department, Spine and Bone Tumor Unit. Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - J Duranteau
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - S Fuentes
- Aix-Marseille University, AP-HM, Department of Neurosurgery, University Hospital Timone, Marseille, France
| | - T Gauss
- Post-Intensive Care Rehabilitation Unit, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - T Geeraerts
- Anaesthesiology and Critical Care Department, Toulouse University Hospital, University of Toulouse 3-Paul Sabatier, Toulouse, France
| | - C Laplace
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - V Martinez
- Neuro Urology Unit, Department of Physical Medicine and Rehabilitation. Raymond Poincaré University Hospital, Garches, France
| | - J F Payen
- Department of Anaesthesia and Critical Care, Grenoble Alps University Hospital, 38000 Grenoble, France
| | - B Perrouin-Verbe
- Department of Neurological Physical Medicine and Rehabilitation, Nantes University Hospital, Nantes, France
| | - A Rodrigues
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - K Tazarourte
- Emergency department, Edouard-Herriot University Hospital, 69003 Lyon, France
| | - B Prunet
- Department of Anaesthesia and Critical Care, Val-de-Grâce Hospital, Paris, France
| | - P Tropiano
- Aix-Marseille University, AP-HM, Orthopaedic and traumatic surgery, University Hospital Timone, Marseille, France
| | - V Vermeersch
- Anaesthesiology and Intensive Care Unit, Brest University Hospital, Brest, France
| | - L Velly
- Aix Marseille University, AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France
| | - H Quintard
- Intensive Care Unit, Nice University Hospital, Pasteur 2 Hospital, Nice, France
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Harrois A, Anstey JR, Taccone FS, Udy AA, Citerio G, Duranteau J, Ichai C, Badenes R, Prowle JR, Ercole A, Oddo M, Schneider A, van der Jagt M, Wolf S, Helbok R, Nelson DW, Skrifvars MB, Cooper DJ, Bellomo R. Correction to: Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study. Ann Intensive Care 2019; 9:136. [PMID: 31802308 PMCID: PMC6892991 DOI: 10.1186/s13613-019-0610-z] [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: 11/19/2022] Open
Affiliation(s)
- A Harrois
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia. .,Department of Anesthesia and Surgical Intensive Care, CHU de Bicetre, APHP, Université Paris Sud, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France.
| | - J R Anstey
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - F S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - A A Udy
- Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - G Citerio
- School of Medicine and Surgery, University Milano Bicocca-Neurointensive Care, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - J Duranteau
- Department of Anesthesia and Surgical Intensive Care, CHU de Bicetre, APHP, Université Paris Sud, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France
| | - C Ichai
- Université Côte d'Azur, Centre hospitalier Universitaire de Nice, Service de Réanimation Polyvalente, Hôpital Pasteur 2, Nice, France
| | - R Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de Valencia, University of Valencia, Valencia, Spain
| | - J R Prowle
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A Ercole
- Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Oddo
- Department of Medical-Surgical Intensive Care Medicine, Faculty of Biology and Medicine, Centre Hospitalier Universitaire, Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - A Schneider
- Department of Medical-Surgical Intensive Care Medicine, Faculty of Biology and Medicine, Centre Hospitalier Universitaire, Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - M van der Jagt
- Department of Intensive Care, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - S Wolf
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - R Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - D W Nelson
- Section for Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - M B Skrifvars
- Division of Intensive Care, Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - D J Cooper
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - R Bellomo
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.,Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.,School of Medicine, University of Melbourne, Melbourne, Australia
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9
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Harrois A, Anstey JR, Taccone FS, Udy AA, Citerio G, Duranteau J, Ichai C, Badenes R, Prowle JR, Ercole A, Oddo M, Schneider A, van der Jagt M, Wolf S, Helbok R, Nelson DW, Skrifvars MB, Cooper DJ, Bellomo R. Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study. Ann Intensive Care 2019; 9:99. [PMID: 31486921 PMCID: PMC6728106 DOI: 10.1186/s13613-019-0574-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/27/2019] [Accepted: 08/26/2019] [Indexed: 12/24/2022] Open
Abstract
Background In traumatic brain injury (TBI) patients desmopressin administration may induce rapid decreases in serum sodium and increase intracranial pressure (ICP). Aim In an international multi-centre study, we aimed to report changes in serum sodium and ICP after desmopressin administration in TBI patients. Methods We obtained data from 14 neurotrauma ICUs in Europe, Australia and UK for severe TBI patients (GCS ≤ 8) requiring ICP monitoring. We identified patients who received any desmopressin and recorded daily dose, 6-hourly serum sodium, and 6-hourly ICP. Results We studied 262 severe TBI patients. Of these, 39 patients (14.9%) received desmopressin. Median length of treatment with desmopressin was 1 [1–3] day and daily intravenous dose varied between centres from 0.125 to 10 mcg. The median hourly rate of decrease in serum sodium was low (− 0.1 [− 0.2 to 0.0] mmol/L/h) with a median period of decrease of 36 h. The proportion of 6-h periods in which the rate of natremia correction exceeded 0.5 mmol/L/h or 1 mmol/L/h was low, at 8% and 3%, respectively, and ICPs remained stable. After adjusting for IMPACT score and injury severity score, desmopressin administration was independently associated with increased 60-day mortality [HR of 1.83 (1.05–3.24) (p = 0.03)]. Conclusions In severe TBI, desmopressin administration, potentially representing instances of diabetes insipidus is common and is independently associated with increased mortality. Desmopressin doses vary markedly among ICUs; however, the associated decrease in natremia rarely exceeds recommended rates and median ICP values remain unchanged. These findings support the notion that desmopressin therapy is safe.
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Affiliation(s)
- A Harrois
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia. .,Department of Anesthesia and Surgical Intensive Care, CHU de Bicetre, APHP, Université Paris Sud, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France.
| | - J R Anstey
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - F S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - A A Udy
- Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - G Citerio
- School of Medicine and Surgery, University Milano Bicocca-Neurointensive Care, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - J Duranteau
- Department of Anesthesia and Surgical Intensive Care, CHU de Bicetre, APHP, Université Paris Sud, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France
| | - C Ichai
- Université Côte d'Azur, Centre hospitalier Universitaire de Nice, Service de Réanimation Polyvalente, Hôpital Pasteur 2, Nice, France
| | - R Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de Valencia, University of Valencia, Valencia, Spain
| | - J R Prowle
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A Ercole
- Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Oddo
- Department of Medical-Surgical Intensive Care Medicine, Faculty of Biology and Medicine, Centre Hospitalier Universitaire, Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - A Schneider
- Department of Medical-Surgical Intensive Care Medicine, Faculty of Biology and Medicine, Centre Hospitalier Universitaire, Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - M van der Jagt
- Department of Intensive Care, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - S Wolf
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - R Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - D W Nelson
- Section for Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - M B Skrifvars
- Division of Intensive Care, Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - D J Cooper
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - R Bellomo
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.,Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.,School of Medicine, University of Melbourne, Melbourne, Australia
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Figueiredo S, Taconet C, Harrois A, Hamada S, Gauss T, Raux M, Duranteau J. How useful are hemoglobin concentration and its variations to predict significant hemorrhage in the early phase of trauma? A multicentric cohort study. Ann Intensive Care 2018; 8:76. [PMID: 29980953 PMCID: PMC6035120 DOI: 10.1186/s13613-018-0420-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 01/24/2018] [Accepted: 06/21/2018] [Indexed: 12/15/2022] Open
Abstract
Background The diagnostic value of hemoglobin (Hb) for detecting a significant hemorrhage (SH) in the early phase of trauma remains controversial. The present study aimed to assess the abilities of Hb measurements taken at different times throughout trauma management to identify patients with SH. Methods All consecutive adult trauma patients directly admitted to six French level-1 trauma centers with at least one prehospital Hb measurement were analyzed. The abilities of the following variables to identify SH (≥ 4 units of red blood cells in the first 6 h and/or death related to uncontrolled bleeding within 24 h) were determined and compared to that of shock index (SI): Hb as measured with a point-of-care (POC) device by the prehospital team on scene (POC-Hbprehosp) and upon patient’s admission to the hospital (POC-Hbhosp), the difference between POC-Hbhosp and POC-Hbprehosp (DeltaPOC-Hb) and Hb as measured by the hospital laboratory on admission (Hb-Labhosp). Results A total of 6402 patients were included, 755 with SH and 5647 controls (CL). POC-Hbprehosp significantly predicted SH with an area under ROC curve (AUC) of 0.72 and best cutoff values of 12 g/dl for women and 13 g/dl for men. POC-Hbprehosp < 12 g/dl had 90% specificity to predict of SH. POC-Hbhosp and Hb-Labhosp (AUCs of 0.92 and 0.89, respectively) predicted SH better than SI (AUC = 0.77, p < 0.001); best cutoff values of POC-Hbhosp were 10 g/dl for women and 12 g/dl for men. DeltaPOC-Hb also predicted SH with an AUC of 0.77, a best cutoff value of − 2 g/dl irrespective of the gender. For a same prehospital fluid volume infused, DeltaPOC-Hb was significantly larger in patients with significant hemorrhage than in controls. Conclusions Challenging the classical idea that early Hb measurement is not meaningful in predicting SH, POC-Hbprehosp was able, albeit modestly, to predict significant hemorrhage. POC-Hbhosp had a greater ability to predict SH when compared to shock index. For a given prehospital fluid volume infused, the magnitude of the Hb drop was significantly higher in patients with significant hemorrhage than in controls. Electronic supplementary material The online version of this article (10.1186/s13613-018-0420-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Figueiredo
- Department of Anaesthesia and Critical Care, Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France. .,Hôpitaux Universitaires Paris Sud, 94275, Le Kremlin Bicêtre, France.
| | - C Taconet
- Department of Anaesthesia and Critical Care, Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.,Hôpitaux Universitaires Paris Sud, 94275, Le Kremlin Bicêtre, France
| | - A Harrois
- Department of Anaesthesia and Critical Care, Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.,Hôpitaux Universitaires Paris Sud, 94275, Le Kremlin Bicêtre, France
| | - S Hamada
- Department of Anaesthesia and Critical Care, Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.,Hôpitaux Universitaires Paris Sud, 94275, Le Kremlin Bicêtre, France
| | - T Gauss
- Department of Anaesthesia and Critical Care, Beaujon Hospital, Hôpitaux Universitaires Paris-Nord Val-de-Seine, Assistance Publique - Hôpitaux de Paris, Clichy, France
| | - M Raux
- SSPI - Accueil des Polytraumatisés, Hôpital Universitaire Pitié Salpêtrière - Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France.,INSERM UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie, Paris, France
| | - J Duranteau
- Department of Anaesthesia and Critical Care, Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.,Hôpitaux Universitaires Paris Sud, 94275, Le Kremlin Bicêtre, France
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Hamada SR, Fromentin M, Ronot M, Gauss T, Harrois A, Duranteau J, Paugam-Burtz C. Femoral arterial and central venous catheters in the trauma resuscitation room. Injury 2018; 49:927-932. [PMID: 29602488 DOI: 10.1016/j.injury.2018.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 02/11/2018] [Accepted: 03/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Arterial and central venous femoral catheters (fAC-CVC) use during the initial management of severe trauma patients is not a standard technique in most trauma centers. Arguments in favor of their use are: continuous monitoring of blood pressure, safe drug administration, easy blood sampling and potentially large bore venous access. The lack of evidence makes the practice heterogeneous. The aim of the present study was to describe the use and complications of fAC-CVC in the trauma bay in two centers where they are routinely used. METHODS This was a retrospective analysis of routine fAC-CVC use from two French trauma centers. All patients admitted directly to the trauma resuscitation room were included. Demographic, clinical and biological data were collected from the scene to discharge to describe the use of catheters during initial trauma management including infectious, mechanical and thrombotic complications. RESULTS 243 pairs of femoral catheters were inserted among 692 patients admitted in both trauma centers. Femoral AC-CVC use was more frequent in critically ill patients with higher ISS 26 [17; 41] vs 13 [8; 24], p < 0.001(median [quartile 1-3]), severe traumatic brain injury (AIS head 1[0-4] vs 0[0-3], p < 0.001), lower systolic blood pressure, 92 (37) vs 113 (28) mmHg, p < 0.001 mean (standard deviation), lower haemoglobin on arrival, 10.9 (3) vs 13.3 (2.1) g/dL (p < 0.001), and higher blood lactate concentration, 4.0 (3.9) vs 2.1 (1.8) mmol/L (p < 0.001). In patients with fAC-CVC use time in the trauma room was longer, 46 [40;60] vs 30 [20;40] minutes (p < 0.05). In total 52 colonizations and 3 bloodstream infections were noted in 1000 catheter days. An incidence of 12% of mechanical complications and of 42% deep venous thromboses were observed. Of the latter none was associated with confirmed pulmonary embolism. CONCLUSION Femoral AC-CVC appeared to be deployed more often in critically ill patients, presenting with shock and/or traumatic brain injury in particular. The observed rate of complications in this sample seems to be low compared to reported rates.
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Affiliation(s)
- S R Hamada
- Anaesthesia and Critical Care Department, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Université Paris Sud, 78 rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France.
| | - M Fromentin
- Anaesthesia and Critical Care Department, AP-HP, Hôpital Cochin, Hôpitaux Universitaires Paris-Centre, 27 Rue du Faubourg Saint-Jacques, Paris, 75014, France
| | - M Ronot
- Radiology Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Université Paris Diderot, 100 rue du Général Leclerc, Clichy, Paris 7, 92110, France
| | - T Gauss
- Anaesthesia and Critical Care Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Université Paris Diderot, 100 rue du Général Leclerc, Clichy, Paris 7, 92110, France
| | - A Harrois
- Anaesthesia and Critical Care Department, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Université Paris Sud, 78 rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France
| | - J Duranteau
- Anaesthesia and Critical Care Department, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Université Paris Sud, 78 rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France
| | - C Paugam-Burtz
- Anaesthesia and Critical Care Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Université Paris Diderot, 100 rue du Général Leclerc, Clichy, Paris 7, 92110, France
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Laplace C, Harrois A, Hamada S, Duranteau J. Traumatismes thoraciques non chirurgicaux. Méd Intensive Réa 2018. [DOI: 10.3166/rea-2018-0006] [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]
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13
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Hamada SR, Espina C, Guedj T, Buaron R, Harrois A, Figueiredo S, Duranteau J. High level of venous thromboembolism in critically ill trauma patients despite early and well-driven thromboprophylaxis protocol. Ann Intensive Care 2017; 7:97. [PMID: 28900890 PMCID: PMC5595705 DOI: 10.1186/s13613-017-0315-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 02/13/2017] [Accepted: 08/29/2017] [Indexed: 12/05/2022] Open
Abstract
Background Venous thromboembolism (VTE) is one of the most common preventable causes of in-hospital death in trauma patients surviving their injuries. We assessed the prevalence, incidence and risk factors for deep venous thrombosis (DVT) and pulmonary embolism (PE) in critically ill trauma patients, in the setting of a mature and early mechanical and pharmacological thromboprophylaxis protocol. Methods This was a prospective observational study on a cohort of patients from a surgical intensive care unit of a university level 1 trauma centre. We enrolled consecutive primary trauma patients expected to be in intensive care for ≥48 h. Thromboprophylaxis was protocol driven. DVT screening was performed by duplex ultrasound of upper and lower extremities within the first 48 h, between 5 and 7 days and then weekly until discharge. We recorded VTE risk factors at baseline and on each examination day. Independent risk factors were analysed using a multivariate logistic regression. Results In 153 patients with a mean Injury Severity Score of 23 ± 12, the prevalence of VTE was 30.7%, 95 CI [23.7–38.8] (29.4% DVT and 4.6% PE). The incidence was 18%, 95 CI [14–24] patients-week. The median time of apparition of DVT was 6 days [1; 4]. The global protocol compliance was 77.8% with a median time of introduction of the pharmacological prophylaxis of 1 day [1; 2]. We identified four independent risk factors for VTE: central venous catheter (OR 4.39, 95 CI [1.1–29]), medullar injury (OR 5.59, 95 CI [1.7–12.9]), initial systolic arterial pressure <80 mmHg (OR 3.64, 95 CI [1.3–10.8]), and pelvic fracture (OR 3.04, 95 CI [1.2–7.9]). Conclusion Despite a rigorous, protocol-driven thromboprophylaxis, critically ill trauma patients showed a high incidence of VTE. Further research is needed to tailor pharmacological prophylaxis and balance the risks and benefits. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0315-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S R Hamada
- Department of Anaesthesia and Critical Care, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
| | - C Espina
- Department of Anaesthesia and Critical Care, AP-HP, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, University Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - T Guedj
- Department of Radiology, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - R Buaron
- Department of Radiology, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - A Harrois
- Department of Anaesthesia and Critical Care, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - S Figueiredo
- Department of Anaesthesia and Critical Care, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - J Duranteau
- Department of Anaesthesia and Critical Care, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
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Leger P, Bonnin P, Moretti R, Tanaka S, Duranteau J, Renolleau S, Baud O, Charriaut-Marlangue C. Early Recruitment of Cerebral Microcirculation by Neuronal Nitric Oxide Synthase Inhibition in a Juvenile Ischemic Rat Model. Cerebrovasc Dis 2015; 41:40-9. [DOI: 10.1159/000441663] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/13/2015] [Indexed: 11/19/2022] Open
Abstract
Background: The development of collateral circulation is proposed as an inherent compensatory mechanism to restore impaired blood perfusion after ischemia, at least in the penumbra. We have studied the dynamic macro- and microcirculation after ischemia-reperfusion in the juvenile rat brain and evaluated the impact of neuronal nitric oxide synthase (nNOS) inhibition on the collateral flow. Methods: Fourteen-day-old (P14) rats were subjected to ischemia-reperfusion and treated with either PBS or 7-nitroindazole (7-NI, an nNOS inhibitor, 25 mg/kg). Arterial blood flow (BF) was measured using 2D-color-coded pulsed ultrasound imaging. Laser speckle contrast (LSC) imaging and sidestream dark-field videomicroscopy were used to measure cortical and microvascular BF, respectively. Results: In basal conditions, 7-NI reduced BF in the internal carotids (by ∼25%) and cortical (by ∼30%) BF, as compared to PBS. During ischemia, the increased mean BF velocity in the basilar trunk after both PBS and 7-NI demonstrated the establishment of collateral support and patency. Upon re-flow, BF immediately recovered to basal values in the internal carotid arteries under both conditions. The 7-NI group showed increased collateral flow in the penumbral tissue during early re-flow compared to PBS, as shown with both LSC imaging and side-stream dark-field videomicroscopy. The proportion of perfused capillaries was significantly increased under 7-NI as compared to PBS when given before ischemia (67.0 ± 3.9 vs. 46.8 ± 8.8, p < 0.01). Perfused capillaries (63.1 ± 17.7 vs. 81.1 ± 20.7, p < 0.001) and the BF index (2.4 ± 0.6 vs. 1.3 ± 0.1, p < 0.001) significantly increased under 7-NI given at the re-flow onset. Conclusions: Collateral support in the penumbra is initiated during ischemia, and may be increased during early re-flow by neuronal NOS inhibition (given in pre- and post-treatment), which may preserve brain tissue in juvenile rats.
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Duranteau J. Nouvelles recommandations SFAR dans le choc hémorragique. Transfus Clin Biol 2015. [DOI: 10.1016/j.tracli.2015.06.212] [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: 10/22/2022]
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Schnell D, Reynaud M, Venot M, Le Maho AL, Dinic M, Baulieu M, Ducos G, Terreaux J, Zeni F, Azoulay E, Meziani F, Duranteau J, Darmon M. Resistive Index or color-Doppler semi-quantitative evaluation of renal perfusion by inexperienced physicians: results of a pilot study. Minerva Anestesiol 2014; 80:1273-1281. [PMID: 24569358] [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: 06/03/2023]
Abstract
BACKGROUND Doppler-based renal resistive index (RI) calculation may help in the early detection of acute kidney injury (AKI). Its feasibility and reproducibility by inexperienced operators remain unknown. The main objective of this study was to compare performances of junior and senior operators in assessing renal perfusion using both the semiquantitative color-Doppler scale and RI calculation. METHODS Prospective cohort study performed in 3 ICUs. Inexperienced juniors physicians attended a half-day course on renal perfusion assessment using RI calculation and color-Doppler (from 0, absence of renal perfusion; to 3, renal vessels identifiable in the entire field of view). Junior and senior operators used both methods in 69 mechanically ventilated patients, in blind fashion. RESULTS Failure to obtain RI occurred for a junior operator in a single patient. RI and color-Doppler semi-quantitative values obtained by operators were correlated (r²=0.64 and r²=0.61, respectively). Systematic bias across operators as assessed using Bland-Altman plots was negligible (-0.001 and -0.29, respectively), although precision was limited (95% confidence intervals, +0.105 to -0.107 and +0.98 to -1.04, respectively). RI calculation and semi-quantitative assessment performed well for diagnosing persistent AKI (area under the receiver-operating characteristic curve, 0.84 [95% confidence interval, 0.73-0.97] and 0.87 [0.77-0.97], respectively). CONCLUSION A brief course on renal Doppler allowed inexperienced operators to assess effectively renal perfusion with a good reliability when compared to senior operators. In addition, our results suggest the good diagnostic performance of both Doppler-based RI and semi-quantitative renal perfusion assessment in predicting short-term renal dysfunction reversibility.
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Affiliation(s)
- D Schnell
- Réanimation médicale, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, Paris, France, Paris-7 University, Paris, France -
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Harrois A, Baudry N, Vicaut E, Duranteau J. 0921. Effect of norepinephrine on intestinal oxygenation during fluid resuscitation of hemorrhagic shock in mice. Intensive Care Med Exp 2014. [PMCID: PMC4798013 DOI: 10.1186/2197-425x-2-s1-o29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Vardon F, Harrois A, Duranteau J, Geeraerts T. [The initial management in intensive care of pelvic ring injury patients]. ACTA ACUST UNITED AC 2014; 33:344-52. [PMID: 24833399 DOI: 10.1016/j.annfar.2014.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/15/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
Abstract
Pelvic trauma care is complex since it is frequently associated with multiple injuries and may lead to dramatic and uncontrollable haemorrhage. After pelvic trauma, the mortality, around 8 to 10%, is mainly related to severe pelvic hemorrhage but also to extrapelvic injuries (thoracic, abdominal or brain injuries). It is therefore crucial to manage pelvic trauma in specialized trauma center. The initial trauma assessment aims to determine the role of the pelvic injury in hemorrhage to define the therapeutic strategy of pelvic trauma care (arterial embolisation/pelvic ring stabilisation). This review was performed with a systematic review of the literature; it describes the pelvic fracture pathophysiology, and the efficacy and safety of haemostatic procedures and with their respective indications. A decision making algorithm is proposed for the treatment of trauma patients with pelvic fracture.
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Affiliation(s)
- F Vardon
- Pôle anesthésie-réanimation, équipe d'accueil « Modélisation de l'agression tissulaire et nociceptive », université Toulouse 3 Paul-Sabatier, centre hospitalier universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex 09, France
| | - A Harrois
- Département d'anesthésie-réanimation chirurgicale, centre hospitalier universitaire de Bicêtre, hôpitaux universitaire Paris-Sud, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - J Duranteau
- Département d'anesthésie-réanimation chirurgicale, centre hospitalier universitaire de Bicêtre, hôpitaux universitaire Paris-Sud, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - T Geeraerts
- Pôle anesthésie-réanimation, équipe d'accueil « Modélisation de l'agression tissulaire et nociceptive », université Toulouse 3 Paul-Sabatier, centre hospitalier universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex 09, France.
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Lund K, Peltzer J, Montespan F, Oru N, Vicaut E, Duranteau J, Lataillade JJ. Effects of mesenchymal stromal cells on human umbilical vein endothelial cells in in vitro sepsis models. Crit Care 2014. [PMCID: PMC4273918 DOI: 10.1186/cc14075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Figueiredo S, Vigué B, Benhamou D, Duranteau J. Emergency reversal of heparin overdose in a neurosurgical patient guided by thromboelastography. Br J Anaesth 2013; 111:303-4. [DOI: 10.1093/bja/aet245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
The initial management of trauma patient is a critical period aiming at: stabilizing the vital functions; following a rigorous injury assessment; defining a therapeutic strategy. This management has to be organized to minimize loss of time that would be deleterious for the patients outcome. Thus, before patient arrival, the trauma team alert should lead to the initiation of care procedures adapted to the announced severity of the patient. Moreover, each individual should know its role in advance and the team should be managed by only one individual (the trauma leader) to avoid conflicts of decision. A rapid trauma injury assessment aims not only at guiding resuscitation (chest drainage, pelvic contention, to define the mean arterial pressure goal) but also to decide a critical intervention in case of hemodynamic instability (laparotomy, thoracotomy, arterial embolisation). This initial assessment includes a chest and a pelvic X-ray, abdominal ultrasound (extended to the lung) and transcranial Doppler (TCD). The whole body scanner with administration of intravenous contrast material is the cornerstone of the injury assessment but can be done for patients stabilized after the initial resuscitation.
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Affiliation(s)
- A Harrois
- Département d'anesthésie-réanimation chirurgicale, université Paris-Sud, hôpital de Bicêtre, hôpitaux universitaires Paris-Sud, Assistance publique-Hôpitaux de Paris, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
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Harrois A, Mertes PM, Tazarourte K, Atchabahian A, Duranteau J, Langeron O, Vigué B. The initial management of trauma patients is an especially relevant setting to evaluate professional practice patterns. Ann Fr Anesth Reanim 2013; 32:492-496. [PMID: 23916520 DOI: 10.1016/j.annfar.2013.07.007] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The initial management of trauma patients in a dedicated location is a crucial step in the treatment of these patients. The characteristics of this phase are such that they meet all the criteria for a professional practice patterns evaluation (PPPE or PPE): formalized protocols, clear-cut timeframes, specific roles of different stakeholders, and multidisciplinary medical and paramedical team. In addition, the expected result of the PPE approach, improved care, will have a direct impact on patient outcomes. This PPE modeled on an audit aims at evaluating the care process based on representative criteria. These criteria should include: the planned structure and organization; the protocols; the strategy and time frames for procedure implementation; the relationships between stakeholders; the results. For each criterion, differences between the expected characteristics and the observed reality are analyzed. The prospective (independent observer or video) and/or retrospective (records, register) collection of data during 20 consecutive encounters should be sufficient to identify dysfunctions and provide guidance on the changes that need to be implemented. The proposed data collection form includes 15 items representative of the five defined criteria. These items often describe departmental choice. The pursuit of quality is defined first in terms of medical and paramedical results, but also in administrative and financial terms. Following the analysis produced by a representative group of actors, a multidisciplinary discussion of the results should be followed by proposals for simple changes approved by everyone. After a few months of implementation, the impact of the proposed improvement measures will be assessed by a new survey. This approach, in addition to improving the quality of care, allows better team stress management and greater work enjoyment.
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Affiliation(s)
- A Harrois
- Département d'anesthésie-réanimation, centre universitaire de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
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Asehnoune K, Roquilly A, Harrois A, Duranteau J. Actualités sur le choc hémorragique. Réanimation 2012. [DOI: 10.1007/s13546-012-0452-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Figueiredo S, Bonnin RA, Poirel L, Duranteau J, Nordmann P. Identification of the naturally occurring genes encoding carbapenem-hydrolysing oxacillinases from Acinetobacter haemolyticus, Acinetobacter johnsonii, and Acinetobacter calcoaceticus. Clin Microbiol Infect 2011; 18:907-13. [PMID: 22128805 DOI: 10.1111/j.1469-0691.2011.03708.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Carbapenem resistance is increasingly being reported among Acinetobacter species, and results mostly from the expression of acquired carbapenem-hydrolysing oxacillinases (CHDLs). Several Acinetobacter species intrinsically possess chromosomal CHDL genes: Acinetobacter baumannii (bla(OXA-51) ), Acinetobacter radioresistens (bla(OXA-23) ), and Acinetobacter lwoffii (bla(OXA-134) ). We aimed to identify the progenitors of novel CHDL-encoding genes for identification of potential reservoirs. We performed PCR screening using degenerated internal primers designed from a sequence alignment of the known CHDLs (OXA-23, OXA-40, OXA-51, OXA-58, OXA-134, and OXA-143) applied to a collection of 50 Acinetobacter strains belonging to 23 different species. Two strains of Acinetobacter johnsonii, one strain of Acinetobacter calcoaceticus and two strains of Acinetobacter haemolyticus were found to harbour, respectively, the totally novel bla(OXA-211) -like, bla(OXA-213) -like and bla(OXA-214) -like genes. In addition, the complete genomes of those three species available in GenBank, i.e. one A. johnsonii genome, four A. calcoaceticus genomes, and one A. haemolyticus genome, were analysed and found to be positive for the presence of bla(OXA211) -like, bla(OXA-213) -like and bla(OXA-214) -like genes, respectively. The β-lactamases OXA-211, OXA-213 and OXA-214 are diverse, with amino acid identities ranging from 53% to 76%, as compared with the naturally occurring OXA-51-like CHDL from A. baumannii. These β-lactamases showed a peculiar hydrolysis profile, including mostly penicillins and carbapenems. Regarding bla(OXA-23) in A. radioresistens and bla(OXA-134) in A. lwoffii, these genes were not expressed (or expressed at a non-significant level) in their host. Detection of these β-lactamase genes might be used as a useful tool for accurate identification of these Acinetobacter species.
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Affiliation(s)
- S Figueiredo
- Service de Bactériologie-Virologie, INSERM U914 Emerging Resistance to Antibiotics, Département Anesthésie-Réanimation, Hôpital de Bicêtre, Assistance Publique/Hôpitaux de Paris, Faculté de Médecine et Université Paris-Sud, K.-Bicêtre, France
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Chalhoub V, Pottecher J, Asehnoune K, Mazoit JX, Duranteau J, Benhamou D. Cytokine response and reactive oxygen species production after low- and intermediate-risk surgery. Acta Anaesthesiol Scand 2011; 55:549-57. [PMID: 21418155 DOI: 10.1111/j.1399-6576.2011.02419.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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: 11/30/2022]
Abstract
BACKGROUND Cytokines are secreted locally in response to surgery and may be released into the systemic circulation. Reactive oxygen species (ROS) production is involved in various inflammatory conditions. The aims of the study were to examine the magnitude of surgical stress on the modulation of immune response and ROS production. METHODS Patients undergoing low- and intermediate-risk surgery (n=32) were enrolled. Blood samples for tumor necrosis factor (TNF)α, interleukin (IL)1β and IL10 assays were obtained before anesthesia, immediately after extubation, at 24 and 72 h after surgery. Measurement in whole-blood cultures of ex vivo lipopolysaccharide (LPS) and Staphylococcus aureus Cowan (SAC)-stimulated production of cytokines was carried out. The pro-oxidant potency of the whole serum was assessed in human umbilical vein endothelial cells using a fluorescent probe after stimulation by the plasma collected at the same time intervals. RESULTS TNFα, IL1β and IL10 did not increase significantly after surgery in either group. Whole-blood cultures response to LPS and SAC stimulation decreased for IL1β at the end of surgery in the two groups and returned to normal within 24 h after surgery. LPS- and SAC-induced IL10 production increased significantly at 24 h in the low-risk surgery group. ROS production was greater after more stressful surgery and was correlated to morphine consumption. CONCLUSION Cytokine release in the systemic circulation was not well correlated to the magnitude of surgical stress, whereas transient immune hyporesponsiveness was seen after moderately stressful surgery. ROS production might be a more accurate indicator of the severity of surgical trauma.
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Affiliation(s)
- V Chalhoub
- Département d'Anesthésie-Réanimation, Hôpital Bicêtre, Univ Paris-Sud, Le Kremlin-Bicêtre, France.
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Harrois A, Duranteau J. Le point sur la coagulation — Coagulopathies et syndromes hémorragiques en réanimation. Réanimation 2011. [DOI: 10.1007/s13546-010-0033-1] [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: 11/24/2022]
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Bouglé A, Duranteau J, Benhamou D. [Haemodynamic monitoring or output cardiac monitoring?]. Ann Fr Anesth Reanim 2010; 29:743-744. [PMID: 20832235 DOI: 10.1016/j.annfar.2010.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 07/23/2010] [Indexed: 05/29/2023]
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Geeraerts T, Haïk W, Tremey B, Duranteau J, Vigué B. [Coagulation disorders after traumatic brain injury: pathophysiology and therapeutic implications]. ACTA ACUST UNITED AC 2010; 29:e177-81. [PMID: 20655167 DOI: 10.1016/j.annfar.2010.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Early activation of coagulation is common after traumatic brain injury. Its origin is probably mainly intracerebral, due to tissue factor release from the injured brain. Abnormalities in blood coagulation tests are associated with poor neurological prognosis. Coagulation activation may induce disseminated intravascular coagulation and fibrinolysis. Disseminated intravascular coagulation is linked to brain ischemia caused by intravascular microthrombosis. This review will focus on pathophysiology of coagulation disorders after traumatic brain injury, and on their implications for therapeutic approaches.
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Affiliation(s)
- T Geeraerts
- Département d'anesthésie-réanimation chirurgicale, hôpital de Bicêtre, AP-HP, faculté de médecine, université Paris Sud, 78 rue du Général-Leclerc, Le-Kremlin-Bicêtre, France.
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Geeraerts T, Roulleau P, Cheisson G, Aidan K, Leguen M, Duranteau J, Benhamou D. Stress induced by simulation-based training in anesthesiologist residents. Crit Care 2010. [PMCID: PMC2934288 DOI: 10.1186/cc8687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chatti R, de Rudniki S, Marqué S, Dumenil AS, Descorps-Declère A, Cariou A, Duranteau J, Aout M, Vicaut E, Cholley BP. Comparison of two versions of the Vigileo-FloTrac system (1.03 and 1.07) for stroke volume estimation: a multicentre, blinded comparison with oesophageal Doppler measurements. Br J Anaesth 2009; 102:463-9. [PMID: 19244262 DOI: 10.1093/bja/aep020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Our aim was to evaluate the validity of stroke volume measurements obtained using the Vigileo-FloTrac system in comparison with those obtained using oesophageal Doppler considered as a reference. METHODS Prospective, multicentre study (four university hospitals), in which investigators were blinded to stroke volume values acquired simultaneously with the other technique. Two different versions of the Vigileo software (1.03 and 1.07) were studied and compared over two consecutive periods of time. Forty critically ill patients (three ICUs) and 20 high-risk surgical patients (one operating theatre) were studied over a 6-month period. RESULTS Two hundred and forty paired stroke volume values obtained using the second version of the Vigileo (1.07) yielded better correlation and agreement (R=0.48, P<0.001; bias=4 ml, limits of agreement: +/- 41 ml) than the 207 paired values obtained using version 1.03 (R=0.12, P=0.1; bias=1 ml, limits of agreement: +/- 75 ml). However, even with the second version, the percentage error in stroke volume measurement was 58%, a value still above the range considered clinically acceptable (30%). CONCLUSIONS The precision of stroke volume estimation using Vigileo-FloTrac has improved with the second version of the software (1.07), but remains insufficient to allow the replacement of the reference technique in the population studied.
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Affiliation(s)
- R Chatti
- Département d'Anesthésie-Réanimation, AP-HP, Hôpital Lariboisière, Paris, France
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Lemiale V, Huet O, Vigué B, Mathonnet A, Spaulding C, Mira J, Carli P, Duranteau J, Cariou A. Changes in cerebral blood flow and oxygen extraction during post-resuscitation syndrome. Resuscitation 2008. [DOI: 10.1016/j.resuscitation.2008.03.106] [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: 11/16/2022]
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32
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Geeraerts T, Merceron S, Benhamou D, Vigue B, Duranteau J. Noninvasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Crit Care 2008. [PMCID: PMC4088488 DOI: 10.1186/cc6338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pajot S, Geeraerts T, Leblanc PE, Duranteau J, Benhamou D. Hiccup during weaning from mechanical ventilation: the use of nefopam. Br J Anaesth 2007; 99:748-9. [PMID: 17933805 DOI: 10.1093/bja/aem287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Leblanc PE, Cheisson G, Geeraerts T, Tazarourte K, Duranteau J, Vigué B. Le syndrome de perte de sel d'origine cérébrale existe-t-il? ACTA ACUST UNITED AC 2007; 26:948-53. [DOI: 10.1016/j.annfar.2007.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Delayed neurological deficit occurs among 30% of patients after aneurysmal subarachnoid haemorrhage, mainly related to cerebral vasospasm. The early detection of cerebral ischemia remains problematic. Conventional cerebral monitoring (as intracranial pressure and cerebral perfusion pressure) appears to be insufficient, because cerebral ischemia may occur without elevated intracranial pressure. Global cerebral monitoring as venous jugular oxygen saturation are useful for regional monitoring. Local monitoring as oxygen tissue partial pressure (PtiO2) and microdialysis are sensible for brain ischemia detection, but may also ignore episodes occurring in non-monitored brain area. For the detection of most episodes of brain ischemia, several monitoring system should be use performing a multimodal intracerebral monitoring. Brain microdialysis and oxygen tissue partial pressure are promising monitoring system.
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Affiliation(s)
- T Geeraerts
- Service du Professeur-Benhamou, département d'anesthésie-réanimation chirurgicale, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, et faculté de médecine Paris-Sud, Le Kremlin-Bicêtre, France.
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36
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Pottecher J, Deruddre S, Duranteau J. Effects of Vasoactive Agents on the Gastrointestinal Microcirculation in Septic Shock. Intensive Care Med 2007. [DOI: 10.1007/978-0-387-49518-7_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: 10/22/2022]
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37
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Repéssé X, Geeraerts T, Pottecher J, Vigué B, Benhamou D, Duranteau J. [Coma with bilateral mydriasis after use of transdermal scopolamine in ICU]. ACTA ACUST UNITED AC 2007; 26:1070-2. [PMID: 17961969 DOI: 10.1016/j.annfar.2007.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Accepted: 09/24/2007] [Indexed: 11/30/2022]
Abstract
We report the case of an ICU patient with previous medical history of head trauma with hydrocephalus requiring ventricular derivation, presenting a coma (Glasgow Coma Score=8) with bilateral mydriasis after the use of transdermal scopolamine (1 mg) for profuse bronchial secretions. Neurological explorations (CT-scan and electroencephalogram) confirmed the absence of organic cause to the neurological deterioration. Neurological status rapidly and completely improved after removal of transdermal scopolamine suggesting a central anticholinergic syndrome.
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Affiliation(s)
- X Repéssé
- Département d'anesthésie-réanimation chirurgicale, hôpital de Bicêtre, APHP, faculté de médecine, université Paris-Sud, 94275 Le Kremlin-Bicêtre, France
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Huet O, Kinirons B, Dupic L, Lajeunie E, Mazoit JX, Benhamou D, Vicaut E, Duranteau J. Induced mild hypothermia reduces mortality during acute inflammation in rats. Acta Anaesthesiol Scand 2007; 51:1211-6. [PMID: 17850561 DOI: 10.1111/j.1399-6576.2007.01419.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [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: 11/30/2022]
Abstract
BACKGROUND Hypothermia has been proposed as a therapeutic possibility in brain trauma, cardiac arrest and hemorrhagic shock. Experimental studies have shown that hypothermia may act by modulating the inflammatory response during endotoxemia. This study was carried out to test whether hypothermia could protect rats from endotoxemic insult. METHODS After general anesthesia and oro-tracheal intubation, Sprague-Dawley rats were randomly assigned to either a hypothermic group or normothermic group. In each group, rats received intraperitoneal lipopolysaccharide (LPS) (10 or 20 mg/kg). Blood samples were taken prior to and 2 h after LPS injection to measure blood gases, liver enzymes, muscular enzymes, tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) plasma levels. After 2 h of hypothermia, the rats were extubated and brought back to their cages. The mortality rate was observed for 7 days following endotoxemia. In a second set of experiments, hypothermia was induced 1 h after endotoxemia (10 mg/kg of intraperitoneal LPS) and the mortality rate was observed for the following 7 days. RESULTS The survival rate was significantly increased in the hypothermic group relative to the normothermic group, regardless of LPS dose. This increased survival rate was also observed when hypothermia was induced 1 h after endotoxemia. In the hypothermic group, IL-10 and the DeltaIL-10/DeltaTNF-alpha ratio were significantly increased relative to those in the normothermic group. CONCLUSION Induced mild hypothermia reduces mortality during endotoxemia in rats. The modulation of the inflammatory response, with an increase in anti-inflammatory cytokines, may be involved in this protective effect.
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Affiliation(s)
- O Huet
- Université Paris XI, Département d'Anesthésie Réanimation, Hôpital Bicêtre, Le Kremlin Bicêtre, France
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Baussart B, Cheisson G, Compain M, Leblanc PE, Tadie M, Benhamou D, Duranteau J. Multimodal cerebral monitoring and decompressive surgery for the treatment of severe bacterial meningitis with increased intracranial pressure. Acta Anaesthesiol Scand 2006; 50:762-5. [PMID: 16987375 DOI: 10.1111/j.1399-6576.2006.01038.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [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: 11/30/2022]
Abstract
Bacterial meningitis is still associated with a high mortality, mainly because of cerebral herniation as a result of increased intracranial pressure. Published data stress the necessity of an early diagnosis and immediate start of antibiotic therapy. Nevertheless, there are only few reports in which therapeutic strategy was based on the monitoring and the reduction of intracranial pressure (ICP). We report one case of bacterial meningitis caused by Neisseria meningitidis with an initial ICP value of 60 mmHg, which was treated by large hemicraniectomy and ventriculostomy, leading to a favorable neurological long-term result. The surgical decision was accelerated by an accurate ICP evaluation based on cerebral monitoring [transcranial Doppler ultrasonography (TCD) and intracranial ICP-device]. In selected patients with bacterial meningitis and clinical and radiological evidence of elevated ICP, cerebral monitoring and aggressive reduction of ICP may be crucial to improve survival and neurological outcome. When maximal medical ICP treatment fails to reduce severe intracranial hypertension, decompressive craniectomy should be rapidly proposed.
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Affiliation(s)
- B Baussart
- Department of Neurosurgery, Bicetre Hospital, Le Kremlin-Bicetre, France
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40
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Therade-Matharan S, Laemmel E, Carpentier S, Obata Y, Levade T, Duranteau J, Vicaut E. Reactive oxygen species production by mitochondria in endothelial cells exposed to reoxygenation after hypoxia and glucose depletion is mediated by ceramide. Am J Physiol Regul Integr Comp Physiol 2005; 289:R1756-62. [PMID: 16278342 DOI: 10.1152/ajpregu.00480.2004] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In endothelium, reoxygenation after hypoxia (H/R) has been shown to induce production of reactive oxygen species (ROS) by complex III of the mitochondrial respiratory chain. The purpose of the present study was to test the involvement of ceramide in this phenomenon. Human umbilical vein endothelial cells underwent 2 h of hypoxia (Po2, ∼20 mmHg) without glucose and 1 h of reoxygenation (Po2, ∼120 mmHg) with glucose. ROS production was measured by the fluorescent marker 2′,7′-dichlorodihydrofluorescein diacetate, and cell death by propidium iodide. We showed that 1) after 1 h of reoxygenation, fluorescence had risen and that ROS production was inhibited by desipramine, an inhibitor of sphingomyelinase, an enzyme responsible for ceramide production (126 ± 7% vs. 48 ± 12%, P < 0.05); 2) administration of ceramide ( N-acetylsphingosine) per se (i.e., in the absence of H/R) induced ROS production (65 ± 3%), which was inhibited by complex III inhibitor: antimycin A (24 ± 3%, P < 0.0001), or stigmatellin (31 ± 2%, P < 0.0001); 3) hypoxia/reoxygenation-induced ROS production was not affected by either ceramide-activated protein kinase inhibitor dimethyl aminopurine or mitochondrial permeability transition inhibitor cyclosporin A but was significantly inhibited by the antiapoptotic protein Bcl-2 (82 ± 8%, P < 0.05); 4) ceramide-induced ROS production was also inhibited by Bcl-2 (41 ± 4%, P < 0.0001). These results demonstrate that in endothelial cells submitted to hypoxia and glucose depletion followed by reoxygenation with glucose, the pathway implicated in mitochondrial complex III ROS production is ceramide dependent and is decreased by the antiapoptotic protein Bcl-2.
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Affiliation(s)
- S Therade-Matharan
- Laboratoire d'Etude de la Microcirculation, Faculté de Médecine, Université Paris 7 10, avenue de Verdun, 75010 Paris, France
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Abstract
BACKGROUND There is considerable variability in the inter-patient response to norepinephrine. Pharmacokinetic studies of dopamine infusion in volunteers and in patients have also shown large variability. The purpose of this study was to define the pharmacokinetics of norepinephrine in septic shock and trauma patients. METHODS After Ethical Committee approval and written informed family consent, 12 patients with septic shock and 11 trauma patients requiring norepinephrine infusion were studied. Norepinephrine dose was increased in three successive steps of 0.1 mg kg(-1) min(-1) at 15-min intervals (20% maximum allowed increase in arterial pressure). Arterial blood was sampled before and at 0.5, 13, and 15 min after each infusion rate change and 30 s, 1, 2, 5, 10, and 15 min after return to baseline dosing. Norepinephrine was assayed by HPLC. The pharmacokinetics were modelled using NONMEM (one-compartment model). The effects of group, body weight (BW), gender and SAPS II (Simplified Acute Physiology Score II) [Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. J Am Med Assoc 1993; 270: 2957-63] patients score on clearance (CL) and volume of distribution (V) were tested. RESULTS Group, gender, and BW did not influence CL or V. CL was negatively related to SAPS II. CL and T(1/2) varied from 3 litre min(-1) and 2 min, respectively, when SAPS II=20 to 0.9 litre min(-1) and 6.8 min when SAPS II=60. CONCLUSION In trauma patients and in septic shock patients, norepinephrine clearance is negatively related to SAPS II.
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Affiliation(s)
- H Beloeil
- Department of Anesthesiology, Université Paris-Sud, Hôpital Bicêtre, F-94275 Le Kremlin Bicêtre, France
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42
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Cheisson G, Duranteau J. [Which benefit for patient can we expect from hyperhydration and haemodynamic per- and postoperative optimization? (II)]. Ann Fr Anesth Reanim 2005; 24:199-205. [PMID: 15737507 DOI: 10.1016/j.annfar.2004.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- G Cheisson
- Département d'anesthésie-réanimation, hôpital de Bicêtre, 78, rue du Général-Bicêtre, 94270 Le-Kremlin-Bicêtre, France.
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Therade-Matharan S, Laemmel E, Duranteau J, Vicaut E. Reoxygenation after hypoxia and glucose depletion causes reactive oxygen species production by mitochondria in HUVEC. Am J Physiol Regul Integr Comp Physiol 2004; 287:R1037-43. [PMID: 15205181 DOI: 10.1152/ajpregu.00048.2004] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In hemorrhagic shock, local hypoxia is present and followed by reoxygenation during the therapeutic process. In endothelium, reactive oxygen species (ROS) have been identified as a cause of inflammatory reactions and tissular lesions in ischemic territory during reoxygenation. This study was designed to identify the enzymatic mechanisms of ROS formation during reoxygenation after hypoxia. Because severe shock, in vivo, can affect both O2and nutriments, we combined hypoxia at a level close to that found in terminal vessels during shock, with glucose depletion, which induces a relevant additional stress. Human umbilical vein endothelial cells (HUVEC) underwent 2 h of hypoxia (Po2∼20 mmHg) without glucose and 1 h of reoxygenation (Po2∼120 mmHg) with glucose. ROS production was measured by the fluorescent marker 2′,7′-dichlorodihydrofluorescein diacetate, and cell death by propidium iodide. After 1 h of reoxygenation, fluorescence had risen by 143 ± 17%. Cell death was equal to 8.6 ± 2.4%. Antimycin A and stigmatellin, which inhibits the type III mitochondrial respiratory chain complex, reduced ROS production to values of 61 ± 10 and 59 ± 7%, respectively, but inhibitors of other chain complexes did not affect it. In addition, the increase in fluorescence was not affected by inhibition of NADPH oxidase, xanthine oxidase, NOS, cyclooxygenase, cytochrome P-450 monooxygenase, or monoamine oxidase. We did not observe any increase in cell death. These results show that, in HUVEC, mitochondria are responsible for ROS production after hypoxia and reoxygenation and suggest that a ROS release site is activated in the cytochrome b of the type III respiratory chain complex.
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Affiliation(s)
- S Therade-Matharan
- Laboratoire d'Etude de la Microcirculation, Université Paris 7, 10, Ave. de Verdun, 75010 Paris, France
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Laplace C, Martin L, Rangheard AS, Menu Y, Duranteau J. Un cas de lésion artérielle pelvienne post-traumatique masquée à l'angiographie par l'emploi d'un pantalon antichoc. ACTA ACUST UNITED AC 2004; 23:998-1002. [PMID: 15501629 DOI: 10.1016/j.annfar.2004.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2004] [Accepted: 07/19/2004] [Indexed: 11/25/2022]
Abstract
Initial reports of pneumatic anti-shock garment (PASG) in severely hypotensive patients appeared promising. Nevertheless, large-scale studies in prehospital settings have shown no overall reduction in mortality rates among hypotensive patients with application of the PASG. However, in a subsample of patients with blood pressure < or =50 mmHg, PASG seems to be useful to reduce bleeding and improve survival. To our knowledge, our case report is the first which directly showns on angiography the hemostatic effect of PASG on pelvic trauma bleeding. In spite of its possible complications, PASG remains one of the tools of trained trauma teams who regularly treated severe haemorrhagic shock.
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Affiliation(s)
- C Laplace
- Département d'anesthésie-réanimation chirurgicale, CHU de Bicêtre, assistance publique-hôpitaux de Paris, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
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Trabold F, Casetta M, Duranteau J, Albaladejo P, Mazoit JX, Samii K, Benhamou D, Sitbon P. Propofol and remifentanil for intubation without muscle relaxant: the effect of the order of injection. Acta Anaesthesiol Scand 2004; 48:35-9. [PMID: 14674971 DOI: 10.1111/j.1399-6576.2004.00259.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Common practice in intubation without muscle relaxant is to inject the opioid drug prior to the hypnotic drug. Because remifentanil reaches adequate cerebral concentration more rapidly than does propofol, we tested the hypothesis that injection of remifentanil after propofol might lead to better intubating conditions. METHODS Thirty ASA I-II patients scheduled for elective surgery and with no anticipated difficult intubation were enrolled in the study. Five minutes after midazolam 30 microg kg(-1), patients were randomized into two groups: group PR received propofol 2.5 mg kg(-1) followed by remifentanil 1 microg kg(-1), and group RP received remifentanil 1 microg kg(-1) followed by propofol 2.5 mg kg(-1). Intubating conditions were compared using a well-validated score, and continuous arterial pressure was recorded non-invasively. RESULTS Compared with group RP, intubating conditions were significantly better in group PR. The mean arterial pressure decrease was more pronounced in group RP. CONCLUSIONS We therefore conclude that in premedicated healthy patients with no anticipated risk of difficult intubation, intubating and haemodynamic conditions are better when remifentanil is injected after propofol.
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Affiliation(s)
- F Trabold
- Department of Anaesthesiology and Intensive Care, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
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Eschwège P, Droupy S, Conti M, Ferlicot S, Paradis V, Loric S, Bedossa P, Duranteau J, Durrbach A, Legrand A, Charpentier B, Benoît G. Value of lipid peroxidation by-products detected during the renal procurement on renal graft function. Transplant Proc 2002; 34:2840. [PMID: 12431629 DOI: 10.1016/s0041-1345(02)03522-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- P Eschwège
- Service d'Urologie et Laboratoire de Chirurgie Expérimentale Faculté de Médecine Paris Sud, Le Kremlin Bicêtre, France.
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Eschwège P, Droupy S, Blanchet P, Hammoudi Y, Laassou K, Hadj AEL, Giuliano F, Izard V, Duranteau J, Decaux A, Richard C, Devictor D, Joseph L, Decaris J, Paradis V, Bedossa P, Huault G, Durrbach A, Charpentier B, Benoît G. Surgical injuries occurring during kidney procurement performed by a renal transplantation team. Transplant Proc 2002; 34:844. [PMID: 12034204 DOI: 10.1016/s0041-1345(01)02931-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- P Eschwège
- Department of Urology, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
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48
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Eschwège P, Droupy S, Blanchet P, Hammoudi Y, Giuliano F, Izard V, Duranteau J, Brivet F, Coulomb F, Decaux A, Richard C, Devictor D, Joseph L, Decaris J, Huault G, Kriaa F, Charpentier B, Benoît G. Local organ procurements are associated with fewer renal transplant complications. Transplant Proc 2002; 34:843. [PMID: 12034203 DOI: 10.1016/s0041-1345(01)02930-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- P Eschwège
- Urology, Hôpital de Dreux, Dreux, Hôpital Antoine Béclère, Clamart, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
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Nakajima Y, Baudry N, Duranteau J, Vicaut E. Microcirculation in intestinal villi: a comparison between hemorrhagic and endotoxin shock. Am J Respir Crit Care Med 2001; 164:1526-30. [PMID: 11704607 DOI: 10.1164/ajrccm.164.8.2009065] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Using intravital microscopy, we studied the effects of hemorrhagic and endotoxin (ETX) shock on the velocity of erythrocytes (red blood cells [RBC]) and the density of perfused villi in mouse small intestine. The mice were divided into four groups: control, normotensive sepsis (a low ETX group, 1.5 mg/kg intravenously), hypotensive sepsis (a high ETX group, 10 mg/kg intravenously), and a hemorrhagic group. One hour after endotoxemia or hemorrhage was induced, mean arterial pressure significantly decreased in the high ETX and hemorrhagic groups (72.5 +/- 1.0 mm Hg in the control group, 71.0 +/- 2.4 in the low ETX group, 42.7 +/- 1.8 in the high ETX group, 43.0 +/- 1.4 in the hemorrhagic group, respectively). We found significant decreases in RBC velocities in the villous tip and capillaries in both ETX groups but not in the hemorrhagic group (in villus tip arteriole, 1.25 +/- 0.02 mm/s, 0.80 +/- 0.02, 0.15 +/- 0.01, 1.20 +/- 0.08; in villus capillaries, 0.55 +/- 0.02, 0.38 +/- 0.02, 0.10 +/- 0.01, 0.61 +/- 0.02, for control, low ETX, high ETX, and hemorrhagic groups, respectively). We also found a significant decrease in the density of RBC-perfused villi in the high ETX and hemorrhagic groups but not in the low ETX or control groups. However, the change in the hemorrhagic group was much less than in the high ETX group (100.0 %, 95.2 +/- 1.6, 32.5 +/- 1.9, 87.3 +/- 3.4, for control, low ETX, high ETX, and hemorrhagic groups, respectively). We concluded that ETX induces a significant decrease in mucosal perfusion characterized by a diminution in RBC velocity and flux in villi found even in a normotensive situation. At a high dose of ETX, these changes are associated with a significant decrease in the number of perfused villi. In addition, we found that at the same level of hypotension, hemodynamics and mucosal perfusion disorders are considerably larger in ETX-induced hypotension than in hemorrhagic hypotension.
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Affiliation(s)
- Y Nakajima
- Laboratoire d'Etude de la Microcirculation, Université Paris VII, Hôpital F. Widal, Paris, France
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Corda S, Laplace C, Vicaut E, Duranteau J. Rapid reactive oxygen species production by mitochondria in endothelial cells exposed to tumor necrosis factor-alpha is mediated by ceramide. Am J Respir Cell Mol Biol 2001; 24:762-8. [PMID: 11415943 DOI: 10.1165/ajrcmb.24.6.4228] [Citation(s) in RCA: 268] [Impact Index Per Article: 11.7] [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: 12/14/2022] Open
Abstract
Tumor necrosis factor (TNF)-alpha increases mitochondrial reactive oxygen species (ROS) production in tumor cells and hepatocytes. However, whether TNF-alpha stimulates mitochondrial ROS production in endothelial cells (EC) has not yet been reported. We studied the effect of TNF-alpha on mitochondrial ROS generation in EC and the signaling pathways involved. Cultured human umbilical vein EC (HUVEC) were studied by fluorescence microscopy, using dichlorodihydrofluorescein diacetate (DCFH-DA) as a marker of ROS production and propidium iodide uptake for cell viability. TNF-alpha increased DCFH oxidation in HUVEC dose-dependently. To determine the source of ROS, the mitochondrial respiratory chain inhibitors rotenone + thenoyltrifluoroacetone (TTFA), which inhibit electron entry to ubiquinone, and antimycin A (AA), a blocker of ubisemiquinone, were used. Rotenone and TTFA inhibited (n = 7, P < 0.05), whereas AA increased (118% in 3 min; n = 4, P < 0.01) ROS generation in HUVEC. In contrast, ROS production was not abolished by the nicotinamide adenine dinucleotide phosphate-dependent oxidase inhibitor diphenylene iodonium, by the xanthine oxidase inhibitor allopurinol, nor by the nitric oxide and cyclooxygenase pathway inhibitors N(omega)-nitro-L-arginine and mefenamic acid. In addition, TNF-alpha-induced ROS production was inhibited by the acidic sphingomyelinase inhibitor desipramine (5 microM; -80%, n = 4, P < 0.01) and totally blocked by the ceramide-activated protein kinase (CAPK) inhibitor dimethylaminopurine (1 mM; n = 6, P < 0.05). Thus, TNF-alpha induces mitochondrial ROS production in HUVEC that primarily occurs at the ubisemiquinone site and is mediated by ceramide-dependent signaling pathways involving CAPK.
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Affiliation(s)
- S Corda
- Laboratoire d'Anesthésie-Réanimation, Université Paris XI, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre; France
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