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Marjanovic N, Macé J, Thille AW, Frat JP. Reply to Understanding the benefits of early high-flow nasal cannula for adults with acute hypoxemic respiratory failure in the ED. Am J Emerg Med 2019; 37:1593-1594. [PMID: 31085012 DOI: 10.1016/j.ajem.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 05/03/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- N Marjanovic
- CHU de Poitiers, Service d'Accueil des Urgences, SAMU 86 et Centre 15, France; Equipe 5 ALIVE, INSERM, CIC-1402, Poitiers, France.
| | - J Macé
- CH de Niort, Service d'Accueil des Urgences, SAMU 79, France
| | - A W Thille
- Equipe 5 ALIVE, INSERM, CIC-1402, Poitiers, France; CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - J P Frat
- Equipe 5 ALIVE, INSERM, CIC-1402, Poitiers, France; CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
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Rebollar Y, Bourgoin-Heck M, Rault C, Ragot S, Petitpas F, Robert R, Coudroy R, Frat JP, Thille AW, Drouot X, Diaz V. Effects of repetitive magnetic cervical stimulation of phrenic roots on diaphragmatic function in healthy volunteers. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1713470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Y. Rebollar
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Anesthésie-Réanimation, CHU de Poitiers, Poitiers, France
| | - M. Bourgoin-Heck
- Neurophysiologie clinique et Explorations Fonctionnelles, CHU de Poitiers, Poitiers, France
| | - C. Rault
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Neurophysiologie clinique et Explorations Fonctionnelles, CHU de Poitiers, Poitiers, France
| | - S. Ragot
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Biostatistiques, CHU de Poitiers, Poitiers, France
| | - F. Petitpas
- Anesthésie-Réanimation, CHU de Poitiers, Poitiers, France
| | - R. Robert
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Réanimation Médicale, CHU de Poitiers, Poitiers, France
| | - R. Coudroy
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Réanimation Médicale, CHU de Poitiers, Poitiers, France
| | - J.-P Frat
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Réanimation Médicale, CHU de Poitiers, Poitiers, France
| | - A.-W Thille
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Réanimation Médicale, CHU de Poitiers, Poitiers, France
| | - X. Drouot
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Neurophysiologie clinique et Explorations Fonctionnelles, CHU de Poitiers, Poitiers, France
| | - V. Diaz
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Neurophysiologie clinique et Explorations Fonctionnelles, CHU de Poitiers, Poitiers, France
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Rochwerg B, Granton D, Wang DX, Helviz Y, Einav S, Frat JP, Mekontso-Dessap A, Schreiber A, Azoulay E, Mercat A, Demoule A, Lemiale V, Pesenti A, Riviello ED, Mauri T, Mancebo J, Brochard L, Burns K. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med 2019; 45:563-572. [PMID: 30888444 DOI: 10.1007/s00134-019-05590-5] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/28/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND This systematic review and meta-analysis summarizes the safety and efficacy of high flow nasal cannula (HFNC) in patients with acute hypoxemic respiratory failure. METHODS We performed a comprehensive search of MEDLINE, EMBASE, and Web of Science. We identified randomized controlled trials that compared HFNC to conventional oxygen therapy. We pooled data and report summary estimates of effect using relative risk for dichotomous outcomes and mean difference or standardized mean difference for continuous outcomes, with 95% confidence intervals. We assessed risk of bias of included studies using the Cochrane tool and certainty in pooled effect estimates using GRADE methods. RESULTS We included 9 RCTs (n = 2093 patients). We found no difference in mortality in patients treated with HFNC (relative risk [RR] 0.94, 95% confidence interval [CI] 0.67-1.31, moderate certainty) compared to conventional oxygen therapy. We found a decreased risk of requiring intubation (RR 0.85, 95% CI 0.74-0.99) or escalation of oxygen therapy (defined as crossover to HFNC in the control group, or initiation of non-invasive ventilation or invasive mechanical ventilation in either group) favouring HFNC-treated patients (RR 0.71, 95% CI 0.51-0.98), although certainty in both outcomes was low due to imprecision and issues related to risk of bias. HFNC had no effect on intensive care unit length of stay (mean difference [MD] 1.38 days more, 95% CI 0.90 days fewer to 3.66 days more, low certainty), hospital length of stay (MD 0.85 days fewer, 95% CI 2.07 days fewer to 0.37 days more, moderate certainty), patient reported comfort (SMD 0.12 lower, 95% CI 0.61 lower to 0.37 higher, very low certainty) or patient reported dyspnea (standardized mean difference [SMD] 0.16 lower, 95% CI 1.10 lower to 1.42 higher, low certainty). Complications of treatment were variably reported amongst included studies, but little harm was associated with HFNC use. CONCLUSION In patients with acute hypoxemic respiratory failure, HFNC may decrease the need for tracheal intubation without impacting mortality.
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Affiliation(s)
- B Rochwerg
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, ON, Canada. .,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. .,Department of Medicine, Division of Critical Care, Juravinski Hospital, 711 Concession St, Hamilton, ON, L8V 1C3, Canada.
| | - D Granton
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - D X Wang
- Schulich School of Medicine, Western University, London, ON, Canada
| | - Y Helviz
- General Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - S Einav
- General Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - J P Frat
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.,INSERM, CIC-1402, équipe ALIVE, Poitiers, France.,Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
| | - A Mekontso-Dessap
- Hôpitaux Universitaires Henri Mondor, Créteil, France.,Université Paris, Créteil, France
| | - A Schreiber
- Department of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada
| | - E Azoulay
- Hôpital Saint-Louis, Paris, France.,Center of Epidemiology and Biostatistics, Paris Diderot Sorbonne University, Paris, France
| | - A Mercat
- Département de Médecine Intensive-Réanimation, CHU d'Angers, Université d'Angers, Angers, France
| | - A Demoule
- Service de Pneumologie et Réanimation Médicale du Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.,Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, UMRS1158, Paris, France
| | - V Lemiale
- Hôpital Saint-Louis, Paris, France.,Center of Epidemiology and Biostatistics, Paris Diderot Sorbonne University, Paris, France
| | - A Pesenti
- Università degli Studi di Milano, Dipartimento di Fisopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - E D Riviello
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - T Mauri
- Università degli Studi di Milano, Dipartimento di Fisopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - J Mancebo
- Servei de Medicina Intensiva, Hospital Universitari Sant Pau, Barcelona, Spain
| | - L Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - K Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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Muller G, Mercier E, Vignon P, Henry-Lagarrigue M, Kamel T, Desachy A, Botoc V, Plantefève G, Frat JP, Bellec F, Quenot JP, Dequin PF, Boulain T. Prognostic significance of central venous-to-arterial carbon dioxide difference during the first 24 hours of septic shock in patients with and without impaired cardiac function. Br J Anaesth 2018; 119:239-248. [PMID: 28854537 DOI: 10.1093/bja/aex131] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2017] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the prognostic significance of central venous-to-arterial carbon dioxide difference (cv-art CO 2 gap) during septic shock in patients with and without impaired cardiac function. Methods We performed a prospective cohort study in 10 French intensive care units. Patients suffering from septic shock were assigned to the impaired cardiac function group ('cardiac group', n =123) if they had atrial fibrillation (AF) and/or left ventricular ejection fraction (LVEF) <50% at study entry and to the non-cardiac group ( n =240) otherwise. Results Central venous and arterial blood gases were sampled every 6 h during the first 24 h to calculate cv-art CO 2 gap. Patients in the cardiac group had a higher cv-art CO 2 gap [at study entry and 6 and 12 h (all P <0.02)] than the non-cardiac group. Patients in the cardiac group with a cv-art CO 2 gap >0.9 kPa at 12 h had a higher risk of day 28 mortality (hazard ratio=3.18; P =0.0049). Among the 59 patients in the cardiac group with mean arterial pressure (MAP) ≥65 mm Hg, central venous pressure (CVP) ≥8 mm Hg and central venous oxygen saturation (ScvO 2 ) ≥70% at 12 h, those with a high cv-art CO 2 gap (>0.9 kPa; n =19) had a higher day 28 mortality (37% vs. 13%; P =0.042). In the non-cardiac group, a high cv-art CO 2 gap was not linked to a higher risk of day 28 death, whatever the threshold value of the cv-art CO 2 gap. Conclusion Patients with septic shock and with AF and/or low LVEF were more prone to a persistent high cv-art CO 2 gap, even when initial resuscitation succeeded in normalizing MAP, CVP, and ScvO 2 . In these patients, a persistent high cv-art CO 2 gap at 12 h was significantly associated with higher day 28 mortality.
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Affiliation(s)
- G Muller
- Medical-Surgical Intensive Care Unit, Regional Hospital Centre, Orléans, France
| | - E Mercier
- Medical Intensive Care Unit, University Hospital, Tours, France
| | - P Vignon
- Medical-Surgical Intensive Care Unit, University Hospital, Limoges, France.,CIC-P 1435, INSERM U1092, Limoges, France
| | - M Henry-Lagarrigue
- Medical-Surgical Intensive Care Unit, District Hospital Centre, La Roche-sur-Yon, France
| | - T Kamel
- Medical-Surgical Intensive Care Unit, Regional Hospital Centre, Orléans, France
| | - A Desachy
- Medical-Surgical Intensive Care Unit, District Hospital Centre, Angoulême, France
| | - V Botoc
- Medical-Surgical Intensive Care Unit, District Hospital Centre, Saint-Malo, France
| | - G Plantefève
- Medical-Surgical Intensive Care Unit, District Hospital Centre, Argenteuil, France
| | - J P Frat
- Medical Intensive Care Unit, University Hospital, Poitiers, France
| | - F Bellec
- Medical-Surgical Intensive Care Unit, District Hospital Centre, Montauban, France
| | - J P Quenot
- Medical Intensive Care Unit, University Hospital, Dijon, France.,Lipness Team, INSERM Research Centre UMR 866 and LabExLipSTIC, University of Burgundy, Dijon, France
| | - P F Dequin
- Medical Intensive Care Unit, University Hospital, Tours, France
| | - T Boulain
- Medical-Surgical Intensive Care Unit, Regional Hospital Centre, Orléans, France
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Coudroy R, Frat JP, Petua P, Robert R, Jamet A, Thille AW. High-flow nasal cannula oxygen therapy versus noninvasive ventilation versus in immunocompromised patients with acute respiratory failure. Intensive Care Med Exp 2015. [PMCID: PMC4796889 DOI: 10.1186/2197-425x-3-s1-a98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Godet C, Frat JP, Le Moal G, Roblot F, Michalakis G, Cabon E, Tasu JP. Legionnaire's pneumonia: Is there really an interstitial disease? Eur J Radiol 2007; 61:150-3. [PMID: 16987630 DOI: 10.1016/j.ejrad.2006.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 04/07/2006] [Revised: 08/17/2006] [Accepted: 08/18/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Legionella pneumonia is usually classified as "atypical pneumonia", which suggests a predominance of interstitial patterns in chest X-rays. Based on a selection of recent clinical cases and a brief review of the literature, the aim of the study is to clarify, how far the actual radiological findings would be consistent with these expectations. PATIENTS AND METHODS A retrospective analysis of 18 epidemic personal cases and a review of the literature data were performed to describe the chest X-ray findings of Legionella pneumophila (LP) community acquired pneumonia. X-ray review was performed simultaneously and in consensus by two radiologists (J.P.T., E.C.) and a physician (C.G.). RESULTS From our series, 17 patients had an abnormal chest X-ray on admission. Among these pathological X-ray cases, infiltrates were more often confluent (n=16), or patchy (n=7), rather than interstitial (n=1). Fifteen patients had infiltrates involving the lower lung fields. Bilateral distribution of abnormalities and pleural effusion were each observed in three cases. Radiological findings deteriorated between the second and seventh days following admission, particularly in the form of patchy infiltrates with pleural effusion. The review of the literature is consistent with these findings, by reporting prevalent confluent or patchy infiltrates. CONCLUSIONS These findings are consistent with the physiopathological particularity of this affection and incite us to avoid the classification "atypical pneumonia" in radiologic terminology. This term is more appropriate for clinical and microbiological use.
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Affiliation(s)
- C Godet
- Service de Maladies Infectieuses, CHU la Milétrie, rue de la milétrie, 86021 Poitiers, France.
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Robert R, Eugène M, Frat JP, Rouffineau J. Diagnosis of unsuspected gamma hydroxy-butyrate poisoning by proton NMR. J Toxicol Clin Toxicol 2002; 39:653-4. [PMID: 11762678 DOI: 10.1081/clt-100108502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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8
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Frat JP, Veinstein A, Wager M, Burucoa C, Robert R. Reversible acute hydrocephalus complicating Listeria monocytogenes meningitis. Eur J Clin Microbiol Infect Dis 2001; 20:512-4. [PMID: 11561813 DOI: 10.1007/pl00011296] [Citation(s) in RCA: 7] [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: 01/02/2023]
Affiliation(s)
- J P Frat
- Department of Neurosurgery, Hĵpital Jean Bernard, Poitiers, France
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Corneloup L, Planchard D, Demarque C, Hira M, Frat JP, Goujon JM, Robert R. [Simultaneous occlusion of the abdominal aorta and both internal carotid arteries as the presenting symptoms of left atrial myxoma]. Arch Mal Coeur Vaiss 2001; 94:287-90. [PMID: 11387935] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Myxoma is a benign tumour but which has redoubtable embolic complications. When situated in the left atrium, the emboli obstruct, in the majority of cases, the cerebral arteries, occasionally the visceral or coronary arteries, and, very rarely, the aorta. In this case, the authors report an atypical presentation with ischaemia of the lower half of the body, associated with pulmonary oedema and deep coma. The left atrial myxoma was responsible for complete and simultaneous obstruction of the internal carotid arteries and the infra-renal abdominal aorta. This report illustrates the fact that myxoma can be responsible for massive, life-threatening, embolisation.
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Affiliation(s)
- L Corneloup
- Service de réanimation médicale, CHU de Poitiers, hôpital Jean-Bernard, BP 577, 86021 Poitiers
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