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Sicard M, Shor N, Davy V, Rouby JJ, Oquendo B, Maisonobe T, Puybasset L, Lehericy S, Lecarpentier A, Donadio C, Oasi C, Belmin J, Lubetzki C, Corvol JC, Grabli D, Saracino D. Cerebellar encephalitis and peripheral neuropathy with an atypical clinical and neuroimaging signature following Covid-19 vaccine: a report of two cases. J Neurol 2024:10.1007/s00415-024-12390-5. [PMID: 38704487 DOI: 10.1007/s00415-024-12390-5] [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] [Received: 03/04/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Marin Sicard
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Natalia Shor
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neuroradiology, Paris, France
| | - Vincent Davy
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - Jean-Jacques Rouby
- Sorbonne Université, GRC 29, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Department of Anesthesiology and Critical Care, Paris, France
| | - Bruno Oquendo
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Thierry Maisonobe
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - Louis Puybasset
- Sorbonne Université, GRC 29, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Department of Anesthesiology and Critical Care, Paris, France
| | - Stephane Lehericy
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neuroradiology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Amandine Lecarpentier
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Cristiano Donadio
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Christel Oasi
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Joël Belmin
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Catherine Lubetzki
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - David Grabli
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Dario Saracino
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France.
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France.
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Departement of Neurology, Reference Centre for Rare or Early Dementias, Paris, France.
- Paris Brain Institute - Institut du Cerveau (ICM), AP-HP - Hôpital Pitié-Salpêtrière, DMU Neurosciences, Département de Neurologie, 47-83 boulevard de l'Hôpital, 75013, Paris, France.
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Dhanani J, Roberts JA, Monsel A, Torres A, Kollef M, Rouby JJ. Understanding the nebulisation of antibiotics: the key role of lung microdialysis studies. Crit Care 2024; 28:49. [PMID: 38373973 PMCID: PMC10875779 DOI: 10.1186/s13054-024-04828-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Nebulisation of antibiotics is a promising treatment for ventilator-associated pneumonia (VAP) caused by multidrug-resistant organisms. Ensuring effective antibiotic concentrations at the site of infection in the interstitial space fluid is crucial for clinical outcomes. Current assessment methods, such as epithelial lining fluid and tissue homogenates, have limitations in providing longitudinal pharmacokinetic data. MAIN BODY Lung microdialysis, an invasive research technique predominantly used in animals, involves inserting probes into lung parenchyma to measure antibiotic concentrations in interstitial space fluid. Lung microdialysis offers unique advantages, such as continuous sampling, regional assessment of antibiotic lung concentrations and avoidance of bronchial contamination. However, it also has inherent limitations including the cost of probes and assay development, the need for probe calibration and limited applicability to certain antibiotics. As a research tool in VAP, lung microdialysis necessitates specialist techniques and resource-intensive experimental designs involving large animals undergoing prolonged mechanical ventilation. However, its potential impact on advancing our understanding of nebulised antibiotics for VAP is substantial. The technique may enable the investigation of various factors influencing antibiotic lung pharmacokinetics, including drug types, delivery devices, ventilator settings, interfaces and disease conditions. Combining in vivo pharmacokinetics with in vitro pharmacodynamic simulations can become feasible, providing insights to inform nebulised antibiotic dose optimisation regimens. Specifically, it may aid in understanding and optimising the nebulisation of polymyxins, effective against multidrug-resistant Gram-negative bacteria. Furthermore, lung microdialysis holds promise in exploring novel nebulisation therapies, including repurposed antibiotic formulations, bacteriophages and immunomodulators. The technique's potential to monitor dynamic biochemical changes in pneumonia, such as cytokines, metabolites and inflammation/infection markers, opens avenues for developing theranostic tools tailored to critically ill patients with VAP. CONCLUSION In summary, lung microdialysis can be a potential transformative tool, offering real-time insights into nebulised antibiotic pharmacokinetics. Its potential to inform optimal dosing regimen development based on precise target site concentrations and contribute to development of theranostic tools positions it as key player in advancing treatment strategies for VAP caused by multidrug-resistant organisms. The establishment of international research networks, exemplified by LUMINA (lung microdialysis applied to nebulised antibiotics), signifies a proactive step towards addressing complexities and promoting multicentre experimental studies in the future.
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Affiliation(s)
- Jayesh Dhanani
- Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Australia.
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Jason A Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Antoine Monsel
- Unité Mixte de Recherche (UMR)-S 959, Immunology-Immunopathology-Immunotherapy, Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Sorbonne University, GRC 29, Assistance Publique Hôpitaux de Paris (AP-HP), DMU DREAM, Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Antoni Torres
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), University of Barcelona, Barcelona, Spain
| | - Marin Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jean-Jacques Rouby
- Sorbonne University, GRC 29, Assistance Publique Hôpitaux de Paris (AP-HP), DMU DREAM, Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
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Li J, Liu K, Lyu S, Jing G, Dai B, Dhand R, Lin HL, Pelosi P, Berlinski A, Rello J, Torres A, Luyt CE, Michotte JB, Lu Q, Reychler G, Vecellio L, de Andrade AD, Rouby JJ, Fink JB, Ehrmann S. Aerosol therapy in adult critically ill patients: a consensus statement regarding aerosol administration strategies during various modes of respiratory support. Ann Intensive Care 2023; 13:63. [PMID: 37436585 DOI: 10.1186/s13613-023-01147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/31/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Clinical practice of aerosol delivery in conjunction with respiratory support devices for critically ill adult patients remains a topic of controversy due to the complexity of the clinical scenarios and limited clinical evidence. OBJECTIVES To reach a consensus for guiding the clinical practice of aerosol delivery in patients receiving respiratory support (invasive and noninvasive) and identifying areas for future research. METHODS A modified Delphi method was adopted to achieve a consensus on technical aspects of aerosol delivery for adult critically ill patients receiving various forms of respiratory support, including mechanical ventilation, noninvasive ventilation, and high-flow nasal cannula. A thorough search and review of the literature were conducted, and 17 international participants with considerable research involvement and publications on aerosol therapy, comprised a multi-professional panel that evaluated the evidence, reviewed, revised, and voted on recommendations to establish this consensus. RESULTS We present a comprehensive document with 20 statements, reviewing the evidence, efficacy, and safety of delivering inhaled agents to adults needing respiratory support, and providing guidance for healthcare workers. Most recommendations were based on in-vitro or experimental studies (low-level evidence), emphasizing the need for randomized clinical trials. The panel reached a consensus after 3 rounds anonymous questionnaires and 2 online meetings. CONCLUSIONS We offer a multinational expert consensus that provides guidance on the optimal aerosol delivery techniques for patients receiving respiratory support in various real-world clinical scenarios.
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Affiliation(s)
- Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, 600 S Paulina St, Suite 765, Chicago, IL, 60612, USA.
| | - Kai Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shan Lyu
- Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Guoqiang Jing
- Department of Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
| | - Bing Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Rajiv Dhand
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Hui-Ling Lin
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Paolo Pelosi
- Anesthesiology and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Ariel Berlinski
- Pulmonary and Sleep Medicine Division, Department of Pediatrics, University of Arkansas for Medical Sciences, and Pediatric Aerosol Research Laboratory at Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Jordi Rello
- Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Research in the ICU, Anaesthesia Department, CHU Nimes, Université de Nimes-Montpellier, Nimes, France
| | - Antoni Torres
- Servei de Pneumologia, Hospital Clinic, University of Barcelona, IDIBAPS CIBERES, Icrea, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Charles-Edouard Luyt
- Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, and INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Jean-Bernard Michotte
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Qin Lu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, and Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Gregory Reychler
- Secteur de Kinésithérapie et Ergothérapie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL and Dermatologie, Université Catholique de Louvain, Brussels, Belgium
| | | | | | - Jean-Jacques Rouby
- Research Department DMU DREAM and Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Sorbonne University of Paris, Paris, France
| | - James B Fink
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, 600 S Paulina St, Suite 765, Chicago, IL, 60612, USA
- Chief Science Officer, Aerogen Pharma Corp, San Mateo, CA, USA
| | - Stephan Ehrmann
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSep F-CRIN Research Network, and INSERM, Centre d'étude des Pathologies Respiratoires, U1100, Université de Tours, Tours, France
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Rello J, Bouglé A, Rouby JJ. Aerosolised antibiotics in critical care. Intensive Care Med 2023; 49:848-852. [PMID: 37085635 DOI: 10.1007/s00134-023-07036-5] [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: 01/31/2023] [Accepted: 03/11/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Jordi Rello
- Global Health eCore, Vall d'Hebron Institute of Research (VHIR), Ps. Vall d'Hebron 129. AMI-14, 08035, Barcelona, Spain.
- Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
- Unité de Recherche FOVERA, Réanimation Douleur Urgences, Centre Hospitalier Universitaire de Nîmes, Nîmes, France.
| | - Adrien Bouglé
- Cardiovascular Intensive Care Unit, Department of Anaesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean-Jacques Rouby
- Research Department, Departement Médico-Universitaire DREAM (DMU DREAM), Sorbonne University of Paris, Paris, France
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Carnicelli P, Otsuki DA, Monteiro Filho A, Kahvegian MAP, Ida KK, Auler-Jr JOC, Rouby JJ, Fantoni DT. Effects of dexmedetomidine on hemodynamic, oxygenation, microcirculation, and inflammatory markers in a porcine model of sepsis. Acta Cir Bras 2022; 37:e370703. [PMID: 36383809 DOI: 10.1590/acb370703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To determine whether dexmedetomidine aggravates hemodynamic, metabolic variables, inflammatory markers, and microcirculation in experimental septic shock. METHODS Twenty-four pigs randomized into: Sham group (n = 8), received saline; Shock group (n = 8), received an intravenous infusion of Escherichia coli O55 (3 × 109 cells/mL, 0.75 mL/kg, 1 hour); Dex-Shock group (n = 8), received bacteria and intravenous dexmedetomidine (bolus 0.5 mcg/kg followed by 0.7 mcg/kg/h). Fluid therapy and/ornorepinephrine were administered to maintain a mean arterial pressure > 65 mmHg. Hemodynamic, metabolic, oxygenation, inflammatory markers, and microcirculation were assessed at baseline, at the end of bacterial infusion, and after 60, 120, 180, and 240 minutes. RESULTS Compared to Shock group, Dex-Shock group presented a significantly increased oxygen extraction ratio at T180 (23.1 ± 9.7 vs. 32.5 ± 9.2%, P = 0.0220), decreased central venous pressure at T120 (11.6 ± 1 vs. 9.61 ± 1.2 mmHg, P = 0.0214), mixed-venous oxygen saturation at T180 (72.9 ± 9.6 vs. 63.5 ± 9.2%, P = 0.026), and increased plasma lactate (3.7 ± 0.5 vs. 5.5 ± 1 mmol/L, P = 0.003). Despite the Dex-Shock group having a better sublingual vessel density at T240 (12.5 ± 0.4 vs. 14.4 ± 0.3 mL/m2; P = 0.0003), sublingual blood flow was not different from that in the Shock group (2.4 ± 0.2 vs. 2.4 ± 0.1 mL/kg, P = 0.4418). CONCLUSIONS Dexmedetomidine did not worsen the hemodynamic, metabolic, inflammatory, or sublingual blood flow disorders resulting from septic shock. Despite inducing a better sublingual vessel density, dexmedetomidine initially and transitorily increased the mismatch between oxygen supply and demand.
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Affiliation(s)
- Paulo Carnicelli
- MSc. Universidade de São Paulo - Faculdade de Medicina Veterinária e Zootecnia - Surgery Department - São Paulo (SP), Brazil
| | - Denise Aya Otsuki
- PhD. Universidade de São Paulo - Hospital das Clínicas da Faculdade de Medicina - LIM08-Laboratory of Anesthesiology - São Paulo (SP), Brazil
| | | | | | - Keila Kazue Ida
- PhD. Texas A&M University - College of Veterinary Medicine and Biomedical Sciences - Department of Small Animal Clinical Sciences - College Station (TX), United States of America
| | - José Otavio Costa Auler-Jr
- PhD. Universidade de São Paulo - Hospital das Clínicas da Faculdade de Medicina - Laboratory of Anesthesiology - São Paulo (SP), Brazil
| | - Jean-Jacques Rouby
- PhD. Assistance Publique Hôpitaux de Paris - La Pitié Salpêtrière Hospital - Multidisciplinary Intensive Care Unit - Medicine Sorbonne University - Department of Anaesthesiology and Critical Care - Paris, France
| | - Denise Tabacchi Fantoni
- PhD. Universidade de São Paulo - Faculdade de Medicina Veterinária e Zootecnia - Surgery Department - São Paulo (SP), Brazil
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Rouby JJ, Zhu Y, Torres A, Rello J, Monsel A. Aerosolized polymyxins for ventilator-associated pneumonia caused by extensive drug resistant Gram-negative bacteria: class, dose and manner should remain the trifecta. Ann Intensive Care 2022; 12:97. [PMID: 36251177 PMCID: PMC9576828 DOI: 10.1186/s13613-022-01068-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/26/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance-Publique Hôpitaux de Paris, Sorbonne University of Paris, Paris, France.
| | - Yinggang Zhu
- Department of Pulmonary and Critical Care Medicine, Hua-Dong Hospital, Fudan University, Shanghai, China
| | - Antoni Torres
- Department of Pneumology, SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Jordi Rello
- Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Clinical Research & Innovation in Pneumonia & Sepsis, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.,Clinical Research, CHU Nîmes, Université Montpellier-Nîmes, Nîmes, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance-Publique Hôpitaux de Paris, Sorbonne University of Paris, Paris, France.,Unité mixte de recherche (UMR)-S 959, Immunology-Immunopathology-Immunotherapy (I3), Institut National de La Santé et de La Recherche Médicale (INSERM), Paris, France.,Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
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Pasqueron J, Dureau P, Arcile G, Duceau B, Hariri G, Lepère V, Lebreton G, Rouby JJ, Bouglé A. Usefulness of lung ultrasound for early detection of hospital-acquired pneumonia in cardiac critically ill patients on venoarterial extracorporeal membrane oxygenation. Ann Intensive Care 2022; 12:43. [PMID: 35596817 PMCID: PMC9124275 DOI: 10.1186/s13613-022-01013-9] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/21/2022] [Indexed: 12/20/2022] Open
Abstract
Background Hospital-acquired pneumonia (HAP) is the most common and severe complication in patients treated with venoarterial extracorporeal membrane oxygenation (VA ECMO) and its diagnosis remains challenging. Nothing is known about the usefulness of lung ultrasound (LUS) in early detection of HAP in patients treated with VA ECMO. Also, LUS and chest radiography were performed when HAP was suspected in cardiac critically ill adult VA ECMO presenting with acute respiratory failure. The sonographic features of HAP in VA ECMO patients were determined and we assessed the performance of the lung ultrasound simplified clinical pulmonary score (LUS-sCPIS), the sCPIS and bioclinical parameters or chest radiography alone for early diagnosis of HAP. Results We included 70 patients, of which 44 (63%) were independently diagnosed with HAP. LUS examination revealed that color Doppler intrapulmonary flow (P = 0.0000043) and dynamic air bronchogram (P = 0.00024) were the most frequent HAP-related signs. The LUS-sCPIS (area under the curve = 0.77) yielded significantly better results than the sCPIS (area under the curve = 0.65; P = 0.004), while leukocyte count, temperature and chest radiography were not discriminating for HAP diagnosis. Discussion Diagnosis of HAP is a daily challenge for the clinician managing patients on venoarterial ECMO. Lung ultrasound can be a valuable tool as the initial imaging modality for the diagnosis of pneumonia. Color Doppler intrapulmonary flow and dynamic air bronchogram appear to be particularly insightful for the diagnosis of HAP. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01013-9.
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Affiliation(s)
- Jean Pasqueron
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Pauline Dureau
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Gauthier Arcile
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Baptiste Duceau
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Geoffroy Hariri
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Victoria Lepère
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Guillaume Lebreton
- Sorbonne Université, Department of Cardiac Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Jacques Rouby
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Multidisciplinary Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Adrien Bouglé
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
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Boisson M, Bouglé A, Sole-Lleonart C, Dhanani J, Arvaniti K, Rello J, Rouby JJ, Mimoz O. Nebulized Antibiotics for Healthcare- and Ventilator-Associated Pneumonia. Semin Respir Crit Care Med 2022; 43:255-270. [PMID: 35042259 DOI: 10.1055/s-0041-1740340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Global emergence of multidrug-resistant and extensive drug-resistant gram-negative bacteria has increased the risk of treatment failure, especially for healthcare- or ventilator-associated pneumonia (HAP/VAP). Nebulization of antibiotics, by providing high intrapulmonary antibiotic concentrations, represents a promising approach to optimize the treatment of HAP/VAP due to multidrug-resistant and extensive drug-resistant gram-negative bacteria, while limiting systemic antibiotic exposure. Aminoglycosides and colistin methanesulfonate are the most common nebulized antibiotics. Although optimal nebulized drug dosing regimen is not clearly established, high antibiotic doses should be administered using vibrating-mesh nebulizer with optimized ventilator settings to ensure safe and effective intrapulmonary concentrations. When used preventively, nebulized antibiotics reduced the incidence of VAP without any effect on mortality. This approach is not yet recommended and large randomized controlled trials should be conducted to confirm its benefit and explore the impact on antibiotic selection pressure. Compared with high-dose intravenous administration, high-dose nebulized colistin methanesulfonate seems to be more effective and safer in the treatment of ventilator-associated tracheobronchitis and VAP caused by multidrug resistant and extensive-drug resistant gram-negative bacteria. Adjunctive nebulized aminoglycosides could increase the clinical cure rate and bacteriological eradication in patients suffering from HAP/VAP due to multidrug-resistant and extensive drug-resistant gram-negative bacteria. As nebulized aminoglycosides broadly diffuse in the systemic circulation of patients with extensive bronchopneumonia, monitoring of plasma trough concentrations is recommended during the period of nebulization. Large randomized controlled trials comparing high dose of nebulized colistin methanesulfonate to high dose of intravenous colistin methanesulfonate or to intravenous new β-lactams in HAP/VAP due to multidrug-resistant and extensive drug-resistant gram-negative bacteria are urgently needed.
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Affiliation(s)
- Matthieu Boisson
- INSERM U1070, Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France.,Service de Prévention et de Contrôle de l'Infection, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Adrien Bouglé
- Medicine Sorbonne University, Anaesthesiology and Critical Care, Cardiology Institute, Paris, France.,Department of Anaesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Candela Sole-Lleonart
- Intensive Care Unit, Consorci Hospitalari de Vic (CHV), The University of Vic - Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Jayesh Dhanani
- Department of Intensive care medicine, Centre for Clinical Research, The University of Queensland, The Royal Brisbane and Women's Hospital Herston, Brisbane, Australia
| | - Kostoula Arvaniti
- Intensive Care Unit Department, Papageorgiou Hospital of Thessaloniki, Thessaloniki, Greece
| | - Jordi Rello
- Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Clinical Research and Innovation in Pneumonia and Sepsis, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.,Clinical Research, CHU Nîmes, Université Montpellier-Nîmes, Nîmes, France
| | - Jean-Jacques Rouby
- Department of Anaesthesiology and Critical Care, Medicine Sorbonne University, Multidisciplinary Intensive Care Unit, La Pitié Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Olivier Mimoz
- INSERM U1070 Université de Poitiers, UFR de Médecine Pharmacie and Service des Urgences Adultes & SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
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Zhou J, Wang T, Belenkiy I, Hardcastle TC, Rouby JJ, Jiang B. Management of severe trauma worldwide: implementation of trauma systems in emerging countries: China, Russia and South Africa. Crit Care 2021; 25:286. [PMID: 34372903 PMCID: PMC8352140 DOI: 10.1186/s13054-021-03681-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/06/2021] [Indexed: 12/04/2022]
Abstract
As emerging countries, China, Russia, and South Africa are establishing and/or improving their trauma systems. China has recently established a trauma system named “the Chinese Regional Trauma Care System” and covered over 200 million populations. It includes paramedic-staffed pre-hospital care, in-hospital care in certified trauma centers, trauma registry, quality assurance, continuous improvement and ongoing coverage of the entire Chinese territory. The Russian trauma system was formed in the first decade of the twenty-first century. Pre-hospital care is region-based, with a regional coordination center that determines which team will go to the scene and the nearest hospital where the victim should be transported. Physician-staffed ambulances are organized according to three levels of trauma severity corresponding to three levels of trauma centers where in-hospital care is managed by a trauma team. No national trauma registry exists in Russia. Improvements to the Russian trauma system have been scheduled. There is no unified trauma system in South Africa, and trauma care is organized by public and private emergency medical service in each province. During the pre-hospital care, paramedics provide basic or advanced life support services and transport the patients to the nearest hospital because of the limited number of trauma centers. In-hospital care is inclusive with a limited number of accredited trauma centers. In-hospital care is managed by emergency medicine with multidisciplinary care by the various specialties. There is no national trauma registry in South Africa. The South African trauma system is facing multiple challenges. An increase in financial support, training for primary emergency trauma care, and coordination of private sector, need to be planned.
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Affiliation(s)
- Jing Zhou
- National Center for Trauma Medicine, Trauma Center, Department of Orthopedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Tianbing Wang
- National Center for Trauma Medicine, Trauma Center, Department of Orthopedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Igor Belenkiy
- Department of the Trauma and Orthopedics, Pavlov First Saint-Petersburg State Medical University, St. Petersburg, Russia.,Department of Trauma and Orthopedics , St. Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia
| | - Timothy Craig Hardcastle
- Trauma and Burns Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.,Department of Surgery, Nelson R Mandela School of Clinical Medicine, UKZN, Durban, South Africa
| | - Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Sorbonne University, La Pitié-Salpêtrière Hospital, Assistance-Publique-Hôpitaux-de-Paris, Paris, France.
| | - Baoguo Jiang
- National Center for Trauma Medicine, Trauma Center, Department of Orthopedics and Traumatology, Peking University People's Hospital, Beijing, China.
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Menezes MCS, Pestana DVS, Gameiro GR, da Silva LFF, Baron Ė, Rouby JJ, Auler JOC. SARS-CoV-2 pneumonia-receptor binding and lung immunopathology: a narrative review. Crit Care 2021; 25:53. [PMID: 33557908 PMCID: PMC7870126 DOI: 10.1186/s13054-020-03399-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/18/2020] [Indexed: 02/08/2023]
Abstract
The current pandemic of COVID-19 caused thousands of deaths and healthcare professionals struggle to properly manage infected patients. This review summarizes information about SARS-CoV-2 receptor binding dynamics and intricacies, lung autopsy findings, immune response patterns, evidence-based explanations for the immune response, and COVID-19-associated hypercoagulability.
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Affiliation(s)
- Maria Clara Saad Menezes
- Anesthesiology and Intensive Care Department, Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, Número 455, São Paulo, SP, 01246903, Brazil
| | - Diego Vinicius Santinelli Pestana
- Anesthesiology and Intensive Care Department, Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, Número 455, São Paulo, SP, 01246903, Brazil
| | - Gustavo Rosa Gameiro
- Anesthesiology and Intensive Care Department, Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, Número 455, São Paulo, SP, 01246903, Brazil
| | | | - Ėlodie Baron
- Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance-Publique-Hôpitaux-de-Paris, Sorbonne University, Paris, France
| | - Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance-Publique-Hôpitaux-de-Paris, Sorbonne University, Paris, France
| | - José Otavio Costa Auler
- Anesthesiology and Intensive Care Department, Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, Número 455, São Paulo, SP, 01246903, Brazil.
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Tonelotto B, Pereira SM, Tucci MR, Vaz DF, Vieira JE, Malbouisson LM, Gay F, Simões CM, Carvalho Carmona MJ, Monsel A, Amato MB, Rouby JJ, Costa Auler JO. Intraoperative pulmonary hyperdistention estimated by transthoracic lung ultrasound: A pilot study. Anaesth Crit Care Pain Med 2020; 39:825-831. [PMID: 33080407 DOI: 10.1016/j.accpm.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/17/2020] [Accepted: 09/03/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Transthoracic lung ultrasound can assess atelectasis reversal and is considered as unable to detect associated hyperdistention. In this study, we describe an ultrasound pattern highly suggestive of pulmonary hyperdistention. METHODS Eighteen patients with normal lungs undergoing lower abdominal surgery were studied. Electrical impedance tomography was calibrated, followed by anaesthetic induction, intubation and mechanical ventilation. To reverse posterior atelectasis, a recruitment manoeuvre was performed. Positive-end expiratory pressure (PEEP) titration was then obtained during a descending trial - 20, 18, 16, 14, 12, 10, 8, 6 and 4cmH2O. Ultrasound and electrical impedance tomography data were collected at each PEEP level and interpreted by two independent observers. Spearman correlation test and receiving operating characteristic curve were used to compare lung ultrasound and electrical impedance tomography data. RESULTS The number of horizontal A lines increased linearly with PEEP: from 3 (0, 5) at PEEP 4cmH2O to 10 (8, 13) at PEEP 20cmH2O. The increase number of A lines was associated with a parallel and significant decrease in intercostal space thickness (p=0.001). The lung ultrasound threshold for detecting pulmonary hyperdistention was defined as the number of A lines counted at the PEEP preceding the PEEP providing the best respiratory compliance. Six A lines was the median threshold for detecting pulmonary hyperdistention. The area under the receiving operating characteristic curve was 0.947. CONCLUSIONS Intraoperative transthoracic lung ultrasound can detect lung hyperdistention during a PEEP descending trial. Six or more A lines detected in normally aerated regions can be considered as indicating lung hyperdistention. TRIAL REGISTRATION NCT02314845 Registered on ClinicalTrials.gov.
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Affiliation(s)
- Bruno Tonelotto
- Divisão de Anestesiologia, Hospital Sírio-Libanês, Dona Adma Jafet Street, 91, São Paulo 1308050, Brazil.
| | - Sérgio Martins Pereira
- Divisão de Anestesiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
| | - Mauro Roberto Tucci
- Divisão de Pneumologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
| | - Diogo Florenzano Vaz
- Divisão de Anestesiologia, Hospital Sírio-Libanês, Dona Adma Jafet Street, 91, São Paulo 1308050, Brazil
| | - Joaquim Edson Vieira
- Divisão de Anestesiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
| | - Luiz Marcelo Malbouisson
- Divisão de Anestesiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
| | - Frédérick Gay
- Department of Parasitology-Mycology, La Pitié-Salpêtrière hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University of Paris, 47, Boulevard de l'Hôpital, 75013 Paris, France
| | - Claudia Marquez Simões
- Divisão de Anestesiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
| | - Maria José Carvalho Carmona
- Divisão de Anestesiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University of Paris, 47, Boulevard de l'Hôpital, 75013 Paris, France
| | - Marcelo Brito Amato
- Divisão de Pneumologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
| | - Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière hospital, Assistance Publique Hôpitaux de Paris, Sorbonne University of Paris, 47, Boulevard de l'Hôpital, 75013 Paris, France
| | - José Otavio Costa Auler
- Divisão de Anestesiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Doutor Eneas de Carvalho Aguiar, 255, São Paulo 0540300, Brazil
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12
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Rouby JJ, Monsel A, Leone M, Mimoz O, Laterre PF, Pugin J. The IASIS, INHALE and VAPORISE trials. Reasons for a triple failure: Study design, aminoglycosides dosing and technique of nebulisation. Anaesth Crit Care Pain Med 2020; 39:179-183. [PMID: 32156643 DOI: 10.1016/j.accpm.2020.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Medicine Sorbonne University, Paris, France.
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Medicine Sorbonne University, Paris, France
| | - Marc Leone
- Department of Anaesthesiology and Critical Care, North Hospital, University Aix-Marseille, Marseille, France
| | - Olivier Mimoz
- Department of Anaesthesiology and Intensive Care, University Hospital of Poitiers, University of Poitiers, Poitiers, France
| | - Pierre-François Laterre
- Saint Luc Clinical Coordinating Centre, Department of Critical Care Medicine, St Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Jérôme Pugin
- Intensive Care Division, University Hospitals of Geneva, Geneva, Switzerland
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13
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Rouby JJ, Sole-Lleonart C, Rello J. Correction to: Ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria: understanding nebulization of aminoglycosides and colistin. Intensive Care Med 2020; 46:832. [PMID: 32130461 PMCID: PMC7222143 DOI: 10.1007/s00134-020-05986-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J J Rouby
- Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Medicine Sorbonne University, Paris, France.
| | - C Sole-Lleonart
- Critical Care Department, Centre Hospitalo-Universtaire Vaudois, Lausanne, Switzerland.,Unitat Cures Intensives, Hospital Universitari de Vic, Barcelona, Spain
| | - J Rello
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto Salud Carlos III, Madrid, Spain.,Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain.,Anesthesiology Department, CHU Nîmes, Université Nîmes-Montepellier, Nîmes, France
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14
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Halter S, Aimade L, Barbié M, Brisson H, Rouby JJ, Langeron O, Klatzmann D, Rosenzwajg M, Monsel A. T regulatory cells activation and distribution are modified in critically ill patients with acute respiratory distress syndrome: A prospective single-centre observational study. Anaesth Crit Care Pain Med 2020; 39:35-44. [DOI: 10.1016/j.accpm.2019.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 12/28/2022]
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Rouby JJ, Sole-Lleonart C, Rello J. Ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria: understanding nebulization of aminoglycosides and colistin. Intensive Care Med 2020; 46:766-770. [PMID: 31915838 PMCID: PMC7223812 DOI: 10.1007/s00134-019-05890-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/01/2019] [Indexed: 01/01/2023]
Affiliation(s)
- J J Rouby
- Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Medicine Sorbonne University, Paris, France.
| | - C Sole-Lleonart
- Critical Care Department, Centre Hospitalo-Universtaire Vaudois, Lausanne, Switzerland
- Unitat Cures Intensives, Hospital Universitari de Vic, Barcelona, Spain
| | - J Rello
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto Salud Carlos III, Madrid, Spain
- Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain
- Anesthesiology Department, CHU Nîmes, Université Nîmes-Montepellier, Nîmes, France
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16
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Shi MM, Monsel A, Rouby JJ, Xu YP, Zhu YG, Qu JM. Inoculation Pneumonia Caused by Coagulase Negative Staphylococcus. Front Microbiol 2019; 10:2198. [PMID: 31636610 PMCID: PMC6787291 DOI: 10.3389/fmicb.2019.02198] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/09/2019] [Indexed: 01/05/2023] Open
Abstract
Rationale Although frequently retrieved in tracheal secretions of critically ill patients on mechanical ventilation, the existence of pneumonia caused by coagulase-negative staphylococci (CoNS) remains controversial. Objective To assess whether Staphylococcus haemolyticus (S. haemolyticus) inoculated in mice’s trachea can infect normal lung parenchyma, increasing concentrations of S. haemolyticus were intratracheally administered in 221 immunocompetent mice. Methods Each animal received intratracheally phosphate-buffered saline (PBS) (n = 43) or live (n = 141) or inactivated (n = 37) S. haemolyticus at increasing load: 1.0 × 106, 1.0 × 107, and 1.0 × 108 colony forming units (CFU). Forty-three animals were sacrificed at 12 h and 178 were sacrificed at 36 h; 64 served for post-mortem lung histology, 157 served for pre-mortem bronchoalveolar lavage (BAL) analysis, and 42 served for post-mortem quantitative bacteriology of lung tissue. The distribution of biofilm-associated genes was investigated in the S. haemolyticus strain used in our in vivo experiment as well as among 19 other clinical S. haemolyticus strains collected from hospitals or nursing houses. Measurements and Main Results Intratracheal inoculation of 1.0 × 108 CFU live S. haemolyticus caused macroscopic and histological confluent pneumonia with significant increase in BAL white cell count, tumor necrosis factor-α (TNF-α), and macrophage inflammatory protein (MIP)-2. At 12 h, high concentrations of S. haemolyticus were identified in BAL. At 36 h, lung injury and BAL inflammation were less severe than at 12 h and moderate concentrations of species belonging to the oropharyngeal flora were identified in lung tissue. The inoculation of 1.0 × 106 and 1.0 × 107 CFU live S. haemolyticus caused histologic interstitial pneumonia and moderate BAL inflammation. Similar results were observed after inoculation of inactivated S. haemolyticus. Moreover, biofilm formation was a common phenotype in S. haemolyticus isolates. The low prevalence of the ica operon in our clinical S. haemolyticus strain collection indicated icaA and icaD independent-biofilm formation. Conclusion In immunocompetent spontaneously breathing mice, inoculation of S. haemolyticus causes concentration-dependent lung infection that spontaneously recovers over time. icaA and icaD independent biofilm formation is a common phenotype in S. haemolyticus isolates.
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Affiliation(s)
- Meng-Meng Shi
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France.,Sorbonne Université, INSERM, UMR-S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France.,Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Yan-Ping Xu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying-Gang Zhu
- Department of Pulmonary and Critical Care Medicine, Huadong Hospital, Fudan University, Shanghai, China
| | - Jie-Ming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Constantin JM, Jabaudon M, Lefrant JY, Jaber S, Quenot JP, Langeron O, Ferrandière M, Grelon F, Seguin P, Ichai C, Veber B, Souweine B, Uberti T, Lasocki S, Legay F, Leone M, Eisenmann N, Dahyot-Fizelier C, Dupont H, Asehnoune K, Sossou A, Chanques G, Muller L, Bazin JE, Monsel A, Borao L, Garcier JM, Rouby JJ, Pereira B, Futier E, Sophie C, Thomas G, Renaud G, Camille V, Russel C, Bernard C, Raiko B, Alexandre L, Nathanael E, Laurent M, Pablo M, Caroline B, Saber B, Claire R, Fouad B, Moussa C, Marion M, Matthieu C, Julie C, Audrey DJ, Auguste D, Pascal A, Thomas L, Yoann L, Antoine R, Raphael C, Caroline B, Anne-Charlotte T, Mathilde B, Benjamin C, Edouard L, Pierre-Marie B, Charlotte A, Laurent Z, Emmanuelle H, Garry D, Calypso M, Herve D, Benoit V, Jean-Christophe O, Hervé Q, Thomas R, Julien CC, Marinne LC, Fabien G, Mona A, Frank P, Jerome M, Serge M, Nanadougmar H. Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial. The Lancet Respiratory Medicine 2019; 7:870-880. [DOI: 10.1016/s2213-2600(19)30138-9] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 12/29/2022]
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Bihan K, Zahr N, Becquemin MH, Lu X, Bertholon JF, Vezinet C, Arbelot C, Monsel A, Rouby JJ, Langeron O, Lu Q. Influence of diluent volume of colistimethate sodium on aerosol characteristics and pharmacokinetics in ventilator-associated pneumonia caused by MDR bacteria. J Antimicrob Chemother 2019; 73:1639-1646. [PMID: 29506194 DOI: 10.1093/jac/dky044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/23/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives Nebulized colistimethate sodium (CMS) can be used to treat ventilator-associated pneumonia caused by MDR bacteria. The influence of the diluent volume of CMS on aerosol delivery has never been studied. The main objectives of the study were to compare aerosol particle characteristics and plasma and urine pharmacokinetics between two diluent volumes in patients treated with nebulized CMS. Methods A crossover study was conducted in eight patients receiving nebulized CMS every 8 h. After inclusion, nebulization started with 4 million international units (MIU) of CMS diluted either in 6 mL (experimental dilution) or in 12 mL (recommended dilution) of normal saline in a random order. For each diluent volume, CMS aerosol particle sizes were measured and plasma and urine samples were collected every 2 h. Nebulization time and stability of colistin in normal saline were assessed. Results The mass median aerodynamic diameters were 1.4 ± 0.2 versus 0.9 ± 0.2 μm (P < 0.001) for 6 and 12 mL diluent volumes, respectively. The plasma area under the concentration-time curve from 0 to 8 h (AUC0-8) of colistinA+B was 6.6 (4.3-17.0) versus 6.7 (3.6-14.0) μg·h/mL (P = 0.461) for each dilution. The total amount of colistin and CMS eliminated in the urine represented, respectively, 17% and 13% of the CMS initially placed in the nebulizer chamber for 6 and 12 mL diluent volumes (P = 0.4). Nebulization time was shorter [66 (58-75) versus 93 (69-136) min, P = 0.042] and colistin stability was better with the 6 mL diluent volume. Conclusions Nebulization with a higher concentration of CMS in saline (4 MIU in 6 mL) decreases nebulization time and improves colistin stability without changing plasma and urine pharmacokinetics or aerosol particle characteristics for lung deposition.
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Affiliation(s)
- Kevin Bihan
- Department of Pharmacology and CIC-1421, F-75013, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Noël Zahr
- Department of Pharmacology and CIC-1421, F-75013, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Marie-Hélène Becquemin
- Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Xiao Lu
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.,Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Jean-François Bertholon
- Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Corinne Vezinet
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Charlotte Arbelot
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Olivier Langeron
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Qin Lu
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
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Rouby JJ, Arbelot C, Gao Y, Zhang M, Lv J, An Y, Chunyao W, Bin D, Valente Barbas CS, Dexheimer Neto FL, Prior Caltabeloti F, Lima E, Cebey A, Perbet S, Constantin JM. Training for Lung Ultrasound Score Measurement in Critically Ill Patients. Am J Respir Crit Care Med 2018. [PMID: 29557671 DOI: 10.1164/rccm.201802-0227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Affiliation(s)
| | | | - Yuzhi Gao
- Second Affiliated Hospital, Zhejiang UniversityHangzhou, China
| | - Mao Zhang
- Second Affiliated Hospital, Zhejiang UniversityHangzhou, China
| | - Jie Lv
- Peking University Health Science CenterBeijing, China
| | - Youzhong An
- Peking University Health Science CenterBeijing, China
| | - Wang Chunyao
- Peking Union Medical College HospitalBeijing, China
| | - Du Bin
- Peking Union Medical College HospitalBeijing, China
| | | | | | | | - Emidio Lima
- Hospital da BahiaSalvador, Brazil
- Santa Helena HospitalCamaçari, Brazil
| | - Andres Cebey
- Hospital de Clínicas Dr Manuel Quintela, Universidad de la RepublicaMontevideo, Uruguayand
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20
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Rouby JJ, Arbelot C, Gao Y, Zhang M, Lv J, An Y, Chunyao W, Bin D, Valente Barbas CS, Dexheimer Neto FL, Prior Caltabeloti F, Lima E, Cebey A, Perbet S, Constantin JM. Training for Lung Ultrasound Score Measurement in Critically Ill Patients. Am J Respir Crit Care Med 2018; 198:398-401. [PMID: 29557671 DOI: 10.1164/rccm.201802-0227le] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
| | | | - Yuzhi Gao
- Second Affiliated Hospital, Zhejiang UniversityHangzhou, China
| | - Mao Zhang
- Second Affiliated Hospital, Zhejiang UniversityHangzhou, China
| | - Jie Lv
- Peking University Health Science CenterBeijing, China
| | - Youzhong An
- Peking University Health Science CenterBeijing, China
| | - Wang Chunyao
- Peking Union Medical College HospitalBeijing, China
| | - Du Bin
- Peking Union Medical College HospitalBeijing, China
| | | | | | | | - Emidio Lima
- Hospital da BahiaSalvador, Brazil.,Santa Helena HospitalCamaçari, Brazil
| | - Andres Cebey
- Hospital de Clínicas Dr Manuel Quintela, Universidad de la RepublicaMontevideo, Uruguayand
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21
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Velly L, Perlbarg V, Boulier T, Adam N, Delphine S, Luyt CE, Battisti V, Torkomian G, Arbelot C, Chabanne R, Jean B, Di Perri C, Laureys S, Citerio G, Vargiolu A, Rohaut B, Bruder N, Girard N, Silva S, Cottenceau V, Tourdias T, Coulon O, Riou B, Naccache L, Gupta R, Benali H, Galanaud D, Puybasset L, Constantin JM, Chastre J, Amour J, Vezinet C, Rouby JJ, Raux M, Langeron O, Degos V, Bolgert F, Weiss N, Similowski T, Demoule A, Duguet A, Tollard E, Veber B, Lotterie JA, SANCHEZ-PENA P, Génestal M, Patassini M. Use of brain diffusion tensor imaging for the prediction of long-term neurological outcomes in patients after cardiac arrest: a multicentre, international, prospective, observational, cohort study. Lancet Neurol 2018; 17:317-326. [DOI: 10.1016/s1474-4422(18)30027-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 01/19/2023]
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22
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Riché A, Adam N, Monsel A, Xia J, Langeron O, Rouby JJ. Sevoflurane in Acute Respiratory Distress Syndrome: Are Lung Protection and Anesthesia Depth Influenced by Pulmonary Morphology? Am J Respir Crit Care Med 2018; 197:830-832. [DOI: 10.1164/rccm.201709-1864le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Jing Xia
- First Affiliated Hospital of Kunming Medical UniversityKunming, China
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23
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Rello J, Rouby JJ, Sole-Lleonart C, Chastre J, Blot S, Luyt CE, Riera J, Vos MC, Monsel A, Dhanani J, Roberts JA. Key considerations on nebulization of antimicrobial agents to mechanically ventilated patients. Clin Microbiol Infect 2017; 23:640-646. [PMID: 28347790 DOI: 10.1016/j.cmi.2017.03.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 03/15/2017] [Accepted: 03/21/2017] [Indexed: 11/30/2022]
Abstract
Nebulized antibiotics have an established role in patients with cystic fibrosis or bronchiectasis. Their potential benefit to treat respiratory infections in mechanically ventilated patients is receiving increasing interest. In this consensus statement of the European Society of Clinical Microbiology and Infectious Diseases, the body of evidence of the therapeutic utility of aerosolized antibiotics in mechanically ventilated patients was reviewed and resulted in the following recommendations: Vibrating-mesh nebulizers should be preferred to jet or ultrasonic nebulizers. To decrease turbulence and limit circuit and tracheobronchial deposition, we recommend: (a) the use of specifically designed respiratory circuits avoiding sharp angles and characterized by smooth inner surfaces, (b) the use of specific ventilator settings during nebulization including use of a volume controlled mode using constant inspiratory flow, tidal volume 8 mL/kg, respiratory frequency 12 to 15 bpm, inspiratory:expiratory ratio 50%, inspiratory pause 20% and positive end-expiratory pressure 5 to 10 cm H2O and (c) the administration of a short-acting sedative agent if coordination between the patient and the ventilator is not obtained, to avoid patient's flow triggering and episodes of peak decelerating inspiratory flow. A filter should be inserted on the expiratory limb to protect the ventilator flow device and changed between each nebulization to avoid expiratory flow obstruction. A heat and moisture exchanger and/or conventional heated humidifier should be stopped during the nebulization period to avoid a massive loss of aerosolized particles through trapping and condensation. If these technical requirements are not followed, there is a high risk of treatment failure and adverse events in mechanically ventilated patients receiving nebulized antibiotics for pneumonia.
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Affiliation(s)
- J Rello
- European Study Group for Infections in Critically Ill Patients (ESGCIP), Barcelona, Spain.
| | - J J Rouby
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie (UPMC) of Paris 6, Paris, France
| | | | - J Chastre
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie (UPMC) of Paris 6, Paris, France
| | - S Blot
- Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, European Study Group for Infections in Critically Ill Patients (ESGCIP), Ghent, Belgium
| | - C E Luyt
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie (UPMC) of Paris 6, Paris, France
| | - J Riera
- Critical Care Department, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Vall d'Hebron Institut of Research, Barcelona, Spain
| | - M C Vos
- Department of Medical Microbiology and Infectious Diseases, European Study Group of Nosocomial Infections (ESGNI), Rotterdam, The Netherlands
| | - A Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie (UPMC) of Paris 6, Paris, France
| | - J Dhanani
- Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Brisbane, Australia
| | - J A Roberts
- Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Brisbane, Australia
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Affiliation(s)
- Fabiola Prior Caltabeloti
- Departamento de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jean-Jacques Rouby
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, University Pierre and Marie Curie of Paris 6, Paris, France
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25
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Mrozek S, Jabaudon M, Jaber S, Paugam-Burtz C, Lefrant JY, Rouby JJ, Asehnoune K, Allaouchiche B, Baldesi O, Leone M, Lu Q, Bazin JE, Roszyk L, Sapin V, Futier E, Pereira B, Constantin JM. Elevated Plasma Levels of sRAGE Are Associated With Nonfocal CT-Based Lung Imaging in Patients With ARDS: A Prospective Multicenter Study. Chest 2016; 150:998-1007. [PMID: 27018314 DOI: 10.1016/j.chest.2016.03.016] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/02/2016] [Accepted: 03/09/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND During ARDS, CT can reveal two distinct lung imaging patterns, focal or nonfocal, with different responses to positive end-expiratory pressure, recruitment maneuvers, and prone position. Nevertheless, their association with plasma biomarkers and their distinct functional/pathobiological mechanisms are unknown. The objective of this study was to characterize focal and nonfocal patterns of lung CT-based imaging with plasma markers of lung injury. METHODS A prospective multicenter cohort study involving 119 consecutive patients with ARDS. Plasma biomarkers (soluble form of the receptor for advanced glycation end product [sRAGE], plasminogen activator inhibitor-1, soluble intercellular adhesion molecule-1, and surfactant protein-D) were measured within 24 h of ARDS onset. Lung CT scan was performed within the first 48 h to assess lung morphology. RESULTS Thirty-two (27%) and 87 (73%) patients had focal and nonfocal ARDS, respectively. Plasma levels of sRAGE were significantly higher in nonfocal ARDS, compared with focal ARDS. A cut-off of 1,188 pg/mL differentiated focal from nonfocal ARDS with a sensitivity of 94% and a specificity of 84%. Nonfocal patterns were associated with higher 28- and 90-day mortality than focal patterns (31% vs 12%, P = .038 and 46% vs 21%, P = .026, respectively). Plasma levels of plasminogen activator inhibitor-1 were significantly higher in nonfocal ARDS. There was no difference in other biomarkers. CONCLUSIONS Plasma sRAGE is associated with a nonfocal ARDS. Such novel findings may suggest a role for RAGE pathway in an underlying endotype of impaired alveolar fluid clearance and stimulate future research on the association between ARDS phenotypes and therapeutic responses.
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Affiliation(s)
- Segolene Mrozek
- Anesthesiology and Critical Care Department, University Hospital of Toulouse, Toulouse, France
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Samir Jaber
- Department of Anesthesiology and Critical Care Medicine B, Saint-Eloi Teaching Hospital, University Hospital of Montpellier, Inserm U-1046, Montpellier, France
| | - Catherine Paugam-Burtz
- Assistance Publique-Hôpitaux de Paris, Département d'Anesthésie et Réanimation, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine and Université Paris Diderot, Sorbonne Paris Cité, France
| | - Jean-Yves Lefrant
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Faculté de Médecine de Nîmes, Université Montpellier 1, Nîmes, France
| | - Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Pierre and Marie Curie of Paris, France
| | - Karim Asehnoune
- Department of Anesthesiology and Critical Care, Hotel-Dieu, Nantes, France
| | - Bernard Allaouchiche
- Hospices Civils de Lyon Service de Réanimation Médicale Centre Hospitalier Lyon-Sud, Pierre Bénite, France
| | | | - Marc Leone
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Qin Lu
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Pierre and Marie Curie of Paris, France
| | - Jean-Etienne Bazin
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurence Roszyk
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France; Department of Biology, University Hospital of Clermont-ferrand, Clermont-ferrand, France
| | - Vincent Sapin
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France; Department of Biology, University Hospital of Clermont-ferrand, Clermont-ferrand, France
| | - Emmanuel Futier
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (Department of Clinical Research and Innovation), University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, Clermont-Ferrand, France.
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26
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Solé-Lleonart C, Rouby JJ, Chastre J, Poulakou G, Palmer LB, Blot S, Felton T, Bassetti M, Luyt CE, Pereira JM, Riera J, Welte T, Roberts JA, Rello J. Intratracheal Administration of Antimicrobial Agents in Mechanically Ventilated Adults: An International Survey on Delivery Practices and Safety. Respir Care 2016; 61:1008-14. [PMID: 26957647 DOI: 10.4187/respcare.04519] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intratracheal antibiotic administration is increasingly used for treating respiratory infections. Limited information is available on delivery devices, techniques, and safety. METHODS An online survey on intratracheal administration of anti-infective agents in mechanically ventilated adults was answered by health-care workers from 192 ICUs to assess the most commonly used devices, current delivery practices, and safety issues. We investigated whether ICU usage experience (≥3 y) impacted its performance. RESULTS Intratracheal antibiotic administration was a current practice in 87 ICUs (45.3%), with 40 (46%) having experience with the technique (≥3 y). Sixty-six (78.6%) of 84 health-care workers reported avoiding intratracheal antibiotic administration due to an absence of evidence-based guidelines (78.6%). Jet nebulizers were the most commonly used devices for delivery, in 24 less experienced ICUs (27.6%) and in 18 (20.7%) experienced ICUs. Direct tracheal instillation (6; 6.9%) was still considered for drug prescription in 12 ICUs (6.9%). More experience resulted in neither greater adherence to measures improving the drug's delivery efficiency (93 measures in the experienced group; 27.9%) nor a greater adoption of measures to increase safety. Indeed, the expiratory filter was changed after each nebulization in only 2 experienced ICUs (6.9%), whereas 15 (51.7%) changed it daily instead. CONCLUSIONS Intratracheal antibiotic administration is a common therapeutic modality in ICUs, but inadequate practices were widely encountered, independent of the level of experience with the technique. This suggests a need to develop standardization to reduce variability and improve safety and efficacy.
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Affiliation(s)
- Candela Solé-Lleonart
- University of Toronto, UHN & Mount Sinai Hospital, Toronto, Canada and Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie (UPMC) of Paris 6, Paris, France
| | - Jean Chastre
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris, Paris, France
| | - Garyfallia Poulakou
- 4th Department of Internal Medicine, Athens University School of Medicine, Attikon University General Hospital, Athens, Greece
| | - Lucy B Palmer
- Pulmonary, Critical Care, and Sleep Division, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Stijn Blot
- Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | - Tim Felton
- Acute Intensive Care Unit, University Hospital of South Manchester, Manchester, United Kingdom
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Charles-Eduard Luyt
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris, Paris, France
| | - Joao Manuel Pereira
- Emergency and Intensive Care Department, Centro Hospitalar S João EPE, University of Porto, Porto, Portugal
| | - Jordi Riera
- Critical Care Department, Vall d'Hebron University Hospital, Centro Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Tobias Welte
- Department of Pulmonary Medicine, Hannover Medical School, Hannover, Germany
| | - Jason A Roberts
- Burns Trauma and Critical Care Research Centre, University of Queensland, Butterfield Street, Herston, Brisbane, Australia
| | - Jordi Rello
- Vall d'Hebron University Hospital, CIBERES, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain.
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27
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Chinardet B, Brisson H, Arbelot C, Langeron O, Rouby JJ, Lu Q. Ultrasound assessment of lung consolidation and reaeration after pleural effusion drainage in patients with Acute Respiratory Distress Syndrome: a pilot study. Acta Anaesthesiol Belg 2016; 67:29-35. [PMID: 27363212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The aim of the pilot study was to assess by ultrasound changes in dimensions of lung consolidation and reaeration after drainage of large pleural effusion in patients with acute respiratory distress syndrome (ARDS). METHODS Lung ultrasound and blood gas were performed before, 2 hours (H2) and 24 hours (H24) after drainage of pleural effusion. Lung ultrasound aeration score was calculated. Cephalocaudal dimension and diaphragmatic transversal area of lung consolidation were measured. RESULTS Ten patients were studied. Median volume of drained effusion was 675 ml at H2 and 895 at H24. Two hours after drainage, dimension of cephalocaudal consolidation and diaphragmatic transversal area decreased significantly. Lung reaeration after drainage occurred mainly in latero-inferior and postero-superior regions. PaO2/FiO2 increased significantly at H24. CONCLUSIONS Ultrasound is a useful method to assess lung consolidation after pleural effusion drainage. Drainage of pleural effusion may lead to a decrease of lung consolidation and improvement of lung reaeration.
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28
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Brossier F, Micaelo M, Luyt CE, Lu Q, Chastre J, Arbelot C, Trouillet JL, Combes A, Rouby JJ, Jarlier V, Aubry A. Could the DiversiLab® semi-automated repetitive-sequence-based PCR be an acceptable technique for typing isolates ofPseudomonas aeruginosa? An answer from our experience and a review of the literature. Can J Microbiol 2015; 61:903-12. [DOI: 10.1139/cjm-2015-0372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recently the DiversiLab® (DL) system (bioMérieux) was developed as an automated platform that uses repetitive element polymerase chain reaction (rep-PCR) technology for standardized, reproducible DNA fingerprinting of bacteria. The purpose of this study was to evaluate the usefulness of DL rep-PCR for typing Pseudomonas aeruginosa isolates. The performance of DL rep-PCR was compared with that of pulsed-field gel electrophoresis (PFGE) in a prospective multicenter study of patients with ventilator-associated pneumonia due to P. aeruginosa, conducted in 3 intensive care units over a 31-month period. In total, 203 P. aeruginosa isolates from 66 patients, from whom at least 2 consecutive respiratory samples each were collected more than 48 h apart, were typed using DL rep-PCR. Forty isolates (corresponding to 20 patients) were also typed using PFGE of SpeI-digested DNA. The typeability was 100% with DL rep-PCR and 95% with PFGE. The discriminatory power was close for DL rep-PCR and for PFGE (Simpson’s diversity indices of 0.901 and 0.947, respectively). Insufficient agreement between DL rep-PCR and PFGE typing results was observed for the 40 selected isolates (adjusted Rand coefficient of 0.419), mostly due to isolates of the same DL rep-PCR type but of different PFGE types (adjusted Wallace coefficients of 0.306 for DL rep-PCR with PFGE, and of 0.667 for PFGE with DL rep-PCR). Considered together with published data, DL rep-PCR results should be interpreted with caution for the investigation of outbreaks caused by P. aeruginosa and evaluated in conjunction with epidemiological data.
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Affiliation(s)
- Florence Brossier
- PRES Sorbonne Universités, UPMC Univ Paris 06, INSERM, U1135, Centre for Immunology and Microbial Infections, team 13, F-75013 Paris, France
- AP-HP, Hôpital Pitié–Salpêtrière, Bactériologie–Hygiène, F-75013 Paris, France
| | - Maïté Micaelo
- AP-HP, Hôpital Pitié–Salpêtrière, Bactériologie–Hygiène, F-75013 Paris, France
| | | | - Qin Lu
- AP-HP, Hôpital Pitié–Salpêtrière, Réanimation Polyvalente, Département d’Anesthésie–Réanimation, F-75013 Paris, France
| | - Jean Chastre
- AP-HP, Hôpital Pitié–Salpêtrière, Réanimation Médicale, F-75013 Paris, France
| | - Charlotte Arbelot
- AP-HP, Hôpital Pitié–Salpêtrière, Réanimation Polyvalente, Département d’Anesthésie–Réanimation, F-75013 Paris, France
| | | | - Alain Combes
- AP-HP, Hôpital Pitié–Salpêtrière, Réanimation Médicale, F-75013 Paris, France
| | - Jean-Jacques Rouby
- AP-HP, Hôpital Pitié–Salpêtrière, Réanimation Polyvalente, Département d’Anesthésie–Réanimation, F-75013 Paris, France
| | - Vincent Jarlier
- PRES Sorbonne Universités, UPMC Univ Paris 06, INSERM, U1135, Centre for Immunology and Microbial Infections, team 13, F-75013 Paris, France
- AP-HP, Hôpital Pitié–Salpêtrière, Bactériologie–Hygiène, F-75013 Paris, France
| | - Alexandra Aubry
- PRES Sorbonne Universités, UPMC Univ Paris 06, INSERM, U1135, Centre for Immunology and Microbial Infections, team 13, F-75013 Paris, France
- AP-HP, Hôpital Pitié–Salpêtrière, Bactériologie–Hygiène, F-75013 Paris, France
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Monsel A, Zhu YG, Gennai S, Hao Q, Hu S, Rouby JJ, Rosenzwajg M, Matthay MA, Lee JW. Therapeutic Effects of Human Mesenchymal Stem Cell-derived Microvesicles in Severe Pneumonia in Mice. Am J Respir Crit Care Med 2015; 192:324-36. [PMID: 26067592 DOI: 10.1164/rccm.201410-1765oc] [Citation(s) in RCA: 332] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Microvesicles (MVs) are anuclear fragments of cells released from the endosomal compartment or shed from surface membranes. We and other investigators demonstrated that MVs released by mesenchymal stem cells (MSCs) were as effective as the cells themselves in inflammatory injuries, such as after endotoxin-induced acute lung injury. However, the therapeutic effects of MVs in an infectious model of acute lung injury remain unknown. OBJECTIVES We investigated the effects of human MSC MVs on lung inflammation, protein permeability, bacterial clearance, and survival after severe bacterial pneumonia. METHODS We tested the effects of MVs derived from human MSCs on Escherichia coli pneumonia in mice. We also studied the interactions between MVs and human monocytes and human alveolar epithelial type 2 cells. MEASUREMENTS AND MAIN RESULTS Administration of MVs derived from human MSCs improved survival in part through keratinocyte growth factor secretion and decreased the influx of inflammatory cells, cytokines, protein, and bacteria in mice injured with bacterial pneumonia. In primary cultures of human monocytes or alveolar type 2 cells, the uptake of MVs was mediated by CD44 receptors, which were essential for the therapeutic effects. MVs enhanced monocyte phagocytosis of bacteria while decreasing inflammatory cytokine secretion and increased intracellular ATP levels in injured alveolar epithelial type 2 cells. Prestimulation of MSCs with a toll-like receptor 3 agonist further enhanced the therapeutic effects of the released MVs. CONCLUSIONS MVs derived from human MSCs were as effective as the parent stem cells in severe bacterial pneumonia.
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Affiliation(s)
- Antoine Monsel
- 1 Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre and Maris Curie (UPMC) Univ Paris 06, Paris, France.,2 Department of Immunology-Immunopathology-Biotherapy UPMC Univ Paris 06, Sorbonne Universités, INSERM UMRS 959, Paris, France; and.,3 Department of Anesthesiology & Medicine, University of California San Francisco, San Francisco, California
| | - Ying-gang Zhu
- 3 Department of Anesthesiology & Medicine, University of California San Francisco, San Francisco, California
| | - Stephane Gennai
- 3 Department of Anesthesiology & Medicine, University of California San Francisco, San Francisco, California
| | - Qi Hao
- 3 Department of Anesthesiology & Medicine, University of California San Francisco, San Francisco, California
| | - Shuling Hu
- 3 Department of Anesthesiology & Medicine, University of California San Francisco, San Francisco, California
| | - Jean-Jacques Rouby
- 1 Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre and Maris Curie (UPMC) Univ Paris 06, Paris, France
| | - Michelle Rosenzwajg
- 2 Department of Immunology-Immunopathology-Biotherapy UPMC Univ Paris 06, Sorbonne Universités, INSERM UMRS 959, Paris, France; and
| | - Michael A Matthay
- 3 Department of Anesthesiology & Medicine, University of California San Francisco, San Francisco, California
| | - Jae W Lee
- 3 Department of Anesthesiology & Medicine, University of California San Francisco, San Francisco, California
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Savier E, Dondero F, Vibert E, Eyraud D, Brisson H, Riou B, Fieux F, Naili-Kortaia S, Castaing D, Rouby JJ, Langeron O, Dokmak S, Hannoun L, Vaillant JC. First experience of liver transplantation with type 2 donation after cardiac death in France. Liver Transpl 2015; 21:631-43. [PMID: 25865077 DOI: 10.1002/lt.24107] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 12/26/2014] [Accepted: 02/08/2015] [Indexed: 02/07/2023]
Abstract
Organ donation after unexpected cardiac death [type 2 donation after cardiac death (DCD)] is currently authorized in France and has been since 2006. Following the Spanish experience, a national protocol was established to perform liver transplantation (LT) with type 2 DCD donors. After the declaration of death, abdominal normothermic oxygenated recirculation was used to perfuse and oxygenate the abdominal organs until harvesting and cold storage. Such grafts were proposed to consenting patients < 65 years old with liver cancer and without any hepatic insufficiency. Between 2010 and 2013, 13 LTs were performed in 3 French centers. Six patients had a rapid and uneventful postoperative recovery. However, primary nonfunction occurred in 3 patients, with each requiring urgent retransplantation, and 4 early allograft dysfunctions were observed. One patient developed a nonanastomotic biliary stricture after 3 months, whereas 8 patients showed no sign of ischemic cholangiopathy at their 1-year follow-up. In comparison with a control group of patients receiving grafts from brain-dead donors (n = 41), donor age and cold ischemia time were significantly lower in the type 2 DCD group. Time spent on the national organ wait list tended to be shorter in the type 2 DCD group: 7.5 months [interquartile range (IQR), 4.0-11.0 months] versus 12.0 months (IQR, 6.8-16.7 months; P = 0.08. The 1-year patient survival rates were similar (85% in the type 2 DCD group versus 93% in the control group), but the 1-year graft survival rate was significantly lower in the type 2 DCD group (69% versus 93%; P = 0.03). In conclusion, to treat borderline hepatocellular carcinoma, LT with type 2 DCD donors is possible as long as strict donor selection is observed.
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Affiliation(s)
- Eric Savier
- Service de Chirurgie Digestive, Hépato-Bilio-Pancréatique, Transplantation Hépatique, Centre Hospitalier Universitaire Pitié Salpetriere, AP-HP, Université Pierre et Marie Curie, Université Paris 06, Paris, France; Ischémie Reperfusion en Transplantation d'Organes Mécanismes et Innovations Thérapeutiques (IRTOMIT), INSERM U1082, Poitiers, France
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Rottembourg J, Rouby JJ, Toledano D, Glaser P, Durande JP, Viars P. High cardiac output in uremic patients with acute pulmonary edema. Contrib Nephrol 2015; 41:266-8. [PMID: 6525841 DOI: 10.1159/000429292] [Citation(s) in RCA: 1] [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: 01/20/2023]
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Moszkowicz D, Trésallet C, Mariani A, Lefevre JH, Godiris-Petit G, Noullet S, Rouby JJ, Menegaux F. Ischaemic colitis: indications, extent, and results of standardized emergency surgery. Dig Liver Dis 2014; 46:505-11. [PMID: 24656307 DOI: 10.1016/j.dld.2014.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/10/2014] [Accepted: 02/10/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute ischaemic colitis can occur postoperatively, mainly after aortic surgery, or spontaneously. Surgical treatment is debated. Study aim was to describe factors related to ischaemic colitis severity, determine if postoperative and spontaneous ischaemic colitis share similar outcomes, and evaluate results of standardized management. METHODS 191 consecutive cases of ischaemic colitis observed from 1997 to 2012 were retrospectively analyzed: 119 (62%) after surgery and 72 (38%) spontaneous. Colon resection was performed for endoscopic type 2 colitis with multiple organ failure, and for every type 3. Types 1 and 2 without multiple organ failure were managed nonoperatively. RESULTS Seventeen patients (9%) were managed nonoperatively, without mortality. Mortality rate after resection was 48% (84/174), within 9 days (range, 0-152). Multivariate analysis found 2 independent factors associated with postoperative death: age≥75 years and multiple organ failure. The context in which ischaemic colitis occurred was not a risk factor for mortality. Mortality rates were 51% for final type 3 (66% with multiple organ failure, 17% without), 53% for final type 2 with multiple organ failure, and 0% for type 1 or type 2 without multiple organ failure. CONCLUSION An aggressive surgical approach in patients with ischaemic colitis seems justified in patients with multiple organ failure and findings of severe form of ischaemia at endoscopy.
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Affiliation(s)
- David Moszkowicz
- Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France
| | - Christophe Trésallet
- Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France
| | - Antoine Mariani
- Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France
| | - Jérémie H Lefevre
- Department of Visceral Surgery, St-Antoine Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France
| | - Gaëlle Godiris-Petit
- Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France
| | - Séverine Noullet
- Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France
| | - Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France
| | - Fabrice Menegaux
- Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France.
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Caltabeloti F, Monsel A, Arbelot C, Brisson H, Lu Q, Gu WJ, Zhou GJ, Auler JOC, Rouby JJ. Early fluid loading in acute respiratory distress syndrome with septic shock deteriorates lung aeration without impairing arterial oxygenation: a lung ultrasound observational study. Crit Care 2014; 18:R91. [PMID: 24887155 PMCID: PMC4055974 DOI: 10.1186/cc13859] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 04/23/2014] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The study was designed to assess the impact of fluid loading on lung aeration, oxygenation and hemodynamics in patients with septic shock and acute respiratory distress syndrome (ARDS). METHODS During a 1-year period, a prospective observational study was performed in 32 patients with septic shock and ARDS. Cardiorespiratory parameters were measured using Swan Ganz (n = 29) or PiCCO catheters (n = 3). Lung aeration and regional pulmonary blood flows were measured using bedside transthoracic ultrasound. Measurements were performed before (T0), at the end of volume expansion (T1) and 40 minutes later (T2), consisting of 1-L of saline over 30 minutes during the first 48 h following onset of septic shock and ARDS. RESULTS Lung ultrasound score increased by 23% at T2, from 13 at baseline to 16 (P < 0.001). Cardiac index and cardiac filling pressures increased significantly at T1 (P < 0.001) and returned to control values at T2. The increase in lung ultrasound score was statistically correlated with fluid loading-induced increase in cardiac index and was not associated with increase in pulmonary shunt or regional pulmonary blood flow. At T1, PaO2/FiO2 significantly increased (P < 0.005) from 144 (123 to 198) to 165 (128 to 226) and returned to control values at T2, whereas lung ultrasound score continued to increase. CONCLUSIONS Early fluid loading transitorily improves hemodynamics and oxygenation and worsens lung aeration. Aeration changes can be detected at the bedside by transthoracic lung ultrasound, which may serve as a safeguard against excessive fluid loading.
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Bouhemad B, Barbry T, Soummer A, Lu Q, Rouby JJ. Doppler study of the effects of inhaled nitric oxide and intravenous almitrine on regional pulmonary blood flows in patients with acute lung injury. Minerva Anestesiol 2014; 80:517-525. [PMID: 24299918] [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: 06/02/2023]
Abstract
BACKGROUND Lung ultrasound can be used at bedside to assess initial lung morphology in hypoxemic patients. We hypothesized that blood flow in consolidated lung and therefore effects of inhaled nitric oxide (iNO) and intravenous almitrine could be directly assessed using Doppler transesophageal echocardiography (TEE). METHODS We conducted a prospective study including 13 ALI patients with consolidated left lower lobe (LLL). Regional arterial and venous flow signals within the consolidation were recorded with TEE using Doppler at baseline, after iNO (5 ppm), almitrine (4 μg/kg/min) and their combination. Pulmonary shunt (Qs/Qt) was measured using a Swan-Ganz catheter. Arterial and venous velocity time integral (VTI), peak velocity (Vmax) and mean velocity (Vmean) were measured. Patients were responders if PaO2 basal value increased by 20% after iNO or almitrine. RESULTS In 7 NO responders, iNO decreased regional arterial VTI (8.1±1.9 vs. 6.7±1.6, P<0.05). In 8 almitrine responders, almitrine decreased regional arterial and venous VTI (from 6.7±2.0 to 4.5±2.3 cm and from 12.3±5.4 to 7.5±3.8 cm, respectively, P<0.05). For all patients, combination of iNO and almitrine decreased regional arterial and venous VTI (from 7.3±0.3 to 4.1±0.3 cm and from 12.6±0.7 to 6.7±0.8 cm, respectively, P<0.05). Arterial and venous Vmean and Vmax significantly decreased. Variations of arterial VTI and venous Vmean were correlated to variations of Qs/Qt (r=.71, P<.001 and r=.62, P<.01, respectively). CONCLUSION Doppler of consolidated LLL allows assessment of regional pulmonary circulation in ICU settings. It detects changes in flow profiles resulting from the administration of NO and/or almitrine. Further applicability remains to be determined.
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Affiliation(s)
- B Bouhemad
- Réanimation Chirurgicale, Département d'Anesthésie-Réanimation, Groupe Hospitalier Paris Saint Joseph, Paris, Cedex 14 France -
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Lu Q, Eggimann P, Luyt CE, Wolff M, Tamm M, François B, Mercier E, Garbino J, Laterre PF, Koch H, Gafner V, Rudolf MP, Mus E, Perez A, Lazar H, Chastre J, Rouby JJ. Pseudomonas aeruginosa serotypes in nosocomial pneumonia: prevalence and clinical outcomes. Crit Care 2014; 18:R17. [PMID: 24428878 PMCID: PMC4057348 DOI: 10.1186/cc13697] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 01/08/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pseudomonas aeruginosa frequently causes nosocomial pneumonia and is associated with poor outcome. The purpose of this study was to assess the prevalence and clinical outcome of nosocomial pneumonia caused by serotype-specific P. aeruginosa in critically ill patients under appropriate antimicrobial therapy management. METHODS A retrospective, non-interventional epidemiological multicenter cohort study involving 143 patients with confirmed nosocomial pneumonia caused by P. aeruginosa. Patients were analyzed for a period of 30 days from time of nosocomial pneumonia onset. Fourteen patients fulfilling the same criteria from a phase IIa studyconducted at the same time/centers were included in the prevalence calculations but not in the clinical outcome analysis. RESULTS The prevalence of serotypes was: O6 (29%), O11 (23%), O10 (10%), O2 (9%), and O1 (8%). Serotypes with a prevalence of less than 5% were found in 13% of patients, 8% were classified as not typeable. Across all serotypes, 19% mortality, 70% clinical resolution, 11% clinical continuation, and 5% clinical recurrence were recorded. Age and higher APACHE II (Acute Physiology and Chronic Health Evaluation II) were predictive risk factors associated with probability of death and lower clinical resolution for P. aeruginosa nosocomial pneumonia. Mortality tends to be higher with O1 (40%) and lower with O2 (0%); clinical resolution tends to be better with O2 (82%) compared to other serotypes. Persisting pneumonia with O6 and O11 was, respectively, 8% and 21%; clinical resolution with O6 and O11 was, respectively, 75% and 57%. CONCLUSIONS In P. aeruginosa nosocomial pneumonia, the most prevalent serotypes were O6 and O11. Further studies including larger group sizes are needed to correlate clinical outcome with virulence factors of P. aeruginosa in patients with nosocomial pneumonia caused by various serotypes; and to compare O6 and O11, the two serotypes most frequently encountered in critically ill patients.
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Kacer S, Rouby JJ, Thomas M. [Support for the families of multi-trauma patients in intensive care]. Soins 2013:41-42. [PMID: 24218921] [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: 06/02/2023]
Abstract
Families are often in a state of shock when they learn that a loved one has been in an accident and been hospitalised in intensive care. The multi-disciplinary team works in synergy to welcome, inform, support and direct these families.
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Affiliation(s)
- Samia Kacer
- Département d'anesthésie-réanimation, réanimation polyvalente, hôpital Pitié-Salpêtrière, 83, boulevard de l'hôpital, Paris Cedex 13, France.
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Jabaudon M, Perbet S, Pereira B, Soummer A, Roszyk L, Guérin R, Futier E, Lu Q, Bazin JE, Sapin V, Rouby JJ, Constantin JM. Plasma levels of sRAGE, loss of aeration and weaning failure in ICU patients: a prospective observational multicenter study. PLoS One 2013; 8:e64083. [PMID: 23724022 PMCID: PMC3664630 DOI: 10.1371/journal.pone.0064083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 04/06/2013] [Indexed: 11/18/2022] Open
Abstract
Rationale Postextubation distress after a successful spontaneous breathing trial (SBT) is associated with increased morbidity and mortality. Lung ultrasound determination of changes in lung aeration predicts weaning failure. It remains unknown whether this derecruitment is related to alveolar epithelial dysfunction or not. Objective To verify whether lung alveolar type I epithelial cell injury marker sRAGE (soluble form of the receptor for advanced glycation end-products) is predictive of postextubation distress and weaning failure or not, and to verify whether plasma sRAGE levels can be related to lung derecruitment during the process of weaning from mechanical ventilation or not. Interventions, Measurements 88 patients from 2 intensive care units were included in this observational prospective study. Plasma sRAGE levels were measured in duplicate by ELISA before, at the end of a 60-minute SBT, and 4 hours after extubation. To quantify lung aeration, a lung ultrasound score was calculated. Main Results 34% of extubated patients experienced postextubation distress. Patients with or without postextubation distress had comparable sRAGE levels before SBT, after SBT, and 4 hours after extubation. In patients with postextubation distress, sRAGE levels were not predictive of the need for mechanical ventilation. sRAGE levels were not associated with lung aeration as assessed by echography. Patients who succeeded SBT (86%) and those who failed (14%) had no differences in sRAGE levels, before (median 1111 vs 1021 pg/mL, p = 0,87) and at the end of SBT (1165 vs 1038 pg/mL, p = 0.74). Conclusions Plasma levels of sRAGE do not predict postextubation distress or SBT failure/success in patients weaning from mechanical ventilation. Lung aeration loss during a successful weaning trial predicts postextubation distress, but may not be evaluable by plasma levels of sRAGE, a marker of alveolar type I epithelial cell injury. Trial Registration ClinicalTrials.gov NCT01098773
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Affiliation(s)
- Matthieu Jabaudon
- Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Estaing Hospital, CHU Clermont-Ferrand, Université d'Auvergne Clermont Ferrand 1, Clermont-Ferrand, France.
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Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38:577-91. [PMID: 22392031 DOI: 10.1007/s00134-012-2513-4] [Citation(s) in RCA: 1696] [Impact Index Per Article: 141.3] [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: 10/29/2011] [Accepted: 01/23/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND The purpose of this study is to provide evidence-based and expert consensus recommendations for lung ultrasound with focus on emergency and critical care settings. METHODS A multidisciplinary panel of 28 experts from eight countries was involved. Literature was reviewed from January 1966 to June 2011. Consensus members searched multiple databases including Pubmed, Medline, OVID, Embase, and others. The process used to develop these evidence-based recommendations involved two phases: determining the level of quality of evidence and developing the recommendation. The quality of evidence is assessed by the grading of recommendation, assessment, development, and evaluation (GRADE) method. However, the GRADE system does not enforce a specific method on how the panel should reach decisions during the consensus process. Our methodology committee decided to utilize the RAND appropriateness method for panel judgment and decisions/consensus. RESULTS Seventy-three proposed statements were examined and discussed in three conferences held in Bologna, Pisa, and Rome. Each conference included two rounds of face-to-face modified Delphi technique. Anonymous panel voting followed each round. The panel did not reach an agreement and therefore did not adopt any recommendations for six statements. Weak/conditional recommendations were made for 2 statements, and strong recommendations were made for the remaining 65 statements. The statements were then recategorized and grouped to their current format. Internal and external peer-review processes took place before submission of the recommendations. Updates will occur at least every 4 years or whenever significant major changes in evidence appear. CONCLUSIONS This document reflects the overall results of the first consensus conference on "point-of-care" lung ultrasound. Statements were discussed and elaborated by experts who published the vast majority of papers on clinical use of lung ultrasound in the last 20 years. Recommendations were produced to guide implementation, development, and standardization of lung ultrasound in all relevant settings.
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Affiliation(s)
- Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, 10043 Orbassano, Torino, Italy.
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Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012. [DOI: 10.1007/s00134-012-2513-4 order by 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: 02/10/2023]
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Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012. [DOI: 10.1007/s00134-012-2513-4 order by 8029-- -] [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: 02/10/2023]
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Affiliation(s)
- Belaïd Bouhemad
- Multidisciplinary Intensive Care Unit Pierre Viars La Pitié-Salpêtrière Hospital Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie of Paris 6Paris, France
| | - Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit Pierre Viars La Pitié-Salpêtrière Hospital Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie of Paris 6Paris, France
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Dellamonica J, Lerolle N, Sargentini C, Beduneau G, Di Marco F, Mercat A, Richard JCM, Diehl JL, Mancebo J, Rouby JJ, Lu Q, Bernardin G, Brochard L. Accuracy and precision of end-expiratory lung-volume measurements by automated nitrogen washout/washin technique in patients with acute respiratory distress syndrome. Crit Care 2011; 15:R294. [PMID: 22166727 PMCID: PMC3388680 DOI: 10.1186/cc10587] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 12/04/2011] [Accepted: 12/07/2011] [Indexed: 11/10/2022] Open
Abstract
Introduction End-expiratory lung volume (EELV) is decreased in acute respiratory distress
syndrome (ARDS), and bedside EELV measurement may help to set positive
end-expiratory pressure (PEEP). Nitrogen washout/washin for EELV measurement is
available at the bedside, but assessments of accuracy and precision in real-life
conditions are scant. Our purpose was to (a) assess EELV measurement precision in
ARDS patients at two PEEP levels (three pairs of measurements), and (b) compare
the changes (Δ) induced by PEEP for total EELV with the PEEP-induced changes
in lung volume above functional residual capacity measured with passive spirometry
(ΔPEEP-volume). The minimal predicted increase in lung volume was calculated
from compliance at low PEEP and ΔPEEP to ensure the validity of lung-volume
changes. Methods Thirty-four patients with ARDS were prospectively included in five
university-hospital intensive care units. ΔEELV and ΔPEEP volumes were
compared between 6 and 15 cm H2O of PEEP. Results After exclusion of three patients, variability of the nitrogen technique was less
than 4%, and the largest difference between measurements was 81 ± 64 ml.
ΔEELV and ΔPEEP-volume were only weakly correlated (r2
= 0.47); 95% confidence interval limits, -414 to 608 ml). In four
patients with the highest PEEP (≥ 16 cm H2O), ΔEELV was
lower than the minimal predicted increase in lung volume, suggesting flawed
measurements, possibly due to leaks. Excluding those from the analysis markedly
strengthened the correlation between ΔEELV and ΔPEEP volume (r2
= 0.80). Conclusions In most patients, the EELV technique has good reproducibility and accuracy, even
at high PEEP. At high pressures, its accuracy may be limited in case of leaks. The
minimal predicted increase in lung volume may help to check for accuracy.
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Affiliation(s)
- Jean Dellamonica
- Réanimation Médicale, AP-HP, Centre Hospitalier Albert Chenevier, Henri Mondor, avenue Marechal de Lattre de Tassigny, Créteil, 94000, France.
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Monsel A, Mal H, Brisson H, Luo R, Eyraud D, Vézinet C, Do CH, Lu Q, Vaillant JC, Hannoun L, Houssel P, Durand F, Rouby JJ. Extracorporeal membrane oxygenation as a bridge to liver transplantation for acute respiratory distress syndrome-induced life-threatening hypoxaemia aggravated by hepatopulmonary syndrome. Crit Care 2011; 15:R234. [PMID: 21958549 PMCID: PMC3334782 DOI: 10.1186/cc10476] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 05/04/2011] [Accepted: 09/29/2011] [Indexed: 02/07/2023]
Abstract
Introduction Combined with massive lung aeration loss resulting from acute respiratory distress syndrome, hepatopulmonary syndrome, a liver-induced vascular lung disorder characterized by diffuse or localized dilated pulmonary capillaries, may induce hypoxaemia and death in patients with end-stage liver disease. Methods The case of such a patient presenting with both disorders and in whom an extracorporeal membrane oxygenation was used is described. Results A 51-year-old man with a five-year history of alcoholic cirrhosis was admitted for acute respiratory failure, platypnoea and severe hypoxaemia requiring emergency tracheal intubation. Following mechanical ventilation, hypoxaemia remained refractory to positive end-expiratory pressure, 100% of inspired oxygen and inhaled nitric oxide. Two-dimensional contrast-enhanced (agitated saline) transthoracic echocardiography disclosed a massive right-to-left extracardiac shunt, without patent foramen ovale. Contrast computed tomography (CT) of the thorax using quantitative analysis and colour encoding system established the diagnosis of acute respiratory distress syndrome aggravated by hepatopulmonary syndrome. According to the severity of the respiratory condition, a veno-venous extracorporeal membrane oxygenation was implemented and the patient was listed for emergency liver transplantation. Orthotopic liver transplantation was performed at Day 13. At the end of the surgical procedure, the improvement in oxygenation allowed removal of extracorporeal membrane oxygenation (Day 5). The patient was discharged from hospital at Day 48. Three months after hospital discharge, the patient recovered a correct physical autonomy status without supplemental O2. Conclusions In a cirrhotic patient, acute respiratory distress syndrome was aggravated by hepatopulmonary syndrome causing life-threatening hypoxaemia not controlled by standard supportive measures. The use of extracorporeal membrane oxygenation, by controlling gas exchange, allowed the performing of a successful liver transplantation and final recovery.
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Affiliation(s)
- Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, UPMC Univ Paris 06, 83 Bd de l'Hôpital, 75013, Paris, France
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Hussenet C, Jauréguiberry S, Robert J, Rouby JJ, Bricaire F, Caumes E. Multidrug-resistant Acinetobacter baumannii infections in three returning travelers evacuated from Algeria, Thailand, and Turkey after hospitalization in local intensive care units. J Travel Med 2011; 18:358-60. [PMID: 21896102 DOI: 10.1111/j.1708-8305.2011.00546.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report three cases of returning travelers evacuated from Algeria, Thailand, and Turkey by aero-medical repatriation, following overseas hospitalization in local intensive care units for accidental injuries or medical problems. All three patients presented with imipenem-resistant Acinetobacter baumannii infections. One died whereas two recovered.
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Affiliation(s)
- Claire Hussenet
- Department of Infectious and Tropical Diseases, Pitié Salpêtrière Hospital, Université Pierre et Marie Curie, APHP, Paris, France
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Lu Q, Yang J, Liu Z, Gutierrez C, Aymard G, Rouby JJ. Nebulized Ceftazidime and Amikacin in Ventilator-associated Pneumonia Caused byPseudomonas aeruginosa. Am J Respir Crit Care Med 2011; 184:106-15. [DOI: 10.1164/rccm.201011-1894oc] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Soummer A, Megarbane B, Boroli F, Arbelot C, Saleh M, Moesch C, Fournier E, Rouby JJ. Severe and prolonged neurologic toxicity following subcutaneous chlorpyrifos self-administration: a case report. Clin Toxicol (Phila) 2011; 49:124-7. [PMID: 21370952 DOI: 10.3109/15563650.2011.552066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [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]
Abstract
INTRODUCTION Organophosphate poisoning by oral or inhalation routes is characterized by a typical time-course of clinical features. CASE PRESENTATION We report a case of subcutaneous chlorpyrifos self-injection leading to a delayed cholinergic phase, prolonged coma, and severe permanent neurologic injury with electrophysiological patterns suggestive of overlapping intermediate syndrome and distal peripheral neuropathy. Time-course and severity of clinical features were not altered by either atropine or pralidoxime administration. Due to prolonged and severe alteration in consciousness, we used brain multimodal nuclear magnetic imaging and auditory cognitive event-related potentials to assess the patient's potential for awakening. Electrophysiological testing used to monitor muscle weakness showed the coexistence of 20 Hz-decremental responses in proximal muscles and severe denervation in distal muscles. Red blood cell acetylcholinesterase activity progressively normalized on day 60, while plasma butyrylcholinesterase activity remained low until day 100. Chlorpyrifos was detectable in serum until day 30 and urine metabolites for up to three months, supporting the hypothesis of a continuous chlorpyrifos release despite repeated surgical debridement. We suggest that adipose and muscle tissues acted as a chlorpyrifos reservoir. At one-year follow-up, the patient exhibited significant neuromuscular sequelae. CONCLUSION Subcutaneous chlorpyrifos self-injection may result in severe toxicity with prolonged neurologic injury, atypical overlapping electrophysiological patterns, and a poor final outcome.
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Affiliation(s)
- Alexis Soummer
- Department of Anesthesiology and Critical Care, Multidisciplinary Intensive Care Unit, Pitié Salpêtrière Hospital, Assistance-Publique-Hôpitaux-de-Paris, UPMC (University Pierre et Marie Curie), Paris 6, France.
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47
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Lu Q, Rouby JJ, Laterre PF, Eggimann P, Dugard A, Giamarellos-Bourboulis EJ, Mercier E, Garbino J, Luyt CE, Chastre J, Georgescu-Kyburz V, Rudolf MP, Gafner V, Lazar H, Koch H, Perez A, Krämer SD, Tamm M. Pharmacokinetics and safety of panobacumab: specific adjunctive immunotherapy in critical patients with nosocomial Pseudomonas aeruginosa O11 pneumonia. J Antimicrob Chemother 2011; 66:1110-6. [PMID: 21398296 DOI: 10.1093/jac/dkr046] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Nosocomial Pseudomonas aeruginosa pneumonia remains a major concern in critically ill patients. We explored the potential impact of microorganism-targeted adjunctive immunotherapy in such patients. PATIENTS AND METHODS This multicentre, open pilot Phase 2a clinical trial (NCT00851435) prospectively evaluated the safety, pharmacokinetics and potential efficacy of three doses of 1.2 mg/kg panobacumab, a fully human monoclonal anti-lipopolysaccharide IgM, given every 72 h in 18 patients developing nosocomial P. aeruginosa (serotype O11) pneumonia. RESULTS Seventeen out of 18 patients were included in the pharmacokinetic analysis. In 13 patients receiving three doses, the maximal concentration after the third infusion was 33.9 ± 8.0 μg/mL, total area under the serum concentration-time curve was 5397 ± 1993 μg h/mL and elimination half-life was 102.3 ± 47.8 h. Panobacumab was well tolerated, induced no immunogenicity and was detected in respiratory samples. In contrast to Acute Physiology and Chronic Health Evaluation II (APACHE II) prediction, all 13 patients receiving three doses survived, with a mean clinical resolution in 9.0 ± 2.7 days. Two patients suffered a recurrence at days 17 and 20. CONCLUSIONS These data suggest that panobacumab is safe, with a pharmacokinetic profile similar to that in healthy volunteers. It was associated with high clinical cure and survival rates in patients developing nosocomial P. aeruginosa O11 pneumonia. We concluded that these promising results warrant further trials.
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Affiliation(s)
- Qin Lu
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, UPMC Paris 6, France
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Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med 2010; 183:341-7. [PMID: 20851923 DOI: 10.1164/rccm.201003-0369oc] [Citation(s) in RCA: 446] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE In the critically ill patients, lung ultrasound (LUS) is increasingly being used at the bedside for assessing alveolar-interstitial syndrome, lung consolidation, pneumonia, pneumothorax, and pleural effusion. It could be an easily repeatable noninvasive tool for assessing lung recruitment. OBJECTIVES Our goal was to compare the pressure-volume (PV) curve method with LUS for assessing positive end-expiratory pressure (PEEP)-induced lung recruitment in patients with acute respiratory distress syndrome/acute lung injury (ARDS/ALI). METHODS Thirty patients with ARDS and 10 patients with ALI were prospectively studied. PV curves and LUS were performed in PEEP 0 and PEEP 15 cm H₂O₂. PEEP-induced lung recruitment was measured using the PV curve method. MEASUREMENTS AND MAIN RESULTS Four LUS entities were defined: consolidation; multiple, irregularly spaced B lines; multiple coalescent B lines; and normal aeration. For each of the 12 lung regions examined, PEEP-induced ultrasound changes were measured, and an ultrasound reaeration score was calculated. A highly significant correlation was found between PEEP-induced lung recruitment measured by PV curves and ultrasound reaeration score (Rho = 0.88; P < 0.0001). An ultrasound reaeration score of +8 or higher was associated with a PEEP-induced lung recruitment greater than 600 ml. An ultrasound lung reaeration score of +4 or less was associated with a PEEP-induced lung recruitment ranging from 75 to 450 ml. A statistically significant correlation was found between LUS reaeration score and PEEP-induced increase in Pa(O₂) (Rho = 0.63; P < 0.05). CONCLUSIONS PEEP-induced lung recruitment can be adequately estimated with bedside LUS. Because LUS cannot assess PEEP-induced lung hyperinflation, it should not be the sole method for PEEP titration.
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Affiliation(s)
- Belaïd Bouhemad
- Multidisciplinary Intensive Care Unit Pierre Viars, Assistance Publique Hôpitaux de Paris.
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Lu Q, Zhang M, Girardi C, Bouhemad B, Kesecioglu J, Rouby JJ. Computed tomography assessment of exogenous surfactant-induced lung reaeration in patients with acute lung injury. Crit Care 2010; 14:R135. [PMID: 20633284 PMCID: PMC2945105 DOI: 10.1186/cc9186] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 04/27/2010] [Accepted: 07/15/2010] [Indexed: 12/02/2022]
Abstract
Introduction Previous randomized trials failed to demonstrate a decrease in mortality of patients with acute lung injury treated by exogenous surfactant. The aim of this prospective randomized study was to evaluate the effects of exogenous porcine-derived surfactant on pulmonary reaeration and lung tissue in patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS). Methods Twenty patients with ALI/ARDS were studied (10 treated by surfactant and 10 controls) in whom a spiral thoracic computed tomography scan was acquired before (baseline), 39 hours and 7 days after the first surfactant administration. In the surfactant group, 3 doses of porcine-derived lung surfactant (200 mg/kg/dose) were instilled in both lungs at 0, 12 and 36 hours. Each instillation was followed by recruitment maneuvers. Gas and tissue volumes were measured separately in poorly/nonaerated and normally aerated lung areas before and seven days after the first surfactant administration. Surfactant-induced lung reaeration was defined as an increase in gas volume in poorly/non-aerated lung areas between day seven and baseline compared to the control group. Results At day seven, surfactant induced a significant increase in volume of gas in poorly/non-aerated lung areas (320 ± 125 ml versus 135 ± 161 ml in controls, P = 0.01) and a significant increase in volume of tissue in normally aerated lung areas (189 ± 179 ml versus -15 ± 105 ml in controls, P < 0.01). PaO2/FiO2 ratio was not different between the surfactant treated group and control group after surfactant replacement. Conclusions Intratracheal surfactant replacement induces a significant and prolonged lung reaeration. It also induces a significant increase in lung tissue in normally aerated lung areas, whose mechanisms remain to be elucidated. Trial registration NCT00742482.
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Affiliation(s)
- Qin Lu
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, UPMC Univ Paris 06, 47-83 boulevard de l'hôpital, 75013 Paris, France.
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Remérand F, Dellamonica J, Mao Z, Ferrari F, Bouhemad B, Jianxin Y, Arbelot C, Lu Q, Ichaï C, Rouby JJ. Multiplane ultrasound approach to quantify pleural effusion at the bedside. Intensive Care Med 2010; 36:656-64. [PMID: 20140421 DOI: 10.1007/s00134-010-1769-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 10/28/2009] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the accuracy of a multiplane ultrasound approach to measure pleural effusion volume (PEV), considering pleural effusion (PE) extension along the cephalocaudal axis and PE area. METHODS Prospective study performed on 58 critically ill patients with 102 PEs. Thoracic drainage was performed in 46 patients (59 PEs) and lung computed tomography (CT) in 24 patients (43 PEs). PE was assessed using bedside lung ultrasound. Adjacent paravertebral intercostal spaces were examined, and ultrasound PEV was calculated by multiplying the paravertebral PE length by its area, measured at half the distance between the apical and caudal limits of the PE. RESULTS Ultrasound PEV was compared to either the volume of the drained PE (59 PE) or PEV assessed on lung CT (43 PE). In patients with lung CT, the accuracy of this new method was compared to the accuracy of previous methods proposed for PEV measurement. Ultrasound PEV was tightly correlated with drained PEV (r = 0.84, p < 0.001) and with CT PEV (r = 0.90, p < 0.001). The mean biases between ultrasound and actual volumes of PE were -33 ml when compared to drainage (limits of agreement -292 to +227 ml) and -53 ml when compared to CT (limits of agreement -303 to +198 ml). This new method was more accurate than previous methods to measure PEV. CONCLUSION Using a multiplane approach increases the accuracy of lung ultrasound to measure the volume of large to small pleural effusions in critically ill patients.
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Affiliation(s)
- Francis Remérand
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hôpital, Assistance Publique Hôpitaux de Paris, UPMC Univ Paris 06, Paris, France
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