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Mezidi M, Yonis H, Chauvelot L, Deniel G, Dhelft F, Gaillet M, Noirot I, Folliet L, Chabert P, David G, Danjou W, Baboi L, Bettinger C, Bernon P, Girard M, Provoost J, Bazzani A, Bitker L, Richard JC. Spontaneous breathing trial with pressure support on positive end-expiratory pressure and extensive use of non-invasive ventilation versus T-piece in difficult-to-wean patients from mechanical ventilation: a randomized controlled trial. Ann Intensive Care 2024; 14:59. [PMID: 38630372 PMCID: PMC11024068 DOI: 10.1186/s13613-024-01290-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/04/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The aim of this study is to assess whether a strategy combining spontaneous breathing trial (SBT) with both pressure support (PS) and positive end-expiratory pressure (PEEP) and extended use of post-extubation non-invasive ventilation (NIV) (extensively-assisted weaning) would shorten the time until successful extubation as compared with SBT with T-piece (TP) and post-extubation NIV performed in selected patients as advocated by guidelines (standard weaning), in difficult-to-wean patients from mechanical ventilation. METHODS The study is a single-center prospective open label, randomized controlled superiority trial with two parallel groups and balanced randomization with a 1:1 ratio. Eligible patients were intubated patients mechanically ventilated for more than 24 h who failed their first SBT using TP. In the extensively-assisted weaning group, SBT was performed with PS (7 cmH2O) and PEEP (5 cmH2O). In case of SBT success, an additional SBT with TP was performed. Failure of this SBT-TP was an additional criterion for post-extubation NIV in this group in addition to other recommended criteria. In the standard weaning group, SBT was performed with TP, and NIV was performed according to international guidelines. The primary outcome criterion was the time between inclusion and successful extubation evaluated with a Cox model with adjustment on randomization strata. RESULTS From May 2019 to March 2023, 98 patients were included and randomized in the study (49 in each group). Four patients were excluded from the intention-to-treat population (2 in both groups); therefore, 47 patients were analyzed in each group. The extensively-assisted weaning group had a higher median age (68 [58-73] vs. 62 [55-71] yrs.) and similar sex ratio (62% male vs. 57%). Time until successful extubation was not significantly different between extensively-assisted and standard weaning groups (median, 172 [50-436] vs. 95 [47-232] hours, Cox hazard ratio for successful extubation, 0.88 [95% confidence interval: 0.55-1.42] using the standard weaning group as a reference; p = 0.60). All secondary outcomes were not significantly different between groups. CONCLUSION An extensively-assisted weaning strategy did not lead to a shorter time to successful extubation than a standard weaning strategy. Trial registration The trial was registered on ClinicalTrials.gov (NCT03861117), on March 1, 2019, before the inclusion of the first patient. https://clinicaltrials.gov/study/NCT03861117 .
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Affiliation(s)
- Mehdi Mezidi
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
- Université Lyon 1, Université de Lyon, Lyon, France.
| | - Hodane Yonis
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Louis Chauvelot
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Guillaume Deniel
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
- CREATIS INSERM, 1044 CNRS 5220, Villeurbanne, France
| | - François Dhelft
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
| | - Maxime Gaillet
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
| | - Ines Noirot
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laure Folliet
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Paul Chabert
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Guillaume David
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - William Danjou
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Loredana Baboi
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Clotilde Bettinger
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pauline Bernon
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Mehdi Girard
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Judith Provoost
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alwin Bazzani
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laurent Bitker
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
- CREATIS INSERM, 1044 CNRS 5220, Villeurbanne, France
| | - Jean-Christophe Richard
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
- CREATIS INSERM, 1044 CNRS 5220, Villeurbanne, France
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Tankéré P, Le Cam P, Folliet L, Bernard E, Cluse F, Gobert F, Ricordeau F, Jaffiol A, Peronnet T, Stauffer E, Peter-Derex L, Petitjean T. Unveiled central hypoventilation after tracheotomy in anti-IgLON5 disease: a case report. J Clin Sleep Med 2023; 19:1701-1704. [PMID: 37166031 PMCID: PMC10476033 DOI: 10.5664/jcsm.10658] [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: 02/21/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/12/2023]
Abstract
Anti-IgLON5 disease is a recently described entity that has been associated with neurological symptoms and sleep disturbances including sleep breathing disorders. Sleep stridor as well as obstructive and less often central sleep apnea have been reported but rarely needing ventilation on tracheotomy. We report the case of a patient in whom obstructive sleep apnea with secondary development of dysphagia and recurrent aspiration pneumonia led to the diagnosis of anti-IgLON 5 disease. Acute respiratory failure due to laryngospasm required intubation and eventually tracheotomy. Yet hypoventilation persisted, and polysomnography demonstrated central sleep apnea alternating with sleep-related tachypnea. Nocturnal ventilation was thus reintroduced. The association of obstructive sleep apnea with dysphagia is a potential red flag for anti-IgLON5 disease, which remains an overlooked diagnosis. Breathing disorders can be complex in this context, with a mixed obstructive and central pattern whose central component can be unveiled after tracheotomy. This highlights the importance of closely monitoring sleep and respiration even after tracheotomy. CITATION Tankéré P, Le Cam P, Folliet L, et al. Unveiled central hypoventilation after tracheotomy in anti-IgLON5 disease: a case report. J Clin Sleep Med. 2023;19(9):1701-1704.
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Affiliation(s)
- Pierre Tankéré
- Reference Center for Rare Pulmonary Diseases, Pulmonary Medicine and Intensive Care Unit, Dijon University Hospital, Dijon, France
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Le Cam
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laure Folliet
- Respiratory Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Emilien Bernard
- ALS Resource and Competence Centre Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
- Electroneuromyography and Neuromuscular Disorders Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon, France
| | - Florent Cluse
- ALS Resource and Competence Centre Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
- Electroneuromyography and Neuromuscular Disorders Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon, France
| | - Florent Gobert
- Intensive Care Unit, Neurological Hospital, Hospices Civils de Lyon, Lyon, France
- Lyon Neuroscience Research Center, IMPACT and CAP Teams, INSERM U1028, CNRS UMR 5292, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - François Ricordeau
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Antoine Jaffiol
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Théo Peronnet
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Emeric Stauffer
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Lyon Neuroscience Research Center, PAM Team, INSERM U1028, CNRS UMR 5292, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Laboratory LIBM EA7424, Team “Vascular Biology and Red Blood Cell,” University of Lyon 1, Lyon, France
| | - Thierry Petitjean
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
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Richard JC, Sigaud F, Gaillet M, Orkisz M, Bayat S, Roux E, Ahaouari T, Davila E, Boussel L, Ferretti G, Yonis H, Mezidi M, Danjou W, Bazzani A, Dhelft F, Folliet L, Girard M, Pozzi M, Terzi N, Bitker L. Response to PEEP in COVID-19 ARDS patients with and without extracorporeal membrane oxygenation. A multicenter case–control computed tomography study. Crit Care 2022; 26:195. [PMID: 35780154 PMCID: PMC9250720 DOI: 10.1186/s13054-022-04076-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background PEEP selection in severe COVID-19 patients under extracorporeal membrane oxygenation (ECMO) is challenging as no study has assessed the alveolar recruitability in this setting. The aim of the study was to compare lung recruitability and the impact of PEEP on lung aeration in moderate and severe ARDS patients with or without ECMO, using computed tomography (CT). Methods We conducted a two-center prospective observational case–control study in adult COVID-19-related patients who had an indication for CT within 72 h of ARDS onset in non-ECMO patients or within 72 h after ECMO onset. Ninety-nine patients were included, of whom 24 had severe ARDS under ECMO, 59 severe ARDS without ECMO and 16 moderate ARDS. Results Non-inflated lung at PEEP 5 cmH2O was significantly greater in ECMO than in non-ECMO patients. Recruitment induced by increasing PEEP from 5 to 15 cmH2O was not significantly different between ECMO and non-ECMO patients, while PEEP-induced hyperinflation was significantly lower in the ECMO group and virtually nonexistent. The median [IQR] fraction of recruitable lung mass between PEEP 5 and 15 cmH2O was 6 [4–10]%. Total superimposed pressure at PEEP 5 cmH2O was significantly higher in ECMO patients and amounted to 12 [11–13] cmH2O. The hyperinflation-to-recruitment ratio (i.e., a trade-off index of the adverse effects and benefits of PEEP) was significantly lower in ECMO patients and was lower than one in 23 (96%) ECMO patients, 41 (69%) severe non-ECMO patients and 8 (50%) moderate ARDS patients. Compliance of the aerated lung at PEEP 5 cmH2O corrected for PEEP-induced recruitment (CBABY LUNG) was significantly lower in ECMO patients than in non-ECMO patients and was linearly related to the logarithm of the hyperinflation-to-recruitment ratio. Conclusions Lung recruitability of COVID-19 pneumonia is not significantly different between ECMO and non-ECMO patients, with substantial interindividual variations. The balance between hyperinflation and recruitment induced by PEEP increase from 5 to 15 cmH2O appears favorable in virtually all ECMO patients, while this PEEP level is required to counteract compressive forces leading to lung collapse. CBABY LUNG is significantly lower in ECMO patients, independently of lung recruitability. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04076-z.
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Chazot G, Bitker L, Mezidi M, Chebib N, Chabert P, Chauvelot L, Folliet L, David G, Provoost J, Yonis H, Richard JC. Prevalence and risk factors of hemodynamic instability associated with preload-dependence during continuous renal replacement therapy in a prospective observational cohort of critically ill patients. Ann Intensive Care 2021; 11:95. [PMID: 34125314 PMCID: PMC8200783 DOI: 10.1186/s13613-021-00883-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background Hemodynamic instability is a frequent complication of continuous renal replacement therapy (CRRT). Postural tests (i.e., passive leg raising in the supine position or Trendelenburg maneuver in the prone position) combined with measurement of cardiac output are highly reliable to identify preload-dependence and may provide new insights into the mechanisms involved in hemodynamic instability related to CRRT (HIRRT). We aimed to assess the prevalence and risk factors of HIRRT associated with preload-dependence in ICU patients. We conducted a single-center prospective observational cohort study in ICU patients with acute kidney injury KDIGO 3, started on CRRT in the last 24 h, and monitored with a PiCCO® device. The primary endpoint was the rate of HIRRT episodes associated with preload-dependence during the first 7 days after inclusion. HIRRT was defined as the occurrence of a mean arterial pressure below 65 mmHg requiring therapeutic intervention. Preload-dependence was assessed by postural tests every 4 h, and during each HIRRT episode. Data are expressed in median [1st quartile–3rd quartile], unless stated otherwise. Results 42 patients (62% male, age 69 [59–77] year, SAPS-2 65 [49–76]) were included 6 [1–16] h after CRRT initiation and studied continuously for 121 [60–147] h. A median of 5 [3–8] HIRRT episodes occurred per patient, for a pooled total of 243 episodes. 131 episodes (54% [CI95% 48–60%]) were associated with preload-dependence, 108 (44%, [CI95% 38–51%]) without preload-dependence, and 4 were unclassified. Multivariate analysis (using variables collected prior to HIRRT) identified the following variables as risk factors for the occurrence of HIRRT associated with preload-dependence: preload-dependence before HIRRT [odds ratio (OR) = 3.82, p < 0.001], delay since last HIRRT episode > 8 h (OR = 0.56, p < 0.05), lactate (OR = 1.21 per 1-mmol L−1 increase, p < 0.05), cardiac index (OR = 0.47 per 1-L min−1 m−2 increase, p < 0.001) and SOFA at ICU admission (OR = 0.91 per 1-point increase, p < 0.001). None of the CRRT settings was identified as risk factor for HIRRT. Conclusions In this single-center study, HIRRT associated with preload-dependence was slightly more frequent than HIRRT without preload-dependence in ICU patients undergoing CRRT. Testing for preload-dependence could help avoiding unnecessary decrease of fluid removal in preload-independent HIRRT during CRRT. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00883-9.
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Affiliation(s)
- Guillaume Chazot
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Laurent Bitker
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France.,CREATIS INSERM 1044 CNRS 5220, Villeurbanne, France
| | - Mehdi Mezidi
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France
| | - Nader Chebib
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France
| | - Paul Chabert
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Louis Chauvelot
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Laure Folliet
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Guillaume David
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Judith Provoost
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Hodane Yonis
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Jean-Christophe Richard
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. .,Université de Lyon, Université LYON I, Lyon, France. .,CREATIS INSERM 1044 CNRS 5220, Villeurbanne, France.
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5
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Bitker L, Dhelft F, Chauvelot L, Frobert E, Folliet L, Mezidi M, Trouillet-Assant S, Belot A, Lina B, Wallet F, Richard JC. Protracted viral shedding and viral load are associated with ICU mortality in Covid-19 patients with acute respiratory failure. Ann Intensive Care 2020; 10:167. [PMID: 33301059 PMCID: PMC7725883 DOI: 10.1186/s13613-020-00783-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 10/03/2020] [Accepted: 11/25/2020] [Indexed: 01/08/2023] Open
Abstract
Background Protracted viral shedding is common in hospitalized patients with COVID-19 pneumonia, and up to 40% display signs of pulmonary fibrosis on computed tomography (CT) after hospital discharge. We hypothesized that COVID-19 patients with acute respiratory failure (ARF) who die in intensive care units (ICU) have a lower viral clearance in the respiratory tract than ICU patients discharged alive, and that protracted viral shedding in respiratory samples is associated with patterns of fibroproliferation on lung CT. We, therefore, conducted a retrospective observational study, in 2 ICU of Lyon university hospital. Results 129 patients were included in the study, of whom 44 (34%) died in ICU. 432 RT-PCR for SARS-CoV-2 were performed and 137 CT scans were analyzed. Viral load was significantly higher in patients deceased as compared to patients alive at ICU discharge (p < 0.001), after adjustment for the site of viral sampling and RT-PCR technique. The median time to SARS-CoV-2 negativation on RT-PCR was 19 days [CI95 %:15–21] in patients alive at ICU discharge and 26 days [CI95 %:17-infinity] in non-survivors at ICU discharge. Competitive risk regression identified patients who died in ICU and age as independent risk factors for longer time to SARS-CoV-2 negativation on RT-PCR, while antiviral treatment was independently associated with shorter time. None of the CT scores exploring fibroproliferation (i.e., bronchiectasis and reticulation scores) were significantly associated with time to SARS-CoV-2 negativation. Conclusions Viral load in respiratory samples is significantly lower and viral shedding significantly shorter in ICU survivors of COVID-19 associated acute respiratory failure. Protracted viral shedding is unrelated to occurrence of fibrosis on lung CT.
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Affiliation(s)
- L Bitker
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université Claude Bernard, Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1206, 69621, Lyon, France
| | - F Dhelft
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université Claude Bernard, Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1206, 69621, Lyon, France
| | - L Chauvelot
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - E Frobert
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Team Virpath, 69007, Lyon, France.,Laboratoire de Virologie, Institut des Agents Infectieux, Hospices Civils de Lyon, National Reference Center for Respiratory Viruses, Department of Virology, Infective Agents Institute, North Hospital Network, Lyon, France; Virpath Laboratory, International Center of Research in Infectiology, INSERM U1111, CNRS-UMR 5308, École Normale Supérieure de Lyon, Université Claude Bernard Lyon, Université Claude Bernard, Lyon, France.,Université de Lyon, Université Claude Bernard, Lyon 1, Lyon, France
| | - L Folliet
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - M Mezidi
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université Claude Bernard, Lyon 1, Lyon, France
| | - S Trouillet-Assant
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Team Virpath, 69007, Lyon, France.,Joint Research Unit Hospices Civils de Lyon-bioMérieux, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - A Belot
- National Referee Centre for Rheumatic AutoImmune and Systemic Diseases in childrEn (RAISE), Lyon, France.,Pediatric Nephrology, Rheumatology, Dermatology Unit, Hospices Civils de Lyon, Pierre-Bénite, France
| | - B Lina
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Team Virpath, 69007, Lyon, France.,Laboratoire de Virologie, Institut des Agents Infectieux, Hospices Civils de Lyon, National Reference Center for Respiratory Viruses, Department of Virology, Infective Agents Institute, North Hospital Network, Lyon, France; Virpath Laboratory, International Center of Research in Infectiology, INSERM U1111, CNRS-UMR 5308, École Normale Supérieure de Lyon, Université Claude Bernard Lyon, Université Claude Bernard, Lyon, France.,Université de Lyon, Université Claude Bernard, Lyon 1, Lyon, France
| | - F Wallet
- Service de Réanimation Polyvalente, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - J C Richard
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. .,Université de Lyon, Université Claude Bernard, Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1206, 69621, Lyon, France.
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Chauvelot L, Bitker L, Dhelft F, Mezidi M, Orkisz M, Davila Serrano E, Penarrubia L, Yonis H, Chabert P, Folliet L, David G, Provoost J, Lecam P, Boussel L, Richard JC. Quantitative-analysis of computed tomography in COVID-19 and non COVID-19 ARDS patients: A case-control study. J Crit Care 2020; 60:169-176. [PMID: 32854088 PMCID: PMC7423516 DOI: 10.1016/j.jcrc.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/25/2020] [Accepted: 08/07/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE The aim of this study was to assess whether the computed tomography (CT) features of COVID-19 (COVID+) ARDS differ from those of non-COVID-19 (COVID-) ARDS patients. MATERIALS AND METHODS The study is a single-center prospective observational study performed on adults with ARDS onset ≤72 h and a PaO2/FiO2 ≤ 200 mmHg. CT scans were acquired at PEEP set using a PEEP-FiO2 table with VT adjusted to 6 ml/kg predicted body weight. RESULTS 22 patients were included, of whom 13 presented with COVID-19 ARDS. Lung weight was significantly higher in COVID- patients, but all COVID+ patients presented supranormal lung weight values. Noninflated lung tissue was significantly higher in COVID- patients (36 ± 14% vs. 26 ± 15% of total lung weight at end-expiration, p < 0.01). Tidal recruitment was significantly higher in COVID- patients (20 ± 12 vs. 9 ± 11% of VT, p < 0.05). Lung density histograms of 5 COVID+ patients with high elastance (type H) were similar to those of COVID- patients, while those of the 8 COVID+ patients with normal elastance (type L) displayed higher aerated lung fraction.
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Affiliation(s)
- Louis Chauvelot
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Laurent Bitker
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 7 Avenue Jean Capelle, 69621 Villeurbanne, France
| | - François Dhelft
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 7 Avenue Jean Capelle, 69621 Villeurbanne, France
| | - Mehdi Mezidi
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, 43 boulevard du 11 Novembre 1918, 69622 Villeurbanne, Cedex, France
| | - Maciej Orkisz
- Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 7 Avenue Jean Capelle, 69621 Villeurbanne, France
| | - Eduardo Davila Serrano
- Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 7 Avenue Jean Capelle, 69621 Villeurbanne, France
| | - Ludmilla Penarrubia
- Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 7 Avenue Jean Capelle, 69621 Villeurbanne, France
| | - Hodane Yonis
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Paul Chabert
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Laure Folliet
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Guillaume David
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Judith Provoost
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Pierre Lecam
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Loic Boussel
- Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 7 Avenue Jean Capelle, 69621 Villeurbanne, France; Service de Radiologie, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Jean-Christophe Richard
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 7 Avenue Jean Capelle, 69621 Villeurbanne, France.
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Perino É, Amat F, Folliet L, Freymond N, Chatté G, Devouassoux G, Just J, Pacheco Y. [Hypersensitivity and respiratory allergies in children and adults. Asthma, rhinitis]. Rev Prat 2017; 67:e281-e292. [PMID: 30512756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Émilie Perino
- Service de pneumologie, hôpital de la Croix-Rousse, GHN, 69317 Lyon Cedex et université Claude-Bernard-Lyon I, France
| | - Flore Amat
- Service d'allergologie, centre de l'asthme et des allergies, hôpital Armand-Trousseau, 75541 Paris Cedex 12. AP-HP, université Paris-6, France
| | - Laure Folliet
- Service de pneumologie, hôpital de la Croix-Rousse, GHN, 69317 Lyon Cedex et université Claude-Bernard-Lyon I, France
| | - Nathalie Freymond
- Service de pneumologie, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France
| | | | - Gilles Devouassoux
- Service de pneumologie, hôpital de la Croix-Rousse, GHN, 69317 Lyon Cedex et université Claude-Bernard-Lyon I, France
| | - Jocelyne Just
- Service d'allergologie, centre de l'asthme et des allergies, hôpital Armand-Trousseau, 75541 Paris Cedex 12. AP-HP, université Paris-6, France
| | - Yves Pacheco
- Faculté de médecine Charles-Mérieux-Lyon-Sud, 69310 Pierre-Bénite, France
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Avrillon V, Locatelli-Sanchez M, Folliet L, Carbonnaux M, Perino E, Fossard G, Desseigne M, Freymond N, Geriniere L, Perrot E, Souquet PJ, Couraud S. Lung cancer may increase serum procalcitonin level. Infect Disord Drug Targets 2016; 15:57-63. [PMID: 25809625 DOI: 10.2174/1871526515666150320162950] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/12/2014] [Accepted: 03/12/2015] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Serum procalcitonin (PCT) is a biomarker used routinely to diagnose infections. Some malignancies are usual false positives for PCT. However, its value and behavior in the setting of lung cancers are poorly known. The objective of this study was to assess PCT positivity in a lung cancer cases series. METHOD Between November 2011 and September 2012, all cases of newly diagnosed lung cancer with a pre-antineoplastic PCT assay and no patent signs of infection were included in the study. All PCT levels were assessed by immunofluorescent assay in a single laboratory. RESULTS Eighty-nine patients were included (70.8% male; mean age 62; small-cell cancer 20.2%; stage IV cancer 60.7%). Overall, PCT was positive in 42%. A neuroendocrine component, having 2 or more metastatic sites, having a pleura or a liver metastasis, and being positive for CRP were all significantly associated with positive PCT in univariate analysis. In multivariate analysis, only the presence of a neuroendocrine component remained strongly associated with a positive PCT (AOR=7.24 [CI=95% 1.91-27.51]; P=0.004). Finally, baseline PCT levels <0.5 µg/l were found in 43% of NSCLC with a neuroendocrine component, vs. 9% of cancers with other histology (P=0.0001). CONCLUSION Lung cancer may cause false positives for procalcitonin, particularly in cases of neuroendocrine cancers or in the presence of multiple metastases. These results should be taken into account for PCT-based decisional algorithms.
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Avrillon V, Couraud S, Folliet L, Carbonnaux M, Perino E, Fossard G, Locatelli-Sanchez M, Freymond N, Gérinière L, Perrot E, Souquet PJ. La procalcitonine est-elle élevée dans certains cancers bronchopulmonaires en dehors de toute infection ? Rev Mal Respir 2013. [DOI: 10.1016/j.rmr.2012.10.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ernesto S, Nesme P, Folliet L, Guérin JC. BPCO chez la femme en France : profil et retentissement de la maladie. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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