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Jabaudon M, Genevrier A, Jaber S, Windisch O, Bulyez S, Laterre PF, Escudier E, Sossou A, Guerci P, Bertrand PM, Danin PE, Bonnassieux M, Bühler L, Heidegger CP, Chabanne R, Godet T, Roszyk L, Sapin V, Futier E, Pereira B, Constantin JM. Thoracic epidural analgesia in intensive care unit patients with acute pancreatitis: the EPIPAN multicenter randomized controlled trial. Crit Care 2023; 27:213. [PMID: 37259157 DOI: 10.1186/s13054-023-04502-w] [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: 04/01/2023] [Accepted: 05/20/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Findings from preclinical studies and one pilot clinical trial suggest potential benefits of epidural analgesia in acute pancreatitis. We aimed to assess the efficacy of thoracic epidural analgesia, in addition to usual care, in improving clinical outcomes of intensive care unit patients with acute pancreatitis. METHODS A multicenter, open-label, randomized, controlled trial including adult patients with a clinical diagnosis of acute pancreatitis upon admission to the intensive care unit. Participants were randomly assigned (1:1) to a strategy combining thoracic epidural analgesia and usual care (intervention group) or a strategy of usual care alone (control group). The primary outcome was the number of ventilator-free days from randomization until day 30. RESULTS Between June 2014 and January 2019, 148 patients were enrolled, and 135 patients were included in the intention-to-treat analysis, with 65 patients randomly assigned to the intervention group and 70 to the control group. The number of ventilator-free days did not differ significantly between the intervention and control groups (median [interquartile range], 30 days [15-30] and 30 days [18-30], respectively; median absolute difference of - 0.0 days, 95% CI - 3.3 to 3.3; p = 0.59). Epidural analgesia was significantly associated with longer duration of invasive ventilation (median [interquartile range], 14 days [5-28] versus 6 days [2-13], p = 0.02). CONCLUSIONS In a population of intensive care unit adults with acute pancreatitis and low requirement for intubation, this first multicenter randomized trial did not show the hypothesized benefit of epidural analgesia in addition to usual care. Safety of epidural analgesia in this setting requires further investigation. TRIAL REGISTRATION ClinicalTrials.gov registration number NCT02126332 , April 30, 2014.
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Affiliation(s)
- Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France.
- iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France.
| | - Alexandra Genevrier
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Samir Jaber
- Saint Eloi Intensive Care Unit, CHU Montpellier, Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Olivier Windisch
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Intensive Care, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphanie Bulyez
- Division of Intensive Care, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
- Service de Recherche Clinique en Soins Critiques, Pôle Anesthésie Douleur Urgences Réanimation, CHU Nîmes, Université de Montpellier, Nîmes, France
| | - Pierre-François Laterre
- Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Etienne Escudier
- Department of Emergency Medicine and Intensive Care, Annecy Genevois General Hospital, Annecy, France
| | - Achille Sossou
- Department of Intensive Care Medicine, Emile-Roux General Hospital, Le Puy-en-Velay, France
| | - Philippe Guerci
- Department of Anesthesiology and Critical Care Medicine, CHU Nancy-Brabois, Nancy, France
- Institut Lorrain du Coeur Et Des Vaisseaux and INSERM U1116, Institut Lorrain du Coeur et des Vaisseaux, University of Lorraine, Nancy, France
| | | | - Pierre-Eric Danin
- Department of Intensive Care Medicine, CHU Nice, Nice, France
- INSERM U1065, Team 8, C3M, CHU de Nice, Nice, France
| | - Martin Bonnassieux
- Department of Intensive Care Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Leo Bühler
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Claudia Paula Heidegger
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Intensive Care, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Russell Chabanne
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Thomas Godet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Laurence Roszyk
- iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
- Department of Biochemistry and Molecular Genetics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Sapin
- iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
- Department of Biochemistry and Molecular Genetics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Futier
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
- iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics and Data Management Unit, Department of Clinical Research and Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Department of Anesthesiology and Critical Care, GRC 29, DMU DREAM, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
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Blondonnet R, Simand LA, Vidal P, Borao L, Bourguignon N, Morand D, Bernard L, Roszyk L, Audard J, Godet T, Monsel A, Garnier M, Quesnel C, Bazin JE, Sapin V, Bastarache JA, Ware LB, Hughes CG, Pandharipande PP, Ely EW, Futier E, Pereira B, Constantin JM, Jabaudon M. Design and Rationale of the Sevoflurane for Sedation in Acute Respiratory Distress Syndrome (SESAR) Randomized Controlled Trial. J Clin Med 2022; 11:2796. [PMID: 35628922 PMCID: PMC9147018 DOI: 10.3390/jcm11102796] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023] Open
Abstract
Preclinical studies have shown that volatile anesthetics may have beneficial effects on injured lungs, and pilot clinical data support improved arterial oxygenation, attenuated inflammation, and decreased lung epithelial injury in patients with acute respiratory distress syndrome (ARDS) receiving inhaled sevoflurane compared to intravenous midazolam. Whether sevoflurane is effective in improving clinical outcomes among patients with ARDS is unknown, and the benefits and risks of inhaled sedation in ARDS require further evaluation. Here, we describe the SESAR (Sevoflurane for Sedation in ARDS) trial designed to address this question. SESAR is a two-arm, investigator-initiated, multicenter, prospective, randomized, stratified, parallel-group clinical trial with blinded outcome assessment designed to test the efficacy of sedation with sevoflurane compared to intravenous propofol in patients with moderate to severe ARDS. The primary outcome is the number of days alive and off the ventilator at 28 days, considering death as a competing event, and the key secondary outcome is 90 day survival. The planned enrollment is 700 adult participants at 37 French academic and non-academic centers. Safety and long-term outcomes will be evaluated, and biomarker measurements will help better understand mechanisms of action. The trial is funded by the French Ministry of Health, the European Society of Anaesthesiology, and Sedana Medical.
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Affiliation(s)
- Raiko Blondonnet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
| | - Laure-Anne Simand
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Perine Vidal
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Lucile Borao
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Nathalie Bourguignon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Dominique Morand
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Lise Bernard
- Department of Clinical Research and Temporary Authorization, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Laurence Roszyk
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
- Department of Medical Biochemistry and Molecular Genetics, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Jules Audard
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Thomas Godet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Antoine Monsel
- Department of Anesthesiology and Critical Care, GRC 29, DMU DREAM, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (A.M.); (J.-M.C.)
| | - Marc Garnier
- Department of Anesthesiology and Critical Care Medicine, DMU DREAM, Saint-Antoine University Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France;
| | - Christophe Quesnel
- Department of Anesthesiology and Critical Care Medicine, DMU DREAM, Tenon University Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75020 Paris, France;
| | - Jean-Etienne Bazin
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Vincent Sapin
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
- Department of Medical Biochemistry and Molecular Genetics, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Julie A. Bastarache
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (J.A.B.); (L.B.W.); (E.W.E.)
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN 37232, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lorraine B. Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (J.A.B.); (L.B.W.); (E.W.E.)
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Christopher G. Hughes
- Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (C.G.H.); (P.P.P.)
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Anesthesia Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN 37212, USA
| | - Pratik P. Pandharipande
- Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (C.G.H.); (P.P.P.)
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Anesthesia Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN 37212, USA
| | - E. Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (J.A.B.); (L.B.W.); (E.W.E.)
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN 37212, USA
| | - Emmanuel Futier
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
| | - Bruno Pereira
- Biostatistics and Data Management Unit, Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Jean-Michel Constantin
- Department of Anesthesiology and Critical Care, GRC 29, DMU DREAM, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (A.M.); (J.-M.C.)
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
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Mourgues C, Rossi A, Favre N, Delabaere A, Roszyk L, Sapin V, Debost-Legrand A, Gallot D. Fetal fibronectin test for threatened preterm delivery 48h after admission: Cost-effectiveness study. Eur J Obstet Gynecol Reprod Biol 2019; 234:75-78. [PMID: 30660942 DOI: 10.1016/j.ejogrb.2018.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/12/2018] [Revised: 12/24/2018] [Accepted: 12/27/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this work was to assess the cost-effectiveness of the fetal fibronectin (fFN) test at 48 h after admission for threatened preterm delivery to promote early discharge. STUDY DESIGN Before-and-after study to calculate the incremental cost-effectiveness ratio (ICER). Patients were enrolled 48 h after admission in a tertiary care centre for threatened preterm delivery between 24+0 and 34+6 weeks. fFN testing was performed. During the first period, physician was blinded to fFN test and discharge occurred after apparent reduced symptomatology at physician's discretion. During the second period, fFN test was revealed to physician and discharge was immediately proposed to negative test patients. The costs considered in this analysis were the direct medical costs from the hospital perspective: costs of hospitalisation, treatment, and imaging procedures. The efficacy criterion selected was the number of deliveries at 7 and at 14 days after admission for threatened preterm delivery. RESULTS The study included 178 pregnant patient, 99 during the first period (July 2008-October 2009) and 79 during the second (March 2010-February 2012). The lengths of hospital stays were shorter during the second period, with more than 50% of women discharged home between 48 and 72 h (p < 0.0001) resulting in a cost-saving of 76 051 euros. The number of deliveries at 7 and at 14 days was similar between the two periods. CONCLUSION The fFN test at 48 h after admission supported early discharge and was safe and cost-effective.
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Affiliation(s)
- Charline Mourgues
- Direction de la Recherche Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CNRS-UMR 6602, Institut Pascal, Axe TGI, équipe PEPRADE, Clermont-Ferrand, France
| | - Amélie Rossi
- Pôle Femme Et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nathalie Favre
- Pôle Femme Et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Amélie Delabaere
- Université Clermont Auvergne, CNRS-UMR 6602, Institut Pascal, Axe TGI, équipe PEPRADE, Clermont-Ferrand, France; Pôle Femme Et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurence Roszyk
- Laboratoire de Biochimie Médicale et Biologie Moléculaire, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; Equipe « Translational Approach to Epithelial Injury and Repair », GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Vincent Sapin
- Laboratoire de Biochimie Médicale et Biologie Moléculaire, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; Equipe « Translational Approach to Epithelial Injury and Repair », GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Anne Debost-Legrand
- Université Clermont Auvergne, CNRS-UMR 6602, Institut Pascal, Axe TGI, équipe PEPRADE, Clermont-Ferrand, France; Pôle Femme Et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Denis Gallot
- Pôle Femme Et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; Equipe « Translational Approach to Epithelial Injury and Repair », GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France.
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Egron C, Roszyk L, Rochette E, Jabaudon M, Sapin V, Mulliez A, Labbé A, Coste K. Serum soluble receptor for advanced glycation end-products during acute bronchiolitis in infant: Prospective study in 93 cases. Pediatr Pulmonol 2018; 53:1429-1435. [PMID: 30113140 PMCID: PMC7167909 DOI: 10.1002/ppul.24141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/25/2018] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Acute bronchiolitis is a major cause of acute respiratory distress in infants. The soluble receptor for advanced glycation end-products (sRAGE) is a biomarker of pulmonary damage processes, with a diagnostic and a prognostic value in acute respiratory distress syndrome (ARDS). The RAGE pathway is also implicated in the pathogenesis of other respiratory diseases like asthma, but the value of sRAGE levels in acute bronchiolitis remains under-investigated. MATERIAL AND METHODS A prospective, observational, and analytical study was conducted at Clermont-Ferrand University Hospital. The main objective was to evaluate the correlation between serum sRAGE and clinical severity of bronchiolitis in hospitalized infants aged <1 year. We analyzed correlations between serum sRAGE and Wainwright score, short-term morbidity attributable to bronchiolitis, causal viruses and risk for recurrent wheezing at 1 year. RESULTS The study included 93 infants. sRAGE levels were significantly lower in acute bronchiolitis patients (mean 1101 pg/mL) than in controls (2203 pg/mL, P < 0.001) but did not correlate with clinical severity. No correlation was found between serum sRAGE and severity score, respiratory viruses, and recurrent wheezing at 1 year. Serum sRAGE levels were negatively correlated with age (r = -0.45, P < 0.001). CONCLUSION Serum sRAGE levels are decreased in acute bronchiolitis but not correlated with disease severity. sRAGE levels should be age-adjusted in infants. Serum sRAGE levels measured in the setting of acute bronchiolitis were not predictive of recurrent wheezing.
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Affiliation(s)
- Carole Egron
- Department of Pediatrics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurence Roszyk
- Department of Medical Biochemistry and Molecular Biology, CHU Clermont-Ferrand and GReD, Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, Clermont-Ferrand, France
| | - Emmanuelle Rochette
- Department of Clinical Research for Children (CRECHE) at CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand and GReD, Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, Clermont-Ferrand, France
| | - Vincent Sapin
- Department of Medical Biochemistry and Molecular Biology, CHU Clermont-Ferrand and GReD, Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, Clermont-Ferrand, France
| | - Aurélien Mulliez
- Department of Clinical Research and Innovation at CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - André Labbé
- Department of Pediatrics, CHU Clermont-Ferrand, Clermont-Ferrand and Université Clermont Auvergne, Clermont-Ferrand, France
| | - Karen Coste
- Department of Pediatrics, CHU Clermont-Ferrand and GReD, Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, Clermont-Ferrand, France
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Blondonnet R, Joubert E, Godet T, Berthelin P, Pranal T, Roszyk L, Chabanne R, Eisenmann N, Lautrette A, Belville C, Cayot S, Gillart T, Souweine B, Bouvier D, Blanchon L, Sapin V, Pereira B, Constantin JM, Jabaudon M. Driving pressure and acute respiratory distress syndrome in critically ill patients. Respirology 2018; 24:137-145. [PMID: 30183115 DOI: 10.1111/resp.13394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/04/2018] [Accepted: 08/09/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Elevated driving pressure (ΔP) may be associated with increased risk of acute respiratory distress syndrome (ARDS) in patients admitted via the emergency department and with post-operative pulmonary complications in surgical patients. This study investigated the association of higher ΔP with the onset of ARDS in a high-risk, intensive care unit (ICU) population. METHODS This is a secondary analysis of a prospective multicentre observational study. Data for this ancillary study were obtained from intubated adult patients with at least one ARDS risk factor upon ICU admission enrolled in a previous multicentre observational study. Patients were followed up for the development of ARDS within 7 days (primary outcome). Univariate and multivariate analyses tested the association between ΔP (measured at ICU admission (baseline) or 24 h later (day 1)) and the development of ARDS. RESULTS A total of 221 patients were included in this study, among whom 34 (15%) developed ARDS within 7 days. These patients had higher baseline ΔP than those who did not (mean ± SD: 12.5 ± 3.1 vs 9.8 ± 3.4 cm H2 O, respectively, P = 0.0001). The association between baseline ΔP and the risk of developing ARDS was robust to adjustment for baseline tidal volume, positive-end expiratory pressure, illness severity, serum lactate and sepsis, pneumonia, severe trauma and shock as primary ARDS risk factors (odds ratio: 1.20; 95% CI: 1.03-1.41; P = 0.02). The same results were found with day 1 ΔP. CONCLUSION Among at-risk ICU patients, higher ΔP may identify those who are more likely to develop ARDS.
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Affiliation(s)
- Raiko Blondonnet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France.,GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Elodie Joubert
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Thomas Godet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pauline Berthelin
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Thibaut Pranal
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurence Roszyk
- GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France.,Department of Medical Biochemistry and Molecular Biology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Russell Chabanne
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nathanael Eisenmann
- Intensive Care Unit, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France
| | | | - Corinne Belville
- GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Sophie Cayot
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Thierry Gillart
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bertrand Souweine
- Medical Intensive Care Unit, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Damien Bouvier
- GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France.,Department of Medical Biochemistry and Molecular Biology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Loic Blanchon
- Department of Medical Biochemistry and Molecular Biology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Sapin
- GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France.,Department of Medical Biochemistry and Molecular Biology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France.,GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France.,GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
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6
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Bulyez S, Pereira B, Caumon E, Imhoff E, Roszyk L, Bernard L, Bühler L, Heidegger C, Jaber S, Lefrant JY, Chabanne R, Bertrand PM, Laterre PF, Guerci P, Danin PE, Escudier E, Sossou A, Morand D, Sapin V, Constantin JM, Jabaudon M. Epidural analgesia in critically ill patients with acute pancreatitis: the multicentre randomised controlled EPIPAN study protocol. BMJ Open 2017; 7:e015280. [PMID: 28554928 PMCID: PMC5730003 DOI: 10.1136/bmjopen-2016-015280] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is associated with high morbidity and mortality in its most severe forms. Most patients with severe AP require intubation and invasive mechanical ventilation, frequently for more than 7 days, which is associated with the worst outcome. Recent increasing evidence from preclinical and clinical studies support the beneficial effects of epidural analgesia (EA) in AP, such as increased gut barrier function and splanchnic, pancreatic and renal perfusion, decreased liver damage and inflammatory response, and reduced mortality. Because recent studies suggest that EA might be a safe procedure in the critically ill, we sought to determine whether EA reduced AP-associated respiratory failure and other major clinical outcomes in patients with AP. METHODS AND ANALYSIS The Epidural Analgesia for Pancreatitis (EPIPAN) trial is an investigator-initiated, prospective, multicentre, randomised controlled two-arm trial with assessor-blinded outcome assessment. The EPIPAN trial will randomise 148 patients with AP requiring admission to an intensive care unit (ICU) to receive EA (with patient-controlled epidural administration of ropivacaine and sufentanil) combined with standard care based on current recommendations on the treatment of AP (interventional group), or standard care alone (reference group). The primary outcome is the number of ventilator-free days at day 30. Secondary outcomes include main complications of AP (eg, organ failure and mortality, among others), levels of biological markers of systemic inflammation, epithelial lung injury, renal failure, and healthcare-associated costs. ETHICS AND DISSEMINATION The study was approved by the appropriate ethics committee (CPP Sud-Est VI). Informed consent is required. If the combined application of EA and standard care proves superior to standard care alone in patients with AP in the ICU, the use of EA may become standard practice in experienced centres, thereby decreasing potential complications related to AP and its burden in critically ill patients. The results will be disseminated in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02126332.
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Affiliation(s)
- Stéphanie Bulyez
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Elodie Caumon
- Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Etienne Imhoff
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurence Roszyk
- Department of Medical Biochemistry and Molecular Biology, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France
| | - Lise Bernard
- Department of Pharmacy, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, Clermont-Ferrand, France
| | - Leo Bühler
- Department of Surgery, Geneva university hospitals, Geneva, Switzerland
| | - Claudia Heidegger
- Division of Intensive Care, Geneva university hospitals, Geneva, Switzerland
| | - Samir Jaber
- Department of Anesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi teaching hospital, Montpellier university hospital, Montpellier, France
| | - Jean-Yves Lefrant
- Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes university hospital and EA 2992, Université Montpellier, Nîmes, France
| | - Russell Chabanne
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Pierre-François Laterre
- Department of Critical Care Medicine, Saint Luc university hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Philippe Guerci
- Department of Anesthesiology and Intensive Care Medicine, Nancy university hospital, Nancy, France
| | - Pierre-Eric Danin
- Anesthesia and Surgical Intensive Care, Nice Archet 2 university hospital and INSERM U1065, team 8, Nice, France
| | - Etienne Escudier
- Intensive Care Unit, Annecy Genevois general hospital, Annecy, France
| | - Achille Sossou
- Department of Anesthesiology and Critical Care Medicine, Emile-Roux general hospital, Le Puy-en-Velay, France
| | - Dominique Morand
- Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Sapin
- Department of Medical Biochemistry and Molecular Biology, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France
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7
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Jabaudon M, Godet T, Futier E, Bazin JÉ, Sapin V, Roszyk L, Pereira B, Constantin JM. Rationale, study design and analysis plan of the lung imaging morphology for ventilator settings in acute respiratory distress syndrome study (LIVE study): Study protocol for a randomised controlled trial. Anaesth Crit Care Pain Med 2017; 36:301-306. [PMID: 28323236 DOI: 10.1016/j.accpm.2017.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 02/02/2017] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 01/09/2023]
Abstract
Different acute respiratory distress syndrome (ARDS) phenotypes may explain controversial results in clinical trials. Lung-morphology is one of the ARDS-phenotypes and physiological studies suggest different responses in terms of positive-end-expiratory-pressure (PEEP) and recruitment-manoeuvres (RM) according to loss of aeration. To evaluate whether tailored ventilator regimens may impact ARDS outcomes, our group has designed a randomised-clinical-trial of ventilator settings according to lung morphology in moderate-to-severe ARDS (LIVE study). METHOD Patients will be enrolled within the first 12hours of ARDS onset. In both groups, volume-controlled ventilation with low tidal-volumes (Vt) will be used to target a plateau pressure≤30 cmH2O. In the control group, the PEEP level and inspired fraction of oxygen (FiO2) will be set using the ARDSNet table; a Vt of 6 mL/kg of predicted body weight (PBW) will be set and prone position (PP) will be applied. In the intervention arm, the ventilator will be set according to lung morphology (focal/non-focal) that will be assessed according to CT-scan±chest x-ray+lung echography. For focal ARDS patients, a Vt of 8 mL/kg PBW will be used along with low PEEP and PP. For non-focal ARDS patients, a Vt of 6 mL/kg PBW will be used with RM and PEEP to reach a plateau pressure≤30 cmH2O. The primary outcome is all-cause 90-day mortality and the secondary outcomes are: in-hospital mortality, mortality at day 28, 60, 180 and 365; ventilator-free days at day 30, quality of life at one year; ventilator-associated pneumonia rate; barotrauma; ICU and hospital length of stay. This RCT is registered on Clinicaltrials.gov under identifier NCT02149589.
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Affiliation(s)
- Matthieu Jabaudon
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Université Clermont-Auvergne, CNRS, Inserm, GReD, 63000 Clermont-Ferrand, France
| | - Thomas Godet
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Université Clermont-Auvergne, CNRS, Inserm, GReD, 63000 Clermont-Ferrand, France
| | - Emmanuel Futier
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Université Clermont-Auvergne, CNRS, Inserm, GReD, 63000 Clermont-Ferrand, France
| | - Jean-Étienne Bazin
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - Vincent Sapin
- Université Clermont-Auvergne, CNRS, Inserm, GReD, 63000 Clermont-Ferrand, France; Department of Medical Biochemistry and Molecular Biology, University Hospital of Clermont-Ferrand, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - Laurence Roszyk
- Université Clermont-Auvergne, CNRS, Inserm, GReD, 63000 Clermont-Ferrand, France; Department of Medical Biochemistry and Molecular Biology, University Hospital of Clermont-Ferrand, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, Department of Clinical Research and Innovation (DRCI), University Hospital of Clermont-Ferrand, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Université Clermont-Auvergne, CNRS, Inserm, GReD, 63000 Clermont-Ferrand, France.
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8
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Jabaudon M, Boucher P, Imhoff E, Chabanne R, Faure JS, Roszyk L, Thibault S, Blondonnet R, Clairefond G, Guérin R, Perbet S, Cayot S, Godet T, Pereira B, Sapin V, Bazin JE, Futier E, Constantin JM. Sevoflurane for Sedation in Acute Respiratory Distress Syndrome. A Randomized Controlled Pilot Study. Am J Respir Crit Care Med 2017; 195:792-800. [DOI: 10.1164/rccm.201604-0686oc] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Matthieu Jabaudon
- Department of Perioperative Medicine
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | | | | | | | | | - Laurence Roszyk
- Department of Medical Biochemistry and Molecular Biology, and
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Sandrine Thibault
- Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France; and
| | - Raiko Blondonnet
- Department of Perioperative Medicine
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Gael Clairefond
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | | | - Sébastien Perbet
- Department of Perioperative Medicine
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | | | | | - Bruno Pereira
- Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France; and
| | - Vincent Sapin
- Department of Medical Biochemistry and Molecular Biology, and
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | | | - Emmanuel Futier
- Department of Perioperative Medicine
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Department of Perioperative Medicine
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
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9
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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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10
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Jabaudon M, Blondonnet R, Roszyk L, Bouvier D, Audard J, Clairefond G, Fournier M, Marceau G, Déchelotte P, Pereira B, Sapin V, Constantin JM. Soluble Receptor for Advanced Glycation End-Products Predicts Impaired Alveolar Fluid Clearance in Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2015; 192:191-9. [PMID: 25932660 DOI: 10.1164/rccm.201501-0020oc] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [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: 01/11/2023] Open
Abstract
RATIONALE Levels of the soluble form of the receptor for advanced glycation end-products (sRAGE) are elevated during acute respiratory distress syndrome (ARDS) and correlate with severity and prognosis. Alveolar fluid clearance (AFC) is necessary for the resolution of lung edema but is impaired in most patients with ARDS. No reliable marker of this process has been investigated to date. OBJECTIVES To verify whether sRAGE could predict AFC during ARDS. METHODS Anesthetized CD-1 mice underwent orotracheal instillation of hydrochloric acid. At specified time points, lung injury was assessed by analysis of blood gases, alveolar permeability, lung histology, AFC, and plasma/bronchoalveolar fluid measurements of proinflammatory cytokines and sRAGE. Plasma sRAGE and AFC rates were also prospectively assessed in 30 patients with ARDS. MEASUREMENTS AND MAIN RESULTS The rate of AFC was inversely correlated with sRAGE levels in the plasma and the bronchoalveolar fluid of acid-injured mice (Spearman's ρ = -0.73 and -0.69, respectively; P < 10(-3)), and plasma sRAGE correlated with AFC in patients with ARDS (Spearman's ρ = -0.59; P < 10(-3)). Similarly, sRAGE levels were significantly associated with lung injury severity, and decreased over time in mice, whereas AFC was restored and lung injury resolved. CONCLUSIONS Our results indicate that sRAGE levels could be a reliable predictor of impaired AFC during ARDS, and should stimulate further studies on the pathophysiologic implications of RAGE axis in the mechanisms leading to edema resolution. Clinical trial registered with www.clinicaltrials.gov (NCT 00811629).
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Affiliation(s)
- Matthieu Jabaudon
- 1 Intensive Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, Estaing University Hospital.,2 Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Raiko Blondonnet
- 1 Intensive Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, Estaing University Hospital.,2 Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Laurence Roszyk
- 3 Department of Medical Biochemistry and Molecular Biology.,2 Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Damien Bouvier
- 3 Department of Medical Biochemistry and Molecular Biology.,2 Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Jules Audard
- 1 Intensive Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, Estaing University Hospital
| | - Gael Clairefond
- 2 Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | | | - Geoffroy Marceau
- 3 Department of Medical Biochemistry and Molecular Biology.,2 Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | | | - Bruno Pereira
- 6 Department of Clinical Research and Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France; and
| | - Vincent Sapin
- 3 Department of Medical Biochemistry and Molecular Biology.,2 Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- 1 Intensive Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, Estaing University Hospital.,2 Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
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11
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Jabaudon M, Blondonnet R, Roszyk L, Pereira B, Guérin R, Perbet S, Cayot S, Bouvier D, Blanchon L, Sapin V, Constantin JM. Soluble Forms and Ligands of the Receptor for Advanced Glycation End-Products in Patients with Acute Respiratory Distress Syndrome: An Observational Prospective Study. PLoS One 2015; 10:e0135857. [PMID: 26274928 PMCID: PMC4537285 DOI: 10.1371/journal.pone.0135857] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/05/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The main soluble form of the receptor for advanced glycation end-products (sRAGE) is elevated during acute respiratory distress syndrome (ARDS). However other RAGE isoforms and multiple ligands have been poorly reported in the clinical setting, and their respective contribution to RAGE activation during ARDS remains unclear. Our goal was therefore to describe main RAGE isoforms and ligands levels during ARDS. METHODS 30 ARDS patients and 30 mechanically ventilated controls were prospectively included in this monocenter observational study. Arterial, superior vena cava and alveolar fluid levels of sRAGE, endogenous-secretory RAGE (esRAGE), high mobility group box-1 protein (HMGB1), S100A12 and advanced glycation end-products (AGEs) were measured in duplicate ELISA on day 0, day 3 and day 6. In patients with ARDS, baseline lung morphology was assessed with computed tomography. RESULTS ARDS patients had higher arterial, central venous and alveolar levels of sRAGE, HMGB1 and S100A12, but lower levels of esRAGE and AGEs, than controls. Baseline arterial sRAGE, HMGB1 and S100A12 were correlated with nonfocal ARDS (AUC 0.79, 0.65 and 0.63, respectively). Baseline arterial sRAGE, esRAGE, S100A12 and AGEs were associated with severity as assessed by PaO2/FiO2. CONCLUSIONS This is the first kinetics study of levels of RAGE main isoforms and ligands during ARDS. Elevated sRAGE, HMGB1 and S100A12, with decreased esRAGE and AGEs, were found to distinguish patients with ARDS from those without. Our findings should prompt future studies aimed at elucidating RAGE/HMGB1/S100A12 axis involvement in ARDS. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01270295.
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Affiliation(s)
- Matthieu Jabaudon
- CHU Clermont-Ferrand, Intensive Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, Estaing Hospital, Clermont-Ferrand, France
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
- * E-mail:
| | - Raiko Blondonnet
- CHU Clermont-Ferrand, Intensive Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, Estaing Hospital, Clermont-Ferrand, France
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Laurence Roszyk
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Department of Medical Biochemistry and Molecular Biology, Estaing University Hospital, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Department of Clinical Research and Innovation (DRCI), Clermont-Ferrand, France
| | - Renaud Guérin
- CHU Clermont-Ferrand, Intensive Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, Estaing Hospital, Clermont-Ferrand, France
| | - Sébastien Perbet
- CHU Clermont-Ferrand, Intensive Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, Estaing Hospital, Clermont-Ferrand, France
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Sophie Cayot
- CHU Clermont-Ferrand, Intensive Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, Estaing Hospital, Clermont-Ferrand, France
| | - Damien Bouvier
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Department of Medical Biochemistry and Molecular Biology, Estaing University Hospital, Clermont-Ferrand, France
| | - Loic Blanchon
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Vincent Sapin
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Department of Medical Biochemistry and Molecular Biology, Estaing University Hospital, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- CHU Clermont-Ferrand, Intensive Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, Estaing Hospital, Clermont-Ferrand, France
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
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Jabaudon M, Futier E, Roszyk L, Sapin V, Pereira B, Constantin JM. Association between intraoperative ventilator settings and plasma levels of soluble receptor for advanced glycation end-products in patients without pre-existing lung injury. Respirology 2015; 20:1131-8. [PMID: 26122046 DOI: 10.1111/resp.12583] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/23/2015] [Accepted: 03/29/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVE The soluble form of the receptor for advanced glycation end-products (sRAGE) is elevated and correlated with severity in patients with acute respiratory distress syndrome (ARDS). The impact of ventilator settings on plasma levels of sRAGE, in patients with or without pre-existing lung injury, remains under-investigated to date. Our objective was to assess the effects of a lung-protective ventilation strategy (combining low tidal volume, positive end-expiratory pressure and recruitment maneuvers), as compared with a non-protective approach (with high tidal volume and zero end-expiratory pressure), on plasma levels of sRAGE in patients without lung injury undergoing major abdominal surgery. METHODS Plasma samples were obtained from 95 patients enrolled in a large randomized controlled trial of lung-protective ventilation for major abdominal surgery. Plasma levels of sRAGE were measured in duplicate with an enzyme-linked immunoassay on day 1, immediately after surgery, and on postoperative days 1, 3 and 7. RESULTS Early postoperative plasma levels of sRAGE were significantly lower in the lung-protective ventilation group (n = 47) than in the non-protective ventilation group (n = 48) (mean (standard deviation), 1782 (836) vs 2171 (1678) pg/mL, respectively, P = 0.03). Intraoperative changes in plasma sRAGE were associated with postoperative hypoxemia and ARDS. CONCLUSIONS A lung-protective ventilation strategy decreased plasma sRAGE in patients without lung injury undergoing major abdominal surgery compared with the patients with non-protective ventilation. This intraoperative decrease could reflect a lesser degree of epithelial injury.
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Affiliation(s)
- Matthieu Jabaudon
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Estaing Hospital, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.,EA 7281, R2D2, Clermont University, University of Auvergne, Clermont-Ferrand, France
| | - Emmanuel Futier
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Estaing Hospital, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.,EA 7281, R2D2, Clermont University, University of Auvergne, Clermont-Ferrand, France
| | - Laurence Roszyk
- Department of Medical Biochemistry and Molecular Biology, Estaing University Hospital, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.,EA 7281, R2D2, Clermont University, University of Auvergne, Clermont-Ferrand, France
| | - Vincent Sapin
- Department of Medical Biochemistry and Molecular Biology, Estaing University Hospital, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.,EA 7281, R2D2, Clermont University, University of Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Department of Clinical Research and Innovation (DRCI), Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Estaing Hospital, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.,EA 7281, R2D2, Clermont University, University of Auvergne, Clermont-Ferrand, France
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Jabaudon M, Hamroun N, Roszyk L, Blondonnet R, Guerin R, Bazin JE, Sapin V, Pereira B, Constantin JM. Effects of a recruitment maneuver on plasma soluble rage in patients with diffuse ARDS: a prospective randomized crossover study. Crit Care 2015. [PMCID: PMC4472626 DOI: 10.1186/cc14321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Amat F, Henquell C, Verdan M, Roszyk L, Mulliez A, Labbé A. Predicting the severity of acute bronchiolitis in infants: should we use a clinical score or a biomarker? J Med Virol 2013; 86:1944-52. [PMID: 24374757 PMCID: PMC7167168 DOI: 10.1002/jmv.23850] [Citation(s) in RCA: 17] [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] [Accepted: 10/18/2013] [Indexed: 01/15/2023]
Abstract
Krebs von den Lungen 6 antigen (KL-6) has been shown to be a useful biomarker of the severity of Respiratory syncytial virus bronchiolitis. To assess the correlation between the clinical severity of acute bronchiolitis, serum KL-6, and the causative viruses, 222 infants with acute bronchiolitis presenting at the Pediatric Emergency Department of Estaing University Hospital, Clermont-Ferrand, France, were prospectively enrolled from October 2011 to May 2012. Disease severity was assessed with a score calculated from oxygen saturation, respiratory rate, and respiratory effort. A nasopharyngeal aspirate was collected to screen for a panel of 20 respiratory viruses. Serum was assessed and compared with a control group of 38 bronchiolitis-free infants. No significant difference in KL-6 levels was found between the children with bronchiolitis (mean 231 IU/mL ± 106) and those without (230 IU/mL ± 102), or between children who were hospitalized or not, or between the types of virus. No correlation was found between serum KL-6 levels and the disease severity score. The absence of Human Rhinovirus was a predictive factor for hospitalization (OR 3.4 [1.4-7.9]; P = 0.006). Older age and a higher oxygen saturation were protective factors (OR 0.65[0.55-0.77]; P < 0.0001 and OR 0.67 [0.54-0.85] P < 0.001, respectively). These results suggest that in infants presenting with bronchiolitis for the first time, clinical outcome depends more on the adaptive capacities of the host than on epithelial dysfunction intensity. Many of the features of bronchiolitis are affected by underlying disease and by treatment.
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Affiliation(s)
- Flore Amat
- Pediatric Emergency Department, CHU-Estaing, Clermont-Ferrand, France
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Janel A, Roszyk L, Rapatel C, Mareynat G, Berger MG, Serre‐Sapin A. Proposal of a score combining red blood cell indices for early differentiation of beta‐thalassemia minor from iron deficiency anemia. Hematology 2013; 16:123-7. [DOI: 10.1179/102453311x12940641877849] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Alexandre Janel
- Hématologie Biologique/ImmunologieCHU, Hôtel Dieu, Boulevard Léon Malfreyt, Clermont Ferrand, France
| | - Laurence Roszyk
- Biochimie MédicaleCHU, Hôtel Dieu, Boulevard Léon Malfreyt, Clermont Ferrand, France
| | - Chantal Rapatel
- Hématologie Biologique/ImmunologieCHU, Hôtel Dieu, Boulevard Léon Malfreyt, Clermont Ferrand, France
| | - Gabrielle Mareynat
- Hématologie Biologique/ImmunologieCHU, Hôtel Dieu, Boulevard Léon Malfreyt, Clermont Ferrand, France
| | - Marc G Berger
- Hématologie Biologique/ImmunologieCHU, Hôtel Dieu, Boulevard Léon Malfreyt, Clermont Ferrand, 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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Constantin JM, Futier E, Perbet S, Roszyk L, Lautrette A, Gillart T, Guerin R, Jabaudon M, Souweine B, Bazin JE, Sapin V. Plasma neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in adult critically ill patients: a prospective study. J Crit Care 2009; 25:176.e1-6. [PMID: 19781900 DOI: 10.1016/j.jcrc.2009.05.010] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [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: 03/17/2009] [Revised: 05/11/2009] [Accepted: 05/15/2009] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of the study was to assess the ability of plasma neutrophil gelatinase-associated lipocalin (pNGAL) to predict acute kidney injury (AKI) in adult intensive care unit (ICU) patients. METHODS All consecutives patients admitted to 3 ICUs were enrolled in this prospective-observational study. Plasma neutrophil gelatinase-associated lipocalin was analyzed at ICU admission. Risk, injury, failure, loss, and end-stage kidney (RIFLE) criteria were calculated at admission and for each day during the first week. Patients were classified according to whether they met the threshold for RIFLE criteria (RIFLE 0 or 1) at admission and during the first week. Four groups were identified: RIFLE (0-0), (1-1), (1-0), and (0-1). RESULTS During this 1-month period, 88 patients were included in the study. Thirty-six patients met the criteria for RIFLE 0-0 with a mean pNGAL of 98 +/- 60 nmol/L, 22 for RIFLE 1-1 with a mean pNGAL of 516 +/- 221 nmol/L, and 20 patients had no AKI at admission but develop AKI at 48 hours (24-96 hours) (RIFLE 0-1) with a pNGAL of 342 +/- 183 nmol/L. Ten patients met the criteria for RIFLE 1-0 and had a mean pNGAL of 169 +/- 100 nmol/L. Using a cutoff of 155 nmol/L, sensitivity and specificity to predict AKI were 82% and 97%, respectively (area under the curve [AUC] = 0.92 [0.852-0.972]; P = .001). Looking at the patients without AKI at admission (n = 56) and who developed (n = 20) or did not develop (n = 36) AKI, receiver operating characteristic curve analysis was as follows: AUC = 0.956 (0.864-0.992). Sensitivity was 85% and specificity was 97%. Of the 7 patients who required renal replacement therapy, all of them had pNGAL of more than 303 nmol/L (AUC = 0.788 [0.687-0.868]). CONCLUSION Plasma neutrophil gelatinase-associated lipocalin at ICU admission is an early biomarker of AKI in adult ICU patients. Plasma neutrophil gelatinase-associated lipocalin increased 48 hours before RIFLE criteria.
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Affiliation(s)
- Jean-Michel Constantin
- Surgical intensive care unit, Department of Anesthesiology and Critical Care Medicine, Hôtel-Dieu Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
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Maisonneuve B, Auclair C, Ali M, Terral D, Deméocq F, Roszyk L, Venzac M, Meyer M, Merlin E. Prévalence des anomalies métaboliques chez l’enfant obèse. Arch Pediatr 2009; 16:991-8. [PMID: 19428227 DOI: 10.1016/j.arcped.2009.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 01/16/2009] [Accepted: 03/31/2009] [Indexed: 11/29/2022]
Affiliation(s)
- B Maisonneuve
- Service de pédiatrie, CHU de Clermont-Ferrand, Hôtel-Dieu, 63001 Clermont-Ferrand, France
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Constantin J, Futier E, Roszyk L, Perbet S, Sapin V, Lautrette A, Souweine B, Bazin JE. Plasma neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill patients: a prospective study. Crit Care 2009. [PMCID: PMC4084139 DOI: 10.1186/cc7417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Constantin JM, Roszyk L, Guerin R, Bannier F, Chartier C, Perbet S, Futier E, Cayot-Constantin S, Sapin V, Bazin JE. [Tolerance of caspofungin in intensive care unit: a prospective study]. ACTA ACUST UNITED AC 2008; 27:819-24. [PMID: 18835682 DOI: 10.1016/j.annfar.2008.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 06/03/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Caspofungin has shown efficacy and very low toxicity in empirical antifungal therapy in refractory invasive Aspergillus infections and invasive candidiasis in neutropenic (or non) patients. To date, there is no data on tolerability of caspofungin in ICU patients. The aim of this study was to evaluate caspofungine tolerability in critical care patients. PATIENTS AND METHOD Over a 36-month period, 1430 patients were admitted in a general intensive care unit. All patients data were collected in a prospective database. All the clinical or biological side effects reported in the multicentric studies were required. The patients were laminated in two groups, according to the initial hepatic function. RESULTS Seventy-three patients were treated with caspofungin (5.1%) and 58% were immunocompromised. Immunosuppression was due to acute leukemia (30%), solid organ transplant (20%) or other causes of immunosuppression. In this group, SAPS2 was higher (51+/-20 versus 44+/-20; p<0.05) as mortality rate was (60% versus 23%). More than 90% of patients were ventilated and 55% needed extrarenal therapy. Caspofungin treatment was initiated for aspergillosis in 12 patients, candidiasis in 33 patients and others indications. Partial or complete response to treatment was 72%. Median duration of caspofungin administration was 11 days, no liver dysfunction or acute renal failure due to caspofungin was reported whatever initial liver function was. CONCLUSION This prospective open study demonstrate the very low toxicity of caspofungin even in critical care patients.
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Affiliation(s)
- J-M Constantin
- Pôle anesthésie-réanimation, service de réanimation adulte, hôpital Hôtel-Dieu, CHU de Clermont-Ferrand, boulevard Léon-Malfreyt, 63058 Clermont-Ferrand, France.
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Futier E, Constantin JM, Combaret L, Mosoni L, Roszyk L, Sapin V, Attaix D, Jung B, Jaber S, Bazin JE. Pressure support ventilation attenuates ventilator-induced protein modifications in the diaphragm. Crit Care 2008; 12:R116. [PMID: 18786263 PMCID: PMC2592744 DOI: 10.1186/cc7010] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2008] [Revised: 07/31/2008] [Accepted: 09/11/2008] [Indexed: 11/10/2022]
Abstract
Introduction Controlled mechanical ventilation (CMV) induces profound modifications of diaphragm protein metabolism, including muscle atrophy and severe ventilator-induced diaphragmatic dysfunction. Diaphragmatic modifications could be decreased by spontaneous breathing. We hypothesized that mechanical ventilation in pressure support ventilation (PSV), which preserves diaphragm muscle activity, would limit diaphragmatic protein catabolism. Methods Forty-two adult Sprague-Dawley rats were included in this prospective randomized animal study. After intraperitoneal anesthesia, animals were randomly assigned to the control group or to receive 6 or 18 hours of CMV or PSV. After sacrifice and incubation with 14C-phenylalanine, in vitro proteolysis and protein synthesis were measured on the costal region of the diaphragm. We also measured myofibrillar protein carbonyl levels and the activity of 20S proteasome and tripeptidylpeptidase II. Results Compared with control animals, diaphragmatic protein catabolism was significantly increased after 18 hours of CMV (33%, P = 0.0001) but not after 6 hours. CMV also decreased protein synthesis by 50% (P = 0.0012) after 6 hours and by 65% (P < 0.0001) after 18 hours of mechanical ventilation. Both 20S proteasome activity levels were increased by CMV. Compared with CMV, 6 and 18 hours of PSV showed no significant increase in proteolysis. PSV did not significantly increase protein synthesis versus controls. Both CMV and PSV increased protein carbonyl levels after 18 hours of mechanical ventilation from +63% (P < 0.001) and +82% (P < 0.0005), respectively. Conclusions PSV is efficient at reducing mechanical ventilation-induced proteolysis and inhibition of protein synthesis without modifications in the level of oxidative injury compared with continuous mechanical ventilation. PSV could be an interesting alternative to limit ventilator-induced diaphragmatic dysfunction.
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Affiliation(s)
- Emmanuel Futier
- General Intensive Care Unit, Hotel-Dieu Hospital, University Hospital of Clermont-Ferrand, Boulevard L. Malfreyt, Clermond-Ferrand, 63058, France
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Candito M, Rivet R, Herbeth B, Boisson C, Rudigoz RC, Luton D, Journel H, Oury JF, Roux F, Saura R, Vernhet I, Gaucherand P, Muller F, Guidicelli B, Heckenroth H, Poulain P, Blayau M, Francannet C, Roszyk L, Brustié C, Staccini P, Gérard P, Fillion-Emery N, Guéant-Rodriguez RM, Van Obberghen E, Guéant JL. Nutritional and genetic determinants of vitamin B and homocysteine metabolisms in neural tube defects: a multicenter case-control study. Am J Med Genet A 2008; 146A:1128-33. [PMID: 18386810 DOI: 10.1002/ajmg.a.32199] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Neural tube defects (NTDs) are severe congenital malformations due to failure of neural tube formation in early pregnancy. The proof that folic acid prevents NTDs raises the question of whether other parts of homocysteine (Hcy) metabolism may affect rates of NTDs. This French case-control study covered: 77 women aged 17-42 years sampled prior to elective abortion for a severe NTDs (cases) and 61 women aged 20-43 years with a normal pregnancy. Plasma and erythrocyte folate, plasma B6, B12 and Hcy were tested as five polymorphisms MTHFR 677 C --> T, MTHFR 1298 A --> C, MTR 2756 A --> G, MTTR 66 A --> G and TCN2 776 C --> G. Cases had significantly lower erythrocyte folate, plasma folate, B12 and B6 concentrations than the controls, and higher Hcy concentration. The odds ratio was 2.15 (95% CI: 1.00-4.59) for women with the MTRR 66 A --> G allele and it was decreased for mothers carrying the MTHFR 1298 A --> C allele. In multivariate analysis, only the erythrocyte folate concentration (P = 0.005) and plasma B6 concentration (P = 0.020) were predictors. Red cell folate is the main determinant of NTDs in France. Folic acid supplement or flour fortification would prevent most cases. Increased consumption of vitamins B12 and B6 could contribute to the prevention of NTDs. Genetic polymorphisms played only a small role. Until folic acid fortification becomes mandatory, all women of reproductive age should consume folic acid in a multivitamin that also contains B12 and B6.
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Affiliation(s)
- Mirande Candito
- Inserm U-145, Department of Biochemistry, CHU Nice Hôpital Pasteur, Nice, France.
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Niro J, Sapin V, Constantin JM, Cotte B, Lebel A, Roszyk L, R. Eglizot, Tauveron I, Jacquetin B, Lémery D, Gallot D. Prise en charge d’une hypertriglycéridémie gravidique par plasmaphérèse. ACTA ACUST UNITED AC 2007; 35:1133-5. [DOI: 10.1016/j.gyobfe.2007.08.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 08/02/2007] [Indexed: 12/01/2022]
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Roszyk L, Faye B, Tournilhac O, Fogli A, Sapin V. [Monoclonal IgM interference with immunoturbidimetric determination of ferritin and transferrin]. Ann Biol Clin (Paris) 2007; 65:659-662. [PMID: 18039612] [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] [Received: 05/16/2007] [Accepted: 08/28/2007] [Indexed: 05/25/2023]
Abstract
When they are present in important blood concentration, the monoclonal immunoglobulins are known to interfere with many immuno-analyze assays. We report the case of a patient presenting a Waldenstrom macroglobulinemia, for which the determination of some parameters of the martial assessment was impossible because of the presence of IgM kappa. The analysis of analytical alarms of the automat as well as the installation of simple and fast pre-treatment protocol of the interference enabled us to quickly make a result useful for the management of this patient.
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Affiliation(s)
- L Roszyk
- Laboratoire de biochimie médicale, CHU de Clermont-Ferrand
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Roszyk L, Faye B, Sapin V, Somda F, Tauveron I. Glycated haemoglobin (HbA1c): today and tomorrow. Ann Endocrinol (Paris) 2007; 68:357-65. [PMID: 17904515 DOI: 10.1016/j.ando.2007.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Revised: 05/03/2007] [Accepted: 06/19/2007] [Indexed: 01/08/2023]
Abstract
The assay of glycated haemoglobin (HbA1c) is a gold standard in bioanalysis, and is essential to ensure the optimal care of diabetic patients. Accordingly, the principal scientific societies in diabetology and clinical chemistry have made efforts to standardize this assay in order to select and validate certain analytical methods and achieve consistency in the results obtained therewith. However, clinicians have to be aware of the caution required when interpreting HbA1c assay results owing to modified lifetime and (or) abnormal synthesis of haemoglobin. Although this biological examination has now become an essential part of diabetes monitoring, its status as a screening tool is still controversial, even after 30 years of debate. Other uses of HbA1c assay are currently being assessed in cardiology (coronary syndromes), vascular diseases (arteriopathy), nephrology (renal insufficiency), haematology (anaemia) and oncology (factors of predisposition).
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Affiliation(s)
- L Roszyk
- Department of Biochemsitry, CHU Clermont-Ferrand, F-63000, Clermont-Ferrand, France.
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Constantin JM, Cayot-Constantin S, Roszyk L, Futier E, Sapin V, Dastugue B, Bazin JE, Rouby JJ. Response to recruitment maneuver influences net alveolar fluid clearance in acute respiratory distress syndrome. Anesthesiology 2007; 106:944-51. [PMID: 17457125 DOI: 10.1097/01.anes.0000265153.17062.64] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alveolar fluid clearance is impaired in the majority of patients with acute respiratory distress syndrome (ARDS). Experimental studies have shown that a reduction of tidal volume increases alveolar fluid clearance. This study was aimed at assessing the impact of the response to a recruitment maneuver (RM) on net alveolar fluid clearance. METHODS In 15 patients with ARDS, pulmonary edema fluid and plasma protein concentrations were measured before and after an RM, consisting of a positive end-expiratory pressure maintained 10 cm H2O above the lower inflection point of the pressure-volume curve during 15 min. Cardiorespiratory parameters were measured at baseline (before RM) and 1 and 4 h later. RM-induced lung recruitment was measured using the pressure-volume curve method. Net alveolar fluid clearance was measured by measuring changes in bronchoalveolar protein concentrations before and after RM. RESULTS In responders, defined as patients showing an RM-induced increase in arterial oxygen tension of 20% of baseline value or greater, net alveolar fluid clearance (19 +/- 13%/h) and significant alveolar recruitment (113 +/- 101 ml) were observed. In nonresponders, neither net alveolar fluid clearance (-24 +/- 11%/h) nor alveolar recruitment was measured. Responders and nonresponders differed only in terms of lung morphology: Responders had a diffuse loss of aeration, whereas nonresponders had a focal loss of aeration, predominating in the lower lobes. CONCLUSION In the absence of alveolar recruitment and improvement in arterial oxygenation, RM decreases the rate of alveolar fluid clearance, suggesting that lung overinflation may be associated with epithelial dysfunction.
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Affiliation(s)
- Jean-Michel Constantin
- Surgical Intensive Care Unit, Department of Anesthesiology, Hôtel-Dieu Hospital, University Hospital of Clermont-Ferrand, INSERM U384, Clermont-Ferrand, France.
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Gallot D, de Chazeron I, Boussiron D, Ughetto S, Vendittelli F, Legros FJ, Roszyk L, Llorca PM, Lemery D, Sapin V. Limits of usual biochemical alcohol markers in cord blood at term: a fetal/maternal population-based study. Clin Chem Lab Med 2007; 45:546-8. [PMID: 17439336 DOI: 10.1515/cclm.2007.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractClin Chem Lab Med 2007;45:546–8.
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Affiliation(s)
- Denis Gallot
- Université d'Auvergne, JE2447, ARDEMO, and CHU, Maternité Hôtel-Dieu, Clermont-Ferrand, France
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Sapin V, Nicolet L, Aublet-Cuvelier B, Sangline F, Roszyk L, Dastugue B, Gazuy N, Deteix P, Souweine B. Rapid decrease in plasma D-lactate as an early potential predictor of diminished 28-day mortality in critically ill septic shock patients. Clin Chem Lab Med 2006; 44:492-6. [PMID: 16599846 DOI: 10.1515/cclm.2006.086] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Splanchnic ischemia plays a major role in the development of organ failure during septic shock. Plasma D-lactate has been proposed as a better marker of splanchnic hypoperfusion than L-lactate. We studied the prognostic ability of plasma D- and L-lactate levels. METHODS A prospective study was performed in an intensive care unit and included patients with septic shock. Two samples for plasma D- and L-lactate determination were collected: the first within 6 h after the patient met the criteria for septic shock (day 1) and the second 24 h later (day 2). RESULTS In univariate analysis, day 1 plasma D- and L-lactate values were associated with 28-day mortality. For plasma D- and L- lactate, the area under the receiver operating characteristic curve was 0.68+/-0.09 and 0.84+/-0.07 on day 1 (p=0.09), and 0.74+/-0.10 and 0.90+/-0.07 on day 2 (p=0.06), respectively. In survivors, D-lactate levels decreased between day 1 and day 2 (p=0.03), but L-lactate did not (p=0.29). In septic shock patients, plasma D- and L-lactate levels reliably discriminate between survivors and non-survivors. The prognostic ability of plasma L-lactate was better than that of plasma D-lactate. CONCLUSION A rapid decrease in plasma D-lactate during the course of septic shock could indicate reduced 28-day mortality.
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Affiliation(s)
- Vincent Sapin
- Department of Biochemistry, Faculty of Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Evrard B, Roszyk L, Fattal S, Dastugue B, Sapin V. [Evaluation of rapid, semi-quantitative assay of C-reactive protein in whole blood, Actim CRP]. Ann Biol Clin (Paris) 2005; 63:525-9. [PMID: 16230290] [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] [Received: 04/16/2005] [Accepted: 06/14/2005] [Indexed: 05/04/2023]
Abstract
We evaluated a rapid and semi-quantitative C-Reactive Protein test on whole blood, the Actim CRP (Fumouze). Based on immuno-chromatography technology, this test ranked the blood sample in four groups: < 10 mg/L, 10-40 mg/L, 40-80 mg/L and > 80 mg/L. This evaluation finds an excellent repeatability, the absence of hook-effect for high levels of CRP and an independence from classical biological interferences: haemolysis, turbidity and bilirubin. The correlation is excellent between the rapid test and classical immuno-turbidimetric plasmatic CRP assay. This test with established analytical properties could be placed as an interesting alternative to replace the classical assays realised on analysers, and more particularly in case of reduced sample volume. The use in "patient care" context had to follow rigorous manufacturer's recommendations to respect analytical specificities identified during our validation process.
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Affiliation(s)
- B Evrard
- Laboratoire de biochimie médicale, Hôtel-Dieu, CHU de Clermont-Ferrand
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Marceau G, Jacomel C, Ughetto S, Roszyk L, Dastugue B, Laurichesse H, Sapin V. [Outcome of hyperlactatemia and lipodystrophy syndromes in patients infected with human immunodeficiency virus]. Ann Biol Clin (Paris) 2004; 62:471-8. [PMID: 15297245] [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: 04/30/2023]
Abstract
HIV-positive persons requiring a highly active antiretroviral therapy containing one or more nucleosidic reverse transcriptase inhibitors associated with or without protease inhibitors are exposed to metabolic side effects among which lipodystrophy and hyperlactemia, defined by blood lactates higher than 2,25 mmol/L. Hyperlactatemia had to be differentiated from lactic acidosis of type B (without hypoxemia, lactates higher than 5 mmol/L and arterial pH lower than 7,3), a rare but potentially fatal complication by multi-visceral failure. The accused INRT induce mitochondrial toxicity by inhibition of DNA gamma polymerase and deterioration of its DNA. Our exploratory study, troop of 282 patients, identified age and stavudine like statistically associated, which has occurred of this metabolic anomaly. The patients having profited of a therapeutic change with the profit from drugs minus hyperlactatogenic presented an obvious clinical and biological improvement; whereas similar switch of therapy occurred for the lipodystrophic patients presented any clinical improvement. Nevertheless, biological parameters (blood lactates, triglycerides, total cholesterol and LDL-cholesterol) were significantly decreased after this therapeutic switch occurred on the lipodystrophic patients. In conclusion, the measurement of the following biological parameters: glycemia, lactatemia, triglycerides, total cholesterol and LDL-cholesterol at patient VIH, in a simple and rigorous pre-analytical and analytical context, appears to us justified in the monitoring of metabolic disorders in treated HIV patients by INRT and/or IP.
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Affiliation(s)
- G Marceau
- Laboratoire de biochimie, Hôtel-Dieu, CHU, 63000 Clermont-Ferrand
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