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Cousin N, Goutay J, Girardie P, Favory R, Drumez E, Mathieu D, Poissy J, Parmentier E, Duburcq T. Effects of high oxygen tension on healthy volunteer microcirculation. Diving Hyperb Med 2022; 52:260-270. [PMID: 36525683 PMCID: PMC10017198 DOI: 10.28920/dhm52.4.260-270] [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: 04/14/2022] [Accepted: 10/01/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Previous studies have highlighted hyperoxia-induced microcirculation modifications, but few have focused on hyperbaric oxygen (HBO) effects. Our primary objective was to explore hyperbaric hyperoxia effects on the microcirculation of healthy volunteers and investigate whether these modifications are adaptative or not. METHODS This single centre, open-label study included 15 healthy volunteers. Measurements were performed under five conditions: T0) baseline value (normobaric normoxia); T1) hyperbaric normoxia; T2) hyperbaric hyperoxia; T3) normobaric hyperoxia; T4) return to normobaric normoxia. Microcirculatory data were gathered via laser Doppler, near-infrared spectroscopy and transcutaneous oximetry (PtcO₂). Vascular-occlusion tests were performed at each step. We used transthoracic echocardiography and standard monitoring for haemodynamic investigation. RESULTS Maximal alterations were observed under hyperbaric hyperoxia which led, in comparison with baseline, to arterial hypertension (mean arterial pressure 105 (SD 12) mmHg vs 95 (11), P < 0.001) and bradycardia (55 (7) beats·min⁻¹ vs 66 (8), P < 0.001) while cardiac output remained unchanged. Hyperbaric hyperoxia also led to microcirculatory vasoconstriction (rest flow 63 (74) vs 143 (73) perfusion units, P < 0.05) in response to increased PtcO₂ (104.0 (45.9) kPa vs 6.3 (2.4), P < 0.0001); and a decrease in laser Doppler parameters indicating vascular reserve (peak flow 125 (89) vs 233 (79) perfusion units, P < 0.05). Microvascular reactivity was preserved in every condition. CONCLUSIONS Hyperoxia significantly modifies healthy volunteer microcirculation especially during HBO exposure. The rise in PtcO₂ promotes an adaptative vasoconstrictive response to protect cellular integrity. Microvascular reactivity remains unaltered and vascular reserve is mobilised in proportion to the extent of the ischaemic stimulus.
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Affiliation(s)
- Nicolas Cousin
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Julien Goutay
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Patrick Girardie
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Raphaël Favory
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Elodie Drumez
- Unité de méthodologie - biostatistique et data management, CHU Lille, Lille, France
| | - Daniel Mathieu
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Julien Poissy
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Erika Parmentier
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
| | - Thibault Duburcq
- Pôle de réanimation, hôpital Roger Salengro, CHU Lille, Lille, France
- Corresponding author: Dr Thibault Duburcq, Centre Hospitalier Universitaire de Lille, Hôpital Roger Salengro - Centre de réanimation, Avenue du Professeur Emile Laine , 59037 LILLE Cedex, France,
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Cousin N, Goutay J, Cailliau E, Gaudet A, Duburcq T. Effects of High PEEP on Intrapulmonary Shunt Ratio in Patients With SARS-CoV-2-Induced ARDS. Respir Care 2022; 67:1456-1459. [PMID: 35820702 PMCID: PMC9993964 DOI: 10.4187/respcare.09941] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Nicolas Cousin
- CHU Lille, Medical Intensive Care Unit, Lille, France; and CHU Lille, Pôle d'Anesthésie Réanimation, Clinique Cardio-vasculaire et thoracique, Lille, France
| | - Julien Goutay
- CHU Lille, Medical Intensive Care Unit, Lille, France
| | - Emeline Cailliau
- Univ Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France; and CHU Lille, Department of Biostatistics, Lille, France
| | - Alexandre Gaudet
- CHU Lille, Medical Intensive Care Unit, Lille, France; and University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Lille, France.
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Descamps R, Moussa MD, Besnier E, Fischer MO, Preau S, Tamion F, Daubin C, Cousin N, Vincentelli A, Goutay J, Du Cheyron D. Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study. Crit Care 2021; 25:127. [PMID: 33810800 PMCID: PMC8019180 DOI: 10.1186/s13054-021-03554-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/26/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hemorrhagic events remain a major concern in patients under extracorporeal membrane oxygenation (ECMO) support. We tested the association between anticoagulation levels and hemorrhagic events under ECMO using anti-Xa activity monitoring. METHODS We performed a retrospective multicenter cohort study in three ECMO centers. All adult patients treated with veno-venous (VV)- or veno-arterial (VA)-ECMO in 6 intensive care units between September 2017 and August 2019 were included. Anti-Xa activities were collected until a hemorrhagic event in the bleeding group and for the duration of ECMO in the non-bleeding group. All dosages were averaged to obtain means of anti-Xa activity for each patient, and patients were compared according to the occurrence or not of bleeding. RESULTS Among 367 patients assessed for eligibility, 121 were included. Thirty-five (29%) presented a hemorrhagic complication. In univariate analysis, anti-Xa activities were significantly higher in the bleeding group than in the non-bleeding group, both for the mean anti-Xa activity (0.38 [0.29-0.67] vs 0.33 [0.22-0.42] IU/mL; p = 0.01) and the maximal anti-Xa activity (0.83 [0.47-1.46] vs 0.66 [0.36-0.91] IU/mL; p = 0.05). In the Cox proportional hazard model, mean anti-Xa activity was associated with bleeding (p = 0.0001). By Kaplan-Meier analysis with the cutoff value at 0.46 IU/mL obtained by ROC curve analysis, the probability of survival under ECMO without bleeding was significantly lower when mean anti-Xa was > 0.46 IU/mL (p = 0.0006). CONCLUSION In critically ill patients under ECMO, mean anti-Xa activity was an independent risk factor for hemorrhagic complications. Anticoagulation targets could be revised downward in both VV- and VA-ECMO.
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Affiliation(s)
- Richard Descamps
- Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France.
| | - Mouhamed D Moussa
- Inserm, CHU Lille, Surgical Critical Care, Department of Anesthesiology and Critical Care, Institut Pasteur de Lille, UMR1011-EGID, Univ. Lille, 59000, Lille, France
| | - Emmanuel Besnier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, 76000, Rouen, France
| | - Marc-Olivier Fischer
- Department of Anesthesiology and Critical Care, Caen University Hospital, 14000, Caen, France
| | - Sébastien Preau
- Department of Medical Intensive Care, Lille University Hospital, 59000, Lille, France
| | - Fabienne Tamion
- UNIROUEN, Inserm U1096, FHU- REMOD-VHF, Normandie Univ, 76000, Rouen, France
- Department of Medical Intensive Care, Rouen University Hospital, 76000, Rouen, France
| | - Cédric Daubin
- Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France
| | - Nicolas Cousin
- Department of Medical Intensive Care, Lille University Hospital, 59000, Lille, France
| | - André Vincentelli
- Inserm, CHU Lille, Department of Cardiac Surgery, Institut Pasteur de Lille, UMR1011-EGID, Univ. Lille, 59000, Lille, France
| | - Julien Goutay
- Department of Medical Intensive Care, Lille University Hospital, 59000, Lille, France
| | - Damien Du Cheyron
- Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France
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Cousin N, Bourel C, Carpentier D, Goutay J, Mugnier A, Labreuche J, Godeau E, Clavier T, Grange S, Tamion F, Durand A, Moussa MD, Duburcq T. SARS-CoV-2 Versus Influenza-associated Acute Respiratory Distress Syndrome Requiring Veno-venous Extracorporeal Membrane Oxygenation Support. ASAIO J 2021; 67:125-131. [PMID: 33060407 PMCID: PMC7846248 DOI: 10.1097/mat.0000000000001325] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
No study has compared patients with COVID-19-related refractory ARDS requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO) to a relevant and homogenous control population. We aimed to compare the outcomes, the clinical characteristics, and the adverse effects of COVID-19 patients to a retrospective cohort of influenza patients. This retrospective case-control study was conducted in the ICUs of Lille and Rouen University Hospitals between January 2014 and May 2020. Two independent cohorts of patients with ARDS requiring V-V ECMO infected with either COVID-19 (n = 30) or influenza (n = 22) were compared. A 3-month follow-up was completed for all patients. Median age of COVID-19 and influenza patients was similar (57 vs. 55 years; p = 0.62). The 28-day mortality rate did not significantly differ between COVID-19 (43.3%) and influenza patients (50%, p = 0.63). There was no significant difference considering the cumulative incidence of ECMO weaning, hospital discharge, and 3-month survival. COVID-19 patients had a lower SAPS II score (58 [37-64] vs. 68 [52-83]; p = 0.039), a higher body mass index (33 [29-38] vs. 30 [26-34] kg/m2; p = 0.05), and were cannulated later (median delay between mechanical support and V-V ECMO 6 vs. 3 days, p = 0.004) compared with influenza patients. No difference in overall adverse events was observed between COVID-19 and influenza patients (70% vs. 95.5% respectively; p = 0.23). Despite differences in clinical presentation before V-V ECMO implantation, 28-day and 3-month mortality rate did not differ between COVID-19 and influenza patients. Considering the lack of specific treatment for COVID-19, V-V ECMO should be considered as a relevant rescue organ support.
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Affiliation(s)
- Nicolas Cousin
- From the Medical Intensive Care Unit, CHU Lille, Lille, France
| | - Claire Bourel
- From the Medical Intensive Care Unit, CHU Lille, Lille, France
| | | | - Julien Goutay
- From the Medical Intensive Care Unit, CHU Lille, Lille, France
| | - Agnes Mugnier
- Department of Cardiovascular Surgery, CHU Lille, Lille, France
| | - Julien Labreuche
- University of Lille, ULR 2694—METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- Department of Biostatistics, CHU Lille, Lille, France
| | - Elise Godeau
- Intensive Care Unit, CHI Elbeuf Louviers Val de Reuil, Elbeuf, France
| | | | - Steven Grange
- Medical Intensive Care Unit, CHU Rouen, Rouen, France
| | | | - Arthur Durand
- From the Medical Intensive Care Unit, CHU Lille, Lille, France
| | - Mouhamed D. Moussa
- Cardiovascular Intensive Care Unit, CHU Lille, Lille, France
- University of Lille, INSERM, Institut Pasteur de Lille, U1011—EGID, Lille, France
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Garcia B, Cousin N, Bourel C, Jourdain M, Poissy J, Duburcq T. Prone positioning under VV-ECMO in SARS-CoV-2-induced acute respiratory distress syndrome. Crit Care 2020; 24:428. [PMID: 32665007 PMCID: PMC7358559 DOI: 10.1186/s13054-020-03162-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Bruno Garcia
- CHU Lille, Pôle de réanimation, F-59000, Lille, France
| | | | - Claire Bourel
- CHU Lille, Pôle de réanimation, F-59000, Lille, France
| | - Mercé Jourdain
- CHU Lille, Pôle de réanimation, F-59000, Lille, France.,Univ. Lille, Inserm Pasteur Lille, Inserm U1190 EGID, F-59000, Lille, France
| | - Julien Poissy
- CHU Lille, Pôle de réanimation, F-59000, Lille, France.,Univ. Lille, Inserm U1285, CNRS, UMR 8576 - Unité de Glycobiologie Structurale et Fonctionnelle, F-59000, Lille, France
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