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Gueret G, Tête X, Le Maguet P. Hyperchloremia: Cause or Consequence of Acute Kidney Injury? Crit Care Med 2024; 52:e245-e246. [PMID: 38619348 DOI: 10.1097/ccm.0000000000006190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Affiliation(s)
- Gildas Gueret
- Anesthesiology department, centre hospitalier de Cornouaille, Quimper, France
| | - Xavier Tête
- Anesthesiology Department, Military Teaching Hospital Clermont Tonnerre, Brest, France
| | - Pascale Le Maguet
- Anesthesiology department, centre hospitalier de Cornouaille, Quimper, France
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Bruno RR, Wernly B, Bagshaw SM, van den Boogaard M, Darvall JN, De Geer L, de Gopegui Miguelena PR, Heyland DK, Hewitt D, Hope AA, Langlais E, Le Maguet P, Montgomery CL, Papageorgiou D, Seguin P, Geense WW, Silva-Obregón JA, Wolff G, Polzin A, Dannenberg L, Kelm M, Flaatten H, Beil M, Franz M, Sviri S, Leaver S, Guidet B, Boumendil A, Jung C. The Clinical Frailty Scale for mortality prediction of old acutely admitted intensive care patients: a meta-analysis of individual patient-level data. Ann Intensive Care 2023; 13:37. [PMID: 37133796 PMCID: PMC10155148 DOI: 10.1186/s13613-023-01132-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 12/27/2022] [Accepted: 04/20/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND This large-scale analysis pools individual data about the Clinical Frailty Scale (CFS) to predict outcome in the intensive care unit (ICU). METHODS A systematic search identified all clinical trials that used the CFS in the ICU (PubMed searched until 24th June 2020). All patients who were electively admitted were excluded. The primary outcome was ICU mortality. Regression models were estimated on the complete data set, and for missing data, multiple imputations were utilised. Cox models were adjusted for age, sex, and illness acuity score (SOFA, SAPS II or APACHE II). RESULTS 12 studies from 30 countries with anonymised individualised patient data were included (n = 23,989 patients). In the univariate analysis for all patients, being frail (CFS ≥ 5) was associated with an increased risk of ICU mortality, but not after adjustment. In older patients (≥ 65 years) there was an independent association with ICU mortality both in the complete case analysis (HR 1.34 (95% CI 1.25-1.44), p < 0.0001) and in the multiple imputation analysis (HR 1.35 (95% CI 1.26-1.45), p < 0.0001, adjusted for SOFA). In older patients, being vulnerable (CFS 4) alone did not significantly differ from being frail. After adjustment, a CFS of 4-5, 6, and ≥ 7 was associated with a significantly worse outcome compared to CFS of 1-3. CONCLUSIONS Being frail is associated with a significantly increased risk for ICU mortality in older patients, while being vulnerable alone did not significantly differ. New Frailty categories might reflect its "continuum" better and predict ICU outcome more accurately. TRIAL REGISTRATION Open Science Framework (OSF: https://osf.io/8buwk/ ).
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Affiliation(s)
- Raphael Romano Bruno
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University, Paracelsusstraße 37, 5110, Oberndorf, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124 Clinical Sciences Building, 8440 112Th ST, Edmonton, AB, T6G 2B7, Canada
| | - Mark van den Boogaard
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jai N Darvall
- Intensive Care Unit and Department of Anaesthesia & Pain Management, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3050, Australia
| | - Lina De Geer
- Department of Anaesthesiology and Intensive Care, Linköping University Hospital, Linköping, Sweden
| | | | - Daren K Heyland
- Clinical Evaluation Research Unit, and Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - David Hewitt
- Glasgow Royal Infirmary Intensive Care Unit, Glasgow, Scotland
| | - Aluko A Hope
- Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Emilie Langlais
- Réanimation Chirurgicale, CHU Rennes, Université Rennes 1, Rennes, France
| | - Pascale Le Maguet
- Département d'Anesthésie Réanimation, CHU Rennes, Rennes, France
- Service d'Anesthésie, CH Quimper, Quimper, France
| | - Carmel L Montgomery
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124 Clinical Sciences Building, 8440 112Th ST, Edmonton, AB, T6G 2B7, Canada
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 3-171, Edmonton, AB, T6G 1C9, Canada
| | - Dimitrios Papageorgiou
- Faculty of Health and Caring Sciences Department of Nursing, University of West Attica (UWA) Athens, Egaleo, Greece
| | - Philippe Seguin
- Réanimation Chirurgicale, CHU Rennes, Université Rennes 1, Rennes, France
| | - Wytske W Geense
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Alberto Silva-Obregón
- Department of Intensive Care Medicine, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Georg Wolff
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Amin Polzin
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Lisa Dannenberg
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Malte Kelm
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), University Hospital of Düsseldorf, Germany, Düsseldorf, Germany
| | - Hans Flaatten
- Department of Clinical Medicine, Department of Anaesthesia and Intensive Care, University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Michael Beil
- Dept. of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Marcus Franz
- Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University, 07737, Jena, Germany
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Bertrand Guidet
- Equipe: Épidémiologie Hospitalière Qualité Et Organisation Des Soins, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, 75012, Paris, France
- Service de Réanimation Médicale, Hôpitaux de Paris, Hôpital Saint-Antoine, 75012, Paris, France
| | - Ariane Boumendil
- Equipe: Épidémiologie Hospitalière Qualité Et Organisation Des Soins, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, 75012, Paris, France
- Service de Réanimation Médicale, Hôpitaux de Paris, Hôpital Saint-Antoine, 75012, Paris, France
| | - Christian Jung
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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Gueret G, Le Maguet P, Fabre R, Laffon M. Carbon Dioxide Removal: Low Bicarbonate or H+ (Cl-) Addition? ASAIO J 2021; 67:e57. [PMID: 32947282 DOI: 10.1097/mat.0000000000001277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Gildas Gueret
- Service d'anesthésie, centre hospitalier de Cornouaille, Quimper, France
| | - Pascale Le Maguet
- Service d'anesthésie, centre hospitalier de Cornouaille, Quimper, France
| | - Renaud Fabre
- Service d'anesthésie, centre hospitalier de Cornouaille, Quimper, France
| | - Marc Laffon
- Département d'anesthésie réanimation, CHRU Clocheville, Tours, France
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Gueret G, Le Maguet P, Lefebvre P, Fabre R. Comment: Assessment of Acute Kidney Injury in Neurologically Injured Patients Receiving Hypertonic Sodium Chloride: Does Chloride Load Matter? Ann Pharmacother 2020; 55:689-690. [PMID: 33025793 DOI: 10.1177/1060028020964746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Gueret G, Lefebvre P, Le Maguet P, Fabre R. Acute kidney injury after aneurysmal subarachnoid hemorrhage: is chloride really responsible? J Intensive Care 2020; 8:73. [PMID: 32999725 PMCID: PMC7520018 DOI: 10.1186/s40560-020-00492-x] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
Sadan et al. find an association between acute kidney injury and high chloride containing a hypertonic solution. Recent large prospective non-randomized studies bring conflicting results on the relationship between chloride and acute kidney injury. We discuss Sadan et al.'s results according to the recent literature.
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Affiliation(s)
- Gildas Gueret
- Service d'anesthésie, centre hospitalier de Cornouaille, 29000 Quimper, France
| | - Pierre Lefebvre
- Service d'anesthésie, centre hospitalier de Cornouaille, 29000 Quimper, France
| | - Pascale Le Maguet
- Service d'anesthésie, centre hospitalier de Cornouaille, 29000 Quimper, France
| | - Renaud Fabre
- Service d'anesthésie, centre hospitalier de Cornouaille, 29000 Quimper, France
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Gueret G, Fabre R, Le Maguet P, Laffon M. Hyperchlorémie et acidose métabolique : l’association est-elle réellement démontrée ? Anesthésie & Réanimation 2020. [DOI: 10.1016/j.anrea.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Gueret G, Le Maguet P, Fabre R, Laffon M. Delayed graft function after kidney transplantation: is saline really responsible? Can J Anaesth 2020; 67:1433-1434. [PMID: 32394339 DOI: 10.1007/s12630-020-01701-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Gildas Gueret
- Service d'anesthésie, Centre Hospitalier de Quimper, Quimper, France.
| | - Pascale Le Maguet
- Service d'anesthésie, Centre Hospitalier de Quimper, Quimper, France
| | - Renaud Fabre
- Service d'anesthésie, Centre Hospitalier de Quimper, Quimper, France
| | - Marc Laffon
- Département d'anesthésie réanimation, CHRU, Tours, France
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Gueret G, Le Maguet P, Fabre R, Laffon M. Should We Avoid Saline in Sepsis? It's Probably Too Early to Definitively Conclude. Am J Respir Crit Care Med 2020; 201:1161-1162. [PMID: 31972097 PMCID: PMC7193865 DOI: 10.1164/rccm.201912-2479le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Renaud Fabre
- Centre Hospitalier de CornouailleQuimper, Franceand
| | - Marc Laffon
- Centre Hospitalier Régional Universitaire ClochevilleTours, France
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Kentish-Barnes N, Chevret S, Cheisson G, Joseph L, Martin-Lefèvre L, Si Larbi AG, Viquesnel G, Marqué S, Donati S, Charpentier J, Pichon N, Zuber B, Lesieur O, Ouendo M, Renault A, Le Maguet P, Kandelman S, Thuong M, Floccard B, Mezher C, Galon M, Duranteau J, Azoulay E. Grief Symptoms in Relatives Who Experienced Organ Donation Requests in the ICU. Am J Respir Crit Care Med 2018; 198:751-758. [DOI: 10.1164/rccm.201709-1899oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - Sylvie Chevret
- Service de Biostatistique et Information Médicale, Saint-Louis University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
- Biostatistics and Clinical Epidemiology Research (ECSTRA) Team, U1153, INSERM, Paris Diderot University, Sorbonne University, Paris, France
| | | | - Liliane Joseph
- Transplant Coordination Team, Bicêtre University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | | | | | - Gérald Viquesnel
- Surgical Intensive Care Unit, Côte de Nacre Hospital, Caen, France
| | - Sophie Marqué
- Medical and Surgical Intensive Care Unit, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Stéphane Donati
- Medical and Surgical Intensive Care Unit, Sainte Musse Hospital, Toulon, France
| | - Julien Charpentier
- Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Nicolas Pichon
- Medical and Surgical Intensive Care Unit, Dupuytren University Hospital, Limoges, France
| | - Benjamin Zuber
- Medical and Surgical Intensive Care Unit, André Mignot Hospital, Versailles, France
| | - Olivier Lesieur
- Medical and Surgical Intensive Care Unit, La Rochelle Hospital, La Rochelle, France
| | - Martial Ouendo
- Medical and Surgical Intensive Care Unit, Amiens-Picardy University Hospital, Amiens, France
| | | | - Pascale Le Maguet
- Surgical Intensive Care, Cavale Blanche University Hospital, Brest, France
| | - Stanislas Kandelman
- Anesthesia and Intensive Care Department, Beaujon University Hospital, Assistance Publique – Hôpitaux de Paris, Clichy, France
| | - Marie Thuong
- Intensive Care Unit, Hospital René-Dubos, Pontoise, France
| | - Bernard Floccard
- Anesthesia and Intensive Care, Hospices Civils de Lyon – Edouard Herriot Hospital, Lyon, France; and
| | - Chaouki Mezher
- Medical and Surgical Intensive Care, Belfort-Montbelliard Hospital, Montbelliard, France
| | | | | | - Elie Azoulay
- Famiréa Research Group and
- Biostatistics and Clinical Epidemiology Research (ECSTRA) Team, U1153, INSERM, Paris Diderot University, Sorbonne University, Paris, France
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Launey Y, Lasocki S, Asehnoune K, Gaudriot B, Chassier C, Cinotti R, Maguet PL, Laksiri L, Mimoz O, Tawa A, Nesseler N, Malledant Y, Perrot B, Seguin P. Impact of Low-Dose Hydrocortisone on the Incidence of Atrial Fibrillation in Patients With Septic Shock: A Propensity Score-Inverse Probability of Treatment Weighting Cohort Study. J Intensive Care Med 2017; 34:238-244. [PMID: 28292220 DOI: 10.1177/0885066617696847] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Atrial fibrillation (AF) is common in the intensive care unit (ICU), notably in patients with septic shock for whom inflammation is an already identified risk factor. The aim of this study was to evaluate the effect of low-dose hydrocortisone on AF occurrence in patients with septic shock. METHODS We performed a prospective nonrandomized observational study in 5 academic ICUs in France. From November 2012 to June 2014, all patients ≥16 years having septic shock were included, except those who had a history of AF, had a pacemaker, and/or experienced AF during hospitalization before the onset of shock or in whom the onset of shock occurred prior to admission to the ICU. Hydrocortisone was administered at the discretion of the attending physician. The incidence of AF was compared among patients who received hydrocortisone, and the effect of low-dose hydrocortisone on AF was estimated using the inverse probability treatment weighting method based on propensity scores. RESULTS A total of 261 patients were included (no-hydrocortisone group, n = 138; hydrocortisone group, n = 123). Atrial fibrillation occurred in 57 (22%) patients. Atrial fibrillation rates were 33 (24%) and 24 (19%) in no-hydrocortisone patients and hydrocortisone patients, respectively. In the weighted sample, the proportion of patients who developed AF was 28.8% in the no-hydrocortisone group and 16.8% in the hydrocortisone group (difference: -11.9%; 95% confidence interval: -23.4% to -0.5%; P = .040). CONCLUSION In patients with septic shock, low-dose hydrocortisone was associated with a lower risk of developing AF during the acute phase.
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Affiliation(s)
- Yoann Launey
- Service d'Anesthésie Réanimation 1, CHU Rennes, Hôpital Pontchaillou, Rennes, France
| | | | - Karim Asehnoune
- Département d'Anesthésie Réanimation, CHU Nantes, Nantes, France
| | - Baptiste Gaudriot
- Service d'Anesthésie Réanimation 1, CHU Rennes, Hôpital Pontchaillou, Rennes, France
| | - Claire Chassier
- Département d'Anesthésie Réanimation, CHU Angers, Angers, France
| | - Raphael Cinotti
- Département d'Anesthésie Réanimation, CHU Nantes, Nantes, France
| | | | - Leila Laksiri
- Département d'Anesthésie Réanimation, CHU Poitiers, Poitiers, France
| | - Olivier Mimoz
- Département d'Anesthésie Réanimation, CHU Poitiers, Poitiers, France
| | - Audrey Tawa
- Service d'Anesthésie Réanimation 1, CHU Rennes, Hôpital Pontchaillou, Rennes, France
| | - Nicolas Nesseler
- Service d'Anesthésie Réanimation 1, CHU Rennes, Hôpital Pontchaillou, Rennes, France
| | - Yannick Malledant
- Service d'Anesthésie Réanimation 1, CHU Rennes, Hôpital Pontchaillou, Rennes, France
| | - Bastien Perrot
- EA 4275 SPHERE "Biostatistics, Pharmacoepidemiology and Human Science Research," UFR des Sciences Pharmaceutiques, Université de Nantes, Nantes, France
| | - Philippe Seguin
- Service d'Anesthésie Réanimation 1, CHU Rennes, Hôpital Pontchaillou, Rennes, France
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Maguet PL, ASEHNOUNE K, AUTET LM, GAILLARD T, LASOCKI S, MIMOZ O, LATTE DDEMEUREDIT, GERGAUD S, MORCET J, SEGUIN P, MALLEDANT Y, TANGUY M. Transitioning from routine to on-demand test ordering in intensive care units: a prospective, multicenter, interventional study. Br J Anaesth 2015. [DOI: 10.1093/bja/el_12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Asehnoune K, Seguin P, Allary J, Feuillet F, Lasocki S, Cook F, Floch H, Chabanne R, Geeraerts T, Roger C, Perrigault PF, Hanouz JL, Lukaszewicz AC, Biais M, Boucheix P, Dahyot-Fizelier C, Capdevila X, Mahe PJ, Maguet PL, Paugam-Burtz C, Gergaud S, Plaud B, Constantin JM, Malledant Y, Flet L, Sebille V, Roquilly A. Hydrocortisone and fludrocortisone for prevention of hospital-acquired pneumonia in patients with severe traumatic brain injury (Corti-TC): a double-blind, multicentre phase 3, randomised placebo-controlled trial. The Lancet Respiratory Medicine 2014; 2:706-16. [DOI: 10.1016/s2213-2600(14)70144-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Launey Y, Nesseler N, Le Maguet P, Mallédant Y, Seguin P. Effect of Osmotherapy on Optic Nerve Sheath Diameter in Patients with Increased Intracranial Pressure. J Neurotrauma 2014; 31:984-8. [DOI: 10.1089/neu.2012.2829] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yoann Launey
- CHU de Rennes, Hôpital Pontchaillou, Département d'Anesthésie Réanimation, Rennes, France
- Inserm U991, Rennes, France
- Université Rennes 1, Rennes, France
| | - Nicolas Nesseler
- CHU de Rennes, Hôpital Pontchaillou, Département d'Anesthésie Réanimation, Rennes, France
- Inserm U991, Rennes, France
- Université Rennes 1, Rennes, France
| | - Pascale Le Maguet
- CHU de Rennes, Hôpital Pontchaillou, Département d'Anesthésie Réanimation, Rennes, France
| | - Yannick Mallédant
- CHU de Rennes, Hôpital Pontchaillou, Département d'Anesthésie Réanimation, Rennes, France
- Inserm U991, Rennes, France
- Université Rennes 1, Rennes, France
| | - Philippe Seguin
- CHU de Rennes, Hôpital Pontchaillou, Département d'Anesthésie Réanimation, Rennes, France
- Inserm U991, Rennes, France
- Université Rennes 1, Rennes, France
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Le Maguet P, Roquilly A, Lasocki S, Asehnoune K, Carise E, Saint Martin M, Mimoz O, Le Gac G, Somme D, Cattenoz C, Feuillet F, Malledant Y, Seguin P. Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study. Intensive Care Med 2014; 40:674-82. [PMID: 24651884 DOI: 10.1007/s00134-014-3253-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/25/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Frailty is a recent concept used for evaluating elderly individuals. Our study determined the prevalence of frailty in intensive care unit (ICU) patients and its impact on the rate of mortality. METHODS A multicenter, prospective, observational study performed in four ICUs in France included 196 patients aged ≥65 years hospitalized for >24 h during a 6-month study period. Frailty was determined using the frailty phenotype (FP) and the clinical frailty score (CFS). The patients were separated as follows: FP score <3 or ≥3 and CFS <5 or ≥5. RESULTS Frailty was observed in 41 and 23% of patients on the basis of an FP score ≥3 and a CFS ≥5, respectively. At admission to the ICU, the Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) scores did not differ between the frail and nonfrail patients. In the multivariate analysis, the risk factors for ICU mortality were FP score ≥3 [hazard ratio (HR), 3.3; 95% confidence interval (CI), 1.6-6.6; p < 0.001], male gender (HR, 2.4; 95% CI, 1.1-5.3; p = 0.026), cardiac arrest before admission (HR, 2.8; 95% CI, 1.1-7.4; p = 0.036), SAPS II score ≥46 (HR, 2.6; 95% CI, 1.2-5.3; p = 0.011), and brain injury before admission (HR, 3.5; 95% CI, 1.6-7.7; p = 0.002). The risk factors for 6-month mortality were a CFS ≥5 (HR, 2.4; 95% CI, 1.49-3.87; p < 0.001) and a SOFA score ≥7 (HR, 2.2; 95% CI, 1.35-3.64; p = 0.002). An increased CFS was associated with significant incremental hospital and 6-month mortalities. CONCLUSIONS Frailty is a frequent occurrence and is independently associated with increased ICU and 6-month mortalities. Notably, the CFS predicts outcomes more effectively than the commonly used ICU illness scores.
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Laviolle B, Donal E, Le Maguet P, Lainé F, Bellissant E. Low doses of fludrocortisone and hydrocortisone, alone or in combination, on vascular responsiveness to phenylephrine in healthy volunteers. Br J Clin Pharmacol 2013; 75:423-30. [PMID: 22703532 DOI: 10.1111/j.1365-2125.2012.04359.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 06/01/2012] [Indexed: 12/15/2022] Open
Abstract
AIMS A single administration of hydrocortisone has been shown to enhance the pressor response to phenylephrine in healthy volunteers and to norepinephrine in septic shock patients. Similar data do not exist for fludrocortisone. Since there continues to be disagreement about the utility of fludrocortisone in septic shock, we assessed the effects of a single administration of low doses of hydrocortisone (50 mg intravenously) and fludrocortisone (50 μg orally), given either alone or in combination, on phenylephrine mean arterial pressure and cardiac systolic and diastolic function dose-response relationships in 12 healthy male volunteers with hypo-aldosteronism induced by intravenous sodium loading. METHODS This was a placebo-controlled, randomized, double-blind, crossover study performed according to a 2 × 2 factorial design. Subjects received first a 2000 ml infusion of NaCl 0.9% during 2 h. Then fludrocortisone 50 μg (or its placebo) was administered orally and hydrocortisone 50 mg (or its placebo) was injected intravenously. At 1.5 h after treatment administration, incremental doses of phenylephrine were infused (from 0.01 to 3 μg kg(-1) min(-1)), each dose being infused during 5 min. RESULTS Both fludrocortisone (P < 0.001) and hydrocortisone (P = 0.002) induced a significant decrease in pressor response to phenylephrine, their effects being additive (fludrocortisone × hydrocortisone interaction, P = 0.792). The two drugs did not induce any detectable cardiac effect. CONCLUSIONS Single administrations of fludrocortisone and hydrocortisone decreased the pressor response to phenylephrine in healthy volunteers with hypo-aldosteronism. These similar effects of hydrocortisone and fludrocortisone probably express a rapid non-genomic vasodilating effect of the two steroids in the context of acute volume loading.
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Affiliation(s)
- Bruno Laviolle
- Inserm, CIC-P 0203 Clinical Investigation Centre, Rennes, France
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Seguin P, Roquilly A, Mimoz O, Le Maguet P, Asehnoune K, Biederman S, Carise E, Malledant Y. Risk factors and outcomes for prolonged versus brief fever: a prospective cohort study. Crit Care 2012; 16:R150. [PMID: 22889136 PMCID: PMC3580739 DOI: 10.1186/cc11465] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 08/13/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Prolonged fever occurs with infectious and noninfectious diseases but is poorly studied in intensive care units. The aims of this prospective multicenter noninterventional study were to determine the incidence and etiologies of prolonged fever in critically ill patients and to compare outcomes for prolonged fever and short-lasting fever. METHODS The study involved two periods of 2 months each, with 507 patients hospitalized ≥ 24 hours. Fever was defined by at least one episode of temperature ≥ 38.3 °C, and prolonged fever, as lasting > 5 days. Backward stepwise logistic regression was performed to identify the independent factors associated with prolonged fever versus short-lasting fever. RESULTS Prolonged or short-lasting fever occurred in 87 (17%) and 278 (55%) patients, respectively. Infectious and noninfectious causes were found in 54 (62%) and 27 (31%) of 87 patients, respectively; in six patients (7%), prolonged fever remained unexplained. The two most common sites of infection were ventilator-associated pneumonia (n = 25) and intraabdominal infection (n = 13). Noninfectious fever (n = 27) was neurogenic in 19 (70%) patients and mainly associated with cerebral injury (84%). Independent risk factors for prolonged fever were cerebral injury at admission (OR = 5.03; 95% CI, 2.51 to 10.06), severe sepsis (OR = 2.79; 95% CI, 1.35 to 5.79), number of infections (OR = 2.35; 95% CI, 1.43 to 3.86), and mechanical-ventilation duration (OR = 1.05; 95% CI, 1.01 to 1.09). Older patients were less likely to develop prolonged fever. ICU mortality did not differ between the two groups. CONCLUSIONS Prolonged fever was common, mainly due to severe infections, particularly ventilator-associated pneumonia, and mixed infectious causes were frequent, warranting systematic and careful search for multiple causes. Neurogenic fever was also especially frequent.
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