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Raymond M, Martin M, Lamouche-Wilquin P, Blonz G, Decamps P, Agbakou M, Desmedt L, Reignier J, Lascarrou JB, Canet E. Clinical features and outcome of influenza pneumonia in critically-ill immunocompromised patients. Medicine (Baltimore) 2022; 101:e32245. [PMID: 36626482 PMCID: PMC9750560 DOI: 10.1097/md.0000000000032245] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Immunocompromised subjects are at risk of severe viral infections which may require intensive care unit (ICU) admission. Data on the outcome of influenza pneumonia in critically-ill immunocompromised subjects are limited. We conducted a single-center observational study. All subjects admitted to the ICU for influenza pneumonia between 2016 and 2020 were included. The main objective was to compare the clinical features and outcome of critically-ill subjects with flu according to their immune status. 137 subjects (age 60 years-old, 58.4% male) were included, of whom 58 (42.34%) were intubated during the ICU stay. Forty-three (31.4%) subjects were immunocompromised. Immunocompromised subjects had a higher Charlson comorbidity index. In contrast, severity scores and hypoxemia at ICU admission, and ventilatory support during ICU stay were similar between the 2 groups. There was no difference in the rate of co-infections and ventilator-associated pneumonia between the 2 groups. Among intubated subjects, 10 (23.26%) immunocompromised subjects developed severe acute respiratory distress syndrome compared to 13 (13.83%) non-immunocompromised (P = .218). ICU mortality was 13.97%, with mortality being 3-times higher in immunocompromised subjects (25.58% vs 8.6%, P = .015). On multivariable analysis, immunocompromised status, higher age and lower arterial oxygen partial pressure/fraction of inspired oxygen were associated with an increased ICU mortality. Immunocompromised subjects with severe influenza pneumonia were more likely to develop severe acute respiratory distress syndrome and had a 3-fold increase in ICU mortality compared to non-immunocompromised subjects. Such difference was not explained by an increased rate of co-infections or nosocomial pneumonia, suggesting that influenza virus was by itself responsible of a more severe form of pulmonary disease in immunocompromised subjects.
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Affiliation(s)
- Matthieu Raymond
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes Université, Jean Monnet, France
| | - Maëlle Martin
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes Université, Jean Monnet, France
| | - Pauline Lamouche-Wilquin
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes Université, Jean Monnet, France
| | - Gauthier Blonz
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes Université, Jean Monnet, France
| | - Paul Decamps
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes Université, Jean Monnet, France
| | - Maïté Agbakou
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes Université, Jean Monnet, France
| | - Luc Desmedt
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes Université, Jean Monnet, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes Université, Jean Monnet, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes Université, Jean Monnet, France
| | - Emmanuel Canet
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes Université, Jean Monnet, France
- * Correspondence: Emmanuel Canet, Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet 44093 Nantes Cedex 1, France (e-mail: )
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Le Calvez B, Eveillard M, Decamps P, Aguilar J, Seguin A, Canet E, Grain A, Touzeau C, Tessoulin B, Gastinne T. Extensive myelitis with eosinophilic meningitis after Chimeric antigen receptor T cells therapy. eJHaem 2022; 3:533-536. [PMID: 35846023 PMCID: PMC9175988 DOI: 10.1002/jha2.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
Immune effector cell‐associated neurotoxicity syndrome (ICANS) is a frequent adverse event after Chimeric antigen receptor T cells (CAR‐T cells). A patient treated with anti‐CD19 CAR‐T cells for a refractory mantle cell lymphoma presented at Day 8 post‐infusion with extensive myelitis. Unusual eosinophilia was disclosed in the patient's cerebrospinal fluid. After treatment with methylprednisolone and siltuximab, a decrease in clinical symptoms and magnetic resonance imaging lesions were obtained. This unprecedented presentation of eosinophilic meningitis after CAR‐T cells therapy highlights the need for a better understanding of the physiopathology of ICANS, especially to identify potentially targetable pathways.
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Affiliation(s)
- Baptiste Le Calvez
- Department of Hematology Nantes University hospital Nantes France
- Pediatric Oncology Nantes University Hospital Nantes France
| | - Marion Eveillard
- Nantes Université, INSERM, CNRS, Université d'Angers, CRCI2NA Nantes France
- Hematology Biology Nantes University Hospital Nantes France
| | - Paul Decamps
- Intensive Care Unit Nantes University Hospital Nantes France
| | - Jesus Aguilar
- Medical Imaging Unit Nantes University Hospital Nantes France
| | - Amélie Seguin
- Intensive Care Unit Nantes University Hospital Nantes France
| | - Emmanuel Canet
- Intensive Care Unit Nantes University Hospital Nantes France
| | - Audrey Grain
- Nantes Université, INSERM, CNRS, Université d'Angers, CRCI2NA Nantes France
- Pediatric Oncology Nantes University Hospital Nantes France
| | - Cyrille Touzeau
- Department of Hematology Nantes University hospital Nantes France
- Nantes Université, INSERM, CNRS, Université d'Angers, CRCI2NA Nantes France
- Site de Recherche Intégrée sur le Cancer, ILIAD INCA‐DGOS‐Inserm U12558 Nantes France
| | - Benoît Tessoulin
- Department of Hematology Nantes University hospital Nantes France
- Nantes Université, INSERM, CNRS, Université d'Angers, CRCI2NA Nantes France
- Site de Recherche Intégrée sur le Cancer, ILIAD INCA‐DGOS‐Inserm U12558 Nantes France
| | - Thomas Gastinne
- Department of Hematology Nantes University hospital Nantes France
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Decamps P, Grillot N, Le Thuaut A, Brule N, Lejus-Bourdeau C, Reignier J, Lascarrou JB. Comparison of four channelled videolaryngoscopes to Macintosh laryngoscope for simulated intubation of critically ill patients: the randomized MACMAN2 trial. Ann Intensive Care 2021; 11:126. [PMID: 34398347 PMCID: PMC8368860 DOI: 10.1186/s13613-021-00916-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/04/2021] [Indexed: 12/26/2022] Open
Abstract
Background Videolaryngoscopes with an operating channel may improve the intubation success rate in critically ill patients. We aimed to compare four channelled videolaryngoscopes to the Macintosh laryngoscope used for intubation of a high-fidelity simulation mannikin, in a scenario that simulated critical illness due to acute respiratory failure. Results Of the 79 residents who participated, 54 were considered inexperienced with orotracheal intubation. Each participant used all five devices in random order. The first-pass success rate was 97.5% [95% CI 91.1–99.7] for Airtraq™, KingVision™, and Pentax AWS200™, 92.4% [95% CI 84.2–97.2] for VividTrac VT-A100™, and 70.9% [95% CI 59.6–80.6] for direct Macintosh laryngoscopy. The first-pass success rate was significantly lower with direct Macintosh laryngoscopy than with the videolaryngoscopes (p < 0.0001 for Airtraq™, KingVision™, Pentax AWS200™, and VividTrac VT-A100™). Conclusion The Airtraq™, KingVision™, and Pentax AWS200™ channelled videolaryngoscopes produced high first-pass success rates with a lower boundary of the 95% CI above 90%. A multicentre, randomised controlled clinical study comparing channelled videolaryngoscopy to direct laryngoscopy should include one of these three videolaryngoscopes. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00916-3.
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Affiliation(s)
- Paul Decamps
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Nicolas Grillot
- Service d'Anesthésie Réanimation Chirurgicale, Université de Nantes, CHU Nantes, Pôle Anesthésie-Réanimation, Hôtel Dieu, 44093, Nantes, France.,Laboratoire Expérimental de Simulation de Médecine Intensive de L'Université (LE SiMU) de Nantes, 9 rue Bias, 44001, Nantes, France
| | - Aurelie Le Thuaut
- Plateforme de Méthodologie Et Biostatistique, Direction de La Recherche de L'Innovation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Noelle Brule
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Corinne Lejus-Bourdeau
- Service d'Anesthésie Réanimation Chirurgicale, Université de Nantes, CHU Nantes, Pôle Anesthésie-Réanimation, Hôtel Dieu, 44093, Nantes, France.,Laboratoire Expérimental de Simulation de Médecine Intensive de L'Université (LE SiMU) de Nantes, 9 rue Bias, 44001, Nantes, France
| | - Jean Reignier
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean-Baptiste Lascarrou
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France. .,Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.
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Martin M, Decamps P, Seguin A, Garret C, Crosby L, Zambon O, Miailhe AF, Canet E, Reignier J, Lascarrou JB. Nationwide survey on training and device utilization during tracheal intubation in French intensive care units. Ann Intensive Care 2020; 10:2. [PMID: 31900637 PMCID: PMC6942097 DOI: 10.1186/s13613-019-0621-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/23/2019] [Indexed: 11/29/2022] Open
Abstract
Background Intubation is a lifesaving procedure that is often performed in intensive care unit (ICU) patients, but leads to serious adverse events in 20–40% of cases. Recent trials aimed to provide guidance about which medications, devices, and modalities maximize patient safety. Videolaryngoscopes are being offered in an increasing range of options and used in broadening indications (from difficult to unremarkable intubation). The objective of this study was to describe intubation practices and device availability in French ICUs. Materials and methods We conducted an online nationwide survey by emailing an anonymous 26-item questionnaire to physicians in French ICUs. A single questionnaire was sent to either the head or the intubation expert at each ICU. Results Of 257 ICUs, 180 (70%) returned the completed questionnaire. The results showed that 43% of intubators were not fully proficient in intubation; among them, 18.8% had no intubation training or had received only basic training (lectures and observation at the bedside). Among the participating ICUs, 94.4% had a difficult intubation trolley, 74.5% an intubation protocol, 92.2% a capnography device (used routinely to check tube position in 69.3% of ICUs having the device), 91.6% a laryngeal mask, 97.2% front-of-neck access capabilities, and 76.6% a videolaryngoscope. In case of difficult intubation, 85.6% of ICUs used a bougie (154/180) and 7.8% switched to a videolaryngoscope (14/180). Use of a videolaryngoscope was reserved for difficult intubation in 84% of ICUs (154/180). Having a videolaryngoscope was significantly associated with having an intubation protocol (P = 0.043) and using capnography (P = 0.02). Airtraq® was the most often used videolaryngoscope (39.3%), followed by McGrath®Mac (36.9%) then by Glidescope® (14.5%). Conclusion Nearly half the intubators in French ICUs are not fully proficient with OTI. Access to modern training methods such as simulation is inadequate. Most ICUs own a videolaryngoscope, but reserve it for difficult intubations.
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Affiliation(s)
- M Martin
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - P Decamps
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - A Seguin
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - C Garret
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - L Crosby
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - O Zambon
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - A F Miailhe
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - E Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - J Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - J B Lascarrou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France.
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