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Laghlam D, Benghanem S, Ortuno S, Bouabdallaoui N, Manzo-Silberman S, Hamzaoui O, Aissaoui N. Management of cardiogenic shock: a narrative review. Ann Intensive Care 2024; 14:45. [PMID: 38553663 PMCID: PMC10980676 DOI: 10.1186/s13613-024-01260-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/06/2024] [Indexed: 04/02/2024] Open
Abstract
Cardiogenic shock (CS) is characterized by low cardiac output and sustained tissue hypoperfusion that may result in end-organ dysfunction and death. CS is associated with high short-term mortality, and its management remains challenging despite recent advances in therapeutic options. Timely diagnosis and multidisciplinary team-based management have demonstrated favourable effects on outcomes. We aimed to review evidence-based practices for managing patients with ischemic and non-ischemic CS, detailing the multi-organ supports needed in this critically ill patient population.
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Affiliation(s)
- Driss Laghlam
- Research & Innovation Department, RIGHAPH, Service de Réanimation polyvalente, CMC Ambroise Paré-Hartmann, 48 Ter boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France.
| | - Sarah Benghanem
- Service de médecine intensive-réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre & Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- AfterROSC, Paris, France
| | - Sofia Ortuno
- Service Médecine intensive-réanimation, Hopital Européen Georges Pompidou, Paris, France
- Université Sorbonne, Paris, France
| | - Nadia Bouabdallaoui
- Institut de cardiologie de Montreal, Université de Montreal, Montreal, Canada
| | - Stephane Manzo-Silberman
- Université Sorbonne, Paris, France
- Sorbonne University, Institute of Cardiology- Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group, Paris, France
| | - Olfa Hamzaoui
- Service de médecine intensive-réanimation polyvalente, Hôpital Robert Debré, CHU de Reims, Reims, France
- Unité HERVI "Hémostase et Remodelage Vasculaire Post-Ischémie" - EA 3801, Reims, France
| | - Nadia Aissaoui
- Service de médecine intensive-réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre & Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- AfterROSC, Paris, France
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Tridon C, Bachelet D, El Baied M, Eloy P, Ortuno S, Para M, Wicky PH, Vellieux G, de Montmollin E, Bouadma L, Manceau H, Timsit JF, Peoc'h K, Sonneville R. Association of Sepsis With Neurologic Outcomes of Adult Patients Treated With Venoarterial Extracorporeal Membrane Oxygnenation. Crit Care Explor 2024; 6:e1042. [PMID: 38333077 PMCID: PMC10852385 DOI: 10.1097/cce.0000000000001042] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES Neurologic outcomes of patients under venoarterial extracorporeal membrane oxygenation (VA-ECMO) may be worsened by secondary insults of systemic origin. We aimed to assess whether sepsis, commonly observed during ECMO support, is associated with brain injury and outcomes. DESIGN Single-center cohort study of the "exposed-non-exposed" type on consecutive adult patients treated by VA-ECMO. SETTING Medical ICU of a university hospital, France, 2013-2020. PATIENTS Patients with sepsis at the time of VA-ECMO cannulation ("sepsis" group) were compared with patients without sepsis ("no sepsis" group). The primary outcome measure was poor functional outcome at 90 days, defined by a score greater than or equal to 4 on the modified Rankin scale (mRS), indicating severe disability or death. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 196 patients were included ("sepsis," n = 128; "no sepsis," n = 68), of whom 87 (44.4%) had presented cardiac arrest before VA-ECMO cannulation. A poor functional outcome (mRS ≥ 4) was observed in 99 of 128 patients (77.3%) of the "sepsis" group and 46 of 68 patients (67.6%) of the "no sepsis" group (adjusted logistic regression odds ratio (OR) 1.21, 95% CI, 0.58-2.47; inverse probability of treatment weighting (IPTW) OR 1.24; 95% CI, 0.79-1.95). Subsequent analyses performed according to pre-ECMO cardiac arrest status suggested that sepsis was independently associated with poorer functional outcomes in the subgroup of patients who had experienced pre-ECMO cardiac arrest (adjusted logistic regression OR 3.44; 95% CI, 1.06-11.40; IPTW OR 3.52; 95% CI, 1.68-7.73), whereas no such association was observed in patients without pre-ECMO cardiac arrest (adjusted logistic regression OR 0.69; 95% CI, 0.27-1.69; IPTW OR 0.76; 95% CI, 0.42-1.35). Compared with the "no sepsis" group, "sepsis" patients presented a significant increase in S100 calcium-binding protein beta concentrations at day 1 (0.94 μg/L vs. 0.52 μg/L, p = 0.03), and more frequent EEG alterations (i.e., severe slowing, discontinuous background, and a lower prevalence of sleep patterns), suggesting brain injury. CONCLUSION We observed a detrimental role of sepsis on neurologic outcomes in the subgroup of patients who had experienced pre-ECMO cardiac arrest, but not in other patients.
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Affiliation(s)
- Chloé Tridon
- Médecine intensive-réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Delphine Bachelet
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, DMU DREAM, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Majda El Baied
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, DMU DREAM, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Philippine Eloy
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, DMU DREAM, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Sofia Ortuno
- Médecine intensive-réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Marylou Para
- Service de Chirurgie Cardiaque, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France. Université de Paris Cité, INSERM U1148, Paris, France
| | - Paul-Henri Wicky
- Médecine intensive-réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Geoffroy Vellieux
- Neurophysiologie clinique, service de Physiologie-Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Etienne de Montmollin
- Médecine intensive-réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, IAME, INSERM, UMR1137, Paris, France
| | - Lila Bouadma
- Médecine intensive-réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, IAME, INSERM, UMR1137, Paris, France
| | - Hana Manceau
- Université de Paris, IAME, INSERM, UMR1137, Paris, France
- Biochimie, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Jean-François Timsit
- Médecine intensive-réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, IAME, INSERM, UMR1137, Paris, France
| | - Katell Peoc'h
- Université de Paris, IAME, INSERM, UMR1137, Paris, France
- Biochimie, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Romain Sonneville
- Médecine intensive-réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, IAME, INSERM, UMR1137, Paris, France
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Marquet Y, Hékimian G, Lebreton G, Kerneis M, Rouvier P, Bay P, Mathian A, Bréchot N, Chommeloux J, Petit M, Gautier M, Lefevre L, Saura O, Levy D, Quentric P, Moyon Q, Ortuno S, Schmidt M, Leprince P, Luyt CE, Combes A, Pineton de Chambrun M. Diagnostic yield, safety and therapeutic consequences of myocardial biopsy in clinically suspected fulminant myocarditis unweanable from mechanical circulatory support. Ann Intensive Care 2023; 13:78. [PMID: 37653258 PMCID: PMC10471530 DOI: 10.1186/s13613-023-01169-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/11/2023] [Accepted: 08/03/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Fulminant myocarditis is a rare and severe disease whose definite and etiological diagnoses rely on pathological examination. Albeit, myocardial biopsy can be associated with significant morbidity and mortality, its therapeutic consequences are unclear. We conducted a study to determine the diagnostic yield, the safety and the therapeutic consequences of myocardial biopsy in patients with fulminant clinically suspected myocarditis unweanable from mechanical circulatory support (MCS). METHODS Monocenter, retrospective, observational cohort study in a 26-bed French tertiary ICU between January 2002 and February 2019. Inclusion of all fulminant clinically suspected myocarditis patients undergoing in-ICU myocardial biopsy while being on MCS. The primary endpoint was the proportion of patients classified as definite myocarditis using Bonaca criteria before and after including myocardial biopsy results. RESULTS Forty-seven patients (median age 41 [30-47], female 53%) were included: 55% died before hospital discharge, 34% could be bridged-to-recovery and 15% bridged-to-transplant. Myocardial biopsy was endomyocardial or surgical in 36% and 64% cases respectively. Tamponade requiring emergency pericardiocentesis occurred in 29% patients after endomyocardial biopsy. After adding the biopsy results in the Bonaca classification algorithm the percentage of definite myocarditis raised from 13 to 55% (p < 0.0001). The rate of biopsy-related treatments modifications was 13%, leading to patients' recovery in only 4% patients. CONCLUSIONS In clinically suspected myocarditis unweanable from MCS, myocardial biopsy increased the rate of definite myocarditis but was associated with a low rate of treatment modification and a significant proportion of adverse events. We believe the benefit/risk ratio of myocardial biopsy should be more carefully weighted in these frail and selected patients than suggested by actual guidelines. Further prospective studies are now needed to determine its value in patients under MCS.
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Affiliation(s)
- Yann Marquet
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Guillaume Hékimian
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Guillaume Lebreton
- Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
- Service de Chirurgie Cardio-Thoracique, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Mathieu Kerneis
- Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
- ACTION Study Group, Département de Cardiologie, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Paris, France
| | - Philippe Rouvier
- Service d'Anatomopathologie, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Paris, France
| | - Pierre Bay
- AP-HP, Hôpitaux Universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation and UPEC (Université Paris Est), INSERM, Unité U955, Équipe 18, 94010, Créteil, France
| | - Alexis Mathian
- Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Paris, France
| | - Nicolas Bréchot
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Juliette Chommeloux
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Matthieu Petit
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Melchior Gautier
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Lucie Lefevre
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Ouriel Saura
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - David Levy
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Paul Quentric
- Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Paris, France
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Quentin Moyon
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
- Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Paris, France
| | - Sofia Ortuno
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
| | - Matthieu Schmidt
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
- Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Pascal Leprince
- Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
- Service de Chirurgie Cardio-Thoracique, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
- Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Alain Combes
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France
- Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex, France.
- Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France.
- Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Paris, France.
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France.
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Ortuno S, Geri G, Bouguoin W, Cariou A, Aissaoui N. Myocardial dysfunction after cardiac arrest: tips and pitfalls. Eur J Emerg Med 2022; 29:188-194. [PMID: 35135980 DOI: 10.1097/mej.0000000000000904] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Postcardiac arrest shock (PCAS) is defined by hemodynamic instability occurring in the first hours after cardiac arrest (CA) and is a major cause of mortality among patients hospitalized after CA. It includes vasoplegia and myocardial dysfunction. This postcardiac arrest myocardial dysfunction is supposed to recover within the 3 days. However, there are many unknowns regarding its definition, its prognosis value and its management. In this review dedicated to emergency physicians, we choose to address tips and pitfalls they should know regarding this prevalent syndrome.
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Affiliation(s)
- Sofia Ortuno
- Assistance Publique des Hôpitaux de Paris (APHP) Cochin, Intensive Care Medicine
- Université de Paris, Paris
| | - Guillaume Geri
- Department of Cardiology and Critical Care, Clinique Ambroise Paré, Neuilly-sur-Seine
- After-ROSC Network, Paris
| | - Wulfran Bouguoin
- After-ROSC Network, Paris
- Service de Médecine Intensive Réanimation, Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy
- INSERM U970
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital
- Paris Sudden-Death-Expertise-Centre, Paris, France
| | - Alain Cariou
- Assistance Publique des Hôpitaux de Paris (APHP) Cochin, Intensive Care Medicine
- Université de Paris, Paris
- After-ROSC Network, Paris
- INSERM U970
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital
- Paris Sudden-Death-Expertise-Centre, Paris, France
| | - Nadia Aissaoui
- Assistance Publique des Hôpitaux de Paris (APHP) Cochin, Intensive Care Medicine
- Université de Paris, Paris
- After-ROSC Network, Paris
- INSERM U970
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital
- Paris Sudden-Death-Expertise-Centre, Paris, France
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Bailleul C, Puymirat E, Aegerter P, Guidet B, Guerot E, Augy JL, Brechot N, Diehl JL, Fagon JY, Hermann B, Novara A, Ortuno S, Younan R, Danchin N, Cariou A, Aissaoui N. In-hospital cardiac arrests admitted alive in intensive care units: Insights from the CubRéa database. J Crit Care 2022; 69:154003. [DOI: 10.1016/j.jcrc.2022.154003] [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] [Received: 10/30/2021] [Revised: 01/21/2022] [Accepted: 01/30/2022] [Indexed: 11/26/2022]
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Ruault C, Zappella N, Labreuche J, Cronier P, Claude B, Garnier M, Vieillard-Baron A, Ortuno S, Mallet M, Cosic O, Crosby L, Lesieur O, Pichon N, Galbois A, Bruel C, Ekpe K, Sauneuf B, Roux D, Legriel S. Identifying early indicators of secondary peritonitis in critically ill patients with cirrhosis. Sci Rep 2021; 11:21076. [PMID: 34702902 PMCID: PMC8548403 DOI: 10.1038/s41598-021-00629-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/08/2021] [Indexed: 11/09/2022] Open
Abstract
Ascitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identify early indicators of secondary peritonitis (SP), which requires emergency surgery, and to describe the outcomes of SP and spontaneous bacterial/fungal peritonitis (SBFP). Adults with cirrhosis and AFI admitted to 16 university or university-affiliated ICUs in France between 2002 and 2017 were studied retrospectively. Cases were identified by searching the hospital databases for relevant ICD-10 codes and hospital charts for AFI. Logistic multivariate regression was performed to identify factors associated with SP. Secondary outcomes were short- and long-term mortality and survivors' functional outcomes. Of 178 included patients (137 men and 41 women; mean age, 58 ± 11 years), 21 (11.8%) had SP, confirmed by surgery in 16 cases and by abdominal computed tomography in 5 cases. Time to diagnosis exceeded 24 h in 7/21 patients with SP. By multivariate analysis, factors independently associated with SP were ascitic leukocyte count > 10,000/mm3 (OR 3.70; 95%CI 1.38-9.85; P = 0.009) and absence of laboratory signs of decompensated cirrhosis (OR 4.53; 95%CI 1.30-15.68; P = 0.017). The 1-year mortality rates in patients with SBFP and SP were 81.0% and 77.5%, respectively (Log-rank test, P = 0.92). Patients with SP vs. SBFP had no differences in 1-year functional outcomes. This multicenter retrospective study identified two indicators of SP as opposed to SBFP in patients with cirrhosis. Using these indicators may help to provide early surgical treatment.
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Affiliation(s)
- Carole Ruault
- Medical-Surgical Intensive Care Unit, Versailles Hospital, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Nathalie Zappella
- Anesthesiology and Critical Care Medicine Departement, DMU PARABOL, Bichat-Claude Bernard Hospital, HUPNVS, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Julien Labreuche
- Centre Hospitalier Régional et Universitaire de Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, 59000, Lille, France
| | - Pierrick Cronier
- Intensive Care Unit, Sud-Francilien Hospital Center, 91100, Corbeil-Essonnes, France
| | - Baptiste Claude
- Department of Intensive Care, University Hospital François Mitterrand, 21000, Dijon, France
| | - Marc Garnier
- Department of Anesthesiology and Critical Care Medicine, Sorbonne University, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Tenon University Hospital, 75020, Paris, France
| | - Antoine Vieillard-Baron
- Medical-Surgical Intensive Care Unit, Ambroise Paré University Hospital, APHP, 92100, Boulogne-Billancourt, France
| | - Sofia Ortuno
- Medical Intensive Care Unit, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France
| | - Maxime Mallet
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), 75013, Paris, France
| | - Olga Cosic
- Medical-Surgical Intensive Care Unit, Hôpital Nord Franche-Comté, 90400, Trevenans, France
| | - Laura Crosby
- Intensive Care Unit, University Hospital of Pointe-à-Pitre, 97159, Pointe-à-Pitre, Guadeloupe, France.,Intensive Care Unit, Centre Hospitalier de Valence, 179 Boulevard Maréchal Juin, 26000, Valence, France
| | - Olivier Lesieur
- Intensive Care Unit, Groupement Hospitalier La Rochelle Ré Aunis, 17000, La Rochelle, France
| | - Nicolas Pichon
- Medical-Surgical Intensive Care Unit, Limoges University Hospital, 87000, Limoges, France
| | - Arnaud Galbois
- Ramsay-Générale de Santé, Hôpital Privé Claude Galien, Service de Réanimation Polyvalente, 91480, Quincy-sous-Sénart, France
| | - Cedric Bruel
- Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, 75014, Paris, France
| | - Kenneth Ekpe
- Medical Intensive Care Unit, Saint Louis Teaching Hospital, Assistance Publique Hôpitaux de Paris, 75010, Paris, France
| | - Bertrand Sauneuf
- General Intensive Care Unit, Cotentin Public Hospital Center, 50100, Cherbourg-en-Cotentin, France
| | - Damien Roux
- Department of Intensive Care, Louis Mourier University Hospital, Assistance Publique-Hôpitaux de Paris, 92700, Colombes, France
| | - Stephane Legriel
- Medical-Surgical Intensive Care Unit, Versailles Hospital, 177 rue de Versailles, 78150, Le Chesnay Cedex, France. .,Université Paris-Saclay, UVSQ, CESP, Team DevPsy, 94807, Villejuif, Inserm, France.
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Sarfati S, Szychowiak P, Flajoliet N, Pepin Lehalleur A, Ortuno S, Devautour C, Pierre A, Giry M. Recommandations pour la mise en place de la phase de consolidation en Médecine Intensive Réanimation. Méd Intensive Réa 2021. [DOI: 10.37051/mir-00085] [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: 11/27/2022]
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Nguyen LS, Ortuno S, Lebrun-Vignes B, Johnson DB, Moslehi JJ, Hertig A, Salem JE. Transplant rejections associated with immune checkpoint inhibitors: A pharmacovigilance study and systematic literature review. Eur J Cancer 2021; 148:36-47. [DOI: 10.1016/j.ejca.2021.01.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/25/2020] [Accepted: 01/29/2021] [Indexed: 12/20/2022]
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9
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Ortuno S, Jozwiak M, Mira JP, Nguyen LS. Case Report: Takotsubo Syndrome Associated With Novel Coronavirus Disease 2019. Front Cardiovasc Med 2021; 8:614562. [PMID: 33693034 PMCID: PMC7937625 DOI: 10.3389/fcvm.2021.614562] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/19/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Takotsubo cardiomyopathy is triggered by emotional or physical stress. It is defined as a reversible myocardial dysfunction, usually with apical ballooning aspect due to apical akinesia associated with hyperkinetic basal left ventricular contraction. Described in cases of viral infections such as influenza, only few have been reported associated with novel coronavirus disease 2019 (COVID-19) in the recent pandemic. Case summary: A 79-years-old man, with cardiovascular risk factors (type 2 diabetes and hypertension) and chronic kidney disease, presented to the emergency room for severe dyspnea after 8 days of presenting respiratory symptoms and fever. Baseline electrocardiogram (ECG) was normal, but he presented marked inflammatory syndrome. He was transferred to an intensive care unit to receive mechanical ventilation within 6 h, due to acute respiratory distress syndrome. He presented circulatory failure 2 days after, requiring norepinephrine support (up to up to 1.04 μg/kg/min). Troponin T was elevated (637 ng/l). ECG showed diffuse T wave inversion. Echocardiography showed reduced left ventricular ejection fraction (LVEF 40%), with visual signs of Takotsubo cardiomyopathy. Cardiac failure resolved after 24 h with troponin T decrease (433 ng/l) and restoration of cardiac function (LVEF 60% with regression of Takotsubo features). Patient died after 15 days of ICU admission, due to septic shock from ventilator-acquired pneumonia. Cardiac function was then normal. Conclusion: Mechanisms of Takotsubo cardiomyopathy in viral infections include catecholamine-induced myocardial toxicity and inflammation related to sepsis. Differential diagnoses include myocarditis and myocardial infarction. Evidence of the benefit of immunomodulatory drugs and dexamethasone are growing to support this hypothesis in COVID-19.
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Affiliation(s)
- Sofia Ortuno
- Assistance Publique - Hôpitaux de Paris, Centre Cochin University Hospital, Intensive Care Medicine Department, Paris, France
| | - Mathieu Jozwiak
- Assistance Publique - Hôpitaux de Paris, Centre Cochin University Hospital, Intensive Care Medicine Department, Paris, France
| | - Jean-Paul Mira
- Assistance Publique - Hôpitaux de Paris, Centre Cochin University Hospital, Intensive Care Medicine Department, Paris, France
| | - Lee S Nguyen
- Assistance Publique - Hôpitaux de Paris, Centre Cochin University Hospital, Intensive Care Medicine Department, Paris, France.,Centre Médico-Chirurgical Ambroise Paré, Research and Innovation, Research and Innovation of CMC Ambroise Paré, Neuilly-sur-Seine, France
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10
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Aissaoui N, Puymirat E, Delmas C, Ortuno S, Durand E, Bataille V, Drouet E, Bonello L, Bonnefoy‐Cudraz E, Lesmeles G, Guerot E, Schiele F, Simon T, Danchin N. Trends in cardiogenic shock complicating acute myocardial infarction. Eur J Heart Fail 2020; 22:664-672. [DOI: 10.1002/ejhf.1750] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/18/2019] [Accepted: 12/28/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nadia Aissaoui
- Department of Critical Care, Assistance Publique‐Hôpitaux de Paris (APHP) Hôpital Européen Georges Pompidou (HEGP) Paris France
- Faculty of Medicine University Paris Descartes Paris France
- INSERM U970, Paris Cardiovascular Research Center PARCC Paris France
| | - Etienne Puymirat
- Faculty of Medicine University Paris Descartes Paris France
- Department of Cardiology Assistance Publique‐Hôpitaux de Paris, Hôpital Européen Georges Pompidou Paris France
| | - Clément Delmas
- Intensive Cardiac Care Unit, CHU Rangueil Toulouse France
| | - Sofia Ortuno
- Department of Critical Care, Assistance Publique‐Hôpitaux de Paris (APHP) Hôpital Européen Georges Pompidou (HEGP) Paris France
- Faculty of Medicine University Paris Descartes Paris France
| | - Eric Durand
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST‐CRB‐CRC) APHP‐Sorbonne Université, Hôpital St Antoine Paris France
- Hôpital Charles Nicolle Rouen France
| | | | - Elodie Drouet
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST‐CRB‐CRC) APHP‐Sorbonne Université, Hôpital St Antoine Paris France
- Hôpital Charles Nicolle Rouen France
| | | | | | | | - Emmanuel Guerot
- Department of Critical Care, Assistance Publique‐Hôpitaux de Paris (APHP) Hôpital Européen Georges Pompidou (HEGP) Paris France
- Faculty of Medicine University Paris Descartes Paris France
| | | | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST‐CRB‐CRC) APHP‐Sorbonne Université, Hôpital St Antoine Paris France
- Unité INSERM U‐1148 Paris France
- FACT (French Alliance for Cardiovascular Trials), An F‐CRIN Network Paris France
- Sorbonne‐Université, UPMC Paris France
| | - Nicolas Danchin
- Faculty of Medicine University Paris Descartes Paris France
- Department of Cardiology Assistance Publique‐Hôpitaux de Paris, Hôpital Européen Georges Pompidou Paris France
- FACT (French Alliance for Cardiovascular Trials), An F‐CRIN Network Paris France
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11
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Nael J, Ruggiu M, Bailleul C, Ortuno S, Diehl JL, Vimpère D, Augy JL, Guerot E, Danchin N, Puymirat E, Aissaoui N. Impact of hyperoxia on patients hospitalized in an intensive care unit for acute heart failure. Arch Cardiovasc Dis 2019; 112:748-753. [PMID: 31690520 DOI: 10.1016/j.acvd.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/23/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Oxygen therapy remains a cornerstone of treatment for acute heart failure in patients with pulmonary congestion. While avoiding hypoxaemia has long been a goal of critical care practitioners, less attention has been paid to the potential hazard related to excessive hyperoxia. AIM To evaluate the impact of early hyperoxia exposure among critically ill patients hospitalized in an intensive care unit for acute heart failure. METHODS In this preliminary study conducted in a Parisian intensive care unit, we assessed patients with acute heart failure admitted with pulmonary congestion and treated with oxygen therapy from 1 January 2015 to 31 December 2016. The hyperoxia group was defined by having at least one partial pressure of oxygen measurement>100mmHg on the first day following admission to the intensive care unit. The primary endpoint was 30-day all-cause mortality. Secondary endpoints were 30-day unplanned hospital admissions, occurrence of infections and intensive care unit and hospital lengths of stay. RESULTS Seventy-five patients were included. Forty-three patients (57.3%) presented hyperoxia, whereas 32 patients (42.7%) did not (control group). The baseline clinical characteristics did not differ between the two groups. The primary endpoint was not statistically different between the two groups (14.0% in the hyperoxia group vs 18.8% in the control group; P=0.85). The secondary endpoints were also not significantly different between the two groups. In the multivariable analysis, hyperoxia was not associated with increased 30-day mortality (odds ratio 0.77, 95% confidence interval 0.24-2.41). CONCLUSION In patients referred to an intensive care unit for acute heart failure, we did not find any difference in outcomes according to the presence of hyperoxia.
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Affiliation(s)
- Julien Nael
- Department of critical care, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Mathilde Ruggiu
- Department of critical care, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - Clotilde Bailleul
- Department of critical care, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - Sofia Ortuno
- Department of critical care, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Jean-Luc Diehl
- Department of critical care, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - Damien Vimpère
- Department of critical care, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - Jean-Loup Augy
- Department of critical care, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - Emmanuel Guerot
- Department of critical care, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Nicolas Danchin
- Department of cardiology, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Etienne Puymirat
- Université Paris Descartes, 75006 Paris, France; Department of cardiology, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Nadia Aissaoui
- Department of critical care, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France; Inserm U970, Équipe 4, 75015 Paris, France.
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12
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Gendron N, Flament H, Litvinova E, Ortuno S, Ajzenberg N, Faille D. The (Fab)ulous Destiny of Idarucizumab: Highlighting Its Interference with Urine Protein Immunofixation. TH Open 2019; 3:e306-e308. [PMID: 31535075 PMCID: PMC6746617 DOI: 10.1055/s-0039-1697642] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/05/2019] [Indexed: 10/27/2022] Open
Abstract
Idarucizumab is a humanized antigen binding fragment (Fab) of a recombinant anti-dabigatran monoclonal antibody (IgG1-kappa) that allows rapid and sustained reversal of dabigatran-induced anticoagulation in case of bleeding or urgent surgery. Herein, we report a very unusual case of dabigatran reversal by idarucizumab in a 79-year-old woman with acute kidney failure admitted to a hospital in a context of hemoptysis. Three repeated injections were necessary because of massive dabigatran overdose and high rebounds of dabigatran plasma concentration. Idarucizumab was found on urine immunofixation up to 6 days after the last injection where it reacted with anti-kappa light chain antibody, but not with anti-gamma heavy chain antibody. Physicians should be aware of the increased half-life of idarucizumab in this context of acute kidney impairment and of its interference with urine immunofixation because it could lead to false-positive results and misdiagnosis of a paraprotein.
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Affiliation(s)
- Nicolas Gendron
- Laboratoire d'Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France.,Université de Paris, INSERM, U1148, Paris, France
| | - Héloïse Flament
- Laboratoire d'Immunologie-Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France.,Université de Paris, INSERM, U1149, Paris, France
| | - Elena Litvinova
- Laboratoire d'Immunologie-Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France.,Université de Paris, INSERM, U1149, Paris, France
| | - Sofia Ortuno
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Nadine Ajzenberg
- Laboratoire d'Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France.,Université de Paris, INSERM, U1148, Paris, France
| | - Dorothée Faille
- Laboratoire d'Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France.,Université de Paris, INSERM, U1148, Paris, France
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13
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Ortuno S, Delmas C, Diehl JL, Bailleul C, Lancelot A, Naili M, Cholley B, Pirracchio R, Aissaoui N. Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use? Ann Cardiothorac Surg 2019; 8:E1-E8. [PMID: 30854330 DOI: 10.21037/acs.2018.08.05] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Refractory cardiogenic shock patients may be rescued by veno-arterial extracorporeal membrane oxygenation (VA ECMO). After a few days of mechanical assistance, the device can sometimes be successfully removed if the patient has partially or fully recovered from the condition that required the use of ECMO. The percentage of patients with refractory cardiogenic shock who are successfully weaned from ECMO varies from 31% to 76%. Weaning does not mean survival, because 20% to 65% of patients weaned from VA ECMO support do not survive to hospital discharge. The high death rate after successful weaning shows that many questions remain unresolved in this field. In this review, we will discuss the various factors influencing survival and a successful weaning from VA ECMO, in addition to weaning approaches proposed in the literature. Based on this information, we will propose a strategy to optimize the weaning process.
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Affiliation(s)
- Sofia Ortuno
- Department of Intensive Care Cnit, Hôpital Européen Georges Pompidou (HEGP) Assistance Publique-Hôpitaux de Paris (APHP) and Université Paris Descartes, Paris, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University, Toulouse, France
| | - Jean-Luc Diehl
- Department of Intensive Care Cnit, Hôpital Européen Georges Pompidou (HEGP) Assistance Publique-Hôpitaux de Paris (APHP) and Université Paris Descartes, Paris, France
| | - Clotilde Bailleul
- Department of Intensive Care Cnit, Hôpital Européen Georges Pompidou (HEGP) Assistance Publique-Hôpitaux de Paris (APHP) and Université Paris Descartes, Paris, France
| | - Aymeric Lancelot
- Department of Intensive Care Cnit, Hôpital Européen Georges Pompidou (HEGP) Assistance Publique-Hôpitaux de Paris (APHP) and Université Paris Descartes, Paris, France
| | - Mahassen Naili
- Department of Cardiology, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Bernard Cholley
- Department of Anesthesiology and Intensive Care, Paris, Hôpital Européen Georges Pompidou, APHP, Université Paris-Descartes, Paris, France
| | - Romain Pirracchio
- Department of Anesthesiology and Intensive Care, Paris, Hôpital Européen Georges Pompidou, APHP, Université Paris-Descartes, Paris, France
| | - Nadia Aissaoui
- Department of Intensive Care Cnit, Hôpital Européen Georges Pompidou (HEGP) Assistance Publique-Hôpitaux de Paris (APHP) and Université Paris Descartes, Paris, France.,Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France
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14
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Hamdan A, Ortuno S, Guerot E, Aissaoui N. L’assistance monoventriculaire gauche de longue durée : indications, management et complications. Méd Intensive Réa 2018. [DOI: 10.3166/rea-2018-0072] [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: 11/20/2022]
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15
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Ruggiu M, Aissaoui N, Nael J, Haw-Berlemont C, Herrmann B, Augy JL, Ortuno S, Vimpère D, Diehl JL, Bailleul C, Guerot E. Hyperoxia effects on intensive care unit mortality: a retrospective pragmatic cohort study. Crit Care 2018; 22:218. [PMID: 30236126 PMCID: PMC6148961 DOI: 10.1186/s13054-018-2142-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 07/30/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Mathilde Ruggiu
- Department of Intensive Care, Hôpital européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
| | - Nadia Aissaoui
- Department of Intensive Care, Hôpital européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
- Université Paris Descartes, 12 rue de l’école de Médecine, 75006 Paris, France
- INSERM U970, 20 rue Leblanc, 75015 Paris, France
| | - Julien Nael
- Department of Intensive Care, Hôpital européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
| | - Caroline Haw-Berlemont
- Department of Intensive Care, Hôpital européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
| | - Bertrand Herrmann
- Department of Intensive Care, Hôpital européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
| | - Jean-Loup Augy
- Department of Intensive Care, Hôpital européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
| | - Sofia Ortuno
- Department of Intensive Care, Hôpital européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
| | - Damien Vimpère
- Department of Intensive Care, Hôpital européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
- Université Paris Descartes, 12 rue de l’école de Médecine, 75006 Paris, France
| | - Jean-Luc Diehl
- Department of Intensive Care, Hôpital européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
- Université Paris Descartes, 12 rue de l’école de Médecine, 75006 Paris, France
| | - Clotilde Bailleul
- Department of Intensive Care, Hôpital européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
- Université Paris Descartes, 12 rue de l’école de Médecine, 75006 Paris, France
| | - Emmanuel Guerot
- Department of Intensive Care, Hôpital européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
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16
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Aissaoui N, Jouan J, Gourjault M, Diebold B, Ortuno S, Hamdan A, Latremouille C, Pirracchio R, Morshuis M. Understanding Left Ventricular Assist Devices. Blood Purif 2018; 46:292-300. [PMID: 30048974 DOI: 10.1159/000491872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Long-term mechanical assist devices are now commonly used in the treatment of severe heart failure to unload the failing ventricle, maintain sufficient end-organ perfusion and improve functional capacity. Depending on the assisted ventricles, 3 categories of long-term assist devices are available: left ventricular assist device (LVAD), biventricular assist device and total artificial heart. Improvements in technology, especially the advent of smaller, durable continuous flow pumps, have led to the use of LVADs in a much broader population of patients in the last 10 years. Both the number of patients living with LVADs and the life expectancy of these patients are increasing. Regarding this growing number of patients with LVAD, intensivists need to understand the physiology of the devices, their functioning, potential complications and their management. METHODS We performed a narrative review of relevant medical literature regarding the physiology of patients with LVAD and management of common complications relevant to the critical care physicians. RESULTS The most frequent complications occurring in the LVAD patients after the post-operative period are bleeding, driveline infections, thrombosis, device malfunction, right ventricular failure and arrhythmias. Bleeding is the most frequent adverse event in LVAD due to a combination of anticoagulation and acquired von Willebrand disease secondary to shear stress produced within the pump. Their management includes antiplatelet therapy arrest, reduction of the anticoagulation regimen and specific therapy if feasible. Infection is the second most common cause of death after cardiac failure in LVAD patients. All infections must be aggressively treated to avoid seeding the device. Device thrombosis can develop even when patients are adequately anticoagulated and taking antiplatelet therapy because the LVAD is responsible for a chronic hypercoagulable state. CONCLUSION Management of these unique patients in the ICU is best accomplished with a multidisciplinary team that includes specialists in advanced heart failure, LVAD nurse coordinators and intensivists.
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Affiliation(s)
- Nadia Aissaoui
- Department of Critical Care Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Université Paris-Descartes, Paris, France.,Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France
| | - Jerome Jouan
- Department of Cardiac surgery, APHP, Hôpital Européen Georges Pompidou (HEGP), Université Paris-Descartes, Paris, France
| | - Melissa Gourjault
- Department of Cardiology, AP-HP, Hôpital Européen Georges Pompidou (HEGP), Université Paris-Descartes, Paris, France
| | - Benoit Diebold
- Department of Cardiology, AP-HP, Hôpital Européen Georges Pompidou (HEGP), Université Paris-Descartes, Paris, France
| | - Sofia Ortuno
- Department of Critical Care Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Université Paris-Descartes, Paris, France
| | - Amer Hamdan
- Department of Critical Care Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Université Paris-Descartes, Paris, France
| | - Christian Latremouille
- Department of Cardiac surgery, APHP, Hôpital Européen Georges Pompidou (HEGP), Université Paris-Descartes, Paris, France
| | - Romain Pirracchio
- Department of Anesthesiology and Intensive Care, APHP, Hôpital Européen Georges Pompidou (HEGP), Université Paris-Descartes, Paris, France
| | - Michiel Morshuis
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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