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Hariri G, Urbina T, Ait-Oufella H. Authors' reply: "Prospective evaluation of bleeding risk among thrombocytopenic patients admitted in intensive care unit". J Crit Care 2024; 81:154526. [PMID: 38272770 DOI: 10.1016/j.jcrc.2024.154526] [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] [Received: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Geoffroy Hariri
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Tomas Urbina
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France.
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Malherbe J, Godard P, Lacherade JC, Coirier V, Argaud L, Hyvernat H, Schneider F, Charpentier J, Wallet F, Pocquet J, Plantefeve G, Quenot JP, Bay P, Delbove A, Georges H, Urbina T, Schnell D, Le Moal C, Stanowski M, Muris C, Jonas M, Sauneuf B, Lesieur O, Lhermitte A, Calvet L, Gueguen I, du Cheyron D. Clinical description and outcome of overall varicella-zoster virus-related organ dysfunctions admitted in intensive care units: the VAZOREA cohort study. Ann Intensive Care 2024; 14:44. [PMID: 38548917 PMCID: PMC10978565 DOI: 10.1186/s13613-024-01270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/23/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Due to aging population and increasing part of immunocompromised patients, a raise in life-threatening organ damage related to VZV can be expected. Two retrospective studies were already conducted on VZV in ICU but focused on specific organ injury. Patients with high-risk of VZV disease still must be identified. The objective of this study was to report the clinical features and outcome of all life-threatening VZV manifestations requiring intensive care unit (ICU) admission. This retrospective cohort study was conducted in 26 French ICUs and included all adult patients with any life-threatening VZV-related event requiring ICU admission or occurring in ICU between 2010 and 2019. RESULTS One-hundred nineteen patients were included with a median SOFA score of 6. One hundred eight patients (90.8%) were admitted in ICU for VZV disease, leaving 11 (9.2%) with VZV disease occurring in ICU. Sixty-one patients (51.3%) were immunocompromised. Encephalitis was the most prominent organ involvement (55.5%), followed by pneumonia (44.5%) and hepatitis (9.2%). Fifty-four patients (45.4%) received norepinephrine, 72 (60.5% of the total cohort) needed invasive mechanical ventilation, and 31 (26.3%) received renal-replacement therapy. In-hospital mortality was 36.1% and was significantly associated with three independent risk factors by multivariable logistic regression: immunosuppression, VZV disease occurring in ICU and alcohol abuse. Hierarchical clustering on principal components revealed five phenotypically distinct clusters of patients: VZV-related pneumonia, mild encephalitis, severe encephalitis in solid organ transplant recipients, encephalitis in other immunocompromised hosts and VZV disease occurring in ICU. In-hospital mortality was highly different across phenotypes, ranging from zero to 75% (p < 0.001). CONCLUSION Overall, severe VZV manifestations are associated with high mortality in the ICU, which appears to be driven by immunosuppression status rather than any specific organ involvement. Deciphering the clinical phenotypes may help clinicians identify high-risk patients and assess prognosis.
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Affiliation(s)
- Jolan Malherbe
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Médecine Intensive - Réanimation, Caen, 14000, France.
| | - Pierre Godard
- Service de Médecine Intensive - Réanimation, CHU Bordeaux site Pellegrin, Bordeaux, France
| | | | - Valentin Coirier
- Service de Médecine Intensive - Réanimation, CHU de Rennes, Rennes, 35000, France
| | - Laurent Argaud
- Service de Médecine Intensive - Réanimation, Hôpital Edouard Herriot, Hospices civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Est, Lyon, France
| | - Hervé Hyvernat
- Service de Médecine Intensive - Réanimation, Université Côte d'Azur (UCA), CHU de Nice, 151 route Saint Antoine de Ginestière, Nice, 06200, France
| | - Francis Schneider
- Médecine Intensive - Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg et Unistra, Strasbourg, France
| | - Julien Charpentier
- Service de Médecine Intensive - Réanimation, Centre-Université Paris Cité, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, 75014, France
| | - Florent Wallet
- Médecine Intensive - Réanimation, CHU Lyon Sud, Pierre Benite, France
- RESHAPE Research on healthcare performance, U1290, Université Claude Bernard Lyon 1, Lyon, France
| | | | | | - Jean-Pierre Quenot
- Department of Intensive Care, Burgundy University Hospital, Dijon, France
| | - Pierre Bay
- Service de Médecine Intensive - Réanimation, AP-HP Assistance Publique Hôpitaux de Paris, Hôpitaux universitaires Henri Mondor, DMU Médecine, Créteil, 94010, France
- UPEC Université Paris-Est Créteil, INSERM, Unité U955, Equipe 18, Créteil, 94010, France
| | - Agathe Delbove
- Service de réanimation polyvalente, CHBA Vannes, Vannes, France
| | - Hugues Georges
- Service de réanimation polyvalente, Centre hospitalier de Tourcoing, Tourcoing, 59200, France
| | - Tomas Urbina
- Service de Médecine Intensive - Réanimation, Hôpital Saint-Antoine, Assistance Publique- Hôpitaux de Paris, Paris, 75012, France
| | - David Schnell
- Réanimation Polyvalente et USC, CH Angoulême, Angoulême Cedex 9, Angoulême, 19959, France
| | - Charlène Le Moal
- Service Réanimation/USC, Centre Hospitalier du Mans, Le Mans, 72037, France
| | | | - Corentin Muris
- Université de Poitiers, CHU de Poitiers, Médecine intensive Réanimation, 2 rue de la miletrie, Poitiers, 86000, France
| | - Maud Jonas
- Service Médecine Intensive - Réanimation/USC, Centre hospitalier de Saint-Nazaire, Saint-Nazaire, 44600, France
| | - Bertrand Sauneuf
- Service de Réanimation polyvalente, Centre Hospitalier Public du Cotentin, Cherbourg en Cotentin, 50100, France
| | - Olivier Lesieur
- Centre Hospitalier Saint-Louis, Réanimation polyvalente, La Rochelle, 17019, France
| | - Amaury Lhermitte
- Hôpital Universitaire Félix Guyon, Réanimation polyvalente, Allée des Topazes, Saint-Denis, La Réunion, 97400, France
| | - Laure Calvet
- Service de Médecine Intensive et Réanimation, CHU de Clermont-Ferrand, Clermont- Ferrand, France
| | - Ines Gueguen
- Service de réanimation médicale, CHRU de Lille, Lille, France
| | - Damien du Cheyron
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Médecine Intensive - Réanimation, Caen, 14000, France
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Urbina T, Gabarre P, Bonny V, Lavillegrand JR, Garnier M, Joffre J, Mario N, Dumas G, Hariri G, Turpin M, Pardo E, Fartoukh M, Guidet B, Maury E, Chantran Y, Boelle PY, Voiriot G, Ait-Oufella H. Corticosteroids induce an early but limited decrease in IL-6 dependent pro-inflammatory responses in critically ill COVID-19 patients. Minerva Anestesiol 2024; 90:172-180. [PMID: 38287776 DOI: 10.23736/s0375-9393.23.17765-0] [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: 01/31/2024]
Abstract
BACKGROUND Corticosteroids have become standard of care for COVID-19 but their effect on the systemic immune-inflammatory response has been little investigated. METHODS Multicenter prospective cohort, including critically ill COVID-19 patients between March and November 2020. C-reactive protein (CRP), lymphocyte count and fibrinogen levels were collected upon hospital admission before initiation of steroid treatment and at ICU admission, three days and seven days later, along with interleukin (IL)-6, IL-10 and tumor necrosis factor-alpha (TNF-α) plasma levels. RESULTS A hundred and fifty patients were included, 47 received corticosteroids, 103 did not. Median age was 62 [53-70], and 96 (65%) patients were mechanically ventilated. Propensity score matching rendered 45 well-balanced pairs of treated and non-treated patients, particularly on pre-treatment CRP levels. Using a mixed model, CRP (P=0.019), fibrinogen (P=0.003) and lymphocyte counts (P=0.006) remained lower in treated patients over ICU stay. Conversely, there was no significant difference over the ICU stay for Il-6 (P=0.146) and IL-10 (0.301), while TNF- α levels were higher in the treated group (P=0.013). Among corticosteroid-treated patients, CRP (P=0.012), fibrinogen (P=0.041) and lymphocyte count (P=0.004) over time were associated with outcome, whereas plasma cytokine levels were not. CONCLUSIONS Steroid treatment was associated with an early and sustained decrease in the downstream IL-6-dependent inflammatory signature but an increase in TNF-α levels. In corticosteroid-treated patients, CRP and lymphocyte count were associated with outcome, conversely to plasma cytokine levels. Further research on using these biomarker's kinetics to individualize immunomodulatory treatments is warranted.
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Affiliation(s)
- Tomas Urbina
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France -
| | - Paul Gabarre
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Vincent Bonny
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Jean-Rémi Lavillegrand
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Marc Garnier
- Sorbonne University, Faculty of Medicine, Paris, France
- Anesthesiology and Critical Care Medicine Department, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Jérémie Joffre
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Nathalie Mario
- Department of Biochemistry, Hormonology and Therapeutic Follow-Up, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Guillaume Dumas
- Intensive Care Unit, Saint-Louis Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Geoffroy Hariri
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Matthieu Turpin
- Sorbonne University, Faculty of Medicine, Paris, France
- Intensive Care Unit, Tenon Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Emmanuel Pardo
- Anesthesiology and Critical Care Medicine Department, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Muriel Fartoukh
- Sorbonne University, Faculty of Medicine, Paris, France
- Intensive Care Unit, Tenon Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Bertrand Guidet
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Eric Maury
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Yannick Chantran
- Department of Biological Immunology, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Pierre-Yves Boelle
- INSERM, Sorbonne University, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Guillaume Voiriot
- Sorbonne University, Faculty of Medicine, Paris, France
- Intensive Care Unit, Tenon Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Hafid Ait-Oufella
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
- Inserm U970, Cardiovascular Research Center, University of Paris, Paris, France
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Penaud V, Vieille T, Urbina T, Bonny V, Gabarre P, Missri L, Gasperment M, Baudel JL, Carbonell N, Beurton A, Chaibi S, Retbi A, Fartoukh M, Piton G, Guidet B, Maury E, Ait-Oufella H, Joffre J. Prediction of esophagogastroduodenoscopy therapeutic usefulness for in-ICU suspected upper gastrointestinal bleeding: the SUGIBI score study. Ann Intensive Care 2024; 14:28. [PMID: 38361004 PMCID: PMC10869326 DOI: 10.1186/s13613-024-01250-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Suspected upper gastrointestinal bleeding (SUGIB) is a common issue during ICU stay. In the absence of specific guidelines on the indication and timing of esophagogastroduodenoscopy (EGD), there is substantial variability in EGD indication depending on accessibility and clinical presentation. This study aimed to investigate factors associated with the need for per-EGD hemostatic therapy and to create a score predicting therapeutic benefit of emergency bedside EGD in ICU patients with SUGIB. METHODS We conducted a retrospective study in our ICU to identify factors associated with the need for hemostatic procedure during EGD performed for SUGIB. From this observational cohort, we derived a score predicting the need for hemostasis during EGD, the SUGIBI score. This score was subsequently validated in a retrospective multicenter cohort. RESULTS Two hundred fifty-five patients not primarily admitted for GI bleeding who underwent a bedside EGD for SUGIB during their ICU stay were analyzed. The preeminent EGD indication were anemia (79%), melena (19%), shock (14%), and hematemesis (13%). EGD was normal in 24.7% of cases, while primary lesions reported were ulcers (23.1%), esophagitis (18.8%), and gastritis (12.5%). Only 12.9% of patients underwent hemostatic endotherapy during EGD. A SUGIBI score < 4 had a negative predictive value of 95% (91-99) for hemostatic endotherapy [AUC of 0.81; 0.75-0.91 (p < 0.0001)]. The SUGIBI score for predicting the need for an EGD-guided hemostatic procedure was next validated in a multicenter cohort with an AUC of 0.75 (0.66-0.85) (p < 0.0001), a score < 4 having a negative predictive value of 95% (92-97). CONCLUSIONS Our study shows that the therapeutic usefulness of bedside emergency EGD for SUGIB in critically ill patients is limited to a minority of patients. The SUGIBI score should help clinicians stratify the probability of a therapeutic EGD.
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Affiliation(s)
- Victor Penaud
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Thibault Vieille
- Intensive Care Unit, Besançon University Hospital, 25000, Besançon, France
| | - Tomas Urbina
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Vincent Bonny
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Paul Gabarre
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Louai Missri
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Maxime Gasperment
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Jean-Luc Baudel
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Nicolas Carbonell
- Gastroenterology Department, AP-HP, Hôpital Saint-Antoine, Sorbonne University, 75012, Paris, France
| | - Alexandra Beurton
- Intensive Care Unit, Tenon University Hospital, APHP, Sorbonne University, 75020, Paris, France
| | - Sayma Chaibi
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Aurélia Retbi
- Département d'Information Médicale, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Muriel Fartoukh
- Intensive Care Unit, Tenon University Hospital, APHP, Sorbonne University, 75020, Paris, France
| | - Gaël Piton
- Intensive Care Unit, Besançon University Hospital, 25000, Besançon, France
| | - Bertrand Guidet
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
- Pierre Louis Institute of Epidemiology and Public Health, Inserm U1136, Sorbonne University, Paris, France
| | - Eric Maury
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
- Paris Cardiovascular Research Center, Inserm U970, Paris Center University, Paris, France
| | - Jérémie Joffre
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
- Centre de Recherche Saint-Antoine, Inserm UMRS-938, Sorbonne University, Paris, France.
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5
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Gabarre P, Desnos C, Morin A, Missri L, Urbina T, Bonny V, Turpin M, Baudel JL, Berard L, Montil M, Guidet B, Voiriot G, Joffre J, Maury E, Ait-Oufella H. Albumin versus saline infusion for sepsis-related peripheral tissue hypoperfusion: a proof-of-concept prospective study. Crit Care 2024; 28:43. [PMID: 38326920 PMCID: PMC10848485 DOI: 10.1186/s13054-024-04827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/04/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Albumin has potential endothelial protective effects through antioxidant and anti-inflammatory properties. However, the effect of albumin on peripheral tissue perfusion in human sepsis remains poorly known. METHODS Bi-centric prospective study included patients with sepsis with or without shock and prolonged CRT > 3 s despite initial resuscitation. Clinicians in charge of the patients were free to infuse either saline 500 mL or human serum albumin 20% 100 mL over 15 min. Global hemodynamic parameters as well as peripheral tissue perfusion were analyzed after 1 (H1) and 4 h (H4). The primary endpoint was CRT normalization (< 3 s) at H1. RESULTS 62 patients were screened, and 50 patients (13 sepsis and 37 septic shock) were included, 21 in the saline group and 29 in the albumin group. SOFA score was 8 [5-11], and SAPS II was 53 [45-70]. Median age was 68 [60-76] years with a higher proportion of men (74%). The primary sources of infection were respiratory (54%) and abdominal (24%). At baseline, comorbidities, clinical and biological characteristics were similar between groups. At H1, CRT normalization (< 3 s) was more frequent in patients receiving albumin as compared to patients treated by saline (63 vs 29%, P = 0.02). The decrease in fingertip CRT was more important in the albumin group when compared to saline group (- 1.0 [- 0.3; - 1.5] vs - 0.2 [- 0.1; - 1.1] seconds, P = 0.04) as well as decrease in mottling score. At H4, beneficial effects of albumin on peripheral tissue perfusion were maintained and urinary output trended to be higher in the albumin group (1.1 [0.5-1.8] vs 0.7 [0.5-0.9] ml/kg/h, P = 0.08). Finally, arterial lactate level did not significantly change between H0 and H4 in the saline group but significantly decreased in the albumin group (P = 0.03). CONCLUSION In patients with resuscitated sepsis, albumin infusion might lead to greater improvement of tissue hypoperfusion compared to saline. CLINICALTRIALS gov Identifier: NCT05094856.
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Affiliation(s)
- Paul Gabarre
- Medical Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Cyrielle Desnos
- Intensive Care Unit, Tenon University Hospital, APHP, Sorbonne University, Paris, France
| | - Alexandra Morin
- Medical Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Louai Missri
- Medical Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Tomas Urbina
- Medical Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Vincent Bonny
- Medical Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Matthieu Turpin
- Intensive Care Unit, Tenon University Hospital, APHP, Sorbonne University, Paris, France
| | - Jean-Luc Baudel
- Medical Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Laurence Berard
- Department of Pharmacology, Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Paris, France
- Clinical Research Platform of East of Paris (URCEST-CRCEST-CRB), Sorbonne Université, Paris, France
| | - Melissa Montil
- Department of Pharmacology, Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Paris, France
- Clinical Research Platform of East of Paris (URCEST-CRCEST-CRB), Sorbonne Université, Paris, France
| | - Bertrand Guidet
- Medical Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Guillaume Voiriot
- Intensive Care Unit, Tenon University Hospital, APHP, Sorbonne University, Paris, France
| | - Jérémie Joffre
- Medical Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
- INSERM UMRS 938, Centre de Recherche Saint-Antoine, CRSA, Immune System and Neuroinflammation Laboratory, Hôpital Saint-Antoine, Sorbonne Université, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Eric Maury
- Medical Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
- Paris Cardiovascular Research Center, Inserm U970, University Paris Cité, Paris, France.
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6
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Petit M, Bidar F, Fosse Q, Lefevre L, Paul M, Urbina T, Masi P, Bavozet F, Lemarié J, de Montmollin E, Andriamifidy-Berti C, Dessajan J, Zuber B, Zafrani L, Peju E, Meng P, Charrier L, Le Guennec L, Simon M, Luyt CE, Haudebourg L, Geri G. Antibiotic definitive treatment in ventilator associated pneumonia caused by AmpC-producing Enterobacterales in critically ill patients: a prospective multicenter observational study. Crit Care 2024; 28:40. [PMID: 38317262 PMCID: PMC10845500 DOI: 10.1186/s13054-024-04820-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/28/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Ventilator associated pneumonia (VAP) due to wild-type AmpC-producing Enterobacterales (wtAE) is frequent in intensive care unit (ICU) patients. Despite a low level of evidence, definitive antimicrobial therapy (AMT) with third generation cephalosporins (3GCs) or piperacillin is discouraged. METHODS Observational prospective study including consecutive wtAE VAP patients in 20 French ICUs. The primary objective was to assess the association of the choice of definitive AMT, i.e. piperacillin ± tazobactam (PTZ), 3GCs or other molecule (4GCs, carbapenems, quinolones, cotrimoxazole; control group), with treatment success at day-7. Recurrence of infection was collected as a secondary outcome, and analyzed accounting for the competing risk of death. RESULTS From February 2021 to June 2022, 274 patients were included. Enterobacter cloacae was the most prevalent specie (31%). Seventy-eight patients (28%) had PTZ as definitive AMT while 44 (16%) had 3GCs and 152 (56%) were classified in the control group. Day-7 success rate was similar between the 3 groups (74% vs. 73% vs. 68% respectively, p = 0.814). Recurrence probability at day-28 was 31% (95% CI 21-42), 40% (95% CI 26-55) and 21% (95% CI 15-28) for PTZ, 3GCs and control groups (p = 0.020). In multivariable analysis, choice of definitive AMT was not associated with clinical success, but definitive AMT with 3GCs was associated with recurrence at day-28 [csHR(95%CI) 10.9 (1.92-61.91)]. CONCLUSION Choice of definitive antimicrobial therapy was not associated with treatment success at day 7. However, recurrence of pneumonia at day-28 was higher in patients treated with third generation cephalosporins with no differences in mortality or mechanical ventilation duration.
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Affiliation(s)
- Matthieu Petit
- Medical Intensive Care Unit, Ambroise Paré Hospital, APHP, UMR 1018, CESP Villejuif, 9, Avenue Charles de Gaulle, Boulogne-Billancourt, France.
| | - Frank Bidar
- Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Quentin Fosse
- AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Lucie Lefevre
- Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marine Paul
- Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay, France
| | - Tomas Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Paul Masi
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 94010, Créteil, France
| | | | - Jérémie Lemarié
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France
| | - Etienne de Montmollin
- INSERM UMR 1137, 75018, Department of Intensive Care Medicine, APHP, Bichat-Claude Bernard University Hospital, Université Paris Cité, 75018, Paris, France
| | - Chloé Andriamifidy-Berti
- Médecine Intensive - Réanimation, Centre Hospitalier de Poissy - Saint Germain en Laye, Poissy, France
| | - Julien Dessajan
- Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin Zuber
- Intensive Care Unit, Hôpital Foch, 92150, Suresnes, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis Hospital, AP-HP, University of Paris Cité, Paris, France
| | - Edwige Peju
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris AP-HP Centre, Université Paris Cité, Paris, France
| | - Paris Meng
- Service de Médecine Intensive Réanimation, CHI Robert Ballanger, Aulnay-sous-Bois, France
| | - Liliane Charrier
- Service de Réanimation, Centre Hospitalier du Cotentin, Cherbourg, France
| | - Loic Le Guennec
- Médecine Intensive Réanimation Neurologique, Hôpital de la Pitié-Salpêtrière - APHP, Sorbonne Université, Paris, France
| | - Marie Simon
- Médecine Intensive Et Réanimation, CHU Edouard Herriot, Lyon, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, ICAN, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Luc Haudebourg
- Service de Pneumologie et Réanimation Médicale du Département R3S, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, Paris, France
| | - Guillaume Geri
- Medical and Surgical Intensive Care Unit, Ambroise Paré Clinic, Neuilly-sur-Seine, France.
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7
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Hariri G, Belossi V, Perol L, Missri L, Gabarre P, Bonny V, Urbina T, Baudel JL, Guidet B, Joffre J, Maury E, Dumas G, Ait-Oufella H. Prospective evaluation of bleeding risk among thrombocytopenic patients admitted in intensive care unit. J Crit Care 2024; 79:154405. [PMID: 37659243 DOI: 10.1016/j.jcrc.2023.154405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/30/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE Bleeding risk evaluation of thrombocytopenic patients admitted in ICU has been poorly investigated. METHODS A prospective observational study conducted in an 18-bed medical ICU. Consecutive patients with thrombocytopenia (<150 Giga/L) and no bleeding at admission were included. RESULTS Over one year, 91 patients were included, mainly men (63%), with an age of 61 [46-68] years and a SOFA score of 6 [3-8]. Twenty-three patients (25%) had an hemorrhagic event during ICU stay, mainly digestive (n = 9; 39%) and urological (n = 6; 26%). The time between ICU admission and bleeding was 8 [2-19] days. Almost half of bleeding events required vasopressor infusion and a hemostatic procedure. At admission, two variables were significantly different between the Bleeding and No-Bleeding groups: plasma urea level was significantly higher in the Bleeding group (9 [5.1; 13] vs. 13 [8.9; 31] mmol/L; p < 0.001) and the presence of skin purpura was associated with a 3-fold higher risk for bleeding during ICU stay (HR: 3.4 [1.3-8.3]; p < 0.05). In contrast, admission platelet count was not significantly different between the 2 groups (90 [32; 128] vs 62 [36; 103] G/L; p = 0.26). CONCLUSION Plasma urea levels and the presence of skin purpura are helpful in identifying thrombocytopenic patients at high-risk of bleeding during ICU stay.
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Affiliation(s)
- Geoffroy Hariri
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France; Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France
| | - Vincent Belossi
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Louis Perol
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Louai Missri
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Paul Gabarre
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Vincent Bonny
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Tomas Urbina
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Jean-Luc Baudel
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Bertrand Guidet
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France; Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France
| | - Jeremie Joffre
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Eric Maury
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Guillaume Dumas
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France; Inserm U970, Paris Research Cardiovascular Center, Paris, France.
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8
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Bonny V, Urbina T, Capes A, Joffre J. Writing the story of immune effector cell-associated neurotoxicity syndrome. EJHaem 2024; 5:283-284. [PMID: 38406526 PMCID: PMC10887236 DOI: 10.1002/jha2.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 02/27/2024]
Affiliation(s)
- Vincent Bonny
- Service de Médecine Intensive RéanimationHôpital Saint‐AntoineAssistance Publique ‐ Hôpitaux de ParisParis Cedex 12France
- Sorbonne UniversitéParisFrance
| | - Tomas Urbina
- Service de Médecine Intensive RéanimationHôpital Saint‐AntoineAssistance Publique ‐ Hôpitaux de ParisParis Cedex 12France
| | - Antoine Capes
- Service d'hématologie et thérapie cellulaire Hôpital Saint‐AntoineAssistance Publique ‐ Hôpitaux de ParisParis Cedex 12France
| | - Jeremie Joffre
- Service de Médecine Intensive RéanimationHôpital Saint‐AntoineAssistance Publique ‐ Hôpitaux de ParisParis Cedex 12France
- Sorbonne UniversitéParisFrance
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9
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Montméat V, Bonny V, Urbina T, Missri L, Baudel JL, Retbi A, Penaud V, Voiriot G, Cohen Y, De Prost N, Guidet B, Maury E, Ait-Oufella H, Joffre J. Epidemiology and Clinical Patterns of Lung Abscesses in ICU: A French Multicenter Retrospective Study. Chest 2024; 165:48-57. [PMID: 37652296 DOI: 10.1016/j.chest.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/13/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Data are scarce regarding epidemiology and management of critically ill patients with lung abscesses. RESEARCH QUESTION What are the clinical and microbiological characteristics of critically ill patients with lung abscesses, how are they managed in the ICU, and what are the risk factors of in-ICU mortality? STUDY DESIGN AND METHODS This was a retrospective observational multicenter study, based on International Classification of Diseases, 10th Revision, codes, between 2015 and 2022 in France. In-ICU mortality-associated factors were determined by multivariate logistic regression. RESULTS We analyzed 171 ICU patients with pulmonary abscesses. Seventy-eight percent were male, with a mean age of 56.5 ± 16.4 years; 20.4% misused alcohol, 25.2% had a chronic lung disease (14% COPD), and 20.5% had a history of cancer. Overall, 40.9% were immunocompromised and 38% qualified for nosocomial infection. Presenting symptoms included fatigue or weight loss in 62%, fever (50.3%), and dyspnea (47.4%). Hemoptysis was reported in 21.7%. A polymicrobial infection was present in 35.6%. The most frequent pathogens were Enterobacteriaceae in 31%, Staphylococcus aureus in 22%, and Pseudomonas aeruginosa in 19.3%. Fungal infections were found in 10.5%. Several clusters of clinicoradiologic patterns were associated with specific microbiological documentation and could guide empiric antibiotic regimen. Percutaneous abscess drainage was performed in 11.7%; surgery was performed in 12.7%, and 12% required bronchial artery embolization for hemoptysis. In-ICU mortality was 21.5%, and age (OR: 1.05 [1.02-1.91], P = .007], renal replacement therapy during ICU stay (OR, 3.56 [1.24-10.57], P = .019), and fungal infection (OR, 9.12 [2.69-34.5], P = .0006) were independent predictors of mortality after multivariate logistic regression, and drainage or surgery were not. INTERPRETATION Pulmonary abscesses in the ICU are a rare but severe disease often resulting from a polymicrobial infection, with a high proportion of Enterobacteriaceae, S aureus, and P aeruginosa. Percutaneous drainage, surgery, or arterial embolization was required in more than one-third of cases. Further prospective studies focusing on first-line antimicrobial therapy and source control procedure are warranted to improve and standardize patient management.
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Affiliation(s)
- Vinca Montméat
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Vincent Bonny
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Tomas Urbina
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Louai Missri
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Jean-Luc Baudel
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Aurélia Retbi
- Département d'Information Médicale, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Victor Penaud
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Guillaume Voiriot
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche Saint-Antoine, Inserm UMRS-938, Sorbonne University, Paris, France
| | - Yves Cohen
- Intensive Care Unit, Avicennes Hospital, APHP, University Sorbonne Paris Nord, Bobigny, France
| | - Nicolas De Prost
- Intensive Care Unit, Henri Mondor University Hospital, APHP, Paris-est Créteil -val de marne University, Créteil, France
| | - Bertrand Guidet
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France; Pierre Louis Institute of Epidemiology and Public Health, Inserm U1136, Sorbonne University, Paris, France
| | - Eric Maury
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Hafid Ait-Oufella
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France; 8 Paris Cardiovascular Research Center, Inserm U970, Paris University, Paris, France
| | - Jérémie Joffre
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France; Centre de Recherche Saint-Antoine, Inserm UMRS-938, Sorbonne University, Paris, France.
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10
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Bonny V, Gabarre P, Urbina T, Mazuet C, Missri L, Joffre J, Baudel JL, Ait Oufella H, Maury E. Never too late to neutralize botulinum neurotoxin. Minerva Anestesiol 2023; 89:950-951. [PMID: 37272271 DOI: 10.23736/s0375-9393.23.17401-3] [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: 06/06/2023]
Affiliation(s)
- Vincent Bonny
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne University, Paris, France
| | - Paul Gabarre
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne University, Paris, France
| | - Tomas Urbina
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne University, Paris, France
| | - Christelle Mazuet
- CNR Bactéries Anaérobies et Botulisme, Pasteur Institute, Paris, France
| | - Louaï Missri
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne University, Paris, France
| | - Jérémie Joffre
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne University, Paris, France
| | - Jean-Luc Baudel
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Hafid Ait Oufella
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne University, Paris, France
| | - Eric Maury
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France -
- Sorbonne University, Paris, France
- UMR S 1136, INSERM and Sorbonne University, Pierre and Marie Curie University - Paris6, Paris, France
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11
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Windsor C, Urbina T, de Prost N. Severe skin infections. Curr Opin Crit Care 2023; 29:407-414. [PMID: 37641501 DOI: 10.1097/mcc.0000000000001069] [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: 08/31/2023]
Abstract
PURPOSE OF REVIEW The incidence of necrotizing soft-tissue infections (NSTI) has increased during recent decades. These infections are still associated with high morbidity and mortality, underlining a need for continued education of the medical community. This review will focus on practical approaches to management of NSTI focusing on antibiotic therapies and optimizing the management of group A streptococcus (GAS)-associated NSTIs. RECENT FINDINGS Antibiotic therapy for NSTI patients faces several challenges as the rapid progression of NSTIs mandates broad-spectrum agents with bactericidal action. Current recommendations support using clindamycin in combination with penicillin in case of GAS-documented NSTIs. Linezolide could be an alternative in case of clindamycin resistance. SUMMARY Reducing the time to diagnosis and first surgical debridement, initiating early broad-spectrum antibiotics and early referral to specialized centres are the key modifiable factors that may impact the prognosis of NSTIs. Causative organisms vary widely according to the topography of the infection, underlying conditions, and geographic location. Approximately one third of NSTIs are monomicrobial, involving mainly GAS or Staphylococcus aureus . Data for antibiotic treatment specifically for necrotizing soft-tissue infections are scarce, with guidelines mainly based on expert consensus.
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Affiliation(s)
- Camille Windsor
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor- Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP)
- Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil
| | - Tomas Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris
| | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor- Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP)
- Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
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12
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Lavillegrand JR, Blum L, Morin A, Urbina T, Gabarre P, Bonny V, Baudel JL, Guidet B, Maury E, Ait-Oufella H. Permissive Hypotension Has No Deleterious Impact on Fluid Balance or Kidney Function. Crit Care Explor 2023; 5:e0991. [PMID: 37868030 PMCID: PMC10586843 DOI: 10.1097/cce.0000000000000991] [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: 10/24/2023] Open
Abstract
OBJECTIVES Mean arterial hypotension between 55 and 65 mm Hg could be tolerated safely in the absence of tissue hypoperfusion, but the consequences on fluid balance and kidney function remain unknown. DESIGN During a 1-year period, we retrospectively collected data of consecutive septic patients admitted for sepsis with a mean arterial pressure (MAP) less than 65 mm Hg despite fluid resuscitation. SETTING Medical 18-bed ICU in a tertiary teaching hospital. PATIENTS Septic patients with a MAP less than 65 mm Hg despite initial resuscitation. INTERVENTIONS In our ICU, MAP between 55 and 65 mm Hg was tolerated in the absence of peripheral hypoperfusion (permissive hypotension) or corrected using norepinephrine (septic shock group) when peripheral tissue hypoperfusion was present. MEASUREMENTS AND MAIN RESULTS Ninety-four consecutive septic patients were included, 15 in the permissive hypotension group and 79 in the septic shock group. Median age was 66 years (57-77 yr) and 42% were women. The main sources of infection were respiratory (45%) and abdominal (18%). Severity was more important in septic shock group with higher Sequential Organ Failure Assessment score (7 [5-10] vs. 4 [1-6]; p < 0.0001), more frequent organ support therapy and ultimately higher mortality (38 vs. 0%; p < 0.01). The total volume of crystalloids infused before ICU admission was not different between groups (1930 ± 250 vs. 1850 ± 150 mL; p = 0.40). Within the 6 first hours of ICU stay, patients in the permissive hypotension group received less fluids (530 ± 170 vs. 1100 ± 110 mL; p = 0.03) and had higher urinary output (1.4 mL [0.88-2.34 mL] vs. 0.47 mL/kg/hr [0.08-1.25 mL/kg/hr]; p < 0.001). In addition, kidney injury evaluated using KDIGO score was lower in the permissive hypotension group at 48 hours (0 hr [0-1 hr] vs. 1 hr [0-2 hr]; p < 0.05). CONCLUSIONS In septic patients without clinical peripheral hypoperfusion, mean arterial hypotension between 55 and 65 mm Hg could be tolerated safely without vasopressor infusion and was not associated with excessive fluid administration or kidney damage.
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Affiliation(s)
- Jean-Rémi Lavillegrand
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne Université, Paris, France
| | - Laurene Blum
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alexandra Morin
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Tomas Urbina
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Paul Gabarre
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne Université, Paris, France
| | - Vincent Bonny
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Luc Baudel
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Bertrand Guidet
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne Université, Paris, France
| | - Eric Maury
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne Université, Paris, France
- Inserm UMR 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne Université, Paris, France
- Inserm UMR 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
- Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France
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Lopinto J, Arrestier R, Peiffer B, Gaillet A, Voiriot G, Urbina T, Luyt CE, Bellaïche R, Pham T, Ait-Hamou Z, Roux D, Clere-Jehl R, Azoulay E, Gaudry S, Mayaux J, Mekontso Dessap A, Canoui-Poitrine F, de Prost N. High-Dose Steroids for Nonresolving Acute Respiratory Distress Syndrome in Critically Ill COVID-19 Patients Treated With Dexamethasone: A Multicenter Cohort Study. Crit Care Med 2023; 51:1306-1317. [PMID: 37199534 DOI: 10.1097/ccm.0000000000005930] [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: 05/19/2023]
Abstract
OBJECTIVES To determine the impact of high doses of corticosteroids (HDCT) in critically ill COVID-19 patients with nonresolving acute respiratory distress syndrome (ARDS) who had been previously treated with dexamethasone as a standard of care. DESIGN Prospective observational cohort study. Eligible patients presented nonresolving ARDS related to severe acute respiratory syndrome coronavirus 2 infection and had received initial treatment with dexamethasone. We compared patients who had received or not HDCT during ICU stay, consisting of greater than or equal to 1 mg/kg of methylprednisolone or equivalent for treatment of nonresolving ARDS. The primary outcome was 90-day mortality. We assessed the impact of HDCT on 90-day mortality using univariable and multivariable Cox regression analysis. Further adjustment for confounding variables was performed using overlap weighting propensity score. The association between HDCT and the risk of ventilator-associated pneumonia was estimated using multivariable cause-specific Cox proportional hazard model adjusting for pre-specified confounders. SETTING We included consecutive patients admitted in 11 ICUs of Great Paris area from September 2020 to February 2021. PATIENTS Three hundred eighty-three patients were included (59 in the HDCT group, 324 in the no HDCT group). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS At day 90, 30 of 59 patients (51%) in the HDCT group and 116 of 324 patients (35.8%) in the no HDCT group had died. HDCT was significantly associated with 90-day mortality in unadjusted (hazard ratio [HR], 1.60; 95% CI, 1.04-2.47; p = 0.033) and adjusted analysis with overlap weighting (adjusted HR, 1.65; 95% CI, 1.03-2.63; p = 0.036). HDCT was not associated with an increased risk of ventilator-associated pneumonia (adjusted cause-specific HR, 0.42; 95% CI, 0.15-1.16; p = 0.09). CONCLUSIONS In critically ill COVID-19 patients with nonresolving ARDS, HDCT result in a higher 90-day mortality.
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Affiliation(s)
- Julien Lopinto
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France
| | - Romain Arrestier
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France
| | - Bastien Peiffer
- Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Antoine Gaillet
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France
| | - Guillaume Voiriot
- Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tomas Urbina
- Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Charles-Edouard Luyt
- Sorbonne University, INSERM, UMRS 1166, ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de médecine intensive-réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Pitié-Salpêtrière Hospital, Paris, France
| | - Raphaël Bellaïche
- Département d'Anesthésie Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Tái Pham
- Université Paris-Saclay, AP-HP, Service de Médecine Intensive Réanimation, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, FHU Sepsis, Le Kremlin-Bicêtre, France
| | - Zakaria Ait-Hamou
- Service de Médecine Intensive Réanimation, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Hôpitaux universitaires Paris-Centre, Paris, France
| | - Damien Roux
- Médecine intensive réanimation, Hôpital Louis Mourier, Assistance Publique - Hôpitaux de Paris, Colombes, France
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, Paris, France
| | - Raphaël Clere-Jehl
- Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Hôpitaux universitaires Paris-Nord, Paris, France
| | - Elie Azoulay
- Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Hôpitaux universitaires Paris-Nord, Paris, France
| | - Stéphane Gaudry
- Réanimation médico-chirurgicale, Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Sorbonne Paris Nord, Bobigny, France
| | - Julien Mayaux
- Service de Médecine Intensive Réanimation et Pneumologie, Hôpital Pitié-Salpêtrière Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France
| | | | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France
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14
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Villa A, Hermand V, Bonny V, Preda G, Urbina T, Gasperment M, Gabarre P, Missri L, Baudel JL, Zafimahazo D, Joffre J, Ait-Oufella H, Maury E. Improvement of central vein ultrasound-guided puncture success using a homemade needle guide-a simulation study. Crit Care 2023; 27:379. [PMID: 37777778 PMCID: PMC10543855 DOI: 10.1186/s13054-023-04661-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/26/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Out-of-plane (OOP) approach is frequently used for ultrasound-guided insertion of central venous catheter (CVC) owing to its simplicity but does not avoid mechanical complication. In-plane (IP) approach might improve safety of insertion; however, it is less easy to master. We assessed, a homemade needle guide device aimed to improve CVC insertion using IP approach. METHOD We evaluated in a randomized simulation trial, the impact of a homemade needle guide on internal jugular, subclavian and femoral vein puncture, using three approaches: out-of-plane free hand (OOP-FH), in-plane free hand (IP-FH), and in-plane needle guided (IP-NG). Success at first pass, the number of needle redirections and arterial punctures was recorded. Time elapsed (i) from skin contact to first skin puncture, (ii) from skin puncture to successful venous puncture and (iii) from skin contact to venous return were measured. RESULTS Thirty operators performed 270 punctures. IP-NG approach resulted in high success rate at first pass (jugular: 80%, subclavian: 95% and femoral: 100%) which was higher than success rate observed with OOP-FH and IP-FH regardless of the site (p = .01). Compared to IP-FH and OOP-FH, the IP-NG approach decreased the number of needle redirections at each site (p = .009) and arterial punctures (p = .001). Compared to IP-FH, the IP-NG approach decreased the total procedure duration for puncture at each site. CONCLUSION In this simulation study, IP approach using a homemade needle guide for ultrasound-guided central vein puncture improved success rate at first pass, reduced the number of punctures/redirections and shortened the procedure duration compared to OOP and IP free-hand approaches.
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Affiliation(s)
- Antoine Villa
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
| | | | - Vincent Bonny
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
- Faculty of Medicine, Sorbonne University, 75013, Paris, France
| | - Gabriel Preda
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
| | - Tomas Urbina
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
| | - Maxime Gasperment
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
| | - Paul Gabarre
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
- Faculty of Medicine, Sorbonne University, 75013, Paris, France
| | - Louai Missri
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
| | - Jean-Luc Baudel
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
| | - Daniel Zafimahazo
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
| | - Jérémie Joffre
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
- Faculty of Medicine, Sorbonne University, 75013, Paris, France
- INSERM UMR_S938, Centre de Recherche Saint-Antoine (CRSA), 75571, Paris Cedex 12, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France
- Faculty of Medicine, Sorbonne University, 75013, Paris, France
- Paris Cardiovascular Research Center, INSERM U970, Paris University, Paris, France
| | - Eric Maury
- Medical Intensive Care Unit, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Saint-Antoine University Hospital, Sorbonne University, 75012, Paris, France.
- Faculty of Medicine, Sorbonne University, 75013, Paris, France.
- Pierre Louis Institute of Epidemiology and Public Health, INSERM U1136, Sorbonne University, Paris, France.
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15
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Bonny V, Joffre J, Gabarre P, Urbina T, Missri L, Ladoire M, Gasperment M, Baudel JL, Guidet B, Dumas G, Maury E, Brochard L, Ait-Oufella H. Sonometric assessment of cough predicts extubation failure: SonoWean-a proof-of-concept study. Crit Care 2023; 27:368. [PMID: 37749612 PMCID: PMC10521471 DOI: 10.1186/s13054-023-04653-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Extubation failure is associated with increased mortality. Cough ineffectiveness may be associated with extubation failure, but its quantification for patients undergoing weaning from invasive mechanical ventilation (IMV) remains challenging. METHODS Patients under IMV for more than 24 h completing a successful spontaneous T-tube breathing trial (SBT) were included. At the end of the SBT, we performed quantitative sonometric assessment of three successive coughing efforts using a sonometer. The mean of the 3-cough volume in decibels was named Sonoscore. RESULTS During a 1-year period, 106 patients were included. Median age was 65 [51-75] years, mainly men (60%). Main reasons for IMV were acute respiratory failure (43%), coma (25%) and shock (17%). Median duration of IMV at enrollment was 4 [3-7] days. Extubation failure occurred in 15 (14%) patients. Baseline characteristics were similar between success and failure extubation groups, except percentage of simple weaning which was lower and MV duration which was longer in extubation failure patients. Sonoscore was significantly lower in patients who failed extubation (58 [52-64] vs. 75 [70-78] dB, P < 0.001). After adjustment on MV duration and comorbidities, Sonoscore remained associated with extubation failure. Sonoscore was predictive of extubation failure with an area under the ROC curve of 0.91 (IC95% [0.83-0.99], P < 0.001). A threshold of Sonoscore < 67.1 dB predicted extubation failure with a sensitivity of 0.93 IC95% [0.70-0.99] and a specificity of 0.82 IC95% [0.73-0.90]. CONCLUSION Sonometric assessment of cough strength might be helpful to identify patients at risk of extubation failure in patients undergoing IMV.
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Affiliation(s)
- Vincent Bonny
- Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
- Sorbonne Université, Paris, France
| | - Jeremie Joffre
- Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
- Sorbonne Université, Paris, France
| | - Paul Gabarre
- Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Tomas Urbina
- Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Louai Missri
- Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
- Sorbonne Université, Paris, France
| | - Mathilde Ladoire
- Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Maxime Gasperment
- Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Jean-Luc Baudel
- Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Bertrand Guidet
- Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
- Sorbonne Université, Paris, France
| | - Guillaume Dumas
- Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes, INSERM U1042-HP2, Université Grenoble-Alpes, Grenoble, France
| | - Eric Maury
- Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
- Sorbonne Université, Paris, France
| | - Laurent Brochard
- Unity Health Toronto, Keenan Research Centre, Interdepartmental Division of Critical Care Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, 508783, Canada
| | - Hafid Ait-Oufella
- Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.
- Sorbonne Université, Paris, France.
- Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France.
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16
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Villa A, Bougouin W, Urbina T, Bonny V, Gabarre P, Missri L, Baudel JL, Buzzi JC, Guidet B, Ait-Oufella H, Maury E, Joffre J. Impact of immunosuppressive regimen on ICU acquired pneumonia in critically ill COVID-19. Minerva Anestesiol 2023; 89:783-791. [PMID: 37166347 DOI: 10.23736/s0375-9393.23.17196-3] [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: 05/12/2023]
Abstract
BACKGROUND Immunosuppressors (IS) such as Dexamethasone (DXM), Tocilizumab, and high-dose methylprednisolone boli (HDMB), are used in COVID-19-related acute respiratory distress syndrome (ARDS). This study aimed to determine whether COVID-19 ARDS-related combined IS therapy was associated with an increased incidence of ICU-acquired pneumonia (IAP). METHODS We retrospectively analyzed COVID-19-ARDS admitted to ICU from March 2020 to April 2022. Patients' and IAP characteristics were analyzed according to five IS regimens: No IS, DXM alone, DXM+HDMB, DXM+tocilizumab, and DXM+tocilizumab+HDMB. To investigate the role of IS on IAP incidence, we performed a multivariate logistic regression and built a propensity score. Ultimately, we used a conditional logistic regression after pairing on the propensity score. RESULTS The study included 496 COVID-19-ARDS. Regarding the IS therapy, 12.7% received no IS, 43% DXM alone, 21.6% DXM+HDMB, 15.5% DXM+tocilizumab and 5.4% DXM+tocilizumab+HDMB. 37% presented at least one IAP, and the IAP incidence was higher with DXM+HDMB (66.4%) compared to no IS (P<0.0001), DXM (P<0.0001) and DXM+tocilizumab (P<0.0001). HDMB and probabilistic antibiotherapy at admission were independent IAP predictors after adjustment on the propensity score (respectively OR:2.44; P<0.0001 and OR:2.85; P<0.001). CONCLUSIONS In critically ill COVID-19, HDMB significantly increases the risk of IAP whereas DXM alone, nor in combination with tocilizumab, did not.
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Affiliation(s)
- Antoine Villa
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
| | - Wulfran Bougouin
- Intensive Care Unit, Ramsay Générale de Santé - Jacques Cartier Hospital, Massy, France
- Paris Cardiovascular Research Center, Paris Sudden Death Expertise Center, INSERM Unit 970, Paris, France
| | - Tomas Urbina
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
| | - Vincent Bonny
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
- Faculty of Medicine, Sorbonne University, Paris, France
| | - Paul Gabarre
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
- Faculty of Medicine, Sorbonne University, Paris, France
| | - Louai Missri
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
| | - Jean-Luc Baudel
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
| | - Jean-Claude Buzzi
- Medical Information Department, Saint Antoine Hospital, Paris, France
| | - Bertrand Guidet
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
- Faculty of Medicine, Sorbonne University, Paris, France
- Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, INSERM U1136, Paris, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
- Paris Cardiovascular Research Center, Paris Sudden Death Expertise Center, INSERM Unit 970, Paris, France
- Paris Cardiovascular Research Center, Paris University, INSERM U970, Paris, France
| | - Eric Maury
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France
- Faculty of Medicine, Sorbonne University, Paris, France
| | - Jérémie Joffre
- Medical Intensive Care Unit, Saint Antoine Hospital, Paris, France -
- Faculty of Medicine, Sorbonne University, Paris, France
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR-S938, Paris, France
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17
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Bonny V, Urbina T, Berti E, Maury É, Ait-Oufella H. Tissue hypoperfusion is associated with poor outcome in patients admitted for acute pulmonary embolism. Eur J Emerg Med 2023; 30:214-215. [PMID: 37103902 DOI: 10.1097/mej.0000000000001013] [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: 04/28/2023]
Affiliation(s)
- Vincent Bonny
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
- Sorbonne Université
| | - Tomas Urbina
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
| | - Enora Berti
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
| | - Éric Maury
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
- Sorbonne Université
| | - Hafid Ait-Oufella
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
- Sorbonne Université
- Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France
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18
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Arrestier R, Chaba A, Mabrouki A, Saccheri C, Canet E, Pineton de Chambrun M, Stoclin A, Picard M, Wallet F, Perier F, Turpin M, Argaud L, Decavèle M, Issa N, Cadoz C, Klouche K, Cohen J, Mokart D, Grouille J, Urbina T, Hua C, Chosidow O, Mekontso-Dessap A, Azoulay E, de Prost N. Necrotizing soft tissue infections in critically ill neutropenic patients: a French multicentre retrospective cohort study. Ann Intensive Care 2023; 13:34. [PMID: 37115415 PMCID: PMC10147851 DOI: 10.1186/s13613-023-01125-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Necrotizing soft tissue infections (NSTIs) are rare life-threatening bacterial infections. Few data are available regarding neutropenic patients with NSTIs. Our objectives were to describe the characteristics and management of neutropenic patients with NSTIs in intensive care units (ICUs). We conducted a retrospective multicentre cohort study in 18 ICUs between 2011 and 2021. Patients admitted with NSTIs and concomitant neutropenia at diagnosis were included and compared to non-neutropenic patients with NSTIs. The relationship between therapeutic interventions and outcomes was assessed using Cox regression and propensity score matching. RESULTS 76 neutropenic patients were included and compared to 165 non-neutropenic patients. Neutropenic patients were younger (54 ± 14 vs 60 ± 13 years, p = 0.002) and had less lower limb (44.7% vs 70.9%, p < 0.001) and more abdomino-perineal NSTIs (43.4% vs 18.8%, p < 0.001). Enterobacterales and non-fermenting gram-negative bacteria were the most frequently isolated microorganisms in neutropenic patients. In-hospital mortality was significantly higher in neutropenic than in non-neutropenic patients (57.9% vs 28.5%, p < 0.001). Granulocyte colony-stimulating factor (G-CSF) administration was associated with a lower risk of in-hospital mortality in univariable Cox (hazard ratio (HR) = 0.43 95% confidence interval (CI) [0.23-0.82], p = 0.010) and multivariable Cox (adjusted HR = 0.46 95% CI [0.22-0.94], p = 0.033) analyses and after overlap propensity score weighting (odds ratio = 0.25 95% CI [0.09; 0.68], p = 0.006). CONCLUSIONS Critically ill neutropenic patients with NSTIs present different clinical and microbiological characteristics and are associated with a higher hospital mortality than non-neutropenic patients. G-CSF administration was associated with hospital survival.
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Affiliation(s)
- Romain Arrestier
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, CEDEX, Créteil, 94010, Paris, France.
- Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, CEDEX, Créteil, 94010, Paris, France.
- INSERM, IMRB, Université Paris Est Créteil, CEDEX, Créteil, 94010, Paris, France.
| | - Anis Chaba
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris-Centre, Hôpital Cochin, Paris, France
| | - Asma Mabrouki
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Clément Saccheri
- Service de Médecine Intensive Réanimation, Hôpital Archet 1, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Emmanuel Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Annabelle Stoclin
- Service de Médecine Intensive Et Réanimation, Institut Gustave Roussy, Villejuif, France
| | - Muriel Picard
- Service de Réanimation Polyvalente, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Florent Wallet
- Hospices Civils de Lyon, Service d'anesthésie, Médecine Intensive, Réanimation, CHU Lyon Sud, Pierre-Bénite, France
| | - François Perier
- Réanimation Médico-Chirurgicale, Hôpital André Mignot, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France
| | - Matthieu Turpin
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
| | - Laurent Argaud
- Service de Médecine Intensive, Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Maxens Decavèle
- AP-HP, Sorbonne Université, Site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, Hôpital Pitié-Salpêtrière, Paris, France
| | - Nahéma Issa
- Médecine Intensive Réanimation, Hôpital Saint-André, CHU Bordeaux, France
| | - Cyril Cadoz
- Réanimation Polyvalente, CHR Metz-Thionville Hôpital de Mercy, Metz, France
| | - Kada Klouche
- Service de Médecine Intensive et Réanimation, CHU Montpellier, France
| | - Johana Cohen
- Service de Médecine Intensive et Réanimation, Groupe Hospitalier Intercommunal le Raincy Montfermeil, Montfermeil, France
| | - Djamel Mokart
- Unité Traitement Soins Intensifs, Institut J.Paoli, I.Calmettes, Marseille, France
| | - Julien Grouille
- Service de Réanimation Polyvalente, Centre Hospitalier Simone Veil, Blois, France
| | - Tomas Urbina
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Camille Hua
- Service de Dermatologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, CEDEX, Créteil, 94010, Paris, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Olivier Chosidow
- Service de Dermatologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, CEDEX, Créteil, 94010, Paris, France
| | - Armand Mekontso-Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, CEDEX, Créteil, 94010, Paris, France
- Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, CEDEX, Créteil, 94010, Paris, France
- INSERM, IMRB, Université Paris Est Créteil, CEDEX, Créteil, 94010, Paris, France
| | - Elie Azoulay
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, CEDEX, Créteil, 94010, Paris, France
- Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, CEDEX, Créteil, 94010, Paris, France
- INSERM, IMRB, Université Paris Est Créteil, CEDEX, Créteil, 94010, Paris, France
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Razazi K, Martins Bexiga A, Arrestier R, Peiffer B, Voiriot G, Luyt CE, Urbina T, Mayaux J, Pham T, Roux D, Bellaiche R, AIt Hamou Z, Gaudry S, Azoulay E, Mekontso Dessap A, Rodriguez C, Pawlotsky JM, Fourati S, de Prost N. SARS-CoV-2 variants and mutational patterns: relationship with risk of ventilator-associated pneumonia in critically ill COVID-19 patients in the era of dexamethasone. Sci Rep 2023; 13:6658. [PMID: 37095145 PMCID: PMC10123590 DOI: 10.1038/s41598-023-33639-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/16/2023] [Indexed: 04/26/2023] Open
Abstract
We aimed to explore the relationships between specific viral mutations/mutational patterns and ventilator-associated pneumonia (VAP) occurrence in COVID-19 patients admitted in intensive care units between October 1, 2020, and May 30, 2021. Full-length SARS-CoV-2 genomes were sequenced by means of next-generation sequencing. In this prospective multicentre cohort study, 259 patients were included. 222 patients (47%) had been infected with pre-existing ancestral variants, 116 (45%) with variant α, and 21 (8%) with other variants. 153 patients (59%) developed at least one VAP. There was no significant relationship between VAP occurrence and a specific SARS CoV-2 lineage/sublineage or mutational pattern.
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Affiliation(s)
- Keyvan Razazi
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 51, Av de Lattre de Tassigny, 94000, Créteil Cedex, France.
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), Créteil, France.
- Université Paris-Est-Créteil (UPEC), Créteil, France.
| | - Anissa Martins Bexiga
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 51, Av de Lattre de Tassigny, 94000, Créteil Cedex, France
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), Créteil, France
| | - Romain Arrestier
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 51, Av de Lattre de Tassigny, 94000, Créteil Cedex, France
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), Créteil, France
| | - Bastien Peiffer
- DMU Medecine, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Guillaume Voiriot
- Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Charles-Edouard Luyt
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Médecine Intensive Réanimation, and INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Tomas Urbina
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Médecine Intensive Réanimation, 75571, Paris Cedex 12, France
| | - Julien Mayaux
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Médecine Intensive Réanimation, Paris, France
| | - Tài Pham
- Université Paris-Est-Créteil (UPEC), Créteil, France
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, FHU Sepsis, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm U1018, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France
| | - Damien Roux
- Université de Paris, APHP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, Colombes, France
- Department of Immunology, Infectiology and Hematology, INSERM U1151, CNRS UMR 8253, Institut Necker-Enfants Malades (INEM), Colombes, Paris, France
| | - Raphael Bellaiche
- Département d'Anesthésie Réanimations Chirurgicales, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Zakaria AIt Hamou
- Médecine Intensive Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Gaudry
- Service de Réanimation, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Elie Azoulay
- Médecine Intensive Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Armand Mekontso Dessap
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 51, Av de Lattre de Tassigny, 94000, Créteil Cedex, France
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), Créteil, France
- Université Paris-Est-Créteil (UPEC), Créteil, France
| | - Christophe Rodriguez
- Université Paris-Est-Créteil (UPEC), Créteil, France
- Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
- INSERM U955, Team «Viruses, Hepatology, Cancer», Créteil, France
| | - Jean-Michel Pawlotsky
- Université Paris-Est-Créteil (UPEC), Créteil, France
- Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
- INSERM U955, Team «Viruses, Hepatology, Cancer», Créteil, France
| | - Slim Fourati
- Université Paris-Est-Créteil (UPEC), Créteil, France
- Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
- INSERM U955, Team «Viruses, Hepatology, Cancer», Créteil, France
| | - Nicolas de Prost
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 51, Av de Lattre de Tassigny, 94000, Créteil Cedex, France
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), Créteil, France
- Université Paris-Est-Créteil (UPEC), Créteil, France
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20
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Mongereau M, Hua C, Urbina T, Woerther PL, Pelegrin T, de'Angelis N, De Roux Q, Bosc R, Hersant B, de Prost N, Chosidow O. Abdominoperineal necrotizing soft tissue infection: A single-centre retrospective study of 61 patients including short- and medium-term source of infection check. J Eur Acad Dermatol Venereol 2023; 37:e463-e465. [PMID: 36373269 DOI: 10.1111/jdv.18729] [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: 07/19/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Margaux Mongereau
- Department of Dermatology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France
| | - Camille Hua
- Department of Dermatology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France
| | - Tomas Urbina
- Department of Intensive Care, AP-HP, Hôpital Saint Antoine, Faculté de Santé, Université Sorbonne, Université Pierre-et-Marie Curie-Paris 6, Paris, France
| | - Paul Louis Woerther
- Department of Microbiology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France
| | - Tiphaine Pelegrin
- Department of Urology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France
| | - Nicola de'Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France
| | - Quentin De Roux
- Department of Surgical Intensive Care Unit, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France
| | - Romain Bosc
- Department of Plastic Surgery, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France
| | - Barbara Hersant
- Department of Plastic Surgery, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France
| | - Nicolas de Prost
- Department of Intensive Care, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France.,Groupe de Recherche Clinique CARMAS, Université Paris-Est, Créteil, France
| | - Olivier Chosidow
- Department of Dermatology, AP-HP, Hôpital Henri Mondor, Faculté de Santé, Université Paris-Est, Créteil, France.,Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
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21
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Joffre J, Raia L, Urbina T, Bonny V, Gabarre P, Missri L, Baudel JL, Coppo P, Guidet B, Maury E, Ait-Oufella H. Reversible skin microvascular hyporeactivity in patients with immune-mediated thrombocytopenic thrombotic purpura. Crit Care 2023; 27:116. [PMID: 36944989 PMCID: PMC10028781 DOI: 10.1186/s13054-023-04405-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare disease characterized by arteriolar and capillary microthrombosis precipitating organ failure. However, the contribution of endothelial dysfunction on impaired microvascular blood flow in iTTP patients has been poorly explored. This pilot observational study aimed to explore endothelial-mediated vasoreactivity in iTTP patients at admission and its changes after plasma exchange therapy (PE). METHODS We conducted a prospective observational study in patients (> 18-year old) admitted in ICU for iTTP. Using laser Doppler flowmetry and acetylcholine (Ach) iontophoresis in the forearm, we recorded the skin microvascular blood flow and the endothelium-mediated vasoreactivity at admission and after PE. Demographics, biological, clinical courses, and outcomes were also collected. As a control group, we used a previously published cohort of young diabetic patients after correction of ketoacidosis. RESULTS Eighteen confirmed iTTP patients and 34 controls were included in the study, mainly female (72%) aged 43 ± 16-year-old. At admission, 55% had neurological abnormalities, 50% cardiac issues and 27.8% an acute kidney injury. Median platelet count was 19 G/mL [10-37]. Baseline microvascular blood flow was decreased in iTTP patients when compared to controls (5.97 ± 4.5 vs. 10.1 ± 6.3 PU, P = 0.03), associated with markedly impaired endothelial-mediated skin microvascular reactivity (AUC: 9627 ± 8122 vs. 16,475 ± 11,738, P = 0.03). Microvascular reactivity improved after the first PE session (AUC: 9627 ± 8122 vs 16,558 ± 10,699, P = 0.007, respectively, baseline and post-PE1) and much more after the second session (26,431 ± 23,181, P = 0.04 post-PE1 vs post-PE2). Hemolysis biomarkers (LDH and bilirubin) negatively correlated with skin microvascular flow and vasoreactivity. CONCLUSION We highlighted a marked yet reversible skin endothelium-mediated microvascular hyporeactivity in iTTP patients that could participate in organ injury pathophysiology.
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Affiliation(s)
- Jérémie Joffre
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
- Centre de Recherche Saint-Antoine Inserm UMR-S 938, Sorbonne University, 75012, Paris, France
| | - Lisa Raia
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Tomas Urbina
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Vincent Bonny
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Paul Gabarre
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Louai Missri
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Jean-Luc Baudel
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Paul Coppo
- Hematology Department, AP-HP, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
- French Reference Center for Thrombotic Microangiopathies (CNR-MAT), Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Bertrand Guidet
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Eric Maury
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Hafid Ait-Oufella
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
- Paris Cardiovascular Research Center, Inserm U970, University Paris Cité, Paris, France.
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22
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Azoulay E, Souppart V, Kentish-Barnes N, Benhamou Y, Joly BS, Zafrani L, Joseph A, Canet E, Presne C, Grall M, Zerbib Y, Provot F, Fadlallah J, Mariotte E, Urbina T, Veyradier A, Coppo P. Post-traumatic stress disorder and quality of life alterations in survivors of immune-mediated thrombotic thrombocytopenic purpura and atypical hemolytic and uremic syndrome. J Crit Care 2023; 76:154283. [PMID: 36931181 DOI: 10.1016/j.jcrc.2023.154283] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/20/2023] [Accepted: 02/22/2023] [Indexed: 03/17/2023]
Abstract
Thrombotic thrombocytopenic purpura (iTTP) and atypical hemolytic-uremic syndrome (aHUS), once in remission, may cause long-term symptoms, among which mental-health impairments may be difficult to detect. We conducted telephone interviews 72 [48-84] months after ICU discharge to assess symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) and the 36-item Short Form questionnaire (SF-36). Of 103 included patients, 52 had iTTP and 51 aHUS; 74% were female, median age was 39 y (31-54), and 39 (38%) patients were still taking treatment. Symptoms of anxiety, PTSD and depression were present in 50%, 27% and 14% of patients, respectively, with no significant difference between the iTTP and aHUS groups. Patients with PTSD symptoms had significantly greater weight gain and significantly worse perceived physical and/or emotional wellbeing, anxiety symptoms, and depression symptoms. The SF-36 physical and mental components indicated significantly greater quality-of-life impairments in patients with vs. without PTSD symptoms and in those with aHUS and PTSD vs. iTTP with or without PTSD. In the aHUS group, quality of life was significantly better in patients with vs. without eculizumab treatment. Factors independently associated with PTSD symptoms were male sex (odds ratio [OR], 0.11; 95%CI, 0.02-0.53), platelet count ≤20 G/L at acute-episode presentation (OR, 2.68; 1.01-7.38), and current treatment (OR, 2.69; 95%CI, 1.01-7.36). Mental-health screening should be routine in patients with iTTP and aHUS to ensure appropriate care.
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Affiliation(s)
- Elie Azoulay
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France,; Famirea Study Group, APHP, Hôpital Saint Louis, Paris, France.
| | - Virginie Souppart
- Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France,; Famirea Study Group, APHP, Hôpital Saint Louis, Paris, France
| | - Nancy Kentish-Barnes
- Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France,; Famirea Study Group, APHP, Hôpital Saint Louis, Paris, France
| | - Ygal Benhamou
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Département de médecine interne, Hôpital universitaire de Rouen, Université de Normandie, Rouen, France
| | - Bérangère S Joly
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Service d'hématologie biologique, laboratoire ADAMTS13, Hôpital Lariboisière, AP-HP Nord, Université Paris Cité, Paris, France; EA3518, Institut de recherche Saint Louis, Université Paris Cité, Paris, France
| | - Lara Zafrani
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France
| | - Adrien Joseph
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France
| | - Emmanuel Canet
- Médecine Intensive et Réanimation, CHU de Nantes, France
| | - Claire Presne
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Service de Néphrologie, Médecine Interne, Hémodialyse, Transplantation du CHU d'AMIENS PICARDIE, France
| | - Maximilien Grall
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Département de médecine interne, Hôpital universitaire de Rouen, Université de Normandie, Rouen, France
| | - Yoann Zerbib
- Médecine Intensive et Réanimation, CHU d'Amiens, France
| | - François Provot
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Département de néphrologie, dialyse et transplantation, Université de Lille, CHU de Lille, France
| | - Jehane Fadlallah
- Département d'immunologie clinique, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Eric Mariotte
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France
| | - Tomas Urbina
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint-Antoine, France
| | - Agnès Veyradier
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Service d'hématologie biologique, laboratoire ADAMTS13, Hôpital Lariboisière, AP-HP Nord, Université Paris Cité, Paris, France; EA3518, Institut de recherche Saint Louis, Université Paris Cité, Paris, France
| | - Paul Coppo
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Service d'Hématologie, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
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23
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Hua C, Urbina T, Bosc R, Parks T, Sriskandan S, de Prost N, Chosidow O. Necrotising soft-tissue infections. Lancet Infect Dis 2023; 23:e81-e94. [PMID: 36252579 DOI: 10.1016/s1473-3099(22)00583-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/05/2022] [Accepted: 08/22/2022] [Indexed: 11/07/2022]
Abstract
The incidence of necrotising soft-tissue infections has increased during recent decades such that most physicians might see at least one case of these potentially life-threatening infections in their career. Despite advances in care, necrotising soft-tissue infections are still associated with high morbidity and mortality, underlining a need for continued education of the medical community. In particular, failure to suspect necrotising soft-tissue infections, fuelled by poor awareness of the disease, promotes delays to first surgical debridement, amplifying disease severity and adverse outcomes. This Review will focus on practical approaches to management of necrotising soft-tissue infections including prompt recognition, initiation of specific management, exploratory surgery, and aftercare. Increased alertness and awareness for these infections should improve time to diagnosis and early referral to specialised centres, with improvement in the prognosis of necrotising soft-tissue infections.
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Affiliation(s)
- Camille Hua
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris, Créteil, France; Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France; Epidemiology in Dermatology and Evaluation of Therapeutics, Université Paris Est Créteil, Créteil, France; Groupe Infectiologie Dermatologique-Infections Sexuellement Transmissibles, Société Française de Dermatologie, Paris, France
| | - Tomas Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Bosc
- Service de Chirurgie Plastique, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Tom Parks
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Shiranee Sriskandan
- Department of Infectious Diseases, Imperial College London, London, UK; MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London, UK
| | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, Créteil, France; CARMAS Research Group, UPEC-Université Paris-Est Créteil Val de Marne, Faculté de médecine de Créteil, Créteil, France
| | - Olivier Chosidow
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris, Créteil, France; Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France; Groupe Infectiologie Dermatologique-Infections Sexuellement Transmissibles, Société Française de Dermatologie, Paris, France; Research group Dynamyc, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France.
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24
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Palayer M, Chaussenery-Lorentz O, Boubekeur L, Urbina T, Maury E, Maubert MA, Pilon A, Bourgogne E. Quantitation of 10 antibiotics in plasma: sulfosalicylic acid combined with 2D-LC-MS/MS is a robust assay for beta-lactam therapeutic drug monitoring. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1221:123685. [PMID: 37023569 DOI: 10.1016/j.jchromb.2023.123685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
Abstract
Therapeutic drug monitoring (TDM) of antibiotics is particularly important in populations with high pharmacokinetic variabilities, such as critically ill patients, leading to unpredictable plasma concentrations and clinical outcomes. Here, we i) describe an original method for the simultaneous quantification of ten antibiotics (cefepime, ceftazidime, ampicillin, piperacillin/tazobactam, cefotaxime, amoxicillin, cloxacillin, oxacillin, linezolid) using 5-sulfosalicylic acid dihydrate (SSA) solution for protein precipitation together with 2D-LC-MS/MS, and ii) evaluate its impact in a one-year retrospective study. The method involved simple dilution with an aqueous mix of deuterated internal standards and plasma protein precipitation with SSA. Twenty microliters of the supernatant was injected into a C8 SPE online cartridge (30 × 2.1 mm) without any evaporation step and back-flushed onto a C18 UHPLC (100 × 2.1 mm) analytical column. Mass spectrometry detection (Xevo TQD) was performed in positive electrospray, in scheduled MRM mode. Overall analytical runtime was 7 min. Due to analytical constraints and the physicochemical properties of the antibiotics, protein precipitation using organic solvents could not be applied. As an alternative, SSA used with 2D-LC offered various advantages: i) lack of dilution resulting in better assay sensitivity, and ii) good chromatography of hydrophilic compounds. Ten microliters of 30% SSA in water eliminated>90% of plasma proteins, including the most abundant high molecular weight proteins at 55 and 72 kDa. The assay was successfully validated according to FDA and EMA guidelines for all the antibiotics, and the coefficients of variation of the quality control (QC) run during sample analysis over one year were below 10%, whatever the QC levels or the antibiotics. The use of 2D-LC combined with SSA precipitation allowed development of a robust, sensitive and rapid quantification assay. Feedback to clinicians was reduced to 24 h, thus allowing rapid dosage adjustment. During one year, 3,304 determinations were performed in our laboratory: 41% were not in the therapeutic range, 58% of which were sub-therapeutic, underlining the importance of early TDM of antibiotics to limit therapeutic failures and the emergence of bacterial resistance.
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25
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Urbina T, Chousterman B. [Two particular forms: cervicofacial fasciitis and Fournier's gangrene]. Rev Prat 2023; 73:150-152. [PMID: 36916254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Tomas Urbina
- Service de médecine intensive réanimation, hôpital Saint-Antoine, AP-HP, Paris, France
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26
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Traineau H, Charpentier C, Lepeule R, Ingen-Housz-Oro S, Hersant B, Urbina T, de Prost N, Hua C, Chosidow O. First-year recurrence rate of skin and soft tissue infections following an initial necrotizing soft tissue infection of the lower extremities: A retrospective cohort study of 93 patients. J Am Acad Dermatol 2023:S0190-9622(23)00088-9. [PMID: 36702443 DOI: 10.1016/j.jaad.2022.12.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/13/2022] [Accepted: 12/25/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Hélène Traineau
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.
| | - Chloé Charpentier
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Raphaël Lepeule
- Antimicrobial Stewardship Team, Department of Prevention, Diagnosis, and Treatment of Infections, APHP, Henri Mondor Hospital, Creteil, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France; Université Paris Est de Créteil EpidermE, UPEC, Créteil, France
| | - Barbara Hersant
- Department of Plastic Surgery, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Tomas Urbina
- Department of Intensive Care Medicine, AP-HP, Saint Antoine Hospital, Paris, France
| | - Nicolas de Prost
- Department of Intensive Care Medicine, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Camille Hua
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Olivier Chosidow
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
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27
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Gabarre P, Urbina T, Cunat S, Merdji H, Bonny V, Lavillegrand JR, Raia L, Bige N, Baudel JL, Maury E, Guidet B, Helms J, Ait-Oufella H. Impact of corticosteroids on the procoagulant profile of critically ill COVID-19 patients: a before-after study. Minerva Anestesiol 2023; 89:48-55. [PMID: 36282222 DOI: 10.23736/s0375-9393.22.16640-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Several studies have reported an increased risk of thrombotic events in COVID-19 patients, but the pathophysiology of this procoagulant phenotype remains poorly understood. We hypothesized that corticosteroids may attenuate this procoagulant state through their anti-inflammatory effects. The aim of this study was to evaluate the impact of dexamethasone (DXM) on the coagulation profile of severely ill COVID-19 patients. METHODS We conducted a retrospective, observational before/after bi-centric cohort study among ICU patients hospitalized for severe COVID-19 and receiving therapeutic anticoagulation by unfractionated heparin (UFH). Before and after the standardized use of DXM, we compared inflammatory and coagulation profiles, as well as the kinetics of heparin requirement, adjusted for weight and anti-Xa activity. RESULTS Eighty-six patients were included, 35 in the no-DXM group, and 51 in the DXM group. At admission, CRP and fibrinogen levels were not different between groups, neither were UFH infusion rates. At day 3 after ICU admission, CRP (178±94 mg/L vs. 99±68 mg/L, P<0.001) and fibrinogen (7.2±1.4 g/L vs. 6.1±1.4 g/L, P=0.001) significantly decreased in the DXM group, but not in the no-DXM group. Over time, UFH infusion rates were lower in the DXM group (P<0.001) without any significant difference in plasma anti-Xa activity. CRP variations correlated with heparin dose variations between Day 0 and Day 3 (r=0.39, P=0.009). Finally, the incidence of venous thromboembolic events during in-ICU stay was significantly reduced in the DXM group (4 vs. 43%, P<0.0001). CONCLUSIONS In critically ill COVID-19 patients, dexamethasone use was associated with a decrease in both pro-inflammatory and procoagulant profile.
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Affiliation(s)
- Paul Gabarre
- Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, France.,Sorbonne University, Paris, France
| | - Tomas Urbina
- Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, France.,Sorbonne University, Paris, France
| | - Sibylle Cunat
- Unit of Intensive Medicine and Resuscitation, Civil Hospital of Strasbourg, Strasbourg, France
| | - Hamid Merdji
- Unit of Intensive Medicine and Resuscitation, Civil Hospital of Strasbourg, Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Vincent Bonny
- Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, France
| | | | - Lisa Raia
- Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, France
| | - Naïke Bige
- Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, France
| | - Jean-Luc Baudel
- Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, France
| | - Eric Maury
- Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, France.,Sorbonne University, Paris, France
| | - Bertrand Guidet
- Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, France.,Sorbonne University, Paris, France
| | - Julie Helms
- Unit of Intensive Medicine and Resuscitation, Civil Hospital of Strasbourg, Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Hafid Ait-Oufella
- Unit of Intensive Medicine and Resuscitation, Saint-Antoine Hospital, Paris, France - .,Sorbonne University, Paris, France.,Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France
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28
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Arrestier R, Bastard P, Belmondo T, Voiriot G, Urbina T, Luyt CE, Gervais A, Bizien L, Segaux L, Ben Ahmed M, Bellaïche R, Pham T, Ait-Hamou Z, Roux D, Clere-Jehl R, Azoulay E, Gaudry S, Mayaux J, Fage N, Ait-Oufella H, Moncomble E, Parfait M, Dorgham K, Gorochov G, Mekontso-Dessap A, Canoui-Poitrine F, Casanova JL, Hue S, de Prost N. Auto-antibodies against type I IFNs in > 10% of critically ill COVID-19 patients: a prospective multicentre study. Ann Intensive Care 2022; 12:121. [PMID: 36586050 PMCID: PMC9803887 DOI: 10.1186/s13613-022-01095-5] [Citation(s) in RCA: 16] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/11/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Auto-antibodies (auto-Abs) neutralizing type I interferons (IFN) have been found in about 15% of critical cases COVID-19 pneumonia and less than 1% of mild or asymptomatic cases. Determining whether auto-Abs influence presentation and outcome of critically ill COVID-19 patients could lead to specific therapeutic interventions. Our objectives were to compare the severity at admission and the mortality of patients hospitalized for critical COVID-19 in ICU with versus without auto-Abs. RESULTS We conducted a prospective multicentre cohort study including patients admitted in 11 intensive care units (ICUs) from Great Paris area hospitals with proven SARS-CoV-2 infection and acute respiratory failure. 925 critically ill COVID-19 patients were included. Auto-Abs neutralizing type I IFN-α2, β and/or ω were found in 96 patients (10.3%). Demographics and comorbidities did not differ between patients with versus without auto-Abs. At ICU admission, Auto-Abs positive patients required a higher FiO2 (100% (70-100) vs. 90% (60-100), p = 0.01), but were not different in other characteristics. Mortality at day 28 was not different between patients with and without auto-Abs (18.7 vs. 23.7%, p = 0.279). In multivariable analysis, 28-day mortality was associated with age (adjusted odds ratio (aOR) = 1.06 [1.04-1.08], p < 0.001), SOFA score (aOR = 1.18 [1.12-1.23], p < 0.001) and immunosuppression (aOR = 1.82 [1.1-3.0], p = 0.02), but not with the presence of auto-Abs (aOR = 0.69 [0.38-1.26], p = 0.23). CONCLUSIONS In ICU patients, auto-Abs against type I IFNs were found in at least 10% of patients with critical COVID-19 pneumonia. They were not associated with day 28 mortality.
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Affiliation(s)
- Romain Arrestier
- grid.412116.10000 0004 1799 3934Service de Médecine Intensive Réanimation, Service de Réanimation Médicale, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, 94010 Paris, Cedex, France ,grid.410511.00000 0001 2149 7878Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France ,grid.462410.50000 0004 0386 3258INSERM, IMRB, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France
| | - Paul Bastard
- grid.412134.10000 0004 0593 9113Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France ,grid.10988.380000 0001 2173 743XImagine Institute, University of Paris, Paris, France ,grid.134907.80000 0001 2166 1519St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY USA
| | - Thibaut Belmondo
- grid.50550.350000 0001 2175 4109Département d’Hématologie et d’Immunologie Biologiques, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalo-Universitaire Chenevier Mondor, Créteil, 94010 Paris, France
| | - Guillaume Voiriot
- Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Tomas Urbina
- grid.412370.30000 0004 1937 1100Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Charles-Edouard Luyt
- grid.462844.80000 0001 2308 1657Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France ,grid.477396.80000 0004 3982 4357INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Adrian Gervais
- grid.412134.10000 0004 0593 9113Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France ,grid.10988.380000 0001 2173 743XImagine Institute, University of Paris, Paris, France ,grid.134907.80000 0001 2166 1519St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY USA
| | - Lucy Bizien
- grid.412134.10000 0004 0593 9113Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France ,grid.10988.380000 0001 2173 743XImagine Institute, University of Paris, Paris, France ,grid.134907.80000 0001 2166 1519St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY USA
| | - Lauriane Segaux
- grid.462410.50000 0004 0386 3258INSERM, IMRB, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France ,grid.50550.350000 0001 2175 4109Unité de Recherche Clinique AP-HP, Hôpitaux Henri-Mondor, 94010 Creteil, Cedex, France
| | - Mariem Ben Ahmed
- grid.10988.380000 0001 2173 743XImagine Institute, University of Paris, Paris, France
| | - Raphaël Bellaïche
- grid.412116.10000 0004 1799 3934Service d’Anesthésie-Réanimation Chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 94000 Créteil, France
| | - Taï Pham
- grid.413784.d0000 0001 2181 7253Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, FHU Sepsis, Groupe de Recherche Clinique CARMAS, Le Kremlin-Bicêtre, France
| | - Zakaria Ait-Hamou
- grid.411784.f0000 0001 0274 3893Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre & Université de Paris, Paris, France
| | - Damien Roux
- grid.414205.60000 0001 0273 556XMédecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, 92700 Colombes, France
| | - Raphael Clere-Jehl
- grid.413328.f0000 0001 2300 6614Service de médecine intensive et réanimation, Hôpital Saint-Louis, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Elie Azoulay
- grid.413328.f0000 0001 2300 6614Service de médecine intensive et réanimation, Hôpital Saint-Louis, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Stéphane Gaudry
- grid.413780.90000 0000 8715 2621Département de réanimation médico-chirurgicale, APHP Hôpital Avicenne, Bobigny, France
| | - Julien Mayaux
- grid.50550.350000 0001 2175 4109Groupe Hospitalier Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, Service de Pneumologie et Réanimation Médicale, Paris, France
| | - Nicolas Fage
- grid.413784.d0000 0001 2181 7253Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, FHU Sepsis, Groupe de Recherche Clinique CARMAS, Le Kremlin-Bicêtre, France
| | - Hafid Ait-Oufella
- grid.412370.30000 0004 1937 1100Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Elsa Moncomble
- grid.412116.10000 0004 1799 3934Service de Médecine Intensive Réanimation, Service de Réanimation Médicale, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, 94010 Paris, Cedex, France ,grid.410511.00000 0001 2149 7878Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France
| | - Mélodie Parfait
- grid.412116.10000 0004 1799 3934Service de Médecine Intensive Réanimation, Service de Réanimation Médicale, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, 94010 Paris, Cedex, France
| | - Karim Dorgham
- grid.463810.8Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), 75013 Paris, France
| | - Guy Gorochov
- grid.463810.8Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), 75013 Paris, France ,grid.411439.a0000 0001 2150 9058Département d’Immunologie, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Armand Mekontso-Dessap
- grid.412116.10000 0004 1799 3934Service de Médecine Intensive Réanimation, Service de Réanimation Médicale, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, 94010 Paris, Cedex, France ,grid.410511.00000 0001 2149 7878Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France ,grid.462410.50000 0004 0386 3258INSERM, IMRB, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France
| | - Florence Canoui-Poitrine
- grid.462410.50000 0004 0386 3258INSERM, IMRB, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France ,grid.50550.350000 0001 2175 4109Groupe Hospitalier Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, Service de Pneumologie et Réanimation Médicale, Paris, France
| | - Jean-Laurent Casanova
- grid.412134.10000 0004 0593 9113Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France ,grid.10988.380000 0001 2173 743XImagine Institute, University of Paris, Paris, France ,grid.134907.80000 0001 2166 1519St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY USA
| | - Sophie Hue
- grid.462410.50000 0004 0386 3258INSERM, IMRB, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France ,grid.50550.350000 0001 2175 4109Département d’Hématologie et d’Immunologie Biologiques, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalo-Universitaire Chenevier Mondor, Créteil, 94010 Paris, France
| | - Nicolas de Prost
- grid.412116.10000 0004 1799 3934Service de Médecine Intensive Réanimation, Service de Réanimation Médicale, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, 94010 Paris, Cedex, France ,grid.410511.00000 0001 2149 7878Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France ,grid.462410.50000 0004 0386 3258INSERM, IMRB, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France
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29
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Windsor C, Hua C, De Roux Q, Harrois A, Anguel N, Montravers P, Vieillard-Baron A, Mira JP, Urbina T, Gaudry S, Turpin M, Damoisel C, Annane D, Ricard JD, Hersant B, Dessap AM, Chosidow O, Layese R, de Prost N. Healthcare trajectory of critically ill patients with necrotizing soft tissue infections: a multicenter retrospective cohort study using the clinical data warehouse of Greater Paris University Hospitals. Ann Intensive Care 2022; 12:115. [PMID: 36538244 PMCID: PMC9768077 DOI: 10.1186/s13613-022-01087-5] [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: 09/26/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Necrotizing skin and soft tissue infections (NSTIs) are rare but serious and rapidly progressive infections characterized by necrosis of subcutaneous tissue, fascia and even muscle. The care pathway of patients with NSTIs is poorly understood. A better characterization of the care trajectory of these patients and a better identification of patients at risk of a complicated evolution, requiring prolonged hospitalization, multiple surgical re-interventions, or readmission to the intensive care unit (ICU), is an essential prerequisite to improve their care. The main objective of this study is to obtain large-scale data on the care pathway of these patients. We performed a retrospective multicenter observational cohort study in 13 Great Paris area hospitals, including patients hospitalized between January 1, 2015 and December 31, 2019 in the ICU for surgically confirmed NSTIs. RESULTS 170 patients were included. The median duration of stay in ICU and hospital was 8 (3-17) and 37 (14-71) days, respectively. The median time from admission to first surgical debridement was 1 (0-2) day but 69.9% of patients were re-operated with a median of 1 (0-3) additional debridement. Inter-hospital transfer was necessary in 52.4% of patients. 80.2% of patients developed organ failures during the course of ICU stay with 51.8% of patients requiring invasive mechanical ventilation, 77.2% needing vasopressor support and 27.7% renal replacement therapy. In-ICU and in-hospital mortality rates were 21.8% and 28.8%, respectively. There was no significant difference between patients with abdomino-perineal NSTIs (n = 33) and others (n = 137) in terms of in-hospital or ICU mortality. Yet, immunocompromised patients (n = 43) showed significantly higher ICU and in-hospital mortality rates than non-immunocompromised patients (n = 127) (37.2% vs. 16.5%, p = 0.009, and 53.5% vs. 20.5%, p < 0.001). Factors associated with a complicated course were the presence of a polymicrobial infection (adjusted odds ratio [aOR = 3.18 (1.37-7.35); p = 0.007], of a bacteremia [aOR = 3.29 (1.14-9.52); p = 0.028] and a higher SAPS II score [aOR = 1.05 (1.02-1.07); p < 0.0001]. 62.3% of patients were re-hospitalized within 6 months. CONCLUSION In this retrospective multicenter study, we showed that patients with NSTI required complex management and are major consumers of care. Two-thirds of them underwent a complicated hospital course, associated with a higher SAPS II score, a polymicrobial NSTI and a bacteremia.
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Affiliation(s)
- Camille Windsor
- grid.50550.350000 0001 2175 4109Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Camille Hua
- grid.50550.350000 0001 2175 4109Service de Dermatologie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique–Hôpitaux de Paris (AP-HP), Créteil, France ,grid.410511.00000 0001 2149 7878Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Quentin De Roux
- grid.412116.10000 0004 1799 3934Département d’anesthésie-Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Anatole Harrois
- grid.413784.d0000 0001 2181 7253Département d’anesthésie-Réanimation, Université Paris Saclay, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Nadia Anguel
- grid.413784.d0000 0001 2181 7253Service de Médecine Intensive Réanimation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Philippe Montravers
- Department of Anesthesiology and Critical Care Medicine, Université Paris Cité, AP-HP, Hôpital Bichat-Claude Bernard; DMU PARABOL, Paris, France ,grid.7429.80000000121866389PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
| | - Antoine Vieillard-Baron
- grid.413756.20000 0000 9982 5352Service de Médecine Intensive Réanimation, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France ,grid.460789.40000 0004 4910 6535CESP, UMR 1018, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Jean-Paul Mira
- grid.411784.f0000 0001 0274 3893Service de Médecine Intensive Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Tomas Urbina
- grid.412370.30000 0004 1937 1100Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Stéphane Gaudry
- grid.413780.90000 0000 8715 2621Service de Médecine Intensive Réanimation, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP), Avicenne, Bobigny, France
| | - Matthieu Turpin
- grid.462844.80000 0001 2308 1657Service de Médecine Intensive Réanimation, Sorbonne Université, AP-HP. Hôpital Tenon, DMU APPROCHES, Paris, France
| | - Charles Damoisel
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Djillali Annane
- grid.413738.a0000 0000 9454 4367Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris (AP-HP), Clamart, France
| | - Jean-Damien Ricard
- grid.414205.60000 0001 0273 556XService de Médecine Intensive Réanimation, Université Paris Cité, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Colombes, France
| | - Barbara Hersant
- grid.50550.350000 0001 2175 4109Service de Chirurgie Plastique Esthétique et Reconstructrice, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Armand Mekontso Dessap
- grid.50550.350000 0001 2175 4109Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France ,grid.410511.00000 0001 2149 7878Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France ,grid.410511.00000 0001 2149 7878Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Olivier Chosidow
- grid.50550.350000 0001 2175 4109Service de Dermatologie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique–Hôpitaux de Paris (AP-HP), Créteil, France ,grid.410511.00000 0001 2149 7878Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Richard Layese
- grid.50550.350000 0001 2175 4109Unité de Recherche Clinique, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France ,grid.462410.50000 0004 0386 3258Equipe CEpiA (Clinical Epidemiology and Ageing), Université Paris-Est Créteil, INSERM, IMRB, Créteil, France
| | - Nicolas de Prost
- grid.50550.350000 0001 2175 4109Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France ,grid.410511.00000 0001 2149 7878Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France ,grid.410511.00000 0001 2149 7878Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
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30
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Elabbadi A, Urbina T, Berti E, Contou D, Plantefève G, Soulier Q, Milon A, Carteaux G, Voiriot G, Fartoukh M, Gibelin A. Spontaneous pneumomediastinum: a surrogate of P-SILI in critically ill COVID-19 patients. Crit Care 2022; 26:350. [PMID: 36371306 PMCID: PMC9652578 DOI: 10.1186/s13054-022-04228-1] [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: 07/06/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022] Open
Abstract
Spontaneous pneumomediastinum (SP) has been described early during the COVID-19 pandemic in large series of patients with severe pneumonia, but most patients were receiving invasive mechanical ventilation (IMV) at the time of SP diagnosis. In this retrospective multicenter observational study, we aimed at describing the prevalence and outcomes of SP during severe COVID-19 with pneumonia before any IMV, to rule out mechanisms induced by IMV in the development of pneumomediastinum.Among 549 patients, 21 patients (4%) developed a SP while receiving non-invasive respiratory support, after a median of 6 days [4-12] from ICU admission. The proportion of patients requiring IMV was similar. However, the time to tracheal intubation was longer in patients with SP (6 days [5-13] vs. 2 days [1-4]; P = 0.00002), with a higher first-line use of non-invasive ventilation (n = 11; 52% vs. n = 150; 28%; P = 0.02). The 21 patients who developed a SP had persisting signs of severe lung disease and respiratory failure with lower ROX index between ICU admission and occurrence of SP (3.94 [3.15-5.55] at admission vs. 3.25 [2.73-4.02] the day preceding SP; P = 0.1), which may underline potential indirect signals of Patient-self inflicted lung injury (P-SILI).In this series of critically ill COVID-19 patients, the prevalence of SP without IMV was not uncommon, affecting 4% of patients. They received more often vasopressors and had a longer ICU length of stay, as compared with their counterparts. One pathophysiological mechanism may potentially be carried out by P-SILI related to a prolonged respiratory failure, as underlined by a delayed use of IMV and the evolution of the ROX index between ICU admission and the day preceding SP.
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Affiliation(s)
- Alexandre Elabbadi
- grid.462844.80000 0001 2308 1657Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France
| | - Tomas Urbina
- grid.462844.80000 0001 2308 1657Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Enora Berti
- grid.412116.10000 0001 2292 1474Assistance Publique – Hôpitaux de Paris, DMU Médecine, Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Damien Contou
- grid.414474.60000 0004 0639 3263Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Gaëtan Plantefève
- grid.414474.60000 0004 0639 3263Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Quintana Soulier
- grid.462844.80000 0001 2308 1657Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Audrey Milon
- grid.462844.80000 0001 2308 1657Assistance Publique – Hôpitaux de Paris, Service de Radiologie, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Guillaume Carteaux
- grid.412116.10000 0001 2292 1474Assistance Publique – Hôpitaux de Paris, DMU Médecine, Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Guillaume Voiriot
- grid.462844.80000 0001 2308 1657Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France
| | - Muriel Fartoukh
- grid.462844.80000 0001 2308 1657Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France
| | - Aude Gibelin
- grid.462844.80000 0001 2308 1657Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France
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Bonny V, Ladoire M, Gabarre P, Missri L, Urbina T, Guidet B. [Acute respiratory failure in the elderly patients]. LA REVUE DU PRATICIEN 2022; 72:775-780. [PMID: 36511970] [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] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ACUTE RESPIRATORY FAILURE IN THE ELDERLY PATIENTS Acute respiratory failure (ARF) requiring an admission in intensive care unit in the old patients presents specific characteristics that must be considered for diagnosis, treatment and prognosis. Old patients are at increased risk of ARF after any assault. It is imperative to assess the prognosis of an old patient requiring invasive treatment in the ICU f or an ARF. Age is only one of the factor accounting for high mortality together with comorbidities, previous functional status, severity of the ARF and frailty. Simple and reliable tools are available to determine the degree of frailty. Thus, chronological age should not only be considered to determine the intensity of care; the concept of physiological age may better assist the clinician in his decision making. Management should be comprehensive and multi-professional; rehabilitation should be as early as possible, which emphasizes the absolute necessity of having a physiotherapist attached to the service.
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Affiliation(s)
- Vincent Bonny
- Hôpital Saint-Antoine, médecine intensive-réanimation, AP-HP, Paris, France
| | - Mathilde Ladoire
- Hôpital Saint-Antoine, médecine intensive-réanimation, AP-HP, Paris, France
| | - Paul Gabarre
- Hôpital Saint-Antoine, médecine intensive-réanimation, AP-HP, Paris, France
| | - Louaï Missri
- Hôpital Saint-Antoine, médecine intensive-réanimation, AP-HP, Paris, France
| | - Tomas Urbina
- Hôpital Saint-Antoine, médecine intensive-réanimation, AP-HP, Paris, France
| | - Bertrand Guidet
- Hôpital Saint-Antoine, médecine intensive-réanimation, AP-HP, Paris, France - Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, Paris, France
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32
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Raia L, Gabarre P, Bonny V, Urbina T, Missri L, Boelle PY, Baudel JL, Guidet B, Maury E, Joffre J, Ait-Oufella H. Kinetics of capillary refill time after fluid challenge. Ann Intensive Care 2022; 12:74. [PMID: 35962860 PMCID: PMC9375797 DOI: 10.1186/s13613-022-01049-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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background Capillary refill time (CRT) is a valuable tool for triage and to guide resuscitation. However, little is known about CRT kinetics after fluid infusion. Methods We conducted a prospective observational study in a tertiary teaching hospital. First, we analyzed the intra-observer variability of CRT. Next, we monitored fingertip CRT in sepsis patients during volume expansion within the first 24 h of ICU admission. Fingertip CRT was measured every 2 min during 30 min following crystalloid infusion (500 mL over 15 min). Results First, the accuracy of repetitive fingertip CRT measurements was evaluated on 40 critically ill patients. Reproducibility was excellent, with an intra-class correlation coefficient of 99.5% (CI 95% [99.3, 99.8]). A CRT variation larger than 0.2 s was considered as significant. Next, variations of CRT during volume expansion were evaluated on 29 septic patients; median SOFA score was 7 [5–9], median SAPS II was 57 [45–72], and ICU mortality rate was 24%. Twenty-three patients were responders as defined by a CRT decrease > 0.2 s at 30 min after volume expansion, and 6 were non-responders. Among responders, we observed that fingertip CRT quickly improved with a significant decrease at 6–8 min after start of crystalloid infusion, the maximal improvement being observed after 10–12 min (−0.7 [−0.3;−0.9] s) and maintained at 30 min. CRT variations significantly correlated with baseline CRT measurements (R = 0.39, P = 0.05). Conclusions CRT quickly improved during volume expansion with a significant decrease 6–8 min after start of fluid infusion and a maximal drop at 10–12 min. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01049-x.
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Affiliation(s)
- Lisa Raia
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris cedex 12, France
| | - Paul Gabarre
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Vincent Bonny
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Tomas Urbina
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris cedex 12, France
| | - Louai Missri
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris cedex 12, France
| | - Pierre-Yves Boelle
- Sorbonne Université, Paris, France.,Service de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Jean-Luc Baudel
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris cedex 12, France
| | - Bertrand Guidet
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris cedex 12, France
| | - Eric Maury
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Jeremie Joffre
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris cedex 12, France. .,Sorbonne Université, Paris, France. .,Inserm U970, Paris Research Cardiovascular Center, Paris, France.
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33
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Fourati S, Audureau E, Arrestier R, Marot S, Dubois C, Voiriot G, Luyt CE, Urbina T, Mayaux J, Roque-Afonso AM, Pham T, Landraud L, Visseaux B, Roux D, Bellaiche R, L’honneur AS, Ait Hamou Z, Brichler S, Gaudry S, Salmona M, Clere-Jehl R, Azoulay E, Morand-Joubert L, Marcelin AG, Chaix ML, Descamps D, Mekontso Dessap A, Rodriguez C, Pawlotsky JM, de Prost N. SARS-CoV-2 Genomic Characteristics and Clinical Impact of SARS-CoV-2 Viral Diversity in Critically Ill COVID-19 Patients: A Prospective Multicenter Cohort Study. Viruses 2022; 14:v14071529. [PMID: 35891509 PMCID: PMC9322524 DOI: 10.3390/v14071529] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 12/15/2022] Open
Abstract
The SARS-CoV-2 variant of concern, α, spread worldwide at the beginning of 2021. It was suggested that this variant was associated with a higher risk of mortality than other variants. We aimed to characterize the genetic diversity of SARS-CoV-2 variants isolated from patients with severe COVID-19 and unravel the relationships between specific viral mutations/mutational patterns and clinical outcomes. This is a prospective multicenter observational cohort study. Patients aged ≥18 years admitted to 11 intensive care units (ICUs) in hospitals in the Greater Paris area for SARS-CoV-2 infection and acute respiratory failure between 1 October 2020 and 30 May 2021 were included. The primary clinical endpoint was day-28 mortality. Full-length SARS-CoV-2 genomes were sequenced by means of next-generation sequencing (Illumina COVIDSeq). In total, 413 patients were included, 183 (44.3%) were infected with pre-existing variants, 197 (47.7%) were infected with variant α, and 33 (8.0%) were infected with other variants. The patients infected with pre-existing variants were significantly older (64.9 ± 11.9 vs. 60.5 ± 11.8 years; p = 0.0005) and had more frequent COPD (11.5% vs. 4.1%; p = 0.009) and higher SOFA scores (4 [3–8] vs. 3 [2–4]; 0.0002). The day-28 mortality was no different between the patients infected with pre-existing, α, or other variants (31.1% vs. 26.2% vs. 30.3%; p = 0.550). There was no association between day-28 mortality and specific variants or the presence of specific mutations. At ICU admission, the patients infected with pre-existing variants had a different clinical presentation from those infected with variant α, but mortality did not differ between these groups. There was no association between specific variants or SARS-CoV-2 genome mutational pattern and day-28 mortality.
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Affiliation(s)
- Slim Fourati
- Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique—Hôpitaux de Paris, 94010 Créteil, France; (S.F.); (C.R.); (J.-M.P.)
- Université Paris-Est-Créteil (UPEC), 94010 Créteil, France;
- INSERM U955, Team «Viruses, Hepatology, Cancer», 94010 Créteil, France
| | - Etienne Audureau
- INSERM U955 Team CEpiA, University Paris-Est-Créteil, 94010 Créteil, France;
- Department of Public Health, Hôpitaux Universitaires Henri Mondor, Assistance Publique—Hôpitaux de Paris, 94010 Créteil, France
| | - Romain Arrestier
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique—Hôpitaux de Paris, 94010 Créteil, France;
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), 94010 Créteil, France;
| | - Stéphane Marot
- Department of Virology, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié–Salpêtrière, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, INSERM U1136, 75013 Paris, France; (S.M.); (A.-G.M.)
| | - Claire Dubois
- Laboratoire de Virologie, Hôpital Universitaire Saint-Antoine, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, AP-HP, 75012 Paris, France; (C.D.); (L.M.-J.)
| | - Guillaume Voiriot
- Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique—Hôpitaux de Paris, 75020 Paris, France;
| | - Charles-Edouard Luyt
- Médecine Intensive Réanimation, Assistance Publique—Hôpitaux de Paris, Hôpital Pitié–Salpêtrière, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, 75013 Paris, France;
| | - Tomas Urbina
- Médecine Intensive Réanimation, Assistance Publique—Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, 75571 Paris, France;
| | - Julien Mayaux
- Médecine Intensive Réanimation, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié–Salpêtrière, Sorbonne Université, 75013 Paris, France;
| | - Anne-Marie Roque-Afonso
- Laboratoire de Virologie, Hôpital Paul Brousse, Assistance Publique—Hôpitaux de Paris, 94800 Villejuif, France;
| | - Tài Pham
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), 94010 Créteil, France;
- Service de Médecine Intensive-Réanimation, Assistance Publique—Hôpitaux de Paris, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, FHU Sepsis, Groupe de Recherche Clinique CARMAS, 94270 Le Kremlin-Bicêtre, France
- Equipe d’Epidémiologie Respiratoire Intégrative, CESP, Université Paris-Saclay, UVSQ, Univ. Paris-Sud, INSERM U1018, 94807 Villejuif, France
| | - Luce Landraud
- Laboratoire de Microbiologie, Hôpital Louis Mourier, Assistance Publique—Hôpitaux de Paris, 92700 Colombes, France;
| | - Benoit Visseaux
- Service de Virologie, Hôpital Bichat-Claude Bernard, Assistance Publique—Hôpitaux de Paris, Université de Paris, IAME INSERM UMR 1137, 75018 Paris, France; (B.V.); (D.D.)
| | - Damien Roux
- Service de Médecine Intensive Réanimation, DMU ESPRIT, Hôpital Louis Mourier, Assistance Publique—Hôpitaux de Paris, 92700 Colombes, France;
- Institut Necker-Enfants Malades (INEM), Department of Immunology, Infectiology and Hematology, INSERM U1151, CNRS UMR 8253, 75015 Paris, France
| | - Raphael Bellaiche
- Département d’Anesthésie Réanimations Chirurgicales, Hôpitaux Universitaires Henri Mondor, Assistance Publique—Hôpitaux de Paris, 94010 Créteil, France;
| | - Anne-Sophie L’honneur
- Laboratoire de Virologie, Hôpital Cochin, Assistance Publique—Hôpitaux de Paris, 75014 Paris, France;
| | - Zakaria Ait Hamou
- Médecine Intensive Réanimation, Hôpital Cochin, Assistance Publique—Hôpitaux de Paris, 75014 Paris, France;
| | - Ségolène Brichler
- Laboratoire de Virologie, Hôpital Avicenne, Assistance Publique—Hôpitaux de Paris, 93000 Bobigny, France;
| | - Stéphane Gaudry
- Service de Réanimation, Hôpital Avicenne, Assistance Publique—Hôpitaux de Paris, 93000 Bobigny, France;
| | - Maud Salmona
- Laboratoire de Virologie, Assistance Publique—Hôpitaux de Paris, Hôpital Saint-Louis, Université de Paris, INSERM HIPI, 75010 Paris, France; (M.S.); (M.-L.C.)
| | - Raphaël Clere-Jehl
- Médecine Intensive Réanimation, Hôpital Saint-Louis, Assistance Publique—Hôpitaux de Paris, 75010 Paris, France; (R.C.-J.); (E.A.)
| | - Elie Azoulay
- Médecine Intensive Réanimation, Hôpital Saint-Louis, Assistance Publique—Hôpitaux de Paris, 75010 Paris, France; (R.C.-J.); (E.A.)
| | - Laurence Morand-Joubert
- Laboratoire de Virologie, Hôpital Universitaire Saint-Antoine, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, AP-HP, 75012 Paris, France; (C.D.); (L.M.-J.)
| | - Anne-Geneviève Marcelin
- Department of Virology, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié–Salpêtrière, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, INSERM U1136, 75013 Paris, France; (S.M.); (A.-G.M.)
| | - Marie-Laure Chaix
- Laboratoire de Virologie, Assistance Publique—Hôpitaux de Paris, Hôpital Saint-Louis, Université de Paris, INSERM HIPI, 75010 Paris, France; (M.S.); (M.-L.C.)
| | - Diane Descamps
- Service de Virologie, Hôpital Bichat-Claude Bernard, Assistance Publique—Hôpitaux de Paris, Université de Paris, IAME INSERM UMR 1137, 75018 Paris, France; (B.V.); (D.D.)
| | - Armand Mekontso Dessap
- Université Paris-Est-Créteil (UPEC), 94010 Créteil, France;
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique—Hôpitaux de Paris, 94010 Créteil, France;
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), 94010 Créteil, France;
| | - Christophe Rodriguez
- Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique—Hôpitaux de Paris, 94010 Créteil, France; (S.F.); (C.R.); (J.-M.P.)
- Université Paris-Est-Créteil (UPEC), 94010 Créteil, France;
- INSERM U955, Team «Viruses, Hepatology, Cancer», 94010 Créteil, France
| | - Jean-Michel Pawlotsky
- Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique—Hôpitaux de Paris, 94010 Créteil, France; (S.F.); (C.R.); (J.-M.P.)
- Université Paris-Est-Créteil (UPEC), 94010 Créteil, France;
- INSERM U955, Team «Viruses, Hepatology, Cancer», 94010 Créteil, France
| | - Nicolas de Prost
- Université Paris-Est-Créteil (UPEC), 94010 Créteil, France;
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique—Hôpitaux de Paris, 94010 Créteil, France;
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), 94010 Créteil, France;
- Correspondence: ; Tel.: +33-1-45-17-86-37
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34
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Raia L, Urbina T, Gabarre P, Bonny V, Hariri G, Ehrminger S, Bigé N, Baudel JL, Guidet B, Maury E, Joffre J, Ait-Oufella H. Impaired skin microvascular endothelial reactivity in critically ill COVID-19 patients. Ann Intensive Care 2022; 12:51. [PMID: 35696007 PMCID: PMC9188908 DOI: 10.1186/s13613-022-01027-3] [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] [Received: 03/13/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Some clinical and histological studies have reported that SARS-CoV-2 infection may damage the endothelium. However, the impact of this virus on endothelial function in vivo remains poorly characterized. In this single-center pilot observational study, we performed iontophoresis of acetylcholine coupled with Laser doppler to investigate microvascular endothelial reactivity in COVID-19 patients compared to patients with non-COVID-19 bacterial pneumonia (NCBP) patients. Results During three consecutive months, 32 COVID-19 patients and 11 control NCBP patients with acute respiratory failure were included. The median age was 59 [50–68] and 69 [57–75] years in COVID-19 and NCBP groups, respectively (P = 0.11). There was no significant difference in comorbidities or medications between the two groups, except for body mass index, which was higher in COVID-19 patients. NCBP patients had a higher SAPS II score compared to COVID-19 patients (P < 0.0001), but SOFA score was not different between groups (P = 0.51). Global hemodynamic and peripheral tissue perfusion parameters were not different between groups. COVID-19 patients had significantly lower skin microvascular basal blood flow than NCBP patients (P = 0.02). In addition, endothelium-dependent microvascular reactivity was threefold lower in COVID-19 patients than NCBP patients (P = 0.008). Conclusions Both baseline skin microvascular blood flow and skin endothelial-dependent microvascular reactivity were impaired in critically ill COVID-19 patients compared to NCBP patients, despite a lower disease severity score supporting a specific pathogenic role of SARS-CoV-2 on the endothelium. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01027-3.
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Affiliation(s)
- Lisa Raia
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Tomas Urbina
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Paul Gabarre
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Vincent Bonny
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Geoffroy Hariri
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Sebastien Ehrminger
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Naïke Bigé
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Jean-Luc Baudel
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Bertrand Guidet
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.,Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, Inserm U1136, Paris, France
| | - Eric Maury
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.,Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, Inserm U1136, Paris, France.,Centre de Recherche Saint-Antoine, Sorbonne University, Inserm U938, 75012, Paris, France
| | - Jeremie Joffre
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.,Centre de Recherche Saint-Antoine, Sorbonne University, Inserm U938, 75012, Paris, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France. .,Paris Cardiovascular Research Center, Paris University, Inserm U970, Paris, France.
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35
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Loyer C, Lapostolle A, Urbina T, Elabbadi A, Lavillegrand JR, Chaigneau T, Simoes C, Dessajan J, Desnos C, Morin-Brureau M, Chantran Y, Aucouturier P, Guidet B, Voiriot G, Ait-Oufella H, Elbim C. Impairment of neutrophil functions and homeostasis in COVID-19 patients: association with disease severity. Crit Care 2022; 26:155. [PMID: 35637483 PMCID: PMC9149678 DOI: 10.1186/s13054-022-04002-3] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/27/2022] [Indexed: 01/08/2023] Open
Abstract
Background A dysregulated immune response is emerging as a key feature of critical illness in COVID-19. Neutrophils are key components of early innate immunity that, if not tightly regulated, contribute to uncontrolled systemic inflammation. We sought to decipher the role of neutrophil phenotypes, functions, and homeostasis in COVID-19 disease severity and outcome. Methods By using flow cytometry, this longitudinal study compares peripheral whole-blood neutrophils from 90 COVID-19 ICU patients with those of 22 SARS-CoV-2-negative patients hospitalized for severe community-acquired pneumonia (CAP) and 38 healthy controls. We also assessed correlations between these phenotypic and functional indicators and markers of endothelial damage as well as disease severity. Results At ICU admission, the circulating neutrophils of the COVID-19 patients showed continuous basal hyperactivation not seen in CAP patients, associated with higher circulating levels of soluble E- and P-selectin, which reflect platelet and endothelial activation. Furthermore, COVID-19 patients had expanded aged-angiogenic and reverse transmigrated neutrophil subsets—both involved in endothelial dysfunction and vascular inflammation. Simultaneously, COVID-19 patients had significantly lower levels of neutrophil oxidative burst in response to bacterial formyl peptide. Moreover patients dying of COVID-19 had significantly higher expansion of aged-angiogenic neutrophil subset and greater impairment of oxidative burst response than survivors. Conclusions These data suggest that neutrophil exhaustion may be involved in the pathogenesis of severe COVID-19 and identify angiogenic neutrophils as a potentially harmful subset involved in fatal outcome. Graphic Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04002-3.
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Affiliation(s)
- Chloé Loyer
- INSERM, UMRS 938, Hôpital St-Antoine, Centre de Recherche Saint-Antoine, Sorbonne Université, 75012, Paris, France.,Sorbonne Université, Paris, France
| | - Arnaud Lapostolle
- INSERM, UMRS 938, Hôpital St-Antoine, Centre de Recherche Saint-Antoine, Sorbonne Université, 75012, Paris, France.,Sorbonne Université, Paris, France
| | - Tomas Urbina
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre Elabbadi
- Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Rémi Lavillegrand
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U970, Cardiovascular Research Center, Université de Paris, Paris, France
| | - Thomas Chaigneau
- INSERM, UMRS 938, Hôpital St-Antoine, Centre de Recherche Saint-Antoine, Sorbonne Université, 75012, Paris, France.,Sorbonne Université, Paris, France
| | - Coraly Simoes
- INSERM, UMRS 938, Hôpital St-Antoine, Centre de Recherche Saint-Antoine, Sorbonne Université, 75012, Paris, France.,Sorbonne Université, Paris, France
| | - Julien Dessajan
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cyrielle Desnos
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mélanie Morin-Brureau
- INSERM, UMRS 938, Hôpital St-Antoine, Centre de Recherche Saint-Antoine, Sorbonne Université, 75012, Paris, France.,Sorbonne Université, Paris, France
| | - Yannick Chantran
- INSERM, UMRS 938, Hôpital St-Antoine, Centre de Recherche Saint-Antoine, Sorbonne Université, 75012, Paris, France.,Sorbonne Université, Paris, France.,Département d'Immunologie Biologique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Aucouturier
- INSERM, UMRS 938, Hôpital St-Antoine, Centre de Recherche Saint-Antoine, Sorbonne Université, 75012, Paris, France.,Sorbonne Université, Paris, France.,Département d'Immunologie Biologique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bertrand Guidet
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Voiriot
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hafid Ait-Oufella
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U970, Cardiovascular Research Center, Université de Paris, Paris, France
| | - Carole Elbim
- INSERM, UMRS 938, Hôpital St-Antoine, Centre de Recherche Saint-Antoine, Sorbonne Université, 75012, Paris, France. .,Sorbonne Université, Paris, France.
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Urbina T, Chauvet M, Lacombe K, Maury E. COVID-19-associated Multi-Inflammatory Syndrome in Adults (MIS-A): look into the eyes! Intensive Care Med 2022; 48:947-948. [PMID: 35286406 PMCID: PMC8919687 DOI: 10.1007/s00134-022-06667-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/03/2022] [Indexed: 11/05/2022]
Affiliation(s)
- T Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, 184 rue du faubourg Saint-Antoine, 75012, Paris, France.
| | - M Chauvet
- Service de Cardiologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - K Lacombe
- Service de Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Paris, France
| | - E Maury
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, 184 rue du faubourg Saint-Antoine, 75012, Paris, France.,Sorbonne Université, Paris, France
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37
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Urbina T, Elabbadi A, Gabarre P, Bigé N, Turpin M, Bonny V, Desnos C, Baudel JL, Lavillegrand JR, Hariri G, Fartoukh M, Guidet B, Maury E, Dumas G, Voiriot G, Ait-Oufella H. Endotracheal intubation rate is lower in critically-ill SARS-CoV-2 patients requiring high-flow nasal oxygen receiving additional face-mask noninvasive ventilation: a retrospective bicentric cohort with propensity score analysis. Minerva Anestesiol 2022; 88:580-587. [PMID: 35191641 DOI: 10.23736/s0375-9393.22.16094-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND SARS-CoV-2 pneumonia is responsible for unprecedented numbers of acute respiratory failure requiring invasive mechanical ventilation (IMV). This work aimed to assess whether adding face-mask noninvasive ventilation (NIV) to high-flow nasal oxygen (HFNO) was associated with a reduced need for endotracheal intubation. METHODS This retrospective cohort study was conducted from July 2020 to January 2021 in two tertiary care intensive care units (ICUs) in Paris, France. Patients admitted for laboratory confirmed SARS-CoV-2 infection with acute hypoxemic respiratory failure requiring HFNO with or without NIV were included. The primary outcome was the rate of endotracheal intubation. Secondary outcomes included day-28 mortality, day-28 respiratory support and IMV free days, ICU and hospital length-of-stay. Sensitivity analyses with both propensity score matching and overlap weighting were used. RESULTS 128 patients were included, 88 (69%) received HFNO alone and 40 (31%) received additional NIV. Additional NIV was associated with a reduced rate of endotracheal intubation in multivariate analysis (53 (60%) vs 15 (38%), HR=0.46 (95%CI, 0.23-0.95), p=0.04). Sensitivity analyses by propensity score matching (HR=0.45 (95%IC, 0.24-0.84), p=0.01) and overlap weighting (HR=0.52 (95% CI, 0.28-0.94), p=0.03) were consistent. Day-28 mortality was 25 (28%) in the HFNO group and 8 (20%) in the NIV group (HR=0.75 (95%CI, 0.15-3.82), p=0.72). NIV was associated with higher IMV free days (20 (0-28) vs 28 (14-28), p=0.015). All sensitivity analyses were consistent regarding secondary outcomes. CONCLUSION Need for endotracheal intubation was lower in critically-ill SARS-CoV-2 patients receiving face-mask noninvasive mechanical ventilation in addition to high-flow oxygen therapy.
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Affiliation(s)
- Tomas Urbina
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France - .,Sorbonne Université, Pierre et Marie-Curie university, Paris, France -
| | - Alexandre Elabbadi
- Sorbonne Université, Pierre et Marie-Curie university, Paris, France.,Intensive Care Unit, Tenon hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Paul Gabarre
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Pierre et Marie-Curie university, Paris, France
| | - Naike Bigé
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Turpin
- Sorbonne Université, Pierre et Marie-Curie university, Paris, France.,Intensive Care Unit, Tenon hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Bonny
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cyrielle Desnos
- Intensive Care Unit, Tenon hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Luc Baudel
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Remi Lavillegrand
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Pierre et Marie-Curie university, Paris, France
| | - Geoffroy Hariri
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Pierre et Marie-Curie university, Paris, France
| | - Muriel Fartoukh
- Sorbonne Université, Pierre et Marie-Curie university, Paris, France.,Intensive Care Unit, Tenon hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bertrand Guidet
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Pierre et Marie-Curie university, Paris, France
| | - Eric Maury
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Pierre et Marie-Curie university, Paris, France
| | - Guillaume Dumas
- Intensive Care Unit, Saint-Louis hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Voiriot
- Sorbonne Université, Pierre et Marie-Curie university, Paris, France.,Intensive Care Unit, Tenon hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hafid Ait-Oufella
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Pierre et Marie-Curie university, Paris, France.,Inserm U970, Cardiovascular research center, Université de Paris, Paris, France
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Guidet B, Bonny V, Gabarre P, Missri L, Urbina T. [Priorisation of old critically-ill patients for an ICU admission]. Rev Prat 2022; 72:131-138. [PMID: 35289518] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PRIORISATION OF OLD CRITICALLY-ILL PATIENTS FOR AN ICU ADMISSION There are currently no national or international recommendations for admission decisions to an intensive care unit (icu) for patients over 80 years of age. The decision, whether, or not to admit an elderly patient to intensive care is probably one of the most difficult decisions for an intensivist with the double risk of loss of chance in the event of refusal or non-beneficial care in the event of acceptance. Doubt should always benefit the patient with icu admission in case of prognosis uncertainty. In that case the patient should be reassessed after a few days for tailoring of the level of care. The best criterion for judging the accuracy of decisions is the vital but also the functional prognosis and the long-term expected quality of life for the patient and his relatives. Current and future demographic changes as well as financial constraints justify producing general guidelines in order to ease the decision-making process and reduce practice heterogeneity. The principle of distributive justice must apply in situations of strain on icu bed availability, as in times of a Covid wave.
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Affiliation(s)
| | - Vincent Bonny
- Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, hôpital Saint-Antoine, service de réanimation, F75012, Paris, France
| | - Paul Gabarre
- Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, hôpital Saint-Antoine, service de réanimation, F75012, Paris, France
| | - Louaï Missri
- Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, hôpital Saint-Antoine, service de réanimation, F75012, Paris, France
| | - Tomas Urbina
- Sorbonne Université, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique, AP-HP, hôpital Saint-Antoine, service de réanimation, F75012, Paris, France
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Urbina T, Lavillegrand JR, Garnier M, Mekinian A, Pacanowski J, Mario N, Dumas G, Hariri G, Pilon A, Darrivère L, Fartoukh M, Guidet B, Maury E, Leblanc J, Chantran Y, Fain O, Lacombe K, Voiriot G, Ait-Oufella H. Delayed inflammation decrease is associated with mortality in Tocilizumab-treated critically ill SARS-CoV-2 patients: A retrospective matched-cohort analysis. Innate Immun 2022; 28:3-10. [PMID: 35089113 PMCID: PMC8841634 DOI: 10.1177/17534259211064602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Little is known about the immuno-inflammatory response to Tocilizumab and its association with outcome in critically-ill SARS-CoV2 pneumonia. In this multicenter retrospective cohort of SARS-CoV-2 patients admitted to three intensive care units between March and April 2020, we matched on gender and SAPS II 21 Tocilizumab-treated patients to 42 non-treated patients. Need for mechanical ventilation was 76% versus 79%. IL-6, C-reactive protein, and fibrinogen had been collected within the first days of admission (T1), 3 d (T2) and 7 d (T3) later. Tocilizumab-treated patients had persistently higher IL-6 plasma levels and persistently lower C-Reactive protein and fibrinogen levels. Among Tocilizumab-treated patients, baseline levels of inflammatory biomarkers were not different according to outcome. Conversely, C-reactive protein and fibrinogen decrease was delayed in non-survivors. C-Reactive protein decreased at T1 in survivors (45 [30–98] vs 170 [69–204] mg/l, P < 0.001) but only at T2 in non-survivors (37 [13–74] vs 277 [235–288], P = 0.03). Fibrinogen decreased at T2 in survivors (4.11 [3.58–4.69] vs 614 [5.61–7.85] g/l, P = 0.005) but not in non-survivors (4.79 [4.12–7.58] vs 7.24 [6.22–9.24] g/l, P = 0.125). Tocilizumab treatment was thus associated with a persistent both increase in plasma IL-6, and decrease in C-reactive protein and fibrinogen. Among Tocilizumab-treated patients, the decrease in inflammatory biomarkers was delayed in non-survivors.
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Affiliation(s)
- Tomas Urbina
- Service de Médecine Intensive-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France.,27063Sorbonne Université, France
| | - Jean-Rémi Lavillegrand
- Service de Médecine Intensive-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France.,27063Sorbonne Université, France
| | - Marc Garnier
- 27063Sorbonne Université, France.,Service d'Anesthésie-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Arsene Mekinian
- 27063Sorbonne Université, France.,Service de médecine interne, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Jerome Pacanowski
- Service de maladies infectieuses, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Nathalie Mario
- Département de Biochimie, Hormonologie et Suivi Thérapeutique, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Guillaume Dumas
- Service de Médecine Intensive-Réanimation, 55663Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, France
| | - Geoffroy Hariri
- Service de Médecine Intensive-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France.,27063Sorbonne Université, France
| | - Antoine Pilon
- Département de Biochimie, Hormonologie et Suivi Thérapeutique, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Lucie Darrivère
- Service d'Anesthésie-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Muriel Fartoukh
- 27063Sorbonne Université, France.,Service de Médecine Intensive-Réanimation, 55705Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, France
| | - Bertrand Guidet
- Service de Médecine Intensive-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France.,27063Sorbonne Université, France
| | - Eric Maury
- Service de Médecine Intensive-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France.,27063Sorbonne Université, France
| | - Judith Leblanc
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, France
| | - Yannick Chantran
- Département d'Immunologie Biologique, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Olivier Fain
- 27063Sorbonne Université, France.,Service de médecine interne, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Karine Lacombe
- 27063Sorbonne Université, France.,Service de maladies infectieuses, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Guillaume Voiriot
- 27063Sorbonne Université, France.,Service de Médecine Intensive-Réanimation, 55705Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France.,27063Sorbonne Université, France.,Inserm U970, Cardiovascular research center, Université de Paris, France
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Lavillegrand JR, Raia L, Urbina T, Hariri G, Gabarre P, Bonny V, Bigé N, Baudel JL, Bruneel A, Dupre T, Guidet B, Maury E, Ait-Oufella H. Vitamin C improves microvascular reactivity and peripheral tissue perfusion in septic shock patients. Crit Care 2022; 26:25. [PMID: 35062987 PMCID: PMC8781452 DOI: 10.1186/s13054-022-03891-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/08/2022] [Indexed: 12/29/2022]
Abstract
Background Vitamin C has potential protective effects through antioxidant and anti-inflammatory properties. However, the effect of vitamin C supplementation on microvascular function and peripheral tissue perfusion in human sepsis remains unknown. We aimed to determine vitamin C effect on microvascular endothelial dysfunction and peripheral tissue perfusion in septic shock patients. Methods Patients with septic shock were prospectively included after initial resuscitation. Bedside peripheral tissue perfusion and skin microvascular reactivity in response to acetylcholine iontophoresis in the forearm area were measured before and 1 h after intravenous vitamin C supplementation (40 mg/kg). Norepinephrine dose was not modified during the studied period. Results We included 30 patients with septic shock. SOFA score was 11 [8–14], SAPS II was 66 [54–79], and in-hospital mortality was 33%. Half of these patients had vitamin C deficiency at inclusion. Vitamin C supplementation strongly improved microvascular reactivity (AUC 2263 [430–4246] vs 5362 [1744–10585] UI, p = 0.0004). In addition, vitamin C supplementation improved mottling score (p = 0.06), finger-tip (p = 0.0003) and knee capillary refill time (3.7 [2.6–5.5] vs 2.9 [1.9–4.7] s, p < 0.0001), as well as and central-to-periphery temperature gradient (6.1 [4.9–7.4] vs 4.6 [3.4–7.0] °C, p < 0.0001). The beneficial effects of vitamin C were observed both in patients with or without vitamin C deficiency. Conclusion In septic shock patients being resuscitated, vitamin C supplementation improved peripheral tissue perfusion and microvascular reactivity whatever plasma levels of vitamin C. ClinicalTrials.gov Identifier: NCT04778605 registered 26 January 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03891-8.
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Massart N, Maxime V, Fillatre P, Razazi K, Ferré A, Moine P, Legay F, Voiriot G, Amara M, Santi F, Nseir S, Marque-Juillet S, Bounab R, Barbarot N, Bruneel F, Luyt CE, Pham T, Pavot A, Monnet X, Richard C, Demoule A, Dres M, Mayaux J, Beurton A, Daubin C, Descamps R, Joret A, Du Cheyron D, Pene F, Chiche JD, Jozwiak M, Jaubert P, Voiriot G, Fartoukh M, Teulier M, Blayau C, Bodenes L, Ferriere N, Auchabie J, Le Meur A, Pignal S, Mazzoni T, Quenot JP, Andreu P, Roudau JB, Labruyère M, Nseir S, Preau S, Poissy J, Mathieu D, Benhamida S, Paulet R, Roucaud N, Thyrault M, Daviet F, Hraiech S, Parzy G, Sylvestre A, Jochmans S, Bouilland AL, Monchi M, Déserts MDD, Mathais Q, Rager G, Pasquier P, Reignier J, Seguin A, Garret C, Canet E, Dellamonica J, Saccheri C, Lombardi R, Kouchit Y, Jacquier S, Mathonnet A, Nay MA, Runge I, Martino F, Flurin L, Rolle A, Carles M, Coudroy R, Thille AW, Frat JP, Rodriguez M, Beuret P, Tientcheu A, Vincent A, Michelin F, Tamion F, Carpentier D, Boyer D, Girault C, Gissot V, Ehrmann S, Gandonniere CS, Elaroussi D, Delbove A, Fedun Y, Huntzinger J, Lebas E, Kisoka G, Grégoire C, Marchetta S, Lambermont B, Argaud L, Baudry T, Bertrand PJ, Dargent A, Guitton C, Chudeau N, Landais M, Darreau C, Ferre A, Gros A, Lacave G, Bruneel F, Neuville M, JérômeDevaquet, Tachon G, Gallo R, Chelha R, Galbois A, Jallot A, Lemoine LC, Kuteifan K, Pointurier V, Jandeaux LM, Mootien J, Damoisel C, Sztrymf B, Schmidt M, Combes A, Chommeloux J, Luyt CE, Schortgen F, Rusel L, Jung C, Gobert F, Vimpere D, Lamhaut L, Sauneuf B, Charrrier L, Calus J, Desmeules I, Painvin B, Tadie JM, Castelain V, Michard B, Herbrecht JE, Baldacini M, Weiss N, Demeret S, Marois C, Rohaut B, Moury PH, Savida AC, Couadau E, Série M, Alexandru N, Bruel C, Fontaine C, Garrigou S, Mahler JC, Leclerc M, Ramakers M, Garçon P, Massou N, Van Vong L, Sen J, Lucas N, Chemouni F, Stoclin A, Avenel A, Faure H, Gentilhomme A, Ricome S, Abraham P, Monard C, Textoris J, Rimmele T, Montini F, Lejour G, Lazard T, Etienney I, Kerroumi Y, Dupuis C, Bereiziat M, Coupez E, Thouy F, Hoffmann C, Donat N, Chrisment A, Blot RM, Kimmoun A, Jacquot A, Mattei M, Levy B, Ravan R, Dopeux L, Liteaudon JM, Roux D, Rey B, Anghel R, Schenesse D, Gevrey V, Castanera J, Petua P, Madeux B, Hartman O, Piagnerelli M, Joosten A, Noel C, Biston P, Noel T, Bouar GLE, Boukhanza M, Demarest E, Bajolet MF, Charrier N, Quenet A, Zylberfajn C, Dufour N, Mégarbane B, Voicu S, Deye N, Malissin I, Legay F, Debarre M, Barbarot N, Fillatre P, Delord B, Laterrade T, Saghi T, Pujol W, Cungi PJ, Esnault P, Cardinale M, Ha VHT, Fleury G, Brou MA, Zafimahazo D, Tran-Van D, Avargues P, Carenco L, Robin N, Ouali A, Houdou L, Le Terrier C, Suh N, Primmaz S, Pugin J, Weiss E, Gauss T, Moyer JD, Burtz CP, La Combe B, Smonig R, Violleau J, Cailliez P, Chelly J, Marchalot A, Saladin C, Bigot C, Fayolle PM, Fatséas J, Ibrahim A, Resiere D, Hage R, Cholet C, Cantier M, Trouiler P, Montravers P, Lortat-Jacob B, Tanaka S, Dinh AT, Duranteau J, Harrois A, Dubreuil G, Werner M, Godier A, Hamada S, Zlotnik D, Nougue H, Mekontso-Dessap A, Carteaux G, Razazi K, De Prost N, Mongardon N, Lamraoui M, Alessandri C, de Roux Q, de Roquetaillade C, Chousterman BG, Mebazaa A, Gayat E, Garnier M, Pardo E, LeaSatre-Buisson, Gutton C, Yvin E, Marcault C, Azoulay E, Darmon M, Oufella HA, Hariri G, Urbina T, Mazerand S, Heming N, Santi F, Moine P, Annane D, Bouglé A, Omar E, Lancelot A, Begot E, Plantefeve G, Contou D, Mentec H, Pajot O, Faguer S, Cointault O, Lavayssiere L, Nogier MB, Jamme M, Pichereau C, Hayon J, Outin H, Dépret F, Coutrot M, Chaussard M, Guillemet L, Goffin P, Thouny R, Guntz J, Jadot L, Persichini R, Jean-Michel V, Georges H, Caulier T, Pradel G, Hausermann MH, Nguyen-Valat TMH, Boudinaud M, Vivier E, SylvèneRosseli, Bourdin G, Pommier C, Vinclair M, Poignant S, Mons S, Bougouin W, Bruna F, Maestraggi Q, Roth C, Bitker L, Dhelft F, Bonnet-Chateau J, Filippelli M, Morichau-Beauchant T, Thierry S, Le Roy C, Jouan MS, Goncalves B, Mazeraud A, Daniel M, Sharshar T, Cadoz C, RostaneGaci, Gette S, Louis G, Sacleux SC, Ordan MA, Cravoisy A, Conrad M, Courte G, Gibot S, Benzidi Y, Casella C, Serpin L, Setti JL, Besse MC, Bourreau A, Pillot J, Rivera C, Vinclair C, Robaux MA, Achino C, Delignette MC, Mazard T, Aubrun F, Bouchet B, Frérou A, Muller L, Quentin C, Degoul S, Stihle X, Sumian C, Bergero N, Lanaspre B, Quintard H, Maiziere EM, Egreteau PY, Leloup G, Berteau F, Cottrel M, Bouteloup M, Jeannot M, Blanc Q, Saison J, Geneau I, Grenot R, Ouchike A, Hazera P, Masse AL, Demiri S, Vezinet C, Baron E, Benchetrit D, Monsel A, Trebbia G, Schaack E, Lepecq R, Bobet M, Vinsonneau C, Dekeyser T, Delforge Q, Rahmani I, Vivet B, Paillot J, Hierle L, Chaignat C, Valette S, Her B, Brunet J, Page M, Boiste F, Collin A, Bavozet F, Garin A, Dlala M, KaisMhamdi, Beilouny B, Lavalard A, Perez S, Veber B, Guitard PG, Gouin P, Lamacz A, Plouvier F, Delaborde BP, Kherchache A, Chaalal A, Ricard JD, Amouretti M, Freita-Ramos S, Roux D, Constantin JM, Assefi M, Lecore M, Selves A, Prevost F, Lamer C, Shi R, Knani L, Floury SP, Vettoretti L, Levy M, Marsac L, Dauger S, Guilmin-Crépon S, Winiszewski H, Piton G, Soumagne T, Capellier G, Putegnat JB, Bayle F, Perrou M, Thao G, Géri G, Charron C, Repessé X, Vieillard-Baron A, Guilbart M, Roger PA, Hinard S, Macq PY, Chaulier K, Goutte S, Chillet P, Pitta A, Darjent B, Bruneau A, Lasocki S, Leger M, Gergaud S, Lemarie P, Terzi N, Schwebel C, Dartevel A, Galerneau LM, Diehl JL, Hauw-Berlemont C, Péron N, Guérot E, Amoli AM, Benhamou M, Deyme JP, Andremont O, Lena D, Cady J, Causeret A, De La Chapelle A, Cracco C, Rouleau S, Schnell D, Foucault C, Lory C, Chapelle T, Bruckert V, Garcia J, Sahraoui A, Abbosh N, Bornstain C, Pernet P, Poirson F, Pasem A, Karoubi P, Poupinel V, Gauthier C, Bouniol F, Feuchere P, Heron A, Carreira S, Emery M, Le Floch AS, Giovannangeli L, Herzog N, Giacardi C, Baudic T, Thill C, Lebbah S, Palmyre J, Tubach F, Hajage D, Bonnet N, Ebstein N, Gaudry S, Cohen Y, Noublanche J, Lesieur O, Sément A, Roca-Cerezo I, Pascal M, Sma N, Colin G, Lacherade JC, Bionz G, Maquigneau N, Bouzat P, Durand M, Hérault MC, Payen JF. Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study. Ann Intensive Care 2022; 12:4. [PMID: 35015163 PMCID: PMC8748185 DOI: 10.1186/s13613-022-00979-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Contou D, Urbina T, de Prost N. Understanding purpura fulminans in adult patients. Intensive Care Med 2022; 48:106-110. [PMID: 34846563 DOI: 10.1007/s00134-021-06580-2] [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: 10/01/2021] [Accepted: 11/08/2021] [Indexed: 01/15/2023]
Affiliation(s)
- Damien Contou
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, Rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France.
| | - Tomas Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Groupe de Recherche CARMAS, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
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Mariette X, Hermine O, Tharaux PL, Resche-Rigon M, Porcher R, Ravaud P, Bureau S, Dougados M, Tibi A, Azoulay E, Cadranel J, Emmerich J, Fartoukh M, Guidet B, Humbert M, Lacombe K, Mahevas M, Pene F, Pourchet-Martinez V, Schlemmer F, Yazdanpanah Y, Baron G, Perrodeau E, Vanhoye D, Kedzia C, Demerville L, Gysembergh-Houal A, Bourgoin A, Dalibey S, Raked N, Mameri L, Alary S, Hamiria S, Bariz T, Semri H, Hai DM, Benafla M, Belloul M, Vauboin P, Flamand S, Pacheco C, Walter-Petrich A, Stan E, Benarab S, Nyanou C, Montlahuc C, Biard L, Charreteur R, Dupré C, Cardet K, Lehmann B, Baghli K, Madelaine C, D'Ortenzio E, Puéchal O, Semaille C, Savale L, Harrois A, Figueiredo S, Duranteau J, Anguel N, Pavot A, Monnet X, Richard C, Teboul JL, Durand P, Tissieres P, Jevnikar M, Montani D, Bulifon S, Jaïs X, Sitbon O, Pavy S, Noel N, Lambotte O, Escaut L, Jauréguiberry S, Baudry E, Verny C, Noaillon M, Lefèvre E, Zaidan M, Le Tiec CLT, Verstuyft C, Roques AM, Grimaldi L, Molinari D, Leprun G, Fourreau A, Cylly L, Virlouvet M, Meftali R, Fabre S, Licois M, Mamoune A, Boudali Y, Georgin-Lavialle S, Senet P, Pialoux G, Soria A, Parrot A, François H, Rozensztajn N, Blin E, Choinier P, Camuset J, Rech JS, Canellas A, Rolland-Debord C, Lemarié N, Belaube N, Nadal M, Siguier M, Petit-Hoang C, Chas J, Drouet E, Lemoine M, Phibel A, Aunay L, Bertrand E, Ravato S, Vayssettes M, Adda A, Wilpotte C, Thibaut P, Fillon J, Debrix I, Fellahi S, Bastard JP, Lefèvre G, Fallet V, Gottenberg JE, Hansmann Y, Andres E, Bayer S, Becker G, Blanc F, Brin S, Castelain V, Chatelus E, Chatron E, Collange O, Danion F, De Blay F, Demonsant E, Diemunsch P, Diemunsch S, Felten R, Goichot B, Greigert V, Guffroy A, Heger B, Hutt A, Kaeuffer C, Kassegne L, Korganow AS, Le Borgne P, Lefebvre N, Martin T, Mertes PM, Metzger C, Meyer N, Nisand G, Noll E, Oberlin M, Ohlmann-Caillard S, Poindron V, Pottecher J, Ruch Y, Sublon C, Tayebi H, Weill F, Mekinian A, Abisror N, Jachiet V, Chopin D, Fain O, Garnier M, Krause le Garrec J, Morgand M, Pacanowski J, Urbina T, McAvoy C, Pereira M, Aratus G, Berard L, Simon T, Daguenel-Nguyen A, Antignac M, Leplay C, Arlet JB, Diehl JL, Bellenfant F, Blanchard A, Buffet A, Cholley B, Fayol A, Flamarion E, Godier A, Gorget T, Hamada SR, Hauw-Berlemont C, Hulot JS, Lebeaux D, Livrozet M, Michon A, Neuschwander A, Penet MA, Planquette B, Ranque B, Sanchez O, Volle G, Briois S, Cornic M, Elisee V, Jesuthasan D, Djadi-Prat J, Jouany P, Junquera R, Henriques M, Kebir A, Lehir I, Meunier J, Patin F, Paquet V, Tréhan A, Vigna V, Sabatier B, Bergerot D, Jouve C, Knosp C, Lenoir O, Mahtal N, Resmini L, Lescure FX, Ghosn J, BACHELARD A, BIRONNE T, BORIE R, BOUNHIOL A, BOUSSARD C, CHAUFFiER J, CHALAL S, CHALAL L, CHANSOMBAT M, CRESPIN P, CRESTANI B, DACONCEICAO O, DECONINCK L, DIEUDE P, DOSSIER A, DUBERT M, DUCROCQ G, FUENTES A, GERVAIS A, GILBERT M, ISERNIA V, ISMAEL S, JOLY V, JULIA Z, LARIVEN S, LE GAC S, LE PLUART D, LOUNI F, NDIAYE A, PAPO T, PARISEY M, PHUNG B, POURBAIX A, RACHLINE A, RIOUX C, SAUTEREAU A, STEG G, TARHINI H, VALAYER S, VALLOIS D, VERMES P, VOLPE T, Nguyen Y, Honsel V, Weiss E, Codorniu A, Zarrouk V, De Lastours V, Uzzan M, Olivier O, Rossi G, Gamany N, Rahli R, Louis Z, Boutboul D, Galicier L, Amara Y, Archer G, Benattia A, Bergeron A, Bondeelle L, De Castro N, Clément M, Darmont M, Denis B, Dupin C, Feredj E, Feyeux D, Joseph A, Lengliné E, Le Guen P, Liégeon G, Lorillon G, Mabrouki A, Mariotte E, Martin de Frémont G, Mirouse A, Molina JM, Peffault de Latour R, Oksenhendler E, Saussereau J, Tazi A, Tudesq JJ, Zafrani L, Brindele I, Bugnet E, Celli Lebras K, Chabert J, Djaghout L, Fauvaux C, Jegu AL, Kozaliewicz E, Meunier M, Tremorin MT, Davoine C, Madeleine I, Caillat-Zucman S, Delaugerre C, Morin F, SENE D, BURLACU R, CHOUSTERMAN B, MEGARBANE B, RICHETTE P, RIVELINE JP, FRAZIER A, VICAUT E, BERTON L, HADJAM T, VASQUEZ-IBARRA MA, JOURDAINE C, JACOB A, SMATI J, RENAUD S, MANIVET P, PERNIN C, SUAREZ L, Semerano L, ABAD S, Benainous R, Bloch Queyrat C, Bonnet N, Brahmi S, Cailhol J, Cohen Y, Comparon C, Cordel H, Dhote R, Dournon N, Duchemann B, Ebstein N, Giroux-Leprieur B, Goupil de Bouille J, Jacolot A, Nunes H, Oziel J, Rathouin V, Rigal M, Roulot D, Tantet C, Uzunhan Y, COSTEDOAT-CHALUMEAU N, Ait Hamou Z, Benghanem S, BLANCHE P, CANOUI E, CARLIER N, CHAIGNE B, CONTEJEAN A, DUNOGUE B, DUPLAND P, DUREL - MAURISSE A, GAUZIT R, JAUBERT P, Joumaa H, Jozwiak M, KERNEIS S, LACHATRE M, Lafoeste H, LEGENDRE P, LUONG NGUYEN LB, MAREY J, MORBIEU C, MOUTHON L, NGUYEN L, Palmieri LJ, REGENT A, SZWEBEL TA, TERRIER B, GUERIN C, ZERBIT J, CHEREF K, CHITOUR K, CISSE MS, CLARKE A, CLAVERE G, DUSANTER I, GAUDEFROY C, JALLOULI M, KOLTA S, LE BOURLOUT C, MARIN N, MENAGE N, MOORES A, PEIGNEY I, PIERRON C, SALEH-MGHIR S, VALLET M, MICHEL M, MELICA G, LELIEVRE JD, FOIS E, LIM P, MATIGNON M, GUILLAUD C, THIEMELE A, SCHMITZ D, BOUHRIS M, BELAZOUZ S, LANGUILLE L, MEKONTSO-DESSAPS A, SADAOUI T, Mayaux J, Cacoub P, Corvol JC, Louapre C, Sambin S, Mariani LL, Karachi C, Tubach F, Estellat C, Gimeno L, Martin K, Bah A, Keo V, Ouamri S, Messaoudi Y, Yelles N, Faye P, Cavelot S, Larcheveque C, Annonay L, Benhida J, Zahrate-Ghoul A, Hammal S, Belilita R, Lecronier M, Beurton A, Haudebourg L, Deleris R, Le Marec J, Virolle S, Nemlaghi S, Bureau C, Mora P, De Sarcus M, Clovet O, Duceau B, Grisot PH, Pari MH, Arzoine J, Clarac U, Faure M, Delemazure J, Decavele M, Morawiec E, Demoule A, Dres M, Vautier M, Allenbach Y, Benveniste O, Leroux G, Rigolet A, Guillaume-Jugnot P, Domont F, Desbois AC, Comarmond C, Champtiaux N, Toquet S, Ghembaza A, Vieira M, Maalouf G, Boleto G, Ferfar Y, Charbonnier F, AGUILAR C, ALBY-LAURENT F, ALYANAKIAN MA, BAKOUBOULA P, BROISSAND C, BURGER C, CAMPOS-VEGA C, CHAVAROT N, CHOUPEAUX L, FOURNIER B, GRANVILLE S, ISSORAT E, ROUZAUD C, VIMPERE D, Geri G, Derridj N, Sguiouar N, Meddah H, Djadel M, Chambrin-Lauvray H, Duclos-Vallée JC, Saliba F, Sacleux SC, Koumis I, Michot JM, Stoclin A, Colomba E, Pommeret F, Willekens C, Sakkal M, Da Silva R, Dejean V, Mekid Y, Ben-Mabrouk I, Pradon C, Drouard L, Camara-Clayette V, Morel A, Garcia G, Mohebbi A, Berbour F, Dehais M, Pouliquen AL, Klasen A, Soyez-Herkert L, London J, Keroumi Y, Guillot E, Grailles G, El Amine Y, Defrancq F, Fodil H, Bouras C, Dautel D, Gambier N, Dieye T, Razurel A, Bienvenu B, Lancon V, Lecomte L, Beziriganyan K, Asselate B, Allanic L, Kiouris E, Legros MH, Lemagner C, Martel P, Provitolo V, Ackermann F, Le Marchand M, Clan Hew Wai A, Fremont D, Coupez E, Adda M, Duée F, Bernard L, Gros A, Henry E, Courtin C, Pattyn A, Guinot PG, Bardou M, Maurer A, Jambon J, Cransac A, Pernot C, Mourvillier B, Servettaz A, Deslée G, Wynckel A, Benoit P, Marquis E, Roux D, Gernez C, Yelnik C, Poissy J, Nizard M, Denies F, Gros H, Mourad JJ, Sacco E, Renet S. Sarilumab in adults hospitalised with moderate-to-severe COVID-19 pneumonia (CORIMUNO-SARI-1): An open-label randomised controlled trial. The Lancet Rheumatology 2022; 4:e24-e32. [PMID: 34812424 PMCID: PMC8598187 DOI: 10.1016/s2665-9913(21)00315-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Patients with COVID-19 pneumonia can have increased inflammation and elevated cytokines, including interleukin (IL)-6, which might be deleterious. Thus, sarilumab, a high-affinity anti-IL-6 receptor antibody, might improve the outcome of patients with moderate-to-severe COVID-19 pneumonia. Methods We did a multicentric, open-label, Bayesian randomised, adaptive, phase 2/3 clinical trial, nested within the CORIMUNO-19 cohort, to test a superiority hypothesis. Patients 18 years or older hospitalised with COVID-19 in six French centres, requiring at least 3L/min of oxygen but without ventilation assistance and a WHO Clinical Progression Scale [CPS] score of 5 were enrolled. Patients were randomly assigned (1:1) via a web-based system, according to a randomisation list stratified on centre and with blocks randomly selected among 2 and 4, to receive usual care plus 400 mg of sarilumab intravenously on day 1 and on day 3 if clinically indicated (sarilumab group) or usual care alone (usual care group). Primary outcomes were the proportion of patients with WHO-CPS scores greater than 5 on the 10-point scale on day 4 and survival without invasive or non-invasive ventilation at day 14. This completed trial is closed to new participants and is registered with ClinicalTrials.gov, NCT04324073. Findings 165 patients were recruited from March 27 to April 6, 2020, and 148 patients were randomised (68 patients to the sarilumab group and 80 to the usual care group) and followed up for 90 days. Median age was 61·7 years [IQR 53·0–71·1] in the sarilumab group and 62·8 years [56·0–71·7] in the usual care group. In the sarilumab group 49 (72%) of 68 were men and in the usual care group 59 (78%) of 76 were men. Four patients in the usual care group withdrew consent and were not analysed. 18 (26%) of 68 patients in the sarilumab group had a WHO-CPS score greater than 5 at day 4 versus 20 (26%) of 76 in the usual care group (median posterior absolute risk difference 0·2%; 90% credible interval [CrI] −11·7 to 12·2), with a posterior probability of absolute risk difference greater than 0 of 48·9%. At day 14, 25 (37%) patients in the sarilumab and 26 (34%) patients in the usual care group needed ventilation or died, (median posterior hazard ratio [HR] 1·10; 90% CrI 0·69–1·74) with a posterior probability HR greater than 1 of 37·4%. Serious adverse events occurred in 27 (40%) patients in the sarilumab group and 28 (37%) patients in the usual care group (p=0·73). Interpretation Sarilumab treatment did not improve early outcomes in patients with moderate-to-severe COVID-19 pneumonia. Further studies are warranted to evaluate the effect of sarilumab on long-term survival. Funding Assistance publique—Hôpitaux de Paris
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Urbina T, Razazi K, Ourghanlian C, Woerther PL, Chosidow O, Lepeule R, de Prost N. Antibiotics in Necrotizing Soft Tissue Infections. Antibiotics (Basel) 2021; 10:antibiotics10091104. [PMID: 34572686 PMCID: PMC8466904 DOI: 10.3390/antibiotics10091104] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 08/27/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 12/23/2022] Open
Abstract
Necrotizing soft tissue infections (NSTIs) are rare life-threatening bacterial infections characterized by an extensive necrosis of skin and subcutaneous tissues. Initial urgent management of NSTIs relies on broad-spectrum antibiotic therapy, rapid surgical debridement of all infected tissues and, when present, treatment of associated organ failures in the intensive care unit. Antibiotic therapy for NSTI patients faces several challenges and should (1) carry broad-spectrum activity against gram-positive and gram-negative pathogens because of frequent polymicrobial infections, considering extended coverage for multidrug resistance in selected cases. In practice, a broad-spectrum beta-lactam antibiotic (e.g., piperacillin-tazobactam) is the mainstay of empirical therapy; (2) decrease toxin production, typically using a clindamycin combination, mainly in proven or suspected group A streptococcus infections; and (3) achieve the best possible tissue diffusion with regards to impaired regional perfusion, tissue necrosis, and pharmacokinetic and pharmacodynamic alterations. The best duration of antibiotic treatment has not been well established and is generally comprised between 7 and 15 days. This article reviews the currently available knowledge regarding antibiotic use in NSTIs.
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Affiliation(s)
- Tomas Urbina
- Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 75571 Paris, France;
- Sorbonne Université, Université Pierre-et-Marie Curie, 75001 Paris, France
| | - Keyvan Razazi
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France;
- Groupe de Recherche Clinique CARMAS, Faculté de Médecine, Université Paris Est Créteil, 94010 Créteil, France
| | - Clément Ourghanlian
- Service de Pharmacie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France;
- Unité Transversale de Traitement des Infections, Département de Prévention, Diagnostic et Traitement des Infections, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France;
| | - Paul-Louis Woerther
- Département de Prévention, Diagnostic et Traitement des Infections, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France;
- Research Group Dynamic, Faculté de Santé de Créteil, Université Paris-Est Créteil Val de Marne (UPEC), 94010 Créteil, France;
| | - Olivier Chosidow
- Research Group Dynamic, Faculté de Santé de Créteil, Université Paris-Est Créteil Val de Marne (UPEC), 94010 Créteil, France;
- Service de Dermatologie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France
| | - Raphaël Lepeule
- Unité Transversale de Traitement des Infections, Département de Prévention, Diagnostic et Traitement des Infections, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France;
| | - Nicolas de Prost
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France;
- Groupe de Recherche Clinique CARMAS, Faculté de Médecine, Université Paris Est Créteil, 94010 Créteil, France
- Correspondence: ; Tel.: +33-1-49-81-23-94
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Gournay V, Dumas G, Lavillegrand JR, Hariri G, Urbina T, Baudel JL, Ait-Oufella H, Maury E, Brissot E, Legrand O, Malard F, Mohty M, Guidet B, Duléry R, Bigé N. Outcome of allogeneic hematopoietic stem cell transplant recipients admitted to the intensive care unit with a focus on haploidentical graft and sequential conditioning regimen: results of a retrospective study. Ann Hematol 2021; 100:2787-2797. [PMID: 34476574 DOI: 10.1007/s00277-021-04640-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/28/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022]
Abstract
Haploidentical transplantation has extended the availability of allogeneic hematopoietic stem cell transplant (alloHCT) to almost all patients. Sequential conditioning regimens have been proposed for the treatment of hematological active disease. Whether these new transplantation procedures affect the prognosis of critically ill alloHCT recipients remains unknown. We evaluated this question in a retrospective study including consecutive alloHCT patients admitted to the intensive care unit of a tertiary academic center from 2010 to 2017. During the study period, 412 alloHCTs were performed and 110 (27%) patients-median age 55 (36-64) years-were admitted to ICU in a median time of 58.5 (14-245) days after alloHCT. Twenty-nine (26%) patients had received a haploidentical graft and 34 (31%) a sequential conditioning. Median SOFA score was 9 (6-11). Invasive mechanical ventilation (MV) was required in 61 (55%) patients. Fifty-six (51%) patients died in the hospital. Independent factors associated with in-hospital mortality were as follows: MV (OR=8.44 [95% CI 3.30-23.19], p<0.001), delta SOFA between day 3 and day 1 (OR=1.60 [95% CI 1.31-2.05], p<0.0001), and sequential conditioning (OR=3.7 [95% CI 1.14-12.92], p=0.033). Sequential conditioning was also independently associated with decreased overall survival (HR=1.86 [95% CI 1.05-3.31], p=0.03). Other independent factors associated with reduced overall survival were HCT-specific comorbidity index ≥2 (HR=1.76 [95% CI 1.10-2.84], p=0.02), acute GVHD grade ≥2 (HR=1.88 [95% CI 1.14-3.10], p=0.01), MV (HR=2.37 [95% CI 1.38-4.07, p=0.002), and vasopressors (HR=2.21 [95% CI 1.38-3.54], p=0.001). Haploidentical transplantation did not affect outcome. Larger multicenter studies are warranted to confirm these results.
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Affiliation(s)
- Viviane Gournay
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France
| | - Guillaume Dumas
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Jean-Rémi Lavillegrand
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Geoffroy Hariri
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Tomas Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Jean-Luc Baudel
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Inserm U970, Paris Research Cardiovascular Center, Paris, France
| | - Eric Maury
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Eolia Brissot
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Ollivier Legrand
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Florent Malard
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Mohamad Mohty
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Bertrand Guidet
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Inserm U1136, Paris, France
| | - Rémy Duléry
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Naïke Bigé
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.
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46
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Manriquez V, Nivoit P, Urbina T, Echenique-Rivera H, Melican K, Fernandez-Gerlinger MP, Flamant P, Schmitt T, Bruneval P, Obino D, Duménil G. Colonization of dermal arterioles by Neisseria meningitidis provides a safe haven from neutrophils. Nat Commun 2021; 12:4547. [PMID: 34315900 PMCID: PMC8316345 DOI: 10.1038/s41467-021-24797-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/30/2021] [Indexed: 01/07/2023] Open
Abstract
The human pathogen Neisseria meningitidis can cause meningitis and fatal systemic disease. The bacteria colonize blood vessels and rapidly cause vascular damage, despite a neutrophil-rich inflammatory infiltrate. Here, we use a humanized mouse model to show that vascular colonization leads to the recruitment of neutrophils, which partially reduce bacterial burden and vascular damage. This partial effect is due to the ability of bacteria to colonize capillaries, venules and arterioles, as observed in human samples. In venules, potent neutrophil recruitment allows efficient bacterial phagocytosis. In contrast, in infected capillaries and arterioles, adhesion molecules such as E-Selectin are not expressed on the endothelium, and intravascular neutrophil recruitment is minimal. Our results indicate that the colonization of capillaries and arterioles by N. meningitidis creates an intravascular niche that precludes the action of neutrophils, resulting in immune escape and progression of the infection.
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Affiliation(s)
- Valeria Manriquez
- Pathogenesis of Vascular Infections unit, INSERM, Institut Pasteur, Paris, France
| | - Pierre Nivoit
- Pathogenesis of Vascular Infections unit, INSERM, Institut Pasteur, Paris, France
| | - Tomas Urbina
- Pathogenesis of Vascular Infections unit, INSERM, Institut Pasteur, Paris, France
| | | | - Keira Melican
- Pathogenesis of Vascular Infections unit, INSERM, Institut Pasteur, Paris, France
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Patricia Flamant
- Experimental Neuropathology Unit, Institut Pasteur, Paris, France
| | | | - Patrick Bruneval
- Service d'Anatomie Pathologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Dorian Obino
- Pathogenesis of Vascular Infections unit, INSERM, Institut Pasteur, Paris, France.
| | - Guillaume Duménil
- Pathogenesis of Vascular Infections unit, INSERM, Institut Pasteur, Paris, France.
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47
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Urbina T, Canoui-Poitrine F, Hua C, Layese R, Alves A, Ouedraogo R, Bosc R, Sbidian E, Chosidow O, Dessap AM, de Prost N. Long-term quality of life in necrotizing soft-tissue infection survivors: a monocentric prospective cohort study. Ann Intensive Care 2021; 11:102. [PMID: 34213694 PMCID: PMC8253876 DOI: 10.1186/s13613-021-00891-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/21/2021] [Indexed: 12/21/2022] Open
Abstract
Background Compared to other life-threatening infection survivors, long-term health-related quality of life (QOL) of patients surviving necrotizing soft-tissue infections (NSTI) and its determinants are little known. In this monocentric prospective cohort including NSTI survivors admitted between 2014 and 2017, QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36), the Hospital Anxiety and Depression (HAD), the activity of daily living (ADL), instrumental ADL (IADL) scales and the Impact of Event Scale-Revised (IES-R). The primary outcome measure was the SF-36 physical component summary (PCS). NSTI patients were compared according to intensive care unit (ICU) admission status. ICU survivors were matched on SAPS II with non-NSTI related septic shock survivors. Results Forty-nine NSTI survivors were phone-interviewed and included in the study. Median PCS was decreased compared to the reference population [− 0.97 (− 2.27; − 0.08) SD]. Previous cardiac disease was the only variable associated with PCS alteration [multivariate regression coefficient: − 8.86 (− 17.64; − 0.07), p = 0.048]. Of NSTI survivors, 15.2% had a HAD-D score ≥ 5 and 61.2% an IES-R score ≥ 33. ICU admission was not associated with lower PCS [35.21 (25.49–46.54) versus (vs) 41.82 (24.12–51.01), p = 0.516], but with higher IES-R score [14 (7.5–34) vs 7 (3–18), p = 0.035] and a higher proportion of HAD-D score ≥ 5 (28.6 vs 4.0%, p = 0.036). Compared to non-NSTI septic shock-matched controls, NSTI patients had similar PCS [33.81 (24.58; − 44.39) vs 44.87 (26.71; − 56.01), p = 0.706] but higher HAD-D [3.5 (1–7) vs 3 (1.5–6), p = 0.048] and IES-R scores [18 (8–35) vs 8 (3–19), p = 0.049]. Conclusions Long-term QOL in NSTI survivors is severely impaired, similarly to that of non-NSTI septic shock patients for physical compartments, but with more frequent depressive and/or post-traumatic stress disorders. Only ICU admission and previous cardiac disease were predictive of QOL impairment. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00891-9.
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Affiliation(s)
- Tomas Urbina
- Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-Et-Marie Curie, Paris 6, France.,Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Florence Canoui-Poitrine
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Camille Hua
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Service de Dermatologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Richard Layese
- Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Aline Alves
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Rachida Ouedraogo
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Romain Bosc
- Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000, Créteil, France.,Henri Mondor Breast Center, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000, Créteil, France.,Biology of the NeuroMuscular System, INSERM Team U955-E10, Paris East University, 94000, Créteil, France
| | - Emilie Sbidian
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Service de Dermatologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France.,Centre D'Investigation Clinique 1430, Inserm, 94010, Créteil, France
| | - Olivier Chosidow
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Service de Dermatologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France.,Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France
| | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France. .,Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France. .,Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France.
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48
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Lavillegrand JR, Garnier M, Spaeth A, Mario N, Hariri G, Pilon A, Berti E, Fieux F, Thietart S, Urbina T, Turpin M, Darrivere L, Fartoukh M, Verdonk F, Dumas G, Tedgui A, Guidet B, Maury E, Chantran Y, Voiriot G, Ait-Oufella H. Correction to: Elevated plasma IL-6 and CRP levels are associated with adverse clinical outcomes and death in critically ill SARS-CoV-2 patients: infammatory response of SARS-CoV-2 patients. Ann Intensive Care 2021; 11:93. [PMID: 34106340 PMCID: PMC8188151 DOI: 10.1186/s13613-021-00879-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Jean-Rémi Lavillegrand
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Marc Garnier
- Sorbonne Université, Paris, France.,Service D'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance PubliqueHôpitaux de Paris, Paris, France
| | - Agathe Spaeth
- Département de Biochimie, Hormonologie et Suivi Thérapeutique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathalie Mario
- Département de Biochimie, Hormonologie et Suivi Thérapeutique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Geofroy Hariri
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Antoine Pilon
- Département de Biochimie, Hormonologie et Suivi Thérapeutique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Enora Berti
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabienne Fieux
- Service D'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance PubliqueHôpitaux de Paris, Paris, France
| | - Sara Thietart
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France
| | - Tomas Urbina
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Matthieu Turpin
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucie Darrivere
- Service D'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance PubliqueHôpitaux de Paris, Paris, France
| | - Muriel Fartoukh
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Franck Verdonk
- Service D'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance PubliqueHôpitaux de Paris, Paris, France
| | - Guillaume Dumas
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France
| | - Alain Tedgui
- Inserm U970, Cardiovascular Research Center, Université de Paris, Paris, France
| | - Bertrand Guidet
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Eric Maury
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Yannick Chantran
- Départe- Ment D'Immunologie Biologique, Hôpital Saint-Antoine, Assistance PubliqueHôpitaux de Paris, Paris, France
| | - Guillaume Voiriot
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hafd Ait-Oufella
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France. .,Sorbonne Université, Paris, France. .,Inserm U970, Cardiovascular Research Center, Université de Paris, Paris, France.
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49
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Hariri G, Urbina T, Mazerand S, Bige N, Baudel JL, Ait-Oufella H. Rate control in atrial fibrillation using Landiolol is safe in critically ill Covid-19 patients. Crit Care 2021; 25:33. [PMID: 33482867 PMCID: PMC7820818 DOI: 10.1186/s13054-021-03470-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/13/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Geoffroy Hariri
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Paris, France
| | - Tomas Urbina
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Paris, France
| | - Sandie Mazerand
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Naike Bige
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Jean-Luc Baudel
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Hafid Ait-Oufella
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France. .,Sorbonne Université, Paris, France. .,Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France.
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50
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Lavillegrand JR, Garnier M, Spaeth A, Mario N, Hariri G, Pilon A, Berti E, Fieux F, Thietart S, Urbina T, Turpin M, Darrivere L, Fartoukh M, Verdonk F, Dumas G, Tedgui A, Guidet B, Maury E, Chantran Y, Voiriot G, Ait-Oufella H. Elevated plasma IL-6 and CRP levels are associated with adverse clinical outcomes and death in critically ill SARS-CoV-2 patients: inflammatory response of SARS-CoV-2 patients. Ann Intensive Care 2021; 11:9. [PMID: 33439360 PMCID: PMC7804215 DOI: 10.1186/s13613-020-00798-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [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: 10/16/2020] [Accepted: 12/29/2020] [Indexed: 01/08/2023] Open
Abstract
Background SARS coronavirus 2 (SARS-CoV-2) is responsible for high morbidity and mortality worldwide, mostly due to the exacerbated inflammatory response observed in critically ill patients. However, little is known about the kinetics of the systemic immune response and its association with survival in SARS-CoV-2+ patients admitted in ICU. We aimed to compare the immuno-inflammatory features according to organ failure severity and in-ICU mortality. Methods Six-week multicentre study (N = 3) including SARS-CoV-2+ patients admitted in ICU. Analysis of plasma biomarkers at days 0 and 3–4 according to organ failure worsening (increase in SOFA score) and 60-day mortality. Results 101 patients were included. Patients had severe respiratory diseases with PaO2/FiO2 of 155 [111–251] mmHg), SAPS II of 37 [31–45] and SOFA score of 4 [3–7]. Eighty-three patients (83%) required endotracheal intubation/mechanical ventilation and among them, 64% were treated with prone position. IL-1β was barely detectable. Baseline IL-6 levels positively correlated with organ failure severity. Baseline IL-6 and CRP levels were significantly higher in patients in the worsening group than in the non-worsening group (278 [70–622] vs. 71 [29–153] pg/mL, P < 0.01; and 178 [100–295] vs. 100 [37–213] mg/L, P < 0.05, respectively). Baseline IL-6 and CRP levels were significantly higher in non-survivors compared to survivors but fibrinogen levels and lymphocyte counts were not different between groups. After adjustment on SOFA score and time from symptom onset to first dosage, IL-6 and CRP remained significantly associated with mortality. IL-6 changes between Day 0 and Day 3–4 were not different according to the outcome. A contrario, kinetics of CRP and lymphocyte count were different between survivors and non-survivors. Conclusions In SARS-CoV-2+ patients admitted in ICU, a systemic pro-inflammatory signature was associated with clinical worsening and 60-day mortality.
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Affiliation(s)
- Jean-Rémi Lavillegrand
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Marc Garnier
- Sorbonne Université, Paris, France.,Service D'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Agathe Spaeth
- Département de Biochimie, Hormonologie et Suivi Thérapeutique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathalie Mario
- Département de Biochimie, Hormonologie et Suivi Thérapeutique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Geoffroy Hariri
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Antoine Pilon
- Département de Biochimie, Hormonologie et Suivi Thérapeutique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Enora Berti
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabienne Fieux
- Service D'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sara Thietart
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France
| | - Tomas Urbina
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Matthieu Turpin
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucie Darrivere
- Service D'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Muriel Fartoukh
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Franck Verdonk
- Service D'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Dumas
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France
| | - Alain Tedgui
- Inserm U970, Cardiovascular Research Center, Université de Paris, Paris, France
| | - Bertrand Guidet
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Eric Maury
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Yannick Chantran
- Département D'Immunologie Biologique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Voiriot
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France. .,Sorbonne Université, Paris, France. .,Inserm U970, Cardiovascular Research Center, Université de Paris, Paris, France.
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