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Sitbon A, Hauw-Berlemont C, Mebarki M, Heming N, Mayaux J, Diehl JL, Demoule A, Annane D, Marois C, Demeret S, Weiss E, Voiriot G, Fartoukh M, Constantin JM, Mégarbane B, Plantefève G, Boucher-Pillet H, Churlaud G, Cras A, Maheux C, Pezzana C, Diallo MH, Lebbah S, Ropers J, Salem JE, Straus C, Menasché P, Larghero J, Monsel A. Treatment of COVID-19-associated ARDS with umbilical cord-derived mesenchymal stromal cells in the STROMA-CoV-2 multicenter randomized double-blind trial: long-term safety, respiratory function, and quality of life. Stem Cell Res Ther 2024; 15:109. [PMID: 38637891 PMCID: PMC11027516 DOI: 10.1186/s13287-024-03729-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/10/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The STROMA-CoV-2 study was a French phase 2b, multicenter, double-blind, randomized, placebo-controlled clinical trial that did not identify a significant efficacy of umbilical cord-derived mesenchymal stromal cells in patients with SARS-CoV-2-induced acute respiratory distress syndrome. Safety on day 28 was found to be good. The aim of our extended study was to assess the 6- and 12-month safety of UC-MSCs administration in the STROMA-CoV-2 cohort. METHODS A detailed multi-domain assessment was conducted at 6 and 12 months following hospital discharge focusing on adverse events, lung computed tomography-scan, pulmonary and muscular functional status, and quality of life in the STROMA-CoV-2 cohort including SARS-CoV-2-related early (< 96 h) mild-to-severe acute respiratory distress syndrome. RESULTS Between April 2020 and October 2020, 47 patients were enrolled, of whom 19 completed a 1-year follow-up. There were no significant differences in any endpoints or adverse effects between the UC-MSCs and placebo groups at the 6- and 12-month assessments. Ground-glass opacities persisted at 1 year in 5 patients (26.3%). Furthermore, diffusing capacity for carbon monoxide remained altered over 1 year, although no patient required oxygen or non-invasive ventilatory support. Quality of life revealed declines in mental, emotional and physical health throughout the follow-up period, and the six-minute walking distance remained slightly impaired at the 1-year patient assessment. CONCLUSIONS This study suggests a favorable safety profile for the use of intravenous UC-MSCs in the context of the first French wave of SARS-CoV-2-related moderate-to-severe acute respiratory distress syndrome, with no adverse effects observed at 1 year.
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Affiliation(s)
- Alexandre Sitbon
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology-Critical Care and Perioperative Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP) Sorbonne University, 47-83, boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Caroline Hauw-Berlemont
- Intensive Care Unit, APHP-CUP, Hôpital Européen Georges-Pompidou, Université Paris Cité, 75015, Paris, France
| | - Miryam Mebarki
- APHP, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Centre d'Investigation Clinique en Biothérapies CBT501, INSERM, Université Paris Cité, Paris, France
| | - Nicholas Heming
- FHU SEPSIS, Department of Intensive Care, Hôpital Raymond-Poincaré (APHP), Laboratory of Infection & Inflammation-INSERM U1173, Simone Veil School of Medicine, University Versailles Saint Quentin-University Paris Saclay, 92380, Garches, France
| | - Julien Mayaux
- APHP, Groupe Hospitalier Universitaire-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Jean-Luc Diehl
- Intensive Care Unit, APHP-CUP, Hôpital Européen Georges-Pompidou, Université Paris Cité, 75015, Paris, France
- Innovative Therapies in Hemostasis, INSERM, Université Paris Cité, 75006, Paris, France
- Biosurgical Research Laboratory (Carpentier Foundation), APHP-CUP, Hôpital Européen Georges-Pompidou, 75015, Paris, France
| | - Alexandre Demoule
- APHP, Groupe Hospitalier Universitaire-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Djillali Annane
- FHU SEPSIS, Department of Intensive Care, Hôpital Raymond-Poincaré (APHP), Laboratory of Infection & Inflammation-INSERM U1173, Simone Veil School of Medicine, University Versailles Saint Quentin-University Paris Saclay, 92380, Garches, France
| | - Clémence Marois
- Neurological Intensive Care Unit, Department of Neurology, La Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
- Groupe de Recherche Clinique en REanimation et Soins Intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE), Sorbonne Université, Paris, France
| | - Sophie Demeret
- Neurological Intensive Care Unit, Department of Neurology, La Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
- Groupe de Recherche Clinique en REanimation et Soins Intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE), Sorbonne Université, Paris, France
| | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU PARABOL, APHP Nord, Paris, France
- Center for Research on Inflammation, INSERM, Université Paris Cité, Paris, France
| | - Guillaume Voiriot
- Centre de Recherche Saint-Antoine UMRS_938 INSERM, Assistance Publique - Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Muriel Fartoukh
- Centre de Recherche Saint-Antoine UMRS_938 INSERM, Assistance Publique - Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Jean-Michel Constantin
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology-Critical Care and Perioperative Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP) Sorbonne University, 47-83, boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS1144, University of Paris, Paris, France
| | - Gaëtan Plantefève
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, Rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France
| | - Hélène Boucher-Pillet
- Centre MEARY de Thérapie Cellulaire et Génique, APHP, Hôpital Saint-Louis, Paris, France
| | - Guillaume Churlaud
- Centre MEARY de Thérapie Cellulaire et Génique, APHP, Hôpital Saint-Louis, Paris, France
| | - Audrey Cras
- APHP, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Centre d'Investigation Clinique en Biothérapies CBT501, INSERM, Université Paris Cité, Paris, France
- INSERM UMR1140, Université Paris Cité, 75006, Paris, France
| | - Camille Maheux
- Centre MEARY de Thérapie Cellulaire et Génique, APHP, Hôpital Saint-Louis, Paris, France
| | - Chloé Pezzana
- INSERM, UMR S 970, Paris Centre de Recherche Cardiovasculaire (PARCC), Université de Paris, Paris, France
| | | | - Said Lebbah
- Clinical Research Unit, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - Jacques Ropers
- Clinical Research Unit, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - Joe-Elie Salem
- Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance Publique - Hôpitaux de Paris (AP-HP), Clinical Investigation Center (CIC-1901), Regional Pharmacovigilance Centre, Department of Pharmacology, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Christian Straus
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S (Respiration, Réanimation, Réadaptation Respiratoire, Sommeil), Service d'Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, Sorbonne Université, 75013, Paris, France
| | - Philippe Menasché
- INSERM UMR1140, Université Paris Cité, 75006, Paris, France
- Department of Cardiovascular Surgery, Hôpital Européen Georges-Pompidou, Paris, France
| | - Jérôme Larghero
- APHP, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Centre d'Investigation Clinique en Biothérapies CBT501, INSERM, Université Paris Cité, Paris, France
- Centre MEARY de Thérapie Cellulaire et Génique, APHP, Hôpital Saint-Louis, Paris, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology-Critical Care and Perioperative Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP) Sorbonne University, 47-83, boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
- INSERM UMRS_959, Immunology-Immunopathology-Immunotherapy (I3), Sorbonne Université, 75013, Paris, France.
- Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, APHP, 75651, Paris, France.
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Messika J, Eloy P, Boulate D, Charvet A, Fessler J, Jougon J, Lacoste P, Mercier O, Portran P, Roze H, Sage E, Thes J, Tronc F, Vourc'h M, Montravers P, Castier Y, Mal H, Mordant P. Protocol for venoarterial ExtraCorporeal Membrane Oxygenation to reduce morbidity and mortality following bilateral lung TransPlantation: the ECMOToP randomised controlled trial. BMJ Open 2024; 14:e077770. [PMID: 38448059 PMCID: PMC10916175 DOI: 10.1136/bmjopen-2023-077770] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Lung transplantation (LTx) aims at improving survival and quality of life for patients with end-stage lung diseases. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used as intraoperative support for LTx, despite no precise guidelines for its initiation. We aim to evaluate two strategies of VA-ECMO initiation in the perioperative period in patients with obstructive or restrictive lung disease requiring bilateral LTx. In the control 'on-demand' arm, high haemodynamic and respiratory needs will dictate VA-ECMO initiation; in the experimental 'systematic' arm, VA-ECMO will be pre-emptively initiated. We hypothesise a 'systematic' strategy will increase the number of ventilatory-free days at day 28. METHODS AND ANALYSIS We designed a multicentre randomised controlled trial in parallel groups. Adult patients with obstructive or restrictive lung disease requiring bilateral LTx, without a formal indication for pre-emptive VA-ECMO before LTx, will be included. Patients with preoperative pulmonary hypertension with haemodynamic collapse, ECMO as a bridge to transplantation, severe hypoxaemia or hypercarbia will be secondarily excluded. In the systematic group, VA-ECMO will be systematically implanted before the first pulmonary artery cross-clamp. In the on-demand group, VA-ECMO will be implanted intraoperatively if haemodynamic or respiratory indices meet preplanned criteria. Non-inclusion, secondary exclusion and VA-ECMO initiation criteria were validated by a Delphi process among investigators. Postoperative weaning of ECMO and mechanical ventilation will be managed according to best practice guidelines. The number of ventilator-free days at 28 days (primary endpoint) will be compared between the two groups in the intention-to-treat population. Secondary endpoints encompass organ failure occurrence, day 28, day 90 and year 1 vital status, and adverse events. ETHICS AND DISSEMINATION The sponsor is the Assistance Publique-Hôpitaux de Paris. The ECMOToP protocol version 2.1 was approved by Comité de Protection des Personnes Ile de France VIII. Results will be published in international peer-reviewed medical journals. TRIAL REGISTRATION NUMBER NCT05664204.
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Affiliation(s)
- Jonathan Messika
- Service de Pneumologie B et Transplantation Pulmonaire, APHP.Nord-Université de Paris, Hôpital Bichat-Claude Bernard, Paris, France
- Physiopathology and Epidemiology of Respiratory Diseases, UMR1152, INSERM and Université de Paris, Paris, France
- Paris Transplant Group, Paris, France
| | - Philippine Eloy
- Département d'épidémiologie, Biostatistiques et Recherche Clinique, Hôpital Bichat, AP-HP Nord, Université de Paris, Hôpital Bichat Claude-Bernard, Paris, France
- INSERM CIC-EC1425, Hôpital Bichat, Paris, France
| | - David Boulate
- Service de chirurgie thoracique, des maladies de l'œsophage et de transplantation pulmonaire, Assistance Publique Hopitaux de Marseille, Hôpital Nord, Marseille, France
| | - Aude Charvet
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Julien Fessler
- Department of Anesthesiology, Hôpital Foch, Suresnes, France
- Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Jacques Jougon
- Department of Thoracic Surgery, Haut-Leveque Hospital, Bordeaux University, Pessac, France
| | - Philippe Lacoste
- Service de chirurgie thoracique et cardiovasculaire, CHU Nantes, Nantes, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Le Plessis Robinson, France
| | - Philippe Portran
- Service d'anesthésie-réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Hadrien Roze
- Department of Anesthesiology and Critical Care, Haut-Leveque Hospital, Bordeaux University Hospital, Pessac, France
| | - Edouard Sage
- Department of Thoracic Surgery and Lung Transplantation, Hopital Foch, Suresnes, France
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | - Jacques Thes
- Department of Anesthesiology, Hôpital Marie-Lannelongue, Groupe hospitalier Paris-Saint Joseph, Le Plessis-Robinson, France
- Cardiothoracic Intensive Care Unit, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Le Plessis-Robinson, France
| | - Francois Tronc
- Service de chirurgie thoracique, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard, Lyon 1, Lyon, France
| | - Mickael Vourc'h
- Service d'Anesthésie-Réanimation Chirurgie Cardiaque, Hôpital Laennec, CHU de Nantes, Nantes, France
- INSERM CIC 0004 Immunologie et Infectiologie, Université de Nantes, Nantes, France
| | - Philippe Montravers
- Unité INSERM UMR 1152, UFR de Médecine Xavier Bichat, Paris, France
- Département d'Anesthésie et Réanimation, DMU PARABOL, APHP.Nord-Université de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Yves Castier
- Physiopathology and Epidemiology of Respiratory Diseases, UMR1152, INSERM and Université de Paris, Paris, France
- Service de Chirurgie Vasculaire, Thoracique et Transplantation, APHP.Nord-Université de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Herve Mal
- Service de Pneumologie B et Transplantation Pulmonaire, APHP.Nord-Université de Paris, Hôpital Bichat-Claude Bernard, Paris, France
- Physiopathology and Epidemiology of Respiratory Diseases, UMR1152, INSERM and Université de Paris, Paris, France
| | - Pierre Mordant
- Physiopathology and Epidemiology of Respiratory Diseases, UMR1152, INSERM and Université de Paris, Paris, France
- Service de Chirurgie Vasculaire, Thoracique et Transplantation, APHP.Nord-Université de Paris, Hôpital Bichat-Claude Bernard, Paris, France
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Peyre H, Peries M, Madieu E, David A, Picot MC, Pickles A, Baghdadli A. Association of difficulties in motor skills with longitudinal changes in social skills in children with autism spectrum disorder: findings from the ELENA French Cohort. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-023-02324-3. [PMID: 38191704 DOI: 10.1007/s00787-023-02324-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024]
Abstract
Developmental coordination disorder is a frequently co-occurring condition with autism spectrum disorder (ASD). Several cross-sectional studies have reported that children with difficulties in motor skills have a higher severity of ASD symptoms. This study aims to examine the association of difficulties in motor skills with longitudinal changes in social skills in children with ASD. Participants were drawn from the ELENA cohort, a French longitudinal cohort of children with ASD. Motor skills were assessed using the Movement Assessment Battery for Children at baseline, while social skills were measured using the Autism Diagnostic Observation Schedule (ADOS-2) and the Vineland Adaptive Behavior Scales (VABS-II) at both the baseline and a follow-up assessment conducted 3 years later. A composite score of social skills was created at baseline and at both time points. Linear regression models were performed to assess the association between difficulties in motor skills and changes in social skills, considering potential confounders such as IQ, age, and gender. The sample included 162 children with ASD. Children with difficulties in global motor skills (N = 114) showed less favorable trajectories in social skills compared to those without motor difficulties. The results were consistent when examining the ADOS-2 and the VABS-II separately. This study provides evidence for the negative impact of difficulties in motor skills on the longitudinal development of social skills in children with ASD. Interventions targeting motor difficulties may have broader benefits, extending beyond motor function to improve socialization.
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Affiliation(s)
- Hugo Peyre
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence Sur l'Autisme et les Troubles du Neurodéveloppement (CeAND), CHU Montpellier, Montpellier, France.
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.
| | - Marianne Peries
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence Sur l'Autisme et les Troubles du Neurodéveloppement (CeAND), CHU Montpellier, Montpellier, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
| | - Emmanuel Madieu
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence Sur l'Autisme et les Troubles du Neurodéveloppement (CeAND), CHU Montpellier, Montpellier, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
| | - Aurore David
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence Sur l'Autisme et les Troubles du Neurodéveloppement (CeAND), CHU Montpellier, Montpellier, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
| | - Marie-Christine Picot
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence Sur l'Autisme et les Troubles du Neurodéveloppement (CeAND), CHU Montpellier, Montpellier, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
- Clinical Research and Epidemiology Unit, Department of Medical Information, University Hospital, CHU Montpellier, Montpellier, France
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Amaria Baghdadli
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence Sur l'Autisme et les Troubles du Neurodéveloppement (CeAND), CHU Montpellier, Montpellier, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
- Faculté de Médecine, Université de Montpellier, Montpellier, France
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Teigné D, Cazet L, Birgand G, Moret L, Maupetit JC, Mabileau G, Terrien N. Improving care safety by characterizing task interruptions during interactions between healthcare professionals: an observational study. Int J Qual Health Care 2023; 35:mzad069. [PMID: 37688401 PMCID: PMC10507660 DOI: 10.1093/intqhc/mzad069] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/11/2023] [Accepted: 09/06/2023] [Indexed: 09/10/2023] Open
Abstract
Few studies have investigated interruptions to the work of professionals practicing in inpatient hospitals, and even fewer take account of the functions that make up the system. Safety of care can be improved by considering avoidable interruptions during interactions between managerial and care delivery functions. The present study describes the characteristics of interruptions to the work of professionals working in the inpatient hospital sector, with respect to their typology, frequency, duration, and avoidability in the context of interactions between functions. This direct observational study of interruptions in hospital care was performed in the Pays de la Loire (west coast) area of France. A total of 23 teams (17 institutions) working in medical or surgical specialties (excluding intensive care) were included. Observations were performed between May and September 2019, and lasted seven consecutive hours per team. A pair of observers simultaneously observed the same professional for ∼30 min. Each occupational category was examined. Reported characteristics were: (i) the method and duration of the request, (ii) the location of interrupted and interrupting persons, (iii) the reaction of the interrupted person, (iv) the characteristics of the interrupting person, and (v) the classification of interrupted and interrupting tasks according to their function. An avoidable interruption was defined. Interruptions during interactions between professionals were categorised in terms of their function and avoidability. Descriptive statistical analyses (mean, standard deviation, and distribution) were run. In particular, cross-comparisons were run to highlight avoidability interruptions and interactions between managerial and care delivery functions during the working day, for different professional categories, and for the location of the request. Overall, 286 interrupted professionals were observed and 1929 interruptions were characterised. The majority of interruptions were due to a face-to-face request (58.7%), lasting ≤30 s (72.5%). Professionals engaged in the response in 49.3% of cases. A total of 57.4% of interruptions were avoidable. The average number of interruptions was 10.5 (SD = 3.2) per hour per professional. An analysis of avoidability and interactions between managerial and care delivery functions found that the period between 12:00 and 13:00 was the riskiest in terms of care safety. This study highlighted the characteristics of interruptions to the activity of professionals working in inpatient hospitals. Care teams could focus on making medical and nursing professionals much more aware of the importance of interruptions, and each team could decide how to best-manage interruptions, in the context of their specific working environment.
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Affiliation(s)
- Delphine Teigné
- Structure Régionale d’Appui (SRA) QualiREL Santé, Hôpital Saint Jacques, 85 rue Saint-Jacques, Nantes Cedex 1 44093, France
- Public Health Department, University Hospital of Nantes, 85 rue Saint-Jacques, Nantes Cedex 1 44093, France
| | - Lucie Cazet
- Structure Régionale d’Appui (SRA) QualiREL Santé, Hôpital Saint Jacques, 85 rue Saint-Jacques, Nantes Cedex 1 44093, France
| | - Gabriel Birgand
- Public Health Department, University Hospital of Nantes, 85 rue Saint-Jacques, Nantes Cedex 1 44093, France
- Centre d’appui pour la Prévention des infections associées aux soins Pays de la Loire, CHU de Nantes, 5 rue Pr Boquien, Nantes cedex 1 44093, France
| | - Leila Moret
- Public Health Department, University Hospital of Nantes, 85 rue Saint-Jacques, Nantes Cedex 1 44093, France
| | - Jean-Claude Maupetit
- Public Health Department, University Hospital of Nantes, 85 rue Saint-Jacques, Nantes Cedex 1 44093, France
- Observatoire du MEdicament, des DIspositifs Médicaux et de l’innovation thérapeutique Pays de la Loire, CHU de Nantes, 85 rue Saint-Jacques, Nantes cedex 1 44093, France
| | - Guillaume Mabileau
- Structure Régionale d’Appui (SRA) QualiREL Santé, Hôpital Saint Jacques, 85 rue Saint-Jacques, Nantes Cedex 1 44093, France
| | - Noémie Terrien
- Structure Régionale d’Appui (SRA) QualiREL Santé, Hôpital Saint Jacques, 85 rue Saint-Jacques, Nantes Cedex 1 44093, France
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Renard Triché L, Futier E, De Carvalho M, Piñol-Domenech N, Bodet-Contentin L, Jabaudon M, Pereira B. Sample size estimation in clinical trials using ventilator-free days as the primary outcome: a systematic review. Crit Care 2023; 27:303. [PMID: 37528425 PMCID: PMC10394791 DOI: 10.1186/s13054-023-04562-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/04/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Ventilator-free days (VFDs) are a composite endpoint increasingly used as the primary outcome in critical care trials. However, because of the skewed distribution and competitive risk between components, sample size estimation remains challenging. This systematic review was conducted to systematically assess whether the sample size was congruent, as calculated to evaluate VFDs in trials, with VFDs' distribution and the impact of alternative methods on sample size estimation. METHODS A systematic literature search was conducted within the PubMed and Embase databases for randomized clinical trials in adults with VFDs as the primary outcome until December 2021. We focused on peer-reviewed journals with 2021 impact factors greater than five. After reviewing definitions of VFDs, we extracted the sample size and methods used for its estimation. The data were collected by two independent investigators and recorded in a standardized, pilot-tested forms tool. Sample sizes were calculated using alternative statistical approaches, and risks of bias were assessed with the Cochrane risk-of-bias tool. RESULTS Of the 26 clinical trials included, 19 (73%) raised "some concerns" when assessing risks of bias. Twenty-four (92%) trials were two-arm superiority trials, and 23 (89%) were conducted at multiple sites. Almost all the trials (96%) were unable to consider the unique distribution of VFDs and death as a competitive risk. Moreover, significant heterogeneity was found in the definitions of VFDs, especially regarding varying start time and type of respiratory support. Methods for sample size estimation were also heterogeneous, and simple models, such as the Mann-Whitney-Wilcoxon rank-sum test, were used in 14 (54%) trials. Finally, the sample sizes calculated varied by a factor of 1.6 to 17.4. CONCLUSIONS A standardized definition and methodology for VFDs, including the use of a core outcome set, seems to be required. Indeed, this could facilitate the interpretation of findings in clinical trials, as well as their construction, especially the sample size estimation which is a trade-off between cost, ethics, and statistical power. Systematic review registration PROSPERO ID: CRD42021282304. Registered 15 December 2021 ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021282304 ).
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Affiliation(s)
- Laurent Renard Triché
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France. lrenard--
| | - Emmanuel Futier
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
- iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | | | | | - Laëtitia Bodet-Contentin
- Medical Intensive Care Unit, CHRU de Tours, Tours, France
- INSERM, SPHERE, UMR1246, Université de Tours et Nantes, Tours et Nantes, France
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
- iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, Department of Clinical Research, and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
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Caspersen E, Guinot PG, Rozec B, Oilleau JF, Fellahi JL, Gaudard P, Lorne E, Mahjoub Y, Besnier E, Moussa MD, Mongardon N, Hanouz JL, Briant AR, Paul LPS, Tomadesso C, Parienti JJ, Descamps R, Denisenko A, Fischer MO. Comparison of landiolol and amiodarone for the treatment of new-onset atrial fibrillation after cardiac surgery (FAAC) trial: study protocol for a randomized controlled trial. Trials 2023; 24:353. [PMID: 37226174 DOI: 10.1186/s13063-023-07353-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 05/05/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Postoperative atrial fibrillation (PoAF) after cardiac surgery has a high incidence of 30%, but its management is controversial. Two strategies are recommended without evidence of a superiority of one against the other: rate control with beta-blocker or rhythm control with amiodarone. Landiolol is a new-generation beta-blocker with fast onset and short half-life. One retrospective, single-center study compared landiolol to amiodarone for PoAF after cardiac surgery with a better hemodynamic stability and a higher rate of reduction to sinus rhythm with landiolol, justifying the need for a multicenter randomized controlled trial. Our aim is to compare landiolol to amiodarone in the setting of PoAF after cardiac surgery with the hypothesis of a higher rate of reduction to sinus rhythm with landiolol during the 48 h after the first episode of POAF. METHODS The FAAC trial is a multicenter single-blind two parallel-arm randomized study, which planned to include 350 patients with a first episode of PoAF following cardiac surgery. The duration of the study is 2 years. The patients are randomized in two arms: a landiolol group and an amiodarone group. Randomization (Ennov Clinical®) is performed by the anesthesiologist in charge of the patient if PoAF is persistent for at least 30 min after correction of hypovolemia, dyskalemia, and absence of pericardial effusion on a transthoracic echocardiography done at bedside. Our hypothesis is an increase of the percentage of patients in sinus rhythm from 70 to 85% with landiolol in less than 48 h after onset of PoAF (alpha risk = 5%, power = 90%, bilateral test). DISCUSSION The FAAC trial was approved by the Ethics Committee of EST III with approval number 19.05.08. The FAAC trial is the first randomized controlled trial comparing landiolol to amiodarone for PoAF after cardiac surgery. In case of higher rate of reduction with landiolol, this beta-blocker could be the drug of choice used in this context as to reduce the need for anticoagulant therapy and reduce the risk of complications of anticoagulant therapy for patients with a first episode of postoperative atrial fibrillation after cardiac surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT04223739. Registered on January 10, 2020.
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Affiliation(s)
- Edouard Caspersen
- Department of Anaesthesiology-Resuscitation and Perioperative Medicine, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Pierre-Grégoire Guinot
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France
- University of Bourgogne and Franche-Comté, LNC UMR1231, Dijon, France
- INSERM, LNC UMR1231, Dijon, France
- LipSTIC LabEx, FCS Bourgogne-Franche Comté, Dijon, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, Hôpital Laennec, CHU Nantes, Nantes, France
- Institut du Thorax, Université de Nantes, CHU Nantes, CNRS, INSERM, Nantes, France
| | - Jean-Ferréol Oilleau
- Department of Anesthesiology and Surgical Intensive Care Unit, Brest University Hospital, 29200, Brest, France
| | - Jean-Luc Fellahi
- Service d'Anesthésie-Réanimation, Hôpital Universitaire Louis Pradel, Hospices Civils de Lyon, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude-Bernard, Lyon 1, Lyon, France
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine Arnaud de Villeneuve, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Emmanuel Lorne
- Department of Anaesthesia and Critical Care Medicine, Clinique du Millénaire, Cedex 2, 34960, Montpellier, France
| | - Yazine Mahjoub
- Anesthesia and Critical Care Department, Amiens Hospital University, Amiens, France
| | - Emmanuel Besnier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Mouhamed Djahoum Moussa
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, F-59000, Lille, France
| | | | - Jean-Luc Hanouz
- Department of Anaesthesiology-Resuscitation and Perioperative Medicine, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Anaïs R Briant
- Department of Biostatistics, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Laure Peyro Saint Paul
- Department of Clinical Research and Innovation, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Clémence Tomadesso
- Department of Clinical Research and Innovation, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Jean-Jacques Parienti
- Department of Biostatistics, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Richard Descamps
- Department of Anaesthesiology-Resuscitation and Perioperative Medicine, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Alina Denisenko
- Department of Anaesthesiology-Resuscitation and Perioperative Medicine, Normandy University, UNICAEN, Caen University Hospital, Normandy, Caen, France
| | - Marc-Olivier Fischer
- Institut Aquitain du Coeur, Clinique Saint Augustin, Elsan, 114 Avenue d'Arès, 33074, Bordeaux Cedex, France.
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Le Meur Y, Nowak E, Barrou B, Thierry A, Badet L, Buchler M, Rerolle JP, Golbin L, Duveau A, Dantal J, Merville P, Kamar N, Demini L, Zal F. Evaluation of the efficacy of HEMO 2life®, a marine OXYgen carrier for Organ Preservation (OxyOp2) in renal transplantation: study protocol for a multicenter randomized trial. Trials 2023; 24:302. [PMID: 37127632 PMCID: PMC10150461 DOI: 10.1186/s13063-023-07302-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/06/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Preventing ischemia‒reperfusion injury (IRI) is a major issue in kidney transplantation, particularly for transplant recipients receiving a kidney from extended criteria donors (ECD). The main consequence of IRI is delayed graft function (DGF). Hypoxia is one of the key factors in IRI, suggesting that the use of an oxygen carrier as an additive to preservation solution may be useful. In the OxyOp trial, we showed that the organs preserved using the oxygen carrier HEMO2life® displayed significantly less DGF. In the OxyOp2 trial, we aim to definitively test and quantify the efficacy of HEMO2life® for organ preservation in a large population of kidney grafts. METHODS OxyOp2 is a prospective, multicenter, randomized, comparative, single-blinded, parallel-group study versus standard of care in renal transplantation. After the selection of a suitable donor according to the inclusion/exclusion criteria, both kidneys will be used in the study. Depending on the characteristics of the donor, both kidneys will be preserved either in static cold storage (standard donors) or on machine perfusion (for ECD and deceased-after-cardiac-death donors (DCD)). The kidneys resulting from one donor will be randomized: one to the standard-of-care arm (organ preserved in preservation solution routinely used according to the local practice) and the other to the active treatment arm (HEMO2life® on top of routinely used preservation solution). HEMO2life® will be used for ex vivo graft preservation at a dose of 1 g/l preservation solution. The primary outcome is the occurrence of DGF, defined as the need for renal replacement therapy during the first week after transplantation. DISCUSSION The use of HEMO2life® in preservation solutions is a novel approach allowing, for the first time, the delivery of oxygen to organs. Improving graft survival by limiting ischemic lesions is a major public-health goal in the field of organ transplantation. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT04181710 . registered on November 29, 2019.
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Affiliation(s)
- Yannick Le Meur
- Department of Nephrology, Hôpital de La Cavale Blanche, CHRU de Brest, Brest, France.
- Centre d'Investigation Clinique INSERM CIC 1412, Hôpital de La Cavale Blanche, CHRU de Brest, Brest, France.
| | - Emmanuel Nowak
- Centre d'Investigation Clinique INSERM CIC 1412, Hôpital de La Cavale Blanche, CHRU de Brest, Brest, France
- Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Brest, France
| | - Benoit Barrou
- Department of UrologyNephrology and Transplantation, Assistance Publique-Hôpitaux de Paris AP-HP, Hôpitaux Universitaire de La Pitié Salpétrière-Charles Foix, Paris, France
| | | | - Lionel Badet
- Department of Urology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Matthias Buchler
- Department of Urology, Hôpital Bretonneau, CHRU de Tours, Tours, France
| | | | | | - Agnès Duveau
- Department of Nephrology and Urology, CHU d'Angers, Angers, France
| | - Jacques Dantal
- Department of Nephrology and Urology, CHU de Nantes, Nantes, France
| | - Pierre Merville
- Department of Nephrology and Urology, Hôpital Pellegrin, Bordeaux, France
| | - Nassim Kamar
- Department of Nephrology and Urology, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | | | - Franck Zal
- HEMARINA, Aéropôle Centre, Morlaix, France
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Dusfour G, Mottet D, Muthalib M, Laffont I, Bakhti K. Comparison of wrist actimetry variables of paretic upper limb use in post stroke patients for ecological monitoring. J Neuroeng Rehabil 2023; 20:52. [PMID: 37106460 PMCID: PMC10134627 DOI: 10.1186/s12984-023-01167-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 03/30/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND To date, many wrist actimetric variables dedicated to measuring the upper limbs (UL) in post-stroke patients have been developed but very few comparisons have been made between them. The objective of this study was to compare different actimetric variables of the ULs between a stroke and healthy population. METHODS Accelerometers were worn continuously for a period of 7 days on both wrists of 19 post-stroke hemiparetic patients as well as 11 healthy subjects. Various wrist actimetry variables were calculated, including the Jerk ratio 50 (JR50, cumulative probability that the Jerk Ratio is between 1 and 2), absolute (FuncUse30) and relative (FuncUseRatio30) amounts of functional use of movements of the ULs with angular amplitude greater than 30°, and absolute (UH) and relative (UseHoursRatio) use hours. RESULTS FuncUse30, FuncUseRatio30, UH, UseHoursRatio and JR50 of the paretic UL of stroke patients were significantly lower than in the non-dominant UL of healthy subjects. Comparing the ratio variables in stroke patients, FuncUseRatio30 was significantly lower than UseHoursRatio and JR50, suggesting a more clinically sensitive variable to monitor. In an exploratory analysis, FuncUseRatio tends to decrease with angular range of motion for stroke patients while it remains stable and close to 1 for healthy subjects. UseHoursRatio, FuncUseRatio30 and JR50 show linear correlation with Fugl-Meyer score (FM), with r2 equal to 0.53, 0.35 and 0.21, respectively. CONCLUSION This study determined that the FuncUseRatio30 variable provides the most sensitive clinical biomarker of paretic UL use in post-stroke patients, and that FuncUseHours-angular range of motion relationship allows the identification of the UL behaviour of each patient. This ecological information on the level of functional use of the paretic UL can be used to improve follow-up and develop patient-specific therapy.
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Affiliation(s)
- Gilles Dusfour
- CARTIGEN, University Hospital of Montpellier, Montpellier, France.
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Alès, Montpellier, France.
| | - Denis Mottet
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Alès, Montpellier, France
| | - Makii Muthalib
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Alès, Montpellier, France
- Physical and Rehabilitation Medicine, Montpellier University Hospital (CHU), Montpellier, France
| | - Isabelle Laffont
- CARTIGEN, University Hospital of Montpellier, Montpellier, France
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Alès, Montpellier, France
- Physical and Rehabilitation Medicine, Montpellier University Hospital (CHU), Montpellier, France
| | - Karima Bakhti
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Alès, Montpellier, France
- Physical and Rehabilitation Medicine, Montpellier University Hospital (CHU), Montpellier, France
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Gourcerol G, Gonzalez JM, Bonaz B, Fontaine S, Zerbib F, Mion F, Basile P, Gillibert A, Labonde A, Soliman H, Vitton V, Coffin B, Jacques J. Gastric electrical stimulation versus per-oral pyloromyotomy for the treatment of nausea and vomiting associated with gastroparesis: An observational study of two cohorts. Neurogastroenterol Motil 2023:e14565. [PMID: 36961085 DOI: 10.1111/nmo.14565] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 02/21/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Both gastric electrical stimulation (GES) and gastric-peroral endoscopic myotomy (G-POEM) can be offered to patients with gastroparesis and predominant nausea and vomiting. The study's aim was to compare GES and G-POEM efficacy on nausea and vomiting scores in patients with gastroparesis. METHODS Two multicenter cohorts of patients with medically refractory gastroparesis with predominant nausea and vomiting (defined as a score >2 on nausea and vomiting subscale that varied from 0 to 4) were treated either with GES (n = 34) or G-POEM (n = 30) and were followed for 24 months (M). Clinical response was defined as a decrease of ≥1 point in nausea and vomiting subscale without premature exclusion due to switch from one to the other technique before M24. Changes in symptomatic scales and quality of life were also monitored. KEY RESULTS Patients from both groups were comparable although the mean score of nausea and vomiting subscale was higher in GES (3.0) compared to G-POEM group (2.6; p = 0.01). At M24, clinical response was achieved in 21/34 (61.7%) patients with GES and in 21/30 (70.0%; p = 0.60) patients with G-POEM. Mean scores of nausea and vomiting subscale decreased at M24 in both GES (from 3.0 to 1.6; p < 0.001) and G-POEM (from 2.6 to 1.2; p < 0.001) groups, although there was no difference between groups (difference adjusted from baseline: -0.28 [-0.77; 0.19]; p = 0.24). Likewise, symptomatic and quality of life scores improved at M24 in both groups, without difference according to treatment group. CONCLUSIONS AND INFERENCES At M24, we did not observe significant difference in efficacy of GES and G-POEM in medically refractory gastroparesis with predominant nausea and vomiting.
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Affiliation(s)
- Guillaume Gourcerol
- Physiology and Gastroenterology Department, INSERM 1073-CIC 1404, RouenUniversity Hospital, Rouen, France
| | | | - Bruno Bonaz
- Gastroenterology Department CHU, Grenoble, France
| | | | - Frank Zerbib
- Gastroenterology Department, Centre Medico-chirurgical Magellan, INSERM CIC 1401, CHU de Bordeaux, Hôpital Haut-Lévêque, Université de Bordeaux, Bordeaux, France
| | | | - Paul Basile
- Physiology and Gastroenterology Department, INSERM 1073-CIC 1404, RouenUniversity Hospital, Rouen, France
| | - André Gillibert
- Biostatistic Department, Rouen University Hospital, Rouen, France
| | | | - Heithem Soliman
- Gastroenterology Department, Université de Paris, AP-HP, Hopital Louis Mourier, DMU ESPRIT, Colombes, France
| | - Véronique Vitton
- Gastroenterology Department, North Hospital AP-HM, Marseille, France
| | - Benoit Coffin
- Gastroenterology Department, Université de Paris, AP-HP, Hopital Louis Mourier, DMU ESPRIT, Colombes, France
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Baghdadli A, Audras-Torrent L, Rattaz C, Gonnier V, Ferrando L, Michelon C, Odoyer R, Maffre T, Picot MC. Multistage screening process for neurodevelopmental disorders in siblings of children with autism: the FRATSA protocol study. BMJ Open 2023; 13:e066520. [PMID: 36717133 PMCID: PMC9887699 DOI: 10.1136/bmjopen-2022-066520] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The elevated rates of neurodevelopmental disorders (NDDs) among siblings of children with autism spectrum disorder (ASD) raise concerns about their developmental monitoring and development. The main aim of this study is to assess the feasibility and acceptability of a standardised screening process on a large sample of siblings. METHODS AND ANALYSIS This prospective study will assess the feasibility of a selective and multi-stage screening process for NDD performed on 384 siblings of children with confirmed ASD. Stage 1 will consist of the screening of NDD performed using online parental questionnaires (Social Responsiveness Scale, IdentiDys scale, DCDQ, parental concerns) through a web platform. In cases of a positive result, the second stage, consisting of a clinical semi-structured interview with a psychologist, will be proposed to the sibling before referral for diagnosis and treatment, if necessary. Approximately 12 months after stage 2, parents will be contacted by telephone to collect the diagnosis established following the referrals and their level of satisfaction concerning the screening process. Based on an expected participation rate of 50%, to estimate this rate with an accuracy of 5%, it is necessary to screen 384 subjects. ETHICS AND DISSEMINATION The Ethics Committee on the Research of Human Subjects of Paris (Ile de France VII) approved this study in March 2022 (number: 2021-A02241-40). Express consent is required from all participants. Findings from the cohort study will be disseminated by publication of peer-reviewed manuscripts, presentations at scientific meetings and conferences with associated teams. TRIAL REGISTRATION NUMBER NCT05512637.
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Affiliation(s)
- Amaria Baghdadli
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neurodeveloppementaux, CHU Montpellier, Montpellier, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France
- Faculté de Médecine, Université de Montpellier, Montpellier, France
| | - Lee Audras-Torrent
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neurodeveloppementaux, CHU Montpellier, Montpellier, France
| | - Cécile Rattaz
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neurodeveloppementaux, CHU Montpellier, Montpellier, France
| | - Véronique Gonnier
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neurodeveloppementaux, CHU Montpellier, Montpellier, France
| | - Laetitia Ferrando
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neurodeveloppementaux, CHU Montpellier, Montpellier, France
| | - Cécile Michelon
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neurodeveloppementaux, CHU Montpellier, Montpellier, France
| | - Roxane Odoyer
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre de Ressources Autisme Midi-Pyrénées, CHU de Toulouse, Toulouse, France
| | - Thierry Maffre
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre de Ressources Autisme Midi-Pyrénées, CHU de Toulouse, Toulouse, France
| | - Marie-Christine Picot
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neurodeveloppementaux, CHU Montpellier, Montpellier, France
- Clinical Research and Epidemiology Unit, Department of Medical Information, University Montpellier, CHU Montpellier, Montpellier, France
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Economos G, Alexandre M, Perceau-Chambard E, Villeneuve L, Subtil F, Haesebaert J, Glehen O. What is the effectiveness and safety of mirtazapine versus escitalopram in alleviating cancer-associated poly-symptomatology (the MIR-P study)? A mixed-method randomized controlled trial protocol. BMC Palliat Care 2022; 21:84. [PMID: 35599320 PMCID: PMC9125889 DOI: 10.1186/s12904-022-00976-7] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Advanced cancer patients often experience multiple symptoms at a same time. This might lead to polypharmacy and increase adverse events representing major threats to the quality of health care, especially in palliative care situations. Mirtazapine, an antidepressant agent, has been suggested as a potential relevant drug to alleviate multiple cancer-related symptoms at a same time. Therefore, the present study aims to assess the effectiveness of mirtazapine in alleviating multiple symptoms at a same time in advanced cancer patients suffering from a major depressive episode compared to a group receiving escitalopram, another antidepressant agent. METHODS Multicentre, prospective, randomized, controlled trial in 12 palliative care services in France. The study will be based on a mixed-method methodology using parallel groups, of oral mirtazapine compared with oral escitalopram, with a 56 day follow-up. The primary outcome will be an improvement of the Global health Status (issued from the EORTC-QLQ-C30) on day 56. 418 participants will be clinically followed-up on day 7 and 56 and will have a telephonic assessment on days 14 and 28. A sub-sample of participants will be invited to take part in semi-structured qualitative interviews at baseline and day 56. For the qualitative part, purposeful sampling will be used. DISCUSSION This study will provide evidence for the pharmaceutics management of poly-symptomatology in advanced cancer patients. This could lead to important changes in the management of those patients by using a single molecule to alleviate multiple symptoms at a same time, potentially improving medication adherence, symptoms' control, and reducing the risk of medications adverse events. TRIAL REGISTRATION Trial registration: NCT04763135 . Registered 18 March 2021.
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Affiliation(s)
- Guillaume Economos
- EA 3738 - CICLy - Centre d'Innovation en Cancérologie de Lyon, UFR Faculté de Médecin Lyon-Sud-Charles Mérieux BP1, Université Claude Bernard Lyon 1, 165, Chemin du Grand Revoyet, 69921, Oullins Cedex, France.
- Palliative Care Center, Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.
| | - Marine Alexandre
- Public Health, Research and Clinical Epidemiology, Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - Elise Perceau-Chambard
- Palliative Care Center, Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - Laurent Villeneuve
- Public Health, Research and Clinical Epidemiology, Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - Fabien Subtil
- Public Health, Research and Clinical Epidemiology, Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - Julie Haesebaert
- Public Health, Research and Clinical Epidemiology, Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - Olivier Glehen
- Surgical Oncology, Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
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Cougot B, Gauvin J, Gillet N, Bach-Ngohou K, Lesot J, Getz I, Deparis X, Longuenesse C, Armant A, Bataille E, Leclere B, Fleury-Bahi G, Moret L, Tripodi D. Impact at two years of an intervention on empowerment among medical care teams: study protocol of a randomised controlled trial in a large French university hospital. BMC Health Serv Res 2019; 19:927. [PMID: 31796029 PMCID: PMC6889667 DOI: 10.1186/s12913-019-4724-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Empowerment of hospital workers is known as a key factor of organizational performance and occupational health. Nevertheless, empowering workers remains a real challenge. As in many traditional organizations, hospitals follow a bureaucratic model defined by a managerial culture of control and a stratified organization, which at once weaken professionals' mastery of their work and hinder their commitment and performance. Based on the existing literature this protocol describes a new managerial and organizational transformation program as well as the study design of its effect on worker empowerment in a large French public hospital. The project is funded by the French Ministry of Health for a total of 498,180 €. METHODS This study is a randomized controlled trial conducted in a French university hospital complex (CHU). The CHU comprises 12 sub-centers (SC) with about 20 care units and 1000 employees each. Randomization is performed at SC level. The intervention lasts 12 months and combines accompaniment of healthcare teams, frontline managers and SC directors to empower first-line professionals in the experimental SC. Quantitative outcome measurements are collected over 2 years during mandatory check-ups in the occupational medicine department. The primary outcomes are structural and psychological empowerment, motivational processes, managerial practices, working conditions, health and performance. Mixed linear modeling is the primary data analysis strategy. DISCUSSION The protocol was approved by the CHU health ethics committee. The results of the analysis of the intervention effects will be reported in a series of scientific articles. The results will contribute to reflection on prevention and management policies, and to the development of Workplace Quality-of-Life. If the intervention is a success, the system will warrant replication in other SCs and in other health facilities. TRIAL REGISTRATION The study was retrospectively registered at ClinicalTrials.gov on July 4, 2019 (NCT04010773).
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Affiliation(s)
- Baptiste Cougot
- Department of Occupational Medicine and Environmental Pathology, Nantes University Hospital, Nantes, France.
- Department of Psychology, University of Tours, Tours, France.
- EE1901 QualiPsy laboratory, University of Tours, Tours, France.
- Department of Public Health, Nantes University Hospital, Nantes, France.
- Department of Occupational Medicine, Nantes University Hospital, Nantes, France.
| | - Jules Gauvin
- Department of Occupational Medicine and Environmental Pathology, Nantes University Hospital, Nantes, France
- Department of Public Health, Nantes University Hospital, Nantes, France
| | - Nicolas Gillet
- Department of Psychology, University of Tours, Tours, France
- EE1901 QualiPsy laboratory, University of Tours, Tours, France
| | - Kalyane Bach-Ngohou
- Department of Biochemistry, Nantes University Hospital, Nantes, France
- UMR 1235 INSERM TENS "The enteric nervous system in gut and brain disorders", University of Nantes, Nantes, France
| | - Johan Lesot
- Department of Occupational Medicine and Environmental Pathology, Nantes University Hospital, Nantes, France
- SSTRN Service de Santé au Travail de la Région Nantaise, Nantes, France
| | - Isaac Getz
- ESCP Europe Business School, Ecole Supérieure de Commerce de Paris Europe, Paris, France
| | - Xavier Deparis
- SSTRN Service de Santé au Travail de la Région Nantaise, Nantes, France
- Army Center for Epidemiology and Public Health, University of Aix-Marseille, Marseille, France
| | - Claire Longuenesse
- Department of Occupational Medicine and Environmental Pathology, Nantes University Hospital, Nantes, France
- Department of Occupational Medicine, Nantes University Hospital, Nantes, France
| | - Anne Armant
- Department of Occupational Medicine and Environmental Pathology, Nantes University Hospital, Nantes, France
- Department of Psychology, University of Nantes, Nantes, France
- EA4638 Psychology Laboratory of Pays de la Loire, University of Nantes, Nantes, France
| | | | - Brice Leclere
- Department of Public Health, Nantes University Hospital, Nantes, France
| | - Ghozlane Fleury-Bahi
- Department of Psychology, University of Nantes, Nantes, France
- EA4638 Psychology Laboratory of Pays de la Loire, University of Nantes, Nantes, France
| | - Leïla Moret
- Department of Public Health, Nantes University Hospital, Nantes, France
- UMR 1246 INSERM SPHERE "MethodS in Patients-centered outcomes and HEalth ResEarch", Universities of Nantes and Tours, Nantes, France
| | - Dominique Tripodi
- Department of Occupational Medicine and Environmental Pathology, Nantes University Hospital, Nantes, France
- Department of Psychology, University of Nantes, Nantes, France
- EA4638 Psychology Laboratory of Pays de la Loire, University of Nantes, Nantes, France
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13
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Vendeuvre T, Monlezun O, Brandet C, Ingrand P, Durand-Zaleski I, Gayet LE, Germaneau A, Khiami F, Roulaud M, Herpe G, Rigoard P. Comparative evaluation of minimally invasive 'tibial tuberoplasty' surgical technique versus conventional open surgery for Schatzker II-III tibial plateau fractures: design of a multicentre, randomised, controlled and blinded trial (TUBERIMPACT study). BMJ Open 2019; 9:e026962. [PMID: 31481365 PMCID: PMC6731842 DOI: 10.1136/bmjopen-2018-026962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Fractures of the tibial plateau are in constant progression. They affect an elderly population suffering from a number of comorbidities, but also a young population increasingly practicing high-risk sports. The conventional open surgical technique used for tibial plateau fractures has several pitfalls: bone and skin devascularisation, increased risks of infection and functional rehabilitation difficulties. Since 2011, Poitiers University Hospital is offering to its patients a new minimally invasive technique for the reduction and stabilisation of tibial plateau fractures, named 'tibial tuberoplasty'. This technique involves expansion of the tibial plateau through inflation using a kyphoplasty balloon, filling of the fracture cavity with cement and percutaneous screw fixation. We designed a study to evaluate the quality of fracture reduction offered by percutaneous tuberoplasty versus conventional open surgery for tibial plateau fracture and its impact on clinical outcome. METHODS AND ANALYSIS This is a multicentre randomised controlled trial comparing two surgical techniques in the treatment of tibial plateau fractures. 140 patients with a Schatzker II or III tibial plateau fracture will be recruited in France. They will be randomised either in tibial tuberoplasty arm or in conventional surgery arm. The primary outcome is the postoperative radiological step-off reduction blindly measured on CT scan (within 48 hours post-op). Additional outcomes include other radiological endpoints, pain, functional abilities, quality of life assessment and health-economic endpoints. Outcomes assessment will be performed at baseline (before surgery), at day 0 (surgery), at 2, 21, 45 days, 3, 6, 12 and 24 months postsurgery. ETHICS AND DISSEMINATION This study has been approved by the ethics committee Ile-De-France X and will be conducted in accordance with current Good Clinical Practice (GCP) guidelines, Declaration of Helsinki and standard operating procedures. The results will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER Clinicaltrial.gov:NCT03444779.
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Affiliation(s)
- Tanguy Vendeuvre
- Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Spine and Neuromodulation Functional Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- ABS Lab, Poitiers University, Poitiers, France
- Institut Pprime, Futuroscope, Poitou-Charentes, France
| | - Olivier Monlezun
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Claire Brandet
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Pierre Ingrand
- UFR Medecine et Pharmacie, Universite de Poitiers, Poitiers, France
| | | | - Louis-Etienne Gayet
- Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | | | - Frederic Khiami
- Department of Orthopaedic Surgery and Traumatology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Manuel Roulaud
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Guillaume Herpe
- Department of Radiology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Philippe Rigoard
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Spine and Neuromodulation Functional Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- ABS Lab, Poitiers University, Poitiers, France
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14
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Gaiffe E, Crepin T, Bamoulid J, Courivaud C, Büchler M, Cassuto E, Albano L, Chemouny JM, Choukroun G, Hazzan M, Kessler L, Legendre C, Le Meur Y, Ouali N, Thierry A, Anota A, Nerich V, Limat S, Bonnetain F, Vernerey D, Ducloux D. PRODIG (Prevention of new onset diabetes after transplantation by a short term treatment of Vildagliptin in the early renal post-transplant period) study: study protocol for a randomized controlled study. Trials 2019; 20:375. [PMID: 31227028 PMCID: PMC6588872 DOI: 10.1186/s13063-019-3392-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/02/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Post-transplant diabetes is a frequent and serious complication of kidney transplantation. There is currently no treatment to prevent or delay the disease. Nevertheless, identification of risk factors make it possible to target a population at risk of developing de novo diabetes. We hypothesized that a short-term treatment with vildagliptin may prevent new onset diabetes after transplantation (NODAT) in high-risk patients. METHODS/DESIGN This is a multicenter, double-blind, placebo-controlled randomized clinical trial. Patients undergoing first kidney transplantation will be included from ten French transplant centers. Included patients will be randomized (1:1) to receive either vildagliptin 100 or 50 mg/day (depending on glomerular filtration rate) during 2 months (the first dose being administered before entering the operating theatres) or placebo. Additional antidiabetic therapy could be administered according to glycemic control. The primary outcome is the proportion of diabetic patients 1 year after transplantation, defined as patients receiving a diabetic treatment, or having a fasting glucose above 7 mmol/l, and/or with an abnormal oral glucose tolerance test. Secondary outcomes include glycated hemoglobin, the occurrence of acute rejection, infection, graft loss and patient death at 3 months, 6 months, and 12 months after transplantation. Outcomes will be correlated to clinical and general characteristics of the patient, cardiovascular history, nephropathy, dialysis history, transplantation data, biological data, health-related quality of life, and the cost-effectiveness of prevention of diabetes with vildagliptin. DISCUSSION We have scarce data on the pharmacological prevention of post-transplant diabetes. If our hypothesis is verified, our results will have a direct application in clinical practice and could limit diabetes-associated morbidity, reduce cardiovascular complications, increase quality of life of renal transplant patients, and consequently promote graft and patient survival. Our results may possibly serve for non-transplant patients carrying a high-risk of diabetes associated with other co-morbidities. TRIAL REGISTRATION ClinicalTrials.gov, NCT02849899 . Registered on 8 February 2016.
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Affiliation(s)
- E. Gaiffe
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, F-25000 Besançon, France
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, CIC Biothérapie, INSERM CIC1431, F-25000 Besançon, France
| | - T. Crepin
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, F-25000 Besançon, France
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, CIC Biothérapie, INSERM CIC1431, F-25000 Besançon, France
| | - J. Bamoulid
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, F-25000 Besançon, France
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, CIC Biothérapie, INSERM CIC1431, F-25000 Besançon, France
| | - C. Courivaud
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, F-25000 Besançon, France
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, CIC Biothérapie, INSERM CIC1431, F-25000 Besançon, France
| | - M. Büchler
- CHU Bretonneau, Department of Nephrology and Clinical Immunology, EA 4245 Transplantation, Immunology, Inflammation, F-37044 Tours, France
| | - E. Cassuto
- Pasteur hospital, L’Archet hospital group, Department of Nephrology, Dialysis, and Renal Transplantation, F-06000 Nice, France
| | - L. Albano
- Pasteur hospital, L’Archet hospital group, Department of Nephrology, Dialysis, and Renal Transplantation, F-06000 Nice, France
| | - J. M. Chemouny
- CHU de Rennes, Department of Nephrology, F-35033 Rennes, France
| | - G. Choukroun
- CHU Amiens, Department of Nephrology, Dialysis, and Renal Transplantation, F-80054 Amiens, France
| | - M. Hazzan
- CHU de Lille, Nephrology department, University of Lille UMR 995, F-59000 Lille, France
| | - L. Kessler
- CHU Strasbourg, Department of Endocrinology, Diabetes and Nutrition, F-67000 Strasbourg, France
| | - C. Legendre
- Necker hospital, Department of Nephrology, Dialysis, and Renal Transplantation, F-75743 Paris, France
| | - Y. Le Meur
- Department of Nephrology, CHU de Brest, UMR1227, Université de Brest, Inserm, F-29609 Brest, France
| | - N. Ouali
- Tenon hospital, Nephrological Emergencies and Kidney Transplantation, F-75571 Paris, France
| | - A. Thierry
- CHU de Poitiers, Department of Nephrology, Dialysis, and Renal Transplantation, F-86021 Poitiers, France
| | - A. Anota
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, Methodology and quality of life unit, F-25000 Besançon, France
| | - V. Nerich
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, department of Pharmacy, F-25030 Besançon, France
| | - S. Limat
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, department of Pharmacy, F-25030 Besançon, France
| | - F. Bonnetain
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, Methodology and quality of life unit, F-25000 Besançon, France
| | - D. Vernerey
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, Methodology and quality of life unit, F-25000 Besançon, France
| | - D. Ducloux
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, F-25000 Besançon, France
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, CIC Biothérapie, INSERM CIC1431, F-25000 Besançon, France
- Service de Néphrologie et transplantation rénale, Centre Hospitalier Régional Universitaire de Besançon, 3, boulevard Alexandre Fleming, 25030 Besançon, cedex France
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15
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Poiroux L, Piquilloud L, Seegers V, Le Roy C, Colonval K, Agasse C, Zinzoni V, Hodebert V, Cambonie A, Saletes J, Bourgeon I, Beloncle F, Mercat A. Effect on comfort of administering bubble-humidified or dry oxygen: the Oxyrea non-inferiority randomized study. Ann Intensive Care 2018; 8:126. [PMID: 30560440 PMCID: PMC6297119 DOI: 10.1186/s13613-018-0472-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The clinical interest of using bubble humidification of oxygen remains controversial. This study was designed to further explore whether delivering dry oxygen instead of bubble-moistened oxygen had an impact on discomfort of ICU patients. METHODS This randomized multicenter non-inferiority open trial included patients admitted in intensive care unit and receiving oxygen. Any patient receiving non-humidified oxygen (between 0 and 15 L/min) for less than 2 h could participate in the study. Randomization was stratified based on the flow rate at inclusion (less or more than 4 L/min). Discomfort was assessed 6-8 and 24 h after inclusion using a dedicated 15-item scale (quoted from 0 to 150). RESULTS Three hundred and fifty-four ICU patients receiving non-humidified oxygen were randomized either in the humidified (HO) (n = 172), using bubble humidifiers, or in the non-humidified (NHO) (n = 182) arms. In modified intention-to-treat analysis at H6-H8, the 15-item score was 26.6 ± 19.4 and 29.8 ± 23.4 in the HO and NHO groups, respectively. The absolute difference between scores in both groups was 3.2 [90% CI 0.0; + 6.5] for a non-inferiority margin of 5.3, meaning that the non-inferiority analysis was not conclusive. This was also true for the subgroups of patients receiving either less or more than 4 L/min of oxygen. At H24, using NHO was not inferior compared to HO in the general population and in the subgroup of patients receiving 4 L/min or less of oxygen. However, for patients receiving more than 4 L/min, a post hoc superiority analysis suggested that patients receiving dry oxygen were less comfortable. CONCLUSIONS Oxygen therapy-related discomfort was low. Dry oxygen could not be demonstrated as non-inferior compared to bubble-moistened oxygen after 6-8 h of oxygen administration. At 24 h, dry oxygen was non-inferior compared to bubble-humidified oxygen for flows below 4 L/min.
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Affiliation(s)
- Laurent Poiroux
- Medical Intensive Care Department, Angers University Hospital, 4, rue Larrey, 49933 Angers Cedex, France
| | - Lise Piquilloud
- Adult Intensive Care and Burn Unit, Medical Intensive Care Department, Lausanne University Hospital, rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Valérie Seegers
- Département de Biométrie, Institut de Cancérologie de l’Ouest, 15 avenue Bocquel, 49055 Angers Cedex 02, France
| | - Cyril Le Roy
- Medical Intensive Care Department, Angers University Hospital, 4, rue Larrey, 49933 Angers Cedex, France
| | - Karine Colonval
- Medical Intensive Care Department, Orléans Regional Hospital, 4 avenue de l’hôpital, 45067 Orléans Cedex, France
| | - Carole Agasse
- Medical Intensive Care Department, Nantes University Hospital, 1 place Alexis-Ricordeau, 44093 Nantes Cedex 1, France
| | - Vanessa Zinzoni
- Intensive Care Department, La Roche-sur-Yon Hospital, Boulevard Stéphane Moreau, 85925 La Roche-Sur-Yon, France
| | - Vanessa Hodebert
- Intensive Care Unit, Saint-Malo Hospital, 1 Rue de la Marne, 35400 Saint-Malo, France
| | - Alexandre Cambonie
- Medical Intensive Care Department, Poitiers University Hospital, 2 rue de la Milétrie, 86000 Poitiers, France
| | - Josselin Saletes
- Intensive Care Unit, Le Mans Hospital, 194 avenue Rubillard, 72037 Le Mans Cedex 9, France
| | - Irma Bourgeon
- Medical Intensive Care Department, Henri Mondor University Hospital, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - François Beloncle
- Medical Intensive Care Department, Angers University Hospital, 4, rue Larrey, 49933 Angers Cedex, France
| | - Alain Mercat
- Medical Intensive Care Department, Angers University Hospital, 4, rue Larrey, 49933 Angers Cedex, France
| | - for the REVA Network
- Medical Intensive Care Department, Angers University Hospital, 4, rue Larrey, 49933 Angers Cedex, France
- Adult Intensive Care and Burn Unit, Medical Intensive Care Department, Lausanne University Hospital, rue du Bugnon 46, 1011 Lausanne, Switzerland
- Département de Biométrie, Institut de Cancérologie de l’Ouest, 15 avenue Bocquel, 49055 Angers Cedex 02, France
- Medical Intensive Care Department, Orléans Regional Hospital, 4 avenue de l’hôpital, 45067 Orléans Cedex, France
- Medical Intensive Care Department, Nantes University Hospital, 1 place Alexis-Ricordeau, 44093 Nantes Cedex 1, France
- Intensive Care Department, La Roche-sur-Yon Hospital, Boulevard Stéphane Moreau, 85925 La Roche-Sur-Yon, France
- Intensive Care Unit, Saint-Malo Hospital, 1 Rue de la Marne, 35400 Saint-Malo, France
- Medical Intensive Care Department, Poitiers University Hospital, 2 rue de la Milétrie, 86000 Poitiers, France
- Intensive Care Unit, Le Mans Hospital, 194 avenue Rubillard, 72037 Le Mans Cedex 9, France
- Medical Intensive Care Department, Henri Mondor University Hospital, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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