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Mokart D, Vieillard-Baron A, Gilon D. What intensivists need to know on cardiac dysfunction in critically ill cancer patients. Intensive Care Med 2024; 50:766-772. [PMID: 38573404 DOI: 10.1007/s00134-024-07373-z] [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: 12/15/2023] [Accepted: 02/25/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Djamel Mokart
- Medical and Surgical ICU, Département d'Anesthésie Réanimation, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille Cedex 09, France.
| | - Antoine Vieillard-Baron
- Medical and Surgical ICU, University Hospital Ambroise Pare, GHU Paris-Saclay, APHP, Boulogne-Billancourt, France
- Inserm U1018, CESP, Université Versailles Saint-Quentin en Yvelines, Guyancourt, France
| | - Dan Gilon
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University, Jerusalem, Israel
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2
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Joseph A, Petit M, Vignon P, Vieillard-Baron A. Fluid responsiveness and venous congestion: unraveling the nuances of fluid status. Crit Care 2024; 28:140. [PMID: 38671461 PMCID: PMC11055218 DOI: 10.1186/s13054-024-04930-2] [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: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Affiliation(s)
- Adrien Joseph
- Medical and Surgical ICU, University Hospital Ambroise Pare, GHU Paris-Saclay, AP-HP, Boulogne-Billancourt, France.
- Inserm U1173, Laboratory of Infection and Inflammation, University Versailles Saint Quentin - University Paris Saclay, Guyancourt, France.
| | - Matthieu Petit
- Medical and Surgical ICU, University Hospital Ambroise Pare, GHU Paris-Saclay, AP-HP, Boulogne-Billancourt, France
- Inserm U1018, CESP, University Versailles Saint Quentin - University Paris Saclay, Guyancourt, France
| | - Philippe Vignon
- Medical-Surgical Intensive Care Unit, INSERM CIC 1435 and Faculty of Medicine, University of Limoges, Limoges, France
| | - Antoine Vieillard-Baron
- Medical and Surgical ICU, University Hospital Ambroise Pare, GHU Paris-Saclay, AP-HP, Boulogne-Billancourt, France
- Inserm U1018, CESP, University Versailles Saint Quentin - University Paris Saclay, Guyancourt, France
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3
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Petit M, Bouaoud M, Jullien E, Joseph A, Evrard B, Charron C, Daulasim A, Legras A, Gourraud M, Goudelin M, Vignon P, Vieillard-Baron A. Right ventricular injury in patients with COVID-19-related ARDS eligible for ECMO support: a multicenter retrospective study. Ann Intensive Care 2024; 14:40. [PMID: 38532049 DOI: 10.1186/s13613-024-01256-8] [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: 11/17/2023] [Accepted: 01/29/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) is associated with high mortality. Extracorporeal membrane oxygenation (ECMO) has been proposed in this setting, but optimal criteria to select target patients remain unknown. Our hypothesis is that evaluation of right ventricular (RV) function could be helpful. The aims of our study were to report the incidence and outcomes of patients eligible for ECMO according to EOLIA criteria, and to identify a subgroup of patients with RV injury, which could be a target for ECMO. METHODS Retrospective observational study involving 3 French intensive care units (ICUs) of teaching hospitals. Patients with confirmed SARS-CoV-2 infection between March 2020 and March 2021, presenting ARDS and with available echocardiography, were included. Patients were classified in three groups according to whether or not they met the EOLIA criteria and the presence of RV injury (RVI) ("EOLIA -", "EOLIA + RVI -" and "EOLIA + RVI + "). RVI was defined by the association of RV to left ventricular end-diastolic area ratio > 0.8 and paradoxical septal motion. Kaplan-Meier survival curves were used to analyze outcome as well as a Cox model for 90 day mortality. RESULTS 915 patients were hospitalized for COVID-19, 418 of them with ARDS. A total of 283 patients with available echocardiography were included. Eighteen (6.3%) patients received ECMO. After exclusion of these patients, 107 (40.5%) were classified as EOLIA -, 126 (47.5%) as EOLIA + RVI -, and 32 (12%) as EOLIA + RVI + . Ninety-day mortality was 21% in the EOLIA-group, 44% in the EOLIA + RVI-group, and 66% in the EOLIA + RVI + group (p < 0.001). After adjustment, RVI was statistically associated with 90-day mortality (HR = 1.92 [1.10-3.37]). CONCLUSIONS Among COVID-19-associated ARDS patients who met the EOLIA criteria, those with significant RV pressure overload had a particularly poor outcome. This subgroup may be a more specific target for ECMO. This represented 12% of our cohort compared to 60% of patients who met the EOLIA criteria only. How the identification of this high-risk subset of patients translates into patient-centered outcomes remains to be evaluated.
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Affiliation(s)
- Matthieu Petit
- Medical Intensive Care Unit, Ambroise Paré Hospital, APHP, 9 Avenue Charles de Gaulles, Boulogne-Billancourt, France
- Paris-Saclay University, UVSQ, Inserm, CESP, 94807, Villejuif, France
| | - Misylias Bouaoud
- Intensive Care Unit, University Hospital of Tours, Tours, France
| | - Edouard Jullien
- Medical Intensive Care Unit, Ambroise Paré Hospital, APHP, 9 Avenue Charles de Gaulles, Boulogne-Billancourt, France
| | - Adrien Joseph
- Medical Intensive Care Unit, Ambroise Paré Hospital, APHP, 9 Avenue Charles de Gaulles, Boulogne-Billancourt, France
| | - Bruno Evrard
- Medical-Surgical Intensive Care Unit and Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France
| | - Cyril Charron
- Medical Intensive Care Unit, Ambroise Paré Hospital, APHP, 9 Avenue Charles de Gaulles, Boulogne-Billancourt, France
| | - Anousone Daulasim
- Medical Intensive Care Unit, Ambroise Paré Hospital, APHP, 9 Avenue Charles de Gaulles, Boulogne-Billancourt, France
| | - Annick Legras
- Intensive Care Unit, University Hospital of Tours, Tours, France
| | - Maeva Gourraud
- Intensive Care Unit, University Hospital of Tours, Tours, France
| | - Marine Goudelin
- Medical-Surgical Intensive Care Unit and Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France
| | - Philippe Vignon
- Medical-Surgical Intensive Care Unit and Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré Hospital, APHP, 9 Avenue Charles de Gaulles, Boulogne-Billancourt, France.
- Paris-Saclay University, UVSQ, Inserm, CESP, 94807, Villejuif, France.
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Arrigo M, Price S, Harjola VP, Huber LC, Schaubroeck HAI, Vieillard-Baron A, Mebazaa A, Masip J. Diagnosis and treatment of right ventricular failure secondary to acutely increased right ventricular afterload (acute cor pulmonale): a clinical consensus statement of the Association for Acute CardioVascular Care of the European Society of Cardiology. Eur Heart J Acute Cardiovasc Care 2024; 13:304-312. [PMID: 38135288 PMCID: PMC10927027 DOI: 10.1093/ehjacc/zuad157] [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] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023]
Abstract
Acute right ventricular failure secondary to acutely increased right ventricular afterload (acute cor pulmonale) is a life-threatening condition that may arise in different clinical settings. Patients at risk of developing or with manifest acute cor pulmonale usually present with an acute pulmonary disease (e.g. pulmonary embolism, pneumonia, and acute respiratory distress syndrome) and are managed initially in emergency departments and later in intensive care units. According to the clinical setting, other specialties are involved (cardiology, pneumology, internal medicine). As such, coordinated delivery of care is particularly challenging but, as shown during the COVID-19 pandemic, has a major impact on prognosis. A common framework for the management of acute cor pulmonale with inclusion of the perspectives of all involved disciplines is urgently needed.
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Affiliation(s)
- Mattia Arrigo
- Department of Internal Medicine, Stadtspital Zurich, Birmensdorferstrasse 497, 8063 Zürich, Switzerland
| | - Susanna Price
- Royal Brompton Hospital, National Heart & Lung Institute, Imperial College London, London, UK
| | - Veli-Pekka Harjola
- Department of Emergency Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Lars C Huber
- Department of Internal Medicine, Stadtspital Zurich, Birmensdorferstrasse 497, 8063 Zürich, Switzerland
| | | | | | - Alexandre Mebazaa
- Department of Anesthesia, Burn and Critical Care Medicine, AP-HP, Hôpitaux Universitaires Saint-Louis-Lariboisière, FHU PROMICE, INI-CRCT, and Université de Paris, MASCOT, Inserm, Paris, France
| | - Josep Masip
- Research Direction, Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain
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Millington SJ, Narasimhan M, Mayo PH, Vieillard-Baron A. Ten Influential Point-of-Care Ultrasound Papers: 2023 in Review. J Intensive Care Med 2024:8850666241233556. [PMID: 38374613 DOI: 10.1177/08850666241233556] [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] [Indexed: 02/21/2024]
Abstract
In an effort to help keep busy clinicians up to date with the latest ultrasound research, our group of experts has selected 10 influential papers from the past 12 months and provided a short summary of each. We hope to provide emergency physicians, intensivists, and other acute care providers with a succinct update concerning some key areas of ultrasound interest.
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Affiliation(s)
- Scott J Millington
- Critical Care, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Mangala Narasimhan
- Critical Care, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Paul H Mayo
- Critical Care, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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6
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Joseph A, Petit M, Vieillard-Baron A. Hemodynamic effects of positive end-expiratory pressure. Curr Opin Crit Care 2024; 30:10-19. [PMID: 38085886 DOI: 10.1097/mcc.0000000000001124] [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: 01/03/2024]
Abstract
PURPOSE OF REVIEW Positive end-expiratory pressure (PEEP) is required in the Berlin definition of acute respiratory distress syndrome and is a cornerstone of its treatment. Application of PEEP increases airway pressure and modifies pleural and transpulmonary pressures according to respiratory mechanics, resulting in blood volume alteration into the pulmonary circulation. This can in turn affect right ventricular preload, afterload and function. At the opposite, PEEP may improve left ventricular function, providing no deleterious effect occurs on the right ventricle. RECENT FINDINGS This review examines the impact of PEEP on cardiac function with regards to heart-lung interactions, and describes its consequences on organs perfusion and function, including the kidney, gut, liver and the brain. PEEP in itself is not beneficious nor detrimental on end-organ hemodynamics, but its hemodynamic effects vary according to both respiratory mechanics and association with other hemodynamic variables such as central venous or mean arterial pressure. There are parallels in the means of preventing deleterious impact of PEEP on the lungs, heart, kidney, liver and central nervous system. SUMMARY The quest for optimal PEEP settings has been a prominent goal in ARDS research for the last decades. Intensive care physician must maintain a high degree of vigilance towards hemodynamic effects of PEEP on cardiac function and end-organs circulation.
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Affiliation(s)
- Adrien Joseph
- Medical Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt
| | - Matthieu Petit
- Medical Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt
- Inserm, CESP, Paris-Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Villejuif, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt
- Inserm, CESP, Paris-Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Villejuif, France
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7
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Millington SJ, Aissaoui N, Bowcock E, Brodie D, Burns KEA, Douflé G, Haddad F, Lahm T, Piazza G, Sanchez O, Savale L, Vieillard-Baron A. High and intermediate risk pulmonary embolism in the ICU. Intensive Care Med 2024; 50:195-208. [PMID: 38112771 DOI: 10.1007/s00134-023-07275-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/11/2023] [Indexed: 12/21/2023]
Abstract
Pulmonary embolism (PE) is a common and important medical emergency, encountered by clinicians across all acute care specialties. PE is a relatively uncommon cause of direct admission to the intensive care unit (ICU), but these patients are at high risk of death. More commonly, patients admitted to ICU develop PE as a complication of an unrelated acute illness. This paper reviews the epidemiology, diagnosis, risk stratification, and particularly the management of PE from a critical care perspective. Issues around prevention, anticoagulation, fibrinolysis, catheter-based techniques, surgical embolectomy, and extracorporeal support are discussed.
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Affiliation(s)
- Scott J Millington
- Critical Care, The University of Ottawa/The Ottawa Hospital, Ottawa, ON, Canada
| | - Nadia Aissaoui
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre & Université Paris Cité, Paris, France
| | - Emma Bowcock
- Department of Intensive Care, Nepean Hospital, University of Sydney, Sydney, Australia
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karine E A Burns
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto-St. Michael's Hospital, Toronto, Canada
| | - Ghislaine Douflé
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
| | - François Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease at Stanford University, Stanford, CA, USA
| | - Tim Lahm
- Pulmonary Sciences and Critical Care Medicine, National Jewish Health, University of Colorado, Rocky Mountain Regional VA Medical Center, Denver, CO, USA
| | - Gregory Piazza
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Olivier Sanchez
- Service de pneumologie et soins intensifs, Hopital Européen Georges Pompidou, APHP, Paris, France
- INSERM UMR S 1140, Innovative Therapies in Hemostasis, Université Paris Cité, Paris, France
| | - Laurent Savale
- Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Antoine Vieillard-Baron
- Medical and Surgical ICU, University Hospital Ambroise Pare, GHU Paris-Saclay, APHP, Boulogne-Billancourt, France.
- Inserm U1018, CESP, Universite Versailles Saint-Quentin en Yvelines, Guyancourt, France.
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De Backer D, Deutschman CS, Hellman J, Myatra SN, Ostermann M, Prescott HC, Talmor D, Antonelli M, Pontes Azevedo LC, Bauer SR, Kissoon N, Loeches IM, Nunnally M, Tissieres P, Vieillard-Baron A, Coopersmith CM. Surviving Sepsis Campaign Research Priorities 2023. Crit Care Med 2024; 52:268-296. [PMID: 38240508 DOI: 10.1097/ccm.0000000000006135] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVES To identify research priorities in the management, epidemiology, outcome, and pathophysiology of sepsis and septic shock. DESIGN Shortly after publication of the most recent Surviving Sepsis Campaign Guidelines, the Surviving Sepsis Research Committee, a multiprofessional group of 16 international experts representing the European Society of Intensive Care Medicine and the Society of Critical Care Medicine, convened virtually and iteratively developed the article and recommendations, which represents an update from the 2018 Surviving Sepsis Campaign Research Priorities. METHODS Each task force member submitted five research questions on any sepsis-related subject. Committee members then independently ranked their top three priorities from the list generated. The highest rated clinical and basic science questions were developed into the current article. RESULTS A total of 81 questions were submitted. After merging similar questions, there were 34 clinical and ten basic science research questions submitted for voting. The five top clinical priorities were as follows: 1) what is the best strategy for screening and identification of patients with sepsis, and can predictive modeling assist in real-time recognition of sepsis? 2) what causes organ injury and dysfunction in sepsis, how should it be defined, and how can it be detected? 3) how should fluid resuscitation be individualized initially and beyond? 4) what is the best vasopressor approach for treating the different phases of septic shock? and 5) can a personalized/precision medicine approach identify optimal therapies to improve patient outcomes? The five top basic science priorities were as follows: 1) How can we improve animal models so that they more closely resemble sepsis in humans? 2) What outcome variables maximize correlations between human sepsis and animal models and are therefore most appropriate to use in both? 3) How does sepsis affect the brain, and how do sepsis-induced brain alterations contribute to organ dysfunction? How does sepsis affect interactions between neural, endocrine, and immune systems? 4) How does the microbiome affect sepsis pathobiology? 5) How do genetics and epigenetics influence the development of sepsis, the course of sepsis and the response to treatments for sepsis? CONCLUSIONS Knowledge advances in multiple clinical domains have been incorporated in progressive iterations of the Surviving Sepsis Campaign guidelines, allowing for evidence-based recommendations for short- and long-term management of sepsis. However, the strength of existing evidence is modest with significant knowledge gaps and mortality from sepsis remains high. The priorities identified represent a roadmap for research in sepsis and septic shock.
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Affiliation(s)
- Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Clifford S Deutschman
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
- Sepsis Research Lab, the Feinstein Institutes for Medical Research, Manhasset, NY
| | - Judith Hellman
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, United Kingdom
| | - Hallie C Prescott
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Massimo Antonelli
- Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Seth R Bauer
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH
| | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Ignacio-Martin Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, Leinster, Dublin, Ireland
| | | | - Pierre Tissieres
- Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency, AP-HP Paris Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Antoine Vieillard-Baron
- Service de Medecine Intensive Reanimation, Hopital Ambroise Pare, Universite Paris-Saclay, Le Kremlin-Bicêtre, France
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Mekontso Dessap A, Bagate F, Repesse X, Blayau C, Fartoukh M, Canoui-Poitrine F, de Prost N, Vieillard-Baron A. Low-flow ECCO 2R conjoined with renal replacement therapy platform to manage pulmonary vascular dysfunction with refractory hypercapnia in ARDS. Heliyon 2024; 10:e23878. [PMID: 38226285 PMCID: PMC10788508 DOI: 10.1016/j.heliyon.2023.e23878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024] Open
Abstract
Background Hypercapnia worsens lung vascular dysfunction during acute respiratory distress syndrome (ARDS). We tested whether an extracorporeal carbon dioxide removal (ECCO2R) device based on a renal replacement therapy platform (Prismalung®) may reduce PaCO2 and alleviate lung vascular dysfunction in ARDS patients with refractory hypercapnia. Methods We planned to prospectively include 20 patients with moderate-to-severe ARDS, pulmonary vascular dysfunction on echocardiography, and PaCO2 ≥ 48 mmHg despite instrumental dead space reduction and the increase in respiratory rate. Hemodynamics, echocardiography, respiratory mechanics, and arterial blood gases were recorded at 2 (H2), 6 (H6) and 24 (H24) hours as ECCO2R treatment was continued for at least 24 h. Results Only eight patients were included, and the study was stopped due to worldwide shortage of ECCO2R membranes and the pandemic. Only one patient fulfilled the primary endpoint criterion (decrease in PaCO2 of more than 20 %) at H2, but this objective was achieved in half of patients (n = 4) at H6. The percentage of patients with a PaCO2 value < 48 mmHg increased with time, from 0/8 (0 %) at H0, to 3/8 (37.5 %) at H2 and 4/8 (50 %) at H6 (p = 0.04). There was no major change in hemodynamic and echocardiographic variables with ECCO2R, except for a significant decrease in heart rate. ECCO2R was prematurely discontinued before H24 in five (62.5 %) patients, due to membrane clotting in all cases. Conclusions This pilot study testing showed a narrow efficacy and high rate of membrane thrombosis with the first version of the system. Improved versions should be tested in future trials. Trial registration Registered at clinicaltrials.gov, identifier: NCT03303807, Registered: October 6, 2017, https://clinicaltrials.gov/ct2/show/NCT03303807.
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Affiliation(s)
- Armand Mekontso Dessap
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Univ Paris Est Créteil, CARMAS, Créteil, F-94010, France
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
| | - François Bagate
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Univ Paris Est Créteil, CARMAS, Créteil, F-94010, France
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
| | - Xavier Repesse
- AP-HP, Hôpital Ambroise Paré, Service de Médecine Intensive Réanimation, Boulogne Billancourt, Créteil, France
| | - Clarisse Blayau
- AP-HP, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France
| | - Muriel Fartoukh
- AP-HP, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, France
| | - Florence Canoui-Poitrine
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, F-94010, Créteil, France
| | - Nicolas de Prost
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France
- Univ Paris Est Créteil, CARMAS, Créteil, F-94010, France
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France
| | - Antoine Vieillard-Baron
- AP-HP, Hôpital Ambroise Paré, Service de Médecine Intensive Réanimation, Boulogne Billancourt, Créteil, France
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10
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Dumas F, Bougouin W, Perier M, Marin N, Goulenok C, Vieillard-Baron A, Diehl J, Legriel S, Deye N, Cronier P, Ricôme S, Chemouni F, Mekontso Dessap A, Beganton F, Marijon E, Jouven X, Empana J, Cariou A. Long-term follow-up of cardiac arrest survivors: Protocol of the DESAC (Devenir des survivants d'Arrets Cardiaques) study, a French multicentric prospective cohort. Resusc Plus 2023; 16:100460. [PMID: 37693335 PMCID: PMC10491722 DOI: 10.1016/j.resplu.2023.100460] [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] [Indexed: 09/12/2023] Open
Abstract
Background While the short-term prognosis of cardiac arrest patients - nearly 250,000 new cases per year in Europe - has been extensively studied, less is known regarding the mid and long-term outcome of survivors. Objective The aim of the DESAC study is to describe mid- and long-term survival rate and functional status of cardiac arrest survivors, and to assess the influence of pre and intra hospital therapeutic strategies on these two outcomes. Methods Between Jul 2015 and Oct 2018, adult patients over 18 years who were discharged alive from any intensive care units (public and private hospitals) in the Ile-de-France area (Paris and suburbs, France) after a non-traumatic cardiac arrest were screened for participation in this multicentric study. Survivors were included after they signed (or the proxies) an informed consent before discharge during initial hospitalisation. We calculated that including 600 patients in total would allow an 80% power to demonstrate a 2 years survival rate difference of 10% between patients who did and those who did not receive therapeutic hypothermia after resuscitation. Pre- and in-hospital data related to the circumstances surrounding the event and to the therapeutic interventions (such as cardio-pulmonary resuscitation, defibrillation, emergent coronary revascularization, neuroprotective therapeutics) were collected. After discharge, patients were interviewed at 3 months, 6 months and every year thereafter for a minimum follow-up of 26 months and a maximum follow-up of 48 months. Information on vital status, occurrence of cardiovascular events, medications and a comprehensive assessment of the functional status (qualitive of life as assessed by the Short-Form General Health Survey (SF36) scale, activities of daily living (ADL) scale, neurological Cerebral Performance Categories (CPC) and Overall Performance Categories (OPC) scales, socio-professional activities) were collected at follow-up interviews. Discussion The DESAC study should provide important information regarding several dimensions of the mid and long-term prognosis of cardiac arrest survivors and on the benefit (and potentially harm) of early therapeutic strategies.
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Affiliation(s)
- F. Dumas
- Emergency Department, Cochin Hospital-APHP, Université Paris Cité, Paris Cardiovascular Research Centre, INSERM U970, Sudden Death Expertise Centre, Paris, France
| | - W. Bougouin
- Medical Intensive Care Unit, Institut Jacques Cartier, Massy, France
- Université Paris Cité, Paris Cardiovascular Research Centre, INSERM U970, Paris Sudden Death Expertise Centre, Paris, France
| | - M.C. Perier
- Université Paris Cité, Paris Cardiovascular Research Centre, INSERM U970, Paris Sudden Death Expertise Centre, Paris, France
| | - N. Marin
- Medical Intensive Care Unit, Cochin Hospital-APHP, Université Paris Cité, France
| | - C. Goulenok
- Medical Intensive Care Unit, Institut Jacques Cartier, Massy, France
| | - A. Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Pare Hospital-APHP, Versailles- Saint Quentin University, France
| | - J.L. Diehl
- Medical Intensive Care Unit, European Georges Pompidou Hospital-APHP, Université Paris Cité, France
| | - S. Legriel
- Medical Intensive Care Unit, Andre Mignot Hospital, France
| | - N. Deye
- Medical Intensive Care Unit, Lariboisiere Hospital-APHP, Université Paris Cité, France
| | - P. Cronier
- Intensive Care Unit, Sud Francilien Hospital, France
| | - S. Ricôme
- Intensive Care Unit, Robert Ballanger Hospital, France
| | - F. Chemouni
- Intensive Care Unit, Grand Hôpital de l’Est Francilien, site de Marne-la-Vallée, Jossigny, France
| | - A. Mekontso Dessap
- Medical Intensive Care Unit, Henri Mondor Hospital-APHP, Paris Est University, France
| | - F. Beganton
- Université Paris Cité, Paris Cardiovascular Research Centre, INSERM U970, Paris Sudden Death Expertise Centre, Paris, France
| | - E. Marijon
- Université Paris Cité, Paris Cardiovascular Research Centre, INSERM U970, Paris Sudden Death Expertise Centre, Paris, France
| | - X. Jouven
- Université Paris Cité, Paris Cardiovascular Research Centre, INSERM U970, Paris Sudden Death Expertise Centre, Paris, France
| | - J.P. Empana
- Université Paris Cité, Paris Cardiovascular Research Centre, INSERM U970, Paris Sudden Death Expertise Centre, Paris, France
| | - A. Cariou
- Université Paris Cité, Paris Cardiovascular Research Centre, INSERM U970, Paris Sudden Death Expertise Centre, Paris, France
- Medical Intensive Care Unit, Cochin Hospital-APHP, Université Paris Cité, France
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11
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Aneman A, Schulz L, Prat G, Slama M, Vignon P, Vieillard-Baron A. Volume responsiveness revisited: an observational multicenter study of continuous versus binary outcomes combining echocardiography and venous return physiology. Am J Physiol Heart Circ Physiol 2023; 325:H1069-H1080. [PMID: 37682234 DOI: 10.1152/ajpheart.00375.2023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/05/2023] [Indexed: 09/09/2023]
Abstract
Echocardiography can assess cardiac preload when fluid administration is used to treat acute circulatory failure. Changes in stroke volume (SV) are inherently a continuous phenomenon relating to the pressure gradient for venous return (VRdP). However, most clinical studies have applied a binary definition based on a fractional change in SV. This study tested the hypothesis that calculating the analog mean systemic filling pressure (Pmsa) and VRdP would enhance echocardiography to describe SV responses to a preload challenge. We investigated 540 (379 males) patients during a standardized passive leg raising (PLR) maneuver. Patients were further categorized by the presence of impaired right ventricular function (impRV) or increased intra-abdominal hypertension (IAH). Multivariable linear regression identified VRdP (partial r = -0.26, P < 0.001), ventilatory-induced variations in superior vena cava diameter (partial r = 0.43, P < 0.001), and left ventricular outflow tract maximum-Doppler velocity (partial r = 0.13, P < 0.001) as independent variables associated with SV changes. The model explained 38% (P < 0.001) of the SV change in the whole cohort and 64% (P < 0.001) when excluding patients with impRV or IAH. The correlation between Pmsa or VRdP and SV changes lost statistical significance with increasing impRV or IAH. A binary definition of volume responsiveness (>10% increase in SV) generated an area under the curve of 0.79 (P < 0.001) in logistic regression but failed to identify Pmsa or VRdP as independent variables and overlooked the confounding influence of impRV and IAH. In conclusion, venous return physiology may enhance echocardiographic assessments of volume responsiveness, which should be based on continuous changes in stroke volume.NEW & NOTEWORTHY The analog mean systemic filling pressure and the pressure gradient for venous return combined with echocardiography predict continuous changes in stroke volume following a passive leg raising maneuver. The confounding effects of impaired right ventricular function and increased intra-abdominal pressure can be identified. Using a binary cutoff for the fractional change in stroke volume, common in previous clinical research, fails to identify the importance of variables relevant to venous return physiology and confounding conditions.
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Affiliation(s)
- Anders Aneman
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- Southwestern Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Luis Schulz
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- Southwestern Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Gwenaël Prat
- Medical Intensive Care Unit, Brest University Hospital, Brest, France
| | - Michel Slama
- Medical Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - Philippe Vignon
- Medical-Surgical Intensive Care Unit, Limoges University Hospital, Limoges, France
- INSERM CIC 1435, Limoges University Hospital, Limoges, France
- Faculty of Medicine, University of Limoges, Limoges, France
| | - Antoine Vieillard-Baron
- Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne-Billancourt, France
- INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
- Faculty of Medicine Paris Ile-de-France Quest, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
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12
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Petit M, Vieillard-Baron A. Ventricular interdependence in critically ill patients: from physiology to bedside. Front Physiol 2023; 14:1232340. [PMID: 37614759 PMCID: PMC10442576 DOI: 10.3389/fphys.2023.1232340] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023] Open
Abstract
The review focuses on the mechanism of ventricular interdependence, a frequently encountered phenomena, especially in critically ill patients. It is explained by the anatomy of the heart, with two ventricles sharing a common wall, the septum, and nested in an acutely inextensible envelope, the pericardium. In pathological situation, it results in abnormal movements of the interventricular septum driven by respiration, leading to abnormal filling of one or the other ventricle. Ventricular interdependence has several clinical applications and explains some situations of hemodynamic impairment, especially in situations of cardiac tamponade, severe acute asthma, right ventricular (RV) overload, or more simply, in case of positive pressure ventilation with underlying acute pulmonary hypertension. Ventricular interdependence can be monitored with pulmonary arterial catheter or echocardiography. Knowledge of this phenomena has very concrete clinical applications in the management of filling or in the prevention or treatment of RV overload.
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Affiliation(s)
- Matthieu Petit
- Medical Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique–Hôpitaux de Paris, Boulogne-Billancourt, France
- Inserm, CESP, Paris-Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Villejuif, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique–Hôpitaux de Paris, Boulogne-Billancourt, France
- Inserm, CESP, Paris-Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Villejuif, France
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13
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Huang S, Vieillard-Baron A, Evrard B, Prat G, Chew MS, Balik M, Clau-Terré F, De Backer D, Mekontso Dessap A, Orde S, Morelli A, Sanfilippo F, Charron C, Vignon P. Echocardiography phenotypes of right ventricular involvement in COVID-19 ARDS patients and ICU mortality: post-hoc (exploratory) analysis of repeated data from the ECHO-COVID study. Intensive Care Med 2023; 49:946-956. [PMID: 37436445 DOI: 10.1007/s00134-023-07147-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [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: 04/24/2023] [Accepted: 06/18/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Exploratory study to evaluate the association of different phenotypes of right ventricular (RV) involvement and mortality in the intensive care unit (ICU) in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). METHODS Post-hoc analysis of longitudinal data from the multicenter ECHO-COVID observational study in ICU patients who underwent at least two echocardiography examinations. Echocardiography phenotypes were acute cor pulmonale (ACP, RV cavity dilatation with paradoxical septal motion), RV failure (RVF, RV cavity dilatation and systemic venous congestion), and RV dysfunction (tricuspid annular plane systolic excursion ≤ 16 mm). Accelerated failure time model and multistate model were used for analysis. RESULTS Of 281 patients who underwent 948 echocardiography studies during ICU stay, 189 (67%) were found to have at least 1 type of RV involvements during one or several examinations: ACP (105/281, 37.4%), RVF (140/256, 54.7%) and/or RV dysfunction (74/255, 29%). Patients with all examinations displaying ACP had survival time shortened by 0.479 [0.284-0.803] times when compared to patients with all examinations depicting no ACP (P = 0.005). RVF showed a trend towards shortened survival time by a factor of 0.642 [0.405-1.018] (P = 0.059), whereas the impact of RV dysfunction on survival time was inconclusive (P = 0.451). Multistate analysis showed that patients might transit in and out of RV involvement, and those who exhibited ACP in their last critical care echocardiography (CCE) examination had the highest risk of mortality (hazard ratio (HR) 3.25 [2.38-4.45], P < 0.001). CONCLUSION RV involvement is prevalent in patients ventilated for COVID-19 ARDS. Different phenotypes of RV involvement might lead to different ICU mortality, with ACP having the worst outcome.
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Affiliation(s)
- Stephen Huang
- Intensive Care Medicine, Nepean Hospital, NBMLHD, The University of Sydney, Sydney, Australia
| | - Antoine Vieillard-Baron
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France
- INSERM UMR 1018, Clinical Epidemiology Team, CESP, Université de Paris Saclay, Villejuif, France
| | - Bruno Evrard
- Medical-Surgical ICU, Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France
| | - Gwenaël Prat
- Service de Médecine Intensive Réanimation, CHU Cavale Blanche Brest, Brest, France
| | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Martin Balik
- Department of Anesthesiology and Intensive Care, General University Hospital and 1St Medical Faculty, Charles University, Prague, Czechia
| | - Fernando Clau-Terré
- Department of Anaesthesiology and Critical Care Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Daniel De Backer
- CHIREC Hospitals Université Libre de Bruxelles, Brussels, Belgium
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique CARMAS, Inserm U955, Université Paris-Est Créteil, 94000, Créteil, France
| | - Sam Orde
- Intensive Care Medicine, Nepean Hospital, NBMLHD, The University of Sydney, Sydney, Australia
| | - Andrea Morelli
- Department Clinical Internal Anesthesiological and Cardiovascular Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Viale del Policlinico, Rome, Italy
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, Policlinico-Vittorio Emanuele University Hospital, Catania, Italy
| | - Cyril Charron
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France
- INSERM UMR 1018, Clinical Epidemiology Team, CESP, Université de Paris Saclay, Villejuif, France
| | - Philippe Vignon
- Medical-Surgical ICU, Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France.
- Réanimation Polyvalente, CHU Dupuytren, 2 Ave. Martin Luther King, 87042, Limoges Cedex, France.
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Mekontso Dessap A, Papazian L, Schaller M, Nseir S, Megarbane B, Haudebourg L, Timsit JF, Teboul JL, Kuteifan K, Gainnier M, Slama M, Houeto P, Lecourt L, Mercat A, Vieillard-Baron A. Inhaled nitric oxide in patients with acute respiratory distress syndrome caused by COVID-19: treatment modalities, clinical response, and outcomes. Ann Intensive Care 2023; 13:57. [PMID: 37368036 DOI: 10.1186/s13613-023-01150-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Inhaled nitric oxide (iNO) has been widely used in patients with COVID-19-related acute respiratory distress syndrome (C-ARDS), though its physiological effects and outcome are debated in this setting. The objective of this cohort study was to describe the modalities of iNO use, clinical response, and outcomes in a large cohort of C-ARDS patients. METHODS Multicentre, retrospective cohort study conducted in France. RESULTS From end February to December 2020, 300 patients (22.3% female) were included, 84.5% were overweight and 69.0% had at least one comorbidity. At ICU admission, their median (IQR) age, SAPS II, and SOFA score were 66 (57-72) years, 37 (29-48), and 5 (3-8), respectively. Patients were all ventilated according to a protective ventilation strategy, and 68% were prone positioned before iNO initiation. At iNO initiation, 2%, 37%, and 61% of patients had mild, moderate, and severe ARDS, respectively. The median duration of iNO treatment was 2.8 (1.1-5.5) days with a median dosage of 10 (7-13) ppm at initiation. Responders (PaO2/FiO2 ratio improving by 20% or more) represented 45.7% of patients at 6 h from iNO initiation. The severity of ARDS was the only predictive factor associated with iNO response. Among all evaluable patients, the crude mortality was not significantly different between responders at 6 h and their counterparts. Of the 62 patients with refractory ARDS (who fulfilled extracorporeal membrane oxygenation criteria before iNO initiation), 32 (51.6%) no longer fulfilled these criteria after 6 h of iNO. The latter showed significantly lower mortality than the other half (who remained ECMO eligible), including after confounder adjustment (adjusted OR: 0.23, 95% CI 0.06, 0.89, p = 0.03). CONCLUSIONS Our study reports the benefits of iNO in improving arterial oxygenation in C-ARDS patients. This improvement seems more relevant in the most severe cases. In patients with ECMO criteria, an iNO-driven improvement in gas exchange was associated with better survival. These results must be confirmed in well-designed prospective studies.
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Affiliation(s)
- Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri-Mondor, AP-HP, 94010, Créteil, France.
- CARMAS research group, Univ Paris Est Créteil, Faculté de Santé, 94010, Créteil, France.
- IMRB, INSERM, Univ Paris Est Créteil, 94010, Créteil, France.
| | - Laurent Papazian
- Médecine Intensive Réanimation, Centre d'Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, 13015, Marseille, France
| | | | - Saad Nseir
- Department of Intensive Care Medicine, Critical Care Center, CHU of Lille, 59000, Lille, France
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM MURS-1144, University of Paris, AP-HP, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Luc Haudebourg
- Service de Pneumologie et Réanimation Médicale du Département R3S, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, Paris, France
| | - Jean-François Timsit
- Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Hospital and U1137, IAME Université Paris-Cité, AP-HP, 75018, Paris, France
| | - Jean-Louis Teboul
- Service de Medecine Intensive-Reanimation, Hôpital de Bicêtre, AP-HP, 78, rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Khaldoun Kuteifan
- Service de Réanimation Médicale, Groupe Hospitalier de la Région Mulhouse Sud Alsace, 68100, Mulhouse, France
| | - Marc Gainnier
- Réanimation des Urgences, Hôpital de La Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Michel Slama
- Medical Intensive Care Unit, CHU Sud Amiens, Amiens, France
| | | | | | - Alain Mercat
- Department of Intensive Care, University of Angers, Angers, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
- Inserm UMR 1018, Équipe 5, CESP, Villejuif, France
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15
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Vieillard-Baron A, Boissier F, Pesenti A. Hemodynamic impact of prone position. Let's protect the lung and its circulation to improve prognosis. Intensive Care Med 2023; 49:692-694. [PMID: 36820879 DOI: 10.1007/s00134-023-07001-2] [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: 01/13/2023] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Antoine Vieillard-Baron
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.
- INSERM UMR 1018, Clinical Epidemiology Team, CESP, Université de Paris Saclay, Villejuif, France.
| | - Florence Boissier
- Service de Médecine Intensive Réanimation, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France
- INSERM CIC 1402 (IS-ALIVE Group), Université de Poitiers, Poitiers, France
| | - Antonio Pesenti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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16
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Vieillard-Baron A, Boissier F, Pesenti A. Correction: Hemodynamic impact of prone position. Let's protect the lung and its circulation to improve prognosis. Intensive Care Med 2023:10.1007/s00134-023-07062-3. [PMID: 37166507 DOI: 10.1007/s00134-023-07062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Antoine Vieillard-Baron
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.
- INSERM UMR 1018, Clinical Epidemiology Team, CESP, Université de Paris Saclay, Villejuif, France.
| | - Florence Boissier
- Service de Médecine Intensive Réanimation, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France
- INSERM CIC 1402 (IS-ALIVE Group), Université de Poitiers, Poitiers, France
| | - Antonio Pesenti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Gaillet A, Bay P, Péju E, Ait-Oufella H, Azoulay E, Benchabane N, Cerf C, Cohen Y, de Prost N, Faguer S, Geri G, Grangé S, Kahn JE, Kreitmann L, Larcher R, Lefèvre G, Mabrouki A, Mekonsto-Dessap A, Panel K, Pène F, Pineton de Chambrun M, Quenot JP, Tandjaoui-Lambiotte Y, Timsit JF, Vieillard-Baron A, Dargent A, Herault A, Groh M. Correction: Epidemiology, clinical presentation, and outcomes of 620 patients with eosinophilia in the intensive care unit. Intensive Care Med 2023; 49:611. [PMID: 37042964 DOI: 10.1007/s00134-023-07059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Antoine Gaillet
- Department of Internal Medicine, Foch Hospital, Suresnes, France.
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France.
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France.
| | - Pierre Bay
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
- Medical Intensive Care Unit, Cardiological Institute, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Edwige Péju
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris AP-HP Centre, Université Paris Cité, Paris, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Nacime Benchabane
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Charles Cerf
- Medical Intensive Care Unit, Foch Hospital, Suresnes, France
| | - Yves Cohen
- Medical Intensive Care Unit, CHU Avicenne, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 93000, Bobigny, France
| | - Nicolas de Prost
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, Centre de Référence Des Maladies Rénales Rares, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Guillaume Geri
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, 37 Boulevard Gambetta, 76031, Rouen Cedex, France
| | - Jean-Emmanuel Kahn
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- Department of Internal Medicine, Hôpital Ambroise-Paré, Boulogne-Billancourt, France
| | - Louis Kreitmann
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Romaric Larcher
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Guillaume Lefèvre
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - Asma Mabrouki
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Armand Mekonsto-Dessap
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
| | - Kewin Panel
- Department of Internal Medicine, Foch Hospital, Suresnes, France
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris AP-HP Centre, Université Paris Cité, Paris, France
| | - Marc Pineton de Chambrun
- Medical Intensive Care Unit, Cardiological Institute, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | | | - Yacine Tandjaoui-Lambiotte
- Medical Intensive Care Unit, CHU Avicenne, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 93000, Bobigny, France
- INSERM U1272 Hypoxia and Lung, Bobigny, France
| | - Jean-Francois Timsit
- Medical Intensive Care Unit, Université Paris Diderot/Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Auguste Dargent
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Antoine Herault
- Medical Intensive Care Unit, Rouen University Hospital, 37 Boulevard Gambetta, 76031, Rouen Cedex, France
| | - Matthieu Groh
- Department of Internal Medicine, Foch Hospital, Suresnes, France
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- CHU Lille, Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, University of Lille, Lille, France
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18
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Abstract
Keeping up with the latest developments in the point-of-care ultrasound (POCUS) literature is challenging, as with any area of medicine. Our group of POCUS experts has selected 10 influential papers from the past 12 months and provided a short summary of each. We hope to provide emergency physicians, intensivists, and other acute care providers with a succinct update concerning some key areas of ultrasound interest.
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Affiliation(s)
- Scott J Millington
- Critical Care Medicine, University of Ottawa/The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Seth J Koenig
- Critical Care Medicine, Kent Hospital, Warwick, RI, USA
| | - Paul H Mayo
- Critical Care Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Celante H, Oubaya N, Fourati S, Beaune S, Khellaf M, Casalino E, Ricard JD, Vieillard-Baron A, Heming N, Dessap AM, de Montmollin E, Benghanem S, Epaillard N, Layese R, de Prost N. Prognosis of hospitalized adult patients with respiratory syncytial virus infection: a multicenter retrospective cohort study. Clin Microbiol Infect 2023:S1198-743X(23)00117-9. [PMID: 36914069 DOI: 10.1016/j.cmi.2023.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/26/2023] [Accepted: 03/05/2023] [Indexed: 03/15/2023]
Abstract
OBJECTIVES Respiratory syncytial virus (RSV) is a common agent of viral respiratory infections with significant morbidity and mortality in adults. The objective of this study is to determine risk factors for mortality, invasive mechanical ventilation and to describe the characteristics of patients who received ribavirin. METHODS Retrospective multicenter observational cohort study conducted in Great Paris area hospitals, including patients hospitalized between January 1, 2015 and December 31, 2019 for documented RSV infection. Data were extracted from the AP-HP Health Data Warehouse. The primary endpoint was in-hospital mortality. RESULTS 1168 patients were hospitalized for RSV infection, including 288 (24.6%) patients who required ICU admission. The median [interquartile range] age of patients was 75 [63-85] years, 54% (n=631/1168) of them were women. In-hospital mortality was 6.6% (n=77/1168) in the whole cohort and 12.8% (n=37/288) in ICU patients. Factors associated with hospital mortality were age>85 years (adjusted odds ratio (aOR)=6.29 95% confidence interval [2.47-15.98]), acute respiratory failure (aOR=2.83 [1.19-6.72]), non-invasive (aOR=12.60 [1.41-112.36]) and invasive mechanical ventilation support (aOR=30.13 [3.17-286.27]) and neutropenia (aOR=13.19 [3.27-53.27]). Factors associated with invasive mechanical ventilation were chronic heart (aOR=1.98 [1.20-3.26]) or respiratory failure (aOR=2.83 [1.67-4.80]), and co-infection (aOR=2.62 [1.60-4.30]). Patients who were treated with ribavirin were significantly younger than others (62 [55-69] vs 75 [63-86] years; p<0.001), more frequently males (n=34/48 (70.8%) vs n=503/1120 (44.9%); p=0.001), and almost exclusively immunocompromised (n=46/48 (95.8%) vs n=299/1120 (26.7%); p<0.001). CONCLUSIONS The mortality rate of patients hospitalized with RSV infections was 6.6%. Twenty-five percent of patients required ICU admission.
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Affiliation(s)
- Héloïse Celante
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor- Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France
| | - Nadia Oubaya
- Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Department of Public Health, F-94010 Créteil, France
| | - Slim Fourati
- Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France; INSERM U955, Team « Viruses, Hepatology, Cancer », Créteil, France
| | - Sébastien Beaune
- Service D'Accueil des Urgences, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne Billancourt, France
| | - Mehdi Khellaf
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France; Service D'Accueil des Urgences, Hôpitaux Universitaires Henri Mondor- Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Enrique Casalino
- Service D'Accueil des Urgences, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Damien Ricard
- Université Paris Cité, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, Colombes, France
| | - Antoine Vieillard-Baron
- Service de Médecine Intensive Réanimation, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France; CESP, UMR 1018, Université Paris-Saclay
| | - Nicholas Heming
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris (AP-HP), Clamart, France
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor- Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France; Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France
| | - Etienne de Montmollin
- Service Médecine Intensive Réanimation, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sara Benghanem
- Service de Médecine Intensive Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Nicolas Epaillard
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Richard Layese
- Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Clinical Research Unit, F-94010 Créteil, France
| | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor- Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France.
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20
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Gaillet A, Bay P, Péju E, Ait-Oufella H, Azoulay E, Benchabane N, Cerf C, Cohen Y, de Prost N, Faguer S, Geri G, Grangé S, Kahn JE, Kreitmann L, Larcher R, Lefèvre G, Mabrouki A, Mekonsto-Dessap A, Panel K, Pène F, Pineton de Chambrun M, Quenot JP, Tandjaoui-Lambiotte Y, Timsit JF, Vieillard-Baron A, Dargent A, Herault A, Groh M. Epidemiology, clinical presentation, and outcomes of 620 patients with eosinophilia in the intensive care unit. Intensive Care Med 2023; 49:291-301. [PMID: 36723637 DOI: 10.1007/s00134-022-06967-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/22/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Although eosinophil-induced manifestations can be life-threatening, studies focusing on the epidemiology and clinical manifestations of eosinophilia in the intensive care unit (ICU) are lacking. METHODS A retrospective, national, multicenter (14 centers) cohort study over 6 years of adult patients who presented with eosinophilia ≥ 1 × 109/L on two blood samples performed from the day before admission to the last day of an ICU stay. RESULTS 620 patients (0.9% of all ICU hospitalizations) were included: 40% with early eosinophilia (within the first 24 h of ICU admission, ICU-Eo1 group) and 56% with delayed (> 24 h after ICU admission, ICU-Eo2 group) eosinophilia. In ICU-Eo1, eosinophilia was mostly due to respiratory (14.9%) and hematological (25.8%) conditions, frequently symptomatic (58.1%, mainly respiratory and cardiovascular manifestations) requiring systemic corticosteroids in 32.2% of cases. In ICU-Eo2, eosinophil-related organ involvement was rare (25%), and eosinophilia was mostly drug-induced (46.8%). Survival rates at day 60 (D60) after ICU admission were 21.4% and 17.2% (p = 0.219) in ICU-Eo1 and ICU-Eo2 patients, respectively. For ICU-Eo1 patients, in multivariate analysis, risk factors for death at D60 were current immunosuppressant therapy at ICU admission, eosinophilia of onco-hematological origin and the use of vasopressors at ICU admission, whereas older age and the use of vasopressors or mechanical ventilation at the onset of eosinophilia were associated with a poorer prognosis for ICU-Eo2 patients. CONCLUSION Eosinophilia ≥ 1 × 109/L is not uncommon in the ICU. According to the timing of eosinophilia, two subsets of patients requiring different etiological workups and management can be distinguished.
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Affiliation(s)
- Antoine Gaillet
- Department of Internal Medicine, Foch Hospital, Suresnes, France.
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France.
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France.
| | - Pierre Bay
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
- Medical Intensive Care Unit, Cardiological Institute, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Edwige Péju
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris AP-HP Centre, Université Paris Cité, Paris, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Nacime Benchabane
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Charles Cerf
- Medical Intensive Care Unit, Foch Hospital, Suresnes, France
| | - Yves Cohen
- Medical Intensive Care Unit, CHU Avicenne, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 93000, Bobigny, France
| | - Nicolas de Prost
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, Centre de Référence Des Maladies Rénales Rares, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Guillaume Geri
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, 37 Boulevard Gambetta, 76031, Rouen Cedex, France
| | - Jean-Emmanuel Kahn
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- Department of Internal Medicine, Hôpital Ambroise-Paré, Boulogne-Billancourt, France
| | - Louis Kreitmann
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Romaric Larcher
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Guillaume Lefèvre
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - Asma Mabrouki
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Armand Mekonsto-Dessap
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
| | - Kewin Panel
- Department of Internal Medicine, Foch Hospital, Suresnes, France
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris AP-HP Centre, Université Paris Cité, Paris, France
| | - Marc Pineton de Chambrun
- Medical Intensive Care Unit, Cardiological Institute, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | | | - Yacine Tandjaoui-Lambiotte
- Medical Intensive Care Unit, CHU Avicenne, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 93000, Bobigny, France
- INSERM U1272 Hypoxia and Lung, Bobigny, France
| | - Jean-Francois Timsit
- Medical Intensive Care Unit, Université Paris Diderot/Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Auguste Dargent
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Antoine Herault
- Medical Intensive Care Unit, Rouen University Hospital, 37 Boulevard Gambetta, 76031, Rouen Cedex, France
| | - Matthieu Groh
- Department of Internal Medicine, Foch Hospital, Suresnes, France
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- CHU Lille, Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, University of Lille, Lille, France
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21
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James A, Petit M, Biancale F, Bougle A, Degos V, Monsel A, Vieillard-Baron A, Constantin JM. Agreement between pulse oximetry and arterial oxygen saturation measurement in critical care patients during COVID-19: a cross-sectional study. J Clin Monit Comput 2023:10.1007/s10877-022-00959-2. [PMID: 36670340 PMCID: PMC9859741 DOI: 10.1007/s10877-022-00959-2] [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: 04/04/2022] [Accepted: 11/30/2022] [Indexed: 01/22/2023]
Abstract
Some publications suggest that pulse oximetry measurement (SpO2) might overestimate arterial oxygen saturation (SaO2) measurement in COVID-19 patients. This study aims to evaluate the agreement between SpO2 and SaO2 among COVID-19 and non-COVID-19 patients. We conducted a multicenter, prospective study including consecutive intensive care patients from October 15, 2020, to March 4, 2021, and compared for each measurement the difference between SpO2 and SaO2, also called the systematic bias. The primary endpoint was the agreement between SpO2 and SaO2 measured with the Lin concordance coefficient and illustrated using the Bland and Altman method. Factors associated with systematic bias were then identified using a generalised estimating equation. The study included 105 patients, 66 COVID-19 positive and 39 COVID-19 negative, allowing for 1539 measurements. The median age was 66 [57; 72] years with median SOFA and SAPSII scores of, respectively, 4 [3; 6] and 37 [31; 47]. The median SpO2 and SaO2 among all measurements was respectively 97 [96-99] and 94 [92-96] with a systematic bias of 0.80 [- 0.6; 2.4]. This difference was, respectively, 0.80 [- 0.7; 2.5] and 0.90 [- 0.3; 2.0] among COVID-19 positive and negative patients. Overall agreement measured with the Lin correlation coefficient was 0.65 [0.63; 0.68] with 0.61 [0.57; 0.64] and 0.53 [0.45; 0.60] among the COVID-19 positive and negative groups, respectively. Factors independently associated with the variation of the SpO2-SaO2 difference were the PaO2/FiO2 ratio and need for mechanical ventilation. In our population, agreement between SpO2 and SaO2 is acceptable. During the COVID-19 pandemic, SaO2 remains an efficient monitoring tool to characterise the level of hypoxemia and follow therapeutic interventions. As is already known about general intensive care unit patients, the greater hypoxemia, the weaker the correlation between SpO2 and SaO2.
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Affiliation(s)
- Arthur James
- grid.462844.80000 0001 2308 1657Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, DMU DREAM, AP-HP, 75013 Paris, France
| | - Matthieu Petit
- grid.463845.80000 0004 0638 6872Intensive Care Unit CHU Ambroise Paré, Université Paris-Saclay, UMR 1018, CESP, Villejuif, Boulogne, France
| | - Flore Biancale
- grid.462844.80000 0001 2308 1657Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, DMU DREAM, AP-HP, 75013 Paris, France
| | - Adrien Bougle
- grid.462844.80000 0001 2308 1657Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, DMU DREAM, AP-HP, 75013 Paris, France
| | - Vincent Degos
- grid.462844.80000 0001 2308 1657Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, DMU DREAM, AP-HP, 75013 Paris, France
| | - Antoine Monsel
- grid.462844.80000 0001 2308 1657Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, DMU DREAM, AP-HP, 75013 Paris, France
| | - Antoine Vieillard-Baron
- grid.463845.80000 0004 0638 6872Intensive Care Unit CHU Ambroise Paré, Université Paris-Saclay, UMR 1018, CESP, Villejuif, Boulogne, France
| | - Jean-Michel Constantin
- grid.462844.80000 0001 2308 1657Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, DMU DREAM, AP-HP, 75013 Paris, France
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22
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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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Tu GW, Monnet X, Vieillard-Baron A, Dobrilovic N, Yin K. Editorial: Perioperative hemodynamic monitoring and management. Front Med (Lausanne) 2022; 9:1096310. [PMID: 36569157 PMCID: PMC9788669 DOI: 10.3389/fmed.2022.1096310] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Guo-wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China,*Correspondence: Guo-wei Tu
| | - Xavier Monnet
- Paris-Saclay University Hospitals, Bicêtre Hospital, Inserm EA S_999, Paris-Saclay University, Paris, France,Xavier Monnet
| | - Antoine Vieillard-Baron
- Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris, Paris, France,Antoine Vieillard-Baron
| | - Nikola Dobrilovic
- Division of Cardiac Surgery, NorthShore University HealthSystem, Chicago, IL, United States,Nikola Dobrilovic
| | - Kanhua Yin
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
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Lascarrou JB, Dumas F, Bougouin W, Legriel S, Aissaoui N, Deye N, Beganton F, Lamhaut L, Jost D, Vieillard-Baron A, Nichol G, Marijon E, Jouven X, Cariou A, Agostinucci J, Aissaoui-Balanant N, Algalarrondo V, Alla F, Alonso C, Amara W, Annane D, Antoine C, Aubry P, Azoulay E, Beganton F, Billon C, Bougouin W, Boutet J, Bruel C, Bruneval P, Cariou A, Carli P, Casalino E, Cerf C, Chaib A, Cholley B, Cohen Y, Combes A, Coulaud J, Da Silva D, Das V, Demoule A, Denjoy I, Deye N, Diehl J, Dinanian S, Domanski L, Dreyfuss D, Dubois-Rande J, Dumas F, Duranteau J, Empana J, Extramiana F, Fagon J, Fartoukh M, Fieux F, Gandjbakhch E, Geri G, Guidet B, Halimi F, Henry P, Jabre P, Joseph L, Jost D, Jouven X, Karam N, Lacotte J, Lahlou-Laforet K, Lamhaut L, Lanceleur A, Langeron O, Lavergne T, Lecarpentier E, Leenhardt A, Lellouche N, Lemiale V, Lemoine F, Linval F, Loeb T, Ludes B, Luyt C, Mansencal N, Mansouri N, Marijon E, Maury E, Maxime V, Megarbane B, Mekontso-Dessap A, Mentec H, Mira J, Monnet X, Narayanan K, Ngoyi N, Perier M, Piot O, Plaisance P, Plaud B, Plu I, Raphalen J, Raux M, Revaux F, Ricard J, Richard C, Riou B, Roussin F, Santoli F, Schortgen F, Sharshar T, Sideris G, Spaulding C, Teboul J, Timsit J, Tourtier J, Tuppin P, Ursat C, Varenne O, Vieillard-Baron A, Voicu S, Wahbi K, Waldmann V. Differential Effect of Targeted Temperature Management Between 32 °C and 36 °C Following Cardiac Arrest According to Initial Severity of Illness: Insights From Two International Data Sets. Chest 2022; 163:1120-1129. [PMID: 36445800 DOI: 10.1016/j.chest.2022.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Recent guidelines have emphasized actively avoiding fever to improve outcomes in patients who are comatose following resuscitation from cardiac arrest (ie, out-of-hospital cardiac arrest). However, whether targeted temperature management between 32 °C and 36 °C (TTM32-36) can improve neurologic outcome in some patients remains debated. RESEARCH QUESTION Is there an association between the use of TTM32-36 and outcome according to severity assessed at ICU admission using a previously derived risk score? STUDY DESIGN AND METHODS Data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (France) between May 2011 and December 2017 and in the Resuscitation Outcomes Consortium Continuous Chest Compressions (ROC-CCC) trial (United States and Canada) between June 2011 and May 2015 were used for this study. Severity at ICU admission was assessed through a modified version of the Cardiac Arrest Hospital Prognosis (mCAHP) score, divided into tertiles of severity. The study explored associations between TTM32-36 and favorable neurologic status at hospital discharge by using multiple logistic regression as well as in tertiles of severity for each data set. RESULTS A total of 2,723 patients were analyzed in the SDEC data set and 4,202 patients in the ROC-CCC data set. A favorable neurologic status at hospital discharge occurred in 728 (27%) patients in the French data set and in 1,239 (29%) patients in the North American data set. Among the French data set, TTM32-36 was independently associated with better neurologic outcome in the tertile of patients with low (adjusted OR, 1.63; 95% CI, 1.15-2.30; P = .006) and high (adjusted OR, 1.94; 95% CI, 1.06-3.54; P = .030) severity according to mCAHP at ICU admission. Similar results were observed in the North American data set (adjusted ORs of 1.36 [95% CI, 1.05-1.75; P = .020] and 2.42 [95% CI, 1.38-4.24; P = .002], respectively). No association was observed between TTM32-36 and outcome in the moderate groups of the two data sets. INTERPRETATION TTM32-36 was significantly associated with a better outcome in patients with low and high severity at ICU admission assessed according to the mCAHP score. Further studies are needed to evaluate individualized temperature control following out-of-hospital cardiac arrest.
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Affiliation(s)
- Jean Baptiste Lascarrou
- Université Paris Cité, INSERM, PARCC, Paris, France; Médecine Intensive Réanimation, University Hospital Center, Nantes, France; AfterROSC Network Group, Paris, France.
| | - Florence Dumas
- Université Paris Cité, INSERM, PARCC, Paris, France; Emergency Department, Cochin University Hospital, APHP, Paris, France
| | - Wulfran Bougouin
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical-Surgical Intensive Care Unit, Hopital Privé Jacques Cartier, Massy, France
| | - Stephane Legriel
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Surgical Intensive Care Unit, Mignot Hospital, Le Chesnay, France
| | - Nadia Aissaoui
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
| | - Nicolas Deye
- AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Lariboisière University Hospital, INSERM U942, Paris, France
| | | | - Lionel Lamhaut
- AfterROSC Network Group, Paris, France; SAMU de Paris-DAR Necker University Hospital-Assistance, Paris, France
| | - Daniel Jost
- Brigade des Sapeurs-Pompiers de Paris, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
| | - Eloi Marijon
- Université Paris Cité, INSERM, PARCC, Paris, France
| | | | - Alain Cariou
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
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Foucrier A, Perrio J, Grisel J, Crépey P, Gayat E, Vieillard-Baron A, Batteux F, Gauss T, Squara P, Lo SH, Wargon M, Hellmann R. Transition matrices model as a way to better understand and predict intra-hospital pathways of covid-19 patients. Sci Rep 2022; 12:17508. [PMID: 36266423 PMCID: PMC9584905 DOI: 10.1038/s41598-022-22227-8] [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: 02/17/2022] [Accepted: 10/11/2022] [Indexed: 01/12/2023] Open
Abstract
Since January 2020, the SARS-CoV-2 pandemic has severely affected hospital systems worldwide. In Europe, the first 3 epidemic waves (periods) have been the most severe in terms of number of infected and hospitalized patients. There are several descriptions of the demographic and clinical profiles of patients with COVID-19, but few studies of their hospital pathways. We used transition matrices, constructed from Markov chains, to illustrate the transition probabilities between different hospital wards for 90,834 patients between March 2020 and July 2021 managed in Paris area. We identified 3 epidemic periods (waves) during which the number of hospitalized patients was significantly high. Between the 3 periods, the main differences observed were: direct admission to ICU, from 14 to 18%, mortality from ICU, from 28 to 24%, length of stay (alive patients), from 9 to 7 days from CH and from 18 to 10 days from ICU. The proportion of patients transferred from CH to ICU remained stable. Understanding hospital pathways of patients is crucial to better monitor and anticipate the impact of SARS-CoV-2 pandemic on health system.
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Affiliation(s)
- Arnaud Foucrier
- Ile-de-France Regional Health Agency, Paris, France ,grid.508487.60000 0004 7885 7602Hôpital Beaujon, DMU PARABOL, University of Paris, APHP, Paris, France
| | - Jules Perrio
- Data Science and Analytics Department, SESAN, Paris, France
| | - Johann Grisel
- Data Science and Analytics Department, SESAN, Paris, France
| | - Pascal Crépey
- grid.410368.80000 0001 2191 9284Ecole des Hautes Etudes en Santé Publique, REPERES (Recherche en Pharmaco-Epidémiologie et Recours Aux Soins), University of Rennes, EA 7449, Rennes, France
| | - Etienne Gayat
- grid.508487.60000 0004 7885 7602Department of Anaesthesiology and Critical Care, Hôpital Lariboisière, DMU PARABOL, University of Paris, Paris, France ,grid.508487.60000 0004 7885 7602Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France
| | - Antoine Vieillard-Baron
- grid.50550.350000 0001 2175 4109University Hospital Ambroise Paré, APHP, Boulogne-Billancourt, and Université de Versailles Saint Quentin en Yvelines UMR 1018, Boulogne-Billancourt, France
| | - Frédéric Batteux
- grid.508487.60000 0004 7885 7602Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Tobias Gauss
- grid.410529.b0000 0001 0792 4829Grenoble Alpes Trauma Centre, Pôle Anesthésie-Réanimation, CHU de Grenoble, La Tronche, France
| | - Pierre Squara
- grid.477172.0Department of Intensive Care and Cardiology, Clinique Ambroise Paré, Neuilly-Sur-Seine, France
| | - Seak-Hy Lo
- Ile-de-France Regional Health Agency, Paris, France
| | - Matthias Wargon
- grid.413961.80000 0004 0443 544XEmergency Department, Hôpital Delafontaine, Saint-Denis, France ,Observatoire Regional Des Soins Non Programmés-Ile-de-France, Saint-Denis, France
| | - Romain Hellmann
- Ile-de-France Regional Health Agency, Paris, France ,grid.50550.350000 0001 2175 4109Emergency Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Chevrot G, Hauguel-Moreau M, Pépin M, Vieillard-Baron A, Lot AS, Ouadahi M, Hergault H, Aïdan V, Greffe S, Costantini A, Dubourg O, Beaune S, Mansencal N. Electrocardiogram abnormalities and prognosis in COVID-19. Front Cardiovasc Med 2022; 9:993479. [PMID: 36277756 PMCID: PMC9581294 DOI: 10.3389/fcvm.2022.993479] [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: 07/13/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background COVID-19 is a major pandemic with potential cardiovascular complications. Few studies have focused on electrocardiogram (ECG) modifications in COVID-19 patients. Method and results We reviewed from our database all patients referred to our hospital for COVID-19 between January 1st, 2020, and December 31st, 2020: 669 patients were included and 98 patients died from COVID-19 (14.6%). We systematically analyzed ECG at admission and during hospitalization if available. ECG was abnormal at admission in 478 patients (71.4%) and was more frequently abnormal in patients who did not survive (88.8 vs. 68.5%, p < 0.001). The most common ECG abnormalities associated with death were left anterior fascicular block (39.8 vs. 20.0% among alive patients, p < 0.001), left and right bundle branch blocks (p = 0.002 and p = 0.02, respectively), S1Q3 pattern (14.3 vs. 6.0%, p = 0.006). In multivariate analysis, at admission, the presence of left bundle branch block remained statistically related to death [OR = 3.82, 95% confidence interval (CI): 1.52–9.28, p < 0.01], as well as S1Q3 pattern (OR = 3.17, 95% CI: 1.38–7.03, p < 0.01) and repolarization abnormalities (OR = 2.41, 95% CI: 1.40–4.14, p < 0.01). On ECG performed during hospitalization, the occurrence of new repolarization abnormality was significantly related to death (OR = 2.72, 95% CI: 1.14–6.54, p = 0.02), as well as a new S1Q3 pattern (OR = 13.23, 95% CI: 1.49–286.56, p = 0.03) and new supraventricular arrhythmia (OR = 3.8, 95% CI: 1.11–13.35, p = 0.03). Conclusion The presence of abnormal ECG during COVID-19 is frequent. Physicians should be aware of the usefulness of ECG for risk stratification during COVID-19.
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Affiliation(s)
- Gabriel Chevrot
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
| | - Marie Hauguel-Moreau
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France,INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France,*Correspondence: Marie Hauguel-Moreau
| | - Marion Pépin
- INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France,Department of Geriatrics, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France
| | - Antoine Vieillard-Baron
- INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France,Intensive Care Unit, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France,FHU SEPSIS IFrancenserm UMR 1144, Université Paris Centre, Paris, France
| | - Anne-Sophie Lot
- Department of Medical Information, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France
| | - Mounir Ouadahi
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
| | - Hélène Hergault
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
| | - Vincent Aïdan
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
| | - Ségolène Greffe
- Department of Internal Medicine, Ambroise Paré University Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France
| | - Adrien Costantini
- Pneumology Department, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France
| | - Olivier Dubourg
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France,INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France
| | - Sébastien Beaune
- FHU SEPSIS IFrancenserm UMR 1144, Université Paris Centre, Paris, France,Department of Emergency Medicine, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France
| | - Nicolas Mansencal
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France,INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France
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Fage N, Demiselle J, Seegers V, Merdji H, Grelon F, Mégarbane B, Anguel N, Mira JP, Dequin PF, Gergaud S, Weiss N, Legay F, Le Tulzo Y, Conrad M, Coudroy R, Gonzalez F, Guitton C, Tamion F, Tonnelier JM, Bedos JP, Van Der Linden T, Vieillard-Baron A, Mariotte E, Pradel G, Lesieur O, Ricard JD, Hervé F, Du Cheyron D, Guerin C, Mercat A, Teboul JL, Radermacher P, Asfar P. Effects of mean arterial pressure target on mottling and arterial lactate normalization in patients with septic shock: a post hoc analysis of the SEPSISPAM randomized trial. Ann Intensive Care 2022; 12:78. [PMID: 35984574 PMCID: PMC9391564 DOI: 10.1186/s13613-022-01053-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background In patients with septic shock, the impact of the mean arterial pressure (MAP) target on the course of mottling remains uncertain. In this post hoc analysis of the SEPSISPAM trial, we investigated whether a low-MAP (65 to 70 mmHg) or a high-MAP target (80 to 85 mmHg) would affect the course of mottling and arterial lactate in patients with septic shock. Methods The presence of mottling was assessed every 2 h from 2 h after inclusion to catecholamine weaning. We compared mottling and lactate time course between the two MAP target groups. We evaluated the patient’s outcome according to the presence or absence of mottling. Results We included 747 patients, 374 were assigned to the low-MAP group and 373 to the high-MAP group. There was no difference in mottling and lactate evolution during the first 24 h between the two MAP groups. After adjustment for MAP and confounding factors, the presence of mottling ≥ 6 h during the first 24 h was associated with a significantly higher risk of death at day 28 and 90. Patients without mottling or with mottling < 6 h and lactate ≥ 2 mmol/L have a higher probability of survival than those with mottling ≥ 6 h and lactate < 2 mmol/L. Conclusion Compared with low MAP target, higher MAP target did not alter mottling and lactate course. Mottling lasting for more than 6 h was associated with higher mortality. Compared to arterial lactate, mottling duration appears to be a better marker of mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01053-1.
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Affiliation(s)
- Nicolas Fage
- Department of Medical Intensive Care, University Hospital of Angers, Angers, France.,MITOVASC Laboratory UMR INSERM (French National Institute of Health and Medical Research), 1083 - CNRS 6015, University of Angers, Angers, France
| | - Julien Demiselle
- Department of Intensive Care (Service de Médecine Intensive - Réanimation), Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS (Fédération de Médecine Translationnelle de Strasbourg), University of Strasbourg, Strasbourg, France
| | - Valérie Seegers
- Service de Biométrie, Institut de Cancérologie de L'Ouest, Centre Paul Papin, Angers, France
| | - Hamid Merdji
- Department of Intensive Care (Service de Médecine Intensive - Réanimation), Nouvel Hôpital Civil, University Hospital of Strasbourg, Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS (Fédération de Médecine Translationnelle de Strasbourg), University of Strasbourg, Strasbourg, France
| | - Fabien Grelon
- Medical and Surgical Intensive Care Unit, Le Mans Hospital, Le Mans, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris University, INSERM UMRS-1144, Paris, France
| | - Nadia Anguel
- Department of Medical Intensive Care, Bicêtre University Hospital, AP-HP, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Jean-Paul Mira
- Department of Medical Intensive Care, Cochin University Hospital, Paris, France
| | | | - Soizic Gergaud
- Department of Surgical Intensive Care, University Hospital of Angers, Angers, France
| | - Nicolas Weiss
- Department of Medical Intensive Care, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France
| | - François Legay
- Medical and Surgical Intensive Care Unit, Saint Brieuc Hospital, Saint Brieuc, France
| | - Yves Le Tulzo
- Department of Infectious Diseases and Medical Intensive Care, Rennes University Hospital, Rennes, France
| | - Marie Conrad
- Department of Medical Intensive Care, Nancy University Hospital, Nancy, France
| | - Remi Coudroy
- Department of Medical Intensive Care, Université de Poitiers, CHU Poitiers, Poitiers, France
| | - Frédéric Gonzalez
- Department of Medical and Surgical Intensive Care, Avicenne Teaching Hospital, Bobigny, France
| | - Christophe Guitton
- Department of Medical Intensive Care, Nantes University Hospital, Nantes, France
| | - Fabienne Tamion
- Department of Medical Intensive Care, Rouen University Hospital, Rouen, France
| | | | | | - Thierry Van Der Linden
- Department of Intensive Care, Saint Philibert Hospital, Catholic University of Lille, Lille, France
| | - Antoine Vieillard-Baron
- Department of Medical Intensive Care, University Hospital of Ambroise Paré, Boulogne Billancourt, France.,Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Faculty of Paris Saclay, Villejuif, France
| | - Eric Mariotte
- Department of Intensive Care, Saint Louis Hospital, Paris, France
| | - Gaël Pradel
- Department of Intensive Care, Avignon Hospital, Avignon, France
| | - Olivier Lesieur
- Department of Medical and Surgical Intensive Care, La Rochelle Saint Louis Hospital, La Rochelle, France
| | - Jean-Damien Ricard
- Université de Paris, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Médecine Intensive Réanimation, Colombes, France
| | - Fabien Hervé
- Department of Medical and Surgical Intensive Care, Quimper Hospital, Quimper, France
| | - Damien Du Cheyron
- Department of Medical Intensive Care, Caen University Hospital, Caen, France
| | - Claude Guerin
- Department of Medical Intensive Care, Edouard Herriot Hospital, Lyon, France
| | - Alain Mercat
- Department of Medical Intensive Care, University Hospital of Angers, Angers, France
| | - Jean-Louis Teboul
- Department of Medical Intensive Care, Bicêtre University Hospital, AP-HP, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Peter Radermacher
- Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Helmholtzstrasse 8-1, Ulm, Germany
| | - Pierre Asfar
- Department of Medical Intensive Care, University Hospital of Angers, Angers, France.
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28
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Vieillard-Baron A, Flicoteaux R, Salmona M, Chariot A, De Maupeou D’Ableiges B, Darmon M, Batteux F. Omicron Variant in the Critical Care Units of the Paris Metropolitan Area: The Reality Research Group. Am J Respir Crit Care Med 2022; 206:349-363. [PMID: 35536284 PMCID: PMC9890255 DOI: 10.1164/rccm.202202-0411le] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Antoine Vieillard-Baron
- Assistance Publique des Hôpitaux de ParisBoulogne, France,Université de Paris SaclayVillejuif, France,Corresponding author (e-mail: )
| | | | - Maud Salmona
- Assistance Publique des Hôpitaux de ParisParis, France,Université de ParisParis, France
| | | | | | - Michael Darmon
- Assistance Publique des Hôpitaux de ParisParis, France,Université de ParisParis, France
| | - Frédéric Batteux
- Assistance Publique des Hôpitaux de ParisParis, France,Université de ParisParis, France
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Sharifzadehgan A, Gaye B, Bougouin W, Narayanan K, Dumas F, Karam N, Rischard J, Plu I, Waldmann V, Algalarrondo V, Gandjbakhch E, Bruneval P, Beganton Date Curation F, Alonso C, Moubarak G, Piot O, Lamhaut L, Jost D, Sideris G, Mansencal N, Deye N, Voicu S, Megarbane B, Geri G, Vieillard-Baron A, Lellouche N, Extramiana F, Wahbi K, Varenne O, Cariou A, Jouven X, Marijon E. Lack of Early Etiologic Investigations in Young Sudden Cardiac Death. Resuscitation 2022; 179:197-205. [PMID: 35788021 DOI: 10.1016/j.resuscitation.2022.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 04/26/2022] [Revised: 06/09/2022] [Accepted: 06/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Since majority of sudden cardiac arrest (SCA) victims die in the intensive care unit (ICU), early etiologic investigations may improve understanding of SCA and targeted prevention. METHODS In this prospective, population-based registry all SCA admitted alive across the 48 hospitals of the Paris area were enrolled. We investigated the extent of early etiologic work-up among young SCD cases (<45 years) eventually dying within the ICU. RESULTS From May 2011 to May 2018, 4,314 SCA patients were admitted alive. Among them, 3,044 died in ICU, including 484 (15.9%) young patients. SCA etiology was established in 233 (48.1%) and remained unexplained in 251 (51.9%). Among unexplained (compared to explained) cases, coronary angiography (17.9 vs. 49.4%, P<0.001), computed tomography scan (24.7 vs. 46.8%, P<0.001) and trans-thoracic echocardiography (31.1 vs. 56.7%, P<0.001) were less frequently performed. Only 22 (8.8%) patients with unexplained SCD underwent all three investigations. SCDs with unexplained status decreased significantly over the 7 years of the study period (from 62.9 to 35.2%, P=0.005). While specialized TTE and CT scan performances have increased significantly, performance of early coronary angiography did not change. Autopsy, genetic analysis and family screening were performed in only 48 (9.9%), 5 (1.0%) and 14 cases (2.9%) respectively. CONCLUSIONS More than half of young SCD dying in ICU remained etiologically unexplained; this was associated with a lack of early investigations. Improving early diagnosis may enhance both SCA understanding and prevention, including for relatives. Failure to identify familial conditions may result in other preventable deaths within these families.
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Affiliation(s)
- Ardalan Sharifzadehgan
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France.
| | - Bamba Gaye
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Wulfran Bougouin
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Jacques Cartier Hospital, Intensive Care Unit, Massy, France
| | - Kumar Narayanan
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Medicover Hospitals, Cardiology Department, Hyderabad, India
| | - Florence Dumas
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France; Cochin Hospital, Emergency Department, Paris, France
| | - Nicole Karam
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Julien Rischard
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | | | - Victor Waldmann
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Vincent Algalarrondo
- Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
| | - Estelle Gandjbakhch
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.); La Pitié Salpêtrière University Hospital, Cardiology Department, Paris, France
| | - Patrick Bruneval
- University of Paris, Paris, France; European Georges Pompidou Hospital, Pathology Department, Paris, France
| | | | - Christine Alonso
- Centres Médico Chirurgicaux Ambroise Paré, Neuilly-sur-Seine, France
| | - Ghassan Moubarak
- Centres Médico Chirurgicaux Ambroise Paré, Neuilly-sur-Seine, France
| | - Olivier Piot
- Centre Cardiologique du Nord, Saint Denis, France
| | - Lionel Lamhaut
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France; Emergency Medical Services (SAMU) 75, Necker University Hospital, APHP, Paris, France
| | - Daniel Jost
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Firefighters Brigade (BSPP), Paris, France
| | | | - Nicolas Mansencal
- Ambroise Paré Hospital, Cardiology Intensive Care Unit, Paris, France
| | - Nicolas Deye
- Lariboisiere Hospital, Intensive Care Unit, Paris, France
| | | | | | - Guillaume Geri
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Ambroise Paré Hospital, Intensive Care Unit, Paris, France
| | | | - Nicolas Lellouche
- University Hospital Henri Mondor, Cardiology Department, Créteil, France
| | - Fabrice Extramiana
- Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
| | - Karim Wahbi
- University of Paris, Paris, France; Cochin Hospital, Cardiology Intensive Care Unit, Paris, France
| | - Olivier Varenne
- University of Paris, Paris, France; Cochin Hospital, Cardiology Intensive Care Unit, Paris, France
| | - Alain Cariou
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France; Cochin Hospital, Intensive Care Unit, Paris, France
| | - Xavier Jouven
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Eloi Marijon
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
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Vieillard-Baron A, Huang S. Characterising right ventricular dysfunction in COVID-19 ARDS: which measurements are the best? Author's reply. Intensive Care Med 2022; 48:1106-1107. [PMID: 35680660 DOI: 10.1007/s00134-022-06774-2] [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] [Accepted: 05/31/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Antoine Vieillard-Baron
- Intensive Care Unit, University Hospital Ambroise Paré, 92100, Boulogne, France.
- INSERM UMR 1018, Clinical Epidemiology Team, CESP, Université de Paris Saclay, Villejuif, France.
| | - Stephen Huang
- Intensive Care Medicine, Nepean Hospital, The University of Sydney, Sydney, Australia
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Takagi K, Akiyama E, Paternot A, Miró Ò, Charron C, Gayat E, Deye N, Cariou A, Monnet X, Jaber S, Guidet B, Damoisel C, Barthélémy R, Azoulay E, Kimmoun A, Fournier MC, Cholley B, Edwards C, Davison BA, Cotter G, Vieillard-Baron A, Mebazaa A. Early echocardiography by treating physicians and outcome in the critically ill: An ancillary study from the prospective multicenter trial FROG-ICU. J Crit Care 2022; 69:154013. [PMID: 35278876 DOI: 10.1016/j.jcrc.2022.154013] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/28/2022] [Accepted: 02/15/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to investigate the association between the use of early echocardiography performed by the treating physician certified in critical care ultrasound and mortality in ICU patients. MATERIALS AND METHODS FROG-ICU was a multi-center cohort designed to investigate the outcome of critically ill patients. Of the 1359 patients admitted to centers where echocardiography was available, 372 patients underwent echocardiography during the initial 3 days. RESULTS Of the ICU patients admitted for cardiac disease, 47.4% underwent echocardiography, and those patients had the lowest left ventricular ejection fraction 40 [31-58] % and the lowest cardiac output 4.2 [3.2-5.7] L/min compared to patients admitted for other causes (p < 0.001 for both). One-year mortality was 36.8% and 39.9% in patients with and without echocardiography, respectively [HR 0.92 (95% CI 0.75-1.11)]. This result was confirmed after multivariable Cox regression analysis [HR 0.88 (95% CI 0.71-1.08)]. Subgroup analyses suggest that among patients admitted to ICU for cardiac disease, those managed with echocardiography had a lower risk of one-year mortality [HR 0.65 (95% CI 0.43-0.98)]. CONCLUSIONS Early echocardiography by treating physicians was not associated with short- or long-term survival in ICU patients. In subgroups, early echocardiography improved survival in ICU patients admitted for cardiac disease. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01367093.
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Affiliation(s)
- Koji Takagi
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Momentum Research, Inc., Chapel Hill, NC, USA
| | - Eiichi Akiyama
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Alexis Paternot
- Intensive Care Unit, University hospital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Barcelona, Spain; IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain; Medical School, University of Barcelona, Barcelona, Spain
| | - Cyril Charron
- Intensive Care Unit, University hospital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - Etienne Gayat
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France
| | - Nicolas Deye
- Medical and Toxicology Intensive Care Unit, Hôpitaux Universitaires Saint Louis-Lariboisière, AP-HP, Université Paris Diderot-Paris 7, Inserm U942, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, AP-HP, Université de Paris, Paris, France
| | - Xavier Monnet
- Medical Intensive Care Unit, Bicêtre Hospital, Paris-Saclay University Hospitals, Inserm UMR_S999, Paris-Suclay University, Le Kremlin-Bicetre, France
| | - Samir Jaber
- Intensive Care Unit, Anaesthesia and Critical Care Department, Saint Eloi Teaching Hospital, Centre Hospitalier, Montpellier, France
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Service de réanimation, F75012 Paris, France
| | - Charles Damoisel
- Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France
| | - Romain Barthélémy
- Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France
| | - Elie Azoulay
- Médecine Intensive et Réanimation, Hôpital Saint-Louis, AP-HP et Université de Paris, Paris, France
| | - Antoine Kimmoun
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Intensive Care Medicine Brabois, CHRU de Nancy, INSERM U1116, Université de Lorraine, 54511 Vandoeuvre-les-Nancy, France
| | - Marie-Céline Fournier
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France
| | - Bernard Cholley
- Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France; Inserm UMR_S 1140, Innovations Thérapeutiques en Hémostase, Paris, France
| | | | - Beth A Davison
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Momentum Research, Inc., Chapel Hill, NC, USA
| | - Gad Cotter
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Momentum Research, Inc., Chapel Hill, NC, USA
| | | | - Alexandre Mebazaa
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France.
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Affiliation(s)
- Armand Mekontso Dessap
- Assistance Publique–Hôpitaux de ParisHôpitaux Universitaires Henri-Mondor,Cardiovascular and Respiratory Manifestations of Acute Lung Injury andSepsis (CARMAS),Institut Mondor de Recherche BiomédicaleUniversité Paris Est CréteilCréteil, France
| | - Antoine Vieillard-Baron
- Assistance Publique–Hôpitaux de ParisHôpital Ambroise-ParéBoulogne-Billancourt, France,Centre de Recherche en Epidémiologie et Santé des PopulationsUniversité de Paris SaclayVillejuif, France
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33
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Huang S, Vignon P, Mekontso-Dessap A, Tran S, Prat G, Chew M, Balik M, Sanfilippo F, Banauch G, Clau-Terre F, Morelli A, De Backer D, Cholley B, Slama M, Charron C, Goudelin M, Bagate F, Bailly P, Blixt PJ, Masi P, Evrard B, Orde S, Mayo P, McLean AS, Vieillard-Baron A. Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study). Intensive Care Med 2022; 48:667-678. [PMID: 35445822 PMCID: PMC9022062 DOI: 10.1007/s00134-022-06685-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [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: 01/19/2022] [Accepted: 03/16/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU). METHODS Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap). RESULTS Six hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR > 4), pulmonary embolism (OR > 5) and increased PaCO2. Exploratory analyses showed that patients with ACP and older age were more likely to die in hospital (including ICU). CONCLUSION Almost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort.
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Affiliation(s)
- Stephen Huang
- Intensive Care Medicine, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - Philippe Vignon
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Inserm CIC 1435 and UMR 1092, 87000, Limoges, France
| | - Armand Mekontso-Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique CARMAS, Inserm U955, Université Paris-Est Créteil, 94000, Créteil, France
| | - Ségolène Tran
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France
| | - Gwenael Prat
- Service de Médecine Intensive Réanimation, CHU Cavale Blanche Brest, Brest, France
| | - Michelle Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Martin Balik
- Department of Anesthesiology and Intensive Care, General University Hospital and 1st Medical Faculty, Charles University, Prague, Czechia
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, Policlinico-Vittorio Emanuele University Hospital, Catania, Italy
| | - Gisele Banauch
- Division of Pulmonary, Critical Care and Allergy, Department of Medicine, UmassMemorial Medical Center, The University Hospital for University of Massachusetts, Worcester, MA, USA
| | - Fernando Clau-Terre
- Department of Anaesthesiology and Critical Care Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrea Morelli
- Department Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Viale del Policlinico, Rome, Italy
| | - Daniel De Backer
- CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Bernard Cholley
- Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP and Université de Paris, 20 Rue Leblanc, 75015, Paris, France
| | - Michel Slama
- Medical Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - Cyril Charron
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France
| | - Marine Goudelin
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Inserm CIC 1435 and UMR 1092, 87000, Limoges, France
| | - Francois Bagate
- Service de Médecine Intensive Réanimation, Hôpitaux universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique CARMAS, Inserm U955, Université Paris-Est Créteil, 94000, Créteil, France
| | - Pierre Bailly
- Service de Médecine Intensive Réanimation, CHU Cavale Blanche Brest, Brest, France
| | - Patrick-Johansson Blixt
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Paul Masi
- Service de Médecine Intensive Réanimation, Hôpitaux universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique CARMAS, Inserm U955, Université Paris-Est Créteil, 94000, Créteil, France
| | - Bruno Evrard
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Inserm CIC 1435 and UMR 1092, 87000, Limoges, France
| | - Sam Orde
- Intensive Care Medicine, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - Paul Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, Hofstra/Northwell, Hempstead, NY, USA
| | - Anthony S McLean
- Intensive Care Medicine, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - Antoine Vieillard-Baron
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.
- INSERM, UMR 1018, Clinical Epidemiology Team, CESP, Université de Paris Saclay, Villejuif, France.
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Wong A, Robba C, Vieillard-Baron A. Basic ultrasound skill for intensivists: future scope for expansion of the recommendations of the European Society of Intensive Care Medicine. Author's reply. Intensive Care Med 2022; 48:973-974. [PMID: 35579688 DOI: 10.1007/s00134-022-06673-6] [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] [Accepted: 03/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Adrian Wong
- Department of Critical Care, King's College Hospital, London, UK. .,European Society of Intensive Care Medicine (ESICM), 19 Rue Belliard, 1040, Brussels, Belgium.
| | - Chiara Robba
- Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS Per L'Oncologia E Le Neuroscienze, Genoa, Italy.,Italy and Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa, Italy.,European Society of Intensive Care Medicine (ESICM), 19 Rue Belliard, 1040, Brussels, Belgium
| | - Antoine Vieillard-Baron
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Billancourt, 92100, Boulogne, France.,INSERM UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, Versailles, France.,European Society of Intensive Care Medicine (ESICM), 19 Rue Belliard, 1040, Brussels, Belgium
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Millington SJ, Arntfield RT, Koenig SJ, Mayo PH, Vieillard-Baron A. Ten Influential Point-of-Care Ultrasound Papers: 2021 in Review. J Intensive Care Med 2022; 37:1535-1539. [PMID: 35440211 PMCID: PMC9548919 DOI: 10.1177/08850666221095050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The ongoing rapid expansion of point-of-care ultrasound (POCUS) and its
corresponding supporting literature leaves the frontline clinician in a
difficult position when trying to keep abreast of the latest developments. Our
group of POCUS experts has selected ten influential POCUS-related papers from
the past twelve months and provided a short summary of each. Our aim is to give
to emergency physicians, intensivists, and other acute care providers key
information, helping them to keep up to date on rapidly evolving POCUS
literature.
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Affiliation(s)
| | | | | | - Paul H Mayo
- 5799Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Gendreau S, Geri G, Pham T, Vieillard-Baron A, Mekontso Dessap A. The role of acute hypercapnia on mortality and short-term physiology in patients mechanically ventilated for ARDS: a systematic review and meta-analysis. Intensive Care Med 2022; 48:517-534. [PMID: 35294565 PMCID: PMC8924945 DOI: 10.1007/s00134-022-06640-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 10/01/2021] [Accepted: 02/03/2022] [Indexed: 12/29/2022]
Abstract
Purpose Hypercapnia is frequent during mechanical ventilation for acute respiratory distress syndrome (ARDS), but its effects on morbidity and mortality are still controversial. We conducted a systematic review and meta-analysis to explore clinical consequences of acute hypercapnia in adult patients ventilated for ARDS. Methods We searched Medline, Embase, and the Cochrane Library via the OVID platform for studies published from 1946 to 2021. “Permissive hypercapnia” defined hypercapnia in studies where the group with hypercapnia was ventilated with a protective ventilation (PV) strategy (lower VT targeting 6 ml/kg predicted body weight) while the group without hypercapnia was managed with a non-protective ventilation (NPV); “imposed hypercapnia” defined hypercapnia in studies where hypercapnic and non-hypercapnic patients were managed with a similar ventilation strategy. Results Twenty-nine studies (10,101 patients) were included. Permissive hypercapnia, imposed hypercapnia under PV, and imposed hypercapnia under NPV were reported in 8, 21 and 1 study, respectively. Studies testing permissive hypercapnia reported lower mortality in hypercapnic patients receiving PV as compared to non-hypercapnic patients receiving NPV: OR = 0.26, 95% CI [0.07–0.89]. By contrast, studies reporting imposed hypercapnia under PV reported increased mortality in hypercapnic patients receiving PV as compared to non-hypercapnic patients also receiving PV: OR = 1.54, 95% CI [1.15–2.07]. There was a significant interaction between the mechanism of hypercapnia and the effect on mortality. Conclusions Clinical effects of hypercapnia are conflicting depending on its mechanism. Permissive hypercapnia was associated with improved mortality contrary to imposed hypercapnia under PV, suggesting a major role of PV strategy on the outcome. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06640-1.
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Affiliation(s)
- Ségolène Gendreau
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive-Réanimation, 94010, Créteil, France
- Université Paris Est Créteil, CARMAS, 94010, Créteil, France
- Université Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France
| | - Guillaume Geri
- AP-HP, Hôpital Universitaire Ambroise-Paré, Service de Médecine Intensive Réanimation, 92100, Boulogne-Billancourt, France
- Université de Paris Saclay, INSERM UMR 1018, Clinical Epidemiology Team, CESP, Villejuif, France
| | - Tai Pham
- AP-HP, Hôpital de Bicêtre, DMU CORREVE, Service de Médecine Intensive-Réanimation, Université Paris-Saclay, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm U1018, Equipe d'Epidémiologie respiratoire intégrative, CESP, 94807, Villejuif, France
| | - Antoine Vieillard-Baron
- AP-HP, Hôpital Universitaire Ambroise-Paré, Service de Médecine Intensive Réanimation, 92100, Boulogne-Billancourt, France
- Université de Paris Saclay, INSERM UMR 1018, Clinical Epidemiology Team, CESP, Villejuif, France
| | - Armand Mekontso Dessap
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive-Réanimation, 94010, Créteil, France.
- Université Paris Est Créteil, CARMAS, 94010, Créteil, France.
- Université Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France.
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Petit M, Jullien E, Vieillard-Baron A. Right Ventricular Function in Acute Respiratory Distress Syndrome: Impact on Outcome, Respiratory Strategy and Use of Veno-Venous Extracorporeal Membrane Oxygenation. Front Physiol 2022; 12:797252. [PMID: 35095561 PMCID: PMC8795709 DOI: 10.3389/fphys.2021.797252] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/21/2021] [Indexed: 12/16/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is characterized by protein-rich alveolar edema, reduced lung compliance and severe hypoxemia. Despite some evidence of improvements in mortality over recent decades, ARDS remains a major public health problem with 30% 28-day mortality in recent cohorts. Pulmonary vascular dysfunction is one of the pivot points of the pathophysiology of ARDS, resulting in a certain degree of pulmonary hypertension, higher levels of which are associated with morbidity and mortality. Pulmonary hypertension develops as a result of endothelial dysfunction, pulmonary vascular occlusion, increased vascular tone, extrinsic vessel occlusion, and vascular remodeling. This increase in right ventricular (RV) afterload causes uncoupling between the pulmonary circulation and RV function. Without any contractile reserve, the right ventricle has no adaptive reserve mechanism other than dilatation, which is responsible for left ventricular compression, leading to circulatory failure and worsening of oxygen delivery. This state, also called severe acute cor pulmonale (ACP), is responsible for excess mortality. Strategies designed to protect the pulmonary circulation and the right ventricle in ARDS should be the cornerstones of the care and support of patients with the severest disease, in order to improve prognosis, pending stronger evidence. Acute cor pulmonale is associated with higher driving pressure (≥18 cmH2O), hypercapnia (PaCO2 ≥ 48 mmHg), and hypoxemia (PaO2/FiO2 < 150 mmHg). RV protection should focus on these three preventable factors identified in the last decade. Prone positioning, the setting of positive end-expiratory pressure, and inhaled nitric oxide (INO) can also unload the right ventricle, restore better coupling between the right ventricle and the pulmonary circulation, and correct circulatory failure. When all these strategies are insufficient, extracorporeal membrane oxygenation (ECMO), which improves decarboxylation and oxygenation and enables ultra-protective ventilation by decreasing driving pressure, should be discussed in seeking better control of RV afterload. This review reports the pathophysiology of pulmonary hypertension in ARDS, describes right heart function, and proposes an RV protective approach, ranging from ventilatory settings and prone positioning to INO and selection of patients potentially eligible for veno-venous extracorporeal membrane oxygenation (VV ECMO).
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Affiliation(s)
- Matthieu Petit
- Medical Intensive Care Unit, University Hospital Ambroise Paré, APHP, Boulogne-Billancourt, France
- UFR des Sciences de la Santé Simone Veil, Université Paris-Saclay, Montigny-le-Bretonneux, France
| | - Edouard Jullien
- Medical Intensive Care Unit, University Hospital Ambroise Paré, APHP, Boulogne-Billancourt, France
- UFR des Sciences de la Santé Simone Veil, Université Paris-Saclay, Montigny-le-Bretonneux, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, University Hospital Ambroise Paré, APHP, Boulogne-Billancourt, France
- UFR des Sciences de la Santé Simone Veil, Université Paris-Saclay, Montigny-le-Bretonneux, France
- *Correspondence: Antoine Vieillard-Baron,
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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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De Baynast Q, Hauguel M, Vieillard-Baron A, Szymanski C, Dubourg O, Mansencal N. Prognosis assessment of acute pulmonary embolism by multimodality imaging: Is it really necessary? Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kattan E, Bakker J, Estenssoro E, Ospina-Tascón GA, Cavalcanti AB, Backer DD, Vieillard-Baron A, Teboul JL, Castro R, Hernández G. Hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol. Rev Bras Ter Intensiva 2022. [DOI: 10.5935/0103-507x.20220004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kattan E, Bakker J, Estenssoro E, Ospina-Tascón GA, Cavalcanti AB, Backer DD, Vieillard-Baron A, Teboul JL, Castro R, Hernández G. Hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol. Rev Bras Ter Intensiva 2022. [PMID: 35766659 PMCID: PMC9345585 DOI: 10.5935/0103-507x.20220004-en] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Indexed: 12/02/2022] Open
Abstract
Background: Early reversion of sepsis-induced tissue hypoperfusion is essential for survival in septic shock. However, consensus regarding the best initial resuscitation strategy is lacking given that interventions designed for the entire population with septic shock might produce unnecessary fluid administration. This article reports the rationale, study design and analysis plan of the ANDROMEDA-2 study, which aims to determine whether a peripheral perfusion-guided strategy consisting of capillary refill time-targeted resuscitation based on clinical and hemodynamic phenotypes is associated with a decrease in a composite outcome of mortality, time to organ support cessation, and hospital length of stay compared to standard care in patients with early (< 4 hours of diagnosis) septic shock. Methods: The ANDROMEDA-2 study is a multicenter, multinational randomized controlled trial. In the intervention group, capillary refill time will be measured hourly for 6 hours. If abnormal, patients will enter an algorithm starting with pulse pressure assessment. Patients with pulse pressure less than 40mmHg will be tested for fluid responsiveness and receive fluids accordingly. In patients with pulse pressure > 40mmHg, norepinephrine will be titrated to maintain diastolic arterial pressure > 50mmHg. Patients who fail to normalize capillary refill time after the previous steps will be subjected to critical care echocardiography for cardiac dysfunction evaluation and subsequent management. Finally, vasopressor and inodilator tests will be performed to further optimize perfusion. A sample size of 1,500 patients will provide 88% power to demonstrate superiority of the capillary refill time-targeted strategy. Conclusions: If hemodynamic phenotype-based, capillary refill time-targeted resuscitation demonstrates to be a superior strategy, care processes in septic shock resuscitation can be optimized with bedside tools.
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Affiliation(s)
- Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile - Santiago, Chile
- Corresponding author: Eduardo Kattan Departamento de Medicina Intensiva, Facultad de Medicina Pontificia Universidad Católica de Chile. Avenida Diagonal Paraguay 362, Postal address: 8330077, Santiago, Chile E-mail:
| | - Jan Bakker
- Department of Pulmonology and Critical Care, Columbia University Medical Center - New York, United States
| | - Elisa Estenssoro
- Servicio de Terapia Intensiva, Hospital Interzonal de Agudos San Martin de La Plata - Buenos Aires, Argentina
| | | | | | - Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles - Brussels, Belgium
| | - Antoine Vieillard-Baron
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré - Boulogne-Billancourt, France
| | - Jean-Louis Teboul
- Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, Université Paris-Saclay - Le Kremlin-Bicêtre, France
| | - Ricardo Castro
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile - Santiago, Chile
| | - Glenn Hernández
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile - Santiago, Chile
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Mayo PH, Chew M, Douflé G, Mekontso-Dessap A, Narasimhan M, Vieillard-Baron A. Machines that save lives in the intensive care unit: the ultrasonography machine. Intensive Care Med 2022; 48:1429-1438. [PMID: 35941260 PMCID: PMC9360728 DOI: 10.1007/s00134-022-06804-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 05/02/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023]
Abstract
This article highlights the ultrasonography machine as a machine that saves lives in the intensive care unit. We review its utility in the limited resource intensive care unit and some elements of machine design that are relevant to both the constrained operating environment and the well-resourced intensive care unit. As the ultrasonography machine can only save lives, if is operated by a competent intensivist; we discuss the challenges of training the frontline clinician to become competent in critical care ultrasonography followed by a review of research that supports its use.
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Affiliation(s)
- Paul H. Mayo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Michelle Chew
- Department of Anaesthesiology and Intensive Care Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ghislaine Douflé
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Armand Mekontso-Dessap
- AP-HP Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 94010 Créteil, France ,Univ Paris Est Créteil, CARMAS, 94010 Créteil, France ,Univ Paris Est Créteil, INSERM, IMRB, 94010 Créteil, France
| | - Mangala Narasimhan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Antoine Vieillard-Baron
- Intensive Care Medicine, University Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France
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Kattan E, Bakker J, Estenssoro E, Ospina-Tascón GA, Cavalcanti AB, Backer DD, Vieillard-Baron A, Teboul JL, Castro R, Hernández G. Hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol. Rev Bras Ter Intensiva 2022; 34:96-106. [PMID: 35766659 DOI: 10.5935/0103-507x.20220004-pt] [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] [Received: 11/01/2021] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Early reversion of sepsis-induced tissue hypoperfusion is essential for survival in septic shock. However, consensus regarding the best initial resuscitation strategy is lacking given that interventions designed for the entire population with septic shock might produce unnecessary fluid administration. This article reports the rationale, study design and analysis plan of the ANDROMEDA-2 study, which aims to determine whether a peripheral perfusion-guided strategy consisting of capillary refill time-targeted resuscitation based on clinical and hemodynamic phenotypes is associated with a decrease in a composite outcome of mortality, time to organ support cessation, and hospital length of stay compared to standard care in patients with early (< 4 hours of diagnosis) septic shock. METHODS The ANDROMEDA-2 study is a multicenter, multinational randomized controlled trial. In the intervention group, capillary refill time will be measured hourly for 6 hours. If abnormal, patients will enter an algorithm starting with pulse pressure assessment. Patients with pulse pressure less than 40mmHg will be tested for fluid responsiveness and receive fluids accordingly. In patients with pulse pressure > 40mmHg, norepinephrine will be titrated to maintain diastolic arterial pressure > 50mmHg. Patients who fail to normalize capillary refill time after the previous steps will be subjected to critical care echocardiography for cardiac dysfunction evaluation and subsequent management. Finally, vasopressor and inodilator tests will be performed to further optimize perfusion. A sample size of 1,500 patients will provide 88% power to demonstrate superiority of the capillary refill time-targeted strategy. CONCLUSIONS If hemodynamic phenotype-based, capillary refill time-targeted resuscitation demonstrates to be a superior strategy, care processes in septic shock resuscitation can be optimized with bedside tools.
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Affiliation(s)
- Eduardo Kattan
- Departamento de Medicina Intensiva, Faculdade de Medicina, Pontifícia Universidad Católica de Chile - Santiago, Chile
| | - Jan Bakker
- Departamento de Pneumologia e Cuidados Intensivos, Columbia University Medical Center - Nova York, Estados Unidos
| | - Elisa Estenssoro
- Serviço de Terapia Intensiva, Hospital Interzonal de Agudos San Martin de La Plata - Buenos Aires, Argentina
| | | | | | - Daniel De Backer
- Departamento de Cuidados Intensivos, CHIREC Hospitals, Université Libre de Bruxelles - Bruxelas, Bélgica
| | - Antoine Vieillard-Baron
- Unidade de Medicina Intensiva, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré - Boulogne-Billancourt, França
| | - Jean-Louis Teboul
- Serviço de Medicina Intensiva-Reanimação, Hôpital de Bicêtre, Université Paris-Saclay - Le Kremlin-Bicêtre, França
| | - Ricardo Castro
- Departamento de Medicina Intensiva, Faculdade de Medicina, Pontifícia Universidad Católica de Chile - Santiago, Chile
| | - Glenn Hernández
- Departamento de Medicina Intensiva, Faculdade de Medicina, Pontifícia Universidad Católica de Chile - Santiago, Chile
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Bertin L, Hauguel-Moreau M, Prati G, Hergault H, Carlier RY, Quentin V, Vieillard-Baron A, Beaune S, Mansencal N. Spontaneous coronary artery rupture in patients' with Ehlers-Danlos syndrome: Mini review. Cardiovasc Revasc Med 2021; 40S:231-234. [PMID: 34872853 DOI: 10.1016/j.carrev.2021.11.023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Lise Bertin
- Cardiology Department, AP-HP, Ambroise Paré Hospital, Université de Versailles Saint-Quentin, Boulogne-Billancourt, France
| | - Marie Hauguel-Moreau
- Cardiology Department, AP-HP, Ambroise Paré Hospital, Université de Versailles Saint-Quentin, Boulogne-Billancourt, France; INSERM U-1018, CESP, Université Paris-Saclay, Villejuif, France.
| | - Giulio Prati
- Cardiology Department, AP-HP, Ambroise Paré Hospital, Université de Versailles Saint-Quentin, Boulogne-Billancourt, France
| | - Hélène Hergault
- Cardiology Department, AP-HP, Ambroise Paré Hospital, Université de Versailles Saint-Quentin, Boulogne-Billancourt, France; INSERM U-1018, CESP, Université Paris-Saclay, Villejuif, France
| | - Robert Yves Carlier
- Department of Radiology, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France; INSERM U 1179, Handicap Neuromusculaire, UVSQ Paris-Saclay, Garches, France
| | - Victor Quentin
- Cardiology Department, AP-HP, Ambroise Paré Hospital, Université de Versailles Saint-Quentin, Boulogne-Billancourt, France
| | - Antoine Vieillard-Baron
- INSERM U-1018, CESP, Université Paris-Saclay, Villejuif, France; Intensive Care Unit, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France
| | - Sébastien Beaune
- Department of Emergency Medicine, Ambroise Paré Hospital, AP-HP, UMR 1173, UVSQ, Boulogne-Billancourt, France
| | - Nicolas Mansencal
- Cardiology Department, AP-HP, Ambroise Paré Hospital, Université de Versailles Saint-Quentin, Boulogne-Billancourt, France; INSERM U-1018, CESP, Université Paris-Saclay, Villejuif, France
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Hamon A, Geri G, Gault E, Duran C, Vieillard-Baron A, Dinh A. Impact of viral respiratory PCR panel assay on antibiotic therapy in patients with community-acquired pneumonia admitted to the intensive care unit. Infect Dis Now 2021; 52:54-55. [PMID: 34856416 DOI: 10.1016/j.idnow.2021.11.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/24/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Antoine Hamon
- Infectious disease unit, Raymond-Poincaré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, 104 Bd Raymond Poincaré, 92380 Garches, France
| | - Guillaume Geri
- Intensive Care Unit, Ambroise-Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, Boulogne-Billancourt, France
| | - Elyanne Gault
- Microbiology laboratory, Ambroise-Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, Boulogne-Billancourt, France
| | - Clara Duran
- Infectious disease unit, Raymond-Poincaré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, 104 Bd Raymond Poincaré, 92380 Garches, France
| | - Antoine Vieillard-Baron
- Intensive Care Unit, Ambroise-Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, Boulogne-Billancourt, France
| | - Aurélien Dinh
- Infectious disease unit, Raymond-Poincaré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, 104 Bd Raymond Poincaré, 92380 Garches, France.
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Ruault C, Zappella N, Labreuche J, Cronier P, Claude B, Garnier M, Vieillard-Baron A, Ortuno S, Mallet M, Cosic O, Crosby L, Lesieur O, Pichon N, Galbois A, Bruel C, Ekpe K, Sauneuf B, Roux D, Legriel S. Identifying early indicators of secondary peritonitis in critically ill patients with cirrhosis. Sci Rep 2021; 11:21076. [PMID: 34702902 PMCID: PMC8548403 DOI: 10.1038/s41598-021-00629-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/08/2021] [Indexed: 11/09/2022] Open
Abstract
Ascitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identify early indicators of secondary peritonitis (SP), which requires emergency surgery, and to describe the outcomes of SP and spontaneous bacterial/fungal peritonitis (SBFP). Adults with cirrhosis and AFI admitted to 16 university or university-affiliated ICUs in France between 2002 and 2017 were studied retrospectively. Cases were identified by searching the hospital databases for relevant ICD-10 codes and hospital charts for AFI. Logistic multivariate regression was performed to identify factors associated with SP. Secondary outcomes were short- and long-term mortality and survivors' functional outcomes. Of 178 included patients (137 men and 41 women; mean age, 58 ± 11 years), 21 (11.8%) had SP, confirmed by surgery in 16 cases and by abdominal computed tomography in 5 cases. Time to diagnosis exceeded 24 h in 7/21 patients with SP. By multivariate analysis, factors independently associated with SP were ascitic leukocyte count > 10,000/mm3 (OR 3.70; 95%CI 1.38-9.85; P = 0.009) and absence of laboratory signs of decompensated cirrhosis (OR 4.53; 95%CI 1.30-15.68; P = 0.017). The 1-year mortality rates in patients with SBFP and SP were 81.0% and 77.5%, respectively (Log-rank test, P = 0.92). Patients with SP vs. SBFP had no differences in 1-year functional outcomes. This multicenter retrospective study identified two indicators of SP as opposed to SBFP in patients with cirrhosis. Using these indicators may help to provide early surgical treatment.
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Affiliation(s)
- Carole Ruault
- Medical-Surgical Intensive Care Unit, Versailles Hospital, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Nathalie Zappella
- Anesthesiology and Critical Care Medicine Departement, DMU PARABOL, Bichat-Claude Bernard Hospital, HUPNVS, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Julien Labreuche
- Centre Hospitalier Régional et Universitaire de Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, 59000, Lille, France
| | - Pierrick Cronier
- Intensive Care Unit, Sud-Francilien Hospital Center, 91100, Corbeil-Essonnes, France
| | - Baptiste Claude
- Department of Intensive Care, University Hospital François Mitterrand, 21000, Dijon, France
| | - Marc Garnier
- Department of Anesthesiology and Critical Care Medicine, Sorbonne University, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Tenon University Hospital, 75020, Paris, France
| | - Antoine Vieillard-Baron
- Medical-Surgical Intensive Care Unit, Ambroise Paré University Hospital, APHP, 92100, Boulogne-Billancourt, France
| | - Sofia Ortuno
- Medical Intensive Care Unit, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France
| | - Maxime Mallet
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), 75013, Paris, France
| | - Olga Cosic
- Medical-Surgical Intensive Care Unit, Hôpital Nord Franche-Comté, 90400, Trevenans, France
| | - Laura Crosby
- Intensive Care Unit, University Hospital of Pointe-à-Pitre, 97159, Pointe-à-Pitre, Guadeloupe, France.,Intensive Care Unit, Centre Hospitalier de Valence, 179 Boulevard Maréchal Juin, 26000, Valence, France
| | - Olivier Lesieur
- Intensive Care Unit, Groupement Hospitalier La Rochelle Ré Aunis, 17000, La Rochelle, France
| | - Nicolas Pichon
- Medical-Surgical Intensive Care Unit, Limoges University Hospital, 87000, Limoges, France
| | - Arnaud Galbois
- Ramsay-Générale de Santé, Hôpital Privé Claude Galien, Service de Réanimation Polyvalente, 91480, Quincy-sous-Sénart, France
| | - Cedric Bruel
- Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, 75014, Paris, France
| | - Kenneth Ekpe
- Medical Intensive Care Unit, Saint Louis Teaching Hospital, Assistance Publique Hôpitaux de Paris, 75010, Paris, France
| | - Bertrand Sauneuf
- General Intensive Care Unit, Cotentin Public Hospital Center, 50100, Cherbourg-en-Cotentin, France
| | - Damien Roux
- Department of Intensive Care, Louis Mourier University Hospital, Assistance Publique-Hôpitaux de Paris, 92700, Colombes, France
| | - Stephane Legriel
- Medical-Surgical Intensive Care Unit, Versailles Hospital, 177 rue de Versailles, 78150, Le Chesnay Cedex, France. .,Université Paris-Saclay, UVSQ, CESP, Team DevPsy, 94807, Villejuif, Inserm, France.
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47
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Vieillard-Baron A, Pinsky MR. The difficulty in defining right ventricular failure at the bedside and its clinical significance. Ann Intensive Care 2021; 11:122. [PMID: 34351534 PMCID: PMC8342748 DOI: 10.1186/s13613-021-00912-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
- A Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, INSERM UMR 1018, Clinical Epidemiology Team, CESP, Paris-Saclay University, Villejuif, France.
| | - M R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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48
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Fartoukh M, Voiriot G, Guérin L, Ricard JD, Combes A, Faure M, Benghanem S, de Montmollin E, Tandjaoui-Lambiotte Y, Vieillard-Baron A, Maury E, Diehl JL, Razazi K, Lemiale V, Trouiller P, Planquette B, Savale L, Heming N, Marey J, Carrat F, Lapidus N. Seasonal burden of severe influenza virus infection in the critically ill patients, using the Assistance Publique-Hôpitaux de Paris clinical data warehouse: a pilot study. Ann Intensive Care 2021; 11:117. [PMID: 34324076 PMCID: PMC8319596 DOI: 10.1186/s13613-021-00884-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose At the critical care level, the flu surveillance system is limited in France, with heterogeneous regional modalities of implementation. Materials, patients and methods We aimed at assessing the relevance of the Assistance Publique-Hôpitaux de Paris (AP-HP) clinical data warehouse for estimating the burden of the influenza epidemic on medical adult critical care units of the AP-HP, and outcome of patients during the flu season 2017–2018. This exploratory multi-site epidemiological study comprised all consecutive adult stays (n = 320) in 18 medical intensive care units (ICU) or intermediate care wards (ICW) for probable or confirmed Influenza virus infection during the 2017–2018 flu season. Results Patients admitted to ICU/ICW had low vaccination coverage (21%), required life support in 60% of cases, stayed in the ICU for a median of 8 days, and had high 28-day mortality rate (19.7%; 95% confidence interval 15.5–24.5). Early prognostic factors included age, core temperature, the acute organ failures score, and the early administration of antiviral therapy. Conclusions Data directly extracted from the electronic medical records stored in the data warehouse provide detailed clinical, care pathway and prognosis information. The real-time availability should enable to detect and assess the burden of the most severe cases. By a firmer and more acute monitoring and adjustment of care and patient management, hospitals could generate more ICU/ICW capacities, sensitize their emergency department and contribute to the recommendations from health authorities. This pilot study is of particular relevance in the context of emerging epidemics of severe acute respiratory diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00884-8.
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Affiliation(s)
- Muriel Fartoukh
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75020, Paris, France. .,Groupe de Recherche Clinique CARMAS, Collégium Gallilée, Créteil, France.
| | - Guillaume Voiriot
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75020, Paris, France.,Groupe de Recherche Clinique CARMAS, Collégium Gallilée, Créteil, France
| | - Laurent Guérin
- Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jean Damien Ricard
- Medical and Surgical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, 92700, Colombes, France.,Infection, Antimicrobials, Modelling and Evolution, IAME UMR 1137 Institut National de la Santé et de la Recherche Médicale, Université de Paris, 75018, Paris, France
| | - Alain Combes
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.,INSERM-UMRS 1166, iCAN Institute of Cardiometabolism/Nutrition, Sorbonne Université, Paris, France
| | - Morgane Faure
- Service de Médecine Intensive - Réanimation (Département "R3S"), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.,UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, Paris, France
| | - Sarah Benghanem
- Medical Intensive Care Unit, Groupe Hospitalier Paris Centre-Cochin University Hospital-Assistance Publique-Hôpitaux de Paris, Paris University, 75014, Paris, France
| | - Etienne de Montmollin
- UMR 1137, IAME, Université de Paris, Paris, France.,Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yacine Tandjaoui-Lambiotte
- Assistance Publique-Hôpitaux de Paris, Service de Réanimation médico-chirurgicale, CHU Avicenne; INSERM U1272 Hypoxie & Poumon, Bobigny, France
| | - Antoine Vieillard-Baron
- Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne Billancourt, France.,Faculty of Medicine Simone Veil, Saint Quentin en Yvelines, France.,Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Faculty of Paris Saclay, Villejuif, France
| | - Eric Maury
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75571, Paris, France.,U 1136, Inserm, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, 75012, Paris, France
| | - Jean-Luc Diehl
- Service de Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.,Faculty of Pharmacy, INSERM UMR-S1140, Paris Descartes University, Paris, France
| | - Keyvan Razazi
- 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
| | - Virginie Lemiale
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, Center of Epidemiology and Biostatistics Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale, Paris Diderot Sorbonne University, Paris, France
| | - Pierre Trouiller
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Paris Sud University, Clamart, France
| | - Benjamin Planquette
- Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, 75015, Paris, France.,Biosurgical Research Laboratory (Carpentier Foundation), Assistance Publique-Hôpitaux de Paris, Georges Pompidou European Hospital, 75015, Paris, France
| | - Laurent Savale
- Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999, Le Kremlin-Bicêtre, France
| | - Nicholas Heming
- General Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Jonathan Marey
- Service de Pneumologie, Institut Cochin, INSERM U1016, Université de Paris, Assitance Publique-Hôpitaux de Paris, Paris, France
| | | | - Fabrice Carrat
- Unité de Santé Publique, INSERM, Institut Pierre Louis d'Epidemiologie et de Sante Publique, Hopital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
| | - Nathanael Lapidus
- Unité de Santé Publique, INSERM, Institut Pierre Louis d'Epidemiologie et de Sante Publique, Hopital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
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Geri G, Darmon M, Zafrani L, Fartoukh M, Voiriot G, Le Marec J, Nemlaghi S, Vieillard-Baron A, Azoulay E. Acute kidney injury in SARS-CoV2-related pneumonia ICU patients: a retrospective multicenter study. Ann Intensive Care 2021; 11:86. [PMID: 34057648 PMCID: PMC8165682 DOI: 10.1186/s13613-021-00875-9] [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: 01/22/2021] [Accepted: 05/13/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND While acute kidney injury (AKI) is frequent in severe SARS-CoV2-related pneumonia ICU patients, few data are still available about its risk factors. METHODS Retrospective observational study performed in four university affiliated hospitals in Paris. AKI was defined according to the KIDGO guidelines. Factors associated with AKI were picked up using multivariable mixed-effects logistic regression. Independent risk factors of day 28 mortality were assessed using Cox model. RESULTS 379 patients (median age 62 [53,69], 77% of male) were included. Half of the patients had AKI (n = 195, 52%) including 58 patients (15%) with AKI stage 1, 44 patients (12%) with AKI stage 2, and 93 patients (25% with AKI stage 3). Chronic kidney disease (OR 7.41; 95% CI 2.98-18.4), need for invasive mechanical ventilation at day 1 (OR 4.83; 95% CI 2.26-10.3), need for vasopressors at day 1 (OR 2.1; 95% CI 1.05-4.21) were associated with increased risk of AKI. Day 28 mortality in the cohort was 26.4% and was higher in patients with AKI (37.4 vs. 14.7%, P < 0.001). Neither AKI (HR 1.35; 95% CI 0.78-2.32) nor AKI stage were associated with mortality (HR [95% CI] for stage 1, 2 and 3 when compared to no AKI of, respectively, 1.02 [0.49-2.10], 1.73 [0.81-3.68] and 1.42 [0.78-2.58]). CONCLUSION In this large cohort of SARS-CoV2-related pneumonia patients admitted to the ICU, AKI was frequent, mostly driven by preexisting chronic kidney disease and life sustaining therapies, with unclear adjusted relationship with day 28 outcome.
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Affiliation(s)
- Guillaume Geri
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.
- Paris Saclay University, Gif-sur-Yvette, France.
- INSERM UMR 1018, CESP, Villejuif, France.
- FHU SEPSIS, Saclay, France.
| | - Michael Darmon
- Medical Intensive Care Unit, Saint Louis Hospital, AP-HP, Paris, France
- Paris University, Paris, France
- INSERM U1153, Centre of Research in Epidemiology and Statistics, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint Louis Hospital, AP-HP, Paris, France
- Paris University, Paris, France
- INSERM U976, Immunologie Humaine, Pathophysiologie et immunothérapie, Paris, France
| | - Muriel Fartoukh
- Medical Intensive Care Unit, Tenon Hospital, AP-HP, Paris, France
- Paris Sorbonne University, Paris, France
| | - Guillaume Voiriot
- Medical Intensive Care Unit, Tenon Hospital, AP-HP, Paris, France
- Paris Sorbonne University, Paris, France
- INSERM U955 (IMRB), Equipe GEIC2O, 94000, Créteil, France
| | - Julien Le Marec
- Paris Sorbonne University, Paris, France
- Medical Intensive Care Unit, Pitié-Salpétrière Hospital, AP-HP, Paris, France
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Saafa Nemlaghi
- Paris Sorbonne University, Paris, France
- Medical Intensive Care Unit, Pitié-Salpétrière Hospital, AP-HP, Paris, France
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
- Paris Saclay University, Gif-sur-Yvette, France
- INSERM UMR 1018, CESP, Villejuif, France
- FHU SEPSIS, Saclay, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint Louis Hospital, AP-HP, Paris, France
- Paris University, Paris, France
- INSERM U1153, Centre of Research in Epidemiology and Statistics, Paris, France
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Abstract
PURPOSE OF REVIEW Recent studies have failed to show significant benefit from a uniform strategy, suggesting that hemodynamic management must be individually adapted in septic shock depending on different phenotypes. Different approaches that may be used to this end will be discussed. RECENT FINDINGS Fluid management is a cornerstone of resuscitation, as the positive fluid balance has been associated with higher mortality and right ventricular failure. Myocardial evaluation is mandatory, as sepsis patients may present with a hyperkinetic state, left ventricular (systolic and diastolic) and/or right ventricular dysfunction, the latter being associated with higher mortality. Statistical approaches with the identification of hemodynamic clusters based on echocardiographic and clinical parameters might be integrated into daily practice to develop precision medicine. Such approaches may also predict the progression of septic shock. SUMMARY Different hemodynamic phenotypes can occur at any stage of sepsis and be associated with one another. The clinician must regularly assess dynamic changes in phenotypes in septic shock patients. Statistical approaches based on machine learning need to be validated by prospective studies.
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Affiliation(s)
- Anousone Daulasim
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, INSERM UMR 1018, Clinical Epidemiology Team, CESP, Paris-Saclay University, Villejuif, France
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