1
|
Lambert R, McCarthy C, Weppner C, Malerba C, Osman D, Holcomb TS, Bottoms BL. Associations between teacher stress and school leadership: A mixed methods study with implications for school psychologists. Sch Psychol 2023; 38:370-384. [PMID: 38127528 DOI: 10.1037/spq0000601] [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: 12/23/2023]
Abstract
School psychologists have the psychological and consultative expertise necessary to support teachers who are vulnerable to stress. Transactional theory offers a lens to guide such support, as it posits that each teacher's unique appraisals of their work demands and resources determine the degree to which they are at risk for stress. This study used a multiphase sequential mixed method design with a transactional theory lens to examine the association of leadership quality and stability with teachers' ratings of workplace conditions. The four phases consisted of (a) input from an expert panel, (b) scale development and validation, (c) interviews with key informants, and (d) multilevel modeling informed by all previous phases. Through key informant interviews, district-level administrators provided ratings of the quality and stability of school leadership. The researchers examined the associations between these ratings and teacher appraisals of classroom demands, classroom resources, job satisfaction, and perceived levels of instructional support collected via a district-wide climate survey. Multilevel models with key informant ratings and school characteristics at Level 2 (Nschools = 47) and teacher characteristics and perceptions at Level 1 (Nteachers = 1,850) demonstrated that the quality and stability of school leadership were associated with teachers' appraisals of their occupational demands and resources, job satisfaction, and ratings of instructional support. Findings show that the quality and stability of school leadership play an important role in the incidence of stress vulnerability, suggesting important pathways for school psychologists seeking to promote the occupational health of teachers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Richard Lambert
- Department of Educational Leadership, University of North Carolina at Charlotte
| | | | - Caroline Weppner
- Department of Educational Psychology, University of Texas at Austin
| | | | | | - T Scott Holcomb
- Department of Educational Leadership, University of North Carolina at Charlotte
| | - Bryndle L Bottoms
- Department of Educational Leadership, University of North Carolina at Charlotte
| |
Collapse
|
2
|
Haaser T, Lahmi L, Osman D, Gesbert C, Cheval V, Constantinides Y, de Crevoisier R, Dejean C, Escande A, Ghannam Y, Lorchel F, Thureau S, Lagrange JL, Durdux C, Huguet F. [Ethical stakes of information in radiation oncology: Thinking the risk and building the therapeutic alliance]. Cancer Radiother 2023; 27:480-486. [PMID: 37573195 DOI: 10.1016/j.canrad.2023.06.006] [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: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 08/14/2023]
Abstract
Informing patients before receiving radiation therapy is a fundamental ethical imperative. As a condition of the possibility of autonomy, information allows people to make health decisions concerning themselves, which is required by French law. This information includes in particular the potential risks due to radiation therapy. It is therefore necessary to think about what risk is, and how to define and assess it, in order to finally communicate it. The practice of informing people involves many ethical issues relating to the very content of the information, the form in which it is transmitted or even the intention that leads the health professional to say (or not to say) the risk. The transmission of information also questions the way to build a relationship of trust with the patients and how to integrate their own representations about these treatments. Between the risks of paternalism or even defensive medicine, this practice is at the heart of our professional practice.
Collapse
Affiliation(s)
- T Haaser
- Service d'oncologie radiothérapie, hôpital Haut Lévêque, centre hospitalier universitaire de Bordeaux, avenue Magellan, 33600 Pessac, France; Centre éthique et recherche en santé de Bordeaux, centre hospitalier universitaire de Bordeaux, Bordeaux, France; EA 4574 sciences, philosophie, humanités, universités de Bordeaux et Bordeaux Montaigne, Pessac, France.
| | - L Lahmi
- Service d'oncologie radiothérapie, institut Curie, Paris, France
| | - D Osman
- Service de médecine intensive-réanimation, hôpital de Bicêtre, AP-HP, DMU Correve, université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France
| | - C Gesbert
- Direction de la qualité, des services aux patients et des parcours, centre hospitalier de Versailles, Versailles, France
| | - V Cheval
- Service universitaire d'oncologie radiothérapie, centre Oscar-Lambret, faculté de médecine Henri-Warembourg, laboratoire CRIStAL, UMR9189, université de Lille, Lille, France
| | - Y Constantinides
- Espace éthique Île-de-France, Paris université Sorbonne Nouvelle, Paris, France
| | - R de Crevoisier
- Service d'oncologie radiothérapie, centre Eugène-Marquis, Rennes, France
| | - C Dejean
- Service d'oncologie radiothérapie, unité de physique médicale, centre Antoine-Lacassagne, Nice, France
| | - A Escande
- Service universitaire d'oncologie radiothérapie, centre Oscar-Lambret, faculté de médecine Henri-Warembourg, laboratoire CRIStAL, UMR9189, université de Lille, Lille, France
| | - Y Ghannam
- Service d'oncologie radiothérapie, hôpital Tenon, centre de recherche Saint-Antoine UMR_S 938, institut universitaire de cancérologie, AP-HP, Sorbonne université, Paris, France
| | - F Lorchel
- Service d'oncologie radiothérapie, centre hospitalier universitaire Lyon-Sud, Lyon, France; Centre d'oncologie radiothérapie et oncologie de Mâcon (Orlam), Mâcon, France
| | - S Thureau
- Service d'oncologie radiothérapie, Quantis Litis EA 4108, centre Henri-Becquerel, Rouen, France
| | - J L Lagrange
- Université Paris-Est Créteil Val-de-Marne, Paris, France
| | - C Durdux
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Paris, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, centre de recherche Saint-Antoine UMR_S 938, institut universitaire de cancérologie, AP-HP, Sorbonne université, Paris, France
| |
Collapse
|
3
|
Krief N, Gabriel R, Cauquil C, Adams D, Fargeot G, Maisonobe T, Osman D, Schmidt M, Chanson JB, Bigaut K, Sole G, Tard C, Nicolas G, Pereon Y, Aure K, Lagrange E, Lefilliatre M, Labeyrie MA, Echaniz-Laguna A. Clinical features and maternal and fetal outcomes in women with Guillain-Barré syndrome in pregnancy. J Neurol 2023; 270:4498-4506. [PMID: 37294323 PMCID: PMC10252168 DOI: 10.1007/s00415-023-11808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Guillain-Barre syndrome (GBS) is an acute inflammatory polyradiculoneuropathy rarely observed during pregnancy. METHODS In this retrospective study, we analyzed the characteristics of pregnant women with GBS (pGBS) diagnosed in French University Hospitals in the 2002-2022 period and compared them with a reference group of same-age non-pregnant women with GBS (npGBS) identified in the same institutions & timeframe. RESULTS We identified 16 pGBS cases. Median age was 31 years (28-36), and GBS developed in the 1st, 2nd, and 3rd trimester in 31%, 31% and 38% of cases respectively. A previous infection was identified in six cases (37%), GBS was demyelinating in nine cases (56%), and four patients (25%) needed respiratory assistance. Fifteen patients (94%) were treated with intravenous immunoglobulins, and neurological recovery was complete in all cases (100%). Unscheduled caesarean section was needed in five cases (31%), and two fetuses (12.5%) died because of cytomegalovirus (CMV) infection (1 case) and HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome (1 case). In comparison with a reference group of 18 npGBS women with a median age of 30 years (27-33), pGBS patients more frequently had CMV infection (31% vs 11%), had a prolonged delay between GBS onset and hospital admission (delay > 7 days: 57% vs 12%), more often needed ICU admission (56% vs 33%) and respiratory assistance (25% vs 11%), and more often presented with treatment-related fluctuations (37% vs 0%). CONCLUSIONS This study shows GBS during pregnancy is a severe maternal condition with significant fetal mortality.
Collapse
Affiliation(s)
- Nolwenn Krief
- Neurology Department, APHP, CHU de Bicêtre, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (NNERF), 94276, Le Kremlin-Bicêtre, France
- INSERM U1195, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - René Gabriel
- Obstetrics and Gynecology Department, CHU de Reims, Reims, France
| | - Cécile Cauquil
- Neurology Department, APHP, CHU de Bicêtre, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (NNERF), 94276, Le Kremlin-Bicêtre, France
- INSERM U1195, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - David Adams
- Neurology Department, APHP, CHU de Bicêtre, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (NNERF), 94276, Le Kremlin-Bicêtre, France
- INSERM U1195, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Guillaume Fargeot
- Neurology Department, APHP, CHU Pitié-Salpêtrière, 75013, Paris, France
- Reference Center for Neuromuscular Disorders, APHP, Sorbonne Université, CHU Pitié-Salpêtrière, Paris, France
| | - Thierry Maisonobe
- Neurology Department, APHP, CHU Pitié-Salpêtrière, 75013, Paris, France
- Reference Center for Neuromuscular Disorders, APHP, Sorbonne Université, CHU Pitié-Salpêtrière, Paris, France
| | - David Osman
- Intensive Care Department, APHP, CHU de Bicêtre, 94276, Le Kremlin-Bicêtre, France
| | - Matthieu Schmidt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, APHP, Sorbonne Université Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Baptiste Chanson
- Department of Neurology, Strasbourg University Hospital, Strasbourg, France
- Neuromuscular Reference Center Nord/Est/Ile de France, Department of Neurology, Strasbourg University Hospital, Strasbourg, France
| | - Kevin Bigaut
- Department of Neurology, Strasbourg University Hospital, Strasbourg, France
- Neuromuscular Reference Center Nord/Est/Ile de France, Department of Neurology, Strasbourg University Hospital, Strasbourg, France
| | - Guilhem Sole
- Department of Neurology and Neuromuscular Diseases, CHU Bordeaux, University of Bordeaux, Bordeaux, France
- AOC National Reference Center for Neuromuscular Disorders, Bordeaux, France
| | - Céline Tard
- Department of Neurology, Centre Hospitalo-Universitaire (CHU) de Lille, Centre de Référence des Maladies Neuromusculaires Nord/Est/Ile-de-France, U1172, Lille, France
| | - Guillaume Nicolas
- Department of Neurology, Hôpital Raymond Poincaré, Université Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - Yann Pereon
- Department of Clinical Neurophysiology, CHU Nantes, Nantes, France
- Centre de Référence Maladies Neuromusculaires Atlantique-Occitanie-Caraïbes, Filnemus, Euro-NMD, Hôtel-Dieu, Nantes, France
| | - Karine Aure
- Service de Neurophysiologie, Hôpital Foch, Suresnes, France
| | - Emmeline Lagrange
- Department of Neurology, Grenoble University Hospital, Grenoble, France
| | | | | | - Andoni Echaniz-Laguna
- Neurology Department, APHP, CHU de Bicêtre, 94276, Le Kremlin-Bicêtre, France.
- French National Reference Center for Rare Neuropathies (NNERF), 94276, Le Kremlin-Bicêtre, France.
- INSERM U1195, Paris-Saclay University, Le Kremlin-Bicêtre, France.
| |
Collapse
|
4
|
Sonneville R, Mazighi M, Collet M, Gayat E, Degos V, Duranteau J, Grégoire C, Sharshar T, Naim G, Cortier D, Jost PH, Foucrier A, Bagate F, de Montmollin E, Papin G, Magalhaes E, Guidet B, Ben Hadj Salem O, Benghanem S, le Guennec L, Delpierre E, Legriel S, Megarbane B, Toumert K, Tran M, Geri G, Monchi M, Bodiguel E, Mariotte E, Demoule A, Zarka J, Diehl JL, Roux D, Barré E, Tanaka S, Osman D, Pasquier P, Lamara F, Crassard I, Boursin P, Ruckly S, Staiquly Q, Timsit JF, Woimant F. One-Year Outcomes in Patients With Acute Stroke Requiring Mechanical Ventilation. Stroke 2023; 54:2328-2337. [PMID: 37497675 DOI: 10.1161/strokeaha.123.042910] [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: 02/14/2023] [Accepted: 06/22/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Long-term outcomes of patients with severe stroke remain poorly documented. We aimed to characterize one-year outcomes of patients with stroke requiring mechanical ventilation in the intensive care unit (ICU). METHODS We conducted a prospective multicenter cohort study in 33 ICUs in France (2017-2019) on patients with consecutive strokes requiring mechanical ventilation for at least 24 hours. Outcomes were collected via telephone interviews by an independent research assistant. The primary end point was poor functional outcome, defined by a modified Rankin Scale score of 4 to 6 at 1 year. Multivariable mixed models investigated variables associated with the primary end point. Secondary end points included quality of life, activities of daily living, and anxiety and depression in 1-year survivors. RESULTS Among the 364 patients included, 244 patients (66.5% [95% CI, 61.7%-71.3%]) had a poor functional outcome, including 190 deaths (52.2%). After adjustment for non-neurological organ failure, age ≥70 years (odds ratio [OR], 2.38 [95% CI, 1.26-4.49]), Charlson comorbidity index ≥2 (OR, 2.01 [95% CI, 1.16-3.49]), a score on the Glasgow Coma Scale <8 at ICU admission (OR, 3.43 [95% CI, 1.98-5.96]), stroke subtype (intracerebral hemorrhage: OR, 2.44 [95% CI, 1.29-4.63] versus ischemic stroke: OR, 2.06 [95% CI, 1.06-4.00] versus subarachnoid hemorrhage: reference) remained independently associated with poor functional outcome. In contrast, a time between stroke diagnosis and initiation of mechanical ventilation >1 day was protective (OR, 0.56 [95% CI, 0.33-0.94]). A sensitivity analysis conducted after exclusion of patients with early decisions of withholding/withdrawal of care yielded similar results. We observed persistent physical and psychological problems at 1 year in >50% of survivors. CONCLUSIONS In patients with severe stroke requiring mechanical ventilation, several ICU admission variables may inform caregivers, patients, and their families on post-ICU trajectories and functional outcomes. The burden of persistent sequelae at 1 year reinforces the need for a personalized, multi-disciplinary, prolonged follow-up of these patients after ICU discharge. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03335995.
Collapse
Affiliation(s)
- Romain Sonneville
- Université de Paris, INSERM UMR 1148, F-75018 Paris, France (R.S., M. Mazighi)
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, F75018 Paris, France (R.S., G.P., F.L., J.-F.T.)
| | - Mikael Mazighi
- Université de Paris, INSERM UMR 1148, F-75018 Paris, France (R.S., M. Mazighi)
- APHP, Department of Neurology, Lariboisière University Hospital, Paris, France (M. Mazighi)
- APHP, Department of Neuroradiology, Rothschild Hospital Foundation, Paris, France (M. Mazighi, P.B.)
| | - Magalie Collet
- APHP.Nord, Department of Anesthesiology and Critical Care, DMU Parabol, Université de Paris, France (M.C., E.G.)
- UMR-S 942 "MASCOT," Inserm, Paris, France (M.C., E.G.)
| | - Etienne Gayat
- APHP.Nord, Department of Anesthesiology and Critical Care, DMU Parabol, Université de Paris, France (M.C., E.G.)
- UMR-S 942 "MASCOT," Inserm, Paris, France (M.C., E.G.)
| | - Vincent Degos
- APHP, Department of Critical Care, Anesthesia and Perioperative Medicine, Pitié-Salpétrière University Hospital and Sorbonne Université, Paris, France (V.D.)
- GRC ARPE, Sorbonne Université, Paris, France (V.D.)
| | - Jacques Duranteau
- APHP, Department of Anesthesiology and Critical Care, Bicêtre University Hospitals, Le Kremlin Bicêtre, France (J.D.)
| | - Charles Grégoire
- Department of Intensive Care, Rothschild Hospital Foundation, Paris, France (C.G.)
| | - Tarek Sharshar
- Department of Neuroanesthesiology and Intensive Care, Saint Anne Hospital, Paris, France (T.S., G.N.)
| | - Giulia Naim
- Department of Neuroanesthesiology and Intensive Care, Saint Anne Hospital, Paris, France (T.S., G.N.)
| | - David Cortier
- Department of Intensive Care, Foch Hospital, Paris, France (D.C.)
| | - Paul-Henri Jost
- APHP, Department of Anesthesiology and Critical Care, Henri Mondor University Hospital, Créteil, France (P.-H.J.)
| | - Arnaud Foucrier
- APHP, Department of Anesthesiology and Critical Care, Beaujon University Hospital, Clichy, France (A.F.)
| | - François Bagate
- APHP, Department of Intensive Care Medicine, Henri Mondor University Hospital and Université de Paris Est Créteil, France (F.B.)
| | - Etienne de Montmollin
- Department of Intensive Care Medicine, Delafontaine Hospital, Saint-Denis, France (E.d.M.)
| | - Gregory Papin
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, F75018 Paris, France (R.S., G.P., F.L., J.-F.T.)
| | - Eric Magalhaes
- Department of Intensive Care Medicine, Sud Francilien Hospital, Corbeil, France (E.M.)
| | - Bertrand Guidet
- APHP, Department of Intensive Care Medicine, Saint Antoine University Hospital, Paris, France (B.G.)
| | - Omar Ben Hadj Salem
- Department of Intensive Care Medicine, Poissy-Saint Germain en Laye Hospital, Paris, France (O.B.H.S.)
| | - Sarah Benghanem
- APHP, Medical ICU, Cochin University Hospital and Université Paris Cité, France (S.B.)
| | - Loïc le Guennec
- APHP, Department of Intensive Care Medicine, La Pitié-Salpêtrière University Hospital and Sorbonne Université, Paris, France (L.l.G.)
| | - Eric Delpierre
- Department of Intensive Care Medicine, Meaux Hospital, France (E.D.)
| | - Stephane Legriel
- Department of Intensive Care Medicine, Versailles Hospital, Le Chesnay, and Paris-Saclay University UVSQ, INSERM, CESP, Villejuif, France (S.L.)
| | - Bruno Megarbane
- APHP, Department of Medical and Toxicological Critical Care, Lariboisière Hospital and INSERM UMRS-1144, Université Paris Cité, France (B.M.)
| | - Karim Toumert
- Department of Intensive Care Medicine, Gonesse Hospital, France (K.T.)
| | - Marc Tran
- Department of Intensive Care Medicine, Paris Saint-Joseph Hospital, Paris, France (M.T.)
| | - Guillaume Geri
- APHP, Department of Intensive Care Medicine, Ambroise Paré University Hospital, Boulogne, France (G.G.)
| | - Mehran Monchi
- Department of Intensive Care Medicine, Melun-Senart Hospital, France (M. Monchi)
| | - Eric Bodiguel
- APHP, Emergency Department, Georges Pompidou University Hospital, Paris, France (E. Bodiguel)
| | - Eric Mariotte
- APHP, Department of Intensive Care Medicine, Saint Louis University Hospital, Paris, France (E.M.)
| | - Alexandre Demoule
- APHP, Department of Intensive Care Medicine (R3S) and Sorbonne Université, INSERM, UMRS1158, Pitié-Salpétrière University Hospital, Paris, France (A.D.)
| | - Jonathan Zarka
- Department of Intensive Care Medicine, Lagny Hospital, France (J.Z.)
| | - Jean-Luc Diehl
- APHP, Department of Intensive Care Medicine, Georges Pompidou University Hospital and INSERM UMR_S 1140 Paris, France (J.-L.D.)
| | - Damien Roux
- APHP, Medico-Surgical ICU, Louis Mourier University Hospital, Colombes and Université Paris Cité, IAME, INSERM, UMR1137, France (D.R.)
| | - Eric Barré
- Department of Intensive Care Medicine, Mantes-la-Jolie Hospital, France (E. Barré)
| | - Sebastien Tanaka
- APHP, Department of Anesthesia and Critical Care Medicine, Bichat-Claude Bernard University Hospital and INSERM UMR 1188 DéTROI, Université de la Réunion, Saint-Denis de la Réunion, France (S.T.)
| | - David Osman
- APHP, Department of Intensive Care Medicine, Bicêtre University Hospital, Le Kremlin Bicêtre, France (D.O.)
| | - Pierre Pasquier
- Department of Anesthesiology and Critical Care, Percy Military Training Hospital, Clamart, France (P.P.)
| | - Fariza Lamara
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, F75018 Paris, France (R.S., G.P., F.L., J.-F.T.)
| | | | - Perrine Boursin
- APHP, Department of Neuroradiology, Rothschild Hospital Foundation, Paris, France (M. Mazighi, P.B.)
| | - Stéphane Ruckly
- Department of Biostatistics, ICUREsearch, Paris, France (S.R., Q.S.)
| | - Quentin Staiquly
- Department of Biostatistics, ICUREsearch, Paris, France (S.R., Q.S.)
| | - Jean-François Timsit
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, F75018 Paris, France (R.S., G.P., F.L., J.-F.T.)
| | - France Woimant
- Agence Régionale de Santé Ile-de-France, Paris, France (I.C., F.W.)
| |
Collapse
|
5
|
Dequin PF, Aubron C, Faure H, Garot D, Guillot M, Hamzaoui O, Lemiale V, Maizel J, Mootien JY, Osman D, Simon M, Thille AW, Vinsonneau C, Kuteifan K. The place of new antibiotics for Gram-negative bacterial infections in intensive care: report of a consensus conference. Ann Intensive Care 2023; 13:59. [PMID: 37400647 DOI: 10.1186/s13613-023-01155-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/11/2023] [Indexed: 07/05/2023] Open
Abstract
INTRODUCTION New beta-lactams, associated or not with beta-lactamase inhibitors (NBs/BIs), can respond to the spread of carbapenemase-producing enterobacteriales and nonfermenting carbapenem-resistant bacteria. The risk of emergence of resistance to these NBs/BIs makes guidelines necessary. The SRLF organized a consensus conference in December 2022. METHODS An ad hoc committee without any conflict of interest (CoI) with the subject identified the molecules (ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-cilastatin-relebactam, meropenem-vaborbactam and cefiderocol); defined 6 generic questions; drew up a list of subquestions according to the population, intervention, comparison and outcomes (PICO) model; and reviewed the literature using predefined keywords. The quality of the data was assessed using the GRADE methodology. Seven experts in the field proposed their own answers to the questions in a public session and answered questions from the jury (a panel of 10 critical-care physicians without any CoI) and the public. The jury then met alone for 48 h to write its recommendations. Due to the frequent lack of powerful studies that have used clinically important criteria of judgment, the recommendations were formulated as expert opinions as often as necessary. RESULTS The jury provided 17 statements answering 6 questions: (1) Is there a place in the ICU for the probabilistic use of new NBs/IBs active against Gram-negative bacteria? (2) In the context of documented infections with sensitivity to several of these molecules, are there pharmacokinetic, pharmacodynamic, ecological or medico-economic elements for prioritization? (3) What are the possible combinations with these molecules and in what context? (4) Should we integrate these new molecules into a carbapenem-sparing strategy? (5) What pharmacokinetic and pharmacodynamic data are available to optimize their mode of administration in critically ill patients? (6) What are the dosage adaptations in cases of renal insufficiency, hepatocellular insufficiency or obesity? CONCLUSION These recommendations should optimize the use of NBs/BIs in ICU patients.
Collapse
Affiliation(s)
- Pierre-François Dequin
- Inserm UMR 1100, Centre d'Etudes des Pathologies Respiratoires, Université, Tours, France.
- Médecine Intensive Réanimation, Hôpital Bretonneau, 37044 Tours cedex 9, Tours, CHU, France.
| | - Cécile Aubron
- Médecine Intensive Réanimation CHU de Brest, Université de Bretagne Occidentale, Brest, France
| | - Henri Faure
- Médecine Intensive Réanimation, Centre Hospitalier Intercommunal Robert Ballanger, Aulnay Sous-Bois, France
| | - Denis Garot
- Médecine Intensive Réanimation, Hôpital Bretonneau, 37044 Tours cedex 9, Tours, CHU, France
| | - Max Guillot
- Médecine Intensive Réanimation CHU, Hôpital de Hautepierre, Strasbourg, France
| | - Olfa Hamzaoui
- Médecine Intensive Réanimation CHU de Reims, Reims, France
| | - Virginie Lemiale
- Medical ICU, Saint Louis Hospital, APHP, 1 Avenue Claude Vellefaux, Paris, France
| | - Julien Maizel
- Medical Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - Joy Y Mootien
- Medical Intensive Care Unit, GHRMSA, Mulhouse, France
| | - David Osman
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Marie Simon
- Maladies Infectieuses Et Tropicales, Hospices Civils de Lyon, Lyon, France
| | - Arnaud W Thille
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation Centre Hospitalier de Bethune, Bethune, France
| | | |
Collapse
|
6
|
Labro G, Tubach F, Belin L, Dubost JL, Osman D, Muller G, Quenot JP, Da Silva D, Zarka J, Turpin M, Mayaux J, Lamer C, Doyen D, Chevrel G, Plantefeve G, Demeret S, Piton G, Manzon C, Ochin E, Gaillard R, Dautzenberg B, Baldacini M, Lebbah S, Miyara M, Pineton de Chambrun M, Amoura Z, Combes A. Nicotine patches in patients on mechanical ventilation for severe COVID-19: a randomized, double-blind, placebo-controlled, multicentre trial. Intensive Care Med 2022; 48:876-887. [PMID: 35676335 PMCID: PMC9177407 DOI: 10.1007/s00134-022-06721-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/27/2022] [Indexed: 01/08/2023]
Abstract
Purpose Epidemiologic studies have documented lower rates of active smokers compared to former or non-smokers in symptomatic patients affected by coronavirus disease 2019 (COVID-19). We assessed the efficacy and safety of nicotine administered by a transdermal patch in critically ill patients with COVID-19 pneumonia. Methods In this multicentre, double-blind, placebo-controlled trial conducted in 18 intensive care units in France, we randomly assigned adult patients (non-smokers, non-vapers or who had quit smoking/vaping for at least 12 months) with proven COVID-19 pneumonia receiving invasive mechanical ventilation for up to 72 h to receive transdermal patches containing either nicotine at a daily dose of 14 mg or placebo until 48 h following successful weaning from mechanical ventilation or for a maximum of 30 days, followed by 3-week dose tapering by 3.5 mg per week. Randomization was stratified by centre, non- or former smoker status and Sequential Organ Function Assessment score (< or ≥ 7). The primary outcome was day-28 mortality. Main prespecified secondary outcomes included 60-day mortality, time to successful extubation, days alive and free from mechanical ventilation, renal replacement therapy, vasopressor support or organ failure at day 28. Results Between November 6th 2020, and April 2nd 2021, 220 patients were randomized from 18 active recruiting centers. After excluding 2 patients who withdrew consent, 218 patients (152 [70%] men) were included in the analysis: 106 patients to the nicotine group and 112 to the placebo group. Day-28 mortality did not differ between the two groups (30 [28%] of 106 patients in the nicotine group vs 31 [28%] of 112 patients in the placebo group; odds ratio 1.03 [95% confidence interval, CI 0.57–1.87]; p = 0.46). The median number of day-28 ventilator-free days was 0 (IQR 0–14) in the nicotine group and 0 (0–13) in the placebo group (with a difference estimate between the medians of 0 [95% CI -3–7]). Adverse events likely related to nicotine were rare (3%) and similar between the two groups. Conclusion In patients having developed severe COVID-19 pneumonia requiring invasive mechanical ventilation, transdermal nicotine did not significantly reduce day-28 mortality. There is no indication to use nicotine in this situation. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06721-1.
Collapse
Affiliation(s)
- Guylaine Labro
- Service de Médecine Intensive-Réanimation Groupement Hospitalier Régional Mulhouse Et Sud Alsace, Hôpital Emile Muller, 68100, Mulhouse, France
| | - Florence Tubach
- Département de Santé Publique, Unité de Recherche Clinique PSL-CFX, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Sorbonne Université, CIC-1901, 75013, Paris, France
| | - Lisa Belin
- Département de Santé Publique, Unité de Recherche Clinique PSL-CFX, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Sorbonne Université, CIC-1901, 75013, Paris, France
| | - Jean-Louis Dubost
- Centre Hospitalier René Dubos, 6, avenue de l'Ile de, 95303, Cergy-Pontoise, France
| | - David Osman
- CHU Bicêtre, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Grégoire Muller
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, Burgundy University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Daniel Da Silva
- Service de Médecine Intensive Réanimation du Centre, Hospitalier de Saint-Denis, Saint-Denis, France
| | - Jonathan Zarka
- Service de Réanimation Polyvalente, Grand Hôpital de L'Est Francilien, site de Marne-La-Vallée, Jossigny, France
| | - Matthieu Turpin
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Intensive RéanimationHôpital Tenon, Sorbonne Université, Paris, France
| | - Julien Mayaux
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Médecine Intensive Et Réanimation (Département R3S), AP-HP, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Université, Paris, France
| | - Christian Lamer
- Service de RéanimationInstitut Mutualiste Montsouris, 42 Bd Jourdan, 75014, Paris, France
| | - Denis Doyen
- Médecine Intensive RéanimationHôpital L'Archet 1, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Guillaume Chevrel
- Service de Réanimation; Centre Hospitalier Sud Francilien (CHSF), 40 Avenue Serge Dassault, Corbeil-Essonne, France
| | - Gaétan Plantefeve
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Victor Dupouy, 95107, Argenteuil, France
| | - Sophie Demeret
- Médecine Intensive Réanimation À Orientation Neurologique - Site Pitié Salpêtrière - Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Gaël Piton
- Service de Réanimation Médicale, CHRU de Besançon, Boulevard Fleming, Besançon, France
| | - Cyril Manzon
- Service de Réanimation, Médipole Lyon Villeurbanne. Service de Réanimation, 158 rue Léon Blum, 69100, Villeurbanne, France
| | - Evelina Ochin
- Service de Médecine Intensive-Réanimation Hôpital Simone Veil, Eaubonne, France
| | - Raphael Gaillard
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, 75014, Paris, France.,Université de Paris, 75006, Paris, France
| | - Bertrand Dautzenberg
- Sorbonne Université APHP (La Pitié-Salpêtrière), 75013, Paris, France.,Tabacologue Institut Arthur Vernes, Paris, France
| | - Mathieu Baldacini
- Service de Médecine Intensive-Réanimation Groupement Hospitalier Régional Mulhouse Et Sud Alsace, Hôpital Emile Muller, 68100, Mulhouse, France
| | - Said Lebbah
- Département de Santé Publique, Unité de Recherche Clinique PSL-CFX, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Sorbonne Université, CIC-1901, 75013, Paris, France
| | - Makoto Miyara
- Service de Médecine Interne 2, Institut E3M, CRMR Lupus. SAPL Et Autres Maladies Auto-Immunes, Hôpital Pitié Salpêtrière Et Université Paris 6, Paris, France
| | - Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France.,INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, 47, Boulevard de l'Hôpital, 75013, Paris, France
| | - Zahir Amoura
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, 75014, Paris, France
| | - Alain Combes
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France. .,INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, 47, Boulevard de l'Hôpital, 75013, Paris, France.
| | | |
Collapse
|
7
|
Shabayek M, Osman T, Wahb M, Elmoazen M, Osman D, Saafan A. Intravesical aminophylline instillation as an alternative for balloon dilatation prior to semi-rigid ureteroscopic management of distal ureteral stones. World J Urol 2022; 40:1805-1811. [PMID: 35618855 PMCID: PMC9237005 DOI: 10.1007/s00345-022-04039-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 05/02/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose In a randomized controlled trial, we evaluated the effect of intravesical aminophylline instillation (IVAI) on intraureteral pressure of lower ureter and its use as an alternative to balloon dilatation after failure of advancing semi-rigid ureteroscope through the ureteric orifice without endodilatation. Methods Our study included 83 patients with juxta-vesical distal ureteral calculi requiring endodilatation after unsuccessfully introducing the semi-rigid ureteroscope through the ureteric orifice. Patients were randomized into two groups: group A (study group) included 41 patients, where IVAI was used to dilate the ureter and facilitate ureteroscopy (the intraureteral pressure was measured using a pressure transducer connected to an invasive pressure monitor before and 5 min after IVAI), whereas group B (control group) included 42 patients, where balloon dilatation was used prior to ureteroscopy. Perioperative surgical outcomes of ureteroscopy were evaluated in both groups. Results A statistically significant decrease in mean intraureteral pressure of intravesical ureter was found after IVAI from 12.34 mmHg ± 1.94 before injection to 8.46 mmHg ± 1.94 after injection (P < 0.001). Ureteral injuries, postoperative pain and hematuria were statistically significantly less among the study group compared to the control group (P < 0.05). We did not find statistically significant differences in operative time, need for DJ ureteral stenting or stone-free rate between both groups and no perioperative side effects were associated with IVAI. Conclusion In ureteroscopic management of distal ureteral stones, intravesical aminophylline instillation is safe, inexpensive and effective in reducing intraureteral pressure and achieves comparable outcomes to balloon dilatation with less ureteral injuries, postoperative pain and hematuria.
Collapse
Affiliation(s)
- M. Shabayek
- Urology department, Ain Shams University Hospitals, Abassia, 11361 Cairo Egypt
| | - T. Osman
- Urology department, Ain Shams University Hospitals, Abassia, 11361 Cairo Egypt
| | - M. Wahb
- Urology department, Ain Shams University Hospitals, Abassia, 11361 Cairo Egypt
| | - M. Elmoazen
- Urology department, Ain Shams University Hospitals, Abassia, 11361 Cairo Egypt
| | - D. Osman
- Urology department, Ain Shams University Hospitals, Abassia, 11361 Cairo Egypt
| | - A. Saafan
- Urology department, Ain Shams University Hospitals, Abassia, 11361 Cairo Egypt
| |
Collapse
|
8
|
Humbert C, Bukreyeva I, Fortineau N, Cuzon G, Leblanc P, Figueiredo S, Anguel N, Osman D, Barrail-Tran A, Escaut L. Fluoroquinolones : les prescriptions sont-elles pertinentes dans notre CHU ? Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.106] [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: 10/23/2022]
|
9
|
Miailhe AF, Mercier E, Maamar A, Lacherade JC, Le Thuaut A, Gaultier A, Asfar P, Argaud L, Ausseur A, Ben Salah A, Botoc V, Chaoui K, Charpentier J, Cracco C, De Prost N, Eustache ML, Ferré A, Gauvin E, Goursaud S, Grall M, Guiot P, Jonas M, Lambiotte F, Landais M, Lemarié J, Lesieur O, Lhommet C, Michel P, Monseau Y, Moschietto S, Nseir S, Osman D, Pillot J, Piton G, Sedillot N, Sirodot M, Thevenin D, Zafrani L, Zerbib Y, Bourhy P, Lascarrou JB, Reignier J. Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs. Intensive Care Med 2019; 45:1763-1773. [PMID: 31654079 DOI: 10.1007/s00134-019-05808-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/26/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To report the incidence, risk factors, clinical presentation, and outcome predictors of severe leptospirosis requiring intensive care unit (ICU) admission in a temperate zone. METHODS LEPTOREA was a retrospective multicentre study conducted in 79 ICUs in metropolitan France. Consecutive adults admitted to the ICU for proven severe leptospirosis from January 2012 to September 2016 were included. Multiple correspondence analysis (MCA) and hierarchical classification on principal components (HCPC) were performed to distinguish different clinical phenotypes. RESULTS The 160 included patients (0.04% of all ICU admissions) had median values of 54 years [38-65] for age, 40 [28-58] for the SAPSII, and 11 [8-14] for the SOFA score. Hospital mortality was 9% and was associated with older age; worse SOFA score and early need for endotracheal ventilation and/or renal replacement therapy; chronic alcohol abuse and worse hepatic dysfunction; confusion; and higher leucocyte count. Four phenotypes were identified: moderately severe leptospirosis (n = 34, 21%) with less organ failure and better outcomes; hepato-renal leptospirosis (n = 101, 63%) with prominent liver and kidney dysfunction; neurological leptospirosis (n = 8, 5%) with the most severe organ failures and highest mortality; and respiratory leptospirosis (n = 17, 11%) with pulmonary haemorrhage. The main risk factors for leptospirosis contamination were contact with animals, contact with river or lake water, and specific occupations. CONCLUSIONS Severe leptospirosis was an uncommon reason for ICU admission in metropolitan France and carried a lower mortality rate than expected based on the high severity and organ-failure scores. The identification in our population of several clinical presentations may help clinicians establish an appropriate index of suspicion for severe leptospirosis.
Collapse
Affiliation(s)
- Arnaud-Félix Miailhe
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Emmanuelle Mercier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bretonneau, CRICS-TRIGGERSEP network, Tours, France
| | - Adel Maamar
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Jean-Claude Lacherade
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France
| | - Aurélie Le Thuaut
- Direction de la recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Aurélie Gaultier
- Direction de la recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Pierre Asfar
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Angers, Angers, France
| | - Laurent Argaud
- Service de Réanimation médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Antoine Ausseur
- Service de Réanimation polyvalente, Centre Hospitalier de Cholet, Cholet, France
| | - Adel Ben Salah
- Service de Réanimation polyvalente, Centre Hospitalier de Chartres, Chartres, France
| | - Vlad Botoc
- Service de Réanimation et surveillance continue, Centre Hospitalier de Saint Malo, Saint-Malo, France
| | - Karim Chaoui
- Service de Réanimation polyvalente, Centre Hospitalier de Cahors, Cahors, France
| | - Julien Charpentier
- Service de Médecine Intensive Réanimation, Hôpital Cochin, Groupe Hospitalier Centre-Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Cracco
- Service de réanimation polyvalente et surveillance continue, Centre Hospitalier d'Angoulême, Angoulême, France
| | - Nicolas De Prost
- Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Marie-Line Eustache
- Service de Réanimation polyvalente, Centre Hospitalier Bretagne-Atlantique, Vannes, France
| | - Alexis Ferré
- Service de Réanimation médico-chirurgicale, Centre hospitalier de Versailles, site André Mignot, Le Chesnay, France
| | - Elena Gauvin
- Service de Réanimation polyvalente, Centre Hospitalier de Niort, Niort, France
| | - Suzanne Goursaud
- Service de Réanimation médicale, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Maximilien Grall
- Service de Réanimation médicale, Hôpital Charles Nicolle, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Philippe Guiot
- Service de réanimation médicale, GHRMSA, Mulhouse, France
| | - Maud Jonas
- Service de Réanimation polyvalente et USC, Centre Hospitalier de Saint Nazaire, Saint Nazaire, France
| | - Fabien Lambiotte
- Service de Réanimation polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Mickael Landais
- Service de Réanimation polyvalente, Centre Hospitalier du Mans, Le Mans, France
| | - Jérémie Lemarié
- MD, INSERM, U1116, 54500, Vandoeuvre-lès-Nancy, France.,Université de Lorraine, Nancy, France.,Service de Réanimation Médicale, Centre Hospitalier Universitaire de Nancy, Hôpital Central, Nancy, France
| | - Olivier Lesieur
- Service de Réanimation et surveillance continue, Hôpital Saint-Louis, La Rochelle, France
| | - Claire Lhommet
- Service de Réanimation polyvalente, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Philippe Michel
- Service de réanimation médico-chirurgicale, Centre Hospitalier René-Dubos, Pontoise, France
| | - Yannick Monseau
- Service de Réanimation polyvalente, Centre Hospitalier de Périgueux, Périgueux, France
| | - Sébastien Moschietto
- Service de Médecine Intensive Réanimation, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Saad Nseir
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Lille, Lille, France.,Faculté de Médecine, Université de Lille, Lille, France
| | - David Osman
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérome Pillot
- Service de réanimation polyvalente, Hôpital Saint-Léon, Centre hospitalier de la Côte Basque, Bayonne, France
| | - Gaël Piton
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Nicholas Sedillot
- Service de réanimation polyvalente, Centre Hospitalier Fleyriat, Bourg-en-Bresse, France
| | - Michel Sirodot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Annecy, Annecy, France
| | - Didier Thevenin
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France
| | - Lara Zafrani
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yoann Zerbib
- Service de Réanimation médicale, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Pascale Bourhy
- Unité de Biologie des Spirochètes, Institut Pasteur, Paris, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France. .,Université de Nantes, Nantes, France. .,Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hotel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France.
| | | |
Collapse
|
10
|
Boilève A, Osman D, Marthey L, Carbonnel F, Jozwiak M. Drug-induced coma after chemotherapy in intensive care unit: How to make the right diagnosis? J Neurol Sci 2018; 392:137-138. [PMID: 30059846 DOI: 10.1016/j.jns.2018.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Alice Boilève
- Hôpitaux universitaires Paris-Sud, Hôpitaux de Paris, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France; Inserm, UMR S_999, Univ Paris-Sud, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France.
| | - David Osman
- Hôpitaux universitaires Paris-Sud, Hôpitaux de Paris, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France; Inserm, UMR S_999, Univ Paris-Sud, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France
| | - Lysiane Marthey
- Hôpitaux universitaires Paris-Sud, Hôpitaux de Paris, Hôpital de Bicêtre, service d'hépato-gastro-entérologie, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France
| | - Franck Carbonnel
- Hôpitaux universitaires Paris-Sud, Hôpitaux de Paris, Hôpital de Bicêtre, service d'hépato-gastro-entérologie, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France
| | - Mathieu Jozwiak
- Hôpitaux universitaires Paris-Sud, Hôpitaux de Paris, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France; Inserm, UMR S_999, Univ Paris-Sud, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France
| |
Collapse
|
11
|
Bonsergent M, Osman D, Escaut L, Barrail-Tran A. Traçabilité de la réévaluation à 48–72 h dans le dossier patient : sommes-nous conformes aux critères de la HAS ? Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.143] [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: 10/14/2022]
|
12
|
Hussein A, Eltoum H, Mohamed D, Taha M, Abdelrahim M, Elfaki M, Alfaki M, Alsherif R, Osman D, Digna M. The correlation between the neurological complications of rheumatoid arthritis with the disease activity and functional impairment (Disability). J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3220] [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: 10/18/2022]
|
13
|
Mullins ES, Stasyshyn O, Alvarez-Román MT, Osman D, Liesner R, Engl W, Sharkhawy M, Abbuehl BE. Extended half-life pegylated, full-length recombinant factor VIII for prophylaxis in children with severe haemophilia A. Haemophilia 2016; 23:238-246. [DOI: 10.1111/hae.13119] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- E. S. Mullins
- Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - O. Stasyshyn
- SI Institute of Blood Pathology and Transfusion Medicine of NAMSU; Lviv Ukraine
| | | | - D. Osman
- Hospital Tengku Ampuan Rahimah; Klang Selangor Malaysia
| | - R. Liesner
- Great Ormond Street Hospital for Children; London UK
| | - W. Engl
- Baxalta Innovations GmbH, now part of Shire; Vienna Austria
| | - M. Sharkhawy
- Baxalta Innovations GmbH, now part of Shire; Vienna Austria
| | - B. E. Abbuehl
- Baxalta Innovations GmbH, now part of Shire; Vienna Austria
| |
Collapse
|
14
|
Bourdin V, Burlacu R, Osman D, Goujard C, Lambotte O. Coagulation intra-vasculaire disséminée au cours de la maladie de Biermer : une présentation atypique. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.077] [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: 10/22/2022]
|
15
|
Vinsonneau C, Allain-Launay E, Blayau C, Darmon M, Ducheyron D, Gaillot T, Honore PM, Javouhey E, Krummel T, Lahoche A, Letacon S, Legrand M, Monchi M, Ridel C, Robert R, Schortgen F, Souweine B, Vaillant P, Velly L, Osman D, Van Vong L. Renal replacement therapy in adult and pediatric intensive care : Recommendations by an expert panel from the French Intensive Care Society (SRLF) with the French Society of Anesthesia Intensive Care (SFAR) French Group for Pediatric Intensive Care Emergencies (GFRUP) the French Dialysis Society (SFD). Ann Intensive Care 2015; 5:58. [PMID: 26714808 PMCID: PMC4695466 DOI: 10.1186/s13613-015-0093-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/27/2015] [Indexed: 12/12/2022] Open
Abstract
Acute renal failure (ARF) in critically ill patients is currently very frequent and requires renal replacement therapy (RRT) in many patients. During the last 15 years, several studies have considered important issues regarding the use of RRT in ARF, like the time to initiate the therapy, the dialysis dose, the types of catheter, the choice of technique, and anticoagulation. However, despite an abundant literature, conflicting results do not provide evidence on RRT implementation. We present herein recommendations for the use of RRT in adult and pediatric intensive care developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of French Intensive Care Society (SRLF), with the participation of the French Society of Anesthesia and Intensive Care (SFAR), the French Group for Pediatric Intensive Care and Emergencies (GFRUP), and the French Dialysis Society (SFD). The recommendations cover 4 fields: criteria for RRT initiation, technical aspects (access routes, membranes, anticoagulation, reverse osmosis water), practical aspects (choice of the method, peritoneal dialysis, dialysis dose, adjustments), and safety (procedures and training, dialysis catheter management, extracorporeal circuit set-up). These recommendations have been designed on a practical point of view to provide guidance for intensivists in their daily practice.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Patrick M Honore
- Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Etienne Javouhey
- Réanimation pédiatrique spécialisée, CHU Lyon, 69677, Bron, France.
| | | | | | | | | | - Mehran Monchi
- Réanimation polyvalente, CH Melun, 77000, Melun, France.
| | | | | | | | | | | | | | - David Osman
- CHU Bicêtre, 94, Le Kremlin Bicêtre, France.
| | - Ly Van Vong
- Réanimation polyvalente, CH Melun, 77000, Melun, France.
| |
Collapse
|
16
|
Richard C, Argaud L, Blet A, Boulain T, Contentin L, Dechartres A, Dejode JM, Donetti L, Fartoukh M, Fletcher D, Kuteifan K, Lasocki S, Liet JM, Lukaszewicz AC, Mal H, Maury E, Osman D, Outin H, Richard JC, Schneider F, Tamion F. [Extracorporeal life support for patients with acute respiratory distress syndrome (adult and paediatric). Consensus conference organized by the French Intensive Care Society]. Rev Mal Respir 2014; 31:779-95. [PMID: 25391514 DOI: 10.1016/j.rmr.2014.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/24/2014] [Indexed: 01/19/2023]
Affiliation(s)
- C Richard
- Service de réanimation médicale, EA 4533, université Paris-Sud, hôpitaux universitaires Paris-Sud, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - L Argaud
- Service de réanimation médicale, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France
| | - A Blet
- Département d'anesthésie-réanimation, centre de traitement des brulés, hôpitaux universitaires Saint-Louis, Lariboisière, Fernand-Widal, hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - T Boulain
- Service de réanimation polyvalente, hôpital de La Source, centre hospitalier régional Orléans, 45067 Orléans, France
| | - L Contentin
- Service de réanimation polyvalente, hôpital Bretonneau, CHRU de Tours, 37000 Tours, France
| | - A Dechartres
- Inserm U1153, équipe « méthodes en évaluation thérapeutique des maladies chroniques », centre de recherche épidémiologie et biostatistique, centre Cochrane français, Hôtel-Dieu, 75004 Paris, France
| | - J-M Dejode
- Réanimation pédiatrique, hôpital Mère-Enfant, CHU de Nantes, 40000 Nantes, France
| | - L Donetti
- Service de réanimation, centre hospitalier Le Raincy-Montfermeil, 93370 Montfermeil, France
| | - M Fartoukh
- Unité de réanimation médicochirurgicale, hôpitaux universitaire Est Parisien, hôpital Tenon, AP-HP, 75020 Paris, France
| | - D Fletcher
- Département d'anesthésie, hôpitaux universitaires Paris Île-de-France Ouest, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - K Kuteifan
- Service de réanimation médicale, hôpital Émile-Muller, 68070 Mulhouse, France
| | - S Lasocki
- Pôle d'anesthésie réanimation, LUNAM université, université d'Angers, CHU d'Angers, 49000 Angers, France
| | - J-M Liet
- Réanimation pédiatrique, hôpital Mère-Enfant, CHU de Nantes, 40000 Nantes, France
| | - A-C Lukaszewicz
- Département d'anesthésie réanimation - réanimation chirurgicale et postopératoire, groupe hospitalier Saint-Louis-Lariboisière-Fernand-Widal, hôpital Lariboisière, AP-HP, 75010 Paris, France
| | - H Mal
- Service de pneumologie, hôpitaux universitaires Paris Nord Val-de-Seine, hôpital Bichat, AP-HP, 75018 Paris, France
| | - E Maury
- Service de réanimation médicale, hôpitaux universitaire Est Parisien, hôpital Saint-Antoine, AP-HP, 75020 Paris, France
| | - D Osman
- Service de réanimation médicale, EA 4533, université Paris-Sud, hôpitaux universitaires Paris-Sud, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - H Outin
- Service de réanimation médicochirurgicale, centre hospitalier intercommunal de Poissy-Saint-Germain-en-Laye, 78300 Poissy, France
| | - J-C Richard
- Service de réanimation médicale, hospices civils de Lyon, hôpital de la Croix-Rousse, 69004 Lyon, France
| | - F Schneider
- Service de réanimation médicale, faculté de médecine, université de Strasbourg, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, Hautepierre, France
| | - F Tamion
- Inserm U1096, IRIB, service de réanimation médicale, université de Rouen, CHU Charles-Nicolle, 76031 Rouen, France
| |
Collapse
|
17
|
Breig O, Bras S, Martinez Soria N, Osman D, Heidenreich O, Haenlin M, Waltzer L. Pontin is a critical regulator for AML1-ETO-induced leukemia. Leukemia 2014; 28:1271-9. [PMID: 24342949 DOI: 10.1038/leu.2013.376] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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] [Received: 11/08/2013] [Revised: 12/05/2013] [Accepted: 12/11/2013] [Indexed: 01/07/2023]
Abstract
The oncogenic fusion protein AML1-ETO, also known as RUNX1-RUNX1T1 is generated by the t(8;21)(q22;q22) translocation, one of the most frequent chromosomal rearrangements in acute myeloid leukemia (AML). Identifying the genes that cooperate with or are required for the oncogenic activity of this chimeric transcription factor remains a major challenge. Our previous studies showed that Drosophila provides a genuine model to study how AML1-ETO promotes leukemia. Here, using an in vivo RNA interference screen for suppressors of AML1-ETO activity, we identified pontin/RUVBL1 as a gene required for AML1-ETO-induced lethality and blood cell proliferation in Drosophila. We further show that PONTIN inhibition strongly impaired the growth of human t(8;21)(+) or AML1-ETO-expressing leukemic blood cells. Interestingly, AML1-ETO promoted the transcription of PONTIN. Moreover, transcriptome analysis in Kasumi-1 cells revealed a strong correlation between PONTIN and AML1-ETO gene signatures and demonstrated that PONTIN chiefly regulated the expression of genes implicated in cell cycle progression. Concordantly, PONTIN depletion inhibited leukemic self-renewal and caused cell cycle arrest. All together our data suggest that the upregulation of PONTIN by AML1-ETO participate in the oncogenic growth of t(8;21) cells.
Collapse
MESH Headings
- ATPases Associated with Diverse Cellular Activities
- Animals
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Blotting, Western
- Carrier Proteins/antagonists & inhibitors
- Carrier Proteins/genetics
- Carrier Proteins/metabolism
- Cell Cycle
- Cell Proliferation
- Chromosomes, Human, Pair 21/genetics
- Chromosomes, Human, Pair 8/genetics
- Core Binding Factor Alpha 2 Subunit/genetics
- Core Binding Factor Alpha 2 Subunit/metabolism
- DNA Helicases/antagonists & inhibitors
- DNA Helicases/genetics
- DNA Helicases/metabolism
- Drosophila melanogaster/genetics
- Drosophila melanogaster/growth & development
- Female
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Humans
- Leukemia, Myeloid, Acute/etiology
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/pathology
- Male
- Oligonucleotide Array Sequence Analysis
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- RNA, Messenger/genetics
- RNA, Small Interfering/genetics
- RUNX1 Translocation Partner 1 Protein
- Real-Time Polymerase Chain Reaction
- Reverse Transcriptase Polymerase Chain Reaction
- Translocation, Genetic
- Tumor Cells, Cultured
Collapse
Affiliation(s)
- O Breig
- CNRS, CBD UMR5547, Université de Toulouse, UPS, CBD (Centre de Biologie du Développement), Bâtiment 4R3, 118 route de Narbonne, Toulouse, France
| | - S Bras
- CNRS, CBD UMR5547, Université de Toulouse, UPS, CBD (Centre de Biologie du Développement), Bâtiment 4R3, 118 route de Narbonne, Toulouse, France
| | - N Martinez Soria
- Northern Institute for Cancer Research, University of Newcastle, Newcastle upon Tyne, UK
| | - D Osman
- CNRS, CBD UMR5547, Université de Toulouse, UPS, CBD (Centre de Biologie du Développement), Bâtiment 4R3, 118 route de Narbonne, Toulouse, France
| | - O Heidenreich
- Northern Institute for Cancer Research, University of Newcastle, Newcastle upon Tyne, UK
| | - M Haenlin
- CNRS, CBD UMR5547, Université de Toulouse, UPS, CBD (Centre de Biologie du Développement), Bâtiment 4R3, 118 route de Narbonne, Toulouse, France
| | - L Waltzer
- CNRS, CBD UMR5547, Université de Toulouse, UPS, CBD (Centre de Biologie du Développement), Bâtiment 4R3, 118 route de Narbonne, Toulouse, France
| |
Collapse
|
18
|
Richard C, Argaud L, Blet A, Boulain T, Contentin L, Dechartres A, Dejode JM, Donetti L, Fartoukh M, Fletcher D, Kuteifan K, Lasocki S, Liet JM, Lukaszewicz AC, Mal H, Maury E, Osman D, Outin H, Richard JC, Schneider F, Tamion F. Assistance extracorporelle au cours du syndrome de détresse respiratoire aiguë (chez l’adulte et l’enfant, à l’exclusion du nouveau-né). Conférence de consensus organisée par la Société de réanimation de langue française. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s13546-014-0858-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
19
|
Drevon L, Ackermann F, Osman D, Lerolle N, Desthieux C, Anguel N, Lambotte O. Traitement par eculizumab d’une microangiopathie thrombotique secondaire à une autogreffe de cellules souches hématopoïétiques conditionnée par BEAM. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
20
|
Diehl JL, Coolen N, Faisy C, Osman D, Prat G, Sebbane M, Nieszkowska A, Gervais C, Richard JCM, Richecoeur J, Brochard L, Mercat A, Guerot E, Borgel D. Growth-Arrest-Specific 6 (GAS6) Protein in ARDS Patients: Determination of Plasma Levels and Influence of PEEP Setting. Respir Care 2013; 58:1886-91. [DOI: 10.4187/respcare.02129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
21
|
Osman D, Djibré M, Da Silva D, Goulenok C. Management by the intensivist of gastrointestinal bleeding in adults and children. Ann Intensive Care 2012; 2:46. [PMID: 23140348 PMCID: PMC3526517 DOI: 10.1186/2110-5820-2-46] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/05/2012] [Indexed: 12/12/2022] Open
Abstract
Intensivists are regularly confronted with the question of gastrointestinal bleeding. To date, the latest international recommendations regarding prevention and treatment for gastrointestinal bleeding lack a specific approach to the critically ill patients. We present recommendations for management by the intensivist of gastrointestinal bleeding in adults and children, developed with the GRADE system by an experts group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF), with the participation of the French Language Group of Paediatric Intensive Care and Emergencies (GFRUP), the French Society of Emergency Medicine (SFMU), the French Society of Gastroenterology (SNFGE), and the French Society of Digestive Endoscopy (SFED). The recommendations cover five fields of application: management of gastrointestinal bleeding before endoscopic diagnosis, treatment of upper gastrointestinal bleeding unrelated to portal hypertension, treatment of upper gastrointestinal bleeding related to portal hypertension, management of presumed lower gastrointestinal bleeding, and prevention of upper gastrointestinal bleeding in intensive care.
Collapse
Affiliation(s)
- David Osman
- AP-HP, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, Service de réanimation médicale, Le Kremlin-Bicêtre, F-94270, France.
| | | | | | | | | |
Collapse
|
22
|
Canet E, Osman D, Lambert J, Guitton C, Heng AE, Argaud L, Klouche K, Mourad G, Legendre C, Timsit JF, Rondeau E, Hourmant M, Durrbach A, Glotz D, Souweine B, Schlemmer B, Azoulay E. Acute respiratory failure in kidney transplant recipients: a multicenter study. Crit Care 2011; 15:R91. [PMID: 21385434 PMCID: PMC3219351 DOI: 10.1186/cc10091] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 01/27/2011] [Accepted: 03/08/2011] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Data on pulmonary complications in renal transplant recipients are scarce. The aim of this study was to evaluate acute respiratory failure (ARF) in renal transplant recipients. METHODS We conducted a retrospective observational study in nine transplant centers of consecutive kidney transplant recipients admitted to the intensive care unit (ICU) for ARF from 2000 to 2008. RESULTS Of 6,819 kidney transplant recipients, 452 (6.6%) required ICU admission, including 200 admitted for ARF. Fifteen (7.5%) of these patients had combined kidney-pancreas transplantations. The most common causes of ARF were bacterial pneumonia (35.5%), cardiogenic pulmonary edema (24.5%) and extrapulmonary acute respiratory distress syndrome (ARDS) (15.5%). Pneumocystis pneumonia occurred in 11.5% of patients. Mechanical ventilation was used in 93 patients (46.5%), vasopressors were used in 82 patients (41%) and dialysis was administered in 104 patients (52%). Both the in-hospital and 90-day mortality rates were 22.5%. Among the 155 day 90 survivors, 115 patients (74.2%) were dialysis-free, including 75 patients (65.2%) who recovered prior renal function. Factors independently associated with in-hospital mortality were shock at admission (odds ratio (OR) 8.70, 95% confidence interval (95% CI) 3.25 to 23.29), opportunistic fungal infection (OR 7.08, 95% CI 2.32 to 21.60) and bacterial infection (OR 2.53, 95% CI 1.07 to 5.96). Five factors were independently associated with day 90 dialysis-free survival: renal Sequential Organ Failure Assessment (SOFA) score on day 1 (OR 0.68/SOFA point, 95% CI 0.52 to 0.88), bacterial infection (OR 0.43, 95% CI 0.21 to 0.90), three or four quadrants involved on chest X-ray (OR 0.44, 95% CI 0.21 to 0.91), time from hospital to ICU admission (OR 0.98/day, 95% CI 0.95 to 0.99) and oxygen flow at admission (OR 0.93/liter, 95% CI 0.86 to 0.99). CONCLUSIONS In kidney transplant recipients, ARF is associated with high mortality and graft loss rates. Increased Pneumocystis and bacterial prophylaxis might improve these outcomes. Early ICU admission might prevent graft loss.
Collapse
Affiliation(s)
- Emmanuel Canet
- Medical Intensive Care Unit and Biostatistics Departments, Saint-Louis Teaching Hospital, 1 avenue Claude Vellefaux, Paris F-75010, France
| | - David Osman
- Medical Intensive Care Unit, Bicêtre Teaching Hospital, 78 rue du Général Leclerc, Kremlin-Bicêtre F-94275, France
| | - Jérome Lambert
- Medical Intensive Care Unit and Biostatistics Departments, Saint-Louis Teaching Hospital, 1 avenue Claude Vellefaux, Paris F-75010, France
| | - Christophe Guitton
- Medical Intensive Care Unit, Hôtel-Dieu Teaching Hospital, Place Alexis Ricordeau, Nantes, 44093, France
| | - Anne-Elisabeth Heng
- Departments of Intensive Care Medicine, Nephrology and Transplantation, Gabriel Montpied Teaching Hospital, 58 rue Montalembert, Clermont-Ferrand F-63003, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Edouard Herriot Teaching Hospital, 5 Place d'Arsonval, Lyon, 69437, France
| | - Kada Klouche
- Medical Intensive Care Unit, Nephrology and Transplantation, Lapeyronnie Teaching Hospital, 371 Avenue du doyen Gaston Giraud, Montpellier F-34295, France
| | - Georges Mourad
- Medical Intensive Care Unit, Nephrology and Transplantation, Lapeyronnie Teaching Hospital, 371 Avenue du doyen Gaston Giraud, Montpellier F-34295, France
| | - Christophe Legendre
- Department of Nephrology and Transplantation, Necker Teaching Hospital, 149 rue de Sèvres, Paris F-75743, France
| | - Jean-François Timsit
- Medical Intensive Care Unit, A. Michallon Teaching Hospital, Avenue de Chantourne, Grenoble F-38043, France
| | - Eric Rondeau
- Department of Nephrology and Transplantation, Tenon Teaching Hospital, 4 Rue de la Chine, Paris F-75970, France
| | - Maryvonne Hourmant
- Department of Nephrology and Transplantation, Hôtel-Dieu Teaching Hospital, Place Alexis Ricordeau, Nantes F-44093, France
| | - Antoine Durrbach
- Nephrology and Transplantation, Bicêtre Teaching Hospital, 78 rue du Général Leclerc, Kremlin-Bicêtre F-94275, France
| | - Denis Glotz
- Department of Nephrology and Transplantation, Saint-Louis Teaching Hospital, 1 avenue Claude Vellefaux, Paris F-75010, France
| | - Bertrand Souweine
- Departments of Intensive Care Medicine, Nephrology and Transplantation, Gabriel Montpied Teaching Hospital, 58 rue Montalembert, Clermont-Ferrand F-63003, France
| | - Benoît Schlemmer
- Medical Intensive Care Unit and Biostatistics Departments, Saint-Louis Teaching Hospital, 1 avenue Claude Vellefaux, Paris F-75010, France
| | - Elie Azoulay
- Medical Intensive Care Unit and Biostatistics Departments, Saint-Louis Teaching Hospital, 1 avenue Claude Vellefaux, Paris F-75010, France
| |
Collapse
|
23
|
Dufour N, Chemla D, Teboul JL, Monnet X, Richard C, Osman D. Changes in pulse pressure following fluid loading: a comparison between aortic root (non-invasive tonometry) and femoral artery (invasive recordings). Intensive Care Med 2011; 37:942-9. [PMID: 21380524 DOI: 10.1007/s00134-011-2154-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 12/29/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE To document the relationship between stroke volume (SV) and pulse pressure (PP) recorded at the femoral and aortic sites during volume expansion (VE) in patients in shock. We hypothesized that non-invasively estimated aortic PP would exhibit the same ability as PP recorded invasively at the femoral level to track SV changes. METHODS Included in this prospective study were 56 ICU patients needing VE. Femoral PP (indwelling catheter), aortic PP (tonometry) and cardiac output (thermodilution) were recorded before and after VE. Responders were defined as patients who showed an increase in SV of ≥15% after VE. RESULTS Of the 56 included patients in shock, 39 (age 57 ± 14 years, SAPS II 46 ± 18) completed the study. At both sites, PP increased after VE in responders (n=17, mean SV increase 30 ± 15%) but not in non-responders. In the overall population, there was a positive relationship between VE-induced changes in SV and in PP at the femoral (r=0.60, p<0.001) and aortic (r=0.52, p<0.001) sites. Increases in femoral PP of ≥9% indicated SV increases of ≥15% with 82% sensitivity and 95% specificity. Increases in aortic PP of ≥4.5% indicated SV increases of ≥15% with 76% sensitivity and 82% specificity. Areas under the ROC curves indicated that aortic PP was not different from femoral PP for tracking changes in SV. CONCLUSION The ability of non-invasively estimated aortic PP to track fluid response was the same as that of invasively recorded femoral PP. This may have implications for non-invasive haemodynamic monitoring.
Collapse
Affiliation(s)
- Nicolas Dufour
- Service de Réanimation Médicale, Hôpital Bicêtre, Assistance Publique, Hôpitaux de Paris, Université Paris Sud 11, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | | | | | | | | | | |
Collapse
|
24
|
Fadda H, Khanna M, Santos J, Osman D, Gaisford S, Basit A. The use of dynamic mechanical analysis (DMA) to evaluate plasticization of acrylic polymer films under simulated gastrointestinal conditions. Eur J Pharm Biopharm 2010; 76:493-7. [DOI: 10.1016/j.ejpb.2010.08.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 08/20/2010] [Indexed: 11/26/2022]
|
25
|
Monnet X, Vidal-Petiot E, Osman D, Hamzaoui O, Durrbach A, Goujard C, Miceli C, Bourée P, Richard C. Correction: Critical care management and outcome of severe Pneumocystis pneumonia in patients with and without HIV infection. Crit Care 2009. [PMCID: PMC2689511 DOI: 10.1186/cc7796] [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: 12/01/2022] Open
|
26
|
Kamouh W, Jabot J, Osman D, Lambotte O, Goujard C. Purpura thrombotique thrombocytopénique chez une patiente infectée par le VIH : décès brutal au cours d’une perfusion de rituximab. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
27
|
Morin S, Maigné G, Osman D, Pallier C, Goujard C, Lambotte O. Syndrome d’activation macrophagique et maladie de Castelman : rechercher HHV8 malgré une sérologie négative : intérêt de la PCR. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Anguel N, Monnet X, Osman D, Castelain V, Richard C, Teboul JL. Increase in plasma protein concentration for diagnosing weaning-induced pulmonary oedema. Intensive Care Med 2008; 34:1231-8. [DOI: 10.1007/s00134-008-1038-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Accepted: 01/24/2008] [Indexed: 10/22/2022]
|
29
|
Mercat A, Richard JCM, Vielle B, Jaber S, Osman D, Diehl JL, Lefrant JY, Prat G, Richecoeur J, Nieszkowska A, Gervais C, Baudot J, Bouadma L, Brochard L. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2008; 299:646-55. [PMID: 18270353 DOI: 10.1001/jama.299.6.646] [Citation(s) in RCA: 812] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT The need for lung protection is universally accepted, but the optimal level of positive end-expiratory pressure (PEEP) in patients with acute lung injury (ALI) or acute respiratory distress syndrome remains debated. OBJECTIVE To compare the effect on outcome of a strategy for setting PEEP aimed at increasing alveolar recruitment while limiting hyperinflation to one aimed at minimizing alveolar distension in patients with ALI. DESIGN, SETTING, AND PATIENTS A multicenter randomized controlled trial of 767 adults (mean [SD] age, 59.9 [15.4] years) with ALI conducted in 37 intensive care units in France from September 2002 to December 2005. INTERVENTION Tidal volume was set at 6 mL/kg of predicted body weight in both strategies. Patients were randomly assigned to a moderate PEEP strategy (5-9 cm H(2)O) (minimal distension strategy; n = 382) or to a level of PEEP set to reach a plateau pressure of 28 to 30 cm H(2)O (increased recruitment strategy; n = 385). MAIN OUTCOME MEASURES The primary end point was mortality at 28 days. Secondary end points were hospital mortality at 60 days, ventilator-free days, and organ failure-free days at 28 days. RESULTS The 28-day mortality rate in the minimal distension group was 31.2% (n = 119) vs 27.8% (n = 107) in the increased recruitment group (relative risk, 1.12 [95% confidence interval, 0.90-1.40]; P = .31). The hospital mortality rate in the minimal distension group was 39.0% (n = 149) vs 35.4% (n = 136) in the increased recruitment group (relative risk, 1.10 [95% confidence interval, 0.92-1.32]; P = .30). The increased recruitment group compared with the minimal distension group had a higher median number of ventilator-free days (7 [interquartile range {IQR}, 0-19] vs 3 [IQR, 0-17]; P = .04) and organ failure-free days (6 [IQR, 0-18] vs 2 [IQR, 0-16]; P = .04). This strategy also was associated with higher compliance values, better oxygenation, less use of adjunctive therapies, and larger fluid requirements. CONCLUSIONS A strategy for setting PEEP aimed at increasing alveolar recruitment while limiting hyperinflation did not significantly reduce mortality. However, it did improve lung function and reduced the duration of mechanical ventilation and the duration of organ failure. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00188058.
Collapse
Affiliation(s)
- Alain Mercat
- Département de Réanimation Médicale et Médecine Hyperbare, CHU d'Angers, Angers, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Monnet X, Vidal-Petiot E, Osman D, Hamzaoui O, Durrbach A, Goujard C, Miceli C, Bourée P, Richard C. Critical care management and outcome of severe Pneumocystis pneumonia in patients with and without HIV infection. Crit Care 2008; 12:R28. [PMID: 18304356 PMCID: PMC2374632 DOI: 10.1186/cc6806] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 12/17/2007] [Accepted: 01/25/2008] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Little is known about the most severe forms of Pneumocystis jiroveci pneumonia (PCP) in HIV-negative as compared with HIV-positive patients. Improved knowledge about the differential characteristics and management modalities could guide treatment based on HIV status. METHODS We retrospectively compared 72 patients (73 cases, 46 HIV-positive) admitted for PCP from 1993 to 2006 in the intensive care unit (ICU) of a university hospital. RESULTS The yearly incidence of ICU admissions for PCP in HIV-negative patients increased from 1993 (0%) to 2006 (6.5%). At admission, all but one non-HIV patient were receiving corticosteroids. Twenty-three (85%) HIV-negative patients were receiving an additional immunosuppressive treatment. At admission, HIV-negative patients were significantly older than HIV-positive patients (64 [18 to 82] versus 37 [28 to 56] years old) and had a significantly higher Simplified Acute Physiology Score (SAPS) II (38 [13 to 90] versus 27 [11 to 112]) but had a similar PaO2/FiO2 (arterial partial pressure of oxygen/fraction of inspired oxygen) ratio (160 [61 to 322] versus 183 [38 to 380] mm Hg). Ventilatory support was required in a similar proportion of HIV-negative and HIV-positive cases (78% versus 61%), with a similar proportion of first-line non-invasive ventilation (NIV) (67% versus 54%). NIV failed in 71% of HIV-negative and in 13% of HIV-positive patients (p < 0.01). Mortality was significantly higher in HIV-negative than HIV-positive cases (48% versus 17%). The HIV-negative status (odds ratio 3.73, 95% confidence interval 1.10 to 12.60) and SAPS II (odds ratio 1.07, 95% confidence interval 1.02 to 1.12) were independently associated with mortality at multivariate analysis. CONCLUSION The yearly incidence of ICU admissions for PCP in HIV-negative patients in our unit increased from 1993 to 2006. The course of the disease and the outcome were worse in HIV-negative patients. NIV often failed in HIV-negative cases, suggesting that NIV must be watched closely in this population.
Collapse
Affiliation(s)
- Xavier Monnet
- AP-HP, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
- Univ Paris-Sud, Faculté de médecine Paris-Sud, EA 4046, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
| | - Emmanuelle Vidal-Petiot
- AP-HP, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
- Univ Paris-Sud, Faculté de médecine Paris-Sud, EA 4046, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
| | - David Osman
- AP-HP, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
- Univ Paris-Sud, Faculté de médecine Paris-Sud, EA 4046, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
| | - Olfa Hamzaoui
- AP-HP, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
- Univ Paris-Sud, Faculté de médecine Paris-Sud, EA 4046, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
| | - Antoine Durrbach
- AP-HP, Hôpital de Bicêtre, service de néphrologie, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
| | - Cécile Goujard
- AP-HP, Hôpital de Bicêtre, service de médecine interne, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
- Univ Paris-Sud, INSERM, UMR_S 802, 78, rue du Général Leclerc, Le Kremlin Bicêtre, F-94270, France
| | - Corinne Miceli
- Univ Paris-Sud, INSERM, UMR_S 802, 78, rue du Général Leclerc, Le Kremlin Bicêtre, F-94270, France
- AP-HP, Hôpital de Bicêtre, service de rhumatologie, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
| | - Patrice Bourée
- Univ Paris-Sud, Faculté de médecine Paris-Sud, EA 4046, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
- AP-HP, Hôpital de Bicêtre, unité des maladies parasitaires, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
| | - Christian Richard
- AP-HP, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
- Univ Paris-Sud, Faculté de médecine Paris-Sud, EA 4046, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France
| |
Collapse
|
31
|
Lamia B, Teboul JL, Monnet X, Osman D, Maizel J, Richard C, Chemla D. Contribution of arterial stiffness and stroke volume to peripheral pulse pressure in ICU patients: an arterial tonometry study. Intensive Care Med 2007; 33:1931-7. [PMID: 17579834 DOI: 10.1007/s00134-007-0738-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Accepted: 05/09/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Peripheral arterial pulse pressure is increasingly used to assess hemodynamic status. Our aim was to test the respective influence of arterial stiffness, stroke volume, peripheral resistance, and various hemodynamic and demographic variables on peripheral pulse pressure in critically ill patients. DESIGN Prospective study. SETTING Medical intensive care unit of a university hospital. INTERVENTIONS None. PATIENTS 67 sinus rhythm patients (mean age 57+/-17 years) of whom 17 received vasoactive agents. MEASUREMENTS AND RESULTS The stroke volume was calculated by Doppler echocardiography. Radial pressures were calibrated from systolic and diastolic brachial cuff pressures. Central aortic pressure was estimated by radial applanation tonometry. The arterial compliance was estimated from the aortic pressure curve using the area method and the arterial stiffness was calculated as 1/compliance. The influences of age, body surface area, arterial stiffness, stroke volume, peripheral resistance, and time intervals on peripheral pulse pressure were tested using univariate and multivariate analyses. The mean arterial pressure ranged from 42 to 113 mmHg. Peripheral pulse pressure (59+/-17 mmHg) was higher than aortic pulse pressure (40+/-14 mmHg, p<0.001). In patients aged >or= 60 years whose mean arterial pressure was >or= 80 mmHg, peripheral pulse pressure was related to arterial stiffness (r2=0.41) and to stroke volume (multiple r2 =0.90). A similar but weaker relationship was observed in the overall population (multiple r2=0.52). CONCLUSIONS In critically ill patients, and especially in aged subjects with hemodynamic stability, peripheral pulse pressure mainly reflected the combined influences of arterial stiffness and stroke volume.
Collapse
Affiliation(s)
- Bouchra Lamia
- Université Paris-Sud 11, Equipe d'Accueil EA4046, 94275 Le Kremlin-Bicêtre, France
| | | | | | | | | | | | | |
Collapse
|
32
|
Monnet X, Chemla D, Osman D, Anguel N, Richard C, Pinsky MR, Teboul JL. Measuring aortic diameter improves accuracy of esophageal Doppler in assessing fluid responsiveness. Crit Care Med 2007; 35:477-82. [PMID: 17204996 DOI: 10.1097/01.ccm.0000254725.35802.17] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Fluid responsiveness requires the accurate measurement of cardiac output that can be approached by aortic blood flow (ABF) as measured by esophageal Doppler monitoring (EDM). EDM devices may either include an echo-determination of aortic diameter or estimate aortic diameter from nomograms and thus consider it as constant. However, it is unclear if measuring aortic diameter increases the accuracy of EDM to identify fluid responsiveness. Aortic diameter varies with arterial pressure such that its measure could be essential for assessing the changes in ABF during acute circulatory failure. We attempted to demonstrate that measuring aortic diameter improved the accuracy of EDM to assess fluid responsiveness. DESIGN Prospective study. SETTING University hospital intensive care unit. PATIENTS Seventy-six patients with acute circulatory failure in whom a fluid challenge was given. INTERVENTIONS Rapid volume expansion (500 mL of NaCl 0.9%). MEASUREMENTS AND MAIN RESULTS We measured aortic velocity and area by EDM before and after fluid loading and evaluated the effects of fluid challenge on ABF, either measured after fluid infusion (measured ABFafter) or estimated assuming an unchanging aortic area (estimated ABFafter). If measured ABFafter was used for assessing fluid response, it was increased above 15% compared with ABF at baseline in 41 patients (responders). Conversely, estimated ABFafter increased above 15% from ABF at baseline in 27 patients only; that is, the effects of the challenge were underestimated in 14 patients. In these 14 patients, the relative change in mean arterial pressure during volume expansion was of greater magnitude than in patients who were classified as nonresponders by considering measured ABFafter. CONCLUSIONS Monitoring the changes in aortic diameter improves the accuracy of EDM in assessing the hemodynamic effects of a fluid challenge, especially if it induces a large increase in arterial pressure. Estimating rather than measuring the aortic diameter may lead to underestimation of fluid responsiveness.
Collapse
Affiliation(s)
- Xavier Monnet
- Service de réanimation médicale, Equipe d'accueil 4046, Centre Hospitalier Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, Equipe d'accueil 4046, Université Paris 11, Le Kremlin-Bicêtre, France
| | | | | | | | | | | | | |
Collapse
|
33
|
Osman D, Ridel C, Ray P, Monnet X, Anguel N, Richard C, Teboul JL. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med 2007; 35:64-8. [PMID: 17080001 DOI: 10.1097/01.ccm.0000249851.94101.4f] [Citation(s) in RCA: 484] [Impact Index Per Article: 28.5] [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: 01/08/2023]
Abstract
OBJECTIVE Values of central venous pressure of 8-12 mm Hg and of pulmonary artery occlusion pressure of 12-15 mm Hg have been proposed as volume resuscitation targets in recent international guidelines on management of severe sepsis. By analyzing a large number of volume challenges, our aim was to test the significance of the recommended target values in terms of prediction of volume responsiveness. DESIGN Retrospective study. SETTING A 24-bed medical intensive care unit. PATIENTS All consecutive septic patients monitored with a pulmonary artery catheter who underwent a volume challenge between 2001 and 2004. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS A total of 150 volume challenges in 96 patients were reviewed. In 65 instances, the volume challenge resulted in an increase in cardiac index of > or =15% (responders). The pre-infusion central venous pressure was similar in responders and nonresponders (8 +/- 4 vs. 9 +/- 4 mm Hg). The pre-infusion pulmonary artery occlusion pressure was slightly lower in responders (10 +/- 4 vs. 11 +/- 4 mm Hg, p < .05). However, the significance of pulmonary artery occlusion pressure to predict fluid responsiveness was poor and similar to that of central venous pressure, as indicated by low values of areas under the receiver operating characteristic curves (0.58 and 0.63, respectively). A central venous pressure of <8 mm Hg and a pulmonary artery occlusion pressure of <12 mm Hg predicted volume responsiveness with a positive predictive value of only 47% and 54%, respectively. With the knowledge of a low stroke volume index (<30 mL.m), their positive predictive values were still unsatisfactory: 61% and 69%, respectively. When the combination of central venous pressure and pulmonary artery occlusion pressure was considered instead of either pressure alone, the degree of prediction of volume responsiveness was not improved. CONCLUSION Our study demonstrates that cardiac filling pressures are poor predictors of fluid responsiveness in septic patients. Therefore, their use as targets for volume resuscitation must be discouraged, at least after the early phase of sepsis has concluded.
Collapse
Affiliation(s)
- David Osman
- Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris XI, Le Kremlin-Bicêtre, France
| | | | | | | | | | | | | |
Collapse
|
34
|
Ridel C, Osman D, Mercadal L, Anguel N, Petitclerc T, Richard C, Vinsonneau C. Ionic dialysance: a new valid parameter for quantification of dialysis efficiency in acute renal failure? Intensive Care Med 2007; 33:460-5. [PMID: 17235509 DOI: 10.1007/s00134-006-0514-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 12/18/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Several studies have reported a close relationship between an increased dose of dialysis and survival in patients treated for acute renal failure. Unfortunately, the quantification of dialysis in critically ill patients based on the urea nitrogen formula Kt/V is not applicable. Ionic dialysance is a new parameter calculated in real time from the dialysate conductivity and correlated with the effective urea clearance in chronic hemodialysis patients. The aim of our study was to evaluate ionic dialysance in the quantification of dialysis in critically ill patients with acute renal failure. DESIGN Prospective open-label study. SETTING An 18-bed medical intensive care unit. PATIENTS Thirty-one patients with multiple organ dysfunction syndrome and acute renal failure requiring intermittent hemodialysis were included. MEASUREMENTS Using the first dialysis session of each patient, we compared the delivered dose of dialysis based on ionic dialysance measurement (Kt(ID)) with the well-accepted gold standard method based on fractional dialysate sampling (Kt(dialysate)). The data were analyzed using linear regression and Bland-Altman analysis. RESULTS Thirty-one intermittent hemodialysis sessions were performed in 31 critically ill patients (mean age 58+/-12 years, SAPS II score 56+/-10). We found a close correlation between Kt(dialysate) and Kt(ID) (Kt(dialysate) = 36.3+/-11.4 l; Kt(ID)=38.4+/-11.8; r=0.96) with excellent limits of agreement (-2.2 l; 6.4 l). CONCLUSION The feasibility of dialysis quantification based on ionic dialysance in the critically ill patient is good. This method is a simple and accurate tool for the determination of dialysis dose in critically ill patients.
Collapse
Affiliation(s)
- Christophe Ridel
- Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris XI, Le Kremlin-Bicêtre, Paris, France.
| | | | | | | | | | | | | |
Collapse
|
35
|
Monnet X, Anguel N, Osman D, Hamzaoui O, Richard C, Teboul JL. Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDS. Intensive Care Med 2007; 33:448-53. [PMID: 17221189 DOI: 10.1007/s00134-006-0498-6] [Citation(s) in RCA: 184] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 11/29/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To test whether assessing pulmonary permeability by transpulmonary thermodilution enables to differentiate increased permeability pulmonary edema (ALI/ARDS) from hydrostatic pulmonary edema. DESIGN Retrospective review of cases. SETTING A 24-bed medical intensive care unit of a university hospital. PATIENTS Forty-eight critically ill patients ventilated for acute respiratory failure with bilateral infiltrates on chest radiograph, a PaO(2)/FiO(2) ratio < 300 mmHg and extravascular lung water indexed for body weight >/= 12 ml/kg. INTERVENTION We assessed pulmonary permeability by two indexes obtained from transpulmonary thermodilution: extravascular lung water/pulmonary blood volume (PVPI) and the ratio of extravascular lung water index over global end-diastolic volume index. The cause of pulmonary edema was determined a posteriori by three experts, taking into account medical history, clinical features, echocardiographic left ventricular function, chest radiography findings, B-type natriuretic peptide serum concentration and the time-course of these findings with therapy. Experts were blind for pulmonary permeability indexes and for global end-diastolic volume. MEASUREMENTS AND RESULTS ALI/ARDS was diagnosed in 36 cases. The PVPI was 4.7+/-1.8 and 2.1+/-0.5 in patients with ALI/ARDS and hydrostatic pulmonary edema, respectively (p<0.05). The extravascular lung water index/global end-diastolic volume index ratio was 3.0 x 10(-2)+/-1.2 x 10(-2) and 1.4 x 10(-2)+/-0.4 x 10(-2) in patients with ALI/ARDS and with hydrostatic pulmonary edema, respectively (p<0.05). A PVPI >/= 3 and an extravascular lung water index/global end-diastolic index ratio >/= 1.8 x 10(-2) allowed the diagnosis of ALI/ARDS with a sensitivity of 85% and specificity of 100%. CONCLUSION These results suggest that indexes of pulmonary permeability provided by transpulmonary thermodilution may be useful for determining the mechanism of pulmonary edema in the critically ill.
Collapse
Affiliation(s)
- Xavier Monnet
- Service de réanimation médicale, Centre hospitalier universitaire de Bicêtre, 78, rue du Général Leclerc, 94 270, Le Kremlin-Bicêtre, France
| | | | | | | | | | | |
Collapse
|
36
|
Abstract
OBJECTIVE Passive leg raising (PLR) represents a "self-volume challenge" that could predict fluid response and might be useful when the respiratory variation of stroke volume cannot be used for that purpose. We hypothesized that the hemodynamic response to PLR predicts fluid responsiveness in mechanically ventilated patients. DESIGN Prospective study. SETTING Medical intensive care unit of a university hospital. PATIENTS We investigated 71 mechanically ventilated patients considered for volume expansion. Thirty-one patients had spontaneous breathing activity and/or arrhythmias. INTERVENTIONS We assessed hemodynamic status at baseline, after PLR, and after volume expansion (500 mL NaCl 0.9% infusion over 10 mins). MEASUREMENTS AND MAIN RESULTS We recorded aortic blood flow using esophageal Doppler and arterial pulse pressure. We calculated the respiratory variation of pulse pressure in patients without arrhythmias. In 37 patients (responders), aortic blood flow increased by > or =15% after fluid infusion. A PLR increase of aortic blood flow > or =10% predicted fluid responsiveness with a sensitivity of 97% and a specificity of 94%. A PLR increase of pulse pressure > or =12% predicted volume responsiveness with significantly lower sensitivity (60%) and specificity (85%). In 30 patients without arrhythmias or spontaneous breathing, a respiratory variation in pulse pressure > or =12% was of similar predictive value as was PLR increases in aortic blood flow (sensitivity of 88% and specificity of 93%). In patients with spontaneous breathing activity, the specificity of respiratory variations in pulse pressure was poor (46%). CONCLUSIONS The changes in aortic blood flow induced by PLR predict preload responsiveness in ventilated patients, whereas with arrhythmias and spontaneous breathing activity, respiratory variations of arterial pulse pressure poorly predict preload responsiveness.
Collapse
Affiliation(s)
- Xavier Monnet
- Service de réanimation médicale, Centre Hospitalier Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris 11, Le Kremlin-Bicêtre, France
| | | | | | | | | | | | | |
Collapse
|
37
|
Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, Teboul JL. Esophageal Doppler monitoring predicts fluid responsiveness in critically ill ventilated patients. Intensive Care Med 2005; 31:1195-201. [PMID: 16059723 DOI: 10.1007/s00134-005-2731-0] [Citation(s) in RCA: 188] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Accepted: 06/23/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To test whether fluid responsiveness can be predicted by the respiratory variation in aortic blood flow and/or the flow time corrected for heart rate monitored with esophageal Doppler. DESIGN AND SETTING Prospective study in a 24-bed medical intensive care unit of a university hospital. PATIENTS 38 mechanically ventilated patients with sinus rhythm and without spontaneous breathing activity in whom volume expansion was planned. INTERVENTIONS The aortic blood flow was measured using an esophageal Doppler monitoring device before and after fluid infusion (500 ml NaCl 0.9% over 10 min). The variation in aortic blood flow over a respiratory cycle between its minimal and maximal values was calculated. The flow time was also measured. MEASUREMENTS AND RESULTS Aortic blood flow increased by at least 15% after volume expansion in 20 patients (defined as responders). Before fluid infusion the respiratory variation in aortic flow was higher in responders than in nonresponders (28+/-12% vs. 12+/-5%). It significantly decreased after volume expansion (18+/-11%) in responders only. A respiratory variation in aortic flow before volume expansion of at least 18% predicted fluid responsiveness with a sensitivity of 90% and a specificity of 94%. Flow time increased with fluid infusion in responders and nonresponders. A flow time corrected for heart rate below 277 ms predicted fluid responsiveness with a sensitivity of 55% and a specificity of 94%. The area under the ROC curve generated for variation in aortic blood flow ABF was greater than that generated for flow time. CONCLUSIONS The respiratory variation in aortic blood flow reliably predicts fluid responsiveness in patients with sinus rhythm and without breathing activity.
Collapse
Affiliation(s)
- Xavier Monnet
- Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris XI, 78 rue du Général Leclerc, 94270 le Kremlin-Bicêtre, France
| | | | | | | | | | | | | |
Collapse
|
38
|
Guiard-Schmid JB, Lacombe K, Osman D, Meynard JL, Fèbvre M, Meyohas MC, Frottier J. [Paragonimiasis: a rare little known disease]. Presse Med 1998; 27:1835-7. [PMID: 9856127] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Paragonimiasis, caused by a lung fluke, is an parasitic disease rarely encountered in France. CASE REPORT A 52-year-old man developed dyspnea, cough, mild fever and chest pain. Pleural effusion suggested possible pulmonary embolism or tuberculosis. Cell counts in blood and pleural effusion fluid revealed major eosinophila in this patient who had recently returned from a trip to Japan. Paragonimiasis was confirmed by ELISA. Treatment with praziquantel led to complete clinical and radiographic recovery. DISCUSSION The clinical and radiographic features of paragonimiasis are often similar to tuberculosis with pleuropneumopathy, mild fever and dyspnea. ELISA has now replaced parasitologic diagnosis. Cure is achieved with praziquantel.
Collapse
Affiliation(s)
- J B Guiard-Schmid
- Service des Maladies infectieuses et Tropicales, Hôpital Saint-Antoine, Paris, France
| | | | | | | | | | | | | |
Collapse
|
39
|
Schmid JBG, Osman D, Nathan N, Meynard JL, Meyohas MC, Frottier J. Tuberculose cérébrale: aggravation radiologique initiale paradoxale sous traitement. Rev Med Interne 1998. [DOI: 10.1016/s0248-8663(98)80273-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
Majumdar S, Newitt D, Mathur A, Osman D, Gies A, Chiu E, Lotz J, Kinney J, Genant H. Magnetic resonance imaging of trabecular bone structure in the distal radius: relationship with X-ray tomographic microscopy and biomechanics. Osteoporos Int 1996; 6:376-85. [PMID: 8931032 DOI: 10.1007/bf01623011] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The contribution of trabecular bone structure to bone strength is of considerable interest in the study of osteoporosis and other disorders characterized by changes in the skeletal system. Magnetic resonance (MR) imaging of trabecular bone has emerged as a promising technique for assessing trabecular bone structure. In this in vitro study we compare the measures of trabecular structure obtained using MR imaging and higher-resolution X-ray tomographic microscopy (XTM) imaging of cubes from human distal radii. The XTM image resolution is similar to that obtained from histomorphometric sections (18 microns isotropic), while the MR images are obtained at a resolution comparable to that achievable in vivo (156 x 156 x 300 microns). Standard histomorphometric measures, such as trabecular bone area fraction (synonymous with BV/TV), trabecular width, trabecular spacing and trabecular number, texture-related measures and three-dimensional connectivity (first Betti number/volume) of the trabecular network have been derived from these images. The variation in these parameters as a function of resolution, and the relationship between the structural parameters, bone mineral density and the elastic modulus are also examined. In MR images, because the resolution is comparable to the trabecular dimensions, partial volume effects occur, which complicate the segmentation of the image into bone and marrow phases. Using a standardized thresholding criterion for all images we find that there is an overestimation of trabecular bone area fraction (approximately 3 times), trabecular width (approximately 3 times), fractal dimension (approximately 1.4 times) and first Betti number/ volume (approximately 10 times), and an underestimation of trabecular spacing (approximately 1.6 times) in the MR images compared with the 18-microns XTM images. However, even for a factor of 9 difference in spatial resolution, the differences in the morphological trabecular structure measures ranged from a factor of 1.4 to 3.0. We have found that trabecular width, area fraction, number, fractal dimension and Betti number/volume measured from the XTM and MR images increases, while trabecular spacing decreases, as the bone mineral density and elastic modulus increase. A preliminary bivariate analysis showed that in addition to bone mineral density alone, the Betti number, trabecular number and spacing contributed to the prediction of the elastic modulus. This preliminary study indicates that measures of trabecular bone structure using MR imaging may play a role in the study of osteoporosis.
Collapse
Affiliation(s)
- S Majumdar
- Department of Radiology, University of California San Francisco 94143, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Grabowski SJ, Grabowski SJ, Wilamowski J, Wilamowski J, Osman D, Osman D, Sepiol JJ, Sepiol JJ, Rodier N, Rodier N. Synthesis, Crystal Structure and Intramolecular Interactions of 2-Methyl-3-(2-Methylphenyl)but-1-ene-1,1-dicarbonitrile (MMBD). Aust J Chem 1996. [DOI: 10.1071/ch9960951] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
2-Methyl-3-(2-methylphenyl)but-1-ene-1,1-dicarbonitrile (MMBD) has been synthesized from 3-(o-tolyl)butan-2-one. The crystal and molecular structure of this compound was solved by X-ray diffraction, with estimated standard deviations ≤ � 0.005 Ǻ for bond lengths, and ≤ 0.3° for bond angles. Intramolecular interactions of the C≡N group, i.e. of the C-H...N, C-H...π (electrons) and C-H...C type, were observed, and the possibility of weak intramolecular hydrogen bridges in the molecule of MMBD was considered. The geometry of the MMBD molecule from AM1 calculations was compared with the X-ray structure.
Collapse
|
42
|
Majumdar S, Newitt D, Jergas M, Gies A, Chiu E, Osman D, Keltner J, Keyak J, Genant H. Evaluation of technical factors affecting the quantification of trabecular bone structure using magnetic resonance imaging. Bone 1995; 17:417-30. [PMID: 8573417 DOI: 10.1016/s8756-3282(95)00263-4] [Citation(s) in RCA: 145] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
High resolution magnetic resonance (MR) techniques combined with standard techniques of stereology and texture analysis have been used to quantify trabecular structure. Using dried excised specimens from the tibia (n = 10) and radius (n = 2) we evaluate the impact of using volumetric gradient-echo (GE) and spin-echo (SE) MR imaging sequences, the relative importance of echo time in gradient-echo MR imaging, and the impact of different threshold values to segment the bone and bone marrow on the estimation of trabecular bone structure. We also investigate the inter-relationships between the different structural parameters derived from MR images. Images were obtained using fast gradient-echo and spin-echo imaging sequences, with TE values ranging from 7 to 17 ms using 4.7 and 1.5 Tesla imaging systems. In-plane image resolution ranged from 128 to 156 microns, and slice thickness ranged from 128 to 1000 microns. We derived stereological measures such as the mean intercept length, trabecular width, fractional area of trabecular bone, trabecular number, and trabecular spacing, the fractal dimension as a texture-related parameter and the Euler number as a measure of connectivity from these images. We found that the mean intercept length as a function of angle traced an ellipse with the orientation of the principal axis of the ellipse, a measure of trabecular orientation, identical when measured from the spin-echo or gradient-echo MR images. Absolute measures such as the fractional area, trabecular width, trabecular number, and fractal dimension as measured from gradient echo images were 28%, 30%, 1.3%, and 0.6% greater, respectively, than those calculated from spin-echo images, while the trabecular spacing was 14% less when calculated from gradient-echo images compared to spin-echo images. The structural parameters also depended on the echo time used to obtain the MR image. The choice of the threshold used to segment the high resolution images also affected the estimated structural parameters significantly. Our results indicate that MR may be used to visualize and quantify trabecular bone architecture; however, the different technical factors that could affect the appearance of MR images must be understood and considered in the data analysis and interpretation.
Collapse
Affiliation(s)
- S Majumdar
- Magnetic Resonance Science Center, University of California, San Francisco 94143, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Lewin AA, Cohen A, Abitbol AA, Schwade JG, Osman D, DerHagopian R, Ostroski J, Marcial-Vega V, Houdek P, Gould E. Conservative surgery and radiation therapy for intraductal carcinoma of the breast. J Fla Med Assoc 1992; 79:762-5. [PMID: 1336028] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Nineteen women with intraductal carcinoma of the breast were treated with conservative surgery and radiotherapy from 1982 to 1990. All underwent excisional biopsy or wide local excision of the primary tumor. Definitive irradiation consisted of 4500 cGy in 180 cGy fractions given through tangential fields followed by a breast boost to the primary site to a total dose of 5900-6500 cGy. No patient received regional node irradiation. Median follow-up was 38 months. The five year actuarial rate of local failure was 9%. One patient failed with an infiltrating ductal carcinoma in the treated breast 31 months after initial treatment. Salvage mastectomy was performed. She remains without evidence of disease 43 months after initial treatment. Metastatic breast carcinoma has not developed in any of the patients. Cosmetic result was good to excellent in all patients. With short-term follow-up, conservative surgery and radiotherapy appear to be an acceptable alternative to mastectomy in carefully selected patients with ductal carcinoma in situ. As retrospective and randomized trials mature, the natural history of these lesions treated with conservative surgery and irradiation will be further defined.
Collapse
Affiliation(s)
- A A Lewin
- Department of Radiation Oncology, Baptist Hospital of Miami
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Lewin AA, Abitbol AA, Schwade JG, Osman D, DerHagopian R, Ostroski J, Serago C, Houdek P, Bujnoski J. Conservative surgery and radiation therapy for early stage breast cancer. Can large trial experiences be reproduced in a community hospital setting? J Fla Med Assoc 1990; 77:1034-6. [PMID: 1963436] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Conservative surgery and radiation therapy were used to treat 212 patients with AJC clinical Stage I or II breast carcinoma at the Baptist Hospital of Miami. All had lumpectomy and most axillary lymph node dissection, followed by breast irradiation to a dose of 45 Gy and a boost dose of 14 to 16 Gy to the surgical bed. Median follow-up was 55 months. The five-year actuarial local control and survival rates were 94% and 86% respectively. Eighty-six percent of the patients had excellent or good cosmetic results with minimal differences between the treated and untreated breasts. Treatment-related complications were minor and infrequent. These results appear comparable to retrospective reviews at major university centers and ongoing prospective randomized trials.
Collapse
Affiliation(s)
- A A Lewin
- Baptist Hospital of Miami, Regional Cancer Treatment Center 33256
| | | | | | | | | | | | | | | | | |
Collapse
|