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Labaste F, Cauquil P, Lestarquit M, Sanchez-Verlaan P, Aljuayli A, Marcheix B, Geeraerts T, Ferre F, Vardon-Bounes F, Minville V. Postoperative outcomes after total sevoflurane inhalation sedation using a disposable delivery system (Sedaconda-ACD) in cardiac surgery. Front Med (Lausanne) 2024; 11:1340119. [PMID: 38504912 PMCID: PMC10948405 DOI: 10.3389/fmed.2024.1340119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/12/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction The COVID-19 pandemic prompted our team to develop new solutions for performing cardiac surgery without intravenous anesthetics due to a shortage of these drugs. We utilized an anesthetic conserving device (Sedaconda-ACD) to administer total inhaled anesthesia because specific vaporizers were unavailable for administering inhaled agents during cardiopulmonary bypass (CPB) in our center. We documented our experience and postoperative cardiovascular outcomes. The primary outcome was the peak level of troponin, with secondary outcomes encompassing other cardiovascular complications. Material and methods A single-center retrospective study was conducted. We performed a multivariate analysis with a propensity score. This investigation took place at a large university referral center. Participants Adult patients (age ≥ 18) who underwent elective cardiac surgery with CPB between June 2020 to March 2021. Intervention During the inclusion period, two anesthesia protocols for the maintenance of anesthesia coexisted-total inhaled anesthesia with Sedaconda-ACD and our classic protocol with intravenous drugs during and after CPB. Primary endpoint Troponin peak level recorded after surgery (highest level recorded within 48 h following the surgery). Results Out of the 654 included patients, 454 were analyzed after matching (intravenous group = 297 and inhaled group = 157). No significant difference was found between the groups in postoperative troponin peak levels (723 ng/l vs. 993 ng/l-p = 0.2). Total inhaled anesthesia was associated with a decreased requirement for inotropic medications (OR = 0.53, 95% CI 0.29-0.99, p = 0.04). Conclusion In our cohort, the Sedaconda-ACD device enabled us to achieve anesthesia without intravenous agents, and we did not observe any increase in postoperative complications. Total inhaled anesthesia with sevoflurane was not associated with a lower incidence of myocardial injury assessed by the postoperative troponin peak level. However, in our cohort, the use of inotropic drugs was lower.
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Affiliation(s)
- François Labaste
- Anesthesiology and Critical Care Unit, Toulouse University Teaching Hospital, Toulouse, France
- RESTORE, UMR 1301 Inserm - 5070 CNRS - Université Paul Sabatier, Université de Toulouse, Toulouse, France
| | - Paul Cauquil
- Anesthesiology and Critical Care Unit, Toulouse University Teaching Hospital, Toulouse, France
| | - Magda Lestarquit
- Anesthesiology and Critical Care Unit, Toulouse University Teaching Hospital, Toulouse, France
| | - Pascale Sanchez-Verlaan
- Anesthesiology and Critical Care Unit, Toulouse University Teaching Hospital, Toulouse, France
| | - Abdulrahman Aljuayli
- Department of Cardiac Surgery, Toulouse University Teaching Hospital, Toulouse, France
| | - Bertrand Marcheix
- Department of Cardiac Surgery, Toulouse University Teaching Hospital, Toulouse, France
| | - Thomas Geeraerts
- Anesthesiology and Critical Care Unit, Toulouse University Teaching Hospital, Toulouse, France
| | - Fabrice Ferre
- Anesthesiology and Critical Care Unit, Toulouse University Teaching Hospital, Toulouse, France
| | - Fanny Vardon-Bounes
- Anesthesiology and Critical Care Unit, Toulouse University Teaching Hospital, Toulouse, France
| | - Vincent Minville
- Anesthesiology and Critical Care Unit, Toulouse University Teaching Hospital, Toulouse, France
- RESTORE, UMR 1301 Inserm - 5070 CNRS - Université Paul Sabatier, Université de Toulouse, Toulouse, France
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2
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Hites M, Massonnaud CR, Lapique EL, Belhadi D, Jamard S, Goehringer F, Danion F, Reignier J, de Castro N, Garot D, Lacombe K, Tolsma V, Faure E, Malvy D, Staub T, Courjon J, Cazenave-Roblot F, Dyrhol Riise AM, Leturnier P, Martin-Blondel G, Roger C, Akinosoglou K, Moing VL, Piroth L, Sellier P, Lescure X, Trøseid M, Clevenbergh P, Dalgard O, Gallien S, Gousseff M, Loubet P, Vardon-Bounes F, Visée C, Belkhir L, Botelho-Nevers É, Cabié A, Kotanidou A, Lanternier F, Rouveix-Nordon E, Silva S, Thiery G, Poignard P, Carcelain G, Diallo A, Mercier N, Terzic V, Bouscambert-Duchamp M, Gaymard A, Trabaud MA, Destras G, Josset L, Billard N, Han THL, Guedj J, Couffin-Cadiergues S, Dechanet A, Delmas C, Esperou H, Fougerou-Leurent C, Mestre SL, Métois A, Noret M, Bally I, Dergan-Dylon S, Tubiana S, Kalif O, Bergaud N, Leveau B, Eustace J, Greil R, Hajdu E, Halanova M, Paiva JA, Piekarska A, Rodriguez Baño J, Tonby K, Trojánek M, Tsiodras S, Unal S, Burdet C, Costagliola D, Yazdanpanah Y, Peiffer-Smadja N, Mentré F, Ader F. Tixagevimab-cilgavimab (AZD7442) for the treatment of patients hospitalized with COVID-19 (DisCoVeRy): A phase 3, randomized, double-blind, placebo-controlled trial. J Infect 2024; 88:106120. [PMID: 38367705 DOI: 10.1016/j.jinf.2024.106120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Affiliation(s)
- Maya Hites
- Clinic of Infectious Diseases, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles, Brussels, Belgium.
| | - Clément R Massonnaud
- Université Paris Cité, Inserm, IAME, F-75018 Paris, France; AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France
| | - Eva Larranaga Lapique
- Clinic of Infectious Diseases, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles, Brussels, Belgium
| | - Drifa Belhadi
- Université Paris Cité, Inserm, IAME, F-75018 Paris, France; AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France
| | - Simon Jamard
- Service de Maladies Infectieuses Et Tropicales (SMIT), Centre Hospitalier Universitaire de Tours, 37044 Tours, France
| | - François Goehringer
- Université de Lorraine, CHRU de Nancy, Service des Maladies Infectieuses et Tropicales, F-54000 Nancy, France
| | - François Danion
- Hôpitaux Universitaires de Strasbourg, Département de maladies infectieuses et tropicales, F-67091 Strasbourg, France
| | - Jean Reignier
- CHU de Nantes, Service de Médecine Intensive et Réanimation, Université de Nantes, F-44093 Nantes, France
| | - Nathalie de Castro
- Département des Maladies Infectieuses et Tropicales, GH Saint-Louis/Lariboisière-Fernand Widal, Université de Paris Cité, INSERM U 944, Paris, France
| | - Denis Garot
- CHRU Tours, Service de Médecine Intensive Réanimation, F-37044 Tours, France
| | - Karine Lacombe
- Sorbonne Université, Inserm, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, F-75013 Paris, France; APHP, Hôpital Saint-Antoine, Service de maladies infectieuses et tropicales, F-75012 Paris, France
| | - Violaine Tolsma
- Centre Hospitalier Annecy Genevois, Service des Maladies Infectieuses et Tropicales, F-74374 Annecy, France
| | - Emmanuel Faure
- Université de Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Denis Malvy
- Department of Infectious Diseases and Tropical Medicine, CHU Bordeaux, Bordeaux, France
| | - Thérèse Staub
- Centre hospitalier de Luxembourg, Service des maladies infectieuses, L-1210 Luxembourg, Luxembourg
| | - Johan Courjon
- Université Côte d'Azur, CHU Nice, Nice, France, Infectious Disease Unit, Nice, France
| | - France Cazenave-Roblot
- Département des Maladies Infectieuses et Tropicales, CHU de Poitiers, INSERM U1070, Poitiers, France
| | | | - Paul Leturnier
- Department of Infectious Diseases, Hôtel-Dieu University Hospital, University Hospital of Nantes, Nantes, France
| | - Guillaume Martin-Blondel
- CHU de Toulouse, Service des maladies infectieuses et Tropicales, F-31320 Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, F-31320 Toulouse, France
| | - Claire Roger
- Department of Anesthesiology, Critical Care Pain, and Emergency Medicine, Nimes University Hospital, Nimes, France
| | - Karolina Akinosoglou
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, Patras, Greece
| | - Vincent Le Moing
- CHU de Montpellier, Service des Maladies Infectieuses et Tropicales, F-34295 Montpellier, France
| | - Lionel Piroth
- CHU de Dijon, Département de Maladies Infectieuses, F-21000, Dijon, France; Université Bourgogne Franche-Comté, CIC 1432, INSERM, F-21000, Dijon, France
| | - Pierre Sellier
- Infectious Diseases Department, Lariboisière Hospital, AP-HP, Paris, France
| | - Xavier Lescure
- Université Paris Cité, Inserm, IAME, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de Maladies Infectieuses et Tropicales, F-75018 Paris, France
| | - Marius Trøseid
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Olav Dalgard
- Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sébastien Gallien
- APHP, Hôpital Henri Mondor, Département de maladies infectieuses, F-94000 Créteil, France; INSERM U955, Team 16, IMRB Créteil, Créteil, France
| | - Marie Gousseff
- Maladies infectieuses, Centre Hospitalier Bretagne-Atlantique, Vannes, France
| | - Paul Loubet
- Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, France; VBIC, INSERM U1047, University of Montpellier, Nimes, France
| | - Fanny Vardon-Bounes
- CHU de Toulouse, Département d'anesthésie et de soins intensifs, F-31300 Toulouse, France; Université Toulouse 3 Paul Sabatier, Inserm U1297, F-31300 Toulouse, France
| | - Clotilde Visée
- Department of Infectious Disease, Centre Hospitalier Régional Mons-Hainaut/Groupe Jolimont, Mons Belgium/Groupe Helora, Mons, Belgium
| | - Leila Belkhir
- Department of Internal Medicine and Infectious Diseases, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Élisabeth Botelho-Nevers
- CHU de Saint-Etienne, Service d'Infectiologie, F-42055 Saint-Etienne, France; Université Jean Monnet, Université Claude Bernard Lyon 1, GIMAP, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, F-42023 Saint-Etienne, France; CIC 1408, INSERM, F, 42055 Saint-Etienne, France
| | - André Cabié
- PCCEI, Univ Montpellier, Univ Antilles, Inserm, EFS, F-34394 Montpellier, France; CHU de Martinique, Service des maladies infectieuses et tropicales, Inserm CIC1424, F-97200 Fort de France, France
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, 45-47 Ipsilantou Street, 10676 Athens, Greece
| | - Fanny Lanternier
- Infectious Diseases Unit, Necker-Enfants Malades University Hospital, AP-HP, Paris, France
| | - Elisabeth Rouveix-Nordon
- AP-HP, Hôpital Ambroise-Paré, Service de Maladies Infectieuses et Tropicales, Boulogne-Billancourt, France
| | - Susana Silva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no 135, 4050-600 Porto, Portugal
| | - Guillaume Thiery
- CHU Saint-Etienne, Hopital Nord, Medical Intensive Care Unit, Saint-Priest-En-Jarez, France
| | - Pascal Poignard
- Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France; Univ. Grenoble Alpes, CEA, CNRS, Institut de Biologie Structurale (IBS), Grenoble, France; Laboratoire de Virologie, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Guislaine Carcelain
- Immunology Department, Robert Debré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université Paris Cité, INSERM U976, Paris, France
| | - Alpha Diallo
- ANRS | Maladies Infectieuses Emergentes, Paris, France
| | | | - Vida Terzic
- ANRS | Maladies Infectieuses Emergentes, Paris, France
| | - Maude Bouscambert-Duchamp
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux de Lyon, Centre National de Référence des virus respiratoires France Sud, F-69317 Lyon, France; Université Claude Bernard Lyon 1, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, F-69372 Lyon, France
| | - Alexandre Gaymard
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux de Lyon, Centre National de Référence des virus respiratoires France Sud, F-69317 Lyon, France; Université Claude Bernard Lyon 1, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, F-69372 Lyon, France
| | | | - Grégory Destras
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux de Lyon, Centre National de Référence des virus respiratoires France Sud, F-69317 Lyon, France
| | - Laurence Josset
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux de Lyon, Centre National de Référence des virus respiratoires France Sud, F-69317 Lyon, France
| | - Nicolas Billard
- AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France
| | - Thi-Hong-Lien Han
- AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France
| | - Jérémie Guedj
- Université Paris Cité, Inserm, IAME, F-75018 Paris, France
| | | | - Aline Dechanet
- AP-HP, Hôpital Bichat, Unité de recherche clinique, F-75018 Paris, France
| | - Christelle Delmas
- Institut de santé publique, Pôle recherche clinique, INSERM, Paris, France
| | - Hélène Esperou
- Institut de santé publique, Pôle recherche clinique, INSERM, Paris, France
| | | | | | - Anabelle Métois
- AP-HP, Hôpital Bichat, Unité de recherche clinique, F-75018 Paris, France
| | - Marion Noret
- Renarci, Réseau National De Recherche Clinique En Infectiologie, Paris, France
| | - Isabelle Bally
- Univ. Grenoble Alpes, CEA, CNRS, Institut de Biologie Structurale (IBS), Grenoble, France
| | - Sebastián Dergan-Dylon
- Univ. Grenoble Alpes, CEA, CNRS, Institut de Biologie Structurale (IBS), Grenoble, France
| | - Sarah Tubiana
- Université Paris Cité, Inserm, IAME, F-75018 Paris, France; AP-HP, Hôpital Bichat, Centre de ressources biologiques, F-75018 Paris, France
| | - Ouifiya Kalif
- AP-HP, Hôpital Bichat, Centre de ressources biologiques, F-75018 Paris, France
| | | | | | | | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; Cancer Cluster Salzburg, 5020 Salzburg, Austria; AGMT, 5020 Salzburg, Austria
| | - Edit Hajdu
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, Állomás Street 1-3, 6725 Szeged, Hungary
| | - Monika Halanova
- LF UPJŠ - Pavol Jozef Šafárik University in Košice Faculty of Medicine, Košice, Slovakia
| | - Jose-Artur Paiva
- Centro Hospitalar São João, Emergency and Intensive Care Department, Porto, Portugal; Universidade do Porto, Faculty of Medicine, Porto, Portugal
| | - Anna Piekarska
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, Łódź, Poland
| | - Jesus Rodriguez Baño
- Infectious Diseases and Microbiology Division, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Kristian Tonby
- Department of Infectious Diseases, Oslo University Hospital, 0424 Oslo, Norway
| | - Milan Trojánek
- Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Serhat Unal
- Department of Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Charles Burdet
- Université Paris Cité, Inserm, IAME, F-75018 Paris, France; AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France
| | - Dominique Costagliola
- Sorbonne Université, Inserm, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, F-75013 Paris, France
| | - Yazdan Yazdanpanah
- Université Paris Cité, Inserm, IAME, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de Maladies Infectieuses et Tropicales, F-75018 Paris, France
| | - Nathan Peiffer-Smadja
- Université Paris Cité, Inserm, IAME, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de Maladies Infectieuses et Tropicales, F-75018 Paris, France; National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - France Mentré
- Université Paris Cité, Inserm, IAME, F-75018 Paris, France; AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France
| | - Florence Ader
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Département des Maladies Infectieuses et Tropicales, F-69004 Lyon, France; Université Claude Bernard Lyon 1, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, F-69372 Lyon, France
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Pey V, Doumard E, Komorowski M, Rouget A, Delmas C, Vardon-Bounes F, Poette M, Ratineau V, Dray C, Ader I, Minville V. A locally optimised machine learning approach to early prognostication of long-term neurological outcomes after out-of-hospital cardiac arrest. Digit Health 2024; 10:20552076241234746. [PMID: 38628633 PMCID: PMC11020739 DOI: 10.1177/20552076241234746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 04/19/2024] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) represents a major burden for society and health care, with an average incidence in adults of 67 to 170 cases per 100,000 person-years in Europe and in-hospital survival rates of less than 10%. Patients and practitioners would benefit from a prognostication tool for long-term good neurological outcomes. Objective We aim to develop a machine learning (ML) pipeline on a local database to classify patients according to their neurological outcomes and identify prognostic features. Methods We collected clinical and biological data consecutively from 595 patients who presented OHCA and were routed to a single regional cardiac arrest centre in the south of France. We applied recursive feature elimination and ML analyses to identify the main features associated with a good neurological outcome, defined as a Cerebral Performance Category score less than or equal to 2 at six months post-OHCA. Results We identified 12 variables 24 h after admission, capable of predicting a six-month good neurological outcome. The best model (extreme gradient boosting) achieved an AUC of 0.96 and an accuracy of 0.92 in the test cohort. Conclusion We demonstrated that it is possible to build accurate, locally optimised prediction and prognostication scores using datasets of limited size and breadth. We proposed and shared a generic machine-learning pipeline which allows external teams to replicate the approach locally.
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Affiliation(s)
- Vincent Pey
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Emmanuel Doumard
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
| | - Matthieu Komorowski
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Antoine Rouget
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Clément Delmas
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
| | - Fanny Vardon-Bounes
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Michaël Poette
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Valentin Ratineau
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Cédric Dray
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
| | - Isabelle Ader
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
| | - Vincent Minville
- RESTORE Research Center, University Toulouse 3-Paul Sabatier, INSERM, CNRS, EFS, ENVT, Toulouse, France
- Department of Anaesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France
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Pangot Q, Labaste F, Pey V, Médrano C, Tuijnman A, Ruiz S, Conil JM, Minville V, Vardon-Bounes F. Comparing COVID-19 and influenza: Epidemiology, clinical characteristics, outcomes and mortality in the ICU. J Clin Virol 2023; 169:105600. [PMID: 37948984 DOI: 10.1016/j.jcv.2023.105600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 11/12/2023]
Abstract
RATIONALE Several authors have compared COVID-19 infection with influenza in the ICU. OBJECTIVE This study aimed to compare the baseline clinical profiles, care procedures, and mortality outcomes of patients admitted to the intensive care unit, categorized by infection status (Influenza vs. COVID-19). METHODS Retrospective observational study. Data were extracted from the Toulouse University Hospital from March 2014 to March 2021. To compare survival curves, we plotted the survival at Day-90 using the Kaplan-Meier curve and conducted a log-rank test. Additionally, we performed propensity score matching to adjust for confounding factors between the COVID-19 and influenza groups. Furthermore, we use the CART model for multivariate analysis. RESULTS The study included 363 patients admitted to the ICU due to severe viral pneumonia: 152 patients (41.9 %) with influenza and 211 patients (58.1 %) with COVID-19. COVID-19 patients exhibited a higher prevalence of cardiovascular risk factors, whereas influenza patients had significantly higher severity scores (SOFA: 10 [6-12] vs. 6 [3-9], p<0.01 and SAPS II: 51 [35-67] vs. 37 [29-50], p<0.001). Overall mortality rates were comparable between the two groups (27.6 % (n = 42) in the influenza group vs. 21.8 % (n = 46) in the COVID-19 group, p=NS). Mechanical ventilation was more commonly employed in the influenza group (76.3 % (n = 116) vs. 59.7 % (n = 126), p<0.001); however, COVID-19 patients required longer durations of mechanical ventilation (18 [9-29] days vs. 13 [5-24] days, p<0.006) and longer hospital stays (23 [13-34] days vs. 18.5 [9-34.5] days, p = 0.009). The CART analysis revealed that the use of extra renal replacement therapy was the most influential prognostic factor in the influenza group, while the PaO2/FiO2-PEEP ratio played a significant role in the COVID-19 group. CONCLUSIONS Despite differences in clinical presentation and prognostic factors, the mortality rates at 90 days, after adjusting for confounding factors, were similar between COVID-19 and influenza patients.
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Affiliation(s)
- Quentin Pangot
- Anaesthesiology and Critical Care Department, Toulouse University Hospital, Toulouse, France
| | - François Labaste
- Anaesthesiology and Critical Care Department, Toulouse University Hospital, Toulouse, France
| | - Vincent Pey
- Anaesthesiology and Critical Care Department, Toulouse University Hospital, Toulouse, France
| | - Chloé Médrano
- Departments of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Adam Tuijnman
- Anaesthesiology and Critical Care Department, Toulouse University Hospital, Toulouse, France
| | - Stéphanie Ruiz
- Anaesthesiology and Critical Care Department, Toulouse University Hospital, Toulouse, France
| | - Jean-Marie Conil
- Anaesthesiology and Critical Care Department, Toulouse University Hospital, Toulouse, France
| | - Vincent Minville
- Anaesthesiology and Critical Care Department, Toulouse University Hospital, Toulouse, France
| | - Fanny Vardon-Bounes
- Anaesthesiology and Critical Care Department, Toulouse University Hospital, Toulouse, France.
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Garcia C, Compagnon B, Ribes A, Voisin S, Vardon-Bounes F, Payrastre B. SARS-CoV-2 Omicron variant infection affects blood platelets, a comparative analysis with Delta variant. Front Immunol 2023; 14:1231576. [PMID: 37828997 PMCID: PMC10565689 DOI: 10.3389/fimmu.2023.1231576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction In November 2021, the SARS-CoV-2 Omicron variant of concern has emerged and is currently dominating the COVID-19 pandemic over the world. Omicron displays a number of mutations, particularly in the spike protein, leading to specific characteristics including a higher potential for transmission. Although Omicron has caused a significant number of deaths worldwide, it generally induces less severe clinical signs compared to earlier variants. As its impact on blood platelets remains unknown, we investigated platelet behavior in severe patients infected with Omicron in comparison to Delta. Methods Clinical and biological characteristics of severe COVID-19 patients infected with the Omicron (n=9) or Delta (n=11) variants were analyzed. Using complementary methods such as flow cytometry, confocal imaging and electron microscopy, we examined platelet activation, responsiveness and phenotype, presence of virus in platelets and induction of selective autophagy. We also explored the direct effect of spike proteins from the Omicron or Delta variants on healthy platelet signaling. Results Severe Omicron variant infection resulted in platelet activation and partial desensitization, presence of the virus in platelets and selective autophagy response. The intraplatelet processing of Omicron viral cargo was different from Delta as evidenced by the distribution of spike protein-positive structures near the plasma membrane and the colocalization of spike and Rab7. Moreover, spike proteins from the Omicron or Delta variants alone activated signaling pathways in healthy platelets including phosphorylation of AKT, p38MAPK, LIMK and SPL76 with different kinetics. Discussion Although SARS-CoV-2 Omicron has different biological characteristics compared to prior variants, it leads to platelet activation and desensitization as previously observed with the Delta variant. Omicron is also found in platelets from severe patients where it induces selective autophagy, but the mechanisms of intraplatelet processing of Omicron cargo, as part of the innate response, differs from Delta, suggesting that mutations on spike protein modify virus to platelet interactions.
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Affiliation(s)
- Cédric Garcia
- Inserm UMR1297 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Laboratoire d’Hématologie, Toulouse, France
| | - Baptiste Compagnon
- Inserm UMR1297 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Pôle Anesthésie-Réanimation, Toulouse, France
| | - Agnès Ribes
- Inserm UMR1297 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Laboratoire d’Hématologie, Toulouse, France
| | - Sophie Voisin
- Inserm UMR1297 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Laboratoire d’Hématologie, Toulouse, France
| | - Fanny Vardon-Bounes
- Inserm UMR1297 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Pôle Anesthésie-Réanimation, Toulouse, France
| | - Bernard Payrastre
- Inserm UMR1297 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Laboratoire d’Hématologie, Toulouse, France
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Raymond V, Aïtout C, Ducos G, Coullomb A, Ferré F, Vardon-Bounes F, Riu-Poulenc B, Seguin T, Boukhatem L, Geeraerts T, Minville V, Fourcade O, Birmes P, Arbus C, Silva S, Salles J. Effectiveness of psychiatric support for PTSD among a cohort of relatives of patients hospitalized in an intensive care unit during the French COVID-19 lockdown-The OLAF (Opération Liaison et Aide aux Familles): A quasi-randomized clinical trial. Gen Hosp Psychiatry 2023; 84:266-267. [PMID: 37357092 PMCID: PMC10284447 DOI: 10.1016/j.genhosppsych.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/19/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Valentin Raymond
- Department of Psychiatry, Toulouse University Hospital, Toulouse, France
| | - Camille Aïtout
- Department of Anesthesiology, Critical Care Medicine and Perioperative Medicine, Toulouse University Hospital, Toulouse, France
| | - Guillaume Ducos
- Department of Anesthesiology, Critical Care Medicine and Perioperative Medicine, Toulouse University Hospital, Toulouse, France
| | - Alexis Coullomb
- Cancer Research Center of Toulouse, UMR 1037 INSERM, Université Paul Sabatier III, Toulouse, France
| | - Fabrice Ferré
- Department of Anesthesiology, Critical Care Medicine and Perioperative Medicine, Toulouse University Hospital, Toulouse, France
| | - Fanny Vardon-Bounes
- Department of Anesthesiology, Critical Care Medicine and Perioperative Medicine, Toulouse University Hospital, Toulouse, France
| | - Béatrice Riu-Poulenc
- Department of Anesthesiology, Critical Care Medicine and Perioperative Medicine, Toulouse University Hospital, Toulouse, France
| | - Thierry Seguin
- Department of Anesthesiology, Critical Care Medicine and Perioperative Medicine, Toulouse University Hospital, Toulouse, France
| | - Leïla Boukhatem
- Department of Anesthesiology, Critical Care Medicine and Perioperative Medicine, Toulouse University Hospital, Toulouse, France
| | - Thomas Geeraerts
- Department of Anesthesiology, Critical Care Medicine and Perioperative Medicine, Toulouse University Hospital, Toulouse, France; Tonic INSERM, Université Paul Sabatier III, Toulouse, France
| | - Vincent Minville
- Department of Anesthesiology, Critical Care Medicine and Perioperative Medicine, Toulouse University Hospital, Toulouse, France
| | - Olivier Fourcade
- Department of Anesthesiology, Critical Care Medicine and Perioperative Medicine, Toulouse University Hospital, Toulouse, France
| | - Philippe Birmes
- Department of Psychiatry, Toulouse University Hospital, Toulouse, France
| | - Christophe Arbus
- Department of Psychiatry, Toulouse University Hospital, Toulouse, France
| | - Stein Silva
- Department of Anesthesiology, Critical Care Medicine and Perioperative Medicine, Toulouse University Hospital, Toulouse, France; Tonic INSERM, Université Paul Sabatier III, Toulouse, France
| | - Juliette Salles
- Department of Psychiatry, Toulouse University Hospital, Toulouse, France; Infinity (Toulouse Institute for Infectious and Inflammatory Diseases), INSERM UMR1291, CNRS UMR5051, Université Toulouse III, Toulouse, France.
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Martin C, Minville V, Mayeur J, Conil JM, Vardon-Bounes F. Transforming waste management in intensive care units: a path towards environmental sustainability and resource optimization. Intensive Care Med 2023; 49:1136-1137. [PMID: 37439873 DOI: 10.1007/s00134-023-07091-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Charlotte Martin
- Critical Care Unit, Critical Care Department, Toulouse University Hospital, 1 Av du Pr J Poulhès, 31400, Toulouse, France
| | - Vincent Minville
- Critical Care Unit, Critical Care Department, Toulouse University Hospital, 1 Av du Pr J Poulhès, 31400, Toulouse, France
| | - Julie Mayeur
- Critical Care Unit, Critical Care Department, Toulouse University Hospital, 1 Av du Pr J Poulhès, 31400, Toulouse, France
| | - Jean-Marie Conil
- Critical Care Unit, Critical Care Department, Toulouse University Hospital, 1 Av du Pr J Poulhès, 31400, Toulouse, France
| | - Fanny Vardon-Bounes
- Critical Care Unit, Critical Care Department, Toulouse University Hospital, 1 Av du Pr J Poulhès, 31400, Toulouse, France.
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Ruiz S, Vardon-Bounes F, Virtos M, Seguin T, Crognier L, Rouget A, Georges B, Conil JM, Minville V. Influence of arterial blood gases on the renal arterial resistive index in intensive care unit. J Transl Med 2023; 21:541. [PMID: 37573336 PMCID: PMC10423423 DOI: 10.1186/s12967-023-04407-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: 05/15/2023] [Accepted: 07/31/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Renal artery Doppler sonography with resistive index (RI) determination is a noninvasive, fast, and reliable diagnostic tool increasingly used in the intensive care unit (ICU) to predict and assess the reversibility of acute kidney injury (AKI). However, interpreting the RI can be challenging due to numerous influencing factors. While some studies have explored various confounding factors, arterial blood gases have received limited attention. Therefore, our study aims to evaluate the impact of arterial blood gases on the RI in the ICU setting. METHODS This prospective observational study enrolled ICU patients who required blood gas analysis and had not experienced significant hemodynamic changes recently. The RI was measured using standardized Doppler ultrasound within an hour of the arterial blood gases sampling and analysis. RESULTS A total of sixty-four patients were included in the analysis. Univariate analysis revealed a correlation between the RI and several variables, including PaCO2 (R = 0.270, p = 0.03), age (R = 0.574, p < 0.0001), diastolic arterial pressure (DAP) (R = - 0.368, p = 0.0028), and SaO2 (R = - 0.284, p = 0.0231). Multivariate analysis confirmed that age > 58 years and PaCO2 were significant factors influencing the RI, with respective odds ratios of 18.67 (p = 0.0003) and 1.132 (p = 0.0267). CONCLUSION The interpretation of renal arterial RI should take into account thresholds for PaCO2, age, and diastolic arterial pressure. Further studies are needed to develop a comprehensive scoring system that incorporates all these cofactors for a reliable analysis of RI levels. Trial registration This observational study, registered under number 70-0914, received approval from local Ethical Committee of Toulouse University Hospital.
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Affiliation(s)
- Stéphanie Ruiz
- Department of Anesthesiology and Intensive Care, Rangueil University Hospital, University Hospital of Toulouse, University Paul Sabatier, Avenue Jean Poulhès, Toulouse, France
| | - Fanny Vardon-Bounes
- Department of Anesthesiology and Intensive Care, Rangueil University Hospital, University Hospital of Toulouse, University Paul Sabatier, Avenue Jean Poulhès, Toulouse, France
| | - Marie Virtos
- Department of Anesthesiology and Intensive Care, Rangueil University Hospital, University Hospital of Toulouse, University Paul Sabatier, Avenue Jean Poulhès, Toulouse, France
| | - Thierry Seguin
- Department of Anesthesiology and Intensive Care, Rangueil University Hospital, University Hospital of Toulouse, University Paul Sabatier, Avenue Jean Poulhès, Toulouse, France
| | - Laure Crognier
- Department of Anesthesiology and Intensive Care, Rangueil University Hospital, University Hospital of Toulouse, University Paul Sabatier, Avenue Jean Poulhès, Toulouse, France
| | - Antoine Rouget
- Department of Anesthesiology and Intensive Care, Rangueil University Hospital, University Hospital of Toulouse, University Paul Sabatier, Avenue Jean Poulhès, Toulouse, France
| | - Bernard Georges
- Department of Anesthesiology and Intensive Care, Rangueil University Hospital, University Hospital of Toulouse, University Paul Sabatier, Avenue Jean Poulhès, Toulouse, France
| | - Jean-Marie Conil
- Department of Anesthesiology and Intensive Care, Rangueil University Hospital, University Hospital of Toulouse, University Paul Sabatier, Avenue Jean Poulhès, Toulouse, France
| | - Vincent Minville
- Department of Anesthesiology and Intensive Care, Rangueil University Hospital, University Hospital of Toulouse, University Paul Sabatier, Avenue Jean Poulhès, Toulouse, France
- RESTORE, UMR 1301, Inserm CNRS-Université Paul Sabatier, Université de Toulouse, 5070 Toulouse, France
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9
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Bourdiol A, Legros V, Vardon-Bounes F, Rimmele T, Abraham P, Hoffmann C, Dahyot-Fizelier C, Jonas M, Bouju P, Cirenei C, Launey Y, Le Gac G, Boubeche S, Lamarche E, Huet O, Bezu L, Darrieussecq J, Szczot M, Delbove A, Schmitt J, Lasocki S, Auchabie J, Petit L, Kuhn-Bougouin E, Asehnoune K, Ingles H, Roquilly A, Cinotti R. Prevalence and risk factors of significant persistent pain symptoms after critical care illness: a prospective multicentric study. Crit Care 2023; 27:199. [PMID: 37226261 DOI: 10.1186/s13054-023-04491-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Prevalence, risk factors and medical management of persistent pain symptoms after critical care illness have not been thoroughly investigated. METHODS We performed a prospective multicentric study in patients with an intensive care unit (ICU) length of stay ≥ 48 h. The primary outcome was the prevalence of significant persistent pain, defined as a numeric rating scale (NRS) ≥ 3, 3 months after admission. Secondary outcomes were the prevalence of symptoms compatible with neuropathic pain (ID-pain score > 3) and the risk factors of persistent pain. RESULTS Eight hundred fourteen patients were included over a 10-month period in 26 centers. Patients had a mean age of 57 (± 17) years with a SAPS 2 score of 32 (± 16) (mean ± SD). The median ICU length of stay was 6 [4-12] days (median [interquartile]). At 3 months, the median intensity of pain symptoms was 2 [1-5] in the entire population, and 388 (47.7%) patients had significant pain. In this group, 34 (8.7%) patients had symptoms compatible with neuropathic pain. Female (Odds Ratio 1.5 95% CI [1.1-2.1]), prior use of anti-depressive agents (OR 2.2 95% CI [1.3-4]), prone positioning (OR 3 95% CI [1.4-6.4]) and the presence of pain symptoms on ICU discharge (NRS ≥ 3) (OR 2.4 95% CI [1.7-3.4]) were risk factors of persistent pain. Compared with sepsis, patients admitted for trauma (non neuro) (OR 3.5 95% CI [2.1-6]) were particularly at risk of persistent pain. Only 35 (11.3%) patients had specialist pain management by 3 months. CONCLUSIONS Persistent pain symptoms were frequent in critical illness survivors and specialized management remained infrequent. Innovative approaches must be developed in the ICU to minimize the consequences of pain. TRIAL REGISTRATION NCT04817696. Registered March 26, 2021.
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Affiliation(s)
- Alexandre Bourdiol
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Vincent Legros
- Service d'Anesthésie-Réanimation, Hôpital Maison Blanche, CHU de Reims, 51100, Reims, France
| | - Fanny Vardon-Bounes
- Service d'Anesthésie-Réanimation, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Thomas Rimmele
- Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- EA7426 Pathophysiology of Injury-Induced Immunosuppression (Pi3), Hospices Civils de Lyon-Biomérieux-Université Claude Bernard Lyon 1, Lyon, France
| | - Paul Abraham
- Service de médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Clément Hoffmann
- Burn Center, Percy Military Training Hospital, 101, Avenue Henri Barbusse - BP 406, 92141, Clamart, France
| | - Claire Dahyot-Fizelier
- Intensive Care and Anesthesia Department, University Hospital of Poitiers, University of Poitiers, Poitiers, France
- INSERM U1770, University of Poitiers, Poitiers, France
| | - Maud Jonas
- Service de Réanimation, Hôpital de Saint-Nazaire, Saint-Nazaire, France
| | - Pierre Bouju
- Service de Réanimation Polyvalente, Centre Hospitalier de Bretagne Sud, Lorient, France
| | - Cédric Cirenei
- Hôpital Claude Huriez, Pôle Anesthésie-Réanimation, médecine périopératoire et douleur, CHU Lille, 59000, Lille, France
| | - Yoann Launey
- Department of Anaesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France
| | - Gregoire Le Gac
- Department of Anaesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France
- UMR_S 1242, Chemistry Oncogenesis Stress Signaling, University of Rennes, 35000, Rennes, France
| | - Samia Boubeche
- Service d'Anesthésie-Réanimation, CHU de Rouen, Rouen, France
| | - Edouard Lamarche
- Department of Anaesthesia and Critical Care, University Hospital of Tours, 37000, Tours, France
| | - Olivier Huet
- Department of Anaesthesia and Critical Care, University Hospital of Brest, 29000, Brest, France
| | - Lucillia Bezu
- Service de Réanimation Polyvalente, Gustave Roussy, 94805, Villejuif, France
- Metabolomics and Cell Biology Platforms, Université Paris Saclay, Université de Paris, Sorbonne Université, Inserm UMR1138, Villejuif, France
| | - Julie Darrieussecq
- CH Aubagne, Pôle CARK, Service d'Anesthésie-Réanimation chirurgicale, Edmond Garcin, 179 Av. des soeurs Gastine, 13400, Aubagne, France
| | - Magdalena Szczot
- Service d'Anesthésie-Réanimation, Hôpital Hautepierre, CHU Strasbourg, Strasbourg, France
| | - Agathe Delbove
- Service de Réanimation Polyvalente, CHBA Vannes, Vannes, France
| | - Johan Schmitt
- Hôpital d'Instruction des Armées Clermont Tonnerre, Rue Colonel Fonferrier, 29240, Brest, France
| | - Sigismond Lasocki
- Department of Anaesthesia and Critical Care, University Hospital of Tours, 49100, Angers, France
| | - Johann Auchabie
- Service de Réanimation, centre hospitalier de Cholet, Cholet, France
| | - Ludivine Petit
- CHU Saint-Etienne, Service d'Anesthésie-Réanimation, Saint-Étienne, France
| | - Emmanuelle Kuhn-Bougouin
- Centre d'Etude et de Traitement de la Douleur, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Karim Asehnoune
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Hugo Ingles
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Antoine Roquilly
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
- UMR 1064, Center for Research in Transplantation and Translational Immunology, INSERM, Nantes Université, 44000, Nantes, France
| | - Raphaël Cinotti
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France.
- MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, INSERM, Nantes Université, Univ Tours, CHU Nantes, CHU Tours, 44000, Nantes, France.
- Department of Anesthesia and Critical Care, Hôtel-Dieu, University Hospital of Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
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Roquet F, Godier A, Garrigue-Huet D, Hanouz JL, Vardon-Bounes F, Legros V, Pirracchio R, Ausset S, Duranteau J, Vigué B, Hamada SR. Comprehensive analysis of coagulation factor delivery strategies in a cohort of trauma patients. Anaesth Crit Care Pain Med 2023; 42:101180. [PMID: 36460214 DOI: 10.1016/j.accpm.2022.101180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/18/2022] [Accepted: 11/01/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The 5th edition of The European recommendations for the management of major bleeding and coagulopathy following trauma leaves room for various coagulation factor administration strategies. The present study examines these strategies reporting prevalence and timing of administration, quantity dispensed, and transfusion ratios in French trauma centers and their compliance with recommendations alongside associated mortality data. METHODS All adult patients, admitted directly to participating centers between 2011 and 2019, were extracted from a trauma registry. Two subpopulations were studied: severe hemorrhage (SH) and massive transfusion (MT) groups. RESULTS A total of 19,396 patients were included, among whom 8.4% (1630) experienced SH and 3% (579) received MT. Within the first 24 hours, 10% received fresh frozen plasma (FFP), rising to 93% and 99% in the subgroups of patients experiencing SH and MT respectively. Only, 8% received fibrinogen concentrate (FC), increasing to 75% and 92% in subgroups SH and MT respectively. Co-administration of FFP and FC became the dominant strategy with 68% of patients at 6 h and 72% at 24 h in SH subgroup. In unadjusted data, mortality was systematically lower in groups that complied with recommendations, a lower mortality than expected was mostly observed in contrast to non-compliant subgroups. The per-patient compliance to studied recommendations was 21% and 22% in SH and MT subgroups. CONCLUSION The main hemostatic strategy for major bleeding combined the administration of both FFP and FC, favoring an early additional supply of fibrinogen. Compliance with the recommendations was low in SH and MT subgroups.
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Affiliation(s)
- Florian Roquet
- Département d'Anesthésie Réanimation, Assistance Publique-Hôpitaux de Paris, HEGP, Université de Paris, Paris, France; INSERM UMR 1153, Université de Paris, Paris, France.
| | - Anne Godier
- Département d'Anesthésie Réanimation, Assistance Publique-Hôpitaux de Paris, HEGP, Université de Paris, Paris, France; INSERM UMRS-1140, Université de Paris, Paris, France
| | | | - Jean-Luc Hanouz
- CHU de Caen, Département d'Anesthésie Réanimation, Caen, France
| | | | - Vincent Legros
- CHU de Reims, Département d'Anesthésie Réanimation, Reims, France
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | | | - Jacques Duranteau
- Département d'Anesthésie Réanimation, CHU de Bicêtre, Le Kremlin Bicêtre, France
| | - Bernard Vigué
- Centre d'Étude et de Santé des Populations INSERM U 10-18, Université Paris-Saclay, Paris, France
| | - Sophie Rym Hamada
- Département d'Anesthésie Réanimation, Assistance Publique-Hôpitaux de Paris, HEGP, Université de Paris, Paris, France; Centre d'Étude et de Santé des Populations INSERM U 10-18, Université Paris-Saclay, Paris, France
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Caillard A, Vardon-Bounes F, Rozencwajg S. Fiche flash recommandation : pancréatite aiguë grave du patient adulte en soins critiques. Anesthésie & Réanimation 2022. [DOI: 10.1016/j.anrea.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Sarton B, Grare M, Vardon-Bounes F, Gaubert A, Silva S, Crognier L, Riu B, Seguin T, Georges B, Minville V, Ruiz S. Co-Infection and Ventilator-Associated Pneumonia in Critically Ill COVID-19 Patients Requiring Mechanical Ventilation: A Retrospective Cohort Study. Biomedicines 2022; 10:biomedicines10081952. [PMID: 36009500 PMCID: PMC9405710 DOI: 10.3390/biomedicines10081952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 12/12/2022] Open
Abstract
Considering virus-related and drug-induced immunocompromised status of critically ill COVID-19 patients, we hypothesize that these patients would more frequently develop ventilator-associated pneumonia (VAP) than patients with ARDS from other viral causes. We conducted a retrospective observational study in two intensive care units (ICUs) from France, between 2017 and 2020. We compared bacterial co-infection at ICU admission and throughout the disease course of two retrospective longitudinally sampled groups of critically ill patients, who were admitted to ICU for either H1N1 or SARS-CoV-2 respiratory infection and depicted moderate-to-severe ARDS criteria upon admission. Sixty patients in the H1N1 group and 65 in the COVID-19 group were included in the study. Bacterial co-infection at the endotracheal intubation time was diagnosed in 33% of H1N1 and 16% COVID-19 patients (p = 0.08). The VAP incidence per 100 days of mechanical ventilation was 3.4 (2.2−5.2) in the H1N1 group and 7.2 (5.3−9.6) in the COVID-19 group (p < 0.004). The HR to develop VAP was of 2.33 (1.34−4.04) higher in the COVID-19 group (p = 0.002). Ten percent of H1N1 patients and 30% of the COVID-19 patients had a second episode of VAP (p = 0.013). COVID-19 patients have fewer bacterial co-infections upon admission, but the incidence of secondary infections increased faster in this group compared to H1N1 patients.
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Affiliation(s)
- Benjamine Sarton
- Réanimation Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France
| | - Marion Grare
- Plateau Technique Infectiologie, Laboratoire de Bactériologie-Hygiène, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France
- INSERM-INRA-ENVT-UPS: UMR1220, Institut de Recherche en Santé Digestive (IRSD), 31059 Toulouse, France
| | - Fanny Vardon-Bounes
- Réanimation Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France
| | - Anna Gaubert
- Réanimation Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France
| | - Stein Silva
- Réanimation Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France
| | - Laure Crognier
- Réanimation Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France
| | - Béatrice Riu
- Réanimation Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France
| | - Thierry Seguin
- Réanimation Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France
| | - Bernard Georges
- Réanimation Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France
| | - Vincent Minville
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France
| | - Stéphanie Ruiz
- Réanimation Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France
- Correspondence:
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Caillard A, Vardon-Bounes F, Rozencwajg S. Management of patients with severe acute pancreatitis. Anaesth Crit Care Pain Med 2022; 41:101123. [PMID: 35803576 DOI: 10.1016/j.accpm.2022.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Anaïs Caillard
- Centre Hospitalier Universitaire La Cavale Blanche Université de Bretagne Ouest, Anaesthesiology, Critical care and Perioperative medicine Department, Brest, France.
| | - Fanny Vardon-Bounes
- University Hospital of Toulouse, Anaesthesia, Critical Care & Perioperative Medicine, Toulouse, France; University of Toulouse III, INSERM U1297, Institute of Cardiovascular and Metabolic Diseases, Toulouse, France
| | - Sacha Rozencwajg
- Department of Anaesthesiology and Surgical Intensive Care, Bichat Claude-Bernard Hospital, AP-HP, DMU PARABOL, France
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Garcia C, Compagnon B, Poëtte M, Gratacap MP, Lapébie FX, Voisin S, Minville V, Payrastre B, Vardon-Bounes F, Ribes A. Platelet Versus Megakaryocyte: Who Is the Real Bandleader of Thromboinflammation in Sepsis? Cells 2022; 11:1507. [PMID: 35563812 PMCID: PMC9104300 DOI: 10.3390/cells11091507] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
Platelets are mainly known for their key role in hemostasis and thrombosis. However, studies over the last two decades have shown their strong implication in mechanisms associated with inflammation, thrombosis, and the immune system in various neoplastic, inflammatory, autoimmune, and infectious diseases. During sepsis, platelets amplify the recruitment and activation of innate immune cells at the site of infection and contribute to the elimination of pathogens. In certain conditions, these mechanisms can lead to thromboinflammation resulting in severe organ dysfunction. Here, we discuss the interactions of platelets with leukocytes, neutrophil extracellular traps (NETs), and endothelial cells during sepsis. The intrinsic properties of platelets that generate an inflammatory signal through the NOD-like receptor family, pyrin domain-containing 3 (NLRP3) inflammasome are discussed. As an example of immunothrombosis, the implication of platelets in vaccine-induced immune thrombotic thrombocytopenia is documented. Finally, we discuss the role of megakaryocytes (MKs) in thromboinflammation and their adaptive responses.
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Affiliation(s)
- Cédric Garcia
- Laboratoire d’Hématologie, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France; (C.G.); (S.V.); (B.P.)
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm UMR1297 and Université Toulouse 3, 31024 Toulouse, France; (B.C.); (M.P.); (M.-P.G.); (F.V.-B.)
| | - Baptiste Compagnon
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm UMR1297 and Université Toulouse 3, 31024 Toulouse, France; (B.C.); (M.P.); (M.-P.G.); (F.V.-B.)
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France;
| | - Michaël Poëtte
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm UMR1297 and Université Toulouse 3, 31024 Toulouse, France; (B.C.); (M.P.); (M.-P.G.); (F.V.-B.)
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France;
| | - Marie-Pierre Gratacap
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm UMR1297 and Université Toulouse 3, 31024 Toulouse, France; (B.C.); (M.P.); (M.-P.G.); (F.V.-B.)
| | - François-Xavier Lapébie
- Service de Médecine Vasculaire, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France;
| | - Sophie Voisin
- Laboratoire d’Hématologie, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France; (C.G.); (S.V.); (B.P.)
| | - Vincent Minville
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France;
| | - Bernard Payrastre
- Laboratoire d’Hématologie, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France; (C.G.); (S.V.); (B.P.)
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm UMR1297 and Université Toulouse 3, 31024 Toulouse, France; (B.C.); (M.P.); (M.-P.G.); (F.V.-B.)
| | - Fanny Vardon-Bounes
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm UMR1297 and Université Toulouse 3, 31024 Toulouse, France; (B.C.); (M.P.); (M.-P.G.); (F.V.-B.)
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France;
| | - Agnès Ribes
- Laboratoire d’Hématologie, Centre Hospitalier Universitaire de Toulouse, 31059 Toulouse, France; (C.G.); (S.V.); (B.P.)
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm UMR1297 and Université Toulouse 3, 31024 Toulouse, France; (B.C.); (M.P.); (M.-P.G.); (F.V.-B.)
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15
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Delamarre L, Couarraze S, Vardon-Bounes F, Marhar F, Fernandes M, Legendre M, Houze-Cerfon CH, Rigal R, Pizzuto R, Mathe O, Larcher C, Ruiz J, Ferré F, Riu B, Seguin T, Osinski D, Silva S, Malavaud S, Georges B, Minville V, Fourcade O, Geeraerts T. Mass Training In Situ During COVID-19 Pandemic: Enhancing Efficiency and Minimizing Sick Leaves. Simul Healthc 2022; 17:42-48. [PMID: 35104829 PMCID: PMC8808751 DOI: 10.1097/sih.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Avoiding coronavirus disease 2019 (COVID-19) work-related infection in frontline healthcare workers is a major challenge. A massive training program was launched in our university hospital for anesthesia/intensive care unit and operating room staff, aiming at upskilling 2249 healthcare workers for COVID-19 patients' management. We hypothesized that such a massive training was feasible in a 2-week time frame and efficient in avoiding sick leaves. METHODS We performed a retrospective observational study. Training focused on personal protective equipment donning/doffing and airway management in a COVID-19 simulated patient. The educational models used were in situ procedural and immersive simulation, peer-teaching, and rapid cycle deliberate practice. Self-learning organization principles were used for trainers' management. Ordinary disease quantity in full-time equivalent in March and April 2020 were compared with the same period in 2017, 2018, and 2019. RESULTS A total of 1668 healthcare workers were trained (74.2% of the target population) in 99 training sessions over 11 days. The median number of learners per session was 16 (interquartile range = 9-25). In the first 5 days, the median number of people trained per weekday was 311 (interquartile range = 124-385). Sick leaves did not increase in March to April 2020 compared with the same period in the 3 preceding years. CONCLUSIONS Massive training for COVID-19 patient management in frontline healthcare workers is feasible in a very short time and efficient in limiting the rate of sick leave. This experience could be used in the anticipation of new COVID-19 waves or for rapidly preparing hospital staff for an unexpected major health crisis.
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Vardon-Bounes F, Garcia C, Piton A, Series J, Gratacap MP, Poëtte M, Seguin T, Crognier L, Ruiz S, Silva S, Conil JM, Minville V, Payrastre B. Evolution of Platelet Activation Parameters During Septic Shock in Intensive Care Unit. Platelets 2021; 33:918-925. [PMID: 34915822 DOI: 10.1080/09537104.2021.2007873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
During severe sepsis, platelet activation may induce disseminate microvascular thrombosis, which play a key role in critical organ failure. Crucially, most of the studies in this field have explored platelet-leukocyte interactions in animal models, or explored platelets under the spectrum of thrombocytopenia or disseminated intravascular coagulation and have not taken into account the complex interplay that might exist between platelets and leukocytes during human septic shock nor the kinetics of platelet activation. Here, we assessed platelet activation parameters at the admission of patients with sepsis to the intensive care unit (ICU) and 48 hours later. Twenty-two patients were enrolled in the study, thirteen (59.1%) of whom were thrombocytopenic. The control group was composed of twelve infection-free patients admitted during the study period. The activation parameters studied included platelet-leukocyte interactions, assessed by flow cytometry in whole blood, as well as membrane surface and soluble platelet activation markers measured by flow cytometry and dedicated ELISA kits. We also investigated platelet aggregation and secretion responses of patients with sepsis following stimulation, compared to controls. At admission, the level of circulating monocyte-platelet and neutrophil-platelet heterotypic aggregates was significantly higher in sepsis patients compared to controls and returned to a level comparable to controls or even below 48 hours later. Basal levels of CD62P and CD63 platelet membrane exposure at admission and 48 hours later were low and similar to controls. In contrast, plasma level of soluble GPVI and soluble CD40 ligand was significantly increased in septic patients, at the two times of analysis, reflecting previous platelet activation. Platelet aggregation and secretion responses induced by specific agonists were significantly decreased in septic conditions, particularly 48 hours after admission. Hence, we have observed for the first time that critically ill septic patients compared to controls have both an early and durable platelet activation while their circulating platelets are less responsive to different agonists.
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Affiliation(s)
- Fanny Vardon-Bounes
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1297, Institut des Maladies Métaboliques et Cardiovasculaires, Université Paul Sabatier Toulouse 3, Toulouse, France
| | - Cédric Garcia
- INSERM UMR 1297, Institut des Maladies Métaboliques et Cardiovasculaires, Université Paul Sabatier Toulouse 3, Toulouse, France.,Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Alexandra Piton
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1297, Institut des Maladies Métaboliques et Cardiovasculaires, Université Paul Sabatier Toulouse 3, Toulouse, France
| | - Jennifer Series
- INSERM UMR 1297, Institut des Maladies Métaboliques et Cardiovasculaires, Université Paul Sabatier Toulouse 3, Toulouse, France.,Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Marie-Pierre Gratacap
- INSERM UMR 1297, Institut des Maladies Métaboliques et Cardiovasculaires, Université Paul Sabatier Toulouse 3, Toulouse, France.,Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Michaël Poëtte
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1297, Institut des Maladies Métaboliques et Cardiovasculaires, Université Paul Sabatier Toulouse 3, Toulouse, France
| | - Thierry Seguin
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Laure Crognier
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Stéphanie Ruiz
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Stein Silva
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1214, ToNIC: Toulouse NeuroImaging Center, Toulouse, France
| | - Jean-Marie Conil
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Vincent Minville
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1297, Institut des Maladies Métaboliques et Cardiovasculaires, Université Paul Sabatier Toulouse 3, Toulouse, France
| | - Bernard Payrastre
- INSERM UMR 1297, Institut des Maladies Métaboliques et Cardiovasculaires, Université Paul Sabatier Toulouse 3, Toulouse, France.,Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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17
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Rouget A, Vardon-Bounes F, Lorber P, Vavasseur A, Marion O, Marcheix B, Lairez O, Balardy L, Fourcade O, Conil JM, Minville V. Prevalence of malnutrition in coronavirus disease 19: the NUTRICOV study. Br J Nutr 2021; 126:1296-1303. [PMID: 33342449 PMCID: PMC7853739 DOI: 10.1017/s0007114520005127] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/16/2020] [Accepted: 12/09/2020] [Indexed: 01/08/2023]
Abstract
Recent European Society of Parenteral and Enteral Nutrition guidelines highlighted the interest of prevention, diagnosis and treatment of malnutrition in the management of coronavirus disease 19 (COVID-19) patients. The aim of our study was to evaluate the prevalence of malnutrition in patients hospitalised for COVID-19. In a prospective observational cohort study malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) two-step approach. Patients were divided into two groups according to the diagnosis of malnutrition. Covariate selection for the multivariate analysis was based on P <0·2 in univariate analysis, with a logistic regression model and a backward elimination procedure. A partitioning of the population was realised. Eighty patients were prospectively enrolled. Thirty patients (37·5 %) had criteria for malnutrition. The need for intensive care unit admission (n 46, 57·5 %) was similar in the two groups. Three patients who died (3·75 %) were malnourished. Multivariate analysis exhibited that low BMI (OR 0·83, 95 % CI 0·73, 0·96, P = 0·0083), dyslipidaemia (OR 29·45, 95 % CI 3·12, 277·73, P = 0·0031), oral intake reduction <50 % (OR 3·169, 95 % CI 1·04, 9·64, P = 0·0422) and glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration; CKD-EPI) at admission (OR 0·979, 95 % CI 0·96, 0·998, P = 0·0297) were associated with the occurrence of malnutrition. We demonstrate the existence of a high prevalence of malnutrition in a general cohort of COVID-19 inpatients according to GLIM criteria. Nutritional support in COVID-19 care seems an essential element.
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Affiliation(s)
- Antoine Rouget
- Department of Anesthesiology and Critical Care Unit, CHU Toulouse Rangueil, 1 av du Pr Jean Poulhès, 31400Toulouse, France
| | - Fanny Vardon-Bounes
- Department of Anesthesiology and Critical Care Unit, CHU Toulouse Rangueil, 1 av du Pr Jean Poulhès, 31400Toulouse, France
- INSERM UMR 1048, Institut des maladies métaboliques et cardiovasculaires, CHU Toulouse, 1 av du Pr Jean Poulhès, 31400Toulouse, France
| | - Pierre Lorber
- Department of Anesthesiology and Critical Care Unit, CHU Toulouse Rangueil, 1 av du Pr Jean Poulhès, 31400Toulouse, France
| | - Adrien Vavasseur
- Department of Radiology, CHU Toulouse Rangueil, 1 av du Pr J Poulhès, 31400Toulouse, France
| | - Olivier Marion
- Department of Nephrology and Organ Transplant, CHU Toulouse Rangueil, 1 av du Pr Jean Poulhès, 31400Toulouse, France
| | - Bertrand Marcheix
- Department of Cardiac Surgery, CHU Toulouse Rangueil, 1 av du Pr Jean Poulhès, 31400Toulouse, France
| | - Olivier Lairez
- INSERM UMR 1048, Institut des maladies métaboliques et cardiovasculaires, CHU Toulouse, 1 av du Pr Jean Poulhès, 31400Toulouse, France
- Department of Cardiology, CHU Toulouse Rangueil, 1 av du Pr Jean Poulhès, 31400Toulouse, France
| | - Laurent Balardy
- Department of Geriatric Medicine, CHU Toulouse Purpan, Place du Dr Baylac, 31000Toulouse, France
| | - Olivier Fourcade
- Department of Anesthesiology and Critical Care Unit, CHU Toulouse Rangueil, 1 av du Pr Jean Poulhès, 31400Toulouse, France
| | - Jean-Marie Conil
- Department of Anesthesiology and Critical Care Unit, CHU Toulouse Rangueil, 1 av du Pr Jean Poulhès, 31400Toulouse, France
| | - Vincent Minville
- Department of Anesthesiology and Critical Care Unit, CHU Toulouse Rangueil, 1 av du Pr Jean Poulhès, 31400Toulouse, France
- INSERM UMR 1048, Institut des maladies métaboliques et cardiovasculaires, CHU Toulouse, 1 av du Pr Jean Poulhès, 31400Toulouse, France
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Houzé-Cerfon CH, Boet S, Saint-Jean M, Cros J, Vardon-Bounes F, Marhar F, Couarraze S, Der Sahakian G, Mattatia L, Nicolle L, Balen F, Charpentier S, Bounes V, Geeraerts T. Effect of combined individual-collective debriefing of participants in interprofessional simulation courses on crisis resource management: a randomized controlled multicenter trial. Emergencias 2021; 32:111-117. [PMID: 32125110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Interprofessional simulation (IPS) training is an effective way to learn crisis resource management. The type of debriefing used in IPS training may affect participants' performance and their level of psychological safety. We aimed to assess and compare performance after standard collective debriefing versus a combination of individual and collective debriefing ("combined" approach). MATERIAL AND METHODS Randomized, controlled multicenter trial. IPS sessions were randomized to have either standard or combined debriefing. Each team's performance in the IPS session was assessed with the Team Emergency Assessment Measure. The participants assessed the debriefing quality with the Debriefing Assessment for Simulation in Healthcare. RESULTS Forty IPS sessions were randomized, and 30 were analyzed, 15 using standard collective debriefing and 15 the combined individual-collective method. Teams' performance improved with both types of debriefing, based on pre-post testing (P<.01), and there were no significant differences in overall performance scores between the 2 types of debriefing (P=.64). However, the combined approach was associated with higher scores for leadership skills (P<.05) and psychological safety, and the participants' learning experience was better (P<.05). CONCLUSION During IPS courses on crisis resource management, debriefing improves participants' performance, but similar overall results can be obtained with both debriefing methods. Combined debriefing might be more effective for improving participants' leadership skills and psychological safety and also provide a better learning experience.
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Affiliation(s)
- Charles H Houzé-Cerfon
- Toulouse Institute of Simulation Healthcare, University Hospital Toulouse, Toulouse, Francia. Emergency Department, University Hospital of Toulouse, Toulouse, Francia. University of Toulouse 2 Jean Jaurès, UMR EFTS, Toulouse, Francia
| | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital and Department of innovation and Medical Education, Ottawa University, Ontario, Ottawa. Canadá
| | | | - Jérome Cros
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Limoges, Limoges, Francia
| | - Fanny Vardon-Bounes
- Department of Anesthesiology and Intensive Care Medicine, Toulouse University Hospital, Toulouse, Francia
| | - Fouad Marhar
- Department of Anesthesiology and Intensive Care Medicine, Toulouse University Hospital, Toulouse, Francia
| | - Sébastien Couarraze
- University of Toulouse 2 Jean Jaurès, UMR EFTS, Toulouse, Francia. Department of Anesthesiology and Intensive Care Medicine, Toulouse University Hospital, Toulouse, Francia
| | - Guillaume Der Sahakian
- Medical Simulation Center CESIM84, Orange, Francia. Paris Descartes University, Paris, Francia
| | - Laurent Mattatia
- Nîmes simulation center SimHU, Department of anesthesiology, Nîmes University Hospital, Nîmes, Francia
| | - Laurent Nicolle
- Emergency Department, University Hospital of Toulouse, Toulouse, Francia. University Toulouse III Paul Sabatier, Toulouse, Francia
| | - Frederic Balen
- Emergency Department, University Hospital of Toulouse, Toulouse, Francia. University Toulouse III Paul Sabatier, Toulouse, Francia
| | | | - Vicent Bounes
- Toulouse Institute of Simulation Healthcare, University Hospital Toulouse, Toulouse, Francia. Department of Anesthesiology and Intensive Care Medicine, Toulouse University Hospital, Toulouse, Francia. University Toulouse III Paul Sabatier, Toulouse, Francia
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19
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Lairez O, Blanchard V, Balardy L, Vardon-Bounes F, Cazalbou S, Ruiz S, Collot S, Houard V, Rolland Y, Conil JM, Minville V. Cardiac Imaging Phenotype in Patients with Coronavirus Disease 2019 - COCARDE study: prospective observational study. JMIR Res Protoc 2021; 11:e24931. [PMID: 34751159 PMCID: PMC8734604 DOI: 10.2196/24931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 01/08/2023] Open
Abstract
Background The effects of SARS-CoV-2 (COVID-19) on the myocardium and their role in the clinical course of infected patients are still unknown. The severity of SARS-CoV-2 is driven by hyperinflammation, and the effects of SARS-CoV-2 on the myocardium may be significant. This study proposes to use bedside observations and biomarkers to characterize the association of COVID-19 with myocardial injury. Objective The aim of the study is to describe the myocardial function and its evolution over time in patients infected with SARS-CoV-2 and to investigate the link between inflammation and cardiac injury. Methods This prospective, monocentric, observational study enrolled 150 patients with suspected or confirmed SARS-CoV-2 infection at Toulouse University Hospital, Toulouse, France. Patients admitted to the intensive care unit (ICU), regular cardiologic ward, and geriatric ward of our tertiary university hospital were included during the pandemic period. Blood sampling, electrocardiography, echocardiography, and morphometric and demographic data were prospectively collected. Results A total of 100 patients were included. The final enrolment day was March 31, 2020, with first report of results at the end of the first quarter of 2021. The first echocardiographic results at admission of 31 patients of the COCARDE-ICU substudy population show that biological myocardial injury in COVID-19 has low functional impact on left ventricular systolic function. Conclusions A better understanding of the effects of COVID-19 on myocardial function and its link with inflammation would improve patient follow-up and care. Trial Registration Clinicaltrials.gov NCT04358952; https://clinicaltrials.gov/ct2/show/NCT04358952 International Registered Report Identifier (IRRID) DERR1-10.2196/24931
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Affiliation(s)
- Olivier Lairez
- Department of cardiology, Rangueil University Hospital, 1 avenue Jean Poulhès, Toulouse, FR
| | | | - Laurent Balardy
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital, Toulouse, FR
| | - Fanny Vardon-Bounes
- Department of Anesthesiology and Intensive care, Toulouse University Hospital, Toulouse, FR
| | | | - Stéphanie Ruiz
- Department of Anesthesiology and Intensive care, Toulouse University Hospital, Toulouse, FR
| | - Samia Collot
- Department of Radiology, Rangueil University Hospital, Toulouse, FR
| | - Valérie Houard
- Department of cardiology, Rangueil University Hospital, Toulouse, FR
| | - Yves Rolland
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital, Toulouse, FR
| | - Jean-Marie Conil
- Department of Anesthesiology and Intensive care, Toulouse University Hospital, Toulouse, FR
| | - Vincent Minville
- Department of Anesthesiology and Intensive care, Toulouse University Hospital, Toulouse, FR
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20
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Descamps C, Hamada S, Hanouz JL, Vardon-Bounes F, James A, Garrigue D, Abback P, Cardinale M, Dubreuil G, Chatelon J, Cook F, Neuschwander A, de Garambé N, Ausset S, Boutonnet M. Gunshot and stab wounds in France: descriptive study from a national trauma registry. Eur J Trauma Emerg Surg 2021; 48:3821-3829. [PMID: 34232339 DOI: 10.1007/s00068-021-01742-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Severe trauma is a major problem worldwide. In France, blunt trauma (BT) is predominant and few studies are available on penetrating trauma (PT). The purpose of this study was to perform a descriptive analysis of severe gunshot (GSW) and stab wounds (SW) in patients who were treated in French trauma centers. METHODS Retrospective study on prospectively collected data in a national trauma registry. All adult (> 15 years) trauma patients primarily admitted in 1 of the 17 trauma centers members of the Traumabase between January 2015 to December 2018 were included. Data from patients who had a PT were compared with those who had suffered a BT over the same period. Due to the known differences between GSW and SW, sub-group analyses on data from GSW, SW and BT were also performed. RESULTS 8128 patients were included. Twelve percent of the study group had a PT. The main mechanism of PT was SW (68.1%). Five hundred and eighty patients with PT (59.4%) required surgery within the first 24 h. Severe hemorrhage was more frequent in penetrating traumas (11.2% vs. 7.8% p < 0.001). Hospital mortality following PT was 8.9% vs 11% for blunt trauma (p = 0.047). Among PT the mortality after GSW was ten times higher than after SW (23.8% vs 2%). CONCLUSION This work is the largest study to date that has specifically focused on GSW and SW in France, and will help improving knowledge in managing such patients in our country.
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Affiliation(s)
- Chloé Descamps
- Anesthesiology and Intensive Care Unit, Percy Military Teaching Hospital, Clamart, France
| | - Sophie Hamada
- Department of Anaesthesiology and Critical Care, Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, 25, rue Leblanc, 75015, Paris, France.,CESP, INSERM, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Maison de Solenn, 97, boulevard de Port-Royal, 75014, Paris, France
| | - Jean-Luc Hanouz
- Department of Anesthesiology and Intensive Care Medicine, Caen University Hospital, and Normandie Univ, UNICAEN, Caen, France
| | - Fanny Vardon-Bounes
- Department of Anesthesiology and Critical Care, Toulouse University Hospital, Toulouse, France
| | - Arthur James
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, 75013, Paris, France
| | - Delphine Garrigue
- Department of Anesthesiology and Critical Care, Centre Hospitalier Universitaire de Lille, 59000, Lille, France
| | - Paer Abback
- Department of Anaesthesiology and Intensive Care, DMU PARABOL, AP-HP.Nord, Beaujon Hospital, University of Paris, Clichy, France
| | - Mickaël Cardinale
- Anesthesiology and Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Guillaume Dubreuil
- Department of Anesthesia and Critical Care, AP-HP, Bicêtre Hospital, Paris, France
| | - Jeanne Chatelon
- Anesthesiology and Intensive Care Unit. Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Fabrice Cook
- Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris-Est Créteil University, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Arthur Neuschwander
- Department of Anaesthesiology and Critical Care, Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, 25, rue Leblanc, 75015, Paris, France
| | - Nathalie de Garambé
- Anesthesiology and Intensive Care Unit, Percy Military Teaching Hospital, Clamart, France
| | - Sylvain Ausset
- French Military Health Service Schools, Lyon-Bron, France
| | - Mathieu Boutonnet
- Anesthesiology and Intensive Care Unit, Percy Military Teaching Hospital, Clamart, France. .,Val-de-Grâce Military Health Academy, Paris, France.
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Puel F, Minville V, Vardon-Bounes F. What place for virtual reality in the intensive care unit during medical procedures? J Intensive Care 2021; 9:30. [PMID: 33771220 PMCID: PMC8004406 DOI: 10.1186/s40560-021-00545-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Abstract
In the intensive care unit, patients are subject to discomforts and pain. Their management is essentially based on pharmacologic approaches. Immersive virtual reality could represent an adjunctive non-invasive and non-pharmacological pain control technique. It is based on real-time interaction with an artificial 360° immersive world using interfaces that enable physical and emotional perceptions to make the user feel better trying to reduce pain perception and to limit anxiety. Evaluation of virtual reality in intensive care unit is lacking and further studies are necessary before to introduce this alternative method for critical patients.
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Affiliation(s)
- Floriane Puel
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31400, Toulouse, France
| | - Vincent Minville
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31400, Toulouse, France.,RESTORE UMR 1301, Inserm 5070 CNRS, Paul Sabatier University, Toulouse, France
| | - Fanny Vardon-Bounes
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31400, Toulouse, France. .,INSERM U1297, Paul Sabatier University, Toulouse, France. .,Toulouse University Hospital, 1 av du Pr J Poulhès, 31400, Toulouse, France.
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22
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Lapébie FX, Minville V, Ribes A, Combis B, Thery A, Geeraerts T, Silva S, Bura-Rivière A, Vardon-Bounes F. Systematic Screening for Deep Vein Thrombosis in Critically Ill Inpatients With COVID-19: Impact on the Incidence of Venous Thromboembolism. Front Med (Lausanne) 2021; 7:624808. [PMID: 33521028 PMCID: PMC7840698 DOI: 10.3389/fmed.2020.624808] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/01/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Several studies suggest an increased incidence of thrombosis in COVID-19 patients. However, evidence on how to prevent and even treat it is scarce. The aim of this study was to compare the cumulative incidence of venous thromboembolism (VTE) of two different methods for lower extremity deep vein thrombosis (LE-DVT) diagnosis: systematic vs. clinically guided complete compression venous ultrasonography (CCUS). We conducted a monocentric, prospective, open-label, non-randomized study. All consecutive patients admitted in three intensive care units (ICUs) of University Hospital of Toulouse for COVID-19 pneumonia were included: one performed systematic screening for LE-DVT, the others did not. The primary outcome was the 21-day cumulative incidence of VTE. The secondary end points were the 21-day cumulative incidences of major bleeding and death. Results: Among the 78 patients included, 27 (34.6%) underwent systematic screening for DVT 7 ± 2 days after ICU admission. Thirty-two patients (41.0%) were diagnosed with VTE, with a 21-day cumulative incidence of 42.3% (95% CI, 31.4–55.2), without difference between screened and non-screened patients (hazard ratio 1.45, 95% CI, 0.72–2.93). In the screened group, the frequency of isolated DVT was higher (25.9 vs. 5.9%, p-value = 0.027), but the frequency of pulmonary embolism was not reduced (25.9 vs. 29.4%, p-value = 0.745). The 21-day cumulative incidences of major bleeding and death were 9.6% (95% CI, 4.7–19.2) and 10.3% (95% CI, 5.0–20.8), respectively, without difference between the two groups. Conclusions: A systematic screening for DVT in patients hospitalized in ICU was not associated with a higher diagnosis of VTE or a reduced diagnosis of PE.
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Affiliation(s)
- François-Xavier Lapébie
- Department of Vascular Medicine, Toulouse University Hospital, Toulouse, France.,UMR 1027 INSERM, Toulouse III - Paul Sabatier University, Toulouse, France
| | - Vincent Minville
- Department of Anesthesiology and Critical Care, Toulouse University Hospital, Toulouse, France.,UMR 1048 INSERM, I2MC, Toulouse III - Paul Sabatier University, Toulouse, France
| | - Agnès Ribes
- UMR 1048 INSERM, I2MC, Toulouse III - Paul Sabatier University, Toulouse, France.,Laboratory of Hematology, Toulouse University Hospital, Toulouse, France
| | - Bertrand Combis
- Department of Anesthesiology and Critical Care, Toulouse University Hospital, Toulouse, France
| | - Arthur Thery
- Department of Vascular Medicine, Toulouse University Hospital, Toulouse, France
| | - Thomas Geeraerts
- Department of Anesthesiology and Critical Care, Toulouse University Hospital, Toulouse, France.,ToNIC (Toulouse Neuro-Imaging Center) INSERM, Toulouse III - Paul Sabatier University, Toulouse, France
| | - Stein Silva
- Department of Anesthesiology and Critical Care, Toulouse University Hospital, Toulouse, France.,ToNIC (Toulouse Neuro-Imaging Center) INSERM, Toulouse III - Paul Sabatier University, Toulouse, France
| | - Alessandra Bura-Rivière
- Department of Vascular Medicine, Toulouse University Hospital, Toulouse, France.,UMR 1031 INSERM, StromaLab, Toulouse III - Paul Sabatier University, Toulouse, France
| | - Fanny Vardon-Bounes
- Department of Anesthesiology and Critical Care, Toulouse University Hospital, Toulouse, France.,UMR 1048 INSERM, I2MC, Toulouse III - Paul Sabatier University, Toulouse, France
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23
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Vardon-Bounes F, Gracia R, Abaziou T, Crognier L, Seguin T, Labaste F, Geeraerts T, Georges B, Conil JM, Minville V. A study of patients' quality of life more than 5 years after trauma: a prospective follow-up. Health Qual Life Outcomes 2021; 19:18. [PMID: 33419450 PMCID: PMC7796607 DOI: 10.1186/s12955-020-01652-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/29/2019] [Accepted: 12/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The long-term fate of severely injured patients in terms of their quality of life is not well known. Our aim was to assess the quality of life of patients who have suffered moderate to severe trauma and to identify primary factors of long-term quality of life impairment. METHODS A prospective monocentric study conducted on a number of patients who were victims of moderate to severe injuries during the year 2012. Patients were selected based on an Injury Severity Score (ISS) more than or equal to 9. Quality of life was assessed by the MOS SF-36 and NHP scores as a primary evaluation criterion. The secondary evaluation criteria were the determination of the socio-economic impact on quality of life and the identification of factors associated with disability. RESULTS Two hundred and eight patients were contacted by e-mail or telephone. Fifty-five patients participated in this study (with a participation level of 26.4%), including 78.2% men, with a median age of 46. Significant alterations in quality of life were observed with the NHP and MOS SF-36 scale, including physical and psychological components. This resulted in a major socio-economic impact as 26% of the patients could not resume their professional activities (n = 10), 20% required retraining in other lines of work, and 36.4% had a disability status. The study showed that scores ≤ 85 on the physical functioning variable of the MOS SF 36 scale was associated with disability. CONCLUSION More than five years after a moderate to severe injury, patients' quality of life was significantly impacted, resulting in significant socio-economic consequences. Disability secondary to major trauma seems to be associated with a score ≤ 85 on the physical functioning dimension of the MOS SF-36 scale. This study raises the question of whether or not early rehabilitation programs should be implemented in order to limit the long-term impact of major trauma.
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Affiliation(s)
- Fanny Vardon-Bounes
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France. .,Inserm U1048, I2MC, Université Paul Sabatier, 31024, Toulouse Cedex 03, France.
| | - Romain Gracia
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - Timothée Abaziou
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - Laure Crognier
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - Thierry Seguin
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - François Labaste
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - Thomas Geeraerts
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - Bernard Georges
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - Jean-Marie Conil
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France
| | - Vincent Minville
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 1 av du Pr Jean Poulhès, 31059, Toulouse, France.,Inserm U1048, I2MC, Université Paul Sabatier, 31024, Toulouse Cedex 03, France
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24
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Abaziou T, Vardon-Bounes F, Conil JM, Rouget A, Ruiz S, Grare M, Fourcade O, Suc B, Leone M, Minville V, Georges B. Outcome of community- versus hospital-acquired intra-abdominal infections in intensive care unit: a retrospective study. BMC Anesthesiol 2020; 20:295. [PMID: 33261586 PMCID: PMC7705430 DOI: 10.1186/s12871-020-01209-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background To compare patients hospitalised in the intensive care unit (ICU) after surgery for community-acquired intra-abdominal infection (CA-IAI) and hospital-acquired intra-abdominal infection (HA-IAI) in terms of mortality, severity and complications. Methods Retrospective study including all patients admitted to 2 ICUs within 48 h of undergoing surgery for peritonitis. Results Two hundred twenty-six patients were enrolled during the study period. Patients with CA-IAI had an increased 28-day mortality rate compared to those with HA-IAI (30% vs 15%, respectively (p = 0.009)). At 90 days, the mortality rates were 36.7 and 37.5% in the CA-IAI group and HA-IAI group, respectively, with a similar APACHE II score on admission (median: 21 [15–25] vs. 21 [15–24] respectively, p = 0.63). The patients with HA-IAI had prolonged ICU and hospital stays (median: 17 [7–36] vs. 6[3–12] days, p < 0.001 and 41 [24–66] vs. 17 [7–32] days, p = 0.001), and experienced more complications (reoperation and reintubation) than those with CA-IAI. Conclusion CA-IAI group had higher 28-day mortality rate than HA-IAI group. Mortality was similar at 90 days but those with HA-IAI had a prolonged ICU and hospital stay. In addition, they developed more complications.
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Affiliation(s)
- Timothée Abaziou
- Département D'Anesthésie-Réanimation (Department of Anesthesia and ICU), CHU Rangueil (University Hospital Centre of Rangeuil), 1 Avenue du Professeur Jean Poulhes TSA 50032, 31059, Toulouse, France.
| | - Fanny Vardon-Bounes
- Département D'Anesthésie-Réanimation (Department of Anesthesia and ICU), CHU Rangueil (University Hospital Centre of Rangeuil), 1 Avenue du Professeur Jean Poulhes TSA 50032, 31059, Toulouse, France
| | - Jean-Marie Conil
- Département D'Anesthésie-Réanimation (Department of Anesthesia and ICU), CHU Rangueil (University Hospital Centre of Rangeuil), 1 Avenue du Professeur Jean Poulhes TSA 50032, 31059, Toulouse, France
| | - Antoine Rouget
- Département D'Anesthésie-Réanimation (Department of Anesthesia and ICU), CHU Rangueil (University Hospital Centre of Rangeuil), 1 Avenue du Professeur Jean Poulhes TSA 50032, 31059, Toulouse, France
| | - Stéphanie Ruiz
- Département D'Anesthésie-Réanimation (Department of Anesthesia and ICU), CHU Rangueil (University Hospital Centre of Rangeuil), 1 Avenue du Professeur Jean Poulhes TSA 50032, 31059, Toulouse, France
| | - Marion Grare
- Laboratoire de Bactériologie et Hygiène (Bacteriology and Hygiene Laboratory), Institut Fédératif de Biologie (Federative Institute of Biology), 330 Avenue de Grande Bretagne, Cedex 9, 31059, Toulouse, France
| | - Olivier Fourcade
- Département D'Anesthésie-Réanimation (Department of Anesthesia and ICU), CHU Rangueil (University Hospital Centre of Rangeuil), 1 Avenue du Professeur Jean Poulhes TSA 50032, 31059, Toulouse, France
| | - Bertrand Suc
- Service de Chirurgie Digestive (Department of Gastrointestinal Surgery), CHU Rangueil (University Hospital Centre of Rangueil), 1 Avenue du Professeur Jean Poulhes, 31059, Toulouse, France
| | - Marc Leone
- Aix Marseille Université, Assistance Publique Hôpitaux de Marseille (Public Hospitals of Marseille), Service D'Anesthésie-Réanimation (Department of Anaesthesia and ICU), Hôpital Nord, Chemin des Bourrely, 13015 Marseille, France
| | - Vincent Minville
- Département D'Anesthésie-Réanimation (Department of Anesthesia and ICU), CHU Rangueil (University Hospital Centre of Rangeuil), 1 Avenue du Professeur Jean Poulhes TSA 50032, 31059, Toulouse, France
| | - Bernard Georges
- Département D'Anesthésie-Réanimation (Department of Anesthesia and ICU), CHU Rangueil (University Hospital Centre of Rangeuil), 1 Avenue du Professeur Jean Poulhes TSA 50032, 31059, Toulouse, France
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25
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Ribes A, Vardon-Bounes F, Mémier V, Poette M, Au-Duong J, Garcia C, Minville V, Sié P, Bura-Rivière A, Voisin S, Payrastre B. Thromboembolic events and Covid-19. Adv Biol Regul 2020; 77:100735. [PMID: 32773098 PMCID: PMC7833411 DOI: 10.1016/j.jbior.2020.100735] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 01/08/2023]
Abstract
The novel Corona virus infection (Covid-19) first identified in China in December 2019 has rapidly progressed in pandemic leading to significant mortality and unprecedented challenge for healthcare systems. Although the clinical spectrum of Covid-19 is variable, acute respiratory failure and systemic coagulopathy are common in severe Covid-19 patients. Lung is an important target of the SARS-CoV-2 virus causing eventually acute respiratory distress syndrome associated to a thromboinflammatory state. The cytokinic storm, thromboinflammation and pulmonary tropism are the bedrock of tissue lesions responsible for acute respiratory failure and for prolonged infection that may lead to multiple organ failure and death. The thrombogenicity of this infectious disease is illustrated by the high frequency of thromboembolic events observed even in Covid-19 patients treated with anticoagulation. Increased D-Dimers, a biomarker reflecting activation of hemostasis and fibrinolysis, and low platelet count (thrombocytopenia) are associated with higher mortality in Covid-19 patients. In this review, we will summarize our current knowledge on the thromboembolic manifestations, the disturbed hemostatic parameters, and the thromboinflammatory conditions associated to Covid-19 and we will discuss the modalities of anticoagulant treatment or other potential antithrombotic options.
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Affiliation(s)
- Agnès Ribes
- Inserm U1048 and Université Toulouse III Paul Sabatier, I2MC, 31024, Toulouse Cedex 03, France; Laboratoire d'Hématologie, CHU de Toulouse, 31059, Toulouse, France
| | - Fanny Vardon-Bounes
- Inserm U1048 and Université Toulouse III Paul Sabatier, I2MC, 31024, Toulouse Cedex 03, France; Pôle Anesthésie-Réanimation, CHU de Toulouse, 31059, Toulouse, France
| | - Vincent Mémier
- Laboratoire d'Hématologie, CHU de Toulouse, 31059, Toulouse, France
| | - Michael Poette
- Inserm U1048 and Université Toulouse III Paul Sabatier, I2MC, 31024, Toulouse Cedex 03, France; Pôle Anesthésie-Réanimation, CHU de Toulouse, 31059, Toulouse, France
| | - Jonathan Au-Duong
- Inserm U1048 and Université Toulouse III Paul Sabatier, I2MC, 31024, Toulouse Cedex 03, France; Pôle Anesthésie-Réanimation, CHU de Toulouse, 31059, Toulouse, France
| | - Cédric Garcia
- Inserm U1048 and Université Toulouse III Paul Sabatier, I2MC, 31024, Toulouse Cedex 03, France; Laboratoire d'Hématologie, CHU de Toulouse, 31059, Toulouse, France
| | - Vincent Minville
- Pôle Anesthésie-Réanimation, CHU de Toulouse, 31059, Toulouse, France
| | - Pierre Sié
- Inserm U1048 and Université Toulouse III Paul Sabatier, I2MC, 31024, Toulouse Cedex 03, France; Laboratoire d'Hématologie, CHU de Toulouse, 31059, Toulouse, France
| | | | - Sophie Voisin
- Inserm U1048 and Université Toulouse III Paul Sabatier, I2MC, 31024, Toulouse Cedex 03, France; Laboratoire d'Hématologie, CHU de Toulouse, 31059, Toulouse, France
| | - Bernard Payrastre
- Inserm U1048 and Université Toulouse III Paul Sabatier, I2MC, 31024, Toulouse Cedex 03, France; Laboratoire d'Hématologie, CHU de Toulouse, 31059, Toulouse, France.
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26
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Ruiz S, Vardon-Bounes F, Buléon M, Guilbeau-Frugier C, Séguelas MH, Conil JM, Girolami JP, Tack I, Minville V. Kinin B1 receptor: a potential therapeutic target in sepsis-induced vascular hyperpermeability. J Transl Med 2020; 18:174. [PMID: 32306971 PMCID: PMC7168845 DOI: 10.1186/s12967-020-02342-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background In sepsis, the endothelial barrier becomes incompetent, with the leaking of plasma into interstitial tissues. VE-cadherin, an adherens junction protein, is the gatekeeper of endothelial cohesion. Kinins, released during sepsis, induce vascular leakage and vasodilation. They act via two G-protein coupled receptors: B1 (B1R) and B2 (B2R). B1R is inducible in the presence of pro-inflammatory cytokines, endotoxins or after tissue injury. It acts at a later stage of sepsis and elicits a sustained inflammatory response. The aim of our study was to investigate the relationships between B1R and VE-cadherin destabilization in vivo in a later phase of sepsis. Methods Experimental, prospective study in a university research laboratory. We used a polymicrobial model of septic shock by cecal ligation and puncture in C57BL6 male mice or C57BL6 male mice that received a specific B1R antagonist (R-954). We studied the influence of B1R on sepsis-induced vascular permeability 30 h after surgery for several organs, and VE-cadherin expression in the lung and kidneys by injecting R-954 just before surgery. The 96-h survival was determined in mice without treatment or in animals receiving R-954 as a “prophylactic” regimen (a subcutaneous injection of 200 µg/kg, prior to CLP and 24 h after CLP), or as a “curative” regimen (injection of 100 µg/kg at H6, H24 and H48 post-surgery). Results B1R inactivation helps to maintain MAP above 65 mmHg but induces different permeability profiles depending on whether or not organ perfusion is autoregulated. In our model, VE-cadherin was destabilized in vivo during septic shock. At a late stage of sepsis, the B1R blockade reduced the VE-cadherin disruption by limiting eNOS activation. The survival rate for mice that received R-954 after sepsis induction was higher than in animals that received an antagonist as a prophylactic treatment. Conclusions B1R antagonizing reduced mortality in our model of murine septic shock by limiting the vascular permeability induced by VE-cadherin destabilization through maintenance of the macrohemodynamics, consequently limiting organ dysfunctions.
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Affiliation(s)
- Stéphanie Ruiz
- Department of Anesthesiology and Intensive Care, Rangueil Hospital-University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès TSA 50032, 31059, Toulouse Cedex 9, France. .,Institute of Metabolic and Cardiovascular Diseases, INSERM/UPS UMR, 1048-I2MC, Equipe 3, Paul Sabatier University, Toulouse, France.
| | - Fanny Vardon-Bounes
- Department of Anesthesiology and Intensive Care, Rangueil Hospital-University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès TSA 50032, 31059, Toulouse Cedex 9, France.,Institute of Metabolic and Cardiovascular Diseases, INSERM/UPS UMR, 1048-I2MC, Equipe 3, Paul Sabatier University, Toulouse, France
| | - Marie Buléon
- Institute of Metabolic and Cardiovascular Diseases, INSERM/UPS UMR, 1048-I2MC, Equipe 3, Paul Sabatier University, Toulouse, France
| | - Céline Guilbeau-Frugier
- Institute of Metabolic and Cardiovascular Diseases, INSERM/UPS UMR, 1048-I2MC, Equipe 3, Paul Sabatier University, Toulouse, France.,Department of Forensic Medicine, Rangueil Hospital-University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès TSA 50032, 31059, Toulouse Cedex 9, France.,Biological Electron Microscopy Center, Rangueil Faculty of Medicine, Toulouse University, Toulouse, France
| | - Marie-Hélène Séguelas
- Institute of Metabolic and Cardiovascular Diseases, INSERM/UPS UMR, 1048-I2MC, Equipe 3, Paul Sabatier University, Toulouse, France
| | - Jean-Marie Conil
- Department of Anesthesiology and Intensive Care, Rangueil Hospital-University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès TSA 50032, 31059, Toulouse Cedex 9, France
| | - Jean-Pierre Girolami
- Institute of Metabolic and Cardiovascular Diseases, INSERM/UPS UMR, 1048-I2MC, Equipe 3, Paul Sabatier University, Toulouse, France
| | - Ivan Tack
- Institute of Metabolic and Cardiovascular Diseases, INSERM/UPS UMR, 1048-I2MC, Equipe 3, Paul Sabatier University, Toulouse, France.,Department of Physiology, Rangueil Hospital-University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès TSA 50032, 31059, Toulouse Cedex 9, France
| | - Vincent Minville
- Department of Anesthesiology and Intensive Care, Rangueil Hospital-University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès TSA 50032, 31059, Toulouse Cedex 9, France.,Institute of Metabolic and Cardiovascular Diseases, INSERM/UPS UMR, 1048-I2MC, Equipe 3, Paul Sabatier University, Toulouse, France
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27
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Vardon-Bounes F, Gratacap MP, Groyer S, Ruiz S, Georges B, Seguin T, Garcia C, Payrastre B, Conil JM, Minville V. Kinetics of mean platelet volume predicts mortality in patients with septic shock. PLoS One 2019; 14:e0223553. [PMID: 31622365 PMCID: PMC6797099 DOI: 10.1371/journal.pone.0223553] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/05/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction Thrombocytopenia is well recognized as a poor prognosis sign associated with increased mortality and prolonged Intensive Care Unit (ICU) stay, particularly in septic patients. Mean platelet volume (MPV) could represent a relevant predictive marker of mortality. Here we investigated whether MPV kinetics during the first 15 days after hospital admission has a potential prognostic value for clinical outcome in septic shock. Methods We performed a retrospectively analysis of a cohort of 301 septic patients admitted in ICU. Three-month mortality was the primary endpoint. The prognostic value of the covariates of interest was ascertained by multidimensional analysis. We proposed a classification and regression trees analysis to predict survival probability. Results MPV kinetics was significantly different between 90-day survivors and non-survivors when followed during 15 days (except on day 3). 10-day MPV >11.6fL was an independent predictive factor of 90-day mortality (Hazard Ratio (HR) 3.796, 95% Confidence Interval (CI) [1.96–7.35], p = 0.0001) in multivariate analysis. Base excess on day 4 <1.9mmol/L was also a predictive factor of mortality (HR 2.972, 95%CI [1.38–6.40], p = 0.0054. Conclusion MPV increase during the first 15 days after ICU admission in non-survivors was observed during septic shock and 10-day MPV >11.6fL was an independent predictive factor of 90-day mortality. This could be explained by the emergent response to acute platelet loss during septic shock, leading to megakaryocyte rupture to produce new but potentially immature platelets in the circulation. Therefore, continuous monitoring of MPV may be a useful parameter to stratify mortality risk in septic shock.
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Affiliation(s)
- Fanny Vardon-Bounes
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France
- INSERM UMR 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Equipe 11, Toulouse, France
- * E-mail:
| | - Marie-Pierre Gratacap
- INSERM UMR 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Equipe 11, Toulouse, France
| | - Samuel Groyer
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France
| | - Stéphanie Ruiz
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France
- INSERM UMR 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Equipe 11, Toulouse, France
| | - Bernard Georges
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France
| | - Thierry Seguin
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France
| | - Cédric Garcia
- Hematology laboratory, Toulouse University Hospital, Toulouse, France
| | - Bernard Payrastre
- INSERM UMR 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Equipe 11, Toulouse, France
- Hematology laboratory, Toulouse University Hospital, Toulouse, France
| | - Jean-Marie Conil
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France
| | - Vincent Minville
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France
- INSERM UMR 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Equipe 11, Toulouse, France
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Druge S, Ruiz S, Vardon-Bounes F, Grare M, Labaste F, Seguin T, Fourcade O, Minville V, Conil JM, Georges B. Risk factors and the resistance mechanisms involved in Pseudomonas aeruginosa mutation in critically ill patients. J Intensive Care 2019; 7:36. [PMID: 31360523 PMCID: PMC6639906 DOI: 10.1186/s40560-019-0390-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/05/2019] [Indexed: 12/29/2022] Open
Abstract
Background The objective of this study was to determine the main risk factors of Pseudomonas aeruginosa mutation as well as the mechanisms of acquired resistance. Methods We conducted a 2-year prospective study in patients who were carriers of a Pseudomonas aeruginosa strain and who had been admitted to a medical/surgical ICU. Results Of the 153 patients who were included, 34 had a mutation in their strain. In a multivariate analysis, a duration of ventilation > 24 days was a risk factor for mutation (risk ratio 4.29; CI 95% 1.94-9.49) while initial resistance was a protective factor (RR 0.36; CI 95% 0.18-0.71). In a univariate analysis, exposure of P. aeruginosa to ceftazidime was associated with an over-production of AmpC cephalosporinase and exposure to meropenem was associated with impermeability. A segmentation method based on the duration of ventilation (> 24 days), initial resistance, and exposure of strains to ceftazidime made it possible to predict at 83% the occurrence of mutation. Conclusion The duration of ventilation and the presence of resistance as soon as P. aeruginosa is identified are predictive factors of mutation in ICU patients.
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Affiliation(s)
- Stéphanie Druge
- 1Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Stéphanie Ruiz
- 1Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Fanny Vardon-Bounes
- 1Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Marion Grare
- Laboratoire de Bactériologie et Hygiène, Institut Fédératif de Biologie, 330 Avenue de Grande Bretagne, TSA 40031, 31059 Toulouse Cedex 9, France
| | - François Labaste
- 1Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Thierry Seguin
- 1Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Olivier Fourcade
- 1Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Vincent Minville
- 1Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Jean-Marie Conil
- 1Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Bernard Georges
- 1Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059 Toulouse Cedex 9, France.,3Department of Anesthesiology and Intensive Care Units, University Hospital of Toulouse, 31059 Toulouse Cedex 9, France
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Vardon-Bounes F, Ruiz S, Gratacap MP, Garcia C, Payrastre B, Minville V. Platelets Are Critical Key Players in Sepsis. Int J Mol Sci 2019; 20:ijms20143494. [PMID: 31315248 PMCID: PMC6679237 DOI: 10.3390/ijms20143494] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 01/13/2023] Open
Abstract
Host defense against infection is based on two crucial mechanisms: the inflammatory response and the activation of coagulation. Platelets are involved in both hemostasis and immune response. These mechanisms work together in a complex and synchronous manner making the contribution of platelets of major importance in sepsis. This is a summary of the pathophysiology of sepsis-induced thrombocytopenia, microvascular consequences, platelet-endothelial cells and platelet–pathogens interactions. The critical role of platelets during sepsis and the therapeutic implications are also reviewed.
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Affiliation(s)
- Fanny Vardon-Bounes
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 31059 Toulouse, France.
- INSERM I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, 31059 Toulouse, France.
| | - Stéphanie Ruiz
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 31059 Toulouse, France
| | - Marie-Pierre Gratacap
- INSERM I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, 31059 Toulouse, France
| | - Cédric Garcia
- Hematology Laboratory, Toulouse University Hospital, 31059 Toulouse, France
| | - Bernard Payrastre
- INSERM I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, 31059 Toulouse, France
- Hematology Laboratory, Toulouse University Hospital, 31059 Toulouse, France
| | - Vincent Minville
- Anesthesiology and Critical Care Unit, Toulouse University Hospital, 31059 Toulouse, France
- INSERM I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, 31059 Toulouse, France
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30
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Delmas C, Jacquemin A, Vardon-Bounes F, Georges B, Guerrero F, Hernandez N, Marcheix B, Seguin T, Minville V, Conil JM, Silva S. Anticoagulation Monitoring Under ECMO Support: A Comparative Study Between the Activated Coagulation Time and the Anti-Xa Activity Assay. J Intensive Care Med 2018; 35:679-686. [DOI: 10.1177/0885066618776937] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose: Extra Corporeal Membrane Oxygenation (ECMO) is used in cases of severe respiratory and/or circulatory failure over periods of several days to several weeks. Its circuitry requires a closely monitored anticoagulation therapy that is empirically supported by activated clotting time (ACT)—a method often associated with large inter- and intraindividual variability. We aimed to compare the measurement of heparin activity with ACT and the direct measurement of the heparin activity (anti-Xa) in a large ECMO population. Methods: All patients treated by venoarterial or venovenous ECMO in our intensive care unit between January 2014 and December 2015 were prospectively included. A concomitant measurement of the anti-Xa activity and ACT was performed on the same sample collected twice a day (morning–evening) for unfractionated heparin adaptation with an ACT target range of 180 to 220 seconds. Results: One hundred and nine patients (men 69.7%, median age 54 years) treated with ECMO (70.6% venoarterial) were included. Spearman analysis found no correlation between anti-Xa and ACT (ρ < 0.4) from day 1 and worsened over time. Kappa analysis showed no agreement between the respective target ranges of ACT and anti-Xa. Conclusions: We demonstrate that concomitant measurement of ACT and anti-Xa activity is irrelevant in ECMO patients. Since ACT is poorly correlated with heparin dosage, anti-Xa activity appears to be a more suitable assay for anticoagulation monitoring.
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Affiliation(s)
- Clément Delmas
- Intensive Care Unit, Anesthesia and Critical Care Department, Rangueil University Hospital, Toulouse, France
- Intensive Cardiac Care, Cardiology Department, Rangueil University Hospital, Toulouse, France
- Institut des Maladies Métaboliques et Cardiovasculaires, Rangueil, Toulouse, France
| | - Aemilia Jacquemin
- Intensive Care Unit, Anesthesia and Critical Care Department, Rangueil University Hospital, Toulouse, France
| | - Fanny Vardon-Bounes
- Intensive Care Unit, Anesthesia and Critical Care Department, Rangueil University Hospital, Toulouse, France
| | - Bernard Georges
- Intensive Care Unit, Anesthesia and Critical Care Department, Rangueil University Hospital, Toulouse, France
| | - Felipe Guerrero
- Hematology Laboratory, Rangueil University Hospital, Toulouse, France
| | - Nicolas Hernandez
- Intensive Care Unit, Anesthesia and Critical Care Department, Rangueil University Hospital, Toulouse, France
| | - Bertrand Marcheix
- Cardiac Surgery Department, Rangueil University Hospital, Toulouse, France
| | - Thierry Seguin
- Intensive Care Unit, Anesthesia and Critical Care Department, Rangueil University Hospital, Toulouse, France
| | - Vincent Minville
- Intensive Care Unit, Anesthesia and Critical Care Department, Rangueil University Hospital, Toulouse, France
- Institut des Maladies Métaboliques et Cardiovasculaires, Rangueil, Toulouse, France
| | - Jean-Marie Conil
- Intensive Care Unit, Anesthesia and Critical Care Department, Rangueil University Hospital, Toulouse, France
| | - Stein Silva
- Intensive Care Unit, Anesthesia and Critical Care Department, Rangueil University Hospital, Toulouse, France
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Delmas C, Zapetskaia T, Conil JM, Georges B, Vardon-Bounes F, Seguin T, Crognier L, Fourcade O, Brouchet L, Minville V, Silva S. 3-month prognostic impact of severe acute renal failure under veno-venous ECMO support: Importance of time of onset. J Crit Care 2017; 44:63-71. [PMID: 29073534 DOI: 10.1016/j.jcrc.2017.10.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/19/2017] [Accepted: 10/17/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Veno-venous ECMO is increasingly used for the management of refractory ARDS. In this context, acute kidney injury (AKI) is a major and frequent complication, often associated with poor outcome. We aimed to identify characteristics associated with severe renal failure (Kidney Disease Improving Global Outcome (KDIGO) 3) and its impact on 3-month outcome. METHODS Between May 2009 and April 2016, 60 adult patients requiring VV-ECMO in our University Hospital were prospectively included. RESULTS AKI occurrence was frequent (75%; n=45), 51% of patients (n=31) developed KDIGO 3 - predominantly prior to ECMO insertion - and renal replacement therapy was required in 43% (n=26) of cases. KDIGO 3 was associated with a lower mechanical ventilation weaning rate (24% vs 68% for patients with no AKI or other stages of AKI; p<0.001) and a higher 90-day mortality rate (72% vs 32%, p=0.002). Multivariate logistic regression suggested that KDIGO 3 occurrence prior to ECMO insertion, as well as PaCO2>57mmHg and mSOFA>12 were independent risks factors for 90-day mortality. CONCLUSION KDIGO 3 AKI occurrence is correlated with the severity of patients' clinical condition prior to ECMO insertion and is negatively associated with 90-day survival.
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Affiliation(s)
- C Delmas
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France; Intensive Cardiac care, Cardiology department, Rangueil University Hospital, 1 Av Jean-Poulhes, 31059 Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, INSERM 1048, Rangueil, Toulouse, France.
| | - T Zapetskaia
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France
| | - J M Conil
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France
| | - B Georges
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France
| | - F Vardon-Bounes
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, INSERM 1048, Rangueil, Toulouse, France
| | - T Seguin
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France
| | - L Crognier
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France
| | - O Fourcade
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France
| | - L Brouchet
- Thoracic Surgery department, Larrey University Hospital, 24 chemin de Pouvourville, TSA 30030, 31059 Toulouse, France
| | - V Minville
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, INSERM 1048, Rangueil, Toulouse, France
| | - S Silva
- Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France
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Malagurski B, Péran P, Sarton B, Riu B, Gonzalez L, Vardon-Bounes F, Seguin T, Geeraerts T, Fourcade O, de Pasquale F, Silva S. Neural signature of coma revealed by posteromedial cortex connection density analysis. Neuroimage Clin 2017; 15:315-324. [PMID: 28560156 PMCID: PMC5440358 DOI: 10.1016/j.nicl.2017.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/27/2017] [Accepted: 03/28/2017] [Indexed: 01/15/2023]
Abstract
Posteromedial cortex (PMC) is a highly segregated and dynamic core, which appears to play a critical role in internally/externally directed cognitive processes, including conscious awareness. Nevertheless, neuroimaging studies on acquired disorders of consciousness, have traditionally explored PMC as a homogenous and indivisible structure. We suggest that a fine-grained description of intrinsic PMC topology during coma, could expand our understanding about how this cortical hub contributes to consciousness generation and maintain, and could permit the identification of specific markers related to brain injury mechanism and useful for neurological prognostication. To explore this, we used a recently developed voxel-based unbiased approach, named functional connectivity density (CD). We compared 27 comatose patients (15 traumatic and 12 anoxic), to 14 age-matched healthy controls. The patients' outcome was assessed 3 months later using Coma Recovery Scale-Revised (CRS-R). A complex pattern of decreased and increased connections was observed, suggesting a network imbalance between internal/external processing systems, within PMC during coma. The number of PMC voxels with hypo-CD positive correlation showed a significant negative association with the CRS-R score, notwithstanding aetiology. Traumatic injury specifically appeared to be associated with a greater prevalence of hyper-connected (negative correlation) voxels, which was inversely associated with patient neurological outcome. A logistic regression model using the number of hypo-CD positive and hyper-CD negative correlations, accurately permitted patient's outcome prediction (AUC = 0.906, 95%IC = 0.795–1). These points might reflect adaptive plasticity mechanism and pave the way for innovative prognosis and therapeutics methods. A twofold pattern of decreased and increased connections within PMC was observed during coma. The number of PMC voxels with decreased positive connections, was significantly associated with patient's outcome. Greater prevalence of hyperconnected PMC voxels in traumatic brain injury was correlated to outcome in this subgroup.
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Key Words
- Acute brain injury
- BI, brain injury
- BOLD, blood oxygen level–dependent
- CDN, connection density based on negative correlation
- CDP, connection density based on positive correlation
- CRS-R, Coma Recovery Scale–Revised
- Coma
- Connection density
- DMN, default-mode network
- DOC, disorders of consciousness
- PCC, posterior cingulate cortex
- PMC, posteromedial cortex
- PreCu, precuneus
- Prognosis
- Resting state
- TBI, traumatic brain injury
- mPFC, medial prefrontal cortex
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Affiliation(s)
| | - Patrice Péran
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Benjamine Sarton
- Critical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Beatrice Riu
- Critical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Leslie Gonzalez
- Critical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Fanny Vardon-Bounes
- Critical Care Unit, University Teaching Hospital of Rangueil, F-31060 Toulouse Cedex 9, France
| | - Thierry Seguin
- Critical Care Unit, University Teaching Hospital of Rangueil, F-31060 Toulouse Cedex 9, France
| | - Thomas Geeraerts
- Neurocritical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Olivier Fourcade
- Neurocritical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France
| | - Francesco de Pasquale
- ITAB, Department of Neuroscience Imaging and Clinical Science, G. D'Annunzio University, Chieti, Italy
| | - Stein Silva
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; Critical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, F-31059 Toulouse Cedex 9, France.
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Ruiz S, Vardon-Bounes F, Merlet-Dupuy V, Conil JM, Buléon M, Fourcade O, Tack I, Minville V. Sepsis modeling in mice: ligation length is a major severity factor in cecal ligation and puncture. Intensive Care Med Exp 2016; 4:22. [PMID: 27430881 PMCID: PMC4949182 DOI: 10.1186/s40635-016-0096-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/07/2016] [Indexed: 02/01/2023] Open
Abstract
Background The cecal ligation and puncture (CLP) model, a gold standard in sepsis research, is associated with an important variability in mortality. While the number of punctures and needle size is well described in CLP animal studies, the length of cecal ligation is often not. The relationship between cecal ligation and survival in mice is briefly reported in the literature; therefore, we devised an investigation in mice of the consequences of three standardized cecal ligation lengths on mortality and the severity of the ensued sepsis. Methods Male C57BL/6J mice underwent standardized CLP. The cecum was ligated at 5, 20, or 100 % of its total length and further perforated by a single 20-G puncture. Mortality was analyzed. We assessed blood lactate, serum creatinine levels, and serum cytokines (TNF-α, IL-1β, IL-6, and IL-10) after procedure in a control group and in ligated mice. Results Mortality was directly related to ligation length: median survival was 24 h for the “100 %” group and 44 h for the “20 %” group. Blood lactate increased proportionally with the ligation length. At 6 h post-procedure, pro-inflammatory cytokines significantly increased in the ligated group with significantly higher serum levels of IL-6 in the 100 % group compared to the other ligated groups. The 20 % group exhibited the characteristics of septic shock with hypotension below 65 mmHg, pro-inflammatory balance, organ dysfunction, and hyperlactatemia. Conclusions Cecal ligation length appears to be a major limiting factor in the mouse CLP model. Thus, this experimental model should be performed with high consistency in future protocol designs.
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Affiliation(s)
- Stéphanie Ruiz
- Department of Anesthesiology and Intensive Care, Rangueil Hospital, University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès TSA 50032, 31059, Toulouse, Cedex 9, France. .,Inserm/UPS UMR 1048 - I2MC, Equipe 3, Toulouse, France.
| | - Fanny Vardon-Bounes
- Department of Anesthesiology and Intensive Care, Rangueil Hospital, University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès TSA 50032, 31059, Toulouse, Cedex 9, France.,Inserm/UPS UMR 1048 - I2MC, Equipe 3, Toulouse, France
| | - Virginie Merlet-Dupuy
- Department of Anesthesiology and Intensive Care, Rangueil Hospital, University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès TSA 50032, 31059, Toulouse, Cedex 9, France
| | - Jean-Marie Conil
- Department of Anesthesiology and Intensive Care, Rangueil Hospital, University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès TSA 50032, 31059, Toulouse, Cedex 9, France
| | - Marie Buléon
- Inserm/UPS UMR 1048 - I2MC, Equipe 12, Toulouse, France
| | - Olivier Fourcade
- Department of Anesthesiology and Intensive Care, Rangueil Hospital, University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès TSA 50032, 31059, Toulouse, Cedex 9, France.,EA 4564 - MATN - Laboratoire de Modélisation de l'Agression Tissulaire et de la Nociception Toulouse, Institut Louis Bugnard (IFR 150), Toulouse, France
| | - Ivan Tack
- Inserm/UPS UMR 1048 - I2MC, Equipe 12, Toulouse, France.,Department of Physiology, Rangueil Hospital, University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès TSA 50032, 31059, Toulouse Cedex 9, France
| | - Vincent Minville
- Department of Anesthesiology and Intensive Care, Rangueil Hospital, University Hospital of Toulouse, 1 Avenue du Professeur Jean Poulhès TSA 50032, 31059, Toulouse, Cedex 9, France.,Inserm/UPS UMR 1048 - I2MC, Equipe 3, Toulouse, France
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