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Outin H, Gueye P, Alvarez V, Auvin S, Clair B, Convers P, Crespel A, Demeret S, Dupont S, Engels JC, Engrand N, Freund Y, Gelisse P, Girot M, Marcoux MO, Navarro V, Rossetti A, Santoli F, Sonneville R, Szurhaj W, Thomas P, Titomanlio L, Villega F, Lefort H, Peigne V. Recommandations Formalisées d’Experts SRLF/SFMU : Prise en charge des états de mal épileptiques en préhospitalier, en structure d’urgence et en réanimation dans les 48 premières heures (A l’exclusion du nouveau-né et du nourrisson). Ann Fr Med Urgence 2020. [DOI: 10.3166/afmu-2020-0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La Société de réanimation de langue française et la Société française de médecine d’urgence ont décidé d’élaborer de nouvelles recommandations sur la prise en charge de l’état mal épileptique (EME) avec l’ambition de répondre le plus possible aux nombreuses questions pratiques que soulèvent les EME : diagnostic, enquête étiologique, traitement non spécifique et spécifique. Vingt-cinq experts ont analysé la littérature scientifique et formulé des recommandations selon la méthodologie GRADE. Les experts se sont accordés sur 96 recommandations. Les recommandations avec le niveau de preuve le plus fort ne concernent que l’EME tonico-clonique généralisé (EMTCG) : l’usage des benzodiazépines en première ligne (clonazépam en intraveineux direct ou midazolam en intramusculaire) est recommandé, répété 5 min après la première injection (à l’exception du midazolam) en cas de persistance clinique. En cas de persistance 5 min après cette seconde injection, il est proposé d’administrer la seconde ligne thérapeutique : valproate de sodium, (fos-)phénytoïne, phénobarbital ou lévétiracétam. La persistance avérée de convulsions 30 min après le début de l’administration du traitement de deuxième ligne signe l’EMETCG réfractaire. Il est alors proposé de recourir à un coma thérapeutique au moyen d’un agent anesthésique intraveineux de type midazolam ou propofol. Des recommandations spécifiques à l’enfant et aux autres EME sont aussi énoncées.
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Lesieur O, Messika J, Touati S, Chagnon JL, Diehl JL, Outin H, Rigaud JP, Sement A, Terzi N, Thévenin D, Annane D, Bodet-Contentin L, Dreyfuss D, Misset B. Quel effectif médical dans les services de réanimation et surveillance continue en France ? Une position du syndicat des médecins réanimateurs des hôpitaux publics. Méd Intensive Réa 2019. [DOI: 10.3166/rea-2019-0121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Richard C, Argaud L, Blet A, Boulain T, Contentin L, Dechartres A, Dejode JM, Donetti L, Fartoukh M, Fletcher D, Kuteifan K, Lasocki S, Liet JM, Lukaszewicz AC, Mal H, Maury E, Osman D, Outin H, Richard JC, Schneider F, Tamion F. [Extracorporeal life support for patients with acute respiratory distress syndrome (adult and paediatric). Consensus conference organized by the French Intensive Care Society]. Rev Mal Respir 2014; 31:779-95. [PMID: 25391514 DOI: 10.1016/j.rmr.2014.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/24/2014] [Indexed: 01/19/2023]
Affiliation(s)
- C Richard
- Service de réanimation médicale, EA 4533, université Paris-Sud, hôpitaux universitaires Paris-Sud, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - L Argaud
- Service de réanimation médicale, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France
| | - A Blet
- Département d'anesthésie-réanimation, centre de traitement des brulés, hôpitaux universitaires Saint-Louis, Lariboisière, Fernand-Widal, hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - T Boulain
- Service de réanimation polyvalente, hôpital de La Source, centre hospitalier régional Orléans, 45067 Orléans, France
| | - L Contentin
- Service de réanimation polyvalente, hôpital Bretonneau, CHRU de Tours, 37000 Tours, France
| | - A Dechartres
- Inserm U1153, équipe « méthodes en évaluation thérapeutique des maladies chroniques », centre de recherche épidémiologie et biostatistique, centre Cochrane français, Hôtel-Dieu, 75004 Paris, France
| | - J-M Dejode
- Réanimation pédiatrique, hôpital Mère-Enfant, CHU de Nantes, 40000 Nantes, France
| | - L Donetti
- Service de réanimation, centre hospitalier Le Raincy-Montfermeil, 93370 Montfermeil, France
| | - M Fartoukh
- Unité de réanimation médicochirurgicale, hôpitaux universitaire Est Parisien, hôpital Tenon, AP-HP, 75020 Paris, France
| | - D Fletcher
- Département d'anesthésie, hôpitaux universitaires Paris Île-de-France Ouest, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - K Kuteifan
- Service de réanimation médicale, hôpital Émile-Muller, 68070 Mulhouse, France
| | - S Lasocki
- Pôle d'anesthésie réanimation, LUNAM université, université d'Angers, CHU d'Angers, 49000 Angers, France
| | - J-M Liet
- Réanimation pédiatrique, hôpital Mère-Enfant, CHU de Nantes, 40000 Nantes, France
| | - A-C Lukaszewicz
- Département d'anesthésie réanimation - réanimation chirurgicale et postopératoire, groupe hospitalier Saint-Louis-Lariboisière-Fernand-Widal, hôpital Lariboisière, AP-HP, 75010 Paris, France
| | - H Mal
- Service de pneumologie, hôpitaux universitaires Paris Nord Val-de-Seine, hôpital Bichat, AP-HP, 75018 Paris, France
| | - E Maury
- Service de réanimation médicale, hôpitaux universitaire Est Parisien, hôpital Saint-Antoine, AP-HP, 75020 Paris, France
| | - D Osman
- Service de réanimation médicale, EA 4533, université Paris-Sud, hôpitaux universitaires Paris-Sud, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - H Outin
- Service de réanimation médicochirurgicale, centre hospitalier intercommunal de Poissy-Saint-Germain-en-Laye, 78300 Poissy, France
| | - J-C Richard
- Service de réanimation médicale, hospices civils de Lyon, hôpital de la Croix-Rousse, 69004 Lyon, France
| | - F Schneider
- Service de réanimation médicale, faculté de médecine, université de Strasbourg, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, Hautepierre, France
| | - F Tamion
- Inserm U1096, IRIB, service de réanimation médicale, université de Rouen, CHU Charles-Nicolle, 76031 Rouen, France
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Richard C, Argaud L, Blet A, Boulain T, Contentin L, Dechartres A, Dejode JM, Donetti L, Fartoukh M, Fletcher D, Kuteifan K, Lasocki S, Liet JM, Lukaszewicz AC, Mal H, Maury E, Osman D, Outin H, Richard JC, Schneider F, Tamion F. Assistance extracorporelle au cours du syndrome de détresse respiratoire aiguë (chez l’adulte et l’enfant, à l’exclusion du nouveau-né). Conférence de consensus organisée par la Société de réanimation de langue française. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s13546-014-0858-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Annane D, Diehl JL, Drault JN, Farkas JC, Gouello JP, Fourrier F, Fraïsse F, Jars-Guincestre MC, Mira JP, Misset B, Outin H, Monnet X, Reignier J, Souweine B, Thevenin D, Vieillard-Baron A, Wolff M. Démographie et structures des services de réanimation français (hors réanimation chirurgicale): état des lieux. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13546-013-0647-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Crozier S, Santoli F, Outin H, Aegerter P, Ducrocq X, Bollaert PÉ. [Severe stroke: prognosis, intensive care admission and withhold and withdrawal treatment decisions]. Rev Neurol (Paris) 2011; 167:468-73. [PMID: 21565374 DOI: 10.1016/j.neurol.2011.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 11/26/2010] [Accepted: 01/17/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Stroke can produce irreversible brain damage of massive proportion leading to severe disability and poor quality of life. Resuscitation and mechanical ventilation of these patients remain controversial because of the high mortality and severe disability involved. STATE OF ART When prognosis is very poor, do-not-resuscitate orders (DNR orders) and withhold or withdrawal of treatment may be discussed. Studies have shown that DNR orders are relatively frequent in acute stroke: up to 30% of all patients, and 50% of which are given upon admission. DNR orders are closely associated with severity of the neurological deficit and age. Precise estimates of withhold and withdrawal of treatment are not available, but terminal extubations in severe stroke could contribute to 40,000 to 60,000 acute stage deaths per year. Little is known about the decision making process and palliative care in these situations. The neurological prognosis is the main explicit criterion. However, evaluation of neurological outcome is highly uncertain and difficult, and does not always reflect quality of life. Several studies have raised the issue of this disability paradox. Thus, physician estimation of prognosis has a profound impact on decisions for life sustaining therapies, and may lead to self-fulfilling prophecies in case of false appreciation of published evidence. Other criteria could influence the withhold and withdrawal of treatment decision, such as social conditions and patient values. PERSPECTIVES AND CONCLUSION Decisions for life-sustaining therapies in severe stroke are always difficult and often based on subjective and uncertain criteria. We have to improve prognosis estimation and our understanding of patient preferences to promote patient-centered care. An ethical approach may guide these complex decisions.
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Affiliation(s)
- S Crozier
- Service Urgences Cérébrovasculaires, CHU Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Outin H. [Emergency and intensive care unit management of status epilepticus Société de réanimation de langue française Experts Recommendations: the transient triumph of the followers of Sisyphus?]. Rev Neurol (Paris) 2009; 165:293-5. [PMID: 19296999 DOI: 10.1016/j.neurol.2009.01.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
A sedation strategy aimed at minimizing alteration of consciousness once comfort, analgesia and adaptation to the ventilator have been ensured is feasible in critically-ill patients requiring mechanical ventilation, even if, in patients with severe ARDS or ICH, the high dosages of sedatives and analgesics transiently required to provide perfect adaptation to the ventilator often preclude preservation of consciousness. The main components of a sedation algorithm include a clear objective of sedation-analgesia, regular assessments of patient status using validated clinical tools and a precise yet simple dosage adaptation schedule. Development and implementation of a sedation algorithm requires a multidisciplinary approach and an important input from both physicians and nurses. However, several methodologically-correct interventional studies have shown that using an algorithm to administrate sedatives and analgesics results in a significant reduction of MV duration, reaching 50% in some studies. This might translate into a real benefit for the patient point of view provided that preserving patient's comfort remains a constant concern for the caregivers. There is no reliable evidence to date to use propofol rather than midazolam as a sedative agent. Indeed, the way the sedative drug is used, as part of a sedation algorithm, is very likely more important than the selection of the drug itself. Analgesia-based sedation, promoting the use of morphinics alone before the adjunction of hypnotics, represents a new alternative to the traditional combined administration of hypnotics and morphinics. However data on the impact of analgesia-based sedation on patients' outcomes remain sparse to date.
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Affiliation(s)
- B De Jonghe
- Réanimation médicochirurgicale, centre hospitalier de Poissy, 10, rue du Champ-Gaillard, 78300 Poissy, France.
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Fangio P, Desbouchages L, Lachérade JC, De Jonghe B, Terville JP, Leneveu M, Outin H. Neisseria meningitidis C:2b:P1.2,5 with decreased susceptibility to penicillin isolated from a patient with meningitis and purpura fulminans. Eur J Clin Microbiol Infect Dis 2005; 24:140-1. [PMID: 15685394 DOI: 10.1007/s10096-005-1283-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This report describes the case of an 18-year-old woman with meningococcal meningitis and purpura fulminans. Cerebrospinal fluid culture revealed Neisseria meningitidis serogroup-serotype-serosubtype C:2b:P1.2,5 as the pathogenic organism. Following treatment with cefotaxime and management of multiple organ failure, the patient survived without sequelae. To the best of our knowledge this report represents the first case of a meningococcal strain with a minimum inhibitory concentration of 1.5 mug/ml for penicillin, without beta-lactamase production, to be documented in France. The prevalence of meningococci with reduced susceptibility to penicillin is increasing. The emergence of such strains might represent a serious problem affecting the empirical antibiotic treatment of meningococcal disease.
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Affiliation(s)
- P Fangio
- Intensive Care Unit, Poissy Hospital Center, 78300 Poissy Cedex, France.
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Fangio P, De Jonghe B, Pasquereau V, Lachérade JC, Outin H. [Giant cerebral aneurysm]. Ann Fr Anesth Reanim 2003; 22:676. [PMID: 12946505 DOI: 10.1016/s0750-7658(03)00204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Outin H, Liot P, De Jonghe B, Thomas P. [Management of adult refractory convulsive status epilepticus in the intensive care unit]. Rev Neurol (Paris) 2002; 158:1059-68. [PMID: 12451338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Patients with convulsive status epilepticus in whom first line treatment is not rapidly effective, or with a persistent delay in recovering consciousness must be admitted in an ICU even if assisted, mechanical ventilation is not performed. Continuous EEG monitoring performed in close collaboration with a neurophysiologist/epileptologist is mandatory to detect and treat subtle status epilepticus and to exclude post-anoxic encephalopathy. A number of drugs and anaesthetic agents have been proposed to control refractory status epilepticus. Midazolam and/or propofol have been recently recommended before performing general barbiturate anaesthesia. However, this approach is not rigorously assessed, because patients and series are heterogeneous, and controlled studies are difficult to design. Prognosis is closely related to the quality of initial management, to the development of subtle status epilepticus and, above all, to aetiology.
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Affiliation(s)
- H Outin
- Réanimation médicale, CHI Poissy/Saint-Germain-En-Laye, 78303 Poissy, France
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Tonnellier M, Nieszkowska A, Merrer J, Proost O, Outin H. [Enterococcal meningitis revealing endocarditis]. Presse Med 2002; 31:933-4. [PMID: 12148139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION Enterococci are frequently responsible for endocarditis, but a rare cause of meningitis. OBSERVATION A 55 years-old man presented with Enterococcus faecium meningitis. Systematic transoesophageal echocardiography (TOE), despite the absence of organic murmur and the negativity of the hemocultures, revealed a concomitant aortic endocarditis. CONCLUSION Review of the literature suggests that the association of endocarditis with enterococcal meningitis is far from accidental. We suggest that a TOS be conducted systematically when faced with this disease. The therapeutic implications are important, notably regarding the duration of antibiotherapy.
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Affiliation(s)
- M Tonnellier
- Service de réanimation médicale, Hôpital Saint-Antoine, 184, rue du faubourg Saint-Antoine, 75012 Paris.
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Woimant F, Hommel M, Adnet Bonte C, Baldauf E, Chedru F, Cohen A, de Broucker T, Devailly JP, Duclos H, Gaston A, Grobuis S, Kassiotis P, Levasseur M, Merland JJ, Mounier Vehier F, Nibbio A, Orgogozo JM, Outin H, Pinel F, Pruvo JP, Rancurel G, Saudeau D, Scart-Gres C, Sévène M, Touboul PJ, Vassel P, Zuber M, Arquizan C, Baron JC, Becker F, Bes A, Boulliat J, Bousser MG, Bracard S, Branchereau A, Castel JP, Caussanel JP, Civit J, Collard M, Davoine P, Deroudille L, Dumas R, Frerebeau P, Giroud M, Goldstein P, Lagarrigue J, Lejeune JP, Lestavel P, Leys D, Mahagne MH, Manelfe C, Mas JL, Masson M, Michel D, Moulin T, Perret J, Petit H, Proust B, Rouanet F, Rougemont D, Roux FX, Samson Y, Trouillas P. [Recommendations for the creation of neuro-vascular units]. Rev Neurol (Paris) 2001; 157:1447-56; discussion 1457-8. [PMID: 11924017] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- F Woimant
- Service de Neurologie, Hôpital Lariboisière, 2, rue Ambroise Paré, 75475 Paris
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Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, Rigaud JP, Casciani D, Misset B, Bosquet C, Outin H, Brun-Buisson C, Nitenberg G. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 2001; 286:700-7. [PMID: 11495620 DOI: 10.1001/jama.286.6.700] [Citation(s) in RCA: 764] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT Whether venous catheterization at the femoral site is associated with an increased risk of complications compared with that at the subclavian site is debated. OBJECTIVE To compare mechanical, infectious, and thrombotic complications of femoral and subclavian venous catheterization. DESIGN AND SETTING Concealed, randomized controlled clinical trial conducted between December 1997 and July 2000 at 8 intensive care units (ICUs) in France. PATIENTS Two hundred eighty-nine adult patients receiving a first central venous catheter. INTERVENTIONS Patients were randomly assigned to undergo central venous catheterization at the femoral site (n = 145) or subclavian site (n = 144). MAIN OUTCOME MEASURES Rate and severity of mechanical, infectious, and thrombotic complications, compared by catheterization site in 289, 270, and 223 patients, respectively. RESULTS Femoral catheterization was associated with a higher incidence rate of overall infectious complications (19.8% vs 4.5%; P<.001; incidence density of 20 vs 3.7 per 1000 catheter-days) and of major infectious complications (clinical sepsis with or without bloodstream infection, 4.4% vs 1.5%; P =.07; incidence density of 4.5 vs 1.2 per 1000 catheter-days), as well as of overall thrombotic complications (21.5% vs 1.9%; P<.001) and complete thrombosis of the vessel (6% vs 0%; P =.01); rates of overall and major mechanical complications were similar between the 2 groups (17.3% vs 18.8 %; P =.74 and 1.4% vs 2.8%; P =.44, respectively). Risk factors for mechanical complications were duration of insertion (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.08 per additional minute; P<.001); insertion in 2 of the centers (OR, 4.52; 95% CI, 1.81-11.23; P =.001); and insertion during the night (OR, 2.06; 95% CI, 1.04-4.08; P =.03). The only factor associated with infectious complications was femoral catheterization (hazard ratio [HR], 4.83; 95% CI, 1.96-11.93; P<.001); antibiotic administration via the catheter decreased risk of infectious complications (HR, 0.41; 95% CI, 0.18-0.93; P =.03). Femoral catheterization was the only risk factor for thrombotic complications (OR, 14.42; 95% CI, 3.33-62.57; P<.001). CONCLUSION Femoral venous catheterization is associated with a greater risk of infectious and thrombotic complications than subclavian catheterization in ICU patients.
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Affiliation(s)
- J Merrer
- Service de Réanimation Médicale, Hôpital de Poissy/St Germain-en-Laye, 10 Rue du Champ-Gaillard, 78303 Poissy, France.
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Santoli F, De Jonghe B, Hayon J, Tran B, Piperaud M, Merrer J, Outin H. Mechanical ventilation in patients with acute ischemic stroke: survival and outcome at one year. Intensive Care Med 2001; 27:1141-6. [PMID: 11534561 DOI: 10.1007/s001340100998] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the prognosis of patients with acute ischemic stroke who require mechanical ventilation and to determine early factors influencing mortality. DESIGN Prospective observational study. SETTING Medical intensive care unit with a cerebrovascular emergency unit in a university-affiliated hospital. PATIENTS Fifty-eight consecutive patients (mean age 65+/-13 years) requiring mechanical ventilation in the early course of an acute ischemic stroke. MEASUREMENTS AND RESULTS Clinical data were recorded before intubation according to a standardized procedure. Mortality and functional outcome were assessed after a 1-year follow-up. Mechanical ventilation was started within 48 h after admission in 53 patients (91.4%). The mean duration of ventilation was similar in survivors (9.7+/-9.0 days) and non-survivors (8.6+/-8.7 days). Mortality was 72.4% at 1 year. Among the 16 survivors, none were in a persistent vegetative state and 11 had a Barthel index of 60, reflecting good functional status. Bilateral absence of corneal reflex and bilateral absence of pupillary light reflex had a positive predictive value of death of 1 (95% CI 0.78-1.00 and 0.74-1.00, respectively). After Cox regression analysis, presence of stupor or coma (OR 2.6, 95% CI 1.5-5.0), bilateral absence of corneal reflex before intubation (OR 3.4, 95% CI 1.4-8.7) and presence of ischemic cardiopathy (OR 2.8, 95% CI 1.4-5.5) were independent predictors of mortality. CONCLUSIONS Systematic withholding of endotracheal intubation in patients with AIS is not recommended. Careful and rigorous neurologic examination, including assessment of brain stem reflexes, might help to identify patients with a very high probability of death despite mechanical ventilation.
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Affiliation(s)
- F Santoli
- Service de Réanimation Médicale, Centre Hospitalier de Poissy-Saint Germain en Laye, France
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Appere-De Vecchi C, De Jonghe B, Santoli F, Louboutin A, Outin H. Severe acute asthma with bowel infarction and pneumatosis intestinalis in a young adult. J Asthma 2001; 38:215-9. [PMID: 11392361 DOI: 10.1081/jas-100000108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A young patient presented with a small bowel infarction with pneumatosis intestinalis in the early course of life-threatening severe acute asthma. Low cardiac output with severe congestive right heart failure combined with the use of high doses of epinephrine to reverse the near-fatal bronchospasm probably contributed to this previously unreported complication. The presence of gas collections in the submucosal space was possibly the consequence of diffuse small bowel mucosal disruption. Early recognition of this unusual complication is of major importance to ensure appropriate therapeutic management.
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Abstract
Conventional treatment of Candida prosthetic joint infection usually includes surgery followed by a long period of antifungal medication. We report a case of Candida albicans prosthetic arthritis successfully treated with fluconazole alone.
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Affiliation(s)
- J Merrer
- Service de Réanimation Médicale Centre Hospitalier de Poissy / St Germain, France
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De Jonghe B, Appere-De-Vechi C, Fournier M, Tran B, Merrer J, Melchior JC, Outin H. A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Crit Care Med 2001; 29:8-12. [PMID: 11176150 DOI: 10.1097/00003246-200101000-00002] [Citation(s) in RCA: 248] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess the amount of nutrients delivered, prescribed, and required for critically ill patients and to identify the reasons for discrepancies between prescriptions and requirements and between prescriptions and actual delivery of nutrition. DESIGN Prospective cohort study. SETTING Twelve-bed medical intensive care unit in a university-affiliated general hospital. PATIENTS Fifty-one consecutive patients, receiving nutritional support either enterally or intravenously for > or = 2 days. We followed patients for the first 14 days of nutritional delivery. MEASUREMENTS AND MAIN RESULTS The amount of calories prescribed and the amount actually delivered were recorded daily and compared with the theoretical energy requirements. A combined regimen of enteral and parenteral nutrition was administered on 58% of the 484 nutrition days analyzed, and 63.5% of total caloric intake was delivered enterally. Seventy-eight percent of the mean caloric amount required was prescribed, and 71% was effectively delivered. The amount of calories actually delivered compared with the amount prescribed was significantly lower in enteral than in parenteral administration (86.8% vs. 112.4%, p < .001). Discrepancies between prescription and delivery of enterally administered nutrients were attributable to interruptions caused by digestive intolerance (27.7%, mean daily wasted volume 641 mL), airway management (30.8%, wasted volume 745 mL), and diagnostic procedures (26.6%, wasted volume 567 mL). Factors significantly associated with a low prescription rate of nutritional support were the administration of vasoactive drugs, central venous catheterization, and the need for extrarenal replacement. CONCLUSIONS An inadequate delivery of enteral nutrition and a low rate of nutrition prescription resulted in low caloric intake in our intensive care unit patients. A large volume of enterally administered nutrients was wasted because of inadequate timing in stopping and restarting enteral feeding. The inverse correlation between the prescription rate of nutrition and the intensity of care required suggests that physicians need to pay more attention to providing appropriate nutritional support for the most severely ill patients.
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Affiliation(s)
- B De Jonghe
- Service de Reanimation Medicale, Hopital de Poissy-Saint-Germain, France.
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Merrer J, Santoli F, Appéré de Vecchi C, Tran B, De Jonghe B, Outin H. "Colonization pressure" and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2000; 21:718-23. [PMID: 11089656 DOI: 10.1086/501721] [Citation(s) in RCA: 226] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the roles of "colonization pressure," work load or patient severity in patient acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units (ICUs). DESIGN Prospectively collected data from October 1996 through December 1998. SETTING A 12-bed medical ICU in a university-affiliated general hospital. PATIENTS Patients with risk factors for MRSA admitted to the ICU were screened within 72 hours of admission and weekly thereafter. MRSA was considered imported if detected during the first 72 hours of admission and nosocomial if detected only thereafter. Three screening strategies were used on admission during three consecutive periods. INTERVENTIONS The unit of time chosen for measurements was the week. Weekly colonization pressure (WCP) was defined as the number of MRSA-carrier patient-days/total number of patient-days. Patient severity (number of deaths, Simplified Acute Physiologic Score [SAPS] II), work load (number of admis sions, Omega score), and colonization pressure (number of MRSA carriers at the time of admission, WCP) were compared with the number of MRSA-nosocomial cases during the following week. RESULTS Of the 1,016 patients admitted over 116 weeks, 691 (68%) were screened. MRSA was imported in 91 (8.9%) admitted patients (13.1% of screened patients) and nosocomial in 46 (4.5%). The number of MRSA-nosocomial cases was correlated to the SAPS II (P=.007), the Omega 3 score (P=.007), the number of MRSA-imported cases (P=.01), WCP (P<.0001), and the screening period (P<.0001). In multivariate analysis, WCP was the only independent predictive factor for MRSA acquisition (P=.0002). Above 30% of WCP, the risk of acquisition of MRSA was approximately fivefold times higher (relative risk, 4.9; 95% confidence interval, 1.2-19.9; P<.0001). CONCLUSION Acquisition of MRSA in ICU patients is strongly and independently influenced by colonization pressure.
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Affiliation(s)
- J Merrer
- Service de Réanimation Médicale, Centre Hospitalier de Poissy, St Germain, France
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Abstract
OBJECTIVE To systematically review instruments for measuring the level and effectiveness of sedation in adult and pediatric ICU patients. STUDY IDENTIFICATION We searched MEDLINE, EMBASE, the Cochrane Library and reference lists of the relevant articles. We selected studies if the sedation instrument reported items related to consciousness and one or more additional items related to the effectiveness or side effects of sedation. DATA ABSTRACTION We extracted data on the description of the instrument and on their measurement properties (internal consistency, reliability, validity and responsiveness). RESULTS We identified 25 studies describing relevant sedation instruments. In addition to the level of consciousness, agitation and synchrony with the ventilator were the most frequently assessed aspects of sedation. Among the 25 instruments, one developed in pediatric ICU patients (the Comfort Scale), and 3 developed in adult ICU patients (the Ramsay scale, the Sedation-Agitation-Scale and the Motor Activity Assessment Scale), were tested for both reliability and validity. None of these instruments were tested for their ability to detect change in sedation status over time (responsiveness). CONCLUSION Many instruments have been used to measure sedation effectiveness in ICU patients. However, few of them exhibit satisfactory clinimetric properties. To help clinicians assess sedation at the bedside, to aid readers critically appraise the growing number of sedation studies in the ICU literature, and to inform the design of future investigations, additional information about the measurement properties of sedation effectiveness instruments is needed.
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Affiliation(s)
- B De Jonghe
- Service de Reanimation Medicale, Centre Hospitalier de Poissy-Saint-Germain, France.
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De Jonghe B, Cook D, Outin H. Reply. Intensive Care Med 1999. [DOI: 10.1007/s001340050922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Merrer J, Perin-Dureau F, Appéré C, Palmer P, Santoli F, De Jonghe B, Lebon P, Outin H. [Severe forms of rubella encephalitis: arguments for a better vaccination policy]. Presse Med 1999; 28:395-7. [PMID: 10093596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Two cases of rubella encephalitis in young adults are reported. CASES REPORTS 2 patients, 19 and 16-year-old, presented with severe encephalitis. One required mechanical ventilation. Neither were vaccinated against rubella. MRI scan of the brain was normal. The diagnosis was confirmed by serology. Good recovery was noted in both patients. DISCUSSION Both cases of rubella encephalitis occurring in young adults illustrate the severity of this rare disease. As already shown in Finland, improvement with the French vaccination policy should lead to the prevention of rubella encephalitis.
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Affiliation(s)
- J Merrer
- Service de réanimation médicale, Centre hospitalier intercommunal, Poissy/Saint-Germain.
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De Jonghe B, Cook D, Sharshar T, Lefaucheur JP, Carlet J, Outin H. Acquired neuromuscular disorders in critically ill patients: a systematic review. Groupe de Reflexion et d'Etude sur les Neuromyopathies En Reanimation. Intensive Care Med 1998; 24:1242-50. [PMID: 9885875 PMCID: PMC7094970 DOI: 10.1007/s001340050757] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To summarize the prospective clinical studies of neuromuscular abnormalities in intensive care unit (ICU) patients. STUDY IDENTIFICATION AND SELECTION: Studies were identified through MEDLINE, EMBASE, references in primary and review articles, personal files, and contact with authors. Through duplicate independent review, we selected prospective cohort studies evaluating ICU-acquired neuromuscular disorders. DATA ABSTRACTION In duplicate, independently, we abstracted key data regarding design features, the population, clinical and laboratory diagnostic tests, and clinical outcomes. RESULTS We identified eight studies that enrolled 242 patients. Inception cohorts varied; some were mechanically ventilated patients for > or = 5 days, others were based on a diagnosis of sepsis, organ failure, or severe asthma while others were selected on the basis of exposure to muscle relaxants, or because of participation in muscle biochemistry studies. Weakness was systematically assessed in two of the eight studies, concerning patients with severe asthma, with a reported frequency of 36 and 70%, respectively. Electrophysiologic and histologic abnormalities consisted of both peripheral nerve and muscle involvement and were frequently reported, even in non-selected ICU patients. In a population of patients mechanically ventilated for more than 5 days, electrophysiologic abnormalities were reported in 76 % of cases. Two studies showed a clinically important increase (5 and 9 days, respectively) in duration of mechanical ventilation and a mortality twice as high in patients with critical illness neuromuscular abnormalities, compared to those without. CONCLUSIONS Prospective studies of ICU-acquired neuromuscular abnormalities include a small number of patients with various electrophysiologic findings but insufficiently reported clinical correlations. Evaluation of risk factors for these disorders and studies examining their contribution to weaning difficulties and long-term disability are needed.
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Affiliation(s)
- B. De Jonghe
- />Service de Réanimation Médicale, Hôpital de Poissy, 10 rue du Champ-Gaillard, F-78 300 Poissy, France Tel.: + 33 139 27 5202 Fax: + 33 139 27 4446, , , , FR
| | - D. Cook
- />Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada, , , , CA
| | - T. Sharshar
- />Service de Réanimation Médicale, Hôpital Raymond Poincaré, Garches, France, , , , FR
| | - J.-P. Lefaucheur
- />Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Créteil, France, , , , FR
| | - J. Carlet
- />Service de Réanimation Polyvalente, Fondation Hôpital St. Joseph, Paris, France, , , , FR
| | - H. Outin
- />Service de Réanimation Médicale, Hôpital de Poissy, 10 rue du Champ-Gaillard, F-78 300 Poissy, France Tel.: + 33 139 27 5202 Fax: + 33 139 27 4446, , , , FR
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Merrer J, De Jonghe B, Hayon J, Outin H, Simon N, Nouailhat F. [Cellulitis of the thigh caused by Haemophilus influenzae in an adult]. Presse Med 1996; 25:171. [PMID: 8728905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Gajdos P, Outin H, Elkharrat D, Brunel D, de Rohan-Chabot P, Raphael JC, Goulon M, Goulon-Goeau C, Morel E. High-dose intravenous gammaglobulin for myasthenia gravis. Lancet 1984; 1:406-7. [PMID: 6198570 DOI: 10.1016/s0140-6736(84)90469-0] [Citation(s) in RCA: 126] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Manigand G, Boccara M, Puech I, Outin H. [Atloido-axoid dislocation in association with Reiter's syndrome]. Nouv Presse Med 1977; 6:3113. [PMID: 917823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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