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Cousin C, Di Maria J, Hartley S, Vaugier I, Delord V, Bensmail D, Prigent H, Léotard A. Predictive factors and screening strategy for obstructive sleep apnea in patients with advanced multiple sclerosis. Mult Scler Relat Disord 2024; 86:105608. [PMID: 38614056 DOI: 10.1016/j.msard.2024.105608] [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: 01/23/2023] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) screening questionnaires have been evaluated in Multiple Sclerosis (MS) but not yet validated in patients with advanced disease. The aim of this study is to identify OSA predictive factors in advanced MS and to discuss screening strategies. METHODS Oximetry data from 125 patients were retrospectively derived from polysomnographic reports. Univariate and multivariate analysis were used to determine predictive factors for OSA. A two-level screening model was assessed combining the oxygen desaturation index (ODI) and a method of visual analysis. RESULTS multivariate analysis showed that among the clinical factors only age and snoring were associated with OSA. Usual predictive factors such as sleepiness, Body mass index (BMI) or sex were not significantly associated with increased Apnea Hypopnea Index (AHI). The ODI was highly predictive (p < 0.0001) and correctly identified 84.1 % of patients with moderate OSA and 93.8 % with severe OSA. The visual analysis model combined with the ODI did not outperform the properties of ODI used alone. CONCLUSION As the usual clinical predictors are not associated with OSA in patients with advanced MS, questionnaires developed for the general population are not appropriate in these patients. Nocturnal oximetry seems a pertinent, ambulatory and accessible method for OSA screening in this population.
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Affiliation(s)
- C Cousin
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, Garches, France; Unité de recherche clinique Paris Saclay Ouest, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - J Di Maria
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, Garches, France; « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France
| | - S Hartley
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - I Vaugier
- Centre d'investigation clinique 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | | | - D Bensmail
- « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France; Service de médecine physique et de réadaptation, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - H Prigent
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, Garches, France; « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France
| | - A Léotard
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, Garches, France; « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France; Sleep Lab Initiative In PMR group (SLIIP), France.
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Orlikowski D, Mansencal N, Nguyen S, Wahbi K, Becane HM, Yaou RB, Leturcq F, Lofaso F, Prigent H, Dubourg O, Stojkovic T, Fontaine B, Duboc D, Annane D, Laforet P, Fayssoil A. Prognosis of right ventricular systolic dysfunction in Duchenne muscular dystrophy patients. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.091] [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: 12/31/2022]
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Lefeuvre C, Brisset M, Sarlon M, Petit N, Orlikowski D, Clair B, Thiry T, Carlier RY, Prigent H, Nicolas G, Annane D, Laforet P, Pouplin S. Nusinersen treatment in adults with severe spinal muscular atrophy: A real-life retrospective observational cohort study. Rev Neurol (Paris) 2022; 178:234-240. [PMID: 35000792 DOI: 10.1016/j.neurol.2021.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Spinal muscular atrophy (SMA) is a progressive neurodegenerative disease due to homozygous loss-of-function of the survival motor neuron gene SMN1 with absence of the functional SMN protein. Nusinersen, a costly intrathecally administered drug approved in 2017 in Europe, induces alternative splicing of the SMN2 gene, which then produces functional SMN protein, whose amount generally increases with the number of SMN2 gene copies. METHODS We retrospectively collected data from consecutive wheelchair-bound adults with SMA managed at a single center in 2018-2020. The following were collected at each injection, on days 1, 14, 28, 63, 183, and 303: 32-item Motor Function Measurement (MFM) total score and D2 and D3 subscores; the Canadian Occupational Performance Measure (COPM) performance and satisfaction scores; and lung function tests. The patients were divided into two groups based on whether their MFM total score was<or≥the mean (15.6%). Adverse events were recorded. RESULTS We identified 18 patients who received 4 to 8 Nusinersen injections. No significant improvements occurred over time in any of the MFM scores or lung function test results, which did not differ between groups. The COPM performance score improved significantly from day 0 to day 303 in the high-MFM group and the COPM satisfaction score in the overall population from D0 to D183. Half the patients achieved the minimal clinically important difference for both COPM scores. DISCUSSION The overall stability of conventional motor assessment in this population with advanced disabilities is encouraging to use more sensitive tools based on self-perception and autonomy in daily life activities, such as COPM. Our finding of a significant COPM performance score improvement from days 0 to 303 only in the patients with initial MFM-32 scores above the mean in the population suggests that the severity of the baseline disabilities may affect treatment efficacy. CLASSIFICATION OF EVIDENCE LEVEL IV, retrospective observational cohort study.
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Affiliation(s)
- C Lefeuvre
- Neurology department, Raymond-Poincaré university hospital, AP-HP, Garches, France; Nord-Est-Île-de-France neuromuscular reference center, FHU PHENIX, France; Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France.
| | - M Brisset
- Neurology department, Raymond-Poincaré university hospital, AP-HP, Garches, France; Nord-Est-Île-de-France neuromuscular reference center, FHU PHENIX, France; Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
| | - M Sarlon
- New Technologies Platform, Raymond-Poincaré hospital, AP-HP, Garches, France; Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
| | - N Petit
- Neurology department, Raymond-Poincaré university hospital, AP-HP, Garches, France; Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
| | - D Orlikowski
- Critical care medical department, Raymond-Poincaré hospital, AP-HP, Garches, France; CIC 1429 AP-HP INSERM, université Versailles-Saint-Quentin-en-Yvelines, Paris-Saclay, France; Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
| | - B Clair
- Critical care medical department, Raymond-Poincaré hospital, AP-HP, Garches, France; Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
| | - T Thiry
- Diagnostic and interventional medical imaging department, Raymond-Poincaré hospital, DMU smart imaging, GH université Paris-Saclay, AP-HP, Garches, France; Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
| | - R-Y Carlier
- U 1179 INSERM, université Versailles-Saint-Quentin-en-Yvelines, Paris-Saclay, France; Diagnostic and interventional medical imaging department, Raymond-Poincaré hospital, DMU smart imaging, GH université Paris-Saclay, AP-HP, Garches, France; Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
| | - H Prigent
- Nord-Est-Île-de-France neuromuscular reference center, FHU PHENIX, France; Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France; Physiology department, Raymond-Poincaré university hospital, AP-HP, Garches, France
| | - G Nicolas
- Neurology department, Raymond-Poincaré university hospital, AP-HP, Garches, France; Nord-Est-Île-de-France neuromuscular reference center, FHU PHENIX, France; U 1179 INSERM, université Versailles-Saint-Quentin-en-Yvelines, Paris-Saclay, France; Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
| | - D Annane
- Critical care medical department, Raymond-Poincaré hospital, AP-HP, Garches, France; Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
| | - P Laforet
- Neurology department, Raymond-Poincaré university hospital, AP-HP, Garches, France; Nord-Est-Île-de-France neuromuscular reference center, FHU PHENIX, France; U 1179 INSERM, université Versailles-Saint-Quentin-en-Yvelines, Paris-Saclay, France; Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
| | - S Pouplin
- New Technologies Platform, Raymond-Poincaré hospital, AP-HP, Garches, France; U 1179 INSERM, université Versailles-Saint-Quentin-en-Yvelines, Paris-Saclay, France; Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
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Fayssol A, Chaffaut C, Prigent H, Laforet P, Clair B, Orlikowsky D, Ogna A, Chevret S, Meng P, Annane D, Lofaso F, Crenn P. Nutrition et ventilation : le dilemme du patient myopathe adulte de type Duchenne. Analyse d’une cohorte de 117 patients en VAD (ventilation à domicile). NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Leotard A, Lebret M, Prigent H, Arnol N, Pépin JL, Hartley S, Lofaso F, Borel JC. Facteurs associés au masque de ventilation non invasive nocturne chez les patients neuromusculaires adultes. Rev Mal Respir 2020; 37:99-104. [DOI: 10.1016/j.rmr.2019.11.646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/26/2019] [Indexed: 11/29/2022]
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Fayssoil A, Yaou RB, Ogna A, Chaffaut C, Leturcq F, Nardi O, Lofaso F, Prigent H, Clair B, Chevret S, Orlikowski D, Annane D. Left bundle branch block in Duchenne muscular dystrophy: Prevalence, genetic relationship and prognosis. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Levy J, Prigent H, Bensmail D. Respiratory rehabilitation in multiple sclerosis: A narrative review of rehabilitation techniques. Ann Phys Rehabil Med 2017; 61:38-45. [PMID: 29128525 DOI: 10.1016/j.rehab.2017.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/24/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Respiratory disorders in multiple sclerosis (MS) are an important issue. They can occur early during the course of the disease, are associated with the neurological impairment, and can lead to pneumonia and respiratory failure, which are the main causes of death in advanced MS. Prevailing impaired expiratory muscles and cough abilities has been demonstrated in this population and might constitute a specific target for rehabilitation interventions. However, international guidelines lack recommendations regarding respiratory rehabilitation in MS. Here we performed a systematic review of the published literature related to respiratory rehabilitation in MS. METHODS We searched the databases MEDLINE via PubMed, PEDro and Cochrane Library for English or French reports of clinical trials and well-designed cohorts published up to December 2016 with no restriction on start date by using the search terms "multiple sclerosis", "respiratory rehabilitation", "respiratory muscle training", "lung volume recruitment", "cough assistance", and "mechanical in-exsufflation". Literature reviews, case reports and physiological studies were excluded. The Maastricht criteria were used to assess the quality of clinical trials. We followed the Oxford Centre for Evidence-Based Medicine guidelines to determine level of evidence and grade of recommendations. RESULTS Among the 21 reports of studies initially selected, 11 were retained for review. Seven studies were randomized controlled trials (RCTs), 2 were non-RCTs, and 2 were observational studies. Respiratory muscle training (inspiratory and/or expiratory) by use of a portable resistive mouthpiece was the most frequently evaluated technique, with 2 level-1 RCTs. Another level-1 RCT evaluated deep-breathing exercises. All reviewed studies evaluated home-based rehabilitation programs and focused on spirometric outcomes. The disparities in outcome measures among published studies did not allow for a meta-analysis and cough assistance devices were not evaluated in this population. CONCLUSION Although respiratory muscle training can improve maximal respiratory pressure in MS and lung volume recruitment can slow the decline in vital capacity, evidence is lacking to recommend specific respiratory rehabilitation programs adapted to the level of disability induced by the disease.
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Affiliation(s)
- J Levy
- Department of physical medicine and rehabilitation, Raymond-Poincaré university hospital, AP-HP, 92380 Garches, France; UMR 1179, Inserm, university of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France.
| | - H Prigent
- Department of physiology, Raymond-Poincaré university hospital, AP-HP, 92380 Garches, France; UMR 1179, Inserm, university of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France.
| | - D Bensmail
- Department of physical medicine and rehabilitation, Raymond-Poincaré university hospital, AP-HP, 92380 Garches, France; UMR 1179, Inserm, university of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France.
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Levy J, Bensmail D, Prigent H. Response to comments on: 'Respiratory impairment in multiple sclerosis: a study of respiratory function in wheelchair-bound patients'. Eur J Neurol 2017; 24:e49-e50. [PMID: 28707813 DOI: 10.1111/ene.13343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 05/15/2017] [Indexed: 11/30/2022]
Affiliation(s)
- J Levy
- Department of Physical and Rehabilitation Medicine, Raymond Poincaré Hospital, APHP, Garches, France.,UMR 1179 - INSERM, University of Versailles Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - D Bensmail
- Department of Physical and Rehabilitation Medicine, Raymond Poincaré Hospital, APHP, Garches, France.,UMR 1179 - INSERM, University of Versailles Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - H Prigent
- UMR 1179 - INSERM, University of Versailles Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France.,Department of Physiology and Functional Testing - Raymond Poincaré Hospital, Garches, France
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Levy J, Bensmail D, Brotier-Chomienne A, Butel S, Joussain C, Hugeron C, Prigent H. Respiratory impairment in multiple sclerosis: a study of respiratory function in wheelchair-bound patients. Eur J Neurol 2017; 24:497-502. [DOI: 10.1111/ene.13231] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/23/2016] [Indexed: 12/12/2022]
Affiliation(s)
- J. Levy
- Department of Physical Medicine and Rehabilitation; Raymond Poincaré University Hospital - APHP; Garches France
- UMR1179 - INSERM, Versailles Saint-Quentin-en-Yvelines University; Montigny-le-Bretonneux France
| | - D. Bensmail
- Department of Physical Medicine and Rehabilitation; Raymond Poincaré University Hospital - APHP; Garches France
- UMR1179 - INSERM, Versailles Saint-Quentin-en-Yvelines University; Montigny-le-Bretonneux France
| | - A. Brotier-Chomienne
- Department of Physical Medicine and Rehabilitation; Raymond Poincaré University Hospital - APHP; Garches France
| | - S. Butel
- Department of Physiology; Raymond Poincaré University Hospital - APHP; Garches France
| | - C. Joussain
- Department of Physical Medicine and Rehabilitation; Raymond Poincaré University Hospital - APHP; Garches France
- UMR1179 - INSERM, Versailles Saint-Quentin-en-Yvelines University; Montigny-le-Bretonneux France
| | - C. Hugeron
- Department of Physical Medicine and Rehabilitation; Raymond Poincaré University Hospital - APHP; Garches France
| | - H. Prigent
- UMR1179 - INSERM, Versailles Saint-Quentin-en-Yvelines University; Montigny-le-Bretonneux France
- Department of Physiology; Raymond Poincaré University Hospital - APHP; Garches France
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Papadopoulos C, Orlikowski D, Prigent H, Perniconi B, Taouagh N, Lacour A, Tard C, Furby A, Praline J, Solé G, Semplicini C, Kaminsky P, Eymard B, Hamroun D, Laforêt P. Effect of enzyme replacement therapy with alglucosidase alfa (Myozyme®) in 12 patients with advanced late-onset Pompe disease. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ogna A, Prigent H, Falaize L, Leroux K, Santos D, Vaugier I, Orlikowski D, Lofaso F. Évaluation sur banc des ventilateurs de domicile pour la ventilation par pièce buccale. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.352] [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: 11/25/2022]
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Dill C, Prigent H, Behin A, Piemonte F, Bertini E, Orlikowski D, Estournet B, Ferreiro A. Launching the first clinical trial in SEPN1-related myopathy: The SELNAC study. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Levy J, Prigent H, Butel S, Bensmail D. Respiratory dysfunction in multiple sclerosis: A preliminary study of respiratory dysfunction in patients with motor disability. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Orlikowski D, Prigent H. Myasthénie auto-immune, prise en charge et traitement. Réanimation 2014. [DOI: 10.1007/s13546-013-0812-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boyer FC, Rapin A, Reveillère C, Hardouin JB, Calmus A, Flucher A, Tiffreau V, Richard I, Gallais B, Eymard B, Fournier-Mehouas M, Dramé M, Prigent H, Bassez G, Moronne I, Novella JL, Jolly D. Nouveau questionnaire Qol-NMD v1.0 : mesures rapportées par les patients atteints de maladies musculaires d’origine génétique. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Prigent H. Anesthésie locale en odontologie : élaboration d’un document pi-sourd. Rev Epidemiol Sante Publique 2013. [DOI: 10.1016/j.respe.2013.07.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Lofaso F, Prigent H, Tiffreau V, Menoury N, Toussaint M, Finet Monnier A, Stremler N, Devaux C, Leroux K, Orlikowski D, Mauri C, Pin I, Sacconi S, Pereira C, Pepin JL, Fauroux B. Long-Term Mechanical Ventilation Equipment for Neuromuscular Patients: Meeting the Expectations of Patients and Prescribers. Respir Care 2013; 59:97-106. [DOI: 10.4187/respcare.02229] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Boudarham J, Pradon D, Prigent H, Vaugier I, Barbot F, Letilly N, Falaize L, Orlikowski D, Petitjean M, Lofaso F. Optoelectronic Vital Capacity Measurement for Restrictive Diseases. Respir Care 2013; 58:633-8. [DOI: 10.4187/respcare.01916] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Nardi J, Prigent H, Adala A, Bohic M, Lebargy F, Quera-Salva MA, Orlikowski D, Lofaso F. Nocturnal Oximetry and Transcutaneous Carbon Dioxide in Home-Ventilated Neuromuscular Patients. Respir Care 2012; 57:1425-30. [DOI: 10.4187/respcare.01658] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Nardi J, Prigent H, Garnier B, Lebargy F, Quera-Salva M, Orlikowski D, Lofaso F. Sommeil et efficacité de la ventilation invasive à domicile dans la dystrophie musculaire de Duchenne. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Nardi J, Prigent H, Adala A, Bohic M, Lebargy F, Quera-Salva M, Orlikowski D, Lofaso F. Évaluation nocturne de l’efficacité de la ventilation mécanique à domicile par oxymétrie et PtcCO2 dans les maladies neuromusculaires. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Lofaso F, Fauroux B, Orlikowski D, Prigent H. Daytime predictors of sleep-disordered breathing in neuromuscular patients to better schedule polysomnography. Eur Respir J 2011; 37:231-2. [DOI: 10.1183/09031936.00122610] [Citation(s) in RCA: 5] [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: 11/05/2022]
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Prigent H, Roche N, Laffont I, Lejaille M, Falaize L, Barbot F, Lofaso F. Relation between corset use and lung function postural variation in spinal cord injury. Eur Respir J 2009; 35:1126-9. [DOI: 10.1183/09031936.00034209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Daoud K, Gounant V, Prigent H, François T, Milleron B. [Diffuse interstitial pneumonitis with acute respiratory failure]. Rev Pneumol Clin 2007; 63:230-3. [PMID: 17675947 DOI: 10.1016/s0761-8417(07)90128-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Drug-induced pneumonia due to ibuprofen is exceptional. We report the case of hypoxic interstitial pneumonitis with eosinophilic alveolitis induced by ibuprofen. The resolution was spontaneously obtained by the stop of this drug.
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Affiliation(s)
- K Daoud
- Service de Pneumologie et Réanimation Respiratoire, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris Cedex 20
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Picard C, Parrot A, Prigent H, Fartoukh M, Mayaud C, Cadranel J. 518 Construction d’un score diagnostic de l’origine immune des hémorragies intra-alvéolaires (HIA) chez l’immunocompétent. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)72895-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Messika J, Stoclin A, Parrot A, Prigent H, Mayaud C, Fartoukh M. 49 Épidémiologie microbienne des pneumonies liées aux soins (Bourse SPLF 2006). Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)72424-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Andréjak C, Bazelly B, Prigent H, Parrot A, Stoclin A, Khalil A, Fartoukh M. 39 Place de la chirurgie dans la prise en charge des hémoptysies graves admises en réanimation. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)72414-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mayaud C, Fartoukh M, Prigent H, Parrot A, Cadranel J. [Critical evaluation and predictive value of clinical presentation in out-patients with acute community-acquired pneumonia]. Med Mal Infect 2006; 36:625-35. [PMID: 17084571 DOI: 10.1016/j.medmal.2006.07.014] [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] [Received: 06/02/2006] [Accepted: 07/21/2006] [Indexed: 10/23/2022]
Abstract
Diagnostic probability of community-acquired pneumonia (CAP) depends on data related to age and clinical and radiological findings. The critical evaluation of data in the literature leads to the following conclusions: 1) the prevalence of CAP in a given population with acute respiratory disease is 5% in outpatients and 10% in an emergency care unit. This could be as low as 2% in young people and even higher than 40% in hospitalized elderly patients; 2) the collection of clinical data is linked to the way the patient is examined and to the expertise of the clinician. The absolute lack of "vital signs" has a good negative predictive value in CAP; presence of unilateral crackles has a good positive predictive value; 3) there is a wide range of X-ray abnormalities: localized alveolar opacities; interstitial opacities, limited of diffused. The greatest radiological difficulties are encountered in old people with disorders including chronic respiratory or cardiac opacities and as a consequence of the high prevalence of bronchopneumonia episodes at this age; 4) among patients with lower respiratory tract (LRT) infections, the blood levels of leukocytes, CRP and procalcitonine are higher in CAP patients, mainly when their disease has a bacterial origin. Since you have not a threshold value reliably demonstrated in large populations with LRT infections or acute respiratory disease, presence or absence of these parameters could only be taken as a slight hint for a CAP diagnosis.
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Affiliation(s)
- C Mayaud
- Service de pneumologie et de réanimation respiratoire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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Orlikowski D, Prigent H, Gonzalez J, Sharshar T, Raphael JC. [Long term domiciliary mechanical ventilation in patients with neuromuscular disease (indications, establishment and follow up)]. Rev Mal Respir 2006; 22:1021-30. [PMID: 16598862 DOI: 10.1016/s0761-8425(05)85732-8] [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: 10/22/2022]
Abstract
UNLABELLED Neuromuscular diseases represent a heterogeneous group of pathologies which common feature is the development of a restrictive ventilatory failure. BACKGROUND Respiratory insufficiency of neuromuscular origin manifests itself by functional symptoms that must be carefully searched for in the history, such as headaches, sleep disorders, or dyspnoea of effort, sometimes very mild, or in severe cases associated with orthopnoea. Follow up should be multi-disciplinary. On the respiratory level regular measurement of blood gases, vital capacity, maximum inspiratory and expiratory pressures as well as sleep studies, will detect the criteria for mechanical ventilation (hypercarbia > 45 mm Hg, nocturnal desaturation < 88%, vital capacity < 60%, PImax < 60 cm H2O). STATE OF THE ART The establishment of mechanical ventilation is a major decision for patients with neuromuscular disease because of the important physical, psychological, social and sometimes financial consequences. The patients and their family must be instructed precisely in order to obtain the best possible observation and compliance. The establishment requires a stay in hospital of several days to optimise the choice of ventilator, its settings, and connections. The link with the organisation managing the domiciliary ventilation is fundamental in ensuring follow up after discharge from hospital. Techniques of cough assistance must be taught to each neuromuscular patient requiring mechanical ventilation. CONCLUSION Ventilation of neuromuscular patients requires careful evaluation of the indications and rigorous follow up by a multidisciplinary team with wide experience of this type of disease.
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Affiliation(s)
- D Orlikowski
- Service de réanimation médicale et pôle de ventilation 6 domicile, Hôpital Raymond Poincaré, Garches
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Prigent H, Orlikowski D, Blumen MB, Leroux K, Legrand L, Lejaille M, Falaize L, Ruquet M, Raphael JC, Lofaso F. Characteristics of tracheostomy phonation valves. Eur Respir J 2006; 27:992-6. [PMID: 16707394 DOI: 10.1183/09031936.06.00009405] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 11/05/2022]
Abstract
Phonation valves are commonly used devices that allow the restoration of speech in tracheostomised patients. However, their use should not compromise the physiological benefit of tracheostomy. Six commercialised phonation valves were studied in a dynamic set-up simulating a respiratory frequency of 20 breaths.min(-1), a tidal volume of 0.5 L and a peak flow rate of 0.5 L.s(-1). Resistance and additional work of breathing (WOB) were calculated. In 10 tracheostomised patients, evaluations using no phonation valve (baseline), and the most and one of the least resistive valves were carried out. Respiratory patterns and gas exchanges were recorded. Inspiratory difficulty was evaluated using the modified Borg scale. Valves displayed a wide array of resistance ranging 1.3-5.9 cmH2O.L(-1).s(-1). Additional WOB varied with a ratio of 4.4 between the best and the worst valve. While the different clinical conditions did not modify respiratory patterns and gas exchanges, a significant effect on the Borg scale rating was observed using ANOVA and post hoc analysis of baseline versus worst valve and one of the best valves versus worst valve. In conclusion, the variety of aerodynamic characteristics of phonation valves should be considered when choosing the device, according to the underlying condition of the patients benefiting from their use.
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Affiliation(s)
- H Prigent
- Service de Réanimation Médicale, Hôpital Raymond Poincaré, 92380 Garches, France
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Messika J, Berkane N, Parrot A, Prigent H, Mayaud C, Fartoukh M. Œdème pulmonaire au cours de la tocolyse par les inhibiteurs calciques. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)72311-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Durand MC, Prigent H, Sivadon-Tardy V, Orlikowski D, Caudie C, Devaux C, Clair B, Gaillard JL, Lofaso F, Raphael JC, Sharshar T. Significance of phrenic nerve electrophysiological abnormalities in Guillain-Barre syndrome. Neurology 2005; 65:1646-9. [PMID: 16301497 DOI: 10.1212/01.wnl.0000184589.62101.b9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors investigated whether the amplitude and latency of diaphragm compound muscle action potential helped predict respiratory failure in Guillain-Barré syndrome. Both variables were significantly but weakly correlated with vital capacity (VC) and were similar in unventilated (n = 60) and ventilated (n = 10) patients. In ventilated patients, motor loss severity, progression, and VC reduction were significantly greater, and bulbar dysfunction was more common. Predicting respiratory failure must rely on clinical features and VC.
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Affiliation(s)
- M C Durand
- Functional Testing Department, Raymond Poincaré Teaching Hospital, Garches, France
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Abstract
Speech is an essential component of quality of life for patients treated with long term mechanical ventilation. Therefore trying to improve phonation should always sought by physicians treating these patients. We review the different tools and techniques available in order to restore speech for patients with home mechanical ventilation whether ventilation is done continuously or not.
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Affiliation(s)
- J Gonzalez-Bermejo
- Service de pneumologie et de réanimation, Groupe Hospitalier PitiéSalpêtrière, Assistance Publique, Hôpitaux de Paris, France.
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Mayaud C, Fartoukh M, Prigent H, Lavolé A, Gounand V, Parrot A. [Acute forms of diffuse interstitial hypoxemic pneumonia in immunocompetent patients]. Rev Pneumol Clin 2005; 61:70-7. [PMID: 16012360 DOI: 10.1016/s0761-8417(05)84792-3] [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] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The large majority of patients with acute respiratory failure present diffuse pulmonary opacities resulting from pulmonary embolism, intra-alveolar hemorrhage, or a classical cause of ARDS. In a small number of patients however, these opacities correspond to diffuse interstitial pneumonia. This should be suspected in light of the context, the time of formation, and the unusual respiratory and/or extrarespiratory signs. If there is a clinical doubt, thoracic scan and bronchoalveolar lavage should be performed together with infectious and immunology tests. Treatment depends on the cause and/or the type of lesion.
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Affiliation(s)
- C Mayaud
- Service de Pneumologie et de Réanimation Respiratoire, Hôpital Tenon, 4 rue de la Chine, 75970 Paris.
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Lofaso F, Prigent H, Orlikowski D, Trebbia G, Lejaille M, Falaize L, Louis A, Ruquet M, Raphaël JC. [Neuromuscular diseases in adults: which respiratory muscle explorations for what type of management?]. Rev Mal Respir 2005; 22:2S78-85. [PMID: 15968800] [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: 05/03/2023]
Affiliation(s)
- F Lofaso
- Services de Reanimation Médicale, de Physiologie-Explorations Fonctionnelles et Centre d'lnnovations Technologiques, Hôpital Raymond Poincaré, AP-HP, Garches, France.
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Fuhrman C, Parrot A, Wislez M, Prigent H, Boussaud V, Bernaudin JF, Mayaud C, Cadranel J. Spectrum of CD4 to CD8 T-cell ratios in lymphocytic alveolitis associated with methotrexate-induced pneumonitis. Am J Respir Crit Care Med 2001; 164:1186-91. [PMID: 11673207 DOI: 10.1164/ajrccm.164.7.2010120] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The present study was conducted to confirm the presence of severe lymphocytic alveolitis and to determine the factors responsible for the very different alveolar CD4 to CD8 T-cell ratios (CD4/ CD8) described in methotrexate-induced pneumonitis (MTX-pneumonitis). Clinical and radiologic findings, as well as bronchoalveolar lavage (BAL) data, including CD4 and CD8 subset analysis, were retrospectively reviewed for patients hospitalized between 1985 and 2000 for MTX-pneumonitis. BAL cell counts from patients with MTX-pneumonitis (cases) were compared with those from patients receiving MTX but who did not have evidence of MTX toxicity (MTX-exposed patients) and those from healthy subjects (control subjects). Nineteen BAL were performed in 14 consecutive cases of MTX-pneumonitis. MTX was given for various underlying diseases. All cases presented a subacute diffuse interstitial pneumonitis that recovered, with MTX discontinuation and/or initiation of adjunctive steroid therapy. At the time of diagnosis, BAL cell counts in MTX-pneumonitis indicated severe lymphocytic alveolitis when compared with MTX-exposed patients and control subjects and moderate neutrophil alveolitis compared with control subjects. The lymphocytic alveolitis resulted from an increase in both CD4 and CD8 lymphocyte cell counts. Nevertheless, alveolar CD4/ CD8 T-cell ratios ranged from 0.4 to 9.6. CD4/CD8 values correlated positively with lymphocyte counts but negatively with time elapsed between last MTX administration and BAL and with steroid cumulative dose received by the patients. Severe lymphocytic alveolitis was confirmed in our series of MTX-pneumonitis. The between-patient variation in CD4/CD8 T-cell ratios may reflect the large range of time intervals between last MTX administration and BAL evaluation and the use of adjunctive steroid therapy.
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Affiliation(s)
- C Fuhrman
- Service de Pneumologie et de Réanimation Respiratoire, Hôpital Tenon, AP-HP, Paris, France
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Abstract
To evaluate the biocompatibility of a new titanium-tantalum alloy, with qualities superior to titanium alone, for use in oral implantology, fibroblast and epithelial cell lines were grown on plastic, titanium, copper, and titanium-tantalum supports. Studies using scanning electron microscopy, flow cytometry, and cytotoxicity assays were conducted to compare the different supports. Scanning electron microscopic observations showed high densities of fibroblasts and epithelial cells with well-developed attachment systems in the form of cytoplasmic projections. Cell densities were lower on titanium and titanium-tantalum surfaces than on plastic. Cell numbers, as determined by cytotoxicity assays, were significantly higher on plastic than on titanium or titanium-tantalum surfaces while fibroblasts proliferated better than epithelial cells on both metal surfaces. Flow cytometric analyses of cell cycles did not reveal any significant variations in the distribution of cells among the cycle phases on the three materials. We found no differences with regard to the parameters studied between titanium and the titanium-tantalum alloy.
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Affiliation(s)
- H Prigent
- Equipe de Biologie Buccale (EA 1256), UFR d'Odontologie, Université de Rennes, France
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