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Reignier J, Plantefeve G, Mira JP, Argaud L, Asfar P, Aissaoui N, Badie J, Botoc NV, Brisard L, Bui HN, Chatellier D, Chauvelot L, Combes A, Cracco C, Darmon M, Das V, Debarre M, Delbove A, Devaquet J, Dumont LM, Gontier O, Groyer S, Guérin L, Guidet B, Hourmant Y, Jaber S, Lambiotte F, Leroy C, Letocart P, Madeux B, Maizel J, Martinet O, Martino F, Maxime V, Mercier E, Nay MA, Nseir S, Oziel J, Picard W, Piton G, Quenot JP, Reizine F, Renault A, Richecoeur J, Rigaud JP, Schneider F, Silva D, Sirodot M, Souweine B, Tamion F, Terzi N, Thévenin D, Thiery G, Thieulot-Rolin N, Timsit JF, Tinturier F, Tirot P, Vanderlinden T, Vinatier I, Vinsonneau C, Voicu S, Lascarrou JB, Le Gouge A. Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3). Lancet Respir Med 2023; 11:602-612. [PMID: 36958363 DOI: 10.1016/s2213-2600(23)00092-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/10/2023] [Accepted: 02/27/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND The optimal calorie and protein intakes at the acute phase of severe critical illness remain unknown. We hypothesised that early calorie and protein restriction improved outcomes in these patients, compared with standard calorie and protein targets. METHODS The pragmatic, randomised, controlled, multicentre, open-label, parallel-group NUTRIREA-3 trial was performed in 61 French intensive care units (ICUs). Adults (≥18 years) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned to early nutrition (started within 24 h after intubation) with either low or standard calorie and protein targets (6 kcal/kg per day and 0·2-0·4 g/kg per day protein vs 25 kcal/kg per day and 1·0-1·3 g/kg per day protein) during the first 7 ICU days. The two primary endpoints were time to readiness for ICU discharge and day 90 all-cause mortality. Key secondary outcomes included secondary infections, gastrointestinal events, and liver dysfunction. The trial is registered on ClinicalTrials.gov, NCT03573739, and is completed. FINDINGS Of 3044 patients randomly assigned between July 5, 2018, and 8 Dec 8, 2020, eight withdrew consent to participation. By day 90, 628 (41·3%) of 1521 patients in the low group and 648 (42·8%) of 1515 patients in the standard group had died (absolute difference -1·5%, 95% CI -5·0 to 2·0; p=0·41). Median time to readiness for ICU discharge was 8·0 days (IQR 5·0-14·0) in the low group and 9·0 days (5·0-17·0) in the standard group (hazard ratio [HR] 1·12, 95% CI 1·02 to 1·22; p=0·015). Proportions of patients with secondary infections did not differ between the groups (HR 0·85, 0·71 to 1·01; p=0·06). The low group had lower proportions of patients with vomiting (HR 0·77, 0·67 to 0·89; p<0·001), diarrhoea (0·83, 0·73 to 0·94; p=0·004), bowel ischaemia (0·50, 0·26 to 0·95; p=0·030), and liver dysfunction (0·92, 0·86-0·99; p=0·032). INTERPRETATION Compared with standard calorie and protein targets, early calorie and protein restriction did not decrease mortality but was associated with faster recovery and fewer complications. FUNDING French Ministry of Health.
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Affiliation(s)
- Jean Reignier
- Movement, Interactions, Performance, UR 4334, Nantes Université, Nantes, France; Médecine Intensive Réanimation, CHU de Nantes, Hôtel-Dieu, Nantes, France.
| | - Gaetan Plantefeve
- Service de Médecine Intensive Réanimation, Centre Hospitalier d'Argenteuil, Argenteuil, France
| | - Jean-Paul Mira
- Service de Médecine Intensive Réanimation, Hôpital Cochin, Groupe Hospitalier Paris Centre-Université Paris Cité, AP-HP, Paris, France
| | - Laurent Argaud
- Service de Médecine Intensive Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Pierre Asfar
- Service de Médecine Intensive Réanimation, CHU Angers, Angers, France
| | - Nadia Aissaoui
- Service de Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Julio Badie
- Service de Médecine Intensive Réanimation, Hôpital Nord Franche Comté, Trevenans, France
| | - Nicolae-Vlad Botoc
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint Malo, Saint-Malo, France
| | - Laurent Brisard
- Service d'Anesthésie RéanimationChirurgicale, Hôpital Laënnec, CHU de Nantes, Nantes, France
| | - Hoang-Nam Bui
- Service de Médecine Intensive Réanimation, CHU de Bordeaux, Bordeaux, France
| | - Delphine Chatellier
- Service de Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France
| | - Louis Chauvelot
- Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Alain Combes
- Service de Médecine Intensive Réanimation, Sorbonne Université, Inserm, UMRS 1166-ICAN, Institute of Cardiometabolism and Nutrition, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Christophe Cracco
- Service de Médecine Intensive Réanimation, Centre Hospitalier d'Angoulême, Angoulême, France
| | - Michael Darmon
- Université Paris Cité, Service de Médecine Intensive Réanimation, CHU Saint Louis, AP-HP, Paris, France
| | - Vincent Das
- Service de Médecine Intensive Réanimation, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
| | - Matthieu Debarre
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Agathe Delbove
- Service de Réanimation Polyvalente, Centre Hospitalier Bretagne-Atlantique, Vannes, France
| | - Jérôme Devaquet
- Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France
| | - Louis-Marie Dumont
- Service de Médecine Intensive Réanimation, Hôpital Louis-Mourier, AP-HP, Colombes, France
| | - Olivier Gontier
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Chartres, Chartres, France
| | - Samuel Groyer
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Montauban, Montauban, France
| | - Laurent Guérin
- Service de Médecine Intensive Réanimation, CHU Bicêtre, AP-HP, Paris, France
| | - Bertrand Guidet
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Service de Médecine IntensiveRéanimation, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Yannick Hourmant
- CHU de Nantes, Inserm, Nantes Université, Anesthesie Reanimation, CIC 1413, Nantes, France
| | - Samir Jaber
- Service de Réanimation Chirurgicale, Hôpital Saint-Eloi, CHU de Montpellier, Montpellier, France; PhyMedExp, Inserm, CNRS, Montpellier, France
| | - Fabien Lambiotte
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Christophe Leroy
- Service de Médecine Intensive Réanimation, Centre Hospitalier Emile Roux, Le Puy-en-Velay, France
| | - Philippe Letocart
- Service de Médecine Intensive Réanimation, Centre Hospitalier Jacques Puel, Rodez, France
| | - Benjamin Madeux
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Bigorre, Tarbes, France
| | - Julien Maizel
- Service de Médecine Intensive Réanimation, CHU Amiens-Picardie, Amiens, France
| | - Olivier Martinet
- Service de Médecine Intensive Réanimation, CHU de la Réunion, Saint-Denis, La Réunion, France
| | - Frédéric Martino
- Service de Médecine Intensive Réanimation, CHU de la Guadeloupe, Abymes, Guadeloupe, France
| | - Virginie Maxime
- Service de Médecine Intensive Réanimation, Hôpital Raymond Poincaré, AP-HP, Garches, France; Inserm U 1173, Université de Versailles-Saint Quentin en Yvelines, Versailles, France
| | - Emmanuelle Mercier
- Service de Médecine Intensive Réanimation, CHU de Tours, CRICS-TRIGGERSEP Network Tours, France
| | - Mai-Anh Nay
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, CHU Lille, France; CNRS, Inserm, UMR 8576-U1285, Unité de Glycobiologie Structurale et Fonctionnelle, Université de Lille, France
| | - Johanna Oziel
- Service de Médecine Intensive Réanimation, Hôpital Avicenne, AP-HP, Bobigny, France
| | - Walter Picard
- Service deMédecine Intensive Réanimation, Centre Hospitalier de Pau, Pau, France
| | - Gael Piton
- Service de Médecine Intensive Réanimation, CHU de Besançon, Besançon, France; Université de Franche Comté, Equipe EA 3920, Besançon, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive Réanimation, CHU François Mitterrand, Dijon, France; Lipness Team, Inserm, LabExLipSTIC France; Inserm Centres d'Investigation Clinique, Département d'Epidémiologie Clinique, Université de Bourgogne, Dijon, France
| | - Florian Reizine
- Service de Médecine Intensive Réanimation, CHU de Rennes, Rennes, France
| | - Anne Renault
- Service de Médecine Intensive Réanimation, CHU la Cavale Blanche, Brest, France
| | - Jack Richecoeur
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Beauvais, Beauvais, France
| | - Jean-Philippe Rigaud
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Dieppe, France
| | - Francis Schneider
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Daniel Silva
- Service de Médecine Intensive Réanimation, Hôpital Delafontaine, Saint-Denis, France
| | - Michel Sirodot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Bertrand Souweine
- Service de Médecine Intensive Réanimation, CHU Gabriel-Montpied, Clermont-Ferrand, France
| | - Fabienne Tamion
- Service de Médecine Intensive Réanimation, Hôpital Charles Nicolle, CHU de Rouen, Normandie Université, UNIROUEN, Inserm U1096, FHU REMOD-VHF, Rouen, France
| | - Nicolas Terzi
- Service de Médecine Intensive Réanimation, Université de Grenoble-Alpes, Inserm U1042, Grenoble, France
| | - Didier Thévenin
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France
| | - Guillaume Thiery
- Service de Médecine Intensive Réanimation, CHU de Saint Étienne, Saint Priest en Jarez, France
| | - Nathalie Thieulot-Rolin
- Service de Médecine Intensive Réanimation, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Jean-Francois Timsit
- Service de Médecine Intensive Réanimation, CHU Bichat-Claude Bernard, AP-HP, Paris, France; Université Paris-Cité, Inserm IAME, U1137, Team DesCID, Paris, France
| | - Francois Tinturier
- Service de Réanimation Chirurgicale, CHU Amiens-Picardie, Amiens, France
| | - Patrice Tirot
- Service de Médecine Intensive Réanimation, Centre Hospitalier du Mans, Le Mans, France
| | - Thierry Vanderlinden
- Service de Médecine Intensive Réanimation, Groupement Hospitalier de l'Institut Catholique de Lille, FMMS-ETHICS EA 7446, Université Catholique de Lille, Lille, France
| | - Isabelle Vinatier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Béthune, Béthune, France
| | - Sebastian Voicu
- Service de Médecine Intensive Réanimation, CHU Lariboisière, AP-HP, Paris, France
| | - Jean-Baptiste Lascarrou
- Movement, Interactions, Performance, UR 4334, Nantes Université, Nantes, France; Médecine Intensive Réanimation, CHU de Nantes, Hôtel-Dieu, Nantes, France
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Lentjes EGWM, Bui HN, Ruhaak LR, Kema IP, Coene KLM, van den Ouweland JMW. LC-MS/MS in Clinical Chemistry: did it live up to its promise?: Consideration from the Dutch EQAS organisation. Clin Chim Acta 2023; 546:117391. [PMID: 37196897 DOI: 10.1016/j.cca.2023.117391] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Over the past decade the use of LC-MS/MS has increased significantly in the hospital laboratories. Clinical laboratories have switched from immunoassays to LC-MS/MS methods due to the promise of improvements in sensitivity and specificity, better standardization with often non-commutable international standards, and better between-laboratory comparison. However, it remains unclear whether routine performance of the LC-MS/MS methods have met these expectations. METHOD This study examined the EQAS results, from the Dutch SKML, of serum cortisol, testosterone, 25OH-vitaminD and cortisol in urine and saliva over 9 surveys (2020 to first half of 2021). RESULTS The study found a significant increase in the number of compounds and in the number of results measured in the different matrices, with LC-MS/MS over a period of eleven years. In 2021, approximately 4000 LC-MS/MS results were submitted (serum: urine: saliva = 58:31:11%) compared to only 34 in 2010. When compared to the individual immunoassays, the LC-MS/MS based methods for serum cortisol, testosterone and 25OH-vitaminD showed comparable but also higher between-laboratory CVs in different samples of the surveys. For cortisol, testosterone and 25OH-vitaminD the median CV was 6.8%, 6.1% and 4.7% respectively for the LC-MS/MS compared to 3.9-8.0%,4.5-6.7%, and 7.5-18.3% for immunoassays. However, the bias and imprecision of the LC-MS/MS was better than that of the immunoassays. CONCLUSION Despite the expectation that LC-MS/MS methods would result in smaller between-laboratory differences, as they are relatively matrix independent and better to standardize, the results of the SKML round robins do not reflect this for some analytes and may be in part explained by the fact that in most cases laboratory developed tests were used.
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Affiliation(s)
- E G W M Lentjes
- Central Diagnostic Laboratory, University Medical Center Utrecht, The Netherlands.
| | - H N Bui
- Clinical Chemistry , Reinier de Graaf Groep Diagnostisch Centrum SSDZ, The Netherlands
| | - L R Ruhaak
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, The Netherlands
| | - I P Kema
- Department of Laboratory Medicine, University Medical Center Groningen, the Netherlands
| | - K L M Coene
- Laboratory of Clinical Chemistry & Hematology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands
| | - J M W van den Ouweland
- Department of Clinical Chemistry, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Enaud R, Sioniac P, Imbert S, Janvier PL, Camino A, Bui HN, Pillet O, Orieux A, Boyer A, Berger P, Gruson D, Delhaes L, Prevel R. Lung Mycobiota α-Diversity Is Linked to Severity in Critically Ill Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Microbiol Spectr 2023:e0506222. [PMID: 36976010 PMCID: PMC10100765 DOI: 10.1128/spectrum.05062-22] [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] [Indexed: 03/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) affects more than 200 million people worldwide. The chronic course of COPD is frequently worsened by acute exacerbations (AECOPD). Mortality in patients hospitalized for severe AECOPD remains dramatically high, and the underlying mechanisms are poorly understood. Lung microbiota is associated with COPD outcomes in nonsevere AECOPD, but no study specifically investigated severe AECOPD patients. The aim of this study is thus to compare lung microbiota composition between severe AECOPD survivors and nonsurvivors. Induced sputum or endotracheal aspirate was collected at admission from every consecutive severe AECOPD patient. After DNA extraction, the V3-V4 and ITS2 regions were amplified by PCR. Deep-sequencing was performed on a MiSeq sequencer (Illumina); the data were analyzed using DADA2 pipeline. Among 47 patients admitted for severe AECOPD, 25 (53%) with samples of sufficient quality were included: 21 of 25 (84%) survivors and 4 of 25 (16%) nonsurvivors. AECOPD nonsurvivors had lower α-diversities indices than survivors for lung mycobiota but not for lung bacteriobiota. Similar results were demonstrated comparing patients receiving invasive mechanical ventilation (n = 13 [52%]) with those receiving only noninvasive ventilation (n = 12 [48%]). Previous systemic antimicrobial therapy and long-term inhaled corticosteroid therapy could alter the lung microbiota composition in severe AECOPD patients. In acidemic AECOPD, lower lung mycobiota α-diversity is linked to the severity of the exacerbation, assessed by mortality and the requirement for invasive mechanical ventilation, whereas lung bacteriobiota α-diversity is not. This study encourages a multicenter cohort study investigating the role of lung microbiota, especially fungal kingdom, in severe AECOPD. IMPORTANCE In AECOPD with acidemia, more severe patients-i.e., nonsurvivors and patients requiring invasive mechanical ventilation-have lower lung mycobiota α-diversity than survivors and patients receiving only noninvasive ventilation, respectively. This study encourages a large multicenter cohort study investigating the role of lung microbiota in severe AECOPD and urges investigation of the role of the fungal kingdom in severe AECOPD.
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Affiliation(s)
- Raphaël Enaud
- Université Bordeaux, Center de Recherche Cardio-Thoracique de Bordeaux, INSERM UMR 1045, Bordeaux, France
- Centre Hospitalier Universitaire Bordeaux, Le Centre de Ressources et de Compétences de la Mucoviscidose Pédiatrique, CIC 1401, Bordeaux, France
| | - Pierre Sioniac
- Centre Hospitalier Universitaire Bordeaux, Medical Intensive Care Unit, Bordeaux, France
| | - Sebastien Imbert
- Université Bordeaux, Center de Recherche Cardio-Thoracique de Bordeaux, INSERM UMR 1045, Bordeaux, France
- Centre Hospitalier Universitaire Bordeaux, Mycology-Parasitology Department, CIC 1401, Bordeaux, France
| | - Pierre-Laurent Janvier
- Centre Hospitalier Universitaire Bordeaux, Medical Intensive Care Unit, Bordeaux, France
| | - Adrian Camino
- Université Bordeaux, Center de Recherche Cardio-Thoracique de Bordeaux, INSERM UMR 1045, Bordeaux, France
| | - Hoang-Nam Bui
- Centre Hospitalier Universitaire Bordeaux, Medical Intensive Care Unit, Bordeaux, France
| | - Odile Pillet
- Centre Hospitalier Universitaire Bordeaux, Medical Intensive Care Unit, Bordeaux, France
| | - Arthur Orieux
- Centre Hospitalier Universitaire Bordeaux, Medical Intensive Care Unit, Bordeaux, France
| | - Alexandre Boyer
- Université Bordeaux, Center de Recherche Cardio-Thoracique de Bordeaux, INSERM UMR 1045, Bordeaux, France
- Centre Hospitalier Universitaire Bordeaux, Medical Intensive Care Unit, Bordeaux, France
| | - Patrick Berger
- Université Bordeaux, Center de Recherche Cardio-Thoracique de Bordeaux, INSERM UMR 1045, Bordeaux, France
| | - Didier Gruson
- Université Bordeaux, Center de Recherche Cardio-Thoracique de Bordeaux, INSERM UMR 1045, Bordeaux, France
- Centre Hospitalier Universitaire Bordeaux, Medical Intensive Care Unit, Bordeaux, France
| | - Laurence Delhaes
- Université Bordeaux, Center de Recherche Cardio-Thoracique de Bordeaux, INSERM UMR 1045, Bordeaux, France
- Centre Hospitalier Universitaire Bordeaux, Mycology-Parasitology Department, CIC 1401, Bordeaux, France
| | - Renaud Prevel
- Université Bordeaux, Center de Recherche Cardio-Thoracique de Bordeaux, INSERM UMR 1045, Bordeaux, France
- Centre Hospitalier Universitaire Bordeaux, Medical Intensive Care Unit, Bordeaux, France
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4
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Piton G, Le Gouge A, Boisramé-Helms J, Anguel N, Argaud L, Asfar P, Botoc V, Bretagnol A, Brisard L, Bui HN, Canet E, Chatelier D, Chauvelot L, Darmon M, Das V, Devaquet J, Djibré M, Ganster F, Garrouste-Orgeas M, Gaudry S, Gontier O, Groyer S, Guidet B, Herbrecht JE, Hourmant Y, Lacherade JC, Letocart P, Martino F, Maxime V, Mercier E, Mira JP, Nseir S, Quenot JP, Richecoeur J, Rigaud JP, Roux D, Schnell D, Schwebel C, Silva D, Sirodot M, Souweine B, Thieulot-Rolin N, Tinturier F, Tirot P, Thévenin D, Thiéry G, Lascarrou JB, Reignier J. Factors associated with acute mesenteric ischemia among critically ill ventilated patients with shock: a post hoc analysis of the NUTRIREA2 trial. Intensive Care Med 2022; 48:458-466. [PMID: 35190840 DOI: 10.1007/s00134-022-06637-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/27/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Acute mesenteric ischemia (AMI) is a rare, but life-threatening condition occurring among critically ill patients. Several factors have been associated with AMI, but the causal link is debated, most studies being retrospective. Among these factors, enteral nutrition (EN) could be associated with AMI, in particular among patients with shock. We aimed to study the factors independently associated with AMI in a post hoc analysis of the NUTRIREA-2 trial including 2410 critically ill ventilated patients with shock, randomly assigned to receive EN or parenteral nutrition (PN). METHODS Post hoc analysis of the NUTRIREA-2 trial was conducted. Ventilated adults with shock were randomly assigned to receive EN or PN. AMI was assessed by computed tomography, endoscopy, or laparotomy. Factors associated with AMI were studied by univariate and multivariate analysis. RESULTS 2410 patients from 44 French intensive care units (ICUs) were included in the study: 1202 patients in the enteral group and 1208 patients in the parenteral group. The median age was 67 [58-76] years, with 67% men, a SAPS II score of 59 [46-74], and a medical cause for ICU admission in 92.7%. AMI was diagnosed among 24 (1%) patients, mainly by computed tomography (79%) or endoscopy (38%). The mechanism of AMI was non-occlusive mesenteric ischemia (n = 12), occlusive (n = 4), and indeterminate (n = 8). The median duration between inclusion in the trial and AMI diagnosis was 4 [1-11] days. Patients with AMI were older, had a higher SAPS II score at ICU admission, had higher plasma lactate, creatinine, and ASAT concentrations and lower hemoglobin concentration, had more frequently EN, dobutamine, and CVVHDF at inclusion, developed more frequently bacteremia during ICU stay, and had higher 28-day and 90-day mortality rates compared with patients without AMI. By multivariate analysis, AMI was independently associated with EN, dobutamine use, SAPS II score ≥ 62 and hemoglobin concentration ≤ 10.9 g/dL. CONCLUSION Among critically ill ventilated patients with shock, EN, dobutamine use, SAPS II score ≥ 62 and hemoglobin ≤ 10.9 g/dL were independently associated with AMI. Among critically ill ventilated patients requiring vasopressors, EN should be delayed or introduced cautiously in case of low cardiac output requiring dobutamine and/or in case of multiple organ failure with high SAPS II score.
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Affiliation(s)
- Gaël Piton
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Besançon, Besançon, France. .,Service de Réanimation Médicale, CHRU de Besançon, Boulevard Fleming, 25030, Besançon, France.
| | - Amélie Le Gouge
- Inserm CIC 1415, Tours, France.,Centre Hospitalier Universitaire de Tours, Tours, France
| | - Julie Boisramé-Helms
- EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nadia Anguel
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Argaud
- Service de Médecine Intensive Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Pierre Asfar
- 6 Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Angers, Angers, France
| | - Vlad Botoc
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint Malo, Saint-Malo, France
| | - Anne Bretagnol
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Laurent Brisard
- Service d'Anesthésie Réanimation Chirurgicale, Hopital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Hoang-Nam Bui
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Emmanuel Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Université de Nantes, Nantes, France
| | - Delphine Chatelier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Louis Chauvelot
- Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Michael Darmon
- 16 Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Das
- Service de Médecine Intensive Réanimation, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
| | - Jérôme Devaquet
- Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France
| | - Michel Djibré
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | - Stéphane Gaudry
- Service de Médecine Intensive Réanimation, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Olivier Gontier
- 25 Service de Médecine Intensive Réanimation, Centre Hospitalier de Chartres, Chartres, France
| | - Samuel Groyer
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Montauban, Montauban, France
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins,, 75012, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France
| | - Jean-Etienne Herbrecht
- Service de Médecine Intensive Réanimation, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Yannick Hourmant
- Centre Hospitalier Universitaire de Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation ChirurgicaleHôtel Dieu, 44093, Nantes, France
| | - Jean-Claude Lacherade
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France
| | - Philippe Letocart
- Service de Médecine Intensive Réanimation, Centre Hospitalier Jacques Puel, Rodez, France
| | - Frédéric Martino
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Pointe-à-Pitre-Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Virginie Maxime
- Service de Médecine Intensive Réanimation, Hôpital Raymond Poincaré, Assistance Publique des Hôpitaux de Paris, Garches, France.,Inserm U 1173, Université de Versailles-Saint Quentin en Yvelines, Versailles, France
| | - Emmanuelle Mercier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bretonneau, CRICS-TRIGGERSEP Network, Tours, France
| | - Jean-Paul Mira
- Service de Médecine Intensive Réanimation, Hôpital Cochin, Groupe Hospitalier Centre-Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Saad Nseir
- CHU de Lille, Médecine Intensive Réanimation, Lille, France.,Université de Lille, Inserm U1285, CNRS, UMR 8576-UGSF, Unité de Glycobiologie Structurale et Fonctionnelle, 59000, Lille, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire François Mitterrand, Dijon, France.,Lipness Team, INSERM, LabExLipSTICUniversité de Bourgogne, Dijon, France.,INSERM Centres d'Investigation Clinique, Département d'épidémiologie clinique, Université de Bourgogne, Dijon, France
| | - Jack Richecoeur
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Beauvais, Beauvais, France
| | - Jean-Philippe Rigaud
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Dieppe, France
| | - Damien Roux
- Service de Médecine Intensive Réanimation, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France
| | - David Schnell
- Service de Médecine Intensive Réanimation, Centre Hospitalier d'Angoulême, Angoulême, France
| | - Carole Schwebel
- Service de Médecine Intensive Réanimation, Université de Grenoble-Alpes, Grenoble, France.,INSERM 1039, Grenoble, France
| | - Daniel Silva
- Service de Médecine Intensive Réanimation, Hôpital Delafontaine, Saint-Denis, France
| | - Michel Sirodot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Annecy Genevois, Pringy, France
| | - Bertrand Souweine
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Gabriel-Montpied, Clermont-Ferrand, France
| | | | - François Tinturier
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Patrice Tirot
- Service de Médecine Intensive Réanimation, Centre Hospitalier du Mans, Le Mans, France
| | - Didier Thévenin
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France
| | - Guillaume Thiéry
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Saint Etienne, Saint Priest en Jarez, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Université de Nantes, Nantes, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Université de Nantes, Nantes, France
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Reignier J, Le Gouge A, Lascarrou JB, Annane D, Argaud L, Hourmant Y, Asfar P, Badie J, Nay MA, Botoc NV, Brisard L, Bui HN, Chatellier D, Chauvelot L, Combes A, Cracco C, Darmon M, Das V, Debarre M, Delbove A, Devaquet J, Voicu S, Aissaoui-Balanant N, Dumont LM, Oziel J, Gontier O, Groyer S, Guidet B, Jaber S, Lambiotte F, Leroy C, Letocart P, Madeux B, Maizel J, Martinet O, Martino F, Mercier E, Mira JP, Nseir S, Picard W, Piton G, Plantefeve G, Quenot JP, Renault A, Guérin L, Richecoeur J, Rigaud JP, Schneider F, Silva D, Sirodot M, Souweine B, Reizine F, Tamion F, Terzi N, Thévenin D, Thiéry G, Thieulot-Rolin N, Timsit JF, Tinturier F, Tirot P, Vanderlinden T, Vinatier I, Vinsonneau C, Maugars D, Giraudeau B. Impact of early low-calorie low-protein versus standard-calorie standard-protein feeding on outcomes of ventilated adults with shock: design and conduct of a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3). BMJ Open 2021; 11:e045041. [PMID: 33980526 PMCID: PMC8117996 DOI: 10.1136/bmjopen-2020-045041] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION International guidelines include early nutritional support (≤48 hour after admission), 20-25 kcal/kg/day, and 1.2-2 g/kg/day protein at the acute phase of critical illness. Recent data challenge the appropriateness of providing standard amounts of calories and protein during acute critical illness. Restricting calorie and protein intakes seemed beneficial, suggesting a role for metabolic pathways such as autophagy, a potential key mechanism in safeguarding cellular integrity, notably in the muscle, during critical illness. However, the optimal calorie and protein supply at the acute phase of severe critical illness remains unknown. NUTRIREA-3 will be the first trial to compare standard calorie and protein feeding complying with guidelines to low-calorie low-protein feeding. We hypothesised that nutritional support with calorie and protein restriction during acute critical illness decreased day 90 mortality and/or dependency on intensive care unit (ICU) management in mechanically ventilated patients receiving vasoactive amine therapy for shock, compared with standard calorie and protein targets. METHODS AND ANALYSIS NUTRIREA-3 is a randomised, controlled, multicentre, open-label trial comparing two parallel groups of patients receiving invasive mechanical ventilation and vasoactive amine therapy for shock and given early nutritional support according to one of two strategies: early calorie-protein restriction (6 kcal/kg/day-0.2-0.4 g/kg/day) or standard calorie-protein targets (25 kcal/kg/day, 1.0-1.3 g/kg/day) at the acute phase defined as the first 7 days in the ICU. We will include 3044 patients in 61 French ICUs. Two primary end-points will be evaluated: day 90 mortality and time to ICU discharge readiness. The trial will be considered positive if significant between-group differences are found for one or both alternative primary endpoints. Secondary outcomes include hospital-acquired infections and nutritional, clinical and functional outcomes. ETHICS AND DISSEMINATION The NUTRIREA-3 study has been approved by the appropriate ethics committee. Patients are included after informed consent. Results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03573739.
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Affiliation(s)
- Jean Reignier
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Amélie Le Gouge
- INSERM CIC 1415, Centre Hospitalier Regional Universitaire de Tours, Tours, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Djillali Annane
- Service de Médecine Intensive Réanimation, Hôpital Raymond Poincaré, Garches, France
| | - Laurent Argaud
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Yannick Hourmant
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, CHU Nantes, Nantes, France
| | - Pierre Asfar
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Julio Badie
- Service de Médecine Intensive Réanimation, Hôpital Nord Franche-Comté, Montbeliard, France
| | - Mai-Anh Nay
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orleans Hôpital de La Source, Orleans, France
| | - Nicolae-Vlad Botoc
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint-Malo, Saint-Malo, France
| | - Laurent Brisard
- Service d'Anesthésie Réanimation Chirurgicale, CHU Nantes, Nantes, France
| | - Hoang-Nam Bui
- Service de Médecine Intensive Réanimation, CHU de Bordeaux, Bordeaux, France
| | | | - Louis Chauvelot
- Service de Médecine Intensive Réanimation, CHU Lyon, Lyon, France
| | - Alain Combes
- Service de Médecine Intensive Réanimation, Hôpital Universitaire Pitié Salpêtrière, Paris, France
| | - Christophe Cracco
- Service de Médecine Intensive Réanimation, Centre Hospitalier d'Angouleme, Angouleme, France
| | - Michael Darmon
- Service de Médecine Intensive Réanimation, Hôpital Saint-Louis, Paris, France
| | - Vincent Das
- Médecine Intensive Réanimation, CHI André Grégoire, Montreuil, France
| | - Matthieu Debarre
- Médecine Intensive Réanimation, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Agathe Delbove
- Réanimation Polyvalente, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Jérôme Devaquet
- Medical-Surgical Intensive Care Unit, Hôpital Foch, Suresnes, France
| | - Sebastian Voicu
- Médecine Intensive Réanimation, Hopital Lariboisiere, Paris, France
| | - Nadia Aissaoui-Balanant
- Médecine Intensive Réanimation, Hôpital Europeen Georges-Pompidou - Broussais, Paris, France
| | - Louis-Marie Dumont
- Service de Médecine Intensive Réanimation, Hôpital Louis-Mourier, Colombes, France
| | - Johanna Oziel
- Service de Médecine Intensive Réanimation, Hôpital Avicenne, Bobigny, France
| | - Olivier Gontier
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Chartres, Chartres, France
| | - Samuel Groyer
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Montauban, Montauban, France
| | - Bertrand Guidet
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Paris, France
| | - Samir Jaber
- Service de Réanimation Chirurgicale, Hôpital Saint-Eloi, Montpellier, France
| | - Fabien Lambiotte
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Christophe Leroy
- Service de Médecine Intensive Réanimation, Centre Hospitalier Emile Roux, Le Puy en Velay, France
| | - Philippe Letocart
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Rodez, Rodez, France
| | - Benjamin Madeux
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Bigorre, Tarbes, France
| | - Julien Maizel
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Olivier Martinet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, France
| | - Frédéric Martino
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Pointe-à-Pitre Abymes, Pointe-a-Pitre, Guadeloupe
| | - Emmanuelle Mercier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Jean-Paul Mira
- Service de Médecine Intensive Réanimation, Hôpital Cochin, Paris, France
| | - Saad Nseir
- Service de Médecine Intensive Réanimation, CHU Lille, Lille, France
| | - Walter Picard
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Pau, Pau, France
| | - Gael Piton
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | - Gaetan Plantefeve
- Service de Médecine Intensive Réanimation, Centre Hospitalier d'Argenteuil, Argenteuil, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Anne Renault
- Service de Médecine Intensive Réanimation, CHRU de Brest, Brest, France
| | - Laurent Guérin
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin-Bicetre, France
| | - Jack Richecoeur
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Beauvais, Beauvais, France
| | - Jean Philippe Rigaud
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Dieppe, France
| | - Francis Schneider
- Service de Médecine Intensive Réanimation, Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - Daniel Silva
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint Denis, Saint Denis, France
| | - Michel Sirodot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Bertrand Souweine
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Florian Reizine
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Fabienne Tamion
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Nicolas Terzi
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Grenoble Alpes Hopital Michallon, La Tronche, France
| | - Didier Thévenin
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France
| | - Guillaume Thiéry
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | | | - Jean-François Timsit
- Service de Médecine Intensive Réanimation, Hôpital Bichat - Claude-Bernard, Paris, France
| | - François Tinturier
- Réanimation Chirurgicale, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Patrice Tirot
- Service de Médecine Intensive Réanimation, Centre Hospitalier du Mans, Le Mans, France
| | - Thierry Vanderlinden
- Service de Médecine Intensive Réanimation, Institut Catholique de Lille, Lille, France
| | - Isabelle Vinatier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Béthune, Bethune, France
| | - Diane Maugars
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Bruno Giraudeau
- INSERM CIC 1415, Centre Hospitalier Regional Universitaire de Tours, Tours, France
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Rubin S, Orieux A, Prevel R, Garric A, Bats ML, Dabernat S, Camou F, Guisset O, Issa N, Mourissoux G, Dewitte A, Joannes-Boyau O, Fleureau C, Rozé H, Carrié C, Petit L, Clouzeau B, Sazio C, Bui HN, Pillet O, Rigothier C, Vargas F, Combe C, Gruson D, Boyer A. Characterization of acute kidney injury in critically ill patients with severe coronavirus disease 2019. Clin Kidney J 2020; 13:354-361. [PMID: 32695326 PMCID: PMC7314187 DOI: 10.1093/ckj/sfaa099] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-associated acute kidney injury (AKI) frequency, severity and characterization in critically ill patients has not been reported. METHODS Single-centre cohort performed from 3 March 2020 to 14 April 2020 in four intensive care units in Bordeaux University Hospital, France. All patients with COVID-19 and pulmonary severity criteria were included. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. A systematic urinary analysis was performed. The incidence, severity, clinical presentation, biological characterization (transient versus persistent AKI; proteinuria, haematuria and glycosuria) and short-term outcomes were evaluated. RESULTS Seventy-one patients were included, with basal serum creatinine (SCr) of 69 ± 21 µmol/L. At admission, AKI was present in 8/71 (11%) patients. Median [interquartile range (IQR)] follow-up was 17 (12-23) days. AKI developed in a total of 57/71 (80%) patients, with 35% Stage 1, 35% Stage 2 and 30% Stage 3 AKI; 10/57 (18%) required renal replacement therapy (RRT). Transient AKI was present in only 4/55 (7%) patients and persistent AKI was observed in 51/55 (93%). Patients with persistent AKI developed a median (IQR) urine protein/creatinine of 82 (54-140) (mg/mmol) with an albuminuria/proteinuria ratio of 0.23 ± 20, indicating predominant tubulointerstitial injury. Only two (4%) patients had glycosuria. At Day 7 after onset of AKI, six (11%) patients remained dependent on RRT, nine (16%) had SCr >200 µmol/L and four (7%) had died. Day 7 and Day 14 renal recovery occurred in 28% and 52%, respectively. CONCLUSION Severe COVID-19-associated AKI is frequent, persistent, severe and characterized by an almost exclusive tubulointerstitial injury without glycosuria.
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Affiliation(s)
- Sébastien Rubin
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
- Unité INSERM U1034, Université de Bordeaux, Bordeaux, France
| | - Arthur Orieux
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Renaud Prevel
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Antoine Garric
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Marie-Lise Bats
- Service de Biochimie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
- Unité INSERM U1034, Université de Bordeaux, Bordeaux, France
| | - Sandrine Dabernat
- Service de Biochimie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Fabrice Camou
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Olivier Guisset
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Nahema Issa
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Gaelle Mourissoux
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Antoine Dewitte
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Catherine Fleureau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Hadrien Rozé
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Cédric Carrié
- Service d’Anesthésie-Réanimation, Pellegrin CHU de Bordeaux, Bordeaux, France
| | - Laurent Petit
- Service d’Anesthésie-Réanimation, Pellegrin CHU de Bordeaux, Bordeaux, France
| | - Benjamin Clouzeau
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Charline Sazio
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Hoang-Nam Bui
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Odile Pillet
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Claire Rigothier
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Frederic Vargas
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Christian Combe
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Didier Gruson
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Alexandre Boyer
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
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Lannou A, Prevel R, Hilbert G, Bui HN. Acute respiratory distress syndrome and cutaneous eruption in an immunocompetent adult. Intensive Care Med 2020; 46:806-807. [PMID: 31588979 PMCID: PMC7095304 DOI: 10.1007/s00134-019-05803-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/25/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Alexandre Lannou
- CHU Bordeaux, Medical Intensive Care Unit, Pellegrin Hospital, 33000, Bordeaux, France
| | - Renaud Prevel
- CHU Bordeaux, Medical Intensive Care Unit, Pellegrin Hospital, 33000, Bordeaux, France.
- CHU Bordeaux, FHU ACRONIM, 33000, Bordeaux, France.
| | - Gilles Hilbert
- CHU Bordeaux, Medical Intensive Care Unit, Pellegrin Hospital, 33000, Bordeaux, France
| | - Hoang-Nam Bui
- CHU Bordeaux, Medical Intensive Care Unit, Pellegrin Hospital, 33000, Bordeaux, France
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8
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Reignier J, Boisramé-Helms J, Brisard L, Lascarrou JB, Ait Hssain A, Anguel N, Argaud L, Asehnoune K, Asfar P, Bellec F, Botoc V, Bretagnol A, Bui HN, Canet E, Da Silva D, Darmon M, Das V, Devaquet J, Djibre M, Ganster F, Garrouste-Orgeas M, Gaudry S, Gontier O, Guérin C, Guidet B, Guitton C, Herbrecht JE, Lacherade JC, Letocart P, Martino F, Maxime V, Mercier E, Mira JP, Nseir S, Piton G, Quenot JP, Richecoeur J, Rigaud JP, Robert R, Rolin N, Schwebel C, Sirodot M, Tinturier F, Thévenin D, Giraudeau B, Le Gouge A. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet 2018; 391:133-143. [PMID: 29128300 DOI: 10.1016/s0140-6736(17)32146-3] [Citation(s) in RCA: 298] [Impact Index Per Article: 49.7] [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] [Received: 04/18/2017] [Revised: 06/20/2017] [Accepted: 07/17/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition. METHODS In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20-25 kcal/kg per day), within 24 h after intubation. Randomisation was stratified by centre using permutation blocks of variable sizes. Given that route of nutrition cannot be masked, blinding of the physicians and nurses was not feasible. Patients receiving parenteral nutrition could be switched to enteral nutrition after at least 72 h in the event of shock resolution (no vasopressor support for 24 consecutive hours and arterial lactate <2 mmol/L). The primary endpoint was mortality on day 28 after randomisation in the intention-to-treat-population. This study is registered with ClinicalTrials.gov, number NCT01802099. FINDINGS After the second interim analysis, the independent Data Safety and Monitoring Board deemed that completing patient enrolment was unlikely to significantly change the results of the trial and recommended stopping patient recruitment. Between March 22, 2013, and June 30, 2015, 2410 patients were enrolled and randomly assigned; 1202 to the enteral group and 1208 to the parenteral group. By day 28, 443 (37%) of 1202 patients in the enteral group and 422 (35%) of 1208 patients in the parenteral group had died (absolute difference estimate 2·0%; [95% CI -1·9 to 5·8]; p=0·33). Cumulative incidence of patients with ICU-acquired infections did not differ between the enteral group (173 [14%]) and the parenteral group (194 [16%]; hazard ratio [HR] 0·89 [95% CI 0·72-1·09]; p=0·25). Compared with the parenteral group, the enteral group had higher cumulative incidences of patients with vomiting (406 [34%] vs 246 [20%]; HR 1·89 [1·62-2·20]; p<0·0001), diarrhoea (432 [36%] vs 393 [33%]; 1·20 [1·05-1·37]; p=0·009), bowel ischaemia (19 [2%] vs five [<1%]; 3·84 [1·43-10·3]; p=0·007), and acute colonic pseudo-obstruction (11 [1%] vs three [<1%]; 3·7 [1·03-13·2; p=0·04). INTERPRETATION In critically ill adults with shock, early isocaloric enteral nutrition did not reduce mortality or the risk of secondary infections but was associated with a greater risk of digestive complications compared with early isocaloric parenteral nutrition. FUNDING La Roche-sur-Yon Departmental Hospital and French Ministry of Health.
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Affiliation(s)
- Jean Reignier
- Médecine Intensive Réanimation, CHU de Nantes, Nantes, France; Université de Nantes, Nantes, France.
| | - Julie Boisramé-Helms
- EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France; Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Laurent Brisard
- CHU de Nantes, Hôpital Laennec, Département d'Anesthésie et Réanimation, Nantes, France
| | - Jean-Baptiste Lascarrou
- Médecine Intensive Réanimation, CHU de Nantes, Nantes, France; Université de Nantes, Nantes, France
| | - Ali Ait Hssain
- Medical Intensive Care Unit, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nadia Anguel
- Medical Intensive Care Unit, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Karim Asehnoune
- Surgical Intensive Care Unit, Hotel Dieu, CHU de Nantes, Nantes, France; Université de Nantes, Nantes, France
| | - Pierre Asfar
- Medical Intensive Care and Hyperbaric Oxygen Therapy Unit, Centre Hospitalier Universitaire Angers, Angers, France; Laboratoire de Biologie Neurovasculaire et Mitochondriale Intégrée, CNRS UMR 6214 - INSERM U1083, Université Angers, UBL, Angers, France
| | - Frédéric Bellec
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Montauban, Montauban, France
| | - Vlad Botoc
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Saint-Malo, Saint-Malo, France
| | - Anne Bretagnol
- Medical Intensive Care Unit, CHR Orléans, Orléans, France
| | - Hoang-Nam Bui
- Medical Intensive Care Unit, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Emmanuel Canet
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Daniel Da Silva
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Michael Darmon
- Medical-Surgical Intensive Care Unit, University Hospital, Saint Etienne, France
| | - Vincent Das
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
| | - Jérôme Devaquet
- Medical-Surgical Intensive Care Unit, Hôpital Foch, Suresnes, France
| | - Michel Djibre
- Medical-Surgical Intensive Care Unit, Tenon University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Maité Garrouste-Orgeas
- UMR 1137, IAME Team 5, Decision Sciences in Infectious Diseases (DeSCID), Control and Care, Sorbonne Paris Cité, Inserm-Paris Diderot University, Paris, France; Medical-Surgical Unit, Hôpital Saint-Joseph, Paris France; Medical Unit and Palliative Research Group, French and British Institute, Levallois-Perret, France; OUTCOMEREA Research Group, Drancy, France
| | - Stéphane Gaudry
- Medical-Surgical Intensive Care Unit, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France; Université Paris Diderot, ECEVE, UMR 1123, Sorbonne Paris Cité, Paris, France
| | - Olivier Gontier
- Medical-Surgical Intensive Care Unit, Hôpital de Chartres, Chartres, France
| | - Claude Guérin
- Medical Intensive Care Unit, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France; Université de Lyon, IMRB INSERM 955, Lyon, France
| | - Bertrand Guidet
- Medical Intensive Care Unit, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Sorbonne Université, UPMC Université Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, Paris, France
| | | | - Jean-Etienne Herbrecht
- Medical Intensive Care Unit, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Faculté de Médecine U1121, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Jean-Claude Lacherade
- Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France
| | - Philippe Letocart
- Medical-Surgical Intensive Care Unit, Hôpital Jacques Puel, Rodez, France
| | - Frédéric Martino
- Medical-Surgical Intensive Care Unit, CHU de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Virginie Maxime
- Medical-Surgical Intensive Care Unit, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Emmanuelle Mercier
- Médecine Intensive Réanimation, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Jean-Paul Mira
- Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Saad Nseir
- Medical Intensive Care Unit, CHU Lille, Lille, France; Université Lille, Medicine School, Lille, France
| | - Gael Piton
- Medical Intensive Care Unit, CHRU Besançon, Besançon, France; EA3920, Université de Franche Comté, Besançon, France
| | - Jean-Pierre Quenot
- Medical-Surgical Intensive Care Unit, François Mitterrand University Hospital, Dijon, France; Lipness Team, INSERM UMR 866 and LabExLipSTIC, Université de Bourgogne, Dijon, France
| | - Jack Richecoeur
- Medical-Surgical Intensive Care Unit, Hôpital de Beauvais, Beauvais, France
| | | | - René Robert
- Medical Intensive Care Unit, CHU Poitiers, Poitiers, France; Université de Poitiers, INSERM CIC1402, Poitiers, France
| | - Nathalie Rolin
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Melun, Melun, France
| | - Carole Schwebel
- Medical Intensive Care Unit, CHU Albert Michallon Grenoble, Grenoble, France; Inserm U1039, Radiopharmaceutiques Biocliniques, Université Grenoble Alpes, La Tronche, France
| | - Michel Sirodot
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy, France
| | | | - Didier Thévenin
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Docteur Schaffner, Lens, France
| | - Bruno Giraudeau
- Inserm CIC 1415, Tours, France; Université de Tours, Tours, France; CHU Tours, Tours, France; Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Amélie Le Gouge
- Inserm CIC 1415, Tours, France; Université de Tours, Tours, France; CHU Tours, Tours, France
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Vargas F, Clavel M, Sanchez-Verlan P, Garnier S, Boyer A, Bui HN, Clouzeau B, Sazio C, Kerchache A, Guisset O, Benard A, Asselineau J, Gauche B, Gruson D, Silva S, Vignon P, Hilbert G. Intermittent noninvasive ventilation after extubation in patients with chronic respiratory disorders: a multicenter randomized controlled trial (VHYPER). Intensive Care Med 2017; 43:1626-1636. [PMID: 28393258 DOI: 10.1007/s00134-017-4785-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Early noninvasive ventilation (NIV) after extubation decreases the risk of respiratory failure and lowers 90-day mortality in patients with hypercapnia. Patients with chronic respiratory disease are at risk of extubation failure. Therefore, it could be useful to determine the role of NIV with a discontinuous approach, not limited to patients with hypercapnia. We assessed the efficacy of early NIV in decreasing respiratory failure after extubation in patients with chronic respiratory disorders. METHODS A prospective randomized controlled multicenter study was conducted. We enrolled 144 mechanically ventilated patients with chronic respiratory disorders who tolerated a spontaneous breathing trial. Patients were randomly allocated after extubation to receive either NIV (NIV group, n = 72), performed with a discontinuous approach, for the first 48 h, or conventional oxygen treatment (usual care group, n = 72). The primary endpoint was decreased respiratory failure within 48 h after extubation. Analysis was by intention to treat. This trial was registered with ClinicalTrials.gov (NCT01047852). RESULTS Respiratory failure after extubation was less frequent in the NIV group: 6 (8.5%) versus 20 (27.8%); p = 0.0016. Six patients (8.5%) in the NIV group versus 13 (18.1%) in the usual care group were reintubated; p = 0.09. Intensive care unit (ICU) mortality and 90-day mortality did not differ significantly between the two groups (p = 0.28 and p = 0.33, respectively). Median postrandomization ICU length of stay was lower in the usual care group: 3 days (IQR 2-6) versus 4 days (IQR 2-7; p = 0.008). Patients with hypercapnia during a spontaneous breathing trial were at risk of developing postextubation respiratory failure [adjusted odds ratio (95% CI) = 4.56 (1.59-14.00); p = 0.006] and being intubated [adjusted odds ratio (95% CI) = 3.60 (1.07-13.31); p = 0.04]. CONCLUSIONS Early NIV performed following a sequential protocol for the first 48 h after extubation decreased the risk of respiratory failure in patients with chronic respiratory disorders. Reintubation and mortality did not differ between NIV and conventional oxygen therapy.
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Affiliation(s)
- Frédéric Vargas
- Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Centre Hospitalier Universitaire (CHU) de Bordeaux, 1 Place Amélie Raba-Léon, 33076, Bordeaux, France. .,Centre de Recherche Cardio-Thoracique, INSERM 1045, CIC 0005, Université de Bordeaux, Bordeaux, France.
| | - Marc Clavel
- Service de Réanimation Polyvalente, CHU de Limoges, Hôpital Dupuytren, Limoges, France
| | | | - Sylvain Garnier
- Service de Réanimation Polyvalente, Centre Hospitalier d'Albi, Albi, France
| | - Alexandre Boyer
- Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Centre Hospitalier Universitaire (CHU) de Bordeaux, 1 Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Hoang-Nam Bui
- Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Centre Hospitalier Universitaire (CHU) de Bordeaux, 1 Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Benjamin Clouzeau
- Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Centre Hospitalier Universitaire (CHU) de Bordeaux, 1 Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Charline Sazio
- Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Centre Hospitalier Universitaire (CHU) de Bordeaux, 1 Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Aissa Kerchache
- Service de Réanimation Polyvalente, Centre Hospitalier d'Agen, Agen, France
| | - Olivier Guisset
- Service de Réanimation Médicale, CHU de Bordeaux, Hôpital Saint-André, Bordeaux, France
| | - Antoine Benard
- Service d'Information Médicale, CHU de Bordeaux, Pôle de Santé Publique, USMR, Bordeaux, France
| | - Julien Asselineau
- Service d'Information Médicale, CHU de Bordeaux, Pôle de Santé Publique, USMR, Bordeaux, France
| | - Bernard Gauche
- Service de Réanimation Polyvalente, Centre Hospitalier de Libourne, Libourne, France
| | - Didier Gruson
- Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Centre Hospitalier Universitaire (CHU) de Bordeaux, 1 Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Stein Silva
- Service de Réanimation Polyvalente, CHU de Toulouse, Hôpital Purpan, Toulouse, France.,INSERM, URM 1214, Université de Toulouse, Toulouse, France
| | - Philippe Vignon
- Service de Réanimation Polyvalente, CHU de Limoges, Hôpital Dupuytren, Limoges, France
| | - Gilles Hilbert
- Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Centre Hospitalier Universitaire (CHU) de Bordeaux, 1 Place Amélie Raba-Léon, 33076, Bordeaux, France.,Centre de Recherche Cardio-Thoracique, INSERM 1045, CIC 0005, Université de Bordeaux, Bordeaux, France
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10
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Bui HN, Bogers JPAM, Cohen D, Njo T, Herruer MH. Evaluation of the performance of a point-of-care method for total and differential white blood cell count in clozapine users. Int J Lab Hematol 2016; 38:703-709. [PMID: 27565762 DOI: 10.1111/ijlh.12561] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 07/11/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We evaluated the performance of the HemoCue WBC DIFF, a point-of-care device for total and differential white cell count, primarily to test its suitability for the mandatory white blood cell monitoring in clozapine use. METHOD Leukocyte count and 5-part differentiation was performed by the point-of-care device and by routine laboratory method in venous EDTA-blood samples from 20 clozapine users, 20 neutropenic patients, and 20 healthy volunteers. From the volunteers, also a capillary sample was drawn. Intra-assay reproducibility and drop-to-drop variation were tested. RESULTS The correlation between both methods in venous samples was r > 0.95 for leukocyte, neutrophil, and lymphocyte counts. The correlation between point-of-care (capillary sample) and routine (venous sample) methods for these cells was 0.772; 0.817 and 0.798, respectively. Only for leukocyte and neutrophil counts, the intra-assay reproducibility was sufficient. CONCLUSION The point-of-care device can be used to screen for leukocyte and neutrophil counts. Because of the relatively high measurement uncertainty and poor correlation with venous samples, we recommend to repeat the measurement with a venous sample if cell counts are in the lower reference range. In case of clozapine therapy, neutropenia can probably be excluded if high neutrophil counts are found and patients can continue their therapy.
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Affiliation(s)
- H N Bui
- Atalmedial Medical Diagnostic Centers, Hoofddorp, The Netherlands
| | - J P A M Bogers
- Psychiatric Centre Rivierduinen, Oegstgeest, The Netherlands
| | - D Cohen
- Department of Community Mental Health, Mental Health Service North Holland North, Heerhugowaard, The Netherlands
| | - T Njo
- Saltro Diagnostic Center for Primary Care, Utrecht, The Netherlands
| | - M H Herruer
- Atalmedial Medical Diagnostic Centers, Hoofddorp, The Netherlands
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Bui HN, Sluss PM, Hayes FJ, Blincko S, Knol DL, Blankenstein MA, Heijboer AC. Testosterone, free testosterone, and free androgen index in women: Reference intervals, biological variation, and diagnostic value in polycystic ovary syndrome. Clin Chim Acta 2015; 450:227-32. [PMID: 26327459 DOI: 10.1016/j.cca.2015.08.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 10/09/2014] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of our study was to determine reference intervals and biologic variation for testosterone (T), free testosterone (fT), and free androgen index (FAI) in women with accurate methods and to test the discriminative value of these parameters in a polycystic ovary syndrome (PCOS)-population. METHODS Serum was obtained daily during a normal menstrual cycle from 25 healthy women (677 data-points). A single serum sample was obtained from 44 PCOS-patients. T was measured by LC–MS/MS and by Architect® 2nd generation T Immunoassay. Sex hormone-binding globulin was measured to calculate fT and FAI. Results: Reference intervals which were established in healthy women with an ovulatory menstrual cycle were T = 0.3-1.6 nmol/L and 0.5-2.0 nmol/L, fT = 5.2-26 pmol/L and 7.2-33 pmol/L, and FAI = 0.4-2.9 and 0.6-4.4, by LC-MS/MS and immunoassay, respectively. T, fT and FAI were higher in PCOS patients than in controls (p b 0.0001). The areas under the curve of receiver operator characteristic (ROC) plots were not different for T, fT, or FAI when T was measured by LC–MS/MS versus immunoassay based on prediction of PCOS. FAI and fT were the strongest predictors of PCOS. CONCLUSIONS When based upon the appropriate reference intervals and ROC analysis, LC-MS/MS and second generation immunoassay have equivalent clinical utility for the diagnosis of PCOS.
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Affiliation(s)
- H N Bui
- Dept. of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - P M Sluss
- Clinical Pathology Core Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - F J Hayes
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - S Blincko
- Abbott Diagnostics, Wiesbaden, Germany
| | - D L Knol
- Dept. of Epidemiology and Biostatistics, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - M A Blankenstein
- Dept. of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - A C Heijboer
- Dept. of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
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Brisard L, Le Gouge A, Lascarrou JB, Dupont H, Asfar P, Sirodot M, Piton G, Bui HN, Gontier O, Hssain AA, Gaudry S, Rigaud JP, Quenot JP, Maxime V, Schwebel C, Thévenin D, Nseir S, Parmentier E, El Kalioubie A, Jourdain M, Leray V, Rolin N, Bellec F, Das V, Ganster F, Guitton C, Asehnoune K, Bretagnol A, Anguel N, Mira JP, Canet E, Guidet B, Djibre M, Misset B, Robert R, Martino F, Letocart P, Silva D, Darmon M, Botoc V, Herbrecht JE, Meziani F, Devaquet J, Mercier E, Richecoeur J, Martin S, Gréau E, Giraudeau B, Reignier J. Impact of early enteral versus parenteral nutrition on mortality in patients requiring mechanical ventilation and catecholamines: study protocol for a randomized controlled trial (NUTRIREA-2). Trials 2014; 15:507. [PMID: 25539571 PMCID: PMC4307984 DOI: 10.1186/1745-6215-15-507] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/02/2014] [Indexed: 12/26/2022] Open
Abstract
Background Nutritional support is crucial to the management of patients receiving invasive mechanical ventilation (IMV) and the most commonly prescribed treatment in intensive care units (ICUs). International guidelines consistently indicate that enteral nutrition (EN) should be preferred over parenteral nutrition (PN) whenever possible and started as early as possible. However, no adequately designed study has evaluated whether a specific nutritional modality is associated with decreased mortality. The primary goal of this trial is to assess the hypothesis that early first-line EN, as compared to early first-line PN, decreases day 28 all-cause mortality in patients receiving IMV and vasoactive drugs for shock. Methods/Design The NUTRIREA-2 study is a multicenter, open-label, parallel-group, randomized controlled trial comparing early PN versus early EN in critically ill patients requiring IMV for an expected duration of at least 48 hours, combined with vasoactive drugs, for shock. Patients will be allocated at random to first-line PN for at least 72 hours or to first-line EN. In both groups, nutritional support will be started within 24 hours after IMV initiation. Calorie targets will be 20 to 25 kcal/kg/day during the first week, then 25 to 30 kcal/kg/day thereafter. Patients receiving PN may be switched to EN after at least 72 hours in the event of shock resolution (no vasoactive drugs for 24 consecutive hours and arterial lactic acid level below 2 mmol/L). On day 7, all patients receiving PN and having no contraindications to EN will be switched to EN. In both groups, supplemental PN may be added to EN after day 7 in patients with persistent intolerance to EN and inadequate calorie intake. We plan to recruit 2,854 patients at 44 participating ICUs. Discussion The NUTRIREA-2 study is the first large randomized controlled trial designed to assess the hypothesis that early EN improves survival compared to early PN in ICU patients. Enrollment started on 22 March 2013 and is expected to end in November 2015. Trial registration ClinicalTrials.gov Identifier:
NCT01802099 (registered 27 February 2013)
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jean Reignier
- UPRES EA-3826, Clinical and Experimental Therapies for Infections, University of Nantes, Nantes, France.
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Delmas Y, Vendrely B, Clouzeau B, Bachir H, Bui HN, Lacraz A, Hélou S, Bordes C, Reffet A, Llanas B, Skopinski S, Rolland P, Gruson D, Combe C. Outbreak of Escherichia coli O104:H4 haemolytic uraemic syndrome in France: outcome with eculizumab. Nephrol Dial Transplant 2013; 29:565-72. [PMID: 24293658 PMCID: PMC3938298 DOI: 10.1093/ndt/gft470] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background An outbreak of haemolytic uraemic syndrome (HUS) due to Shiga toxin-secreting Escherichia coli (STEC) O104:H4 from contaminated fenugreek sprouts occurred in June 2011 near Bordeaux, France. In the context of this outbreak, all patients were treated with the monoclonal anti-C5 antibody, eculizumab. Methods The diagnosis of HUS was made based on haemolytic anaemia, low platelet count and acute kidney injury. Data were obtained from initial gastrointestinal symptoms to the end of follow-up 10 weeks after the start of eculizumab. Results Among 24 cases of STEC gastroenteritis, HUS developed in nine patients (eight adults and one child), 6 (median; range 3–12) days after digestive symptoms begun. The median (range) highest or lowest biological values were platelet count 26 (range 14–93) G/L; haemoglobin 6.6 (range 5–10.7) g/dL; LDH 1520 (range 510–2568) IU/L; creatinine 152 (range 48–797) µmol/L. All patients had extra-renal complications (liver 9, pancreas 5, brain 3 and heart 3). Two patients were dialysed, and one was ventilated. After failure of plasma exchange to increase platelets in the first three patients, eculizumab was administered in all nine patients, 0–4 days after HUS diagnosis (median 1 day). One patient with very severe neurological HUS received immunoadsorption. Outcome was favourable in all patients, with rapid normalization of haemoglobin, platelets, LDH levels, renal function and neurological improvement. There were no deaths and no serious adverse events related to eculizumab. Conclusions Early treatment of O104:H4 STEC-HUS by eculizumab was associated with a rapid and efficient recovery. Controlled prospective evaluation of eculizumab in STEC-HUS is warranted.
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Affiliation(s)
- Yahsou Delmas
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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Bui HN, Germain P, Traissac T, Biau G, Longy-Boursier M. [It's not that bizarre!]. Rev Med Interne 1999; 20 Suppl 2:292s-293s. [PMID: 10422175 DOI: 10.1016/s0248-8663(99)80470-6] [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] [Indexed: 10/18/2022]
Affiliation(s)
- H N Bui
- Service de médecine interne, hôpital de Saint-André, Bordeaux
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