1
|
Duclos G, Heireche F, Siroutot M, Delamarre L, Sartorius MA, Mergueditchian C, Velly L, Carvelli J, Bordais A, Pilarczyk E, Leone M. The association between regional guidelines compliance and mortality in severe trauma patients: an observational, retrospective study. Eur J Emerg Med 2024; 31:208-215. [PMID: 38265763 DOI: 10.1097/mej.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND AND IMPORTANCE Trauma is a major cause of mortality and morbidity. Regional trauma systems are the cornerstones of healthcare systems, helping to improve outcomes and avoid preventable deaths in severe trauma patients. OBJECTIVES The goal of this study was to evaluate the association between compliance with the guidelines of a regional trauma management system and survival at 28 days of severe trauma patients. DESIGN, SETTINGS AND PARTICIPANTS We conducted a retrospective observational study from 1 January 2019 to 31 December 2019. All adult patients admitted for trauma at the University Hospital of Marseille (France) and requiring a pre-hospital medical team were analysed. Compliance with a list of 30 items based on the regional guidelines for the trauma management was evaluated. Each item was classified as compliant, not compliant or not applicable. The global compliance was calculated for each patient as the ratio between the number of compliant items over the number of applicable items. OUTCOME MEASURES AND ANALYSIS The primary aim was to measure the association between compliance with the guidelines and survival at 28 days using a logistic regression. Secondary objectives were to measure the association between compliance with the guidelines and survival at 28 days and 6 months according to the severity of the patients, using a cut-off of the injury severity score at 24. MAIN RESULTS A total of 494 patients with a median age of 35.0 (25.0-50.0) years were analysed. Global compliance with guidelines was 63%. Mortality at 28 days and 6 months was assessed at 33 (6.7%) and 37 (7.5%) patients, respectively. The level of compliance was associated with reduced mortality at 28 days [odds ratio (OR) at 0.94 and 95% confidence interval (CI) at 0.89-0.98]. In the subgroup of 122 patients with an injury severity score above 23, the level of compliance was associated with reduced mortality at 28 days [OR: 0.93 (95% CI: 0.88-0.99)] and 6 months [OR: 0.93 (95% CI: 0.87-0.99)]. CONCLUSION Increased levels of compliance with the guidelines in severe trauma patients were associated with an increase in survival, notably in the most severe patients.
Collapse
Affiliation(s)
- Gary Duclos
- Aix- Marseille Université, Service d'anesthésie et de réanimation, Assistance Publique Hôpitaux de Marseille, Hôpital Nord
| | - Fouzia Heireche
- Aix-Marseille Université, Service d'Aide Médicale d'Urgence 13, Assistance Publique Hôpitaux de Marseille, hôpital de la Timone, Marseille
| | | | - Louis Delamarre
- Aix- Marseille Université, Service d'anesthésie et de réanimation, Assistance Publique Hôpitaux de Marseille, Hôpital Nord
| | - Max-Antoine Sartorius
- Aix-Marseille Université, Service des urgences, Assistance Publique Hôpitaux de Marseille, hôpital Nord
| | - Celine Mergueditchian
- Aix-Marseille Université, Service des urgences, Assistance Publique Hôpitaux de Marseille, hôpital de la Timone
| | - Lionel Velly
- Aix-Marseille Université, Service d'anesthésie et de réanimation, Assistance Publique Hôpitaux de Marseille, hôpital de la Timone
| | - Julien Carvelli
- Aix-Marseille Université, Médecine Intensive et Réanimation, Unité de Réanimation des Urgences, Assistance Publique Hôpitaux de Marseille, hôpital de la Timone, Marseille, France
| | - Aurelia Bordais
- Aix-Marseille Université, Service des urgences, Assistance Publique Hôpitaux de Marseille, hôpital Nord
| | - Estelle Pilarczyk
- Aix-Marseille Université, Service d'Aide Médicale d'Urgence 13, Assistance Publique Hôpitaux de Marseille, hôpital de la Timone, Marseille
| | - Marc Leone
- Aix- Marseille Université, Service d'anesthésie et de réanimation, Assistance Publique Hôpitaux de Marseille, Hôpital Nord
| |
Collapse
|
2
|
Guigal C, Simeone P, Denis JB, Jaloux C, Legré R, Mayoly A, Kachouh N, Bruder N, Velly L. Improvement in the perioperative satisfaction of the patient under loco-regional anesthesia by hypnosis or distraction with virtual reality. Minerva Anestesiol 2024; 90:340-342. [PMID: 38652453 DOI: 10.23736/s0375-9393.23.17813-8] [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: 04/25/2024]
Affiliation(s)
- Chloe Guigal
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Pierre Simeone
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France -
- French National Center for Scientific Research, UMR7289, Institute of Neuroscience de la Timone, Aix Marseille University, Marseille, France
| | - Jean-Baptiste Denis
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Charlotte Jaloux
- Department of Hand and Limb Reconstructive Surgery, La Timone University Hospital, Marseille, France
| | - Régis Legré
- Department of Hand and Limb Reconstructive Surgery, La Timone University Hospital, Marseille, France
| | - Alice Mayoly
- Department of Hand and Limb Reconstructive Surgery, La Timone University Hospital, Marseille, France
| | - Najib Kachouh
- Department of Hand and Limb Reconstructive Surgery, La Timone University Hospital, Marseille, France
| | - Nicolas Bruder
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Lionel Velly
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
- French National Center for Scientific Research, UMR7289, Institute of Neuroscience de la Timone, Aix Marseille University, Marseille, France
| |
Collapse
|
3
|
Boussen S, Benard-Tertrais M, Ogéa M, Malet A, Simeone P, Antonini F, Bruder N, Velly L. Heart rate complexity helps mortality prediction in the intensive care unit: A pilot study using artificial intelligence. Comput Biol Med 2024; 169:107934. [PMID: 38183707 DOI: 10.1016/j.compbiomed.2024.107934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 12/10/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024]
Abstract
BACKGROUND In intensive care units (ICUs), accurate mortality prediction is crucial for effective patient management and resource allocation. The Simplified Acute Physiology Score II (SAPS-2), though commonly used, relies heavily on comprehensive clinical data and blood samples. This study sought to develop an artificial intelligence (AI) model utilizing key hemodynamic parameters to predict ICU mortality within the first 24 h and assess its performance relative to SAPS-2. METHODS We conducted an analysis of select hemodynamic parameters and the structure of heart rate curves to identify potential predictors of ICU mortality. A machine-learning model was subsequently trained and validated on distinct patient cohorts. The AI algorithm's performance was then compared to the SAPS-2, focusing on classification accuracy, calibration, and generalizability. MEASUREMENTS AND MAIN RESULTS The study included 1298 ICU admissions from March 27th, 2015, to March 27th, 2017. An additional cohort from 2022 to 2023 comprised 590 patients, resulting in a total dataset of 1888 patients. The observed mortality rate stood at 24.0%. Key determinants of mortality were the Glasgow Coma Scale score, heart rate complexity, patient age, duration of diastolic blood pressure below 50 mmHg, heart rate variability, and specific mean and systolic blood pressure thresholds. The AI model, informed by these determinants, exhibited a performance profile in predicting mortality that was comparable, if not superior, to the SAPS-2. CONCLUSIONS The AI model, which integrates heart rate and blood pressure curve analyses with basic clinical parameters, provides a methodological approach to predict in-hospital mortality in ICU patients. This model offers an alternative to existing tools that depend on extensive clinical data and laboratory inputs. Its potential integration into ICU monitoring systems may facilitate more streamlined mortality prediction processes.
Collapse
Affiliation(s)
- Salah Boussen
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France; Laboratoire de Biomécanique Appliquée-Université Gustave-Eiffel, Aix-Marseille Université, UMR T24, 51 boulevard Pierre Dramard, 13015, Marseille, France.
| | - Manuela Benard-Tertrais
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Mathilde Ogéa
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Arthur Malet
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Pierre Simeone
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France; Aix Marseille University, CNRS, Inst Neurosci Timone, UMR7289, Marseille, France
| | - François Antonini
- Intensive Care and Anesthesiology Department, Hôpital Nord Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Nicolas Bruder
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Lionel Velly
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France; Aix Marseille University, CNRS, Inst Neurosci Timone, UMR7289, Marseille, France
| |
Collapse
|
4
|
Simoncini E, Jarry A, Moussion A, Marcheschi A, Giordanino P, Lusenti C, Bruder N, Velly L, Boussen S. Predictive Modeling of COVID-19 Intensive Care Unit Patient Flows and Nursing Complexity: A Monte Carlo Simulation Study. Comput Inform Nurs 2024:00024665-990000000-00154. [PMID: 38252546 DOI: 10.1097/cin.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
This study aimed to develop a Monte Carlo simulation model to forecast the number of ICU beds needed for COVID-19 patients and the subsequent nursing complexity in a French teaching hospital during the first and second pandemic outbreaks. The model used patient data from March 2020 to September 2021, including age, sex, ICU length of stay, and number of patients on mechanical ventilation or extracorporeal membrane oxygenation. Nursing complexity was assessed using a simple scale with three levels based on patient status. The simulation was performed 1000 times to generate a scenario, and the mean outcome was compared with the observed outcome. The model also allowed for a 7-day forecast of ICU occupancy. The simulation output had a good fit with the actual data, with an R2 of 0.998 and a root mean square error of 0.22. The study demonstrated the usefulness of the Monte Carlo simulation model for predicting the demand for ICU beds and could help optimize resource allocation during a pandemic. The model's extrinsic validity was confirmed using open data from the French Public Health Authority. This study provides a valuable tool for healthcare systems to anticipate and manage surges in ICU demand during pandemics.
Collapse
Affiliation(s)
- Elsa Simoncini
- Author Affiliations: Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université (Ms Simoncini, Mrs Jarry, Mrs Moussion, Ms Marcheschi, Mrs Giordanino, Ms Lusenti, and Drs Bruder, Velly, and Boussen); Aix Marseille Université, IFSTTAR, LBA UMR_T 24 (Dr Boussen); and Institut des Neurociences de la Timone, CNRS UMR1106, Faculté de Médecine, Aix-Marseille Université (Dr Velly), France
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Boussen S, Denis JB, Simeone P, Lagier D, Bruder N, Velly L. ChatGPT and the stochastic parrot: artificial intelligence in medical research. Br J Anaesth 2023; 131:e120-e121. [PMID: 37516646 DOI: 10.1016/j.bja.2023.06.065] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/10/2023] [Accepted: 06/28/2023] [Indexed: 07/31/2023] Open
Affiliation(s)
- Salah Boussen
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France; Aix Marseille Université, IFSTTAR, LBA UMR_T 24, Marseille, France.
| | - Jean-Baptiste Denis
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Pierre Simeone
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France; Institut des Neurociences de la Timone, CNRS UMR1106, Aix-Marseille Université, Marseille, France
| | - David Lagier
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Nicolas Bruder
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Lionel Velly
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France; Institut des Neurociences de la Timone, CNRS UMR1106, Aix-Marseille Université, Marseille, France
| |
Collapse
|
6
|
Guilhaumou R, Chevrier C, Setti JL, Jouve E, Marsot A, Julian N, Blin O, Simeone P, Lagier D, Mokart D, Bruder N, Garnier M, Velly L. β-Lactam Pharmacokinetic/Pharmacodynamic Target Attainment in Intensive Care Unit Patients: A Prospective, Observational, Cohort Study. Antibiotics (Basel) 2023; 12:1289. [PMID: 37627709 PMCID: PMC10451857 DOI: 10.3390/antibiotics12081289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The aims of this study were to describe pharmacokinetic/pharmacodynamic target attainment in intensive care unit (ICU) patients treated with continuously infused ß-lactam antibiotics, their associated covariates, and the impact of dosage adjustment. METHODS This prospective, observational, cohort study was performed in three ICUs. Four ß-lactams were continuously infused, and therapeutic drug monitoring (TDM) was performed at days 1, 4, and 7. The primary pharmacokinetic/pharmacodynamic target was an unbound ß-lactam plasma concentration four times above the bacteria's minimal inhibitory concentration during the whole dosing interval. The demographic and clinical covariates associated with target attainment were evaluated. RESULTS A total of 170 patients were included (426 blood samples). The percentages of empirical ß-lactam underdosing at D1 were 66% for cefepime, 43% for cefotaxime, 47% for ceftazidime, and 14% for meropenem. Indexed creatinine clearance was independently associated with treatment underdose if increased (adjusted odds ratio per unit, 1.01; 95% CI, 1.00 to 1.01; p = 0.014) or overdose if decreased (adjusted odds ratio per unit, 0.95; 95% CI, 0.94 to 0.97; p < 0.001). Pharmacokinetic/pharmacodynamic target attainment was significantly increased after ß-lactam dosage adjustment between day 1 and day 4 vs. no adjustment (53.1% vs. 26.2%; p = 0.018). CONCLUSIONS This study increases our knowledge on the optimization of ß-lactam therapy in ICU patients. A large inter- and intra-patient variability in plasmatic concentrations was observed, leading to inadequate exposure. A combined indexed creatinine clearance and TDM approach enables adequate dosing for better pharmacokinetic/pharmacodynamic target attainment.
Collapse
Affiliation(s)
- Romain Guilhaumou
- Department of Clinical Pharmacology and Pharmacosurveillance, La Timone University Hospital; 13005 Marseille, France
- Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM UMR 1106, 13005 Marseille, France
| | - Constance Chevrier
- Department of Clinical Pharmacology and Pharmacosurveillance, La Timone University Hospital; 13005 Marseille, France
- Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM UMR 1106, 13005 Marseille, France
| | - Jean Loup Setti
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
| | - Elisabeth Jouve
- Department of Clinical Pharmacology and Pharmacosurveillance, La Timone University Hospital; 13005 Marseille, France
- Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM UMR 1106, 13005 Marseille, France
| | - Amélie Marsot
- Faculté de Pharmacie, Université de Montréal, Montreal, QC H3T 1J4, Canada;
| | - Nathan Julian
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
| | - Olivier Blin
- Department of Clinical Pharmacology and Pharmacosurveillance, La Timone University Hospital; 13005 Marseille, France
- Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM UMR 1106, 13005 Marseille, France
| | - Pierre Simeone
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
- Inst Neurosci Timone, INT, CNRS, Aix Marseille University, UMR7289, 13005 Marseille, France
| | - David Lagier
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
- C2VN, Inserm 1263, Inra 1260, Aix Marseille Université, 13005 Marseille, France
| | - Djamel Mokart
- Department of Anaesthesiology and Critical Care Medicine, Institut Paoli-Calmette, 13009 Marseille, France
| | - Nicolas Bruder
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
| | - Marc Garnier
- Sorbonne University, GRC29, APHP, DMU DREAM, Rive Droite, Site Tenon, 75020 Paris, France
- Département d’Anesthésie-Réanimation et Médecine Périopératoire, CHU de Clermont-Ferrand, University Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Lionel Velly
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
- Inst Neurosci Timone, INT, CNRS, Aix Marseille University, UMR7289, 13005 Marseille, France
| |
Collapse
|
7
|
Gil-Jardiné C, Payen JF, Bernard R, Bobbia X, Bouzat P, Catoire P, Chauvin A, Claessens YE, Douay B, Dubucs X, Galanaud D, Gauss T, Gauvrit JY, Geeraerts T, Glize B, Goddet S, Godier A, Le Borgne P, Rousseau G, Sapin V, Velly L, Viglino D, Vigue B, Cuvillon P, Frasca D, Claret PG. Management of patients suffering from mild traumatic brain injury 2023. Anaesth Crit Care Pain Med 2023; 42:101260. [PMID: 37285919 DOI: 10.1016/j.accpm.2023.101260] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 06/09/2023]
Abstract
OBJECTIVE To develop a multidisciplinary French reference that addresses initial pre- and in-hospital management of a mild traumatic brain injury patient. DESIGN A panel of 22 experts was formed on request from the French Society of Emergency Medicine (SFMU) and the French Society of Anaesthesiology and Critical Care Medicine (SFAR). A policy of declaration and monitoring of links of interest was applied and respected throughout the process of producing the guidelines. Similarly, no funding was received from any company marketing a health product (drug or medical device). The expert panel had to respect and follow the Grade® (Grading of Recommendations Assessment, Development and Evaluation) methodology to evaluate the quality of the evidence on which the recommendations were based. Given the impossibility of obtaining a high level of evidence for most of the recommendations, it was decided to adopt a "Recommendations for Professional Practice" (RPP) format, rather than a Formalized Expert Recommendation (FER) format, and to formulate the recommendations using the terminology of the SFMU and SFAR Guidelines. METHODS Three fields were defined: 1) pre-hospital assessment, 2) emergency room management, and 3) emergency room discharge modalities. The group assessed 11 questions related to mild traumatic brain injury. Each question was formulated using a PICO (Patients Intervention Comparison Outcome) format. RESULTS The experts' synthesis work and the application of the GRADE® method resulted in the formulation of 14 recommendations. After two rounds of rating, strong agreement was obtained for all recommendations. For one question, no recommendation could be made. CONCLUSION There was strong agreement among the experts on important, transdisciplinary recommendations, the purpose of which is to improve management practices for patients with mild head injury.
Collapse
Affiliation(s)
- Cédric Gil-Jardiné
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, Service des Urgences-Adultes, Population Health, INSERM U1219, équipe aHeAD, Université de Bordeaux, Bordeaux, France.
| | - Jean-François Payen
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000 Grenoble, France
| | - Rémy Bernard
- Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Xavier Bobbia
- Montpellier University, UR UM 103 (IMAGINE), Department of Emergency Medicine, CHU Montpellier, Montpellier, France
| | - Pierre Bouzat
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000 Grenoble, France
| | - Pierre Catoire
- Emergency Consultant, Academic Clinical Fellow (Pitié-Salpétrière University, General Emergency Department, Paris) - Tactical Ultrasound Course for Ukraine (TUSC-UA) Course Director - Mehad, France
| | - Anthony Chauvin
- Service d'Accueil des Urgences/SMUR, CHU Lariboisière, Université de Paris - Inserm U942 MASCOT, Université de Paris, Paris, France
| | - Yann-Erick Claessens
- Département de Médecine d'urgence, Centre Hospitalier Princesse Grace, Avenue Pasteur, MC-98002, Monaco
| | - Bénédicte Douay
- SMUR/Service des Urgences, Hôpital Beaujon, AP-HP Nord, Clichy, France
| | - Xavier Dubucs
- Emergency Departement, Centre Hospitalo-Universitaire de Toulouse, Place du Docteur Baylac, 31300 Toulouse, France
| | - Damien Galanaud
- Service de Neuroradiologie, GH Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Tobias Gauss
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000 Grenoble, France
| | - Jean-Yves Gauvrit
- Service de Neuroradiologie, Hôpital Pontchaillou, CHU Rennes, Rennes, France
| | - Thomas Geeraerts
- Pole Anesthesie Réanimation et INSERM Tonic, CHU de Toulouse et Universite Toulouse 3, Toulouse, France
| | - Bertrand Glize
- PMR Department, CHU de Bordeaux, ACTIVE Team, BPH INSERM U1219, University of Bordeaux, France
| | - Sybille Goddet
- Samu-21, CHU de Dijon, SAU-Smur, CH du Creusot, Dijon, France
| | - Anne Godier
- Université Paris Cité, APHP, Hôpital Européen Georges Pompidou, Service d'anesthésie Réanimation and Inserm UMRS_1140, Paris, France
| | - Pierrick Le Borgne
- Emergency Department, University Hospitals of Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France - INSERM UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), Faculté de Médecine, Université de Strasbourg, 4 rue Kirschleger, 67085 Strasbourg Cedex, France
| | | | - Vincent Sapin
- Service de Biochimie et de Génétique Moléculaire, Centre de Biologie, CHU de Clermont-Ferrand, France
| | - Lionel Velly
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Damien Viglino
- University Grenoble-Alpes, Emergency Department, CHU Grenoble-Alpes, Grenoble, France - HP2 Laboratory INSERM U1300, Grenoble, France
| | - Bernard Vigue
- Département d'Anesthésie Réanimation, Hôpital Universitaire de Bicêtre, Le Kremlin Bicêtre, France
| | - Philippe Cuvillon
- EA 2992 IMAGINE, Prévention et Prise en Charge de la Défaillance Circulatoire des Patients en état de Choc, Anaesthesiology Department, CHU Nîmes, University Montpellier, 30000 Nîmes, France
| | - Denis Frasca
- Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France, Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France, INSERM U1246, Methods in Patients-Centered Outcomes and Health Research - SPHERE, Nantes, France
| | | |
Collapse
|
8
|
Chabanne R, Geeraerts T, Begard M, Balança B, Rapido F, Degos V, Tavernier B, Molliex S, Velly L, Verdonk F, Lukaszewicz AC, Perrigault PF, Albucher JF, Cognard C, Guyot A, Fernandez C, Masgrau A, Moreno R, Ferrier A, Jaber S, Bazin JE, Pereira B, Futier E. Outcomes After Endovascular Therapy With Procedural Sedation vs General Anesthesia in Patients With Acute Ischemic Stroke: The AMETIS Randomized Clinical Trial. JAMA Neurol 2023; 80:474-483. [PMID: 37010829 PMCID: PMC10071397 DOI: 10.1001/jamaneurol.2023.0413] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/03/2023] [Indexed: 04/04/2023]
Abstract
Importance General anesthesia and procedural sedation are common practice for mechanical thrombectomy in acute ischemic stroke. However, risks and benefits of each strategy are unclear. Objective To determine whether general anesthesia or procedural sedation for anterior circulation large-vessel occlusion acute ischemic stroke thrombectomy are associated with a difference in periprocedural complications and 3-month functional outcome. Design, Setting, and Participants This open-label, blinded end point randomized clinical trial was conducted between August 2017 and February 2020, with final follow-up in May 2020, at 10 centers in France. Adults with occlusion of the intracranial internal carotid artery and/or the proximal middle cerebral artery treated with thrombectomy were enrolled. Interventions Patients were assigned to receive general anesthesia with tracheal intubation (n = 135) or procedural sedation (n = 138). Main Outcomes and Measures The prespecified primary composite outcome was functional independence (a score of 0 to 2 on the modified Rankin Scale, which ranges from 0 [no neurologic disability] to 6 [death]) at 90 days and absence of major periprocedural complications (procedure-related serious adverse events, pneumonia, myocardial infarction, cardiogenic acute pulmonary edema, or malignant stroke) at 7 days. Results Among 273 patients evaluable for the primary outcome in the modified intention-to-treat population, 142 (52.0%) were women, and the mean (SD) age was 71.6 (13.8) years. The primary outcome occurred in 38 of 135 patients (28.2%) assigned to general anesthesia and in 50 of 138 patients (36.2%) assigned to procedural sedation (absolute difference, 8.1 percentage points; 95% CI, -2.3 to 19.1; P = .15). At 90 days, the rate of patients achieving functional independence was 33.3% (45 of 135) with general anesthesia and 39.1% (54 of 138) with procedural sedation (relative risk, 1.18; 95% CI, 0.86-1.61; P = .32). The rate of patients without major periprocedural complications at 7 days was 65.9% (89 of 135) with general anesthesia and 67.4% (93 of 138) with procedural sedation (relative risk, 1.02; 95% CI, 0.86-1.21; P = .80). Conclusions and Relevance In patients treated with mechanical thrombectomy for anterior circulation acute ischemic stroke, general anesthesia and procedural sedation were associated with similar rates of functional independence and major periprocedural complications. Trial Registration ClinicalTrials.gov Identifier: NCT03229148.
Collapse
Affiliation(s)
- Russell Chabanne
- Département Anesthésie Réanimation et Médecine Périopératoire, Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, Clermont-Ferrand, France
| | - Thomas Geeraerts
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU) Toulouse, Université Toulouse 3-Paul Sabatier, TONIC, INSERM, Toulouse, France
| | - Marc Begard
- Département Anesthésie Réanimation et Médecine Périopératoire, Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, Clermont-Ferrand, France
| | - Baptiste Balança
- Service d’Anesthésie Réanimation, Neuroscience Research Center, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer and Université Lyon 1, Lyon, France
| | - Francesca Rapido
- Service d’Anesthésie Réanimation, Pôle Neurosciences Tête et Cou, Centre Hospitalier Universitaire (CHU) de Montpellier, Hôpital Gui de Chauliac, Montpellier, France
| | - Vincent Degos
- Anesthésie et Neuro-Réanimation chirurgicale Babinski, Département d’Anesthésie-Réanimation, Assistance Publique Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | - Benoit Tavernier
- Pôle d’Anesthésie-Réanimation, Centre Hospitalier Universitaire (CHU) Lille, Université Lille, ULR 2694 – METRICS, Lille, France
| | - Serge Molliex
- Service d’Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU) Saint-Etienne, Université Jean Monnet, Saint-Etienne, France
| | - Lionel Velly
- Service d’Anesthésie Réanimation, Assistance Publique Hôpitaux de Marseille (AP-HM), Hôpital La Timone and Institut des Neurosciences, MeCA, Aix Marseille Université, Marseille, France
| | - Franck Verdonk
- Département d’Anesthésie-Réanimation, Institut Pasteur, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Paris, France
| | - Anne-Claire Lukaszewicz
- Service d’Anesthésie Réanimation, Neuroscience Research Center, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer and Université Lyon 1, Lyon, France
| | - Pierre-François Perrigault
- Service d’Anesthésie Réanimation, Pôle Neurosciences Tête et Cou, Centre Hospitalier Universitaire (CHU) de Montpellier, Hôpital Gui de Chauliac, Montpellier, France
| | - Jean-François Albucher
- Service de Neurologie Vasculaire, Centre Hospitalier Universitaire (CHU) Toulouse, Université Toulouse 3-Paul Sabatier, TONIC, INSERM, Toulouse, France
| | - Christophe Cognard
- Département de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier Universitaire (CHU) Toulouse, Université Toulouse 3-Paul Sabatier, Toulouse, France
| | - Adrien Guyot
- Département Anesthésie Réanimation et Médecine Périopératoire, Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, Clermont-Ferrand, France
| | - Charlotte Fernandez
- Département Anesthésie Réanimation et Médecine Périopératoire, Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélie Masgrau
- Direction de la Recherche Clinique et de l’Innovation (DRCI), Secteur Biométrie et Médico-Economie, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
| | - Ricardo Moreno
- Département de Neuroradiologie, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
| | - Anna Ferrier
- Département de Neurologie Vasculaire, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
| | - Samir Jaber
- Service d’Anesthésie Réanimation B (DAR B), Centre Hospitalier Universitaire (CHU) de Montpellier, Hôpital Saint-Eloi, Université de Montpellier, INSERM U-1046, Montpellier, France
| | - Jean-Etienne Bazin
- Département Anesthésie Réanimation et Médecine Périopératoire, Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de la Recherche Clinique et de l’Innovation (DRCI), Secteur Biométrie et Médico-Economie, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Futier
- Département Anesthésie Réanimation et Médecine Périopératoire, Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, GRED, CNRS, INSERM U1103, Clermont-Ferrand, France
| |
Collapse
|
9
|
El-Haffaf I, Guilhaumou R, Velly L, Marsot A. Impact of piperacillin unbound fraction variability on dosing recommendations in critically ill patients. Br J Clin Pharmacol 2023; 89:1502-1508. [PMID: 36445340 DOI: 10.1111/bcp.15619] [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: 08/03/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022] Open
Abstract
A common approach to assess the efficacy of piperacillin is to first measure the total concentration and afterwards apply a theoretical unbound fraction of 70% to obtain the unbound concentration. However, hypoalbuminemia is a common phenomenon in critically ill patients, resulting in variations in unbound fraction, therefore we aimed to simulate the impact of piperacillin unbound fraction fluctuations on the predictive performance of a population pharmacokinetic model and on the dosing recommendations of piperacillin. Unbound factors of 70%, 75%, 80% and 85% were applied to total concentrations of piperacillin administered by continuous infusion from an external dataset. A validated model was used for assessment of predictive performance and to estimate patient clearance. Dosing simulations were performed to evaluate target attainment. Variation in unbound fractions caused minimal impact on piperacillin clearance and target attainment but seemed to influence model validity.
Collapse
Affiliation(s)
- Ibrahim El-Haffaf
- Faculty of Pharmacy, Université de Montréal, Pavillon Jean-Coutu, Montreal, Québec, Canada.,Laboratoire de Suivi Thérapeutique Pharmacologique et Pharmacocinétique, Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, Assistance Publique des Hôpitaux de Marseille, Marseille, France.,Institut de neurosciences des systèmes, Inserm UMR 1106, Aix Marseille Université, Marseille, France
| | - Lionel Velly
- Service d'anesthésie-réanimation, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille et Institut de neurosciences de la Timone, CNRS, Aix Marseille Université, Marseille, France
| | - Amélie Marsot
- Faculty of Pharmacy, Université de Montréal, Pavillon Jean-Coutu, Montreal, Québec, Canada.,Laboratoire de Suivi Thérapeutique Pharmacologique et Pharmacocinétique, Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada.,Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
| |
Collapse
|
10
|
Letournel E, Brunet L, Velly L, Morales T, Fuentes S, Blondel B, Prost S, Simeone P, Bruder N. Erector spinal plane block use for rehabilitation in spine surgery: is pain a good endpoint? Minerva Anestesiol 2023:S0375-9393.22.17106-3. [PMID: 36752607 DOI: 10.23736/s0375-9393.22.17106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Etienne Letournel
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Marseille, France.,Aix Marseille University, AP-HM, Marseille, France
| | - Lucie Brunet
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Marseille, France.,Aix Marseille University, AP-HM, Marseille, France
| | - Lionel Velly
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Marseille, France.,Aix Marseille University, AP-HM, Marseille, France.,UMR7289, Institut Neurosci Timone, CNRS, Aix Marseille University, Marseille, France
| | - Timothée Morales
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Marseille, France.,Aix Marseille University, AP-HM, Marseille, France
| | - Stephane Fuentes
- Spine Unit, Marseille University Hospital Timone, AP-HM, Marseille, France.,Department of Neurosurgery, Marseille University Hospital Timone, AP-HM, Marseille, France
| | - Benjamin Blondel
- Spine Unit, Marseille University Hospital Timone, AP-HM, Marseille, France.,Department of Orthopedic Surgery, Marseille University Hospital Timone, AP-HM, Marseille, France
| | - Solene Prost
- Spine Unit, Marseille University Hospital Timone, AP-HM, Marseille, France.,Department of Orthopedic Surgery, Marseille University Hospital Timone, AP-HM, Marseille, France
| | - Pierre Simeone
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Marseille, France.,Aix Marseille University, AP-HM, Marseille, France.,UMR7289, Institut Neurosci Timone, CNRS, Aix Marseille University, Marseille, France
| | - Nicolas Bruder
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Marseille, France - .,Aix Marseille University, AP-HM, Marseille, France
| |
Collapse
|
11
|
Grimaldi S, Eusebio A, Carron R, Regis JM, Velly L, Azulay JP, Witjas T. Deep Brain Stimulation-Withdrawal Syndrome in Parkinson's Disease: Risk Factors and Pathophysiological Hypotheses of a Life-Threatening Emergency. Neuromodulation 2023; 26:424-434. [PMID: 36344398 DOI: 10.1016/j.neurom.2022.09.008] [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: 05/04/2022] [Revised: 08/24/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Subthalamic nucleus deep brain stimulation (DBS) is the most common therapeutic surgical procedure for patients with Parkinson's disease with motor fluctuations, dyskinesia, or tremor. Routine follow-up of patients allows clinicians to anticipate replacement of the DBS battery reaching the end of its life. Patients who experience a sudden stop of the DBS battery experience a rapid worsening of symptoms unresponsive to high dose of levodopa, in a life-threatening phenomenon called "DBS-withdrawal syndrome." In the current context of the COVID-19 pandemic, in which many surgeries are being deprogrammed, it is of utmost importance to determine to what extent DBS battery replacement surgeries should be considered an emergency. In this study, we attempt to identify risk factors of DBS-withdrawal syndrome and provide new insights about pathophysiological hypotheses. We then elaborate on the optimal approach to avoid and manage such a situation. MATERIALS AND METHODS We conducted a systematic review of the literature on the subject and reported the cases of 20 patients (including five from our experience) with DBS-withdrawal syndrome, comparing them with 15 undisturbed patients (including three from our experience), all having undergone neurostimulation discontinuation. RESULTS A long disease duration at battery removal and many years of DBS therapy are the main potential identified risk factors (p < 0.005). In addition, a trend for older age at the event and higher Unified Parkinson's Disease Rating Scale motor score before initial DBS implantation (evaluated in OFF-drug condition) was found (p < 0.05). We discuss several hypotheses that might explain this phenomenon, including discontinued functioning of the thalamic-basal ganglia loop due to DBS-stimulation cessation in a context in which cortical-basal ganglia loop had lost its cortical input, and possible onset of a severe bradykinesia through the simultaneous occurrence of an alpha and high-beta synchronized state. CONCLUSIONS The patients' clinical condition may deteriorate rapidly, be unresponsive to high dose of levodopa, and become life-threatening. Hospitalization is suggested for clinical monitoring. In the context of the current COVID-19 pandemic, it is important to widely communicate the replacement of DBS batteries reaching the end of their life. More importantly, in cases in which the battery has stopped, there should be no delay in performing replacement as an emergent surgery.
Collapse
Affiliation(s)
- Stephan Grimaldi
- Department of Neurology and Movement Disorders, Timone University Hospital, Aix-Marseille University, Marseille, France; Centre national de la recherche scientifique (CNRS), Centre de Résonance Magnétique Biologique et Médicale (CRMBM), Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Aix-Marseille University, Marseille, France.
| | - Alexandre Eusebio
- Department of Neurology and Movement Disorders, Timone University Hospital, Aix-Marseille University, Marseille, France; Centre national de la recherche scientifique (CNRS), Institut de Neurosciences de la Timone (INT), Aix-Marseille University, Marseille, France
| | - Romain Carron
- Department of Functional and Stereotactic Neurosurgery and Gamma Knife Radiosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France; Institut national de la santé et de la recherche médicale (INSERM), Institut de Neuroscience des Systèmes (INS), Aix-Marseille University, Marseille, France
| | - Jean-Marie Regis
- Department of Functional and Stereotactic Neurosurgery and Gamma Knife Radiosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Lionel Velly
- Centre national de la recherche scientifique (CNRS), Institut de Neurosciences de la Timone (INT), Aix-Marseille University, Marseille, France; Department of Anesthesiology and Critical Care Medicine, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Jean-Philippe Azulay
- Department of Neurology and Movement Disorders, Timone University Hospital, Aix-Marseille University, Marseille, France; Centre national de la recherche scientifique (CNRS), Laboratoire de Neurosciences conginitives (LNC), Aix-Marseille University, Marseille, France
| | - Tatiana Witjas
- Department of Neurology and Movement Disorders, Timone University Hospital, Aix-Marseille University, Marseille, France; Centre national de la recherche scientifique (CNRS), Institut de Neurosciences de la Timone (INT), Aix-Marseille University, Marseille, France
| |
Collapse
|
12
|
Berger B, Cungi PJ, Arzalier S, Lieutaud T, Velly L, Simeone P, Bruder N. Incidence of Burnout Syndrome among Anesthesiologists and Intensivists in France: The REPAR Study. Int J Environ Res Public Health 2023; 20:1771. [PMID: 36767139 PMCID: PMC9914122 DOI: 10.3390/ijerph20031771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Burnout syndrome (BOS) impacts health workers and has become a real public health issue. The primary objective of this observational study was to re-evaluate the incidence of BOS among anesthesiologists and intensivists (AI) in France, ten years after the SESMAT study, a French Physician Health Survey carried out among burnout salaried AI. The secondary objective was to investigate risks factors. METHODS The REPAR survey is an observational study carried in France among AI, residents, and seniors, whatever their main mode of practice, in the framework of a self-questionnaire distributed on the Internet from 11 April 2018 to 1 July 2018. BOS was assessed using the Copenhagen Burnout Inventory (CBI). A score above 50% on two of the dimensions (personal burnout and work-related burnout) indicated BOS, as a main criterion. In order to investigate risks factors, questions were about sociodemographic characteristics, professional and extraprofessional environments, personality and mood using the Major Depression Inventory (MDI). A significance threshold of p < 0.05 was retained. RESULTS Among 1519 questionnaires received, 1500 completed questionnaires were analyzed. There were 775 men (52%) and 721 women (48%), aged 23 to 74 years. Among those, 24% suffered from BOS, 9% showed depressive symptoms (MDI > 25) and 35% were considering changing jobs or stopping their studies. There was no significant difference with the SESMAT study for the general BOS score. After multivariate analysis, 12 variables were significantly associated with the main criterion. CONCLUSIONS Ten years after the SESMAT study, the incidence of BOS in AI has not decreased in the largest cohort of AI studied to date in France.
Collapse
Affiliation(s)
- Barnabé Berger
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix Marseille University, F-13005 Marseille, France
| | - Pierre-Julien Cungi
- Fédération Anesthésie Réanimation, Hôpital d’Instruction des Armées Sainte Anne, F-83000 Toulon, France
| | - Ségolène Arzalier
- Département d’Anesthésie–Réanimation, University Hospital of Caen, Avenue Côte-de-Nacre, F-14000 Caen, France
- Comité Vie Professionnelle Santé au Travail (CVP-ST), Société Française d’Anesthésie-Réanimation (SFAR), 74, Rue Raynouard, F-75016 Paris, France
| | - Thomas Lieutaud
- UMRESTTE, UMR-T9405, Université Gustave Eiffel, Université Claude Bernard de Lyon, CEDEX, F-69675 Bron, France
| | - Lionel Velly
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix Marseille University, F-13005 Marseille, France
- CNRS, Institut de Neurosciences de la Timone, Aix Marseille University, UMR7289, F-13005 Marseille, France
| | - Pierre Simeone
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix Marseille University, F-13005 Marseille, France
- CNRS, Institut de Neurosciences de la Timone, Aix Marseille University, UMR7289, F-13005 Marseille, France
| | - Nicolas Bruder
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix Marseille University, F-13005 Marseille, France
| |
Collapse
|
13
|
Puybasset L, Perlbarg V, Unrug J, Cassereau D, Galanaud D, Torkomian G, Battisti V, Lefort M, Velly L, Degos V, Citerio G, Bayen É, Pelegrini-Issac M. Prognostic value of global deep white matter DTI metrics for 1-year outcome prediction in ICU traumatic brain injury patients: an MRI-COMA and CENTER-TBI combined study. Intensive Care Med 2022; 48:201-212. [PMID: 34904191 DOI: 10.1007/s00134-021-06583-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/11/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE A reliable tool for outcome prognostication in severe traumatic brain injury (TBI) would improve intensive care unit (ICU) decision-making process by providing objective information to caregivers and family. This study aimed at designing a new classification score based on magnetic resonance (MR) diffusion metrics measured in the deep white matter between day 7 and day 35 after TBI to predict 1-year clinical outcome. METHODS Two multicenter cohorts (29 centers) were used. MRI-COMA cohort (NCT00577954) was split into MRI-COMA-Train (50 patients enrolled between 2006 and mid-2014) and MRI-COMA-Test (140 patients followed up in clinical routine from 2014) sub-cohorts. These latter patients were pooled with 56 ICU patients (enrolled from 2014 to 2020) from CENTER-TBI cohort (NCT02210221). Patients were dichotomised depending on their 1-year Glasgow outcome scale extended (GOSE) score: GOSE 1-3, unfavorable outcome (UFO); GOSE 4-8, favorable outcome (FO). A support vector classifier incorporating fractional anisotropy and mean diffusivity measured in deep white matter, and age at the time of injury was developed to predict whether the patients would be either UFO or FO. RESULTS The model achieved an area under the ROC curve of 0.93 on MRI-COMA-Train training dataset, and 49% sensitivity for 96.8% specificity in predicting UFO and 58.5% sensitivity for 97.1% specificity in predicting FO on the pooled MRI-COMA-Test and CENTER-TBI validation datasets. CONCLUSION The model successfully identified, with a specificity compatible with a personalized decision-making process in ICU, one in two patients who had an unfavorable outcome at 1 year after the injury, and two-thirds of the patients who experienced a favorable outcome.
Collapse
Affiliation(s)
- Louis Puybasset
- Neurosurgical Intensive Care Unit, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, Paris, France.
- Department of Anesthesiology and Intensive Care, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
- Clinical Research Group 29, Sorbonne Université, Paris, France.
| | | | - Jean Unrug
- Neurosurgical Intensive Care Unit, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, Paris, France
| | - Didier Cassereau
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, Paris, France
| | - Damien Galanaud
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, Paris, France
- Department of Neuroradiology, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Grégory Torkomian
- Neurosurgical Intensive Care Unit, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Valentine Battisti
- Neurosurgical Intensive Care Unit, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Muriel Lefort
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, Paris, France
| | - Lionel Velly
- Department of Anesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix Marseille University, Marseille, France
- CNRS, Institute of Neuroscience Timone, UMR7289, Aix Marseille University, Marseille, France
| | - Vincent Degos
- Clinical Research Group 29, Sorbonne Université, Paris, France
- Department of Anesthesia, Critical Care and Peri-Operative Medicine, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM UMR 1141, Paris, France
| | - Guiseppe Citerio
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Neurointensive Care Unit, Department of Emergency and Urgency, ASST-Monza, San Gerardo Hospital, Monza, Italy
| | - Éléonore Bayen
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, Paris, France
- Rehabilitation Unit, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | | |
Collapse
|
14
|
Bobot M, Tonon D, Peres N, Guervilly C, Lefèvre F, Max H, Bommel Y, Volff M, Leone M, Lopez A, Simeone P, Carvelli J, Chopinet S, Hraiech S, Papazian L, Velly L, Bourenne J, Forel JM. Impact of Dexamethasone and Inhaled Nitric Oxide on Severe Acute Kidney Injury in Critically Ill Patients with COVID-19. J Clin Med 2022; 11:jcm11206130. [PMID: 36294451 PMCID: PMC9604787 DOI: 10.3390/jcm11206130] [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: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Acute kidney injury (AKI) is the second most frequent condition after acute respiratory distress syndrome (ARDS) in critically ill patients with severe COVID-19 and is strongly associated with mortality. The aim of this multicentric study was to assess the impact of the specific treatments of COVID-19 and ARDS on the risk of severe AKI in critically ill COVID-19 patients. Methods: In this cohort study, data from consecutive patients older than 18 years admitted to 6 ICUs for COVID-19-related ARDS requiring invasive mechanical ventilation were included. The incidence and severity of AKI, defined according to the 2012 KDIGO definition, were monitored during the entire ICU stay until day 90. Patients older than 18 years admitted to the ICU for COVID-19-related ARDS requiring invasive mechanical ventilation were included. Results: 164 patients were included in the final analysis; 97 (59.1%) displayed AKI, of which 39 (23.8%) had severe stage 3 AKI, and 21 (12.8%) required renal replacement therapy (RRT). In univariate analysis, severe AKI was associated with angiotensin-converting enzyme inhibitors (ACEI) exposure (p = 0.016), arterial hypertension (p = 0.029), APACHE-II score (p = 0.004) and mortality at D28 (p = 0.008), D60 (p < 0.001) and D90 (p < 0.001). In multivariate analysis, the factors associated with the onset of stage 3 AKI were: exposure to ACEI (OR: 4.238 (1.307−13.736), p = 0.016), APACHE II score (without age) (OR: 1.138 (1.044−1.241), p = 0.003) and iNO (OR: 5.694 (1.953−16.606), p = 0.001). Prone positioning (OR: 0.234 (0.057−0.967), p = 0.045) and dexamethasone (OR: 0.194 (0.053−0.713), p = 0.014) were associated with a decreased risk of severe AKI. Conclusions: Dexamethasone was associated with the prevention of the risk of severe AKI and RRT, and iNO was associated with severe AKI and RRT in critically ill patients with COVID-19. iNO should be used with caution in COVID-19-related ARDS.
Collapse
Affiliation(s)
- Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, 13005 Marseille, France
- Aix Marseille University, INSERM 1263, INRAE 1260, C2VN, European Center for Medical Imaging Research (CERIMED), Campus Santé Timone, 13005 Marseille, France
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
- Correspondence: ; Tel.: +33-491-383-042
| | - David Tonon
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Conception, AP-HM, 13005 Marseille, France
| | - Noémie Peres
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
| | - Christophe Guervilly
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
| | - Flora Lefèvre
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, 13005 Marseille, France
| | - Howard Max
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
| | - Youri Bommel
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
| | - Maxime Volff
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
| | - Marc Leone
- Service d’Anesthésie-Réanimation, Hôpital Nord, AP-HM, 13005 Marseille, France
| | - Alexandre Lopez
- Service d’Anesthésie-Réanimation, Hôpital Nord, AP-HM, 13005 Marseille, France
| | - Pierre Simeone
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
- CNRS, Institut des Neurosciences de la Timone, UMR7289, 13005 Marseille, France
| | - Julien Carvelli
- Service de Réanimation et Surveillance Continue, Hôpital de la Timone, AP-HM, Aix-Marseille University, 13005 Marseille, France
| | - Sophie Chopinet
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, AP-HM, 13005 Marseille, France
- European Center for Medical Imaging Research CERIMED, Laboratoire d’imagerie Interventionnelle Ex-périmentale (LIIE), Aix-Marseille Université, Campus Santé Timone, 13005 Marseille, France
| | - Sami Hraiech
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
| | - Laurent Papazian
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
| | - Lionel Velly
- Département d’Anesthésie-Réanimation, Aix-Marseille University, CHU Timone, AP-HM, 13005 Marseille, France
- CNRS, Institut des Neurosciences de la Timone, UMR7289, 13005 Marseille, France
| | - Jérémy Bourenne
- Service de Réanimation et Surveillance Continue, Hôpital de la Timone, AP-HM, Aix-Marseille University, 13005 Marseille, France
| | - Jean-Marie Forel
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de vie EA 3279, Aix-Marseille University, 13015 Marseille, France
| |
Collapse
|
15
|
Zalta A, Trébuchon A, Lagarde S, Lacroix C, Velly L, Jamon A, Blin O, Guilhaumou R. WE-140. Optimizing the monitoring of beta-lactam antibiotics in intensive care patients: A Neurophysio-Pharmacological study. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.07.184] [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: 11/03/2022]
|
16
|
Garnier M, Julian N, Velly L. Heat moisture exchange/high-efficiency particulate filters and the risk of contamination of the ventilatory circuit and patient environment with SARS-CoV-2: A brief report. Anaesth Crit Care Pain Med 2022; 41:101065. [PMID: 35487410 PMCID: PMC9040434 DOI: 10.1016/j.accpm.2022.101065] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Marc Garnier
- Sorbonne Université, GRC29, Assistance Publique-Hôpitaux de Paris, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire « Rive Droite », Site Tenon, 75020 Paris, France.
| | - Nathan Julian
- Assistance Publique-Hôpitaux de Paris, DMU PARABOL, Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital Lariboisière, 75010 Paris, France; Université de Paris, INSERM U942 MASCOT, 75006 Paris, France
| | - Lionel Velly
- Université Aix-Marseille, Assistance Publique Hôpitaux de Marseille, Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital Universitaire de la Timone, 13005 Marseille, France; Université Aix-Marseille, CNRS, Institut Neuroscience Timone, UMR7289, Marseille, France
| |
Collapse
|
17
|
Bobot M, Heim X, Max H, Simeone P, Velly L, Bruder N, Forel JM, Carvelli J, Stein C, Hraiech S, Boucraut J, Gainnier M, Mege JL, Guervilly C, Jourde-Chiche N, Papazian L, Burtey S. MO333: Prevalence of COVID-Associated Renal Injury in ICU and Prognosis of Proximal Tubular Dysfunction in Acute Respiratory Distress Syndrome. Nephrol Dial Transplant 2022. [PMCID: PMC9383871 DOI: 10.1093/ndt/gfac068.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND AIMS During COVID-19, the renal impairment is the most frequent after lung impairment and is associated of poor prognosis particularly in the intensive care unit (ICU). In this work, we aim to assess the incidence of acute kidney injury (AKI) in COVID-19-related acute respiratory distress syndrome (ARDS) patients, the existence of an early renal dysfunction and its prognosis, and its specificity compared with patients with non-COVID ARDS. METHOD This a prospective and multicentric study led in four ICUs. Patients of 18 years and older in ICU with invasive mechanical ventilation for ARDS were enrolled. Precise evaluation of renal dysfunction markers, including urinary protein electrophoresis, was performed within 24 h after the onset of mechanical ventilation. RESULTS From March 2020 to September 2021, 131 patients in ICU for ARDS were enrolled, 98 COVID-19 ARDS and 33 ARDS from other causes. There was more tubular profile in COVID-19 patients (68% versus 24%; P = .001) and a more mixed, tubular and glomerular profile in non-COVID-19 patients (29% versus 14%; P = .001). COVID-19 patients displayed an important tubular proteinuria, tended to display more AKI (49% versus 31%; P = .07), and had a longer duration of mechanical ventilation (18 versus 10 days; P = .002) and longer ICU length of stay (23 versus 15 days; P = .013). In COVID-19 patients, tubular proteinuria was associated with poor renal prognosis with a significant association with the onset of KDIGO ≥ 2 AKI. CONCLUSION COVID-19 ARDS patients had a specific renal impairment with tubular dysfunction, which appeared to be of poor prognosis on kidney and disease evolution.
Collapse
Affiliation(s)
- Mickaël Bobot
- Assistance Publique Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
- Aix-Marseille Université, C2VN, Marseille, France
| | - Xavier Heim
- Assistance Publique Hôpitaux de Marseille, Laboratoire d'Immunologie, Hôpital La Conception, Marseille, France
| | - Howard Max
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Pierre Simeone
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Lionel Velly
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Nicolas Bruder
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation, Hôpital La Conception, Marseille, France
| | - Jean-Marie Forel
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Julien Carvelli
- Assistance Publique Hôpitaux de Marseille, Réanimation des Urgences, Hôpital de la Timone, Marseille, France
| | - Claire Stein
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Sami Hraiech
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - José Boucraut
- Assistance Publique Hôpitaux de Marseille, Laboratoire d'Immunologie, Hôpital La Conception, Marseille, France
| | - Marc Gainnier
- Assistance Publique Hôpitaux de Marseille, Réanimation des Urgences, Hôpital de la Timone, Marseille, France
| | - Jean-Louis Mege
- Assistance Publique Hôpitaux de Marseille, Laboratoire d'Immunologie, Hôpital La Conception, Marseille, France
| | - Christophe Guervilly
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Noemie Jourde-Chiche
- Assistance Publique Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
| | - Laurent Papazian
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Stephane Burtey
- Assistance Publique Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
| |
Collapse
|
18
|
Bobot M, Tonon D, Peres N, Guervilly C, Lefèvre F, Carvelli J, Papazian L, Max H, Leone M, Lopez A, Bommel Y, Volff M, Velly L, Bruder N, Hraiech S, Simeone P, Bourenne J, Forel JM. MO303: Impact of Dexamethasone and Inhaled Nitric Oxide on Severe Acute Kidney Injury in Critically ill Patients With COVID-19. Nephrol Dial Transplant 2022. [PMCID: PMC9383862 DOI: 10.1093/ndt/gfac068.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIMS Kidney failure is the second most frequent condition after acute respiratory distress syndrome (ARDS) in critically ill patients with severe COVID-19 and is strongly associated with mortality. The aim of this multicentric study was to assess the impact of the specific treatments of COVID-19 and ARDS on the risk of severe acute kidney injury (AKI) in critically ill COVID patients. METHOD Data from a prospectively collected database of consecutive patients hospitalized in six ICUs for COVID-19 was retrospectively analysed. The incidence and severity of AKI were monitored during the entire ICU stay. Patients older than 18 years hospitalized in for COVID-19-related ARDS requiring mechanical ventilation were included. RESULTS A total of 164 patients were included in the final analysis, 97 (59.1%) displayed AKI, of which 39 had severe stage 3 AKI and 21 (12.8%) requiring renal replacement therapy (RRT). In univariate analysis, severe AKI was associated with ACEI exposure (P = .016), high blood pressure (P = .029), APACHE-II score (P = .004) and mortality at D28 (P = .008), D60 (P < .001) and D90 (P < .001). In multivariate analysis, the factors associated with the onset of stage 3 AKI were: exposure to CEI [OR: 4.238 (1.307–13.736); P = .016], APACHE II score (without age) [OR: 1.138 (1.044–1.241); P = .003] and iNO [OR: 5.694 (1.953–16.606); P = .001], protective factors were prone positioning [OR: 0.234 (0.057–0.967); P = .045] and dexamethasone [OR: 0.194 (0.053–0.713); P = .014]. CONCLUSION Dexamethasone seems to prevent the risk of severe AKI and RRT, and iNO seems associated with severe AKI and RRT in critically ill patients with COVID-19. iNO must be used with caution in COVID-19 related ARDS.
Collapse
Affiliation(s)
- Mickaël Bobot
- Assistance Publique—Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
- Aix-Marseille Université, C2VN, Marseille, France
| | - David Tonon
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation, Hôpital La Conception, Marseille, France
| | - Noémie Peres
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Christophe Guervilly
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Flora Lefèvre
- Assistance Publique—Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
| | - Julien Carvelli
- Assistance Publique Hôpitaux de Marseille, Réanimation des Urgences, Hôpital de la TImone, Marseille, France
| | - Laurent Papazian
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Howard Max
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Marc Leone
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation Polyvalente, Hôpital Nord, Marseille, France
| | - Alexandre Lopez
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation Polyvalente, Hôpital Nord, Marseille, France
| | - Youri Bommel
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Maxime Volff
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Lionel Velly
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Nicolas Bruder
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation, Hôpital La Conception, Marseille, France
| | - Sami Hraiech
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Pierre Simeone
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Jérémy Bourenne
- Assistance Publique Hôpitaux de Marseille, Réanimation des Urgences, Hôpital de la Timone, Marseille, France
| | - Jean-Marie Forel
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| |
Collapse
|
19
|
Boussen S, Cordier PY, Malet A, Simeone P, Cataldi S, Vaisse C, Roche X, Castelli A, Assal M, Pepin G, Cot K, Denis JB, Morales T, Velly L, Bruder N. Triage and monitoring of COVID-19 patients in intensive care using unsupervised machine learning. Comput Biol Med 2021; 142:105192. [PMID: 34998220 PMCID: PMC8719000 DOI: 10.1016/j.compbiomed.2021.105192] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND We designed an algorithm to assess COVID-19 patients severity and dynamic intubation needs and predict their length of stay using the breathing frequency (BF) and oxygen saturation (SpO2) signals. METHODS We recorded the BF and SpO2 signals for confirmed COVID-19 patients admitted to the ICU of a teaching hospital during both the first and subsequent outbreaks of the pandemic in France. An unsupervised machine-learning algorithm (the Gaussian mixture model) was applied to the patients' data for clustering. The algorithm's robustness was ensured by comparing its results against actual intubation rates. We predicted intubation rates using the algorithm every hour, thus conducting a severity evaluation. We designed a S24 severity score that represented the patient's severity over the previous 24 h; the validity of MS24, the maximum S24 score, was checked against rates of intubation risk and prolonged ICU stay. RESULTS Our sample included 279 patients. . The unsupervised clustering had an accuracy rate of 87.8% for intubation recognition (AUC = 0.94, True Positive Rate 86.5%, true Negative Rate 90.9%). The S24 score of intubated patients was significantly higher than that of non-intubated patients at 48 h before intubation. The MS24 score allowed for the distinguishing between three severity levels with an increased risk of intubation: green (3.4%), orange (37%), and red (77%). A MS24 score over 40 was highly predictive of an ICU stay greater than 5 days at an accuracy rate of 81.0% (AUC = 0.87). CONCLUSIONS Our algorithm uses simple signals and seems to efficiently visualize the patients' respiratory situations, meaning that it has the potential to assist staffs' in decision-making. Additionally, real-time computation is easy to implement.
Collapse
Affiliation(s)
- Salah Boussen
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France; Aix Marseille Université, IFSTTAR, LBA UMR_T 24, 13916, Marseille, France.
| | - Pierre-Yves Cordier
- Aix Marseille Université, IFSTTAR, LBA UMR_T 24, 13916, Marseille, France; Intensive Care Unit, Laveran Military Teaching Hospital, 34, boulevard Laveran, 13384, Marseille, France
| | - Arthur Malet
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Pierre Simeone
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France; Institut des Neurociences de la Timone, CNRS UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
| | - Sophie Cataldi
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Camille Vaisse
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Xavier Roche
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Alexandre Castelli
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Mehdi Assal
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Guillaume Pepin
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Kevin Cot
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Jean-Baptiste Denis
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Timothée Morales
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Lionel Velly
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France; Aix Marseille Université, IFSTTAR, LBA UMR_T 24, 13916, Marseille, France; Intensive Care Unit, Laveran Military Teaching Hospital, 34, boulevard Laveran, 13384, Marseille, France; Institut des Neurociences de la Timone, CNRS UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
| | - Nicolas Bruder
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| |
Collapse
|
20
|
Daviet F, Guilloux P, Hraiech S, Tonon D, Velly L, Bourenne J, Porto A, Gragueb-Chatti I, Bobot M, Baumstarck K, Papazian L, Collart F, Forel JM, Guervilly C. Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort. Ann Intensive Care 2021; 11:157. [PMID: 34779944 PMCID: PMC8591429 DOI: 10.1186/s13613-021-00943-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Received: 08/06/2021] [Accepted: 10/20/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Since March 2020, health care systems were importantly affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, with some patients presenting severe acute respiratory distress syndrome (ARDS), requiring extra-corporeal membrane oxygenation (ECMO). We designed an ambispective observational cohort study including all consecutive adult patients admitted to 5 different ICUs from a university hospital. The main objective was to identify the risk factors of severe COVID-19 ARDS patients supported by ECMO associated with 90-day survival. RESULTS Between March 1st and November 30th 2020, 76 patients with severe COVID-19 ARDS were supported by ECMO. Median (interquartile range IQR) duration of mechanical ventilation (MV) prior to ECMO was of 6 (3-10) days. At ECMO initiation, patients had a median PaO2:FiO2 of 71 mmHg (IQR 62-81), median PaCO2 of 58 mmHg (IQR 51-66) and a median arterial pH of 7.33 (IQR 7.25-7.38). Forty-five patients (59%) were weaned from ECMO. Twenty-eight day, 60-day and 90-day survival rates were, respectively, 92, 62 and 51%. In multivariate logistic regression analysis, with 2 models, one with the RESP score and one with the PRESERVE score, we found that higher BMI was associated with higher 90-day survival [odds ratio (OR): 0.775 (0.644-0.934), p = 0.007) and 0.631 (0.462-0.862), respectively]. Younger age was also associated with 90-day survival in both models [OR: 1.1354 (1.004-1.285), p = 0.044 and 1.187 (1.035-1.362), p = 0.014 respectively]. Obese patients were ventilated with higher PEEP than non-obese patients and presented slightly higher respiratory system compliance. CONCLUSION In this ambispective observational cohort of COVID-19 severe ARDS supported by ECMO, obesity was an independent factor associated with improved survival at 90-day.
Collapse
Affiliation(s)
- Florence Daviet
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L'Hôpital Nord, Assistance Publique hôpitaux de Marseille, chemin des Bourrely, 13015, Marseille, France.
- Faculté de Médecine Centre d'Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France.
| | - Philippe Guilloux
- Département d'Anesthésie-réanimation, Centre hospitalier Universitaire La Timone, Assistance Publique Hôpitaux de Marseille, 13005, Marseille, France
| | - Sami Hraiech
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L'Hôpital Nord, Assistance Publique hôpitaux de Marseille, chemin des Bourrely, 13015, Marseille, France
- Faculté de Médecine Centre d'Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
| | - David Tonon
- Département d'Anesthésie-réanimation, Centre hospitalier Universitaire La Timone, Assistance Publique Hôpitaux de Marseille, 13005, Marseille, France
| | - Lionel Velly
- Département d'Anesthésie-réanimation, Centre hospitalier Universitaire La Timone, Assistance Publique Hôpitaux de Marseille, 13005, Marseille, France
| | - Jeremy Bourenne
- Médecine intensive Réanimation, Réanimation des Urgences, Centre hospitalier Universitaire La Timone 2, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Alizée Porto
- Département de chirurgie cardiaque, Centre Hospitalier Universitaire La Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Inès Gragueb-Chatti
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L'Hôpital Nord, Assistance Publique hôpitaux de Marseille, chemin des Bourrely, 13015, Marseille, France
| | - Mickael Bobot
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L'Hôpital Nord, Assistance Publique hôpitaux de Marseille, chemin des Bourrely, 13015, Marseille, France
| | - Karine Baumstarck
- Faculté de Médecine, Centre d'Etudes et de Recherches sur les Services de Santé et Qualité de Vie EA 3279, Aix-Marseille Université, Marseille, France
| | - Laurent Papazian
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L'Hôpital Nord, Assistance Publique hôpitaux de Marseille, chemin des Bourrely, 13015, Marseille, France
- Faculté de Médecine Centre d'Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
| | - Frédéric Collart
- Département de chirurgie cardiaque, Centre Hospitalier Universitaire La Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Jean-Marie Forel
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L'Hôpital Nord, Assistance Publique hôpitaux de Marseille, chemin des Bourrely, 13015, Marseille, France
- Faculté de Médecine Centre d'Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
| | - Christophe Guervilly
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L'Hôpital Nord, Assistance Publique hôpitaux de Marseille, chemin des Bourrely, 13015, Marseille, France
- Faculté de Médecine Centre d'Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
| |
Collapse
|
21
|
Choucha A, Boissonneau S, Beucler N, Graillon T, Ranque S, Bruder N, Fuentes S, Velly L, Dufour H. Meningoencephalitis with refractory intracranial hypertension : Consider Decompressive craniectomy. J Neurosurg Sci 2021; 67:248-256. [PMID: 34342197 DOI: 10.23736/s0390-5616.21.05397-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The benefits of decompressive craniectomy (DC) have been demonstrated in malignant ischemic stroke and traumatic brain injuries with refractory intracranial hypertension (ICH) by randomized controlled trials. Some reports advocate the potential of DC in the context of ICH due to meningoencephalitis (ME) with focal cerebral edema but its interest remains controversial especially when there is diffuse cerebral edema. The aim of this study is to assess the benefits of DC in meningoencephalitis with malignant cerebral edema whether it is focal or diffuse. METHODS We report two cases successfully treated in our instution, plus we conducted a systematic literature review focused on cases of DC in ME in compliance with prisma guidelines. RESULTS the first patient is a 36-years-old woman who suffered from fulminant pneumococcal meningoencephalitis (ME) with refractory ICH following a transphenoidal removal of pituitary adenoma. The second patient is a 20-years-old man suffering from neuromeningeal cryptococcosis with refractory ICH. In both cases DC led to major clinical improvement with a GOS-E 8 at one year. These results are consistent with the literature review which reports a favorable outcome in 85% of cases. CONCLUSIONS DC appears to be a promising therapeutic option in cases of ME with refractory ICH. Thus, reliable criteria will have to be defined to guide us in our practice in emergency cases where DC has not been part of the therapeutic arsenal yet.
Collapse
Affiliation(s)
- Anis Choucha
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France -
| | - Sebastien Boissonneau
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France.,Inst Neurosci Syst, Aix Marseille Univ, INSERM, INS, Marseille, France
| | - Nathan Beucler
- Department of Neurosurgery, Sainte-Anne Military Teaching Hospital, Toulon, France
| | - Thomas Graillon
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France.,Inst Neurosci Timone, Aix Marseille Univ, CNRS, CRN2M, Marseille, France
| | - Stephane Ranque
- Aix Marseille Univ, IRD, APHM, SSA, VITROME, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Nicolas Bruder
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France.,Inst Neurosci Timone, Aix Marseille Univ, CNRS, INT, Marseille, France
| | - Stephane Fuentes
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France.,Spine Unit, Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France
| | - Lionel Velly
- Inst Neurosci Timone, Aix Marseille Univ, CNRS, INT, Marseille, France.,Department of Anaesthesiology and Critical Care Medicine, Aix Marseille Univ, APHM, UH Timone, Marseille, France
| | - Henry Dufour
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France.,Inst Neurosci Timone, Aix Marseille Univ, CNRS, CRN2M, Marseille, France
| |
Collapse
|
22
|
Pottecher J, Lefort H, Adam P, Barbier O, Bouzat P, Charbit J, Galinski M, Garrigue D, Gauss T, Georg Y, Hamada S, Harrois A, Kedzierewicz R, Pasquier P, Prunet B, Roger C, Tazarourte K, Travers S, Velly L, Gil-Jardiné C, Quintard H. Guidelines for the acute care of severe limb trauma patients. Anaesth Crit Care Pain Med 2021; 40:100862. [PMID: 34059492 DOI: 10.1016/j.accpm.2021.100862] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
GOAL To provide healthcare professionals with comprehensive multidisciplinary expert recommendations for the acute care of severe limb trauma patients, both during the prehospital phase and after admission to a Trauma Centre. DESIGN A consensus committee of 21 experts was formed. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations remained non-graded. METHODS The committee addressed eleven questions relevant to the patient suffering severe limb trauma: 1) What are the key findings derived from medical history and clinical examination which lead to the patient's prompt referral to a Level 1 or Level 2 Trauma Centre? 2) What are the medical devices that must be implemented in the prehospital setting to reduce blood loss? 3) Which are the clinical findings prompting the performance of injected X-ray examinations? 4) What are the ideal timing and modalities for performing fracture fixation? 5) What are the clinical and operative findings which steer the surgical approach in case of vascular compromise and/or major musculoskeletal attrition? 6) How to best prevent infection? 7) How to best prevent thromboembolic complications? 8) What is the best strategy to precociously detect and treat limb compartment syndrome? 9) How to best and precociously detect post-traumatic rhabdomyolysis and prevent rhabdomyolysis-induced acute kidney injury? 10) What is the best strategy to reduce the incidence of fat emboli syndrome and post-traumatic systemic inflammatory response? 11) What is the best therapeutic strategy to treat acute trauma-induced pain? Every question was formulated in a PICO (Patient Intervention Comparison Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 19 recommendations. Among the formalised recommendations, 4 had a high level of evidence (GRADE 1+/-) and 12 had a low level of evidence (GRADE 2+/-). For 3 recommendations, the GRADE method could not be applied, resulting in an expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. CONCLUSIONS There was significant agreement among experts on strong recommendations to improve practices for severe limb trauma patients.
Collapse
Affiliation(s)
- Julien Pottecher
- Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098 Strasbourg Cedex, France; Université de Strasbourg, FMTS, France.
| | - Hugues Lefort
- Structure des urgences, Hôpital d'Instruction des Armées Legouest, BP 9000, 57077 Metz Cédex 03, France
| | - Philippe Adam
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098 Strasbourg Cedex, France
| | - Olivier Barbier
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital d'Instruction des Armées Sainte Anne, 2 boulevard Sainte Anne, 83000 Toulon, France; Ecole du Val de Grace, 2 place Alphonse Laveran, 75005 Paris, France
| | - Pierre Bouzat
- Université Grenoble Alpes, Pôle Anesthésie-Réanimation, Centre Hospitalo-Universitaire Grenoble-Alpes, Grenoble, France
| | - Jonathan Charbit
- Soins critiques DAR Lapeyronie, CHU Montpellier, France; Réseau OcciTRAUMA, Réseau Régional Occitanie de prise en charge des traumatisés sévères, France
| | - Michel Galinski
- Pôle urgences adultes - SAMU 33, Hôpital Pellegrin, CHU de Bordeaux 3300 Bordeaux, France; INSERM U1219, ISPED, Bordeaux Population Health Research Center INSERM U1219-"Injury Epidemiology Transport Occupation" Team, F-33076 Bordeaux Cedex, France
| | - Delphine Garrigue
- Pôle d'Anesthésie Réanimation, Pôle de l'Urgence, CHU Lille, F-59000 Lille, France
| | - Tobias Gauss
- Service d'Anesthésie-Réanimation, Hôpital Beaujon, DMU PARABOL, AP-HP Nord, Clichy, France; Université de Paris, Paris, France
| | - Yannick Georg
- Service de Chirurgie Vasculaire et Transplantation Rénale, Hôpitaux Universitaire de Strasbourg, Strasbourg, France
| | - Sophie Hamada
- Département d'Anesthésie Réanimation, Hôpital Européen Georges Pompidou, APHP, Université de Paris, Paris, France
| | - Anatole Harrois
- Département d'anesthésie-réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Saclay, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Romain Kedzierewicz
- Ecole du Val de Grace, 2 place Alphonse Laveran, 75005 Paris, France; Bureau de Médecine d'Urgence, Division Santé, Brigade de Sapeurs-Pompiers de Paris, 1 place Jules Renard, 75017 Paris, France
| | - Pierre Pasquier
- Département anesthésie-réanimation, Hôpital d'instruction des armées Percy, Clamart, France; Brigade de Sapeurs-Pompiers de Paris, Paris, France
| | - Bertrand Prunet
- Ecole du Val de Grace, 2 place Alphonse Laveran, 75005 Paris, France; Brigade de Sapeurs-Pompiers de Paris, Paris, France
| | - Claire Roger
- Service de Réanimation Chirurgicale, Pôle Anesthésie Réanimation Douleur Urgence, CHU Carémeau, 30000 Nîmes, France
| | - Karim Tazarourte
- Service SAMU-Urgences, CHU Edouard Herriot, Hospices civils de Lyon, Lyon, France; Université Lyon 1 Hesper EA 7425, Lyon, France
| | - Stéphane Travers
- Ecole du Val de Grace, 2 place Alphonse Laveran, 75005 Paris, France; 1ère Chefferie du Service de Santé, Villacoublay, France
| | - Lionel Velly
- Service d'Anesthésie Réanimation, CHU Timone Adultes, 264 rue St Pierre 13005 Marseille, France; MeCA, Institut de Neurosciences de la Timone - UMR 7289, Aix Marseille Université, Marseille, France
| | - Cédric Gil-Jardiné
- Pôle Urgences adultes SAMU-SMUR, CHU Bordeaux, Bordeaux Population Health - INSERM U1219 Université de Bordeaux, Equipe IETO, Bordeaux, France
| | - Hervé Quintard
- Soins Intensifs, Hôpitaux Universitaires de Genève, Genève, Suisse
| |
Collapse
|
23
|
Lacroix C, Bera-Jonville AP, Montastruc F, Velly L, Micallef J, Guilhaumou R. Serious Neurological Adverse Events of Ceftriaxone. Antibiotics (Basel) 2021; 10:540. [PMID: 34066591 PMCID: PMC8148437 DOI: 10.3390/antibiotics10050540] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 11/21/2022] Open
Abstract
We described ceftriaxone-induced CNS adverse events through the largest case series of Adverse Drug Reactions (ADRs) reports, from 1995 to 2017, using the French Pharmacovigilance Database. In total, 152 cases of serious CNS ADRs were analyzed; 112 patients were hospitalized or had a prolonged hospitalization (73.7%), 12 dead (7.9%) and 16 exhibited life-threatening ADRs (10.5%). The median age was 74.5 years, mainly women (55.3%), with a median creatinine clearance of 35 mL/min. Patients mainly exhibited convulsions, status epilepticus, myoclonia (n = 75, 49.3%), encephalopathy (n = 45, 29.6%), confused state (n = 34, 22.4%) and hallucinations (n = 16, 10.5%). The median time of onset was 4 days, and the median duration was 4.5 days. The mean daily dose was 1.7 g mainly through an intravenous route (n = 106, 69.7%), and three patients received doses above maximal dose of Summary of Product Characteristics. Ceftriaxone plasma concentrations were recorded for 19 patients (12.5%), and 8 were above the toxicity threshold. Electroencephalograms (EEG) performed for 32.9% of the patients (n = 50) were abnormal for 74% (n = 37). We described the world's biggest case series of ceftriaxone-induced serious CNS ADRs. Explorations (plasma concentrations, EEG) are contributive to confirm the ceftriaxone toxicity-induced. Clinicians may be cautious with the use of ceftriaxone, especially in the older age or renal impairment population.
Collapse
Affiliation(s)
- Clémence Lacroix
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique, APHM, INSERM, Institut Neurosciences Système, UMR 1106, Aix Marseille Université, 13005 Marseille, France; (C.L.); (J.M.)
| | - Annie-Pierre Bera-Jonville
- Centre Régional de Pharmacovigilance et d’Information sur le Médicament Centre-Val-de-Loire, Service de Pharmacosurveillance, Centre Hospitalier Régional Universitaire de Tours, 37000 Tours, France;
| | - François Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, Pharmacoépidémiologie et d’Informations sur le Médicament, Centre Hospitalier Universitaire, Faculté de Médecine, 31000 Toulouse, France;
- Unité Clinique de Pharmacologie Psychiatrique, Faculté de Médecine, Centre Hospitalier Universitaire, 31000 Toulouse, France
| | - Lionel Velly
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille Université, 13005 Marseille, France;
- CNRS, INT, Institut Neurosci Timone, UMR 7289, Aix Marseille Université, 13005 Marseille, France
| | - Joëlle Micallef
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique, APHM, INSERM, Institut Neurosciences Système, UMR 1106, Aix Marseille Université, 13005 Marseille, France; (C.L.); (J.M.)
| | - Romain Guilhaumou
- Laboratoire de Pharmacologie Clinique, Service de Pharmacologie Clinique, APHM, INSERM, Institut Neurosciences Système, UMR 1106, Aix Marseille Université, 13005 Marseille, France
| |
Collapse
|
24
|
Becker Y, Phelipon R, Sein J, Velly L, Renaud L, Meguerditchian A. Planum temporale grey matter volume asymmetries in newborn monkeys (Papio anubis). Brain Struct Funct 2021; 227:463-468. [PMID: 33937939 DOI: 10.1007/s00429-021-02278-9] [Citation(s) in RCA: 6] [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: 02/22/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
The Planum temporale (PT) is one of the key hubs of the language network in the human brain. The gross asymmetry of this perisylvian region toward the left brain was considered as the most emblematic marker of hemispheric specialization of language processes in the brain. Interestingly, this neuroanatomical signature was documented also in newborn infants and preterms, suggesting the early brain's readiness for language acquisition. Nevertheless, this latter interpretation was questioned by a recent report in non-human primates of a potential similar signature in newborn baboons Papio anubis based on PT surface measures. Whether this "tip of the iceberg" PT asymmetry is actually reflecting asymmetry of its underlying grey matter volume remains unclear but critical to investigate potential continuities of cortical specialization with human infants. Here we report a population-level leftward asymmetry of the PT grey matter volume in in vivo 34 newborn baboons P. anubis, which showed intra-individual positive correlation with PT surface's asymmetry measures but also a more pronounced degree of leftward asymmetry at the population level. This finding demonstrates that PT leftward structural asymmetry in this Old World monkey species is a robust phenomenon in early primate development, which clearly speaks for a continuity with early human brain specialization. Results also strengthen the hypothesis that early PT asymmetry might be not a human-specific marker for the pre-wired language-ready brain in infants.
Collapse
Affiliation(s)
- Yannick Becker
- Laboratoire de Psychologie Cognitive, UMR 7290, Université Aix-Marseille/CNRS, 13331, Marseille, France.,Institut des Neurosciences de La Timone, UMR 7289, Université Aix-Marseille/CNRS, 13005, Marseille, France
| | - Romane Phelipon
- Laboratoire de Psychologie Cognitive, UMR 7290, Université Aix-Marseille/CNRS, 13331, Marseille, France
| | - Julien Sein
- Institut des Neurosciences de La Timone, UMR 7289, Université Aix-Marseille/CNRS, 13005, Marseille, France
| | - Lionel Velly
- Institut des Neurosciences de La Timone, UMR 7289, Université Aix-Marseille/CNRS, 13005, Marseille, France
| | - Luc Renaud
- Institut des Neurosciences de La Timone, UMR 7289, Université Aix-Marseille/CNRS, 13005, Marseille, France
| | - Adrien Meguerditchian
- Laboratoire de Psychologie Cognitive, UMR 7290, Université Aix-Marseille/CNRS, 13331, Marseille, France. .,Station de Primatologie, UPS846, CNRS, 13790, Rousset, France.
| |
Collapse
|
25
|
Khozenko A, Lamperti M, Velly L, Simeone P, Tufegdzic B. Role of anaesthesia in neurosurgical enhanced recovery programmes. Best Pract Res Clin Anaesthesiol 2020; 35:241-253. [PMID: 34030808 DOI: 10.1016/j.bpa.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022]
Abstract
The application of Enhanced Recovery After Surgery (ERAS) in neurosurgical practice is a relatively new concept. A limited number of studies involving ERAS protocols within neurosurgery, specifically for elective craniotomy, have been published, contrary to the ERAS spine surgery pathways that are now promoted by numerous national and international dedicated surgical societies and hospitals. In this review, we want to present the patient surgical journey from an anaesthesia perspective through the key components that can be included in the ERAS pathways for neurosurgical procedures, both craniotomies and major spine surgery.
Collapse
Affiliation(s)
- Andrey Khozenko
- Anaesthesiology Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO box 112412, Abu Dhabi, United Arab Emirates
| | - Massimo Lamperti
- Anaesthesiology Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO box 112412, Abu Dhabi, United Arab Emirates.
| | - Lionel Velly
- Aix Marseille Univ, AP-HM, Department of Anesthesiology and Critical Care Medicine, University Hospital Timone, 264 rue saint Pierre, 13005, CEDEX 5, Marseille, France.
| | - Pierre Simeone
- Aix Marseille Univ, AP-HM, Department of Anesthesiology and Critical Care Medicine, University Hospital Timone, 264 rue saint Pierre, 13005, CEDEX 5, Marseille, France.
| | - Boris Tufegdzic
- Anaesthesiology Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO box 112412, Abu Dhabi, United Arab Emirates.
| |
Collapse
|
26
|
Garnier M, Velly L. Answer to the letter by Niño et al. Anaesth Crit Care Pain Med 2020; 39:743-744. [PMID: 33011331 PMCID: PMC7529826 DOI: 10.1016/j.accpm.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marc Garnier
- Sorbonne University, GRC 29, APHP Saint-Antoine Hospital, Department of Anaesthesiology and Critical Care Medicine, 75012 Paris, France.
| | - Lionel Velly
- Aix-Marseille University, AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix-Marseille University, CNRS, Institut Neuroscience Timone, UMR7289, 13005 Marseille, France
| |
Collapse
|
27
|
Lasocki S, Pène F, Ait-Oufella H, Aubron C, Ausset S, Buffet P, Huet O, Launey Y, Legrand M, Lescot T, Mekontso Dessap A, Piagnerelli M, Quintard H, Velly L, Kimmoun A, Chanques G. Management and prevention of anemia (acute bleeding excluded) in adult critical care patients. Ann Intensive Care 2020; 10:97. [PMID: 32700082 PMCID: PMC7374293 DOI: 10.1186/s13613-020-00711-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 12/14/2022] Open
Abstract
Objective Anemia is very common in critical care patients, on admission (affecting about two-thirds of patients), but also during and after their stay, due to repeated blood loss, the effects of inflammation on erythropoiesis, a decreased red blood cell life span, and haemodilution. Anemia is associated with severity of illness and length of stay. Methods A committee composed of 16 experts from four scientific societies, SFAR, SRLF, SFTS and SFVTT, evaluated three fields: (1) anemia prevention, (2) transfusion strategies and (3) non-transfusion treatment of anemia. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology. Results The SFAR–SRLF guideline panel provided ten statements concerning the management of anemia in adult critical care patients. Acute haemorrhage and chronic anemia were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for ten recommendations. Three of these recommendations had a high level of evidence (GRADE 1±) and four had a low level of evidence (GRADE 2±). No GRADE recommendation could be provided for two questions in the absence of strong consensus. Conclusions The experts reached a substantial consensus for several strong recommendations for optimal patient management. The experts recommended phlebotomy reduction strategies, restrictive red blood cell transfusion and a single-unit transfusion policy, the use of red blood cells regardless of storage time, treatment of anaemic patients with erythropoietin, especially after trauma, in the absence of contraindications and avoidance of iron therapy (except in the context of erythropoietin therapy).
Collapse
Affiliation(s)
- Sigismond Lasocki
- Département d'anesthésie-réanimation, Pôle ASUR, CHU Angers, UMR INSERM 1084, CNRS 6214, Université d'Angers, 49000, Angers, France.
| | - Frédéric Pène
- Service de Médecine Intensive et Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris. Centre, Université de Paris, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie Paris, Paris, France
| | - Cécile Aubron
- Médecine Intensive Réanimation, CHRU de Brest, Université de Bretagne Occidentale, 29200, Brest, France
| | - Sylvain Ausset
- Ecoles Militaires de Santé de Lyon-Bron, 69500, Bron, France
| | - Pierre Buffet
- Université de Paris, UMRS 1134, Inserm, 75015, Paris, France.,Laboratory of Excellence GREx, 75015, Paris, France
| | - Olivier Huet
- Département d'Anesthésie Réanimation, Hôpital de la Cavale-Blanche, CHRU de Brest, 29200, Brest, France.,UFR de Médecine de Brest, Université de Bretagne Occidentale, 29200, Brest, France
| | - Yoann Launey
- Critical Care Unit, Department of Anaesthesia, Critical Care Medicine and Perioperative Medicine, Rennes University Hospital, 2, Rue Henri-Le-Guilloux, 35033, Rennes, France
| | - Matthieu Legrand
- Department of Anaesthesiology and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Thomas Lescot
- Département d'Anesthésie-Réanimation, Hôpital Saint-Antoine, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Armand Mekontso Dessap
- AP-HP, Hôpitaux Universitaires Henri-Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, 94010, Créteil, France
| | - Michael Piagnerelli
- Intensive Care, CHU-Charleroi Marie-Curie, Experimental Medicine Laboratory, Université Libre de Bruxelles, (ULB 222) Unit, 140, Chaussée de Bruxelles, 6042, Charleroi, Belgium
| | - Hervé Quintard
- Réanimation Médico-Chirurgicale, Hôpital Pasteur 2, CHU Nice, 30, Voie Romaine, Nice, France
| | - Lionel Velly
- AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, 13005, Marseille, France.,Aix Marseille University, CNRS, Inst Neurosci Timone, UMR7289, Marseille, France
| | - Antoine Kimmoun
- Service de Médecine Intensive et Réanimation Brabois, Université de Lorraine, CHRU de Nancy, Inserm U1116, Nancy, France
| | - Gérald Chanques
- Department of Anaesthesia and Intensive Care, Montpellier University Saint-Eloi Hospital, and PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| |
Collapse
|
28
|
Lasocki S, Kimmoun A, Chanques G, Velly L, Pène F. Treating critically ill anaemic patients with erythropoietin: why not? Intensive Care Med 2020; 46:1794-1795. [PMID: 32676678 DOI: 10.1007/s00134-020-06175-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Sigismond Lasocki
- Département Anesthésie Réanimation, Université d'Angers, CHU Angers, 4 rue Larrey, 49933, Angers Cedex 9, France.
| | - Antoine Kimmoun
- Service de Médecine Intensive et Réanimation, Université de Lorraine, CHRU de Nancy, Inserm U1116, Brabois, Nancy, France
| | - Gerald Chanques
- Département Anesthésie Réanimation, Hopital Saint-Éloi Hospital, Et PhyMedExp, INSERM, CNRS, Université de Montpellier, Montpellier, France
| | - Lionel Velly
- Service d'Anesthésie Réanimation, APHM, CHU Timone, Marseille, France.,MeCA, Institut de Neurosciences de La Timone, UMR 7289, Aix Marseille Université, Marseille, France
| | - Frédéric Pène
- Service de Médecine Intensive et Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Paris, France
| |
Collapse
|
29
|
Volff M, Tonon D, Bourenne J, Simeone P, Velly L. No added value of the modified NEWS score to predict clinical deterioration in COVID-19 patients. Anaesth Crit Care Pain Med 2020; 39:577-578. [PMID: 32659455 PMCID: PMC7351041 DOI: 10.1016/j.accpm.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Maxime Volff
- Aix Marseille University, AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France
| | - David Tonon
- Aix Marseille University, AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France
| | - Jeremy Bourenne
- Aix Marseille University, AP-HM, Emergency and Critical Care Medicine, University Hospital Timone, Marseille, France.
| | - Pierre Simeone
- Aix Marseille University, AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France; CNRS, Institut des neurosciences de la Timone, UMR 7289, Marseille, France
| | - Lionel Velly
- Aix Marseille University, AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France; CNRS, Institut des neurosciences de la Timone, UMR 7289, Marseille, France
| |
Collapse
|
30
|
Wang YL, Guilhaumou R, Blin O, Velly L, Marsot A. External evaluation of population pharmacokinetic models for continuous administration of meropenem in critically ill adult patients. Eur J Clin Pharmacol 2020; 76:1281-1289. [PMID: 32495084 DOI: 10.1007/s00228-020-02922-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/29/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Beta-lactams (BL), the most commonly prescribed class of antibiotics, are recommended as the first-line therapy for multiple indications in infectious disease guidelines. Meropenem (MERO) is frequently used in intensive care units (ICU) to treat bacterial infections with or without sepsis. The pharmacokinetics of MERO display a large variability in patients admitted to ICUs due to altered pathophysiology. The aim of this study was to perform an external evaluation of published population pharmacokinetic models of MERO in order to test their predictive performance in a cohort of ICU adult patients. METHODS A literature search in PubMed/Medline database was made following the PRISMA statement. External evaluation was performed using NONMEM software, and the bias and inaccuracy values were calculated. RESULTS An external validation dataset from the Timone Hospital in Marseille, France, included 84 concentration samples from 27 patients. Four models of MERO were identified according to the inclusion criteria of the study. None of the models presented acceptable values of bias and inaccuracy. CONCLUSION While performing external evaluations on some populations may confirm a model's suitability to diverse groups of patients, there is still some variability that cannot be explained nor solved by the procedure. This brings to light the difficulty to develop only one model for ICU patients and the need to develop one specific model to each population of critically ill patients.
Collapse
Affiliation(s)
- Y L Wang
- Laboratoire de Suivi Thérapeutique Pharmacologique et Pharmacocinétique, Faculté de Pharmacie, Université de Montréal, Pavillon Jean-Coutu, 2940 chemin de Polytechnique, Montréal, QC, H3T 1J4, Canada.,Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada
| | - R Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France.,Pharmacologie intégrée et interface clinique et industrielle, Institut de Neuroscience des systèmes, CNRS 7289, Aix Marseille Université, 13385, Marseille, France
| | - O Blin
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France.,Pharmacologie intégrée et interface clinique et industrielle, Institut de Neuroscience des systèmes, CNRS 7289, Aix Marseille Université, 13385, Marseille, France
| | - L Velly
- Service d'Anesthésie-Réanimation, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Amélie Marsot
- Laboratoire de Suivi Thérapeutique Pharmacologique et Pharmacocinétique, Faculté de Pharmacie, Université de Montréal, Pavillon Jean-Coutu, 2940 chemin de Polytechnique, Montréal, QC, H3T 1J4, Canada. .,Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada. .,Centre de Recherche, CHU Sainte Justine, Montréal, QC, Canada.
| |
Collapse
|
31
|
Velly L, Gayat E, Quintard H, Weiss E, De Jong A, Cuvillon P, Audibert G, Amour J, Beaussier M, Biais M, Bloc S, Bonnet MP, Bouzat P, Brezac G, Dahyot-Fizelier C, Dahmani S, de Queiroz M, Di Maria S, Ecoffey C, Futier E, Geeraerts T, Jaber H, Heyer L, Hoteit R, Joannes-Boyau O, Kern D, Langeron O, Lasocki S, Launey Y, le Saché F, Lukaszewicz AC, Maurice-Szamburski A, Mayeur N, Michel F, Minville V, Mirek S, Montravers P, Morau E, Muller L, Muret J, Nouette-Gaulain K, Orban JC, Orliaguet G, Perrigault PF, Plantet F, Pottecher J, Quesnel C, Reubrecht V, Rozec B, Tavernier B, Veber B, Veyckmans F, Charbonneau H, Constant I, Frasca D, Fischer MO, Huraux C, Blet A, Garnier M. Guidelines: Anaesthesia in the context of COVID-19 pandemic. Anaesth Crit Care Pain Med 2020; 39:395-415. [PMID: 32512197 PMCID: PMC7274119 DOI: 10.1016/j.accpm.2020.05.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The world is currently facing an unprecedented healthcare crisis caused by the COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic. METHODS The group has endeavoured to produce a minimum number of recommendations to highlight the strengths to be retained in the 7 predefined areas: (1) protection of staff and patients; (2) benefit/risk and patient information; (3) preoperative assessment and decision on intervention; (4) modalities of the preanaesthesia consultation; (5) specificity of anaesthesia and analgesia; (6) dedicated circuits and (7) containment exit type of interventions. RESULTS The SFAR Guideline panel provides 51 statements on anaesthesia management in the context of COVID-19 pandemic. After one round of discussion and various amendments, a strong agreement was reached for 100% of the recommendations and algorithms. CONCLUSION We present suggestions for how the risk of transmission by and to anaesthetists can be minimised and how personal protective equipment policies relate to COVID-19 pandemic context.
Collapse
Affiliation(s)
- Lionel Velly
- Aix-Marseille University, AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, 13005 Marseille, France; Aix-Marseille University, CNRS, Institut Neuroscience Timone, UMR7289, Marseille, France.
| | - Etienne Gayat
- Department of Anaesthesiology and Critical Care, Lariboisière Hospital, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France
| | - Hervé Quintard
- Intensive Care Unit, Centre Hospitalier Universitaire de Nice, Pasteur 2 Hospital, Nice, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Paris, France; Inserm UMR_S1149, Inserm, Université de Paris, Paris, France
| | - Audrey De Jong
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Éloi Hospital, Montpellier, France; PhyMedExp, University of Montpellier, Inserm U1046, CNRS UMR, 9214, Montpellier, France
| | - Philippe Cuvillon
- Department of Anaesthesiology, Beaujon Hospital, CHU Carémeau, Nîmes, France
| | - Gérard Audibert
- Department of Anaesthesia and Intensive Care, Lorraine University, Nancy University Hospital, 54000 Nancy, France
| | - Julien Amour
- Cardiovascular and Thoracic Surgery Department, Hôpital Privé Jacques-Cartier, 91300 Massy, France
| | - Marc Beaussier
- Département d'Anesthésie, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Matthieu Biais
- Department of Anaesthesiology and Critical Care, Pellegrin Hospital, CHU de Bordeaux, Bordeaux, France; Inserm UMR-S 1034, Biology of Cardiovascular Diseases, Bordeaux University, Bordeaux, France
| | - Sébastien Bloc
- CMC Ambroise-Paré, Département d'anesthésie, 92200 Neuilly-sur-Seine, France
| | - Marie Pierre Bonnet
- Department of Anaesthesiology and Critical Care, Armand-Trousseau University Hospital, Assistance publique-Hôpitaux de Paris, Paris, France; Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé), Inserm INRA, Paris, France; Department of Anaesthesiology and Critical Care, Cochin-Port Royal University Hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Pierre Bouzat
- Department of Anaesthesiology and Intensive Care Medicine, Grenoble University Hospital, 38000 Grenoble, France
| | - Gilles Brezac
- Anaesthesiology, Lenval Children's Hospital, 06200 Nice, France
| | - Claire Dahyot-Fizelier
- Anaesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France; Inserm UMR1070, Pharmacology of Anti-infective Agents, University of Poitiers, Poitiers, France
| | - Souhayl Dahmani
- Department of Anaesthesia and Intensive Care, Robert-Debré University Hospital, AP-HP, DHU PROTECT, Inserm U1141, Paris, France
| | - Mathilde de Queiroz
- Department of Paediatric Anaesthesia and Intensive Care, Femme-Mère-Enfant Hospital, Lyon, France
| | - Sophie Di Maria
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Claude Ecoffey
- Department of Anaesthesia and Intensive Care, CHU de Rennes, Inserm UMR 991, CIC 1414, Rennes 1 University, Rennes, France
| | - Emmanuel Futier
- Department of Anaesthesiology and Critical Care, Estaing Hospital, CHU de Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CNRS, Inserm U-1103, Clermont-Ferrand, France
| | - Thomas Geeraerts
- Pôle Anesthésie-Réanimation, Inserm, UMR 1214, Toulouse Neuroimaging Centre (ToNIC), université Toulouse 3 - Paul-Sabatier, CHU de Toulouse, 31059 Toulouse, France
| | - Haithem Jaber
- Departments of Anaesthesia and Intensive Care, Caen University Hospital, Caen, France
| | - Laurent Heyer
- Intensive Care Unit, Department of Anaesthesiology and Intensive Care Medicine, Croix-Rousse Hospital, Lyon, France
| | - Rim Hoteit
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Éloi Hospital, Montpellier, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, 33000 Bordeaux, France
| | - Delphine Kern
- Departments of Anaesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France
| | - Olivier Langeron
- Department of Anaesthesiology and Critical Care Medicine, Henri-Mondor University Hospital, University Paris-Est Créteil (UPEC), Assistance publique-Hôpitaux de Paris, Paris, France
| | - Sigismond Lasocki
- Department of Anaesthesiology and Critical Care Medicine, UBL Université d'Angers, CHU d'Angers, Angers, France
| | - Yoan Launey
- Department of Anaesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Frederic le Saché
- Department of Anaesthesiology and Intensive Care, DMU DREAM, AP-HP, 6 Sorbonne Université, Paris, France; Clinique Remusat, 75016 Paris, France; Clinique Jouvenet, 75016 Paris, France
| | - Anne Claire Lukaszewicz
- University of Lyon, EA 7426: Pathophysiology of Injury-Induced Immunosuppression (PI3), Lyon, France; Department of Anaesthesiology and Critical Care, Neurological hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Nicolas Mayeur
- Anaesthesiology and intensive care medicine, Clinique Pasteur, 31076 Toulouse, France
| | - Fabrice Michel
- Department of Paediatric Intensive Care Unit, Assistance publique-Hôpitaux de Marseille, La Timone Hospital, Marseille, France
| | - Vincent Minville
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, 31432 Toulouse, France; Inserm, U1048, Université Paul-Sabatier, Institute of Metabolic and Cardiovascular Diseases, I2MC, 31432 Toulouse, France
| | - Sébastien Mirek
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, 21079 Dijon, France; U-SEEM, Healthcare Simulation Centre of University Hospital of Dijon, 21079 Dijon, France
| | - Philippe Montravers
- Department of Anaesthesiology and Critical Care, CHU Bichat-Claude-Bernard, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 1152, Epidemiology and Physiopathology of Respiratory Diseases, University of Paris, Paris, France
| | - Estelle Morau
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Universitaire Arnaud-de-Villeneuve, Montpellier, France
| | - Laurent Muller
- Department of Anaesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Université Montpellier, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France; Physiology Department, EA 2992, Faculty of Medicine, Université Montpellier, Montpellier-Nimes University, Nîmes, France
| | - Jane Muret
- Institut Curie PSL Research University, 75005 Paris, France
| | - Karine Nouette-Gaulain
- Department of Anaesthesiology, Intensive Care and Pain, Institut Curie, 75005 Paris, France
| | - Jean Christophe Orban
- Department of Anaesthesiology and Intensive Care Medicine, Nice University Hospital, Nice, France
| | - Gilles Orliaguet
- Surgical Paediatric Intensive Care Unit, Universitary Hospital Necker-Enfants-Malades, Paris, France; EA08 Pharmacologie et Évaluation des Thérapeutiques chez l'Enfant et la Femme Enceinte, Paris Descartes University (Paris V), Paris, France
| | - Pierre François Perrigault
- Department of Anaesthesia and Critical Care Medicine, Montpellier University, Gui-de-Chauliac Hospital, Montpellier, France
| | - Florence Plantet
- Service d'Anesthésie-Réanimation, Clinique Générale, 4, chemin de la Tour-la-Reine, Annecy, France
| | - Julien Pottecher
- Department of Anaesthesiology and Critical Care, Les Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Christophe Quesnel
- Inserm UMR-S 1152, Epidemiology and Physiopathology of Respiratory Diseases, University of Paris, Paris, France; Department of Anaesthesiology and Critical Care, Tenon Hospital, DMU DREAM, AP-HP, 6 Sorbonne Université School of Medicine, Paris, France
| | - Vanessa Reubrecht
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Bertrand Rozec
- Anesthésie-Réanimation, CHU Nantes, Hôpital Laennec, 1, boulevard Jacques-Monod, 44093 Nantes cedex, France
| | - Benoit Tavernier
- Department of Anaesthesiology and Critical Care, CHU de Lille, Pôle d'Anesthésie-Réanimation, 59000 Lille, France
| | - Benoit Veber
- Department of Anaesthesiology and Critical Care, Université de Rouen Normandie, Rouen, France
| | - Francis Veyckmans
- Department of Paediatric Anaesthesia, Jeanne-de-Flandre Hospital, University Hospitals of Lille, Lille, France
| | - Hélène Charbonneau
- Anaesthesiology and intensive care medicine, Clinique Pasteur, 31076 Toulouse, France
| | - Isabelle Constant
- Anaesthesiology Department, Hôpital Armand-Trousseau, Sorbonne Université, Assistance publique-Hôpitaux de Paris, DMU DREAM, Sorbonne Université, Paris, France
| | - Denis Frasca
- Department of Anaesthesiology and Critical Care, Poitiers University, CHU de Poitiers, Poitiers, France
| | - Marc-Olivier Fischer
- Department of Anaesthesiology and Critical Care, Normandie Université, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - Catherine Huraux
- Department of Anaesthesiology, Clinique des Cèdres, 38130 Échirolles, France
| | - Alice Blet
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France; Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc Garnier
- Inserm UMR-S 1152, Epidemiology and Physiopathology of Respiratory Diseases, University of Paris, Paris, France; Department of Anaesthesiology and Critical Care, Saint-Antoine Hospital, DMU DREAM, AP-HP, 6 Sorbonne Université, Paris, France; Sorbonne Université School of Medicine, Paris, France
| |
Collapse
|
32
|
Payen JF, Chanques G, Futier E, Velly L, Jaber S, Constantin JM. Sedation for critically ill patients with COVID-19: Which specificities? One size does not fit all. Anaesth Crit Care Pain Med 2020; 39:341-343. [PMID: 32360979 PMCID: PMC7189860 DOI: 10.1016/j.accpm.2020.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Jean-François Payen
- Department of Anaesthesia and Intensive Care, Grenoble-Alpes University Hospital, and Grenoble-Alpes University, Grenoble Institut des Neurosciences, INSERM U1216, 38000 Grenoble, France.
| | - Gérald Chanques
- Department of Anaesthesia and Intensive Care, University of Montpellier Saint-Éloi Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, 34295 Montpellier cedex 5, France
| | - Emmanuel Futier
- Department of Anaesthesia and Intensive Care, Estaing Hospital, and Université Clermont-Auvergne, CNRS, INSERM U-1103, 63000 Clermont-Ferrand, France
| | - Lionel Velly
- Department of Anaesthesiology and Critical Care Medicine, Aix-Marseille University, AP-HM, University Hospital La Timone, Marseille, France
| | - Samir Jaber
- Department of Anaesthesia and Intensive Care, University of Montpellier Saint-Éloi Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, 34295 Montpellier cedex 5, France
| | - Jean-Michel Constantin
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, and Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| |
Collapse
|
33
|
Roquilly A, Vigué B, Boutonnet M, Bouzat P, Buffenoir K, Cesareo E, Chauvin A, Court C, Cook F, de Crouy AC, Denys P, Duranteau J, Fuentes S, Gauss T, Geeraerts T, Laplace C, Martinez V, Payen JF, Perrouin-Verbe B, Rodrigues A, Tazarourte K, Prunet B, Tropiano P, Vermeersch V, Velly L, Quintard H. French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury. Anaesth Crit Care Pain Med 2020; 39:279-289. [PMID: 32229270 DOI: 10.1016/j.accpm.2020.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To update the French guidelines on the management of trauma patients with spinal cord injury or suspected spinal cord injury. DESIGN A consensus committee of 27 experts was formed. A formal conflict-of-interest (COI) policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. METHODS The committee studied twelve questions: (1) What are the indications and arrangements for spinal immobilisation? (2) What are the arrangements for pre-hospital orotracheal intubation? (3) What are the objectives of haemodynamic resuscitation during the lesion assessment, and during the first few days in hospital? (4) What is the best way to manage these patients to improve their long-term prognosis? (5) What is the place of corticosteroid therapy in the initial phase? (6) What are the indications for magnetic resonance imaging in the lesion assessment phase? (7) What is the optimal time for surgical management? (8) What are the best arrangements for orotracheal intubation in the hospital environment? (9) What are the specific conditions for weaning these patients from mechanical ventilation for? (10) What are the procedures for analgesic treatment of these patients? (11) What are the specific arrangements for installing and mobilising these patients? (12) What is the place of early intermittent bladder sampling in these patients? Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® Methodology. RESULTS The experts' work synthesis and the application of the GRADE method resulted in 19 recommendations. Among the recommendations formalised, 2 have a high level of evidence (GRADE 1+/-) and 12 have a low level of evidence (GRADE 2+/-). For 5 recommendations, the GRADE method could not be applied, resulting in expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. CONCLUSIONS There was significant agreement among experts on strong recommendations to improve practices for the management of patients with spinal cord injury.
Collapse
Affiliation(s)
- A Roquilly
- Anaesthesiology and Intensive Care Unit, Hôtel-Dieu, Nantes University Hospital, Nantes, France.
| | - B Vigué
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - M Boutonnet
- Hôpital d'instruction des armées Percy, Clamart, France
| | - P Bouzat
- Grenoble Alps Trauma Centre, Department of Anaesthesia and Critical Care, Grenoble University Hospital, Grenoble, France
| | - K Buffenoir
- Neurosurgery department, Nantes University Hospital, Nantes, France
| | - E Cesareo
- Edouard-Herriot University Hospital, Lyon, France
| | - A Chauvin
- Anaesthesiology and Intensive Care Unit, Lariboisière Hospital, AP-HP, Paris, France
| | - C Court
- Orthopaedic Surgery Department, Spine and Bone Tumor Unit, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - F Cook
- Unité de réanimation chirurgicale polyvalente et de polytraumatologie, Albert-Chenevier-Henri-Mondor University Hospital, Créteil, France
| | - A C de Crouy
- Unité SRPR/Réanimation chirurgicale, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - P Denys
- Orthopaedic department, Spine and Bone Tumor Unit. Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - J Duranteau
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - S Fuentes
- Aix-Marseille University, AP-HM, Department of Neurosurgery, University Hospital Timone, Marseille, France
| | - T Gauss
- Post-Intensive Care Rehabilitation Unit, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - T Geeraerts
- Anaesthesiology and Critical Care Department, Toulouse University Hospital, University of Toulouse 3-Paul Sabatier, Toulouse, France
| | - C Laplace
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - V Martinez
- Neuro Urology Unit, Department of Physical Medicine and Rehabilitation. Raymond Poincaré University Hospital, Garches, France
| | - J F Payen
- Department of Anaesthesia and Critical Care, Grenoble Alps University Hospital, 38000 Grenoble, France
| | - B Perrouin-Verbe
- Department of Neurological Physical Medicine and Rehabilitation, Nantes University Hospital, Nantes, France
| | - A Rodrigues
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - K Tazarourte
- Emergency department, Edouard-Herriot University Hospital, 69003 Lyon, France
| | - B Prunet
- Department of Anaesthesia and Critical Care, Val-de-Grâce Hospital, Paris, France
| | - P Tropiano
- Aix-Marseille University, AP-HM, Orthopaedic and traumatic surgery, University Hospital Timone, Marseille, France
| | - V Vermeersch
- Anaesthesiology and Intensive Care Unit, Brest University Hospital, Brest, France
| | - L Velly
- Aix Marseille University, AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France
| | - H Quintard
- Intensive Care Unit, Nice University Hospital, Pasteur 2 Hospital, Nice, France
| |
Collapse
|
34
|
Plaud B, Baillard C, Bourgain JL, Bouroche G, Desplanque L, Devys JM, Fletcher D, Fuchs-Buder T, Lebuffe G, Meistelman C, Motamed C, Raft J, Servin F, Sirieix D, Slim K, Velly L, Verdonk F, Debaene B. Guidelines on muscle relaxants and reversal in anaesthesia. Anaesth Crit Care Pain Med 2020; 39:125-142. [PMID: 31926308 DOI: 10.1016/j.accpm.2020.01.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To provide an update to the 1999 French guidelines on "Muscle relaxants and reversal in anaesthesia", a consensus committee of sixteen experts was convened. A formal policy of declaration and monitoring of conflicts of interest (COI) was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE®) system to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making strong recommendations based on low-quality evidence were stressed. Few of the recommendations remained ungraded. METHODS The panel focused on eight questions: (1) In the absence of difficult mask ventilation criteria, is it necessary to check the possibility of ventilation via a facemask before muscle relaxant injection? Is it necessary to use muscle relaxants to facilitate facemask ventilation? (2) Is the use of muscle relaxants necessary to facilitate tracheal intubation? (3) Is the use of muscle relaxants necessary to facilitate the insertion of a supraglottic device and management of related complications? (4) Is it necessary to monitor neuromuscular blockade for airway management? (5) Is the use of muscle relaxants necessary to facilitate interventional procedures, and if so, which procedures? (6) Is intraoperative monitoring of neuromuscular blockade necessary? (7) What are the strategies for preventing and treating residual neuromuscular blockade? (8) What are the indications and precautions for use of both muscle relaxants and reversal agents in special populations (e.g. electroconvulsive therapy, obese patients, children, neuromuscular diseases, renal/hepatic failure, elderly patients)? All questions were formulated using the Population, Intervention, Comparison and Outcome (PICO) model for clinical questions and evidence profiles were generated. The results of the literature analysis and the recommendations were then assessed using the GRADE® system. RESULTS The summaries prepared by the SFAR Guideline panel resulted in thirty-one recommendations on muscle relaxants and reversal agents in anaesthesia. Of these recommendations, eleven have a high level of evidence (GRADE 1±) while twenty have a low level of evidence (GRADE 2±). No recommendations could be provided using the GRADE® system for five of the questions, and for two of these questions expert opinions were given. After two rounds of discussion and an amendment, a strong agreement was reached for all the recommendations. CONCLUSION Substantial agreement exists among experts regarding many strong recommendations for the improvement of practice concerning the use of muscle relaxants and reversal agents during anaesthesia. In particular, the French Society of Anaesthesia and Intensive Care (SFAR) recommends the use of a device to monitor neuromuscular blockade throughout anaesthesia.
Collapse
Affiliation(s)
- Benoît Plaud
- Université de Paris, Assistance publique-Hôpitaux de Paris, service d'anesthésie et de réanimation, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Christophe Baillard
- Université de Paris, Assistance publique-Hôpitaux de Paris, service d'anesthésie et de réanimation, hôpital Cochin-Port Royal, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Jean-Louis Bourgain
- Institut Gustave-Roussy, service d'anesthésie, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Gaëlle Bouroche
- Centre Léon-Bérard, service d'anesthésie, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - Laetitia Desplanque
- Assistance publique-Hôpitaux de Paris, service d'anesthésie et de réanimation, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75877 Paris cedex, France
| | - Jean-Michel Devys
- Fondation ophtalmologique Adolphe-de-Rothschild, service d'anesthésie et de réanimation, 29, rue Manin, 75019 Paris, France
| | - Dominique Fletcher
- Université de Versailles-Saint-Quentin-en-Yvelines, Assistance publique-Hôpitaux de Paris, hôpital Ambroise-Paré, service d'anesthésie, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Thomas Fuchs-Buder
- Université de Lorraine, CHU de Brabois, service d'anesthésie et de réanimation, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - Gilles Lebuffe
- Université de Lille, hôpital Huriez, service d'anesthésie et de réanimation, rue Michel-Polonovski, 59037 Lille, France
| | - Claude Meistelman
- Université de Lorraine, CHU de Brabois, service d'anesthésie et de réanimation, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - Cyrus Motamed
- Institut Gustave-Roussy, service d'anesthésie, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Julien Raft
- Institut de cancérologie de Lorraine, service d'anesthésie, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Frédérique Servin
- Assistance publique-Hôpitaux de Paris, service d'anesthésie et de réanimation, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75877 Paris cedex, France
| | - Didier Sirieix
- Groupe polyclinique Marzet-Navarre, service d'anesthésie, 40, boulevard d'Alsace-Lorraine, 64000 Pau, France
| | - Karem Slim
- Université d'Auvergne, service de chirurgie digestive et hépatobiliaire, hôpital d'Estaing, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - Lionel Velly
- Université Aix-Marseille, hôpital de la Timone adultes, service d'anesthésie et de réanimation, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - Franck Verdonk
- Sorbonne université, hôpital Saint-Antoine, 84, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Bertrand Debaene
- Université de Poitiers, service d'anesthésie et de réanimation, CHU de Poitiers, BP 577, 86021 Poitiers cedex, France
| |
Collapse
|
35
|
Chabanne R, Fernandez-Canal C, Degos V, Lukaszewicz AC, Velly L, Mrozek S, Perrigault PF, Molliex S, Tavernier B, Dahyot-Fizelier C, Verdonk F, Caumon E, Masgrau A, Begard M, Chabert E, Ferrier A, Jaber S, Bazin JE, Pereira B, Futier E. Sedation versus general anaesthesia in endovascular therapy for anterior circulation acute ischaemic stroke: the multicentre randomised controlled AMETIS trial study protocol. BMJ Open 2019; 9:e027561. [PMID: 31519668 PMCID: PMC6747652 DOI: 10.1136/bmjopen-2018-027561] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/23/2022] Open
Abstract
INTRODUCTION Endovascular thrombectomy is the standard of care for anterior circulation acute ischaemic stroke (AIS) secondary to emergent large vessel occlusion in patients who qualify. General anaesthesia (GA) or conscious sedation (CS) is usually required to ensure patient comfort and avoid agitation and movement during thrombectomy. However, the question of whether the use of GA or CS might influence functional outcome remains debated. Indeed, conflicting results exist between observational studies with better outcomes associated with CS and small monocentric randomised controlled trials favouring GA. Therefore, we aim to evaluate the effect of CS versus GA on functional outcome and periprocedural complications in endovascular mechanical thrombectomy for anterior circulation AIS. METHODS AND ANALYSIS Anesthesia Management in Endovascular Therapy for Ischemic Stroke (AMETIS) trial is an investigator initiated, multicentre, prospective, randomised controlled, two-arm trial. AMETIS trial will randomise 270 patients with anterior circulation AIS in a 1:1 ratio, stratified by centre, National Institutes of Health Stroke Scale (≤15 or >15) and association of intravenous thrombolysis or not to receive either CS or GA. The primary outcome is a composite of functional independence at 3 months and absence of perioperative complication occurring by day 7 after endovascular therapy for anterior circulation AIS. Functional independence is defined as a modified Rankin Scale score of 0-2 by day 90. Perioperative complications are defined as intervention-associated arterial perforation or dissection, pneumonia or myocardial infarction or cardiogenic acute pulmonary oedema or malignant stroke evolution occurring by day 7. ETHICS AND DISSEMINATION The AMETIS trial was approved by an independent ethics committee. Study began in august 2017. Results will be published in an international peer-reviewed medical journal. TRIAL REGISTRATION NUMBER NCT03229148.
Collapse
Affiliation(s)
- Russell Chabanne
- Department of Perioperative Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Charlotte Fernandez-Canal
- Department of Perioperative Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Degos
- Anesthésie et Neuro-Réanimation chirurgicale Babinski, Assistance Publique Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Anne-Claire Lukaszewicz
- Service d'Anesthésie Réanimation, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Lionel Velly
- Service d'Anesthésie Réanimation, Assistance Publique Hôpitaux de Marseille (AP-HM), Hôpital La Timone, Marseille, France
| | - Segolene Mrozek
- Anesthesiology and Critical Care Department, Centre Hospitalier Universitaire de Toulouse, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Pierre-François Perrigault
- Service d'Anesthésie Réanimation, Pôle Neurosciences Tête et Cou, CHU de Montpellier, Montpellier, France
| | - Serge Molliex
- Departement Anesthésie Réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Benoit Tavernier
- Pôle Anesthésie Réanimation, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | | | - Franck Verdonk
- Département d'Anesthésie-Réanimation, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Paris, France
| | - Elodie Caumon
- Department of Clinical Research and Innovation (DRCI), Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélie Masgrau
- Department of Clinical Research and Innovation (DRCI), Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Marc Begard
- Department of Perioperative Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Chabert
- Department of Neuroradiology, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Anna Ferrier
- Department of Neurology, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Samir Jaber
- Anesthesia and Critical Care, Montpellier University Hospital, Montpellier, France
| | - Jean-Etienne Bazin
- Department of Perioperative Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit of the Department of Clinical Research and Innovation (DRCI), University Hospital CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Futier
- Department of Perioperative Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, GRED, CNRS, Inserm U1103, Clermont-Ferrand, France
| |
Collapse
|
36
|
Leone M, Bouadma L, Bouhemad B, Brissaud O, Dauger S, Gibot S, Hraiech S, Jung B, Kipnis E, Launey Y, Luyt C, Margetis D, Michel F, Mokart D, Montravers P, Monsel A, Nseir S, Pugin J, Roquilly A, Velly L, Zahar J, Bruyère R, Chanques G. Pneumonies associées aux soins de réanimation* RFE commune SFAR–SRLF. Méd Intensive Réa 2019. [DOI: 10.3166/rea-2019-0106] [Citation(s) in RCA: 2] [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: 11/20/2022]
|
37
|
Dadure C, Sabourdin N, Veyckemans F, Babre F, Bourdaud N, Dahmani S, Queiroz MD, Devys JM, Dubois MC, Kern D, Laffargue A, Laffon M, Lejus-Bourdeau C, Nouette-Gaulain K, Orliaguet G, Gayat E, Velly L, Salvi N, Sola C. Management of the child's airway under anaesthesia: The French guidelines. Anaesth Crit Care Pain Med 2019; 38:681-693. [PMID: 30807876 DOI: 10.1016/j.accpm.2019.02.004] [Citation(s) in RCA: 8] [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] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To provide French guidelines about "Airway management during paediatric anaesthesia". DESIGN A consensus committee of 17 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie-Réanimation, SFAR) and the Association of French speaking paediatric anaesthesiologists and intensivists (Association Des Anesthésistes Réanimateurs Pédiatriques d'Expression Francophone, ADARPEF) was convened. The entire process was conducted independently of any industry funding. The authors followed the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to assess the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations were not graded. METHODS The panel focused on 7 questions: 1) Supraglottic Airway devices 2) Cuffed endotracheal tubes 3) Videolaryngoscopes 4) Neuromuscular blocking agents 5) Rapid sequence induction 6) Airway device removal 7) Airway management in the child with recent or ongoing upper respiratory tract infection. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the redaction of the recommendations were then conducted according to the GRADE® methodology. RESULTS The SFAR Guideline panel provides 17 statements on "airway management during paediatric anaesthesia". After two rounds of discussion and various amendments, a strong agreement was reached for 100% of the recommendations. Of these recommendations, 6 have a high level of evidence (Grade 1 ± ), 6 have a low level of evidence (Grade 2 ± ) and 5 are experts' opinions. No recommendation could be provided for 3 questions. CONCLUSIONS Substantial agreement exists among experts regarding many strong recommendations for paediatric airway management.
Collapse
Affiliation(s)
- Christophe Dadure
- Département d'anesthesiologie réanimation femme-mère-enfant, CHU de Lapeyronie, institut de génomique fonctionnelle, UMR 5203 CNRS - U 1191 Inserm, université de Montpellier, 34285 Montpellier, France.
| | - Nada Sabourdin
- Département d'anesthésiologie-réanimation hôpital Armand Trousseau, AP-HP, 26, avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Francis Veyckemans
- Department of paediatric anaesthesia, Jeanne de Flandre hospital, university hospitals of Lille, 59037 Lille, France
| | - Florence Babre
- Department of anaesthesia, Bergonié institute, 33000 Bordeaux, France
| | - Nathalie Bourdaud
- Département d'Anesthésiologie Réanimation Pédiatrique, Hôpital Femme Mère Enfant, 69677 Bron, France
| | - Souhayl Dahmani
- Department of anaesthesia and intensive care. Robert-Debré university hospital, assistance publique Hôpitaux de Paris, Paris Diderot University, Paris Sorbonne Cité, Paris, Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France
| | - Mathilde De Queiroz
- Département d'Anesthésiologie Réanimation Pédiatrique, Hôpital Femme Mère Enfant, 69677 Bron, France
| | - Jean-Michel Devys
- Service d'anesthésie-réanimation, fondation ophtalmologique Adolphe de Rothschild, 25, rue Manin, 75019 Paris, France
| | - Marie-Claude Dubois
- Service d'anesthésie-réanimation, fondation ophtalmologique Adolphe de Rothschild, 25, rue Manin, 75019 Paris, France
| | - Delphine Kern
- Departments of anaesthesia and intensive care, university hospital of Toulouse, place du Dr Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Anne Laffargue
- Department of paediatric anaesthesia, Jeanne de Flandre hospital, university hospitals of Lille, 59037 Lille, France
| | - Marc Laffon
- Department of anesthesia and intensive care, university hospital and medical university François-Rabelais, Tours, France
| | - Corinne Lejus-Bourdeau
- Service d'anesthesie réanimation chirurgicale, Hôtel Dieu, Hôpital Mère Enfant, CHU de Nantes, 44093 Nantes cedex, France
| | - Karine Nouette-Gaulain
- Service d'anesthésie réanimation Pellegrin, hôpital Pellegrin, CHU de Bordeaux, place Amélie Raba Léon, 33000 Bordeaux, France; Université Bordeaux, Inserm U12-11, laboratoire de maladies rares: génétique et métabolisme (MRGM), 176, rue Léo-Saignat, 33000 Bordeaux, France
| | - Gilles Orliaguet
- Department of anaesthesia and intensive care, assistance publique Hôpitaux de Paris, Necker-Enfants Malades hospital, EA08 pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Paris Descartes University (Paris V), PRES Paris Sorbonne Cité, 75743 Paris, France
| | - Etienne Gayat
- Department of anesthesiology and Intensive care, Saint Louis, Lariboisière university hospital, université Paris Diderot, BioCANVAS, UMR-S 942, Inserm, 75010 Paris, France
| | - Lionel Velly
- Service d'anesthesie réanimation, CHU de Timone adultes, 264, rue St Pierre, 13005 MeCA, institut de neurosciences de la Timone, UMR 7289, Aix Marseille université, Marseille, France
| | - Nadège Salvi
- Department of anaesthesia and intensive care, assistance publique Hôpitaux de Paris, Necker-Enfants Malades Hospital, 75743 Paris, France
| | - Chrystelle Sola
- Département d'anesthesiologie réanimation femme-mère-enfant, CHU de Lapeyronie, institut de génomique fonctionnelle, UMR 5203 CNRS - U 1191 Inserm, université de Montpellier, 34285 Montpellier, France
| |
Collapse
|
38
|
Langeron O, Bourgain JL, Francon D, Amour J, Baillard C, Bouroche G, Chollet Rivier M, Lenfant F, Plaud B, Schoettker P, Fletcher D, Velly L, Nouette-Gaulain K. Difficult intubation and extubation in adult anaesthesia. Anaesth Crit Care Pain Med 2018; 37:639-651. [DOI: 10.1016/j.accpm.2018.03.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 12/17/2022]
|
39
|
Leone M, Bouadma L, Bouhemad B, Brissaud O, Dauger S, Gibot S, Hraiech S, Jung B, Kipnis E, Launey Y, Luyt CE, Margetis D, Michel F, Mokart D, Montravers P, Monsel A, Nseir S, Pugin J, Roquilly A, Velly L, Zahar JR, Bruyère R, Chanques G. Brief summary of French guidelines for the prevention, diagnosis and treatment of hospital-acquired pneumonia in ICU. Ann Intensive Care 2018; 8:104. [PMID: 30392084 PMCID: PMC6215539 DOI: 10.1186/s13613-018-0444-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 10/08/2018] [Indexed: 11/23/2022] Open
Abstract
Background The French Society of Anaesthesia and Intensive Care Medicine and the French Society of Intensive Care edited guidelines focused on hospital-acquired pneumonia (HAP) in intensive care unit. The goal of 16 French-speaking experts was to produce a framework enabling an easier decision-making process for intensivists.
Results The guidelines were related to 3 specific areas related to HAP (prevention, diagnosis and treatment) in 4 identified patient populations (COPD, neutropenia, post-operative and paediatric). The literature analysis and the formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research over the last 10 years was conducted based on publications indexed in PubMed™ and Cochrane™ databases.
Conclusions HAP should be prevented by a standardised multimodal approach and the use of selective digestive decontamination in units where multidrug-resistant bacteria prevalence was below 20%. Diagnosis relies on clinical assessment and microbiological findings. Monotherapy, in the absence of risk factors for multidrug-resistant bacteria, non-fermenting Gram-negative bacilli and/or increased mortality (septic shock, organ failure), is strongly recommended. After microbiological documentation, it is recommended to reduce the spectrum and to prefer monotherapy for the antibiotic therapy of HAP, including for non-fermenting Gram-negative bacilli.
Collapse
Affiliation(s)
- Marc Leone
- Service d'Anesthésie et de Réanimation, Aix-Marseille Universite Hopital Nord, chemin des Bourrely, 13015, Marseille, France.
| | - Lila Bouadma
- Service de Réanimation Médicale, Hopital Bichat - Claude-Bernard, AP-HP, Paris, France
| | - Bélaïd Bouhemad
- Service d'Anesthésie et Réanimation, Centre Hospitalier Universitaire de Dijon, Paris, France
| | - Olivier Brissaud
- Unité de Réanimation Pédiatrique, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Stéphane Dauger
- Service de Réanimation Pédiatrique, Hopital Universitaire Robert-Debre, Paris, France
| | - Sébastien Gibot
- Service de Réanimation Médicale, CHU de Nancy, Vandoeuvre-les-Nancy, France
| | - Sami Hraiech
- Service de Réanimation des Détresses Respiratoires et des Infections Sévères, Aix-Marseille Universite, Hopital Nord, Marseille, France
| | - Boris Jung
- Service d'Anesthésie et Réanimation, CHU de Montpellier, Montpellier, France
| | - Eric Kipnis
- Service d'Anesthésie et Réanimation, CHU de Lille, Lille, France
| | - Yoann Launey
- Service d'Anesthésie et Réanimation, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Charles-Edouard Luyt
- Institut de Cardiologie, Service de Réanimation Médicale, Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
| | - Dimitri Margetis
- Service de Réanimation Médicale - Hôpital Saint-Antoine, Paris, France
| | - Fabrice Michel
- Service d'Anesthésie et Réanimation, Hopital La timone, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Djamel Mokart
- Service de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Philippe Montravers
- Département d'Anesthésie Réanimation, CHU Bichat - Claude-Bernard, AP-HP, Paris, France
| | - Antoine Monsel
- Département d'Anesthésie et Réanimation, Université Pierre et Marie Curie, Paris, France
| | - Saad Nseir
- Centre de Soins Intensifs, Service de Réanimation, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Jérôme Pugin
- Service de Soins Intensifs, Hopitaux Universitaires de Geneve, Geneve, Switzerland
| | - Antoine Roquilly
- Service d'Anesthésie et Réanimation, CHU de Nantes, Nantes, France
| | - Lionel Velly
- Département d'Anesthésie et Réanimation, Hopital de la Timone, AP-HM, Paris, France
| | - Jean-Ralph Zahar
- Département de Microbiologie Clinique, Hopital Avicenne, APHP, Paris, France
| | - Rémi Bruyère
- Service de Réanimation, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, France
| | - Gérald Chanques
- Département d'Anesthésie Réanimation, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | | | | |
Collapse
|
40
|
Quintard H, Velly L, Boussen S, Chiosi X, Amoretti ME, Cervantes E, Ichai C. Data on prognostication models comparison for neurological recovery after cardiac arrest using proton chemical shift imaging ( 1H-CSI). Data Brief 2018; 21:893-898. [PMID: 30426042 PMCID: PMC6222258 DOI: 10.1016/j.dib.2018.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/10/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022] Open
Abstract
We report in this data article the statistical comparison of three models for neurological prognostication 6 months after cardiac arrest: M1 associated SAPS II and coma Glasgow score at MRI, M2 associated SAPS II, coma Glasgow score, and FLAIR-DWI “deep gray nuclei”score, M3 associated SAPS II, coma Glasgow score, FLAIR-DWI “deep gray nuclei”score, and Lenticular cores NAA/Cr ratio. These data are related to “Value of assessment of multivoxel proton chemical shift imaging to predict long term outcome in patients after out-of-hospital cardiac arrest: A preliminary prospective observational study” (Quintard et al., 2018) [1].
Collapse
Affiliation(s)
- Hervé Quintard
- Université Côte d׳Azur, CHU de Nice, Department of Anaesthesiology and Critical Care Medicine, Hôpital Pasteur 2, Nice, France.,CNRS, UMR 7275, Sophia Antipolis, France
| | - Lionel Velly
- Aix Marseille University, Department of Anaesthesiology and Critical Care Medicine, University Hospital La Timone, Marseille, France.,Aix Marseille University, Institut de Neuroscience de la Timone (INT), Marseille, France
| | - Salah Boussen
- Aix Marseille University, Department of Anaesthesiology and Critical Care Medicine, University Hospital La Timone, Marseille, France.,Aix Marseille University, Laboratoire de Biomécanique Appliquée (IFSTTAR), Marseille, France
| | - Xavier Chiosi
- Université Côte d׳Azur, CHU de Nice, Department of Anaesthesiology and Critical Care Medicine, Hôpital Pasteur 2, Nice, France
| | - Marie-Eve Amoretti
- Université Côte d׳Azur, CHU de Nice, Radiology Department, Hôpital Pasteur 2, Nice, France
| | - Elodie Cervantes
- Université Côte d׳Azur, CHU de Nice, Radiology Department, Hôpital Pasteur 2, Nice, France
| | - Carole Ichai
- Université Côte d׳Azur, CHU de Nice, Department of Anaesthesiology and Critical Care Medicine, Hôpital Pasteur 2, Nice, France
| |
Collapse
|
41
|
Jaber S, Paugam C, Futier E, Lefrant JY, Lasocki S, Lescot T, Pottecher J, Demoule A, Ferrandière M, Asehnoune K, Dellamonica J, Velly L, Abback PS, de Jong A, Brunot V, Belafia F, Roquilly A, Chanques G, Muller L, Constantin JM, Bertet H, Klouche K, Molinari N, Jung B. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet 2018; 392:31-40. [PMID: 29910040 DOI: 10.1016/s0140-6736(18)31080-8] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [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: 03/20/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute acidaemia is frequently observed during critical illness. Sodium bicarbonate infusion for the treatment of severe metabolic acidaemia is a possible treatment option but remains controversial, as no studies to date have examined its effect on clinical outcomes. Therefore, we aimed to evaluate whether sodium bicarbonate infusion would improve these outcomes in critically ill patients. METHODS We did a multicentre, open-label, randomised controlled, phase 3 trial. Local investigators screened eligible patients from 26 intensive care units (ICUs) in France. We included adult patients (aged ≥18 years) who were admitted within 48 h to the ICU with severe acidaemia (pH ≤7·20, PaCO2 ≤45 mm Hg, and sodium bicarbonate concentration ≤20 mmol/L) and with a total Sequential Organ Failure Assessment score of 4 or more or an arterial lactate concentration of 2 mmol/L or more. We randomly assigned patients (1:1), by stratified randomisation with minimisation via a restricted web platform, to receive either no sodium bicarbonate (control group) or 4·2% of intravenous sodium bicarbonate infusion (bicarbonate group) to maintain the arterial pH above 7·30. Our protocol recommended that the volume of each infusion should be within the range of 125-250 mL in 30 min, with a maximum of 1000 mL within 24 h after inclusion. Randomisation criteria were stratified among three prespecified strata: age, sepsis status, and the Acute Kidney Injury Network (AKIN) score. The primary outcome was a composite of death from any cause by day 28 and the presence of at least one organ failure at day 7. All analyses were done on data from the intention-to-treat population, which included all patients who underwent randomisation. This study is registered with ClinicalTrials.gov, number NCT02476253. FINDINGS Between May 5, 2015, and May 7, 2017, we enrolled 389 patients into the intention-to-treat analysis in the overall population (194 in the control group and 195 in the bicarbonate group). The primary outcome occurred in 138 (71%) of 194 patients in the control group and 128 (66%) of 195 in the bicarbonate group (absolute difference estimate -5·5%, 95% CI -15·2 to 4·2; p=0·24). The Kaplan-Meier method estimate of the probability of survival at day 28 between the control group and bicarbonate group was not significant (46% [95% CI 40-54] vs 55% [49-63]; p=0·09. In the prespecified AKIN stratum of patients with a score of 2 or 3, the Kaplan-Meier method estimate of survival by day 28 between the control group and bicarbonate group was significant (37% [95% CI 28-48] vs 54% [45-65]; p=0·0283). [corrected] Metabolic alkalosis, hypernatraemia, and hypocalcaemia were observed more frequently in the bicarbonate group than in the control group, with no life-threatening complications reported. INTERPRETATION In patients with severe metabolic acidaemia, sodium bicarbonate had no effect on the primary composite outcome. However, sodium bicarbonate decreased the primary composite outcome and day 28 mortality in the a-priori defined stratum of patients with acute kidney injury. FUNDING French Ministry of Health and the Société Française d'Anesthésie Réanimation.
Collapse
Affiliation(s)
- Samir Jaber
- Saint Eloi ICU, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France.
| | - Catherine Paugam
- AP-HP, Département Anesthésie et Réanimation, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - Emmanuel Futier
- CHU de Clermont-Ferrand, Department of Perioperative Medicine, GReD, UMR/CNRS6293, University Clermont Auvergne, INSERM U1103, Clermont-Ferrand, France
| | - Jean-Yves Lefrant
- CHU de Nîmes, Département Anesthésie et Réanimation, University of Montpellier-Nîmes, Nîmes, France
| | | | - Thomas Lescot
- AP-HP, Département Anesthésie et Réanimation, Hôpital Saint Antoine, Paris, France
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Service d'Anesthésie-Réanimation Chirurgicale-Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Alexandre Demoule
- Service de Pneumologie, Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Paris, France
| | | | - Karim Asehnoune
- CHU de Nantes, Département Anesthésie et Réanimation Chirurgicale, Nantes, France
| | - Jean Dellamonica
- CHU de Nice, Département de Réanimation Médicale, INSERM-C3M-Université Cote d'Azur, Nice, France
| | - Lionel Velly
- Aix-Marseille Université, AP-HM, Département Anesthésie et Réanimation Chirurgicale, Groupe Hospitalier Timone, UMR 7289, CNRS, Marseille, France
| | - Paër-Sélim Abback
- AP-HP, Département Anesthésie et Réanimation, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - Audrey de Jong
- Saint Eloi ICU, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Vincent Brunot
- Département de Médecine Intensive et Réanimation, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Fouad Belafia
- Saint Eloi ICU, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Antoine Roquilly
- CHU de Nantes, Département Anesthésie et Réanimation Chirurgicale, Nantes, France
| | - Gérald Chanques
- Saint Eloi ICU, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Laurent Muller
- CHU de Nîmes, Département Anesthésie et Réanimation, University of Montpellier-Nîmes, Nîmes, France
| | - Jean-Michel Constantin
- CHU de Clermont-Ferrand, Department of Perioperative Medicine, GReD, UMR/CNRS6293, University Clermont Auvergne, INSERM U1103, Clermont-Ferrand, France
| | - Helena Bertet
- CHU de Montpellier, Department of Statistics, Montpellier University, Montpellier, France
| | - Kada Klouche
- Département de Médecine Intensive et Réanimation, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Nicolas Molinari
- CHU de Montpellier, Department of Statistics, Montpellier University, Montpellier, France
| | - Boris Jung
- Département de Médecine Intensive et Réanimation, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France
| |
Collapse
|
42
|
Champey J, Mourey C, Francony G, Pavese P, Gay E, Gergele L, Manet R, Velly L, Bruder N, Payen JF. Strategies to reduce external ventricular drain-related infections: a multicenter retrospective study. J Neurosurg 2018; 130:2034-2039. [PMID: 29932377 DOI: 10.3171/2018.1.jns172486] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 10/02/2017] [Accepted: 01/15/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Various strategies have been proposed to reduce the incidence of external ventricular drain (EVD)-related infections. The authors retrospectively studied the impact of EVD care management on EVD-related infections at 3 French university hospital intensive care units. METHODS Between 2010 and 2014, 462 consecutive adult patients with no evidence of a preexisting CSF infection received EVDs as part of their care at one of the following sites: Grenoble (221 patients), Saint-Etienne (130 patients), and Marseille (111 patients). Written protocols describing the EVD placement procedure, management, and removal were implemented at the 3 sites. Daily CSF sampling and intraventricular administration of antibiotics prior to EVD removal were performed at the Grenoble site only. EVD-related infection was considered for any confirmed ventriculostomy-related infection (VRI) and ventriculitis. VRI was defined as one or more positive CSF cultures or Gram stain with CSF pleocytosis and biochemical abnormalities. Ventriculitis was defined as CSF pleocytosis and biochemical abnormalities with degradation of neurological status and fever. RESULTS A total of 6945 EVD days were observed in the entire population. In the Grenoble cohort, the mean cumulative incidence of EVD-related infections was significantly lower than that in the 2 other cohorts: 1.4% (95% CI 0.0%-2.9%) versus 9.2% (95% CI 4.2%-14.2%) and 7.2% (95% CI 2.4%-12.0%) at Saint-Etienne and Marseille, respectively (p < 0.01). Accounting for the duration of external ventricular drainage at each site, the risk for EVD-related CSF infections was significantly higher at Saint-Etienne and Marseille than at Grenoble, with ORs of 15.9 (95% CI 3.6-71.4, p < 0.001) and 10.0 (95% CI 2.2-45.5, p = 0.003), respectively. CONCLUSIONS These findings indicate that it is possible to attain a low incidence of EVD-related infections, provided that an EVD care bundle, which can include routine daily CSF sampling, is implemented and strongly adhered to.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Lionel Velly
- 6Pôle Anesthésie Réanimation, CHU La Timone, Marseille
| | | | - Jean-François Payen
- 1Pôle Anesthésie Réanimation
- 7Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble; and
- 8INSERM, U1216, Grenoble, France
| |
Collapse
|
43
|
Boussen S, Spiegler A, Benar C, Carrère M, Bartolomei F, Metellus P, Voituriez R, Velly L, Bruder N, Trébuchon A. Time rescaling reproduces EEG behavior during transition from propofol anesthesia-induced unconsciousness to consciousness. Sci Rep 2018; 8:6015. [PMID: 29662089 PMCID: PMC5902625 DOI: 10.1038/s41598-018-24405-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/03/2018] [Indexed: 02/02/2023] Open
Abstract
General anesthesia (GA) is a reversible manipulation of consciousness whose mechanism is mysterious at the level of neural networks leaving space for several competing hypotheses. We recorded electrocorticography (ECoG) signals in patients who underwent intracranial monitoring during awake surgery for the treatment of cerebral tumors in functional areas of the brain. Therefore, we recorded the transition from unconsciousness to consciousness directly on the brain surface. Using frequency resolved interferometry; we studied the intermediate ECoG frequencies (4-40 Hz). In the theoretical study, we used a computational Jansen and Rit neuron model to simulate recovery of consciousness (ROC). During ROC, we found that f increased by a factor equal to 1.62 ± 0.09, and δf varied by the same factor (1.61 ± 0.09) suggesting the existence of a scaling factor. We accelerated the time course of an unconscious EEG trace by an approximate factor 1.6 and we showed that the resulting EEG trace match the conscious state. Using the theoretical model, we successfully reproduced this behavior. We show that the recovery of consciousness corresponds to a transition in the frequency (f, δf) space, which is exactly reproduced by a simple time rescaling. These findings may perhaps be applied to other altered consciousness states.
Collapse
Affiliation(s)
- S Boussen
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France.
- Aix Marseille Université, IFSTTAR, LBA UMR_T 24, 13916, Marseille, France.
| | - A Spiegler
- Institut de Neurosciences des Systèmes - Inserm UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
| | - C Benar
- Institut de Neurosciences des Systèmes - Inserm UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
| | - M Carrère
- Institut de Neurosciences des Systèmes - Inserm UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
| | - F Bartolomei
- Institut de Neurosciences des Systèmes - Inserm UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
- Clinical Electrophysiology Department, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - P Metellus
- Neurosurgery Department, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - R Voituriez
- Laboratoire Jean Perrin-UMR 8237 CNRS Université Pierre et Marie Curie, 75005, Paris, France
| | - L Velly
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
- Institut des Neurciences de la Timone, CNRS UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
| | - N Bruder
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - A Trébuchon
- Institut de Neurosciences des Systèmes - Inserm UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
- Clinical Electrophysiology Department, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| |
Collapse
|
44
|
Velly L, Perlbarg V, Boulier T, Adam N, Delphine S, Luyt CE, Battisti V, Torkomian G, Arbelot C, Chabanne R, Jean B, Di Perri C, Laureys S, Citerio G, Vargiolu A, Rohaut B, Bruder N, Girard N, Silva S, Cottenceau V, Tourdias T, Coulon O, Riou B, Naccache L, Gupta R, Benali H, Galanaud D, Puybasset L, Constantin JM, Chastre J, Amour J, Vezinet C, Rouby JJ, Raux M, Langeron O, Degos V, Bolgert F, Weiss N, Similowski T, Demoule A, Duguet A, Tollard E, Veber B, Lotterie JA, SANCHEZ-PENA P, Génestal M, Patassini M. Use of brain diffusion tensor imaging for the prediction of long-term neurological outcomes in patients after cardiac arrest: a multicentre, international, prospective, observational, cohort study. Lancet Neurol 2018; 17:317-326. [DOI: 10.1016/s1474-4422(18)30027-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 01/19/2023]
|
45
|
Leone M, Bouadma L, Bouhemad B, Brissaud O, Dauger S, Gibot S, Hraiech S, Jung B, Kipnis E, Launey Y, Luyt CE, Margetis D, Michel F, Mokart D, Montravers P, Monsel A, Nseir S, Pugin J, Roquilly A, Velly L, Zahar JR, Bruyère R, Chanques G. Hospital-acquired pneumonia in ICU. Anaesth Crit Care Pain Med 2018; 37:83-98. [DOI: 10.1016/j.accpm.2017.11.006] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
46
|
Geeraerts T, Velly L, Abdennour L, Asehnoune K, Audibert G, Bouzat P, Bruder N, Carrillon R, Cottenceau V, Cotton F, Courtil-Teyssedre S, Dahyot-Fizelier C, Dailler F, David JS, Engrand N, Fletcher D, Francony G, Gergelé L, Ichai C, Javouhey É, Leblanc PE, Lieutaud T, Meyer P, Mirek S, Orliaguet G, Proust F, Quintard H, Ract C, Srairi M, Tazarourte K, Vigué B, Payen JF. Management of severe traumatic brain injury (first 24hours). Anaesth Crit Care Pain Med 2017; 37:171-186. [PMID: 29288841 DOI: 10.1016/j.accpm.2017.12.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The latest French Guidelines for the management in the first 24hours of patients with severe traumatic brain injury (TBI) were published in 1998. Due to recent changes (intracerebral monitoring, cerebral perfusion pressure management, treatment of raised intracranial pressure), an update was required. Our objective has been to specify the significant developments since 1998. These guidelines were conducted by a group of experts for the French Society of Anesthesia and Intensive Care Medicine (Société francaise d'anesthésie et de réanimation [SFAR]) in partnership with the Association de neuro-anesthésie-réanimation de langue française (ANARLF), The French Society of Emergency Medicine (Société française de médecine d'urgence (SFMU), the Société française de neurochirurgie (SFN), the Groupe francophone de réanimation et d'urgences pédiatriques (GFRUP) and the Association des anesthésistes-réanimateurs pédiatriques d'expression française (ADARPEF). The method used to elaborate these guidelines was the Grade® method. After two Delphi rounds, 32 recommendations were formally developed by the experts focusing on the evaluation the initial severity of traumatic brain injury, the modalities of prehospital management, imaging strategies, indications for neurosurgical interventions, sedation and analgesia, indications and modalities of cerebral monitoring, medical management of raised intracranial pressure, management of multiple trauma with severe traumatic brain injury, detection and prevention of post-traumatic epilepsia, biological homeostasis (osmolarity, glycaemia, adrenal axis) and paediatric specificities.
Collapse
Affiliation(s)
- Thomas Geeraerts
- Pôle anesthésie-réanimation, Inserm, UMR 1214, Toulouse neuroimaging center, ToNIC, université Toulouse 3-Paul Sabatier, CHU de Toulouse, 31059 Toulouse, France.
| | - Lionel Velly
- Service d'anesthésie-réanimation, Aix-Marseille université, CHU Timone, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Lamine Abdennour
- Département d'anesthésie-réanimation, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - Karim Asehnoune
- Service d'anesthésie et de réanimation chirurgicale, Hôtel-Dieu, CHU de Nantes, 44093 Nantes cedex 1, France
| | - Gérard Audibert
- Département d'anesthésie-réanimation, hôpital Central, CHU de Nancy, 54000 Nancy, France
| | - Pierre Bouzat
- Pôle anesthésie-réanimation, CHU Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - Nicolas Bruder
- Service d'anesthésie-réanimation, Aix-Marseille université, CHU Timone, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Romain Carrillon
- Service d'anesthésie-réanimation, hôpital neurologique Pierre-Wertheimer, groupement hospitalier Est, hospices civils de Lyon, 69677 Bron, France
| | - Vincent Cottenceau
- Service de réanimation chirurgicale et traumatologique, SAR 1, hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - François Cotton
- Service d'imagerie, centre hospitalier Lyon Sud, hospices civils de Lyon, 69495 Pierre-Bénite cedex, France
| | - Sonia Courtil-Teyssedre
- Service de réanimation pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron, France
| | | | - Frédéric Dailler
- Service d'anesthésie-réanimation, hôpital neurologique Pierre-Wertheimer, groupement hospitalier Est, hospices civils de Lyon, 69677 Bron, France
| | - Jean-Stéphane David
- Service d'anesthésie réanimation, centre hospitalier Lyon Sud, hospices civils de Lyon, 69495 Pierre-Bénite, France
| | - Nicolas Engrand
- Service d'anesthésie-réanimation, Fondation ophtalmologique Adolphe de Rothschild, 75940 Paris cedex 19, France
| | - Dominique Fletcher
- Service d'anesthésie réanimation chirurgicale, hôpital Raymond-Poincaré, université de Versailles Saint-Quentin, AP-HP, Garches, France
| | - Gilles Francony
- Pôle anesthésie-réanimation, CHU Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - Laurent Gergelé
- Département d'anesthésie-réanimation, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | - Carole Ichai
- Service de réanimation médicochirurgicale, UMR 7275, CNRS, Sophia Antipolis, hôpital Pasteur, CHU de Nice, 06000 Nice, France
| | - Étienne Javouhey
- Service de réanimation pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron, France
| | - Pierre-Etienne Leblanc
- Département d'anesthésie-réanimation, hôpital de Bicêtre, hôpitaux universitaires Paris-Sud, AP-HP, Le Kremlin-Bicêtre, France; Équipe TIGER, CNRS 1072-Inserm 5288, service d'anesthésie, centre hospitalier de Bourg en Bresse, centre de recherche en neurosciences, Lyon, France
| | - Thomas Lieutaud
- UMRESTTE, UMR-T9405, IFSTTAR, université Claude-Bernard de Lyon, Lyon, France; Service d'anesthésie-réanimation, hôpital universitaire Necker-Enfants-Malades, université Paris Descartes, AP-HP, Paris, France
| | - Philippe Meyer
- EA 08 Paris-Descartes, service de pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, 75743 Paris cedex 15, France
| | - Sébastien Mirek
- Service d'anesthésie-réanimation, CHU de Dijon, Dijon, France
| | - Gilles Orliaguet
- EA 08 Paris-Descartes, service de pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, 75743 Paris cedex 15, France
| | - François Proust
- Service de neurochirurgie, hôpital Hautepierre, CHU de Strasbourg, 67098 Strasbourg, France
| | - Hervé Quintard
- Service de réanimation médicochirurgicale, UMR 7275, CNRS, Sophia Antipolis, hôpital Pasteur, CHU de Nice, 06000 Nice, France
| | - Catherine Ract
- Département d'anesthésie-réanimation, hôpital de Bicêtre, hôpitaux universitaires Paris-Sud, AP-HP, Le Kremlin-Bicêtre, France; Équipe TIGER, CNRS 1072-Inserm 5288, service d'anesthésie, centre hospitalier de Bourg en Bresse, centre de recherche en neurosciences, Lyon, France
| | - Mohamed Srairi
- Pôle anesthésie-réanimation, Inserm, UMR 1214, Toulouse neuroimaging center, ToNIC, université Toulouse 3-Paul Sabatier, CHU de Toulouse, 31059 Toulouse, France
| | - Karim Tazarourte
- SAMU/SMUR, service des urgences, hospices civils de Lyon, hôpital Édouard-Herriot, 69437 Lyon cedex 03, France
| | - Bernard Vigué
- Département d'anesthésie-réanimation, hôpital de Bicêtre, hôpitaux universitaires Paris-Sud, AP-HP, Le Kremlin-Bicêtre, France; Équipe TIGER, CNRS 1072-Inserm 5288, service d'anesthésie, centre hospitalier de Bourg en Bresse, centre de recherche en neurosciences, Lyon, France
| | - Jean-François Payen
- Pôle anesthésie-réanimation, CHU Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Sair HI, Hannawi Y, Li S, Kornbluth J, Demertzi A, Di Perri C, Chabanne R, Jean B, Benali H, Perlbarg V, Pekar J, Luyt CE, Galanaud D, Velly L, Puybasset L, Laureys S, Caffo B, Stevens RD. Early Functional Connectome Integrity and 1-Year Recovery in Comatose Survivors of Cardiac Arrest. Radiology 2017; 287:247-255. [PMID: 29043908 DOI: 10.1148/radiol.2017162161] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose To assess whether early brain functional connectivity is associated with functional recovery 1 year after cardiac arrest (CA). Materials and Methods Enrolled in this prospective multicenter cohort were 46 patients who were comatose after CA. Principal outcome was cerebral performance category at 12 months, with favorable outcome (FO) defined as cerebral performance category 1 or 2. All participants underwent multiparametric structural and functional magnetic resonance (MR) imaging less than 4 weeks after CA. Within- and between-network connectivity was measured in dorsal attention network (DAN), default-mode network (DMN), salience network (SN), and executive control network (ECN) by using seed-based analysis of resting-state functional MR imaging data. Structural changes identified with fluid-attenuated inversion recovery and diffusion-weighted imaging sequences were analyzed by using validated morphologic scales. The association between connectivity measures, structural changes, and the principal outcome was explored with multivariable modeling. Results Patients underwent MR imaging a mean 12.6 days ± 5.6 (standard deviation) after CA. At 12 months, 11 patients had an FO. Patients with FO had higher within-DMN connectivity and greater anticorrelation between SN and DMN and between SN and ECN compared with patients with unfavorable outcome, an effect that was maintained after multivariable adjustment. Anticorrelation of SN-DMN predicted outcomes with higher accuracy than fluid-attenuated inversion recovery or diffusion-weighted imaging scores (area under the receiver operating characteristic curves, respectively, 0.88, 0.74, and 0.71). Conclusion MR imaging-based measures of cerebral functional network connectivity obtained in the acute phase of CA were independently associated with FO at 1 year, warranting validation as early markers of long-term recovery potential in patients with anoxic-ischemic encephalopathy. © RSNA, 2017.
Collapse
Affiliation(s)
- Haris I Sair
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Yousef Hannawi
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Shanshan Li
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Joshua Kornbluth
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Athena Demertzi
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Carol Di Perri
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Russell Chabanne
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Betty Jean
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Habib Benali
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Vincent Perlbarg
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - James Pekar
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Charles-Edouard Luyt
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Damien Galanaud
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Lionel Velly
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Louis Puybasset
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Steven Laureys
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Brian Caffo
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Robert D Stevens
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | -
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| |
Collapse
|
48
|
Boissonneau S, Tabouret É, Graillon T, Meyer M, Velly L, Girard N, Brunel H, Bruder N, Fuentes S, Dufour H. Rational use of systematic postoperative CT scans after neurosurgical craniotomy. J Neurosurg Sci 2017; 64:335-340. [PMID: 28959872 DOI: 10.23736/s0390-5616.17.04082-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this retrospective study was to evaluate the relevance of a systematic postoperative CT scan after neurosurgical craniotomy and to identify predictive factors of complications. METHODS This retrospective analysis included all the patients at our institution who benefited from a cerebral postoperative CT scan within 24 hours post-craniotomy. Patient characteristics and neuroimaging abnormalities were recorded. Predictive factors were identified using a recursive partitioning analysis. RESULTS A total of 633 patients were included. Of these, 17.9% of patients suffered from postoperative complications and 7.4% of them required a new surgery. The decision for reoperation was based on the neurological deterioration and the CT scan, but never on the CT scan alone. The mortality rate was 1.1%. The risk to be reoperated was correlated to the occurrence of a new postoperative neurological deficit (P<0.001, HR=4.60) and in situ hemorrhage (P<0.001, HR=4.19). The risk of postoperative hematoma was correlated to the supratentorial location versus infratentorial (P=0.027, HR=2.50). With clinical factors, such as location and etiology of the lesion, schedule type of surgery, and the age of patients, we proposed six classes with the risk to present with hemorrhage or midline shift on postoperative CT scans. CONCLUSIONS The post-craniotomy CT scan did not impact patient management as an independent decisional tool. We identified several variables associated with the risk of clinical modification that can impact the decision to reoperate and allow establishment of a risk score. This score could be an interesting tool in order to reduce the systematic use of CT scans in the post-surgical period but has to be validated in a prospective study.
Collapse
Affiliation(s)
- Sébastien Boissonneau
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France -
| | - Émeline Tabouret
- Department of Neuro-Oncology, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France.,INSERM Unit of Research UMR S911, Biologic Oncology and Oncologic Pharmacology Research Center (CRO2), Faculty of Medical and Paramedical Sciences, Aix-Marseille University, Marseille, France
| | - Thomas Graillon
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France.,Center for Research in Neurobiology and Neurophysiology of Marseille (CRN2M), National Center of Scientific Research (CNRS), Aix-Marseille University, Marseille, France
| | - Mikael Meyer
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Lionel Velly
- Department of Anesthesiology and Intensive Care, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Nadine Girard
- Service of Neuroradiology, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Hervé Brunel
- Service of Neuroradiology, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Nicolas Bruder
- Department of Anesthesiology and Intensive Care, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Stéphane Fuentes
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Henry Dufour
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France.,Center for Research in Neurobiology and Neurophysiology of Marseille (CRN2M), National Center of Scientific Research (CNRS), Aix-Marseille University, Marseille, France
| |
Collapse
|
49
|
Satori D, Setti J, Marsot A, Triglia T, Bruder N, Blin O, Velly L, Guilhaumou R. Suivi thérapeutique pharmacologique des beta-lactamines administrées en perfusion continue en réanimation. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.138] [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: 10/19/2022]
|
50
|
Boussen S, Barral PA, Triglia T, Velly L, Collart F, Bruder N. A Sudden Cheek Swelling After a Periaortic Graft Infection. Ann Thorac Surg 2017; 103:e195. [PMID: 28109389 DOI: 10.1016/j.athoracsur.2016.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 09/07/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Salah Boussen
- Department of Anesthesiology and Critical Care Medicine, Aix-Marseille University, APHM, University Hospital Timone, Marseille, France.
| | - Pierre-Antoine Barral
- Department of Radiology, Aix-Marseille University, APHM, University Hospital Timone, Marseille, France
| | - Thibaut Triglia
- Department of Anesthesiology and Critical Care Medicine, Aix-Marseille University, APHM, University Hospital Timone, Marseille, France
| | - Lionel Velly
- Department of Anesthesiology and Critical Care Medicine, Aix-Marseille University, APHM, University Hospital Timone, Marseille, France
| | - Frederic Collart
- Department of Cardiac Surgery, Aix-Marseille University, APHM, University Hospital Timone, Marseille, France
| | - Nicolas Bruder
- Department of Anesthesiology and Critical Care Medicine, Aix-Marseille University, APHM, University Hospital Timone, Marseille, France
| |
Collapse
|